TY - JOUR AU - Huma, E. Zil AU - Struik, Laura AU - Bottorff, L. Joan AU - Hasan, Khalad Mohammad PY - 2022/4/1 TI - Preferences for Mobile-Supported e-Cigarette Cessation Interventions Among Young Adults: Qualitative Descriptive Study JO - JMIR Form Res SP - e33640 VL - 6 IS - 4 KW - qualitative research KW - electronic nicotine delivery systems KW - e-cigarette KW - cessation KW - young adults KW - smartphone apps KW - mHealth KW - mobile phone N2 - Background: Despite the steady rise in electronic cigarette (e-cigarette) uptake among young adults, increasingly more young people want to quit. Given the popularity of smartphones among young adults, mobile-based e-cigarette cessation interventions hold significant promise. Smartphone apps are particularly promising due to their varied and complex capabilities to engage end users. However, evidence around young adults? preferences and expectations from an e-cigarette cessation smartphone app remains unexplored. Objective: The purpose of this study was to take an initial step toward understanding young adults? preferences and perceptions on app-based e-cigarette cessation interventions. Methods: Using a qualitative descriptive approach, we interviewed 12 young adults who used e-cigarettes and wanted to quit. We inductively derived themes using the framework analysis approach and NVivo 12 qualitative data analysis software. Results: All participants agreed that a smartphone app for supporting cessation was desirable. In addition, we found 4 key themes related to their preferences for app components: (1) flexible personalization (being able to enter and modify goals); (2) e-cigarette behavior tracking (progress and benefits of quitting); (3) safely managed social support (moderated and anonymous); and (4) positively framed notifications (encouraging and motivational messages). Some gender-based differences indicate that women were more likely to use e-cigarettes to cope with stress, preferred more aesthetic tailoring in the app, and were less likely to quit cold turkey compared with men. Conclusions: The findings provide direction for the development and testing of app-based e-cigarette cessation interventions for young adults. UR - https://formative.jmir.org/2022/4/e33640 UR - http://dx.doi.org/10.2196/33640 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363140 ID - info:doi/10.2196/33640 ER - TY - JOUR AU - Hendawi, Rasha AU - Alian, Shadi AU - Li, Juan PY - 2022/4/1 TI - A Smart Mobile App to Simplify Medical Documents and Improve Health Literacy: System Design and Feasibility Validation JO - JMIR Form Res SP - e35069 VL - 6 IS - 4 KW - health literacy KW - knowledge graph KW - natural language processing KW - machine learning KW - medical entity recognition N2 - Background: People with low health literacy experience more challenges in understanding instructions given by their health providers, following prescriptions, and understanding their health care system sufficiently to obtain the maximum benefits. People with insufficient health literacy have high risk of making medical mistakes, more chances of experiencing adverse drug effects, and inferior control of chronic diseases. Objective: This study aims to design, develop, and evaluate a mobile health app, MediReader, to help individuals better understand complex medical materials and improve their health literacy. Methods: MediReader is designed and implemented through several steps, which are as follows: measure and understand an individual?s health literacy level; identify medical terminologies that the individual may not understand based on their health literacy; annotate and interpret the identified medical terminologies tailored to the individual?s reading skill levels, with meanings defined in the appropriate external knowledge sources; evaluate MediReader using task-based user study and satisfaction surveys. Results: On the basis of the comparison with a control group, user study results demonstrate that MediReader can improve users? understanding of medical documents. This improvement is particularly significant for users with low health literacy levels. The satisfaction survey showed that users are satisfied with the tool in general. Conclusions: MediReader provides an easy-to-use interface for users to read and understand medical documents. It can effectively identify medical terms that a user may not understand, and then, annotate and interpret them with appropriate meanings using languages that the user can understand. Experimental results demonstrate the feasibility of using this tool to improve an individual?s understanding of medical materials. UR - https://formative.jmir.org/2022/4/e35069 UR - http://dx.doi.org/10.2196/35069 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363142 ID - info:doi/10.2196/35069 ER - TY - JOUR AU - Reyzelman, M. Alexander AU - Shih, Chia-Ding AU - Tovmassian, Gregory AU - Nathan, Mohan AU - Ma, Ran AU - Scholten, Jan Henk AU - Malhotra, Kara AU - Armstrong, G. David PY - 2022/4/1 TI - An Evaluation of Real-world Smart Sock?Based Temperature Monitoring Data as a Physiological Indicator of Early Diabetic Foot Injury: Case-Control Study JO - JMIR Form Res SP - e31870 VL - 6 IS - 4 KW - diabetes KW - diabetic foot ulcer KW - temperature monitoring KW - Charcot foot KW - digital health KW - wearable KW - neuropathy KW - remote patient monitoring KW - foot ulcer KW - monitoring device KW - patient monitoring N2 - Background: Lower extremity complications of diabetes represent major health care complications both in terms of cost and impact to quality of life for patients with diabetic peripheral neuropathy. Temperature monitoring has been shown in previous studies to provide a useful signal of inflammation that may indicate the early presence of a foot injury. Objective: In this study, we evaluated the temperature data for patients that presented with a diabetic foot injury while using a sock-based remote temperature monitoring device. Methods: The study abstracted data from patients who were enrolled in a remote temperature monitoring program (2020-2021) using a smart sock (Siren Care). In the study cohort, a total of 5 participants with a diabetes-related lower extremity injury during the study period were identified. In the second comparison cohort, a total of 26 patients met the criteria for monitoring by the same methods but did not present with a diabetes-related podiatric lower extremity injury during the same period. The 15-day temperature differential between 6 defined locations on each foot was the primary outcome measure among subjects who presented with a diagnosed foot injury. Paired t tests were used to compare the differences between the two groups. Results: A significant difference in temperature differential (temperature measured in °F) was observed in the group that presented with a podiatric injury over the course of evaluation versus the comparator group that did not present with a podiatric injury. The average difference from all 6 measured points was 1.4 °F between the injury group (mean 3.6, SD 3.0) and the comparator group (mean 2.2, SD 2.5, t=?71.4, df=39; P<.001). Conclusions: The results of this study suggest temperature monitoring in a sock form factor could be used to predict a developing foot injury. The continuous temperature monitoring system employed has implications for further algorithm development to enable early detection. The study was limited by a nonrandomized, observational design with limited injuries present in the study period. We look forward to further studies that will refine the predictive potential and confirm or refute the current promising data. UR - https://formative.jmir.org/2022/4/e31870 UR - http://dx.doi.org/10.2196/31870 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363148 ID - info:doi/10.2196/31870 ER - TY - JOUR AU - Fecho, Karamarie AU - Ahalt, C. Stanley AU - Appold, Stephen AU - Arunachalam, Saravanan AU - Pfaff, Emily AU - Stillwell, Lisa AU - Valencia, Alejandro AU - Xu, Hao AU - Peden, B. David PY - 2022/4/1 TI - Development and Application of an Open Tool for Sharing and Analyzing Integrated Clinical and Environmental Exposures Data: Asthma Use Case JO - JMIR Form Res SP - e32357 VL - 6 IS - 4 KW - open patient data KW - electronic health records KW - airborne pollutant exposures KW - socioeconomic exposures KW - medication exposures KW - asthma exacerbation N2 - Background: The Integrated Clinical and Environmental Exposures Service (ICEES) serves as an open-source, disease-agnostic, regulatory-compliant framework and approach for openly exposing and exploring clinical data that have been integrated at the patient level with a variety of environmental exposures data. ICEES is equipped with tools to support basic statistical exploration of the integrated data in a completely open manner. Objective: This study aims to further develop and apply ICEES as a novel tool for openly exposing and exploring integrated clinical and environmental data. We focus on an asthma use case. Methods: We queried the ICEES open application programming interface (OpenAPI) using a functionality that supports chi-square tests between feature variables and a primary outcome measure, with a Bonferroni correction for multiple comparisons (?=.001). We focused on 2 primary outcomes that are indicative of asthma exacerbations: annual emergency department (ED) or inpatient visits for respiratory issues; and annual prescriptions for prednisone. Results: Of the 157,410 patients within the asthma cohort, 26,332 (16.73%) had 1 or more annual ED or inpatient visits for respiratory issues, and 17,056 (10.84%) had 1 or more annual prescriptions for prednisone. We found that close proximity to a major roadway or highway, exposure to high levels of particulate matter ?2.5 ?m (PM2.5) or ozone, female sex, Caucasian race, low residential density, lack of health insurance, and low household income were significantly associated with asthma exacerbations (P<.001). Asthma exacerbations did not vary by rural versus urban residence. Moreover, the results were largely consistent across outcome measures. Conclusions: Our results demonstrate that the open-source ICEES can be used to replicate and extend published findings on factors that influence asthma exacerbations. As a disease-agnostic, open-source approach for integrating, exposing, and exploring patient-level clinical and environmental exposures data, we believe that ICEES will have broad adoption by other institutions and application in environmental health and other biomedical fields. UR - https://formative.jmir.org/2022/4/e32357 UR - http://dx.doi.org/10.2196/32357 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363149 ID - info:doi/10.2196/32357 ER - TY - JOUR AU - Murray, Andy AU - Marenus, Michele AU - Cahuas, Ana AU - Friedman, Kathryn AU - Ottensoser, Haley AU - Kumaravel, Varun AU - Sanowski, Julia AU - Chen, Weiyun PY - 2022/4/1 TI - The Impact of Web-Based Physical Activity Interventions on Depression and Anxiety Among College Students: Randomized Experimental Trial JO - JMIR Form Res SP - e31839 VL - 6 IS - 4 KW - depression KW - anxiety KW - college students KW - mindfulness KW - aerobic exercise KW - resistance training KW - web-based intervention N2 - Background: Depression and anxiety are growing issues for college students, with both aerobic resistance training and mindfulness yoga exercises known to be effective in reducing symptoms and severity. However, no known research is available comparing these 2 depression and anxiety interventions simultaneously and in a web-based environment. Objective: This study aims to determine the effects of a web-based aerobic resistance exercise intervention (WeActive) and a web-based yoga mindfulness exercise intervention (WeMindful) on depression and anxiety symptoms in college students. Methods: The participants were 77 college students who anonymously completed a Qualtrics survey, including the Generalized Anxiety Disorder Scale and the Major Depression Inventory at baseline and after the intervention. Participants were randomly assigned to either the WeActive or WeMindful group and underwent two 30-minute web-based aerobic resistance exercise lessons or yoga mindfulness lessons per week for 8 weeks. Results: The results of analysis of covariance with repeated measures indicated that although not statistically significant, both groups showed a notable decrease in anxiety with a marginally significant main effect of time (F1=3.485; P=.07; ?2=0.047) but no significant main effect of group and no significant interaction effect of time with group. The 2 intervention groups experienced a significant decrease in depression with the main effect of time (F=3.892; P=.05; ?2=0.052). There was no significant main effect of group or interaction effect of time with group for depression. Conclusions: College students in both WeActive and WeMindful groups experienced a significant decrease in depression symptoms and a decrease, although not significant, in anxiety as well. The study suggests that web-based WeActive and WeMindful interventions are effective approaches to managing US college students? depression and anxiety during a pandemic. UR - https://formative.jmir.org/2022/4/e31839 UR - http://dx.doi.org/10.2196/31839 UR - http://www.ncbi.nlm.nih.gov/pubmed/35363151 ID - info:doi/10.2196/31839 ER - TY - JOUR AU - Bentvelsen, G. Robbert AU - Bruijning, L. Marguerite AU - Chavannes, H. Niels AU - Veldkamp, Ellen Karin PY - 2022/4/4 TI - Reducing Inappropriate Urinary Catheter Use by Involving Patients Through the Participatient App: Before-and-After Study JO - JMIR Form Res SP - e28983 VL - 6 IS - 4 KW - infection control KW - catheter-associated urinary tract infections KW - urinary catheter KW - patient empowerment KW - catheter KW - urology KW - infection KW - urinary tract infection KW - smartphone app KW - surgical nursing N2 - Background: The risk of urinary tract infections is increased by the inappropriate placement and unnecessary prolongation of the use of indwelling urinary catheters. Sustained behavior change in infection prevention could be promoted by empowering patients through a smartphone app. Objective: The aim of this study is to assess the feasibility and efficacy of implementation actions on patients? use of the Participatient app on a clinical ward and to compare 3 survey methods for urinary catheter use. Methods: Participatient was introduced for all admitted patients at the surgical nursing ward in a university hospital in the Netherlands. Over a period of 3 months, the number of new app users, days of use, and sessions were recorded. In a comparison of urinary catheter use before and after the implementation of the app, 3 methods for point prevalence surveys of catheter use were tested. Surveys were conducted through manual parsing of the text in patients? electronic medical records, parsing a survey of checkbox items, and parsing nursing notes. Results: In all, 475 patients were admitted to the ward, 42 (8.8%) installed the app, with 1 to 5 new users per week. The actions with the most ensuing app use were the kick-off with the clinical lesson and recruiting of the intake nurse. Between the survey methods, there was considerable variation in catheter use prevalence. Therefore, we used the standard method of manual parsing in further analyses. Catheter use prevalence decreased from 38% (36/96) to 27% (23/86) after app introduction (OR 0.61, 95% CI 0.32-1.14). Conclusions: The clinical application of Participatient, the infection prevention app for patients, could be feasible when implementation actions are also used. For surveying indwelling urinary catheter use prevalence, manual parsing is the best approach. UR - https://formative.jmir.org/2022/4/e28983 UR - http://dx.doi.org/10.2196/28983 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377323 ID - info:doi/10.2196/28983 ER - TY - JOUR AU - Lara, Asunción Ma AU - Patiño, Pamela AU - Tiburcio, Marcela AU - Navarrete, Laura PY - 2022/4/4 TI - Satisfaction and Acceptability Ratings of a Web-Based Self-help Intervention for Depression: Retrospective Cross-sectional Study From a Resource-Limited Country JO - JMIR Form Res SP - e29566 VL - 6 IS - 4 KW - depression KW - web-based intervention KW - unguided intervention KW - acceptability KW - satisfaction KW - resource-limited country N2 - Background: Web-based interventions are at an early stage in non?English-speaking low- and middle-income countries, where they remain scarce. Help for Depression (HDep) is one of the few unguided web-based interventions available in Latin America. The results of a use/usability analysis of the original version served as the basis for generating a more user-friendly second version. Objective: The aim of this study is to explore participants? satisfaction and acceptability for the second version of HDep. Methods: A retrospective cross-sectional design was used. An email invitation to complete a web-based survey was sent to all people who accessed HDep in 2018. The questionnaire included satisfaction and acceptability scales and open-ended questions. Complete questionnaires were retrieved from 191 participants: 35.1% (67/191) from those who visited only the home page (home page users [HPUs]) and 6.47% (124/1916) from those who registered to use the program (program users [PUs]). Results: In all groups, users experienced high levels of depressive symptoms (189/191, 98.9%; Center for Epidemiological Studies Scale-Depression >16). Moderate levels of satisfaction (HPUs: mean 21.9, SD 6.7; PUs: mean 21.1, SD 5.8; range: 8-32) and acceptability (HPUs: mean 13.8, SD 3.9; PUs: mean 13.9, SD 3.2; range: 5-20) were found in both groups. Logistic regression analyses showed that among HPUs, women were more satisfied with HDep (odds ratio [OR] 3.4, 95% CI 1.1-10.0), whereas among PUs, older respondents (OR 1.04, 95% CI 1.01-1.08), those with paid work (OR 3.1, 95% CI 2.4-7.6), those who had not been in therapy (OR 2.42, 95% CI 1.09-5.98), and those who had not attempted suicide (OR 3.4, 95% CI 1.1-11.1) showed higher satisfaction. None of the sociodemographic/mental health variables distinguished the acceptability ratings among HPUs. Among PUs, those with paid work (OR 2.5, 95% CI 1.1-5.5), those who had not been in therapy (OR 3.1, 95% CI 1.3-7.3), those without disability (OR 2.9, 95% CI 1.3-6.6), and those who had not attempted suicide (OR 2.6, 95% CI 1.0-6.6) showed higher acceptability. Conclusions: HDep has good levels of satisfaction and acceptability for approximately half of its users, and the information provided by respondents suggested feasible ways to remedy some of the deficiencies. This qualitative?quantitative study from a low- to middle-income, non?English-speaking country adds to existing knowledge regarding acceptance and satisfaction with web-based interventions for depression in resource-limited countries. This information is important for the creation and adaptation of web-based interventions in low- and middle-income countries, where access to treatment is a major concern, and web-based prevention and treatment programs can help deliver evidence-based alternatives. It is necessary to document the pitfalls, strengths, and challenges of such interventions in this context. Understanding how users perceive an intervention might suggest modifications to increase adherence. UR - https://formative.jmir.org/2022/4/e29566 UR - http://dx.doi.org/10.2196/29566 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377324 ID - info:doi/10.2196/29566 ER - TY - JOUR AU - Krämer, Rico AU - Köhne-Volland, Lea AU - Schumacher, Anna AU - Köhler, Stephan PY - 2022/4/4 TI - Efficacy of a Web-Based Intervention for Depressive Disorders: Three-Arm Randomized Controlled Trial Comparing Guided and Unguided Self-Help With Waitlist Control JO - JMIR Form Res SP - e34330 VL - 6 IS - 4 KW - major depressive disorder KW - online intervention KW - blended treatment KW - public health KW - routine practice KW - randomized controlled trial KW - depression KW - disorder KW - intervention KW - treatment KW - efficacy KW - self-help KW - guidance N2 - Background: Digital health apps are efficacious treatment options for mild-to-moderate depressive disorders. However, the extent to which psychological guidance increases the efficacy of these apps is controversial. Objective: We evaluated the efficacy of a web-based intervention, called Selfapy, for unipolar depression. We also investigated differences between psychotherapist-guided and unguided versions. Methods: Selfapy is a cognitive behavioral therapy?based intervention for depressive disorders. Participants with mild-to-severe depressive disorders were assigned randomly to participate in either guided (weekly 25-minute duration telephone calls) intervention, unguided version, or waiting list (control group) for 12 weeks. We assessed depressive symptoms at the start of the study, midway through the intervention (6 weeks), at the end of the intervention (12 weeks), and at follow-up (6 months). The main outcome was difference in the Beck Depression Inventory score between the start of the study and the end of the intervention. Secondary outcomes were the Quick Inventory of Depressive Symptomatology?Self Report, the Hamilton Rating Depression Scale, and the Beck Anxiety Inventory. Results: Of 401 participants, 301 participants (75.1%) completed the intervention. Changes in the Beck Depression Inventory from baseline differed significantly between groups at the postintervention (F2,398=37.20, P<.001). The reductions in scores for both guided and unguided intervention groups were greater than that for the control group, with large between-group effect sizes (guided vs control: d=1.63, 95% CI 1.37 to 1.93; unguided vs control: d=1.47, 95% CI 1.22 to 1.73) at postintervention. No significant differences were found between guided and unguided intervention groups (P=.18). At follow-up (6 months), treatment effects on the primary outcome were maintained for both intervention groups (guided: F1,194=0.62, P>.999; unguided: F1,176=0.13, P>.999). Conclusions: Both guided and unguided versions of the intervention were highly effective in reducing depressive symptoms. Follow-up data suggest that these effects could be maintained. The guided version was not superior to the unguided version. Trial Registration: German Clinical Trials Register DRKS00017191; https://tinyurl.com/2p9h5hnx International Registered Report Identifier (IRRID): RR2-10.1186/s13063-021-05218-4 UR - https://formative.jmir.org/2022/4/e34330 UR - http://dx.doi.org/10.2196/34330 UR - http://www.ncbi.nlm.nih.gov/pubmed/35105536 ID - info:doi/10.2196/34330 ER - TY - JOUR AU - Ngo, M. Quyen AU - Braughton, E. Jacqueline AU - Gliske, Kate AU - Waller, A. Lance AU - Sitar, Siara AU - Kretman, N. Danielle AU - Cooper, F. Hannah L. AU - Welsh, W. Justine PY - 2022/4/4 TI - In-Person Versus Telehealth Setting for the Delivery of Substance Use Disorder Treatment: Ecologically Valid Comparison Study JO - JMIR Form Res SP - e34408 VL - 6 IS - 4 KW - telehealth KW - substance use treatment KW - patient outcomes N2 - Background: The COVID-19 pandemic has profoundly transformed substance use disorder (SUD) treatment in the United States, with many web-based treatment services being used for this purpose. However, little is known about the long-term treatment effectiveness of SUD interventions delivered through digital technologies compared with in-person treatment, and even less is known about how patients, clinicians, and clinical characteristics may predict treatment outcomes. Objective: This study aims to analyze baseline differences in patient demographics and clinical characteristics across traditional and telehealth settings in a sample of participants (N=3642) who received intensive outpatient program (IOP) substance use treatment from January 2020 to March 2021. Methods: The virtual IOP (VIOP) study is a prospective longitudinal cohort design that follows adult (aged ?18 years) patients who were discharged from IOP care for alcohol and substance use?related treatment at a large national SUD treatment provider between January 2020 and March 2021. Data were collected at baseline and up to 1 year after discharge from both in-person and VIOP services through phone- and web-based surveys to assess recent substance use and general functioning across several domains. Results: Initial baseline descriptive data were collected on patient demographics and clinical inventories. No differences in IOP setting were detected by race (?22=0.1; P=.96), ethnicity (?22=0.8; P=.66), employment status (?22=2.5; P=.29), education level (?24=7.9; P=.10), or whether participants presented with multiple SUDs (?28=11.4; P=.18). Significant differences emerged for biological sex (?22=8.5; P=.05), age (?26=26.8; P<.001), marital status (?24=20.5; P<.001), length of stay (F2,3639=148.67; P<.001), and discharge against staff advice (?22=10.6; P<.01). More differences emerged by developmental stage, with emerging adults more likely to be women (?23=40.5; P<.001), non-White (?23=15.8; P<.001), have multiple SUDs (?23=453.6; P<.001), have longer lengths of stay (F3,3638=13.51; P<.001), and more likely to be discharged against staff advice (?23=13.3; P<.01). Conclusions: The findings aim to deepen our understanding of SUD treatment efficacy across traditional and telehealth settings and its associated correlates and predictors of patient-centered outcomes. The results of this study will inform the effective development of data-driven benchmarks and protocols for routine outcome data practices in treatment settings. UR - https://formative.jmir.org/2022/4/e34408 UR - http://dx.doi.org/10.2196/34408 UR - http://www.ncbi.nlm.nih.gov/pubmed/35377318 ID - info:doi/10.2196/34408 ER - TY - JOUR AU - Majithia, R. Amit AU - Erani, M. David AU - Kusiak, M. Coco AU - Layne, E. Jennifer AU - Lee, Armento Amy AU - Colangelo, R. Francis AU - Romanelli, J. Robert AU - Robertson, Scott AU - Brown, M. Shayla AU - Dixon, F. Ronald AU - Zisser, Howard PY - 2022/4/5 TI - Medication Optimization Among People With Type 2 Diabetes Participating in a Continuous Glucose Monitoring?Driven Virtual Care Program: Prospective Study JO - JMIR Form Res SP - e31629 VL - 6 IS - 4 KW - continuous glucose monitoring KW - digital health KW - GLP-1 receptor agonist KW - HbA1c KW - telemedicine KW - type 2 diabetes KW - monitoring KW - diabetes KW - optimization KW - medication KW - virtual care KW - prospective KW - app KW - lifestyle KW - coaching KW - self-management N2 - Background: The Onduo virtual care program for people with type 2 diabetes (T2D) includes a mobile app, remote lifestyle coaching, connected devices, and telemedicine consultations with endocrinologists for medication management and prescription of real-time continuous glucose monitoring (RT-CGM) devices. In a previously described 4-month prospective study of this program, adults with T2D and baseline glycated hemoglobin (HbA1c) ?8.0% to ?12.0% experienced a mean HbA1c decrease of 1.6% with no significant increase in hypoglycemia. Objective: The objective of this analysis was to evaluate medication optimization and management in the 4-month prospective T2D study. Methods: Study participants received at least 1 telemedicine consultation with an Onduo endocrinologist for diabetes medication management and used RT-CGM intermittently to guide therapy and dosing. Medication changes were analyzed. Results: Of 55 participants, 48 (87%) had a medication change consisting of a dose change, addition, or discontinuation. Of these, 15 (31%) participants had a net increase in number of diabetes medication classes from baseline. Mean time to first medication change for these participants was 36 days. The percentage of participants taking a glucagon-like peptide-1 receptor agonist increased from 25% (12/48) to 56% (n=27), while the percentages of participants taking a sulfonylurea or dipeptidyl peptidase 4 inhibitor decreased from 56% (n=27) to 33% (n=16) and 17% (n=8) to 6% (n=3), respectively. Prescriptions of other antidiabetic medication classes including insulin did not change significantly. Conclusions: The Onduo virtual care program can play an important role in providing timely access to guideline-based diabetes management medications and technologies for people with T2D. Trial Registration: ClinicalTrials.gov NCT03865381; https://clinicaltrials.gov/ct2/show/NCT03865381 UR - https://formative.jmir.org/2022/4/e31629 UR - http://dx.doi.org/10.2196/31629 UR - http://www.ncbi.nlm.nih.gov/pubmed/35147501 ID - info:doi/10.2196/31629 ER - TY - JOUR AU - Ogawa, Takahisa AU - Castelo-Branco, Luis AU - Hatta, Kotaro AU - Usui, Chie PY - 2022/4/6 TI - Association Between Step Count Measured With a Smartphone App (Pain-Note) and Pain Level in Patients With Chronic Pain: Observational Study JO - JMIR Form Res SP - e23657 VL - 6 IS - 4 KW - smartphone KW - iPhone KW - cross-sectional study KW - chronic pain KW - fibromyalgia KW - step count N2 - Background: Chronic pain is the leading cause of disability, affecting between 20% and 50% of the global population. The key recommended treatment is physical activity, which can be measured in daily life using a pedometer. However, poor adherence to pedometer use can result in incorrect measurements. Furthermore, only a few studies have investigated a possible curvilinear association between physical activity and chronic pain. Objective: In this study, we developed the Pain-Note smartphone app to collect real-world data on step count, using the smartphone?s built-in pedometer. The aims of our research are (1) to evaluate the association between daily step count and pain level among patients with chronic pain and (2) determine if the association between daily step count and pain level was curvilinear. Methods: We conducted a cross-sectional study based on step count data collected with the app and on the results of questionnaires, which measured the duration and intensity of pain, the widespread pain index, the symptom severity score, and the insomnia severity scale, including 7 questions for symptoms of depression. We analyzed the association between step count and pain level as a nonlinear relationship using a restricted cubic spline model. A prespecified subgroup analysis was also conducted based on fibromyalgia criteria. Results: Between June 1, 2018, and June 11, 2020, a total of 6138 records were identified, of which 1273 were analyzed. The mean age of the participants was 38.7 years, 81.9% (1043/1273) were female, and chronic pain was present for more than 5 years in 43.2% (550/1273) of participants. Participants in the third and fourth quartiles for step count (more than 3045 and 5668 steps a day, respectively) showed a significant positive association between higher step count and lower numerical pain rating scale (mean difference ?0.43, 95% CI ?0.78 to ?0.08, P=.02; ?0.45; 95% CI ?0.8 to ?0.1, P=.01, respectively) than those in the first quartile (less than or equal to 1199 steps a day). The restricted cubic spline model for the association between step count and pain scale displayed a steep decline followed by a moderate decrease as the step count increased; the inflection point was 5000 steps. However, this association was not observed among participants who met the fibromyalgia criteria (491/1273), who showed a steep positive increase below 2000 steps. Data were collected between June 1, 2018, and June 11, 2020, and were analyzed on November 18, 2021. Conclusions: Step count measured with the Pain-Note app showed a nonlinear association with pain level. Although participants with and without fibromyalgia showed a negative correlation between step count and pain level, participants who meet the criteria for fibromyalgia may present a different relationship between walking and pain perception compared to those in the general chronic pain population. UR - https://formative.jmir.org/2022/4/e23657 UR - http://dx.doi.org/10.2196/23657 UR - http://www.ncbi.nlm.nih.gov/pubmed/35384846 ID - info:doi/10.2196/23657 ER - TY - JOUR AU - Gray, Kathleen AU - Chapman, Wendy AU - Khan, R. Urooj AU - Borda, Ann AU - Budge, Marc AU - Dutch, Martin AU - Hart, K. Graeme AU - Gilbert, Cecily AU - Wani, Ahmad Tafheem PY - 2022/4/6 TI - The Rapid Development of Virtual Care Tools in Response to COVID-19: Case Studies in Three Australian Health Services JO - JMIR Form Res SP - e32619 VL - 6 IS - 4 KW - COVID-19 KW - health system innovation KW - rapid development and deployment methods KW - remote patient monitoring KW - software development N2 - Background: News of the impact of COVID-19 around the world delivered a brief opportunity for Australian health services to plan new ways of delivering care to large numbers of people while maintaining staff safety through greater physical separation. The rapid pivot to telemedicine and virtual care provided immediate and longer term benefits; however, such rapid-cycle development also created risks. Objective: The aim of this study was to understand the sociotechnical aspects of the rapid-cycle development of seven different COVID-19 virtual care tools, and to identify enablers, barriers, and risks at three health services in Victoria, Australia. Methods: A qualitative, embedded, multiple case study design was adopted. Researchers from three health services collaborated with university researchers who were independent from those health services to gather and analyze structured interview data from key people involved in either clinical or technical aspects of designing and deploying seven different virtual care tools. Results: The overall objectives of each health service reflected the international requirements for managing large numbers of patients safely but remotely and for protecting staff. However, the governance, digital maturity, and specific use cases at each institution shaped the methodology and specific outcomes required. Dependence on key individuals and their domain knowledge within an existing governance framework generally enabled rapid deployment, but sometimes posed barriers. Existing relationships with technical service developers enabled strong solutions, which in some cases were highly scalable. Conventional project methodologies such as steering committees, scope, budget control, tight functional specification, consumer engagement and codesign, universal accessibility, and postimplementation evaluation were ignored almost universally in this environment. Conclusions: These three health services took a variety of approaches to the rapid-cycle development of virtual care tools to meet their urgent needs for triaging and remote monitoring during the first year of the COVID-19 pandemic. Their experiences provided insights into many social and technical barriers and enablers to the development of virtual care tools. If these are addressed proactively, they will improve clinical governance and technical management of future virtual care. Some changes can be made within individual health services, while others entail health system policy reforms. Enhancing the environment for virtual care tool design and implementation now will yield returns not only during future health emergencies but also in many more routine care settings. UR - https://formative.jmir.org/2022/4/e32619 UR - http://dx.doi.org/10.2196/32619 UR - http://www.ncbi.nlm.nih.gov/pubmed/35297765 ID - info:doi/10.2196/32619 ER - TY - JOUR AU - Muhamad, Asiah Nor AU - Selvarajah, Vinesha AU - Dharmaratne, Anuja AU - Inthiran, Anushia AU - Mohd Dali, Soleha Nor AU - Chaiyakunapruk, Nathorn AU - Lai, Ming Nai PY - 2022/4/6 TI - Online Searching as a Practice for Evidence-Based Medicine in the Neonatal Intensive Care Unit, University of Malaya Medical Center, Malaysia: Cross-sectional Study JO - JMIR Form Res SP - e30687 VL - 6 IS - 4 KW - evidence-based practice KW - online information searching KW - information retrieval KW - information seeking KW - clinical setting N2 - Background: The use of the internet for research is essential in the practice of evidence-based medicine. The online search habits of medical practitioners in clinical settings, particularly from direct observation, have received little attention. Objective: The goal of the research is to explore online searching for information as an evidence-based practice among medical practitioners. Methods: A cross-sectional study was conducted to evaluate the clinical teams? use of evidence-based practice when making clinical decisions for their patients' care. Data were collected through online searches from 2015 to 2018. Participants were medical practitioners and medical students in a Malaysian public teaching hospital?s neonatal intensive care unit who performed online searches to find answers to clinical questions that arose during ward rounds. Results: In search sessions conducted by the participants, 311 queries were observed from 2015 to 2018. Most participants (34/47, 72%) were house officers and medical students. Most of the searches were conducted by house officers (51/99, 52%) and medical students (32/99, 32%). Most searches (70/99, 71%) were directed rather than self-initiated, and 90% (89/99) were completed individually rather than collaboratively. Participants entered an average of 4 terms in each query; three-quarters of the queries yielded relevant evidence, with two-thirds yielding more than one relevant source of evidence. Conclusions: Our findings suggest that junior doctors and medical students need more training in evidence-based medicine skills such as clinical question formulation and online search techniques for performing independent online searches effectively. However, because the findings were based on intermittent opportunistic observations in a specific clinical setting, they may not be generalizable. UR - https://formative.jmir.org/2022/4/e30687 UR - http://dx.doi.org/10.2196/30687 UR - http://www.ncbi.nlm.nih.gov/pubmed/35384844 ID - info:doi/10.2196/30687 ER - TY - JOUR AU - James, Peter AU - Trudel-Fitzgerald, Claudia AU - Lee, H. Harold AU - Koga, K. Hayami AU - Kubzansky, D. Laura AU - Grodstein, Francine PY - 2022/4/7 TI - Linking Individual-Level Facebook Posts With Psychological and Health Data in an Epidemiological Cohort: Feasibility Study JO - JMIR Form Res SP - e32423 VL - 6 IS - 4 KW - social media KW - cohort KW - psychological factors KW - recruitment KW - feasibility KW - middle-aged and older adults KW - women N2 - Background: Psychological factors (eg, depression) and related biological and behavioral responses are associated with numerous physical health outcomes. Most research in this area relies on self-reported assessments of psychological factors, which are difficult to scale because they may be expensive and time-consuming. Investigators are increasingly interested in using social media as a novel and convenient platform for obtaining information rapidly in large populations. Objective: We evaluated the feasibility of obtaining Facebook data from a large ongoing cohort study of midlife and older women, which may be used to assess psychological functioning efficiently with low cost. Methods: This study was conducted with participants in the Nurses? Health Study II (NHSII), which was initiated in 1989 with biennial follow-ups. Facebook does not share data readily; therefore, we developed procedures to enable women to download and transfer their Facebook data to cohort servers (for linkage with other study data they have provided). Since privacy is a critical concern when collecting individual-level data, we partnered with a third-party software developer, Digi.me, to enable participants to obtain their own Facebook data and to send it securely to our research team. In 2020, we invited a subset of the 18,519 NHSII participants (aged 56-73 years) via email to participate. Women were selected if they reported on the 2017-2018 questionnaire that they regularly posted on Facebook and were still active cohort participants. We included an exit survey for those who chose not to participate in order to gauge the reasons for nonparticipation. Results: We invited 309 women to participate. Few women signed the consent form (n=52), and only 3 used the Digi.me app to download and transfer their Facebook data. This low participation rate was observed despite modifying our protocol between waves of recruitment, including by (1) excluding active health care workers, who might be less available to participate due to the pandemic, (2) developing a Frequently Asked Questions factsheet to provide more information regarding the protocol, and (3) simplifying the instructions for using the Digi.me app. On our exit survey, the reasons most commonly reported for not participating were concerns regarding data privacy and hesitation sharing personal Facebook posts. The low participation rate suggests that obtaining individual-level Facebook data in a cohort of middle-aged and older women may be challenging. Conclusions: In this cohort of midlife and older women who were actively participating for over three decades, we were largely unable to obtain permission to access individual-level data from participants? Facebook accounts. Despite working with a third-party developer to customize an app to implement safeguards for privacy, data privacy remained a key concern in these women. Future studies aiming to leverage individual-level social media data should explore alternate populations or means of sharing social media data. UR - https://formative.jmir.org/2022/4/e32423 UR - http://dx.doi.org/10.2196/32423 UR - http://www.ncbi.nlm.nih.gov/pubmed/35389368 ID - info:doi/10.2196/32423 ER - TY - JOUR AU - Mair, Louise Jacqueline AU - Hayes, D. Lawrence AU - Campbell, K. Amy AU - Buchan, S. Duncan AU - Easton, Chris AU - Sculthorpe, Nicholas PY - 2022/4/7 TI - A Personalized Smartphone-Delivered Just-in-time Adaptive Intervention (JitaBug) to Increase Physical Activity in Older Adults: Mixed Methods Feasibility Study JO - JMIR Form Res SP - e34662 VL - 6 IS - 4 KW - mobile health KW - mHealth KW - sedentary lifestyle KW - digital health intervention KW - intervention design KW - feasibility study KW - aging KW - mobile phone N2 - Background: Just-in-time adaptive interventions (JITAIs) provide real time in-the-moment behavior change support to people when they need it most. JITAIs could be a viable way to provide personalized physical activity (PA) support to older adults in the community. However, it is unclear how feasible it is to remotely deliver a PA intervention through a smartphone to older adults or how acceptable they would find a JITAI targeting PA in everyday life. Objective: The aims of this study are to describe the development of JitaBug, a personalized smartphone-delivered JITAI designed to support older adults to increase or maintain their PA level, assess the feasibility of conducting an effectiveness trial of the JitaBug intervention, and explore the acceptability of JitaBug among older adults in a free-living setting. Methods: The intervention was developed using the Behavior Change Wheel and consisted of a wearable activity tracker (Fitbit) and a companion smartphone app (JitaBug) that delivered goal-setting, planning, reminders, and JITAI messages to encourage achievement of personalized PA goals. Message delivery was tailored based on time of day, real time PA tracker data, and weather conditions. We tested the feasibility of remotely delivering the intervention with older adults in a 6-week trial. Data collection involved assessment of PA through accelerometery and activity tracker, self-reported mood and mental well-being through ecological momentary assessment, and contextual information on PA through voice memos. Feasibility outcomes included recruitment capability and adherence to the intervention, intervention delivery in the wild, appropriateness of data collection methodology, adverse events, and participant satisfaction. Results: Of the 46 recruited older adults (aged 56-72 years), 31 (67%) completed the intervention. The intervention was successfully delivered as intended; 87% (27/31) of the participants completed the intervention independently; 94% (2247/2390) of the PA messages were successfully delivered; 99% (2239/2261) of the Fitbit and 100% (2261/2261) of the weather data calls were successful. Valid and usable wrist-worn accelerometer data were obtained from 90% (28/31) of the participants at baseline and follow-up. On average, the participants recorded 50% (7.9/16, SD 7.3) of the voice memos, 38% (3.3/8, SD 4.2) of the mood assessments, and 50% (2.1/4, SD 1.6) of the well-being assessments through the app. Overall acceptability of the intervention was very good (23/30, 77% expressed satisfaction). Participant feedback suggested that more diverse and tailored PA messages, app use reminders, technical refinements, and an improved user interface could improve the intervention and make it more appealing. Conclusions: This study suggests that a smartphone-delivered JITAI is an acceptable way to support PA in older adults in the community. Overall, the intervention is feasible; however, based on user feedback, the JitaBug app requires further technical refinements that may enhance use, engagement, and user satisfaction before moving to effectiveness trials. UR - https://formative.jmir.org/2022/4/e34662 UR - http://dx.doi.org/10.2196/34662 UR - http://www.ncbi.nlm.nih.gov/pubmed/35389348 ID - info:doi/10.2196/34662 ER - TY - JOUR AU - Seljelid, Berit AU - Varsi, Cecilie AU - Solberg Nes, Lise AU - Øystese, Astrid Kristin AU - Børøsund, Elin PY - 2022/4/7 TI - Feasibility of a Digital Patient?Provider Communication Intervention to Support Shared Decision-Making in Chronic Health Care, InvolveMe: Pilot Study JO - JMIR Form Res SP - e34738 VL - 6 IS - 4 KW - digital assessment KW - secure messages KW - patient portal KW - remote shared decision-making KW - chronic health conditions KW - assessment KW - portal KW - decision-making KW - chronic condition KW - chronic KW - communication KW - intervention KW - feasibility KW - pilot KW - acceptability KW - usage KW - demand KW - patient-reported outcome measures KW - PROM KW - outcome N2 - Background: Enhanced communication with health care providers (HCPs) can improve symptom management and health-related quality of life (HRQoL) for patients with chronic health conditions. Access to appropriate communication venues is needed to improve communication, however. As such, digital communication interventions mediated by patient portals carry the potential to support patient-provider communication and interaction and through this, also facilitate shared decision-making (SDM). The InvolveMe intervention was designed to provide patients with the opportunity to communicate symptoms and informational needs prior to consultation via digital assessment, including prioritizing what is most important to discuss with their HCPs, as well as to interact with HCPs through secure messages between outpatient visits. Objective: The aim of this study was to assess the feasibility of the InvolveMe intervention by investigating acceptability, demand (ie, system use), and limited efficacy. Methods: The study was designed as a single-arm, pre-post feasibility study combining quantitative and qualitative methods for data collection. Patients from an endocrine outpatient clinic were invited to use the InvolveMe intervention for 3 months, and HCPs administering InvolveMe were invited to participate in a focus group. Guided by descriptions of how to design feasibility studies by Bowen et al, feasibility was tested by exploring (1) acceptability, using data collected during recruitment from patient participants and nonparticipants (ie, declined to participate or did not meet study requirements), HCP experiences with recruitment, and the System Usability Scale (SUS); (2) demand via exploration of system use through extraction of system log data and HCP experiences with system use; and (3) limited efficacy testing, via exploration of potential effects from the Short-Form Health Survey (RAND 36), Hospital Anxiety and Depression Scale, and Health Literacy Questionnaire. Results: Patient participants (N=23) were a median 54 (range 26-78) years old and primarily male (14/23, 61%). Nonparticipants (N=16) were a median 73 (range 55-80) years old and primarily male (12/16, 75%). The average SUS score was 72.2, indicating good system usability. Assessments were completed by 8 participants from home prior to outpatient visits. The assessments entailed various bodily symptoms and needs for information. Participants sent 17 secure messages related to patient administrative matters, symptoms, and challenges. Focus group participants (N=4) were all female and registered nurses. Data were analyzed in 2 predefined themes: Acceptability and Demand. Acceptability included the subthemes intervention attractiveness and intervention suitability. Demand included the subthemes elements of SDM and intervention challenges and opportunities. All patient participants completed outcome measures at baseline, and 19 (19/23, 83%) completed outcome measures at 3 months. These preliminary efficacy findings were mixed and inconclusive. Conclusions: The study design provided findings from both patient and HCP perspectives and supported feasibility of the InvolveMe intervention. The investigation of acceptability and demand supported the potential for remote SDM mediated by patient portals using assessments and secure messages. Trial Registration: ClinicalTrials.gov NCT NCT04218721; https://www.clinicaltrials.gov/ct2/show/NCT04218721 UR - https://formative.jmir.org/2022/4/e34738 UR - http://dx.doi.org/10.2196/34738 UR - http://www.ncbi.nlm.nih.gov/pubmed/35389356 ID - info:doi/10.2196/34738 ER - TY - JOUR AU - Mosch, Katharina Lina AU - Poncette, Akira-Sebastian AU - Spies, Claudia AU - Weber-Carstens, Steffen AU - Schieler, Monique AU - Krampe, Henning AU - Balzer, Felix PY - 2022/4/8 TI - Creation of an Evidence-Based Implementation Framework for Digital Health Technology in the Intensive Care Unit: Qualitative Study JO - JMIR Form Res SP - e22866 VL - 6 IS - 4 KW - digital health KW - patient monitoring KW - intensive care medicine KW - intensive care unit KW - technological innovation KW - user-centered KW - usability KW - implementation KW - implementation science KW - qualitative research KW - interview N2 - Background: Digital health technologies such as continuous remote monitoring and artificial intelligence?driven clinical decision support systems could improve clinical outcomes in intensive care medicine. However, comprehensive evidence and guidelines for the successful implementation of digital health technologies into specific clinical settings such as the intensive care unit (ICU) are scarce. We evaluated the implementation of a remote patient monitoring platform and derived a framework proposal for the implementation of digital health technology in an ICU. Objective: This study aims to investigate barriers and facilitators to the implementation of a remote patient monitoring technology and to develop a proposal for an implementation framework for digital health technology in the ICU. Methods: This study was conducted from May 2018 to March 2020 during the implementation of a tablet computer?based remote patient monitoring system. The system was installed in the ICU of a large German university hospital as a supplementary monitoring device. Following a hybrid qualitative approach with inductive and deductive elements, we used the Consolidated Framework for Implementation Research and the Expert Recommendations for Implementing Change to analyze the transcripts of 7 semistructured interviews with clinical ICU stakeholders and descriptive questionnaire data. The results of the qualitative analysis, together with the findings from informal meetings, field observations, and previous explorations, provided the basis for the derivation of the proposed framework. Results: This study revealed an insufficient implementation process due to lack of staff engagement and few perceived benefits from the novel solution. Further implementation barriers were the high staff presence and monitoring coverage in the ICU. The implementation framework includes strategies to be applied before and during implementation, targeting the implementation setting by involving all ICU stakeholders, assessing the intervention?s adaptability, facilitating the implementation process, and maintaining a vital feedback culture. Setting up a unit responsible for implementation, considering the guidance of an implementation advisor, and building on existing institutional capacities could improve the institutional context of implementation projects in the ICU. Conclusions: Implementation of digital health in the ICU should involve a thorough preimplementation assessment of the ICU?s need for innovation and its readiness to change, as well as an ongoing evaluation of the implementation conditions. Involvement of all stakeholders, transparent communication, and continuous feedback in an equal atmosphere are essential, but leadership roles must be clearly defined and competently filled. Our proposed framework may guide health care providers with concrete, evidence-based, and step-by-step recommendations for implementation practice, facilitating the introduction of digital health in intensive care. Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 UR - https://formative.jmir.org/2022/4/e22866 UR - http://dx.doi.org/10.2196/22866 UR - http://www.ncbi.nlm.nih.gov/pubmed/35394445 ID - info:doi/10.2196/22866 ER - TY - JOUR AU - Heath, L. Emma AU - Ackerman, Ilana AU - Lorimer, Michelle AU - Rainbird, Sophia AU - O'Donohue, Grace AU - Brock, Andrew AU - Graves, Stephen AU - Harris, Ian PY - 2022/4/8 TI - National Implementation of an Electronic Patient-Reported Outcome Measures Program for Joint Replacement Surgery: Pilot Study JO - JMIR Form Res SP - e30245 VL - 6 IS - 4 KW - cost KW - cost-benefit KW - online platform KW - patient-reported outcome measure KW - registry science KW - electronic data collection KW - electronic data KW - capture KW - joint replacement KW - PROMs KW - PROM KW - outcome measure KW - patient report KW - data capture KW - registry KW - surgery KW - operation KW - postoperative KW - surgical KW - data reporting KW - data collection N2 - Background: There is a global emphasis on expanding data collection for joint replacement procedures beyond implant attributes and progression to revision surgery. Patient-reported outcome measures (PROMs) are increasingly considered as an important measure of surgical outcomes from a patient?s perspective. However, a major limitation preventing wider use of PROMs data in national data collection has been the inability to systematically collect and share electronic information with relevant stakeholders in a comprehensive and financially sustainable manner. Objective: This study reports on the development of an electronic data capture and reporting system by a national registry for the collection of PROMs and the processes used to identify and overcome barriers to implementation and uptake. The study also aims to provide a cost breakdown of establishing and maintaining a nationwide electronic PROMs program. Methods: Between 2018 and 2020, 3 governance and advisory committees were established to develop and implement a PROMs pilot program nested within a nationwide joint replacement registry. The program involved electronic collection of preoperative and 6-month postoperative data for hip, knee, or shoulder replacement surgery from 44 Australian hospitals. Resource requirements for the program included a project manager, software developers, data manager, and statistician. An online platform was tested, refined, and implemented for electronic PROMs collection with scalability considered for future expansion to all Australian hospitals and additional data fields. Technical capabilities included different access for multiple user types, patient registration, automatic reminders via SMS text messages and email, online consent, and patient outcome real-time dashboards accessible for different user groups (surgeons, patients, hospitals, and project stakeholders). Results: During the PROMs pilot period there were 19,699 primary procedures undertaken with 10,204 registered procedures in the electronic system. This equated to 51.80% of people who had a joint replacement at participating hospitals during this period. Patient registration and data collection were efficient (20-30 seconds and 10-12 minutes, respectively). Engagement with the reporting dashboards (as a proportion of those who viewed their dashboard) varied by user group: 197/277 (71.1%) hospital administrators, 68/129 (52.7%) project stakeholders, 177/391 (45.3%) surgeons, and 1138/8840 patients (12.9%). Cost analysis determined an overall cost per patient of Aus $7-15 (approximately US $5-12) for 2 PROMs collections per joint replacement procedure once the program was established. Conclusions: Successful implementation of an orthopedic PROMs program with planned scalability for a broader national rollout requires significant funding and staffing resources. However, this expenditure can be considered worthwhile, given that collection and reporting of PROMs can drive health care improvement processes. Further consideration of strategies to improve stakeholder engagement with electronic reporting dashboards (particularly for patients and surgeons) will be critical to the ongoing success of a national PROMs program. UR - https://formative.jmir.org/2022/4/e30245 UR - http://dx.doi.org/10.2196/30245 UR - http://www.ncbi.nlm.nih.gov/pubmed/35394439 ID - info:doi/10.2196/30245 ER - TY - JOUR AU - Coles, Theresa AU - Lucas, Nicole AU - Daniell, Erin AU - Sullivan, Caitlin AU - Wang, Ke AU - Olsen, M. Jennifer AU - Shepherd-Banigan, Megan PY - 2022/4/8 TI - Prioritizing Support Offered to Caregivers by Examining the Status Quo and Opportunities for Enhancement When Using Web-Based Self-reported Health Questionnaires: Descriptive Qualitative Study JO - JMIR Form Res SP - e30877 VL - 6 IS - 4 KW - caregiver KW - web-based questionnaires KW - self-report questionnaires KW - caregiver outcomes KW - intervention technology KW - patient-reported outcome measures N2 - Background: The Rosalynn Carter Institute for Caregivers (RCI) offers evidence-based interventions to promote caregivers? health and well-being. Trained coaches regularly meet with caregivers to offer education and instructions to improve caregiver health, build skill sets, and increase resilience. Two of these interventions, RCI Resources for Enhancing Alzheimer's Caregiver Health (REACH) and Operation Family Caregiver (OFC), use a set of caregiver-reported questionnaires to monitor caregivers? health status and needs. Objective: This study aims to describe how web-based assessment questionnaires are used to identify and monitor caregiver status in the RCI REACH and OFC programs and outlines perceived enhancements to the web-based system that could support caregiver-coach encounters by directing priorities. Methods: This was a descriptive, qualitative study. Data were collected via semistructured interviews with caregivers and coaches in the RCI REACH and OFC programs from July 2020 to October 2020. During the interviews, participants were asked to describe how the assessment questionnaires were used to inform caregiver-coach encounters, perceived usefulness of enhancements to web-based display, and preference for the structure of score results. The interviews were recorded, transcribed, and coded using structural and interpretive codes from a structured codebook. Qualitative content analysis was used to identify themes and summarize the results. Results: A total of 25 caregivers (RCI REACH: 13/25, 52%; OFC: 12/25, 48%) and 11 coaches (RCI REACH: 5/11, 45%; OFC: 6/11, 55%) were interviewed. Most caregivers indicated that the assessment questions were relevant to their caregiving experience. Some caregivers and coaches indicated that they thought the assessment should be administered multiple times throughout the program to evaluate the caregiver progress. Overall, caregivers did not want their scores to be compared with those of other caregivers, and there was heterogeneity in how caregivers preferred to view their results at the question or topic level. Coaches were uncertain as to which and how much of the results from the self-reported questionnaires should be shared with caregivers. Overall, the results were very similar, regardless of program affiliation (RCI REACH vs OFC). Conclusions: Web-based and procedural enhancements were identified to enrich caregiver-coach encounters. New and enhanced strategies for using web-based assessment questionnaires to direct priorities in the caregiver-coach encounters included integrating figures showing caregiver progress at the individual caregiver level, ability to toggle results through different figures focused on individual versus aggregate results, and support for interpreting scores. The results of this qualitative study will drive the next steps for RCI?s web-based platform and expand on current standards for administering self-reported questionnaires in clinical practice settings. UR - https://formative.jmir.org/2022/4/e30877 UR - http://dx.doi.org/10.2196/30877 UR - http://www.ncbi.nlm.nih.gov/pubmed/35394436 ID - info:doi/10.2196/30877 ER - TY - JOUR AU - Witkovic, Darin Yong AU - Kim, Cindy Hyunjin AU - Bright, Jovon Darius AU - Tan, Y. Judy PY - 2022/4/8 TI - Recruiting Black Men Who Have Sex With Men (MSM) Couples via Dating Apps: Pilot Study on Challenges and Successes JO - JMIR Form Res SP - e31901 VL - 6 IS - 4 KW - African American KW - sexual and gender minorities KW - homosexuality, male KW - HIV KW - mHealth intervention KW - mobile applications KW - apps KW - sexual partners KW - investigative techniques KW - community engagement KW - MSM KW - Black men KW - mobile app KW - LGBT KW - research methods KW - recruitment KW - online dating KW - social network N2 - Background: HIV disproportionately impacts Black men who have sex with men (MSM), and targeting the primary relationship (ie, couples) using mobile technology for health holds promise for HIV prevention. Web-based recruitment of MSM is commonly employed in HIV prevention and intervention research. However, little known about recruiting Black MSM couples on the internet in the United States. Objective: This study describes the process of recruiting Black MSM couples over social networking and dating apps frequented by MSM. We describe the activities for recruiting, screening, and enrolling participants as part of a randomized trial employing a multipronged recruitment approach. Methods: Black MSM in couples were recruited via three apps (ie, Jack?d, Adam4Adam, and Growlr) between May 2020 and March 2021 during the COVID-19 pandemic in the United States. Black MSM couples were eligible if one or both partners are Black, MSM, and living with HIV, and if both partners were 18 years or older, and have been together for at least 2 months in what they both consider a primary relationship (ie, one in which both partners reported feeling most committed to over any other partner or relationship). Results: A total of 10 Black MSM couples (n=20) were enrolled via social networking apps. App recruitment activities were a combination of passive (eg, in-app advertisements) and active (eg, direct messaging of users) engagement. Recruitment approaches varied by the social networking app owing to differences in app features. A full-time recruiter experienced challenges such as bugs (ie, technical errors in computer program or system), navigating technical requirements specific to each app, and web-based harassment. Conclusions: Despite challenges, it was possible to recruit Black MSM couples virtually into research as part of a multipronged recruitment strategy. We identify tips for using web-based dating and other social networking apps as part of a recruitment strategy in future research with Black MSM couples. UR - https://formative.jmir.org/2022/4/e31901 UR - http://dx.doi.org/10.2196/31901 UR - http://www.ncbi.nlm.nih.gov/pubmed/35394432 ID - info:doi/10.2196/31901 ER - TY - JOUR AU - Perdacher, Elke AU - Kavanagh, David AU - Sheffield, Jeanie AU - Healy, Karyn AU - Dale, Penny AU - Heffernan, Edward PY - 2022/4/8 TI - Using the Stay Strong App for the Well-being of Indigenous Australian Prisoners: Feasibility Study JO - JMIR Form Res SP - e32157 VL - 6 IS - 4 KW - First Nation KW - Indigenous KW - digital mental health KW - e-mental health KW - mental health KW - social and emotional well-being KW - SEWB KW - prisoner KW - prison KW - mobile phone N2 - Background: The gap between mental health needs and resources for Aboriginal and Torres Strait Islander people, the Indigenous people of Australia, is most marked in the prison population. Indigenous people are overrepresented in Australian prisons. In prison, this group experiences mental disorders to a greater degree than non-Indigenous prisoners. This group has also been found to experience mental disorder at a higher rate than Indigenous people in the community. In addition to pre-existing determinants of poor mental health, these high prevalence rates may reflect poor engagement in mainstream interventions or the efficacy of available interventions. In community populations, the use of digital mental health resources may help to increase access to well-being support. However, culturally appropriate digital tools have not been available to Indigenous people in prisons. The absence of feasibility and efficacy studies of these tools needs to be addressed. Objective: The aim of this study is to determine the feasibility of the Stay Strong app as a digital well-being and mental health tool for use by Indigenous people in prison. Methods: Dual government agency (health and corrective services) precondition requirements of implementation were identified and resolved. This was essential given that the Stay Strong app was to be delivered by an external health agency to Indigenous prisoners. Then, acceptability at a practice level was tested using postuse qualitative interviews with clients and practitioners of the Indigenous Mental Health Intervention Program. All Indigenous Mental Health Intervention Program practitioners (10/37, 27%) and client participants who had completed their second follow-up (review of the Stay Strong app; 27/37, 73%) during the study period were invited to participate. Results: Owing to the innovative nature of this project, identifying and resolving the precondition requirements of implementation was challenging but provided support for the implementation of the app in practice. Acceptability of the app by clients and practitioners at a practice level was demonstrated, with nine themes emerging across the interviews: satisfaction with the current Stay Strong app, supported client goal setting, increased client self-insight, improved client empowerment, cultural appropriateness, enhanced engagement, ease of use, problems with using an Android emulator, and recommendations to improve personalization. Conclusions: The Stay Strong Custody Project is a pioneering example of digital mental health tools being implemented within Australian prisons. Using the app within high-security prison settings was found to be feasible at both strategic and practice levels. Feedback from both clients and practitioners supported the use of the app as a culturally safe digital mental health and well-being tool for Aboriginal and Torres Strait Islander people in prison. UR - https://formative.jmir.org/2022/4/e32157 UR - http://dx.doi.org/10.2196/32157 UR - http://www.ncbi.nlm.nih.gov/pubmed/35394444 ID - info:doi/10.2196/32157 ER - TY - JOUR AU - Schapira, M. Marilyn AU - Chhatre, Sumedha AU - Prigge, M. Jason AU - Meline, Jessica AU - Kaminstein, Dana AU - Rodriguez, L. Keri AU - Fraenkel, Liana AU - Kravetz, D. Jeffrey AU - Whittle, Jeff AU - Bastian, A. Lori AU - Vachani, Anil AU - Akers, Scott AU - Schrand, Susan AU - Ibarra, V. Jennifer AU - Asan, Onur PY - 2022/4/8 TI - A Veteran-Centric Web-Based Decision Aid for Lung Cancer Screening: Usability Analysis JO - JMIR Form Res SP - e29039 VL - 6 IS - 4 KW - lung cancer screening KW - decision aid KW - usability KW - implementation KW - cancer screening KW - shared decision-making KW - veterans KW - patient engagement KW - mobile phone N2 - Background: Web-based tools developed to facilitate a shared decision-making (SDM) process may facilitate the implementation of lung cancer screening (LCS), an evidence-based intervention to improve cancer outcomes. Veterans have specific risk factors and shared experiences that affect the benefits and potential harms of LCS and thus may value a veteran-centric LCS decision tool (LCSDecTool). Objective: This study aims to conduct usability testing of an LCSDecTool designed for veterans receiving care at a Veteran Affairs medical center. Methods: Usability testing of the LCSDecTool was conducted in a prototype version (phase 1) and a high-fidelity version (phase 2). A total of 18 veterans and 8 clinicians participated in phase 1, and 43 veterans participated in phase 2. Quantitative outcomes from the users included the System Usability Scale (SUS) and the End User Computing Satisfaction (EUCS) in phase 1 and the SUS, EUCS, and Patient Engagement scale in phase 2. Qualitative data were obtained from observations of user sessions and brief interviews. The results of phase 1 informed the modifications of the prototype for the high-fidelity version. Phase 2 usability testing took place in the context of a pilot hybrid type 1 effectiveness-implementation trial. Results: In the phase 1 prototype usability testing, the mean SUS score (potential range: 0-100) was 81.90 (SD 9.80), corresponding to an excellent level of usability. The mean EUCS score (potential range: 1-5) was 4.30 (SD 0.71). In the phase 2 high-fidelity usability testing, the mean SUS score was 65.76 (SD 15.23), corresponding to a good level of usability. The mean EUCS score was 3.91 (SD 0.95); and the mean Patient Engagement scale score (potential range 1 [low] to 5 [high]) was 4.62 (SD 0.67). The median time to completion in minutes was 13 (IQR 10-16). A thematic analysis of user statements documented during phase 2 high-fidelity usability testing identified the following themes: a low baseline level of awareness and knowledge about LCS increased after use of the LCSDecTool; users sought more detailed descriptions about the LCS process; the LCSDecTool was generally easy to use, but specific navigation challenges remained; some users noted difficulty understanding medical terms used in the LCSDecTool; and use of the tool evoked veterans? struggles with prior attempts at smoking cessation. Conclusions: Our findings support the development and use of this eHealth technology in the primary care clinical setting as a way to engage veterans, inform them about a new cancer control screening test, and prepare them to participate in an SDM discussion with their provider. UR - https://formative.jmir.org/2022/4/e29039 UR - http://dx.doi.org/10.2196/29039 UR - http://www.ncbi.nlm.nih.gov/pubmed/35394433 ID - info:doi/10.2196/29039 ER - TY - JOUR AU - Occa, Aurora AU - Stahl, M. Hayley AU - Julien-Bell, Sarah PY - 2022/4/11 TI - Helping Children to Participate in Human Papillomavirus?Related Discussions: Mixed Methods Study of Multimedia Messages JO - JMIR Form Res SP - e28676 VL - 6 IS - 4 KW - animation KW - game KW - HPV KW - child-parent communication KW - child-physician communication KW - pilot study KW - children KW - health communication KW - communication technologies KW - vaccination KW - health education N2 - Background: Human papillomavirus (HPV) can cause several types of cancers and genital warts. A vaccine is available to prevent HPV infections, and several efforts have been made to increase HPV education and, eventually, vaccination. Although previous studies have focused on the development of messages to educate children about HPV and the existence of the HPV vaccine, limited research is available on how to help children better communicate with their parents and health care professionals about the HPV vaccination. In addition, limited research is available on the target audience of this study (Italian children). Objective: This manuscript describes a study assessing the feasibility of using an evidence-based animated video and a web-based game to help children (aged 11-12 years) participate in discussions about their health?in particular when such conversations center around the HPV vaccination?and improve several HPV-related outcomes. The study also compares the effects of these 2 educational multimedia materials on children?s knowledge and perceptions of HPV prevention. Methods: A mixed methods approach consisting of focus group discussions and an experiment with children (N=35) was used to understand children?s experiences with, and perceptions of, the animated video and the game and to measure possible improvements resulting from their interaction with these materials. Results: Both the animated video and a web-based game increased children?s knowledge and positive perceptions about HPV and HPV vaccination. Any single message was not more effective than the others. The children discussed aspects of the features and characters they liked and those that need improvements. Conclusions: This study shows that both materials were effective for improving children?s education about the HPV vaccine and for helping them to feel more comfortable and willing to communicate with their parents and health care professionals about their health. Several elements emerged that will allow further improvements in the design and development of the messages used in this study as well as the creation of future campaigns. UR - https://formative.jmir.org/2022/4/e28676 UR - http://dx.doi.org/10.2196/28676 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404265 ID - info:doi/10.2196/28676 ER - TY - JOUR AU - Metcalf, Mary AU - Rossie, Karen AU - Stokes, Katie AU - Tanner, Bradley PY - 2022/4/11 TI - Health Care Professionals? Clinical Skills to Address Vaping and e-Cigarette Use by Patients: Needs and Interest Questionnaire Study JO - JMIR Form Res SP - e32242 VL - 6 IS - 4 KW - clinical skills KW - vaping KW - e-cigarettes KW - nicotine KW - brief interventions KW - addiction treatment KW - health care professionals KW - continuing education N2 - Background: Widespread vaping and e-cigarette use is a relatively new phenomenon. Youth vaping peaked in 2019, with over 25% of high school students currently vaping. e-Cigarettes are used where smoking is not permitted or as an alternative smoking cessation treatment instead of Food and Drug Administration?approved options. Vaping and e-cigarette use has the potential to harm health, including causing adverse respiratory effects and nicotine addiction. Health care professionals need skills training to help their patients with this relatively new and evolving health problem. Objective: The aim of this study is to understand health care professionals? training needs in this subject area to determine the focus for web-based continuing education training. Methods: We reviewed the literature on clinical aspects of vaping and e-cigarette use. Using the results and our experience in substance use continuing education, we created a list of key clinical skills and surveyed health care professionals about their training needs. We also asked about their interest in a list of related topics. We recruited individuals who completed our web-based courses on substance use, members of health care professional?related groups, and experts who had published an article on the subject. Half of the 31 health care professionals who completed the survey were physicians and the remainder were primarily nurses, social workers, and counselors. Participants self-identified as nonexperts (n=25) and experts (n=6) on vaping. Results: Participants who were nonexperts on average agreed or strongly agreed that they needed training in each of 8 clinical skills (n=25; range 3.7-4.4 agreement out of 5). The top two skills were recommending treatments for patients (4.4 out of 5, SD 0.49) and evaluating and treating the health effects of vaping and e-cigarette use (4.4 out of 5, SD 0.50). Experts agreed on the importance of training for health care professionals in all skills but rated the need for training higher than nonexperts for each topic. Over half of the participating health care professionals (44%-80%) were interested in nearly all (9/10, 90%) vaping-related topics on a checklist. The topics participants were most interested in were the pros and cons of vaping versus smoking and the health effects of second- and third-hand vaping. Primary care physicians showed more interest in vaping-related topics than nonprimary care physicians (t13=2.17; P=.02). Conclusions: This study confirmed gaps in health care professionals? vaping-related clinical skills identified in the literature by identifying a perceived need for training in related skills and health care professionals? interest in key topics related to vaping prevention and cessation. This study provides specific guidance on which clinical skills training is most needed and which topics are most interesting to health care professionals. UR - https://formative.jmir.org/2022/4/e32242 UR - http://dx.doi.org/10.2196/32242 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404264 ID - info:doi/10.2196/32242 ER - TY - JOUR AU - Valenzuela, Waldo AU - Balsiger, Fabian AU - Wiest, Roland AU - Scheidegger, Olivier PY - 2022/4/11 TI - Medical-Blocks?A Platform for Exploration, Management, Analysis, and Sharing of Data in Biomedical Research: System Development and Integration Results JO - JMIR Form Res SP - e32287 VL - 6 IS - 4 KW - biomedical research KW - data sharing KW - data handling KW - data science KW - platform KW - software KW - translational medical research KW - medical informatics KW - PACS KW - DICOM N2 - Background: Biomedical research requires health care institutions to provide sensitive clinical data to leverage data science and artificial intelligence technologies. However, providing researchers access to health care data in a simple and secure manner proves to be challenging for health care institutions. Objective: This study aims to introduce and describe Medical-Blocks, a platform for exploration, management, analysis, and sharing of data in biomedical research. Methods: The specification requirements for Medical-Blocks included connection to data sources of health care institutions with an interface for data exploration, management of data in an internal file storage system, data analysis through visualization and classification of data, and data sharing via a file hosting service for collaboration. Medical-Blocks should be simple to use via a web-based user interface and extensible with new functionalities by a modular design via microservices (blocks). The scalability of the platform should be ensured through containerization. Security and legal regulations were considered during development. Results: Medical-Blocks is a web application that runs in the cloud or as a local instance at a health care institution. Local instances of Medical-Blocks access data sources such as electronic health records and picture archiving and communication system at health care institutions. Researchers and clinicians can explore, manage, and analyze the available data through Medical-Blocks. Data analysis involves the classification of data for metadata extraction and the formation of cohorts. In collaborations, metadata (eg, the number of patients per cohort) or the data alone can be shared through Medical-Blocks locally or via a cloud instance with other researchers and clinicians. Conclusions: Medical-Blocks facilitates biomedical research by providing a centralized platform to interact with medical data in collaborative research projects. Access to and management of medical data are simplified. Data can be swiftly analyzed to form cohorts for research and be shared among researchers. The modularity of Medical-Blocks makes the platform feasible for biomedical research where heterogeneous medical data are required. UR - https://formative.jmir.org/2022/4/e32287 UR - http://dx.doi.org/10.2196/32287 UR - http://www.ncbi.nlm.nih.gov/pubmed/35232718 ID - info:doi/10.2196/32287 ER - TY - JOUR AU - Di Pelino, Stephanie AU - Lamarche, Larkin AU - Carr, Tracey AU - Datta, Julie AU - Gaber, Jessica AU - Oliver, Doug AU - Gallagher, Jay AU - Dragos, Steven AU - Price, David AU - Mangin, Dee PY - 2022/4/11 TI - Lessons Learned Through Two Phases of Developing and Implementing a Technology Supporting Integrated Care: Case Study JO - JMIR Form Res SP - e34899 VL - 6 IS - 4 KW - integrated care KW - information and communication technology (ICT) KW - program evaluation KW - older adults KW - primary care N2 - Background: As health care becomes more fragmented, it is even more important to focus on the provision of integrated, coordinated care between health and social care systems. With the aging population, this coordination is even more vital. Information and communication technology (ICT) can support integrated care if the form of technology follows and supports functional integration. Health TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) is a program centered on the health of older adults, supported by volunteers, primary care teams, community engagement and connections, and an ICT known as the Health TAPESTRY application (TAP-App), a web-based application that supports volunteers in completing client surveys, volunteer coordinators in managing the volunteer program, and primary care teams in requesting and receiving information. Objective: This paper describes the development, evolution, and implementation of the TAP-App ICT to share the lessons learned. Methods: A case study was conducted with the TAP-App as the case and the perspectives of end users and stakeholders as the units of analysis. The data consisted of researchers? perspectives on the TAP-App from their own experiences, as well as feedback from other stakeholders and end user groups. Data were collected through written retrospective reflection with the program manager, a specific interview with the technology lead, key emailed questions to the TAP-App developer, and viewpoints and feedback during paper drafting from other research team members. There were 2 iterations of Health TAPESTRY and the TAP-App and we focused on learnings from the second implementation (2018-2020) which was a pragmatic implementation scale-up trial using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework at 6 primary care sites across Ontario, Canada. Results: TAP-App (version 1.0), which was iteratively developed, was introduced as a tool to schedule volunteer and client visits and collect survey data using a tablet computer. TAP-App (version 2.0) was developed based on this initial experience and a desire for a program management tool that focused more on dual flow among users and provided better support for research. The themes of the lessons learned were as follows: iterative feedback is valuable; if ICT will be used for research, develop it with research in mind; prepare for challenges in the integration of ICT into the existing workflow; ask whether interoperability should be a goal; and know that technology cannot do it alone yet?the importance of human touch points. Conclusions: Health TAPESTRY is human-centered. The TAP-App does not replace these elements but rather helps enable them. Despite this shift in supporting integrated care, barriers remained to the uptake of the TAP-App that would have allowed a full flow of information between health and social settings in supporting patient care. This indicates the need for an ongoing focus on the human use of ICT in similar programs. UR - https://formative.jmir.org/2022/4/e34899 UR - http://dx.doi.org/10.2196/34899 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404253 ID - info:doi/10.2196/34899 ER - TY - JOUR AU - Kramer, L. Lean AU - van Velsen, Lex AU - Clark, L. Jenna AU - Mulder, C. Bob AU - de Vet, Emely PY - 2022/4/11 TI - Use and Effect of Embodied Conversational Agents for Improving Eating Behavior and Decreasing Loneliness Among Community-Dwelling Older Adults: Randomized Controlled Trial JO - JMIR Form Res SP - e33974 VL - 6 IS - 4 KW - eHealth KW - online intervention KW - embodied conversational agent KW - lifestyle change KW - older adult KW - user experience KW - eating habits KW - eating behavior N2 - Background: Embodied conversational agents (ECAs) have been proposed as a promising interaction modality for the delivery of programs focused on promoting lifestyle changes. However, it is not understood what factors influence the health effects of ECAs or their use. Objective: We aimed to (1) identify whether ECAs could persuade community-dwelling older adults to change their dietary behavior and whether ECA use could decrease loneliness, (2) test the pathways to these effects, and (3) understand factors influencing the use of ECAs. Methods: A randomized controlled trial was conducted. The intervention group received access to the PACO service for 8 weeks. The waitlist group started PACO use after waiting for 4 weeks. Two primary outcomes (eating behavior and loneliness) were assessed via online questionnaires at intake, upon joining the waitlist, after 4 weeks, and after 8 weeks. The third primary outcome (use) was assessed via data logs. Secondary outcomes were measured at the same time points, via questionnaires or an optional interview. Results: In total, 32 participants completed the intervention. We found a significant correlation between use in minutes on the one hand, and perceived usefulness (r=0.39, P=.03) and enjoyment on the other (r=0.38, P=.03). However, these did not predict use in the full regression model (F2,29=1.98, P=.16, R2=0.12). Additionally, PACO use did not lead to improvement in eating behavior (?22=0.34, P=.85) or a decrease in loneliness (?22=0.02, P=.99). Conclusions: Our study did not provide any concluding evidence about factors that are linked to the use or health effects of ECAs. Future service design could benefit from either creating a functional design catering to the predominant stage in the precaution adoption process model of the targeted population, or by personalizing the service based on an intake in which the end user?s stage is determined. Trial Registration: ClinicalTrials.gov NCT04510883; https://clinicaltrials.gov/ct2/show/NCT04510883 International Registered Report Identifier (IRRID): RR2-10.2196/22186 UR - https://formative.jmir.org/2022/4/e33974 UR - http://dx.doi.org/10.2196/33974 UR - http://www.ncbi.nlm.nih.gov/pubmed/35404255 ID - info:doi/10.2196/33974 ER - TY - JOUR AU - Underwood, Jody AU - McCloskey, Susan AU - Raldow, Ann AU - Kishan, Amar AU - Zalkin, Chad AU - Navarro, Daniel AU - Holt, Scott Lisa AU - Webb, Andrew AU - Lynch, A. Kathleen AU - Atkinson, M. Thomas PY - 2022/4/12 TI - Developing a Mobile Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events Administration System to Capture Postradiation Toxicity in Oncology: Usability and Feasibility Study JO - JMIR Form Res SP - e27775 VL - 6 IS - 4 KW - neoplasms KW - patient outcome assessment KW - radiation oncology KW - toxicity KW - public health informatics KW - mobile apps KW - mobile health KW - mobile administration system KW - radiation therapy KW - eHealth N2 - Background: Accurate self-reported symptomatic toxicity documentation via the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) is essential throughout cancer treatment to ensure safety and understand therapeutic efficacy. However, the capture of accurate toxicities from patients undergoing radiation therapy is challenging because this is generally provided only at the time of scheduled visits. Objective: This study seeks to establish the usability and feasibility of a mobile PRO-CTCAE Administration System (mPROS) to capture toxicities related to radiation therapy. Methods: English-speaking adult patients who were undergoing radiation therapy for cancer were enrolled and given a brief demonstration of the Say All Your Symptoms (SAYS) and Symptom Tracking Entry Program (STEP) interfaces of the mPROS app, followed by a patient-use phase where patient actions were observed as they navigated mPROS to enter toxicities. Patient feedback was captured via a semistructured interview and brief questionnaire. Results: We enrolled 25 patients (age: mean 60.7 years; females: n=13, 52%; White patients: n=13; 52%; non-Hispanic patients: n=19, 76%; college graduates: n=17, 68%). Patients almost equally preferred the SAYS (n=14, 56%) or STEP (n=11, 44%) interfaces, with 21 patients (84%) agreeing that they would use mPROS to report their symptoms to their health care team and 19 patients (76%) agreeing that they would recommend mPROS to others. Conclusions: The mPROS app is usable and feasible for facilitating the patient reporting of radiation therapy?related symptomatic toxicities. A revised version of mPROS that incorporates patient input and includes electronic health record integration is being developed and validated as part of a multicenter trial. UR - https://formative.jmir.org/2022/4/e27775 UR - http://dx.doi.org/10.2196/27775 UR - http://www.ncbi.nlm.nih.gov/pubmed/35412466 ID - info:doi/10.2196/27775 ER - TY - JOUR AU - Mendes-Santos, Cristina AU - Nunes, Francisco AU - Weiderpass, Elisabete AU - Santana, Rui AU - Andersson, Gerhard PY - 2022/4/12 TI - Understanding Mental Health Professionals? Perspectives and Practices Regarding the Implementation of Digital Mental Health: Qualitative Study JO - JMIR Form Res SP - e32558 VL - 6 IS - 4 KW - barriers KW - digital mental health KW - drivers KW - implementation KW - internet interventions KW - psychotherapy KW - technology acceptance and adoption KW - mental health professionals KW - Portugal KW - European Union KW - EU N2 - Background: Despite the potential of digital mental health to provide cost-effective mental health care, its adoption in clinical settings is limited, and little is known about the perspectives and practices of mental health professionals regarding its implementation or the factors influencing these perspectives and practices. Objective: This study aims to characterize in depth the perspectives and practices of mental health professionals regarding the implementation of digital mental health and explore the factors affecting such perspectives and practices. Methods: A qualitative study using in-depth semistructured interviews with Portuguese mental health professionals (N=13)?psychologists and psychiatrists?was conducted. The transcribed interviews were thematically analyzed. Results: Mental health professionals deemed important or engaged in the following practices during the implementation of digital mental health: indication evaluation, therapeutic contract negotiation, digital psychological assessment, technology setup and management, and intervention delivery and follow-up. Low-threshold accessibility and professionals? perceived duty to provide support to their clients facilitated the implementation of digital mental health. Conversely, the lack of structured intervention frameworks; the unavailability of usable, validated, and affordable technology; and the absence of structured training programs inhibited digital mental health implementation by mental health professionals. Conclusions: The publication of practice frameworks, development of evidence-based technology, and delivery of structured training seem key to expediting implementation and encouraging the sustained adoption of digital mental health by mental health professionals. UR - https://formative.jmir.org/2022/4/e32558 UR - http://dx.doi.org/10.2196/32558 UR - http://www.ncbi.nlm.nih.gov/pubmed/35412459 ID - info:doi/10.2196/32558 ER - TY - JOUR AU - Williams, H. Patricia A. AU - Lovelock, Brendan AU - Cabarrus, Antonio Javier PY - 2022/4/12 TI - A Sense of Coherence Approach to Improving Patient Experience Using Information Infrastructure Modeling: Design Science Research JO - JMIR Form Res SP - e35418 VL - 6 IS - 4 KW - medical informatics KW - information infrastructure KW - digital hospitals KW - patient experience KW - implementation KW - eHealth N2 - Background: Health care provider organizations are complex and dynamic environments. Consequently, how the physical and social environment of such organizations interact with an individual is a primary driver of an individual?s experience. Increasingly, the capabilities required for them to successfully interact with those within their care are critically dependent on the information infrastructure they have in place, which enables people, both patients and staff, to work optimally together to deliver their clinical and operational objectives. Objective: This study aims to design a framework to address the challenge of how to assemble information systems in health care to support an improved sense of coherence for patients, as well as potentially innovate patients? experiences, by connecting and orchestrating the synergy among people, processes, and systems. Methods: It is necessary to understand the needs of health care providers and patients to address this challenge at a level relevant to information process design and technology development. This paper describes the design science research method used to combine the sense of coherence, which is a core concept within the Antonosky salutogenic approach to health and well-being, with an established information infrastructure maturity framework, demonstrating the coalescence of 2 distinct conceptual perspectives on care delivery. This paper provides an approach to defining a positive and supportive health care experience and linking this to the capabilities of an information- and technology-enabled environment. Results: This research delivers a methodology for describing the patient experience in a form relevant to information infrastructure design, articulating a pathway from information infrastructure to patient experience. It proposes that patient experience can be viewed pragmatically in terms of the established sense of coherence concept, with its ability to identify and guide resources to modulate a patient?s environmental stressors. This research establishes a framework for determining and optimizing the capability of a facility?s information infrastructure to support the sense of coherence defined by the experiences of its patients. Conclusions: This groundbreaking research provides a framework for health care provider organizations to understand and assess the ability of their information infrastructure to support and improve the patient experience. The tool assists providers in defining their technology-dependent operational goals around patient experience and, consequently, in identifying the information capabilities needed to support these goals. The results demonstrate how a fundamental shift in thinking about the use of information infrastructure can transform the patient experience. This study details an approach to describing information infrastructure within an experience-oriented framework that enables the impact of technology on experience to be designed explicitly. The contribution to knowledge is a new perspective on modeling how information infrastructure can contribute to supportive health-promoting environments. Furthermore, it may significantly affect the design and deployment of future digital infrastructures in health care. UR - https://formative.jmir.org/2022/4/e35418 UR - http://dx.doi.org/10.2196/35418 UR - http://www.ncbi.nlm.nih.gov/pubmed/35307641 ID - info:doi/10.2196/35418 ER - TY - JOUR AU - Brown, Poppy AU - Waite, Felicity AU - Lambe, Sinead AU - Jones, Julia AU - Jenner, Lucy AU - Diamond, Rowan AU - Freeman, Daniel PY - 2022/4/12 TI - Automated Virtual Reality Cognitive Therapy (gameChange) in Inpatient Psychiatric Wards: Qualitative Study of Staff and Patient Views Using an Implementation Framework JO - JMIR Form Res SP - e34225 VL - 6 IS - 4 KW - virtual reality KW - automated KW - therapy KW - inpatient psychiatric care KW - implementation N2 - Background: Automated virtual reality (VR) therapy could allow a greater number of patients to receive evidence-based psychological therapy. The aim of the gameChange VR therapy is to help patients overcome anxious avoidance of everyday social situations. gameChange has been evaluated with outpatients, but it may also help inpatients prepare for discharge from psychiatric hospital. Objective: The aim of this study is to explore the views of patients and staff on the provision of VR therapy on psychiatric wards. Methods: Focus groups or individual interviews were conducted with patients (n=19) and National Health Service staff (n=22) in acute psychiatric wards. Questions were derived from the nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability framework. Expectations of VR therapy were discussed, and participants were then given the opportunity to try out the gameChange VR therapy before they were asked questions that focused on opinions about the therapy and feasibility of adoption. Results: There was great enthusiasm for the use of gameChange VR therapy on psychiatric wards. It was considered that gameChange could help build confidence, reduce anxiety, and ?bridge that gap? between the differences of being in hospital and being discharged to the community. However, it was reflected that the VR therapy may not suit everyone, especially if they are acutely unwell. VR on hospital wards for entertainment and relaxation was also viewed positively. Participants were particularly impressed by the immersive quality of gameChange and the virtual coach. It was considered that a range of staff groups could support VR therapy delivery. The staff thought that implementation would be facilitated by having a lead staff member, having ongoing training accessible, and involving the multidisciplinary team in decision-making for VR therapy use. The most significant barrier to implementation identified by patients and staff was a practical one: access to sufficient, private space to provide the therapy. Conclusions: Patients and staff were keen for VR to be used on psychiatric wards. In general, patients and staff viewed automated VR therapy as possible to implement within current care provision, with few significant barriers other than constraints of space. Patients and staff thought of many further uses of VR on psychiatric wards. The value of VR therapy on psychiatric wards now requires systematic evaluation. International Registered Report Identifier (IRRID): RR2-10.2196/20300 UR - https://formative.jmir.org/2022/4/e34225 UR - http://dx.doi.org/10.2196/34225 UR - http://www.ncbi.nlm.nih.gov/pubmed/35412462 ID - info:doi/10.2196/34225 ER - TY - JOUR AU - Mande, Archana AU - Moore, L. Susan AU - Banaei-Kashani, Farnoush AU - Echalier, Benjamin AU - Bull, Sheana AU - Rosenberg, A. Michael PY - 2022/4/12 TI - Assessment of a Mobile Health iPhone App for Semiautomated Self-management of Chronic Recurrent Medical Conditions Using an N-of-1 Trial Framework: Feasibility Pilot Study JO - JMIR Form Res SP - e34827 VL - 6 IS - 4 KW - mHealth KW - patient-specific modeling KW - chronic disease KW - smartphone KW - implementation and deployment KW - facilitators and barriers N2 - Background: Management of chronic recurrent medical conditions (CRMCs), such as migraine headaches, chronic pain, and anxiety/depression, remains a major challenge for modern providers. Our team has developed an edge-based, semiautomated mobile health (mHealth) technology called iMTracker that employs the N-of-1 trial approach to allow self-management of CRMCs. Objective: This study examines the patterns of adoption, identifies CRMCs that users selected for self-application, and explores barriers to use of the iMTracker app. Methods: This is a feasibility pilot study with internet-based recruitment that ran from May 15, 2019, to December 23, 2020. We recruited 180 patients to pilot test the iMTracker app for user-selected CRMCs for a 3-month period. Patients were administered surveys before and after the study. Results: We found reasonable usage rates: a total of 73/103 (70.9%) patients who were not lost to follow-up reported the full 3-month use of the app. Most users chose to use the iMTracker app to self-manage chronic pain (other than headaches; 80/212, 37.7%), followed by headaches in 36/212 (17.0%) and mental health (anxiety and depression) in 27/212 (12.8%). The recurrence rate of CRMCs was at least weekly in over 93% (169/180) of patients, with 36.1% (65/180) of CRMCs recurring multiple times in a day, 41.7% (75/180) daily, and 16.1% (29/180) weekly. We found that the main barriers to use were the design and technical function of the app, but that use of the app resulted in an improvement in confidence in the efficiency and safety/privacy of this approach. Conclusions: The iMTracker app provides a feasible platform for the N-of-1 trial approach to self-management of CRMCs, although internet-based recruitment provided limited follow-up, suggesting that in-person evaluation may be needed. The rate of CRMC recurrence was high enough to allow the N-of-1 trial assessment for most traits. UR - https://formative.jmir.org/2022/4/e34827 UR - http://dx.doi.org/10.2196/34827 UR - http://www.ncbi.nlm.nih.gov/pubmed/35412460 ID - info:doi/10.2196/34827 ER - TY - JOUR AU - Sidani, E. Jaime AU - Hoffman, Beth AU - Colditz, B. Jason AU - Wolynn, Riley AU - Hsiao, Lily AU - Chu, Kar-Hai AU - Rose, J. Jason AU - Shensa, Ariel AU - Davis, Esa AU - Primack, Brian PY - 2022/4/13 TI - Discussions and Misinformation About Electronic Nicotine Delivery Systems and COVID-19: Qualitative Analysis of Twitter Content JO - JMIR Form Res SP - e26335 VL - 6 IS - 4 KW - COVID-19 KW - coronavirus KW - e-cigarette KW - electronic nicotine delivery systems KW - Twitter KW - social media KW - misinformation KW - discussion KW - public health KW - communication KW - concern KW - severity KW - conspiracy N2 - Background: Misinformation and conspiracy theories related to COVID-19 and electronic nicotine delivery systems (ENDS) are increasing. Some of this may stem from early reports suggesting a lower risk of severe COVID-19 in nicotine users. Additionally, a common conspiracy is that the e-cigarette or vaping product use?associated lung injury (EVALI) outbreak of 2019 was actually an early presentation of COVID-19. This may have important public health ramifications for both COVID-19 control and ENDS use. Objective: Twitter is an ideal tool for analyzing real-time public discussions related to both ENDS and COVID-19. This study seeks to collect and classify Twitter messages (?tweets?) related to ENDS and COVID-19 to inform public health messaging. Methods: Approximately 2.1 million tweets matching ENDS-related keywords were collected from March 1, 2020, through June 30, 2020, and were then filtered for COVID-19?related keywords, resulting in 67,321 original tweets. A 5% (n=3366) subsample was obtained for human coding using a systematically developed codebook. Tweets were coded for relevance to the topic and four overarching categories. Results: A total of 1930 (57.3%) tweets were coded as relevant to the research topic. Half (n=1008, 52.2%) of these discussed a perceived association between ENDS use and COVID-19 susceptibility or severity, with 42.4% (n=818) suggesting that ENDS use is associated with worse COVID-19 symptoms. One-quarter (n=479, 24.8%) of tweets discussed the perceived similarity/dissimilarity of COVID-19 and EVALI, and 13.8% (n=266) discussed ENDS use behavior. Misinformation and conspiracy theories were present throughout all coding categories. Conclusions: Discussions about ENDS use and COVID-19 on Twitter frequently highlight concerns about the susceptibility and severity of COVID-19 for ENDS users; however, many contain misinformation and conspiracy theories. Public health messaging should capitalize on these concerns and amplify accurate Twitter messaging. UR - https://formative.jmir.org/2022/4/e26335 UR - http://dx.doi.org/10.2196/26335 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311684 ID - info:doi/10.2196/26335 ER - TY - JOUR AU - Hill, Claire AU - Reardon, Tessa AU - Taylor, Lucy AU - Creswell, Cathy PY - 2022/4/13 TI - Online Support and Intervention for Child Anxiety (OSI): Development and Usability Testing JO - JMIR Form Res SP - e29846 VL - 6 IS - 4 KW - user-centered design KW - co-design KW - usability testing KW - internet-based treatment KW - app KW - CBT KW - anxiety KW - children KW - mobile phone N2 - Background: Internet-based treatments for child anxiety may help to increase access to evidence-based therapies; however, user engagement, uptake, and adherence within routine clinical practice remain as challenges. Involving the intended end users in the development process through user-centered design and usability testing is crucial for maximizing user engagement and adoption of internet-based treatments, but so far this has been lacking for internet-based treatments for child anxiety. Objective: The aim of this study is to develop an internet-based treatment for child anxiety through a process of user-centered design (phase 1) and usability testing (phase 2), based on an existing evidence-based, face-to-face, therapist-supported, parent-led cognitive behavioral therapy intervention. It is intended that the internet-based version of this treatment would consist of a parent website, case management system for clinicians, and mobile game app for children. Methods: Parents, children, and clinicians who were familiar with the face-to-face version of the treatment were recruited from 2 National Health Service clinics. In phase 1, participants participated in 3 workshops to gain feedback on the overall concept, explore their wants and needs for the websites and game, generate ideas on how the treatment may look, and gain feedback on initial mock-ups of the websites and game. In phase 2, participants attended 3 individual usability testing sessions where they were presented with working prototypes of the website or game and asked to perform a series of tasks on the website (parents and clinicians) or play the game (children). The frequency and details on usability errors were recorded. Participants were asked for their feedback on the website and game using a standardized usability questionnaire and semistructured interviews. The websites and game were iterated after each round of usability testing in response to this feedback. Results: In phase 1, participants approved the general concept and rated the initial mock-ups of the website and game positively. In phase 2, working prototypes were rated positively and usability errors declined across the iterations and were mainly cosmetic or minor issues relating to esthetic preference, with few issues regarding ability to navigate the website or technical issues affecting functionality. Feedback from the semistructured interviews further supported the positive response of participants to the website and game, and helped identify areas for improvement during the iteration process. The final iteration of the website and game are presented. Conclusions: Taking an iterative approach to development through user-centered design and usability testing has resulted in an internet-based treatment for child anxiety (Online Support and Intervention for child anxiety) that appears to meet the needs and expectations of the intended users (parents, children, and clinicians) and is easy and enjoyable to use. UR - https://formative.jmir.org/2022/4/e29846 UR - http://dx.doi.org/10.2196/29846 UR - http://www.ncbi.nlm.nih.gov/pubmed/35416781 ID - info:doi/10.2196/29846 ER - TY - JOUR AU - Lattimer, A. Tahleen AU - Tenzek, E. Kelly AU - Ophir, Yotam AU - Sullivan, S. Suzanne PY - 2022/4/13 TI - Exploring Web-Based Twitter Conversations Surrounding National Healthcare Decisions Day and Advance Care Planning From a Sociocultural Perspective: Computational Mixed Methods Analysis JO - JMIR Form Res SP - e35795 VL - 6 IS - 4 KW - advance care planning KW - National Healthcare Decisions Day KW - Twitter KW - good death KW - hashtag activism KW - topic modeling KW - social media KW - end of life N2 - Background: Within the cultures and societies of the United States, topics related to death and dying continue to be taboo, and as a result, opportunities for presence and engagement during the end of life, which could lead to a good death, are avoided. Several efforts have been made to help people engage in advance care planning (ACP) conversations, including completing advance care directives so that they may express their goals of care if they become too sick to communicate their wishes. A major effort in the United States toward encouraging such challenging discussions is the annual celebration of the National Healthcare Decisions Day. Objective: This study aimed to explore ACP from a sociocultural perspective by using Twitter as a communication tool. Methods: All publicly available tweets published between August 1, 2020, and July 30, 2021 (N=9713) were collected and analyzed using the computational mixed methods Analysis of Topic Model Network approach. Results: The results revealed that conversations driven primarily by laypersons (7107/7410, 95.91% of tweets originated from unverified accounts) surrounded the following three major themes: importance and promotion, surrounding language, and systemic issues. Conclusions: On the basis of the results, we argue that there is a need for awareness of the barriers that people may face when engaging in ACP conversations, including systemic barriers, literacy levels, misinformation, policies (including Medicare reimbursements), and trust among health care professionals, in the United States. This is incredibly important for clinicians and scholars worldwide to be aware of as we strive to re-envision ACP, so that people are more comfortable engaging in ACP conversations. In terms of the content of tweets, we argue that there is a chasm between the biomedical and biopsychosocial elements of ACP, including patient narratives. If used properly, Twitter conversations and National Health Care Decision Day hashtags could be harnessed to serve as a connecting point among organizations, physicians, patients, and family members to lay the groundwork for the trajectory toward a good death. UR - https://formative.jmir.org/2022/4/e35795 UR - http://dx.doi.org/10.2196/35795 UR - http://www.ncbi.nlm.nih.gov/pubmed/35416783 ID - info:doi/10.2196/35795 ER - TY - JOUR AU - Mehdizadeh, Hamed AU - Asadi, Farkhondeh AU - Emami, Hassan AU - Mehrvar, Azim AU - Nazemi, Eslam PY - 2022/4/15 TI - An mHealth Self-management System for Support Children With Acute Lymphocytic Leukemia and Their Caregivers: Qualitative Co-design Study JO - JMIR Form Res SP - e36721 VL - 6 IS - 4 KW - digital health KW - eHealth KW - mHealth KW - mobile app KW - smartphone KW - mobile phone KW - self-management KW - patient education KW - children KW - caregivers KW - acute lymphocytic leukemia KW - user-centered design N2 - Background: The unique features of smartphones have extended their use in different fields, especially in the health care domain. These features offer new opportunities to support patients with chronic conditions by providing them with information, education, and self-management skills. We developed a digital self-management system to support children with cancer and their caregivers in Iran (low- and middle-income country). Objective: This study is aimed at the development and preliminary evaluation of a cancer self-management system (CanSelfMan) tailored to the needs of children with cancer and their parents or caregivers. Methods: This study was conducted in collaboration with a multidisciplinary team between January and February 2020 at MAHAK?s Pediatric Cancer Treatment and Research Center. We developed a self-management system in six stages: requirement analysis, conformity assessment, preparation of educational content, app prototyping, preliminary evaluation, and developing the final version. Results: A total of 35 people (n=24, 69% parents and n=11, 31% children) volunteered to participate in the study. However, only 63% (15/24) of parents and 73% (8/11) of children were eligible to participate. By adopting a user-centered design approach, we developed a mobile app, CanSelfMan, that includes five main modules (knowledge base, self-management tips, self-assessment report, ask a question, and reminders) that provide access to reliable information about acute lymphocytic leukemia and the self-management skills required for side effect measurement and reporting. A web-based dashboard was also developed for oncologists and included a dashboard to monitor users? symptoms and answer their questions. Conclusions: The CanSelfMan app can support these groups by providing access to reliable information about cancer, facilitating communication between children or parents and health care providers, and helping promote medication adherence through a reminder function. The active participation of the target group can help identify their needs. Therefore, through the involvement of stakeholders such as patients, caregivers, and oncologists in the design process, we improved usability and ensured that the final product was useful. This app is now ready to proceed with feasibility studies. UR - https://formative.jmir.org/2022/4/e36721 UR - http://dx.doi.org/10.2196/36721 UR - http://www.ncbi.nlm.nih.gov/pubmed/35228195 ID - info:doi/10.2196/36721 ER - TY - JOUR AU - McCallum, Meaghan AU - Ho, Suh Annabell AU - Mitchell, Siobhan Ellen AU - May, N. Christine AU - Behr, Heather AU - Ritschel, Lorie AU - Mochrie, Kirk AU - Michaelides, Andreas PY - 2022/4/15 TI - Feasibility, Acceptability, and Preliminary Outcomes of a Cognitive Behavioral Therapy?Based Mobile Mental Well-being Program (Noom Mood): Single-Arm Prospective Cohort Study JO - JMIR Form Res SP - e36794 VL - 6 IS - 4 KW - mHealth KW - mobile mental health KW - mental health KW - stress KW - anxiety N2 - Background: The prevalence of anxiety, depression, and general distress has risen in recent years. Mobile mental health programs have been found to provide support to nonclinical populations and may overcome some of the barriers associated with traditional in-person treatment; however, researchers have voiced concerns that many publicly available mobile mental health programs lack evidence-based theoretical foundations, peer-reviewed research, and sufficient engagement from the public. Objective: This study aimed to evaluate the feasibility, acceptability, and preliminary outcomes of Noom Mood, a commercial mobile cognitive behavioral therapy? and mindfulness-based program. Methods: In this single-arm prospective cohort study, individuals who joined Noom Mood between August and October 2021 completed surveys at baseline and 4-week follow-up. Per-protocol analyses included those who completed both surveys (n=113), and intention-to-treat analyses included all participants (N=185). Results: A majority of the sample reported that the program is easy to use, they felt confident recommending the program to a friend, and they perceived the program to be effective at improving stress and anxiety. There were significant improvements in anxiety symptoms, perceived stress, depressive feelings, emotion regulation, and optimism in both the per-protocol and intention-to-treat analyses (all P<.001). Participants reported benefiting most from learning skills (eg, breathing and cognitive reframing techniques), interacting with the program features, and gaining awareness of their emotions and thought patterns. Participants also made a number of suggestions to improve product functionality and usability. Conclusions: Results suggest that Noom Mood is feasible and acceptable to participants, with promising preliminary outcomes. Future studies should build on these results to evaluate the effects of Noom Mood using more rigorous designs. UR - https://formative.jmir.org/2022/4/e36794 UR - http://dx.doi.org/10.2196/36794 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436218 ID - info:doi/10.2196/36794 ER - TY - JOUR AU - Holtz, Bree AU - Mitchell, Katharine AU - Hirko, Kelly AU - Ford, Sabrina PY - 2022/4/15 TI - Using the Technology Acceptance Model to Characterize Barriers and Opportunities of Telemedicine in Rural Populations: Survey and Interview Study JO - JMIR Form Res SP - e35130 VL - 6 IS - 4 KW - telehealth KW - technology acceptance model KW - pilot study KW - rural KW - Michigan KW - health care access KW - telemedicine KW - phone interviews KW - paper surveys N2 - Background: Health care access issues have long plagued rural Americans. One approach to alleviating the challenges and poor health outcomes for rural individuals is through the use of telemedicine, sometimes called telehealth. It is important to understand factors that may be related to telemedicine adoption or nonadoption, particularly in underserved rural settings. Objective: This pilot study examines telemedicine perceptions among rural, underserved populations using the Technology Acceptance Model, which serves as a framework to explore the adoption of telemedicine services by those who have used it. This study also explores the differences between user and nonuser perceptions of telemedicine. Methods: Paper surveys and phone interviews were conducted in rural Northern Lower Michigan. Results: Perceived usefulness and perceived ease of use explained 91% of the variability in attitude toward telemedicine (R2=0.91; F1,15=73.406; P<.001). Ease of use was a significant predictor (mean 2.36, SD 1.20; P<.001), but usefulness (mean 3.16, SD 0.81; P=.20) was not. Furthermore, there were significant differences in individual perception of telemedicine between users and nonusers. For example, nonusers believed they would receive better care in person (users: mean 3.30, SD 1.22; nonusers: mean 1.91, SD 1.14; F1,32=10.126; P=.003). The quantitative findings were reinforced by the qualitative results from the phone interviews. Conclusions: Overall, the Technology Acceptance Model is an appropriate model to understand the attitudes toward telemedicine that may lead to its adoption by rural Americans. UR - https://formative.jmir.org/2022/4/e35130 UR - http://dx.doi.org/10.2196/35130 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436207 ID - info:doi/10.2196/35130 ER - TY - JOUR AU - Sagstad, Haaland Mari AU - Morken, Nils-Halvdan AU - Lund, Agnethe AU - Dingsør, Jannike Linn AU - Nilsen, Vika Anne Britt AU - Sorbye, Marie Linn PY - 2022/4/18 TI - Quantitative User Data From a Chatbot Developed for Women With Gestational Diabetes Mellitus: Observational Study JO - JMIR Form Res SP - e28091 VL - 6 IS - 4 KW - chatbot KW - gestational diabetes mellitus KW - user data KW - log review KW - eHealth KW - diabetes KW - pregnancy KW - dialogue N2 - Background: The rising prevalence of gestational diabetes mellitus (GDM) calls for the use of innovative methods to inform and empower these pregnant women. An information chatbot, Dina, was developed for women with GDM and is Norway?s first health chatbot, integrated into the national digital health platform. Objective: The aim of this study is to investigate what kind of information users seek in a health chatbot providing support on GDM. Furthermore, we sought to explore when and how the chatbot is used by time of day and the number of questions in each dialogue and to categorize the questions the chatbot was unable to answer (fallback). The overall goal is to explore quantitative user data in the chatbot?s log, thereby contributing to further development of the chatbot. Methods: An observational study was designed. We used quantitative anonymous data (dialogues) from the chatbot?s log and platform during an 8-week period in 2018 and a 12-week period in 2019 and 2020. Dialogues between the user and the chatbot were the unit of analysis. Questions from the users were categorized by theme. The time of day the dialogue occurred and the number of questions in each dialogue were registered, and questions resulting in a fallback message were identified. Results are presented using descriptive statistics. Results: We identified 610 dialogues with a total of 2838 questions during the 20 weeks of data collection. Questions regarding blood glucose, GDM, diet, and physical activity represented 58.81% (1669/2838) of all questions. In total, 58.0% (354/610) of dialogues occurred during daytime (8 AM to 3:59 PM), Monday through Friday. Most dialogues were short, containing 1-3 questions (340/610, 55.7%), and there was a decrease in dialogues containing 4-6 questions in the second period (P=.013). The chatbot was able to answer 88.51% (2512/2838) of all posed questions. The mean number of dialogues per week was 36 in the first period and 26.83 in the second period. Conclusions: Frequently asked questions seem to mirror the cornerstones of GDM treatment and may indicate that the chatbot is used to quickly access information already provided for them by the health care service but providing a low-threshold way to access that information. Our results underline the need to actively promote and integrate the chatbot into antenatal care as well as the importance of continuous content improvement in order to provide relevant information. UR - https://formative.jmir.org/2022/4/e28091 UR - http://dx.doi.org/10.2196/28091 UR - http://www.ncbi.nlm.nih.gov/pubmed/35436213 ID - info:doi/10.2196/28091 ER - TY - JOUR AU - Irgens, Ingebjørg AU - Midelfart-Hoff, Jana AU - Jelnes, Rolf AU - Alexander, Marcalee AU - Stanghelle, Kvalvik Johan AU - Thoresen, Magne AU - Rekand, Tiina PY - 2022/4/19 TI - Videoconferencing in Pressure Injury: Randomized Controlled Telemedicine Trial in Patients With Spinal Cord Injury JO - JMIR Form Res SP - e27692 VL - 6 IS - 4 KW - telemedicine KW - telecommunication KW - videoconference KW - outpatient follow-up KW - spinal cord injury KW - pressure injury KW - healing KW - participant satisfaction KW - participant interaction KW - health-related quality of life N2 - Background: Geographical, financial and travel-related barriers may impact access to necessary health care for people in need of long-term follow-up. Objective: The goal of the research was to perform a nonblinded, randomized, controlled trial on health-related quality of life (HRQoL), healing, interaction, and satisfaction of patients with spinal cord injury (SCI) and PI receiving multidisciplinary videoconference consultations from a wound clinic to the participant?s home versus regular outpatient care. The multidisciplinary team consisted of a medical doctor, a wound nurse, and an occupational therapist. In both groups, district nurses attended the consultations at the participant?s home. Methods: A total of 56 participants, 28 in each group, were randomized to a videoconference group (VCG) or a regular care group (RCG). Validated questionnaires were used to measure and compare the follow-up effect on HRQoL. Percentage reduction of wound volume was measured at end of the follow-up. A Likert scale was used to measure the satisfaction of the patients and district nurses regarding the interaction between different modalities of care in the 2 groups. Results: The HRQoL did not show significant differences between the 2 groups (P values ranging from .09 to .88) or the rate of PI healing, experienced interaction, and satisfaction in the groups. A total of 67% (37/55) of all PIs healed, 64% (18/28) in the VCG and 70% (19/27) in the RCG. Mean reduction in ulcer volume was 79% in the VCG and 85% in the RCG (P=.32). A Kaplan-Meier plot with a logrank test regarding time to healing did not show any significant difference between the 2 groups. Conclusions: Videoconference-based care seems to be a safe and efficient way to manage PIs in terms of HRQoL, healing, interaction, and satisfaction compared to conventional care for people with SCI. This should be considered when planning for future care. SCI has a huge impact on the individual, the family, and the health care system. There is an urgent need to improve systems of care so that individuals who live far from specialists and require long-term follow-up for conditions such as PI can get optimal treatment. Trial Registration: ClinicalTrials.gov NCT02800915; https://clinicaltrials.gov/ct2/show/NCT02800915 and Current Research Information System in Norway (CRISTIN) 545284; https://app.cristin.no/projects/show.jsf?id=545284 UR - https://formative.jmir.org/2022/4/e27692 UR - http://dx.doi.org/10.2196/27692 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438645 ID - info:doi/10.2196/27692 ER - TY - JOUR AU - Jones, C. Amanda AU - Grout, Leah AU - Wilson, Nick AU - Nghiem, Nhung AU - Cleghorn, Christine PY - 2022/4/19 TI - The Cost-effectiveness of a Mass Media Campaign to Promote Smartphone Apps for Weight Loss: Updated Modeling Study JO - JMIR Form Res SP - e29291 VL - 6 IS - 4 KW - mass media KW - smartphone apps KW - weight loss KW - cost-effectiveness KW - simulation modeling KW - health equity KW - mobile phone N2 - Background: Evidence suggests that smartphone apps can be effective in the self-management of weight. Given the low cost, broad reach, and apparent effectiveness of weight loss apps, governments may seek to encourage their uptake as a tool to reduce excess weight in the population. Mass media campaigns are 1 mechanism for promoting app use. However, the cost and potential cost-effectiveness are important considerations. Objective: The aim of our study was to use modeling to assess the health impacts, health system costs, cost-effectiveness, and health equity of a mass media campaign to promote high-quality smartphone apps for weight loss in New Zealand. Methods: We used an established proportional multistate life table model that simulates the 2011 New Zealand adult population over the lifetime, subgrouped by age, sex, and ethnicity (M?ori [Indigenous] or non-M?ori). The risk factor was BMI. The model compared business as usual to a one-off mass media campaign intervention, which included the pooled effect size from a recent meta-analysis of smartphone weight loss apps. The resulting impact on BMI and BMI-related diseases was captured through changes in health gain (quality-adjusted life years) and in health system costs. The difference in total health system costs was the net sum of intervention costs and downstream cost offsets because of altered disease rates. An annual discount rate of 3% was applied to health gains and health system costs. Multiple scenarios and sensitivity analyses were conducted, including an equity adjustment. Results: Across the remaining lifetime of the modeled 2011 New Zealand population, the mass media campaign to promote weight loss app use had an estimated overall health gain of 181 (95% uncertainty interval 113-270) quality-adjusted life years and health care costs of ?NZ $606,000 (?US $408,000; 95% uncertainty interval ?NZ $2,540,000 [?US $1,709,000] to NZ $907,000 [US $610,000]). The mean health care costs were negative, representing overall savings to the health system. Across the outcomes examined in this study, the modeled mass media campaign to promote weight loss apps among the general population would be expected to provide higher per capita health gain for M?ori and hence reduce health inequities arising from high BMI, assuming that the intervention would be as effective for M?ori as it is for non-M?ori. Conclusions: A modeled mass media campaign to encourage the adoption of smartphone apps to promote weight loss among the New Zealand adult population is expected to yield an overall gain in health and to be cost-saving to the health system. Although other interventions in the nutrition and physical activity space are even more beneficial to health and produce larger cost savings (eg, fiscal policies and food reformulation), governments may choose to include strategies to promote health app use as complementary measures. UR - https://formative.jmir.org/2022/4/e29291 UR - http://dx.doi.org/10.2196/29291 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438643 ID - info:doi/10.2196/29291 ER - TY - JOUR AU - Almoallim, Sultan AU - Sas, Corina PY - 2022/4/19 TI - Toward Research-Informed Design Implications for Interventions Limiting Smartphone Use: Functionalities Review of Digital Well-being Apps JO - JMIR Form Res SP - e31730 VL - 6 IS - 4 KW - digital well-being KW - smartphone apps KW - tracking use KW - monitoring against set use limits KW - interventions for limiting use KW - barriers KW - design for friction KW - screen time KW - attention KW - self-regulation KW - mobile phone N2 - Background: Much research in human-computer interaction has focused on well-being and how it can be better supported through a range of technologies, from affective interfaces to mindfulness systems. At the same time, we have seen a growing number of commercial digital well-being apps. However, there has been limited scholarly work reviewing these apps. Objective: This paper aims to report on an autoethnographic study and functionality review of the 39 most popular commercial digital well-being apps on Google Play Store and 17 apps described in academic papers. Methods: From 1250 apps on Google Play Store, we selected 39 (3.12%) digital well-being apps, and from Google Scholar, we identified 17 papers describing academic apps. Both sets of digital well-being apps were analyzed through a review of their functionalities based on their descriptions. The commercial apps were also analyzed through autoethnography, wherein the first author interacted with them to understand how these functionalities work and how they may be experienced by users in their daily lives. Results: Our findings indicate that these apps focus mostly on limiting screen time, and we advanced a richer conversation about such apps, articulating the distinctions among monitoring use, tracking use against set limits, and 4 specific interventions supporting limited use. Conclusions: We conclude with 6 implications for designing digital well-being apps, namely calling to move beyond screen time and support the broader focus of digital well-being; supporting meaningful use rather than limiting meaningless use; leveraging (digital) navigation in design for friction; supporting collaborative interaction to limit phone overuse; supporting explicit, time-based visualizations for monitoring functionality; and supporting the ethical design of digital well-being apps. UR - https://formative.jmir.org/2022/4/e31730 UR - http://dx.doi.org/10.2196/31730 UR - http://www.ncbi.nlm.nih.gov/pubmed/35188897 ID - info:doi/10.2196/31730 ER - TY - JOUR AU - Rosenberg, Ellen Nora AU - Tembo, A. Tapiwa AU - Simon, R. Katherine AU - Mollan, Katie AU - Rutstein, E. Sarah AU - Mwapasa, Victor AU - Masiano, Steven AU - Huffstetler, E. Hanna AU - Go, Vivian AU - Kim, H. Maria PY - 2022/4/19 TI - Development of a Blended Learning Approach to Delivering HIV-Assisted Contact Tracing in Malawi: Applied Theory and Formative Research JO - JMIR Form Res SP - e32899 VL - 6 IS - 4 KW - HIV KW - e-learning KW - digitial learning KW - blended learning KW - digital KW - contact tracing KW - assisted partner services N2 - Background: Despite progress toward the Joint United Nations Programme on HIV/AIDS ?95-95-95? targets (95% of HIV-positive persons tested, 95% of tested persons on treatment, and 95% of treated persons virally suppressed), a gap remains in achieving the first 95% target. Assisted contact tracing (ACT), in which health workers support HIV-positive index clients to recruit their contacts (sexual partners and children) for HIV testing, efficiently identifies HIV-positive persons in need of treatment. Although many countries, including Malawi, began implementing ACT, testing outcomes in routine settings have been worse than those in trial settings. Objective: The aim of this paper is to use formative research and frameworks to develop and digitize an implementation package to bridge the gap between ACT research and practice. Methods: Semistructured qualitative research was conducted in 2019 in Malawi with key informants. Barriers and facilitators to intervention delivery were identified using the Consolidated Framework for Implementation Research. Approaches to digitization were examined using human-centered design principles. Results: Limited clinic coordination and health worker capacity to address the complexities of ACT were identified as barriers. Ongoing individual training consisting of learning, observing, practicing, and receiving feedback, as well as group problem-solving were identified as facilitators. Important features of digitization included (1) culturally relevant visual content, (2) capability of offline use, and (3) simple designs and basic editing to keep costs low. Conclusions: Formative research and frameworks played a key role in designing and digitizing an implementation package for ACT delivery in a low-income setting such as Malawi. UR - https://formative.jmir.org/2022/4/e32899 UR - http://dx.doi.org/10.2196/32899 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438644 ID - info:doi/10.2196/32899 ER - TY - JOUR AU - Preuhs, Katharina AU - van Keulen, Hilde AU - Andree, Rosa AU - Wins, Sophie AU - van Empelen, Pepijn PY - 2022/4/19 TI - A Tailored Web-Based Video Intervention (ParentCoach) to Support Parents With Children With Sleeping Problems: User-Centered Design Approach JO - JMIR Form Res SP - e33416 VL - 6 IS - 4 KW - positive parenting KW - usability testing KW - lower health literacy KW - user-centered design KW - iterative development KW - eHealth KW - web-based intervention KW - mobile health KW - mHealth KW - parenting N2 - Background: Many parents frequently struggle with undesirable or problematic behavior (ie, temper tantrums and whining) displayed by their child. To support parents in promoting positive parenting skills (ie, recognizing challenging situations and reacting appropriately), the interactive video e-learning tool ParentCoach was developed. The tool aims to teach parents generic behavioral responses by means of situational learning, tailoring, and problem solving. The first demonstration focused on sleeping problems. Objective: The aim of this paper is to illustrate the user-centered development of ParentCoach. Methods: We conducted usability, understandability, and acceptance tests among the target group (29 parents, 7 youth health care professionals, and 4 individuals with former lower health literacy) in different phases of the development process via focus groups, interviews, and surveys. This allowed for relevant insights on specifications and user requirements to guide the development and revision of the tool in each iteration. Results: Iterative testing and development allowed for the final demonstration of ParentCoach to be experienced as a relevant and accessible parenting intervention that can be used as a stand-alone program or in combination with another program. Conclusions: This paper elaborates on the iterative development process and its benefits for the final demonstration of ParentCoach. UR - https://formative.jmir.org/2022/4/e33416 UR - http://dx.doi.org/10.2196/33416 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438640 ID - info:doi/10.2196/33416 ER - TY - JOUR AU - Payvandi, Lily AU - Parsons, Chase AU - Bourgeois, C. Fabienne AU - Hron, D. Jonathan PY - 2022/4/19 TI - Inpatient Telehealth Experience of Patients With Limited English Proficiency: Cross-sectional Survey and Semistructured Interview Study JO - JMIR Form Res SP - e34354 VL - 6 IS - 4 KW - telemedicine KW - telehealth KW - inpatient KW - social determinants of health KW - limited English proficiency KW - health-related social needs KW - Spanish KW - English as a second language KW - English proficiency N2 - Background: Patients with limited English proficiency (LEP) are at a higher risk of poor health outcomes and are less likely to use telehealth than English-speaking patients. To date, there is no formal evaluation of inpatient (IP) telehealth user experience of patients and their families by language preference during visits with their clinicians. Objective: This study aims to compare the experiences of English- and Spanish-speaking patients and their families using IP telehealth, as well as to evaluate the experience of Spanish interpreters providing services through IP telehealth. Methods: We prospectively administered a survey to English- and Spanish-speaking patients and their families who used IP telehealth from October 1, 2020, to March 31, 2021. We performed semistructured phone interviews of hospital-based Spanish interpreters who provided services through IP telehealth. Results: A total of 661 surveys were administered, with completion rates of 18% (112/621) in English and 62% (25/40) in Spanish. On a 10-point scale, the overall satisfaction of Spanish speakers (median 10, IQR 10-10) was higher than that of English speakers (median 9, IQR 8-10; P=.001). Both English- and Spanish-speaking patients used IP telehealth for visits with their primary IP care team, subspecialty consultants, and other clinicians. Hospital tablets were used more often than personal devices, and only English-speaking patients used personal laptops. Patients and their families encountered challenges with log-in, team coordination with multiple users, and equipment availability. Interpreters encountered challenges with audio and video quality, communication, safety, and Wi-Fi access. Conclusions: Both English- and Spanish-speaking patients reported high satisfaction using IP telehealth across multiple disciplines despite the workflow challenges identified by interpreters. Significant investment is needed to provide robust infrastructure to support use by all patients, especially the integration of multiple users to provide interpreter services for patients with LEP. UR - https://formative.jmir.org/2022/4/e34354 UR - http://dx.doi.org/10.2196/34354 UR - http://www.ncbi.nlm.nih.gov/pubmed/35438641 ID - info:doi/10.2196/34354 ER - TY - JOUR AU - Lynch, A. Kathleen AU - Atkinson, M. Thomas AU - Omisore, D. Adeleye AU - Famurewa, Olusola AU - Olasehinde, Olalekan AU - Odujoko, Oluwole AU - Alatise, I. Olusegun AU - Egberongbe, Adedeji AU - Kingham, Peter T. AU - Morris, A. Elizabeth AU - Sutton, Elizabeth PY - 2022/4/20 TI - Developing a Technology Acceptability and Usage Survey (TAUS) for mHealth Intervention Planning and Evaluation in Nigeria: Pilot Study JO - JMIR Form Res SP - e34035 VL - 6 IS - 4 KW - measure development KW - survey methods KW - technology acceptability and use KW - global health KW - mHealth KW - Nigeria N2 - Background: Technology acceptability and usage surveys (TAUS) are brief questionnaires that measure technology comfort, typical daily use, and access in a population. However, current measures are not adapted to low- and middle-income country (LMIC) contexts. Objective: The objective of this pilot study was to develop a TAUS that could be used to inform the implementation of a mobile health (mHealth) intervention in Nigeria. Methods: A literature review of validated technology comfort and usage scales was conducted to identify candidate items. The draft measure was reviewed for face validity by an expert panel comprised of clinicians and researchers with cultural, methodological, and clinical expertise. The measure was piloted by radiologists at an oncology symposium in Nigeria. Results: After expert review, the final measure included 18 items organized into 3 domains: (1) comfort with using mobile applications, (2) reliability of internet or electricity, and (3) attitudes toward using computers or mobile applications in clinical practice. The pilot sample (n=16) reported high levels of comfort and acceptability toward using mHealth applications in the clinical setting but faced numerous infrastructure challenges. Conclusions: Pilot results indicate that the TAUS may be a feasible and appropriate measure for assessing technology usage and acceptability in LMIC clinical contexts. Dedicating a domain to technology infrastructure and access yielded valuable insights for program implementation. UR - https://formative.jmir.org/2022/4/e34035 UR - http://dx.doi.org/10.2196/34035 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442204 ID - info:doi/10.2196/34035 ER - TY - JOUR AU - Hollanda De Sa Neto, Herul AU - Habfast-Robertson, Ines AU - Hempel-Bruder, Christina AU - Durand, Marie-Anne AU - Jacot-Sadowski, Isabelle AU - Khazaal, Yasser AU - Berlin, Ivan AU - Selby, Kevin PY - 2022/4/20 TI - Formative Provider Testing of a New Encounter Decision Aid for Smoking Cessation: Questionnaire Study JO - JMIR Form Res SP - e32960 VL - 6 IS - 4 KW - decision aid KW - smoking cessation KW - electronic tool KW - shared decision-making N2 - Background: Smoking cessation is an essential part of preventing and reducing the risk of smoking-associated morbidity and mortality. However, there is often little time to discuss smoking cessation in primary care. Decision aids (DAs) designed for clinic visits (encounter DAs) need to be clear, short, and concise to optimize therapeutic education, increase interaction, and improve the therapeutic alliance. Such a DA for smoking cessation could potentially improve counseling and increase the use of pharmacological treatments. Objective: We aimed to collect feedback on an electronic encounter DA that facilitates physician-patient interaction and shared decision-making for smoking cessation in primary care. Methods: We developed an electronic, encounter DA (howtoquit.ch) from a paper version created by our team in 2017 following user-centered design principles. The DA is a 1-page interactive website presenting and comparing medications for tobacco cessation and electronic cigarettes. Each smoking cessation medication has a drop down menu that presents additional information, a video demonstration, and prescribing information for physicians. To test the DA, we submitted a questionnaire to approximately 20 general practitioner residents of an academic general medicine department, 5 general practitioners, and 6 experts in the field of smoking cessation. The questionnaire consisted of 4 multiple-choice and 2 free-text questions assessing the usability or acceptability of the DA, the acquisition of new knowledge for practitioners, the perceived utility in supporting shared decision-making, perceived strengths and weaknesses, and whether the participants would recommend the tool to other clinicians. Results: In all, 6 residents, 3 general practitioners in private practice, and 2 tobacco cessation experts completed the questionnaire (N=11), with 4 additional experts providing open-text feedback. On the 11 questionnaires, the DA was rated as practical and intuitive (mean 4.6/5), and providers felt it supported shared decision-making (mean 4.4/5), as comparisons were readily possible. Inclusion of explanatory videos was seen as a bonus. Several changes were suggested, like grouping together similar medications and adding a landing page to briefly explain the site. Changes were implemented according to end-user comments. Conclusions: The overall assessment of the encounter DA by a group of physicians and experts was positive. The ultimate objective is to have the tool deployed and easily accessible for all to use. UR - https://formative.jmir.org/2022/4/e32960 UR - http://dx.doi.org/10.2196/32960 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442200 ID - info:doi/10.2196/32960 ER - TY - JOUR AU - Garbin, Alexander AU - Díaz, Jesús AU - Bui, Vy AU - Morrison, Janina AU - Fisher, E. Beth AU - Palacios, Carina AU - Estrada-Darley, Ingrid AU - Haase, Danielle AU - Wing, David AU - Amezcua, Lilyana AU - Jakowec, W. Michael AU - Kaplan, Charles AU - Petzinger, Giselle PY - 2022/4/20 TI - Promoting Physical Activity in a Spanish-Speaking Latina Population of Low Socioeconomic Status With Chronic Neurological Disorders: Proof-of-Concept Study JO - JMIR Form Res SP - e34312 VL - 6 IS - 4 KW - exercise KW - quality of life KW - motivation KW - promotion KW - community study KW - clinical trial N2 - Background: Physical activity (PA) is known to improve quality of life (QoL) as well as reduce mortality and disease progression in individuals with chronic neurological disorders. However, Latina women are less likely to participate in recommended levels of PA due to common socioeconomic barriers, including limited resources and access to exercise programs. Therefore, we developed a community-based intervention with activity monitoring and behavioral coaching to target these barriers and facilitate sustained participation in an exercise program promoting PA. Objective: The aim of this study was to determine the feasibility and efficacy of a community-based intervention to promote PA through self-monitoring via a Fitbit and behavioral coaching among Latina participants with chronic neurological disorders.  Methods: We conducted a proof-of-concept study among 21 Spanish-speaking Latina participants recruited from the Los Angeles County and University of Southern California (LAC+USC) neurology clinic; participants enrolled in the 16-week intervention at The Wellness Center at The Historic General Hospital in Los Angeles. Demographic data were assessed at baseline. Feasibility was defined by participant attrition and Fitbit adherence. PA promotion was determined by examining change in time spent performing moderate-to-vigorous PA (MVPA) over the 16-week period. The effect of behavioral coaching was assessed by quantifying the difference in MVPA on days when coaching occurred versus on days without coaching. Change in psychometric measures (baseline vs postintervention) and medical center visits (16 weeks preintervention vs during the intervention) were also examined. Results: Participants were of low socioeconomic status and acculturation. A total of 19 out of 21 (90%) participants completed the study (attrition 10%), with high Fitbit wear adherence (mean 90.31%, SD 10.12%). Time performing MVPA gradually increased by a mean of 0.16 (SD 0.23) minutes per day (P<.001), which was equivalent to an increase of approximately 18 minutes in MVPA over the course of the 16-week study period. Behavioral coaching enhanced intervention effectiveness as evidenced by a higher time spent on MVPA on days when coaching occurred via phone (37 min/day, P=.02) and in person (45.5 min/day, P=.01) relative to days without coaching (24 min/day). Participants improved their illness perception (effect size g=0.30) and self-rated QoL (effect size g=0.32). Additionally, a reduction in the number of medical center visits was observed (effect size r=0.44), and this reduction was associated with a positive change in step count during the study period (P.=04). Conclusions: Self-monitoring with behavioral coaching is a feasible community-based intervention for PA promotion among Latina women of low socioeconomic status with chronic neurological conditions. PA is known to be important for brain health in neurological conditions but remains relatively unexplored in minority populations. Trial Registration: ClinicalTrials.gov NCT04820153; https://clinicaltrials.gov/ct2/show/NCT04820153 UR - https://formative.jmir.org/2022/4/e34312 UR - http://dx.doi.org/10.2196/34312 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442197 ID - info:doi/10.2196/34312 ER - TY - JOUR AU - Andrews, Anya PY - 2022/4/21 TI - Integration of Augmented Reality and Brain-Computer Interface Technologies for Health Care Applications: Exploratory and Prototyping Study JO - JMIR Form Res SP - e18222 VL - 6 IS - 4 KW - digital health KW - augmented reality KW - brain-computer interface KW - health professional education KW - clinical performance support KW - interprofessional teamwork KW - patient education KW - mHealth KW - mobile health KW - technology integration N2 - Background: Augmented reality (AR) and brain-computer interface (BCI) are promising technologies that have a tremendous potential to revolutionize health care. While there has been a growing interest in these technologies for medical applications in the recent years, the combined use of AR and BCI remains a fairly unexplored area that offers significant opportunities for improving health care professional education and clinical practice. This paper describes a recent study to explore the integration of AR and BCI technologies for health care applications. Objective: The described effort aims to advance an understanding of how AR and BCI technologies can effectively work together to transform modern health care practice by providing new mechanisms to improve patient and provider learning, communication, and shared decision-making. Methods: The study methods included an environmental scan of AR and BCI technologies currently used in health care, a use case analysis for a combined AR-BCI capability, and development of an integrated AR-BCI prototype solution for health care applications. Results: The study resulted in a novel interface technology solution that enables interoperability between consumer-grade wearable AR and BCI devices and provides the users with an ability to control digital objects in augmented reality using neural commands. The article discusses this novel solution within the context of practical digital health use cases developed during the course of the study where the combined AR and BCI technologies are anticipated to produce the most impact. Conclusions: As one of the pioneering efforts in the area of AR and BCI integration, the study presents a practical implementation pathway for AR-BCI integration and provides directions for future research and innovation in this area. UR - https://formative.jmir.org/2022/4/e18222 UR - http://dx.doi.org/10.2196/18222 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451963 ID - info:doi/10.2196/18222 ER - TY - JOUR AU - Jones, Chelsea AU - Miguel Cruz, Antonio AU - Smith-MacDonald, Lorraine AU - Brown, G. Matthew R. AU - Vermetten, Eric AU - Brémault-Phillips, Suzette PY - 2022/4/21 TI - Technology Acceptance and Usability of a Virtual Reality Intervention for Military Members and Veterans With Posttraumatic Stress Disorder: Mixed Methods Unified Theory of Acceptance and Use of Technology Study JO - JMIR Form Res SP - e33681 VL - 6 IS - 4 KW - PTSD KW - UTAUT KW - technology acceptance model KW - trauma KW - mental health KW - therapy KW - rehabilitation KW - digital health KW - psychotherapy KW - military KW - veteran KW - 3MDR KW - technology acceptability KW - technology acceptance KW - Canadian Armed Forces KW - virtual reality N2 - Background: Military members and veterans exhibit higher rates of injuries and illnesses such as posttraumatic stress disorder (PTSD) because of their increased exposure to combat and other traumatic scenarios. Novel treatments for PTSD are beginning to emerge and increasingly leverage advances in gaming and other technologies, such as virtual reality. Without assessing the degree of technology acceptance and perception of usability to the end users, including the military members, veterans, and their attending therapists and staff, it is difficult to determine whether a technology-based treatment will be used successfully in wider clinical practice. The Unified Theory of Acceptance and Use of Technology model is commonly used to address the technology acceptance and usability of applications in 5 domains. Objective: Using the Unified Theory of Acceptance and Use of Technology model, the purpose of this study was to determine the technology acceptance and usability of multimodal motion-assisted memory desensitization and reconsolidation (3MDR) on a virtual reality system in the primary user group (military members and veterans with treatment-resistant PTSD, 3MDR therapists, and virtual reality environment operators). Methods: This mixed methods embedded pilot study included military members (n=3) and veterans (n=8) with a diagnosis of combat-related PTSD, as well as their therapists (n=13) and operators (n=5) who completed pre-post questionnaires before and on completion of 6 weekly sessions of 3MDR. A partial least squares structural equation model was used to analyze the questionnaire results. Qualitative data from the interviews were assessed using thematic analysis. Results: Effort expectancy, which was the most notable predictor of behavioral intention, increased after a course of 3MDR with the virtual reality system, whereas all other constructs demonstrated no significant change. Participants? expectations of the technology were met, as demonstrated by the nonsignificant differences in the pre-post scores. The key qualitative themes included feasibility and function, technical support, and tailored immersion. Conclusions: 3MDR via a virtual reality environment appears to be a feasible, usable, and accepted technology for delivering 3MDR to military members and veterans who experience PTSD and 3MDR therapists and operators who facilitate their treatment. UR - https://formative.jmir.org/2022/4/e33681 UR - http://dx.doi.org/10.2196/33681 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451971 ID - info:doi/10.2196/33681 ER - TY - JOUR AU - van Strien-Knippenberg, S. Inge AU - Altendorf, B. Maria AU - Hoving, Ciska AU - van Weert, M. Julia C. AU - Smit, S. Eline PY - 2022/4/21 TI - Message Frame?Tailoring in Digital Health Communication: Intervention Redesign and Usability Testing JO - JMIR Form Res SP - e33886 VL - 6 IS - 4 KW - digital health communication KW - web-based computer tailoring KW - smoking cessation intervention KW - message framing KW - usability testing N2 - Background: Message frame?tailoring based on the need for autonomy is a promising strategy to improve the effectiveness of digital health communication interventions. An example of a digital health communication intervention is Personal Advice in Stopping smoking (PAS), a web-based content-tailored smoking cessation program. PAS was effective in improving cessation success rates, but its effect sizes were small and disappeared after 6 months. Therefore, investigating whether message frame?tailoring based on the individual?s need for autonomy might improve effect rates is worthwhile. However, to our knowledge, this has not been studied previously. Objective: To investigate whether adding message frame?tailoring based on the need for autonomy increases the effectiveness of content-tailored interventions, the PAS program was redesigned to incorporate message frame?tailoring also. This paper described the process of redesigning the PAS program to include message frame?tailoring, providing smokers with autonomy-supportive or controlling message frames?depending on their individual need for autonomy. Therefore, we aimed to extend framing theory, tailoring theory, and self-determination theory. Methods: Extension of the framing theory, tailoring theory, and self-determination theory by redesigning the PAS program to include message frame?tailoring was conducted in close collaboration with scientific and nonscientific smoking cessation experts (n=10), smokers (n=816), and communication science students (n=19). Various methods were used to redesign the PAS program to include message frame?tailoring with optimal usability: usability testing, think-aloud methodology, heuristic evaluations, and a web-based experiment. Results: The most autonomy-supportive and controlling message frames were identified, the cutoff point for the need for autonomy to distinguish between people with high and those with low need for autonomy was determined, and the usability was optimized. Conclusions: This resulted in a redesigned digital health communication intervention that included message frame?tailoring and had optimal usability. A detailed description of the redesigning process of the PAS program is provided. Trial Registration: Netherlands Trial Register NL6512 (NRT6700); https://www.trialregister.nl/trial/6512 UR - https://formative.jmir.org/2022/4/e33886 UR - http://dx.doi.org/10.2196/33886 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451988 ID - info:doi/10.2196/33886 ER - TY - JOUR AU - Guglani, Sheena AU - Liddy, Clare AU - Afkham, Amir AU - Mitchell, Rhea AU - Keely, Erin PY - 2022/4/22 TI - The Ontario Electronic Consultation (eConsult) Service: Cross-sectional Analysis of Utilization Data for 2 Models JO - JMIR Form Res SP - e32101 VL - 6 IS - 4 KW - eConsult KW - access to care KW - utilization KW - consultation KW - primary care provider KW - direct-to-specialist KW - Ontario KW - healthcare system N2 - Background: The Ontario electronic consultation (eConsult) service allows a primary care provider (PCP) to access specialist advice through 2 models: the direct-to-specialist (DTS) model, where PCPs select a specialist from a directory, and the Building Access to Specialists Through eConsultation (BASE)?managed specialty service, where PCPs choose a specialty group and are assigned a specialist from a qualified pool based on availability. Objective: The aim of this study is to examine patterns of use between the 2 models of eConsult delivery. Methods: We conducted a cross-sectional analysis of utilization data collected from eConsults completed between October 2018 and September 2019. Cases were grouped based on the model used for submission (ie, BASE or DTS). Each model was assessed for the number of cases over time, specialty distribution, proportion resulting in new or additional information, impact on PCPs? decisions to refer, and billing time. Results: PCPs submitted 26,121 eConsults during the study period. The monthly case volume increased by 43% over the duration of the study, primarily in the BASE model (66% compared to 6% for DTS). PCPs were able to confirm a course of action that they originally had in mind in 41.4% (6373/15,376) of BASE cases and 41.3% (3363/8136) of DTS cases and received advice for a new or additional course of action in 54.7% (8418/15,376) of BASE cases and 56.3% (4582/8136) of DTS cases. A referral was originally contemplated but avoided in 51.3% (7887/15,376) of BASE cases and 53.3% (4336/8136) of DTS cases, originally contemplated and still needed in 19.4% (2986/15,376) of BASE cases and 17.7% (1438/8136) of DTS cases, and neither originally contemplated nor needed in 21.7% (3334/15,376) of BASE cases and 21.9% (1781/8136) of DTS cases. Conclusions: Both eConsult models had strong uptake. Use patterns varied between models, with the majority of growth occurring under BASE, but survey responses showed that both models provided similar outcomes in terms of new information offered and impact on decision to refer. UR - https://formative.jmir.org/2022/4/e32101 UR - http://dx.doi.org/10.2196/32101 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451985 ID - info:doi/10.2196/32101 ER - TY - JOUR AU - Dark, Tyra AU - Simpson, N. Kit AU - Gurung, Sitaji AU - Pennar, L. Amy AU - Chew, Marshall AU - Naar, Sylvie PY - 2022/4/25 TI - Feasibility of Using Electronic Health Records for Cascade Monitoring and Cost Estimates in Implementation Science Studies in the Adolescent Trials Network for HIV/AIDS Interventions JO - JMIR Form Res SP - e25483 VL - 6 IS - 4 KW - EHR KW - HIV KW - youth KW - viral load KW - antiretroviral therapy KW - treatment cascade N2 - Background: One of the most difficult areas in the fight against HIV/AIDS is reaching out to youth aged 13 to 24 years. The proportion of youth living with HIV/AIDS on antiretroviral therapy (ART) and who are virally undetectable is low, highlighting significant challenges for reaching the Joint United Nations Program on HIV targets. Objective: This study aimed to assess the feasibility of obtaining key clinical indicators and monitoring treatment, viral suppression, and retention components of the youth HIV treatment cascade in Adolescent Trials Network for HIV/AIDS Interventions clinics using electronic health record (EHR) downloads and to provide baseline characteristics for the study participants. Methods: EHR data were systematically obtained from multiple clinical sites and used to meaningfully capture clinical characteristics, initiation of antiretrovirals, and retention in care, which are part of the Centers for Disease Control and Prevention?s 4 continuum of care measures. In addition, this study used standard cost values attached to Current Procedural Terminology codes to estimate the cost per visit. Results: Only 2 of the 4 Centers for Disease Control and Prevention treatment cascade measures were assessed using routine EHR data. EHR data are not adequate for monitoring HIV testing or linkage to care because denominator data are not available. However, the data work well for measuring ART initiation and adequately for retention in care. The sites were broadly able to provide information for the required data. However, in most cases, these data are insufficient for identifying patterns of missed appointments because such misses are not captured in the EHR system. Sites with good access to data management resources can operate more efficiently for cascade monitoring study purposes. Conclusions: Data other than EHRs are needed to measure HIV testing and linkage to youth care. EHR data are useful for measuring ART initiation and work moderately well for measuring retention in care. Site data management resources should be part of the selection process when looking for site partners for clinical studies that plan to use EHR data. Study planners should determine the feasibility of additional funding for organizations in need of additional information technology or data management resources. UR - https://formative.jmir.org/2022/4/e25483 UR - http://dx.doi.org/10.2196/25483 UR - http://www.ncbi.nlm.nih.gov/pubmed/35468087 ID - info:doi/10.2196/25483 ER - TY - JOUR AU - Norris, C. Evan AU - Halaska, Ciarra AU - Sachs, B. Peter AU - Lin, Chen-Tan AU - Sanfilippo, Kate AU - Honce, M. Justin PY - 2022/4/25 TI - Understanding Patient Experiences, Opinions, and Actions Taken After Viewing Their Own Radiology Images Online: Web-Based Survey JO - JMIR Form Res SP - e29496 VL - 6 IS - 4 KW - personal health records KW - patient-accessible electronic health records KW - online radiology image viewing KW - imaging informatics KW - patient portals KW - electronic health records KW - digital health KW - mobile phone N2 - Background: The ability for patients to directly view their radiology images through secure electronic portals is rare in the American health care system. We previously surveyed patients within our health system and found that a large majority wanted to view their own radiology images online, and we have since implemented this new feature. Objective: We aim to understand patient experiences, opinions, and actions taken after viewing their own radiology images online. Methods: We emailed a web-based survey to patients who recently viewed their radiology images via our electronic patient portal. Results: We sent 1825 surveys to patients and received 299 responses (response rate 16.4%). Patients reported a favorable experience (258/299, 86.3% agree) viewing their radiology images online. Patients found value in reading their radiology reports (288/299, 96.3% agree) and viewing their images (267/299, 89.3% agree). Overall, patients felt that accessing and viewing their radiology images online increased their understanding of their medical condition (258/299, 82.9%), made them feel more in control and reassured (237/299, 79.2% and 220/299, 73.6%, respectively), and increased levels of trust (214/299, 71.6%). Only 6.4% (19/299) of the patients indicated concerns with finding errors, 6.4% (19/299) felt that viewing their images online made them worry more, and 7% (21/299) felt confused when viewing their images online. Of patients who viewed their images online, 45.2% (135/299) took no action with their images, 32.8% (98/299) saved a copy for their records, 25.4% (76/299) shared them with their doctor, and 14.7% (44/299) shared them with another doctor for a second opinion. A total of 9 patients (3%) shared their radiology images on Facebook, Instagram, or both, primarily to inform family and friends. Approximately 10.4% (31/299) of the patients had questions about their radiology images after viewing them online, with the majority (20/31, 65%) seeking out a doctor, and far fewer (5/31, 16%) choosing to ask a family member about their images. Finally, respondents viewed their images online using 1 or more devices, including computers, smartphones, tablets, or a combination of these devices. Approximately 26.7% (103/385) of the responses noted technical difficulties, with the highest incidence rate occurring with smartphones. Conclusions: We report the first known survey results from patients who viewed their own radiology images through a web-based portal. Patients reported high levels of satisfaction and increased levels of trust, autonomy, reassurance, and medical understanding. Only a small minority of patients expressed anxiety or confusion. We suggest that patient access to radiology images, such as patient access to radiology reports, is highly desired by patients and is operationally practical. Other health care institutions should consider offering patients access to their radiology images online in the pursuit of information transparency. UR - https://formative.jmir.org/2022/4/e29496 UR - http://dx.doi.org/10.2196/29496 UR - http://www.ncbi.nlm.nih.gov/pubmed/35468086 ID - info:doi/10.2196/29496 ER - TY - JOUR AU - Stearns-Yoder, A. Kelly AU - Ryan, T. Arthur AU - Smith, A. Alexandra AU - Forster, E. Jeri AU - Barnes, M. Sean AU - Brenner, A. Lisa PY - 2022/4/25 TI - Computerized Cognitive Behavioral Therapy Intervention for Depression Among Veterans: Acceptability and Feasibility Study JO - JMIR Form Res SP - e31835 VL - 6 IS - 4 KW - computerized cognitive behavioral therapy KW - depression KW - veterans KW - acceptability KW - feasibility N2 - Background: Computerized cognitive behavioral therapies (cCBTs) have been developed to deliver efficient, evidence-based treatment for depression and other mental health conditions. Beating the Blues (BtB) is one of the most empirically supported cCBTs for depression. The previous trial of BtB with veterans included regular guidance by health care personnel, which increased the complexity and cost of the intervention. Objective: This study, conducted by researchers at a Veterans Affairs Medical Center, aims to test the acceptability and feasibility of unguided cCBT for depression among US military veterans. Methods: To examine the acceptability of BtB delivered without additional peer or other mental health care provider support, a before-and-after trial was conducted among United States (US) military veterans experiencing mild to moderate depressive symptoms. The feasibility of the study design for a future efficacy trial was also evaluated. Results: In total, 49 veterans completed preintervention assessments and received access to BtB, and 29 participants completed all postintervention assessments. The predetermined acceptability criterion for the intervention was met. Although the predetermined feasibility criteria regarding screening eligibility rate, number of BtB modules completed, and completion of a posttreatment assessment were not met, the results were comparable with those of other cCBT studies. Conclusions: This is the first study among US military veterans to demonstrate support for the implementation of cCBT for depression without the assistance of a mental health professional or a peer support specialist, suggesting that stand-alone computer-aided interventions may be viable. Ideas for improving feasibility in future trials based on this study are discussed. UR - https://formative.jmir.org/2022/4/e31835 UR - http://dx.doi.org/10.2196/31835 UR - http://www.ncbi.nlm.nih.gov/pubmed/35468088 ID - info:doi/10.2196/31835 ER - TY - JOUR AU - MacPherson, Megan AU - Merry, Kohle AU - Locke, Sean AU - Jung, Mary PY - 2022/4/26 TI - Developing Mobile Health Interventions With Implementation in Mind: Application of the Multiphase Optimization Strategy (MOST) Preparation Phase to Diabetes Prevention Programming JO - JMIR Form Res SP - e36143 VL - 6 IS - 4 KW - text messaging KW - prediabetic state KW - telemedicine KW - telecommunications KW - exercise KW - diet KW - preventive medicine KW - mHealth KW - intervention development KW - behavior change KW - mobile phone UR - https://formative.jmir.org/2022/4/e36143 UR - http://dx.doi.org/10.2196/36143 UR - http://www.ncbi.nlm.nih.gov/pubmed/35471473 ID - info:doi/10.2196/36143 ER - TY - JOUR AU - Burton, Lindsay AU - Rush, L. Kathy AU - Smith, A. Mindy AU - Davis, Selena AU - Rodriguez Echeverria, Patricia AU - Suazo Hidalgo, Lina AU - Görges, Matthias PY - 2022/4/27 TI - Empowering Patients Through Virtual Care Delivery: Qualitative Study With Micropractice Clinic Patients and Health Care Providers JO - JMIR Form Res SP - e32528 VL - 6 IS - 4 KW - virtual care KW - micropractice KW - focus groups KW - patient portals KW - COVID-19 KW - family practice KW - rural care KW - digital health technology KW - telehealth N2 - Background: Prior to the wider adoption of digital health technologies during the COVID-19 pandemic, applications of virtual care were largely limited to specialist visits and remote care using telehealth (phone or video) applications. Data sharing approaches using tethered patient portals were mostly built around hospitals and larger care systems. These portals offer opportunities for improved communication, but despite a belief that care has improved, they have so far shown few outcome improvements beyond medication adherence. Less is known about use of virtual care and related tools in the outpatient context and particularly in rural community contexts. Objective: This study aims to reflect on the opportunities and barriers for sustainable virtual care through an example of a digitally enabled rural micropractice, which has provided 10%-15% virtual care since 2016 and 70% virtual care since March 2020. Methods: Three focus groups, 1 with providers (physician and medical office manager) and 2 with a total of 8 patients from a rural micropractice in British Columbia, were conducted in November 2020 and December 2020. Virtual care delivery was explored through the topics of communication approach, mixing virtual and in-person care, the practice team?s journey in developing these approaches, and provider and patient satisfaction with the care model. Interviews were transcribed, checked for accuracy against recordings, and thematically analyzed. Results: Both patients and providers reported ease of communication and high satisfaction. Either could initiate communication, and patients found the ability to share health information asynchronously through the portal allowed time to reflect and prepare their thoughts. Patients were highly engaged and reported feeling empowered and true partners in their health care, although they noted limited care coordination with specialists. The mix of virtual and in-person visits was highly regarded by patients and providers, and patients reported feeling safe and cared for 24/7, although both expressed concern about work spilling into the provider?s home life. The physician worried about missed diagnoses with virtual care. With respect to establishing the micropractice, solutions took about 5 years to optimize, with providers noting a learning curve requiring technical support for both themselves and their patients and a willingness to respond to patient feedback to identify the best solutions. Despite a mature virtual practice, patients reported deferred care due to COVID-19. Conclusions: The micropractice?s hybrid care model encouraged patients to be true partners in their care and resulted in high patient engagement and satisfaction; yet, success may rely on the patient population being willing to engage and being comfortable with technology. Barriers lie in gaps in care coordination and provider fear that signs or symptoms more evident with an in-person exam could be missed. Even in this setting, deferral of care in light of COVID-19 was present, and opportunities to address care gaps should be sought. UR - https://formative.jmir.org/2022/4/e32528 UR - http://dx.doi.org/10.2196/32528 UR - http://www.ncbi.nlm.nih.gov/pubmed/35413002 ID - info:doi/10.2196/32528 ER - TY - JOUR AU - Linkewich, Elizabeth AU - Quant, Sylvia AU - Bechard, Lauren AU - Donald, Michelle PY - 2022/4/27 TI - Using a Virtual Community of Practice to Support Stroke Best Practice Implementation: Mixed Methods Evaluation JO - JMIR Form Res SP - e31827 VL - 6 IS - 4 KW - stroke KW - rehabilitation KW - knowledge translation KW - implementation KW - quality improvement KW - evidence-based practice KW - evaluation KW - continuing education KW - social media KW - internet KW - web-based learning KW - allied health N2 - Background: Successful best practice implementation is influenced by access to peer support and knowledge exchange. The Toronto Stroke Networks Virtual Community of Practice, a secure social media platform, is a knowledge translation tool supporting dissemination and adoption of stroke best practices for interprofessional stroke stakeholders. Objective: The aim of this study is to evaluate the use of a virtual community of practice (VCoP) in supporting regional stroke care best practice implementation in an urban context. Methods: A mixed methods approach was used. Qualitative data were collected through focus groups and interviews with stroke care provider members of the VCoP working in acute and rehabilitation settings. Thematic analysis was completed, and the Wenger Value Creation Model and developmental evaluation were used to reflect practice change. Quantitative data were collected and analyzed using website analytics on VCoP use. Results: A year after implementation, the VCoP had 379 members. Analysis of web analytics data and transcripts from focus groups and interviews conducted with 26 VCoP members indicated that the VCoP provided immediate value in supporting user networking, community activities, and interactions. Skill acquisition and changes in perspective acquired through discussion and project work on the VCoP were valued by members, with potential value for supporting practice change. Learning about new stroke best practices through the VCoP was a starting point for individuals and teams to contemplate change. Conclusions: These findings suggest that the VCoP supports the early stages of practice change and stroke best practice implementation. Future research should examine how VCoPs can support higher levels of value creation for implementing stroke best practices. UR - https://formative.jmir.org/2022/4/e31827 UR - http://dx.doi.org/10.2196/31827 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475730 ID - info:doi/10.2196/31827 ER - TY - JOUR AU - Mace, A. Ryan AU - Greenberg, Jonathan AU - Lemaster, Nicole AU - Duarte, Brooke AU - Penn, Terence AU - Kanaya, Millan AU - Doorley, D. James AU - Burris, L. Jessica AU - Jacobs, A. Cale AU - Vranceanu, Ana-Maria PY - 2022/4/27 TI - Live Video Mind-Body Program for Patients With Knee Osteoarthritis, Comorbid Depression, and Obesity: Development and Feasibility Pilot Study JO - JMIR Form Res SP - e34654 VL - 6 IS - 4 KW - knee osteoarthritis KW - depression KW - obesity KW - mind-body KW - physical activity KW - mixed-methods KW - mobile phone N2 - Background: Knee osteoarthritis (KOA) is the most common joint disorder in the United States and a leading cause of disability. Depression and obesity are highly comorbid with KOA and accelerate knee degeneration and disability through biopsychosocial mechanisms. Mind-body physical activity programs can engage biological, mechanical, and psychological mechanisms to improve outcomes in KOA, but such programs are not currently available. Objective: This mixed methods study aims to adapt a mind-body activity program for the unique needs of patients with KOA, depression, and obesity (GetActive-OA) delivered via live video. Methods: Participants were adults (aged ?45 years) from rural Kentucky with obesity (BMI?30 kg/m2), idiopathic KOA with mild to moderate radiographic changes, and elevated depressive symptoms (9-item Patient Health Questionnaire ?10) recruited from 2 orthopedic centers. In phase 1, we developed GetActive-OA and the study protocol using qualitative focus group feedback from the study population (N=9; 2 focus groups, 90 minutes) and multidisciplinary expertise from clinical psychologists and orthopedic researchers. In phase 2, we explored the initial feasibility, credibility, and acceptability of GetActive-OA, live video delivery, and study procedures via an open pilot with exit interviews (N=5; 1 group). This research was guided by National Institutes of Health (NIH) model stage IA. Results: Phase 1 qualitative analyses revealed nuanced information about challenges with coping and increasing activity, high interest in a mind-body activity program, program participation facilitators (flexibility with technology) and barriers (amotivation and forgetfulness), and perceived challenges with data collection procedures (blood and urine samples and homework). Phase 2 quantitative analyses showed that GetActive-OA met most a priori feasibility markers: acceptability (80%), expectancy (100%), credibility (100%), clinician adherence (90%), homework adherence (80%), questionnaire data collection (100%), program satisfaction (100%), and safety (100%). Adherence to ActiGraph wear (80% baseline, 20% posttest) and collection of blood samples (60%) were low. Participation in GetActive-OA was associated with signals of improvements in general coping (Cohen d=2.41), pain catastrophizing (Cohen d=1.24), depression (Cohen d=0.88), anxiety (Cohen d=0.78), self-efficacy (Cohen d=0.73), pain (Cohen d=0.39), and KOA symptoms (Cohen d=0.36). Qualitative exit interviews confirmed quantitative findings and provided valuable information to optimize the program and protocol. Conclusions: Patients with KOA, depression, and obesity from rural Kentucky were interested in a live video mind-body activity program. GetActive-OA shows promise; however, the program and protocol require further NIH stage I refinement before formal efficacy testing (NIH model stage II). International Registered Report Identifier (IRRID): RR2-10.1016/j.conctc.2021.100720 UR - https://formative.jmir.org/2022/4/e34654 UR - http://dx.doi.org/10.2196/34654 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475787 ID - info:doi/10.2196/34654 ER - TY - JOUR AU - Suen, Tung Michelle Man AU - Lai, Kwan Agnes Yuen AU - Wang, Ping Man AU - Ho, Yin Daniel Sai AU - Lam, Hing Tai PY - 2022/4/28 TI - Development and Evaluation of an Innovative Web-Based Training, Learning, and Sharing Platform for Social Workers (Hong Kong Jockey Club SMART Family-Link Project): Mixed Methods Evaluation Study JO - JMIR Form Res SP - e32894 VL - 6 IS - 4 KW - web-based KW - learning platform KW - capacity building KW - social work practice KW - ICT KW - social work KW - professional development KW - information and communication technology KW - Google Analytics KW - family services KW - mobile phone N2 - Background: Information and communication technology (ICT) use may enhance social work practice and continuous professional development. Under the Hong Kong Jockey Club SMART Family-Link Project, we developed an innovative web-based training, learning, and sharing platform (i-TLS) to support not only ICT and other learning needs of Hong Kong social workers but also their practice. Objective: We developed i-TLS with 3 major components (i-Training, i-Learning, and i-Sharing) and assessed its acceptability and impact on facilitating ICT use in family services. Methods: We described the i-TLS development based on a 4-phase model and evaluated i-TLS using the platform database, Google Analytics, a self-administered survey, and individual phone interviews 1 year after launching. Results: i-TLS was launched in 12 nongovernmental organizations on July 1, 2019. The COVID-19 outbreak in December 2019 limited face-to-face services, which galvanized digital transformation in social work practice. By July 31, 2020, 313 social workers had registered with i-TLS. Approximately 79.6% (249/313) of users accessed i-TLS at least once in the past 28 days, averaging 3.2 (SD 1.35) platform visits per day and viewing 4.8 (SD 1.42) pages per visit. i-Training provided 41 mini-modules on applying ICT to family services, with 730 enrollments. Approximately 70% (511/730) of users completed the mini-modules and obtained digital mini-certificates. i-Learning provided 112 items of learning resources centered on ICT use in family services, with nearly 4000 page views. i-Sharing had 25 discussion threads with 59 posts. Approximately 53.7% (168/313) of users completed the 1-year evaluation survey, including 7.1% (12/168) who were phone interviewed. The mean i-TLS satisfaction score (out of 10) increased from light (4.99, SD 1.54) to occasional (6.15, SD 1.34) and frequent (6.31, SD 2.29) users. Frequent users showed higher scores (out of 10) than light users for an increase in knowledge (5.84, SD 1.34 vs 4.09, SD 1.74; P<.001), self-efficacy (5.23, SD 1.92 vs 3.96, SD 1.77; P=.02), and knowledge application (6.46, SD 1.33 vs 1.91, SD 1.40; P<.001). Interviewees reported increased ICT use in services and considered i-TLS an acceptable and supportive tool for learning and practice, especially during the pandemic. Conclusions: i-TLS is acceptable to social workers and enhances their learning and use of ICT in family services. This was achieved through access to self-directed and collaborative learning and sharing of experiences within their practice. Further research on enhancing web-based platforms is needed to expand participation and capacity building among social workers and other health and social care professionals. UR - https://formative.jmir.org/2022/4/e32894 UR - http://dx.doi.org/10.2196/32894 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482365 ID - info:doi/10.2196/32894 ER - TY - JOUR AU - Rian, Torbjørn AU - Sand, Kari AU - Skogvoll, Eirik AU - Klepstad, Pål AU - Wik, S. Tina PY - 2022/4/28 TI - A Web-Based Communication Tool for Postoperative Follow-up and Pain Assessment at Home After Primary Knee Arthroplasty: Feasibility and Usability Study JO - JMIR Form Res SP - e34543 VL - 6 IS - 4 KW - feasibility studies KW - postoperative follow-up KW - primary knee arthroplasty, pain assessment KW - mobile application KW - pain treatment KW - follow-up at home N2 - Background: We report the use of an electronic tool, Eir (Eir Solutions AS, Norway), for symptom registration at home after knee arthroplasty. This electronic tool was used in a randomized controlled trial (RCT) comparing 3 different analgesic regimens with respect to postoperative pain and side effects. Objective: The aim of this substudy was to investigate this electronic tool for symptom registrations at home with respect to usability (ie, how easy it was to use) and feasibility (ie, how well the tool served its purpose). Methods: To assess the tool's usability, all participants were invited to fill out the 10-item System Usability Scale (SUS) after using the tool for 8 days. To assess feasibility, data regarding the participants' ability to use the tool with or without assistance or reminders were collected qualitatively on a daily basis during the study period. Results: A total of 134 patients completed the RCT. Data concerning feasibility of the web-based tool were collected from all 134 patients. The SUS was completed by 119 of the 134 patients; 70.2% (94/134) of the patients managed to use the tool at home without any technical support. All technical challenges were related to the login procedure or internet access. The mean SUS score was 89.6 (median 92.5; range 22.5-100). Conclusions: This study showed high feasibility and high usability of the Eir web tool. The received reports gave the necessary information needed for both research data and clinical follow-up. Trial Registration: ClinicalTrials.gov NCT02604446; https://www.clinicaltrials.gov/ct2/show/NCT02604446 UR - https://formative.jmir.org/2022/4/e34543 UR - http://dx.doi.org/10.2196/34543 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482392 ID - info:doi/10.2196/34543 ER - TY - JOUR AU - Scott, Jodie AU - Oxlad, Melissa AU - Dodd, Jodie AU - Szabo, Claudia AU - Deussen, Andrea AU - Turnbull, Deborah PY - 2022/4/28 TI - Promoting Health Behavior Change in the Preconception Period: Combined Approach to Intervention Planning JO - JMIR Form Res SP - e35108 VL - 6 IS - 4 KW - intervention mapping KW - preconception KW - behavior change KW - healthy lifestyle KW - maternal health KW - weight management N2 - Background: Half of women begin pregnancy above the healthy weight range, increasing the risk of complications and adversely affecting the lifelong health of their babies. Maternal obesity remains the strongest risk factor for offspring obesity across childhood, adolescence, and adulthood. Previous research suggests that women should be encouraged to be within a healthy weight range before conception to improve health outcomes. Objective: We outlined the intervention planning and design process to develop an evidence-informed eHealth intervention to promote weight management. The intervention, based on psychological theories and behavior change techniques, has been developed for women affected by overweight or obesity who intend to become pregnant. The Begin Better web application is part of an integrated program being evaluated in a clinical trial to assess if weight management before pregnancy can influence clinical outcomes for mothers and babies. Methods: Our intervention development process was guided by intervention mapping and person-based methods. This study documents steps 2 to 4 of a 6-step iterative intervention mapping approach informed by the Information-Motivation-Behavioral Skills model and the findings of a previous interview study. We defined behavior change objectives for each of the Information-Motivation-Behavioral Skills behavioral determinants as well as theory-based behavior change techniques and practical strategies. We also used persuasive system design principles to assist in translating these strategies into a digital environment. Results: The resultant intervention comprises nutritional and physical activity content along with psychological strategies, which are notably absent from mainstream weight management programs. Strategies to increase motivation, garner social support, and promote self-care are integral to maintaining engagement with the intervention, which aims to improve lifestyle behaviors and enhance well-being. Important elements include tracking mechanisms for percentage progress toward goals to enable feedback on behaviors and outcomes; in-application messages of praise on entry of goals or habits; and strategies to prompt habit formation and action planning via small, easily achievable steps toward positive change. Conclusions: Design decisions and processes for idea generation about intervention content, format, and delivery are often not reported. In this study, we respond to this gap in the literature and outline a process that is potentially transferable to the development of other interventions. UR - https://formative.jmir.org/2022/4/e35108 UR - http://dx.doi.org/10.2196/35108 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482370 ID - info:doi/10.2196/35108 ER - TY - JOUR AU - Tenbult, Nicole AU - Kraal, Jos AU - Brouwers, Rutger AU - Spee, Ruud AU - Eijsbouts, Sabine AU - Kemps, Hareld PY - 2022/4/29 TI - Adherence to a Multidisciplinary Lifestyle Program for Patients With Atrial Fibrillation and Obesity: Feasibility Study JO - JMIR Form Res SP - e32625 VL - 6 IS - 4 KW - cardiac rehabilitation KW - atrial fibrillation KW - obesity KW - participation KW - completion KW - adherence KW - lifestyle N2 - Background: Atrial fibrillation is commonly associated with obesity. Observational studies have shown that weight loss is associated with improved prognosis and a decrease in atrial fibrillation frequency and severity. However, despite these benefits, nonadherence to lifestyle programs is common. Objective: In this study, we evaluated adherence to and feasibility of a multidisciplinary lifestyle program focusing on behavior change in patients with atrial fibrillation and obesity. Methods: Patients with atrial fibrillation and obesity participated in a 1-year goal-oriented cardiac rehabilitation program. After baseline assessment, the first 3 months included a cardiac rehabilitation intervention with 4 fixed modules: lifestyle counseling (with an advanced nurse practitioner), exercise training, dietary consultation, and psychosocial therapy; relaxation sessions were an additional optional treatment module. An advanced nurse practitioner monitored the personal lifestyle of each individual patient, with assessments and consultations at 3 months (ie, immediately after the intervention) and at the end of the year (ie, 9 months after the intervention). At each timepoint, level of physical activity, personal goals and progress, atrial fibrillation symptoms and frequency (Atrial Fibrillation Severity Scale), psychosocial stress (Generalized Anxiety Disorder?7), and depression (Patient Health Questionnaire?9) were assessed. The primary endpoints were adherence (defined as the number of visits attended as percentage of the number of planned visits) and completion rates of the cardiac rehabilitation intervention (defined as performing at least of 80% of the prescribed sessions). In addition, we performed an exploratory analysis of effects of the cardiac rehabilitation program on weight and atrial fibrillation symptom frequency and severity. Results: Patients with atrial fibrillation and obesity (male: n=8; female: n=2; age: mean 57.2 years, SD 9.0; baseline weight: mean 107.2 kg, SD 11.8; baseline BMI: mean 32.4 kg/m2, SD 3.5) were recruited. Of the 10 participants, 8 participants completed the 3-month cardiac rehabilitation intervention, and 2 participants did not complete the cardiac rehabilitation intervention (both because of personal issues). Adherence to the fixed treatment modules was 95% (mean 3.8 sessions attended out of mean 4 planned) for lifestyle counseling, 86% (mean 15.2 sessions attended out of mean 17.6 planned) for physiotherapy sessions, 88% (mean 3.7 sessions attended out of mean 4.1 planned) for dietician consultations, and 60% (mean 0.6 sessions attended out of mean 1.0 planned) for psychosocial therapy; 70% of participants (7/10) were referred to the optional relaxation sessions, for which adherence was 86% (mean 2 sessions attended out of mean 2.4 planned). The frequency of atrial fibrillation symptoms was reduced immediately after the intervention (before: mean 35.6, SD 3.8; after: mean 31.2, SD 3.3), and this was sustained at 12 months (mean 24.8, SD 3.2). The severity of atrial fibrillation complaints immediately after the intervention (mean 20.0, SD 3.7) and at 12 months (mean 9.3, SD 3.6) were comparable to that at baseline (mean 16.6, SD 3.3). Conclusions: A 1-year multidisciplinary lifestyle program for obese patients with atrial fibrillation was found to be feasible, with high adherence and completion rates. Exploratory analysis revealed a sustained reduction in atrial fibrillation symptoms; however, these results remain to be confirmed in large-scale studies. UR - https://formative.jmir.org/2022/4/e32625 UR - http://dx.doi.org/10.2196/32625 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486435 ID - info:doi/10.2196/32625 ER - TY - JOUR AU - Bartlett, Kiera Yvonne AU - Farmer, Andrew AU - Newhouse, Nikki AU - Miles, Lisa AU - Kenning, Cassandra AU - French, P. David PY - 2022/4/29 TI - Effects of Using a Text Message Intervention on Psychological Constructs and the Association Between Changes to Psychological Constructs and Medication Adherence in People With Type 2 Diabetes: Results From a Randomized Controlled Feasibility Study JO - JMIR Form Res SP - e30058 VL - 6 IS - 4 KW - medication adherence KW - type 2 diabetes mellitus KW - behavior change techniques KW - text messaging KW - feasibility studies KW - diabetes KW - medication KW - digital health N2 - Background: Poor adherence to oral medications is common in people with type 2 diabetes and can lead to an increased chance of health complications. Text messages may provide an effective delivery method for an intervention; however, thus far, the majority of these interventions do not specify either a theoretical basis or propose specific mechanisms of action. This makes it hard to determine how and whether an intervention is having an effect. The text messages included in the current intervention have been developed to deliver specific behavior change techniques. These techniques are the ?active ingredients? of the intervention and were selected to target psychological constructs identified as predictors of medication adherence. Objective: There are 2 aims of this study: (1) to assess whether a text message intervention with specified behavior change techniques can change the constructs that predict medication adherence behaviors in people with type 2 diabetes and (2) to assess whether changes to psychological constructs are associated with changes in self-reported medication adherence. Methods: We conducted a randomized controlled, 6-month feasibility trial. Adults prescribed oral medication for type 2 diabetes (N=209) were recruited from general practice and randomized to either receive a text message?based intervention or care as usual. Data were analyzed with repeated measures analysis of covariance and Spearman rho correlation coefficients. Results: For 8 of the 14 constructs that were measured, a significant time-by-condition interaction was found: necessity beliefs, intention, maintenance self-efficacy, recovery self-efficacy, action control, prompts and cues, social support, and satisfaction with experienced consequences all increased in the intervention group compared to the control group. Changes in action self-efficacy, intention, automaticity, maintenance self-efficacy, and satisfaction with experienced consequences were positively associated with changes in self-reported medication adherence. Conclusions: A relatively low-cost, scalable, text message?only intervention targeting medication adherence using behavior change techniques can influence psychological constructs that predict adherence. Not only do these constructs predict self-reported medication adherence, but changes in these constructs are correlated with changes in self-reported medication adherence. These findings support the promise of text message?based interventions for medication adherence in this population and suggest likely mechanisms of action. Trial Registration: ISRCTN Registry ISRCTN13404264; https://www.isrctn.com/ISRCTN13404264 UR - https://formative.jmir.org/2022/4/e30058 UR - http://dx.doi.org/10.2196/30058 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486430 ID - info:doi/10.2196/30058 ER - TY - JOUR AU - Nelson, A. Lyndsay AU - Pennings, S. Jacquelyn AU - Sommer, C. Evan AU - Popescu, Filoteia AU - Barkin, L. Shari PY - 2022/4/29 TI - A 3-Item Measure of Digital Health Care Literacy: Development and Validation Study JO - JMIR Form Res SP - e36043 VL - 6 IS - 4 KW - digital literacy KW - digital health care KW - telehealth KW - health equity KW - scale development KW - mobile phone N2 - Background: With increased reliance on digital health care, including telehealth, efficient and effective ways are needed to assess patients? comfort and confidence with using these services. Objective: The goal of this study was to develop and validate a brief scale that assesses digital health care literacy. Methods: We first developed an item pool using existing literature and expert review. We then administered the items to participants as part of a larger study. Participants were caregivers of children receiving care at a pediatric clinic who completed a survey either on the web or over the telephone. We randomized participants into development and confirmatory samples, stratifying by language so that exploratory factor analysis and confirmatory factor analysis could be performed with separate samples of participants. We assessed the scale?s validity by examining its associations with participants? demographics, digital access, and prior digital health care use. Results: Participants (N=508) were, on average, aged 34.7 (SD 7.7) years, and 89.4% (454/508) were women. Of the 508 participants, 280 (55.1%) preferred English as their primary language, 157 (30.9%) preferred Spanish, and 71 (14%) preferred Arabic; 228 (45%) had a high school degree or less; and 230 (45.3%) had an annual household income of pFad - Phonifier reborn

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