@Article{info:doi/10.2196/36949,
author="Jarvis, Tamika
and Mah, L. Allison M.
and Wang, H. Rosalie
and Wilson, G. Michael",
title="Web-Based System Navigation Database to Support Equitable Access to Assistive Technology: Usability Testing Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="3",
volume="6",
number="11",
pages="e36949",
keywords="assistive technology",
keywords="program funding",
keywords="usability testing",
keywords="internet",
keywords="web-based database",
keywords="health services",
abstract="Background: Assistive technology (AT) can contribute to how individuals participate and engage in everyday activities, such as communication and mobility, and facilitates access to the services they require. Navigating Canada's AT system has been described as fragmented and complex, presenting barriers for individuals who require AT, caregivers, and health service providers. AccessATCanada was developed as a centralized web-based resource to help support access to AT by providing information about the existing jurisdictional funding programs and services. Objective: This study aimed to evaluate the usability of AccessATCanada by gathering feedback about its features, functionality, and areas of strength and opportunity from potential end users. Methods: A usability testing study using a think-aloud approach and semistructured interviews was conducted to measure the effectiveness and efficiency of and user satisfaction with AccessATCanada and to identify issues with the interface during end-user interaction. A qualitative thematic analysis was used to generate insights into and core themes about user experiences. User feedback was used to inform subsequent updates of the database with the goal of enhancing website friendliness and functionality before its official launch. Results: A total of 10 participants (6 consumers, 1 caregiver, and 3 providers) participated in the usability testing study. The usability performance and scores tended to improve between the 2 testing cycles. Most participants were able to successfully complete all the tasks independently. The efficiency scores tended to improve as the users continued to engage with the interface. The website received an overall System Usability Score of 62.22, which was ranked as ``OK/fair to good.'' The users provided an overall positive evaluation of the beta version of the web-based resource tested over 2 cycles and helped to identify areas for improvement. They commented on the functionality and added value of the website, discovery of new programs and resources, and design aesthetics. Most usability issues were reported as minor challenges related to presentation, functionality, and language, and feedback was adopted into later iterations of the website. Conclusions: This study provides reflections on the value of usability testing and elements that are key to the creation of user-centered resources, such as the inclusion of participants with various abilities and considerations regarding website design and accessibility in an increasingly web-based world. AccessATCanada is now part of a growing global response to expand the reach of AT programs and services, improve the equity of access to AT, and reduce the complexity of navigating AT systems. ",
doi="10.2196/36949",
url="https://formative.jmir.org/2022/11/e36949",
url="http://www.ncbi.nlm.nih.gov/pubmed/36326813"
}


@Article{info:doi/10.2196/39637,
author="Timmers, Thomas
and van der Weegen, Walter
and Janssen, Loes
and Kremer, Jan
and Kool, Bertijn Rudolf",
title="Importance of Patient Involvement in Creating Content for eHealth Interventions: Qualitative Case Report in Orthopedics",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="3",
volume="6",
number="11",
pages="e39637",
keywords="eHealth",
keywords="qualitative research",
keywords="qualitative",
keywords="focus group",
keywords="knee",
keywords="surgery",
keywords="feedback",
keywords="user need",
keywords="patient need",
keywords="user centered",
keywords="content codevelopment",
keywords="patient involvement",
keywords="co-design",
keywords="participatory",
keywords="app design",
keywords="mobile health",
keywords="mHealth",
keywords="health app",
keywords="orthopedic",
keywords="mobile phone",
abstract="Background: In many industries, collaboration with end users is a standard practice when developing or improving a product or service. This process aims for a much better understanding of who the end user is and how the product or service could be of added value to them. Although patient (end user) involvement in the development of eHealth apps is increasing, this involvement has mainly focused on the design, functionalities, usability, and readability of its content thus far. Although this is very important, it does not ensure that the content provided aligns with patients' priorities. Objective: In this study, we aimed to explore the added value of patient involvement in developing the content for an eHealth app. By comparing the findings from this study with the existing app, we aimed to identify the additional informational needs of patients. In addition, we aimed to help improve the content of apps that are already available for patients with knee replacements, including the app our group studied in 2019. Methods: Patients from a large Dutch orthopedic clinic participated in semistructured one-on-one interviews and a focus group session. All the patients had undergone knee replacement surgery in the months before the interviews, had used the app, and were therefore capable of discussing what information they missed or wished for before and after the surgery. The output was inductively organized into larger themes and an overview of suggestions for improvement. Results: The interviews and focus group session with 11 patients identified 6 major themes and 30 suggestions for improvement, ranging from information for better management of expectations to various practical needs during each stage of the treatment. The outcomes were discussed with the medical staff for learning purposes and properly translated into an improved version of the app's content. Conclusions: In this study, patients identified many suggestions for improvement, demonstrating the added value of involving patients when creating the content of eHealth interventions. In addition, our study demonstrates that a relatively small group of patients can contribute to improving an app's content from the patient's perspective. Given the growing emphasis on patients' self-management, it is crucial that the information they receive is not only relevant from a health care provider's perspective but also aligns with what really matters to patients. Trial Registration: Netherlands Trial Register NL8295; https://trialsearch.who.int/Trial2.aspx?TrialID=NL8295 ",
doi="10.2196/39637",
url="https://formative.jmir.org/2022/11/e39637",
url="http://www.ncbi.nlm.nih.gov/pubmed/36326799"
}


@Article{info:doi/10.2196/35864,
author="Hunter, Inga
and Lockhart, Caroline
and Rao, Vasudha
and Tootell, Beth
and Wong, Samuel",
title="Enabling Rural Telehealth for Older Adults in Underserved Rural Communities: Focus Group Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="4",
volume="6",
number="11",
pages="e35864",
keywords="access",
keywords="choice",
keywords="trust",
keywords="telehealth",
keywords="rural",
keywords="barriers",
keywords="enablers",
keywords="underserved populations",
keywords="underserved",
keywords="equity",
keywords="elder",
keywords="older adult",
keywords="eHealth",
keywords="telemedicine",
keywords="barrier",
keywords="enabler",
keywords="facilitator",
keywords="focus group",
abstract="Background: Telehealth is often suggested to improve access to health care and has had significant publicity worldwide during the COVID-19 pandemic. However, limited studies have examined the telehealth needs of underserved populations such as rural communities. Objective: This study aims to investigate enablers for telehealth use in underserved rural populations to improve access to health care for rural older adults. Methods: In total, 7 focus group discussions and 13 individual interviews were held across 4 diverse underserved rural communities. A total of 98 adults aged ?55 years participated. The participants were asked whether they had used telehealth, how they saw their community's health service needs evolving, how telehealth might help provide these services, and how they perceived barriers to and enablers of telehealth for older adults in rural communities. Focus group transcripts were thematically analyzed. Results: The term telehealth was not initially understood by many participants and required an explanation. Those who had used telehealth reported positive experiences (time and cost savings) and were likely to use telehealth again. A total of 2 main themes were identified through an equity lens. The first theme was trust, with 3 subthemes---trust in the telehealth technology, trust in the user (consumer and health provider), and trust in the health system. Having access to reliable and affordable internet connectivity and digital devices was a key enabler for telehealth use. Most rural areas had intermittent and unreliable internet connectivity. Another key enabler is easy access to user support. Trust in the health system focused on waiting times, lack of and/or delayed communication and coordination, and cost. The second theme was choice, with 3 subthemes---health service access, consultation type, and telehealth deployment. Access to health services through telehealth needs to be culturally appropriate and enable access to currently limited or absent services such as mental health and specialist services. Accessing specialist care through telehealth was extremely popular, although some participants preferred to be seen in person. A major enabler for telehealth was telehealth deployment by a fixed community hub or on a mobile bus, with support available, particularly when combined with non--health-related services such as internet banking. Conclusions: Overall, participants were keen on the idea of telehealth. Several barriers and enablers were identified, particularly trust and choice. The term telehealth is not well understood. The unreliable and expensive connectivity options available to rural communities have limited telehealth experience to phone or patient portal use for those with connectivity. Having the opportunity to try telehealth, particularly by using video, would increase the understanding and acceptance of telehealth. This study highlights that local rural communities need to be involved in designing telehealth services within their communities. ",
doi="10.2196/35864",
url="https://formative.jmir.org/2022/11/e35864",
url="http://www.ncbi.nlm.nih.gov/pubmed/36331533"
}


@Article{info:doi/10.2196/37280,
author="Campo, David
and Elie, Valery
and de Gallard, Tristan
and Bartet, Pierre
and Morichau-Beauchant, Tristan
and Genain, Nicolas
and Fayol, Antoine
and Fouassier, David
and Pasteur-Rousseau, Adrien
and Puymirat, Etienne
and Nahum, Julien",
title="Atrial Fibrillation Detection With an Analog Smartwatch: Prospective Clinical Study and Algorithm Validation",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="4",
volume="6",
number="11",
pages="e37280",
keywords="atrial fibrillation",
keywords="mobile health",
keywords="mHealth",
keywords="diagnosis",
keywords="electrocardiogram",
keywords="ECG",
keywords="smartwatch",
keywords="smart technology",
keywords="wearable",
keywords="cardiology",
keywords="cardiac",
keywords="heart failure",
keywords="heart disease",
keywords="cardiovascular",
keywords="morbidity",
keywords="automatic detection",
keywords="algorithm",
keywords="physician",
keywords="sensor",
keywords="digital health",
abstract="Background: Atrial fibrillation affects approximately 4\% of the world's population and is one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity. It can be difficult to diagnose when asymptomatic or in the paroxysmal stage, and its natural history is not well understood. New wearables and connected devices offer an opportunity to improve on this situation. Objective: We aimed to validate an algorithm for the automatic detection of atrial fibrillation from a single-lead electrocardiogram taken with a smartwatch. Methods: Eligible patients were recruited from 4 sites in Paris, France. Electrocardiograms (12-lead reference and single lead) were captured simultaneously. The electrocardiograms were reviewed by independent, blinded board-certified cardiologists. The sensitivity and specificity of the algorithm to detect atrial fibrillation and normal sinus rhythm were calculated. The quality of single-lead electrocardiograms (visibility and polarity of waves, interval durations, heart rate) was assessed in comparison with the gold standard (12-lead electrocardiogram). Results: A total of 262 patients (atrial fibrillation: n=100, age: mean 74.3 years, SD 12.3; normal sinus rhythm: n=113, age: 61.8 years, SD 14.3; other arrhythmia: n=45, 66.9 years, SD 15.2; unreadable electrocardiograms: n=4) were included in the final analysis; 6.9\% (18/262) were classified as Noise by the algorithm. Excluding other arrhythmias and Noise, the sensitivity for atrial fibrillation detection was 0.963 (95\% CI lower bound 0.894), and the specificity was 1.000 (95\% CI lower bound 0.967). Visibility and polarity accuracies were similar (1-lead electrocardiogram: P waves: 96.9\%, QRS complexes: 99.2\%, T waves: 91.2\%; 12-lead electrocardiogram: P waves: 100\%, QRS complexes: 98.8\%, T waves: 99.5\%). P-wave visibility accuracy was 99\% (99/100) for patients with atrial fibrillation and 95.7\% (155/162) for patients with normal sinus rhythm, other arrhythmias, and unreadable electrocardiograms. The absolute values of the mean differences in PR duration and QRS width were <3 ms, and more than 97\% were <40 ms. The mean difference between the heart rates from the 1-lead electrocardiogram calculated by the algorithm and those calculated by cardiologists was 0.55 bpm. Conclusions: The algorithm demonstrated great diagnostic performance for atrial fibrillation detection. The smartwatch's single-lead electrocardiogram also demonstrated good quality for physician use in daily routine care. Trial Registration: ClinicalTrials.gov NCT04351386; http://clinicaltrials.gov/ct2/show/NCT04351386 ",
doi="10.2196/37280",
url="https://formative.jmir.org/2022/11/e37280",
url="http://www.ncbi.nlm.nih.gov/pubmed/35481559"
}


@Article{info:doi/10.2196/38164,
author="Darville-Sanders, Gabrielle
and Reinoso, Humberto
and MacInnes, Jann
and Corluyan, Emilie
and Munroe, Dominique
and Mathis, W. Mary
and Madden, Lamarca Suzie
and Hamrick, Johnathan
and Dickerson, Lisa
and Gaddis, Cheryl",
title="HPV Vaccine Communication Competency Scale for Medical Trainees: Interdisciplinary Development Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="4",
volume="6",
number="11",
pages="e38164",
keywords="human papillomavirus",
keywords="HPV",
keywords="HPV vaccine",
keywords="provider communication",
keywords="medical trainees",
keywords="immunization",
keywords="vaccine",
keywords="communication",
keywords="student",
keywords="sexually transmitted infection",
keywords="STI",
keywords="United States of America",
keywords="USA",
keywords="young adult",
keywords="teen",
keywords="patient",
keywords="parent",
keywords="mobile phone",
abstract="Background: Human papillomavirus (HPV) infection is the most common sexually transmitted infection in the United States. High-risk HPV strains are associated with cancer of the cervix, oropharynx, anus, rectum, penis, vagina, and vulva. To combat increasing HPV-related cancers, the 9-valent HPV vaccine Gardasil was developed. Recommendation of the HPV vaccine by a health care provider has been cited as the number one factor affecting vaccine uptake among adolescents and young adults. Physician assistants, nurse practitioners, and pharmacists have been enlisted to bridge the gap. Objective: The specific aim of this research study was to develop a reliable and valid HPV vaccine communication scale that can be used to measure the competency of primary care providers when recommending the need for vaccination to parents and patients. Methods: Using a descriptive study, we collected data via a literature review, focus groups, and an expert panel to inform the scale domains and blueprint design. Pretesting (cognitive interviews) was used to inform item revision decisions. An item analysis was also conducted for the responses provided in the cognitive interviews. Item statistics (means and SDs), interitem correlations, and reliability were examined. Data were analyzed using SPSS (IBM Corp) software. Results: A valid and reliable 42-item HPV vaccine communication competency scale was developed. The scale included 6 domains of interest. Scale items were moderately to strongly correlated with one another, and Cronbach $\alpha$ indicated good internal consistency with each scale. Scale items included were related to provider introduction or rapport ($\alpha$=.796), patient respect or empathy ($\alpha$=.737), provider interview or intake ($\alpha$=.9), patient counseling or education ($\alpha$=.935), provider communication closure ($\alpha$=.896), and provider knowledge ($\alpha$=.824). Conclusions: Pharmacists, nurse practitioners, and physician assistants should be trained to be competent in HPV vaccine communication and recommendation due to their expanded roles. Interdisciplinary collaboration is important to account for the trainee's individual differences and ensure the best health care outcomes for patients. A standardized HPV communication scale can be used to ensure effective and consistent recommendation by health care providers, thus affecting immunization rates. ",
doi="10.2196/38164",
url="https://formative.jmir.org/2022/11/e38164",
url="http://www.ncbi.nlm.nih.gov/pubmed/36331545"
}


@Article{info:doi/10.2196/39511,
author="Paetzold, Isabell
and Schick, Anita
and Rauschenberg, Christian
and Hirjak, Dusan
and Banaschewski, Tobias
and Meyer-Lindenberg, Andreas
and Butz, Sebastian
and Floesser, Chiara
and Schueltke, Leonie
and Boehnke, Rasmus Jan
and Boecking, Benjamin
and Reininghaus, Ulrich",
title="A Hybrid Ecological Momentary Compassion--Focused Intervention for Enhancing Resilience in Help-Seeking Young People: Prospective Study of Baseline Characteristics in the EMIcompass Trial",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="4",
volume="6",
number="11",
pages="e39511",
keywords="mobile health intervention",
keywords="mHealth intervention",
keywords="digital intervention",
keywords="just-in-time adaptive intervention",
keywords="JITAI",
keywords="blended care",
keywords="public mental health",
keywords="inclusiveness",
keywords="transdiagnostic",
keywords="clinical staging",
keywords="intervention manual",
keywords="mobile phone",
abstract="Background: Young people are a target population for mental health--related early intervention and prevention. Although evidence for early intervention is promising, availability of and access to youth mental health services remain limited. Therefore, the development of an evidence-based hybrid intervention is urgently needed. Objective: This study aimed to present a manual for a hybrid intervention, combining an ecological momentary intervention and face-to-face sessions aimed for enhancing resilience in help-seeking young people based on compassion-focused interventions, and explore whether participants' baseline characteristics are associated with putative mechanisms and outcomes of the EMIcompass intervention. Specifically, we aimed to explore initial signals as to whether participants' sociodemographic, clinical, and functional characteristics at baseline are associated with putative mechanisms (ie, change in self-compassion, change in emotion regulation, working alliance, training frequency); and whether participants' sociodemographic, clinical, and functional characteristics, self-compassion, and emotion regulation at baseline are associated with clinical outcomes (ie, psychological distress and general psychopathology at postintervention and 4-week follow-ups) in the experimental condition and obtain first parameter estimates. Methods: We recruited young people aged 14 to 25 years, with psychological distress, Clinical High At-Risk Mental State, or first episodes of severe mental disorder for an exploratory randomized controlled trial with assessments at baseline and postintervention and 4-week follow-ups. A structured manual was developed and optimized based on a pilot study's manual, a scoping review of existing literature and manuals, exchange with experts, the team's clinical experience of working with compassion-focused interventions, and the principles of ecological momentary interventions. This analysis focuses on the experimental condition receiving the EMIcompass intervention. Results: A total of 46 young individuals were randomized to the experimental condition. There was evidence for initial signals of effects of age (B=0.11, 95\% CI 0.00-0.22), general psychopathology (B=0.08, 95\% CI ?0.01 to 0.16), and clinical stage (B=1.50, 95\% CI 0.06-2.93) on change in momentary self-compassion and change in emotion regulation from baseline to postintervention assessments. There was no evidence for associations of other baseline characteristics (eg, gender, minority status, and level of functioning) and putative mechanisms (eg, overall self-compassion, working alliance, and training frequency). In addition, except for an initial signal for an association of momentary self-compassion at baseline and psychological distress (B=?2.83, 95\% CI ?5.66 to 0.00), we found no evidence that baseline characteristics related to clinical outcomes. Conclusions: The findings indicated the reach of participants by the intervention largely independent of sociodemographic, clinical, and functional baseline characteristics. The findings need to be confirmed in a definitive trial. Trial Registration: German Clinical Trials Register NDRKS00017265; https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00017265 International Registered Report Identifier (IRRID): RR2-10.2196/27462 ",
doi="10.2196/39511",
url="https://formative.jmir.org/2022/11/e39511",
url="http://www.ncbi.nlm.nih.gov/pubmed/36331526"
}


@Article{info:doi/10.2196/33638,
author="Bulzacchelli, T. Maria
and Bellantoni, M. Jenna
and McCue, Leigh
and Dzugan, Jerry",
title="The Receptivity to Safety-Related Mobile Apps Among Commercial Fishing Captains: Descriptive Exploratory Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="8",
volume="6",
number="11",
pages="e33638",
keywords="mobile app",
keywords="mobile device",
keywords="mobile phone",
keywords="smartphone",
keywords="safety",
keywords="workplace safety",
keywords="occupational safety",
keywords="mobile health",
keywords="mHealth",
keywords="commercial fishing",
keywords="cross-sectional study",
abstract="Background: Mobile apps addressing a variety of workplace safety issues have proliferated over the last decade as mobile technology has advanced and smartphone ownership has increased. Workplace safety interventions are often designed for a specific work site. However, some of the most dangerous jobs are ones in which workers frequently change field locations, such as commercial fishing. Mobile apps may be particularly suitable for delivering safety interventions to these workers. Objective: We sought to gauge the potential for using mobile apps to deliver safety interventions to commercial fishing workers. The purpose of this paper is to describe how fishermen use their mobile devices during fishing operations and identify any mobile apps they already use for safety. Methods: Participants comprised commercial fishing captains who already owned an iOS or Android smartphone or tablet. They completed a questionnaire that asked about their current mobile device use and their use of safety-related mobile apps, in addition to questions about their fishing operations. We performed descriptive analyses of the data. Results: A total of 61 participants completed the questionnaire. The most common types of mobile devices participants reported owning were iPhones (n=36, 59\%) and Android phones (n=24, 39\%). Most participants (n=53, 87\%) reported using their mobile device for both work and personal purposes, including while out at sea (n=52, 85\%). Over half of the participants reported that they had either safety-related apps (n=17, 28\%) or apps that help them with their work (n=35, 57\%). The types of apps most frequently mentioned were apps for weather, wind, tides, and navigation. Conclusions: The results of this study indicate that some commercial fishing captains who own a mobile device are receptive to using safety-related apps for work. Apps that help avoid hazards by monitoring environmental conditions and apps optimized for use on smartphones may be most likely to be adopted and used. Overall, these results suggest that mobile apps are a promising avenue for improving safety among workers in commercial fishing and similar occupations. ",
doi="10.2196/33638",
url="https://formative.jmir.org/2022/11/e33638",
url="http://www.ncbi.nlm.nih.gov/pubmed/36346649"
}


@Article{info:doi/10.2196/37865,
author="Dauber, Sarah
and Hammond, Cori
and Hogue, Aaron
and Henderson, Craig
and Nugent, Jessica
and Ford, Veronica
and Brown, Jill
and Scott, Lenore
and Ondersma, Steven",
title="Development of an Electronic Screening and Brief Intervention to Address Perinatal Substance Use in Home Visiting: Qualitative User-Centered Approach",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="8",
volume="6",
number="11",
pages="e37865",
keywords="pregnant women",
keywords="postpartum women",
keywords="home visiting",
keywords="substance use",
keywords="computerized intervention",
keywords="mobile health",
keywords="mobile phone",
abstract="Background: Perinatal substance use (SU) is prevalent during pregnancy and the postpartum period and may increase the risks to maternal and child health. Many pregnant and postpartum women do not seek treatment for SU because of fear of child removal. Home visiting (HV), a voluntary supportive program for high-risk families during the perinatal period, is a promising avenue for addressing unmet SU needs. Confidential delivery of screening and brief intervention (BI) for SU via computers has demonstrated high user satisfaction among pregnant and postpartum women as well as efficacy in reducing perinatal SU. This study describes the development of the electronic screening and BI for HV (e--SBI-HV), a digital screening and BI program that is adapted from an existing electronic screening and BI (e-SBI) for perinatal SU and tailored to the HV context. Objective: This study aimed to describe the user-centered intervention development process that informed the adaptation of the original e-SBI into the e--SBI-HV, present specific themes extracted from the user-centered design process that directly informed the e--SBI-HV prototype and describe the e--SBI-HV prototype. Methods: Adaptation of the original e-SBI into the e--SBI-HV followed a user-centered design process that included 2 phases of interviews with home visitors and clients. The first phase focused on adaptation and the second phase focused on refinement. Themes were extracted from the interviews using inductive coding methods and systematically used to inform e--SBI-HV adaptations. Participants included 17 home visitors and 7 clients across 3 Healthy Families America programs in New Jersey. Results: The e--SBI-HV is based on an existing e-SBI for perinatal SU that includes screening participants for SU followed by a brief motivational intervention. On the basis of the themes extracted from the user-centered design process, the original e-SBI was adapted to address population-specific motivating factors, address co-occurring problems, address concerns about confidentiality, acknowledge fear of child protective services, capitalize on the home visitor--client relationship, and provide information about SU treatment while acknowledging that many clients prefer not to access the formal treatment system. The full e--SBI-HV prototype included 2 digital intervention sessions and home visitor facilitation protocols. Conclusions: This study describes a user-centered approach for adapting an existing e-SBI for SU for use in the HV context. Despite the described challenges, home visitors and clients generally reacted favorably to the e--SBI-HV, noting that it has the potential to fill a significant gap in HV services. If proven effective, the e--SBI-HV could provide a way for clients to receive help with SU within HV, while maintaining their privacy and avoiding the overburdening of home visitors. The next step in this study would be to test the feasibility and preliminary efficacy of the e--SBI-HV. ",
doi="10.2196/37865",
url="https://formative.jmir.org/2022/11/e37865",
url="http://www.ncbi.nlm.nih.gov/pubmed/36346648"
}


@Article{info:doi/10.2196/35447,
author="Kim, H. Lawrence
and Saha, Gourab
and Leon, Amelia Annel
and King, C. Abby
and Mauriello, Louis Matthew
and Paredes, E. Pablo",
title="Shared Autonomy to Reduce Sedentary Behavior Among Sit-Stand Desk Users in the United States and India: Web-Based Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="9",
volume="6",
number="11",
pages="e35447",
keywords="shared autonomy",
keywords="automation",
keywords="sedentary behavior",
keywords="sit-stand desk",
keywords="nonvolitional behavior change",
keywords="culture",
abstract="Background: Fitness technologies such as wearables and sit-stand desks are increasingly being used to fight sedentary lifestyles by encouraging physical activity. However, adherence to such technologies decreases over time because of apathy and increased dismissal of behavioral nudges. Objective: To address this problem, we introduced shared autonomy in the context of sit-stand desks, where user input is integrated with robot autonomy to control the desk and reduce sedentary behavior and investigated user reactions and preferences for levels of automation with a sit-stand desk. As demographics affect user acceptance of robotic technology, we also studied how perceptions of nonvolitional behavior change differ across cultures (United States and India), sex, familiarity, dispositional factors, and health priming messages. Methods: We conducted a web-based vignette study in the United States and India where a total of 279 participants watched video vignettes of a person interacting with sit-stand desks of various levels of automation and answered questions about their perceptions of the desks such as ranking of the different levels of automation. Results: Participants generally preferred either manual or semiautonomous desks over the fully autonomous option (P<.001). However, participants in India were generally more amenable to the idea of nonvolitional interventions from the desk than participants in the United States (P<.001). Male participants had a stronger desire for having control over the desk than female participants (P=.01). Participants who were more familiar with sit-stand desks were more likely to adopt autonomous sit-stand desks (P=.001). No effects of health priming messages were observed. We estimated the projected health outcome by combining ranking data and hazard ratios from previous work and found that the semiautonomous desk led to the highest projected health outcome. Conclusions: These results suggest that the shared autonomy desk is the optimal level of automation in terms of both user preferences and estimated projected health outcomes. Demographics such as culture and sex had significant effects on how receptive users were to autonomous intervention. As familiarity improves the likelihood of adoption, we propose a gradual behavior change intervention to increase acceptance and adherence, especially for populations with a high desire for control. ",
doi="10.2196/35447",
url="https://formative.jmir.org/2022/11/e35447",
url="http://www.ncbi.nlm.nih.gov/pubmed/36350687"
}


@Article{info:doi/10.2196/33676,
author="Sterling, Andrew William
and Sobolev, Michael
and Van Meter, Anna
and Guinart, Daniel
and Birnbaum, L. Michael
and Rubio, M. Jose
and Kane, M. John",
title="Digital Technology in Psychiatry: Survey Study of Clinicians",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="10",
volume="6",
number="11",
pages="e33676",
keywords="digital psychiatry",
keywords="passive monitoring technology",
keywords="digital phenotype",
keywords="psychiatry",
keywords="mental health",
keywords="clinicians",
keywords="clinician perspectives",
keywords="digital health",
keywords="physicians",
keywords="psychiatrists",
abstract="Background: Digital technology has the potential?to transform psychiatry, but its adoption has been?limited. The proliferation of telepsychiatry during the COVID-19 pandemic has increased the urgency of optimizing technology for clinical practice. Understanding clinician attitudes and preferences is crucial to?effective implementation and patient benefit. Objective: Our objective was to elicit clinician perspectives on emerging digital technology. Methods: Clinicians in a large psychiatry department (inpatient and outpatient) were invited to complete a web-based survey about their attitudes toward digital technology in practice, focusing on implementation, clinical benefits, and expectations about patients' attitudes. The survey consisted of 23 questions that could be answered on either a 3-point or 5-point Likert scale. We report the frequencies and percentages of responses. Results: In total, 139 clinicians completed the survey---they represent a variety of years of experience, credentials, and diagnostic subspecialties (response rate 69.5\%). Overall, 83.4\% (n=116) of them stated that digital data could improve their practice, and 23.0\% (n=32) of responders reported that they had viewed patients' profiles on social media. Among anticipated benefits, clinicians rated symptom self-tracking (n=101, 72.7\%) as well as clinical intervention support (n=90, 64.7\%) as most promising. Among anticipated challenges, clinicians mostly expressed concerns over greater time demand (n=123, 88.5\%) and whether digital data would be actionable (n=107, 77\%). Furthermore, 95.0\% (n=132) of clinicians expected their patients to share digital data. Conclusions: Overall, clinicians reported a positive attitude toward the use of digital data to not only improve patient outcomes but also highlight significant barriers that implementation would need to overcome. Although clinicians' self-reported attitudes about digital technology may not necessarily translate into behavior, our results suggest that technologies that reduce clinician burden and are easily interpretable have the greatest likelihood of uptake. ",
doi="10.2196/33676",
url="https://formative.jmir.org/2022/11/e33676",
url="http://www.ncbi.nlm.nih.gov/pubmed/36355414"
}


@Article{info:doi/10.2196/40507,
author="Magee, R. Michael
and Gholamrezaei, Ali
and McNeilage, G. Amy
and Sim, Alison
and Dwyer, Leah
and Ferreira, L. Manuela
and Darnall, D. Beth
and Glare, Paul
and Ashton-James, E. Claire",
title="A Digital Video and Text Messaging Intervention to Support People With Chronic Pain During Opioid Tapering: Content Development Using Co-design",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="10",
volume="6",
number="11",
pages="e40507",
keywords="chronic pain",
keywords="deprescribing",
keywords="tapering",
keywords="dose reduction",
keywords="opioids",
keywords="mHealth",
keywords="mobile health",
keywords="SMS",
keywords="text messaging",
keywords="digital health",
keywords="behavior change",
keywords="self-efficacy",
keywords="consumer engagement",
keywords="co-design",
keywords="coproduction",
abstract="Background: People living with chronic pain report that tapering prescribed opioids is challenging and more support is needed. In our formative research, consumers indicated that mobile health (mHealth) technology could be an acceptable form of support for opioid tapering and may improve tapering self-efficacy. Objective: We aimed to evaluate and improve the content of an mHealth intervention before pilot-testing, based on consumer and clinician feedback. Methods: Participants were 12 consumers and 12 clinicians who evaluated an initial draft of a video script and 90 SMS text messages. Consumers and clinicians rated the appropriateness and likely usefulness (consumers) or likely effectiveness (clinicians) of a video script and a random selection of 15 SMS text messages using a 5-point Likert-type scale (1=totally disagree; 5=totally agree). Each draft SMS text message was reviewed by 2 consumers and 2 clinicians. Texts were deemed acceptable for inclusion in the pilot intervention only if the summed participant ratings of text appropriateness and usefulness or effectiveness were ?8. Participants were also invited to provide open-text feedback on the draft script and SMS text messages. Results: Consumers generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.4, SD 0.52; text: mean 4.3, SD 0.79) and useful (video: mean 4.3, SD 0.65; text: mean 4.2, SD 0.84). Similarly, clinicians generally agreed that the draft video script and text content were likely to be appropriate (video: mean 4.5, SD 0.67; text: mean 4.4, SD 0.81) and effective (video: mean 4.0, SD 0.43; text: mean 4.3, SD 0.76). Overall, 77\% (69/90) of the draft texts met the threshold rating for acceptability for inclusion in the pilot test of mHealth intervention by consumers, and 82\% (74/90) met the threshold for acceptability by clinicians. Consumers' and clinicians' ratings were used to rank order the texts. The top 56 draft texts (all meeting the threshold levels of acceptability) were selected for inclusion in the pilot intervention. When consumer or clinician feedback was provided, the texts meeting the criteria for inclusion in the pilot were further revised and improved. Feedback on the video script was also used to further improve the acceptability of the video script before pilot-testing the intervention. Conclusions: This study describes the process by which a 28-day mHealth intervention to support patients with chronic pain to taper opioid medications was evaluated and improved before pilot-testing. The mHealth intervention consisted of a 10-minute psychoeducational video about pain and opioid tapering and 56 unique SMS text messages providing information and reassurance (texts delivered twice per day for 28 days). Having established that the content of the mHealth intervention is acceptable to both consumer and clinician groups, the mHealth intervention will be piloted in future research. ",
doi="10.2196/40507",
url="https://formative.jmir.org/2022/11/e40507",
url="http://www.ncbi.nlm.nih.gov/pubmed/36355415"
}


@Article{info:doi/10.2196/41721,
author="Gliske, Kate
and Berry, R. Katie
and Ballard, Jaime
and Evans-Chase, Michelle
and Solomon, L. Phyllis
and Fenkel, Caroline",
title="Mental Health Outcomes for Youths With Public Versus Private Health Insurance Attending a Telehealth Intensive Outpatient Program: Quality Improvement Analysis",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="10",
volume="6",
number="11",
pages="e41721",
keywords="telehealth",
keywords="telepsychiatry",
keywords="telemedicine",
keywords="intensive outpatient",
keywords="remote outpatient",
keywords="mental health",
keywords="quality improvement",
keywords="routine outcome monitoring",
keywords="mental health treatment",
keywords="patient outcome",
keywords="outpatient program",
keywords="youth",
keywords="young adult",
keywords="depression",
keywords="suicidal ideation",
keywords="health outcome",
keywords="outcome monitoring",
abstract="Background: COVID-19 exacerbated a growing mental health crisis among youths and young adults, worsened by a lack of existing in-person options for high-acuity care. The emergence and growth of remote intensive outpatient programs (IOPs) is a solution to overcome geographic limitations to care. However, it remains unclear whether remote IOPs engender equivalent clinical outcomes among youths with public insurance (eg, Medicaid) versus private insurance (eg, commercial) given the disparities found in previous research on place-based treatment in both clinical and engagement outcomes. Objective: This analysis sought to establish, as part of ongoing quality improvement efforts, whether engagement and clinical outcomes among adolescents and young adults attending remote IOP treatment differed between youths with public and those with private insurance. The identification of disparities by payer type was used to inform programmatic decisions within the remote IOP system for which this quality improvement analysis was conducted. Methods: Pearson chi-square analyses and independent 2-tailed t tests were used to establish that the 2 groups defined by insurance type were equivalent on clinical outcomes (depression, suicidal ideation, and nonsuicidal self-injury [NSSI]) at intake and compare changes in clinical outcomes. McNemar chi-square analyses and repeated-measure 2-tailed t tests were used to assess changes in clinical outcomes between intake and discharge in the sample overall. In total, 495 clients who attended the remote IOP for youths and young adults in 14 states participated in ?7 treatment sessions, and completed intake and discharge surveys between July 2021 and April 2022 were included in the analysis. Results: Overall, the youths and young adults in the remote IOP attended a median of 91\% of their scheduled group sessions (mean 85.9\%, SD 16.48\%) and reported significantly fewer depressive symptoms at discharge (t447=12.51; P<.001). McNemar chi-square tests of change indicated significant reductions from intake to discharge in suicidal ideation (N=470, $\chi$21=104.4; P<.001), with nearly three-quarters of youths who reported active suicidal ideation at intake (200/468, 42.7\%) no longer reporting it at discharge (142/200, 71\%), and in NSSI (N=430, $\chi$21=40.7; P<.001), with more than half of youths who reported NSSI at intake (205/428, 47.9\%) reporting lower self-harm at discharge (119/205, 58\%). No significant differences emerged by insurance type in attendance (median public 89\%, median private 92\%; P=.10), length of stay (t416=?0.35; P=.73), or reductions in clinical outcomes (depressive symptom severity: t444=?0.87 and P=.38; active suicidal ideation: N=200, $\chi$21=0.6 and P=.49; NSSI frequency: t426=?0.98 and P=.33). Conclusions: Our findings suggest that youths and young adults who participated in remote IOP had significant reductions in depression, suicidal ideation, and NSSI. Given access to the same remote high-acuity care, youths and young adults on both public and private insurance engaged in programming at comparable rates and achieved similar improvements in clinical outcomes. ",
doi="10.2196/41721",
url="https://formative.jmir.org/2022/11/e41721",
url="http://www.ncbi.nlm.nih.gov/pubmed/36355428"
}


@Article{info:doi/10.2196/40765,
author="Li, Xueying Sophia
and Halabi, Ramzi
and Selvarajan, Rahavi
and Woerner, Molly
and Fillipo, Griffith Isabell
and Banerjee, Sreya
and Mosser, Brittany
and Jain, Felipe
and Are{\'a}n, Patricia
and Pratap, Abhishek",
title="Recruitment and Retention in Remote Research: Learnings From a Large, Decentralized Real-world Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="14",
volume="6",
number="11",
pages="e40765",
keywords="participant recruitment",
keywords="participant retention",
keywords="decentralized studies",
keywords="active and passive data collection",
keywords="retention",
keywords="adherence",
keywords="compliance",
keywords="engagement",
keywords="smartphone",
keywords="mobile health",
keywords="mHealth",
keywords="sensor data",
keywords="clinical research",
keywords="data sharing",
keywords="recruitment",
keywords="mobile phone",
abstract="Background: Smartphones are increasingly used in health research. They provide a continuous connection between participants and researchers to monitor long-term health trajectories of large populations at a fraction of the cost of traditional research studies. However, despite the potential of using smartphones in remote research, there is an urgent need to develop effective strategies to reach, recruit, and retain the target populations in a representative and equitable manner. Objective: We aimed to investigate the impact of combining different recruitment and incentive distribution approaches used in remote research on cohort characteristics and long-term retention. The real-world factors significantly impacting active and passive data collection were also evaluated. Methods: We conducted a secondary data analysis of participant recruitment and retention using data from a large remote observation study aimed at understanding real-world factors linked to cold, influenza, and the impact of traumatic brain injury on daily functioning. We conducted recruitment in 2 phases between March 15, 2020, and January 4, 2022. Over 10,000 smartphone owners in the United States were recruited to provide 12 weeks of daily surveys and smartphone-based passive-sensing data. Using multivariate statistics, we investigated the potential impact of different recruitment and incentive distribution approaches on cohort characteristics. Survival analysis was used to assess the effects of sociodemographic characteristics on participant retention across the 2 recruitment phases. Associations between passive data-sharing patterns and demographic characteristics of the cohort were evaluated using logistic regression. Results: We analyzed over 330,000 days of engagement data collected from 10,000 participants. Our key findings are as follows: first, the overall characteristics of participants recruited using digital advertisements on social media and news media differed significantly from those of participants recruited using crowdsourcing platforms (Prolific and Amazon Mechanical Turk; P<.001). Second, participant retention in the study varied significantly across study phases, recruitment sources, and socioeconomic and demographic factors (P<.001). Third, notable differences in passive data collection were associated with device type (Android vs iOS) and participants' sociodemographic characteristics. Black or African American participants were significantly less likely to share passive sensor data streams than non-Hispanic White participants (odds ratio 0.44-0.49, 95\% CI 0.35-0.61; P<.001). Fourth, participants were more likely to adhere to baseline surveys if the surveys were administered immediately after enrollment. Fifth, technical glitches could significantly impact real-world data collection in remote settings, which can severely impact generation of reliable evidence. Conclusions: Our findings highlight several factors, such as recruitment platforms, incentive distribution frequency, the timing of baseline surveys, device heterogeneity, and technical glitches in data collection infrastructure, that could impact remote long-term data collection. Combined together, these empirical findings could help inform best practices for monitoring anomalies during real-world data collection and for recruiting and retaining target populations in a representative and equitable manner. ",
doi="10.2196/40765",
url="https://formative.jmir.org/2022/11/e40765",
url="http://www.ncbi.nlm.nih.gov/pubmed/36374539"
}


@Article{info:doi/10.2196/36340,
author="Heiden, Emily
and Jones, Tom
and Brogaard Maczka, Annika
and Kapoor, Melissa
and Chauhan, Milan
and Wiffen, Laura
and Barham, Helen
and Holland, Jeremy
and Saxena, Manish
and Wegerif, Simon
and Brown, Thomas
and Lomax, Mitch
and Massey, Heather
and Rostami, Shahin
and Pearce, Laurence
and Chauhan, Anoop",
title="Measurement of Vital Signs Using Lifelight Remote Photoplethysmography: Results of the VISION-D and VISION-V Observational Studies",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="14",
volume="6",
number="11",
pages="e36340",
keywords="general practice",
keywords="vital signs/methods",
keywords="vital signs/standards",
keywords="photoplethysmography",
keywords="remote photoplethysmography",
keywords="Lifelight",
keywords="contactless",
keywords="software",
keywords="algorithm development",
keywords="algorithm",
keywords="blood pressure",
keywords="health monitoring",
keywords="health technology",
keywords="remote monitoring",
abstract="Background: The detection of early changes in vital signs (VSs) enables timely intervention; however, the measurement of VSs requires hands-on technical expertise and is often time-consuming. The contactless measurement of VSs is beneficial to prevent infection, such as during the COVID-19 pandemic. Lifelight is a novel software being developed to measure VSs by remote photoplethysmography based on video captures of the face via the integral camera on mobile phones and tablets. We report two early studies in the development of Lifelight. Objective: The objective of the Vital Sign Comparison Between Lifelight and Standard of Care: Development (VISION-D) study (NCT04763746) was to measure respiratory rate (RR), pulse rate (PR), and blood pressure (BP) simultaneously by using the current standard of care manual methods and the Lifelight software to iteratively refine the software algorithms. The objective of the Vital Sign Comparison Between Lifelight and Standard of Care: Validation (VISION-V) study (NCT03998098) was to validate the use of Lifelight software to accurately measure VSs. Methods: BP, PR, and RR were measured simultaneously using Lifelight, a sphygmomanometer (BP and PR), and the manual counting of RR. Accuracy performance targets for each VS were defined from a systematic literature review of the performance of state-of-the-art VSs technologies. Results: The VISION-D data set (17,233 measurements from 8585 participants) met the accuracy targets for RR (mean error 0.3, SD 3.6 vs target mean error 2.3, SD 5.0; n=7462), PR (mean error 0.3, SD 4.0 vs mean error 2.2, SD 9.2; n=10,214), and diastolic BP (mean error ?0.4, SD 8.5 vs mean error 5.5, SD 8.9; n=8951); for systolic BP, the mean error target was met but not the SD (mean error 3.5, SD 16.8 vs mean error 6.7, SD 15.3; n=9233). Fitzpatrick skin type did not affect accuracy. The VISION-V data set (679 measurements from 127 participants) met all the standards: mean error ?0.1, SD 3.4 for RR; mean error 1.4, SD 3.8 for PR; mean error 2.8, SD 14.5 for systolic BP; and mean error ?0.3, SD 7.0 for diastolic BP. Conclusions: At this early stage in development, Lifelight demonstrates sufficient accuracy in the measurement of VSs to support certification for a Level 1 Conformit{\'e} Europ{\'e}enne mark. As the use of Lifelight does not require specific training or equipment, the software is potentially useful for the contactless measurement of VSs by nonclinical staff in residential and home care settings. Work is continuing to enhance data collection and processing to achieve the robustness and accuracy required for routine clinical use. International Registered Report Identifier (IRRID): RR2-10.2196/14326 ",
doi="10.2196/36340",
url="https://formative.jmir.org/2022/11/e36340",
url="http://www.ncbi.nlm.nih.gov/pubmed/36374541"
}


@Article{info:doi/10.2196/38780,
author="Beeman, M. Chase
and Abrams, Ann Mary
and Zajo, N. Kristin
and Stanek, Joseph
and O'Brien, H. Sarah
and Chan, Peter
and Shen, Yvette
and McCorkle, Ben
and Johnson, Latrice
and Chisolm, Deena
and Barnard-Kirk, Toyetta
and Mahan, D. John
and Martinez-Mendez, Alexandra
and Phillips, L. Whitney
and Creary, E. Susan",
title="Acceptability to and Engagement With a Virtual Sickle Cell Trait Education Program (SCTaware): Single-Center Prospective Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="17",
volume="6",
number="11",
pages="e38780",
keywords="virtual education",
keywords="remote education",
keywords="internet-based",
keywords="health education",
keywords="hematology",
keywords="patient education",
keywords="sickle cell",
keywords="genetic",
keywords="child",
keywords="parenting",
keywords="sickle cell trait",
keywords="public health education",
keywords="acceptability",
keywords="Hemoglobin S-trait",
keywords="screening",
keywords="newborn",
keywords="eHealth",
keywords="digital health",
keywords="telemedicine",
keywords="telehealth",
abstract="Background: Public health programs are tasked with educating the community on health topics, but it is unclear whether these programs are acceptable to learners. Currently, these programs are delivered via a variety of platforms including in-person, virtually, and over the telephone. Sickle cell trait (SCT) education for parents of children with this trait is one of many education programs provided by the Ohio Department of Health. The novel SCTaware videoconference education program was developed by a research team after central Ohio's standard program transitioned from in-person to telephone-only education during the COVID-19 pandemic. Objective: Our objectives were to investigate the acceptability of the format and engagement with the SCTaware education and assess parental worry about having a child with SCT before and after receiving SCTaware. Methods: This was a single-center, prospective study of English-speaking parents of children <3 years of age identified to have hemoglobin S trait by newborn screening. Parents who previously received SCT education by telephone, were able to be contacted, and had access to an electronic device capable of videoconferencing were eligible to complete surveys after receiving the virtual SCTaware education program. The SCTaware educator also completed a survey to assess participant engagement. Data were summarized descriptively and a McNemar test was used to compare parental worry before and after receiving SCTaware. Results: In total, 55 participants completed follow-up surveys after receiving standard SCT telephone education and then completing SCTaware. Most (n=51) participants reported that the SCTaware content and visuals were very easy to understand (n=47) and facilitated conversation with the educator (n=42). All of them said the visuals were respectful and trustworthy, helped them understand content better, and that their questions were addressed. Nearly two-thirds (62\%, n=34) reported that the pictures appeared very personal and applied to them. The educator noted most participants (n=45) were engaged and asked questions despite having to manage distractions during their education sessions. Many participants (n=33) reported some level of worry following telephone-only education; this was significantly reduced after receiving SCTaware (P<.001). Conclusions: Our results suggest that SCTaware is acceptable and engaging to parents. While telephone education may make SCT education more accessible, these findings suggest that many parents experience significant worry about their child with SCT after these sessions. A study to evaluate SCTaware's effectiveness at closing parents' SCT knowledge gaps is ongoing. ",
doi="10.2196/38780",
url="https://formative.jmir.org/2022/11/e38780",
url="http://www.ncbi.nlm.nih.gov/pubmed/36394943"
}


@Article{info:doi/10.2196/42955,
author="Shi, Jiaxiao
and Fassett, J. Michael
and Chiu, Y. Vicki
and Avila, C. Chantal
and Khadka, Nehaa
and Brown, Brittany
and Patel, Pooja
and Mensah, Nana
and Xie, Fagen
and Peltier, R. Morgan
and Getahun, Darios",
title="Postpartum Migraine Headache Coding in Electronic Health Records of a Large Integrated Health Care System: Validation Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="17",
volume="6",
number="11",
pages="e42955",
keywords="migraine headache",
keywords="validation",
keywords="diagnosis",
keywords="pharmacy",
keywords="postpartum",
keywords="medical record",
keywords="health plan",
keywords="electronic health record",
keywords="coding",
keywords="pharmacy record",
keywords="diagnostic code",
keywords="EHR system",
abstract="Background: Migraine is a common neurological disorder characterized by repeated headaches of varying intensity. The prevalence and severity of migraine headaches disproportionally affects women, particularly during the postpartum period. Moreover, migraines during pregnancy have been associated with adverse maternal outcomes, including preeclampsia and postpartum stroke. However, due to the lack of a validated instrument for uniform case ascertainment on postpartum migraine headache, there is uncertainty in the reported prevalence in the literature. Objective: The aim of this study was to evaluate the completeness and accuracy of reporting postpartum migraine headache coding in a large integrated health care system's electronic health records (EHRs) and to compare the coding quality before and after the implementation of the International Classification of Diseases, 10th revision, Clinical Modification (ICD-10-CM) codes and pharmacy records in EHRs. Methods: Medical records of 200 deliveries in all 15 Kaiser Permanente Southern California hospitals during 2 time periods, that is, January 1, 2012 through December 31, 2014 (International Classification of Diseases, 9th revision, Clinical Modification [ICD-9-CM] coding period) and January 1, 2017 through December 31, 2019 (ICD-10-CM coding period), were randomly selected from EHRs for chart review. Two trained research associates reviewed the EHRs for all 200 women for postpartum migraine headache cases documented within 1 year after delivery. Women were considered to have postpartum migraine headache if either a mention of migraine headache (yes for diagnosis) or a prescription for treatment of migraine headache (yes for pharmacy records) was noted in the electronic chart. Results from the chart abstraction served as the gold standard and were compared with corresponding diagnosis and pharmacy prescription utilization records for both ICD-9-CM and ICD-10-CM coding periods through comparisons of sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), as well as the summary statistics of F-score and Youden J statistic (J). The kappa statistic ($\kappa$) for interrater reliability was calculated. Results: The overall agreement between the identification of migraine headache using diagnosis codes and pharmacy records compared to the medical record review was strong. Diagnosis coding (F-score=87.8\%; J=82.5\%) did better than pharmacy records (F-score=72.7\%; J=57.5\%) when identifying cases, but combining both of these sources of data produced much greater accuracy in the identification of postpartum migraine cases (F-score=96.9\%; J=99.7\%) with sensitivity, specificity, PPV, and NPV of 100\%, 99.7\%, 93.9\%, and 100\%, respectively. Results were similar across the ICD-9-CM (F-score=98.7\%, J=99.9\%) and ICD-10-CM coding periods (F-score=94.9\%; J=99.6\%). The interrater reliability between the 2 research associates for postpartum migraine headache was 100\%. Conclusions: Neither diagnostic codes nor pharmacy records alone are sufficient for identifying postpartum migraine cases reliably, but when used together, they are quite reliable. The completeness of the data remained similar after the implementation of the ICD-10-CM coding in the EHR system. ",
doi="10.2196/42955",
url="https://formative.jmir.org/2022/11/e42955",
url="http://www.ncbi.nlm.nih.gov/pubmed/36394937"
}


@Article{info:doi/10.2196/38677,
author="Han, Feng
and Zhang, ZiHeng
and Zhang, Hongjian
and Nakaya, Jun
and Kudo, Kohsuke
and Ogasawara, Katsuhiko",
title="Extraction and Quantification of Words Representing Degrees of Diseases: Combining the Fuzzy C-Means Method and Gaussian Membership",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="18",
volume="6",
number="11",
pages="e38677",
keywords="medical text",
keywords="fuzzy c-means",
keywords="cluster",
keywords="algorithm",
keywords="machine learning",
keywords="word quantification",
keywords="fuzzification",
keywords="Gauss",
keywords="radiology",
keywords="medical report",
keywords="documentation",
keywords="text mining",
keywords="data mining",
keywords="extraction",
keywords="unstructured",
keywords="free text",
keywords="quantification",
keywords="fuzzy",
keywords="diagnosis",
keywords="diagnostic",
keywords="EHR",
keywords="support system",
abstract="Background: Due to the development of medical data, a large amount of clinical data has been generated. These unstructured data contain substantial information. Extracting useful knowledge from this data and making scientific decisions for diagnosing and treating diseases have become increasingly necessary. Unstructured data, such as in the Marketplace for Medical Information in Intensive Care III (MIMIC-III) data set, contain several ambiguous words that demonstrate the subjectivity of doctors, such as descriptions of patient symptoms. These data could be used to further improve the accuracy of medical diagnostic system assessments. To the best of our knowledge, there is currently no method for extracting subjective words that express the extent of these symptoms (hereinafter, ``degree words''). Objective: Therefore, we propose using the fuzzy c-means (FCM) method and Gaussian membership to quantify the degree words in the clinical medical data set MIMIC-III. Methods: First, we preprocessed the 381,091 radiology reports collected in MIMIC-III, and then we used the FCM method to extract degree words from unstructured text. Thereafter, we used the Gaussian membership method to quantify the extracted degree words, which transform the fuzzy words extracted from the medical text into computer-recognizable numbers. Results: The results showed that the digitization of ambiguous words in medical texts is feasible. The words representing each degree of each disease had a range of corresponding values. Examples of membership medians were 2.971 (atelectasis), 3.121 (pneumonia), 2.899 (pneumothorax), 3.051 (pulmonary edema), and 2.435 (pulmonary embolus). Additionally, all extracted words contained the same subjective words (low, high, etc), which allows for an objective evaluation method. Furthermore, we will verify the specific impact of the quantification results of ambiguous words such as symptom words and degree words on the use of medical texts in subsequent studies. These same ambiguous words may be used as a new set of feature values to represent the disorders. Conclusions: This study proposes an innovative method for handling subjective words. We used the FCM method to extract the subjective degree words in the English-interpreted report of the MIMIC-III and then used the Gaussian functions to quantify the subjective degree words. In this method, words containing subjectivity in unstructured texts can be automatically processed and transformed into numerical ranges by digital processing. It was concluded that the digitization of ambiguous words in medical texts is feasible. ",
doi="10.2196/38677",
url="https://formative.jmir.org/2022/11/e38677",
url="http://www.ncbi.nlm.nih.gov/pubmed/36399376"
}


@Article{info:doi/10.2196/40996,
author="Wong, Sze Ngai
and Kwan, Ho Tsz
and Chan, C. Denise P.
and Lui, Y. Grace C.
and Lee, Shan Shui",
title="Regular Testing of HIV and Sexually Transmitted Infections With Self-Collected Samples From Multiple Anatomic Sites to Monitor Sexual Health in Men Who Have Sex With Men: Longitudinal Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="18",
volume="6",
number="11",
pages="e40996",
keywords="HIV testing",
keywords="STI testing",
keywords="self-sampling",
keywords="internet-based testing",
keywords="men who have sex with men",
keywords="HIV",
keywords="monitoring",
keywords="sex",
keywords="infection",
keywords="prevention",
keywords="community",
keywords="engagement",
keywords="cohort study",
keywords="testing",
abstract="Background: Regular HIV and sexually transmitted infection (STI) testing for men who have sex with men (MSM) is an important means of infection prevention, the adoption of which remains suboptimal in the community. Objective: On the hypothesis that engagement plays an important role in sexual health monitoring, this study aimed to pilot-test internet-based HIV and STI testing with self-sampling to enhance engagement of MSM with regular testing. Methods: This 1-year cohort study was conducted on HIV-negative MSM aged 18 years or older. A designated website was set up to enable participants to make appointments for baseline and follow-up visits at 3-monthly intervals. On-site blood sampling was performed for HIV and syphilis tests, along with self-collection of pharyngeal swabs, rectal swabs, and urine samples for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) testing. Full engagement, as defined by having made at least 3 visits over a 6-12 months' follow-up period, was compared with partial engagement in the bivariable logistic regression model. Results: Between August 2019 and October 2020, 204 MSM were recruited, after the exclusion of 2 baseline HIV-positive MSM. The majority (189/204, 92.7\%) were Chinese, the median age was 31 (IQR 26-39) years, and 58.0\% (116/200) had experience with pre-exposure prophylaxis (PrEP) at baseline. Full engagement (146/204, 71.6\%) was associated with incident STI during the follow-ups (odds ratio [OR] 4.23, 95\% CI 1.63-10.94), seeking a medical referral after STI detection (OR 10.25, 95\% CI 3.25-29.79), and a synchronized schedule of HIV and STI testing with PrEP visits (OR 51.85, 95\% CI 19.30-139.34). No incident HIV was detected in the follow-up period. At baseline, the overall STI (CT, NG, or syphilis) prevalence was 30\%, with CT at 18\%, NG at 13\%, and syphilis at 5\%. During follow-up, the incidences were 59.08/100 person-years (py) for any STI, 33.05/100 py for CT, 29.86/100 py for NG, and 10.4/100 py for syphilis. The detection rates of CT and NG in urine samples were lower than with pharyngeal swabs and rectal swabs. The scores for convenience, confidence of correct sampling, and accuracy of self-sampling were high (7 to 8 out of 10). Conclusions: Both baseline prevalence and incidence of STI were high among MSM engaged in regular testing. A high degree of engagement in regular STI and HIV testing was positively associated with incident STI, history of health-seeking behaviors, and perceived convenience of self-sampling. Self-sampling could be introduced as a means of enhancing engagement in regular HIV and STI testing. ",
doi="10.2196/40996",
url="https://formative.jmir.org/2022/11/e40996",
url="http://www.ncbi.nlm.nih.gov/pubmed/36399372"
}


@Article{info:doi/10.2196/39357,
author="Fee, Connie
and Fuller, Julia
and Guss, E. Carly
and Woods, R. Elizabeth
and Cooper, R. Ellen
and Bhaumik, Urmi
and Graham, Dionne
and Burchett, K. Sandra
and Dumont, Olivia
and Martey, B. Emily
and Narvaez, Maria
and Haberer, E. Jessica
and Swendeman, Dallas
and Mulvaney, A. Shelagh
and Kumar, S. Vikram
and Jackson, L. Jonathan
and Ho, Xian Y.",
title="A Digital Platform to Support HIV Case Management for Youth and Young Adults: Mixed Methods Feasibility Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="21",
volume="6",
number="11",
pages="e39357",
keywords="HIV",
keywords="case management",
keywords="youth",
keywords="young adult",
keywords="mobile health",
keywords="mHealth",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Advances in medical treatments in recent years have contributed to an overall decline in HIV-related opportunistic infections and deaths in youth; however, mortality and morbidity rates in perinatally and nonperinatally infected adolescents and young adults (AYA) living with HIV remain relatively high today. Objective: The goal of this project was to assess the use, utility, and cost-effectiveness of PlusCare, a digital app for HIV case management in AYA living with HIV. The app supports routine case management tasks, such as scheduling follow-up visits, sharing documents for review and signature, laboratory test results, and between-visit communications (eg, encouraging messages). Methods: We conducted a single-group mixed methods pre-post study with HIV case management programs in 2 large urban hospitals in the Boston metro area. Case management staff (case managers [CMs], N=20) and AYA living with HIV participants (N=45) took part in the study with access to PlusCare for up to 15 and 12 months, respectively. Results: The CMs and AYA living with HIV reported mean System Usability Scale scores of 51 (SD 7.9) and 63 (SD 10.6), respectively. Although marginally significant, total charges billed at 1 of the 2 sites compared with the 12 months before app use (including emergency, inpatient, and outpatient charges) decreased by 41\% (P=.046). We also observed slight increases in AYA living with HIV self-reported self-efficacy in chronic disease management and quality of life (Health-Related Quality of Life-4) from baseline to the 12-month follow-up (P=.02 and P=.03, respectively) and increased self-efficacy from the 6- to 12-month follow-up (P=.02). There was no significant change in HIV viral suppression, appointment adherence, or medication adherence in this small-sample pilot study. Conclusions: Although perceived usability was low, qualitative feedback from CMs and use patterns suggested that direct messaging and timely, remote, and secure sharing of laboratory results and documents (including electronic signatures) between CMs and AYA living with HIV can be particularly useful and have potential value in supporting care coordination and promoting patient self-efficacy and quality of life. Trial Registration: ClinicalTrials.gov NCT03758066; https://clinicaltrials.gov/ct2/show/NCT03758066 ",
doi="10.2196/39357",
url="https://formative.jmir.org/2022/11/e39357",
url="http://www.ncbi.nlm.nih.gov/pubmed/36409541"
}


@Article{info:doi/10.2196/26925,
author="Khusial, Rishi
and van Koppen, Sophia
and Honkoop, Persijn
and Rijssenbeek-Nouwens, Lucia
and Fieten, Berthine Karin
and Keij, Sascha
and Drijver-Messelink, Marieke
and Sont, Jacob",
title="Patients' and Health Care Providers' Perceptions on mHealth Use After High-Altitude Climate Therapy for Severe Asthma: Mixed Methods Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="22",
volume="6",
number="11",
pages="e26925",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="asthma",
keywords="self-management",
keywords="home monitoring",
keywords="mobile phone",
abstract="Background: Asthma is a common chronic disease with various clinical presentations. Although most patients are able to reach good asthma control, some patients are not able to reach sufficient asthma control following the regular treatment guidelines and could be referred to high-altitude climate therapy (HACT). HACT includes environmental trigger avoidance in the alpine climate with multidisciplinary clinical treatment. Patients with severe and difficult-to-control asthma, who are unable to reach asthma control at sea level, can follow a 12-week lung rehabilitation program at 1600 m above sea level. Mobile health (mHealth) tools can be used to enhance self-management in these patients when they return home. For an mHealth system to be effective, it must meet the expectations of the end users. Objective: In this Davos@home study, we explored the attitudes toward mHealth aimed at supporting the self-management of patients with severe, difficult-to-control asthma who underwent HACT and asthma health care providers. Methods: In the first stage, interviews with referrers to HACT and focus groups with patients with asthma who participated in or completed HACT were conducted. The data were then analyzed thematically. On the basis of these results, a questionnaire was developed. In the second stage of the study, this questionnaire, combined with the Asthma Control Questionnaire and the Individual Innovativeness Questionnaire, was provided to patients who completed HACT. Results: In total, 11 interviews and 3 focus groups (n=18, age 47.6, SD 12.1 years, Asthma Control Questionnaire score 2.6, SD 1.0) were conducted. A total of 3 themes were identified: potential goals, useful measurements, and perceived barriers and facilitators. The questionnaire developed in stage 2 included items based on these results. The most agreed-upon goal among the 52 patients who completed the questionnaire was to increase their asthma control (45/52, 86\% of the patients). Conclusions: Different patients reported that they would benefit the most from different functionalities. Therefore, it is important to tailor functionalities to individual (treatment) goals. When developing an mHealth intervention, it is important to allow personalization to avoid overwhelming the users. ",
doi="10.2196/26925",
url="https://formative.jmir.org/2022/11/e26925",
url="http://www.ncbi.nlm.nih.gov/pubmed/36413384"
}


@Article{info:doi/10.2196/40242,
author="Nicol, Ginger
and Wang, Ruoyun
and Graham, Sharon
and Dodd, Sherry
and Garbutt, Jane",
title="Chatbot-Delivered Cognitive Behavioral Therapy in Adolescents With Depression and Anxiety During the COVID-19 Pandemic: Feasibility and Acceptability Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="22",
volume="6",
number="11",
pages="e40242",
keywords="COVID-19",
keywords="adolescent depression",
keywords="mobile health",
keywords="cognitive behavioral therapy",
keywords="chatbot",
keywords="relational conversational agent",
keywords="depression",
keywords="anxiety",
keywords="suicide",
keywords="self-harm",
keywords="pandemic",
keywords="pediatric",
keywords="youth",
keywords="adolescent",
keywords="adolescence",
keywords="psychiatry",
keywords="conversational agent",
keywords="CBT",
keywords="clinic",
keywords="data",
keywords="acceptability",
keywords="feasibility",
keywords="usability",
keywords="primary care",
keywords="intervention",
keywords="mental health",
keywords="digital health",
keywords="technology mediated",
keywords="computer mediated",
abstract="Background: Symptoms of depression and anxiety, suicidal ideation, and self-harm have escalated among adolescents to crisis levels during the COVID-19 pandemic. As a result, primary care providers (PCPs) are often called on to provide first-line care for these youth. Digital health interventions can extend mental health specialty care, but few are evidence based. We evaluated the feasibility of delivering an evidence-based mobile health (mHealth) app with an embedded conversational agent to deliver cognitive behavioral therapy (CBT) to symptomatic adolescents presenting in primary care settings during the pandemic. Objective: In this 12-week pilot study, we evaluated the feasibility of delivering the app-based intervention to adolescents aged 13 to 17 years with moderate depressive symptoms who were treated in a practice-based research network (PBRN) of academically affiliated primary care clinics. We also obtained preliminary estimates of app acceptability, effectiveness, and usability. Methods: This small, pilot randomized controlled trial (RCT) evaluated depressive symptom severity in adolescents randomized to the app or to a wait list control condition. The primary end point was depression severity at 4-weeks, measured by the 9-item Patient Health Questionnaire (PHQ-9). Data on acceptability, feasibility, and usability were collected from adolescents and their parent or legal guardian. Qualitative interviews were conducted with 13 PCPs from 11 PBRN clinics to identify facilitators and barriers to incorporating mental health apps in treatment planning for adolescents with depression and anxiety. Results: The pilot randomized 18 participants to the app (n=10, 56\%) or to a wait list control condition (n=8, 44\%); 17 participants were included in the analysis, and 1 became ineligible upon chart review due to lack of eligibility based on documented diagnosis. The overall sample was predominantly female (15/17, 88\%), White (15/17, 88\%), and privately insured (15/17, 88\%). Mean PHQ-9 scores at 4 weeks decreased by 3.3 points in the active treatment group (representing a shift in mean depression score from moderate to mild symptom severity categories) and 2 points in the wait list control group (no shift in symptom severity category). Teen- and parent-reported usability, feasibility, and acceptability of the app was high. PCPs reported preference for introducing mHealth interventions like the one in this study early in the course of care for individuals presenting with mild or moderate symptoms. Conclusions: In this small study, we demonstrated the feasibility, acceptability, usability, and safety of using a CBT-based chatbot for adolescents presenting with moderate depressive symptoms in a network of PBRN-based primary care clinics. This pilot study could not establish effectiveness, but our results suggest that further study in a larger pediatric population is warranted. Future study inclusive of rural, socioeconomically disadvantaged, and underrepresented communities is needed to establish generalizability of effectiveness and identify implementation-related adaptations needed to promote broader uptake in pediatric primary care. Trial Registration: ClinicalTrials.gov NCT04603053; https://clinicaltrials.gov/ct2/show/NCT04603053 ",
doi="10.2196/40242",
url="https://formative.jmir.org/2022/11/e40242",
url="http://www.ncbi.nlm.nih.gov/pubmed/36413390"
}


@Article{info:doi/10.2196/39185,
author="Pech, Marion
and Gbessemehlan, Antoine
and Dupuy, Lucile
and Sauz{\'e}on, H{\'e}l{\`e}ne
and Lafitte, St{\'e}phane
and Bachelet, Philippe
and Amieva, H{\'e}l{\`e}ne
and P{\'e}r{\`e}s, Karine",
title="Lessons Learned From the SoBeezy Program for Older Adults During the COVID-19 Pandemic: Experimentation and Evaluation",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="24",
volume="6",
number="11",
pages="e39185",
keywords="voice assistance",
keywords="social isolation",
keywords="healthy aging",
keywords="living in place",
keywords="acceptability",
keywords="technologies",
keywords="digital divide",
keywords="older adults",
keywords="aging",
keywords="elderly population",
keywords="voice assistant",
keywords="COVID-19",
abstract="Background: The SoBeezy program is an innovative intervention aimed at promoting and fostering healthy aging and aging in place by proposing to older adults concrete solutions to face daily life, tackle loneliness, promote social participation, and reduce the digital divide, thanks to a specific, easy-to-use voice assistant (the BeeVA smart display). Objective: This study aims to assess the acceptability of the SoBeezy program and its voice assistant and to identify potential areas of improvement. Methods: A 12-month experimentation of the program was deployed in real-life conditions among older adults living in the community in 4 pilot cities of France. Launched during the first lockdown of the COVID-19 crisis, this multisite study aimed to assess acceptability using questionnaires and interviews conducted at baseline and at the end of the experimentation. In addition, a series of meetings were conducted with SoBeezy staff members to obtain direct feedback from the ground. Results: In total, 109 older individuals were equipped with BeeVA to use the SoBeezy program; of these, 32 (29.4\%) left the experimentation before its end and 69 (63.3\%) completed the final questionnaires. In total, 335 interventions were conducted and 27 (39\%) of the participants requested services, mainly for supportive calls and visits and assistance with shopping, transportation, and crafting-gardening. Of the whole sample, 52 (75\%) considered BeeVA as a reassuring presence, and few persons (15/69, 22\%) reported a negative opinion about the program. Among the participants, the voice assistant appeared easy to use (n=57, 82\%) and useful (n=53, 77\%). They also were positive about the BeeVA smart display and the SoBeezy intervention. Conclusions: This multisite study conducted in real-life conditions among more than 100 older adults living in the community provides enlightening results of the reality from the ground of digital tools designed for the aging population. The COVID-19 context appeared both as an opportunity, given the massive needs of the older adults during this crisis, and as limiting due to sanitary constraints. Nevertheless, the experimentation showed overall good acceptability of the voice assistant and a high level of satisfaction of the participants among those who really used the system and could be a way of improving the autonomy and well-being of older adults and their families. However, the findings also highlighted resistance to change and difficulties for the users to ask for help. The experimentation also emphasized levers for next deployments and future research. The next step will be the experimentation of the activity-sharing component that could not be tested due to the COVID-19 context. ",
doi="10.2196/39185",
url="https://formative.jmir.org/2022/11/e39185",
url="http://www.ncbi.nlm.nih.gov/pubmed/36355629"
}


@Article{info:doi/10.2196/30285,
author="Kaseva, Kaisa
and Tervaniemi, Mari
and Heikura, Enni
and Kostilainen, Kaisamari
and P{\"o}yh{\"o}nen-Alho, Maritta
and Shoemaker, Kevin J.
and Petrella, J. Robert
and Peltonen, E. Juha",
title="Identifying Personality Characteristics and Indicators of Psychological Well-Being Associated With Attrition in the Motivation Makes the Move! Physical Activity Intervention: Randomized Technology-Supported Trial",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="25",
volume="6",
number="11",
pages="e30285",
keywords="randomized trial",
keywords="physical activity",
keywords="lifestyles",
keywords="personality",
keywords="psychological well-being",
keywords="study attrition",
keywords="mental health",
keywords="lifestyle interventions",
abstract="Background: Data attrition has been a common problem in longitudinal lifestyle interventions. The contributors to attrition in technology-supported physical activity interventions have not been thoroughly studied. Objective: The present study examined the roles of personality characteristics and indicators of psychological well-being in data attrition within a technology-supported, longitudinal intervention study with overweight adults. Methods: Participants (N=89) were adults from the Motivation Makes the Move! intervention study. Data attrition was studied after a 3-month follow-up. Participants' personality characteristics were studied using the Short Five self-report questionnaire. Psychological well-being indicators were assessed with the RAND 36-item health survey, Positive and Negative Affect Schedule, and Beck Depression Inventory. Logistic regression analyses were conducted to assess the risk of discontinuing the study. The analyses were adjusted for sex, age, study group, and educational status. Results: At the 3-month follow-up, 65 of 89 participants (73\% of the initial sample) had continued in the study. Participants' personality characteristics and indicators of psychological well-being were not associated with the risk of dropping out of the study (all P values >.05). The results remained the same after covariate controls. Conclusions: Participant attrition was not attributable to personality characteristics or psychological well-being in the Motivation Makes the Move! study conducted with overweight adults. As attrition remains a challenge within longitudinal, technology-supported lifestyle interventions, attention should be paid to the potentially dynamic natures of personality and psychological well-being, as well as other elements beyond these. Trial Registration: ClinicalTrials.gov NCT02686502; https://clinicaltrials.gov/ct2/show/NCT02686502 ",
doi="10.2196/30285",
url="https://formative.jmir.org/2022/11/e30285",
url="http://www.ncbi.nlm.nih.gov/pubmed/36427239"
}


@Article{info:doi/10.2196/39322,
author="Kanning, Martina
and Bollenbach, Lukas
and Schmitz, Julian
and Niermann, Christina
and Fina, Stefan",
title="Analyzing Person-Place Interactions During Walking Episodes: Innovative Ambulatory Assessment Approach of Walking-Triggered e-Diaries",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="25",
volume="6",
number="11",
pages="e39322",
keywords="ecological momentary assessment",
keywords="active transport",
keywords="socio-ecological model",
keywords="subjective well-being",
keywords="mental health",
keywords="urban health",
keywords="GEMA",
keywords="geographically explicit ecological momentary assessment",
keywords="behaviour change",
keywords="walking",
keywords="experience",
keywords="environment",
keywords="monitoring",
keywords="activity",
keywords="tracking",
keywords="e-diary",
keywords="assessment",
abstract="Background: Walking behavior is positively associated with physiological and mental health as much evidence has already shown. Walking is also becoming a critical issue for health promotion in urban environments as it is the most often used form of active mobility and helps to replace carbon dioxide emissions from motorized forms of transport. It therefore contributes to mitigate the negative effects of climate change and heat islands within cities. However, to promote walking among urban dwellers and to utilize its health-enhancing potential, we need to know more about the way in which physical and social environments shape individual experiences during walking episodes. Such person-place interactions could not adequately be analyzed in former studies owing to methodological constraints. Objective: This study introduces walking-triggered e-diaries as an innovative ambulatory assessment approach for time-varying associations, and investigates its accuracy with 2 different validation strategies. Methods: The walking trigger consists of a combination of movement acceleration via an accelerometer and mobile positioning of the cellphone via GPS and transmission towers to track walking activities. The trigger starts an e-diary whenever a movement acceleration exceeds a predetermined threshold and participants' locations are identified as nonstationary outside a predefined place of residence. Every 420 ({\textpm}300) seconds, repeated e-diaries were prompted as long as the trigger conditions were met. Data were assessed on 10 consecutive days. First, to investigate accuracy, we reconstructed walking routes and calculated a percentage score for all triggered prompts in relation to all walking routes where a prompt could have been triggered. Then, to provide data about its specificity, we used momentary self-reports and objectively assessed movement behavior to describe activity levels before the trigger prompted an e-diary. Results: Data of 67 participants could be analyzed and the walking trigger led to 3283 e-diary prompts, from which 2258 (68.8\%) were answered. Regarding accuracy, the walking trigger prompted an e-diary on 732 of 842 (86.9\%) reconstructed walking routes. Further, in 838 of 1206 (69.5\%) triggered e-diaries, participants self-reported that they were currently walking outdoors. Steps and acceleration movement was higher during these self-reported walking episodes than when participants denied walking outdoors (steps: 106 vs 32; acceleration>0.2 g in 58.4\% vs 19\% of these situations). Conclusions: Accuracy analysis revealed that walking-triggered e-diaries are suitable to collect different data of individuals' current experiences in situations in which a person walks outdoors. Combined with environmental data, such an approach increases knowledge about person-place interactions and provides the possibility to gain knowledge about user preferences for health-enhancing urban environments. From a methodological viewpoint, however, specificity analysis showed how changes in trigger conditions (eg, increasing the threshold for movement acceleration) lead to changes in accuracy. ",
doi="10.2196/39322",
url="https://formative.jmir.org/2022/11/e39322",
url="http://www.ncbi.nlm.nih.gov/pubmed/36427231"
}


@Article{info:doi/10.2196/42343,
author="Bucher, Amy
and Blazek, Susanne E.
and West, B. Ashley",
title="Feasibility of a Reinforcement Learning--Enabled Digital Health Intervention to Promote Mammograms: Retrospective, Single-Arm, Observational Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="28",
volume="6",
number="11",
pages="e42343",
keywords="artificial intelligence",
keywords="reinforcement learning",
keywords="feasibility studies",
keywords="mammograms",
keywords="nudging",
keywords="behavioral intervention",
keywords="digital health",
keywords="email",
keywords="health equity",
keywords="cancer screening",
abstract="Background: Preventive screenings such as mammograms promote health and detect disease. However, mammogram attendance lags clinical guidelines, with roughly one-quarter of women not completing their recommended mammograms. A scalable digital health intervention leveraging behavioral science and reinforcement learning and delivered via email was implemented in a US health system to promote uptake of recommended mammograms among patients who were 1 or more years overdue for the screening (ie, 2 or more years from last mammogram). Objective: The aim of this study was to establish the feasibility of a reinforcement learning--enabled mammography digital health intervention delivered via email. The research aims included understanding the intervention's reach and ability to elicit behavioral outcomes of scheduling and attending mammograms, as well as understanding reach and behavioral outcomes for women of different ages, races, educational attainment levels, and household incomes. Methods: The digital health intervention was implemented in a large Catholic health system in the Midwestern United States and targeted the system's existing patients who had not received a recommended mammogram in 2 or more years. From August 2020 to July 2022, 139,164 eligible women received behavioral science--based email messages assembled and delivered by a reinforcement learning model to encourage clinically recommended mammograms. Target outcome behaviors included scheduling and ultimately attending the mammogram appointment. Results: In total, 139,164 women received at least one intervention email during the study period, and 81.52\% engaged with at least one email. Deliverability of emails exceeded 98\%. Among message recipients, 24.99\% scheduled mammograms and 22.02\% attended mammograms (88.08\% attendance rate among women who scheduled appointments). Results indicate no practical differences in the frequency at which people engage with the intervention or take action following a message based on their age, race, educational attainment, or household income, suggesting the intervention may equitably drive mammography across diverse populations. Conclusions: The reinforcement learning--enabled email intervention is feasible to implement in a health system to engage patients who are overdue for their mammograms to schedule and attend a recommended screening. In this feasibility study, the intervention was associated with scheduling and attending mammograms for patients who were significantly overdue for recommended screening. Moreover, the intervention showed proportionate reach across demographic subpopulations. This suggests that the intervention may be effective at engaging patients of many different backgrounds who are overdue for screening. Future research will establish the effectiveness of this type of intervention compared to typical health system outreach to patients who have not had recommended screenings as well as identify ways to enhance its reach and impact. ",
doi="10.2196/42343",
url="https://formative.jmir.org/2022/11/e42343",
url="http://www.ncbi.nlm.nih.gov/pubmed/36441579"
}


@Article{info:doi/10.2196/33952,
author="Mughal, Fiza
and Raffe, William
and Stubbs, Peter
and Kneebone, Ian
and Garcia, Jaime",
title="Fitbits for Monitoring Depressive Symptoms in Older Aged Persons: Qualitative Feasibility Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="29",
volume="6",
number="11",
pages="e33952",
keywords="digital mental health",
keywords="Fitbit",
keywords="smartwatch",
keywords="smart wearable",
keywords="geriatric",
keywords="aging",
keywords="health informatics",
keywords="feasibility",
keywords="usability",
keywords="older aged",
abstract="Background: In 2022, an estimated 1.105 billion people used smart wearables and 31 million used Fitbit devices worldwide. Although there is growing evidence for the use of smart wearables to benefit physical health, more research is required on the feasibility of using these devices for mental health and well-being. In studies focusing on emotion recognition, emotions are often inferred and dependent on external cues, which may not be representative of true emotional states. Objective: The aim of this study was to evaluate the feasibility and acceptability of using consumer-grade activity trackers for apps in the remote mental health monitoring of older aged people. Methods: Older adults were recruited using criterion sampling. Participants were provided an activity tracker (Fitbit Alta HR) and completed weekly online questionnaires, including the Geriatric Depression Scale, for 4 weeks. Before and after the study period, semistructured qualitative interviews were conducted to provide insight into the acceptance and feasibility of performing the protocol over a 4-week period. Interview transcripts were analyzed using a hybrid inductive-deductive thematic analysis. Results: In total, 12 participants enrolled in the study, and 9 returned for interviews after the study period. Participants had positive attitudes toward being remotely monitored, with 78\% (7/9) of participants experiencing no inconvenience throughout the study period. Moreover, 67\% (6/9) were interested in trialing our prototype when it is implemented. Participants stated they would feel more comfortable if mental well-being was being monitored by carers remotely. Conclusions: Fitbit-like devices were an unobtrusive and convenient tool to collect physiological user data. Future research should integrate physiological user inputs to differentiate and predict depressive tendencies in users. ",
doi="10.2196/33952",
url="https://formative.jmir.org/2022/11/e33952",
url="http://www.ncbi.nlm.nih.gov/pubmed/36268552"
}


@Article{info:doi/10.2196/27421,
author="Ami, Olivier
and Maran, Jean-Christophe
and Musset, Dominique
and Dubray, Claude
and Mage, G{\'e}rard
and Boyer, Louis",
title="Using Magnetic Resonance Imaging During Childbirth to Demonstrate Fetal Head Moldability and Brain Compression: Prospective Cohort Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="30",
volume="6",
number="11",
pages="e27421",
keywords="parturition",
keywords="magnetic resonance imaging",
keywords="obstetrics",
keywords="fetus",
keywords="cephalopelvic disproportion",
abstract="Background: Childbirth is a physiological process with significant medical risk, given that neurological impairment due to the birthing process can occur at any time. Improvements in risk assessment and anticipatory interventions are constantly needed; however, the birthing process is difficult to assess using simple imaging technology because the maternal bony pelvis and fetal skeleton interfere with visualizing the soft tissues. Magnetic resonance imaging (MRI) is a noninvasive technique with no ionizing radiation that can monitor the biomechanics of the birthing process. However, the effective use of this modality requires teamwork and the implementation of the appropriate safeguards to achieve appropriate safety levels. Objective: This study describes a clinically effective and safe method to perform real-time MRI during the birthing process. We reported the experience of our team as part of the IMAGINAITRE study protocol (France), which aimed to better understand the biomechanics of childbirth. Methods: A total of 27 pregnant women were examined with 3D MRI sequences before going into labor using a 1-Tesla open-field MRI. Of these 27 patients, 7 (26\%) subsequently had another set of 3D MRI sequences during the second stage of labor. Volumes of 2D images were transformed into finite element 3D reconstructions. Polygonal meshes for each part of the fetal body were used to study fetal head moldability and brain compression. Results: All 7 observed babies showed a sugarloaf skull deformity and brain compression at the middle strait. The fetus showing the greatest degree of molding and brain shape deformation weighed 4525 g and was born spontaneously but also presented with a low Apgar score. In this case, observable brain shape deformation demonstrated that brain compression had occurred, and it was not necessarily well tolerated by the fetus. Depending on fetal head moldability, these observations suggest that cephalopelvic disproportion can result in either obstructed labor or major fetal head molding with brain compression. Conclusions: This study suggests the presence of skull moldability as a confounding factor explaining why MRI, even with the best precision to measure radiological landmarks, fails to accurately predict the modality of childbirth. This introduces the fetal head compliance criterion as a way to better understand cephalopelvic disproportion mechanisms in obstetrics. MRI might be the best imaging technology by which to explore all combined aspects of cephalopelvic disproportion and achieve a better understanding of the underlying mechanisms of fetal head molding and moldability. ",
doi="10.2196/27421",
url="https://formative.jmir.org/2022/11/e27421",
url="http://www.ncbi.nlm.nih.gov/pubmed/36322921"
}


@Article{info:doi/10.2196/39199,
author="Ahmed, Mona
and Mar{\'i}n, Mayca
and How, Daniella
and Judica, Elda
and Tropea, Peppino
and Bentlage, Ellen
and J Ferreira, Joaquim
and Bou{\c{c}}a-Machado, Raquel
and Brach, Michael",
title="End Users' and Other Stakeholders' Needs and Requirements in the Development of a Personalized Integrated Care Platform (PROCare4Life) for Older People With Dementia or Parkinson Disease: Mixed Methods Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="30",
volume="6",
number="11",
pages="e39199",
keywords="neurodegenerative",
keywords="Parkinson disease",
keywords="dementia",
keywords="chronic diseases",
keywords="health care technologies",
keywords="integrated care",
keywords="information and communication technology",
keywords="ICT",
keywords="user-centered design",
keywords="mobile phone",
abstract="Background: With what has been known as the ``triple-win effect'', introducing information and communication technologies (ICTs) in the health care of neurodegenerative diseases is beneficial in delaying the need for institutional care, reducing the associated health care costs, reducing the caregiving burden, and improving individuals' quality of life. Nevertheless, the mismatch between the users' expectations and their actual needs remains one of the main challenges that can reduce the usability of technology solutions. Therefore, the European project Personalized Integrated Care Promoting Quality of Life for Older People (PROCare4Life), which aimed to develop an ICT-based platform for all parties involved in the health care of neurodegenerative diseases, adopted a user-centered design approach, where all users are involved from the inception and throughout the platform development and implementation to integrate their needs and requirements in the proposed platform. Objective: This paper presents the results of a study on the needs and requirements of the potential end users (older people with neurodegenerative diseases, caregivers, and health care professionals) and other key stakeholders in the development of the PROCare4Life platform. Methods: A mixed qualitative and quantitative study design was used, including 2 web-based surveys, 40 interviews, and 4 workshops. The study was conducted between April and September 2020 in 5 European countries: Germany, Italy, Portugal, Romania, and Spain. Both data types were analyzed separately and then merged and interpreted, with greater priority placed on qualitative research. Results: A total of 217 participants were recruited; 157 (72.4\%) of them completed the web-based surveys (n=85, 54.1\% patients and n=72, 45.9\% caregivers), and 60 (27.6\%) individuals participated in the qualitative research (20/60, 33\% health care professionals; 5/60, 8\% patients; 5/60, 8\% caregivers; and 30/60, 50\% key stakeholders). We identified 3 main themes (T): (T1) experiences associated with illness, (T2) thoughts about the platform technology, and (T3) desired properties. Alerts for adverse events, communication tools, reminders, and monitoring are constantly needed functionalities, whereas ease of use, personalization, and user-friendliness are foreseen as necessary features. Conclusions: This paper identified the key personal, social, and health factors that influence the daily lives of the potential end users and reflected on their needs and expectations regarding the design of the proposed PROCare4Life platform. The collected data were useful for the development of the PROCare4Life platform. Although the combination and collection of features for diverse user groups are typical for integrated care platforms, it results in exponential complexity for designers, developers, and users. Contradicting opinions and several concerns in this study demonstrate that an ICT-integrated care platform should not promise too much for too many. Instead, selection, focus, and, sometimes, restriction to essentials are necessary. Users and other stakeholders should be involved in these decisions. International Registered Report Identifier (IRRID): RR2-10.2196/22463 ",
doi="10.2196/39199",
url="https://formative.jmir.org/2022/11/e39199",
url="http://www.ncbi.nlm.nih.gov/pubmed/36449340"
}


@Article{info:doi/10.2196/40339,
author="Watanabe, Kazuhiro
and Tsutsumi, Akizumi",
title="The Passive Monitoring of Depression and Anxiety Among Workers Using Digital Biomarkers Based on Their Physical Activity and Working Conditions: 2-Week Longitudinal Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="30",
volume="6",
number="11",
pages="e40339",
keywords="digital biomarkers",
keywords="mobile health",
keywords="mental health",
keywords="psychological distress",
keywords="depression",
keywords="anxiety",
keywords="physical activity",
abstract="Background: Digital data on physical activity are useful for self-monitoring and preventing depression and anxiety. Although previous studies have reported machine or deep learning models that use physical activity for passive monitoring of depression and anxiety, there are no models for workers. The working population has different physical activity patterns from other populations, which is based on commuting, holiday patterns, physical demands, occupations, and industries. These working conditions are useful in optimizing the model used in predicting depression and anxiety. Further, recurrent neural networks increase predictive accuracy by using previous inputs on physical activity, depression, and anxiety. Objective: This study evaluated the performance of a deep learning model optimized for predicting depression and anxiety in workers. Psychological distress was considered a depression and anxiety indicator. Methods: A 2-week longitudinal study was conducted with workers in urban areas in Japan. Absent workers were excluded. In a daily survey, psychological distress was measured using a self-reported questionnaire. As features, activity time by intensity was determined using the Google Fit application. Additionally, we measured age, gender, occupations, employment status, work shift types, working hours, and whether the response date was a working or nonworking day. A deep learning model, using long short-term memory, was developed and validated to predict psychological distress the next day, using features of the previous day. Further, a 5-fold cross-validation method was used to evaluate the performance of the aforementioned model. As the primary indicator of performance, classification accuracy for the severity of the psychological distress (light, subthreshold, and severe) was considered. Results: A total of 1661 days of supervised data were obtained from 236 workers, who were aged between 20 and 69 years. The overall classification accuracy for psychological distress was 76.3\% (SD 0.04\%). The classification accuracy for severe-, subthreshold-, and light-level psychological distress was 51.1\% (SD 0.05\%), 60.6\% (SD 0.05\%), and 81.6\% (SD 0.04\%), respectively. The model predicted a light-level psychological distress the next day after the participants had been involved in 3 peaks of activity (in the morning, noon, and evening) on the previous day. Lower activity levels were predicted as subthreshold- and severe-level psychological distress. Different predictive results were observed on the basis of occupations and whether the previous day was a working or nonworking day. Conclusions: The developed deep learning model showed a similar performance as in previous studies and, in particular, high accuracy for light-level psychological distress. Working conditions and long short-term memory were useful in maintaining the model performance for monitoring depression and anxiety, using digitally recorded physical activity in workers. The developed model can be implemented in mobile apps and may further be practically used by workers to self-monitor and maintain their mental health state. ",
doi="10.2196/40339",
url="https://formative.jmir.org/2022/11/e40339",
url="http://www.ncbi.nlm.nih.gov/pubmed/36449342"
}


@Article{info:doi/10.2196/42126,
author="Shaveet, Eden
and Urquhart, Catherine
and Gallegos, Marissa
and Dammann, Olaf
and Corlin, Laura",
title="Web-Based Health Information--Seeking Methods and Time Since Provider Engagement: Cross-sectional Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="30",
volume="6",
number="11",
pages="e42126",
keywords="internet",
keywords="social media",
keywords="information-seeking behavior",
keywords="consumer health information",
keywords="physician-patient relations",
keywords="trust",
abstract="Background: The use of web-based methods to seek health information is increasing in popularity. As web-based health information (WHI)--seeking affects health-related decision support and chronic symptom self-management, WHI-seeking from online sources may impact health care decisions and outcomes, including care-seeking decisions. Patients who are routinely connected to physicians are more likely to receive better and more consistent care. Little is known about whether WHI-seeking impacts the frequency at which patients engage with health care providers. Objective: Our primary objective was to describe the associations between the use of web-based methods to seek information about one's own health and the time since last engaging with a health care provider about one's own health. Additionally, we aimed to assess participants' trust in health care organizations to contextualize our findings. Methods: We analyzed data from US adults participating in the nationally representative Tufts Equity in Health, Wealth, and Civic Engagement Survey (N=1034). Bivariate associations between demographic characteristics and health information--seeking methods were assessed with Pearson chi-squared tests. Bivariate associations of Medical Mistrust Index (MMI) scores with each health information--seeking method and time since provider engagement were assessed with F tests and adjusted Wald tests. We fit a multivariable logistic regression model to assess the association between WHI-seeking within the 12 months prior to survey (alone or in combination with provider-based methods versus provider only) and engagement with a provider more than 1 year prior to the time of survey, adjusting for age, race and ethnicity, sex, education, insurance coverage, and MMI. Results: Age, race and ethnicity, educational attainment, health insurance source, MMI, and time since provider engagement were each significantly associated with the health information--seeking method in bivariate analyses. Compared to using only provider-based health information seeking methods, WHI-based methods alone or in combination with provider-based methods were associated with a 51\% lower likelihood (odds ratio 0.49, 95\% CI 0.27-0.87) of engaging with a provider within the previous year. Participants who used WHI-seeking methods alone and those who had not engaged with a health care provider within the previous year demonstrated a higher mean MMI score; however, MMI was not a significant predictor of time since engagement with a provider in the multivariable analysis. Conclusions: Our findings from a nationally representative survey suggest that for those who use WHI-seeking methods (alone or in combination with provider-based information-seeking methods), there is a statistically significant lower likelihood of engaging with a provider in a year compared to those who only use provider-based methods. Future research should consider the intent of a person's visit with a provider, trust in health care systems, methods of provider engagement, and specific web-based platforms for health information. ",
doi="10.2196/42126",
url="https://formative.jmir.org/2022/11/e42126",
url="http://www.ncbi.nlm.nih.gov/pubmed/36449328"
}


@Article{info:doi/10.2196/37101,
author="Huang, Heyin
and Wang, Yichen
and Zhang, Lanzhi
and Zhang, Qinxiu
and Wu, Xiaojuan
and He, Hengsheng",
title="Psychological Disorders of Patients With Allergic Rhinitis in Chengdu, China: Exploratory Research",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="10",
volume="6",
number="11",
pages="e37101",
keywords="psychological disorders",
keywords="allergic rhinitis",
keywords="Chengdu",
keywords="China",
abstract="Background: The number of patients with allergic rhinitis (AR) has exceeded 500 million worldwide due to the unstable curative effect that can easily produce mental and psychological disorders. However, most of the relevant existing literature is one-on-one retrospective analyses or targeted meta-analyses of AR with psychological disorders like irritability, depression, and anxiety, while ``multi-hospital + interdisciplinary'' multiple regression analyses are scarce. Objective: This study aims to precisely identify the psychological disorders of patients with AR who were diagnosed and treated in the five most renowned hospitals in Chengdu, China over the past 5 years using 10 classification methods so as to attract attention and care from otolaryngologists. Methods: The Symptom Checklist 90 (SCL-90) was used to group and score the mental state of 827 strictly screened patients with AR according to 9 classification criteria. The scores were then compared within groups. Intergroup comparisons were made between the study group and the Chinese norm, and the positive factors for psychological disorders were extracted. Four symptoms in the study group, that is, nasal itching, sneezing, clear discharge, and nasal congestion, were scored on a visual analog scale. Partial correlation analysis was performed between the extracted positive factors for psychological disorders and the symptom scores by the multiple regression statistical method. Results: Among 827 patients, 124 (15\%) had no mental health impairments, 176 (21.3\%) had mild impairments, 474 (57.3\%) had mild to moderate impairments, 41 (5\%) had moderate to severe impairments, and 12 (1.4\%) had severe impairments. The average score of the SCL-90 for all 827 patients was 2.64 (SD 0.25), which corresponded to mild to moderate mental health impairments. The 827 patients scored significantly higher for the 4 positive factors: depression, anxiety, psychosis, and other (sleep, diet). Depression was positively correlated with sneezing and clear discharge, anxiety was positively correlated with nasal itching and congestion, psychosis was positively correlated with nasal itching and sneezing, and other (sleep, diet) was positively correlated with clear discharge and nasal congestion. Conclusions: Patients with AR have mild to moderate mental health impairments, with women and those with abnormal BMI, aged ?45 years, with a monthly salary <{\textyen}5110 (US \$700), with a disease duration <13 years, residing in urban areas, with a high school or above education, or who are indoor laborers being at high risk and requiring more care, follow-up, and comprehensive therapy from otolaryngologists. ",
doi="10.2196/37101",
url="https://formative.jmir.org/2022/11/e37101",
url="http://www.ncbi.nlm.nih.gov/pubmed/36355407"
}


@Article{info:doi/10.2196/29713,
author="Marshall, Skye
and G Rich, Graeme
and Cohen, Felicity
and Soni, Asha
and Isenring, Elizabeth",
title="Matched Endoscopic Sleeve Gastroplasty and Laparoscopic Sleeve Gastrectomy Cases: Formative Cohort Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="24",
volume="6",
number="11",
pages="e29713",
keywords="endoscopic sleeve gastroplasty",
keywords="laparoscopic sleeve gastrectomy",
keywords="obesity",
keywords="bariatric surgery",
keywords="interdisciplinary research",
keywords="cohort study",
keywords="metabolic surgery",
keywords="weight loss",
keywords="comorbidity",
keywords="body composition",
keywords="surgery",
keywords="gastroplasty",
keywords="endoscopic surgery",
keywords="gastroenterology",
keywords="preoperative",
keywords="postoperative",
keywords="outcome",
keywords="body mass index",
keywords="sex",
keywords="age",
keywords="gastrointestinal",
keywords="prospective",
abstract="Background: Bariatric weight-loss surgery rates are increasing internationally. Endoscopic sleeve gastroplasty (ESG) is a novel, minimally invasive endoscopic procedure thought to mimic some of the effects of a more common surgery, laparoscopic sleeve gastrectomy (LSG). Patient factors affecting procedural choice are unexplored. Objective: This formative study aimed to determine the preoperative and early postoperative characteristics of adults matched for age, sex, and BMI who chose ESG versus LSG. Methods: This prospective cohort study recruited ESG and matched LSG adults in Australia. Preoperative outcomes were medical history, glycemic biomarkers, blood lipids, liver function enzymes, albumin, blood pressure, hepatic steatosis index, the Gastrointestinal Symptom Rating Scale, the Impact of Weight on Quality of Life--Lite questionnaire, and body composition via dual-energy x-ray absorptiometry. Adverse events were recorded preoperatively and up to 2 weeks postoperatively. SPSS was used to test if there were differences between cohorts by comparing means or mean ranks, and binary regression was used to understand how characteristics might predict procedure choice. Results: A total of 50 (including 25 ESG and 25 LSG) patients were recruited, who were primarily White (45/50, 90\%) and female (41/50, 82\%) with a mean age of 41.7 (SD 9.4) years. Participants had a mean of 4.0 (SD 2.2) active comorbid conditions, with the most common being nonalcoholic fatty liver disease (38/50, 76\%), back pain (32/50, 64\%), anxiety or depression (24/50, 48\%), and joint pain (23/50, 46\%). The LSG cohort had higher hemoglobin A1c (5.3\%, SD 0.2\%) than the ESG cohort (5\%, SD 0.2\%; P=.008). There was a 2.4 kg/m2 difference in median BMI (P=.03) between the groups, but fat and fat-free mass had no meaningful differences. Comparing the LSG and ESG groups showed that the LSG group had lower total quality of life (49.5\%, SD 10.6\% vs 56.6\%, SD 12.7\%; P=.045), lower weight-related self-esteem (10.7\%, IQR 3.6\%-25\% vs 25\%, IQR 17.9\%-39.3\%; P=.02), and worse abdominal pain (38.9\%, IQR 33.3\%-50\% vs 53.9\%, SD 14.2\%, P=.01). For every percent improvement in weight-related self-esteem, the odds for selecting ESG increased by 4.4\% (95\% CI 1.004-1.085; P=.03). For every percent worsening in hunger pain, the odds for selecting ESG decreased by 3.3\% (95\% CI 0.944-0.990; P=.004). Conclusions: There was very little evidence that Australian adults who chose an endoscopic versus surgical sleeve had different rates of comorbidities, body fat percentage, or weight-related quality of life. There was evidence against the test hypothesis, that is, there was evidence suggesting that lower self-esteem predicted choosing a more invasive sleeve (ie, LSG rather than ESG) Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12618000337279; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374595 ",
doi="10.2196/29713",
url="https://formative.jmir.org/2022/11/e29713",
url="http://www.ncbi.nlm.nih.gov/pubmed/36422944"
}


@Article{info:doi/10.2196/37371,
author="Scher, Nathaniel
and Guetta, Liath
and Draghi, Cl{\'e}ment
and Yahiaoui, Safia
and Terzioglu, Mathilde
and Butaye, Emilie
and Henriques, Kathy
and Alavoine, Marie
and Elharar, Ayala
and Guetta, Andre
and Toledano, Alain",
title="Sleep Disorders and Quality of Life in Patients With Cancer: Prospective Observational Study of the Rafael Institute",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="24",
volume="6",
number="11",
pages="e37371",
keywords="cancer",
keywords="sleep disorder",
keywords="sleep",
keywords="fatigue",
keywords="nocturnal",
keywords="oncology",
keywords="cancer care",
keywords="patient-centred approach",
keywords="patient-centered",
keywords="personalized",
keywords="personalization",
keywords="customized",
keywords="customization",
keywords="care plan",
keywords="quality of life",
keywords="mood",
keywords="pain",
keywords="cancer treatment",
keywords="overweight",
keywords="obese",
keywords="hormone therapy",
keywords="breast",
keywords="prostate",
abstract="Background: Sleep disorders are a common occurrence in the general population. Yet today, it is clearly agreed that sleep disorders represent both a cancer risk factor and a biological consequence of the of the activation of the immuno-inflammatory system induced by cancer itself. Objective: The aim of this study was to assess the impact of sleep disorders on quality of life and identify the type of disorder and its causes in order to offer an adapted and personalized care plan. Methods: In a survey completed during the COVID-19 lockdown, 2000 hours of interviews were collected by remote consultations. During these calls, we administered a sleep questionnaire. This questionnaire was inspired by the STOP-BANG questionnaire and enquired about 6 items. The demographic details of each patient (eg, age and sex), the nature of the pathology, their past treatments, the ongoing cancer treatment, the mood, whether or not the patient is anxious or depressed, and the use of sleeping drug pills were analyzed. A univariate analysis was performed according to the presence or absence of fatigue. Chi-square test was applied to assess possible differences of variables' link to sleep disturbance between patients complaining of fatigue and those without fatigue. The same test was then used to analyze patients on hormone therapy and those with no hormone therapy for 2 types of cancer---breast cancer and prostate cancer. Results: A total of 905 patients were prospectively included in this study. The average age was 66.7 (5 SD) years, and 606 (67\%) patients were women; 142 patients declared being overweight. Breast cancer was the most frequently reported cancer. Nocturnal awakening was reported by 70\% (n=633), fatigue by 50\% (n=452), difficulty falling asleep by 38\% (n=343), snoring reported by an independent observer in 38\% (n=343), and apnea reported by an independent observer in 9\% (n=81) of the patients. The univariate analysis showed that the feeling of tiredness was significantly greater in patients reporting difficulty falling asleep (P?.99), pain (P<.001), and frequent awakening (P<.001), as well as in patients who were not receiving cancer treatment (P<.001). The univariate analysis showed that patients who were receiving breast cancer treatment and were under hormone therapy reported difficulty falling asleep (P=.04) and pain (P=.05). In a univariate analysis of patients treated for prostate cancer, being overweight was the only factor reported that had a statistically significant value. Conclusions: Our preliminary data support and are consistent with data in the literature regarding the importance of sleep disorders in oncology. This justifies the usefulness of a diagnosis and early treatment of sleep disorders in patients with cancer. The Rafael Institute sleep observatory will enable patients to be identified and treated. ",
doi="10.2196/37371",
url="https://formative.jmir.org/2022/11/e37371",
url="http://www.ncbi.nlm.nih.gov/pubmed/36422866"
}


@Article{info:doi/10.2196/40063,
author="Williams, Hants
and Steinberg, Sarah
and Leon, Kendall
and O'Shea, Catherine
and Berzin, Robin
and Hagg, Heather",
title="Validity of the Parsley Symptom Index---an Electronic Patient-Reported Outcomes Measure Designed for Telehealth: Prospective Cohort Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="3",
volume="6",
number="11",
pages="e40063",
keywords="telemedicine",
keywords="eHealth",
keywords="mHealth",
keywords="web-based",
abstract="Background: Electronic patient-reported outcomes measures (e-PROMs) are a valuable tool for the monitoring and management of chronic conditions over time. However, there are few validated tools available that capture symptoms across body systems in telehealth settings. The Parsley Symptom Index (PSI) is a recently developed symptom assessment for adults with chronic disease in telehealth settings. A previous study demonstrated the feasibility and acceptability of the PSI in a clinical telehealth setting. Objective: The purpose of this study was to assess convergent validity between the PSI and the self-rated health (SRH) item. Methods: This prospective cohort study took place from January 15, 2021, to December 15, 2021, among a sample of 10,519 adult patients at Parsley Health, a subscription-based holistic medical practice. The PSI and the SRH were completed by patients via an online portal. The association between the PSI and SRH was assessed via polyserial and polychoric correlations, while weighted $\kappa$ scores provided information related to agreement between the PSI and SRH. Results: From 22,748 responses, there were moderate levels of association (polyserial r=0.51; polychoric r=0.52) and agreement (weighted $\kappa$=0.46) between the PSI and SRH. In total, 74.13\% (n=16,865) of responses between the PSI and SRH were relatively congruent while 36.17\% (n=8229) were literally congruent. Conclusions: The PSI demonstrates convergent validity with the SRH for adults with chronic disease in a telehealth setting. This finding further supports the validation of the PSI in a real-world clinical setting. Although it is conceptually similar to the 1-question SRH, the PSI is a 45-item PROM designed to capture quality of life and specific symptoms by body system. Future studies will compare the PSI to multi-item PROMs. ",
doi="10.2196/40063",
url="https://formative.jmir.org/2022/11/e40063",
url="http://www.ncbi.nlm.nih.gov/pubmed/36326802"
}


@Article{info:doi/10.2196/35933,
author="Henriksen, Berg Hege
and Knudsen, Dines Markus
and Carlsen, Hauger Monica
and Hjart{\aa}ker, Anette
and Blomhoff, Rune",
title="A Short Digital Food Frequency Questionnaire (DIGIKOST-FFQ) Assessing Dietary Intake and Other Lifestyle Factors Among Norwegians: Qualitative Evaluation With Focus Group Interviews and Usability Testing",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="8",
volume="6",
number="11",
pages="e35933",
keywords="digital assessment tool",
keywords="assessment tool",
keywords="food frequency questionnaire",
keywords="food",
keywords="diet",
keywords="nutrition",
keywords="questionnaire",
keywords="focus group",
keywords="interview",
keywords="usability",
keywords="physical activity",
keywords="lifestyle factor",
keywords="dietary intake",
keywords="digital health",
keywords="chronic disease",
keywords="chronic condition",
keywords="health promotion",
keywords="cancer",
keywords="survivor",
keywords="thematic analysis",
keywords="research tool",
keywords="measurement tool",
abstract="Background: In-person dietary counseling and interventions have shown promising results in changing habits toward healthier lifestyles, but they are costly to implement in large populations. Developing digital tools to assess individual dietary intake and lifestyle with integrated personalized feedback systems may help overcome this challenge. We developed a short digital food frequency questionnaire, known as the DIGIKOST-FFQ, to assess diet and other lifestyle factors based on the Norwegian Food-Based Dietary Guidelines. The DIGIKOST-FFQ includes a personalized feedback system, the DIGIKOST report, that benchmarks diet and lifestyle habits. We used qualitative focus group interviews and usability tests to test the feasibility and usability of the DIGIKOST application. Objective: We aimed to explore attitudes, perceptions, and challenges in completing the DIGIKOST-FFQ. We also investigated perceptions and understanding of the personalized feedback in the DIGIKOST report and the technical flow and usability of the DIGIKOST-FFQ and the DIGIKOST report. Methods: Healthy individuals and cancer survivors were invited to participate in the focus group interviews. The transcripts were analyzed using thematic analysis. Another group of healthy individuals completed the usability testing, which was administered individually by a moderator and 2 observers. The results were analyzed based on predefined assignments and discussion with the participants about the interpretation of the DIGIKOST report and technical flow of the DIGIKOST-FFQ. Results: A total of 20 individuals participated in the focus group interviews, divided into 3 groups of healthy individuals and 3 groups of cancer survivors. Each group consisted of 3 to 4 individuals. Five main themes were investigated: (1) completion time (on average 19.1, SD 8.3, minutes, an acceptable duration), (2) layout (participants reported the DIGIKOST-FFQ was easy to navigate and had clear questions but presented challenges in reporting dietary intake, sedentary time, and physical activity in the last year), (3) questions (the introductory questions on habitual intake worked well), (4) pictures (the pictures were very helpful, but some portion sizes were difficult to differentiate and adding weight in grams would have been helpful), and (5) motivation (users were motivated to obtain personalized feedback). Four individuals participated in the usability testing. The results showed that the users could seamlessly log in, give consent, fill in the DIGIKOST-FFQ, and receive, print, and read the DIGIKOST report. However, parts of the report were perceived as difficult to interpret. Conclusions: The DIGIKOST-FFQ was overall well received by participants, who found it feasible to use; however, some adjustments with regard to reporting dietary intake and lifestyle habits were suggested. The DIGIKOST report with personalized feedback was the main motivation to complete the questionnaire. The results from the usability testing revealed a need for adjustments and updates to make the report easier to read. ",
doi="10.2196/35933",
url="https://formative.jmir.org/2022/11/e35933",
url="http://www.ncbi.nlm.nih.gov/pubmed/36346647"
}


@Article{info:doi/10.2196/41489,
author="Fenton, Alex
and Heinze, Aleksej
and Osborne, McVal
and Ahmed, Wasim",
title="How to Use the Six-Step Digital Ethnography Framework to Develop Buyer Personas: The Case of Fan Fit",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="25",
volume="6",
number="11",
pages="e41489",
keywords="health tracking",
keywords="digital",
keywords="ethnography",
keywords="apps",
keywords="mobile app",
keywords="customer",
keywords="physical activity",
abstract="Background: One of the key features of digital marketing is customer centricity, which can be applied to the domain of health. This is expressed through the ability to target specific customer segments with relevant content using appropriate channels and having data to track and understand each interaction. In order to do this, marketers create buyer personas based on a wide spectrum of quantitative and qualitative data. Digital ethnography is another established method for studying web-based communities. However, for practitioners, the complexity, rigor, and time associated with ethnographical work are sometimes out of reach. Objective: This paper responds to the gaps in the practically focused method of using social media for digital ethnography to develop buyer personas. This paper aims to demonstrate how digital ethnography can be used as a way to create and refine buyer personas. Methods: Using a case study of the Fan Fit smartphone app, which aimed to increase physical activity, a digital ethnography was applied to create a better understanding of customers and to create and refine buyer personas. Results: We propose two buyer personas, and we develop a 6-step digital ethnography framework designed for the development of buyer personas. Conclusions: The key contribution of this work is the proposal of a 6-step digital ethnography framework designed for the development of buyer personas. We highlight that the 6-step digital ethnography could be a robust tool for practitioners and academicians to analyze digital communications for the process of creating and updating data-driven buyer personas to create deeper insights into digital and health marketing efforts. ",
doi="10.2196/41489",
url="https://formative.jmir.org/2022/11/e41489",
url="http://www.ncbi.nlm.nih.gov/pubmed/36427232"
}


@Article{info:doi/10.2196/38460,
author="Sharma, Gaurav
and Schlosser, Lisa
and Jones, M. Brett D.
and Blumberger, M. Daniel
and Gratzer, David
and Husain, Omair M.
and Mulsant, H. Benoit
and Rappaport, Lance
and Stergiopoulos, Vicky
and Husain, Ishrat Muhammad",
title="Brief App-Based Cognitive Behavioral Therapy for Anxiety Symptoms in Psychiatric Inpatients: Feasibility Randomized Controlled Trial",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="2",
volume="6",
number="11",
pages="e38460",
keywords="inpatient",
keywords="mental health",
keywords="mental disorder",
keywords="psychiatry",
keywords="psychiatric",
keywords="smartphone app",
keywords="cognitive behavioral therapy",
keywords="CBT",
keywords="anxiety",
keywords="mobile app",
keywords="mobile health",
keywords="mHealth",
keywords="health app",
keywords="digital health",
keywords="eHealth",
keywords="feasibility study",
keywords="randomized controlled trial",
keywords="RCT",
keywords="feasibility",
keywords="acceptability",
abstract="Background: Psychiatric inpatients often have limited access to psychotherapeutic education or skills for managing anxiety, a common transdiagnostic concern in severe and acute mental illness. COVID-19--related restrictions further limited access to therapy groups on inpatient psychiatric units. App-based interventions may improve access, but evidence supporting the feasibility of their use, acceptability, and effectiveness in psychiatric inpatient settings is limited. MindShift CBT is a free app based on cognitive behavioral therapy principles with evidence for alleviating anxiety symptoms in the outpatient setting. Objective: We aimed to recruit 24 participants from an acute general psychiatric inpatient ward to a 1-month randomized control study assessing the feasibility and acceptability of providing patients with severe and acute mental illness access to the MindShift CBT app for help with managing anxiety symptoms. Methods: Recruitment, data collection, analysis, and interpretation were completed collaboratively by clinician and peer researchers. Inpatients were randomized to two conditions: treatment as usual (TAU) versus TAU plus use of the MindShift CBT app over 6 days. We collected demographic and quantitative data on acceptability and usability of the intervention. Symptoms of depression, anxiety, and psychological distress were measured in pre- and poststudy surveys for preliminary signals of efficacy. We conducted individual semistructured interviews with participants in the MindShift CBT app group at the end of their trial period, which were interpreted using a standardized protocol for thematic analysis. Results: Over 4 weeks, 33 inpatients were referred to the study, 24 consented to participate, 20 were randomized, and 11 completed the study. Of the 9 randomized participants who did not complete the study, 7 were withdrawn because they were discharged or transferred prior to study completion, with a similar distribution among both conditions. Among the enrolled patients, 65\% (13/20) were admitted for a psychotic disorder and no patient was admitted primarily for an anxiety disorder. The average length of stay was 20 days (SD 4.4; range 3-21) and 35\% (7/20) of patients were involuntarily admitted to hospital. Small sample sizes limited accurate interpretation of the efficacy data. Themes emerging from qualitative interviews included acceptability and usability of the app, and patient agency associated with voluntary participation in research while admitted to hospital. Conclusions: Our study benefitted from collaboration between peer and clinician researchers. Due to rapid patient turnover in the acute inpatient setting, additional flexibility in recruitment and enrollment is needed to determine the efficacy of using app-based psychotherapy on an acute psychiatric ward. Despite the limited sample size, our study suggests that similar interventions may be feasible and acceptable for acutely unwell inpatients. Further study is needed to compare the efficacy of psychotherapeutic apps with existing standards of care in this setting. Trial Registration: ClinicalTrials.gov NCT04841603; https://clinicaltrials.gov/ct2/show/NCT04841603 ",
doi="10.2196/38460",
url="https://formative.jmir.org/2022/11/e38460",
url="http://www.ncbi.nlm.nih.gov/pubmed/36322113"
}


@Article{info:doi/10.2196/30327,
author="Machado, Munck Nathalia
and Gomide, Pinto Henrique
and Bernardino, Soares Heder
and Ronzani, Mota Telmo",
title="Internet-Based Intervention Compared to Brief Intervention for Smoking Cessation in Brazil: Pilot Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="3",
volume="6",
number="11",
pages="e30327",
keywords="smoking cessation",
keywords="internet-based intervention",
keywords="digital intervention",
keywords="mobile health",
keywords="mHealth",
keywords="tobacco",
keywords="addiction",
keywords="public health",
keywords="substance use",
abstract="Background: Smoking is still the leading cause of preventable death. Governments and health care providers should make available more accessible resources to help tobacco users stop. Objective: This study describes a pilot longitudinal study that evaluated the efficacy of an internet-based intervention compared to the brief intervention for smoking cessation among Brazilians. Methods: Eligible participants were recruited and randomly allocated to one of the two interventions. Measures were drawn by comparing cessation rates, motivation scores, and sought treatment between groups, assessed 1 and 3 months after the intervention. Inferential analysis was performed to compare the participants' characteristics, and the intention to treat was calculated. Results: A total of 49 smokers were enrolled in this study (n=25, 51\% in the brief intervention group; n=24, 49\% in the internet-based intervention group). Mean age was 44.5 (SD 13.3) years; most were male (n=29, 59.2\%), had elementary school (n=22, 44.9\%), smoked 14.5 cigarettes per day on average (SD 8.6), and had a mean score of 4.65 for nicotine dependence and 5.7 for motivation to quit. Moreover, 35 (71\%) participants answered follow-up 1, and 19 (39\%) answered follow-up 2. The results showed similar rates of cessation and reduction for both intervention groups. Conclusions: The internet-based intervention was slightly more effective for smoking cessation, while the brief intervention was more effective in reducing the number of cigarettes smoked per day. This difference was small and had no statistical significance even after adjusting for intention-to-treat analysis. These results should be interpreted with caution, especially due to the small sample size. ",
doi="10.2196/30327",
url="https://formative.jmir.org/2022/11/e30327",
url="http://www.ncbi.nlm.nih.gov/pubmed/36326817"
}


@Article{info:doi/10.2196/40907,
author="Nagawa, S. Catherine
and Lane, A. Ian
and McKay, E. Colleen
and Kamberi, Ariana
and Shenette, L. Lisa
and Kelly, M. Megan
and Davis, Maryann
and Sadasivam, S. Rajani",
title="Use of a Rapid Qualitative Method to Inform the Development of a Text Messaging Intervention for People With Serious Mental Illness Who Smoke: Formative Research Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="7",
volume="6",
number="11",
pages="e40907",
keywords="serious mental illness",
keywords="mental disorder",
keywords="psychiatric disorder",
keywords="tobacco use",
keywords="smoking cessation",
keywords="text messaging",
keywords="intervention",
keywords="smoking",
keywords="mental health",
keywords="virtual",
keywords="COVID-19",
keywords="pandemic",
keywords="symptom",
abstract="Background: People with serious mental illness are disproportionately affected by smoking and face barriers to accessing smoking cessation treatments in mental health treatment settings. Text-based interventions are cost-effective and represent a widely accessible approach to providing smoking cessation support. Objective: We aimed to identify key factors for adapting text-based cessation interventions for people with serious mental illness who smoke. Methods: We recruited 24 adults from mental health programs who had a serious mental illness and currently smoked cigarettes or had quit smoking within the past 5 years. We then conducted virtual qualitative interviews between November 2020 and August 2021. Data were analyzed using the rapid thematic analytic approach. Results: We identified the following 3 major themes: (1) interplay between smoking and having a serious mental illness, (2) social contextual factors of smoking in adults with serious mental illness, and (3) smoking and quitting behaviors similar to the general population. Participants reported barriers and facilitators to quitting across the 3 themes. Within the ``interplay between smoking and having a serious mental illness'' theme, barriers included smoking to manage stress and mental health symptoms, and facilitators to quitting included the awareness of the harm of smoking on mental health and patient-provider discussions on smoking and mental health. In the ``social contextual factors of smoking in adults with serious mental illness'' theme, barriers included high social acceptability of smoking among peers. Positive support and the combined social stigma of smoking and having a mental health condition outside of peer groups motivated individuals to quit. Some participants indicated that low exposure to other smokers during the COVID-19 pandemic helped them to engage in cessation efforts. In the ``smoking and quitting behaviors similar to the general population'' theme, barriers included smoking after eating, having coffee, drinking alcohol, and experiencing negative social support, and facilitators included health concerns, improvement in the general quality of life, and use of evidence-based tobacco treatments when available. Conclusions: People with serious mental illness often smoke to cope with intense emotional states, manage mental health symptoms, or maintain social bonds. Text message content emphasizing equally effective and less harmful ways for stress reduction and mental health symptom management may improve quit rates in individuals with serious mental illness. ",
doi="10.2196/40907",
url="https://formative.jmir.org/2022/11/e40907",
url="http://www.ncbi.nlm.nih.gov/pubmed/36342765"
}


@Article{info:doi/10.2196/42376,
author="Hallgren, A. Kevin",
title="Remotely Assessing Mechanisms of Behavioral Change in Community Substance Use Disorder Treatment to Facilitate Measurement-Informed Care: Pilot Longitudinal Questionnaire Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="7",
volume="6",
number="11",
pages="e42376",
keywords="addiction",
keywords="clinical pilot",
keywords="measurement-based care",
keywords="mechanisms of change",
keywords="mobile health",
keywords="mHealth",
keywords="mobile phone",
abstract="Background: Research shows that improvements in coping strategies, abstinence self-efficacy, craving, and depression are potential mechanisms of behavioral change (MOBC) in treatments for substance use disorders (SUDs). However, little is known about how these insights regarding MOBC can be applied to SUD treatment settings. One way to facilitate MOBC-informed care in frontline settings could be to measure and monitor changes in MOBC throughout treatment using brief, frequent questionnaires that patients complete by using mobile technologies (eg, smartphones). The results derived from these questionnaires could potentially be used for clinical monitoring (ie, measurement-based care) to better understand whether individual patients are experiencing treatment-related improvements on key clinical targets. Objective: This study evaluated whether brief, weekly MOBC questionnaires completed by patients remotely can potentially provide clinically meaningful information about changes in MOBC in the context of real-world, community-based SUD treatment. Methods: A total of 30 patients (14/30, 47\% female; 13/30, 43\% racial or ethnic minority) in a community SUD treatment clinic participated in a pilot study where they were invited to complete brief, weekly questionnaires that assessed various MOBC, including coping strategies, abstinence self-efficacy, craving, depression, and therapeutic alliance. Questionnaires were typically completed remotely via smartphone for up to 6 months; 618 questionnaires were completed in total. Participants also completed longer, psychometrically validated measures of the same MOBC at baseline and 6-month research appointments. Statistical analyses tested whether brief, weekly, remotely completed MOBC questionnaires exhibited characteristics that would be desirable for real-world longitudinal clinical monitoring, including a tendency to detect within-person changes in MOBC over time; cross-sectional and longitudinal associations with longer, psychometrically validated measures completed at research appointments; and similar patterns of associations with 6-month percentage of days abstinent as longer, psychometrically validated MOBC measures completed at research appointments. Results: The results of this study indicated that the brief, weekly, remotely completed MOBC measures exhibited characteristics that are desirable for clinical monitoring, including a tendency to vary longitudinally (within patients over time) more often than measures of alcohol and drug consumption, generally having medium to large cross-sectional and longitudinal correlations with longer psychometrically validated measures of MOBC completed at research appointments, and generally having similar patterns of association with 6-month percentage of days abstinent from alcohol and drugs as longer psychometrically validated MOBC measures completed at research appointments. Conclusions: The results of this pilot study provide initial evidence that incorporating brief, weekly, and remotely completed MOBC questionnaires into community SUD treatment may be a viable approach for facilitating MOBC-informed care. Such questionnaires can potentially support measurement-based care by providing meaningful information about within-patient changes in clinical domains that are often directly targeted in SUD treatments and predict long-term substance use outcomes. ",
doi="10.2196/42376",
url="https://formative.jmir.org/2022/11/e42376",
url="http://www.ncbi.nlm.nih.gov/pubmed/36342773"
}


@Article{info:doi/10.2196/42010,
author="Mullan, Barbara
and Liddelow, Caitlin
and Haywood, Darren
and Breare, Hayley",
title="Behavior Change Training for Health Professionals: Evaluation of a 2-Hour Workshop",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="18",
volume="6",
number="11",
pages="e42010",
keywords="behaviour change",
keywords="psychology",
keywords="psychological",
keywords="BCT",
keywords="health professional",
keywords="health care professional",
keywords="medical education",
keywords="health care provider",
keywords="continuing education",
keywords="professional development",
keywords="theory of planned behaviour",
keywords="COM-B",
keywords="workshop",
keywords="intervention",
keywords="clinical practice",
abstract="Background: Rates of noncommunicable diseases continue to rise worldwide. Many of these diseases are a result of engaging in risk behaviors. Without lifestyle and behavioral intervention, noncommunicable diseases can worsen and develop into more debilitating diseases. Behavioral interventions are an effective strategy to reduce the burden of disease. Behavior change techniques can be described as the ``active ingredients'' in behavior change and address the components that need to be altered in order for the target behavior to change. Health professionals, such as pharmacists and nurses, can engage in opportunistic behavior change with their patients, to encourage positive health behaviors. Objective: We aimed to develop, implement, and evaluate a behavior change workshop targeted at health professionals in Australia, with the goal of increasing knowledge of behavior change techniques and psychological variables. Methods: A prospective study design was used to develop and evaluate a 2-hour behavior change workshop targeted at health professionals. The workshop was developed based on the Capability, Opportunity, Motivation, and Behavior Model and had five core objectives: (1) to detail the role of health professionals in delivering optimal care, (2) to demonstrate opportunities to change behavior, (3) to describe principles of behavior change, (4) to explain behavior change techniques, and (5) to determine the most appropriate behavior change techniques to use and when to use them. A total of 10 workshops were conducted. To evaluate the workshops and identify any potential long-term changes in behavior, we collected pre- and postworkshop data on knowledge and psychological constructs from the attendees. Results: A final sample of 41 health professionals comprising general practitioners, nurses, and pharmacists completed the pre- and postworkshop surveys. Following the workshops, there were significant improvements in knowledge of behavior change techniques (t40=--5.27, P<.001), subjective norms (t40=--3.49, P=.001), descriptive norms (t40=--3.65, P<.001), perceived behavioral control (t40=--3.30, P=.002), and intention (t36=--3.32, P=.002); each had a large effect size. There was no significant difference in postworkshop attitude (t40=0.78, P=.44). The participants also found the workshops to be highly acceptable. Conclusions: A 2-hour, theoretically informed workshop designed to facilitate the use of behavior change techniques by health professionals was shown to be largely effective. The workshops resulted in increases in knowledge, descriptive and subjective norms, perceived behavioral control, and intention, but not in attitude. The intervention was also shown to be highly acceptable, with the large majority of participants deeming the intervention to be needed, useful, appropriate, and applicable, as well as interesting and worth their time. Future research should examine the lasting impacts of the workshop on health professionals' practices. ",
doi="10.2196/42010",
url="https://formative.jmir.org/2022/11/e42010",
url="http://www.ncbi.nlm.nih.gov/pubmed/36399382"
}


@Article{info:doi/10.2196/26041,
author="M{\"u}ller, Alison
and Cau, Alessandro
and Muhammed, Semakula
and Abdullahi, Osman
and Hayward, Andrew
and Nsanzimana, Sabin
and Lester, Richard",
title="Digital mHealth and Virtual Care Use During COVID-19 in 4 Countries: Rapid Landscape Review",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="30",
volume="6",
number="11",
pages="e26041",
keywords="COVID-19",
keywords="virtual care",
keywords="public health",
keywords="mHealth",
keywords="contact tracing",
keywords="telehealth",
keywords="Canada",
keywords="United Kingdom",
keywords="Kenya",
keywords="Rwanda",
keywords="global health",
keywords="apps",
abstract="Background: As a result of the COVID-19 pandemic, providing health care while maintaining social distancing has resulted in the need to provide care remotely, support quarantined or isolated individuals, monitor infected individuals and their close contacts, as well as disseminate accurate information regarding COVID-19 to the public. This has led to an unprecedented rapid expansion of digital tools to provide digitized virtual care globally, especially mobile phone--facilitated health interventions, called mHealth. To help keep abreast of different mHealth and virtual care technologies being used internationally to facilitate patient care and public health during the COVID-19 pandemic, we carried out a rapid investigation of solutions being deployed and considered in 4 countries. Objective: The aim of this paper was to describe mHealth and the digital and contact tracing technologies being used in the health care management of the COVID-19 pandemic among 2 high-income and 2 low-middle income countries. Methods: We compared virtual care interventions used for COVID-19 management among 2 high-income countries (the United Kingdom and Canada) and 2 low-middle income (Kenya and Rwanda) countries. We focused on interventions used to facilitate patient care and public health. Information regarding specific virtual care technologies was procured from a variety of resources including gray literature, government and health organization websites, and coauthors' personal experiences as implementers of COVID-19 virtual care strategies. Search engine queries were performed to find health information that would be easily accessible to the general public, with keywords including ``COVID-19,'' ``contact-tracing,'' ``tool-kit,'' ``telehealth,'' and ``virtual care,'' in conjunction with corresponding national health authorities. Results: We identified a variety of technologies in Canada, the United Kingdom, Rwanda, and Kenya being used for patient care and public health. These countries are using both video and text message--based platforms to facilitate communication with health care providers (eg, WelTel and Zoom). Nationally developed contact tracing apps are provided free to the public, with most of them using Bluetooth-based technology. We identified that often multiple complimentary technologies are being utilized for different aspects of patient care and public health with the common purpose to disseminate information safely. There was a negligible difference among the types of technologies used in both high-income and low-middle income countries, although the latter implemented virtual care interventions earlier during the pandemic's first wave, which may account for their effective response. Conclusions: Virtual care and mHealth technologies have evolved rapidly as a tool for health care support for both patient care and public health. It is evident that, on an international level, a variety of mHealth and virtual care interventions, often in combination, are required to be able to address patient care and public health concerns during the COVID-19 pandemic, independent of a country's economic standing. ",
doi="10.2196/26041",
url="https://formative.jmir.org/2022/11/e26041",
url="http://www.ncbi.nlm.nih.gov/pubmed/34932498"
}


@Article{info:doi/10.2196/36412,
author="Chantziara, Sofia
and Brigden L C, Amberly
and Mccallum, H. Claire
and Craddock, J. Ian",
title="Using Digital Tools for Contact Tracing to Improve COVID-19 Safety in Schools: Qualitative Study Exploring Views and Experiences Among School Staff",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="1",
volume="6",
number="11",
pages="e36412",
keywords="schools",
keywords="contact tracing",
keywords="COVID-19 mitigation",
keywords="COVID-19",
keywords="pandemic",
keywords="disease prevention",
keywords="health technology",
keywords="COVID-19 management",
keywords="technology support",
keywords="digital tool",
keywords="mobile health",
keywords="mobile technology",
abstract="Background: Throughout the pandemic, governments worldwide have issued guidelines to manage the spread and impact of COVID-19 in schools, including measures around social distancing and contact tracing. Whether schools required support to implement these guidelines has not yet been explored in depth. Despite the development of a range of technologies to tackle COVID-19, such as contact-tracing apps and electronic vaccine certificates, research on their usefulness in school settings has been limited. Objective: The aim of the study was to explore the needs of school staff in managing COVID-19 and their experiences and perspectives on technological support in relation to contact tracing. School staff are the ones likely to make key implementation decisions regarding new technologies, and they are also the ones responsible for using the new tools daily. Including both management staff and class teachers in the development of school-based technologies can lead to their successful adoption by schools. Methods: Semistructured interviews were conducted with UK school staff, including primary and secondary school teachers and school managers. Thematic analysis, facilitated by NVivo, was used to analyze the data. Two of the authors independently coded 5 (28\%) of the interviews and reached a consensus on a coding framework. Results: Via purposive sampling, we recruited 18 participants from 5 schools. Findings showed that primary schools did not perform contact tracing, while in secondary schools, digital seating plans were used to identify close contacts in the classroom and manual investigations were also conducted identify social contacts. Participants reported that despite their efforts, high-risk interactions between students were not adequately monitored. There was a need to improve accuracy when identifying close contacts in common areas where students congregate. Proximity tracking, use of access cards, and closed-circuit television (CCTV) emerged as potential solutions, but there were concerns surrounding false alerts, burden, and security. Conclusions: School staff have found it difficult to monitor and implement social distancing and contact-tracing provisions. There are opportunities for mobile digital technologies and CCTV to support school staff in keeping their students and colleagues safe; however, these must place minimal demands on staff and prioritize security measures. Study findings can help researchers and practitioners who work in different contexts and settings understand what particular challenges are faced by school staff, and inform further research on the design and application of digital solutions for contact tracing. ",
doi="10.2196/36412",
url="https://formative.jmir.org/2022/11/e36412",
url="http://www.ncbi.nlm.nih.gov/pubmed/36191172"
}


@Article{info:doi/10.2196/38794,
author="Ismail, Nashwa
and Kbaier, Dhouha
and Farrell, Tracie
and Kane, Annemarie",
title="The Experience of Health Professionals With Misinformation and Its Impact on Their Job Practice: Qualitative Interview Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="2",
volume="6",
number="11",
pages="e38794",
keywords="health misinformation",
keywords="social media",
keywords="health professional",
keywords="patients",
keywords="trust",
keywords="communication, COVID-19",
keywords="intervention",
keywords="qualitative research",
keywords="interpretive phenomenological analysis",
keywords="thematic analysis",
keywords="misinformation",
keywords="health practitioner",
keywords="infodemiology",
abstract="Background: Misinformation is often disseminated through social media, where information is spread rapidly and easily. Misinformation affects many patients' decisions to follow a treatment prescribed by health professionals (HPs). For example, chronic patients (eg, those with diabetes) may not follow their prescribed treatment plans. During the recent pandemic, misinformed people rejected COVID-19 vaccines and public health measures, such as masking and physical distancing, and used unproven treatments. Objective: This study investigated the impact of health-threatening misinformation on the practices of health care professionals in the United Kingdom, especially during the outbreaks of diseases where a great amount of health-threatening misinformation is produced and released. The study examined the misinformation surrounding the COVID-19 outbreak to determine how it may have impacted practitioners' perceptions of misinformation and how that may have influenced their practice. In particular, this study explored the answers to the following questions: How do HPs react when they learn that a patient has been misinformed? What misinformation do they believe has the greatest impact on medical practice? What aspects of change and intervention in HPs' practice are in response to misinformation? Methods: This research followed a qualitative approach to collect rich data from a smaller subset of health care practitioners working in the United Kingdom. Data were collected through 1-to-1 online interviews with 13 health practitioners, including junior and senior physicians and nurses in the United Kingdom. Results: Research findings indicated that HPs view misinformation in different ways according to the scenario in which it occurs. Some HPs consider it to be an acute incident exacerbated by the pandemic, while others see it as an ongoing phenomenon (always present) and address it as part of their daily work. HPs are developing pathways for dealing with misinformation. Two main pathways were identified: first, to educate the patient through coaching, advising, or patronizing and, second, to devote resources, such as time and effort, to facilitate 2-way communication between the patient and the health care provider through listening and talking to them. Conclusions: HPs do not receive the confidence they deserve from patients. The lack of trust in health care practitioners has been attributed to several factors, including (1) trusting alternative sources of information (eg, social media) (2) patients' doubts about HPs' experience (eg, a junior doctor with limited experience), and (3) limited time and availability for patients, especially during the pandemic. There are 2 dimensions of trust: patient-HP trust and patient-information trust. There are 2 necessary actions to address the issue of lack of trust in these dimensions: (1) building trust and (2) maintaining trust. The main recommendations of the HPs are to listen to patients, give them more time, and seek evidence-based resources. ",
doi="10.2196/38794",
url="https://formative.jmir.org/2022/11/e38794",
url="http://www.ncbi.nlm.nih.gov/pubmed/36252133"
}


@Article{info:doi/10.2196/38904,
author="van Gend, Elmar Joris
and van 't Klooster, Roderick Jan Willem Jaap
and Bolman, Wilhelmina Catherine Adriana
and van Gemert-Pijnen, Cornelia Julia Elisabeth Wilhelmina",
title="The Dutch COVID-19 Notification App: Lessons Learned From a Mixed Methods Evaluation Among End Users and Contact-Tracing Employees",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="4",
volume="6",
number="11",
pages="e38904",
keywords="eHealth",
keywords="contact tracing",
keywords="digital contact tracing",
keywords="contact-tracing apps",
keywords="COVID-19",
keywords="adherence",
keywords="public health",
keywords="mobile health",
keywords="topic analysis",
keywords="health service",
keywords="user experience",
keywords="eHealth intervention",
keywords="mobile phone",
abstract="Background: The Dutch CoronaMelder (CM) app is the official Dutch contact-tracing app (CTA). It has been used to contain the spread of the SARS-CoV-2 in the Netherlands. It allows its users and those of connected apps to anonymously exchange warnings about potentially high-risk contacts with individuals infected with the SARS-CoV-2. Objective: The goal of this mixed methods study is to understand the use of CTA in the pandemic and its integration into the Municipal Health Services (MHS) efforts of containment through contact tracing. Moreover, the study aims to investigate both the motivations and user experience--related factors concerning adherence to quarantine and isolation measures. Methods: A topic analysis of 56 emails and a web-based survey of 1937 adults from the Netherlands, combined with a series of 48 in-depth interviews with end users of the app and 14 employees of the Dutch MHS involved in contact tracing, were conducted. Mirroring sessions were held (n=2) with representatives from the development (n=2) and communication teams (n=2) responsible for the creation and implementation of the CM app. Results: Topic analysis and interviews identified procedural and technical issues in the use of the CTA. Procedural issues included the lack of training of MHS employees in the use of CTAs. Technical issues identified for the end users included the inability to send notifications without phone contact with the MHS, unwarranted notifications, and nightly notifications. Together, these issues undermined confidence in and satisfaction with the app's use. The interviews offered a deeper understanding of the various factors at play and their effects on users; for example, the mixed experiences of the app's users, the end user's own fears, and uncertainties concerning the SARS-CoV-2; problematic infrastructure at the time of the app's implementation on the side of the health services; the effects of the society-wide efforts in containment of the SARS-CoV-2 on the CM app's perception, resulting in further doubts concerning the app's effectiveness among MHS workers and citizens; and problems with adherence to behavioral measures propagated by the app because of the lack of confidence in the app and uncertainty concerning the execution of the behavioral measures. All findings were evaluated with the app's creators and have since contributed to improvements. Conclusions: Although most participants perceived the app positively, procedural and technical issues identified in this study limited satisfaction and confidence in the CM app and affected its adoption and long-term use. Moreover, these same issues negatively affected the CM app's effectiveness in improving compliance with behavioral measures aimed at reducing the spread of the SARS-CoV-2. This study offers lessons learned for future eHealth interventions in pandemics. Lessons that can aid in more effective design, implementation, and communication for more effective and readily adoptable eHealth applications. ",
doi="10.2196/38904",
url="https://formative.jmir.org/2022/11/e38904",
url="http://www.ncbi.nlm.nih.gov/pubmed/36074930"
}


@Article{info:doi/10.2196/39861,
author="Lee, Katherine
and Bolton, Shay-Lee
and Shterenberg, Ravit
and Bolton, M. James
and Hensel, M. Jennifer",
title="Early Learning From a Low-Resource COVID-Response Virtual Mental Health Crisis Ward: Mixed Methods Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="4",
volume="6",
number="11",
pages="e39861",
keywords="virtual ward",
keywords="mental health",
keywords="COVID-19",
keywords="implementation",
keywords="driver diagram",
keywords="virtual care",
keywords="virtual health care",
keywords="acceptance",
keywords="psychiatric support",
keywords="crisis support",
keywords="provider perspectives",
abstract="Background: The COVID-19 pandemic was accompanied by the accelerated uptake of virtual care, leading to a proliferation of virtual ward models as alternatives to facility-based care. Early in the pandemic, our program implemented a virtual mental health crisis ward (vWard) to provide options for individuals requiring intense psychiatric and/or crisis support but who preferred to remain in the community and were deemed safe to do so. Objective: The aim of this study was to identify early learnings from the vWard, which was implemented rapidly in a resource-constrained environment, to inform the future state should it be sustained beyond the pandemic. Methods: Mixed methods of data collection were used to evaluate provider perspectives on the vWard, develop archetypes for individuals who are a good fit for the vWard model, and create a driver diagram. Data sources included an anonymous survey of clinical and managerial staff involved in the vWard, a service planning workshop, and program discharge forms for all individuals admitted between March 2020 and April 2021. Survey responses were coded for themes under categories of ``benefits'' and ``challenges.'' Discharge forms where the team indicated that the vWard was a good fit for an individual were examined for characteristics common to these admissions. These findings were reviewed in the service planning workshop and refined with input from the participants into patient archetypes. A driver diagram was created for the future state. Results: Survey respondents (N=60) represented diverse roles in crisis services and the vWard team. Ten providers took part in the service planning workshop. A total of 467 discharge forms were reviewed. The vWard was felt to be a model that worked by 39 survey respondents, one respondent felt it did not work, and the remaining participants had no response. Several benefits for the individual and the system were identified alongside challenges, including certain processes and materials related to the nature of rapid implementation during the pandemic, and others due to lack of fit for certain individuals. The model was felt to be a good fit for 67.5\% of admissions. Four patient archetypes representing a good fit with the model were developed. The driver diagram connected the program aim with primary drivers of (1) reduce barriers to care; (2) improve outcomes; and (3) provide collaborative, patient- and family-centered care to secondary drivers and interventions that leveraged virtual technology among other crisis care interventions. Conclusions: Despite some challenges, the vWard demonstrated high levels of provider acceptance and a range of mechanisms by which the model works for a variety of patient archetypes. These early learnings provide a foundation for growth, sustainability, and spread of this model going forward beyond the pandemic. ",
doi="10.2196/39861",
url="https://formative.jmir.org/2022/11/e39861",
url="http://www.ncbi.nlm.nih.gov/pubmed/36252139"
}


@Article{info:doi/10.2196/41914,
author="Gabashvili, S. Irene",
title="The Incidence and Effect of Adverse Events Due to COVID-19 Vaccines on Breakthrough Infections: Decentralized Observational Study With Underrepresented Groups",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="4",
volume="6",
number="11",
pages="e41914",
keywords="COVID-19",
keywords="COVID-19 vaccines",
keywords="vaccine adverse events",
keywords="breakthrough infections",
keywords="decentralized participatory study",
keywords="elderly",
keywords="older individuals",
keywords="medically underserved populations",
keywords="aging",
keywords="elderly population",
keywords="vaccination",
keywords="genetic disparity",
keywords="microbiome disparity",
keywords="impaired immunity",
abstract="Background: Despite continuing efforts to improve the inclusion of underserved groups in clinical research, gaps in diversity remain. Participation of special populations is especially important when facing problems of unprecedented complexity such as the COVID-19 pandemic. A better understanding of factors associated with the immune response in diverse populations would advance future preventive and curative approaches. Objective: The objective of this study was to investigate the factors potentially responsible for adverse events following COVID-19 immunization. The study population included adults from rural areas, transitional countries, and those with medically understudied conditions, across a broad age range. Methods: The study evolved from peer support networks developed during the COVID-19 pandemic. Participants were recruited digitally through online neighborhood and health communities. Some of the participants volunteered as study investigators assisting with offline recruitment and safety monitoring. Individuals who consented to participate were asked to share their vaccination experiences either using constantly evolving web-based surveys or via one-on-one communication. Inferential statistical analysis to estimate differences between study groups was performed using parametric and nonparametric tests. Results: Of 1430 participants who shared their vaccination experiences, 648 had outcome measures at their 1.5-year follow-up. Significant differences were found between age groups, types of vaccine adverse events (VAEs), incidences of breakthrough infections, and health conditions linked to the microbiome. Pairwise comparisons showed that VAEs interfering with daily activities were significantly higher in both younger (18-59 years) and older age groups (80-100 years, P<.001) than in the 60-79--year age group. Short-term VAEs were associated with lower incidence of breakthrough COVID-19 infections relative to those who reported either minimal or long-term adverse events (P<.001). A genetic origin was suggested for some adverse reactions. Conclusions: The findings of this study demonstrate that vaccine adverse reactions in older individuals are being overlooked, and the incidence of VAEs impairing immunity may be higher than previously perceived. Better preventive measures are needed for all those at risk for life-threatening and long-term adverse events due to vaccination. Supportive community-based studies focusing on these populations could add important data to the current body of knowledge. Further and more comprehensive studies should follow. Trial Registration: ClinicalTrials.gov NCT04832932; https://clinicaltrials.gov/ct2/show/NCT04832932 International Registered Report Identifier (IRRID): RR2-10.1101/2021.06.28.21256779 ",
doi="10.2196/41914",
url="https://formative.jmir.org/2022/11/e41914",
url="http://www.ncbi.nlm.nih.gov/pubmed/36309347"
}


@Article{info:doi/10.2196/36933,
author="Logaras, Evangelos
and Billis, Antonis
and Kyparissidis Kokkinidis, Ilias
and Ketseridou, Nafsika Smaranda
and Fourlis, Alexios
and Tzotzis, Aristotelis
and Imprialos, Konstantinos
and Doumas, Michael
and Bamidis, Panagiotis",
title="Risk Assessment of COVID-19 Cases in Emergency Departments and Clinics With the Use of Real-World Data and Artificial Intelligence: Observational Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="8",
volume="6",
number="11",
pages="e36933",
keywords="COVID-19 pandemic",
keywords="risk assessment",
keywords="wearable device",
keywords="respiration evaluation",
keywords="emergency department",
keywords="artificial intelligence",
keywords="real-world data",
abstract="Background: The recent COVID-19 pandemic has highlighted the weaknesses of health care systems around the world. In the effort to improve the monitoring of cases admitted to emergency departments, it has become increasingly necessary to adopt new innovative technological solutions in clinical practice. Currently, the continuous monitoring of vital signs is only performed in patients admitted to the intensive care unit. Objective: The study aimed to develop a smart system that will dynamically prioritize patients through the continuous monitoring of vital signs using a wearable biosensor device and recording of meaningful clinical records and estimate the likelihood of deterioration of each case using artificial intelligence models. Methods: The data for the study were collected from the emergency department and COVID-19 inpatient unit of the Hippokration General Hospital of Thessaloniki. The study was carried out in the framework of the COVID-X H2020 project, which was funded by the European Union. For the training of the neural network, data collection was performed from COVID-19 cases hospitalized in the respective unit. A wearable biosensor device was placed on the wrist of each patient, which recorded the primary characteristics of the visual signal related to breathing assessment. Results: A total of 157 adult patients diagnosed with COVID-19 were recruited. Lasso penalty function was used for selecting 18 out of 48 predictors and 2 random forest--based models were implemented for comparison. The high overall performance was maintained, if not improved, by feature selection, with random forest achieving accuracies of 80.9\% and 82.1\% when trained using all predictors and a subset of them, respectively. Preliminary results, although affected by pandemic limitations and restrictions, were promising regarding breathing pattern recognition. Conclusions: This study represents a novel approach that involves the use of machine learning methods and Edge artificial intelligence to assist the prioritization and continuous monitoring procedures of patients with COVID-19 in health departments. Although initial results appear to be promising, further studies are required to examine its actual effectiveness. ",
doi="10.2196/36933",
url="https://formative.jmir.org/2022/11/e36933",
url="http://www.ncbi.nlm.nih.gov/pubmed/36197836"
}


@Article{info:doi/10.2196/38562,
author="Tump, Danielle
and Narayan, Nitin
and Verbiest, Vera
and Hermsen, Sander
and Goris, Annelies
and Chiu, Chui-De
and Van Stiphout, Ruud",
title="Stressors and Destressors in Working From Home Based on Context and Physiology From Self-Reports and Smartwatch Measurements: International Observational Study Trial",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="10",
volume="6",
number="11",
pages="e38562",
keywords="stress",
keywords="telework",
keywords="wearables",
keywords="COVID-19",
keywords="pandemic",
keywords="remote working",
keywords="employees",
keywords="stressors",
keywords="destressors",
keywords="remote work",
keywords="mental health",
keywords="psychological health",
keywords="smartphone",
keywords="digital questionnaire",
keywords="stress management",
keywords="occupational health",
keywords="stress detection",
keywords="prediction model",
abstract="Background: The COVID-19 pandemic has greatly boosted working from home as a way of working, which is likely to continue for most companies in the future, either in fully remote or in hybrid form. To manage stress levels in employees working from home, insights into the stressors and destressors in a home office first need to be studied. Objective: We present an international remote study with employees working from home by making use of state-of-the-art technology (ie, smartwatches and questionnaires through smartphones) first to determine stressors and destressors in people working from home and second to identify smartwatch measurements that could represent these stressors and destressors. Methods: Employees working from home from 3 regions of the world (the United States, the United Kingdom, and Hong Kong) were asked to wear a smartwatch continuously for 7 days and fill in 5 questionnaires each day and 2 additional questionnaires before and after the measurement week. The entire study was conducted remotely. Univariate statistical analyses comparing variable distributions between low and high stress levels were followed by multivariate analysis using logistic regression, considering multicollinearity by using variance inflation factor (VIF) filtering. Results: A total of 202 people participated, with 198 (98\%) participants finishing the experiment. Stressors found were other people and daily life getting in the way of work (P=.05), job intensity (P=.01), a history of burnout (P=.03), anxiety toward the pandemic (P=.04), and environmental noise (P=.01). Destressors found were access to sunlight (P=.02) and fresh air (P<.001) during the workday and going outdoors (P<.001), taking breaks (P<.001), exercising (P<.001), and having social interactions (P<.001). The smartwatch measurements positively related to stress were the number of active intensity periods (P<.001), the number of highly active intensity periods (P=.04), steps (P<.001), and the SD in the heart rate (HR; P<.001). In a multivariate setting, only a history of burnout (P<.001) and family and daily life getting in the way of work (P<.001) were positively associated with stress, while self-reports of social activities (P<.001) and going outdoors (P=.03) were negatively associated with stress. Stress prediction models based on questionnaire data had a similar performance (F1=0.51) compared to models based on automatic measurable data alone (F1=0.47). Conclusions: The results show that there are stressors and destressors when working from home that should be considered when managing stress in employees. Some of these stressors and destressors are (in)directly measurable with unobtrusive sensors, and prediction models based on these data show promising results for the future of automatic stress detection and management. Trial Registration: Netherlands Trial Register NL9378; https://trialsearch.who.int/Trial2.aspx?TrialID=NL9378 ",
doi="10.2196/38562",
url="https://formative.jmir.org/2022/11/e38562",
url="http://www.ncbi.nlm.nih.gov/pubmed/36265030"
}


@Article{info:doi/10.2196/39634,
author="Wilczewski, Hattie
and Paige, R. Samantha
and Ong, Triton
and Soni, Hiral
and Barrera, F. Janelle
and Welch, M. Brandon
and Bunnell, E. Brian",
title="Providers' Perspectives on Telemental Health Usage After the COVID-19 Pandemic: Retrospective Analysis",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="11",
volume="6",
number="11",
pages="e39634",
keywords="telemedicine",
keywords="telehealth",
keywords="COVID-19",
keywords="telemental health",
keywords="mental health",
keywords="pandemic",
keywords="perception",
keywords="use",
keywords="usefulness",
keywords="usage",
keywords="workflow",
abstract="Background: Mental health care pivoted to telemedicine during the COVID-19 pandemic, and there is uncertainty around the sustainability of this rapid shift. Objective: This study examined how intentions to continue using telemedicine after the COVID-19 pandemic are influenced by provider perceptions of usefulness, ease of use, and professional social influence, facilitating organizational conditions. Methods: We conducted a web-based, cross-sectional survey of 369 telemental health providers between February and March 2021. A hierarchical linear regression analysis was conducted to predict intentions to continue using telemedicine after the COVID-19 pandemic. Results: Most providers began using telemedicine in March 2020 or later (257/369, 69.6\%) and attended to ?50\% of their clients via telemedicine (299/369, 81.0\%). Intention to continue using telemedicine after the COVID-19 pandemic was predicted by the telemedicine caseload ($\beta$=.10; P=.005), perceived usefulness in general ($\beta$=.10; P=.008), ease of use ($\beta$=.08; P=.04), social influence ($\beta$=.68; P<.001), and facilitating conditions ($\beta$=.08; P=.047). Conclusions: Exploration of the predictors of telemedicine usage beyond the COVID-19 pandemic aids in surveillance of telemedicine usage, integration with future clinic workflows, and the shaping of public policy. It is important to consider telemedicine services as not only a response to a crisis but also an effective and useful solution for everyday life. Our results suggest widespread, sustainable telemedicine adoption. ",
doi="10.2196/39634",
url="https://formative.jmir.org/2022/11/e39634",
url="http://www.ncbi.nlm.nih.gov/pubmed/36322787"
}


@Article{info:doi/10.2196/37698,
author="Chen, Xi
and Yik, Michelle",
title="The Emotional Anatomy of the Wuhan Lockdown: Sentiment Analysis Using Weibo Data",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="14",
volume="6",
number="11",
pages="e37698",
keywords="Wuhan lockdown",
keywords="COVID-19",
keywords="public health emergency",
keywords="emotion",
keywords="circumplex model of affect",
keywords="Weibo",
keywords="jiayou",
abstract="Background: On January 23, 2020, the city of Wuhan, China, was sealed off in response to the COVID-19 pandemic. Studies have found that the lockdown was associated with both positive and negative emotions, although their findings are not conclusive. In these studies, emotional responses to the Wuhan lockdown were identified using lexicons based on limited emotion types. Objective: This study aims to map Chinese people's emotional responses to the Wuhan lockdown and compare Wuhan residents' emotions with those of people elsewhere in China by analyzing social media data from Weibo using a lexicon based on the circumplex model of affect. Methods: Social media posts on Weibo from 2 weeks before to 2 weeks after the Wuhan lockdown was imposed (January 9, 2020, to February 6, 2020) were collected. Each post was coded using a valence score and an arousal score. To map emotional trajectories during the study period, we used a data set of 359,190 posts. To compare the immediate emotional responses to the lockdown and its longer-term emotional impact on Wuhan residents (n=1236) and non-Hubei residents (n=12,714), we used a second data set of 57,685 posts for multilevel modeling analyses. Results: Most posts (248,757/359,190, 69.25\%) made during the studied lockdown period indicated a pleasant mood with low arousal. A gradual increase in both valence and arousal before the lockdown was observed. The posts after the lockdown was imposed had higher valence and arousal than prelockdown posts. On the day of lockdown, the non-Hubei group had a temporarily boosted valence ($\gamma$20=0.118; SE 0.021; P<.001) and arousal ($\gamma$30=0.293; SE 0.022; P<.001). Compared with non-Hubei residents, the Wuhan group had smaller increases in valence ($\gamma$21=?0.172; SE 0.052; P<.001) and arousal ($\gamma$31=?0.262; SE 0.053; P<.001) on the day of lockdown. Weibo users' emotional valence ($\gamma$40=0.000; SE 0.001; P=.71) and arousal ($\gamma$40=0.001; SE 0.001; P=.56) remained stable over the 2 weeks after the lockdown was imposed regardless of geographical location (valence: $\gamma$41=?0.004, SE 0.003, and P=.16; arousal: $\gamma$41=0.003, SE 0.003, and P=.26). Conclusions: During the early stages of the pandemic, most Weibo posts indicated a pleasant mood with low arousal. The overall increase in the posts' valence and arousal after the lockdown announcement might indicate collective cohesion and mutual support in web-based communities during a public health crisis. Compared with the temporary increases in valence and arousal of non-Hubei users on the day of lockdown, Wuhan residents' emotions were less affected by the announcement. Overall, our data suggest that Weibo users were not influenced by the lockdown measures in the 2 weeks after the lockdown announcement. Our findings offer policy makers insights into the usefulness of social connections in maintaining the psychological well-being of people affected by a lockdown. ",
doi="10.2196/37698",
url="https://formative.jmir.org/2022/11/e37698",
url="http://www.ncbi.nlm.nih.gov/pubmed/36166650"
}


@Article{info:doi/10.2196/34388,
author="Nu{\~n}ez, R. Tania
and Pallasch, Nina
and Radtke, Theda",
title="Students' Emotional Well-being and Academic Functioning Before, During, and After Lockdown in Germany: Cohort Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="15",
volume="6",
number="11",
pages="e34388",
keywords="self-efficacy",
keywords="academic self-concept",
keywords="test anxiety",
keywords="achievement motivation",
keywords="positive and negative affect",
keywords="mobile phone",
keywords="COVID-19",
abstract="Background: The COVID-19 lockdowns have led to social detriments and altered learning environments among university students. Recent research indicates that such ramifications may engender various impairments to students' mental health. However, such research has major limitations, such as the lack of a prepandemic control measure, the focus on singular well-being parameters, or the investigation of only the early phases of the pandemic. Objective: To address these research gaps, this comprehensive and nationwide study compared 3 student cohorts (aged 17-48 years) in Germany: a prepandemic cohort (January-February 2020), a postlockdown cohort (May 2020-July 2020), and an intralockdown cohort (January-February 2021) regarding students' general emotional well-being and academic functioning. It was hypothesized that, because of rigorous lockdown-related restrictions, students in the intralockdown cohort would report diminished general emotional well-being compared with the other cohorts. Furthermore, because of ongoing remote learning since the beginning of the pandemic, it was expected that students' academic functioning would decrease across all 3 cohorts. Methods: The data collection was performed over 3 consecutive semesters (fall semester 2019-2020, spring semester 2020, and fall semester 2020-2021). Students were surveyed on the web on various aspects regarding their general emotional well-being (eg, stress and general well-being) and academic functioning (eg, concentration and study-related flow). Data analyses were performed using multivariate ANOVAs. Results: A total of 787 students participated in this study. Results indicated higher general well-being in the postlockdown cohort than in the intralockdown cohort (P=.02). As for students' academic functioning, our results revealed that students in the prepandemic cohort reported higher study-related flow (P=.007) and concentration (P=.001) than those in the intralockdown cohort. In addition, students reported higher flow (P=.04) and concentration (P=.04) in the postlockdown cohort than those in the intralockdown cohort. No cohort effects were revealed for other aspects of general emotional well-being (eg, perceived stress) and academic functioning (eg, procrastination). Conclusions: This study indicates that students' general emotional well-being as well as motivational and attentional components of academic functioning can be impaired owing to the COVID-19 lockdowns and ongoing remote learning formats. The necessity and design of interventional programs remedying such effects in light of the ongoing crisis need to be addressed. ",
doi="10.2196/34388",
url="https://formative.jmir.org/2022/11/e34388",
url="http://www.ncbi.nlm.nih.gov/pubmed/36228133"
}


@Article{info:doi/10.2196/35730,
author="Anderson, M. Katherine
and Stockman, K. Jamila",
title="Fear of COVID-19 and Prevention Behaviors: Cross-Lagged Panel Analysis",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="17",
volume="6",
number="11",
pages="e35730",
keywords="fear appeals",
keywords="structural equation modelling",
keywords="cross-lagged model",
keywords="prevention behavior",
keywords="COVID-19",
keywords="fear",
keywords="women",
keywords="behavior",
keywords="change",
keywords="health",
keywords="physical distance",
keywords="relationships",
keywords="pandemic",
keywords="research",
keywords="association",
keywords="prevention",
keywords="experience",
keywords="panel",
keywords="interest",
keywords="public",
keywords="distancing",
abstract="Background: The ongoing COVID-19 pandemic has brought forth conversations about effective behavior change models for increasing prevention behavior, ranging from wearing masks in public to physical distancing. Among the considered behavior change techniques is the use of fear appeals, through which a negative possible outcome is emphasized to invoke fear, which in turn may promote prevention behaviors to counter the likelihood of the negative outcome. Although fear is hypothesized as health promoting in some theories of health behavior, little research has rigorously assessed the relationship. Objective: In our exploratory analyses, we aim to examine the association, including directionality of the association between fear of COVID-19 and COVID-19 prevention behaviors across 2 time points during the early COVID-19 pandemic among a sample of US women. Methods: The COPE study, a web-based survey of US women's COVID-19 experiences, was deployed in May-June 2020 (time 1) with follow-up in December 2020-January 2021 (time 2; n=200). Demographic characteristics as well as fear of COVID-19 and COVID-19 prevention behaviors (eg, staying home except for essential activities, physical distancing in public, and masking in public) were measured. Descriptive and bivariate analyses were used to characterize COVID-19 prevention behaviors and fear of COVID-19 among participants. Cross-lagged panel analysis, a type of structural equation modeling that assesses directionality of temporal associations, was used to understand relationships, if any, between variables of interest. Results: We found cross-sectional associations between fear of COVID-19 and staying home and physical distancing, as well as temporal associations between fear at time 1 and time 2 and prevention behaviors at time 1 and time 2. However, results of the cross-lagged panel analysis indicated no cross-lagged temporal relationships between fear of COVID-19 and COVID-19 prevention behaviors 6 months apart. Conclusions: Fear of COVID-19 did not appear to predict COVID-19 prevention behaviors 6 months after initial measurements among the sample of women recruited for our study. Future research should rigorously test these associations longitudinally, and alternative methods of public health prevention promotion should be considered. ",
doi="10.2196/35730",
url="https://formative.jmir.org/2022/11/e35730",
url="http://www.ncbi.nlm.nih.gov/pubmed/36346895"
}


@Article{info:doi/10.2196/38425,
author="Ackleh-Tingle, V. Jonathan
and Jordan, M. Natalie
and Onwubiko, N. Udodirim
and Chandra, Christina
and Harton, E. Paige
and Rentmeester, T. Shelby
and Chamberlain, T. Allison",
title="Prevalence and Correlates of COVID-19 Vaccine Information on Family Medicine Practices' Websites in the United States: Cross-sectional Website Content Analysis",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="17",
volume="6",
number="11",
pages="e38425",
keywords="primary care",
keywords="vaccine hesitancy",
keywords="COVID-19",
keywords="health communications",
keywords="health information",
keywords="health website",
keywords="family practice",
keywords="vaccine information",
keywords="online health",
keywords="health platform",
keywords="online information",
abstract="Background: Primary care providers are regarded as trustworthy sources of information about COVID-19 vaccines. Although primary care practices often provide information about common medical and public health topics on their practice websites, little is known about whether they also provide information about COVID-19 vaccines on their practice websites. Objective: This study aimed to investigate the prevalence and correlates of COVID-19 vaccine information on family medicine practices' website home pages in the United States. Methods: We used the Centers for Medicare and Medicaid National Provider Identifier records to create a sampling frame of all family medicine providers based in the United States, from which we constructed a nationally representative random sample of 964 family medicine providers. Between September 20 and October 8, 2021, we manually examined the practice websites of these providers and extracted data on the availability of COVID-19 vaccine information, and we implemented a 10\% cross-review quality control measure to resolve discordances in data abstraction. We estimated the prevalence of COVID-19 vaccine information on practice websites and website home pages and used Poisson regression with robust error variances to estimate crude and adjusted prevalence ratios for correlates of COVID-19 vaccine information, including practice size, practice region, university affiliation, and presence of information about seasonal influenza vaccines. Additionally, we performed sensitivity analyses to account for multiple comparisons. Results: Of the 964 included family medicine practices, most (n=509, 52.8\%) had ?10 distinct locations, were unaffiliated with a university (n=838, 87.2\%), and mentioned seasonal influenza vaccines on their websites (n=540, 56.1\%). In total, 550 (57.1\%) practices mentioned COVID-19 vaccines on their practices' website home page, specifically, and 726 (75.3\%) mentioned COVID-19 vaccines anywhere on their practice website. As practice size increased, the likelihood of finding COVID-19 vaccine information on the home page increased (n=66, 27.7\% among single-location practices, n=114, 52.5\% among practices with 2-9 locations, n=66, 56.4\% among practices with 10-19 locations, and n=304, 77.6\% among practices with 20 or more locations, P<.001 for trend). Compared to clinics in the Northeast, those in the West and Midwest United States had a similar prevalence of COVID-19 vaccine information on website home pages, but clinics in the south had a lower prevalence (adjusted prevalence ratio 0.8, 95\% CI 0.7 to 1.0; P=.02). Our results were largely unchanged in sensitivity analyses accounting for multiple comparisons. Conclusions: Given the ongoing COVID-19 pandemic, primary care practitioners who promote and provide vaccines should strongly consider utilizing their existing practice websites to share COVID-19 vaccine information. These existing platforms have the potential to serve as an extension of providers' influence on established and prospective patients who search the internet for information about COVID-19 vaccines. ",
doi="10.2196/38425",
url="https://formative.jmir.org/2022/11/e38425",
url="http://www.ncbi.nlm.nih.gov/pubmed/36343211"
}


@Article{info:doi/10.2196/41847,
author="Yagiz, Ismail Jan
and Goderis, Geert",
title="The Impact of the COVID-19 Pandemic on eHealth Use in the Daily Practice and Life of Dutch-Speaking General Practitioners in Belgium: Qualitative Study With Semistructured Interviews",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="28",
volume="6",
number="11",
pages="e41847",
keywords="COVID-19",
keywords="impact",
keywords="eHealth",
keywords="GPs",
keywords="Flemish",
keywords="practice",
keywords="qualitative study",
keywords="semistructured interviews",
abstract="Background: The COVID-19 crisis has led to rapid and far-reaching changes in digital health care, but little is known about what, why, and how changes occurred in eHealth use in Flemish general practice during the pandemic. Objective: This study aims to understand how general practitioners (GPs) perceive and evaluate eHealth solutions and their eHealth experience during the COVID-19 pandemic. Methods: This qualitative study was conducted using in-depth 1-on-1 semistructured interviews with the help of an interview guide. Several areas were identified beforehand to help assess the impact of the COVID-19 pandemic: perceptions of digital technologies in GP practices; changes in the use of these technologies during and after the COVID-19 pandemic; GPs' adaptation to digitalization, benefits, risks, and challenges of eHealth; GPs motivations to change practice; and future perspectives on eHealth. In this study, purposive sampling and snowballing methods were used. Between October 2021 and April 2022, we interviewed 15 Dutch-speaking GPs in the Flemish region via the Zoom online conferencing tool. Results: GPs indicated that eHealth was used more frequently during the COVID-19 pandemic than before, a change that helped them reduce their workload, enabling greater accessibility to health care services and the complementary use of digital and physical consultations. Our findings suggest that physicians underwent a significant cognitive shift in their perceptions, causing them to be more open and prepared to adopt eHealth solutions. However, there remains significant doubt and uncertainty about digital literacy for certain groups, privacy, data security, reimbursement, and the burden of technical information and communication technologies (ICT) issues. Conclusions: The COVID-19 pandemic seems to have been a turning point for eHealth by Flemish GPs. eHealth is an essential complementary health care service that can reduce pressure on health care as well as increase health care accessibility. Sensitive aspects, such as privacy, data security, digital literacy, reimbursement, and the burden of technical ICT issues, are particularly emphasized. With our results, we can offer recommendations to health IT policymakers and developers that will help maintain the continuity of eHealth solutions beyond the COVID-19 pandemic, considering the expectations and sensitivities presented in the study. ",
doi="10.2196/41847",
url="https://formative.jmir.org/2022/11/e41847",
url="http://www.ncbi.nlm.nih.gov/pubmed/36399650"
}


@Article{info:doi/10.2196/38357,
author="Pullyblank, Kristin
and Atav, Serdar",
title="Enrollment and Completion Characteristics for Novel Remote Delivery Modes of the Self-management Programs During the COVID-19 Pandemic: Exploratory Analysis",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="30",
volume="6",
number="11",
pages="e38357",
keywords="self-management programs",
keywords="self management",
keywords="internet-based intervention",
keywords="health promotion",
keywords="COVID-19",
keywords="health equity",
keywords="socioeconomic status",
keywords="remote healthcare",
keywords="health delivery",
keywords="virtual care",
keywords="remote care",
keywords="remote delivery",
keywords="videoconference",
keywords="videoconferencing",
keywords="adherence",
keywords="attrition",
keywords="completion",
keywords="virtual health",
abstract="Background: In-person, evidence-based, peer-facilitated chronic disease self-management programs have been shown to be effective for individuals from a variety of backgrounds, including rural and minority populations and those with lower socioeconomic status. Based in social learning theory, these programs use group processes to help participants better manage their chronic disease symptoms and improve their quality of life. During the pandemic, these in-person programs were forced to rapidly transition to remote delivery platforms, and it was unclear whether doing so increased disparities within our rural population. Objective: The objectives of this analysis were to ascertain self-management program enrollment and completion characteristics between 2 remote delivery platforms, as well as determine the individual level characteristics that drove enrollment and completion across delivery modes. Methods: We analyzed enrollment and completion characteristics of 183 individuals who either enrolled in a self-management workshop delivered through a web-based videoconference (VC) system or through a traditional, audio-only conference call (CC) offered by our health care network between April and December 2020. Chi-square tests of association were used to describe the characteristics of and differences between groups. Logistic regression analysis was used to determine significant predictors of enrollment and completion. Results: Those who enrolled in the VC platform were significantly likelier to be younger and college educated than those who enrolled in the CC platform. Those who completed a program, regardless of delivery mode, were likelier to be older and college educated than those who did not complete a program. Multivariate analyses indicated that of those enrolled in the CC platform, completers were likelier to not be enrolled in Medicaid. Among those enrolled in the VC platform, completers were older, college graduates, female, and likelier to have reported poorer health than those who did not complete the program. Conclusions: The transition of self-management programs to remote delivery modes, particularly to those that rely on VC platforms, revealed that certain demographic groups may no longer be able or willing to access the service. Efforts need to be made to increase engagement in remote self-management workshops. In addition, equivalent quality services that do not rely on a digital platform must continue to be offered in order to promote health equity. ",
doi="10.2196/38357",
url="https://formative.jmir.org/2022/11/e38357",
url="http://www.ncbi.nlm.nih.gov/pubmed/36413622"
}


@Article{info:doi/10.2196/39912,
author="Smit, Dorien
and Vrijsen, N. Janna
and Broekman, Theo
and Groeneweg, Bart
and Spijker, Jan",
title="User Engagement Within an Online Peer Support Community (Depression Connect) and Recovery-Related Changes in Empowerment: Longitudinal User Survey",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="2",
volume="6",
number="11",
pages="e39912",
keywords="depression",
keywords="online peer support community",
keywords="internet support group",
keywords="experiential knowledge",
keywords="self-management",
keywords="empowerment",
keywords="user engagement",
keywords="longitudinal user survey",
abstract="Background: The chronic nature of depression and limited availability of evidence-based treatments emphasize the need for complementary recovery-oriented services, such as peer support interventions (PSIs). Peer support is associated with positive effects on clinical and personal recovery from mental illness, but little is known about the processes of engagement that foster change, and studies targeting individuals with depression specifically are limited. Objective: This study aimed to evaluate whether the level of user engagement, assessed on several dimensions, in an online peer support community for individuals with depression promotes empowerment and the use of self-management strategies and reduces symptom severity and disability. Methods: In a longitudinal survey conducted from June 2019 to September 2020, we analyzed the data of the users of Depression Connect (DC), an online peer support community hosted by the Dutch Patient Association for Depression and the Pro Persona Mental Health Care institute, on measures of empowerment, self-management, depression, and disability. Of the 301 respondents, 49 (16.3\%) respondents completed the survey again after 3 months and 74 (24.6\%) respondents, after 6 months. Analysis of 3 parameters (ie, total time spent on the platform, number of page views, and number of posts) derived from their data logs yielded 4 engagement profiles. Linear mixed models were fitted to determine whether the outcomes had significantly changed over time and differed for the various profiles. Results: Baseline engagement with the online peer support community was ``very low'' (177/301, 58.8\%) or ``low'' (87/301, 28.9\%) for most of the participants, with few showing ``medium'' (30/301, 9.9\%) or ``high'' engagement patterns (7/301, 2.3\%), while user profiles did not differ in demographic and clinical characteristics. Empowerment, self-management, depressive symptoms, and disability improved over time, but none were associated with the intensity or nature of user engagement. Conclusions: With most DC members showing very low to low engagement and only a few being identified as high-engaged users, it is likely that this flexibility in use frequency is what provides value to online PSI users. In other more formal supportive environments for depression, a certain level of engagement is predetermined either by their organizational or by their societal context; at DC, users can adapt the intensity and nature of their engagement to their current needs on their personal road to recovery. This study added to the current knowledge base on user engagement for PSIs because previous studies targeting depression with an online format focused on active users, precluding passive and flexible engagement. Future studies should explore the content and quality of the interactions in online PSIs to identify optimal user engagement as a function of current, self-reported clinical parameters and reasons to engage in the PSI. ",
doi="10.2196/39912",
url="https://formative.jmir.org/2022/11/e39912",
url="http://www.ncbi.nlm.nih.gov/pubmed/36322110"
}


@Article{info:doi/10.2196/38862,
author="Moyano, Luz Daniela
and Lopez, Victoria Mar{\'i}a
and Cavallo, Ana
and Candia, Patricia Julia
and Kaen, Aaron
and Irazola, Vilma
and Beratarrechea, Andrea",
title="The Use of 2 e-Learning Modalities for Diabetes Education Using Facebook in 2 Cities of Argentina During the COVID-19 Pandemic: Qualitative Study",
journal="JMIR Form Res",
year="2022",
month="Nov",
day="16",
volume="6",
number="11",
pages="e38862",
keywords="COVID-19",
keywords="social media",
keywords="diabetes mellitus",
keywords="public health",
keywords="qualitative research",
keywords="COVID-19 pandemic",
keywords="teaching and learning settings",
keywords="online learning",
keywords="eHealth literacy",
abstract="Background: The COVID-19 pandemic and the confinement that was implemented in Argentina generated a need to implement innovative tools for the strengthening of diabetes care. Diabetes self-management education (DSME) is a core element of diabetes care; however, because of COVID-19 restrictions, in-person diabetes educational activities were suspended. Social networks have played an instrumental role in this context to provide DSME in 2 cities of Argentina and help persons with diabetes in their daily self-management. Objective: The aim of this study is to evaluate 2 diabetes education modalities (synchronous and asynchronous) using the social media platform Facebook through the content of posts on diabetes educational sessions in 2 cities of Argentina during the COVID-19 pandemic. Methods: In this qualitative study, we explored 2 modalities of e-learning (synchronous and asynchronous) for diabetes education that used the Facebook pages of public health institutions in Chaco and La Rioja, Argentina, in the context of confinement. Social media metrics and the content of the messages posted by users were analyzed. Results: A total of 332 messages were analyzed. We found that in the asynchronous modality, there was a higher number of visualizations, while in the synchronous modality, there were more posts and interactions between educators and users. We also observed that the number of views increased when primary care clinics were incorporated as disseminators, sharing educational videos from the sessions via social media. Positive aspects were observed in the posts, consisting of messages of thanks and, to a lesser extent, reaffirmations, reflections or personal experiences, and consultations related to the subject treated. Another relevant finding was that the educator/moderator role had a greater presence in the synchronous modality, where posts were based on motivation for participation, help to resolve connectivity problems, and answers to specific user queries. Conclusions: Our findings show positive contributions of an educational intervention for diabetes care using the social media platform Facebook in the context of the COVID-19 pandemic. Although each modality (synchronous vs asynchronous) could have differential and particular advantages, we believe that these strategies have potential to be replicated and adapted to other contexts. However, more documented experiences are needed to explore their sustainability and long-term impact from the users' perspective. ",
doi="10.2196/38862",
url="https://formative.jmir.org/2022/11/e38862",
url="http://www.ncbi.nlm.nih.gov/pubmed/36322794"
}



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