TY - JOUR AU - Ceasar, Nashae Joniqua AU - Claudel, Elizabeth Sophie AU - Andrews, R. Marcus AU - Tamura, Kosuke AU - Mitchell, Valerie AU - Brooks, T. Alyssa AU - Dodge, Tonya AU - El-Toukhy, Sherine AU - Farmer, Nicole AU - Middleton, Kimberly AU - Sabado-Liwag, Melanie AU - Troncoso, Melissa AU - Wallen, R. Gwenyth AU - Powell-Wiley, M. Tiffany PY - 2019/01/04 TI - Community Engagement in the Development of an mHealth-Enabled Physical Activity and Cardiovascular Health Intervention (Step It Up): Pilot Focus Group Study JO - JMIR Formativ Res SP - e10944 VL - 3 IS - 1 KW - cardiovascular health KW - community-based participatory research KW - health behaviors KW - mHealth KW - mobile phone KW - physical activity KW - qualitative data N2 - Background: Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. Objective: This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. Methods: We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participants? experiences of using the app. FGs were audiorecorded and transcribed verbatim, with subsequent behavioral theory-driven thematic analysis. Key themes based on the Health Belief Model and emerging themes were identified from the transcripts. Three independent reviewers iteratively coded the transcripts until consensus was reached. Then, the final codebook was approved by a qualitative research expert. Results: In this study, 10 main themes emerged. Participants emphasized the need to improve the app by optimizing automation, increasing relatability (eg, photos that reflect target demographic), increasing educational material (eg, health information), and connecting with community resources (eg, cooking classes and exercise groups). Conclusions: Involving target users in the development of a culturally sensitive PA app is an essential step for creating an app that has a higher likelihood of acceptance and use in a technology-enabled intervention. This may decrease health disparities in cardiovascular diseases by more effectively increasing PA in a minority population. UR - https://formative.jmir.org/2019/1/e10944/ UR - http://dx.doi.org/10.2196/10944 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684422 ID - info:doi/10.2196/10944 ER - TY - JOUR AU - Garabiles, R. Melissa AU - Harper Shehadeh, Melissa AU - Hall, J. Brian PY - 2019/03/29 TI - Cultural Adaptation of a Scalable World Health Organization E-Mental Health Program for Overseas Filipino Workers JO - JMIR Form Res SP - e11600 VL - 3 IS - 1 KW - cultural adaptation KW - migrant workers KW - e-mental health KW - overseas Filipino workers N2 - Background: Electronic mental (e-mental) health interventions can address mental health needs of different populations. Cultural adaptation of these interventions is crucial to establish a better fit with the cultural group and to achieve better treatment outcomes. Objective: This study aimed to describe the cultural adaptation of the World Health Organization?s e-mental health program Step-by-Step for overseas Filipino workers. We used a framework which posits that cultural adaptation should enhance (1) relevance, wherein the cultural group can relate with the content; (2) acceptability, where the cultural group will not find any element offensive; (3) comprehensibility, where the program is understandable; and (4) completeness, wherein the adapted version covers the same concepts and constructs as the original program. We aimed to have English and Filipino and male and female versions. Methods: Overall, 3 experienced Filipino psychologists provided their perspectives on the program and how it might be adapted for overseas Filipino workers. We then adapted the program and obtained feedback from 28 overseas Filipino workers from diverse industries through focus group discussions. We conducted 7 and 9 focus group discussions with male and female participants, respectively. Per discussion, cognitive interviewing was used to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Participant feedback guided iterative program adaptations, which were again shown to participants for validation and improvement. Results: Several issues were raised by participants about the generic version of Step-by-Step. There were elements deemed irrelevant, like unfitting characters, lack of Filipino values, and unsuitable problems and activities. There were unacceptable components that were stigmatizing, political, inappropriate to context or subgroups, and too feminine for male users. Some elements were incomprehensible, unclear, or complicated. To address these issues, we made key adaptations. To enhance relevance, we adapted the narrative to match the experiences of overseas Filipino workers, incorporated Filipino values, and illustrated familiar problems and activities. To increase acceptability, our main characters were changed to wise elders rather than health professionals (reducing mental health and help-seeking stigma), political or unacceptable content was removed, and the program was made suitable for overseas Filipino workers from different sectors. To increase comprehension, we used English and Filipino languages, simplified the text to ease interpretation of abstract terms, and ensured that text and illustrations matched. We also used Taglish (ie, merged English and Filipino) when participants deemed pure Filipino translations sounded odd or incomprehensible. Finally, we retained the core elements and concepts included in the original Step-by-Step program to maintain completeness. Conclusions: This study showed the utility of a 4-point framework that focuses on acceptance, relevance, comprehensibility, and completeness in cultural adaptation. Moreover, we achieved a culturally appropriate adapted version of the Step-by-Step program for overseas Filipino workers. We discuss lessons learned in the process to guide future cultural adaptation projects of e-mental health interventions. UR - https://formative.jmir.org/2019/1/e11600/ UR - http://dx.doi.org/10.2196/11600 UR - http://www.ncbi.nlm.nih.gov/pubmed/30924784 ID - info:doi/10.2196/11600 ER - TY - JOUR AU - Plans, David AU - Morelli, Davide AU - Sütterlin, Stefan AU - Ollis, Lucie AU - Derbyshire, Georgia AU - Cropley, Mark PY - 2019/01/11 TI - Use of a Biofeedback Breathing App to Augment Poststress Physiological Recovery: Randomized Pilot Study JO - JMIR Formativ Res SP - e12227 VL - 3 IS - 1 KW - biofeedback KW - breathing KW - heart rate variability KW - recovery KW - rumination KW - stress N2 - Background: The speed of physiological recovery from stress may be a marker for cardiovascular disease risk. Stress management programs that incorporate guided breathing have been shown to moderate the stress response and augment recovery. Objective: The aim of this study was to examine the effectiveness of an app-based brief relaxation intervention (BioBase) for facilitating physiological recovery in individuals exposed to a brief psychological stressor. Methods: A total of 75 participants (44 women) completed a stressor speech task and were randomly assigned to one of three conditions: control, rumination, or an app-based relaxation breathing (BioBase) conditions. Heart rate variability (HRV) was assessed as a measure of autonomic function at baseline (6 min), during stress (6 min), and during recovery (6 min). Results: There was a significant increase in subjective stress following stress exposure, but the ratings returned to baseline after recovery in all three groups. In addition, there was a significant decrease in vagally mediated HRV in the poststress period. During recovery, the root mean square of successive differences (P<.001), the percentage of successive interbeat (RR) intervals that differ by >50?ms (pNN50; P<.001), and high-frequency (P<.02) HRV were significantly higher in the BioBase breathing condition than the rumination and control conditions. There was no difference in HRV values between the rumination and control conditions during recovery. Conclusions: App-based relaxed breathing interventions could be effective in reducing cardiovascular disease risk. These results provide additional utility of biofeedback breathing in augmenting physiological recovery from psychological stress. UR - https://formative.jmir.org/2019/1/e12227/ UR - http://dx.doi.org/10.2196/12227 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684437 ID - info:doi/10.2196/12227 ER - TY - JOUR AU - Allman-Farinelli, Margaret AU - Ijaz, Kiran AU - Tran, Helen AU - Pallotta, Hermes AU - Ramos, Sidney AU - Liu, Junya AU - Wellard-Cole, Lyndal AU - Calvo, A. Rafael PY - 2019/01/09 TI - A Virtual Reality Food Court to Study Meal Choices in Youth: Design and Assessment of Usability JO - JMIR Formativ Res SP - e12456 VL - 3 IS - 1 KW - virtual reality KW - nutrition promotion KW - food policy KW - take-out food KW - obesity KW - young adults N2 - Background: Regular consumption of take-out and fast foods with sugary drinks is associated with poor quality diets and higher prevalence of obesity. Among the settings where such food is consumed is the food court typically found in shopping malls prominent in many countries. Objective: The objective of this research was to develop a virtual reality food court that could be used to test food environmental interventions, such as taxation, and ultimately to facilitate the selection of healthier food choices. Methods: Fourteen food courts in Sydney, Australia were selected to include those in the city center and suburbs of high and low socioeconomic status. Researchers visited the courts to collect information on number and type of food outlets, all menu items for sale, cost of foods and beverages and sales promotions. This information was used to assemble 14 food outlets typically found in food courts, and representative menus were compiled. The UNITY gaming platform was used to design a virtual reality food court that could be used with HTC VIVE goggles. Participants navigated the virtual reality food court using the head-mounted display, keyboard, and mouse and selected a lunch meal, including food and beverage. A validated questionnaire on presence within the virtual reality food court and system usability was completed at the end of the session. The constructs for presence included a sense of control, sensory fidelity, realism, distraction, and involvement. Questions were rated on a scale from 1 (worst) through 7 (best) for each of 28 questions giving a maximum total score of 196. The systems usability scale (SUS) that gives a final score out of 100 was also assessed. Results: One hundred and sixty-two participants with a mean age of 22.5 (SD 3.1) years completed the survey. The mean score for total presence was 144 (SE 1.4) consisting of control: 62.1 (SE 0.8), realism: 17.5 (SE 0.2), involvement: 9.6 (SE 0.2), sensory fidelity: 34.9 (SE 0.4), and distraction: 24.0 (SE 0.3). The mean SUS was 69 (SE 1.1). Conclusions: Virtual reality shows promise as a tool to study food choice for test interventions to inform practice and policy. UR - http://formative.jmir.org/2019/1/e12456/ UR - http://dx.doi.org/10.2196/12456 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684440 ID - info:doi/10.2196/12456 ER - TY - JOUR AU - Oakley-Girvan, Ingrid AU - Lavista, M. Juan AU - Miller, Yasamin AU - Davis, Sharon AU - Acle, Carlos AU - Hancock, Jeffrey AU - Nelson, M. Lorene PY - 2019/01/11 TI - Evaluation of a Mobile Device Survey System for Behavioral Risk Factors (SHAPE): App Development and Usability Study JO - JMIR Formativ Res SP - e10246 VL - 3 IS - 1 KW - mobile phone KW - demographic characteristics KW - health surveys KW - risk behaviors KW - mobile apps N2 - Background: Risk factors, including limited exercise, poor sleep, smoking, and alcohol and drug use, if mitigated early, can improve long-term health. Risk prevalence has traditionally been measured using methods that now have diminished participation rates. With >75% of American citizens owning smartphones, new data collection methods using mobile apps can be evaluated. Objective: The objective of our study was to describe the development, implementation, and evaluation of a mobile device?based survey system for behavioral risk assessment. Specifically, we evaluated its feasibility, usability, acceptability, and validity. Methods: We enrolled 536 students from 3 Vermont State Colleges. Iterative mobile app development incorporated focus groups, extensive testing, and the following 4 app versions: iOS standard, iOS gamified, Android standard, and Android gamified. We aimed to capture survey data, paradata, and ambient data such as geolocation. Using 3 separate surveys, we asked a total of 27 questions that included demographic characteristics, behavioral health, and questions regarding the app?s usability and survey process. Results: Planned enrollment was exceeded in just a few days. There were 1392 ?hits? to the landing page where the app could be downloaded. Excluding known project testers and others not part of the study population, 670 participants downloadeded the SHAPE app. Of those, 94.9% of participants (636/670) agreed to participate by providing in-app consent. Of the 636 who provided consent, 84.3% (536/636) were deemed eligible for the study. The majority of eligible respondents completed the initial survey (459/536, 85.6%), whereas 29.9% (160/536) completed the second survey and 28.5% (153/536) completed the third survey. The SHAPE survey obtained 414 participants on the behavioral risk items in survey 1, which is nearly double the 209 participants who completed the traditional Vermont College Health Survey in 2014. SHAPE survey responses were consistent with the traditionally collected Vermont College Health Survey data. Conclusions: This study provides data highlighting the potential for mobile apps to improve population-based health, including an assessment of recruitment methods, burden and response rapidity, and future adaptations. Although gamification and monetary rewards were relatively unimportant to this study population, item response theory may be technologically feasible to reduce individual survey burden. Additional data collected by smartphones, such as geolocation, could be important in additional analysis, such as neighborhood characteristics and their impact on behavioral risk factors. Mobile tools that offer rapid adaptation for specific populations may improve research data collection for primary prevention and could be used to improve engagement and health outcomes. UR - https://formative.jmir.org/2019/1/e10246/ UR - http://dx.doi.org/10.2196/10246 UR - http://www.ncbi.nlm.nih.gov/pubmed/30684441 ID - info:doi/10.2196/10246 ER - TY - JOUR AU - Goldin, R. Philippe AU - Lindholm, Riku AU - Ranta, Kristian AU - Hilgert, Outi AU - Helteenvuori, Tiia AU - Raevuori, Anu PY - 2019/01/22 TI - Feasibility of a Therapist-Supported, Mobile Phone?Delivered Online Intervention for Depression: Longitudinal Observational Study JO - JMIR Formativ Res SP - e11509 VL - 3 IS - 1 KW - cognitive therapy KW - depression KW - digital health KW - digital therapeutics KW - mindfulness KW - online intervention N2 - Background: Depression is a very common condition that impairs functioning and is often untreated. More than 60% of the treatments for depressive disorder are administered in primary care settings by care providers who lack the time and expertise to treat depression. To address this issue, we developed Ascend, a therapist-supported, mobile phone?delivered 8-week intervention administered at the Meru Health Online Clinic in Finland. Objective: We conducted two pilot studies to examine the feasibility of the Ascend intervention, specifically, dropout rates, daily practice, weekly group chat use, and changes in depression symptoms. We also explored whether daily practice and weekly group chat use were associated with changes in depression symptoms. Methods: A total of 117 Finnish adults with elevated depressive symptoms enrolled in Ascend, a program that included daily cognitive behavioral and mindfulness meditation exercises delivered through a mobile phone app, anonymous group chat with other users, and chat/phone access to a licensed therapist. Eight weekly themes were delivered in a fixed, sequential format. Depression symptoms were measured at baseline, every second week during the intervention, immediately after the intervention, and 4 weeks after completion of the intervention. Data were analyzed using intent-to-treat repeated-measures analysis of variance and linear regression models. Results: For studies 1 and 2, we observed dropout rates of 27% and 15%, respectively, decreasing daily practice and group chat use, and decreased depression symptoms from baseline to immediately and 4 weeks after the intervention (P<.001). We found that both more daily practice and chat group use predicted the occurrence of fewer depressive symptoms at 4 weeks postintervention (Study 1: ?R2=.38, P=.004 and ?R2=.38, P=.002, respectively; Study 2: ?R2=.16, P<.001 and ?R2=.08, P=.002, respectively). Conclusions: This therapist-supported, mobile phone?delivered treatment for depression is feasible and associated with reduced depression symptoms. Design features that enhance daily practice and group chat use are areas of future investigation. Validation of these results using a controlled study design is needed to establish the evidence base for the Ascend intervention. UR - http://formative.jmir.org/2019/1/e11509/ UR - http://dx.doi.org/10.2196/11509 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/11509 ER - TY - JOUR AU - Bensley, J. Robert AU - Brusk, J. John PY - 2019/01/23 TI - Impact of Food Preparation Video Exposure on Online Nutrition Education in Women, Infants, and Children (WIC) Program Participants: Retrospective Study JO - JMIR Formativ Res SP - e12508 VL - 3 IS - 1 KW - internet KW - online video KW - WIC KW - engagement N2 - Background: The impact of integrating video into health education delivery has been extensively investigated; however, the effect of integrating video on a learner?s subsequent performance in an online educational setting is rarely reported. Results of the relationship between the learner?s online video viewing and subsequent progression toward health behavior change in a self-directed online educational session are lacking. Objective: This study aimed to determine the relationship between viewing a Health eKitchen online video and key engagement performance indicators associated with online nutrition education for women, infants, and children (WIC). Methods: This study involved a retrospective cohort of users grouped on the basis of whether Health eKitchen exposure occurred before or after completing a nutrition education lesson. A two-sample test for equality of proportions was performed to test the difference in the likelihood of progression between the groups overall and when stratified by lesson type, which was defined by whether the lesson focused on food preparation. Welch two-sample t tests were performed to test the difference in average link depth and duration of use between groups overall and stratified by lesson type. Logistic regression was conducted to validate the impact of video viewing prior to lesson completion while controlling for lesson type and factors known to be associated with WIC key performance indicators. Results: A greater stage of change progression was observed for both food preparation (?2=12.6, P<.001) and non-food preparation (?2=62.8, P<.001) lessons among early stage users who had viewed a Health eKitchen video before completing a lesson. Time spent viewing educational learning resource links within the lesson was also significantly longer for both food preparation (t=7.8, P<.001) and non-food preparation (t=2.5, P=.01) lessons. Logistic regression analysis corroborated these results while controlling for known confounding factors. The odds of user progression were nearly three times greater among those who viewed a Health eKitchen video prior to lesson completion (odds ratio=2.61; 95% CI=2.08-3.29). Type of lesson (food vs non-food preparation) was the strongest predictor of progression odds (odds ratio=3.12; 95% CI=2.47-3.95). Conclusions: User access to a Health eKitchen video prior to completion of an online educational session had a significant impact on achieving lesson goals, regardless of the food preparation focus. This observation suggests the potential benefit of providing an application-oriented video at the onset of online nutrition education lessons. UR - http://formative.jmir.org/2019/1/e12508/ UR - http://dx.doi.org/10.2196/12508 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/12508 ER - TY - JOUR AU - Dubin, Ruth AU - Rubinsky, Anna PY - 2019/02/06 TI - A Digital Modality Decision Program for Patients With Advanced Chronic Kidney Disease JO - JMIR Form Res SP - e12528 VL - 3 IS - 1 KW - chronic kidney disease KW - end-stage renal disease KW - online social networking KW - patient education KW - renal dialysis N2 - Background: Patient education regarding end-stage renal disease (ESRD) has the potential to reduce adverse outcomes and increase the use of in-home renal replacement therapies. Objective: This study aimed to investigate whether an online, easily scalable education program can improve patient knowledge and facilitate decision making regarding renal replacement therapy options. Methods: We developed a 4-week online, digital educational program that included written information, short videos, and social networking features. Topics included kidney transplant, conservative management, peritoneal dialysis, in-home hemodialysis, and in-center hemodialysis. We recruited patients with advanced chronic kidney disease (stage IV and V) to enroll in the online program, and we evaluated the feasibility and potential impact of the digital program by conducting pre- and postintervention surveys in areas of knowledge, self-efficacy, and choice of ESRD care. Results: Of the 98 individuals found to be eligible for the study, 28 enrolled and signed the consent form and 25 completed the study. The average age of participants was 65 (SD 15) years, and the average estimated glomerular filtration rate was 21 (SD 6) ml/min/1.73 m2. Before the intervention, 32% of patients (8/25) were unable to make an ESRD treatment choice; after the intervention, all 25 participants made a choice. The proportion of persons who selected kidney transplant as the first choice increased from 48% (12/25) at intake to 84% (21/25) after program completion (P=.01). Among modality options, peritoneal dialysis increased as the first choice for 4/25 (16%) patients at intake to 13/25 (52%) after program completion (P=.004). We also observed significant increases in knowledge score (from 65 [SD 56] to 83 [SD 14]; P<.001) and self-efficacy score (from 3.7 [SD 0.7] to 4.3 [SD 0.5]; P<.001). Conclusions: Implementation of a digital ESRD education program is feasible and may facilitate patients? decisions about renal replacement therapies. Larger studies are necessary to understand whether the program affects clinical outcomes. Trial Registration: ClinicalTrials.gov NCT02976220; https://clinicaltrials.gov/ct2/show/NCT02976220 UR - http://formative.jmir.org/2019/1/e12528/ UR - http://dx.doi.org/10.2196/12528 UR - http://www.ncbi.nlm.nih.gov/pubmed/30724735 ID - info:doi/10.2196/12528 ER - TY - JOUR AU - Holzmann, Laura Sophie AU - Dischl, Felicitas AU - Schäfer, Hanna AU - Groh, Georg AU - Hauner, Hans AU - Holzapfel, Christina PY - 2019/02/13 TI - Digital Gaming for Nutritional Education: A Survey on Preferences, Motives, and Needs of Children and Adolescents JO - JMIR Form Res SP - e10284 VL - 3 IS - 1 KW - adolescents KW - children KW - communication KW - motives KW - mobile phone KW - needs KW - nutrition KW - obesity KW - overweight KW - preferences KW - serious games KW - survey N2 - Background: Use of novel information and communication technologies are frequently discussed as promising tools to prevent and treat overweight and obesity in children and adolescents. Objective: This survey aims to describe the preferences, motives, and needs of children and adolescents regarding nutrition and digital games. Methods: We conducted a survey in 6 secondary schools in the southern region of Germany using a 43-item questionnaire. Questions referred to preferences, motives, and needs of children and adolescents regarding nutrition and digital games. In addition, knowledge regarding nutrition was assessed with 4 questions. We collected self-reported sociodemographic and anthropometric data. Descriptive statistical analyses were performed using SPSS. Results: In total, 293 children and adolescents participated in the study, with ages 12-18 years (137 girls, 46.8%), weight 30.0-120.0 (mean 60.2 [SD 13.2]) kg, and height 1.4-2.0 (mean 1.7 [SD 0.1]) m. A total of 5.5% (16/290) correctly answered the 4 questions regarding nutrition knowledge. Study participants acquired digital nutritional information primarily from the internet (166/291, 57.0%) and television (97/291, 33.3%), while school education (161/291, 55.3%) and parents or other adults (209/291, 71.8%) were the most relevant nondigital information sources. Most participants (242/283, 85.5%) reported that they regularly play digital games. More than half (144/236, 61.0%) stated that they play digital games on a daily basis on their smartphones or tablets, and almost 70% (151/282, 66.5%) reported playing digital games for ?30 minutes without any interruption. One-half of respondents (144/280, 51.4%) also stated that they were interested in receiving information about nutrition while playing digital games. Conclusions: This survey suggests that nutrition knowledge in children and adolescents might be deficient. Most children and adolescents play digital games and express interest in acquiring nutritional information during digital gameplay. A digital game with a focus on sound nutrition could be a potential educational tool for imparting nutrition knowledge and promoting healthier nutrition behaviors in children and adolescents. UR - http://formative.jmir.org/2019/1/e10284/ UR - http://dx.doi.org/10.2196/10284 UR - http://www.ncbi.nlm.nih.gov/pubmed/30758290 ID - info:doi/10.2196/10284 ER - TY - JOUR AU - Subasinghe, Kokila Asvini AU - Garland, Marie Suzanne AU - Gorelik, Alexandra AU - Tay, Ilona AU - Wark, Dennis John PY - 2019/02/25 TI - Using Mobile Technology to Improve Bone-Related Lifestyle Risk Factors in Young Women With Low Bone Mineral Density: Feasibility Randomized Controlled Trial JO - JMIR Form Res SP - e9435 VL - 3 IS - 1 KW - behavior therapy methods KW - mobile phones KW - health behavior KW - primary prevention methods KW - self-care methods N2 - Background: Poor bone health in adolescent and young adult females is a growing concern. Given the widespread use of mobile phones in this population, mobile health (mHealth) interventions may help improve health behaviors related to bone health in young women. Objective: The goal of the study was to determine the acceptability and feasibility of an mHealth intervention called Tap4Bone in improving health behaviors associated with the risk of osteoporosis in young women. Methods: The Tap4Bone mHealth intervention comprised the use of mobile phone apps, short messaging service (text messaging), and Web emails to encourage health behavior changes. The education group received osteoporosis prevention education leaflets. Changes in the bone health?related behaviors exercise, smoking, and calcium intake were assessed. User experiences and acceptance of the app were collected through focus group interviews. Results: A total of 35 (22 completed, mean age 23.1 [SD 1.8] years) were randomized to either the mobile phone (intervention n=18) or education (control n=17) group. Although there were trends toward improvement in calcium intake, sports activity, and smoking behaviors in the mHealth intervention group compared to the education group, these were not statistically significant. Conclusions: The Tap4Bone mHealth intervention was shown to be acceptable and feasible in subsets of the participants. The intervention should be improved upon using participant feedback to improve functionality. Findings from this study may aid in the development and modification of health care apps to reduce participant attrition. UR - http://formative.jmir.org/2019/1/e9435/ UR - http://dx.doi.org/10.2196/formative.9435 UR - http://www.ncbi.nlm.nih.gov/pubmed/30801253 ID - info:doi/10.2196/formative.9435 ER - TY - JOUR AU - Steele Gray, Carolyn AU - Gravesande, Janelle AU - Hans, Kaur Parminder AU - Nie, X. Jason AU - Sharpe, Sarah AU - Loganathan, Mayura AU - Lyons, Renee AU - Cott, Cheryl PY - 2019/02/27 TI - Using Exploratory Trials to Identify Relevant Contexts and Mechanisms in Complex Electronic Health Interventions: Evaluating the Electronic Patient-Reported Outcome Tool JO - JMIR Form Res SP - e11950 VL - 3 IS - 1 KW - eHealth KW - mHealth KW - multiple chronic conditions KW - clinical trial, phase III KW - health care evaluation mechanisms KW - quantitative evaluation KW - qualitative evaluation KW - narrative analysis N2 - Background: Designing appropriate studies for evaluating complex interventions, such as electronic health solutions to support integrated care, remains a methodological challenge. With the many moving parts of complex interventions, it is not always clear how program activities are connected to anticipated and unanticipated outcomes. Exploratory trials can be used to uncover determinants (or mechanisms) to inform content theory that underpins complex interventions before designing a full evaluation plan. Objective: A multimethod exploratory trial of the electronic patient-reported outcome (ePRO) tool was conducted to uncover contexts, processes and outcome variables, and the mechanisms that link these variables before full-scale evaluation. ePRO is a mobile app and portal designed to support goal-oriented care in interdisciplinary primary health care practices (clinical-level integration). This paper offers evaluation findings and methodological insight on how to use exploratory trial data to identify relevant context, process, and outcome variables, as well as central (necessary to achieving outcomes) versus peripheral (less critical and potentially context dependent) mechanisms at play. Methods: The 4-month trial was conducted in 2 primary health care practices in Toronto, Canada. The patients were randomized into control and intervention groups and compared pre and post on quality of life and activation outcome measures. Semistructured interviews were conducted with providers and patients in the intervention group. Narrative analysis was used to uncover dominant mechanisms that inform the intervention?s content theory (how context and process variables are linked to outcomes). Results: Overall, 7 providers, 1 administrator, and 16 patients (7-control, 9-intervention) participated in the study. This study uncovered many complex and nuanced context, process, and outcome variables at play in the intervention. Narrative analysis of patient and provider interviews revealed dominant story lines that help to tease apart central and peripheral mechanisms driving the intervention. Provider and patient story lines centered around fitting the new intervention into everyday work and life of patients and providers and meaningfulness of the intervention. These themes were moderated by patient-provider relationships going into and throughout the intervention, their comfort with technology, and the research process. Conclusions: Identifying dominant story lines using narrative analysis helps to identify the most relevant context and process variables likely to influence study outcomes. Normalization process theory emerges as a useful theory to uncover underlying mechanisms because of its emphasis on the social production and normalization of technological, processual, and social aspects of work; all found to be critical to our intervention. The number of complex, overlapping influencing variables suggests that complex interventions such as ePRO require us to pay careful attention to central versus peripheral mechanisms that will influence study outcomes. The narrative methods presented here are shown to be useful in uncovering these mechanisms and help to guide subsequent larger evaluation studies. UR - http://formative.jmir.org/2019/1/e11950/ UR - http://dx.doi.org/10.2196/11950 UR - http://www.ncbi.nlm.nih.gov/pubmed/30810532 ID - info:doi/10.2196/11950 ER - TY - JOUR AU - Lipson-Smith, Ruby AU - White, Fiona AU - White, Alan AU - Serong, Lesley AU - Cooper, Guy AU - Price-Bell, Georgia AU - Hyatt, Amelia PY - 2019/03/12 TI - Co-Design of a Consultation Audio-Recording Mobile App for People With Cancer: The SecondEars App JO - JMIR Form Res SP - e11111 VL - 3 IS - 1 KW - referral and consultation KW - adult KW - humans KW - cancer KW - audiovisual aids KW - mobile apps KW - community-based participatory research KW - health behavior KW - psychological theory N2 - Background: Many patients choose to audio-record their medical consultations so that they can relisten to them at home and share them with family. Consultation audio-recordings can improve patients? recall and understanding of medical information and increase their involvement in decision making. A hospital-endorsed consultation audio-recording mobile app would provide patients with the permission and means to audio-record their consultations. The Theory of Planned Behavior provides a framework for understanding how patients can be encouraged to appropriately audio-record consultations. Objective: The aim of this study was to use a co-design process to develop a consultation audio-recording mobile app called SecondEars. Methods: App development began with stakeholder engagement, followed by a series of 6 co-design workshops and then user acceptance testing. Stakeholder engagement included advice from legal, information technology (IT), clinical and allied health leads; digital strategy; and medical records. he co-design workshops were attended by: patient consumers, members of the research team, IT staff, the app designers, clinicians, and staff from medical records. During workshops 1 to 4, the purpose and scope of the app were refined, possible pitfalls were addressed, and design features were discussed. The app designers then incorporated the results from these workshops to produce a wireframe mock-up of the proposed SecondEars app, which was presented for feedback at workshops 5 and 6. Results: The stakeholders identified 6 requirements for the app, including that it be patient driven, secure, clear in terms of legal responsibilities, linked to the patient?s medical record, and that it should require minimal upfront and ongoing resources. These requirements informed the scope of the co-design workshops. The workshops were attended by between 4 and 13 people. The workshop attendees developed a list of required features and suggestions for user interface design. The app developers used these requirements and recommendations to develop a prototype of the SecondEars app in iOS, which was then refined through user acceptance testing. Conclusions: The SecondEars app allows patients to have control and autonomy over audio-recording and sharing their consultations while maintaining privacy and safety for medical information and legal protection for clinicians. The app has been designed to have low upkeep and minimal impact on clinical processes. The SecondEars prototype is currently being tested with patients in a clinical setting. UR - http://formative.jmir.org/2019/1/e11111/ UR - http://dx.doi.org/10.2196/11111 UR - http://www.ncbi.nlm.nih.gov/pubmed/30860487 ID - info:doi/10.2196/11111 ER - TY - JOUR AU - Alturki, Ryan AU - Gay, Valerie PY - 2019/03/14 TI - The Development of an Arabic Weight-Loss App Akser Waznk: Qualitative Results JO - JMIR Form Res SP - e11785 VL - 3 IS - 1 KW - weight loss KW - mobile app KW - obesity KW - physical activity KW - smartphone KW - mHealth KW - motivation N2 - Background: Obesity and its related illnesses are a major health problem around the world. Saudi Arabia has one of the highest national obesity rates globally; however, it is not easy to intervene to prevent obesity and becoming overweight owing to Saudi Arabia?s cultural and social norms, and linguistic barriers. In recent years, there has been an exponential growth in the usage of smartphones and apps in Saudi Arabia. These could be used as a cost-effective tool to facilitate the delivery of behavior-modification interventions for obese and overweight people. There are a variety of health and fitness apps that claim to offer lifestyle-modification tools. However, these do not identify the motivational features required to overcome obesity, consider the evidence-based practices for weight management, or enhance the usability of apps by considering usability attributes. Objective: This study aimed to explore the opportunity and the need to develop an Arabic weight-loss app that provides localized content and addresses the issues with existing apps identified here. This study has explained the steps taken to design an Arabic weight-loss app that was developed to facilitate the adjustment of key nutritional and physical activities and behaviors, which considers the social and cultural norms of Saudi Arabia. Methods: Qualitative studies were conducted with 26 obese Saudi Arabians, who tested the level of usability of 2 weight-loss apps and then provided feedback and recommendations. The app Akser Waznk is an interactive, user-friendly app designed primarily for iPhones. It has several features intended to assist users to monitor and track their food consumption and physical activities. The app provides personalized diet and weight loss advice. Unique features such as Let?s Walk are designed to motivate users to walk more. An augmented reality function is implemented to provide information regarding fitness equipment, fruits, and vegetables. The app uses behavior-change techniques to increase activities and healthy behaviors and evidence-informed practices for weight-loss management. The Akser Waznk app considers user privacy and data security by applying a number of guidelines and procedures. Results: The development of the app took 26 months. In all, 7 experts (5 dietitians, and 2 physical activity professionals) evaluated the app?s contents. Moreover, 10 potential users (5 men and 5 women) tested the app?s level of usability, its features, and performance during a pilot study. They reported that the app?s design is interactive, and the motivational features are user-friendly. Conclusions: Mobile technology, such as mobile apps, has the potential to be an effective tool that facilitates the changing of unhealthy lifestyle behaviors within the Saudi community. To be successful, the target group, the usability, motivational features, and social and cultural norms must be considered. UR - http://formative.jmir.org/2019/1/e11785/ UR - http://dx.doi.org/10.2196/11785 UR - http://www.ncbi.nlm.nih.gov/pubmed/30869639 ID - info:doi/10.2196/11785 ER - TY - JOUR AU - McLinden, Daniel AU - Myers, Sarah AU - Seid, Michael AU - Busch, Melida AU - Davis, David AU - Murphy, John PY - 2019/03/14 TI - The Learning Exchange, a Community Knowledge Commons for Learning Networks: Qualitative Evaluation to Test Acceptability, Feasibility, and Utility JO - JMIR Form Res SP - e9858 VL - 3 IS - 1 KW - quality improvement KW - knowledge management KW - community networks KW - intersectoral collaboration KW - database management systems KW - patient-centered care N2 - Background: Learning Networks are distributed learning health systems that enable collaboration at scale to improve health and health care. A key requirement for such networks is having a way to create and share information and knowledge in furtherance of the work of the community. Objective: We describe a Learning Exchange?a bespoke, scalable knowledge management and exchange platform initially built and tested for improving pediatric inflammatory bowel disease outcomes in the ImproveCareNow (ICN) Network?and assess evidence of its acceptability, feasibility, and utility in facilitating creation and sharing of information in furtherance of the work of the community and as a model for other communities. Methods: Acceptability was assessed via growth in active users and activity. Feasibility was measured in terms of the percentage of users with a log-in who became active users as well as user surveys and a case study. Utility was measured in terms of the type of work that the Learning Exchange facilitated for the community. Results: The ICNExchange has over 1000 users and supported sharing of resources across all care centers in ICN. Users reported that the Learning Exchange has facilitated their work and resulted in increased ability to find resources relevant to local information needs. Conclusions: The ICNExchange is acceptable, feasible, and useful as a knowledge management and exchange platform in service of the work of ICN. Experience with the ICNExchange suggests that the design principles are extensible to other chronic care Learning Networks. UR - http://formative.jmir.org/2019/1/e9858/ UR - http://dx.doi.org/10.2196/formative.9858 UR - http://www.ncbi.nlm.nih.gov/pubmed/30869643 ID - info:doi/10.2196/formative.9858 ER - TY - JOUR AU - Ng, Denise AU - McMurray, Josephine AU - Wallace, James AU - Morita, Plinio PY - 2019/03/18 TI - What Is Being Used and Who Is Using It: Barriers to the Adoption of Smartphone Patient Experience Surveys JO - JMIR Form Res SP - e9922 VL - 3 IS - 1 KW - quality of healthcare KW - surveys and questionnaires KW - patient satisfaction KW - data collection KW - smartphone KW - mobile phone KW - risk KW - privacy N2 - Background: Smartphones are positioned to transform the way health care services gather patient experience data through advanced mobile survey apps which we refer to as smart surveys. In comparison with traditional methods of survey data capture, smartphone sensing survey apps have the capacity to elicit multidimensional, in situ user experience data in real time with unprecedented detail, responsiveness, and accuracy. Objective: This study aimed to explore the context and circumstances under which patients are willing to use their smartphones to share data on their service experiences. Methods: We conducted in-person, semistructured interviews (N=24) with smartphone owners to capture their experiences, perceptions, and attitudes toward smart surveys. Results: Analysis examining perceived risk revealed a few barriers to use; however, major potential barriers to adoption were the identity of recipients, reliability of the communication channel, and potential for loss of agency. The results demonstrate that the classical dimensions of perceived risk raised minimal concerns for the use of smartphones to collect patient service experience feedback. However, trust in the doctor-patient relationship, the reliability of the communication channel, the altruistic motivation to contribute to health service quality for others, and the risk of losing information agency were identified as determinants in the patients? adoption of smart surveys. Conclusions: On the basis of these findings, we provide recommendations for the design of smart surveys in practice and suggest a need for privacy design tools for voluntary, health-related technologies. UR - http://formative.jmir.org/2019/1/e9922/ UR - http://dx.doi.org/10.2196/formative.9922 UR - http://www.ncbi.nlm.nih.gov/pubmed/30882354 ID - info:doi/10.2196/formative.9922 ER - TY - JOUR AU - Lai, Byron AU - Wilroy, Jereme AU - Young, Hui-Ju AU - Howell, Jennifer AU - Rimmer, H. James AU - Mehta, Tapan AU - Thirumalai, Mohanraj PY - 2019/03/19 TI - A Mobile App to Promote Adapted Exercise and Social Networking for People With Physical Disabilities: Usability Study JO - JMIR Form Res SP - e11689 VL - 3 IS - 1 KW - exercise KW - telehealth KW - rehabilitation KW - mHealth N2 - Background: People with physical disabilities (PWD) experience several unique challenges that prevent them from participating in onsite exercise programs. Although mobile apps can provide a ubiquitous channel for delivering convenient exercise services within the community, no exercise apps have been designed for people with disabilities who experience certain functional limitations. Objective: The aim of this study was to examine the usability of a mobile exercise app in PWD. Methods: A sequential explanatory mixed-method design was used to holistically test usability in 4 core areas: effectiveness (ie, ease of use), efficiency (ie, operation speed), perceived satisfaction, and usefulness. Participants completed 7 face-to-face usability tasks and 1 structured interview. Equipment included a computer tablet that came preinstalled with the exercise app. The app included exercise videos that focused on several components of fitness: aerobic capacity, muscular strength, functional strength or balance, and range of motion. The app contained 3 different versions of the exercise program: (1) a program for people with the ability to use the upper and lower limbs, (2) a seated program for people with the ability to use only upper limbs, and (3) a program designed for people with hemiparesis. The app also included educational resources in the form of infographics aimed at addressing key social cognitive theory constructs included social support, outcome expectancies, self-efficacy, and barriers or facilitators to exercising. Participant characteristics and quantitative usability data were descriptively reported. Qualitative data were analyzed using thematic analysis. Results: A total of 12 PWD tested the usability of the exercise app and completed 96% (69/72) of the usability tasks on the first attempt. Operation speed varied among users, which prompted the development team to make minor revisions to the app. Qualitative results demonstrated 3 overarching themes: facilitates exercise adoption, positive experiences of videos, and easy to learn. Participants noted that the app circumvented several barriers to exercise associated with leaving the home (eg, inclement weather conditions, exacerbations of health conditions or disability symptoms, difficulties with transportation, and social support). Conclusions: The mobile exercise app provided a simple platform that was effective, useful, and appreciated by PWD. Participants also perceived the app as easy to use and felt it was a valuable tool for assisting PWD to obtain regular exercise. Study findings also offered insight into the participants? preferences for mobile exercise apps that can aid future research and development projects. Future exercise trials are needed to determine the true impact of mobile app technology on lifestyle physical activity in people with disabilities. Trial Registration: Clinicaltrials.gov NCT03024320; https://clinicaltrials.gov/ct2/show/NCT03024320 (Archived by WebCite at http://www.webcitation.org/75hNLgRFH). UR - http://formative.jmir.org/2019/1/e11689/ UR - http://dx.doi.org/10.2196/11689 UR - http://www.ncbi.nlm.nih.gov/pubmed/30888325 ID - info:doi/10.2196/11689 ER - TY - JOUR AU - Alharbey, Riad AU - Chatterjee, Samir PY - 2019/03/19 TI - An mHealth Assistive System ?MyLung? to Empower Patients with Chronic Obstructive Pulmonary Disease: Design Science Research JO - JMIR Form Res SP - e12489 VL - 3 IS - 1 KW - assistive technology KW - patient empowerment KW - chronic obstructive pulmonary disease KW - design science research N2 - Background: Chronic obstructive pulmonary disease (COPD) comprises a group of progressive diseases that deteriorate lung functions. When patients cannot breathe, nothing else in their lives matter. Breathlessness has negative implications on patients? lives, which leads to physical and psychological limitations. Moreover, the lack of relevant and updated information about the causes and consequences of the disease can exacerbate the problems of health literacy, information accessibility, and medical adherence. Objective: The objective of this study is to design an innovative mobile health (mHealth) app system called ?MyLung? that provides complete solutions in order to increase self-awareness and promote better self-care management. This system, an information technology artifact, includes three novel integrative modules: education, risk reduction, and monitoring. Methods: The utility and effectiveness of the assistive mobile-based technology were evaluated using a mixed-methods approach. The study combined quantitative and qualitative research methods to thoroughly understand how the assistive mobile-based technology can influence patients? behavioral intention to change their lifestyle. Thirty patients were categorized into two groups (intervention group and control group). Results: The results from the quantitative analysis led to four follow-up interviews in the qualitative study. The results of the quantitative study provided significant evidence to show that the design of MyLung leads to a change in the awareness level, self-efficacy, and behavioral intention for patients with COPD. The t tests revealed a significant difference before and after using the mobile-based app with regard to the awareness level (mean 3.28 vs 4.56; t10=6.062; P<.001), self-efficacy (mean 3.11 vs 5.56; t10=2.96; P=.01), and behavioral intention (mean 2.91 vs 4.55; t10=3.212; P=.009). Independent sample t tests revealed significant differences between the intervention group and the control group in terms of the awareness level (mean 4.56 vs 3.31; t19=4.80; P<.001) and self-efficacy (mean 5.56 vs 3.66; t19=2.8; P<.01). Integration of findings from quantitative and qualitative studies reveled the impact of the design in a comprehensive manner. These inferences are referred to as ?meta-inferences? in this study. Conclusions: We designed an innovative assistive mobile-based technology to empower patients with COPD, which helped increase awareness and engage patients in self-care management activities. The assistive technology aims to inform patients about the risk factors of COPD and to improve access to relevant information. Meta-inferences that emerge from the research outputs contribute to research into chronic management information systems by helping us gain a more complete understanding of the potential impacts of this proposed mobile-based design on patients with chronic disease. UR - http://formative.jmir.org/2019/1/e12489/ UR - http://dx.doi.org/10.2196/12489 UR - http://www.ncbi.nlm.nih.gov/pubmed/30888329 ID - info:doi/10.2196/12489 ER - TY - JOUR AU - Laurence, Colleen AU - Wispelwey, Erin AU - Flickinger, E. Tabor AU - Grabowski, Marika AU - Waldman, Lena Ava AU - Plews-Ogan, Erin AU - Debolt, Claire AU - Reynolds, George AU - Cohn, Wendy AU - Ingersoll, Karen AU - Dillingham, Rebecca PY - 2019/03/20 TI - Development of PositiveLinks: A Mobile Phone App to Promote Linkage and Retention in Care for People With HIV JO - JMIR Form Res SP - e11578 VL - 3 IS - 1 KW - mHealth KW - HIV KW - treatment adherence and compliance KW - retention in care N2 - Background: Linkage to and retention in HIV care are challenging, especially in the Southeastern United States. The rise in mobile phone app use and the potential for an app to deliver just in time messaging provides a new opportunity to improve linkage and retention among people living with HIV (PLWH). Objective: This study aimed to develop an app to engage, link, and retain people in care. We evaluated the acceptability, feasibility, and impact of the app among users. Methods: App development was informed by principles of chronic disease self-management and formative interviews with PLWH. Once developed, the app was distributed among participants, and usability feedback was incorporated in subsequent iterations. We interviewed app users after 3 weeks to identify usability issues, need for training on the phone or app, and to assess acceptability. We tracked and analyzed usage of app features for the cohort over 2 years. Results: A total of 77 participants used the app during the pilot study. The query response rate for the first 2 years was 47.7%. Query response declined at a rate of 0.67% per month. The community message board was the most popular feature, and 77.9% (60/77) of users posted on the board at least once during the 2 years. Conclusions: The PositiveLinks app was feasible and acceptable among nonurban PLWH. High participation on the community message board suggests that social support from peers is important for people recently diagnosed with or returning to care for HIV. UR - http://formative.jmir.org/2019/1/e11578/ UR - http://dx.doi.org/10.2196/11578 UR - http://www.ncbi.nlm.nih.gov/pubmed/30892269 ID - info:doi/10.2196/11578 ER - TY - JOUR AU - Hendrie, A. Gilly AU - James-Martin, Genevieve AU - Williams, Gemma AU - Brindal, Emily AU - Whyte, Ben AU - Crook, Anna PY - 2019/03/27 TI - The Development of VegEze: Smartphone App to Increase Vegetable Consumption in Australian Adults JO - JMIR Form Res SP - e10731 VL - 3 IS - 1 KW - mHealth KW - mobile applications KW - vegetables KW - adult N2 - Background: Poor-quality dietary patterns are often characterized by inadequate consumption of fruits and vegetables. Changing dietary behavior is difficult, and although it is often clear what needs to change, how to enact change is more difficult. Smartphones have characteristics that may support the complexity of changing dietary behavior. Objective: This paper describes the iterative process of developing a theory-based smartphone app called VegEze that aimed to increase vegetable consumption. Methods: To upscale, reach target users, and create a user-friendly end product, a collaborative research-industry partnership was formed to build the app over a 20-week period. The Integrate, Design, Assess, and Share framework was used as a scientific basis to guide the development. The behavior change wheel was also used as a theoretical grounding in combination with other theory-based strategies, such as self-monitoring, social comparison, and gamification?which have all been shown to be successful in dietary change or digital health interventions. We conducted 1 consumer survey (N=1068), 1 usability testing session (N=11), and a pilot effectiveness and usability trial (N=283) to inform the design of the app. Results: The target behavior for the app was defined as having 3 different types of vegetables at dinner. The perceived achievability of this target behavior was high; 93% of respondents (993/1068 users) felt they were likely or very likely to be able to regularly achieve the behavior. App features that users wanted included the following: recipes and meal ideas (876/1068, 82% of users), functionality to track their intake (662/1068, 62%), and information on how to prepare vegetables (545/1068, 51%). On the basis of importance of self-monitoring as a behavior change technique (BCT) and its rating by users, the vegetable tracker was a core feature of the app and was designed to be quick and simple to use. Daily feedback messages for logging intake and communicating progress were designed to be engaging and fun, using friendly, positive language and emoji icons. Daily and weekly feedback on vegetable consumption was designed to be simple, informative, and reinforce monitoring. A creative team was engaged to assist in the branding of the app to ensure it had an identity that reflected the fun and simple nature of the underlying behavior. The app included 16 BCTs, most of which were from the goals and planning subsection of the BCT taxonomy. Conclusions: Combining a theoretical framework with an industry perspective and input resulted in an app that was developed in a timely manner while retaining its evidence-base. VegEze is an iOS app currently available in the App Store, and the overall impact of the VegEze app will be evaluated in an uncontrolled, quantitative study. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000481279; http://www.anzctr.org.au/TrialSearch.aspx?searchTxt=ACTRN12618000481279 (Archived by WebCite: at http://www.webcitation.org/769oG9EaA) UR - http://formative.jmir.org/2019/1/e10731/ UR - http://dx.doi.org/10.2196/10731 UR - http://www.ncbi.nlm.nih.gov/pubmed/30916653 ID - info:doi/10.2196/10731 ER - TY - JOUR AU - Moraes Carrilho, Juliana AU - Oliveira, Ramos Isaias José AU - Santos, Dimitri AU - Osanan, Costa Gabriel AU - Cruz-Correia, João Ricardo AU - Reis, Nogueira Zilma Silveira PY - 2019/03/28 TI - Pregnant Users? Perceptions of the Birth Plan Interface in the ?My Prenatal Care? App: Observational Validation Study JO - JMIR Form Res SP - e11374 VL - 3 IS - 1 KW - birth plan KW - perinatal care KW - usability, mobile health KW - mobile app KW - pregnancy KW - prenatal care KW - mobile phone N2 - Background: Birth plans are meant to be a declaration of the expectations and preferences of pregnant woman regarding childbirth. The My Prenatal Care app engages pregnant women in an educational intervention for a healthy pregnancy. We hypothesized that users? positive perception of an in-app birth plan is a relevant step for establishing direct communication between pregnant women and the health care team, based on an online report available on the app. Objective: This study aimed to evaluate pregnant women?s perception about the communicability of birth-plan preparation using a mobile app. Methods: This was an observational, exploratory, descriptive study. The methodology was user centered, and both qualitative and quantitative approaches were employed. The tools of the communicability evaluation method were applied. Overall, 11 pregnant women evaluated their experience of using a birth-plan prototype interface. The evaluation was performed in a controlled environment, with authorized video recording. There were 8 task-oriented interactions proposed to evaluate interface communicability with users when using the Birth Plan menu. For evaluating perceptions and experiences, a survey with structured and open-ended questions in addition to the free expression of participants was conducted. The primary outcomes assessed were interface communicability and user?s perception of the Birth Plan prototype interface in the My Prenatal Care mobile app. Secondarily, we involved users in the prototyping phase of the interface to identify bottlenecks for making improvements in the app. Results: Regarding users? performance in accomplishing previously prepared tasks, we found that 10 of 11 (91%) women were capable of completing at least 6 of 8 (75%) tasks. A positive relationship was found between the number of communicability problems and the success of completing the tasks. An analysis of the records revealed three communicability breakdowns related to the data entry, save, and scrollbar functions. The participants freely expressed suggestions for improvements such as for the save function and the process of sharing the birth-plan form upon completion. Conclusions: Users had a positive perception of the Birth Plan menu of the My Prenatal Care app. This user-centered validation enabled the identification of solutions for problems, resulting in improvements in the app. UR - http://formative.jmir.org/2019/1/e11374/ UR - http://dx.doi.org/10.2196/11374 UR - http://www.ncbi.nlm.nih.gov/pubmed/30920372 ID - info:doi/10.2196/11374 ER - TY - JOUR AU - Doarn, R. Charles AU - Vonder Meulen, Beth Mary AU - Pallerla, Harini AU - Acquavita, P. Shauna AU - Regan, Saundra AU - Elder, Nancy AU - Tubb, R. Matthew PY - 2019/03/29 TI - Challenges in the Development of e-Quit worRx: An iPad App for Smoking Cessation Counseling and Shared Decision Making in Primary Care JO - JMIR Form Res SP - e11300 VL - 3 IS - 1 KW - mobile health KW - smoking cessation KW - primary care KW - decision aid N2 - Background: Smoking is the leading preventable cause of morbidity and mortality in the United States, killing more than 450,000 Americans. Primary care physicians (PCPs) have a unique opportunity to discuss smoking cessation evidence in a way that enhances patient-initiated change and quit attempts. Patients today are better equipped with technology such as mobile devices than ever before. Objective: The aim of this study was to evaluate the challenges in developing a tablet-based, evidence-based smoking cessation app to optimize interaction for shared decision making between PCPs and their patients who smoke. Methods: A group of interprofessional experts developed content and a graphical user interface for the decision aid and reviewed these with several focus groups to determine acceptability and usability in a small population. Results: Using a storyboard methodology and subject matter experts, a mobile app, e-Quit worRx, was developed through an iterative process. This iterative process helped finalize the content and ergonomics of the app and provided valuable feedback from both patients and provider teams. Once the app was made available, other technical and programmatic challenges arose. Conclusions: Subject matter experts, although generally amenable to one another?s disciplines, are often challenged with effective interactions, including language, scope, clinical understanding, technology awareness, and expectations. The successful development of this app and its evaluation in a clinical setting highlighted those challenges and reinforced the need for effective communications and team building. UR - https://formative.jmir.org/2019/1/e11300/ UR - http://dx.doi.org/10.2196/11300 UR - http://www.ncbi.nlm.nih.gov/pubmed/30924783 ID - info:doi/10.2196/11300 ER - TY - JOUR AU - Leary, P. Miriam AU - Clegg, N. Emily AU - Santella, E. Madison AU - Murray, J. Pamela AU - Downs, S. Julie AU - Olfert, D. Melissa PY - 2019/03/01 TI - Consumption of Health-Related Content on Social Media Among Adolescent Girls: Mixed-Methods Pilot Study JO - JMIR Form Res SP - e11404 VL - 3 IS - 1 KW - adolescent KW - female KW - social media KW - health information KW - health behaviors N2 - Background: Consumption of health- and fitness-related social media content is a predominant behavior among teenage girls, which puts them at risk for consuming unreliable health-related information. Objective: This mixed-methods study (qualitative and quantitative) assessed health behavior attitudes and practices as well as social media use among adolescent girls. Additionally, similar practices and behaviors of adults who regularly interact with this population were studied. Methods: Girls aged 12-18 years were recruited to complete a 28-item survey and participate in a 45- to 60-minute focus group. Adults who regularly interact with adolescent girls, including parents, teachers, and healthcare professionals, were recruited from the local community and given a link to provide online consent and complete a survey. Results: A total of 27 adolescent girls participated in one of nine focus groups. Participants included 18 high school (age: mean 16.1 years; SD 1.3 years) and 9 middle school (age: mean 12.4 years; SD 0.7 years) girls. Eleven adults completed the online survey. Adolescents used social media to communicate and connect with friends, rather than as a source of health information. Although adolescents may see health-related content, most do not follow health-related pages or share such pages themselves, and fewer are actively searching for this information. Adolescents tend to trust information from familiar sources, and the participants reported that they do not follow official news accounts. Adults considered modeling and discussing healthy behaviors important and reportedly expected adolescents to see some level of health-related, especially fitness-related, content on social media. Conclusions: Education interventions are warranted for both adolescents and adults with whom adolescent girls regularly interact, in the areas of sedentary behavior to guide them to access reliable online health-related information and be judicious consumers of online health information. UR - http://formative.jmir.org/2019/1/e11404/ UR - http://dx.doi.org/10.2196/11404 UR - http://www.ncbi.nlm.nih.gov/pubmed/30821696 ID - info:doi/10.2196/11404 ER -