%0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e23366 %T Plausibility of Using a Checklist With YouTube to Facilitate the Discovery of Acute Low Back Pain Self-Management Content: Exploratory Study %A Zheluk,Andrey %A Maddock,Jess %+ School of Biomedical Sciences, Charles Sturt University, Panorama Avenue, Bathurst, 2795, Australia, 61 269332100, andreyzheluk@gmail.com %K YouTube %K low back pain %K lower back pain %K self-management %K social media %K infodemiology %K infodemic %K quality of health information %D 2020 %7 20.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Access to guideline-consistent effective care for acute low back pain (ALBP) is generally regarded as limited. Researchers have recognized the potential of YouTube as a clinical and patient education resource that may improve access to appropriate care. However, the heterogeneity of evaluation approaches and variable quality of health information have generally limited the potential of YouTube as a self-management intervention. Objective: This study aims to increase the understanding of ALBP content available on YouTube in 2020 and to establish the plausibility of using a simple checklist to facilitate the discovery of YouTube content consistent with current guidelines. We examined the following 4 research questions: how was the data set defined, what are the metadata characteristics of the videos in the data set, what is the information quality of ALBP YouTube videos, and what are the characteristics of the YouTube data set based on an ALBP self-management checklist? Methods: This was an exploratory, qualitative infodemiology study. We identified videos in our data set through YouTube search based on popular ALBP-relevant search terms identified through Google Trends for YouTube. We accessed YouTube metadata using the YouTube data tools developed by the University of Amsterdam. We used a modified Brief DISCERN checklist to examine the information quality. We developed a checklist based on the 2018 Lancet Low Back Pain guidelines to examine self-management content. Results: We analyzed a data set of 202 YouTube videos authored by chiropractors, physicians, physiotherapists, and instructors of yoga and other disciplines. We identified clear differences in the ALBP videos in our data set based on the authors’ disciplines. We found that the videos authored by each discipline strongly featured a specific intervention domain, that is, education, treatment, or exercise. We also found that videos authored by physicians were consistently coded with the highest ALBP self-management content scores than all other disciplines. Conclusions: The results returned by YouTube in response to a search for back pain–related content were highly variable. We suggest that a simple checklist may facilitate the discovery of guideline-concordant ALBP self-management content on YouTube. Further research may identify the clinical contexts in which the use of an ALBP checklist with YouTube is feasible. %M 33216003 %R 10.2196/23366 %U http://formative.jmir.org/2020/11/e23366/ %U https://doi.org/10.2196/23366 %U http://www.ncbi.nlm.nih.gov/pubmed/33216003 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e21309 %T Partnering With Massage Therapists to Communicate Information on Reducing the Risk of Skin Cancer Among Clients: Longitudinal Study %A Loescher,Lois %A Heslin,Kelly %A Silva,Graciela %A Muramoto,Myra %+ College of Nursing, University of Arizona, 1305 N Martin Ave, P.O. Box 210203, Tucson, AZ, 85721, United States, 1 5206266169, loescher@arizona.edu %K cancer prevention %K skin cancer %K e-training %K electronic intervention %K massage therapists %D 2020 %7 2.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Skin cancer affects millions of Americans and is an important focus of disease prevention efforts. Partnering with non–health care practitioners such as massage therapists (MTs) can reduce the risk of skin cancer. MTs see clients’ skin on a regular basis, which can allow MTs to initiate “helping conversations” (ie, brief behavioral interventions aimed at reducing the risk of skin cancer). Objective: The purpose of this study was to evaluate (1) the feasibility of recruiting, enrolling, and retaining Arizona MTs in an online electronic training (e-training) and (2) the preliminary efficacy of e-training on knowledge, attitudes/beliefs, and practice of risk reduction for skin cancer. We explored MTs’ ability to assess suspicious skin lesions. Methods: We adapted the existing educational content on skin cancer for applicability to MTs and strategies from previous research on helping conversations. We assessed the feasibility of providing such e-training, using Research Electronic Data Capture (REDCap) tools for data capture. We assessed the preliminary efficacy using established self-report surveys at baseline, immediately post training, and at 3 and 6 months post training. Results: A total of 95 participants enrolled in the study, of which 77% (73/95) completed the assessments at 6 months (overall attrition=23%). Project satisfaction and e-training acceptability were high. Knowledge, personal behaviors (skin self-examination, clinical skin examination, sun protection frequency), and practice attitudes (appropriateness and comfort with client-focused communication) of risk reduction for skin cancer improved significantly and were sustained throughout the study. Conclusions: The e-training was feasible and could be delivered online successfully to MTs. Participants were highly satisfied with and accepting of the e-training. As such, e-training has potential as an intervention in larger trials with MTs for reducing the risk of skin cancer. International Registered Report Identifier (IRRID): RR2-10.2196/13480 %M 33136054 %R 10.2196/21309 %U https://formative.jmir.org/2020/11/e21309 %U https://doi.org/10.2196/21309 %U http://www.ncbi.nlm.nih.gov/pubmed/33136054 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e17359 %T A Behavioral Change Smartphone App and Program (ToDo-CR) to Decrease Sedentary Behavior in Cardiac Rehabilitation Participants: Prospective Feasibility Cohort Study %A Freene,Nicole %A van Berlo,Sander %A McManus,Margaret %A Mair,Tarryn %A Davey,Rachel %+ Physiotherapy, University of Canberra, University Dr, Bruce, 2617, Australia, 61 262015550, nicole.freene@canberra.edu.au %K mHealth %K eHealth %K sedentary behavior %K cardiac rehabilitation %K mobile phone %D 2020 %7 3.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Cardiac rehabilitation participants are encouraged to meet physical activity guidelines to reduce the risk of repeat cardiac events. However, previous studies have found that physical activity levels are low and sedentary behavior is high, both during and after cardiac rehabilitation. There is potential for smartphone apps to be effective in reducing sedentary behavior, although among the few studies that have investigated smartphone apps in cardiac rehabilitation, none targeted sedentary behavior. Objective: This study aims to evaluate the feasibility of a behavioral smartphone app (Vire) and a web-based behavior change program (ToDo-CR) to decrease sedentary behavior in cardiac rehabilitation participants. Methods: Using a single-center, pre-post design, participants were recruited by nursing staff on admission to cardiac rehabilitation. All eligible participants installed the Vire app, were given a Fitbit Flex, and received the 6-week ToDo-CR program while attending cardiac rehabilitation. The ToDo-CR program uses personalized analytics to interpret important behavioral aspects (physical activity, variety, and social opportunity) and real-time information for generating and suggesting context-specific actionable microbehavioral alternatives (Do’s). Do’s were delivered via the app, with participants receiving 14 to 19 Do’s during the 6-week intervention period. Outcome measures were collected at 0, 6, and 16 weeks. The assessors were not blinded. Feasibility outcomes included recruitment and follow-up rates, resource requirements, app usability (Unified Theory of Acceptance and Use of Technology 2 [UTAUT2] questionnaire), and objectively measured daily minutes of sedentary behavior (ActiGraph) for sample size estimation. Secondary outcomes included functional aerobic capacity (6-min walk test), quality of life (MacNew Heart Disease Health-Related Quality of Life Questionnaire), anxiety and depression (Hospital Anxiety and Depression Scale questionnaire), BMI, waist circumference, waist-to-hip ratio, and blood pressure. Results: Between January and May 2019, 20 participants were recruited consecutively. One-third of people who commenced cardiac rehabilitation were eligible to participate. Other than declining to take part in the study (15/40, 38%), not having a smartphone was a major reason for exclusion (11/40, 28%). Those excluded without a smartphone were significantly older than participants with a smartphone (mean difference 20 [SD 5] years; P<.001). Participants were, on average, aged 54 (SD 13) years, mostly male (17/20, 85%), and working (12/20, 67%). At 6 weeks, 95% (19/20) of participants were assessed, and 60% (12/20) of participants were assessed at 16 weeks. Participants were relatively satisfied with the usability of the app (UTAUT2 questionnaire). Overall, participants spent 11 to 12 hours per day sitting. There was a medium effect size (Cohen d=0.54) for the reduction in sedentary behavior (minutes per day) over 16 weeks. Conclusions: The use of a behavioral smartphone app to decrease sitting time appears to be feasible in cardiac rehabilitation. A larger randomized controlled trial is warranted to determine the effectiveness of the app. %M 33141091 %R 10.2196/17359 %U https://formative.jmir.org/2020/11/e17359 %U https://doi.org/10.2196/17359 %U http://www.ncbi.nlm.nih.gov/pubmed/33141091 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e23337 %T Co-Designing a Web-Based Decision Aid Tool for Employees Disclosure of Mental Health Conditions: A Participatory Study Design Using Employee and Organizational Preferences %A Stratton,Elizabeth %A Choi,Isabella %A Peters,Dorian %A Calvo,Rafael A %A Harvey,Samuel B %A Glozier,Nicholas %+ Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia, 61 295151439, Elizabeth.stratton@sydney.edu.au %K employee disclosure %K decision aid tool %K mental health %K web-based %D 2020 %7 6.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Decisions of whether to disclose mental health conditions are extremely personal and require the consideration of multiple factors associated with the disclosure process (eg, weighing the risks and benefits). Decision aid tools help people make these complex decisions. Such an aid needs to be confidential, easily accessible, and easy to use with the potential to access the tool on multiple occasions. Web programs are well suited to meet these requirements and, if properly developed, can provide feasible, accessible, affordable, and effective workplace interventions. Objective: This study aims to gain insights from potential end users, in this case both employees and organizations, into what type of components including language, style, and content would avoid potential stigma and ensure that elements of clear value for users would be built into a web-based decision aid tool that aims to assist employees in making decisions about the disclosure of their mental health condition at work. Methods: A participatory design approach was used to allow developers, researchers, experts, and end users to collaborate in co-designing the tool. During the user research phase of the development of the web-based tool, a participatory design workshop approach was selected as a part of a larger study of focus groups. Australian employees and managers in rural, suburban, and urban locations participated in an exploratory qualitative study involving participatory workshops designed to elicit their perspectives and preferences for a decision aid tool. Results: A total of 2 workshops were conducted with 13 participants. The majority were from a transport company (9/13, 69%), male (8/13, 62%), and employed full time (11/13, 85%). Six employees had previous experience disclosing their own mental health condition, and 7 were in a supervisory role and had previously been disclosed to. In any co-design development, there are certain trade-offs that need to be made between the views of experts, developers, end users, and the available budget. In this specific instance of a very delicate, personal decision, the end users provided valuable design insights into key areas such as language, and they were very antipathetic to a key feature, the avatar, which was thought to be desirable by experts and developers. Findings including aspects of the tool where all stakeholders were in agreement, aspects where some stakeholders disagreed and adaptations were implemented, where disagreements could not be implemented because of financial constraints, and misalignment between stakeholders and how to decide on a balance were shared. Conclusions: The co-design with a lived experience approach is useful for contributing much to the design, language, and features. The key in this study was balancing the needs of the workers and the potential impact for the managers and organizations, while ensuring legislation and regulation requirements were upheld. %M 33155982 %R 10.2196/23337 %U https://formative.jmir.org/2020/11/e23337 %U https://doi.org/10.2196/23337 %U http://www.ncbi.nlm.nih.gov/pubmed/33155982 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18067 %T Effectiveness of a Smartphone App (BioBase) for Reducing Anxiety and Increasing Mental Well-Being: Pilot Feasibility and Acceptability Study %A Kawadler,Jamie M %A Hemmings,Nicola Rose %A Ponzo,Sonia %A Morelli,Davide %A Bird,Geoffrey %A Plans,David %+ Huma Therapeutics Limited, 13th Floor Millbank Tower, 21-24 Millbank, , London, , United Kingdom, 44 7527016574, jamie@biobeats.com %K health and well-being %K health promotion %K organizational and leadership support %K workplace %D 2020 %7 10.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of workplace-related stress and anxiety is high, resulting in stress-related physical and mental illness. Digital self-guided interventions aimed at key areas of workplace design may be able to provide remote anxiolytic effects. Objective: The aim of this feasibility study is to assess changes in anxiety and mental well-being after use of the BioBase programme, a mobile phone platform for psycho-educational modules, tools, and real-time feedback of physiological data. Methods: A 4-week observational study was carried out in 55 healthy adults who were screened for stress with the Depression Anxiety Stress Scale (DASS) Stress subscale. Participants completed anxiety (6-item State-Trait Anxiety Inventory [STAI]) and mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) questionnaires at baseline and at 4 weeks. Feedback questionnaires were administered after 4 weeks. Results: After 4 weeks of using the programme and controlling for any effect of being paid to take part in the study, STAI significantly decreased (baseline mean 45.52 [SD 13.2]; 4-week mean 39.82 [SD 11.2]; t54=–3.51; P<.001; CI –8.88 to –2.52; Cohen d=0.96) and WEMWBS significantly increased (baseline mean 48.12 [SD 6.4]; 4-week mean 50.4 [SD 6.9]; t53=2.41; P=.019; CI 0.44-4.23; Cohen d=0.66). Further, higher baseline stress was significantly associated with a greater decrease in STAI (t53=–3.41; P=.001; CI –8.10 to –2.10; R2=0.180) and a greater increase in WEMWBS (t52=2.41; P=.019; CI 0.38-4.11, R2=0.101). On feedback, participants found the programme easy to use/navigate, with the content being acceptable and relevant to workplace-related stressors; 70% (21/30) of participants would recommend the programme to a friend. Conclusions: The BioBase programme is a potentially effective intervention in decreasing anxiety and increasing mental well-being, with larger changes in those with higher baseline levels of stress. %M 32969341 %R 10.2196/18067 %U https://formative.jmir.org/2020/11/e18067 %U https://doi.org/10.2196/18067 %U http://www.ncbi.nlm.nih.gov/pubmed/32969341 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e24587 %T Diagnosing Chronic Obstructive Airway Disease on a Smartphone Using Patient-Reported Symptoms and Cough Analysis: Diagnostic Accuracy Study %A Porter,Paul %A Claxton,Scott %A Brisbane,Joanna %A Bear,Natasha %A Wood,Javan %A Peltonen,Vesa %A Della,Phillip %A Purdie,Fiona %A Smith,Claire %A Abeyratne,Udantha %+ Joondalup Health Campus, Suite 204, Joondalup Health Campus, , Perth, 6027, Australia, 61 0412484747, phporter@iinet.net.au %K respiratory %K medicine %K diagnostic algorithm %K telehealth %K acute care %D 2020 %7 10.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Rapid and accurate diagnosis of chronic obstructive pulmonary disease (COPD) is problematic in acute care settings, particularly in the presence of infective comorbidities. Objective: The aim of this study was to develop a rapid smartphone-based algorithm for the detection of COPD in the presence or absence of acute respiratory infection and evaluate diagnostic accuracy on an independent validation set. Methods: Participants aged 40 to 75 years with or without symptoms of respiratory disease who had no chronic respiratory condition apart from COPD, chronic bronchitis, or emphysema were recruited into the study. The algorithm analyzed 5 cough sounds and 4 patient-reported clinical symptoms, providing a diagnosis in less than 1 minute. Clinical diagnoses were determined by a specialist physician using all available case notes, including spirometry where available. Results: The algorithm demonstrated high positive percent agreement (PPA) and negative percent agreement (NPA) with clinical diagnosis for COPD in the total cohort (N=252; PPA=93.8%, NPA=77.0%, area under the curve [AUC]=0.95), in participants with pneumonia or infective exacerbations of COPD (n=117; PPA=86.7%, NPA=80.5%, AUC=0.93), and in participants without an infective comorbidity (n=135; PPA=100.0%, NPA=74.0%, AUC=0.97). In those who had their COPD confirmed by spirometry (n=229), PPA was 100.0% and NPA was 77.0%, with an AUC of 0.97. Conclusions: The algorithm demonstrated high agreement with clinical diagnosis and rapidly detected COPD in participants presenting with or without other infective lung illnesses. The algorithm can be installed on a smartphone to provide bedside diagnosis of COPD in acute care settings, inform treatment regimens, and identify those at increased risk of mortality due to seasonal or other respiratory ailments. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618001521213; http://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375939 %M 33170129 %R 10.2196/24587 %U http://formative.jmir.org/2020/11/e24587/ %U https://doi.org/10.2196/24587 %U http://www.ncbi.nlm.nih.gov/pubmed/33170129 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e20167 %T Assessing the Efficacy and Acceptability of a Web-Based Intervention for Resilience Among College Students: Pilot Randomized Controlled Trial %A Enrique Roig,Angel %A Mooney,Olwyn %A Salamanca-Sanabria,Alicia %A Lee,Chi Tak %A Farrell,Simon %A Richards,Derek %+ E-mental Health Research Group, School of Psychology, Trinity College Dublin, The University of Dublin, College Green, Dublin, , Ireland, 353 1 896 1000, enriquea@tcd.ie %K web-based intervention %K resilience %K well-being %K positive psychology %K human support %K automated support %K college students %K randomized controlled trial %D 2020 %7 11.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: College students are at elevated risk for developing mental health problems and face specific barriers around accessing evidence-based treatment. Web-based interventions that focus on mental health promotion and strengthening resilience represent one possible solution. Providing support to users has shown to reduce dropout in these interventions. Further research is needed to assess the efficacy and acceptability of these interventions and explore the viability of automating support. Objective: This study investigated the feasibility of a new web-based resilience program based on positive psychology, provided with human or automated support, in a sample of college students. Methods: A 3-armed closed pilot randomized controlled trial design was used. Participants were randomized to the intervention with human support (n=29), intervention with automated support (n=26), or waiting list (n=28) group. Primary outcomes were resilience and well-being, respectively measured by the Connor–Davidson Resilience Scale and Pemberton Happiness Index. Secondary outcomes included measures of depression and anxiety, self-esteem, and stress. Outcomes were self-assessed through online questionnaires. Intention-to-treat and per-protocol analyses were conducted. Results: All participants demonstrated significant improvements in resilience and related outcomes, including an unexpected improvement in the waiting list group. Within- and between-group effect sizes ranged from small to moderate and within-group effects were typically larger for the human than automated support group. A total of 36 participants began the program and completed 46.46% of it on average. Participants were generally satisfied with the program and found it easy to use. Conclusions: Findings support the feasibility of the intervention. Preliminary evidence for the equal benefit of human and automated support needs to be supported by further research with a larger sample. Results of this study will inform the development of a full-scale trial, from which stronger conclusions may be drawn. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 11866034; http://www.isrctn.com/ISRCTN11866034 International Registered Report Identifier (IRRID): RR2-10.1016/j.invent.2019.100254 %M 33174530 %R 10.2196/20167 %U http://formative.jmir.org/2020/11/e20167/ %U https://doi.org/10.2196/20167 %U http://www.ncbi.nlm.nih.gov/pubmed/33174530 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e14988 %T Evaluation of Treatment Descriptions and Alignment With Clinical Guidance of Apps for Depression on App Stores: Systematic Search and Content Analysis %A Bowie-DaBreo,Dionne %A Sünram-Lea,Sandra I %A Sas,Corina %A Iles-Smith,Heather %+ Research and Innovation Centre, Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Beckett Street, Leeds, LS9 7TF, United Kingdom, 44 113 206 0469, dionne.bowie@nhs.net %K mobile mental health %K mHealth %K mobile apps %K depression %K clinical guidance %K NICE guidelines %K NHS %K safety %K ethics %K content analysis %D 2020 %7 13.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The use of apps for the treatment of depression shows great promise. However, there is uncertainty regarding the alignment of publicly available apps for depression with clinical guidance, their treatment fidelity and evidence base, and their overall safety. Objective: Built on previous analyses and reviews, this study aims to explore the treatment and safety issues of publicly available apps for depression. Methods: We conducted a content analysis of apps for depression in the 2 main UK app stores (Google Play and Apple App Store). App store listings were analyzed for intervention content, treatment fidelity, and fit with the National Institute for Health and Care Excellence (NICE) guidelines for the treatment of depression in adults. Results: A total of 353 apps for depression were included in the review. App descriptions reported the use of 20 treatment approaches and 37 treatment strategies. Many apps used transdiagnostic (155/353, 43.9%) and multitheoretical interventions to treat multiple disorders including depression. Although many interventions appeared to be evidence-informed, there were issues with treatment fidelity, research evidence, and fit with clinical guidelines. None of the apps fully aligned with the NICE guidelines for depression. Conclusions: App developers have adopted many evidence-informed treatments in their interventions; however, more work is needed to improve clinical validity, treatment fidelity, and the safety of apps. We urge developers to consult relevant guidelines and standards, and to engage in reflective questioning on treatment and safety to address these issues and to improve treatment content and intervention design. %M 33185566 %R 10.2196/14988 %U http://formative.jmir.org/2020/11/e14988/ %U https://doi.org/10.2196/14988 %U http://www.ncbi.nlm.nih.gov/pubmed/33185566 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e17065 %T Artificial Intelligence Chatbot for Depression: Descriptive Study of Usage %A Dosovitsky,Gilly %A Pineda,Blanca S %A Jacobson,Nicholas C %A Chang,Cyrus %A Escoredo,Milagros %A Bunge,Eduardo L %+ Palo Alto University, 1791 Arastradero Road, Palo Alto, CA, 94304, United States, 1 650 417 2015, ebunge@paloaltou.edu %K chatbot %K artificial intelligence %K depression %K mobile health %K telehealth %D 2020 %7 13.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Chatbots could be a scalable solution that provides an interactive means of engaging users in behavioral health interventions driven by artificial intelligence. Although some chatbots have shown promising early efficacy results, there is limited information about how people use these chatbots. Understanding the usage patterns of chatbots for depression represents a crucial step toward improving chatbot design and providing information about the strengths and limitations of the chatbots. Objective: This study aims to understand how users engage and are redirected through a chatbot for depression (Tess) to provide design recommendations. Methods: Interactions of 354 users with the Tess depression modules were analyzed to understand chatbot usage across and within modules. Descriptive statistics were used to analyze participant flow through each depression module, including characters per message, completion rate, and time spent per module. Slide plots were also used to analyze the flow across and within modules. Results: Users sent a total of 6220 messages, with a total of 86,298 characters, and, on average, they engaged with Tess depression modules for 46 days. There was large heterogeneity in user engagement across different modules, which appeared to be affected by the length, complexity, content, and style of questions within the modules and the routing between modules. Conclusions: Overall, participants engaged with Tess; however, there was a heterogeneous usage pattern because of varying module designs. Major implications for future chatbot design and evaluation are discussed in the paper. %M 33185563 %R 10.2196/17065 %U http://formative.jmir.org/2020/11/e17065/ %U https://doi.org/10.2196/17065 %U http://www.ncbi.nlm.nih.gov/pubmed/33185563 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e19508 %T Use of the Consumer-Based Meditation App Calm for Sleep Disturbances: Cross-Sectional Survey Study %A Huberty,Jennifer %A Puzia,Megan E %A Larkey,Linda %A Irwin,Michael R %A Vranceanu,Ana-Maria %+ College of Health Solutions, Arizona State University, 550 North 3rd St., Phoenix, AZ, 85004, United States, 1 602 827 2456, jennifer.huberty@asu.edu %K insomnia %K mental health %K mindfulness %K meditation %K mobile apps %K consumer behavior %K mobile phone %D 2020 %7 13.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Over 30% of Americans report regular sleep disturbance, and consumers are increasingly seeking strategies to improve sleep. Self-guided mindfulness mobile apps may help individuals improve their sleep. Despite the recent proliferation of sleep content within commercially available mindfulness apps, there is little research on how consumers are using these apps for sleep. Objective: We conducted a cross-sectional survey among subscribers to Calm, a popular, consumer-based, mindfulness-based meditation app, and described and compared how good sleepers, poor sleepers, and those with self-reported insomnia use the app for sleep. Methods: Participants who were paying subscribers of Calm and had used a sleep component of Calm in the last 90 days were invited to complete an investigator-developed survey that included questions about sleep disturbance and the use of Calm for sleep. Based on self-reports of sleep disturbances and of insomnia diagnosis, participants were categorized as “good sleepers,” “poor sleepers,” or “those with insomnia diagnosis.” Chi-square tests compared reasons for downloading the app and usage patterns across participants with and without sleep disturbance. Results: There was a total of 9868 survey respondents. Approximately 10% of participants (1008/9868, 10.21%) were good sleepers, 78% were poor sleepers (7565/9868, 77.66%), and 11% reported a diagnosis of insomnia (1039/9868, 10.53%). The sample was mostly White (8185/9797, 83.55%), non-Hispanic (8929/9423, 94.76%), and female (8166/9578, 85.26%). The most common reasons for sleep disturbances were racing thoughts (7084/8604, 82.33%), followed by stress or anxiety (6307/8604, 73.30%). Poor sleepers and those with insomnia were more likely than good sleepers to have downloaded Calm to improve sleep (χ22=1548.8, P<.001), reduce depression or anxiety (χ22=15.5, P<.001), or improve overall health (χ22=57.6, P<.001). Respondents with insomnia used Calm most often (mean 5.417 days/week, SD 1.936), followed by poor sleepers (mean 5.043 days/week, SD 2.027; F2=21.544, P<.001). The most common time to use Calm was while lying down to sleep (7607/9686, 78.54%), and bedtime use was more common among poor sleepers and those with insomnia (χ22=382.7, P<.001). Compared to good and poor sleepers, those with insomnia were more likely to use Calm after waking up at night (χ22=410.3, P<.001). Most participants tried to use Calm on a regular basis (5031/8597, 58.52%), but regular nighttime use was most common among those with insomnia (646/977, 66.1%), followed by poor sleepers (4040/6930, 58.30%; χ22=109.3, P<.001). Conclusions: Of the paying subscribers to Calm who have used one of the sleep components, approximately 90% have sleep difficulties, and 77% started using Calm primarily for sleep. These descriptive data point to areas of focus for continued refinement of app features and content, followed by prospective trials testing efficacy of consumer-based meditation mobile apps for improving sleep. %M 33185552 %R 10.2196/19508 %U http://formative.jmir.org/2020/11/e19508/ %U https://doi.org/10.2196/19508 %U http://www.ncbi.nlm.nih.gov/pubmed/33185552 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e21450 %T A Cardiovascular Health and Wellness Mobile Health Intervention Among Church-Going African Americans: Formative Evaluation of the FAITH! App %A Brewer,LaPrincess C %A Kumbamu,Ashok %A Smith,Christina %A Jenkins,Sarah %A Jones,Clarence %A Hayes,Sharonne N %A Burke,Lora %A Cooper,Lisa A %A Patten,Christi A %+ Department of Cardiovascular Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 538 0325, brewer.laprincess@mayo.edu %K mobile health %K eHealth %K community-based participatory research %K health promotion %K African Americans %K mobile phone %D 2020 %7 17.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In light of the scarcity of culturally tailored mobile health (mHealth) lifestyle interventions for African Americans, we designed and pilot tested the Fostering African-American Improvement in Total Health (FAITH!) App in a community-based participatory research partnership with African American churches to promote cardiovascular health and wellness in this population. Objective: This report presents the results of a formative evaluation of the FAITH! App from participants in an intervention pilot study. Methods: We included 2 semistructured focus groups (n=4 and n=5) to explore participants’ views on app functionality, utility, and satisfaction as well as its impact on healthy lifestyle change. Sessions were audio-recorded and transcribed verbatim, and qualitative data were analyzed by using general inductive analysis to generate themes. Results: In total, 6 overarching themes emerged among the 9 participants: overall impression, content usefulness, formatting, implementation, impact, and suggestions for improvement. Underpinning the themes was a high level of agreement that the intervention facilitated healthy behavioral change through cultural tailoring, multimedia education modules, and social networking. Suggestions for improvement were streamlining the app self-monitoring features, prompts to encourage app use, and personalization based on individuals’ cardiovascular risk. Conclusions: This formative evaluation found that the FAITH! App had high reported satisfaction and impact on the health-promoting behaviors of African Americans, thereby improving their overall cardiovascular health. Further development and testing of the app among African Americans is warranted. Trial Registration: ClinicalTrials.gov NCT03084822; https://clinicaltrials.gov/ct2/show/NCT03084822. %M 33200999 %R 10.2196/21450 %U http://formative.jmir.org/2020/11/e21450/ %U https://doi.org/10.2196/21450 %U http://www.ncbi.nlm.nih.gov/pubmed/33200999 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18759 %T Technology-Enabled Solutions for Australian Mental Health Services Reform: Impact Evaluation %A LaMonica,Haley M %A Milton,Alyssa %A Braunstein,Katharine %A Rowe,Shelley C %A Ottavio,Antonia %A Jackson,Tanya %A Easton,Michael A %A Hambleton,Ashlea %A Hickie,Ian B %A Davenport,Tracey A %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Camperdown, 2050, Australia, 61 293510785, haley.lamonica@sydney.edu.au %K evaluation methodology %K mental health %K health care reform %K technology %K mobile phone %K community-based participatory research %D 2020 %7 19.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Health information technologies (HITs) are becoming increasingly recognized for their potential to provide innovative solutions to improve the delivery of mental health services and drive system reforms for better outcomes. Objective: This paper describes the baseline results of a study designed to systematically monitor and evaluate the impact of implementing an HIT, namely the InnoWell Platform, into Australian mental health services to facilitate the iterative refinement of the HIT and the service model in which it is embedded to meet the needs of consumers and their supportive others as well as health professionals and service providers. Methods: Data were collected via web-based surveys, semistructured interviews, and a workshop with staff from the mental health services implementing the InnoWell Platform to systematically monitor and evaluate its impact. Descriptive statistics, Fisher exact tests, and a reliability analysis were used to characterize the findings from the web-based surveys, including variability in the results between the services. Semistructured interviews were coded using a thematic analysis, and workshop data were coded using a basic content analysis. Results: Baseline data were collected from the staff of 3 primary youth mental health services (n=18), a counseling service for veterans and their families (n=23), and a helpline for consumers affected by eating disorders and negative body image issues (n=6). As reported via web-based surveys, staff members across the services consistently agreed or strongly agreed that there was benefit associated with using technology as part of their work (38/47, 81%) and that the InnoWell Platform had the potential to improve outcomes for consumers (27/45, 60%); however, there was less certainty as to whether their consumers’ capability to use technology aligned with how the InnoWell Platform would be used as part of their mental health care (11/45, 24% of the participants strongly disagreed or disagreed; 15/45, 33% were neutral; and 19/45, 42% strongly agreed or agreed). During the semistructured interviews (n=3) and workshop, participants consistently indicated that the InnoWell Platform was appropriate for their respective services; however, they questioned whether the services’ respective consumers had the digital literacy required to use the technology. Additional potential barriers to implementation included health professionals’ digital literacy and service readiness for change. Conclusions: Despite agreement among participants that HITs have the potential to result in improved outcomes for consumers and services, service readiness for change (eg, existing technology infrastructure and the digital literacy of staff and consumers) was noted to potentially impact the success of implementation, with less than half (20/45, 44%) of the participants indicating that their service was ready to implement new technologies to enhance mental health care. Furthermore, participants reported mixed opinions as to whether it was their responsibility to recommend technology as part of standard care. %M 33211024 %R 10.2196/18759 %U https://formative.jmir.org/2020/11/e18759 %U https://doi.org/10.2196/18759 %U http://www.ncbi.nlm.nih.gov/pubmed/33211024 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e21577 %T Early-Stage Feasibility of a Mobile Health Intervention (Copilot) to Enhance Exacerbation-Related Self-Management in Patients With Chronic Obstructive Pulmonary Disease: Multimethods Approach %A Korpershoek,Yvonne JG %A Holtrop,Tjitske %A Vervoort,Sigrid CJM %A Schoonhoven,Lisette %A Schuurmans,Marieke J %A Trappenburg,Jaap CA %+ Research Group Chronic Illnesses, University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584 CS, Netherlands, 31 638763949, yvonne.korpershoek@hu.nl %K mobile health %K mHealth %K mobile app %K COPD %K exacerbation %K self-management %K self-care %D 2020 %7 19.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: There is an emergence of mobile health (mHealth) interventions to support self-management in patients with chronic obstructive pulmonary disease (COPD). Recently, an evidence-driven mHealth intervention has been developed to support patients with COPD in exacerbation-related self-management: the Copilot app. Health care providers (HCPs) are important stakeholders as they are the ones who have to provide the app to patients, personalize the app, and review the app. It is, therefore, important to investigate at an early stage whether the app is feasible in the daily practice of the HCPs. Objective: The aim of this study is to evaluate the perceived feasibility of the Copilot app in the daily practice of HCPs. Methods: A multimethods design was used to investigate how HCPs experience working with the app and how they perceive the feasibility of the app in their daily practice. The feasibility areas described by Bowen et al were used for guidance. HCPs were observed while performing tasks in the app and asked to think aloud. The System Usability Scale was used to investigate the usability of the app, and semistructured interviews were conducted to explore the feasibility of the app. The study was conducted in primary, secondary, and tertiary care settings in the Netherlands from February 2019 to September 2019. Results: In total, 14 HCPs participated in this study—8 nurses, 5 physicians, and 1 physician assistant. The HCPs found the app acceptable to use. The expected key benefits of the app were an increased insight into patient symptoms, more structured patient conversations, and more tailored self-management support. The app especially fits within the available time and workflow of nurses. The use of the app will be influenced by the autonomy of the professional, the focus of the organization on eHealth, costs associated with the app, and compatibility with the current systems used. Most HCPs expressed that there are conditions that must be met to be able to use the app. The app can be integrated into the existing care paths of primary, secondary, and tertiary health care settings. Individual organizational factors must be taken into account when integrating the app into daily practice. Conclusions: This early-stage feasibility study shows that the Copilot app is feasible to use in the daily practice of HCPs and can be integrated into primary, secondary, and tertiary health care settings in the Netherlands. The app was considered to best fit the role of the nurses. The app will be less feasible for those organizations in which many conditions need to be met to use the app. This study provides a new approach to evaluate the perceived feasibility of mHealth interventions at an early stage and provides valuable insights for further feasibility testing. %M 33211013 %R 10.2196/21577 %U http://formative.jmir.org/2020/11/e21577/ %U https://doi.org/10.2196/21577 %U http://www.ncbi.nlm.nih.gov/pubmed/33211013 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18565 %T Integrating a Web-Based Self-Management Tool (Managing Joint Pain on the Web and Through Resources) for People With Osteoarthritis-Related Joint Pain With a Web-Based Social Network Support Tool (Generating Engagement in Network Involvement): Design, Development, and Early Evaluation %A Clarkson,Paul %A Vassilev,Ivaylo %A Rogers,Anne %A Brooks,Charlotte %A Wilson,Nicky %A Lawson,Jem %A Adams,Jo %+ NIHR ARC Wessex, Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, School of Health Sciences, University of Southampton, Building 67 (Nightingale), University Road, Southampton, SO17 1BJ, United Kingdom, 44 02380 597909, p.d.clarkson@soton.ac.uk %K joint pain %K osteoarthritis %K internet %K self-management %K social networks %D 2020 %7 26.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Joint pain caused by osteoarthritis (OA) is highly prevalent and can be extremely debilitating. Programs to support self-management of joint pain can be effective; however, most programs are designed to build self-efficacy and rarely engage social networks. Digital interventions are considered acceptable by people with joint pain. However, many existing resources are not accessible for or developed alongside people with lower health literacy, which disproportionately affects people with OA. Objective: This study aims to design and develop an accessible digital self-management tool for people with joint pain and integrate this with an existing social network activation tool (Generating Engagement in Network Involvement [GENIE]) and to explore the feasibility of these linked tools for supporting the management of joint pain. Methods: The study was conducted in 2 phases: a design and development stage and a small-scale evaluation. The first phase followed the person-based approach to establish guiding principles for the development of a new site (Managing joint Pain On the Web and through Resources [EMPOWER]) and its integration with GENIE. People with joint pain were recruited from libraries, a community café, and an exercise scheme to take part in 3 focus groups. EMPOWER was tested and refined using think-aloud interviews (n=6). In the second phase, participants were recruited through the web via libraries to participate in a small-scale evaluation using the LifeGuide platform to record use over a 1-month period. Participants (n=6) were asked to complete evaluation questionnaires on their experiences. The NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework was used to explore the feasibility of the sites. Results: The focus groups established guiding principles for the development of the tool. These included ensuring accessibility and relevance for people with OA-related joint pain and recognizing that joint pain is the reason for seeking support, trust, social facilitation, and goal setting. Think-aloud interviews identified issues with user experience and site navigation and the need for professional input for referral and goal setting, confusion, and tensions over the role of GENIE and site connectivity. Participants expected the sites to be specific to their pain-related needs. EMPOWER was accessed 18 times; 6 users registered with the site during the evaluation study. Participants mostly explored information pages on being active and being a healthy weight. Only one participant undertook goal setting and 4 participants visited the GENIE website. Conclusions: Using the NASSS framework, we identified the complexity associated with integrating EMPOWER and GENIE. The value proposition domain highlighted the technical and conceptual complexity associated with integrating approaches. Although identified as theoretically achievable, the integration of differing propositions may have caused cognitive and practical burdens for users. Nevertheless, we believe that both approaches have a distinct role in the self-management of joint pain. %M 33242011 %R 10.2196/18565 %U http://formative.jmir.org/2020/11/e18565/ %U https://doi.org/10.2196/18565 %U http://www.ncbi.nlm.nih.gov/pubmed/33242011 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18567 %T Surveillance of Cardiovascular Risk Factors in the Fifth Military Sector Health Center, Ngaoundéré, Cameroon: Observational Study %A Bell Ngan,Williams %A Essama Eno Belinga,Lawrence %A Essam Nlo'o,Alain Serges Patrick %A Roche,Frederic %A Goethals,Luc %A Mandengue,Samuel Honoré %A Bongue,Bienvenu %+ Autonomic Nervous System Research Laboratory, University of Jean Monnet, 10 rue tréfilerie, Saint-Etienne, France, 33 0681021199, bienvenu.bongue@cetaf.fr %K prevention %K noncommunicable disease %K cardiovascular diseases %K cardiovascular risk %K soldiers %D 2020 %7 26.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Noncommunicable diseases (NCDs) are the leading causes of death worldwide. They were responsible for 40 million of the 57 million deaths recorded worldwide in 2016. In Cameroon, epidemiological studies have been devoted to NCDs and their risk factors. However, none provides specific information on their extent or the distribution of their risk factors within the Cameroonian defense forces. Objective: The objective of our study was to assess the cardiovascular risk of a Cameroonian military population compared with that of its neighboring civilian population. Methods: We conducted a cross-sectional study that involved subjects aged 18 to 58 years, recruited from October 2017 to November 2018 at the Fifth Military Sector Health Center in Ngaoundéré, Cameroon. Data collection and assessment were done according to the World Health Organization (WHO)’s STEPS manual for surveillance of risk factors for chronic NCDs and the Alcohol Use Disorders Identification Test. Five cardiovascular risk factors were assessed: smoking, harmful alcohol consumption, obesity/overweight, hypertension, and diabetes. The risk was considered high in subjects with 3 or more of the factors. Univariate analysis and multivariate logistic regression were carried out according to their indications. Results: Our study sample of 566 participants included 295 soldiers and 271 civilians of the same age group (median age 32 years versus 33 years, respectively; P=.57). The military sample consisted of 31 officers and 264 noncommissioned officers (NCOs). Soldiers were more exposed to behavioral risk factors than civilians, with a prevalence of smoking of 13.9% versus 4.4% (P<.001) and excessive alcohol consumption of 61.7% versus 14.8% (P<.001). They also presented with a higher cardiovascular risk than civilians (odds ratio 2.7, 95% CI 1.50-4.81; P<.001), and among the military participants, the cardiovascular risk was higher for officers than for NCOs (51.6% versus 14.0%, respectively; P<.001). Conclusions: Cameroonian soldiers are particularly exposed to cardiovascular behavioral risk factors and consequently are at higher risk of NCDs. Trial Registration: ClinicalTrials.gov NCT04315441; https://clinicaltrials.gov/ct2/show/NCT04315441 %M 33242013 %R 10.2196/18567 %U http://formative.jmir.org/2020/11/e18567/ %U https://doi.org/10.2196/18567 %U http://www.ncbi.nlm.nih.gov/pubmed/33242013 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e22756 %T Informing the Development of a Digital Health Platform Through Universal Points of Care: Qualitative Survey Study %A Craven,Michael P %A Andrews,Jacob A %A Lang,Alexandra R %A Simblett,Sara K %A Bruce,Stuart %A Thorpe,Sarah %A Wykes,Til %A Morriss,Richard %A Hollis,Chris %A , %+ Division of Psychiatry and Applied Psychology, Institute of Mental Health, School of Medicine, University of Nottingham, Mindtech, Institute of Mental Health, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 0115 7484 218, jacob.andrews@nottingham.ac.uk %K epilepsy %K multiple sclerosis %K depression %K wearable electronic devices %K remote sensing technology %K health personnel %K mobile phones %K mHealth %K eHealth %D 2020 %7 26.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Epilepsy, multiple sclerosis (MS), and depression are chronic conditions where technology holds potential in clinical monitoring and self-management. Over 5 years, the Remote Assessment of Disease and Relapse - Central Nervous System (RADAR-CNS) consortium has explored the application of remote measurement technology (RMT) to the management and self-management of patients in these clinical areas. The consortium is large and includes clinical and nonclinical researchers as well as a patient advisory board. Objective: This formative development study aimed to understand how consortium members viewed the potential of RMT in epilepsy, MS, and depression. Methods: In this qualitative survey study, we developed a methodological tool, universal points of care (UPOC), to gather views on the potential use, acceptance, and value of a novel RMT platform across 3 chronic conditions (MS, epilepsy, and depression). UPOC builds upon use case scenario methodology, using expert elicitation and analysis of care pathways to develop scenarios applicable across multiple conditions. After developing scenarios, we elicited views on the potential of RMT in these different scenarios through a survey administered to 28 subject matter experts, consisting of 16 health care practitioners; 5 health care services researchers; and 7 people with lived experience of MS, epilepsy, or depression. Survey results were analyzed thematically and using an existing framework of factors describing links between design and context. Results: The survey elicited potential beneficial applications of the RADAR-CNS RMT system as well as patient, clinical, and nonclinical requirements of RMT across the 3 conditions of interest. Potential applications included recognition of early warning signs of relapse from subclinical signals for MS, seizure precipitant signals for epilepsy, and behavior change in depression. RMT was also thought to have the potential to overcome the problem of underreporting, which is especially problematic in epilepsy, and to allow the capture of secondary symptoms that are not generally collected in MS, such as mood. Conclusions: Respondents suggested novel and unanticipated uses of RMT, including the use of RMT to detect emerging side effects of treatment, enable behavior change for sleep regulation and activity, and offer a way to include family and other carers in a care network, which could assist with goal setting. These suggestions, together with others from this and related work, will inform the development of the system for its eventual application in research and clinical practice. The UPOC methodology was effective in directing respondents to consider the value of health care technologies in condition-specific experiences of everyday life and working practice. %M 33242009 %R 10.2196/22756 %U http://formative.jmir.org/2020/11/e22756/ %U https://doi.org/10.2196/22756 %U http://www.ncbi.nlm.nih.gov/pubmed/33242009 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e14787 %T Smartphone and App Usage in Orthopedics and Trauma Surgery: Survey Study of Physicians Regarding Acceptance, Risks, and Future Prospects in Germany %A Dittrich,Florian %A Back,David Alexander %A Harren,Anna Katharina %A Landgraeber,Stefan %A Reinecke,Felix %A Serong,Sebastian %A Beck,Sascha %+ Department for Orthopaedics and Orthopaedic Surgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Kirrbergerstraße 100, Building 37, Homburg, 66421, Germany, 49 68411624520, Florian.Dittrich@uks.eu %K mHealth %K smartphone %K communication %K medicine %K surveys and questionnaires %K technology %K orthopedics %K trauma surgery %D 2020 %7 30.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: In the course of digitization, smartphones are affecting an increasing number of areas of users’ lives, giving them almost ubiquitous access to the internet and other web applications. Mobile health (mHealth) has become an integral part of some areas of patient care. In contrast to other disciplines, routine integration of mobile devices in orthopedics and trauma surgery in Germany is still in its infancy. Objective: This study aimed to investigate physicians’ current state of opinion regarding acceptance, future prospects, and risks of medical apps in the field of orthopedics and trauma surgery in Germany. Methods: A web-based survey among orthopedics and trauma surgeons in German university hospitals on the use of medical apps in everyday clinical practice was conducted between September 2018 and February 2019. The survey consisted of 13 open- and closed-ended or multiple-choice questions. A logistic regression analysis was performed to ascertain the effects of interindividual characteristics on the likelihood of participants’ app and smartphone usage behavior. Results: A total of 206 physicians participated in the survey. All of the participants (206/206, 100%) owned a smartphone, and 79.1% (159/201) used the device, while 64.7% (130/201) used apps regularly in everyday clinical practice. Medical apps were perceived as beneficial, given their substantial future promise, by 90.1% (181/201) of the participants. However, 62.5% (120/192) of the participants were not satisfied with the current supply of medical apps in app stores. Desired specifications for future apps were “intuitive usability” (167/201, 83.1%), “no advertising” (145/201, 72.1%), and “free apps” (92/201, 45.8%). The attributes “transparent app development and app sponsoring” (75/201, 37.3%) and the existence of an “easy-to-understand privacy statement” (50/201, 24.9%) were of minor relevance. The majority of the participants (162/194, 83.5%) considered that future apps in the field of “medical research” would provide the greatest benefit. The greatest predicted risks were “data misuse” (147/189, 77.8%), “usage of untrustworthy apps” (135/189, 71.4%), and “alienation from patients” (51/189, 27.0%). Increasing age was significantly associated with a reduction in the likelihood of regular smartphone (odds ratio [OR] 0.91, 95% CI 0.86-0.97; P=.002) and app (OR 0.90, 95% CI 0.85-0.96; P=.001) usage, while the medical profession grade had no significant impact on the usage behavior. Conclusions: The study demonstrates that young German doctors in orthopedics and trauma surgery already use smartphones and apps in everyday clinical practice. Medical apps are considered to play an important role in the future. However, a significant discrepancy exists between the supply and demand of mHealth applications, which creates a legal and ethical vacuum with regard to data protection. %M 33252340 %R 10.2196/14787 %U http://formative.jmir.org/2020/11/e14787/ %U https://doi.org/10.2196/14787 %U http://www.ncbi.nlm.nih.gov/pubmed/33252340 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e22507 %T Development of a Web-Based Acceptance and Commitment Therapy Intervention to Support Lifestyle Behavior Change and Well-Being in Health Care Staff: Participatory Design Study %A Brown,Menna %A Hooper,Nic %A Eslambolchilar,Parisa %A John,Ann %+ Swansea University Medical School, Swansea University, Singleton Park Campus, Data Science Building, Floor 3, Swansea, SA2 8PP, United Kingdom, 44 1792 606312, menna.brown@swansea.ac.uk %K participatory design %K eMental health %K engagement %K acceptance and commitment therapy %D 2020 %7 30.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Positive emotional well-being is associated with healthier lifestyle choices and overall health function, whereas poor mental health is associated with significant economic and psychological costs. Thus, the development of effective interventions that improve emotional well-being is crucial to address the worldwide burden of disease. Objective: This study aims to develop a web-based emotional well-being intervention for use by health care staff using participatory design to consider adherence and engagement from a user perspective. Methods: A 3-staged iterative participatory design process was followed, including multiple stakeholders: researchers, computer scientists, mental health experts, and health care staff. Stage 1 used document analyses, direct observation, and welcome interviews; stage 2 used focus group discussions, rapid prototyping, and usability tasks; and stage 3 evaluated a high-fidelity prototype. Results: Different health care staff (N=38) participated during a sustained period. A structured, sequential, automated, 12-week, web-based emotional well-being intervention based on acceptance and commitment therapy was developed. Freely navigated psychoeducational resources were also included. Conclusions: The iterative and collaborative participatory design process successfully met its objectives. It generated an in-depth understanding of well-being within the workplace and identified barriers to access. The 3-staged process ensured that participants had the opportunity to explore and articulate criteria relevant to their roles over time and reflect on decisions made at each stage. %M 33252350 %R 10.2196/22507 %U https://formative.jmir.org/2020/11/e22507 %U https://doi.org/10.2196/22507 %U http://www.ncbi.nlm.nih.gov/pubmed/33252350 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e24798 %T Evolution of Bystander Intention to Perform Resuscitation Since Last Training: Web-Based Survey %A Regard,Simon %A Rosa,Django %A Suppan,Mélanie %A Giangaspero,Chiara %A Larribau,Robert %A Niquille,Marc %A Sarasin,François %A Suppan,Laurent %+ Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, Geneva, 1205, Switzerland, 41 795532579, laurent.suppan@hcuge.ch %K out-of-hospital cardiac arrest %K cardiopulmonary resuscitation %K basic life support %K confidence %K first aid %K bystander %K behavior %K cardiac arrest %K heart attack %K intention %K resuscitation %K survey %K attitude %K belief %D 2020 %7 30.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Victims of out-of-hospital cardiac arrest (OHCA) have higher survival rates and more favorable neurological outcomes when basic life support (BLS) maneuvers are initiated quickly after collapse. Although more than half of OHCAs are witnessed, BLS is infrequently provided, thereby worsening the survival and neurological prognoses of OHCA victims. According to the theory of planned behavior, the probability of executing an action is strongly linked to the intention of performing it. This intention is determined by three distinct dimensions: attitude, subjective normative beliefs, and control beliefs. We hypothesized that there could be a decrease in one or more of these dimensions even shortly after the last BLS training session. Objective: The aim of this study was to measure the variation of the three dimensions of the intention to perform resuscitation according to the time elapsed since the last first-aid course. Methods: Between January and April 2019, the two largest companies delivering first-aid courses in the region of Geneva, Switzerland sent invitation emails on our behalf to people who had followed a first-aid course between January 2014 and December 2018. Participants were asked to answer a set of 17 psychometric questions based on a 4-point Likert scale (“I don’t agree,” “I partially agree,” “I agree,” and “I totally agree”) designed to assess the three dimensions of the intention to perform resuscitation. The primary outcome was the difference in each of these dimensions between participants who had followed a first-aid course less than 6 months before taking the questionnaire and those who took the questionnaire more than 6 months and up to 5 years after following such a course. Secondary outcomes were the change in each dimension using cutoffs at 1 year and 2 years, and the change regarding each individual question using cutoffs at 6 months, 1 year, and 2 years. Univariate and multivariable linear regression were used for analyses. Results: A total of 204 surveys (76%) were analyzed. After adjustment, control beliefs was the only dimension that was significantly lower in participants who took the questionnaire more than 6 months after their last BLS course (P<.001). Resisting diffusion of responsibility, a key element of subjective normative beliefs, was also less likely in this group (P=.001). By contrast, members of this group were less afraid of disease transmission (P=.03). However, fear of legal action was higher in this group (P=.02). Conclusions: Control beliefs already show a significant decrease 6 months after the last first-aid course. Short interventions should be designed to restore this dimension to its immediate postcourse state. This could enhance the provision of BLS maneuvers in cases of OHCA. %M 33252342 %R 10.2196/24798 %U http://formative.jmir.org/2020/11/e24798/ %U https://doi.org/10.2196/24798 %U http://www.ncbi.nlm.nih.gov/pubmed/33252342 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18555 %T Multilingual Global E-Learning Pediatric Endocrinology and Diabetes Curriculum for Front Line Health Care Providers in Resource-Limited Countries: Development Study %A Kalaitzoglou,Evangelia %A Majaliwa,Edna %A Zacharin,Margaret %A de Beaufort,Carine %A Chanoine,Jean-Pierre %A van Wijngaard-DeVugt,Conny %A Sperla,Ervin %A Boot,Annemieke M %A Drop,Stenvert L S %+ Department of Pediatrics, Barnstable Brown Diabetes Center, University of Kentucky, 2195 Harrodsburg Rd, Suite 125, Lexington, KY, 40504, United States, 1 859 218 6641, evangelia.kalaitzoglou@uky.edu %K pediatric endocrinology %K diabetes mellitus %K e-learning %K online learning %K continuing education %K resource-limited country %K multilingual medical education %D 2020 %7 5.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic learning (e-learning) is a widely accessible, low-cost option for learning remotely in various settings that allows interaction between an instructor and a learner. Objective: We describe the development of a free and globally accessible multilingual e-learning module that provides education material on topics in pediatric endocrinology and diabetes and that is intended for first-line physicians and health workers but also trainees or medical specialists in resource-limited countries. Methods: As complements to concise chapters, interactive vignettes were constructed, exemplifying clinical issues and pitfalls, with specific attention to the 3 levels of medical health care in resource-limited countries. The module is part of a large e-learning portal, ESPE e-learning, which is based on ILIAS (Integriertes Lern-, Informations- und Arbeitskooperations-System), an open-source web-based learning management system. Following a review by global experts, the content was translated by native French, Spanish, Swahili, and Chinese–speaking colleagues into their respective languages using a commercial web-based translation tool (SDL Trados Studio). Results: Preliminary data suggest that the module is well received, particularly in targeted parts of the world and that active promotion to inform target users is warranted. Conclusions: The e-learning module is a free globally accessible multilingual up-to-date tool for use in resource-limited countries that has been utilized thus far with success. Widespread use will require dissemination of the tool on a global scale. %M 33151156 %R 10.2196/18555 %U https://formative.jmir.org/2020/11/e18555 %U https://doi.org/10.2196/18555 %U http://www.ncbi.nlm.nih.gov/pubmed/33151156 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e24169 %T Arabic Translation of the Weight Self-Stigma Questionnaire: Instrument Validation Study of Factor Structure and Reliability %A BinDhim,Nasser F %A Althumiri,Nora A %A Basyouni,Mada H %A Sims,Omar T %A Alhusseini,Noara %A Alqahtani,Saleh A %+ Sharik Association for Health Research, 4 anas ibn malik Rd, Riyadh, 11778, Saudi Arabia, 966 580033299, nd@nasserdhim.com %K overweight %K stigma %K weight self-stigma %K Weight Self-Stigma Questionnaire %K obesity %K Saudi Arabia %K questionnaire %K validation %K reliability %K validity %D 2020 %7 13.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: While it is most often associated with its effects on physical health, obesity is also associated with serious self-stigmatization. The lack of a suitable, validated tool to measure weight-related self-stigma in Arabic countries may be partly responsible for the scarcity of literature about this problem. Objective: This study investigated the reliability and validity of an Arabic version of the Weight Self-Stigma Questionnaire (WSSQ). Methods: Data on the Arabic-translated version of the 12-item WSSQ were collected using two cross-sectional electronic questionnaires distributed among Saudi nationals through the Sharik Association for Health Research’s database in June 2020. Internal consistency, test-retest reliability, and exploratory factor analysis of the Arabic WSSQ were assessed and compared with the original English version and other translations. Results: For reliability analysis, 43 participants completed the Arabic WSSQ during two time periods. Internal consistency was α=.898 for the overall survey, α=.819 for the fear of enacted stigma subscale (factor 1), and α=.847 for the self-devaluation subscale (factor 2). The test-retest reliability of the intraclass correlation coefficient was α=.982. In the factor structure analysis, 295 participants completed the questionnaire. The Arabic WSSQ loading of the items was consistent with the original WSSQ, except for the loading of item 9, which was stronger in factor 2 than in factor 1. The two factors accounted for the observed variances of 47.7% and 10.6%. Conclusions: The Arabic version of the WSSQ has good internal consistency and reliability, and the factorial structure is similar to that of the original WSSQ. The Arabic WSSQ is adaptable for clinicians seeking to assess weight-related self-stigma in Arabic-speaking people. %M 33185558 %R 10.2196/24169 %U http://formative.jmir.org/2020/11/e24169/ %U https://doi.org/10.2196/24169 %U http://www.ncbi.nlm.nih.gov/pubmed/33185558 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e21995 %T Consumers’ Intentions to Adopt Blockchain-Based Personal Health Records and Data Sharing: Focus Group Study %A Lu,Chang %A Batista,Danielle %A Hamouda,Hoda %A Lemieux,Victoria %+ Blockchain@UBC, University of British Columbia, 179 - 2366 Main Mall, Vancouver, BC, V6T 1Z4, Canada, chang.lu@ubc.ca %K blockchain %K personal health record %K health data sharing %K consumers’ intentions to adopt %K focus group study %K microinterlocutor analysis %D 2020 %7 5.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Although researchers are giving increased attention to blockchain-based personal health records (PHRs) and data sharing, the majority of research focuses on technical design. Very little is known about health care consumers’ intentions to adopt the applications. Objective: This study aims to explore the intentions and concerns of health care consumers regarding the adoption of blockchain-based personal health records and data sharing. Methods: Three focus groups were conducted, in which 26 participants were shown a prototype of a user interface for a self-sovereign blockchain-based PHR system (ie, a system in which the individual owns, has custody of, and controls access to their personal health information) to be used for privacy and secure health data sharing. A microinterlocutor analysis of focus group transcriptions was performed to show a descriptive overview of participant responses. NVivo 12.0 was used to code the categories of the responses. Results: Participants did not exhibit a substantial increase in their willingness to become owners of health data and share the data with third parties after the blockchain solution was introduced. Participants were concerned about the risks of losing private keys, the resulting difficulty in accessing care, and the irrevocability of data access on blockchain. They did, however, favor a blockchain-based PHR that incorporates a private key recovery system and offers a health wallet hosted by government or other positively perceived organizations. They were more inclined to share data via blockchain if the third party used the data for collective good and offered participants nonmonetary forms of compensation and if the access could be revoked from the third party. Conclusions: Health care consumers were not strongly inclined to adopt blockchain-based PHRs and health data sharing. However, their intentions may increase when the concerns and recommendations demonstrated in this study are considered in application design. %M 33151149 %R 10.2196/21995 %U http://formative.jmir.org/2020/11/e21995/ %U https://doi.org/10.2196/21995 %U http://www.ncbi.nlm.nih.gov/pubmed/33151149 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 11 %P e18982 %T Adaptation and Evaluation of a Symptom-Monitoring Digital Health Intervention for Patients With Relapsed and Refractory Multiple Myeloma: Pilot Mixed-Methods Implementation Study %A Biran,Noa %A Anthony Kouyaté,Robin %A Yucel,Emre %A McGovern,Gillian E %A Schoenthaler,Antoinette M %A Durling,Olivia G %A Unawane,Rashmi %A Schutt,Andrew %A Panjabi,Sumeet %+ Division of Multiple Myeloma, John Theurer Cancer Center, Hackensack University Medical Center, 92 Second Street, Hackensack, NJ, 07601, United States, 1 551 996 8704, Noa.Biran@hackensackmeridian.org %K mHealth %K digital health %K electronic patient-reported outcome %K ePRO %K patient-reported outcome %K PRO %K mobile %K app %K implementation science %K multiple myeloma %K relapsed refractory multiple myeloma %D 2020 %7 17.11.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Relapsed and refractory multiple myeloma (RRMM) is a bone marrow cancer that requires systemic treatment, which often results in severe symptom burden. Recent studies have found that electronic patient-reported outcome (ePRO) interventions implemented in the clinic setting have had positive outcomes for other oncology populations. Evidence of the efficacy of a similar approach is lacking for patients with RRMM. Objective: Recent recommendations for digital health interventions call for the publication of descriptions of iterative development processes in order to improve reproducibility and comparability. This study is an implementation pilot aiming to evaluate the acceptability and appropriateness of an ePRO intervention for patients with RRMM and to explore its impact on clinic workflow. Methods: A total of 11 patients with RRMM were recruited from the John Theurer Cancer Center in Hackensack, New Jersey. Patients used a mobile app to report on 17 symptoms at 4 sessions, each a week apart. Patients could also report symptoms ad hoc. When reports met predefined thresholds, the clinic was alerted and patients received automated guidance. Study end points were assessed using qualitative and quantitative methods. Results: A total of 9 patients (mean age 69.7 years) completed the study. Overall, 83% (30/36) of weekly sessions were completed. Patients found the frequency and time required to complete reporting acceptable. All patients agreed that the app was easy to use and understand. Providers felt the alerts they received required refinement. Patients and providers agreed it would be beneficial for patients to report for longer than 4 weeks. Patients felt that the training they received was adequate but contained too much information for a single session. All patients found the symptoms tracked to be appropriate; providers suggested shortening the list. All patients understood how to use the app for weekly reporting but had confusion about using it ad hoc. Providers felt the ad hoc feature could be removed. Neither patients nor providers viewed the in-app data reports but agreed on their potential value. Patients reported benefitting from symptom reporting through increased awareness of their symptoms. Clinic staff reported that app alerts were too numerous and redundant. They had difficulty responding to alerts within their existing workflow, partially because the data were not integrated into the electronic medical record system. Conclusions: Overall, the intervention was found to be acceptable and appropriate for patients with RRMM. Points of friction integrating the intervention into the clinic workflow were identified. Clinic staff provided recommendations for addressing these issues. Once such modifications are implemented, ePRO data from patients with RRMM could be used to inform and improve clinical research and care. This study underlines the importance of an iterative approach to implementation that includes all stakeholders in order to ensure successful adoption. %M 33200997 %R 10.2196/18982 %U http://formative.jmir.org/2020/11/e18982/ %U https://doi.org/10.2196/18982 %U http://www.ncbi.nlm.nih.gov/pubmed/33200997