TY - JOUR AU - Power, Mary Julianne AU - Bersamin, Andrea PY - 2018/07/06 TI - A Text Messaging Intervention (Txt4HappyKids) to Promote Fruit and Vegetable Intake Among Families With Young Children: Pilot Study JO - JMIR Formativ Res SP - e13 VL - 2 IS - 2 KW - fruits and vegetables KW - nutrition education KW - nutrition intervention KW - young children KW - text messaging N2 - Background: Increasing fruit and vegetable intake among low-income populations, especially children, is a priority for United States federal food assistance programs. With over 49 million federal food assistance program recipients, cost-effective and efficient methods are needed to effectively deliver nutrition education to such a large population. Objective: The objective of our study was to examine the preliminary efficacy and acceptability of a text messaging intervention, Txt4HappyKids, to promote fruit and vegetable intake among families with young children. Methods: The intervention was evaluated using a pre-post study design. Parents (N=72) in Alaska were recruited from venues that serve a predominantly low-income population to participate in an 11-week intervention based on social cognitive theory. Parents received two texts per week promoting child fruit and vegetable intake. Behaviors, self-efficacy, and attitudes related to fruit and vegetable intake were measured at baseline and postintervention. Perceived changes in behaviors and open-ended feedback were also collected postintervention. Results: Of all participants, 67.3% (72/107) completed the intervention. We found no changes in behavior (P=.26), self-efficacy (P=.43), or attitudes (P=.35) related to fruit and vegetable intake from pre- to postintervention. Completers reported that since their participation in Txt4HappyKids, 92% (66/72) served more fruits and vegetables to their child because they thought fruits and vegetables were beneficial, 86% (62/72) tried to follow a healthier diet, 85% (61/72) tried different ways of preparing fruits and vegetables, and 81% (58/72) were more aware of the foods their child consumes. Additionally, 79% (57/72) of completers thought that Txt4HappyKids was credible, 71% (51/72) found texts useful, and 82% (59/72) would recommend it to a friend. Conclusions: A text messaging intervention was not sufficient to increase fruit and vegetable intake among families with young children. However, parents felt positively impacted by Txt4HappyKids and were receptive to nutrition information, despite the absence of face-to-face contact. High satisfaction among completers indicates that text messaging may be an acceptable complement to budget-constrained nutrition programs. These findings are an important first step in developing larger multi-level interventions utilizing mobile technology; however, a more rigorous evaluation of the Txt4HappyKids intervention is warranted. UR - http://formative.jmir.org/2018/2/e13/ UR - http://dx.doi.org/10.2196/formative.8544 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684412 ID - info:doi/10.2196/formative.8544 ER - TY - JOUR AU - Cowie, Julie AU - Boa, Sally AU - King, Emma AU - Wells, Mary AU - Cairns, David PY - 2018/08/17 TI - Electronic Swallowing Intervention Package to Support Swallowing Function in Patients With Head and Neck Cancer: Development and Feasibility Study JO - JMIR Formativ Res SP - e15 VL - 2 IS - 2 KW - head and neck cancer KW - eHealth KW - self-management KW - mHealth KW - chemoradiotherapy KW - mobile phones N2 - Background: Many patients undergoing treatment for head and neck cancer (HNC) experience significant swallowing difficulties, and there is some evidence that swallowing exercises may improve outcomes, including quality of life. This feasibility study developed an evidence-based, practical Swallowing Intervention Package (SiP) for patients undergoing chemoradiotherapy (CRT) for HNC. As part of the study, an electronic version of SiP (e-SiP) was concurrently developed to support patients to self-manage during treatment. This paper reports on the e-SiP component of this work. Objective: The objective of our study was to develop and conduct a preliminary evaluation of an electronic support system (e-SiP) for patients undergoing CRT for HNC. Methods: The study was conducted using a recognized mHealth development and evaluation framework and involved health professionals and patients who were undergoing CRT for HNC. The scoping stage of e-SiP development investigated the potential usefulness of the app, exploring how e-SiP would look and feel and what content would be appropriate to provide. Patient and carer focus groups and a health professionals? consensus day were used as means of data gathering around potential e-SiP content. A repeat focus group looked at an outline version of e-SiP and informed the next stage of its development with regard to refining the requirements for the tool. This was followed by further development and a testing stage of e-SiP that involved the coding of a prototype, which was then evaluated using a series of steering group meetings, semistructured interviews with both patients and health care professionals, and analysis of e-SiP log data. Results: Feedback from focus groups and health professional interviews was very positive, and it was felt e-SiP use would support and encourage patients in conducting their swallowing exercises. However, of the 10 patients who were offered e-SiP, only 2 opted to use it. For these patients, the aspects of the e-SiP app were considered useful, in particular, the ease of keeping a diary of exercises performed. Interviews with users and nonusers suggested significant barriers to its use. Most significantly, the lack of flexibility of the platform on which e-SiP could be accessed appeared a dominant factor in deterring e-SiP use. Conclusions: The results suggest that further research needs to be conducted around the implementation of e-SiP. This involves evaluating how e-SiP can be better integrated into usual care and through patient training and staff engagement, can be perceived as a beneficial tool to help support patients in conducting swallowing exercises. UR - http://formative.jmir.org/2018/2/e15/ UR - http://dx.doi.org/10.2196/formative.9703 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/formative.9703 ER - TY - JOUR AU - Côté, José AU - Fortin, Marie-Chantal AU - Auger, Patricia AU - Rouleau, Geneviève AU - Dubois, Sylvie AU - Boudreau, Nathalie AU - Vaillant, Isabelle AU - Gélinas-Lemay, Élisabeth PY - 2018/07/19 TI - Web-Based Tailored Intervention to Support Optimal Medication Adherence Among Kidney Transplant Recipients: Pilot Parallel-Group Randomized Controlled Trial JO - JMIR Formativ Res SP - e14 VL - 2 IS - 2 KW - medication adherence KW - transplant recipient KW - self-management KW - nursing KW - Web-based tailored intervention KW - randomized controlled trial N2 - Background: Optimal immunosuppressive medication adherence is essential to graft survival. Transplant-TAVIE is a Web-based tailored intervention developed to promote this adherence. Objective: The objective of our study was to evaluate the Transplant-TAVIE intervention?s acceptability, feasibility, and preliminary efficacy. Methods: In a pilot, parallel-group, randomized controlled trial, we randomly assigned a convenience sample of 70 kidney transplant patients on immunosuppressive medication either to an experimental group (Transplant-TAVIE) or to a control group (existing websites). Kidney transplant recipients had to be older than 18 years, be taking immunosuppressant medication, and have access to the internet to participate in this study. Transplant-TAVIE was composed of three interactive Web-based sessions hosted by a virtual nurse. We documented user appreciation of and exposure to the intervention. Furthermore, we assessed medication adherence, medication self-efficacy, intake-related skills, and medication side effects at baseline and 3 and 6 months later. Analyses of variance were used to assess intergroup differences over time. Results: After baseline questionnaire completion, participants were randomly assigned either to Transplant-TAVIE (n=35) or to the websites (n=35) group. All participants had received their kidney graft <1 year to 32 years earlier (mean 6.8 years). Of the experimental group, 54% (19/35) completed the sessions of Transplant-TAVIE. Users found the intervention to be acceptable?33% were extremely satisfied (6/18), 39% were very satisfied (7/18), and 28% were satisfied (5/18). At baseline and over time, both experimental and control groups reported high medication adherence, high medication self-efficacy, and frequent use of skills related to medication intake. No intergroup differences emerged over time. Conclusions: The results of this study support the feasibility and acceptability of Transplant-TAVIE. It could constitute an accessible adjunct in support of existing specialized services. UR - http://formative.jmir.org/2018/2/e14/ UR - http://dx.doi.org/10.2196/formative.9707 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684400 ID - info:doi/10.2196/formative.9707 ER - TY - JOUR AU - Poss-Doering, Regina AU - Kunz, Aline AU - Pohlmann, Sabrina AU - Hofmann, Helene AU - Kiel, Marion AU - Winkler, C. Eva AU - Ose, Dominik AU - Szecsenyi, Joachim PY - 2018/08/03 TI - Utilizing a Prototype Patient-Controlled Electronic Health Record in Germany: Qualitative Analysis of User-Reported Perceptions and Perspectives JO - JMIR Formativ Res SP - e10411 VL - 2 IS - 2 KW - personal patient-controlled electronic health record KW - eHealth KW - nationwide implementation KW - continuity of care N2 - Background: Personal electronic health records (PHR) are considered instrumental in improving health care quality and efficiency, enhancing communication between all parties involved and strengthening the patient?s role. Technical architectures, data privacy, and applicability issues have been discussed for many years. Nevertheless, nationwide implementation of a PHR is still pending in Germany despite legal regulations provided by the eHealth Act passed in 2015. Within the information technology for patient-oriented care project funded by the Federal Ministry of Education and Research (2012-2017), a Web-based personal electronic health record prototype (PEPA) was developed enabling patient-controlled information exchange across different care settings. Gastrointestinal cancer patients and general practitioners utilized PEPA during a 3-month trial period. Both patients and physicians authorized by them could view PEPA content online and upload or download files. Objective: This paper aims to outline findings of the posttrial qualitative study carried out to evaluate user-reported experiences, perceptions, and perspectives, focusing on their interpretation of PEPA beyond technical usability and views on a future nationwide implementation. Methods: Data were collected through semistructured guide-based interviews with 11 patients and 3 physicians (N=14). Participants were asked to share experiences, views of perceived implications, and perspectives towards nationwide implementation. Further data were generated through free-text fields in a subsequent study-specific patient questionnaire and researcher?s notes. Data were pseudonymized, audiotaped, and transcribed verbatim. Content analysis was performed through the Framework Analysis approach. All qualitative data were systemized by using MAXQDA Analytics PRO 12 (Rel.12.3.1). Additionally, participant characteristics were analyzed descriptively using IBM SPSS Statistics Version 24. Results: Users interpreted PEPA as a central medium containing digital chronological health-related documentation that simplifies information sharing across care settings. While patients consider the implementation of PEPA in Germany in the near future, physicians are more hesitant. Both groups believe in PEPA?s concept, but share awareness of concerns about data privacy and older or impaired people?s abilities to manage online records. Patients perceive benefits for involvement in treatment processes and continuity of care but worry about financing and the implementation of functionally reduced versions. Physicians consider integration into primary systems critical for interoperability but anticipate technical challenges, as well as resistance from older patients and colleagues. They omit clear positioning regarding PEPA?s potential incremental value for health care organizations or the provider-patient relationship. Conclusions: Digitalization in German health care will continue to bring change, both organizational and in the physician-patient relationship. Patients endorse and expect a nationwide PEPA implementation, anticipating various benefits. Decision makers and providers need to contribute to closing modernization gaps by committing to new concepts and by invigorating transformed roles. UR - http://formative.jmir.org/2018/2/e10411/ UR - http://dx.doi.org/10.2196/10411 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684411 ID - info:doi/10.2196/10411 ER - TY - JOUR AU - Wray, Tyler AU - Kahler, W. Christopher AU - Simpanen, M. Erik AU - Operario, Don PY - 2018/08/23 TI - Game Plan: Development of a Web App Designed to Help Men Who Have Sex With Men Reduce Their HIV Risk and Alcohol Use JO - JMIR Formativ Res SP - e10125 VL - 2 IS - 2 KW - alcohol KW - HIV risk KW - internet KW - intervention N2 - Background: Men who have sex with men (MSM) are at high risk for HIV, and alcohol use is a major risk factor for HIV infection. Internet-facilitated brief interventions have been shown to reduce alcohol use and HIV-risk behavior in other at-risk populations, but have so far incorporated limited content and have not been tested among MSM. Objective: This manuscript describes Game Plan, an interactive, tablet-optimized web application designed to help heavy drinking, high-risk MSM consider reducing their alcohol use and sexual risk behavior. In this paper, we discuss the rationale, goals, and flow for each of Game Plan?s components, which were modelled after common in-person and web-based brief motivational interventions for these behaviors. Methods: The development of Game Plan was informed by a thorough user-focused design research process that included (1) audits of existing interventions, (2) focus groups with stakeholders and (3) intended users (high-risk, heavy drinking MSM), and (4) usability testing. The aesthetic, features, and content of the app were designed iteratively throughout this process Results: The fully-functional Game Plan app provides (1) specific and personal feedback to users about their level of risk, (2) exercises to help prompt users to reflect on whether their current behavior aligns with other important life goals and values, and for those open to change, (3) exercises to help users understand factors that contribute to risk, and (4) a change planning module. In general, this flow was constructed to roughly align with the two phases described in early accounts of motivational interviewing (MI): (1) Content intended to elicit intrinsic motivation for change, and when/if sufficient motivation is present, (2) content intended to translate that motivation into specific goals and plans for change. This sequence first focuses on the user?s HIV risk behavior, followed by their alcohol use and the connection between the two. The app?s overall aesthetic (eg, branding, color palettes, icons/graphics) and its onboarding sequence was also designed to align with the ?spirit? of MI by conveying respect for autonomy, open-mindedness (ie, avoiding judgment), and empathy. Conclusions: Should future research support its efficacy in facilitating behavior change, Game Plan could represent a wide-reaching and scalable tool that is well-suited for use in settings where delivering evidence-based, in-person interventions would be difficult or cost-prohibitive. UR - http://formative.jmir.org/2018/2/e10125/ UR - http://dx.doi.org/10.2196/10125 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684415 ID - info:doi/10.2196/10125 ER - TY - JOUR AU - Healy, Nissa Genevieve AU - Eakin, G. Elizabeth AU - Winkler, AH Elisabeth AU - Hadgraft, Nyssa AU - Dunstan, W. David AU - Gilson, D. Nicholas AU - Goode, D. Ana PY - 2018/08/28 TI - Assessing the Feasibility and Pre-Post Impact Evaluation of the Beta (Test) Version of the BeUpstanding Champion Toolkit in Reducing Workplace Sitting: Pilot Study JO - JMIR Formativ Res SP - e17 VL - 2 IS - 2 KW - BeUpstanding Champion Toolkit KW - implementation KW - physical activity KW - sedentary KW - workplace sitting N2 - Background: The Web-based, evidence-informed BeUpstanding Champion Toolkit was developed to provide employers (via a ?train-the-champion approach?) with resources and support to help in reducing prolonged sitting in their own desk-based workplace. As part of a five-phase research-to-dissemination process, this study reports on the evaluation of the beta (test) version of this toolkit (Phase 2). Objective: The objective of our study was to evaluate (1) the implementation of the toolkit by workplace champions and (2) the impact of the toolkit on sitting (primary outcome), standing, and moving; use of activity-promoting strategies; knowledge and attitudes; and indicators of health and work performance. Methods: An implementation study using a pre-post design was conducted in 7 desk-based workplaces in Australia (September 2015 to May 2016), with work teams (one per workplace) purposively recruited to ensure representation across a range of sectors (white- or blue-collar), organizational sizes (small or medium or large), and locations (metropolitan or regional). All staff within participating teams were invited to participate in the relevant toolkit activities. Implementation outcomes (time commitment required by champions and toolkit activities completed) were collected from each champion via telephone interviews. Changes in impact outcomes, measured via a Web-based questionnaire completed by employees at baseline and 3 months postimplementation, were assessed using mixed models, correcting for clustering. Results: Champions reported a 30-60 minutes per week time commitment to the toolkit activities. All teams formed a wellbeing committee and sent the staff surveys at both time points; most champions held a staff consultation workshop (6/7), identified team-level strategies within that workshop (5/7), used the communication resources provided within the toolkit (emails, posters; 6/7), and completed the action plan (5/7). In total, 52% (315 of ?600) employees participated in at least one survey and 97 (16%) participated in both. At follow-up, there was a significant (P<.05) reduction in self-reported workplace sitting time compared to baseline (?6.3%, 95% CI ?10.1 to ?2.5; n=85) equating to ?30 minutes per workday. Significant benefits were also observed for the use of activity-promoting strategies, with small, nonsignificant changes observed for knowledge and attitudes and indicators of health and work performance. Conclusions: The beta version of the BeUpstanding Champion Toolkit was feasible to implement and effective in reducing self-reported workplace sitting across a broad range of desk-based workplaces. The next phase (Phase 3) will build on these findings to optimize the toolkit for wider-scale implementation and longer term evaluation. UR - http://formative.jmir.org/2018/2/e17/ UR - http://dx.doi.org/10.2196/formative.9343 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684420 ID - info:doi/10.2196/formative.9343 ER - TY - JOUR AU - McKelvey, Karma AU - Ramo, Danielle PY - 2018/09/04 TI - Conversation Within a Facebook Smoking Cessation Intervention Trial For Young Adults (Tobacco Status Project): Qualitative Analysis JO - JMIR Formativ Res SP - e11138 VL - 2 IS - 2 KW - Facebook KW - intervention KW - qualitative analysis KW - smoking cessation KW - social media KW - young adults N2 - Background: Smoking cessation interventions delivered through social media have the potential to engage young people in behavior change. Objective: The aim of this study was to describe participant-posted messages in a Facebook smoking cessation intervention for young adults to discern support for behavior change. Methods: We qualitatively analyzed data from the treatment arm of a randomized trial testing the efficacy of the Tobacco Status Project Facebook intervention. Young adults (N=138) aged 18-25 years (female: 81/138, 58.7%; white: 101/138, 73.2%; mean age 21 years) were recruited using Facebook and placed into one of the 15 secret Facebook groups based on readiness-to-quit smoking. Messages posted to groups for 90 consecutive days were tailored to readiness-to-quit: Not Ready (46/138, 33.3%), Thinking (66/138, 47.8%), and Getting Ready (26/138, 18.8%). Groups were randomized to receive up to US $90 for posting or no incentive. Two independent coders conducted open coding of user posts. We considered content by readiness-to-quit group and incentive condition. Results: There were 4 dominant themes across all groups: coping skills, friends and family, motivation to quit, and benefits of quitting. The dominant themes in Not Ready groups were friends and family (incentive) and motivation to quit (no incentive), whereas coping skills was the dominant theme in Thinking and Getting Ready groups. The expression of themes varied by readiness-to-quit group but not by incentive condition. Conclusions: Intervention messages tailored to readiness-to-quit appear useful in eliciting the desired responses from young adult smokers, with limited influence by monetary incentive. Trial Registration: ClinicalTrials.gov NCT02207036; https://clinicaltrials.gov/ct2/show/NCT02207036 (Archived by WebCite at http://www.webcitation.org/722XAEAAz) UR - http://formative.jmir.org/2018/2/e11138/ UR - http://dx.doi.org/10.2196/11138 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684432 ID - info:doi/10.2196/11138 ER - TY - JOUR AU - Børøsund, Elin AU - Mirkovic, Jelena AU - Clark, M. Matthew AU - Ehlers, L. Shawna AU - Andrykowski, A. Michael AU - Bergland, Anne AU - Westeng, Marianne AU - Solberg Nes, Lise PY - 2018/09/06 TI - A Stress Management App Intervention for Cancer Survivors: Design, Development, and Usability Testing JO - JMIR Formativ Res SP - e19 VL - 2 IS - 2 KW - stress management KW - mindfulness KW - cancer KW - eHealth KW - mHealth KW - mobile apps KW - development KW - usability KW - user-centered design KW - mobile phones N2 - Background: Distress is prevalent in cancer survivors. Stress management interventions can reduce distress and improve quality of life for cancer patients, but many people with cancer are unfortunately not offered or able to attend such in-person stress management interventions. Objective: The objective of this study was to develop an evidence-based stress management intervention for patients living with cancer that can be delivered electronically with wide reach and dissemination. This paper describes the design and development process of a technology-based stress management intervention for cancer survivors, including the exploration phase, intervention content development, iterative software development (including design, development, and formative evaluation of low- and high-level prototypes), and security and privacy considerations. Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=48). In the exploration phase, identifying needs and requirements for the intervention, 28 participants gave input, including male and female cancer survivors (n=11) representing a wide age range (31-81 years) and cancer diagnoses, healthcare providers (n=8) including psychosocial oncology experts, and eHealth experts (n=9) including information technology design and developers. To ensure user involvement in each phase various user-centered design and service design methods were included, such as interviews, usability testing, and think aloud processes. Overall, participants were involved usability testing in the software development and formative evaluation phase, including cancer survivors (n=6), healthy volunteers (n=7), health care providers (n=2), and eHealth experts (n=5). Intervention content was developed by stress management experts based on well-known cognitive behavioral stress management strategies and adjusted to electronic format through multiple iterations with stakeholders. Privacy and security issues were considered throughout. Results: The design and development process identified a variety of stakeholder requirements. Cancer survivors preferred stress management through a mobile app rather than through a personal computer (PC) and identified usefulness, easy access, user friendliness, use of easily understandable language, and many brief sections rather than longer ones as important components of the intervention. These requirements were also supported by recommendations from health care providers and eHealth experts. The final intervention was named StressProffen and the hospital Privacy and Security Protection Committee was part of the final intervention approval to also ensure anchoring in the hospital organization. Conclusions: Interventions, even evidence-based, have little impact if not actively used. This study illustrates how user-centered design and service design can be applied to identify and incorporate essential stakeholder aspects in the entire design and development process. In combination with evidence-based concepts, this process facilitated development of a stress management intervention truly designed for the end users, in this case, cancer survivors. Trial Registration: ClinicalTrials.gov NCT02939612; https://clinicaltrials.gov/ct2/show/NCT02939612 (Archived at WebCite at http://www.webcitation.org/71l9HcfcB) UR - http://formative.jmir.org/2018/2/e19/ UR - http://dx.doi.org/10.2196/formative.9954 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684438 ID - info:doi/10.2196/formative.9954 ER - TY - JOUR AU - Silfee, J. Valerie AU - Lopez-Cepero, Andrea AU - Lemon, C. Stephenie AU - Estabrook, Barbara AU - Nguyen, Oanh AU - Wang, L. Monica AU - Rosal, C. Milagros PY - 2018/09/10 TI - Adapting a Behavioral Weight Loss Intervention for Delivery via Facebook: A Pilot Series Among Low-Income Postpartum Women JO - JMIR Formativ Res SP - e18 VL - 2 IS - 2 KW - Facebook KW - health disparities KW - postpartum women KW - social media KW - weight loss N2 - Background: Efforts to translate evidence-based weight loss interventions, such as the Diabetes Prevention Program (DPP), to low-income postpartum women have resulted in poor intervention attendance and high attrition. Strategies that improve engagement and retention in this population are needed to maximize the reach of evidence-based weight loss interventions. Objective: The objective of this study was to adapt a DPP-based weight loss intervention (Fresh Start) for Facebook delivery and to evaluate its feasibility among low-income postpartum women. Methods: This study comprised 3 single-group pilot studies where feasibility outcomes iteratively informed changes from one pilot to the next. We paralleled the in-person program for Facebook delivery by translating the protocol to a content library of Facebook posts with additional posts from lifestyle coaches. Low-income postpartum women were recruited from Women, Infants, and Children (WIC) clinics in Worcester, Massachusetts. Participants were enrolled into a 16-week weight loss intervention delivered via Facebook. During the first 8 weeks, Facebook intervention posts were delivered 2 times per day, with additional posts from coaches aiming to stimulate interaction among participants or respond to participants? questions and challenges. For the following 8 weeks, posts were delivered once per day without additional coaching. Feasibility outcomes were engagement (defined by number of likes, comments, and posts measured throughout intervention delivery), acceptability, and retention (survey at follow-up and assessment completion rate, respectively). Changes in weight were also assessed at baseline and follow-up. Results: Pilot 1 had a retention rate of 89% (24/27), and on average, 62% (17/27) of women actively engaged with the group each week during the 8-week coached phase. Mean weight loss was 2.6 (SD 8.64) pounds, and 79% (19/27) would recommend the program to a friend. Pilot 2 had a retention rate of 83% (20/24), and on average, 55% (13/24) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 2.5 (SD 9.23) pounds, and 80% (16/24) would recommend the program to a friend. Pilot 3 had a retention rate of 88% (14/16), and on average, 67% (11/16) of women actively engaged with the group weekly during the 8-week coached phase. Mean weight loss was 7.0 (SD 11.6) pounds, and 100% (16/16) would recommend the program to a friend. Conclusions: Our findings demonstrated that a Facebook-delivered intervention was acceptable and could be feasibly delivered to low-income postpartum women. Future research is needed to evaluate the efficacy of a Facebook-delivered weight loss intervention. UR - http://formative.jmir.org/2018/2/e18/ UR - http://dx.doi.org/10.2196/formative.9597 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684423 ID - info:doi/10.2196/formative.9597 ER - TY - JOUR AU - Lopez, N. Keila AU - O'Connor, Michael AU - King, Jason AU - Alexander, James AU - Challman, Melissa AU - Lovick, K. Donna AU - Goodly, Nicole AU - Smith, Amelia AU - Fawcett, Elliott AU - Mulligan, Courtney AU - Thompson, Debbe AU - Fordis, Michael PY - 2018/09/11 TI - Improving Transitions of Care for Young Adults With Congenital Heart Disease: Mobile App Development Using Formative Research JO - JMIR Formativ Res SP - e16 VL - 2 IS - 2 KW - adolescent health KW - chronic disease KW - transitions of care KW - health disparities KW - mobile health KW - mHealth KW - patient empowerment KW - patient involvement KW - self-efficacy KW - user-centered design N2 - Background: Congenital heart diseases (CHDs) are the most common type of birth defects. Improvements in CHD care have led to approximately 1.4 million survivors reaching adulthood. Successful transition and transfer from pediatric to adult care is crucial. Unfortunately, less than 30% of adolescents with CHD successfully transition to adult care; this number is lower for minority and lower socioeconomic status populations. Few CHD programs exist to facilitate successful transition. Objective: The goal of our study was to describe the formative research used to develop a prototype mobile app to facilitate transition to adult care for adolescents with CHD. Methods: A literature search about best practices in transition medicine for CHD was conducted to inform app development. Formative research with a diverse group of CHD adolescents and their parents was conducted to determine gaps and needs for CHD transition to adult care. As part of the interview, surveys assessing transition readiness and CHD knowledge were completed. Two adolescent CHD expert panels were convened to inform educational content and app design. Results: The literature review revealed 113 articles, of which 38 were studies on transition programs and attitudes and 3 identified best practices in transition specific to CHD. A total of 402 adolescents aged 15 to 22 years (median 16 years) participated in semistructured interviews. The group was racially and ethnically diverse (12.6% [51/402] African American and 37.8% [152/402] Latino) and 42.0% (169/402) female; 36.3% (146/402) received public insurance. Most adolescents (313/402, 76.7%) had moderate or severe CHD complexity and reported minimal CHD understanding (79.0% [275/348] of those aged 15 to 17 years and 61.1% [33/54] of those aged 18 to 22 years). Average initial transition readiness score was 50.9/100, meaning that transition readiness training was recommended. When participants with moderate to severe CHD (313/402, 77.9%) were asked about technology use, 94.2% (295/313) reported having access to a mobile phone. Interviews with parents revealed limited interactions with the pediatric cardiologist about transition-related topics: 79.4% (331/417) reported no discussions regarding future family planning, and 55.2% (230/417) reported the adolescent had not been screened for mental health concerns (depression, anxiety). Further, 66.4% (277/417) reported not understanding how health care changes as adolescents become adults. Adolescents in the expert panels (2 groups of 3 adolescents each) expressed interest in a CHD-specific tailored app consisting of quick access to specific educational questions (eg, ?Can I exercise??), a CHD story-blog forum, a mentorship platform, a question and answer space, and a checklist to facilitate transition. They expressed interest in using the app to schedule CHD clinic appointments and receive medication reminders. Based on this data, a prototype mobile app was created to assist in adolescent CHD transition. Conclusions: Formative research revealed that most adolescents with CHD had access to mobile phones, were not prepared for transition to adult care, and were interested in an app to facilitate transition to adult CHD care. Understanding adolescent and parent needs, interests, and concerns helped in the development of a mobile app with a broader, tailored approach for adolescents with CHD. UR - http://formative.jmir.org/2018/2/e16/ UR - http://dx.doi.org/10.2196/formative.9963 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/formative.9963 ER - TY - JOUR AU - Roberts, Courtney AU - Sage, Adam AU - Geryk, Lorie AU - Sleath, Betsy AU - Carpenter, Delesha PY - 2018/09/13 TI - Adolescent Preferences and Design Recommendations for an Asthma Self-Management App: Mixed-Methods Study JO - JMIR Formativ Res SP - e10055 VL - 2 IS - 2 KW - asthma KW - mHealth KW - mobile app KW - patient engagement KW - self-management KW - usability N2 - Background: Approximately 10% of adolescents in the United States have asthma. Adolescents widely use apps on mobile phones and tablet technology for social networking and gaming purposes. Given the increase in recreational app use among adolescents, leveraging apps to support adolescent asthma disease management seems warranted. However, little empirical research has influenced asthma app development; adolescent users are seldom involved in the app design process. Objective: The aim of this mixed-methods study was to assess adolescent preferences and design recommendations for an asthma self-management app. Methods: A total of 20 adolescents with persistent asthma (aged 12-16 years) provided feedback on two asthma self-management apps during in-person semistructured interviews following their regularly scheduled asthma clinic visit and via telephone 1 week later. Interviews were audiorecorded, transcribed verbatim, analyzed using SPSS v24, and coded thematically using MAXQDA 11. Results: Regarding esthetics, app layout and perceived visual simplicity were important to facilitate initial app use. Adolescents were more likely to continually engage with apps that were deemed useful and met their informational needs. Adolescents also desired app features that fit within their existing paradigm or schema and included familiar components (eg, medication alerts that appear and sound like FaceTime notifications and games modeled after Quiz Up and Minecraft), as well as the ability to customize app components. They also suggested that apps include other features, such as an air quality tracker and voice command. Conclusions: Adolescents desire specific app characteristics including customization and tailoring to meet their asthma informational needs. Involving adolescents in early stages of app development is likely to result in an asthma app that meets their self-management needs and design preferences and ultimately the adoption and maintenance of positive asthma self-management behaviors. UR - http://formative.jmir.org/2018/2/e10055/ UR - http://dx.doi.org/10.2196/10055 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684424 ID - info:doi/10.2196/10055 ER - TY - JOUR AU - Liang, Li AU - Wiens, O. Matthew AU - Lubega, Phaisal AU - Spillman, Ian AU - Mugisha, Samuel PY - 2018/9/24 TI - A Locally Developed Electronic Health Platform in Uganda: Development and Implementation of Stre@mline JO - JMIR Formativ Res SP - e20 VL - 2 IS - 2 KW - electronic health record KW - locally developed technology KW - appropriate technology KW - eHealth in low-resource settings N2 - Background: Electronic health records (EHRs) are especially important in low-resource settings due to their potential to address unique challenges such as a high number of patients requiring long-term treatments who are lost to follow-up, the frequent shortages of essential drugs, poor maintenance and storage of records, and inefficient clinical triaging. However, there is a lack of affordable and practical EHR solutions. Stre@mline is an EHR platform that has been locally developed by Ugandan clinicians and engineers in Southwestern Uganda. It is tailored to the specific context and needs of low-resource hospitals. It operates without internet access, incorporates locally relevant standards and key patient safety features, has a medication inventory management component, has local technical support available, and is economically sustainable without funding from international donors. Stre@mline is currently used by over 60,000 patients at 2 hospitals, with plans to expand across Uganda. Objective: The purpose of this article is to describe the key opportunities and challenges in EHR development in sub-Saharan Africa and to summarize the development and implementation of a ?Made-for-Africa? EHR, Stre@mline, and how it has led to improved care for over 60,000 vulnerable patients in a rural region of Southwestern Uganda. Methods: A quantitative user survey consisting of a set of 33 questions on usability and performance was conducted at Kisiizi Hospital. Users responded to each question through a Likert scale with the values of strongly disagree, disagree, agree, and strongly agree. Through purposive sampling, 30 users were identified and 28 users completed the survey. Results: We found that users were generally very satisfied with the ease of use of Stre@mline, with 96% (27/28) finding it easy to learn and 100% (28/28) finding it easy to use. Users found that Stre@mline was helpful in improving both clinical efficiency and enhancing patient care. Conclusions: The partnership of local clinicians and developers is crucial to the design and adoption of user-centered technologies tailored to the specific needs of low-resource settings. The EHR described here could serve as a model for the development of future technologies suitable for developing countries. UR - http://formative.jmir.org/2018/2/e20/ UR - http://dx.doi.org/10.2196/formative.9658 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684419 ID - info:doi/10.2196/formative.9658 ER - TY - JOUR AU - Jungmann, Manuela AU - Vencatachellum, Shervin AU - Van Ryckeghem, Dimitri AU - Vögele, Claus PY - 2018/10/09 TI - Effects of Cold Stimulation on Cardiac-Vagal Activation in Healthy Participants: Randomized Controlled Trial JO - JMIR Formativ Res SP - e10257 VL - 2 IS - 2 KW - cold stimulation KW - heart rate reduction KW - lateral neck region KW - diving reflex KW - stress reduction KW - wearable electronic devices KW - thermode-based stimulation KW - acute stress KW - technology for stress relief KW - vagus nerve stimulation KW - psychological stress N2 - Background: The experience of psychological stress has not yet been adequately tackled with digital technology by catering to healthy individuals who wish to reduce their acute stress levels. For the design of digitally mediated solutions, physiological mechanisms need to be investigated that have the potential to induce relaxation with the help of technology. Research has shown that physiological mechanisms embodied in the face and neck regions are effective for diminishing stress-related symptoms. Our study expands on these areas with the design for a wearable in mind. As this study charts new territory in research, it also is a first evaluation of the viability for a wearables concept to reduce stress. Objective: The objectives of this study were to assess whether (1) heart rate variability would increase and (2) heart rate would decrease during cold stimulation using a thermode device compared with a (nonstimulated) control condition. We expected effects in particular in the neck and cheek regions and less in the forearm area. Methods: The study was a fully randomized, within-participant design. Volunteer participants were seated in a laboratory chair and tested with cold stimulation on the right side of the body. A thermode was placed on the neck, cheek, and forearm. We recorded and subsequently analyzed participants? electrocardiogram. The cold stimulation was applied in 16-second intervals over 4 trials per testing location. The control condition proceeded exactly like the cold condition, except we manipulated the temperature variable to remain at the baseline temperature. We measured heart rate as interbeat intervals in milliseconds and analyzed root mean square of successive differences to index heart rate variability. We analyzed data using a repeated-measures ANOVA (analysis of variance) approach with 2 repeated-measures factors: body location (neck, cheek, forearm) and condition (cold, control). Results: Data analysis of 61 participants (after exclusion of outliers) showed a main effect and an interaction effect for body location and for condition, for both heart rate and heart rate variability. The results demonstrate a pattern of cardiovascular reactivity to cold stimulation, suggesting an increase in cardiac-vagal activation. The effect was significant for cold stimulation in the lateral neck area. Conclusions: The results confirmed our main hypothesis that cold stimulation at the lateral neck region would result in higher heart rate variability and lower heart rate than in the control condition. This sets the stage for further investigations of stress reduction potential in the neck region by developing a wearable prototype that can be used for cold application. Future studies should include a stress condition, test for a range of temperatures and durations, and collect self-report data on perceived stress levels to advance findings. UR - http://formative.jmir.org/2018/2/e10257/ UR - http://dx.doi.org/10.2196/10257 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684416 ID - info:doi/10.2196/10257 ER - TY - JOUR AU - Balls-Berry, Joyce AU - Sinicrope, Pamela AU - Valdez Soto, Miguel AU - Brockman, Tabetha AU - Bock, Martha AU - Patten, Christi PY - 2018/10/24 TI - Linking Podcasts With Social Media to Promote Community Health and Medical Research: Feasibility Study JO - JMIR Formativ Res SP - e10025 VL - 2 IS - 2 KW - biomedical research KW - community health KW - community and patient engagement in research KW - podcast KW - social media N2 - Background: Linking podcasts with social media is a strategy to promote and disseminate health and health research information to the community without constraints of time, weather, and geography. Objective: To describe the process of creating a podcast library and promoting it on social media as a strategy for disseminating health and biomedical research topics to the community. Methods: We used a community and patient engagement in research approach for developing a process to use podcasts for dissemination of health and health research information. We have reported the aspects of audience reach, impressions, and engagement on social media through the number of downloads, shares, and reactions posted on SoundCloud, Twitter, and Facebook, among others. Results: In collaboration with our local community partner, we produced 45 podcasts focused on topics selected from a community health needs assessment with input from health researchers. Episodes lasted about 22 minutes and presented health-related projects, community events, and community resources, with most featured guests from Olmsted County (24/45, 53%). Health research was the most frequently discussed topic. Between February 2016 and June 2017, episodes were played 1843 times on SoundCloud and reached 1702 users on our Facebook page. Conclusions: This study demonstrated the process and feasibility of creating a content library of podcasts for disseminating health- and research-related information. Further examination is needed to determine the best methods to develop a sustainable social media plan that will further enhance dissemination (audience reach), knowledge acquisition, and communication of health topics. UR - http://formative.jmir.org/2018/2/e10025/ UR - http://dx.doi.org/10.2196/10025 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684430 ID - info:doi/10.2196/10025 ER - TY - JOUR AU - Verdaguer, Sandra AU - Mateo, F. Katrina AU - Wyka, Katarzyna AU - Dennis-Tiwary, A. Tracy AU - Leung, May May PY - 2018/11/01 TI - A Web-Based Interactive Tool to Reduce Childhood Obesity Risk in Urban Minority Youth: Usability Testing Study JO - JMIR Formativ Res SP - e21 VL - 2 IS - 2 KW - usability testing KW - interactive technology KW - mHealth, childhood obesity KW - minority KW - health nutrition KW - health education N2 - Background: Childhood obesity is a serious public health issue among minority youth in the United States. Technology-enhanced approaches can be effective for promoting healthy behavior change. Objective: The purpose of this study was to test the usability of prototypes of a Web-based interactive tool promoting healthy dietary behaviors to reduce childhood obesity risk in urban minority youth. The Web-based tool comprised a manga-style comic with interactive features (eg, sound effects, clickable pop-ups), tailored messaging, and goal setting, and was optimized for use on tablet devices. Methods: Latino and black/African American children ages 9 to 13 years were recruited to participate in two rounds of usability testing. A modified think-aloud method was utilized. Self-reported surveys and field notes were collected. Audio recordings and field notes from usability testing sessions were systematically reviewed by extracting and coding user feedback as either positive comments or usability or negative issues. The quantitative data from self-reported questionnaires were analyzed using descriptive statistics. Results: Twelve children (four female; eight black/African American) with a mean age of 10.92 (SD 1.16) years participated. Testing highlighted overall positive experiences with the Web-based interactive tool, especially related to storyline, sound effects, and color schemes. Specific usability issues were classified into six themes: appearance, content, special effects, storyline, terminology, and navigation. Changes to the Web-based tool after round 1 included adding a navigation guide, making clickable icons more visible, improving graphic designs, and fixing programming errors. In round 2 of testing (after modifications to the Web-based tool were incorporated), many of the usability issues that were identified in round 1 did not emerge. Conclusions: Results of testing will inform further development and finalization of the tool, which will be tested using a two-group pilot randomized study, with the goal of reducing childhood obesity risk in minority, low-income youth. UR - http://formative.jmir.org/2018/2/e21/ UR - http://dx.doi.org/10.2196/formative.9747 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684417 ID - info:doi/10.2196/formative.9747 ER - TY - JOUR AU - Elsbernd, Abbey AU - Hjerming, Maiken AU - Visler, Camilla AU - Hjalgrim, Lyngsie Lisa AU - Niemann, Utoft Carsten AU - Boisen, Arntz Kirsten AU - Jakobsen, Jens AU - Pappot, Helle PY - 2018/11/01 TI - Using Cocreation in the Process of Designing a Smartphone App for Adolescents and Young Adults With Cancer: Prototype Development Study JO - JMIR Formativ Res SP - e23 VL - 2 IS - 2 KW - adolescent and young adult KW - cancer KW - cocreation KW - mHealth KW - oncology N2 - Background: Adolescent and young adult (AYA) oncology and hematology is a developing field of medicine, focusing on a population that faces many challenges throughout medical treatment and beyond. Mobile health (mHealth) interventions provide exciting new opportunities for improvement of health-related quality of life (HRQoL) in AYAs with cancer. Many smartphone apps are currently available for AYAs with cancer; however, for AYAs with cancer, very few apps have been designed with direct input from AYAs themselves or have demonstrated their effectiveness and benefit. Objective: The objective of this project was to develop the prototype of a smartphone app for AYAs with cancer through the process of cocreation, with the active input of AYAs who have received treatment for cancer directly impacting content and design. Methods: Patients were recruited from a population of Danish AYAs who had received treatment for cancer between the ages of 15 and 29 years. The cocreation process was completed over the course of 3 workshops and intermittent ad hoc meetings, where the recruited AYAs worked in coordination with 1 nurse, 1 doctor, and 2 representatives from a digital agency and app developer. During each workshop, participants prioritized their goals for the app. After new app content was developed, feedback was requested from the participants, and changes were made accordingly. This iterative process continued until consensus on final product features and design were achieved. Health care professionals provided minimal input and primarily performed observational roles in the workshops, with direct interaction limited to introducing the project and explaining measurement features of the app in development. Results: Three key features to be included in the prototype app were identified from the cocreation workshops: (1) a community forum; (2) an information library; and (3) a symptom and side-effect tracking tool. Bright, warm colors were selected for the app by the participating AYAs. The final prototype will be launched for pilot testing and implementation testing in February of 2018. Conclusions: The process of cocreation is a user-involved process that can create an end product that is useful and customized for the target population. This process, as such, is a beneficial process to utilize when addressing the specific needs of AYAs with cancer. The results of the here described app prototype will be evaluated in more detail in the near future. However, this description of the cocreation process in app development can be utilized for the creation of other mHealth interventions. UR - http://formative.jmir.org/2018/2/e23/ UR - http://dx.doi.org/10.2196/formative.9842 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684439 ID - info:doi/10.2196/formative.9842 ER - TY - JOUR AU - Comulada, Scott W. AU - Swendeman, Dallas AU - Rezai, Roxana AU - Ramanathan, Nithya PY - 2018/11/05 TI - Time Series Visualizations of Mobile Phone-Based Daily Diary Reports of Stress, Physical Activity, and Diet Quality in Mostly Ethnic Minority Mothers: Feasibility Study JO - JMIR Formativ Res SP - e11062 VL - 2 IS - 2 KW - changepoint KW - diet quality KW - mobile phone KW - moving average KW - physical activity KW - stress KW - time series N2 - Background: Health behavior patterns reported through daily diary data are important to understand and intervene upon at the individual level in N-of-1 trials and related study designs. There is often interest in relationships between multiple outcomes, such as stress and health behavior. However, analyses often utilize regressions that evaluate aggregate effects across individuals, and standard analyses target single outcomes. Objective: This paper aims to illustrate how individuals? daily reports of stress and health behavior (time series) can be explored using visualization tools. Methods: Secondary analysis was conducted on 6 months of daily diary reports of stress and health behavior (physical activity and diet quality) from mostly ethnic minority mothers who pilot-tested a self-monitoring mobile health app. Time series with minimal missing data from 14 of the 44 mothers were analyzed. Correlations between stress and health behavior within each time series were reported as a preliminary step. Stress and health behavior time series patterns were visualized by plotting moving averages and time points where mean shifts in the data occurred (changepoints). Results: Median correlation was small and negative for associations of stress with physical activity (r=?.14) and diet quality (r=?.08). Moving averages and changepoints for stress and health behavior were aligned for some participants but not for others. A third subset of participants exhibited little variation in stress and health behavior reports. Conclusions: Median correlations in this study corroborate prior findings. In addition, time series visualizations highlighted variations in stress and health behavior across individuals and time points, which are difficult to capture through correlations and regression-based summary measures. UR - https://formative.jmir.org/2018/2/e11062/ UR - http://dx.doi.org/10.2196/11062 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684407 ID - info:doi/10.2196/11062 ER - TY - JOUR AU - Kim, H. Rebecca AU - Patel, S. Mitesh PY - 2018/11/06 TI - Barriers and Opportunities for Using Wearable Devices to Increase Physical Activity Among Veterans: Pilot Study JO - JMIR Formativ Res SP - e10945 VL - 2 IS - 2 KW - veterans KW - wearable devices KW - connected health device KW - physical activity KW - mobile phone N2 - Background: Few studies have examined the use of wearable devices among the veteran population. Objective: The objective of this study was to evaluate veterans? perceptions of and experiences with wearable devices and identify the potential barriers and opportunities to using such devices to increase physical activity levels in this population. Methods: Veterans able to ambulate with or without assistance completed surveys about their mobile technology use and physical activity levels. They were then given the option of using a wearable device to monitor their activity levels. Follow-up telephone interviews were conducted after 2 months. Results: A total of 16 veterans were enrolled in this study, and all of them agreed to take home and use the wearable device to monitor their activity levels. At follow-up, 91% (10/11) veterans were still using the device daily. Veterans identified both opportunities and barriers for incorporating these devices into interventions to increase physical activity. Conclusions: Veterans engaged in using wearable devices at high rates. UR - http://formative.jmir.org/2018/2/e10945/ UR - http://dx.doi.org/10.2196/10945 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684414 ID - info:doi/10.2196/10945 ER - TY - JOUR AU - Lo, L. Louisa AU - Collins, M. Ian AU - Bressel, Mathias AU - Butow, Phyllis AU - Emery, Jon AU - Keogh, Louise AU - Weideman, Prue AU - Steel, Emma AU - Hopper, L. John AU - Trainer, H. Alison AU - Mann, B. Gregory AU - Bickerstaffe, Adrian AU - Antoniou, C. Antonis AU - Cuzick, Jack AU - Phillips, Kelly-Anne PY - 2018/11/07 TI - The iPrevent Online Breast Cancer Risk Assessment and Risk Management Tool: Usability and Acceptability Testing JO - JMIR Formativ Res SP - e24 VL - 2 IS - 2 KW - clinical decision support KW - breast cancer KW - BRCA1 gene KW - BRCA2 gene KW - risk KW - preventive health KW - screening N2 - Background: iPrevent estimates breast cancer (BC) risk and provides tailored risk management information. Objective: The objective of this study was to assess the usability and acceptability of the iPrevent prototype. Methods: Clinicians were eligible for participation in the study if they worked in primary care, breast surgery, or genetics clinics. Female patients aged 18-70 years with no personal cancer history were eligible. Clinicians were first familiarized with iPrevent using hypothetical paper-based cases and then actor scenarios; subsequently, they used iPrevent with their patients. Clinicians and patients completed the System Usability Scale (SUS) and an Acceptability questionnaire 2 weeks after using iPrevent; patients also completed measures of BC worry, anxiety, risk perception, and knowledge pre- and 2 weeks post-iPrevent. Data were summarized using descriptive statistics. Results: The SUS and Acceptability questionnaires were completed by 19 of 20 clinicians and 37 of 43 patients. Usability was above average (SUS score >68) for 68% (13/19) clinicians and 76% (28/37) patients. The amount of information provided by iPrevent was reported as ?about right? by 89% (17/19) clinicians and 89% (33/37) patients and 95% (18/19) and 97% (36/37), respectively, would recommend iPrevent to others, although 53% (10/19) clinicians and 27% (10/37) patients found it too long. Exploratory analyses suggested that iPrevent could improve risk perception, decrease frequency of BC worry, and enhance BC prevention knowledge without changing state anxiety. Conclusions: The iPrevent prototype demonstrated good usability and acceptability. Because concerns about length could be an implementation barrier, data entry has been abbreviated in the publicly available version of iPrevent. UR - http://formative.jmir.org/2018/2/e24/ UR - http://dx.doi.org/10.2196/formative.9935 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684421 ID - info:doi/10.2196/formative.9935 ER - TY - JOUR AU - Metting, Esther AU - Schrage, Jantine Aaltje AU - Kocks, WH Janwillem AU - Sanderman, Robbert AU - van der Molen, Thys PY - 2018/11/22 TI - Assessing the Needs and Perspectives of Patients With Asthma and Chronic Obstructive Pulmonary Disease on Patient Web Portals: Focus Group Study JO - JMIR Formativ Res SP - e22 VL - 2 IS - 2 KW - asthma KW - chronic obstructive pulmonary disease KW - health care KW - health literacy KW - internet KW - electronic medical record KW - self-management N2 - Background: As accessibility to the internet has increased in society, many health care organizations have developed patient Web portals (PWPs), which can provide a range of self-management options to improve patient access. However, the available evidence suggests that they are used inefficiently and do not benefit patients with low health literacy. Asthma and chronic obstructive pulmonary disease (COPD) are common chronic diseases that require ongoing self-management. Moreover, patients with COPD are typically older and have lower health literacy. Objective: This study aimed to obtain and present an overview of patients? perspectives of PWPs to facilitate the development of a portal that better meets the needs of patients with asthma and COPD. Methods: We performed a focus group study using semistructured interviews in 3 patient groups from the north of the Netherlands who were recruited through the Dutch Lung Foundation. Each group met 3 times for 2 hours each at a 1-week interval. Data were analyzed with coding software, and patient descriptors were analyzed with nonparametric tests. The consolidated criteria for reporting qualitative research were followed when conducting the study. Results: We included 29 patients (16/29, 55% male; mean age 65 [SD 10] years) with COPD (n=14), asthma-COPD overlap (n=4), asthma (n=10), or other respiratory disease (n=1). There was a large variation in the internet experience; some patients hardly used the internet (4/29, 14%), whereas others used internet >3 times a week (23/29, 79%). In general, patients were positive about having access to a PWP, considering access to personal medical records as the most important option, though only after discussion with their physician. A medication overview was considered a useful option. We found that communication between health care professionals could be improved if patients could use the PWP to share information with their health care professionals. However, as participants were worried about the language and usability of portals, it was recommended that language should be adapted to the patient level. Another concern was that disease monitoring through Web-based questionnaire use would only be useful if the results were discussed with health care professionals. Conclusions: Participants were positive about PWPs and considered them a logical step. Today, most patients tend to be better educated and have internet access, while also being more assertive and better informed about their disease. A PWP could support these patients. Our participants also provided practical suggestions for implementation in current and future PWP developments. The next step will be to develop a portal based on these recommendations and assess whether it meets the needs of patients and health care providers. UR - http://formative.jmir.org/2018/2/e22/ UR - http://dx.doi.org/10.2196/formative.8822 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684436 ID - info:doi/10.2196/formative.8822 ER - TY - JOUR AU - Warren, Ian AU - Meads, Andrew AU - Whittaker, Robyn AU - Dobson, Rosie AU - Ameratunga, Shanthi PY - 2018/11/26 TI - Behavior Change for Youth Drivers: Design and Development of a Smartphone-Based App (BackPocketDriver) JO - JMIR Formativ Res SP - e25 VL - 2 IS - 2 KW - smartphone KW - public health KW - telemedicine KW - telemetry N2 - Background: The over-representation of youth in road crash injury and fatality rates is a major public health issue globally. In New Zealand, youth drivers are most vulnerable in the restricted license period when they can drive without the requirement for supervision by an experienced adult. Behavioral change interventions delivered using mobile phone technology to young drivers could serve as a useful mechanism to develop safe driving skills, but this potential remains to be fully explored. Objective: This study aimed to apply behavioral change principles to design and develop a smartphone-based intervention with the aim of helping youth drivers to develop and hone safe driving skills. Methods: An iterative process was used to support development of the smartphone intervention. We reviewed behavioral change literature, identifying fundamental principles and exploring use of behavior change techniques (BCTs) in other areas of public health. We engaged with key stakeholders, including young drivers, government agencies, and relevant organizations. We also took into account technology adoption considerations when designing the app. Results: We developed BackPocketDriver (BPD), an Android smartphone app that uses in-built sensors to monitor and infer driver behavior. The app implements features that were identified during the design process and are traceable to BCTs and theory. A key feature is messaging, which is used to instruct, motivate, educate, and relay feedback to participants. In addition, messaging addresses attitudes and beliefs. Other features include journey feedback summaries, goal setting, achievements, and leaderboards. Conclusions: BPD?s design rests on a sound foundation of theory and evidence. With explicit links between theory and features, the app aims to be an effective intervention to change and improve youth driver behavior. The next phase of this study is to run a small pilot study to assess BPD?s effectiveness. UR - http://formative.jmir.org/2018/2/e25/ UR - http://dx.doi.org/10.2196/formative.9660 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684435 ID - info:doi/10.2196/formative.9660 ER - TY - JOUR AU - Allen, M. Alicia AU - Lundeen, Kim AU - Murphy, E. Sharon AU - Spector, Logan AU - Harlow, L. Bernard PY - 2018/11/05 TI - Web-Delivered Multimedia Training Materials for the Self-Collection of Dried Blood Spots: A Formative Project JO - JMIR Formativ Res SP - e11025 VL - 2 IS - 2 KW - dried blood spot KW - internet KW - feasibility studies N2 - Background: The use of dried blood spots (DBS) in biomedical research has been increasing as an objective measure for variables that are typically plagued by self-report, such as smoking status and medication adherence. The development of training materials for the self-collection of DBS that can be delivered through the Web would allow for broader use of this methodology. Objective: The objective of this study was to evaluate the acceptability and feasibility of the self-collection of DBS using newly developed multimedia training materials that were delivered through the Web. We also aimed to assess the usability of the collected DBS samples. Methods: We recruited participants through Facebook advertising for two distinct studies. The first study evaluated the acceptability of our newly developed DBS training materials, while the second assessed the implementation of this protocol into a larger Web-based study. Results: In the first study, participants (N=115) were aged, on average, 26.1 (SD 6.4) years. Training materials were acceptable (113/115, 98.2%, of participants were willing to collect DBS again) and produced usable samples (110/115, 95.7%, collected DBS were usable). In the second study, response rate was 25.0% (41/164), with responders being significantly younger than nonresponders (20.3 [SD 0.2] vs 22.0 [SD 0.4]; P<.001), and 92% (31/41) of collected DBS samples were usable by the laboratory. Conclusions: Overall, while the protocol is acceptable, feasible, and produced usable samples, additional work is needed to improve response rates. UR - http://formative.jmir.org/2018/2/e11025/ UR - http://dx.doi.org/10.2196/11025 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684406 ID - info:doi/10.2196/11025 ER - TY - JOUR AU - Apolinário-Hagen, Jennifer AU - Menzel, Mireille AU - Hennemann, Severin AU - Salewski, Christel PY - 2018/12/12 TI - Acceptance of Mobile Health Apps for Disease Management Among People With Multiple Sclerosis: Web-Based Survey Study JO - JMIR Formativ Res SP - e11977 VL - 2 IS - 2 KW - multiple sclerosis KW - eHealth KW - mHealth, acceptability of health care KW - patient preference N2 - Background: Mobile health (mHealth) apps might have the potential to promote self-management of people with multiple sclerosis (MS) in everyday life. However, the uptake of MS apps remains poor, and little is known about the facilitators and barriers for their efficient utilization, such as technology acceptance. Objective: The aim of this study was to examine the acceptance of mHealth apps for disease management in the sense of behavioral intentions to use and explore determinants of utilization among people with MS based on the Unified Theory of Acceptance and Use of Technology (UTAUT). Methods: Participants for this Web-based cross-sectional study were recruited throughout Germany with the support of regional MS associations and self-help groups. To identify determinants of intention to use MS apps, a measure based on the UTAUT was adapted with 4 key determinants (performance expectancy, effort expectancy, social influence, and facilitating conditions) and extended by Intolerance of Uncertainty (IU) and electronic health literacy. Potential influencing effects of both MS and computer self-efficacy (C-SE) as mediators and fatigue as a moderator were analyzed using Hayes?s PROCESS macro (SPSS version 3.0) for IBM SPSS version 24.0. Results: A total of 98 participants (mean age 47.03 years, SD 10.17; 66/98, 67% female) with moderate fatigue levels completed the survey. Although most participants (91/98, 92%) were daily smartphone users, almost two-thirds (62/98, 63%) reported no experience with MS apps. Overall, the acceptance was moderate on average (mean 3.11, SD 1.31, minimum=1 and maximum=5), with lower scores among persons with no experience (P=.04) and higher scores among current users (P<.001). In multiple regression analysis (R2=63% variance explained), performance expectancy (beta=.41) and social influence (beta=.33) were identified as significant predictors of acceptance (all P<.001). C-SE was confirmed as a partial mediator in the relationship between IU and acceptance (indirect effect: B=?.095, 95% CI ?0.227 to ?0.01). Furthermore, a moderated mediation by C-SE was shown in the relationship between IU and behavioral intentions to use MS apps for low (95% CI ?0.42 to ?0.01) and moderate levels (95% CI ?0.27 to ?0.01) of fatigue. Conclusions: Overall, this exploratory pilot study indicates for the first time that positive expectations about the helpfulness for self-management purposes and social support might be important factors to be considered for improving the acceptance of MS apps among smartphone users with MS. However, given some inconsistent findings, especially regarding the role of effort expectancy and IU and self-efficacy, the conceptual model needs replication with a larger sample of people with MS, varying more in fatigue levels, and a longitudinal assessment of the actual usage of MS apps predicted by acceptance in the sense of behavioral intentions to use. UR - http://formative.jmir.org/2018/2/e11977/ UR - http://dx.doi.org/10.2196/11977 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684408 ID - info:doi/10.2196/11977 ER - TY - JOUR AU - Oremus, Mark AU - Sharafoddini, Anis AU - Morgano, Paolo Gian AU - Jin, Xuejing AU - Xie, Feng PY - 2018/07/06 TI - Multimedia Appendix Correction: A Computer-Assisted Personal Interview App in ResearchElectronic Data Capture for Administering Time Trade-off Surveys(REDCap): Development and Pretest JO - JMIR Formativ Res SP - e11436 VL - 2 IS - 2 UR - http://formative.jmir.org/2018/2/e11436/ UR - http://dx.doi.org/10.2196/11436 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684410 ID - info:doi/10.2196/11436 ER -