%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66751 %T COVID-19 Perceptions Among Communities Living on Ground Crossings of Somali Region of Ethiopia: Community Cross-Sectional Survey Study %A Farah,Alinoor Mohamed %A Abdulahi,Abdifatah %A Hussein,Abdulahi %A Hussein,Ahmed Abdikadir %A Osman,Abdi %A Mohamud,Mohamed %A Mowlid,Hasan %A Hailu,Girum %A Alwan,Fathia %A Bizuneh,Ermiyas Abebe %A Ibrahim,Ahmed Mohammed %A Abdulahi,Elyas %K COVID-19 %K perceptions %K border-crossings %K SARS-CoV-2 %K coronavirus %K respiratory %K infectious %K pandemic %K Somali %K Ethiopia %K Africa %K community-based %K World Health Organization %K WHO %K cross-sectional study %K multistage sampling technique %K transmission %K cross-border %K community engagement %D 2025 %7 24.4.2025 %9 %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has profoundly affected the movement of people across borders in Eastern and Southern Africa. The implementation of border closures and restrictive measures has disrupted the region’s economic and social dynamics. In areas where national authorities lack full control over official and unofficial land crossings, enforcing public health protocols to mitigate health risks may prove challenging. Objective: This study aimed to assess perceived factors that influence the spread and control of COVID-19 among Somali communities living on and near ground crossings in Tog Wajaale, Somali region, Ethiopia. Methods: A community-based cross-sectional study was conducted using a multistage sampling technique. Beliefs and perceptions of the virus’s spread and control were partially adapted from the World Health Organization (WHO) resources, exploring four main perception themes: (1) perceived facilitators for the spread of the virus, (2) perceived inhibitors, (3) risk labeling, and (4) sociodemographic variables. A sample size of 634 was determined using the single proportion formula. Standardized mean scores (0‐100) and SDs categorized perception themes, with mean differences by sociodemographic variables analyzed using ANOVA and t tests. Statistical significance was established with a 95% CI and a P value below .05. The data were analyzed using STATA version 14.1. Results: Factors influencing COVID-19 spread and control include behavioral nonadherence and enabling environments. A total of 81.9% (439/536) did not comply with social distancing, and 92.2% (493/536) faced constraints preventing them from staying home and enabling environments. Misconceptions were prevalent, including beliefs about hot weather (358/536, 66.8%), traditional medicine (36/536, 6.7%), and religiosity (425/536, 79.3%). False assurances also contributed, such as feeling safe due to geographic distance from hot spots (76/536, 14.2%) and perceiving the virus as low-risk or exaggerated (162/536, 30.2%). Only 25.2% (135/536) followed standard precautions and 29.9% (160/536) were vaccinated. Employment, region, income, sex, education, and information sources significantly influenced behavioral nonadherence, myth prevalence, and false assurances. Conclusions: The findings highlight the need for substantial risk communication and community engagement. Only 46.6% (250/536) of individuals adhered to precautionary measures, there was a high perception of nonadherence, and essential COVID-19 resources were lacking. Additionally, numerous misconceptions and false reassurances were noted. Understanding cross-border community behavior is crucial for developing effective, contextually appropriate strategies to mitigate COVID-19 risk in these regions. %R 10.2196/66751 %U https://formative.jmir.org/2025/1/e66751 %U https://doi.org/10.2196/66751 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e66003 %T Assessing the Causal Association Between COVID-19 and Graves Disease: Mendelian Randomization Study %A Nian,Hui %A Bai,Yu %A Yu,Hua %K Graves disease %K COVID-19 %K Mendelian randomization %K causal relationship %K autoimmune disease %D 2025 %7 8.4.2025 %9 %J JMIR Form Res %G English %X Background: Graves disease (GD) is an autoimmune thyroid disorder characterized by hyperthyroidism and autoantibodies. The COVID-19 pandemic has raised questions about its potential relationship with autoimmune diseases like GD. Objective: This study aims to investigate the causal association between COVID-19 and GD through Mendelian randomization (MR) analysis and assess the impact of COVID-19 on GD. Methods: We conducted an MR study using extensive genome-wide association study data for GD and COVID-19 susceptibility and its severity. We used stringent single nucleotide polymorphism selection criteria and various MR methodologies, including inverse-variance weighting, MR-Egger, and weighted median analyses, to assess causal relationships. We also conducted tests for directional pleiotropy and heterogeneity, as well as sensitivity analyses. Results: The MR analysis, based on the largest available dataset to date, did not provide evidence supporting a causal relationship between COVID-19 susceptibility (odds ratio [OR] 0.989, 95% CI 0.405‐2.851; P=.93), COVID-19 hospitalization (OR 0.974, 95% CI 0.852‐1.113; P=.70), COVID-19 severity (OR 0.979, 95% CI 0.890‐1.077; P=.66), and GD. Tests for directional pleiotropy and heterogeneity, as well as sensitivity analyses, supported these findings. Conclusions: This comprehensive MR study does not provide sufficient evidence to support a causal relationship between COVID-19 and the onset or exacerbation of GD. These results contribute to a better understanding of the potential association between COVID-19 and autoimmune diseases, alleviating concerns about a surge in autoimmune thyroid diseases due to the pandemic. Further research is warranted to explore this complex relationship thoroughly. %R 10.2196/66003 %U https://formative.jmir.org/2025/1/e66003 %U https://doi.org/10.2196/66003 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65767 %T Impact of a Sensorimotor Integration and Hyperstimulation Program on Global Motor Skills in Moroccan Children With Autism Spectrum Disorder: Exploratory Clinical Quasi-Experimental Study %A Touali,Rachid %A Zerouaoui,Jamal %A Chakir,El Mahjoub %A Bui,Hung Tien %A Leone,Mario %A Allisse,Maxime %+ , Faculty of Physical Activity Sciences, University of Sherbrooke, 2500 Boulevard de l'Université, Sherbrooke, QC, J1K 2R1, Canada, 1 819 821 8000 ext 63875, maxime.allisse@usherbrooke.ca %K classical physical education %K children with a neurotypical profile %K children with ASD %K UQAC-UQAM test battery %K University of Québec in Chicoutimi-University of Québec in Montréal %K sensorimotor integration %K hyperstimulation %K Morocco %K sensorimotor %K integration %K motor skill %K Moroccan children %K Moroccan %K children %K autism spectrum disorder %K ASD %K exploratory study %K autism %K mental health %K young %K youth %K feasibility %D 2025 %7 26.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Children with autism spectrum disorders (ASDs) often struggle with processing information, which can impact their coordination, balance, and other motor skills. Studies have demonstrated that intervention programs based on sensory integration can enhance motor performance in these children. Objective: The objective of this study is to evaluate the applicability of a standardized battery of gross motor skill tests for Moroccan children aged 6 to 12 years with ASD. The objective is to assess the potential efficacy of an innovative pedagogical approach focused on sensorimotor integration and hyperstimulation. This approach will be compared to traditional physical education (PE) sessions to determine its feasibility and potential to bridge the developmental gaps in motor skills between children with ASD and those with a neurotypical profile. Methods: A convenience sample of 14 Moroccan children with ASD aged 6 to 12 years participated in this exploratory study. Children with ASD were divided into an experimental group (n=7) and a control group (n=7) based on age, sex, motor performance, and socioeconomic status. The control group followed the standard PE program, while the experimental group underwent a specialized program combining sensorimotor integration and hyperstimulation for a period of 15 weeks. All participants were classified as level 2 (moderate) on the Autism Severity Rating Scale based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR) criteria. Gross motor skills were measured at baseline and after 15 weeks of intervention using the UQAC-UQAM (University of Québec in Chicoutimi-University of Québec in Montréal) test battery protocol, which includes 10 items. Results: At baseline (T1), no significant difference was observed between the control and experimental groups of children with ASD. Following the 15-week intervention, the group participating in traditional PE showed an overall improvement in motor skills of approximately 14.5%. Conversely, the results of the ASD experimental group suggest a more substantial improvement of 44.5%. Additionally, the experimental group exhibited significant better performance across all motor skill variables compared to the control group (minimum P values of <.02) with large effect sizes (>0.80). In this regard, a 2-way repeated measures ANOVA confirms the efficiency of the program implemented within the experimental group, demonstrating significant effects associated with both group and time factors as well as a clinically highly significant group×time interaction across all measured variables (η2p>0.14). Conclusions: The results of this study suggest that the approach that emphasizes sensorimotor integration and management of hyperstimulation was more effective in improving motor skills in this population. However, other more exhaustive studies will need to be carried out in order to be able to more precisely measure the full potential of this approach. %M 40137439 %R 10.2196/65767 %U https://formative.jmir.org/2025/1/e65767 %U https://doi.org/10.2196/65767 %U http://www.ncbi.nlm.nih.gov/pubmed/40137439 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54803 %T Synthetic Data-Driven Approaches for Chinese Medical Abstract Sentence Classification: Computational Study %A Li,Jiajia %A Wang,Zikai %A Yu,Longxuan %A Liu,Hui %A Song,Haitao %K medical abstract sentence classification %K large language models %K synthetic datasets %K deep learning %K Chinese medical %K dataset %K traditional Chinese medicine %K global medical research %K algorithm %K robustness %K efficiency %K accuracy %D 2025 %7 19.3.2025 %9 %J JMIR Form Res %G English %X Background: Medical abstract sentence classification is crucial for enhancing medical database searches, literature reviews, and generating new abstracts. However, Chinese medical abstract classification research is hindered by a lack of suitable datasets. Given the vastness of Chinese medical literature and the unique value of traditional Chinese medicine, precise classification of these abstracts is vital for advancing global medical research. Objective: This study aims to address the data scarcity issue by generating a large volume of labeled Chinese abstract sentences without manual annotation, thereby creating new training datasets. Additionally, we seek to develop more accurate text classification algorithms to improve the precision of Chinese medical abstract classification. Methods: We developed 3 training datasets (dataset #1, dataset #2, and dataset #3) and a test dataset to evaluate our model. Dataset #1 contains 15,000 abstract sentences translated from the PubMed dataset into Chinese. Datasets #2 and #3, each with 15,000 sentences, were generated using GPT-3.5 from 40,000 Chinese medical abstracts in the CSL database. Dataset #2 used titles and keywords for pseudolabeling, while dataset #3 aligned abstracts with category labels. The test dataset includes 87,000 sentences from 20,000 abstracts. We used SBERT embeddings for deeper semantic analysis and evaluated our model using clustering (SBERT-DocSCAN) and supervised methods (SBERT-MEC). Extensive ablation studies and feature analyses were conducted to validate the model’s effectiveness and robustness. Results: Our experiments involved training both clustering and supervised models on the 3 datasets, followed by comprehensive evaluation using the test dataset. The outcomes demonstrated that our models outperformed the baseline metrics. Specifically, when trained on dataset #1, the SBERT-DocSCAN model registered an impressive accuracy and F1-score of 89.85% on the test dataset. Concurrently, the SBERT-MEC algorithm exhibited comparable performance with an accuracy of 89.38% and an identical F1-score. Training on dataset #2 yielded similarly positive results for the SBERT-DocSCAN model, achieving an accuracy and F1-score of 89.83%, while the SBERT-MEC algorithm recorded an accuracy of 86.73% and an F1-score of 86.51%. Notably, training with dataset #3 allowed the SBERT-DocSCAN model to attain the best with an accuracy and F1-score of 91.30%, whereas the SBERT-MEC algorithm also showed robust performance, obtaining an accuracy of 90.39% and an F1-score of 90.35%. Ablation analysis highlighted the critical role of integrated features and methodologies in improving classification efficiency. Conclusions: Our approach addresses the challenge of limited datasets for Chinese medical abstract classification by generating novel datasets. The deployment of SBERT-DocSCAN and SBERT-MEC models significantly enhances the precision of classifying Chinese medical abstracts, even when using synthetic datasets with pseudolabels. %R 10.2196/54803 %U https://formative.jmir.org/2025/1/e54803 %U https://doi.org/10.2196/54803 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e58976 %T Improving Pre-Exposure Prophylaxis Provision as Part of Routine Gynecologic Care Among Black Cisgender Women (Project PrEP4Her): Protocol for the Implementation of an Intervention %A Sohail,Maira %A Matthews,Lynn %A Williams,Audra %A Kempf,Mirjam-Colette %A Phillips,Desiree %A Goymer,Hannah %A Johnson,,Bernadette %A Mugavero,Michael %A Elopre,Latesha %+ Department of Medicine, University of Alabama at Birmingham, 845 19th Street South, BBRB 206, Birmingham, AL, 35205, United States, 1 205 975 2457, lelopre@uabmc.edu %K Black %K cis-Gender women %K PrEP %K pre-exposure prophylaxis %K South %K HIV %K gynecology %D 2025 %7 14.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although HIV pre-exposure prophylaxis (PrEP) has been proven to be an effective prevention tool in decreasing HIV transmission, achieving adequate PrEP uptake has remained a challenge among Black cisgender women living in the Southern United States. Gynecology clinics, which provide primary health care services for many cisgender women, have the potential to be an ideal setting for the integration of PrEP services. Objective: We designed an intervention, PrEP4Her, which aims to implement PrEP service delivery at gynecology clinics in Alabama, the United States, as part of routine reproductive and sexual health care visits to improve PrEP engagement rates among Black cisgender women. Methods: Guided by the information gathered on (1) factors impacting PrEP implementation at gynecology clinics, including key barriers and facilitators to PrEP implementation and potential strategies to address the identified barriers (in-depth interviews with the gynecology care team), (2) structural barriers and provider-level barriers to PrEP implementation (cross-sectional study among gynecologists), and (3) implementation strategies on how to integrate PrEP services into routine gynecology care (in-depth interviews and focus groups with Black cisgender women), a multicomponent implementation strategy, tailored for Black cisgender women, was developed to integrate PrEP in routine women’s health visits (ie, PrEP4Her). To determine the efficacy of the program, we will measure implementation outcomes, reach (increase in the absolute number of Black cisgender women receiving PrEP prescriptions), effectiveness (increase in the proportion of PrEP prescriptions over time), and adoption (proportion of team members willing to implement PrEP4Her) using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. In addition, acceptability (the extent to which providers and Black cisgender women feel PrEP4Her to be acceptable—in-depth interviews); Feasibility (appropriateness of PrEP4Her for a larger, full-scale trial—the Feasibility of Intervention Measure scale); and fidelity (the degree to which PrEP4Her program was implemented as designed—electronic survey with patients) will also be assessed. Results: The qualitative and quantitative data from the gynecology care team and the qualitative data from Black cisgender women were collected from August 9, 2022, to April 19, 2023, and were integrated through joint displays to identify major themes. The combined findings provided a comprehensive understanding of factors that were fundamental in the development and refinement of PrEP4Her implementation. The PrEP4Her was implemented from January 29, 2024, to August 16, 2024. The information gathered is being used to assess PrEP4Her efficacy (based on reach, effectiveness, adoption, acceptability, feasibility, and fidelity). Conclusions: Upon completion of our research, our interdisciplinary team, which includes experts in infectious diseases, implementation science, community-engaged research, and psychology, will be primed to lead a multisite type III implementation trial for PrEP service delivery at gynecology clinics across the Southern United States. International Registered Report Identifier (IRRID): DERR1-10.2196/58976 %M 40085134 %R 10.2196/58976 %U https://www.researchprotocols.org/2025/1/e58976 %U https://doi.org/10.2196/58976 %U http://www.ncbi.nlm.nih.gov/pubmed/40085134 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67223 %T Predictors of the Intention to Stop Using Smart Devices at Bedtime Among University Students in Saudi Arabia: Cross-Sectional Survey %A Almalki,Manal %+ Public Health Department, College of Nursing and Health Sciences, Jazan University, 1st Fl, Al Maarefah Rd, Jazan, 45142, Saudi Arabia, 966 173290000 ext 5548, almalki@jazanu.edu.sa %K smart devices %K smartphone %K digital health %K digital technology %K sleep quality %K university student %K bedtime habits %K Saudi Arabia %K path analysis %K sleep disturbances %K well-being %K usage %K intention %K behavior %K mobile phone %D 2025 %7 10.3.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The widespread use of smart devices, particularly among university students, has raised concerns about their impact on sleep quality. Bedtime usage of smart devices is associated with sleep disruptions and poor sleep quality. Objective: This study aimed to explore the behavioral and perceptual factors influencing university students’ intention to stop using smart devices at bedtime in Saudi Arabia. Methods: A cross-sectional survey was conducted in June 2024 and distributed via social media platforms to university students (aged ≥18 years). The questionnaire collected data on demographics, smart device usage habits, perceived negative effects on sleep, and physical sleep disturbances. The Pittsburgh Sleep Quality Index was used to assess sleep quality. Path analysis was performed to evaluate relationships between the outcome variables, intended to stop using smart device usage, and 3 latent variables: sleep quality smartphone usage, sleep quality perceived negative effects, and sleep quality during the past month. Model fit was assessed using chi-square, comparative fit index, and root mean square error of approximation. Results: Of the 774 participants, 90.43% (700/774) reported using their smart devices every night and 72.48% (561/774) believed bedtime device use negatively affected them the next morning. The most frequently reported next-morning symptoms were fatigue or drowsiness (480/774, 62.01%). Common purposes for bedtime device use were staying in touch with friends or family (432/774, 55.81%), entertainment (355/774, 45.86%), and filling up spare time (345/774, 44.57%). Overall, 58.26% (451/774) expressed an intention to stop bedtime device use within the next 3 months. Path analysis demonstrated that frequent nightly use (path coefficient=0.36) and after-lights-off usage (0.49) were positively associated with the intention to stop, whereas spending ≥3 hours on devices (–0.35) and engaging in multiple activities (–0.18) had negative associations. The strongest predictors of the intention to stop were perceived negative effects on next-morning well-being (0.71) and difficulty breathing comfortably during sleep (0.64). Model fit was excellent (comparative fit index=0.845 and root mean square error of approximation=0.039). Conclusions: Perceived negative effects on sleep quality and physical sleep disturbances are strong predictors of the intention to stop using smart devices at bedtime among university students in Saudi Arabia. Interventions aimed at improving sleep hygiene should focus on raising awareness about the impact of smart device use on well-being and addressing behaviors such as late-night usage and heavy screen time. Public health strategies should target both psychological and physiological aspects of bedtime smart device use to improve sleep quality in this population. %M 40063070 %R 10.2196/67223 %U https://formative.jmir.org/2025/1/e67223 %U https://doi.org/10.2196/67223 %U http://www.ncbi.nlm.nih.gov/pubmed/40063070 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e57398 %T Tobacco Use, Risk Perceptions, and Characteristics of Adults Who Used a Heated Tobacco Product (IQOS) in the United States: Cross-Sectional Survey Study %A Cheng,Hui G %A Noggle,Brendan %A Vansickel,Andrea R %A Largo,Edward G %A Magnani,Pierpaolo %+ Altria Client Services LLC, 601 East Jackson Street, Richmond, VA, 23219, United States, 1 8595765695, Andrea.R.Vansickel@altria.com %K United States Food and Drug Administration %K FDA %K IQOS %K Tobacco Heating System %K THS %K heated tobacco products %K modified risk tobacco products %K MRTP %K tobacco %K nicotine %K smokers %K tobacco harm reduction %K cross-sectional surveys %K cigarettes %D 2025 %7 7.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The Tobacco Heating System (THS; commercialized as IQOS) is a smoke-free heated tobacco product introduced in the United States in 2019 and authorized by the US Food and Drug Administration as a modified risk tobacco product (MRTP) in 2020. THS consists of a holder and specially designed tobacco sticks that are heated instead of burned to produce a nicotine-containing aerosol. THS was available in Atlanta, Georgia; Richmond, Virginia; Charlotte, North Carolina; the Northern Virginia region; and South Carolina before its market removal in November 2021. Objective: This study aims to describe selected sociodemographic characteristics and self-reported health history of adults who used IQOS (AUIs), their tobacco use patterns (eg, tobacco use history, exclusive and dual-use, and switching from cigarette smoking), their risk perceptions of the product, and their understanding of MRTP messages. Methods: The IQOS Cross-Sectional Postmarket Adult Consumer Study was a study of AUIs aged 21 years or older who were recruited from a consumer database via direct postal mail and emails. Participants completed the online survey between September and November 2021. Results: The survey was completed by 645 current and 43 former AUIs who had used at least 100 tobacco sticks (considered established THS use) before the assessment. Of the 688 participants, 424 (61.6%) were male, 502 (73.0%) were non–Hispanic White, and the mean age was 45 years. The vast majority (680/688, 98.8%) of AUIs had ever smoked combusted cigarettes before first trying THS and 628 (91.3%) had smoked cigarettes in the 30 days before first using THS. At the time of assessment, 161 (23.4%) reported using e-cigarettes (vs 229, 33.3%, before THS use), 92 (13.4%) reported smoking cigars (vs 114, 16.6%, before THS use), and 338 (49.1%) were still smoking after an average of 1 year of THS use. Among those currently using THS who were still smoking (n=298), 249 (83.6%) smoked fewer cigarettes compared with before first trying THS; 362 of 688 (52.6%) AUIs reported having no physical health conditions evaluated in this study and almost three-quarters reported having no mental health conditions. Among all AUIs, over 563 (81.8%) had never used a cessation treatment or had not used it in the past 12 months, and 555 (80.7%) AUIs demonstrated a correct understanding of the MRTP message and AUIs perceived THS as having a lower risk than cigarettes (43.8 vs 64.4 on a 100-point composite score scale). Conclusions: This study provides evidence that THS can help adult smokers in the United States completely switch away from cigarettes or reduce smoking. %M 39919732 %R 10.2196/57398 %U https://formative.jmir.org/2025/1/e57398 %U https://doi.org/10.2196/57398 %U http://www.ncbi.nlm.nih.gov/pubmed/39919732 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63556 %T Impact of Psychological Resilience on the Fear of Pain and Activity Recovery in Postsurgical Patients: Observational Cohort Study %A Luo,Yang %A Li,Sisi %A Feng,Lijuan %A Zheng,Junyi %A Peng,Chunfen %A Bao,Lihong %K psychological resilience %K fear of pain %K postsurgical recovery %K fear avoidance belief %K pain management %K activity recovery %D 2025 %7 7.2.2025 %9 %J JMIR Form Res %G English %X Background: The fear of pain (FOP) and fear avoidance belief (FAB) play a crucial role in the occurrence and development of chronic pain. However, the dynamics of these factors in postsurgical pain appear to differ, with the FOP often learned from others rather than directly caused by painful experiences. Psychological resilience refers to an individual’s capacity to adapt effectively to adversity, challenges, and threats, and may play a significant role in overcoming the FOP and avoidance behavior. Objective: The aim of this study was to investigate the role of psychological resilience in overcoming the FOP and avoidance behavior among surgical patients undergoing lung surgery. Methods: Participants were recruited at the Wuhan Union Hospital. Psychological resilience was measured using the Connor-Davidson Resilience Scale. The FOP was assessed using the simplified Chinese version of the Fear of Pain-9 items. The FAB was measured using the Physical Activity subscale of the Fear-Avoidance Beliefs Questionnaire. Activity recovery was assessed through questions related to social activities and household responsibilities. The adaptive least absolute shrinkage and selection operator (Lasso) regression analysis under nested cross-validation was used to identify key factors affecting postoperative FOP and activity recovery. Results: A total of 144 participants were included in the final analysis. The results showed that preoperative FOP (coefficient=8.620) and FAB (coefficient=8.560) were mainly positively correlated with postoperative FOP, while psychological resilience (coefficient=−5.822) and age (coefficient=−2.853) were negatively correlated with it. These average R2 of these models was 73% (SD 6%). Psychological resilience was the most important factor in predicting activity recovery, and these models obtained an average accuracy of 0.820 (SD 0.024) and an average area under the curve of 0.926 (SD 0.044). Conclusions: Psychological resilience was negatively associated with the postoperative FOP and positively with activity recovery in patients who underwent lung surgery. Patients with higher resilience are more likely to cope effectively with postsurgical pain and recover activities sooner. These findings highlight the importance of assessing and potentially enhancing psychological resilience in the perioperative period to improve postoperative outcomes. %R 10.2196/63556 %U https://formative.jmir.org/2025/1/e63556 %U https://doi.org/10.2196/63556 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e68371 %T Identifying High-Priority Ethical Challenges for Precision Emergency Medicine: Nominal Group Study %A Rose,Christian %A Shearer,Emily %A Woller,Isabela %A Foster,Ashley %A Ashenburg,Nicholas %A Kim,Ireh %A Newberry,Jennifer %K precision medicine %K emergency medicine %K ethical considerations %K nominal group study %K consensus framework %D 2025 %7 6.2.2025 %9 %J JMIR Form Res %G English %X Background: Precision medicine promises to revolutionize health care by providing the right care to the right patient at the right time. However, the emergency department’s unique mandate to treat “anyone, anywhere, anytime” creates critical tensions with precision medicine’s requirements for comprehensive patient data and computational analysis. As emergency departments serve as health care’s safety net and provide a growing proportion of acute care in America, identifying and addressing the ethical challenges of implementing precision medicine in this setting is crucial to prevent exacerbation of existing health care disparities. The rapid advancement of precision medicine technologies makes it imperative to understand these challenges before widespread implementation in emergency care settings. Objective: This study aimed to identify high priority ethical concerns facing the implementation of precision medicine in the emergency department. Methods: We conducted a qualitative study using a modified nominal group technique (NGT) with emergency physicians who had previous knowledge of precision medicine concepts. The NGT process consisted of four phases: (1) silent generation of ideas, (2) round-robin sharing of ideas, (3) structured discussion and clarification, and (4) thematic grouping of priorities. Participants represented diverse practice settings (county hospital, community hospital, academic center, and integrated managed care consortium) and subspecialties (education, ethics, pediatrics, diversity, equity, inclusion, and informatics) across various career stages from residents to late-career physicians. Results: A total of 12 emergency physicians identified 82 initial challenges during individual ideation, which were consolidated to 48 unique challenges after removing duplicates and combining related items. The average participant contributed 6.8 (SD 2.9) challenges. These challenges were organized into a framework with 3 themes: values, privacy, and justice. The framework identified the need to address these themes across 3 time points of the precision medicine process: acquisition of data, actualization in the care setting, and the after effects of its use. This systematic organization revealed interrelated concerns spanning from data collection and bias to implementation challenges and long-term consequences for health care equity. Conclusions: Our study developed a novel framework that maps critical ethical challenges across 3 domains (values, privacy, and justice) and 3 temporal stages of precision medicine implementation. This framework identifies high-priority areas for future research and policy development, particularly around data representation, privacy protection, and equitable access. Successfully addressing these challenges is essential to realize precision medicine’s potential while preserving emergency medicine’s core mission as health care’s safety net. %R 10.2196/68371 %U https://formative.jmir.org/2025/1/e68371 %U https://doi.org/10.2196/68371 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 6 %N %P e50458 %T Converting Organic Municipal Solid Waste Into Volatile Fatty Acids and Biogas: Experimental Pilot and Batch Studies With Statistical Analysis %A Borhany,Hojjat %K multistep fermentation %K specific methane production %K anaerobic digestion %K kinetics study %K biochar %K first-order %K modified Gompertz %K mass balance %K waste management %K environment sustainability %D 2025 %7 4.2.2025 %9 %J JMIRx Med %G English %X Background: Italy can augment its profit from biorefinery products by altering the operation of digesters or different designs to obtain more precious bioproducts like volatile fatty acids (VFAs) than biogas from organic municipal solid waste. In this context, recognizing the process stability and outputs through operational interventions and its technical and economic feasibility is a critical issue. Hence, this study involves an anaerobic digester in Treviso in northern Italy. Objective: This research compares a novel line, consisting of pretreatment, acidogenic fermentation, and anaerobic digestion, with single-step anaerobic digestion regarding financial profit and surplus energy. Therefore, a mass flow model was created and refined based on the outputs from the experimental and numerical studies. These studies examine the influence of hydraulic retention time (HRT), pretreatment, biochar addition, and fine-tuned feedstock/inoculum (FS/IN) ratio on bioproducts and operational parameters. Methods: VFA concentration, VFA weight ratio distribution, and biogas yield were quantified by gas chromatography. A t test was then conducted to analyze the significance of dissimilar HRTs in changing the VFA content. Further, a feasible biochar dosage was identified for an assumed FS/IN ratio with an adequately long HRT using the first-order rate model. Accordingly, the parameters for a mass flow model were adopted for 70,000 population equivalents to determine the payback period and surplus energy for two scenarios. We also explored the effectiveness of amendments in improving the process kinetics. Results: Both HRTs were identical concerning the ratio of VFA/soluble chemical oxygen demand (0.88 kg/kg) and VFA weight ratio distribution: mainly, acetic acid (40%), butyric acid (24%), and caproic acid (17%). However, a significantly higher mean VFA content was confirmed for an HRT of 4.5 days than the quantity for an HRT of 3 days (30.77, SD 2.82 vs 27.66, SD 2.45 g–soluble chemical oxygen demand/L), using a t test (t8=−2.68; P=.03; CI=95%). In this research, 83% of the fermented volatile solids were converted into biogas to obtain a specific methane (CH4) production of 0.133 CH4-Nm3/kg–volatile solids. While biochar addition improved only the maximum methane content by 20% (86% volumetric basis [v/v]), the FS/IN ratio of 0.3 volatile solid basis with thermal plus fermentative pretreatment improved the hydrolysis rate substantially (0.57 vs 0.07, 1/d). Furthermore, the biochar dosage of 0.12 g-biochar/g–volatile solids with an HRT of 20 days was identified as a feasible solution. Principally, the payback period for our novel line would be almost 2 years with surplus energy of 2251 megajoules [MJ] per day compared to 45 years and 21,567 MJ per day for single-step anaerobic digestion. Conclusions: This research elaborates on the advantage of the refined novel line over the single-step anaerobic digestion and confirms its financial and technical feasibility. Further, changing the HRT and other amendments significantly raised the VFA concentration and the process kinetics and stability. %R 10.2196/50458 %U https://xmed.jmir.org/2025/1/e50458 %U https://doi.org/10.2196/50458 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60829 %T Designing the First Pregnancy Guaranteed Income Program in the United States: Qualitative Needs Assessment and Human-Centered Design to Develop the Abundant Birth Project %A Karasek,Deborah %A Williams,Jazzmin C %A Taylor,Michaela A %A De La Cruz,Monica M %A Arteaga,Stephanie %A Bell,Sabra %A Castillo,Esperanza %A Chand,Maile A %A Coats,Anjeanette %A Hubbard,Erin M %A Love-Goodlett,Latriece %A Powell,Breezy %A Spellen,Solaire %A Malawa,Zea %A Gomez,Anu Manchikanti %+ Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, 110 Haviland Hall, MC 7400, Berkeley, CA, 94720-7400, United States, 1 510 6420722, anugomez@berkeley.edu %K maternal and child health %K economics %K public health %K qualitative research methods %K programs (evaluation and funding) %K community-centered %K pregnancy %K first pregnancy %K behavioral interventions %K racial health %K financial stress %K Abundant Birth Project %K infant health %K infant %K Black %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Racial inequities in pregnancy outcomes persist despite investments in clinical, educational, and behavioral interventions, indicating that a new approach is needed to address the root causes of health disparities. Guaranteed income during pregnancy has the potential to narrow racial health inequities for birthing people and infants by alleviating financial stress. Objective: We describe community-driven formative research to design the first pregnancy-guaranteed income program in the United States—the Abundant Birth Project (ABP). Informed by birth equity and social determinants of health perspectives, ABP targets upstream structural factors to improve racial disparities in maternal and infant health. Methods: The research team included community researchers, community members with lived experience as Black or Pacific Islander pregnant, and parenting people in the San Francisco Bay Area. The team conducted needs assessment interviews and facilitated focus groups with participants using human-centered design methods. Needs assessment participants later served as co-designers of the ABP program and research, sharing their experiences with financial hardships and government benefits programs and providing recommendations on key program elements, including fund disbursement, eligibility, and amount. Results: Housing affordability and the high cost of living in San Francisco emerged as significant sources of stress in pregnancy. Participants reported prohibitively low income eligibility thresholds and burdensome enrollment processes as challenges or barriers to existing social services. These insights guided the design of prototypes of ABP’s program components, which were used in a design sprint to determine the final components. Based on this design process, the ABP program offered US $1000/month for 12 months to pregnant Black and Pacific Islander people, selected through a lottery called an abundance drawing. Conclusions: The formative design process maximized community input and shared decision-making to co-design a guaranteed income program for Black and Pacific Islander women and people. Our upstream approach and community research model can inform the development of public health and social service programs. %M 39869889 %R 10.2196/60829 %U https://formative.jmir.org/2025/1/e60829 %U https://doi.org/10.2196/60829 %U http://www.ncbi.nlm.nih.gov/pubmed/39869889 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65561 %T Development of the Big Ten Academic Alliance Collaborative for Women in Medicine and Biomedical Science: “We Built the Airplane While Flying It” %A Iyer,Maya S %A Moe,Aubrey %A Massick,Susan %A Davis,Jessica %A Ballinger,Megan %A Townsend,Kristy %K collaborative %K gender equity %K women in medicine %K women in science %K biomedical science %K women %K women+ %K gender %K medicine %K university %K faculty %K accessibility %K career %K equity %K networking %K opportunity %K retaining %K programming %K Big Ten Academic Alliance %K BTAA %K academic alliance %D 2025 %7 23.1.2025 %9 %J JMIR Form Res %G English %X Women-identifying and women+ gender faculty (hereto described as women+ faculty) face numerous barriers to career advancement in medicine and biomedical sciences. Despite accumulating evidence that career development programming for women+ is critical for professional advancement and well-being, accessibility of these programs is generally limited to small cohorts, only offered to specific disciplines, or otherwise entirely unavailable. Opportunities for additional, targeted career development activities are imperative in developing and retaining women+ faculty. Our goal was the development of a new collaborative of Big Ten Academic Alliance (BTAA) institutions to support gender equity for women+ faculty in medicine and biomedical sciences, with two initial aims: (1) hosting an inaugural conference and establishing a foundation for rotation of conference hosts across BTAA schools, and (2) creating an infrastructure to develop programming, share resources, conduct environmental scans, and promote networking. In 2022, leaders from The Ohio State University College of Medicine Women in Medicine and Science envisioned, developed, and implemented a collaborative named CommUNITYten: The Big Ten Academic Alliance for Women in Medicine and Biomedical Science. Conference program development occurred through an iterative and collaborative process across external and internal task forces alongside industry partners. We developed a fiscal model to guide registration fees, budget tracking, and solicitation of conference funding from academic and industry sponsors. Attendees completed postconference surveys assessing speaker or workshop effectiveness and suggestions for future events. Finally, we developed an environmental scan survey to assess gender equity needs and existing programming across BTAA institutions. In June 2024, The Ohio State University hosted the inaugural CommUNITYten conference in Columbus, Ohio, featuring 5 keynote presentations, 9 breakout sessions, and networking opportunities across one and a half days of curated programming. Nearly 180 people attended, with representation from 9 BTAA institutions, 6 industry companies, staff, and trainees. Postconference surveys showed 50% (n=27) of respondents were likely to attend another in-person conference and suggested future conference topics. The environmental scan survey launched in October 2024. We successfully established the CommUNITYten collaborative and hosted the inaugural conference. Establishing key stakeholders from each BTAA institution, obtaining sponsorship, and detailed conference planning and partnerships were critical in ensuring realization of this collaborative. The conference brought together leaders, faculty, staff, trainees, and industry partners from across the country and met the initial goal of networking, sharing resources, and building community for women+ faculty. These efforts lay a robust foundation for the BTAA CommUNITYten collaborative to foster ongoing collaboration, innovation, and progress in the years to come. Given the importance of steady improvements, this viewpoint may further guide the efforts of other individuals, groups, and leadership supporting women+ as they consider approaches and strategies advocating for gender equity at the national level. %R 10.2196/65561 %U https://formative.jmir.org/2025/1/e65561 %U https://doi.org/10.2196/65561 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e59203 %T Assessment of Geriatric Problems and Risk Factors for Delirium in Surgical Medicine: Protocol for Multidisciplinary Prospective Clinical Study %A Möllmann,Henriette Louise %A Alhammadi,Eman %A Boulghoudan,Soufian %A Kuhlmann,Julian %A Mevissen,Anica %A Olbrich,Philipp %A Rahm,Louisa %A Frohnhofen,Helmut %+ Department of Oral-, Maxillo- and Plastic Facial Surgery, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, Düsseldorf, 40225, Germany, 49 15206802915, henriettelouise.moellmann@med.uni-duesseldorf.de %K delirium %K older patients %K perioperative assessment %K age-related surgical risk factors %K geriatric assessment %K gerontology %K aging %K surgical medicine %K surgical care %K surgery %K multidisciplinary %K prospective study %K perioperative %K screening %K palliative care %K health informatics %D 2025 %7 22.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: An aging population in combination with more gentle and less stressful surgical procedures leads to an increased number of operations on older patients. This collectively raises novel challenges due to higher age heavily impacting treatment. A major problem, emerging in up to 50% of cases, is perioperative delirium. It is thus vital to understand whether and which existing geriatric assessments are capable of reliably identifying risk factors, how high the incidence of delirium is, and whether the resulting management of these risk factors might lead to a reduced incidence of delirium. Objective: This study aimed to determine the frequency and severity of geriatric medical problems in elective patients of the Clinics of Oral and Maxillofacial Surgery, Vascular Surgery, and Orthopedics, General Surgery, and Trauma Surgery, revealing associations with the incidence of perioperative delirium regarding potential risk factors, and recording the long-term effects of geriatric problems and any perioperative delirium that might have developed later the patient’s life. Methods: We performed both pre- and postoperative assessments in patients of 4 different surgical departments who are older than 70 years. Patient-validated screening instruments will be used to identify risk factors. A geriatric assessment with the content of basal and instrumental activities of daily living (basal activities of daily living [Katz index], instrumental activities of daily living [Lawton and Brody score], cognition [6-item screener and clock drawing test], mobility [de Morton Mobility Index and Sit-to-Stand test], sleep [Pittsburgh Sleep Quality Index and Insomnia Severity Index/STOP-BANG], drug therapy [polypharmacy and quality of medication, Fit For The Aged classification, and anticholinergic burden score], and pain assessment and delirium risk (Delirium Risk Assessment Tool) will be performed. Any medical problems detected will be treated according to current standards, and no intervention is planned as part of the study. In addition, a telephone follow-up will be performed 3, 6, and 12 months after discharge. Results: Recruitment started in August 2022, with 421 patients already recruited at the time of submission. Initial analyses of the data are to be published at the end of 2024 or the beginning of 2025. Conclusions: In the current study, we investigate whether the risk factors addressed in the assessment are associated with an increase in the delirium rate. The aim is then to reduce this comprehensive assessment to the central aspects to be able to conduct targeted and efficient risk screening. Trial Registration: German Clinical Trials Registry DRKS00028614; https://www.drks.de/search/de/trial/DRKS00028614 International Registered Report Identifier (IRRID): DERR1-10.2196/59203 %M 39841510 %R 10.2196/59203 %U https://www.researchprotocols.org/2025/1/e59203 %U https://doi.org/10.2196/59203 %U http://www.ncbi.nlm.nih.gov/pubmed/39841510 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64258 %T Assessment, Decision, Adaptation, Production, Topical Experts-Integration, Training, and Testing (ADAPT-ITT) Framework to Tailor Evidence-Based Posttraumatic Stress Disorder Treatment for People With HIV to Enhance Engagement and Adherence: Qualitative Results from a Feasibility Randomized Controlled Trial %A Lopez,Cristina M %A Moreland,Angela D %A Amaya,Stephanie %A Bisca,Erin %A Mujica,Christin %A Wilson,Tayler %A Baker,Nathaniel %A Richey,Lauren %A Eckard,Allison Ross %A Resick,Patricia A %A Safren,Steven A %A Danielson,Carla Kmett %+ Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, 67 President St, Charleston, SC, 29425-5712, United States, 1 843 792 2945, lopezcm@musc.edu %K PTSD %K HIV %K adherence %K minoritized populations %K adaptation %K evidence-based %K treatment %K engagement %K posttraumatic stress disorder %K stress %K trauma %K antiretroviral therapy %K therapy %K symptoms %K acceptability %K self-efficacy %D 2025 %7 16.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals with co-occurring posttraumatic stress disorder (PTSD) and HIV are at high-risk for negative HIV-related outcomes, including low adherence to antiretroviral therapy, faster disease progression, more hospitalizations, and almost twice the rate of death. Despite high rates of PTSD in persons with HIV (PWH) and poor HIV-related health outcomes associated with PTSD, an effective evidence-based treatment for PTSD symptoms in PWH does not exist. Objective: This study aimed to describe the adaptation and theater testing of an evidence-based intervention designed for people with co-occurring PTSD and HIV. Methods: The Assessment, Decision, Adaptation, Production, Topical experts-integration, Training, and Testing (ADAPT-ITT) framework guided the formative process used to modify an evidence-based PTSD treatment (cognitive processing therapy; CPT) to meet the unique needs of PWH experiencing PTSD. With the integration of Life-Steps for Medication Adherence (Life-Steps), the adapted protocol (CPT-Life-Steps for integration of adherence; CPT-L) targeted HIV-related stigma and HIV medication adherence within a trauma-informed framework. Theater testing was completed with 7 participants to evaluate acceptability of CPT-L for PWH. The qualitative data (N=54 recordings) used to evaluate and adapt CPT-L emerged from individual interviews conducted with participants after each therapy session as well as exit interviews conducted at posttreatment data collection. Results: After challenging stigma-related appraisals, participants expressed feeling less constrained by maladaptive thoughts. These shifts translated to increased self-efficacy with both HIV-related care and mental health. Conclusions: These results indicate that trauma-informed work with PWH should consider the impact of HIV on trauma-related stuck points, intersecting identities (including living with HIV), and challenging internalized stigma. Findings provide evidence that CPT-L is acceptable and effective in addressing internalized HIV stigma that impacts PTSD symptom maintenance and HIV treatment engagement. Trial Registration: ClinicalTrials.gov; NCT05275842; https://clinicaltrials.gov/study/NCT05275842?id=NCT05275842&rank=1 International Registered Report Identifier (IRRID): RR2-10.1016/j.conctc.2023.101150 %M 39819749 %R 10.2196/64258 %U https://formative.jmir.org/2025/1/e64258 %U https://doi.org/10.2196/64258 %U http://www.ncbi.nlm.nih.gov/pubmed/39819749 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63217 %T Resilience Informatics in Public Health: Qualitative Analysis of Conference Proceedings %A Block Ngaybe,Maiya G %A Azurdia Sierra,Lidia %A McNair,Andrew %A Gonzalez,Myla %A Arora,Mona %A Ernst,Kacey %A Noriega-Atala,Enrique %A Iyengar,M Sriram %+ College of Medicine - Phoenix, University of Arizona, 475 N 5th St, Phoenix, AZ, 85004, United States, 1 281 793 4733, msiyengar@arizona.edu %K resilience %K public health %K informatics %K mobile phone %K artificial intelligence %K AI %D 2025 %7 16.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, public health has confronted 2 formidable challenges: the devastating COVID-19 pandemic and the enduring threat of climate change. The convergence of these crises underscores the urgent need for resilient solutions. Resilience informatics (RI), an emerging discipline at the intersection of informatics and public health, leverages real-time data integration from health systems, environmental monitoring, and technological tools to develop adaptive responses to multifaceted crises. It offers promising avenues for mitigating and adapting to these challenges by proactively identifying vulnerabilities and fostering adaptive capacity in public health systems. Addressing critical questions regarding target audiences, privacy concerns, and scalability is paramount to fostering resilience in the face of evolving health threats. Objective: The University of Arizona held a workshop, titled Resilience Informatics in Public Health, in November 2023 to serve as a pivotal forum for advancing these discussions and catalyzing collaborative efforts within the field. This paper aims to present a qualitative thematic analysis of the findings from this workshop. Methods: A purposive sampling strategy was used to invite 40 experts by email from diverse fields, including public health, medicine, weather services, informatics, environmental science, and resilience, to participate in the workshop. The event featured presentations from key experts, followed by group discussions facilitated by experts. The attendees engaged in collaborative reflection and discussion on predetermined questions. Discussions were systematically recorded by University of Arizona students, and qualitative analysis was conducted. A detailed thematic analysis was performed using an inductive approach, supported by MAXQDA software to manage and organize data. Two independent researchers coded the transcripts; discrepancies in coding were resolved through consensus, ensuring a rigorous synthesis of the findings. Results: The workshop hosted 27 experts at the University of Arizona, 21 (78%) of whom were from public health–related fields. Of these 27 experts, 8 (30%) were from the field of resilience. In addition, participants from governmental agencies, American Indian groups, weather services, and a mobile health organization attended. Qualitative analysis identified major themes, including the potential of RI tools, threats to resilience (eg, health care access, infrastructure, and climate change), challenges with RI tools (eg, usability, funding, and real-time response), and standards for RI tools (eg, technological, logistical, and sociological). The attendees emphasized the importance of equitable access, community engagement, and iterative development in RI projects. Conclusions: The RI workshop emphasized the necessity for accessible, user-friendly tools bridging technical knowledge and community needs. The workshop’s conclusions provide a road map for future public health resilience, highlighting the need for scalable, culturally sensitive, community-driven interventions. Future directions include focused discussions to yield concrete outputs such as implementation guidelines and tool designs, reshaping public health strategies in the face of emerging threats. %M 39819984 %R 10.2196/63217 %U https://formative.jmir.org/2025/1/e63217 %U https://doi.org/10.2196/63217 %U http://www.ncbi.nlm.nih.gov/pubmed/39819984 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64873 %T Identification of Behavioral, Clinical, and Psychological Antecedents of Acute Stimulant Poisoning: Development and Implementation of a Mixed Methods Psychological Autopsy Study %A Antolin Muñiz,Marley %A McMahan,Vanessa M %A Luna Marti,Xochitl %A Brennan,Sarah %A Tavasieff,Sophia %A Rodda,Luke N %A Knoll,James %A Coffin,Phillip O %K psychological autopsy %K acute stimulant poisoning %K overdose %K cocaine %K methamphetamine %K fentanyl %D 2025 %7 13.1.2025 %9 %J JMIR Form Res %G English %X Background: Despite increasing fatal stimulant poisoning in the United States, little is understood about the mechanism of death. The psychological autopsy (PA) has long been used to distinguish the manner of death in equivocal cases, including opioid overdose, but has not been used to explicitly explore stimulant mortality. Objective: We aimed to develop and implement a large PA study to identify antecedents of fatal stimulant poisoning, seeking to maximize data gathering and ethical interactions during the collateral interviews. Methods: We ascertained death records from the California Electronic Death Reporting System (CA-EDRS) and the San Francisco Office of the County Medical Examiner (OCME) from June 2022 through December 2023. We selected deaths determined to be due to acute poisoning from cocaine or methamphetamine, which occurred 3‐12 months prior and were not attributed to suicide or homicide. We identified 31 stimulant-fentanyl and 70 stimulant-no-opioid decedents. We sought 2 informants for each decedent, who were able to describe the decedent across their life course. Informants were at least 18 years of age, communicated with the decedent within the year before death, and were aware that the decedent had been using substances during that year. Upon completion of at least one informant interview conducted by staff with bachelor’s or master’s degrees, we collected OCME, medical record, and substance use disorder treatment data for the decedent. Planned analyses include least absolute shrinkage and selection operator regressions of quantitative data and thematic analyses of qualitative data. Results: We identified and interviewed at least one informant (N=141) for each decedent (N=101). Based on feedback during recruitment, we adapted language to improve rapport, including changing the term “accidental death” to “premature death,” offering condolences, and providing content warnings. As expected, family members were able to provide more data about the decedent’s childhood and adolescence, and nonfamily informants provided more data regarding events proximal to death. We found that the interviews were stressful for both the interviewee and interviewer, especially when participants thought the study was intrusive or experienced significant grief during the interviews. Conclusions: In developing and implementing PA research on fatal stimulant poisoning, we noted the importance of recruitment language regarding cause of death and condolences with collateral informants. Compassion and respect were critical to facilitate the interview process and maintain an ethical framework. We discuss several barriers to success and lessons learned while conducting PA interviews, as well as recommendations for future PA studies. %R 10.2196/64873 %U https://formative.jmir.org/2025/1/e64873 %U https://doi.org/10.2196/64873 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64586 %T Impact of Preventive Intravenous Amiodarone on Reperfusion Ventricular Fibrillation in Patients With Left Ventricular Hypertrophy Undergoing Open-Heart Surgery: Randomized Controlled Clinical Trial %A Gong,Chan-Juan %A Zhou,Xiao-Kai %A Zhang,Zhen-Feng %A Fang,Yin %K amiodarone %K left ventricular hypertrophy %K reperfusion ventricular fibrillation %K open-heart surgery %K randomized controlled trial %K RCT %K clinical trial %K ventricular fibrillation %K vicious arrhythmia %K aortic cross-clamp %K surgery %K effectiveness %K defibrillation %D 2025 %7 13.1.2025 %9 %J JMIR Form Res %G English %X Background: Ventricular fibrillation (VF) is a vicious arrhythmia usually generated after removal of the aortic cross-clamp (ACC) in patients undergoing open-heart surgery, which could damage cardiomyocytes, especially in patients with left ventricular hypertrophy (LVH). Amiodarone has the prominent properties of converting VF and restoring sinus rhythm. However, few studies concentrated on the effect of amiodarone before ACC release on reducing VF in patients with LVH. Objective: The study was designed to explore the effectiveness of prophylactic intravenous amiodarone in reducing VF after the release of the ACC in patients with LVH. Methods: A total of 54 patients with LVH scheduled for open-heart surgery were enrolled and randomly divided (1:1) into 2 groups—group A (amiodarone group) and group P (placebo-controlled group). Thirty minutes before removal of the ACC, the trial drugs were administered intravenously. In group A, 150 mg of amiodarone was pumped in 15 minutes. In group P, the same volume of normal saline was pumped in 15 minutes. The primary outcome was the incidence of VF 10 minutes after removal of the ACC. Results: The incidence of VF was lower in group A than in group P (30% vs 70%, P=.003). The duration of VF, the number of defibrillations, and the defibrillation energy were also lower in group A than in group P (P<.001, P=.002, and P=.002, respectively). After the end of cardiopulmonary bypass, the heart rate and mean arterial pressure were lower in group A, and the mean pulmonary arterial pressure and the dose of vasoactive drugs were higher than those in group P (P<.001, P<.001, P=.04, and P=.02, respectively). However, there were no significant differences in the use of vasoactive-inotropic agents and hemodynamic status between the 2 groups before the end of surgery. Conclusions: In patients with LVH who undergo open-heart surgery, amiodarone can be safely used to reduce the incidence of VF, the duration of VF, the frequency of defibrillation, and the energy of defibrillation after ACC removal. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000035057; https://www.chictr.org.cn/showprojEN.html?proj=57145 %R 10.2196/64586 %U https://formative.jmir.org/2025/1/e64586 %U https://doi.org/10.2196/64586 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58650 %T Co-Design of an Escape Room for e-Mental Health Training of Mental Health Care Professionals: Research Through Design Study %A Bierbooms,Joyce J P A %A Sluis-Thiescheffer,Wouter R J W %A Feijt,Milou Anne %A Bongers,Inge M B %+ Tilburg University, PO box 90153, Tilburg, 5000 LE, Netherlands, 31 13 466 31 39, j.j.p.a.bierbooms@tilburguniversity.edu %K serious gaming %K mental health care professionals %K e-mental health %K skill enhancement %K training %D 2025 %7 7.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Many efforts to increase the uptake of e-mental health (eMH) have failed due to a lack of knowledge and skills, particularly among professionals. To train health care professionals in technology, serious gaming concepts such as educational escape rooms are increasingly used, which could also possibly be used in mental health care. However, such serious-game concepts are scarcely available for eMH training for mental health care professionals. Objective: This study aims to co-design an escape room for training mental health care professionals’ eMH skills and test the escape room’s usability by exploring their experiences with this concept as a training method. Methods: This project used a research through design approach with 3 design stages. In the first stage, the purpose, expectations, and storylines for the escape room were formulated in 2 co-design sessions with mental health care professionals, game designers, innovation staff, and researchers. In the second stage, the results were translated into the first escape room, which was tested in 3 sessions, including one web version of the escape room. In the third stage, the escape room was tested with mental health care professionals outside the co-design team. First, 2 test sessions took place, followed by 3 field study sessions. In the field study sessions, a questionnaire was used in combination with focus groups to assess the usability of the escape room for eMH training in practice. Results: An escape room prototype was iteratively developed and tested by the co-design team, which delivered multiple suggestions for adaptations that were assimilated in each next version of the prototype. The field study showed that the escape room creates a positive mindset toward eMH. The suitability of the escape room to explore the possibilities of eMH was rated 4.7 out of 5 by the professionals who participated in the field study. In addition, it was found to be fun and educational at the same time, scoring 4.7 (SD 0.68) on a 5-point scale. Attention should be paid to the game’s complexity, credibility, and flexibility. This is important for the usefulness of the escape room in clinical practice, which was rated an average of 3.8 (SD 0.77) on a 5-point scale. Finally, implementation challenges should be addressed, including organizational policy and stimulation of eMH training. Conclusions: We can conclude that the perceived usability of an escape room for training mental health care professionals in eMH skills is promising. However, it requires additional effort to transfer the learnings into mental health care professionals’ clinical practice. A straightforward implementation plan and testing the effectiveness of an escape room on skill enhancement in mental health care professionals are essential next steps to reach sustainable goals. %M 39773391 %R 10.2196/58650 %U https://formative.jmir.org/2025/1/e58650 %U https://doi.org/10.2196/58650 %U http://www.ncbi.nlm.nih.gov/pubmed/39773391 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56091 %T Associations Between Successful Home Discharge and Posthospitalization Care Planning: Cross-Sectional Ecological Study %A Takashi,Naoki %A Fujisawa,Misaki %A Ohtera,Shosuke %+ Department of Health Economics, Center for Gerontology and Social Science, Research Institute, National Center for Geriatrics and Gerontology, 7-430, Morioka-Cho, Aichi, 474-8511, Japan, 81 562 46 2311, takashi@ncgg.go.jp %K health services research %K health policy %K quality of care %K access to care %K outcome assessment %K public health %K health service %K accessible %K accessibility %K care coordination %K health outcome %K surveillance %K regional disparities %K nonstandardized care %K nonstandardization %K hospital discharge %K hospital care %K analysis %K Japan %K older adults %D 2024 %7 12.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective discharge planning is crucial for successful care transitions, reducing hospital length of stay and readmission rates. Japan offers a financial incentive to enhance the coordination of posthospitalization care planning for patients with complex needs. However, the national impact of this incentive remains unclear. Objective: This study aimed to (1) assess the association between the number of claims submitted for discharge planning, as an indicator of the provision of posthospitalization care planning, and key health care outcomes, including discharges to home, 30-day readmissions, length of stay, and medical expenditures at the prefectural level in Japan, and (2) to describe regional differences in the provision of posthospitalization care planning and explore associated factors. Methods: This ecological study used prefectural-level data from fiscal year 2020. Claims submitted for discharge planning were used as indicators that posthospitalization care planning was provided. Supply-adjusted standardized claim ratios (SCRs) were calculated using data from the Seventh National Database of Health Insurance Claims, to evaluate and compare the number of claims across 47 prefectures in Japan, accounting for differences in population structure. Key outcomes included discharges to home, 30-day readmissions, length of stay, and medical expenditures. Multivariate negative binomial regression models assessed associations between SCRs and outcomes, adjusting for socioeconomic covariates. In addition, regional differences in the provision of posthospitalization care planning and associated factors were analyzed using the Mann-Whitney U test. Prefectures were divided into 3 groups (low, medium, and high) based on tertiles of each factor, and supply-adjusted SCRs were compared across these groups. Results: The ratio of the minimum to maximum supply-adjusted SCR was 10.63, highlighting significant regional variation. Higher supply-adjusted SCRs, indicating more frequent provision of posthospitalization care planning, were associated with an increase of 9.68 (95% CI 0.98-18.47) discharges to home per 1000 patients for each SD increase in supply-adjusted SCR. Several factors contributed to regional differences in the supply-adjusted SCR for posthospitalization care planning. A higher supply-adjusted SCR was significantly associated with a greater number of nurses per 100 hospital beds (median SCR in low, medium, and high groups: 0.055, 0.101, and 0.103, respectively); greater number of care manager offices per 100 km2 of habitable area (0.088, 0.082, and 0.116); higher proportion of hospitals providing electronic medical information to patients (0.083, 0.095, and 0.11); lower proportion of older adults living alone (0.116; 0.092; 0.071); and higher average per capita income (0.078, 0.102, and 0.102). Conclusions: The provision of posthospitalization care planning is associated with an increased likelihood of discharge to home, underscoring its importance in care transitions. However, significant regional disparities in care coordination exist. Addressing these disparities is crucial for equitable health care outcomes. Further research is needed to clarify causal mechanisms. %R 10.2196/56091 %U https://formative.jmir.org/2024/1/e56091 %U https://doi.org/10.2196/56091 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57884 %T Visualizing Empathy in Patient-Practitioner Interactions Using Eye-Tracking Technology: Proof-of-Concept Study %A Park,Yuyi %A ­Kim,Hyungsin %A Kim,Hakkyun %K clinical empathy %K eye tracking %K medical communication %K nonverbal behavior %K doctor-patient encounters %D 2024 %7 11.12.2024 %9 %J JMIR Form Res %G English %X Background: Communication between medical practitioners and patients in health care settings is essential for positive patient health outcomes. Nonetheless, researchers have paid scant attention to the significance of clinical empathy in these interactions as a practical skill. Objective: This study aims to understand clinical empathy during practitioner-patient encounters by examining practitioners’ and patients’ verbal and nonverbal behaviors. Using eye-tracking techniques, we focused on the relationship between traditionally assessed clinical empathy and practitioners’ actual gaze behavior. Methods: We used mixed methods to understand clinical encounters by comparing 3 quantitative measures: eye-tracking data, scores from the Korean version of the Jefferson Scale of Empathy–Health Professional, and Consultation and Relational Empathy survey scores. We also conducted qualitative interviews with patients regarding their encounters. Results: One practitioner and 6 patients were involved in the experiment. Perceived empathy on the part of the practitioner was notably higher when the practitioner focused on a patient’s mouth area during the consultation, as indicated by gaze patterns that focused on a patient’s face. Furthermore, an analysis of areas of interest revealed different patterns in interactions with new as opposed to returning patients. Postconsultation interviews suggested that task-oriented and socially oriented empathy are critical in aligning with patients’ expectations of empathetic communication. Conclusions: This proof-of-concept study advocates a multidimensional approach to clinical empathy, revealing that a combination of verbal and nonverbal behaviors significantly reinforces perceived empathy from health care workers. This evolved paradigm of empathy underscores the profound consequences for medical education and the quality of health care delivery. %R 10.2196/57884 %U https://formative.jmir.org/2024/1/e57884 %U https://doi.org/10.2196/57884 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59621 %T Incentivizing Rural Work Preferences Among Specialist Physicians: Protocol for a Discrete Choice Experiment %A Joshi,Anushree %A Panchamia,Jallavi %A Pandya,Apurvakumar %+ Department of Health Policy, Management and Behavioral Science, Indian Institute of Public Health Gandhinagar, NH 147, Palaj Village, Opp. Air Force Headquarter, Gandhinagar, Gujarat, 382042, India, 91 9166052350, ajoshi@iiphg.org %K discrete choice experiment %K specialist physicians %K community health centers %K rural retention %K policy interventions %D 2024 %7 9.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Retaining specialist physicians in rural parts of India poses a fundamental challenge, which affects the health care system’s functionality and provision of standard health care services. There has been an acute shortfall of specialist physicians in the fields of medicine, pediatrics, obstetrics and gynecology, and surgery at rural community health centers. This necessitates urgent policy focus to address the shortages and design effective rural retention strategies. In this study, which uses a discrete choice experiment (DCE), individuals choose from multiple-choice preferences that resemble hypothetical job descriptions. Objective: DCEs are a quantitative approach to assessing several aspects of job selection. This study aims to develop a detailed plan of a DCE method used to determine specialist physicians’ job choices. This protocol outlines the DCE method, which uses an exploratory sequential mixed methods research design to understand specialist physicians’ preferences and design reward packages that would effectively motivate them to work in underserved regions. Methods: The qualitative phase of the study involved identifying job attributes and their corresponding levels for the DCE. We followed a meticulous process, which included reviewing relevant literature, performing qualitative pilot work, conducting in-depth individual interviews, and consulting with medical and health experts. The quantitative phase involved generating a D-efficient orthogonal fractional factorial design using Ngene software to create choice scenarios using the identified job factors and their corresponding levels. The generated choice scenarios were blocked into 6 versions in 6 blocks. The DCE was undertaken among final-year postgraduate medical residents and specialist physicians from several health care facilities in Rajasthan. Various statistical models will be applied to explore the response variability and quantify the trade-offs that participants are willing to make for nonmonetary features as a substitute for adjustments in the monetary attribute. Results: After the ethics committee’s approval of the study, the qualitative data collection phase occurred from September to December 2021, while the quantitative phase took place from May to August 2022. Six attributes and 14 levels were identified and established through qualitative surveys. The experimental design resulted in 36 choice situations, which were grouped into 6 blocks. The preliminary investigation demonstrated that the instrument was valid and reliable. Statistical data analysis has been initiated, and the principal findings are expected to be disseminated in January 2025. Conclusions: The protocol provides a systematic framework to assess specialist physicians’ preferences regarding working in rural health care centers. This research has the potential to substantially influence the future of rural health care by laying the foundation for understanding specialist physicians’ choices, which will help design future incentive schemes, policy interventions, and research. International Registered Report Identifier (IRRID): DERR1-10.2196/59621 %M 39652867 %R 10.2196/59621 %U https://www.researchprotocols.org/2024/1/e59621 %U https://doi.org/10.2196/59621 %U http://www.ncbi.nlm.nih.gov/pubmed/39652867 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57452 %T Tracking Implementation Outcomes of an Intensive Case Management Program for HIV: Protocol for a Mixed Methods Study %A Mengistu,Meron %A Tom,Kris %A Gebremikael,Liben %A Massaquoi,Notisha %A Ezezika,Obidimma %+ Global Health & Innovation Lab, Faculty of Health Sciences, University of Western Ontario, 1151 Richmond Street, London, ON, N6A3K7, Canada, 1 519 661 2111 ext 87823, oezezika@uwo.ca %K implementation science %K intensive case management %K ICM %K human immunodeficiency virus %K HIV %K tracking %K outcome %K fidelity %K reach %K sustainability %K implementation outcomes %K perspective %K perception %K Toronto %K Canada %K descriptive statistics %K evidence-based intervention %K effectiveness %K barriers %K facilitators %K adoption %D 2024 %7 29.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Implementation science investigates the processes and factors that influence the successful adoption, implementation, and sustainability of interventions in many settings. Although conventional research places significant emphasis on the advancement and effectiveness of interventions, it is equally imperative to comprehend their performance in practical, real-life situations. Through outcome tracking, implementation science enables researchers to investigate complex implementation dynamics and go beyond efficacy, identifying the various aspects that contribute to the success of interventions. Objective: This study aims to evaluate the implementation outcomes of TAIBU’s intensive case management (ICM) model tailored for African, Caribbean, and Black communities living with HIV in the Greater Toronto Area. Specifically, it seeks to assess the fidelity, reach, and sustainability of the ICM program. Fidelity monitoring will ensure adherence to program protocols and consistency in service delivery, essential for achieving desired health outcomes. Reach assessment will examine the program’s capacity to reach the target population, including demographic coverage and engagement levels among African, Caribbean, and Black individuals. Sustainability assessment will explore the determinants influencing the longevity and impact of the ICM program. Methods: The study uses a mixed methods approach, where we will use probing questionnaires, interviews, and focus-group discussions to gather program performance and engagement data, in-depth insights, and perspectives from the implementation team responsible for delivering the ICM intervention. The collected fidelity and reach data through questionnaires will be analyzed using appropriate statistical techniques, such as descriptive statistics, to summarize the responses and identify patterns and trends within the data. Sustainability data collected through the interviews and focus groups will be analyzed and organized based on the Consolidated Framework for Implementation Research, which provides an organized way to identify and comprehend the determinants influencing implementation outcomes. Results: The study commenced in January 2024, and initial data collection is expected to be completed by December 2024. As of September 2024, we have enrolled 5 participants. Conclusions: This study will significantly contribute to improving the implementation of the ICM program. By conducting a study in an organizational or institutional setting, researchers can acquire valuable insights into the implementation process from those who are directly involved. The information gathered will inform strategies for improving implementation effectiveness; removing impediments; and enhancing the overall quality of the ICM program for African, Caribbean, and Black individuals living with HIV. International Registered Report Identifier (IRRID): DERR1-10.2196/57452 %M 39612213 %R 10.2196/57452 %U https://www.researchprotocols.org/2024/1/e57452 %U https://doi.org/10.2196/57452 %U http://www.ncbi.nlm.nih.gov/pubmed/39612213 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59572 %T Factors Influencing Poststroke Cognitive Dysfunction: Cross-Sectional Analysis %A Zhou,Wu %A Feng,HaiXia %A Tao,Hua %A Sun,Hui %A Zhang,TianTian %A Wang,QingXia %A Zhang,Li %+ School of Medicine, Southeast University, 87 Dingjiaqiao, Gulou District, Jiangsu Province, Nanjing, 210009, China, 86 02583272077, xrzfhx@163.com %K stroke %K cognitive dysfunction %K analysis of associated factors %K MMSE %K Mini-Mental State Examination %K status survey %K cognitive %K survey %K cognitive impairment %K cross-sectional study %K cross sectional %K stroke patients %K cognition %K education %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Poststroke cognitive impairment (PSCI) is a common and debilitating complication that affects stroke survivors, impacting memory, attention, and executive function. Despite its prevalence, the factors contributing to PSCI remain unclear, with limited insights into how demographic and clinical variables influence cognitive outcomes. Objective: This study investigates the incidence of cognitive impairment in patients with stroke and examines key demographic and clinical factors, such as age, gender, and education level, which contribute to cognitive decline. The aim is to provide a deeper understanding of PSCI to inform early intervention strategies for improving patient outcomes. Methods: A cross-sectional study was conducted on 305 patients with ischemic stroke admitted to Zhongda Hospital, Southeast University, from January 2019 to September 2022. Cognitive function was assessed using the Mini-Mental State Examination (MMSE) within 72 hours of hospital admission. Demographic information, including age, gender, and education level, were collected. Statistical analyses were performed using chi-square tests, independent t tests, and multivariate regression to assess the relationship between cognitive function and key variables. Pearson correlation analysis explored associations among age, education, and MMSE scores. Results: Among the 305 patients with stroke, 16.7% (n=51) were diagnosed with cognitive impairment based on MMSE scores. The prevalence of cognitive impairment was slightly higher in males (17.6%, n=159) than females (15.8%, n=146), but this difference was not statistically significant. A strong negative correlation was found between MMSE scores and age (r=–0.32; P<.01), indicating that older patients had lower cognitive function. Education level showed a positive correlation with MMSE scores (r=0.41; P<.01), with patients with higher educational attainment demonstrating better cognitive outcomes. Cognitive function showed a marked decline in patients older than 60 years, particularly in domains such as memory, attention, and language skills. Conclusions: This study confirms that age and education are significant factors in determining cognitive outcomes after stroke. The results align with existing literature showing that cognitive function declines with age, while higher educational attainment serves as a protective factor. The findings suggest that individuals with greater cognitive reserve, often linked to higher education, are better equipped to cope with the impact of brain injury. However, the study’s reliance on MMSE may have limited its ability to detect domain-specific impairments. Future studies should consider using more sensitive cognitive tools, such as the Montreal Cognitive Assessment (MoCA), to provide a more comprehensive evaluation of PSCI. Cognitive impairment is prevalent among stroke survivors, with age and education level being key factors influencing outcomes. These findings underscore the importance of early detection and targeted interventions to mitigate cognitive decline. Further research with larger samples and more sensitive cognitive assessments is needed to fully understand PSCI and improve rehabilitation strategies for patients with stroke. %M 39560985 %R 10.2196/59572 %U https://formative.jmir.org/2024/1/e59572 %U https://doi.org/10.2196/59572 %U http://www.ncbi.nlm.nih.gov/pubmed/39560985 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e57265 %T Knowledge, Attitudes, and Behaviors Toward Salt Consumption and Its Association With 24-Hour Urinary Sodium and Potassium Excretion in Adults Living in Mexico City: Cross-Sectional Study %A Gutiérrez-Salmeán,Gabriela %A Miranda-Alatriste,Paola Vanessa %A Benítez-Alday,Patricio %A Orozco-Rivera,Luis Enrique %A Islas-Vargas,Nurit %A Espinosa-Cuevas,Ángeles %A Correa-Rotter,Ricardo %A Colin-Ramirez,Eloisa %+ Centro de Investigación en Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Anáhuac México, Avenida Universidad Anáhuac 46,, Lomas Anáhuac, Huixquilucan, Estado de México, 52786, Mexico, 52 55 5627 0210, eloisa.colinr@incmnsz.mx %K beliefs %K attitudes %K hypertension %K knowledge %K salt consumption %K sodium intake %K potassium intake %K Mexico %D 2024 %7 18.11.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The World Health Organization recommends a daily sodium intake of less than 2000 mg for adults; however, the Mexican population, like many others globally, consumes more sodium than this recommended amount. Excessive sodium intake is often accompanied by inadequate potassium intake. The association between knowledge, attitudes, and behaviors (KAB) and actual sodium intake has yielded mixed results across various populations. In Mexico, however, salt/sodium-related KAB and its relationship with sodium and potassium intake have not been evaluated. Objective: This study primarily aims to describe salt/sodium-related KAB in a Mexican population and, secondarily, to explore the association between KAB and 24-hour urinary sodium and potassium excretion. Methods: We conducted a cross-sectional study in an adult population from Mexico City and the surrounding metropolitan area. Self-reported KAB related to salt/sodium intake was assessed using a survey developed by the Pan American Health Organization. Anthropometric measurements were taken, and 24-hour urinary sodium and potassium excretion levels were determined. Descriptive statistics were stratified by sex and presented as means (SD) or median (25th-75th percentiles) for continuous variables, and as absolute and relative frequencies for categorical variables. The associations between KAB and sodium and potassium excretion were assessed using analysis of covariance, adjusting for age, sex, BMI, and daily energy intake as covariates, with the Šidák correction applied for multiple comparisons. Results: Overall, 232 participants were recruited (women, n=184, 79.3%). The mean urinary sodium and potassium excretion were estimated to be 2582.5 and 1493.5 mg/day, respectively. A higher proportion of men did not know the amount of sodium they consumed compared with women (12/48, 25%, vs 15/184, 8.2%, P=.01). More women reported knowing that there is a recommended amount for daily sodium intake than men (46/184, 25%, vs 10/48, 20.8%, P=.02). Additionally, more than half of men (30/48, 62.5%) reported never or rarely reading food labels, compared with women (96/184, 52.1%, P=.04). Better salt/sodium-related KAB was associated with higher adjusted mean sodium and potassium excretion. For example, mean sodium excretion was 3011.5 (95% CI 2640.1-3382.9) mg/day among participants who reported knowing the difference between salt and sodium, compared with 2592.8 (95% CI 2417.2-2768.3) mg/day in those who reported not knowing this difference (P=.049). Similarly, potassium excretion was 1864.9 (95% CI 1669.6-2060.3) mg/day for those who knew the difference, compared with 1512.5 (95% CI 1420.1-1604.8) mg/day for those who did not (P=.002). Additionally, higher urinary sodium excretion was observed among participants who reported consuming too much sodium (3216.0 mg/day, 95% CI 2867.1-3565.0 mg/day) compared with those who claimed to eat just the right amount (2584.3 mg/day, 95% CI 2384.9-2783.7 mg/day, P=.01). Conclusions: Salt/sodium-related KAB was poor in this study sample. Moreover, KAB had a greater impact on potassium excretion than on sodium excretion, highlighting the need for more strategies to improve KAB related to salt/sodium intake. Additionally, it is important to consider other strategies aimed at modifying the sodium content of foods. %M 39556832 %R 10.2196/57265 %U https://www.i-jmr.org/2024/1/e57265 %U https://doi.org/10.2196/57265 %U http://www.ncbi.nlm.nih.gov/pubmed/39556832 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57244 %T Role of HIV Serostatus Communication on Frequent HIV Testing and Self-Testing Among Men Who Have Sex With Men Who Seek Sexual Partners on the Internet in Zhejiang, China: Cross-Sectional Study %A Chen,Wanjun %A Chen,Lin %A Ni,Zhikan %A He,Lin %A Pan,Xiaohong %+ Department of AIDS and STD Prevention and Control, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang, 310051, China, 86 057187115190, xhpan@cdc.zj.cn %K human immunodeficiency virus %K HIV %K men who have sex with men %K HIV serostatus communication %K HIV testing %K HIV self-testing %D 2024 %7 14.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Men who have sex with men (MSM) are increasingly using the internet to meet casual sexual partners. Those who do are at higher risk of sexually transmitted diseases. However, little is known about the rates and associations of frequent HIV testing and self-testing among such MSM. Objective: We aimed to examine HIV serostatus communication and perceptions regarding the HIV infection risk of internet-based partners, along with their associations with frequent HIV testing and self-testing. Methods: A cross-sectional study was conducted between May 2018 and April 2019 in Zhejiang Province, China. The study participants were assigned male at birth, were aged 18 years or older, had had casual sex with another male found through the internet in the last 6 months, and were HIV-negative. Information was obtained on HIV-testing behavior, along with demographic characteristics, HIV-related knowledge, internet-based behaviors, sexual behaviors with male partners, HIV serostatus communication, and perceptions regarding the HIV infection risk of internet-based partners. Uni- and multivariate logistic regression models were used to measure the associations of HIV testing and self-testing. Results: The study recruited 281 individuals who had sought casual sexual partners through the internet during the previous 6 months. Of the participants, 61.9% (174/281) reported frequent HIV testing (twice or more frequently) and 50.9% (119/234; 47 with missing values) reported frequent HIV self-testing. MSM who always or usually communicated about the HIV serostatus of internet-based partners in the previous 6 months had 3.12 (95% CI 1.76-5.52) and 2.45 (95% CI 1.42-4.22) times higher odds of being frequently tested or self-tested for HIV, respectively, compared with those who communicated about this issue minimally or not at all. Conclusions: There remains a need to improve the frequency of HIV testing and self-testing among internet-based MSM. HIV serostatus communication should be improved within the context of social networking applications to promote frequent HIV testing among internet-based MSM, especially for those who communicated about this issue minimally or not at all. %M 39541583 %R 10.2196/57244 %U https://formative.jmir.org/2024/1/e57244 %U https://doi.org/10.2196/57244 %U http://www.ncbi.nlm.nih.gov/pubmed/39541583 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e64575 %T Transitional Care Support for Medicaid-Insured Patients With Serious Mental Illness: Protocol for a Type I Hybrid Effectiveness-Implementation Stepped-Wedge Cluster Randomized Controlled Trial %A Brooks Carthon,J Margo %A Brom,Heather %A Amenyedor,Kelvin Eyram %A Harhay,Michael O %A Grantham-Murillo,Marsha %A Nikpour,Jacqueline %A Lasater,Karen B %A Golinelli,Daniela %A Cacchione,Pamela Z %A Bettencourt,Amanda P %+ Center for Health Outcomes and Policy Research, School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA, 19104, United States, 1 215 498 8050, jmbrooks@nursing.upenn.edu %K serious mental illness %K health care disparities %K Medicaid %K evidence-based practice %K implementation science %K socioeconomic disparities in health %D 2024 %7 12.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: People diagnosed with a co-occurring serious mental illness (SMI; ie, major depressive disorder, bipolar disorder, or schizophrenia) but hospitalized for a nonpsychiatric condition experience higher rates of readmissions and other adverse outcomes, in part due to poorly coordinated care transitions. Current hospital-to-home transitional care programs lack a focus on the integrated social, medical, and mental health needs of these patients. The Thrive clinical pathway provides transitional care support for patients insured by Medicaid with multiple chronic conditions by focusing on posthospitalization medical concerns and the social determinants of health. This study seeks to evaluate an adapted version of Thrive that also meets the needs of patients with co-occurring SMI discharged from a nonpsychiatric hospitalization. Objective: This study aimed to (1) engage staff and community advisors in participatory implementation processes to adapt the Thrive clinical pathway for all Medicaid-insured patients, including those with SMI; (2) examine utilization outcomes (ie, Thrive referral, readmission, emergency department [ED], primary, and specialty care visits) for Medicaid-insured individuals with and without SMI who receive Thrive compared with usual care; and (3) evaluate the acceptability, appropriateness, feasibility, and cost-benefit of an adapted Thrive clinical pathway that is tailored for Medicaid-insured patients with co-occurring SMI. Methods: This study will use a prospective, type I hybrid effectiveness-implementation, stepped-wedge, cluster randomized controlled trial design. We will randomize the initiation of Thrive referrals at the unit level. Data collection will occur over 24 months. Inclusion criteria for Thrive referral include individuals who (1) are Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) reside in Philadelphia; (3) are admitted for a medical diagnosis for over 24 hours at the study hospital; (4) are planned for discharge to home; (5) agree to receive home care services; and (6) are aged ≥18 years. Primary analyses will use a mixed-effects negative binomial regression model to evaluate readmission and ED utilization, comparing those with and without SMI who receive Thrive to those with and without SMI who receive usual care. Using a convergent parallel mixed methods design, analyses will be conducted simultaneously for the survey and interview data of patients, clinicians, and health care system leaders. The cost of Thrive will be calculated from budget monitoring data for the research budget, the cost of staff time, and average Medicaid facility fee payments. Results: This research project was funded in October 2023. Data collection will occur from April 2024 through December 2025. Results are anticipated to be published in 2025-2027. Conclusions: We anticipate that patients with and without co-occurring SMI will benefit from the adapted Thrive clinical pathway. We also anticipate the adapted version of Thrive to be deemed feasible, acceptable, and appropriate by patients, clinicians, and health system leaders. Trial Registration: ClinicalTrials.gov NCT06203509; https://clinicaltrials.gov/ct2/show/NCT06203509 International Registered Report Identifier (IRRID): DERR1-10.2196/64575 %M 39531274 %R 10.2196/64575 %U https://www.researchprotocols.org/2024/1/e64575 %U https://doi.org/10.2196/64575 %U http://www.ncbi.nlm.nih.gov/pubmed/39531274 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55643 %T Relatives’ and Intensive Care Unit Personnel’s Perspectives of Care in Organ Donation: Protocol for a Multiple Methods Study %A Meyer,Kathe B %A Rohde,Gudrun %A Frivold,Gro %+ Department of Health and Nursing Sciences, University of Agder, Universitetsveien 25, Kristiansand, 4604, Norway, 47 91896844, gro.frivold@uia.no %K organ procurement %K qualitative research %K public health %K patient-reported outcome %K organ donation %K organ care %K perspectives %K donors %K intensive care personnel %K Scandinavia %K donor relatives %K family satisfaction %K descriptive analysis %K comparative analysis %K organ harvesting %D 2024 %7 11.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In organ donation from deceased donors, the interaction between the donor’s relatives and intensive care personnel is an important factor. The organ donation (OD) process is complex, and patients’ relatives play a vital role. Intensive care professionals need knowledge about how relatives perceive and experience the process to create a caring environment and support them throughout. Therefore, this collaborative project aims to explore both relatives’ and intensive care personnel’s perspectives of care in deceased organ donation in Scandinavia. Objective: This study aims to (1) investigate donor relatives’ satisfaction and ICU personnel’s perception of their own professional competence and (2) explore donor relatives’ and ICU personnel’s experiences in the OD process to design for care and support in OD. Methods: This protocol outlines a Scandinavian (Norway, Sweden, and Denmark) project, including 4 work packages. Work package 1 started in 2023 with the translation and validation of the Family Satisfaction in the Intensive Care Unit questionnaire into a Danish version and the translation of the Professional Competence in Organ Donation Questionnaire into a Swedish and Danish version. A cross-sectional survey measuring Scandinavian relatives’ perception of support in and satisfaction with the organ donation process and a cross-sectional survey measuring Scandinavian intensive care personnel’s competence in organ donation are the foundation for work package 2 (2024). The data from both surveys will be analyzed using descriptive and comparative analysis. The results will inform the interview guides in qualitative studies (work packages 3 and 4). Participants in the quantitative study will be invited to participate in in-depth interviews. In work package 3, in-depth interviews will be conducted to illuminate relatives’ experiences in the organ donation process. The interviews will be analyzed using thematic analysis, according to Braun and Clarke. In work package 4 (2025-2026), 1 qualitative design study will be conducted to illuminate ICU personnel’s experiences. Furthermore, the results from work packages 2 and 3 will inform the development of specific programs for care, support, and communication in the organ donation process. Results: The project was funded by the Norwegian Organ Donor Foundation in 2022 and Scandiatransplant in 2023. The Norwegian Nurses Organisation supports the project by funding a PhD student. The PhD student was employed by the University in Agder in May 2024. Conclusions: This project will provide new knowledge that will assist us in designing and establishing programs for care, support, and donor relatives’ involvement in OD processes. International Registered Report Identifier (IRRID): PRR1-10.2196/55643 %M 39527789 %R 10.2196/55643 %U https://www.researchprotocols.org/2024/1/e55643 %U https://doi.org/10.2196/55643 %U http://www.ncbi.nlm.nih.gov/pubmed/39527789 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54792 %T Associations Among Cardiometabolic Risk Factors, Sleep Duration, and Obstructive Sleep Apnea in a Southeastern US Rural Community: Cross-Sectional Analysis From the SLUMBRx-PONS Study %A Knowlden,Adam P %A Winchester,Lee J %A MacDonald,Hayley V %A Geyer,James D %A Higginbotham,John C %+ Department of Health Science, The University of Alabama, Russell Hall 104, Box 870313, Tuscaloosa, AL, 35487, United States, 1 2053481625, apknowlden@ua.edu %K obstructive sleep apnea %K obesity %K adiposity %K cardiometabolic %K cardiometabolic disease %K risk factors %K sleep %K sleep duration %K sleep apnea %K Short Sleep Undermines Cardiometabolic Health-Public Health Observational study %K SLUMBRx study %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Short sleep and obstructive sleep apnea are underrecognized strains on the public health infrastructure. In the United States, over 35% of adults report short sleep and more than 80% of individuals with obstructive sleep apnea remain undiagnosed. The associations between inadequate sleep and cardiometabolic disease risk factors have garnered increased attention. However, challenges persist in modeling sleep-associated cardiometabolic disease risk factors. Objective: This study aimed to report early findings from the Short Sleep Undermines Cardiometabolic Health-Public Health Observational study (SLUMBRx-PONS). Methods: Data for the SLUMBRx-PONS study were collected cross-sectionally and longitudinally from a nonclinical, rural community sample (n=47) in the southeast United States. Measures included 7 consecutive nights of wrist-based actigraphy (eg, mean of 7 consecutive nights of total sleep time [TST7N]), 1 night of sleep apnea home testing (eg, apnea-hypopnea index [AHI]), and a cross-sectional clinical sample of anthropometric (eg, BMI), cardiovascular (eg, blood pressure), and blood-based biomarkers (eg, triglycerides and glucose). Correlational analyses and regression models assessed the relationships between the cardiometabolic disease risk factors and the sleep indices (eg, TST7N and AHI). Linear regression models were constructed to examine associations between significant cardiometabolic indices of TST7N (model 1) and AHI (model 2). Results: Correlational assessment in model 1 identified significant associations between TST7N and AHI (r=–0.45, P=.004), BMI (r=–0.38, P=.02), systolic blood pressure (r=0.40, P=.01), and diastolic blood pressure (r=0.32, P=.049). Pertaining to model 1, composite measures of AHI, BMI, systolic blood pressure, and diastolic blood pressure accounted for 25.1% of the variance in TST7N (R2adjusted=0.25; F2,38=7.37; P=.002). Correlational analyses in model 2 revealed significant relationships between AHI and TST7N (r=–0.45, P<.001), BMI (r=0.71, P<.001), triglycerides (r=0.36, P=.03), and glucose (r=0.34, P=.04). Results from model 2 found that TST7N, triglycerides, and glucose accounted for 37.6% of the variance in the composite measure of AHI and BMI (R2adjusted=0.38; F3,38=8.63; P<.001). Conclusions: Results from the SLUMBRx-PONS study highlight the complex interplay between sleep-associated risk factors for cardiometabolic disease. Early findings underscore the need for further investigations incorporating the collection of clinical, epidemiological, and ambulatory measures to inform public health, health promotion, and health education interventions addressing the cardiometabolic consequences of inadequate sleep. International Registered Report Identifier (IRRID): RR2-10.2196/27139 %M 39514856 %R 10.2196/54792 %U https://formative.jmir.org/2024/1/e54792 %U https://doi.org/10.2196/54792 %U http://www.ncbi.nlm.nih.gov/pubmed/39514856 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49761 %T #TraumaTok—TikTok Videos Relating to Trauma: Content Analysis %A Woolard,Alix %A Paciente,Rigel %A Munro,Emily %A Wickens,Nicole %A Wells,Gabriella %A Ta,Daniel %A Mandzufas,Joelie %A Lombardi,Karen %+ The Kids Research Institute Australia, 15 Hospital Avenue, Nedlands, 6009, Australia, 61 63191823, alix.woolard@thekids.org.au %K trauma %K traumatic events %K traumatic stress %K TikTok %K public health %K social media %K content analysis %D 2024 %7 7.11.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: Experiencing a traumatic event can significantly impact mental and emotional well-being. Social media platforms offer spaces for sharing stories, seeking support, and accessing psychoeducation. TikTok (ByteDance), a rapidly growing social media platform, is increasingly used for advice, validation, and information, although the content of this requires further study. Research is particularly needed to better understand TikTok content relating to trauma and the potential implications for young viewers, considering the distressing nature of the subject and the possibility of users experiencing vicarious trauma through exposure to these videos. Objective: This study aims to explore the content of trauma-related videos on TikTok, focusing on hashtags related to trauma. Specifically, this study analyzes how TikTok videos present information, advice, stories, and support relating to trauma. Methods: A quantitative cross-sectional descriptive content analysis was performed on TikTok in December 2022. A total of 5 hashtags related to trauma were selected: #trauma, #traumatized, #traumatok, #traumatic, and #traumabond, with the top 50 videos from each hashtag analyzed (total N=250 videos). A standardized codebook was developed inductively to analyze the content of the videos, while an existing generic codebook was used to collect the video features (eg, age of people in the video) and metadata (likes, comments, and shares) for each video. Results: A total of 2 major content themes were identified, which were instructional videos (54/250, 21.6%) and videos disclosing personal stories (168/250, 67.3%). The videos garnered significant engagement, with a total of 296.6 million likes, 2.3 million comments, and 4.6 million shares, indicating that users find this content engaging and useful. Alarmingly, only 3.7% (9/250) of videos included a trigger warning, despite many featuring highly distressing stories that young people and those with trauma may be exposed to. Conclusions: The study highlights the potential risks of vicarious trauma due to trauma dumping without trigger warnings on TikTok, and the need for further research to assess the accuracy of advice and information in these videos. However, it also underscores the platform’s potential to foster social connections, provide validation, and reduce stigma around mental health issues. Public health professionals should leverage social media to disseminate accurate mental health information, while promoting user education and content moderation to mitigate potential harms. People often use social media, such as TikTok to share advice, stories, and support around mental health, including their experiences with trauma. Out of 250 videos, most were either giving advice (54/250, 21.6%) or sharing personal experiences (168/250, 67.3%). The study found many videos lacked warnings about upsetting content, which could potentially harm young viewers or people suffering from trauma. While TikTok can help people feel connected and reduce the stigma around mental health, it is important to seek support from professionals when needed. %M 39509697 %R 10.2196/49761 %U https://formative.jmir.org/2024/1/e49761 %U https://doi.org/10.2196/49761 %U http://www.ncbi.nlm.nih.gov/pubmed/39509697 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e60370 %T Interest in the Use of Herbal Supplements to Close the Treatment Gap for Hazardous Alcohol Use Among Men Who Have Sex With Men: Secondary Analysis of a Cross-Sectional Study %A Hernandez,Christopher %A Rowe,Christopher %A Ikeda,Janet %A Arenander,Justine %A Santos,Glenn-Milo %+ David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, 90095, United States, 1 (310) 825 6373, chrishernandezb@berkeley.edu %K alcohol use disorder %K herbal supplements %K HIV %K herbal %K supplement %K alcohol %K alcoholic %K alcohol use %K alcohol consumption %K cross-sectional study %K California %K USA: binge drinking %K alcohol dependence %K men %K social %K clinical %K logistic regression %K drinking %D 2024 %7 29.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Hazardous alcohol consumption is highly prevalent for men who have sex with men (MSM). The 4 treatments currently approved by the Food and Drug Administration for alcohol use are reaching an alarmingly low percentage of people who would benefit from a reduction in their alcohol use. There is increasing interest in alternative methods of treatment, such as herbal supplements, to address hazardous drinking. However, research on the acceptability of alternative pharmacotherapies among MSM remains limited. Objective: We examined the prevalence and correlates of expressing interest in using herbal supplements for alcohol treatment among MSM with hazardous alcohol consumption. Methods: We conducted a secondary data analysis from a cross-sectional study of MSM who use alcohol, conducted from March 2015 to July 2017 in San Francisco, California, to assess the overall prevalence of interest in using herbal supplements to help reduce alcohol consumption. Associations between expressing interest in herbal supplements and demographic, social, and clinical characteristics were examined using bivariate and multivariable logistic regression models. Results: One-third (66/200, 33%) of the participants expressed interest in an herbal supplement for reducing alcohol consumption. In the multivariable analyses, weekly binge drinking (adjusted odds ratio [aOR] 2.85, 95% CI 1.17-6.93), interest in abstaining from alcohol use (aOR 5.04, 95% CI 1.46-17.40), higher severity of alcohol dependence score (aOR 1.22, 95% CI 1.04-1.41), and interest in naltrexone (aOR 3.22, 95% CI 2.12-4.91) were independently associated with higher odds of being interested in using an herbal supplement to reduce alcohol consumption, adjusting for age, race or ethnicity, and education. Conclusions: We found that MSM who have hazardous drinking habits, more severe alcohol dependence, and interest in pharmacotherapy were more likely to express interest in using an herbal supplement for reducing alcohol consumption. To our knowledge, this is the first study that has evaluated correlates of interest in herbal supplements for alcohol use among MSM. As researchers implement novel alcohol treatment studies, they should focus on recruitment efforts among MSM with a motivation to reduce their alcohol use patterns. %M 39471379 %R 10.2196/60370 %U https://formative.jmir.org/2024/1/e60370 %U https://doi.org/10.2196/60370 %U http://www.ncbi.nlm.nih.gov/pubmed/39471379 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58658 %T An Evidence-Based Nurse-Led Intervention to Reduce Diabetes Distress Among Adults With Type 1 Diabetes and Diabetes Distress (REDUCE): Development of a Complex Intervention Using Qualitative Methods Informed by the Medical Research Council Framework %A Stenov,Vibeke %A Cleal,Bryan %A Willaing,Ingrid %A Christensen,Jette Normann %A Jensen,Christian Gaden %A Mouritsen,Julie Drotner %A Due-Christensen,Mette %+ Department of Prevention, Health Promotion and Community Care, Steno Diabetes Center Copenhagen-Copenhagen University Hospital, Borgmester Ib Juels Vej 83, Herlev, 2730, Denmark, 45 24488359, vibeke.stenov@regionh.dk %K diabetes mellitus %K mental health %K diabetes distress %K qualitative research %K co-design study %K complex intervention %K Medical Research Council framework %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes distress refers to the negative emotional reaction to living with the demands of diabetes; it occurs in >40% of adults with type 1 diabetes (T1D). However, no interventions to reduce diabetes distress are specifically designed to be an integral part of diabetes care. Objective: This study aims to modify and adapt existing evidence-based methods into a nurse-led group intervention to reduce diabetes distress among adults with T1D and moderate to severe diabetes distress. Methods: The overall framework of this study was informed by the initial phase of the Medical Research Council’s complex intervention framework that focused on undertaking intervention identification and development to guide the adaptation of the intervention. This study took place at 2 specialized diabetes centers in Denmark from November 2019 to June 2021. A total of 36 adults with T1D participated in 10 parallel workshops. A total of 12 diabetes-specialized nurses were interviewed and participated in 1 cocreation workshop; 12 multidisciplinary specialists, including psychologists, educational specialists, and researchers, participated in 4 cocreation workshops and 14 feedback meetings. Data were analyzed by applying a deductive analytic approach. Results: The intervention included 5 biweekly 2.5-hour small group sessions involving adults with T1D and diabetes distress. Guided by a detailed step-by-step manual, the intervention was delivered by 2 trained diabetes specialist nurses. The intervention material included visual conversation tools covering seven diabetes-specific sources derived from the 28-item Type 1 Diabetes Distress Scale for measuring diabetes distress: (1) powerlessness, (2) self-management, (3) fear of hypoglycemia, (4) food and eating, (5) friends and family, (6) negative social perception, and (7) physician distress. The tools are designed to kick-start awareness and sharing of diabetes-specific challenges and strengths, individual reflections, as well as plenary and peer-to-peer discussions about strategies to manage diabetes distress, providing new perspectives on diabetes worries and strategies to overcome negative emotions. Diabetes specialist nurses expressed a need for a manual with descriptions of methods and detailed guidelines for using the tools. To deliver the intervention, nurses need increased knowledge about diabetes distress, how to support diabetes distress reduction, and training and supervision to improve skills. Conclusions: This co-design study describes the adaptation of a complex intervention with a strong evidence base, including detailed reporting of the theoretical underpinnings and core mechanisms. %M 39239797 %R 10.2196/58658 %U https://formative.jmir.org/2024/1/e58658 %U https://doi.org/10.2196/58658 %U http://www.ncbi.nlm.nih.gov/pubmed/39239797 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64085 %T Understanding Patient Portal Uses and Needs: Cross-Sectional Study in a State Fair Setting %A Rajamani,Sripriya %A Austin,Robin %A Richwine,Chelsea %A Britt-Lalich,Malin %A Thakur,Madhur %A Odowa,Yasmin %A Jantraporn,Ratchada %A Marquard,Jenna %+ University of Minnesota, 6-174 Weaver Densford 308 Harvard St SE, Minneapolis, MN, 55455, United States, 1 651 278 7426, sripriya@umn.edu %K patient portals %K patient engagement %K health information technology %K consumer health informatics %K health informatics %K use %K online access %K medical records %K data access %K functionality %D 2024 %7 11.10.2024 %9 Research Letter %J JMIR Form Res %G English %X This study identified 22 features that are used and the needs for desired features/data in patient portals that enable online access to medical records. Data collected at a Midwestern state fair indicates that while most participants used patient portals, use and desirability of specific features varied widely. Identified needs for enhanced data access, portal functionality, and usability can be used to inform effective patient portal design. %M 39393063 %R 10.2196/64085 %U https://formative.jmir.org/2024/1/e64085 %U https://doi.org/10.2196/64085 %U http://www.ncbi.nlm.nih.gov/pubmed/39393063 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50028 %T Increasing Colorectal Cancer Screening Among Black Men in Virginia: Development of an mHealth Intervention %A Thomson,Maria D %A Shahab,Guleer H %A Cooper-McGill,Chelsey A %A Sheppard,Vanessa B %A Hill,Sherrick S %A Preston,Michael %A Keen II,Larry %+ Department of Social and Behavioral Sciences, Virginia Commonwealth University, 830 E Main Street, Richmond, VA, 23219, United States, 1 8044844910, mthomson2@vcu.edu %K colorectal cancer %K cancer screening %K mHealth %K screening %K Black men %K early detection %K health disparities %K design thinking %D 2024 %7 10.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, colorectal cancer (CRC) is the third leading cause of cancer death among Black men. Compared to men of all other races or ethnicities, Black men have the lowest rates of CRC screening participation, which contributes to later-stage diagnoses and greater mortality. Despite CRC screening being a critical component of early detection and increased survival, few interventions have been tailored for Black men. Objective: This study aims to report on the multistep process used to translate formative research including prior experiences implementing a national CRC education program, community advisory, and preliminary survey results into a culturally tailored mobile health (mHealth) intervention. Methods: A theoretically and empirically informed translational science public health intervention was developed using the Behavioral Design Thinking approach. Data to inform how content should be tailored were collected from the empirical literature and a community advisory board of Black men (n=7) and reinforced by the preliminary results of 98 survey respondents. Results: A community advisory board identified changes for delivery that were private, self-paced, and easily accessible and content that addressed medical mistrust, access delays for referrals and appointments, lack of local information, misinformation, and the role of families. Empirical literature and survey results identified the need for local health clinic involvement as critical to screening uptake, leading to a partnership with local Federally Qualified Health Centers to connect participants directly to clinical care. Men surveyed (n=98) who live or work in the study area were an average of 59 (SD 7.9) years old and held high levels of mistrust of health care institutions. In the last 12 months, 25% (24/98) of them did not see a doctor and 16.3% (16/98) of them did not have a regular doctor. Regarding CRC, 27% (26/98) and 38% (37/98) of them had never had a colonoscopy or blood stool test, respectively. Conclusions: Working with a third-party developer, a prototype mHealth app that is downloadable, optimized for iPhone and Android users, and uses familiar sharing, video, and text messaging modalities was created. Guided by our results, we created 4 short videos (1:30-2 min) including a survivor vignette, animated videos about CRC and the type of screening tests, and a message from a community clinic partner. Men also receive tailored feedback and direct navigation to local Federally Qualified Health Center partners including via school-based family clinics. These content and delivery elements of the mHealth intervention were the direct result of the multipronged, theoretically informed approach to translate an existing but generalized CRC knowledge–based intervention into a digital, self-paced, tailored intervention with links to local community clinics. Trial Registration: ClinicalTrials.gov NCT05980182; https://clinicaltrials.gov/study/NCT05980182 %M 39388688 %R 10.2196/50028 %U https://formative.jmir.org/2024/1/e50028 %U https://doi.org/10.2196/50028 %U http://www.ncbi.nlm.nih.gov/pubmed/39388688 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e60858 %T Effectiveness of 675-nm Wavelength Laser Therapy in the Treatment of Androgenetic Alopecia Among Indian Patients: Clinical Experimental Study %A Chandrashekar,BS %A Lobo,Oliver Clement %A Fusco,Irene %A Madeddu,Francesca %A Zingoni,Tiziano %+ El.En. Group, Via Baldanzese 17, Calenzano, 50041, Italy, 39 3286853105, i.fusco@deka.it %K androgenetic alopecia %K AGA %K 675-nm laser %K Indian patients %K hair restoration %K effectiveness %K laser therapy %K therapy %K treatment %K Indian %K patients %K patient %K India %K hair loss %K hair %K laser stimulation %K hair density %D 2024 %7 23.9.2024 %9 Original Paper %J JMIR Dermatol %G English %X Background: Androgenetic alopecia (AGA) is the most prevalent cause of hair loss around the world. Objective: The purpose of this study was to evaluate the efficacy of laser stimulation with a 675-nm wavelength for the treatment of AGA in male and female Indian patients. Methods: A total of 20 Indian healthy patients aged 23-57 years who presented a grade of alopecia stage I to stage V underwent one single pass with a 675-nm laser to the scalp area twice a week for a total of 8 sessions, followed by once a week for 4 sessions and once in 2 weeks for 2 sessions. There are 14 laser treatments in total. Macro- and dermatoscopic images have been acquired at T0 (baseline) and T1 (4 months). The vertex, frontal, and parietal areas of the scalp were evaluated. Many parameters were analyzed including hair count and hair density of terminal; mean thickness; vellus follicles; total follicular units; units with 1 hair, 2 hairs, 3 hairs, 4 hairs, and >4 hairs; unit density; and average hair/unit. Results: The macroimages and dermatoscopic evaluations showed good improvement over the entire treated area, with a clear increase in the number of hairs and hair thickness. General parameters such as hair count and hair density showed a percentage increase of around 17%. The hair mean thickness parameters showed a significant (P<.001) percentage increase of 13.91%. Similar results were obtained for terminal and vellus hair: terminal hair count and hair density significantly (P=.04 and P=.01, respectively) increased by 17.45%, vellus hair count increased by 16.67% (P=.06), and the density of vellus hair increased by 16.61% (P=.06). Conclusions: The study findings demonstrate that the 675-nm laser system improved AGA in Indian patients, facilitating the anagen phase and improving hair density and other positive hair parameters. %M 39312769 %R 10.2196/60858 %U https://derma.jmir.org/2024/1/e60858 %U https://doi.org/10.2196/60858 %U http://www.ncbi.nlm.nih.gov/pubmed/39312769 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e57384 %T Challenges Experienced by Health Care Workers During Service Delivery in the Geographically Challenging Terrains of North-East India: Study Involving a Thematic Analysis %A Aggarwal,Sumit %A Simmy,Simmy %A Mahajan,Nupur %A Nigam,Kuldeep %+ Indian Council of Medical Research, V Ramalingaswami Bhawan, PO Box No. 4911, Ansari Nagar, New Delhi, 110029, India, 91 8329944688, drsumiticmr@gmail.com %K challenges %K thematic analysis %K infrastructure %K communication %K supply distribution %K resilience %K adaptability %K vaccination awareness %K innovative solutions %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The public health landscape in North-East India is marked by the foundational principle of equitable health care provision, a critical endeavor considering the region’s intricate geography and proximity to international borders. Health care workers grapple with challenges, such as treacherous routes, limited infrastructure, and diverse cultural nuances, when delivering essential medical services. Despite improvements since the National Rural Health Mission in 2005, challenges persist, prompting a study to identify health care workers’ challenges and alternative strategies in Manipur and Nagaland. Objective: This study aims to document the challenges experienced by health care workers during service delivery in the geographically challenging terrains of North-East India. Methods: This study is part of the i-DRONE (Indian Council of Medical Research’s Drone Response and Outreach for North East) project, which aims to assess the feasibility of drone-mediated vaccine and medical delivery. This study addresses the secondary objective of the i-DRONE project. In-depth interviews of 29 health care workers were conducted using semistructured questionnaires in 5 districts (Mokokchung and Tuensang in Nagaland, and Imphal West, Bishnupur, and Churachandpur in Manipur). Nineteen health facilities, including primary health care centers, community health centers, and district hospitals, were selected. The study considered all levels of health care professionals who were in active employment for the past 6 months without a significant vacation and those who were engaged in ground-level implementation, policy, and maintenance activities. Data were recorded, transcribed, and translated, and subsequently, codes, themes, and subthemes were developed using NVivo 14 (QSR International) for thematic analysis. Results: Five themes were generated from the data: (1) general challenges (challenges due to being an international borderline district, human resource constraints, logistical challenges for medical supply, infrastructural issues, and transportation challenges); (2) challenges during the COVID-19 pandemic (increased workload, lack of diagnostic centers, mental health challenges and family issues, routine health care facilities affected, stigma and fear of infection, and vaccine hesitancy and misinformation); (3) perception and awareness regarding COVID-19 vaccination; (4) alternative actions or strategies adopted by health care workers to address the challenges; and (5) suggestions provided by health care workers. Health care workers demonstrated adaptability by overcoming these challenges and provided suggestions for addressing these challenges in the future. Conclusions: Health care workers in Manipur and Nagaland have shown remarkable resilience in the face of numerous challenges exacerbated by the pandemic. Despite infrastructural limitations, communication barriers, and inadequate medical supply distribution in remote areas, they have demonstrated adaptability through innovative solutions like efficient data management, vaccination awareness campaigns, and leveraging technology for improved care delivery. The findings are pertinent for not only health care practitioners and policymakers but also the broader scientific and public health communities. However, the findings may have limited generalizability beyond Manipur and Nagaland. %M 39255009 %R 10.2196/57384 %U https://formative.jmir.org/2024/1/e57384 %U https://doi.org/10.2196/57384 %U http://www.ncbi.nlm.nih.gov/pubmed/39255009 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56402 %T Harnessing Innovative Technologies to Train Nurses in Suicide Safety Planning With Hospital Patients: Formative Acceptability Evaluation of an eLearning Continuing Education Training %A Darnell,Doyanne %A Pierson,Andria %A Tanana,Michael J %A Dorsey,Shannon %A Boudreaux,Edwin D %A Areán,Patricia A %A Comtois,Katherine Anne %+ Department of Psychiatry & Behavioral Sciences, University of Washington, 325 9th Ave, Box 359911, Seattle, WA, 98104, United States, 1 12067449108, darnelld@uw.edu %K suicide prevention %K hospital %K training %K e-learning %K artificial intelligence %K AI %K task-shifting %K quality assessment %K fidelity %K acceptability %K feasibility %K eLearning %K suicide %K quality %K innovative %K nurse %K education training %K safety planning %K pilot study %K virtual patient %K web-based %K role-play %K microcounseling skills %K United States %D 2024 %7 6.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide is the 12th leading cause of death in the United States. Health care provider training is a top research priority identified by the National Action Alliance for Suicide Prevention; however, evidence-based approaches that target skill building are resource intensive and difficult to implement. Novel computer technologies harnessing artificial intelligence are now available, which hold promise for increasing the feasibility of providing trainees opportunities across a range of continuing education contexts to engage in skills practice with constructive feedback on performance. Objective: This pilot study aims to evaluate the feasibility and acceptability of an eLearning training in suicide safety planning among nurses serving patients admitted to a US level 1 trauma center for acute or intensive care. The training included a didactic portion with demonstration, practice of microcounseling skills with a web-based virtual patient (Client Bot Emily), role-play with a patient actor, and automated coding and feedback on general counseling skills based on the role-play via a web-based platform (Lyssn Advisor). Secondarily, we examined learning outcomes of knowledge, confidence, and skills in suicide safety planning descriptively. Methods: Acute and intensive care nurses were recruited between November 1, 2021, and May 31, 2022, to participate in a formative evaluation using pretraining, posttraining, and 6-month follow-up surveys, as well as observation of the nurses’ performance in delivering suicide safety planning via standardized patient role-plays over 6 months and rated using the Safety Plan Intervention Rating Scale. Nurses completed the System Usability Scale after interacting with Client Bot Emily and reviewing general counseling scores based on their role-play via Lyssn Advisor. Results: A total of 18 nurses participated in the study; the majority identified as female (n=17, 94%) and White (n=13, 72%). Of the 17 nurses who started the training, 82% (n=14) completed it. On average, the System Usability Scale score for Client Bot Emily was 70.3 (SD 19.7) and for Lyssn Advisor was 65.4 (SD 16.3). On average, nurses endorsed a good bit of knowledge (mean 3.1, SD 0.5) and confidence (mean 2.9, SD 0.5) after the training. After completing the training, none of the nurses scored above the expert-derived cutoff for proficiency on the Safety Plan Intervention Rating Scale (≥14); however, on average, nurses were above the cutoffs for general counseling skills per Lyssn Advisor (empathy: mean 4.1, SD 0.6; collaboration: mean 3.6, SD 0.7). Conclusions: Findings suggest the completion of the training activities and use of novel technologies within this context are feasible. Technologic modifications may enhance the training acceptability and utility, such as increasing the virtual patient conversational abilities and adding automated coding capability for specific suicide safety planning skills. International Registered Report Identifier (IRRID): RR2-10.2196/33695 %M 39239987 %R 10.2196/56402 %U https://formative.jmir.org/2024/1/e56402 %U https://doi.org/10.2196/56402 %U http://www.ncbi.nlm.nih.gov/pubmed/39239987 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58727 %T Application and Evaluation of a Multimodal Training on the Second Victim Phenomenon at the European Researchers’ Network Working on Second Victims Training School: Mixed Methods Study %A Guerra-Paiva,Sofia %A Mira,José Joaquín %A Strametz,Reinhard %A Fernandes,Joana %A Klemm,Victoria %A Madarasova Geckova,Andrea %A Knezevic,Bojana %A Potura,Eva %A Buttigieg,Sandra %A Carrillo,Irene %A Sousa,Paulo %+ NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, NOVA University Lisbon, Avenida Padre Cruz, Lisbon, 1600-560, Portugal, 351 961908960, sg.paiva@ensp.unl.pt %K patient safety %K second victim %K training %K education %K healthcare %D 2024 %7 30.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care workers (HCWs) are often impacted by distressing situations during patient care and can experience the second victim phenomenon (SVP). Addressing an adequate response, training, and increasing awareness of the SVP can increase HCWs’ well-being and ultimately improve the quality of care and patient safety. Objective: This study aims to describe and evaluate a multimodal training organized by the European Researchers’ Network Working on Second Victims to increase knowledge and overall awareness of SVP and second victim programs. Methods: We implemented a multimodal training program, following an iterative approach based on a continuous quality improvement process, to enhance the methodology and materials of the training program over the duration of 2 years. We conducted web-based surveys and group interviews to evaluate the scope and design of the training, self-directed learning materials, and face-to-face activities. Results: Out of 42 accepted candidates, 38 (90%) participants attended the 2 editions of the Training School program. In the second edition, the level of participants’ satisfaction increased, particularly when adjusting the allocated time for the case studies’ discussion (P<.001). After the multimodal training, participants stated that they had a better awareness and understanding of the SVP, support interventions, and its impact on health care. The main strengths of this Training School were the interdisciplinary approach as well as the contact with multiple cultures, the diversity of learning materials, and the commitment of the trainers and organizing team. Conclusions: This multimodal training is suitable for different stakeholders of the health care community, including HCWs, clinical managers, patient safety and quality-of-care teams, academicians, researchers, and postgraduate students, regardless of their prior experience with SVP. Furthermore, this study represents a pioneering effort in elucidating the materials and methodology essential for extending this training approach to similar contexts. %R 10.2196/58727 %U https://formative.jmir.org/2024/1/e58727 %U https://doi.org/10.2196/58727 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58330 %T Current Status of Outcomes Reported by Patients With Stroke and an Analysis of Influencing Factors: Cross-Sectional Questionnaire Study %A Sun,Jia %A Ma,Liang %A Miao,Xiao %A Sun,Hui %A Zhu,SuSu %A Zhang,Ran %A Fan,LeLe %A Hu,TingTing %+ Nursing Department, The Affiliated Lianyungang Hospital of Xuzhou Medical University, No.6 Zhenhua East Road, Haizhou District, Lianyungang, 222061, China, 86 18961322211, 18961322211@189.cn %K stroke %K patient-reported outcomes %K blood lipids %K influence factor %K correlation analysis %K nursing care %D 2024 %7 26.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Stroke is the leading cause of acquired disability and the second leading cause of death worldwide. Its rate of incidence, disability, mortality, and recurrence is high, and the patients experience various symptoms of discomfort, which not only affect their rehabilitation function but also reduce their ability to perform daily activities and their quality of life. Nowadays, with the improvement of China’s medical standards, patients are increasingly attentive to their quality of life and health status. However, diagnostic techniques and effective treatments for patients with stroke are still limited but urgently required. Objective: This study aimed to evaluate the quality of life during hospitalization using a stroke patient-reported outcomes (PROs) scale and additionally to recognize potential factors and risk indicators that may impact recurrent events, facilitating early intervention measures. Methods: This is a registry-based, retrospective observational cross-sectional study on patients with stroke. A convenient sampling method was used to select various indicators of patients. The Stroke-PRO scale was then used to assess patients’ conditions across physical, psychological, social, and therapeutic domains. Multiple linear regression analysis was applied to identify factors influencing stroke PROs, while correlation analysis was conducted to explore the relationship between these outcomes and blood lipid levels. Results: The mean Stroke-PRO score in this study was 4.09 (SD 0.29) points. By multiple linear regression analysis, residence, occupation, physical exercise, Barthel index, Braden scale, National Institutes of Health Stroke Scale scores at admission, and stroke type were the risk factors for reported outcomes of patients with stroke (P<.05). Correlation analysis showed that serum triglyceride, total cholesterol, and low-density lipoprotein were negatively correlated with Stroke-PRO scores in patients with stroke (P<.05), while high-density lipoprotein was positively correlated with patients with stroke (P<.05). The 95% CI was –0.31 to –0.03 for triglyceride, 0.17-0.44 for high-density lipoprotein, –0.29 to –0.01 for cholesterol, –0.30 to –0.02 for low-density lipoprotein, and –0.12 to 0.16 for blood glucose. Conclusions: Patients with stroke have a low level of health, and their reported outcomes need to be improved. Accordingly, nursing staff should pay attention to the quality of life and blood lipid indexes of patients with stroke, actively assess their actual health status, and take early intervention measures to promote their recovery. %M 39186763 %R 10.2196/58330 %U https://formative.jmir.org/2024/1/e58330 %U https://doi.org/10.2196/58330 %U http://www.ncbi.nlm.nih.gov/pubmed/39186763 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56197 %T Exploring New Models for Implementing Sustainable Integrated Health Access for People in Vulnerable Positions: Protocol for a Mixed Methods Multiple Case Study %A Mejsner,Sofie Buch %A Aslaug,Jane %A Bech,Mickael %A Burau,Viola %A Mark,Dorte %A Vixø,Kathrine %A Westergaard,Caroline Louise %A Fehsenfeld,Michael %+ Department of Public Health, Aarhus University, Bartholins alle 2, Aarhus, 8000, Denmark, 45 8715 0000, sbm@ph.au.dk %K health care organization %K social inequality in health %K vulnerable people %K integrated health access %K healthcare access %K accessibility %K healthcare %K Europe %K social inequalities %K health inequalities %K mental illness %K inequality %K Denmark %D 2024 %7 23.8.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care is a strongly universal right across European welfare states; however, social inequalities in health persist. This literature argues that health care organization is an important but overlooked determinant of social inequalities in health, as health systems buffer or amplify structural and individual health determinants. The Client-Centered Coordination Platform (3CP) model offers integrated health access to people with severe mental illness, through core groups of professionals from across health and social services. Objective: This study focuses on vulnerable people with severe mental health problems and aims to analyze how the model can give people with severe mental illness more integrated access to health and social care. This can form a stepping-stone for the upscaling of the 3CP model. Methods: We conduct a 5-year multiple case study of 3 municipalities in Denmark, where 3CP is being implemented. In a 1-year pilot study, we expect to gather quantitative registry data from the municipalities and the Central Denmark Region to explore the characteristics of people included in 3CP. We will also collect qualitative data, including 21 hours of observations; 36 interviews with users, professionals, and managers; and 3 focus groups across the 3 municipalities. In a subsequent, 4-year qualitative study, we aim to conduct 120 hours of observations, 120 interviews, and 24 focus groups. In parallel with the qualitative study, we will facilitate a cocreation process to develop tools for sustaining integrated health access. Results: As of January 2024, we have completed the individual interviews with users of 3CP and professionals and the focus groups. Individual interviews of managers will be conducted during the 1st quarter of 2024. The quantitative data are being collected. Conclusions: Inequality is one of the greatest challenges that European societies face. Understanding new and innovative approaches to integrated care may provide valuable solutions to the challenges posed. Especially understanding and designing health and social care systems that meet the needs and abilities of those users requiring them most, is vitally important to tackle inequality. International Registered Report Identifier (IRRID): DERR1-10.2196/56197 %M 39178409 %R 10.2196/56197 %U https://www.researchprotocols.org/2024/1/e56197 %U https://doi.org/10.2196/56197 %U http://www.ncbi.nlm.nih.gov/pubmed/39178409 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55339 %T Behavioral Intervention for Adults With Autism on Distribution of Attention in Triadic Conversations: A/B-Tested Pre-Post Study %A Tepencelik,Onur Necip %A Wei,Wenchuan %A Luo,Mirabel %A Cosman,Pamela %A Dey,Sujit %+ Electrical and Computer Engineering, University of California San Diego, UC San Diego, 9500 Gilman Dr, La Jolla, CA, 92093, United States, 1 (858) 534 2230, otepence@ucsd.edu %K autism spectrum condition %K social attention %K social orienting %K behavioral intervention %K attention distribution %K triadic conversation %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Cross-neurotype differences in social communication patterns contribute to high unemployment rates among adults with autism. Adults with autism can be unsuccessful in job searches or terminated from employment due to mismatches between their social attention behaviors and society’s expectations on workplace communication. Objective: We propose a behavioral intervention concerning distribution of attention in triadic (three-way) conversations. Specifically, the objective is to determine whether providing personalized feedback to each individual with autism based on an analysis of their attention distribution behavior during an initial conversation session would cause them to modify their orientation behavior in a subsequent conversation session. Methods: Our system uses an unobtrusive head orientation estimation model to track the focus of attention of each individual. Head orientation sequences from a conversation session are analyzed based on five statistical domains (eg, maximum exclusion duration and average contact duration) representing different types of attention distribution behavior. An intervention is provided to a participant if they exceeded the nonautistic average for that behavior by at least 2 SDs. The intervention uses data analysis and video modeling along with a constructive discussion about the targeted behaviors. Twenty-four individuals with autism with no intellectual disabilities participated in the study. The participants were divided into test and control groups of 12 participants each. Results: Based on their attention distribution behavior in the initial conversation session, 11 of the 12 participants in the test group received an intervention in at least one domain. Of the 11 participants who received the intervention, 10 showed improvement in at least one domain on which they received feedback. Independent t tests for larger test groups (df>15) confirmed that the group improvements are statistically significant compared with the corresponding controls (P<.05). Crawford-Howell t tests confirmed that 78% of the interventions resulted in significant improvements when compared individually against corresponding controls (P<.05). Additional t tests comparing the first conversation sessions of the test and control groups and comparing the first and second conversation sessions of the control group resulted in nonsignificant differences, pointing to the intervention being the main effect behind the behavioral changes displayed by the test group, as opposed to confounding effects or group differences. Conclusions: Our proposed behavioral intervention offers a useful framework for practicing social attention behavior in multiparty conversations that are common in social and professional settings. %M 39133914 %R 10.2196/55339 %U https://formative.jmir.org/2024/1/e55339 %U https://doi.org/10.2196/55339 %U http://www.ncbi.nlm.nih.gov/pubmed/39133914 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52533 %T Preuniversity Students' Perceptions and Attitudes About an Anatomy and Physiology Outreach Program: Survey Study and Inductive Thematic Analysis %A Vallabhajosyula,Ranganath %A Perumal,Vivek %A Chandrasekaran,Ramya %A Mogali,Sreenivasulu Reddy %+ Department of Anatomy, Lee Kong Chian School of Medicine, Nanyang Technological University, 11, Mandalay Road, Singapore, 308232, Singapore, 65 94455527, sreenivasulu.reddy@ntu.edu.sg %K anatomy %K physiology %K educational outreach %K preuniversity outreach %K team-based learning %K anatomy workshop %K medical education %K health profession education %K health professions %K health care careers %K student %K students %K outreach activity %K physiological %K school %K university %K Singapore %K thematic analysis %K learning %K education %K motivation %K health care %K health profession %K medical school %D 2024 %7 12.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Science and health outreach activities are aimed at motivating and sparking interest among prospective students to pursue careers in these fields; however, research studies supporting this hypothesis are limited. Objective: The aim of our study was to organize an integrated Anatomy and Physiology outreach to examine preuniversity students’ learning experiences (learning tools, activities, and facilitators) and motivation to pursue a career in health care and to gather evidence on their attitudes and perceptions of such activities. Methods: A 2-day course on cardiorespiratory and gastrointestinal anatomical systems was presented at the Lee Kong Chian School of Medicine in Singapore using its key pedagogies, that is, multimodal practical and team-based learning. Ninety preuniversity students from 21 preuniversity institutions in Singapore participated in this 2-day course, and their experiences were evaluated using a 4-point Likert scale and open-ended survey questions. Free-text comments were analyzed using inductive thematic analysis. Results: The survey using the 4-point Likert scale was completed by 81 (92%) of the 88 participants. Most students felt that the course materials were adequate (mean 3.57, SD 0.57) and met the learning objectives (mean 3.73, SD 0.52). The students felt that the instructors were clear (mean 3.73, SD 0.52) and effective (mean 3.70, SD 0.53). They liked the organization of the outreach session (mean 3.64, SD 0.48) and were highly motivated to study medicine or allied/biomedical sciences (mean 3.69, SD 0.54). Practical and team-based learning were regarded as exceedingly satisfactory (mean 3.63, SD 0.53 and mean 3.58, SD 0.54, respectively). All the respondents said that they would recommend this course to peers. Thematic analysis revealed that the participants gained a new perspective of the human body structure and function, they liked the unique learning settings, they were motivated to pursue a career in health care, they were satisfied with the sessions, and interactions with the facilitators increased their understanding of the human anatomy and physiology. Conclusions: Structured health outreach activities provide students with unique opportunities to experience a preclinical learning environment in a medical school, deepen their understanding of human body structure and function, and increase their motivation and interest in science. Further, outreach programs may lay the foundations for potential students aiming to pursue health profession education. %M 39133908 %R 10.2196/52533 %U https://formative.jmir.org/2024/1/e52533 %U https://doi.org/10.2196/52533 %U http://www.ncbi.nlm.nih.gov/pubmed/39133908 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55577 %T Benchmarking Large Language Models for Cervical Spondylosis %A Zhang,Boyan %A Du,Yueqi %A Duan,Wanru %A Chen,Zan %+ Xuanwu Hospital, Capital Medical University, 45 Changchun Street, Beijing, 100000, China, 86 13911712120, chenzan66@163.com %K cervical spondylosis %K large language model %K LLM %K patient %K ChatGPT %D 2024 %7 5.8.2024 %9 Research Letter %J JMIR Form Res %G English %X Cervical spondylosis is the most common degenerative spinal disorder in modern societies. Patients require a great deal of medical knowledge, and large language models (LLMs) offer patients a novel and convenient tool for accessing medical advice. In this study, we collected the most frequently asked questions by patients with cervical spondylosis in clinical work and internet consultations. The accuracy of the answers provided by LLMs was evaluated and graded by 3 experienced spinal surgeons. Comparative analysis of responses showed that all LLMs could provide satisfactory results, and that among them, GPT-4 had the highest accuracy rate. Variation across each section in all LLMs revealed their ability boundaries and the development direction of artificial intelligence. %M 39102674 %R 10.2196/55577 %U https://formative.jmir.org/2024/1/e55577 %U https://doi.org/10.2196/55577 %U http://www.ncbi.nlm.nih.gov/pubmed/39102674 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55408 %T Assessing the Impact of the Mindfulness-Based Body Scan Technique on Sleep Quality in Multiple Sclerosis Using Objective and Subjective Assessment Tools: Single-Case Study %A Iliakis,Ioannis %A Anagnostouli,Maria %A Chrousos,George %+ Medical School, University of Athens, National and Kapodistrian University of Athens, Omiriou 22, Athens, 16122, Greece, 30 6948531978, kiko_sympa@hotmail.com %K multiple sclerosis %K MS %K sleep problems %K electronic portable device %K EPD %K mindfulness-based body scan technique %K sleep quality %K neurodegenerative disease %K quality of life %K anxiety %K pain %K nocturia %K assessment tools %K single-case study %K effectiveness %D 2024 %7 25.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Multiple sclerosis (MS) is a chronic inflammatory disease affecting the central nervous system, often leading to poor sleep quality and diminished quality of life (QoL) for affected patients. Sleep disturbances in MS do not always correlate linearly with other symptoms such as anxiety, depression, fatigue, or pain. Various approaches, including stress reduction techniques such as mindfulness-based interventions, have been proposed to manage MS-related sleep issues. Objective: The aim of this study was to evaluate the effects of the mindfulness-based body scan technique on sleep quality and QoL in patients with MS using both subjective (questionnaires) and objective (electronic portable device) measures. Methods: A single-case study was performed involving a 31-year-old woman diagnosed with relapsing-remitting MS. The patient practiced the mindfulness-based body scan technique daily before bedtime and outcomes were compared to measures evaluated at baseline. Results: The mindfulness-based body scan intervention demonstrated positive effects on both sleep quality and overall QoL. Biometric data revealed a notable dissociation between daily stress levels and sleep quality during the intervention period. Although self-report instruments indicated significant improvement, potential biases were noted. Conclusions: While this study is limited to a single patient, the promising outcomes suggest the need for further investigation on a larger scale. These findings underscore the potential benefits of the mindfulness-based body scan technique in managing sleep disturbances and enhancing QoL among patients with MS. %M 39052996 %R 10.2196/55408 %U https://formative.jmir.org/2024/1/e55408 %U https://doi.org/10.2196/55408 %U http://www.ncbi.nlm.nih.gov/pubmed/39052996 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55797 %T Japanese Perception of Organ Donation and Implications for New Medical Technologies: Quantitative and Qualitative Social Media Analyses %A Vargas Meza,Xanat %A Oikawa,Masanori %+ Institute for the Advanced Study of Human Biology, Kyoto University, Yoshida-Konoe-cho, Sakyo-ku, Japan Faculty of Medicine Bldg.B, Kyoto, 606-8501, Japan, 81 0757539882, vargasmeza.xanat.8z@kyoto-u.ac.jp %K Japan %K organ donation %K social media %K multidimensional analysis %K Twitter/X %K YouTube %D 2024 %7 19.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The Rapid Autopsy Program (RAP) is a valuable procedure for studying human biology and diseases such as cancer. However, implementing the RAP in Japan necessitates a thorough understanding of concepts such as good death and the integration of sociocultural aspects. By revising perceptions of organ donation on social media, we bring attention to the challenges associated with implementing new medical research procedures such as the RAP. Objective: This study aims to examine YouTube and Twitter/X to identify stakeholders, evaluate the quality of organ donation communication, and analyze sociocultural aspects associated with organ donation. Based on our findings, we propose recommendations for the implementation of new medical research procedures. Methods: Using the term “臓器提供” (organ donation), we collected data from YouTube and Twitter/X, categorizing them into 5 dimensions: time, individuality, place, activity, and relationships. We utilized a scale to evaluate the quality of organ donation information and categorized YouTube videos into 3 groups to analyze their differences using statistical methods. Additionally, we conducted a text-based analysis to explore narratives associated with organ donation. Results: Most YouTube videos were uploaded in 2021 (189/638, 29.6%) and 2022 (165/638, 25.9%), while tweets about organ donation peaked between 2019 and 2022. Citizens (184/770, 23.9%), media (170/770, 22.0%), and unknown actors (121/770, 15.7%) were the primary uploaders of videos on organ donation. In a sample of average retweeted and liked tweets, citizens accounted for the majority of identified users (64/91, 70%, and 65/95, 68%, respectively). Regarding Japanese regions, there were numerous information videos about organ donation in Hokkaido (F2.46,147.74=–5.28, P=.005) and Kyushu and Okinawa (F2.46,147.74=–5.28, P=.005). On Twitter/X, Japan and China were the most frequently mentioned countries in relation to organ donation discussions. Information videos often focused on themes such as borrowed life and calls to register as donors, whereas videos categorized as no information and misinformation frequently included accusations of organ trafficking, often propagated by Chinese-American media. Tweets primarily centered around statements of donation intention and discussions about family consent. The majority of video hyperlinks directed users to YouTube and Twitter/X platforms, while Twitter/X hyperlinks predominantly led to news reports from Japanese media outlets. Conclusions: There is significant potential to implement new medical research procedures such as the RAP in Japan. Recommendations include conceptualizing research data as borrowed data, implementing horizontally diversified management of donation programs, and addressing issues related to science misinformation and popular culture trends. %M 39028549 %R 10.2196/55797 %U https://formative.jmir.org/2024/1/e55797 %U https://doi.org/10.2196/55797 %U http://www.ncbi.nlm.nih.gov/pubmed/39028549 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48434 %T The Impact of COVID-19 Health Measures on Adults With Multiple Chemical Sensitivity: Cross-Sectional Study %A Bray,Riina %A Wang,Yifan %A Argiropoulos,Nikolas %A Robins,Stephanie %A Molot,John %A Pigeon,Marie-Andrée %A Gaudet,Michel %A Auger,Pierre %A Bélanger,Emilie %A Peris,Rohini %+ Association pour la santé environnementale du Québec - Environmental Health Association of Québec, 1065 Montée Saint-Elmire, Saint Sauveur, QC, J0R 1R1, Canada, 1 5147955701, rohiniperis@aseq-ehaq.ca %K COVID-19 %K multiple chemical sensitivity %K Canada %K accessibility %K social isolation %K physical environment %K health care %K air pollution %K pollution %K air quality %K isolation %K social network %K social interaction %K lived experience %K sensitivity %K environment %K environmental %D 2024 %7 17.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Multiple chemical sensitivity (MCS) develops in response to repeated small-level chemical exposures or a major exposure in a subset of people, who then experience symptoms that can range from mild to debilitating when exposed to chemicals. The arrival of the COVID-19 pandemic and the stringent health measures put in place may have increased the burden for those living with MCS, as it became more challenging to avoid chemicals that trigger their condition. Objective: This study aimed to better understand the lived experience of Canadians living with MCS during the first year of the COVID-19 pandemic. Methods: An online questionnaire was created to ask participants to compare daily living during the pandemic to before March 11, 2020. Data were collected in January and February 2021. Three areas were investigated: (1) environmental exposures to chemical triggers from ambient air (pollution from industry, farming, and traffic) and indoor air (the smell of cleaning products, cooking odors, and smoke); (2) access to, and satisfaction with, health care visits; and (3) how people experiencing MCS rated contact with their social network. Results: In all, 119 Canadians who had lived with MCS for more than a year completed the questionnaire. The participant sample was mostly female (86.6%, n=103) and highly educated, with 57.1% (n=68) having a university degree. Slightly more than half (57.1%, n=68) were older than 55 years. McNemar chi-square and Wilcoxon signed rank tests were used to evaluate if there were statistically significant changes before (“prepandemic period”) and after (“postpandemic period”) March 11, 2020. Perceived exposure to pollution from a highway or a road was significantly decreased from the prepandemic to postpandemic period (z=–3.347; P<.001). Analysis of industry or power plants also suggested a significant decrease in the perceived exposure from the prepandemic to postpandemic period (z=–2.152; P=.04). Participants reported an increase in exposure to odors from disinfectants or sanitizers that entered their living environment (P<.001). There was a significant decrease between prepandemic and postpandemic levels of satisfaction when attending in-person meetings with a physician (z=–2.048; P=.04), yet there were no significant differences between prepandemic and postpandemic levels of satisfaction for online or telephone meetings with a physician. Although people with MCS experienced increased social isolation (P<.001), they also reported an increase in understanding from family (P=.03) and a decrease in stigma for wearing personal protective equipment (P<.001). Conclusions: During the first year of the COVID-19 pandemic, people with MCS were impacted by inaccessibility, loss of social support, and barriers to accessing health care. This study highlights unique challenges and possible benefits associated with the COVID-19 pandemic public health measures for individuals living with MCS. These findings can guide decision makers to improve policies on accessibility through appropriate accommodation measures. %M 39018551 %R 10.2196/48434 %U https://formative.jmir.org/2024/1/e48434 %U https://doi.org/10.2196/48434 %U http://www.ncbi.nlm.nih.gov/pubmed/39018551 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56716 %T Patient and Provider Satisfaction With a Geomapping Tool for Finding Community Family Physicians in Ontario, Canada: Cross-Sectional Online Survey Study %A Belanger,Christopher %A Peixoto,Cayden %A Francoeur,Sara %A Bjerre,Lise M %+ Institut du Savoir Montfort, 713 Montréal Rd, Ottawa, ON, K1K 0T2, Canada, 1 613 746 4621, lbjerre@uottawa.ca %K primary care %K language-concordant care %K web-based maps %K maps %K physicians %K experience %K language %K access %K accessibility %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Language-concordant health care, or health care in a patient’s language of choice, is an important element of health accessibility that improves patient safety and comfort and facilitates an increased quality of care. However, prior research has found that linguistic minorities often face higher travel burdens to access language-concordant care compared to the general population. Objective: This study intended to assess patient experiences and satisfaction with an online interactive physician map that allows patients to find family physicians who speak their preferred language in and around Ottawa, Ontario, Canada, as a means of identifying areas of improvement. Methods: This study used an online survey with questions related to user satisfaction. Responses to Likert-scale questions were compiled as summary statistics and short-answer responses underwent thematic analysis. The study setting was Ottawa and Renfrew County, Ontario, and the surrounding region, including the province of Quebec. Results: A total of 93 respondents completed the survey and self-identified as living in Ontario or Quebec. Overall, 57 (61%) respondents were “very satisfied” or “somewhat satisfied” with the map, 16 (17%) were “neither satisfied nor dissatisfied,” and 20 (22%) were “very dissatisfied” or “somewhat dissatisfied.” We found no significant differences in satisfaction by preferred language, age group, physician attachment, or intended beneficiary. A total of 56 respondents provided short-answer responses to an open-ended question about map improvements. The most common specific suggestion was to show which physicians are accepting new patients (n=20). Other suggestions included data refreshes (n=6), user interface adjustments (n=23), and additional languages (n=2). Some participants also provided positive feedback (n=5) or expressed concern with their inability to find a family physician (n=5). Several comments included multiple suggestions. Conclusions: While most patients were satisfied with the online map, a significant minority expressed dissatisfaction that the map did not show which family physicians were accepting new patients. This suggests that there may be public interest in an accessible database of which family physicians in Ontario are currently accepting new patients. %M 38980717 %R 10.2196/56716 %U https://formative.jmir.org/2024/1/e56716 %U https://doi.org/10.2196/56716 %U http://www.ncbi.nlm.nih.gov/pubmed/38980717 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e46570 %T Biochemical Changes in Adult Male Gamers During Prolonged Gaming: Pilot Study %A Krarup,Kasper Bygum %A Riis,Johannes %A Mørk,Morten %A Nguyen,Hien Thi Thu %A Søkilde Pedersen,Inge %A Risom Kristensen,Søren %A Handberg,Aase %A Krarup,Henrik Bygum %+ Department of Geriatrics, Aalborg University Hospital, Reberbansgade 15, Aalborg, 9000, Denmark, 45 61781289, kasper.krarup@rn.dk %K long gaming sessions %K local area network party %K biochemistry %K cortisol %K glucose %K gaming %K biochemical %K blood sample %K hematology %K hematological %K games %K gamers %K hemoglobin %K adults %K males %K men %K blood %D 2024 %7 8.7.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Gaming has become an integrated part of life for children and adults worldwide. Previous studies on the impact of gaming on biochemical parameters have primarily addressed the acute effects of gaming. The literature is limited, and the study designs are very diverse. The parameters that have been investigated most thoroughly are blood glucose and cortisol. Objective: This exploratory study is the first to investigate the effects of long gaming sessions on the biochemical parameters of healthy male adults. The extensive testing allowed us to observe short-term changes (within 6 hours), long-term changes during the duration of the gaming sessions, and follow-up after 1 week to determine whether any changes were longer lasting. Methods: In total, 9 experienced gamers completed 2 back-to-back 18-hour gaming sessions interspersed with a 6-hour rest period. All participants adhered to a structured sleep pattern due to daytime employment or attending university. Blood, saliva, and urine samples were collected from the participants every 6 hours. Linear mixed-effect models were used to analyze the repeated-measures data accumulated during the study. A total of 51 biochemical parameters were investigated. Results: In total, 12 of the 51 biochemical parameters significantly changed during the study: alkaline phosphatase, aspartate aminotransferase, bilirubin, chloride, creatinine, glucose, hemoglobin, immature reticulocyte fraction, lactate, methemoglobin, sodium, and thrombocytes. All changes were within the normal range. The mean glucose level of the participants was 4.39 (SD 0.07) mmol/L at baseline, which increased significantly by 0.24 (SD 0.07) mmol/L per 6 hours during the first period and by 0.38 (SD 0.07) mmol/L per 6 hours in the second period (P<.001). The glucose levels during the second session increased even though the participants had little energy intake. Cortisol levels did not change significantly, although the cortisol pattern deviated from the typical circadian rhythm. During both gaming sessions, we observed increasing cortisol levels from 6 AM until noon. The participants were relatively dehydrated at the start of the study. The patients were asked to fast before the first blood sampling. Within the first 6 hours of the study, the participants rehydrated, followed by relative dehydration during the remainder of the study. This pattern was identified using the following parameters: albumin, creatinine, hemoglobin, erythrocytes, potassium, and platelets. Conclusions: This study is the first of its kind, and many of the analyses in the study yielded novel results. The study was designed to emulate the behavior of gamers during the weekend and other long gaming sessions. At this point, we are not able to determine the difference between the effects of gaming and behavior during gaming. Regardless, the results of this study suggest that healthy gamers can partake in long gaming sessions, with ample amounts of unhealthy foods and little rest, without acute impacts on health. %M 38976326 %R 10.2196/46570 %U https://www.i-jmr.org/2024/1/e46570 %U https://doi.org/10.2196/46570 %U http://www.ncbi.nlm.nih.gov/pubmed/38976326 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52779 %T Body Composition and Energy Expenditure in Youth With Spina Bifida: Protocol for a Multisite, Cross-Sectional Study %A Polfuss,Michele %A Smith,Kathryn %A Hopson,Betsy %A Moosreiner,Andrea %A Huang,Chiang-Ching %A Ravelli,Michele N %A Ding,Dan %A Huang,Zijian %A Rocque,Brandon G %A White-Traut,Rosemary %A Van Speybroeck,Alexander %A Sawin,Kathleen J %+ School of Nursing, College of Health Professions and Sciences, University of Wisconsin - Milwaukee, 1921 E Hartford Avenue, Milwaukee, WI, 53211, United States, 1 414 229 2609, mpolfuss@uwm.edu %K obesity %K overweight %K body composition %K energy expenditure %K doubly labeled water %K spina bifida %K children %K adolescents %K wearable device %D 2024 %7 2.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Obesity prevalence in youth with spina bifida is higher than in their typically developing peers. Obesity is associated with lifelong medical, psychological, and economic burdens. Successful prevention or treatment of obesity in individuals with spina bifida is compromised by (1) the lack of valid and reliable methods to identify body fat in a clinical setting and (2) limited data on energy expenditure that are necessary to provide daily caloric recommendations. Objective: The objectives of this study will be to develop 2 algorithms for use in youth with spina bifida in a clinical setting, one to model body fat and one to predict total daily energy expenditure. In addition, physical activity and dietary intake will be described for the sample. Methods: This multisite, prospective, national clinical study will enroll 232 youth with myelomeningocele aged 5 to 18 years (stratified by age and mobility). Participants will be enrolled for 1 week. Data obtained include 4 measures of body composition, up to 5 height measures, a ramped activity protocol, and a nutrition and physical activity screener. Participants will wear an accelerometer for the week. On the final study day, 2 samples of urine or saliva, which complete the doubly labeled water protocol, will be obtained. The analysis will include descriptive statistics, Bland-Altman plots, concordance correlation, and regression analysis. Results: The study received extramural federal funding in July 2019. Data collection was initiated in March 2020. As of April 2024, a total of 143 (female participants: n=76, 53.1%; male participants: n=67, 46.9%) out of 232 participants have been enrolled. Data collection is expected to continue throughout 2024. A no-cost extension until November 2025 will be requested for data analysis and dissemination of findings. Conclusions: This study furthers previous pilot work that confirmed the acceptability and feasibility of obtaining alternate height, body composition, and energy expenditure measures. The findings from this study will enhance screening, prevention, and treatment of abnormal weight status by facilitating the accurate identification of youths’ weight status category and recommendations of daily caloric needs for this population that is at higher risk of obesity. Furthermore, the findings have the potential to impact outcomes for youth diagnosed with disabilities other than spina bifida who experience similar challenges related to alterations in body composition or fat distribution or measurement challenges secondary to mobility issues or musculoskeletal problems. International Registered Report Identifier (IRRID): DERR1-10.2196/52779 %M 38954458 %R 10.2196/52779 %U https://www.researchprotocols.org/2024/1/e52779 %U https://doi.org/10.2196/52779 %U http://www.ncbi.nlm.nih.gov/pubmed/38954458 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e13642 %T Assessment of the Feasibility of Objective Parameters as Primary End Points for Patients Affected by Knee Osteoarthritis: Protocol for a Pilot, Open Noncontrolled Trial (:SMILE:) %A Dogaru,Dumitru Emanuel %A Rosu,Serban %A Barattini,Dionisio Franco %A Guadagna,Simone %A Barattini,Luca %A Andor,Bogdan %+ Department of Orthopaedics - Traumatology, Victor Babeş University of Medicine and Pharmacy, St Piața Eftimie Murgu 2, Timisoara, 300041, Romania, 40 0724345115, de.dogaru@gmail.com %K pilot trial %K feasibility study %K knee osteoarthritis %K hyaluronic acid %K outcome assessment %K osteoarthritis %K ultrasonography %K knee %K pain %D 2024 %7 28.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Osteoarthritis (OA) is a disabling condition that affects more than one-third of people older than 65 years. Currently, 80% of these patients report movement limitations, 20% are unable to perform major activities of daily living, and approximately 11% require personal care. In 2014, the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) recommended, as the first step in the pharmacological treatment of knee osteoarthritis, a background therapy with chronic symptomatic slow-acting osteoarthritic drugs such as glucosamine sulfate, chondroitin sulfate, and hyaluronic acid. The latter has been extensively evaluated in clinical trials as intra-articular and oral administration. Recent reviews have shown that studies on oral hyaluronic acid generally measure symptoms using only subjective parameters, such as visual analog scales or quality of life questionnaires. As a result, objective measures are lacking, and data validity is generally impaired. Objective: The main goal of this pilot study with oral hyaluronic acid is to evaluate the feasibility of using objective tools as outcomes to evaluate improvements in knee mobility. We propose ultrasound and range of motion measurements with a goniometer that could objectively correlate changes in joint mobility with pain reduction, as assessed by the visual analog scale. The secondary objective is to collect data to estimate the time and budget for the main double-blind study randomized trial. These data may be quantitative (such as enrollment rate per month, number of screening failures, and new potential outcomes) and qualitative (such as site logistical issues, patient reluctance to enroll, and interpersonal difficulties for investigators). Methods: This open-label pilot and feasibility study is conducted in an orthopedic clinic (Timisoara, Romania). The study includes male and female participants, aged 50-70 years, who have been diagnosed with symptomatic knee OA and have experienced mild joint discomfort for at least 6 months. Eight patients must be enrolled and treated with Syalox 300 Plus (River Pharma) for 8 weeks. It is a dietary supplement containing high-molecular-weight hyaluronic acid, which has already been marketed in several European countries. Assessments are made at the baseline and final visits. Results: Recruitment and treatment of the 8 patients began on February 15, 2018, and was completed on May 25, 2018. Data analysis was planned to be completed by the end of 2018. The study was funded in February 2019. We expect the results to be published in a peer-reviewed clinical journal in the last quarter of 2024. Conclusions: The data from this pilot study will be used to assess the feasibility of a future randomized clinical trial in OA. In particular, the planned outcomes (eg, ultrasound and range of motion), safety, and quantitative and qualitative data must be evaluated to estimate in advance the time and budget required for the future main study. Finally, the pilot study should provide preliminary information on the efficacy of the investigational product. Trial Registration: ClinicalTrials.gov NCT03421054; https://clinicaltrials.gov/study/NCT03421054 International Registered Report Identifier (IRRID): RR1-10.2196/13642 %M 38941599 %R 10.2196/13642 %U https://www.researchprotocols.org/2024/1/e13642 %U https://doi.org/10.2196/13642 %U http://www.ncbi.nlm.nih.gov/pubmed/38941599 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54970 %T Combination of Curcuminoids and Acupressure for Inflammation and Pain in Older People with Osteoarthritis Genu: Protocol for a Randomized Controlled Trial %A Mahanani,Srinalesti %A Kertia,Nyoman %A Madyaningrum,Ema %+ Department of Internal Medicine, Faculty of Medicine, Public Health, and Nursing, Universitas Gadjah Mada, Jl Kesehatan Sendowo No 1, Sendowo, Sinduadi, Kec. Mlati, Kabupaten Sleman, Yogyakarta, 55281, Indonesia, 62 274 545458, nyoman.kertia@ugm.ac.id %K osteoarthritis %K acupressure %K curcuminoids %K endorphins %K biomarkers %K genu %K older people %K randomized controlled trial %D 2024 %7 24.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Curcuminoids and acupressure have beneficial effects in reducing pain and inflammation in patients with osteoarthritis. However, only a few clinical trials are investigating biomarkers to prove this objectively. Objective: This study aims to investigate the effect of acupressure and curcuminoids on inflammatory markers and pain in older people with osteoarthritis genu. Methods: A randomized controlled trial (RCT) was conducted among older people with osteoarthritis. All participants were randomized to a group that received 30 mg of curcuminoids in turmeric extract capsules and acupressure (group 1) or a group that received a placebo and sham acupressure (group 2) for 3 weeks. Results: The study was approved by the research ethics board; ClinicalTrials.gov reviewed this protocol. The extracts were manufactured from May 2023 to June 2023. Participant recruitment was conducted in September and October 2023; a total of 72 participants aged 60 years or older participated, of whom 75% (n=54) were female. Data were analyzed in April 2024, and dissemination of results is expected by the end of 2024. Conclusions: Primary outcomes were assessed at baseline and after the intervention. Relationships were assessed with inflammatory markers, endorphin hormones, and blood level of cycloxygenase-2 hormone. Additionally, secondary outcomes included pain, ability to perform activities of daily living, and quality of life. The beneficial effects that may be found in this trial may be exceptionally relevant in clinical practice, justifying this scientific inquiry. The benefits of herbs and acupressure can be helpful as additional options in treating inflammation and pain in patients with osteoarthritis. Trial Registration: ClinicalTrials.gov NCT06105840; https://clinicaltrials.gov/study/NCT06105840 International Registered Report Identifier (IRRID): DERR1-10.2196/54970 %M 38771152 %R 10.2196/54970 %U https://www.researchprotocols.org/2024/1/e54970 %U https://doi.org/10.2196/54970 %U http://www.ncbi.nlm.nih.gov/pubmed/38771152 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54074 %T Demographic Profile, Health, and Associated Factors of Family Caregivers and Functionality of Hospitalized Older Adults: Cross-Sectional, Exploratory, and Descriptive Study %A Gomes,Mateus Cunha %A Castro,Robert %A Silva Serra,Willian %A Sagica de Vasconcelos,Jhak %A Parente,Andressa %A Botelho,Eliã Pinheiro %A Ferreira,Glenda %A Sousa,Fabianne %+ Nursing School, Federal University of Para, Rua Augusto Correa n 1, Belem, 66075-110, Brazil, 55 91 981219404, fabiannesousa@hotmail.com %K family caregiver %K older adult %K hospitalization %K functionality %K caregiver %K health %D 2024 %7 21.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The longevity of the world population can contribute to an increase in hospitalizations and, consequently, to the emergence of functional limitations, resulting in the need for family caregivers. Hospitalized older adults may become dependent and require more care, increasing the burden on family caregivers. Thus, the nursing team in the hospital environment faces a new situation: an increase in the number of older adults occupying hospital beds and the presence of their family caregivers. Objective: We aimed to analyze the association between the demographic variables of interest and the self-rated health of family caregivers and to describe the functionality of older adults hospitalized in a university hospital in the Amazonian context. Methods: This cross-sectional, quantitative, exploratory, and descriptive study was carried out through individual interviews with 98 interviewees, divided into 49 family caregivers and 49 older adults hospitalized in the surgical clinic sector of a university hospital in Brazil between February and March 2023. Demographic data and health conditions were collected from family caregivers, and to describe the functionality of hospitalized older adults, the Barthel Index was applied. Descriptive (frequency and percentage) and inferential analyses were used, and the student t test was applied. The significance level of 5% was adopted. Results: Among the 49 family caregivers, the majority were women (n=40, 81.6%) with an average age of 46.9 (SD 13.3) years. Most were single (n=28, 57.1%) and had completed an average level of education (n=26, 53.1%). Additionally, 25 (51%) caregivers were caring for their parents. Regarding health conditions, respondents self-assessed their health as good (25/49, 51%; P=.01), and they considered that their health status was not affected by the provision of care (36/49, 73.5%; P=.01). There was a significant association between demographic variables (ie, gender, age, and education) and self-assessment of family caregivers (P=.01, P=.01, and P=.04, respectively). Of the 49 older adults hospitalized, the majority (n=31, 63.2%) were men, with a mean age of 69.2 (SD 7.12) years. Regarding the assessment of functionality, most older adults were classified as having mild dependence on care (n=23, 46.9%), specifically in the age group between 60 and 69 years (21/49, 67.8%). Conclusions: The data revealed that female gender, age, and education of family caregivers contributed favorably to the provision of care to hospitalized older adults with a lower degree of functional dependence. It is important to emphasize that during the older adult’s hospitalization, the family caregiver should not be seen as a delegation of responsibilities or as a complement of human resources to assist in their recovery. Health professionals need to implement assertive interventions so that the family caregiver functions as a therapeutic resource. %M 38905627 %R 10.2196/54074 %U https://formative.jmir.org/2024/1/e54074 %U https://doi.org/10.2196/54074 %U http://www.ncbi.nlm.nih.gov/pubmed/38905627 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56484 %T The Effect of Acupuncture on Brain Iron Deposition and Body Iron Metabolism in Vascular Cognitive Impairment: Protocol for a Randomized Controlled Trial %A Wu,Mingli %A Chen,Lulu %A Wang,Yamin %A Li,Yunpeng %A An,Yuqi %A Wu,Ruonan %A Zhang,Yuhan %A Gao,Jing %A Su,Kaiqi %A Feng,Xiaodong %+ Rehabilitation Center, The First Affiliated Hospital of Henan University of Chinese Medicine, 19 Renmin Road, Jinshui District, Zhengzhou, 450099, China, 86 15303828605, fxd0502@163.com %K acupuncture %K vascular cognitive impairment %K iron metabolism %K mechanisms explored %K clinical trial %K needling technique %K dry needling %K acupunctures %K activities of daily living %K iron %K prevalence %K cerebrovascular diseases %K vascular dementia %K vascular %K traditional Chinese method %K Chinese methods %D 2024 %7 17.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Vascular cognitive impairment (VCI) persistently impairs cognition and the ability to perform activities of daily living, seriously compromising patients’ quality of life. Previous studies have reported that disorders of serum iron metabolism and iron deposition in the brain can lead to inflammation, abnormal protein aggregation and degeneration, and massive neuronal apoptosis in the central nervous system, which in turn leads to a progressive decline in cognitive processes. Our previous clinical studies have found acupuncture to be a safe and effective intervention for treating VCI, but the specific mechanisms require further exploration. Objective: The objective of the trial is to evaluate the clinical efficacy of Tongdu Xingshen acupuncture and to investigate whether it can improve VCI by regulating brain iron deposition and body iron metabolism. Methods: In total, 42 patients with VCI and 21 healthy individuals will participate in this clinical trial. The 42 patients with VCI will be randomized into acupuncture and control groups, while the 21 healthy individuals will be in the healthy control group. Both the control and acupuncture groups will receive conventional medical treatment and cognitive rehabilitation training. In addition, the acupuncture group will receive electroacupuncture treatment with Tongdu Xingshen for 30 minutes each time, 6 times a week for 4 weeks. Meanwhile, the healthy control group will not receive any intervention. All 3 groups will undergo baseline assessments of brain iron deposition, serum iron metabolism, and neuropsychological tests after enrollment. The acupuncture and control groups will be evaluated again at the end of 4 weeks of treatment, as described earlier. By comparing neuropsychological test scores between groups, we will examine the efficacy of Tongdu Xingshen acupuncture in treating VCI. Additionally, we will test the correlations between neuropsychological test scores, brain iron deposition, and body iron metabolism indexes to explore the possible mechanisms of Tongdu Xingshen acupuncture in treating VCI. Results: Participants are currently being recruited. The first participant was enrolled in June 2023, which marked the official start of the experiment. As of the submission of the paper, there were 23 participants. The recruitment process is expected to continue until June 2025, at which point the processing and analysis of data will begin. As of May 15, 2024, up to 30 people have been enrolled in this clinical trial. Conclusions: This study will provide data on the effects of Tongdu Xingshen acupuncture on cerebral iron deposition as well as somatic iron metabolism in patients with VCI. These results will help to prove whether Tongdu Xingshen acupuncture can improve VCI by regulating brain iron deposition and body iron metabolism, which will provide the clinical and theoretical basis for the wide application of acupuncture therapy in VCI rehabilitation. Trial Registration: China Clinical Registration Agency ChiCTR2300072188; https://tinyurl.com/5fcydtkv International Registered Report Identifier (IRRID): PRR1-10.2196/56484 %M 38885500 %R 10.2196/56484 %U https://www.researchprotocols.org/2024/1/e56484 %U https://doi.org/10.2196/56484 %U http://www.ncbi.nlm.nih.gov/pubmed/38885500 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51599 %T Effect of a 12-Week High-Calorie-Expenditure Multimodal Exercise Program on Health Indices in Women With Overweight: Protocol for a Randomized Controlled Trial %A Abdollahi Diba,Mitra %A Sari Sarraf,Vahid %A Amirsasan,Ramin %A Dabbagh Nikoukheslat,Saeid %+ Department of Exercise Physiology, Faculty of Physical Education and Sports Sciences, University of Tabriz, 29 Bahman Blvd, Tabriz, 5166836411, Iran, 98 914 313 1056, nikookheslat@tabrizu.ac.ir %K high-calorie expenditure %K multimodal exercise %K International Physical Activity Questionnaire %K IPAQ %K body composition %K metabolic health %D 2024 %7 13.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: High-calorie-expenditure training is common among endurance athletes and is an effective strategy for weight loss. Although many training protocols include walking, running, cycling, and swimming according to a target heart rate, there is limited research on high-calorie-expenditure interventions with multimodal training programs using quantitative methods. Objective: The aims of this research protocol are to (1) develop a high-calorie-expenditure training program to cover target calorie expenditure according to the trainability of women classified as overweight (according to a BMI of 25-29.9 kg/m2); (2) determine the effect of high-calorie-expenditure workouts on conditioning, glycemic variables, and body composition; and (3) evaluate the implementation of the intervention and results in comparison with outcomes obtained under a standard-calorie-expenditure training program. Methods: This is a randomized controlled trial with a pretest-posttest design. Participants include 33 women with a BMI in the overweight range (25-29.9) allocated to three groups: two intervention groups and one control group. The intervention will be conducted for 12 weeks. Participants in the first group will be assigned an exercise program with high energy expenditure of approximately 3000-3500 kilocalories/week in the form of 5 sessions per week with an intensity of 50%-75% maximum oxygen rate (VO2 max) and 60%-80% target heart rate. The second group will be assigned an exercise program with a standard energy expenditure of approximately 1200-1500 kilocalories/week with 3 sessions per week at an intensity of 60%-75% VO2 max, according to The American College of Sports Medicine guideline. The effects of the multimodal training program with daily tasks will be compared to those of the standard-calorie-expenditure and control (no exercise) conditions with respect to changes in glycemic indices and body composition. Daily calories will be calculated through the International Physical Activity Questionnaire and using Nutrition 4 software. Results: Preliminary results show significant weight loss in both the high- and standard-calorie-expenditure groups (P=.003). Significant improvements were also found in muscle percentage (P=.05) and BMI (P=.05) for the high-calorie-expenditure group. Analyses are ongoing for glycemic indices, inflammation factors, and blood parameters. Conclusions: High-calorie-expenditure training can cause further weight loss than standard exercise, which can eventually lead to greater fat mass reduction and improvement in glycemic indices. These results demonstrate that, in some cases, it may be necessary to increase the activity of women and use multimodal exercise programs with increased volume and intensity to increase the expenditure of exercise and daily activity. We found a net effect of exercise and daily activity at the individual level, whereas the daily lifestyle and physical behaviors of the participants remained constant. Trial Registration: Iranian Registry of Clinical Trials IRCT20220202053916N1; https://tinyurl.com/c8jxfw36 International Registered Report Identifier (IRRID): DERR1-10.2196/51599 %M 38870518 %R 10.2196/51599 %U https://www.researchprotocols.org/2024/1/e51599 %U https://doi.org/10.2196/51599 %U http://www.ncbi.nlm.nih.gov/pubmed/38870518 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 11 %N %P e52811 %T Quality of Life, Physical Activity Participation, and Perceptions of Physical Rehabilitation Among Community-Reintegrated Veterans With Lower Limb Amputation in Sri Lanka: Convergent Parallel Mixed Methods Study %A Wijekoon,Ashan %A Gamage Dona,Dilanthi %A Jayawardana,Subashini %A Beane,Abigail %+ Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, 25 Kynsey Road, Colombo, 00800, Sri Lanka, 94 112695300, ashan@nicslk.com %K amputation %K community-based rehabilitation %K lower limb %K military %K physical activity %K quality of life %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Lower limb amputation (LLA) impacts physical activity (PA) participation and quality of life (QoL). To minimize the effects of these challenges, LLA survivors need to have opportunities to engage in appropriately tailored rehabilitation throughout their lives. However, in Sri Lanka, where a 3-decade civil war resulted in trauma-related LLA among young male soldiers, access to rehabilitation was limited to the immediate postinjury period. Developing rehabilitation interventions for these veterans requires an understanding of their current health status and rehabilitation perceptions. Objective: This study was conducted to evaluate the QoL and PA participation of veterans with LLA and explore perceptions of factors influencing their PA participation and expectations for a future community-based physical rehabilitation (CBPR) intervention. Methods: This mixed methods study combined a comparative cross-sectional quantitative survey with qualitative semistructured interviews in 5 districts of Sri Lanka. QoL and PA participation were assessed among community-reintegrated veterans with LLA (n=85) and compared with a matched able-bodied cohort (control; n=85) using Mann-Whitney U and Chi-square tests. PA was assessed in terms of metabolic equivalent of task (MET) minutes per week and was computed for walking, moderate-intensity, and vigorous-intensity activities. PA was classified as sufficiently active, low, or sedentary. The design of interview questions was guided by the Theoretical Domains Framework and followed a phenomenological approach. Interviews were conducted with 25 veterans and were analyzed thematically, and the perceptions regarding PA participation and CBPR were codified using the Consolidated Framework for Implementation Research (CFIR). Results: Based on the quantitative survey findings, scores for both physical (P<.001) and psychological (P<.001) well-being and participation in walking (P=.004) and vigorous-intensity activities (P<.001) were significantly lower among veterans than among controls. A “sedentary” classification was made for 43% (34/79) of veterans and 12% (10/82) of controls. Veterans mostly engaged in moderate-intensity PA inside the house (49/79, 62%) and in the yard (30/79, 38%). Qualitative interviews revealed that barriers to PA exist at individual (eg, comorbidity burden), primary care (eg, absence of community rehabilitation services), and policy levels (eg, limited resources) and facilitators exist primarily at societal (eg, inclusive community) and individual levels (eg, preinjury activity baseline and positive attitudes toward exercise). Expectations regarding CBPR included individualized rehabilitation parameters; functional exercises; and involvement of peers, amputee societies, and community health care providers. The nonresponse rate for interviews was 7% (2/27). Conclusions: The findings of reduced PA participation, poor QoL, and physical and psychological impairments among relatively young veterans reveal the long-term impacts of living with LLA in the absence of long-term rehabilitation. Policy-level changes need to be implemented along with behavior-change strategies to promote PA participation and minimize physical inactivity–induced health issues. Veterans’ perceptions regarding future CBPR programs were positive and centered on holistic, individualized, and peer-led activities. %M 38869933 %R 10.2196/52811 %U https://rehab.jmir.org/2024/1/e52811 %U https://doi.org/10.2196/52811 %U http://www.ncbi.nlm.nih.gov/pubmed/38869933 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 9 %N %P e54666 %T An Engineering Alternative to Lockdown During COVID-19 and Other Airborne Infectious Disease Pandemics: Feasibility Study %A Fujii,Yusaku %+ School of Science and Technology, Gunma University, 1-5-1 Tenjin-cho, Kiryu, 3768515, Japan, 81 8035505585, fujii@gunma-u.ac.jp %K COVID-19 %K airborne infectious diseases %K lockdown %K powered air purifying respirator (PAPR) %K infectious dose %K airborne transmission %K emergency evacuation %K herd immunity %K pandemic %K aerosol %K air %K quality %K infection control %K infectious %K respiratory %K purifier %K purifiers %K purifying %K respirator %K respirators %K device %K devices %K airborne %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Biomed Eng %G English %X Background: Now and in the future, airborne diseases such as COVID-19 could become uncontrollable and lead the world into lockdowns. Finding alternatives to lockdowns, which limit individual freedoms and cause enormous economic losses, is critical. Objective: The purpose of this study was to assess the feasibility of achieving a society or a nation that does not require lockdown during a pandemic due to airborne infectious diseases through the mass production and distribution of high-performance, low-cost, and comfortable powered air purifying respirators (PAPRs). Methods: The feasibility of a social system using PAPR as an alternative to lockdown was examined from the following perspectives: first, what PAPRs can do as an alternative to lockdown; second, how to operate a social system utilizing PAPR; third, directions of improvement of PAPR as an alternative to lockdown; and finally, balancing between efficiency of infection control and personal freedom through the use of Internet of Things (IoT). Results: PAPR was shown to be a possible alternative to lockdown through the reduction of airborne and droplet transmissions and through a temporary reduction of infection probability per contact. A social system in which individual constraints imposed by lockdown are replaced by PAPRs was proposed, and an example of its operation is presented in this paper. For example, the government determines the type and intensity of the lockdown and activates it. At that time, the government will also indicate how PAPR can be substituted for the different activity and movement restrictions imposed during a lockdown, for example, a curfew order may be replaced with the permission to go outside if wearing a PAPR. The following 7 points were raised as directions for improvement of PAPR as an alternative method to lockdown: flow optimization, precise differential pressure control, design improvement, maintenance method, variation development such as booth type, information terminal function, and performance evaluation method. In order to achieve the effectiveness and efficiency in controlling the spread of infection and the individual freedom at a high level in a social system that uses PAPRs as an alternative to lockdown, it was considered effective to develop a PAPR wearing rate network management system utilizing IoT. Conclusions: This study shows that using PAPR with infection control ability and with less economic and social damage as an alternative to nationwide lockdown is possible during a pandemic due to airborne infectious diseases. Further, the efficiency of the government’s infection control and each citizen’s freedom can be balanced by using the PAPR wearing rate network management system utilizing an IoT system. %M 38875692 %R 10.2196/54666 %U https://biomedeng.jmir.org/2024/1/e54666 %U https://doi.org/10.2196/54666 %U http://www.ncbi.nlm.nih.gov/pubmed/38875692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51728 %T Quality Improvement Intervention Using Social Prescribing at Discharge in a University Hospital in France: Quasi-Experimental Study %A Cailhol,Johann %A Bihan,Hélène %A Bourovali-Zade,Chloé %A Boloko,Annie %A Duclos,Catherine %+ Laboratoire Educations et Promotion de la Santé, University Sorbonne Paris Nord, 74 rue marcel cachin, Bobigny, 93007, France, 33 148955426, johann.cailhol@aphp.fr %K social prescription %K discharge coordination %K language barriers %K readmission rates %K ethnic matching %K trust %K personalized care %K discharge %K social determinant %K social need %K tool %K quality of care %K readmission %K quality improvement %D 2024 %7 13.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social prescription is seen as a public health intervention tool with the potential to mitigate social determinants of health. On one side, social prescription is not yet well developed in France, where social workers usually attend to social needs, and historically, there is a deep divide between the health and social sectors. On the other side, discharge coordination is gaining attention in France as a critical tool to improve the quality of care, assessed indirectly using unplanned rehospitalization rates. Objective: This study aims to combine social prescription and discharge coordination to assess the need for social prescription and its effect on unplanned rehospitalization rates. Methods: We conducted a quasi-experimental study in two departments of medicine in a French university hospital in a disadvantaged suburb of Paris over 2 years (October 2019-October 2021). A discharge coordinator screened patients for social prescribing needs and provided services on the spot or referred the patient to the appropriate service when needed. The primary outcome was the description of the services delivered by the discharge coordinator and of its process, as well as the characteristics of the patients in terms of social needs. The secondary outcome was the comparison of unplanned rehospitalization rates after data chaining. Results: A total of 223 patients were included in the intervention arm, with recruitment being disrupted by the COVID-19 pandemic. More than two-thirds of patients (n=154, 69.1%) needed help understanding discharge information. Slightly less than half of the patients (n=98, 43.9%) seen by the discharge coordinator needed social prescribing, encompassing language, housing, health literacy, and financial issues. The social prescribing covered a large range of services, categorized into finding a general practitioner or private sector nurse, including language-matching; referral to a social worker; referral to nongovernmental organization or group activities; support for transportation issues; support for health-related administrative procedures; and support for additional appointments with nonmedical clinicians. All supports were delivered in a highly personalized way. Ethnic data collection was not legally permitted, but for 81% (n=182) of the patients, French was not the mother tongue. After data chaining, rehospitalization rates were compared between 203 patients who received the intervention (n=5, 3.1%) versus 2095 patients who did not (n=51, 2.6%), and there was no statistical difference. Conclusions: First, our study revealed the breadth of patient’s unmet social needs in our university hospital, which caters to an area where the immigrant population is high. The study also revealed the complexity of the discharge coordinator’s work, who provided highly personalized support and managed to gain trust. Hospital discharge could be used in France as an opportunity in disadvantaged settings. Eventually, indicators other than the rehospitalization rate should be devised to evaluate the effect of social prescribing and discharge coordination. %M 38739912 %R 10.2196/51728 %U https://formative.jmir.org/2024/1/e51728 %U https://doi.org/10.2196/51728 %U http://www.ncbi.nlm.nih.gov/pubmed/38739912 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53898 %T Practice Standards in International Medical Departments of Public Academic Hospitals in China: Cross-Sectional Study %A Zhou,Yaxu %A Zhou,Ying %A Xu,Di %A Min,Jie %A Du,Yu %A Duan,Qi %A Bao,Wen %A Sun,Yingying %A Xi,Huiqin %A Wang,Chunming %A Bischof,Evelyne %+ Smart Hospital Development Department, Renji Hospital, Shanghai Jiaotong University School of Medicine, No160 Pujian Road, Shanghai, 200127, China, 86 2168383408, wangchunming@renji.com %K patients %K international medical service %K demand %K satisfaction %K strategy %K health care optimization %K smart hospital %D 2024 %7 13.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Improving health care in cities with a diverse, international population is crucial for ensuring health equity, particularly for foreigners facing challenges due to cultural and language barriers. This situation is especially relevant in China, a major destination for expatriates and travelers, where optimizing health care services and incorporating international standards in the public sector are vital. Achieving this involves understanding the operational details, cultural and linguistic nuances, and advancing medical digitalization. A strategic approach focusing on cultural competence and awareness of health care systems is essential for effectively navigating health care for foreigners and expatriates in China. Objective: The aim of this study was to perform an in-depth analysis of the subjective and objective experiences of local and international patients in public hospitals in China to provide a basis for enhancing the medical experience of all patients. Methods: A structured questionnaire was provided to patients at an international outpatient service of a top-tier university hospital in China. Qualitative analysis of the survey responses was performed to methodically categorize and analyze medical treatment, focusing on patient demand and satisfaction across four main category elements (“high demand, high satisfaction”; “high demand, low satisfaction”; “low demand, high satisfaction”; and “low demand, low satisfaction”), enabling a detailed cross-sectional analysis to identify areas for improvement. Results: Elements falling under “high demand, high satisfaction” for both Chinese and international patients were primarily in the realms of medical quality and treatment processes. In contrast, elements identified as “high demand, low satisfaction” were significantly different between the two patient groups. Conclusions: The findings highlight the importance of systematic, objective research in advancing the quality of international health care services within China’s leading academic medical centers. Key to this improvement is rigorous quality control involving both patients and providers. This study highlights the necessity of certifying such centers and emphasizes the role of digital platforms in disseminating information about medical services. This strategy is expected to cater to diverse patient needs, enhancing the overall patient experience. Furthermore, by developing comprehensive diagnosis and treatment services and highlighting the superior quality and costs associated with international health care, these efforts aim to foster a sense of belonging among international patients and increase the attractiveness of China’s medical services for this demographic. %M 38739428 %R 10.2196/53898 %U https://formative.jmir.org/2024/1/e53898 %U https://doi.org/10.2196/53898 %U http://www.ncbi.nlm.nih.gov/pubmed/38739428 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55470 %T Brief Parent-Child Substance Use Education Intervention for Black Families in Urban Cities in New Jersey: Protocol for a Formative Study Design %A Opara,Ijeoma %A Pierre,Kimberly %A Cayo,Sandy %A Aneni,Kammarauche %A Mwai,Catherine %A Hogue,Aaron %A Becker,Sara %+ Yale University School of Public Health, 60 College Street, New Haven, CT, 06510, United States, 1 2037852867, ijeoma.opara@yale.edu %K black families %K parents %K drug use %K prevention %K urban community %D 2024 %7 9.5.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Substance use continues to remain a public health issue for youths in the United States. Black youths living in urban communities are at a heightened risk of poor outcomes associated with substance use and misuse due to exposure to stressors in their neighborhoods, racial discrimination, and lack of prevention education programs specifically targeting Black youths. Many Black youths, especially those who live in urban communities, do not have access to culturally tailored interventions, leaving a critical gap in prevention. Since family is a well-known protective factor against substance misuse for Black youths, it is essential to create sustainable and accessible programming that incorporates Black youths’ and their families’ voices to develop a suitable prevention program for them. Objective: We aim to understand the cultural and environmental level factors that influence substance use among Black youths and develop a prevention program to increase parent-child substance use education among Black families. Methods: This study will take place within urban cities in New Jersey such as Paterson and East Orange, New Jersey, which will be the main study sites. Both cities have a large population of Black youths and this study’s team has strong ties with youths-serving organizations there. A formative, qualitative study will be conducted first. Using the first 3 steps of the ADAPT-ITT (Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, and Testing) framework we begin the development of an intervention for Black families. Three aims will be described: aim 1, collect qualitative data from Black parents and youths aged 11-17 years from parent-child dyads (N=20) on the challenges, barriers, and facilitators to communicating about substance use; aim 2, adapt a selected evidence-based intervention for Black families and develop a family advisory board to guide the adaptation; and aim 3 assess the feasibility of the intervention through theater testing, involving the family and community advisory board. Results: This study is part of a 2-year research pilot study award from the National Institutes of Drug Abuse. Data collection began in May 2023, and for aim 1, it is 95% complete. All aim 1 data collection is expected to be complete by December 30, 2023. Data analysis will immediately follow. Aim 2 activity will occur in spring 2024. Aim 3 activity may begin in fall 2024 and conclude in 2025. Conclusions: This study will be one of the few interventions that address substance use among youths and uses parents and families in urban communities as a protective factor within the program. We anticipate that the intervention will benefit Black youths not only in New Jersey but across the nation, working on building culturally appropriate, community-specific prevention education and building on strong families’ relationships, resulting in a reduction of or delayed substance use. International Registered Report Identifier (IRRID): DERR1-10.2196/55470 %M 38722676 %R 10.2196/55470 %U https://www.researchprotocols.org/2024/1/e55470 %U https://doi.org/10.2196/55470 %U http://www.ncbi.nlm.nih.gov/pubmed/38722676 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55064 %T Dashboards to Support Implementation of the Quebec Alzheimer Plan: Evaluation Study With Regional and Professional Considerations %A Arsenault-Lapierre,Genevieve %A Lemay-Compagnat,Alexandra %A Guillette,Maxime %A Couturier,Yves %A Massamba,Victoria %A Dufour,Isabelle %A Maubert,Eric %A Fournier,Christine %A Denis,Julie %A Morin,Caroline %A Vedel,Isabelle %+ Center for Research and Expertise in Social Gerontology, Centre intégré universitaire de santé et de services sociaux du Centre-Ouest de l'Ile de Montréal, 5800 Boulevard Cavendish suite 600, Côte Saint-Luc, QC, H4W 2T5, Canada, 1 514 484 7878 ext 61553, genevieve.arsenault-lapierre@mail.mcgill.ca %K dashboard %K learning health system %K health policy %K dementia care %K health care regionalization %K dementia %K Alzheimer disease %K qualitative %K collaborative %K focus group %K primary care %K implementation %K attitude %K opinion %K perception %K perspective %K service %K health care management %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Health organizations face the critical task of executing and overseeing comprehensive health care. To address the challenges associated with this task, evidence-based dashboards have emerged as valuable tools. Since 2016, the regional health organizations of Quebec, Canada, have been responsible for ensuring implementation of the Quebec Alzheimer Plan (QAP), a provincial plan that aims to reinforce the capacity of primary care services to detect, diagnose, and treat persons with dementia. Despite the provincial scope of the QAP, the diverse material and human resources across regions introduce variability in the interest, utility, and specific needs associated with these dashboards. Objective: The aim of this study was to assess the interest and utility of dashboards to support the QAP implementation, as well as to determine the needs for improving these aspects according to the perspectives of various types of professionals involved across regions. Methods: An evaluative study using qualitative methods was conducted within a collaborative research approach involving different stakeholders, including the ministerial advisor and the four project managers responsible for supporting the implementation of the QAP, as well as researchers/scientific advisors. To support these organizations, we developed tailored, 2-page paper dashboards, detailing quantitative data on the prevalence of dementia, the use of health services by persons with dementia, and achievements and challenges of the QAP implementation in each organization’s jurisdiction. We then conducted 23 focus groups with the managers and leading clinicians involved in the implementation of the QAP of each regional health organization. Real-time notes were taken using a structured observation grid. Content analysis was conducted according to different regions (organizations with university mandates or nearby organizations, labeled “university/peripheral”; organizations for which only part of the territory is in rural areas, labeled “mixed”; and organizations in remote or isolated areas, labeled “remote/isolated”) and according to different types of participants (managers, leading clinicians, and other participants). Results: Participants from organizations in all regions expressed interest in these dashboards and found them useful in several ways. However, they highlighted the need for indicators on orphan patients and other health care providers. Differences between regions were observed, particularly in the interest in continuity of care in university/peripheral regions and the need for diagnostic tools adapted to the culture in remote/isolated regions. Conclusions: These dashboards support the implementation of an Alzheimer Plan and contribute to the emergence of a learning health care system culture. This project allows each region to increase its monitoring capacity for the implementation of the QAP and facilitates reflection among individuals locally carrying out the implementation. The perspectives expressed will guide the preparation of the next iteration of the dashboards. %M 38717803 %R 10.2196/55064 %U https://formative.jmir.org/2024/1/e55064 %U https://doi.org/10.2196/55064 %U http://www.ncbi.nlm.nih.gov/pubmed/38717803 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54026 %T Detection of Urinary Misfolded Proteins for Imminent Prediction of Preeclampsia in Pregnant Women With Suspected Cases: Protocol for a Prospective Noninterventional Study %A Tang,Haiyang %A Tian,Yijia %A Fang,Jing %A Yuan,Xiaoying %A Yao,Minli %A Wang,Yujia %A Feng,Yan %A Shu,Jia %A Ni,Yan %A Yu,Ying %A Wang,Yuanhe %A Liang,Ping %A Li,Xingmin %A Bai,Xiaoxia %+ Women’s Hospital, School of Medicine, Zhejiang University, 1 Xueshi Road, Shangcheng District, Hangzhou, 310006, China, 86 57189995378, baixiaoxia@zju.edu.cn %K preeclampsia %K misfolded protein %K congophilia %K noninvasive %K prospective %D 2024 %7 26.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Preeclampsia (PE) is one of the most common hypertensive diseases, affecting 2%-8% of all pregnancies. The high maternal and fetal mortality rates of PE are due to a lack of early identification of affected pregnant women that would have led to closer monitoring and care. Recent data suggest that misfolded proteins might be a promising biomarker for PE prediction, which can be detected in urine samples of pregnant women according to their congophilia (aggregated) characteristic. Objective: The main purpose of this trial is to evaluate the value of the urine congophilia-based detection of misfolded proteins for the imminent prediction of PE in women presenting with suspected PE. The secondary objectives are to demonstrate that the presence of urine misfolded proteins correlates with PE-related maternal or neonatal adverse outcomes, and to establish an accurate PE prediction model by combining misfolded proteins with multiple indicators. Methods: At least 300 pregnant women with clinical suspicion of PE will be enrolled in this prospective cohort study. Participants should meet the following inclusion criteria in addition to a suspicion of PE: ≥18 years old, gestational week between 20+0 and 33+6, and single pregnancy. Consecutive urine samples will be collected, blinded, and tested for misfolded proteins and other PE-related biomarkers at enrollment and at 4 follow-up visits. Clinical assessments of PE status and related complications for all participants will be performed at regular intervals using strict diagnostic criteria. Investigators and participants will remain blinded to the results. Follow-up will be performed until 42 days postpartum. Data from medical records, including maternal and fetal outcomes, will be collected. The performance of urine misfolded proteins alone and combined with other biomarkers or clinical variables for the prediction of PE will be statistically analyzed. Results: Enrollment started in July 2023 and was still open upon manuscript submission. As of March 2024, a total of 251 eligible women have been enrolled in the study and enrollment is expected to continue until August 2024. Results analysis is scheduled to start after all participants reach the follow-up endpoint and complete clinical data are collected. Conclusions: Upon completion of the study, we expect to derive an accurate PE prediction model, which will allow for proactive management of pregnant women with clinical suspicion of PE and possibly reduce the associated adverse pregnancy outcomes. The additional prognostic value of misfolded proteins is also expected to be confirmed. Trial Registration: Chinese Clinical Trials Registry ChiCTR2300074878; https://www.chictr.org.cn/showproj.html?proj=202096 International Registered Report Identifier (IRRID): PRR1-10.2196/54026 %M 38669061 %R 10.2196/54026 %U https://www.researchprotocols.org/2024/1/e54026 %U https://doi.org/10.2196/54026 %U http://www.ncbi.nlm.nih.gov/pubmed/38669061 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49815 %T Patient Satisfaction With the Health Care Services of a Government-Financed Health Protection Scheme in Bangladesh: Cross-Sectional Study %A Hasan,Md Zahid %A Rabbani,Md Golam %A Akter,Orin %A Mehdi,Gazi Golam %A Ahmed,Mohammad Wahid %A Ahmed,Sayem %A Chowdhury,Mahbub Elahi %+ Health Systems and Population Studies Division, icddr,b, 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh, 880 01673163613, md.zahid@icddrb.org %K Shasthyo Surokhsha Karmasuchi %K health care services %K health care utilization %K satisfaction %K below poverty line %K Bangladesh %K patient satisfaction %K physician behavior %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Since 2016, the government of Bangladesh has been piloting a health protection scheme known as Shasthyo Surokhsha Karmasuchi (SSK), which specifically targets households living below the poverty line. This noncontributory scheme provides enrolled households access to inpatient health care services for 78 disease groups. Understanding patients’ experiences with health care utilization from the pilot SSK scheme is important for enhancing the quality of health care service delivery during the national-level scale-up of the scheme. Objective: We aimed to evaluate patient satisfaction with the health care services provided under the pilot health protection scheme in Bangladesh. Methods: A cross-sectional survey was conducted with the users of the SSK scheme from August to November 2019. Patients who had spent a minimum of 2 nights at health care facilities were selected for face-to-face exit interviews. During these interviews, we collected information on patients’ socioeconomic characteristics, care-seeking experiences, and level of satisfaction with various aspects of health care service delivery. To measure satisfaction, we employed a 5-point Likert scale (very satisfied, 5; satisfied, 4; neither satisfied nor dissatisfied, 3; dissatisfied, 2; very dissatisfied, 1). Descriptive statistics, statistical inferential tests (t-test and 1-way ANOVA), and linear regression analyses were performed. Results: We found that 55.1% (241/438) of users were either very satisfied or satisfied with the health care services of the SSK scheme. The most satisfactory indicators were related to privacy maintained during diagnostic tests (mean 3.91, SD 0.64), physicians’ behaviors (mean 3.86, SD 0.77), services provided at the registration booth (mean 3.86, SD 0.62), confidentiality maintained regarding diseases (mean 3.78, SD 0.72), and nurses’ behaviors (mean 3.60, SD 0.83). Poor satisfaction was identified in the interaction of patients with providers about illness-related information (mean 2.14, SD 1.40), availability of drinking water (mean 1.46, SD 0.76), cleanliness of toilets (mean 2.85, SD 1.04), and cleanliness of the waiting room (mean 2.92, SD 1.09). Patient satisfaction significantly decreased by 0.20 points for registration times of 16-30 minutes and by 0.32 points for registration times of >30 minutes compared with registration times of ≤15 minutes. Similarly, patient satisfaction significantly decreased with an increase in the waiting time to obtain services. However, the satisfaction of users significantly increased if they received a complete course of medicines and all prescribed diagnostic services. Conclusions: More than half of the users were satisfied with the services provided under the SSK scheme. However, there is scope for improving user satisfaction. To improve the satisfaction level, the SSK scheme implementation authorities should pay attention to reducing the registration time and waiting time to obtain services and improving the availability of drugs and prescribed diagnostic services. The authorities should also ensure the supply of drinking water and enhance the cleanliness of the facility. %M 38656783 %R 10.2196/49815 %U https://formative.jmir.org/2024/1/e49815 %U https://doi.org/10.2196/49815 %U http://www.ncbi.nlm.nih.gov/pubmed/38656783 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50032 %T Supportive Care Needs in Chinese, Vietnamese, and Korean Americans With Metastatic Cancer: Mixed Methods Protocol for the DAWN Study %A Kim,Jacqueline H J %A Kagawa Singer,Marjorie %A Bang,Lisa %A Ko,Amy %A Nguyen,Becky %A Chen Stokes,Sandy %A Lu,Qian %A Stanton,Annette L %+ Department of Medicine, University of California, Irvine, 100 Theory, Suite 100, Irvine, CA, 92617, United States, 1 9498249216, jhjkim@hs.uci.edu %K Asian American %K disparities %K metastatic cancer %K psychosocial %K supportive care %K unmet needs %K well-being %D 2024 %7 22.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Asian Americans with metastatic cancer are an understudied population. The Describing Asian American Well-Being and Needs in Cancer (DAWN) Study was designed to understand the supportive care needs of Chinese-, Vietnamese-, and Korean-descent (CVK) patients with metastatic cancer. Objective: This study aims to present the DAWN Study protocol involving a primarily qualitative, convergent, mixed methods study from multiple perspectives (patients or survivors, caregivers, and health care professionals). Methods: CVK Americans diagnosed with solid-tumor metastatic cancer and their caregivers were recruited nationwide through various means (registries, community outreach newsletters, newspapers, radio advertisements, etc). Potentially eligible individuals were screened and consented on the web or through a phone interview. The study survey and interview for patients or survivors and caregivers were provided in English, traditional/simplified Chinese and Cantonese/Mandarin, Vietnamese, and Korean, and examined factors related to facing metastatic cancer, including quality of life, cultural values, coping, and cancer-related symptoms. Community-based organizations assisted in recruiting participants, developing and translating study materials, and connecting the team to individuals for conducting interviews in Asian languages. Health care professionals who have experience working with CVK patients or survivors with metastatic solid cancer were recruited through referrals from the DAWN Study community advisory board and were interviewed to understand unmet supportive care needs. Results: Recruitment began in November 2020; data collection was completed in October 2022. A total of 66 patients or survivors, 13 caregivers, and 15 health care professionals completed all portions of the study. We completed data management in December 2023 and will submit results for patients or survivors and caregivers to publication outlets in 2024. Conclusions: Future findings related to this protocol will describe and understand the supportive care needs of CVK patients or survivors with metastatic cancer and will help develop culturally appropriate psychosocial interventions that target known predictors of unmet supportive care needs in Chinese, Vietnamese, and Korean Americans with metastatic cancer. International Registered Report Identifier (IRRID): DERR1-10.2196/50032 %M 38648633 %R 10.2196/50032 %U https://www.researchprotocols.org/2024/1/e50032 %U https://doi.org/10.2196/50032 %U http://www.ncbi.nlm.nih.gov/pubmed/38648633 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45700 %T Effect of the COVID-19 Pandemic on Gambling Behavior in Mainland Chinese Gamblers in Macau: Cross-Sectional Survey Study %A Zhou,Jinquan %A Ho,Hong-Wai %A Chan,ChiBiu %+ Macao Polytechnic University, R de Luís Gonzaga Gomes, Macao, China, 853 88593326, jqzhou@mpu.edu.mo %K Chinese gamblers %K gambling behavior %K online gambling %K COVID-19 %K Macau %D 2024 %7 22.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: This study examined the effects of the COVID-19 pandemic on the gambling behavior of individuals who were already actively engaged in such pursuits. We aimed to uncover the intricate consequences of the pandemic on this specific demographic, emphasizing the importance of understanding the complex connection between public health concerns such as the COVID-19 pandemic and gambling behavior from a public health perspective. In addition to identifying immediate impacts, this study holds significance in assessing potential long-term public health implications for the broader gambling industry. Objective: This study investigated how the COVID-19 pandemic has affected the gambling behavior of Mainland Chinese tourists in Macau from a public health perspective. We aimed to understand the changing patterns of gambling habits within this specific demographic by comparing their behavior before and during the pandemic, with a particular emphasis on the evolving dynamics of gambling and their public health consequences. This study provides a detailed exploration of the impact and implications of global health emergencies on this particular demographic’s gambling behaviors and preferences. Methods: This study used a robust cross-sectional analysis involving a sample of 334 Mainland Chinese gamblers with prior experiences in casinos in Macau. The sample deliberately encompassed individuals involved in gambling before and during the COVID-19 pandemic. Data were collected through carefully designed questionnaires to gather information on gambling habits, preferences, and observed behavioral changes in the sample. Results: This study unveiled a notable shift in Mainland Chinese gamblers’ behavior during the COVID-19 pandemic. A considerable number of participants opted for web-based platforms over traditional land-based casinos, resulting in reduced budgets, less time spent on gambling, and decreased participation in social gambling. Remarkably, there was a notable surge in online gambling, indicating a noteworthy adaptability of gamblers to changing circumstances. These findings emphasize the dynamic nature of gambling habits during global public health emergencies, revealing the resilient and evolving preferences of Mainland Chinese gamblers in response to the challenges posed by the pandemic. Conclusions: This study highlights the negative impact of the COVID-19 pandemic on casino gambling, notably evident in a significant decline in Mainland Chinese tourists visiting Macau for gambling. There is a noticeable shift from traditional gambling to web-based alternatives, with individuals seeking options within the pandemic constraints. Furthermore, the findings point out an increase in gambling among the younger generation and behavioral changes in individuals with mood disorders. The findings of this study emphasize the critical need for proactive measures to address evolving gambling preferences and associated risks during public health crises; furthermore, these findings underscore the importance of adaptive strategies within the gambling industry, as well as the necessity for effective public health interventions and regulatory frameworks to respond to unprecedented challenges with efficacy and precision. %M 38648630 %R 10.2196/45700 %U https://formative.jmir.org/2024/1/e45700 %U https://doi.org/10.2196/45700 %U http://www.ncbi.nlm.nih.gov/pubmed/38648630 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51779 %T How a National Organization Works in Partnership With People Who Have Lived Experience in Mental Health Improvement Programs: Protocol for an Exploratory Case Study %A Robertson,Ciara %A Hibberd,Carina %A Shepherd,Ashley %A Johnston,Gordon %+ Faculty of Health Sciences and Sport, University of Stirling, Pathfoot building, Stirling, FK9 4LA, United Kingdom, 44 1786 466334, carina.hibberd@stir.ac.uk %K partnership %K engagement %K case study %K mental health %K improvement %K national program %K quality improvement %D 2024 %7 19.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: This is a research proposal for a case study to explore how a national organization works in partnership with people with lived experience in national mental health improvement programs. Quality improvement is considered a key solution to addressing challenges within health care, and in Scotland, there are significant efforts to use quality improvement as a means of improving health and social care delivery. In 2016, Healthcare Improvement Scotland (HIS) established the improvement hub, whose purpose is to lead national improvement programs that use a range of approaches to support teams and services. Working in partnership with people with lived experience is recognized as a key component of such improvement work. There is, however, little understanding of how this is manifested in practice in national organizations. To address gaps in evidence and strengthen a consistent approach, a greater understanding is required to improve partnership working. Objective: The aim of this study is to better understand how a national organization works in partnership with people who have lived experience with improvement programs in mental health services, exploring people’s experiences of partnership working in a national organization. An exploratory case study approach will be used to address the research questions in relation to the Personality Disorder (PD) Improvement Programme: (1) How is partnership working described in the PD Improvement Programme? (2) How is partnership working manifested in practice in the PD Improvement Programme? and (3) What factors influence partnership working in the PD Improvement Programme? Methods: An exploratory case study approach will be used in relation to the PD Improvement Programme, led by HIS. This research will explore how partnership working with people with lived experience is described and manifested in practice, outlining factors influencing partnership working. Data will be gathered from various qualitative sources, and analysis will deepen an understanding of partnership working. Results: This study is part of a clinical doctorate program at the University of Stirling and is unfunded. Data collection was completed in October 2023; analysis is expected to be completed and results will be published in January 2025. Conclusions: This study will produce new knowledge on ways of working with people with lived experience and will have practical implications for all improvement-focused interventions. Although the main focus of the study is on national improvement programs, it is anticipated that this study will contribute to the understanding of how all national public service organizations work in partnership with people with lived experience of mental health care. International Registered Report Identifier (IRRID): DERR1-10.2196/51779 %M 38640479 %R 10.2196/51779 %U https://www.researchprotocols.org/2024/1/e51779 %U https://doi.org/10.2196/51779 %U http://www.ncbi.nlm.nih.gov/pubmed/38640479 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51542 %T The Effect of a Combined Intermittent Fasting Healthy Plate Intervention on Anthropometric Outcomes and Body Composition Among Adults With Overweight and Obesity: Nonrandomized Controlled Trial %A Abdullah,Shazana Rifham %A Wan Mohd Zin,Ruziana Mona %A Azizul,Nur Hayati %A Sulaiman,Nur Suffia %A Khalid,Norhayati Mustafa %A Mohd Salim Mullahi Jahn,Roshan Jahn %A Khalil,Muhamad Khairul Nazrin %A Abu Seman,Norhashimah %A Zainal Abidin,Nur Azlin %A Ali,Azizan %A Tan,You Zhuan %A Omar,Azahadi %A Seman,Zamtira %A Yahya,Abqariyah %A Md Noh,Mohd Fairulnizal %+ Nutrition, Metabolism and Cardiovascular Research Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health, Persiaran Setia Murni, Setia Alam, Shah Alam, 40170, Malaysia, 60 333627487, shazana.a@moh.gov.my %K intermittent fasting %K dry fasting %K healthy plate %K obesity %K overweight %D 2024 %7 10.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adult obesity and overweight pose a substantial risk to global public health and are associated with various noncommunicable diseases. Although intermittent fasting (IF) is increasingly used as a relatively new dietary strategy for weight loss, the effectiveness of 2 days per week of dry fasting remains unknown. Objective: This study aims to evaluate the effectiveness of a combined dry IF and healthy plate (IFHP) and healthy plate (HP) intervention in improving anthropometric outcomes and body composition. Methods: This nonrandomized controlled trial involved 177 adults who were overweight and obese. Among them, 91 (51.4%) were allocated to the IFHP group and 86 (48.6%) were allocated to the HP group. The overall study duration was 6 months (October 2020 to March 2021). The intervention was divided into 2 phases: supervised (3 months) and unsupervised (3 months). The data were collected at baseline, after the supervised phase (month 3), and after the unsupervised phase (month 6). Anthropometric (weight, height, waist circumference, and hip circumference) and body composition (body fat percentage, body fat mass, skeletal muscle mass, and visceral fat area) data were measured at all 3 data collection points. Sociodemographic data were obtained using a questionnaire at baseline. Results: Most participants were female (147/177, 83.1%) and Malay (141/177, 79.7%). After 3 months, there were significant reductions in weight (difference −1.68; P<.001), BMI (difference −0.62; P<.001), body fat percentage (difference −0.921; P<.001), body fat mass (difference −1.28; P<.001), and visceral fat area (difference −4.227; P=.008) in the IFHP group, whereas no significant changes were observed in the HP group. Compared to baseline, participants in the IFHP group showed a significant decrease in weight (difference −1.428; P=.003), BMI (difference −0.522; P=.005), body fat percentage (difference −1.591; P<.001), body fat mass (difference −1.501; P<.001), visceral fat area (difference −7.130; P<.001), waist circumference (difference −2.304; P=.001), and hip circumference (difference −1.908; P=.002) at month 6. During the unsupervised phase, waist (IFHP difference −3.206; P<.001, HP difference −2.675; P=.004) and hip (IFHP difference −2.443; P<.001; HP difference −2.896; P<.001) circumferences were significantly reduced in both groups (P<.01), whereas skeletal muscle mass (difference 0.208; P=.04) and visceral fat area (difference −2.903; P=.003) were significantly improved in the IFHP group only. No significant difference in the between-group comparison was detected throughout the intervention (all P>.05). Conclusions: A combined IFHP intervention was effective in improving anthropometric outcomes and body composition in adults with overweight and obesity. International Registered Report Identifier (IRRID): RR2-10.2196/33801. %M 38598283 %R 10.2196/51542 %U https://formative.jmir.org/2024/1/e51542 %U https://doi.org/10.2196/51542 %U http://www.ncbi.nlm.nih.gov/pubmed/38598283 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51848 %T Exploring the Implementation of Shared Decision-Making Involving Health Coaches for Diabetes and Hypertension Self-Management: Qualitative Study %A Yoon,Sungwon %A Tan,Chao Min %A Phang,Jie Kie %A Liu,Venice Xi %A Tan,Wee Boon %A Kwan,Yu Heng %A Low,Lian Leng %+ Duke-NUS Medical School, 8 College Rd, Singapore, 169857, Singapore, 65 65167666, sungwon.yoon@duke-nus.edu.sg %K decision-making %K diabetes %K health coach %K health coaching %K healthcare professional %K hypertension %K patient %K patient-centered care %K person-centered care %K qualitative research %K self-management %K shared decision-making %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: An emerging focus on person-centered care has prompted the need to understand how shared decision-making (SDM) and health coaching could support self-management of diabetes and hypertension. Objective: This study aims to explore preferences for the scope of involvement of health coaches and health care professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs. Methods: We conducted focus group discussions with 39 patients with diabetes and hypertension and 45 HCPs involved in their care. The main topics discussed included the roles of health coaches and HCPs in self-management, views toward health coaching and SDM, and factors that should be considered for optimal implementation of SDM that involves health coaches. All focus group discussions were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Participants agreed that the main responsibility of HCPs should be identifying the patient’s stage of change and medication education, while health coaches should focus on lifestyle education, monitoring, and motivational conversation. The health coach was seen to be more effective in engaging patients in lifestyle education and designing goal management plans as health coaches have more time available to spend with patients. The importance of a health coach’s personal attributes (eg, sufficient knowledge of both medical and psychosocial management of disease conditions) and credentials (eg, openness, patience, and empathy) was commonly emphasized. Participants viewed that addressing the following five elements would be necessary for the optimal implementation of SDM: (1) target population (newly diagnosed and less stable patients), (2) commitment of all stakeholders (discrepancy on targeted times and modality), (3) continuity of care (familiar faces), (4) philosophy of care (person-centered communication), and (5) faces of legitimacy (physician as the ultimate authority). Conclusions: The findings shed light on the appropriate roles of health coaches vis-à-vis HCPs in SDM as perceived by patients and HCPs. Findings from this study also contribute to the understanding of SDM on self-management strategies for patients with diabetes and hypertension and highlight potential opportunities for integrating health coaches into the routine care process. %M 38573763 %R 10.2196/51848 %U https://formative.jmir.org/2024/1/e51848 %U https://doi.org/10.2196/51848 %U http://www.ncbi.nlm.nih.gov/pubmed/38573763 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51084 %T Development of a Core Outcome Set for Family and Community Nursing: Protocol for a Delphi Study %A Russo,Sara %A Caruso,Rosario %A Conte,Gianluca %A Magon,Arianna %A Vangone,Ida %A Bascape',Barbara %A Maga,Giulia %A Pasek,Malgorzata %A Arrigoni,Cristina %+ Department of Biomedicine and Prevention, University of Rome Tor Vergata, Via Montpellier, 1, Rome, 00133, Italy, 39 0382433709, sara.russo@grupposandonato.it %K clinical knowledge %K core outcomes set %K Delphi survey %K family and community nurse %K health interventions %K health promotion %K primary care %K stakeholder engagement %D 2024 %7 29.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Family and community nurses (FCNs) play a crucial role in delivering primary care to patients within their homes and communities. A key aspect of their role involves various health interventions, which are influenced by their unique competencies, such as health promotion, advanced clinical knowledge, and strong interpersonal skills. However, it is essential to understand which specific health outcomes these interventions impact to better understand the relationship between FCNs’ skills and the health results. Objective: This study aims to outline the steps we will take to develop a set of core outcomes. These outcomes will be particularly sensitive to the health interventions carried out by FCNs, providing a clearer picture of their practice’s impact. Methods: A Delphi survey will be used for this research, conducted from January to December 2024. The process will involve 5 steps and input from 3 stakeholder categories. These stakeholders will help identify a preliminary list of outcomes that will form the basis of our core outcome set (COS). Results: This guideline will be beneficial for a wide range of stakeholders involved in COS development, including COS developers, trialists, systematic reviewers, journal editors, policy makers, and patient groups. As of January 2024, we have successfully completed the first stage of the study, with the stakeholder group approving the reported outcomes and assigning participant lists for each stakeholder group. Conclusions: This study will provide a roadmap for identifying the key health outcomes influenced by the interventions of FCNs. The multistakeholder, multiphase approach will ensure a comprehensive and inclusive process. Ultimately, the findings will enhance our understanding of FCNs’ impact on health outcomes, leading to more effective primary care strategies and policies. International Registered Report Identifier (IRRID): PRR1-10.2196/51084 %M 38551623 %R 10.2196/51084 %U https://www.researchprotocols.org/2024/1/e51084 %U https://doi.org/10.2196/51084 %U http://www.ncbi.nlm.nih.gov/pubmed/38551623 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51669 %T Health Behavior Change Intervention Preferences Expressed by American Indian Cancer Survivors From a Southwest Tribal Community: Semistructured Interview Study %A Erdrich,Jennifer %A Cordova-Marks,Felina M %A Carson,William O %A Bea,Jennifer W %A Montfort,William R %A Thomson,Cynthia A %+ Department of Surgery, College of Medicine, University of Arizona, 1501 North Campbell Avenue, Tucson, AZ, 85724-5018, United States, 1 520 626 2635, jerdrich@surgery.arizona.edu %K Native American cancer disparities %K diet %K physical activity %K prehabilitation %K native %K exercise %K fitness %K interviews %K thematic analysis %K lifestyle %K Apache %D 2024 %7 27.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: While many factors, including social determinants of health, affect cancer mortality, one modifiable risk factor that may contribute to cancer disparities is obesity. The prevalence of obesity in the American Indian/Alaska Native population is 48.1% per the Centers for Disease Control and Prevention. The overall cancer mortality for the American Indian/Alaska Native population is 18% higher than the White population as reported by the American Cancer Society. Interventions tailored to American Indian/Alaska Native communities that promote healthy lifestyle behaviors after cancer diagnosis and prior to cancer surgery (prehab) might improve cancer outcomes for this population. Objective: The aim of the study is to characterize the lifestyle behaviors of San Carlos Apache cancer survivors and identify preferences for the adaption of a prehab intervention. Methods: Semistructured interviews and validated questionnaires were completed with San Carlos Apache cancer survivors (N=4), exploring their viewpoints on healthy lifestyle and cancer risk and preferences for program development. A thematic content analysis was conducted. Results: Participants had an average BMI of 31 kg/m2 and walked 53 minutes daily. The majority of participants reported a high willingness to change eating habits (n=3, 75%). All 4 reported willingness to participate in a diet and exercise program. Important themes and subthemes were identified: (1) cancer is perceived as a serious health condition in the community (N=4, 100%); (2) environmental exposures are perceived as cancer-causing threats (n=3, 75%); (3) healthy diet, exercise, and avoiding harmful substances are perceived as mitigating cancer risk (n=3, 75%); (4) barriers to healthy habits include distance to affordable groceries (n=3, 75%) and lack of transportation (n=2, 50%); (5) there is high interest in a prehab program geared toward patients with cancer (N=4, 100%); and (6) standard monitoring practiced in published prehab programs showed early acceptability with participants (N=4, 100%). Conclusions: Collaboration with tribal partners provided important insight that can help inform the adaptation of a culturally appropriate prehab program for San Carlos Apache patients diagnosed with cancer. %M 38536214 %R 10.2196/51669 %U https://formative.jmir.org/2024/1/e51669 %U https://doi.org/10.2196/51669 %U http://www.ncbi.nlm.nih.gov/pubmed/38536214 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55701 %T Comparison of Spontaneous Pushing and Directed Pushing During the Second Stage of Labor Among Chinese Women Without Epidural Analgesia: Protocol for a Noninferior Feasibility Study %A Yao,Jiasi %A Roth,Heike %A Anderson,Debra %A Lu,Hong %A Rong,Huijuan %A Baird,Kathleen %+ Faculty of Health, University of Technology Sydney, 235 Jones Street, Ultimo, Sydney, 2007, Australia, 61 0415 786 708, jiasi.yao@student.uts.edu.au %K spontaneous pushing %K directed pushing %K labour stage, labour %K labor %K obstetric %K obstetrics %K child %K birth %K delivery %K second %K feasibility study %K China %K Chinese %K women %K protocol %K maternal-neonatal outcomes %K maternal %K healthcare %K labouring women %K cohort %K effectiveness %K Midwives %K midwife %K midwifery %K childbirth %D 2024 %7 26.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Maternal pushing during the second stage of labor could influence labor progress and maternal-neonatal outcomes. Although the image of health care providers directing the laboring women to push during the second stage of labor could be commonly observed globally, this practice is not sufficiently researched and is questioned regarding its effectiveness and outcomes on the mother and baby. Meanwhile, a strategy referred to as “spontaneous pushing,” which supports women to push by following their bodily urges, has been evaluated in several trials. However, in China, spontaneous pushing is not common practice. Notwithstanding the evaluation of spontaneous pushing, there is a lack of high-quality evidence to support either strategies of directed pushing or spontaneous pushing. Objective: This study aims to test the feasibility of a future randomized controlled trial to compare the effects of spontaneous pushing and directed pushing during the second stage of labor for maternal and neonatal outcomes in China. Methods: A nonrandomized, single-group, noninferiority feasibility study will be conducted in a public hospital in Hebei Province, China. In total, 105 women meeting the selection criteria will be recruited to receive the intervention (spontaneous pushing), while 105 sets of medical notes from women who received routine care (directed pushing) will be identified and reviewed to compare outcomes for both cohorts. A mixed methods approach will be used to assess primary outcomes (feasibility and acceptability) and secondary outcomes (effectiveness). Results: Data collection took place between May and October 2023. A total of 110 women were invited to participate in the intervention of spontaneous pushing. Midwives’ interviews were conducted and will be transcribed for analysis in March 2024. The data analysis is planned to be completed by May 2024. Conclusions: This feasibility study will provide important information by conducting a full-scale clinical trial in the future as well as the potential facilitators and barriers of it. A future randomized controlled trial is likely to have considerable policy and funding impacts regarding pushing management during the second stage of labor and improvement in women’s childbirth experience. Trial Registration: Chinese Clinical Trial Register ChiCTR2300071178; https://tinyurl.com/mudtnbft International Registered Report Identifier (IRRID): DERR1-10.2196/55701 %M 38530330 %R 10.2196/55701 %U https://www.researchprotocols.org/2024/1/e55701 %U https://doi.org/10.2196/55701 %U http://www.ncbi.nlm.nih.gov/pubmed/38530330 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53353 %T Factors Associated With Perception of Stigma Among Parents of Children With Cleft Lip and Palate: Cross-Sectional Study %A Zhang,Yanan %A Zhang,Xinwen %A Jiang,Jinzhuo %A Xie,Wanhua %A Xiang,Daoman %+ Outpatient Department, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangdong Provincial Clinical Research Center for Child Health, 9 Jinsui Road, Guangzhou, 510623, China, 1 13725370379, xiewanhua1@126.com %K stigma %K social anxiety %K depression %K parents of children with cleft lip and palate %K cleft lip %K cleft palate %K cross-sectional study %D 2024 %7 4.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Parents of children with cleft lip with or without cleft palate (CL/P) often face stigmatization, which has a significant impact on their quality of life and mental health. However, to date, there is a lack of comprehensive, multicenter empirical research on parents of children with CL/P in China, particularly those with large-scale samples. Objective: This study aimed to identify major factors that contribute to the perception of stigma experienced by parents of children with CL/P. Methods: A cross-sectional survey was conducted. A total of 104 parents of children diagnosed with CL/P in 2 hospitals were selected by convenience sampling. Demographics and disease information, the Chinese Perception of Stigma Questionnaire, the Center for Epidemiological Studies Depression Scale, and the Social Anxiety Scale were used in this study. Descriptive statistics, t tests, and one-way ANOVA were used to compare the differences between participants’ demographic information and perception of stigma. Multivariable linear regression was performed to assess associations between demographic factors, social anxiety, depression, and perception of stigma. Results: The mean scores for the dimensions of perception of stigma, depression, and social anxiety were 22.97 (SD 9.21), 38.34 (SD 8.25), and 22.86 (SD 6.69), respectively. Depression and social anxiety were positively associated with discrimination, while surgery status was a negatively associated variable. Parents with a college education or higher had significantly lower levels of perceived stigma compared to parents with a junior high school education (all P values <.05). These 4 factors explained 40.4% of the total model variance (F8=9.726; P<.001; R2=0.450; adjusted R2=0.404). Conclusions: Our findings highlight a concerning trend of diminished quality of life among parents of children with CL/P. Factors such as parents’ education level, surgery status, depression, and social anxiety are shown to influence the level of stigma experienced. Implementing comprehensive nursing care and providing presurgical support are effective strategies for alleviating parents’ social anxiety, reducing perceived stigma, and preventing depression. %M 38437002 %R 10.2196/53353 %U https://formative.jmir.org/2024/1/e53353 %U https://doi.org/10.2196/53353 %U http://www.ncbi.nlm.nih.gov/pubmed/38437002 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50827 %T Medical Students’ Perceptions on Identifying and Addressing Emotional Responses in Emergency Medicine: Pilot Investigation %A Agarwal,Anish Kumar %A Gonzales,Rachel %A Munden,Cory %A Albright,DaCarla %A Tsao,Suzana %+ Department of Emergency Medicine, University of Pennsylvania, 423 Guardian Drive, 410 Blockley Hall, Philadelphia, PA, 19104, United States, 1 215 573 6784, anish.agarwal@pennmedicine.upenn.edu %K well-being %K burnout %K medical education %K coping %K student %K students %K university %K college %K acute care %K trauma %K traumatic %K emotion %K emotional %K stress %K distress %K psychological %K cross-sectional %K survey %K surveys %K critical %K critically %K perception %K perspectives %K prepared %K preparedness %D 2024 %7 10.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Training in acute care, such as emergency medicine (EM), where exposure to critically ill and injured patients is high, impacts the well-being of trainees and contributes to burnout. Investigating how, and if, trainees prepare for these situations is necessary to ensure they are supported. Objective: This study aimed to evaluate medical students’ perspectives and emotional preparedness for handling acute care and trauma. Methods: We conducted a pilot investigation using a remote digital survey of medical students during their EM clerkship at a large, urban academic institution. The primary outcome of interest was student-reported preparedness and comfort in handling trauma and critical care patient encounters. Secondary outcomes included awareness of well-being resources and comfort in accessing digital well-being resources. Results: A total of 57 medical students completed the voluntary digital survey, and half of the students (n=28, 49%) reported having witnessed the care of a critically ill or a penetrating trauma patient (eg, a victim of gun violence). A majority (n=40, 70%) had thought about how these events may impact them, and over half felt unprepared to identify the emotional impact these cases may have on them (n=31, 54%) or address the emotional or mental health impact (n=36, 63%). Less than a quarter (n=14, 25%) were aware of digital mental health resources, and 58% (n=33) did not feel fully comfortable connecting with resources if needed. Students who had previously witnessed critical care were significantly more likely to report feeling well prepared in identifying the emotional impact and addressing this impact. Conclusions: In this cross-sectional survey, students did not feel fully prepared to identify or address the emotional impact of working in EM. Additionally, they lacked awareness of or comfort with accessing digital institutional resources meant to support their well-being, such as a large web-based platform. These findings can help inform and guide interventions by educational and academic leaders. The aim would be to create and promote environments that empower students with tools to identify their own emotions and connect to well-being resources. %M 38198202 %R 10.2196/50827 %U https://formative.jmir.org/2024/1/e50827 %U https://doi.org/10.2196/50827 %U http://www.ncbi.nlm.nih.gov/pubmed/38198202 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46631 %T Parent Perceptions of Trainees in Pediatric Care: Cross-Sectional Study %A Strouf Motley,Haley %A Kerr,Bradley %A Sklansky,Daniel J %A Eickhoff,Jens %A Moreno,Megan A %A Babal,Jessica C %+ Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI, 53792, United States, 1 6082852942, hstrouf@wisc.edu %K latent class analysis %K medical student %K resident %K trainee %K medical education %K trust %K comfort %K parents %K pediatrics %K parent perception %K pediatric care %K clinical autonomy %D 2023 %7 13.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinical experience and progressive autonomy are essential components of medical education and must be balanced with patient comfort. While previous studies have suggested that most patients accept trainee involvement in their care, few studies have focused specifically on the views of parents of pediatric patients or examined groups who may not report acceptance. Objective: This study aims to understand parental profiles of resident and medical student involvement in pediatric care and to use latent class analysis (LCA) methodology to identify classes of responses associated with parent demographic characteristics. Methods: We used data from a national cross-sectional web-based survey of 3000 parents. The survey used a 5-point Likert scale to assess 8 measures of parent perceptions of residents and medical students. We included participants who indicated prior experience with residents or medical students. We compared responses about resident involvement in pediatric care with responses about student involvement, used LCA to identify latent classes of parent responses, and compared demographic features between the latent classes. Results: Of the 3000 parents who completed the survey, 1543 met the inclusion criteria for our study. Participants reported higher mean scores for residents than for medical students for perceived quality of care, comfort with autonomously performing an examination, and comfort with autonomously giving medical advice. LCA identified 3 latent classes of parent responses: Trainee-Hesitant, Trainee-Neutral, and Trainee-Supportive. Compared with the Trainee-Supportive and Trainee-Neutral classes, the Trainee-Hesitant class had significantly more members reporting age <30 years, household income < US $50,000, no college degree, and lesser desire to receive future care at a teaching hospital (all P<.05). Conclusions: Parents may prefer greater clinical autonomy for residents than medical students. Importantly, views associated with the Trainee-Hesitant class may be held disproportionately by members of historically and currently socially marginalized demographic groups. Future studies should investigate underlying reasons for trainee hesitancy in these groups, including the possibility of mistrust in medicine. %M 38090789 %R 10.2196/46631 %U https://formative.jmir.org/2023/1/e46631 %U https://doi.org/10.2196/46631 %U http://www.ncbi.nlm.nih.gov/pubmed/38090789 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47354 %T Integrated Alcohol Use and Sexual Assault Prevention Program for College Men Who Engage in Heavy Drinking: Randomized Pilot Study %A Orchowski,Lindsay M %A Merrill,Jennifer E %A Oesterle,Daniel W %A Barnett,Nancy P %A Borsari,Brian %A Zlotnick,Caron %A Haikalis,Michelle P %A Bekowitz,Alan D %+ Rhode Island Hospital, 146 West River Street, Suite 11A, Providence, RI, 02904, United States, 1 401 444 7021, lindsay_orchowski@brown.edu %K sexual assault %K alcohol use %K prevention %K student %K men %K alcoholism %K college %K intervention %K program %K peer engagement %D 2023 %7 23.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual assault is prevalent on college campuses and most commonly is perpetrated by men. Problematically, there is a dearth of evidence-based prevention programs targeting men as perpetrators of sexual aggression. The Sexual Assault and Alcohol Feedback and Education (SAFE) program is an integrated alcohol and sexual assault prevention intervention for college men who engage in heavy drinking that aims to address sexual aggression proclivity and alcohol use outcomes by incorporating social norms theory, bystander intervention, and motivational interviewing. Objective: This study aims to examine the initial feasibility-, acceptability-, and efficacy-related outcomes of a randomized pilot trial of an integrated alcohol and sexual assault prevention program for college men who engage in heavy drinking. Methods: This study included 115 college men who engaged in heavy drinking, who were randomly assigned to the SAFE program or a mindfulness-based control condition (MBCC). The feasibility of implementation, adequacy of participant retention, fidelity and competency of program administration, and satisfaction and utility of the intervention were evaluated. The primary outcomes of alcohol use and sexual aggression were evaluated at 2 and 6 months after baseline. The secondary outcomes of perceived peer norms, risks for sexual aggression, and bystander intervention were also assessed. The extent to which the motivational interviewing session with personalized normative feedback facilitated changes in the proximal outcomes of drinking intentions, motivation to change, and self-efficacy was also examined. Results: The study procedures resulted in high program completion and retention (>80%), high fidelity to the program manual (>80% of the content included), high competency in program administration, and high ratings of satisfaction and program utility in addressing sexual relationships and alcohol use. Both groups reported declines in the number of drinks per week and number of heavy drinking days. Compared with the MBCC participants, the SAFE participants reported higher motivation to change alcohol use after the program, as well as greater use of alcohol protective behavioral strategies at 6 months. Compared with the MBCC participants, the SAFE participants also reported lower perceived peer engagement in sexual coercion, perceived peer comfort with sexism, and peer drinking norms at 2 and 6 months. However, no group differences were observed in sexual aggression severity, rape myth acceptance, or the labeling of sexual consent. Results regarding bystander intervention intentions were mixed, with the MBCC group showing decreased intentions at 2 months and the SAFE group reporting increased intentions at both 2 and 6 months. Conclusions: The findings provide promising evidence for the feasibility, acceptability, utility, and preliminary efficacy of the SAFE program in reducing alcohol use and positively influencing perceived peer norms and intentions for bystander intervention among college men who drink. Trial Registration: ClinicalTrials.gov NCT05773027; https://clinicaltrials.gov/study/NCT05773027 %M 37995129 %R 10.2196/47354 %U https://formative.jmir.org/2023/1/e47354 %U https://doi.org/10.2196/47354 %U http://www.ncbi.nlm.nih.gov/pubmed/37995129 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49817 %T Demographic, Clinical, and Quality of Life Profiles of Older People With Diabetes During the COVID-19 Pandemic: Cross-Sectional Study %A Sousa,Fabianne %A de Araujo,Lucianne Nascimento %A de Oliveira,Tainá Sayuri Onuma %A Gomes,Mateus Cunha %A Ferreira,Glenda %A Aben-Athar,Cintia %A da Silva,Silvio Eder Dias %A Cruz Ramos,Aline MP %A Rodrigues,Diego Pereira %+ Nursing School, Federal University of Para, Rua Agusto Correa 1 S/N, Belém, 66075-110, Brazil, 55 91 981219404, fabiannesousa@hotmail.com %K aged %K diabetes mellitus %K COVID-19 %K cross-sectional study %K quality of life %K long COVID-19 %K diabetic %K older people %D 2023 %7 16.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Diabetes mellitus, one of the main diseases that affects the Brazilian population older than 60 years, is defined as a divergent group of metabolic disorders that present a high level of glycemia (hyperglycemia), causing damage to various organs and systems of the body, including the heart, kidneys, eyes, and nervous system. It is believed that in 2025, in Brazil alone, there will be more than 18.5 million individuals diagnosed with diabetes mellitus. Therefore, it is important to know the individuals’ quality of life in the context of life and culture. Objective: This study aimed to assess the demographic, clinical, and quality of life profiles of older adults with diabetes during the COVID-19 pandemic in a university hospital complex in the northern Amazon region. Methods: We conducted a cross-sectional, exploratory, noninterventional, descriptive, and analytical study using a nonrandom sample of 54 older people diagnosed with diabetes mellitus at the geriatrics outpatient clinic of the medium and high complexity university hospital in the western Brazilian Amazon between 2020 and 2022. We used 3 instruments, namely, a sociodemographic questionnaire, a clinical conditions questionnaire, and Diabetes-39. Qualitative data were described using absolute and relative frequencies. The Kolmogorov-Smirnov normality test was applied, and the z test was used for inferential analysis. SPSS software (version 27) was used for data analysis, and the significance level was 5%. Results: Of the 54 interviewees, the majority were women, married, retired, and had a good quality of life. Of these, 48.1% (n=26) were infected by COVID-19, 61.5% (n=16) of whom progressed to long COVID, presenting with fatigue or muscle weakness. As for the quality of life, the “social overload” (P<.001) and “sexual functioning” (P<.001) dimensions had with low scores compared to the “energy and mobility” (P=.005), “diabetes control” (P<.001), and “anxiety and worry” (P<.001) dimensions. Quality of life was negatively impacted in the “anxiety and worry” dimension. Among those affected by COVID-19, most progressed to long COVID; however, there was a lack of data on this theme in the population of older people with diabetes. Conclusions: The majority of interviewees progressed to long COVID, with their quality of life negatively impacted in the “anxiety and worry” dimension, reflecting that health actions prioritizing mental health should be implemented by health professionals. %M 37971795 %R 10.2196/49817 %U https://formative.jmir.org/2023/1/e49817 %U https://doi.org/10.2196/49817 %U http://www.ncbi.nlm.nih.gov/pubmed/37971795 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46363 %T Twice-Weekly Outpatient Rehabilitation Intervention for Young Children With Spinal Muscular Atrophy Treated With Genetic-Based Therapies: Protocol for a Feasibility Study %A Ippolito,Christina %A Canthiya,Lathushikka %A Floreani,Amanda %A Luckhart,Kathleen %A Hoffman,Andrea %A McAdam,Laura %+ Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Rd, Toronto, ON, M4G1R8, Canada, 1 416 425 6220 ext 6605, lmcadam@hollandbloorview.ca %K active rehabilitation %K atrophy %K child %K feasibility trial %K feasibility %K genetic-based %K genetic-based therapy %K infant %K occupation therapy %K pediatric %K physical therapy %K physiotherapy %K pilot trial %K rehabilitation %K spinal muscular atrophy %D 2023 %7 2.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Spinal muscular atrophy (SMA) is a progressive neuromuscular disorder that causes muscle weakness and is the leading genetic cause of infant mortality worldwide. While no definitive cure exists, the approval of 3 genetic-based therapies in Canada since 2018 has led to significant improvements in muscle function for children with SMA. With that, there are no evidence-based rehabilitation interventions and minimal evidence on the combined effects of genetic-based therapies and rehabilitation. Objective: This protocol describes the methodology to assess the feasibility of a twice-weekly outpatient rehabilitation intervention focusing on gross and fine motor function to inform the methodology and sample size of a definitive clinical trial. Methods: We will conduct a single-center nonrandomized pilot and feasibility trial to explore an outpatient rehabilitation intervention for children aged 6 months to 3 years with SMA treated with genetic-based therapies. Participation in the study will occur over a 25-week period, with a baseline assessment visit followed by a 12-week intervention period and a 12-week nonintervention period. The rehabilitation intervention comprises weekly physical and occupational therapy for 11 weeks. Assessments will occur at baseline (week 0), end of intervention or early withdrawal (week 12), and follow-up (week 24). Predetermined feasibility indicators will evaluate study feasibility across process (recruitment rates, eligibility criteria, adherence rates, retention rates, questionnaire suitability, and acceptability), resource (time, implementation, and execution), management (materials and data), and scientific (safety, tolerability, and preliminary efficacy) domains. Results: This project was funded in March 2022, and data will be collected between March 2023 and December 2023. Data analysis will occur between January 2024 and March 2024, with publication expected in the fall of 2024. The protocol for the feasibility trial will be considered successful if it meets the success criteria set out for the feasibility indicators. Indicators of specific interest include all process indicators, as well as time. Exploratory indicators will be reported. Pragmatically, the results of the feasibility trial will inform changes to the protocol and the start-up of a definitive multisite trial. Conclusions: This novel twice-weekly outpatient rehabilitation intervention will be the first step toward filling the need for an evidence-based rehabilitation intervention for children with SMA treated with genetic-based therapies. It is expected that consistent and intensive rehabilitation therapy will augment functional gains being observed in this population. In the future, a definitive trial will measure the efficacy of the intervention. Trial Registration: ClinicalTrials.gov NCT05638750; https://clinicaltrials.gov/study/NCT05638750 International Registered Report Identifier (IRRID): DERR1-10.2196/46363 %M 37917140 %R 10.2196/46363 %U https://www.researchprotocols.org/2023/1/e46363 %U https://doi.org/10.2196/46363 %U http://www.ncbi.nlm.nih.gov/pubmed/37917140 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47109 %T Transient Elastography and Video Recovery Narrative Access to Support Recovery From Alcohol Misuse: Development of a Novel Intervention for Use in Community Alcohol Treatment Services %A Rennick-Egglestone,Stefan %A Subhani,Mohsan %A Knight,Holly %A Jones,Katy A %A Hutton,Clare %A Jackson,Tracey %A Hutton,Matthew %A Wragg,Andrew %A Morling,Joanne R %A Sprange,Kirsty %A Ryder,Stephen D %+ School of Health Sciences, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 115 82 ext 30926, stefan.egglestone@nottingham.ac.uk %K recovery narrative %K recovery story %K alcohol misuse %K alcohol use disorder %K feasibility trial %K complex intervention %K KLIFAD intervention %D 2023 %7 4.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mortality from alcohol-related liver disease has risen significantly for 3 decades. Transient elastography (TE) is a noninvasive test providing a numerical marker of liver disease. Preliminary evidence suggests that TE can reduce alcohol consumption. The KLIFAD (does knowledge of liver fibrosis affect high-risk drinking behavior?) study has developed a complex intervention wherein people receiving alcohol treatment are provided with access to TE, accompanied by scripted feedback tailored to their disease state, and access to video narratives describing alcohol misuse recovery after receiving TE. Recovery narratives are included due to preliminary evidence from mental health studies which suggest that access to digital narratives describing recovery from mental health problems can help people affected by mental health problems, including through mechanisms with the potential to be transferable to an alcohol treatment setting, for example, by increasing hope for the future, enabling learning from the experience of others, or promoting help-seeking behaviors. Objective: We aimed to develop the KLIFAD intervention to the point that it could be delivered in a feasibility trial and to produce knowledge relevant to clinicians and researchers developing interventions making use of biomarkers of disease. Methods: In research activity 1, standardized scripted feedback was developed by this study, and then iterated through focus groups with people who had experienced alcohol misuse and TE, and key alcohol workers with experience in delivering TE. We report critical design considerations identified through focus groups, in the form of sensitizing concepts. In research activity 2, a video production guide was coproduced to help produce impactful video-based recovery narratives, and a patient and public involvement (PPI) panel was consulted for recommendations on how best to integrate recovery narratives into an alcohol treatment setting. We report PPI recommendations and an overview of video form and content. Results: Through research activity 1, we learnt that patient feedback has not been standardized in prior use of TE, that receiving a numeric marker can provide an objective target that motivates and rewards recovery, and that key alcohol workers regularly tailor information to their clients. Through research activity 2, we developed a video production guide asking narrators what recovery means to them, what helped their recovery, and what they have learned about recovery. We produced 10 recovery narratives and collected PPI recommendations on maximizing impact and safety. These led to the production of unplanned videos presenting caregiver and clinician perspectives, and a choice to limit narrative availability to alcohol treatment settings, where support is available around distressing content. These choices have been evaluated through a feasibility randomized controlled trial [ISRCTN16922410]. Conclusions: Providing an objective target that motivates and rewards recovery is a candidate change mechanism for complex interventions integrating biomarkers of disease. Recovery narratives can contain distressing content; intervention developers should attend to safe usage. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-054954 %M 37792440 %R 10.2196/47109 %U https://formative.jmir.org/2023/1/e47109 %U https://doi.org/10.2196/47109 %U http://www.ncbi.nlm.nih.gov/pubmed/37792440 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47887 %T Effects of Melatonin on Glycemic Variability in Type 2 Diabetes Mellitus: Protocol for a Crossover, Double-Blind, Placebo-Controlled Trial %A Martorina,Wagner %A Tavares,Almir %+ Institute of Biological Sciences, Federal University of Minas Gerais, Av Pres Antônio Carlos, 6627, Belo Horizonte, 31270-901, Brazil, 55 31 3409 5000, wmartorina@yahoo.com %K type 2 diabetes mellitus %K glycemic control %K melatonin %K randomized controlled trial %K cross-over studies %K T2DM %K glucose %K glycemic variability %K circadian rhythm %D 2023 %7 16.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Glycemic variability is recognized as a significant factor contributing to the development of micro- and macrovascular complications in individuals with type 2 diabetes mellitus (T2DM). Numerous studies have shown that melatonin, a hormone involved in regulating various biological rhythms, including those related to glucose regulation, such as hunger, satiety, sleep, and circadian hormone secretion (ie, cortisol, growth hormone, catecholamines, and insulin), is deficient in individuals with T2DM. This raises an important question: Could melatonin replacement potentially reduce glycemic variability in these patients? This warrants investigation as a novel approach to improving glycemic control and reducing the risk of complications associated with T2DM. Objective: We aimed to investigate whether melatonin replacement in individuals with T2DM who supposedly have melatonin deficiency can positively impact the regulation of insulin secretion rhythms and improve insulin sensitivity, ultimately resulting in a reduction in glycemic variability. Methods: This study will use a crossover, randomized, double-blind, placebo-controlled trial design. Patients with T2DM in group 1 will receive 3 mg of melatonin at 9:00 PM in the first week, undergo a washout period in the second week, and receive a placebo in the third week (melatonin-washout-placebo). Group 2 will be randomized to receive a placebo-washout-melatonin sequence (3 mg). Capillary blood glucose levels will be measured at 6 different times before and after meals during the last 3 days of the first and third weeks. The study aims to compare the mean differences in blood glucose levels and the coefficient of glycemic variability in patients receiving melatonin and placebo during the first and third weeks. After analyzing the initial results, the number of needed patients will be recalculated. If the recalculated number is higher than 30, new participants will be recruited. Thirty patients with T2DM will be randomized into the 2 groups: melatonin-washout-placebo or placebo-washout-melatonin. Results: Participant recruitment took place between March 2023 to April 2023. In all, 30 participants were eligible and completed the study. We expect that patients will show different glycemic variability on the days they receive placebo or melatonin. Studies on melatonin and glycemic control have shown both positive and negative results. We hope that there will be a positive outcome regarding glycemic variability (ie, a reduction in glycemic variability), as melatonin has a well-described chronobiotic effect in the literature. Conclusions: This study aims to determine whether melatonin supplementation can effectively reduce glycemic variability in patients with T2DM. The crossover design is necessary due to the multiple variables involved in the circadian variations of glucose, including diet, physical activity, sleep parameters, and pharmacological treatments. The relatively low cost of melatonin and its potential role in reducing the severe complications associated with T2DM have motivated this research effort. Furthermore, the indiscriminate use of melatonin in current times makes conducting this study essential to evaluate the effect of this substance in patients with T2DM. Trial Registration: Brazilian Registry of Clinical Trials RBR-6wg54rb; https://ensaiosclinicos.gov.br/rg/RBR-6wg54rb International Registered Report Identifier (IRRID): DERR1-10.2196/47887 %M 37410852 %R 10.2196/47887 %U https://www.researchprotocols.org/2023/1/e47887 %U https://doi.org/10.2196/47887 %U http://www.ncbi.nlm.nih.gov/pubmed/37410852 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46341 %T Exploring Caregiver Interest in and Preferences for Interventions for Children With Risk of Asthma Exacerbation: Web-Based Survey %A Pogge,Gabrielle %A Fedele,David A %A Waters,Erika A %A Maki,Julia %A Hunleth,Jean M %A Prabhakaran,Sreekala %A Bowen,Deborah J %A Shepperd,James A %+ Division of Public Health Sciences, Washington University in St Louis, 660 S Euclid Ave, St Louis, MO, 63104, United States, 1 7326890430, waterse@wustl.edu %K asthma %K children %K caregivers %K decision-making %K intervention %K asthma exacerbations %D 2023 %7 2.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Maintaining control of asthma symptoms is the cornerstone of asthma treatment guidelines in the United States. However, suboptimal asthma control and asthma exacerbations among young people are common and are associated with many negative outcomes. Interventions to improve asthma control are needed. For such interventions to be successful, it is necessary to understand the types of interventions that are appealing to caregivers of children with different levels of risk of exacerbation. Objective: This study aimed to evaluate whether caregivers of children with high (vs low) risk of asthma exacerbation show different levels of interest in and preferences for potential intervention programs and delivery methods. Methods: We contracted with Ipsos to administer a web-based survey to caregivers of children with asthma who were residing in the United States. Caregivers (N=394) reported their interest (1=not at all; 3=a lot) in 9 possible intervention programs and 8 possible intervention delivery methods. Caregivers also indicated their preferences by selecting the 3 intervention programs and 3 delivery methods that “most” interested them. Finally, caregivers completed 2 open-ended questions asking what other resources might be useful for managing their children’s asthma. We classified children as having a high risk of exacerbation if they had an exacerbation in the past 3 months (n=116) and a low risk of exacerbation if otherwise (n=278). Results: Caregivers reported higher levels of interest in all intervention programs and delivery methods if they cared for a child with a high risk rather than a low risk of exacerbation. However, regardless of the child’s risk status, caregivers expressed the highest levels of interest in programs to increase their child’s self-management skills, to help pay for asthma care, and to work with the school to manage asthma. Caregivers expressed the highest levels of interest in delivery methods that maintained personal control over accessing information (websites, videos, printed materials, and smartphone apps). Caregivers’ preferences were consistent with their interests; programs and delivery methods that were rated as high in interest were also selected as one of the 3 that “most” interested them. Although most caregivers did not provide additional suggestions for the open-ended questions, a few caregivers suggested intervention programs and delivery methods that we had not included (eg, education about avoiding triggers and medication reminders). Conclusions: Similar interests and preferences among caregivers of children with high and low risk of exacerbation suggest a broad need for support in managing childhood asthma. Providers could help caregivers by directing them toward resources that make asthma care more affordable and by helping their children with asthma self-management. Interventions that accommodate caregivers’ concerns about having personal control over access to asthma information are likely to be more successful than interventions that do not. %M 37531188 %R 10.2196/46341 %U https://formative.jmir.org/2023/1/e46341 %U https://doi.org/10.2196/46341 %U http://www.ncbi.nlm.nih.gov/pubmed/37531188 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46476 %T Determinants of Inadequate Health Literacy Among Faculty of Medical Technical Sciences Students in Albania: Cross-Sectional Survey %A Rustami,Etleva %A Toçi,Dorina %A Poshi,Klodiana %A Peka,Elida %A Pano,Irida %A Pula,Alma %+ Department of Clinical Subject, University of Medicine Tirane, Rr Rexhep Jella Selite, RR Dibres Tirane, Tirane, 1005, Albania, 355 692217426, etleva.rustami@umed.edu.al %K Albania %K health literacy %K nursing %K prevalence %K sociodemographic factors %K students %K Faculty of Medical Technical Sciences %K FMTS %D 2023 %7 18.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Health literacy (HL) refers to people’s ability to find, understand, and use health information in order to make appropriate health decisions. Health literacy among students is important so that tomorrow’s health professionals can deliver high-quality health care and enhance patient education and communication. Objective: In this context, the aim of this study was to assess the HL level of Faculty of Medical Technical Sciences (FMTS) students in order to shed light on this underresearched topic in Albanian settings. Methods: A cross-sectional study involving 193 FMTS students of various study branches (nursing, midwifery, physiotherapy, and laboratory technician) was carried out during June 22-29, 2022, on the premises of the FMTS Faculty in Tirana, Albania. The international European Health Literacy Survey Questionnaire (HLS-EU-Q) standardized questionnaire, validated in Albanian, was used to collect information about FMTS students’ general HL through a face-to-face interview. Basic sociodemographic information was collected as well. Binary logistic regression was used to assess the factors associated with inadequate, problematic, or limited HL. Results: The mean level of general HL was 37.2 (on a scale from 0 [minimum HL] to 50 [maximal HL]). About one-quarter of FMTS students had inadequate (9/193, 4.7%) or problematic (38/193, 19.7%) HL, 51.3% (99/193) had sufficient HL, and 24.4% (47/193) had excellent HL. The prevalence of limited HL (inadequate and problematic HL) was higher among male than female students (6/12, 50% vs 41/181, 22.6%, respectively) and those with lower social and economic status. Upon adjusting for confounding effects, the only factor significantly increasing the likelihood of limited HL was male gender (odds ratio 8.13, 95% CI 1.68-39.39). Findings suggested that low social and economic status also increased the likelihood of limited HL, but such associations did not reach statistical significance. Conclusions: To our knowledge, this is the first study exploring the level of HL and its associated factors among FMTS students in Albania. The prevalence of limited HL was relatively high among FMTS students. There is a need for targeted interventions to increase the HL of nursing and midwifery students, such as the inclusion of HL subjects in the nursing curriculum. %M 37463034 %R 10.2196/46476 %U https://formative.jmir.org/2023/1/e46476 %U https://doi.org/10.2196/46476 %U http://www.ncbi.nlm.nih.gov/pubmed/37463034 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48829 %T HIV-Response Intergenerational Participation Intervention Among Black Men in Ontario, Canada: Protocol for a Pilot Intervention Study %A Etowa,Egbe B %A Boakye,Priscilla N %A Antabe,Roger %A Wong,Josephine Pui-Hing %+ Ontario HIV Treatment Network, 1300 Yonge St Suite, Toronto, ON, M4T 1X3, Canada, 1 (416) 642 6486, eetowa@torontomu.ca %K community-based participatory project %K heterosexual Black men %K HIV response %K intergenerational participation %K intervention %D 2023 %7 11.7.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Black men and their communities are more affected by HIV. Although they constitute less than 5% of the Ontarian population, they accounted for 26% of new HIV diagnoses in 2015, nearly half of which (48.6%) were attributed to heterosexual contact. HIV stigma and discrimination reinforce African, Caribbean, and Black men’s HIV vulnerability by creating unsafe environments that deter them from testing and disclosure, resulting in isolation, depression, delayed diagnosis and linkage to treatment and care, and poor health outcomes. In response to these challenges, intergenerational strategies were identified from previous community-based participatory studies as best practices to reduce HIV vulnerabilities and promote resilience among heterosexual Black men and communities. The proposed intervention is premised on this recommendation of intergenerational intervention. Objective: The overarching objective is to engage heterosexual Black men and communities in cocreating a community centered, culturally safe intergenerational intervention to reduce HIV vulnerabilities and related health disparities. Methods: We will engage 12 diverse community stakeholders in Ontario, inclusive of heterosexual Black men, in 8 weekly sessions to evaluate existing evidence of effective HIV health literacy interventions, identify essential and relevant aspects, and work collaboratively to co-design the HIV-Response Intergenerational Participation (HIP) intervention for use with Black men and communities. Next, we will recruit 24 self-identified heterosexual Black men aged 18-29, 29-49, and ≥50 years. We will pilot and evaluate the HIP intervention with 24 heterosexual Black men from these 3 age groups (split as 2 events: a total of 12 participants in person in Toronto and 12 participants on the web in Windsor, London, and Ottawa). We will use the data obtained along with questionnaires from validated scales and focus groups to evaluate the effectiveness of HIP. The data will include HIV knowledge, perceived stigma toward people living with HIV, acceptance and uptake of HIV testing, preexposure prophylaxis (PrEP), postexposure prophylaxis (PEP), and condom use. We will also collect data related to perceptions about system-level factors such as discrimination, socially misconstrued masculine identity, etc. Quantitative analysis will essentially be a univariate descriptive analysis. We will use thematic analysis to highlight the results of the focus group discussions. Finally, we will disseminate the evaluation results and engage researchers, leaders, Black men, and communities to expand the project team and scale up the intervention in Ontario and across Canada. Results: Implementation commences by May 2023, and by September 2023, we should have produced, among others, an evidence-informed HIP intervention that can be adapted for use by heterosexual Black men and communities beyond Ontario. Conclusions: The pilot intervention will strengthen critical health literacy and build resilience against HIV through intergenerational dialogue among heterosexual Black men of all ages. International Registered Report Identifier (IRRID): PRR1-10.2196/48829 %M 37432719 %R 10.2196/48829 %U https://www.researchprotocols.org/2023/1/e48829 %U https://doi.org/10.2196/48829 %U http://www.ncbi.nlm.nih.gov/pubmed/37432719 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47461 %T Assessment and Documentation of Social Determinants of Health Among Health Care Providers: Qualitative Study %A Yelton,Brooks %A Rumthao,Jancham Rachel %A Sakhuja,Mayank %A Macauda,Mark M %A Donelle,Lorie %A Arent,Michelle A %A Yang,Xueying %A Li,Xiaoming %A Noblet,Samuel %A Friedman,Daniela B %+ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Suite 557, Columbia, SC, 29208, United States, 1 803 576 5815, dfriedma@mailbox.sc.edu %K social determinants of health %K SDOH %K health equity %K Healthy People 2030 %K interviews %K thematic analysis %K health care worker %K health care provider %K health equity %K barrier %K facilitator %K qualitative study %K web-based %K patient health %K well-being %K community health status %D 2023 %7 3.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Research clearly demonstrates social determinants of health (SDOH) impact health outcomes. Provider consideration of patient SDOH in prevention and treatment planning is critical for improved health care quality and health equity. Despite awareness of the connections between SDOH and improved population health, research demonstrates few providers document patient SDOH. Objective: This qualitative study aimed to better understand the barriers and facilitators of SDOH assessment, documentation, and referral in different health care settings and roles. Methods: Individual semistructured interviews were conducted with practicing health care providers in South Carolina between August 25, 2022, and September 2, 2022. Participants were recruited via community partners’ web-based newsletters or listservs using a purposive sampling design. An interview guide with 19 questions was used to explore the following research question: How do SDOH impact patient health and what are the facilitators and barriers experienced by multidisciplinary health care providers assessing and documenting patient SDOH? Results: Participants (N=5) included a neonatal intensive care unit registered nurse, a nurse practitioner, a certified nurse midwife, a family and preventive medicine physician, and a counselor (licensed clinical social worker) with careers spanning 12 to 32 years. Participant responses are presented according to the following 5 themes: participants’ understanding of SDOH for the patient population, assessment and documentation practices, referrals to other providers and community-based resources, barriers and facilitators of SDOH assessment and documentation, and SDOH assessment and documentation training preferences. Overall, participants were aware of the importance of including patient SDOH in assessment and intervention but noted a variety of institutional and interpersonal barriers to assessment and documentation, including time constraints, perceptions of stigma around discussion of SDOH, and limited referral protocols. Conclusions: Incentivizing inclusion of patient SDOH in health care must be facilitated from the top down, so assessment and documentation can be universally implemented in a pragmatic way that works for providers in a variety of roles and settings for the betterment of health care quality, health equity, and improved population health outcomes. Partnering with community organizations can serve to augment health care organizations’ resource and referral availability for addressing patients’ social needs. %M 37399064 %R 10.2196/47461 %U https://formative.jmir.org/2023/1/e47461 %U https://doi.org/10.2196/47461 %U http://www.ncbi.nlm.nih.gov/pubmed/37399064 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e47263 %T Exploring Acceptability of Employment Interventions to Support People Living With Cancer: Qualitative Study of Cancer Survivors, Health Care Providers, and Employers %A Forcino,Rachel C %A Rotenberg,Sivan %A Morrissette,Kali J %A Godzik,Cassandra M %A Lichtenstein,Jonathan D %A Schiffelbein,Jenna E %A Stevens,Courtney J %A Sundar,Vidya %A Brucker,Debra L %A Connolly,Deirdre %A Keysor,Julie %A Lyons,Kathleen Doyle %+ Occupational Therapy Department, Massachusetts General Hospital Institute of Health Professions, 36 First Ave, Boston, MA, 02129, United States, 1 (617) 643 5372, KLyons2@MGHIHP.EDU %K cancer %K employment %K intervention development %K intervention %K people living with cancer %K cancer survivor %K health care provider %D 2023 %7 26.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Employment contributes to cancer survivors’ quality of life, but this population faces a variety of challenges when working during and after treatment. Factors associated with work outcomes among cancer survivors include disease and treatment status, work environment, and social support. While effective employment interventions have been developed in other clinical contexts, existing interventions have demonstrated inconsistent effectiveness in supporting cancer survivors at work. We conducted this study as a preliminary step toward program development for employment support among survivors at a rural comprehensive cancer center. Objective: We aimed (1) to identify supports and resources that stakeholders (cancer survivors, health care providers, and employers) suggest may help cancer survivors to maintain employment and (2) to describe stakeholders’ views on the advantages and disadvantages of intervention delivery models that incorporate those supports and resources. Methods: We conducted a descriptive study collecting qualitative data from individual interviews and focus groups. Participants included adult cancer survivors, health care providers, and employers living or working in the Vermont–New Hampshire catchment area of the Dartmouth Cancer Center in Lebanon, New Hampshire. We grouped interview participants’ recommended supports and resources into 4 intervention delivery models, which ranged on a continuum from less to more intensive to deliver. We then asked focus group participants to discuss the advantages and disadvantages of each of the 4 delivery models. Results: Interview participants (n=45) included 23 cancer survivors, 17 health care providers, and 5 employers. Focus group participants (n=12) included 6 cancer survivors, 4 health care providers, and 2 employers. The four delivery models were (1) provision of educational materials, (2) individual consultation with cancer survivors, (3) joint consultation with both cancer survivors and their employers, and (4) peer support or advisory groups. Each participant type acknowledged the value of providing educational materials, which could be crafted to improve accommodation-related interactions between survivors and employers. Participants saw usefulness in individual consultation but expressed concern about the costs of program delivery and potential mismatches between consultant recommendations and the limits of what employers can provide. For joint consultation, employers liked being part of the solution and the possibility of enhanced communication. Potential drawbacks included additional logistical burden and its perceived generalizability to all types of workers and workplaces. Survivors and health care providers viewed the efficiency and potency of peer support as benefits of a peer advisory group but acknowledged the sensitivity of financial topics as a possible disadvantage of addressing work challenges in a group setting. Conclusions: The 3 participant groups identified both common and unique advantages and disadvantages of the 4 delivery models, reflecting varied barriers and facilitators to their potential implementation in practice. Theory-driven strategies to address implementation barriers should play a central role in further intervention development. %M 37358907 %R 10.2196/47263 %U https://formative.jmir.org/2023/1/e47263 %U https://doi.org/10.2196/47263 %U http://www.ncbi.nlm.nih.gov/pubmed/37358907 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42769 %T Gait Stability Characteristics in Able-Bodied Individuals During Self-paced Inclined Treadmill Walking: Within-Subject Repeated-Measures Study %A Lu,Chenmiao %A Al-Juaid,Rawan %A Al-Amri,Mohammad %+ School of Healthcare Science, Cardiff University, Room 13.17, 13th Floor, Eastgate House, 35-43 Newport Road, Cardiff, CF24 0AB, United Kingdom, 44 (029)20 68 7115, Al-AmriM@cardiff.ac.uk %K healthy individuals %K muscle activation %K self-paced walking %K slope walking %K stability %K treadmill-based gait analysis %K virtual reality %D 2023 %7 5.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Inclined walking is a challenging task that requires active neuromuscular control to maintain stability. However, the adaptive strategies that preserve stability during inclined walking are not well understood. Investigating the effects of self-paced inclined treadmill walking on gait stability characteristics and the activation patterns of key lower limb muscles can provide insights into these strategies. Objective: The aim of this study was to investigate the effects of self-paced inclined treadmill walking on gait stability characteristics and the activation of key lower limb muscles. Methods: Twenty-eight able-bodied individuals (mean age 25.02, SD 2.06 years) walked on an augmented instrumented treadmill for 3 minutes at 3 inclination angles (−8°, 0°, and 8°) at their preferred walking speed. Changes in gait characteristics (ie, stability, walking speed, spatial-temporal, kinematic, and muscle forces) across inclination angles were assessed using a repeated measures ANOVA and the Friedman test. Results: The study revealed that inclined treadmill walking has a significant impact on gait characteristics (P<.001). Changes were observed in spatial-temporal parameters, joint angles, and muscle activations depending on the treadmill inclination. Specifically, stability and walking speed decreased significantly during uphill walking, indicating that it was the most challenging walking condition. Uphill walking also led to a decrease in spatial parameters by at least 13.53% and a 5.26% to 10.96% increase in temporal parameters. Furthermore, joint kinematics and peak activation of several muscles, including the hamstrings (biceps femoris, long head=109.5%, biceps femoris, short head=53.3%, semimembranosus=98.9%, semitendinosus=90.9%), gastrocnemius (medial gastrocnemius=40.6%, lateral gastrocnemius=35.3%), and vastii muscles (vastus intermedius=12.8%, vastus lateralis=16.7%) increased significantly during uphill walking. In contrast, downhill walking resulted in bilateral reductions in spatial-temporal gait parameters, with knee flexion increasing and hip flexion and ankle dorsiflexion decreasing. The peak activation of antagonist muscles, such as the quadriceps, tibialis anterior, and tibialis posterior, significantly increased during downhill walking (rectus femoris=97.7%, vastus lateralis =70.6%, vastus intermedius=68.7%, tibialis anterior=72%, tibialis posterior=107.1%). Conclusions: Our findings demonstrate that able-bodied individuals adopt specific walking patterns during inclined treadmill walking to maintain a comfortable and safe walking performance. The results suggest that inclined treadmill walking has the potential to serve as a functional assessment and rehabilitation tool for gait stability by targeting muscle training. Future research should investigate the effects of inclined treadmill walking on individuals with gait impairments and the potential benefits of targeted muscle training. A better understanding of the adaptive strategies used during inclined walking may lead to the development of more effective rehabilitation interventions for individuals with lower limb injuries. %M 37276010 %R 10.2196/42769 %U https://formative.jmir.org/2023/1/e42769 %U https://doi.org/10.2196/42769 %U http://www.ncbi.nlm.nih.gov/pubmed/37276010 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43636 %T Cognitive Bias Modification Training Targeting Fatigue in Patients With Kidney Disease: Usability Study %A Geerts,Jody %A Pieterse,Marcel %A Laverman,Goos %A Waanders,Femke %A Oosterom,Nicole %A Slegten,Jacqueline %A Salemink,Elske %A Bode,Christina %+ Centre for eHealth & Well-being Research, Section Psychology, Health and Technology, University of Twente, De Zul 10, Enschede, 7522 NJ, Netherlands, 31 53 489 8595, j.a.geerts@utwente.nl %K cognitive bias %K patient perspective %K qualitative study %K nephrology %K fatigue %K vitality %K acceptability %K applicability %K usability %K design %D 2023 %7 29.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Fatigue is an important symptom for many patients, including patients with kidney disease. Cognitive biases, such as attentional bias and self-identity bias, are thought to influence fatigue. Cognitive bias modification (CBM) training is a promising technique to counter fatigue. Objective: We aimed to evaluate a CBM training among patients with kidney disease and health care professionals (HCPs) and assess acceptability and applicability in the clinical setting using an iterative design process to evaluate expectations and experiences with the training. Methods: This was a longitudinal, qualitative, and multiple stakeholder–perspective usability study in which we interviewed end users and HCPs during the prototyping phase and after the end of training. We conducted semistructured interviews with 29 patients and 16 HCPs. The interviews were transcribed and analyzed thematically. Next to a general evaluation of the training, the acceptability of the training was evaluated using the Theoretical Framework of Acceptability, and applicability was assessed by evaluating obstacles and solutions for implementation in the kidney care setting. Results: Generally, participants were positive about the training and its applicability. The biggest negatives were doubts about effectiveness and annoyance about the repetitive character of CBM. Acceptability was judged with a mixed evaluation, with a negative evaluation of perceived effectiveness; mixed results for burden, intervention coherence, and self-efficacy; and positive results for affective attitude, ethicality, and opportunity costs. Barriers for applicability were patients’ varying computer skills, subjectivity of fatigue, and integration with regular treatment (eg, the role of HCPs). Possible solutions included assigning representatives among nurses, offering training on an app, and providing assistance via a help desk. The iterative design process, including repeated waves of testing user expectations and experiences, yielded complementary data. Conclusions: To the best of our knowledge, this study is the first to introduce a CBM training targeting fatigue. Furthermore, this study provides one of the first user evaluations of a CBM training, both among patients with kidney disease and their care providers. Overall, the training was evaluated positively, although acceptability showed mixed results. Applicability was positive although barriers were identified. The proposed solutions require further testing, preferably following the same frameworks, as the iteration in this study contributed positively to the quality of the training. Therefore, future research should follow the same frameworks and consider stakeholders and end users in eHealth intervention design. %M 37247217 %R 10.2196/43636 %U https://formative.jmir.org/2023/1/e43636 %U https://doi.org/10.2196/43636 %U http://www.ncbi.nlm.nih.gov/pubmed/37247217 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42666 %T Factors Associated With Limited Cancer Health Literacy Among Chinese People: Cross-sectional Survey Study %A Shan,Yi %A Ji,Meng %A Xing,Zhaoquan %A Dong,Zhaogang %+ School of Languages and Cultures, University of Sydney, A18 - Brennan MacCallum Building, Sydney, NSW 2006, Australia, 61 2 9351 4512, christine.ji@sydney.edu.au %K factor %K limited cancer health literacy %K Chinese people %K logistic regression %D 2023 %7 24.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Limited cancer health literacy may be attributed to various factors. Although these factors play decisive roles in identifying individuals with limited cancer health literacy, they have not been sufficiently investigated, especially in China. There is a pressing need to ascertain the factors that effectively identify Chinese people with poor cancer health literacy. Objective: This study aimed to identify the factor associated with limited cancer health literacy among Chinese people based on the 6-Item Cancer Health Literacy Test (CHLT-6). Methods: We first categorized Chinese study participants according to the answers provided for cancer health literacy as follows: people who provided ≤3 correct answers were labeled as having limited cancer health literacy, whereas those who provided between 4 and 6 correct answers were labeled as having adequate cancer health literacy. We then adopted logistic regression to analyze the factors that were closely related to limited cancer health literacy among at-risk study participants. Results: The logistic regression analysis identified the following factors that effectively predicted limited cancer health literacy: (1) male gender, (2) low education attainment, (3) age, (4) high levels of self-assessed general disease knowledge, (5) low levels of digital health literacy, (6) limited communicative health literacy, (7) low general health numeracy, and (8) high levels of mistrust in health authorities. Conclusions: Using regression analysis, we successfully identified 8 factors that could be used as predictors of limited cancer health literacy among Chinese populations. These findings have important clinical implications for supporting Chinese people with limited cancer health literacy through the development of more targeted health educational programs and resources that better align with their actual skill levels. %M 37223982 %R 10.2196/42666 %U https://formative.jmir.org/2023/1/e42666 %U https://doi.org/10.2196/42666 %U http://www.ncbi.nlm.nih.gov/pubmed/37223982 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41925 %T Belief in COVID-19 Conspiracy Theories, Level of Trust in Government Information, and Willingness to Take COVID-19 Vaccines Among Health Care Workers in Nigeria: Survey Study %A Oyeyemi,Sunday Oluwafemi %A Fagbemi,Stephen %A Busari,Ismaila Iyanda %A Wynn,Rolf %+ Department of Clinical Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, PO Box 6050 Langnes, Tromsø, N-9037, Norway, 47 77620888, rolf.wynn@uit.no %K COVID-19 %K vaccination %K misinformation %K conspiracy theories %K health workers %K Nigeria %K government %K information %K threat %K vaccine %K willingness %K genetic %D 2023 %7 2.5.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The World Health Organization recently declared vaccine hesitancy or refusal as a threat to global health. COVID-19 vaccines have been proven efficacious and are central to combatting the pandemic. However, many—including skilled health care workers (HCWs)—have been hesitant in taking the vaccines. Conspiracy theories spread on social media may play a central role in fueling vaccine hesitancy. Objective: The objective of this study was to investigate HCWs’ belief in COVID-19 vaccine conspiracy theories (ie, that the vaccines can alter one’s DNA or genetic information and that the vaccines contain microchips) and trust in government information on COVID-19 vaccines. Methods: Health care workers in Ondo State, Nigeria, representing different health care professions were asked to participate anonymously in an online survey. The participants were asked about their beliefs in 2 viral conspiracy theories and their trust in government information on COVID-19 vaccines. We used multivariable logistic regressions to investigate the relationships between trust in government information on COVID-19 vaccines and (1) belief in DNA alteration, (2) belief in microchip implantation through the vaccine, and (3) willingness to accept the vaccine. Results: A total of 557 HCWs (n=156, 28% men and n=395, 70.9% women) were included in the study. A total of 26.4% (n=147) of the sampled HCWs believed COVID-19 vaccines contained digital microchips, while 30% (n=167) believed the vaccines could alter one’s DNA or genetic information. The beliefs varied according to professional group, with 45.8% (55/120) and 50% (5/10) of nurses and pharmacists, respectively, believing in the DNA alteration theory and 33.3% (40/120) and 37.5% (6/16) of the nurses and laboratory scientists, respectively, believing in the microchip theory. Social media was an important source of COVID-19 information for 45.4% (253/557) of HCWs. A total of 76.2% (419/550) of the participants expressed a willingness to take the vaccine. The odds of HCWs believing that COVID-19 vaccines contained digital microchips increased significantly with decreasing level of trust in government information on COVID-19 vaccines (odds ratio [OR] 4.6, 95% CI 2.6-8.0). We made a similar finding in those who believed COVID-19 vaccines could alter DNA and genetic information (OR 5.2, 95% CI 3.1-8.8). Conclusions: Misinformation regarding COVID-19 vaccines reaches and influences HCWs. A high proportion of the sampled HCWs believed that COVID-19 vaccines contained microchips or that the vaccines could alter recipients’ DNA and genetic information. This might have negative consequences in terms of the HCWs’ own COVID-19 vaccination and their influence on other people. Lack of trust in government and its institutions might explain the belief in both conspiracy theories and vaccine hesitancy. There is a need for health care stakeholders in Nigeria and around the world to actively counteract misinformation, especially on social media, and give HCWs necessary scientifically sound information. %M 37068055 %R 10.2196/41925 %U https://formative.jmir.org/2023/1/e41925 %U https://doi.org/10.2196/41925 %U http://www.ncbi.nlm.nih.gov/pubmed/37068055 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40660 %T An Investigation of Factors Influencing the Postponement of the Use of Distributed Research Networks in South Korea: Web-Based Users’ Survey Study %A Rho,Mi Jung %A Park,Jihwan %+ Department of Computer Education, Dankook Liberal Art College, Dankook University, 119, Dandae-ro, Dongnam-gu, Cheonan-si, Chungcheongnam-do, 31116, Republic of Korea, 82 415501391, bosoagalaxy@gmail.com %K distributed research networks %K postponement %K performance risk %K workload %D 2023 %7 12.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Distributed research networks (DRNs) offer researchers the advantage of using various big data sets that are difficult to access and use. In addition, since the data are not physically exposed to the outside, it is possible to conduct research using medical data safely without data exposure. However, researchers still have difficulties and are concerned about using DRNs. Few studies involving DRNs have been conducted from the user’s viewpoint. Therefore, it is necessary to look at DRNs from the researcher’s point of view and find ways to facilitate the active use of DRNs. Objective: This study aimed to identify the factors that made researchers hesitate to use DRNs and to derive a method to facilitate active DRN use. Methods: We conducted a web-based survey of people working in the medical fields, such as hospitals and universities. We used 131 respondents’ data from a survey from December 6 to 17, 2021. We conducted multiple regression analyses to determine the factors affecting the postponement of using DRNs. In addition, 2 independent sample t tests were conducted to analyze the difference between the 2 groups according to the following factors: organization, gender, experience with DRNs, length of the research career, position, and age. Results: Performance risk (t5=2.725, P=.007) and workload from DRNs (t5=3.543, P=.001) were significantly associated with users’ postponement of DRN use. Researchers working at hospitals were found to feel more burdened by DRN use than researchers working at universities (t129=1.975, P=.05). It was also found that women perceived a higher privacy risk of DRNs than men (t129=–2.303, P=.02) and that those who had experience using DRNs delayed their use less than those without experience (t129=–4.215, P<.001). Conclusions: It is necessary to simplify the research and approval processes to reduce the performance risk and workload of research using DRNs. To optimize the process, DRN providers should develop a way to improve users’ experiences. More user-friendly functionalities should be developed from the researcher's point of view. It is necessary to continuously promote effective functionalities for DRNs to reduce concerns about privacy risks. This study identified the concerns of DRN users in terms of DRN use and suggested ways to actively use DRNs. The derived results can be reflected in planning and developing DRNs. Our research will be helpful to prepare an activation plan for DRNs. %M 37043286 %R 10.2196/40660 %U https://formative.jmir.org/2023/1/e40660 %U https://doi.org/10.2196/40660 %U http://www.ncbi.nlm.nih.gov/pubmed/37043286 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39891 %T The Factors Associated With Confidence in Using the Internet to Access Health Information: Cross-sectional Data Analysis %A Van Heel,Kasi Lou %A Nelson,Anna %A Handysides,Daniel %A Shah,Huma %+ Dr Kiran C Patel College of Osteopathic Medicine, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL, 33314-7796, United States, 1 954 262 1613, kasilouvanheel@gmail.com %K confidence %K health information access %K health information seeking %K health information sources %K internet %K health information %D 2023 %7 11.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Confidence in health information access is a measure of the perceived ability to obtain health information. One’s beliefs or perceived ability to access health information is particularly important in understanding trends in health care access. Previous literature has found that access to health information is lowest among society’s most vulnerable population groups. These groups include older, less educated, and low-income populations. While health confidence has previously been used as a scale to measure health outcomes, additional research is needed describing the demographic factors associated with users’ confidence in health information access. This may be a key component of health information seeking that affects beneficial health outcomes such as prevention and treatment. Objective: This study examines the demographic factors associated with the levels of confidence in using the internet to access health information for adults 18 years and older in the United States. Methods: Using a cross-sectional design, secondary data from the Health Information National Trends Survey (HINTS) 5, Cycle 3 (2019) were analyzed (N=5374). An ordinal regression stratified by internet use was used to determine the association between demographic characteristics and level of confidence in health information access. Results: When the internet is the primary source for health information, high school graduates (adjusted odds ratio [AOR] 0.58, 95% CI 0.37-0.89) compared to those with a college degree or more had significantly lower odds of being confident in obtaining health information. In addition, non-Hispanic Asian participants (AOR 0.44, 95% CI 0.24-0.82) compared to non-Hispanic White participants, male participants (AOR 0.72, 95% CI 0.54-0.97) compared to female participants, and those who made between US $20,000-$35,000 annually (AOR 0.55, 95% CI 0.31-0.98) compared to those who made US $75,000 or more annually had significantly lower odds of being confident in obtaining health information via the internet. Moreover, when the internet is the primary source for health information, those with health insurance had significantly higher odds of being confident in obtaining health information (AOR 2.91, 95% CI 1.58-5.34) compared to those who do not have health insurance. Lastly, a significant association was observed between confidence in health information access and primary health information source and frequency of visiting a health care provider. Conclusions: Confidence in accessing health information can differ by individual demographics. Accessing health-related information from the internet has become increasingly more common and can provide insight into health information-seeking behaviors. Further exploration of these factors can inform the science of health education by providing deeper insight into improving access to health information for vulnerable populations. %M 37040161 %R 10.2196/39891 %U https://formative.jmir.org/2023/1/e39891 %U https://doi.org/10.2196/39891 %U http://www.ncbi.nlm.nih.gov/pubmed/37040161 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43494 %T Community and Health Care Provider Perspectives on Barriers to and Enablers of Family Planning Use in Rural Sindh, Pakistan: Qualitative Exploratory Study %A Memon,Zahid Ali %A Mian,Abeer %A Reale,Sophie %A Spencer,Rachael %A Bhutta,Zulfiqar %A Soltani,Hora %+ Centre of Excellence in Women and Child health, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan, 92 3085550859, zahid.memon@aku.edu %K gender %K sexual and reproductive health %K modern contraception %K family planning %D 2023 %7 10.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Unmet need for family planning in Pakistan is high, with 17% of all married women wanting to avoid or delay pregnancy. However, they cannot owing to a lack of access to modern contraception and sociocultural hindrances. With the modern contraceptive prevalence rate stagnant at approximately 25% over the last 5 years, it is important to explore barriers and enablers to modern contraception uptake to reduce maternal and child mortality and improve reproductive health outcomes for young girls and women. Objective: A formative research approach was taken to explore community member and health care provider perspectives on access to and use of family planning methods in 2 rural districts of Sindh, Pakistan. The broader goal of this study was to provide evidence to design and implement a socioculturally appropriate family planning intervention within the existing service delivery platforms to increase modern contraceptive uptake in the context of rural Sindh. Methods: A qualitative exploratory design was used. Between October 2020 and December 2020, 11 focus group discussions and 11 in-depth interviews were conducted. Focus group discussions were held with men and women from the community, including adolescents, to build an understanding of community beliefs and concepts regarding modern contraceptive methods. In-depth interviews were conducted with health care workers and explored intersections between family planning and reproductive health service delivery at the facility and outreach levels. Results: The findings revealed that limited financial autonomy, restricted women’s mobility, discriminatory gender norms, and cultural practices left women with little opportunity for independent decision-making on the use of modern contraceptive methods. Furthermore, facility-level and supply-side barriers, including frequent stock-outs of modern contraceptives combined with a lack of capacity of health workers to provide quality family planning services and counseling, played an important role in demotivating women from seeking services. In addition, a lack of integration of family planning with maternal and child health service delivery at the health system level was emphasized as a major missed opportunity for contraceptive uptake. Several demand-side barriers to family planning uptake were also highlighted. These included husbands’ or in-laws’ disapproval, social stigma, and perceived fear of side effects regarding modern family planning method use. More importantly, a lack of adolescent-friendly reproductive health services and spaces for counseling was identified as a critical intervention area. Conclusions: This study provides qualitative evidence on issues related to the effectiveness of family planning interventions, specifically in the context of rural Sindh. The findings emphasize the need to design socioculturally appropriate and health system–relevant family planning interventions—the effectiveness of which can be improved through their integration with maternal and child health service delivery mechanisms, consistent service provision, and opportunities for the capacity building of the health care workforce. International Registered Report Identifier (IRRID): RR2-10.2196/35291 %M 36897626 %R 10.2196/43494 %U https://formative.jmir.org/2023/1/e43494 %U https://doi.org/10.2196/43494 %U http://www.ncbi.nlm.nih.gov/pubmed/36897626 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40573 %T Rethinking the Difficult Patient: Formative Qualitative Study Using Participatory Theater to Improve Physician-Patient Communication in Rheumatology %A Leung,Jerik %A Som,Avira %A McMorrow,Lily %A Zickuhr,Lisa %A Wolbers,John %A Bain,Karen %A Flood,Julia %A Baker,Elizabeth A %+ Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, United States, 1 404 727 3956, jerik.leung@emory.edu %K physician-patient communication %K arts-based education %K social determinants of health %K rheumatology %K concordance %K communication %K participatory theater %K health equity %K physician education %K interactivity %D 2023 %7 6.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Effective physician-patient communication is crucial for positive health outcomes for patients with chronic diseases. However, current methods of physician education in communication are often insufficient to help physicians understand how patients’ actions are influenced by the contexts within which they live. An arts-based participatory theater approach can provide the necessary health equity framing to address this deficiency. Objective: The aim of this study was to develop, pilot, and conduct a formative evaluation of an interactive arts-based communication skills intervention for graduate-level medical trainees grounded in a narrative representative of the experience of patients with systemic lupus erythematosus. Methods: We hypothesized that the delivery of interactive communication modules through a participatory theater approach would lead to changes in both attitudes and the capacity to act on those attitudes among participants in 4 conceptual categories related to patient communication (understanding social determinants of health, expressing empathy, shared decision-making, and concordance). We developed a participatory, arts-based intervention to pilot this conceptual framework with the intended audience (rheumatology trainees). The intervention was delivered through routine educational conferences at a single institution. We conducted a formative evaluation by collecting qualitative focus group feedback to evaluate the implementation of the modules. Results: Our formative data suggest that the participatory theater approach and the design of the modules added value to the participants’ learning experience by facilitating interconnection of the 4 communication concepts (eg, participants were able to gain insight into both what physicians and patients were thinking about on the same topic). Participants also provided several suggestions for improving the intervention such as ensuring that the didactic material had more active engagement and considering additional ways to acknowledge real-world constraints (eg, limited time with patients) in implementing communication strategies. Conclusions: Our findings from this formative evaluation of communication modules suggest that participatory theater is an effective method for framing physician education with a health equity lens, although considerations in the realms of functional demands of health care providers and use of structural competency as a framing concept are needed. The integration of social and structural contexts into the delivery of this communication skills intervention may be important for the uptake of these skills by intervention participants. Participatory theater provided an opportunity for dynamic interactivity among participants and facilitated greater engagement with the communication module content. %M 36877547 %R 10.2196/40573 %U https://formative.jmir.org/2023/1/e40573 %U https://doi.org/10.2196/40573 %U http://www.ncbi.nlm.nih.gov/pubmed/36877547 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43800 %T Prevalence and Associated Factors of Maternal Depression and Anxiety Among African Immigrant Women in Alberta, Canada: Quantitative Cross-sectional Survey Study %A Nwoke,Chinenye Nmanma %A Awosoga,Oluwagbohunmi A %A McDonald,Sheila %A Bonifacio,Glenda T %A Leung,Brenda M Y %+ Faculty of Health Sciences, University of Lethbridge, 4401 University Drive, Lethbridge, AB, T1K 3M4, Canada, 1 4035617125, chinenye.nwoke@uleth.ca %K African women %K immigrant women %K mental health %K pregnancy %K postpartum health %K depression %K anxiety %D 2023 %7 20.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Although there is a significant body of evidence on maternal mental health, an inadequate focus has been placed on African immigrant women. This is a significant limitation given the rapidly changing demographics in Canada. The prevalence of maternal depression and anxiety among African immigrant women in Alberta and Canada, as well as the associated risk factors, are not well understood and remain largely unknown. Objective: The purpose of this study was to investigate the prevalence and associated factors of maternal depression and anxiety among African immigrant women living in Alberta, Canada up to 2 years postpartum. Methods: This cross-sectional study surveyed 120 African immigrant women within 2 years of delivery in Alberta, Canada from January 2020 to December 2020. The English version of the Edinburgh Postnatal Depression Scale-10 (EPDS-10), the Generalized Anxiety Disorder-7 (GAD-7) scale, and a structured questionnaire regarding associated factors were administered to all participants. A cutoff score of 13 on the EPDS-10 was indicative of depression, while a cutoff score of 10 on the GAD-7 scale was indicative of anxiety. Multivariable logistic regression was used to determine the factors significantly associated with maternal depression and anxiety. Results: Among the 120 African immigrant women, 27.5% (33/120) met the EPDS-10 cutoff score for depression and 12.1% (14/116) met the GAD-7 cutoff score for anxiety. The majority of respondents with maternal depression were younger (18/33, 56%), had a total household income of CAD $60,000 or more (US $45,000 or more; 21/32, 66%), rented their homes (24/33, 73%), had an advanced degree (19/33, 58%), were married (26/31, 84%), were recent immigrants (19/30, 63%), had friends in the city (21/31, 68%), had a weak sense of belonging in the local community (26/31, 84%), were satisfied with their settlement process (17/28, 61%), and had access to a regular medical doctor (20/29, 69%). In addition, the majority of respondents with maternal anxiety were nonrecent immigrants (9/14, 64%), had friends in the city (8/13, 62%), had a weak sense of belonging in the local community (12/13, 92%), and had access to a regular medical doctor (7/12, 58%). The multivariable logistic regression model identified demographic and social factors significantly associated with maternal depression (maternal age, working status, presence of friends in the city, and access to a regular medical doctor) and maternal anxiety (access to a regular medical doctor and sense of belonging in the local community). Conclusions: Social support and community belonging initiatives may improve the maternal mental health outcomes of African immigrant women. Given the complexities immigrant women face, more research is needed on a comprehensive approach for public health and preventive strategies regarding maternal mental health after migration, including increasing access to family doctors. %M 36808093 %R 10.2196/43800 %U https://formative.jmir.org/2023/1/e43800 %U https://doi.org/10.2196/43800 %U http://www.ncbi.nlm.nih.gov/pubmed/36808093 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44059 %T Direct and Indirect Predictors of Medication Adherence With Bipolar Disorder: Path Analysis %A Cohen,Bar %A Sixsmith,Andrew %A Pollock Star,Ariel %A Haglili,Ophir %A O'Rourke,Norm %+ Department of Epidemiology, Biostatistics and Community Health Sciences, Ben-Gurion University of the Negev, Building M6, Room #308, P.O. Box 653, Be'er Sheva, 8421637, Israel, 972 8 6477301, ORourke@bgu.ac.il %K alcohol misuse %K bipolar disorder %K cognitive loss %K depression %K hypo/mania %K mania %K medication adherence %K mental health %K path analysis %K perceived cognitive failures %K polypharmacy %K psychiatric disorder %K psychosocial %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the efficacy of treatment and severity of symptoms, medication adherence by many with bipolar disorder (BD) is variable at best. This poses a significant challenge for BD care management. Objective: For this study, we set out to identify psychosocial and psychiatric predictors of medication adherence with BD. Methods: Using microtargeted social media advertising, we recruited an international sample of young and older adults with BD living in North America (Canada and the United States), Western Europe (eg, United Kingdom and Ireland), Australia and New Zealand (N=92). On average, participants were 55.35 (SD 9.65; range 22-73) years of age, had been diagnosed with BD 14.25 (SD 11.14; range 1-46) years ago, and were currently prescribed 2.40 (SD 1.28; range 0-6) psychotropic medications. Participants completed questionnaires online including the Morisky Medication Adherence Scale. Results: Medication adherence did not significantly differ across BD subtypes, country of residence, or prescription of lithium versus other mood stabilizers (eg, anticonvulsants). Path analyses indicate that alcohol misuse and subjective or perceived cognitive failures are direct predictors of medication adherence. BD symptoms, psychological well-being, and the number of comorbid psychiatric conditions emerged as indirect predictors of medication adherence via perceived cognitive failures. Conclusions: Alcohol misuse did not predict perceived cognitive failures. Nor did age predict medication adherence or cognitive failures. This is noteworthy given the 51-year age range of participants. That is, persons in their 20s with BD reported similar levels of medication adherence and perceived cognitive failures as those in their 60s. This suggests that perceived cognitive loss is a facet of adult life with BD, in contrast to the assumption that accelerated cognitive aging with BD begins in midlife. %M 36749623 %R 10.2196/44059 %U https://formative.jmir.org/2023/1/e44059 %U https://doi.org/10.2196/44059 %U http://www.ncbi.nlm.nih.gov/pubmed/36749623 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41193 %T Supporting Parents of Children With Type 1 Diabetes: Experiment Comparing Message and Delivery Types %A Holtz,Bree %A Mitchell,Katharine %+ Department of Advertising and Public Relations, College of Communication Arts and Sciences, Michigan State University, 404 Wilson Road, Room 309, East Lansing, MI, 48823, United States, 1 5173030159, bholtz@msu.edu %K caregiving %K children %K development %K diabetes %K diagnosis %K effectiveness %K email %K intervention %K management %K social support %K stress %K support %K type 1 diabetes %D 2023 %7 3.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Type 1 diabetes (T1D) is a chronic condition that typically affects young age group people and is estimated to afflict approximately 154,000 people younger than 20 years in the United States. Since T1D typically impacts children, parents must play an active role in helping their child manage the condition. This creates a substantial burden and responsibility for the parents. Objective: This pilot study sought to find ways to help parents with children with T1D in coping with stresses related to managing and monitoring their child’s disease by providing informational support, either about parenting a child with T1D or general parenting messages through different channels. Methods: Parents (N=120) of children with T1D were recruited through an email listserv through local T1D Facebook groups. A total of 102 participants were included in the analysis. We conducted a 2×2 experimental study over an 8-week period to test 2 types of messages (diabetes specific vs general parenting) and the medium in which the messages were delivered (Facebook vs SMS text message). Diabetes behavior, informational support, emotional support, and quality of life were the main outcomes of interest. Results: The results suggested that the participants in the diabetes message groups showed improvement in diabetes behaviors (F1,99=3.69; P=.05) and were more satisfied with the intervention (F3,98=4.59; P=.005). There were no differences between message and medium groups on informational support, emotional support, or quality of life. Conclusions: The results of this study demonstrate that the medium—Facebook or SMS text messaging—does not matter for parents’ perceptions of social support or quality of life. The diabetes message group reported higher levels of disease management. Finally, the groups with the diabetes support messages were more satisfied than those who received general parenting messages. The findings provide starting guidance for the development of social support interventions for this population. %M 36735338 %R 10.2196/41193 %U https://formative.jmir.org/2023/1/e41193 %U https://doi.org/10.2196/41193 %U http://www.ncbi.nlm.nih.gov/pubmed/36735338 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40008 %T African Immigrant Mothers’ Views of Perinatal Mental Health and Acceptability of Perinatal Mental Health Screening: Quantitative Cross-sectional Survey Study %A Nwoke,Chinenye Nmanma %A Awosoga,Oluwagbohunmi A %A McDonald,Sheila %A Bonifacio,Glenda T %A Leung,Brenda M Y %+ Faculty of Health Sciences, University of Lethbridge, 4401 University Drive West, Lethbridge, AB, T1K 3M4, Canada, 1 403 561 7125, chinenye.nwoke@uleth.ca %K African women %K perinatal mental health %K screening %K anxiety %K mental health literacy %K pregnancy %K postpartum %K depression %K acceptability %K knowledge %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Mental health disorders are the most common perinatal conditions. They affect mothers, babies, partners, and support networks. However, <15% of pregnant and postpartum women seek timely help for their mental health care. Low perinatal mental health knowledge and universal screening unacceptability are cited as important deterrents to obtaining timely mental health care. Objective: The purpose of this quantitative cross-sectional study was 2-fold: (1) to determine African immigrant mothers’ views of perinatal mental health and to identify predictors of those views and (2) to identify African immigrant mothers’ views regarding perinatal mental health screening and to determine factors associated with those views. Methods: A cross-sectional survey was conducted using a convenience sample of African immigrant women from the province of Alberta, Canada. Respondents were eligible to participate if they were aged ≥18 years, had a live birth, and the infant was aged ≤2 years. Questions were drawn from the Edinburgh Postnatal Depression Scale, the Generalized Anxiety Disorder-7 scale, and additional questions were developed using the Alberta Maternal Mental Health 2012 survey as a guide and tested to reflect the immigrant context. Descriptive and multivariable regression analyses were conducted. Results: Among the 120 respondents, 46.5% (53/114) were aged 31-35 years, 76.1% (89/117) were employed or on maternity leave, 92.5% (111/120) were married, and 55.6% (65/117) had younger infants aged 0 to 12 months. Significantly more respondents had higher levels of knowledge of postnatal (109/115, 94.8%) than prenatal (57/110, 51.2%) mental health (P<.001). Only 25.4% (28/110) of the respondents accurately identified that prenatal anxiety or depression could negatively impact child development. Personal knowledge of postpartum anxiety and depression was a significant predictor of prenatal and postnatal mental health knowledge. Most respondents strongly agreed or agreed that all women should be screened in the prenatal (82/109, 75.2%) and postnatal (91/110, 82.7%) periods. Respondents reported that their partner would be their first choice when seeking help and support. The acceptability of postnatal screening was a significant predictor of prenatal mental health knowledge (P<.001), whereas the acceptability of prenatal screening was a significant predictor of postnatal mental health knowledge (P=.03). Prenatal mental health knowledge was a significant predictor of both prenatal (P<.001) and postnatal (P=.001) screening acceptability. Conclusions: Although African mothers’ knowledge of postnatal mental health is high, their prenatal mental health knowledge and its influence on child development are limited. Perinatal mental health interventions for African immigrant mothers in Alberta should target these knowledge gaps. The high acceptability of universal perinatal mental health screening among African mothers provides a promising strategy for perinatal mental health literacy initiatives to achieve optimal perinatal mental health. %M 36705944 %R 10.2196/40008 %U https://formative.jmir.org/2023/1/e40008 %U https://doi.org/10.2196/40008 %U http://www.ncbi.nlm.nih.gov/pubmed/36705944 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39226 %T An Analysis of Power Dynamics Affecting Handwashing Interventions in Sierra Leone: Findings From a Qualitative Participatory Study %A Luetke Lanfer,Hanna %A Brew-Sam,Nicola %A Rossmann,Constanze %+ School of Public Health, Bielefeld University, Universitätsstraße 25, Bielefeld, 33615, Germany, 49 255260780, hanna.luetkelanfer@uni-bielefeld.de %K participatory approaches %K health promotion %K handwashing %K power dynamics %K Sierra Leone %D 2023 %7 27.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Handwashing is an effective and cost-efficient health behavior for preventing infectious diseases; however, its practice is shaped by multiple contextual factors and inequalities between different social groups in Sierra Leone. To address these inequalities, participatory approaches that allow a more equitable distribution of resources and the development of locally tailored interventions are increasingly used. However, social power dynamics have not been well integrated into the concept of participation, despite their known impact. Objective: We sought to investigate the role of power dynamics in participatory approaches to handwashing in Sierra Leone. Methods: From a socio-ecological perspective, this qualitative, formative interview study aimed to identify relevant actors and their power relationships before designing a participatory handwashing project in rural Sierra Leone. A field experiment with focus groups and a research diary compared the development of power dynamics in a participatory, community-driven approach with that in a nonparticipatory top-down approach. Results: According to our formative study, in community-based projects, multiple groups and actors interact directly or indirectly with each other, located within a macro level (eg, political institutions), meso level (eg, community leaders and groups), and micro level (eg, families) of a socio-ecological model. Although distinct leadership structures were noticeable and affected intervention attendance and processes of change in nonparticipatory approaches, community-led activities and handwashing increased in the participatory approach, irrespective of the leadership structure. Despite their ambivalence, the strategic inclusion of different community leaders appeared essential to enhance the value of the project, mobilize creative action, and empower lower-ranking individuals to practice handwashing. A similar ambivalent role could be observed in relation to external researchers, especially if they come from a different cultural background than the research participants, for example, from a Western country in a non-Western project setting. Although external researchers can initiate a project or provide certain resources, distinct expectations regarding their roles and resources can impact participatory efforts and power relations. Conclusions: The results highlight the advantages of participatory approaches for health promotion. Power dynamics should be a core component of continuous reflection and analysis in participatory projects. %M 36705952 %R 10.2196/39226 %U https://formative.jmir.org/2023/1/e39226 %U https://doi.org/10.2196/39226 %U http://www.ncbi.nlm.nih.gov/pubmed/36705952 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41820 %T Investigation and Countermeasures Research of Hospital Information Construction of Tertiary Class-A Public Hospitals in China: Questionnaire Study %A Shu,Chang %A Chen,Yueyue %A Yang,Huiyuan %A Tao,Ran %A Chen,Xiaoping %A Yu,Jingjing %+ Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, Wuhan, 430030, China, 86 83662495, yujingjingtjh@163.com %K public hospital %K hospital information construction %K current situation %K development %K countermeasures %D 2023 %7 20.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Medical informatization has initially demonstrated its advantages in improving the medical service industry. Over the past decade, the Chinese government have made a lot of effort to complete infrastructural information construction in the medical and health domain, and smart hospitals will be the next priority according to policies released by Chinese government in recent years. Objective: To provide strategic support for further development of medical information construction in China, this study aimed to investigate the current situation of medical information construction in tertiary class-A public hospitals and analyze the existing problems and countermeasures. Methods: This study surveyed 23 tertiary class-A public hospitals in China who voluntarily responded to a self-designed questionnaire distributed in April 2020 to investigate the current medical information construction status. Descriptive statistics were used to summarize the current configurations of hospital information department, hospital information systems, hospital internet service and its application, and the satisfaction of hospital information construction. Interviews were also conducted with the respondents in this study for requirement analysis. Results: The results show that hospital information construction has become one of the priorities of the hospitals’ daily work, and the medical information infrastructural construction and internet service application of the hospitals are good; however, a remarkable gap among the different level of hospitals can be observed. Although most hospitals had built their own IT team to undertake information construction work, the actual utilization rate of big data collected and stored in the hospital information system was not satisfactory. Conclusions: Support for the construction of information technology in primary care institutions should be increased to balance the level of development of medical informatization in medical institutions at all levels. The training of complex talents with both IT and medical backgrounds should be emphasized, and specialized disease information standards should be developed to lay a solid data foundation for data utilization and improve the utilization of medical big data. %M 36662565 %R 10.2196/41820 %U https://formative.jmir.org/2023/1/e41820 %U https://doi.org/10.2196/41820 %U http://www.ncbi.nlm.nih.gov/pubmed/36662565 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e37344 %T HIV Prevalence and Risk Factors Among Young Men Who Have Sex With Men in Southwest China: Cross-sectional Questionnaire Study %A Song,Liping %A Yu,Xiangyuan %A Su,Bing %A Geng,Wen Kui %A Lan,Guanghua %A Zhang,Xiangjun %+ Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, 881 Madison Avenue, Memphis, TN, 38163, United States, 1 901 448 1763, zxj@nevada.unr.edu %K HIV %K young men who have sex with men %K syphilis %K sexually transmitted infection %K ethnic minority %D 2023 %7 11.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous studies showed an increase in HIV prevalence among young men who have sex with men aged 25 years or younger in China. Objective: This study aimed to assess HIV prevalence and associated factors among young men who have sex with men in the Guangxi Zhuang Autonomous Region. Methods: This study was conducted in 4 cities (Guilin, Liuzhou, Beihai, and Nanning) in the Guangxi Zhuang Autonomous Region between June 2014 and May 2016. Participants were reached through web-based and site recruitment approaches. Laboratory tests were performed to detect HIV and syphilis infections. A self-administered questionnaire was used to collect data from 632 eligible young men who have sex with men. Results: The prevalence of HIV and syphilis was 9.3% (59/632) and 11.4% (72/632), respectively. Multivariable logistic analysis showed that ethnic minority (adjusted odds ratio [AOR] for Han Chinese vs other minorities 0.28, 95% CI 0.11-0.71, P=.007), receptive sexual positioning in the past 6 months (AOR 2.94, 95% CI 1.32-6.53, P=.008), current syphilis infection (AOR for individuals without vs those with infection 0.38, 95% CI 0.19-0.75, P=.005), inconsistent condom use in the past 6 months (AOR 1.91, 95% CI 1.06-3.45, P=.03), and psychotropic drug use before last anal intercourse (AOR 16.70, 95% CI 2.34-119.18, P=.005) were independently associated with HIV infection. Conclusions: There is an urgent need to scale up HIV and syphilis interventions in young men who have sex with men. Some subgroups might need specific attention for HIV prevention, including ethnic minority men, individuals with a history of sexually transmitted infections, and individuals who have been engaging in receptive anal sex. %M 36630166 %R 10.2196/37344 %U https://formative.jmir.org/2023/1/e37344 %U https://doi.org/10.2196/37344 %U http://www.ncbi.nlm.nih.gov/pubmed/36630166 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36401 %T New Heat and Moisture Exchangers for Laryngectomized Patients in Germany: Mixed Methods Study on the Expected Effectiveness %A Ahmed,Anam %A Mewes,Janne C %A Boot,Iris W A %A Vrijhoef,Hubertus J M %+ Panaxea, Science Park 400, Amsterdam, 1098 XH, Netherlands, 31 639421854, anam.ahmed@panaxea.eu %K heat and moisture exchanger %K HME %K laryngectomy %K device %K laryngeal cancer %K mixed methods %K review %K interview %K structured expert elicitation %D 2023 %7 11.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Notwithstanding the benefits of heat and moisture exchangers (HMEs) in both clinical research and practice, a gap exists between the optimal physiological humidification created through the nasal function and the humidification capacity of HMEs for patients after total laryngectomy. In this study, 5 new HMEs (Provox Life) specialized for situational use with improved humidification capacities were evaluated. Objective: This study aims to evaluate the effectiveness of the existing HMEs, assess the potential effectiveness of the new HMEs, and elicit expert judgments on the new HMEs’ expected effectiveness and impact on health care use. Methods: First, a rapid literature review (RLR) was performed to identify evidence on the clinical outcomes, health outcomes, and complications of HMEs in patients who underwent laryngectomy. Second, semistructured interviews with German experts (n=4) were conducted to validate the findings of the RLR and identify reasonable expectations regarding the potential of the new HMEs. Third, a structured expert elicitation among German experts (n=19) was used to generate quantitative evidence on the expected effectiveness of the new HMEs in clinical and health outcomes. Results: The RLR (n=10) demonstrated that HME use by patients has advantages compared with no HME use concerning breathing resistance, tracheal dryness and irritation, mucus production and plugging, frequency of cough and forced expectorations, sleep quality, voice quality, use of physiotherapy, tracheobronchitis or pneumonia episodes, quality of life, and patient satisfaction. From the expert interviews and structured expert elicitation, it was found that, on average, experts expect that compared with the second-generation HMEs, the new HMEs will lead to a decrease in tracheal dryness or irritation (51%, SD 24%, of patients), mucus plug events (33%, SD 32%, of patients), mucus production (53%, SD 22%, of patients), physiotherapy (0.74, SD 0.70, days) and pulmonary infections (34%, SD 32%) and an increase or improvement in speech quality (25%, SD 23%, of patients), social contacts (13%, SD 18%), quality of life (33%, SD 30%), and patient satisfaction (44%, SD 30%). An improvement in breathing (53%, SD 28%, of patients) and shortness of breath (48%, SD 25%, of patients) was expected. The average number of daily cough periods and forced expectorations was expected to be 2.95 (SD 1.61) and 2.46 (SD 1.42), respectively. Experts expect that, on average, less than half of the patients will experience sleeping problems (48%, SD 22%) and psychosocial problems (24%, SD 20%). Conclusions: According to German experts, it is expected that the new HMEs with improved humidification levels will lead to additional (clinical) effectiveness on pulmonary health and an improved overall quality of life of patients compared with the currently available HMEs. %M 36630171 %R 10.2196/36401 %U https://formative.jmir.org/2023/1/e36401 %U https://doi.org/10.2196/36401 %U http://www.ncbi.nlm.nih.gov/pubmed/36630171 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e39947 %T Theoretical Approach and Scale Construction of Patient Privacy Protection Behavior of Doctors in Public Medical Institutions in China: Pilot Development Study %A Xu,Jie %A Lu,Lu %A Xing,Kaichen %A Shi,Huwei %A Chen,Ruiyao %A Yao,Yujun %A Liu,Sichen %A Xiao,Zhongzhou %A Peng,Xinwei %A Luo,Shuqing %A Zhong,Yun %+ Shanghai Artificial Intelligence Laboratory, West Bank International Artificial Intelligence Center, 701 Yunjin Road, Shanghai, 200030, China, 86 021 23537800, xujie@pjlab.org.cn %K scale %K Chinese public medical institutions %K doctors’ protection behavior of patients’ privacy %D 2022 %7 14.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Considering the high incidence of medical privacy disclosure, it is of vital importance to study doctors’ privacy protection behavior and its influencing factors. Objective: We aim to develop a scale for doctors’ protection of patients’ privacy in Chinese public medical institutions, following construction of a theoretical model framework through grounded theory, and subsequently to validate the scale to measure this protection behavior. Methods: Combined with the theoretical paradigm of protection motivation theory (PMT) and semistructured interview data, the grounded theory research method, followed by the Delphi expert and group discussion methods, a theoretical framework and initial scale for doctors in Chinese public medical institutions to protect patients' privacy was formed. The adjusted scale was collected online using a WeChat electronic survey measured using a 5-point Likert scale. Exploratory and confirmatory factor analysis (EFA and CFA) and tests to analyze reliability and validity were performed on the sample data. SPSS 19.0 and Amos 26.0 statistical analysis software were used for EFA and CFA of the sample data, respectively. Results: According to the internal logic of PMT, we developed a novel theoretical framework of a “storyline,” which was a process from being unaware of patients' privacy to having privacy protection behavior, that affected doctors' cognitive intermediary and changed the development of doctors' awareness, finally affecting actual privacy protection behavior in Chinese public medical institutions. Ultimately, we created a scale to measure 18 variables in the theoretical model, comprising 63 measurement items, with a total of 208 doctors participating in the scaling survey, who were predominantly educated to the master’s degree level (n=151, 72.6%). The department distribution was relatively balanced. Prior to EFA, the Kaiser-Meyer-Olkin (KMO) value was 0.702, indicating that the study was suitable for factor analysis. The minimum value of Cronbach α for each study variable was .754, which met the internal consistency requirements of the scale. The standard factor loading value of each potential measurement item in CFA had scores greater than 0.5, which signified that all the items in the scale could effectively converge to the corresponding potential variables. Conclusions: The theoretical framework and scale to assess doctors' patient protection behavior in public medical institutions in China fills a significant gap in the literature and can be used to further the current knowledge of physicians’ thought processes and adoption decisions. %M 36515996 %R 10.2196/39947 %U https://formative.jmir.org/2022/12/e39947 %U https://doi.org/10.2196/39947 %U http://www.ncbi.nlm.nih.gov/pubmed/36515996 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e37371 %T Sleep Disorders and Quality of Life in Patients With Cancer: Prospective Observational Study of the Rafael Institute %A Scher,Nathaniel %A Guetta,Liath %A Draghi,Clément %A Yahiaoui,Safia %A Terzioglu,Mathilde %A Butaye,Emilie %A Henriques,Kathy %A Alavoine,Marie %A Elharar,Ayala %A Guetta,Andre %A Toledano,Alain %+ Integrative Medicine, Rafael Institute, 3 boulevard Bineau, Levallois-Perret, 92300, France, 33 0184007007, nathaniel.scher@gmail.com %K cancer %K sleep disorder %K sleep %K fatigue %K nocturnal %K oncology %K cancer care %K patient-centred approach %K patient-centered %K personalized %K personalization %K customized %K customization %K care plan %K quality of life %K mood %K pain %K cancer treatment %K overweight %K obese %K hormone therapy %K breast %K prostate %D 2022 %7 24.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Sleep disorders are a common occurrence in the general population. Yet today, it is clearly agreed that sleep disorders represent both a cancer risk factor and a biological consequence of the of the activation of the immuno-inflammatory system induced by cancer itself. Objective: The aim of this study was to assess the impact of sleep disorders on quality of life and identify the type of disorder and its causes in order to offer an adapted and personalized care plan. Methods: In a survey completed during the COVID-19 lockdown, 2000 hours of interviews were collected by remote consultations. During these calls, we administered a sleep questionnaire. This questionnaire was inspired by the STOP-BANG questionnaire and enquired about 6 items. The demographic details of each patient (eg, age and sex), the nature of the pathology, their past treatments, the ongoing cancer treatment, the mood, whether or not the patient is anxious or depressed, and the use of sleeping drug pills were analyzed. A univariate analysis was performed according to the presence or absence of fatigue. Chi-square test was applied to assess possible differences of variables’ link to sleep disturbance between patients complaining of fatigue and those without fatigue. The same test was then used to analyze patients on hormone therapy and those with no hormone therapy for 2 types of cancer—breast cancer and prostate cancer. Results: A total of 905 patients were prospectively included in this study. The average age was 66.7 (5 SD) years, and 606 (67%) patients were women; 142 patients declared being overweight. Breast cancer was the most frequently reported cancer. Nocturnal awakening was reported by 70% (n=633), fatigue by 50% (n=452), difficulty falling asleep by 38% (n=343), snoring reported by an independent observer in 38% (n=343), and apnea reported by an independent observer in 9% (n=81) of the patients. The univariate analysis showed that the feeling of tiredness was significantly greater in patients reporting difficulty falling asleep (P≥.99), pain (P<.001), and frequent awakening (P<.001), as well as in patients who were not receiving cancer treatment (P<.001). The univariate analysis showed that patients who were receiving breast cancer treatment and were under hormone therapy reported difficulty falling asleep (P=.04) and pain (P=.05). In a univariate analysis of patients treated for prostate cancer, being overweight was the only factor reported that had a statistically significant value. Conclusions: Our preliminary data support and are consistent with data in the literature regarding the importance of sleep disorders in oncology. This justifies the usefulness of a diagnosis and early treatment of sleep disorders in patients with cancer. The Rafael Institute sleep observatory will enable patients to be identified and treated. %M 36422866 %R 10.2196/37371 %U https://formative.jmir.org/2022/11/e37371 %U https://doi.org/10.2196/37371 %U http://www.ncbi.nlm.nih.gov/pubmed/36422866 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e29713 %T Matched Endoscopic Sleeve Gastroplasty and Laparoscopic Sleeve Gastrectomy Cases: Formative Cohort Study %A Marshall,Skye %A G Rich,Graeme %A Cohen,Felicity %A Soni,Asha %A Isenring,Elizabeth %+ Bond University Nutrition & Dietetics Research Group, Faculty of Health Sciences & Medicine, Bond University, University Drive, Gold Coast, 4116, Australia, 61 0411166230, skye_marshall@bond.edu.au %K endoscopic sleeve gastroplasty %K laparoscopic sleeve gastrectomy %K obesity %K bariatric surgery %K interdisciplinary research %K cohort study %K metabolic surgery %K weight loss %K comorbidity %K body composition %K surgery %K gastroplasty %K endoscopic surgery %K gastroenterology %K preoperative %K postoperative %K outcome %K body mass index %K sex %K age %K gastrointestinal %K prospective %D 2022 %7 24.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Bariatric weight-loss surgery rates are increasing internationally. Endoscopic sleeve gastroplasty (ESG) is a novel, minimally invasive endoscopic procedure thought to mimic some of the effects of a more common surgery, laparoscopic sleeve gastrectomy (LSG). Patient factors affecting procedural choice are unexplored. Objective: This formative study aimed to determine the preoperative and early postoperative characteristics of adults matched for age, sex, and BMI who chose ESG versus LSG. Methods: This prospective cohort study recruited ESG and matched LSG adults in Australia. Preoperative outcomes were medical history, glycemic biomarkers, blood lipids, liver function enzymes, albumin, blood pressure, hepatic steatosis index, the Gastrointestinal Symptom Rating Scale, the Impact of Weight on Quality of Life–Lite questionnaire, and body composition via dual-energy x-ray absorptiometry. Adverse events were recorded preoperatively and up to 2 weeks postoperatively. SPSS was used to test if there were differences between cohorts by comparing means or mean ranks, and binary regression was used to understand how characteristics might predict procedure choice. Results: A total of 50 (including 25 ESG and 25 LSG) patients were recruited, who were primarily White (45/50, 90%) and female (41/50, 82%) with a mean age of 41.7 (SD 9.4) years. Participants had a mean of 4.0 (SD 2.2) active comorbid conditions, with the most common being nonalcoholic fatty liver disease (38/50, 76%), back pain (32/50, 64%), anxiety or depression (24/50, 48%), and joint pain (23/50, 46%). The LSG cohort had higher hemoglobin A1c (5.3%, SD 0.2%) than the ESG cohort (5%, SD 0.2%; P=.008). There was a 2.4 kg/m2 difference in median BMI (P=.03) between the groups, but fat and fat-free mass had no meaningful differences. Comparing the LSG and ESG groups showed that the LSG group had lower total quality of life (49.5%, SD 10.6% vs 56.6%, SD 12.7%; P=.045), lower weight-related self-esteem (10.7%, IQR 3.6%-25% vs 25%, IQR 17.9%-39.3%; P=.02), and worse abdominal pain (38.9%, IQR 33.3%-50% vs 53.9%, SD 14.2%, P=.01). For every percent improvement in weight-related self-esteem, the odds for selecting ESG increased by 4.4% (95% CI 1.004-1.085; P=.03). For every percent worsening in hunger pain, the odds for selecting ESG decreased by 3.3% (95% CI 0.944-0.990; P=.004). Conclusions: There was very little evidence that Australian adults who chose an endoscopic versus surgical sleeve had different rates of comorbidities, body fat percentage, or weight-related quality of life. There was evidence against the test hypothesis, that is, there was evidence suggesting that lower self-esteem predicted choosing a more invasive sleeve (ie, LSG rather than ESG) Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12618000337279; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374595 %M 36422944 %R 10.2196/29713 %U https://formative.jmir.org/2022/11/e29713 %U https://doi.org/10.2196/29713 %U http://www.ncbi.nlm.nih.gov/pubmed/36422944 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e37101 %T Psychological Disorders of Patients With Allergic Rhinitis in Chengdu, China: Exploratory Research %A Huang,Heyin %A Wang,Yichen %A Zhang,Lanzhi %A Zhang,Qinxiu %A Wu,Xiaojuan %A He,Hengsheng %+ Department of Otolaryngology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, No. 39-41, Shierqiao Road, Jinniu District, Chengdu, 610000, China, 86 18980880173, zhqinxiu@163.com %K psychological disorders %K allergic rhinitis %K Chengdu %K China %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The number of patients with allergic rhinitis (AR) has exceeded 500 million worldwide due to the unstable curative effect that can easily produce mental and psychological disorders. However, most of the relevant existing literature is one-on-one retrospective analyses or targeted meta-analyses of AR with psychological disorders like irritability, depression, and anxiety, while “multi-hospital + interdisciplinary” multiple regression analyses are scarce. Objective: This study aims to precisely identify the psychological disorders of patients with AR who were diagnosed and treated in the five most renowned hospitals in Chengdu, China over the past 5 years using 10 classification methods so as to attract attention and care from otolaryngologists. Methods: The Symptom Checklist 90 (SCL-90) was used to group and score the mental state of 827 strictly screened patients with AR according to 9 classification criteria. The scores were then compared within groups. Intergroup comparisons were made between the study group and the Chinese norm, and the positive factors for psychological disorders were extracted. Four symptoms in the study group, that is, nasal itching, sneezing, clear discharge, and nasal congestion, were scored on a visual analog scale. Partial correlation analysis was performed between the extracted positive factors for psychological disorders and the symptom scores by the multiple regression statistical method. Results: Among 827 patients, 124 (15%) had no mental health impairments, 176 (21.3%) had mild impairments, 474 (57.3%) had mild to moderate impairments, 41 (5%) had moderate to severe impairments, and 12 (1.4%) had severe impairments. The average score of the SCL-90 for all 827 patients was 2.64 (SD 0.25), which corresponded to mild to moderate mental health impairments. The 827 patients scored significantly higher for the 4 positive factors: depression, anxiety, psychosis, and other (sleep, diet). Depression was positively correlated with sneezing and clear discharge, anxiety was positively correlated with nasal itching and congestion, psychosis was positively correlated with nasal itching and sneezing, and other (sleep, diet) was positively correlated with clear discharge and nasal congestion. Conclusions: Patients with AR have mild to moderate mental health impairments, with women and those with abnormal BMI, aged ≥45 years, with a monthly salary <¥5110 (US $700), with a disease duration <13 years, residing in urban areas, with a high school or above education, or who are indoor laborers being at high risk and requiring more care, follow-up, and comprehensive therapy from otolaryngologists. %M 36355407 %R 10.2196/37101 %U https://formative.jmir.org/2022/11/e37101 %U https://doi.org/10.2196/37101 %U http://www.ncbi.nlm.nih.gov/pubmed/36355407 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e34268 %T Factors Influencing the Adoption of Voluntary Nonpharmaceutical Interventions to Control COVID-19 in Japan: Cross-sectional Study %A Kuroki,Makoto %A Yamamoto,Kiyoshi %A Goldfinch,Shaun %+ Australia New Zealand School of Government, PO box 230, Carlton South, Victoria, Melbourne, 3053, Australia, 61 466 949 289, shaun.goldfinch@curtin.edu.au %K COVID-19 %K nonpharmaceutical interventions %K social distancing %K phone tracing %K trust in government %K confidence in scientists %D 2022 %7 2.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Trust in government is seen to facilitate crisis management and policy instrument adoption across numerous studies. However, in Japan, public support for government handling of the COVID-19 pandemic and trust in the government is low, yet the adoption of voluntary nondigital nonpharmaceutical interventions (NPIs) is high. This is an important tension this study seeks to unravel. Objective: The aim of this study is to understand the antecedents of nondigital NPI and tracking app adoption in the COVID-19 pandemic in Japan. Methods: A commercial company was contracted to deliver an online survey of 1248 Japanese citizens in December 2020. A quota technique was used to deliver a sample representative in terms of gender, age, residence, income, and education. Results: The adoption of voluntary nondigital NPIs is predicted by confidence in public health scientists and a favoring of infection control over reducing economic and social costs. A novel and unexpected finding is that trust in government does not predict nondigital NPI use. Perceived risk and knowledge of infection did not increase the use of nondigital NPIs. Education and income were not significant factors, although female and older respondents demonstrated greater compliance. For the adoption of a phone tracking app, trust in government is important, as is urban residence, albeit with a lower use of the app compared to nondigital NPIs. Conclusions: Voluntary compliance in the adoption of nondigital NPIs—if skillfully led by trusted scientific experts and in accord with societal norms—can be effectively achieved. We provide evidence that trust in government is effective in encouraging the use of the Japanese tracking app. Moreover, the technical efficacy of digital initiatives and perceptions of such will unsurprisingly affect citizen support and use of digital tools. %M 35916697 %R 10.2196/34268 %U https://formative.jmir.org/2022/8/e34268 %U https://doi.org/10.2196/34268 %U http://www.ncbi.nlm.nih.gov/pubmed/35916697 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e34044 %T Examining Hashtag Use of #blackboyjoy and #theblackmancan and Related Content on Instagram: Descriptive Content Analysis %A Williams,Kofoworola D A %A Dougherty,Sharyn A %A Lattie,Emily G %A Guidry,Jeanine P D %A Carlyle,Kellie E %+ Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, 750 North Lake Shore Drive, 10th Floor, Chicago, IL, 60660, United States, 1 312 503 2922, kofoworola.williams@northwestern.edu %K Black/African American men %K mental health prevention %K social media %K Instagram %K hashtags %K content analysis %K Black masculinity %D 2022 %7 1.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media is widely accessible and increasingly utilized. Social media users develop hashtags and visual, text-based imagery to challenge misrepresentations, garner social support, and discuss a variety of mental health issues. Understanding how Black men are represented on social media and are using social media may be an avenue for promoting their engagement with and uptake of digital mental health interventions. Objective: The aim of this study was to conduct a content analysis of posts containing visual and text-based components related to representations of Black men’s race, gender, and behaviors. Methods: An exploratory, descriptive content analysis was conducted for 500 Instagram posts to examine characteristics, content, and public engagement of posts containing the hashtags #theblackmancan and #blackboyjoy. Posts were selected randomly and extracted from Instagram using a social network mining tool during Fall 2018 and Spring 2019. A codebook was developed, and all posts were analyzed by 2 independent coders. Analyses included frequency counts and descriptive analysis to determine content and characteristics of posts. Mann-Whitney U tests and Kruskal-Wallis H tests were conducted to assess engagement associated with posts via likes, comments, and video views. Results: Of the 500 posts extracted, most were image based (368/500, 73.6%), 272/500 (54.4%) were posted by an individual and 135/500 (27.0%) by a community organization, 269/500 (53.8%) were posted by individuals from Black populations, and 177/500 (35.4%) posts contained images of only males. Posts depicted images of Black men as fathers (100/500, 20.0%), Black men being celebrated (101/500, 20.2%), and Black men expressing joy (217/500, 43.4%). Posts (127/500, 25.4%) also depicted Black men in relation to gender atypical behavior, such as caring for children or styling their children’s hair. Variables related to education and restrictive affection did not show up often in posts. Engagement via likes (median 1671, P<.001), comments (P<.001), and views (P<.001) for posts containing #theblackmancan was significantly higher compared with posts containing #blackboyjoy (median 140). Posts containing elements of celebrating Black men (P=.02) and gender atypical behavior (P<.001) also had significantly higher engagement. Conclusions: This is one of the first studies to look at hashtag use of #blackboyjoy and #theblackmancan. Posts containing #blackboyjoy and #theblackmancan promoted positive user-generated visual and text-based content on Instagram and promoted positive interactions among Black and diverse communities. With the popularity of social media and hashtag use increasing, researchers and future interventional research should investigate the potential for such imagery to serve as culturally relevant design components for digital mental health prevention efforts geared towards Black men and the communities they exist and engage with. %M 35916699 %R 10.2196/34044 %U https://formative.jmir.org/2022/8/e34044 %U https://doi.org/10.2196/34044 %U http://www.ncbi.nlm.nih.gov/pubmed/35916699 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37243 %T How Community-Based Teams Use the Stroke Recovery in Motion Implementation Planner: Longitudinal Qualitative Field Test Study %A Reszel,Jessica %A van den Hoek,Joan %A Nguyen,Tram %A Aravind,Gayatri %A Bayley,Mark T %A Bird,Marie-Louise %A Edwards,Kate %A Eng,Janice J %A Moore,Jennifer L %A Nelson,Michelle L A %A Ploughman,Michelle %A Richardson,Julie %A Salbach,Nancy M %A Tang,Ada %A Graham,Ian D %+ Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada, 1 613 737 8899, igraham@ohri.ca %K knowledge translation %K knowledge mobilization %K implementation science %K implementation planning %K stroke %K rehabilitation %K capacity building %K community-based exercise programs %D 2022 %7 29.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The Stroke Recovery in Motion Implementation Planner guides teams through the process of planning for the implementation of community-based exercise programs for people with stroke, in alignment with implementation science frameworks. Objective: The purpose of this study was to conduct a field test with end users to describe how teams used the Planner in real-world conditions; describe the effects of Planner use on participants’ implementation-planning knowledge, attitudes, and activities; and identify factors influencing the use of the Planner. Methods: This field test study used a longitudinal qualitative design. We recruited teams across Canada who intended to implement a community-based exercise program for people with stroke in the next 6 to 12 months and were willing to use the Planner to guide their work. We completed semistructured interviews at the time of enrollment, monitoring calls every 1 to 2 months, and at the end of the study to learn about implementation-planning work completed and Planner use. The interviews were analyzed using conventional content analysis. Completed Planner steps were plotted onto a timeline for comparison across teams. Results: We enrolled 12 participants (program managers and coordinators, rehabilitation professionals, and fitness professionals) from 5 planning teams. The teams were enrolled in the study between 4 and 14 months, and we conducted 25 interviews. We observed that the teams worked through the planning process in diverse and nonlinear ways, adapted to their context. All teams provided examples of how using the Planner changed their implementation-planning knowledge (eg, knowing the steps), attitudes (eg, valuing community engagement), and activities (eg, hosting stakeholder meetings). We identified team, organizational, and broader contextual factors that hindered and facilitated uptake of the Planner. Participants shared valuable tips from the field to help future teams optimize use of the Planner. Conclusions: The Stroke Recovery in Motion Implementation Planner is an adaptable resource that may be used in diverse settings to plan community-based exercise programs for people with stroke. These findings may be informative to others who are developing resources to build the capacity of those working in community-based settings to implement new programs and practices. Future work is needed to monitor the use and understand the effect of using the Planner on exercise program implementation and sustainability.  %M 35904855 %R 10.2196/37243 %U https://formative.jmir.org/2022/7/e37243 %U https://doi.org/10.2196/37243 %U http://www.ncbi.nlm.nih.gov/pubmed/35904855 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37189 %T The Stroke Recovery in Motion Implementation Planner: Mixed Methods User Evaluation %A Reszel,Jessica %A van den Hoek,Joan %A Nguyen,Tram %A Aravind,Gayatri %A Bayley,Mark T %A Bird,Marie-Louise %A Edwards,Kate %A Eng,Janice J %A Moore,Jennifer L %A Nelson,Michelle L A %A Ploughman,Michelle %A Richardson,Julie %A Salbach,Nancy M %A Tang,Ada %A Graham,Ian D %+ Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON, K1H 8L6, Canada, 1 613 737 8899, igraham@ohri.ca %K stroke %K rehabilitation %K community-based exercise programs %K knowledge translation %K knowledge mobilization %K implementation science %D 2022 %7 29.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: As more people are surviving stroke, there is a growing need for services and programs that support the long-term needs of people living with the effects of stroke. Exercise has many benefits; however, most people with stroke do not have access to specialized exercise programs that meet their needs in their communities. To catalyze the implementation of these programs, our team developed the Stroke Recovery in Motion Implementation Planner, an evidence-informed implementation guide for teams planning a community-based exercise program for people with stroke. Objective: This study aimed to conduct a user evaluation to elicit user perceptions of the usefulness and acceptability of the Planner to inform revisions. Methods: This mixed methods study used a concurrent triangulation design. We used purposive sampling to enroll a diverse sample of end users (program managers and coordinators, rehabilitation health partners, and fitness professionals) from three main groups: those who are currently planning a program, those who intend to plan a program in the future, and those who had previously planned a program. Participants reviewed the Planner and completed a questionnaire and interviews to identify positive features, areas of improvement, value, and feasibility. We used descriptive statistics for quantitative data and content analysis for qualitative data. We triangulated the data sources to identify Planner modifications. Results: A total of 39 people participated in this study. Overall, the feedback was positive, highlighting the value of the Planner’s comprehensiveness, tools and templates, and real-world examples. The identified areas for improvement included clarifying the need for specific steps, refining navigation, and creating more action-oriented content. Most participants reported an increase in knowledge and confidence after reading the Planner and reported that using the resource would improve their planning approach. Conclusions: We used a rigorous and user-centered process to develop and evaluate the Planner. End users indicated that it is a valuable resource and identified specific changes for improvement. The Planner was subsequently updated and is now publicly available for community planning teams to use in the planning and delivery of evidence-informed, sustainable, community-based exercise programs for people with stroke. %M 35904870 %R 10.2196/37189 %U https://formative.jmir.org/2022/7/e37189 %U https://doi.org/10.2196/37189 %U http://www.ncbi.nlm.nih.gov/pubmed/35904870 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 7 %P e37382 %T Using a Brief Mental Imagery Competing Task to Reduce the Number of Intrusive Memories: Exploratory Case Series With Trauma-Exposed Women %A Thorarinsdottir,Kristjana %A Holmes,Emily A %A Hardarson,Johann %A Stephenssen,Elin S %A Jonasdottir,Marianna H %A Kanstrup,Marie %A Singh,Laura %A Hauksdottir,Arna %A Halldorsdottir,Thorhildur %A Gudmundsdottir,Berglind %A Thordardottir,Edda %A Valdimarsdottir,Unnur %A Bjornsson,Andri %+ Department of Psychology, University of Iceland, Sæmundargata 12, Reykjavík, 102, Iceland, 354 5254240, kth35@hi.is %K trauma %K intrusive memories %K visuospatial task %K Tetris gameplay %K mental imagery %K imagery competing task %K case series %K mobile phone %K posttraumatic stress %D 2022 %7 20.7.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Novel interventions should be developed for people who have undergone psychological trauma. In a previous case study, we found that the number of intrusive memories of trauma could be reduced with a novel intervention. The intervention included a brief memory reminder, a visuospatial task and mental rotation, and targeted trauma memory hotspots one at a time in separate sessions. Objective: This case series (N=3) extended the first case study with 3 new cases to determine whether a similar pattern of beneficial results is observed. We explored whether the brief intervention would result in reduced numbers of intrusive memories and whether it would impact symptoms of posttraumatic stress, depression and anxiety, and general functioning. Acceptability of the intervention was also explored. Methods: A total of 3 women completed the study: 2 with posttraumatic stress disorder and other comorbidities and 1 with subthreshold posttraumatic stress disorder. The primary outcome was the change in the number of intrusive memories from the baseline phase to the intervention phase and at the 1-month follow-up, with an assessment of the intrusion frequency at 3 months. Participants monitored the number of intrusive memories in a daily diary for 1 week at baseline, for maximum of 6 weeks during the intervention phase and for 1 week at the 1-month and 3-month follow-ups. The intervention was delivered in person or digitally, with guidance from a clinical psychologist. A repeated AB design was used (A was a preintervention baseline phase and B intervention phase). Intrusions were targeted individually, creating repetitions of an AB design. Results: The total number of intrusive memories was reduced from the baseline to the intervention phase for all participants. The total number for participant 3 (P3) reduced from 38.8 per week during the baseline phase to 18.0 per week in the intervention phase. It was 13 at the 3-month follow-up. The total number for P4 reduced from 10.8 per week at baseline to 4.7 per week in the intervention phase. It was 0 at the 3-month follow-up. The total number for P5 was reduced from 33.7 at baseline to 20.7 per week in the intervention phase. It was 8 at the 3-month follow-up. All participants reported reduction in posttraumatic stress symptoms in the postintervention phase. Depression and anxiety symptoms reduced in 2 of the 3 participants in the postintervention phase. Acceptability was favorable. Conclusions: We observed good compliance with the intervention and intrusive memory diary in all 3 cases. The number of intrusive memories was reduced for all participants during the intervention phase and at the 1-month follow-up, with some improvement in other symptoms and functioning. Further research should explore the remote delivery of the intervention and whether nonspecialists can deliver the intervention effectively. %M 35857368 %R 10.2196/37382 %U https://formative.jmir.org/2022/7/e37382 %U https://doi.org/10.2196/37382 %U http://www.ncbi.nlm.nih.gov/pubmed/35857368 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32892 %T The Association Between the Use of Low-Slice Computed Tomography Machines and Downstream Care: Comparative Study of 16-Slice and 64-Slice Computed Tomography Angiography %A Powell,Adam C %A Long,James W %A Deshmukh,Uday U %A Simmons,Jeffrey D %+ HealthHelp, 16945 Northchase Drive, Suite 1300, Houston, TX, 77060, United States, 1 6179399168, powellad@healthhelp.com %K computed tomography %K tomography %K diagnostic imaging %K outpatient %K angiography %K obsolescence %K computed tomography angiography of the neck %K neck %K low-slice computed tomography %K cervicocerebral angiography %K downstream testing %K computed tomography machine %K invasive testing %K machine %K testing %K invasive %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Although computed tomography (CT) studies on machines with more slices have reported higher positive and negative predictive values, the impact of using low-slice (16-slice) CT machines on downstream testing has not been well studied. In community outpatient settings, low-slice CT machines remain in use, although many hospitals have adopted higher-slice machines. Objective: This study examines the association between the use of low-slice CT machines and downstream invasive testing in the context of the CT angiography of the neck. Methods: Included health insurance claims pertained to adults with commercial or Medicare Advantage health plans who underwent the CT angiography of the neck. Site certification data were used to assign counts of slices to claims. Claims that were made in the 60 days after CT were examined for cervicocerebral angiography. The association between the number of slices and cervicocerebral angiography was evaluated by using a chi-square test and multivariate logistic regression. Results: Claims for 16-slice CT had a 5.1% (33/641) downstream cervicocerebral angiography rate, while claims for 64-slice CT had a 3.1% (35/1125) rate, and a significant difference (P=.03) was observed. An analysis that was adjusted for patient demographics also found a significant relationship (odds ratio 1.64, 95% CI 1.00-2.69; P=.047). Conclusions: The use of low-slice CT machines in the community may impact the quality of care and result in more downstream testing. %M 35771601 %R 10.2196/32892 %U https://formative.jmir.org/2022/6/e32892 %U https://doi.org/10.2196/32892 %U http://www.ncbi.nlm.nih.gov/pubmed/35771601 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e36339 %T Effect of a Daily Collagen Peptide Supplement on Digestive Symptoms in Healthy Women: 2-Phase Mixed Methods Study %A Abrahams,Mariette %A O’Grady,Rochez %A Prawitt,Janne %+ Rousselot BV, Meulestedekaai 81, Gent, 9000, Belgium, 32 92551818, janne.prawitt@rousselot.com %K collagen peptides %K collagen hydrolysates %K digital study %K gut %K digestive symptoms %K technology %K bloating %K Peptan %K microbiome %K health care professionals %K mobile phone %D 2022 %7 31.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The effect of dietary collagen on managing digestive symptoms is currently lacking in the literature. Objective: To gain a better understanding of this issue, we conducted a 2-phase mixed methods study. Methods: Phase 1 was a mixed methods design to explore current attitude and practice among consumers and health care practitioners. The findings were used to design an 8-week phase 2 digital study called Gutme! conducted in the United States in healthy female volunteers (BMI>25 kg/m2). Our aim was, first, to determine the feasibility of conducting a fully digital mixed methods study; second, the study explored the effect of an 8-week daily supplementation of 20 g dietary collagen peptide (Peptan) on digestive symptoms. Phase 2 was a prospective, open-label, longitudinal, single-arm study. Participation involved 2 weeks of baseline tracking (digestive symptoms, mood, stool, and lifestyle) using an app, followed by 8 weeks of tracking and taking 20 g collagen peptide supplement split into 2 dosages per day. Participants were required to complete a web-based symptom questionnaire at baseline, week 2, and week 8, as well as participate in 2 scheduled video interviews. Results: Phase 1 revealed that consumer awareness of collagen for digestive health is low (64/204, 31.4%). Among the dietitians prescribing collagen for their patients, the most common dosage was 20 g a day with notable effects after 6 weeks of intake. Within the phase 2 study, of the 40 recruited participants, 14 (35%) completed the full course of supplementation. The findings indicate that 93% (13/14) of those who completed the study experienced a reduction in digestive symptoms, which included bloating. Conclusions: A mixed methods digital study design is feasible and acceptable for collecting relevant data in a real-life setting. The use of a 20 g daily collagen peptide supplement may reduce bloating and improve mild digestive symptoms in otherwise healthy female adults in the absence of any other dietary or lifestyle interventions. Trial Registration: ClinicalTrials.gov NCT04245254; https://clinicaltrials.gov/ct2/show/NCT04245254 %M 35639457 %R 10.2196/36339 %U https://formative.jmir.org/2022/5/e36339 %U https://doi.org/10.2196/36339 %U http://www.ncbi.nlm.nih.gov/pubmed/35639457 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34808 %T Valuing Diversity and Inclusion in Health Care to Equip the Workforce: Survey Study and Pathway Analysis %A Khuntia,Jiban %A Ning,Xue %A Cascio,Wayne %A Stacey,Rulon %+ Health Administration Research Consortium, Business School, University of Colorado, 1475 Lawrence Street, Denver, CO, 80202, United States, 1 3038548024, jiban.khuntia@ucdenver.edu %K health system %K workforce %K workplace %K diversity %K inclusion %K improve %K recruit %K collaborate %K health care %K worker %K employee %K CEO %K chief executive officer %K United States %K North America %K characteristic %K benefit %K influence %K strategy %K pathway %K hiring %K hire %K collaboration %K talent %K student %D 2022 %7 6.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic, with all its virus variants, remains a serious situation. Health systems across the United States are trying their best to respond. On average, the health care workforce is relatively homogenous, even though it cares for a highly diverse array of patients. This perennial problem in the US health care workforce has only been accentuated during the COVID-19 pandemic. Medical workers should reflect on the variety of patients they care for and strive to understand their mindsets within the larger contexts of culture, gender, sexual orientation, religious beliefs, and socioeconomic realities. Along with talent and skills, diversity and inclusion (D&I) are essential for maintaining a workforce that can treat the myriad needs and populations that health systems serve. Developing hiring strategies that will help achieve greater workforce diversity remains a challenge for health system leaders. Objective: The primary aims of this study were to: (1) explore the characteristics of US health systems and their associations with D&I practices and benefits, (2) examine the associations between D&I practices and three pathways to equip workforces, and (3) examine the associations between the three pathways to better equip workforces and business and service benefits. The three pathways are: (1) improving D&I among existing employees (IMPROVE), (2) using multiple channels to find and recruit the workforce (RECRUIT), and (3) collaborating with universities to find new talent and establish plans to train students (COLLABORATE). Methods: During February to March 2021, 625 health systems in the United States were surveyed with the help of a consultant, 135 (21.6%) of whom responded. We assessed workforce talent- and diversity-relevant factors. We collected secondary data from the Agency for Healthcare Research and Quality Compendium of the US Health Systems, leading to a matched data set of 124 health systems for analysis. We first explored differences in diversity practices and benefits across the health systems. We then examined the relationships among diversity practices, pathways, and benefits. Results: Health system characteristics such as size, location, ownership, teaching, and revenue have varying associations with diversity practices and outcomes. D&I and talent strategies exhibited different associations with the three workforce pathways. Regarding the mediating effects, the IMPROVE pathway seems to be more effective than the RECRUIT and COLLABORATE pathways, enabling the diversity strategy to prompt business or service benefits. Moreover, these pathway effects go hand-in-hand with a talent strategy, indicating that both talent and diversity strategies need to be aligned to achieve the best results for a health system. Conclusions: Diversity and talent plans can be aligned to realize multiple desired benefits for health systems. However, a one-size-fits-all approach is not a viable strategy for improving D&I. Health systems need to follow a multipronged approach based on their characteristics. To get D&I right, proactive plans and genuine efforts are essential. %M 35452404 %R 10.2196/34808 %U https://formative.jmir.org/2022/5/e34808 %U https://doi.org/10.2196/34808 %U http://www.ncbi.nlm.nih.gov/pubmed/35452404 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e36710 %T Critical Care Nurses’ Knowledge of Correct Line Types for Administration of Common Intravenous Medications: Assessment and Intervention Study %A Al-Jaber,Rania %A Samuda,Natalie %A Chaker,Ahmad %A Waterson,James %+ Medical Affairs, Medication Management Solutions, Becton Dickinson, 11F Blue Bay Tower, Business Bay, Dubai, 52279, United Arab Emirates, 971 0566035154, james.waterson@bd.com %K critical care, intravenous medication, compatibility, administration error, infusion maintenance, medication interaction %K knowledge %K survey %D 2022 %7 26.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a paucity of information in the literature on core nursing staff knowledge on the requirements of specific intravenous administration lines for medications regularly given in critical care. There is also a lack of well-researched and appropriate information in the literature for intravenous administration line selection, and the need for filtration, protection from light, and other line-material selection precautions for many critical and noncritical medications used in these settings to maintain their potency and efficacy. Objective: We aimed to assess the knowledge gap of clinicians with respect to intravenous administration line set material requirements for critical care medications. Methods: Data were drawn from a clinician knowledge questionnaire, a region-wide database of administered infusions, and regional data on standard and special intravenous administration line consumption for 1 year (2019-2020) from an enterprise resource planning system log. The clinician knowledge questionnaire was validated with 3 groups (n=35) and then released for a general survey of critical care nurses (n=72) by assessing response dispersal and interrater reliability (Cronbach α=.889). Correct answers were determined by referencing available literature, with consensus between the team’s pharmacists. Percentage deviations from correct answers (which had multiple possible selections) were calculated for control and test groups. We reviewed all 3 sources of information to identify the gap between required usage and real usage, and the impact of knowledge deficits on this disparity. Results: Percentage deviations from correct answers were substantial in the control groups and extensive in the test group for all medications tested (percentage deviation range –43% to 93%), with the exception of for total parenteral nutrition. Respondents scored poorly on questions about medications requiring light protection, and there was a difference of 2.75% between actual consumption of lines and expected consumption based on medication type requirement. Confusion over the requirements for low-sorbing lines, light protection of infusions, and the requirement for filtration of specific solutions was evident in all evidence sources. The consumption of low-sorbing lines (125,090/1,454,440, 8.60%) was larger than the regional data of medication usage data would suggest as being appropriate (15,063/592,392, 2.54%). Conclusions: There is no single source of truth for clinicians on the interactions of critical care intravenous medications and administration line materials, protection from light, and filtration. Nursing staff showed limited knowledge of these requirements. To reduce clinical variability in this area, it is desirable to have succinct easy-to-access information available for clinicians to make decisions on which administration line type to use for each medication. The study’s results will be used to formulate solutions for bedside delivery of accurate information on special intravenous line requirements for critical care medications. %M 35471247 %R 10.2196/36710 %U https://formative.jmir.org/2022/4/e36710 %U https://doi.org/10.2196/36710 %U http://www.ncbi.nlm.nih.gov/pubmed/35471247 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e33893 %T Characteristics and Outcomes of Clinical Trials on Gene Therapy in Noncongenital Cardiovascular Diseases: Cross-sectional Study of Three Clinical Trial Registries %A Pinczak,Witold %A Trzcińska,Sylwia %A Kamiński,Mikołaj %+ Bogdanowo 15, Oborniki, 64-600, Poland, 48 500295319, mikolaj.w.kaminski@gmail.com %K gene therapy %K cardiovascular disease %K clinical trials %K trial design %K heart disease %K clinical trial %K therapy %K cardiac risk factor %K health intervention %D 2022 %7 21.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide. Gene therapies (GTs) may become a novel therapeutic option for cardiovascular diseases. Objective: We aimed to characterize all trials involving human subjects utilizing GT to treat noncongenital cardiovascular diseases. Methods: In March 2021, we searched for clinical trials on the ClinicalTrials.gov (CT), International Clinical Trials Registry Platform (ICTRP), and International Standard Randomised Controlled Trials Number (ISRCTN) databases. Two authors screened the titles and registry notes of all the searched studies. We collected details of the included studies regarding their design, location funding source, treated conditions, completion, publication statuses, and final outcomes. Results: We generated a total of 3508 records, and 50 unique clinical trials met our eligibility criteria. Of these, 20 (40%) concerned peripheral artery disease, and 18 (36%) concerned coronary artery disease. Most studies were randomized (34/50, 68%) and were performed in multiple locations (30/50, 60%), and around half of the trials compared GT with a placebo (27/50, 54%), while one in four were single-arm (14/50, 28%), and the rest concerned dose-finding (22%). More than half of the trials (29/50, 58%) were funded by industry. Of the 50 clinical trials, 28 (56%) published their results by the data collection date (March 2021), and 22 of 31 (71%) were slated to be completed before 2021. Overall, 12 of 28 (42.9%) clinical trials showed favorable outcomes of the intervention. Conclusions: Among noncongenital cardiovascular diseases, GTs are mostly investigated in peripheral artery disease and coronary artery disease. Many clinical trials on GT use in noncongenital cardiovascular diseases did not disclose their results. Regardless of the trial phase, less than half of published studies on GT in noncongenital cardiovascular diseases showed promising results. %M 35451992 %R 10.2196/33893 %U https://formative.jmir.org/2022/4/e33893 %U https://doi.org/10.2196/33893 %U http://www.ncbi.nlm.nih.gov/pubmed/35451992 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 2 %P e26990 %T Robotic Table and Serious Games for Integrative Rehabilitation in the Early Poststroke Phase: Two Case Reports %A Burdea,Grigore %A Kim,Nam %A Polistico,Kevin %A Kadaru,Ashwin %A Grampurohit,Namrata %A Hundal,Jasdeep %A Pollack,Simcha %+ Corporate Laboratories, Bright Cloud International Corp, 675 US Hwy 1, Suite B203, New Jersey Bioscience Center, North Brunswick, NJ, 08902, United States, 1 732 640 0400, diplomatru@yahoo.com %K subacute stroke %K virtual reality %K gamification %K therapeutic game controller %K integrative rehabilitation %K BrightArm Duo %K BrightArm Compact %K upper extremity %K cognition %K depression %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: BrightArm Compact is a new rehabilitation system for the upper extremities. It provides bimanual training with gradated gravity loading and mediates interactions with cognitively challenging serious games. Objective: The aim of this study is to design and test a robotic rehabilitation table–based virtual rehabilitation system for functional impact of the integrative training in the early poststroke phase. Methods: A new robotic rehabilitation table, controllers, and adaptive games were developed. The 2 participants underwent 12 experimental sessions in addition to the standard of care. Standardized measures of upper extremity function (primary outcome), depression, and cognition were administered before and after the intervention. Nonstandardized measures included game variables and subjective evaluations. Results: The 2 case study participants attained high total arm repetitions per session (504 and 957) and achieved high grasp and finger-extension counts. Training intensity contributed to marked improvements in affected shoulder strength (225% and 100% increase), grasp strength (27% and 16% increase), and pinch strength (31% and 15% increase). The shoulder flexion range increased by 17% and 18% and elbow supination range by 75% and 58%. Improvements in motor function were at or above minimal clinically important difference for the Fugl-Meyer Assessment (11 and 10 points), Chedoke Arm and Hand Activity Inventory (11 and 14 points), and Upper Extremity Functional Index (19 and 23 points). Cognitive and emotive outcomes were mixed. Subjective rating by participants and training therapists were positive (average 4, SD 0.22, on a 5-point Likert scale). Conclusions: The design of the robotic rehabilitation table was tested on 2 participants in the early poststroke phase, and results are encouraging for upper extremity functional gains and technology acceptance. Trial Registration: ClinicalTrials.gov NCT04252170; https://clinicaltrials.gov/ct2/show/NCT04252170 %M 35416787 %R 10.2196/26990 %U https://rehab.jmir.org/2022/2/e26990 %U https://doi.org/10.2196/26990 %U http://www.ncbi.nlm.nih.gov/pubmed/35416787 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e31277 %T Development of the Socioeconomic Screening, Active Engagement, Follow-up, Education, Discharge Readiness, and Consistency (SAFEDC) Model for Improving Transitions of Care: Participatory Design %A Shin,Ji Youn %A Okammor,Nkiru %A Hendee,Karly %A Pawlikowski,Amber %A Jenq,Grace %A Bozaan,David %+ Department of Internal Medicine, Michigan Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, United States, 1 (734) 1936 7302, dabozaan@med.umich.edu %K care transition %K discharge %K readmission %K patient-centered care %K design %K participatory design %D 2022 %7 12.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Transition to home after hospitalization involves the potential risk of adverse patient events, such as knowledge deficits related to self-care, medication errors, and readmissions. Despite broad organizational efforts to provide better care transitions for patients, there are challenges in implementing interventions that effectively improve care transition outcomes, as evidenced by readmission rates. Collaborative efforts that require health care professionals, patients, and caregivers to work together are necessary to identify gaps associated with transitions of care and generate effective transitional care interventions. Objective: This study aims to understand the usefulness of participatory design approaches in identifying the design implications of transition of care interventions in health care settings. Through a series of participatory design workshops, we have brought stakeholders of the health care system together. With a shared understanding of care transition and patient experience, we have provided participants with opportunities to generate possible design implications for care transitions. Methods: We selected field observations in clinical settings and participatory design workshops to develop transitional care interventions that serve each hospital’s unique situation and context. Patient journey maps were created and functioned as tools for creating a shared understanding of the discharge process across different stakeholders in the health care environment. The intervention sustainability was also assessed. By applying thematic analysis methods, we analyzed the problem statements and proposed interventions collected from participatory design workshops. The findings showed patterns of major discussion during the workshop. Results: On the basis of the workshop results, we formalized the transition of care model—the socioeconomic, active engagement, follow-up, education, discharge readiness tool, and consistency (Integrated Michigan Patient-centered Alliance in Care Transitions transition of care model)—which other organizations can apply to improve patient experiences in care transition. This model highlights the most significant themes that should necessarily be considered to improve the transition of care. Conclusions: Our study presents the benefits of the participatory design approach in defining the challenges associated with transitions of care related to patient discharge and generating sustainable interventions to improve care transitions. %M 35412461 %R 10.2196/31277 %U https://formative.jmir.org/2022/4/e31277 %U https://doi.org/10.2196/31277 %U http://www.ncbi.nlm.nih.gov/pubmed/35412461 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e30102 %T Sleeping in an Inclined Position to Reduce Snoring and Improve Sleep: In-home Product Intervention Study %A Danoff-Burg,Sharon %A Rus,Holly M %A Weaver,Morgan A %A Raymann,Roy J E M %+ SleepScore Labs, 2175 Salk Avenue, Suite 200, Carlsbad, CA, 92008, United States, 1 858 264 5828, sharon.danoff-burg@sleepscorelabs.com %K snoring %K sleep %K sleep tracker %K snoring tracker %K adjustable bed %K digital health %K health technology %K digital tracker %K intervention %K measurement %D 2022 %7 6.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Accurately and unobtrusively testing the effects of snoring and sleep interventions at home has become possible with recent advances in digital measurement technologies. Objective: The aim of this study was to examine the effectiveness of using an adjustable bed base to sleep with the upper body in an inclined position to reduce snoring and improve sleep, measured at home using commercially available trackers. Methods: Self-reported snorers (N=25) monitored their snoring and sleep nightly and completed questionnaires daily for 8 weeks. They slept flat for the first 4 weeks, then used an adjustable bed base to sleep with the upper body at a 12-degree incline for the next 4 weeks. Results: Over 1000 nights of data were analyzed. Objective snoring data showed a 7% relative reduction in snoring duration (P=.001) in the inclined position. Objective sleep data showed 4% fewer awakenings (P=.04) and a 5% increase in the proportion of time spent in deep sleep (P=.02) in the inclined position. Consistent with these objective findings, snoring and sleep measured by self-report improved. Conclusions: New measurement technologies allow intervention studies to be conducted in the comfort of research participants’ own bedrooms. This study showed that sleeping at an incline has potential as a nonobtrusive means of reducing snoring and improving sleep in a nonclinical snoring population. %M 35384849 %R 10.2196/30102 %U https://formative.jmir.org/2022/4/e30102 %U https://doi.org/10.2196/30102 %U http://www.ncbi.nlm.nih.gov/pubmed/35384849 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e36354 %T Adapting Child Health Knowledge Translation Tools for Somali Parents: Qualitative Study Exploring Process Considerations and Stakeholder Engagement %A Elliott,Sarah A %A Wright,Kelsey S %A Scott,Shannon D %A Mohamed,Muna %A Farah,Asha %A Hartling,Lisa %+ Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, 4-472 Edmonton Clinic Health Academy, Edmonton, AB, ​T6G 1C9, Canada, 1 (780) 492 6124, hartling@ualberta.ca %K knowledge translation %K cultural adaptation %K trust %K linguistics %K parents %K child health %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: We have developed a series of knowledge translation (KT) tools that integrate parental experiences to communicate evidence-based information about acute childhood health conditions to parents and caregivers. While we created these tools with parent input, it is unclear if they are useful for diverse parent groups, including specific immigrant and refugee groups in Canada. Objective: This study aims to explore the usefulness of our preexisting KT tools within our local Somali community, and understand what cultural and linguistic adaptations could improve their usability. Methods: After viewing 4 KT tools (differing in design and format) about various acute child health conditions, health care providers (HCPs) and knowledge brokers (KBs) who work with Somali families were interviewed about the usability of these tools and discussed considerations for adapting KT tools for use within the Somali community. Results: A total of 13 HCPs and KBs participated and indicated that the Somali community values accessibility, representation, and the role of trusted others in delivering effective KT products. Understanding accessibility barriers, the power of adequate representation, and engaging meaningfully with prominent community leaders were key suggestions for ensuring relevance of KT products and uptake by community members. Conclusions: This study represents an essential piece of understanding processes for adapting or developing KT products for culturally and linguistically diverse communities. %M 35377330 %R 10.2196/36354 %U https://formative.jmir.org/2022/4/e36354 %U https://doi.org/10.2196/36354 %U http://www.ncbi.nlm.nih.gov/pubmed/35377330 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34258 %T A Platform (Authorships.org) for the Objective Qualification and Order of Academic Authorship in Medical and Science Journals: Development and Evaluation Study Using the Design Science Research Methodology %A Raptis,Dimitri Aristotle %A Raptis,Aristotle %A Tinguely,Pascale %A , %+ Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Royal Free Hospital, Pond Street, London, United Kingdom, 44 020 7794 0500, Dimitri.raptis@nhs.net %K authorship %K writing %K dissent and disputes %K research ethics %K software design %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The qualification and order of authorship in scientific manuscripts are the main disputes in collaborative research work. Objective: The aim of this project was to develop an open-access web-based platform for objective decision-making of authorship qualification and order in medical and science journals. Methods: The design science process methodology was used to develop suitable software for authorship qualification and order. The first part of the software was designed to differentiate between qualification for authorship versus acknowledgment, using items of the recommendations of the International Committee of Medical Journal Editors. The second part addressed the order of authorship, using the analytical hierarchy process for objective multiple criteria decision-making and ranking. The platform was evaluated qualitatively (n=30) and quantitatively (n=18) using a dedicated questionnaire, by an international panel of medical and biomedical professionals and research collaborators worldwide. Results: Authorships.org represents an open-access software compatible with all major platforms and web browsers. Software usability and output were evaluated and presented for 3 existing clinical and biomedical research studies. All 18 international evaluators felt that the Authorships.org platform was easy to use or remained neutral. Moreover, 59% (n=10) were satisfied with the software output results while the rest were unsure, 59% (n=10) would definitely use it for future projects while 41% (n=7) would consider it, 94% (n=16) felt it may prove useful to eliminate disputes regarding authorship, 82% (n=14) felt that it should become mandatory for manuscript submission to journals, and 53% (n=9) raised concerns regarding the potential unethical use of the software as a tool. Conclusions: Authorships.org allows transparent evaluation of authorship qualification and order in academic medical and science journals. Objectified proof of authorship contributions may become mandatory during manuscript submission in high-quality academic journals. %M 35298392 %R 10.2196/34258 %U https://formative.jmir.org/2022/3/e34258 %U https://doi.org/10.2196/34258 %U http://www.ncbi.nlm.nih.gov/pubmed/35298392 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34029 %T A Lifestyle Intervention to Delay Early Chronic Kidney Disease in African Americans With Diabetic Kidney Disease: Pre-Post Pilot Study %A Ozieh,Mukoso N %A Egede,Leonard E %+ Department of Medicine, Division of Nephrology, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, United States, 1 4149558839, mozieh@mcw.edu %K type 2 diabetes mellitus %K chronic kidney insufficiency %K healthy lifestyle %K outcomes research %K African Americans %K quasiexperimental study %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Behavioral factors, such as lifestyle, have been shown to explain approximately 24% of the excess risk of chronic kidney disease (CKD) among African Americans. However, there are limited intervention studies culturally tailored to African Americans with type 2 diabetes mellitus and CKD. Objective: The main objective of this study was to examine the feasibility and preliminary efficacy of a culturally tailored lifestyle intervention among African Americans with type 2 diabetes mellitus and CKD. Methods: A pre-post design was used to test the feasibility of a lifestyle intervention in 30 African American adults recruited from the Medical University of South Carolina between January 2017 and February 2017. A research nurse delivered the manualized study intervention weekly for 6 weeks. Clinical outcomes (hemoglobin A1c, blood pressure, and estimated glomerular filtration rate [eGFR]) were measured at baseline and postintervention. Disease knowledge, self-care, and behavior outcomes were also measured using validated structured questionnaires at baseline and postintervention. Descriptive statistics and effect sizes were calculated to determine clinically important changes from baseline. Results: Significant pre-post mean differences and decreases were observed for hemoglobin A1c (mean 0.75%, 95% CI 0.16-1.34; P=.01), total cholesterol (mean 16.38 mg/dL, 95% CI 5.82-26.94; P=.004), low-density lipoprotein (mean 13.73 mg/dL, 95% CI 3.91-23.54; P=.008), and eGFR (mean 6.73 mL/min/1.73m2, 95% CI 0.97-12.48; P=.02). Significant pre-post mean differences and increases were observed for CKD self-efficacy (mean −11.15, 95% CI −21.55 to −0.75; P=.03), CKD knowledge (mean −2.62, 95% CI −3.98 to −1.25; P<.001), exercise behavior (mean −1.21, 95% CI −1.96 to −0.46; P=.003), and blood sugar testing (mean −2.15, 95% CI −3.47 to −0.83; P=.003). Conclusions: This study provides preliminary data for a large-scale appropriately powered randomized controlled trial to examine a culturally tailored lifestyle intervention in African Americans with type 2 diabetes mellitus and CKD in order to improve clinical, knowledge, self-care, and behavior outcomes in this population. %M 35289751 %R 10.2196/34029 %U https://formative.jmir.org/2022/3/e34029 %U https://doi.org/10.2196/34029 %U http://www.ncbi.nlm.nih.gov/pubmed/35289751 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e27286 %T The Beneficial Effect of the First COVID-19 Lockdown on Undergraduate Students of Education: Prospective Cohort Study %A Joseph,Gili %A Schori,Hadas %+ Department of Physical Activity and Movement, Faculty of Science, Seminar Hakibbutzim College of Education, 149 Namir Drive, Tel Aviv, 6250769, Israel, 972 544577095, gilijosephphd@gmail.com %K sleep quality %K exercise %K well-being %K undergraduate students %K COVID-19 lockdown %K COVID-19 %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has been spreading consistently since the beginning of 2020. On February 27, 2020, the first patient with coronavirus was diagnosed in Israel. On March 14, 2020, the Israeli government declared a general lockdown that lasted about a month, which altered the lives of the entire population. Objective: The objective of this paper is to evaluate the change in the well-being, physical activity, and sleep quality of undergraduate students of education at 2 time points: before (November 2019) and during (April 2020) the first COVID-19 lockdown. Methods: In total, 533 undergraduate students of education submitted an online questionnaire before the lockdown and at its end. The questionnaire comprised 4 parts: a (1) sociodemographic and (2) weekly exercise questionnaire taken from the International Physical Activity Questionnaire–Short Form; (3) sleep quality, rated using the Mini Sleep Questionnaire; and (4) well-being, rated using the short version of the Mental Health Inventory. This was a pre-post prospective cohort questionnaire study. Results: It was predicted that there would be a decrease in the aforementioned parameters. Contrary to all expectations, an increase was observed in all 3. Results showed that during the lockdown, there was an increase in the level of exercise students engaged in. Overall, 102 (61.4%) of 166 students engaged in a greater amount of physical activity during the COVID-19 lockdown compared to 150 (40.9%) of 367 students who engaged in a greater amount of physical activity before COVID-19. Levels of sleep quality (mean 5.34 [SD 0.92] vs mean 5.12 [SD 0.46], P=.02) and well-being (mean 3.79 [SD 0.62] vs mean 3.67 [SD 0.59], P=.02) were also higher during the COVID-19 lockdown. Conclusions: These findings indicate that undergraduate students seem to have taken advantage of the change in lifestyle due to the lockdown, directing the free time toward improving health by engaging in more physical activity, thus improving sleep quality and well-being. %M 35072635 %R 10.2196/27286 %U https://formative.jmir.org/2022/2/e27286 %U https://doi.org/10.2196/27286 %U http://www.ncbi.nlm.nih.gov/pubmed/35072635 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e34966 %T COVID-19 Preventive Behaviors and Health Literacy, Information Evaluation, and Decision-making Skills in Japanese Adults: Cross-sectional Survey Study %A Nakayama,Kazuhiro %A Yonekura,Yuki %A Danya,Hitomi %A Hagiwara,Kanako %+ Department of Nursing Informatics, Graduate School of Nursing Science, St. Luke’s International University, 10-1, Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan, 81 3 5550 2284, nakayama@slcn.ac.jp %K coronavirus %K COVID-19 %K health literacy %K health information %K decision-making %K health promotion %K prevention %K behavior %K survey %K evaluation %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health literacy is important for the prevention of COVID-19 transmission. Research in Japan shows that health literacy is related to skills in evaluating information and decision-making (skills that are not necessarily limited to information about health). Such basic skills are important, particularly when individuals encounter new health issues for which there is insufficient evidence. Objective: We aimed to determine the extent to which COVID-19 preventive behaviors were associated with health literacy and skills in evaluating information and making decisions. Methods: A web-based questionnaire survey was conducted using a Japanese internet research company. The measures comprised 8 items on COVID-19 preventive behaviors, health literacy items (European Health Literacy Survey Questionnaire), 5 items on information evaluation, and 4 items on decision-making process. Pearson correlations between these variables were calculated. Multivariable analyses were also conducted using the COVID-19 preventive behavior score as a dependent variable. Results: A total of 3914 valid responses were received.COVID-19 preventive behaviors were significantly correlated with health literacy (r=0.23), information evaluation (r=0.24), and decision-making process (r=0.30). Standardized regression coefficients (health literacy: β=.11; information evaluation: β=.13; decision-making: β=.18) showed that decision-making process contributed the most. Conclusions: Although comprehensive health literacy is necessary for COVID-19 preventive behaviors, the skills to evaluate a wide range of information and to make appropriate decisions are no less important. Opportunities for people to acquire these skills should be available at all times. %M 34982036 %R 10.2196/34966 %U https://formative.jmir.org/2022/1/e34966 %U https://doi.org/10.2196/34966 %U http://www.ncbi.nlm.nih.gov/pubmed/34982036 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33322 %T Designing an Adaptive Adolescent Physical Activity and Nutrition Intervention for COVID-19–Related Health Challenges: Formative Research Study %A Grimes,Amanda %A Lightner,Joseph S %A Pina,Kimberly %A Donis de Miranda,Evelyn S %A Meissen-Sebelius,Emily %A Shook,Robin P %A Hurley,Emily A %+ School of Nursing and Health Studies, University of Missouri-Kansas City, 2464 Charlotte St, Kansas City, MO, 64108, United States, 1 816 235 1737, grimesa@umkc.edu %K intervention %K physical activity %K nutrition %K adolescents %K formative research %K COVID-19 %K exercise %K young adult %K teenager %K focus group %K qualitative %K interview %K urban %K barrier %D 2022 %7 21.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: With rates of childhood obesity continually increasing, effective physical activity and nutrition interventions are needed. Formative research is used to tailor interventions to different cultural and geographic contexts and can be vital in adapting intervention strategies in the face of significant disruptive circumstances (like COVID-19). Objective: We conducted formative research via in-person and web-based focus groups among middle schoolers and parents to better understand the facilitators and barriers to physical activity and fruit and vegetable consumption and to inform the design of a large intervention for a low-income, urban setting in the US Midwest. Methods: We conducted 2 phases of qualitative focus groups with parents (n=20) and 6th-9th grade middle schoolers (n=23). Phase 1 was conducted prior to the COVID-19 pandemic in late 2019, and phase 2 was conducted during the COVID-19 pandemic in the summer of 2020. Focus groups were transcribed and thematically coded using the Dedoose software. Results: The main facilitators of physical activity prior to the pandemic included the opportunity to have fun, peer influence, competition (for some), and incentives, while the main barriers to physical activity were time constraints and social discomfort. The main facilitators of eating fruits and vegetables included parental influence, preparation technique, and convenience, while barriers included dislike of vegetables, time constraints, and preparation or freshness. During the pandemic, facilitators of physical activity remained the same, while additional barriers to physical activity such as lack of motivation and limited time spent outside of the home were reported. For fruit and vegetable consumption, both facilitators and barriers remained the same for both time periods. Additionally, for some participants, the pandemic offered an opportunity to offer more fruits and vegetables to middle schoolers throughout the day. Conclusions: Some themes identified were common to those reported in previous studies, such as peer influence on physical activity and parental influence on fruit and vegetable consumption. Novel themes such as lack of motivation to be active and limited time outside the home helped improve intervention adaptation, specifically during the COVID-19 pandemic. The continuity of formative research after a major unexpected change in the intervention context can be essential in targeting areas of an intervention that can be retained and those that need to be adjusted. %M 34932499 %R 10.2196/33322 %U https://formative.jmir.org/2022/1/e33322 %U https://doi.org/10.2196/33322 %U http://www.ncbi.nlm.nih.gov/pubmed/34932499 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e19750 %T Short-Term and Long-Term Renal Outcomes in Patients With Obesity After Minimally Invasive Versus Open Partial Nephrectomy for the Treatment of Renal Cancer: Retrospective Study %A Flippo,Brittany %A Stone,Bradley %A Stahr,Shelbie %A Khalil,Mahmoud %A Davis,Rodney %A Kamel,Mohamed %A Singh,Manisha %+ University of Arkansas for Medical Sciences, #501, 4301 West Markham st, Little Rock, AR, 72205, United States, 1 5012405804, msingh@uams.edu %K renal outcomes %K renal cell carcinoma %K minimally invasive vs open partial nephrectomy %K obesity %K kidney %K cancer %K surgery %K retrospective %K outcome %K short-term %K long-term %D 2022 %7 10.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Obesity is significantly associated with renal cell carcinoma. Surgery is the preferred treatment for demarcated lesions of renal cell carcinoma; however, obesity increases the complexity of surgical outcomes. Minimally invasive surgical techniques are preferred over open partial nephrectomy (OPN), but controversy remains regarding the most efficacious technique in patients with obesity. Objective: This study aims to determine whether minimally invasive partial nephrectomy (MIPN) or OPN better preserves renal function and investigate short- and long-term renal outcomes in patients with obesity undergoing a partial nephrectomy. Methods: We conducted a retrospective chart review of 242 adult patients aged ≥18 years who underwent MIPN or OPN between January 1, 2005, and December 31, 2016, at the University of Arkansas for Medical Sciences. Using creatinine as a measure of kidney function, patients’ preoperative levels were compared with their postoperative levels in 2-time frames: short (3-6 months postsurgery) or long (>6 months). The primary outcome was the change in creatinine values from preoperative to >6 months postoperatively in patients with obesity. Secondary outcomes included the change in creatinine values from preoperative to 3 to 6 months postoperatively in patients with obesity who underwent MIPN versus OPN. We also analyzed the creatinine values of nonobese patients (BMI <30) who underwent partial nephrectomy using the same time frames. Unconditional logistic regression was used to estimate crude and multivariable-adjusted odds ratios (ORs) and 95% CI to observe associations between surgery type and changes in creatinine values from while stratifying for obesity. Results: A total of 140 patients were included in the study, of whom 75 were obese and 65 were nonobese. At >6 months after MIPN (n=20), the odds of patients with obesity having a decrease or no change in creatinine values was 1.24 times higher than those who had OPN (n=13; OR 1.24, 95% CI 0.299-6.729; P=.80). At 3 to 6 months after MIPN (n=27), the odds were 0.62 times lower than those after OPN (n=17; OR 0.62, 95% CI 0.140-2.753; P=.56). In the nonobese group, at 3 to 6 months after undergoing minimally invasive surgery (n=18), the odds of having a decrease or no change in creatinine values was 4.86 times higher than those who had open surgery (n=21; OR 4.86, 95% CI 1.085-21.809; P=.04). At more than 6 months after MIPN (n=14), the odds were 4.13 times higher than those after OPN (n=11; OR 4.13, 95% CI 0.579-29.485; P=.16). Conclusions: We observed a nonstatistically significant preservation of renal function in patients with obesity who underwent OPN at 3 to 6 months postoperatively. Conversely, after 6 months, the same was true for MIPN, indicating the long-term benefit of MIPN. In the nonobese group, MIPN was favored over OPN.  %M 35006078 %R 10.2196/19750 %U https://formative.jmir.org/2022/1/e19750 %U https://doi.org/10.2196/19750 %U http://www.ncbi.nlm.nih.gov/pubmed/35006078 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32422 %T Perceptions of Educational Needs in an Era of Shifting Mental Health Care to Primary Care: Exploratory Pilot Study %A Sutherland,Stephanie %A Jeong,Dahn %A Cheng,Michael %A St-Jean,Mireille %A Jalali,Alireza %+ Department of Innovation in Medical Education, Faculty of Medicine, University of Ottawa, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada, 1 6135625800, ajalali@uottawa.ca %K mental health %K Canada %K qualitative research %K caregiver %K family physician %K mentorship %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an unmet need for mental health care in Canada. Primary care providers such as general practitioners and family physicians are the essential part of mental health care services; however, mental health is often underestimated and underprioritized by family physicians. It is currently not known what is required to increase care providers’ willingness, comfort, and skills to adequately provide care to patients who present with mental health issues. Objective: The aim of this study was to understand the need of caregivers (family members overseeing care of an individual with a mental health diagnosis) and family physicians regarding the care and medical management of individuals with mental health conditions. Methods: A needs assessment was designed to understand the educational needs of caregivers and family physicians regarding the provision of mental health care, specifically to seek advice on the format and delivery mode for an educational curriculum to be accessed by both stakeholder groups. Exploratory qualitative interviews were conducted, and data were collected and analyzed iteratively until thematic saturation was achieved. Results: Caregivers of individuals with mental health conditions (n=24) and family physicians (n=10) were interviewed. Both the caregivers and the family physicians expressed dissatisfaction with the status quo regarding the provision of mental health care at the family physician’s office. They stated that there was a need for more educational materials as well as additional support. The caregivers expressed a general lack of confidence in family physicians to manage their son’s or daughter’s mental health condition, while family physicians sought more networking opportunities to improve and facilitate the provision of mental health care. Conclusions: Robust qualitative studies are necessary to identify the educational and medical management needs of caregivers and family physicians. Understanding each other’s perspectives is an essential first step to collaboratively designing, implementing, and subsequently evaluating community-based mental health care. Fortunately, there are initiatives underway to address these need areas (eg, websites such as the eMentalHealth, as well as the mentorship and collaborative care network), and information from this study can help inform the gaps in those existing initiatives. %M 34994704 %R 10.2196/32422 %U https://formative.jmir.org/2022/1/e32422 %U https://doi.org/10.2196/32422 %U http://www.ncbi.nlm.nih.gov/pubmed/34994704 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30663 %T Understanding Perceptions and Practices for Designing an Appropriate Community-Based Kangaroo Mother Care Implementation Package: Qualitative Exploratory Study %A Ariff,Shabina %A Maznani,Ikram %A Bhura,Maria %A Memon,Zahid %A Arshad,Tayyaba %A Samejo,Tariq Ahmed %A Zaidi,Shujaat %A Umer,Muhammad %A Ahmed,Imran %A Habib,Muhammad Atif %A Soofi,Sajid Bashir %A Bhutta,Zulfiqar A %+ Center of Excellence in Women & Child Health, Aga Khan University, Stadium Road, Karachi, Pakistan, 92 2134864798, zulfiqar.bhutta@aku.edu %K kangaroo mother care %K low birth weight %K neonatal mortality formative research %K Pakistan %K newborn care %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Low birth weight (LBW) is a common outcome of preterm birth, which increases the risk of an infant’s morbidity and mortality. Approximately 20 million infants are born with LBW globally per year. Since a significant number of births in Pakistan take place at home, it is important to focus on the use of kangaroo mother care (KMC), the practice of skin-to-skin contact, in communities to prevent neonatal mortality and morbidity. Objective: We employed a formative research approach to understand the context of communities and facilities with regard to neonatal care and KMC practice. The broader aims were to inform the design and delivery of culturally appropriate platforms to introduce KMC in communities, and develop effective recruitment and retention strategies of KMC in rural areas of the Dadu district in the Sindh province of Pakistan. Methods: We conducted focus group discussions, in-depth interviews, and key informant interviews with families of LBW babies, community members, health care providers, and hospital administrators to identify barriers, enablers, and a knowledge base for KMC interventions. Results: Newborn care practices in communities were found to be suboptimal. The community was generally unaware of the KMC intervention for the care of LBW babies. However, facility health care providers, the community, and family members were willing to provide KMC to improve outcomes. We found significant support from the community members and health care providers for KMC practices. Mothers were also ready to provide intermittent KMC. The administrative staff at the hospitals accepted the introduction of KMC practices for LBW babies. Conclusions: KMC as a method of treating LBW babies is widely accepted in the community. This formative research provides strategically valuable information that will be helpful for developing effective implementation strategies by identifying common community practices for LBW babies, along with identifying the barriers and enablers to KMC practice. %M 34994692 %R 10.2196/30663 %U https://formative.jmir.org/2022/1/e30663 %U https://doi.org/10.2196/30663 %U http://www.ncbi.nlm.nih.gov/pubmed/34994692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e24936 %T Role of 18F-Fluorodeoxyglucose–Positron Emission Tomography/Computed Tomography Imaging in the Prediction of Prognosis in Patients With Indolent Lymphoma: Prospective Study %A AlShehry,Nawal Faiez %A Shanker,Raja %A Zaidi,Syed Ziauddin Ahmed %A AlGhmlas,Fahad %A Motabi,Ibraheem Hussein %A Iqbal,Shahid %A Butt,Ahmad Ali %A AlShehri,Hassan %A Tailor,Imran Khan %A Altaf,Syed Yasir %A AlGhamdi,Mubarak %A Marie,Mohammed %A AlFayez,Mansour %A Al Zahrani,Kamal %A Dwaimah,Mohammed %A Al-Halouli,Tahani %A Al-Shakweer,Wafaa %A AlShehery,Maied Zaher %A Zaidi,Abdul Rehman Zia %A Gill,Atta Munawar %A Albtoosh,Belal Mohammed %A Ahmed,Musab %+ Department of Adult Hematology/Bone Marrow Transplantation, King Fahad Medical City, Comprehensive Cancer Center, PO Box 59046, Riyadh, 11525, Saudi Arabia, 966 112889999 ext 23040, nalshehry@kfmc.med.sa %K positron emission tomography %K lymphoma %K prognosis %K indolent lymphoma %K SUVmax %K Deauville criteria %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The role of fluorodeoxyglucose–positron emission tomography/computed tomography (FDG-PET/CT) in indolent lymphoma has been minimally studied. Objective: This study aims to assess the value of FDG-PET/CT in predicting the prognosis of indolent lymphoma. Methods: We prospectively recruited 42 patients with indolent lymphoma. A total of 2 patients were excluded, and 40 underwent baseline PET/CT and follow-up at various time points. A total of 9 patients were observed only, 7 received 4 doses of rituximab alone, and 24 received chemoimmunotherapy. Metabolic response on follow-up PET/CT was assessed using the maximum standardized uptake value (SUVmax) and Deauville criteria (DC). We aimed to obtain the best SUVmax and DC to predict optimal survival rates, risk stratification, and optimize therapeutic strategies. The mean follow-up from the initial diagnosis was 33.83 months. Results: SUVmax <4.35 at interim PET/CT provided the best discrimination, with a progression-free survival (PFS) of 100% and a median survival time of 106.67 months compared with SUVmax ≥4.35 (P=.04), which had a PFS of 43.8% and a median survival time of 50.17 months. This cutoff was also valuable in predicting overall survival at baseline, that is, 100% overall survival with baseline SUVmax <4.35, versus 58.4% for SUVmax ≥4.35 (P=.13). The overall survival of patients with a baseline DC score <3.0 was 100%, with a median overall survival of 106.67 months. Conclusions: We demonstrated the utility of PET/CT in indolent lymphomas. SUVmax (<4.35 vs ≥4.35) on interim PET/CT performed best in predicting PFS. %M 34508363 %R 10.2196/24936 %U https://formative.jmir.org/2021/11/e24936 %U https://doi.org/10.2196/24936 %U http://www.ncbi.nlm.nih.gov/pubmed/34508363 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e25329 %T Body Image Distress and Its Associations From an International Sample of Men and Women Across the Adult Life Span: Web-Based Survey Study %A Milton,Alyssa %A Hambleton,Ashlea %A Roberts,Anna %A Davenport,Tracey %A Flego,Anna %A Burns,Jane %A Hickie,Ian %+ Sydney School of Medicine, Faculty of Medicine and Health, University of Sydney, Professor Marie Bashir Centre, 67-73 Missenden Rd, Camperdown, 2050, Australia, 61 02 93510774, alyssa.milton@sydney.edu.au %K body image %K mental health %K well-being %K web-based survey %K sex differences %K age %D 2021 %7 4.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Previous research on body image distress mainly relied on samples that were small, generally homogeneous in age or sex, often limited to one geographical region, and were characterized by a lack of comprehensive analysis of multiple psychosocial domains. The research presented in this paper extends the international literature using the results of the web-based Global Health and Wellbeing Survey 2015. The survey included a large sample of both men and women aged ≥16 years from Australia, Canada, New Zealand, the United Kingdom, or the United States. Objective: The main objectives of this study are to examine body image distress across the adult life span (≥16 years) and sex and assess the association between body image distress and various psychosocial risk and protective factors. Methods: Data were extracted from the Global Health and Wellbeing Survey 2015, a web-based international self-report survey with 10,765 respondents, and compared with previous web-based surveys conducted in 2009 and 2012. Results: The body image distress of young Australians (aged 16-25 years) significantly rose by 33% from 2009 to 2015. In 2015, 75.19% (961/1278) of 16- to 25-year-old adults reported body image distress worldwide, and a decline in body image distress was noted with increasing age. More women reported higher levels of body image distress than men (1953/3338, 58.51% vs 853/2175, 39.22%). Sex, age, current dieting status, perception of weight, psychological distress, alcohol and other substance misuse, and well-being significantly explained 24% of the variance in body image distress in a linear regression (F15,4966=105.8; P<.001). Conclusions: This study demonstrates the significant interplay between body image distress and psychosocial factors across age and sex. %M 34734831 %R 10.2196/25329 %U https://formative.jmir.org/2021/11/e25329 %U https://doi.org/10.2196/25329 %U http://www.ncbi.nlm.nih.gov/pubmed/34734831 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e22809 %T Web-Based Information Seeking Behaviors of Low-Literacy Hispanic Survivors of Breast Cancer: Observational Pilot Study %A Iacobelli,Francisco %A Dragon,Ginger %A Mazur,Giselle %A Guitelman,Judith %+ Computer Science Department, Northeastern Illinois University, 5500 N. St. Louis Ave., Chicago, IL, 60625, United States, 1 7734424728, f-iacobelli@neiu.edu %K low literacy %K health literacy %K online searches %K Hispanic breast cancer survivors %D 2021 %7 27.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Internet searching is a useful tool for seeking health information and one that can benefit low-literacy populations. However, low-literacy Hispanic survivors of breast cancer do not normally search for health information on the web. For them, the process of searching can be frustrating, as frequent mistakes while typing can result in misleading search results lists. Searches using voice (dictation) are preferred by this population; however, even if an appropriate result list is displayed, low-literacy Hispanic women may be challenged in their ability to fully understand any individual article from that list because of the complexity of the writing. Objective: This observational study aims to explore and describe web-based search behaviors of Hispanic survivors of breast cancer by themselves and with their caregivers, as well as to describe the challenges they face when processing health information on the web. Methods: We recruited 7 Hispanic female survivors of breast cancer. They had the option to bring a caregiver. Of the 7 women, 3 (43%) did, totaling 10 women. We administered the Health LiTT health literacy test, a demographic survey, and a breast cancer knowledge assessment. Next, we trained the participants to search on the web with either a keyboard or via voice. Then, they had to find information about 3 guided queries and 1 free-form query related to breast cancer. Participants were allowed to search in English or in Spanish. We video and audio recorded the computer activity of all participants and analyzed it. Results: We found web articles to be written for a grade level of 11.33 in English and 7.15 in Spanish. We also found that most participants preferred searching using voice but struggled with this modality. Pausing while searching via voice resulted in incomplete search queries, as it confused the search engine. At other times, background noises were detected and included in the search. We also found that participants formulated overly general queries to broaden the results list hoping to find more specific information. In addition, several participants considered their queries satisfied based on information from the snippets on the result lists alone. Finally, participants who spent more time reviewing articles scored higher on the health literacy test. Conclusions: Despite the problems of searching using speech, we found a preference for this modality, which suggests a need to avoid potential errors that could appear in written queries. We also found the use of general questions to increase the chances of answers to more specific concerns. Understanding search behaviors and information evaluation strategies for low-literacy Hispanic women survivors of breast cancer is fundamental to designing useful search interfaces that yield relevant and reliable information on the web. %M 34704952 %R 10.2196/22809 %U https://formative.jmir.org/2021/10/e22809 %U https://doi.org/10.2196/22809 %U http://www.ncbi.nlm.nih.gov/pubmed/34704952 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e26314 %T Using a Constraint-Based Method to Identify Chronic Disease Patients Who Are Apt to Obtain Care Mostly Within a Given Health Care System: Retrospective Cohort Study %A Tong,Yao %A Liao,Zachary C %A Tarczy-Hornoch,Peter %A Luo,Gang %+ Department of Biomedical Informatics and Medical Education, University of Washington, UW Medicine South Lake Union, 850 Republican Street, Building C, Box 358047, Seattle, WA, 98195, United States, 1 206 221 4596, gangluo@cs.wisc.edu %K asthma %K chronic kidney disease %K chronic obstructive pulmonary disease %K data analysis %K diabetes mellitus %K emergency department %K health care system %K inpatients %K patient care management %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: For several major chronic diseases including asthma, chronic obstructive pulmonary disease, chronic kidney disease, and diabetes, a state-of-the-art method to avert poor outcomes is to use predictive models to identify future high-cost patients for preemptive care management interventions. Frequently, an American patient obtains care from multiple health care systems, each managed by a distinct institution. As the patient’s medical data are spread across these health care systems, none has complete medical data for the patient. The task of building models to predict an individual patient’s cost is currently thought to be impractical with incomplete data, which limits the use of care management to improve outcomes. Recently, we developed a constraint-based method to identify patients who are apt to obtain care mostly within a given health care system. Our method was shown to work well for the cohort of all adult patients at the University of Washington Medicine for a 6-month follow-up period. It is unknown how well our method works for patients with various chronic diseases and over follow-up periods of different lengths, and subsequently, whether it is reasonable to perform this predictive modeling task on the subset of patients pinpointed by our method. Objective: To understand our method’s potential to enable this predictive modeling task on incomplete medical data, this study assesses our method’s performance at the University of Washington Medicine on 5 subgroups of adult patients with major chronic diseases and over follow-up periods of 2 different lengths. Methods: We used University of Washington Medicine data for all adult patients who obtained care at the University of Washington Medicine in 2018 and PreManage data containing usage information from all hospitals in Washington state in 2019. We evaluated our method’s performance over the follow-up periods of 6 months and 12 months on 5 patient subgroups separately—asthma, chronic kidney disease, type 1 diabetes, type 2 diabetes, and chronic obstructive pulmonary disease. Results: Our method identified 21.81% (3194/14,644) of University of Washington Medicine adult patients with asthma. Around 66.75% (797/1194) and 67.13% (1997/2975) of their emergency department visits and inpatient stays took place within the University of Washington Medicine system in the subsequent 6 months and in the subsequent 12 months, respectively, approximately double the corresponding percentage for all University of Washington Medicine adult patients with asthma. The performance for adult patients with chronic kidney disease, adult patients with chronic obstructive pulmonary disease, adult patients with type 1 diabetes, and adult patients with type 2 diabetes was reasonably similar to that for adult patients with asthma. Conclusions: For each of the 5 chronic diseases most relevant to care management, our method can pinpoint a reasonably large subset of patients who are apt to obtain care mostly within the University of Washington Medicine system. This opens the door to building models to predict an individual patient’s cost on incomplete data, which was formerly deemed impractical. International Registered Report Identifier (IRRID): RR2-10.2196/13783 %M 34617906 %R 10.2196/26314 %U https://formative.jmir.org/2021/10/e26314 %U https://doi.org/10.2196/26314 %U http://www.ncbi.nlm.nih.gov/pubmed/34617906 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e26980 %T Knowledge, Attitudes, and Practices Regarding COVID-19 Among Health Care Workers in Public Health Facilities in Eastern Ethiopia: Cross-sectional Survey Study %A Farah,Alinoor Mohamed %A Nour,Tahir Yousuf %A Obsiye,Muse %A Aden,Mowlid Akil %A Ali,Omar Moeline %A Hussein,Muktar Arab %A Budul,Abdullahi Bedel %A Omer,Muktar %A Getnet,Fentabil %+ Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Jigjiga University, CoMHS Building, 2nd Floor, Jigjiga, 1020, Ethiopia, 251 911053913, alinuriana@yahoo.com %K COVID-19 %K knowledge %K attitude %K practice %K health care workers %K Eastern Ethiopia %D 2021 %7 1.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: On March 13, 2020, Ethiopia reported the first confirmed case of COVID-19 in Addis Ababa. COVID-19 is likely to overwhelm an already-fragile health care delivery system and reduce the availability of essential health services. This analysis of data from the Somali Region of Eastern Ethiopia on health care workers’ (HCWs) knowledge, attitudes, and practices regarding the prevention and control of COVID-19 may be used in planning health education programs about the emerging viral disease. Objective: This study aimed to investigate the knowledge, attitudes, and practices of HCWs regarding COVID-19 infection. Methods: This cross-sectional study was conducted among HCWs in three public health facilities in the Somali Region, Eastern Ethiopia. A self-administered questionnaire was shared with all HCWs working at the public health facilities. A total of 15 knowledge questions were scored as 1 or 0 for correct or incorrect responses, respectively. A total of 14 practice questions were scored on a 3-point scale from 1 (“always”) to 3 (“never”). A total of six attitude questions were rated on a 5-point Likert scale, in a negative dimension, as follows: 1 (“strongly agree”), 2 (“agree”), 3 (“neutral”), 4 (“disagree”), and 5 (“strongly disagree”). Mean scores were calculated and used as a cut point to dichotomize the outcome variables (>13.7 indicated good knowledge, <18.8 indicated good practices, and ≤10.5 indicated favorable attitudes). We used t tests and analyses of variance (ie, F tests) to analyze the mean score differences of knowledge, attitudes, and practices between the independent variables. Spearman correlation was used to assess the relationship between mean knowledge and attitude scores. Results: Of the 686 HCWs approached, a total of 434 HCWs responded (63.3% response rate). The mean age of the participants was 27.6 (SD 5.3) years, and the majority of the participants were male (293/434, 67.5%). The mean knowledge score was 13.7 (SD 2.6), and 73.3% (318/434) of participants had sufficient knowledge. The mean attitude score was 10.5 (SD 4.1), and 54.8% (238/434) of the participants had a good attitude toward COVID-19. The mean practice score was 18.8 (SD 5.8), and 61.5% (267/434) of the participants practiced precautionary measures to prevent COVID-19. There was a negative correlation between knowledge and attitude scores (r=–0.295, P<.001) and between knowledge and practice scores (r=–0.298, P<.001). Conclusions: The overall levels of knowledge and practice were relatively better than the attitude level. This highlights the need to implement strategies that enhance the positive attitudes and safe practices of the HCWs for better containment of the pandemic and supporting of essential health care services. %M 34477559 %R 10.2196/26980 %U https://formative.jmir.org/2021/10/e26980 %U https://doi.org/10.2196/26980 %U http://www.ncbi.nlm.nih.gov/pubmed/34477559 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e27477 %T Informed Decision-making for Health Insurance Enrollment: Survey Study %A Colón-Morales,Coralys M %A Giang,Wayne C W %A Alvarado,Michelle %+ Department of Industrial and Systems Engineering, University of Florida, 303 Weil Hall, Gainesville, FL, 32603, United States, 1 (352) 392 1464, ccolonmorales@ufl.edu %K health insurance %K information %K sources %K survey %K literacy %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health insurance enrollment is a difficult financial decision with large health impacts. Challenges such as low health insurance literacy and lack of knowledge about choosing a plan further complicate this decision-making process. Therefore, to support consumers in their choice of a health insurance plan, it is essential to understand how individuals go about making this decision. Objective: This study aims to understand the sources of information used by individuals to support their employer-provided health insurance enrollment decisions. It seeks to describe how individual descriptive factors lead to choosing a particular type of information source. Methods: An introduction was presented on health insurance plan selection and the sources of information used to support these decisions from the 1980s to the present. Subsequently, an electronic survey of 151 full-time faculty and staff members was conducted. The survey consisted of four sections: demographics, sources of information, health insurance literacy, and technology acceptance. Descriptive statistics were used to show the demographic characteristics of the 126 eligible respondents and to study the response behaviors in the remaining survey sections. Proportion data analysis was performed using the Cochran-Armitage trend test to understand the strength of the association between our variables and the types of sources used by the respondents. Results: In terms of demographics, most of the respondents were women (103/126, 81.7%), represented a small household (1-2 persons; 87/126, 69%), and used their insurance 3-12 times a year (52/126, 41.3%). They assessed themselves as having moderate to high health insurance literacy and high acceptance of technology. The most selected and top-ranked sources were Official employer or state websites and Official Human Resources Virtual Benefits Counselor Alex. From our data analysis, we found that the use of official primary sources was constant across age groups and health insurance use groups. Meanwhile, the use of friends or family as a primary source slightly decreased as age and use increased. Conclusions: In this exploratory study, we identified the main sources of health insurance information among full-time employees from a large state university and found that most of the respondents needed 2-3 sources to gather all the information that they desired. We also studied and identified the relationships between individual factors (such as age, gender, and literacy) and 2 dependent variables on the types of primary sources of information. We encountered several limitations, which will be addressed in future studies. %M 34387555 %R 10.2196/27477 %U https://formative.jmir.org/2021/8/e27477 %U https://doi.org/10.2196/27477 %U http://www.ncbi.nlm.nih.gov/pubmed/34387555 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e27062 %T Improving Diabetes Self-management by Providing Continuous Positive Airway Pressure Treatment to Patients With Obstructive Sleep Apnea and Type 2 Diabetes: Qualitative Exploratory Interview Study %A Laursen,Ditte Hjorth %A Rom,Gitte %A Banghøj,Anne Margareta %A Tarnow,Lise %A Schou,Lone %+ Institute of Nursing, University College Copenhagen, Tagensvej 86, Copenhagen, 2200, Denmark, 45 61303770, dittehjorth@gmail.com %K diabetes %K diabetes self-management %K obstructive sleep apnea %K continued positive airway pressure %K sleep patterns %K sleepiness in daily life %K sleep apnea %K elderly %K sleep %D 2021 %7 20.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a high prevalence of unexplained and unexplored obstructive sleep apnea (OSA) among patients with type 2 diabetes. The daytime symptoms of OSA include severe fatigue, cognitive problems, a decreased quality of life, and the reduced motivation to perform self-care. These symptoms impair the management of both diabetes and daily life. OSA may therefore have negative implications for diabetes self-management. Continuous positive airway pressure (CPAP) therapy is used to treat OSA. This treatment improves sleep quality, insulin resistance, and glycemic control. Although the benefits of using CPAP as a treatment for OSA are clear, the noncompliance rate is high, and the evidence for the perceived effect that CPAP treatment has on patients with type 2 diabetes and OSA is poor. Objective: The purpose of this study was to analyze the impacts that comorbid diabetes and OSA have on the daily lives of older adults and to investigate the perceived effect that CPAP treatment for OSA has on patients’ diabetes self-management. Methods: A qualitative follow-up study that involved in-depth, semistructured dyad interviews with couples before and after CPAP treatment (N=22) was conducted. Patients were recruited from the Hilleroed Hospital in Denmark and were all diagnosed with type 2 diabetes, aged >18 years, and had an apnea-hypopnea index of ≥15. All interviews were coded and analyzed via thematic analysis. Results: The results showed that patients and their partners did not consider OSA to be a serious disorder, as they believed that OSA symptoms were similar to those of the process of aging. Patients experienced poor nocturnal sleep, took frequent daytime naps, exhibited reduced cognitive function, and had low levels of physical activity and a high-calorie diet. These factors negatively influenced their diabetes self-management. Despite the immediate benefit of CPAP treatment, most patients (11/12, 92%) faced technical challenges when using the CPAP device. Only the patients with severe OSA symptoms that affected their daily lives overcame the challenges of using the CPAP device and thereby improved their diabetes self-management. Patients with less severe symptoms rated CPAP-related challenges as more burdensome than their symptoms. Conclusions: If used correctly, CPAP has the potential to significantly improve OSA, resulting in better sleep quality; improved physical activity; improved diet; and, in the end, better diabetes self-management. However, there are many barriers to undergoing CPAP treatment, and only few patients manage to overcome these barriers and comply with correct treatment. %M 34283032 %R 10.2196/27062 %U https://formative.jmir.org/2021/7/e27062 %U https://doi.org/10.2196/27062 %U http://www.ncbi.nlm.nih.gov/pubmed/34283032 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e25043 %T Exploring the Potential of Personalized Dietary Advice for Health Improvement in Motivated Individuals With Premetabolic Syndrome: Pretest-Posttest Study %A van der Haar,Sandra %A Hoevenaars,Femke P M %A van den Brink,Willem J %A van den Broek,Tim %A Timmer,Mariëlle %A Boorsma,André %A Doets,Esmée L %+ Wageningen Food & Biobased Research, Wageningen University & Research, Bornse Weilanden 9, Wageningen, 6708 WG, Netherlands, 31 0317 480171, sandra.vanderhaar@wur.nl %K personalized nutrition %K metabolic syndrome %K dietary behavior %K diet %K metabolic %K metabolic health %K dietary advice %K dietary feedback %K digital health %D 2021 %7 24.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Dietary quality plays an essential role in the prevention and management of metabolic syndrome (MetS). Objective: The aim of this pilot study is to organize personalized dietary advice in a real-life setting and to explore the effects on dietary intake, metabolic health, and perceived health. Methods: We followed a one-group pretest-posttest design and included 37 individuals at risk of MetS, who indicated motivation to change dietary behavior. For a period of 16 weeks, participants received personalized advice (t=0 and t=8) and feedback (t=0, t=4, t=8, t=12 and t=16) on dietary quality and metabolic health (ie, waist circumference, BMI, blood pressure, lipid profile, fasting glucose levels, and C-peptide). Personalized advice was generated in a two-stage process. In stage 1, an automated algorithm generated advice per food group, integrating data on individual dietary quality (Dutch Healthy Diet Index; total score 8-80) and metabolic health parameters. Stage 2 included a telephone consultation with a trained dietitian to define a personal dietary behavior change strategy and to discuss individual preferences. Dietary quality and metabolic health markers were assessed at t=0, t=8, and t=16. Self-perceived health was evaluated on 7-point Likert scales at t=0 and t=16. Results: At the end of the study period, dietary quality was significantly improved compared with the baseline (Dutch Healthy Diet Index +4.3; P<.001). In addition, lipid profile (triglycerides, P=.02; total cholesterol, P=.01; high-density lipoprotein, P<.001; and low-density lipoprotein, P<.001), BMI (P<.001), waist circumference (P=.01), and C-peptide (P=.01) were all significantly improved, whereas plasma glucose increased by 0.23 nmol/L (P=.04). In line with these results, self-perceived health scores were higher at t=16 weeks than at baseline (+0.67; P=.005). Conclusions: This exploratory study showed that personalized dietary advice resulted in positive effects on dietary behavior, metabolic health, and self-perceived health in motivated pre-MetS adults. The study was performed in a do-it-yourself setting, highlighting the potential of at-home health improvement through dietary changes. Trial Registration: ClinicalTrials.gov NCT04595669; https://clinicaltrials.gov/ct2/show/NCT04595669 %M 34185002 %R 10.2196/25043 %U https://formative.jmir.org/2021/6/e25043/ %U https://doi.org/10.2196/25043 %U http://www.ncbi.nlm.nih.gov/pubmed/34185002 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e25083 %T Patients’ and Providers’ Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment %A Hoffman,Aubri %A Crocker,Laura %A Mathur,Aakrati %A Holman,Deborah %A Weston,June %A Campbell,Sukhkamal %A Housten,Ashley %A Bradford,Andrea %A Agrawala,Shilpi %A Woodard,Terri L %+ Department of Gynecological Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1155 Pressler Street, Unit 1362, Houston, TX, 77030-4009, United States, 1 713 745 7591, tlwoodard@mdanderson.org %K cancer %K decision support techniques %K fertility preservation %K oncofertility %K oncology %K needs assessment %K patient decision aids %K patient needs %K shared decision making %D 2021 %7 7.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: As cancer treatments continue to improve, it is increasingly important that women of reproductive age have an opportunity to decide whether they want to undergo fertility preservation treatments to try to protect their ability to have a child after cancer. Clinical practice guidelines recommend that providers offer fertility counseling to all young women with cancer; however, as few as 12% of women recall discussing fertility preservation. The long-term goal of this program is to develop an interactive web-based patient decision aid to improve awareness, access, knowledge, and decision making for all young women with cancer. The International Patient Decision Aid Standards collaboration recommends a formal decision-making needs assessment to inform and guide the design of understandable, meaningful, and usable patient decision aid interventions. Objective: This study aims to assess providers’ and survivors’ fertility preservation decision-making experiences, unmet needs, and initial design preferences to inform the development of a web-based patient decision aid. Methods: Semistructured interviews and an ad hoc focus group assessed current decision-making experiences, unmet needs, and recommendations for a patient decision aid. Two researchers coded and analyzed the transcripts using NVivo (QSR International). A stakeholder advisory panel guided the study and interpretation of results. Results: A total of 51 participants participated in 46 interviews (18 providers and 28 survivors) and 1 ad hoc focus group (7 survivors). The primary themes included the importance of fertility decisions for survivorship, the existence of significant but potentially modifiable barriers to optimal decision making, and a strong support for developing a carefully designed patient decision aid website. Providers reported needing an intervention that could quickly raise awareness and facilitate timely referrals. Survivors reported needing understandable information and help with managing uncertainty, costs, and pressures. Design recommendations included providing tailored information (eg, by age and cancer type), optional interactive features, and multimedia delivery at multiple time points, preferably outside the consultation. Conclusions: Decision making about fertility preservation is an important step in providing high-quality comprehensive cancer care and a priority for many survivors’ optimal quality of life. Decision support interventions are needed to address gaps in care and help women quickly navigate toward an informed, values-congruent decision. Survivors and providers support developing a patient decision aid website to make information directly available to women outside of the consultation and to provide self-tailored content according to women’s clinical characteristics and their information-seeking and deliberative styles. %M 34096871 %R 10.2196/25083 %U https://formative.jmir.org/2021/6/e25083 %U https://doi.org/10.2196/25083 %U http://www.ncbi.nlm.nih.gov/pubmed/34096871 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e29365 %T Meaning in Life Among Patients With Chronic Pain and Suicidal Ideation: Mixed Methods Study %A Costanza,Alessandra %A Chytas,Vasileios %A Piguet,Valérie %A Luthy,Christophe %A Mazzola,Viridiana %A Bondolfi,Guido %A Cedraschi,Christine %+ Department of Psychiatry, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, Geneva, 1211, Switzerland, 41 223795900, alessandra.costanza@unige.ch %K suicide %K suicidal behavior %K suicidal ideation %K suicide attempt %K chronic pain %K meaning in life %K protective factors %K risk factors %K mental health %D 2021 %7 4.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Patients with chronic pain have elevated risk of suicidal ideation and behavior, including suicide attempts and completed suicides. In most studies, associations between chronic pain and suicidal ideation/suicidal behavior are robust even after adjusting for the effect of sociodemographics and psychiatric comorbidity. However, to refine the risk profile of these patients, further exploration of other possible risk and protective factors is necessary. Objective: There is a common clinical observation that experiencing chronic pain often requires a revision of life goals and expectations, and hence, it impacts the existential domain including one’s perception of the meaning in life (MiL). This study aimed to characterize the main domains that constitute the personal MiL, including the “presence of” and “search for” constructs, in a group of patients with chronic pain and suicidal ideation. Methods: Seventy participants were enlisted by ongoing recruitment through a larger project anchored in daily clinical practice at the Multidisciplinary Pain Center of the Geneva University Hospitals. It was an observational mixed method study. Data were recorded through both validated quantitative questionnaires and qualitative open-ended questions. Results: The total sample consisted of 70 patients. Responses to questionnaires showed a depressive episode in 68 (97%) patients and anxious disorders in 25 (36%) patients. With a score threshold for positive MiL of 24, the mean score for the “presence of” construct was 20.13 (SD 8.23), and 63% (44/70) of respondents had a score <24. The mean score for the “search for” construct was lower at 18.14 (SD 8.64), and 70% (49/70) of respondents had a score <24. The “presence of” and “search for” constructs were significantly positively correlated (R=0.402; P=.001). An open question addressed the “presence of” construct by inviting the respondents to cite domains they consider as providing meaning in their life at the present time. All patients responded to this question, citing one or more domains. The three main dimensions that emerged from content analysis of this qualitative section were as follows: the domain of relationships, the domain of personal activities, and pain and its consequences on MiL. Conclusions: The study results provide insights into patients with chronic pain and suicidal ideation, including the domains that provide them with meaning in their lives and the impact of pain on these domains with regard to suicidal ideation. The main clinical implications concern both prevention and supportive/psychotherapeutic interventions. They are based on a narrative approach aiming to explore with the patients the content of their suffering and the MiL domains that they could identify to mitigate it, in order to restructure/reinforce these domains and thus possibly reduce suicidal ideation. Specifically, a focus on maintaining the domains of interpersonal relationships and personal activities can allow patients to ultimately escape the biopsychosocial vicious cycle of chronic pain–induced deep moral suffering. %M 34003136 %R 10.2196/29365 %U https://formative.jmir.org/2021/6/e29365 %U https://doi.org/10.2196/29365 %U http://www.ncbi.nlm.nih.gov/pubmed/34003136 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25663 %T Physical Activity Patterns and Neighborhood Characteristics of First-Generation Latina Immigrants Living in Arizona: Cross-sectional Study %A Joseph,Rodney P %A Vega-López,Sonia %A Han,SeungYong %+ Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, 500 N 3rd St, Phoenix, AZ, 85004, United States, 1 6024960772, rodney.joseph@asu.edu %K emigrants and immigrants %K physical activity %K exercise %K residence characteristics %K female %K metabolic disease %K Latina %K immigrants %K emigrants %K health outcomes %D 2021 %7 17.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Metabolic diseases, including obesity and type 2 diabetes, are a major health concern for Latina immigrants. Performing regular aerobic physical activity (PA) is a lifestyle behavior associated with the prevention and control of these conditions. However, PA levels of most Latina immigrants are below national guidelines. Neighborhood environmental factors may influence the PA levels of adults, but limited research has explored associations between the neighborhood environment and PA levels among Latina immigrants. Objective: The objective of this study was to explore the PA patterns of first-generation US Latina immigrants and how neighborhood environmental factors are related to those PA patterns. Methods: Using a cross-sectional study design, 50 first-generation Latina immigrants completed the International Physical Activity Questionnaire (IPAQ) and the Neighborhood Scales Questionnaire, which assessed 6 perceived neighborhood factors: (1) walking environment, (2) aesthetic quality, (3) safety, (4) violence, (5) social cohesion, and (6) activities with neighbors. Median self-reported metabolic equivalent (MET)-minutes/week of PA were used to summarize domain-specific (ie, work, domestic/household, leisure, and transportation) and intensity-specific (ie, walking, moderate, vigorous, moderate to vigorous) PA patterns. Logistic regression examined associations between neighborhood factors and engaging in leisure-time PA (ie, dichotomous outcome of some versus no leisure-time PA), transportation PA (ie, dichotomous outcome of some versus no transportation PA), and meeting national PA guidelines (ie, dichotomous outcome of meeting versus not meeting guidelines). Results: Preliminary analyses showed that 10 participants reported excessively high PA levels and 1 participant had incomplete PA data; these women were excluded from analyses based on IPAQ scoring guidelines. The remaining 39 participants (mean age 40.5 years; mean length of US residency 4.6 years) reported a median of 4512 MET-minutes/week of total PA. The majority of PA was acquired through domestic activities (median 2160 MET-minutes/week), followed by leisure-time PA (median 396 MET-minutes/week), transportation PA (median 198 MET-minutes/week), and work PA (0 MET-minutes/week). Intensity-specific PA patterns showed a median of 594 MET-minutes/week of walking activity and 3500 MET-minutes/week of moderate-to-vigorous PA. Logistic regression models indicated that the neighborhood factors of walking environment, aesthetic quality, and safety were positively associated with engaging in leisure-time PA (odds ratios of 5.95, 95% CI 1.49-23.74; 2.45, 95% CI 1.01-5.93; and 3.30, 95% CI 1.26-8.67, respectively) and meeting national PA guidelines (odds ratios of 4.15, 95% CI 1.13-15.18; 6.43, 95% CI 1.45-28.39; and 2.53, 95% CI 1.00-6.36, respectively). The neighborhood factors of violence, social cohesion, and activities with neighbors were not significantly associated with PA outcomes. Conclusions: Although most participants met national PA guidelines (ie, ≥500 MET-minutes/week of moderate-to-vigorous PA), the majority of their PA was achieved through domestic activities, with limited leisure, transportation, and work PA. Given that leisure-time PA in particular plays a significant role in improving health outcomes, findings suggest that many Latina immigrants could benefit from a leisure-time PA intervention. Such interventions should consider neighborhood environmental influences, as these factors may serve as determinants of PA. %M 33999003 %R 10.2196/25663 %U https://formative.jmir.org/2021/5/e25663 %U https://doi.org/10.2196/25663 %U http://www.ncbi.nlm.nih.gov/pubmed/33999003 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e24446 %T Reporting of Differences in Taste Between Branded and Unbranded Cigarettes by Smokers Blinded to Cigarette Branding: Within-Person, Randomized Crossover Study %A BinDhim,Nasser F %A Althumiri,Nora A %A Basyouni,Mada H %A Almubark,Rasha A %A Alkhamaali,Zaied %A Banjar,Weam %A Zamakhshary,Mohammed %A AlKattan,Khaled M %+ Sharik Association for Health Research, 4 Anas ibn Malik, Riyadh, 11778, Saudi Arabia, 966 505435544, nora@althumiri.net %K smoking %K plain packaging %K sensory %K Saudi Arabia %K tobacco %K virtual reality %K cigarettes %D 2021 %7 14.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Saudi Arabia implemented a plain tobacco packaging regulation, one of the World Health Organization’s recommended initiatives to help reduce smoking rates, in August 2019. A few weeks after implementation, a large number of smokers complained via various media channels, especially social media (eg, Twitter), that an extreme change in cigarette taste had occurred, frequency of coughing had increased, and for some, shortness of breath had led to hospitalization. Objective: The main objective is to determine whether smokers blinded to cigarette branding report differences in taste between branded and unbranded cigarettes. The secondary objective is to observe the frequency of immediate cough or shortness of breath. Methods: This study employed a within-person, randomized crossover design that recruited current smokers 18 years and older who were cleared upon physical assessment before the experiment. Participants received 6 sequences of different random exposures (3 puffs) to 3 plain-packaged cigarettes (2 from their favorite brand and 1 from another brand as a control) and 3 branded cigarettes (2 from the favorite brand and 1 from another brand as a control). Participants wore virtual reality goggles accompanied by special software to alter visual reality and gloves to alter the touch sensation. Results: This study recruited 18 participants, measured at 6 time points, to produce 108 experiments. Participants were not able to identify the correct type of cigarettes (plain or branded, estimate of fixed effect=−0.01, P=.79). Moreover, there were no differences in the ability of the participants to identify their favorite brand (t107=−0.63, mean 0.47, P=.53). In terms of immediate coughing, out of the 108 experiments, 1 episode of short coughing was observed, which was attributed to the branded cigarette, not the plain-packaged cigarette. Conclusions: After controlling the visual and touch sensations, participants were not able to differentiate between branded and plain-packaged cigarettes in terms of taste or inducing immediate shortness of breath or cough. Interestingly, participants were not able to identify their favorite brand. %M 33988511 %R 10.2196/24446 %U https://formative.jmir.org/2021/5/e24446 %U https://doi.org/10.2196/24446 %U http://www.ncbi.nlm.nih.gov/pubmed/33988511 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25577 %T Using a Multisectoral Approach to Advance Health Equity in Rural Arizona: Community-Engaged Survey Development and Implementation Study %A Remiker,Mark %A Sabo,Samantha %A Jiménez,Dulce %A Samarron Longorio,Alexandra %A Chief,Carmenlita %A Williamson,Heather %A Teufel-Shone,Nicolette %+ Center for Health Equity Research, Northern Arizona University, 1395 Knoles Dr., Flagstaff, AZ, 86011, United States, 1 2627487095, mark.remiker@nau.edu %K health equity %K community-engaged %K multisector %K survey development %D 2021 %7 12.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Over the past decade, public health research and practice sectors have shifted their focus away from identifying health disparities and toward addressing the social, environmental, and economic determinants of health equity. Given the complex and interrelated nature of these determinants, developing policies that will advance health equity requires collaboration across sectors outside of health. However, engaging various stakeholder groups, tapping into their unique knowledge systems, and identifying common objectives across sectors is difficult and time consuming and can impede collaborative efforts. Objective: The Southwest Health Equity Research Collaborative at Northern Arizona University, in partnership with an 11-member community advisory council, is addressing this need with a joint community-campus effort to develop and implement a Regional Health Equity Survey (RHES) designed to generate an interdisciplinary body of knowledge, which will be used to guide future multisectoral action for improving community health and well-being. Methods: Researchers and community partners used facilitated discussions and free listing techniques to generate survey items. The community partners pilot tested the survey instrument to evaluate its feasibility and duration before survey administration. Respondent-driven sampling was used to ensure that participants included leadership from across all sectors and regions of northern Arizona. Results: Over the course of 6 months, 206 participants representing 13 sectors across the 5 counties of northern Arizona were recruited to participate in an RHES. Survey response rates, completion percentage, and sector representation were used to assess the effectiveness and feasibility of using a community-engaged apporach for survey development and participant recruitment. The findings describe the current capacity to impact health equity by using a multisectoral approach in northern Arizona. Conclusions: The Southwest Health Equity Research Collaborative effectively engaged community members to assist with the development and implementation of an RHES aimed at understanding and promoting multisectoral action on the root causes of health inequity. The results will help to build research and evaluation capacity to address the social, economic, and environmental conditions of health inequity in the region. %M 33978596 %R 10.2196/25577 %U https://formative.jmir.org/2021/5/e25577 %U https://doi.org/10.2196/25577 %U http://www.ncbi.nlm.nih.gov/pubmed/33978596 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21481 %T Written Advice Given by African American Smokers to Their Peers: Qualitative Study of Motivational Messages %A Nagawa,Catherine S %A Faro,Jamie M %A Menon,Anitha J %A Ito Fukunaga,Mayuko %A Williams,Jessica H %A Mourao,Dalton %A Emidio,Oluwabunmi M %A Davis,Maryann %A Pbert,Lori %A Cutrona,Sarah L %A Houston,Thomas K %A Sadasivam,Rajani S %+ Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, United States, 1 508 856 8999, catherine.nagawa@umassmed.edu %K tobacco disparities %K peer-to-peer %K communication %K smoking %K cessation %K thematic analysis %K intervention %K African American %D 2021 %7 30.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although African Americans have the lowest rates of smoking onset and progression to daily smoking, they are less likely to achieve long-term cessation. Interventions tailored to promote use of cessation resources in African American individuals who smoke are needed. In our past work, we demonstrated the effectiveness of a technology-assisted peer-written message intervention for increasing smoking cessation in non-Hispanic White smokers. In this formative study, we have adapted this intervention to be specific for African American smokers. Objective: We aimed to report on the qualitative analysis of messages written by African American current and former smokers for their peers in response to hypothetical scenarios of smokers facing cessation challenges. Methods: We recruited African American adult current and former smokers (n=41) via ResearchMatch between April 2017 and November 2017. We asked participants to write motivational messages for their peers in response to smoking-related hypothetical scenarios. We also collected data on sociodemographic factors and smoking characteristics. Thematic analysis was conducted to identify cessation strategies suggested by the study participants. Results: Among the study participants, 60% (25/41) were female. Additionally, more than half (23/41, 56%) were thinking about quitting, 29% (12/41) had set a quit date, and 27% (11/41) had used electronic cigarettes in the past 30 days. Themes derived from the qualitative analysis of peer-written messages were (1) behavioral strategies, (2) seeking help, (3) improvements in quality of life, (4) attitudes and expectations, and (5) mindfulness/religious or spiritual practices. Under the behavioral strategies theme, distraction strategies were the most frequently suggested strategies (referenced 84 times in the 318 messages), followed by use of evidence-based treatments/cessation strategies. Within the seeking help theme, subthemes included seeking help or support from family/friends or close social networks (referenced 56 times) and health care professionals (referenced 22 times). The most frequent subthemes that emerged from improvements in the quality of life theme included improving one’s health (referenced 22 times) and quality of life (referenced 21 times). Subthemes that emerged from the attitude and expectations theme included practicing positive self-talk (referenced 27 times), autonomy/independence from the smoking habit (referenced six times), and financial cost of smoking (referenced five times). The two subthemes that emerged from the mindfulness/religious or spiritual practices theme were use of self-awareness techniques (referenced 36 times) and religious or spiritual practices to cope (referenced 13 times). Conclusions: Our approach to adapt a prior peer-message intervention to African American smokers yielded a set of evidence-based messages that may be suitable for smokers at all phases of motivation to quit (ready to quit or not ready to quit). In future research, we plan to assess the impact of texting these messages to African American smokers in a smoking cessation trial. %M 33929332 %R 10.2196/21481 %U https://formative.jmir.org/2021/4/e21481 %U https://doi.org/10.2196/21481 %U http://www.ncbi.nlm.nih.gov/pubmed/33929332 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e25438 %T Exploring the Association Between Physical Activity and Risk of Mental Health Disorders in Saudi Arabian Adults: Cross-sectional Study %A Althumiri,Nora A %A Basyouni,Mada H %A BinDhim,Nasser F %+ Sharik Association For Health Research, Anas Ibn Malik RD, Riyadh, Saudi Arabia, 966 505435544, nora@althumiri.net %K Saudi Arabia %K physical activity %K mental health %K depression %K anxiety %K risk %K symptoms %K cross-sectional %K survey %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The relationship between physical activity and mental health, especially the symptoms of major depressive disorder (MDD) and generalized anxiety disorder (GAD), has received increasing attention in recent years. Objective: The aim of this study was to explore the association between fulfilling the World Health Organization (WHO) global recommendations on physical activity and the risk and symptoms of MDD and GAD in the Saudi population. Methods: This study was a secondary analysis of data from a large nationwide cross-sectional survey conducted via phone interviews in June and July 2020. In this study, a proportional quota sampling technique was used to obtain an equal distribution of participants, stratified by age and gender, across the 13 regions of Saudi Arabia. The main mental health screening tool used for the risk of MDD was the Patient Health Questionnaire-9 (PHQ-9). Risk of GAD was measured using the Generalized Anxiety Disorder-7 (GAD-7) scale. Participants self-reported whether they fulfill the WHO global recommendations on (1) moderate-intensity aerobic physical activity (MIPA) and (2) vigorous-intensity aerobic physical activity (VIPA). The results were then analyzed based on the following two categories: fulfilling the WHO global recommendations or not. Results: The data analysis included 8333 participants recruited in the main study between June and July 2020. The response rate was 81.45% (8333/10,231). Of them, 50.3% (4192/8333) were female, and the mean age was 36.5 years, with a median age of 36 years and a range from 18 to 90 years. The average total PHQ-9 score was 5.61, and the average total GAD-7 score was 4.18. For men, the average total PHQ-9 and GAD-7 scores were associated with fulfilling recommendations for MIPA; however, there were no associations for VIPA in both sexes. Fulfilling the WHO’s recommendations for MIPA was associated with considerably fewer depressive symptoms in six of the nine items in the PHQ-9. Moreover, fulfilling recommendations for MIPA was associated with considerably fewer anxiety symptoms in six of the seven items in the GAD-7. However, fulfilling recommendations for VIPA was significantly associated with more depressive symptoms in one of the PHQ-9 items (“Thoughts that you would be better off dead or thoughts of hurting yourself in some way;” P<.001). Conclusions: This study has shown that fulfilling guidelines on MIPA is associated with less overall risk of MDD and GAD in males and fewer depressive and anxiety symptoms generally in a nonclinical population. In the general population, an increase in MIPA may improve well-being and general mental health. %M 33851932 %R 10.2196/25438 %U https://publichealth.jmir.org/2021/4/e25438 %U https://doi.org/10.2196/25438 %U http://www.ncbi.nlm.nih.gov/pubmed/33851932 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e27107 %T An Acute Stress Scale for Health Care Professionals Caring for Patients With COVID-19: Validation Study %A Mira,Jose Joaquin %A Cobos,Angel %A Martínez García,Olga %A Bueno Domínguez,María José %A Astier-Peña,María Pilar %A Pérez Pérez,Pastora %A Carrillo,Irene %A Guilabert,Mercedes %A Perez-Jover,Virtudes %A Fernandez,Cesar %A Vicente,María Asuncion %A Lahera-Martin,Matilde %A Silvestre Busto,Carmen %A Lorenzo Martínez,Susana %A Sanchez Martinez,Ascension %A Martin-Delgado,Jimmy %A Mula,Aurora %A Marco-Gomez,Barbara %A Abad Bouzan,Cristina %A Aibar-Remon,Carlos %A Aranaz-Andres,Jesus %A , %+ Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, Hermanos López de Osaba, Alicante, Spain, 34 606433599, jose.mira@umh.es %K SARS-CoV-2 virus %K COVID-19 outbreak %K medical staff %K acute stress %K moral injury %K posttraumatic stress %K COVID-19 %D 2021 %7 9.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has affected the response capacity of the health care workforce, and health care professionals have been experiencing acute stress reactions since the beginning of the pandemic. In Spain, the first wave was particularly severe among the population and health care professionals, many of whom were infected. These professionals required initial psychological supports that were gradual and in line with their conditions. Objective: In the early days of the pandemic in Spain (March 2020), this study aimed to design and validate a scale to measure acute stress experienced by the health care workforce during the care of patients with COVID-19: the Self-applied Acute Stress Scale (EASE). Methods: Item development, scale development, and scale evaluation were considered. Qualitative research was conducted to produce the initial pool of items, assure their legibility, and assess the validity of the content. Internal consistency was calculated using Cronbach α and McDonald ω. Confirmatory factor analysis and the Mann-Whitney-Wilcoxon test were used to assess construct validity. Linear regression was applied to assess criterion validity. Back-translation methodology was used to translate the scale into Portuguese and English. Results: A total of 228 health professionals from the Spanish public health system responded to the 10 items of the EASE scale. Internal consistency was .87 (McDonald ω). Goodness-of-fit indices confirmed a two-factor structure, explaining 55% of the variance. As expected, the highest level of stress was found among professionals working in health services where a higher number of deaths from COVID-19 occurred (P<.05). Conclusions: The EASE scale was shown to have adequate metric properties regarding consistency and construct validity. The EASE scale could be used to determine the levels of acute stress among the health care workforce in order to give them proportional support according to their needs during emergency conditions, such as the COVID-19 pandemic. %M 33687343 %R 10.2196/27107 %U https://formative.jmir.org/2021/3/e27107 %U https://doi.org/10.2196/27107 %U http://www.ncbi.nlm.nih.gov/pubmed/33687343 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e24302 %T Educational Needs and Preferences for Patient-Centered Outcomes Research in the Cystic Fibrosis Community: Mixed Methods Study %A Godfrey,Emily M %A Kazmerski,Traci M %A Brown,Georgia %A Thayer,Erin K %A Mentch,Laura %A Pam,Molly %A Al Achkar,Morhaf %+ Department of Family Medicine, University of Washington School of Medicine, 4311 11th Ave NE, Suite 210, Box 354982, Seattle, WA, 98105, United States, 1 206 685 4895, godfreye@uw.edu %K cystic fibrosis %K needs assessment %K patient-centered outcomes research %K training %K education %K team building %K patient engagement %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Cystic fibrosis (CF) is a rare, life-shortening, multiorgan disease, the treatment of which has seen significant increases in the life expectancy of those with CF. Many advances in CF care are thanks to the dedicated and active participation of people with CF as research participants. Unfortunately, most CF research teams still do not fully partner with people with CF or their caregivers. Objective: The aim of this study was to determine the interest, knowledge gaps, and desired format for patient-centered outcomes research (PCOR) training in the CF community. Methods: We surveyed patients, caregivers, researchers, research staff, and diverse health care providers via list servers and social media outreach about their knowledge of, experience with, and preferences for PCOR training components. We followed the survey with 3 small-group discussion sessions with 22 participants who completed the survey to establish consensus and prioritize key learning components of a PCOR training program. We summarized results using descriptive statistics. Results: A total of 170 participants completed the survey (patients/caregivers: 96/170, 56.5%; researchers/health care providers: 74/170, 43.5%). Among providers, 26% (19/74) were physicians/advanced practice providers, 20% (15/74) were nurses, and 54% (40/74) were from other disciplines. Among all participants, 86.5% (147/170) expressed interest in learning about PCOR, although training topics and training format differed between the patient/caregiver and researcher/health care provider groups. Before participating in PCOR, patients/caregivers wanted to understand more about expectations of them as partners on PCOR research teams (82/96, 85%). Meanwhile, researchers/health care providers desired information on how to include outcomes important to patients/caregivers (55/74, 74%) and the quality and impact of PCOR research (52/74, 70% and 51/74, 69%, respectively). Patients/caregivers were most interested in learning about the time commitment as a PCOR team member (75/96, 78%). Researchers/health care providers wanted to receive training about how to establish trust (47/74, 64%) and maintain confidentiality (47/74, 64%) when including patient or caregiver partners on the PCOR team. During follow-up discussions, participants emphasized the importance of addressing the traditional patient/caregiver and researchers/health care provider hierarchy by teaching about transparency, appreciation, creating a common language between the groups, and providing specific training on “how” to do PCOR. Conclusions: Our findings suggest CF community members are interested in PCOR. A high-quality training program would fill a current deficit in methodological research. This assessment identified the topics and formats desired and can be used to develop targeted training to enhance meaningful PCOR in CF. %M 33661127 %R 10.2196/24302 %U https://formative.jmir.org/2021/3/e24302 %U https://doi.org/10.2196/24302 %U http://www.ncbi.nlm.nih.gov/pubmed/33661127 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 1 %P e23523 %T Barriers and Facilitators to Genetic Service Delivery Models: Scoping Review %A Raspa,Melissa %A Moultrie,Rebecca %A Toth,Danielle %A Haque,Saira Naim %+ RTI International, 3040 E Cornwallis Drive, Research Triangle Park, NC, 27709, United States, 1 19193163442, shaque@rti.org %K genetics %K telehealth %K genetic services %K rare diseases %D 2021 %7 25.2.2021 %9 Review %J Interact J Med Res %G English %X Background: Advances in diagnostics testing and treatment of genetic conditions have led to increased demand for genetic services in the United States. At the same time, there is a shortage of genetic services professionals. Thus, understanding the models of service delivery currently in use can help increase access and improve outcomes for individuals identified with genetic conditions. Objective: This review aims to provide an overview of barriers and facilitators to genetic service delivery models to inform future service delivery. Methods: We conducted a scoping literature review of the evidence to more fully understand barriers and facilitators around the provision of genetic services. Results: There were a number of challenges identified, including the limited number of genetics specialists, wait time for appointments, delivery of services by nongenetics providers, reimbursement, and licensure. The ways to address these challenges include the use of health information technology such as telehealth, group genetic counseling, provider-to-provider education, partnership models, and training; expanding genetic provider types; and embedding genetic counselors in clinical settings. Conclusions: The literature review highlighted the need to expand access to genetic services. Ways to expand services include telehealth, technical assistance, and changing staffing models. In addition, using technology to improve knowledge among related professionals can help expand access. %M 33629958 %R 10.2196/23523 %U https://www.i-jmr.org/2021/1/e23523 %U https://doi.org/10.2196/23523 %U http://www.ncbi.nlm.nih.gov/pubmed/33629958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e26406 %T Central Auditory Tests to Track Cognitive Function in People With HIV: Longitudinal Cohort Study %A Niemczak,Christopher %A Fellows,Abigail %A Lichtenstein,Jonathan %A White-Schwoch,Travis %A Magohe,Albert %A Gui,Jiang %A Wilbur,Jed %A Clavier,Odile %A Massawe,Enica %A Moshi,Ndeserua %A Boivin,Michael %A Kraus,Nina %A Buckey,Jay %+ Geisel School of Medicine at Dartmouth, Dartmouth College, One Medical Center Drive, Lebanon, NH, 03755, United States, 1 603 650 6012, christopher.e.niemczak@dartmouth.edu %K HIV %K central auditory function %K auditory perception %K cognitive dysfunction %K testing %K cognition %K cognitive function %K neurocognitive deficit %K longitudinal %K auditory %K nervous system %K screening %K monitoring %K surveillance %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The development of neurocognitive deficits in people infected with HIV is a significant public health problem. Previous cross-sectional studies have shown that performance on central auditory tests (CATs) correlates with cognitive test results in those with HIV, but no longitudinal data exist for confirmation. We have been performing longitudinal assessments of central auditory and cognitive function on a cohort of HIV-positive and HIV-negative individuals in Dar es Salaam, Tanzania to understand how the central auditory system could be used to study and track the progress of central nervous system dysfunction. Objective: The goal of the project was to determine if CATs can track the trajectory of cognitive function over time in people diagnosed with HIV. Methods: Tests of peripheral and central auditory function as well as cognitive performance were performed on 382 individuals over the course of 3.5 years. Visits were scheduled every 6 months. CATs included tests of auditory temporal processing (gap detection) and speech perception in noise (Hearing in Noise Test and Triple Digit Test). Cognitive tests included the Montreal Cognitive Assessment (MoCA), Test of Variables of Attention (TOVA), and subtests from the Cogstate battery. HIV-positive subjects were divided into groups based on their CAT results at their final visit (bottom 20%, top 20%, middle 60%). Primary analyses focused on the comparison between HIV-positive individuals that performed worse on CATs (bottom 20%) and the overall HIV-positive group (middle 60%). Data were analyzed using linear mixed-effect models with time as the main fixed effect. Results: The group with the worst (bottom 20%) CAT performance showed a difference in trajectory for the MoCA (P=.003), TOVA (P<.048), and Cogstate (P<.046) over the course of the study period compared to the overall HIV-positive group. A battery of three CATs showed a significant difference in cognitive trajectory over a relatively short study period of 3.5 years independent of age (bottom 20% vs HIV-positive group). Conclusions: The results of this study support the ability for CATs to track cognitive function over time, suggesting that central auditory processing can provide a window into central nervous system performance. CATs can be simple to perform, and are relatively insensitive to education and socioeconomic status because they only require repeating sentences, numbers, or detecting gaps in noise. These tests could potentially provide a time-efficient, low-cost method to screen for and monitor cognitive decline in patients with HIV, making them a useful surveillance tool for this major public health problem. %M 33470933 %R 10.2196/26406 %U http://formative.jmir.org/2021/2/e26406/ %U https://doi.org/10.2196/26406 %U http://www.ncbi.nlm.nih.gov/pubmed/33470933 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e18732 %T Prevailing Outcome Themes Reported by People With Degenerative Cervical Myelopathy: Focus Group Study %A Khan,Danyal Zaman %A Fitzpatrick,Siobhan Mairead %A Hilton,Bryn %A McNair,Angus GK %A Sarewitz,Ellen %A Davies,Benjamin Marshall %A Kotter,Mark RN %A , %+ Academic Neurosurgery Department, University of Cambridge, Box 167, Cambridge Biomedical Campus, Addenbrooke’s Hospital, Cambridge, United Kingdom, 44 122 333 6946, mrk25@cam.ac.uk %K cervical %K myelopathy %K spondylosis %K spondylotic %K stenosis %K disc herniation %K ossification posterior longitudinal ligament %K qualitative %K thematic analysis %K core outcomes set %K consensus %K Delphi %K patient perspectives %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Degenerative cervical myelopathy (DCM) arises when arthritic changes of the cervical spine cause compression and a progressive injury to the spinal cord. It is common and potentially disabling. People with DCM have among the lowest quality of life scores (Short Form Health Survey–36 item [SF-36]) of chronic disease, although the drivers of the imapact of DCM are not entirely understood. DCM research faces a number of challenges, including the heterogeneous reporting of study data. The AO Spine Research Objectives and Common Data Elements for Degenerative Cervical Myelopathy (RECODE-DCM) project is an international consensus process that aims to improve research efficiency through formation of a core outcome set (COS). A key part of COS development process is organizing outcomes into domains that represent key aspects of the disease. To facilitate this, we sought to qualitatively explore the context and impact of patient-reported outcomes in DCM on study participants. Objective: The goal of the research was to qualitatively explore the patient-reported outcomes in DCM to improve understanding of patient perspective and assist the organization of outcomes into domains for the consensus process. Methods: Focus group sessions were hosted in collaboration with Myelopathy.org, a charity and support group for people with DCM. A 40-minute session was audiorecorded and transcribed verbatim. Two authors familiarized themselves with the data and then performed data coding independently. Codes were grouped into themes and a thematic analysis was performed guided by Braun and Clarke’s 6-phase approach. The themes were subsequently reviewed with an independent stakeholder with DCM, assisting in the process of capturing the true context and importance of themes. Results: Five people with DCM (3 men and 2 women) participated in the focus group session. The median age was 53 years, and the median score on the modified Japanese Orthopaedic Association scale was 11 (interquartile range 9.5-11.5), indicating the participants had moderate to severe DCM. A total of 54 codes were reviewed and grouped into 10 potential themes that captured the impact of the disability on people with DCM: acceptance of symptoms, anticipatory anxiety, coping mechanisms/resilience, feelings of helplessness, financial consequences, lack of recognition, mental health impact, loss of life control, social reclusiveness and isolation, and social stigma. Conclusions: This qualitative analysis of the perspectives of people with DCM has highlighted a number of prevailing themes currently unmeasured in clinical research or care. The determinants of low quality of life in DCM are currently unknown, and these findings provide a novel and so far, unique perspective. Continued inclusion of online communities and use of targeted digital software will be important in establishing a consensus-based COS for patients with DCM that is inclusive of all relevant stakeholders including people with DCM. %M 33533719 %R 10.2196/18732 %U https://formative.jmir.org/2021/2/e18732 %U https://doi.org/10.2196/18732 %U http://www.ncbi.nlm.nih.gov/pubmed/33533719 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e21220 %T COVID-19–Related Knowledge and Practices Among Health Care Workers in Saudi Arabia: Cross-sectional Questionnaire Study %A Shaikhain,Talal Ahmad %A Al-Husayni,Faisal Abdulmohsen %A Alhejaili,Essam Awadh %A Al-Harbi,Maha Nawaf %A Bogari,Anas Abdullah %A Baghlaf,Bayan Abdulaziz %A Alzahrani,Mohammed Saeed %+ Department of Infectious Disease, National Guard Hospital, Old Makkah Road, Jeddah, 22384, Saudi Arabia, 966 556655712, mzahrani@gmail.com %K COVID-19 %K health care workers %K infection control %K attitude %K knowledge %K Saudi Arabia %D 2021 %7 25.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care workers are at the front line against COVID-19. The risk of transmission decreases with adequate knowledge of infection prevention methods. However, health care workers reportedly lack a proper attitude and knowledge of different viral outbreaks. Objective: This study aimed to assess the knowledge and attitude of health care workers in Saudi Arabia toward COVID-19. Assessment of these parameters may help researchers focus on areas that require improvement. Methods: A cross-sectional questionnaire study was conducted among 563 participants recruited from multiple cities in Saudi Arabia. An online questionnaire was shared via social media applications, which contained questions to health care workers about general information regarding COVID-19 and standard practices. Results: The mean age of the study population was 30.7 (SD 8) years. Approximately 8.3% (47/563) of the health care workers were isolated as suspected cases of COVID-19, and 0.9% (n=5) were found positive. The majority agreed that social distancing, face masks, and hand washing are effective methods for preventing disease transmission. However, only 63.7% (n=359) knew the correct duration of hand washing. Almost 70% (n=394) strictly adhered to hand hygiene practices, but less than half complied with the practice of wearing a face mask. Significant differences in health care workers' attitudes were observed on the basis of their city of residence, their adherence to COVID-19 practices, and their compliance with the use of a face mask. Among the health care workers, 27.2% (n=153) declared that they will isolate themselves at home and take influenza medication if they experience COVID-19 symptoms. Conclusions: The majority of health care workers in Saudi Arabia presented acceptable levels of general knowledge on COVID-19, but they lack awareness in some crucial details that may prevent disease spread. Intense courses and competency assessments are highly recommended. Prevention of disease progression is the only option for the time being. %M 33460390 %R 10.2196/21220 %U http://formative.jmir.org/2021/1/e21220/ %U https://doi.org/10.2196/21220 %U http://www.ncbi.nlm.nih.gov/pubmed/33460390 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e21409 %T The Effect of a Name-Based Mask Rationing Plan in Taiwan on Public Anxiety Regarding a Mask Shortage During the COVID-19 Pandemic: Observational Study %A Tai,Yu-Lin %A Chi,Hsin %A Chiu,Nan-Chang %A Tseng,Cheng-Yin %A Huang,Ya-Ning %A Lin,Chien-Yu %+ Hsinchu MacKay Memorial Hospital, Department of Pediatrics and Infectious Disease, 690 Guanfu Rd, East District, Hsinchu, 300, Taiwan, 886 6119595 ext 2582, mmhped.lin@gmail.com %K coronavirus %K COVID-19 %K novel coronavirus %K SARS-CoV-2 %K mask %K rationing %K Taiwan %K anxiety %K mental health %K observational %K crisis %K plan %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is a severe global health crisis. Wearing a mask is a straightforward action that can be taken, but shortage of stock and equity of allocation were important issues in Taiwan. Furthermore, increased anxiety leading to the stockpiling of masks has been common during the pandemic. Objective: We aim to summarize the name-based mask rationing plan implemented in Taiwan and explore the public’s perceived anxiety about mask shortages. Methods: The government of Taiwan took action to control the supply and allocation of face masks. We summarize the timeline and important components of the mask rationing plan. A survey that aimed to investigate the overall response to the mask rationing plan was answered by 44 participants. Results: The mask rationing plan was implemented in late January 2020. Daily production capacity was increased from 2 million masks to 16 million masks in April 2020. People could buy 9 masks in 14 days by verification via their National Health Insurance card. Digital face mask availability maps were created. Moreover, the mask plan safeguarded the purchase of masks and resulted in decreased anxiety about a mask shortage (4.05 [SD 1.15] points; 72.7% [n=32] of participants answered “agree” or “strongly agree”). The majority of people felt that the mask plan was satisfactory (4.2 [SD 0.92] points; 79.5% [n=35] of participants answered “agree” or “strongly agree”). Conclusions: We found that the unique name-based mask rationing plan allowed for control of the production and supply of masks, and contributed to the appropriate allocation of masks. The mask rationing plan not only provided the public with physical protection, but also resulted in reduced anxiety about mask shortages during the pandemic. %M 33400678 %R 10.2196/21409 %U http://formative.jmir.org/2021/1/e21409/ %U https://doi.org/10.2196/21409 %U http://www.ncbi.nlm.nih.gov/pubmed/33400678 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e21602 %T Grocery Delivery of Healthy Foods to Pregnant Young Women With Low Incomes: Feasibility and Acceptability Mixed Methods Study %A Locher,Ione %A Waselewski,Marika %A Sonneville,Kendrin %A Resnicow,Ken %A Chang,Tammy %+ University of Michigan, 2800 Plymouth Road, Ann Arbor, MI, 48109, United States, 1 734 730 4636, tachang@med.umich.edu %K pregnancy %K adolescent %K young adult %K female %K gestational weight gain %K diet %K food preferences %K text messaging %K feasibility studies %D 2020 %7 24.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Poor maternal diets increase the risk of excess gestational weight gain which can contribute to serious intergenerational morbidity for both the mother and infant. Pregnant young women with low incomes have disproportionately high rates of inadequate fruit and vegetable consumption as well as excess weight gains during pregnancy. Objective: Our aim was to describe the feasibility and acceptability of Special Delivery, a longitudinal nutrition intervention that delivers healthy foods to pregnant youth (aged 14-24 years) with low incomes. Methods: The Special Delivery pilot study, conducted in Michigan, enrolled pregnant young women with low incomes. Study participants were sent twice-monthly grocery deliveries consisting of US $35 worth of healthy foods, primarily fruits and vegetables. Between grocery deliveries, participants received daily SMS text message prompts to confirm receipt of delivery and document diet and weight. Program feasibility was assessed by the number of grocery orders placed, delivered, and confirmed by participants. Qualitative interviews and SMS text message data were used to determine acceptability by assessing participants’ perspectives on grocery delivery, participants’ perspectives on dietary impact of the program, and foods consumed by participants. Results: A total of 27 participants were enrolled in the pilot study. The mean age was 20.3 years (SD 2.0), and 59.3% (16/27) were African American or Black. During the pilot, 263 deliveries were sent with 98.5% (259/263) successful deliveries and 89.4% (235/263) deliveries confirmed by participants. Participants reported that grocery delivery was convenient; that delivered foods were high quality; and that the program improved their diet, increased access to healthy foods, and promoted healthy habits during pregnancy. Conclusions: A grocery delivery–based weight gain and nutrition intervention is both feasible and acceptable among low-income pregnant youth. Grocery deliveries were successfully completed and participants were willing and able to receive grocery deliveries, eat the healthy foods that were delivered, and communicate via SMS text message with study coordinators. The Special Delivery program warrants further evaluation for efficacy in promoting healthy weight gain for low-income youth during pregnancy. %M 33361055 %R 10.2196/21602 %U http://formative.jmir.org/2020/12/e21602/ %U https://doi.org/10.2196/21602 %U http://www.ncbi.nlm.nih.gov/pubmed/33361055 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e22411 %T Reasons People Who Use Opioids Do Not Accept or Carry No-Cost Naloxone: Qualitative Interview Study %A Bennett,Alex S %A Freeman,Robert %A Des Jarlais,Don C %A Aronson,Ian David %+ Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 665 Broadway, 11th Floor, New York, NY, 10012, United States, 1 917 470 7000, asb19@nyu.edu %K overdose %K opioids %K naloxone %K people who use opioids %K messaging %K harm reduction %K public health intervention %D 2020 %7 23.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Many people use opioids and are at risk of overdose. Naloxone is an opioid antagonist used to counter the effects of opioid overdose. There is an increased availability of naloxone in New York City; however, many who use opioids decline no-cost naloxone even when offered. Others may have the medication but opt not to carry it and report that they would be reluctant to administer it if they were to witness an overdose. Objective: We aim to better understand why people who use opioids may be reluctant to accept, carry, and administer naloxone, and to inform the development of messaging content that addresses barriers to its acceptance and use. Methods: We conducted formative qualitative interviews with 20 people who use opioids who are 18 years and older in New York City. Participants were recruited via key informants and chain referral. Results: Participants cited 4 main barriers that may impede rates of naloxone acceptance, possession, and use: (1) stigma related to substance use, (2) indifference toward overdose, (3) fear of negative consequences of carrying naloxone, and (4) fear of misrecognizing the need for naloxone. Participants also offered suggestions about messaging content to tackle the identified barriers, including messages designed to normalize naloxone possession and use, encourage shared responsibility for community health, and elicit empathy for people who use drugs. Taken together, participants’ narratives hold implications for the following potential messaging content: (1) naloxone is short-acting, and withdrawal sickness does not have to be long-lasting; (2) it is critical to accurately identify an opioid-involved overdose; (3) anyone can overdose; (4) naloxone cannot do harm; and (5) the prompt administration of the medication can help ensure that someone can enjoy another day. Finally, participants suggested that messaging should also debunk myths and stereotypes about people who use drugs more generally; people who use opioids who reverse overdoses should be framed as lay public health advocates and not just “others” to be managed with stigmatizing practices and language. Conclusions: It must be made a public health priority to get naloxone to people who use opioids who are best positioned to reverse an overdose, and to increase the likelihood that they will carry naloxone and use it when needed. Developing, tailoring, and deploying messages to address stigma, indifference toward overdose, fear and trepidation about reversing an overdose, and fear of police involvement may help alleviate fears among some people who are reluctant to obtain naloxone and use the medication on someone in an overdose situation. %M 33355094 %R 10.2196/22411 %U http://formative.jmir.org/2020/12/e22411/ %U https://doi.org/10.2196/22411 %U http://www.ncbi.nlm.nih.gov/pubmed/33355094 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e24798 %T Evolution of Bystander Intention to Perform Resuscitation Since Last Training: Web-Based Survey %A Regard,Simon %A Rosa,Django %A Suppan,Mélanie %A Giangaspero,Chiara %A Larribau,Robert %A Niquille,Marc %A Sarasin,François %A Suppan,Laurent %+ Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, Geneva, 1205, Switzerland, 41 795532579, laurent.suppan@hcuge.ch %K out-of-hospital cardiac arrest %K cardiopulmonary resuscitation %K basic life support %K confidence %K first aid %K bystander %K behavior %K cardiac arrest %K heart attack %K intention %K resuscitation %K survey %K attitude %K belief %D 2020 %7 30.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Victims of out-of-hospital cardiac arrest (OHCA) have higher survival rates and more favorable neurological outcomes when basic life support (BLS) maneuvers are initiated quickly after collapse. Although more than half of OHCAs are witnessed, BLS is infrequently provided, thereby worsening the survival and neurological prognoses of OHCA victims. According to the theory of planned behavior, the probability of executing an action is strongly linked to the intention of performing it. This intention is determined by three distinct dimensions: attitude, subjective normative beliefs, and control beliefs. We hypothesized that there could be a decrease in one or more of these dimensions even shortly after the last BLS training session. Objective: The aim of this study was to measure the variation of the three dimensions of the intention to perform resuscitation according to the time elapsed since the last first-aid course. Methods: Between January and April 2019, the two largest companies delivering first-aid courses in the region of Geneva, Switzerland sent invitation emails on our behalf to people who had followed a first-aid course between January 2014 and December 2018. Participants were asked to answer a set of 17 psychometric questions based on a 4-point Likert scale (“I don’t agree,” “I partially agree,” “I agree,” and “I totally agree”) designed to assess the three dimensions of the intention to perform resuscitation. The primary outcome was the difference in each of these dimensions between participants who had followed a first-aid course less than 6 months before taking the questionnaire and those who took the questionnaire more than 6 months and up to 5 years after following such a course. Secondary outcomes were the change in each dimension using cutoffs at 1 year and 2 years, and the change regarding each individual question using cutoffs at 6 months, 1 year, and 2 years. Univariate and multivariable linear regression were used for analyses. Results: A total of 204 surveys (76%) were analyzed. After adjustment, control beliefs was the only dimension that was significantly lower in participants who took the questionnaire more than 6 months after their last BLS course (P<.001). Resisting diffusion of responsibility, a key element of subjective normative beliefs, was also less likely in this group (P=.001). By contrast, members of this group were less afraid of disease transmission (P=.03). However, fear of legal action was higher in this group (P=.02). Conclusions: Control beliefs already show a significant decrease 6 months after the last first-aid course. Short interventions should be designed to restore this dimension to its immediate postcourse state. This could enhance the provision of BLS maneuvers in cases of OHCA. %M 33252342 %R 10.2196/24798 %U http://formative.jmir.org/2020/11/e24798/ %U https://doi.org/10.2196/24798 %U http://www.ncbi.nlm.nih.gov/pubmed/33252342 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e15007 %T The Diabetes and Emotional Health Handbook and Toolkit for Health Professionals Supporting Adults With Type 1 and Type 2 Diabetes: Formative Evaluation %A Halliday,Jennifer A %A Speight,Jane %A Bennet,Andrea %A Beeney,Linda J %A Hendrieckx,Christel %+ School of Psychology, Deakin University, Locked Bag 20000, Geelong, 3220, Australia, 61 (0) 3 92445278, j.halliday@deakin.edu.au %K diabetes mellitus %K mental health %K medical reference books %K needs assessment %K evaluation studies %K qualitative research %D 2020 %7 21.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Health professionals have expressed unmet needs, including lacking the skills, confidence, training, and resources needed to properly attend to the psychological needs of people with diabetes. Objective: Informed by needs assessments, this study aimed to develop practical, evidence-based resources to support health professionals to address the emotional needs of adults with type 1 or type 2 diabetes. Methods: We developed a new handbook and toolkit informed by formative evaluation, including literature reviews, stakeholder consultation and review, and a qualitative study. In the qualitative study, health professionals participated in interviews after reading sections of the handbook and toolkit. Results: The literature review uncovered that psychological problems are common among adults with diabetes, but health professionals lack resources to provide related support. We planned and drafted resources to fill this unmet need, guided by stakeholder consultation and an Expert Reference Group (ERG). Before finalizing the resources, we implemented feedback received from stakeholders (ERG, health professionals, academics, and people with diabetes). The resulting resources were the practical, evidence-based Diabetes and Emotional Health handbook and toolkit. A total of 19 health professionals took part in the qualitative study about the handbook and toolkit. They viewed the resources favorably, felt empowered to support people with diabetes experiencing psychological problems, and felt motivated to share the resources with others. Some gave examples of how they had used the handbook in clinical practice. A perceived highlight was the inclusion of a process model outlining 7 steps for identifying and supporting people with emotional problems: the 7 A’s model. With funding from the National Diabetes Services Scheme (NDSS), more than 2400 copies of Diabetes and Emotional Health have been distributed. It is freely available on the Web. The NDSS is an initiative of the Australian Government administered with the assistance of Diabetes Australia. Conclusions: The new evidence-based resources are perceived by stakeholders as effective aids to assist health professionals in providing emotional support to adults with diabetes. The 7 A’s model may have clinical utility for routine monitoring of other psychological and health-related problems, as part of person-centered clinical care. %M 32130112 %R 10.2196/15007 %U https://formative.jmir.org/2020/2/e15007 %U https://doi.org/10.2196/15007 %U http://www.ncbi.nlm.nih.gov/pubmed/32130112 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e15500 %T Experiences and Needs of Multicultural Youth and Their Mentors, and Implications for Digital Mentoring Platforms: Qualitative Exploratory Study %A Radlick,Rebecca Lynn %A Mirkovic,Jelena %A Przedpelska,Sarah %A Halvorsen Brendmo,Elanor %A Gammon,Deede %+ Norwegian Research Centre (NORCE), Nygårdsgaten 112, Bergen, 5008, Norway, 47 56107634, rera@norceresearch.no %K e-mentoring %K immigrants %K social capital %K youth %K mentoring %K eHealth %D 2020 %7 4.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Mentoring programs (ie, programs that connect youths with adult volunteers) have been shown to improve outcomes across the behavioral, social, and academic domains of youth development. As in other European countries, mentoring programs have few traditions in Norway, where interventions for multicultural youths are usually profession driven and publicly funded. Faced with the risk of disparities in education and health, there is a need to better understand this group’s experiences and requirements relative to mentoring. This would also serve as a basis for designing and implementing digital support. Objective: The objective of this study was to gain insight into multicultural youth mentees’ and adult mentors’ experiences and needs in the context of an ongoing mentoring program, how digital support (electronic mentoring) might address these needs, and how such support could be designed and implemented. Methods: The study used a qualitative approach, with data from 28 respondents (21 mentees and 7 mentors). In total, 4 workshops with mentees as well as semistructured interviews with mentees and mentors were conducted. The sessions were audio recorded, transcribed, and analyzed thematically. Results: In total, 3 main themes were identified from the experiences and needs reported by the mentees and mentors. These included a need for connection, help in achieving goals, and the need for security and control. Subthemes encompassed a desire to socialize with others, balancing the nature of the relationship, paying it forward, building trust, sharing insights and information with peers, goal-oriented mentees and mentors wanting to assist with goal achievement, and the fundamental need for privacy and anonymity in the digital platform. Conclusions: The findings of this study are supported by the literature on traditional mentoring, while also offering suggestions for the design of digital solutions to supplement the in-person mentoring of multicultural youth. Suggestions include digital support for managing the mentee-mentor relationships, fostering social capital, and ways of ensuring security and control. Features of existing electronic health apps can be readily adapted to a mentoring program context, potentially boosting the reach and benefits of mentoring. %M 32014847 %R 10.2196/15500 %U https://formative.jmir.org/2020/2/e15500 %U https://doi.org/10.2196/15500 %U http://www.ncbi.nlm.nih.gov/pubmed/32014847 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e15017 %T Trends in Scientific Reports on Cartilage Bioprinting: Scoping Review %A Salvador Vergés,Àngels %A Yildirim,Meltem %A Salvador,Bertran %A Garcia Cuyas,Francesc %+ Digital Care Research Group, Universitat de Vic - Universitat Central de Catalunya, Magi Casanovas, 11, Barcelona, 08870, Spain, 34 630887995, angels.salvador@uvic.cat %K cartilage 3D printing %K knowledge %K tissue engineering %K surgery %K cartilage repair %K chondrogenesis %K cartilage biomaterials %D 2019 %7 28.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Satisfactory therapeutic strategies for cartilaginous lesion repair do not yet exist. This creates a challenge for surgeons and biomedical engineers and leads them to investigate the role of bioprinting and tissue engineering as viable treatments through orthopedic surgery, plastic surgery, and otorhinolaryngology. Recent increases in related scientific literature suggest that bioprinted cartilage may develop into a viable solution. Objective: The objectives of this review were to (1) synthesize the scientific advances published to date, (2) identify unresolved technical problems regarding human application, and (3) identify more effective ways for the scientific community to transfer their findings to clinicians. Methods: This scoping review considered articles published between 2009 and 2019 that were identified through searching PubMed, Scopus, Web of Science, and Google Scholar. Arksey and O'Malley’s five-step framework was used to delimit and direct the initial search results, from which we established the following research questions: (1) What do authors of current research say about human application? (2) What necessary technical improvements are identified in the research? (3) On which issues do the authors agree? and (4) What future research priorities emerge in the studies? We used the Cohen kappa statistic to validate the interrater reliability. Results: The 13 articles included in the review demonstrated the feasibility of cartilage bioprinting in live animal studies. Some investigators are already considering short-term human experimentation, although technical limitations still need to be resolved. Both the use and manufacturing process of stem cells need to be standardized, and a consensus is needed regarding the composition of hydrogels. Using on-site printing strategies and predesigned implants may allow techniques to adapt to multiple situations. In addition, the predictive capacity of implant behavior may lead to optimal results. Conclusions: Cartilage bioprinting for surgical applications is nearing its initial use in humans. Current research suggests that surgeons will soon be able to replace damaged tissue with bioprinted material. %M 31464195 %R 10.2196/15017 %U http://formative.jmir.org/2019/3/e15017/ %U https://doi.org/10.2196/15017 %U http://www.ncbi.nlm.nih.gov/pubmed/31464195 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13643 %T Pedal-Assist Mountain Bikes: A Pilot Study Comparison of the Exercise Response, Perceptions, and Beliefs of Experienced Mountain Bikers %A Hall,Cougar %A Hoj,Taylor H %A Julian,Clark %A Wright,Geoff %A Chaney,Robert A %A Crookston,Benjamin %A West,Joshua %+ Department of Public Health, Brigham Young University, 2140 Life Science Building, Provo, UT, 84602, United States, 1 8014225656, cougar_hall@byu.edu %K public health %K physical activity %K heart rate %D 2019 %7 13.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Mountain biking is an aerobic physical activity that has experienced rapid growth. The emergence of the electric pedal-assist mountain bike (eMTB), while not without its critics, presents the potential for an even larger segment of the population to enjoy the health benefits of mountain biking. Although the research focused on the use of e-bikes generally is growing, there is limited research specifically targeting eMTB use. Research is needed exploring the potential exercise response of riding an eMTB, together with the beliefs and perceptions of mountain bikers who have and have not experienced eMTB riding. Objective: This study aimed to compare conventional mountain bike and eMTB use. This was done by investigating 2 questions: (1) What proportion of exercise response is retained for an experienced mountain biker while using an eMTB when compared with a conventional mountain bike? and (2) What are the perceptions and beliefs of experienced mountain bikers toward eMTBs both before and after riding an eMTB? Methods: A convergent mixed methods data collection approach was used in the study. Participants completed both a pre- and postride questionnaire, and data regarding heart rate were collected. Heart rates from each ride were compared against each other. Results: The average heart rate during eMTB use was 94% (31/33) of the average heart rate during conventional mountain bike use. Therefore, eMTB use in this study achieved a majority of the exercise response and exceeded established biometric thresholds for cardiovascular fitness. Paired t test statistics were calculated to compare beliefs of conventional mountain bikes and eMTBs and to compare mean heart rate and speed between conventional mountain bike and eMTB use on the study loop. Participants overwhelmingly perceived the potential impact of eMTB use to be positive on both pre- and post-eMTB ride questionnaires. Conclusions: Despite the measured benefit, participants’ perceived exertion while riding the eMTB was low. %M 31411139 %R 10.2196/13643 %U http://formative.jmir.org/2019/3/e13643/ %U https://doi.org/10.2196/13643 %U http://www.ncbi.nlm.nih.gov/pubmed/31411139 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 1 %P e11533 %T Primary Prevention of Intimate Partner Violence Among Recently Married Dyads Residing in the Slums of Pune, India: Development and Rationale for a Dyadic Intervention %A Kalokhe,Ameeta Shivdas %A Iyer,Sandhya %A Katendra,Tuman %A Gadhe,Keshav %A Kolhe,Ambika R %A Paranjape,Anuradha %A del Rio,Carlos %A Stephenson,Rob %A Sahay,Seema %+ Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, 1518 Clifton Road Office 6009, Atlanta, GA, 30322, United States, 1 4047121924, akalokh@emory.edu %K intimate partner violence %K prevention %K gender-based violence %K domestic violence %K intervention %D 2019 %7 18.01.2019 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Intimate partner violence (IPV) is frequently experienced by women of low socioeconomic status in India. It is a human rights violation and associated with negative effects on physical and mental well-being, underscoring the need for effective prevention strategies. Objective: This study aimed to develop a dyadic intervention for the primary prevention of IPV among newly married couples residing in slum communities in India. Methods: The intervention was developed using a community-based, mixed-methods design rooted in couple-interdependence theory and guided by the intervention mapping (IM) framework. It used the six critical IM steps to inform the content and delivery of the intervention: (1) needs assessment, (2) preparation of matrices of change objectives, (3) selection of theory-based methods and practical applications, (4) production of intervention components and materials, (5) intervention adoption and implementation, and (6) evaluation planning. Results: The resulting Ghya Bharari Ekatra (Take a Flight Together) intervention is intended to be delivered in 6 weekly sessions by a trained pair of male and female lay community educators to groups of 3 to 5 newly married couples in the community in which they reside. It uses games, discussions, self-reflections, and skill-building exercises to cover the following topics: enhancing relationship quality time, self-esteem and resilience, communication and conflict management, goal setting and implementation, sexual communication and sexual health and reproductive health knowledge, and redefining and challenging norms surrounding IPV occurrence. The formative work guided the protocol, including module duration and timing (2-hour sessions of convenience to participants), ordering of modules (based on potential level of interest and sensitivity of the topics), content (ie, informed scripts of role plays and films), intervention delivery methods (ie, interactive activities), and selection of the interventionists (based on capacity to connect with participants) and venue (community-based, convenient, and safe spaces). Ghya Bharari Ekatra was piloted between January and May 2018, and evaluation is presently underway. Conclusions: Ghya Bharari Ekatra is evidence-based, grounded in intervention-mapping, and developed and iteratively refined using a community-based participatory research approach, suggesting it has great potential to be an acceptable and effective solution to preventing IPV among newly married couples. Trial Registration: ClinicalTrials.gov NCT03332134; https://clinicaltrials.gov/ct2/show/NCT03332134 %M 30664483 %R 10.2196/11533 %U http://www.researchprotocols.org/2019/1/e11533/ %U https://doi.org/10.2196/11533 %U http://www.ncbi.nlm.nih.gov/pubmed/30664483 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e11189 %T Assessing the Perceptions of Inspiratory Muscle Training in Children With Cystic Fibrosis and Their Multidisciplinary Team: Mixed-Methods Study %A McCreery,Jessica L %A Mackintosh,Kelly A %A Cox,Narelle S %A McNarry,Melitta A %+ School of Sport and Exercise Sciences, College of Engineering, Swansea University, Fabien Way, Crymlyn Burrows, Skewen, Swansea, SA1 8EN, United Kingdom, 44 01792 513069, jessmccreery@googlemail.com %K cystic fibrosis %K health perceptions %K inspiratory muscle training %K mobile phone %K pediatrics %K qualitative %D 2018 %7 25.10.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Little is known about the opinions or perceived benefits of an inspiratory muscle training intervention in patients with cystic fibrosis and their multidisciplinary team. Objective: The aim of this qualitative study was to examine patients' and multidisciplinary teams' views on inspiratory muscle training to inform and tailor future interventions. Methods: Individual, semistructured interviews were conducted to evaluate participants’ perspectives of a 4-week inspiratory muscle training intervention. In this study, 8 of 13 individuals involved in the inspiratory muscle training program (5 children aged 11-14 years; 2 physiotherapists; and 1 respiratory physician) participated. Interviews were transcribed verbatim, analyzed using thematic analyses, and then coded into relevant themes. Results: Four key themes emerged: acceptability, facilitators, barriers, and recommendations. While fun, enjoyment, and improved perceived physical ability were reported by children and their multidisciplinary team following the inspiratory muscle training program, the multidisciplinary team identified factors such as time and cost as key barriers. Conclusions: A short inspiratory muscle training program was perceived to have positive effects on the physical ability and psychosocial health of children with cystic fibrosis. These findings highlight the importance of obtaining participants’ and multidisciplinary teams' perceptions and recommendations to ensure the efficacy and optimal design of future inspiratory muscle training protocols. %M 31518290 %R 10.2196/11189 %U http://pediatrics.jmir.org/2018/2/e11189/ %U https://doi.org/10.2196/11189 %U http://www.ncbi.nlm.nih.gov/pubmed/31518290 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e2 %T A Simple Pre-Exposure Prophylaxis (PrEP) Optimization Intervention for Health Care Providers Prescribing PrEP: Pilot Study %A Saberi,Parya %A Berrean,Beth %A Thomas,Sean %A Gandhi,Monica %A Scott,Hyman %+ Center for AIDS Prevention Studies, University of California, San Francisco, 550 16th St., 3rd floor, UCSF Box 0886, San Francisco, CA, 94143, United States, 1 415 476 6357, Parya.Saberi@ucsf.edu %K pre-exposure prophylaxis %K PrEP %K health care providers %K HIV %K technology %K panel management %D 2018 %7 16.01.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Pre-exposure prophylaxis (PrEP) has been shown to be highly effective for the prevention of HIV in clinical trials and demonstration projects, but PrEP uptake and adherence outside of these settings in the United States has been limited. Lack of knowledge and willingness of health care providers (HCPs) to prescribe PrEP is an important barrier to implementation. Objective: The objective of this study was to describe and examine the feasibility and acceptability of a PrEP Optimization Intervention (PrEP-OI) targeted at HCPs. The ultimate purpose of this intervention was to increase PrEP uptake, adherence, and persistence among those at risk for HIV acquisition. Methods: This intervention included the following: (1) a Web-based panel management tool called PrEP-Rx, which provides comprehensive HIV risk assessment, automates reminders for follow-up, and reports patients’ history of PrEP use; and (2) centralized PrEP coordination by a clinical support staff member (ie, the PrEP coordinator) who can identify individuals at risk for HIV, provide medical insurance navigation, and support multiple HCPs. Feasibility was evaluated based on HCPs’ ability to log in to PrEP-Rx and use it as needed. Acceptability was assessed via individual formative qualitative interviews with HCPs after 1 month of the intervention. Results: The intervention was feasible and acceptable among HCPs (N=6). HCPs identified system-level barriers to PrEP provision, many of which can be addressed by this intervention. HCPs noted that the intervention improved their PrEP knowledge; increased ease of PrEP prescription; and was likely to improve patient engagement and retention in care, enhance communication with patients, and improve patient monitoring and follow-up. Conclusions: Given the critical role HCPs serve in disseminating PrEP, we created an easy-to-use PrEP optimization intervention deemed feasible and acceptable to providers. Further research on this tool and its ability to impact the PrEP continuum of care is needed. %R 10.2196/formative.8623 %U http://formative.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/formative.8623