%0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e51270 %T Fast Healthcare Interoperability Resources (FHIR)–Based Interoperability Design in Indonesia: Content Analysis of Developer Hub’s Social Networking Service %A Heryawan,Lukman %A Mori,Yukiko %A Yamamoto,Goshiro %A Kume,Naoto %A Lazuardi,Lutfan %A Fuad,Anis %A Kuroda,Tomohiro %K interoperability %K Fast Healthcare Interoperability Resources (FHIR) %K COVID-19 %K Satusehat %K Indonesia %K interoperability design %K social networking %K health information %K content analysis %K private clinic %D 2025 %7 21.4.2025 %9 %J JMIR Form Res %G English %X Background: Interoperability in health care is a critical aspect for the exchange of health information. The Fast Healthcare Interoperability Resources (FHIR) framework has become widely adopted to provide interoperable data exchange in the health care industry. The COVID-19 pandemic has demonstrated the significance of interoperable data in tracking patients who have contracted the virus and keeping track of the vaccinated population. Indonesia is one of the many countries that have implemented interoperable data systems to track patients with COVID-19, and it has aspirations to expand the system to other use cases, particularly in the primary health care setting. The primary health care providers in Indonesia include Puskesmas (community health centers) and private clinics. Objective: To promote interoperable health data exchange in the primary health care sector, the Indonesian government has launched the Satusehat project. The goal of the Satusehat platform is to make health data in Indonesia interoperable and exchangeable between health care organizations, particularly Puskesmas and private clinics. Methods: For a successful implementation of the Satusehat platform in Puskesmas and private clinics, it is crucial to understand the challenges that may arise. This study analyzed the pain points of the Satusehat platform based on a content analysis of the Satusehat Social Networking Service Telegram group messages. The study revealed the pain points and suggested existing approaches to address them, which can be used as a proposed design of interoperability for Puskesmas and private clinics, making it easier for these organizations to adopt the Satusehat platform. Results: The pain points identified in this study include issues with the FHIR server, problems with FHIR profile selection, and the mapping of electronic medical record data into standardized data, such as mapping into the Systematized Nomenclature of Medicine Clinical Terminology. The results show that the value of the mapping issue is 37, profile issue 9, and server issue 61. Among the 3 categories, server issues had the highest population, followed by mapping issues and then profile issues. To address these issues, the study proposed practical approaches, including a federated architecture for the FHIR server instead of a centralized architecture, an FHIR writer and FHIR viewer system inspired by the Standardized Structured Medical Record Information eXchange system in Japan, and an FHIR conversion framework that integrates with our FHIR writer and FHIR viewer system. Conclusions: These proposed solutions can help resolve the pain points identified in the study and help the advancement of the Satusehat platform implementation in Puskesmas and private clinics in Indonesia. We believed that the proposed solutions have potential to be adopted to other countries with similar issues when conducting nationwide project in health care interoperability design. %R 10.2196/51270 %U https://formative.jmir.org/2025/1/e51270 %U https://doi.org/10.2196/51270 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66683 %T Associations Among Online Health Information Seeking Behavior, Online Health Information Perception, and Health Service Utilization: Cross-Sectional Study %A Li,Hongmin %A Li,Dongxu %A Zhai,Min %A Lin,Li %A Cao,ZhiHeng %+ School of Public Health, Jining Medical University, No 133 Hehua Road, Taibaihu District, Shandong, Jining, 272067, China, 86 05373616333, lidongxu0602@126.com %K online health information seeking (OHIS) %K online health information perception (OHIP) %K mediating effect %K health service utilization %K health information %K health perception %K data %K China %K Chinese General Social Survey (CGSS) %K database %K medical information %K survey %D 2025 %7 14.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Seeking online health information can empower individuals to better understand their health concerns, facilitating their ability to manage their health conditions more effectively. It has the potential to change the likelihood and frequency of health service usage. Although existing literature has demonstrated the prevalence of seeking online health information among different populations, the factors affecting online health information perception and discussions on the associations between seeking online health information and health service utilization are limited. Objective: We analyzed the associations between online health information seeking behavior and health service utilization, as well as the online health information perception delivery mechanism. Methods: We analyzed data from the Chinese General Social Survey, the first national representative survey conducted in mainland China. The independent variable was the online health information seeking behavior. The outcome variable was health service utilization by the respondents, and online health information perception was selected as the mediating variable in this analysis. Factor analysis was conducted to obtain online health information perception. Multiple regressions were performed to investigate the effect of online health information seeking behavior on physician visits. Bootstrap methods were conducted to test the mediation effects of online health information perception. Results: This analysis included 1475 cases. Among the participants, 939 (63.66%) sought online health information in the last 12 months. The mean age of the respondents was 46.72 (SD 15.86) years, and 794 (53.83%) were females. After controlling for other variables, individuals with online health information seeking behaviors showed 0.289 times more outpatient visits (P=.003), 0.131 times more traditional Chinese medicine outpatient visits (P=.01), and 0.158 times more Western medicine outpatient visits (P=.007) over the past year compared to those who did not seek health information online. Additionally, multiple regression analyses revealed statistically significant effects of gender, age, and health status on physician visits. The total effect revealed that seeking online health information significantly influenced the total physician visits (β=0.290; P=.003), indicating a certain correlation between online health information seeking behavior and physician visits. Seeking online health information had a significant positive impact on the perception (β=0.265; P<.001). The mediation effects analysis identified that online health information perception led to a significant increase in physician visits with the increase in the online health information seeking behaviors (β=0.232; P=.02). Conclusions: The online health information perception of an individual influences the effect online health information seeking has on the frequency of physician visits. The online health information seeking behavior impacts outpatient service utilization both directly and indirectly through online health information perception and significantly increases the frequency of clinic visits after controlling for other variables. Interventions can be explored to improve the health utilization of residents by increasing their online health information perception. %M 40085841 %R 10.2196/66683 %U https://www.jmir.org/2025/1/e66683 %U https://doi.org/10.2196/66683 %U http://www.ncbi.nlm.nih.gov/pubmed/40085841 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e67515 %T Crisis Communication About the Maui Wildfires on TikTok: Content Analysis of Engagement With Maui Wildfire–Related Posts Over 1 Year %A Stimpson,Jim P %A Srivastava,Aditi %A Tamirisa,Ketan %A Kaholokula,Joseph Keaweʻaimoku %A Ortega,Alexander N %K social media %K public health %K disasters %K Hawaii %K media %K post %K communication %K disaster %K disaster communication %K wildfire %K information %K dissemination %K engagement %K content analysis %K content %K metrics %K misinformation %K community %K support %D 2025 %7 4.3.2025 %9 %J JMIR Form Res %G English %X Background: The August 2023 wildfire in the town of Lāhainā on the island of Maui in Hawaiʻi caused catastrophic damage, affecting thousands of residents, and killing 102 people. Social media platforms, particularly TikTok, have become essential tools for crisis communication during disasters, providing real-time crisis updates, mobilizing relief efforts, and addressing misinformation. Understanding how disaster-related content is disseminated and engaged with on these platforms can inform strategies for improving emergency communication and community resilience. Objective: Guided by Social-Mediated Crisis Communication theory, this study examined TikTok posts related to the Maui wildfires to assess content themes, public engagement, and the effectiveness of social media in disseminating disaster-related information. Methods: TikTok posts related to the Maui wildfires were collected from August 8, 2023, to August 9, 2024. Using TikTok’s search functionality, we identified and reviewed public posts that contained relevant hashtags. Posts were categorized into 3 periods: during the disaster (August 8 to August 31, 2023), the immediate aftermath (September 1 to December 31, 2023), and the long-term recovery (January 1 to August 9, 2024). Two researchers independently coded the posts into thematic categories, achieving an interrater reliability of 87%. Engagement metrics (likes and shares) were analyzed to assess public interaction with different themes. Multivariable linear regression models were used to examine the associations between log-transformed likes and shares and independent variables, including time intervals, video length, the inclusion of music or effects, content themes, and hashtags. Results: A total of 275 TikTok posts were included in the analysis. Most posts (132/275, 48%) occurred in the immediate aftermath, while 76 (27.6%) were posted during the long-term recovery phase, and 24.4% (n=67) were posted during the event. Posts during the event garnered the highest average number of likes (mean 75,092, SD 252,759) and shares (mean 10,928, SD 55,308). Posts focused on “Impact & Damage” accounted for the highest engagement, representing 36.8% (4,090,574/11,104,031) of total likes and 61.2% (724,848/1,184,049) of total shares. “Tourism Impact” (2,172,991/11,104,031, 19.6% of likes; 81,372/1,184,049, 6.9% of shares) and “Relief Efforts” (509,855/11,104,031, 4.6% of likes; 52,587/1,184,049, 4.4% of shares) were also prominent themes. Regression analyses revealed that videos with “Misinformation & Fake News” themes had the highest engagement per post, with a 4.55 coefficient for log-shares (95% CI 2.44-6.65), while videos about “Tourism Impact” and “Relief Efforts” also showed strong engagement (coefficients for log-likes: 2.55 and 1.76, respectively). Conclusions: TikTok is an influential tool for disaster communication, amplifying both critical disaster updates and misinformation, highlighting the need for strategic content moderation and evidence-based messaging to enhance the platform’s role in crisis response. Public health officials, emergency responders, and policy makers can leverage TikTok’s engagement patterns to optimize communication strategies, improve real-time risk messaging, and support long-term community resilience. %R 10.2196/67515 %U https://formative.jmir.org/2025/1/e67515 %U https://doi.org/10.2196/67515 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e55391 %T Planned Behavior in the United Kingdom and Ireland Online Medicine Purchasing Context: Mixed Methods Survey Study %A Naughton,Bernard D %+ School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, University of Dublin, College Green, Dublin 2, Dublin, D02 PN40, Ireland, 353 18962824, bernard.naughton@tcd.ie %K planned behavior %K consumer behavior %K perceived behavioral control %K attitudes %K online purchasing %K medicine %D 2025 %7 21.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Online medicine purchasing is a growing health care opportunity. However, there is a scarcity of available evidence through a behavioral lens, which addresses why consumers buy medicines online. Governments try to influence online medicine purchasing behavior using health campaigns. However, there are little data regarding specific online medicine purchasing behaviors to support these campaigns. Objective: The theory of planned behavior explains that perceived behavioral control (PBC), attitudes, and norms contribute to intentions, leading to behaviors. This study challenges these assumptions, by testing them in an online medicine purchasing context. We asked: What is the role of attitudes, norms, and PBC in an online medicine purchasing context. Methods: An anonymous online snowball convenience sample survey, including open and closed questions concerning online medicine purchasing, was implemented. The data were thematically analyzed until data saturation. The emerging themes were applied to each individual response, as part of a case-by-case narrative analysis. Results: Of the 190 consumers from the United Kingdom and Ireland who consented to participate in the study, 46 participants had purchased medicines online, 9 of which were illegal sales. Of the 113 participants who demonstrated an intention to purchase, 42 (37.2%) completed a purchase. There were many cases in which participants demonstrated an intention to buy medicines online, but this intention did not translate to a purchasing behavior (71/190, 37.4%). Reasons for consumers progressing from intention to behavior are suggested to be impacted by PBC and attitudes. Qualitative data identified access to medicine as a factor encouraging online medicine purchasing behaviors and a facilitator of behavior transition. Despite understanding the importance of why some medicines required a prescription, which is described as an example of legal and health norms, and despite suspicion and concern categorized as negative attitudes in this paper, some participants were still buying products illegally online. Risk reduction strategies were performed by 17 participants (17/190, 9%). These strategies facilitated a transition from intention to behavior. Conclusions: The study results indicate that a consumer’s intention to buy does not automatically translate to a purchasing behavior online; instead, a transition phase exists. Second, consumers followed different pathways to purchase and used risk reduction practices while transitioning from an intention to a behavior. Finally, owing to the covert nature of online medicine purchasing, norms do not appear to be as influential as PBC and attitudes in an online medicine purchasing setting. Understanding how a consumer transitions from an intention to a behavior could be useful for researchers, health care professionals, and policymakers involved in public health campaigns. We encourage future research to focus on different consumer behavior pathways or ideal types, rather than taking a blanket approach to public health campaigns. %M 39983105 %R 10.2196/55391 %U https://formative.jmir.org/2025/1/e55391 %U https://doi.org/10.2196/55391 %U http://www.ncbi.nlm.nih.gov/pubmed/39983105 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e64757 %T Informal Caregivers Connecting on the Web: Content Analysis of Posts on Discussion Forums %A Foster,Michelle L %A Egwuonwu,Chinenye %A Vernon,Erin %A Alarifi,Mohammad %A Hughes,M Courtney %K informal caregivers %K family caregivers %K discussion forum %K caregiver support %K support group %K social support %K caregiver navigation %K content analysis %K adults %K United States %K informal care %K codebook %K thematic analysis %K web-based discussion %K web-based forums %K clinicians %K medical care %K peer-to-peer support %K web-based communities %K caregivers %D 2025 %7 17.1.2025 %9 %J JMIR Form Res %G English %X Background: About 53 million adults in the United States offer informal care to family and friends with disease or disability. Such care has an estimated economic value of US $600 million. Most informal caregivers are not paid nor trained in caregiving, with many experiencing higher-than-average levels of stress and depression and lower levels of physical health. Some informal caregivers participate in web-based forums related to their caregiving role. Objective: This study aimed to explore how informal caregivers use easy-to-access caregiving web-based forums, including the types of information they share and seek from others. It also aimed to gain insights into the informal caregiver experience from the content these informal caregivers posted. Methods: The study population consisted of participants who posted on 5 web-based forums for informal caregivers between February and April 2024. Researchers extracted the first 6 responses to the first 20 questions and comments to appear posted by the informal caregivers in each of the 5 forums, removing any individually identifying information. We used a codebook thematic analysis approach to examine the data with Dedoose (SocioCultural Research Consultants). Researchers independently read all posts and coded the data. The author group discussed the codes, reiteratively refined them, and identified themes within the data. Results: The data consisted of 100 initial posts and 600 responses. Over half of the initial posts included specific questions, with the remaining initial posts sharing experiences or reflections. Posts ranged in length from a sentence to more than 500 words. Domains identified included handling interpersonal challenges, navigating complicated systems, gathering tactical coping strategies, managing emotions, and connecting with others in similar situations. Negative interpersonal interactions were mentioned 123 times, with 77 posts describing challenging situations with extended family. Posters inquired about accessing resources, with health care and health insurance included 51 times, while legal and financial concerns were addressed 124 times. Caregiving challenges were mentioned hundreds of times, including discussion of hygiene (n=18), nutrition (n=21), and desire for a caregiving break (n=47). Posters expressed emotion in their comments 180 times, which included 32 mentions of guilt and 26 mentions of positive emotion. The importance of web-based group support was mentioned 301 times. Conclusions: Informal caregivers play an essential role in society. Many experience multifaceted challenges related to their caregiving role, and some turn to the internet for community. Accessing web-based discussion forums is a low-barrier method for informal caregivers to connect with others who may be experiencing similar emotions and challenges. Gaining a greater understanding of the ways informal caregivers seek advice and offer support to one another provides insight into the challenges they face. The domains identified on these forums may be helpful, as clinicians provide information to care recipients and their informal caregivers along their health journeys. %R 10.2196/64757 %U https://formative.jmir.org/2025/1/e64757 %U https://doi.org/10.2196/64757 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e49585 %T Differences in eHealth Access, Use, and Perceived Benefit Between Different Socioeconomic Groups in the Dutch Context: Secondary Cross-Sectional Study %A Standaar,Lucille %A van Tuyl,Lilian %A Suijkerbuijk,Anita %A Brabers,Anne %A Friele,Roland %+ Department of Population Health and Health Services Research, Centre for Public Health, Healthcare and Society, National Institute for Public Health and the Environment, PO Box 1, Bilthoven, 3723 BA, Netherlands, 31 302743243, lucille.standaar@rivm.nl %K eHealth %K digital divide %K socioeconomic factors %K education %K income %K neighborhood %K health disparities %K cross-sectional studies %K digital health care %K health equity %K Netherlands %D 2025 %7 7.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a growing concern that digital health care may exacerbate existing health disparities. Digital health care or eHealth encompasses the digital apps that are used in health care. Differences in access, use, and perceived benefits of digital technology among socioeconomic groups are commonly referred to as the digital divide. Current research shows that people in lower socioeconomic positions (SEPs) use eHealth less frequently. Objective: This study aims to (1) investigate the association between SEP and eHealth access to, use of, and perceived benefit within the adult Dutch population and (2) evaluate disparities in eHealth access, use, and perceived benefit through three socioeconomic variables—education, standardized income, and the socioeconomic status of the neighborhood. Methods: A secondary analysis was conducted on data from the Nivel Dutch Health Care Consumer Panel (response rate 57%, 849/1500), to assess access to, use of, and perceived benefits from eHealth. These data were collected to monitor eHealth developments in the Netherlands. eHealth was examined through two concepts: (1) eHealth in general and (2) websites, apps, and wearables. Results were stratified into 9 SEP populations based on 3 indicators—education, standardized income, and socioeconomic status level of the neighborhood. Logistic regression analyses were performed to evaluate whether the outcomes varied significantly across different SEP groups. Age was included as a covariate to control for confounding. Results: This study confirms the association between eHealth and SEP and shows that low SEP respondents have less access (odds ratio [OR] 5.72, 95% CI 3.06-10.72) and use (OR 4.96, 95% CI 2.66-9.24) of eHealth compared to medium or high SEP respondents. Differences were most profound when stratifying for levels of education. Conclusions: The access to and use of eHealth has a socioeconomic gradient and emphasizes that SEP indicators cannot be used interchangeably to assess eHealth access and use. The results underline the importance of activities and policies aimed at improving eHealth accessibility and usage among low SEP groups to mitigate disparities in health between different socioeconomic groups. %R 10.2196/49585 %U https://formative.jmir.org/2025/1/e49585 %U https://doi.org/10.2196/49585 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53340 %T Survey of Citizens’ Preferences for Combined Contact Tracing App Features During a Pandemic: Conjoint Analysis %A Bito,Seiji %A Hayashi,Yachie %A Fujita,Takanori %A Takahashi,Ikuo %A Arai,Hiromi %A Yonemura,Shigeto %+ National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 1528602, Japan, 81 334113130, bitoseiji@gmail.com %K digital contact tracing apps %K infectious disease %K conjoint analysis %K user attitudes %K public preferences %K citizen values %K attitude to health %K COVID-19 %K contact tracing %K privacy %K questionnaires %D 2024 %7 14.11.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the COVID-19 pandemic, an increased need for novel solutions such as digital contact tracing apps to mitigate virus spread became apparent. These apps have the potential to enhance public health initiatives through timely contact tracing and infection rate reduction. However, public and academic scrutiny has emerged around the adoption and use of these apps due to privacy concerns. Objective: This study aims to investigate public attitudes and preferences for contact tracing apps, specifically in Japan, using conjoint analysis to examine what specifications the public values most in such apps. By offering a nuanced understanding of the values that citizens prioritize, this study can help balance public health benefits and data privacy standards when designing contact tracing apps and serve as reference data for discussions on legal development and social consensus formation in the future. Methods: A cross-sectional, web-based questionnaire survey was conducted to determine how various factors related to the development and integration of infectious disease apps affect the public’s intention to use such apps. Individuals were recruited anonymously by a survey company. All respondents were asked to indicate their preferences for a combination of basic attributes and infectious disease app features for conjoint analysis. The respondents were randomly divided into 2 groups: one responded to a scenario where the government was assumed to be the entity dealing with infectious disease apps (ie, the government cluster), and the other responded to a scenario where a commercial company was assumed to be this entity (ie, the business cluster). Samples of 500 respondents from each randomly selected group were used as target data. Results: For the government cluster, the most important attribute in scenario A was distributor rights (42.557), followed by public benefits (29.458), personal health benefits (22.725), and profit sharing (5.260). For the business cluster, the most important attribute was distributor rights (45.870), followed by public benefits (32.896), personal health benefits (13.994), and profit sharing (7.240). Hence, personal health benefits tend to be more important in encouraging active app use than personal financial benefits. However, the factor that increased motivation for app use the most was the public health benefits of cutting infections by half. Further, concern about the use of personal data collected by the app for any secondary purpose was a negative incentive, which was more significant toward app use compared to the other 3 factors. Conclusions: The findings suggest that potential app users are positively motivated not only by personal health benefits but also by contributing to public health. Thus, a combined approach can be taken to increase app use. %M 39541579 %R 10.2196/53340 %U https://publichealth.jmir.org/2024/1/e53340 %U https://doi.org/10.2196/53340 %U http://www.ncbi.nlm.nih.gov/pubmed/39541579 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55247 %T Usability Evaluation Methods Used in Electronic Discharge Summaries: Literature Review %A Tesfaye,Wubshet %A Jordan,Margaret %A Chen,Timothy F %A Castelino,Ronald Lynel %A Sud,Kamal %A Dabliz,Racha %A Aslani,Parisa %+ The University of Sydney School of Pharmacy, A15, Science Rd, Camperdown NSW 2050, Sydney, Australia, 61 61 2 9036 6541, parisa.aslani@sydney.edu.au %K electronic discharge summaries %K usability testing %K heuristic evaluation %K heuristics, think-aloud %K adoption %K digital health %K usability %K electronic %K discharge summary %K end users %K evaluation %K user-centered %D 2024 %7 12.9.2024 %9 Review %J J Med Internet Res %G English %X Background: With the widespread adoption of digital health records, including electronic discharge summaries (eDS), it is important to assess their usability in order to understand whether they meet the needs of the end users. While there are established approaches for evaluating the usability of electronic health records, there is a lack of knowledge regarding suitable evaluation methods specifically for eDS. Objective: This literature review aims to identify the usability evaluation approaches used in eDS. Methods: We conducted a comprehensive search of PubMed, CINAHL, Web of Science, ACM Digital Library, MEDLINE, and ProQuest databases from their inception until July 2023. The study information was extracted and reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). We included studies that assessed the usability of eDS, and the systems used to display eDS. Results: A total of 12 records, including 11 studies and 1 thesis, met the inclusion criteria. The included studies used qualitative, quantitative, or mixed methods approaches and reported the use of various usability evaluation methods. Heuristic evaluation was the most used method to assess the usability of eDS systems (n=7), followed by the think-aloud approach (n=5) and laboratory testing (n=3). These methods were used either individually or in combination with usability questionnaires (n=3) and qualitative semistructured interviews (n=4) for evaluating eDS usability issues. The evaluation processes incorporated usability metrics such as user performance, satisfaction, efficiency, and impact rating. Conclusions: There are a limited number of studies focusing on usability evaluations of eDS. The identified studies used expert-based and user-centered approaches, which can be used either individually or in combination to identify usability issues. However, further research is needed to determine the most appropriate evaluation method which can assess the fitness for purpose of discharge summaries. %M 39264712 %R 10.2196/55247 %U https://www.jmir.org/2024/1/e55247 %U https://doi.org/10.2196/55247 %U http://www.ncbi.nlm.nih.gov/pubmed/39264712 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54407 %T A Simple and Systematic Approach to Qualitative Data Extraction From Social Media for Novice Health Care Researchers: Tutorial %A Pretorius,Kelly %+ School of Health Sciences, St. Edward's University, 3001 South Congress Avenue, Austin, TX, 78704, United States, 1 (512) 448 8500, kpretori@stedwards.edu %K social media analysis %K data extraction %K health care research %K extraction tutorial %K Facebook extraction %K Facebook analysis %K safe sleep %K sudden unexpected infant death %K social media %K analysis %K systematic approach %K qualitative data %K data extraction %K Facebook %K health-related %K maternal perspective %K maternal perspectives %K sudden infant death syndrome %K mother %K mothers %K women %K United States %K SIDS %K SUID %K post %K posts %D 2024 %7 9.7.2024 %9 Tutorial %J JMIR Form Res %G English %X Social media analyses have become increasingly popular among health care researchers. Social media continues to grow its user base and, when analyzed, offers unique insight into health problems. The process of obtaining data for social media analyses varies greatly and involves ethical considerations. Data extraction is often facilitated by software tools, some of which are open source, while others are costly and therefore not accessible to all researchers. The use of software for data extraction is accompanied by additional challenges related to the uniqueness of social media data. Thus, this paper serves as a tutorial for a simple method of extracting social media data that is accessible to novice health care researchers and public health professionals who are interested in pursuing social media research. The discussed methods were used to extract data from Facebook for a study of maternal perspectives on sudden unexpected infant death. %M 38980712 %R 10.2196/54407 %U https://formative.jmir.org/2024/1/e54407 %U https://doi.org/10.2196/54407 %U http://www.ncbi.nlm.nih.gov/pubmed/38980712 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52503 %T Social Media Authentication and Users’ Assessments of Health Information: Random Assignment Survey Experiment %A Neely,Stephen %A Witkowski,Kaila %+ School of Public Affairs, University of South Florida, 4202 E. Fowler Ave, SOC 107, Tampa, FL, 33620, United States, 1 412 335 5055, srneely@usf.edu %K social media %K verification markers %K vaccine efficacy %K health communication %K trust %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In an effort to signal the authenticity of user accounts, social networking sites (SNSs) such as Facebook and X, formerly known as Twitter, use visual heuristics (blue checkmarks) to signify whether accounts are verified. While these verification badges are generally well recognized (and often coveted) by SNS users, relatively little is known about how they affect users’ perceptions of accuracy or their likelihood of engaging with web-based information. This is particularly true in the case of information posted by medical experts and health care professionals. Objective: This study aims to use an experimental survey design to assess the effect of these verification badges on SNS users’ assessments of information accuracy as well as their proclivity to recirculate health information or follow verified medical experts in their social network. Methods: A survey experiment using random assignment was conducted on a representative sample of 534 adult SNS users in Florida, United States. A total of 2 separate experimental scenarios exposed users to vaccine-related posts from verified medical experts on X. In each case, the original post contained a platform-issued verification badge (treatment group), which was subsequently edited out of the image as an experimental control. For each scenario, respondents were randomly assigned to either the treatment or control group, and responses to 3 follow-up questions were assessed through a series of chi-square analyses and 2 logit regression models. Responses were fielded using a stratified quota sampling approach to ensure representativeness of the state’s population based on age, sex, race, ethnicity, and political affiliation. Results: Users’ assessments of information accuracy were not significantly impacted by the presence or absence of verification badges, and users exposed to the experimental treatment (verification badge) were not any more likely to repost the message or follow the author. While verification badges did not influence users’ assessments or subsequent behaviors, reliance on social media for health-related information and political affiliation were substantial predictors of accuracy assessments in both experimental scenarios. In scenario 1, which included a post addressing COVID-19 vaccine efficacy, users who relied on social media “a great deal” for health information were 2 times more likely to assess the post as accurate (odds ratio 2.033, 95% CI 1.129-3.661; P=.01). In scenario 2, which included a post about measles vaccines, registered Republicans were nearly 6 times less likely to assess the post as accurate (odds ratio 0.171, 95% CI 0.097-0.299; P<.001). Conclusions: For health professionals and medical experts wishing to leverage social networks to combat misinformation and spread reliable health-related content, account verification appears to offer little by way of added value. On the basis of prior research, other heuristics and communication strategies are likely to yield better results. %M 38980714 %R 10.2196/52503 %U https://formative.jmir.org/2024/1/e52503 %U https://doi.org/10.2196/52503 %U http://www.ncbi.nlm.nih.gov/pubmed/38980714 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53336 %T Professional Social Media Use Among Orthopedic and Trauma Surgeons in Germany: Cross-Sectional Questionnaire-Based Study %A Youssef,Yasmin %A Gehlen,Tobias %A Ansorg,Jörg %A Back,David Alexander %A Scherer,Julian %+ Department of Traumatology, University Hospital of Zurich, Raemistrasse 100, Zurich, 8091, Switzerland, 41 762030775, julian.scherer@usz.ch %K social media %K digitalization %K digital communication %K orthopedics %K traumatology %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media (SM) has been recognized as a professional communication tool in the field of orthopedic and trauma surgery that can enhance communication with patients and peers, and increase the visibility of research and offered services. The specific purposes of professional SM use and the benefits and concerns among orthopedic and trauma surgeons, however, remain unexplored. Objective: This study aims to demonstrate the specific uses of different SM platforms among orthopedic and trauma surgeons in Germany as well as the advantages and concerns. Methods: A web-based questionnaire was developed on the use of SM in a professional context by considering the current literature and the authors’ topics of interest. The final questionnaire consisted of 33 questions and was distributed among German orthopedic and trauma surgeons via the mail distributor of the Berufsverband für Orthopädie und Unfallchirurgie (Professional Association of Orthopaedic Surgeons in Germany). The study was conducted between June and July 2022. A subgroup analysis was performed for sex (male vs female), age (<60 years vs ≥60 years), and type of workplace (practice vs hospital). Results: A total of 208 participants answered the questionnaire (male: n=166, 79.8%; younger than 60 years: n=146, 70.2%). In total, all of the participants stated that they use SM for professional purposes. In contrast, the stated specific uses of SM were low. Overall, the most used platforms were employment-oriented SM, messenger apps, and Facebook. Instagram emerged as a popular choice among female participants and participants working in hospital settings. The highest specific use of SM was for professional networking, followed by receiving and sharing health-related information. The lowest specific use was for education and the acquisition of patients. Conventional websites occupied a dominating position, exceeding the use of SM across all specific uses. The key benefit of SM was professional networking. Under 50% of the participants stated that SM could be used to enhance communication with their patients, keep up-to-date, or increase their professional visibility. In total, 65.5% (112/171) of participants stated that SM use was time-consuming, 43.9% (76/173) stated that they lacked application knowledge, and 45.1% (78/173) stated that they did not know what content to post. Additionally, 52.9% (91/172) mentioned medicolegal concerns. Conclusions: Overall, SM did not seem to be used actively in the professional context among orthopedic and trauma surgeons in Germany. The stated advantages were low, while the stated concerns were high. Adequate education and information material are needed to elucidate the possible professional applications of SM and to address legal concerns. %M 38639987 %R 10.2196/53336 %U https://formative.jmir.org/2024/1/e53336 %U https://doi.org/10.2196/53336 %U http://www.ncbi.nlm.nih.gov/pubmed/38639987 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46195 %T Evaluation of the Effectiveness of Suicide.ca, Quebec’s Digital Suicide Prevention Strategy Platform: Cross-Sectional Descriptive Study %A Côté,Louis-Philippe %A Lane,Julie %+ Centre for Research and Intervention on Suicide, Ethical Issues and End-of-life practices, Université du Québec à Montréal, 100 rue Sherbrooke Ouest, Montreal, QC, H2X 3P2, Canada, 1 (514) 987 4832, cote.louis-philippe.3@courrier.uqam.ca %K suicide prevention %K public health %K information and communication technology %K digital mental health %K helpline %K digital strategy %K communication technology %K information technology %K suicide %K psychoeducation %K mobile app %K suicide risk %K risk factor %K users %K mental health %K text %K website %K prevention strategy %K prevention %K Google Analytics %K Canada %K Quebec %K questionnaire %K mobile phone %D 2024 %7 6.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In 2017, the Quebec government assigned the Association québécoise de prévention du suicide (AQPS) to develop a digital suicide prevention strategy (DSPS). The AQPS responded by creating a centralized website that provides information on suicide and mental health, identifies at-risk individuals on the internet, and offers direct crisis intervention support via chat and text. Objective: This study aims to evaluate the effectiveness of suicide.ca, Quebec’s DSPS platform. Methods: This study used a cross-sectional descriptive design. The study population comprised internet users from Quebec, Canada, who visited the suicide.ca platform between October 2020 and October 2021. Various data sources, such as Google Analytics, Firebase Console, and Customer Relation Management data, were analyzed to document the use of the platform. To understand the profile of suicide.ca users, frequency analyses were conducted using data from the self-assessment module questionnaires, the intervention service’s triage questionnaire, and the counselors’ intervention reports. The effectiveness of the platform’s promotional activities on social media was assessed by examining traffic peaks. Google Analytics was used to evaluate the effectiveness of AQPS’ strategy for identifying at-risk internet users. The impact of the intervention service was evaluated through an analysis of counselors’ intervention reports and postintervention survey results. Results: The platform received traffic from a diverse range of sources, with promotional efforts on social media directly contributing to the increased traffic. The requirement of a user account posed a barrier to the use of the mobile app, and a triage question that involved personal information led to a substantial number of dropouts during the intervention service triage. AdWords campaigns and fact sheets addressing suicide risk factors played a crucial role in driving traffic to the platform. With regard to the profile of suicide.ca users, the findings revealed that the platform engaged individuals with diverse levels of suicidal risk. Notably, users of the chat service displayed a higher suicide risk than those who used the self-assessment module. Crisis chat counselors reported a positive impact on approximately half of the contacts, and overall, intervention service users expressed satisfaction with the support they received. Conclusions: A centralized digital platform can be used to implement a DSPS, effectively reaching the general population, individuals with risk factors for suicide, and those facing suicidal issues. %M 38446536 %R 10.2196/46195 %U https://formative.jmir.org/2024/1/e46195 %U https://doi.org/10.2196/46195 %U http://www.ncbi.nlm.nih.gov/pubmed/38446536 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45573 %T Privacy Concerns About Sharing General and Specific Health Information on Twitter: Quantitative Study %A Esmaeilzadeh,Pouyan %+ Department of Information Systems and Business Analytics, College of Business, Florida International University, Modesto A. Maidique Campus 11200 S.W. 8th St, RB 261 B, Miami, FL, 33199, United States, 1 3053483302, pesmaeil@fiu.edu %K concern for information privacy %K CFIP %K peer privacy concern %K PrPC %K health information disclosure %K Twitter %K empirical study %D 2024 %7 12.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Twitter is a common platform for people to share opinions, discuss health-related topics, and engage in conversations with a wide audience. Twitter users frequently share health information related to chronic diseases, mental health, and general wellness topics. However, sharing health information on Twitter raises privacy concerns as it involves sharing personal and sensitive data on a web-based platform. Objective: This study aims to adopt an interactive approach and develop a model consisting of privacy concerns related to web-based vendors and web-based peers. The research model integrates the 4 dimensions of concern for information privacy that express concerns related to the practices of companies and the 4 dimensions of peer privacy concern that reflect concerns related to web-based interactions with peers. This study examined how this interaction may affect individuals’ information-sharing behavior on Twitter. Methods: Data were collected from 329 Twitter users in the United States using a web-based survey. Results: Results suggest that privacy concerns related to company practices might not significantly influence the sharing of general health information, such as details about hospitals and medications. However, privacy concerns related to companies and third parties can negatively shape the disclosure of specific health information, such as personal medical issues (β=−.43; P<.001). Findings show that peer-related privacy concerns significantly predict sharing patterns associated with general (β=−.38; P<.001) and specific health information (β=−.72; P<.001). In addition, results suggest that people may disclose more general health information than specific health information owing to peer-related privacy concerns (t165=4.72; P<.001). The model explains 41% of the variance in general health information disclosure and 67% in specific health information sharing on Twitter. Conclusions: The results can contribute to privacy research and propose some practical implications. The findings provide insights for developers, policy makers, and health communication professionals about mitigating privacy concerns in web-based health information sharing. It particularly underlines the importance of addressing peer-related privacy concerns. The study underscores the need to build a secure and trustworthy web-based environment, emphasizing the significance of peer interactions and highlighting the need for improved regulations, clear data handling policies, and users’ control over their own data. %M 38214964 %R 10.2196/45573 %U https://formative.jmir.org/2024/1/e45573 %U https://doi.org/10.2196/45573 %U http://www.ncbi.nlm.nih.gov/pubmed/38214964 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44382 %T Web-Based Public Reporting as a Decision-Making Tool for Consumers of Long-Term Care in the United States and the United Kingdom: Systematic Analysis of Report Cards %A Kast,Kristina %A Otten,Sara-Marie %A Konopik,Jens %A Maier,Claudia B %+ Chair of Health Care Management, Institute of Management, Friedrich-Alexander-Universität Erlangen-Nürnberg, Lange Gasse 20, Nürnberg, 90403, Germany, 49 911530296393, kristina.kast@fau.de %K long-term care %K medical decision-making %K nursing homes %K public reporting %K quality improvement %K report cards %D 2023 %7 14.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Report cards can help consumers make an informed decision when searching for a long-term care facility. Objective: This study aims to examine the current state of web-based public reporting on long-term care facilities in the United States and the United Kingdom. Methods: We conducted an internet search for report cards, which allowed for a nationwide search for long-term care facilities and provided freely accessible quality information. On the included report cards, we drew a sample of 1320 facility profiles by searching for long-term care facilities in 4 US and 2 UK cities. Based on those profiles, we analyzed the information provided by the included report cards descriptively. Results: We found 40 report cards (26 in the United States and 14 in the United Kingdom). In total, 11 of them did not state the source of information. Additionally, 7 report cards had an advanced search field, 24 provided simplification tools, and only 3 had a comparison function. Structural quality information was always provided, followed by consumer feedback on 27 websites, process quality on 15 websites, prices on 12 websites, and outcome quality on 8 websites. Inspection results were always displayed as composite measures. Conclusions: Apparently, the identified report cards have deficits. To make them more helpful for users and to bring public reporting a bit closer to its goal of improving the quality of health care services, both countries are advised to concentrate on optimizing the existing report cards. Those should become more transparent and improve the reporting of prices and consumer feedback. Advanced search, simplification tools, and comparison functions should be integrated more widely. %M 38096004 %R 10.2196/44382 %U https://formative.jmir.org/2023/1/e44382 %U https://doi.org/10.2196/44382 %U http://www.ncbi.nlm.nih.gov/pubmed/38096004 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41388 %T Assessment of the Dissemination of COVID-19–Related Articles Across Social Media: Altmetrics Study %A Tornberg,Haley %A Moezinia,Carine %A Wei,Chapman %A Bernstein,Simone A %A Wei,Chaplin %A Al-Beyati,Refka %A Quan,Theodore %A Diemert,David J %+ Department of Medicine, David Geffen School of Medicine at University of California, 10833 Le Conte Ave, Los Angeles, CA, 90095, United States, 1 313 310 2931, Ralbeyat@gmail.com %K Altmetric %K COVID-19 %K citation %K dissemination %K information spread %K impact factor %K information %K social media %K bibliometric %K scientometric %K health professional %K Twitter %K database %K data %K citation %K impact factor %D 2023 %7 12.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of social media assists in the distribution of information about COVID-19 to the general public and health professionals. Alternative-level metrics (ie, Altmetrics) is an alternative method to traditional bibliometrics that assess the extent of dissemination of a scientific article on social media platforms. Objective: Our study objective was to characterize and compare traditional bibliometrics (citation count) with newer metrics (Altmetric Attention Score [AAS]) of the top 100 Altmetric-scored articles on COVID-19. Methods: The top 100 articles with the highest AAS were identified using the Altmetric explorer in May 2020. AAS, journal name, and mentions from various social media platforms (Twitter, Facebook, Wikipedia, Reddit, Mendeley, and Dimension) were collected for each article. Citation counts were collected from the Scopus database. Results: The median AAS and citation count were 4922.50 and 24.00, respectively. TheNew England Journal of Medicine published the most articles (18/100, 18%). Twitter was the most frequently used social media platform with 985,429 of 1,022,975 (96.3%) mentions. Positive correlations were observed between AAS and citation count (r2=0.0973; P=.002). Conclusions: Our research characterized the top 100 COVID-19–related articles by AAS in the Altmetric database. Altmetrics could complement traditional citation count when assessing the dissemination of an article regarding COVID-19. International Registered Report Identifier (IRRID): RR2-10.2196/21408 %M 37343075 %R 10.2196/41388 %U https://formative.jmir.org/2023/1/e41388 %U https://doi.org/10.2196/41388 %U http://www.ncbi.nlm.nih.gov/pubmed/37343075 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44926 %T Human-to-Computer Interactivity Features Incorporated Into Behavioral Health mHealth Apps: Systematic Search %A Collier,Ann Futterman %A Hagemann,Shelby %A Trinidad,Susan Brown %A Vigil-Hayes,Morgan %+ Research Department, Southcentral Foundation, 4085 Tudor Centre Drive, Anchorage, AK, 99508, United States, 1 907 729 8623, acollier@southcentralfoundation.com %K app %K behavioral app %K behavioral health %K consumers %K engagement %K health application %K interactivity %K mHealth %K stickiness %K support %K therapeutic %K user engagement %K users %D 2023 %7 30.6.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: While there are thousands of behavioral health apps available to consumers, users often quickly discontinue their use, which limits their therapeutic value. By varying the types and number of ways that users can interact with behavioral health mobile health apps, developers may be able to support greater therapeutic engagement and increase app stickiness. Objective: The main objective of this analysis was to systematically characterize the types of user interactions that are available in behavioral health apps and then examine if greater interactivity was associated with greater user satisfaction, as measured by app metrics. Methods: Using a modified PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) methodology, we searched several different app clearinghouse websites and identified 76 behavioral health apps that included some type of interactivity. We then filtered the results to ensure we were examining behavioral health apps and further refined our search to include apps that identified one or more of the following terms: peer or therapist forum, discussion, feedback, professional, licensed, buddy, friend, artificial intelligence, chatbot, counselor, therapist, provider, mentor, bot, coach, message, comment, chat room, community, games, care team, connect, share, and support in the app descriptions. In the final group of 34 apps, we examined the presence of 6 types of human-machine interactivities: human-to-human with peers, human-to-human with providers, human-to–artificial intelligence, human-to-algorithms, human-to-data, and novel interactive smartphone modalities. We also downloaded information on app user ratings and visibility, as well as reviewed other key app features. Results: We found that on average, the 34 apps reviewed included 2.53 (SD 1.05; range 1-5) features of interactivity. The most common types of interactivities were human-to-data (n=34, 100%), followed by human-to-algorithm (n=15, 44.2%). The least common type of interactivity was human–artificial intelligence (n=7, 20.5%). There were no significant associations between the total number of app interactivity features and user ratings or app visibility. We found that a full range of therapeutic interactivity features were not used in behavioral health apps. Conclusions: Ideally, app developers would do well to include more interactivity features in behavioral health apps in order to fully use the capabilities of smartphone technologies and increase app stickiness. Theoretically, increased user engagement would occur by using multiple types of user interactivity, thereby maximizing the benefits that a person would receive when using a mobile health app. %M 37389916 %R 10.2196/44926 %U https://formative.jmir.org/2023/1/e44926 %U https://doi.org/10.2196/44926 %U http://www.ncbi.nlm.nih.gov/pubmed/37389916 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e43966 %T Exploring Patient Journey Mapping and the Learning Health System: Scoping Review %A Joseph,Amanda L %A Monkman,Helen %A Kushniruk,Andre %A Quintana,Yuri %+ School of Health Information Science, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada, 1 250 721 8575, amandalynnjoseph@uvic.ca %K patient journey map %K journey map %K patient health information %K learning health system %K learning health care system %K delivery of health care %K service delivery %K scoping review %K health informatics %K user experience %K data integration %D 2023 %7 27.2.2023 %9 Review %J JMIR Hum Factors %G English %X Background: Journey maps are visualization tools that can facilitate the diagrammatical representation of stakeholder groups by interest or function for comparative visual analysis. Therefore, journey maps can illustrate intersections and relationships between organizations and consumers using products or services. We propose that some synergies may exist between journey maps and the concept of a learning health system (LHS). The overarching goal of an LHS is to use health care data to inform clinical practice and improve service delivery processes and patient outcomes. Objective: The purpose of this review was to assess the literature and establish a relationship between journey mapping techniques and LHSs. Specifically, in this study, we explored the current state of the literature to answer the following research questions: (1) Is there a relationship between journey mapping techniques and an LHS in the literature? (2) Is there a way to integrate the data from journey mapping activities into an LHS? (3) How can the data gleaned from journey map activities be used to inform an LHS? Methods: A scoping review was conducted by querying the following electronic databases: Cochrane Database of Systematic Reviews (Ovid), IEEE Xplore, PubMed, Web of Science, Academic Search Complete (EBSCOhost), APA PsycInfo (EBSCOhost), CINAHL (EBSCOhost), and MEDLINE (EBSCOhost). Two researchers applied the inclusion criteria and assessed all articles by title and abstract in the first screen, using Covidence. Following this, a full-text review of included articles was done, with relevant data extracted, tabulated, and assessed thematically. Results: The initial search yielded 694 studies. Of those, 179 duplicates were removed. Following this, 515 articles were assessed during the first screening phase, and 412 were excluded, as they did not meet the inclusion criteria. Next, 103 articles were read in full, and 95 were excluded, resulting in a final sample of 8 articles that satisfied the inclusion criteria. The article sample can be subsumed into 2 overarching themes: (1) the need to evolve service delivery models in health care, and (2) the potential value of using patient journey data in an LHS. Conclusions: This scoping review demonstrated the gap in knowledge regarding integrating the data from journey mapping activities into an LHS. Our findings highlighted the importance of using the data from patient experiences to enrich an LHS and provide holistic care. To satisfy this gap, the authors intend to continue this investigation to establish the relationship between journey mapping and the concept of LHSs. This scoping review will serve as phase 1 of an investigative series. Phase 2 will entail the creation of a holistic framework to guide and streamline data integration from journey mapping activities into an LHS. Lastly, phase 3 will provide a proof of concept to demonstrate how patient journey mapping activities could be integrated into an LHS. %M 36848189 %R 10.2196/43966 %U https://humanfactors.jmir.org/2023/1/e43966 %U https://doi.org/10.2196/43966 %U http://www.ncbi.nlm.nih.gov/pubmed/36848189 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e26041 %T Digital mHealth and Virtual Care Use During COVID-19 in 4 Countries: Rapid Landscape Review %A Müller,Alison %A Cau,Alessandro %A Muhammed,Semakula %A Abdullahi,Osman %A Hayward,Andrew %A Nsanzimana,Sabin %A Lester,Richard %+ Division of Infectious Diseases, Department of Medicine, University of British Columbia, 575 - Vancouver General Hospital Research Pavilion, 828 W 10th Ave, Vancouver, BC, V5Z1M9, Canada, 1 604 875 4111 ext 66294, amuller8@mail.ubc.ca %K COVID-19 %K virtual care %K public health %K mHealth %K contact tracing %K telehealth %K Canada %K United Kingdom %K Kenya %K Rwanda %K global health %K apps %D 2022 %7 30.11.2022 %9 Review %J JMIR Form Res %G English %X Background: As a result of the COVID-19 pandemic, providing health care while maintaining social distancing has resulted in the need to provide care remotely, support quarantined or isolated individuals, monitor infected individuals and their close contacts, as well as disseminate accurate information regarding COVID-19 to the public. This has led to an unprecedented rapid expansion of digital tools to provide digitized virtual care globally, especially mobile phone–facilitated health interventions, called mHealth. To help keep abreast of different mHealth and virtual care technologies being used internationally to facilitate patient care and public health during the COVID-19 pandemic, we carried out a rapid investigation of solutions being deployed and considered in 4 countries. Objective: The aim of this paper was to describe mHealth and the digital and contact tracing technologies being used in the health care management of the COVID-19 pandemic among 2 high-income and 2 low-middle income countries. Methods: We compared virtual care interventions used for COVID-19 management among 2 high-income countries (the United Kingdom and Canada) and 2 low-middle income (Kenya and Rwanda) countries. We focused on interventions used to facilitate patient care and public health. Information regarding specific virtual care technologies was procured from a variety of resources including gray literature, government and health organization websites, and coauthors’ personal experiences as implementers of COVID-19 virtual care strategies. Search engine queries were performed to find health information that would be easily accessible to the general public, with keywords including “COVID-19,” “contact-tracing,” “tool-kit,” “telehealth,” and “virtual care,” in conjunction with corresponding national health authorities. Results: We identified a variety of technologies in Canada, the United Kingdom, Rwanda, and Kenya being used for patient care and public health. These countries are using both video and text message–based platforms to facilitate communication with health care providers (eg, WelTel and Zoom). Nationally developed contact tracing apps are provided free to the public, with most of them using Bluetooth-based technology. We identified that often multiple complimentary technologies are being utilized for different aspects of patient care and public health with the common purpose to disseminate information safely. There was a negligible difference among the types of technologies used in both high-income and low-middle income countries, although the latter implemented virtual care interventions earlier during the pandemic’s first wave, which may account for their effective response. Conclusions: Virtual care and mHealth technologies have evolved rapidly as a tool for health care support for both patient care and public health. It is evident that, on an international level, a variety of mHealth and virtual care interventions, often in combination, are required to be able to address patient care and public health concerns during the COVID-19 pandemic, independent of a country’s economic standing. %M 34932498 %R 10.2196/26041 %U https://formative.jmir.org/2022/11/e26041 %U https://doi.org/10.2196/26041 %U http://www.ncbi.nlm.nih.gov/pubmed/34932498 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 10 %P e36818 %T Separating Features From Functionality in Vaccination Apps: Computational Analysis %A Shaw Jr,George %A Nadkarni,Devaki %A Phann,Eric %A Sielaty,Rachel %A Ledenyi,Madeleine %A Abnowf,Razaan %A Xu,Qian %A Arredondo,Paul %A Chen,Shi %+ Public Health Sciences, School of Data Science, University of North Carolina, 9201 University City Blvd., Charlotte, NC, 28223-0001, United States, 1 704 562 0021, gshaw11@uncc.edu %K vaccines %K mobile health %K mHealth %K principal component analysis %K PCA %K k-means clustering %K information exchange %K mobile phone %D 2022 %7 11.10.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Some latest estimates show that approximately 95% of Americans own a smartphone with numerous functions such as SMS text messaging, the ability to take high-resolution pictures, and mobile software apps. Mobile health apps focusing on vaccination and immunization have proliferated in the digital health information technology market. Mobile health apps have the potential to positively affect vaccination coverage. However, their general functionality, user and disease coverage, and exchange of information have not been comprehensively studied or evaluated computationally. Objective: The primary aim of this study is to develop a computational method to explore the descriptive, usability, information exchange, and privacy features of vaccination apps, which can inform vaccination app design. Furthermore, we sought to identify potential limitations and drawbacks in the apps’ design, readability, and information exchange abilities. Methods: A comprehensive codebook was developed to conduct a content analysis on vaccination apps’ descriptive, usability, information exchange, and privacy features. The search and selection process for vaccination-related apps was conducted from March to May 2019. We identified a total of 211 apps across both platforms, with iOS and Android representing 62.1% (131/211) and 37.9% (80/211) of the apps, respectively. Of the 211 apps, 119 (56.4%) were included in the final study analysis, with 42 features evaluated according to the developed codebook. The apps selected were a mix of apps used in the United States and internationally. Principal component analysis was used to reduce the dimensionality of the data. Furthermore, cluster analysis was used with unsupervised machine learning to determine patterns within the data to group the apps based on preselected features. Results: The results indicated that readability and information exchange were highly correlated features based on principal component analysis. Of the 119 apps, 53 (44.5%) were iOS apps, 55 (46.2%) were for the Android operating system, and 11 (9.2%) could be found on both platforms. Cluster 1 of the k-means analysis contained 22.7% (27/119) of the apps; these were shown to have the highest percentage of features represented among the selected features. Conclusions: We conclude that our computational method was able to identify important features of vaccination apps correlating with end user experience and categorize those apps through cluster analysis. Collaborating with clinical health providers and public health officials during design and development can improve the overall functionality of the apps. %M 36222791 %R 10.2196/36818 %U https://formative.jmir.org/2022/10/e36818 %U https://doi.org/10.2196/36818 %U http://www.ncbi.nlm.nih.gov/pubmed/36222791 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e37641 %T Digital Twins for Managing Health Care Systems: Rapid Literature Review %A Elkefi,Safa %A Asan,Onur %+ School of Systems and Enterprises, Stevens Institute of Technology, 1 Castle Point Terrace, Hoboken, NJ, 07030, United States, 1 4145264330, oasan@stevens.edu %K health care %K digital twins %K safety %K information management %K supply chain management %K operational control %K well-being promotion %K human factors %K technology %K health informatics %K literature synthesis %K scheduling and optimization %K digital health %D 2022 %7 16.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Although most digital twin (DT) applications for health care have emerged in precision medicine, DTs can potentially support the overall health care process. DTs (twinned systems, processes, and products) can be used to optimize flows, improve performance, improve health outcomes, and improve the experiences of patients, doctors, and other stakeholders with minimal risk. Objective: This paper aims to review applications of DT systems, products, and processes as well as analyze the potential of these applications for improving health care management and the challenges associated with this emerging technology. Methods: We performed a rapid review of the literature and reported available studies on DTs and their applications in health care management. We searched 5 databases for studies published between January 2002 and January 2022 and included peer-reviewed studies written in English. We excluded studies reporting DT usage to support health care practice (organ transplant, precision medicine, etc). Studies were analyzed based on their contribution toward DT technology to improve user experience in health care from human factors and systems engineering perspectives, accounting for the type of impact (product, process, or performance/system level). Challenges related to the adoption of DTs were also summarized. Results: The DT-related studies aimed at managing health care systems have been growing over time from 0 studies in 2002 to 17 in 2022, with 7 published in 2021 (N=17 studies). The findings reported on applications categorized by DT type (system: n=8; process: n=5; product: n=4) and their contributions or functions. We identified 4 main functions of DTs in health care management including safety management (n=3), information management (n=2), health management and well-being promotion (n=3), and operational control (n=9). DTs used in health care systems management have the potential to avoid unintended or unexpected harm to people during the provision of health care processes. They also can help identify crisis-related threats to a system and control the impacts. In addition, DTs ensure privacy, security, and real-time information access to all stakeholders. Furthermore, they are beneficial in empowering self-care abilities by enabling health management practices and providing high system efficiency levels by ensuring that health care facilities run smoothly and offer high-quality care to every patient. Conclusions: The use of DTs for health care systems management is an emerging topic. This can be seen in the limited literature supporting this technology. However, DTs are increasingly being used to ensure patient safety and well-being in an organized system. Thus, further studies aiming to address the challenges of health care systems challenges and improve their performance should investigate the potential of DT technology. In addition, such technologies should embed human factors and ergonomics principles to ensure better design and more successful impact on patient and doctor experiences. %M 35972776 %R 10.2196/37641 %U https://www.jmir.org/2022/8/e37641 %U https://doi.org/10.2196/37641 %U http://www.ncbi.nlm.nih.gov/pubmed/35972776 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e40181 %T Self-management Interventions for People With Parkinson Disease: Scoping Review %A Milne-Ives,Madison %A Carroll,Camille %A Meinert,Edward %+ Centre for Health Technology, University of Plymouth, 6 Kirkby Place, Room 2, Plymouth, PL4 6DN, United Kingdom, 44 01752600600, edward.meinert@plymouth.ac.uk %K Parkinson disease %K self-management %K self-care %K home nursing %K self-efficacy %K quality of life %K signs and symptoms %K health behaviour %D 2022 %7 5.8.2022 %9 Review %J J Med Internet Res %G English %X Background: Parkinson disease can impose substantial distress and costs on patients, their families and caregivers, and health care systems. To address these burdens for families and health care systems, there is a need to better support patient self-management. To achieve this, an overview of the current state of the literature on self-management is needed to identify what is being done, how well it is working, and what might be missing. Objective: The aim of this scoping review was to provide an overview of the current body of research on self-management interventions for people with Parkinson disease and identify any knowledge gaps. Methods: The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and Population, Intervention, Comparator, Outcome, and Study type frameworks were used to structure the methodology of the review. Due to time and resource constraints, 1 reviewer systematically searched 4 databases (PubMed, Ovid, Scopus, and Web of Science) for the evaluations of self-management interventions for Parkinson disease published in English. The references were screened using the EndNote X9 citation management software, titles and abstracts were manually reviewed, and studies were selected for inclusion based on the eligibility criteria. Data were extracted into a pre-established form and synthesized in a descriptive analysis. Results: There was variation among the studies on study design, sample size, intervention type, and outcomes measured. The randomized controlled trials had the strongest evidence of effectiveness: 5 out of 8 randomized controlled trials found a significant difference between groups favoring the intervention on their primary outcome, and the remaining 3 had significant effects on at least some of the secondary outcomes. The 2 interventions included in the review that targeted mental health outcomes both found significant changes over time, and the 3 algorithms evaluated performed well. The remaining studies examined patient perceptions, acceptability, and cost-effectiveness and found generally positive results. Conclusions: This scoping review identified a wide variety of interventions designed to support various aspects of self-management for people with Parkinson disease. The studies all generally reported positive results, and although the strength of the evidence varied, it suggests that self-management interventions are promising for improving the care and outcomes of people with Parkinson disease. However, the research tended to focus on the motor aspects of Parkinson disease, with few nonmotor or holistic interventions, and there was a lack of evaluation of cost-effectiveness. This research will be important to providing self-management interventions that meet the varied and diverse needs of people with Parkinson disease and determining which interventions are worth promoting for widespread adoption. %M 35930315 %R 10.2196/40181 %U https://www.jmir.org/2022/8/e40181 %U https://doi.org/10.2196/40181 %U http://www.ncbi.nlm.nih.gov/pubmed/35930315 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33637 %T Applying the Health Belief Model to Characterize Racial/Ethnic Differences in Digital Conversations Related to Depression Pre- and Mid-COVID-19: Descriptive Analysis %A Castilla-Puentes,Ruby %A Pesa,Jacqueline %A Brethenoux,Caroline %A Furey,Patrick %A Gil Valletta,Liliana %A Falcone,Tatiana %+ Center for Public Health Practice, Drexel University, 530 S 2nd st Suite 743, Philadelphia, PA, 19147, United States, 1 6108642528, rcastil4@its.jnj.com %K depression %K COVID-19 %K treatment %K race/ethnicity %K digital conversations %K health belief model %K artificial intelligence %K natural language processing %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of depression in the United States is >3 times higher mid-COVID-19 versus prepandemic. Racial/ethnic differences in mindsets around depression and the potential impact of the COVID-19 pandemic are not well characterized. Objective: This study aims to describe attitudes, mindsets, key drivers, and barriers related to depression pre- and mid-COVID-19 by race/ethnicity using digital conversations about depression mapped to health belief model (HBM) concepts. Methods: Advanced search, data extraction, and artificial intelligence–powered tools were used to harvest, mine, and structure open-source digital conversations of US adults who engaged in conversations about depression pre- (February 1, 2019-February 29, 2020) and mid-COVID-19 pandemic (March 1, 2020-November 1, 2020) across the internet. Natural language processing, text analytics, and social data mining were used to categorize conversations that included a self-identifier into racial/ethnic groups. Conversations were mapped to HBM concepts (ie, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy). Results are descriptive in nature. Results: Of 2.9 and 1.3 million relevant digital conversations pre- and mid-COVID-19, race/ethnicity was determined among 1.8 million (62.2%) and 979,000 (75.3%) conversations, respectively. Pre-COVID-19, 1.3 million (72.1%) conversations about depression were analyzed among non-Hispanic Whites (NHW), 227,200 (12.6%) among Black Americans (BA), 189,200 (10.5%) among Hispanics, and 86,800 (4.8%) among Asian Americans (AS). Mid-COVID-19, a total of 736,100 (75.2%) conversations about depression were analyzed among NHW, 131,800 (13.5%) among BA, 78,300 (8.0%) among Hispanics, and 32,800 (3.3%) among AS. Conversations among all racial/ethnic groups had a negative tone, which increased pre- to mid-COVID-19; finding support from others was seen as a benefit among most groups. Hispanics had the highest rate of any racial/ethnic group of conversations showing an avoiding mindset toward their depression. Conversations related to external barriers to seeking treatment (eg, stigma, lack of support, and lack of resources) were generally more prevalent among Hispanics, BA, and AS than among NHW. Being able to benefit others and building a support system were key drivers to seeking help or treatment for all racial/ethnic groups. Conclusions: There were considerable racial/ethnic differences in drivers and barriers to seeking help and treatment for depression pre- and mid-COVID-19. As expected, COVID-19 has made conversations about depression more negative and with frequent discussions of barriers to seeking care. Applying concepts of the HBM to data on digital conversation about depression allowed organization of the most frequent themes by race/ethnicity. Individuals of all groups came online to discuss their depression. These data highlight opportunities for culturally competent and targeted approaches to addressing areas amenable to change that might impact the ability of people to ask for or receive mental health help, such as the constructs that comprise the HBM. %M 35275834 %R 10.2196/33637 %U https://formative.jmir.org/2022/6/e33637 %U https://doi.org/10.2196/33637 %U http://www.ncbi.nlm.nih.gov/pubmed/35275834 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e28025 %T Data Privacy Concerns Using mHealth Apps and Smart Speakers: Comparative Interview Study Among Mature Adults %A Schroeder,Tanja %A Haug,Maximilian %A Gewald,Heiko %+ Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, 75 Talavera Road, Sydney, NSW 2109, Australia, 61 2 9850 ext 6281, tanja.schroeder@hdr.mq.edu.au %K data privacy concerns %K privacy paradox %K mHealth app %K smart speaker %K mature adults %K smartphone %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: New technologies such as mobile health (mHealth) apps and smart speakers make intensive use of sensitive personal data. Users are typically aware of this and express concerns about their data privacy. However, many people use these technologies although they think their data are not well protected. This raises specific concerns for sensitive health data. Objective: This study aimed to contribute to a better understanding of data privacy concerns of mature adults using new technologies and provide insights into their data privacy expectations and associated risks and the corresponding actions of users in 2 different data contexts: mHealth apps and smart speakers. Methods: This exploratory research adopted a qualitative approach, engaging with 20 mature adults (aged >45 years). In a 6-month test period, 10 (50%) participants used a smart speaker and 10 (50%) participants used an mHealth app. In interviews conducted before and after the test period, we assessed the influence of data privacy concerns on technology acceptance, use behavior, and continued use intention. Results: Our results show that although participants are generally aware of the need to protect their data privacy, they accept the risk of misuse of their private data when using the technology. Surprisingly, the most frequently stated risk was not the misuse of personal health data but the fear of receiving more personalized advertisements. Similarly, surprisingly, our results indicate that participants value recorded verbal data higher than personal health data. Conclusions: Older adults are initially concerned about risks to their data privacy associated with using data-intensive technologies, but those concerns diminish fairly quickly, culminating in resignation. We find that participants do not differentiate between risky behaviors, depending on the type of private data used by different technologies. %M 35699993 %R 10.2196/28025 %U https://formative.jmir.org/2022/6/e28025 %U https://doi.org/10.2196/28025 %U http://www.ncbi.nlm.nih.gov/pubmed/35699993 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e35062 %T Ethical, Legal, and Sociocultural Issues in the Use of Mobile Technologies and Call Detail Records Data for Public Health in the East African Region: Scoping Review %A Sekandi,Juliet Nabbuye %A Murray,Kenya %A Berryman,Corinne %A Davis-Olwell,Paula %A Hurst,Caroline %A Kakaire,Robert %A Kiwanuka,Noah %A Whalen,Christopher C %A Mwaka,Erisa Sabakaki %+ Global Health Institute, College of Public Health, University of Georgia, Wright Hall, Room 227B, 100 Foster Rd, Athens, GA, 30602, United States, 1 706 542 5257, jsekandi@uga.edu %K mobile health %K public health %K ethics %K privacy %K call detail records %K East Africa %K Africa %K mobile apps %K mHealth %D 2022 %7 2.6.2022 %9 Review %J Interact J Med Res %G English %X Background: The exponential scale and pace of real-time data generated from mobile phones present opportunities for new insights and challenges across multiple sectors, including health care delivery and public health research. However, little attention has been given to the new ethical, social, and legal concerns related to using these mobile technologies and the data they generate in Africa. Objective: The objective of this scoping review was to explore the ethical and related concerns that arise from the use of data from call detail records and mobile technology interventions for public health in the context of East Africa. Methods: We searched the PubMed database for published studies describing ethical challenges while using mobile technologies and related data in public health research between 2000 and 2020. A predefined search strategy was used as inclusion criteria with search terms such as “East Africa,” “mHealth,” “mobile phone data,” “public health,” “ethics,” or “privacy.” We screened studies using prespecified eligibility criteria through a two-stage process by two independent reviewers. Studies were included if they were (1) related to mobile technology use and health, (2) published in English from 2000 to 2020, (3) available in full text, and (4) conducted in the East African region. We excluded articles that (1) were conference proceedings, (2) studies presenting an abstract only, (3) systematic and literature reviews, (4) research protocols, and (5) reports of mobile technology in animal subjects. We followed the five stages of a published framework for scoping reviews recommended by Arksey and O’Malley. Data extracted included title, publication year, target population, geographic region, setting, and relevance to mobile health (mHealth) and ethics. Additionally, we used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Extension for Scoping Reviews checklist to guide the presentation of this scoping review. The rationale for focusing on the five countries in East Africa was their geographic proximity, which lends itself to similarities in technology infrastructure development. Results: Of the 94 studies identified from PubMed, 33 met the review inclusion criteria for the final scoping review. The 33 articles retained in the final scoping review represent studies conducted in three out of five East African countries: 14 (42%) from Uganda, 13 (39%) from Kenya, and 5 (16%) from Tanzania. Three main categories of concerns related to the use of mHealth technologies and mobile phone data can be conceptualized as (1) ethical issues (adequate informed consent, privacy and confidentiality, data security and protection), (2) sociocultural issues, and (3) regulatory/legal issues. Conclusions: This scoping review identified major cross-cutting ethical, regulatory, and sociocultural concerns related to using data from mobile technologies in the East African region. A comprehensive framework that accounts for the critical concerns raised would be valuable for guiding the safe use of mobile technology data for public health research purposes. %M 35533323 %R 10.2196/35062 %U https://www.i-jmr.org/2022/1/e35062 %U https://doi.org/10.2196/35062 %U http://www.ncbi.nlm.nih.gov/pubmed/35533323 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34104 %T Indoor Temperatures in the 2018 Heat Wave in Quebec, Canada: Exploratory Study Using Ecobee Smart Thermostats %A Oetomo,Arlene %A Jalali,Niloofar %A Costa,Paula Dornhofer Paro %A Morita,Plinio Pelegrini %+ School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L3G1, Canada, 1 519 888 456 ext 41372, arlene.oetomo@uwaterloo.ca %K Internet of Things %K IoT %K heat waves %K public health %K smart home technology %K smart thermostats %K indoor temperature %K air conditioning %K heat alert response systems %K thermostat %K unsafe temperatures %K uHealth %D 2022 %7 12.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Climate change, driven by human activity, is rapidly changing our environment and posing an increased risk to human health. Local governments must adapt their cities and prepare for increased periods of extreme heat and ensure that marginalized populations do not suffer detrimental health outcomes. Heat warnings traditionally rely on outdoor temperature data which may not reflect indoor temperatures experienced by individuals. Smart thermostats could be a novel and highly scalable data source for heat wave monitoring. Objective: The objective of this study was to explore whether smart thermostats can be used to measure indoor temperature during a heat wave and identify houses experiencing indoor temperatures above 26°C. Methods: We used secondary data—indoor temperature data recorded by ecobee smart thermostats during the Quebec heat waves of 2018 that claimed 66 lives, outdoor temperature data from Environment Canada weather stations, and indoor temperature data from 768 Quebec households. We performed descriptive statistical analyses to compare indoor temperatures differences between air conditioned and non–air conditioned houses in Montreal, Gatineau, and surrounding areas from June 1 to August 31, 2018. Results: There were significant differences in indoor temperature between houses with and without air conditioning on both heat wave and non–heat wave days (P<.001). Households without air conditioning consistently recorded daily temperatures above common indoor temperature standards. High indoor temperatures persisted for an average of 4 hours per day in non–air conditioned houses. Conclusions: Our findings were consistent with current literature on building warming and heat retention during heat waves, which contribute to increased risk of heat-related illnesses. Indoor temperatures can be captured continuously using smart thermostats across a large population. When integrated with local heat health action plans, these data could be used to strengthen existing heat alert response systems and enhance emergency medical service responses. %M 35550317 %R 10.2196/34104 %U https://formative.jmir.org/2022/5/e34104 %U https://doi.org/10.2196/34104 %U http://www.ncbi.nlm.nih.gov/pubmed/35550317 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e28135 %T The Quality of Internet Websites for People Experiencing Psychosis: Pilot Expert Assessment %A Wilhelm,Kay %A Handley,Tonelle %A McHugh,Catherine %A Lowenstein,David %A Arrold,Kristy %+ Discipline of Psychiatry, School of Medicine, University of Notre Dame, O'Brien Centre, St Vincent's Hospital, Sydney, 2010, Australia, 61 416 143 717, kwilhelm@bigpond.net.au %K psychosis %K schizophrenia %K DISCERN %K quality %K websites %K mental health %K Australia %K health information %K patients %K consumers %K accessibility %K patient empowerment %K reliability %K eHealth %K electronic health %K website %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinicians need to be able to assess the quality of the available information to aid clinical decision-making. The internet has become an important source of health information for consumers and their families. Objective: This study aimed to rate the quality of websites with psychosis-related information (to provide clinicians with a basis for recommending material to guide clinical decision-making with consumers and their families), using a validated instrument as well as a purpose-developed checklist, and consider improvement in quality over a 4-year period. Methods: Two measures of website quality were used: the DISCERN scale and the Psychosis Website Quality Checklist (PWQC). Terms related to psychosis, including “psychotic,” “psychosis,” “schizophrenia,” “delusion,” and “hallucination,” were entered into Google, and the first 25 results were analyzed. In total, 6 raters with varying health professional backgrounds were used to evaluate the websites across two time points: January-March 2014 and January-March 2018. Results: Of the 25 websites rated, only the 6 highest ranked websites achieved a DISCERN score, indicating that they were of “good” quality (51-62 out of a possible 75), while the mean score of the websites (mean 43.96, SD 12.08) indicated an overall “fair” quality. The PWQC revealed that websites scored highly on “availability and usability” (mean 16.82, SD 3.96) but poorly on “credibility” (mean 20.99, SD 6.68), “currency” (mean 5.16, SD 2.62), and “breadth and accuracy” (mean 77.87, SD 23.20). Most sites lacked information about early intervention, recreational drug use and suicide risk, with little change in content over time. Stating an editorial or review process on the website (found in 56% of websites) was significantly associated with a higher quality score on both scales (the DISCERN scale, P=.002; the PWQC, P=.006). Conclusions: The information on the internet available for clinicians to recommend to people affected by psychosis tended to be of “fair” quality. While higher-quality websites exist, it is generally not easy way to assess this on face value. Evidence of an editorial or review process was one indicator of website quality. While sites generally provided basic clinical information, most lacked material addressing weighing up risks and benefits of medication and alternatives, the role of coercive treatment and other more contentious issues. Insufficient emphasis is placed on detailed information on early intervention and importance of lifestyle modifications or how families and friends can contribute. These are likely to be the very answers that consumers and carers are seeking and this gap contributes to unmet needs among this group. We suggest that clinicians should be aware of what is available and where there are gaps. %M 35436206 %R 10.2196/28135 %U https://formative.jmir.org/2022/4/e28135 %U https://doi.org/10.2196/28135 %U http://www.ncbi.nlm.nih.gov/pubmed/35436206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31135 %T Examining the Influence on Perceptions of Endometriosis via Analysis of Social Media Posts: Cross-sectional Study %A Metzler,Julian Matthias %A Kalaitzopoulos,Dimitrios Rafail %A Burla,Laurin %A Schaer,Gabriel %A Imesch,Patrick %+ Department of Gynecology, University Hospital Zurich, Frauenklinikstrasse 10, Zurich, 8091, Switzerland, 41 442551111, julian.metzler@usz.ch %K endometriosis %K social media %K Facebook %K Instagram %K influencer %K engagement %D 2022 %7 18.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media platforms, such as Facebook and Instagram, are increasingly being used to share health-related information by “influencers,” regular users, and institutions alike. While patients may benefit in various ways from these interactions, little is known about the types of endometriosis-related information published on social media. As digital opinion leaders influence the perceptions of their followers, physicians need to be aware about ideas and beliefs that are available online, in order to address possible misconceptions and provide optimal patient care. Objective: The aim of this study was to identify and analyze frequent endometriosis-related discussion topics on social media in order to offer caregivers insight into commonly discussed subject matter and aspects. Methods: We performed a systematic search using predefined parameters. Using the term “endometriosis” in Facebook’s search function and a social media search engine, a list of Facebook pages was generated. A list of Instagram accounts was generated using the terms “endometriosis” and “endo” in Instagram’s search function. Pages and accounts in English with 5000 or more followers or likes were included. Nonpublic, unrelated, or inactive pages and accounts were excluded. For each account, the most recent 10 posts were identified and categorized by two independent examiners using qualitative content analysis. User engagement was calculated using the numbers of interactions (ie, shares, likes, and comments) for each post, stratified by the number of followers. Results: A total of 39 Facebook pages and 43 Instagram accounts with approximately 1.4 million followers were identified. Hospitals and medical centers made up 15% (6/39) of the Facebook pages and 5% (2/43) of the Instagram accounts. Top accounts had up to 111,600 (Facebook) and 41,400 (Instagram) followers. A total of 820 posts were analyzed. On Facebook, most posts were categorized as “awareness” (101/390, 25.9% of posts), “education and research” (71/390, 18.2%), and “promotion” (64/390, 16.4%). On Instagram, the top categories were “inspiration and support” (120/430, 27.9% of posts), “awareness” (72/430, 16.7%), and “personal story” (72/430, 16.7%). The frequency of most categories differed significantly between platforms. User engagement was higher on Instagram than on Facebook (3.20% vs 0.97% of followers per post). On Instagram, the highest percentage of users engaged with posts categorized as “humor” (mean 4.19%, SD 4.53%), “personal story” (mean 3.02%, SD 4.95%), and “inspiration and support” (mean 2.83%, SD 3.08%). On Facebook, posts in the categories “awareness” (mean 2.05%, SD 15.56%), “humor” (mean 0.91%, SD 1.07%), and “inspiration and support” (mean 0.56%, SD 1.37%) induced the most user engagement. Posts made by hospitals and medical centers generated higher user engagement than posts by regular accounts on Facebook (mean 1.44%, SD 1.11% vs mean 0.88%, SD 2.71% of followers per post) and Instagram (mean 3.33%, SD 1.21% vs mean 3.19%, SD 2.52% of followers per post). Conclusions: Facebook and Instagram are widely used to share endometriosis-related information among a large number of users. Most posts offer inspiration or support, spread awareness about the disease, or cover personal issues. Followers mostly engage with posts with a humoristic, supportive, and awareness-generating nature. Health care providers should be aware about the topics discussed online, as this may lead to an increased understanding of the needs and demands of digitally proficient patients with endometriosis. %M 35302501 %R 10.2196/31135 %U https://formative.jmir.org/2022/3/e31135 %U https://doi.org/10.2196/31135 %U http://www.ncbi.nlm.nih.gov/pubmed/35302501 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e25055 %T Engagement With Web-Based Fitness Videos on YouTube and Instagram During the COVID-19 Pandemic: Longitudinal Study %A Sui,Wuyou %A Rush,Jonathan %A Rhodes,Ryan E %+ Exercise and Health Psychology Lab, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada, 1 5196612111 ext 81189, yoahsui@gmail.com %K eHealth %K physical activity %K adults %K adherence %K COVID-19 %K fitness %K video %K YouTube %K Instagram %K social media %K longitudinal %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has drastically changed the physical activity (PA) landscape through the closures of gymnasiums, schools, and many outdoor spaces. Physical distancing guidelines have also reduced opportunity for PA. The popularity of free web-based home fitness videos on video hosting platforms (eg, YouTube and Instagram) has spiked during the pandemic. Many web-based fitness videos offer a convenient, accessible, and cost-effective means of engaging in PA through regularly posted videos or discrete programs. Notably, traditional PA programs often suffer from poor adherence and high dropout rates, despite many advantages over web-based workout programs (eg, equipment, feedback, and in-person engagement). Thus, notwithstanding clear advantages of these web-based fitness videos, their ability to maintain long-term engagement and adherence is unknown. Objective: We explored patterns of engagement (ie, views, likes, and comments) for channels posting daily or program-based web-based fitness videos since the declaration of COVID-19 as a pandemic, over 4 months. Our secondary objective was to examine potential moderators of engagement metrics. Methods: An environmental scan was used to identify eligible channels. Eligible channels were (1) freely available on YouTube or Instagram and (2) posted daily or weekday series workouts or offered quarantine-specific workout programs. Searches for eligible channels were conducted on June 1 and 4, 2020. Engagement metrics of views, likes, and comments were then collected from channels’ videos posted between March 11 and June 26 or 30, 2020, inclusive, on June 26 or July 8, 2020. A series of multilevel modeling analyses were conducted to examine longitudinal changes in each of the 3 outcome variables. Results: Ten channels were deemed eligible and included in analyses; 6 posted regularly, while the other 4 posted discrete workout programs. Multilevel models revealed that both views and likes significantly decreased across days. Visually, channels display the sharpest drop in engagement within the first week. Linear change estimate indicates that the number of views initially declined by 24,700 per day (95% CI –44,400 to –11,300, P=.01) on average across all the channels. Channels with more subscribers declined in their views, likes, and comments at a significantly higher rate than those with fewer subscribers (P≤.04). The day of the week a video is posted, “virality,” and content of a video appear to influence engagement. Integrating behavior change techniques and posting new and varied videos often may help garner further engagement with these videos. Future research should examine common elements of videos, which drive engagement. Conclusions: Despite raw engagement metrics, each channel demonstrated peak engagement with the initial video followed by decreased engagement with subsequent videos. As many countries maintain restrictions on traditional PA facilities owing to the COVID-19 pandemic, determining methods to improve engagement and adherence with web-based fitness videos becomes increasingly important. %M 35258459 %R 10.2196/25055 %U https://formative.jmir.org/2022/3/e25055 %U https://doi.org/10.2196/25055 %U http://www.ncbi.nlm.nih.gov/pubmed/35258459 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32752 %T Discussions of Asperger Syndrome on Social Media: Content and Sentiment Analysis on Twitter %A Gabarron,Elia %A Dechsling,Anders %A Skafle,Ingjerd %A Nordahl-Hansen,Anders %+ Department of Education, ICT and Learning, Østfold University College, B R A Veien 4, Halden, 1757, Norway, 47 94863460, egabarron@gmail.com %K social media %K autism spectrum disorder %K health literacy %K famous persons %K Asperger %K Elon Musk %K twitter %K tweets %K mental health %K autism %K sentiment analysis %D 2022 %7 7.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: On May 8, 2021, Elon Musk, a well-recognized entrepreneur and business magnate, revealed on a popular television show that he has Asperger syndrome. Research has shown that people’s perceptions of a condition are modified when influential individuals in society publicly disclose their diagnoses. It was anticipated that Musk's disclosure would contribute to discussions on the internet about the syndrome, and also to a potential change in the perception of this condition. Objective: The objective of this study was to compare the types of information contained in popular tweets about Asperger syndrome as well as their engagement and sentiment before and after Musk’s disclosure. Methods: We extracted tweets that were published 1 week before and after Musk's disclosure that had received >30 likes and included the terms “Aspergers” or “Aspie.” The content of each post was classified by 2 independent coders as to whether the information provided was valid, contained misinformation, or was neutral. Furthermore, we analyzed the engagement on these posts and the expressed sentiment by using the AFINN sentiment analysis tool. Results: We extracted a total of 227 popular tweets (34 posted the week before Musk’s announcement and 193 posted the week after). We classified 210 (92.5%) of the tweets as neutral, 13 (5.7%) tweets as informative, and 4 (1.8%) as containing misinformation. Both informative and misinformative tweets were posted after Musk’s disclosure. Popular tweets posted before Musk’s disclosure were significantly more engaging (received more comments, retweets, and likes) than the tweets posted the week after. We did not find a significant difference in the sentiment expressed in the tweets posted before and after the announcement. Conclusions: The use of social media platforms by health authorities, autism associations, and other stakeholders has the potential to increase the awareness and acceptance of knowledge about autism and Asperger syndrome. When prominent figures disclose their diagnoses, the number of posts about their particular condition tends to increase and thus promote a potential opportunity for greater outreach to the general public about that condition. %M 35254265 %R 10.2196/32752 %U https://formative.jmir.org/2022/3/e32752 %U https://doi.org/10.2196/32752 %U http://www.ncbi.nlm.nih.gov/pubmed/35254265 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32871 %T Informal Coping Strategies Among People Who Use Opioids During COVID-19: Thematic Analysis of Reddit Forums %A Arshonsky,Josh %A Krawczyk,Noa %A Bunting,Amanda M %A Frank,David %A Friedman,Samuel R %A Bragg,Marie A %+ Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, United States, 1 646 501 2717, SeedProgramPaperSubmissions@nyulangone.org %K opioid use %K Reddit %K coping strategies %K COVID-19 %K opioid %K drug %K coping %K social media %K strategy %K content analysis %K abstain %K addiction %K data mining %K support %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has transformed how people seeking to reduce opioid use access treatment services and navigate efforts to abstain from using opioids. Social distancing policies have drastically reduced access to many forms of social support, but they may have also upended some perceived barriers to reducing or abstaining from opioid use. Objective: This qualitative study aims to identify informal coping strategies for reducing and abstaining from opioid use among Reddit users who have posted in opioid-related subreddits at the beginning of the COVID-19 pandemic. Methods: We extracted data from 2 major opioid-related subreddits. Thematic data analysis was used to evaluate subreddit posts dated from March 5 to May 13, 2020, that referenced COVID-19 and opioid use, resulting in a final sample of 300 posts that were coded and analyzed. Results: Of the 300 subreddit posts, 100 (33.3%) discussed at least 1 type of informal coping strategy. Those strategies included psychological and behavioral coping skills, adoption of healthy habits, and use of substances to manage withdrawal symptoms. In addition, 12 (4%) subreddit posts explicitly mentioned using social distancing as an opportunity for cessation of or reduction in opioid use. Conclusions: Reddit discussion forums have provided a community for people to share strategies for reducing opioid use and support others during the COVID-19 pandemic. Future research needs to assess the impact of COVID-19 on opioid use behaviors, especially during periods of limited treatment access and isolation, as these can inform future efforts in curbing the opioid epidemic and other substance-related harms. %M 35084345 %R 10.2196/32871 %U https://formative.jmir.org/2022/3/e32871 %U https://doi.org/10.2196/32871 %U http://www.ncbi.nlm.nih.gov/pubmed/35084345 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e31533 %T Use of Social Networks in the Context of the Dietitian’s Practice in Brazil and Changes During the COVID-19 Pandemic: Exploratory Study %A Sbardelotto,Jackson %A Martins,Bárbara Birck %A Buss,Caroline %+ Department of Nutrition, Graduate Study Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil, 55 513303 8830, carolinebuss@ufcspa.edu.br %K dietitian %K social networks %K nutrition %K health communication %K COVID-19 %K social media %K Brazil %K perception %K health information %K usage %K behavior %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social networks have been pointed out as 1 of the greatest means of spreading information. A large part of the population is already present on these platforms, looking up subjects such as health, nutrition, and food. To reach this audience, it may be important for dietitians to explore social networks. However, there is a gap in scientific studies on exploring the ways in which these platforms are used by dietitians in Brazil, and the roles they play in the profession have not been well defined. Objective: This study aims to describe the roles that social networks play in dietitians' practice in Brazil and their mode of use of social networks. This study also aims to identify professionals’ perceptions and opinions regarding the use of these tools, as well as changes in behavior on social network usage caused by the COVID-19 pandemic. Methods: We carried out a quantitative cross-sectional study, collecting data through an online questionnaire, submitted between October 2020 and January 2021 to dietitians registered on the Federal Council of Dietitians. All participants included in the study answered questions about the use of social networks in their professional context. Results: In total, 264 (91.7%) of the 288 participants reported using social networks for professional practice. Instagram was the social network most often used by professionals (224/264, 84.8%). Dietitians (N=288) related to the use of social networks (always to almost always) for sharing information about their services (n=114-72 [39.6%-25%], respectively), following the work of other dietitians (n=172-64 [59.7%-22.2%], respectively), and writing about topics related to food and nutrition (n=166-53 [57.6%-18.4%], respectively). The roles played by social networks in the professional context of dietitians were attracting more clients (210/289, 72.7%) and keeping in touch with them (195/289, 67.5%). Furthermore, 227 (78.5%) of the 289 dietitians strongly agreed that social networks are good tools to promote their services. During the COVID-19 pandemic, 216 (74.7%) of the 289 participants noticed changes in their behavior, feelings, or beliefs on the use of social networks related to professional practice, and 149 (51.6%) have increased the frequency of sharing information about nutrition and health in general on social networks. Conclusions: The main roles of social networks in the professional context of dietitians are to attract clients and to facilitate the contact between professional and client. The modes of use reported by the professionals included sharing information about their services, following the work of professional colleagues, and writing about topics related to nutrition. Most of them reported believing that social networks are an effective way to disseminate their services. Moreover, most professionals claimed to have noticed changes in their behaviors or beliefs on social media during the COVID-19 pandemic. %M 35023837 %R 10.2196/31533 %U https://formative.jmir.org/2022/2/e31533 %U https://doi.org/10.2196/31533 %U http://www.ncbi.nlm.nih.gov/pubmed/35023837 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e28342 %T Determining Priorities in the Aboriginal and Islander Mental Health Initiative for Youth App Second Phase Participatory Design Project: Qualitative Study and Narrative Literature Review %A Povey,Josie %A Sweet,Michelle %A Nagel,Tricia %A Lowell,Anne %A Shand,Fiona %A Vigona,Jahdai %A Dingwall,Kylie M %+ Menzies School of Health Research, Charles Darwin University, Red 9 CDU Campus, Casuarina, 0820, Australia, 61 8 8946 8487, josie.povey@menzies.edu.au %K Aboriginal and Torres Strait Islander %K young people %K digital mental health %K app %K participatory design %K decision-making %K mobile phone %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital mental health tools can promote access to culturally safe early intervention mental health services for Aboriginal and Torres Strait Islander young people. Participatory design methodology facilitates user engagement in the co-design of digital resources. However, several challenges have been identified that limit the methodological rigor of this approach. Objective: This paper aims to present an in-depth account of the second phase of participatory design in the development of the Aboriginal and Islander Mental Health Initiative for Youth (AIMhi-Y) app. Methods: A first idea storyboard, generated from a formative phase of the AIMhi-Y project, was refined through a series of youth co-design workshops and meetings. A narrative review of the literature, 6 service provider interviews, and engagement with an expert reference group also informed the design process. Generative design activities, storyboarding, discussions, and voting strategies were used. Results: The participatory design process identified the app features preferred by young people and service providers and assessed their alignment with current recommendations from the scientific literature. Findings from the co-design process are presented across 9 app characteristic domains. Integration of findings into app design proved complex. Although most preferred features identified by young people were included to some degree, other inclusions were restricted by budget, time, and the need to integrate best practice recommendations. A process of prioritization was required. Conclusions: Participatory design is often cited in the development of digital mental health resources; however, methods are diverse and often lack detailed descriptions. This study reports the outcomes and strategies used to determine priorities in the second phase of the development of the AIMhi-Y app. We provide an example and the key learnings to inform others seeking to use participatory design with a similar cohort. %M 35179498 %R 10.2196/28342 %U https://formative.jmir.org/2022/2/e28342 %U https://doi.org/10.2196/28342 %U http://www.ncbi.nlm.nih.gov/pubmed/35179498 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32443 %T Assessing COVID-19 Health Information on Google Using the Quality Evaluation Scoring Tool (QUEST): Cross-sectional and Readability Analysis %A Bachu,Vismaya S %A Mahjoub,Heba %A Holler,Albert E %A Crihalmeanu,Tudor %A Bachu,Dheevena M %A Ayyaswami,Varun %A Parker,Pearman D %A Prabhu,Arpan V %+ Department of Radiation Oncology, University of Arkansas for Medical Sciences, Winthrop P Rockefeller Cancer Institute, 4130 Shuffield Dr, Little Rock, AR, 72205, United States, 1 5016644568, avprabhu@uams.edu %K COVID-19 %K COVID-19 pandemic %K health literacy %K readability %K QUEST %K online health information %K cross-sectional %K trend %K internet %K spread %K symptom %K quality %K United States %D 2022 %7 11.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic spurred an increase in online information regarding disease spread and symptomatology. Objective: Our purpose is to systematically assess the quality and readability of articles resulting from frequently Google-searched COVID-19 terms in the United States. Methods: We used Google Trends to determine the 25 most commonly searched health-related phrases between February 29 and April 30, 2020. The first 30 search results for each term were collected, and articles were analyzed using the Quality Evaluation Scoring Tool (QUEST). Three raters scored each article in authorship, attribution, conflict of interest, currency, complementarity, and tone. A readability analysis was conducted. Results: Exactly 709 articles were screened, and 195 fulfilled inclusion criteria. The mean article score was 18.4 (SD 2.6) of 28, with 7% (14/189) scoring in the top quartile. National news outlets published the largest share (70/189, 36%) of articles. Peer-reviewed journals attained the highest average QUEST score compared to national/regional news outlets, national/state government sites, and global health organizations (all P<.05). The average reading level was 11.7 (SD 1.9, range 5.4-16.9). Only 3 (1.6%) articles were written at the recommended sixth grade level. Conclusions: COVID-19–related articles are vastly varied in their attributes and levels of bias, and would benefit from revisions for increased readability. %M 34995206 %R 10.2196/32443 %U https://formative.jmir.org/2022/2/e32443 %U https://doi.org/10.2196/32443 %U http://www.ncbi.nlm.nih.gov/pubmed/34995206 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e31131 %T An Association of Influenza Epidemics in Children With Mobile App Data: Population-Based Observational Study in Osaka, Japan %A Katayama,Yusuke %A Kiyohara,Kosuke %A Hirose,Tomoya %A Ishida,Kenichiro %A Tachino,Jotaro %A Nakao,Shunichiro %A Noda,Tomohiro %A Ojima,Masahiro %A Kiguchi,Takeyuki %A Matsuyama,Tasuku %A Kitamura,Tetsuhisa %+ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, Japan, 81 6 6879 5707, orion13@hp-emerg.med.osaka-u.ac.jp %K syndromic surveillance %K mobile app %K influenza %K epidemic %K children %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Early surveillance to prevent the spread of influenza is a major public health concern. If there is an association of influenza epidemics with mobile app data, it may be possible to forecast influenza earlier and more easily. Objective: We aimed to assess the relationship between seasonal influenza and the frequency of mobile app use among children in Osaka Prefecture, Japan. Methods: This was a retrospective observational study that was performed over a three-year period from January 2017 to December 2019. Using a linear regression model, we calculated the R2 value of the regression model to evaluate the relationship between the number of “fever” events selected in the mobile app and the number of influenza patients ≤14 years of age. We conducted three-fold cross-validation using data from two years as the training data set and the data of the remaining year as the test data set to evaluate the validity of the regression model. And we calculated Spearman correlation coefficients between the calculated number of influenza patients estimated using the regression model and the number of influenza patients, limited to the period from December to April when influenza is prevalent in Japan. Results: We included 29,392 mobile app users. The R2 value for the linear regression model was 0.944, and the adjusted R2 value was 0.915. The mean Spearman correlation coefficient for the three regression models was 0.804. During the influenza season (December–April), the Spearman correlation coefficient between the number of influenza patients and the calculated number estimated using the linear regression model was 0.946 (P<.001). Conclusions: In this study, the number of times that mobile apps were used was positively associated with the number of influenza patients. In particular, there was a good association of the number of influenza patients with the number of “fever” events selected in the mobile app during the influenza epidemic season. %M 35142628 %R 10.2196/31131 %U https://formative.jmir.org/2022/2/e31131 %U https://doi.org/10.2196/31131 %U http://www.ncbi.nlm.nih.gov/pubmed/35142628 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e28959 %T Mobile Phone Apps for Intimate Partner and Sexual Violence Prevention and Response: Systematic Search on App Stores %A Draughon Moret,Jessica %A Todd,Angela %A Rose,Lauren %A Pollitt,Erin %A Anderson,Jocelyn %+ Betty Irene Moore School of Nursing, University of California, Davis, 2570 48th Street, Suite 2600, Sacramento, CA, 95817, United States, 1 916 734 0511, jdmoret@ucdavis.edu %K rape %K intimate partner violence %K gender-based violence %K smartphone %K mobile phone app %D 2022 %7 8.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the 2008 advent of the smartphone, more than 180 billion copies of apps have been downloaded from Apple App Store, with more than 2.6 million apps available for Android and 2.2 million apps available for iOS. Many violence prevention and response apps have been developed as part of this app proliferation. Objective: This study aims to evaluate the prevalence and quality of freely available mobile phone apps targeting intimate partner violence (IPV) and sexual violence (SV) prevention and response. Methods: We conducted a systematic search of violence prevention and response mobile phone apps freely available in Apple App Store (iOS; March 2016) and Google Play Store (Android; July 2016). Search terms included violence prevention, sexual assault, domestic violence, intimate partner violence, sexual violence, forensic nursing, wife abuse, and rape. Apps were included for review if they were freely available, were available in English, and had a primary purpose of prevention of or response to SV or IPV regardless of app target end users. Results: Using the Mobile Application Rating Scale (MARS), we evaluated a total of 132 unique apps. The majority of included apps had a primary purpose of sharing information or resources. Included apps were of low-to-moderate quality, with the overall subjective quality mean for the reviewed apps being 2.65 (95% CI 2.58-2.72). Quality scores for each of the 5 MARS categories ranged from 2.80 (engagement) to 4.75 (functionality). An incidental but important finding of our review was the difficulty in searching for apps and the plethora of nonrelated apps that appear when searching for keywords such as “rape” and “domestic violence” that may be harmful to people seeking help. Conclusions: Although there are a variety of mobile apps available designed to provide information or other services related to SV and IPV, they range greatly in quality. They are also challenging to find, given the current infrastructure of app store searches, keyword prioritization, and highlighting based on user rating. It is important for providers to be aware of these resources and be knowledgeable about how to review and recommend mobile phone apps to patients, when appropriate. %M 35133285 %R 10.2196/28959 %U https://formative.jmir.org/2022/2/e28959 %U https://doi.org/10.2196/28959 %U http://www.ncbi.nlm.nih.gov/pubmed/35133285 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e33941 %T Exploring Relationships Between Tweet Numbers and Over-the-counter Drug Sales for Allergic Rhinitis: Retrospective Analysis %A Wakamiya,Shoko %A Morimoto,Osamu %A Omichi,Katsuhiro %A Hara,Hideyuki %A Kawase,Ichiro %A Koshiba,Ryuji %A Aramaki,Eiji %+ Graduate School of Science and Technology, Nara Institute of Science and Technology, 8916-5, Takayama-cho, Ikoma, Nara, 6300192, Japan, 81 743 72 5250, wakamiya@is.naist.jp %K infoveillance %K social media %K Twitter %K over-the-counter drugs %K allergic rhinitis %K hay fever %K drug %K treatment %K allergy %K immunology %K surveillance %K monitoring %K prevalence %K motivation %K Japan %K symptom %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health-related social media data are increasingly being used in disease surveillance studies. In particular, surveillance of infectious diseases such as influenza has demonstrated high correlations between the number of social media posts mentioning the disease and the number of patients who went to the hospital and were diagnosed with the disease. However, the prevalence of some diseases, such as allergic rhinitis, cannot be estimated based on the number of patients alone. Specifically, individuals with allergic rhinitis typically self-medicate by taking over-the-counter (OTC) medications without going to the hospital. Although allergic rhinitis is not a life-threatening disease, it represents a major social problem because it reduces people’s quality of life, making it essential to understand its prevalence and people’s motives for self-medication behavior. Objective: This study aims to explore the relationship between the number of social media posts mentioning the main symptoms of allergic rhinitis and the sales volume of OTC rhinitis medications in Japan. Methods: We collected tweets over 4 years (from 2017 to 2020) that included keywords corresponding to the main nasal symptoms of allergic rhinitis: “sneezing,” “runny nose,” and “stuffy nose.” We also obtained the sales volume of OTC drugs, including oral medications and nasal sprays, for the same period. We then calculated the Pearson correlation coefficient between time series data on the number of tweets per week and time series data on the sales volume of OTC drugs per week. Results: The results showed a much higher correlation (r=0.8432) between the time series data on the number of tweets mentioning “stuffy nose” and the time series data on the sales volume of nasal sprays than for the other two symptoms. There was also a high correlation (r=0.9317) between the seasonal components of these time series data. Conclusions: We investigated the relationships between social media data and behavioral patterns, such as OTC drug sales volume. Exploring these relationships can help us understand the prevalence of allergic rhinitis and the motives for self-care treatment using social media data, which would be useful as a marketing indicator to reduce the number of out-of-stocks in stores, provide (sell) rhinitis medicines to consumers in a stable manner, and reduce the loss of sales opportunities. In the future, in-depth investigations are required to estimate sales volume using social media data, and future research could investigate other diseases and countries. %M 35107434 %R 10.2196/33941 %U https://formative.jmir.org/2022/2/e33941 %U https://doi.org/10.2196/33941 %U http://www.ncbi.nlm.nih.gov/pubmed/35107434 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e22586 %T Patient Utilization of Online Information and its Influence on Orthopedic Surgeon Selection: Cross-sectional Survey of Patient Beliefs and Behaviors %A Hoang,Victor %A Parekh,Amit %A Sagers,Kevin %A Call,Trevor %A Howard,Shain %A Hoffman,Jason %A Lee,Daniel %+ Valley Hospital Medical Center, 620 Shadow Lane, Las Vegas, NV, 89106, United States, 1 7148374577, hoangorthopedics@gmail.com %K orthopedics %K practice management %K physician selection %K internet reviews %K patient decision %K practice %K patient online review %K social media %K physician perception %K patient choice %K health literacy %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient attitudes and behavior are critical to understand owing to the increasing role of patient choice. There is a paucity of investigation into the perceived credibility of online information and whether such information impacts how patients choose their surgeons. Objective: The purpose of this study was to explore the attitudes and behavior of patients regarding online information and orthopedic surgeon selection. Secondary purposes included gaining insight into the relative importance of provider selection factors, and their association with patient age and education level. Methods: This was a cross-sectional study involving five multispecialty orthopedic surgery groups. A total of 329 patients who sought treatment by six different orthopedic surgeons were asked to anonymously answer a questionnaire consisting of 25 questions. Four questions regarded demographic information, 10 questions asked patients to rate the importance of specific criteria regarding the selection of their orthopedic surgeon (on a 4-point Likert scale), and 6 questions were designed to determine patient attitude and behaviors related to online information. Results: Patient-reported referral sources included the emergency room (29/329, 8.8%), friend (42/329, 12.8%), insurance company (47/329, 14.3%), internet search/website (28/329, 8.5%), primary care physician (148/329, 45.0%), and other (34/329, 10.3%). Among the 329 patients, 130 (39.5%) reported that they searched the internet for information before their first visit. There was a trend of increased belief in online information to be accurate and complete in younger age groups (P=.02). There was an increased relative frequency in younger groups to perceive physician rating websites to be unbiased (P=.003), provide sufficient patient satisfaction information (P=.01), and information about physician education and training (P=.03). There was a significant trend for patients that found a surgeon’s website to be useful (P<.001), with the relative frequency increased in younger age groups. Conclusions: This study shows that insurance network, physician referrals, appointment availability, and office location are important to patients, whereas advertising and internet reviews by other patients were considered to be not as helpful in choosing an orthopedic surgeon. Future studies may seek to identify obstacles to patients in integrating online resources for decision-making and strategies to improve health-seeking behaviors. %M 35044319 %R 10.2196/22586 %U https://formative.jmir.org/2022/1/e22586 %U https://doi.org/10.2196/22586 %U http://www.ncbi.nlm.nih.gov/pubmed/35044319 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e34429 %T Assessment of Social Support and Quitting Smoking in an Online Community Forum: Study Involving Content Analysis %A Struik,Laura %A Khan,Shaheer %A Assoiants,Artem %A Sharma,Ramona H %+ School of Nursing, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada, 1 2508079972, laura.struik@ubc.ca %K qualitative research %K smoking cessation %K social media %K social support %K smoking %K tobacco use %K tobacco %K online forum %D 2022 %7 13.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: A key factor in successfully reducing and quitting smoking, as well as preventing smoking relapse is access to and engagement with social support. Recent technological advances have made it possible for smokers to access social support via online community forums. While community forums associated with smoking cessation interventions are now common practice, there is a gap in understanding how and when the different types of social support identified by Cutrona and Suhr (1992) (emotional, esteem, informational, tangible, and network) are exchanged on such forums. Community forums that entail “superusers” (a key marker of a successful forum), like QuitNow, are ripe for exploring and leveraging promising social support exchanges on these platforms. Objective: The purpose of this study was to characterize the posts made on the QuitNow community forum at different stages in the quit journey, and determine when and how the social support constructs are present within the posts. Methods: A total of 506 posts (including original and response posts) were collected. Using conventional content analysis, the original posts were coded inductively to generate categories and subcategories, and the responses were coded deductively according to the 5 types of social support. Data were analyzed using Microsoft Excel software. Results: Overall, individuals were most heavily engaged on the forum during the first month of quitting, which then tapered off in the subsequent months. In relation to the original posts, the majority of them fit into the categories of sharing quit successes, quit struggles, updates, quit strategies, and desires to quit. Asking for advice and describing smoke-free benefits were the least represented categories. In relation to the responses, encouragement (emotional), compliment (esteem), and suggestion/advice (informational) consistently remained the most prominent types of support throughout all quit stages. Companionship (network) maintained a steady downward trajectory over time. Conclusions: The findings of this study highlight the complexity of how and when different types of social support are exchanged on the QuitNow community forum. These findings provide directions for how social support can be more strategically employed and leveraged in these online contexts to support smoking cessation. %M 35023834 %R 10.2196/34429 %U https://formative.jmir.org/2022/1/e34429 %U https://doi.org/10.2196/34429 %U http://www.ncbi.nlm.nih.gov/pubmed/35023834 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e33331 %T Campus Smoking Policies and Smoking-Related Twitter Posts Originating From California Public Universities: Retrospective Study %A Yang,Joshua S %A Cuomo,Raphael E %A Purushothaman,Vidya %A Nali,Matthew %A Shah,Neal %A Bardier,Cortni %A Obradovich,Nick %A Mackey,Tim %+ Global Health Program, Department of Anthropology, University of California, San Diego, 9500 Gilman Drive, Mail Code 0505, La Jolla, CA, 92093, United States, 1 9514914161, tkmackey@ucsd.edu %K tobacco-free policies %K social media %K colleges and universities %K smoking %K smoking %K smoking policy %K campus policy %K tobacco use %K Twitter analysis %K smoke-free %K tobacco-free %K Twitter %K college students %K students %K campus %K health policy %D 2021 %7 24.12.2021 %9 Short Paper %J JMIR Form Res %G English %X Background: The number of colleges and universities with smoke- or tobacco-free campus policies has been increasing. The effects of campus smoking policies on overall sentiment, particularly among young adult populations, are more difficult to assess owing to the changing tobacco and e-cigarette product landscape and differential attitudes toward policy implementation and enforcement. Objective: The goal of the study was to retrospectively assess the campus climate toward tobacco use by comparing tweets from California universities with and those without smoke- or tobacco-free campus policies. Methods: Geolocated Twitter posts from 2015 were collected using the Twitter public application programming interface in combination with cloud computing services on Amazon Web Services. Posts were filtered for tobacco products and behavior-related keywords. A total of 42,877,339 posts were collected from 2015, with 2837 originating from a University of California or California State University system campus, and 758 of these manually verified as being about smoking. Chi-square tests were conducted to determine if there were significant differences in tweet user sentiments between campuses that were smoke- or tobacco-free (all University of California campuses and California State University, Fullerton) compared to those that were not. A separate content analysis of tweets included in chi-square tests was conducted to identify major themes by campus smoking policy status. Results: The percentage of positive sentiment tweets toward tobacco use was higher on campuses without a smoke- or tobacco-free campus policy than on campuses with a smoke- or tobacco-free campus policy (76.7% vs 66.4%, P=.03). Higher positive sentiment on campuses without a smoke- or tobacco-free campus policy may have been driven by general comments about one’s own smoking behavior and comments about smoking as a general behavior. Positive sentiment tweets originating from campuses without a smoke- or tobacco-free policy had greater variation in tweet type, which may have also contributed to differences in sentiment among universities. Conclusions: Our study introduces preliminary data suggesting that campus smoke- and tobacco-free policies are associated with a reduction in positive sentiment toward smoking. However, continued expressions and intentions to smoke and reports of one’s own smoking among Twitter users suggest a need for more research to better understand the dynamics between implementation of smoke- and tobacco-free policies and resulting tobacco behavioral sentiment. %M 34951597 %R 10.2196/33331 %U https://formative.jmir.org/2021/12/e33331 %U https://doi.org/10.2196/33331 %U http://www.ncbi.nlm.nih.gov/pubmed/34951597 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e22390 %T Use and Appreciation of a Web-Based, Computer-Tailored Diet and Physical Activity Intervention Based on the Self-determination Theory: Evaluation Study of Process and Predictors %A Coumans,Juul M J %A Oenema,Anke %A Bolman,Catherine A W %A Lechner,Lilian %+ Department of Health Psychology, Faculty of Psychology, Open University of the Netherlands, Valkenburgerweg 177, Heerlen, 6419 AT, Netherlands, 31 45 576 2635, juul.coumans@ou.nl %K diet %K physical activity %K eHealth %K self-determination theory %K motivational interviewing %K process evaluation %K nonusage attrition %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth is a promising tool for promoting lifestyle behaviors such as a healthy diet and physical activity (PA). However, making people use interventions is a crucial and challenging problem in eHealth. More insight into use patterns and predicting factors is needed to improve future interventions. Objective: This study aims to examine the use, predictors of use, and appreciation of a web-based, computer-tailored, dietary and PA promotion intervention, MyLifestyleCoach, which is based on the self-determination theory. First, we depict the participants’ flow in the intervention and identify moments when they are likely to discontinue use. Second, we investigate whether demographic, motivational, and program-related characteristics predict the use of several intervention elements. Finally, we report the appreciation scores for the intervention and the participant and program characteristics associated with these scores. Methods: This study was based on data from web-based self-report questionnaires. Here, objectively assessed intervention use data were analyzed from participants randomized to the intervention condition. Multiple stepwise (logistic) regression analyses were conducted to examine the predictors of intervention use and evaluation scores. Results: Our findings indicate a low full completion rate for the intervention among those who chose and completed the diet module (49/146, 33.6%), the PA module (2/12, 17%), and both modules (58/273, 21.2%). Several points in the intervention where participants were likely to stop using the intervention were identified. Autonomous and intrinsic motivation toward diet were related to the completion of the initial sessions of the intervention (ie, the opening session in which participants could choose which module to follow and the first session of the diet module). In contrast, controlled motivation was linked to the completion of both modules (initial and follow-up sessions). Appreciation scores were somewhat positive. Appreciation was predicted by several motivational constructs, such as amotivation and basic psychological needs (eg, competence) and program-related features (eg, number of completed sessions). Conclusions: This study adds meaningful information on the use and appreciation of a web-based, computer-tailored dietary and PA intervention, MyLifestyleCoach. The results indicate that different types of motivations, such as extrinsic and intrinsic motivation, are at play at the points when people are likely to stop using the intervention. The intervention was appreciated fairly well, and several motivational constructs and fulfillment of basic psychological needs were associated with appreciation. Practical implications of these findings have been provided in this study. %M 34860670 %R 10.2196/22390 %U https://formative.jmir.org/2021/12/e22390 %U https://doi.org/10.2196/22390 %U http://www.ncbi.nlm.nih.gov/pubmed/34860670 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e29146 %T Googling for Suicide–Content and Quality Analysis of Suicide-Related Websites: Thematic Analysis %A Chen,Wen %A Boggero,Andrea %A Del Puente,Giovanni %A Olcese,Martina %A Prestia,Davide %A Jahrami,Haitham %A Chalghaf,Nasr %A Guelmami,Noomen %A Azaiez,Fairouz %A Bragazzi,Nicola Luigi %+ Laboratory for Industrial and Applied Mathematics, Department of Mathematics and Statistics, York University, 4700 Keele St, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100, bragazzi@yorku.ca %K suicide %K internet %K world wide web %K content analysis %K HONcode %K mental health %K webpage %K health information %K eHealth %D 2021 %7 11.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Suicide represents a public health concern, imposing a dramatic burden. Prosuicide websites are “virtual pathways” facilitating a rise in suicidal behaviors, especially among socially isolated, susceptible individuals. Objective: The aim of this study is to characterize suicide-related webpages in the Italian language. Methods: The first 5 most commonly used search engines in Italy (ie, Bing, Virgilio, Yahoo, Google, and Libero) were mined using the term “suicidio” (Italian for suicide). For each search, the first 100 webpages were considered. Websites resulting from each search were collected and duplicates deleted so that unique webpages could be analyzed and rated with the HONcode instrument Results: A total of 65 webpages were included: 12.5% (8/64) were antisuicide and 6.3% (4/64) explicitly prosuicide. The majority of the included websites had a mixed or neutral attitude toward suicide (52/64, 81.2%) and had informative content and purpose (39/64, 60.9%). Most webpages targeted adolescents as an age group (38/64, 59.4%), contained a reference to other psychiatric disorders or comorbidities (42/64, 65.6%), included medical/professional supervision or guidance (45/64, 70.3%), lacked figures or pictures related to suicide (41/64, 64.1%), and did not contain any access restraint (62/64, 96.9%). The major shortcoming to this study is the small sample size of webpages analyzed and the search limited to the keyword “suicide.” Conclusions: Specialized mental health professionals should try to improve their presence online by providing high-quality material. %M 34689118 %R 10.2196/29146 %U https://formative.jmir.org/2021/11/e29146 %U https://doi.org/10.2196/29146 %U http://www.ncbi.nlm.nih.gov/pubmed/34689118 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e24448 %T Twitter Use by Academic Nuclear Medicine Programs: Pilot Content Analysis Study %A Panda,Ananya %A Sharma,Akash %A Dundar,Ayca %A Packard,Ann %A Aase,Lee %A Kotsenas,Amy %A Kendi,Ayse Tuba %+ Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, United States, 1 612 408 9737, kendi.ayse@mayo.edu %K social media %K Twitter %K radiology %K nuclear medicine %K nuclear radiology %K social network %K medical education %K networking %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There is scant insight into the presence of nuclear medicine (NM) and nuclear radiology (NR) programs on social media. Objective: Our purpose was to assess Twitter engagement by academic NM/NR programs in the United States. Methods: We measured Twitter engagement by the academic NM/NR community, accounting for various NM/NR certification pathways. The Twitter presence of NM/NR programs at both the department and program director level was identified. Tweets by programs were cross-referenced against potential high-yield NM- or NR-related hashtags, and tabulated at a binary level. A brief survey was done to identify obstacles and benefits to Twitter use by academic NM/NR faculty. Results: For 2019-2020, 88 unique programs in the United States offered NM/NR certification pathways. Of these, 52% (46/88) had Twitter accounts and 24% (21/88) had at least one post related to NM/NR. Only three radiology departments had unique Twitter accounts for the NM/molecular imaging division. Of the other 103 diagnostic radiology residency programs, only 16% (16/103) had a presence on Twitter and 5% (5/103) had tweets about NM/NR. Only 9% (8/88) of NM/NR program directors were on Twitter, and three program directors tweeted about NM/NR. The survey revealed a lack of clarity and resources around using Twitter, although respondents acknowledged the perceived value of Twitter engagement for attracting younger trainees. Conclusions: Currently, there is minimal Twitter engagement by the academic NM/NR community. The perceived value of Twitter engagement is counterbalanced by identifiable obstacles. Given radiologists’ overall positive views of social media’s usefulness, scant social media engagement by the NM community may represent a missed opportunity. More Twitter engagement and further research by trainees and colleagues should be encouraged, as well as the streamlined use of unique hashtags. %M 34747708 %R 10.2196/24448 %U https://formative.jmir.org/2021/11/e24448 %U https://doi.org/10.2196/24448 %U http://www.ncbi.nlm.nih.gov/pubmed/34747708 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e26181 %T Usability-In-Place—Remote Usability Testing Methods for Homebound Older Adults: Rapid Literature Review %A Hill,Jordan R %A Brown,Janetta C %A Campbell,Noll L %A Holden,Richard J %+ Department of Pharmacy Practice, College of Pharmacy, Purdue University, 640 Eskenazi Ave, Indianapolis, IN, 46202, United States, 1 7655438559, hill265@purdue.edu %K mobile usability testing %K usability inspection %K methods %K aging %K literature synthesis %K usability study %K mobile usability %K elderly %K older adults %K remote usability %K mobility restriction %D 2021 %7 2.11.2021 %9 Review %J JMIR Form Res %G English %X Background: Technology can benefit older adults in many ways, including by facilitating remote access to services, communication, and socialization for convenience or out of necessity when individuals are homebound. As people, especially older adults, self-quarantined and sheltered in place during the COVID-19 pandemic, the importance of usability-in-place became clear. To understand the remote use of technology in an ecologically valid manner, researchers and others must be able to test usability remotely. Objective: Our objective was to review practical approaches for and findings about remote usability testing, particularly remote usability testing with older adults. Methods: We performed a rapid review of the literature and reported on available methods, their advantages and disadvantages, and practical recommendations. This review also reported recommendations for usability testing with older adults from the literature. Results: Critically, we identified a gap in the literature—a lack of remote usability testing methods, tools, and strategies for older adults, despite this population’s increased remote technology use and needs (eg, due to disability or technology experience). We summarized existing remote usability methods that were found in the literature as well as guidelines that are available for conducting in-person usability testing with older adults. Conclusions: We call on the human factors research and practice community to address this gap to better support older adults and other homebound or mobility-restricted individuals. %M 34726604 %R 10.2196/26181 %U https://formative.jmir.org/2021/11/e26181 %U https://doi.org/10.2196/26181 %U http://www.ncbi.nlm.nih.gov/pubmed/34726604 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e31421 %T Patterns of Missing Data With Ecological Momentary Assessment Among People Who Use Drugs: Feasibility Study Using Pilot Study Data %A Markowski,Kelly L %A Smith,Jeffrey A %A Gauthier,G Robin %A Harcey,Sela R %+ Rural Drug Addiction Research Center, University of Nebraska-Lincoln, 660 N 12th St, Lincoln, NE, 68508, United States, 1 8153536605, kmarkowski2@unl.edu %K EMA %K ecological momentary assessment %K PWUD %K people who use drugs %K noncompliance %K missing data %K mobile phone %D 2021 %7 24.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Ecological momentary assessment (EMA) is a set of research methods that capture events, feelings, and behaviors as they unfold in their real-world setting. Capturing data in the moment reduces important sources of measurement error but also generates challenges for noncompliance (ie, missing data). To date, EMA research has only examined the overall rates of noncompliance. Objective: In this study, we identify four types of noncompliance among people who use drugs and aim to examine the factors associated with the most common types. Methods: Data were obtained from a recent pilot study of 28 Nebraskan people who use drugs who answered EMA questions for 2 weeks. We examined questions that were not answered because they were skipped, they expired, the phone was switched off, or the phone died after receiving them. Results: We found that the phone being switched off and questions expiring comprised 93.34% (1739/1863 missing question-instances) of our missing data. Generalized structural equation model results show that participant-level factors, including age (relative risk ratio [RRR]=0.93; P=.005), gender (RRR=0.08; P=.006), homelessness (RRR=3.80; P=.04), personal device ownership (RRR=0.14; P=.008), and network size (RRR=0.57; P=.001), are important for predicting off missingness, whereas only question-level factors, including time of day (ie, morning compared with afternoon, RRR=0.55; P<.001) and day of week (ie, Tuesday-Saturday compared with Sunday, RRR=0.70, P=.02; RRR=0.64, P=.005; RRR=0.58, P=.001; RRR=0.55, P<.001; and RRR=0.66, P=.008, respectively) are important for predicting expired missingness. The week of study is important for both (ie, week 2 compared with week 1, RRR=1.21, P=.03, for off missingness and RRR=1.98, P<.001, for expired missingness). Conclusions: We suggest a three-pronged strategy to preempt missing EMA data with high-risk populations: first, provide additional resources for participants likely to experience phone charging problems (eg, people experiencing homelessness); second, ask questions when participants are not likely to experience competing demands (eg, morning); and third, incentivize continued compliance as the study progresses. Attending to these issues can help researchers ensure maximal data quality. %M 34464327 %R 10.2196/31421 %U https://formative.jmir.org/2021/9/e31421 %U https://doi.org/10.2196/31421 %U http://www.ncbi.nlm.nih.gov/pubmed/34464327 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28878 %T Redesigning a Web-Based Stakeholder Consensus Meeting About Core Outcomes for Clinical Trials: Formative Feedback Study %A Katiri,Roulla %A Hall,Deborah A %A Hoare,Derek J %A Fackrell,Kathryn %A Horobin,Adele %A Buggy,Nóra %A Hogan,Nicholas %A Kitterick,Pádraig T %A , %+ National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, United Kingdom, 44 1158232626, padraig.kitterick@nottingham.ac.uk %K COVID-19 %K nominal group technique %K formative research %K patient participation %K persons with hearing impairments %K mobile phone %D 2021 %7 19.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinical trials that assess the benefits and harms of an intervention do so by measuring and reporting outcomes. Inconsistent selection and diversity in the choice of outcomes make it challenging to directly compare interventions. To achieve an agreed core set of outcomes, a consensus methodology is recommended, comprising a web-based Delphi survey and a face-to-face consensus meeting. However, UK government regulations to control the pandemic prohibited plans for a face-to-face consensus meeting as part of the Core Rehabilitation Outcome Set for Single-Sided Deafness (CROSSSD) study. Objective: This study aims to evaluate the modifications made by the CROSSSD study team to achieve consensus using web-based methods, but with minimal deviation from the original study protocol. Methods: The study team worked with health care users and professionals to translate the planned face-to-face consensus meeting in a web-based format, preserving the key elements of the nominal group technique. A follow-up survey gathered evaluation feedback on the experiences of the 22 participating members. Feedback covered premeeting preparation, the process of facilitated discussions and voting, ability to contribute, and perceived fairness of the outcome. Results: Overall, 98% (53/54) of feedback responses agreed or strongly agreed with the statements given, indicating that the web-based meeting achieved its original goals of open discussion, debate, and voting to agree with a core outcome set for single-sided deafness. Hearing-impaired participants were fully engaged, but there were some methodological challenges. For the participants, challenges included building rapport, understanding, and delivering the tasks in hand. For the study team, challenges included the need for thorough preparation and management of the unpredictability of tasks on the day. Conclusions: Sharing our experiences and lessons learned can benefit future core outcome set developers. Overcoming the challenges of delivering a web-based consensus exercise in the face of the pandemic can be applied more generally to maximize inclusiveness, enhance geographical access, and reduce research costs. %M 34420915 %R 10.2196/28878 %U https://formative.jmir.org/2021/8/e28878 %U https://doi.org/10.2196/28878 %U http://www.ncbi.nlm.nih.gov/pubmed/34420915 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e21357 %T Enabling Guidelines for the Adoption of eHealth Solutions: Scoping Review %A Støme,Linn Nathalie %A Wilhelmsen,Christian Ringnes %A Kværner,Kari Jorunn %+ Centre for Connected Care, Oslo University Hospital, Kirkeveien 166, Oslo, Norway, 47 94 88 08 25, linast@ous-hf.no %K eHealth %K feasibility %K global health %K implementation %D 2021 %7 30.4.2021 %9 Review %J JMIR Form Res %G English %X Background: Globally, public health care is under increasing pressure, an economic burden currently amplified by the COVID-19 outbreak. With the recognition that universal health coverage improves the health of a population and reduces health inequalities, universal health coverage has been acknowledged as a priority goal. To meet the global needs in a population with increased chronic illness and longer life expectancy, the health care system is in dire need of new, emerging technologies. eHealth solutions as a method of delivery may have an impact on quality of care and health care costs. As such, it is important to study methods previously used to avoid suboptimal implementation and promote general guidelines to further develop eHealth solutions. Objective: This study aims to explore and thematically categorize a selected representation of early phase studies on eHealth technologies, focusing on papers that are under development or undergoing testing. Further, we want to assess enablers and barriers in terms of usability, scaling, and data management of eHealth implementation. The aim of this study to explore early development phase and feasibility studies was an intentional effort to provide applicable guidelines for evaluation at different stages of implementation. Methods: A structured search was performed in PubMed, MEDLINE, and Cochrane to identify and provide insight in current eHealth technology and methodology under development and gain insight in the future potential of eHealth technologies. Results: In total, 27 articles were included in this review. The clinical studies were categorized thematically by illness comparing 4 technology types deemed relevant: apps/web-based technology, sensor technology, virtual reality, and television. All eHealth assessment and implementation studies were categorized by their focus point: usability, scaling, or data management. Studies assessing the effect of eHealth were divided into feasibility studies, qualitative studies, and heuristic assessments. Studies focusing on usability (16/27) mainly addressed user involvement and learning curve in the adoption of eHealth, while the majority of scaling studies (6/27) focused on strategic and organizational aspects of upscaling eHealth solutions. Studies focusing on data management (5/27) addressed data processing and data sensitivity in adoption and diffusion of eHealth. Efficient processing of data in a secure manner, as well as user involvement and feedback, both throughout small studies and during upscaling, were the important enablers considered for successful implementation of eHealth. Conclusions: eHealth interventions have considerable potential to improve lifestyle changes and adherence to treatment recommendations. To promote efficient implementation and scaling, user involvement to promote user-friendliness, secure and adaptable data management, and strategical considerations needs to be addressed early in the development process. eHealth should be assessed during its development into health services. The wide variation in interventions and methodology makes comparison of the results challenging and calls for standardization of methods. %M 33929330 %R 10.2196/21357 %U https://formative.jmir.org/2021/4/e21357 %U https://doi.org/10.2196/21357 %U http://www.ncbi.nlm.nih.gov/pubmed/33929330 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e14563 %T Investigating the Food and Drug Administration Biotherapeutics Review and Approval Process: Narrative Review %A Bonet Olivencia,Samuel %A Sasangohar,Farzan %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843, United States, 1 9794582337, sasangohar@tamu.edu %K biotherapeutics %K drug approval %K drug review process %K model-based systems engineering %D 2021 %7 4.3.2021 %9 Review %J JMIR Form Res %G English %X Background: The development, review, and approval process of therapeutic biological products in the United States presents two primary challenges: time and cost. Advancing a biotherapeutic from concept to market may take an average of 12 years, with costs exceeding US $1 billion, and the product may still fail the US Food and Drug Administration (FDA) approval process. Despite the FDA’s practices to expedite the approval of new therapies, seeking FDA approval remains a long, costly, and risky process. Objective: The objective of this paper is to explore the factors and gaps related to the FDA review and approval process that contribute to process inefficiencies and complexities as well as proposed methods and solutions to address such gaps. This paper also aims to investigate the available modeling efforts for the FDA approval process of therapeutic biological products. Methods: A narrative review of literature was conducted to understand the scope of published knowledge about challenges, opportunities, and specific methods to address the factors and gaps related to the review and approval of new drugs, including therapeutic biological products. Relevant peer-reviewed journal articles, conference proceedings, book chapters, official reports from public policy professional centers, and official reports and guidelines from the FDA were reviewed. Results: Of the 23 articles identified in this narrative literature review, none modeled the current FDA review and approval process structure to address issues related to the robustness, reliability, and efficiency of its operations from an external point of view. Although several studies summarize the FDA approval process with clarity, in addition to bringing to light the problems and challenges faced by the regulatory agency, only a few attempts have been made to provide solutions for the problems and challenges identified. In addition, although several reform models have been discussed, these models lack the application of scientific methodologies and modeling techniques in understanding FDA as a complex sociotechnical system. Furthermore, tools and methods to assess the efficacy of the models before implementation are largely absent. Conclusions: The findings suggest the efficacy of model-based systems engineering approaches for identifying opportunities for significant improvements to the FDA review and approval process. Using this holistic approach will serve several investigative purposes: identify influential sources of variability that cause major delays, including individual, team, and organizational decision making; identify the human-system bottlenecks; identify areas of opportunity for design-driven improvements; study the effect of induced changes in the system; and assess the robustness of the structure of the FDA approval process in terms of enforcement and information symmetry. %M 33661119 %R 10.2196/14563 %U https://formative.jmir.org/2021/3/e14563 %U https://doi.org/10.2196/14563 %U http://www.ncbi.nlm.nih.gov/pubmed/33661119 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e13888 %T Identifying Health Economic Considerations to Include in the Research Protocol of a Randomized Controlled Trial (the REDUCE-RISK Trial): Systematic Literature Review and Assessment %A Neyt,Mattias %A Christiaens,Annick %A Aloi,Marina %A de Ridder,Lissy %A Croft,Nicholas M %A Koletzko,Sibylle %A Levine,Arie %A Turner,Dan %A Russell,Richard K %A Ruemmele,Frank M %A Veereman,Gigi %+ Medical Evaluation and Technology Assessment (ME-TA), Jan Burssensstraat 23, Merendree, 9850, Belgium, 32 477901317, mattias.neyt@me-ta.eu %K Crohn disease %K cost-benefit analysis %K adalimumab %K clinical trial %K protocol %K technology assessment, biomedical %D 2021 %7 25.1.2021 %9 Review %J JMIR Form Res %G English %X Background: The REDUCE-RISK trial was set up to compare the effectiveness of weekly subcutaneously administered methotrexate with daily oral azathioprine or 6-mercaptopurine in low-risk Crohn disease (CD) or subcutaneously administered adalimumab (ADA) in high-risk CD in a pediatric population (age 6-17 years). Objective: The aim of this study is to perform a systematic review to provide input into the research protocol to gather the necessary information to improve the performance of an evidence-based economic evaluation when the trial is finished. Methods: The Centre for Reviews and Dissemination (CRD) Health Technology Assessment (HTA) database, websites of HTA institutes, CRD’s National Health Service Economic Evaluation Database, MEDLINE (OVID), and Embase databases were consulted to retrieve (reviews of) relevant economic evaluations. Studies were eligible if they included a pediatric or adult population with inflammatory bowel diseases (CD and ulcerative colitis [UC]) treated with ADA (Humira). There were no restrictions on the comparator. Only economic evaluations expressing outcomes in life years gained or quality-adjusted life years gained were selected. Results: A total of 12 primary studies were identified. None of these studies included a pediatric population because of a lack of supporting trials. The economic evaluations identified in our systematic review indicate that ADA is an appropriate intervention for inclusion in such a trial. From a health economic point of view, it is important to make an incremental analysis comparing such an intervention with standard care and not immediately versus another (expensive) biological treatment. Information on the impact of children’s school attendance and parents’ productivity is currently lacking in economic evaluations, and none of the underlying trials measured quality of life (QoL) using a generic utility instrument. Conclusions: The review of the economic literature on ADA for the treatment of patients with CD supports the performance of a trial with biologicals in pediatric patients, including making a distinction according to disease severity. Conducting an economic literature review enabled us to decide which variables should be added to the research protocol from an economic point of view. Measurements for children’s and parents’ QoL (EuroQol 5-Dimension questionnaires), children’s school attendance, and parents’ productivity (WPAI-CD-CG questionnaire) were added to the research protocol. This will provide support for the calculation of the cost-effectiveness of the interventions evaluated in the REDUCE-RISK trial. Trial Registration: ClinicalTrials.gov NCT02852694; https://clinicaltrials.gov/ct2/show/NCT02852694 %M 33492239 %R 10.2196/13888 %U http://formative.jmir.org/2021/1/e13888/ %U https://doi.org/10.2196/13888 %U http://www.ncbi.nlm.nih.gov/pubmed/33492239 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e17687 %T What You Need to Know Before Implementing a Clinical Research Data Warehouse: Comparative Review of Integrated Data Repositories in Health Care Institutions %A Gagalova,Kristina K %A Leon Elizalde,M Angelica %A Portales-Casamar,Elodie %A Görges,Matthias %+ Department of Anesthesiology, Pharmacology and Therapeutics, University of British Columbia, Rm V3-324, 950 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada, 1 875 2000 ext 5616, mgorges@bcchr.ca %K database %K data warehousing %K data aggregation %K information storage and retrieval %K data analytics %K health informatics %D 2020 %7 27.8.2020 %9 Review %J JMIR Form Res %G English %X Background: Integrated data repositories (IDRs), also referred to as clinical data warehouses, are platforms used for the integration of several data sources through specialized analytical tools that facilitate data processing and analysis. IDRs offer several opportunities for clinical data reuse, and the number of institutions implementing an IDR has grown steadily in the past decade. Objective: The architectural choices of major IDRs are highly diverse and determining their differences can be overwhelming. This review aims to explore the underlying models and common features of IDRs, provide a high-level overview for those entering the field, and propose a set of guiding principles for small- to medium-sized health institutions embarking on IDR implementation. Methods: We reviewed manuscripts published in peer-reviewed scientific literature between 2008 and 2020, and selected those that specifically describe IDR architectures. Of 255 shortlisted articles, we found 34 articles describing 29 different architectures. The different IDRs were analyzed for common features and classified according to their data processing and integration solution choices. Results: Despite common trends in the selection of standard terminologies and data models, the IDRs examined showed heterogeneity in the underlying architecture design. We identified 4 common architecture models that use different approaches for data processing and integration. These different approaches were driven by a variety of features such as data sources, whether the IDR was for a single institution or a collaborative project, the intended primary data user, and purpose (research-only or including clinical or operational decision making). Conclusions: IDR implementations are diverse and complex undertakings, which benefit from being preceded by an evaluation of requirements and definition of scope in the early planning stage. Factors such as data source diversity and intended users of the IDR influence data flow and synchronization, both of which are crucial factors in IDR architecture planning. %M 32852280 %R 10.2196/17687 %U http://formative.jmir.org/2020/8/e17687/ %U https://doi.org/10.2196/17687 %U http://www.ncbi.nlm.nih.gov/pubmed/32852280 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12248 %T Predisposing and Motivational Factors Related to Social Network Sites Use: Systematic Review %A Mancinelli,Elisa %A Bassi,Giulia %A Salcuni,Silvia %+ Department of General Psychology, University of Padua, Via Venezia 8, Padua, 35219, Italy, 39 3342799698, elisa.mancinelli@studenti.unipd.it %K social networks %K individual differences %K motivation %K adolescents %K adults %D 2019 %7 9.6.2019 %9 Review %J JMIR Form Res %G English %X Background: Social network sites (SNSs) have been defined as Web services that involve creating a private or semiprivate profile. Through these services, adolescents and adults can maintain and create new relationships. Adolescents, in particular, can be considered the main users of these sites as they spend a lot of time on SNSs. In using SNSs, individuals can exert greater control over the conversation and on the information shared, which is associated with a desire for self-presentation. Moreover, the need for self-presentation is related to personality traits such as those of the Big Five, namely extraversion, neuroticism, openness to experience, agreeableness, and conscientiousness, as well as emotional stability, introversion, narcissism, and motivational aspects. The latter are usually linked to an underlying social purpose that might predispose an individual to using SNSs, with the intent of satisfying particular needs, such as belongingness and interpersonal competency. Objective: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method, this study aimed to present a systematic review of the scientific literature regarding the predisposing factors related to the Big Five personality traits and motivational aspects associated with the use of SNSs, for both adolescents (12-19 years) and adults (>20 years). Methods: A search ranging from 2007 to 2017 was conducted through the academic database of Google Scholar and PsycINFO, in which the following terms and their derivatives were considered: predisposing factors, personality traits, Big Five model, self-esteem, self-presentation, interpersonal competency, social network site, Facebook, motivation, five-factor model, use, abuse, and addiction. Based on a defined list of inclusion and exclusion criteria, a total of 9 papers were finally included in the review. Results: Our findings identified 3 main personality traits to be of greater value: extraversion, neuroticism, and openness to experience. Extraversion was a good predictor of motivation and SNS use, whereas the latter trait showed relevance for age differences. All 3 features further played a role in gender differences. Apart from extraversion, the self-presentational motive was also related to narcissism, whereas the need to belong presented an association with agreeableness and neuroticism. Further underlining the social value behind SNS use, people perceived interpersonal competency as being related to Facebook use intensity. Conclusions: Extraversion was recognized as the main forerunner for SNS use and motivation for use. Neuroticism seems to be related to an attempt at compensating for difficulties in real-life social contexts. Openness to experiences has a strong valence for both adults and older adults since SNSs are still perceived as a novelty. Moreover, gender differences in SNS usage were observed to be the product of differences in motivation. Implications and limitations of the study were discussed. %M 31199318 %R 10.2196/12248 %U http://formative.jmir.org/2019/2/e12248/ %U https://doi.org/10.2196/12248 %U http://www.ncbi.nlm.nih.gov/pubmed/31199318