TY - JOUR AU - Kautsar, Prawira Angga AU - Sinuraya, Kurnia Rano AU - van der Schans, Jurjen AU - Postma, Jacobus Maarten AU - Suwantika, A. Auliya PY - 2025/3/27 TI - Exploring Public Sentiment on the Repurposing of Ivermectin for COVID-19 Treatment: Cross-Sectional Study Using Twitter Data JO - JMIR Form Res SP - e50536 VL - 9 KW - COVID-19 KW - ivermectin KW - sentiment analysis KW - Twitter KW - social media KW - public health KW - misinformation KW - geolocation analysis UR - https://formative.jmir.org/2025/1/e50536 UR - http://dx.doi.org/10.2196/50536 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50536 ER - TY - JOUR AU - Li, Mingyan AU - Sun, Changxuan AU - Ji, Chai AU - Gao, Meiying AU - Wang, Xia AU - Yao, Dan AU - Guo, Junxia AU - Sun, Lidan AU - Rafay, Abdul AU - George, Shereen Antonita AU - Muhandiramge, Samararathna Sanduni Hasara Samararathna AU - Bai, Guannan PY - 2025/3/26 TI - Vaccine Hesitancy and Associated Factors Among Caregivers of Children With Special Health Care Needs in the COVID-19 Era in China: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e67487 VL - 11 KW - COVID-19 KW - caregivers KW - children with special health care needs KW - vaccination hesitancy KW - decision-making N2 - Background: Immunization is a cost-effective way to prevent infectious diseases in children, but parental hesitancy leads to low vaccination rates, leaving children at risk. Caregivers of children with special health care needs are more hesitant about vaccines than those of healthy children. Objective: The aim of the study is to investigate the changes in caregivers? vaccination hesitation of children with special health care needs before, during, and after the COVID-19 pandemic in China and to identify associated factors for caregivers? attitudes toward National Immunization Program (NIP) and non-NIP vaccines. Methods: We included 7770 caregivers of children with special health care needs (median age 7.0, IQR 2.4-24.1 months) who visited the Vaccination Consultation Clinic at Children?s Hospital, Zhejiang University School of Medicine (Hangzhou, China) from May 2017 to May 2023. General and clinical information was extracted from the immunization evaluation system for children with special health care needs and medical records. We compared the differences in caregivers? willingness and hesitation for vaccinating their children across the 3 stages of the COVID-19 pandemic using chi-square tests. Multinomial logistic regression models were used to identify independent variables that were associated with caregivers? willingness and hesitation toward NIP and non-NIP vaccines. Results: There is a statistically significant difference in caregivers? vaccine hesitancy before, during, and after the COVID-19 pandemic (P<.05). During the COVID-19 pandemic, the percentages of choosing NIP, alternative non-NIP, and non-NIP vaccines are highest (n=1428, 26%, n=3148, 57.4%, and n=3442, 62.7%, respectively) than those at other 2 stages. In comparison, caregivers? hesitation toward NIP and non-NIP vaccines is lowest (n=911, 16.6% and n=2045, 37.3%, respectively). Despite the stages of the COVID-19 pandemic, multiple factors, including children?s age and sex, parents? educational level, comorbidities, and history of allergy, were significantly associated with caregivers? attitude toward NIP and non-NIP vaccines (P<.05). The profiles of risk factors for hesitancy toward NIP and non-NIP vaccines are different, as indicated by the results from the logistic regression models. Conclusions: This study demonstrated that caregivers? willingness to vaccinate their children with special health care needs with NIP and non-NIP vaccines was highest during the COVID-19 pandemic in China, and their hesitancy was lowest. Additionally, we have identified multiple factors associated with caregivers? willingness and hesitancy to vaccinate their children. These findings provide evidence-based support for developing personalized health education strategies. UR - https://publichealth.jmir.org/2025/1/e67487 UR - http://dx.doi.org/10.2196/67487 ID - info:doi/10.2196/67487 ER - TY - JOUR AU - Senathirajah, Yalini AU - Kaufman, R. David AU - Cato, Kenrick AU - Daniel, Pia AU - Roblin, Patricia AU - Kushniruk, Andre AU - Borycki, M. Elizabeth AU - Feld, Emanuel AU - Debi, Poli PY - 2025/3/26 TI - The Impact of the Burden of COVID-19 Regulatory Reporting in a Small Independent Hospital and a Large Network Hospital: Comparative Mixed Methods Study JO - Online J Public Health Inform SP - e63681 VL - 17 KW - regulatory reporting KW - human factors KW - reporting burden KW - emergency response KW - COVID-19 KW - hospital resilience KW - pandemic response N2 - Background: During the COVID-19 pandemic in 2020, hospitals encountered numerous challenges that compounded their difficulties. Some of these challenges directly impacted patient care, such as the need to expand capacities, adjust services, and use new knowledge to save lives in an ever-evolving situation. In addition, hospitals faced regulatory challenges. Objective: This paper presents the findings of a qualitative study that aimed to compare the effects of reporting requirements on a small independent hospital and a large network hospital during the COVID-19 pandemic. Methods: We used both quantitative and qualitative analyses and conducted 51 interviews, which were thematically analyzed. We quantified the changes in regulatory reporting requirements during the first 14 months of the pandemic. Results: Reporting requirements placed a substantial time burden on key clinical personnel at the small independent hospital, consequently reducing the time available for patient care. Conversely, the large network hospital had dedicated nonclinical staff responsible for reporting duties, and their robust health information system facilitated this work. Conclusions: The discrepancy in health IT capabilities suggests that there may be significant institutional inequities affecting smaller hospitals? ability to respond to a pandemic and adequately support public health efforts. Electronic certification guidelines are essential to addressing the substantial equity issues. We discuss in detail the health care policy implications of these findings. UR - https://ojphi.jmir.org/2025/1/e63681 UR - http://dx.doi.org/10.2196/63681 UR - http://www.ncbi.nlm.nih.gov/pubmed/40137048 ID - info:doi/10.2196/63681 ER - TY - JOUR AU - Kaur, Harleen AU - Sachdeva, Jyoti AU - Bawaskar, Ramesh AU - Goyal, Twinkle PY - 2025/3/19 TI - Comparative Evaluation of Effectiveness of Standard of Care Alone and in Combination With Homoeopathic Treatment in COVID-19?Related Rhino-Orbito-Cerebral Mucormycosis (ROCM): Protocol for a Single Blind, Randomized Controlled Trial JO - JMIR Res Protoc SP - e57905 VL - 14 KW - Rhino-orbital-cerebral mucormycosis, randomized controlled trial, homoeopathy, fungus, CE-MRI PNS mucormycosis KW - India KW - medical care KW - mortality rate KW - conventional therapy KW - ethical KW - mortality KW - survival KW - recovery KW - homoeopathic medicines KW - management N2 - Background: Rhino-orbital-cerebral mucormycosis (ROCM) is the most common (45%-74%) mucormycosis in India. With contemporary medical care, ROCM has a mortality rate of 40%-50% and 70% of survivors are left with residual defects. Recently, several cases of mucormycosis in people with COVID-19 have been increasingly reported worldwide, from India, due to immune dysregulation caused by SARS-CoV-2. To reduce the high mortality rate and residual defect in most survivors under the guidelines of the Ministry of AYUSH, the Government of India recommended homoeopathy as an add-on therapy to maximize the effectiveness of standard treatment in conventional therapy. Objective: This study aimed to evaluate the role of existing homoeopathic treatment as an adjuvant therapy in patients with COVID-19?related ROCM and enhancing the survival of the patients hospitalized due to COVID-19 infection and to access the initial treatment response and duration required for significant or complete recovery in patients receiving adjuvant treatment. Methods: This superiority, randomized controlled clinical trial would include two parallel comparator groups A and B. Group A would be the experimental group and would receive homoeopathic treatment along with the standard line of treatment as per investigational medicinal product (IMP) and group B would be the control arm and would receive standard line of treatment as per IMP along with identical placebo. Allocation would be 1:1 through randomization. Based on the inclusion and exclusion criteria, 36 participants per arm would be screened. Participants would be assessed clinically twice a day and magnetic resonance imagery or endoscopy cum-biopsy would be assessed on days 1, 14, and 28. Laboratory investigations may vary as per demand of disease conditions. Results: In India, the COVID-19 pandemic, particularly during the second wave, resulted in a surge of mucormycosis cases among patients with COVID-19. At the time this protocol was being developed, there was a significant spike in mucormycosis cases in India, particularly in Mumbai (June 2021). However, by the time the Central Council for Research in Homoeopathy obtained the necessary approvals and ethical clearance for the study, the incidence of mucormycosis had drastically declined (September 2021). As a result, the study was not initiated and registered. The authors feel it is their ethical responsibility to share the reviewed protocol with the medical community as a reference for future work. Conclusions: This study aims to evaluate the role of existing homoeopathic medicines as an adjuvant therapy in managing COVID-19?related ROCM, potentially contributing to the use of homoeopathy as an evidence-based medical approach. The protocol can also serve as a valuable resource for clinicians and researchers addressing mucormycosis cases unrelated to COVID-19, particularly in immunocompromised patients. It would help ensure preparedness, whether or not sufficient evidence is available, in the event of a future health emergency. International Registered Report Identifier (IRRID): PRR1-10.2196/57905 UR - https://www.researchprotocols.org/2025/1/e57905 UR - http://dx.doi.org/10.2196/57905 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57905 ER - TY - JOUR AU - Parveen, Sana AU - Pereira, Garcia Agustin AU - Garzon-Orjuela, Nathaly AU - McHugh, Patricia AU - Surendran, Aswathi AU - Vornhagen, Heike AU - Vellinga, Akke PY - 2025/3/19 TI - COVID-19 Public Health Communication on X (Formerly Twitter): Cross-Sectional Study of Message Type, Sentiment, and Source JO - JMIR Form Res SP - e59687 VL - 9 KW - public health communication KW - surveillance KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - respiratory KW - infectious KW - pulmonary KW - pandemic KW - public health messaging KW - healthcare information KW - social media KW - tweets KW - text mining KW - data mining KW - social marketing KW - infoveillance KW - intervention planning N2 - Background: Social media can be used to quickly disseminate focused public health messages, increasing message reach and interaction with the public. Social media can also be an indicator of people?s emotions and concerns. Social media data text mining can be used for disease forecasting and understanding public awareness of health-related concerns. Limited studies explore the impact of type, sentiment and source of tweets on engagement. Thus, it is crucial to research how the general public reacts to various kinds of messages from different sources. Objective: The objective of this paper was to determine the association between message type, user (source) and sentiment of tweets and public engagement during the COVID-19 pandemic. Methods: For this study, 867,485 tweets were extracted from January 1, 2020 to March 31, 2022 from Ireland and the United Kingdom. A 4-step analytical process was undertaken, encompassing sentiment analysis, bio-classification (user), message classification and statistical analysis. A combination of manual content analysis with abductive coding and machine learning models were used to categorize sentiment, user category and message type for every tweet. A zero-inflated negative binomial model was applied to explore the most engaging content mix. Results: Our analysis resulted in 12 user categories, 6 message categories, and 3 sentiment classes. Personal stories and positive messages have the most engagement, even though not for every user group; known persons and influencers have the most engagement with humorous tweets. Health professionals receive more engagement with advocacy, personal stories/statements and humor-based tweets. Health institutes observe higher engagement with advocacy, personal stories/statements, and tweets with a positive sentiment. Personal stories/statements are not the most often tweeted category (22%) but have the highest engagement (27%). Messages centered on shock/disgust/fear-based (32%) have a 21% engagement. The frequency of informative/educational communications is high (33%) and their engagement is 16%. Advocacy message (8%) receive 9% engagement. Humor and opportunistic messages have engagements of 4% and 0.5% and low frequenciesof 5% and 1%, respectively. This study suggests the optimum mix of message type and sentiment that each user category should use to get more engagement. Conclusions: This study provides comprehensive insight into Twitter (rebranded as X in 2023) users? responses toward various message type and sources. Our study shows that audience engages with personal stories and positive messages the most. Our findings provide valuable guidance for social media-based public health campaigns in developing messages for maximum engagement. UR - https://formative.jmir.org/2025/1/e59687 UR - http://dx.doi.org/10.2196/59687 ID - info:doi/10.2196/59687 ER - TY - JOUR AU - Shao, Anqi AU - Chen, Kaiping AU - Johnson, Branden AU - Miranda, Shaila AU - Xing, Qidi PY - 2025/3/10 TI - Ubiquitous News Coverage and Its Varied Effects in Communicating Protective Behaviors to American Adults in Infectious Disease Outbreaks: Time-Series and Longitudinal Panel Study JO - J Med Internet Res SP - e64307 VL - 27 KW - risk communication KW - panel study KW - computational method KW - intermedia agenda setting KW - protective behaviors KW - infectious disease N2 - Background: Effective communication is essential for promoting preventive behaviors during infectious disease outbreaks like COVID-19. While consistent news can better inform the public about these health behaviors, the public may not adopt them. Objective: This study aims to explore the role of different media platforms in shaping public discourse on preventive measures to infectious diseases such as quarantine and vaccination, and how media exposure influences individuals? intentions to adopt these behaviors in the United States. Methods: This study uses data from 3 selected top national newspapers in the United States, Twitter discussions, and a US nationwide longitudinal panel survey from February 2020 to April 2021. We used the Intermedia Agenda-Setting Theory and the Protective Action Decision Model to develop the theoretical framework. Results: We found a 2-way agenda flow between selected national newspapers and the social media platform Twitter, particularly in controversial topics like vaccination (F1,426=16.39; P<.001 for newspapers; F1,426=44.46; P<.001 for Twitter). Exposure to media coverage increased individuals? perceived benefits of certain behaviors like vaccination but did not necessarily translate into behavioral adoption. For example, while individuals? media exposure increased perceived benefits of mask-wearing (?=.057; P<.001 for household benefits; ?=.049; P<.001 for community benefits), it was not consistently linked to higher intentions to wear masks (?=?.026; P=.04). Conclusions: This study integrates media flow across platforms with US national panel survey data, offering a comprehensive view of communication dynamics during the early stage of an infectious disease outbreak. The findings caution against a one-size-fits-all approach in communicating different preventive behaviors, especially where individual and community benefits may not always align. UR - https://www.jmir.org/2025/1/e64307 UR - http://dx.doi.org/10.2196/64307 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64307 ER - TY - JOUR AU - Biliotti, Carolina AU - Fraccaroli, Nicolò AU - Puliga, Michelangelo AU - Bargagli-Stoffi, J. Falco AU - Riccaboni, Massimo PY - 2025/3/4 TI - The Impact of Stay-At-Home Mandates on Uncertainty and Sentiments: Quasi-Experimental Study JO - J Med Internet Res SP - e64667 VL - 27 KW - lockdown policy KW - sentiment analysis KW - uncertainty KW - social media KW - quasi-experiment N2 - Background: As the spread of the SARS-CoV-2 virus coincided with lockdown measures, it is challenging to distinguish public reactions to lockdowns from responses to COVID-19 itself. Beyond the direct impact on health, lockdowns may have worsened public sentiment toward politics and the economy or even heightened dissatisfaction with health care, imposing a significant cost on both the public and policy makers. Objective: This study aims to analyze the causal effect of COVID-19 lockdown policies on various dimensions of sentiment and uncertainty, using the Italian lockdown of February 2020 as a quasi-experiment. At the time of implementation, communities inside and just outside the lockdown area were equally exposed to COVID-19, enabling a quasi-random distribution of the lockdown. Additionally, both areas had similar socioeconomic and demographic characteristics before the lockdown, suggesting that the delineation of the strict lockdown zone approximates a randomized experiment. This approach allows us to isolate the causal effects of the lockdown on public emotions, distinguishing the impact of the policy itself from changes driven by the virus?s spread. Methods: We used Twitter data (N=24,261), natural language models, and a difference-in-differences approach to compare changes in sentiment and uncertainty inside (n=1567) and outside (n=22,694) the lockdown areas before and after the lockdown began. By fine-tuning the AlBERTo (Italian BERT optimized) pretrained model, we analyzed emotions expressed in tweets from 1124 unique users. Additionally, we applied dictionary-based methods to categorize tweets into 4 dimensions?economy, health, politics, and lockdown policy?to assess the corresponding emotional reactions. This approach enabled us to measure the direct impact of local policies on public sentiment using geo-referenced social media and can be easily adapted for other policy impact analyses. Results: Our analysis shows that the lockdown had no significant effect on economic uncertainty (b=0.005, SE 0.007, t125=0.70; P=.48) or negative economic sentiment (b=?0.011, SE 0.0089, t125=?1.32; P=.19). However, it increased uncertainty about health (b=0.036, SE 0.0065, t125=5.55; P<.001) and lockdown policy (b=0.026, SE 0.006, t125=4.47; P<.001), as well as negative sentiment toward politics (b=0.025, SE 0.011, t125=2.33; P=.02), indicating that lockdowns have broad externalities beyond health. Our key findings are confirmed through a series of robustness checks. Conclusions: Our findings reveal that lockdowns have broad externalities extending beyond health. By heightening health concerns and negative political sentiment, policy makers have struggled to secure explicit public support for government measures, which may discourage future leaders from implementing timely stay-at-home policies. These results highlight the need for authorities to leverage such insights to enhance future policies and communication strategies, reducing uncertainty and mitigating social panic. UR - https://www.jmir.org/2025/1/e64667 UR - http://dx.doi.org/10.2196/64667 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053818 ID - info:doi/10.2196/64667 ER - TY - JOUR AU - Tan, Jin Rayner Kay AU - Hensel, Devon AU - Ivanova, Olena AU - Bravo, Gomez Raquel AU - Olumide, Adesola AU - Adebayo, Emmanuel AU - Cleeve, Amanda AU - Gesselman, Amanda AU - Shah, Jyoti Sonam AU - Adesoba, Helen AU - Marley, Gifty AU - Tang, Weiming PY - 2025/3/4 TI - Telemedicine Use During the COVID-19 Pandemic in 8 Countries From the International Sexual Health and Reproductive Health Consortium: Web-Based Cross-Sectional Survey Study JO - J Med Internet Res SP - e60369 VL - 27 KW - COVID-19 KW - telemedicine KW - sexual and reproductive health KW - pandemic KW - web-based survey KW - sexual health KW - reproductive health KW - communication technology KW - medical education KW - contraception KW - abortion KW - health care delivery KW - care KW - chronic condition N2 - Background: Telemedicine is an important way to fill in the access gap to in-person health care services during challenging times like pandemics. Objective: This study aimed to investigate the role that telemedicine played during the COVID-19 pandemic by multicountry comparison of the use of telemedicine prior to and during the pandemic. Methods: This study analyzes data from the second wave of the International Sexual Health and Reproductive Health study. This included data collected between April 2021 and July 2022 in 8 countries, including Armenia (n=296), Egypt (n=889), Germany (n=138), Moldova (n=311), Nigeria (n=205), Portugal (n=951), Singapore (n=13), and Spain (n=54). This study covered sociodemographics, sexual and reproductive health (SRH), and telemedicine use. Descriptive statistics and multilevel modeling were used to assess the factors influencing the use of telemedicine. Results: Overall, 2857 participants were recruited. Approximately 57.6% (n=1646) of participants had never used telemedicine prior to COVID-19 measures, while 45.9% (n=1311) of participants required health care but reported not using telemedicine services following the introduction of COVID-19 measures. In high-income countries, the most common mode reported was audio-based telemedicine services, with 283 (71.8%) and 417 (73.5%) participants doing so before and during COVID-19, respectively. This was followed by text-based telemedicine services, with 152 (38.6%) and 173 (30.5%) participants doing so before and during COVID-19, respectively. In low- to middle-income countries, many participants also reported using audio-based telemedicine services, with 288 (35.3%) and 237 (40.8%) participants doing so before and during COVID-19, respectively. This was followed by chat-based telemedicine services, with 265 (32.4%) and 217 (37.3%) participants doing so before and during COVID-19, respectively. Multilevel modeling revealed that those who were older (adjusted odds ratio [aOR] 0.99, 95% CI 0.99-1.00) and were in countries with a higher gross domestic product per capita (aOR 0.99, 95% CI 0.98-1.00) were less likely to have ever used telemedicine. Participants who were of male sex assigned at birth (aOR 0.79, 95% CI 0.65-0.96) were less likely to use telemedicine during the pandemic. Participants who perceived that they were worse off financially were more likely to have switched to telemedicine during COVID-19 (aOR 1.39, 95% CI 1.02-1.89) and were more likely to report having a poor or fair experience of telemedicine services (aOR 1.75, 95% CI 1.34-2.29). When sexual orientation was included in the model, nonheterosexual individuals were more likely to ever use telemedicine prior to COVID-19 (aOR 1.35, 95% CI 1.08-1.69), more likely to have used telemedicine during COVID-19 (aOR 1.58, 95% CI 1.24-2.02), and more likely to have switched to telemedicine during COVID-19 (aOR 1.55, 95% CI 1.09-2.21). Conclusions: Telemedicine played a key role in addressing health care needs during the COVID-19 pandemic. Age, sex, economic status, and sexual orientation influenced its use. UR - https://www.jmir.org/2025/1/e60369 UR - http://dx.doi.org/10.2196/60369 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053813 ID - info:doi/10.2196/60369 ER - TY - JOUR AU - Li, Yadi AU - Zhou, Jianlong AU - Wei, Zheng AU - Liang, Lizhu AU - Xu, Hualing AU - Lv, Caihong AU - Liu, Gang AU - Li, Wenlin AU - Wu, Xin AU - Xiao, Yunhui AU - Sunzi, Kejimu PY - 2025/3/3 TI - Efficacy and Safety of Acupuncture for Post?COVID-19 Insomnia: Protocol for a Systematic Review and Meta-Analysis JO - JMIR Res Protoc SP - e69417 VL - 14 KW - acupuncture KW - traditional Chinese medicine KW - post?COVID-19 condition KW - long COVID-19 KW - insomnia KW - sleep disorder KW - depression KW - complementary and alternative medicine KW - treatment KW - public health KW - study protocol KW - systematic review N2 - Background: The COVID-19 pandemic has had a profound global impact, leading to a range of persistent sequelae referred to as post?COVID-19 condition or ?long COVID? that continue to affect patients worldwide. Among these sequelae, post?COVID-19 insomnia (PCI) has emerged as a significant issue. Conventional treatments, including cognitive behavioral therapy and pharmacological interventions, face limitations such as variable efficacy, potential side effects, and substantial costs. Recently, acupuncture has gained traction due to its efficacy, cost-effectiveness, and safety profile. Objective: This study aims to conduct a meta-analysis and systematic review evaluating the efficacy and safety of acupuncture for the treatment of PCI to delineate the optimal modality, intervention frequency, and duration for achieving the most beneficial outcomes, thereby providing a comprehensive understanding of acupuncture?s role in managing PCI, contributing to evidence-based clinical practice, and informing clinical decision-making. Methods: Electronic searches will be performed in 12 databases from inception to October 2024 without language restrictions. This includes both English databases (PubMed, Cochrane Library, Web of Science, Embase, OVID and Scopus), as well as Chinese databases (China National Knowledge Infrastructure, Wan-Fang Data, Chinese Biomedical Literature Database, Chinese Scientific Journal Database, Duxiu Database and the Chinese Clinical Trial Registry Center). Randomized controlled trials on acupuncture for PCI will be included. Primary outcomes will include the response rate and insomnia severity; secondary outcomes will include the Traditional Chinese Medicine Symptom Scale (TCMSS) and adverse event rates. Data synthesis will use risk ratios for dichotomous data and mean differences for continuous data. Study selection, data extraction, and quality assessment will be conducted independently by 2 reviewers. Methodological quality of eligible studies will be evaluated following the Cochrane Handbook for Systematic Reviews of Interventions (version 6.3). Meta-analysis will be performed with RevMan 5.3. Results: Based on the data on response rate, insomnia severity, TCMSS score, and adverse event rates, this study will provide an evidence-based review of the efficacy and safety of acupuncture for PCI treatment. Conclusions: This systematic review will present the current evidence for acupuncture for PCI, aiming to inform clinical practices and decision-making and to enhance the understanding of acupuncture?s role in managing PCI. Furthermore, it will identify research gaps and suggest potential areas for future investigation. Trial Registration: PROSPERO CRD42024499284; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=499284 International Registered Report Identifier (IRRID): DERR1-10.2196/69417 UR - https://www.researchprotocols.org/2025/1/e69417 UR - http://dx.doi.org/10.2196/69417 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053784 ID - info:doi/10.2196/69417 ER - TY - JOUR AU - Nagpal, Meghan AU - Jalali, Niloofar AU - Sherifali, Diana AU - Morita, Plinio AU - Cafazzo, A. Joseph PY - 2025/2/21 TI - Investigating Reddit Data on Type 2 Diabetes Management During the COVID-19 Pandemic Using Latent Dirichlet Allocation Topic Modeling and Valence Aware Dictionary for Sentiment Reasoning Analysis: Content Analysis JO - JMIR Form Res SP - e51154 VL - 9 KW - diabetes KW - diabetes mellitus KW - DM KW - COVID-19 KW - pandemics KW - social media KW - health behavior KW - health knowledge KW - attitudes KW - practice KW - self-management KW - patient-generated health data KW - perspective KW - T2DM N2 - Background: Type 2 diabetes (T2D) is a chronic disease that can be partially managed through healthy behaviors. However, the COVID-19 pandemic impacted how people managed T2D due to work and school closures and social isolation. Moreover, individuals with T2D were at increased risk of complications from COVID-19 and experienced worsened mental health due to stress and anxiety. Objective: This study aims to synthesize emerging themes related to the health behaviors of people living with T2D, and how they were affected during the early stages of the COVID-19 pandemic by examining Reddit forums dedicated to people living with T2D. Methods: Data from Reddit forums related to T2D, from January 2018 to early March 2021, were downloaded using the Pushshift API; support vector machines were used to classify whether a post was made in the context of the pandemic. Latent Dirichlet allocation topic modelling was performed to identify topics of discussion across the entire dataset and a subsequent iteration was performed to identify topics specific to the COVID-19 pandemic. Sentiment analysis using the VADER (Valence Aware Dictionary for Sentiment Reasoning) algorithm was performed to assess attitudes towards the pandemic. Results: From all posts, the identified topics of discussion were classified into the following themes: managing lifestyle (sentiment score 0.25, 95% CI 0.25-0.26), managing blood glucose (sentiment score 0.19, 95% CI 0.18-0.19), obtaining diabetes care (sentiment score 0.19, 95% CI 0.18-0.20), and coping and receiving support (sentiment score 0.34, 95% CI 0.33-0.35). Among the COVID-19?specific posts, the topics of discussion were coping with poor mental health (sentiment score 0.04, 95% CI ?0.01 to0.11), accessing doctor and medications and controlling blood glucose (sentiment score 0.14, 95% CI 0.09-0.20), changing food habits during the pandemic (sentiment score 0.25, 95% CI 0.20-0.31), impact of stress on blood glucose levels (sentiment score 0.03, 95% CI ?0.03 to 0.08), changing status of employment and insurance (sentiment score 0.17, 95% CI 0.13-0.22), and risk of COVID-19 complications (sentiment score 0.09, 95% CI 0.03-0.14). Overall, posts classified as COVID-19?related (0.12, 95% CI 0.01-0.15) were associated with a lower sentiment score than those classified as nonCOVID (0.25, 95% CI 0.24-0.25). This study was limited due to the lack of a method for assessing the demographics of users and verifying whether users had T2D. Conclusions: Themes identified from Reddit data suggested that the COVID-19 pandemic significantly influenced how people with T2D managed their disease, particularly in terms of accessing care and dealing with the complications of the virus. Overall, the early stages of the pandemic negatively impacted the attitudes of people living with T2D. This study demonstrates that social media data can be a qualitative data source for understanding patient perspectives. UR - https://formative.jmir.org/2025/1/e51154 UR - http://dx.doi.org/10.2196/51154 ID - info:doi/10.2196/51154 ER - TY - JOUR AU - Sillence, Elizabeth AU - Branley-Bell, Dawn AU - Moss, Mark AU - Briggs, Pam PY - 2025/2/13 TI - A Model of Trust in Online COVID-19 Information and Advice: Cross-Sectional Questionnaire Study JO - JMIR Infodemiology SP - e59317 VL - 5 KW - eHealth KW - electronic health KW - digital intervention KW - trust KW - online information seeking KW - scientific credibility KW - digital resources KW - COVID-19 KW - SARS-CoV-2 KW - respiratory KW - infectious KW - pulmonary KW - pandemic KW - public health KW - health information KW - global health KW - surveys KW - social media N2 - Background: During the COVID-19 pandemic, many people sought information from websites and social media. Understanding the extent to which these sources were trusted is important in relation to health communication. Objective: This study aims to identify the key factors influencing UK citizens? trust and intention to act on advice about COVID-19 found via digital resources and to test whether an existing model of trust in eHealth provided a good fit for COVID-19?related information seeking online. We also wished to identify any differences between the evaluation of general information and information relating specifically to COVID-19 vaccines. Methods: In total, 525 people completed an online survey in January 2022 encompassing a general web trust questionnaire, measures of information corroboration, coping perceptions, and intention to act. Data were analyzed using principal component analysis and structural equation modeling. The evaluation responses of general information and COVID-19 vaccine information were also compared. Results: The principal component analysis revealed 5 trust factors: (1) credibility and impartiality, (2) familiarity, (3) privacy, (4) usability, and (5) personal experiences. In the final structural equation modeling model, trust had a significant direct effect on intention to act (?=.65; P<.001). Of the trust factors, credibility and impartiality had a significant positive direct effect on trust (?=.82; P<.001). People searching for vaccination information felt less at risk, less anxious, and more optimistic after reading the information. We noted that most people sought information from ?official? sources. Finally, in the context of COVID-19, ?credibility and impartiality? remain a key predictor of trust in eHealth resources, but in comparison with previous models of trust in online health information, checking and corroborating information did not form a significant part of trust evaluations. Conclusions: In times of uncertainty, when faced with a global emergent health concern, people place their trust in familiar websites and rely on the perceived credibility and impartiality of those digital sources above other trust factors. UR - https://infodemiology.jmir.org/2025/1/e59317 UR - http://dx.doi.org/10.2196/59317 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59317 ER - TY - JOUR AU - Zhang, Kehe AU - Hunyadi, V. Jocelyn AU - de Oliveira Otto, C. Marcia AU - Lee, Miryoung AU - Zhang, Zitong AU - Ramphul, Ryan AU - Yamal, Jose-Miguel AU - Yaseen, Ashraf AU - Morrison, C. Alanna AU - Sharma, Shreela AU - Rahbar, Hossein Mohammad AU - Zhang, Xu AU - Linder, Stephen AU - Marko, Dritana AU - Roy, White Rachel AU - Banerjee, Deborah AU - Guajardo, Esmeralda AU - Crum, Michelle AU - Reininger, Belinda AU - Fernandez, E. Maria AU - Bauer, Cici PY - 2025/2/11 TI - Increasing COVID-19 Testing and Vaccination Uptake in the Take Care Texas Community-Based Randomized Trial: Adaptive Geospatial Analysis JO - JMIR Form Res SP - e62802 VL - 9 KW - COVID-19 testing KW - COVID-19 vaccination KW - study design KW - community-based interventions KW - geospatial analysis KW - public health KW - social determinants of health KW - data dashboard N2 - Background: Geospatial data science can be a powerful tool to aid the design, reach, efficiency, and impact of community-based intervention trials. The project titled Take Care Texas aims to develop and test an adaptive, multilevel, community-based intervention to increase COVID-19 testing and vaccination uptake among vulnerable populations in 3 Texas regions: Harris County, Cameron County, and Northeast Texas. Objective: We aimed to develop a novel procedure for adaptive selections of census block groups (CBGs) to include in the community-based randomized trial for the Take Care Texas project. Methods: CBG selection was conducted across 3 Texas regions over a 17-month period (May 2021 to October 2022). We developed persistent and recent COVID-19 burden metrics, using real-time SARS-CoV-2 monitoring data to capture dynamic infection patterns. To identify vulnerable populations, we also developed a CBG-level community disparity index, using 12 contextual social determinants of health (SDOH) measures from US census data. In each adaptive round, we determined the priority CBGs based on their COVID-19 burden and disparity index, ensuring geographic separation to minimize intervention ?spillover.? Community input and feedback from local partners and health workers further refined the selection. The selected CBGs were then randomized into 2 intervention arms?multilevel intervention and just-in-time adaptive intervention?and 1 control arm, using covariate adaptive randomization, at a 1:1:1 ratio. We developed interactive data dashboards, which included maps displaying the locations of selected CBGs and community-level information, to inform the selection process and guide intervention delivery. Selection and randomization occurred across 10 adaptive rounds. Results: A total of 120 CBGs were selected and followed the stepped planning and interventions, with 60 in Harris County, 30 in Cameron County, and 30 in Northeast Texas counties. COVID-19 burden presented substantial temporal changes and local variations across CBGs. COVID-19 burden and community disparity exhibited some common geographical patterns but also displayed distinct variations, particularly at different time points throughout this study. This underscores the importance of incorporating both real-time monitoring data and contextual SDOH in the selection process. Conclusions: The novel procedure integrated real-time monitoring data and geospatial data science to enhance the design and adaptive delivery of a community-based randomized trial. Adaptive selection effectively prioritized the most in-need communities and allowed for a rigorous evaluation of community-based interventions in a multilevel trial. This methodology has broad applicability and can be adapted to other public health intervention and prevention programs, providing a powerful tool for improving population health and addressing health disparities. UR - https://formative.jmir.org/2025/1/e62802 UR - http://dx.doi.org/10.2196/62802 ID - info:doi/10.2196/62802 ER - TY - JOUR AU - Davoody, Nadia AU - Stathakarou, Natalia AU - Swain, Cara AU - Bonacina, Stefano PY - 2025/2/10 TI - Exploring the Impact of the COVID-19 Pandemic on Learning Experience, Mental Health, Adaptability, and Resilience Among Health Informatics Master?s Students: Focus Group Study JO - JMIR Med Educ SP - e63708 VL - 11 KW - COVID-19 pandemic KW - eHealth KW - blended learning KW - health informatics KW - higher education adaptation N2 - Background: The shift to online education due to the COVID-19 pandemic posed significant challenges and opportunities for students, affecting their academic performance, mental well-being, and engagement. Objective: This study aimed to explore the overall learning experience among health informatics master?s students at Karolinska Institutet, Sweden, and the strategies they used to overcome learning challenges posed by the COVID-19 pandemic. Methods: Through 3 structured focus groups, this study explored health informatics master?s students? experiences of shifting learning environments for classes that started in 2019, 2020, and 2021. All focus group sessions were recorded and transcribed verbatim. Inductive content analysis was used to analyze the data. Results: The results highlight the benefits of increased autonomy and flexibility and identify challenges such as technical difficulties, diminished social interactions, and psychological impacts. This study underscores the importance of effective online educational strategies, technological preparedness, and support systems to enhance student learning experiences during emergencies. The findings of this study highlight implications for educators, students, and higher education institutions to embrace adaptation and foster innovation. Implications for educators, students, and higher education institutions include the need for educators to stay current with the latest educational technologies and design teaching strategies and pedagogical approaches suited to both online and in-person settings to effectively foster student engagement. Students must be informed about the technological requirements for online learning and adequately prepared to meet them. Institutions play a critical role in ensuring equitable access to technology, guiding and supporting educators in adopting innovative tools and methods, and offering mental health resources to assist students in overcoming the challenges of evolving educational environments. Conclusions: This research contributes to understanding the complexities of transitioning to online learning in urgent circumstances and offers insights for better preparing educational institutions for future pandemics. UR - https://mededu.jmir.org/2025/1/e63708 UR - http://dx.doi.org/10.2196/63708 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63708 ER - TY - JOUR AU - Alshanik, Farah AU - Khasawneh, Rawand AU - Dalky, Alaa AU - Qawasmeh, Ethar PY - 2025/2/10 TI - Unveiling Topics and Emotions in Arabic Tweets Surrounding the COVID-19 Pandemic: Topic Modeling and Sentiment Analysis Approach JO - JMIR Infodemiology SP - e53434 VL - 5 KW - topic modeling KW - sentiment analysis KW - COVID-19 KW - social media KW - Twitter KW - public discussion N2 - Background: The worldwide effects of the COVID-19 pandemic have been profound, and the Arab world has not been exempt from its wide-ranging consequences. Within this context, social media platforms such as Twitter have become essential for sharing information and expressing public opinions during this global crisis. Careful investigation of Arabic tweets related to COVID-19 can provide invaluable insights into the common topics and underlying sentiments that shape discussions about the COVID-19 pandemic. Objective: This study aimed to understand the concerns and feelings of Twitter users in Arabic-speaking countries about the COVID-19 pandemic. This was accomplished through analyzing the themes and sentiments that were expressed in Arabic tweets about the COVID-19 pandemic. Methods: In this study, 1 million Arabic tweets about COVID-19 posted between March 1 and March 31, 2020, were analyzed. Machine learning techniques, such as topic modeling and sentiment analysis, were applied to understand the main topics and emotions that were expressed in these tweets. Results: The analysis of Arabic tweets revealed several prominent topics related to COVID-19. The analysis identified and grouped 16 different conversation topics that were organized into eight themes: (1) preventive measures and safety, (2) medical and health care aspects, (3) government and social measures, (4) impact and numbers, (5) vaccine development and research, (6) COVID-19 and religious practices, (7) global impact of COVID-19 on sports and countries, and (8) COVID-19 and national efforts. Across all the topics identified, the prevailing sentiments regarding the spread of COVID-19 were primarily centered around anger, followed by disgust, joy, and anticipation. Notably, when conversations revolved around new COVID-19 cases and fatalities, public tweets revealed a notably heightened sense of anger in comparison to other subjects. Conclusions: The study offers valuable insights into the topics and emotions expressed in Arabic tweets related to COVID-19. It demonstrates the significance of social media platforms, particularly Twitter, in capturing the Arabic-speaking community?s concerns and sentiments during the COVID-19 pandemic. The findings contribute to a deeper understanding of the prevailing discourse, enabling stakeholders to tailor effective communication strategies and address specific public concerns. This study underscores the importance of monitoring social media conversations in Arabic to support public health efforts and crisis management during the COVID-19 pandemic. UR - https://infodemiology.jmir.org/2025/1/e53434 UR - http://dx.doi.org/10.2196/53434 UR - http://www.ncbi.nlm.nih.gov/pubmed/39928401 ID - info:doi/10.2196/53434 ER - TY - JOUR AU - Bragazzi, Luigi Nicola AU - Buchinger, Michèle AU - Atwan, Hisham AU - Tuma, Ruba AU - Chirico, Francesco AU - Szarpak, Lukasz AU - Farah, Raymond AU - Khamisy-Farah, Rola PY - 2025/2/5 TI - Proficiency, Clarity, and Objectivity of Large Language Models Versus Specialists? Knowledge on COVID-19's Impacts in Pregnancy: Cross-Sectional Pilot Study JO - JMIR Form Res SP - e56126 VL - 9 KW - COVID-19 KW - vaccine KW - reproductive health KW - generative artificial intelligence KW - large language model KW - chatGPT KW - google bard KW - microsoft copilot KW - vaccination KW - natural language processing KW - obstetric KW - gynecology KW - women KW - text mining KW - sentiment KW - accuracy KW - zero shot KW - pregnancy KW - readability KW - infectious N2 - Background: The COVID-19 pandemic has significantly strained health care systems globally, leading to an overwhelming influx of patients and exacerbating resource limitations. Concurrently, an ?infodemic? of misinformation, particularly prevalent in women?s health, has emerged. This challenge has been pivotal for health care providers, especially gynecologists and obstetricians, in managing pregnant women?s health. The pandemic heightened risks for pregnant women from COVID-19, necessitating balanced advice from specialists on vaccine safety versus known risks. In addition, the advent of generative artificial intelligence (AI), such as large language models (LLMs), offers promising support in health care. However, they necessitate rigorous testing. Objective: This study aimed to assess LLMs? proficiency, clarity, and objectivity regarding COVID-19?s impacts on pregnancy. Methods: This study evaluates 4 major AI prototypes (ChatGPT-3.5, ChatGPT-4, Microsoft Copilot, and Google Bard) using zero-shot prompts in a questionnaire validated among 159 Israeli gynecologists and obstetricians. The questionnaire assesses proficiency in providing accurate information on COVID-19 in relation to pregnancy. Text-mining, sentiment analysis, and readability (Flesch-Kincaid grade level and Flesch Reading Ease Score) were also conducted. Results: In terms of LLMs? knowledge, ChatGPT-4 and Microsoft Copilot each scored 97% (32/33), Google Bard 94% (31/33), and ChatGPT-3.5 82% (27/33). ChatGPT-4 incorrectly stated an increased risk of miscarriage due to COVID-19. Google Bard and Microsoft Copilot had minor inaccuracies concerning COVID-19 transmission and complications. In the sentiment analysis, Microsoft Copilot achieved the least negative score (?4), followed by ChatGPT-4 (?6) and Google Bard (?7), while ChatGPT-3.5 obtained the most negative score (?12). Finally, concerning the readability analysis, Flesch-Kincaid Grade Level and Flesch Reading Ease Score showed that Microsoft Copilot was the most accessible at 9.9 and 49, followed by ChatGPT-4 at 12.4 and 37.1, while ChatGPT-3.5 (12.9 and 35.6) and Google Bard (12.9 and 35.8) generated particularly complex responses. Conclusions: The study highlights varying knowledge levels of LLMs in relation to COVID-19 and pregnancy. ChatGPT-3.5 showed the least knowledge and alignment with scientific evidence. Readability and complexity analyses suggest that each AI?s approach was tailored to specific audiences, with ChatGPT versions being more suitable for specialized readers and Microsoft Copilot for the general public. Sentiment analysis revealed notable variations in the way LLMs communicated critical information, underscoring the essential role of neutral and objective health care communication in ensuring that pregnant women, particularly vulnerable during the COVID-19 pandemic, receive accurate and reassuring guidance. Overall, ChatGPT-4, Microsoft Copilot, and Google Bard generally provided accurate, updated information on COVID-19 and vaccines in maternal and fetal health, aligning with health guidelines. The study demonstrated the potential role of AI in supplementing health care knowledge, with a need for continuous updating and verification of AI knowledge bases. The choice of AI tool should consider the target audience and required information detail level. UR - https://formative.jmir.org/2025/1/e56126 UR - http://dx.doi.org/10.2196/56126 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56126 ER - TY - JOUR AU - Rowley, AK Elizabeth AU - Mitchell, K. Patrick AU - Yang, Duck-Hye AU - Lewis, Ned AU - Dixon, E. Brian AU - Vazquez-Benitez, Gabriela AU - Fadel, F. William AU - Essien, J. Inih AU - Naleway, L. Allison AU - Stenehjem, Edward AU - Ong, C. Toan AU - Gaglani, Manjusha AU - Natarajan, Karthik AU - Embi, Peter AU - Wiegand, E. Ryan AU - Link-Gelles, Ruth AU - Tenforde, W. Mark AU - Fireman, Bruce PY - 2025/1/27 TI - Methods to Adjust for Confounding in Test-Negative Design COVID-19 Effectiveness Studies: Simulation Study JO - JMIR Form Res SP - e58981 VL - 9 KW - disease risk score KW - propensity score KW - vaccine effectiveness KW - COVID-19 KW - simulation study KW - usefulness KW - comorbidity KW - assessment N2 - Background: Real-world COVID-19 vaccine effectiveness (VE) studies are investigating exposures of increasing complexity accounting for time since vaccination. These studies require methods that adjust for the confounding that arises when morbidities and demographics are associated with vaccination and the risk of outcome events. Methods based on propensity scores (PS) are well-suited to this when the exposure is dichotomous, but present challenges when the exposure is multinomial. Objective: This simulation study aimed to investigate alternative methods to adjust for confounding in VE studies that have a test-negative design. Methods: Adjustment for a disease risk score (DRS) is compared with multivariable logistic regression. Both stratification on the DRS and direct covariate adjustment of the DRS are examined. Multivariable logistic regression with all the covariates and with a limited subset of key covariates is considered. The performance of VE estimators is evaluated across a multinomial vaccination exposure in simulated datasets. Results: Bias in VE estimates from multivariable models ranged from ?5.3% to 6.1% across 4 levels of vaccination. Standard errors of VE estimates were unbiased, and 95% coverage probabilities were attained in most scenarios. The lowest coverage in the multivariable scenarios was 93.7% (95% CI 92.2%-95.2%) and occurred in the multivariable model with key covariates, while the highest coverage in the multivariable scenarios was 95.3% (95% CI 94.0%-96.6%) and occurred in the multivariable model with all covariates. Bias in VE estimates from DRS-adjusted models was low, ranging from ?2.2% to 4.2%. However, the DRS-adjusted models underestimated the standard errors of VE estimates, with coverage sometimes below the 95% level. The lowest coverage in the DRS scenarios was 87.8% (95% CI 85.8%-89.8%) and occurred in the direct adjustment for the DRS model. The highest coverage in the DRS scenarios was 94.8% (95% CI 93.4%-96.2%) and occurred in the model that stratified on DRS. Although variation in the performance of VE estimates occurred across modeling strategies, variation in performance was also present across exposure groups. Conclusions: Overall, models using a DRS to adjust for confounding performed adequately but not as well as the multivariable models that adjusted for covariates individually. UR - https://formative.jmir.org/2025/1/e58981 UR - http://dx.doi.org/10.2196/58981 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58981 ER - TY - JOUR AU - Valla, Guido Luca AU - Rossi, Michele AU - Gaia, Alessandra AU - Guaita, Antonio AU - Rolandi, Elena PY - 2025/1/9 TI - The Impact of the COVID-19 Pandemic on Oldest-Old Social Capital and Health and the Role of Digital Inequalities: Longitudinal Cohort Study JO - J Med Internet Res SP - e62824 VL - 27 KW - older adults KW - information and communication technology KW - ICT KW - ICT use KW - COVID-19 KW - social capital KW - health KW - mental health KW - digital divide N2 - Background: During the COVID-19 pandemic, information and communication technology (ICT) became crucial for staying connected with loved ones and accessing health services. In this scenario, disparities in ICT use may have exacerbated other forms of inequality, especially among older adults who were less familiar with technology and more vulnerable to severe COVID-19 health consequences. Objective: This study investigated changes in ICT use, psychological and physical health, and social capital before and after the pandemic among the oldest old population (aged 80 years or older after the pandemic) and explored how internet use influenced these changes. Methods: We leveraged data from the InveCe.Ab study, a population-based longitudinal cohort of people born between 1935 and 1939 and living in Abbiategrasso, a municipality on the outskirts of Milan, Italy. Participants underwent multidimensional assessment at baseline (2010) and after 2, 4, 8, and 12 years. We restricted our analysis to cohort members who participated in the last wave (ie, 2022) and who did not have a diagnosis of dementia (n=391). We used linear mixed models to assess the impact of COVID-19 and time on changes in social capital, physical and psychological health, and ICT use in a discontinuity regression design while controlling for age, sex, education, and income satisfaction. Then, we assessed the influence of internet use and its interaction with COVID-19 on these changes. Results: COVID-19 had a significant impact on social relationships (?=?4.35, 95% CI 6.38 to ?2.32; P<.001), cultural activities (?=?.55, 95% CI ?0.75 to ?0.35; P<.001), cognitive functioning (?=?1.00, 95% CI ?1.28 to ?0.72; P<.001), depressive symptoms (?=.42, 95% CI 0.10-0.74; P=.009), physical health (?=.07, 95% CI 0.04-0.10; P<.001), and ICT use (?=?.11, 95% CI ?0.18 to ?0.03; P=.008). Internet use predicts reduced depressive symptoms (?=?.56, 95% CI ?1.07 to ?0.06; P=.03) over time. The interaction between internet use and COVID-19 was significant for cultural activities (?=?.73, 95% CI ?1.22 to ?0.24; P=.003) and cognitive functioning (?=1.36, 95% CI 0.67-2.05; P<.001). Conclusions: The pandemic had adverse effects on older adults? health and social capital. Contrary to expectations, even ICT use dropped significantly after the pandemic. Internet users maintained higher psychological health regardless of time and COVID-19 status. However, COVID-19 was associated with a steeper decline in cognitive functioning among internet nonusers. Policy makers may develop initiatives to encourage ICT adoption among older adults or strengthen their digital skills. Trial Registration: ClinicalTrials.gov NCT01345110; https://clinicaltrials.gov/study/NCT01345110 UR - https://www.jmir.org/2025/1/e62824 UR - http://dx.doi.org/10.2196/62824 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62824 ER - TY - JOUR AU - Sasaki, Kenji AU - Ikeda, Yoichi AU - Nakano, Takashi PY - 2025/1/3 TI - Quantifying the Regional Disproportionality of COVID-19 Spread: Modeling Study JO - JMIR Form Res SP - e59230 VL - 9 KW - infectious disease KW - COVID-19 KW - epidemiology KW - public health KW - SARS-CoV-2 KW - pandemic KW - inequality measure KW - information theory KW - Kullback-Leibler divergence N2 - Background: The COVID-19 pandemic has caused serious health, economic, and social consequences worldwide. Understanding how infectious diseases spread can help mitigate these impacts. The Theil index, a measure of inequality rooted in information theory, is useful for identifying geographic disproportionality in COVID-19 incidence across regions. Objective: This study focused on capturing the degrees of regional disproportionality in incidence rates of infectious diseases over time. Using the Theil index, we aim to assess regional disproportionality in the spread of COVID-19 and detect epicenters where the number of infected individuals was disproportionately concentrated. Methods: To quantify the degree of disproportionality in the incidence rates, we applied the Theil index to the publicly available data of daily confirmed COVID-19 cases in the United States over a 1100-day period. This index measures relative disproportionality by comparing daily regional case distributions with population proportions, thereby identifying regions where infections are disproportionately concentrated. Results: Our analysis revealed a dynamic pattern of regional disproportionality in the confirmed cases by monitoring variations in regional contributions to the Theil index as the pandemic progressed. Over time, the index reflected a transition from localized outbreaks to widespread transmission, with high values corresponding to concentrated cases in some regions. We also found that the peaks in the Theil index often preceded surges in confirmed cases, suggesting its potential utility as an early warning signal. Conclusions: This study demonstrated that the Theil index is one of the effective indices for quantifying regional disproportionality in COVID-19 incidence rates. Although the Theil index alone cannot fully capture all aspects of pandemic dynamics, it serves as a valuable tool when used alongside other indicators such as infection and hospitalization rates. This approach allows policy makers to monitor regional disproportionality efficiently, offering insights for early intervention and targeted resource allocation. UR - https://formative.jmir.org/2025/1/e59230 UR - http://dx.doi.org/10.2196/59230 ID - info:doi/10.2196/59230 ER - TY - JOUR AU - Sharma, Nikita AU - Wrede, Christian AU - Bastoni, Sofia AU - Braakman-Jansen, Annemarie AU - van Gemert-Pijnen, Lisette PY - 2024/12/31 TI - Continued Implementation and Use of a Digital Informal Care Support Platform Before and After COVID-19: Multimethod Study JO - JMIR Form Res SP - e54734 VL - 8 KW - digital care platform KW - eHealth KW - implementation KW - informal care KW - new digital normal KW - COVID KW - Caren KW - consolidated framework N2 - Background: With the growing need of support for informal caregivers (ICs) and care recipients (CRs) during COVID-19, the uptake of digital care collaboration platforms such as Caren increased. Caren is a platform designed to (1) improve communication and coordination between ICs and health care professionals, (2) provide a better overview of the care process, and (3) enhance safe information sharing within the care network. Insights on the impact of COVID-19 on the implementation and use of informal care platforms such as Caren are still lacking. Objective: This study aimed to (1) identify technology developers? lessons learned from the continued implementation of Caren during COVID-19 and (2) examine pre-post COVID-19 changes in usage behavior and support functionality use of Caren. Methods: A focus group with developers of the Caren platform (N=3) was conducted to extract implementation lessons learned. Focus group data were first analyzed deductively, using the Consolidated Framework for Implementation Research domains (ie, individual characteristics, intervention characteristics, inner setting, and outer setting). Later, inductive analysis of overarching themes was performed. Furthermore, survey data were collected in 2019 (N=11,635) and 2022 (N=5573) among Caren platform users for comparing usage behavior and support functionality use. Data were analyzed using descriptive and inferential statistics. Results: Several lessons from the continued implementation of Caren during COVID-19 were identified. Those included, for example, alternative ways to engage with end users, incorporating automated user support and large-scale communication features, considering the fluctuation of user groups, and addressing data transparency concerns in health care. Quantitative results showed that the number of ICs and CRs who used Caren several times per day increased significantly (P<.001 for ICs and CRs) between 2019 (ICs: 23.8%; CRs: 23.2%) and 2022 (ICs: 35.2%; CRs: 37%), as well as the use of certain support functionalities such as a digital agenda to make and view appointments, a messaging function to receive updates and communicate with formal and informal caregivers, and digital notes to store important information. Conclusions: Our study offers insights into the influence of the COVID-19 pandemic on the usage and implementation of the digital informal care support platform Caren. The study shows how platform developers maintained the implementation during COVID-19 and which support functionalities gained relevance among ICs and CRs throughout the pandemic. The findings can be used to improve the design and implementation of current and future digital platforms to support informal care toward the ?new digital normal.? UR - https://formative.jmir.org/2024/1/e54734 UR - http://dx.doi.org/10.2196/54734 ID - info:doi/10.2196/54734 ER - TY - JOUR AU - Wallraf, Simon AU - Dierks, Marie-Luise AU - John, Cosima AU - Lander, Jonas PY - 2024/12/20 TI - Patient Organizations? Digital Responses to the COVID-19 Pandemic: Scoping Review JO - J Med Internet Res SP - e58566 VL - 26 KW - patient organizations KW - COVID-19 KW - digital adaptation KW - digital transformation KW - scoping review N2 - Background: Patient organizations (POs) play a crucial role in supporting individuals with health conditions. Their activities range from counseling to support groups to advocacy. The COVID-19 pandemic and its related public health measures prompted rapid digital transformation efforts across multiple sectors, including health care. Objective: This study aimed to explore how POs digitally responded to pandemic-related circumstances, focusing on aspects such as the technologies used, positive outcomes, and challenges encountered. Methods: This scoping review followed the methodological guidance of the JBI (Joanna Briggs Institute) Scoping Review Methodology Group and adhered to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting guidelines. A systematic search of PubMed, the Web of Science Core Collection, and the WHO (World Health Organization) COVID-19 database, supplemented by a citation search approach, was conducted. The initial search was performed on November 10, 2022, and updated on November 8, 2023. Publications were eligible if they were published after November 30, 2019, and addressed pandemic-related digitalization efforts of POs, defined as nonprofit organizations with a focus on health-related support. A 2-step screening process was used to identify relevant literature. Data were extracted using a standardized table to capture aspects such as digital adaptation activities (eg, types of technologies implemented, positive outcomes, challenges, and facilitating factors) and coded inductively to identify similarities across included publications, and the findings were synthesized narratively. Results: The search and its subsequent update yielded 2212 records, with 13 articles included in this review. These articles revealed a range of PO services that were digitally adapted during the pandemic, with videoconferencing software emerging as the most commonly used tool (n=9 articles). The digital adaptation of group-based support activities was the most frequently reported transformation (n=9). Other adaptations included the digitalization of counseling services (n=3) and the delivery of information and education (n=3), including educational workshops, weekly webinars, and the dissemination of information through digital newsletters. While the use of digital formats, particularly for POs? group activities, often increased accessibility by breaking down preexisting barriers (n=5), they also created new barriers for certain groups, such as those lacking digital skills or resources (n=4). Some participants experienced a loss of interpersonal aspects, like a sense of community (n=3). However, further findings suggest that the digital delivery of such group activities preserved essential interpersonal aspects (n=7) and a preference among some participants to continue digital group activities (n=4), suggesting the potential for sustainability of such options post the COVID-19 pandemic. Conclusions: The rapid digitalization efforts of POs demonstrate their adaptability and the potential of digital technologies to improve support services, despite some challenges. Future digitalization strategies should focus, among other things, on promoting digital literacy to ensure the accessibility and inclusiveness of digital services. Trial Registration: OSF Registries, https://osf.io/anvf4 UR - https://www.jmir.org/2024/1/e58566 UR - http://dx.doi.org/10.2196/58566 UR - http://www.ncbi.nlm.nih.gov/pubmed/39705075 ID - info:doi/10.2196/58566 ER - TY - JOUR AU - Ahmed, Nisar AU - Hall, Alex AU - Poku, Brenda AU - McDermott, Jane AU - Astbury, Jayne AU - Todd, Chris PY - 2024/12/18 TI - Experiences and Views of Older Adults of South Asian, Black African, and Caribbean Backgrounds About the Digitalization of Primary Care Services Since the COVID-19 Pandemic: Qualitative Focus Group Study JO - JMIR Form Res SP - e57580 VL - 8 KW - digital health and primary care services KW - digital exclusion KW - digital divide KW - health inequalities KW - older adults KW - South Asian KW - Black African KW - Caribbean KW - COVID-19 pandemic KW - qualitative focus group study N2 - Background: The COVID-19 pandemic from 2020 to 2022 prompted governments worldwide to enforce lockdowns and social restrictions, alongside the rapid adoption of digital health and care services. However, there are concerns about the potential exclusion of older adults, who face barriers to digital inclusion, such as age, socioeconomic status, literacy level, and ethnicity. Objective: This study aims to explore the experiences of older adults from the 3 largest minoritized ethnic groups in England and Wales?people of South Asian, Black African, and Caribbean backgrounds?in the use of digitalized primary care services since the beginning of the COVID-19 pandemic. Methods: In total, 27 individuals participated in 4 focus groups (April and May 2023) either in person or via online videoconferencing. Patient and public involvement and engagement were sought through collaboration with community organizations for focus group recruitment and feedback on the topic guide. Data were analyzed using framework analysis. Results: This paper summarizes the perspectives of 27 older adults from these 3 minoritized ethnic groups and identifies four key themes: (1) service accessibility through digital health (participants faced difficulties accessing digital health care services through online platforms, primarily due to language barriers and limited digital skills, with reliance on younger family members or community organizations for assistance; the lack of digital literacy among older community members was a prominent concern, and digital health care services were felt to be tailored for English speakers, with minimal consultation during the development phase), (2) importance of face-to-face (in-person) appointments for patient-clinician interactions (in-person appointments were strongly preferred, emphasizing the value of physical interaction and connection with health care professionals; video consultations were seen as an acceptable alternative), (3) stressors caused by the shift to remote access (the transition to remote digital access caused stress, fear, and anxiety; participants felt that digital health solutions were imposed without sufficient explanation or consent; and Black African and Caribbean participants reported experiences of racial discrimination within the health care system), and (4) digital solutions (evaluating technology acceptance; participants acknowledged the importance of digitalization but cautioned against viewing it as a one-size-fits-all solution; they advocated for offline alternatives and a hybrid approach, emphasizing the need for choice and a well-staffed clinical workforce). Conclusions: Digital health initiatives should address the digital divide, health inequalities, and the specific challenges faced by older adults, particularly those from minoritized ethnic backgrounds, ensuring accessibility, choice, and privacy. Overcoming language barriers involves more than mere translation. Maintaining in-person options for consultations, addressing sensitive issues, and implementing support systems at the practice level to support those struggling to access services are vital. This study recommends that policy makers ensure the inclusivity of older adults from diverse backgrounds in the design and implementation of digital health and social care services. UR - https://formative.jmir.org/2024/1/e57580 UR - http://dx.doi.org/10.2196/57580 UR - http://www.ncbi.nlm.nih.gov/pubmed/39693146 ID - info:doi/10.2196/57580 ER - TY - JOUR AU - Na, Kilhoe AU - Zimdars, Melissa AU - Cullinan, E. Megan PY - 2024/12/5 TI - Understanding Membership in Alternative Health Social Media Groups and Its Association with COVID-19 and Influenza Vaccination: Web-Based Cross-Sectional Survey JO - JMIR Form Res SP - e54092 VL - 8 KW - alternative health KW - social media KW - misinformation KW - vaccination KW - COVID-19 KW - Coronavirus N2 - Background: Social media platforms have become home to numerous alternative health groups where people share health information and scientifically unproven treatments. Individuals share not only health information but also health misinformation in alternative health groups on social media. Yet, little research has been carried out to understand members of these groups. This study aims to better understand various characteristics of members in alternative health groups and the association between membership and attitudes toward vaccination and COVID-19 and influenza vaccination?related behaviors. Objective: This study aims to test hypotheses about different potential characteristics of members in alternative health groups and the association between membership and attitudes toward vaccination and vaccine-related behaviors. Methods: A web-based cross-sectional survey (N=1050) was conducted. Participants were recruited from 19 alternative health social media groups and Amazon?s Mechanical Turk. A total of 596 participants were members of alternative health groups and 454 were nonmembers of alternative health groups. Logistic regressions were performed to test the hypotheses about the relationship between membership and the variables of interest. Results: Logistic regression revealed that there is a positive association between alternative health social media group membership and 3 personal characteristics: sharing trait (B=.83, SE=.11; P<.01; odds ratio [OR] 2.30, 95% CI 1.85-2.86), fear of negative evaluations (B=.19, SE=.06; P<.001, OR 1.21, 95% CI 1.06-1.37), and conspiratorial mentality (B=.33, SE=.08; P<.01; OR 1.40, 95% CI 1.18-1.65). Also, the results indicate that there is a negative association between membership and 2 characteristics: health literacy (B=?1.09, SE=.17; P<.001; OR .33, 95% CI 0.23-0.47) and attitudes toward vaccination (B=? 2.33, SE=.09; P=.02; OR 0.79, 95% CI 0.65-0.95). However, there is no association between membership and health consciousness (B=.12, SE=.10; P=.24; OR 1.13, 95% CI 0.92-1.38). Finally, membership is negatively associated with COVID-19 vaccination status (B=?.84, SE=.17; P<.001; OR 48, 95% CI 0.32-0.62), and influenza vaccination practice (B=?1.14, SE=.17; P<.001; OR .31, 95% CI 0.22-0.45). Conclusions: Our findings indicate that people joining alternative health social media groups differ from nonmembers in different aspects, such as sharing, fear of negative evaluations, conspiratorial mentality, and health literacy. They also suggest that there is a significant relationship between membership and vaccination. By more thoroughly exploring the demographic, or by better understanding the people for whom interventions are designed, this study is expected to help researchers to more strategically and effectively develop and implement interventions. UR - https://formative.jmir.org/2024/1/e54092 UR - http://dx.doi.org/10.2196/54092 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54092 ER - TY - JOUR AU - Qiu, Yuanbo AU - Huang, Huang AU - Gai, Junjie AU - De Leo, Gianluca PY - 2024/12/4 TI - The Effects of the COVID-19 Pandemic on Age-Based Disparities in Digital Health Technology Use: Secondary Analysis of the 2017-2022 Health Information National Trends Survey JO - J Med Internet Res SP - e65541 VL - 26 KW - age-based disparities KW - health equity KW - digital health technology use KW - digital divide KW - health policy KW - COVID-19 KW - mobile phone N2 - Background: The COVID-19 pandemic accelerated the adoption of digital health technology, but it could also impact age-based disparities as existing studies have pointed out. Compared with the pre-pandemic period, whether the rapid digitalization of the health care system during the pandemic widened the age-based disparities over a long period remains unclear. Objective: This study aimed to analyze the long-term effects of the COVID-19 pandemic on the multifaceted landscape of digital health technology used across diverse age groups among US citizens. Methods: We conducted the retrospective observational study using the 2017-2022 Health Information National Trends Survey to identify the influence of the COVID-19 pandemic on a wide range of digital health technology use outcomes across various age groups. The sample included 15,505 respondents, which were categorized into 3 age groups: adults (18-44 years), middle-aged adults (45-64 years), and older adults (more than 65 years). We also designated the time point of March 11, 2020, to divide the pre- and post-pandemic periods. Based on these categorizations, multivariate linear probability models were used to assess pre-post changes in digital health technology use, controlling for demographic, socioeconomic, and health-related variables among different age groups. Results: Essentially, older adults were found to be significantly less likely to use digital health technology compared with adults, with a 26.28% lower likelihood of using the internet for health information (P<.001) and a 32.63% lower likelihood of using health apps (P<.001). The usage of digital health technology for all age groups had significantly increased after the onset of the pandemic, and the age-based disparities became smaller in terms of using the internet to look for health information. However, the disparities have widened for older adults in using the internet to look up test results (11.21%, P<.001) and make appointments (10.03%, P=.006) and using wearable devices to track health (8.31%, P=.01). Conclusions: Our study reveals a significant increase in the use of digital health technology among all age groups during the pandemic. However, while the disparities in accessing online information have narrowed, age-based disparities, particularly for older adults, have widened in most areas such as looking up test results and making appointments with doctors. Therefore, older adults are more likely left behind by the rapidly digitalized US health care system during the pandemic. Policy makers and health care providers should focus on addressing these disparities to ensure equitable access to digital health resources for US baby boomers. UR - https://www.jmir.org/2024/1/e65541 UR - http://dx.doi.org/10.2196/65541 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65541 ER - TY - JOUR AU - Béchard, Benoît AU - Gramaccia, A. Julie AU - Gagnon, Dominique AU - Laouan-Sidi, Anassour Elhadji AU - Dubé, Ève AU - Ouimet, Mathieu AU - de Hemptinne, Delphine AU - Tremblay, Sébastien PY - 2024/12/4 TI - The Resilience of Attitude Toward Vaccination: Web-Based Randomized Controlled Trial on the Processing of Misinformation JO - JMIR Form Res SP - e52871 VL - 8 KW - attitude toward vaccination KW - misinformation KW - reinformation KW - confidence KW - perceived tentativeness KW - vaccine hesitancy KW - COVID-19 N2 - Background: Before the COVID-19 pandemic, it was already recognized that internet-based misinformation and disinformation could influence individuals to refuse or delay vaccination for themselves, their families, or their children. Reinformation, which refers to hyperpartisan and ideologically biased content, can propagate polarizing messages on vaccines, thereby contributing to vaccine hesitancy even if it is not outright disinformation. Objective: This study aimed to evaluate the impact of reinformation on vaccine hesitancy. Specifically, the goal was to investigate how misinformation presented in the style and layout of a news article could influence the perceived tentativeness (credibility) of COVID-19 vaccine information and confidence in COVID-19 vaccination. Methods: We conducted a web-based randomized controlled trial by recruiting English-speaking Canadians aged 18 years and older from across Canada through the Qualtrics (Silver Lake) paid opt-in panel system. Participants were randomly assigned to 1 of 4 distinct versions of a news article on COVID-19 vaccines, each featuring variations in writing style and presentation layout. After reading the news article, participants self-assessed the tentativeness of the information provided, their confidence in COVID-19 vaccines, and their attitude toward vaccination in general. Results: The survey included 537 participants, with 12 excluded for not meeting the task completion time. The final sample comprised 525 participants distributed about equally across the 4 news article versions. Chi-square analyses revealed a statistically significant association between general attitude toward vaccination and the perceived tentativeness of the information about COVID-19 vaccines included in the news article (?21=37.8, P<.001). The effect size was small to moderate, with Cramer V=0.27. An interaction was found between vaccine attitude and writing style (?21=6.2, P=.01), with a small effect size, Cramer V=0.11. In addition, a Pearson correlation revealed a significant moderate to strong correlation between perceived tentativeness and confidence in COVID-19 vaccination, r(523)=0.48, P<.001. The coefficient of determination (r2) was 0.23, indicating that 23% of the variance in perceived tentativeness was explained by confidence in COVID-19 vaccines. In comparing participants exposed to a journalistic-style news article with those exposed to an ideologically biased article, Cohen d was calculated to be 0.38, indicating a small to medium effect size for the difference in the perceived tentativeness between these groups. Conclusions: Exposure to a news article conveying misinformation may not be sufficient to change an individual?s level of vaccine hesitancy. The study reveals that the predominant factor in shaping individuals? perceptions of COVID-19 vaccines is their attitude toward vaccination in general. This attitude also moderates the influence of writing style on perceived tentativeness; the stronger one?s opposition to vaccines, the less pronounced the impact of writing style on perceived tentativeness. International Registered Report Identifier (IRRID): RR2-10.2196/41012 UR - https://formative.jmir.org/2024/1/e52871 UR - http://dx.doi.org/10.2196/52871 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52871 ER - TY - JOUR AU - Lungu, Adrian Daniel AU - Røislien, Jo AU - Smeets, Ionica AU - Wiig, Siri AU - Brønnick, Kallesten Kolbjørn PY - 2024/12/4 TI - Individual Characteristics in the Comprehension of Pandemic Video Communication: Randomized Controlled Between-Subjects Design JO - J Med Internet Res SP - e48882 VL - 26 KW - video communication KW - COVID-19 pandemic KW - comprehension KW - health literacy KW - video KW - videos KW - health communication KW - psychology KW - perception KW - comprehend KW - understanding KW - coronavirus disease 2019 N2 - Background: Video played an important role in health communication throughout the COVID-19 pandemic. It was used to communicate pandemic information to the public, with a variety of formats, presenters, and topics. Evidence regarding the effectiveness of video features is available, while how individual characteristics of recipients influence communication comprehension is still limited. Objective: This study aimed to test 6 individual characteristics and assess their effect on the comprehension of pandemic video communication. Methods: Short health communication videos were presented to a large sample of subjects, receiving questionnaire responses from 1194 participants. Individual characteristics consisted of age, sex, living area, education level, income level, and belief in science. Communication comprehension consisted of both perceived and objective comprehension. The data were analyzed by multiple linear regression. Results: Age had a negative effect on both perceived and objective comprehension?age was negatively associated with comprehension. There were sex differences, with higher perceived comprehension and lower objective comprehension among female than male individuals. Living in an urban or a rural area had no significant effect (all P>.05). The level of education and income had a positive effect on both subjective and objective comprehension. Finally, the belief in science had a positive effect on perceived comprehension (P<.001) but did not have a statistically significant effect on objective comprehension (P=.87). Conclusions: The main differences between those who think they understand pandemic communication and those who comprehend it better are sex (female individuals have a higher perception of having comprehended, while male individuals have higher levels of objective comprehension) and belief in science (higher belief in science leads to higher perceived comprehension, while it does not have any impact on objectively understanding the message conveyed). UR - https://www.jmir.org/2024/1/e48882 UR - http://dx.doi.org/10.2196/48882 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48882 ER - TY - JOUR AU - Golsong, Konstanze AU - Kaufmann, Luisa AU - Baldofski, Sabrina AU - Kohls, Elisabeth AU - Rummel-Kluge, Christine PY - 2024/12/4 TI - Acceptability, User Satisfaction, and Feasibility of an App-Based Support Service During the COVID-19 Pandemic in a Psychiatric Outpatient Setting: Prospective Longitudinal Observational Study JO - JMIR Form Res SP - e60461 VL - 8 KW - mental health KW - eHealth KW - app KW - health care KW - app-based support KW - psychiatric symptoms KW - mobile phone KW - COVID-19 N2 - Background: Patients with mental disorders often have difficulties maintaining a daily routine, which can lead to exacerbated symptoms. It is known that apps can help manage mental health in a low-threshold way and can be used in therapeutic settings to complement existing therapies. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of an app-based support service specifically developed for outpatients with severe mental disorders in addition to regular face-to-face therapy during the COVID-19 pandemic. Methods: Patients in a psychiatric outpatient department at a German university hospital were invited to use an app-based support service designed transdiagnostically for mental disorders for 4 weeks. The app included 7 relaxation modules, consisting of video, audio, and psychoeducational text; ecological momentary assessment?like questionnaires on daily mood answered via a visual smiley-face scale; and an activity button to record and encourage daily activities. Standardized questionnaires at baseline (T0; preintervention time point) and after 4 weeks (T2; postintervention time point) were analyzed. Feedback via the smiley-face scale was provided after using the app components (T1; during the intervention). Measures included depressive symptoms, quality of life, treatment credibility and expectancy, and satisfaction. Furthermore, participation rates, use of app modules and the activity button, and daily mood and the provided feedback were analyzed (T2). Results: In total, 57 patients participated in the study, and the data of 38 (67%) were analyzed; 17 (30%) dropped out. Satisfaction with the app was high, with 53% (30/57) of the participants stating being rather satisfied or satisfied. Furthermore, 79% (30/38) of completers stated they would be more likely or were definitely likely to use an app-based support service again and recommend it. Feasibility and acceptability were high, with nearly half (18/38, 47%) of the completers trying relaxation modules and 71% (27/38) regularly responding to the ecological momentary assessment?like questionnaire between 15 and 28 times (mean 19.91, SD 7.57 times). The activity button was used on average 12 (SD 15.72) times per completer, and 58% (22/38) felt ?definitely? or ?rather? encouraged to perform the corresponding activities. Depressive symptomatology improved significantly at the postintervention time point (P=.02). Quality of life showed a nonsignificant increase in the physical, psychological, and social domains (P=.59, P=.06, and P=.42, respectively) and a significant improvement in the environment domain (P=.004). Treatment credibility and expectancy scores were moderate and significantly decreased at T2 (P=.02 and P<.001, respectively). Posttreatment expectancy scores were negatively associated with posttreatment depressive symptomatology (r=?0.36; P=.03). Conclusions: App-based programs seem to be an accessible tool for stabilizing patients with severe mental disorders, supporting them in maintaining a daily routine, complementing existing face-to-face treatments, and overall helping respond to challenging situations such as the COVID-19 pandemic. UR - https://formative.jmir.org/2024/1/e60461 UR - http://dx.doi.org/10.2196/60461 UR - http://www.ncbi.nlm.nih.gov/pubmed/39630503 ID - info:doi/10.2196/60461 ER - TY - JOUR AU - Jagomast, Tobias AU - Finck, Jule AU - Tangemann-Münstedt, Imke AU - Auth, Katharina AU - Drömann, Daniel AU - Franzen, F. Klaas PY - 2024/12/3 TI - Google Trends Assessment of Keywords Related to Smoking and Smoking Cessation During the COVID-19 Pandemic in 4 European Countries: Retrospective Analysis JO - Online J Public Health Inform SP - e57718 VL - 16 KW - internet KW - coronavirus KW - COVID-19 KW - SARS-CoV-2 KW - pandemics KW - public health KW - smoking cessation KW - tobacco products KW - Google Trends KW - relative search volume KW - Europe KW - online KW - search KW - smoking KW - addiction KW - quit KW - cessation KW - trend KW - cluster KW - public interest KW - lockdown KW - vaccination KW - spread KW - incidence N2 - Background: Smoking is a modifiable risk factor for SARS-CoV-2 infection. Evidence of smoking behavior during the pandemic is ambiguous. Most investigations report an increase in smoking. In this context, Google Trends data monitor real-time public information?seeking behavior and are therefore useful to characterize smoking-related interest over the trajectory of the pandemic. Objective: This study aimed to use Google Trends data to evaluate the effect of the pandemic on public interest in smoking-related topics with a focus on lockdowns, vaccination campaigns, and incidence. Methods: The weekly relative search volume was retrieved from Google Trends for England, Germany, Italy, and Spain from December 31, 2017, to April 18, 2021. Data were collected for keywords concerning consumption, cessation, and treatment. The relative search volume before and during the pandemic was compared, and general trends were evaluated using the Wilcoxon rank-sum test. Short-term changes and hereby temporal clusters linked to lockdowns or vaccination campaigns were addressed by the flexible spatial scan statistics proposed by Takahashi and colleagues. Subsequently, the numbers of clusters after the onset of the pandemic were compared by chi-square test. Results: Country-wise minor differences were observed while 3 overarching trends prevailed. First, regarding cessation, the statistical comparison revealed a significant decline in interest for 58% (7/12) of related keywords, and fewer clusters were present during the pandemic. Second, concerning consumption, significantly reduced relative search volume was observed for 58% (7/12) of keywords, while treatment-related keywords exhibited heterogeneous trends. Third, substantial clusters of increased interest were sparsely linked to lockdowns, vaccination campaigns, or incidence. Conclusions: This study reports a substantial decline in overall relative search volume and clusters for cessation interest. These results underline the importance of intensifying cessation aid during times of crisis. Lockdowns, vaccination, and incidence had less impact on information-seeking behavior. Other public measures that positively affect smoking behavior remain to be determined. UR - https://ojphi.jmir.org/2024/1/e57718 UR - http://dx.doi.org/10.2196/57718 UR - http://www.ncbi.nlm.nih.gov/pubmed/39626237 ID - info:doi/10.2196/57718 ER - TY - JOUR AU - Richardson, Leanne AU - Noori, Nihal AU - Fantham, Jack AU - Timlin, Gregor AU - Siddle, James AU - Godec, Thomas AU - Taylor, Mike AU - Baum, Charles PY - 2024/12/3 TI - Personalized Smartphone-Enabled Assessment of Blood Pressure and Its Treatment During the SARS-CoV-2 COVID-19 Pandemic in Patients From the CURE-19 Study: Longitudinal Observational Study JO - JMIR Mhealth Uhealth SP - e53430 VL - 12 KW - digital diary KW - hypertension KW - blood pressure KW - remote monitoring KW - smartphone app KW - mobile phone KW - app KW - monitoring KW - COVID-19 KW - SARS-CoV-2 KW - digital intervention KW - management KW - observational study KW - deployment KW - feasibility KW - use KW - safety KW - medication KW - symptoms KW - community KW - systolic KW - diastolic KW - utilization N2 - Background: The use of digital interventions by patients for remote monitoring and management of health and disease is increasing. This observational study examined the feasibility, use, and safety of a digital smartphone app for routine monitoring of blood pressure (BP), medication, and symptoms of COVID-19 during the COVID-19 pandemic. Objective: The objective of this study was to deploy and test electronic data recording using a smartphone app developed for routine monitoring of BP in patients with primary hypertension. We tested the app for ease of data entry in BP management and tracking symptoms of new-onset COVID-19 to determine if participants found this app approach useful and sustainable. Methods: This remote, decentralized, 12-week, prospective, observational study was conducted in a community setting within the United States. Participants were approached and recruited from affiliated sites where they were enrolled in an ongoing remote decentralized study (CURE-19) of participants experiencing the COVID-19 pandemic. Potential participants were asked to complete a digital screener to determine eligibility and given informed consent forms to read and consent to using the Curebase digital platform. Following enrollment, participants downloaded the digital app to their smartphones for all data collection. Participants recorded daily BP, associated medication use, and emergent symptoms associated with SARS-CoV-2 infection. In addition, usability (adherence, acceptability, and user experience) was assessed using standard survey questions. Adverse events were collected based on participant self-report. Compliance and engagement were determined from user data entry rates. Feasibility and participant feedback were assessed upon study completion using the User Experience Questionnaire. Results: Of the 389 participants who enrolled in and completed the study, 380 (98%) participants downloaded and entered BP routines in week 1. App engagement remained high; 239 (62.9%) of the 380 participants remained in the study for the full 12-week observation period, and 201 (84.1%) of the 239 participants entered full BP routines into the digital app 80% or more of the time. The smartphone app scored an overall positive evaluation as assessed by the User Experience Questionnaire and was benchmarked as ?excellent? for domains of perspicuity, efficiency, and dependability and ?above average? for domains of attractiveness and stimulation. Highly adherent participants with hypertension demonstrated well-controlled BP, with no significant changes in average systolic or diastolic BP between week 1 and week 12 (all P>.05). Participants were able to record BP medications and symptoms of SARS-CoV-2 infection. No adverse events attributable to the use of the smartphone app were reported during the observational period. Conclusions: The high retention, engagement and acceptability and positive feedback in this study demonstrates that routine monitoring of BP and medications using a smartphone app is feasible for patients with hypertension in a community setting. Remote monitoring of BP and data collection could be coupled with hypertensive medication in a combination product (drug+digital) for precision management of hypertension. UR - https://mhealth.jmir.org/2024/1/e53430 UR - http://dx.doi.org/10.2196/53430 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53430 ER - TY - JOUR AU - Charles, Lesley AU - Tang, Eileen AU - Tian, Jaminal Peter George AU - Chan, Karenn AU - Brémault-Phillips, Suzette AU - Dobbs, Bonnie AU - Vokey, Camelia AU - Polard, Sharna AU - Parmar, Jasneet PY - 2024/11/25 TI - Characteristics, Barriers, and Facilitators of Virtual Decision-Making Capacity Assessments During the COVID-19 Pandemic: Online Survey JO - JMIR Form Res SP - e60574 VL - 8 KW - decision making capacity KW - mental competency KW - aged KW - mobile applications KW - mobile phone KW - Canada KW - covid-19 KW - pandemics KW - dementia KW - survey KW - virtual capacity assessment KW - characteristics KW - barriers KW - facilitators KW - virtual decision making KW - assessment N2 - Background: With a growing older adult population, the number of persons with dementia is expected to rise. Consequently, the number of persons needing decision-making capacity assessments (DMCA) will increase. The COVID-19 pandemic has impacted how we deliver patient care including DMCAs with a much more rapid shift to virtual assessments. Virtual DMCAs offer patients and health care professionals distinct advantages over in-person delivery by improving reach, access, and timely provision of health care. However, questions have arisen as to whether DMCAs can be effectively conducted virtually. Objective: This study aimed to determine the characteristics, barriers, and facilitators of conducting virtual DMCA during the COVID-19 pandemic. Methods: We conducted an online survey among health care providers who perform DMCAs in Alberta from March 2022 to February 2023. The survey consisted of 25 questions on demographics, preferences, and experience in conducting DMCAs virtually, and risks and barriers to doing virtual DMCAs. The data were analyzed using descriptive statistics. Results: There were 31 respondents with a mean age of 51.1 (SD 12.7) years. The respondents consisted of physicians (45.2%, 14/31), occupational therapists (29%, 9/31), and social workers (16.1%, 5/31), with a majority (93.6%, 29/31) based in Edmonton. The mean number of years of experience conducting DMCAs was 12.3 (SD 10.7), with a median of 8 DMCAs (IQR 18.5) conducted per year. Most respondents conduct capacity interviews, with a majority (55.2%, 16/29) being associated primarily with acute care services. Furthermore, 54.8% (17/31) were interested in conducting DMCAs virtually; however, only 25.8% (8/31) had administered DMCAs virtually. Barriers and facilitators to virtual DMCAs relate to patients? characteristics and environment (such as communication difficulties, hearing or visual impairment, language barriers, ease of use of technology, or cognitive impairment), technology and technical support (need for technical support in both the client?s and assessor?s sides, the unreliability of internet connection in rural settings, and the availability of high-fidelity equipment), and assessors? ability to perform DMCA?s virtually (ability to observe body language, interact with the client physically when needed, and build rapport can all be affected when conducting a DMCA virtually). In terms of implications for clinical practice, it is recommended that the patient or caregiver be familiar with technology, have a stable internet connection, use a private room, not be recorded, use a standardized assessment template, and have a backup plan in case of technical difficulties. Conclusions: Conducting DMCAs virtually is a relatively infrequent undertaking. Barriers and facilitators to adequate assessment need to be addressed given that virtual assessments are time-saving and expand reach. UR - https://formative.jmir.org/2024/1/e60574 UR - http://dx.doi.org/10.2196/60574 UR - http://www.ncbi.nlm.nih.gov/pubmed/39585735 ID - info:doi/10.2196/60574 ER - TY - JOUR AU - Kang, Ye Ji AU - Jung, Weon AU - Kim, Ji Hyun AU - An, Hyun Ji AU - Yoon, Hee AU - Kim, Taerim AU - Chang, Hansol AU - Hwang, Yeon Sung AU - Park, Eun Jong AU - Lee, Tak Gun AU - Cha, Chul Won AU - Heo, Sejin AU - Lee, Uk Se PY - 2024/11/20 TI - Temporary Telemedicine Policy and Chronic Disease Management in South Korea: Retrospective Analysis Using National Claims Data JO - JMIR Public Health Surveill SP - e59138 VL - 10 KW - telemedicine KW - public health KW - medication adherence KW - COVID-19 KW - chronic diseases N2 - Background: Since its introduction, telemedicine for patients with chronic diseases has been studied in various clinical settings. However, there is limited evidence of the effectiveness and medical safety of the nationwide adoption of telemedicine. Objective: This study aimed to analyze the effects of telemedicine on chronic diseases during the COVID-19 pandemic under a temporary telemedicine policy in South Korea using national claims data. Methods: Health insurance claims data were extracted over 2 years: 1 year before (from February 24, 2019, to February 23, 2020) and 1 year after the policy was implemented (from February 24, 2020, to February 23, 2021). We included all patients who used telemedicine at least once in the first year after the policy was implemented and compared them with a control group of patients who never used telemedicine. The comparison focused on health care use; the medication possession ratio (MPR); and admission rates to general wards (GWs), emergency departments (EDs), and intensive care units (ICUs) using difference-in-differences analysis. A total of 4 chronic diseases were targeted: hypertension, diabetes mellitus (DM), chronic obstructive pulmonary disease (COPD), and common mental disorders. Results: A total of 1,773,454 patients with hypertension; 795,869 patients with DM; 37,460 patients with COPD; and 167,084 patients with common mental disorders were analyzed in this study. Patients diagnosed with hypertension or DM showed increased MPRs without an increase in GW, ED, or ICU admission rates during the policy year. Moreover, patients in the DM group who did not use telemedicine had higher rates of ED, GW, and ICU admissions, and patients in the hypertension group had higher rates of GW or ICU admissions after 1 year of policy implementation. This trend was not evident in COPD and common mental disorders. Conclusions: The temporary telemedicine policy was effective in increasing medication adherence and reducing admission rates for patients with hypertension and DM; however, the efficacy of the policy was limited for patients with COPD and common mental disorders. Future studies are required to demonstrate the long-term effects of telemedicine policies with various outcome measures reflecting disease characteristics. UR - https://publichealth.jmir.org/2024/1/e59138 UR - http://dx.doi.org/10.2196/59138 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59138 ER - TY - JOUR AU - Cornelis, Justien AU - Christiaens, Wendy AU - de Meester, Christophe AU - Mistiaen, Patriek PY - 2024/11/19 TI - Remote Patient Monitoring at Home in Patients With COVID-19: Narrative Review JO - JMIR Nursing SP - e44580 VL - 7 KW - COVID-19 KW - coronavirus disease KW - telemonitoring KW - remote patient monitoring KW - review KW - pandemic KW - at-home monitoring KW - implementation KW - health care KW - patient care N2 - Background: During the pandemic, health care providers implemented remote patient monitoring (RPM) for patients experiencing COVID-19. RPM is an interaction between health care professionals and patients who are in different locations, in which certain patient functioning parameters are assessed and followed up for a certain duration of time. The implementation of RPM in these patients aimed to reduce the strain on hospitals and primary care. Objective: With this literature review, we aim to describe the characteristics of RPM interventions, report on patients with COVID-19 receiving RPM, and provide an overview of outcome variables such as length of stay (LOS), hospital readmission, and mortality. Methods: A combination of different searches in several database types (traditional databases, trial registers, daily [Google] searches, and daily PubMed alerts) was run daily from March 2020 to December 2021. A search update for randomized controlled trials (RCTs) was performed in April 2022. Results: The initial search yielded more than 4448 articles (not including daily searches). After deduplication and assessment for eligibility, 241 articles were retained describing 164 telemonitoring studies from 160 centers. None of the 164 studies covering 248,431 patients reported on the presence of a randomized control group. Studies described a ?prehosp? group (96 studies) with patients who had a suspected or confirmed COVID-19 diagnosis and who were not hospitalized but closely monitored at home or a ?posthosp? group (32 studies) with patients who were monitored at home after hospitalization for COVID-19. Moreover, 34 studies described both groups, and in 2 studies, the description was unclear. In the prehosp and posthosp groups, there were large variations in the number of emergency department (ED) visits (0%-36% and 0%-16%, respectively) and no convincing evidence that RPM leads to less or more ED visits or hospital readmissions (0%-30% and 0%-22%, respectively). Mortality was generally low, and there was weak to no evidence that RPM is associated with lower mortality. Moreover, there was no evidence that RPM shortens previous LOS. A literature update identified 3 small-scale RCTs, which could not demonstrate statistically significant differences in these outcomes. Most papers claimed savings; however, the scientific base for these claims was doubtful. The overall patient experiences with RPM were positive, as patients felt more reassured, although many patients declined RPM for several reasons (eg, technological embarrassment, digital literacy). Conclusions: Based on these results, there is no convincing evidence that RPM in COVID-19 patients avoids ED visits or hospital readmissions and shortens LOS or reduces mortality. On the other hand, there is no evidence that RPM has adverse outcomes. Further research should focus on developing, implementing, and evaluating an RPM framework. UR - https://nursing.jmir.org/2024/1/e44580 UR - http://dx.doi.org/10.2196/44580 UR - http://www.ncbi.nlm.nih.gov/pubmed/39287362 ID - info:doi/10.2196/44580 ER - TY - JOUR AU - Phadnis, Rachael AU - Perera, Udara AU - Lea, Veronica AU - Davlin, Stacy AU - Lee, Juliette AU - Siesel, Casey AU - Abeygunathilaka, Dhanushka AU - Wickramasinghe, C. S. PY - 2024/11/8 TI - Designing and Validating a Survey for National-Level Data During the COVID-19 Pandemic in Sri Lanka: Cross-Sectional Mobile Phone Surveys JO - JMIR Form Res SP - e49708 VL - 8 KW - pilot study KW - mobile phone survey KW - survey methodology KW - COVID-19 KW - data collection KW - national survey KW - pandemic KW - population-based study KW - Sri Lanka KW - middle-income countries KW - low-income countries KW - vaccine acceptability KW - vaccine KW - COVID-19 vaccination N2 - Background: The COVID-19 pandemic has generated a demand for timely data, resulting in a surge of mobile phone surveys for tracking the impacts of and responses to the pandemic. Mobile phone surveys have become a preferred mode of data collection across low- and middle-income countries. Objective: This study piloted 2 population-based, cross-sectional mobile phone surveys among Sri Lankan residents in 2020 and 2021 during the COVID-19 pandemic. The surveys aimed to gather data on knowledge, attitudes, and practices, vaccine acceptability, availability, and barriers to COVID-19 testing, and use of a medicine distribution service. Methods: The study used Surveda, an open-source survey tool developed by the NCD (noncommunicable disease) Mobile Phone Survey Data 4 Health Initiative, for data collection and management. The surveys were conducted through interactive voice response using automated, prerecorded messages in Sinhala, Tamil, and English. The sample design involved random sampling of mobile phone numbers, stratified by sex, proportional to the general population. Eligibility criteria varied between surveys, targeting adults aged 35 years and older with any noncommunicable disease for the first survey and all adults for the second survey. The data were adjusted to population estimates, and statistical analysis was conducted using SAS (SAS Institute) and R software (R Core Team). Descriptive statistics, Rao-Scott chi-square tests, and z tests were used to analyze the data. Response rates, cooperation rates, and productivity of the sampling approach were calculated. Results: In the first survey, n=5001, the overall response rate was 7.5%, with a completion rate of 85.6%. In the second survey, n=1250, the overall response rate was 10.9%, with a completion rate of 61.9%. Approximately 3 out of 4 adults reported that they avoided public places (888/1175, 75.6%), more than two-thirds avoided public transportation (808/1173, 68.9%), and 9 out of 10 practiced physical distancing (1046/1167, 89.7%). Approximately 1 out of 10 Sri Lankan persons reported being tested for COVID-19, and the majority of those received a polymerase chain reaction test (112/161, 70%). Significantly more males than females reported being tested for COVID-19 (98/554, 17.8% vs 61/578, 10.6%, respectively; P<.001). Finally, the majority of adult Sri Lankan people reported that they definitely or probably would get the COVID-19 vaccination (781/1190, 65.7%). Conclusions: The surveys revealed that, overall, the adult Sri Lankan population adhered to COVID-19 mitigation strategies. These findings underscore the use of mobile phone surveys in swiftly and easily providing essential data to inform a country?s response during the COVID-19 pandemic, obviating the need for face-to-face data collection. UR - https://formative.jmir.org/2024/1/e49708 UR - http://dx.doi.org/10.2196/49708 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49708 ER - TY - JOUR AU - Chen, En-ling AU - Bai, Chyi-Huey AU - Kocis, T. Paul AU - Hwang, Wenke PY - 2024/10/24 TI - The Perspectives of Community Pharmacists Toward the Name-Based Rationing System During the COVID-19 Pandemic in Taiwan: Cross-Sectional Survey Study JO - JMIR Form Res SP - e60000 VL - 8 KW - name-based rationing system KW - NBRS KW - community pharmacy KW - community pharmacist KW - COVID-19 KW - SARS-CoV-2 KW - KAP KW - knowledge, attitude, and practices KW - public health KW - health emergencies KW - government strategy KW - mobile phone N2 - Background: In Taiwan?s public health system, community-based pharmacists are key first-line health care providers due to their high accessibility. During the COVID-19 pandemic, the pharmacists played a central role in the distribution of these supplies through the Name-Based Rationing System (NBRS), during an acute shortage of masks and testing kits, that helped reduce the spread of the disease. The NBRS, an innovative government-guided strategy developed after the COVID-19 outbreak, provided equitable and convenient access to masks and COVID-19 test kits. Objective: This study aimed to investigate (1) Taiwanese pharmacists? knowledge, attitude, and practices (KAPs) of COVID-19, with the intention to assess their preparedness for public health emergencies and their capabilities to implement COVID-19?related policies effectively; (2) their perspectives toward the NBRS; and (3) the association between individual?s KAP and corresponding perspectives toward the NBRS. Methods: A cross-sectional, web-based survey was conducted in 2 major cities in Taiwan, from June 18 to September 11, 2022, during the peak of the COVID-19 pandemic. To gauge community pharmacists? KAP, a 66-question instrument was developed using guidelines from the Taiwanese Centers for Disease Control, the International Pharmaceutical Federation, and the Taiwanese Pharmacist Association. The instrument?s internal consistency reliability was ascertained using Cronbach ? (0.819), and its content validity was verified by field experts. Results: Overall, 343 Taiwanese community pharmacists were recruited in the study. Among them, 88% (303/343) scored high on knowledge domain questions related to SARS-CoV-2; 58% (201/343) and 39% (136/343) held positive and neutral attitudes toward COVID-19?related policies, respectively; and 77% (266/343) practiced infectious disease prevention measures in compliance with official guidelines. The results demonstrated a high level of competency in pharmacists in a public health crisis. It revealed that factors including age, pharmacy characteristics, and the number of customers were associated with their perceptions and willingness to continuously participate in the NBRS. Overall, the community pharmacists showed greater support for the COVID-19?testing NBRS compared with the mask NBRS, because of the more favorable influence on the revenue and workforce of the pharmacies and the well-being of the pharmacists. Responses also highlighted concerns about rapid government policy changes and supply dynamics, underscoring the importance of effective communication and considering supply availability in facilitating a successful NBRS. Conclusions: The strong KAP of the community pharmacists justified the government leveraging their expertise in Taiwan?s COVID-19 response. While community pharmacies have proven to be essential distribution centers through the NBRS, improving community connections, communication with the government, and supply management are recommended to strengthen the system. These potential approaches aim to ensure successful NBRS implementation and better preparedness for future public health emergencies. Overall, pharmacists have demonstrated their integral role in achieving equitable outcomes and their dedication to public health efforts during crises. UR - https://formative.jmir.org/2024/1/e60000 UR - http://dx.doi.org/10.2196/60000 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60000 ER - TY - JOUR AU - Kilaberia, R. Tina AU - Hu, Yuanyuan AU - Bell, F. Janice PY - 2024/10/18 TI - Habit and Help?Experiences of Technology Use During the COVID-19 Pandemic: Interview Study Among Older Adults JO - JMIR Form Res SP - e58242 VL - 8 KW - pandemic KW - older people KW - technology habit KW - subjective experience KW - acceptance of technology N2 - Background: The COVID-19 pandemic compelled older adults to engage with technology to a greater extent given emergent public health observance and home-sheltering restrictions in the United States. This study examined subjective experiences of technology use among older adults as a result of unforeseen and widespread public health guidance catalyzing their use of technology differently, more often, or in new ways. Objective: This study aimed to explore whether older adults scoring higher on the Unified Theory of Acceptance and Use of Technology questionnaire fared better in aspects of technology use, and reported better subjective experiences, in comparison with those scoring lower. Methods: A qualitative study using prevalence and thematic analyses of data from 18 older adults (mean age 79 years) in 2 groups: 9 scoring higher and 9 scoring lower on the Unified Theory of Acceptance and Use of Technology questionnaire. Results: Older adults were fairly competent technology users across both higher- and lower-scoring groups. The higher-scoring group noted greater use of technology in terms of telehealth and getting groceries and household items. Cognitive difficulty was described only among the lower-scoring group; they used technology less to get groceries and household items and to obtain health information. Qualitative themes depict the role of habit in technology use, enthusiasm about technology buttressed by the protective role of technology, challenges in technology use, and getting help regardless of technology mastery. Conclusions: Whereas the pandemic compelled older adults to alter or increase technology use, it did not change their global outlook on technology use. Older adults? prepandemic habits of technology use and available help influenced the degree to which they made use of technology during the COVID-19 pandemic. UR - https://formative.jmir.org/2024/1/e58242 UR - http://dx.doi.org/10.2196/58242 UR - http://www.ncbi.nlm.nih.gov/pubmed/39422990 ID - info:doi/10.2196/58242 ER - TY - JOUR AU - Szeto, D. Mindy AU - Laughter, R. Melissa AU - Maymone, C. Mayra B. AU - Patel, M. Payal AU - Sivesind, E. Torunn AU - Presley, L. Colby AU - Lada, M. Steven AU - Pulsipher, J. Kayd AU - De La Garza, Henriette AU - Dellavalle, P. Robert PY - 2024/10/16 TI - Gender Representation in Authorship of Academic Dermatology Publications During the COVID-19 Pandemic: Cross-Sectional Study JO - JMIR Dermatol SP - e50396 VL - 7 KW - women KW - gender KW - representation KW - authorship KW - academic KW - leadership KW - diversity KW - equity KW - inclusion KW - dermatology KW - journals KW - publications KW - COVID-19 KW - pandemic KW - bibliometric UR - https://derma.jmir.org/2024/1/e50396 UR - http://dx.doi.org/10.2196/50396 ID - info:doi/10.2196/50396 ER - TY - JOUR AU - Hirschtick, L. Jana AU - Slocum, Elizabeth AU - Xie, Yanmei AU - Power, E. Laura AU - Elliott, R. Michael AU - Orellana, C. Robert AU - Fleischer, L. Nancy PY - 2024/10/1 TI - Associations Between Acute COVID-19 Symptom Profiles and Long COVID Prevalence: Population-Based Cross-Sectional Study JO - JMIR Public Health Surveill SP - e55697 VL - 10 KW - SARS-CoV-2 KW - COVID-19 KW - post-acute COVID-19 syndrome KW - epidemiology KW - surveillance N2 - Background: Growing evidence suggests that severe acute COVID-19 illness increases the risk of long COVID (also known as post?COVID-19 condition). However, few studies have examined associations between acute symptoms and long COVID onset. Objective: This study aimed to examine associations between acute COVID-19 symptom profiles and long COVID prevalence using a population-based sample. Methods: We used a dual mode (phone and web-based) population-based probability survey of adults with polymerase chain reaction?confirmed SARS-CoV-2 between June 2020 and May 2022 in the Michigan Disease Surveillance System to examine (1) how acute COVID-19 symptoms cluster together using latent class analysis, (2) sociodemographic and clinical predictors of symptom clusters using multinomial logistic regression accounting for classification uncertainties, and (3) associations between symptom clusters and long COVID prevalence using modified Poisson regression. Results: In our sample (n=4169), 15.9% (n=693) had long COVID, defined as new or worsening symptoms at least 90 days post SARS-CoV-2 infection. We identified 6 acute COVID-19 symptom clusters resulting from the latent class analysis, with flu-like symptoms (24.7%) and fever (23.6%) being the most prevalent in our sample, followed by nasal congestion (16.4%), multi-symptomatic (14.5%), predominance of fatigue (10.8%), and predominance of shortness of breath (10%) clusters. Long COVID prevalence was highest in the multi-symptomatic (39.7%) and predominance of shortness of breath (22.4%) clusters, followed by the flu-like symptom (15.8%), predominance of fatigue (14.5%), fever (6.4%), and nasal congestion (5.6%) clusters. After adjustment, females (vs males) had greater odds of membership in the multi-symptomatic, flu-like symptom, and predominance of fatigue clusters, while adults who were Hispanic or another race or ethnicity (vs non-Hispanic White) had greater odds of membership in the multi-symptomatic cluster. Compared with the nasal congestion cluster, the multi-symptomatic cluster had the highest prevalence of long COVID (adjusted prevalence ratio [aPR] 6.1, 95% CI 4.3?8.7), followed by the predominance of shortness of breath (aPR 3.7, 95% CI 2.5?5.5), flu-like symptom (aPR 2.8, 95% CI 1.9?4.0), and predominance of fatigue (aPR 2.2, 95% CI 1.5?3.3) clusters. Conclusions: Researchers and clinicians should consider acute COVID-19 symptom profiles when evaluating subsequent risk of long COVID, including potential mechanistic pathways in a research context, and proactively screen high-risk patients during the provision of clinical care. UR - https://publichealth.jmir.org/2024/1/e55697 UR - http://dx.doi.org/10.2196/55697 ID - info:doi/10.2196/55697 ER - TY - JOUR AU - Dominguez-Rodriguez, Alejandro AU - Sanz-Gomez, Sergio AU - González Ramírez, Patricia Leivy AU - Herdoiza-Arroyo, Erika Paulina AU - Trevino Garcia, Edith Lorena AU - de la Rosa-Gómez, Anabel AU - González-Cantero, Omar Joel AU - Macias-Aguinaga, Valeria AU - Arenas Landgrave, Paulina AU - Chávez-Valdez, Margarita Sarah PY - 2024/9/30 TI - Evaluation and Future Challenges in a Self-Guided Web-Based Intervention With and Without Chat Support for Depression and Anxiety Symptoms During the COVID-19 Pandemic: Randomized Controlled Trial JO - JMIR Form Res SP - e53767 VL - 8 KW - self-guided web-based intervention KW - chat support KW - depression KW - anxiety KW - COVID-19 KW - opinion KW - usability KW - randomized control trial N2 - Background: The COVID-19 pandemic has had an impact on mental health worldwide. Low- and middle-income countries were largely affected by it. Mexico was one of the most affected countries. Extended periods of lockdowns, isolation, and social distancing, among other factors, highlighted the need to introduce web-based psychological interventions to the Mexican population. In this context, Mental Health COVID-19 emerged as a self-guided web-based intervention (SGWI) aimed at adults to improve mental health during the COVID-19 pandemic. Objective: This study aims to assess the efficacy of 2 modalities of a self-guided intervention (with and without chat support) in reducing depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation. In addition, it aimed to compare the moderating role of coping strategies, acceptance, and satisfaction in participants? symptom reduction. We hypothesize that the self-guided, chat-supported modality will show higher efficacy than the modality without chat support in achieving clinical change and better performance as a moderator of depression symptoms, generalized anxiety, community posttraumatic stress, widespread fear, anxiety, sleep quality, physiological and affective coping, and suicide ideation, as well as an increase in participants? satisfaction and acceptability. Methods: A randomized controlled trial was conducted. Data were collected from May 2020 to June 2022. We performed intrasubject measures at 4 evaluation periods: pretest, posttest, and follow-up measurements at 3 and 6 months. Differences between intervention groups were assessed through the Mann-Whitney U test for continuous variables and the chi-square test for categorical variables. Changes due to intervention were analyzed using Wilcoxon W test. Moderated regression analysis was performed to test the hypothesized moderating role of coping strategies, usability, and opinion about treatment on clinical change. Results: A total of 36 participants completed the intervention; of these, 5 (14%) were part of the SGWI group, and 31 (86%) were on the SGWI plus chat support (SGWI+C) group, which included a chat service with therapists. The perceived high complexity of the system for the SGWI group had a moderating effect associated with a lack of efficacy of the intervention regarding depression, but not when controlled for sociodemographic variables. A perception of lower helpfulness of the intervention was associated with poorer outcomes. Coping strategies did not show moderating effects. Conclusions: Enhancing the utility of web-based interventions for reducing clinical symptoms by incorporating a support chat to boost treatment adherence seemed to improve the perception of the intervention?s usefulness. Web-based interventions face several challenges, such as eliminating complexities in platform use and increasing the users? perceived utility of the intervention, among other issues identified in the study. Trial Registration: ClinicalTrials.gov NCT04468893; https://clinicaltrials.gov/study/NCT04468893?tab=results International Registered Report Identifier (IRRID): RR2-10.2196/23117 UR - https://formative.jmir.org/2024/1/e53767 UR - http://dx.doi.org/10.2196/53767 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53767 ER - TY - JOUR AU - Escobar-Agreda, Stefan AU - Silva-Valencia, Javier AU - Soto-Becerra, Percy AU - Reategui-Rivera, Mahony C. AU - De la Cruz-Torralva, Kelly AU - Chahuara-Rojas, Max AU - Hernandez-Iriarte, Bruno AU - Espinoza-Herrera, Hector Daniel AU - Delgado, Alberto Carlos AU - Matassini, Silvana AU - Vargas-Herrera, Javier AU - Rojas-Mezarina, Leonardo PY - 2024/9/13 TI - Patient Engagement With and Perceptions of the COVIDA Project, a Volunteer-Led Telemonitoring and Teleorientation Service for COVID-19 Community Management: Mixed Methods Study JO - JMIR Form Res SP - e51237 VL - 8 KW - telemonitoring KW - volunteers KW - engagement KW - COVID-19 KW - Peru KW - telehealth KW - perceptions N2 - Background: During the pandemic in Peru, the COVIDA (Collaboration Network of Volunteer Brigade Members for the Investigation, Detection, and Primary Management of Community Cases Affected by COVID-19) project proposed an innovative way to provide telemonitoring and teleorientation to COVID-19 patients, led by health care student volunteers. However, it has not been described how this interaction is perceived from the patient?s perspective and which factors increase their engagement with this service. Objective: The aim of this study is to describe the perceptions of patients about COVIDA and identify factors associated with their engagement with this service. Methods: A mixed methods study was conducted to evaluate perceptions of patients that participated in the COVIDA project. This telehealth intervention organized by the National University of San Marcos was implemented in Peru from August to December 2020. The service involved daily phone calls by volunteer students to monitor registered COVID-19 patients until the completion of the 14th day of the illness or if a warning sign was identified. The volunteers also provided teleorientation to address the patients? needs and concerns. Quantitative analysis was performed to describe the characteristics of the patients and to assess the factors related to their engagement with the service, which was defined by the percentage of participants who completed the follow-up according to their individual schedule. Qualitative analysis through semistructured interviews evaluated the patients? perceptions of the service regarding the aspects of communication, interaction, and technology. Results: Of the 770 patients enrolled in COVIDA, 422 (55.7%) were female; the median age was 39 (IQR 28-52) years. During the monitoring, 380 patients (49.4%) developed symptoms, and 471 (61.2%) showed warning signs of COVID-19. The overall median for engagement was 93% (IQR 35.7%-100%). Among those patients who did not develop warning signs, engagement was associated with the presence of symptoms (OR 3.04, 95% CI 2.22-4.17), a positive COVID-19 test at the start of follow-up (OR 1.97, 95% CI 1.48-2.61), and the presence of comorbidities (OR 1.83, 95% CI 1.29-2.59). Patients reported that the volunteers provided clear and valuable information and emotional support. Communication via phone calls took place smoothly and without interruptions. Conclusions: COVIDA represents a well-accepted and well-perceived alternative model for student volunteers to provide telemonitoring, teleorientation, and emotional support to patients with COVID-19 in the context of overwhelmed demand for health care services. The deployment of this kind of intervention should be prioritized among patients with symptoms and comorbidities, as they show more engagement with these services. UR - https://formative.jmir.org/2024/1/e51237 UR - http://dx.doi.org/10.2196/51237 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51237 ER - TY - JOUR AU - Abascal Miguel, Lucía AU - Forster, Maeve AU - Gallalee, Sarah AU - Carson, Mariam AU - Fieldhouse, K. Jane AU - Keir, Alexandra AU - Maya, Sigal AU - Rahman, Sabahat AU - Reid, A. Michael J. AU - Vasilopoulos, Hariclea AU - Lima Sanchez, Nimbe Dania PY - 2024/9/9 TI - Bridging Language Barriers in COVID-19 Research: Descriptive Study of AccesoCovid.com?s Reach and User Engagement JO - JMIR Form Res SP - e53978 VL - 8 KW - COVID-19 research dissemination KW - multilingual scientific platform KW - language barriers in science KW - Spanish scientific communication KW - equitable access to research KW - global health equity N2 - Background: The COVID-19 pandemic underscored the challenge of swiftly disseminating research findings to a global audience. Language barriers further exacerbated disparities in access to timely scientific information, particularly for non-English speaking communities. The majority of COVID-19 research was published in English, limiting accessibility for Spanish-speaking populations. Objective: This paper aims to assess the reach and effectiveness of AccesoCovid.com, a platform designed to disseminate up-to-date COVID-19 research in both English and Spanish, addressing the language gap in scientific communication. Methods: AccesoCovid.com was developed through a partnership between the University of California, San Francisco (UCSF) and Universidad Nacional Autónoma de México (UNAM). The website?s performance and user engagement were evaluated using Google Analytics over a span of 2 years. Key metrics included user language preference, geographical distribution, and site traffic. The website summarized and translated 1032 articles on various COVID-19 topics, such as ?Pharmaceutical Interventions and Vaccines.? Results: From February 2021 to February 2023, the platform attracted 57,000 users. Of the 43,000 unique new visitors, 84.2% (n=36,219) hailed from Spanish-speaking regions. The majority accessed the site organically through search engines, with 88.4% (n=38,000) of users arriving this way, while 5000 (11.6%) users accessed the site directly. Most users (n=30,894, 72.1%) preferred the Spanish version of the site. The website?s most accessed category was ?Pharmaceutical Interventions and Vaccines,? followed by ?Clinical Presentation and Management? and ?Mental Health.? Regarding language distribution, 72.1% (n=30,894) of users primarily used Spanish; 21.4% (n=9215) used English; and 6.7% (n=2891) spoke other languages, including Portuguese, Chinese, and German. Geographically, the website attracted visitors from 179 countries, with the highest visitor counts from Mexico (n=12,342, 28.7%), Spain (n=6405, 14.9%), the United States (n=4416, 10.3%), and Peru (n=3821, 8.9%). Conclusions: AccesoCovid.com successfully bridged a critical language gap in the dissemination of COVID-19 research. Its success underscores the pressing need for multilingual scientific resources. The platform demonstrated significant user engagement and reach, particularly in Spanish-speaking countries. This highlights the potential for similar platforms to ensure equitable access to scientific knowledge across diverse linguistic communities. Future efforts should focus on expanding to other languages and conducting formal evaluations to enhance user satisfaction and impact. UR - https://formative.jmir.org/2024/1/e53978 UR - http://dx.doi.org/10.2196/53978 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250219 ID - info:doi/10.2196/53978 ER - TY - JOUR AU - Victoria-Castro, Maria Angela AU - Arora, Tanima AU - Simonov, Michael AU - Biswas, Aditya AU - Alausa, Jameel AU - Subair, Labeebah AU - Gerber, Brett AU - Nguyen, Andrew AU - Hsiao, Allen AU - Hintz, Richard AU - Yamamoto, Yu AU - Soufer, Robert AU - Desir, Gary AU - Wilson, Perry Francis AU - Villanueva, Merceditas PY - 2024/9/3 TI - Promoting Collaborative Scholarship During the COVID-19 Pandemic Through an Innovative COVID-19 Data Explorer and Repository at Yale School of Medicine: Development and Usability Study JO - JMIR Form Res SP - e52120 VL - 8 KW - COVID-19 KW - database KW - data access KW - interdepartmental communication KW - collaborative scholarship KW - clinical data KW - repository KW - researchers KW - large-scale database KW - innovation N2 - Background: The COVID-19 pandemic sparked a surge of research publications spanning epidemiology, basic science, and clinical science. Thanks to the digital revolution, large data sets are now accessible, which also enables real-time epidemic tracking. However, despite this, academic faculty and their trainees have been struggling to access comprehensive clinical data. To tackle this issue, we have devised a clinical data repository that streamlines research processes and promotes interdisciplinary collaboration. Objective: This study aimed to present an easily accessible up-to-date database that promotes access to local COVID-19 clinical data, thereby increasing efficiency, streamlining, and democratizing the research enterprise. By providing a robust database, a broad range of researchers (faculty and trainees) and clinicians from different areas of medicine are encouraged to explore and collaborate on novel clinically relevant research questions. Methods: A research platform, called the Yale Department of Medicine COVID-19 Explorer and Repository (DOM-CovX), was constructed to house cleaned, highly granular, deidentified, and continually updated data from over 18,000 patients hospitalized with COVID-19 from January 2020 to January 2023, across the Yale New Haven Health System. Data across several key domains were extracted including demographics, past medical history, laboratory values during hospitalization, vital signs, medications, imaging, procedures, and outcomes. Given the time-varying nature of several data domains, summary statistics were constructed to limit the computational size of the database and provide a reasonable data file that the broader research community could use for basic statistical analyses. The initiative also included a front-end user interface, the DOM-CovX Explorer, for simple data visualization of aggregate data. The detailed clinical data sets were made available for researchers after a review board process. Results: As of January 2023, the DOM-CovX Explorer has received 38 requests from different groups of scientists at Yale and the repository has expanded research capability to a diverse group of stakeholders including clinical and research-based faculty and trainees within 15 different surgical and nonsurgical specialties. A dedicated DOM-CovX team guides access and use of the database, which has enhanced interdepartmental collaborations, resulting in the publication of 16 peer-reviewed papers, 2 projects available in preprint servers, and 8 presentations in scientific conferences. Currently, the DOM-CovX Explorer continues to expand and improve its interface. The repository includes up to 3997 variables across 7 different clinical domains, with continued growth in response to researchers? requests and data availability. Conclusions: The DOM-CovX Data Explorer and Repository is a user-friendly tool for analyzing data and accessing a consistently updated, standardized, and large-scale database. Its innovative approach fosters collaboration, diversity of scholarly pursuits, and expands medical education. In addition, it can be applied to other diseases beyond COVID-19. UR - https://formative.jmir.org/2024/1/e52120 UR - http://dx.doi.org/10.2196/52120 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52120 ER - TY - JOUR AU - Luong, Nguyen AU - Mark, Gloria AU - Kulshrestha, Juhi AU - Aledavood, Talayeh PY - 2024/9/3 TI - Sleep During the COVID-19 Pandemic: Longitudinal Observational Study Combining Multisensor Data With Questionnaires JO - JMIR Mhealth Uhealth SP - e53389 VL - 12 KW - computational social science KW - digital health KW - COVID-19 KW - sleep KW - longitudinal KW - wearables KW - surveys KW - observational study KW - isolation KW - sleep patterns KW - sleep pattern KW - questionnaires KW - Finland KW - fitness trackers KW - fitness tracker KW - wearable KW - sleeping habits KW - sleeping habit KW - work from home N2 - Background: The COVID-19 pandemic prompted various containment strategies, such as work-from-home policies and reduced social contact, which significantly altered people?s sleep routines. While previous studies have highlighted the negative impacts of these restrictions on sleep, they often lack a comprehensive perspective that considers other factors, such as seasonal variations and physical activity (PA), which can also influence sleep. Objective: This study aims to longitudinally examine the detailed changes in sleep patterns among working adults during the COVID-19 pandemic using a combination of repeated questionnaires and high-resolution passive measurements from wearable sensors. We investigate the association between sleep and 5 sets of variables: (1) demographics; (2) sleep-related habits; (3) PA behaviors; and external factors, including (4) pandemic-specific constraints and (5) seasonal variations during the study period. Methods: We recruited working adults in Finland for a 1-year study (June 2021-June 2022) conducted during the late stage of the COVID-19 pandemic. We collected multisensor data from fitness trackers worn by participants, as well as work and sleep-related measures through monthly questionnaires. Additionally, we used the Stringency Index for Finland at various points in time to estimate the degree of pandemic-related lockdown restrictions during the study period. We applied linear mixed models to examine changes in sleep patterns during this late stage of the pandemic and their association with the 5 sets of variables. Results: The sleep patterns of 27,350 nights from 112 working adults were analyzed. Stricter pandemic measures were associated with an increase in total sleep time (TST) (?=.003, 95% CI 0.001-0.005; P<.001) and a delay in midsleep (MS) (?=.02, 95% CI 0.02-0.03; P<.001). Individuals who tend to snooze exhibited greater variability in both TST (?=.15, 95% CI 0.05-0.27; P=.006) and MS (?=.17, 95% CI 0.03-0.31; P=.01). Occupational differences in sleep pattern were observed, with service staff experiencing longer TST (?=.37, 95% CI 0.14-0.61; P=.004) and lower variability in TST (?=?.15, 95% CI ?0.27 to ?0.05; P<.001). Engaging in PA later in the day was associated with longer TST (?=.03, 95% CI 0.02-0.04; P<.001) and less variability in TST (?=?.01, 95% CI ?0.02 to 0.00; P=.02). Higher intradaily variability in rest activity rhythm was associated with shorter TST (?=?.26, 95% CI ?0.29 to ?0.23; P<.001), earlier MS (?=?.29, 95% CI ?0.33 to ?0.26; P<.001), and reduced variability in TST (?=?.16, 95% CI ?0.23 to ?0.09; P<.001). Conclusions: Our study provided a comprehensive view of the factors affecting sleep patterns during the late stage of the pandemic. As we navigate the future of work after the pandemic, understanding how work arrangements, lifestyle choices, and sleep quality interact will be crucial for optimizing well-being and performance in the workforce. UR - https://mhealth.jmir.org/2024/1/e53389 UR - http://dx.doi.org/10.2196/53389 UR - http://www.ncbi.nlm.nih.gov/pubmed/39226100 ID - info:doi/10.2196/53389 ER - TY - JOUR AU - Lanza, T. Stephanie AU - Whetzel, Courtney AU - Bhandari, Sandesh PY - 2024/8/23 TI - Health and Well-Being Among College Students in the United States During the COVID-19 Pandemic: Daily Diary Study JO - Interact J Med Res SP - e45689 VL - 13 KW - daily diary KW - college student KW - young adult KW - mental health KW - substance use KW - stress KW - well-being KW - belonging N2 - Background: There is evidence that anxiety and stress increased among college students during the COVID-19 pandemic. However, less is known about daily experiences of affect, worry, substance use behaviors, experiences of pleasure, concern over food security, experiences of bias or discrimination, feelings of belongingness, and other indicators of well-being and how they vary across days in this population. Objective: This study surveyed a wide range of indicators of health and well-being in daily life over 21 days with a sample of college students in a large university system in the United States during the pandemic. The overall variance in each daily measure was partitioned to reflect the proportion due to (1) between-person differences versus (2) within-person, day-to-day variability. This is important because measures that vary primarily due to between-person differences may be more amenable to interventions that target particular students, whereas measures that vary more due to day-to-day variability may be more amenable to interventions that target day-level contextual factors. Methods: A sample of 2068 young adult college students (aged 18-24, mean 19.8, SD 1.3 years; 66.6% women) completed a baseline survey; 97.3% (n=2012) then completed up to 21 consecutive daily surveys that assessed a comprehensive set of daily markers of health, behavior, and well-being. The daily diary study produced a total of 33,722 person-days. Results: Among all person-days, a minority were substance use days (eg, 14.5% of days involved alcohol use, 5.6% vaping, and 5.5% cannabis). Experiences of pleasure were reported on most (73.5%) days. Between-person differences explained more than 50% of the variance in numerous indicators of health and well-being, including daily vaping, cannabis use, other illicit substance use, experiences of bias or discrimination, positive affect, negative affect, worry, food insecurity, and feelings of belonging at the university. In contrast, within-person differences explained more than 50% of the variance in daily alcohol use, cigarette use, stress, experiences of pleasure, where the student slept last night, and physical activity. Conclusions: College student health and well-being are multifaceted, with some aspects likely driven by person-level characteristics and experiences and other aspects by more dynamic, contextual risk factors that occur in daily life. These findings implicate services and interventions that should target individual students versus those that should target days on which students are at high risk for poor experiences or behaviors. UR - https://www.i-jmr.org/2024/1/e45689 UR - http://dx.doi.org/10.2196/45689 UR - http://www.ncbi.nlm.nih.gov/pubmed/39178037 ID - info:doi/10.2196/45689 ER - TY - JOUR AU - Marley, Gifty AU - Dako-Gyeke, Phyllis AU - Nepal, Prajwol AU - Rajgopal, Rohini AU - Koko, Evelyn AU - Chen, Elizabeth AU - Nuamah, Kwabena AU - Osei, Kingsley AU - Hofkirchner, Hubertus AU - Marks, Michael AU - Tucker, D. Joseph AU - Eggo, Rosalind AU - Ampofo, William AU - Sylvia, Sean PY - 2024/8/12 TI - Collective Intelligence?Based Participatory COVID-19 Surveillance in Accra, Ghana: Pilot Mixed Methods Study JO - JMIR Infodemiology SP - e50125 VL - 4 KW - information markets KW - participatory disease surveillance KW - collective intelligence KW - community engagement KW - the wisdom of the crowds KW - Ghana KW - mobile phone N2 - Background: Infectious disease surveillance is difficult in many low- and middle-income countries. Information market (IM)?based participatory surveillance is a crowdsourcing method that encourages individuals to actively report health symptoms and observed trends by trading web-based virtual ?stocks? with payoffs tied to a future event. Objective: This study aims to assess the feasibility and acceptability of a tailored IM surveillance system to monitor population-level COVID-19 outcomes in Accra, Ghana. Methods: We designed and evaluated a prediction markets IM system from October to December 2021 using a mixed methods study approach. Health care workers and community volunteers aged ?18 years living in Accra participated in the pilot trading. Participants received 10,000 virtual credits to trade on 12 questions on COVID-19?related outcomes. Payoffs were tied to the cost estimation of new and cumulative cases in the region (Greater Accra) and nationwide (Ghana) at specified future time points. Questions included the number of new COVID-19 cases, the number of people likely to get the COVID-19 vaccination, and the total number of COVID-19 cases in Ghana by the end of the year. Phone credits were awarded based on the tally of virtual credits left and the participant?s percentile ranking. Data collected included age, occupation, and trading frequency. In-depth interviews explored the reasons and factors associated with participants? user journey experience, barriers to system use, and willingness to use IM systems in the future. Trading frequency was assessed using trend analysis, and ordinary least squares regression analysis was conducted to determine the factors associated with trading at least once. Results: Of the 105 eligible participants invited, 21 (84%) traded at least once on the platform. Questions estimating the national-level number of COVID-19 cases received 13 to 19 trades, and obtaining COVID-19?related information mainly from television and radio was associated with less likelihood of trading (marginal effect: ?0.184). Individuals aged <30 years traded 7.5 times more and earned GH ¢134.1 (US $11.7) more in rewards than those aged >30 years (marginal effect: 0.0135). Implementing the IM surveillance was feasible; all 21 participants who traded found using IM for COVID-19 surveillance acceptable. Active trading by friends with communal discussion and a strong onboarding process facilitated participation. The lack of bidirectional communication on social media and technical difficulties were key barriers. Conclusions: Using an IM system for disease surveillance is feasible and acceptable in Ghana. This approach shows promise as a cost-effective source of information on disease trends in low- and middle-income countries where surveillance is underdeveloped, but further studies are needed to optimize its use. UR - https://infodemiology.jmir.org/2024/1/e50125 UR - http://dx.doi.org/10.2196/50125 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50125 ER - TY - JOUR AU - Palmer, Anna AU - Sharma, Shaishab AU - Nagpal, Jayesh AU - Kimani, Victor AU - Mai, Florence AU - Ahmed, Zara PY - 2024/8/12 TI - Identifying Barriers to the Adoption of Digital Contact Tracing Apps in England: Semistructured Interview Study With Professionals Involved in the Pandemic Response JO - JMIR Form Res SP - e56000 VL - 8 KW - COVID-19 KW - global health KW - public health KW - qualitative study KW - tracing KW - England KW - apps KW - effectiveness KW - contact tracing KW - barrier KW - digital health KW - thematic analysis KW - privacy KW - communication KW - social support KW - tracing app KW - digital illiteracy KW - technology KW - support N2 - Background: The NHS (National Health Service) COVID-19 app was a digital contact tracing app (DCTA) used in England in response to the COVID-19 pandemic. The aim of which was to limit the spread of COVID-19 by providing exposure alerts. At the time of the pandemic, questions were raised regarding the effectiveness and cost of the NHS COVID-19 app and whether DCTAs have a role in future pandemics. Objective: This study aims to explore key barriers to DCTAs in England during the COVID-19 pandemic. Methods: This is a qualitative study using semistructured video interviews conducted with professionals in public health, digital health, clinicians, health care law, and health executives who had an active role in the COVID-19 pandemic. These interviews aimed to explore the perspective of different experts involved in the pandemic response and gauge their opinions on the key barriers to DCTAs in England during the COVID-19 pandemic. The initial use of maximum variation sampling combined with a snowball sampling approach ensured diversity within the cohort of interviewees. Interview transcripts were then analyzed using Braun and Clarke's 6 steps for thematic analysis. Results: Key themes that acted as barriers to DCTAs were revealed by interviewees such as privacy concerns, poor communication, technological accessibility, digital literacy, and incorrect use of the NHS COVID-19 app. Interviewees believed that some of these issues stemmed from poor governmental communication and a lack of transparency regarding how the NHS COVID-19 app worked, resulting in decreased public trust. Moreover, interviewees highlighted that a lack of social support integration within the NHS COVID-19 app and delayed app notification period also contributed to the poor adoption rates. Conclusions: Qualitative findings from interviews highlighted barriers to the NHS COVID-19 app, which can be applied to DCTAs more widely and highlight some important implications for the future use of DCTAS. There was no consensus among interviewees as to whether the NHS COVID-19 app was a success; however, all interviewees provided recommendations for improvements in creating and implementing DCTAs in the future. UR - https://formative.jmir.org/2024/1/e56000 UR - http://dx.doi.org/10.2196/56000 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56000 ER - TY - JOUR AU - Philippi, A. Keito F. AU - Zeier, Peter AU - Brahmer, Alexandra AU - Neuberger, I. Elmo W. AU - Sandner, Magdalena AU - Hagenah, Matthias AU - Porten, Thilo AU - Lenz, Regina AU - Ochmann, T. David AU - Wedekink, Florian AU - Wischhusen, Jörg AU - Lutz, Beat AU - Lieb, Klaus AU - Wessa, Michèle AU - Simon, Perikles PY - 2024/8/8 TI - Remote Exercise Training Intervention During the COVID-19 Pandemic: Randomized Controlled Trial JO - J Med Internet Res SP - e53145 VL - 26 KW - physical exercise KW - web-based KW - COVID-19 KW - lockdown KW - aerobic capacity KW - depression KW - feasibility KW - aerobic KW - anxiety KW - randomized controlled trial KW - prepandemic cohort KW - mental health KW - pandemic KW - remote exercise KW - intervention KW - pre-COVID-19 KW - lockdown cohort KW - pandemic-related KW - adult KW - adults N2 - Background: Societal measures to contain the spread of COVID-19 (eg, lockdown and contact restrictions) have been associated with decreased health and well-being. A multitude of prepandemic studies identified the beneficial effects of physical exercise on both physical and mental health. Objective: We report on the feasibility of a remote physical exercise intervention and its stress-buffering potential in 2 untrained cohorts: a pre?COVID-19 cohort that completed the intervention in 2019 and a lockdown cohort that started the intervention shortly before pandemic-related restrictions were implemented. Methods: In a randomized controlled trial, participants were assigned to either an intervention group (IG; pre?COVID-19 cohort: n=7 and lockdown cohort: n=9) or a control group (CG; pre?COVID-19 cohort: n=6 and lockdown cohort: n=6). IG participants received weekly individualized training recommendations delivered via web-based support. The intervention period was initially planned for 8 weeks, which was adhered to in the pre?COVID-19 cohort (mean 8.3, SD 0.5 weeks) but was extended to an average of 17.7 (SD 2.0) weeks in the lockdown cohort. Participants? health parameters were assessed before and after the intervention: aerobic capacity was measured as peak oxygen uptake (VO2peak) via cardiopulmonary exercise testing. Depressive symptoms were scored via the depression subscale of the Brief Symptom Inventory-18. Results: Dropout rates were low in both cohorts in the IG (pre?COVID-19 cohort: n=0, 0% and lockdown cohort: n=2, 16.7%) and the CG (pre?COVID-19 cohort: n=0, 0% and lockdown cohort: n=2, 20%). The mean adherence to the training sessions of the IG for both cohorts was 84% (pre?COVID-19 cohort: SD 5.5% and lockdown cohort: SD 11.6%). Aligned rank transform ANOVAs in the lockdown cohort indicated deterioration of VO2peak and depressive symptoms from before to after the intervention in the CG but no longitudinal changes in the IG. Analyses in the pre?COVID-19 cohort revealed significant increases in VO2peak for the IG compared to the CG (P=.04) but no intervention effects on depressive symptoms. Conclusions: With low dropout rates and high adherence, the remote intervention was feasible for healthy adults under regular conditions and in the face of pandemic-related stressors. Moreover, our results hint at a stress-buffering effect as well as a buffering of a lockdown-induced deconditioning of remote physical exercise interventions in the pandemic scenario, which can be used in future studies to overcome equally stressful periods of life. However, due to limited statistical power, these findings should be replicated in similar scenarios. Trial Registration: German Clinical Trials Register DRKS00018078; https://drks.de/search/en/trial/DRKS00018078 UR - https://www.jmir.org/2024/1/e53145 UR - http://dx.doi.org/10.2196/53145 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53145 ER - TY - JOUR AU - Nagpal, S. Meghan AU - Jalali, Niloofar AU - Sherifali, Diana AU - Morita, P. Plinio AU - Cafazzo, A. Joseph PY - 2024/8/8 TI - Managing Type 2 Diabetes During the COVID-19 Pandemic: Scoping Review and Qualitative Study Using Systematic Literature Review and Reddit JO - Interact J Med Res SP - e49073 VL - 13 KW - type 2 diabetes KW - social media KW - patient-generated health data KW - big data KW - machine learning KW - natural language processing KW - COVID-19, COVID-19 stress syndrome, health behaviors KW - Reddit KW - qualitative KW - analysis KW - diabetes KW - scoping review N2 - Background: The COVID-19 pandemic impacted how people accessed health services and likely how they managed chronic conditions such as type 2 diabetes (T2D). Social media forums present a source of qualitative data to understand how adaptation might have occurred from the perspective of the patient. Objective: Our objective is to understand how the care-seeking behaviors and attitudes of people living with T2D were impacted during the early part of the pandemic by conducting a scoping literature review. A secondary objective is to compare the findings of the scoping review to those presented on a popular social media platform Reddit. Methods: A scoping review was conducted in 2021. Inclusion criteria were population with T2D, studies are patient-centered, and study objectives are centered around health behaviors, disease management, or mental health outcomes during the COVID-19 pandemic. Exclusion criteria were populations with other noncommunicable diseases, examining COVID-19 as a comorbidity to T2D, clinical treatments for COVID-19 among people living with T2D, genetic expressions of COVID-19 among people living with T2D, gray literature, or studies not published in English. Bias was mitigated by reviewing uncertainties with other authors. Data extracted from the studies were classified into thematic categories. These categories reflect the findings of this study as per our objective. Data from the Reddit forums related to T2D from March 2020 to early March 2021 were downloaded, and support vector machines were used to classify if a post was published in the context of the pandemic. Latent Dirichlet allocation topic modeling was performed to gather topics of discussion specific to the COVID-19 pandemic. Results: A total of 26 studies conducted between February and September 2020, consisting of 13,673 participants, were included in this scoping literature review. The studies were qualitative and relied mostly on qualitative data from surveys or questionnaires. Themes found from the literature review were ?poorer glycemic control,? ?increased consumption of unhealthy foods,? ?decreased physical activity,? ?inability to access medical appointments,? and ?increased stress and anxiety.? Findings from latent Dirichlet allocation topic modeling of Reddit forums were ?Coping With Poor Mental Health,? ?Accessing Doctor & Medications and Controlling Blood Glucose,? ?Changing Food Habits During Pandemic,? ?Impact of Stress on Blood Glucose Levels,? ?Changing Status of Employment & Insurance,? and ?Risk of COVID Complications.? Conclusions: Topics of discussion gauged from the Reddit forums provide a holistic perspective of the impact of the pandemic on people living with T2D, which were found to be comparable to the findings of the literature review. The study was limited by only having 1 reviewer for the literature review, but biases were mitigated by consulting authors when there were uncertainties. Qualitative analysis of Reddit forms can supplement traditional qualitative studies of the behaviors of people living with T2D. UR - https://www.i-jmr.org/2024/1/e49073 UR - http://dx.doi.org/10.2196/49073 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/49073 ER - TY - JOUR AU - Markovic, Andjela AU - Kovacevic, Vladimir AU - Brakenhoff, B. Timo AU - Veen, Duco AU - Klaver, Paul AU - Mitratza, Marianna AU - Downward, S. George AU - Grobbee, E. Diederick AU - Cronin, Maureen AU - Goodale, M. Brianna AU - PY - 2024/7/31 TI - Physiological Response to the COVID-19 Vaccine: Insights From a Prospective, Randomized, Single-Blinded, Crossover Trial JO - J Med Internet Res SP - e51120 VL - 26 KW - wearable technology KW - biosignals KW - digital health KW - SARS-CoV-2 KW - vaccine reactogenicity KW - menstrual cycle KW - vaccine KW - wearables KW - sex KW - development KW - implementation KW - medical device KW - breathing rate KW - heart rate KW - biological mechanism KW - immune response KW - vaccination N2 - Background: Rapid development and implementation of vaccines constituted a crucial step in containing the COVID-19 pandemic. A comprehensive understanding of physiological responses to these vaccines is important to build trust in medicine. Objective: This study aims to investigate temporal dynamics before and after COVID-19 vaccination in 4 physiological parameters as well as the duration of menstrual cycle phases. Methods: In a prospective trial, 17,825 adults in the Netherlands wore a medical device on their wrist for up to 9 months. The device recorded their physiological signals and synchronized with a complementary smartphone app. By means of multilevel quadratic regression, we examined changes in wearable-recorded breathing rate, wrist skin temperature, heart rate, heart rate variability, and objectively assessed the duration of menstrual cycle phases in menstruating participants to assess the effects of COVID-19 vaccination. Results: The recorded physiological signals demonstrated short-term increases in breathing rate and heart rate after COVID-19 vaccination followed by a prompt rebound to baseline levels likely reflecting biological mechanisms accompanying the immune response to vaccination. No sex differences were evident in the measured physiological responses. In menstruating participants, we found a 0.8% decrease in the duration of the menstrual phase following vaccination. Conclusions: The observed short-term changes suggest that COVID-19 vaccines are not associated with long-term biophysical issues. Taken together, our work provides valuable insights into continuous fluctuations of physiological responses to vaccination and highlights the importance of digital solutions in health care. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-021-05241-5 UR - https://www.jmir.org/2024/1/e51120 UR - http://dx.doi.org/10.2196/51120 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51120 ER - TY - JOUR AU - Unlu, Ozan AU - Pikcilingis, Aaron AU - Letourneau, Jonathan AU - Landman, Adam AU - Patel, Rajesh AU - Shenoy, S. Erica AU - Hashimoto, Dean AU - Kim, Marvel AU - Pellecer, Johnny AU - Zhang, Haipeng PY - 2024/7/25 TI - Implementation of a Web-Based Chatbot to Guide Hospital Employees in Returning to Work During the COVID-19 Pandemic: Development and Before-and-After Evaluation JO - JMIR Form Res SP - e43119 VL - 8 KW - chatbot KW - return to work KW - employee KW - health care personnel KW - COVID-19 KW - conversational agent KW - occupational health KW - support service KW - health care delivery KW - agile methodology KW - digital intervention KW - digital support KW - work policy KW - hospital staff N2 - Background: Throughout the COVID-19 pandemic, multiple policies and guidelines were issued and updated for health care personnel (HCP) for COVID-19 testing and returning to work after reporting symptoms, exposures, or infection. The high frequency of changes and complexity of the policies made it difficult for HCP to understand when they needed testing and were eligible to return to work (RTW), which increased calls to Occupational Health Services (OHS), creating a need for other tools to guide HCP. Chatbots have been used as novel tools to facilitate immediate responses to patients? and employees? queries about COVID-19, assess symptoms, and guide individuals to appropriate care resources. Objective: This study aims to describe the development of an RTW chatbot and report its impact on demand for OHS support services during the first Omicron variant surge. Methods: This study was conducted at Mass General Brigham, an integrated health care system with over 80,000 employees. The RTW chatbot was developed using an agile design methodology. We mapped the RTW policy into a unified flow diagram that included all required questions and recommendations, then built and tested the chatbot using the Microsoft Azure Healthbot Framework. Using chatbot data and OHS call data from December 10, 2021, to February 17, 2022, we compared OHS resource use before and after the deployment of the RTW chatbot, including the number of calls to the OHS hotline, wait times, call length, and time OHS hotline staff spent on the phone. We also assessed Centers for Disease Control and Prevention data for COVID-19 case trends during the study period. Results: In the 5 weeks post deployment, 5575 users used the RTW chatbot with a mean interaction time of 1 minute and 17 seconds. The highest engagement was on January 25, 2022, with 368 users, which was 2 weeks after the peak of the first Omicron surge in Massachusetts. Among users who completed all the chatbot questions, 461 (71.6%) met the RTW criteria. During the 10 weeks, the median (IQR) number of daily calls that OHS received before and after deployment of the chatbot were 633 (251-934) and 115 (62-167), respectively (U=163; P<.001). The median time from dialing the OHS phone number to hanging up decreased from 28 minutes and 22 seconds (IQR 25:14-31:05) to 6 minutes and 25 seconds (IQR 5:32-7:08) after chatbot deployment (U=169; P<.001). Over the 10 weeks, the median time OHS hotline staff spent on the phone declined from 3 hours and 11 minutes (IQR 2:32-4:15) per day to 47 (IQR 42-54) minutes (U=193; P<.001), saving approximately 16.8 hours per OHS staff member per week. Conclusions: Using the agile methodology, a chatbot can be rapidly designed and deployed for employees to efficiently receive guidance regarding RTW that complies with the complex and shifting RTW policies, which may reduce use of OHS resources. UR - https://formative.jmir.org/2024/1/e43119 UR - http://dx.doi.org/10.2196/43119 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/43119 ER - TY - JOUR AU - Roschke, Kristy AU - Koskan, M. Alexis AU - Sivanandam, Shalini AU - Irby, Jonathan PY - 2024/7/24 TI - Partisan Media, Trust, and Media Literacy: Regression Analysis of Predictors of COVID-19 Knowledge JO - JMIR Form Res SP - e53904 VL - 8 KW - COVID-19 KW - misinformation KW - media literacy KW - news consumption KW - institutional trust KW - media KW - trust KW - prevention KW - control KW - health care professional KW - health care N2 - Background: The COVID-19 pandemic was a devastating public health event that spurred an influx of misinformation. The increase in questionable health content was aided by the speed and scale of digital and social media and certain news agencies? and politicians? active dissemination of misinformation about the virus. The popularity of certain COVID-19 myths created confusion about effective health protocols and impacted trust in the health care and government sectors deployed to manage the pandemic. Objective: This study explored how people?s information habits, their level of institutional trust, the news media outlets they consume and the technologies in which they access it, and their media literacy skills influenced their COVID-19 knowledge. Methods: We administered a web-based survey using Amazon Mechanical Turk (MTurk) to assess US adults? (n=1498) COVID-19 knowledge, media and news habits, media literacy skills, and trust in government and health-related institutions. The data were analyzed using a hierarchical linear regression to examine the association between trust, media literacy, news use, and COVID-19 knowledge. Results: The regression model of demographic variables, political affiliation, trust in institutions, media literacy, and the preference for watching Fox or CNN was statistically significant (R2=0.464; F24,1434=51.653; P<.001; adjusted R2=0.455) in predicting COVID-19 knowledge scores. People who identified as politically conservative, watched Fox News, and reported lower levels of institutional trust and media literacy, scored lower on COVID-19 knowledge questions than those who identified as politically liberal, did not watch Fox News and reported higher levels of institutional trust and media literacy. Conclusions: This study suggests that the media outlets people turn to, their trust in institutions, and their perceived degree of agency to discern credible information can impact people?s knowledge of COVID-19, which has potential implications for managing communication in other public health events. UR - https://formative.jmir.org/2024/1/e53904 UR - http://dx.doi.org/10.2196/53904 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53904 ER - TY - JOUR AU - Turzhitsky, Vladimir AU - Bash, D. Lori AU - Urman, D. Richard AU - Kattan, Michael AU - Hofer, Ira PY - 2024/7/22 TI - Factors Influencing Neuromuscular Blockade Reversal Choice in the United States Before and During the COVID-19 Pandemic: Retrospective Longitudinal Analysis JO - JMIR Perioper Med SP - e52278 VL - 7 KW - neuromuscular blockade KW - sugammadex KW - neostigmine KW - rocuronium, vecuronium, intubation, counterfactual KW - anesthesia KW - anesthetic KW - anesthesiologist KW - anesthesiologists KW - surgery KW - surgical KW - preference KW - preferences KW - retrospective KW - utilization KW - pattern KW - patterns KW - trend KW - trends KW - national KW - healthcare database KW - healthcare databases KW - COVID-19 KW - time-trend analysis KW - neuromuscular KW - longitudinal analysis KW - longitudinal KW - neuromuscular blockade agent KW - clinical KW - surgical procedure KW - inpatient KW - inpatient surgery KW - retrospective analysis KW - USA KW - United States N2 - Background: Neuromuscular blockade (NMB) agents are a critical component of balanced anesthesia. NMB reversal methods can include spontaneous reversal, sugammadex, or neostigmine and the choice of reversal strategy can depend on various factors. Unanticipated changes to clinical practice emerged due to the COVID-19 pandemic, and a better understanding of how NMB reversal trends were affected by the pandemic may help provide insight into how providers view the tradeoffs in the choice of NMB reversal agents. Objective: We aim to analyze NMB reversal agent use patterns for US adult inpatient surgeries before and after the COVID-19 outbreak to determine whether pandemic-related practice changes affected use trends. Methods: A retrospective longitudinal analysis of a large all-payer national electronic US health care database (PINC AI Healthcare Database) was conducted to identify the use patterns of NMB reversal during early, middle, and late COVID-19 (EC, MC, and LC, respectively) time periods. Factors associated with NMB reversal choices in inpatient surgeries were assessed before and after the COVID-19 pandemic reached the United States. Multivariate logistic regression assessed the impact of the pandemic on NMB reversal, accounting for patient, clinical, procedural, and site characteristics. A counterfactual framework was used to understand if patient characteristics affected how COVID-19?era patients would have been treated before the pandemic. Results: More than 3.2 million inpatients experiencing over 3.6 million surgical procedures across 931 sites that met all inclusion criteria were identified between March 1, 2017, and December 31, 2021. NMB reversal trends showed a steady increase in reversal with sugammadex over time, with the trend from January 2018 onwards being linear with time (R2>0.99). Multivariate analysis showed that the post?COVID-19 time periods had a small but statistically significant effect on the trend, as measured by the interaction terms of the COVID-19 time periods and the time trend in NMB reversal. A slight increase in the likelihood of sugammadex reversal was observed during EC relative to the pre?COVID-19 trend (odds ratio [OR] 1.008, 95% CI 1.003-1.014; P=.003), followed by negation of that increase during MC (OR 0.992, 95% CI 0.987-0.997; P<.001), and no significant interaction identified during LC (OR 1.001, 95% CI 0.996-1.005; P=.81). Conversely, active reversal (using either sugammadex or neostigmine) did not show a significant association relative to spontaneous reversal, or a change in trend, during EC or MC (P>.05), though a slight decrease in the active reversal trend was observed during LC (OR 0.987, 95% CI 0.983-0.992; P<.001). Conclusions: We observed a steady increase in NMB active reversal overall, and specifically with sugammadex compared to neostigmine, during periods before and after the COVID-19 outbreak. Small, transitory alterations in the NMB reversal trends were observed during the height of the COVID-19 pandemic, though these alterations were independent of the underlying NMB reversal time trends. UR - https://periop.jmir.org/2024/1/e52278 UR - http://dx.doi.org/10.2196/52278 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52278 ER - TY - JOUR AU - Hamline, Y. Michelle AU - Xing, Guibo AU - Kravitz, L. Richard AU - Miller, Marykate AU - Melnikow, Joy PY - 2024/7/17 TI - Physician and Practice Characteristics Influencing Telemedicine Uptake Among Frontline Clinicians in the Early COVID-19 Pandemic Response: National Survey Study JO - JMIR Form Res SP - e50751 VL - 8 KW - telemedicine KW - telehealth KW - COVID-19 pandemic KW - frontline clinicians KW - telemonitoring KW - frontliners KW - virtual care KW - influence KW - clinician KW - physician KW - pre-pandemic KW - pandemic KW - survey KW - health outcome N2 - Background:  Telemedicine expanded rapidly during the COVID-19 pandemic, as key policy changes, financial support, and pandemic fears tipped the balance toward internet-based care. Despite this increased support and benefits to patients and clinicians, telemedicine uptake was variable across clinicians and practices. Little is known regarding physician and institutional characteristics underlying this variability. Objective:  This study aimed to evaluate factors influencing telemedicine uptake among frontline physicians in the early pandemic response. Methods:  We surveyed a national stratified sample of frontline clinicians drawn from the American Medical Association Physician Professional Data in June or July 2020. The survey inquired about the first month and most recent month (June 2020) of pandemic telemedicine use; sample data included clinician gender, specialty, census region, and years in practice. Local pandemic conditions were estimated from county-level data on COVID-19 rates at the time of survey response. Data were analyzed in a weighted logistic regression, controlling for county-specific pandemic data, and weighted to account for survey data stratification and nonresponse. Results:  Over the first 3-4 months of the pandemic, the proportion of physicians reporting use of telemedicine in >30% of visits increased from 29.2% (70/239) to 35.7% (85/238). Relative to primary care, odds of substantial telemedicine use (>30%) both during the first month of the pandemic and in June 2020 were increased among infectious disease and critical care physicians and decreased among hospitalists and emergency medicine physicians. At least minimal prepandemic telemedicine use (odds ratio [OR] 11.41, 95% CI 1.34-97.04) and a high 2-week moving average of local COVID-19 cases (OR 10.16, 95% CI 2.07-49.97) were also associated with substantial telemedicine use in June 2020. There were no significant differences according to clinician gender, census region, or years in practice. Conclusions:  Prepandemic telemedicine use, high local COVID-19 case counts, and clinician specialty were associated with higher levels of substantial telemedicine use during the early pandemic response. These results suggest that telemedicine uptake in the face of the pandemic may have been heavily influenced by the level of perceived threat and the resources available for implementation. Such understanding has important implications for reducing burnout and preparation for future public health emergencies. UR - https://formative.jmir.org/2024/1/e50751 UR - http://dx.doi.org/10.2196/50751 UR - http://www.ncbi.nlm.nih.gov/pubmed/39018095 ID - info:doi/10.2196/50751 ER - TY - JOUR AU - Peprah, Emmanuel AU - Amesimeku, Etornam AU - Angulo, Brian AU - Chhetri, Himani AU - Fordjuoh, Judy AU - Ruan, Christina AU - Wang, Cong AU - Patena, John AU - Vieira, Dorice AU - Ryan, Nessa AU - Iloegbu, Chukwuemeka AU - Gyamfi, Joyce AU - Odumegwu, Jonathan PY - 2024/6/17 TI - How College Students Used Information From Institutions of Higher Education in the United States During COVID-19: Web-Based Cross-Sectional Survey Study JO - JMIR Form Res SP - e51292 VL - 8 KW - COVID-19 KW - pandemic KW - public health KW - preventative KW - prevention KW - social distancing KW - masks KW - personal protective equipment KW - cross-sectional KW - surveys KW - higher learning KW - higher education KW - university students KW - information source KW - web-based information KW - health information KW - dissemination KW - awareness KW - information spread KW - young adults KW - social media KW - university KW - postsecondary KW - students KW - young adult KW - college KW - concern KW - worry KW - anxiety KW - perceptions N2 - Background: The start of the COVID-19 pandemic resulted in the implementation of nonpharmaceutical interventions by US institutions of higher education at an unprecedented level. During the backdrop of an emerging pandemic, younger adults (eg, college students) had an overall lower risk for severe outcomes for SARS-CoV-2, making this population a potential source of transmission for age groups with high susceptibility and negative health outcomes. We examine how college students? level of concern for COVID-19 was influenced by different sources of information, their living status, income level, and other demographic identifiers and its association with prevention behavior change. Objective: We sought to examine the level of concern, defined as the extent to which the participant would take corrective action to mitigate contracting or spreading the virus (to family or friends) by using personal protective equipment such as a face mask, practicing social distancing, and following other public health recommendations, among college students during the COVID-19 pandemic. Methods: A cross-sectional, web-based survey was conducted in 2021 among 185 college students aged 18-41 years, with most living in New York City and the United States (n=134, 72.4%). Out of 185 college students, 94 provided their zip codes, with 51 of those college students indicating they lived in New York City areas. The participants completed the survey via a QR code. Study participants who did not complete the full survey or were not college students in any US college or university were excluded. Analyses were conducted using R (version 4.2.2; R Foundation for Statistical Computing). Results: Of 185 respondents participated in the study, 25 (13.5.%) used emails from their schools, 51 (27.6%) used mainstream media, and 109 (58.9%) used social media and other sources to obtain information about COVID-19. Of the 109 participants who learned about the pandemic from social media, 91 (83.5%) were concerned; however, only 63% (32/51) and 60% (15/25) of the participants who sourced information from mainstream media and their schools? email, respectively, were concerned. Further, the participants who received information from social media and other sources were about 3 times more likely to be concerned about COVID-19 than participants who received information from the university via email (P=.036; OR=3.07, 95% CI: 1.06-8.83).. Conclusions: College students who received information from social media and other sources were more likely to be concerned about COVID-19 than students who received information from their school via emails. UR - https://formative.jmir.org/2024/1/e51292 UR - http://dx.doi.org/10.2196/51292 UR - http://www.ncbi.nlm.nih.gov/pubmed/38885019 ID - info:doi/10.2196/51292 ER - TY - JOUR AU - Pienkowska, Anita AU - Ravaut, Mathieu AU - Mammadova, Maleyka AU - Ang, Chin-Siang AU - Wang, Hanyu AU - Ong, Chwen Qi AU - Bojic, Iva AU - Qin, Mengqi Vicky AU - Sumsuzzman, Md Dewan AU - Ajuebor, Onyema AU - Boniol, Mathieu AU - Bustamante, Paola Juana AU - Campbell, James AU - Cometto, Giorgio AU - Fitzpatrick, Siobhan AU - Kane, Catherine AU - Joty, Shafiq AU - Car, Josip PY - 2024/6/13 TI - Understanding COVID-19 Impacts on the Health Workforce: AI-Assisted Open-Source Media Content Analysis JO - JMIR Form Res SP - e53574 VL - 8 KW - World Health Organization KW - WHO KW - public surveillance KW - natural language processing KW - NLP KW - artificial intelligence KW - AI KW - COVID-19 KW - SARS-COV-2 KW - COVID-19 pandemic KW - human-generated analysis KW - decision-making KW - strategic policy KW - health workforce KW - news article KW - media content analysis KW - news coverage KW - health care worker KW - mental health KW - death risk KW - intervention KW - efficiency KW - public health KW - surveillance KW - innovation KW - innovative method N2 - Background: To investigate the impacts of the COVID-19 pandemic on the health workforce, we aimed to develop a framework that synergizes natural language processing (NLP) techniques and human-generated analysis to reduce, organize, classify, and analyze a vast volume of publicly available news articles to complement scientific literature and support strategic policy dialogue, advocacy, and decision-making. Objective: This study aimed to explore the possibility of systematically scanning intelligence from media that are usually not captured or best gathered through structured academic channels and inform on the impacts of the COVID-19 pandemic on the health workforce, contributing factors to the pervasiveness of the impacts, and policy responses, as depicted in publicly available news articles. Our focus was to investigate the impacts of the COVID-19 pandemic and, concurrently, assess the feasibility of gathering health workforce insights from open sources rapidly. Methods: We conducted an NLP-assisted media content analysis of open-source news coverage on the COVID-19 pandemic published between January 2020 and June 2022. A data set of 3,299,158 English news articles on the COVID-19 pandemic was extracted from the World Health Organization Epidemic Intelligence through Open Sources (EIOS) system. The data preparation phase included developing rules-based classification, fine-tuning an NLP summarization model, and further data processing. Following relevancy evaluation, a deductive-inductive approach was used for the analysis of the summarizations. This included data extraction, inductive coding, and theme grouping. Results: After processing and classifying the initial data set comprising 3,299,158 news articles and reports, a data set of 5131 articles with 3,007,693 words was devised. The NLP summarization model allowed for a reduction in the length of each article resulting in 496,209 words that facilitated agile analysis performed by humans. Media content analysis yielded results in 3 sections: areas of COVID-19 impacts and their pervasiveness, contributing factors to COVID-19?related impacts, and responses to the impacts. The results suggest that insufficient remuneration and compensation packages have been key disruptors for the health workforce during the COVID-19 pandemic, leading to industrial actions and mental health burdens. Shortages of personal protective equipment and occupational risks have increased infection and death risks, particularly at the pandemic?s onset. Workload and staff shortages became a growing disruption as the pandemic progressed. Conclusions: This study demonstrates the capacity of artificial intelligence?assisted media content analysis applied to open-source news articles and reports concerning the health workforce. Adequate remuneration packages and personal protective equipment supplies should be prioritized as preventive measures to reduce the initial impact of future pandemics on the health workforce. Interventions aimed at lessening the emotional toll and workload need to be formulated as a part of reactive measures, enhancing the efficiency and maintainability of health delivery during a pandemic. UR - https://formative.jmir.org/2024/1/e53574 UR - http://dx.doi.org/10.2196/53574 UR - http://www.ncbi.nlm.nih.gov/pubmed/38869940 ID - info:doi/10.2196/53574 ER - TY - JOUR AU - Cermak, A. Carly AU - Read, Heather AU - Jeffs, Lianne PY - 2024/5/28 TI - Health Care Professionals? Experiences With Using Information and Communication Technologies in Patient Care During the COVID-19 Pandemic: Qualitative Study JO - JMIR Form Res SP - e53056 VL - 8 KW - COVID-19 KW - information and communication technology KW - health care provider experiences KW - web-based care KW - interview N2 - Background: The COVID-19 pandemic acted as a catalyst for the use of information and communication technology (ICT) in inpatient and outpatient health care settings. Digital tools were used to connect patients, families, and providers amid visitor restrictions, while web-based platforms were used to continue care amid COVID-19 lockdowns. What we have yet to learn is the experiences of health care providers (HCPs) regarding the use of ICT that supported changes to clinical care during the COVID-19 pandemic. Objective: The aim of this paper was to describe the experiences of HCPs in using ICT to support clinical care changes during the COVID-19 pandemic. This paper is reporting on a subset of a larger body of data that examined changes to models of care during the pandemic. Methods: This study used a qualitative, descriptive study design. In total, 30 HCPs were recruited from 3 hospitals in Canada. One-on-one semistructured interviews were conducted between December 2022 and June 2023. Qualitative data were analyzed using an inductive thematic approach to identify themes across participants. Results: A total of 30 interviews with HCPs revealed 3 themes related to their experiences using ICT to support changes to clinical care during the COVID-19 pandemic. These included the use of ICT (1) to support in-person communication with patients, (2) to facilitate connection between provider to patient and patient to family, and (3) to provide continuity of care. Conclusions: HCP narratives revealed the benefits of digital tools to support in-person communication between patient and provider, the need for thoughtful consideration for the use of ICT at end-of-life care, and the decision-making that is needed when choosing service delivery modality (eg, web based or in person). Moving forward, organizations are encouraged to provide education and training on how to support patient-provider communication, find ways to meet patient and family wishes at end-of-life care, and continue to give autonomy to HCPs in their clinical decision-making regarding service delivery modality. UR - https://formative.jmir.org/2024/1/e53056 UR - http://dx.doi.org/10.2196/53056 UR - http://www.ncbi.nlm.nih.gov/pubmed/38805250 ID - info:doi/10.2196/53056 ER - TY - JOUR AU - Harnik, Alexander Michael AU - Scheidegger, Alina AU - Blättler, Larissa AU - Nemecek, Zdenek AU - Sauter, C. Thomas AU - Limacher, Andreas AU - Reisig, Florian AU - grosse Holtforth, Martin AU - Streitberger, Konrad PY - 2024/4/29 TI - Acceptance, Satisfaction, and Preference With Telemedicine During the COVID-19 Pandemic in 2021-2022: Survey Among Patients With Chronic Pain JO - JMIR Form Res SP - e53154 VL - 8 KW - acceptance KW - satisfaction KW - patient preferences KW - COVID-19 pandemic KW - health care providers KW - phone consultations KW - pain therapy KW - eHealth services KW - patient care KW - health care delivery KW - telemedicine KW - chronic pain KW - preference N2 - Background: The COVID-19 pandemic has forced many health care providers to make changes in their treatment, with telemedicine being expanded on a large scale. An earlier study investigated the acceptance of telephone calls but did not record satisfaction with treatment or patients? preferences. This warranted a follow-up study to investigate acceptance, satisfaction, and preferences regarding telemedicine, comprising of phone consultations, among health care recipients. Objective: The primary aim was to assess the acceptance and satisfaction of telemedicine during the subsequent months of 2021-2022, after the initial wave of the COVID-19 pandemic in Switzerland. Furthermore, we aimed to assess patients? preferences and whether these differed in patients who had already experienced telemedicine in the past, as well as correlations between acceptance and satisfaction, pain intensity, general condition, perception of telemedicine, and catastrophizing. Finally, we aimed to investigate whether more governmental restrictions were correlated with higher acceptance. Methods: An anonymous cross-sectional web-based survey was conducted between January 27, 2021, and February 4, 2022, enrolling patients undergoing outpatient pain therapy in a tertiary university clinic. We conducted a descriptive analysis of acceptance and satisfaction with telemedicine and investigated patients? preferences. Further, we conducted a descriptive and correlational analysis of the COVID-19 stringency index. Spearman correlation analysis and a chi-square test for categorical data were used with Cramer V statistic to assess effect sizes. Results: Our survey was completed by 60 patients. Telemedicine acceptance and satisfaction were high, with an average score of 7.6 (SD 3.3; on an 11-point Numeric Rating Scale from 0=not at all to 10=completely), and 8.8 (SD 1.8), respectively. Respondents generally preferred on-site consultations to telemedicine (n=35, 58% vs n=24, 40%). A subgroup analysis revealed that respondents who already had received phone consultation, showed a higher preference for telemedicine (n/N=21/42, 50% vs n/N=3/18, 17%; ?22 [N=60]=7.5, P=.02, Cramer V=0.354), as well as those who had been treated for more than 3 months (n/N=17/31, 55% vs n/N=7/29, 24%; ?22 [N=60]=6.5, P=.04, Cramer V=0.329). Acceptance of telemedicine showed a moderate positive correlation with satisfaction (rs{58}=0.41, P<.05), but there were no correlations between the COVID-19 stringency index and the other variables. Conclusions: Despite high acceptance of and satisfaction with telemedicine, patients preferred on-site consultations. Preference for telemedicine was markedly higher in patients who had already received phone consultations or had been treated for longer than 3 months. This highlights the need to convey knowledge of eHealth services to patients and the value of building meaningful relationships with patients at the beginning of treatment. During the COVID-19 pandemic, the modality of patient care should be discussed individually. UR - https://formative.jmir.org/2024/1/e53154 UR - http://dx.doi.org/10.2196/53154 UR - http://www.ncbi.nlm.nih.gov/pubmed/38684086 ID - info:doi/10.2196/53154 ER - TY - JOUR AU - Gotra, Milena AU - Lindberg, Katharine AU - Jasinski, Nicholas AU - Scarisbrick, David AU - Reilly, Shannon AU - Perle, Jonathan AU - Miller, Liv AU - Mahoney III, James PY - 2024/4/29 TI - Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study JO - JMIR Form Res SP - e50303 VL - 8 KW - COVID-19 pandemic KW - mental health KW - social worker KW - psychologist KW - neuropsychologist KW - academic medical center KW - community mental health KW - private practice KW - Veteran?s Affairs hospital KW - longitudinal questionnaire study KW - COVID-19 KW - implementation KW - telemental health KW - hybrid model KW - availability N2 - Background: The COVID-19 pandemic impacted the practices of most mental health providers and resulted in a rapid transition to providing telemental health services, changes that were likely related to stay-at-home policies as well as increased need for services. Objective: The aim of this study was to examine whether these changes to practice have been sustained over time throughout the course of the COVID-19 pandemic and whether there are differences among mental health provider type and setting. We hypothesized that there would be an increase in the number of patients seen in person after the initial surge of the pandemic in spring 2020 and subsequent discontinuation of stay-at-home policies, though with continued implementation of telemental health services across settings. Methods: This study surveyed 235 of the 903 mental health providers who responded to a survey in spring 2020 (Time point 1) and at a 1-year follow-up in spring 2021 (Time point 2). Differences in practice adjustments, factors related to telemental health, and number of patients seen were examined across provider type (social worker, psychologist, neuropsychologist) and setting (academic medical center [AMC], community mental health, private practice, and Veterans Affairs hospital). Results: From Time point 1 to Time point 2, there was a small but significant increase in the overall number of providers who were implementing telehealth (191/235, 81% to 204/235, 87%, P=.01) and there was a significant decline in canceled or rescheduled appointments (25%-50% in 2020 to 3%-7% in 2021, P<.001). Psychologists and providers working at AMCs reported decreased difficulty with telehealth implementation (P<.001), and providers working at AMCs and in private practice settings indicated they were more likely to continue telehealth services beyond spring 2021 (P<.001). The percent of time working remotely decreased overall (78% to 59%, P<.001), which was most notable among neuropsychologists and providers working at an AMC. There was an overall increase in the average number of patients seen in person per week compared with earlier in the pandemic (mean 4.3 to 8.7, P<.001), with no change in the number of patients seen via telehealth (mean 9.7 to 9.9, P=.66). Conclusions: These results show that the rapid transition to telemental health at the onset of the COVID-19 pandemic in spring 2020 was sustained over the next year, despite an overall increase in the number of patients seen in person. Although more providers reported returning to working on-site, over 50% of providers continued to use a hybrid model, and many providers reported they would be more likely to continue telemental health beyond spring 2021. This suggests the continued importance and reliance on telemental health services beyond the acute pandemic phase and has implications for future policies regulating the availability of telemental health services to patients. UR - https://formative.jmir.org/2024/1/e50303 UR - http://dx.doi.org/10.2196/50303 UR - http://www.ncbi.nlm.nih.gov/pubmed/38683653 ID - info:doi/10.2196/50303 ER - TY - JOUR AU - Wang, Di AU - Li, Peifan AU - Huang, Xiaoling AU - Liu, Yixuan AU - Mao, Shihang AU - Yin, Haoning AU - Wang, Na AU - Luo, Yan AU - Sun, Shan PY - 2024/4/24 TI - Exploring the Prevalence of Tinnitus and Ear-Related Symptoms in China After the COVID-19 Pandemic: Online Cross-Sectional Survey JO - JMIR Form Res SP - e54326 VL - 8 KW - COVID-19 pandemic KW - tinnitus KW - ear-related symptoms KW - online survey KW - prevalence KW - ear-related KW - China KW - cross-sectional KW - complex KW - heterogeneous KW - symptom KW - symptoms KW - Chinese KW - population KW - investigate KW - health care KW - exploratory KW - teen KW - teens KW - teenager KW - teenagers KW - older adult KW - older adults KW - elder KW - elderly KW - older person KW - older people KW - COVID-19 KW - regression analysis N2 - Background: Tinnitus is a complex and heterogeneous disease that has been identified as a common manifestation of COVID-19. To gain a comprehensive understanding of tinnitus symptoms in individuals following COVID-19 infection, we conducted an online survey called the China Ear Nose and Throat Symptom Survey in the COVID-19 Pandemic (CENTSS) among the Chinese population. Objective: Our objective was to investigate tinnitus and ear-related symptoms after COVID-19 infection in the Chinese population, with the aim of providing a solid empirical foundation for improved health care. The findings from CENTSS can contribute to the development of enhanced management strategies for tinnitus in the context of long COVID. By gaining a better understanding of the factors contributing to tinnitus in individuals with COVID-19, health care providers can tailor interventions to address the specific needs of affected patients. Furthermore, this study serves as a basis for research on the long-term consequences of COVID-19 infection and its associated tinnitus symptoms. Methods: A quantitative, online, cross-sectional survey study design was used to explore the impact of the COVID-19 pandemic on experiences with tinnitus in China. Data were collected through an online questionnaire designed to identify the presence of tinnitus and its impacts. Descriptive statistics were used to analyze individuals' demographic characteristics, COVID-19 infection?related ear symptoms, and the cognitive and emotional implications of tinnitus. Univariable and multivariable logistic regression analyses were used to model the cross-sectional baseline associations between demographic characteristics, noise exposure, educational level, health and lifestyle factors, and the occurrence of tinnitus. Results: Between December 19, 2022, and February 1, 2023, we obtained responses from 1262 Chinese participants representing 24 regions, with an average age of 37 years. Among them, 540 patients (42.8%) reported experiencing ear-related symptoms after COVID-19 infection. Only 114 (9%) of these patients sought medical attention specifically for their ear symptoms, while 426 (33.8%) did not seek hospital care. Tinnitus emerged as the most prevalent and impactful symptom among all ear-related symptoms experienced after COVID-19 infection. Of the respondents, female participants (688/888, 77.78%), younger individuals (<30 years), individuals with lower education levels, participants residing in western China, and those with a history of otolaryngology diseases were more likely to develop tinnitus following COVID-19 infection. Conclusions: In summary, tinnitus was identified as the most common ear-related symptom during COVID-19 infection. Individuals experiencing tinnitus after COVID-19 infection were found to have poorer cognitive and emotional well-being. Different ear-related symptoms in patients post?COVID-19 infection may suggest viral invasion of various parts of the ear. It is therefore crucial to monitor and manage hearing-related changes resulting from COVID-19 as clinical services resume. UR - https://formative.jmir.org/2024/1/e54326 UR - http://dx.doi.org/10.2196/54326 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54326 ER - TY - JOUR AU - Guan, Huixin AU - Wang, Wei PY - 2024/4/17 TI - Factors Impacting Chinese Older Adults? Intention to Prevent COVID-19 in the Post?COVID-19 Pandemic Era: Survey Study JO - JMIR Form Res SP - e53608 VL - 8 KW - COVID-19 KW - SARS-CoV-2 KW - health protection KW - social capital KW - media exposure KW - negative emotions KW - structural influence model of communication KW - SIM KW - protect KW - protection KW - protective KW - intent KW - intention KW - prevention KW - preventative KW - restriction KW - restrictions KW - public health measures KW - safety KW - news KW - newspaper KW - media KW - radio KW - health communication KW - influence KW - influencing KW - infectious KW - infection control KW - pandemic KW - gerontology KW - geriatric KW - geriatrics KW - older adult KW - older adults KW - older person KW - older people KW - aging N2 - Background: Understanding the factors influencing individuals? health decisions is a dynamic research question. Particularly, after China announced the deregulation of the COVID-19 epidemic, health risks escalated rapidly. The convergence of ?no longer controlled? viruses and the infodemic has created a distinctive social period during which multiple factors may have influenced people?s decision-making. Among these factors, the precautionary intentions of older individuals, as a susceptible health group, deserve special attention. Objective: This study aims to examine the intention of older adults to engage in preventive behaviors and the influencing factors, including social, media, and individual factors, within the context of the postepidemic era. Drawing upon the structural influence model of communication, this study tests the potential mediating roles of 3 different types of media exposure between cognitive and structural social capital and protective behavior intention, as well as the moderating role of negative emotions between social capital and media exposure. Methods: In this study, a web survey was used to collect self-reported quantitative data on social capital, media exposure, negative emotions, and the intention to prevent COVID-19 among older adults aged ?60 years (N=399) in China. Results: The results indicate that cognitive social capital significantly influenced protective behavior intention (P<.001), with cell phone exposure playing an additional impactful role (P<.001). By contrast, newspaper and radio exposure and television exposure mediated the influence of structural social capital on protective behavior intention (P<.001). Furthermore, negative emotions played a moderating role in the relationship between cognitive social capital and cell phone exposure (P<.001). Conclusions: This study suggests that using tailored communication strategies across various media channels can effectively raise health awareness among older adults dealing with major pandemics in China, considering their diverse social capital characteristics and emotional states. UR - https://formative.jmir.org/2024/1/e53608 UR - http://dx.doi.org/10.2196/53608 UR - http://www.ncbi.nlm.nih.gov/pubmed/38630517 ID - info:doi/10.2196/53608 ER - TY - JOUR AU - Verot, Elise AU - Chaux, Robin AU - Gagnaire, Julie AU - Bonjean, Paul AU - Gagneux-Brunon, Amandine AU - Berthelot, Philippe AU - Pelissier, Carole AU - Boulamail, Billal AU - Chauvin, Franck AU - Pozzetto, Bruno AU - Botelho-Nevers, Elisabeth PY - 2024/4/11 TI - Evaluating the Knowledge of and Behavior Toward COVID-19 and the Possibility of Isolating at a City Level: Survey Study JO - JMIR Public Health Surveill SP - e47170 VL - 10 KW - SARS-CoV-2 KW - COVID-19 KW - health literacy KW - knowledge, attitude, and perception/practices (KAP) KW - public health KW - population KW - mass testing KW - screening KW - pandemic KW - sociological trends KW - COVID-19 screening N2 - Background: Mass testing campaigns were proposed in France during the first wave of the COVID-19 pandemic to detect and isolate asymptomatic individuals infected by SARS-CoV-2. During mass testing in Saint-Étienne (February 2021), we performed a survey of the general population. Objective: We evaluated, on the scale of a city?s population, the literacy level about SARS-CoV-2 transmission, barrier gesture respect, and isolation acceptability or possibility in case of SARS-CoV-2 infection. Methods: We used the validated CovQuest-CC questionnaire. Data were analyzed and correlated with volunteer characteristics and their SARS-CoV-2 screening results using multivariate analysis. Results: In total, 4707 participants completed the CovQuest-CC questionnaire. Multivariate analysis revealed that female sex was a determinant of a higher score of knowledge about SARS-CoV-2 transmission (adjusted ? coefficient=0.14, 95% CI 0.04-0.23; corrected P=.02). Older ages of 50-59 years (adjusted ? coefficient=0.25, 95% CI 0.19-0.31; corrected P<.001) and ?60 years (adjusted ? coefficient=0.25, 95% CI 0.15-0.34; corrected P<.001) were determinants of a higher score on barrier gesture respect compared to ages 20-49 years considered as reference. Female sex was also a determinant of a higher score on barrier gesture respect (adjusted ? coefficient=0.10, 95% CI 0.02-4.63; corrected P<.001). The knowledge score was correlated with the score on barrier gesture respect measures (adjusted ? coefficient=0.03, 95% CI 0.001-0.004; corrected P=.001). Older ages of 50-59 years (adjusted ? coefficient=0.21, 95% CI 0.13-0.29; corrected P<.001) and ?60 years (adjusted ? coefficient=0.25, 95% CI 0.1-0.38; corrected P<.001) were determinants of a higher score on isolation acceptability or possibility compared to the age of 20-49 years considered as reference. Finally, the knowledge score regarding SARS-CoV-2 transmission was significantly associated with a lower risk of RT-PCR (reverse transcriptase?polymerase chain reaction) positivity (adjusted odds ratio 0.80, 95% CI 0.69-0.94; corrected P<.03), implying that a 1-point increase in the knowledge score lowers the risk of positivity by 20% on average. Conclusions: This study identified factors associated with health literacy regarding SARS-CoV-2 infection in asymptomatic individuals in a large French city?s population. We can confirm that in the context of the COVID-19 pandemic, the determinants of better health literacy are not the same as those in other contexts. It seems critical to obtain a more detailed understanding of the determinants of individual citizens? behavior, as part of a strategy to combat the large-scale spread of the virus. The harsh experience of this pandemic should teach us how to nurture research to structure customized interventions to encourage the adoption of ad hoc behaviors to engage citizens in adapting behaviors more favorable to their health. UR - https://publichealth.jmir.org/2024/1/e47170 UR - http://dx.doi.org/10.2196/47170 UR - http://www.ncbi.nlm.nih.gov/pubmed/38602767 ID - info:doi/10.2196/47170 ER - TY - JOUR AU - Palakshappa, A. Jessica AU - Hale, R. Erica AU - Brown, D. Joshua AU - Kittel, A. Carol AU - Dressler, Emily AU - Rosenthal, E. Gary AU - Cutrona, L. Sarah AU - Foley, L. Kristie AU - Haines, R. Emily AU - Houston II, K. Thomas PY - 2024/4/8 TI - Longitudinal Monitoring of Clinician-Patient Video Visits During the Peak of the COVID-19 Pandemic: Adoption and Sustained Challenges in an Integrated Health Care Delivery System JO - J Med Internet Res SP - e54008 VL - 26 KW - telehealth KW - telemedicine KW - e-health KW - eHealth KW - video visits KW - video KW - ICT KW - information and communication technology KW - survey KW - surveys KW - adoption KW - usability KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - COVID-19 N2 - Background: Numerous prior opinion papers, administrative electronic health record data studies, and cross-sectional surveys of telehealth during the pandemic have been published, but none have combined assessments of video visit success monitoring with longitudinal assessments of perceived challenges to the rapid adoption of video visits during the pandemic. Objective: This study aims to quantify (1) the use of video visits (compared with in-person and telephone visits) over time during the pandemic, (2) video visit successful connection rates, and (3) changes in perceived video visit challenges. Methods: A web-based survey was developed for the dual purpose of monitoring and improving video visit implementation in our health care system during the COVID-19 pandemic. The survey included questions regarding rates of in-person, telephone, and video visits for clinician-patient encounters; the rate of successful connection for video visits; and perceived challenges to video visits (eg, software, hardware, bandwidth, and technology literacy). The survey was distributed via email to physicians, advanced practice professionals, and clinicians in May 2020. The survey was repeated in March 2021. Differences between the 2020 and 2021 responses were adjusted for within-respondent correlation across surveys and tested using generalized estimating equations. Results: A total of 1126 surveys were completed (511 surveys in 2020 and 615 surveys in 2021). In 2020, only 21.7% (73/336) of clinicians reported no difficulty connecting with patients during video visits and 28.6% (93/325) of clinicians reported no difficulty in 2021. The distribution of the percentage of successfully connected video visits (?Over the past two weeks of scheduled visits, what percentage did you successfully connect with patients by video??) was not significantly different between 2020 and 2021 (P=.74). Challenges in conducting video visits persisted over time. Poor connectivity was the most common challenge reported by clinicians. This response increased over time, with 30.5% (156/511) selecting it as a challenge in 2020 and 37.1% (228/615) in 2021 (P=.01). Patients not having access to their electronic health record portals was also a commonly reported challenge (109/511, 21.3% in 2020 and 137/615, 22.3% in 2021, P=.73). Conclusions: During the pandemic, our health care delivery system rapidly adopted synchronous patient-clinician communication using video visits. As experience with video visits increased, the reported failure rate did not significantly decline, and clinicians continued to report challenges related to general network connectivity and patient access to technology. UR - https://www.jmir.org/2024/1/e54008 UR - http://dx.doi.org/10.2196/54008 UR - http://www.ncbi.nlm.nih.gov/pubmed/38587889 ID - info:doi/10.2196/54008 ER - TY - JOUR AU - van den Bosch, C. Stefanie AU - van Dalen, Demi AU - Meinders, Marjan AU - van Goor, Harry AU - Bergé, Stefaan AU - Stommel, Martijn AU - van Dulmen, Sandra PY - 2024/3/27 TI - Outpatient Video Visits During the COVID-19 Pandemic: Cross-Sectional Survey Study of Patients? Experiences and Characteristics JO - J Med Internet Res SP - e49058 VL - 26 KW - telemedicine KW - video visit KW - remote consultation KW - eHealth KW - patient-centered care KW - COVID-19 KW - mobile phone N2 - Background: During the first lockdown of the COVID-19 pandemic, an exponential increase in video consultations replacing in-person outpatient visits was observed in hospitals. Insight into patients? experiences with this type of consultation is helpful for a broad, sustainable, and patient-centered implementation of video consultation. Objective: This study aims to examine patients? experiences with video consultation during the COVID-19 pandemic and identify discriminative patient and consultation characteristics to determine when video consultation is most feasible. Methods: A cross-sectional survey study was conducted. Patients aged ?18 years and scheduled for a video consultation at the outpatient clinic of a Dutch university medical center from August 2020 to December 2020 for all medical specialties were eligible. Patients? experiences were explored through a study-specific survey using descriptive quantitative statistics. Open-ended questions were qualitatively analyzed and thematically categorized into appreciated aspects and aspects for improvement. Discriminative patient and consultation characteristics were identified using 3 distinctive survey items. Characteristics of patients who scored and those who did not score all 3 items positively were analyzed using binary logistic regression. Results: A total of 1054 patients were included in the analysis. Most patients (964/1054, 91.46%) were satisfied with their video consultation, with a mean overall grade of 8.6 (SD 1.3) of 10. In the qualitative analyses, 70.02% (738/1054) of the patients cited aspects they appreciated and 44.97% (474/1054) mentioned aspects for improvement during their consultation. Patients with better self-rated health reported a positive evaluation significantly more often (P=.001), which also held true for other medical specialties (vs surgical and nonsurgical specialties; P<.001). Conclusions: Video consultation was perceived as highly satisfactory by patients during the COVID-19 pandemic, with the best experience reported by healthy participants and those undergoing their first consultation. Appreciated aspects are mainly at the individual professional level, organizational level, and innovation level itself. The aspects that were mentioned for improvement can be changed for the better. UR - https://www.jmir.org/2024/1/e49058 UR - http://dx.doi.org/10.2196/49058 UR - http://www.ncbi.nlm.nih.gov/pubmed/38536236 ID - info:doi/10.2196/49058 ER - TY - JOUR AU - Ullah, Nazifa AU - Martin, Sam AU - Poduval, Shoba PY - 2024/3/26 TI - A Snapshot of COVID-19 Vaccine Discourse Related to Ethnic Minority Communities in the United Kingdom Between January and April 2022: Mixed Methods Analysis JO - JMIR Form Res SP - e51152 VL - 8 KW - COVID-19 KW - ethnic minorities KW - vaccine KW - hesitancy KW - social media KW - discourse KW - minority groups N2 - Background: Existing literature highlights the role of social media as a key source of information for the public during the COVID-19 pandemic and its influence on vaccination attempts. Yet there is little research exploring its role in the public discourse specifically among ethnic minority communities, who have the highest rates of vaccine hesitancy (delay or refusal of vaccination despite availability of services). Objective: This study aims to understand the discourse related to minority communities on social media platforms Twitter and YouTube. Methods: Social media data from the United Kingdom was extracted from Twitter and YouTube using the software Netlytics and YouTube Data Tools to provide a ?snapshot? of the discourse between January and April 2022. A mixed method approach was used where qualitative data were contextualized into codes. Network analysis was applied to provide insight into the most frequent and weighted keywords and topics of conversations. Results: A total of 260 tweets and 156 comments from 4 YouTube videos were included in our analysis. Our data suggests that the most popular topics of conversation during the period sampled were related to communication strategies adopted during the booster vaccine rollout. These were noted to be divisive in nature and linked to wider conversations around racism and historical mistrust toward institutions. Conclusions: Our study suggests a shift in narrative from concerns about the COVID-19 vaccine itself, toward the strategies used in vaccination implementation, in particular the targeting of ethnic minority groups through vaccination campaigns. The implications for public health communication during crisis management in a pandemic context include acknowledging wider experiences of discrimination when addressing ethnic minority communities. UR - https://formative.jmir.org/2024/1/e51152 UR - http://dx.doi.org/10.2196/51152 UR - http://www.ncbi.nlm.nih.gov/pubmed/38530334 ID - info:doi/10.2196/51152 ER - TY - JOUR AU - Xian, Xuechang AU - Neuwirth, J. Rostam AU - Chang, Angela PY - 2024/3/19 TI - Government-Nongovernmental Organization (NGO) Collaboration in Macao?s COVID-19 Vaccine Promotion: Social Media Case Study JO - JMIR Infodemiology SP - e51113 VL - 4 KW - COVID-19 KW - government KW - vaccine KW - automated content analysis KW - Granger causality test KW - network agenda setting KW - QAP KW - social media N2 - Background: The COVID-19 pandemic triggered unprecedented global vaccination efforts, with social media being a popular tool for vaccine promotion. Objective: This study probes into Macao?s COVID-19 vaccine communication dynamics, with a focus on the multifaceted impacts of government agendas on social media. Methods: We scrutinized 22,986 vaccine-related Facebook posts from January 2020 to August 2022 in Macao. Using automated content analysis and advanced statistical methods, we unveiled intricate agenda dynamics between government and nongovernment entities. Results: ?Vaccine importance? and ?COVID-19 risk? were the most prominent topics co-occurring in the overall vaccine communication. The government tended to emphasize ?COVID-19 risk? and ?vaccine effectiveness,? while regular users prioritized vaccine safety and distribution, indicating a discrepancy in these agendas. Nonetheless, the government has limited impact on regular users in the aspects of vaccine importance, accessibility, affordability, and trust in experts. The agendas of government and nongovernment users intertwined, illustrating complex interactions. Conclusions: This study reveals the influence of government agendas on public discourse, impacting environmental awareness, public health education, and the social dynamics of inclusive communication during health crises. Inclusive strategies, accommodating public concerns, and involving diverse stakeholders are paramount for effective social media communication during health crises. UR - https://infodemiology.jmir.org/2024/1/e51113 UR - http://dx.doi.org/10.2196/51113 UR - http://www.ncbi.nlm.nih.gov/pubmed/38502184 ID - info:doi/10.2196/51113 ER - TY - JOUR AU - Blazek, Susanne E. AU - Bucher, Amy PY - 2024/3/19 TI - Barriers to COVID-19 Vaccination in a Troop of Fleet Antiterrorism Security Team Marines: Observational Study JO - JMIR Form Res SP - e50181 VL - 8 KW - behavioral barriers KW - benefits KW - COVID-19 KW - Marine Corps KW - military KW - vaccine reluctance N2 - Background: In 2019, the World Health Organization declared the reluctance to vaccinate despite the availability of vaccination services as one of the top 10 threats to global health. In early 2021, self-reported reluctance to vaccinate among military personnel might have been considered a significant threat to national security. Having a choice architecture that made COVID-19 vaccination optional rather than required for military personnel could have inadvertently undermined military readiness if vaccination uptake did not reach an acceptable threshold. Objective: The purpose of this observational study was to examine Marines? self-reported reasons for planning to decline the COVID-19 vaccine to understand their barriers to vaccination. Methods: As the vaccination became available to 1 company of Fleet Antiterrorism Security Team (FAST) Marines in early 2021, company command required those planning to decline vaccination to write an essay with up to 5 reasons for their choice. These essays provided the data for this study. Qualitative descriptive analysis with elements from grounded theory was used to thematically categorize FAST Marines? written reasons for planning to decline the COVID-19 vaccine into a codebook describing 8 key behavioral determinants. Interrater agreement among 2 qualitatively trained researchers was very good (?=0.81). Results: A troop of 47 Marines provided 235 reasons why they planned to decline the COVID-19 vaccine. The most frequent reasons were difficulty understanding health information (105/235, 45%), low estimates of risk (33/235, 14%), and fear of physical discomfort (29/235, 12%). Resulting interventions directly targeted Marines? self-reported reasons by reducing barriers (eg, normalized getting the vaccine), increasing vaccine benefits (eg, improved access to base gyms and recreational facilities), and increasing nonvaccine friction (eg, required in writing 5 reasons for declining the vaccine). Conclusions: Understanding the barriers military personnel experience toward COVID-19 vaccination remains critical as vaccine acquisition and availability continue to protect military personnel. Insights from subpopulations like FAST Marines can enhance our ability to identify barriers and appropriate intervention techniques to influence COVID-19 vaccination behaviors. UR - https://formative.jmir.org/2024/1/e50181 UR - http://dx.doi.org/10.2196/50181 UR - http://www.ncbi.nlm.nih.gov/pubmed/38502179 ID - info:doi/10.2196/50181 ER - TY - JOUR AU - González-Salinas, I. Anna AU - Andrade, L. Elizabeth AU - Abroms, C. Lorien AU - Gómez, Kaitlyn AU - Favetto, Carla AU - Gómez, M. Valeria AU - Collins, K. Karen PY - 2024/3/14 TI - Latino Parents? Reactions to and Engagement With a Facebook Group?Based COVID-19 Vaccine Promotion Intervention: Mixed Methods Pilot Study JO - JMIR Form Res SP - e51331 VL - 8 KW - COVID-19 KW - misinformation KW - social media KW - Latino parents KW - Spanish KW - vaccines KW - digital intervention N2 - Background: Misinformation in Spanish on social media platforms has contributed to COVID-19 vaccine hesitancy among Latino parents. Brigada Digital de Salud was established to disseminate credible, science-based information about COVID-19 in Spanish on social media. Objective: This study aims to assess participants? reactions to and engagement with Brigada Digital content that sought to increase COVID-19 vaccine uptake among US Latino parents and their children. Methods: We conducted a 5-week intervention in a private, moderator-led Facebook (Meta Platforms, Inc) group with Spanish-speaking Latino parents of children aged ?18 years (N=55). The intervention participants received 3 to 4 daily Brigada Digital posts and were encouraged to discuss the covered topics through comments and polls. To assess participants? exposure, reactions, and engagement, we used participants? responses to a web-based survey administered at 2 time points (baseline and after 5 weeks) and Facebook analytics to calculate the average number of participant views, reactions, and comments. Descriptive statistics were assessed for quantitative survey items, qualitative responses were thematically analyzed, and quotes were selected to illustrate the themes. Results: Overall, 101 posts were published. Most participants reported visiting the group 1 to 3 times (22/55, 40%) or 4 to 6 (18/55, 33%) times per week and viewing 1 to 2 (23/55, 42%) or 3 to 4 (16/55, 29%) posts per day. Facebook analytics validated this exposure, with 36 views per participant on average. The participants reacted positively to the intervention. Most participants found the content informative and trustworthy (49/55, 89%), easy to understand, and presented in an interesting manner. The participants thought that the moderators were well informed (51/55, 93%) and helpful (50/55, 91%) and praised them for being empathic and responsive. The participants viewed the group environment as welcoming and group members as friendly (45/55, 82%) and supportive (19/55, 35%). The 3 most useful topics for participants were the safety and efficacy of adult COVID-19 vaccines (29/55, 53%), understanding child risk levels (29/55, 53%), and the science behind COVID-19 (24/55, 44%). The preferred formats were educational posts that could be read (38/55, 69%) and videos, including expert (28/55, 51%) and instructional (26/55, 47%) interviews. Regarding engagement, most participants self-reported reacting to posts 1 to 2 (16/55, 29%) or 3 to 4 (15/55, 27%) times per week and commenting on posts 1 to 2 (16/55, 29%) or <1 (20/55, 36%) time per week. This engagement level was validated by analytics, with 10.6 reactions and 3 comments per participant, on average, during the 5 weeks. Participants recommended more opportunities for engagement, such as interacting with the moderators in real time. Conclusions: With adequate intervention exposure and engagement and overall positive participant reactions, the findings highlight the promise of this digital approach for COVID-19 vaccine?related health promotion. UR - https://formative.jmir.org/2024/1/e51331 UR - http://dx.doi.org/10.2196/51331 UR - http://www.ncbi.nlm.nih.gov/pubmed/38483457 ID - info:doi/10.2196/51331 ER - TY - JOUR AU - Elliott, Mary AU - Khallouf, Camille AU - Hirsch, Jennifer AU - de Camps Meschino, Diane AU - Zamir, Orit AU - Ravitz, Paula PY - 2024/3/14 TI - Novel Web-Based Drop-In Mindfulness Sessions (Pause-4-Providers) to Enhance Well-Being Among Health Care Workers During the COVID-19 Pandemic: Descriptive and Qualitative Study JO - JMIR Form Res SP - e43875 VL - 8 KW - COVID-19 KW - pandemic KW - health care worker KW - resilience KW - mental health KW - burnout KW - well-being KW - mindfulness meditation KW - web-based group KW - drop-in KW - mindfulness KW - health care staff KW - meditation KW - worker KW - job KW - occupational health N2 - Background: The COVID-19 pandemic exerted extraordinary pressure on health care workers (HCWs), imperiling their well-being and mental health. In response to the urgent demand to provide barrier-free support for the health care workforce, Pause-4-Providers implemented 30-minute live web-based drop-in mindfulness sessions for HCWs. Objective: This study aims to evaluate the use, feasibility, satisfaction, and acceptability of a novel mindfulness program aimed at enhancing the well-being of HCWs during the COVID-19 pandemic. Methods: Accrual for the study continued throughout the first 3 pandemic waves, and attendees of ?1 session were invited to participate. The evaluation framework included descriptive characteristics, including participant demographics, resilience at work, and single-item burnout scores; feedback questionnaires on reasons attended, benefits, and satisfaction; qualitative interviews to further understand participant experience, satisfaction, benefits, enablers, and barriers; and the number of participants in each session summarized according to the pandemic wave. Results: We collected descriptive statistics from 50 consenting HCWs. Approximately half of the participants (24/50, 48%) attended >1 session. The study participants were predominantly female individuals (40/50, 80%) and comprised physicians (17/50, 34%), nurses (9/50, 18%), and other HCWs (24/50, 48%), who were largely from Ontario (41/50, 82%). Of 50 attendees, 26 (52%) endorsed feeling burned out. The highest attendance was in May 2020 and January 2021, corresponding to the first and second pandemic waves. The participants endorsed high levels of satisfaction (43/47, 92%). The most cited reasons for attending the program were to relax (38/48, 79%), manage stress or anxiety (36/48, 75%), wish for loving kindness or self-compassion (30/48, 64%), learn mindfulness (30/48, 64%), and seek help with emotional reactivity (25/48, 53%). Qualitative interviews with 15 out of 50 (30%) participants identified positive personal and professional impacts. Personal impacts revealed that participation helped HCWs to relax, manage stress, care for themselves, sleep better, reduce isolation, and feel recognized. Professional impacts included having a toolbox of mindfulness techniques, using mindfulness moments, and being calmer at work. Some participants noted that they shared techniques with their colleagues. The reported barriers included participants? needing time to prioritize themselves, fatigue, forgetting to apply skills on the job, and finding a private place to participate. Conclusions: The Pause-4-Providers participants reported that the web-based groups were accessible; appreciated the format, content, and faculty; and had high levels of satisfaction with the program. Both novel format (eg, drop-in, live, web-based, anonymous, brief, and shared activity with other HCWs) and content (eg, themed mindfulness practices including micropractices, with workplace applications) were enablers to participation. This study of HCW support sessions was limited by the low number of consenting participants and the rolling enrollment project design; however, the findings suggest that a drop-in web-based mindfulness program has the potential to support the well-being of HCWs. UR - https://formative.jmir.org/2024/1/e43875 UR - http://dx.doi.org/10.2196/43875 UR - http://www.ncbi.nlm.nih.gov/pubmed/38180869 ID - info:doi/10.2196/43875 ER - TY - JOUR AU - Chou, Ya-Hsin AU - Lin, Chemin AU - Lee, Shwu-Hua AU - Lee, Yen-Fen AU - Cheng, Li-Chen PY - 2024/3/13 TI - User-Friendly Chatbot to Mitigate the Psychological Stress of Older Adults During the COVID-19 Pandemic: Development and Usability Study JO - JMIR Form Res SP - e49462 VL - 8 KW - geriatric psychiatry KW - mental health KW - loneliness KW - chatbot KW - user experience KW - health promotion KW - older adults KW - technology-assisted interventions KW - pandemic KW - lonely KW - gerontology KW - elderly KW - develop KW - design KW - development KW - conversational agent KW - geriatric KW - geriatrics KW - psychiatry N2 - Background: To safeguard the most vulnerable individuals during the COVID-19 pandemic, numerous governments enforced measures such as stay-at-home orders, social distancing, and self-isolation. These social restrictions had a particularly negative effect on older adults, as they are more vulnerable and experience increased loneliness, which has various adverse effects, including increasing the risk of mental health problems and mortality. Chatbots can potentially reduce loneliness and provide companionship during a pandemic. However, existing chatbots do not cater to the specific needs of older adult populations. Objective: We aimed to develop a user-friendly chatbot tailored to the specific needs of older adults with anxiety or depressive disorders during the COVID-19 pandemic and to examine their perspectives on mental health chatbot use. The primary research objective was to investigate whether chatbots can mitigate the psychological stress of older adults during COVID-19. Methods: Participants were older adults belonging to two age groups (?65 years and <65 years) from a psychiatric outpatient department who had been diagnosed with depressive or anxiety disorders by certified psychiatrists according to the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) criteria. The participants were required to use mobile phones, have internet access, and possess literacy skills. The chatbot?s content includes monitoring and tracking health data and providing health information. Participants had access to the chatbot for at least 4 weeks. Self-report questionnaires for loneliness, depression, and anxiety were administered before and after chatbot use. The participants also rated their attitudes toward the chatbot. Results: A total of 35 participants (mean age 65.21, SD 7.51 years) were enrolled in the trial, comprising 74% (n=26) female and 26% (n=9) male participants. The participants demonstrated a high utilization rate during the intervention, with over 82% engaging with the chatbot daily. Loneliness significantly improved in the older group ?65 years. This group also responded positively to the chatbot, as evidenced by changes in University of California Los Angeles Loneliness Scale scores, suggesting that this demographic can derive benefits from chatbot interaction. Conversely, the younger group, <65 years, exhibited no significant changes in loneliness after the intervention. Both the older and younger age groups provided good scores in relation to chatbot design with respect to usability (mean scores of 6.33 and 6.05, respectively) and satisfaction (mean scores of 5.33 and 5.15, respectively), rated on a 7-point Likert scale. Conclusions: The chatbot interface was found to be user-friendly and demonstrated promising results among participants 65 years and older who were receiving care at psychiatric outpatient clinics and experiencing relatively stable symptoms of depression and anxiety. The chatbot not only provided caring companionship but also showed the potential to alleviate loneliness during the challenging circumstances of a pandemic. UR - https://formative.jmir.org/2024/1/e49462 UR - http://dx.doi.org/10.2196/49462 UR - http://www.ncbi.nlm.nih.gov/pubmed/38477965 ID - info:doi/10.2196/49462 ER - TY - JOUR AU - English, Andrew AU - McDaid, Darren AU - Lynch, M. Seodhna AU - McLaughlin, Joseph AU - Cooper, Eamonn AU - Wingfield, Benjamin AU - Kelly, Martin AU - Bhavsar, Manav AU - McGilligan, Victoria AU - Irwin, E. Rachelle AU - Bucholc, Magda AU - Zhang, Shu-Dong AU - Shukla, Priyank AU - Rai, Singh Taranjit AU - Bjourson, J. Anthony AU - Murray, Elaine AU - Gibson, S. David AU - Walsh, Colum PY - 2024/2/14 TI - Genomic, Proteomic, and Phenotypic Biomarkers of COVID-19 Severity: Protocol for a Retrospective Observational Study JO - JMIR Res Protoc SP - e50733 VL - 13 KW - COVID-19 KW - clinical research KW - multiomics KW - comorbidity KW - severity KW - electronic health record N2 - Background: Health organizations and countries around the world have found it difficult to control the spread of COVID-19. To minimize the future impact on the UK National Health Service and improve patient care, there is a pressing need to identify individuals who are at a higher risk of being hospitalized because of severe COVID-19. Early targeted work was successful in identifying angiotensin-converting enzyme-2 receptors and type II transmembrane serine protease dependency as drivers of severe infection. Although a targeted approach highlights key pathways, a multiomics approach will provide a clearer and more comprehensive picture of severe COVID-19 etiology and progression. Objective: The COVID-19 Response Study aims to carry out an integrated multiomics analysis to identify biomarkers in blood and saliva that could contribute to host susceptibility to SARS-CoV-2 and the development of severe COVID-19. Methods: The COVID-19 Response Study aims to recruit 1000 people who recovered from SARS-CoV-2 infection in both community and hospital settings on the island of Ireland. This protocol describes the retrospective observational study component carried out in Northern Ireland (NI; Cohort A); the Republic of Ireland cohort will be described separately. For all NI participants (n=519), SARS-CoV-2 infection has been confirmed by reverse transcription-quantitative polymerase chain reaction. A prospective Cohort B of 40 patients is also being followed up at 1, 3, 6, and 12 months postinfection to assess longitudinal symptom frequency and immune response. Data will be sourced from whole blood, saliva samples, and clinical data from the electronic care records, the general health questionnaire, and a 12-item general health questionnaire mental health survey. Saliva and blood samples were processed to extract DNA and RNA before whole-genome sequencing, RNA sequencing, DNA methylation analysis, microbiome analysis, 16S ribosomal RNA gene sequencing, and proteomic analysis were performed on the plasma. Multiomics data will be combined with clinical data to produce sensitive and specific prognostic models for severity risk. Results: An initial demographic and clinical profile of the NI Cohort A has been completed. A total of 249 hospitalized patients and 270 nonhospitalized patients were recruited, of whom 184 (64.3%) were female, and the mean age was 45.4 (SD 13) years. High levels of comorbidity were evident in the hospitalized cohort, with cardiovascular disease and metabolic and respiratory disorders being the most significant (P<.001), grouped according to the International Classification of Diseases 10 codes. Conclusions: This study will provide a comprehensive opportunity to study the mechanisms of COVID-19 severity in recontactable participants. International Registered Report Identifier (IRRID): DERR1-10.2196/50733 UR - https://www.researchprotocols.org/2024/1/e50733 UR - http://dx.doi.org/10.2196/50733 UR - http://www.ncbi.nlm.nih.gov/pubmed/38354037 ID - info:doi/10.2196/50733 ER - TY - JOUR AU - Swift, Jim AU - O'Kelly, Noel AU - Barker, Chris AU - Woodward, Alex AU - Ghosh, Sudip PY - 2024/2/13 TI - A Digital Respiratory Ward in Leicester, Leicestershire, and Rutland, England, for Patients With COVID-19: Economic Evaluation of the Impact on Acute Capacity and Wider National Health Service Resource Use JO - JMIR Form Res SP - e47441 VL - 8 KW - Covid-19 KW - telemedicine KW - digital technology KW - home transition KW - length of stay KW - cost-effectiveness analysis KW - cost KW - costs KW - economic KW - economics KW - telehealth KW - hospitalization KW - hospital KW - hospitals KW - hospitalizations KW - resource KW - resources KW - hospital stay KW - ward KW - wards KW - virtual care KW - remote care KW - financial KW - finance KW - finances KW - remote KW - respiratory KW - SARS-CoV-2 KW - pulmonary KW - lung KW - lungs KW - service KW - services KW - delivery N2 - Background: The COVID-19 pandemic stressed global health care systems? acute capacity and caused a diversion of resources from elective care to the treatment of acute respiratory disease. In preparing for a second wave of COVID-19 infections, England?s National Health Service (NHS) in Leicester, Leicestershire, and Rutland sought to protect acute capacity in the winter of 2020-2021. Their plans included the introduction of a digital ward where patients were discharged home early and supported remotely by community-based respiratory specialists, who were informed about patient health status by a digital patient monitoring system. Objective: The objective of the digital ward was to maintain acute capacity through safe, early discharge of patients with COVID-19 respiratory disease. The study objective was to establish what impact this digital ward had on overall NHS resource use. Methods: There were no expected differences in patient outcomes. A cost minimization was performed to demonstrate the impact on the NHS resource use from discharging patients into a digital COVID-19 respiratory ward, compared to acute care length of stay (LOS). This evaluation included all 310 patients enrolled in the service from November 2020 (service commencement) to November 2021. Two primary methods, along with sensitivity analyses, were used to help overcome the uncertainty associated with the estimated comparators for the observational data on COVID-19 respiratory acute LOS, compared with the actual LOS of the 279 (90%) patients who were not discharged on oxygen nor were in critical care. Historic comparative LOS and an ordinary least squares model based on local monthly COVID-19 respiratory median LOS were used as comparators. Actual comparator data were sourced for the 31 (10%) patients who were discharged home and into the digital ward for oxygen weaning. Resource use associated with delivering care in the digital ward was sourced from the digital system and respiratory specialists. Results: In the base case, the digital ward delivered estimated health care system savings of 846.5 bed-days and US $504,197 in net financial savings across the 2 key groups of patients?those on oxygen and those not on oxygen at acute discharge (both P<.001). The mean gross and net savings per patient were US $1850 and US $1626 in the base case, respectively, without including any savings associated with a potential reduction in readmissions. The 30-day readmission rate was 2.9%, which was below comparative data. The mean cost of the intervention was US $223.53 per patient, 12.1% of the estimated gross savings. It was not until the costs were increased and the effect reduced simultaneously by 78.4% in the sensitivity analysis that the intervention was no longer cost saving. Conclusions: The digital ward delivered increased capacity and substantial financial savings and did so with a high degree of confidence, at a very low absolute and relative cost. UR - https://formative.jmir.org/2024/1/e47441 UR - http://dx.doi.org/10.2196/47441 UR - http://www.ncbi.nlm.nih.gov/pubmed/38349716 ID - info:doi/10.2196/47441 ER - TY - JOUR AU - Ueda, Ryuichiro AU - Han, Feng AU - Zhang, Hongjian AU - Aoki, Tomohiro AU - Ogasawara, Katsuhiko PY - 2024/2/6 TI - Verification in the Early Stages of the COVID-19 Pandemic: Sentiment Analysis of Japanese Twitter Users JO - JMIR Infodemiology SP - e37881 VL - 4 KW - COVID-19 KW - sentiment analysis KW - Twitter KW - infodemiology KW - NLP KW - Natural Language Processing N2 - Background: The COVID-19 pandemic prompted global behavioral restrictions, impacting public mental health. Sentiment analysis, a tool for assessing individual and public emotions from text data, gained importance amid the pandemic. This study focuses on Japan?s early public health interventions during COVID-19, utilizing sentiment analysis in infodemiology to gauge public sentiment on social media regarding these interventions. Objective: This study aims to investigate shifts in public emotions and sentiments before and after the first state of emergency was declared in Japan. By analyzing both user-generated tweets and retweets, we aim to discern patterns in emotional responses during this critical period. Methods: We conducted a day-by-day analysis of Twitter (now known as X) data using 4,894,009 tweets containing the keywords ?corona,? ?COVID-19,? and ?new pneumonia? from March 23 to April 21, 2020, approximately 2 weeks before and after the first declaration of a state of emergency in Japan. We also processed tweet data into vectors for each word, employing the Fuzzy-C-Means (FCM) method, a type of cluster analysis, for the words in the sentiment dictionary. We set up 7 sentiment clusters (negative: anger, sadness, surprise, disgust; neutral: anxiety; positive: trust and joy) and conducted sentiment analysis of the tweet groups and retweet groups. Results: The analysis revealed a mix of positive and negative sentiments, with ?joy? significantly increasing in the retweet group after the state of emergency declaration. Negative emotions, such as ?worry? and ?disgust,? were prevalent in both tweet and retweet groups. Furthermore, the retweet group had a tendency to share more negative content compared to the tweet group. Conclusions: This study conducted sentiment analysis of Japanese tweets and retweets to explore public sentiments during the early stages of COVID-19 in Japan, spanning 2 weeks before and after the first state of emergency declaration. The analysis revealed a mix of positive (joy) and negative (anxiety, disgust) emotions. Notably, joy increased in the retweet group after the emergency declaration, but this group also tended to share more negative content than the tweet group. This study suggests that the state of emergency heightened positive sentiments due to expectations for infection prevention measures, yet negative information also gained traction. The findings propose the potential for further exploration through network analysis. UR - https://infodemiology.jmir.org/2024/1/e37881 UR - http://dx.doi.org/10.2196/37881 UR - http://www.ncbi.nlm.nih.gov/pubmed/38127840 ID - info:doi/10.2196/37881 ER - TY - JOUR AU - Yu, Chuen Chou AU - Tou, Xiang Nien AU - Low, Alvin James PY - 2024/2/6 TI - Internet Use and Effects on Mental Well-being During the Lockdown Phase of the COVID-19 Pandemic in Younger Versus Older Adults: Observational Cross-Sectional Study JO - JMIR Form Res SP - e46824 VL - 8 KW - COVID-19 KW - digital divide KW - well-being KW - older adults KW - information and communication technology KW - internet of things KW - online KW - mental health KW - lockdown KW - depression KW - stress KW - anxiety KW - digital technology KW - pandemic N2 - Background: Majority of individuals, including both younger and older adults, had to adapt to digital means to cope with lockdown measures and pandemic-induced lifestyle changes during the COVID-19 pandemic. While internet accessibility was beneficial during the pandemic, existing literature suggests that excessive use could lead to the rise of problematic internet use in adolescents and younger adults. However, the effects on older adults remain unclear. Objective: This study aimed to examine differences in internet use during the lockdown phase of the COVID-19 pandemic and explore how age differences in mental health could be explained by time spent on the internet. Methods: A door-to-door survey of a nationally representative sample of 602 adults in Singapore was carried out using computer-assisted personal interviewing during the early phase of the COVID-19 pandemic (October to November 2020). Participants were categorized into younger (21-59 years old) and older (60 years or above) age groups. We assessed self-reported measures of depression, anxiety, and stress; psychosocial adaptability; ability to perform essential activities; social support; health status; digital media use patterns, and time spent on the internet. Procedures complied with existing safe distancing measures. Results: Older adults reported being less able to use digital platforms to meet needs and acquire information updates compared with younger adults during the lockdown period of the pandemic. Older adults spent significantly less time on the internet for both work and personal uses per day (mean 146.00 min, SD 9.18 min) compared with younger adults (mean 433.27 min, SD 14.32 min). Significant age differences in depression, anxiety, and stress were found, with younger adults showing poorer mental health. Mediation analysis showed that age differences in depression, anxiety, and stress were partially explained by time spent on the internet. These variables together explained 43%, 40%, and 40% of the variances in depression, anxiety, and stress scores, respectively. Conclusions: The findings showed that younger adults spent significantly more time on the internet compared with older adults during the lockdown phase of the pandemic. They were also ahead in their ability to use digital resources to meet needs and engage socially compared with older adults. Despite this, the mental health of younger adults was poor, and this was partially accounted for by the amount of time spent on the internet. Since past research suggests that excessive time spent on the internet could lead to disordered use, the benefits brought by digital technologies could have been attenuated during the lockdown phase of the pandemic. Considering this potential negative effect, it is imperative to educate both young and old adults in the appropriate use of information and communication technology. UR - https://formative.jmir.org/2024/1/e46824 UR - http://dx.doi.org/10.2196/46824 UR - http://www.ncbi.nlm.nih.gov/pubmed/38319700 ID - info:doi/10.2196/46824 ER - TY - JOUR AU - Heaton, Dan AU - Nichele, Elena AU - Clos, Jérémie AU - Fischer, E. Joel PY - 2024/2/1 TI - Perceptions of the Agency and Responsibility of the NHS COVID-19 App on Twitter: Critical Discourse Analysis JO - J Med Internet Res SP - e50388 VL - 26 KW - COVID-19 KW - information system KW - automated decisions KW - agency metaphor KW - corpus linguistics KW - decision-making algorithm KW - transitivity N2 - Background: Since September 2020, the National Health Service (NHS) COVID-19 contact-tracing app has been used to mitigate the spread of COVID-19 in the United Kingdom. Since its launch, this app has been a part of the discussion regarding the perceived social agency of decision-making algorithms. On the social media website Twitter, a plethora of views about the app have been found but only analyzed for sentiment and topic trajectories thus far, leaving the perceived social agency of the app underexplored. Objective: We aimed to examine the discussion of social agency in social media public discourse regarding algorithm-operated decisions, particularly when the artificial intelligence agency responsible for specific information systems is not openly disclosed in an example such as the COVID-19 contact-tracing app. To do this, we analyzed the presentation of the NHS COVID-19 App on Twitter, focusing on the portrayal of social agency and the impact of its deployment on society. We also aimed to discover what the presentation of social agents communicates about the perceived responsibility of the app. Methods: Using corpus linguistics and critical discourse analysis, underpinned by social actor representation, we used the link between grammatical and social agency and analyzed a corpus of 118,316 tweets from September 2020 to July 2021 to see whether the app was portrayed as a social actor. Results: We found that active presentations of the app?seen mainly through personalization and agency metaphor?dominated the discourse. The app was presented as a social actor in 96% of the cases considered and grew in proportion to passive presentations over time. These active presentations showed the app to be a social actor in 5 main ways: informing, instructing, providing permission, disrupting, and functioning. We found a small number of occasions on which the app was presented passively through backgrounding and exclusion. Conclusions: Twitter users presented the NHS COVID-19 App as an active social actor with a clear sense of social agency. The study also revealed that Twitter users perceived the app as responsible for their welfare, particularly when it provided instructions or permission, and this perception remained consistent throughout the discourse, particularly during significant events. Overall, this study contributes to understanding how social agency is discussed in social media discourse related to algorithmic-operated decisions This research offers valuable insights into public perceptions of decision-making digital contact-tracing health care technologies and their perceptions on the web, which, even in a postpandemic world, may shed light on how the public might respond to forthcoming interventions. UR - https://www.jmir.org/2024/1/e50388 UR - http://dx.doi.org/10.2196/50388 UR - http://www.ncbi.nlm.nih.gov/pubmed/38300688 ID - info:doi/10.2196/50388 ER - TY - JOUR AU - Guo, Feipeng AU - Liu, Zixiang AU - Lu, Qibei AU - Ji, Shaobo AU - Zhang, Chen PY - 2024/1/31 TI - Public Opinion About COVID-19 on a Microblog Platform in China: Topic Modeling and Multidimensional Sentiment Analysis of Social Media JO - J Med Internet Res SP - e47508 VL - 26 KW - COVID-19 KW - social media public opinion KW - microblog KW - sentiment analysis KW - topic modeling N2 - Background: The COVID-19 pandemic raised wide concern from all walks of life globally. Social media platforms became an important channel for information dissemination and an effective medium for public sentiment transmission during the COVID-19 pandemic. Objective: Mining and analyzing social media text information can not only reflect the changes in public sentiment characteristics during the COVID-19 pandemic but also help the government understand the trends in public opinion and reasonably control public opinion. Methods: First, this study collected microblog comments related to the COVID-19 pandemic as a data set. Second, sentiment analysis was carried out based on the topic modeling method combining latent Dirichlet allocation (LDA) and Bidirectional Encoder Representations from Transformers (BERT). Finally, a machine learning logistic regression (ML-LR) model combined with a sparse matrix was proposed to explore the evolutionary trend in public opinion on social media and verify the high accuracy of the model. Results: The experimental results show that, in different stages, the characteristics of public emotion are different, and the overall trend is from negative to positive. Conclusions: The proposed method can effectively reflect the characteristics of the different times and space of public opinion. The results provide theoretical support and practical reference in response to public health and safety events. UR - https://www.jmir.org/2024/1/e47508 UR - http://dx.doi.org/10.2196/47508 UR - http://www.ncbi.nlm.nih.gov/pubmed/38294856 ID - info:doi/10.2196/47508 ER - TY - JOUR AU - Sharma, Pravesh AU - Kamath, Celia AU - Brockman, A. Tabetha AU - Roche, Anne AU - Sinicrope, Pamela AU - Jiang, Ruoxiang AU - Decker, A. Paul AU - Pazdernik, Vanessa AU - Patten, Christi PY - 2024/1/24 TI - Demographics and Social Factors Associated With Persistent Nonuse of Video Appointments at a Multisite Health Care Institution: Cross-Sectional Study JO - JMIR Form Res SP - e50572 VL - 8 KW - digital health KW - telemedicine KW - telehealth KW - video visits KW - appointments KW - SDoH, social determinants of health KW - social determinants KW - appointment KW - users KW - sociodemographic KW - prevention KW - discomfort KW - video communication KW - communication KW - willingness KW - mobile phone N2 - Background: During the COVID-19 outbreak, video appointments became a popular method for health care delivery, particularly in the early stages of the pandemic. Although Mayo Clinic aimed to reduce face-to-face (F2F) appointments to prevent the spread of the virus, some patients continued seeing their health care providers in person. In the later stages of the pandemic, many patients became comfortable with video appointments, even if they were initially hesitant. However, a subset of patients continued to avoid video appointments. It is not yet clear what sociodemographic factors may be associated with this group of patients. Objective: This cross-sectional study aimed to examine demographic and social determinant of health (SDoH) factors associated with persistent nonusers of video appointments among a sample of patients within a multistate health care organization. We also explored patient beliefs about the use of video for health care appointments. Methods: We conducted a 1-time cross-sectional paper survey, mailed between July and December 2022, of patients matching the eligibility criteria: (1) aged ?18 years as of April 2020, (2) Mayo Clinic Midwest, Florida, or Arizona patient, (3) did not use video appointment services during April-December 2020 but attended F2F appointments in the departments of primary care and psychiatry/psychology. The survey asked patients, ?Have you ever had a video appointment with a healthcare provider?? ?Yes? respondents were defined as ?users? (adapted to video appointments), and ?no? respondents were defined as ?persistent nonusers? of video appointments. We analyzed demographics, SDoH, and patient beliefs toward video appointments in 2 groups: persistent nonusers of video appointments and users. We used chi-square and 2-tailed t tests for analysis. Results: Our findings indicate that patients who were older, lived in rural areas, sought care at Mayo Clinic Midwest, and did not have access to the patient portal system were likely to be persistent nonusers of video appointments. Only 1 SDoH factor (not having a disability, handicap, or chronic disease) was associated with persistent nonuse of video appointments. Persistent nonusers of video appointments held personal beliefs such as discomfort with video communication, difficulty interpreting nonverbal cues, and personal preference for F2F appointments over video. Conclusions: Our study identified demographic (older age and rural residence), sociodemographic factors (not having a disability, handicap, or chronic disease), and personal beliefs associated with patients? decisions to choose between video versus F2F appointments for health care delivery. Health care institutions should assess patients? negative attitudes toward technology prior to introducing them to digital health care services. Failing to do so may result in its restricted usage, negative patient experience, and wasted resources. For patients who hold negative beliefs about technology but are willing to learn, a ?digital health coordinator? could be assigned to assist with various digital health solutions. UR - https://formative.jmir.org/2024/1/e50572 UR - http://dx.doi.org/10.2196/50572 UR - http://www.ncbi.nlm.nih.gov/pubmed/38265855 ID - info:doi/10.2196/50572 ER - TY - JOUR AU - Waheed, Atif Muhammad AU - Al Mannai, Lolwa AU - Khudadad, Hanan AU - Alenbawi, Jamil AU - Mansaray, Aminata Mariama AU - Al Abdulla, Samya PY - 2024/1/18 TI - Assessment of Qatar?s Health Care Community Call Center Efficacy in Addressing COVID-19 Pandemic Health Care Challenges: Cross-Sectional Study JO - JMIR Form Res SP - e42753 VL - 8 KW - COVID-19 KW - COVID Response Service KW - community call center KW - virtual consultations N2 - Background: The global COVID-19 pandemic caused by SARS-CoV-2 created many unprecedented challenges for health care organizations worldwide, placing a great deal of strain on the health care systems, especially access to health care services. To address these challenges, Qatar established a centralized digital platform as a community call center, initially offering digital consultations via its hotline (number: 16000) and later expanding to include a COVID-19 vaccination hotline (number: 7077) for mass immunization. Objective: This study aims to comprehensively examine the community call center?s operations and their significant role during the COVID-19 pandemic. Methods: Retrospective data were collected from the Health Information and Technology Department of the Primary Health Care Corporation, Qatar, from March 29, 2020, to January 27, 2022. Data analysis for the hotline (number: 16000) focused on telephone and video call volumes, call response rates, abandonment rates, and call classification. In addition, data from the COVID-19 vaccination hotline (number: 7077) were analyzed for call volumes, call response rates, abandonment rates, appointment booking rates, confirmations, rescheduling, and cancellations. Results: The hotline (number: 16000) received a substantial total of 429,212 calls, with 284,849 (66.37%) calls effectively answered. The average number of calls received per day during the study period was 640.61 (SD 470.53), and the average number of calls answered per day was 425.14 (SD 206.64). Notably, of the total 128,468 consultations, video consultations were conducted for 3810 (2.96%). Among the diverse call categories, diabetes mellitus (6284/84,299, 7.45%), prescriptions and medications (4709/84,299, 5.59%), hypertension (3874/84,299, 4.6%), vitamin D-related issues (3770/84,299, 4.47%), upper respiratory tract infections (2690/84,299, 3.19%), and COVID-19?related inquiries (2590/84,299, 3.07%) were most frequently addressed. For the COVID-19 vaccination hotline (number: 7077), an impressive total of 1,512,354 calls were received, with a 58.27% (n=881,305) call response rate. The average number of calls per day during the study period was 3828.74 (SD 2931.94), and the average number of calls answered per day was 2231.15 (SD 1496.02). Appointment booking accounted for 26.37% (265,721/1,007,596), appointment confirmation accounted for 10.24% (103,136/1,007,596), rescheduling accounted for 7.95% (80,124/1,007,596), and cancellations accounted for 1.6% (16,128/1,007,596) of the calls. Conclusions: The findings of this research highlight the crucial significance of the community call center hotline (number: 16000) and the COVID-19 vaccination hotline (number: 7077) in effectively addressing the multifaceted challenges posed by the global COVID-19 pandemic. In Qatar, the community call center emerged as an indispensable and accessible centralized resource, facilitating streamlined digital consultations and vaccination appointments. The impressive call response rate highlights its operational efficiency, adeptly managing a diverse range of health-related issues. This study emphasizes the critical role of community call centers in health care emergency response, signaling their potential as invaluable assets for future preparedness and effective mitigation strategies during similar public health crises. UR - https://formative.jmir.org/2024/1/e42753 UR - http://dx.doi.org/10.2196/42753 UR - http://www.ncbi.nlm.nih.gov/pubmed/38085918 ID - info:doi/10.2196/42753 ER - TY - JOUR AU - Bartl, Gabriel PY - 2024/1/16 TI - Social and Ethical Implications of Digital Crisis Technologies: Case Study of Pandemic Simulation Models During the COVID-19 Pandemic JO - J Med Internet Res SP - e45723 VL - 26 KW - public health technologies KW - simulation models KW - algorithmic governance KW - preparedness KW - crisis, uncertainty, and ignorance KW - social implications of mathematical modeling KW - normativity KW - transparency KW - legitimacy N2 - Background: Responses to public health crises are increasingly technological in nature, as the prominence of COVID-19?related statistics and simulations amply demonstrates. However, the use of technologies is preconditional and has various implications. These implications can not only affect acceptance but also challenge the acceptability of these technologies with regard to the ethical and normative dimension. Objective: This study focuses on pandemic simulation models as algorithmic governance tools that played a central role in political decision-making during the COVID-19 pandemic. To assess the social implications of pandemic simulation models, the premises of data collection, sorting, and evaluation must be disclosed and reflected upon. Consequently, the social construction principles of digital health technologies must be revealed and examined for their effects with regard to social, ethical, and ultimately political issues. Methods: This case study starts with a systematization of different simulation approaches to create a typology of pandemic simulation models. On the basis of this, various properties, functions, and challenges of these simulation models are revealed and discussed in detail from a socioscientific point of view. Results: The typology of pandemic simulation methods reveals the diversity of model-driven handling of pandemic threats. However, it is reasonable to assume that the use of simulation models could increasingly shift toward agent-based or artificial intelligence models in the future, thus promoting the logic of algorithmic decision-making in response to public health crises. As algorithmic decision-making focuses more on predicting future dynamics than statistical practices of assessing pandemic events, this study discusses this development in detail, resulting in an operationalized overview of the key social and ethical issues related to pandemic crisis technologies. Conclusions: This study identifies 3 major recommendations for the future of pandemic crisis technologies. UR - https://www.jmir.org/2024/1/e45723 UR - http://dx.doi.org/10.2196/45723 UR - http://www.ncbi.nlm.nih.gov/pubmed/38227361 ID - info:doi/10.2196/45723 ER - TY - JOUR AU - Apio, Catherine AU - Han, Kyulhee AU - Lee, Doeun AU - Lee, Bogyeom AU - Park, Taesung PY - 2024/1/8 TI - Development of New Stringency Indices for Nonpharmacological Social Distancing Policies Implemented in Korea During the COVID-19 Pandemic: Random Forest Approach JO - JMIR Public Health Surveill SP - e47099 VL - 10 KW - COVID-19 KW - restriction policy KW - Stringency Index KW - Korea Stringency Index KW - social distancing KW - physical distancing KW - pandemic KW - government KW - restriction KW - effectiveness KW - policy N2 - Background: In the absence of an effective treatment method or vaccine, the outbreak of the COVID-19 pandemic elicited a wide range of unprecedented restriction policies aimed at mitigating and suppressing the spread of the SARS-CoV-2 virus. These policies and their Stringency Index (SI) of more than 160 countries were systematically recorded in the Oxford COVID-19 Government Response Tracker (OxCGRT) data set. The SI is a summary measure of the overall strictness of these policies. However, the OxCGRT SI may not fully reflect the stringency levels of the restriction policies implemented in Korea. Korea implemented 33 COVID-19 restriction policies targeting 4 areas: public facilities, public events, social gatherings, and religious gatherings. Objective: This study aims to develop new Korea Stringency Indices (KSIs) that reflect the stringency levels of Korea?s restriction policies better and to determine which government-implemented policies were most effective in managing the COVID-19 pandemic in Korea. Methods: The random forest method was used to calculate the new KSIs using feature importance values and determine their effectiveness in managing daily COVID-19 confirmed cases. Five analysis periods were considered, including November 01, 2020, to January 20, 2021 (Period 1), January 20, 2021, to June 27, 2021 (Period 2), November 01, 2020, to June 27, 2021 (Period 3), June 27, 2021, to November 01, 2021 (Period 4), and November 01, 2021, to April 24, 2022 (Period 5). Results: Among the KSIs, public facilities in period 4, public events in period 2, religious gatherings in periods 1 and 3, and social gatherings in period 5 had the highest importance. Among the public facilities, policies associated with operation hour restrictions in cinemas, restaurants, PC rooms, indoor sports facilities, karaoke, coffee shops, night entertainment facilities, and baths or saunas had the highest importance across all analysis periods. Strong positive correlations were observed between daily confirmed cases and public facilities, religious gatherings, and public events in period 1 of the pandemic. From then, weaker and negative correlations were observed in the remaining analysis periods. The comparison with the OxCGRT SI showed that the SI had a relatively lower feature importance and correlation with daily confirmed cases than the proposed KSIs, making KSIs more effective than SI. Conclusions: Restriction policies targeting public facilities were the most effective among the policies analyzed. In addition, different periods call for the enforcement of different policies given their effectiveness varies during the pandemic. UR - https://publichealth.jmir.org/2024/1/e47099 UR - http://dx.doi.org/10.2196/47099 UR - http://www.ncbi.nlm.nih.gov/pubmed/38190233 ID - info:doi/10.2196/47099 ER - TY - JOUR AU - Monahan, Ken AU - Gould, Edward AU - Rice, Todd AU - Wright, Patty AU - Vasilevskis, Eduard AU - Harrell, Frank AU - Drago, Monique AU - Mitchell, Sarah PY - 2024/1/3 TI - Impact of the COVID-19 Pandemic on Medical Grand Rounds Attendance: Comparison of In-Person and Remote Conferences JO - JMIR Med Educ SP - e43705 VL - 10 KW - continuing medical education KW - COVID-19 KW - distance education KW - professional development KW - virtual learning N2 - Background: Many academic medical centers transitioned from in-person to remote conferences due to the COVID-19 pandemic, but the impact on faculty attendance is unknown. Objective: This study aims to evaluate changes in attendance at medical grand rounds (MGR) following the transition from an in-person to remote format and as a function of the COVID-19 census at Vanderbilt Medical Center. Methods: We obtained the faculty attendee characteristics from Department of Medicine records. Attendance was recorded using a SMS text message?based system. The daily COVID-19 census was recorded independently by hospital administration. The main attendance metric was the proportion of eligible faculty that attended each MGR. Comparisons were made for the entire cohort and for individual faculty. Results: The observation period was from March 2019 to June 2021 and included 101 MGR conferences with more than 600 eligible faculty. Overall attendance was unchanged during the in-person and remote formats (12,536/25,808, 48.6% vs 16,727/32,680, 51.2%; P=.44) and did not change significantly during a surge in the COVID-19 census. Individual faculty members attendance rates varied widely. Absolute differences between formats were less than ?20% or greater than 20% for one-third (160/476, 33.6%) of faculty. Pulmonary or critical care faculty attendance increased during the remote format compared to in person (1450/2616, 55.4% vs 1004/2045, 49.1%; P<.001). A cloud-based digital archive of MGR lectures was accessed by <1% of faculty per conference. Conclusions: Overall faculty attendance at MGR did not change following the transition to a remote format, regardless of the COVID-19 census, but individual attendance habits fluctuated in a bidirectional manner. Incentivizing the use of a digital archive may represent an opportunity to increase faculty consumption of MGR. UR - https://mededu.jmir.org/2024/1/e43705 UR - http://dx.doi.org/10.2196/43705 UR - http://www.ncbi.nlm.nih.gov/pubmed/38029287 ID - info:doi/10.2196/43705 ER - TY - JOUR AU - Danias, George AU - Appel, Jacob PY - 2023/12/29 TI - Public Interest in Psilocybin and Psychedelic Therapy in the Context of the COVID-19 Pandemic: Google Trends Analysis JO - JMIR Form Res SP - e43850 VL - 7 KW - psilocybin KW - Google Trends KW - COVID-19 KW - medical informatics KW - depression KW - anxiety KW - substance use KW - social media KW - trend analysis KW - antidepressant N2 - Background: Psychedelic substances have demonstrated promise in the treatment of depression, anxiety, and substance use disorders. Significant media coverage has been dedicated to psychedelic medicine, but it is unclear whether the public associates psilocybin with its potential therapeutic benefits. The COVID-19 pandemic led to an increase in depression, anxiety, and substance abuse in the general population. Objective: This study attempts to link increases in interest in these disorders with increases in interest in psilocybin using Google Trends. Methods: Weekly interest-over-time Google Trends data for 4 years, from the week of March 11, 2018, to the week of March 6, 2022, were obtained for the following terms: ?psilocybin,? ?psychedelic therapy,? ?cannabis,? ?cocaine,? ?antidepressant,? ?depression,? ?anxiety,? and ?addiction.? Important psilocybin-related news and the declaration of the pandemic were noted. Trends data for each of the queried terms were plotted, and multiple regression analysis was performed to determine the slope of the prepandemic and postpandemic data with 95% CIs. Nonparametric Tau-U analysis was performed correcting for baseline trends. Results from this test were used to make inferences about the pre- and postpandemic trends and inferences about the change in overall level of searches between the 2 groups. Results: Tau values for prepandemic data were significant for stable trends, all ranging ?0.4 to 0.4. Tau values for postpandemic data showed positive trends for ?psilocybin,? ?psychedelic therapy,? and ?antidepressant.? All other trends remained stable in the range of ?0.4 to 0.4. When comparing Tau values for pre- and postpandemic data, overall increases in relative search volume (RSV) were seen for ?psilocybin,? ?psychedelic therapy,? and ?anxiety,? and overall decreases in RSV were seen for ?depression,? ?addiction,? and ?cocaine.? Overall RSVs for ?cannabis? and ?antidepressant? remained stable as Tau values ranged between ?0.4 and 0.4. In the immediate aftermath of the declaration of the pandemic, drop-offs in interest were seen for all terms except for ?anxiety? and ?cannabis.? After the initial shock of a global pandemic, ?psilocybin? and ?psychedelic therapy? groups demonstrated increases in interest trends and overall RSV. Conclusions: These data suggest that overall interest in ?psilocybin? and ?psychedelic therapy? increased at higher rates and to higher levels after than before the declaration of the pandemic. This is consistent with our hypothesis that interest increased for these treatments after the pandemic as incidence of depression, anxiety, and addiction increased. However, there may be other drivers of interest for these topics, since interest in antidepressants?the typical pharmacologic treatments for depression and anxiety?followed the expected pattern of drop-off and accelerated interest back to prepandemic levels. Interest in ?psilocybin? and ?psychedelic therapy? may have also been partially driven by popular culture hype and novelty, explaining why interest increased at a higher rate post pandemic and continued to grow, surpassing prior interest. UR - https://formative.jmir.org/2023/1/e43850 UR - http://dx.doi.org/10.2196/43850 UR - http://www.ncbi.nlm.nih.gov/pubmed/38064635 ID - info:doi/10.2196/43850 ER - TY - JOUR AU - John, Alby AU - M, Jagadeesan AU - Rubeshkumar, Polani AU - Ganeshkumar, Parasuraman AU - Masanam Sriramulu, Hemalatha AU - Narnaware, Manish AU - Singh Bedi, Gagandeep AU - Kaur, Prabhdeep PY - 2023/12/18 TI - Implementation of a Triage Protocol Outside the Hospital Setting for Timely Referral During the COVID-19 Second Wave in Chennai, India JO - JMIR Form Res SP - e42798 VL - 7 KW - COVID-19 KW - triage KW - low- and middle-income countries KW - LMIC KW - India KW - pulse oximeter KW - implementation KW - health care system KW - self-management KW - patient care KW - community health KW - low income KW - health disparity KW - low-resource setting UR - https://formative.jmir.org/2023/1/e42798 UR - http://dx.doi.org/10.2196/42798 UR - http://www.ncbi.nlm.nih.gov/pubmed/37235721 ID - info:doi/10.2196/42798 ER - TY - JOUR AU - Chung, Ping-Chen AU - Chen, J. Kevin AU - Chang, Hui-Mei AU - Chan, Ta-Chien PY - 2023/12/15 TI - Evaluating the Effectiveness of School Closure in COVID-19?Related Syndromes From Community-Based Syndromic Surveillance: Longitudinal Observational Study JO - Interact J Med Res SP - e44606 VL - 12 KW - school closure KW - COVID-19 KW - syndromic surveillance KW - outpatient KW - mobility N2 - Background: During the COVID-19 pandemic, a school closure policy was adopted to prevent cluster transmission in schools and subsequent household transmission. However, the effectiveness of school closure is not consistent in studies conducted in different countries. Objective: This study aimed to explore the association between school closure and the daily standardized incidence of COVID-19?related syndromes in an outpatient syndromic surveillance system. Methods: We calculated the incidence of COVID-19?related syndromes derived from a community-based syndromic surveillance system between the first week of January and the second or fourth weeks after school closure in 2021 and 2022 in Taipei City, Taiwan. The effect of school closure on the standardized incidence of COVID-19?related syndromes was evaluated by interrupted time series analysis using an autoregressive integrated moving average with a distributed lag function. The exogenous variables were changes in human mobility measured by Google COVID-19 community mobility reports. Furthermore, the models quantified the influence of different age groups and the hierarchy of medical facilities, such as clinics or community hospitals. Results: School closure was only negatively and significantly associated with the overall standardized incidence of COVID-19?related syndromes in 2021 for 2 weeks after the intervention (coefficient ?1.24, 95% CI ?2.40 to ?0.08). However, in different age groups, school closure had a significantly negative association with the standardized incidence among people aged 13-18 years and ?65 years for 2 weeks after the intervention in clinics in 2021. In community hospitals, school closure was significantly positively associated with the standardized incidence among people aged 19-24 years in 2021. In 2022, 2 weeks after the intervention, school closure had a significantly negative association with the standardized incidence among people aged 0-6, 7-12, and 19-24 years in community hospitals and aged >45 years in clinics. Furthermore, the standardized incidence was positively associated with movement change toward grocery and pharmacy stores in all age groups in 2022. In addition, movement changes toward residences were significantly positively associated with the standardized incidence among all age groups. Conclusions: Overall, school closure effectively suppresses COVID-19?related syndromes in students owing to the reduction of physical contact. In addition, school closure has a spillover effect on elderly people who stay at home. UR - https://www.i-jmr.org/2023/1/e44606 UR - http://dx.doi.org/10.2196/44606 UR - http://www.ncbi.nlm.nih.gov/pubmed/38100192 ID - info:doi/10.2196/44606 ER - TY - JOUR AU - Wang, Guoyong AU - Gao, Kai AU - Liu, Qianyang AU - Wu, Yuxin AU - Zhang, Kaijun AU - Zhou, Wei AU - Guo, Chunbao PY - 2023/12/14 TI - Potential and Limitations of ChatGPT 3.5 and 4.0 as a Source of COVID-19 Information: Comprehensive Comparative Analysis of Generative and Authoritative Information JO - J Med Internet Res SP - e49771 VL - 25 KW - ChatGPT 3.5 KW - ChatGPT 4.0 KW - artificial intelligence KW - AI KW - COVID-19 KW - pandemic KW - public health KW - information retrieval N2 - Background: The COVID-19 pandemic, caused by the SARS-CoV-2 virus, has necessitated reliable and authoritative information for public guidance. The World Health Organization (WHO) has been a primary source of such information, disseminating it through a question and answer format on its official website. Concurrently, ChatGPT 3.5 and 4.0, a deep learning-based natural language generation system, has shown potential in generating diverse text types based on user input. Objective: This study evaluates the accuracy of COVID-19 information generated by ChatGPT 3.5 and 4.0, assessing its potential as a supplementary public information source during the pandemic. Methods: We extracted 487 COVID-19?related questions from the WHO?s official website and used ChatGPT 3.5 and 4.0 to generate corresponding answers. These generated answers were then compared against the official WHO responses for evaluation. Two clinical experts scored the generated answers on a scale of 0-5 across 4 dimensions?accuracy, comprehensiveness, relevance, and clarity?with higher scores indicating better performance in each dimension. The WHO responses served as the reference for this assessment. Additionally, we used the BERT (Bidirectional Encoder Representations from Transformers) model to generate similarity scores (0-1) between the generated and official answers, providing a dual validation mechanism. Results: The mean (SD) scores for ChatGPT 3.5?generated answers were 3.47 (0.725) for accuracy, 3.89 (0.719) for comprehensiveness, 4.09 (0.787) for relevance, and 3.49 (0.809) for clarity. For ChatGPT 4.0, the mean (SD) scores were 4.15 (0.780), 4.47 (0.641), 4.56 (0.600), and 4.09 (0.698), respectively. All differences were statistically significant (P<.001), with ChatGPT 4.0 outperforming ChatGPT 3.5. The BERT model verification showed mean (SD) similarity scores of 0.83 (0.07) for ChatGPT 3.5 and 0.85 (0.07) for ChatGPT 4.0 compared with the official WHO answers. Conclusions: ChatGPT 3.5 and 4.0 can generate accurate and relevant COVID-19 information to a certain extent. However, compared with official WHO responses, gaps and deficiencies exist. Thus, users of ChatGPT 3.5 and 4.0 should also reference other reliable information sources to mitigate potential misinformation risks. Notably, ChatGPT 4.0 outperformed ChatGPT 3.5 across all evaluated dimensions, a finding corroborated by BERT model validation. UR - https://www.jmir.org/2023/1/e49771 UR - http://dx.doi.org/10.2196/49771 UR - http://www.ncbi.nlm.nih.gov/pubmed/38096014 ID - info:doi/10.2196/49771 ER - TY - JOUR AU - Singh, Akanksha AU - Schooley, Benjamin AU - Patel, Nitin PY - 2023/12/14 TI - Effects of User-Reported Risk Factors and Follow-Up Care Activities on Satisfaction With a COVID-19 Chatbot: Cross-Sectional Study JO - JMIR Mhealth Uhealth SP - e43105 VL - 11 KW - patient engagement KW - chatbot KW - population health KW - health recommender systems KW - conversational recommender systems KW - design factors KW - COVID-19 N2 - Background: The COVID-19 pandemic influenced many to consider methods to reduce human contact and ease the burden placed on health care workers. Conversational agents or chatbots are a set of technologies that may aid with these challenges. They may provide useful interactions for users, potentially reducing the health care worker burden while increasing user satisfaction. Research aims to understand these potential impacts of chatbots and conversational recommender systems and their associated design features. Objective: The objective of this study was to evaluate user perceptions of the helpfulness of an artificial intelligence chatbot that was offered free to the public in response to COVID-19. The chatbot engaged patients and provided educational information and the opportunity to report symptoms, understand personal risks, and receive referrals for care. Methods: A cross-sectional study design was used to analyze 82,222 chats collected from patients in South Carolina seeking services from the Prisma Health system. Chi-square tests and multinomial logistic regression analyses were conducted to assess the relationship between reported risk factors and perceived chat helpfulness using chats started between April 24, 2020, and April 21, 2022. Results: A total of 82,222 chat series were started with at least one question or response on record; 53,805 symptom checker questions with at least one COVID-19?related activity series were completed, with 5191 individuals clicking further to receive a virtual video visit and 2215 clicking further to make an appointment with a local physician. Patients who were aged >65 years (P<.001), reported comorbidities (P<.001), had been in contact with a person with COVID-19 in the last 14 days (P<.001), and responded to symptom checker questions that placed them at a higher risk of COVID-19 (P<.001) were 1.8 times more likely to report the chat as helpful than those who reported lower risk factors. Users who engaged with the chatbot to conduct a series of activities were more likely to find the chat helpful (P<.001), including seeking COVID-19 information (3.97-4.07 times), in-person appointments (2.46-1.99 times), telehealth appointments with a nearby provider (2.48-1.9 times), or vaccination (2.9-3.85 times) compared with those who did not perform any of these activities. Conclusions: Chatbots that are designed to target high-risk user groups and provide relevant actionable items may be perceived as a helpful approach to early contact with the health system for assessing communicable disease symptoms and follow-up care options at home before virtual or in-person contact with health care providers. The results identified and validated significant design factors for conversational recommender systems, including triangulating a high-risk target user population and providing relevant actionable items for users to choose from as part of user engagement. UR - https://mhealth.jmir.org/2023/1/e43105 UR - http://dx.doi.org/10.2196/43105 UR - http://www.ncbi.nlm.nih.gov/pubmed/38096007 ID - info:doi/10.2196/43105 ER - TY - JOUR AU - Delabre, M. Rosemary AU - Di Ciaccio, Marion AU - Lorente, Nicolas AU - Villes, Virginie AU - Castro Avila, Juliana AU - Yattassaye, Adam AU - Bonifaz, César AU - Ben Moussa, Amal AU - Sikitu, Ingrid-Zaïre AU - Khodabocus, Niloufer AU - Freitas, Rosa AU - Spire, Bruno AU - Veras, Amélia Maria AU - Sagaon-Teyssier, Luis AU - Girard, Gabriel AU - Roux, Perrine AU - Velter, Annie AU - Delpech, Valérie AU - Ghosn, Jade AU - Riegel, Lucas AU - Rojas Castro, Daniela PY - 2023/12/14 TI - Impact of the COVID-19 Health Crisis on Key Populations at Higher Risk for, or Living With, HIV or Hepatitis C Virus and People Working With These Populations: Multicountry Community-Based Research Study Protocol (EPIC Program) JO - JMIR Res Protoc SP - e45204 VL - 12 KW - COVID-19 KW - key populations KW - health KW - crisis KW - HIV KW - mobile phone N2 - Background: Information concerning the impact of the COVID-19 health crisis on populations most affected by HIV and hepatitis C virus (HCV; or key populations [KP]), and those working with these populations in community settings, is limited. Community-based organizations working in the field of HIV and viral hepatitis are well placed to identify and meet the new needs of KP owing to the health crisis. Objective: This study aims to describe the development and implementation of an exploratory and descriptive multicountry, community-based research program, EPIC (Enquêtes Pour évaluer l?Impact de la crise sanitaire covid en milieu Communautaire), within an international network of community-based organizations involved in the response to HIV and viral hepatitis. The EPIC program aimed to study the impact of the COVID-19 health crisis on KP or people living with HIV or HCV and people working with these populations at the community level (community health workers [CHWs]) and to identify the key innovations and adaptations in HIV and HCV services. Methods: A general protocol and study documents were developed and shared within the Coalition PLUS network. The protocol had a built-in flexibility that allowed participating organizations to adapt the study to local needs in terms of the target population and specific themes of interest. Data were collected using surveys or interviews. Results: From July 2020 to May 2022, a total of 79 organizations participated in the EPIC program. Across 32 countries, 118 studies were conducted: 66 quantitative (n=12,060 among KP or people living with HIV or people living with HCV and n=811 among CHWs) and 52 qualitative (n=766 among KP or people living with HIV or people living with HCV and n=136 among CHWs). Conclusions: The results of the EPIC program will provide data to describe the impact of the health crisis on KP and CHWs and identify their emerging needs. Documentation of innovative solutions that were put into place in this context may help improve the provision of services after COVID-19 and for future health crises. International Registered Report Identifier (IRRID): DERR1-10.2196/45204 UR - https://www.researchprotocols.org/2023/1/e45204 UR - http://dx.doi.org/10.2196/45204 UR - http://www.ncbi.nlm.nih.gov/pubmed/38096016 ID - info:doi/10.2196/45204 ER - TY - JOUR AU - Berthelot, Simon AU - Longtin, Yves AU - Margni, Manuele AU - Guertin, Robert Jason AU - LeBlanc, Annie AU - Marx, Tania AU - Mangou, Khadidiatou AU - Bluteau, Ariane AU - Mantovani, Diego AU - Mikhaylin, Sergey AU - Bergeron, Frédéric AU - Dancause, Valérie AU - Desjardins, Anne AU - Lahrichi, Nadia AU - Martin, Danielle AU - Sossa, Jérôme Charles AU - Lachapelle, Philippe AU - Genest, Isabelle AU - Schaal, Stéphane AU - Gignac, Anne AU - Tremblay, Stéphane AU - Hufty, Éric AU - Bélanger, Lynda AU - Beatty, Erica PY - 2023/12/7 TI - Postpandemic Evaluation of the Eco-Efficiency of Personal Protective Equipment Against COVID-19 in Emergency Departments: Proposal for a Mixed Methods Study JO - JMIR Res Protoc SP - e50682 VL - 12 KW - COVID-19 KW - SARS-CoV-2 KW - personal protective equipment KW - emergency department KW - health care workers KW - systematic review KW - cost-consequence analysis KW - time-driven activity-based costing KW - life cycle assessment KW - ecological footprint N2 - Background: The COVID-19 pandemic has had a profound impact on emergency department (ED) care in Canada and around the world. To prevent transmission of COVID-19, personal protective equipment (PPE) was required for all ED care providers in contact with suspected cases. With mass vaccination and improvements in several infection prevention components, our hypothesis is that the risks of transmission of COVID-19 will be significantly reduced and that current PPE use will have economic and ecological consequences that exceed its anticipated benefits. Evidence is needed to evaluate PPE use so that recommendations can ensure the clinical, economic, and environmental efficiency (ie, eco-efficiency) of its use. Objective: To support the development of recommendations for the eco-efficient use of PPE, our research objectives are to (1) estimate the clinical effectiveness (reduced transmission, hospitalizations, mortality, and work absenteeism) of PPE against COVID-19 for health care workers; (2) estimate the financial cost of using PPE in the ED for the management of suspected or confirmed COVID-19 patients; and (3) estimate the ecological footprint of PPE use against COVID-19 in the ED. Methods: We will conduct a mixed method study to evaluate the eco-efficiency of PPE use in the 5 EDs of the CHU de Québec-Université Laval (Québec, Canada). To achieve our goals, the project will include four phases: systematic review of the literature to assess the clinical effectiveness of PPE (objective 1; phase 1); cost estimation of PPE use in the ED using a time-driven activity-based costing method (objective 2; phase 2); ecological footprint estimation of PPE use using a life cycle assessment approach (objective 3; phase 3); and cost-consequence analysis and focus groups (integration of objectives 1 to 3; phase 4). Results: The first 3 phases have started. The results of these phases will be available in 2023. Phase 4 will begin in 2023 and results will be available in 2024. Conclusions: While the benefits of PPE use are likely to diminish as health care workers? immunity increases, it is important to assess its economic and ecological impacts to develop recommendations to guide its eco-efficient use. Trial Registration: PROSPERO CRD42022302598; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302598 International Registered Report Identifier (IRRID): DERR1-10.2196/50682 UR - https://www.researchprotocols.org/2023/1/e50682 UR - http://dx.doi.org/10.2196/50682 UR - http://www.ncbi.nlm.nih.gov/pubmed/38060296 ID - info:doi/10.2196/50682 ER - TY - JOUR AU - Tin, Jason AU - Stevens, Hannah AU - Rasul, Ehab Muhammad AU - Taylor, D. Laramie PY - 2023/11/29 TI - Incivility in COVID-19 Vaccine Mandate Discourse and Moral Foundations: Natural Language Processing Approach JO - JMIR Form Res SP - e50367 VL - 7 KW - incivility KW - vaccine hesitancy KW - moral foundations KW - COVID-19 KW - vaccines KW - morality KW - social media KW - natural language processing KW - machine learning N2 - Background: Vaccine hesitancy poses a substantial threat to efforts to mitigate the harmful effects of the COVID-19 pandemic. To combat vaccine hesitancy, officials in the United States issued vaccine mandates, which were met with strong antivaccine discourse on social media platforms such as Reddit. The politicized and polarized nature of COVID-19 on social media has fueled uncivil discourse related to vaccine mandates, which is known to decrease confidence in COVID-19 vaccines. Objective: This study examines the moral foundations underlying uncivil COVID-19 vaccine discourse. Moral foundations theory poses that individuals make decisions to express approval or disapproval (ie, uncivil discourse) based on innate moral values. We examine whether moral foundations are associated with dimensions of incivility. Further, we explore whether there are any differences in the presence of incivility between the r/coronaviruscirclejerk and r/lockdownskepticism subreddits. Methods: Natural language processing methodologies were leveraged to analyze the moral foundations underlying uncivil discourse in 2 prominent antivaccine subreddits, r/coronaviruscirclejerk and r/lockdownskepticism. All posts and comments from both of the subreddits were collected since their inception in March 2022. This was followed by filtering the data set for key terms associated with the COVID-19 vaccine (eg, ?vaccinate? and ?Pfizer?) and mandates (eg, ?forced? and ?mandating?). These key terms were selected based on a review of existing literature and because of their salience in both of the subreddits. A 10% sample of the filtered key terms was used for the final analysis. Results: Findings suggested that moral foundations play a role in the psychological processes underlying uncivil vaccine mandate discourse. Specifically, we found substantial associations between all moral foundations (ie, care and harm, fairness and cheating, loyalty and betrayal, authority and subversion, and sanctity and degradation) and dimensions of incivility (ie, toxicity, insults, profanity, threat, and identity attack) except for the authority foundation. We also found statistically significant differences between r/coronaviruscirclejerk and r/lockdownskepticism for the presence of the dimensions of incivility. Specifically, the mean of identity attack, insult, toxicity, profanity, and threat in the r/lockdownskepticism subreddit was significantly lower than that in the r/coronaviruscirclejerk subreddit (P<.001). Conclusions: This study shows that moral foundations may play a substantial role in the presence of incivility in vaccine discourse. On the basis of the findings of the study, public health practitioners should tailor messaging by addressing the moral values underlying the concerns people may have about vaccines, which could manifest as uncivil discourse. Another way to tailor public health messaging could be to direct it to parts of social media platforms with increased uncivil discourse. By integrating moral foundations, public health messaging may increase compliance and promote civil discourse surrounding COVID-19. UR - https://formative.jmir.org/2023/1/e50367 UR - http://dx.doi.org/10.2196/50367 UR - http://www.ncbi.nlm.nih.gov/pubmed/38019581 ID - info:doi/10.2196/50367 ER - TY - JOUR AU - Candelo, Estephania AU - Arias-Valderrama, Oriana AU - Triviño-Arias, Jacobo AU - Quiroz, Felipe AU - Isaza-Pierotti, Francisco Daniel AU - Victoria, William AU - Tintinago, F. Luis PY - 2023/11/29 TI - Airway Sequelae After Mechanical Ventilation for COVID-19: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e41811 VL - 12 KW - airway KW - sequelae KW - COVID-19 KW - mechanical ventilation KW - SARS-CoV-2 KW - scoping review KW - pulmonary KW - mortality KW - voice production KW - health care cost KW - health intervention N2 - Background: The epidemiology, morbidity, and burden of disease related to airway sequelae associated with invasive mechanical ventilation in the context of the COVID-19 pandemic remain unclear. Objective: This scoping review aims to summarize the current knowledge regarding airway sequelae after severe SARS-CoV-2 infection. This knowledge will help guide research endeavors and decision-making in clinical practice. Methods: This scoping review will include participants of all genders, and no particular age group who developed post?COVID-19 airway-related complication will be excluded. No exclusion criteria will be applied from country, language, or document type. The information source will include analytical observational studies. Unpublished data will not be completely covered as gray literature will be covered. A total of 2 independent reviewers will participate in the process of screening, selection, and data extraction, and the whole process will be performed blindly. Conflict between the reviewers will be solved through discussion and an additional reviewer. The results will be reported by using descriptive statistics, and information will be displayed on RedCap (Research Electronic Data Capture). Results: The literature search was conducted in May 2022 in the following databases: PubMed, Embase, SCOPUS, Cochrane Library, as well as LILACS and gray literature to identify observational studies; a total of 738 results were retrieved. The scoping review will be finished by March 2023. Conclusions: This scoping review will describe current knowledge on the most frequently encountered laryngeal or tracheal sequelae in patients exposed to mechanical ventilation due to SARS-CoV-2 infection. This scoping review will find the incidence of airway sequelae post COVID-19 and the most common sequelae such as airway granuloma, vocal fold paralysis, and airway stenoses. Future studies should evaluate the incidence of these disorders. International Registered Report Identifier (IRRID): DERR1-10.2196/41811 UR - https://www.researchprotocols.org/2023/1/e41811 UR - http://dx.doi.org/10.2196/41811 UR - http://www.ncbi.nlm.nih.gov/pubmed/37191952 ID - info:doi/10.2196/41811 ER - TY - JOUR AU - Soto, Raymond AU - Paul, Litty AU - Porucznik, A. Christina AU - Xie, Heng AU - Stinnett, Czako Rita AU - Briggs, Benjamin AU - Biggerstaff, Matthew AU - Stanford, Joseph AU - Schlaberg, Robert PY - 2023/11/24 TI - Effectiveness of Self-Collected, Ambient Temperature?Preserved Nasal Swabs Compared to Samples Collected by Trained Staff for Genotyping of Respiratory Viruses by Shotgun RNA Sequencing: Comparative Study JO - JMIR Form Res SP - e32848 VL - 7 KW - genotyping KW - self-collected nasal swabs KW - RNA sequencing KW - respiratory virus surveillance KW - surveillance KW - respiratory virus KW - influenza virus KW - pandemic KW - preparedness KW - testing capacity KW - self-test KW - viral genome analysis KW - swabs KW - barriers KW - early detection KW - nasal swab KW - temperature KW - public health KW - specimen KW - collection KW - diagnosis KW - laboratory KW - respiratory KW - virus KW - COVID-19 N2 - Background: The SARS-CoV-2 pandemic has underscored the need for field specimen collection and transport to diagnostic and public health laboratories. Self-collected nasal swabs transported without dependency on a cold chain have the potential to remove critical barriers to testing, expand testing capacity, and reduce opportunities for exposure of health professionals in the context of a pandemic. Objective: We compared nasal swab collection by study participants from themselves and their children at home to collection by trained research staff. Methods: Each adult participant collected 1 nasal swab, sampling both nares with the single swab, after which they collected 1 nasal swab from 1 child. After all the participant samples were collected for the household, the research staff member collected a separate single duplicate sample from each individual. Immediately after the sample collection, the adult participants completed a questionnaire about the acceptability of the sampling procedures. Swabs were placed in temperature-stable preservative and respiratory viruses were detected by shotgun RNA sequencing, enabling viral genome analysis. Results: In total, 21 households participated in the study, each with 1 adult and 1 child, yielding 42 individuals with paired samples. Study participants reported that self-collection was acceptable. Agreement between identified respiratory viruses in both swabs by RNA sequencing demonstrated that adequate collection technique was achieved by brief instructions. Conclusions: Our results support the feasibility of a scalable and convenient means for the identification of respiratory viruses and implementation in pandemic preparedness for novel respiratory pathogens. UR - https://formative.jmir.org/2023/1/e32848 UR - http://dx.doi.org/10.2196/32848 UR - http://www.ncbi.nlm.nih.gov/pubmed/37999952 ID - info:doi/10.2196/32848 ER - TY - JOUR AU - Gable, M. Jessica S. AU - Sauvayre, Romy AU - Chauvière, Cédric PY - 2023/11/23 TI - Fight Against the Mandatory COVID-19 Immunity Passport on Twitter: Natural Language Processing Study JO - J Med Internet Res SP - e49435 VL - 25 KW - mandatory vaccination KW - public policy KW - public health measures KW - COVID-19 KW - vaccine KW - social media analysis KW - Twitter KW - natural language processing KW - deep learning KW - social media KW - public health KW - vaccination KW - immunity KW - social distancing KW - neural network KW - effectiveness N2 - Background: To contain and curb the spread of COVID-19, the governments of countries around the world have used different strategies (lockdown, mandatory vaccination, immunity passports, voluntary social distancing, etc). Objective: This study aims to examine the reactions produced by the public announcement of a binding political decision presented by the president of the French Republic, Emmanuel Macron, on July 12, 2021, which imposed vaccination on caregivers and an immunity passport on all French people to access restaurants, cinemas, bars, and so forth. Methods: To measure these announcement reactions, 901,908 unique tweets posted on Twitter (Twitter Inc) between July 12 and August 11, 2021, were extracted. A neural network was constructed to examine the arguments of the tweets and to identify the types of arguments used by Twitter users. Results: This study shows that in the debate about mandatory vaccination and immunity passports, mostly ?con? arguments (399,803/847,725, 47%; ?26=952.8; P<.001) and ?scientific? arguments (317,156/803,583, 39%; ?26=5006.8; P<.001) were used. Conclusions: This study shows that during July and August 2021, social events permeating the public sphere and discussions about mandatory vaccination and immunity passports collided on Twitter. Moreover, a political decision based on scientific arguments led citizens to challenge it using pseudoscientific arguments contesting the effectiveness of vaccination and the validity of these political decisions. UR - https://www.jmir.org/2023/1/e49435 UR - http://dx.doi.org/10.2196/49435 UR - http://www.ncbi.nlm.nih.gov/pubmed/37850906 ID - info:doi/10.2196/49435 ER - TY - JOUR AU - Martínez-Baz, Iván AU - Bullón-Vela, Vanessa AU - Soldevila, Núria AU - Torner, Núria AU - Palma, David AU - García Cenoz, Manuel AU - Pérez, Glòria AU - Burgui, Cristina AU - Castilla, Jesús AU - Godoy, Pere AU - Domínguez, Angela AU - Toledo, Diana PY - 2023/11/23 TI - Assessment of Knowledge and Attitudes Over Time in Postacute COVID-19 Environments: Protocol for an Epidemiological Study JO - JMIR Res Protoc SP - e52114 VL - 12 KW - COVID-19 KW - knowledge KW - attitudes KW - household contact KW - vaccination KW - preventive measures KW - survey N2 - Background: Globally, COVID-19 is in transition from the acute pandemic phase into a postacute phase, and special attention should be paid at this time to COVID-19 control strategies. Understanding public knowledge and attitudes plays a pivotal role in controlling COVID-19?s spread and provides information about the public?s adherence to preventive and control measures. Objective: This study protocol describes the planning and management of a survey to investigate the persistent or changing trends in knowledge and attitudes regarding COVID-19, vaccination, and nonpharmaceutical preventive measures among COVID-19 cases? household contacts aged 18 years and older, after the acute phase of the pandemic in Catalonia and Navarre in Spain. The secondary objectives include investigating the rate of secondary transmission in households, taking into account the demographic characteristics, clinical manifestations, and preventive measures toward COVID-19. Methods: A telephone questionnaire was designed to assess the changing trends in knowledge, preventive measures, and attitudes toward COVID-19 in 3 rounds (after identification as a household contact, 3 months later, and 6 months later). The questionnaire was developed following an extensive literature review and through discussions with a panel of experts who designed and assessed the validity of the questionnaire in terms of relevance, consistency, completeness, and clarity. The questionnaire consists of the following 7 sections: social and demographic characteristics (ie, gender, age, educational level, and workplace), comorbidities and risk factors (according to the recommendations from the COVID-19 vaccination strategy), epidemiological data (ie, exposure time, relationship with index cases, and frequency of use of nonpharmaceutical preventive measures), COVID-19 vaccination status (ie, the number and date of doses received), knowledge and attitudes toward COVID-19 (assessed using a 5-point Likert scale?totally agree, agree, neither agree nor disagree, disagree, and totally disagree), and sources of information (including traditional mass media, social media, and official sources). Results: A pilot study was performed in May 2022 to evaluate the questionnaire with 22 household contacts. Preliminary findings indicated that the questionnaire was feasible and acceptable in the general population. The average response time was 15 minutes, with greater variations in responses by older participants. After the pilot study, recruitment of participants began and is expected to be completed at the end of the year 2023, after which the final results will be available in 2024. Conclusions: Despite the low transmission levels of SARS-CoV-2 and the relaxation of containment measures, the implementation of the survey during the postacute phase will provide valuable insight to assist public health decision-making and control the transmission of SARS-CoV-2 and other respiratory viruses, thereby attenuating the negative effects of COVID-19 at individual and population level. International Registered Report Identifier (IRRID): DERR1-10.2196/52114 UR - https://www.researchprotocols.org/2023/1/e52114 UR - http://dx.doi.org/10.2196/52114 UR - http://www.ncbi.nlm.nih.gov/pubmed/37995118 ID - info:doi/10.2196/52114 ER - TY - JOUR AU - Cordoba, Raul AU - Lopez-Garcia, Alberto AU - Morillo, Daniel AU - Perez-Saenz, Maria-Angeles AU - Askari, Elham AU - Prieto, Elena Rosa AU - Castillo Bazan, Eva AU - Llamas Sillero, Pilar AU - Herrero Gonzalez, Antonio AU - Short Apellaniz, Jorge AU - del Olmo, Marta AU - Arcos, Javier PY - 2023/11/17 TI - Feasibility of Telemedicine in the Management Strategy of Patients With Lymphoma Amid the COVID-19 Pandemic in Spain: Prospective Observational Study JO - JMIR Form Res SP - e34128 VL - 7 KW - telemedicine KW - lymphoma KW - COVID-19 KW - cancer KW - telehealth KW - risk factor KW - patient portal KW - electronic health record KW - EHR N2 - Background: On March 14, 2020, a state of alarm was declared in Spain due to the spread of SARS-CoV-2. Beyond this date, COVID-19 in the country changed the practice of oncologic care. Objective: Since recurrent hospital visits were a potential risk factor for contagion, the aim of this prospective observational study was to analyze the consequences of the COVID-19 pandemic in the health care of patients with lymphoma. Methods: All data were obtained from the electronic medical record. Variables such as age, sex, reason of the visit, use of the patient portal, changes in management, enrollment in clinical trials, and COVID-19 infection were recorded. Results: In all, 290 patients visited the lymphoma clinic, totaling 437 appointments. The median age was 66 (range 18-94) years, and 157 (54.1%) patients were male. Of them, 214 (73.8%) patients had only 1 visit to the clinic. Only 23 (7.9%) patients did not have access to the patient portal. Amid the COVID-19 pandemic, 78 (26.9%) patients remained in active treatment, 35 (12.1%) experienced delays in their treatments, and 6 (2.1%) experienced treatment discontinuation. During the follow-up, only 7 (2.4%) patients had a COVID-19 infection (6 cases with confirmed polymerase chain reaction test and 1 case with clinical suspicion). Despite the implementation of telemedicine strategies to avoid visits to the hospital, 66 (22.8%) patients had in-person visits at the lymphoma clinic. Patients who attended in-person consultations were younger than those who preferred telemedicine consultations (62 vs 66 years; P=.10) and had less use of the patient portal (17/224, 7.6% vs 6/66, 9%; P=.10), although these differences did not reach statistical significance. Patients who attended in-person visits were more likely to have had only 1 visit to the hospital (29/66, 43.9% vs 185/224, 82.6%; P<.001). Regarding the reason of in-person consultations, more patients were on active treatment in comparison to those using telemedicine resources (37/66, 56.1% vs 42/224, 18.3%; P<.001). Patients with a preference for telemedicine strategies had more surveillance visits (147/224, 65.6% vs 24/66, 36.4%; P<.001). Regarding treatment modifications, more treatment delays (29/224, 12.9% vs 6/66, 9.1%; P=.10) and more definite treatment discontinuations (6/224, 2.7% vs 0/66, 0%; P=.10) were seen in patients using telemedicine resources when compared to patients attending in-person visits, although these differences did not reach statistical significance. Regarding the type of therapy, patients attending in-person visits were more likely to receive an intravenous treatment rather than those using telemedicine (23/66, 62.2% vs 17/224, 40.5%; P<.001). Conclusions: Telemedicine such as patient portals are feasible strategies in the management of patients with lymphoma during the COVID-19 pandemic, with a reduction of in-person visits to the hospital and a very low contagion rate. UR - https://formative.jmir.org/2023/1/e34128 UR - http://dx.doi.org/10.2196/34128 UR - http://www.ncbi.nlm.nih.gov/pubmed/36645838 ID - info:doi/10.2196/34128 ER - TY - JOUR AU - Zhou, Xinyu AU - Song, Suhang AU - Zhang, Ying AU - Hou, Zhiyuan PY - 2023/11/6 TI - Deep Learning Analysis of COVID-19 Vaccine Hesitancy and Confidence Expressed on Twitter in 6 High-Income Countries: Longitudinal Observational Study JO - J Med Internet Res SP - e49753 VL - 25 KW - COVID-19 vaccine KW - hesitancy KW - confidence KW - social media KW - machine learning N2 - Background: An ongoing monitoring of national and subnational trajectory of COVID-19 vaccine hesitancy could offer support in designing tailored policies on improving vaccine uptake. Objective: We aim to track the temporal and spatial distribution of COVID-19 vaccine hesitancy and confidence expressed on Twitter during the entire pandemic period in major English-speaking countries. Methods: We collected 5,257,385 English-language tweets regarding COVID-19 vaccination between January 1, 2020, and June 30, 2022, in 6 countries?the United States, the United Kingdom, Australia, New Zealand, Canada, and Ireland. Transformer-based deep learning models were developed to classify each tweet as intent to accept or reject COVID-19 vaccination and the belief that COVID-19 vaccine is effective or unsafe. Sociodemographic factors associated with COVID-19 vaccine hesitancy and confidence in the United States were analyzed using bivariate and multivariable linear regressions. Results: The 6 countries experienced similar evolving trends of COVID-19 vaccine hesitancy and confidence. On average, the prevalence of intent to accept COVID-19 vaccination decreased from 71.38% of 44,944 tweets in March 2020 to 34.85% of 48,167 tweets in June 2022 with fluctuations. The prevalence of believing COVID-19 vaccines to be unsafe continuously rose by 7.49 times from March 2020 (2.84% of 44,944 tweets) to June 2022 (21.27% of 48,167 tweets). COVID-19 vaccine hesitancy and confidence varied by country, vaccine manufacturer, and states within a country. The democrat party and higher vaccine confidence were significantly associated with lower vaccine hesitancy across US states. Conclusions: COVID-19 vaccine hesitancy and confidence evolved and were influenced by the development of vaccines and viruses during the pandemic. Large-scale self-generated discourses on social media and deep learning models provide a cost-efficient approach to monitoring routine vaccine hesitancy. UR - https://www.jmir.org/2023/1/e49753 UR - http://dx.doi.org/10.2196/49753 UR - http://www.ncbi.nlm.nih.gov/pubmed/37930788 ID - info:doi/10.2196/49753 ER - TY - JOUR AU - Akhras, Aya AU - ElSaban, Mariam AU - Tamil?Selvan, Varshini AU - Alzaabi, Zain Shaika AU - Senok, Abiola? AU - Zary, Nabil AU - Ho, B. Samuel PY - 2023/11/6 TI - An Inquiry-Based Distance Learning Tool for Medical Students Under Lockdown (?COVID-19 Rounds?): Cross-Sectional Study JO - JMIR Med Educ SP - e40264 VL - 9 KW - medical education KW - COVID-19 KW - technology-enhanced learning KW - distance learning KW - student engagement KW - 5E instructional model N2 - Background: The COVID-19 pandemic presented significant challenges to both clinical practice and the delivery of medical education. Educators and learners implemented novel techniques, including distance learning and web-based rounds, while trying to stay updated with the surge of information regarding COVID-19 epidemiology, pathogenesis, and treatment. Hence, we designed and implemented a technologically enhanced course called ?COVID-19 Rounds? to educate students about the rapidly evolving pandemic. Objective: The objectives of this study are to describe a technologically enhanced course called ?COVID-19 Rounds? and evaluate the following: (1) student satisfaction and program usefulness in achieving preset objectives, (2) perceived improvement in literacy regarding the pandemic, and (3) the impact of student engagement by designing infographics and initiating COVID-19?related research projects. Methods: This is a cross-sectional study measuring the impact of the implementation of the web-based ?COVID-19 Rounds? course. This program included web-based clinical experiences with physicians on actual rounds in COVID-19 wards in the hospital, weekly updates on evolving data and new research, and engagement in student-led projects. The study population included 47 fourth-year medical students at the Mohamed Bin Rashid University of Medicine and Health Sciences in Dubai, the United Arab Emirates, who attended the course. We designed and administered a 47-item survey to assess student satisfaction, program usefulness, impact on knowledge, and student engagement. Data were collected at the end of program delivery via Microsoft Forms. Results: In total, 38 (81%) out of 47 fourth-year medical students participated in this study. The final course evaluation revealed an overall high satisfaction rate, with a mean rating of 3.9 (SD 0.94) on the 5-point Likert scale. Most students were satisfied with the course format (27/38, 71%), organization (31/38, 82%), and the learning experience (28/38, 74%) that the course offered. The course was particularly appreciated for offering evidence-based talks about aspects of the pandemic (34/38, 90%), providing weekly updates regarding emerging evidence (32/38, 84%), and enhancing understanding of the challenges of the pandemic (34/38, 90%). Satisfaction with distance learning was moderate (23/37, 62%), and a minority of students would have preferred an in-person version of the course (10/37, 27%). Student engagement in the course was high. All students participated in small group presentations of infographics of pandemic-related topics. Perceived advantages included conciseness and visual appeal, and disadvantages included the lack of detail and the time-consuming nature of infographic design, especially for students with no prior design experience. After the course ended, 27 (57%) students began research projects. This resulted in 6 abstracts presented at local meetings and 8 scientific papers published or submitted for publication. Conclusions: This inquiry-based adaptive approach to educating medical students about updates on COVID-19 via web-based learning was successful in achieving objectives and encouraging engagement in research. However, shortcomings of the course related to the lack of in-person teaching and clinical activities were also highlighted. UR - https://mededu.jmir.org/2023/1/e40264 UR - http://dx.doi.org/10.2196/40264 UR - http://www.ncbi.nlm.nih.gov/pubmed/37856734 ID - info:doi/10.2196/40264 ER - TY - JOUR AU - Nazarov, Anthony AU - Fikretoglu, Deniz AU - Liu, Aihua AU - Born, Jennifer AU - Michaud, Kathy AU - Hendriks, Tonya AU - Bélanger, AH Stéphanie AU - Do, T. Minh AU - Lam, Quan AU - Brooks, Brenda AU - King, Kristen AU - Sudom, Kerry AU - Jetly, Rakesh AU - Garber, Bryan AU - Thompson, Megan PY - 2023/11/6 TI - Moral Distress, Mental Health, and Risk and Resilience Factors Among Military Personnel Deployed to Long-Term Care Facilities During the COVID-19 Pandemic: Research Protocol and Participation Metrics JO - JMIR Res Protoc SP - e44299 VL - 12 KW - mental health KW - military KW - Canadian Armed Forces KW - operational organization KW - logistics support KW - health care KW - moral distress KW - moral injury KW - deployment KW - risk factors KW - COVID-19 KW - quarantine KW - readiness KW - well-being KW - resilience KW - long-term care facility KW - centre de soins de longue durée KW - survey KW - older adult KW - qualitative interviews KW - quantitative N2 - Background: The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID-19 cases and COVID-19?related deaths among residents of long-term care facilities (LTCFs). As part of Canada?s response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to the hardest-hit LTCFs (Operation LASER LTCF) to support the remaining civilian staff in ensuring the continued delivery of care to residents. Akin to what was observed following past CAF international humanitarian missions, there was an expected increased risk of exposure to multiple stressors that may be psychologically traumatic and potentially morally injurious in nature (ie, related to core values, eg, witnessing human suffering). Emerging data from health care workers exposed to the unprecedented medical challenges and dilemmas of the early pandemic stages also indicated that such experiences were associated with increased risk of adverse mental health outcomes. Objective: This study aims to identify and quantify the individual-, group-, and organizational-level risk and resilience factors associated with moral distress, moral injury, and traditional mental health and well-being outcomes of Operation LASER LTCF CAF personnel. This paper aimed to document the methodology, implementation procedures, and participation metrics. Methods: A multimethod research initiative was conducted consisting of 2 primary data collection studies (a quantitative survey and qualitative interviews). The quantitative arm was a complete enumeration survey with web-based, self-report questionnaires administered at 3 time points (3, 6, and 12 mo after deployment). The qualitative arm consisted of individual, web-based interviews with a focus on understanding the nuanced lived experiences of individuals participating in the Operation LASER LTCF deployment. Results: CAF personnel deployed to Operation LASER LTCF (N=2595) were invited to participate in the study. Data collection is now complete. Overall, of the 2595 deployed personnel, 1088 (41.93%), 582 (22.43%), and 497 (19.15%) responded to the survey at time point 1 (3 mo), time point 2 (6 mo), and time point 3 (12 mo) after deployment, respectively. The target sample size for the qualitative interviews was set at approximately 50 considering resourcing and data saturation. Interest in participating in qualitative interviews surpassed expectations, with >200 individuals expressing interest; this allowed for purposive sampling across key characteristics, including gender, rank, Operation LASER LTCF role, and province. In total, 53 interviews were conducted. Conclusions: The data generated through this research have the potential to inform and promote better understanding of the well-being and mental health of Operation LASER LTCF personnel over time; identify general and Operation LASER LTCF?specific risk and protective factors; provide necessary support to the military personnel who served in this mission; and inform preparation and interventions for future missions, especially those more domestic and humanitarian in nature. International Registered Report Identifier (IRRID): DERR1-10.2196/44299 UR - https://www.researchprotocols.org/2023/1/e44299 UR - http://dx.doi.org/10.2196/44299 UR - http://www.ncbi.nlm.nih.gov/pubmed/37676877 ID - info:doi/10.2196/44299 ER - TY - JOUR AU - Muroi, Kei AU - Ishitsuka, Mami AU - Hachisuka, Tomoko AU - Shibata, Itsuka AU - Ikeda, Tomohiko AU - Hori, Daisuke AU - Doki, Shotaro AU - Takahashi, Tsukasa AU - Sasahara, Shin-ichiro AU - Matsuzaki, Ichiyo PY - 2023/11/3 TI - Factors Associated With Work Engagement of Nurses During the Fifth Wave of the COVID-19 Pandemic in Japan: Web-Based Cross-Sectional Study JO - JMIR Form Res SP - e45830 VL - 7 KW - age KW - COVID-19 KW - cross-sectional study KW - engagement KW - experience KW - gender KW - intensive care KW - Japan KW - JD-R model KW - job demands-resources KW - mental health KW - nurses KW - psychiatric KW - psychological KW - survey KW - work engagement N2 - Background: The COVID-19 pandemic has brought to light the prevalence of mental health issues among nurses. Work engagement (WE) is a concept that describes work-related positive psychological states and is of importance within mental health measures. There is, however, a lack of research on factors associated with the WE of nurses during the COVID-19 pandemic. Objective: We aimed to determine which factors are associated with WE among nurses during the COVID-19 pandemic using the job demands-resources (JD-R) model as a framework. Methods: A web-based cross-sectional survey was conducted among nurses working in acute care and psychiatric institutions in the prefectures of Chiba and Tokyo in Japan. The survey period occurred between August 8 and September 30, 2021, during a time when the number of patients with a positive COVID-19 infection increased. The 3-item version of the Utrecht Work Engagement Scale (UWES-3) was used to measure WE. Factors such as age, gender, years of experience, affiliated ward, COVID-19?related stress, financial rewards from the government and hospital, encouragement from the government and patients, and workplace social capital were assessed. A total of 187 participants were included in the final analysis. Multiple regression analysis was performed to examine the factors related to WE. Partial regression coefficients (B), 95% CI, and P values were calculated. Results: The mean overall score for the UWES-3 was 3.19 (SD 1.21). Factors negatively associated with UWES-3 were COVID-19?related stress on work motivation and escape behavior (? ?0.16, 95% CI ?0.24 to ?0.090; P<.001), and factors positively associated with UWES-3 were affiliation of intensive care units (? 0.76, 95% CI 0.020-1.50; P=.045) and financial rewards from the government and hospital (? 0.40, 95% CI 0.040-0.76; P=.03). Conclusions: This study examined factors related to WE among nurses during the COVID-19 pandemic using the JD-R model. When compared with findings from previous studies, our results suggest that nurses? WE was lower than before the COVID-19 pandemic. Negative motivation and escape behaviors related to COVID-19 were negatively associated with WE, while there were positive associations with financial rewards from the government and hospital and affiliation with an intensive care unit. Further research into larger populations is needed to confirm these findings. UR - https://formative.jmir.org/2023/1/e45830 UR - http://dx.doi.org/10.2196/45830 UR - http://www.ncbi.nlm.nih.gov/pubmed/37921864 ID - info:doi/10.2196/45830 ER - TY - JOUR AU - Dai, Jing AU - Lyu, Fang AU - Yu, Lin AU - He, Yunyu PY - 2023/11/2 TI - Temporal and Emotional Variations in People?s Perceptions of Mass Epidemic Infectious Disease After the COVID-19 Pandemic Using Influenza A as an Example: Topic Modeling and Sentiment Analysis Based on Weibo Data JO - J Med Internet Res SP - e49300 VL - 25 KW - mass epidemic infections KW - sentiment analysis KW - text mining KW - spatial differences KW - temporal differences KW - influenza A KW - COVID-19 N2 - Background: The COVID-19 pandemic has had profound impacts on society, including public health, the economy, daily life, and social interactions. Social distancing measures, travel restrictions, and the influx of pandemic-related information on social media have all led to a significant shift in how individuals perceive and respond to health crises. In this context, there is a growing awareness of the role that social media platforms such as Weibo, among the largest and most influential social media sites in China, play in shaping public sentiment and influencing people?s behavior during public health emergencies. Objective: This study aims to gain a comprehensive understanding of the sociospatial impact of mass epidemic infectious disease by analyzing the spatiotemporal variations and emotional orientations of the public after the COVID-19 pandemic. We use the outbreak of influenza A after the COVID-19 pandemic as a case study. Through temporal and spatial analyses, we aim to uncover specific variations in the attention and emotional orientations of people living in different provinces in China regarding influenza A. We sought to understand the societal impact of large-scale infectious diseases and the public?s stance after the COVID-19 pandemic to improve public health policies and communication strategies. Methods: We selected Weibo as the data source and collected all influenza A?related Weibo posts from November 1, 2022, to March 31, 2023. These data included user names, geographic locations, posting times, content, repost counts, comments, likes, user types, and more. Subsequently, we used latent Dirichlet allocation topic modeling to analyze the public?s focus as well as the bidirectional long short-term memory model to conduct emotional analysis. We further classified the focus areas and emotional orientations of different regions. Results: The research findings indicate that, compared with China?s western provinces, the eastern provinces exhibited a higher volume of Weibo posts, demonstrating a greater interest in influenza A. Moreover, inland provinces displayed elevated levels of concern compared with coastal regions. In addition, female users of Weibo exhibited a higher level of engagement than male users, with regular users comprising the majority of user types. The public?s focus was categorized into 23 main themes, with the overall emotional sentiment predominantly leaning toward negativity (making up 7562 out of 9111 [83%] sentiments). Conclusions: The results of this study underscore the profound societal impact of the COVID-19 pandemic. People tend to be pessimistic toward new large-scale infectious diseases, and disparities exist in the levels of concern and emotional sentiments across different regions. This reflects diverse societal responses to health crises. By gaining an in-depth understanding of the public?s attitudes and focal points regarding these infectious diseases, governments and decision makers can better formulate policies and action plans to cater to the specific needs of different regions and enhance public health awareness. UR - https://www.jmir.org/2023/1/e49300 UR - http://dx.doi.org/10.2196/49300 UR - http://www.ncbi.nlm.nih.gov/pubmed/37917144 ID - info:doi/10.2196/49300 ER - TY - JOUR AU - Krämer, Dennis AU - Brachem, Elisabeth AU - Schneider-Reuter, Lydia AU - D'Angelo, Isabella AU - Vollmann, Jochen AU - Haltaufderheide, Joschka PY - 2023/10/20 TI - Smartphone Apps for Containing the COVID-19 Pandemic in Germany: Qualitative Interview Study With Experts Based on Grounded Theory JO - J Med Internet Res SP - e45549 VL - 25 KW - Corona-Warn-App KW - COVID-19 pandemic KW - eHealth KW - Germany KW - health technology KW - mobile phone KW - qualitative research KW - sovereignty KW - transparency N2 - Background: Smartphone apps, including those for digital contact tracing (DCT), played a crucial role in containing infections during the COVID-19 pandemic. Their primary function is to generate and disseminate information to disrupt transmissions based on various events, such as encounters, vaccinations, locations, or infections. Although the functionality of these apps has been extensively studied, there is still a lack of qualitative research addressing critical issues. Objective: We will demonstrate that the use of DCT presents a challenge due to the tension between continuous health monitoring and uncertainties related to transparency and user sovereignty. On one hand, DCT enables the monitoring of various risk factors, including data-based calculations of infection probabilities. On the other hand, continuous risk management is intertwined with several uncertainties, including the unclear storage of personal data, who has access to it, and how it will be used in the future. Methods: We focus on the German ?Corona-Warn-App? and support our argument with empirical data from 19 expert interviews conducted between 2020 and 2021. The interviews were conducted using a semistructured questionnaire and analyzed according to the principles of grounded theory. Results: Our data underscores 3 dimensions: transparency, data sovereignty, and the east-west divide. While transparency is considered an essential foundation for establishing trust in the use of DCT by providing a sense of security, data sovereignty is seen as a high value during the pandemic, protecting users from an undesired loss of control. The aspect of the east-west divide highlights the idea of incorporating sociocultural values and standards into technology, emphasizing that algorithms and data-driven elements, such as distance indicators, encounters, and isolations, are also influenced by sociocultural factors. Conclusions: The effective use of DCT for pandemic containment relies on achieving a balance between individual control and technological prevention. Maximizing the technological benefits of these tools is crucial. However, users must also be mindful of the information they share and maintain control over their shared data. UR - https://www.jmir.org/2023/1/e45549 UR - http://dx.doi.org/10.2196/45549 UR - http://www.ncbi.nlm.nih.gov/pubmed/37862068 ID - info:doi/10.2196/45549 ER - TY - JOUR AU - Koskan, M. Alexis AU - Sivanandam, Shalini AU - Roschke, Kristy AU - Irby, Jonathan AU - Helitzer, L. Deborah AU - Doebbeling, Bradley PY - 2023/10/20 TI - Sharing Reliable COVID-19 Information and Countering Misinformation: In-Depth Interviews With Information Advocates JO - JMIR Infodemiology SP - e47677 VL - 3 KW - COVID-19 KW - coronavirus KW - pandemic KW - infodemic KW - misinformation KW - social media KW - qualitative research KW - public health KW - health communication N2 - Background: The rampant spread of misinformation about COVID-19 has been linked to a lower uptake of preventive behaviors such as vaccination. Some individuals, however, have been able to resist believing in COVID-19 misinformation. Further, some have acted as information advocates, spreading accurate information and combating misinformation about the pandemic. Objective: This work explores highly knowledgeable information advocates? perspectives, behaviors, and information-related practices. Methods: To identify participants for this study, we used outcomes of survey research of a national sample of 1498 adults to find individuals who scored a perfect or near-perfect score on COVID-19 knowledge questions and who also self-reported actively sharing or responding to news information within the past week. Among this subsample, we selected a diverse sample of 25 individuals to participate in a 1-time, phone-based, semistructured interview. Interviews were recorded and transcribed, and the team conducted an inductive thematic analysis. Results: Participants reported trusting in science, data-driven sources, public health, medical experts, and organizations. They had mixed levels of trust in various social media sites to find reliable health information, noting distrust in particular sites such as Facebook (Meta Platforms) and more trust in specific accounts on Twitter (X Corp) and Reddit (Advance Publications). They reported relying on multiple sources of information to find facts instead of depending on their intuition and emotions to inform their perspectives about COVID-19. Participants determined the credibility of information by cross-referencing it, identifying information sources and their potential biases, clarifying information they were unclear about with health care providers, and using fact-checking sites to verify information. Most participants reported ignoring misinformation. Others, however, responded to misinformation by flagging, reporting, and responding to it on social media sites. Some described feeling more comfortable responding to misinformation in person than online. Participants? responses to misinformation posted on the internet depended on various factors, including their relationship to the individual posting the misinformation, their level of outrage in response to it, and how dangerous they perceived it could be if others acted on such information. Conclusions: This research illustrates how well-informed US adults assess the credibility of COVID-19 information, how they share it, and how they respond to misinformation. It illustrates web-based and offline information practices and describes how the role of interpersonal relationships contributes to their preferences for acting on such information. Implications of our findings could help inform future training in health information literacy, interpersonal information advocacy, and organizational information advocacy. It is critical to continue working to share reliable health information and debunk misinformation, particularly since this information informs health behaviors. UR - https://infodemiology.jmir.org/2023/1/e47677 UR - http://dx.doi.org/10.2196/47677 UR - http://www.ncbi.nlm.nih.gov/pubmed/37862066 ID - info:doi/10.2196/47677 ER - TY - JOUR AU - Chau, Brian AU - Taba, Melody AU - Dodd, Rachael AU - McCaffery, Kirsten AU - Bonner, Carissa PY - 2023/10/18 TI - Twitch Data in Health Promotion Research: Protocol for a Case Study Exploring COVID-19 Vaccination Views Among Young People JO - JMIR Res Protoc SP - e48641 VL - 12 KW - twitch KW - social media KW - COVID-19 KW - vaccination communication KW - video gaming KW - gaming KW - health promotion KW - streaming N2 - Background: Social media platforms have emerged as a useful channel for health promotion communication, offering different channels to reach targeted populations. For example, social media has recently been used to disseminate information about COVID-19 vaccination across various demographics. Traditional modes of health communication such as television, health events, and newsletters may not reach all groups within a community. Health communications for younger generations are increasingly disseminated through social media to reflect key information sources. This paper explores a social media gaming platform as an alternative way to reach young people in health promotion research. Objective: This protocol study aimed to pilot-test the potential of Twitch, a live streaming platform initially designed for video gaming, to conduct health promotion research with young people. We used COVID-19 vaccination as a topical case study that was recommended by Australian health authorities at the time of the research. Methods: The research team worked with a Twitch Account Manager to design and test a case study within the guidelines and ethics protocols required by Twitch, identify suitable streamers to approach and establish a protocol for conducting research on the platform. This involved conducting a poll to initiate discussion about COVID-19 vaccination, monitoring the chat in 3 live Twitch sessions with 2 streamers to pilot the protocol, and briefly analyze Twitch chat logs to observe the range of response types that may be acquired from this methodology. Results: The Twitch streams provided logs and videos on demand that were derived from the live session. These included demographics of viewers, chat logs, and polling results. The results of the poll showed a range of engagement in health promotion for the case study topic: the majority of participants had received their vaccination by the time of the poll; however, there was still a proportion that had not received their vaccination yet or had decided to not be vaccinated. Analysis of the Twitch chat logs demonstrated a range of both positive and negative themes regarding health promotion for the case study topic. This included irrelevant comments, misinformation (compared to health authority information at the time of this study), comedic and conspiracy responses, as well as vaccine status, provaccine comments, and vaccine-hesitant comments. Conclusions: This study developed and tested a protocol for using Twitch data for health promotion research with young people. With live polling, open text discussion between participants and immediate responses to questions, Twitch can be used to collect both quantitative and qualitative research data from demographics that use social media. The platform also presents some challenges when engaging with independent streamers and sensitive health topics. This study provides an initial protocol for future researchers to use and build on. International Registered Report Identifier (IRRID): RR1-10.2196/48641 UR - https://www.researchprotocols.org/2023/1/e48641 UR - http://dx.doi.org/10.2196/48641 UR - http://www.ncbi.nlm.nih.gov/pubmed/37851494 ID - info:doi/10.2196/48641 ER - TY - JOUR AU - Wong, W. Kirstie H. T. AU - Lau, Y. Wallis C. AU - Man, C. Kenneth K. AU - Bilbow, Andrea AU - Ip, Patrick AU - Wei, Li PY - 2023/10/17 TI - Effectiveness of Facebook Groups and Pages on Participant Recruitment Into a Randomized Controlled Trial During the COVID-19 Pandemic: Descriptive Study JO - J Med Internet Res SP - e46190 VL - 25 KW - 1-2-3 Magic, ADHD KW - attention deficit/hyperactivity disorder KW - behavioral parenting training KW - BPT KW - clinical trial KW - COVID-19 KW - Facebook group KW - Facebook page KW - Facebook KW - pediatric KW - randomized controlled trial KW - recruitment KW - social media KW - youth KW - Zoom N2 - Background: In response to the unprecedented challenges posed by the COVID-19 pandemic, conventional recruitment approaches were halted, causing the suspension of numerous clinical trials. Previously, Facebook (Meta Platforms, Inc) has emerged as a promising tool for augmenting participant recruitment. While previous research has explored the use of Facebook for surveys and qualitative studies, its potential for recruiting participants into randomized controlled trials (RCTs) remains underexplored. Objective: This study aimed to comprehensively examine the effectiveness of using Facebook groups and pages to facilitate participant recruitment during the COVID-19 pandemic for an RCT on the effectiveness of a remote parenting program, 1-2-3 Magic, in families who have children with attention-deficit/hyperactivity disorder (ADHD) in the United Kingdom. Methods: We disseminated 5 Facebook posts with an attached digital flyer across 4 prominent ADHD UK support groups and pages run by the National Attention Deficit Disorder Information and Support Services, reaching an audience of around 16,000 individuals over 2 months (January 7 to March 4, 2022). Eligibility criteria mandated participants to be parents or caregivers of a child with diagnosed ADHD aged 12 years or younger, be residing in the United Kingdom, have access to stable internet, and have a device with the Zoom (Zoom Video Communications) app. Participants were required to have never attended 1-2-3 Magic training previously. Prospective participants expressed their interest through Microsoft Forms (Microsoft Corporation). The trial aimed to recruit 84 parents. It is important to note that the term ?parent? or ?caregiver? in the RCT and in this study within a trial refers to anybody who has legal responsibility for the child. Results: Overall, 478 individuals registered their interest through Microsoft Forms within the stipulated 2-month window. After the eligibility check, 135 participants were contacted for a baseline meeting through Zoom. The first 84 participants who attended a baseline meeting and returned a completed consent form were enrolled. Subsequently, another 16 participants were added, resulting in a final sample of 100 participants. This recruitment strategy incurred negligible expenses and demanded minimal human resources. The approach yielded favorable outcomes by efficiently attracting eligible participants in a condensed time frame, transcending geographical barriers throughout the United Kingdom, which would have been tedious to achieve through traditional recruitment methods. Conclusions: Our experience demonstrated that digital flyers posted in the targeted Facebook groups were a cost-effective and quick method for recruiting for an RCT, which opened during the COVID-19 pandemic when lockdown restrictions were in place in the United Kingdom. Trialists should consider this low-cost recruitment intervention for trials going forward, and in the case of a global pandemic, this novel recruitment method enabled the trial to continue where many have failed. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 15281572; https://www.isrctn.com/ISRCTN15281572 UR - https://www.jmir.org/2023/1/e46190 UR - http://dx.doi.org/10.2196/46190 UR - http://www.ncbi.nlm.nih.gov/pubmed/37847536 ID - info:doi/10.2196/46190 ER - TY - JOUR AU - Prado, Silva Aneliana da AU - Kohls, Elisabeth AU - Baldofski, Sabrina AU - Rummel-Kluge, Christine AU - Freitas, Lucas Joanneliese de PY - 2023/10/13 TI - Acceptability and Feasibility of Online Support Groups for Mental Health Promotion in Brazilian Graduate Students During the COVID-19 Pandemic: Longitudinal Observational Study JO - JMIR Form Res SP - e44887 VL - 7 KW - support group KW - online group KW - COVID-19 pandemic KW - higher education KW - graduate students KW - university students KW - mental health KW - online intervention KW - internet intervention KW - e?mental health KW - mental health promotion KW - feasibility KW - students KW - acceptability N2 - Background: The outbreak of the COVID-19 pandemic in 2020 aggravated already existing difficulties and added new challenges for students. Owing to the gap between needed and available psychological services, group interventions may offer a helpful strategy for student mental health promotion. Objective: This study aimed to investigate the acceptability and feasibility of a 4-week online support group program designed for mental health promotion tailored to graduate students at a Brazilian public university in the context of the COVID-19 pandemic (May 2022 to June 2022). Methods: Participants in the program took part in online support groups based on a pilot group facilitated by a trained clinical psychologist. Self-administered, standardized web-based questionnaires were assessed at the baseline (T0; before the intervention), postintervention (T2), and follow-up (T3; after 4-6 weeks) time points. We measured sociodemographic variables, treatment credibility and expectancy (Credibility and Expectancy Questionnaire), satisfaction (Client Satisfaction Questionnaire), negative effects of the intervention (Negative Effects Questionnaire), depressive symptoms (Patient Health Questionnaire?9 [PHQ-9]), and participants? quality of life (abbreviated World Health Organization Quality of Life assessment). A 9?answer option questionnaire and open-ended questions also assessed the group?s perceived positive and negative outcomes. Results: The total sample comprised 32 participants. Most (23/32, 72%) were doctoral students. Credibility and expectancy scores were high. Participants? satisfaction (Client Satisfaction Questionnaire) with the program was high at the postintervention (T2) and follow-up (T3) evaluations (T2: mean 28.66, SD 3.02; T3: mean 27.91, SD 3.02). Most participants reported that they could learn from other participants? experiences (T2: 29/32, 91%; T3: 27/32, 84%) and felt encouraged to take better care of themselves (T2: 22/32, 69%; T3: 24/32, 75%). None of the participants reported that they had no benefits from the program. The PHQ-9 scores showed mild to moderate depressive symptoms (mean 9.59, SD 6.34), whereas the answers of 9% (3/32) of the participants to the PHQ-9 item 9 indicated suicidality at baseline (T0). Finally, the 4 domains of quality of life (physical: P=.01; psychological: P=.004; social: P=.02; and environmental: P<.001) showed a slight and statistically significant improvement at the postintervention evaluation (T0: mean 57.03, SD 15.39 to 59.64, SD 17.21; T2: mean 64.32, SD 11.97 to 68.75, SD 8.87). Conclusions: Online support groups for the mental health promotion of graduate students are feasible and can be especially useful for universities with students allocated to different cities. They are also satisfactory and may positively influence participants? quality of life. Therefore, they can be considered a helpful mental health promotion strategy in the educational context. Further studies could evaluate these (or similar) programs under nonpandemic circumstances. UR - https://formative.jmir.org/2023/1/e44887 UR - http://dx.doi.org/10.2196/44887 UR - http://www.ncbi.nlm.nih.gov/pubmed/37831483 ID - info:doi/10.2196/44887 ER - TY - JOUR AU - Kang, Annie AU - Hetrick, Sarah AU - Cargo, Tania AU - Hopkins, Sarah AU - Ludin, Nicola AU - Bodmer, Sarah AU - Stevenson, Kiani AU - Holt-Quick, Chester AU - Stasiak, Karolina PY - 2023/10/12 TI - Exploring Young Adults? Views About Aroha, a Chatbot for Stress Associated With the COVID-19 Pandemic: Interview Study Among Students JO - JMIR Form Res SP - e44556 VL - 7 KW - chatbot KW - mental health KW - COVID-19 KW - young adults KW - acceptability KW - qualitative methods N2 - Background: In March 2020, New Zealand was plunged into its first nationwide lockdown to halt the spread of COVID-19. Our team rapidly adapted our existing chatbot platform to create Aroha, a well-being chatbot intended to address the stress experienced by young people aged 13 to 24 years in the early phase of the pandemic. Aroha was made available nationally within 2 weeks of the lockdown and continued to be available throughout 2020. Objective: In this study, we aimed to evaluate the acceptability and relevance of the chatbot format and Aroha?s content in young adults and to identify areas for improvement. Methods: We conducted qualitative in-depth and semistructured interviews with young adults as well as in situ demonstrations of Aroha to elicit immediate feedback. Interviews were recorded, transcribed, and analyzed using thematic analysis assisted by NVivo (version 12; QSR International). Results: A total of 15 young adults (age in years: median 20; mean 20.07, SD 3.17; female students: n=13, 87%; male students: n=2, 13%; all tertiary students) were interviewed in person. Participants spoke of the challenges of living during the lockdown, including social isolation, loss of motivation, and the demands of remote work or study, although some were able to find silver linings. Aroha was well liked for sounding like a ?real person? and peer with its friendly local ?Kiwi? communication style, rather than an authoritative adult or counselor. The chatbot was praised for including content that went beyond traditional mental health advice. Participants particularly enjoyed the modules on gratitude, being active, anger management, job seeking, and how to deal with alcohol and drugs. Aroha was described as being more accessible than traditional mental health counseling and resources. It was an appealing option for those who did not want to talk to someone in person for fear of the stigma associated with mental health. However, participants disliked the software bugs. They also wanted a more sophisticated conversational interface where they could express themselves and ?vent? in free text. There were several suggestions for making Aroha more relevant to a diverse range of users, including developing content on navigating relationships and diverse chatbot avatars. Conclusions: Chatbots are an acceptable format for scaling up the delivery of public mental health and well-being?enhancing strategies. We make the following recommendations for others interested in designing and rolling out mental health chatbots to better support young people: make the chatbot relatable to its target audience by working with them to develop an authentic and relevant communication style; consider including holistic health and lifestyle content beyond traditional ?mental health? support; and focus on developing features that make users feel heard, understood, and empowered. UR - https://formative.jmir.org/2023/1/e44556 UR - http://dx.doi.org/10.2196/44556 UR - http://www.ncbi.nlm.nih.gov/pubmed/37527545 ID - info:doi/10.2196/44556 ER - TY - JOUR AU - Tran, Xuan Bach AU - Dam, Trong Vu Anh AU - Auquier, Pascal AU - Boyer, Laurent AU - Fond, Guillaume AU - Nguyen, Manh Hung AU - Nguyen, Tuan Hung AU - Le, Thi Huong AU - Tran, Thi Ha Nhi AU - Vu, Thu Giang AU - Nguyen, Duc Manh AU - Nguyen, Thi Duong Anh AU - Ly, Viet Bang AU - Latkin, A. Carl AU - Zhang, WB Melvyn AU - Ho, CM Roger AU - Ho, SH Cyrus PY - 2023/10/11 TI - Structural Equation Model for Social Support and Quality of Life Among Individuals With Mental Health Disorders During the COVID-19 Pandemic JO - JMIR Public Health Surveill SP - e47239 VL - 9 KW - contextual KW - social support KW - quality of life KW - mental health disorders KW - Vietnam KW - mental health KW - mental illness KW - cross-sectional KW - association N2 - Background: In light of the COVID-19 pandemic, the distribution of social support for mental health problems has likely become unequal. Family- and community-based social support has been recognized as a promising approach for mental disorders; however, limited global frameworks have been applied to developing countries such as Vietnam. Objective: The aim of this study was to evaluate the quality of life and social support among patients with mental health disorders in Vietnam and to investigate the factors associated with quality of life among these patients. Methods: A cross-sectional study was conducted on 222 psychiatric patients in Hanoi from 2020 to 2022. A structured questionnaire was developed based on four standardized scales: Mental Well-Being-5 scale, Multidimensional Scale of Perceived Social Support, EuroQoL-visual analog scale (EQ-VAS), and EuroQoL-5 dimensions-5 levels (EQ-5D-5L) scale. Tobit regression was used to identify factors associated with the EQ-5D-5L and EQ-VAS scores. Structural equation modeling was applied to verify the relationship between quality of life and social support. Results: The results showed that perceived support from family scored the highest compared to support from friends and significant others. Patients with depression reported the lowest quality of life and perceived social support. Structural equation modeling showed a root mean square error of approximation of 0.055 (90% CI 0.006-0.090), comparative fit index of 0.954, Tucker-Lewis index of 0.892, and standardized root mean squared error of 0.036 (P<.001). The hypothetical model indicated statistically significant correlations between EQ-VAS score and social support (P=.004), EQ-5D-5L and mental well-being (P<.001), and social support and mental well-being (P<.001). Critical deterioration of quality of life and inconsistency in social support for patients with mental illness were also recorded. Conclusions: There is a need to enhance social support and service delivery in Vietnam, focusing on occupation and quality of life. The correlations between social support, quality of life, and mental health issues suggest the potential of a clinical-social integrated intervention model of care. UR - https://publichealth.jmir.org/2023/1/e47239 UR - http://dx.doi.org/10.2196/47239 UR - http://www.ncbi.nlm.nih.gov/pubmed/37819706 ID - info:doi/10.2196/47239 ER - TY - JOUR AU - Rambaud, Kimberly AU - van Woerden, Simon AU - Palumbo, Leonardo AU - Salvi, Cristiana AU - Smallwood, Catherine AU - Rockenschaub, Gerald AU - Okoliyski, Michail AU - Marinova, Lora AU - Fomaidi, Galina AU - Djalalova, Malika AU - Faruqui, Nabiha AU - Melo Bianco, Viviane AU - Mosquera, Mario AU - Spasov, Ivaylo AU - Totskaya, Yekaterina PY - 2023/10/10 TI - Building a Chatbot in a Pandemic JO - J Med Internet Res SP - e42960 VL - 25 KW - COVID-19 KW - chatbots KW - evidence-based communication channels KW - conversational agent KW - user-centered KW - health promotion KW - digital health intervention KW - online health information KW - digital health tool KW - health communication UR - https://www.jmir.org/2023/1/e42960 UR - http://dx.doi.org/10.2196/42960 UR - http://www.ncbi.nlm.nih.gov/pubmed/37074958 ID - info:doi/10.2196/42960 ER - TY - JOUR AU - Velez, Tom AU - Wang, Tony AU - Garibaldi, Brian AU - Singman, Eric AU - Koutroulis, Ioannis PY - 2023/10/6 TI - Identification and Prediction of Clinical Phenotypes in Hospitalized Patients With COVID-19: Machine Learning From Medical Records JO - JMIR Form Res SP - e46807 VL - 7 KW - big data KW - COVID KW - respiratory distress KW - critical care KW - early warning KW - electronic medical record KW - machine learning KW - clinical phenotypes KW - pathogenesis KW - infection KW - immune response KW - treatment KW - biomarkers KW - training KW - sepsis KW - mortality KW - utility KW - phenotype KW - support tool N2 - Background: There is significant heterogeneity in disease progression among hospitalized patients with COVID-19. The pathogenesis of SARS-CoV-2 infection is attributed to a complex interplay between virus and host immune response that in some patients unpredictably and rapidly leads to ?hyperinflammation? associated with increased risk of mortality. The early identification of patients at risk of progression to hyperinflammation may help inform timely therapeutic decisions and lead to improved outcomes. Objective: The primary objective of this study was to use machine learning to reproducibly identify specific risk-stratifying clinical phenotypes across hospitalized patients with COVID-19 and compare treatment response characteristics and outcomes. A secondary objective was to derive a predictive phenotype classification model using routinely available early encounter data that may be useful in informing optimal COVID-19 bedside clinical management. Methods: This was a retrospective analysis of electronic health record data of adult patients (N=4379) who were admitted to a Johns Hopkins Health System hospital for COVID-19 treatment from 2020 to 2021. Phenotypes were identified by clustering 38 routine clinical observations recorded during inpatient care. To examine the reproducibility and validity of the derived phenotypes, patient data were randomly divided into 2 cohorts, and clustering analysis was performed independently for each cohort. A predictive phenotype classifier using the gradient-boosting machine method was derived using routine clinical observations recorded during the first 6 hours following admission. Results: A total of 2 phenotypes (designated as phenotype 1 and phenotype 2) were identified in patients admitted for COVID-19 in both the training and validation cohorts with similar distributions of features, correlations with biomarkers, treatments, comorbidities, and outcomes. In both the training and validation cohorts, phenotype-2 patients were older; had elevated markers of inflammation; and were at an increased risk of requiring intensive care unit?level care, developing sepsis, and mortality compared with phenotype-1 patients. The gradient-boosting machine phenotype prediction model yielded an area under the curve of 0.89 and a positive predictive value of 0.83. Conclusions: Using machine learning clustering, we identified and internally validated 2 clinical COVID-19 phenotypes with distinct treatment or response characteristics consistent with similar 2-phenotype models derived from other hospitalized populations with COVID-19, supporting the reliability and generalizability of these findings. COVID-19 phenotypes can be accurately identified using machine learning models based on readily available early encounter clinical data. A phenotype prediction model based on early encounter data may be clinically useful for timely bedside risk stratification and treatment personalization. UR - https://formative.jmir.org/2023/1/e46807 UR - http://dx.doi.org/10.2196/46807 UR - http://www.ncbi.nlm.nih.gov/pubmed/37642512 ID - info:doi/10.2196/46807 ER - TY - JOUR AU - Xu, Stanley AU - Hong, Vennis AU - Sy, S. Lina AU - Bruxvoort, J. Katia AU - Lewin, Bruno AU - Han, Bing AU - Holmquist, J. Kimberly AU - Qian, Lei PY - 2023/10/4 TI - Risk Factors for Not Completing a 2-Dose Primary Series of Messenger RNA COVID-19 Vaccination in a Large Health Care System in Southern California: Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e46318 VL - 9 KW - mRNA COVID-19 vaccines KW - 2-dose primary series KW - vaccines KW - SARS-CoV-2 KW - coronavirus KW - respiratory KW - infectious KW - communicable KW - immunization KW - immunize KW - noncompletion KW - risk factors KW - multiple Poisson regression model KW - COVID-19 KW - vaccination KW - vaccine KW - dose KW - dosing KW - regression KW - risk KW - risks KW - health outcome KW - health outcomes KW - retrospective KW - cohort KW - dosage KW - United States KW - community KW - inoculation N2 - Background: COVID-19 vaccination is crucial in combating the COVID-19 pandemic. Messenger RNA COVID-19 vaccines were initially authorized as a 2-dose primary series and have been widely used in the United States; completing the 2-dose primary series offers protection against infection, severe illness, and death. Understanding the risk factors for not completing the 2-dose primary series is critical to evaluate COVID-19 vaccination programs and promote completion of the 2-dose primary series. Objective: This study examined potential risk factors for not completing a 2-dose primary series of mRNA COVID-19 vaccination. Methods: We conducted a retrospective cohort study among members aged ?18 years from a large integrated health care system, Kaiser Permanente Southern California, from December 14, 2020, to June 30, 2022. Noncompletion of the 2-dose primary series was defined as not completing the second dose within 6 months after receipt of the first dose. Crude noncompletion rates were estimated overall and by demographic characteristics, health care use patterns, comorbidity, and community-level socioeconomic factors. A Poisson regression model was fit to examine associations of individual-level and community-level risk factors with noncompletion of the 2-dose primary series. Results: Among 2.5 million recipients of ?1 dose of mRNA COVID-19 vaccines, 3.3% (n=81,202) did not complete the second dose within 6 months. Members aged 25-44 years, 65-74 years, and ?75 years were less likely to not complete the 2-dose primary series than those aged 18-24 years, while members aged 45-64 years were more likely to not complete the 2-dose primary series (adjusted risk ratio [aRR] 1.13, 95% CI 1.10-1.15). Male sex was associated with a higher risk of noncompletion (aRR 1.17, 95% CI 1.15-1.19). Hispanic and non-Hispanic Black race/ethnicity were associated with a lower risk of noncompletion (range aRR 0.78-0.91). Having Medicaid and prior influenza vaccination were associated with a higher risk of noncompletion. Having SARS-CoV-2 infection, experiencing an adverse event, or having an inpatient and emergency department visit during the minimum recommended dose intervals were associated with a higher risk of not completing the 2-dose primary series (aRR 1.98, 95% CI 1.85-2.12; 1.99, 95% CI 1.43-2.76; and 1.85, 95% CI 1.77-1.93, respectively). Those who received the first dose after June 30, 2021, were more likely to not complete the 2-dose primary series within 6 months of receipt of the first dose. Conclusions: Despite limitations such as being a single-site study and the inability to consider social factors such as employment and vaccine attitudes, our study identified several risk factors for not completing a 2-dose primary series of mRNA vaccination, including being male; having Medicaid coverage; and experiencing SARS-CoV-2 infection, adverse events, or inpatient and emergency department visits during the minimum recommended dose intervals. These findings can inform future efforts in developing effective strategies to enhance vaccination coverage and improve the completion rate of necessary doses. UR - https://publichealth.jmir.org/2023/1/e46318 UR - http://dx.doi.org/10.2196/46318 UR - http://www.ncbi.nlm.nih.gov/pubmed/37792452 ID - info:doi/10.2196/46318 ER - TY - JOUR AU - Bacon, Elizabeth AU - An, Lawrence AU - Yang, Penny AU - Hawley, Sarah AU - Van Horn, Lee M. AU - Resnicow, Ken PY - 2023/9/27 TI - Novel Psychosocial Correlates of COVID-19 Vaccine Hesitancy: Cross-Sectional Survey JO - JMIR Form Res SP - e45980 VL - 7 KW - COVID-19 vaccination KW - health communication KW - psychological predictors KW - psychology KW - public health KW - conspiracy beliefs KW - vaccine misinformation KW - religious beliefs KW - anti-vaccination beliefs KW - reactance KW - dogmatism KW - political beliefs KW - health care system distrust KW - gender roles KW - gender KW - online survey KW - USA KW - adults KW - death KW - illness KW - virus KW - psychosocial N2 - Background: Effective COVID-19 vaccines have been available since early 2021 yet many Americans refuse or delayed uptake. As of mid-2022, still around 30% of US adults remain unvaccinated against COVID-19. The majority (81%) of these unvaccinated adults say they will ?definitely not? be getting the COVID-19 vaccine. Understanding the determinants of COVID-19 vaccine uptake is critical to reducing death and illness from the virus, as well as to inform future vaccine efforts, such as the more recent bivalent (omicron) booster. Objective: This study aimed to expand our understanding of psychosocial determinants of COVID-19 vaccine uptake. We focus on both COVID-19?specific factors, such as COVID-19 conspiracy beliefs, as well as more global personality attributes such as dogmatism, reactance, gender roles, political beliefs, and religiosity. Methods: We conducted a web-based survey in mid-2021 of a representative sample of 1376 adults measuring both COVID-19?specific beliefs and attitudes, as well as global personality attributes. COVID-19 vaccination status is reported at 3 levels: vaccinated; unvaccinated-may-get-it; unvaccinated-hard-no. Results: Our analyses focused on the correlation of COVID-19 vaccination status with 10 psychosocial attributes: COVID-19-specific conspiracy theory beliefs; COVID-19 vaccine misinformation; COVID-19?related Rapture beliefs; general antivaccination beliefs; trait reactance; trait dogmatism; belief in 2020 election fraud; belief in a QAnon conspiracy; health care system distrust; and identification with traditional gender roles. We used a multivariate analysis of covariance to examine mean differences across vaccine status groups for each of the correlates while holding constant the effects of age, gender, race, income, education, political party, and Evangelicalism. Across the 10 psychosocial correlates, several different response scales were used. To allow for comparison of effects across correlates, measures of effect size were computed by converting correlates to z scores and then examining adjusted mean differences in z scores between the groups. We found that all 10 psychosocial variables were significantly associated with vaccination status. After general antivaccination beliefs, COVID-19 misinformation beliefs and COVID-19 conspiracy beliefs had the largest effect on vaccine uptake. Conclusions: The association of these psychosocial factors with COVID-19 vaccine hesitancy may help explain why vaccine uptake has not shifted much among the unvaccinated-hard-no group since vaccines became available. These findings deepen our understanding of those who remain resistant to getting vaccinated and can guide more effective tailored communications to reach them. Health communication professionals may apply lessons learned from countering related beliefs and personality attributes around issues such as climate change and other forms of vaccine hesitancy. For example, using motivational interviewing strategies that are equipped to handle resistance and provide correct information in a delicate manner that avoids reactance. UR - https://formative.jmir.org/2023/1/e45980 UR - http://dx.doi.org/10.2196/45980 UR - http://www.ncbi.nlm.nih.gov/pubmed/37756115 ID - info:doi/10.2196/45980 ER - TY - JOUR AU - Faviez, Carole AU - Talmatkadi, Manissa AU - Foulquié, Pierre AU - Mebarki, Adel AU - Schück, Stéphane AU - Burgun, Anita AU - Chen, Xiaoyi PY - 2023/9/25 TI - Assessment of the Early Detection of Anosmia and Ageusia Symptoms in COVID-19 on Twitter: Retrospective Study JO - JMIR Infodemiology SP - e41863 VL - 3 KW - social media KW - COVID-19 KW - anosmia KW - ageusia KW - infodemiology KW - symptom KW - Twitter KW - psychological KW - tweets KW - pandemic KW - rapid stage KW - epidemic KW - information KW - knowledge KW - online health KW - misinformation KW - education KW - online education KW - ehealth KW - qualitative N2 - Background: During the unprecedented COVID-19 pandemic, social media has been extensively used to amplify the spread of information and to express personal health-related experiences regarding symptoms, including anosmia and ageusia, 2 symptoms that have been reported later than other symptoms. Objective: Our objective is to investigate to what extent Twitter users reported anosmia and ageusia symptoms in their tweets and if they connected them to COVID-19, to evaluate whether these symptoms could have been identified as COVID-19 symptoms earlier using Twitter rather than the official notice. Methods: We collected French tweets posted between January 1, 2020, and March 31, 2020, containing anosmia- or ageusia-related keywords. Symptoms were detected using fuzzy matching. The analysis consisted of 3 parts. First, we compared the coverage of anosmia and ageusia symptoms in Twitter and in traditional media to determine if the association between COVID-19 and anosmia or ageusia could have been identified earlier through Twitter. Second, we conducted a manual analysis of anosmia- and ageusia-related tweets to obtain quantitative and qualitative insights regarding their nature and to assess when the first associations between COVID-19 and these symptoms were established. We randomly annotated tweets from 2 periods: the early stage and the rapid spread stage of the epidemic. For each tweet, each symptom was annotated regarding 3 modalities: symptom (yes or no), associated with COVID-19 (yes, no, or unknown), and whether it was experienced by someone (yes, no, or unknown). Third, to evaluate if there was a global increase of tweets mentioning anosmia or ageusia in early 2020, corresponding to the beginning of the COVID-19 epidemic, we compared the tweets reporting experienced anosmia or ageusia between the first periods of 2019 and 2020. Results: In total, 832 (respectively 12,544) tweets containing anosmia (respectively ageusia) related keywords were extracted over the analysis period in 2020. The comparison to traditional media showed a strong correlation without any lag, which suggests an important reactivity of Twitter but no earlier detection on Twitter. The annotation of tweets from 2020 showed that tweets correlating anosmia or ageusia with COVID-19 could be found a few days before the official announcement. However, no association could be found during the first stage of the pandemic. Information about the temporality of symptoms and the psychological impact of these symptoms could be found in the tweets. The comparison between early 2020 and early 2019 showed no difference regarding the volumes of tweets. Conclusions: Based on our analysis of French tweets, associations between COVID-19 and anosmia or ageusia by web users could have been found on Twitter just a few days before the official announcement but not during the early stage of the pandemic. Patients share qualitative information on Twitter regarding anosmia or ageusia symptoms that could be of interest for future analyses. UR - https://infodemiology.jmir.org/2023/1/e41863 UR - http://dx.doi.org/10.2196/41863 UR - http://www.ncbi.nlm.nih.gov/pubmed/37643302 ID - info:doi/10.2196/41863 ER - TY - JOUR AU - Lumini, José Maria AU - Sousa, Rui Maria AU - Salazar, Berta AU - Martins, Teresa PY - 2023/9/25 TI - Assessing the Effectiveness of a Massive Open Online Course for Caregivers Amid the COVID-19 Pandemic: Methodological Study JO - JMIR Form Res SP - e48398 VL - 7 KW - caregivers KW - education KW - COVID-19 KW - distance KW - effectiveness KW - skill KW - safe care KW - health system KW - older people KW - family KW - social isolation KW - massive open online courses KW - care challenges N2 - Background: The COVID-19 pandemic has presented significant challenges to health care systems, particularly impacting the older population due to their vulnerability and increased susceptibility to severe complications. Many of the most vulnerable individuals rely on informal caregivers, who play a vital role in enabling them to continue living in their homes. However, social isolation and limited access to health services during the pandemic have made caregiving more difficult. In response, massive open online courses (MOOCs) have emerged as a training and support solution for caregivers. This study focuses on a MOOC developed to assist caregivers during the pandemic, aiming to enhance their knowledge of COVID-19 and prevention measures and promote effective self-care practices. Objective: The study?s aim is to develop and validate a MOOC integrating personal and housing hygiene measures to be adopted in self-care?related activities, surveillance, and monitoring by caregivers of the most vulnerable home-dwelling?dependent people, to provide safe care and prevent SARS-CoV-2 infection. Methods: A methodological study was developed. The content of the MOOC was developed based on scientific evidence and a Delphi study. The course was organized into 9 modules, addressing aspects related to safe self-care assistance and minimizing the risk of contagion. A convenience sample of 33 informal caregivers was recruited through a caregivers? association to verify the adequacy of the course. Knowledge questionnaires were administered before and after the course to assess the impact on caregivers? knowledge. The Family Caregiving Factors Inventory was used to evaluate caregiver resources, knowledge, expectations, and difficulties. Additionally, the technology acceptance model was applied to assess participants? satisfaction with the MOOC. Results: Prior to attending the MOOC, participants demonstrated an average knowledge level score of mean 14.94 (SD 2.72). After completing the course, this score significantly increased to mean 16.52 (SD 2.28), indicating an improvement in knowledge. Caregivers found the course accessible, valuable, and applicable to their caregiving roles. Feedback regarding the MOOC?s structure, illustrative videos, and language was overwhelmingly positive. Participants perceived the course as a valuable resource for decision-making in care delivery, leading to enhanced self-esteem and confidence. Conclusions: The MOOC has proven to be an effective tool for increasing caregivers? knowledge and empowering them in their roles. Remarkably, even low-literacy caregivers found the course valuable for its clear and understandable information. The MOOC demonstrated its adaptability to challenges faced during the pandemic, ensuring access to relevant information. This empowering strategy for caregivers has yielded positive outcomes. The MOOC represents a tool to support and empower informal caregivers, enabling them to provide optimal care during difficult times. UR - https://formative.jmir.org/2023/1/e48398 UR - http://dx.doi.org/10.2196/48398 UR - http://www.ncbi.nlm.nih.gov/pubmed/37747772 ID - info:doi/10.2196/48398 ER - TY - JOUR AU - Kang-Auger, Sarit AU - Lewin, Antoine AU - Ayoub, Aimina AU - Bilodeau-Bertrand, Marianne AU - Marcoux, Sophie AU - Auger, Nathalie PY - 2023/9/25 TI - Social Media and Selfie-Related Mortality Amid COVID-19: Interrupted Time Series Analysis JO - JMIR Form Res SP - e42857 VL - 7 KW - COVID-19 KW - injury KW - mortality KW - mortality rate KW - web-based news KW - selfie KW - social media KW - time series regression N2 - Background: COVID-19 had a considerable impact on mortality, but its effect on behaviors associated with social media remains unclear. As travel decreased due to lockdowns during the pandemic, selfie-related mortality may have decreased, as fewer individuals were taking smartphone photographs in risky locations. Objective: In this study, we examined the effect of the COVID-19 pandemic on trends in selfie-related mortality. Methods: We identified fatal selfie-related injuries reported in web-based news reports worldwide between March 2014 and April 2021, including the deaths of individuals attempting a selfie photograph or anyone else present during the incident. The main outcome measure was the total number of selfie-related deaths per month. We used interrupted time series regression to estimate the monthly change in the number of selfie-related deaths over time, comparing the period before the pandemic (March 2014 to February 2020) with the period during the pandemic (March 2020 to April 2021). Results: The study included a total of 332 selfie-related deaths occurring between March 2014 and April 2021, with 18 (5.4%) deaths during the pandemic. Most selfie-related deaths occurred in India (n=153, 46.1%) and involved men (n=221, 66.6%) and young individuals (n=296, 89.2%). During the pandemic, two-thirds of selfie-related deaths were due to falls, whereas a greater proportion of selfie-related deaths before the pandemic were due to drowning. Based on interrupted time series regression, there was an average of 1.3 selfie-related deaths per month during the pandemic, compared with 4.3 deaths per month before the pandemic. The number of selfie-related deaths decreased by 2.6 in the first month of the pandemic alone and continued to decrease thereafter. Conclusions: Our findings indicate that the COVID-19 pandemic led to a marked decrease in selfie-related mortality, suggesting that lockdowns and travel restrictions likely prevented hazardous selfie-taking. The decrease in selfie-related mortality occurred despite a potential increase in social media use during the pandemic. UR - https://formative.jmir.org/2023/1/e42857 UR - http://dx.doi.org/10.2196/42857 UR - http://www.ncbi.nlm.nih.gov/pubmed/37747765 ID - info:doi/10.2196/42857 ER - TY - JOUR AU - Werkmeister, Benjamin AU - Haase, M. Anne AU - Fleming, Theresa AU - Officer, N. Tara PY - 2023/9/22 TI - Global Implications From the Rise and Recession of Telehealth in Aotearoa New Zealand Mental Health Services During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Form Res SP - e50486 VL - 7 KW - telehealth KW - mental health services KW - Aotearoa New Zealand KW - mixed methods research KW - clinician KW - COVID-19 N2 - Background: The COVID-19 pandemic accelerated the adoption of telehealth services for remote mental health care provision. Although studies indicate that telehealth can enhance the efficiency of service delivery and might be favored or even preferred by certain clients, its use varied after the pandemic. Once the pandemic-related restrictions eased, some regions curtailed their telehealth offerings, whereas others sustained them. Understanding the factors that influenced these decisions can offer valuable insights for evidence-based decision-making concerning the future of telehealth in mental health services. Objective: This study explored the factors associated with the uptake of and retreat from telehealth across a multiregional outpatient mental health service in Aotearoa New Zealand. We aimed to contribute to the understanding of the factors influencing clinicians? use of telehealth services to inform policy and practice. Methods: Applying an interpretive description methodology, this sequential mixed methods study involved semistructured interviews with 33 mental health clinicians, followed by a time-series analysis of population-level quantitative data on clinician appointment activities before and throughout the COVID-19 pandemic. The interviews were thematically analyzed, and select themes were reframed for quantitative testing. The time-series analysis was conducted using administrative data to explore the extent to which these data supported the themes. In total, 4,117,035 observations were analyzed between September 2, 2019, and August 1, 2022. The findings were then synthesized through the rereview of qualitative themes. Results: The rise and recession of telehealth in the study regions were related to 3 overarching themes: clinician preparedness and role suitability, population determinants, and service capability. Participants spoke about the importance of familiarity and training but noted differences between specialist roles. Quantitative data further suggested differences based on the form of telehealth services offered (eg, audiovisual or telephone). In addition, differences were noted based on age, gender, and ethnicity; however, clinicians recognized that effective telehealth use enabled clinicians? flexibility and client choice. In turn, clinicians spoke about system factors such as telehealth usability and digital exclusion that underpinned the daily functionality of telehealth. Conclusions: For telehealth services to thrive when they are not required by circumstances such as pandemic, investment is needed in telehealth training for clinicians, digital infrastructure, and resources for mental health teams. The strength of this study lies in its use of population-level data and consideration of a telehealth service operating across a range of teams. In turn, these findings reflect the voice of a variety of mental health clinicians, including teams operating from within specific cultural perspectives. UR - https://formative.jmir.org/2023/1/e50486 UR - http://dx.doi.org/10.2196/50486 UR - http://www.ncbi.nlm.nih.gov/pubmed/37738075 ID - info:doi/10.2196/50486 ER - TY - JOUR AU - Ng, Margaret Yee Man AU - Hoffmann Pham, Katherine AU - Luengo-Oroz, Miguel PY - 2023/9/15 TI - Exploring YouTube?s Recommendation System in the Context of COVID-19 Vaccines: Computational and Comparative Analysis of Video Trajectories JO - J Med Internet Res SP - e49061 VL - 25 KW - algorithmic auditing KW - antivaccine sentiment KW - crowdsourcing KW - recommendation systems KW - watch history KW - YouTube N2 - Background: Throughout the COVID-19 pandemic, there has been a concern that social media may contribute to vaccine hesitancy due to the wide availability of antivaccine content on social media platforms. YouTube has stated its commitment to removing content that contains misinformation on vaccination. Nevertheless, such claims are difficult to audit. There is a need for more empirical research to evaluate the actual prevalence of antivaccine sentiment on the internet. Objective: This study examines recommendations made by YouTube?s algorithms in order to investigate whether the platform may facilitate the spread of antivaccine sentiment on the internet. We assess the prevalence of antivaccine sentiment in recommended videos and evaluate how real-world users? experiences are different from the personalized recommendations obtained by using synthetic data collection methods, which are often used to study YouTube?s recommendation systems. Methods: We trace trajectories from a credible seed video posted by the World Health Organization to antivaccine videos, following only video links suggested by YouTube?s recommendation system. First, we gamify the process by asking real-world participants to intentionally find an antivaccine video with as few clicks as possible. Having collected crowdsourced trajectory data from respondents from (1) the World Health Organization and United Nations system (nWHO/UN=33) and (2) Amazon Mechanical Turk (nAMT=80), we next compare the recommendations seen by these users to recommended videos that are obtained from (3) the YouTube application programming interface?s RelatedToVideoID parameter (nRTV=40) and (4) from clean browsers without any identifying cookies (nCB=40), which serve as reference points. We develop machine learning methods to classify antivaccine content at scale, enabling us to automatically evaluate 27,074 video recommendations made by YouTube. Results: We found no evidence that YouTube promotes antivaccine content; the average share of antivaccine videos remained well below 6% at all steps in users? recommendation trajectories. However, the watch histories of users significantly affect video recommendations, suggesting that data from the application programming interface or from a clean browser do not offer an accurate picture of the recommendations that real users are seeing. Real users saw slightly more provaccine content as they advanced through their recommendation trajectories, whereas synthetic users were drawn toward irrelevant recommendations as they advanced. Rather than antivaccine content, videos recommended by YouTube are likely to contain health-related content that is not specifically related to vaccination. These videos are usually longer and contain more popular content. Conclusions: Our findings suggest that the common perception that YouTube?s recommendation system acts as a ?rabbit hole? may be inaccurate and that YouTube may instead be following a ?blockbuster? strategy that attempts to engage users by promoting other content that has been reliably successful across the platform. UR - https://www.jmir.org/2023/1/e49061 UR - http://dx.doi.org/10.2196/49061 UR - http://www.ncbi.nlm.nih.gov/pubmed/37713243 ID - info:doi/10.2196/49061 ER - TY - JOUR AU - Lin, Li-Yin AU - Lin, Chun-Ji AU - Kuan, Chen-I AU - Chiou, Hung-Yi PY - 2023/9/12 TI - Potential Determinants Contributing to COVID-19 Vaccine Acceptance and Hesitancy in Taiwan: Rapid Qualitative Mixed Methods Study JO - JMIR Form Res SP - e41364 VL - 7 KW - COVID-19 KW - vaccine acceptance KW - vaccine hesitancy KW - google trends KW - public health KW - vaccination KW - health promotion KW - thematic analysis KW - infoveillance N2 - Background: Although vaccination has been shown to be one of the most important interventions, COVID-19 vaccine hesitancy remains one of the top 10 global public health challenges worldwide. Objective: The objective of this study is to investigate (1) major determinants of vaccine hesitancy, (2) changes in the determinants of vaccine hesitancy at different time periods, and (3) the potential factors affecting vaccine acceptance. Methods: This study applied a mixed methods approach to explore the potential determinants contributing to vaccine hesitancy among the Taiwanese population. The quantitative design of this study involved using Google Trends search query data. We chose the search term ???? (vaccine), selected ???? (Taiwan) as the location, and selected the period between December 18, 2020, and July 31, 2021. The rising keywords related to vaccine acceptance and hesitancy were collected. Based on the responses obtained from the qualitative study and the rising keywords obtained in Google Trends, the 3 most popular keywords related to vaccine hesitancy were identified and used as search queries in Google Trends between December 18, 2020, and July 31, 2021, to generate relative search volumes (RSVs). Lastly, autoregressive integrated moving average modeling was used to forecast the RSVs for the 3 keywords between May 29 and July 31, 2021. The estimated RSVs were compared to the observed RSVs in Google Trends within the same time frame. Results: The 4 prevailing factors responsible for COVID-19 vaccine acceptance and hesitancy were doubts about the government and manufacturers, side effects, deaths associated with vaccination, and efficacy of vaccination. During the vaccine observation period, ?political role? was the overarching consideration leading to vaccine hesitancy. During the peak of the pandemic, side effects, death, and vaccine protection were the main factors contributing to vaccine hesitancy. The popularity of the 3 frequently searched keywords ?side effects,? ?vaccine associated deaths,? and ?vaccine protection? continued to rise throughout the pandemic outbreak. Lastly, the highest Google search queries related to COVID-19 vaccines emerged as ?side effects? prior to vaccination, deaths associated with vaccines during the period when single vaccines were available, and ?side effects? and ?vaccine protection? during the period when multiple vaccines were available. Conclusions: Investigating the key factors influencing COVID-19 vaccine hesitancy appears to be a fundamental task that needs to be undertaken to ensure effective implementation of COVID-19 vaccination. Google Trends may be used as a complementary infoveillance tool by government agencies for future vaccine policy implementation and communication. UR - https://formative.jmir.org/2023/1/e41364 UR - http://dx.doi.org/10.2196/41364 UR - http://www.ncbi.nlm.nih.gov/pubmed/37698904 ID - info:doi/10.2196/41364 ER - TY - JOUR AU - Tewary, Sweta AU - Cook, Nicole AU - Dezine, Marie AU - Shnayder, Oksana AU - Pandya, Naushira PY - 2023/9/11 TI - Supporting Vulnerable Older Adults With Telehealth Through Wellness Calls and Tablet Distribution During COVID-19: Quality Improvement Project JO - JMIR Form Res SP - e46002 VL - 7 KW - COVID-19 KW - telehealth KW - older adults KW - isolation KW - health education KW - mental wellness KW - telemedicine KW - health literacy KW - digital health KW - mental health KW - social isolation N2 - Background: Loneliness, social isolation, and lack of technical literacy are associated with poorer health outcomes. To help improve social connection during the COVID-19 pandemic, Nova Southeastern University?s South Florida Geriatric Workforce Enhancement Program partnered with a community-based organization to provide educational resources to promote telehealth services. Objective: This study aimed to provide educational resources to older adults with limited resources and promote the use of telehealth services in this population. Methods: Through this pilot project, we contacted 66 vulnerable older adults who expressed interest in telehealth support through wellness calls, with 44 participants moving on to participate in tablet usage. All tablets were preloaded with educational information on using the device, COVID-19 resources, and accessing telehealth services for patients, caregivers, and families. Results: Feedback from wellness assessments suggested a significant need for telehealth support. Participants used the tablets mainly for telehealth (n=6, 15%), to connect with friends and family (n=10, 26%), and to connect with faith communities (n=3, 8%). Conclusions: The findings from the pilot project suggest that wellness calls and telehealth education are beneficial to support telehealth usage among older adults. UR - https://formative.jmir.org/2023/1/e46002 UR - http://dx.doi.org/10.2196/46002 UR - http://www.ncbi.nlm.nih.gov/pubmed/37695647 ID - info:doi/10.2196/46002 ER - TY - JOUR AU - Shoemaker, E. Holly AU - Thorpe, Alistair AU - Stevens, Vanessa AU - Butler, M. Jorie AU - Drews, A. Frank AU - Burpo, Nicole AU - Scherer, D. Laura AU - Fagerlin, Angela PY - 2023/9/8 TI - Telehealth Use During the COVID-19 Pandemic Among Veterans and Nonveterans: Web-Based Survey Study JO - JMIR Form Res SP - e42217 VL - 7 KW - telehealth KW - telemedicine KW - veterans KW - COVID-19 KW - health care KW - nationwide web-based survey KW - underserved population KW - accessible health care KW - health inequality KW - health care disparity N2 - Background: In the first year of the COVID-19 pandemic, studies reported delays in health care usage due to safety concerns. Delays in care may result in increased morbidity and mortality from otherwise treatable conditions. Telehealth provides a safe alternative for patients to receive care when other circumstances make in-person care unavailable or unsafe, but information on patient experiences is limited. Understanding which people are more or less likely to use telehealth and their experiences can help tailor outreach efforts to maximize the impact of telehealth. Objective: This study aims to examine the characteristics of telehealth users and nonusers and their reported experiences among veteran and nonveteran respondents. Methods: A nationwide web-based survey of current behaviors and health care experiences was conducted in December 2020-March 2021. The survey consisted of 3 waves, and the first wave is assessed here. Respondents included US adults participating in Qualtrics web-based panels. Primary outcomes were self-reported telehealth use and number of telehealth visits. The analysis used a 2-part regression model examining the association between telehealth use and the number of visits with respondent characteristics. Results: There were 2085 participants in the first wave, and 898 (43.1%) reported using telehealth since the pandemic began. Most veterans who used telehealth reported much or somewhat preferring an in-person visit (336/474, 70.9%), while slightly less than half of nonveterans (189/424, 44.6%) reported this preference. While there was no significant difference between veteran and nonveteran likelihood of using telehealth (odds ratio [OR] 1.33, 95% CI 0.97-1.82), veterans were likely to have more visits when they did use it (incidence rate ratio [IRR] 1.49, 95% CI 1.07-2.07). Individuals were less likely to use telehealth and reported fewer visits if they were 55 years and older (OR 0.39, 95% CI 0.25-0.62 for ages 55-64 years; IRR 0.43, 95% CI 0.28-0.66) or lived in a small city (OR 0.63, 95% CI 0.43-0.92; IRR 0.71, 95% CI 0.51-0.99). Receiving health care partly or primarily at the Veterans Health Administration (VA) was associated with telehealth use (primarily VA: OR 3.25, 95% CI 2.20-4.81; equal mix: OR 2.18, 95% CI 1.40-3.39) and more telehealth visits (primarily VA: IRR 1.5, 95% CI 1.10-2.04; equal mix: IRR 1.57, 95% CI 1.11-2.24). Conclusions: Telehealth will likely continue to be an important source of health care for patients, especially following situations like the COVID-19 pandemic. Some groups who may benefit from telehealth are still underserved. Telehealth services and outreach should be improved to provide accessible care for all. UR - https://formative.jmir.org/2023/1/e42217 UR - http://dx.doi.org/10.2196/42217 UR - http://www.ncbi.nlm.nih.gov/pubmed/37527547 ID - info:doi/10.2196/42217 ER - TY - JOUR AU - Chu, MY Amanda AU - Chong, Y. Andy C. AU - Lai, T. Nick H. AU - Tiwari, Agnes AU - So, P. Mike K. PY - 2023/9/7 TI - Enhancing the Predictive Power of Google Trends Data Through Network Analysis: Infodemiology Study of COVID-19 JO - JMIR Public Health Surveill SP - e42446 VL - 9 KW - internet search volumes KW - network analysis KW - pandemic risk KW - health care analytics KW - network connectedness KW - infodemiology KW - infoveillance KW - mobile phone KW - COVID-19 N2 - Background: The COVID-19 outbreak has revealed a high demand for timely surveillance of pandemic developments. Google Trends (GT), which provides freely available search volume data, has been proven to be a reliable forecast and nowcast measure for public health issues. Previous studies have tended to use relative search volumes from GT directly to analyze associations and predict the progression of pandemic. However, GT?s normalization of the search volumes data and data retrieval restrictions affect the data resolution in reflecting the actual search behaviors, thus limiting the potential for using GT data to predict disease outbreaks. Objective: This study aimed to introduce a merged algorithm that helps recover the resolution and accuracy of the search volume data extracted from GT over long observation periods. In addition, this study also aimed to demonstrate the extended application of merged search volumes (MSVs) in combination of network analysis, via tracking the COVID-19 pandemic risk. Methods: We collected relative search volumes from GT and transformed them into MSVs using our proposed merged algorithm. The MSVs of the selected coronavirus-related keywords were compiled using the rolling window method. The correlations between the MSVs were calculated to form a dynamic network. The network statistics, including network density and the global clustering coefficients between the MSVs, were also calculated. Results: Our research findings suggested that although GT restricts the search data retrieval into weekly data points over a long period, our proposed approach could recover the daily search volume over the same investigation period to facilitate subsequent research analyses. In addition, the dynamic time warping diagrams show that the dynamic networks were capable of predicting the COVID-19 pandemic trends, in terms of the number of COVID-19 confirmed cases and severity risk scores. Conclusions: The innovative method for handling GT search data and the application of MSVs and network analysis to broaden the potential for GT data are useful for predicting the pandemic risk. Further investigation of the GT dynamic network can focus on noncommunicable diseases, health-related behaviors, and misinformation on the internet. UR - https://publichealth.jmir.org/2023/1/e42446 UR - http://dx.doi.org/10.2196/42446 UR - http://www.ncbi.nlm.nih.gov/pubmed/37676701 ID - info:doi/10.2196/42446 ER - TY - JOUR AU - Benton, Mark PY - 2023/9/7 TI - Experience and Impact of COVID-19 on a Newly Formed Rural University Medical Office: Survey Study JO - JMIR Form Res SP - e48299 VL - 7 KW - remote KW - access KW - COVID-19 KW - learning KW - survey KW - office KW - HOPE KW - administration KW - administrative KW - medical education KW - education system KW - education systems N2 - Background: The COVID-19 pandemic had large social effects, particularly in the fields of medicine and medical education. Medical organizations in the United States operate in overlapping contexts with interrelated goals inside multiple organizations, and the context of work strongly influenced how organizations were able to respond to COVID-19 restrictions. Objective: This research examines the experience and impact of COVID-19 on the implementation of a Health Resources and Services Administration grant in a newly formed university medical office with the interrelated goals of health policy, health outreach, and medical education. The goal is to understand how COVID-19 created different experiences and challenges for leaders and their collaborators working in medical education compared to those working in public health outreach or health policy. Methods: A survey about COVID-19 opportunities and challenges was administered to work unit leaders and their project collaborators. The most common experiences and challenges are shown, direct educational and other respondents? experiences and challenges are compared, and open-ended comment segments are analyzed. Results: Helping others adjust to digital work, remoteness, and coordination were common experiences during COVID-19. Common challenges include coordination and an inability to make comparisons to previous program years. On average, respondents had 11.3 (SD 7.8) experiences and 8.3 (SD 6.9) challenges considered in the survey. While all units were influenced by COVID-19 restrictions, medical education units had more experiences and challenges. Those involved directly in medical education experienced 69% (18.6/27) of their possible experiences and 54% (14.7/27) of their possible challenges on average compared to 35% (7/20) and 21% (4.2/20) among other respondents (P<.001). COVID-19 restrictions increased the complexity of project work and presented challenges, especially in terms of coordinating responses and access to locations. Conclusions: The findings suggest that COVID-19 made the overall administration of programs more complex and drew attention from other medical and public health programs. While remoteness is appropriate for some medical education tasks, it is less appropriate for clinical learning. Remoteness presents an especially large challenge to clinical education. Employees now have expectations for remoteness to be built into programs and workplaces. Program administrators will have to integrate remoteness? benefits and drawbacks into their organization for the foreseeable future. UR - https://formative.jmir.org/2023/1/e48299 UR - http://dx.doi.org/10.2196/48299 UR - http://www.ncbi.nlm.nih.gov/pubmed/37676708 ID - info:doi/10.2196/48299 ER - TY - JOUR AU - Neely, Stephen AU - Hao, Feng PY - 2023/9/5 TI - Diagnosis Disclosure and Peer-to-Peer Information Seeking Among COVID-19?Infected Social Media Users: Survey of US-Based Adults JO - JMIR Form Res SP - e48581 VL - 7 KW - chronic health condition KW - COVID-19 KW - diagnosis disclosure KW - information seeking KW - information sharing KW - online health communities KW - peer support KW - social media KW - social support KW - survey sample N2 - Background: Research examining online health communities suggests that individuals affected by chronic health conditions can obtain valuable information and social support through participation in peer-to-peer web-based information exchanges, including information sharing and seeking behaviors. The risks and rewards of these same behaviors in the case of acute illnesses, such as COVID-19, are less well understood, though there is reason to believe that individuals with COVID-19 and other acute illnesses may accrue similar benefits. Objective: This study examines the propensity of American adults to disclose and discuss their COVID-19 diagnosis and symptoms on social media while actively infected with the SARS-CoV-2 virus, as well as to engage in peer-to-peer information seeking in order to better understand the illness that they are experiencing. Additionally, this study seeks to identify the motivations for these behaviors as well as their subsequent impacts on perceived social connectedness and health anxiety in patients with COVID-19. Methods: We conducted a representative survey of 2500 US-based adults using a sample purchased through an industry-leading market research provider. Participants were selected through a stratified quota sampling approach to ensure a representative sample of the US population. Balanced quotas were determined (by region of the country) for gender, age, race, ethnicity, and political affiliation. Responses were analyzed from 946 participants who reported having an active social media account and testing positive for COVID-19 at least once since the start of the pandemic. Results: The results show that only a small portion of social media users (166/946, 18%) chose to disclose and discuss their COVID-19 diagnosis while infected with the virus. However, among those who did, an overwhelming majority (206/251, 82%) said that doing so helped them feel more connected and supported while infected with the virus. A larger percentage of the 946 respondents (n=319, 34%) engaged in peer-to-peer information seeking while infected with COVID-19. Among those who did, a large majority (301/319, 94%) said that doing so was ?helpful,? but more than one-third (115/319, 36%) said that reading about other people?s experiences made them ?more worried? about having COVID-19, while 33% (108/319) said that it made them ?less worried.? Illness severity and political affiliation were significant predictors of both information sharing and seeking. Conclusions: The findings suggest that the benefits (and risks) associated with online health communities are germane to patients with acute illnesses such as COVID-19. It is recommended that public health officials and health care providers take a proactive approach to cultivating professionally moderated forums supporting peer-to-peer engagement during future outbreaks of COVID-19 and other acute illnesses in order to improve patient outcomes and promote social support and connectedness among infected patients. UR - https://formative.jmir.org/2023/1/e48581 UR - http://dx.doi.org/10.2196/48581 UR - http://www.ncbi.nlm.nih.gov/pubmed/37669087 ID - info:doi/10.2196/48581 ER - TY - JOUR AU - Hirabayashi, Mai AU - Shibata, Daisaku AU - Shinohara, Emiko AU - Kawazoe, Yoshimasa PY - 2023/9/5 TI - Influence of Tweets Indicating False Rumors on COVID-19 Vaccination: Case Study JO - JMIR Form Res SP - e45867 VL - 7 KW - coronavirus KW - correlation KW - COVID-19 KW - disinformation KW - false information KW - infodemiology KW - misinformation KW - rumor KW - rumor-indication KW - SARS-CoV-2 KW - social media KW - tweet KW - Twitter KW - vaccination KW - vaccine N2 - Background: As of December 2022, the outbreak of COVID-19 showed no sign of abating, continuing to impact people?s lives, livelihoods, economies, and more. Vaccination is an effective way to achieve mass immunity. However, in places such as Japan, where vaccination is voluntary, there are people who choose not to receive the vaccine, even if an effective vaccine is offered. To promote vaccination, it is necessary to clarify what kind of information on social media can influence attitudes toward vaccines. Objective: False rumors and counterrumors are often posted and spread in large numbers on social media, especially during emergencies. In this paper, we regard tweets that contain questions or point out errors in information as counterrumors. We analyze counterrumors tweets related to the COVID-19 vaccine on Twitter. We aimed to answer the following questions: (1) what kinds of COVID-19 vaccine?related counterrumors were posted on Twitter, and (2) are the posted counterrumors related to social conditions such as vaccination status? Methods: We use the following data sets: (1) counterrumors automatically collected by the ?rumor cloud? (18,593 tweets); and (2) the number of COVID-19 vaccine inoculators from September 27, 2021, to August 15, 2022, published on the Prime Minister?s Office?s website. First, we classified the contents contained in counterrumors. Second, we counted the number of COVID-19 vaccine?related counterrumors from data set 1. Then, we examined the cross-correlation coefficients between the numbers of data sets 1 and 2. Through this verification, we examined the correlation coefficients for the following three periods: (1) the same period of data; (2) the case where the occurrence of the suggestion of counterrumors precedes the vaccination (negative time lag); and (3) the case where the vaccination precedes the occurrence of counterrumors (positive time lag). The data period used for the validation was from October 4, 2021, to April 18, 2022. Results: Our classification results showed that most counterrumors about the COVID-19 vaccine were negative. Moreover, the correlation coefficients between the number of counterrumors and vaccine inoculators showed significant and strong positive correlations. The correlation coefficient was over 0.7 at ?8, ?7, and ?1 weeks of lag. Results suggest that the number of vaccine inoculators tended to increase with an increase in the number of counterrumors. Significant correlation coefficients of 0.5 to 0.6 were observed for lags of 1 week or more and 2 weeks or more. This implies that an increase in vaccine inoculators increases the number of counterrumors. These results suggest that the increase in the number of counterrumors may have been a factor in inducing vaccination behavior. Conclusions: Using quantitative data, we were able to reveal how counterrumors influence the vaccination status of the COVID-19 vaccine. We think that our findings would be a foundation for considering countermeasures of vaccination. UR - https://formative.jmir.org/2023/1/e45867 UR - http://dx.doi.org/10.2196/45867 UR - http://www.ncbi.nlm.nih.gov/pubmed/37669092 ID - info:doi/10.2196/45867 ER - TY - JOUR AU - Esener, Yildiz AU - McCall, Terika AU - Lakdawala, Adnan AU - Kim, Heejun PY - 2023/8/31 TI - Seeking and Providing Social Support on Twitter for Trauma and Distress During the COVID-19 Pandemic: Content and Sentiment Analysis JO - J Med Internet Res SP - e46343 VL - 25 KW - COVID-19 KW - social support KW - trauma KW - distress KW - posttraumatic stress disorder KW - PTSD KW - Twitter KW - social media KW - mental health N2 - Background: The COVID-19 pandemic can be recognized as a traumatic event that led to stressors, resulting in trauma or distress among the general population. Social support is vital in the management of these stressors, especially during a traumatic event, such as the COVID-19 pandemic. Because of the limited face-to-face interactions enforced by physical distancing regulations during the pandemic, people sought solace on social media platforms to connect with, and receive support from, one another. Hence, it is crucial to investigate the ways in which people seek and offer support on social media for mental health management. Objective: The research aimed to examine the types of social support (eg, emotional, informational, instrumental, and appraisal) sought and provided for trauma or distress on Twitter during the COVID-19 pandemic. In addition, this study aimed to gain insight into the difficulties and concerns of people during the pandemic by identifying the associations between terms representing the topics of interest related to trauma or distress and their corresponding sentiments. Methods: The study methods included content analysis to investigate the type of social support people sought for trauma or distress during the pandemic. Sentiment analysis was also performed to track the negative and positive sentiment tweets posted between January 1, 2020, and March 15, 2021. Association rule mining was used to uncover associations between terms and sentiments in tweets. In addition, the research used Kruskal-Wallis and Mann-Whitney U tests to determine whether the retweet count and like count varied based on the social support type. Results: Most Twitter users who indicated trauma or distress sought emotional support. Regarding sentiment, Twitter users mostly posted negative sentiment tweets, particularly in January 2021. An intriguing observation was that wearing masks could trigger and exacerbate trauma or distress. The results revealed that people mostly sought and provided emotional support on Twitter regarding difficulties with wearing masks, mental health status, financial hardships, and treatment methods for trauma or distress. In addition, tweets regarding emotional support received the most endorsements from other users, highlighting the critical role of social support in fostering a sense of community and reducing the feelings of isolation during the pandemic. Conclusions: This study demonstrates the potential of social media as a platform to exchange social support during challenging times and to identify the specific concerns (eg, wearing masks and exacerbated symptoms) of individuals with self-reported trauma or distress. The findings provide insights into the types of support that were most beneficial for those struggling with trauma or distress during the pandemic and may inform policy makers and health organizations regarding better practices for pandemic response and special considerations for groups with a history of trauma or distress. UR - https://www.jmir.org/2023/1/e46343 UR - http://dx.doi.org/10.2196/46343 UR - http://www.ncbi.nlm.nih.gov/pubmed/37651178 ID - info:doi/10.2196/46343 ER - TY - JOUR AU - Vargas Meza, Xanat AU - Park, Woo Han PY - 2023/8/23 TI - Information Circulation Among Spanish-Speaking and Caribbean Communities Related to COVID-19: Social Media?Based Multidimensional Analysis JO - J Med Internet Res SP - e42669 VL - 25 KW - COVID-19 KW - social media KW - Spanish KW - multidimensional analysis KW - Caribbean KW - accessibility N2 - Background: Scienti?c studies from North America and Europe tend to predominate the internet and bene?t English-speaking users. Meanwhile, the COVID-19 death rate was high at the onset of the pandemic in Spanish-speaking countries, and information about nearby Caribbean countries was rarely highlighted. Given the rise in social media use in these regions, the web-based dissemination of scientific information related to COVID-19 must be thoroughly examined. Objective: This study aimed to provide a multidimensional analysis of peer-reviewed information circulation related to COVID-19 in Spanish-speaking and Caribbean regions. Methods: COVID-19?related, peer-reviewed resources shared by web-based accounts located in Spanish-speaking and Caribbean regions were identified through the Altmetric website, and their information was collected. A multidimensional model was used to examine these resources, considering time, individuality, place, activity, and relations. Time was operationalized as the 6 dates of data collection, individuality as the knowledge area and accessibility level, place as the publication venue and affiliation countries, activity as the Altmetric score and number of mentions in the selected regions, and relations as coauthorship between countries and types of social media users who disseminated COVID-19?related information. Results: The highest information circulation peaks in Spanish-speaking countries were from April 2020 to August 2020 and from December 2020 to April 2021, whereas the highest peaks in Caribbean regions were from December 2019 to April 2020. Regarding Spanish-speaking regions, at the onset of the pandemic, scientific expertise was concentrated on a few peer-reviewed sources written in English. The top scienti?c journals mentioned were from English-speaking, westernized regions, whereas the top scienti?c authorships were from China. The most mentioned scientific resources were about breakthrough findings in the medical and health sciences area, written in highly technical language. The top relationships were self-loops in China, whereas international collaborations were between China and the United States. Argentina had high closeness and betweenness, and Spain had high closeness. On the basis of social media data, a combination of media outlets; educational institutions; and expert associations, particularly from Panama, influenced the diffusion of peer-reviewed information. Conclusions: We determined the diffusion patterns of peer-reviewed resources in Spanish-speaking countries and Caribbean territories. This study aimed to advance the management and analysis of web-based public data from non-white people to improve public health communication in their regions. UR - https://www.jmir.org/2023/1/e42669 UR - http://dx.doi.org/10.2196/42669 UR - http://www.ncbi.nlm.nih.gov/pubmed/37402284 ID - info:doi/10.2196/42669 ER - TY - JOUR AU - Shin, Hocheol AU - Yuniar, Tri Cindra AU - Oh, SuA AU - Purja, Sujata AU - Park, Sera AU - Lee, Haeun AU - Kim, Eunyoung PY - 2023/8/16 TI - The Adverse Effects and Nonmedical Use of Methylphenidate Before and After the Outbreak of COVID-19: Machine Learning Analysis JO - J Med Internet Res SP - e45146 VL - 25 KW - methylphenidate KW - attention-deficit/hyperactivity disorder (ADHD) KW - social network services KW - adverse effect KW - nonmedical use KW - machine learning KW - deep learning KW - child KW - adolescent KW - psychiatric disorder N2 - Background: Methylphenidate is an effective first-line treatment for attention-deficit/hyperactivity disorder (ADHD). However, many adverse effects of methylphenidate have been recorded from randomized clinical trials and patient-reported outcomes, but it is difficult to determine abuse from them. In the context of COVID-19, it is important to determine how drug use evaluation, as well as misuse of drugs, have been affected by the pandemic. As people share their reasons for using medication, patient sentiments, and the effects of medicine on social networking services (SNSs), the application of machine learning and SNS data can be a method to overcome the limitations. Proper machine learning models could be evaluated to validate the effects of the COVID-19 pandemic on drug use. Objective: To analyze the effect of the COVID-19 pandemic on the use of methylphenidate, this study analyzed the adverse effects and nonmedical use of methylphenidate and evaluated the change in frequency of nonmedical use based on SNS data before and after the outbreak of COVID-19. Moreover, the performance of 4 machine learning models for classifying methylphenidate use based on SNS data was compared. Methods: In this cross-sectional study, SNS data on methylphenidate from Twitter, Facebook, and Instagram from January 2019 to December 2020 were collected. The frequency of adverse effects, nonmedical use, and drug use before and after the COVID-19 pandemic were compared and analyzed. Interrupted time series analysis about the frequency and trends of nonmedical use of methylphenidate was conducted for 24 months from January 2019 to December 2020. Using the labeled training data set and features, the following 4 machine learning models were built using the data, and their performance was evaluated using F-1 scores: naïve Bayes classifier, random forest, support vector machine, and long short-term memory. Results: This study collected 146,352 data points and detected that 4.3% (6340/146,352) were firsthand experience data. Psychiatric problems (521/1683, 31%) had the highest frequency among the adverse effects. The highest frequency of nonmedical use was for studies or work (741/2016, 36.8%). While the frequency of nonmedical use before and after the outbreak of COVID-19 has been similar (odds ratio [OR] 1.02 95% CI 0.91-1.15), its trend has changed significantly due to the pandemic (95% CI 2.36-22.20). Among the machine learning models, RF had the highest performance of 0.75. Conclusions: The trend of nonmedical use of methylphenidate has changed significantly due to the COVID-19 pandemic. Among the machine learning models using SNS data to analyze the adverse effects and nonmedical use of methylphenidate, the random forest model had the highest performance. UR - https://www.jmir.org/2023/1/e45146 UR - http://dx.doi.org/10.2196/45146 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585250 ID - info:doi/10.2196/45146 ER - TY - JOUR AU - Livesay, Karen AU - Petersen, Sacha AU - Walter, Ruby AU - Zhao, Lin AU - Butler-Henderson, Kerryn AU - Abdolkhani, Robab PY - 2023/8/16 TI - Sociotechnical Challenges of Digital Health in Nursing Practice During the COVID-19 Pandemic: National Study JO - JMIR Nursing SP - e46819 VL - 6 KW - nursing informatics KW - digital health KW - COVID-19 pandemic KW - workforce KW - sociotechnical approach N2 - Background: The COVID-19 pandemic has accelerated the use of digital health innovations, which has greatly impacted nursing practice. However, little is known about the use of digital health services by nurses and how this has changed during the pandemic. Objective: This study explored the sociotechnical challenges that nurses encountered in using digital health services implemented during the pandemic and, accordingly, what digital health capabilities they expect from the emerging workforce. Methods: Five groups of nurses, including chief nursing information officers, nurses, clinical educators, nurse representatives at digital health vendor companies, and nurse representatives in government bodies across Australia were interviewed. They were asked about their experience of digital health during the pandemic, their sociotechnical challenges, and their expectations of the digital health capabilities of emerging nurses to overcome these challenges. Interviews were deductively analyzed based on 8 sociotechnical themes, including technical challenges, nurse-technology interaction, clinical content management, training and human resources, communication and workflow, internal policies and guidelines, external factors, and effectiveness assessment of digital health for postpandemic use. Results: Sixteen participants were interviewed. Human factors and clinical workflow challenges were highly mentioned. Nurses? lack of knowledge and involvement in digital health implementation and evaluation led to inefficient use of these technologies during the pandemic. They expected the emerging workforce to be digitally literate and actively engaged in digital health interventions beyond documentation, such as data analytics and decision-making. Conclusions: Nurses should be involved in digital health interventions to efficiently use these technologies and provide safe and quality care. Collaborative efforts among policy makers, vendors, and clinical and academic industries can leverage digital health capabilities in the nursing workforce. UR - https://nursing.jmir.org/2023/1/e46819 UR - http://dx.doi.org/10.2196/46819 UR - http://www.ncbi.nlm.nih.gov/pubmed/37585256 ID - info:doi/10.2196/46819 ER - TY - JOUR AU - Campos-Castillo, Celeste PY - 2023/8/16 TI - Impact of Beliefs About Local Physician Supply and Self-Rated Health on Willingness to See a Nurse Practitioner During the COVID-19 Pandemic: Web-Based Survey and Experiment JO - JMIR Form Res SP - e38965 VL - 7 KW - primary care shortage KW - workforce KW - health care seeking KW - public opinion KW - consumers KW - online studies KW - COVID-19 KW - pandemic KW - primary care KW - nurse practitioners KW - nurse KW - healthcare KW - resources KW - advocacy N2 - Background: The COVID-19 pandemic overburdened primary care clinicians. For nurse practitioners (NPs) to alleviate the burden, the public must be willing to see an NP over a physician. Those with poor health tended to continue seeking care during the pandemic, suggesting that they may be willing to see an NP. Objective: The aim of this study is to evaluate the public?s willingness to see an NP for primary care and how this may be associated with their beliefs about the local supply of physicians and self-rated health. Two studies were conducted: (1) a survey to identify correlations and (2) an experiment to assess how willingness is dependent on information about the local supply of physicians. Methods: The survey and experiment were conducted digitally in April and December 2020, respectively. Participants were US adults recruited from Amazon?s Mechanical Turk platform. The key independent variables were self-rated health, which was a dichotomized 5-point scale (excellent, very good, good vs fair, and poor), and beliefs about local physician supply. The survey measured beliefs about local physician supply, while the experiment manipulated beliefs by altering information the participants read about the local supply of physicians. Willingness to see an NP was assessed in 2 ways. First as an overall preference over a physician and the second as a preference given 2 clinically significant scenarios in which participants imagined they were experiencing either coughing or a headache (presentation order randomized). Multiple regressions and ANOVAs were used to assess how beliefs about the local physician supply and self-rated health were associated with overall willingness to see an NP. Bivariate probits simultaneously estimated willingness to see an NP in the 2 clinically significant scenarios. Results: The survey showed that concerns about physician supply were associated with lower willingness to see an NP among respondents with comparatively better health but a greater willingness among respondents with comparatively worse health. The experiment suggests that only the latter is causal. For the 2 clinically significant scenarios, these patterns appeared for the coughing scenario in the survey and the headache scenario in the experiment. Conclusions: US adults with comparatively worse self-rated health become more willing to see an NP for primary care when they hear information that raises their concerns about the local physician supply. The differences between the survey and experiment results may be useful for interpreting findings from future studies. Findings may aid in managing finite health care resources during public health crises and crafting successful messaging by NP advocacy groups. Efforts to address nursing shortages will also be needed. UR - https://formative.jmir.org/2023/1/e38965 UR - http://dx.doi.org/10.2196/38965 UR - http://www.ncbi.nlm.nih.gov/pubmed/37347928 ID - info:doi/10.2196/38965 ER - TY - JOUR AU - Zaidi, Zainab AU - Ye, Mengbin AU - Samon, Fergus AU - Jama, Abdisalan AU - Gopalakrishnan, Binduja AU - Gu, Chenhao AU - Karunasekera, Shanika AU - Evans, Jamie AU - Kashima, Yoshihisa PY - 2023/8/8 TI - Topics in Antivax and Provax Discourse: Yearlong Synoptic Study of COVID-19 Vaccine Tweets JO - J Med Internet Res SP - e45069 VL - 25 KW - COVID-19 vaccine KW - vaccine hesitancy KW - antivax KW - stance detection KW - topic modeling KW - misinformation KW - disinformation N2 - Background: Developing an understanding of the public discourse on COVID-19 vaccination on social media is important not only for addressing the ongoing COVID-19 pandemic but also for future pathogen outbreaks. There are various research efforts in this domain, although, a need still exists for a comprehensive topic-wise analysis of tweets in favor of and against COVID-19 vaccines. Objective: This study characterizes the discussion points in favor of and against COVID-19 vaccines posted on Twitter during the first year of the pandemic. The aim of this study was primarily to contrast the views expressed by both camps, their respective activity patterns, and their correlation with vaccine-related events. A further aim was to gauge the genuineness of the concerns expressed in antivax tweets. Methods: We examined a Twitter data set containing 75 million English tweets discussing the COVID-19 vaccination from March 2020 to March 2021. We trained a stance detection algorithm using natural language processing techniques to classify tweets as antivax or provax and examined the main topics of discourse using topic modeling techniques. Results: Provax tweets (37 million) far outnumbered antivax tweets (10 million) and focused mostly on vaccine development, whereas antivax tweets covered a wide range of topics, including opposition to vaccine mandate and concerns about safety. Although some antivax tweets included genuine concerns, there was a large amount of falsehood. Both stances discussed many of the same topics from opposite viewpoints. Memes and jokes were among the most retweeted messages. Most tweets from both stances (9,007,481/10,566,679, 85.24% antivax and 24,463,708/37,044,507, 66.03% provax tweets) came from dual-stance users who posted both provax and antivax tweets during the observation period. Conclusions: This study is a comprehensive account of COVID-19 vaccine discourse in the English language on Twitter from March 2020 to March 2021. The broad range of discussion points covered almost the entire conversation, and their temporal dynamics revealed a significant correlation with COVID-19 vaccine?related events. We did not find any evidence of polarization and prevalence of antivax discourse over Twitter. However, targeted countering of falsehoods is important because only a small fraction of antivax discourse touched on a genuine issue. Future research should examine the role of memes and humor in driving web-based social media activity. UR - https://www.jmir.org/2023/1/e45069 UR - http://dx.doi.org/10.2196/45069 UR - http://www.ncbi.nlm.nih.gov/pubmed/37552535 ID - info:doi/10.2196/45069 ER - TY - JOUR AU - Wang, Yijun AU - Chukwusa, Emeka AU - Koffman, Jonathan AU - Curcin, Vasa PY - 2023/8/7 TI - Public Opinions About Palliative and End-of-Life Care During the COVID-19 Pandemic: Twitter-Based Content Analysis JO - JMIR Form Res SP - e44774 VL - 7 KW - palliative care KW - end-of-life care KW - COVID-19 KW - Twitter KW - public opinions N2 - Background: Palliative and end-of-life care (PEoLC) played a critical role in relieving distress and providing grief support in response to the heavy toll caused by the COVID-19 pandemic. However, little is known about public opinions concerning PEoLC during the pandemic. Given that social media have the potential to collect real-time public opinions, an analysis of this evidence is vital to guide future policy-making. Objective: This study aimed to use social media data to investigate real-time public opinions regarding PEoLC during the COVID-19 crisis and explore the impact of vaccination programs on public opinions about PEoLC. Methods: This Twitter-based study explored tweets across 3 English-speaking countries: the United States, the United Kingdom, and Canada. From October 2020 to March 2021, a total of 7951 PEoLC-related tweets with geographic tags were retrieved and identified from a large-scale COVID-19 Twitter data set through the Twitter application programming interface. Topic modeling realized through a pointwise mutual information?based co-occurrence network and Louvain modularity was used to examine latent topics across the 3 countries and across 2 time periods (pre- and postvaccination program periods). Results: Commonalities and regional differences among PEoLC topics in the United States, the United Kingdom, and Canada were identified specifically: cancer care and care facilities were of common interest to the public across the 3 countries during the pandemic; the public expressed positive attitudes toward the COVID-19 vaccine and highlighted the protection it affords to PEoLC professionals; and although Twitter users shared their personal experiences about PEoLC in the web-based community during the pandemic, this was more prominent in the United States and Canada. The implementation of the vaccination programs raised the profile of the vaccine discussion; however, this did not influence public opinions about PEoLC. Conclusions: Public opinions on Twitter reflected a need for enhanced PEoLC services during the COVID-19 pandemic. The insignificant impact of the vaccination program on public discussion on social media indicated that public concerns regarding PEoLC continued to persist even after the vaccination efforts. Insights gleaned from public opinions regarding PEoLC could provide some clues for policy makers on how to ensure high-quality PEoLC during public health emergencies. In this post?COVID-19 era, PEoLC professionals may wish to continue to examine social media and learn from web-based public discussion how to ease the long-lasting trauma caused by this crisis and prepare for public health emergencies in the future. Besides, our results showed social media?s potential in acting as an effective tool to reflect public opinions in the context of PEoLC. UR - https://formative.jmir.org/2023/1/e44774 UR - http://dx.doi.org/10.2196/44774 UR - http://www.ncbi.nlm.nih.gov/pubmed/37368840 ID - info:doi/10.2196/44774 ER - TY - JOUR AU - Scharnetzki, Elizabeth AU - Waterston, Leo AU - Scherer, M. Aaron AU - Thorpe, Alistair AU - Fagerlin, Angela AU - Han, J. Paul K. PY - 2023/8/1 TI - Effects of Prosocial and Hope-Promoting Communication Strategies on COVID-19 Worry and Intentions for Risk-Reducing Behaviors and Vaccination: Experimental Study JO - JMIR Form Res SP - e41959 VL - 7 KW - COVID-19 KW - communication KW - hope KW - prosocial KW - vaccination KW - risk KW - behavior KW - vaccine KW - effect KW - effectiveness KW - social KW - messages KW - public KW - web-based KW - survey N2 - Background: The COVID-19 pandemic has engendered widespread fear and skepticism about recommended risk-reducing behaviors including vaccination. Health agencies are faced with the need to communicate to the public in ways that both provide reassurance and promote risk-reducing behaviors. Communication strategies that promote prosocial (PS) values and hope are being widely used; however, the existing research on the persuasiveness of these strategies has offered mixed evidence. There is also very little research examining the comparative effectiveness of PS and hope-promoting (HP) strategies. Objective: The aim of this study is to evaluate the comparative effectiveness of PS and HP messages in reassuring the public and motivating COVID-19 risk?reducing behaviors. Methods: A web-based factorial experiment was conducted in which a diverse sample of the US public was randomized to read messages which adapted existing COVID-19 information from a public website produced by a state government public health department to include alternative framing language: PS, HP, or no additional framing (control). Participants then completed surveys measuring COVID-19 worry and intentions for COVID-19 risk?reducing behaviors and vaccination. Results: COVID-19 worry was unexpectedly higher in the HP than in the control and PS conditions. Intentions for COVID-19 risk?reducing behaviors did not differ between groups; however, intentions for COVID-19 vaccination were higher in the HP than in the control condition, and this effect was mediated by COVID-19 worry. Conclusions: It appears that HP communication strategies may be more effective than PS strategies in motivating risk-reducing behaviors in some contexts but with the paradoxical cost of promoting worry. UR - https://formative.jmir.org/2023/1/e41959 UR - http://dx.doi.org/10.2196/41959 UR - http://www.ncbi.nlm.nih.gov/pubmed/37379364 ID - info:doi/10.2196/41959 ER - TY - JOUR AU - Patel, S. Khushi AU - Corbett, F. Cynthia AU - Combs, M. Elizabeth AU - Donevant, B. Sara AU - Selph, J. Margaret AU - Gibson, M. Lynette AU - Dawson, M. Robin AU - Sheth, P. Amit AU - Hughes, G. Ronda PY - 2023/7/28 TI - Perceptions of COVID-19 and the Use of Health Information Technology Among People Who Are Uninsured: Multimethod Survey Study JO - JMIR Form Res SP - e45349 VL - 7 KW - COVID-19 KW - medically uninsured KW - medical informatics KW - telemedicine KW - mobile apps KW - health literacy KW - mobile phone N2 - Background: As of May 2023, the novel SARS-CoV-2 has claimed nearly 7 million lives globally and >1.1 million lives in the United States. Low-income populations are often disproportionately affected by risk factors such as lifestyle, employment, and limited health literacy. These populations may lack the knowledge of appropriate infection precautions or have reduced access to care during illness, particularly in countries without universal health care. Objective: We aimed to explore the perceptions and experiences of COVID-19, including symptoms and risk factors among uninsured individuals seeking care at a free medical clinic, and to obtain respondents? perceptions of and suggestions for adapting a mobile health (mHealth) app to an uninsured population known to have low health literacy. Methods: We conducted a prospective multimethod survey study with a convenience sample of uninsured adults seeking care at 3 free clinics in the United States. Respondents were questioned about their risk for and awareness of COVID-19 symptoms, COVID-19 testing, current technology use, and the use of technology to facilitate their health regarding COVID-19. Data were analyzed using descriptive statistics (eg, frequencies and mean differences). In addition, a small subset of respondents from one of the clinics (n=10) participated in interviews to provide feedback about the design of a COVID-19 web-based smartphone (mHealth) app. Results: The survey respondents (N=240) were 53.8% (n=129) female, were primarily White (n=113, 47.1%), and had a mean age of 50.0 (SD 11.67; range 19-72) years. Most respondents (162/222, 73%) did not think that they were at risk for COVID-19. Although respondents reported only moderate confidence in their knowledge of the short- and long-term symptoms of COVID-19, their knowledge of the symptoms aligned well with reports published by the Centers for Disease Control and Prevention of the most common acute (590/610, 96.7%) and long-term (217/271, 80.1%) symptoms. Most respondents (159/224, 71%) reported an interest in using the mHealth app to gain additional information regarding COVID-19 and available community resources. Respondents who were interviewed provided suggestions to improve the mHealth app but had overall positive perceptions about the potential usefulness and usability of the app. Conclusions: It was encouraging that the knowledge of COVID-19 symptoms aligned well with the reports published by the Centers for Disease Control and Prevention and that respondents were enthusiastic about using an mHealth app to monitor symptoms. However, it was concerning that most respondents did not think they were at a risk of contracting COVID-19. UR - https://formative.jmir.org/2023/1/e45349 UR - http://dx.doi.org/10.2196/45349 UR - http://www.ncbi.nlm.nih.gov/pubmed/37505792 ID - info:doi/10.2196/45349 ER - TY - JOUR AU - Jin, Qiang AU - Raza, Hassan Syed AU - Yousaf, Muhammad AU - Zaman, Umer AU - Ogadimma, C. Emenyeonu AU - Shah, Ali Amjad AU - Core, Rachel AU - Malik, Aqdas PY - 2023/7/26 TI - Assessing How Risk Communication Surveillance Prompts COVID-19 Vaccine Acceptance Among Internet Users by Applying the Situational Theory of Problem Solving: Cross-Sectional Study JO - JMIR Form Res SP - e43628 VL - 7 KW - COVID-19 KW - vaccine safety KW - risk communication KW - digital interventions KW - health communication KW - Situational Theory of Problem Solving N2 - Background: The World Health Organization has recently raised concerns regarding the low number of people fully vaccinated against COVID-19. The low ratio of fully vaccinated people and the emergence of renewed infectious variants correspond to worsening public health. Global health managers have highlighted COVID-19 vaccine?related infodemics as a significant risk perception factor hindering mass vaccination campaigns. Objective: Given the ambiguous digital communication environment that has fostered infodemics, resource-limited nations struggle to boost public willingness to encourage people to fully vaccinate. Authorities have launched some risk communication?laden digital interventions in response to infodemics. However, the value of the risk communication strategies used to tackle infodemics needs to be evaluated. The current research using the tenets of the Situational Theory of Problem Solving is novel, as it explores the impending effects of risk communication strategies. The relationship between infodemic-induced risk perception of COVID-19 vaccine safety and risk communication actions to intensify willingness to be fully vaccinated was examined. Methods: This study used a cross-sectional research design vis-à-vis a nationally representative web-based survey. We collected data from 1946 internet users across Pakistan. Participants voluntarily participated in this research after completing the consent form and reading ethical permissions. Responses were received over 3 months, from May 2022 to July 2022. Results: The results delineated that infodemics positively affected risk perception. This realization pushed the public to engage in risky communicative actions through reliance on and searches for accurate information. Therefore, the prospect of managing infodemics through risk information exposure (eg, digital interventions) using the situational context could predict robust willingness to be fully vaccinated against COVID-19. Conclusions: These pioneering results offer strategic considerations for health authorities to effectively manage the descending spiral of optimal protection against COVID-19. This research concludes that the likelihood of managing infodemics using situational context through exposure to relevant information could improve one?s knowledge of forfending and selection, which can lead to robust protection against COVID-19. Hence, more situation-specific information about the underlying problem (ie, the selection of an appropriate vaccine) can be made accessible through several official digital sources to achieve a more active public health response. UR - https://formative.jmir.org/2023/1/e43628 UR - http://dx.doi.org/10.2196/43628 UR - http://www.ncbi.nlm.nih.gov/pubmed/37315198 ID - info:doi/10.2196/43628 ER - TY - JOUR AU - Abuauf, Mawahib AU - Raboe, Hassan Enaam AU - Alshareef, Muneera AU - Rabie, Nada AU - Zailaie, Roaa AU - Alharbi, Abdullah AU - Felemban, Walaa AU - Alnasser, Ibrahim AU - Shalaby, Hanin PY - 2023/7/11 TI - COVID-19 Conceptual Modeling: Single-Center Cross-Sectional Study JO - JMIR Form Res SP - e41376 VL - 7 KW - conceptual model KW - conceptual framework KW - modeling KW - Saudi Arabia KW - COVID-19 KW - SARS-CoV-2 KW - mortality KW - morbidity KW - CURB-65 KW - socioeconomic KW - health care KW - hospital database KW - electronic record KW - medical decision-making KW - hospital admission KW - hospitalization KW - cross-sectional KW - death KW - intensive care N2 - Background: Conceptual models are abstract representations of the real world. They are used to refine medical and nonmedical health care scopes of service. During the COVID-19 pandemic, numerous analytic predictive models were generated aiming to evaluate the impact of implemented policies on mitigating the spread of the virus. The models also aimed to examine the psychosocial factors that might govern the general population?s adherence to these policies and to identify factors that could affect COVID-19 vaccine uptake and allocation. The outcomes of these analytic models helped set priorities when vaccines were available and predicted readiness to resume non?COVID-19 health care services. Objective: The objective of our research was to implement a descriptive-analytical conceptual model that analyzes the data of all COVID-19?positive cases admitted to our hospital from March 1 to May 31, 2020, the initial wave of the pandemic, the time interval during which local policies and clinical guidelines were constantly updated to mitigate the local effects of COVID-19, minimize mortality, reduce intensive care unit (ICU) admission, and ensure the safety of health care providers. The primary outcome of interest was to identify factors that might affect mortality and ICU admission rates and the impact of the implemented policy on COVID-19 positivity among health care providers. The secondary outcome of interest was to evaluate the sensitivity of the COVID-19 visual score, implemented by the Saudi Arabia Ministry of Health for COVID-19 risk assessment, and CURB-65 (confusion, urea, respiratory rate, blood pressure, and age >65 years) scores in predicting ICU admission or mortality among the study population. Methods: This was a cross-sectional study. The relevant attributes were constructed based on research findings from the first wave of the pandemic and were electronically retrieved from the hospital database. Analysis of the conceptual model was based on the International Society for Pharmacoeconomics and Outcomes Research guidelines and the Society for Medical Decision-Making. Results: A total of 275 individuals tested positive for COVID-19 within the study design interval. The conceptualization model revealed a low-risk population based on the following attributes: a mean age of 42 (SD 19.2) years; 19% (51/275) of the study population being older adults ?60 years of age; 80% (220/275) having a CURB-65 score <4; 53% (147/275) having no comorbidities; 5% (13/275) having extreme obesity; and 20% (55/275) having a significant hematological abnormality. The overall rate of ICU admission for the study population was 5% (13/275), and the overall mortality rate was 1.5% (4/275). The multivariate correlation analysis revealed that a high-selectivity approach was adopted, resulting in patients with complex medical problems not being sent to MOH isolation facilities. Furthermore, 5% of health care providers tested positive for COVID-19, none of whom were health care providers allocated to the COVID-19 screening areas, indicating the effectiveness of the policy implemented to ensure the safety of health care providers. Conclusions: Based on the conceptual model outcome, the selectivity applied in retaining high-risk populations within the hospital might have contributed to the observed low mortality rate, without increasing the risk to attending health care providers. UR - https://formative.jmir.org/2023/1/e41376 UR - http://dx.doi.org/10.2196/41376 UR - http://www.ncbi.nlm.nih.gov/pubmed/37256829 ID - info:doi/10.2196/41376 ER - TY - JOUR AU - Cummins, A. Jack AU - Lipworth, D. Adam PY - 2023/7/6 TI - Reddit and Google Activity Related to Non-COVID Epidemic Diseases Surged at Start of COVID-19 Pandemic: Retrospective Study JO - JMIR Form Res SP - e44603 VL - 7 KW - COVID-19 KW - Reddit KW - Google Trends KW - chikungunya KW - Ebola KW - H1N1 KW - Middle Eastern respiratory syndrome KW - MERS KW - severe acute respiratory syndrome KW - SARS KW - Zika KW - infectious disease KW - social media KW - search data KW - search query KW - web-based search KW - information behavior KW - information seeking KW - public interest N2 - Background: Resources such as Google Trends and Reddit provide opportunities to gauge real-time popular interest in public health issues. Despite the potential for these publicly available and free resources to help optimize public health campaigns, use for this purpose has been limited. Objective: The purpose of this study is to determine whether early public awareness of COVID-19 correlated with elevated public interest in other infectious diseases of public health importance. Methods: Google Trends search data and Reddit comment data were analyzed from 2018 through 2020 for the frequency of keywords ?chikungunya,? ?Ebola,? ?H1N1,? ?MERS,? ?SARS,? and ?Zika,? 6 highly publicized epidemic diseases in recent decades. After collecting Google Trends relative popularity scores for each of these 6 terms, unpaired 2-tailed t tests were used to compare the 2020 weekly scores for each term to their average level over the 3-year study period. The number of Reddit comments per month with each of these 6 terms was collected and then adjusted for the total estimated Reddit monthly comment volume to derive a measure of relative use, analogous to the Google Trends popularity score. The relative monthly incidence of comments with each search term was then compared to the corresponding search term?s pre-COVID monthly comment data, again using unpaired 2-tailed t tests. P value cutoffs for statistical significance were determined a priori with a Bonferroni correction. Results: Google Trends and Reddit data both demonstrate large and statistically significant increases in the usage of each evaluated disease term through at least the initial months of the pandemic. Google searches and Reddit comments that included any of the evaluated infectious disease search terms rose significantly in the first months of 2020 above their baseline usage, peaking in March 2020. Google searches for ?SARS? and ?MERS? remained elevated for the entirety of the 2020 calendar year, as did Reddit comments with the words ?Ebola,? ?H1N1,? ?MERS,? and ?SARS? (P<.001, for each weekly or monthly comparison, respectively). Conclusions: Google Trends and Reddit can readily be used to evaluate real-time general interest levels in public health?related topics, providing a tool to better time and direct public health initiatives that require a receptive target audience. The start of the COVID-19 pandemic correlated with increased public interest in other epidemic infectious diseases. We have demonstrated that for 6 distinct infectious causes of epidemics over the last 2 decades, public interest rose substantially and rapidly with the outbreak of COVID-19. Our data suggests that for at least several months after the initial outbreak, the public may have been particularly receptive to dialogue on these topics. Public health officials should consider using Google Trends and social media data to identify patterns of engagement with public health topics in real time and to optimize the timing of public health campaigns. UR - https://formative.jmir.org/2023/1/e44603 UR - http://dx.doi.org/10.2196/44603 UR - http://www.ncbi.nlm.nih.gov/pubmed/37256832 ID - info:doi/10.2196/44603 ER - TY - JOUR AU - Mabuka, Thabo AU - Naidoo, Natalie AU - Ncube, Nesisa AU - Yiga, Thabo AU - Ross, Michael AU - Kurehwa, Kuzivakwashe AU - Nare Nyathi, Mothabisi AU - Silaji, Andrea AU - Ndemera, Tinashe AU - Lemeke, Tlaleng AU - Taiwo, Ridwan AU - Macharia, Willie AU - Sithole, Mthokozisi PY - 2023/7/3 TI - The Impact of SARS-CoV-2 Lineages (Variants) and COVID-19 Vaccination on the COVID-19 Epidemic in South Africa: Regression Study JO - JMIRx Med SP - e34598 VL - 4 KW - COVID-19 KW - SARS-CoV-2 KW - vaccines KW - variants KW - lineages KW - South Africa KW - epidemiology KW - statistics N2 - Background: Emerging SARS-CoV-2 variants have been attributed to the occurrence of secondary, tertiary, quaternary, and quinary COVID-19 epidemic waves threatening vaccine efforts owing to their immune invasiveness. Since the importation of SARS-CoV-2 in South Africa, with the first reported COVID-19 case on March 5, 2020, South Africa has observed 5 consecutive COVID-19 epidemic waves. The evolution of SARS-CoV-2 has played a major role in the resurgence of COVID-19 epidemic waves in South Africa and across the globe. Objective: We aimed to conduct descriptive and inferential statistical analysis on South African COVID-19 epidemiological data to investigate the impact of SARS-CoV-2 lineages and COVID-19 vaccinations in South African COVID-19 epidemiology. Methods: The general methodology involved the collation and stratification, covariance, regression analysis, normalization, and comparative inferential statistical analysis through null hypothesis testing (paired 2-tailed t tests) of South African COVID-19 epidemiological data. Results: The mean daily positive COVID-19 tests in South Africa?s first, second, third, fourth, and fifth COVID-19 epidemic wave periods were 11.5% (SD 8.58%), 11.5% (SD 8.45%), 13.3% (SD 9.72%), 13.1% (SD 9.91%), and 14.3% (SD 8.49%), respectively. The COVID-19 transmission rate in the first and second COVID-19 epidemic waves in South Africa was similar, while the COVID-19 transmission rate was higher in the third, fourth, and fifth COVID-19 epidemic waves than in the aforementioned waves. Most COVID-19 hospitalized cases in South Africa were in the general ward (60%-79.1%). Patients with COVID-19 on oxygen were the second-largest admission status (11.2%-16.8%), followed by patients with COVID-19 in the intensive care unit (8.07%-16.7%). Most patients hospitalized owing to COVID-19 in South Africa?s first, second, third, and fourth COVID-19 epidemic waves were aged between 40 and 49 years (16.8%-20.4%) and 50 and 59 years (19.8%-25.3%). Patients admitted to the hospital owing to COVID-19 in the age groups of 0 to 19 years were relatively low (1.98%-4.59%). In general, COVID-19 hospital admissions in South Africa for the age groups between 0 and 29 years increased after each consecutive COVID-19 epidemic wave, while for age groups between 30 and 79 years, hospital admissions decreased. Most COVID-19 hospitalization deaths in South Africa in the first, second, third, fourth, and fifth COVID-19 epidemic waves were in the ages of 50 to 59 years (15.8%-24.8%), 60 to 69 years (15.9%-29.5%), and 70 to 79 years (16.6%-20.7%). Conclusions: The relaxation of COVID-19 nonpharmaceutical intervention health policies in South Africa and the evolution of SARS-CoV-2 were associated with increased COVID-19 transmission and severity in the South African population. COVID-19 vaccination in South Africa was strongly associated with a decrease in COVID-19 hospitalization and severity in South Africa. UR - https://med.jmirx.org/2023/1/e34598 UR - http://dx.doi.org/10.2196/34598 UR - http://www.ncbi.nlm.nih.gov/pubmed/37463043 ID - info:doi/10.2196/34598 ER - TY - JOUR AU - Shania, Mila AU - Handayani, Wuri Putu AU - Asih, Sali PY - 2023/7/3 TI - Designing High-Fidelity Mobile Health for Depression in Indonesian Adolescents Using Design Science Research: Mixed Method Approaches JO - JMIR Form Res SP - e48913 VL - 7 KW - mobile health KW - mental health KW - user interface KW - design science research KW - Indonesia KW - digital app KW - mHealth KW - depression KW - pandemic KW - adolescents N2 - Background: COVID-19 mitigation protocols, enacted to control the pandemic, have also been shown to have a negative impact on mental health, including the mental health of adolescents. The threat of being infected by SARS-CoV-2 and substantial changes in lifestyle, including limited social interaction due to stay-at-home orders, led to loneliness as well as depressive symptoms. However, offline psychological assistance is restricted, as psychologists are bounded by mitigation protocols. Further, not all adolescents? guardians are open to their children attending or have the means to pay for psychological service; thus, adolescents remain untreated. Having a mobile health (mHealth) app for mental health that uses monitoring, provides social networks, and delivers psychoeducation may provide a solution, especially in countries that have limited health facilities and mental health workers. Objective: This study aimed to design an mHealth app to help prevent and monitor depression in adolescents. The design of this mHealth app was carried out as a high-fidelity prototype. Methods: We used a design science research (DSR) methodology with 3 iterations and 8 golden rule guidelines. The first iteration used interviews, and the second and third iterations used mixed method approaches. The DSR stages include the following: (1) identify the problem; (2) define the solution; (3) define the solution objective; (4) develop, demonstrate, and evaluate the solution; and (5) communicate the solution. This study involved students and medical experts. Results: The first iteration resulted in a wireframe and prototype for the next iteration. The second iteration resulted in a System Usability Scale score of 67.27, indicating a good fit. In the third iteration, the system usefulness, information quality, interface quality, and overall values were 2.416, 2.341, 2.597, and 2.261, respectively, indicating a good design. Key features of this mHealth app include a mood tracker, community, activity target, and meditation, and supporting features that complement the design include education articles and early detection features. Conclusions: Our findings provide guidance for health facilities and to design and implement future mHealth apps to help treat adolescent depression. UR - https://formative.jmir.org/2023/1/e48913 UR - http://dx.doi.org/10.2196/48913 UR - http://www.ncbi.nlm.nih.gov/pubmed/37399059 ID - info:doi/10.2196/48913 ER - TY - JOUR AU - Isip Tan, Thiele Iris AU - Cleofas, Jerome AU - Solano, Geoffrey AU - Pillejera, Genevive Jeanne AU - Catapang, Kyle Jasper PY - 2023/6/28 TI - Interdisciplinary Approach to Identify and Characterize COVID-19 Misinformation on Twitter: Mixed Methods Study JO - JMIR Form Res SP - e41134 VL - 7 KW - COVID-19 KW - misinformation KW - natural language processing KW - Twitter KW - biterm topic modeling N2 - Background: Studying COVID-19 misinformation on Twitter presents methodological challenges. A computational approach can analyze large data sets, but it is limited when interpreting context. A qualitative approach allows for a deeper analysis of content, but it is labor-intensive and feasible only for smaller data sets. Objective: We aimed to identify and characterize tweets containing COVID-19 misinformation. Methods: Tweets geolocated to the Philippines (January 1 to March 21, 2020) containing the words coronavirus, covid, and ncov were mined using the GetOldTweets3 Python library. This primary corpus (N=12,631) was subjected to biterm topic modeling. Key informant interviews were conducted to elicit examples of COVID-19 misinformation and determine keywords. Using NVivo (QSR International) and a combination of word frequency and text search using key informant interview keywords, subcorpus A (n=5881) was constituted and manually coded to identify misinformation. Constant comparative, iterative, and consensual analyses were used to further characterize these tweets. Tweets containing key informant interview keywords were extracted from the primary corpus and processed to constitute subcorpus B (n=4634), of which 506 tweets were manually labeled as misinformation. This training set was subjected to natural language processing to identify tweets with misinformation in the primary corpus. These tweets were further manually coded to confirm labeling. Results: Biterm topic modeling of the primary corpus revealed the following topics: uncertainty, lawmaker?s response, safety measures, testing, loved ones, health standards, panic buying, tragedies other than COVID-19, economy, COVID-19 statistics, precautions, health measures, international issues, adherence to guidelines, and frontliners. These were categorized into 4 major topics: nature of COVID-19, contexts and consequences, people and agents of COVID-19, and COVID-19 prevention and management. Manual coding of subcorpus A identified 398 tweets with misinformation in the following formats: misleading content (n=179), satire and/or parody (n=77), false connection (n=53), conspiracy (n=47), and false context (n=42). The discursive strategies identified were humor (n=109), fear mongering (n=67), anger and disgust (n=59), political commentary (n=59), performing credibility (n=45), overpositivity (n=32), and marketing (n=27). Natural language processing identified 165 tweets with misinformation. However, a manual review showed that 69.7% (115/165) of tweets did not contain misinformation. Conclusions: An interdisciplinary approach was used to identify tweets with COVID-19 misinformation. Natural language processing mislabeled tweets, likely due to tweets written in Filipino or a combination of the Filipino and English languages. Identifying the formats and discursive strategies of tweets with misinformation required iterative, manual, and emergent coding by human coders with experiential and cultural knowledge of Twitter. An interdisciplinary team composed of experts in health, health informatics, social science, and computer science combined computational and qualitative methods to gain a better understanding of COVID-19 misinformation on Twitter. UR - https://formative.jmir.org/2023/1/e41134 UR - http://dx.doi.org/10.2196/41134 UR - http://www.ncbi.nlm.nih.gov/pubmed/37220196 ID - info:doi/10.2196/41134 ER - TY - JOUR AU - Rodríguez-Blanque, Raquel AU - Sánchez-García, Carlos Juan AU - Cobos Vargas, Angel AU - Leyva Martínez, Socorro M. AU - Martínez Diz, Silvia AU - Cortés-Martín, Jonathan AU - Tovar-Gálvez, Isabel María PY - 2023/6/28 TI - Evaluation of Lactobacillus Coryniformis K8 Consumption by Health Care Workers Exposed to COVID-19 (LactoCor2 Project): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e37857 VL - 12 KW - COVID-19 KW - coronavirus KW - Lactobacillus KW - health care workers KW - Lactobacilo KW - trabajadores de la salud KW - SARS-CoV-2 KW - probiótico N2 - Background: Lactobacillus coryniformis K8 CECT5711 has immune-modulating properties, enhances the immune response to viral antigens leading to the production of specific antibodies, and has anti-inflammatory activity, which may help to prevent uncontrolled inflammatory processes leading to respiratory and other organ failures. Objective: The purpose of this study is to evaluate the effect of the consumption of a probiotic strain on the incidence and severity of COVID-19 in health personnel who carry out their professional work among patients with infection or suspected infection by SARS-CoV-2. Methods: This is a double-blind randomized clinical trial in which the experimental group will receive a capsule of L coryniformis K8 per day (3×109 colony former units/day), and the control group will receive a daily placebo capsule consisting of maltodextrin. A sample size of 314 volunteers was calculated. Volunteers must meet the following inclusion criteria: older than 20 years and active health personnel caring for patients with COVID-19, including all professionals such as medical doctors, nurses, and caretakers at the 2 referral hospitals that treat patients with COVID-19. The main outcome of the clinical trial will be the incidence of symptomatic infection by SARS-CoV-2 in personnel who care for patients with suspected or confirmed COVID-19. Results: The study had to be extended to the 2 referral hospitals that treat patients with COVID-19 in the province of Granada (Andalusia, Spain); Hospital San Cecilio and Hospital Virgen de las Nieves. A total of 255 individuals met the inclusion criteria and were randomly assigned to one of the 2 groups. Conclusions: The results of this randomized controlled trial will provide valuable information regarding the administration of L coryniformis K8 against COVID-19, including whether there are fewer infectious processes due to this virus or, in case of occurrence, whether the disease is milder in participants taking the probiotic strain. Trial Registration: ClinicalTrials.gov NCT04366180; http://www.clinicaltrials.gov/ct2/show/NCT04366180 International Registered Report Identifier (IRRID): RR1-10.2196/37857 UR - https://www.researchprotocols.org/2023/1/e37857 UR - http://dx.doi.org/10.2196/37857 UR - http://www.ncbi.nlm.nih.gov/pubmed/37285326 ID - info:doi/10.2196/37857 ER - TY - JOUR AU - Latorre, Eligado Angelica Anne AU - Nakamura, Keiko AU - Seino, Kaoruko AU - Hasegawa, Takanori PY - 2023/6/27 TI - Vector Autoregression for Forecasting the Number of COVID-19 Cases and Analyzing Behavioral Indicators in the Philippines: Ecologic Time-Trend Study JO - JMIR Form Res SP - e46357 VL - 7 KW - COVID-19 KW - forecasting KW - interest by the general public KW - mobility KW - surveillance KW - vector autoregression N2 - Background: Traditional surveillance systems rely on routine collection of data. The inherent delay in retrieval and analysis of data leads to reactionary rather than preventive measures. Forecasting and analysis of behavior-related data can supplement the information from traditional surveillance systems. Objective: We assessed the use of behavioral indicators, such as the general public?s interest in the risk of contracting SARS-CoV-2 and changes in their mobility, in building a vector autoregression model for forecasting and analysis of the relationships of these indicators with the number of COVID-19 cases in the National Capital Region. Methods: An etiologic, time-trend, ecologic study design was used to forecast the daily number of cases in 3 periods during the resurgence of COVID-19. We determined the lag length by combining knowledge on the epidemiology of SARS-CoV-2 and information criteria measures. We fitted 2 models to the training data set and computed their out-of-sample forecasts. Model 1 contains changes in mobility and number of cases with a dummy variable for the day of the week, while model 2 also includes the general public?s interest. The forecast accuracy of the models was compared using mean absolute percentage error. Granger causality test was performed to determine whether changes in mobility and public?s interest improved the prediction of cases. We tested the assumptions of the model through the Augmented Dickey-Fuller test, Lagrange multiplier test, and assessment of the moduli of eigenvalues. Results: A vector autoregression (8) model was fitted to the training data as the information criteria measures suggest the appropriateness of 8. Both models generated forecasts with similar trends to the actual number of cases during the forecast period of August 11-18 and September 15-22. However, the difference in the performance of the 2 models became substantial from January 28 to February 4, as the accuracy of model 2 remained within reasonable limits (mean absolute percentage error [MAPE]=21.4%) while model 1 became inaccurate (MAPE=74.2%). The results of the Granger causality test suggest that the relationship of public interest with number of cases changed over time. During the forecast period of August 11-18, only change in mobility (P=.002) improved the forecasting of cases, while public interest was also found to Granger-cause the number of cases during September 15-22 (P=.001) and January 28 to February 4 (P=.003). Conclusions: To the best of our knowledge, this is the first study that forecasted the number of COVID-19 cases and explored the relationship of behavioral indicators with the number of COVID-19 cases in the Philippines. The resemblance of the forecasts from model 2 with the actual data suggests its potential in providing information about future contingencies. Granger causality also implies the importance of examining changes in mobility and public interest for surveillance purposes. UR - https://formative.jmir.org/2023/1/e46357 UR - http://dx.doi.org/10.2196/46357 UR - http://www.ncbi.nlm.nih.gov/pubmed/37368473 ID - info:doi/10.2196/46357 ER - TY - JOUR AU - Verma, Neha AU - Buch, Bimal AU - Taralekar, Radha AU - Acharya, Soumyadipta PY - 2023/6/23 TI - Diagnostic Concordance of Telemedicine as Compared With Face-to-Face Care in Primary Health Care Clinics in Rural India: Randomized Crossover Trial JO - JMIR Form Res SP - e42775 VL - 7 KW - telemedicine KW - telehealth KW - eHealth KW - opensource KW - digital assistant KW - diagnostic concordance KW - COVID-19 KW - primary care KW - rural health KW - teleconsultation KW - patient care N2 - Background: With the COVID-19 pandemic, there was an increase and scaling up of provider-to-provider telemedicine programs that connect frontline health providers such as nurses and community health workers at primary care clinics with remote doctors at tertiary facilities to facilitate consultations for rural patients. Considering this new trend of increasing use of telemedicine, this study was conducted to generate evidence for patients, health providers, and policymakers to compare if provider-to-provider telemedicine-based care is equivalent to in-person care and is safe and acceptable in terms of diagnostic and treatment standards. Objective: This study aims to compare the diagnosis and treatment decisions from teleconsultations to those of in-person care in teleclinics in rural Gujarat. Methods: We conducted a diagnostic concordance study using a randomized crossover study design with 104 patients at 10 telemedicine primary care clinics. Patients reporting to 10 telemedicine primary care clinics were randomly assigned to first receive an in-person doctor consultation (59/104, 56.7%) or to first receive a health worker?assisted telemedicine consultation (45/104, 43.3%). The 2 groups were then switched, with the first group undergoing a telemedicine consultation following the in-person consultation and the second group receiving an in-person consultation after the teleconsultation. The in-person doctor and remote doctor were blinded to the diagnosis and management plan of the other. The diagnosis and treatment plan of in-person doctors was considered the gold standard. Results: We enrolled 104 patients reporting a range of primary health care issues into the study. We observed 74% (77/104) diagnostic concordance and 79.8% (83/104) concordance in the treatment plan between the in-person and remote doctors. No significant association was found between the diagnostic and treatment concordance and the order of the consultation (P=.65 and P=.81, respectively), the frontline health worker?doctor pair (both P=.93), the gender of the patient (both P>.99), or the mode of teleconsultation (synchronous vs asynchronous; P=.32 and P=.29, respectively), as evaluated using Fisher exact tests. A significant association was seen between the diagnostic and treatment concordance and the type of case (P=.004 and P=.03, respectively). The highest diagnostic concordance was seen in the management of hypertension (20/21, 95% concordance; Cohen kappa=0.93) and diabetes (14/15, 93% concordance; Cohen kappa=0.89). The lowest values were seen in cardiology (1/3, 33%) and patients presenting with nonspecific symptoms (3/10, 30%). The use of a digital assistant to facilitate the consultation resulted in increased adherence to evidence-based care protocols. Conclusions: The findings reflect that telemedicine can be a safe and acceptable alternative mode of care especially in remote rural settings when in-person care is not accessible. Telemedicine has advantages. for the potential gains for improved health care?seeking behavior for patients, reduced costs for the patient, and improved health system efficiency by reducing overcrowding at tertiary health facilities. UR - https://formative.jmir.org/2023/1/e42775 UR - http://dx.doi.org/10.2196/42775 UR - http://www.ncbi.nlm.nih.gov/pubmed/37130015 ID - info:doi/10.2196/42775 ER - TY - JOUR AU - Montiel Ishino, Alejandro Francisco AU - Villalobos, Kevin AU - Williams, Faustine PY - 2023/6/20 TI - COVID-19 Vaccination Among US-Born and Non?US-Born Residents of the United States From a Nationally Distributed Survey: Cross-sectional Study JO - JMIR Form Res SP - e43672 VL - 7 KW - COVID-19 KW - vaccination KW - nativity KW - health disparity KW - survey KW - sociodemographics KW - socioeconomics KW - pandemic KW - vaccine KW - US KW - USA KW - United States KW - birth KW - country N2 - Background: Extended literature has demonstrated that COVID-19 vaccination is crucial for the health of all individuals, regardless of age. Research on vaccination status in the United States (US) among US-born and non?US-born residents is limited. Objective: The objective of our study was to examine COVID-19 vaccination during the pandemic among US-born and non?US-born people, while accounting for sociodemographic and socioeconomic factors gathered through a nationally distributed survey. Methods: A descriptive analysis was conducted on a comprehensive 116-item survey distributed between May 2021 and January 2022 across the US by self-reported COVID-19 vaccination and US/non-US birth status. For participants that responded that they were not vaccinated, we asked if they were ?not at all likely,? ?slightly to moderately likely,? or ?very to extremely likely? to be vaccinated. Race and ethnicity were categorized as White, Black or African American, Asian, American Indian or Alaskan Native, Hawaiian or Pacific Islander, African, Middle Eastern, and multiracial or multiethnic. Additional sociodemographic and socioeconomic variables included gender, sexual orientation, age group, annual household income, educational attainment, and employment status. Results: The majority of the sample, regardless of whether they were US-born or non?US-born, reported being vaccinated (3639/5404, 67.34%). The US-born participants with the highest proportion of COVID-19 vaccination self-identified as White (1431/2753, 51.98%), while the highest proportion of vaccination among non?US-born participants was found among participants who self-identified as Hispanic/Latino (310/886, 34.99%). Comparing US-born and non?US-born participants showed that among those who were not vaccinated, the highest self-reported sociodemographic characteristics by proportion were similar between the groups, and included identifying as a woman, being straight or heterosexual, being aged 18 to 35 years, having an annual household income <$25,000, and being unemployed or taking part in nontraditional work. Among the 32.66% (1765/5404) of participants that reported not being vaccinated, 45.16% (797/1765) stated that they were not at all likely to seek vaccination. Examining US/non?US birth status and the likelihood to be vaccinated for COVID-19 among nonvaccinated participants revealed that the highest proportions of both US-born and non?US-born participants reported being not at all likely to seek vaccination. Non?US-born participants, however, were almost proportionally distributed in their likelihood to seek vaccination; they reported to be ?very to extremely likely? to vaccinate (112/356, 31.46%); compared to 19.45% (274/1409) of US-born individuals reporting the same. Conclusions: Our study highlights the need to further explore factors that can increase the likelihood of seeking vaccination among underrepresented and hard-to-reach populations, with a particular focus on tailoring interventions for US-born individuals. For instance, non?US-born individuals were most likely to vaccinate when reporting COVID-19 nonvaccination than US-born individuals. These findings will aid in identifying points of intervention for vaccine hesitancy and promoting vaccine adoption during current and future pandemics. UR - https://formative.jmir.org/2023/1/e43672 UR - http://dx.doi.org/10.2196/43672 UR - http://www.ncbi.nlm.nih.gov/pubmed/37097810 ID - info:doi/10.2196/43672 ER - TY - JOUR AU - Hengst, M. Tessi AU - Lechner, Lilian AU - van der Laan, Nynke Laura AU - Hommersom, Arjen AU - Dohmen, Daan AU - Hooft, Lotty AU - Metting, Esther AU - Ebbers, Wolfgang AU - Bolman, W. Catherine A. PY - 2023/6/20 TI - The Adoption of a COVID-19 Contact-Tracing App: Cluster Analysis JO - JMIR Form Res SP - e41479 VL - 7 KW - contact-tracing app KW - CTA KW - CoronaMelder KW - intention KW - adoption KW - cluster analysis KW - application KW - psychosocial KW - data KW - risk KW - societal KW - social norm KW - norm KW - COVID-19 KW - adaptation KW - acceptance KW - mHealth KW - mobile health N2 - Background: During the COVID-19 pandemic, there was limited adoption of contact-tracing apps (CTAs). Adoption was particularly low among vulnerable people (eg, people with a low socioeconomic position or of older age), while this part of the population tends to have lesser access to information and communication technology and is more vulnerable to the COVID-19 virus. Objective: This study aims to understand the cause of this lagged adoption of CTAs in order to facilitate adoption and find indications to make public health apps more accessible and reduce health disparities. Methods: Because several psychosocial variables were found to be predictive of CTA adoption, data from the Dutch CTA CoronaMelder (CM) were analyzed using cluster analysis. We examined whether subgroups could be formed based on 6 psychosocial perceptions (ie, trust in the government, beliefs about personal data, social norms, perceived personal and societal benefits, risk perceptions, and self-efficacy) of (non)users concerning CM in order to examine how these clusters differ from each other and what factors are predictive of the intention to use a CTA and the adoption of a CTA. The intention to use and the adoption of CM were examined based on longitudinal data consisting of 2 time frames in October/November 2020 (N=1900) and December 2020 (N=1594). The clusters were described by demographics, intention, and adoption accordingly. Moreover, we examined whether the clusters and the variables that were found to influence the adoption of CTAs, such as health literacy, were predictive of the intention to use and the adoption of the CM app. Results: The final 5-cluster solution based on the data of wave 1 contained significantly different clusters. In wave 1, respondents in the clusters with positive perceptions (ie, beneficial psychosocial variables for adoption of a CTA) about the CM app were older (P<.001), had a higher education level (P<.001), and had higher intention (P<.001) and adoption (P<.001) rates than those in the clusters with negative perceptions. In wave 2, the intention to use and adoption were predicted by the clusters. The intention to use CM in wave 2 was also predicted using the adoption measured in wave 1 (P<.001, ?=?2.904). Adoption in wave 2 was predicted by age (P=.022, exp(B)=1.171), the intention to use in wave 1 (P<.001, exp(B)=1.770), and adoption in wave 1 (P<.001, exp(B)=0.043). Conclusions: The 5 clusters, as well as age and previous behavior, were predictive of the intention to use and the adoption of the CM app. Through the distinguishable clusters, insight was gained into the profiles of CM (non)intenders and (non)adopters. Trial Registration: OSF Registries osf.io/cq742; https://osf.io/cq742 UR - https://formative.jmir.org/2023/1/e41479 UR - http://dx.doi.org/10.2196/41479 UR - http://www.ncbi.nlm.nih.gov/pubmed/37338969 ID - info:doi/10.2196/41479 ER - TY - JOUR AU - Islam, Ashraful AU - Chaudhry, Moalla Beenish PY - 2023/6/8 TI - Design Validation of a Relational Agent by COVID-19 Patients: Mixed Methods Study JO - JMIR Hum Factors SP - e42740 VL - 10 KW - COVID-19 KW - relational agent KW - mHealth KW - design validation KW - health care KW - chatbot KW - digital health intervention KW - health care professional KW - heuristic KW - health promotion KW - mental well-being KW - design validation survey KW - self-isolation N2 - Background: Relational agents (RAs) have shown effectiveness in various health interventions with and without doctors and hospital facilities. In situations such as a pandemic like the COVID-19 pandemic when health care professionals (HCPs) and facilities are unable to cope with increased demands, RAs may play a major role in ameliorating the situation. However, they have not been well explored in this domain. Objective: This study aimed to design a prototypical RA in collaboration with COVID-19 patients and HCPs and test it with the potential users, for its ability to deliver services during a pandemic. Methods: The RA was designed and developed in collaboration with people with COVID-19 (n=21) and 2 groups of HCPs (n=19 and n=16, respectively) to aid COVID-19 patients at various stages by performing 4 main tasks: testing guidance, support during self-isolation, handling emergency situations, and promoting postrecovery mental well-being. A design validation survey was conducted with 98 individuals to evaluate the usability of the prototype using the System Usability Scale (SUS), and the participants provided feedback on the design. In addition, the RA?s usefulness and acceptability were rated by the participants using Likert scales. Results: In the design validation survey, the prototypical RA received an average SUS score of 58.82. Moreover, 90% (88/98) of participants perceived it to be helpful, and 69% (68/98) of participants accepted it as a viable alternative to HCPs. The prototypical RA received favorable feedback from the participants, and they were inclined to accept it as an alternative to HCPs in non-life-threatening scenarios despite the usability rating falling below the acceptable threshold. Conclusions: Based on participants? feedback, we recommend further development of the RA with improved automation and emotional support, ability to provide information, tracking, and specific recommendations. UR - https://humanfactors.jmir.org/2023/1/e42740 UR - http://dx.doi.org/10.2196/42740 UR - http://www.ncbi.nlm.nih.gov/pubmed/36350760 ID - info:doi/10.2196/42740 ER - TY - JOUR AU - Muhajarine, Nazeem AU - Dixon, James AU - Dyck, Erika AU - Clifford, Jim AU - Chassé, Patrick AU - Gupta, Datta Suvadra AU - Christopherson-Cote, Colleen AU - PY - 2023/6/6 TI - Capturing and Documenting the Wider Health Impacts of the COVID-19 Pandemic Through the Remember Rebuild Saskatchewan Initiative: Protocol for a Mixed Methods Interdisciplinary Project JO - JMIR Res Protoc SP - e46643 VL - 12 KW - COVID-19 KW - Saskatchewan, Canada KW - mixed methods KW - interdisciplinary KW - mental health and substance use KW - food insecurity KW - housing precarity KW - archive N2 - Background: In the Canadian province of Saskatchewan, the global COVID-19 pandemic appeared amidst existing social health challenges in food insecurity, housing precarity and homelessness, poor mental health, and substance misuse. These chronic features intersected with the pandemic, producing a moment in time when the urgency of COVID-19 brought attention to underlying shortcomings in public health services. Objective: The objectives of the program of research are (1) to identify and measure relationships between the pandemic and wider health and social impacts, namely, food insecurity, housing precarity and homelessness, and mental health and substance use in Saskatchewan, and (2) to create an oral history of the pandemic in Saskatchewan in an accessible digital public archive. Methods: We are using a mixed methods approach to identify the impacts of the pandemic on specific equity-seeking groups and areas of social health concern by developing cross-sectional population-based surveys and producing results based on statistical analysis. We augmented the quantitative analysis by conducting qualitative interviews and oral histories to generate more granular details of people?s experiences of the pandemic. We are focusing on frontline workers, other service providers, and individuals within equity-seeking groups. We are capturing digital evidence and social media posts; we are collecting and organizing key threads using a free open-source research tool, Zotero, to trace the digital evidence of the pandemic in Saskatchewan. This study is approved by the Research Ethics Board at the University of Saskatchewan (Beh-1945). Results: Funding for this program of research was received in March and April 2022. Survey data were collected between July and November 2022. The collection of oral histories began in June 2022 and concluded in March 2023. In total, 30 oral histories have been collected at the time of this writing. Qualitative interviews began in April 2022 and will continue until March 2024. Survey analysis began in January 2023, and results are expected to be published in mid-2023. All data and stories collected in this work are archived for preservation and freely accessible on the Remember Rebuild Saskatchewan project?s website. We will share results in academic journals and conferences, town halls and community gatherings, social and digital media reports, and through collaborative exhibitions with public library systems. Conclusions: The pandemic?s ephemeral nature poses a risk of us ?forgetting? this moment and the attendant social inequities. These challenges inspired a novel fusion among health researchers, historians, librarians, and service providers in the creation of the Remember Rebuild Saskatchewan project, which focuses on preserving the legacy of the pandemic and capturing data to support an equitable recovery in Saskatchewan. International Registered Report Identifier (IRRID): DERR1-10.2196/46643 UR - https://www.researchprotocols.org/2023/1/e46643 UR - http://dx.doi.org/10.2196/46643 UR - http://www.ncbi.nlm.nih.gov/pubmed/37279056 ID - info:doi/10.2196/46643 ER - TY - JOUR AU - Frick, Ulrich AU - Sipar, Dilan AU - Bücheler, Leonie AU - Haug, Fabian AU - Haug, Julian AU - Almeqbaali, Mohammed Khalifa AU - Pryss, Rüdiger AU - Rosner, Rita AU - Comtesse, Hannah PY - 2023/6/5 TI - A Mobile-Based Preventive Intervention for Young, Arabic-Speaking Asylum Seekers During the COVID-19 Pandemic in Germany: Design and Implementation JO - JMIR Form Res SP - e44551 VL - 7 KW - prevention KW - COVID-19 KW - refugees KW - asylum seekers KW - adolescents KW - feasibility KW - behavior planning KW - vaccination KW - mobile phone N2 - Background: Most individuals seeking asylum in Germany live in collective housing and are thus exposed to a higher risk of contagion during the COVID-19 pandemic. Objective: In this study, we aimed to test the feasibility and efficacy of a culture-sensitive approach combining mobile app?based interventions and a face-to-face group intervention to improve knowledge about COVID-19 and promote vaccination readiness among collectively accommodated Arabic-speaking adolescents and young adults. Methods: We developed a mobile app that consisted of short video clips to explain the biological basis of COVID-19, demonstrate behavior to prevent transmission, and combat misconceptions and myths about vaccination. The explanations were provided in a YouTube-like interview setting by a native Arabic-speaking physician. Elements of gamification (quizzes and rewards for solving the test items) were also used. Consecutive videos and quizzes were presented over an intervention period of 6 weeks, and the group intervention was scheduled as an add-on for half of the participants in week 6. The manual of the group intervention was designed to provide actual behavioral planning based on the health action process approach. Sociodemographic information, mental health status, knowledge about COVID-19, and available vaccines were assessed using questionnaire-based interviews at baseline and after 6 weeks. Interpreters assisted with the interviews in all cases. Results: Enrollment in the study proved to be very challenging. In addition, owing to tightened contact restrictions, face-to-face group interventions could not be conducted as planned. A total of 88 participants from 8 collective housing institutions were included in the study. A total of 65 participants completed the full-intake interview. Most participants (50/65, 77%) had already been vaccinated at study enrollment. They also claimed to comply with preventive measures to a very high extent (eg, ?always wearing masks? was indicated by 43/65, 66% of participants), but practicing behavior that was not considered as effective against COVID-19 transmission was also frequently reported as a preventive measure (eg, mouth rinsing). By contrast, factual knowledge of COVID-19 was limited. Preoccupation with the information materials presented in the app steeply declined after study enrollment (eg, 12/61, 20% of participants watched the videos scheduled for week 3). Of the 61 participants, only 18 (30%) participants could be reached for the follow-up interviews. Their COVID-19 knowledge did not increase after the intervention period (P=.56). Conclusions: The results indicated that vaccine uptake was high and seemed to depend on organizational determinants for the target group. The current mobile app?based intervention demonstrated low feasibility, which might have been related to various obstacles faced during the delivery. Therefore, in the case of future pandemics, transmission prevention in a specific target group should rely more on structural aspects rather than sophisticated psychological interventions. UR - https://formative.jmir.org/2023/1/e44551 UR - http://dx.doi.org/10.2196/44551 UR - http://www.ncbi.nlm.nih.gov/pubmed/37134019 ID - info:doi/10.2196/44551 ER - TY - JOUR AU - Fahim, Christine AU - Cooper, Jeanette AU - Theivendrampillai, Suvabna AU - Pham, Ba' AU - Straus, Sharon PY - 2023/6/2 TI - Ontarians? Perceptions of Public Health Communications and Misinformation During the COVID-19 Pandemic: Survey Study JO - JMIR Form Res SP - e38323 VL - 7 KW - misinformation KW - information seeking KW - COVID-19 KW - trust KW - dissemination KW - health communication KW - risk KW - communication KW - policy maker KW - transmission KW - health emergency KW - age KW - gender KW - survey N2 - Background: Clear, accurate, and transparent risk communication is critical to providing policy makers and the public with directions to effectively implement public health strategies during a health emergency. Objective: We aimed to explore the public?s preferred sources of obtaining COVID-19 information, perceptions on the prevalence and drivers of misinformation during the pandemic, and suggestions to optimize health communications during future public health emergencies. Methods: We administered a web-based survey that included Likert scale, multiple choice and open-ended response questions to residents of Ontario, Canada. We aimed to recruit a sample that reflected population diversity with respect to age and gender. Data were collected between June 10, 2020, and December 31, 2020, and were analyzed using descriptive statistics; open-ended data were analyzed using content analysis. Subgroup analyses to explore perceptions by age and gender were conducted using ordinal regression. Results: A total of 1823 individuals participated in the survey (n=990, 54% women; n=703, 39% men; n=982, 54% aged 18-40 years; n=518, 28% aged 41-60 years; and n=215, 12% aged ?61 years). Participants most commonly obtained COVID-19 information from local television news (n=1118, 61%) followed by social media (n=938, 51%), national or international television news (n=888, 49%), and friends and family (n=835, 46%). Approximately 55% (n=1010) of the participants believed they had encountered COVID-19?related misinformation; 70% (n=1284) of the participants reported high levels of trust in health authority websites and health care providers; 66% (n=1211) reported high levels of trust in health ministers or public health organizations. Sources perceived to be less trustworthy included friends and family, talk radio, social media, as well as blogs and opinion websites. Men were more likely to report encountering misinformation and to trust friends or family (odds ratio [OR] 1.49, 95% CI 1.24-1.79) and blogs or opinion websites (OR 1.24, 95% CI 1.03-1.50), compared to women. Compared to those aged 18-40 years, participants aged ?41years were more likely to trust all assessed information sources, with the exception of web-based media sources, and less likely to report encountering misinformation. Of those surveyed, 58% (n=1053) had challenges identifying or appraising COVID-19 information. Conclusions: Over half of our participants perceived that they had encountered COVID-19 misinformation, and 58% had challenges identifying or appraising COVID-19 information. Gender and age differences in perceptions of misinformation and trust in information sources were observed. Future research to confirm the validity of these perceptions and to explore information-seeking patterns by population subgroups may provide useful insights on how to optimize health communication during public health emergencies. UR - https://formative.jmir.org/2023/1/e38323 UR - http://dx.doi.org/10.2196/38323 UR - http://www.ncbi.nlm.nih.gov/pubmed/37159394 ID - info:doi/10.2196/38323 ER - TY - JOUR AU - Officer, N. Tara AU - Tait, Marika AU - McBride-Henry, Karen AU - Burnet, Laura AU - Werkmeister, J. Benjamin PY - 2023/5/26 TI - Mental Health Client Experiences of Telehealth in Aotearoa New Zealand During the COVID-19 Pandemic: Lessons and Implications JO - JMIR Form Res SP - e47008 VL - 7 KW - telehealth KW - mental health service delivery KW - COVID-19 KW - Aotearoa New Zealand KW - clients KW - patient-centered care KW - telemedicine KW - mental health KW - experience KW - satisfaction KW - perception KW - perspective KW - attitude N2 - Background: The COVID-19 pandemic and consequent lockdowns disrupted mental health service delivery worldwide, accelerating the adoption of telehealth services to provide care continuity. Telehealth-based research largely highlights the value of this service delivery method for a range of mental health conditions. However, only limited research exists exploring client perspectives of mental health services delivered via telehealth during the pandemic. Objective: This study aimed to increase understanding of the perspectives of mental health clients around services provided via telehealth over the 2020 COVID-19 lockdown in Aotearoa New Zealand. Methods: Interpretive description methodology underpinned this qualitative inquiry. Semistructured interviews were conducted with 21 individuals (15 clients and 7 support people; 1 person was both a client and support person) to explore their experiences of outpatient mental health care delivered via telehealth during the COVID-19 pandemic in Aotearoa New Zealand. A thematic analysis approach supported by field notes was used to analyze interview transcripts. Results: The findings reveal that mental health services delivered via telehealth differed from those provided in person and led some participants to feel they need to manage their own care more actively. Participants highlighted several factors affecting their telehealth journey. These included the importance of maintaining and building relationships with clinicians, the creation of safe spaces within client and clinician home environments, and clinician readiness in facilitating care for clients and their support people. Participants noted weaknesses in the ability of clients and clinicians to discern nonverbal cues during telehealth conversations. Participants also emphasized that telehealth was a viable option for service delivery but that the reason for telehealth consultations and the technicalities of service delivery needed to be addressed. Conclusions: Successful implementation requires ensuring solid relationship foundations between clients and clinicians. To safeguard minimum standards in delivering telehealth-based care, health professionals must ensure that the intent behind telehealth appointments is clearly articulated and documented for each person. In turn, health systems must ensure that health professionals have access to training and professional guidance to deliver effective telehealth consultations. Future research should aim to identify how therapeutic engagement with mental health services has changed, following a return to usual service delivery processes. UR - https://formative.jmir.org/2023/1/e47008 UR - http://dx.doi.org/10.2196/47008 UR - http://www.ncbi.nlm.nih.gov/pubmed/37234041 ID - info:doi/10.2196/47008 ER - TY - JOUR AU - Smail, J. Emily AU - Livingston, Torie AU - Wolach, Adam AU - Cenko, Erta AU - Kaufmann, N. Christopher AU - Manini, M. Todd PY - 2023/5/22 TI - Media Consumption and COVID-19?Related Precautionary Behaviors During the Early Pandemic: Survey Study of Older Adults JO - JMIR Form Res SP - e46230 VL - 7 KW - health communication KW - COVID-19 KW - older adult KW - precautionary behavior change KW - behavior change KW - behavior KW - precaution KW - awareness KW - behavior modification KW - media KW - news KW - association N2 - Background: During the COVID-19 pandemic, media sources dedicated significant time and resources to improve knowledge of COVID-19 precautionary behaviors (eg, wearing a mask). Many older adults report using the television, radio, print newspapers, or web-based sources to get information on political news, yet little is known about whether consuming news in the early phase of the pandemic led to behavior change, particularly in older adults. Objective: The goals of this study were to determine (1) whether dosage of news consumption on the COVID-19 pandemic was associated with COVID-19 precautionary behaviors; (2) whether being an ever-user of social media was associated with engagement in COVID-19 precautionary behaviors; and (3) among social media users, whether change in social media use during the early stages of the pandemic was associated with engagement in COVID-19 precautionary behaviors. Methods: Data were obtained from a University of Florida?administered study conducted in May and June of 2020. Linear regression models were used to assess the association between traditional news and social media use on COVID-19 precautionary behaviors (eg, mask wearing, hand washing, and social distancing behaviors). Analyses were adjusted for demographic characteristics, including age, sex, marital status, and education level. Results: In a sample of 1082 older adults (mean age 73, IQR 68-78 years; 615/1082, 56.8% female), reporting 0 and <1 hour per day of media consumption, relative to >3 hours per day, was associated with lower engagement in COVID-19 precautionary behaviors in models adjusted for demographic characteristics (?=?2.00; P<.001 and ?=?.41; P=.01, respectively). In addition, increasing social media use (relative to unchanged use) was associated with engagement in more COVID-19 precautionary behaviors (?=.70, P<.001). No associations were found between being an ever-user of social media and engaging in COVID-19 precautionary behaviors. Conclusions: The results demonstrated an association between higher media consumption and greater engagement in COVID-19 precautionary behaviors in older adults. These findings suggest that media can be effectively used as a public health tool for communication of prevention strategies and best practices during future health threats, even among populations who are historically less engaged in certain types of media. UR - https://formative.jmir.org/2023/1/e46230 UR - http://dx.doi.org/10.2196/46230 UR - http://www.ncbi.nlm.nih.gov/pubmed/37213166 ID - info:doi/10.2196/46230 ER - TY - JOUR AU - Chantziara, Sofia AU - Craddock, J. Ian AU - Mccallum, H. Claire AU - Brigden, C. Amberly L. PY - 2023/5/22 TI - Views and Needs of Students, Parents, and Teachers on Closed-Circuit Television, Proximity Trackers, and Access Cards to Facilitate COVID-19 Contact Tracing in Schools: Thematic Analysis of Focus Groups and Interviews JO - JMIR Form Res SP - e44592 VL - 7 KW - digital contact tracing KW - school KW - student KW - teacher KW - focus group KW - proximity tracking KW - Unified Theory of Technology and Acceptance KW - UTAUT KW - acceptance KW - adoption KW - CCTV KW - COVID-19 KW - contact tracing KW - public health intervention KW - digital health intervention KW - implementation KW - digital tool KW - technology acceptance KW - privacy KW - surveillance technology KW - surveillance N2 - Background: Contact tracing is considered a key measure in preventing the spread of infectious diseases. Governments around the world adopted contact tracing to limit the spread of COVID-19 in schools. Contact tracing tools utilizing digital technology (eg, GPS chips, Bluetooth radios) can increase efficiency compared to manual methods. However, these technologies can introduce certain privacy challenges in relation to retention, tracking, and the using and sharing of personal data, and little is known about their applicability in schools. Objective: This is the second of two studies exploring the potential of digital tools and systems to help schools deal with the practical challenges of preventing and coping with an outbreak of COVID-19. The aim was to explore the views, needs, and concerns among secondary school stakeholders (parents, teachers, pupils) regarding the implementation of three digital tools for contact tracing: access cards, proximity tracking, and closed-circuit television (CCTV). Methods: Focus groups and interviews were conducted with secondary school students, parents, and teachers. The topic guide was informed by the Unified Theory of Technology and Acceptance. Data-driven and theory-driven approaches were combined to identify themes and subthemes. Results: We recruited 22 participants. Findings showed that there is no single solution that is suitable for all schools, with each technology option having advantages and limitations. Existing school infrastructure (eg, CCTV and smart/access cards technology) and the geography of each school would determine which tools would be optimal for a particular school. Concerns regarding the cost of installing and maintaining equipment were prominent among all groups. Parents and teachers worried about how the application of these solutions will affect students? right to privacy. Parents also appeared not to have adequate knowledge of the surveillance technologies already available in schools (eg, CCTV). Students, who were mostly aware of the presence of surveillance technologies, were less concerned about any potential threats to their privacy, while they wanted reassurances that any solutions would be used for their intended purposes. Conclusions: Findings revealed that there is not one tool that would be suitable for every school and the context will determine which tool would be appropriate. This study highlights important ethical issues such as privacy concerns, balancing invasions of privacy against potential benefits, transparency of communication around surveillance technology and data use, and processes of consent. These issues need to be carefully considered when implementing contact tracing technologies in school settings. Communication, transparency, and consent within the school community could lead to acceptance and engagement with the new tools. UR - https://formative.jmir.org/2023/1/e44592 UR - http://dx.doi.org/10.2196/44592 UR - http://www.ncbi.nlm.nih.gov/pubmed/36939667 ID - info:doi/10.2196/44592 ER - TY - JOUR AU - Alaqra, Sarah Ala AU - Khumalo, C. Akhona PY - 2023/5/12 TI - Handling Public Well-being During the COVID-19 Crisis: Empirical Study With Representatives From Municipalities in Sweden JO - JMIR Form Res SP - e40669 VL - 7 KW - COVID-19 KW - Sweden KW - government KW - well-being KW - public health KW - information and communications technology KW - recreational activities N2 - Background: COVID-19 has had a significant impact on the public?s health and well-being due to infections and restrictions imposed during the crisis. Recreational activities are important for the public?s well-being; however, the public?s safety from the COVID-19 virus is the top priority. Sweden, a country with a decentralized public health and welfare system, relied on less stringent approaches for handling the crisis. The limited restrictions in Sweden allowed recreational activities to take place despite the pandemic, which could be attributed to considerations for the public?s well-being. Objective: The objective of this study was to investigate municipal approaches for handling and supporting recreational activities during the COVID-19 crisis. Methods: We conducted an empirical study (qualitative and quantitative), using an online survey for data collection, with 23 participants. They were representatives holding mostly managerial roles in 18 distinct municipalities (18 counties). A thematic analysis was conducted to analyze open-ended responses, and descriptive statistics were used to summarize the closed-ended responses. Results: In this study, we report on the status of municipalities during the COVID-19 pandemic. The highlighted results showed a significant impact on the municipalities as a result of COVID-19, where 78% (18/23) of participants stated significant changes due to the pandemic. Moreover, 91% (21/23) indicated efforts and approaches for supporting recreational activities during COVID-19. Following national guidelines for the public?s health and safety was indicated by 78% (18/23) of participants. Information and communications technology (ICT) was considered significant for dealing with COVID-19 according to 87% (20/23) of participants. Our qualitative results further showed details of the public?s health and safety considerations, the efforts to support recreational activities particularly for youth, and the role and requirements of ICT. Challenges relating to the usability of ICT were also highlighted. Conclusions: Despite the critique of Sweden?s lenient strategy for handling the COVID-19 crisis, our results showed significant considerations for the public?s safety and well-being by the municipalities (regional and local levels) in this study. The Swedish approach to handling the crisis involved trusting the public with safety guidelines in addition to efforts for the public?s safety, supporting the public?s well-being with approaches for maintaining recreational activities, and giving special care to the youth. Despite having technological solutions in place, challenges in using digital solutions and requirements for future development were noted. UR - https://formative.jmir.org/2023/1/e40669 UR - http://dx.doi.org/10.2196/40669 UR - http://www.ncbi.nlm.nih.gov/pubmed/37053098 ID - info:doi/10.2196/40669 ER - TY - JOUR AU - Tham, Cong Xiang AU - Whitton, Clare AU - Müller-Riemenschneider, Falk AU - Petrunoff, Alexander Nicholas PY - 2023/5/9 TI - Young Adults? Use of Mobile Food Delivery Apps and the Potential Impacts on Diet During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Form Res SP - e38959 VL - 7 KW - young adults KW - food delivery KW - mobile app KW - COVID-19 KW - diet KW - sugar-sweetened beverages KW - mixed methods KW - fruits KW - vegetables KW - physical activity KW - mobile phone N2 - Background: A poor diet contributes substantially to the development of noncommunicable diseases. In Singapore, it is recommended to consume at least 2 servings of fruits and vegetables daily to reduce the risk of developing noncommunicable diseases. However, the adherence rate among young adults is low. The COVID-19 pandemic has led to frequent users of mobile food delivery apps (MFDAs) adopting unhealthy eating habits, including high consumption of sugar-sweetened beverages, making it crucial to gain a deeper understanding of the underlying factors driving their use patterns. Objective: We aimed to examine the use patterns of MFDAs among young adults during the COVID-19 pandemic; investigate the association between MFDA use and sociodemographic factors, dietary factors, and BMI; identify the underlying reasons for the observed use patterns of MFDAs among users; and compare the influences of MFDA use between frequent and infrequent users. Methods: A sequential mixed methods design was used involving a web-based survey and in-depth interviews with a subset of respondents. Poisson regression and thematic analysis were used to analyze the quantitative and qualitative data, respectively. Results: The quantitative results revealed that 41.7% (150/360) of participants reported using MFDAs frequently, defined as at least once a week. Although not substantial, the study found that frequent users were less likely to consume 2 servings of vegetables per day and more likely to drink sugar-sweetened beverages. Nineteen individuals who had participated in the quantitative component were selected for and completed the interviews. Qualitative analysis identified 4 primary themes: deliberations about other sources of meals versus meals purchased via MFDAs, convenience is vital, preference for unhealthy meals ordered from MFDAs most of the time, and cost is king. Before making any purchase, MFDA users consider all these themes at the same time, with cost being the most important influential factor. A conceptual framework based on these themes was presented. Lack of culinary skills and COVID-19 restrictions were also found to influence frequent use. Conclusions: This study suggests that interventions should focus on promoting healthy dietary patterns in young adults who frequently use MFDAs. Teaching cooking skills, especially among young male individuals, and time management skills could be useful to reduce reliance on MFDAs. This study highlights the need for public health policies that make healthy food options more affordable and accessible. Given the unintended changes in behavior during the pandemic, such as reduced physical activity, sedentary behavior, and altered eating patterns, it is essential to consider behavior change in interventions aimed at promoting healthy lifestyles among young adults who frequently use MFDAs. Further research is needed to evaluate the effectiveness of interventions during COVID-19 restrictions and assess the impact of the post?COVID-19 new normal on dietary patterns and physical activity levels. UR - https://formative.jmir.org/2023/1/e38959 UR - http://dx.doi.org/10.2196/38959 UR - http://www.ncbi.nlm.nih.gov/pubmed/37018540 ID - info:doi/10.2196/38959 ER - TY - JOUR AU - Trzebi?ski, Wojciech AU - Claessens, Toni AU - Buhmann, Jeska AU - De Waele, Aurélie AU - Hendrickx, Greet AU - Van Damme, Pierre AU - Daelemans, Walter AU - Poels, Karolien PY - 2023/5/8 TI - The Effects of Expressing Empathy/Autonomy Support Using a COVID-19 Vaccination Chatbot: Experimental Study in a Sample of Belgian Adults JO - JMIR Form Res SP - e41148 VL - 7 KW - COVID-19 KW - vaccinations KW - chatbot KW - empathy KW - autonomy support KW - perceived user autonomy KW - chatbot patronage intention KW - vaccination intention KW - conversational agent KW - public health KW - digital health intervention KW - health promotion N2 - Background: Chatbots are increasingly used to support COVID-19 vaccination programs. Their persuasiveness may depend on the conversation-related context. Objective: This study aims to investigate the moderating role of the conversation quality and chatbot expertise cues in the effects of expressing empathy/autonomy support using COVID-19 vaccination chatbots. Methods: This experiment with 196 Dutch-speaking adults living in Belgium, who engaged in a conversation with a chatbot providing vaccination information, used a 2 (empathy/autonomy support expression: present vs absent) × 2 (chatbot expertise cues: expert endorser vs layperson endorser) between-subject design. Chatbot conversation quality was assessed through actual conversation logs. Perceived user autonomy (PUA), chatbot patronage intention (CPI), and vaccination intention shift (VIS) were measured after the conversation, coded from 1 to 5 (PUA, CPI) and from ?5 to 5 (VIS). Results: There was a negative interaction effect of chatbot empathy/autonomy support expression and conversation fallback (CF; the percentage of chatbot answers ?I do not understand? in a conversation) on PUA (PROCESS macro, model 1, B=?3.358, SE 1.235, t186=2.718, P=.007). Specifically, empathy/autonomy support expression had a more negative effect on PUA when the CF was higher (conditional effect of empathy/autonomy support expression at the CF level of +1SD: B=?.405, SE 0.158, t186=2.564, P=.011; conditional effects nonsignificant for the mean level: B=?0.103, SE 0.113, t186=0.914, P=.36; conditional effects nonsignificant for the ?1SD level: B=0.031, SE=0.123, t186=0.252, P=.80). Moreover, an indirect effect of empathy/autonomy support expression on CPI via PUA was more negative when CF was higher (PROCESS macro, model 7, 5000 bootstrap samples, moderated mediation index=?3.676, BootSE 1.614, 95% CI ?6.697 to ?0.102; conditional indirect effect at the CF level of +1SD: B=?0.443, BootSE 0.202, 95% CI ?0.809 to ?0.005; conditional indirect effects nonsignificant for the mean level: B=?0.113, BootSE 0.124, 95% CI ?0.346 to 0.137; conditional indirect effects nonsignificant for the ?1SD level: B=0.034, BootSE 0.132, 95% CI ?0.224 to 0.305). Indirect effects of empathy/autonomy support expression on VIS via PUA were marginally more negative when CF was higher. No effects of chatbot expertise cues were found. Conclusions: The findings suggest that expressing empathy/autonomy support using a chatbot may harm its evaluation and persuasiveness when the chatbot fails to answer its users? questions. The paper adds to the literature on vaccination chatbots by exploring the conditional effects of chatbot empathy/autonomy support expression. The results will guide policy makers and chatbot developers dealing with vaccination promotion in designing the way chatbots express their empathy and support for user autonomy. UR - https://formative.jmir.org/2023/1/e41148 UR - http://dx.doi.org/10.2196/41148 UR - http://www.ncbi.nlm.nih.gov/pubmed/37074978 ID - info:doi/10.2196/41148 ER - TY - JOUR AU - Curran, R. Vernon AU - Hollett, Ann AU - Peddle, Emily PY - 2023/5/1 TI - Patient Experiences With Virtual Care During the COVID-19 Pandemic: Phenomenological Focus Group Study JO - JMIR Form Res SP - e42966 VL - 7 KW - virtual care KW - focus group KW - patients KW - patient education KW - qualitative study KW - patient experience KW - health care system KW - digital literacy KW - rural community KW - technology adoption KW - COVID-19 N2 - Background: Virtual care has expanded during the COVID-19 pandemic and enabled greater access and continuity of care for many patients. From a patient-oriented research perspective, understanding the patient experience with virtual care appointments is an important first step in identifying ways to better support patient use and satisfaction. Objective: The purpose of this qualitative study was (1) to explore patients? experiences and perspectives with the adoption and use of virtual care during COVID-19 in Newfoundland and Labrador, Canada, and (2) identify the education and informational needs of patients to inform future strategies for supporting patient use of virtual care. Methods: Using a phenomenological approach, we conducted a focus group interview with a purposive sample of patient representatives representing a cross-section of the population of the province of Newfoundland and Labrador. Five patient representatives were recruited from the Newfoundland and Labrador Support Patient Advisory Council and participated in the focus group. The focus group was conducted in February 2022 via videoconferencing technology. Using thematic analysis, we identified several recurrent themes that described respondents? experiences with the use of virtual care during COVID-19, as well as their perceptions of education and informational needs to support more effective patient use of virtual care. Results: Respondents felt that virtual care is a beneficial addition to the health care system, enabling greater convenience and access to health care services. Key barriers and challenges in adopting and using virtual care appear to primarily arise from patients? lack of knowledge, understanding, and familiarity with respect to virtual care. Cost, technological access, connectivity, and low digital literacy were challenges for some patients, particularly in rural communities and among older patient population. Patient education and support were critical and needed to be inclusive, easy to understand, and include information regarding privacy, security, consent, and the technology itself. The types of patient education experiences regarded as most helpful included peer support and knowledge sharing among patients themselves. Conclusions: Beyond the COVID-19 pandemic, virtual care will have a continuing role in enhancing the continuity of care for patients through more convenient access. The education and informational needs of patients are important considerations in promoting the adoption and use of virtual care. Key education and informational needs and strategies were identified to enable and empower patients with the knowledge, digital literacy skills, and support to effectively use virtual care. UR - https://formative.jmir.org/2023/1/e42966 UR - http://dx.doi.org/10.2196/42966 UR - http://www.ncbi.nlm.nih.gov/pubmed/37036827 ID - info:doi/10.2196/42966 ER - TY - JOUR AU - Hickey, Grainne AU - Dunne, Claire AU - Maguire, Lauren AU - McCarthy, Niamh PY - 2023/4/28 TI - An Exploration of Practitioners? Experiences of Delivering Digital Social Care Interventions to Children and Families During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Form Res SP - e43498 VL - 7 KW - digital social care KW - social care practice KW - children and families KW - COVID-19 KW - mobile phone N2 - Background: Digital technology is an increasing feature of social care practice, and its use has accelerated greatly in response to the COVID-19 pandemic. Objective: This study aimed to assess social care practitioners? experiences of delivering digital interventions to vulnerable children and families during the pandemic. Methods: A mixed methods study combining survey and qualitative research was conducted. In total, 102 social care practitioners working in the Republic of Ireland who delivered a range of digital social care support took part in a web-based survey. This survey captured practitioners? engagement and experiences of delivering digital social care interventions to children and families as well as training and capacity building needs. Subsequently, 19 focus groups with 106 social care practitioners working with children and families were also conducted. These focus groups were directed by a topic guide and explored in more depth practitioners? perceptions of digital social care practice, the perceived impact of digital technology on their work with children and families, and the future application of digital social care interventions. Results: The survey findings revealed that 52.9% (54/102) and 45.1% (46/102) of practitioners, respectively, felt ?confident? and ?comfortable? engaging in digital service delivery. The vast majority of practitioners (93/102, 91.2%) identified maintaining connection during the pandemic as a benefit of digital social care practice; approximately three-quarters of practitioners (74/102, 72.5%) felt that digital social care practice offered service users ?increased access and flexibility?; however, a similar proportion of practitioners (70/102, 68.6%) identified inadequate home environments (eg, lack of privacy) during service provision as a barrier to digital social care practice. More than half of the practitioners (54/102, 52.9%) identified poor Wi-Fi or device access as a challenge to child and family engagement with digital social care. In total, 68.6% (70/102) of practitioners felt that they needed further training on the use of digital platforms for service delivery. Thematic analysis of qualitative (focus group) data revealed 3 overarching themes: perceived advantages and disadvantages for service users, practitioners? challenges in working with children and families through digital technologies, and practitioners? personal challenges and training needs. Conclusions: These findings shed light on practitioners? experiences of delivering digital child and family social care services during the COVID-19 pandemic. Both benefits and challenges within the delivery of digital social care support as well as conflicting findings across the experiences of practitioners were identified. The implications of these findings for the development of therapeutic practitioner?service user relationships through digital practice as well as confidentiality and safeguarding are discussed. Training and support needs for the future implementation of digital social care interventions are also outlined. UR - https://formative.jmir.org/2023/1/e43498 UR - http://dx.doi.org/10.2196/43498 UR - http://www.ncbi.nlm.nih.gov/pubmed/36888555 ID - info:doi/10.2196/43498 ER - TY - JOUR AU - Niculaescu, Corina-Elena AU - Sassoon, Karen Isabel AU - Landa-Avila, Cecilia Irma AU - Colak, Ozlem AU - Jun, Thomas Gyuchan AU - Balatsoukas, Panagiotis PY - 2023/4/27 TI - Individual Factors Influencing the Public?s Perceptions About the Importance of COVID-19 Immunity Certificates in the United Kingdom: Cross-sectional Web-based Questionnaire Survey JO - JMIR Form Res SP - e37139 VL - 7 KW - immunity passports KW - immunity certificates KW - vaccine passports KW - COVID-19 KW - health belief model KW - vaccination KW - pandemic KW - cross-sectional survey KW - low income KW - vulnerable population KW - socioeconomic KW - public perception KW - public policy N2 - Background: Understanding how perceptions around immunity certificates are influenced by individual characteristics is important to inform evidence-based policy making and implementation strategies for services around immunity and vaccine certification. Objective: This study aimed to assess what were the main individual factors influencing people?s perception of the importance of using COVID-19 immunity certificates, including health beliefs about COVID-19, vaccination views, sociodemographics, and lifestyle factors. Methods: A cross-sectional web-based survey with a nationally representative sample in the United Kingdom was conducted on August 3, 2021. Responses were collected and analyzed from 534 participants, aged 18 years and older, who were residents of the United Kingdom. The primary outcome measure (dependent variable) was the participants? perceived importance of using immunity certificates, computed as an index of 6 items. The following individual drivers were used as the independent variables: (1) personal beliefs about COVID-19 (using constructs adapted from the Health Belief Model), (2) personal views on vaccination, (3) willingness to share immunity status with service providers, and (4) variables related to respondents? lifestyle and sociodemographic characteristics. Results: The perceived importance of immunity certificates was higher among respondents who felt that contracting COVID-19 would have a severe negative impact on their health (?=0.2564; P<.001) and felt safer if vaccinated (?=0.1552; P<.001). The prospect of future economic recovery positively influenced the perceived importance of immunity certificates. Respondents who were employed or self-employed (?=?0.2412; P=.001) or experienced an increase in income after the COVID-19 pandemic (?=?0.1287; P=.002) perceived the use of immunity certificates as less important compared to those who were unemployed or had retired or those who had experienced a reduction in their income during the pandemic. Conclusions: The findings of our survey suggest that more vulnerable members in our society (those unemployed or retired and those who believe that COVID-19 would have a severe impact on their health) and people who experienced a reduction in income during the pandemic perceived the severity of not using immunity certificates in their daily life as higher. UR - https://formative.jmir.org/2023/1/e37139 UR - http://dx.doi.org/10.2196/37139 UR - http://www.ncbi.nlm.nih.gov/pubmed/36920837 ID - info:doi/10.2196/37139 ER - TY - JOUR AU - Nuss, Kayla AU - Sui, Wuyou AU - Rhodes, Ryan AU - Liu, Sam PY - 2023/4/24 TI - Motivational Profiles and Associations With Physical Activity Before, During, and After the COVID-19 Pandemic: Retrospective Study JO - JMIR Form Res SP - e43411 VL - 7 KW - motivational profile KW - self-determination theory KW - physical activity KW - COVID-19 KW - health lifestyle KW - latent profile analysis KW - mental well-being KW - health intervention N2 - Background: In March 2020, the World Health Organization declared the worldwide COVID-19 outbreak a pandemic, triggering many countries, including Canada, to issue stay-at-home orders to their citizens. Research indicates that these stay-at-home orders are associated with a decline in physical activity (PA), a behavior that can reduce disease risk and improve the quality of life. Many behavioral change theories, such as the self-determination theory (SDT) of motivation, state that PA engagement is mediated by psychological constructs, such as motivation. According to the SDT, motivation exists on a continuum from more controlled (external or coerced) to more autonomous (volitional) regulatory forms. Individuals move along the continuum from more controlled to more autonomous forms through the fulfillment of 3 psychological needs: autonomy, competence, and relatedness. Research indicates that moderate-to-vigorous physical activity (MVPA) is positively associated with the autonomous regulatory form of motivation. Recently, researchers have speculated that a better method to describe motivation than movement along the continuum is to generate motivational profiles, which represent combinations of differing levels of controlled and autonomous regulation existing simultaneously. Objective: We aimed to identify distinct motivational profiles and determine their association with MVPA before, during, and after the COVID-19 pandemic. Methods: Using a cross-sectional, retrospective design, we surveyed 977 Canadian adults. We assessed motivation for PA using the Behavioral Regulations in Exercise Questionnaire-3 (BREQ-3). We assessed PA pre?, during, and post?COVID-19 stay-at-home orders in Canada using the International Physical Activity Questionnaire (IPAQ). We derived motivational profiles using latent profile analysis (LPA). Using motivational profiles as an independent variable, we assessed their effect on PA at all 3 time points with multilevel models that included the participant ID as a random variable. Results: We identified 4 profiles: high controlled and high autonomous (HCHA), low overall motivation (LOM), high autonomous and introjected (HAI), and high amotivation and external (HAE). The HCHA profile had the highest levels of weekly MVPA minutes at all 3 time points, followed by the HAI profile. Conclusions: Our results suggest that a combination of both autonomous and controlled regulatory forms may be more effective in influencing MVPA than the controlled or autonomous forms alone, particularly during times of high stress, such as a worldwide pandemic. Although the odds of another global pandemic are low, these results may also be applied to other times of stress, such as job transitions, relationship changes (eg, change in marital status), or the death of a loved one. We suggest that clinicians and practitioners consider developing PA interventions that seek to increase both controlled and autonomous regulatory forms instead of aiming to reduce controlled forms. UR - https://formative.jmir.org/2023/1/e43411 UR - http://dx.doi.org/10.2196/43411 UR - http://www.ncbi.nlm.nih.gov/pubmed/36927666 ID - info:doi/10.2196/43411 ER - TY - JOUR AU - Gonzales, Aldren AU - Custodio, Razel AU - Lapitan, Carmela Marie AU - Ladia, Ann Mary PY - 2023/4/20 TI - End Users' Perspectives on the Quality and Design of mHealth Technologies During the COVID-19 Pandemic in the Philippines: Qualitative Study JO - JMIR Form Res SP - e41838 VL - 7 KW - mHealth KW - COVID-19 KW - pandemic KW - digital health KW - mobile health KW - end-user engagement KW - focus group KW - technology implementation KW - Philippines KW - technology use KW - privacy KW - user engagement N2 - Background: The COVID-19 pandemic has expanded the use of mobile health (mHealth) technologies in contact tracing, communicating COVID-19?related information, and monitoring the health conditions of the general population in the Philippines. However, the limited end-user engagement in the features and feedback along the development cycle of mHealth technologies results in risks in adoption. The World Health Organization (WHO) recommends user-centric design and development of mHealth technologies to ensure responsiveness to the needs of the end users. Objective: The goal of the study is to understand, using end users? perspectives, the design and quality of mHealth technology implementations in the Philippines during the COVID-19 pandemic, with a focus on the areas identified by stakeholders: (1) utility, (2) technology readiness level, (3) design, (4) information, (5) usability, (6) features, and (7) security and privacy. Methods: Using a descriptive qualitative design, we conducted 5 interviews and 3 focus group discussions (FGDs) with a total of 16 participants (6, 37.5%, males and 10, 62.5%, females). Questions were based on the Mobile App Rating Scale (MARS). Using the cyclical coding approach, transcripts were analyzed with NVivo 12. Themes were identified. Results: The qualitative analysis identified 18 themes that were organized under the 7 focus areas: (1) utility: use of mHealth technologies and motivations in using mHealth; (2) technology readiness: mobile technology literacy and user segmentation; (3) design: user interface design, language and content accessibility, and technology design; (4) information: accuracy of information and use of information; (5) usability: design factors, dependency on human processes, and technical issues; (6) features: interoperability and data integration, other feature and design recommendations, and technology features and upgrades; and (7) privacy and security: trust that mHealth can secure data, lack of information, and policies. To highlight, accessibility, privacy and security, a simple interface, and integration are some of the design and quality areas that end users find important and consider in using mHealth tools. Conclusions: Engaging end users in the development and design of mHealth technologies ensures adoption and accessibility, making it a valuable tool in curbing the pandemic. The 6 principles for developers, researchers, and implementers to consider when scaling up or developing a new mHealth solution in a low-resource setting are that it should (1) be driven by value in its implementation, (2) be inclusive, (3) address users? physical and cognitive restrictions, (4) ensure privacy and security, (5) be designed in accordance with digital health systems? standards, and (6) be trusted by end users. UR - https://formative.jmir.org/2023/1/e41838 UR - http://dx.doi.org/10.2196/41838 UR - http://www.ncbi.nlm.nih.gov/pubmed/36943932 ID - info:doi/10.2196/41838 ER - TY - JOUR AU - Nair, V. Chithira AU - Moni, Merlin AU - Edathadathil, Fabia AU - A, Appukuttan AU - Prasanna, Preetha AU - Pushpa Raghavan, Roshni AU - Sathyapalan, T. Dipu AU - Jayant, Aveek PY - 2023/4/18 TI - Incidence and Characterization of Post-COVID-19 Symptoms in Hospitalized COVID-19 Survivors to Recognize Syndemic Connotations in India: Single-Center Prospective Observational Cohort Study JO - JMIR Form Res SP - e40028 VL - 7 KW - COVID-19 KW - follow-up KW - incidence KW - fatigue KW - long COVID KW - post-COVID KW - post-COVID-19 symptoms KW - questionnaire KW - tertiary-care center KW - intensive care KW - symptom monitoring KW - prospective observational study KW - treatment KW - steroid KW - viral therapy KW - postdischarge N2 - Background: Long COVID, or post-COVID-19 syndrome, is the persistence of signs and symptoms that develop during or after COVID-19 infection for more than 12 weeks and are not explained by an alternative diagnosis. In spite of health care recouping to prepandemic states, the post-COVID-19 state tends to be less recognized from low- and middle-income country settings and holistic therapeutic protocols do not exist. Owing to the syndemic nature of COVID-19, it is important to characterize post-COVID-19 syndrome. Objective: We aimed to determine the incidence of post-COVID-19 symptoms in a cohort of inpatients who recovered from COVID-19 from February to July 2021 at a tertiary-care center in South India. In addition, we aimed at comparing the prevalence of post-COVID-19 manifestations in intensive care unit (ICU) and non-ICU patients, assessing the persistence, severity, and characteristics of post-COVID-19 manifestations, and elucidating the risk factors associated with the presence of post-COVID-19 manifestations. Methods: A total of 120 adult patients admitted with COVID-19 in the specified time frame were recruited into the study after providing informed written consent. The cohort included 50 patients requiring intensive care and 70 patients without intensive care. The follow-up was conducted on the second and sixth weeks after discharge with a structured questionnaire. The questionnaire was filled in by the patient/family member of the patient during their visit to the hospital for follow-up at 2 weeks and through telephone follow-up at 6 weeks. Results: The mean age of the cohort was 55 years and 55% were men. Only 5% of the cohort had taken the first dose of COVID-19 vaccination. Among the 120 patients, 58.3% had mild COVID-19 and 41.7% had moderate to severe COVID-19 infection. In addition, 60.8% (n=73) of patients had at least one persistent symptom at the sixth week of discharge and 50 (41.7%) patients required intensive care during their inpatient stay. The presence of persistent symptoms at 6 weeks was not associated with severity of illness, age, or requirement for intensive care. Fatigue was the most common reported persistent symptom with a prevalence of 55.8%, followed by dyspnea (20%) and weight loss (16.7%). Female sex (odds ratio [OR] 2.4, 95% CI 1.03-5.58; P=.04) and steroid administration during hospital stay (OR 4.43, 95% CI 1.9-10.28; P=.001) were found to be significant risk factors for the presence of post-COVID-19 symptoms at 6 weeks as revealed by logistic regression analysis. Conclusions: Overall, 60.8% of inpatients treated for COVID-19 had post-COVID-19 symptoms at 6 weeks postdischarge from the hospital. The incidence of post-COVID-19 syndrome in the cohort did not significantly differ across the mild, moderate, and severe COVID-19 severity categories. Female sex and steroid administration during the hospital stay were identified as predictors of the persistence of post-COVID-19 symptoms at 6 weeks. UR - https://formative.jmir.org/2023/1/e40028 UR - http://dx.doi.org/10.2196/40028 UR - http://www.ncbi.nlm.nih.gov/pubmed/36920842 ID - info:doi/10.2196/40028 ER - TY - JOUR AU - Ishizuka-Inoue, Mami AU - Shimoura, Kanako AU - Nagai-Tanima, Momoko AU - Aoyama, Tomoki PY - 2023/4/17 TI - The Relationship Between Health Literacy, Knowledge, Fear, and COVID-19 Prevention Behavior in Different Age Groups: Cross-sectional Web-Based Study JO - JMIR Form Res SP - e41394 VL - 7 KW - infodemic KW - COVID-19 KW - health literacy KW - fear of COVID-19 KW - cross-sectional study KW - behavior KW - age group KW - misinformation KW - influence KW - prevention KW - disease N2 - Background: COVID-19 prevention behaviors have become part of our lives, and they have been reported to be associated with health literacy, knowledge, and fear. However, the COVID-19 pandemic may be characterized by different situations in each age group. Since the severity of the infection and the means of accessing information differ by age group, the relationship between health literacy, knowledge, and fear may differ. Thus, factors that promote preventive behavior may differ by age group. Clarifying the factors related to prevention behaviors by age may help us consider age-appropriate promotion. Objective: This study aims to examine the association between COVID-19 prevention behaviors and health literacy, COVID-19 knowledge, and fear of COVID-19 by age group. Methods: A cross-sectional study was conducted among 512 participants aged 20-69 years, recruited from a web-based sample from November 1 to November 5, 2021. A web-based self-administered questionnaire was used to obtain the participants? characteristics, COVID-19 prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19. The Kruskal-Wallis rank sum test was used to compare the scores of each item for each age group. The relationships among COVID-19 prevention behaviors, health literacy, COVID-19 knowledge, and fear of COVID-19 were analyzed using the Spearman rank correlation analysis. Additionally, multiple regression analysis was conducted with COVID-19 prevention behaviors as dependent variables; health literacy, COVID-19 knowledge, and fear of COVID-19 as independent variables; and sex and age as adjustment variables. Results: For all participants, correlation and multiple regression analyses revealed that prevention behaviors were significantly related to health literacy, COVID-19 knowledge, and fear of COVID-19 (P<.001). Additionally, correlation analysis revealed that fear of COVID-19 was significantly negatively correlated with COVID-19 knowledge (P<.001). There was also a significant positive correlation between health literacy and COVID-19 knowledge (P<.001). Furthermore, analysis by age revealed that the factors associated with prevention behaviors differed by age group. In the age groups 20-29, 30-39, and 40-49 years, multiple factors, including health literacy, influenced COVID-19 prevention behaviors, whereas in the age groups 50-59 and 60-69 years, only fear of COVID-19 had an impact. Conclusions: The results of this study revealed that the factors associated with prevention behaviors differ by age. Age-specific approaches should be considered to prevent infection. UR - https://formative.jmir.org/2023/1/e41394 UR - http://dx.doi.org/10.2196/41394 UR - http://www.ncbi.nlm.nih.gov/pubmed/37011226 ID - info:doi/10.2196/41394 ER - TY - JOUR AU - Vike, L. Nicole AU - Bari, Sumra AU - Stetsiv, Khrystyna AU - Woodward, Sean AU - Lalvani, Shamal AU - Stefanopoulos, Leandros AU - Kim, Woo Byoung AU - Maglaveras, Nicos AU - Katsaggelos, K. Aggelos AU - Breiter, C. Hans PY - 2023/4/14 TI - The Relationship Between a History of High-risk and Destructive Behaviors and COVID-19 Infection: Preliminary Study JO - JMIR Form Res SP - e40821 VL - 7 KW - substance use KW - gambling KW - violent behaviors KW - COVID-19 KW - destructive behaviors KW - mental health N2 - Background: The COVID-19 pandemic has heightened mental health concerns, but the temporal relationship between mental health conditions and SARS-CoV-2 infection has not yet been investigated. Specifically, psychological issues, violent behaviors, and substance use were reported more during the COVID-19 pandemic than before the pandemic. However, it is unknown whether a prepandemic history of these conditions increases an individual?s susceptibility to SARS-CoV-2. Objective: This study aimed to better understand the psychological risks underlying COVID-19, as it is important to investigate how destructive and risky behaviors may increase a person?s susceptibility to COVID-19. Methods: In this study, we analyzed data from a survey of 366 adults across the United States (aged 18 to 70 years); this survey was administered between February and March of 2021. The participants were asked to complete the Global Appraisal of Individual Needs?Short Screener (GAIN-SS) questionnaire, which indicates an individual?s history of high-risk and destructive behaviors and likelihood of meeting diagnostic criteria. The GAIN-SS includes 7 questions related to externalizing behaviors, 8 related to substance use, and 5 related to crime and violence; responses were given on a temporal scale. The participants were also asked whether they ever tested positive for COVID-19 and whether they ever received a clinical diagnosis of COVID-19. GAIN-SS responses were compared between those who reported and those who did not report COVID-19 to determine if those who reported COVID-19 also reported GAIN-SS behaviors (Wilcoxon rank sum test, ?=.05). In total, 3 hypotheses surrounding the temporal relationships between the recency of GAIN-SS behaviors and COVID-19 infection were tested using proportion tests (?=.05). GAIN-SS behaviors that significantly differed (proportion tests, ?=.05) between COVID-19 responses were included as independent variables in multivariable logistic regression models with iterative downsampling. This was performed to assess how well a history of GAIN-SS behaviors statistically discriminated between those who reported and those who did not report COVID-19. Results: Those who reported COVID-19 more frequently indicated past GAIN-SS behaviors (Q<0.05). Furthermore, the proportion of those who reported COVID-19 was higher (Q<0.05) among those who reported a history of GAIN-SS behaviors; specifically, gambling and selling drugs were common across the 3 proportion tests. Multivariable logistic regression revealed that GAIN-SS behaviors, particularly gambling, selling drugs, and attention problems, accurately modeled self-reported COVID-19, with model accuracies ranging from 77.42% to 99.55%. That is, those who exhibited destructive and high-risk behaviors before and during the pandemic could be discriminated from those who did not exhibit these behaviors when modeling self-reported COVID-19. Conclusions: This preliminary study provides insights into how a history of destructive and risky behaviors influences infection susceptibility, offering possible explanations for why some persons may be more susceptible to COVID-19, potentially in relation to reduced adherence to prevention guidelines or not seeking vaccination. UR - https://formative.jmir.org/2023/1/e40821 UR - http://dx.doi.org/10.2196/40821 UR - http://www.ncbi.nlm.nih.gov/pubmed/36888554 ID - info:doi/10.2196/40821 ER - TY - JOUR AU - Handayani, Wuri Putu AU - Zagatti, Augusto Guilherme AU - Kefi, Hajer AU - Bressan, Stéphane PY - 2023/4/13 TI - Impact of Social Media Usage on Users? COVID-19 Protective Behavior: Survey Study in Indonesia JO - JMIR Form Res SP - e46661 VL - 7 KW - COVID-19 KW - pandemic KW - infectious diseases KW - social media KW - trust KW - behavior KW - Indonesia N2 - Background: Social media have become the source of choice for many users to search for health information on COVID-19 despite possible detrimental consequences. Several studies have analyzed the association between health information?searching behavior and mental health. Some of these studies examined users? intentions in searching health information on social media and the impact of social media use on mental health in Indonesia. Objective: This study investigates both active and passive participation in social media, shedding light on cofounding effects from these different forms of engagement. In addition, this study analyses the role of trust in social media platforms and its effect on public health outcomes. Thus, the purpose of this study is to analyze the impact of social media usage on COVID-19 protective behavior in Indonesia. The most commonly used social media platforms are Instagram, Facebook, YouTube, TikTok, and Twitter. Methods: We used primary data from an online survey. We processed 414 answers to a structured questionnaire to evaluate the relationship between these users? active and passive participation in social media, trust in social media, anxiety, self-efficacy, and protective behavior to COVID-19. We modeled the data using partial least square structural equation modeling. Results: This study reveals that social media trust is a crucial antecedent, where trust in social media is positively associated with active contribution and passive consumption of COVID-19 content in social media, users? anxiety, self-efficacy, and protective behavior. This study found that active contribution of content related to COVID-19 on social media is positively correlated with anxiety, while passive participation increases self-efficacy and, in turn, protective behavior. This study also found that active participation is associated with negative health outcomes, while passive participation has the opposite effects. The results of this study can potentially be used for other infectious diseases, for example, dengue fever and diseases that can be transmitted through the air and have handling protocols similar to that of COVID-19. Conclusions: Public health campaigns can use social media for health promotion. Public health campaigns should post positive messages and distil the received information parsimoniously to avoid unnecessary and possibly counterproductive increased anxiety of the users. UR - https://formative.jmir.org/2023/1/e46661 UR - http://dx.doi.org/10.2196/46661 UR - http://www.ncbi.nlm.nih.gov/pubmed/37052987 ID - info:doi/10.2196/46661 ER - TY - JOUR AU - Li, Dan AU - Shelby, Tyler AU - Brault, Marie AU - Manohar, Rajit AU - Vermund, Sten AU - Hagaman, Ashley AU - Forastiere, Laura AU - Caruthers, Tyler AU - Egger, Emilie AU - Wang, Yizhou AU - Manohar, Nathan AU - Manohar, Peter AU - Davis, Lucian J. AU - Zhou, Xin PY - 2023/4/7 TI - Implementation of a Hardware-Assisted Bluetooth-Based COVID-19 Tracking Device in a High School: Mixed Methods Study JO - JMIR Form Res SP - e39765 VL - 7 KW - contact tracing KW - COVID-19 KW - digital contact tracing KW - Bluetooth device KW - school health KW - secondary school KW - implementation science KW - mixed methods N2 - Background: Contact tracing is a vital public health tool used to prevent the spread of infectious diseases. However, traditional interview-format contact tracing (TCT) is labor-intensive and time-consuming and may be unsustainable for large-scale pandemics such as COVID-19. Objective: In this study, we aimed to address the limitations of TCT. The Yale School of Engineering developed a Hardware-Assisted Bluetooth-based Infection Tracking (HABIT) device. Following the successful implementation of HABIT in a university setting, this study sought to evaluate the performance and implementation of HABIT in a high school setting using an embedded mixed methods design. Methods: In this pilot implementation study, we first assessed the performance of HABIT using mock case simulations in which we compared contact tracing data collected from mock case interviews (TCT) versus Bluetooth devices (HABIT). For each method, we compared the number of close contacts identified and identification of unique contacts. We then conducted an embedded mixed methods evaluation of the implementation outcomes of HABIT devices using pre- and postimplementation quantitative surveys and qualitative focus group discussions with users and implementers according to the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. Results: In total, 17 students and staff completed mock case simulations in which 161 close contact interactions were detected by interview or Bluetooth devices. We detected significant differences in the number of close contacts detected by interview versus Bluetooth devices (P<.001), with most (127/161, 78.9%) contacts being reported by interview only. However, a significant number (26/161, 16.1%; P<.001) of contacts were uniquely identified by Bluetooth devices. The interface, ease of use, coherence, and appropriateness were highly rated by both faculty and students. HABIT provided emotional security to users. However, the prototype design and technical difficulties presented barriers to the uptake and sustained use of HABIT. Conclusions: Implementation of HABIT in a high school was impeded by technical difficulties leading to decreased engagement and adherence. Nonetheless, HABIT identified a significant number of unique contacts not reported by interview, indicating that electronic technologies may augment traditional contact tracing once user preferences are accommodated and technical glitches are overcome. Participants indicated a high degree of acceptance, citing emotional reassurance and a sense of security with the device. UR - https://formative.jmir.org/2023/1/e39765 UR - http://dx.doi.org/10.2196/39765 UR - http://www.ncbi.nlm.nih.gov/pubmed/36525333 ID - info:doi/10.2196/39765 ER - TY - JOUR AU - Monteiro, Goldnadel Maristela AU - Pantani, Daniela AU - Pinsky, Ilana AU - Hernandes Rocha, Augusto Thiago PY - 2023/4/6 TI - Using the Pan American Health Organization Digital Conversational Agent to Educate the Public on Alcohol Use and Health: Preliminary Analysis JO - JMIR Form Res SP - e43165 VL - 7 KW - alcohol use KW - alcohol risk assessment KW - digital health worker KW - artificial intelligence KW - health literacy KW - digital health KW - chatbot KW - misinformation KW - online health information KW - digital health education KW - health risk KW - COVID-19 N2 - Background: There is widespread misinformation about the effects of alcohol consumption on health, which was amplified during the COVID-19 pandemic through social media and internet channels. Chatbots and conversational agents became an important piece of the World Health Organization (WHO) response during the COVID-19 pandemic to quickly disseminate evidence-based information related to COVID-19 and tobacco to the public. The Pan American Health Organization (PAHO) seized the opportunity to develop a conversational agent to talk about alcohol-related topics and therefore complement traditional forms of health education that have been promoted in the past. Objective: This study aimed to develop and deploy a digital conversational agent to interact with an unlimited number of users anonymously, 24 hours a day, about alcohol topics, including ways to reduce risks from drinking, that is accessible in several languages, at no cost, and through various devices. Methods: The content development was based on the latest scientific evidence on the impacts of alcohol on health, social norms about drinking, and data from the WHO and PAHO. The agent itself was developed through a nonexclusive license agreement with a private company (Soul Machines) and included Google Digital Flow ES as the natural language processing software and Amazon Web Services for cloud services. Another company was contracted to program all the conversations, following the technical advice of PAHO staff. Results: The conversational agent was named Pahola, and it was deployed on November 19, 2021, through the PAHO website after a launch event with high publicity. No identifiable data were used and all interactions were anonymous, and therefore, this was not considered research with human subjects. Pahola speaks in English, Spanish, and Portuguese and interacts anonymously with a potentially infinite number of users through various digital devices. Users were required to accept the terms and conditions to enable access to their camera and microphone to interact with Pahola. Pahola attracted good attention from the media and reached 1.6 million people, leading to 236,000 clicks on its landing page, mostly through mobile devices. Only 1532 users had a conversation after clicking to talk to Pahola. The average time users spent talking to Pahola was 5 minutes. Major dropouts were observed in different steps of the conversation flow. Some questions asked by users were not anticipated during programming and could not be answered. Conclusions: Our findings showed several limitations to using a conversational agent for alcohol education to the general public. Improvements are needed to expand the content to make it more meaningful and engaging to the public. The potential of chatbots to educate the public on alcohol-related topics seems enormous but requires a long-term investment of resources and research to be useful and reach many more people. UR - https://formative.jmir.org/2023/1/e43165 UR - http://dx.doi.org/10.2196/43165 UR - http://www.ncbi.nlm.nih.gov/pubmed/36961920 ID - info:doi/10.2196/43165 ER - TY - JOUR AU - Chen, Emily AU - Hollowell, Adam AU - Truong, Tracy AU - Bentley-Edwards, Keisha AU - Myers, Evan AU - Erkanli, Alaattin AU - Holt, Lauren AU - Swartz, J. Jonas PY - 2023/3/14 TI - Contraceptive Access and Use Among Undergraduate and Graduate Students During COVID-19: Online Survey Study JO - JMIR Form Res SP - e38491 VL - 7 KW - COVID-19 KW - contraception KW - college KW - disparities KW - LARC KW - sexual health KW - social media KW - health promotion KW - telehealth KW - health messaging KW - health resource KW - health disparity KW - risk factor KW - healthcare access N2 - Background: The COVID-19 pandemic led to widespread college campus closures in the months of March to June 2020, endangering students? access to on-campus health resources, including reproductive health services. Objective: To assess contraceptive access and use among undergraduate and graduate students in North Carolina during the COVID-19 pandemic. Methods: We conducted a cross-sectional web-based survey of undergraduate and graduate students enrolled at degree-granting institutions in North Carolina. Participants were recruited using targeted Instagram advertisements. The survey queried several aspects of participants? sexual behavior, including sex drive, level of sexual experience, number of sexual partners, digital sexual experience, dating patterns, and types of contraception used. Participants were asked to compare many of these behaviors before and after the pandemic. The survey also assessed several sociodemographic factors that we hypothesized would be associated with contraceptive use based on prior data, including educational background, sexual orientation and gender minority status (ie, lesbian, gay, bisexual, transgender, queer), health insurance status, race, ethnicity, degree of sensation seeking, religiosity, and desire to become pregnant. Results: Over 10 days, 2035 Instagram users began our survey, of whom 1002 met eligibility criteria. Of these 1002 eligible participants, 934 completed the survey, for a 93% completion rate. Our respondents were mostly female (665/934, 71%), cisgender (877/934, 94%), heterosexual (592/934, 64%), white (695/934 75%), not Hispanic (835/934, 89%), and enrolled at a 4-year college (618/934, 66%). Over 95% (895/934) of respondents reported that they maintained access to their preferred contraception during the COVID-19 pandemic. In a multivariable analysis, participants who were enrolled in a 4-year college or graduate program were less likely to lose contraceptive access when compared to participants enrolled in a 2-year college (risk ratio [RR] 0.34, 95% CI 0.16-0.71); in addition, when compared to cisgender participants, nonbinary and transgender participants were more likely to lose contraceptive access (RR 2.43, 95% CI 1.01-5.87). Respondents reported that they were more interested in using telehealth to access contraception during the pandemic. The contraceptive methods most commonly used by our participants were, in order, condoms (331/934, 35.4%), oral contraception (303/934, 32.4%), and long-acting reversible contraception (LARC; 221/934, 23.7%). The rate of LARC use among our participants was higher than the national average for this age group (14%). Emergency contraception was uncommonly used (25/934, 2.7%). Conclusions: Undergraduate and graduate students in North Carolina overwhelmingly reported that they maintained access to their preferred contraceptive methods during the COVID-19 pandemic and through changing patterns of health care access, including telehealth. Gender nonbinary and transgender students and 2-year college students may have been at greater risk of losing access to contraception during the first year of the COVID-19 pandemic. UR - https://formative.jmir.org/2023/1/e38491 UR - http://dx.doi.org/10.2196/38491 UR - http://www.ncbi.nlm.nih.gov/pubmed/36827491 ID - info:doi/10.2196/38491 ER - TY - JOUR AU - Quinn, Emma AU - Hsiao, Hsun Kai AU - Johnstone, Travers AU - Gomez, Maria AU - Parasuraman, Arun AU - Ingleton, Andrew AU - Hirst, Nicholas AU - Najjar, Zeina AU - Gupta, Leena PY - 2023/3/13 TI - Protecting Older Adult Residents in Care Facilities Against Influenza and COVID-19 Using the Influenza Communication, Advice and Reporting (FluCARE) App: Prospective Cohort Mixed Methods Study JO - JMIR Form Res SP - e38080 VL - 7 KW - web app KW - digital health KW - influenza KW - COVID-19 KW - outbreak KW - monitoring KW - disease control KW - infection spread KW - infection control KW - detect KW - aged care KW - elderly KW - elderly population KW - older adult KW - long term care KW - care home KW - AFC KW - LTC KW - nursing home KW - retirement home KW - mobile application KW - health application KW - mHealth KW - care facility KW - online training KW - health impact KW - feasibility KW - efficacy KW - satisfaction KW - prevention KW - disease spread KW - notification N2 - Background: Early detection and response to influenza and COVID-19 outbreaks in aged care facilities (ACFs) are critical to minimizing health impacts. The Sydney Local Health District (SLHD) Public Health Unit (PHU) has developed and implemented a novel web-based app with integrated functions for online line listings, detection algorithms, and automatic notifications to responders, to assist ACFs in outbreak response. The goal of the Influenza Outbreak Communication, Advice and Reporting (FluCARE) app is to reduce time delays to notifications, which we hope will reduce the spread, duration, and health impacts of an influenza or COVID-19 outbreak, as well as ease workload burdens on ACF staff. Objective: The specific aims of the study were to (1) evaluate the acceptability and user satisfaction of the implementation and use of FluCARE in helping ACFs recognize, notify, and manage influenza and COVID-19 outbreaks in their facility; (2) identify the safety of FluCARE and any potential adverse outcomes of using the app; and (3) identify any perceived barriers or facilitators to the implementation and use of FluCARE from the ACF user perspective. Methods: The FluCARE app was piloted from September 2019 to December 2020 in the SLHD. Associated implementation included promotion and engagement, user training, and operational policies. Participating ACF staff were invited to complete a posttraining survey. Staff were also invited to complete a postpilot evaluation survey that included the user Mobile Application Rating Scale (uMARS) measuring app acceptance, utility, and barriers and facilitators to use. An issues log was also prospectively maintained to assess safety. Survey data were analyzed descriptively or via content analysis where appropriate. Results: Surveys were completed by 31 consenting users from 27 ACFs. FluCARE was rated 3.91 of 5 overall on the uMARS. Of the 31 users, 25 (80%) would definitely use FluCARE for future outbreaks, and all users agreed that the app was useful for identifying influenza and COVID-19 outbreaks at their facilities. There were no reported critical issues with incorrect or missed outbreak detection. User training, particularly online training modules, and technical support were identified as key facilitators to FluCARE use. Conclusions: FluCARE is an acceptable, useful, and safe app to assist ACF staff with early detection and response to influenza and COVID-19 outbreaks. This study supports feasibility for ongoing implementation and efficacy evaluation, followed by scale-up into other health districts in New South Wales. UR - https://formative.jmir.org/2023/1/e38080 UR - http://dx.doi.org/10.2196/38080 UR - http://www.ncbi.nlm.nih.gov/pubmed/36763638 ID - info:doi/10.2196/38080 ER - TY - JOUR AU - Robinson, Eric AU - Jones, Andrew PY - 2023/3/3 TI - Hangover-Related Internet Searches Before and During the COVID-19 Pandemic in England: Observational Study JO - JMIR Form Res SP - e40518 VL - 7 KW - alcohol KW - COVID-19 KW - hangover KW - Google Trends KW - social media KW - public health KW - online information KW - alcohol use KW - internet search N2 - Background: It is unclear whether heavy alcohol use and associated hangover symptoms changed as a result of the COVID-19 pandemic. Due to a lack of available accurate and nonretrospective self-reported data, it is difficult to directly assess hangover symptoms during the COVID-19 pandemic. Objective: This study aimed to examine whether alcohol-induced hangover-related internet searches (eg, ?how to cure a hangover??) increased, decreased, or remained the same in England before versus during the COVID-19 pandemic (2020-2021) and during periods of national lockdown. Secondary aims were to examine if hangover-related internet searches in England differed compared to a country that did not impose similar COVID-19 lockdown restrictions. Methods: Using historical data from Google Trends for England, we compared the relative search volume (RSV) of hangover-related searches in the years before (2016-2019) versus during the COVID-19 pandemic (2020-2021), as well as in periods of national lockdown versus the same periods in 2016-2019. We also compared the RSV of hangover-related searches during the same time frames in a European country that did not introduce national COVID-19 lockdowns at the beginning of the pandemic (Sweden). Hangover-related search terms were identified through consultation with a panel of alcohol researchers and a sample from the general public. Statistical analyses were preregistered prior to data collection. Results: There was no overall significant difference in the RSV of hangover-related terms in England during 2016-2019 versus 2020-2021 (P=.10; robust d=0.02, 95% CI 0.00-0.03). However, during national lockdowns, searches for hangover-related terms were lower, particularly during the first national lockdown in England (P<.001; d=.19, 95% CI 0.16-0.24; a 44% relative decrease). In a comparison country that did not introduce a national lockdown in the early stages of the pandemic (Sweden), there was no significant decrease in hangover-related searches during the same time period (P=.06). However, across both England and Sweden, during later periods of COVID-19 restrictions in 2020 and 2021, the RSV of hangover-related terms was lower than that in the same periods during 2016-2019. Exploratory analyses revealed that national monthly variation in alcohol sales both before and during the COVID-19 pandemic were positively correlated with the frequency of hangover-related searches, suggesting that changes in hangover-related searches may act as a proxy for changes in alcohol consumption. Conclusions: Hangover-related internet searches did not differ before versus during the COVID-19 pandemic in England but did reduce during periods of national lockdown. Further research is required to confirm how changes in hangover-related search volume relate to heavy episodic alcohol use. Trial Registration: Open Science Framework 2Y86E; https://osf.io/2Y86E UR - https://formative.jmir.org/2023/1/e40518 UR - http://dx.doi.org/10.2196/40518 UR - http://www.ncbi.nlm.nih.gov/pubmed/36827489 ID - info:doi/10.2196/40518 ER - TY - JOUR AU - Brusk, J. John AU - Bensley, J. Robert PY - 2023/3/2 TI - COVID-19 Response Resource Engagement and User Characteristics of the Wichealth Web-Based Nutrition Education System: Comparative Cross-sectional Study JO - JMIR Form Res SP - e38667 VL - 7 KW - COVID-19 KW - user engagement KW - infodemic KW - Women, Infants, and Children KW - WIC KW - educational resource KW - health care KW - digital health KW - nutrition KW - web-based education KW - web-based nutrition KW - pediatric KW - parenting KW - dashboard N2 - Background: In response to the COVID-19 pandemic, Wichealth launched 4 information resources on the site?s user landing dashboard page. These resources were used consistently during the period in which they were available (April 1, 2020, through October 31, 2021); however, only 9% (n=50,888) of Wichealth users eligible for inclusion in the study accessed at least one resource. User engagement with emergency response resources within the context of a web-based health educational tool has not been well investigated due to a paucity of opportunities and a lack of the ability to evaluate relevant users at scale. Objective: This investigation was carried out to understand if user characteristics and behaviors measured by the Wichealth web-based education system are associated with a participant's motivation, or lack thereof, to engage with the added COVID-19 resources. Methods: Sociodemographic characteristics were gathered from Wichealth users with at least one lesson completed and a complete user profile to identify which factors increase the likelihood of user access of any of the Wichealth COVID-19 response resources during the 19-month period between April 1, 2020, and October 31, 2021. A logistic regression analysis was conducted to determine the relative importance of all factors on the likelihood of a user accessing the COVID-19 resources. Results: A total of 50,888 unique Wichealth users included in the study accessed the COVID-19 response resources 66,849 times during the time period. During the same period, 510,939 unique Wichealth users completed at least one lesson about how to engage in healthy behaviors with respect to parent-child feeding but did not access any COVID-19 resources. Therefore, only 9% of Wichealth users who completed a lesson during the time when COVID-19 response resources were available accessed any of the information in those resources. Users of the Spanish language Wichealth version, older users, those less educated, and users with prior Wichealth lesson engagement demonstrated the greatest likelihood of COVID-19 resource use. Conclusions: This investigation presents findings that demonstrate significant differences between Wichealth users that opted to access COVID-19?specific resources and those who chose not to during their web-based educational session. Reaching users of a web-based educational system with supplemental information may require multiple strategies to increase coverage and ensure the widest possible distribution. UR - https://formative.jmir.org/2023/1/e38667 UR - http://dx.doi.org/10.2196/38667 UR - http://www.ncbi.nlm.nih.gov/pubmed/36787232 ID - info:doi/10.2196/38667 ER - TY - JOUR AU - Howell, Pamella AU - Abdelhamid, Mohamed PY - 2023/3/1 TI - Protection Motivation Perspective Regarding the Use of COVID-19 Mobile Tracing Apps Among Public Users: Empirical Study JO - JMIR Form Res SP - e36608 VL - 7 KW - COVID-19 KW - mobile tracing app KW - protection motivation theory KW - privacy concerns KW - global health N2 - Background: Access to data is crucial for decision-making; this fact has become more evident during the pandemic. Data collected using mobile apps can positively influence diagnosis and treatment, the supply chain, and the staffing resources of health care facilities. Developers and health care professionals have worked to create apps that can track a person?s COVID-19 status. For example, these apps can monitor positive COVID-19 test results and vaccination status. Regrettably, people may be concerned about sharing their data with government or private sector organizations that are developing apps. Understanding user perceptions is essential; without substantial user adoption and the use of mobile tracing apps, benefits cannot be achieved. Objective: This study aimed to assess the factors that positively and negatively affect the use of COVID-19 tracing apps by examining individuals? perceptions about sharing data on mobile apps, such as testing regularity, infection, and immunization status. Methods: The hypothesized research model was tested using a cross-sectional survey instrument. The survey contained 5 reflective constructs and 4 control variables selected after reviewing the literature and interviewing health care professionals. A digital copy of the survey was created using Qualtrics. After receiving approval, data were collected from 367 participants through Amazon Mechanical Turk (MTurk). Participants of any gender who were 18 years or older were considered for inclusion to complete the anonymized survey. We then analyzed the theoretical model using structural equation modeling. Results: After analyzing the quality of responses, 325 participants were included. Of these 325 participants, 216 (66.5%) were male and 109 (33.5%) were female. Among the participants in the final data set, 72.6% (236/325) were employed. The results of structural equation modeling showed that perceived vulnerability (?=0.688; P<.001), self-efficacy (?=0.292; P<.001), and an individual?s prior infection with COVID-19 (?=0.194; P=.002) had statistically significant positive impacts on the intention to use mobile tracing apps. Privacy concerns (?=?0.360; P<.001), risk aversion (?=?0.150; P=.09), and a family member?s prior infection with COVID-19 (?=?0.139; P=.02) had statistically significant negative influences on a person?s intention to use mobile tracing apps. Conclusions: This study illustrates that various user perceptions affect whether individuals use COVID-19 tracing apps. By working collaboratively on legislation and the messaging provided to potential users before releasing an app, developers, health care professionals, and policymakers can improve the use of tracking apps. Health care professionals need to emphasize disease vulnerability to motivate people to use mobile tracing apps, which can help reduce the spread of viruses and diseases. In addition, more work is needed at the policy-making level to protect the privacy of users, which in return can increase user engagement. UR - https://formative.jmir.org/2023/1/e36608 UR - http://dx.doi.org/10.2196/36608 UR - http://www.ncbi.nlm.nih.gov/pubmed/36735838 ID - info:doi/10.2196/36608 ER - TY - JOUR AU - Cellai, Michele AU - Roberts, Jodi AU - Moore, A. Miranda AU - Gandrakota, Nikhila PY - 2023/2/23 TI - Clinical Outcomes After Use of Inhaled Corticosteroids or Oral Steroids in a COVID-19 Telemedicine Clinic Cohort: Retrospective Chart Review JO - JMIR Form Res SP - e36023 VL - 7 KW - COVID-19 KW - lung KW - post-acute sequela KW - steroid use KW - ICS KW - pandemic KW - therapy KW - treatment KW - steroid treatment KW - COVID-19 treatment KW - patient outcome KW - pulmonary KW - COVID symptoms KW - telehealth N2 - Background: COVID-19 concerns remain among health care providers, as there are few outpatient treatment options. In the early days of the pandemic, treatment options for nonhospitalized patients were limited, and symptomatic treatment and home-grown guidelines that used recommendations from the Global Initiative for Asthma Management and Treatment were used. Objective: The possibility that inhaled corticosteroids (ICS) might reduce the risk of respiratory symptoms and promote recovery was the impetus for this review, as it has already been shown that in the nonhospitalized patient population, oral corticosteroids (OCS) in the acute phase could have an adverse effect on recovery. We investigated if (1) patients treated with ICS were less likely to require referral to a post?COVID-19 clinic or pulmonary specialist than patients without ICS treatment or with OCS therapy, and (2) if OCS use was associated with worse health outcomes. Methods: In a retrospective chart review, we identified all patients with acute illness due to COVID-19 that were followed and managed by a telemedicine clinic team between June and December 2020. The data were electronically pulled from electronic medical records through April 2021 and reviewed to determine which patients eventually required referral to a post?COVID-19 clinic or pulmonary specialist due to persistent respiratory symptoms of COVID-19. The data were then analyzed to compare outcomes between patients prescribed OCS and those prescribed ICS. We specifically looked at patients treated acutely with ICS or OCS that then required referral to a pulmonary specialist or post?COVID-19 clinic. We excluded any patients with a history of chronic OCS or ICS use for any reason. Results: Prescribing ICS during the acute phase did not reduce the possibility of developing persistent symptoms. There was no difference in the referral rate to a pulmonary specialist or post?COVID-19 clinic between patients treated with OCS versus ICS. However, our data may not be generalizable to other populations, as it represents a patient population enrolled in a telemedicine program at a single center. Conclusions: We found that ICS, as compared to OCS, did not reduce the risk of developing persistent respiratory symptoms. This finding adds to the body of knowledge that ICS and OCS medications remain potent treatments in patients with acute and postacute COVID-19 seen in an outpatient setting. UR - https://formative.jmir.org/2023/1/e36023 UR - http://dx.doi.org/10.2196/36023 UR - http://www.ncbi.nlm.nih.gov/pubmed/36480687 ID - info:doi/10.2196/36023 ER - TY - JOUR AU - Nguyen, Tue Trong AU - Ho, Tu Cam AU - Bui, Thu Huong Thi AU - Ho, Khanh Lam AU - Ta, Thanh Van PY - 2023/2/16 TI - Multidimensional Machine Learning for Assessing Parameters Associated With COVID-19 in Vietnam: Validation Study JO - JMIR Form Res SP - e42895 VL - 7 KW - COVID-19 KW - multidimensional analysis KW - hierarchical cluster analysis KW - regression analysis KW - mild KW - moderate KW - severe KW - age KW - scoring index of chest x-ray KW - percentage and quantity of neutrophils KW - albumin KW - C-reactive protein KW - ratio of lymphocytes N2 - Background: Machine learning (ML) is a type of artificial intelligence strategy. Its algorithms are used on big data sets to see patterns, learn from their results, and perform tasks autonomously without being instructed on how to address problems. New diseases like COVID-19 provide important data for ML. Therefore, all relevant parameters should be explicitly quantified and modeled. Objective: The purpose of this study was to determine (1) the overall preclinical characteristics, (2) the cumulative cutoff values and risk ratios (RRs), and (3) the factors associated with COVID-19 severity in unidimensional and multidimensional analyses involving 2173 SARS-CoV-2 patients. Methods: The study population consisted of 2173 patients (1587 mild status [mild group] and asymptomatic patients, 377 moderate status patients [moderate group], and 209 severe status patients [severe group]). The status of the patients was recorded from September 2021 to March 2022. Two correlation tests, relative risk, and RR were used to eliminate unbalanced parameters and select the most remarkable parameters. The independent methods of hierarchical cluster analysis and k-means were used to classify parameters according to their r values. Finally, network analysis provided a 3-dimensional view of the results. Results: COVID-19 severity was significantly correlated with age (mild-moderate group: RR 4.19, 95% CI 3.58-4.95; P<.001), scoring index of chest x-ray (mild-moderate group: RR 3.29, 95% CI 2.76-3.92; P<.001; moderate-severe group: RR 3.03, 95% CI 2.4023-3.8314; P<.001), percentage of neutrophils (mild-moderate group: RR 3.18, 95% CI 2.73-3.70; P<.001; moderate-severe group: RR 3.32, 95% CI 2.6480-4.1529; P<.001), quantity of neutrophils (moderate-severe group: RR 3.15, 95% CI 2.6153-3.8025; P<.001), albumin (moderate-severe group: RR 0.46, 95% CI 0.3650-0.5752; P<.001), C-reactive protein (mild-moderate group: RR 3.4, 95% CI 2.91-3.97; P<.001), and ratio of lymphocytes (moderate-severe group: RR 0.34, 95% CI 0.2743-0.4210; P<.001). Significant inversion of correlations among the severity groups is important. Alanine transaminase and leucocytes showed a significant negative correlation (r=?1; P<.001) in the mild group and a significant positive correlation in the moderate group (r=1; P<.001). Transferrin and anion Cl showed a significant positive correlation (r=1; P<.001) in the mild group and a significant negative correlation in the moderate group (r=?0.59; P<.001). The clustering and network analysis showed that in the mild-moderate group, the closest neighbors of COVID-19 severity were ferritin and age. C-reactive protein, scoring index of chest x-ray, albumin, and lactate dehydrogenase were the next closest neighbors of these 3 factors. In the moderate-severe group, the closest neighbors of COVID-19 severity were ferritin, fibrinogen, albumin, quantity of lymphocytes, scoring index of chest x-ray, white blood cell count, lactate dehydrogenase, and quantity of neutrophils. Conclusions: This multidimensional study in Vietnam showed possible correlations between several elements and COVID-19 severity to provide clinical reference markers for surveillance and diagnostic management. UR - https://formative.jmir.org/2023/1/e42895 UR - http://dx.doi.org/10.2196/42895 UR - http://www.ncbi.nlm.nih.gov/pubmed/36668902 ID - info:doi/10.2196/42895 ER - TY - JOUR AU - Aolymat, Iman AU - Abdul Kadir, Lina AU - Al Nsour, Mohannad AU - Taha, Hana PY - 2023/2/16 TI - The Impact of the COVID-19 Pandemic on Female Sexual Function in Jordan: Cross-sectional Study JO - JMIR Form Res SP - e40772 VL - 7 KW - COVID-19 KW - pandemic KW - female sexual function KW - sexual dysfunction KW - stress physiology KW - Jordan N2 - Background: Sexual function is a complex physiological process controlled by neurovascular and endocrine mechanisms that are affected by stressful events. The sexual response cycle consists of four main phases, which are sexual desire or libido, arousal or excitement, orgasm, and resolution. The COVID-19 outbreak is one of the most stressful events historically, causing several unpleasant consequences, including major physical and mental disorders, and sexual dysfunction and alteration in sexual behavior are possible anticipated consequences of the pandemic. Moreover, there are social taboos related to sexual behavior in Jordan, and the current knowledge on changes in Jordanian female sexual function during COVID-19 pandemic is limited. Objective: This study aims to evaluate the impact of COVID?19 on women's sexual function during the early COVID-19 pandemic in Jordan. Methods: This is a cross-sectional study that employed a web-based survey to follow 200 female individuals from the general population in Jordan. The survey evaluated sexual function both during COVID-19 and 6 months prior to the pandemic. The primary outcomes investigated in this study were the changes in sexual intercourse frequency and sexual function aspects, including desire, arousal, satisfaction, orgasm, lubrication, and pain during sexual activity. Data were analyzed using paired t test, McNemar test, Pearson correlations, and multiple linear regression using SPSS 25. Results: During the COVID-19 pandemic, the participants? sexual intercourse frequency increased while their sexual satisfaction was significantly changed. The proportion of participants who had 0-2 times per week of sexual intercourse was decreased during the COVID-19 pandemic compared with that before the pandemic (n=90, 45% vs n=103, 51.5%; P=.02). Conversely, the number of female individuals with 3-7 times per week of sexual intercourse increased after the pandemic compared with the prepandemic state (n=103, 51.5% vs n=91, 45.5%; P=.04). Female sexual satisfaction was significantly reduced after the COVID-19 pandemic compared with that before the pandemic (3.39 vs 3.30; P=.049). The other categories of sexual function, including desire, arousal, satisfaction, orgasm, lubrication, and dyspareunia showed no significant changes during the COVID-19 pandemic compared with the previous 6 months. There were no significant differences between the total sexual function mean scores during COVID-19 (15.73) compared with the prepandemic scores (15.85; P=.41). The total score of female sexual function during the pandemic was negatively associated with the participants? age and education level. Correlations between various demographics and sexual function categories during the COVID-19 pandemic were identified. Conclusions: This is the first study exploring female sexual function during the COVID-19 outbreak in Jordan. The results suggest that COVID-19?associated stress is influencing women's sexual function, necessitating the provision of adequate emotional and physiological well-being support for women during similar crises. UR - https://formative.jmir.org/2023/1/e40772 UR - http://dx.doi.org/10.2196/40772 UR - http://www.ncbi.nlm.nih.gov/pubmed/36745774 ID - info:doi/10.2196/40772 ER - TY - JOUR AU - Bønes, Erlend AU - Granja, Conceição AU - Solvoll, Terje PY - 2023/2/9 TI - Experiences and Expectations of Information and Communication Technologies in Flexible Assertive Community Treatment Teams: Qualitative Study JO - JMIR Form Res SP - e42796 VL - 7 KW - mental health KW - FACT KW - electronic health records KW - eHealth KW - EHR KW - electronic whiteboards KW - community KW - treatment KW - qualitative KW - COVID-19 KW - patient care KW - mental illness KW - information technology KW - thematic analysis KW - data access KW - information and communication solutions KW - ICT KW - Norway KW - semistructured interviews N2 - Background: Flexible Assertive Community Treatment (FACT) is a model of integrated care for patients with long-term serious mental illness. FACT teams deliver services using assertive outreach to treat patients who can be hard to reach by the health care service, and focus on both the patient?s health and their social situation. However, in Norway, FACT team members have challenges with their information and communication (ICT) solutions. Objective: The aim of this study was to explore Norwegian FACT teams? experiences and expectations of their ICT solutions, including electronic health records, electronic whiteboards, and calendars. Methods: We gathered data in two phases. In the first phase, we conducted semistructured interviews with team leaders and team coordinators, and made observations in FACT teams targeting adults. In the second phase, we conducted semistructured group interviews in FACT teams targeting youth. We performed a thematic analysis of the data in a theoretical manner to address the specific objectives of the study. Results: A total of 8 teams were included, with 5 targeting adults and 3 targeting youth. Due to the COVID-19 pandemic, we were not able to perform observations in 2 of the teams targeting adults. Team leaders and coordinators in all 5 teams targeting adults were interviewed, with a total of 7 team members participating in the teams targeting youth. We found various challenges with communication, documentation, and organization for FACT teams. The COVID-19 pandemic was challenging for the teams and changed the way they used ICT solutions. There were issues with some technical solutions used in the teams, including electronic health records, electronic whiteboards, and calendars. Lack of integration and access to data were some of the main issues identified. Conclusions: Despite the FACT model being successfully implemented in Norway, there are several issues regarding the ICT solutions they use, mainly related to access to data and integration. Further research is required to detail how improved ICT solutions should be designed. While FACT teams targeting adults and youth differ in some ways, their needs for ICT solutions are largely similar. UR - https://formative.jmir.org/2023/1/e42796 UR - http://dx.doi.org/10.2196/42796 UR - http://www.ncbi.nlm.nih.gov/pubmed/36730062 ID - info:doi/10.2196/42796 ER - TY - JOUR AU - Schneider, Margaret AU - Woodworth, Amanda AU - Mehrabadi, Asgari Milad PY - 2023/2/8 TI - The Relationship Between Exercise Habits and Stress Among Individuals With Access to Internet-Connected Home Fitness Equipment: Single-Group Prospective Analysis JO - JMIR Form Res SP - e41877 VL - 7 KW - stress KW - exercise KW - internet-connected home fitness equipment KW - physical activity KW - healthcare cost KW - health care KW - psychological well-being KW - COVID-19 KW - online survey KW - user data KW - Peloton N2 - Background: Physical activity (PA) confers numerous benefits to health and health care costs, yet most adults are not meeting recommended PA guidelines. Stress may be a factor that influences PA behavior. Research investigating the impact of stress on PA has yielded inconsistent findings. Most studies find that stress negatively impacts PA, but there is some evidence that habitual exercising buffers this association. Objective: This study aims to examine the relationship between stress and exercise habits among habitual exercisers with internet-connected home fitness equipment (Peloton Bike) during the COVID-19 lockdown. Methods: Participants were recruited through Facebook (N=146) and asked to complete an internet-based survey that assessed COVID-19?related stressors, perceived stress associated with those stressors, and general perceived stress. Self-reported exercise was assessed on the survey using the Godin Leisure-time Exercise Questionnaire (GLTEQ). Participants were also asked for consent to access their Peloton usage data through the Peloton platform. From their usage data, the frequency and duration of cycling classes was calculated for 4 weeks prior to and 12 weeks following the survey. Hierarchical regression equations tested the association between stress reported on the survey and subsequent exercise participation. Exercise participation was quantified both as the frequency and duration of Peloton cycling over the 12 weeks following the survey and as self-reported moderate to vigorous activity on a second survey completed by a subset of participants 12 weeks after the initial survey. Results: There were 146 participants in our Peloton analysis sample and 66 in the self-reported exercise analysis. Peloton user data showed that study participants cycled frequently (mean 5.9 times per week) in the month prior to the initial survey, and that presurvey Peloton use was a strong predictor of exercise frequency (R2=0.57; F2,143=95.27; P<.001) and duration (R2=0.58; F2,143=102.58; P<.001) for the 12 subsequent weeks. Self-reported overall exercise likewise showed that this sample was very active, with an average of more than 8 times per week of moderate to vigorous exercise at the initial survey. Self-reported exercise on the initial survey was a strong predictor of self-reported exercise 12 weeks later (R2=0.31; F1,64=29.03; P<.001). Perceived stress did not impact Peloton cycling duration or frequency (P=.81 and .76, respectively) or self-reported exercise (P=.28). Conclusions: The results suggest that stress did not negatively impact exercise participation among habitually active adults with access to internet-connected home fitness equipment. Habitual exercise may buffer the impact of stress on participation in regular moderate to vigorous activity. Future research should examine the role that the availability of home-based internet-connected exercise equipment may play in this buffering. UR - https://formative.jmir.org/2023/1/e41877 UR - http://dx.doi.org/10.2196/41877 UR - http://www.ncbi.nlm.nih.gov/pubmed/36719817 ID - info:doi/10.2196/41877 ER - TY - JOUR AU - Yang, Liuqing AU - Ji, Lili AU - Wang, Qiang AU - Yang, Guoping AU - Xiu, Shixin AU - Cui, Tingting AU - Shi, Naiyang AU - Zhu, Lin AU - Xu, Xuepeng AU - Jin, Hui AU - Zhen, Shiqi PY - 2023/2/7 TI - Understanding Drivers of Vaccine Hesitancy During the COVID-19 Pandemic Among Older Adults in Jiangsu Province, China: Cross-sectional Survey JO - JMIR Form Res SP - e39994 VL - 7 KW - vaccine hesitancy KW - older adults KW - socioeconomic status KW - vaccination history KW - COVID-19 KW - 3Cs model KW - confidence, complacency, and convenience N2 - Background: Older adults are particularly at risk from infectious diseases, including serve complications, hospitalization, and death. Objective: This study aimed to explore the drivers of vaccine hesitancy among older adults based on the ?3Cs? (confidence, complacency, and convenience) framework, where socioeconomic status and vaccination history played the role of moderators. Methods: A cross-sectional questionnaire survey was conducted in Jiangsu Province, China, between June 1 and July 20, 2021. Older adults (aged ?60 years) were recruited using a stratified sampling method. Vaccine hesitancy was influenced by the 3Cs in the model. Socioeconomic status and vaccination history processed through the item parceling method were used to moderate associations between the 3Cs and hesitancy. Hierarchical regression analyses and structural equation modeling were used to test the validity of the new framework. We performed 5000 trials of bootstrapping to calculate the 95% CI of the pathway?s coefficients. Results: A total of 1341 older adults participated. The mean age was 71.3 (SD 5.4) years, and 44.7% (599/1341) of participants were men. Confidence (b=0.967; 95% CI 0.759-1.201; P=.002), convenience (b=0.458; 95% CI 0.333-0.590; P=.002), and less complacency (b=0.301; 95% CI 0.187-0.408; P=.002) were positively associated with less vaccine hesitancy. Socioeconomic status weakened the positive effect of low complacency (b=?0.065; P=.03) on low vaccine hesitancy. COVID-19 vaccination history negatively moderated the positive association between confidence (b=?0.071; P=.02) and lower vaccine hesitancy. Conclusions: Our study identified that confidence was the more influential dimension in reducing vaccine hesitancy among older adults. COVID-19 vaccination history, as well as confidence, had a positive association with less vaccine hesitancy and could weaken the role of confidence in vaccine hesitancy. Socioeconomic status had a substitution relationship with less complacency, which suggested a competitive positive association between them on less vaccine hesitancy. UR - https://formative.jmir.org/2023/1/e39994 UR - http://dx.doi.org/10.2196/39994 UR - http://www.ncbi.nlm.nih.gov/pubmed/36693149 ID - info:doi/10.2196/39994 ER - TY - JOUR AU - Tan, Ying Jamaica Pei AU - Tan, J. Michelle W. AU - Towle, Marie Rachel AU - Lee, Win Joanne Sze AU - Lei, Xiaofeng AU - Liu, Yong AU - Goh, Mong Rick Siow AU - Chee Ping, Tan Franklin AU - Tan, Choon Teck AU - Ting, Wei Daniel Shu AU - Lee, Ee Chen AU - Low, Leng Lian PY - 2023/2/7 TI - mHealth App to Facilitate Remote Care for Patients With COVID-19: Rapid Development of the DrCovid+ App JO - JMIR Form Res SP - e38555 VL - 7 KW - mobile health KW - mHealth KW - rapid development KW - remote care KW - COVID-19 KW - hospital-at-home KW - mobile app KW - app development KW - virtual care KW - Telegram service KW - clinical care KW - continuity of care KW - digital health N2 - Background: The 2019 novel COVID-19 has severely burdened the health care system through its rapid transmission. Mobile health (mHealth) is a viable solution to facilitate remote monitoring and continuity of care for patients with COVID-19 in a home environment. However, the conceptualization and development of mHealth apps are often time and labor-intensive and are laden with concerns relating to data security and privacy. Implementing mHealth apps is also a challenging feat as language-related barriers limit adoption, whereas its perceived lack of benefits affects sustained use. The rapid development of an mHealth app that is cost-effective, secure, and user-friendly will be a timely enabler. Objective: This project aimed to develop an mHealth app, DrCovid+, to facilitate remote monitoring and continuity of care for patients with COVID-19 by using the rapid development approach. It also aimed to address the challenges of mHealth app adoption and sustained use. Methods: The Rapid Application Development approach was adopted. Stakeholders including decision makers, physicians, nurses, health care administrators, and research engineers were engaged. The process began with requirements gathering to define and finalize the project scope, followed by an iterative process of developing a working prototype, conducting User Acceptance Tests, and improving the prototype before implementation. Co-designing principles were applied to ensure equal collaborative efforts and collective agreement among stakeholders. Results: DrCovid+ was developed on Telegram Messenger and hosted on a cloud server. It features a secure patient enrollment and data interface, a multilingual communication channel, and both automatic and personalized push messaging. A back-end dashboard was also developed to collect patients? vital signs for remote monitoring and continuity of care. To date, 400 patients have been enrolled into the system, amounting to 2822 hospital bed?days saved. Conclusions: The rapid development and implementation of DrCovid+ allowed for timely clinical care management for patients with COVID-19. It facilitated early patient hospital discharge and continuity of care while addressing issues relating to data security and labor-, time-, and cost-effectiveness. The use case for DrCovid+ may be extended to other medical conditions to advance patient care and empowerment within the community, thereby meeting existing and rising population health challenges. UR - https://formative.jmir.org/2023/1/e38555 UR - http://dx.doi.org/10.2196/38555 UR - http://www.ncbi.nlm.nih.gov/pubmed/36649223 ID - info:doi/10.2196/38555 ER - TY - JOUR AU - Shi, Yueping AU - Gu, Pinhua AU - Wang, Qiufeng AU - Zhang, Xuelian PY - 2023/2/6 TI - The Nurse-Physician Relationship During the COVID-19 Pandemic in Shanghai, China: Cross-sectional Study JO - JMIR Form Res SP - e41729 VL - 7 KW - nurse KW - physician KW - collaboration KW - online survey KW - nursing KW - COVID-19 KW - structural equation modeling KW - equation modeling KW - nurse-physician KW - ordinal logistic regression N2 - Background: The nurse-physician relationship is important for the stability of collaboration. The COVID-19 pandemic has put unprecedented pressure on the health care system and has placed greater demands on nurse-physician collaboration. Nurses and physicians often struggle to share mutual responsibility and communicate effectively. Objective: This study aimed to evaluate the relationship between nurses and physicians during the COVID-19 pandemic and construct a new model combining the attitude and behaviors of the 2 groups to assess various factors? impacts on job satisfaction and confrontational behavior. Methods: We conducted this quantitative cross-sectional study to assess the relationship between nurses and physicians based on the attitudes and behaviors toward nurse-physician collaboration. We first investigated the satisfaction of nurses and physicians with their relationship and how they thought the COVID-19 pandemic had affected that relationship. We used an adapted and modified Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration questionnaire that consisted of 17 items under 5 dimensions. Structural equation modeling was used to assess the relationships between domains. Ordinal logistic regression was used to evaluate the relationship between different domains of the questionnaire and the satisfaction of the current nurse-physician relationship. Results: We included a total of 176 nurses and 124 physicians in this study. Compared to 7.2% (9/124) of physicians, 22.7% (40/176) of nurses were dissatisfied with the current nurse-physician relationship. Most physicians (101/124, 81.5%) and nurses (131/176, 74.5%) agreed that the nurse-physician relationship had become better because of the COVID-19 pandemic and that the public had greater respect for them. However, significantly fewer nurses (59/176, 33.5% vs 79/124, 63.7%; P<.001) thought that physicians and nurses were treated with the same respect. Nurses scored significantly higher scores in caring versus curing (mean 16.27, SD 2.88 vs mean 17.43, SD 2.50; P<.001) and physician?s authority (mean 8.72, SD 3.21 vs mean 7.24, SD 3.32; P<.001) subscales compared with physicians. The shared education and collaboration subscale had a significantly positive relationship with the nurse?s autonomy subscale (standardized coefficient=0.98; P<.001). Logistic regression showed that 4 subscales (shared education and collaboration: P<.001; caring versus curing: P<.001; nurse?s autonomy: P<.001; and confrontation: P=.01) were significantly associated with the level of satisfaction of the current nurse-physician relationship. Conclusions: This study showed that nurses were more dissatisfied with the current nurse-physician relationship than physicians in Shanghai. Policy makers and managers in the medical and educational system should emphasize an interprofessional collaboration between nurses and physicians. Positive attitudes toward shared collaboration and responsibility may help to improve the relationship between the 2 parties. UR - https://formative.jmir.org/2023/1/e41729 UR - http://dx.doi.org/10.2196/41729 UR - http://www.ncbi.nlm.nih.gov/pubmed/36745499 ID - info:doi/10.2196/41729 ER - TY - JOUR AU - Shamiyah, Adnan Khalid AU - Whitebridge, Simon AU - Kumar, Nitya AU - Aljenaee, Khaled AU - Atkin, L. Stephen AU - Ali, Fuad Khawla PY - 2023/2/2 TI - The Impact of COVID-19 on the Prevalence and Perception of Telehealth Use in the Middle East and North Africa Region: Survey Study JO - JMIR Form Res SP - e34074 VL - 7 KW - COVID-19 KW - telehealth KW - Instagram KW - WhatsApp KW - social media KW - telemedicine KW - impact KW - prevalence KW - perception KW - view KW - usage KW - utilization KW - safety KW - acceptability KW - survey N2 - Background: Due to the COVID-19 pandemic, telehealth has become a safer way to access health care. The telehealth industry has rapidly expanded over the last decade as a modality to provide patient-centered care. However, the prevalence of its use and patient acceptability remains unclear in the Middle East and North Africa (MENA) region. Objective: The primary aim was to assess the prevalence of telehealth use before and during the pandemic by using social media (Instagram) as an online platform for survey administration across different countries simultaneously. Our secondary aim was to assess the perceptions regarding telehealth among those using it. Methods: An Instagram account that reaches 130,000 subjects daily was used to administer a questionnaire that assessed the current prevalence of telehealth use and public attitudes and acceptability toward this modality of health care delivery during the COVID-19 pandemic. Results: A total of 1524 respondents participated in the survey (n=1356, 89% female; median age 31 years), of whom 97.6% (n=1487) lived in the Gulf Cooperation Council (GCC) region. Prior to COVID-19, 1350 (88.6%) had no exposure to telehealth. Following the COVID-19 pandemic, telehealth use increased by 251% to a total of 611 users (40% of all users). About 89% (571/640) of telehealth users used virtual visits for specialist visits. Of the 642 participants who reported using telehealth, 236 (36.8%) reported their willingness to continue using telehealth, 241 (37.5%) were unsure, and 164 (25.5%) did not wish to continue to use telehealth after the COVID-19 pandemic. An inverse trend, although not statistically significant, was seen between willingness to continue telehealth use and the number of medical comorbidities (odds ratio [OR] 0.81, 95% CI 0.64-1.03; P=.09). Compared to the respondents who chose only messaging as the modality they used for telehealth, respondents who chose both messaging and phone calls were significantly less likely to recommend telehealth (OR 0.42, 95% CI 0.22-0.80; P=.009). Overall, there was general satisfaction with telehealth, and respondents reported that telehealth consultations made them feel safer and saved both time and money. Conclusions: Telehealth use increased dramatically after the COVID-19 pandemic, and telehealth was found to be acceptable among some young adult groups on Instagram. However, further innovation is warranted to increase acceptability and willingness to continue telehealth use for the delivery of health care. UR - https://formative.jmir.org/2023/1/e34074 UR - http://dx.doi.org/10.2196/34074 UR - http://www.ncbi.nlm.nih.gov/pubmed/36652596 ID - info:doi/10.2196/34074 ER - TY - JOUR AU - Sinha, Chaitali AU - Meheli, Saha AU - Kadaba, Madhura PY - 2023/1/26 TI - Understanding Digital Mental Health Needs and Usage With an Artificial Intelligence?Led Mental Health App (Wysa) During the COVID-19 Pandemic: Retrospective Analysis JO - JMIR Form Res SP - e41913 VL - 7 KW - digital mental health KW - COVID-19 KW - engagement KW - retention KW - perceived needs KW - pandemic waves KW - chatbot KW - conversational agent KW - mental health app KW - mobile health KW - digital health intervention N2 - Background: There has been a surge in mental health concerns during the COVID-19 pandemic, which has prompted the increased use of digital platforms. However, there is little known about the mental health needs and behaviors of the global population during the pandemic. This study aims to fill this knowledge gap through the analysis of real-world data collected from users of a digital mental health app (Wysa) regarding their engagement patterns and behaviors, as shown by their usage of the service. Objective: This study aims to (1) examine the relationship between mental health distress, digital health uptake, and COVID-19 case numbers; (2) evaluate engagement patterns with the app during the study period; and (3) examine the efficacy of the app in improving mental health outcomes for its users during the pandemic. Methods: This study used a retrospective observational design. During the COVID-19 pandemic, the app?s installations and emotional utterances were measured from March 2020 to October 2021 for the United Kingdom, the United States of America, and India and were mapped against COVID-19 case numbers and their peaks. The engagement of the users from this period (N=4541) with the Wysa app was compared to that of equivalent samples of users from a pre?COVID-19 period (1000 iterations). The efficacy was assessed for users who completed pre-post assessments for symptoms of depression (n=2061) and anxiety (n=1995) on the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7) test measures, respectively. Results: Our findings demonstrate a significant positive correlation between the increase in the number of installs of the Wysa mental health app and the peaks of COVID-19 case numbers in the United Kingdom (P=.02) and India (P<.001). Findings indicate that users (N=4541) during the COVID period had a significantly higher engagement than the samples from the pre-COVID period, with a medium to large effect size for 80% of these 1000 iterative samples, as observed on the Mann-Whitney test. The PHQ-9 and GAD-7 pre-post assessments indicated statistically significant improvement with a medium effect size (PHQ-9: P=.57; GAD-7: P=.56). Conclusions: This study demonstrates that emotional distress increased substantially during the pandemic, prompting the increased uptake of an artificial intelligence?led mental health app (Wysa), and also offers evidence that the Wysa app could support its users and its usage could result in a significant reduction in symptoms of anxiety and depression. This study also highlights the importance of contextualizing interventions and suggests that digital health interventions can provide large populations with scalable and evidence-based support for mental health care. UR - https://formative.jmir.org/2023/1/e41913 UR - http://dx.doi.org/10.2196/41913 UR - http://www.ncbi.nlm.nih.gov/pubmed/36540052 ID - info:doi/10.2196/41913 ER - TY - JOUR AU - Perez-Ramos, G. Jose AU - Leon-Thomas, Mariela AU - Smith, L. Sabrina AU - Silverman, Laura AU - Perez-Torres, Claudia AU - Hall, C. Wyatte AU - Iadarola, Suzannah PY - 2023/1/25 TI - COVID-19 Vaccine Equity and Access: Case Study for Health Care Chatbots JO - JMIR Form Res SP - e39045 VL - 7 KW - mHealth KW - ICT KW - Information and Communication Technology KW - community KW - chatbot KW - COVID-19 KW - health equity KW - mobile health KW - health outcome KW - health disparity KW - minority population KW - health care gap KW - chatbot tool KW - user experience KW - chatbot development KW - health information N2 - Background: Disparities in COVID-19 information and vaccine access have emerged during the pandemic. Individuals from historically excluded communities (eg, Black and Latin American) experience disproportionately negative health outcomes related to COVID-19. Community gaps in COVID-19 education, social, and health care services (including vaccines) should be prioritized as a critical effort to end the pandemic. Misinformation created by the politicization of COVID-19 and related public health measures has magnified the pandemic?s challenges, including access to health care, vaccination and testing efforts, as well as personal protective equipment. Information and Communication Technology (ICT) has been demonstrated to reduce the gaps of marginalization in education and access among communities. Chatbots are an increasingly present example of ICTs, particularly in health care and in relation to the COVID-19 pandemic. Objective: This project aimed to (1) follow an inclusive and theoretically driven design process to develop and test a COVID-19 information ICT bilingual (English and Spanish) chatbot tool named ?Ana? and (2) characterize and evaluate user experiences of these innovative technologies. Methods: Ana was developed following a multitheoretical framework, and the project team was comprised of public health experts, behavioral scientists, community members, and medical team. A total of 7 iterations of ß chatbots were tested, and a total of 22 ß testers participated in this process. Content was curated primarily to provide users with factual answers to common questions about COVID-19. To ensure relevance of the content, topics were driven by community concerns and questions, as ascertained through research. Ana?s repository of educational content was based on national and international organizations as well as interdisciplinary experts. In the context of this development and pilot project, we identified an evaluation framework to explore reach, engagement, and satisfaction. Results: A total of 626 community members used Ana from August 2021 to March 2022. Among those participants, 346 used the English version, with an average of 43 users per month; and 280 participants used the Spanish version, with an average of 40 users monthly. Across all users, 63.87% (n=221) of English users and 22.14% (n=62) of Spanish users returned to use Ana at least once; 18.49% (n=64) among the English version users and 18.57% (n=52) among the Spanish version users reported their ranking. Positive ranking comprised the ?smiley? and ?loved? emojis, and negative ranking comprised the ?neutral,? ?sad,? and ?mad? emojis. When comparing negative and positive experiences, the latter was higher across Ana?s platforms (English: n=41, 64.06%; Spanish: n=41, 77.35%) versus the former (English: n=23, 35.93%; Spanish: n=12, 22.64%). Conclusions: This pilot project demonstrated the feasibility and capacity of an innovative ICT to share COVID-19 information within diverse communities. Creating a chatbot like Ana with bilingual content contributed to an equitable approach to address the lack of accessible COVID-19?related information. UR - https://formative.jmir.org/2023/1/e39045 UR - http://dx.doi.org/10.2196/39045 UR - http://www.ncbi.nlm.nih.gov/pubmed/36630649 ID - info:doi/10.2196/39045 ER - TY - JOUR AU - Wlasak, Wendy AU - Zwanenburg, Paul Sander AU - Paton, Chris PY - 2023/1/25 TI - Supporting Autonomous Motivation for Physical Activity With Chatbots During the COVID-19 Pandemic: Factorial Experiment JO - JMIR Form Res SP - e38500 VL - 7 KW - autonomous motivation KW - chatbots KW - self-determination theory KW - physical activity KW - factorial experiment KW - mobile phone KW - COVID-19 N2 - Background: Although physical activity can mitigate disease trajectories and improve and sustain mental health, many people have become less physically active during the COVID-19 pandemic. Personal information technology, such as activity trackers and chatbots, can technically converse with people and possibly enhance their autonomous motivation to engage in physical activity. The literature on behavior change techniques (BCTs) and self-determination theory (SDT) contains promising insights that can be leveraged in the design of these technologies; however, it remains unclear how this can be achieved. Objective: This study aimed to evaluate the feasibility of a chatbot system that improves the user?s autonomous motivation for walking based on BCTs and SDT. First, we aimed to develop and evaluate various versions of a chatbot system based on promising BCTs. Second, we aimed to evaluate whether the use of the system improves the autonomous motivation for walking and the associated factors of need satisfaction. Third, we explored the support for the theoretical mechanism and effectiveness of various BCT implementations. Methods: We developed a chatbot system using the mobile apps Telegram (Telegram Messenger Inc) and Google Fit (Google LLC). We implemented 12 versions of this system, which differed in 3 BCTs: goal setting, experimenting, and action planning. We then conducted a feasibility study with 102 participants who used this system over the course of 3 weeks, by conversing with a chatbot and completing questionnaires, capturing their perceived app support, need satisfaction, physical activity levels, and motivation. Results: The use of the chatbot systems was satisfactory, and on average, its users reported increases in autonomous motivation for walking. The dropout rate was low. Although approximately half of the participants indicated that they would have preferred to interact with a human instead of the chatbot, 46.1% (47/102) of the participants stated that the chatbot helped them become more active, and 42.2% (43/102) of the participants decided to continue using the chatbot for an additional week. Furthermore, the majority thought that a more advanced chatbot could be very helpful. The motivation was associated with the satisfaction of the needs of competence and autonomy, and need satisfaction, in turn, was associated with the perceived system support, providing support for SDT underpinnings. However, no substantial differences were found across different BCT implementations. Conclusions: The results provide evidence that chatbot systems are a feasible means to increase autonomous motivation for physical activity. We found support for SDT as a basis for the design, laying a foundation for larger studies to confirm the effectiveness of the selected BCTs within chatbot systems, explore a wider range of BCTs, and help the development of guidelines for the design of interactive technology that helps users achieve long-term health benefits. UR - https://formative.jmir.org/2023/1/e38500 UR - http://dx.doi.org/10.2196/38500 UR - http://www.ncbi.nlm.nih.gov/pubmed/36512402 ID - info:doi/10.2196/38500 ER - TY - JOUR AU - Kittipimpanon, Kamonrat AU - Noyudom, Angun AU - Panjatharakul, Pawanrat AU - Visudtibhan, Janepanish Poolsuk PY - 2023/1/24 TI - Use of and Satisfaction With Mobile Health Education During the COVID-19 Pandemic in Thailand: Cross-sectional Study JO - JMIR Form Res SP - e43639 VL - 7 KW - mHealth KW - COVID-19 KW - chatbot KW - use KW - satisfaction N2 - Background: RamaCovid is a mobile health (mHealth) education system that provides the Thai population with information about COVID-19 and self-risk assessment. RamaCovid has a chatbot system that provides automatic conversations (available 24 hours per day) and a live chat function that allows users to directly communicate with health professionals (available 4 hours per day in the evening). The system consists of (1) COVID-19 vaccine information, (2) self-care after vaccination, (3) frequently asked questions, (4) self-risk assessment, (5) hospital finding, (6) contact number finding, and (7) live chat with a health professional. Objective: This study investigates the use of and satisfaction with the RamaCovid system. Methods: Overall, 400 people were recruited via RamaCovid by broadcasting an infographic about the study. Questionnaires collected demographic data, users? experiences of RamaCovid, and the use of and satisfaction with the system. The questions were answered using a 5-point Likert scale. Descriptive statistics were used to describe the participant characteristics and their use of and satisfaction with the RamaCovid system. The Mann-Whitney U test was performed to examine the difference in use and satisfaction between the adult and older adult groups. Results: The participants showed high use of and satisfaction with the RamaCovid system. They used the information to take care of themselves and their family, and they gained information about their COVID-19 risk. The users were satisfied with the system because the information was easy to understand, trustworthy, and up to date. However, the older adult group had lower use of and satisfaction with the system compared to the adult group. Conclusions: RamaCovid is an example of the successful implementation of mHealth education. It was an alternative way to work with the call center during the COVID-19 pandemic and increased access to health information and health care services. Providing ongoing updated information, improving the attractiveness of the media information, and the age group difference are important issues for further system development. UR - https://formative.jmir.org/2023/1/e43639 UR - http://dx.doi.org/10.2196/43639 UR - http://www.ncbi.nlm.nih.gov/pubmed/36596210 ID - info:doi/10.2196/43639 ER - TY - JOUR AU - Hoogendoorn, Petra AU - Versluis, Anke AU - van Kampen, Sanne AU - McCay, Charles AU - Leahy, Matt AU - Bijlsma, Marlou AU - Bonacina, Stefano AU - Bonten, Tobias AU - Bonthuis, Marie-José AU - Butterlin, Anouk AU - Cobbaert, Koen AU - Duijnhoven, Thea AU - Hallensleben, Cynthia AU - Harrison, Stuart AU - Hastenteufel, Mark AU - Holappa, Terhi AU - Kokx, Ben AU - Morlion, Birgit AU - Pauli, Norbert AU - Ploeg, Frank AU - Salmon, Mark AU - Schnoor, Kyma AU - Sharp, Mary AU - Sottile, Angelo Pier AU - Värri, Alpo AU - Williams, Patricia AU - Heidenreich, Georg AU - Oughtibridge, Nicholas AU - Stegwee, Robert AU - Chavannes, H. Niels PY - 2023/1/23 TI - What Makes a Quality Health App?Developing a Global Research-Based Health App Quality Assessment Framework for CEN-ISO/TS 82304-2: Delphi Study JO - JMIR Form Res SP - e43905 VL - 7 KW - health app KW - wellness app KW - mobile health KW - mHealth KW - Delphi technique KW - quality assessment KW - assessment framework KW - standard KW - standardization KW - COVID-19 N2 - Background: The lack of an international standard for assessing and communicating health app quality and the lack of consensus about what makes a high-quality health app negatively affect the uptake of such apps. At the request of the European Commission, the international Standard Development Organizations (SDOs), European Committee for Standardization, International Organization for Standardization, and International Electrotechnical Commission have joined forces to develop a technical specification (TS) for assessing the quality and reliability of health and wellness apps. Objective: This study aimed to create a useful, globally applicable, trustworthy, and usable framework to assess health app quality. Methods: A 2-round Delphi technique with 83 experts from 6 continents (predominantly Europe) participating in one (n=42, 51%) or both (n=41, 49%) rounds was used to achieve consensus on a framework for assessing health app quality. Aims included identifying the maximum 100 requirement questions for the uptake of apps that do or do not qualify as medical devices. The draft assessment framework was built on 26 existing frameworks, the principles of stringent legislation, and input from 20 core experts. A follow-up survey with 28 respondents informed a scoring mechanism for the questions. After subsequent alignment with related standards, the quality assessment framework was tested and fine-tuned with manufacturers of 11 COVID-19 symptom apps. National mirror committees from the 52 countries that participated in the SDO technical committees were invited to comment on 4 working drafts and subsequently vote on the TS. Results: The final quality assessment framework includes 81 questions, 67 (83%) of which impact the scores of 4 overarching quality aspects. After testing with people with low health literacy, these aspects were phrased as ?Healthy and safe,? ?Easy to use,? ?Secure data,? and ?Robust build.? The scoring mechanism enables communication of the quality assessment results in a health app quality score and label, alongside a detailed report. Unstructured interviews with stakeholders revealed that evidence and third-party assessment are needed for health app uptake. The manufacturers considered the time needed to complete the assessment and gather evidence (2-4 days) acceptable. Publication of CEN-ISO/TS 82304-2:2021 Health software ? Part 2: Health and wellness apps ? Quality and reliability was approved in May 2021 in a nearly unanimous vote by 34 national SDOs, including 6 of the 10 most populous countries worldwide. Conclusions: A useful and usable international standard for health app quality assessment was developed. Its quality, approval rate, and early use provide proof of its potential to become the trusted, commonly used global framework. The framework will help manufacturers enhance and efficiently demonstrate the quality of health apps, consumers, and health care professionals to make informed decisions on health apps. It will also help insurers to make reimbursement decisions on health apps. UR - https://formative.jmir.org/2023/1/e43905 UR - http://dx.doi.org/10.2196/43905 UR - http://www.ncbi.nlm.nih.gov/pubmed/36538379 ID - info:doi/10.2196/43905 ER - TY - JOUR AU - Baldwin, M. Molly AU - Daynes, Enya AU - Chaplin, Emma AU - Goddard, Amye AU - Lloyd-Evans, I. Phoebe H. AU - Mills, George AU - Hong, Annabel AU - Gardiner, Nikki AU - Singh, J. Sally PY - 2023/1/20 TI - Public Use of the ?Your COVID Recovery? Website Designed to Help Individuals Manage Their COVID-19 Recovery: Observational Study JO - JMIR Form Res SP - e37811 VL - 7 KW - COVID-19 KW - coronavirus KW - pandemic KW - symptom management KW - digital healthcare KW - Google Analytics KW - website analysis KW - digital health tool KW - user behavior KW - healthcare platform N2 - Background: At the start of the COVID-19 pandemic, unprecedented pressure was placed on health care services globally. An opportunity to alleviate this pressure was to introduce a digital health platform that provided COVID-19?related advice and helped individuals understand and manage their COVID-19 symptoms. Therefore, in July 2020, the Your COVID Recovery website was launched by the National Health Service of England with the aim of creating a practical tool that provides advice and support to individuals recovering from COVID-19. The website includes information on many of the key COVID-19 symptoms. To date, public use of the Your COVID Recovery website and user behavior remain unknown. However, this information is likely to afford insight into the impact of the website and most commonly experienced COVID-19 symptoms. Objective: This study aimed to evaluate public use of the Your COVID Recovery website, a digital health platform that provides support to individuals recovering from COVID-19, and determine user behavior during its first year of operation. Methods: Google Analytics software that was integrated into the Your COVID Recovery website was used to assess website use and user behavior between July 31, 2020, and July 31, 2021. Variables that were tracked included the number of users, user country of residence, traffic source, number of page views, number of session views, and mean session duration. User data were compared to COVID-19 case data downloaded from the UK government?s website. Results: During the study period, 2,062,394 users accessed the Your COVID Recovery website. The majority of users were located in the United Kingdom (1,265,061/2,062,394, 61.30%) and accessed the website via a search engine (1,443,057/2,062,394, 69.97%). The number of daily website users (n=15,298) peaked on January 18, 2021, during the second wave of COVID-19 in the United Kingdom. The most frequently visited pages after the home page were for the following COVID-19 symptoms: Cough (n=550,190, 12.17%), Fatigue (n=432,421, 9.56%), Musculoskeletal pain (n=406,859, 9.00%), Taste and smell (n=270,599, 5.98%), and Breathlessness (n=203,136, 4.49%). The average session duration was 1 minute 13 seconds. Conclusions: A large cohort of individuals actively sought help with their COVID-19 recovery from the website, championing the potential of this tool to target an unmet health care need. User behavior demonstrated that individuals were primarily seeking advice on how to relieve and manage COVID-19 symptoms, especially symptoms of cough, fatigue, and musculoskeletal pain. COVID-19 rehabilitation programs should use the results of this study to ensure that the program content meets the needs of the post?COVID-19 population. UR - https://formative.jmir.org/2023/1/e37811 UR - http://dx.doi.org/10.2196/37811 UR - http://www.ncbi.nlm.nih.gov/pubmed/36626648 ID - info:doi/10.2196/37811 ER - TY - JOUR AU - Rao, Suchitra AU - Bozio, Catherine AU - Butterfield, Kristen AU - Reynolds, Sue AU - Reese, E. Sarah AU - Ball, Sarah AU - Steffens, Andrea AU - Demarco, Maria AU - McEvoy, Charlene AU - Thompson, Mark AU - Rowley, Elizabeth AU - Porter, M. Rachael AU - Fink, V. Rebecca AU - Irving, A. Stephanie AU - Naleway, Allison PY - 2023/1/17 TI - Accuracy of COVID-19?Like Illness Diagnoses in Electronic Health Record Data: Retrospective Cohort Study JO - JMIR Form Res SP - e39231 VL - 7 KW - COVID-19 KW - COVID-like illness KW - COVID-19 case definition KW - sensitivity KW - specificity KW - positive predictive value KW - negative predictive value N2 - Background: Electronic health record (EHR) data provide a unique opportunity to study the epidemiology of COVID-19, clinical outcomes of the infection, comparative effectiveness of therapies, and vaccine effectiveness but require a well-defined computable phenotype of COVID-19?like illness (CLI). Objective: The objective of this study was to evaluate the performance of pathogen-specific and other acute respiratory illness (ARI) International Statistical Classification of Diseases-9 and -10 codes in identifying COVID-19 cases in emergency department (ED) or urgent care (UC) and inpatient settings. Methods: We conducted a retrospective observational cohort study using EHR, claims, and laboratory information system data of ED or UC and inpatient encounters from 4 health systems in the United States. Patients who were aged ?18 years, had an ED or UC or inpatient encounter for an ARI, and underwent a SARS-CoV-2 polymerase chain reaction test between March 1, 2020, and March 31, 2021, were included. We evaluated various CLI definitions using combinations of International Statistical Classification of Diseases-10 codes as follows: COVID-19?specific codes; CLI definition used in VISION network studies; ARI signs, symptoms, and diagnosis codes only; signs and symptoms of ARI only; and random forest model definitions. We evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of each CLI definition using a positive SARS-CoV-2 polymerase chain reaction test as the reference standard. We evaluated the performance of each CLI definition for distinct hospitalization and ED or UC cohorts. Results: Among 90,952 hospitalizations and 137,067 ED or UC visits, 5627 (6.19%) and 9866 (7.20%) were positive for SARS-CoV-2, respectively. COVID-19?specific codes had high sensitivity (91.6%) and specificity (99.6%) in identifying patients with SARS-CoV-2 positivity among hospitalized patients. The VISION CLI definition maintained high sensitivity (95.8%) but lowered specificity (45.5%). By contrast, signs and symptoms of ARI had low sensitivity and positive predictive value (28.9% and 11.8%, respectively) but higher specificity and negative predictive value (85.3% and 94.7%, respectively). ARI diagnoses, signs, and symptoms alone had low predictive performance. All CLI definitions had lower sensitivity for ED or UC encounters. Random forest approaches identified distinct CLI definitions with high performance for hospital encounters and moderate performance for ED or UC encounters. Conclusions: COVID-19?specific codes have high sensitivity and specificity in identifying adults with positive SARS-CoV-2 test results. Separate combinations of COVID-19-specific codes and ARI codes enhance the utility of CLI definitions in studies using EHR data in hospital and ED or UC settings. UR - https://formative.jmir.org/2023/1/e39231 UR - http://dx.doi.org/10.2196/39231 UR - http://www.ncbi.nlm.nih.gov/pubmed/36383633 ID - info:doi/10.2196/39231 ER - TY - JOUR AU - Kaplan, Samantha AU - von Isenburg, Megan AU - Waldrop, Lucy PY - 2023/1/11 TI - Prepandemic Antivaccination Websites' COVID-19 Vaccine Behavior: Content Analysis of Archived Websites JO - JMIR Form Res SP - e40291 VL - 7 KW - antivaccination behavior KW - web archiving KW - content analysis KW - COVID-19 vaccines KW - COVID-19 KW - vaccine KW - website KW - web KW - pandemic KW - safety KW - science KW - content N2 - Background: The onset of the COVID-19 pandemic and the concurrent development of vaccines offered a rare and somewhat unprecedented opportunity to study antivaccination behavior as it formed over time via the use of archived versions of websites. Objective: This study aims to assess how existing antivaccination websites modified their content to address COVID-19 vaccines and pandemic restrictions. Methods: Using a preexisting collection of 25 antivaccination websites curated by the IvyPlus Web Collection Program prior to the pandemic and crawled every 6 months via Archive-It, we conducted a content analysis to see how these websites acknowledged or ignored COVID-19 vaccines and pandemic restrictions. Websites were assessed for financial behaviors such as having storefronts, mention of COVID-19 vaccines in general or by manufacturer name, references to personal freedom such as masking, safety concerns like side effects, and skepticism of science. Results: The majority of websites addressed COVID-19 vaccines in a negative fashion, with more websites making appeals to personal freedom or expressing skepticism of science than questioning safety. This can potentially be attributed to the lack of available safety data about the vaccines at the time of data collection. Many of the antivaccination websites we evaluated actively sought donations and had a membership option, evidencing these websites have financial motivations and actively build a community around these issues. The content analysis also offered the opportunity to test the viability of archived websites for use in scholarly research. The archived versions of the websites had significant shortcomings, particularly in search functionality, and required supplementation with the live websites. For web archiving to be a viable source of stand-alone content for research, the technology needs to make significant improvements in its capture abilities. Conclusions: In summary, we found antivaccination websites existing prior to the COVID-19 pandemic largely adapted their messaging to address COVID-19 vaccines with very few sites ignoring the pandemic altogether. This study also demonstrated the timely and significant need for more robust web archiving capabilities as web-based environments become more ephemeral and unstable. UR - https://formative.jmir.org/2023/1/e40291 UR - http://dx.doi.org/10.2196/40291 UR - http://www.ncbi.nlm.nih.gov/pubmed/36548948 ID - info:doi/10.2196/40291 ER - TY - JOUR AU - Ishigaki, Yo AU - Yokogawa, Shinji AU - Minamoto, Yuki AU - Saito, Akira AU - Kitamura, Hiroko AU - Kawauchi, Yuto PY - 2022/12/30 TI - Pilot Evaluation of Possible Airborne Transmission in a Geriatric Care Facility Using Carbon Dioxide Tracer Gas: Case Study JO - JMIR Form Res SP - e37587 VL - 6 IS - 12 KW - nursing home KW - care home KW - airborne transmission KW - ventilation frequency KW - air change rate KW - ACR KW - computational fluid dynamics KW - CFD KW - mobile phone N2 - Background: Although several COVID-19 outbreaks have occurred in older adult care facilities throughout Japan, no field studies focusing on airborne infections within these settings have been reported. Countermeasures against airborne infection not only consider the air change rate (ACR) in a room but also the airflow in and between rooms. However, a specific method has not yet been established by Japanese public health centers or infectious disease?related organizations. Objective: In April 2021, 59 COVID-19 cases were reported in an older adult care facility in Miyagi, Japan, and airborne transmission was suspected. The objective of this study was to simultaneously reproduce the ACR and aerosol advection in this facility using the carbon dioxide (CO2) tracer gas method to elucidate the specific location and cause of the outbreak. These findings will guide our recommendations to the facility to prevent recurrence. Methods: In August 2021, CO2 sensors were placed in 5 rooms where airborne infection was suspected, and the CO2 concentration was intentionally increased using dry ice, which was subsequently removed. The ACR was then estimated by applying the Seidel equation to the time-series changes in the CO2 concentration due to ventilation. By installing multiple sensors outside the room, advection outside the room was monitored simultaneously. Aerosol advection was verified using computer simulations. Although the windows were closed at the time of the outbreak, we conducted experiments under open-window conditions to quantify the effects of window opening. Results: The ACR values at the time of the outbreak were estimated to be 2.0 to 6.8 h?1 in the rooms of the facility. A low-cost intervention of opening windows improved the ventilation frequency by a factor of 2.2 to 5.7. Ventilation depended significantly on the window-opening conditions (P values ranging from .001 to .03 for all rooms). Aerosol advection was detected from the private room to the day room in agreement with the simulation results. Considering that the individual who initiated the infection was in the private room on the day of infection, and several residents, who later became secondarily infected, were gathered in the day room, it was postulated that the infectious aerosol was transmitted by this air current. Conclusions: The present results suggest that secondary infections can occur owing to aerosol advection driven by large-scale flow, even when the building design adheres to the ventilation guidelines established in Japan. Moreover, the CO2 tracer gas method facilitates the visualization of areas at a high risk of airborne infection and demonstrates the effectiveness of window opening, which contributes to improved facility operations and recurrence prevention. UR - https://formative.jmir.org/2022/12/e37587 UR - http://dx.doi.org/10.2196/37587 UR - http://www.ncbi.nlm.nih.gov/pubmed/36583933 ID - info:doi/10.2196/37587 ER - TY - JOUR AU - Konteh, Hassan Frederick AU - Mannion, Russell AU - Jacobs, Rowena PY - 2022/12/29 TI - IT and the Quality and Efficiency of Mental Health Care in a Time of COVID-19: Case Study of Mental Health Providers in England JO - JMIR Form Res SP - e37533 VL - 6 IS - 12 KW - COVID-19 KW - mental health care KW - information technology KW - digital KW - inequalities KW - sociotechnical systems N2 - Background: In England, COVID-19 has significantly affected mental health care and tested the resilience of health care providers. In many areas, the increased use of IT has enabled traditional modes of service delivery to be supported or even replaced by remote forms of provision. Objective: This study aimed to assess the use and impact of IT, in remote service provision, on the quality and efficiency of mental health care during the pandemic. We drew on sociotechnical systems theory as a conceptual framework to help structure the gathering, analysis, and interpretation of data. Methods: We conducted a national scoping survey that involved documentary analysis and semistructured interviews with 6 national stakeholders and case studies of 4 purposefully selected mental health providers in England involving interviews with 53 staff members. Results: Following the outbreak of COVID-19, mental health providers rapidly adjusted their traditional forms of service delivery, switching to digital and telephone consultations for most services. The informants provided nuanced perspectives on the impact on the quality and efficiency of remote service delivery during the pandemic. Notably, it has allowed providers to attend to as many patients as possible in the face of COVID-19 restrictions, to the convenience of both patients and staff. Among its negative effects are concerns about the unsuitability of remote consultation for some people with mental health conditions and the potential to widen the digital divide and exacerbate existing inequalities. Sociotechnical systems theory was found to be a suitable framework for understanding the range of systemic and sociotechnical factors that influence the use of technology in mental health care delivery in times of crisis and normalcy. Conclusions: Although the use of IT has boosted mental health care delivery during the pandemic, it has had mixed effects on quality and efficiency. In general, patients have benefited from the convenience of remote consultation when face-to-face contact was impossible. In contrast, patient choice was often compromised, and patient experience and outcomes might have been affected for some people with mental health conditions for which remote consultation is less suitable. However, the full impact of IT on the quality and efficiency of mental health care provision along with the systemic and sociotechnical determinants requires more sustained and longitudinal research. UR - https://formative.jmir.org/2022/12/e37533 UR - http://dx.doi.org/10.2196/37533 UR - http://www.ncbi.nlm.nih.gov/pubmed/36423321 ID - info:doi/10.2196/37533 ER - TY - JOUR AU - Cai, Ruilie AU - Zhang, Jiajia AU - Li, Zhenlong AU - Zeng, Chengbo AU - Qiao, Shan AU - Li, Xiaoming PY - 2022/12/20 TI - Using Twitter Data to Estimate the Prevalence of Symptoms of Mental Disorders in the United States During the COVID-19 Pandemic: Ecological Cohort Study JO - JMIR Form Res SP - e37582 VL - 6 IS - 12 KW - mental health KW - anxiety disorder KW - depressive disorder KW - COVID-19 KW - national survey KW - social media KW - Twitter KW - mixed model KW - anxiety KW - National Household Pulse survey KW - geospatial N2 - Background: Existing research and national surveillance data suggest an increase of the prevalence of mental disorders during the COVID-19 pandemic. Social media platforms, such as Twitter, could be a source of data for estimation owing to its real-time nature, high availability, and large geographical coverage. However, there is a dearth of studies validating the accuracy of the prevalence of mental disorders on Twitter compared to that reported by the Centers for Disease Control and Prevention (CDC). Objective: This study aims to verify the feasibility of Twitter-based prevalence of mental disorders symptoms being an instrument for prevalence estimation, where feasibility is gauged via correlations between Twitter-based prevalence of mental disorder symptoms (ie, anxiety and depressive symptoms) and that based on national surveillance data. In addition, this study aims to identify how the correlations changed over time (ie, the temporal trend). Methods: State-level prevalence of anxiety and depressive symptoms was retrieved from the national Household Pulse Survey (HPS) of the CDC from April 2020 to July 2021. Tweets were retrieved from the Twitter streaming application programming interface during the same period and were used to estimate the prevalence of symptoms of mental disorders for each state using keyword analysis. Stratified linear mixed models were used to evaluate the correlations between the Twitter-based prevalence of symptoms of mental disorders and those reported by the CDC. The magnitude and significance of model parameters were considered to evaluate the correlations. Temporal trends of correlations were tested after adding the time variable to the model. Geospatial differences were compared on the basis of random effects. Results: Pearson correlation coefficients between the overall prevalence reported by the CDC and that on Twitter for anxiety and depressive symptoms were 0.587 (P<.001) and 0.368 (P<.001), respectively. Stratified by 4 phases (ie, April 2020, August 2020, October 2020, and April 2021) defined by the HPS, linear mixed models showed that Twitter-based prevalence for anxiety symptoms had a positive and significant correlation with CDC-reported prevalence in phases 2 and 3, while a significant correlation for depressive symptoms was identified in phases 1 and 3. Conclusions: Positive correlations were identified between Twitter-based and CDC-reported prevalence, and temporal trends of these correlations were found. Geospatial differences in the prevalence of symptoms of mental disorders were found between the northern and southern United States. Findings from this study could inform future investigation on leveraging social media platforms to estimate symptoms of mental disorders and the provision of immediate prevention measures to improve health outcomes. UR - https://formative.jmir.org/2022/12/e37582 UR - http://dx.doi.org/10.2196/37582 UR - http://www.ncbi.nlm.nih.gov/pubmed/36459569 ID - info:doi/10.2196/37582 ER - TY - JOUR AU - Abou-Arraj, Elias Nadeem AU - Maddah, Diana AU - Buhamdan, Vanessa AU - Abbas, Roua AU - Jawad, Kamel Nadine AU - Karaki, Fatima AU - Alami, H. Nael AU - Geldsetzer, Pascal PY - 2022/12/14 TI - Perceptions of, and Obstacles to, SARS-CoV-2 Vaccination Among Adults in Lebanon: Cross-sectional Online Survey JO - JMIR Form Res SP - e36827 VL - 6 IS - 12 KW - Lebanon KW - COVID-19 KW - SARS-CoV-2 KW - coronavirus KW - vaccination KW - vaccine hesitancy KW - vaccine acceptance KW - health care system KW - misinformation KW - public health N2 - Background: The COVID-19 pandemic is an additional burden on Lebanon?s fragmented health care system and adds to its ongoing political, economic, and refugee crises. Vaccination is an important means of reducing the impact of the pandemic. Objective: Our study?s aims were to (1) assess the prevalences of intention to vaccinate and vaccine hesitancy in Lebanon; (2) determine how vaccine hesitancy in Lebanon varies by sociodemographic, economic, and geographic characteristics; and (3) understand individuals? motivations for vaccinating as well as concerns and obstacles to vaccination. Methods: We performed a cross-sectional study from January 29, 2021, to March 11, 2021, using an online questionnaire of open- and closed-ended questions in Arabic via convenience ?snowball? sampling to assess the perceptions of adults residing in Lebanon. Results: Of the 1185 adults who participated in the survey, 46.1% (95% CI: 43.2%-49.0%) intended to receive the SARS-CoV-2 vaccine when available to them, 19.0% (95% CI 16.8%-21.4%) indicated they would not, and 34.0% (95% CI 31.3%-36.8%) were unsure (with an additional 0.9% skipping this question). The most common reasons for hesitancy were concerns about safety, limited testing, side effects, and efficacy. Top motivations for vaccinating were to protect oneself, protect one?s family and the public, and end the pandemic. Despite financial hardships in Lebanon, barriers to vaccine access were not frequently described as concerns. Established health care facilities, rather than new temporary vaccination centers, were most frequently selected as preferred vaccination sites. Conclusions: Vaccine hesitancy appears to be high in Lebanon. Disseminating clear, consistent, evidence-based safety and efficacy information on vaccines may help reduce vaccine hesitancy, especially among the large proportion of adults who appear to be unsure about (rather than opposed to) vaccination. UR - https://formative.jmir.org/2022/12/e36827 UR - http://dx.doi.org/10.2196/36827 UR - http://www.ncbi.nlm.nih.gov/pubmed/36383635 ID - info:doi/10.2196/36827 ER - TY - JOUR AU - Villius Zetterholm, My AU - Nilsson, Lina AU - Jokela, Päivi PY - 2022/12/12 TI - Using a Proximity-Detection Technology to Nudge for Physical Distancing in a Swedish Workplace During the COVID-19 Pandemic: Retrospective Case Study JO - JMIR Form Res SP - e39570 VL - 6 IS - 12 KW - case study KW - COVID-19 KW - feasibility KW - mixed methods KW - nudging KW - physical distance KW - preventive behavior KW - preventive technologies KW - proximity detecting technology KW - wearables N2 - Background: The recent COVID-19 pandemic has contributed to the emergence of several technologies for infectious disease management. Although much focus has been placed on contact-tracing apps, another promising new tactic is proximity tracing, which focuses on health-related behavior and can be used for primary prevention. Underpinned by theories on behavioral design, a proximity-detection system can be devised that provides a user with immediate nudges to maintain physical distance from others. However, the practical feasibility of proximity detection during an infectious disease outbreak has not been sufficiently investigated. Objective: We aimed to evaluate the feasibility of using a wearable device to nudge for distance and to gather important insights about how functionality and interaction are experienced by users. The results of this study can guide future research and design efforts in this emerging technology. Methods: In this retrospective case study, a wearable proximity-detection technology was used in a workplace for 6 weeks during the production of a music competition. The purpose of the technology was to nudge users to maintain their physical distance using auditory feedback. We used a mixed methods sequential approach, including interviews (n=8) and a survey (n=30), to compile the experiences of using wearable technology in a real-life setting. Results: We generated themes from qualitative analysis based on data from interviews and open-text survey responses. The quantitative data were subsequently integrated into these themes: feasibility (implementation and acceptance?establishing a shared problem; distance tags in context?strategy, environment, and activities; understanding and learning; and accomplishing the purpose) and design aspects (a purposefully annoying device; timing, tone, and proximity; and additional functions). Conclusions: This empirical study reports on the feasibility of using wearable technology based on proximity detection to nudge individuals to maintain physical distance in the workplace. The technology supports attention to distance, but the usability of this approach is dependent on the context and situation. In certain situations, the audio signal is frustrating, but most users agree that it needs to be annoying to ensure sufficient behavioral adaption. We proposed a dual nudge that involves vibration followed by sound. There are indications that the technology also facilitates learning how to maintain a greater distance from others, and that this behavior can persist beyond the context of technology use. This study demonstrates that the key value of this technology is that it places the user in control and enables immediate action when the distance to others is not maintained. This study provides insights into the emerging field of personal and wearable technologies used for primary prevention during infectious disease outbreaks. Future research is needed to evaluate the preventive effect on transmission and investigate behavioral changes in detail and in relation to different forms of feedback. UR - https://formative.jmir.org/2022/12/e39570 UR - http://dx.doi.org/10.2196/39570 UR - http://www.ncbi.nlm.nih.gov/pubmed/36343202 ID - info:doi/10.2196/39570 ER - TY - JOUR AU - Zhang, Zhan AU - Vaghefi, Isaac PY - 2022/12/8 TI - Continued Use of Contact-Tracing Apps in the United States and the United Kingdom: Insights From a Comparative Study Through the Lens of the Health Belief Model JO - JMIR Form Res SP - e40302 VL - 6 IS - 12 KW - contact tracing KW - app adoption KW - app continued use KW - public attitudes KW - health belief model KW - COVID-19 N2 - Background: To contain the spread of SARS-CoV-2, contact-tracing (CT) mobile apps were developed and deployed to identify and notify individuals who have exposure to the virus. However, the effectiveness of these apps depends not only on their adoption by the general population but also on their continued use in the long term. Limited research has investigated the facilitators of and barriers to the continued use of CT apps. Objective: In this study, we aimed to examine factors influencing the continued use intentions of CT apps based on the health belief model. In addition, we investigated the differences between users and nonusers and between the US and UK populations. Methods: We administered a survey in the United States and the United Kingdom. Respondents included individuals who had previously used CT technologies and those without experience. We used the structural equation modeling technique to validate the proposed research model and hypotheses. Results: Analysis of data collected from 362 individuals showed that perceived benefits, self-efficacy, perceived severity, perceived susceptibility, and cues to action positively predicted the continued use intentions of CT apps, while perceived barriers could reduce them. We observed few differences between the US and UK groups; the only exception was the effect of COVID-19 threat susceptibility, which was significant for the UK group but not for the US group. Finally, we found that the only significant difference between users and nonusers was related to perceived barriers, which may not influence nonusers? continued use intentions but significantly reduce experienced users? intentions. Conclusions: Our findings have implications for technological design and policy. These insights can potentially help governments, technology companies, and media outlets to create strategies and policies to promote app adoption for new users and sustain continued use for existing users in the long run. UR - https://formative.jmir.org/2022/12/e40302 UR - http://dx.doi.org/10.2196/40302 UR - http://www.ncbi.nlm.nih.gov/pubmed/36351080 ID - info:doi/10.2196/40302 ER - TY - JOUR AU - Wells, Kenneth AU - Thames, Denise April AU - Young, S. Alexander AU - Zhang, Lily AU - Heilemann, V. MarySue AU - Romero, Flores Daniela AU - Oliva, Adrian AU - Jones, Felica AU - Tang, Lingqi AU - Brymer, Melissa AU - Elliott, Thomas AU - Arevian, Armen AU - PY - 2022/12/7 TI - Engagement, Use, and Impact of Digital Mental Health Resources for Diverse Populations in COVID-19: Community-Partnered Evaluation JO - JMIR Form Res SP - e42031 VL - 6 IS - 12 KW - digital mental health KW - prevention KW - COVID-19 KW - depression KW - hotline use KW - health disparity KW - community health KW - public health KW - health resource KW - mental well-being KW - ethnic KW - website engagement KW - minority population KW - digital resource N2 - Background: The COVID-19 pandemic increased disparities for communities burdened by structural barriers such as reduced affordable housing, with mental health consequences. Limited data are available on digital resources for public mental health prevention during the COVID-19 pandemic. Objective: The study aim was to evaluate engagement in and impact of free digital resources on the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website during COVID-19 in California. Methods: A pilot evaluation of T4W/Juntos was performed, with partner agencies inviting providers, clients, and partners to visit the website and complete surveys at baseline (September 20, 2021, to April 4, 2022) and at 4-6?week follow-up (October 22, 2021, to May 17, 2022). Website use was assessed by three engagement items (ease of use, satisfaction, relevance), comfort in use, and use of six resource categories. Primary outcomes at follow-up were depression and anxiety (scores?3 on Patient Health Questionnaire-2 item [PHQ2] and Generalized Anxiety Disorder-2 item [GAD2] scales). Secondary outcomes were post-pre differences in PHQ2 and GAD2 scores, and use of behavioral health hotlines and services the month before follow-up. Results: Of 366 eligible participants, 315 (86.1%) completed baseline and 193 (61.3%) completed follow-up surveys. Of baseline participants, 72.6% identified as female, and 21.3% identified as lesbian, gay, bisexual, transgender, queer/questioning, and others (LGBTQ+). In terms of ethnicity, 44.0% identified as Hispanic, 17.8% as African American, 26.9% as non-Hispanic white, and 11.4% as other ethnicity. Overall, 32.7% had moderate anxiety or depression (GAD2/PHQ2?3) at baseline. Predictors of baseline website engagement included being Hispanic versus other race/ethnicity (?=.27, 95% CI .10-.44; P=.002) and number of COVID-19?related behavior changes (?=.09, 95% CI .05-.13; P<.001). Predictors of comfort using the website were preferring English for website use (odds ratio [OR] 5.57, 95% CI 2.22-13.96; P<.001) and COVID-19?related behavior changes (OR 1.37, 95% CI 1.12-1.66; P=.002); receiving overnight behavioral health treatment in the prior 6 months (OR 0.15, 95% CI 0.03-0.69, P=.015) was associated with less comfort in website use. The main predictor of depression at follow-up (PHQ2?3) was baseline depression (OR 6.24, 95% CI 2.77-14.09; P<.001). Engagement in T4W/Juntos was associated with lower likelihood of depression (OR 0.54, 95% CI 0.34-0.86; P=.01). Website use the month before follow-up was associated with a post-pre reduction in PHQ2 score (?=?.62, 95% CI ?1.04 to ?0.20; P=.004). The main predictor of GAD2?3 at follow-up was baseline GAD2?3 (OR 13.65, 95% CI 6.06-30.72; P<.001). Greater baseline website engagement predicted reduced hotline use (OR 0.36, 95% CI 0.18-0.71; P=.004). Conclusions: Ethnicity/language and COVID-19?related behavior changes were associated with website engagement; engagement and use predicted reduced follow-up depression and behavioral hotline use. Findings are based on participants recommended by community agencies with moderate follow-up rates; however, significance was similar when weighting for nonresponse. This study may inform research and policy on digital mental health prevention resources. UR - https://formative.jmir.org/2022/12/e42031 UR - http://dx.doi.org/10.2196/42031 UR - http://www.ncbi.nlm.nih.gov/pubmed/36346902 ID - info:doi/10.2196/42031 ER - TY - JOUR AU - Flaks-Manov, Natalie AU - Bai, Jiawei AU - Zhang, Cindy AU - Malpani, Anand AU - Ray, C. Stuart AU - Taylor, Overby Casey PY - 2022/12/6 TI - Assessing Associations Between COVID-19 Symptomology and Adverse Outcomes After Piloting Crowdsourced Data Collection: Cross-sectional Survey Study JO - JMIR Form Res SP - e37507 VL - 6 IS - 12 KW - COVID-19 KW - coronavirus KW - symptoms KW - symptomology KW - crowdsourcing KW - adverse outcomes KW - data quality N2 - Background: Crowdsourcing is a useful way to rapidly collect information on COVID-19 symptoms. However, there are potential biases and data quality issues given the population that chooses to participate in crowdsourcing activities and the common strategies used to screen participants based on their previous experience. Objective: The study aimed to (1) build a pipeline to enable data quality and population representation checks in a pilot setting prior to deploying a final survey to a crowdsourcing platform, (2) assess COVID-19 symptomology among survey respondents who report a previous positive COVID-19 result, and (3) assess associations of symptomology groups and underlying chronic conditions with adverse outcomes due to COVID-19. Methods: We developed a web-based survey and hosted it on the Amazon Mechanical Turk (MTurk) crowdsourcing platform. We conducted a pilot study from August 5, 2020, to August 14, 2020, to refine the filtering criteria according to our needs before finalizing the pipeline. The final survey was posted from late August to December 31, 2020. Hierarchical cluster analyses were performed to identify COVID-19 symptomology groups, and logistic regression analyses were performed for hospitalization and mechanical ventilation outcomes. Finally, we performed a validation of study outcomes by comparing our findings to those reported in previous systematic reviews. Results: The crowdsourcing pipeline facilitated piloting our survey study and revising the filtering criteria to target specific MTurk experience levels and to include a second attention check. We collected data from 1254 COVID-19?positive survey participants and identified the following 6 symptomology groups: abdominal and bladder pain (Group 1); flu-like symptoms (loss of smell/taste/appetite; Group 2); hoarseness and sputum production (Group 3); joint aches and stomach cramps (Group 4); eye or skin dryness and vomiting (Group 5); and no symptoms (Group 6). The risk factors for adverse COVID-19 outcomes differed for different symptomology groups. The only risk factor that remained significant across 4 symptomology groups was influenza vaccine in the previous year (Group 1: odds ratio [OR] 6.22, 95% CI 2.32-17.92; Group 2: OR 2.35, 95% CI 1.74-3.18; Group 3: OR 3.7, 95% CI 1.32-10.98; Group 4: OR 4.44, 95% CI 1.53-14.49). Our findings regarding the symptoms of abdominal pain, cough, fever, fatigue, shortness of breath, and vomiting as risk factors for COVID-19 adverse outcomes were concordant with the findings of other researchers. Some high-risk symptoms found in our study, including bladder pain, dry eyes or skin, and loss of appetite, were reported less frequently by other researchers and were not considered previously in relation to COVID-19 adverse outcomes. Conclusions: We demonstrated that a crowdsourced approach was effective for collecting data to assess symptomology associated with COVID-19. Such a strategy may facilitate efficient assessments in a dynamic intersection between emerging infectious diseases, and societal and environmental changes. UR - https://formative.jmir.org/2022/12/e37507 UR - http://dx.doi.org/10.2196/37507 UR - http://www.ncbi.nlm.nih.gov/pubmed/36343205 ID - info:doi/10.2196/37507 ER - TY - JOUR AU - Craighead, G. Caitlin AU - Collart, Christina AU - Frankel, Richard AU - Rose, Susannah AU - Misra-Hebert, D. Anita AU - Tucker Edmonds, Brownsyne AU - Michie, Marsha AU - Chien, Edward AU - Coleridge, Marissa AU - Goje, Oluwatosin AU - Ranzini, C. Angela AU - Farrell, M. Ruth PY - 2022/12/5 TI - Impact of Telehealth on the Delivery of Prenatal Care During the COVID-19 Pandemic: Mixed Methods Study of the Barriers and Opportunities to Improve Health Care Communication in Discussions About Pregnancy and Prenatal Genetic Testing JO - JMIR Form Res SP - e38821 VL - 6 IS - 12 KW - prenatal health care delivery KW - health care communication KW - telehealth KW - access to health care KW - COVID-19 KW - pregnancy N2 - Background: The COVID-19 pandemic brought significant changes in health care, specifically the accelerated use of telehealth. Given the unique aspects of prenatal care, it is important to understand the impact of telehealth on health care communication and quality, and patient satisfaction. This mixed methods study examined the challenges associated with the rapid and broad implementation of telehealth for prenatal care delivery during the pandemic. Objective: In this study, we examined patients? perspectives, preferences, and experiences during the COVID-19 pandemic, with the aim of supporting the development of successful models to serve the needs of pregnant patients, obstetric providers, and health care systems during this time. Methods: Pregnant patients who received outpatient prenatal care in Cleveland, Ohio participated in in-depth interviews and completed the Coronavirus Perinatal Experiences-Impact Survey (COPE-IS) between January and December 2021. Transcripts were coded using NVivo 12, and qualitative analysis was used, an approach consistent with the grounded theory. Quantitative data were summarized and integrated during analysis. Results: Thematic saturation was achieved with 60 interviews. We learned that 58% (35/60) of women had telehealth experience prior to their current pregnancy. However, only 8% (5/60) of women had used both in-person and virtual visits during this pregnancy, while the majority (54/60, 90%) of women participated in only in-person visits. Among 59 women who responded to the COPE-IS, 59 (100%) felt very well supported by their provider, 31 (53%) were moderately to highly concerned about their child?s health, and 17 (29%) reported that the single greatest stress of COVID-19 was its impact on their child. Lead themes focused on establishing patient-provider relationships that supported shared decision-making, accessing the information needed for shared decision-making, and using technology effectively to foster discussions during the COVID-19 pandemic. Key findings indicated that participants felt in-person visits were more personal, established greater rapport, and built better trust in the patient-provider relationship as compared to telehealth visits. Further, participants felt they could achieve a greater dialogue and ask more questions regarding time-sensitive information, including prenatal genetic testing information, through an in-person visit. Finally, privacy concerns arose if prenatal genetic testing or general pregnancy conversations were to take place outside of the health care facility. Conclusions: While telehealth was recognized as an option to ensure timely access to prenatal care during the COVID-19 pandemic, it also came with multiple challenges for the patient-provider relationship. These findings highlighted the barriers and opportunities to achieve effective and patient-centered communication with the continued integration of telehealth in prenatal care delivery. It is important to address the unique needs of this population during the pandemic and as health care increasingly adopts a telehealth model. UR - https://formative.jmir.org/2022/12/e38821 UR - http://dx.doi.org/10.2196/38821 UR - http://www.ncbi.nlm.nih.gov/pubmed/36383634 ID - info:doi/10.2196/38821 ER - TY - JOUR AU - Nguyen, Elaine AU - Wright, Melanie AU - Holmes, John AU - Cleveland, Kevin AU - Oliphant, Catherine AU - Nies, Mary AU - Robinson, Renee PY - 2022/12/1 TI - Influences, Barriers, and Facilitators to COVID-19 Vaccination: Cross-sectional Survey on Vaccine Hesitancy in 2 Rural States JO - JMIR Form Res SP - e39109 VL - 6 IS - 12 KW - COVID-19 KW - COVID-19 vaccines KW - vaccine hesitancy KW - cross-sectional studies KW - rural populations N2 - Background: Vaccination remains one of the most effective ways to limit the spread of infectious diseases such as that caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19. Unfortunately, vaccination hesitancy continues to be a threat to national and global health. Further research is necessary to determine the modifiable and nonmodifiable factors contributing to COVID-19 vaccine hesitancy in under-resourced, underserved, and at-risk rural and urban communities. Objective: This study aimed to identify, understand, and address modifiable barriers and factors contributing to COVID-19 vaccine hesitancy among vaccine-eligible individuals with access to the vaccine in Alaska and Idaho. Methods: An electronic survey based on the World Health Organization (WHO) Strategic Advisory Group on Experts (SAGE) on Immunization survey tool and investigators? previous work was created and distributed in June 2021 and July 2021. To be eligible to participate in the survey, individuals had to be ?18 years of age and reside in Alaska or Idaho. Responses were grouped into 4 mutually exclusive cohorts for data analysis and reporting based on intentions to be vaccinated. Respondent characteristics and vaccine influences between cohorts were compared using Chi-square tests and ANOVA. Descriptive statistics were also used. Results: There were data from 736 usable surveys with 40 respondents who did not intend to be vaccinated, 27 unsure of their intentions, 8 who intended to be fully vaccinated with no doses received, and 661 fully vaccinated or who intended to be vaccinated with 1 dose received. There were significant differences in characteristics and influences between those who were COVID-19 vaccine-hesitant and those who had been vaccinated. Concerns related to possible side effects, enough information on long-term side effects, and enough information that is specific to the respondent?s health conditions were seen in those who did not intend to be fully vaccinated and unsure about vaccination. In all cohorts except those who did not intend to be fully vaccinated, more information about how well the vaccine works was a likely facilitator to vaccination. Conclusions: These survey results from 2 rural states indicate that recognition of individual characteristics may influence vaccine choices. However, these individual characteristics represent only a starting point to delivering tailored messages that should come from trusted sources to address vaccination barriers. UR - https://formative.jmir.org/2022/12/e39109 UR - http://dx.doi.org/10.2196/39109 UR - http://www.ncbi.nlm.nih.gov/pubmed/36067411 ID - info:doi/10.2196/39109 ER - TY - JOUR AU - Pullyblank, Kristin AU - Atav, Serdar PY - 2022/11/30 TI - Enrollment and Completion Characteristics for Novel Remote Delivery Modes of the Self-management Programs During the COVID-19 Pandemic: Exploratory Analysis JO - JMIR Form Res SP - e38357 VL - 6 IS - 11 KW - self-management programs KW - self management KW - internet-based intervention KW - health promotion KW - COVID-19 KW - health equity KW - socioeconomic status KW - remote healthcare KW - health delivery KW - virtual care KW - remote care KW - remote delivery KW - videoconference KW - videoconferencing KW - adherence KW - attrition KW - completion KW - virtual health N2 - Background: In-person, evidence-based, peer-facilitated chronic disease self-management programs have been shown to be effective for individuals from a variety of backgrounds, including rural and minority populations and those with lower socioeconomic status. Based in social learning theory, these programs use group processes to help participants better manage their chronic disease symptoms and improve their quality of life. During the pandemic, these in-person programs were forced to rapidly transition to remote delivery platforms, and it was unclear whether doing so increased disparities within our rural population. Objective: The objectives of this analysis were to ascertain self-management program enrollment and completion characteristics between 2 remote delivery platforms, as well as determine the individual level characteristics that drove enrollment and completion across delivery modes. Methods: We analyzed enrollment and completion characteristics of 183 individuals who either enrolled in a self-management workshop delivered through a web-based videoconference (VC) system or through a traditional, audio-only conference call (CC) offered by our health care network between April and December 2020. Chi-square tests of association were used to describe the characteristics of and differences between groups. Logistic regression analysis was used to determine significant predictors of enrollment and completion. Results: Those who enrolled in the VC platform were significantly likelier to be younger and college educated than those who enrolled in the CC platform. Those who completed a program, regardless of delivery mode, were likelier to be older and college educated than those who did not complete a program. Multivariate analyses indicated that of those enrolled in the CC platform, completers were likelier to not be enrolled in Medicaid. Among those enrolled in the VC platform, completers were older, college graduates, female, and likelier to have reported poorer health than those who did not complete the program. Conclusions: The transition of self-management programs to remote delivery modes, particularly to those that rely on VC platforms, revealed that certain demographic groups may no longer be able or willing to access the service. Efforts need to be made to increase engagement in remote self-management workshops. In addition, equivalent quality services that do not rely on a digital platform must continue to be offered in order to promote health equity. UR - https://formative.jmir.org/2022/11/e38357 UR - http://dx.doi.org/10.2196/38357 UR - http://www.ncbi.nlm.nih.gov/pubmed/36413622 ID - info:doi/10.2196/38357 ER - TY - JOUR AU - Yagiz, Ismail Jan AU - Goderis, Geert PY - 2022/11/28 TI - The Impact of the COVID-19 Pandemic on eHealth Use in the Daily Practice and Life of Dutch-Speaking General Practitioners in Belgium: Qualitative Study With Semistructured Interviews JO - JMIR Form Res SP - e41847 VL - 6 IS - 11 KW - COVID-19 KW - impact KW - eHealth KW - GPs KW - Flemish KW - practice KW - qualitative study KW - semistructured interviews N2 - Background: The COVID-19 crisis has led to rapid and far-reaching changes in digital health care, but little is known about what, why, and how changes occurred in eHealth use in Flemish general practice during the pandemic. Objective: This study aims to understand how general practitioners (GPs) perceive and evaluate eHealth solutions and their eHealth experience during the COVID-19 pandemic. Methods: This qualitative study was conducted using in-depth 1-on-1 semistructured interviews with the help of an interview guide. Several areas were identified beforehand to help assess the impact of the COVID-19 pandemic: perceptions of digital technologies in GP practices; changes in the use of these technologies during and after the COVID-19 pandemic; GPs? adaptation to digitalization, benefits, risks, and challenges of eHealth; GPs motivations to change practice; and future perspectives on eHealth. In this study, purposive sampling and snowballing methods were used. Between October 2021 and April 2022, we interviewed 15 Dutch-speaking GPs in the Flemish region via the Zoom online conferencing tool. Results: GPs indicated that eHealth was used more frequently during the COVID-19 pandemic than before, a change that helped them reduce their workload, enabling greater accessibility to health care services and the complementary use of digital and physical consultations. Our findings suggest that physicians underwent a significant cognitive shift in their perceptions, causing them to be more open and prepared to adopt eHealth solutions. However, there remains significant doubt and uncertainty about digital literacy for certain groups, privacy, data security, reimbursement, and the burden of technical information and communication technologies (ICT) issues. Conclusions: The COVID-19 pandemic seems to have been a turning point for eHealth by Flemish GPs. eHealth is an essential complementary health care service that can reduce pressure on health care as well as increase health care accessibility. Sensitive aspects, such as privacy, data security, digital literacy, reimbursement, and the burden of technical ICT issues, are particularly emphasized. With our results, we can offer recommendations to health IT policymakers and developers that will help maintain the continuity of eHealth solutions beyond the COVID-19 pandemic, considering the expectations and sensitivities presented in the study. UR - https://formative.jmir.org/2022/11/e41847 UR - http://dx.doi.org/10.2196/41847 UR - http://www.ncbi.nlm.nih.gov/pubmed/36399650 ID - info:doi/10.2196/41847 ER - TY - JOUR AU - Pech, Marion AU - Gbessemehlan, Antoine AU - Dupuy, Lucile AU - Sauzéon, Hélène AU - Lafitte, Stéphane AU - Bachelet, Philippe AU - Amieva, Hélène AU - Pérès, Karine PY - 2022/11/24 TI - Lessons Learned From the SoBeezy Program for Older Adults During the COVID-19 Pandemic: Experimentation and Evaluation JO - JMIR Form Res SP - e39185 VL - 6 IS - 11 KW - voice assistance KW - social isolation KW - healthy aging KW - living in place KW - acceptability KW - technologies KW - digital divide KW - older adults KW - aging KW - elderly population KW - voice assistant KW - COVID-19 N2 - Background: The SoBeezy program is an innovative intervention aimed at promoting and fostering healthy aging and aging in place by proposing to older adults concrete solutions to face daily life, tackle loneliness, promote social participation, and reduce the digital divide, thanks to a specific, easy-to-use voice assistant (the BeeVA smart display). Objective: This study aims to assess the acceptability of the SoBeezy program and its voice assistant and to identify potential areas of improvement. Methods: A 12-month experimentation of the program was deployed in real-life conditions among older adults living in the community in 4 pilot cities of France. Launched during the first lockdown of the COVID-19 crisis, this multisite study aimed to assess acceptability using questionnaires and interviews conducted at baseline and at the end of the experimentation. In addition, a series of meetings were conducted with SoBeezy staff members to obtain direct feedback from the ground. Results: In total, 109 older individuals were equipped with BeeVA to use the SoBeezy program; of these, 32 (29.4%) left the experimentation before its end and 69 (63.3%) completed the final questionnaires. In total, 335 interventions were conducted and 27 (39%) of the participants requested services, mainly for supportive calls and visits and assistance with shopping, transportation, and crafting-gardening. Of the whole sample, 52 (75%) considered BeeVA as a reassuring presence, and few persons (15/69, 22%) reported a negative opinion about the program. Among the participants, the voice assistant appeared easy to use (n=57, 82%) and useful (n=53, 77%). They also were positive about the BeeVA smart display and the SoBeezy intervention. Conclusions: This multisite study conducted in real-life conditions among more than 100 older adults living in the community provides enlightening results of the reality from the ground of digital tools designed for the aging population. The COVID-19 context appeared both as an opportunity, given the massive needs of the older adults during this crisis, and as limiting due to sanitary constraints. Nevertheless, the experimentation showed overall good acceptability of the voice assistant and a high level of satisfaction of the participants among those who really used the system and could be a way of improving the autonomy and well-being of older adults and their families. However, the findings also highlighted resistance to change and difficulties for the users to ask for help. The experimentation also emphasized levers for next deployments and future research. The next step will be the experimentation of the activity-sharing component that could not be tested due to the COVID-19 context. UR - https://formative.jmir.org/2022/11/e39185 UR - http://dx.doi.org/10.2196/39185 UR - http://www.ncbi.nlm.nih.gov/pubmed/36355629 ID - info:doi/10.2196/39185 ER - TY - JOUR AU - Ackleh-Tingle, V. Jonathan AU - Jordan, M. Natalie AU - Onwubiko, N. Udodirim AU - Chandra, Christina AU - Harton, E. Paige AU - Rentmeester, T. Shelby AU - Chamberlain, T. Allison PY - 2022/11/17 TI - Prevalence and Correlates of COVID-19 Vaccine Information on Family Medicine Practices? Websites in the United States: Cross-sectional Website Content Analysis JO - JMIR Form Res SP - e38425 VL - 6 IS - 11 KW - primary care KW - vaccine hesitancy KW - COVID-19 KW - health communications KW - health information KW - health website KW - family practice KW - vaccine information KW - online health KW - health platform KW - online information N2 - Background: Primary care providers are regarded as trustworthy sources of information about COVID-19 vaccines. Although primary care practices often provide information about common medical and public health topics on their practice websites, little is known about whether they also provide information about COVID-19 vaccines on their practice websites. Objective: This study aimed to investigate the prevalence and correlates of COVID-19 vaccine information on family medicine practices? website home pages in the United States. Methods: We used the Centers for Medicare and Medicaid National Provider Identifier records to create a sampling frame of all family medicine providers based in the United States, from which we constructed a nationally representative random sample of 964 family medicine providers. Between September 20 and October 8, 2021, we manually examined the practice websites of these providers and extracted data on the availability of COVID-19 vaccine information, and we implemented a 10% cross-review quality control measure to resolve discordances in data abstraction. We estimated the prevalence of COVID-19 vaccine information on practice websites and website home pages and used Poisson regression with robust error variances to estimate crude and adjusted prevalence ratios for correlates of COVID-19 vaccine information, including practice size, practice region, university affiliation, and presence of information about seasonal influenza vaccines. Additionally, we performed sensitivity analyses to account for multiple comparisons. Results: Of the 964 included family medicine practices, most (n=509, 52.8%) had ?10 distinct locations, were unaffiliated with a university (n=838, 87.2%), and mentioned seasonal influenza vaccines on their websites (n=540, 56.1%). In total, 550 (57.1%) practices mentioned COVID-19 vaccines on their practices? website home page, specifically, and 726 (75.3%) mentioned COVID-19 vaccines anywhere on their practice website. As practice size increased, the likelihood of finding COVID-19 vaccine information on the home page increased (n=66, 27.7% among single-location practices, n=114, 52.5% among practices with 2-9 locations, n=66, 56.4% among practices with 10-19 locations, and n=304, 77.6% among practices with 20 or more locations, P<.001 for trend). Compared to clinics in the Northeast, those in the West and Midwest United States had a similar prevalence of COVID-19 vaccine information on website home pages, but clinics in the south had a lower prevalence (adjusted prevalence ratio 0.8, 95% CI 0.7 to 1.0; P=.02). Our results were largely unchanged in sensitivity analyses accounting for multiple comparisons. Conclusions: Given the ongoing COVID-19 pandemic, primary care practitioners who promote and provide vaccines should strongly consider utilizing their existing practice websites to share COVID-19 vaccine information. These existing platforms have the potential to serve as an extension of providers? influence on established and prospective patients who search the internet for information about COVID-19 vaccines. UR - https://formative.jmir.org/2022/11/e38425 UR - http://dx.doi.org/10.2196/38425 UR - http://www.ncbi.nlm.nih.gov/pubmed/36343211 ID - info:doi/10.2196/38425 ER - TY - JOUR AU - Anderson, M. Katherine AU - Stockman, K. Jamila PY - 2022/11/17 TI - Fear of COVID-19 and Prevention Behaviors: Cross-Lagged Panel Analysis JO - JMIR Form Res SP - e35730 VL - 6 IS - 11 KW - fear appeals KW - structural equation modelling KW - cross-lagged model KW - prevention behavior KW - COVID-19 KW - fear KW - women KW - behavior KW - change KW - health KW - physical distance KW - relationships KW - pandemic KW - research KW - association KW - prevention KW - experience KW - panel KW - interest KW - public KW - distancing N2 - Background: The ongoing COVID-19 pandemic has brought forth conversations about effective behavior change models for increasing prevention behavior, ranging from wearing masks in public to physical distancing. Among the considered behavior change techniques is the use of fear appeals, through which a negative possible outcome is emphasized to invoke fear, which in turn may promote prevention behaviors to counter the likelihood of the negative outcome. Although fear is hypothesized as health promoting in some theories of health behavior, little research has rigorously assessed the relationship. Objective: In our exploratory analyses, we aim to examine the association, including directionality of the association between fear of COVID-19 and COVID-19 prevention behaviors across 2 time points during the early COVID-19 pandemic among a sample of US women. Methods: The COPE study, a web-based survey of US women?s COVID-19 experiences, was deployed in May-June 2020 (time 1) with follow-up in December 2020-January 2021 (time 2; n=200). Demographic characteristics as well as fear of COVID-19 and COVID-19 prevention behaviors (eg, staying home except for essential activities, physical distancing in public, and masking in public) were measured. Descriptive and bivariate analyses were used to characterize COVID-19 prevention behaviors and fear of COVID-19 among participants. Cross-lagged panel analysis, a type of structural equation modeling that assesses directionality of temporal associations, was used to understand relationships, if any, between variables of interest. Results: We found cross-sectional associations between fear of COVID-19 and staying home and physical distancing, as well as temporal associations between fear at time 1 and time 2 and prevention behaviors at time 1 and time 2. However, results of the cross-lagged panel analysis indicated no cross-lagged temporal relationships between fear of COVID-19 and COVID-19 prevention behaviors 6 months apart. Conclusions: Fear of COVID-19 did not appear to predict COVID-19 prevention behaviors 6 months after initial measurements among the sample of women recruited for our study. Future research should rigorously test these associations longitudinally, and alternative methods of public health prevention promotion should be considered. UR - https://formative.jmir.org/2022/11/e35730 UR - http://dx.doi.org/10.2196/35730 UR - http://www.ncbi.nlm.nih.gov/pubmed/36346895 ID - info:doi/10.2196/35730 ER - TY - JOUR AU - Nuñez, R. Tania AU - Pallasch, Nina AU - Radtke, Theda PY - 2022/11/15 TI - Students' Emotional Well-being and Academic Functioning Before, During, and After Lockdown in Germany: Cohort Study JO - JMIR Form Res SP - e34388 VL - 6 IS - 11 KW - self-efficacy KW - academic self-concept KW - test anxiety KW - achievement motivation KW - positive and negative affect KW - mobile phone KW - COVID-19 N2 - Background: The COVID-19 lockdowns have led to social detriments and altered learning environments among university students. Recent research indicates that such ramifications may engender various impairments to students? mental health. However, such research has major limitations, such as the lack of a prepandemic control measure, the focus on singular well-being parameters, or the investigation of only the early phases of the pandemic. Objective: To address these research gaps, this comprehensive and nationwide study compared 3 student cohorts (aged 17-48 years) in Germany: a prepandemic cohort (January-February 2020), a postlockdown cohort (May 2020-July 2020), and an intralockdown cohort (January-February 2021) regarding students? general emotional well-being and academic functioning. It was hypothesized that, because of rigorous lockdown-related restrictions, students in the intralockdown cohort would report diminished general emotional well-being compared with the other cohorts. Furthermore, because of ongoing remote learning since the beginning of the pandemic, it was expected that students? academic functioning would decrease across all 3 cohorts. Methods: The data collection was performed over 3 consecutive semesters (fall semester 2019-2020, spring semester 2020, and fall semester 2020-2021). Students were surveyed on the web on various aspects regarding their general emotional well-being (eg, stress and general well-being) and academic functioning (eg, concentration and study-related flow). Data analyses were performed using multivariate ANOVAs. Results: A total of 787 students participated in this study. Results indicated higher general well-being in the postlockdown cohort than in the intralockdown cohort (P=.02). As for students? academic functioning, our results revealed that students in the prepandemic cohort reported higher study-related flow (P=.007) and concentration (P=.001) than those in the intralockdown cohort. In addition, students reported higher flow (P=.04) and concentration (P=.04) in the postlockdown cohort than those in the intralockdown cohort. No cohort effects were revealed for other aspects of general emotional well-being (eg, perceived stress) and academic functioning (eg, procrastination). Conclusions: This study indicates that students? general emotional well-being as well as motivational and attentional components of academic functioning can be impaired owing to the COVID-19 lockdowns and ongoing remote learning formats. The necessity and design of interventional programs remedying such effects in light of the ongoing crisis need to be addressed. UR - https://formative.jmir.org/2022/11/e34388 UR - http://dx.doi.org/10.2196/34388 UR - http://www.ncbi.nlm.nih.gov/pubmed/36228133 ID - info:doi/10.2196/34388 ER - TY - JOUR AU - Chen, Xi AU - Yik, Michelle PY - 2022/11/14 TI - The Emotional Anatomy of the Wuhan Lockdown: Sentiment Analysis Using Weibo Data JO - JMIR Form Res SP - e37698 VL - 6 IS - 11 KW - Wuhan lockdown KW - COVID-19 KW - public health emergency KW - emotion KW - circumplex model of affect KW - Weibo KW - jiayou N2 - Background: On January 23, 2020, the city of Wuhan, China, was sealed off in response to the COVID-19 pandemic. Studies have found that the lockdown was associated with both positive and negative emotions, although their findings are not conclusive. In these studies, emotional responses to the Wuhan lockdown were identified using lexicons based on limited emotion types. Objective: This study aims to map Chinese people?s emotional responses to the Wuhan lockdown and compare Wuhan residents? emotions with those of people elsewhere in China by analyzing social media data from Weibo using a lexicon based on the circumplex model of affect. Methods: Social media posts on Weibo from 2 weeks before to 2 weeks after the Wuhan lockdown was imposed (January 9, 2020, to February 6, 2020) were collected. Each post was coded using a valence score and an arousal score. To map emotional trajectories during the study period, we used a data set of 359,190 posts. To compare the immediate emotional responses to the lockdown and its longer-term emotional impact on Wuhan residents (n=1236) and non-Hubei residents (n=12,714), we used a second data set of 57,685 posts for multilevel modeling analyses. Results: Most posts (248,757/359,190, 69.25%) made during the studied lockdown period indicated a pleasant mood with low arousal. A gradual increase in both valence and arousal before the lockdown was observed. The posts after the lockdown was imposed had higher valence and arousal than prelockdown posts. On the day of lockdown, the non-Hubei group had a temporarily boosted valence (?20=0.118; SE 0.021; P<.001) and arousal (?30=0.293; SE 0.022; P<.001). Compared with non-Hubei residents, the Wuhan group had smaller increases in valence (?21=?0.172; SE 0.052; P<.001) and arousal (?31=?0.262; SE 0.053; P<.001) on the day of lockdown. Weibo users? emotional valence (?40=0.000; SE 0.001; P=.71) and arousal (?40=0.001; SE 0.001; P=.56) remained stable over the 2 weeks after the lockdown was imposed regardless of geographical location (valence: ?41=?0.004, SE 0.003, and P=.16; arousal: ?41=0.003, SE 0.003, and P=.26). Conclusions: During the early stages of the pandemic, most Weibo posts indicated a pleasant mood with low arousal. The overall increase in the posts? valence and arousal after the lockdown announcement might indicate collective cohesion and mutual support in web-based communities during a public health crisis. Compared with the temporary increases in valence and arousal of non-Hubei users on the day of lockdown, Wuhan residents? emotions were less affected by the announcement. Overall, our data suggest that Weibo users were not influenced by the lockdown measures in the 2 weeks after the lockdown announcement. Our findings offer policy makers insights into the usefulness of social connections in maintaining the psychological well-being of people affected by a lockdown. UR - https://formative.jmir.org/2022/11/e37698 UR - http://dx.doi.org/10.2196/37698 UR - http://www.ncbi.nlm.nih.gov/pubmed/36166650 ID - info:doi/10.2196/37698 ER - TY - JOUR AU - Wilczewski, Hattie AU - Paige, R. Samantha AU - Ong, Triton AU - Soni, Hiral AU - Barrera, F. Janelle AU - Welch, M. Brandon AU - Bunnell, E. Brian PY - 2022/11/11 TI - Providers? Perspectives on Telemental Health Usage After the COVID-19 Pandemic: Retrospective Analysis JO - JMIR Form Res SP - e39634 VL - 6 IS - 11 KW - telemedicine KW - telehealth KW - COVID-19 KW - telemental health KW - mental health KW - pandemic KW - perception KW - use KW - usefulness KW - usage KW - workflow N2 - Background: Mental health care pivoted to telemedicine during the COVID-19 pandemic, and there is uncertainty around the sustainability of this rapid shift. Objective: This study examined how intentions to continue using telemedicine after the COVID-19 pandemic are influenced by provider perceptions of usefulness, ease of use, and professional social influence, facilitating organizational conditions. Methods: We conducted a web-based, cross-sectional survey of 369 telemental health providers between February and March 2021. A hierarchical linear regression analysis was conducted to predict intentions to continue using telemedicine after the COVID-19 pandemic. Results: Most providers began using telemedicine in March 2020 or later (257/369, 69.6%) and attended to ?50% of their clients via telemedicine (299/369, 81.0%). Intention to continue using telemedicine after the COVID-19 pandemic was predicted by the telemedicine caseload (?=.10; P=.005), perceived usefulness in general (?=.10; P=.008), ease of use (?=.08; P=.04), social influence (?=.68; P<.001), and facilitating conditions (?=.08; P=.047). Conclusions: Exploration of the predictors of telemedicine usage beyond the COVID-19 pandemic aids in surveillance of telemedicine usage, integration with future clinic workflows, and the shaping of public policy. It is important to consider telemedicine services as not only a response to a crisis but also an effective and useful solution for everyday life. Our results suggest widespread, sustainable telemedicine adoption. UR - https://formative.jmir.org/2022/11/e39634 UR - http://dx.doi.org/10.2196/39634 UR - http://www.ncbi.nlm.nih.gov/pubmed/36322787 ID - info:doi/10.2196/39634 ER - TY - JOUR AU - Tump, Danielle AU - Narayan, Nitin AU - Verbiest, Vera AU - Hermsen, Sander AU - Goris, Annelies AU - Chiu, Chui-De AU - Van Stiphout, Ruud PY - 2022/11/10 TI - Stressors and Destressors in Working From Home Based on Context and Physiology From Self-Reports and Smartwatch Measurements: International Observational Study Trial JO - JMIR Form Res SP - e38562 VL - 6 IS - 11 KW - stress KW - telework KW - wearables KW - COVID-19 KW - pandemic KW - remote working KW - employees KW - stressors KW - destressors KW - remote work KW - mental health KW - psychological health KW - smartphone KW - digital questionnaire KW - stress management KW - occupational health KW - stress detection KW - prediction model N2 - Background: The COVID-19 pandemic has greatly boosted working from home as a way of working, which is likely to continue for most companies in the future, either in fully remote or in hybrid form. To manage stress levels in employees working from home, insights into the stressors and destressors in a home office first need to be studied. Objective: We present an international remote study with employees working from home by making use of state-of-the-art technology (ie, smartwatches and questionnaires through smartphones) first to determine stressors and destressors in people working from home and second to identify smartwatch measurements that could represent these stressors and destressors. Methods: Employees working from home from 3 regions of the world (the United States, the United Kingdom, and Hong Kong) were asked to wear a smartwatch continuously for 7 days and fill in 5 questionnaires each day and 2 additional questionnaires before and after the measurement week. The entire study was conducted remotely. Univariate statistical analyses comparing variable distributions between low and high stress levels were followed by multivariate analysis using logistic regression, considering multicollinearity by using variance inflation factor (VIF) filtering. Results: A total of 202 people participated, with 198 (98%) participants finishing the experiment. Stressors found were other people and daily life getting in the way of work (P=.05), job intensity (P=.01), a history of burnout (P=.03), anxiety toward the pandemic (P=.04), and environmental noise (P=.01). Destressors found were access to sunlight (P=.02) and fresh air (P<.001) during the workday and going outdoors (P<.001), taking breaks (P<.001), exercising (P<.001), and having social interactions (P<.001). The smartwatch measurements positively related to stress were the number of active intensity periods (P<.001), the number of highly active intensity periods (P=.04), steps (P<.001), and the SD in the heart rate (HR; P<.001). In a multivariate setting, only a history of burnout (P<.001) and family and daily life getting in the way of work (P<.001) were positively associated with stress, while self-reports of social activities (P<.001) and going outdoors (P=.03) were negatively associated with stress. Stress prediction models based on questionnaire data had a similar performance (F1=0.51) compared to models based on automatic measurable data alone (F1=0.47). Conclusions: The results show that there are stressors and destressors when working from home that should be considered when managing stress in employees. Some of these stressors and destressors are (in)directly measurable with unobtrusive sensors, and prediction models based on these data show promising results for the future of automatic stress detection and management. Trial Registration: Netherlands Trial Register NL9378; https://trialsearch.who.int/Trial2.aspx?TrialID=NL9378 UR - https://formative.jmir.org/2022/11/e38562 UR - http://dx.doi.org/10.2196/38562 UR - http://www.ncbi.nlm.nih.gov/pubmed/36265030 ID - info:doi/10.2196/38562 ER - TY - JOUR AU - Logaras, Evangelos AU - Billis, Antonis AU - Kyparissidis Kokkinidis, Ilias AU - Ketseridou, Nafsika Smaranda AU - Fourlis, Alexios AU - Tzotzis, Aristotelis AU - Imprialos, Konstantinos AU - Doumas, Michael AU - Bamidis, Panagiotis PY - 2022/11/8 TI - Risk Assessment of COVID-19 Cases in Emergency Departments and Clinics With the Use of Real-World Data and Artificial Intelligence: Observational Study JO - JMIR Form Res SP - e36933 VL - 6 IS - 11 KW - COVID-19 pandemic KW - risk assessment KW - wearable device KW - respiration evaluation KW - emergency department KW - artificial intelligence KW - real-world data N2 - Background: The recent COVID-19 pandemic has highlighted the weaknesses of health care systems around the world. In the effort to improve the monitoring of cases admitted to emergency departments, it has become increasingly necessary to adopt new innovative technological solutions in clinical practice. Currently, the continuous monitoring of vital signs is only performed in patients admitted to the intensive care unit. Objective: The study aimed to develop a smart system that will dynamically prioritize patients through the continuous monitoring of vital signs using a wearable biosensor device and recording of meaningful clinical records and estimate the likelihood of deterioration of each case using artificial intelligence models. Methods: The data for the study were collected from the emergency department and COVID-19 inpatient unit of the Hippokration General Hospital of Thessaloniki. The study was carried out in the framework of the COVID-X H2020 project, which was funded by the European Union. For the training of the neural network, data collection was performed from COVID-19 cases hospitalized in the respective unit. A wearable biosensor device was placed on the wrist of each patient, which recorded the primary characteristics of the visual signal related to breathing assessment. Results: A total of 157 adult patients diagnosed with COVID-19 were recruited. Lasso penalty function was used for selecting 18 out of 48 predictors and 2 random forest?based models were implemented for comparison. The high overall performance was maintained, if not improved, by feature selection, with random forest achieving accuracies of 80.9% and 82.1% when trained using all predictors and a subset of them, respectively. Preliminary results, although affected by pandemic limitations and restrictions, were promising regarding breathing pattern recognition. Conclusions: This study represents a novel approach that involves the use of machine learning methods and Edge artificial intelligence to assist the prioritization and continuous monitoring procedures of patients with COVID-19 in health departments. Although initial results appear to be promising, further studies are required to examine its actual effectiveness. UR - https://formative.jmir.org/2022/11/e36933 UR - http://dx.doi.org/10.2196/36933 UR - http://www.ncbi.nlm.nih.gov/pubmed/36197836 ID - info:doi/10.2196/36933 ER - TY - JOUR AU - Gabashvili, S. Irene PY - 2022/11/4 TI - The Incidence and Effect of Adverse Events Due to COVID-19 Vaccines on Breakthrough Infections: Decentralized Observational Study With Underrepresented Groups JO - JMIR Form Res SP - e41914 VL - 6 IS - 11 KW - COVID-19 KW - COVID-19 vaccines KW - vaccine adverse events KW - breakthrough infections KW - decentralized participatory study KW - elderly KW - older individuals KW - medically underserved populations KW - aging KW - elderly population KW - vaccination KW - genetic disparity KW - microbiome disparity KW - impaired immunity N2 - Background: Despite continuing efforts to improve the inclusion of underserved groups in clinical research, gaps in diversity remain. Participation of special populations is especially important when facing problems of unprecedented complexity such as the COVID-19 pandemic. A better understanding of factors associated with the immune response in diverse populations would advance future preventive and curative approaches. Objective: The objective of this study was to investigate the factors potentially responsible for adverse events following COVID-19 immunization. The study population included adults from rural areas, transitional countries, and those with medically understudied conditions, across a broad age range. Methods: The study evolved from peer support networks developed during the COVID-19 pandemic. Participants were recruited digitally through online neighborhood and health communities. Some of the participants volunteered as study investigators assisting with offline recruitment and safety monitoring. Individuals who consented to participate were asked to share their vaccination experiences either using constantly evolving web-based surveys or via one-on-one communication. Inferential statistical analysis to estimate differences between study groups was performed using parametric and nonparametric tests. Results: Of 1430 participants who shared their vaccination experiences, 648 had outcome measures at their 1.5-year follow-up. Significant differences were found between age groups, types of vaccine adverse events (VAEs), incidences of breakthrough infections, and health conditions linked to the microbiome. Pairwise comparisons showed that VAEs interfering with daily activities were significantly higher in both younger (18-59 years) and older age groups (80-100 years, P<.001) than in the 60-79?year age group. Short-term VAEs were associated with lower incidence of breakthrough COVID-19 infections relative to those who reported either minimal or long-term adverse events (P<.001). A genetic origin was suggested for some adverse reactions. Conclusions: The findings of this study demonstrate that vaccine adverse reactions in older individuals are being overlooked, and the incidence of VAEs impairing immunity may be higher than previously perceived. Better preventive measures are needed for all those at risk for life-threatening and long-term adverse events due to vaccination. Supportive community-based studies focusing on these populations could add important data to the current body of knowledge. Further and more comprehensive studies should follow. Trial Registration: ClinicalTrials.gov NCT04832932; https://clinicaltrials.gov/ct2/show/NCT04832932 International Registered Report Identifier (IRRID): RR2-10.1101/2021.06.28.21256779 UR - https://formative.jmir.org/2022/11/e41914 UR - http://dx.doi.org/10.2196/41914 UR - http://www.ncbi.nlm.nih.gov/pubmed/36309347 ID - info:doi/10.2196/41914 ER - TY - JOUR AU - Lee, Katherine AU - Bolton, Shay-Lee AU - Shterenberg, Ravit AU - Bolton, M. James AU - Hensel, M. Jennifer PY - 2022/11/4 TI - Early Learning From a Low-Resource COVID-Response Virtual Mental Health Crisis Ward: Mixed Methods Study JO - JMIR Form Res SP - e39861 VL - 6 IS - 11 KW - virtual ward KW - mental health KW - COVID-19 KW - implementation KW - driver diagram KW - virtual care KW - virtual health care KW - acceptance KW - psychiatric support KW - crisis support KW - provider perspectives N2 - Background: The COVID-19 pandemic was accompanied by the accelerated uptake of virtual care, leading to a proliferation of virtual ward models as alternatives to facility-based care. Early in the pandemic, our program implemented a virtual mental health crisis ward (vWard) to provide options for individuals requiring intense psychiatric and/or crisis support but who preferred to remain in the community and were deemed safe to do so. Objective: The aim of this study was to identify early learnings from the vWard, which was implemented rapidly in a resource-constrained environment, to inform the future state should it be sustained beyond the pandemic. Methods: Mixed methods of data collection were used to evaluate provider perspectives on the vWard, develop archetypes for individuals who are a good fit for the vWard model, and create a driver diagram. Data sources included an anonymous survey of clinical and managerial staff involved in the vWard, a service planning workshop, and program discharge forms for all individuals admitted between March 2020 and April 2021. Survey responses were coded for themes under categories of ?benefits? and ?challenges.? Discharge forms where the team indicated that the vWard was a good fit for an individual were examined for characteristics common to these admissions. These findings were reviewed in the service planning workshop and refined with input from the participants into patient archetypes. A driver diagram was created for the future state. Results: Survey respondents (N=60) represented diverse roles in crisis services and the vWard team. Ten providers took part in the service planning workshop. A total of 467 discharge forms were reviewed. The vWard was felt to be a model that worked by 39 survey respondents, one respondent felt it did not work, and the remaining participants had no response. Several benefits for the individual and the system were identified alongside challenges, including certain processes and materials related to the nature of rapid implementation during the pandemic, and others due to lack of fit for certain individuals. The model was felt to be a good fit for 67.5% of admissions. Four patient archetypes representing a good fit with the model were developed. The driver diagram connected the program aim with primary drivers of (1) reduce barriers to care; (2) improve outcomes; and (3) provide collaborative, patient- and family-centered care to secondary drivers and interventions that leveraged virtual technology among other crisis care interventions. Conclusions: Despite some challenges, the vWard demonstrated high levels of provider acceptance and a range of mechanisms by which the model works for a variety of patient archetypes. These early learnings provide a foundation for growth, sustainability, and spread of this model going forward beyond the pandemic. UR - https://formative.jmir.org/2022/11/e39861 UR - http://dx.doi.org/10.2196/39861 UR - http://www.ncbi.nlm.nih.gov/pubmed/36252139 ID - info:doi/10.2196/39861 ER - TY - JOUR AU - van Gend, Elmar Joris AU - van 't Klooster, Roderick Jan Willem Jaap AU - Bolman, Wilhelmina Catherine Adriana AU - van Gemert-Pijnen, Cornelia Julia Elisabeth Wilhelmina PY - 2022/11/4 TI - The Dutch COVID-19 Notification App: Lessons Learned From a Mixed Methods Evaluation Among End Users and Contact-Tracing Employees JO - JMIR Form Res SP - e38904 VL - 6 IS - 11 KW - eHealth KW - contact tracing KW - digital contact tracing KW - contact-tracing apps KW - COVID-19 KW - adherence KW - public health KW - mobile health KW - topic analysis KW - health service KW - user experience KW - eHealth intervention KW - mobile phone N2 - Background: The Dutch CoronaMelder (CM) app is the official Dutch contact-tracing app (CTA). It has been used to contain the spread of the SARS-CoV-2 in the Netherlands. It allows its users and those of connected apps to anonymously exchange warnings about potentially high-risk contacts with individuals infected with the SARS-CoV-2. Objective: The goal of this mixed methods study is to understand the use of CTA in the pandemic and its integration into the Municipal Health Services (MHS) efforts of containment through contact tracing. Moreover, the study aims to investigate both the motivations and user experience?related factors concerning adherence to quarantine and isolation measures. Methods: A topic analysis of 56 emails and a web-based survey of 1937 adults from the Netherlands, combined with a series of 48 in-depth interviews with end users of the app and 14 employees of the Dutch MHS involved in contact tracing, were conducted. Mirroring sessions were held (n=2) with representatives from the development (n=2) and communication teams (n=2) responsible for the creation and implementation of the CM app. Results: Topic analysis and interviews identified procedural and technical issues in the use of the CTA. Procedural issues included the lack of training of MHS employees in the use of CTAs. Technical issues identified for the end users included the inability to send notifications without phone contact with the MHS, unwarranted notifications, and nightly notifications. Together, these issues undermined confidence in and satisfaction with the app?s use. The interviews offered a deeper understanding of the various factors at play and their effects on users; for example, the mixed experiences of the app?s users, the end user?s own fears, and uncertainties concerning the SARS-CoV-2; problematic infrastructure at the time of the app?s implementation on the side of the health services; the effects of the society-wide efforts in containment of the SARS-CoV-2 on the CM app?s perception, resulting in further doubts concerning the app?s effectiveness among MHS workers and citizens; and problems with adherence to behavioral measures propagated by the app because of the lack of confidence in the app and uncertainty concerning the execution of the behavioral measures. All findings were evaluated with the app?s creators and have since contributed to improvements. Conclusions: Although most participants perceived the app positively, procedural and technical issues identified in this study limited satisfaction and confidence in the CM app and affected its adoption and long-term use. Moreover, these same issues negatively affected the CM app?s effectiveness in improving compliance with behavioral measures aimed at reducing the spread of the SARS-CoV-2. This study offers lessons learned for future eHealth interventions in pandemics. Lessons that can aid in more effective design, implementation, and communication for more effective and readily adoptable eHealth applications. UR - https://formative.jmir.org/2022/11/e38904 UR - http://dx.doi.org/10.2196/38904 UR - http://www.ncbi.nlm.nih.gov/pubmed/36074930 ID - info:doi/10.2196/38904 ER - TY - JOUR AU - Ismail, Nashwa AU - Kbaier, Dhouha AU - Farrell, Tracie AU - Kane, Annemarie PY - 2022/11/2 TI - The Experience of Health Professionals With Misinformation and Its Impact on Their Job Practice: Qualitative Interview Study JO - JMIR Form Res SP - e38794 VL - 6 IS - 11 KW - health misinformation KW - social media KW - health professional KW - patients KW - trust KW - communication, COVID-19 KW - intervention KW - qualitative research KW - interpretive phenomenological analysis KW - thematic analysis KW - misinformation KW - health practitioner KW - infodemiology N2 - Background: Misinformation is often disseminated through social media, where information is spread rapidly and easily. Misinformation affects many patients' decisions to follow a treatment prescribed by health professionals (HPs). For example, chronic patients (eg, those with diabetes) may not follow their prescribed treatment plans. During the recent pandemic, misinformed people rejected COVID-19 vaccines and public health measures, such as masking and physical distancing, and used unproven treatments. Objective: This study investigated the impact of health-threatening misinformation on the practices of health care professionals in the United Kingdom, especially during the outbreaks of diseases where a great amount of health-threatening misinformation is produced and released. The study examined the misinformation surrounding the COVID-19 outbreak to determine how it may have impacted practitioners' perceptions of misinformation and how that may have influenced their practice. In particular, this study explored the answers to the following questions: How do HPs react when they learn that a patient has been misinformed? What misinformation do they believe has the greatest impact on medical practice? What aspects of change and intervention in HPs' practice are in response to misinformation? Methods: This research followed a qualitative approach to collect rich data from a smaller subset of health care practitioners working in the United Kingdom. Data were collected through 1-to-1 online interviews with 13 health practitioners, including junior and senior physicians and nurses in the United Kingdom. Results: Research findings indicated that HPs view misinformation in different ways according to the scenario in which it occurs. Some HPs consider it to be an acute incident exacerbated by the pandemic, while others see it as an ongoing phenomenon (always present) and address it as part of their daily work. HPs are developing pathways for dealing with misinformation. Two main pathways were identified: first, to educate the patient through coaching, advising, or patronizing and, second, to devote resources, such as time and effort, to facilitate 2-way communication between the patient and the health care provider through listening and talking to them. Conclusions: HPs do not receive the confidence they deserve from patients. The lack of trust in health care practitioners has been attributed to several factors, including (1) trusting alternative sources of information (eg, social media) (2) patients' doubts about HPs' experience (eg, a junior doctor with limited experience), and (3) limited time and availability for patients, especially during the pandemic. There are 2 dimensions of trust: patient-HP trust and patient-information trust. There are 2 necessary actions to address the issue of lack of trust in these dimensions: (1) building trust and (2) maintaining trust. The main recommendations of the HPs are to listen to patients, give them more time, and seek evidence-based resources. UR - https://formative.jmir.org/2022/11/e38794 UR - http://dx.doi.org/10.2196/38794 UR - http://www.ncbi.nlm.nih.gov/pubmed/36252133 ID - info:doi/10.2196/38794 ER - TY - JOUR AU - Chantziara, Sofia AU - Brigden L C, Amberly AU - Mccallum, H. Claire AU - Craddock, J. Ian PY - 2022/11/1 TI - Using Digital Tools for Contact Tracing to Improve COVID-19 Safety in Schools: Qualitative Study Exploring Views and Experiences Among School Staff JO - JMIR Form Res SP - e36412 VL - 6 IS - 11 KW - schools KW - contact tracing KW - COVID-19 mitigation KW - COVID-19 KW - pandemic KW - disease prevention KW - health technology KW - COVID-19 management KW - technology support KW - digital tool KW - mobile health KW - mobile technology N2 - Background: Throughout the pandemic, governments worldwide have issued guidelines to manage the spread and impact of COVID-19 in schools, including measures around social distancing and contact tracing. Whether schools required support to implement these guidelines has not yet been explored in depth. Despite the development of a range of technologies to tackle COVID-19, such as contact-tracing apps and electronic vaccine certificates, research on their usefulness in school settings has been limited. Objective: The aim of the study was to explore the needs of school staff in managing COVID-19 and their experiences and perspectives on technological support in relation to contact tracing. School staff are the ones likely to make key implementation decisions regarding new technologies, and they are also the ones responsible for using the new tools daily. Including both management staff and class teachers in the development of school-based technologies can lead to their successful adoption by schools. Methods: Semistructured interviews were conducted with UK school staff, including primary and secondary school teachers and school managers. Thematic analysis, facilitated by NVivo, was used to analyze the data. Two of the authors independently coded 5 (28%) of the interviews and reached a consensus on a coding framework. Results: Via purposive sampling, we recruited 18 participants from 5 schools. Findings showed that primary schools did not perform contact tracing, while in secondary schools, digital seating plans were used to identify close contacts in the classroom and manual investigations were also conducted identify social contacts. Participants reported that despite their efforts, high-risk interactions between students were not adequately monitored. There was a need to improve accuracy when identifying close contacts in common areas where students congregate. Proximity tracking, use of access cards, and closed-circuit television (CCTV) emerged as potential solutions, but there were concerns surrounding false alerts, burden, and security. Conclusions: School staff have found it difficult to monitor and implement social distancing and contact-tracing provisions. There are opportunities for mobile digital technologies and CCTV to support school staff in keeping their students and colleagues safe; however, these must place minimal demands on staff and prioritize security measures. Study findings can help researchers and practitioners who work in different contexts and settings understand what particular challenges are faced by school staff, and inform further research on the design and application of digital solutions for contact tracing. UR - https://formative.jmir.org/2022/11/e36412 UR - http://dx.doi.org/10.2196/36412 UR - http://www.ncbi.nlm.nih.gov/pubmed/36191172 ID - info:doi/10.2196/36412 ER - TY - JOUR AU - Okonkwo, Wilfred Chinedu AU - Amusa, Babatunde Lateef AU - Twinomurinzi, Hossana PY - 2022/10/27 TI - COVID-Bot, an Intelligent System for COVID-19 Vaccination Screening: Design and Development JO - JMIR Form Res SP - e39157 VL - 6 IS - 10 KW - chatbot KW - COVID-Bot KW - COVID-19 KW - students KW - vaccine KW - exemption letter KW - vaccination KW - artificial intelligence N2 - Background: Coronavirus continues to spread worldwide, causing various health and economic disruptions. One of the most important approaches to controlling the spread of this disease is to use an artificial intelligence (AI)?based technological intervention, such as a chatbot system. Chatbots can aid in the fight against the spread of COVID-19. Objective: This paper introduces COVID-Bot, an intelligent interactive system that can help screen students and confirm their COVID-19 vaccination status. Methods: The design and development of COVID-Bot followed the principles of the design science research (DSR) process, which is a research method for creating a new scientific artifact. COVID-Bot was developed and implemented using the SnatchBot chatbot application programming interface (API) and its predefined tools, which are driven by various natural language processing algorithms. Results: An evaluation was carried out through a survey that involved 106 university students in determining the functionality, compatibility, reliability, and usability of COVID-Bot. The findings indicated that 92 (86.8%) of the participants agreed that the chatbot functions well, 85 (80.2%) agreed that it fits well with their mobile devices and their lifestyle, 86 (81.1%) agreed that it has the potential to produce accurate and consistent responses, and 85 (80.2%) agreed that it is easy to use. The average obtained ? was .87, indicating satisfactory reliability. Conclusions: This study demonstrates that incorporating chatbot technology into the educational system can combat the spread of COVID-19 among university students. The intelligent system does this by interacting with students to determine their vaccination status. UR - https://formative.jmir.org/2022/10/e39157 UR - http://dx.doi.org/10.2196/39157 UR - http://www.ncbi.nlm.nih.gov/pubmed/36301616 ID - info:doi/10.2196/39157 ER - TY - JOUR AU - Woodward, F. Sean AU - Bari, Sumra AU - Vike, Nicole AU - Lalvani, Shamal AU - Stetsiv, Khrystyna AU - Kim, Woo Byoung AU - Stefanopoulos, Leandros AU - Maglaveras, Nicos AU - Breiter, Hans AU - Katsaggelos, K. Aggelos PY - 2022/10/25 TI - Anxiety, Post?COVID-19 Syndrome-Related Depression, and Suicidal Thoughts and Behaviors in COVID-19 Survivors: Cross-sectional Study JO - JMIR Form Res SP - e36656 VL - 6 IS - 10 KW - COVID-19 KW - post?COVID-19 syndrome KW - suicidality KW - depression KW - Patient Health Questionnaire-9 KW - PHQ-9 KW - State Trait Anxiety Index KW - STAI N2 - Background: Although the mental health impacts of COVID-19 on the general population have been well studied, studies of the long-term impacts of COVID-19 on infected individuals are relatively new. To date, depression, anxiety, and neurological symptoms associated with post?COVID-19 syndrome (PCS) have been observed in the months following COVID-19 recovery. Suicidal thoughts and behavior (STB) have also been preliminarily proposed as sequelae of COVID-19. Objective: We asked 3 questions. First, do participants reporting a history of COVID-19 diagnosis or a close relative having severe COVID-19 symptoms score higher on depression (Patient Health Questionnaire-9 [PHQ-9]) or state anxiety (State Trait Anxiety Index) screens than those who do not? Second, do participants reporting a COVID-19 diagnosis score higher on PCS-related PHQ-9 items? Third, do participants reporting a COVID-19 diagnosis or a close relative having severe COVID-19 symptoms score higher in STB before, during, or after the first year of the pandemic? Methods: This preliminary study analyzed responses to a COVID-19 and mental health questionnaire obtained from a US population sample, whose data were collected between February 2021 and March 2021. We used the Mann-Whitney U test to detect differences in the medians of the total PHQ-9 scores, PHQ-9 component scores, and several STB scores between participants claiming a past clinician diagnosis of COVID-19 and those denying one, as well as between participants claiming severe COVID-19 symptoms in a close relative and those denying them. Where significant differences existed, we created linear regression models to predict the scores based on COVID-19 response as well as demographics to identify potential confounding factors in the Mann-Whitney relationships. Moreover, for STB scores, which corresponded to 5 questions asking about 3 different time intervals (i.e., past 1 year or more, past 1 month to 1 year, and past 1 month), we developed repeated-measures ANOVAs to determine whether scores tended to vary over time. Results: We found greater total depression (PHQ-9) and state anxiety (State Trait Anxiety Index) scores in those with COVID-19 history than those without (Bonferroni P=.001 and Bonferroni P=.004) despite a similar history of diagnosed depression and anxiety. Greater scores were noted for a subset of depression symptoms (PHQ-9 items) that overlapped with the symptoms of PCS (all Bonferroni Ps<.05). Moreover, we found greater overall STB scores in those with COVID-19 history, equally in time windows preceding, during, and proceeding infection (all Bonferroni Ps<.05). Conclusions: We confirm previous studies linking depression and anxiety diagnoses to COVID-19 recovery. Moreover, our findings suggest that depression diagnoses associated with COVID-19 history relate to PCS symptoms, and that STB associated with COVID-19 in some cases precede infection. UR - https://formative.jmir.org/2022/10/e36656 UR - http://dx.doi.org/10.2196/36656 UR - http://www.ncbi.nlm.nih.gov/pubmed/35763757 ID - info:doi/10.2196/36656 ER - TY - JOUR AU - Herbert, Carly AU - Broach, John AU - Heetderks, William AU - Qashu, Felicia AU - Gibson, Laura AU - Pretz, Caitlin AU - Woods, Kelsey AU - Kheterpal, Vik AU - Suvarna, Thejas AU - Nowak, Christopher AU - Lazar, Peter AU - Ayturk, Didem AU - Barton, Bruce AU - Achenbach, Chad AU - Murphy, Robert AU - McManus, David AU - Soni, Apurv PY - 2022/10/18 TI - Feasibility of At-Home Serial Testing Using Over-the-Counter SARS-CoV-2 Tests With a Digital Smartphone App for Assistance: Longitudinal Cohort Study JO - JMIR Form Res SP - e35426 VL - 6 IS - 10 KW - COVID-19 KW - SARS-CoV-2 KW - rapid tests KW - MyDataHelps smartphone app KW - mHealth KW - mobile health KW - serial self-testing KW - digital health KW - pandemic KW - self test N2 - Background: The ongoing SARS-CoV-2 pandemic necessitates the development of accurate, rapid, and affordable diagnostics to help curb disease transmission, morbidity, and mortality. Rapid antigen tests are important tools for scaling up testing for SARS-CoV-2; however, little is known about individuals? use of rapid antigen tests at home and how to facilitate the user experience. Objective: This study aimed to describe the feasibility and acceptability of serial self-testing with rapid antigen tests for SARS-CoV-2, including need for assistance and the reliability of self-interpretation. Methods: A total of 206 adults in the United States with smartphones were enrolled in this single-arm feasibility study in February and March 2021. All participants were asked to self-test for COVID-19 at home using rapid antigen tests daily for 14 days and use a smartphone app for testing assistance and to report their results. The main outcomes were adherence to the testing schedule, the acceptability of testing and smartphone app experiences, and the reliability of participants versus study team?s interpretation of test results. Descriptive statistics were used to report the acceptability, adherence, overall rating, and experience of using the at-home test and MyDataHelps app. The usability, acceptability, adherence, and quality of at-home testing were analyzed across different sociodemographic, age, and educational attainment groups. Results: Of the 206 enrolled participants, 189 (91.7%) and 159 (77.2%) completed testing and follow-up surveys, respectively. In total, 51.3% (97/189) of study participants were women, the average age was 40.7 years, 34.4% (65/189) were non-White, and 82% (155/189) had a bachelor?s degree or higher. Most (n=133/206, 64.6%) participants showed high testing adherence, meaning they completed over 75% of the assigned tests. Participants? interpretations of test results demonstrated high agreement (2106/2130, 98.9%) with the study verified results, with a ? score of 0.29 (P<.001). Participants reported high satisfaction with self-testing and the smartphone app, with 98.7% (157/159) reporting that they would recommend the self-test and smartphone app to others. These results were consistent across age, race/ethnicity, and gender. Conclusions: Participants? high adherence to the recommended testing schedule, significant reliability between participants and study staff?s test interpretation, and the acceptability of the smartphone app and self-test indicate that self-tests for SARS-CoV-2 with a smartphone app for assistance and reporting is a highly feasible testing modality among a diverse population of adults in the United States. UR - https://formative.jmir.org/2022/10/e35426 UR - http://dx.doi.org/10.2196/35426 UR - http://www.ncbi.nlm.nih.gov/pubmed/36041004 ID - info:doi/10.2196/35426 ER - TY - JOUR AU - Severson, A. Marie AU - Cassada, A. David AU - Huber, C. Victor AU - Snow, D. Daniel AU - McFadden, M. Lisa PY - 2022/10/17 TI - Population Health Metrics During the Early Stages of the COVID-19 Pandemic: Correlative Pilot Study JO - JMIR Form Res SP - e40215 VL - 6 IS - 10 KW - COVID-19 KW - ethyl glucuronide KW - wastewater KW - stress KW - helpline N2 - Background: COVID-19 has caused nearly 1 million deaths in the United States, not to mention job losses, business and school closures, stay-at-home orders, and mask mandates. Many people have suffered increased anxiety and depression since the pandemic began. Not only have mental health symptoms become more prevalent, but alcohol consumption has also increased during this time. Helplines offer important insight into both physical and mental wellness of a population by offering immediate, anonymous, cheap, and accessible resources for health and substance use disorders (SUD) that was unobstructed by many of the mandates of the pandemic. Further, the pandemic also launched the use of wastewater surveillance, which has the potential for tracking not only population infections but also consumption of substances such as alcohol. Objective: This study assessed the feasibility of using multiple public surveillance metrics, such as helpline calls, COVID-19 cases, and alcohol metabolites in wastewater, to better understand the need for interventions or public health programs in the time of a public health emergency. Methods: Ethanol metabolites were analyzed from wastewater collected twice weekly from September 29 to December 4, 2020, in a Midwestern state. Calls made to the helpline regarding housing, health care, and mental health/SUD were correlated with ethanol metabolites analyzed from wastewater samples, as well as the number of COVID-19 cases during the sampling period. Results: Correlations were observed between COVID-19 cases and helpline calls regarding housing and health care needs. No correlation was observed between the number of COVID-19 cases and mental health/SUD calls. COVID-19 cases on Tuesdays were correlated with the alcohol metabolite ethyl glucuronide (EtG). Finally, EtG levels were negatively associated with mental health/SUD helpline calls. Conclusions: Although helpline calls provided critical services for health care and housing-related concerns early in the pandemic, evidence suggests helpline calls for mental health/SUD-related concerns were unrelated to COVID-19 metrics. Instead, COVID metrics were associated with alcohol metabolites in wastewater. Although this research was formative, with continued and expanded monitoring of population metrics, such as helpline usage, COVID-19 metrics, and wastewater, strategies can be implemented to create precision programs to address the needs of the population. UR - https://formative.jmir.org/2022/10/e40215 UR - http://dx.doi.org/10.2196/40215 UR - http://www.ncbi.nlm.nih.gov/pubmed/36219745 ID - info:doi/10.2196/40215 ER - TY - JOUR AU - Tsai, A. Krystle AU - Cassidy, Omni AU - Arshonsky, Josh AU - Bond, Sara AU - Del Giudice, M. Inés AU - Bragg, A. Marie PY - 2022/10/14 TI - COVID-Washing in US Food and Beverage Marketing on Twitter: Content Analysis JO - JMIR Form Res SP - e37642 VL - 6 IS - 10 KW - COVID-19 KW - food and beverage marketing KW - Twitter KW - obesity KW - social media KW - nutrition KW - risk factor KW - health advertising KW - marketing N2 - Background: Food companies have increased digital and social media ad expenditures during the COVID-19 pandemic, capitalizing on the coinciding increase in social media use during the pandemic. The extent of pandemic-related social media advertising and marketing tactics have been previously reported. No studies, however, have evaluated how food and beverage companies used COVID-washing on social media posts in the United States or analyzed the nutritional content of advertised food and beverage products. This study was designed to address these gaps by evaluating how food and beverage companies capitalize on the COVID-19 pandemic to promote unhealthy foods and sugary beverages. Objective: We aimed to document the types and frequencies of COVID-19?related themes in US food and beverage companies? Twitter posts during the first wave of the pandemic in the United States, and assess the nutritional quality of food and beverage products featured in these tweets. Methods: Research assistants visited the Twitter accounts of the most-marketed food and beverage brands, and screen-captured all tweets posted between March 1 and May 31, 2020. Researchers documented the date of the tweet; the number of likes, views, comments, and ?retweets?; and the type of food and beverage products. We coded tweets for the following 10 COVID-19 themes: (1) social distancing, staying home, or working remotely; (2) contactless delivery or pick-up; (3) handwashing or sanitizing; (4) masks; (5) safety or protection; (6) staying connected with others; (7) staying active; (8) frontline or essential workers; (9) monetary relief, donations, or unemployment; and (10) pandemic, unprecedented, or difficult times. Researchers calculated the nutrient profile index scores for featured foods and sorted beverages into categories based on sugar content. Results: Our final sample included 874 COVID-19?themed tweets from 52 food and beverage brands. Social distancing themes appeared most frequently (n=367, 42%), followed by pandemic, unprecedented, or difficult times (n=246, 28.2%), and contactless delivery (n=237, 27.1%). The majority of tweets (n=682, 78%) promoted foods and beverages. Among those tweets featuring foods and beverages, 89.6% (n=611) promoted unhealthy products, whereas 17.2% (n=117) promoted healthy products. Conclusions: Our findings point to a concerning marketing tactic in which major food and beverage companies promote unhealthy foods and sugary beverages during the COVID-19 pandemic. Given that nutrition-related diseases such as obesity and diabetes are risk factors for COVID-19 morbidity and mortality, food and beverage companies should reduce the promotion of unhealthy products to help decrease the prevalence of health conditions that place people at higher risk for severe illness and death due to COVID-19. UR - https://formative.jmir.org/2022/10/e37642 UR - http://dx.doi.org/10.2196/37642 UR - http://www.ncbi.nlm.nih.gov/pubmed/36040957 ID - info:doi/10.2196/37642 ER - TY - JOUR AU - Fu, Chunye AU - Lyu, Xiaokang AU - Mi, Mingdi PY - 2022/10/4 TI - Collective Value Promotes the Willingness to Share Provaccination Messages on Social Media in China: Randomized Controlled Trial JO - JMIR Form Res SP - e35744 VL - 6 IS - 10 KW - individual value KW - collective value KW - vaccination KW - message-sharing willingness KW - perceived responsibility KW - misinformation KW - vaccine misinformation KW - public health KW - influenza vaccine KW - social media KW - COVID-19 N2 - Background: The proliferation of vaccine misinformation on social media has seriously corrupted the public?s confidence in vaccination. Proactively sharing provaccination messages on social media is a cost-effective way to enhance global vaccination rates and resist vaccine misinformation. However, few strategies for encouraging the public to proactively share vaccine-related knowledge on social media have been developed. Objective: This research examines the effect of value type (individual vs collective) and message framing (gain vs loss) on influenza vaccination intention (experiment 1) and the willingness to share provaccination messages (experiment 2) among Chinese adults during the COVID-19 pandemic. The primary aim was to evaluate whether messages that emphasized collective value were more effective in increasing the willingness to share than messages that emphasized individual value. Methods: We enrolled 450 Chinese adults for experiment 1 (n=250, 55.6%) and experiment 2 (n=200, 44.4%). Participants were randomly assigned to individual-gain, individual-loss, collective-gain, or collective-loss conditions with regard to the message in each experiment using the online survey platform?s randomization function. Experiment 1 also included a control group. The primary outcome was influenza vaccination intention in experiment 1 and the willingness to share provaccination messages in experiment 2. Results: The valid sample included 213 adults in experiment 1 (females: n=151, 70.9%; mean age 29 [SD 9] years; at least some college education: n=202, 94.8%; single: n=131, 61.5%) and 171 adults in experiment 2 (females: n=106, 62.0%; mean age 28 [SD 7] years; at least some college education: n=163, 95.3%; single: n=95, 55.6%). Influenza vaccination intention was stronger in the individual-value conditions than in the collective-value conditions (F3,166=4.96, P=.03, ?2=0.03). The reverse result was found for the willingness to share provaccination messages (F3,165=6.87, P=.01, ?2=0.04). Specifically, participants who received a message emphasizing collective value had a higher intention to share the message than participants who read a message emphasizing individual value (F3,165=6.87, P=.01, ?2=0.04), and the perceived responsibility for message sharing played a mediating role (indirect effect=0.23, 95% lower limit confidence interval [LLCI] 0.41, 95% upper limit confidence interval [ULCI] 0.07). In addition, gain framing facilitated influenza vaccination intention more than loss framing (F3,166=5.96, P=.02, ?2=0.04). However, experiment 2 did not find that message framing affected message-sharing willingness. Neither experiment found an interaction between value type and message framing. Conclusions: Strengthened individual value rather than collective value is more likely to persuade Chinese adults to vaccinate. However, these adults are more likely to share a message that emphasizes collective rather than individual value, and the perceived responsibility for message sharing plays a mediating role. UR - https://formative.jmir.org/2022/10/e35744 UR - http://dx.doi.org/10.2196/35744 UR - http://www.ncbi.nlm.nih.gov/pubmed/36067417 ID - info:doi/10.2196/35744 ER - TY - JOUR AU - Li, Zhongqiang AU - Li, Zheng AU - Yao, Luke AU - Chen, Qing AU - Zhang, Jian AU - Li, Xin AU - Feng, Ji-Ming AU - Li, Yanping AU - Xu, Jian PY - 2022/10/4 TI - Multiple-Inputs Convolutional Neural Network for COVID-19 Classification and Critical Region Screening From Chest X-ray Radiographs: Model Development and Performance Evaluation JO - JMIR Bioinform Biotech SP - e36660 VL - 3 IS - 1 KW - COVID-19 KW - chest X-ray radiography KW - multiple-inputs convolutional neural network KW - screening critical COVID regions N2 - Background: The COVID-19 pandemic is becoming one of the largest, unprecedented health crises, and chest X-ray radiography (CXR) plays a vital role in diagnosing COVID-19. However, extracting and finding useful image features from CXRs demand a heavy workload for radiologists. Objective: The aim of this study was to design a novel multiple-inputs (MI) convolutional neural network (CNN) for the classification of COVID-19 and extraction of critical regions from CXRs. We also investigated the effect of the number of inputs on the performance of our new MI-CNN model. Methods: A total of 6205 CXR images (including 3021 COVID-19 CXRs and 3184 normal CXRs) were used to test our MI-CNN models. CXRs could be evenly segmented into different numbers (2, 4, and 16) of individual regions. Each region could individually serve as one of the MI-CNN inputs. The CNN features of these MI-CNN inputs would then be fused for COVID-19 classification. More importantly, the contributions of each CXR region could be evaluated through assessing the number of images that were accurately classified by their corresponding regions in the testing data sets. Results: In both the whole-image and left- and right-lung region of interest (LR-ROI) data sets, MI-CNNs demonstrated good efficiency for COVID-19 classification. In particular, MI-CNNs with more inputs (2-, 4-, and 16-input MI-CNNs) had better efficiency in recognizing COVID-19 CXRs than the 1-input CNN. Compared to the whole-image data sets, the efficiency of LR-ROI data sets showed approximately 4% lower accuracy, sensitivity, specificity, and precision (over 91%). In considering the contributions of each region, one of the possible reasons for this reduced performance was that nonlung regions (eg, region 16) provided false-positive contributions to COVID-19 classification. The MI-CNN with the LR-ROI data set could provide a more accurate evaluation of the contribution of each region and COVID-19 classification. Additionally, the right-lung regions had higher contributions to the classification of COVID-19 CXRs, whereas the left-lung regions had higher contributions to identifying normal CXRs. Conclusions: Overall, MI-CNNs could achieve higher accuracy with an increasing number of inputs (eg, 16-input MI-CNN). This approach could assist radiologists in identifying COVID-19 CXRs and in screening the critical regions related to COVID-19 classifications. UR - https://bioinform.jmir.org/2022/1/e36660 UR - http://dx.doi.org/10.2196/36660 UR - http://www.ncbi.nlm.nih.gov/pubmed/36277075 ID - info:doi/10.2196/36660 ER - TY - JOUR AU - Koss, Jonathan AU - Bohnet-Joschko, Sabine PY - 2022/10/3 TI - Social Media Mining of Long-COVID Self-Medication Reported by Reddit Users: Feasibility Study to Support Drug Repurposing JO - JMIR Form Res SP - e39582 VL - 6 IS - 10 KW - social media mining KW - drug repurposing KW - long-COVID KW - crowdsourcing KW - COVID-19 KW - Reddit KW - social media KW - content analysis KW - network analysis KW - recognition algorithm KW - treatment N2 - Background: Since the beginning of the COVID-19 pandemic, over 480 million people have been infected and more than 6 million people have died from COVID-19 worldwide. In some patients with acute COVID-19, symptoms manifest over a longer period, which is also called ?long-COVID.? Unmet medical needs related to long-COVID are high, since there are no treatments approved. Patients experiment with various medications and supplements hoping to alleviate their suffering. They often share their experiences on social media. Objective: The aim of this study was to explore the feasibility of social media mining methods to extract important compounds from the perspective of patients. The goal is to provide an overview of different medication strategies and important agents mentioned in Reddit users? self-reports to support hypothesis generation for drug repurposing, by incorporating patients? experiences. Methods: We used named-entity recognition to extract substances representing medications or supplements used to treat long-COVID from almost 70,000 posts on the ?/r/covidlonghaulers? subreddit. We analyzed substances by frequency, co-occurrences, and network analysis to identify important substances and substance clusters. Results: The named-entity recognition algorithm achieved an F1 score of 0.67. A total of 28,447 substance entities and 5789 word co-occurrence pairs were extracted. ?Histamine antagonists,? ?famotidine,? ?magnesium,? ?vitamins,? and ?steroids? were the most frequently mentioned substances. Network analysis revealed three clusters of substances, indicating certain medication patterns. Conclusions: This feasibility study indicates that network analysis can be used to characterize the medication strategies discussed in social media. Comparison with existing literature shows that this approach identifies substances that are promising candidates for drug repurposing, such as antihistamines, steroids, or antidepressants. In the context of a pandemic, the proposed method could be used to support drug repurposing hypothesis development by prioritizing substances that are important to users. UR - https://formative.jmir.org/2022/10/e39582 UR - http://dx.doi.org/10.2196/39582 UR - http://www.ncbi.nlm.nih.gov/pubmed/36007131 ID - info:doi/10.2196/39582 ER - TY - JOUR AU - Maragh-Bass, Allysha AU - Comello, Leonora Maria AU - Tolley, Ellen Elizabeth AU - Stevens Jr, Darrell AU - Wilson, Jade AU - Toval, Christina AU - Budhwani, Henna AU - Hightow-Weidman, Lisa PY - 2022/9/26 TI - Digital Storytelling Methods to Empower Young Black Adults in COVID-19 Vaccination Decision-Making: Feasibility Study and Demonstration JO - JMIR Form Res SP - e38070 VL - 6 IS - 9 KW - young Black adults KW - COVID-19 KW - vaccine hesitancy KW - digital storytelling KW - community-based participatory research KW - digital health intervention N2 - Background: Despite high rates of novel COVID-19, acceptance of COVID-19 vaccination is low among Black adults. In response, we developed a digital health intervention (Tough Talks-COVID) that includes digital stories created in a workshop we held with young Black adults. Objective: Our formative research using digital storytelling workshops asked 3 research questions: (1) What issues did participants have in conceptualizing their stories, and what themes emerged from the stories they created? (2) What issues did participants have related to production techniques, and which techniques were utilized in stories? and (3) Overall, how did participants evaluate their workshop experience? Methods: Participants were workshop-eligible if they were vaccine-accepting based on a baseline survey fielded in late 2021. Final participants (N=11) completed a consent process, all 3 workshops, and a media release form for their digital story. The first 2 workshops provided background information and hands-on digital storytelling skills from pre- to postproduction. The third workshop served as a screening and feedback session for participants? final videos. Qualitative and quantitative feedback elements were incorporated into all 3 sessions. Results: Digital stories addressed one or more of 4 broad themes: (1) COVID-19 vulnerability, (2) community connections, (3) addressing vaccine hesitancy, and (4) countering vaccine misinformation. Participants incorporated an array of technical approaches, including unique creative elements such as cartoon images and instant messaging tools to convey social interactions around COVID-19 decision-making. Most (9/11, 82%) strongly agreed the digital storytelling workshops were delivered as expected; 10 of 11 agreed (n=5) or strongly agreed (n=5) that they had some ideas about what story to tell by the end of the first workshop, and most (8/11, 73%) strongly agreed they had narrowed down their ideas by workshop two. Of the participants, 9 felt they would very likely (n=6) or likely (n=3) use digital storytelling techniques for personal use in the future, and even more were very likely (n=7) to use the techniques for professional use. Conclusions: Our study is one of the first to incorporate digital storytelling as a central component to a digital health intervention and the only one to do so with exclusive focus on young Black adults. Our emphasis on digital storytelling was shown to be highly acceptable. Similar approaches, including careful consideration of the ethical challenges of community-based participatory approaches, are applicable to other populations experiencing both COVID-19 inequities and marginalization, such as other age demographics and people of color. UR - https://formative.jmir.org/2022/9/e38070 UR - http://dx.doi.org/10.2196/38070 UR - http://www.ncbi.nlm.nih.gov/pubmed/36155984 ID - info:doi/10.2196/38070 ER - TY - JOUR AU - Layug, Alyan AU - Krishnamurthy, Samiksha AU - McKenzie, Rachel AU - Feng, Bo PY - 2022/9/19 TI - The Impacts of Social Media Use and Online Racial Discrimination on Asian American Mental Health: Cross-sectional Survey in the United States During COVID-19 JO - JMIR Form Res SP - e38589 VL - 6 IS - 9 KW - Asian Americans KW - mental health KW - COVID-19 pandemic KW - racial discrimination KW - social media KW - anxiety KW - depression KW - secondary traumatic stress KW - negative affect KW - racial/ethnic identification N2 - Background: During the COVID-19 pandemic, increased social media usage has led to worsened mental health outcomes for many people. Moreover, due to the sociopolitical climate during the pandemic, the prevalence of online racial discrimination has contributed to worsening psychological well-being. With increases in anti-Asian hate, Asian and Asian American social media users may experience the negative effects of online racial discrimination in addition to the reduced psychological well-being resulting from exposure to online COVID-19 content. Objective: This study aims to investigate the impact of COVID-19?related social media use and exposure to online racial discrimination during the pandemic on the mental health outcomes (ie, anxiety, depression, and secondary traumatic stress [STS]) of Asian Americans compared with those of non-Asian Americans. In addition, this study explores the mediating role of negative affect and the moderating role of racial/ethnic identification. Methods: An online survey was conducted through Amazon Mechanical Turk and a university-wide research portal from March 3 to March 15, 2021. A total of 1147 participants took the survey. Participants? social media usage related to COVID-19 and exposure to 2 online forms of racial discrimination (individual and vicarious), mental health outcomes (anxiety, depression, and STS), racial/ethnic identification, negative affect, and demographics were assessed. Results: Our results showed that COVID-19?related social media use, individual discrimination, and vicarious discrimination were predictors of negative mental health outcomes (anxiety, depression, and STS). Asian Americans reported higher vicarious discrimination than Latinx and White Americans, but Asian Americans? mental health outcomes did not differ substantially from those of the other racial/ethnic groups. Racial/ethnic identification moderated the relationship between both types of discrimination and STS, and negative affect served as a mediator between both types of discrimination and all 3 mental health outcomes. Conclusions: These results suggest that social media exposure continues to have a dire effect on mental health during the COVID-19 pandemic. This study helps to contextualize the rise of anti-Asian American hate and its impact on mental health outcomes in the United States. UR - https://formative.jmir.org/2022/9/e38589 UR - http://dx.doi.org/10.2196/38589 UR - http://www.ncbi.nlm.nih.gov/pubmed/36121698 ID - info:doi/10.2196/38589 ER - TY - JOUR AU - Yousef, Murooj AU - Dietrich, Timo AU - Rundle-Thiele, Sharyn PY - 2022/9/15 TI - Actions Speak Louder Than Words: Sentiment and Topic Analysis of COVID-19 Vaccination on Twitter and Vaccine Uptake JO - JMIR Form Res SP - e37775 VL - 6 IS - 9 KW - COVID-19 KW - COVID-19 vaccination KW - sentiment analysis KW - public health campaigns KW - vaccine uptake KW - Twitter KW - social media KW - vaccines N2 - Background: The lack of trust in vaccines is a major contributor to vaccine hesitancy. To overcome vaccine hesitancy for the COVID-19 vaccine, the Australian government launched multiple public health campaigns to encourage vaccine uptake. This sentiment analysis examines the effect of public health campaigns and COVID-19?related events on sentiment and vaccine uptake. Objective: This study aims to examine the relationship between sentiment and COVID-19 vaccine uptake and government actions that impacted public sentiment about the vaccine. Methods: Using machine learning methods, we collected 137,523 publicly available English language tweets published in Australia between February and October 2021 that contained COVID-19 vaccine?related keywords. Machine learning methods were used to extract topics and sentiments relating to COVID-19 vaccination. The relationship between public vaccination sentiment on Twitter and vaccine uptake was examined. Results: The majority of collected tweets expressed negative (n=91,052, 66%) rather than positive (n=21,686, 16%) or neutral (n=24,785, 18%) sentiments. Topics discussed within the study time frame included the role of the government in the vaccination rollout, availability and accessibility of the vaccine, and vaccine efficacy. There was a significant positive correlation between negative sentiment and the number of vaccine doses administered daily (r267=.15, P<.05), with positive sentiment showing the inverse effect. Public health campaigns, lockdowns, and antivaccination protests were associated with increased negative sentiment, while vaccination mandates had no significant effect on sentiment. Conclusions: The study findings demonstrate that negative sentiment was more prevalent on Twitter during the Australian vaccination rollout but vaccine uptake remained high. Australians expressed anger at the slow rollout and limited availability of the vaccine during the study period. Public health campaigns, lockdowns, and antivaccination rallies increased negative sentiment. In contrast, news of increased vaccine availability for the public and government acquisition of more doses were key government actions that reduced negative sentiment. These findings can be used to inform government communication planning. UR - https://formative.jmir.org/2022/9/e37775 UR - http://dx.doi.org/10.2196/37775 UR - http://www.ncbi.nlm.nih.gov/pubmed/36007136 ID - info:doi/10.2196/37775 ER - TY - JOUR AU - Rauer, Thomas AU - Scherer, Julian AU - Stäubli, Pascal AU - Gerber, Jonas AU - Pape, Hans-Christoph AU - Heining, Sandro-Michael PY - 2022/9/12 TI - Satisfaction With Telemedicine in Patients With Orthopedic Trauma During the COVID-19 Lockdown: Interview Study JO - JMIR Form Res SP - e35718 VL - 6 IS - 9 KW - COVID-19 KW - digital KW - survey KW - telehealth KW - follow-up KW - orthopedic trauma KW - trauma KW - attitude N2 - Background: Telemedicine can take many forms, from telephone-only consultations to video consultations via a smartphone or personal computer, depending on the goals of the treatment. One of the advantages of videoconferencing is the direct visual contact between patients and therapists even over long distances. Although some telemedicine models require specially designed add-on devices, others get by with off-the-shelf equipment and software and achieve similarly successful successful results. This depends, among other things, on the nature of the injury, the desired outcome of therapy, and the medical consultation. In the last decade, the science and practice of telemedicine have grown exponentially and even more so during the COVID-19 pandemic. Depending on the traumatic lesion, posttraumatic and postoperative treatment and care of patients who experience trauma may require medical or physical therapy consultations in a clinic or office. However, due to the COVID-19 lockdown, direct physical follow-up was more difficult, and therefore, telemedicine solutions were sought and implemented. Objective: The aim of this study was to assess satisfaction with telemedical aftercare in patients with orthopedic trauma. Methods: Between March and July 2020, a standardized interview using a standardized questionnaire?Freiburg Index of Patient Satisfaction (FIPS)?among patients with orthopedic trauma who received telemedical postsurgical or physiotherapeutic care was conducted. The FIPS is composed of 5 questions regarding treatment and 1 question on the overall treatment satisfaction. Furthermore, we assessed patients? demographics and their telemedical use. Subgroup analysis was performed for age groups (<65 years vs ?65 years), the used device, and gender. Results: In total, we assessed 25 patients with a mean age of 43 (SD 24.31) years (14 female). The majority of patients (n=19, 76%) used their smartphone for consultations. The mean overall FIPS score assessed was 2.14 (SD 0.87). The mean FIPS score for younger patients was 2.23 (SD 0.90) vs 1.91 (SD 0.82) for older patients. The vast majority of the surveyed patients (n=20, 80%) were absolutely confident with their smartphone or tablet use. Conclusions: Most patients surveyed stated a high satisfaction with the telemedical follow-up. Older patients showed a higher satisfaction rate than their younger counterparts. It seems that telemedical postsurgical or physiotherapeutic care is a viable option, especially in times of reduced contact, like the current COVID-19 pandemic. Thus, telemedicine offers the opportunity to ensure access to effective patient care, even over long distances, while maintaining patient satisfaction. UR - https://formative.jmir.org/2022/9/e35718 UR - http://dx.doi.org/10.2196/35718 UR - http://www.ncbi.nlm.nih.gov/pubmed/36040961 ID - info:doi/10.2196/35718 ER - TY - JOUR AU - Splinter, Bas AU - Saadah, H. Nicholas AU - Chavannes, H. Niels AU - Kiefte-de Jong, C. Jessica AU - Aardoom, J. Jiska PY - 2022/9/9 TI - Optimizing the Acceptability, Adherence, and Inclusiveness of the COVID Radar Surveillance App: Qualitative Study Using Focus Groups, Thematic Content Analysis, and Usability Testing JO - JMIR Form Res SP - e36003 VL - 6 IS - 9 KW - COVID-19 KW - corona KW - eHealth KW - self-report KW - mobile app KW - track-and-trace strategies KW - population surveillance KW - citizen science KW - usability KW - mobile phone N2 - Background: The COVID Radar app was developed as a population-based surveillance instrument to identify at-risk populations and regions in response to the COVID-19 pandemic. The app boasts of >8.5 million completed questionnaires, with >280,000 unique users. Although the COVID Radar app is a valid tool for population-level surveillance, high user engagement is critical to the success of the COVID Radar app in maintaining validity. Objective: This study aimed to identify optimization targets of the COVID Radar app to improve its acceptability, adherence, and inclusiveness. Methods: The main component of the COVID Radar app is a self-report questionnaire that assesses COVID-19 symptoms and social distancing behaviors. A total of 3 qualitative substudies were conducted. First, 3 semistructured focus group interviews with end users (N=14) of the app were conducted to gather information on user experiences. The output was transcribed and thematically coded using the framework method. Second, a similar qualitative thematic analysis was conducted on 1080 end-user emails. Third, usability testing was conducted in one-on-one sessions with 4 individuals with low literacy levels. Results: All 3 substudies identified optimization targets in terms of design and content. The results of substudy 1 showed that the participants generally evaluated the app positively. They reported the app to be user-friendly and were satisfied with its design and functionalities. Participants? main motivation to use the app was to contribute to science. Participants suggested adding motivational tools to stimulate user engagement. A larger national publicity campaign for the app was considered potentially helpful for increasing the user population. In-app updates informing users about the project and its outputs motivated users to continue using the app. Feedback on the self-report questionnaire, stemming from substudies 1 and 2, mostly concerned the content and phrasing of the questions. Furthermore, the section of the app allowing users to compare their symptoms and behaviors to those of their peers was found to be suboptimal because of difficulties in interpreting the figures presented in the app. Finally, the output of substudy 3 resulted in recommendations primarily related to simplification of the text to render it more accessible and comprehensible for individuals with low literacy levels. Conclusions: The convenience of app use, enabling personal adjustments of the app experience, and considering motivational factors for continued app use (ie, altruism and collectivism) were found to be crucial to procuring and maintaining a population of active users of the COVID Radar app. Further, there seems to be a need to increase the accessibility of public health tools for individuals with low literacy levels. These results can be used to improve the this and future public health apps and improve the representativeness of their user populations and user engagement, ultimately increasing the validity of the tools. UR - https://formative.jmir.org/2022/9/e36003 UR - http://dx.doi.org/10.2196/36003 UR - http://www.ncbi.nlm.nih.gov/pubmed/35781492 ID - info:doi/10.2196/36003 ER - TY - JOUR AU - Seifarth, Jack AU - Pinaire, Megan AU - Zicker, John AU - Singh, Inder AU - Bloch, Danielle PY - 2022/9/8 TI - Circulating Illness and Changes in Thermometer Use Behavior: Series of Cross-sectional Analyses JO - JMIR Form Res SP - e37509 VL - 6 IS - 9 KW - thermometer KW - health behavior KW - influenza KW - COVID-19 KW - fever KW - surveillance KW - perceived risk KW - percent positivity KW - smart technology KW - smart thermometer KW - population demography KW - older adult KW - elderly population KW - health monitoring N2 - Background: Temperature-taking behaviors vary with levels of circulating infectious illness; however, little is known about how these behaviors differ by demographic characteristics. Populations with higher perceived risks of illness are more likely to adopt protective health behaviors. Objective: We investigated differences in temperature-taking frequency and the proportion of readings that were feverish among demographic groups (age, gender, urban/rural status) over influenza offseason; influenza season; and waves 1, 2, and 3 of the COVID-19 pandemic. Methods: Using data from smart thermometers collected from May 1, 2019, to February 28, 2021, across the United States, we calculated the frequency of temperature-taking and the proportion of temperature readings that were feverish. Mixed-effects negative binomial and mixed-effects logistic regression analyses were performed to identify demographic characteristics associated with temperature-taking frequency and the proportion of feverish readings, respectively. Separate models were fit over five study periods: influenza offseason (n=122,480), influenza season (n=174,191), wave 1 of COVID-19 (n=350,385), wave 2 (n=366,489), and wave 3 (n=391,578). Results: Both temperature-taking frequency and the proportion of feverish readings differed by study period (ANOVA P<.001) and were the highest during influenza season. During all periods, children aged 2-5 years and 6-11 years had significantly higher frequencies of temperature-taking than users aged 19-30 years, and children had the highest proportion of feverish readings of all age groups, after adjusting for covariates. During wave 1 of COVID-19, users over the age of 60 years had 1.79 times (95% CI 1.76-1.83) the rate of temperature-taking as users aged 19-30 years and 74% lower odds (95% CI 72%-75%) of a reading being feverish. Across all periods, men had significantly lower temperature-taking frequency and significantly higher odds of having a feverish reading compared to women. Users living in urban areas had significantly higher frequencies of temperature-taking than rural users during all periods, except wave 2 of COVID-19, and urban users had higher odds of a reading being feverish in all study periods except wave 1 of COVID-19. Conclusions: Temperature-taking behavior and the proportion of readings that were feverish are associated with both population disease levels and individual demographic characteristics. Differences in the health behavior of temperature-taking may reflect changes in both perceived and actual illness risk. Specifically, older adults may have experienced an increase in perceived risk during the first three waves of COVID-19, leading to increased rates of temperature monitoring, even when their odds of fever were lower than those of younger adults. Men?s perceived risk of circulating infectious illnesses such as influenza and COVID-19 may be lower than that of women, since men took their temperature less frequently and each temperature had a higher odds of being feverish across all study periods. Infectious disease surveillance should recognize and incorporate how behavior impacts illness monitoring and testing. UR - https://formative.jmir.org/2022/9/e37509 UR - http://dx.doi.org/10.2196/37509 UR - http://www.ncbi.nlm.nih.gov/pubmed/35998174 ID - info:doi/10.2196/37509 ER - TY - JOUR AU - Oyibo, Kiemute AU - Morita, Pelegrini Plinio PY - 2022/9/6 TI - The Effect of Persuasive Design on the Adoption of Exposure Notification Apps: Quantitative Study Based on COVID Alert JO - JMIR Form Res SP - e34212 VL - 6 IS - 9 KW - contact tracing app KW - exposure notification app KW - COVID Alert KW - COVID-19 KW - persuasive technology KW - behavior change KW - exposure KW - behavior KW - effect KW - design KW - adoption KW - use KW - case study KW - effectiveness KW - user interface KW - mobile phone N2 - Background: The adoption of contact tracing apps worldwide has been low. Although considerable research has been conducted on technology acceptance, little has been done to show the benefit of incorporating persuasive principles. Objective: This research aimed to investigate the effect of persuasive features in the COVID Alert app, created by Health Canada, by focusing on the no-exposure status, exposure status, and diagnosis report interfaces. Methods: We conducted a study among 181 Canadian residents, including 65 adopters and 116 nonadopters. This study was based on screenshots of the 3 interfaces, of which each comprised a persuasive design and a control design. The persuasive versions of the first two interfaces supported self-monitoring (of exposure levels), and that of the third interface supported social learning (about how many other users have reported their diagnosis). The 6 screenshots were randomly assigned to 6 groups of participants to provide feedback on perceived persuasiveness and adoption willingness. Results: A multivariate repeated-measure ANOVA showed that there is an interaction among interface, app design, and adoption status regarding the perceived persuasiveness of the interfaces. This resulted in a 2-way ANOVA for each interface. For the no-exposure interface, there was an interaction between adoption status and app design. Among adopters, there was no significant difference P=.31 between the persuasive design (mean 5.36, SD 1.63) and the control design (mean 5.87, SD 1.20). However, among nonadopters, there was an effect of app design (P<.001), with participants being more motivated by the persuasive design (mean 5.37, SD 1.30) than by the control design (mean 4.57, SD 1.19). For the exposure interface, adoption status had a main effect (P<.001), with adopters (mean 5.91, SD 1.01) being more motivated by the designs than nonadopters (mean 4.96, SD 1.43). For the diagnosis report interface, there was an interaction between adoption status and app design. Among nonadopters, there was no significant difference P=.99 between the persuasive design (mean 4.61, SD 1.84) and the control design (mean 4.77, SD 1.21). However, among adopters, there was an effect of app design (P=.006), with participants being more likely to report their diagnosis using the persuasive design (mean 6.00, SD 0.97) than using the control design (mean 5.03, SD 1.22). Finally, with regard to willingness to download the app, pairwise comparisons showed that nonadopters were more likely to adopt the app after viewing the persuasive version of the no-exposure interface (13/21, 62% said yes) and the diagnosis report interface (12/17, 71% said yes) than after viewing the control versions (3/17, 18% and 7/16, 44%, respectively, said yes). Conclusions: Exposure notification apps are more likely to be effective if equipped with persuasive features. Incorporating self-monitoring into the no-exposure status interface and social learning into the diagnosis report interface can increase adoption by >30%. UR - https://formative.jmir.org/2022/9/e34212 UR - http://dx.doi.org/10.2196/34212 UR - http://www.ncbi.nlm.nih.gov/pubmed/35580138 ID - info:doi/10.2196/34212 ER - TY - JOUR AU - Stoner, CD Marie AU - Browne, N. Erica AU - Tweedy, David AU - Pettifor, E. Audrey AU - Maragh-Bass, C. Allysha AU - Toval, Christina AU - Tolley, E. Elizabeth AU - Comello, G. Maria Leonora AU - Muessig, E. Kathryn AU - Budhwani, Henna AU - Hightow-Weidman, B. Lisa PY - 2022/9/2 TI - Exploring Motivations for COVID-19 Vaccination Among Black Young Adults in 3 Southern US States: Cross-sectional Study JO - JMIR Form Res SP - e39144 VL - 6 IS - 9 KW - COVID-19 KW - COVID-19 vaccination KW - young people KW - vaccination motivations KW - vaccination beliefs KW - online survey KW - health disparity KW - minority population KW - vaccine hesitancy KW - misinformation KW - vaccine safety N2 - Background: Few studies have focused on attitudes toward COVID-19 vaccination among Black or African American young adults (BYA) in the Southern United States, despite high levels of infection in this population. Objective: To understand this gap, we conducted an online survey to explore beliefs and experiences related to COVID-19 vaccination among BYA (aged 18-29 years) in 3 southern states. Methods: We recruited 150 BYA to participate in an online survey as formative research for an intervention to address vaccine hesitancy in Alabama, Georgia, and North Carolina from September 22, 2021, to November 18, 2021. Participants were recruited through social media ads on Facebook, Twitter, Instagram, and YouTube. Additionally, we distributed information about the survey through organizations working with BYA in Alabama, Georgia, and North Carolina; our community partners; and network collaborations. We used measures that had been used and were previously validated in prior surveys, adapting them to the context of this study. Results: Roughly 28 (19%) of the participants had not received any doses of the COVID-19 vaccine. Half of the unvaccinated respondents (n=14, 50%) reported they wanted to wait longer before getting vaccinated. Motivators to get vaccinated were similar between unvaccinated and vaccinated respondents (eg, if required, to protect the health of others), but the main motivator for those vaccinated was to protect one?s own health. Among unvaccinated individuals, reasons for not receiving the COVID-19 vaccine included concern about vaccine side effects (n=15, 54%) and mistrust of vaccine safety (n=13, 46%), of effectiveness (n=12, 43%), and of the government?s involvement with vaccines (n=12, 43%). Experiences of discrimination (n=60, 40%) and mistrust of vaccines (n=54, 36%) were common overall. Among all respondents, those who said they would be motivated to get vaccinated if it was required for school, work, or travel were more likely to endorse negative beliefs about vaccines compared to those motivated for other reasons. Conclusions: Mistrust in COVID-19 vaccine safety and efficacy is common among BYA in the Southern United States, irrespective of vaccination status. Other motivators, such as safety of family and community and vaccination requirements, may be able to tip the scales toward a decision to be vaccinated among those who are initially hesitant. However, it is unclear how vaccine requirements among BYA in the South affect trust in the government or health care in the long term. Interventions that include BYA in vaccination messaging and programs may more proactively build feelings of trust and combat misinformation. UR - https://formative.jmir.org/2022/9/e39144 UR - http://dx.doi.org/10.2196/39144 UR - http://www.ncbi.nlm.nih.gov/pubmed/35969516 ID - info:doi/10.2196/39144 ER - TY - JOUR AU - Williams, D. Kimberly AU - Jurkovitz, T. Claudine AU - Papas, A. Mia AU - Muther, Kathryn Ann AU - Anderson, L. Sharon AU - Anderson, L. Tammy PY - 2022/8/30 TI - Feasibility of a Novel COVID-19 Telehealth Care Management Program Among Individuals Receiving Treatment for Opioid Use Disorder: Analysis of a Pilot Program JO - JMIR Form Res SP - e39772 VL - 6 IS - 8 KW - opioid use disorder KW - substance use KW - drug addiction KW - opioid treatment program KW - COVID-19 KW - telehealth KW - telemedicine KW - eHealth KW - Short Message Service KW - SMS KW - text messaging KW - text message KW - opioid use KW - opioid KW - care management KW - patient care management KW - health intervention KW - telehealth intervention N2 - Background: The emergence of COVID-19 exacerbated the existing epidemic of opioid use disorder (OUD) across the United States due to the disruption of in-person treatment and support services. Increased use of technology including telehealth and the development of new partnerships may facilitate coordinated treatment interventions that comprehensively address the health and well-being of individuals with OUD. Objective: The analysis of this pilot program aimed to determine the feasibility of delivering a COVID-19 telehealth care management program using SMS text messages for patients receiving OUD treatment. Methods: Eligible individuals were identified from a statewide opioid treatment program (OTP) network. Those who screened positive for COVID-19 symptoms were invited to connect to care management through a secure SMS text message that was compliant with Health Insurance Portability and Accountability Act standards. Care management monitoring for COVID-19 was provided for a period of up to 14 days. Monitoring services consisted of daily SMS text messages from the care manager inquiring about the participant?s physical health in relation to COVID-19 symptoms by confirming their temperature, if the participant was feeling worse since the prior day, and if the participant was experiencing symptoms such as coughing or shortness of breath. If COVID-19 symptoms worsened during this observation period, the care manager was instructed to refer participants to the hospital for acute care services. The feasibility of the telehealth care management intervention was assessed by the rates of adoption in terms of program enrollment, engagement as measured by the number of SMS text message responses per participant, and retention in terms of the number of days participants remained in the program. Results: Between January and April 2021, OTP staff members referred 21 patients with COVID-19 symptoms, and 18 (82%) agreed to be contacted by a care manager. Participants ranged in age from 27 to 65 years and primarily identified as female (n=12, 67%) and White (n=15, 83%). The majority of participants were Medicaid recipients (n=14, 78%). There were no statistically significant differences in the demographic characteristics between those enrolled and not enrolled in the program. A total of 12 (67%) patients were enrolled in the program, with 2 (11%) opting out of SMS text message communication and choosing instead to speak with a care manager verbally by telephone. The remaining 10 participants answered a median of 7 (IQR 4-10) SMS text messages and were enrolled in the program for a median of 9 (IQR 7.5-12) days. No participants were referred for acute care services or hospitalized during program enrollment. Conclusions: These results demonstrate the feasibility of a novel telehealth intervention to monitor COVID-19 symptoms among OTP patients in treatment for OUD. Further research is needed to determine the applicability of this intervention to monitor patients with comorbid chronic conditions in addition to the acceptability among patients and providers using the SMS text messaging modality. UR - https://formative.jmir.org/2022/8/e39772 UR - http://dx.doi.org/10.2196/39772 UR - http://www.ncbi.nlm.nih.gov/pubmed/35973033 ID - info:doi/10.2196/39772 ER - TY - JOUR AU - Wiciak, Teresa Michelle AU - Shazley, Omar AU - Santhosh, Daphne PY - 2022/8/24 TI - An Observational Report of Screen Time Use Among Young Adults (Ages 18-28 Years) During the COVID-19 Pandemic and Correlations With Mental Health and Wellness: International, Online, Cross-sectional Study JO - JMIR Form Res SP - e38370 VL - 6 IS - 8 KW - coronavirus KW - COVID-19 KW - pandemic KW - mental health KW - depression KW - anxiety KW - screen-time usage KW - young adults KW - students KW - international study KW - observational study KW - cross-sectional study KW - smoking N2 - Background: Screen time (ST) drastically increased during the COVID-19 pandemic, but there is little research on the specific type of ST use, degree of change from before COVID-19, and possible associations with other factors. Young adults are a particular interest since previous studies have shown the detriment ST has on a young person?s health. With the combination of a life-changing pandemic, there are unreached depths regarding ST and young adults. This study aims to provide insight into these unknowns. Objective: This study aims to assess ST in 3 domains (entertainment, social media [SM], and educational/professional) in young adults early in the COVID-19 pandemic; identify trends; and identify any correlations with demographics, mental health, substance abuse, and overall wellness. Methods: An online, cross-sectional observational study was performed from September 2020 to January 2021 with 183 eligible respondents. Data were collected on ST, trauma from COVID-19, anxiety, depression, substance use, BMI, and sleep. Results: The average total ST during COVID-19 was 23.26 hours/week, entertainment ST was 7.98 hours/week, SM ST was 6.79 hours/week, and ST for educational or professional purposes was 8.49 hours/week. For all categories, the average ST during COVID-19 was higher than before COVID-19 (P<.001). We found ST differences between genders, student status, and continent of location. Increased well-being scores during COVID-19 were correlated with greater change in total ST (P=.01). Poorer sleep quality (P=.01) and longer sleep duration (P=.03) were associated with a greater change in entertainment ST (P=.01). More severe depression and more severe anxiety was associated with the amount of entertainment ST (P=.047, P=.03, respectively) and greater percent change in SM (P=.007, P=.002, respectively). Greater stress from COVID-19 was associated with the amount of ST for educational/professional purposes (P=.05), change in total ST (P=.006), change in entertainment ST (P=.01), and change in ST for educational/professional purposes (P=.02). Higher Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) tobacco scores were associated with greater change in total ST (P=.004), and higher pack-years were associated with greater change in SM ST (P=.003). Higher alcohol scores (P=.004) and servings of alcohol per week (P=.003) were associated with greater change in entertainment ST. Quarantining did not negatively impact these variables. Conclusions: There is no doubt ST and worsening mental health increased during COVID-19 in young adults. However, these findings indicate there are many significant associations between ST use and mental health. These associations are more complex than originally thought, especially since we found quarantining is not associated with mental health. Although other factors need to be further investigated, this study emphasizes different types of ST and degree of change in ST affect various groups of people in discrete ways. Acknowledging these findings can help young adults optimize their mental health during pandemics. UR - https://formative.jmir.org/2022/8/e38370 UR - http://dx.doi.org/10.2196/38370 UR - http://www.ncbi.nlm.nih.gov/pubmed/35878157 ID - info:doi/10.2196/38370 ER - TY - JOUR AU - Delanerolle, Gayathri AU - Williams, Robert AU - Stipancic, Ana AU - Byford, Rachel AU - Forbes, Anna AU - Tsang, M. Ruby S. AU - Anand, N. Sneha AU - Bradley, Declan AU - Murphy, Siobhán AU - Akbari, Ashley AU - Bedston, Stuart AU - Lyons, A. Ronan AU - Owen, Rhiannon AU - Torabi, Fatemeh AU - Beggs, Jillian AU - Chuter, Antony AU - Balharry, Dominique AU - Joy, Mark AU - Sheikh, Aziz AU - Hobbs, Richard F. D. AU - de Lusignan, Simon PY - 2022/8/22 TI - Methodological Issues in Using a Common Data Model of COVID-19 Vaccine Uptake and Important Adverse Events of Interest: Feasibility Study of Data and Connectivity COVID-19 Vaccines Pharmacovigilance in the United Kingdom JO - JMIR Form Res SP - e37821 VL - 6 IS - 8 KW - Systematized Nomenclature of Medicine KW - COVID-19 vaccines KW - COVID-19 KW - sinus thrombosis KW - anaphylaxis KW - pharmacovigilance KW - vaccine uptake KW - medical outcome KW - clinical coding system KW - health database KW - health information KW - clinical outcome KW - vaccine effect KW - data model N2 - Background: The Data and Connectivity COVID-19 Vaccines Pharmacovigilance (DaC-VaP) UK-wide collaboration was created to monitor vaccine uptake and effectiveness and provide pharmacovigilance using routine clinical and administrative data. To monitor these, pooled analyses may be needed. However, variation in terminologies present a barrier as England uses the Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT), while the rest of the United Kingdom uses the Read v2 terminology in primary care. The availability of data sources is not uniform across the United Kingdom. Objective: This study aims to use the concept mappings in the Observational Medical Outcomes Partnership (OMOP) common data model (CDM) to identify common concepts recorded and to report these in a repeated cross-sectional study. We planned to do this for vaccine coverage and 2 adverse events of interest (AEIs), cerebral venous sinus thrombosis (CVST) and anaphylaxis. We identified concept mappings to SNOMED CT, Read v2, the World Health Organization?s International Classification of Disease Tenth Revision (ICD-10) terminology, and the UK Dictionary of Medicines and Devices (dm+d). Methods: Exposures and outcomes of interest to DaC-VaP for pharmacovigilance studies were selected. Mappings of these variables to different terminologies used across the United Kingdom?s devolved nations? health services were identified from the Observational Health Data Sciences and Informatics (OHDSI) Automated Terminology Harmonization, Extraction, and Normalization for Analytics (ATHENA) online browser. Lead analysts from each nation then confirmed or added to the mappings identified. These mappings were then used to report AEIs in a common format. We reported rates for windows of 0-2 and 3-28 days postvaccine every 28 days. Results: We listed the mappings between Read v2, SNOMED CT, ICD-10, and dm+d. For vaccine exposure, we found clear mapping from OMOP to our clinical terminologies, though dm+d had codes not listed by OMOP at the time of searching. We found a list of CVST and anaphylaxis codes. For CVST, we had to use a broader cerebral venous thrombosis conceptual approach to include Read v2. We identified 56 SNOMED CT codes, of which we selected 47 (84%), and 15 Read v2 codes. For anaphylaxis, our refined search identified 60 SNOMED CT codes and 9 Read v2 codes, of which we selected 10 (17%) and 4 (44%), respectively, to include in our repeated cross-sectional studies. Conclusions: This approach enables the use of mappings to different terminologies within the OMOP CDM without the need to catalogue an entire database. However, Read v2 has less granular concepts than some terminologies, such as SNOMED CT. Additionally, the OMOP CDM cannot compensate for limitations in the clinical coding system. Neither Read v2 nor ICD-10 is sufficiently granular to enable CVST to be specifically flagged. Hence, any pooled analysis will have to be at the less specific level of cerebrovascular venous thrombosis. Overall, the mappings within this CDM are useful, and our method could be used for rapid collaborations where there are only a limited number of concepts to pool. UR - https://formative.jmir.org/2022/8/e37821 UR - http://dx.doi.org/10.2196/37821 UR - http://www.ncbi.nlm.nih.gov/pubmed/35786634 ID - info:doi/10.2196/37821 ER - TY - JOUR AU - Selick, Avra AU - Durbin, Janet AU - Hamdani, Yani AU - Rayner, Jennifer AU - Lunsky, Yona PY - 2022/8/22 TI - Accessibility of Virtual Primary Care for Adults With Intellectual and Developmental Disabilities During the COVID-19 Pandemic: Qualitative Study JO - JMIR Form Res SP - e38916 VL - 6 IS - 8 KW - COVID-19 KW - intellectual disability KW - developmental disability KW - qualitative KW - telemedicine KW - virtual care KW - primary care N2 - Background: The COVID-19 pandemic has led to an unprecedented increase in the delivery of virtual primary care. Adults with intellectual and developmental disabilities (IDDs) have complex health care needs, and little is known about the value and appropriateness of virtual care for this patient population. Objective: The aim of this study was to explore the accessibility of virtual primary care for patients with IDDs during the pandemic. Methods: We conducted semistructured interviews with 38 participants in Ontario, Canada between March and November 2021. A maximum variation sampling strategy was used to achieve a diverse sample including 11 adults with IDDs, 13 family caregivers, 5 IDD support staff members, and 9 primary care physicians. An iterative mixed inductive and deductive thematic analysis approach was used to code the data and synthesize higher-level themes. The analysis was informed by the Levesque Patient-Centered Access to Health Care Framework. Results: We identified themes related to 4 of 5 access-to-care dimensions that highlighted both the benefits and challenges of virtual care for adults with IDDs. The benefits included saving time spent traveling and waiting; avoiding anxiety and challenging behavior for patients who struggle to attend in-person visits; allowing caregivers who live far away from their loved ones to participate; reducing illness transmission; and allowing health care providers to see patients in their home environments. The challenges included lack of access to necessary technology, lack of comfort or skill using technology, and lack of nonverbal communication; difficulty engaging and establishing rapport; patient exclusion from the health care encounter; and concerns about privacy and confidentiality. An overarching theme was that ?one size does not fit all,? and the accessibility of virtual care was dependent on the interaction between the following 5 categories of factors: patient characteristics, patient context, caregiver characteristics, service context, and reason for a particular primary care visit. Though virtual care was not always appropriate, in some cases, it dramatically improved patients? abilities to access necessary health care. Conclusions: This study suggests that a flexible patient-centered system including multiple delivery modalities is needed to ensure all patients have access to primary care. Implementing this system will require improved virtual care platforms, access to technology for patients and caregivers, training for primary care providers, and appropriately aligned primary care funding models. UR - https://formative.jmir.org/2022/8/e38916 UR - http://dx.doi.org/10.2196/38916 UR - http://www.ncbi.nlm.nih.gov/pubmed/35951444 ID - info:doi/10.2196/38916 ER - TY - JOUR AU - Rush, L. Kathy AU - Seaton, L. Cherisse AU - Corman, Kendra AU - Hawe, Nicole AU - Li, Hung Eric Ping AU - Dow-Fleisner, J. Sarah AU - Hasan, Khalad Mohammad AU - Oelke, D. Nelly AU - Currie, M. Leanne AU - Pesut, Barbara PY - 2022/8/22 TI - Virtual Care Prior to and During COVID-19: Cross-sectional Survey of Rural and Urban Adults JO - JMIR Form Res SP - e37059 VL - 6 IS - 8 KW - virtual care KW - rural KW - urban KW - COVID-19 KW - digital literacy KW - unmet needs N2 - Background: To reduce person-to-person contact, the COVID-19 pandemic has driven a massive shift to virtual care. Defined as the use of technology (synchronous or asynchronous) to support communication between health care providers and patients, rural-urban differences in virtual care are relatively unexplored. Objective: The 2-fold purpose of this study was to examine rural and urban virtual care access, use, and satisfaction during the pandemic and to identify any unmet needs. Methods: This study was a cross-sectional online survey exploring virtual care among rural and urban adults in summer 2021 using a combination of fixed and open-ended response options. Quantitative data were analyzed using both descriptive and inferential statistics, and qualitative data were analyzed using inductive thematic content analysis. Results: Overall, 501 (373, 74.4% female; age range 19-86 years; 237, 47.3% rural-living) Western Canadians completed the survey. Virtual care use was high among both rural (171/237, 72.2%) and urban (188/264, 71.2%) participants, with over one-half (279/501, 55.7%) reporting having only started to use virtual care since the pandemic. The self-reported need for mental health programs and services increased during the pandemic, compared with prior for both rural and urban participants. Among virtual care users, interest in its continuation was high. Our analysis also shows that internet quality (all P<.05) and eHealth literacy (all P<.001) were positively associated with participants? perceptions of virtual care usefulness, ease of use, and satisfaction, with no rural-urban differences. Rural participants were less likely to have used video in communicating with doctors or health care providers, compared with urban participants (P<.001). When describing unmet needs, participants described a (1) lack of access to care, (2) limited health promotion and prevention options, and (3) lack of mental health service options. Conclusions: The increased demand for and use of virtual care may reflect increased availability and a lack of alternatives due to limited in-person services during the COVID-19 pandemic, so a balance between virtual care and in-person care is important to consider postpandemic. Further, ensuring availability of high-speed internet and education to support patients will be important for providing accessible and effective virtual care, especially for rural residents. UR - https://formative.jmir.org/2022/8/e37059 UR - http://dx.doi.org/10.2196/37059 UR - http://www.ncbi.nlm.nih.gov/pubmed/35849794 ID - info:doi/10.2196/37059 ER - TY - JOUR AU - Bari, Sumra AU - Vike, L. Nicole AU - Stetsiv, Khrystyna AU - Woodward, Sean AU - Lalvani, Shamal AU - Stefanopoulos, Leandros AU - Kim, Woo Byoung AU - Maglaveras, Nicos AU - Breiter, C. Hans AU - Katsaggelos, K. Aggelos PY - 2022/8/16 TI - The Prevalence of Psychotic Symptoms, Violent Ideation, and Disruptive Behavior in a Population With SARS-CoV-2 Infection: Preliminary Study JO - JMIR Form Res SP - e36444 VL - 6 IS - 8 KW - COVID-19 KW - paranoia KW - delusions KW - disruptive behavior KW - violent ideation KW - psychotic symptoms KW - pandemic KW - mental health KW - distress KW - stress KW - psychological health KW - psychosis KW - risk KW - machine learning N2 - Background: The COVID-19 disease results from infection by the SARS-CoV-2 virus to produce a range of mild to severe physical, neurological, and mental health symptoms. The COVID-19 pandemic has indirectly caused significant emotional distress, triggering the emergence of mental health symptoms in individuals who were not previously affected or exacerbating symptoms in those with existing mental health conditions. Emotional distress and certain mental health conditions can lead to violent ideation and disruptive behavior, including aggression, threatening acts, deliberate harm toward other people or animals, and inattention to or noncompliance with education or workplace rules. Of the many mental health conditions that can be associated with violent ideation and disruptive behavior, psychosis can evidence greater vulnerability to unpredictable changes and being at a greater risk for them. Individuals with psychosis can also be more susceptible to contracting COVID-19 disease. Objective: This study aimed to investigate whether violent ideation, disruptive behavior, or psychotic symptoms were more prevalent in a population with COVID-19 and did not precede the pandemic. Methods: In this preliminary study, we analyzed questionnaire responses from a population sample (N=366), received between the end of February 2021 and the start of March 2021 (1 year into the COVID-19 pandemic), regarding COVID-19 illness, violent ideation, disruptive behavior, and psychotic symptoms. Using the Wilcoxon rank sum test followed by multiple comparisons correction, we compared the self-reported frequency of these variables for 3 time windows related to the past 1 month, past 1 month to 1 year, and >1 year ago among the distributions of people who answered whether they tested positive or were diagnosed with COVID-19 by a clinician. We also used multivariable logistic regression with iterative resampling to investigate the relationship between these variables occurring >1 year ago (ie, before the pandemic) and the likelihood of contracting COVID-19. Results: We observed a significantly higher frequency of self-reported violent ideation, disruptive behavior, and psychotic symptoms, for all 3 time windows of people who tested positive or were diagnosed with COVID-19 by a clinician. Using multivariable logistic regression, we observed 72% to 94% model accuracy for an increased incidence of COVID-19 in participants who reported violent ideation, disruptive behavior, or psychotic symptoms >1 year ago. Conclusions: This preliminary study found that people who reported a test or clinician diagnosis of COVID-19 also reported higher frequencies of violent ideation, disruptive behavior, or psychotic symptoms across multiple time windows, indicating that they were not likely to be the result of COVID-19. In parallel, participants who reported these behaviors >1 year ago (ie, before the pandemic) were more likely to be diagnosed with COVID-19, suggesting that violent ideation, disruptive behavior, in addition to psychotic symptoms, were associated with COVID-19 with an approximately 70% to 90% likelihood. UR - https://formative.jmir.org/2022/8/e36444 UR - http://dx.doi.org/10.2196/36444 UR - http://www.ncbi.nlm.nih.gov/pubmed/35763758 ID - info:doi/10.2196/36444 ER - TY - JOUR AU - Bachina, Preetham AU - Lippincott, Kirk Christopher AU - Perry, Allison AU - Munk, Elizabeth AU - Maltas, Gina AU - Bohr, Rebecca AU - Rock, Bryan Robert AU - Shah, Maunank PY - 2022/8/5 TI - Programmatic Adoption and Implementation of Video-Observed Therapy in Minnesota: Prospective Observational Cohort Study JO - JMIR Form Res SP - e38247 VL - 6 IS - 8 KW - video directly observed therapy KW - vDOT KW - mobile health KW - mHealth KW - tuberculosis KW - medication adherence KW - telemedicine KW - treatment KW - telehealth KW - observed therapy KW - COVID-19 KW - primary outcome KW - treatment adherence KW - technology adoption KW - virtual health N2 - Background: In-person directly observed therapy (DOT) is standard of care for tuberculosis (TB) treatment adherence monitoring in the US, with increasing use of video-DOT (vDOT). In Minneapolis, vDOT became available in 2019. Objective: In this paper, we aimed to evaluate the use and effectiveness of vDOT in a program setting, including comparison of verified adherence among those receiving vDOT and in-person DOT. We also sought to understand the impact of COVID-19 on TB treatment adherence and technology adoption. Methods: We abstracted routinely collected data on individuals receiving therapy for TB in Minneapolis, MN, between September 2019 and June 2021. Our primary outcomes were to assess vDOT use and treatment adherence, defined as the proportion of prescribed doses (7 days per week) verified by observation (in person versus video-DOT), and to compare individuals receiving therapy in the pre?COVID-19 (before March 2020), and post?COVID-19 (after March 2020) periods; within the post?COVID-19 period, we evaluated early COVID-19 (March-August 2020), and intra?COVID-19 (after August 2020) periods. Results: Among 49 patients with TB (mean age 41, SD 19; n=27, 55% female and n=47, 96% non?US born), 18 (36.7%) received treatment during the post?COVID-19 period. Overall, verified adherence (proportion of observed doses) was significantly higher when using vDOT (mean 81%, SD 17.4) compared to in-person DOT (mean 54.5%, SD 10.9; P=.001). The adoption of vDOT increased significantly from 35% (11/31) of patients with TB in the pre?COVID-19 period to 67% (12/18) in the post?COVID-19 period (P=.04). Consequently, overall verified (ie, observed) adherence among all patients with TB in the clinic improved across the study periods (56%, 67%, and 79%, P=.001 for the pre?, early, and intra?COVID-19 periods, respectively). Conclusions: vDOT use increased after the COVID-19 period, was more effective than in-person DOT at verifying ingestion of prescribed treatment, and led to overall increased verified adherence in the clinic despite the onset of the COVID-19 pandemic. UR - https://formative.jmir.org/2022/8/e38247 UR - http://dx.doi.org/10.2196/38247 UR - http://www.ncbi.nlm.nih.gov/pubmed/35834671 ID - info:doi/10.2196/38247 ER - TY - JOUR AU - Mousavi, Avah Zahra AU - Lai, Jocelyn AU - Simon, Katharine AU - Rivera, P. Alexander AU - Yunusova, Asal AU - Hu, Sirui AU - Labbaf, Sina AU - Jafarlou, Salar AU - Dutt, D. Nikil AU - Jain, C. Ramesh AU - Rahmani, M. Amir AU - Borelli, L. Jessica PY - 2022/8/5 TI - Sleep Patterns and Affect Dynamics Among College Students During the COVID-19 Pandemic: Intensive Longitudinal Study JO - JMIR Form Res SP - e33964 VL - 6 IS - 8 KW - sleep KW - objective sleep outcomes KW - COVID-19 KW - affect variability KW - affect dynamics N2 - Background: Sleep disturbance is a transdiagnostic risk factor that is so prevalent among young adults that it is considered a public health epidemic, which has been exacerbated by the COVID-19 pandemic. Sleep may contribute to mental health via affect dynamics. Prior literature on the contribution of sleep to affect is largely based on correlational studies or experiments that do not generalize to the daily lives of young adults. Furthermore, the literature examining the associations between sleep variability and affect dynamics remains scant. Objective: In an ecologically valid context, using an intensive longitudinal design, we aimed to assess the daily and long-term associations between sleep patterns and affect dynamics among young adults during the COVID-19 pandemic. Methods: College student participants (N=20; female: 13/20, 65%) wore an Oura ring (?ura Health Ltd) continuously for 3 months to measure sleep patterns, such as average and variability in total sleep time (TST), wake after sleep onset (WASO), sleep efficiency, and sleep onset latency (SOL), resulting in 1173 unique observations. We administered a daily ecological momentary assessment by using a mobile health app to evaluate positive affect (PA), negative affect (NA), and COVID-19 worry once per day. Results: Participants with a higher sleep onset latency (b=?1.09, SE 0.36; P=.006) and TST (b=?0.15, SE 0.05; P=.008) on the prior day had lower PA on the next day. Further, higher average TST across the 3-month period predicted lower average PA (b=?0.36, SE 0.12; P=.009). TST variability predicted higher affect variability across all affect domains. Specifically, higher variability in TST was associated higher PA variability (b=0.09, SE 0.03; P=.007), higher negative affect variability (b=0.12, SE 0.05; P=.03), and higher COVID-19 worry variability (b=0.16, SE 0.07; P=.04). Conclusions: Fluctuating sleep patterns are associated with affect dynamics at the daily and long-term scales. Low PA and affect variability may be potential pathways through which sleep has implications for mental health. UR - https://formative.jmir.org/2022/8/e33964 UR - http://dx.doi.org/10.2196/33964 UR - http://www.ncbi.nlm.nih.gov/pubmed/35816447 ID - info:doi/10.2196/33964 ER - TY - JOUR AU - Mehta, N. Shivani AU - Burger, C. Zoe AU - Meyers-Pantele, A. Stephanie AU - Garfein, S. Richard AU - Ortiz, O. Dayanna AU - Mudhar, K. Pavan AU - Kothari, B. Smit AU - Kothari, Jigna AU - Meka, Meena AU - Rodwell, Timothy PY - 2022/8/4 TI - Knowledge, Attitude, Practices, and Vaccine Hesitancy Among the Latinx Community in Southern California Early in the COVID-19 Pandemic: Cross-sectional Survey JO - JMIR Form Res SP - e38351 VL - 6 IS - 8 KW - COVID-19 KW - knowledge KW - attitude KW - practices KW - KAP survey KW - vaccine hesitancy KW - Latinx KW - Latinx cohort KW - minority population KW - primary care KW - sociodemographic characteristic KW - public health KW - vulnerable population KW - epidemiology N2 - Background: The Latinx population in the United States has experienced high rates of infection, hospitalization, and death since the beginning of the COVID-19 pandemic. There is little data on the knowledge, attitude, and practices (KAP) specifically in Latinx communities in the United States. Objective: We aimed to assess COVID-19 KAP and vaccine hesitancy among a Latinx cohort in the early stages of the COVID-19 pandemic (from July 2020 to October 2020), at a unique time when a vaccine was not available.  Methods: Participants aged ?18 years were recruited at a primary care clinic in Southern California and asked to self-report sociodemographic characteristics, KAP, and vaccine hesitancy. A subset of the participants answered the vaccine hesitancy assessment as it was added after the start of data collection. KAP items were summed to create composite scores, with higher scores reflecting increased COVID-19 knowledge, positive attitudes toward the COVID-19 pandemic, and disease prevention practices. Bivariate and multivariable regression models were fitted to test associations between sociodemographic characteristics and KAP scores. For our analysis, we only included patients who self-identified as Latinx. Results: Our final data set included 265 participants. The participants had a mean age of 49 (IQR 38.5-59) years, and 72.1% (n=191) were female, 77% (n=204) had at most a high school degree, 34.7% (n=92) had an annual income 2.5). Participants were satisfied with the ENERGY System overall (65%, 39/60) as well as the length of time it took to answer the questions (90%, 54/60), which they found easy to answer (87%, 52/60). Conclusions: This study provided initial support for the feasibility of the ENERGY System, a DMH tool capable of screening for resource and mental health needs and providing automated, personalized, and free resources and techniques to meet the identified needs. Future studies should seek direct feedback from community members to further improve the ENERGY System and its dissemination to encourage use. UR - https://formative.jmir.org/2022/6/e38162 UR - http://dx.doi.org/10.2196/38162 UR - http://www.ncbi.nlm.nih.gov/pubmed/35696607 ID - info:doi/10.2196/38162 ER - TY - JOUR AU - Föll, Simon AU - Lison, Adrian AU - Maritsch, Martin AU - Klingberg, Karsten AU - Lehmann, Vera AU - Züger, Thomas AU - Srivastava, David AU - Jegerlehner, Sabrina AU - Feuerriegel, Stefan AU - Fleisch, Elgar AU - Exadaktylos, Aristomenis AU - Wortmann, Felix PY - 2022/6/21 TI - A Scalable Risk-Scoring System Based on Consumer-Grade Wearables for Inpatients With COVID-19: Statistical Analysis and Model Development JO - JMIR Form Res SP - e35717 VL - 6 IS - 6 KW - COVID-19 KW - risk scoring KW - wearable devices KW - wearable KW - smartwatches KW - smartwatch KW - Bayesian survival analysis KW - remote monitoring KW - patient monitoring KW - remote patient monitoring KW - smart device KW - digital health KW - risk score KW - scalable KW - general ward KW - hospital KW - measurement tool KW - measurement instrument N2 - Background: To provide effective care for inpatients with COVID-19, clinical practitioners need systems that monitor patient health and subsequently allow for risk scoring. Existing approaches for risk scoring in patients with COVID-19 focus primarily on intensive care units (ICUs) with specialized medical measurement devices but not on hospital general wards. Objective: In this paper, we aim to develop a risk score for inpatients with COVID-19 in general wards based on consumer-grade wearables (smartwatches). Methods: Patients wore consumer-grade wearables to record physiological measurements, such as the heart rate (HR), heart rate variability (HRV), and respiration frequency (RF). Based on Bayesian survival analysis, we validated the association between these measurements and patient outcomes (ie, discharge or ICU admission). To build our risk score, we generated a low-dimensional representation of the physiological features. Subsequently, a pooled ordinal regression with time-dependent covariates inferred the probability of either hospital discharge or ICU admission. We evaluated the predictive performance of our developed system for risk scoring in a single-center, prospective study based on 40 inpatients with COVID-19 in a general ward of a tertiary referral center in Switzerland. Results: First, Bayesian survival analysis showed that physiological measurements from consumer-grade wearables are significantly associated with patient outcomes (ie, discharge or ICU admission). Second, our risk score achieved a time-dependent area under the receiver operating characteristic curve (AUROC) of 0.73-0.90 based on leave-one-subject-out cross-validation. Conclusions: Our results demonstrate the effectiveness of consumer-grade wearables for risk scoring in inpatients with COVID-19. Due to their low cost and ease of use, consumer-grade wearables could enable a scalable monitoring system. Trial Registration: Clinicaltrials.gov NCT04357834; https://www.clinicaltrials.gov/ct2/show/NCT04357834 UR - https://formative.jmir.org/2022/6/e35717 UR - http://dx.doi.org/10.2196/35717 UR - http://www.ncbi.nlm.nih.gov/pubmed/35613417 ID - info:doi/10.2196/35717 ER - TY - JOUR AU - Khuntia, Jiban AU - Mejia, J. Frances AU - Ning, Xue AU - Helton, Jeff AU - Stacey, Rulon PY - 2022/6/15 TI - Integration vs Collaborative Redesign Strategies of Health Systems? Supply Chains in the Post-COVID-19 New Normal: Cross-sectional Survey Across the United States JO - JMIR Form Res SP - e35317 VL - 6 IS - 6 KW - COVID-19 KW - post-COVID-19 KW - health systems KW - supply chain integration KW - supply chain collaboration KW - supply chain resilience N2 - Background: Given the widespread disruptions to supply chains in 2020 because of the COVID-19 pandemic, questions such as how health systems are shaping strategies to restore the supply chain disruptions are essential to have confidence in health systems? supply chain model strategies. Plausibly, health systems have an opportunity for redesign, growth, and innovation by utilizing collaborative strategies now, compared to the usual strategies of integrating their existing supply chains to reduce inefficiencies. Objective: This study focuses on teasing out the nuance of supply chain integration versus collaborative redesign strategies for health systems in the post-COVID-19 new normal. We focus on 2 research questions. First, we explore the impact of perceived supply chain challenges and disruptions on health systems? supply chain integration (SC-INTEGRATION) and collaborative redesign (SC-REDESIGN) strategies. Second, we examine the outcomes of integration and collaborative redesign strategic choices on growth and service outcomes. Methods: We used data for this study collected through a consultant from a robust group of health system chief executive officers (CEOs) across the United States from February to March 2021. Among the 625 health system CEOs contacted, 135 (21.6%) responded to our survey. We considered supply chain?relevant strategy and outcome variables from the literature and ratified them via expert consensus. We collected secondary data from the Agency for Healthcare Research and Quality (AHRQ) Compendium of the US Health Systems, leading to a matched data set from the 124 health systems. Next, we used ordered logit model estimation to examine CEO preferences for partnership strategies to address current supply disruptions and the outcomes of strategy choices. Results: Health systems with higher disruptions would choose integration (positive, P<.001) over redesign, indicating that they still trust the existing partners. Integration strategy is perceived to result in better service outcomes (P<.01), while collaborations are perceived to lead to greater growth opportunities (P<.05); however, the role of integration in growth is not entirely ruled out (combined model, P<.001). Plausibly, some health systems would choose integration and collaborative redesign models, which have a significant relationship with both services (combined model, P<.01) and growth, establishing the importance of mixed strategies for health systems. Conclusions: The cost of health care continues to rise, and supply-related costs constitute a large portion of a hospital?s expenditure. Understanding supply chain strategic choices are essential for a health system?s success. Although collaboration is an option, focusing on and improving existing integration dynamics is helpful to foster both growth and services for health systems. UR - https://formative.jmir.org/2022/6/e35317 UR - http://dx.doi.org/10.2196/35317 UR - http://www.ncbi.nlm.nih.gov/pubmed/35452405 ID - info:doi/10.2196/35317 ER - TY - JOUR AU - Nordtug, Maja AU - Assing Hvidt, Elisabeth AU - Lüchau, Christine Elle AU - Grønning, Anette PY - 2022/6/14 TI - General Practitioners? Experiences of Professional Uncertainties Emerging from the Introduction of Video Consultations in General Practice: Qualitative Study JO - JMIR Form Res SP - e36289 VL - 6 IS - 6 KW - video consultation technology KW - general practice, COVID-19, doctor-patient communication KW - uncertainties KW - general practitioners KW - video consultation KW - virtual health KW - physician KW - digital health KW - pandemic N2 - Background: Uncertainties are omnipresent in health care, but little is known about general practitioners? (GPs) professional uncertainties concerning digital consultations. This is problematic, as many countries have undergone an extensive digital transformation. Objective: The aim of this study was to explore the professional uncertainties that emerged among Danish GPs with the introduction of video consultations. Methods: We conducted qualitative interviews with 15 Danish GPs during the beginning of the COVID-19 pandemic in 2020. The interviews were analyzed using an abductive approach. Results: We identified 3 categories of uncertainty: integrity, setting, and interaction. Respectively, these 3 categories of uncertainty refer to (1) uncertainties related to how technology may impede the provision of health care; (2) uncertainties related to the potentials of video technology; and (3) uncertainties related to how the video consultation technology affects interactions with patients. Conclusions: The uncertainties experienced by Danish GPs appear to be a typical reaction to the introduction of new technology. Embedding video consultation technology into GPs? working routines will take time, and GPs do not necessarily feel intuitively capable of transferring their abilities, such as being good and socially present for video-mediated consultations. The heterogeneity of professional uncertainties experienced among the GPs suggests that they are the product of individual GP-technology relationships?not of the technology in itself. Consequently, we cannot expect that uncertainties can be remedied by changing or precluding new technology. UR - https://formative.jmir.org/2022/6/e36289 UR - http://dx.doi.org/10.2196/36289 UR - http://www.ncbi.nlm.nih.gov/pubmed/35653607 ID - info:doi/10.2196/36289 ER - TY - JOUR AU - Shi, Qiming AU - Herbert, Carly AU - Ward, V. Doyle AU - Simin, Karl AU - McCormick, A. Beth AU - Ellison III, T. Richard AU - Zai, H. Adrian PY - 2022/6/13 TI - COVID-19 Variant Surveillance and Social Determinants in Central Massachusetts: Development Study JO - JMIR Form Res SP - e37858 VL - 6 IS - 6 KW - geographic information science KW - GIS KW - COVID-19 KW - SARS-CoV-2 KW - variants KW - surveillance KW - dashboard KW - web mapping KW - public health KW - web-based information KW - digital health KW - epidemiology N2 - Background: Public health scientists have used spatial tools such as web-based Geographical Information System (GIS) applications to monitor and forecast the progression of the COVID-19 pandemic and track the impact of their interventions. The ability to track SARS-CoV-2 variants and incorporate the social determinants of health with street-level granularity can facilitate the identification of local outbreaks, highlight variant-specific geospatial epidemiology, and inform effective interventions. We developed a novel dashboard, the University of Massachusetts? Graphical user interface for Geographic Information (MAGGI) variant tracking system that combines GIS, health-associated sociodemographic data, and viral genomic data to visualize the spatiotemporal incidence of SARS-CoV-2 variants with street-level resolution while safeguarding protected health information. The specificity and richness of the dashboard enhance the local understanding of variant introductions and transmissions so that appropriate public health strategies can be devised and evaluated. Objective: We developed a web-based dashboard that simultaneously visualizes the geographic distribution of SARS-CoV-2 variants in Central Massachusetts, the social determinants of health, and vaccination data to support public health efforts to locally mitigate the impact of the COVID-19 pandemic. Methods: MAGGI uses a server-client model?based system, enabling users to access data and visualizations via an encrypted web browser, thus securing patient health information. We integrated data from electronic medical records, SARS-CoV-2 genomic analysis, and public health resources. We developed the following functionalities into MAGGI: spatial and temporal selection capability by zip codes of interest, the detection of variant clusters, and a tool to display variant distribution by the social determinants of health. MAGGI was built on the Environmental Systems Research Institute ecosystem and is readily adaptable to monitor other infectious diseases and their variants in real-time. Results: We created a geo-referenced database and added sociodemographic and viral genomic data to the ArcGIS dashboard that interactively displays Central Massachusetts? spatiotemporal variants distribution. Genomic epidemiologists and public health officials use MAGGI to show the occurrence of SARS-CoV-2 genomic variants at high geographic resolution and refine the display by selecting a combination of data features such as variant subtype, subject zip codes, or date of COVID-19?positive sample collection. Furthermore, they use it to scale time and space to visualize association patterns between socioeconomics, social vulnerability based on the Centers for Disease Control and Prevention?s social vulnerability index, and vaccination rates. We launched the system at the University of Massachusetts Chan Medical School to support internal research projects starting in March 2021. Conclusions: We developed a COVID-19 variant surveillance dashboard to advance our geospatial technologies to study SARS-CoV-2 variants transmission dynamics. This real-time, GIS-based tool exemplifies how spatial informatics can support public health officials, genomics epidemiologists, infectious disease specialists, and other researchers to track and study the spread patterns of SARS-CoV-2 variants in our communities. UR - https://formative.jmir.org/2022/6/e37858 UR - http://dx.doi.org/10.2196/37858 UR - http://www.ncbi.nlm.nih.gov/pubmed/35658093 ID - info:doi/10.2196/37858 ER - TY - JOUR AU - Petrova, Mariya AU - Miller-Perusse, Michael AU - Hirshfield, Sabina AU - Carrico, Adam AU - Horvath, Keith PY - 2022/5/31 TI - Effect of the COVID-19 Pandemic on Stimulant Use and Antiretroviral Therapy Adherence Among Men Who Have Sex With Men Living With HIV: Qualitative Focus Group Study JO - JMIR Form Res SP - e30897 VL - 6 IS - 5 KW - stimulants KW - HIV KW - ART KW - antiretroviral therapy KW - MSM KW - men who have sex with men KW - COVID-19 KW - pandemic KW - therapy KW - drug use KW - virtual focus groups KW - virtual health KW - medication adherence N2 - Background: Evidence suggests that economic, social, and psychological circumstances brought about by the COVID-19 pandemic may have a serious impact on behavioral health. Men who have sex with men (MSM) are disproportionally impacted by HIV and stimulant use, the co-occurrence of which heightens HIV transmission risk and undermines nationwide treatment strategies as prevention efforts for ending the HIV epidemic. There is a paucity of information regarding the potential impact of the COVID-19 pandemic on the substance use and HIV medication adherence in this key vulnerable population?MSM who use stimulants and are living with HIV. Objective: The aim of this qualitative study was to identify ways in which the COVID-19 pandemic has affected stimulant use and antiretroviral therapy (ART) adherence among a sample of MSM living with HIV. Methods: Two focus groups were conducted in August 2020 via videoconferencing technology compliant with the Health Insurance Portability and Accountability Act. Potential participants from an established research participant registry at State University of New York Downstate Health Sciences University were invited and screened for study participation on the basis of inclusion criteria. A semistructured interview guide was followed. A general inductive approach was used to analyze the data. Findings in two general areas of interest, the impact of the COVID-19 pandemic on stimulant use and ART adherence, emerged directly from the raw data. Results: A total of 12 ethnically diverse participants over the age of 25 years took part in the study. Results were heterogeneous in terms of the effects of the pandemic on both stimulant use and ART adherence among MSM living with HIV. Some men indicated increased or sustained stimulant use and ART adherence, and others reported decreased stimulant use and ART adherence. Reasons for these behavioral changes ranged from concerns about their own health and that of their loved ones to challenges brought about by the lack of daily structure during the lockdown phase of the pandemic and emotion regulation difficulties. Conclusions: The COVID-19 pandemic has had a differential impact on stimulant use and ART medication adherence among MSM living with HIV. The reasons for behavioral change identified in this study may be salient intervention targets to support ART medication adherence and lower stimulant use among MSM in the aftermath of the of the COVID-19 pandemic, as well as beyond. UR - https://formative.jmir.org/2022/5/e30897 UR - http://dx.doi.org/10.2196/30897 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275839 ID - info:doi/10.2196/30897 ER - TY - JOUR AU - Lloret-Pineda, Amanda AU - He, Yuelu AU - Haro, Maria Josep AU - Cristóbal-Narváez, Paula PY - 2022/5/19 TI - Types of Racism and Twitter Users? Responses Amid the COVID-19 Outbreak: Content Analysis JO - JMIR Form Res SP - e29183 VL - 6 IS - 5 KW - COVID-19 KW - racism KW - Chinese KW - advocacy KW - Twitter N2 - Background: When the first COVID-19 cases were noticed in China, many racist comments against Chinese individuals spread. As there is a huge need to better comprehend why all of these targeted comments and opinions developed specifically at the start of the outbreak, we sought to carefully examine racism and advocacy efforts on Twitter in the first quarter of 2020 (January 15 to March 3, 2020). Objective: The first research question aimed to understand the main type of racism displayed on Twitter during the first quarter of 2020. The second research question focused on evaluating Twitter users? positive and negative responses regarding racism toward Chinese individuals. Methods: Content analysis of tweets was utilized to address the two research questions. Using the NCapture browser link and NVivo software, tweets in English and Spanish were pulled from the Twitter data stream from January 15 to March 3, 2020. A total of 19,150 tweets were captured using the advanced Twitter search engine with the keywords and hashtags #nosoyunvirus, #imNotAVirus, #ChineseDon?tComeToJapan, #racism, ?No soy un virus,? and ?Racismo Coronavirus.? After cleaning the data, a total of 402 tweets were codified and analyzed. Results: The data confirmed clear sentiments of racism against Chinese individuals during the first quarter of 2020. The tweets displayed individual, cultural, and institutional racism. Individual racism was the most commonly reported form of racism, specifically displaying physical and verbal aggression. As a form of resistance, Twitter users created spaces for advocacy and activism. The hashtag ?I am not a virus? helped to break stereotypes, prejudice, and discrimination on Twitter. Conclusions: Advocacy efforts were enormous both inside and outside the Chinese community; an allyship sentiment was fostered by some white users, and an identification with the oppression experienced by the Chinese population was expressed in the Black and Muslim worldwide communities. Activism through social media manifested through art, food sharing, and community support. UR - https://formative.jmir.org/2022/5/e29183 UR - http://dx.doi.org/10.2196/29183 UR - http://www.ncbi.nlm.nih.gov/pubmed/35446780 ID - info:doi/10.2196/29183 ER - TY - JOUR AU - Thimmapuram, Jayaram AU - Patel, Kamlesh AU - Madhusudhan, K. Divya AU - Deshpande, Snehal AU - Bouderlique, Ekta AU - Nicolai, Veronique AU - Rao, Raghavendra PY - 2022/5/17 TI - Health-Related Quality of Life Outcomes With Regular Yoga and Heartfulness Meditation Practice: Results From a Multinational, Cross-sectional Study JO - JMIR Form Res SP - e37876 VL - 6 IS - 5 KW - yoga KW - meditation KW - health-related quality of life KW - Heartfulness KW - COVID-19 KW - healthy living KW - wellness KW - quality of life KW - stress KW - mental health KW - psychological health KW - online survey KW - cross-sectional study KW - health outcome N2 - Background: Although the benefits of yoga are well established across the world, there are limited studies exploring the long-term interrelation between yoga, meditation, and health. Specifically, there is limited research exploring the differences in health-related quality of life (HRQOL) among regular meditators and nonmeditators. Objective: This study explored the differences in 7 domains of HRQOL (including quality of life, ability to adopt a healthy lifestyle, ability to relax, frequency of nervousness and stress, coping with day-to-day stress, workplace productivity, and staying healthy during the COVID-19 pandemic) among practitioners of yoga and meditation. Methods: A cross-sectional, online survey was distributed to all members who participated in a 100-day yoga and meditation program, culminating in the International Day of Yoga event, organized by the Heartfulness Institute in partnership with the Central Council for Research in Yoga and Naturopathy, Ministry of Ayush, SVYASA Yoga University, and Patanjali Yoga Institute, India. The program consisted of daily virtual yoga, meditation, and speaker sessions. The data were analyzed by nonparametric Mann-Whitney U test and Kruskal-Wallis tests for continuous variables and chi-square test for categorical variables. Results: A total of 3164 participants from 39 countries completed the survey. Mean age was 33.8 (SD 13.6) years. The majority of the participants were female (n=1643, 52%) and students (n=1312, 41.5%). Regular yoga and meditation practice was associated with a positive impact on all 7 domains of HRQOL (Mann-Whitney P<.05 and ?2P<.05). Notably, experienced Heartfulness (?2 years) meditators reported better outcomes in all the domains of HRQOL as compared to those not currently practicing this form of meditation and participants with ?1 year of Heartfulness meditation experience (P<.05). Conclusions: This is one of the first cross-sectional studies to explore HRQOL outcomes among participants of a 100-day virtual yoga and meditation program. Overall, a yoga and meditation practice was found to be an effective tool for promoting HRQOL. Regular yoga and meditation practice was associated with factors promoting health and well-being, with long-term meditation practice associated with increased benefits. UR - https://formative.jmir.org/2022/5/e37876 UR - http://dx.doi.org/10.2196/37876 UR - http://www.ncbi.nlm.nih.gov/pubmed/35470800 ID - info:doi/10.2196/37876 ER - TY - JOUR AU - Sharma, Pravesh AU - Sinicrope, R. Anthony AU - Sinicrope, Pamela AU - Brockman, A. Tabetha AU - Reinicke, M. Nicole AU - West, W. Ian AU - Wiepert, M. Liana AU - Glasgow, E. Amy AU - Sangaralingham, R. Lindsey AU - Holland, L. Ashley AU - Patten, A. Christi PY - 2022/5/13 TI - Patient Telemedicine Perceptions During the COVID-19 Pandemic Within a Multi-State Medical Institution: Qualitative Study JO - JMIR Form Res SP - e37012 VL - 6 IS - 5 KW - COVID-19 KW - telehealth KW - video appointment KW - telemedicine KW - qualitative KW - pandemic KW - outpatient KW - clinical care KW - virtual health KW - patient perspective KW - healthcare KW - clinical practice N2 - Background: During the COVID-19 pandemic, to prevent the spread of the virus, federal regulatory barriers around telemedicine were lifted, and health care institutions encouraged patients to use telemedicine, including video appointments. Many patients, however, still chose face-2-face (f2f) appointments for nonemergent clinical care. Objective: We explored patients? personal and environmental barriers to the use of video appointments from April 2020 to December 2020. Methods: We conducted qualitative telephone interviews of Mayo Clinic patients who attended f2f appointments at the Mayo Clinic from April 2020 to December 2020 but did not utilize Mayo Clinic video appointment services during that time frame. Results: We found that, although most patients were concerned about preventing COVID-19 transmission, they trusted Mayo Clinic to keep them safe when attending f2f appointments. Many expressed that a video appointment made it difficult to establish rapport with their providers. Other common barriers to video appointments were perceived therapeutic benefits of f2f appointments, low digital literacy, and concerns about privacy and security. Conclusions: Our study provides an in-depth investigation into barriers to engaging in video appointments for nonemergent clinical care in the context of the COVID-19 pandemic. Our findings corroborate many barriers prevalent in the prepandemic literature and suggest that rapport barriers need to be analyzed and problem-solved at a granular level. UR - https://formative.jmir.org/2022/5/e37012 UR - http://dx.doi.org/10.2196/37012 UR - http://www.ncbi.nlm.nih.gov/pubmed/35452401 ID - info:doi/10.2196/37012 ER - TY - JOUR AU - Minian, Nadia AU - Saiva, Anika AU - Gayapersad, Allison AU - Dragonetti, Rosa AU - Proulx, Catherine AU - Debergue, Patricia AU - Lecce, Julia AU - Hussain, Sarwar AU - Desjardins, Eric AU - Selby, Peter PY - 2022/5/12 TI - Video Game to Attenuate Pandemic-Related Stress From an Equity Lens: Development and Usability Study JO - JMIR Form Res SP - e36820 VL - 6 IS - 5 KW - video games KW - cognitive behavioral therapy KW - usability study KW - self-care KW - digital health KW - technological infrastructure KW - video game development KW - user engagement KW - user perception KW - COVID-19 KW - Mental health KW - mental health care system KW - depression KW - anxiety KW - digital therapy N2 - Background: The emergence of the novel coronavirus (COVID-19) has introduced additional pressures on an already fragile mental health care system due to a significant rise in depression, anxiety, and stress among Canadians. Although cognitive behavioral therapy (CBT) is known to be an efficacious treatment to reduce such mental health issues, few people have access to CBT in an engaging and sustainable manner. To address this gap, a collaboration between the Centre for Addiction and Mental Health (CAMH) and the National Research Council of Canada (NRC) developed CBT-based self-led, online, clinician-tested modules in the form of a video game, named Legend of Evelys, and evaluated its usability in the attenuation of a COVID-19?related increase in stress. Objective: We here present the conceptualization and design of new self-care modules in the form of a video game, its implementation in a technological infrastructure, and inclusivity and privacy considerations that informed the development. A usability study of the modules was performed to assess the video game?s usability, user engagement, and user perceptions. Methods: The development of the video game involved establishment of a technology infrastructure for secure implementation of the software for the modules and a clinician-led assessment of the clinical utility of these modules through two ?whiteboard? sessions. The usability study was informed by a mixed methods sequential explanatory design to evaluate the intervention of the mobile app through two distinct phases: quantitative data collection using in-app analytics data and two surveys, followed by qualitative data collection by semistructured interviews. Results: A total of 32 participants trialed the app for 2 weeks. They used the video game an average of six times and rated the game as ?good? based on the Systems Usability Scale score. In terms of stress reduction, the study demonstrated a significant difference in the participants? Perceived Stress Scale score at baseline (mean 22.14, SD 6.187) compared with that at the 2-week follow-up (mean 18.04, SD 6.083; t27=3.628, P=.001). Qualitative interviews helped participants identify numerous functionality issues and provided specific recommendations, most of which were successfully integrated into the video game for future release. Conclusions: Through this collaboration, we have established that it is possible to incorporate CBT exercises into a video game and have these exercises adopted to address stress. While video games are a promising strategy to help people with their stress and anxiety, there is a further need to examine the real-world effectiveness of the Legend of Evelys in reducing anxiety. UR - https://formative.jmir.org/2022/5/e36820 UR - http://dx.doi.org/10.2196/36820 UR - http://www.ncbi.nlm.nih.gov/pubmed/35413001 ID - info:doi/10.2196/36820 ER - TY - JOUR AU - Shah, S. Harita AU - Dolwick Grieb, Suzanne AU - Flores-Miller, Alejandra AU - Phillips, H. Katherine AU - Page, R. Kathleen AU - Cervantes, Ana AU - Yang, Cui PY - 2022/5/12 TI - A Crowdsourcing Open Contest to Design a Latino-Specific COVID-19 Campaign: Mixed Methods Analysis JO - JMIR Form Res SP - e35764 VL - 6 IS - 5 KW - crowdsourcing KW - Latino KW - open contest KW - community engagement KW - social marketing KW - COVID-19 KW - mixed method KW - implementation KW - thematic analysis N2 - Background: Latino communities are among the most heavily impacted populations by the COVID-19 pandemic in the United States due to intersectional barriers to care. Crowdsourcing open contests can be an effective means of community engagement but have not been well studied in Latino populations nor in addressing the COVID-19 pandemic. Objective: The aims of this study are to (1) implement and evaluate a crowdsourcing open contest to solicit a name for a COVID-19 social marketing campaign for Latino populations in Maryland and (2) conduct a thematic analysis of submitted entries to guide campaign messaging. Methods: To assess the level of community engagement in this crowdsourcing open contest, we used descriptive statistics to analyze data on entries, votes, and demographic characteristics of participants. The submitted text was analyzed through inductive thematic analysis. Results: We received 74 entries within a 2-week period. The top 10 entries were chosen by community judges and the winner was decided by popular vote. We received 383 votes within 1 week. The most common themes were collective efficacy, self-efficacy, and perceived benefits of COVID-19 testing. We used these themes to directly inform our social marketing intervention and found that advertisements based on these themes became the highest performing. Conclusions: Crowdsourcing open contests are an effective means of community engagement and an agile tool for guiding interventions to address COVID-19, including in populations impacted by health care disparities, such as Latino communities. The thematic analysis of contest entries can be a valuable strategy to inform the development of social marketing campaign materials. UR - https://formative.jmir.org/2022/5/e35764 UR - http://dx.doi.org/10.2196/35764 UR - http://www.ncbi.nlm.nih.gov/pubmed/35357317 ID - info:doi/10.2196/35764 ER - TY - JOUR AU - Grimes, Amanda AU - Lightner, S. Joseph AU - Eighmy, Katlyn AU - Steel, Chelsea AU - Shook, P. Robin AU - Carlson, Jordan PY - 2022/4/15 TI - Decreased Physical Activity Among Youth Resulting From COVID-19 Pandemic?Related School Closures: Natural Experimental Study JO - JMIR Form Res SP - e35854 VL - 6 IS - 4 KW - intervention KW - physical activity KW - nutrition KW - adolescents KW - formative research KW - COVID-19 KW - pandemic KW - school closure KW - children KW - youth N2 - Background: The COVID-19 pandemic has resulted in the closure of schools and may have inadvertently resulted in decreased physical activity for youth. Emerging evidence suggests that school closures due to the COVID-19 pandemic could have hastened the inactivity of youth, possibly due to a lack of structure outside of school and increased access to sedentary activities. Objective: The purpose of this study was to assess changes in physical activity from pre?school closure (before the pandemic) to post?school closure (during the pandemic) among youth in spring 2020. Methods: This study used a natural experimental design; youth were enrolled in a physical activity study prior to the lockdown, which was enforced due to the pandemic. The number of device-assessed steps per day and moderate-to-vigorous physical activity minutes per week were measured by using a Garmin Vivofit 4 (Garmin Ltd) accelerometer over 8 weeks. Mixed effects models were used to compare physical activity variables, which were measured before and during the COVID-19 pandemic. Results: Youth were primarily Hispanic or Latinx (8/17, 47%) and female (10/17, 59%). The number of daily steps decreased by 45.4% during the school closure, from a pre?school closure mean of 8003 steps per day to a post?school closure mean of 4366 steps per day. Daily moderate-to-vigorous physical activity decreased by 42.5%, from a pre?school closure mean of 80.18 minutes per week to a post?school closure mean of 46.13 minutes per week. Conclusions: Youth are engaging in roughly half as much physical activity during the school closure as they were prior to the school closure. If additional evidence supports these claims, interventions are needed to support youths? engagement in physical activity in the Midwest. UR - https://formative.jmir.org/2022/4/e35854 UR - http://dx.doi.org/10.2196/35854 UR - http://www.ncbi.nlm.nih.gov/pubmed/35297778 ID - info:doi/10.2196/35854 ER - TY - JOUR AU - Sacca, Lea AU - Markham, Christine AU - Hernandez, Belinda AU - Shegog, Ross AU - Peskin, Melissa AU - Craig Rushing, Stephanie AU - Warren, Hannah AU - Tsosie, Monique PY - 2022/4/11 TI - The Impact of COVID-19 on the Delivery of Educational Programs in Native American Communities: Qualitative Study JO - JMIR Form Res SP - e32325 VL - 6 IS - 4 KW - online sexual health programs KW - COVID-19 KW - COVID-19 pandemic KW - AI/AN youth KW - sexual health educators KW - culturally responsive adaptation KW - program implementation KW - sexual health KW - implementation KW - Native communities KW - American Indian youth KW - Alaskan youth KW - education KW - tribal communities KW - online KW - virtual N2 - Background: Despite the availability of culturally responsive sexual health educational programs for American Indian and Alaska Native (AI/AN) youth, barriers to their uptake and utilization persist in tribal communities. These challenges were exacerbated by the COVID-19 pandemic, which required flexible program delivery using both in-person and virtual classrooms. Objective: This exploratory study provides a preliminary understanding of the extent to which pre-existing challenges impact the delivery of culturally responsive sexual health education programs in Native communities and to what extent they were exacerbated by the COVID-19 pandemic. It also highlights the challenges faced by adolescent health advocates when adapting culturally responsive health curricula to online platforms. Finally, this study discloses major socioeconomic, health, and mental challenges experienced by AI/AN youth during the pandemic. Methods: An exploratory, descriptive, qualitative design approach was adopted to carry out 5 individual and 1 collective in-depth key informant interviews. A total of 8 Native and non-Native sexual health educators served as key informants and shared their personal experiences with the delivery of sexual health education programs for youth during the COVID-19 pandemic. The interviews were conducted virtually from October to November 2020 using Zoom to reach participants dispersed across different regions of the United States. We followed the consolidated criteria for reporting qualitative research (COREQ) as a reference for the study methodology. We also used the Braun and Clarke framework (2006) to conduct a thematic analysis. Results: Experts? opinions were structured according to 5 main themes: (1) competing community priorities during COVID-19; (2) moving to web-based programming: skills, training, support; (3) recruiting youth; and (4) challenges for implementation in a household environment; and (5) recommendations to overcome implementation challenges. These themes are complementary, connected, and should be considered holistically for the development, dissemination, and implementation of online sexual health programs for AI/AN youth, specifically during the COVID-19 pandemic. The results raised the following points for discussion: (1) Building partnerships with schools and community organizations facilitates program adaptation and implementation, (2) there is a need to adopt a holistic approach when addressing youth sexual health in AI/AN communities, (3) a systematic and culturally responsive adaptation approach ensures effective virtual program delivery, and (4) community and youth engagement is essential for the success of virtual sexual health programs. Conclusions: Findings can provide recommendations on actions to be taken by sexual health educators and guidelines to follow to ensure cultural sensitivity, effective adaptation, and successful implementation when setting out to advocate for online sexual health programs for AI/AN youth. UR - https://formative.jmir.org/2022/4/e32325 UR - http://dx.doi.org/10.2196/32325 UR - http://www.ncbi.nlm.nih.gov/pubmed/35348464 ID - info:doi/10.2196/32325 ER - TY - JOUR AU - Zhang, Wei AU - Velez, Dominick PY - 2022/4/4 TI - Effects of COVID-19 on Physical Activity and Its Relationship With Mental Health in a US Community Sample: Cross-sectional, Convenience Sampling?based Online Survey JO - JMIR Form Res SP - e32387 VL - 6 IS - 4 KW - physical activity KW - COVID-19 KW - mental health KW - depression KW - anxiety KW - United States KW - survey KW - cross-sectional KW - distress KW - risk N2 - Background: COVID-19 restrictions may make it difficult for people to engage in the recommended amounts of physical activity (PA). Objective: The influence of the COVID-19 pandemic on PA, as well as the links between PA and mental health, was investigated in this study. Methods: Participants were recruited using convenience sampling and responded to an online survey between April 15 and July 1, 2021, with ages ranging from 18 to 24 years (n=156, 40.9% of the sample) to ?55 years (n=28, 7.4% of the sample). To assess general psychological distress, depression, anxiety, and pandemic anxiety, a battery of mental health assessments was used. The International Physical Activity Questionnaire - Short Form was used to collect PA data from participants, who were then classified as inactive, minimally active, or highly active. Participants also indicated the locations where they performed PA before and during COVID-19. Results: A sample of 381 individuals was included in this research. The logistic regression analysis results were interpreted as odds ratios (ORs), where an OR higher than 1 indicated a greater chance of an event occurring and an OR less than 1 implied a lower likelihood of an event occurring. Logistic regression results revealed that inactive individuals were more likely to develop psychological distress (OR 2.17, 95% CI 1.27-3.69, P=.004), depression (OR 3.81, 95% CI 1.92-7.57, P<.001), and anxiety (OR 1.86, 95% CI 0.99-3.47, P=.05) as compared to highly active individuals. Furthermore, when compared to highly active people, those who were only minimally active had a higher risk of depression (OR 2.14, 95% CI 1.05-4.33, P=.04). Wilcoxon signed-rank tests revealed that COVID-19 has a greater impact on reducing the chances of less active individuals engaging in PA outside and in public spaces. Highly active people's physical exercise locations had changed less, and their exercise frequency at home increased. Conclusions: Programmatic and policy interventions geared particularly toward enhancing PA among those less active may be a helpful strategy for addressing the worldwide pandemic?s mental health crisis. UR - https://formative.jmir.org/2022/4/e32387 UR - http://dx.doi.org/10.2196/32387 UR - http://www.ncbi.nlm.nih.gov/pubmed/35302509 ID - info:doi/10.2196/32387 ER - TY - JOUR AU - Fidel Kinori, Guila Sara AU - Carot-Sans, Gerard AU - Cuartero, Andrés AU - Valero-Bover, Damià AU - Roma Monfa, Rosa AU - Garcia, Elisabet AU - Pérez Sust, Pol AU - Blanch, Jordi AU - Piera-Jiménez, Jordi AU - Ramos-Quiroga, Antoni Josep PY - 2022/3/31 TI - A Web-Based App for Emotional Management During the COVID-19 Pandemic: Platform Development and Retrospective Analysis of its Use Throughout Two Waves of the Outbreak in Spain JO - JMIR Form Res SP - e27402 VL - 6 IS - 3 KW - web-based app KW - emotional management KW - lockdown KW - COVID-19 KW - posttraumatic stress disorder KW - anxiety KW - quarantine KW - PTSD KW - app KW - emotion KW - development KW - platform KW - retrospective KW - usage KW - utilization N2 - Background: Quarantines and nationwide lockdowns implemented for containing the spread of the COVID-19 pandemic may lead to distress and increase the frequency of anxiety and depression symptoms among the general population. During the nationwide lockdown of the first wave of the COVID-19 outbreak in Spain, we developed and launched a web-based app to promote emotional self-care in the general population and facilitate contact with health care professionals. Objective: This study aimed to describe a web-based app and analyze its utilization pattern throughout 2 successive waves of the COVID-19 outbreak in Spain. Methods: Our web-based app targeted all individuals aged 18 years or more and was designed by adapting the contents of a mobile app for adjuvant treatment of posttraumatic stress disorder (ie, the PTSD Coach app) to the general population and the pandemic or lockdown scenario. We retrospectively assessed the utilization pattern of the web-based app using data systematically retrieved from Google Analytics. Data were grouped into 3 time periods, defined using Joinpoint regression analysis of COVID-19 incidence in our area: first wave, between-wave period, and second wave. Results: The resulting web-based app, named gesioemocional.cat, maintains the navigation structure of the PTSD Coach app, with three main modules: tools for emotional self-care, a self-assessment test, and professional resources for on-demand contact. The self-assessment test combines the Patient Health Questionnaire-2 and the 7-item Generalized Anxiety Disorder scale and offers professional contact in the advent of a high level of depression and anxiety; contact is prioritized in accordance with a screening questionnaire administered at the time of obtaining individual consent to be contacted. The tools for emotional self-care can be accessed either on-demand or symptom-driven. The utilization analysis showed a high number of weekly accesses during the first wave. In this period, press releases regarding critical events of the pandemic progression and government decisions on containment measures were followed by a utilization peak, irrespective of the sense (ie, positive or negative) of the information. Positive information pieces (eg, relaxation of containment measures due to a reduction of COVID-19 cases) resulted in a sharp increase in utilization immediately after information release, followed by a successive decline in utilization. The second wave was characterized by a lower and less responsive utilization of the web-based app. Conclusions: mHealth tools may help the general population cope with stressful conditions associated with the pandemic scenario. Future studies shall investigate the effectiveness of these tools among the general population?including individuals without diagnosed mental illnesses?and strategies to reach as many people as possible. UR - https://formative.jmir.org/2022/3/e27402 UR - http://dx.doi.org/10.2196/27402 UR - http://www.ncbi.nlm.nih.gov/pubmed/35142638 ID - info:doi/10.2196/27402 ER - TY - JOUR AU - Farrell, Ruth AU - Collart, Christina AU - Craighead, Caitlin AU - Pierce, Madelyn AU - Chien, Edward AU - Frankel, Richard AU - Tucker Edmonds, Brownsyne AU - Perni, Uma AU - Coleridge, Marissa AU - Ranzini, C. Angela AU - Rose, Susannah PY - 2022/3/30 TI - The Successes and Challenges of Implementing Telehealth for Diverse Patient Populations Requiring Prenatal Care During COVID-19: Qualitative Study JO - JMIR Form Res SP - e32791 VL - 6 IS - 3 KW - prenatal health care delivery KW - telehealth KW - COVID-19 KW - patient experience KW - challenge KW - telemedicine KW - pregnancy KW - women KW - diversity KW - prenatal KW - obstetric KW - reception KW - experience KW - development N2 - Background: Although telehealth appears to have been accepted among some obstetric populations before the COVID-19 pandemic, patients? receptivity and experience with the rapid conversion of this mode of health care delivery are unknown. Objective: In this study, we examine patients' prenatal care needs, preferences, and experiences during the COVID-19 pandemic, with the aim of supporting the development of successful models to serve the needs of pregnant patients, obstetric providers, and health care systems during this time. Methods: This study involved qualitative methods to explore pregnant patients? experiences with prenatal health care delivery at the onset of the COVID-19 pandemic. We conducted in-depth interviews with pregnant patients in the first and second trimester of pregnancy who received prenatal care in Cleveland, Ohio, from May to July 2020. An interview guide was used to probe experiences with health care delivery as it rapidly evolved at the onset of the pandemic. Results: Although advantages of telehealth were noted, there were several concerns noted with the broad implementation of telehealth for prenatal care during the pandemic. This included concerns about monitoring the pregnancy at home; the need for additional reassurance for the pregnancy, given the uncertainties presented by the pandemic; and the ability to have effective patient-provider discussions via a telehealth visit. The need to tailor telehealth to prenatal health care delivery was noted. Conclusions: Although previous studies have demonstrated that telehealth is a flexible and convenient alternative for some prenatal appointments, our study suggests that there may be specific needs and concerns among the diverse patient groups using this modality during the pandemic. More research is needed to understand patients' experiences with telehealth during the pandemic and develop approaches that are responsive to the needs and preferences of patients. UR - https://formative.jmir.org/2022/3/e32791 UR - http://dx.doi.org/10.2196/32791 UR - http://www.ncbi.nlm.nih.gov/pubmed/35275833 ID - info:doi/10.2196/32791 ER - TY - JOUR AU - Khuntia, Jiban AU - Ning, Xue AU - Stacey, Rulon PY - 2022/3/24 TI - Competition and Integration of US Health Systems in the Post-COVID-19 New Normal: Cross-sectional Survey JO - JMIR Form Res SP - e32477 VL - 6 IS - 3 KW - post-COVID-19 KW - health system KW - competition KW - vertical integration KW - horizontal integration KW - COVID-19 KW - integration KW - cross-sectional KW - survey KW - United States KW - characteristic KW - perception KW - decision N2 - Background: How do health systems in the United States view the concept of merger and acquisition (M&A) in a post-COVID 19 ?new normal?? How do new entrants to the market and incumbents influence horizontal and vertical integration of health systems? Traditionally, it has been argued that M&A activity is designed to reduce inequities in the market, shift toward value-based care, or enhance the number and quality of health care offerings in a given market. However, the recent history of M&A activity has yielded fewer noble results. As might be expected, the smaller the geographical region in which M&A activity is pursued, the higher the likelihood that monopolistic tendencies will result. Objective: We focused on three types of competition perceptions, external environment uncertainty?related competition, technology disruption?driven competition, and customer service?driven competition, and two integration plans, vertical integration and horizontal integration. We examined (1) how health system characteristics help discern competition perceptions and integration decisions, and (2) how environment-, technology-, and service-driven competition aspects influence vertical and horizontal integration among US health systems in the post-COVID-19 new normal. Methods: We used data for this study collected through a consultant from a robust group of health system chief executive officers (CEOs) across the United States from February to March 2021. Among the 625 CEOs, 135 (21.6%) responded to our survey. We considered competition and integration aspects from the literature and ratified them via expert consensus. We collected secondary data from the Agency for Healthcare Research and Quality (AHRQ) Compendium of the US Health Systems, leading to a matched data set for 124 health systems. We used inferential statistical comparisons to assess differences across health systems regarding competition and integration, and we used ordered logit estimations to relate competition and integration. Results: Health systems generally have a high level of the four types of competition perceptions, with the greatest concern being technology disruption?driven competition rather than environment uncertainty?related competition and customer service?driven competition. The first set of estimation results showed that size, teaching status, revenue, and uncompensated care burden are the main contingent factors influencing the three competition perceptions. The second set of estimation results revealed the relationships between different competition perceptions and integration plans. For vertical integration, environment uncertainty?related competition had a significant positive influence (P<.001), while the influence of technology disruption?driven competition was significant but negative (P<.001). The influence of customer service?driven competition on vertical integration was not evident. For horizontal integration, the results were similar for environment uncertainty?related competition and technology disruption?driven competition; however, the significance of technology disruption?driven competition was weak (P=.05). The influence of customer service?driven competition in the combined model was significant and negative (P<.001). Conclusions: Competition-driven integration has subtle influences across health systems. Environment uncertainty?related competition is a significant factor, with underlying contingent factors such as revenue concerns and leadership as the leading causes of integration plans. However, technology disruption may hinder integrations. Undoubtedly, small- and low-revenue health systems facing a high level of competition are likely to merge to navigate the health care business successfully. This trend should be a focus of policy to avoid monopolistic markets. UR - https://formative.jmir.org/2022/3/e32477 UR - http://dx.doi.org/10.2196/32477 UR - http://www.ncbi.nlm.nih.gov/pubmed/35133973 ID - info:doi/10.2196/32477 ER - TY - JOUR AU - Aronson, David Ian AU - Bennett, S. Alex AU - Ardouin-Guerrier, Mary-Andrée AU - Rivera-Castellar, German AU - Gibson, Brent AU - Santoscoy, Samantha AU - Vargas-Estrella, Brittney PY - 2022/3/23 TI - How Vaccine Ambivalence Can Lead People Who Inject Drugs to Decline COVID-19 Vaccination and Ways This Can Be Addressed: Qualitative Study JO - JMIR Form Res SP - e35066 VL - 6 IS - 3 KW - SARS-CoV-2 KW - COVID-19 KW - people who inject drugs KW - vaccine KW - vaccine hesitancy KW - barrier KW - vaccination KW - drugs KW - hesitancy KW - qualitative KW - impact KW - interview KW - United States KW - communication KW - danger KW - community N2 - Background: People who inject drugs are disproportionately impacted by SARS-CoV-2 and COVID-19, yet they do not frequently accept vaccination against SARS-CoV-2 when offered. Objective: This study aimed to explore why people who inject drugs decline free vaccines against SARS-CoV-2 and how barriers to vaccination can potentially be addressed. Methods: We conducted semistructured qualitative interviews with 17 unvaccinated adult persons who inject drugs during August and September 2021 at a New York City syringe service program, where approximately three-fourth of participants identified as Latino (55%) or African American (22%). Interviews lasted roughly 20 minutes. The interview guide examined reasons for declining vaccination, participants? understanding of COVID-19 risks, and how messages could be developed to encourage vaccine uptake among people who inject drugs. Results: Participants acknowledged that they faced increased risk from SARS-CoV-2 owing to their injection drug use but feared that long-term substance use may have weakened their health, making them especially vulnerable to side effects. Fears of possible side effects, compounded by widespread medical mistrust and questions about the overall value of vaccination contributed to marked ambivalence among our sample. The desire to protect children and older family members emerged as key potential facilitators of vaccination. Conclusions: Community-developed messages are needed in outreach efforts to explain the importance of vaccination, including the far greater dangers of COVID-19 compared to possible unintended side effects. Messages that emphasize vaccines? ability to prevent inadvertently infecting loved ones, may help increase uptake. Community-focused messaging strategies, such as those used to increase HIV and hepatitis C virus testing and overdose prevention among people who inject drugs, may prove similarly effective. UR - https://formative.jmir.org/2022/3/e35066 UR - http://dx.doi.org/10.2196/35066 UR - http://www.ncbi.nlm.nih.gov/pubmed/35191841 ID - info:doi/10.2196/35066 ER - TY - JOUR AU - Sato, Christa AU - Adumattah, Anita AU - Abulencia, Krisel Maria AU - Garcellano, Dennis Peter AU - Li, Tai-Wai Alan AU - Fung, Kenneth AU - Poon, Kwong-Lai Maurice AU - Vahabi, Mandana AU - Wong, Pui-Hing Josephine PY - 2022/3/22 TI - COVID-19 Mental Health Stressors of Health Care Providers in the Pandemic Acceptance and Commitment to Empowerment Response (PACER) Intervention: Qualitative Study JO - JMIR Form Res SP - e35280 VL - 6 IS - 3 KW - COVID-19 KW - COVID-19 in Canada KW - health care providers KW - pandemic stressors KW - health impact KW - caregiving roles KW - situational identities KW - emotional labor KW - hero discourse KW - social ecological framework N2 - Background: Since the pandemic, more Canadians have reported poorer mental health. A vital group experiencing a high level of stressors consists of health care providers (HCPs) caring for COVID-19 patients, carrying out public health responses, or working with vulnerable populations. The mental health of HCPs is negatively affected by the pandemic, not only at work but also at home and in the community. Intersecting stressors at multiple levels contribute to HCPs? experiences of fatigue, insomnia, anxiety, depression, and posttraumatic stress symptoms. Objective: The aim of this qualitative study was to explore the pandemic stressors experienced by HCPs at work, at home, and in the community before participating in the Pandemic Acceptance and Commitment to Empowerment Response (PACER) online intervention. Methods: Informed by a social ecological approach, we used a qualitative reflective approach to engage 74 HCPs in diverse roles. Data were collected during the first 2 waves of the COVID-19 pandemic (June 2020 to February 2021) in Canada. Results: Informed by a social ecological framework, 5 overarching themes were identified in our thematic analysis: (1) personal level stressors that highlight HCPs? identities and responsibilities beyond the workplace; (2) interpersonal level stressors from disrupted social relationships; (3) organizational stressors that contributed to unsettled workplaces and moral distress; (4) community and societal stressors attributed to vicarious trauma and emotional labor; and (5) the multilevel and cumulative impacts of COVID-19 stressors on HCPs? health. Conclusions: COVID-19 is not merely a communicable disease but also a social and political phenomenon that intensifies the effects of social inequities. Current understanding of pandemic stressors affecting HCPs is largely partial in nature. Although workplace stressors of HCPs are real and intense, they need to be explored and understood in the context of stressors that exist in other domains of HCPs? lives such as family and community to ensure these experiences are not being silenced by the ?hero? discourses or overshadowed by professional demands. UR - https://formative.jmir.org/2022/3/e35280 UR - http://dx.doi.org/10.2196/35280 UR - http://www.ncbi.nlm.nih.gov/pubmed/35138256 ID - info:doi/10.2196/35280 ER - TY - JOUR AU - Bradwell, Hannah AU - Baines, Rebecca AU - Edwards, J. Katie AU - Stevens, Sebastian AU - Atkinson, Kate AU - Wilkinson, Ellen AU - Chatterjee, Arunangsu AU - Jones, B. Ray PY - 2022/3/21 TI - Exploring Patient and Staff Experiences With Video Consultations During COVID-19 in an English Outpatient Care Setting: Secondary Data Analysis of Routinely Collected Feedback Data JO - JMIR Form Res SP - e30486 VL - 6 IS - 3 KW - COVID-19 KW - video consultations KW - remote consultation KW - Attend Anywhere KW - patient feedback KW - patient experience KW - staff feedback KW - outpatients KW - pandemic N2 - Background: Video consultations (VCs) were rapidly implemented in response to COVID-19 despite modest progress before. Objective: We aim to explore staff and patient experiences with VCs implemented during COVID-19 and use feedback insights to support quality improvement and service development. Methods: Secondary data analysis was conducted on 955 patient and 521 staff responses (from 4234 consultations; 955/4234, 22.6% and 521/4234, 12.3%, respectively) routinely collected following a VC between June and July 2020 in a rural, older adult, and outpatient care setting at a National Health Service Trust. Responses were summarized using descriptive statistics and inductive thematic analysis and presented to Trust stakeholders. Results: Most patients (890/955, 93.2%) reported having good (210/955, 22%) or very good (680/955, 71.2%) experience with VCs and felt listened to and understood (904/955, 94.7%). Most patients accessed their VC alone (806/955, 84.4%) except for those aged ?71 years (23/58, 40%), with ease of joining VCs negatively associated with age (P<.001). Despite more difficulties joining, older adults were most likely to be satisfied with the technology (46/58, 79%). Patients and staff generally felt that patients? needs had been met (860/955, 90.1% and 453/521, 86.9%, respectively), although staff appeared to overestimate patient dissatisfaction with VC outcomes (P=.02). Patients (848/955, 88.8%) and staff (419/521, 80.5%) felt able to communicate everything they wanted, although patients were significantly more positive than staff (P<.001). Patient satisfaction with communication was positively associated with technical performance satisfaction (P<.001). Most staff members (466/521, 89.4%) reported positive (185/521, 35.5%) or very positive (281/521, 53.9%) experiences with joining and managing VCs. Staff reported reductions in carbon footprint (380/521, 72.9%) and time (373/521, 71.6%). Most patients (880/955, 92.1%) would choose VCs again. We identified three themes in responses: barriers, including technological difficulties, patient information, and suitability concerns; potential benefits, including reduced stress, enhanced accessibility, cost, and time savings; and suggested improvements, including trial calls, turning music off, photo uploads, expanding written character limit, supporting other internet browsers, and shared online screens. This routine feedback, including evidence to suggest that patients were more satisfied than clinicians had anticipated, was presented to relevant Trust stakeholders, allowing for improved processes and supporting the development of a business case to inform the Trust decision on continuing VCs beyond COVID-19 restrictions. Conclusions: The findings highlight the importance of regularly reviewing and responding to routine feedback following digital service implementation. The feedback helped the Trust improve the VC service, challenge clinician-held assumptions about patient experience, and inform future use of VCs. It has focused improvement efforts on patient information; technological improvements such as blurred backgrounds and interactive whiteboards; and responding to the needs of patients with dementia, communication or cognitive impairment, or lack of appropriate technology. These findings have implications for other health care providers. UR - https://formative.jmir.org/2022/3/e30486 UR - http://dx.doi.org/10.2196/30486 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311688 ID - info:doi/10.2196/30486 ER - TY - JOUR AU - Sharma, E. Anjana AU - Khoong, C. Elaine AU - Sierra, Maribel AU - Rivadeneira, A. Natalie AU - Nijagal, A. Malini AU - Su, George AU - Lyles, R. Courtney AU - DeFries, Triveni AU - Tuot, S. Delphine AU - Sarkar, Urmimala PY - 2022/3/10 TI - System-Level Factors Associated With Telephone and Video Visit Use: Survey of Safety-Net Clinicians During the Early Phase of the COVID-19 Pandemic JO - JMIR Form Res SP - e34088 VL - 6 IS - 3 KW - telemedicine KW - safety-net hospitals KW - health care delivery KW - ambulatory care KW - vulnerable populations KW - COVID-19 KW - survey KW - vulnerable KW - telehealth KW - hospital KW - safety KW - delivery KW - video KW - implementation KW - health system N2 - Background: The COVID-19 pandemic prompted safety-net health care systems to rapidly implement telemedicine services with little prior experience, causing disparities in access to virtual visits. While much attention has been given to patient barriers, less is known regarding system-level factors influencing telephone versus video-visit adoption. As telemedicine remains a preferred service for patients and providers, and reimbursement parity will not continue for audio visits, health systems must evaluate how to support higher-quality video visit access. Objective: This study aimed to assess health system?level factors and their impact on telephone and video visit adoption to inform sustainability of telemedicine for ambulatory safety-net sites. Methods: We conducted a cross-sectional survey among ambulatory care clinicians at a hospital-linked ambulatory clinic network serving a diverse, publicly insured patient population between May 28 and July 14, 2020. We conducted bivariate analyses assessing health care system?level factors associated with (1) high telephone adoption (4 or more visits on average per session); and (2) video visit adoption (at least 1 video visit on average per session). Results: We collected 311 responses from 643 eligible clinicians, yielding a response rate of 48.4%. Clinician respondents (N=311) included 34.7% (n=108) primary or urgent care, 35.1% (n=109) medical, and 7.4% (n=23) surgical specialties. Our sample included 178 (57.2%) high telephone adopters and 81 (26.05%) video adopters. Among high telephone adopters, 72.2% utilized personal devices for telemedicine (vs 59.0% of low telephone adopters, P=.04). Video nonadopters requested more training in technical aspects than adopters (49.6% vs 27.2%, P<.001). Primary or urgent care had the highest proportion of high telephone adoption (84.3%, compared to 50.4% of medical and 37.5% of surgical specialties, P<.001). Medical specialties had the highest proportion of video adoption (39.1%, compared to 14.8% of primary care and 12.5% of surgical specialties, P<.001). Conclusions: Personal device access and department specialty were major factors associated with high telephone and video visit adoption among safety-net clinicians. Desire for training was associated with lower video visit use. Secure device access, clinician technical trainings, and department-wide assessments are priorities for safety-net systems implementing telemedicine. UR - https://formative.jmir.org/2022/3/e34088 UR - http://dx.doi.org/10.2196/34088 UR - http://www.ncbi.nlm.nih.gov/pubmed/35148271 ID - info:doi/10.2196/34088 ER - TY - JOUR AU - El Gindi, Hany AU - Shalaby, Reham AU - Gusnowski, April AU - Vuong, Wesley AU - Surood, Shireen AU - Hrabok, Marianne AU - Greenshaw, J. Andrew AU - Agyapong, Vincent PY - 2022/3/9 TI - The Mental Health Impact of the COVID-19 Pandemic Among Physicians, Nurses, and Other Health Care Providers in Alberta: Cross-sectional Survey JO - JMIR Form Res SP - e27469 VL - 6 IS - 3 KW - COVID-19 KW - health care worker KW - mobile technology KW - Text4Hope KW - anxiety KW - depression KW - stress KW - pandemic KW - e-mental health KW - mental health KW - impact KW - physician KW - nurse KW - Canada N2 - Background: During the COVID-19 pandemic, threats to mental health, psychological safety, and well-being are evident, particularly among the first responders and the health care staff. Objective: This study aims to examine the prevalence and potential predictors of the likely stress, generalized anxiety disorder, and major depressive disorder among health care workers (HCWs). Methods: A cross-sectional survey was used through a survey link sent to gather demographic information and responses on several self-report scales, including the Perceived Stress Scale, the Generalized Anxiety Disorder 7-item scale, and the Patient Health Questionnaire-9 among HCWs enrolled in the Text4Hope program. Results: The result from this study suggests that during the COVID-19 pandemic, HCWs reported a high likelihood of moderate-to-high perceived stress (n=840, 81.2%), moderate-to-severe anxiety (n=369, 38.6%), and depression (n=317, 32.7%) symptoms. Nurses and other HCWs were significantly more likely to report depressive symptoms compared to physicians (F(2, 159.47)=15.89, 95% CI ?5.05 to ?2.04). Younger age groups of HCWs (?30 years) were more prone to report likely stress, anxiety, and depressive symptoms compared to HCWs 41-50 and >50 years old (odds ratio [OR] 1.82-3.03). Similarly, females and those who reported a lack of social support (separated/divorced and single) among HCWs had a higher likelihood to report likely stress and depressive symptoms, respectively (OR 1.8 and 1.6, respectively). Conclusions: This cross-sectional study explored a high level of mental health burdens during the COVID-19 pandemic among HCWs in Alberta. Levels of psychological symptoms were more noticeable in the female gender and the nursing profession. UR - https://formative.jmir.org/2022/3/e27469 UR - http://dx.doi.org/10.2196/27469 UR - http://www.ncbi.nlm.nih.gov/pubmed/34995203 ID - info:doi/10.2196/27469 ER - TY - JOUR AU - Håkansson, Anders AU - Sundvall, Andreas AU - Lyckberg, Axel PY - 2022/3/9 TI - Effects of a National Preventive Intervention Against Potential COVID-19?Related Gambling Problems in Online Gamblers: Self-Report Survey Study JO - JMIR Form Res SP - e33066 VL - 6 IS - 3 KW - gambling disorder KW - problem gambling KW - COVID-19 KW - harm reduction KW - behavioral addiction N2 - Background: The COVID-19 pandemic has been suspected to increase gambling problems in the population. Several governments introduced COVID-19?specific interventions early with the aim to prevent gambling problems, but their effects have not been evaluated. Objective: This study aimed to evaluate a Swedish COVID-19?related temporary legislation imposing an automated weekly deposit limit for online casino gambling. Methods: The study was an anonymous survey sent by a state-owned gambling operator to online gamblers (N=619), among whom 54.0% (n=334) were moderate-risk/problem gamblers who reached the weekly limit on online gambling during the summer of 2020. Results: Overall, 60.1% (372/619) were aware of having been limited by the COVID-19?related deposit limit, and a minority (145/619, 23.4%) perceived the intervention as fairly bad or very bad. Among those aware of the intervention, 38.7% (144/372) believed the intervention decreased their overall gambling, whereas 7.8% (29/372) believed it rather increased it. However, 82.5% (307/372) reported having gambled at more than one operator after the limit, and the most common gambling type reported to have increased at another operator was online casino (42% among moderate-risk/problem gamblers and 19% among others; P<.001). An increase in gambling following the intervention was associated with being a moderate-risk/problem gambler and having negative attitudes toward the intervention. Conclusions: The weekly deposit limit had relatively high acceptability, but the study highlights the limitations of a single-operator deposit limit, given the high number of gamblers also reporting gambling at other operators and the lower effect in clients with gambling problems. UR - https://formative.jmir.org/2022/3/e33066 UR - http://dx.doi.org/10.2196/33066 UR - http://www.ncbi.nlm.nih.gov/pubmed/34678751 ID - info:doi/10.2196/33066 ER - TY - JOUR AU - Parker, Alexandra AU - Dash, Sarah AU - Bourke, Matthew AU - Patten, Rhiannon AU - Craike, Melinda AU - Baldwin, Peter AU - Hosking, Warwick AU - Levinger, Itamar AU - Apostolopoulos, Vasso AU - de Courten, Maximilian AU - Sharples, Jenny AU - Naslund, Monika AU - Stavropoulos, Vasileios AU - Woessner, Mary AU - Sonn, Christopher AU - Stansen, Caroline AU - Pascoe, Michaela PY - 2022/2/25 TI - A Brief, Daily, Online Mental Health and Well-being Intervention for University Staff During the COVID-19 Pandemic: Program Description and Outcomes Using a Mixed Methods Design JO - JMIR Form Res SP - e35776 VL - 6 IS - 2 KW - workplace mental health KW - well-being KW - mental health promotion KW - online intervention KW - telehealth KW - COVID-19 pandemic KW - COVID-19 KW - pandemic KW - health promotion N2 - Background: The unprecedented changes and isolation measures to contain COVID-19 have had multiple psychological and social impacts, with implications for professional and personal functioning. Evidence-informed interventions that can be rapidly implemented under pandemic conditions to support mental health during such times are urgently needed. Objective: The aim of this study was to determine the acceptability and preliminary outcomes of a daily online mental health promotion program for tertiary education staff during the COVID-19 pandemic. Methods: The ?Victoria University (VU) Elevenses? program was delivered as an uncontrolled intervention at Victoria University (VU) in the western metropolitan region of Melbourne, Australia. In April 2020, an email invitation was sent to all academic and professional staff inviting them to: (1) participate in the program and (2) opt-in to the research component. The ?VU Elevenses? program provided 10-15?minute microinterventions comprising lifestyle and well-being strategies to promote mental health via an online meeting platform at 11 AM each weekday. A mixed methods approach was used to evaluate the program, combining structured questionnaires with semistructured interviews to investigate the experiences of staff who participated in the program. Results: Between 16 and 90 participants provided weekly program feedback. A total of 106 university staff opted into the longitudinal research component and 10 staff participated in the interviews. Participants reported high levels of satisfaction with sessions and perceived benefits for mental health. Approximately one quarter of participants reported moderate to severe symptoms of depression, anxiety, and stress at baseline, with significant reductions in these symptoms in the first 7 weeks of the program, corresponding with easing in mandatory isolation (?lockdown?) restrictions. Symptoms of depression, anxiety, and stress all increased when lockdown measures were reintroduced, but not to the same levels as found during the initial lockdown period. Overall changes in depression and anxiety from baseline to the end of the program were explained by changes in COVID-19?related distress, whereas changes in self-compassion explained changes in stress. Conclusions: We show that it is feasible and acceptable to develop and deliver a program of brief interventions in a timely manner, using a simple and accessible online platform. Although participation in the program was initially associated with reduced symptoms of depression, anxiety, and stress, participants? mental health worsened with the reintroduction of a ?lockdown? period. However, as symptoms of depression, anxiety, and stress did not return to levels observed at the start of the VU Elevenses program, participation in the uncontrolled intervention may have offered a protective benefit against the impact of the second significant lockdown period. UR - https://formative.jmir.org/2022/2/e35776 UR - http://dx.doi.org/10.2196/35776 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044304 ID - info:doi/10.2196/35776 ER - TY - JOUR AU - Kadakia, Shevali AU - Stratton, Catherine AU - Wu, Yinfei AU - Feliciano, Josemari AU - Tuakli-Wosornu, A. Yetsa PY - 2022/2/15 TI - The Accessibility of YouTube Fitness Videos for Individuals Who Are Disabled Before and During the COVID-19 Pandemic: Preliminary Application of a Text Analytics Approach JO - JMIR Form Res SP - e34176 VL - 6 IS - 2 KW - persons with disabilities KW - disability KW - exercise KW - physical activity KW - digital health KW - YouTube KW - accessibility KW - fitness KW - COVID-19 KW - text analysis KW - social media KW - video N2 - Background: People with disabilities face barriers to in-person physical activity (PA), including a lack of adaptive equipment and knowledgeable instructors. Given this and the increased need for digital resources due to widespread COVID-19 lockdowns, it is necessary to assess the accessibility of digital fitness resources for people with disabilities. To investigate whether YouTube fitness content creators have made videos accessible to people with disabilities would be informative about access to PA during COVID-19 and could also provide insight into the feasibility of individuals who are disabled relying on YouTube for PA in a post?COVID-19 world. Objective: This study aims to ascertain if disability-friendly PA videos on YouTube are accessible through searching general fitness terms and whether a change in the availability of accessible fitness resources for people with disabilities occurred on YouTube between before and during the COVID-19 pandemic on ?Hospital/Medical Institutions,? ?Individual(s),? and ?Other(s)? channels. Secondary aims are to investigate if different categories of YouTube channels produce more accessible fitness content and highlight any disparities in disability-friendly PA content on YouTube. Methods: A cross-sectional text analysis of exercise-related YouTube videos was conducted. The authors used Python (version 3.0) to access the YouTube database via its data application programming interface. Terms pertaining to PA that were searched on YouTube were at-home exercise, exercise at home, exercise no equipment, home exercise, home-based exercise, no equipment workout, and workout no equipment. Various elements (eg, view count and content generation) of the videos published between January 1 and June 30, 2019 (n=700), were compared to the elements of videos published between January 1 and June 30, 2020 (n=700). To capture a broad idea of disability-friendly videos on YouTube, videos were labeled ?accessible? if they were found in the first 100 video results and if their title, description, or tags contained the following terms: para, paralympic, adaptive, adapted, disabled, disability, differently abled, disability-friendly, wheelchair accessible, and inclusive. Each video and channel were categorized as ?Hospitals/Medical Institutions,? ?Individuals,? or ?Other(s).? Results: The analysis revealed a statistically significant increase in viewership of fitness content on YouTube (P=.001) and in fitness content generated by Hospitals/Medical Institutions (P=.004). Accessible terms applicable to people with disabilities had minimal appearances in 2019 (21 videos) and 2020 (19 videos). None of the top viewed fitness videos that populated on YouTube from 2019 or 2020 were accessible. Conclusions: The proportion of accessible disability-friendly videos remains diminutive relative to the prevalence of disability in the general population, revealing that disability-friendly videos are seldom findable on YouTube. Thus, the need for disability-friendly fitness content to be easily searched and found remains urgent if access to digital fitness resources is to improve. UR - https://formative.jmir.org/2022/2/e34176 UR - http://dx.doi.org/10.2196/34176 UR - http://www.ncbi.nlm.nih.gov/pubmed/35044305 ID - info:doi/10.2196/34176 ER - TY - JOUR AU - Tang, Hao AU - Kim, Sungwoo AU - Laforet, E. Priscila AU - Tettey, Naa-Solo AU - Basch, H. Corey PY - 2022/2/9 TI - Loss of Weight Gained During the COVID-19 Pandemic: Content Analysis of YouTube Videos JO - JMIR Form Res SP - e35164 VL - 6 IS - 2 KW - COVID-19 KW - quarantine KW - weight loss KW - weight gain KW - social media KW - YouTube N2 - Background: Many people experienced unintended weight gain during the COVID-19 pandemic, which has been discussed widely on social media. Objective: This study aims to describe the content of weight loss videos on YouTube (Google LLC) during the COVID-19 pandemic. Methods: By using the keywords weight loss during quarantine, the 100 most viewed English-language videos were identified and coded for content related to losing weight gained during the COVID-19 pandemic. Results: In total, 9 videos were excluded due to having non-English content or posting data before the COVID-19 pandemic. The 91 videos included in the study sample acquired 407,326 views at the time of study and were roughly 14 minutes long. A total of 48% (44/91) of the sample videos included graphic comparisons to illustrate weight change. Videos that included a graphic comparison were more likely to have content related to trigger warnings (?21=6.05; P=.01), weight loss (?21=13.39; P<.001), negative feelings during quarantine (?21=4.75; P=.03), instructions for losing weight (?21=9.17; P=.002), self-love (?21=6.01; P=.01), body shaming (?21=4.36; P=.04), and special dietary practices (?21=11.10; P<.001) but were less likely to include food recipes (?21=5.05; P=.03). Our regression analysis results suggested that mentioning quarantine (P=.05), fat-gaining food (P=.04), self-care and self-love (P=.05), and body shaming (P=.008) and having presenters from both sexes (P<.001) are significant predictors for a higher number of views. Our adjusted regression model suggested that videos with content about routine change have significantly lower view counts (P=.03) than those of videos without such content. Conclusions: The findings of this study indicate the ways in which YouTube is being used to showcase COVID-19?related weight loss in a pre-post fashion. The use of graphic comparisons garnered a great deal of attention. Additional studies are needed to understand the role of graphic comparisons in social media posts. Further studies that focus on people?s attitudes and behaviors toward weight change during the COVID-19 pandemic and the implications of social media on these attitudes and behaviors are warranted. UR - https://formative.jmir.org/2022/2/e35164 UR - http://dx.doi.org/10.2196/35164 UR - http://www.ncbi.nlm.nih.gov/pubmed/34978534 ID - info:doi/10.2196/35164 ER - TY - JOUR AU - Grens, Hilde AU - de Bruin, Peter Jan AU - Huppelschoten, Aleida AU - Kremer, M. Jan A. PY - 2022/2/7 TI - Fertility Workup With Video Consultation During the COVID-19 Pandemic: Pilot Quantitative and Qualitative Study JO - JMIR Form Res SP - e32000 VL - 6 IS - 2 KW - COVID-19 KW - patient centeredness KW - video consultation KW - fertility care KW - telemedicine KW - shared decision making N2 - Background: Due to the COVID-19 pandemic, major parts of elective health care in the Netherlands, such as reproductive medicine, were paused. When health care was resumed, video consultation was used as a new solution to continue consultations with the new governmental rules of social distancing. Prior to this COVID-19 situation, video consultation was not used extensively in the Netherlands; therefore, physicians and patients are not familiar with this way of consultation. Objective: The purpose of this study was to measure the level of patient centeredness and shared decision making in infertile couples who have undergone fertility workup through video consultation. Methods: This is a questionnaire study with an additional qualitative part for a more in depth understanding. Infertile couples (ie, male and female partners with an unfulfilled wish for a child after 1 year of unprotected intercourse) were referred to a fertility center and underwent fertility workup through video consultation. The fertility workup consisted of 2 separate video consultations, with diagnostic tests according to a protocol. After the last video consultation couples received a digital questionnaire, which consisted of a modified version of the Patient-Centered Questionnaire-Infertility (PCQ-I) and CollaboRATE questionnaire. Fifty-three eligible infertile couples were approached, and of these, 22 participated. Four women were approached for a semistructured interview. Results: The median score on the modified PCQ-I (scale of 0 to 3) was 2.64. The highest rating was for the subscale communication and information, and the lowest rating was for the subscale organization of care. The median score on the CollaboRATE questionnaire (scale of 1 to 9) was 8 for all 3 subquestions. Patients mentioned privacy, less travel time, and easy use of the program as possible benefits of video consultation. However, patients preferred the first consultation with their physician to be face-to-face consultation as video consultation was considered less personal. Conclusions: The high levels of patient centeredness and shared decision making show that video consultation is a promising way of providing care remotely, although attention has to be payed to mitigate the more impersonal setting of video consultation when compared with face-to-face consultation. UR - https://formative.jmir.org/2022/2/e32000 UR - http://dx.doi.org/10.2196/32000 UR - http://www.ncbi.nlm.nih.gov/pubmed/34936981 ID - info:doi/10.2196/32000 ER - TY - JOUR AU - Jung, Soyoung AU - Jung, Sooin PY - 2022/1/31 TI - The Impact of the COVID-19 Infodemic on Depression and Sleep Disorders: Focusing on Uncertainty Reduction Strategies and Level of Interpretation Theory JO - JMIR Form Res SP - e32552 VL - 6 IS - 1 KW - COVID-19 KW - social media KW - infodemic KW - construal level theory KW - uncertainty reduction strategy KW - depression KW - sleep disorder KW - preventive actions, affective reaction KW - infodemiology KW - misinformation KW - uncertainty KW - strategy KW - mental health KW - sleep KW - prevention KW - survey KW - usage KW - behavior N2 - Background: During the COVID-19 pandemic, information diffusion about the COVID-19 has attracted public attention through social media. The World Health Organization declared an infodemic of COVID-19 on February 15, 2020. Misinformation and disinformation, including overwhelming amounts of information about COVID-19 on social media, could promote adverse psychological effects. Objective: This study used the Psychological Distance and Level of Construal theory (CLT) to predict peoples? negative psychological symptoms from social media usage. In this study, the CLT intended to show peoples? psychological proximity to objects and events with respect to the COVID-19 pandemic. Furthermore, this study links the uncertainty reduction strategy (URS) and CLT for COVID-19?related preventive behaviors and affective reactions to assess their effects on mental health problems. Methods: A path model was tested (N=297) with data from a web-based survey to examine how social media usage behaviors are associated with URS and psychological distance with COVID-19 (based on the CLT), leading to preventive behaviors and affective reactions. Finally, the path model was used to examine how preventive behaviors and affective reactions are associated with mental health problems including anxiety and sleep disorder. Results: After measuring participants? social media usage behavior, we found that an increase in general social media usage led to higher use of the URS and lower construal level on COVID-19. The URS is associated with preventive behaviors, but the CLT did not show any association with preventive behaviors; however, it increases affective reactions. Moreover, increased preventive behavior showed negative associations with symptoms of mental health problems; that is, depression and sleep disorder. However, the affective reaction tends to be positively associated with depression and sleep disorder. Owing to the infodemic of COVID-19, the psychological perception of the pandemic negatively influenced users? mental health problems. Conclusions: Our results imply that the information from social media usage heightened concerns and had a lower construal level; this does not facilitate taking preventive actions but rather reinforces the negative emotional reaction and mental health problems. Thus, higher URS usage is desirable. UR - https://formative.jmir.org/2022/1/e32552 UR - http://dx.doi.org/10.2196/32552 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870609 ID - info:doi/10.2196/32552 ER - TY - JOUR AU - Klein, Z. Ari AU - O'Connor, Karen AU - Gonzalez-Hernandez, Graciela PY - 2022/1/6 TI - Toward Using Twitter Data to Monitor COVID-19 Vaccine Safety in Pregnancy: Proof-of-Concept Study of Cohort Identification JO - JMIR Form Res SP - e33792 VL - 6 IS - 1 KW - natural language processing KW - social media KW - COVID-19 KW - data mining KW - COVID-19 vaccine KW - pregnancy outcomes N2 - Background: COVID-19 during pregnancy is associated with an increased risk of maternal death, intensive care unit admission, and preterm birth; however, many people who are pregnant refuse to receive COVID-19 vaccination because of a lack of safety data. Objective: The objective of this preliminary study was to assess whether Twitter data could be used to identify a cohort for epidemiologic studies of COVID-19 vaccination in pregnancy. Specifically, we examined whether it is possible to identify users who have reported (1) that they received COVID-19 vaccination during pregnancy or the periconception period, and (2) their pregnancy outcomes. Methods: We developed regular expressions to search for reports of COVID-19 vaccination in a large collection of tweets posted through the beginning of July 2021 by users who have announced their pregnancy on Twitter. To help determine if users were vaccinated during pregnancy, we drew upon a natural language processing (NLP) tool that estimates the timeframe of the prenatal period. For users who posted tweets with a timestamp indicating they were vaccinated during pregnancy, we drew upon additional NLP tools to help identify tweets that reported their pregnancy outcomes. Results: We manually verified the content of tweets detected automatically, identifying 150 users who reported on Twitter that they received at least one dose of COVID-19 vaccination during pregnancy or the periconception period. We manually verified at least one reported outcome for 45 of the 60 (75%) completed pregnancies. Conclusions: Given the limited availability of data on COVID-19 vaccine safety in pregnancy, Twitter can be a complementary resource for potentially increasing the acceptance of COVID-19 vaccination in pregnant populations. The results of this preliminary study justify the development of scalable methods to identify a larger cohort for epidemiologic studies. UR - https://formative.jmir.org/2022/1/e33792 UR - http://dx.doi.org/10.2196/33792 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870607 ID - info:doi/10.2196/33792 ER - TY - JOUR AU - Würstle, Silvia AU - Erber, Johanna AU - Hanselmann, Michael AU - Hoffmann, Dieter AU - Werfel, Stanislas AU - Hering, Svenja AU - Weidlich, Simon AU - Schneider, Jochen AU - Franke, Ralf AU - Maier, Michael AU - Henkel, G. Andreas AU - Schmid, M. Roland AU - Protzer, Ulrike AU - Laxy, Michael AU - Spinner, D. Christoph PY - 2022/1/4 TI - A Telemedicine-Guided Self-Collection Approach for PCR-Based SARS-CoV-2 Testing: Comparative Study JO - JMIR Form Res SP - e32564 VL - 6 IS - 1 KW - self-sampling KW - telemedicine KW - test strategy effectiveness KW - simulation model KW - SARS-CoV-2 KW - COVID-19 N2 - Background: Large-scale, polymerase chain reaction (PCR)-based SARS-CoV-2 testing is expensive, resource intensive, and time consuming. A self-collection approach is a probable alternative; however, its feasibility, cost, and ability to prevent infections need to be evaluated. Objective: This study aims to compare an innovative self-collection approach with a regular SARS-CoV-2 testing strategy in a large European industrial manufacturing site. Methods: The feasibility of a telemedicine-guided PCR-based self-collection approach was assessed for 150 employees (intervention group) and compared with a regular SARS-CoV-2 testing approach used for 143 employees (control group). Acceptance, ergonomics, and efficacy were evaluated using a software application. A simulation model was implemented to evaluate the effectiveness. An interactive R shiny app was created to enable customized simulations. Results: The test results were successfully communicated to and interpreted without uncertainty by 76% (114/150) and 76.9% (110/143) of the participants in the intervention and control groups, respectively (P=.96). The ratings for acceptability, ergonomics, and efficacy among intervention group participants were noninferior when compared to those among control group participants (acceptability: 71.6% vs 37.6%; ergonomics: 88.1% vs 74.5%; efficacy: 86.4% vs 77.5%). The self-collection approach was found to be less time consuming (23 min vs 38 min; P<.001). The simulation model indicated that both testing approaches reduce the risk of infection, and the self-collection approach tends to be slightly less effective owing to its lower sensitivity. Conclusions: The self-collection approach for SARS-CoV-2 diagnosis was found to be technically feasible and well rated in terms of acceptance, ergonomics, and efficacy. The simulation model facilitates the evaluation of test effectiveness; nonetheless, considering context specificity, appropriate adaptation by companies is required. UR - https://formative.jmir.org/2022/1/e32564 UR - http://dx.doi.org/10.2196/32564 UR - http://www.ncbi.nlm.nih.gov/pubmed/34803022 ID - info:doi/10.2196/32564 ER - TY - JOUR AU - Fedoruk, Benjamin AU - Nelson, Harrison AU - Frost, Russell AU - Fucile Ladouceur, Kai PY - 2021/12/21 TI - The Plebeian Algorithm: A Democratic Approach to Censorship and Moderation JO - JMIR Form Res SP - e32427 VL - 5 IS - 12 KW - infodemiology KW - misinformation KW - algorithm KW - social media KW - plebeian KW - natural language processing KW - sentiment analysis KW - sentiment KW - trust KW - decision-making KW - COVID-19 N2 - Background: The infodemic created by the COVID-19 pandemic has created several societal issues, including a rise in distrust between the public and health experts, and even a refusal of some to accept vaccination; some sources suggest that 1 in 4 Americans will refuse the vaccine. This social concern can be traced to the level of digitization today, particularly in the form of social media. Objective: The goal of the research is to determine an optimal social media algorithm, one which is able to reduce the number of cases of misinformation and which also ensures that certain individual freedoms (eg, the freedom of expression) are maintained. After performing the analysis described herein, an algorithm was abstracted. The discovery of a set of abstract aspects of an optimal social media algorithm was the purpose of the study. Methods: As social media was the most significant contributing factor to the spread of misinformation, the team decided to examine infodemiology across various text-based platforms (Twitter, 4chan, Reddit, Parler, Facebook, and YouTube). This was done by using sentiment analysis to compare general posts with key terms flagged as misinformation (all of which concern COVID-19) to determine their verity. In gathering the data sets, both application programming interfaces (installed using Python?s pip) and pre-existing data compiled by standard scientific third parties were used. Results: The sentiment can be described using bimodal distributions for each platform, with a positive and negative peak, as well as a skewness. It was found that in some cases, misinforming posts can have up to 92.5% more negative sentiment skew compared to accurate posts. Conclusions: From this, the novel Plebeian Algorithm is proposed, which uses sentiment analysis and post popularity as metrics to flag a post as misinformation. This algorithm diverges from that of the status quo, as the Plebeian Algorithm uses a democratic process to detect and remove misinformation. A method was constructed in which content deemed as misinformation to be removed from the platform is determined by a randomly selected jury of anonymous users. This not only prevents these types of infodemics but also guarantees a more democratic way of using social media that is beneficial for repairing social trust and encouraging the public?s evidence-informed decision-making. UR - https://formative.jmir.org/2021/12/e32427 UR - http://dx.doi.org/10.2196/32427 UR - http://www.ncbi.nlm.nih.gov/pubmed/34854812 ID - info:doi/10.2196/32427 ER - TY - JOUR AU - Jansen-Kosterink, Stephanie AU - Hurmuz, Marian AU - den Ouden, Marjolein AU - van Velsen, Lex PY - 2021/12/20 TI - Predictors to Use Mobile Apps for Monitoring COVID-19 Symptoms and Contact Tracing: Survey Among Dutch Citizens JO - JMIR Form Res SP - e28416 VL - 5 IS - 12 KW - COVID-19 KW - eHealth KW - mHealth KW - contact tracing KW - symptom management KW - intention to use N2 - Background: eHealth apps have been recognized as a valuable tool to reduce COVID-19?s effective reproduction number. The factors that determine the acceptance of COVID-19 apps remain unknown. The exception here is privacy. Objective: The aim of this article was to identify antecedents of acceptance of (1) a mobile app for COVID-19 symptom recognition and monitoring and (2) a mobile app for contact tracing, both by means of an online survey among Dutch citizens. Methods: Next to the demographics, the online survey contained questions focusing on perceived health, fear of COVID-19, and intention to use. We used snowball sampling via posts on social media and personal connections. To identify antecedents of the model for acceptance of the 2 mobile apps, we conducted multiple linear regression analyses. Results: In total, 238 Dutch adults completed the survey; 59.2% (n=141) of the responders were female and the average age was 45.6 years (SD 17.4 years). For the symptom app, the final model included the predictors age, attitude toward technology, and fear of COVID-19. The model had an r2 of 0.141. The final model for the tracing app included the same predictors and had an r2 of 0.156. The main reason to use both mobile apps was to control the spread of the COVID-19 virus. Concerns about privacy was mentioned as the main reason to not use the mobile apps. Conclusions: Age, attitude toward technology, and fear of COVID-19 are important predictors of the acceptance of COVID-19 mobile apps for symptom recognition and monitoring and for contact tracing. These predictors should be taken into account during the development and implementation of these mobile apps to secure acceptance. UR - https://formative.jmir.org/2021/12/e28416 UR - http://dx.doi.org/10.2196/28416 UR - http://www.ncbi.nlm.nih.gov/pubmed/34818210 ID - info:doi/10.2196/28416 ER - TY - JOUR AU - Parker, K. Jane AU - Kelly, E. Christine AU - Smith, C. Barry AU - Kirkwood, F. Aidan AU - Hopkins, Claire AU - Gane, Simon PY - 2021/12/14 TI - Patients? Perspectives on Qualitative Olfactory Dysfunction: Thematic Analysis of Social Media Posts JO - JMIR Form Res SP - e29086 VL - 5 IS - 12 KW - olfactory dysfunction KW - parosmia KW - phantosmia KW - olfactory perseveration KW - trigger foods KW - mental health KW - COVID-19 KW - patients? perspective KW - thematic analysis KW - social media KW - perspective KW - smell KW - nose KW - symptom KW - concern KW - support N2 - Background: The impact of qualitative olfactory disorders is underestimated. Parosmia, the distorted perception of familiar odors, and phantosmia, the experience of odors in the absence of a stimulus, can arise following postinfectious anosmia, and the incidences of both have increased substantially since the outbreak of COVID-19. Objective: The aims of this study are to explore the symptoms and sequalae of postinfectious olfactory dysfunction syndrome using unstructured and unsolicited threads from social media, and to articulate the perspectives and concerns of patients affected by these debilitating olfactory disorders. Methods: A thematic analysis and content analysis of posts in the AbScent Parosmia and Phantosmia Support group on Facebook was conducted between June and December 2020. Results: In this paper, we identify a novel symptom, olfactory perseveration, which is a triggered, identifiable, and usually unpleasant olfactory percept that persists in the absence of an ongoing stimulus. We also observe fluctuations in the intensity and duration of symptoms of parosmia, phantosmia, and olfactory perseveration. In addition, we identify a group of the most common items (coffee, meat, onion, and toothpaste) that trigger distortions; however, people have difficulty describing these distortions, using words associated with disgust and revulsion. The emotional aspect of living with qualitative olfactory dysfunction was evident and highlighted the detrimental impact on mental health. Conclusions: Qualitative and unsolicited data acquired from social media has provided useful insights into the patient experience of parosmia and phantosmia, which can inform rehabilitation strategies and ongoing research into understanding the molecular triggers associated with parosmic distortions and research into patient benefit. UR - https://formative.jmir.org/2021/12/e29086 UR - http://dx.doi.org/10.2196/29086 UR - http://www.ncbi.nlm.nih.gov/pubmed/34904953 ID - info:doi/10.2196/29086 ER - TY - JOUR AU - Koren, Ainat AU - Alam, Ul Mohammad Arif AU - Koneru, Sravani AU - DeVito, Alexa AU - Abdallah, Lisa AU - Liu, Benyuan PY - 2021/12/10 TI - Nursing Perspectives on the Impacts of COVID-19: Social Media Content Analysis JO - JMIR Form Res SP - e31358 VL - 5 IS - 12 KW - mental health KW - information retrieval KW - coronavirus KW - COVID-19 KW - nursing KW - nurses KW - health care workers KW - pandemic KW - impact KW - social media analytics N2 - Background: Nurses are at the forefront of the COVID-19 pandemic. During the pandemic, nurses have faced an elevated risk of exposure and have experienced the hazards related to a novel virus. While being heralded as lifesaving heroes on the front lines of the pandemic, nurses have experienced more physical, mental, and psychosocial problems as a consequence of the COVID-19 outbreak. Social media discussions by nursing professionals participating in publicly formed Facebook groups constitute a valuable resource that offers longitudinal insights. Objective: This study aimed to explore how COVID-19 impacted nurses through capturing public sentiments expressed by nurses on a social media discussion platform and how these sentiments changed over time. Methods: We collected over 110,993 Facebook discussion posts and comments in an open COVID-19 group for nurses from March 2020 until the end of November 2020. Scraping of deidentified offline HTML tags on social media posts and comments was performed. Using subject-matter expert opinions and social media analytics (ie, topic modeling, information retrieval, and sentiment analysis), we performed a human-in-a-loop analysis of nursing professionals? key perspectives to identify trends of the COVID-19 impact among at-risk nursing communities. We further investigated the key insights of the trends of the nursing professionals? perspectives by detecting temporal changes of comments related to emotional effects, feelings of frustration, impacts of isolation, shortage of safety equipment, and frequency of safety equipment uses. Anonymous quotes were highlighted to add context to the data. Results: We determined that COVID-19 impacted nurses? physical, mental, and psychosocial health as expressed in the form of emotional distress, anger, anxiety, frustration, loneliness, and isolation. Major topics discussed by nurses were related to work during a pandemic, misinformation spread by the media, improper personal protective equipment (PPE), PPE side effects, the effects of testing positive for COVID-19, and lost days of work related to illness. Conclusions: Public Facebook nursing groups are venues for nurses to express their experiences, opinions, and concerns and can offer researchers an important insight into understanding the COVID-19 impact on health care workers. UR - https://formative.jmir.org/2021/12/e31358 UR - http://dx.doi.org/10.2196/31358 UR - http://www.ncbi.nlm.nih.gov/pubmed/34623957 ID - info:doi/10.2196/31358 ER - TY - JOUR AU - Abdel-Razig, Sawsan AU - Anglade, Pascale AU - Ibrahim, Halah PY - 2021/12/7 TI - Impact of the COVID-19 Pandemic on a Physician Group?s WhatsApp Chat: Qualitative Content Analysis JO - JMIR Form Res SP - e31791 VL - 5 IS - 12 KW - WhatsApp KW - social media KW - physician KW - pandemic KW - COVID-19 KW - qualitative KW - communication KW - misinformation KW - information-seeking behavior KW - information seeking KW - information sharing KW - content analysis KW - community N2 - Background: Social media has emerged as an effective means of information sharing and community building among health professionals. The utility of these platforms is likely heightened during times of health system crises and global uncertainty. Studies have demonstrated that physicians? social media platforms serve to bridge the gap of information between on-the-ground experiences of health care workers and emerging knowledge. Objective: The primary aim of this study was to characterize the use of a physician WhatsApp (WhatsApp LLC) group chat during the early months of the COVID-19 pandemic. Methods: Through the lens of the social network theory, we performed a qualitative content analysis of the posts of a women physician WhatsApp group located in the United Arab Emirates between February 1, 2020, and May 31, 2020, that is, during the initial surge of COVID-19 cases. Results: There were 6101 posts during the study period, which reflected a 2.6-fold increase in platform use when compared with platform use in the year prior. A total of 8 themes and 9 subthemes were described. The top 3 uses of the platform were requests for information (posts: 2818/6101, 46.2%), member support and promotion (posts: 988/6101, 16.2%), and information sharing (posts: 896/6101, 14.7%). A substantial proportion of posts were related to COVID-19 (2653/6101, 43.5%), with the most popular theme being requests for logistical (nonmedical) information. Among posts containing COVID-19?related medical information, it was notable that two-thirds (571/868, 65.8%) of these posts were from public mass media or unverified sources. Conclusions: Health crises can potentiate the use of social media platforms among physicians. This reflects physicians? tendency to turn to these platforms for information sharing and community building purposes. However, important questions remain regarding the accuracy and credibility of the information shared. Our findings suggest that the training of physicians in social media practices and information dissemination may be needed. UR - https://formative.jmir.org/2021/12/e31791 UR - http://dx.doi.org/10.2196/31791 UR - http://www.ncbi.nlm.nih.gov/pubmed/34784291 ID - info:doi/10.2196/31791 ER - TY - JOUR AU - Janvrin, Lynn Miranda AU - Korona-Bailey, Jessica AU - Koehlmoos, Pérez Tracey PY - 2021/12/6 TI - Re-examining COVID-19 Self-Reported Symptom Tracking Programs in the United States: Updated Framework Synthesis JO - JMIR Form Res SP - e31271 VL - 5 IS - 12 KW - COVID-19 KW - coronavirus KW - framework analysis KW - information resources KW - monitoring KW - patient-reported outcome measures KW - self-reported KW - surveillance KW - symptom tracking KW - synthesis KW - digital health N2 - Background: Early in the pandemic, in 2020, Koehlmoos et al completed a framework synthesis of currently available self-reported symptom tracking programs for COVID-19. This framework described relevant programs, partners and affiliates, funding, responses, platform, and intended audience, among other considerations. Objective: This study seeks to update the existing framework with the aim of identifying developments in the landscape and highlighting how programs have adapted to changes in pandemic response. Methods: Our team developed a framework to collate information on current COVID-19 self-reported symptom tracking programs using the ?best-fit? framework synthesis approach. All programs from the previous study were included to document changes. New programs were discovered using a Google search for target keywords. The time frame for the search for programs ranged from March 1, 2021, to May 6, 2021. Results: We screened 33 programs, of which 8 were included in our final framework synthesis. We identified multiple common data elements, including demographic information such as race, age, gender, and affiliation (all were associated with universities, medical schools, or schools of public health). Dissimilarities included questions regarding vaccination status, vaccine hesitancy, adherence to social distancing, COVID-19 testing, and mental health. Conclusions: At this time, the future of self-reported symptom tracking for COVID-19 is unclear. Some sources have speculated that COVID-19 may become a yearly occurrence much like the flu, and if so, the data that these programs generate is still valuable. However, it is unclear whether the public will maintain the same level of interest in reporting their symptoms on a regular basis if the prevalence of COVID-19 becomes more common. UR - https://formative.jmir.org/2021/12/e31271 UR - http://dx.doi.org/10.2196/31271 UR - http://www.ncbi.nlm.nih.gov/pubmed/34792469 ID - info:doi/10.2196/31271 ER - TY - JOUR AU - Amundsen, Myklebust Ole AU - Hoffart, Asle AU - Johnson, Urnes Sverre AU - Ebrahimi, V. Omid PY - 2021/12/3 TI - Pandemic Information Dissemination and Its Associations With the Symptoms of Mental Distress During the COVID-19 Pandemic: Cross-sectional Study JO - JMIR Form Res SP - e28239 VL - 5 IS - 12 KW - information sources KW - COVID-19 KW - avoidance KW - psychopathology N2 - Background: The 2020-2021 COVID-19 pandemic has added to the mental health strain on individuals and groups across the world in a variety of ways. Viral mitigation protocols and viral spread affect people on all continents every day, but at widely different degrees. To understand more about the mental health consequences of the pandemic, it is important to investigate whether or how people gather pandemic-related information and how obtaining this information differentially affects individuals. Objective: This study aimed to investigate whether and to what extent higher levels of COVID-19?related media consumption across information sources are associated with the symptoms of anxiety, health anxiety, and depression, and whether and to what extent using social media and online interactive platforms versus traditional media platforms is associated with the symptoms of anxiety, health anxiety, and depression. Additionally, we aimed to investigate whether and to what extent avoidance of COVID-19?related information is associated with the aforementioned symptoms. Methods: In a cross-sectional preregistered survey, 4936 participants responded between June 22 and July 13, 2020. Eligible participants were adults currently residing in Norway and were thus subjected to identical viral mitigation protocols. This sample was representative of the Norwegian population after utilizing an iterative raking algorithm to conduct poststratification. As 2 subgroups (transgender and intersex individuals) were too small to be analyzed, the final sample for descriptive statistics and regressions included 4921 participants. Multiple regressions were used to investigate associations between the symptoms of psychopathology and COVID-19?related information dissemination. Part correlations were calculated as measures of the effect size for each predictor variable. Due to the large anticipated sample size, the preregistered criterion for significance was set at P<.01. Results: The symptoms of anxiety and health anxiety were significantly associated with obtaining information from newspapers (P<.001), social media (P<.001), and the broader categories of online interactive (P<.001) and traditional media (P<.001). The symptoms of depression were significantly associated with obtaining information from newspapers (P=.003), social media (P=.009), and the broader category of online interactive media (P<.001). Additionally, avoidance of COVID-19?related information showed a significant association in all 3 domains of psychopathological symptoms (anxiety and depression, P<.001; health anxiety, P=.007). Conclusions: This study found significant associations between the symptoms of psychopathology and the use of media for obtaining information related to the COVID-19 pandemic. Significant findings for obtaining information through newspapers, social media, and online interactive media were seen across all 3 measures of psychopathology. Avoidance of COVID-19?related information and associations with the symptoms of psychopathology emerged as core findings, with generally higher effect sizes compared with information attainment. Trial Registration: ClinicalTrials.gov NCT04442360; https://clinicaltrials.gov/ct2/show/NCT04442360 UR - https://formative.jmir.org/2021/12/e28239 UR - http://dx.doi.org/10.2196/28239 UR - http://www.ncbi.nlm.nih.gov/pubmed/34678750 ID - info:doi/10.2196/28239 ER - TY - JOUR AU - Jolliff, Anna AU - Zhao, Qianqian AU - Eickhoff, Jens AU - Moreno, Megan PY - 2021/12/2 TI - Depression, Anxiety, and Daily Activity Among Adolescents Before and During the COVID-19 Pandemic: Cross-sectional Survey Study JO - JMIR Form Res SP - e30702 VL - 5 IS - 12 KW - COVID-19 KW - pandemic KW - adolescent KW - depression KW - anxiety KW - socioeconomic status KW - survey KW - mental health N2 - Background: The COVID-19 pandemic has resulted in significant changes to adolescents? daily lives and, potentially, to their mental health. The pandemic has also disproportionately affected historically marginalized and at-risk communities, including people of color, socioeconomically disadvantaged people, people identifying as female, and youth. Objective: This study aimed to understand differences in depression and anxiety among 2 groups of adolescents in the United States before and during the COVID-19 pandemic, and to examine demographic and daily activity variables associated with depression and anxiety. Methods: Online surveys were distributed in 2019 and 2020. Demographic questions were asked at the time of enrollment, and included participants? age, gender, race and ethnicity, and socioeconomic status (SES). The 8-item Patient Health Questionnaire was used to assess symptoms of depression, and the 7-item Generalized Anxiety Disorder scale was used to assess symptoms of anxiety. A total of 4 pandemic-specific daily activity questions were asked only of the pandemic group. Analyses of covariance compared depression and anxiety between prepandemic and pandemic groups. Demographic and lifestyle variables were included as covariates. Results: The sample comprised a total of 234 adolescents, with 100 participants in the prepandemic group and 134 participants in the pandemic group. Within the pandemic group, 94% (n=126) of adolescents reported being out of school due to the pandemic, and another 85.8% (n=115) and 57.1% (n=76) were prevented from extracurricular activities and exercise, respectively. Higher depression was seen in the pandemic group, with a least-squares adjusted mean of 7.62 (SD 1.36) compared to 6.28 (SD 1.42) in the prepandemic group, although the difference was not significant (P=.08). There was no significant difference in anxiety scores between the 2 groups (least-squares adjusted means 5.52, SD 1.30 vs 5.01, SD 1.36; P=.48). Within the pandemic group, lower SES was predictive of anxiety, such that those in the pandemic group of lower SES were more anxious than their higher-SES peers (least-squares adjusted means 11.17, SD 2.34 vs 8.66, SD 2.16; P=.02). Within the pandemic group, being out of work or school and not partaking in extracurricular activities or exercise due to the pandemic were not associated with higher depression or anxiety scores. Conclusions: In this study, neither being in the pandemic group nor experiencing changes in daily activity due to the pandemic was associated with higher depression or anxiety. However, we found that adolescents from lower SES backgrounds experienced significantly more anxiety during the pandemic than their more privileged peers. Both instrumental and mental health interventions for low-income adolescents are imperative. UR - https://formative.jmir.org/2021/12/e30702 UR - http://dx.doi.org/10.2196/30702 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609316 ID - info:doi/10.2196/30702 ER - TY - JOUR AU - Fisher, B. Lauren AU - Tuchman, Sylvie AU - Curreri, J. Andrew AU - Markgraf, Maggie AU - Nyer, B. Maren AU - Cassano, Paolo AU - Iverson, L. Grant AU - Fava, Maurizio AU - Zafonte, D. Ross AU - Pedrelli, Paola PY - 2021/12/1 TI - Transitioning From In-Person to Remote Clinical Research on Depression and Traumatic Brain Injury During the COVID-19 Pandemic: Study Modifications and Preliminary Feasibility From a Randomized Controlled Pilot Study JO - JMIR Form Res SP - e28734 VL - 5 IS - 12 KW - COVID-19 KW - telemental health KW - clinical trial KW - traumatic brain injury KW - depression KW - cognitive behavioral therapy N2 - Background: Telehealth has provided many researchers, especially those conducting psychosocial research, with the tools necessary to transition from in-person to remote clinical trials during the COVID-19 pandemic. A growing body of research supports the effectiveness of telemental health for a variety of psychiatric conditions, but few studies have examined telemental health for individuals with comorbid medical diagnoses. Furthermore, little is known about the remote implementation of clinical trials examining telemental health interventions. Objective: This paper outlines the procedural modifications used to facilitate conversion of an in-person randomized controlled trial of cognitive behavioral therapy (CBT) for depression in individuals with traumatic brain injury (TBI; CBT-TBI) to a telemental health study administered remotely. Methods: Given the nature of remote implementation and specific challenges experienced by individuals with TBI, considerations related to treatment delivery, remote consent, data management, neuropsychological assessment, safety monitoring, and delivery of supportive material have been discussed. Feasibility, acceptability, and safety were evaluated by examining attendance and participant responses on self-report measures of treatment satisfaction and suicidal behavior. Results: High rates of treatment attendance, assessment completion, study retention, and satisfaction with the intervention and modality were reported by participants who completed at least one telemental health CBT-TBI session. Conclusions: Study modifications are necessary when conducting a study remotely, and special attention should be paid to comorbidities and population-specific challenges (eg, cognitive impairment). Preliminary data support the feasibility, acceptability, and safety of remotely conducting a randomized controlled trial of CBT-TBI. Trial Registration: ClinicalTrials.gov NCT03307070; https://clinicaltrials.gov/ct2/show/NCT03307070 UR - https://formative.jmir.org/2021/12/e28734 UR - http://dx.doi.org/10.2196/28734 UR - http://www.ncbi.nlm.nih.gov/pubmed/34662285 ID - info:doi/10.2196/28734 ER - TY - JOUR AU - Valera, Pamela AU - Carmona, David AU - Malarkey, Sarah AU - Sinangil, Noah AU - Owens, Madelyn AU - Lefebre, Asia PY - 2021/11/10 TI - Exploring Online Health Reviews to Monitor COVID-19 Public Health Responses in Alabama State Department of Corrections: Case Example JO - JMIR Form Res SP - e32591 VL - 5 IS - 11 KW - Alabama KW - correctional facilities KW - COVID-19 KW - online health reviews KW - review KW - monitoring KW - public health KW - policy KW - response KW - prison KW - United States KW - case study KW - formative KW - feasibility KW - acceptability KW - survey N2 - Background: COVID-19, caused by SARS-CoV-2, has devastated incarcerated people throughout the United States. Objective: The purpose of this study was to test the feasibility and acceptability of a COVID-19 Health Review for Correctional Facilities. Methods: The COVID-19 Health Review survey for the Department of Corrections was developed in Qualtrics to assess the following: (1) COVID-19 testing, (2) providing personal protective equipment, (3) vaccination procedures, (4) quarantine procedures, (5) COVID-19 mortality rates for inmates, (6) COVID-19 mortality rates for correctional officers and prison staff, (7) COVID-19 infection rates for inmates, (8) COVID-19 infection rates for correctional officers and prison staff, and (9) uptake of COVID-19 vaccines. The estimated time to review the Alabama State Department of Corrections COVID-19 responses on their website and complete the survey items was 45 minutes to 1 hour. Results: Of the 21 participants who completed the COVID-19 Health Review for Correctional Facilities survey, 48% (n=10) identified as female, 43% (n=9) identified as male, and 10% (n=2) identified as transgender. For race, 29% (n=6) self-identified as Black or African American, 24% (n=5) Asian, 24% (n=5) White, 5% (n=1) Pacific Islander or Native Hawaiian, and 19% (n=4) Other. In addition, 5 respondents self-identified as returning citizens. For COVID-19 review questions, the majority concluded that information on personal protective equipment was ?poor? and ?very poor,? information on COVID-19 testing was ?fair? and above, information on COVID-19 death/infection rates between inmates and staff was ?good? and ?very good,? and information on vaccinations was ?good? and ?very good.? There was a significant difference observed (P=.03) between nonreturning citizens and returning citizens regarding the health grade review with respect to available information on COVID-19 infection rates. Conclusions: COVID-19 health reviews may provide an opportunity for the public to review the COVID-19 responses in correctional settings. UR - https://formative.jmir.org/2021/11/e32591 UR - http://dx.doi.org/10.2196/32591 UR - http://www.ncbi.nlm.nih.gov/pubmed/34609313 ID - info:doi/10.2196/32591 ER - TY - JOUR AU - Rabbani, Golam Md AU - Akter, Orin AU - Hasan, Zahid Md AU - Samad, Nandeeta AU - Mahmood, Shaila Shehrin AU - Joarder, Taufique PY - 2021/11/5 TI - COVID-19 Knowledge, Attitudes, and Practices Among People in Bangladesh: Telephone-Based Cross-sectional Survey JO - JMIR Form Res SP - e28344 VL - 5 IS - 11 KW - COVID-19 KW - knowledge KW - attitude KW - practice KW - risk communication and community engagement KW - social and behavior change communication KW - Bangladesh KW - risk KW - pandemic KW - risk communication N2 - Background: The world has been grappling with the COVID-19 pandemic, a dire public health crisis, since December 2019. Preventive and control measures have been adopted to reduce the spread of COVID-19. To date, the public?s knowledge, attitudes, and practices regarding COVID-19 across Bangladesh have been poorly understood. Therefore, it is important to assess people?s knowledge, attitudes, and practices (KAP) toward the disease and suggest appropriate strategies to combat COVID-19 effectively. Objective: This study aimed to assess the KAP of Bangladeshi people toward COVID-19 and to identify their determinants. Methods: We conducted a country-wide cross-sectional telephonic survey from May 7 to 29, 2020. A purposive sampling method was applied, and adult Bangladeshi citizens who have mobile phones were approached to participate in the survey. Interviews were conducted based on verbal consent. Multiple logistic regression analyses and several tests were performed to identify the factors associated with KAP related to COVID-19. Results: A total of 492 of 576 Bangladeshi adults aged 18 years and above completed the interview, with a response rate of 85.4% (492/576). Of the 492 participants, 321 (65.2%) were male, and 304 (61.8%) lived in a rural area. Mean scores for knowledge, attitudes, and practices were 10.56 (SD 2.86), 1.24 (SD 0.83), and 3.17 (SD 1.5), respectively. Among the 492 respondents, 273 (55.5%) had poor knowledge, and 251 (49%) expressed a negative attitude; 192 out of 359 respondents (53.5%) had poor practices toward COVID-19. Mean scores of knowledge, attitudes, and practices differed significantly across various demographic and socioeconomic groups. Rural residents had lower mean scores of knowledge (mean 9.8, SD 3.1, P<.001) and adherence to appropriate practice measures (mean 4, SD 1.4, P<.001) compared to their urban counterparts. Positive and statistically strong correlations between knowledge and attitudes (r=0.21, P<.001), knowledge and practices (r=0.45, P<.001), and attitudes and practices (r=0.27, P<.001) were observed. Television (53.7%) was identified as the major source of knowledge regarding COVID-19. Almost three-quarters of the respondents (359/492, 73%) went outside the home during the lockdown period. Furthermore, the study found that good knowledge (odds ratio [OR] 3.13, 95% CI 2.03-4.83, and adjusted OR 2.33, 95% CI 1.16-4.68) and a positive attitude (OR 2.43, 95% CI 1.59-3.72, and adjusted OR 3.87, 95% CI 1.95-7.68) are significantly associated with better practice of COVID-19 health measures. Conclusions: Evidence-informed and context-specific risk communication and community engagement, and a social and behavior change communication strategy against COVID-19 should be developed in Bangladesh based on the findings of this study, targeting different socioeconomic groups. UR - https://formative.jmir.org/2021/11/e28344 UR - http://dx.doi.org/10.2196/28344 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519660 ID - info:doi/10.2196/28344 ER - TY - JOUR AU - Calvo-Valderrama, Gabriela Maria AU - Marroquín-Rivera, Arturo AU - Burn, Erin AU - Ospina-Pinillos, Laura AU - Bird, Victoria AU - Gómez-Restrepo, Carlos PY - 2021/11/3 TI - Adapting a Mental Health Intervention for Adolescents During the COVID-19 Pandemic: Web-Based Synchronous Focus Group Study JO - JMIR Form Res SP - e30293 VL - 5 IS - 11 KW - pandemic KW - COVID-19 KW - online focus groups KW - qualitative research KW - technology KW - adolescents KW - public health N2 - Background: Although focus groups are a valuable qualitative research tool, face-to-face meetings may be difficult to arrange and time consuming. This challenge has been further compounded by the global COVID-19 pandemic and the subsequent lockdown and physical distancing measures implemented, which caused exceptional challenges to human activities. Online focus groups (OFGs) are an example of an alternative strategy and require further study. At present, OFGs have mostly been studied and used in high-income countries, with little information relating to their implementation in low- and middle-income countries (LMICs). Objective: The aim of this study is to share our experiences of conducting OFGs through a web conferencing service and provide recommendations for future research. Methods: As part of a broader study, OFGs were developed with adults and adolescents in Colombia during the COVID-19 pandemic. Through a convenience sampling method, we invited eligible participants via email in two different cities of Colombia to participate in OFGs conducted via Microsoft Teams. Researcher notes and discussion were used to capture participant and facilitator experiences, as well as practical considerations. Results: Technical issues were encountered, but various measures were taken to minimize them, such as using a web conferencing service that was familiar to participants, sending written instructions, and performing a trial meeting prior to the OFG. Adolescent participants, unlike their adult counterparts, were fluent in using web conferencing platforms and did not encounter technical challenges. Conclusions: OFGs have great potential in research settings, especially during the current and any future public health emergencies. It is important to keep in mind that even with the advantages that they offer, technical issues (ie, internet speed and access to technology) are major obstacles in LMICs. Further research is required and should carefully consider the appropriateness of OFGs in different settings. UR - https://formative.jmir.org/2021/11/e30293 UR - http://dx.doi.org/10.2196/30293 UR - http://www.ncbi.nlm.nih.gov/pubmed/34637395 ID - info:doi/10.2196/30293 ER - TY - JOUR AU - Chan, Lilian AU - El-Haddad, Nouhad AU - Freeman, Becky AU - O'Hara, J. Blythe AU - Woodland, Lisa AU - Harris-Roxas, Ben PY - 2021/11/3 TI - A Case Study of an SMS Text Message Community Panel Survey and Its Potential for Use During the COVID-19 Pandemic JO - JMIR Form Res SP - e28929 VL - 5 IS - 11 KW - data collection KW - mobile phone KW - short message service KW - tobacco KW - COVID-19 KW - survey UR - https://formative.jmir.org/2021/11/e28929 UR - http://dx.doi.org/10.2196/28929 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612824 ID - info:doi/10.2196/28929 ER - TY - JOUR AU - Perrins, Genevieve AU - Ferdous, Tabassum AU - Hay, Dawn AU - Harreveld, Bobby AU - Reid-Searl, Kerry PY - 2021/11/2 TI - Conducting Health Literacy Research With Hard-to-Reach Regional Culturally and Linguistically Diverse Populations: Evaluation Study of Recruitment and Retention Methods Before and During COVID-19 JO - JMIR Form Res SP - e26136 VL - 5 IS - 11 KW - health literacy KW - cultural and linguistic diversity KW - COVID-19 KW - health care barriers KW - hard-to-reach research participants KW - regional Australia KW - health literacy profiles KW - literacy N2 - Background: In health research, culturally and linguistically diverse (CALD) health care consumers are cited as hidden or hard to reach. This paper evaluates the approach used by researchers to attract and retain hard-to-reach CALD research participants for a study investigating health communication barriers between CALD health care users and health care professionals in regional Australia. As the study was taking place during the COVID-19 pandemic, subsequent restrictions emerged. Thus, recruitment and retention methods were adapted. This evaluation considered the effectiveness of recruitment and retention used throughout the pre-COVID and during-COVID periods. Objective: This evaluation sought to determine the effectiveness of recruitment and retention efforts of researchers during a study that targeted regional hard-to-reach CALD participants. Methods: Recruitment and retention methods were categorized into the following 5 phases: recruitment, preintervention data collection, intervention, postintervention data collection, and interviews. To compare the methods used by researchers, recruitment and retention rates were divided into pre-COVID and during-COVID periods. Thereafter, in-depth reflections of the methods employed within this study were made. Results: This paper provides results relating to participant recruitment and retainment over the course of 5 research phases that occurred before and during COVID. During the pre-COVID recruitment phase, 22 participants were recruited. Of these participants, 15 (68%) transitioned to the next phase and completed the initial data collection phase. By contrast, 18 participants completed the during-COVID recruitment phase, with 13 (72%) continuing to the next phase. The success rate of the intervention phase in the pre-COVID period was 93% (14/15), compared with 84.6% (11/13) in the during-COVID period. Lastly, 93% (13/14) of participants completed the postintervention data collection in the pre-COVID period, compared with 91% (10/11) in the during-COVID period. In total, 40 participants took part in the initial data collection phase, with 23 (58%) completing the 5 research phases. Owing to the small sample size, it was not determined if there was any statistical significance between the groups (pre- and during-COVID periods). Conclusions: The success of this program in recruiting and maintaining regional hard-to-reach CALD populations was preserved over the pre- and during-COVID periods. The pandemic required researchers to adjust study methods, thereby inadvertently contributing to the recruitment and retention success of the project. The maintenance of participants during this period was due to flexibility offered by researchers through adaptive methods, such as the use of cultural gatekeepers, increased visibility of CALD researchers, and use of digital platforms. The major findings of this evaluation are 2-fold. First, increased diversity in the research sample required a high level of flexibility from researchers, meaning that such projects may be more resource intensive. Second, community organizations presented a valuable opportunity to connect with potential hard-to-reach research participants. UR - https://formative.jmir.org/2021/11/e26136 UR - http://dx.doi.org/10.2196/26136 UR - http://www.ncbi.nlm.nih.gov/pubmed/34581673 ID - info:doi/10.2196/26136 ER - TY - JOUR AU - Corrêa, Pires Roberta AU - Castro, Carla Helena AU - Quaresma, Salomão Bruna Maria Castro AU - Stephens, Soares Paulo Roberto AU - Araujo-Jorge, Cremonini Tania AU - Ferreira, Rodrigues Roberto PY - 2021/10/22 TI - Perceptions and Feelings of Brazilian Health Care Professionals Regarding the Effects of COVID-19: Cross-sectional Web-Based Survey JO - JMIR Form Res SP - e28088 VL - 5 IS - 10 KW - COVID-19 KW - SARS-CoV-2 KW - health professionals KW - Brazil KW - pandemic KW - mental health KW - health planning N2 - Background: The importance of health professionals has been recognized in COVID-19 pandemic?affected countries, especially in those such as Brazil, which is one of the top 3 countries that have been affected in the world. However, the workers? perception of the stress and the changes that the pandemic has caused in their lives vary according to the conditions offered by these affected countries, including salaries, individual protection equipment, and psychological support. Objective: The purpose of this study was to identify the perceptions of Brazilian health workers regarding the COVID-19 pandemic impact on their lives, including possible self-contamination and mental health. Methods: This cross-sectional web-based survey was conducted in Brazil by applying a 32-item questionnaire, including multiple-choice questions by using the Google Forms electronic assessment. This study was designed to capture spontaneous perceptions from health professionals. All questions were mandatory and divided into 2 blocks with different proposals: personal profile and COVID-19 pandemic impact. Results: We interviewed Brazilian health professionals from all 5 Brazilian regions (N=1376). Our study revealed that 1 in 5 (23%) complained about inadequate personal protective equipment, including face shields (234/1376, 17.0%), masks (206/1376, 14.9%), and laboratory coats (138/1376, 10.0%), whereas 1 in 4 health professionals did not have enough information to protect themselves from the coronavirus disease. These professionals had anxiety due to COVID-19 (604/1376, 43.9%), difficulties in sleep (593/1376, 43.1%), and concentrating on work (453/1376, 32.9%). Almost one-third experienced traumatic situations at work (385/1376, 28.0%), which may have led to negative feelings of fear of COVID-19 and sadness. Despite this situation, there was hope and empathy among their positive feelings. The survey also showed that 1 in 5 acquired COVID-19 with the most classic and minor symptoms, including headache (274/315, 87.0%), body pain (231/315, 73.3%), tiredness (228/315, 72.4%), and loss of taste and smell (208/315, 66.0%). Some of their negative feelings were higher than those of noninfected professionals (fear of COVID-19, 243/315, 77.1% vs 509/1061, 48.0%; impotence, 142/315, 45.1% vs 297/1061, 28.0%; and fault, 38/315, 12.1% vs 567/1061, 53.4%, respectively). Another worrying outcome was that 61.3% (193/315) reported acquiring an infection while working at a health facility and as expected, most of the respondents felt affected (344/1376, 25.0%) or very affected (619/1376, 45.0%) by the COVID-19. Conclusions: In Brazil, the health professionals were exposed to a stressful situation and to the risk of self-contamination?conditions that can spell future psychological problems for these workers. Our survey findings showed that the psychological support for this group should be included in the future health planning of Brazil and of other hugely affected countries to assure a good mental health condition for the medical teams in the near future. UR - https://formative.jmir.org/2021/10/e28088 UR - http://dx.doi.org/10.2196/28088 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519656 ID - info:doi/10.2196/28088 ER - TY - JOUR AU - Sahoo, Prasad Durgesh AU - Singh, Kumar Arvind AU - Sahu, Prasad Dinesh AU - Pradhan, Kumar Somen AU - Patro, Kumar Binod AU - Batmanabane, Gitanjali AU - Mishra, Baijayantimala AU - Behera, Bijayini AU - Das, Ambarish AU - Dora, Susmita G. AU - Anand, L. AU - Azhar, M. S. AU - Nair, Jyolsna AU - Panigrahi, Sasmita AU - Akshaya, R. AU - Sahoo, Kumar Bimal AU - Sahu, Subhakanta AU - Sahoo, Suchismita PY - 2021/10/21 TI - Hospital-Based Contact Tracing of Patients With COVID-19 and Health Care Workers During the COVID-19 Pandemic in Eastern India: Cross-sectional Study JO - JMIR Form Res SP - e28519 VL - 5 IS - 10 KW - COVID-19 KW - SARS-CoV-2 KW - risk categorization KW - health care personnel KW - virus transmission KW - contact tracing KW - pandemic KW - risk stratification N2 - Background: The contact tracing and subsequent quarantining of health care workers (HCWs) are essential to minimizing the further transmission of SARS-CoV-2 infection and mitigating the shortage of HCWs during the COVID-19 pandemic situation. Objective: This study aimed to assess the yield of contact tracing for COVID-19 cases and the risk stratification of HCWs who are exposed to these cases. Methods: This was an analysis of routine data that were collected for the contact tracing of COVID-19 cases at the All India Institute of Medical Sciences, Bhubaneswar, in Odisha, India. Data from March 19 to August 31, 2020, were considered for this study. COVID-19 cases were admitted patients, outpatients, or HCWs in the hospital. HCWs who were exposed to COVID-19 cases were categorized, per the risk stratification guidelines, as high-risk contacts or low-risk contacts Results: During contact tracing, 3411 HCWs were identified as those who were exposed to 360 COVID-19 cases. Of these 360 cases, 269 (74.7%) were either admitted patients or outpatients, and 91 (25.3%) were HCWs. After the risk stratification of the 3411 HCWs, 890 (26.1%) were categorized as high-risk contacts, and 2521 (73.9%) were categorized as low-risk contacts. The COVID-19 test positivity rates of high-risk contacts and low-risk contacts were 3.8% (34/890) and 1.9% (48/2521), respectively. The average number of high-risk contacts was significantly higher when the COVID-19 case was an admitted patient (number of contacts: mean 6.6) rather than when the COVID-19 case was an HCW (number of contacts: mean 4.0) or outpatient (number of contacts: mean 0.2; P=.009). Similarly, the average number of high-risk contacts was higher when the COVID-19 case was admitted in a non?COVID-19 area (number of contacts: mean 15.8) rather than when such cases were admitted in a COVID-19 area (number of contacts: mean 0.27; P<.001). There was a significant decline in the mean number of high-risk contacts over the study period (P=.003). Conclusions: Contact tracing and risk stratification were effective and helped to reduce the number of HCWs requiring quarantine. There was also a decline in the number of high-risk contacts during the study period. This indicates the role of the implementation of hospital-based, COVID-19?related infection control strategies. The contact tracing and risk stratification approaches that were designed in this study can also be implemented in other health care settings. UR - https://formative.jmir.org/2021/10/e28519 UR - http://dx.doi.org/10.2196/28519 UR - http://www.ncbi.nlm.nih.gov/pubmed/34596569 ID - info:doi/10.2196/28519 ER - TY - JOUR AU - Summers, Charlotte AU - Wu, Philip AU - Taylor, G. Alisdair J. PY - 2021/10/6 TI - Supporting Mental Health During the COVID-19 Pandemic Using a Digital Behavior Change Intervention: An Open-Label, Single-Arm, Pre-Post Intervention Study JO - JMIR Form Res SP - e31273 VL - 5 IS - 10 KW - stress KW - mental health KW - COVID-19 KW - digital therapy KW - mHealth KW - support KW - behavior KW - intervention KW - online intervention KW - outcome KW - wellbeing KW - sleep KW - activity KW - nutrition N2 - Background: The COVID-19 pandemic is taking a toll on people?s mental health, particularly as people are advised to adhere to social distancing, self-isolation measures, and government-imposed national lockdowns. Digital health technologies have an important role to play in keeping people connected and in supporting their mental health and well-being. Even before the COVID-19 pandemic, mental health and social services were already strained. Objective: Our objective was to evaluate the 12-week outcomes of the digitally delivered Gro Health intervention, a holistic digital behavior change app designed for self-management of mental well-being, sleep, activity, and nutrition. Methods: The study used a quasi-experimental research design consisting of an open-label, single-arm, pre-post intervention engagement using a convenience sample. Adults who had joined the Gro Health app (intervention) and had a complete baseline dataset (ie, 7-item Generalized Anxiety Disorder scale, Perceived Stress Scale, and 9-item Patient Health Questionnaire) were followed up at 12 weeks (n=273), including 33 (12.1%) app users who reported a positive COVID-19 diagnosis during the study period. User engagement with the Gro Health platform was tracked by measuring total minutes of app engagement. Paired t tests were used to compare pre-post intervention scores. Linear regression analysis was performed to assess the relationship between minutes of active engagement with the Gro Health app and changes in scores across the different mental health measures. Results: Of the 347 study participants, 273 (78.67%) completed both the baseline and follow-up surveys. Changes in scores for anxiety, perceived stress, and depression were predicted by app engagement, with the strongest effect observed for changes in perceived stress score (F1,271=251.397; R2=0.479; P<.001). Conclusions: A digital behavior change platform that provides remote mental well-being support can be effective in managing depression, anxiety, and perceived stress during times of crisis such as the current COVID-19 pandemic. The outcomes of this study may also support the implementation of remote digital health apps supporting behavior change and providing support for low levels of mental health within the community. UR - https://formative.jmir.org/2021/10/e31273 UR - http://dx.doi.org/10.2196/31273 UR - http://www.ncbi.nlm.nih.gov/pubmed/34459740 ID - info:doi/10.2196/31273 ER - TY - JOUR AU - Gordon, S. Judith AU - Sbarra, David AU - Armin, Julie AU - Pace, W. Thaddeus W. AU - Gniady, Chris AU - Barraza, Yessenya PY - 2021/10/4 TI - Use of a Guided Imagery Mobile App (See Me Serene) to Reduce COVID-19?Related Stress: Pilot Feasibility Study JO - JMIR Form Res SP - e32353 VL - 5 IS - 10 KW - COVID-19 KW - stress KW - anxiety KW - isolation KW - intervention KW - guided imagery KW - mobile app N2 - Background: The SARS-CoV-2 pandemic has led to concerns about mental health resulting from regional and national lockdowns, social isolation, job loss, and concern about disease exposure. Objective: We describe results of the pilot feasibility study of the See Me Serene mHealth app. The app provides users with immersive, vivid, nature experiences to reduce stress and anxiety related to COVID-19 and other isolation. The goals of the study were to develop the See Me Serene app and test the feasibility and acceptability of study procedures, and explore the potential impact of the app on stress and anxiety. Methods: We developed and tested the See Me Serene app and our study procedures for feasibility, and gathered preliminary data with a goal of 100 participants. The research was conducted in 2 phases: (1) development and internal testing of the app; and (2) feasibility and pilot testing with participants recruited online through earned media (eg, news stories), presentations at a university campus, and social media (eg, online sharing of earned media and presentations). The feasibility study employed a mixed methods, within-subjects, pre-/posttest design. At baseline and 30-day follow-up, we assessed stress-related variables via validated self-report measures and saliva samples for determination of cortisol concentrations. Results: We met or surpassed all our feasibility benchmarks for recruitment (101 participants recruited), retention (91% [90/99] of 30-day assessment completed), and data collection (99 participants completed all baseline data; 85% [84/99] of salivary cortisol samples returned). Participants adhered to the intervention. On average, participants listened to 48.2 audio files over 30 days or approximately 1.6 audio files per day. Participants were satisfied with the app, with 87% (78/90) rating the app as helpful in dealing with stress and anxiety. The app showed the potential to reduce stress, anxiety, loneliness, and worry. We did not find significant differences (P=.41) in cortisol levels over time. Our findings suggest that future research is warranted to test the efficacy of the See Me Serene app with a representative, diverse sample. Conclusions: There is a need for evidence-based and easily disseminable stress-reduction interventions. See Me Serene is a feasible intervention and has the potential to reduce stress related to COVID-19 and other forms of social isolation. More research on See Me Serene is warranted. UR - https://formative.jmir.org/2021/10/e32353 UR - http://dx.doi.org/10.2196/32353 UR - http://www.ncbi.nlm.nih.gov/pubmed/34546941 ID - info:doi/10.2196/32353 ER - TY - JOUR AU - Hentati, Amira AU - Forsell, Erik AU - Ljótsson, Brjánn AU - Kraepelien, Martin PY - 2021/10/4 TI - Practical and Emotional Problems Reported by Users of a Self-guided Digital Problem-solving Intervention During the COVID-19 Pandemic: Content Analysis JO - JMIR Form Res SP - e31722 VL - 5 IS - 10 KW - digital intervention KW - COVID-19 KW - problem-solving KW - self-guided intervention KW - content analysis KW - public health KW - mental health KW - depression KW - anxiety KW - pandemic N2 - Background: To better direct assessments and interventions toward the general population during both the ongoing COVID-19 pandemic and future crises with societal restrictions, data on the types of practical and emotional problems that people are experiencing are needed. Objective: The aim of this study was to examine the types of practical and emotional problems that the general population is experiencing during the COVID-19 pandemic and to construct an empirically derived inventory based on the findings. Methods: A total of 396 participants, recruited among members of the general public in Sweden who were experiencing practical and/or emotional problems during the pandemic, accessed a self-guided digital problem-solving intervention for a period of 1 week to report and solve the problems they experienced. Prior to accessing the intervention, the participants completed a short self-assessment regarding symptoms of depression and anxiety. Content analysis was used to account for the types of problems participants reported. A set of items for an inventory was later proposed based on the problem categories derived from the analysis. Results: A majority of participants had clinically relevant symptoms of either depression or anxiety. The problems reported were categorized as 13 distinct types of problems. The most common problem was difficulty managing daily activities. Based on the categories, a 13-item inventory was proposed. Conclusions: The 13 types of problems, and the proposed inventory, could be valuable when composing assessments and interventions for the general population during the ongoing pandemic or similar crises with societal restrictions. The most common problem was of a practical nature, indicating the importance of including examples of such problems within assessments and interventions. Trial Registration: ClinicalTrials.gov NCT04677270; https://clinicaltrials.gov/ct2/show/NCT04677270 UR - https://formative.jmir.org/2021/10/e31722 UR - http://dx.doi.org/10.2196/31722 UR - http://www.ncbi.nlm.nih.gov/pubmed/34559670 ID - info:doi/10.2196/31722 ER - TY - JOUR AU - Geronikolou, Styliani AU - Drosatos, George AU - Chrousos, George PY - 2021/9/29 TI - Emotional Analysis of Twitter Posts During the First Phase of the COVID-19 Pandemic in Greece: Infoveillance Study JO - JMIR Form Res SP - e27741 VL - 5 IS - 9 KW - emotional analysis KW - COVID-19 KW - Twitter KW - Greece KW - infodemics KW - emotional contagion KW - epidemiology KW - pandemic KW - mental health N2 - Background: The effectiveness of public health measures depends upon a community?s compliance as well as on its positive or negative emotions. Objective: The purpose of this study was to perform an analysis of the expressed emotions in English tweets by Greek Twitter users during the first phase of the COVID-19 pandemic in Greece. Methods: The period of this study was from January 25, 2020 to June 30, 2020. Data collection was performed by using appropriate search words with the filter-streaming application programming interface of Twitter. The emotional analysis of the tweets that satisfied the inclusion criteria was achieved using a deep learning approach that performs better by utilizing recurrent neural networks on sequences of characters. Emotional epidemiology tools such as the 6 basic emotions, that is, joy, sadness, disgust, fear, surprise, and anger based on the Paul Ekman classification were adopted. Results: The most frequent emotion that was detected in the tweets was ?surprise? at the emerging contagion, while the imposed isolation resulted mostly in ?anger? (odds ratio 2.108, 95% CI 0.986-4.506). Although the Greeks felt rather safe during the first phase of the COVID-19 pandemic, their positive and negative emotions reflected a masked ?flight or fight? or ?fear versus anger? response to the contagion. Conclusions: The findings of our study show that emotional analysis emerges as a valid tool for epidemiology evaluations, design, and public health strategy and surveillance. UR - https://formative.jmir.org/2021/9/e27741 UR - http://dx.doi.org/10.2196/27741 UR - http://www.ncbi.nlm.nih.gov/pubmed/34469328 ID - info:doi/10.2196/27741 ER - TY - JOUR AU - Wati, Laras Risa AU - Ulfa, Sayyidatul Annisa AU - Kevaladandra, Zulfa AU - Shalihat, Shelly AU - Syahadatina, Bella AU - Pratomo, Hadi PY - 2021/9/23 TI - Pretesting a Poster on Recommended Stress Management During the COVID-19 Pandemic in Indonesia: Qualitative Study JO - JMIR Form Res SP - e25615 VL - 5 IS - 9 KW - pretesting KW - media KW - stress KW - COVID-19 N2 - Background: The COVID-19 Peritraumatic Distress Index (CPDI) is a self-report questionnaire developed to evaluate the frequency of anxiety and depression symptoms among individuals during the COVID-19 pandemic. A recent study in China showed high CPDI scores among individuals in the 18-30 years age group and those over 60 years. During the COVID-19 outbreak, people were expected to maintain their mental health conditions, especially stress levels. Therefore, many national governments actively published health promotion media in an effort to educate the public. One such media developed by the Ministry of Health, Republic of Indonesia, was a poster titled ?Hindari Stres dan Tetap Optimis dengan Melakukan Aktivitas Sehari-hari dan Tetap Menjaga Jarak.? Objective: The aim of this study is to conduct a test on a stress management recommendation poster developed by the Ministry of Health, Republic of Indonesia, in response to the COVID-19 outbreak by using pretesting communication theory. Methods: In-depth interviews were conducted among 8 key informants and 1 graphic design expert. Results: Pretesting can identify the strengths and weaknesses of media. The large amount of text and the lack of illustrations made the poster less attractive to readers. Moreover, there was a discrepancy between the title and contents of the poster. The poster was not able to persuade the informants to change their behavior in the near future. Conclusions: The poster was understood and accepted by the informants, but there was still much to be improved considering the poster was a product of the Ministry of Health, Republic of Indonesia. UR - https://formative.jmir.org/2021/9/e25615 UR - http://dx.doi.org/10.2196/25615 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254944 ID - info:doi/10.2196/25615 ER - TY - JOUR AU - Der-Martirosian, Claudia AU - Wyte-Lake, Tamar AU - Balut, Michelle AU - Chu, Karen AU - Heyworth, Leonie AU - Leung, Lucinda AU - Ziaeian, Boback AU - Tubbesing, Sarah AU - Mullur, Rashmi AU - Dobalian, Aram PY - 2021/9/23 TI - Implementation of Telehealth Services at the US Department of Veterans Affairs During the COVID-19 Pandemic: Mixed Methods Study JO - JMIR Form Res SP - e29429 VL - 5 IS - 9 KW - telehealth KW - telemedicine KW - veterans KW - US Department of Veterans Affairs KW - primary care KW - cardiology KW - home-based primary care KW - COVID-19 N2 - Background: At the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting nonurgent in-person appointments. Even though the VA was an early adopter of telehealth in the late 1990s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020. Objective: We compared telehealth service use at a VA Medical Center, Greater Los Angeles across 3 clinics (primary care [PC], cardiology, and home-based primary care [HBPC]) 12 months before and 12 months after the onset of COVID-19 (March 2020). Methods: We used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of monthly outpatient and telehealth visits, as well as telephone and VA Video Connect encounters were examined for each clinic. Semistructured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes. Results: Prior to COVID-19, telehealth use was minimal at all 3 clinics, but at the onset of COVID-19, telehealth use increased substantially at all 3 clinics. Telephone was the main modality of patient choice. Compared with PC and cardiology, video-based care had the greatest increase in HBPC. Several important barriers (multiple steps for videoconferencing, creation of new scheduling grids, and limited access to the internet and internet-connected devices) and facilitators (flexibility in using different video-capable platforms, technical support for patients, identification of staff telehealth champions, and development of workflows to help incorporate telehealth into treatment plans) were noted. Conclusions: Technological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions to improve access to care beyond the pandemic. UR - https://formative.jmir.org/2021/9/e29429 UR - http://dx.doi.org/10.2196/29429 UR - http://www.ncbi.nlm.nih.gov/pubmed/34477554 ID - info:doi/10.2196/29429 ER - TY - JOUR AU - Yamagami, Kan AU - Nomura, Akihiro AU - Kometani, Mitsuhiro AU - Shimojima, Masaya AU - Sakata, Kenji AU - Usui, Soichiro AU - Furukawa, Kenji AU - Takamura, Masayuki AU - Okajima, Masaki AU - Watanabe, Kazuyoshi AU - Yoneda, Takashi PY - 2021/9/16 TI - Early Detection of Symptom Exacerbation in Patients With SARS-CoV-2 Infection Using the Fitbit Charge 3 (DEXTERITY): Pilot Evaluation JO - JMIR Form Res SP - e30819 VL - 5 IS - 9 KW - COVID-19 KW - silent hypoxia KW - wearable device KW - Fitbit KW - estimated oxygen variation KW - detection KW - infectious disease KW - pilot study KW - symptom KW - outpatient KW - oxygen KW - sleep KW - wearable N2 - Background: Some patients with COVID-19 experienced sudden death due to rapid symptom deterioration. Thus, it is important to predict COVID-19 symptom exacerbation at an early stage prior to increasing severity in patients. Patients with COVID-19 could experience a unique ?silent hypoxia? at an early stage of the infection when they are apparently asymptomatic, but with rather low SpO2 (oxygen saturation) levels. In order to continuously monitor SpO2 in daily life, a high-performance wearable device, such as the Apple Watch or Fitbit, has become commercially available to monitor several biometric data including steps, resting heart rate (RHR), physical activity, sleep quality, and estimated oxygen variation (EOV). Objective: This study aimed to test whether EOV measured by the wearable device Fitbit can predict COVID-19 symptom exacerbation. Methods: We recruited patients with COVID-19 from August to November 2020. Patients were asked to wear the Fitbit for 30 days, and biometric data including EOV and RHR were extracted. EOV is a relative physiological measure that reflects users? SpO2 levels during sleep. We defined a high EOV signal as a patient?s oxygen level exhibiting a significant dip and recovery within the index period, and a high RHR signal as daily RHR exceeding 5 beats per day compared with the minimum RHR of each patient in the study period. We defined successful prediction as the appearance of those signals within 2 days before the onset of the primary outcome. The primary outcome was the composite of deaths of all causes, use of extracorporeal membrane oxygenation, use of mechanical ventilation, oxygenation, and exacerbation of COVID-19 symptoms, irrespective of readmission. We also assessed each outcome individually as secondary outcomes. We made weekly phone calls to discharged patients to check on their symptoms. Results: We enrolled 23 patients with COVID-19 diagnosed by a positive SARS-CoV-2 polymerase chain reaction test. The patients had a mean age of 50.9 (SD 20) years, and 70% (n=16) were female. Each patient wore the Fitbit for 30 days. COVID-19 symptom exacerbation occurred in 6 (26%) patients. We were successful in predicting exacerbation using EOV signals in 4 out of 5 cases (sensitivity=80%, specificity=90%), whereas the sensitivity and specificity of high RHR signals were 50% and 80%, respectively, both lower than those of high EOV signals. Coincidental obstructive sleep apnea syndrome confirmed by polysomnography was detected in 1 patient via consistently high EOV signals. Conclusions: This pilot study successfully detected early COVID-19 symptom exacerbation by measuring EOV, which may help to identify the early signs of COVID-19 exacerbation. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000041421; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047290 UR - https://formative.jmir.org/2021/9/e30819 UR - http://dx.doi.org/10.2196/30819 UR - http://www.ncbi.nlm.nih.gov/pubmed/34516390 ID - info:doi/10.2196/30819 ER - TY - JOUR AU - Rashid Soron, Tanjir AU - Ashiq, Rahman Md Ashiqur AU - Al-Hakeem, Marzia AU - Chowdhury, Farzan Zaid AU - Uddin Ahmed, Helal AU - Afrooz Chowdhury, Chaman PY - 2021/9/13 TI - Domestic Violence and Mental Health During the COVID-19 Pandemic in Bangladesh JO - JMIR Form Res SP - e24624 VL - 5 IS - 9 KW - domestic violence KW - COVID-19 KW - mental health KW - violence KW - Bangladesh KW - lockdown KW - isolation KW - anxiety KW - stress KW - telemental health KW - telepsychiatry KW - web-based survey N2 - Background: The COVID-19 lockdown, the advent of working from home, and other unprecedent events have resulted in multilayer and multidimensional impacts on our personal, social, and occupational lives. Mental health conditions are deteriorating, financial crises are increasing in prevalence, and the need to stay at home has resulted in the increased prevalence of domestic violence. In Bangladesh, where domestic violence is already prevalent, the lockdown period and stay-at-home orders could result in more opportunities and increased scope for perpetrators of domestic violence. Objective: In this study, we aimed to determine the prevalence and pattern of domestic violence during the initial COVID-19 lockdown period in Bangladesh and the perceptions of domestic violence survivors with regard to mental health care. Methods: We conducted this cross-sectional web-based study among the Bangladeshi population and used a semistructured self-reported questionnaire to understand the patterns of domestic violence and perceptions on mental health care from August to September 2020. The questionnaire was disseminated on different organizational websites and social media pages (ie, those of organizations that provide mental health and domestic violence services). Data were analyzed by using IBM SPSS (version 22.0; IBM Corporation). Results: We found that 36.8% (50/136) of respondents had faced domestic violence at some point in their lives; psychological abuse was the most common type of violence. However, the prevalence of the economical abuse domestic violence type increased after the COVID-19 lockdown was enforced. Although 96.3% (102/136) of the participants believed that domestic violence survivors need mental health support, only 25% (34/136) of the respondents had an idea about the mental health services that are available for domestic violence survivors in Bangladesh and how and where they could avail mental health services. Conclusions: Domestic violence is one of the most well-known stressors that have direct impacts on physical and mental health. However, the burden of domestic violence is often underreported, and its impact on mental health is neglected in Bangladesh. The burden of this problem has increased during the COVID-19 crisis, and the cry for mental health support is obvious in the country. However, it is necessary to provide information about available support services; telepsychiatry can be good option for providing immediate mental health support in a convenient and cost-effective manner. UR - https://formative.jmir.org/2021/9/e24624 UR - http://dx.doi.org/10.2196/24624 UR - http://www.ncbi.nlm.nih.gov/pubmed/34346893 ID - info:doi/10.2196/24624 ER - TY - JOUR AU - Tuck, B. Alison AU - Thompson, J. Renee PY - 2021/9/7 TI - Social Networking Site Use During the COVID-19 Pandemic and Its Associations With Social and Emotional Well-being in College Students: Survey Study JO - JMIR Form Res SP - e26513 VL - 5 IS - 9 KW - social media KW - social networking sites KW - COVID-19 KW - loneliness KW - well-being N2 - Background: Social distancing during the COVID-19 pandemic has reduced the frequency of in-person social interactions. College students were highly impacted, since many universities transferred curriculum from in-person to entirely online formats, physically separating students with little notice. With social distancing, their use of social networking sites (SNSs) likely changed during the COVID-19 pandemic, possibly holding implications for well-being. Objective: This study aimed to determine (1) how components of SNS use (ie, weekly frequency, time per day, habitual use, engagement, enjoyment, addiction, and emotional impact) changed from before to during COVID-19, (2) how these changes in SNS use were associated with pandemic-related social and emotional well-being, and (3) how SNS use and changes in use during the pandemic were associated with loneliness. Methods: College students (N=176) were surveyed during the time when their university campus in the United States was operating online. Participants completed the same SNS use questionnaires twice, once with regard to the month preceding the onset of COVID-19 and again with regard to the month since this time. They also reported the extent to which they experienced perceived change in social support resulting from the pandemic, pandemic-related stress, and general loneliness. Results: After the onset of COVID-19, participants showed an increase in daily time spent on SNSs (t169=5.53, d=0.42, P<.001), habitual use (t173=3.60, d=0.27, P<.001), and addiction (t173=4.96, d=0.38, P<.001); further, enjoyment on SNSs decreased (t173=?2.10, d=?0.16, P=.04) and the emotional impact of SNS activities became more negative (t172=?3.76, d=?0.29, P<.001). Increased perceived social support during COVID-19 was associated with changes in frequency of SNS use, time per day, addiction, and engagement (r>0.18 for all). Pandemic-related stress was associated with changes in SNS addiction and the extent to which one?s SNS content was related to the pandemic (r>0.20 for all). Loneliness was positively associated with SNS addiction (r=0.26) and negatively associated with SNS engagement (r=?0.19) during the pandemic. Loneliness was also negatively associated with changes in habit and engagement (r