@Article{info:doi/10.2196/63347, author="{\vS}uto Pavi{\v c}i{\'c}, Jelena and Maru{\vs}i{\'c}, Ana and Buljan, Ivan", title="Using ChatGPT to Improve the Presentation of Plain Language Summaries of Cochrane Systematic Reviews About Oncology Interventions: Cross-Sectional Study", journal="JMIR Cancer", year="2025", month="Mar", day="19", volume="11", pages="e63347", keywords="health literacy", keywords="patient education", keywords="health communication", keywords="ChatGPT", keywords="neoplasms", keywords="Cochrane", keywords="oncology", keywords="plain language", keywords="medical information", keywords="decision-making", keywords="large language model", keywords="artificial intelligence", keywords="AI", abstract="Background: Plain language summaries (PLSs) of Cochrane systematic reviews are a simple format for presenting medical information to the lay public. This is particularly important in oncology, where patients have a more active role in decision-making. However, current PLS formats often exceed the readability requirements for the general population. There is still a lack of cost-effective and more automated solutions to this problem. Objective: This study assessed whether a large language model (eg, ChatGPT) can improve the readability and linguistic characteristics of Cochrane PLSs about oncology interventions, without changing evidence synthesis conclusions. Methods: The dataset included 275 scientific abstracts and corresponding PLSs of Cochrane systematic reviews about oncology interventions. ChatGPT-4 was tasked to make each scientific abstract into a PLS using 3 prompts as follows: (1) rewrite this scientific abstract into a PLS to achieve a Simple Measure of Gobbledygook (SMOG) index of 6, (2) rewrite the PLS from prompt 1 so it is more emotional, and (3) rewrite this scientific abstract so it is easier to read and more appropriate for the lay audience. ChatGPT-generated PLSs were analyzed for word count, level of readability (SMOG index), and linguistic characteristics using Linguistic Inquiry and Word Count (LIWC) software and compared with the original PLSs. Two independent assessors reviewed the conclusiveness categories of ChatGPT-generated PLSs and compared them with original abstracts to evaluate consistency. The conclusion of each abstract about the efficacy and safety of the intervention was categorized as conclusive (positive/negative/equal), inconclusive, or unclear. Group comparisons were conducted using the Friedman nonparametric test. Results: ChatGPT-generated PLSs using the first prompt (SMOG index 6) were the shortest and easiest to read, with a median SMOG score of 8.2 (95\% CI 8?8.4), compared with the original PLSs (median SMOG score 13.1, 95\% CI 12.9?13.4). These PLSs had a median word count of 240 (95\% CI 232?248) compared with the original PLSs' median word count of 364 (95\% CI 339?388). The second prompt (emotional tone) generated PLSs with a median SMOG score of 11.4 (95\% CI 11.1?12), again lower than the original PLSs. PLSs produced with the third prompt (write simpler and easier) had a median SMOG score of 8.7 (95\% CI 8.4?8.8). ChatGPT-generated PLSs across all prompts demonstrated reduced analytical tone and increased authenticity, clout, and emotional tone compared with the original PLSs. Importantly, the conclusiveness categorization of the original abstracts was unchanged in the ChatGPT-generated PLSs. Conclusions: ChatGPT can be a valuable tool in simplifying PLSs as medically related formats for lay audiences. More research is needed, including oversight mechanisms to ensure that the information is accurate, reliable, and culturally relevant for different audiences. ", doi="10.2196/63347", url="https://cancer.jmir.org/2025/1/e63347" } @Article{info:doi/10.2196/57697, author="Haegens, L. Lex and Huiskes, B. Victor J. and van den Bemt, F. Bart J. and Bekker, L. Charlotte", title="Factors Influencing the Intentions of Patients With Inflammatory Rheumatic Diseases to Use a Digital Human for Medication Information: Qualitative Study", journal="J Med Internet Res", year="2025", month="Mar", day="13", volume="27", pages="e57697", keywords="digital human", keywords="information provision", keywords="intention to use", keywords="qualitative study", keywords="focus groups", keywords="drug-related problems", keywords="medication safety", keywords="safety information", keywords="information seeking", keywords="Netherlands", keywords="Pharmacotherapy", keywords="medication", keywords="telehealth", keywords="communication technologies", keywords="medication information", keywords="rheumatic diseases", keywords="rheumatology", abstract="Background: Introduction: Patients with inflammatory rheumatic diseases (IRDs) frequently experience drug-related problems (DRPs). DRPs can have negative health consequences and should be addressed promptly to prevent complications. A digital human, which is an embodied conversational agent, could provide medication-related information in a time- and place-independent manner to support patients in preventing and decreasing DRPs. Objective: This study aims to identify factors that influence the intention of patients with IRDs to use a digital human to retrieve medication-related information. Methods: A qualitative study with 3 in-person focus groups was conducted among adult patients diagnosed with an IRD in the Netherlands. The prototype of a digital human is an innovative tool that provides spoken answers to medication-related questions and provides information linked to the topic, such as (instructional) videos, drug leaflets, and other relevant sources. Before the focus group, participants completed a preparatory exercise at home to become familiar with the digital human. A semistructured interview guide based on the Proctor framework for implementation determinants was used to interview participants about the acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability of the digital human. Focus groups were recorded, transcribed, and analyzed thematically. Results: The participants included 22 patients, with a median age of 68 (IQR 52-75) years, of whom 64\% (n=22) were female. In total, 6 themes describing factors influencing patients' intention to use a digital human were identified: (1) the degree to which individual needs for medication-related information are met; (2) confidence in one's ability to use the digital human; (3) the degree to which using the digital human resembles interacting with a human; (4) technical functioning of the digital human; (5) privacy and security; and (6) expected benefit of using the digital human. Conclusions: The intention of patients with IRDs to use a novel digital human to retrieve medication-related information was influenced by factors related to each patient's information needs and confidence in their ability to use the digital human, features of the digital human, and the expected benefits of using the digital human. These identified themes should be considered during the further development of the digital human and during implementation to increase intention to use and future adoption. Thereafter, the effect of applying a digital human as an instrument to improve patients' self-management regarding DRPs could be researched. ", doi="10.2196/57697", url="https://www.jmir.org/2025/1/e57697" } @Article{info:doi/10.2196/56720, author="Varela, Kimahri Luna and Horton, Stephanie and Abdelmoity, Ahmed and Le Pichon, Jean-Baptiste and Hoffman, A. Mark", title="YouTube User Traffic to Paired Epilepsy Education Videos in English and Spanish: Comparative Study", journal="JMIR Form Res", year="2025", month="Mar", day="13", volume="9", pages="e56720", keywords="epilepsy", keywords="patient education", keywords="informatics", keywords="social media", keywords="biomedical research", keywords="social determinants of health", keywords="accessibility", keywords="engagement", keywords="comparative analysis", keywords="clinical videos", keywords="English", keywords="Spanish", keywords="neurological disorder", keywords="YouTube", keywords="bilingual", keywords="audience engagement", keywords="clinical knowledge", abstract="Background: Effectively managing epilepsy in children necessitates the active engagement of parents, a factor that is reliant on their understanding of this neurological disorder. Widely available, high-quality, patient-focused, bilingual videos describing topics important for managing epilepsy are limited. YouTube Analytics is a helpful resource for gaining insights into how users of differing backgrounds consume video content. Objective: This study analyzes traffic to paired educational videos of English and Spanish versions of the same content. By examining the use patterns and preferences of individuals seeking information in different languages, we gained valuable insights into how language influences the use of clinical content. Methods: Physician experts created epilepsy management videos for the REACT (Reaching Out for Epilepsy in Adolescents and Children Through Telemedicine) YouTube channel about 17 subjects, with an English and Spanish version of each. The Children's Mercy Kansas City neurology clinic incorporated these into the department's educational process. YouTube Analytics enabled analysis of traffic patterns and video characteristics between September 2, 2021, and August 31, 2023. Results: The Spanish group had higher engagement and click-through rates. The English versions of all videos had 141,605 total impressions, while impressions for the Spanish versions totaled 156,027. The Spanish videos had 11,339 total views, while the English videos had 3366. The views per month were higher for the Spanish videos (mean 472, SD 292) compared to the English set (mean 140, SD 91; P<.001). The two groups also differed in search behavior and external traffic sources, with WhatsApp driving more traffic to the Spanish videos than the English versions (94 views compared to 1). The frequency of search terms used varied by language. For example, ``tonic clonic'' was the most frequent term (n=372) resulting in views for English videos, while ``tipos de convulsiones'' (types of convulsions) was the most common expression (n=798) resulting in views for Spanish videos. We noted increased monthly views for all videos after adding tags on YouTube. Before tagging, the mean number of views per month for the English-language group was 61 (SD 28), which increased to 220 (SD 53) post tagging. A similar trend can be observed in the Spanish-language group as well. Before tagging, the mean number of monthly views was 201 (SD 71), which increased to 743 (SD 144) after tagging. Conclusions: This study showed high traffic for Spanish video content related to epilepsy in a set of paired English/Spanish videos. This highlights the importance of bilingual health content and optimizing video content based on viewer preferences and search behavior. Understanding audience engagement patterns through YouTube Analytics can further enhance the dissemination of clinical video content to users seeking content in their primary language, and tagging videos can have a substantial impact on views. ", doi="10.2196/56720", url="https://formative.jmir.org/2025/1/e56720" } @Article{info:doi/10.2196/65685, author="Shi, Xiaoyu and Wang, Yijun and Wang, Yuhong and Wang, Jun and Peng, Chen and Cheng, Siyi and Song, Lingpeng and Li, Rui and Guo, Fuding and Li, Zeyan and Duan, Shoupeng and Yang, Xiaomeng and Zhou, Liping and Jiang, Hong and Yu, Lilei", title="The Effectiveness of Digital Animation--Based Multistage Education for Patients With Atrial Fibrillation Catheter Ablation: Randomized Clinical Trial", journal="J Med Internet Res", year="2025", month="Mar", day="11", volume="27", pages="e65685", keywords="animation education", keywords="digital health care", keywords="atrial fibrillation", keywords="catheter ablation", keywords="video", keywords="mHealth", keywords="digital care", keywords="digital health", keywords="digital animation", keywords="randomized clinical trial", keywords="RCT", keywords="digital education", keywords="outpatient", keywords="AFCA", keywords="atrial fibrillation catheter ablation", keywords="therapeutic", keywords="cardiac arrhythmia", keywords="Asian", keywords="animations", keywords="comics", abstract="Background: Digital education for outpatient patients with atrial fibrillation (AF) has gradually increased. However, research on digital education for patients undergoing atrial fibrillation catheter ablation (AFCA) is limited. Objective: This study aimed to develop a novel digital animation-based multistage education system and evaluate its quality-of-life benefits for patients with AFCA. Methods: This randomized controlled clinical trial included 208 patients with AF who underwent catheter ablation in the Department of Cardiology at Renmin Hospital of Wuhan University between January 2022 and August 2023. The patients were randomly assigned to the digital animation intervention (n=104) and standard treatment (n=104) groups. The primary outcome was the difference in the quality of life of patients with atrial fibrillation (AF-QoL-18) scores at 3 months. Secondary outcomes included differences in scores on the 5-item Medication Adherence Report Scale (MARS-5), Self-rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) at 3 months. Results: In the digital animation intervention group, the AF-QoL-18 score increased from 38.02 (SD 6.52) to 47.77 (SD 5.74), the MARS-5 score increased from 17.04 (SD 3.03) to 20.13 (SD 2.12), the SAS score decreased from 52.82 (SD 8.08) to 45.39 (SD 6.13), and the SDS score decreased from 54.12 (SD 6.13) to 45.47 (SD 5.94), 3 months post discharge from the hospital. In the conventional treatment group, the AF-QoL-18 score increased from 36.97 (SD 7.00) to 45.31 (SD 5.71), the MARS-5 score increased from 17.14 (SD 3.01) to 18.47 (SD 2.79), the SAS score decreased from 51.83 (SD 7.74) to 47.31 (SD 5.87), and the SDS score decreased from 52.78 (SD 5.21) to 45.37 (SD 6.18). The mean difference in AF-QoL-18 score change between the 2 groups was 1.41 (95\% CI 2.42-0.40, P=.006) at 3 months. The mean difference in MARS-5 score change was 1.76 (95\% CI 2.42-1.10, P<.001). The mean difference in SAS score was --2.91 (95\% CI --3.88 to --1.95, P<.001). Additionally, the mean difference in SDS score was --1.23 (95\% CI --0.02 to --2.44, P=.047). Conclusions: Our study introduces a novel digital animation educational approach that provides multidimensional, easily understandable, and multistage education for patients with AF undergoing catheter ablation. This educational model effectively improves postoperative anxiety, depression, medication adherence, and quality of life in patients at 3 months post discharge. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400081673; https://www.chictr.org.cn/showproj.html?proj=201059 ", doi="10.2196/65685", url="https://www.jmir.org/2025/1/e65685" } @Article{info:doi/10.2196/66634, author="Haughey, Marketa and Neyens, M. David and Hopkins, S. Casey and Gonzaga, Christofer and Harman, Melinda", title="Identifying Strategies for Home Management of Ostomy Care: Content Analysis of YouTube", journal="JMIR Hum Factors", year="2025", month="Mar", day="6", volume="12", pages="e66634", keywords="medical device usability", keywords="digital health", keywords="online support groups", keywords="living with chronic medical conditions", keywords="ostomy self-care", keywords="YouTube", keywords="patient education", keywords="user needs assessment", keywords="users experience", keywords="social media", keywords="ostomates", keywords="colostomy", keywords="ileostomy", keywords="usability", keywords="usefulness", keywords="utility", keywords="wearable device", keywords="medical device", keywords="support group", keywords="socials", keywords="social network", keywords="ostomy", keywords="digital", keywords="digital technology", keywords="digital intervention", abstract="Background: The social media platform YouTube is a recognized educational resource for health information, but few studies have explored its value for conveying the lived experience of individuals managing chronic health conditions and end users' interactions with medical device technology. Our study explores self-care strategies and end user needs of people living with a stoma because patient education and engagement in ostomy self-care are essential for avoiding ostomy-related complications. Ostomy surgery creates a stoma (an opening) in the abdomen to alter the route of excreta from digestive and urinary organs into a detachable external pouching system. After hospital discharge, people who have undergone ostomies perform critical self-care tasks including frequent ostomy appliance changes and stomal and peristomal skin maintenance. Objective: The purpose of this study was to systematically assess YouTube videos narrated by people who have undergone ostomies about their ostomy self-care in home (nonhospital) settings with a focus on identifying end user needs and different strategies used by people who have undergone ostomies during critical self-care tasks. Methods: Using predefined search terms and clear inclusion and exclusion criteria, we identified YouTube videos depicting narrators who have undergone ostomies and their ostomy self-care in home settings. Using a consensus coding approach among 3 independent reviewers, all videos were analyzed to collect metadata, data of narrators who have undergone ostomies, and specific content data. Results: There were 65 user-generated YouTube videos that met the inclusion and exclusion criteria. These videos were posted by 28 unique content creators representing a broad range of ages who used a variety of supplies. The common challenges discussed were peristomal skin complications, inadequate appliance adhesion and subsequent leakage, and supplies-related challenges. Narrators who have undergone ostomies discussed various expert tricks and tips to successfully combat these challenges. Conclusions: This study used a novel approach to gain insights about end user interactions with medical devices while performing ostomy self-care, which are difficult to gain using traditional behavioral techniques. The analysis revealed that people who have undergone ostomies are willing to share their personal experience with ostomy self-care on the web and that these videos are viewed by the public. User-generated videos demonstrated a variety of supplies used, end user needs, and different strategies for performing ostomy self-care. Future research should examine how these findings connect to YouTube ostomy self-care content generated by health care professionals and organizations and to guidelines for ostomy self-care. ", doi="10.2196/66634", url="https://humanfactors.jmir.org/2025/1/e66634", url="http://www.ncbi.nlm.nih.gov/pubmed/40053741" } @Article{info:doi/10.2196/63058, author="Choo, Seungheon and Yoo, Suyoung and Endo, Kumiko and Truong, Bao and Son, Hi Meong", title="Advancing Clinical Chatbot Validation Using AI-Powered Evaluation With a New 3-Bot Evaluation System: Instrument Validation Study", journal="JMIR Nursing", year="2025", month="Feb", day="27", volume="8", pages="e63058", keywords="artificial intelligence", keywords="patient education", keywords="therapy", keywords="computer-assisted", keywords="computer", keywords="understandable", keywords="accurate", keywords="understandability", keywords="automation", keywords="chatbots", keywords="bots", keywords="conversational agents", keywords="emotions", keywords="emotional", keywords="depression", keywords="depressive", keywords="anxiety", keywords="anxious", keywords="nervous", keywords="nervousness", keywords="empathy", keywords="empathetic", keywords="communication", keywords="interactions", keywords="frustrated", keywords="frustration", keywords="relationships", abstract="Background: The health care sector faces a projected shortfall of 10 million workers by 2030. Artificial intelligence (AI) automation in areas such as patient education and initial therapy screening presents a strategic response to mitigate this shortage and reallocate medical staff to higher-priority tasks. However, current methods of evaluating early-stage health care AI chatbots are highly limited due to safety concerns and the amount of time and effort that goes into evaluating them. Objective: This study introduces a novel 3-bot method for efficiently testing and validating early-stage AI health care provider chatbots. To extensively test AI provider chatbots without involving real patients or researchers, various AI patient bots and an evaluator bot were developed. Methods: Provider bots interacted with AI patient bots embodying frustrated, anxious, or depressed personas. An evaluator bot reviewed interaction transcripts based on specific criteria. Human experts then reviewed each interaction transcript, and the evaluator bot's results were compared to human evaluation results to ensure accuracy. Results: The patient-education bot's evaluations by the AI evaluator and the human evaluator were nearly identical, with minimal variance, limiting the opportunity for further analysis. The screening bot's evaluations also yielded similar results between the AI evaluator and human evaluator. Statistical analysis confirmed the reliability and accuracy of the AI evaluations. Conclusions: The innovative evaluation method ensures a safe, adaptable, and effective means to test and refine early versions of health care provider chatbots without risking patient safety or investing excessive researcher time and effort. Our patient-education evaluator bots could have benefitted from larger evaluation criteria, as we had extremely similar results from the AI and human evaluators, which could have arisen because of the small number of evaluation criteria. We were limited in the amount of prompting we could input into each bot due to the practical consideration that response time increases with larger and larger prompts. In the future, using techniques such as retrieval augmented generation will allow the system to receive more information and become more specific and accurate in evaluating the chatbots. This evaluation method will allow for rapid testing and validation of health care chatbots to automate basic medical tasks, freeing providers to address more complex tasks. ", doi="10.2196/63058", url="https://nursing.jmir.org/2025/1/e63058" } @Article{info:doi/10.2196/53087, author="Krewulak, Karla and Strayer, Kathryn and Jaworska, Natalia and Spence, Krista and Foster, Nadine and Kupsch, Scotty and Sauro, Khara and Fiest, M. Kirsten", title="Evaluation of the Quality of Delirium Website Content for Patient and Family Education: Cross-Sectional Study", journal="J Med Internet Res", year="2025", month="Feb", day="20", volume="27", pages="e53087", keywords="education", keywords="health information", keywords="internet", keywords="delirium", keywords="patient", keywords="caregiver", keywords="brain lesions", keywords="confusion", keywords="inattentiveness", keywords="disorientation", keywords="family education", keywords="information seeking", keywords="readability", keywords="high-quality websites", keywords="accessibility", abstract="Background: Patients and families who have experienced delirium may seek information about delirium online, but the quality and reliability of online delirium-related websites are unknown. Objective: This study aimed to identify and evaluate online delirium-related websites that could be used for patient and family education. Methods: We searched Microsoft Bing, Google, and Yahoo using the keywords ``delirium'' and the misspelled ``delerium'' to identify delirium-related websites created to inform patients, families, and members of the public about delirium. The quality of identified delirium-related website content was evaluated by 2 authors using the validated DISCERN tool and the JAMA (Journal of the American Medical Association) benchmark criteria. Readability was assessed with the Simple Measure of Gobbledygook, the Flesch Reading Ease score, and the Flesch Kincaid grade level. Each piece of website content was assessed for its delirium-related information using a checklist of items co-designed by a working group, which included patients, families, researchers, and clinicians. Results: We identified 106 websites targeted toward patients and families, with most hospital-affiliated (21/106, 20\%) from commercial websites (20/106, 19\%), government-affiliated organizations (19/106, 18\%), or from a foundation or advocacy group (16/106, 15\%). The median time since the last content update was 3 (IQR 2-5) years. Most websites' content (101/106, 95\%) was written at a reading level higher than the recommended grade 6 level. The median DISCERN total score was 42 (IQR 33-50), with scores ranging from 20 (very poor quality) to 78 (excellent quality). The median delirium-related content score was 8 (IQR 6-9), with scores ranging from 1 to 12. Many websites lacked information on the short- and long-term outcomes of delirium as well as how common it is. The median JAMA benchmark score was 1 (IQR 1-3), indicating the quality of the websites' content had poor transparency. Conclusions: We identified high-quality websites that could be used to educate patients, families, or the public about delirium. While most delirium-related website content generally meets quality standards based on DISCERN and JAMA benchmark criteria, high scores do not always ensure patient and family-friendliness. Many of the top-rated delirium content were text-heavy and complex in layout, which could be overwhelming for users seeking clear, concise information. Future efforts should prioritize the development of websites with patients and families, considering usability, accessibility, and cultural relevance to ensure they are truly effective for delirium education. ", doi="10.2196/53087", url="https://www.jmir.org/2025/1/e53087", url="http://www.ncbi.nlm.nih.gov/pubmed/39977019" } @Article{info:doi/10.2196/64259, author="Dinesen, Birthe and Albertsen, Eie Andi and Joensen, Ragnvaldsd{\'o}ttir Elisabet Dortea and Spindler, Helle and Jensen, M{\o}ller Katja and Kidholm, Kristian and Frost, Lars and Dittman, Lars and Gunasegaram, Mathushan and Johnsen, Paaske S{\o}ren and Jochumsen, Rovsing Mads and Svenstrup, Dorthe", title="Future Patient---Telerehabilitation of Patients With Atrial Fibrillation: Protocol for a Multicenter, Mixed Methods, Randomized Controlled Trial", journal="JMIR Res Protoc", year="2025", month="Feb", day="18", volume="14", pages="e64259", keywords="atrial fibrillation", keywords="telerehabilitation", keywords="quality of life", keywords="research design", keywords="patient education", keywords="co-creation", keywords="randomized controlled trial", keywords="chronic", keywords="cardiovascular disease", keywords="adult", keywords="aging", keywords="prevalence", keywords="comorbidity", keywords="Future Patient", keywords="patient engagement", keywords="primary outcome", keywords="cost-effectiveness", keywords="monitoring", keywords="health care professional", keywords="digital health", keywords="remote therapy", keywords="telehealth", abstract="Background: Atrial fibrillation (AF) is a chronic cardiovascular condition with a lifetime risk of 1 in 3 and a prevalence of 3\% among adults. AF's prevalence is predicted to more than double during the next 20 years due to better detection, increasing comorbidities, and an aging population. Due to increased AF prevalence, telerehabilitation has been developed to enhance patient engagement, health care accessibility, and compliance through digital technologies. A telerehabilitation program called ``Future Patient---telerehabilitation of patients with AF (FP-AF)'' has been developed to enhance rehabilitation for AF. The FP-AF program comprises two modules: (1) an education and monitoring module using telerehabilitation technologies (4 months) and (2) a follow-up module, where patients can measure steps and access a data and knowledge-sharing portal, HeartPortal, using their digital devices. Those patients in the FP-AF program measure their heart rhythm, pulse, blood pressure, weight, steps, and sleep. Patients also complete web-based questionnaires regarding their well-being and coping with AF. All recorded data are transmitted to the HeartPortal, accessible to patients, relatives, and health care professionals. Objective: This paper aims to describe the research design, outcome measures, and data collection techniques in a clinical trial of the FP-AF program for patients with AF. Methods: This is a multicenter, mixed methods, randomized controlled trial. Patients are recruited from AF clinics serving the North Jutland region of Denmark. The telerehabilitation group will participate in the FP-AF program, while the control group will follow the conventional care regime based on physical visits to the AF clinic. The primary outcome measure is AF-specific health-related quality of life, to be assessed using the Atrial Fibrillation Effect on Quality-of-Life Questionnaire. Secondary outcomes are knowledge of AF; measurement of vital parameters; level of anxiety and depression; degree of motivation; burden of AF; use of the HeartPortal; qualitative exploration of patients', relatives', and health care professionals' experiences of participating in the FP-AF program; cost-effectiveness evaluation of the program; and analysis of multiparametric monitoring data. Outcomes are assessed through data from digital technologies, interviews, and questionnaires. Results: Patient enrollment began in January 2023 and will be completed by December 2024, with a total of 208 patients enrolled. Qualitative interviews conducted in spring 2024 will be analyzed and published in peer-reviewed journals in 2025. Data from questionnaires and digital technologies will be analyzed upon study completion and presented at international conferences and published in peer-reviewed journals by the fall of 2025. Conclusions: Results from the FP-AF study will determine whether the FP-AF program can increase quality of life for patients with AF and increase their knowledge of symptoms and living with AF in everyday life compared to conventional AF care. The cost-effectiveness evaluation will determine whether telerehabilitation can be a viable alternative for rehabilitation of patients with AF. Trial Registration: ClinicalTrials.gov NCT06101485; https://clinicaltrials.gov/study/NCT06101485 International Registered Report Identifier (IRRID): DERR1-10.2196/64259 ", doi="10.2196/64259", url="https://www.researchprotocols.org/2025/1/e64259" } @Article{info:doi/10.2196/64817, author="Dunleavy, Kim and Radunovich, Liss Heidi and Beneciuk, M. Jason and Hu, Boyi and Yang, Yang and Blythe, McCormick Janeen and Gurka, K. Kelly", title="Self-Management Strategies for Low Back Pain Among Horticulture Workers: Protocol for a Type II Hybrid Effectiveness-Implementation Study", journal="JMIR Res Protoc", year="2025", month="Jan", day="28", volume="14", pages="e64817", keywords="low back pain", keywords="self-management", keywords="implementation", keywords="horticulture workers", keywords="video training", keywords="video feedback", keywords="text message reminders", keywords="agriculture", keywords="ergonomic", keywords="nonpharmacological", abstract="Background: Low back pain (LBP) is highly prevalent and disabling, especially in agriculture sectors. However, there is a gap in LBP prevention and intervention studies in these physically demanding occupations, and to date, no studies have focused on horticulture workers. Given the challenges of implementing interventions for those working in small businesses, self-management offers an attractive and feasible option to address work-related risk factors and manage LBP. Objective: This study will (1) investigate the effectiveness of self-management strategies for nursery and landscape workers by comparing within-subject control and intervention periods and (2) determine if adoption and effectiveness differs between participants randomly assigned to review self-management videos only and those who also receive multimodal implementation support. We will also identify contextual factors impacting effectiveness and implementation. Methods: A pragmatic, mixed methods, hybrid effectiveness and implementation design will be used to compare back pain with work tasks, disability, medication and substance use, and psychological factors between a baseline control and intervention periods. We aim to recruit 122 English- and Spanish-speaking horticulture workers with back pain, 30 supervisors, and 12 focus group participants. Participants will review short video modules designed to increase awareness of opioid risk and introduce self-management and ergonomic choices and use 1 self-management and 1 ergonomic strategy for 10 weeks. They will be randomly assigned to 2 implementation groups: video modules only or video + multimodal personalized support (checklist guidance, review of video feedback for ergonomic problem-solving, and text message reminders). Questionnaires will be administered at 3-month time points: baseline, pre- and postintervention, and at 3 and 6 months. Qualitative analysis of field notes, open-ended comments, and focus groups will expand understanding of results with comprehensive documentation of the context, barriers and facilitators, and reasons for adoption. Results: The project was funded on September 29, 2023 (Centers for Disease Control and Prevention National Institute of Occupational Health and Safety, CDC NIOSH; U54OH011230-07S1), as a core research grant for the Southeast Coastal Center for Agricultural Health and Safety. The design, creation, and editing of English and Spanish videos was completed in June 2024 after comprehensive formative evaluation. Enrollment began in June 2024 with anticipated completion in 2027. Conclusions: We hypothesize that both self-management interventions will result in reductions in work task pain and disability and that the video enhanced with multimodal personalized support will result in greater reductions than the video alone. If self-management is effective, mitigating pain positively impacts quality of life, productivity, and retention, while increasing the use of nonpharmacological alternatives to opioids addresses an important public health issue. Implementation aims will help inform reasons for results, barriers and facilitators, and potential for similar interventions in these and similar industries with physically challenging outdoor work. Trial Registration: ClinicalTrials.gov NCT06153199; http://clinicaltrials.gov/study/NCT06153199 International Registered Report Identifier (IRRID): DERR1-10.2196/64817 ", doi="10.2196/64817", url="https://www.researchprotocols.org/2025/1/e64817" } @Article{info:doi/10.2196/63818, author="Barbazi, Neda and Shin, Youn Ji and Hiremath, Gurumurthy and Lauff, Anne Carlye", title="Developing Assessments for Key Stakeholders in Pediatric Congenital Heart Disease: Qualitative Pilot Study to Inform Designing of a Medical Education Toy", journal="JMIR Form Res", year="2025", month="Jan", day="27", volume="9", pages="e63818", keywords="assessment", keywords="congenital heart disease", keywords="children health literacy", keywords="health education", keywords="caregiving", keywords="patient-centered care", keywords="design", keywords="qualitative pilot", keywords="children health", keywords="educational interventions", abstract="Background: Congenital heart disease (CHD) is a birth defect of the heart that requires long-term care and often leads to additional health complications. Effective educational strategies are essential for improving health literacy and care outcomes. Despite affecting around 40,000 children annually in the United States, there is a gap in understanding children's health literacy, parental educational burdens, and the efficiency of health care providers in delivering education. Objective: This qualitative pilot study aims to develop tailored assessment tools to evaluate educational needs and burdens among children with CHD, their parents, and health care providers. These assessments will inform the design of medical education toys to enhance health management and outcomes for pediatric patients with CHD and key stakeholders. Methods: Through stakeholder feedback from pediatric patients with CHD, parents, and health care providers, we developed three tailored assessments in two phases: (1) iterative development of the assessment tools and (2) pilot testing. In the first phase, we defined key concepts, conducted a literature review, and created initial drafts of the assessments. During the pilot-testing phase, 12 participants were recruited at the M Health Fairview Pediatric Specialty Clinic for Cardiology---Explorer in Minneapolis, Minnesota, United States. We gathered feedback using qualitative methods, including cognitive interviews such as think-aloud techniques, verbal probing, and observations of nonverbal cues. The data were analyzed to identify the strengths and weaknesses of each assessment item and areas for improvement. Results: The 12 participants included children with CHD (n=5), parents (n=4), and health care providers (n=3). The results showed the feasibility and effectiveness of the tailored assessments. Participants showed high levels of engagement and found the assessment items relevant to their education needs. Iterative revisions based on participant feedback improved the assessments' clarity, relevance, and engagement for all stakeholders, including children with CHD. Conclusions: This pilot study emphasizes the importance of iterative assessment development, focusing on multistakeholder engagement. The insights gained from the development process will guide the creation of tailored assessments and inform the development of child-led educational interventions for pediatric populations with CHD. ", doi="10.2196/63818", url="https://formative.jmir.org/2025/1/e63818" } @Article{info:doi/10.2196/56941, author="Specht, Lisa and Scheible, Raphael and Boeker, Martin and Farin-Glattacker, Erik and Kampel, Nikolas and Schm{\"o}lz, Marina and Sch{\"o}pf-Lazzarino, Andrea and Schulz, Stefan and Schlett, Christian and Thomczyk, Fabian and Voigt-Radloff, Sebastian and Wegner, Constanze and Wollmann, Katharina and Maun, Andy", title="Evaluating the Acceptance and Usability of an Independent, Noncommercial Search Engine for Medical Information: Cross-Sectional Questionnaire Study and User Behavior Tracking Analysis", journal="JMIR Hum Factors", year="2025", month="Jan", day="23", volume="12", pages="e56941", keywords="medical information", keywords="health information", keywords="search engine", keywords="user behavior", keywords="health literacy", keywords="digital health literacy", keywords="navigational needs", keywords="information-seeking behavior", keywords="evidence-based content", keywords="Germany", abstract="Background: The internet is a key source of health information, but the quality of content from popular search engines varies, posing challenges for users---especially those with low health or digital health literacy. To address this, the ``tala-med'' search engine was developed in 2020 to provide access to high-quality, evidence-based content. It prioritizes German health websites based on trustworthiness, recency, user-friendliness, and comprehensibility, offering category-based filters while ensuring privacy by avoiding data collection and advertisements. Objective: This study aims to evaluate the acceptance and usability of this independent, noncommercial search engine from the users' perspectives and their actual use of the search engine. Methods: For the questionnaire study, a cross-sectional study design was used. In total, 802 participants were recruited through a web-based panel and were asked to interact with the new search engine before completing a web-based questionnaire. Descriptive statistics and multiple regression analyses were used to assess participants' acceptance and usability ratings, as well as predictors of acceptance. Furthermore, from October 2020 to June 2021, we used the open-source web analytics platform Matomo to collect behavior-tracking data from consenting users of the search engine. Results: The study indicated positive findings on the acceptance and usability of the search engine, with more than half of the participants willing to reuse (465/802, 58\%) and recommend it (507/802, 63.2\%). Of the 802 users, 747 (93.1\%) valued the absence of advertising. Furthermore, 92.3\% (518/561), 93.9\% (553/589), 94.7\% (567/599), and 96.5\% (600/622) of those users who used the filters agreed at least partially that the filter functions were helpful in finding trustworthy, recent, user-friendly, or comprehensible results. Participants criticized some of the search results regarding the selection of domains and shared ideas for potential improvements (eg, for a clearer design). Regression analyses showed that the search engine was especially well accepted among older users, frequent internet users, and those with lower educational levels, indicating an effective targeting of segments of the population with lower health literacy and digital health literacy. Tracking data analysis revealed 1631 sessions, comprising 3090 searches across 1984 unique terms. Users performed 1.64 (SD 1.31) searches per visit on average. They prioritized the search terms ``corona,'' ``back pain,'' and ``cough.'' Filter changes were common, especially for recency and trustworthiness, reflecting the importance that users placed on these criteria. Conclusions: User questionnaires and behavior tracking showed the platform was well received, particularly by older and less educated users, especially for its advertisement-free design and filtering system. While feedback highlighted areas for improvement in design and filter functionality, the search engine's focus on transparency, evidence-based content, and user privacy shows promise in addressing health literacy and navigational needs. Future updates and research will further refine its effectiveness and impact on promoting access to quality health information. ", doi="10.2196/56941", url="https://humanfactors.jmir.org/2025/1/e56941" } @Article{info:doi/10.2196/67143, author="Eisinger, Felix and Holderried, Friederike and Mahling, Moritz and Stegemann--Philipps, Christian and Herrmann--Werner, Anne and Nazarenus, Eric and Sonanini, Alessandra and Guthoff, Martina and Eickhoff, Carsten and Holderried, Martin", title="What's Going On With Me and How Can I Better Manage My Health? The Potential of GPT-4 to Transform Discharge Letters Into Patient-Centered Letters to Enhance Patient Safety: Prospective, Exploratory Study", journal="J Med Internet Res", year="2025", month="Jan", day="21", volume="27", pages="e67143", keywords="GPT-4", keywords="patient letters", keywords="health care communication", keywords="artificial intelligence", keywords="patient safety", keywords="patient education", abstract="Background: For hospitalized patients, the discharge letter serves as a crucial source of medical information, outlining important discharge instructions and health management tasks. However, these letters are often written in professional jargon, making them difficult for patients with limited medical knowledge to understand. Large language models, such as GPT, have the potential to transform these discharge summaries into patient-friendly letters, improving accessibility and understanding. Objective: This study aims to use GPT-4 to convert discharge letters into more readable patient-centered letters. We evaluated how effectively and comprehensively GPT-4 identified and transferred patient safety--relevant information from the discharge letters to the transformed patient letters. Methods: Three discharge letters were created based on common medical conditions, containing 72 patient safety--relevant pieces of information, referred to as ``learning objectives.'' GPT-4 was prompted to transform these discharge letters into patient-centered letters. The resulting patient letters were analyzed for medical accuracy, patient centricity, and the ability to identify and translate the learning objectives. Bloom's taxonomy was applied to analyze and categorize the learning objectives. Results: GPT-4 addressed the majority (56/72, 78\%) of the learning objectives from the discharge letters. However, 11 of the 72 (15\%) learning objectives were not included in the majority of the patient-centered letters. A qualitative analysis based on Bloom's taxonomy revealed that learning objectives in the ``Understand'' category (9/11) were more frequently omitted than those in the ``Remember'' category (2/11). Most of the missing learning objectives were related to the content field of ``prevention of complications.'' By contrast, learning objectives regarding ``lifestyle'' and ``organizational'' aspects were addressed more frequently. Medical errors were found in a small proportion of sentences (31/787, 3.9\%). In terms of patient centricity, the patient-centered letters demonstrated better readability than the discharge letters. Compared with discharge letters, they included fewer medical terms (132/860, 15.3\%, vs 165/273, 60/4\%), fewer abbreviations (43/860, 5\%, vs 49/273, 17.9\%), and more explanations of medical terms (121/131, 92.4\%, vs 0/165, 0\%). Conclusions: Our study demonstrates that GPT-4 has the potential to transform discharge letters into more patient-centered communication. While the readability and patient centricity of the transformed letters are well-established, they do not fully address all patient safety--relevant information, resulting in the omission of key aspects. Further optimization of prompt engineering may help address this issue and improve the completeness of the transformation. ", doi="10.2196/67143", url="https://www.jmir.org/2025/1/e67143" } @Article{info:doi/10.2196/65372, author="Liao, Jiaman and Huang, Xueliang and Huang, Hao and Shen, Cuina and Li, Lixia and Li, Yushao and Zhan, Yiqiang", title="Analysis of ``Dr Ding Xiang'' on WeChat in China to Determine Factors Influencing Readership on Medical Social Media: Observational Study", journal="J Med Internet Res", year="2025", month="Jan", day="20", volume="27", pages="e65372", keywords="WeChat Official Accounts", keywords="Dr Ding Xiang", keywords="health communication", keywords="information dissemination", keywords="readership analysis", abstract="Background: With the rapid expansion of social media platforms, the demand for health information has increased substantially, leading to innovative approaches and new opportunities in health education. Objective: This study aims to analyze the characteristics of articles published on the ``Dr Ding Xiang'' WeChat official account (WOA), one of the most popular institutional accounts on the WeChat platform, to identify factors influencing readership engagement and to propose strategies for enhancing the effectiveness of health information dissemination. Methods: A total of 5286 articles published on the ``Dr Ding Xiang'' WOA from January 2021 to December 2021 were collected and analyzed. Additionally, a random sample of 324 articles was selected for detailed text analysis. Univariate analysis was conducted using the chi-square test, and multivariate analysis was performed using multivariable logistic regression. Results: In 2021, the total number of reads for ``Dr Ding Xiang'' articles reached 323,479,841, with an average of 61,196 reads per article. Articles exceeding 100,000 reads accounted for 33.90\% of the total. Most articles were published during the time slots of 8:00-10:00 AM, 11:30 AM to 1:30 PM, and 8:30-10:30 PM. Analysis indicated that the order of publication, style of the title sentence, number of likes, number of in-views, total likes on comments, and number of replies to comments were significantly associated with an article's number of reads. Text analysis further revealed that the article's reasoning approaches and concluding methods also had a significant impact on readership. Conclusions: To enhance readership and the effectiveness of health communication, health-focused WOAs should consider key factors such as optimal publication timing, engaging title design, and effective content structuring. Attention to these elements can improve user engagement and support the broader dissemination of health information. ", doi="10.2196/65372", url="https://www.jmir.org/2025/1/e65372" } @Article{info:doi/10.2196/59464, author="Rivera Rivera, N. Jessica and Snir, Moran and Simmons, Emilie and Schmidlen, Tara and Sholeh, Misha and Maconi, Leigh Melinda and Geiss, Carley and Fulton, Hayden and Barton, Laura and Gonzalez, D. Brian and Permuth, Jennifer and Vadaparampil, Susan", title="Developing and Assessing a Scalable Digital Health Tool for Pretest Genetic Education in Patients With Early-Onset Colorectal Cancer: Mixed Methods Design", journal="JMIR Cancer", year="2025", month="Jan", day="17", volume="11", pages="e59464", keywords="genetic education", keywords="genetic testing", keywords="genetic counseling", keywords="digital health", keywords="early-onset colorectal cancer", abstract="Background: National guidelines recommend germline genetic testing (GT) for all patients with early-onset colorectal cancer. With recent advances in targeted therapies and GT, these guidelines are expected to expand to include broader groups of patients with colorectal cancer. However, there is a shortage of genetic professionals to provide the necessary education and support for informed consent. As such, there is a pressing need to identify alternative approaches to facilitate and expedite access to GT. Objective: This study describes the development of a pretest education intervention, Nest-CRC, to facilitate the uptake of germline GT among patients with early-onset colorectal cancer. Patients with early-onset colorectal cancer and health care providers reviewed Nest-CRC, and their reactions and recommendations were captured using a nested mixed methods approach. Methods: Using the learner verification approach, we conducted 2 sequential phases of surveys and interviews with English- and Spanish-speaking patients with early-onset colorectal cancer and health care providers. The surveys assessed participants' experiences with genetic services and provided immediate feedback on the Nest-CRC genetic education modules. Semistructured interviews evaluated participants' perceptions of self-efficacy, attraction, comprehension, cultural acceptability, and usability of Nest-CRC. Survey data were analyzed using descriptive statistics (mean, median, and proportions), while interview data were analyzed through line-by-line coding of the transcribed interviews. After each phase, Nest-CRC was refined based on participants' recommendations. Results: A total of 52 participants, including 39 patients with early-onset colorectal cancer and 13 providers, participated in the study. Of these, 19 patients and 6 providers participated in phase 1 (N=25), and 20 patients and 7 providers participated in phase 2 (N=27). Most participants (phase 1: 23/25, 92\%, to 25/25, 100\%; phase 2: 24/27, 89\%, to 27/27, 100\%) agreed that each of the 5 education modules was easy to understand and helpful; 13 patients reported no history of GT, with 11 (85\%) expressing interest in GT and 2 (15\%) remaining unsure after completing Nest-CRC. Participants reported that Nest-CRC provided sufficient information to help them decide about GT. The tool was deemed acceptable by individuals from diverse backgrounds, and participants found it visually attractive, easy to comprehend, and user-friendly. Conclusions: The findings revealed that Nest-CRC is a promising strategy for facilitating pretest education and promoting GT. Nest-CRC has been refined based on participant recommendations and will be re-evaluated. ", doi="10.2196/59464", url="https://cancer.jmir.org/2025/1/e59464" } @Article{info:doi/10.2196/63489, author="Furukawa, Emi and Okuhara, Tsuyoshi and Liu, Mingxin and Okada, Hiroko and Kiuchi, Takahiro", title="Evaluating Online and Offline Health Information With the Patient Education Materials Assessment Tool: Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2025", month="Jan", day="15", volume="14", pages="e63489", keywords="patient education", keywords="health communication", keywords="health information", keywords="behavior change", keywords="understandability", keywords="actionability Patient Education Materials Assessment Tool", keywords="PEMAT", keywords="medical information", keywords="health literacy", keywords="patient education materials", abstract="Background: The Patient Education Materials Assessment Tool (PEMAT) is a reliable and validated instrument for assessing the understandability and actionability of patient education materials. It has been applied across diverse cultural and linguistic contexts, enabling cross-field and cross-national material quality comparisons. Accumulated evidence from studies using the PEMAT over the past decade underscores its potential impact on patient and public action. Objective: This systematic review aims to investigate how the quality of patient education materials has been assessed using the PEMAT. Methods: This review protocol follows PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycInfo, and Web of Science Core Collection will be searched systematically for articles published since September 2014. Two independent reviewers will conduct the search to yield a list of relevant studies based on the inclusion and exclusion criteria. Rayyan QCRI software will be used for screening and data extraction. Results: The results will be included in the full systematic review, which is expected to start in September 2024 and be completed to be submitted for publication by early 2025. Conclusions: The findings are expected to identify the quality of materials evaluated by the PEMAT and the areas under evaluation. This review can also highlight gaps that exist in research and practice for improving the understandability and actionability of the materials, offering deeper insights into how existing materials can facilitate patient and public action. International Registered Report Identifier (IRRID): PRR1-10.2196/63489 ", doi="10.2196/63489", url="https://www.researchprotocols.org/2025/1/e63489" } @Article{info:doi/10.2196/64191, author="Fan, Lok Heidi Sze and Leung, Yan Emily Tsz and Lau, Wing Ka and Wong, Ha Janet Yuen and Choi, Hang Edmond Pui and Lam, Christine and Tarrant, Marie and Ngan, Sheung Hextan Yuen and Ip, Patrick and Lin, Chin Chia and Lok, Wan Kris Yuet", title="A Mobile App for Promoting Breastfeeding-Friendly Communities in Hong Kong: Design and Development Study", journal="JMIR Form Res", year="2025", month="Jan", day="10", volume="9", pages="e64191", keywords="Baby-Friendly Community Initiative", keywords="Baby-Friendly Hospital Initiative", keywords="breastfeeding", keywords="community", keywords="stakeholders", keywords="mobile app", keywords="friendly communities", keywords="baby-friendly", keywords="well-being", keywords="mother", keywords="infant", keywords="application", keywords="mHealth", keywords="qualitative", keywords="user-friendly", keywords="self-management", abstract="Background: Breastfeeding is vital for the health and well-being of both mothers and infants, and it is crucial to create supportive environments that promote and maintain breastfeeding practices. Objective: The objective of this paper was to describe the development of a breastfeeding-friendly app called ``bfGPS'' (HKU TALIC), which provides comprehensive territory-wide information on breastfeeding facilities in Hong Kong, with the goal of fostering a breastfeeding-friendly community. Methods: The development of bfGPS can be categorized into three phases, which are (1) planning, prototype development, and preimplementation evaluation; (2) implementation and updates; and (3) usability evaluation. In phase 1, a meeting was held with experts, including maternal and child health researchers, app developers, breastfeeding individuals, and health professionals, to discuss the focus and functionality of the breastfeeding app. A prototype was developed, and breastfeeding facilities in various public venues in Hong Kong were assessed using a structured checklist. For the preimplementation evaluation, 10 focus groups and 19 one-on-one interviews were conducted between May 2019 and October 2020 with staff working in public premises (n=29) and breastfeeding individuals (n=29). For phase 2, bfGPS was published on iOS (Apple Inc) and Android (Google) platforms in September 2020. App updates were launched in September 2021 and May 2022 based on the suggestions provided by the participants in the preimplementation evaluation. For the usability evaluation, semistructured, in-depth, one-to-one interviews were conducted with breastfeeding individuals (n=30) to understand their experiences of using bfGPS. Content analysis was used to analyze the data. Results: bfGPS is a mobile app that was developed to assist breastfeeding individuals in locating breastfeeding facilities in public venues in Hong Kong. In the preimplementation evaluation, the participants gave comments on the layout and interface of bfGPS, and suggestions were given on incorporating new functions into the app. Based on the suggestions of the participants in the preimplementation evaluation, a few additional functions were added into bfGPS, including allowing the users to rate and upload recent information about breastfeeding facilities and an infant tracker function that encourages users to record infant development. In the usability evaluation, 3 main themes emerged---bfGPS improves the community experience for breastfeeding individuals, facilitates tracking the infant's growth, and provides suggestions for further development. Conclusions: The bfGPS app is the first user-friendly tool designed to assist users in locating breastfeeding facilities within the community. It stands as a guide for similar health care app developments, emphasizing the importance of accurate, current data to ensure user adoption and long-term use. The app's potential lies in the support and reinforcement of breastfeeding practices coupled with self-management strategies. ", doi="10.2196/64191", url="https://formative.jmir.org/2025/1/e64191" } @Article{info:doi/10.2196/60210, author="Varghese, Johny Kevin and Singh, Som and Kamali, Emily and Qureshi, Fahad and Jamal, Aleena and Qureshi, Fawad", title="Modern Digital Query Analytics of Patient Education Materials on Acanthosis Nigricans: Systematic Search and Content Analysis", journal="JMIR Dermatol", year="2025", month="Jan", day="6", volume="8", pages="e60210", keywords="acanthosis nigricans", keywords="dermatology", keywords="patient education", keywords="public health", keywords="skin", keywords="readability", keywords="information resource", keywords="DISCERN", keywords="general public", keywords="reading level", keywords="information seeking", keywords="information behavior", abstract="Background: Online digital materials are integral to patient education and health care outcomes in dermatology. Acanthosis nigricans (AN) is a common condition, often associated with underlying diseases such as insulin resistance. Patients frequently search the internet for information related to this cutaneous finding. To our knowledge, the quality of online educational materials for AN has not been systematically examined. Objective: The primary objective of this study was to profile the readability and quality of the content of publicly available digital educational materials on AN and identify questions frequently asked by patients. Methods: This study analyzed publicly available internet sources to identify the most frequent questions searched by patients regarding AN using the Google Rankbrain algorithm. Furthermore, available articles on AN were evaluated for quality and reading level using metrics such as the Brief DISCERN score, and readability was determined using three specific scales including the Flesch-Kincaid score, Gunning Fog index, and the Coleman-Liau index, based on literature. Results: Patients most frequently accessed facts on AN from government sources, which comprised 30\% (n=15) of the analyzed sources. The available articles did not meet quality standards and were at a reading level not appropriate for the general public. The majority of articles (n=29/50, 58\%) had substandard Brief DISCERN scores, failing to meet the criteria for good quality. Conclusions: Clinicians should be aware of the paucity of valuable online educational material on AN and educate their patients accordingly. ", doi="10.2196/60210", url="https://derma.jmir.org/2025/1/e60210" } @Article{info:doi/10.2196/53205, author="Zhang, Jinbao and Prunty, E. Jonathan and Charles, C. Alison and Forder, Julien", title="Association Between Digital Front Doors and Social Care Use for Community-Dwelling Adults in England: Cross-Sectional Study", journal="J Med Internet Res", year="2025", month="Jan", day="2", volume="27", pages="e53205", keywords="social care support", keywords="long term care", keywords="access", keywords="front door", keywords="easy-read", keywords="self-assessment", keywords="system navigation", keywords="digital system", keywords="digital technology", keywords="internet", abstract="Background: Requests for public social care support can be made through an online portal. These digital ``front doors'' can help people navigate complex social care systems and access services. These systems can be set up in different ways, but there is little evidence about the impact of alternative arrangements. Digital front-door systems should help people better access services, particularly low-intensity services (high-intensity care is likely to require a full in-person assessment). Objective: This study aimed to investigate the association between 2 primary digital front door arrangements, easy-read information, and self-assessment tools provided on official websites, and the type of social care support that is offered: ongoing low-level support (OLLS), short-term care (STC) and long-term care (LTC). Methods: Information on front door arrangements was collected from the official websites of 152 English local authorities in 2021. We conducted a cross-sectional analysis using aggregated service use data from official government returns at the local authority level. The independent variables were derived from the policy information collected, specifically focusing on the availability of online digital easy-read information and self-assessment tools for adults and caregivers through official websites. The dependent variables were the rates of using social care support, including OLLS, STC, and LTC, across different age groups: the adult population (aged 18 and older), younger population (aged between 18 and 64 years), and older population (aged 65 and older). Multivariate regression analysis was used to examine the association between digital front door arrangements and access to social care support, controlling for population size, dependency level, and financial need factors. Results: Less than 20\% (27/147) of local authorities provided an integrated digital easy-read format as part of their digital front door system with about 25\% (37/147) adopting digital self-assessment within their system. We found that local authorities that offered an integrated digital easy-read information format showed higher rates of using OLLS ($\beta$ coefficient=0.54; P=.03; but no statistically significant association with LTC and STC). The provision of an online self-assessment system was not associated with service use in the 1-year (2021) cross-sectional estimate, but when 2 years (2020 and 2021) of service-use data were analyzed, a significant positive association was found on OLLS rates ($\beta$ coefficient=0.41; P=.21). Notably, these findings were consistent across different age groups. Conclusions: These findings are consistent with our hypothesis that digital systems with built-in easy-read and self-assessment may make access to (low-intensity) services easier for people. Adoption of these arrangements could potentially help increase the uptake of support among those who are eligible, with expected benefits for their care-related well-being. Given the limited adoption of the digital front door by local authorities in England, expanding their use could improve care-related outcomes and save social care costs. ", doi="10.2196/53205", url="https://www.jmir.org/2025/1/e53205" } @Article{info:doi/10.2196/58306, author="Hansen, Steffen and Jensen, Secher Tue and Schmidt, Mette Anne and Str{\o}m, Janni and Vistisen, Peter and H{\o}ybye, Terp Mette", title="The Effectiveness of Video Animations as a Tool to Improve Health Information Recall for Patients: Systematic Review", journal="J Med Internet Res", year="2024", month="Dec", day="30", volume="26", pages="e58306", keywords="public health", keywords="health information", keywords="patient information", keywords="animation video", keywords="digital health", keywords="visualization", keywords="memory", keywords="recall", keywords="education", keywords="synthesis", keywords="review methods", keywords="review methodology", keywords="systematic", keywords="PRISMA", abstract="Background: Access to clear and comprehensible health information is crucial for patient empowerment, leading to improved self-care, adherence to treatment plans, and overall health outcomes. Traditional methods of information delivery, such as written documents and oral communication, often result in poor memorization and comprehension. Recent innovations, such as animation videos, have shown promise in enhancing patient understanding, but comprehensive investigations into their effectiveness across various health care settings are lacking. Objective: This systematic review aims to investigate the effectiveness of animation videos on health information recall in adult patients across diverse health care sectors, comparing their impact to usual information delivery methods on short-term and long-term recall of health information. Methods: We conducted systematic searches in PubMed, CINAHL, and Embase databases, supplemented by manual searches of reference lists. Included studies were randomized controlled trials involving adult participants (?18 years) that focused on the use of animation videos to provide health information measured against usual information delivery practice. There were no language restrictions. Out of 2 independent reviewers screened studies, extracted data, and assessed the risk of bias using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2), Covidence was used to handle screening and risk of bias process. A narrative synthesis approach was applied to present results. Results: A total of 15 randomized controlled trials---3 in the United States, 2 in France, 2 in Australia, 2 in Canada, and 1 in the United Kingdom, Japan, Singapore, Brazil, Austria, and T{\"u}rkiye, respectively---met the inclusion criteria, encompassing 2,454 patients across various health care settings. The majority of studies (11/15, 73\%) reported statistically significant improvements in health information recall when animation videos were used, compared with usual care. Animation videos ranged from 1 to 15 minutes in duration with the most common length ranging from 1 to 8 minutes (10/15) and used various styles including 2D cartoons, 3D computers, and whiteboard animations. Most studies (12/15) assessed information recall immediately after intervention, with only 3 studies including longer follow-up periods. Most studies exhibited some concerns related to the risk of bias, particularly in domains related to deviations from intended interventions and selection of reported results. Conclusions: Animation videos appear to significantly improve short-term recall of health information among adult patients across various health care settings compared with usual care. This suggests that animation videos could be a valuable tool for informing patients in different health care settings. However, further research is needed to explore the long-term efficacy of these interventions, their impact on diverse populations, and how different animation styles might affect information recall. Future studies should also address methodological limitations identified in current research, including the use of validated outcome measures and longer follow-up periods. Trial Registration: PROSPERO CRD42022380016; http://crd.york.ac.uk/prospero/display\_record.php?RecordID=380016 ", doi="10.2196/58306", url="https://www.jmir.org/2024/1/e58306" } @Article{info:doi/10.2196/55300, author="Peerawong, Thanarpan and Phenwan, Tharin and Makita, Meiko and Supanichwatana, Sojirat and Puttarak, Panupong and Siammai, Naowanit and Sunthorn, Prakaidao", title="Evaluating Online Cannabis Health Information for Thai Breast Cancer Survivors Using the Quality Evaluation Scoring Tool (QUEST): Mixed Method Study", journal="JMIR Cancer", year="2024", month="Dec", day="24", volume="10", pages="e55300", keywords="cannabis", keywords="medical cannabis", keywords="Thailand", keywords="critical discourse analysis", keywords="mixed method study", keywords="breast cancer", keywords="digital literacy", keywords="legislation", keywords="health literacy", abstract="Background: Following medical cannabis legalization in Thailand in 2019, more people are seeking medical cannabis--related information, including women living with breast cancer. The extent to which they access cannabis-related information from internet sources and social media platforms and the quality of such content are relatively unknown and need further evaluation. Objective: This study aims to analyze the factors determining cannabis-related content quality for breast cancer care from internet sources and on social media platforms and examine the characteristics of such content accessed and consumed by Thai breast cancer survivors. Methods: A mixed methods study was conducted between January 2021 and May 2022, involving a breast cancer survivor support group. The group identified medical cannabis--related content from frequently accessed internet sources and social media platforms. The contents were categorized based on content creators, platforms, content category, and upload dates. Four researchers used the Quality Evaluation Scoring Tool (QUEST) to assess content quality, with scores ranging from 0 to 28. Contents were expert-rated as either high or poor. The QUEST interobserver reliability was analyzed. Receiver-operating characteristic curve analysis with the Youden index was used to determine the QUEST score cut-off point. Statistical significance was set at P<.05. Fairclough Critical Discourse Analysis was undertaken to examine the underlying discourses around poor-quality content. Results: Sixty-two Thai-language cannabis-related items were evaluated. The content sources were categorized as follows: news channels (21/62, 34\%), government sources (16/62, 26\%), health care providers (12/62, 19\%), and alternative medicine providers (12/62, 19\%). Most of the contents (30/62, 48\%) were uploaded to YouTube, whereas 31\% (19/62) appeared on websites and Facebook. Forty of 62 content items (64\%) were news-related and generic cannabis advertisements while 8 of 62 (13\%) content items had no identifiable date. The interobserver QUEST score correlation was 0.86 (P<.001). The mean QUEST score was 12.1 (SD 7.6). Contents were considered ``high'' when the expert rating was >3. With a QUEST score of 15 as the threshold, the sensitivity and specificity for differentiating between high and poor content quality were 81\% and 98\%, respectively. Content creation was the only significant factor between high- and poor-quality content. Poor-quality contents were primarily created by alternative medicine providers and news channels. Two discourses were identified: advocacy for cannabis use normalization and cannabis romanticization as a panacea. These discourses overly normalize and romanticize the use of cannabis, focusing on indications and instructions for cannabis use, and medical cannabis promotion, while neglecting discussions on cannabis contraindications and potential side effects. Conclusions: The varying quality of medical cannabis--related information on internet sources and social media platforms accessed and shared by Thai breast cancer survivors is an issue of concern. Given that content creators are the sole predictive factors of high content quality, future studies should examine a wider range of cannabis-related sources accessible to both the public and patients to gain a more comprehensive understanding of the issue. ", doi="10.2196/55300", url="https://cancer.jmir.org/2024/1/e55300" } @Article{info:doi/10.2196/63334, author="Dorney, Edwina and Hammarberg, Karin and Rodgers, Raymond and Black, I. Kirsten", title="Optimization of a Web-Based Self-Assessment Tool for Preconception Health in People of Reproductive Age in Australia: User Feedback and User-Experience Testing Study", journal="JMIR Hum Factors", year="2024", month="Dec", day="24", volume="11", pages="e63334", keywords="technology", keywords="internet", keywords="eHealth", keywords="user experience", keywords="patient engagement", keywords="self-assessment tool", keywords="preconception", keywords="health communication", abstract="Background: Good preconception health reduces the incidence of preventable morbidity and mortality for women, their babies, and future generations. In Australia, there is a need to increase health literacy and awareness about the importance of good preconception health. Digital health tools are a possible enabler to increase this awareness at a population level. The Healthy Conception Tool (HCT) is an existing web-based, preconception health self-assessment tool, that has been developed by academics and clinicians. Objective: This study aims to optimize the HCT and to seek user feedback to increase the engagement and impact of the tool. Methods: In-depth interviews were held with women and men aged 18?41 years, who spoke and read English and were residing in Australia. Interview transcripts were analyzed, and findings were used to inform an enhanced HCT prototype. This prototype underwent user-experience testing and feedback from users to inform a final round of design changes to the tool. Results: A total of 20 women and 5 men were interviewed; all wanted a tool that was quick and easy to use with personalized results. Almost all participants were unfamiliar with the term ``preconception care'' and stated they would not have found this tool on the internet with its current title. User-experience testing with 6 women and 5 men identified 11 usability issues. These informed further changes to the tool's title, the information on how to use the tool, and the presentation of results. Conclusions: Web-based self-assessment tools need to be easy to find and should communicate health messages effectively. End users' feedback informed changes to improve the tool's acceptability, engagement, and impact. We expect that the revised tool will have greater reach and prompt more people to prepare well for pregnancy. ", doi="10.2196/63334", url="https://humanfactors.jmir.org/2024/1/e63334" } @Article{info:doi/10.2196/51701, author="Almenara, A. Carlos and Gulec, Hayriye", title="Uncovering the Top Nonadvertising Weight Loss Websites on Google: A Data-Mining Approach", journal="JMIR Infodemiology", year="2024", month="Dec", day="11", volume="4", pages="e51701", keywords="consumer health informatics", keywords="cyberattack risk", keywords="data mining", keywords="Google", keywords="information seeking", keywords="weight loss", keywords="online health information", keywords="website analysis", keywords="digital health", keywords="internet search", abstract="Background: Online weight loss information is commonly sought by internet users, and it may impact their health decisions and behaviors. Previous studies examined a limited number of Google search queries and relied on manual approaches to retrieve online weight loss websites. Objective: This study aimed to identify and describe the characteristics of the top weight loss websites on Google. Methods: This study gathered 432 Google search queries collected from Google autocomplete suggestions, ``People Also Ask'' featured questions, and Google Trends data. A data-mining software tool was developed to retrieve the search results automatically, setting English and the United States as the default criteria for language and location, respectively. Domain classification and evaluation technologies were used to categorize the websites according to their content and determine their risk of cyberattack. In addition, the top 5 most frequent websites in nonadvertising (ie, nonsponsored) search results were inspected for quality. Results: The results revealed that the top 5 nonadvertising websites were healthline.com, webmd.com, verywellfit.com, mayoclinic.org, and womenshealthmag.com. All provided accuracy statements and author credentials. The domain categorization taxonomy yielded a total of 101 unique categories. After grouping the websites that appeared less than 5 times, the most frequent categories involved ``Health'' (104/623, 16.69\%), ``Personal Pages and Blogs'' (91/623, 14.61\%), ``Nutrition and Diet'' (48/623, 7.7\%), and ``Exercise'' (34/623, 5.46\%). The risk of being a victim of a cyberattack was low. Conclusions: The findings suggested that while quality information is accessible, users may still encounter less reliable content among various online resources. Therefore, better tools and methods are needed to guide users toward trustworthy weight loss information. ", doi="10.2196/51701", url="https://infodemiology.jmir.org/2024/1/e51701" } @Article{info:doi/10.2196/55161, author="Wetzel, Anna-Jasmin and Preiser, Christine and M{\"u}ller, Regina and Joos, Stefanie and Koch, Roland and Henking, Tanja and Haumann, Hannah", title="Unveiling Usage Patterns and Explaining Usage of Symptom Checker Apps: Explorative Longitudinal Mixed Methods Study", journal="J Med Internet Res", year="2024", month="Dec", day="9", volume="26", pages="e55161", keywords="self-triage", keywords="eHealth", keywords="self-diagnosis", keywords="mHealth", keywords="mobile health", keywords="usage", keywords="patterns", keywords="predicts", keywords="prediction", keywords="symptoms checker", keywords="apps", keywords="applications", keywords="explorative longitudinal study", keywords="self care", keywords="self management", keywords="self-rated", keywords="mixed method", keywords="circumstances", keywords="General Linear Mixed Models", keywords="GLMM", keywords="qualitative data", keywords="content analysis", keywords="Kuckartz", keywords="survey", keywords="participants", keywords="users", abstract="Background: Symptom checker apps (SCA) aim to enable individuals without medical training to classify perceived symptoms and receive guidance on appropriate actions, such as self-care or seeking professional medical attention. However, there is a lack of detailed understanding regarding the contexts in which individuals use SCA and their opinions on these tools. Objective: This mixed methods study aims to explore the circumstances under which medical laypeople use SCA and to identify which aspects users find noteworthy after using SCA. Methods: A total of 48 SCA users documented their medical symptoms, provided open-ended responses, and recorded their SCA use along with other variables over 6 weeks in a longitudinal study. Generalized linear mixed models with and those without regularization were applied to consider the hierarchical structure of the data, and the models' outcomes were evaluated for comparison. Qualitative data were analyzed through Kuckartz qualitative content analysis. Results: Significant predictors of SCA use included the initial occurrence of symptoms, day of measurement (odds ratio [OR] 0.97), self-rated health (OR 0.80, P<.001), and the following International Classification in Primary Care-2--classified symptoms, that are general and unspecified (OR 3.33, P<.001), eye (OR 5.56, P=.001), cardiovascular (OR 8.33, P<.001), musculoskeletal (OR 5.26, P<.001), and skin (OR 4.76, P<.001). The day of measurement and self-rated health showed minor importance due to their small effect sizes. Qualitative analysis highlighted four main themes: (1) reasons for using SCA, (2) diverse affective responses, (3) a broad spectrum of behavioral reactions, and (4) unmet needs including a lack of personalization. Conclusions: The emergence of new and unfamiliar symptoms was a strong determinant for SCA use. Specific International Classification in Primary Care--rated symptom clusters, particularly those related to cardiovascular, eye, skin, general, and unspecified symptoms, were also highly predictive of SCA use. The varied applications of SCA fit into the concept of health literacy as bricolage, where SCA is leveraged as flexible tools by patients based on individual and situational requirements, functioning alongside other health care resources. ", doi="10.2196/55161", url="https://www.jmir.org/2024/1/e55161" } @Article{info:doi/10.2196/54919, author="Chang, Annie and Young, Jade and Para, Andrew and Lamb, Angela and Gulati, Nicholas", title="Efficacy of ChatGPT in Educating Patients and Clinicians About Skin Toxicities Associated With Cancer Treatment", journal="JMIR Dermatol", year="2024", month="Nov", day="20", volume="7", pages="e54919", keywords="artificial intelligence", keywords="ChatGPT", keywords="oncodermatology", keywords="cancer therapy", keywords="language learning model", doi="10.2196/54919", url="https://derma.jmir.org/2024/1/e54919" } @Article{info:doi/10.2196/60575, author="Cauley, Elaine Christy and Rubio, Atziri and Brindle, Mary and Cooper, Zara and Vranceanu, Ana-Maria and Ritchie, S. Christine", title="A Video-Based Communication Intervention for Fecal Ostomy Surgery (CI-oSurg): Protocol for Open Pilot Testing to Improve Intervention Acceptability and Feasibility", journal="JMIR Res Protoc", year="2024", month="Nov", day="15", volume="13", pages="e60575", keywords="fecal ostomy", keywords="distress", keywords="open pilot", keywords="fecal ostomy surgeryl CI-oSurg", keywords="intervention acceptability", keywords="biopsychosocial outcomes", keywords="psychosocial support", keywords="ostomy care", abstract="Background: Approximately 100,000 patients undergo fecal ostomy operations annually across the United States. This patient population experiences high surgical complication rates and poor biopsychosocial outcomes. Surgical teams are not trained to address the psychosocial needs that often arise during recovery after fecal ostomy surgery. Objective: This study aims to refine and establish the acceptability and usability of the Communication Intervention for fecal ostomy Surgery (CI-oSurg), a web-based communication intervention aimed at reducing distress among patients recovering from ostomy surgery. Methods: We describe the proposed study design, methodology, and training protocol. We will conduct an open pilot (n=24 patients and n=8 clinicians) of video-based training to first identify the level and types of distress patients are experiencing. Next, patients will view web videos that address frequent challenges faced by ostomy patients, considering practical management and emotional and adaptation concerns. Qualitative one-to-one semistructured interviews will be conducted with participants to explore the acceptability and feasibility of the program and refine the intervention and study procedures. Results: This study has been approved by the Mass General Brigham Institutional Review Board. Study funding has been obtained, and recruitment is planned for the fall of 2024. Conclusions: Through this study, we will refine CI-oSurg, a web-based communication intervention focused on reducing distress after ostomy surgery, to improve intervention acceptability and usability. These improvements will allow us to establish the usability and acceptability of the intervention before efficacy testing to determine the ability of this intervention to reduce distress after fecal ostomy surgery. Trial Registration: ClinicalTrials.gov NCT06320002; https://clinicaltrials.gov/study/NCT06320002 International Registered Report Identifier (IRRID): PRR1-10.2196/60575 ", doi="10.2196/60575", url="https://www.researchprotocols.org/2024/1/e60575" } @Article{info:doi/10.2196/57390, author="Shojaei, Fereshtehossadat and Shojaei, Fatemehalsadat and Desai, P. Archita and Long, Emily and Mehta, Jade and Fowler, R. Nicole and Holden, J. Richard and Orman, S. Eric and Boustani, Malaz", title="The Feasibility of AgileNudge+ Software to Facilitate Positive Behavioral Change: Mixed Methods Design", journal="JMIR Form Res", year="2024", month="Nov", day="13", volume="8", pages="e57390", keywords="AgileNudge+", keywords="agile", keywords="nudge strategy", keywords="nudging interventions", keywords="agile implementation", keywords="human behavior", keywords="software design", keywords="human-computer interaction", keywords="user experience design", keywords="usability testing", abstract="Background: In today's digital age, web-based apps have become integral to daily life, driving transformative shifts in human behavior. ``AgileNudge+'' (Indiana University Center for Health Innovation and Implementation Science) is a web-based solution to simplify the process of positive behavior change using nudging as an intervention. By integrating knowledge from behavioral economics with technology, AgileNudge+ organizes multiple steps, simplifies complex tasks, minimizes errors by enhancing user engagement, and provides resources for creating and testing nudge interventions. Objective: This paper aimed to outline the design process, methodologies, and usefulness of ``AgileNudge+'' for the development of evidence-based nudges. It used a mixed methods approach to evaluate the software's interface usability and usefulness for creating and testing nudge interventions. Methods: AgileNudge+ was developed through iterative processes integrating principles from behavioral economics and user-centered design. The content of AgileNudge+ operationalizes an Agile science--based process to efficiently design, embed, and disseminate evidence-based nudges that encourage positive behavior change without limiting choice. Using a mixed methods approach, we tested AgileNudge+ software's ability to organize and simplify the nudge intervention process, allowing a diverse range of scholars with limited knowledge of Agile science to use nudges. Usability testing assessed the tool's usefulness and interface with a sample of 18 health care professionals, each asked to interact with the software and create a nudge intervention to solve a problem within their professional project's sphere. Results: The study was funded in August 2022, with data collection occurring from June 2023 to July 2024. As of July 2024, we have enrolled 18 participants. Quantitative results found a mean usefulness rating of AgileNudge+ of 3.83 (95\% CI 3.00-4.66). Qualitative results highlighted ways to modify the language used in AgileNudge+ to be more comprehensible to a diverse user base and promoted modifications to the software that facilitate real-time assistance and prioritize time efficiency in user interactions. Feedback further supported the positive impact of gamification on participant motivation when using the software. Conclusions: AgileNudge+ is an effective assistive tool for simplifying the positive behavior change process using nudge interventions, with tailored content and interactions to meet users' needs and demands. Building onto the current design, future iterations of AgileNudge+ will use artificial intelligence to process large volumes of data while reducing the time and mental energy required to scan for existing cognitive biases and nudge prototypes. The software is also being upgraded to build on current gamification efforts, encouraging more sustained motivation by increasing the temporal resolution of the digital interface. These modifications stay true to the agility and user-centered aspects of AgileNudge+, emphasizing the novelty of the constantly evolving software design process. ", doi="10.2196/57390", url="https://formative.jmir.org/2024/1/e57390" } @Article{info:doi/10.2196/51900, author="Deinboll, Anne and Moe, Fredriksen Cathrine and Ludvigsen, Spliid Mette", title="Participation in eHealth Communication Interventions Among Patients Undergoing Hemodialysis: Scoping Review", journal="J Med Internet Res", year="2024", month="Nov", day="11", volume="26", pages="e51900", keywords="eHealth", keywords="electronic health records", keywords="hemodialysis", keywords="patient participation", keywords="renal dialysis", keywords="renal insufficiency", keywords="chronic", keywords="mobile phone", abstract="Background: eHealth communication interventions have been shown to offer individuals with chronic kidney disease the opportunity to embrace dialysis therapies with greater confidence, the potential to obtain better clinical outcomes, and an increased quality of life. eHealth is an emerging field that offers diverse, flexible designs and delivery options. However, existing evidence on eHealth communication among patients undergoing hemodialysis is sparse and scattered and lacks systematization. Objective: This scoping review aims to identify and map the current evidence on patient participation in eHealth communication interventions. We aimed to map the associations between interventions and electronic health records, the participative role of individuals living with chronic kidney disease and undergoing hemodialysis, and the barriers to and facilitators of patient involvement in eHealth communication with health care professionals. Methods: This study used the Joanna Briggs Institute methodology for conducting a scoping review. Studies eligible for inclusion were those that included adult patients (aged >18 y) undergoing all types of hemodialysis, including prescheduled in-center hemodialysis and conventional home-based hemodialysis. Systematic searches were completed in Ovid MEDLINE, Ovid Embase, EBSCOhost CINAHL with Full Text, Scopus, and ProQuest Dissertations and Theses. Extracted data from the included studies were presented in figures and tables along with descriptions that responded to the research questions. This review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: In total, 9 peer-reviewed studies were included. The main result was a low participative patient role and a vaguely described link to electronic health records. The key participative facilitators were availability of and access to the intervention; security, trust, and confidence; patient knowledge of their health situation and use of self-care; and patient preparedness for an uncertain future health situation and the ability to relate to family and friends about it. The key participative barriers were lack of availability of and access to information, mistrust and lack of safety, lack of knowledge of health situation and self-care, and relational issues. All barriers and facilitators were related to health literacy. Conclusions: This scoping review summarizes 4 specific and 3 nonspecific eHealth communication interventions developed and evaluated in various studies involving patients receiving hemodialysis. A knowledge gap exists between low levels of patient participation in eHealth communication and patients' limited access to electronic health records. eHealth communication interventions should implement patient participation and focus on the fact that different modalities of eHealth communication can complement face-to-face communication. International Registered Report Identifier (IRRID): RR2-10.2196/38615 ", doi="10.2196/51900", url="https://www.jmir.org/2024/1/e51900" } @Article{info:doi/10.2196/53299, author="Perme, Natalie and Reid, Endia and Eluagu, Chinwenwa Macdonald and Thompson, John and Hebert, Courtney and Gabbe, Steven and Swoboda, Marie Christine", title="Development and Usability of the OHiFamily Mobile App to Enhance Accessibility to Maternal and Infant Information for Expectant Families in Ohio: Qualitative Study", journal="JMIR Form Res", year="2024", month="Nov", day="8", volume="8", pages="e53299", keywords="health resources", keywords="pregnancy", keywords="patient engagement", keywords="mHealth", keywords="maternal", keywords="mobile health", keywords="app", keywords="focus group", keywords="landscape analysis", keywords="birth", keywords="preterm", keywords="premature", keywords="mortality", keywords="death", keywords="pediatric", keywords="infant", keywords="neonatal", keywords="design", keywords="development", keywords="obstetric", keywords="mobile phone", abstract="Background: The Infant Mortality Research Partnership in Ohio is working to help pregnant individuals and families on Medicaid who are at risk for infant mortality and preterm birth. As part of this initiative, researchers at The Ohio State University worked to develop a patient-facing mobile app, OHiFamily, targeted toward, and created for, this population. To address the social determinants of health that can affect maternal and infant health, the app provides curated information on community resources, health care services, and educational materials in a format that is easily accessible and intended to facilitate contact between families and resources. The OHiFamily app includes 3 distinct features, that is, infant care logging (eg, feeding and diaper changes), curated educational resources, and a link to the curated Ohio resource database (CORD). This paper describes the development and assessment of the OHiFamily app as well as CORD. Objective: This study aimed to describe the development of the OHiFamily mobile app and CORD and the qualitative feedback received by the app's intended audience. Methods: The researchers performed a landscape analysis and held focus groups to determine the resources and app features of interest to Ohio families on Medicaid. Results: Participants from several focus groups were interested in an app that could offer community resources with contact information, information about medical providers and information and ways to contact them, health tips, and information about pregnancy and infant development. Feedback was provided by 9 participants through 3 focus group sessions. Using this feedback, the team created a curated resource database and mobile app to help users locate and access resources, as well as access education materials and infant tracking features. Conclusions: OHiFamily offers a unique combination of features and access to local resources for families on Medicaid in Ohio not seen in other smartphone apps. ", doi="10.2196/53299", url="https://formative.jmir.org/2024/1/e53299" } @Article{info:doi/10.2196/52295, author="Lee, JooHyun and Lim, JaeHyun and Kang, Soyeon and Kim, Sujin and Jung, Yoon So and Hong, Soon-Beom and Park, Rang Yu", title="Mobile App--Assisted Parent Training Intervention for Behavioral Problems in Children With Autism Spectrum Disorder: Pilot Randomized Controlled Trial", journal="JMIR Hum Factors", year="2024", month="Oct", day="28", volume="11", pages="e52295", keywords="autism spectrum disorder", keywords="parent training program", keywords="parent education", keywords="behavioral problems", keywords="child behavior", keywords="mobile app", keywords="feasibility", keywords="mHealth", keywords="evidence-based parent training", abstract="Background: In children with autism spectrum disorder (ASD), problem behaviors play a dysfunctional role, causing as much difficulty with daily living and adjustment as the core symptoms. If such behaviors are not effectively addressed, they can result in physical, economic, and psychological issues not only for the individual but also for family members. Objective: We aimed to develop and evaluate the feasibility of a mobile app--assisted parent training program for reducing problem behaviors in children with ASD. Methods: This open-label, single-center, randomized controlled trial was conducted among parents of children with ASD aged 36-84 months. Participants were recruited from the Department of Psychiatry at Seoul National University Hospital. Participants were randomly assigned (1:1) by a blinded researcher. Randomization was performed using a stratified block randomization (with a block size of 4). Parents in the intervention group completed the mobile app--assisted parent training program at home over a 12-week period. They continued to receive their usual nondrug treatment in addition to the mobile app--assisted parent training program. The control group continued to receive their usual nonpharmaceutical treatment for 12 weeks without receiving the parent training program intervention. The primary outcome measure was the median change in the Korean Child Behavior Checklist (K-CBCL) scores from before to after the intervention. Lower scores on the K-CBCL indicated a decrease in overall problem behavior. Results: Between November 9, 2022, and December 8, 2022, 64 participants were enrolled. Overall, 42 children (intervention group median age: 49, IQR 41-52.5 months; control group median age: 49, IQR 42-58 months) of the participants joined the program. The intervention group included 20 (48\%) participants and the control group included 22 (52\%) participants. In the intervention group, the K-CBCL total scores showed a decrease after the intervention, with a median difference of --0.5 (95\% CI --4.5 to 3). Pervasive developmental disorder scores also showed a decrease, with a median difference of --2.1 (95\% CI --8.5 to 2.5). However, there was no significant difference in Clinical Global Impression--Severity of Illness scores after the intervention for both the control and intervention groups. Scores on the Korean version of the Social Communication Questionnaire showed a further decrease after the intervention in the intervention group (median difference --2, 95\% CI --4 to 1). Caregivers' stress evaluated using the Korean Parenting Stress Index Fourth Edition--Short Form did not show any significant differences between the control and intervention groups. There were no adverse events related to study participation. Conclusions: The findings demonstrated the feasibility of using mobile devices for evidence-based parent training to reduce problem behaviors in children with ASD. Mobile devices' accessibility and flexibility may provide a viable alternative for offering early intervention for problem behaviors in children with ASD. Trial Registration: CRIS KCT0007841; https://cris.nih.go.kr/cris/search/detailSearch.do?\&seq=23112 ", doi="10.2196/52295", url="https://humanfactors.jmir.org/2024/1/e52295", url="http://www.ncbi.nlm.nih.gov/pubmed/39466295" } @Article{info:doi/10.2196/57219, author="Strandberg, Susanna and Ekstedt, Mirjam and Fagerstr{\"o}m, Cecilia and Back{\aa}berg, Sofia", title="Cocreation of a Video Feedback Tool for Managing Self-Care at Home With Pairs of Older Adults: Remote Experience-Based Co-Design Study", journal="JMIR Form Res", year="2024", month="Oct", day="28", volume="8", pages="e57219", keywords="chronic illness", keywords="eHealth", keywords="experience-based co-design", keywords="older adults", keywords="self-care", keywords="video feedback", abstract="Background: Involving older adults in co-design processes is essential in developing digital technologies and health care solutions to enhance self-care management at home, especially for older adults with chronic illness and their companions. Remote co-design approaches could provide technologically sustainable solutions that address their personal needs. Objective: This study aimed to cocreate and test the usability of a video feedback tool to facilitate self-care management at home. Methods: This experience-based co-design approach involved collaboration between 4 pairs of older adults, 4 researchers, and 2 service designers in three steps: (1) six iterative workshops (5 remote and 1 in person) to cocreate self-care exercises within an existing video feedback tool by identifying factors influencing self-care management; (2) developing and refining the self-care exercises based on suggestions from the older adults; and (3) usability testing of the cocreated exercises with the 4 pairs of older adults in their homes. Among the older adults (68-78 years), 3 adults had heart failure and 1 adult had hypertension. Data were analyzed inductively through thematic analysis and deductively using the USABILITY (Use of Technology to Engage in Adaptation by Older Adults and/or Those With Low or Limited Literacy) framework. Results: The identified influencing factors guiding the contents and format development of 2 new self-care exercises were that pairs of older adults support and learn from each other in performing self-care, which increases their motivation and engagement in practicing self-care at home. The usability test of the 2 new self-care exercises, ``Breathing exercises'' and ``Picking up from the floor,'' revealed that the pairs found the exercises and the video feedback component valuable for learning and understanding, for example, by comparison of performances highlighting movement variability. However, they found it difficult to manage the video feedback tool on their own, and a support structure or tailored education or training was requested. Conclusions: This study emphasizes that the video feedback tool holds the potential to facilitate learning and understanding in self-care management, which may support motivation. The studied video feedback tool can be beneficial for pairs of older adults managing self-care at home as a complement to traditional health care services, but an accurate supporting structure is required. The effectiveness of the video feedback tool and its integration into existing health care services still need to be assessed and improved through careful design and structured support. ", doi="10.2196/57219", url="https://formative.jmir.org/2024/1/e57219", url="http://www.ncbi.nlm.nih.gov/pubmed/39466305" } @Article{info:doi/10.2196/48154, author="Van Oirschot, Garett and Pomphrey, Amanda and Dunne, Caoimhe and Murphy, Kate and Blood, Karina and Doherty, Cailbhe", title="An Evaluation of the Design of Multimedia Patient Education Materials in Musculoskeletal Health Care: Systematic Review", journal="JMIR Rehabil Assist Technol", year="2024", month="Oct", day="15", volume="11", pages="e48154", keywords="health education", keywords="patient education", keywords="patient education materials", keywords="multimedia", keywords="musculoskeletal diseases", keywords="musculoskeletal pain", keywords="eHealth", keywords="self-management", abstract="Background: Educational multimedia is a cost-effective and straightforward way to administer large-scale information interventions to patient populations in musculoskeletal health care. While an abundance of health research informs the content of these interventions, less guidance exists about optimizing their design. Objective: This study aims to identify randomized controlled trials of patient populations with musculoskeletal conditions that used multimedia-based patient educational materials (PEMs) and examine how design was reported and impacted patients' knowledge and rehabilitation outcomes. Design was evaluated using principles from the cognitive theory of multimedia learning (CTML). Methods: PubMed, CINAHL, PsycINFO, and Embase were searched from inception to September 2023 for studies examining adult patients with musculoskeletal conditions receiving multimedia PEMs compared to any other interventions. The primary outcome was knowledge retention measured via test scores. Secondary outcomes were any patient-reported measures. Retrievability was noted, and PEMs were sourced through search, purchase, and author communication. Results: A total of 160 randomized controlled trials were eligible for inclusion: 13 (8.1\%) included their educational materials and 31 (19.4\%) required a web search, purchase, or direct requests for educational materials. Of these 44 (27.5\%) studies, none fully optimized the design of their educational materials, particularly lacking in the CTML principles of coherence, redundancy, modality, and generative activities for the learner. Of the 160 studies, the remaining 116 (72.5\%) contained interventions that could not be retrieved or appraised. Learning was evaluated in 5 (3.1\%) studies. Conclusions: Musculoskeletal studies should use open science principles and provide their PEMs wherever possible. The link between providing multimedia PEMs and patient learning is largely unexamined, but engagement potential may be maximized when considering design principles such as the CTML. ", doi="10.2196/48154", url="https://rehab.jmir.org/2024/1/e48154", url="http://www.ncbi.nlm.nih.gov/pubmed/39162239" } @Article{info:doi/10.2196/55815, author="Chernick, S. Lauren and Bugaighis, Mona and Daylor, Victoria and Hochster, Daniel and Rosen, Evan and Schnall, Rebecca and Stockwell, S. Melissa and Bell, L. David", title="A Digital Sexual Health Intervention for Urban Adolescent and Young Adult Male Emergency Department Patients: User-Centered Design Approach", journal="JMIR Form Res", year="2024", month="Oct", day="4", volume="8", pages="e55815", keywords="sexual health", keywords="adolescent health", keywords="sex education", keywords="emergency medicine", keywords="health planning", keywords="sexual behavior", keywords="SMS text messaging", keywords="mHealth", keywords="mobile app", keywords="condom use", keywords="user-centered design", abstract="Background: Adolescents and young adults frequently present to the emergency department (ED) for medical care and continue to have many unmet sexual health needs. Digital interventions show promise to improve adolescent and young adult sexual health; yet, few interventions focus on male ED patients, despite their infrequent use of contraceptives and rising rates of sexually transmitted infections. Objective: This paper describes the design and development of Dr. Eric (Emergency Room Interventions to Improve Care), a digital app focused on promoting condom use among sexually active adolescent and young adult male ED patients. Methods: This study followed 4 phases of app development, which were based on user-centered design and the software development lifecycle. In phase 1, define, we explored our target population and target health problem (infrequent condom use among male ED patients) by collecting key stakeholder input and conducting in-depth interviews with male patients and urban ED medical providers. In phase 2, discover, we partnered with a digital product agency to explore user experience and digital strategy. In phase 3, design, we refined Dr. Eric's content, a 5-part sexual health educational module and a 10-week SMS text messaging program that focuses on condom use and partner communication about effective contraceptives. We conducted semistructured interviews with male adolescent and young adults to gather feedback on the app and perform usability testing, editing the app after each interview. We also interviewed informatics experts to assess the usability of a high-fidelity prototype. Interviews were recorded and analyzed via descriptive thematic analysis; informatic expert feedback was categorized by Nielsen's heuristic principles. In phase 4, develop, we created the technical architecture and built a responsive web app. These findings were gathered leading to the final version of the digital Dr. Eric program. Results: Using data and key stakeholder input from phases 1 and 2, we iteratively created the Dr. Eric prototype for implementation in the ED setting. Interviews with 8 adolescent and young adult male ED patients suggested that users preferred (1) straightforward information, (2) a clear vision of the purpose of Dr. Eric, (3) open-ended opportunities to explore family planning goals, (4) detailed birth control method information, and (5) games presenting novel information with rewards. Five usability experts provided heuristic feedback aiming to improve the ease of use of the app. These findings led to the final version of Dr. Eric. Conclusions: Following these mobile health development phases, we created a digital sexual health mobile health intervention incorporating the principles of user experience and interface design. Dr. Eric needs further evaluation to assess its efficacy in increasing condom use among adolescent and young adult male ED patients. Researchers can use this framework to form future digital health ED-based digital interventions. ", doi="10.2196/55815", url="https://formative.jmir.org/2024/1/e55815", url="http://www.ncbi.nlm.nih.gov/pubmed/39365657" } @Article{info:doi/10.2196/56611, author="Jamil, Aini Nor and Dhanaseelan, Jashwiny and Buhari, Athirah Nurin", title="Effectiveness of an e-Book on Bone Health as Educational Material for Adolescents: Single-Group Experimental Study", journal="JMIR Pediatr Parent", year="2024", month="Aug", day="26", volume="7", pages="e56611", keywords="osteoporosis", keywords="bone health", keywords="adolescent", keywords="knowledge", keywords="calcium", keywords="physical activity", keywords="e-book", keywords="effectiveness", keywords="educational", keywords="teens", keywords="youth", keywords="bone fragility", keywords="bone", keywords="Malaysia", keywords="online questionnaire", keywords="sociodemographic", keywords="calcium intake", keywords="diet", keywords="behavior change", abstract="Background: Improved bone health during adolescence can have lifelong implications, reducing the risk of bone fragility. Objective: This study aims to evaluate the effectiveness of an e-book in increasing knowledge about and promoting healthy practices related to bone health among Malay adolescents in Kuala Lumpur, Malaysia. Methods: A total of 72 adolescents (female: n=51, 71\%; age: mean 15, SD 0.74 y) were recruited from selected secondary schools. The participants answered a pretest web-based questionnaire on sociodemographic data, knowledge about osteoporosis, and physical activity. A video call was conducted to assess dietary calcium intake. Participants were provided with a link to an e-book on bone health and instructed to read it within 2 weeks. Postintervention assessments included those for knowledge, physical activity, dietary calcium intake, and acceptance of the e-book. Results: There was a significant increase in the median knowledge score, which was 40.6\% (IQR 31.3\%-46.9\%) during the pretest and 71.9\% (IQR 53.9\%-81.3\%) during the posttest (P<.001). However, no changes were observed in dietary calcium intake or physical activity levels. Most participants did not meet the recommended calcium requirements (61/62, 98\%) and exhibited sedentary behavior (pretest: 51/62, 82\%; posttest: 48/62, 77\%). The e-book, however, was well accepted, with the majority reporting that they understood the contents (70/72, 97\%), liked the graphics (71/72, 99\%), and approved of the layout (60/72, 83\%) and font size (66/72, 92\%) used. Conclusions: The developed e-book effectively increases knowledge levels related to bone health and is well accepted among participants. However, this educational material did not improve bone health practices. Additional strategies are necessary to bridge the gap between knowledge and behavior change. ", doi="10.2196/56611", url="https://pediatrics.jmir.org/2024/1/e56611" } @Article{info:doi/10.2196/46220, author="Lonati, Caterina and Wellhausen, Marie and Pennig, Stefan and R{\"o}hr{\ss}en, Thomas and Kircelli, Fatih and Arendt, Svenja and Tschulena, Ulrich", title="The Use of a Novel Virtual Reality Training Tool for Peritoneal Dialysis: Qualitative Assessment Among Health Care Professionals", journal="JMIR Med Educ", year="2024", month="Aug", day="6", volume="10", pages="e46220", keywords="peritoneal dialysis", keywords="virtual reality", keywords="patient education", keywords="patient training", keywords="chronic kidney disease", keywords="nursing", keywords="qualitative assessment", abstract="Background: Effective peritoneal dialysis (PD) training is essential for performing dialysis at home and reducing the risk of peritonitis and other PD-related infections. Virtual reality (VR) is an innovative learning tool that is able to combine theoretical information, interactivity, and behavioral instructions while offering a playful learning environment. To improve patient training for PD, Fresenius Medical Care launched the stay{\textbullet}safe MyTraining VR, a novel educational program based on the use of a VR headset and a handheld controller. Objective: This qualitative assessment aims to investigate opinions toward the new tool among the health care professionals (HCPs) who were responsible for implementing the VR application. Methods: We recruited nursing staff and nephrologists who have gained practical experience with the stay{\textbullet}safe MyTraining VR within pilot dialysis centers. Predetermined open-ended questions were administered during individual and group video interviews. Results: We interviewed 7 HCPs who have 2 to 20 years of experience in PD training. The number of patients trained with the stay{\textbullet}safe MyTraining VR ranged from 2 to 5 for each professional. The stay{\textbullet}safe MyTraining VR was well accepted and perceived as a valuable supplementary tool for PD training. From the respondents' perspective, the technology improved patients' learning experience by facilitating the internalization of both medical information and procedural skills. HCPs highlighted that the opportunity offered by VR to reiterate training activities in a positive and safe learning environment, according to each patient's needs, can facilitate error correction and implement a standardized training curriculum. However, VR had limited use in the final phase of the patient PD training program, where learners need to get familiar with the handling of the materials. Moreover, the traditional PD training was still considered essential to manage the emotional and motivational aspects and address any patient-specific application-oriented questions. In addition to its use within PD training, VR was perceived as a useful tool to support the decision-making process of patients and train other HCPs. Moreover, VR introduction was associated with increased efficiency and productivity of HCPs because it enabled them to perform other activities while the patient was practicing with the device. As for patients' acceptance of the new tool, interviewees reported positive feedback, including that of older adults. Limited use with patients experiencing dementia or severe visual impairment or lacking sensomotoric competence was mentioned. Conclusions: The stay{\textbullet}safe MyTraining VR is suggested to improve training efficiency and efficacy and thus could have a positive impact in the PD training scenario. Our study offers a process proposal that can serve as a guide to the implementation of a VR-based PD training program within other dialysis centers. Dedicated research is needed to assess the operational benefits and the consequences on patient management. ", doi="10.2196/46220", url="https://mededu.jmir.org/2024/1/e46220", url="http://www.ncbi.nlm.nih.gov/pubmed/39106093" } @Article{info:doi/10.2196/51520, author="Teano, L. Anthony and Scott, Ashley and Gipson, Cassandra and Albert, Marilyn and Pettigrew, Corinne", title="Social Media Programs for Outreach and Recruitment Supporting Aging and Alzheimer Disease and Related Dementias Research: Longitudinal Descriptive Study", journal="JMIR Aging", year="2024", month="Jul", day="9", volume="7", pages="e51520", keywords="education", keywords="social media", keywords="outreach", keywords="recruitment", keywords="Alzheimer's disease", keywords="Alzheimer disease", abstract="Background: Social media may be a useful method for research centers to deliver health messages, increase their visibility in the local community, and recruit study participants. Sharing examples of social media--based community outreach and educational programs, and evaluating their outcomes in this setting, is important for understanding whether these efforts have a measurable impact. Objective: The aim of this study is to describe one center's social media activities for community education on topics related to aging, memory loss, and Alzheimer disease and related dementias, and provide metrics related to recruitment into clinical research studies. Methods: Several social media platforms were used, including Facebook, X (formerly Twitter), and YouTube. Objective assessments quantified monthly, based on each platform's native dashboard, included the number of followers, number of posts, post reach and engagement, post impressions, and video views. The number of participants volunteering for research during this period was additionally tracked using a secure database. Educational material posted to social media most frequently included content developed by center staff, content from partner organizations, and news articles or resources featuring center researchers. Multiple educational programs were developed, including social media series, web-based talks, Twitter chats, and webinars. In more recent years, Facebook content was occasionally boosted to increase visibility in the local geographical region. Results: Up to 4 years of page metrics demonstrated continuing growth in reaching social media audiences, as indicated by increases over time in the numbers of likes or followers on Facebook and X/Twitter and views of YouTube videos (growth trajectories). While Facebook reach and X/Twitter impression rates were reasonable, Facebook engagement rates were more modest. Months that included boosted Facebook posts resulted in a greater change in page followers and page likes, and higher reach and engagement rates (all P?.002). Recruitment of participants into center-affiliated research studies increased during this time frame, particularly in response to boosted Facebook posts. Conclusions: These data demonstrate that social media activities can provide meaningful community educational opportunities focused on Alzheimer disease and related dementias and have a measurable impact on the recruitment of participants into research studies. Additionally, this study highlights the importance of tracking outreach program outcomes for evaluating return on investment. ", doi="10.2196/51520", url="https://aging.jmir.org/2024/1/e51520" } @Article{info:doi/10.2196/54739, author="Dangerfield II, T. Derek and Anderson, N. Janeane and Wylie, Charleen and Bluthenthal, Ricky and Beyrer, Chris and Farley, E. Jason", title="A Multicomponent Intervention (POSSIBLE) to Improve Perceived Risk for HIV Among Black Sexual Minority Men: Feasibility and Preliminary Effectiveness Pilot Study", journal="JMIR Hum Factors", year="2024", month="Jun", day="11", volume="11", pages="e54739", keywords="pre-exposure prophylaxis", keywords="PrEP", keywords="sexual health", keywords="peers", keywords="apps", keywords="community", keywords="mobile phone", keywords="HIV", keywords="sexual minority", keywords="minority communities", keywords="minority", keywords="Black", keywords="African American", keywords="patient education", keywords="self-monitoring", keywords="treatment adherence", keywords="treatment participation", keywords="community health", keywords="mobile health", keywords="digital health", keywords="digital technology", keywords="digital interventions", keywords="smartphones", abstract="Background: Increased pre-exposure prophylaxis (PrEP) use is urgently needed to substantially decrease HIV incidence among Black sexual minority men. Low perceived risk for HIV (PRH) is a key unaddressed PrEP barrier for Black sexual minority men. Peers and smartphone apps are popular intervention tools to promote community health behaviors, but few studies have used these together in a multicomponent strategy. Therefore, we designed a multicomponent intervention called POSSIBLE that used an existing smartphone app called PrEPme (Emocha Mobile Health, Inc) and a peer change agent (PCA) to increase PRH as a gateway to PrEP. Objective: This paper aims to describe the feasibility and preliminary impact of POSSIBLE on PRH and willingness to accept a PrEP referral among Black sexual minority men. Methods: POSSIBLE was a theoretically guided, single-group, 2-session pilot study conducted among Black sexual minority men from Baltimore, Maryland between 2019 and 2021 (N=69). POSSIBLE integrated a PCA and the PrEPme app that allows users to self-monitor sexual risk behaviors and chat with the in-app community health worker to obtain PrEP service information. PRH was assessed using the 8-item PRH scale before and after baseline and follow-up study visits. At the end of each study visit, the PCA referred interested individuals to the community health worker to learn more about PrEP service options. Results: The average age of participants was 32.5 (SD 8.1, range 19-62) years. In total, 55 (80\%) participants were retained for follow-up at month 1. After baseline sessions, 29 (42\%) participants were willing to be referred to PrEP services, 20 (69\%) of those confirmed scheduled appointments with PrEP care teams. There were no statistically significant differences in PRH between baseline and follow-up visits (t122=--1.36; P=.17). Conclusions: We observed no statistically significant improvement in PRH between baseline and month 1. However, given the high retention rate and acceptability, POSSIBLE may be feasible to implement. Future research should test a statistically powered peer-based approach on PrEP initiation among Black sexual minority men. Trial Registration: ClinicalTrials.gov NCT04533386; https://clinicaltrials.gov/study/NCT04533386 ", doi="10.2196/54739", url="https://humanfactors.jmir.org/2024/1/e54739", url="http://www.ncbi.nlm.nih.gov/pubmed/38861707" } @Article{info:doi/10.2196/47996, author="Musiimenta, Angella and Tumuhimbise, Wilson and Atukunda, Esther and Mugaba, Aaron and Linnemayr, Sebastian and Haberer, Jessica", title="Digital Adherence Technologies Linked to Mobile Money Incentives for Medication Adherence Among People Living With Tuberculosis: Mixed Methods Feasibility and Acceptability Study", journal="JMIR Hum Factors", year="2024", month="May", day="31", volume="11", pages="e47996", keywords="digital adherence technologies", keywords="real-time monitoring", keywords="SMS text message reminders", keywords="mobile money", keywords="financial incentives", keywords="tuberculosis", keywords="medication adherence", keywords="user-centered approach", abstract="Background: Complementing digital adherence technologies (DATs) with mobile money incentives may improve their utility in supporting tuberculosis medication adherence, yet the feasibility and acceptability of this integrated approach remain unclear. Objective: This study aims to describe the feasibility and acceptability of a novel DAT intervention called My Mobile Wallet composed of real-time adherence monitoring, SMS text message reminders, and mobile money incentives for tuberculosis medication adherence in a low-income setting. Methods: We purposively recruited people living with tuberculosis from the Mbarara Regional Referral Hospital in Mbarara, Uganda, who (1) were starting tuberculosis treatment at enrollment or within the past 4 weeks, (2) owned a mobile phone, (3) were able to use SMS test messaging, (4) were aged ?18 years, and (5) were living in Mbarara district. At study exit (month 6), we used interviews and questionnaires informed by the unified theory of acceptance and use of technology (UTAUT) to collect feasibility and acceptability data, reflecting patients' experiences of using each component of My Mobile Wallet. Feasibility also included tracking the functionality of the adherence monitor (ie, an electronic pillbox) as well as SMS text message and mobile money delivery. We used a content analytical approach to inductively analyze qualitative data and Stata (version 13; StataCorp LLC) to analyze quantitative data. Results: All 39 participants reported that the intervention was feasible because it was easy for them to use (eg, access and read SMS text messages) and worked as expected. Almost all SMS text messages (6880/7064, 97.4\%) were sent as planned. The transmission of adherence data from the monitor worked well, with 98.37\% (5682/5776) of the data transmitted as planned. All participants additionally reported that the intervention was acceptable because it helped them take their tuberculosis medication as prescribed; the mobile money incentives relieved them of tuberculosis-related financial burdens; SMS text message reminders and electronic pillbox--based alarms reminded them to take their medication on time; and participants perceived real-time adherence monitoring as ``being watched'' while taking their medication, which encouraged them to take their medication on time to demonstrate their commitment. The intervention was perceived as a sign of care, which eventually created emotional support and a sense of connectedness to health care. Participants preferred daily SMS text message reminders (32/39, 82\%) to reminders linked to missed doses (7/39, 18\%), citing the fact that tuberculosis medication is taken daily. Conclusions: The use of real-time adherence monitoring linked to SMS text message reminders and mobile money incentives for tuberculosis medication adherence was feasible and acceptable in a low-resource setting where poverty-based structural barriers heavily constrain tuberculosis treatment and care. ", doi="10.2196/47996", url="https://humanfactors.jmir.org/2024/1/e47996", url="http://www.ncbi.nlm.nih.gov/pubmed/38819905" } @Article{info:doi/10.2196/49519, author="Goldgof, M. Gregory and Mishra, Shweta and Bajaj, Kriti", title="Efficacy of the QuitSure App for Smoking Cessation in Adult Smokers: Cross-Sectional Web Survey", journal="JMIR Hum Factors", year="2024", month="May", day="6", volume="11", pages="e49519", keywords="smoking", keywords="quit smoking", keywords="smoking cessation", keywords="smoking app", keywords="QuitSure", keywords="smoke free", keywords="quit vaping", keywords="vaping", keywords="smoker", keywords="smoke", keywords="cross-sectional study", keywords="smartphone app", keywords="tobacco consumption", keywords="tobacco", keywords="survey", keywords="nicotine", keywords="nicotine withdrawal", keywords="mobile phone", abstract="Background: Cigarette smoking remains one of the leading causes of preventable death worldwide. A worldwide study by the World Health Organization concluded that more than 8 million people die every year from smoking, tobacco consumption, and secondhand smoke. The most effective tobacco cessation programs require personalized human intervention combined with costly pharmaceutical supplementation, making them unaffordable or inaccessible to most tobacco users. Thus, digital interventions offer a promising alternative to these traditional methods. However, the leading smartphone apps available in the market today have either not been studied in a clinical setting or are unable to match the smoking cessation success rates of their expensive offline counterparts. We would like to understand whether QuitSure, a novel smoking cessation app built by Rapidkart Online Private Limited, is able to bridge this efficacy gap and deliver affordable and effective smoking cessation at scale. Objective: Our objective was to do an initial exploration into the engagement, efficacy, and safety of QuitSure based on the self-reported experiences of its users. Outcomes measured were program completion, the effect of program completion on smoking behavior, including self-reported cessation outcomes, and negative health events from using the app. Methods: All QuitSure registered users who created their accounts on the QuitSure app between April 1, 2021, and February 28, 2022, were sent an anonymized web-based survey. The survey results were added to their engagement data on the app to evaluate the feasibility and efficacy of the app as a smoking cessation intervention. The data were analyzed using descriptive statistics (frequencies and percentages) and the $\chi$2 test of independence. Results: In total, 1299 users who had completed the QuitSure program submitted the survey and satisfied the inclusion criteria of the study. Of these, 1286 participants had completed the program more than 30 days before filling out the survey, and 1040 (80.1\%, 95\% CI 79.1\%-82.6\%) of them had maintained prolonged abstinence for at least 30 days after program completion. A majority of participants (770/891, 86.4\%) who were still maintaining abstinence at the time of submitting the survey did not experience any severe nicotine withdrawal symptoms, while 41.9\% (373/891) experienced no mild withdrawal symptoms either. Smoking quantity prior to completing the program significantly affected quit rates (P<.001), with heavy smokers (>20 cigarettes per day) having a lower 30-day prolonged abstinence rate (relative risk=0.91; 95\% CI 90.0\%-96.2\%) compared to lighter smokers. No additional adverse events outside of known nicotine withdrawal symptoms were reported. Conclusions: The nature of web-based surveys and cohort selection allows for extensive unknown biases. However, the efficacy rates of survey respondents who completed the program were high and provide a case for further investigation in the form of randomized controlled trials on the QuitSure tobacco cessation program. ", doi="10.2196/49519", url="https://humanfactors.jmir.org/2024/1/e49519", url="http://www.ncbi.nlm.nih.gov/pubmed/38709553" } @Article{info:doi/10.2196/53614, author="Smith, M. Sharissa and Bais, Babette and Ismaili M'hamdi, Hafez and Schermer, HN Maartje and Steegers-Theunissen, PM R{\'e}gine", title="Stimulating Preconception Care Uptake by Women With a Vulnerable Health Status Through a Mobile Health App (Pregnant Faster): Pilot Feasibility Study", journal="JMIR Hum Factors", year="2024", month="Apr", day="22", volume="11", pages="e53614", keywords="preconception care", keywords="mHealth", keywords="mobile health", keywords="pregnancy preparation", keywords="nudge", keywords="health inequality", keywords="socioeconomic status", keywords="lifestyle", keywords="women", keywords="pregnancy", keywords="pregnant women", keywords="pregnant", keywords="socioeconomic", keywords="pilot feasibility study", keywords="mHealth app", keywords="mHealth application", keywords="app", keywords="application", keywords="risk factor", keywords="nutrition", keywords="stress", keywords="chronic stress", keywords="health literacy", keywords="usability", keywords="user satisfaction", keywords="user", keywords="users", abstract="Background: A low socioeconomic status is associated with a vulnerable health status (VHS) through the accumulation of health-related risk factors, such as poor lifestyle behaviors (eg, inadequate nutrition, chronic stress, and impaired health literacy). For pregnant women, a VHS translates into a high incidence of adverse pregnancy outcomes and therefore pregnancy-related inequity. We hypothesize that stimulating adequate pregnancy preparation, targeting lifestyle behaviors and preconception care (PCC) uptake, can reduce these inequities and improve the pregnancy outcomes of women with a VHS. A nudge is a behavioral intervention aimed at making healthy choices easier and more attractive and may therefore be a feasible way to stimulate engagement in pregnancy preparation and PCC uptake, especially in women with a VHS. To support adequate pregnancy preparation, we designed a mobile health (mHealth) app, Pregnant Faster, that fits the preferences of women with a VHS and uses nudging to encourage PCC consultation visits and engagement in education on healthy lifestyle behaviors. Objective: This study aimed to test the feasibility of Pregnant Faster by determining usability and user satisfaction, the number of visited PCC consultations, and the course of practical study conduction. Methods: Women aged 18-45 years, with low-to-intermediate educational attainment, who were trying to become pregnant within 12 months were included in this open cohort. Recruitment took place through social media, health care professionals, and distribution of flyers and posters from September 2021 until June 2022. Participants used Pregnant Faster daily for 4 weeks, earning coins by reading blogs on pregnancy preparation, filling out a daily questionnaire on healthy lifestyle choices, and registering for a PCC consultation with a midwife. Earned coins could be spent on rewards, such as fruit, mascara, and baby products. Evaluation took place through the mHealth App Usability Questionnaire (MAUQ), an additional interview or questionnaire, and assessment of overall study conduction. Results: Due to limited inclusions, the inclusion criterion ``living in a deprived neighborhood'' was dropped. This resulted in the inclusion of 47 women, of whom 39 (83\%) completed the intervention. In total, 16 (41\%) of 39 participants visited a PCC consultation, with their main motivation being obtaining personalized information. The majority of participants agreed with 16 (88.9\%) of 18 statements of the MAUQ, indicating high user satisfaction. The mean rating was 7.7 (SD 1.0) out of 10. Points of improvement included recruitment of the target group, simplification of the log-in system, and automation of manual tasks. Conclusions: Nudging women through Pregnant Faster to stimulate pregnancy preparation and PCC uptake has proven feasible, but the inclusion criteria must be revised. A substantial number of PCC consultations were conducted, and this study will therefore be continued with an open cohort of 400 women, aiming to establish the (cost-)effectiveness of an updated version, named Pregnant Faster 2. International Registered Report Identifier (IRRID): RR2-10.2196/45293 ", doi="10.2196/53614", url="https://humanfactors.jmir.org/2024/1/e53614", url="http://www.ncbi.nlm.nih.gov/pubmed/38648092" } @Article{info:doi/10.2196/55742, author="Gerbutavicius, Rokas and Merle, A. David and Wolf, Armin and Dimopoulos, Spyridon and Kortuem, Ulrich Karsten and Kortuem, Charlotte Friederike", title="User Friendliness and Perioperative Guidance Benefits of a Cataract Surgery Education App: Randomized Controlled Trial", journal="JMIR Form Res", year="2024", month="Mar", day="29", volume="8", pages="e55742", keywords="mHealth", keywords="mobile health", keywords="workflow optimization", keywords="patient satisfaction", keywords="health education", keywords="educational background", keywords="phacoemulsification", abstract="Background: Cataract surgeries are among the most performed surgeries worldwide. A thorough patient education is essential to inform patients about the perioperative process and postoperative target results concerning the intraocular lens and objectives for visual outcomes. However, addressing all relevant aspects and questions is time-consuming. Mobile apps can facilitate this process for both patients and physicians and thus be beneficial. However, the success of such an app depends on its user friendliness and acceptance by patients. Objective: This study aimed to evaluate the user friendliness and acceptance of a cataract surgery education app on mobile devices among patients undergoing cataract surgery, the characteristics of patients who benefit the most from app use, and the influence of the app on patient satisfaction with treatment. Methods: All patients who underwent cataract surgery at an ophthalmological practice from August 2020 to July 2021 were invited to participate in this randomized controlled trial. Out of 493 invited patients, 297 (60.2\%) were enrolled in this study. Patients were randomized into 3 different groups. Half of the patients were offered to participate in Group 1 with use of the ``Patient Journey'' app. However, if they decided not to use the app, they were included in Group 2 (app denial). The other half of the patients were included in Group 3 (control) with no use of the app and with information provided conventionally. The app provided general information on the ophthalmological center, surgeons, cataract, and treatment options. Different questionnaires were used in all 3 groups to evaluate satisfaction with the perioperative process. Group 1 evaluated the app. Demographic characteristics, such as age, gender, and educational degree, were assessed. Results: Group 1 included 77 patients (median age 69 years). Group 2 included 61 patients, and their median age was higher (median age 79 years). Group 3 included 159 patients (median age 74 years). There was no difference in satisfaction with the perioperative process and clinic between the 3 groups. Almost all app users appreciated the digital details provided for the organization and the information on the surgery. Age did not play a major role in appreciation of the app. Female patients tended to appreciate the information provided more than male patients. Patients who did not have a higher university degree experienced more benefits from the informational content of the app and were the most satisfied with the information. However, male patients and academics were in general more aware of technology and handled the app more easily. Conclusions: The app showed high user friendliness and acceptance, and could particularly benefit specific patient groups. App users demonstrated a noninferior high satisfaction with the treatment in the ophthalmological center in comparison with patients who were informed about the surgery only conventionally. ", doi="10.2196/55742", url="https://formative.jmir.org/2024/1/e55742", url="http://www.ncbi.nlm.nih.gov/pubmed/38551619" } @Article{info:doi/10.2196/47913, author="Beyeler, Marina and L{\'e}geret, Corinne and Kiwitz, Fabian and van der Horst, Klazine", title="Usability and Overall Perception of a Health Bot for Nutrition-Related Questions for Patients Receiving Bariatric Care: Mixed Methods Study", journal="JMIR Hum Factors", year="2023", month="Nov", day="8", volume="10", pages="e47913", keywords="bariatric surgery", keywords="nutrition information", keywords="usability", keywords="satisfaction", keywords="artificial intelligence", keywords="health bot", keywords="mobile phone", abstract="Background: Currently, over 4000 bariatric procedures are performed annually in Switzerland. To improve outcomes, patients need to have good knowledge regarding postoperative nutrition. To potentially provide them with knowledge between dietetic consultations, a health bot (HB) was created. The HB can answer bariatric nutrition questions in writing based on artificial intelligence. Objective: This study aims to evaluate the usability and perception of the HB among patients receiving bariatric care. Methods: Patients before or after bariatric surgery tested the HB. A mixed methods approach was used, which consisted of a questionnaire and qualitative interviews before and after testing the HB. The dimensions usability of, usefulness of, satisfaction with, and ease of use of the HB, among others, were measured. Data were analyzed using R Studio (R Studio Inc) and Excel (Microsoft Corp). The interviews were transcribed and a summary inductive content analysis was performed. Results: A total of 12 patients (female: n=8, 67\%; male: n=4, 33\%) were included. The results showed excellent usability with a mean usability score of 87 (SD 12.5; range 57.5-100) out of 100. Other dimensions of acceptability included usefulness (mean 5.28, SD 2.02 out of 7), satisfaction (mean 5.75, SD 1.68 out of 7), and learnability (mean 6.26, SD 1.5 out of 7). The concept of the HB and availability of reliable nutrition information were perceived as desirable (mean 5.5, SD 1.64 out of 7). Weaknesses were identified in the response accuracy, limited knowledge, and design of the HB. Conclusions: The HB's ease of use and usability were evaluated to be positive; response accuracy, topic selection, and design should be optimized in a next step. The perceptions of nutrition professionals and the impact on patient care and the nutrition knowledge of participants need to be examined in further studies. ", doi="10.2196/47913", url="https://humanfactors.jmir.org/2023/1/e47913", url="http://www.ncbi.nlm.nih.gov/pubmed/37938894" } @Article{info:doi/10.2196/48701, author="Welsh, W. Justine and Sitar, I. Siara and Parks, J. Michael and Patton, C. Samantha and Braughton, E. Jacqueline and Waller, A. Lance and Ngo, M. Quyen", title="Association Between Clinician-Level Factors and Patient Outcomes in Virtual and In-Person Outpatient Treatment for Substance Use Disorders: Multilevel Analysis", journal="JMIR Hum Factors", year="2023", month="Nov", day="3", volume="10", pages="e48701", keywords="clinician characteristics", keywords="substance use treatment", keywords="virtual treatment", keywords="in-person treatment", keywords="telehealth", keywords="patient outcomes", keywords="intensive outpatient program", keywords="virtual reality", keywords="treatment", keywords="health care", keywords="substance use", keywords="data collection", keywords="EHR", keywords="electronic health record", abstract="Background: The use of virtual treatment services increased dramatically during the COVID-19 pandemic. Unfortunately, large-scale research on virtual treatment for substance use disorder (SUD), including factors that may influence outcomes, has not advanced with the rapidly changing landscape. Objective: This study aims to evaluate the link between clinician-level factors and patient outcomes in populations receiving virtual and in-person intensive outpatient services. Methods: Data came from patients (n=1410) treated in a virtual intensive outpatient program (VIOP) and an in-person intensive outpatient program (IOP), who were discharged between January 2020 and March 2021 from a national treatment organization. Patient data were nested by treatment providers (n=58) examining associations with no-shows and discharge with staff approval. Empathy, comfort with technology, perceived stress, resistance to change, and demographic covariates were examined at the clinician level. Results: The VIOP ($\beta$=--5.71; P=.03) and the personal distress subscale measure ($\beta$=--6.31; P=.003) were negatively associated with the percentage of no-shows. The VIOP was positively associated with discharges with staff approval (odds ratio [OR] 2.38, 95\% CI 1.50-3.76). Clinician scores on perspective taking ($\beta$=--9.22; P=.02), personal distress ($\beta$=--9.44; P=.02), and male clinician gender ($\beta$=--6.43; P=.04) were negatively associated with in-person no-shows. Patient load was positively associated with discharge with staff approval (OR 1.04, 95\% CI 1.02-1.06). Conclusions: Overall, patients in the VIOP had fewer no-shows and a higher rate of successful discharge. Few clinician-level characteristics were significantly associated with patient outcomes. Further research is necessary to understand the relationships among factors such as clinician gender, patient load, personal distress, and patient retention. ", doi="10.2196/48701", url="https://humanfactors.jmir.org/2023/1/e48701", url="http://www.ncbi.nlm.nih.gov/pubmed/37921853" } @Article{info:doi/10.2196/46346, author="Nattam, Anunita and Vithala, Tripura and Wu, Tzu-Chun and Bindhu, Shwetha and Bond, Gregory and Liu, Hexuan and Thompson, Amy and Wu, Y. Danny T.", title="Assessing the Readability of Online Patient Education Materials in Obstetrics and Gynecology Using Traditional Measures: Comparative Analysis and Limitations", journal="J Med Internet Res", year="2023", month="Aug", day="30", volume="25", pages="e46346", keywords="obstetrics and gynecology", keywords="online patient education materials", keywords="readability", keywords="online education", keywords="education", keywords="health literacy", keywords="literature", keywords="medical documents", keywords="tool", keywords="utilization", keywords="online content", keywords="health education", keywords="education material", keywords="assessment", keywords="obstetrics", keywords="gynecology", abstract="Background: Patient education materials (PEMs) can be vital sources of information for the general population. However, despite American Medical Association (AMA) and National Institutes of Health (NIH) recommendations to make PEMs easier to read for patients with low health literacy, they often do not adhere to these recommendations. The readability of online PEMs in the obstetrics and gynecology (OB/GYN) field, in particular, has not been thoroughly investigated. Objective: The study sampled online OB/GYN PEMs and aimed to examine (1) agreeability across traditional readability measures (TRMs), (2) adherence of online PEMs to AMA and NIH recommendations, and (3) whether the readability level of online PEMs varied by web-based source and medical topic. This study is not a scoping review, rather, it focused on scoring the readability of OB/GYN PEMs using the traditional measures to add empirical evidence to the literature. Methods: A total of 1576 online OB/GYN PEMs were collected via 3 major search engines. In total 93 were excluded due to shorter content (less than 100 words), yielding 1483 PEMs for analysis. Each PEM was scored by 4 TRMs, including Flesch-Kincaid grade level, Gunning fog index, Simple Measure of Gobbledygook, and the Dale-Chall. The PEMs were categorized based on publication source and medical topic by 2 research team members. The readability scores of the categories were compared statistically. Results: Results indicated that the 4 TRMs did not agree with each other, leading to the use of an averaged readability (composite) score for comparison. The composite scores across all online PEMs were not normally distributed and had a median at the 11th grade. Governmental PEMs were the easiest to read amongst source categorizations and PEMs about menstruation were the most difficult to read. However, the differences in the readability scores among the sources and the topics were small. Conclusions: This study found that online OB/GYN PEMs did not meet the AMA and NIH readability recommendations and would be difficult to read and comprehend for patients with low health literacy. Both findings connected well to the literature. This study highlights the need to improve the readability of OB/GYN PEMs to help patients make informed decisions. Research has been done to create more sophisticated readability measures for medical and health documents. Once validated, these tools need to be used by web-based content creators of health education materials. ", doi="10.2196/46346", url="https://www.jmir.org/2023/1/e46346", url="http://www.ncbi.nlm.nih.gov/pubmed/37647115" } @Article{info:doi/10.2196/38706, author="Silva de Medeiros, C{\'a}rmem M{\'a}yra and de Oliveira, Costa Maiara and Gurgel, Barbosa Leonandro Val{\'e}rio and Ribeiro Rodrigues, Dantas Anna Giselle C{\^a}mara and Micussi, Cabral Maria Thereza Albuquerque Barbosa and Magalh{\~a}es, Gomes Adriana", title="A Health App for Evidence-Based Postpartum Information: Development and Validation Study", journal="JMIR Hum Factors", year="2023", month="Jul", day="13", volume="10", pages="e38706", keywords="women's health", keywords="postpartum period", keywords="comprehensive health care", keywords="health technology", keywords="mobile applications", abstract="Background: After childbirth, women undergo substantial physical and emotional changes. Therefore, it is important to provide them with information that helps them identify what is expected during this stage, as well as signs and symptoms that indicate complications after they have been discharged from the hospital. Objective: This study aimed to develop a health app---Towards Motherhood---that provides evidence-based information about the postpartum period and evaluate the usability of the app with the target population. Methods: This was a validation study involving 80 participants, including 24 professionals from the obstetric health field, 15 professionals from the technology field, and 41 postpartum women. The app was developed using React Native technology. Health professionals evaluated the app's content using the Content Validity Index, technology professionals completed a validated evaluation to assess the appearance of the app, and postpartum women completed the System Usability Scale (SUS) to measure the usability of the app. Results: The measurement of content validity using a Likert scale obtained an approval score of 99\%. Regarding the app's appearance, 92\% of responses were positive, reflecting favorable approval. The SUS usability score was 86.2, which represents excellent acceptance. Conclusions: The Towards Motherhood mobile app is a valid tool for promoting self-care during the postpartum period. The app's evidence-based information, user-friendly design, and high usability make it an essential resource for women during this critical stage of their live. ", doi="10.2196/38706", url="https://humanfactors.jmir.org/2023/1/e38706", url="http://www.ncbi.nlm.nih.gov/pubmed/37440288" } @Article{info:doi/10.2196/40111, author="Dingwall, M. Kylie and Povey, Josie and Sweet, Michelle and Friel, Jaylene and Shand, Fiona and Titov, Nickolai and Wormer, Julia and Mirza, Tamoor and Nagel, Tricia", title="Feasibility and Acceptability of the Aboriginal and Islander Mental Health Initiative for Youth App: Nonrandomized Pilot With First Nations Young People", journal="JMIR Hum Factors", year="2023", month="Jun", day="7", volume="10", pages="e40111", keywords="digital mental health", keywords="First Nations", keywords="Indigenous", keywords="young people", keywords="feasibility study", keywords="digital health", keywords="mental health", keywords="depression", keywords="mHealth", keywords="mobile app", keywords="aboriginal", keywords="acceptibility", keywords="youth", abstract="Background: Despite young First Nations Australians being typically healthy, happy, and connected to family and culture, high rates of emotional distress, suicide, and self-harm are also observed. Differing worldviews of service providers and First Nations young people regarding illness and treatment practices, language differences, culturally inappropriate service models, geographical remoteness, and stigma can all inhibit access to appropriate mental health support. Mental health treatments delivered digitally (digital mental health; dMH) offer flexible access to evidence-based, nonstigmatizing, low-cost treatment and early intervention on a broad scale. There is a rapidly growing use and acceptance of these technologies among young First Nations people. Objective: The objective was to assess the feasibility, acceptability, and use of the newly developed Aboriginal and Islander Mental Health Initiative for Youth (AIMhi-Y) app and determine the feasibility of study procedures in preparation for future assessments of effectiveness. Methods: This was a nonrandomized pre-post study using mixed methods. First Nations young people aged 12-25 years who provided consent (with parental consent where appropriate) and possessed the ability to navigate a simple app with basic English literacy were included. Researchers conducted one face-to-face 20-minute session with participants to introduce and orient them to the AIMhi-Y app. The app integrates culturally adapted low-intensity cognitive behavioral therapy (CBT), psychoeducation, and mindfulness-based activities. Participants received supportive text messages weekly throughout the 4-week intervention period and completed assessments of psychological distress, depression, anxiety, substance misuse, help-seeking, service use, and parent-rated strengths and difficulties at baseline and 4 weeks. Qualitative interviews and rating scales were completed at 4 weeks to gain feedback on subjective experience, look and style, content, overall rating, check-ins, and involvement in the study. App use data were collected. Results: Thirty young people (17 males and 13 females) aged between 12 and 18 (mean 14.0, SD 1.55) years were assessed at baseline and 4 weeks. Repeated measures 2-tailed t tests showed improvements in well-being measures that were statistically and clinically significant for psychological distress (Kessler Psychological Distress Scale, 10-item) and depressive symptoms (Patient Health Questionnaire, 2-item). Participants spent on average 37 minutes in the app. The app was rated positively, with mean ratings of 4 out of 5 points (on scales of 1-5). Participants reported that they found the app easy to use, culturally relevant, and useful. The feasibility of the study was demonstrated with a 62\% recruitment rate, a 90\% retention rate, and high study acceptability ratings. Conclusions: This study supports earlier research suggesting that dMH apps that are appropriately designed with and for the target populations are a feasible and acceptable means of lowering symptoms for mental health disorders among First Nations youth. ", doi="10.2196/40111", url="https://humanfactors.jmir.org/2023/1/e40111", url="http://www.ncbi.nlm.nih.gov/pubmed/37285184" } @Article{info:doi/10.2196/41810, author="Stawarz, Katarzyna and Liang, Ju Ian and Alexander, Lyndsay and Carlin, Angela and Wijekoon, Anjana and Western, J. Max", title="Exploring the Potential of Technology to Promote Exercise Snacking for Older Adults Who Are Prefrail in the Home Setting: User-Centered Design Study", journal="JMIR Aging", year="2023", month="May", day="24", volume="6", pages="e41810", keywords="physical activity", keywords="older adults", keywords="Internet of Things", keywords="user-centered design", keywords="qualitative research", keywords="mobile phone", abstract="Background: Older adults are at increased risk of falls, injury, and hospitalization. Maintaining or increasing participation in physical activity during older age can prevent some of the age-related declines in physical functioning that contribute to loss of independence and low reported quality of life. Exercise snacking may overcome some commonly cited barriers to exercise and encourage older adults to engage in muscle strength and balance activity, but the best way to deliver and support this novel format remains unknown. Objective: Our aim was to explore how the novel exercise snacking approach, that is, incorporating short bouts of strength and balance activities into everyday routines, could be supported by technology within a home setting and what types of technologies would be acceptable for older adults who are prefrail. Methods: Following a user-centered design process, 2 design workshops (study 1) were conducted first to understand older adults' (n=11; aged 69-89 years) attitudes toward technology aimed at supporting exercise snacking at home and to inform the design of 2 prototypes. Next, based on the findings of study 1, an exploratory pilot study (study 2) was conducted over 1 day with 2 prototypes (n=5; aged 69-80 years) at the participants' homes. Participants were interviewed over the telephone afterward about their experience. Transcripts were analyzed using framework analysis. Results: The results showed that the participants were positive toward using technology at home to support exercise snacking, but both exercises and technology would need to be simple and match the participants' everyday routines. Workshop discussions (study 1) led to the design of 2 prototypes using a pressure mat to support resistance and balance exercises. The exploratory pilot study (study 2) participants reported the potential in using smart devices to support exercise snacking, but the design of the initial prototypes influenced the participants' attitudes toward them. It also hampered the acceptability of these initial versions and highlighted the challenges in fitting exercise snacking into everyday life. Conclusions: Older adults were positive about using technology in their homes to support strength and balance exercise snacking. However, although promising, the initial prototypes require further refinement and optimization before feasibility, acceptability, and efficacy testing. Technologies to support exercise snacking need to be adaptable and personalized to individuals, to ensure that users are snacking on balance and strengthening exercises that are appropriate for them. ", doi="10.2196/41810", url="https://aging.jmir.org/2023/1/e41810", url="http://www.ncbi.nlm.nih.gov/pubmed/37223992" } @Article{info:doi/10.2196/41328, author="Mourali, Mehdi and Benham, L. Jamie and Lang, Raynell and Fullerton, M. Madison and Boucher, Jean-Christophe and Cornelson, Kirsten and Oxoby, J. Robert and Constantinescu, Cora and Tang, Theresa and Marshall, A. Deborah and Hu, Jia", title="Persuasive Messages for Improving Adherence to COVID-19 Prevention Behaviors: Randomized Online Experiment", journal="JMIR Hum Factors", year="2023", month="Feb", day="13", volume="10", pages="e41328", keywords="COVID-19", keywords="messaging", keywords="persuasion", keywords="behavioral intentions", keywords="public health", keywords="compliance", keywords="prevention", keywords="physical distance", keywords="mask", keywords="sick", keywords="effectiveness", keywords="behavior", abstract="Background: Adherence to nonpharmaceutical interventions for COVID-19, including physical distancing, masking, staying home while sick, and avoiding crowded indoor spaces, remains critical for limiting the spread of COVID-19. Objective: The aim of this study was to test the effectiveness of using various persuasive appeals (deontological moral frame, empathy, identifiable victim, goal proximity, and reciprocity) at improving intentions to adhere to prevention behaviors. Methods: A randomized online experiment using a representative sample of adult Canadian residents with respect to age, ethnicity, and province of residence was performed from March 3 to March 6, 2021. Participants indicated their intentions to follow public health guidelines, saw one of six flyers featuring a persuasive appeal or no appeal, and then rated their intentions a second time. Known correlates of attitudes toward public health measures were also measured. Results: Intentions to adhere to public health measures increased in all appeal conditions. The message featuring an empathy appeal resulted in a greater increase in intentions than the control (no appeal) message. Moreover, the effectiveness of persuasive appeals was moderated by baseline intentions. Deontological, empathy, identifiable victim, and reciprocity appeals improved intentions more than the control message, but only for people with lower baseline intentions to adhere to nonpharmaceutical interventions. Conclusions: Public health marketing campaigns aiming to increase adherence to COVID-19 protective behaviors could achieve modest gains by employing a range of persuasive appeals. However, to maximize impact, it is important that these campaigns be targeted to the right individuals. Trial Registration: ClinicalTrials.gov NCT05722106; https://clinicaltrials.gov/ct2/show/NCT05722106 ", doi="10.2196/41328", url="https://humanfactors.jmir.org/2023/1/e41328", url="http://www.ncbi.nlm.nih.gov/pubmed/36508732" } @Article{info:doi/10.2196/34855, author="Ugaya Mazza, Larissa and Fadrique, Xavier Laura and Kuang, Amethyst and Donovska, Tania and Vaillancourt, H{\'e}l{\`e}ne and Teague, Jennifer and Hailey, A. Victoria and Michell, Stephen and Morita, Pelegrini Plinio", title="Exploring the Use of Pictograms in Privacy Agreements to Facilitate Communication Between Users and Data Collecting Entities: Randomized Controlled Trial", journal="JMIR Hum Factors", year="2023", month="Jan", day="25", volume="10", pages="e34855", keywords="pictograms", keywords="privacy agreements", keywords="user trust", keywords="transparency", abstract="Background: Privacy agreements can foster trust between users and data collecting entities by reducing the fear of data sharing. Users typically identify concerns with their data privacy settings, but due to the complexity and length of privacy agreements, users opt to quickly consent and agree to the terms without fully understanding them. Objective: This study explores the use of pictograms as potential elements to assist in improving the transparency and explanation of privacy agreements. Methods: During the development of the pictograms, the Double Diamond design process was applied for 3 instances of user interactions and 3 iterations of pictograms. The testing was done by performing a comparative study between a control group, which received no pictograms, and an experimental group, which received pictograms. The pictograms were individually tested to assess their efficacy by using an estimated comprehension of information symbols test. Results: A total of 57 participants were recruited for the pictogram evaluation phase. With the addition of pictograms, the overall understanding improved by 13\% (P=.001), and the average time spent answering the questions decreased by 57.33 seconds. A 9\% decrease in perceived user frustration was also reported by users, but the difference was not significant ($\chi$24=4.80; P=.31). Additionally, none of the pictograms passed the estimated comprehension of information symbols test, with 7 being discarded immediately and 5 requiring further testing to assess their efficacy. Conclusions: The addition of pictograms appeared to improve users' understanding of the privacy agreements, despite the pictograms needing further changes to be more understandable. This proves that with the aid of pictographic images, it is possible to make privacy agreements more accessible, thereby allowing trust and open communication to be fostered between users and data collecting entities. Trial Registration: ClinicalTrials.gov NCT05631210; https://clinicaltrials.gov/ct2/show/NCT05631210 ", doi="10.2196/34855", url="https://humanfactors.jmir.org/2023/1/e34855", url="http://www.ncbi.nlm.nih.gov/pubmed/36696167" } @Article{info:doi/10.2196/35070, author="Bondaronek, Paulina and Dicken, J. Samuel and Singh Jennings, Seth and Mallion, Verity and Stefanidou, Chryssa", title="Barriers to and Facilitators of the Use of Digital Tools in Primary Care to Deliver Physical Activity Advice: Semistructured Interviews and Thematic Analysis", journal="JMIR Hum Factors", year="2022", month="Aug", day="30", volume="9", number="3", pages="e35070", keywords="physical activity", keywords="capability, opportunity, and motivation---behavior", keywords="COM-B", keywords="Theoretical Domains Framework", keywords="TDF", keywords="primary care professionals", keywords="health care professionals", keywords="physical activity advice", abstract="Background: Physical inactivity is a leading risk factor for many health conditions, including cardiovascular disease, diabetes, and cancer; therefore, increasing physical activity (PA) is a public health priority. Health care professionals (HCPs) in primary care are pivotal in addressing physical inactivity; however, few HCPs provide PA advice to patients. There can be obstacles to delivering PA advice, including lack of time, confidence, or knowledge. Digital technology has the potential to overcome obstacles and facilitate delivering PA advice. However, it is unknown if and how digital tools are used to deliver PA advice in primary care consultations and what factors influence their use. Objective: We aimed to understand the use of digital tools to support primary care consultations and to identify the barriers to and facilitators of using these systems. Methods: Overall, 25 semistructured interviews were conducted with primary care HCPs. Professionals were sampled based on profession (general practitioners, practice nurses, and health care assistants), prevalence of long-term conditions within their practice area, and rural-urban classification. The data were analyzed thematically to identify the influences on the use of digital tools. Themes were categorized using the COM-B (capability, opportunity, and motivation---behavior) model and the Theoretical Domains Framework to identify the barriers to and facilitators of using digital tools to support the delivery of PA advice in primary care consultations. Results: The identified themes fell within 8 domains of the Theoretical Domains Framework. The most prominent influence (barrier or facilitator) within psychological capability was having the skills to use digital tools. Training in the use of digital tools was also mentioned several times. The most notable influences within physical opportunity were limited digital tools to prompt/support the provision of PA advice, time constraints, efficiency of digital tools, simplicity and ease of use of digital tools, and integration with existing systems. Other physical opportunity influences included lack of access to digital tools and technical support in the use of digital tools. Within social opportunity, a notable barrier was that digital tools reduce interpersonal communication with patients. Patient preference was also identified. Several important influences were within reflective motivation, including confidence to use digital tools, beliefs about the usefulness of digital tools, the belief that digital tools ``are the way forward,'' beliefs related to data privacy and security concerns, and perceptions about patient capabilities. About automatic motivation, influences included familiarity and availability regarding digital tools and the fact that digital tools prompt behavior. Conclusions: A variety of influences were identified on the use of digital tools to support primary care consultations. These findings provide a foundation for designing a digital tool addressing barriers and leverages the facilitators to support PA advice provision within primary care to elicit patient behavior change and increase PA. ", doi="10.2196/35070", url="https://humanfactors.jmir.org/2022/3/e35070", url="http://www.ncbi.nlm.nih.gov/pubmed/36040764" } @Article{info:doi/10.2196/35079, author="Alyami, Mohsen and Serlachius, Anna and Law, Mikaela and Murphy, Rinki and Almigbal, H. Turky and Lyndon, Mataroria and Batais, A. Mohammed and Algaw, K. Rawabi and Broadbent, Elizabeth", title="Utility and Acceptability of a Brief Type 2 Diabetes Visual Animation: Mixed Methods Feasibility Study", journal="JMIR Form Res", year="2022", month="Aug", day="9", volume="6", number="8", pages="e35079", keywords="illness perception", keywords="visualization", keywords="animation", keywords="intervention", keywords="mobile phone", keywords="type 2 diabetes mellitus", abstract="Background: Visualizations of illness and treatment processes are promising interventions for changing unhelpful perceptions and improving health outcomes. However, these are yet to be tested in patients with type 2 diabetes mellitus (T2DM). Objective: This study assesses the cross-cultural acceptability and potential effectiveness of a brief visual animation of T2DM at changing unhelpful illness and treatment perceptions and self-efficacy among patients and family members in 2 countries, New Zealand and Saudi Arabia. Health care professionals' views on visualization are also explored. Methods: A total of 52 participants (n=39, 75\% patients and family members and n=13, 25\% health care professionals) were shown a 7-minute T2DM visual animation. Patients and family members completed a questionnaire on illness and treatment perceptions and self-efficacy before and immediately after the intervention and completed semistructured interviews. Health care professionals completed written open-ended questions. Means and 95\% CIs are reported to estimate potential effectiveness. Inductive thematic analysis was conducted on qualitative data. Results: All participants rated the visual animation as acceptable and engaging. Four main themes were identified: animation-related factors, impact of the animation, animation as an effective format for delivering information, and management-related factors. Effect sizes (ranged from 0.10 to 0.56) suggested potential effectiveness for changing illness and treatment perceptions and self-efficacy among patients and family members. Conclusions: Visualizations are acceptable and may improve the perceptions of patients' with diabetes in a short time frame. This brief visual animation has the potential to improve current T2DM education. A subsequent randomized controlled trial to investigate the effects on illness and treatment perceptions, adherence, glycemic control, and unplanned hospital admission is being prepared. ", doi="10.2196/35079", url="https://formative.jmir.org/2022/8/e35079", url="http://www.ncbi.nlm.nih.gov/pubmed/35943787" } @Article{info:doi/10.2196/33411, author="Siddhpuria, Shailee and Breau, Genevieve and Lackie, E. Madison and Lavery, M. Brynn and Ryan, Deirdre and Shulman, Barbara and Kennedy, L. Andrea and Brotto, A. Lori", title="Women's Preferences and Design Recommendations for a Postpartum Depression Psychoeducation Intervention: User Involvement Study", journal="JMIR Form Res", year="2022", month="Jun", day="23", volume="6", number="6", pages="e33411", keywords="postpartum", keywords="depression", keywords="perinatal mental health", keywords="patient engagement", keywords="women's health", keywords="qualitative", keywords="psychoeducation", keywords="digital tools", abstract="Background: Postpartum depression (PPD) is one of the leading causes of maternal morbidity, affecting up to 18\% of Canadian new mothers. Yet, PPD often remains untreated due to numerous barriers in access to care, including location and cost. Development of eHealth interventions in collaboration with patient partners offers an exciting opportunity to fill this care gap and provide effective and affordable care to new parents across British Columbia. Objective: Our aim was to determine the content and design preferences of women previously diagnosed with PPD to inform changes to the development of a web-enabled intervention for education and management of PPD. Methods: Webpage prototypes were created to mimic the web-enabled resource using findings from completed focus group research that assessed what women want in a web-enabled support resource for PPD. A convenience sample of women aged >18 years and previously diagnosed with PPD was recruited. Feedback was collected on the content and design of the prototypes via semistructured interviews and online surveys. Qualitative, inductive analytic, and quantitative methods were used. Results: A total of 9 women (mean age 37.2 years, SD 4.8 years) completed the interview and a majority of the survey. The following 6 themes were identified: (1) inefficacy of text-heavy layouts, (2) highlighting key information, (3) clarity/understandability of the language, (4) finding support groups, (5) validation and immediate help for feelings of isolation, and (6) helpfulness and accessibility of the resource. Each theme identified elements of content or design that were either effective or may be improved upon. Most women (8/9, 89\%) favored content relating to foundational knowledge of PPD, such as symptoms and management options. The layout, language, and content were found to be generally easy to understand, clear, trustworthy, and helpful. Conclusions: Six key areas were identified by women previously diagnosed with PPD, as requiring focus in a web-enabled psychoeducation program. Consistent with past research, this study also found that support and enthusiasm for web-enabled programs support PPD management as an adjunct to other evidence-based treatments. ", doi="10.2196/33411", url="https://formative.jmir.org/2022/6/e33411", url="http://www.ncbi.nlm.nih.gov/pubmed/35737435" } @Article{info:doi/10.2196/39133, author="Lotto, Matheus and Santana Jorge, Olivia and S{\'a} Menezes, Tamires and Ramalho, Maria Ana and Marchini Oliveira, Thais and Bevilacqua, Fernando and Cruvinel, Thiago", title="Psychophysiological Reactions of Internet Users Exposed to Fluoride Information and Disinformation: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2022", month="Jun", day="16", volume="11", number="6", pages="e39133", keywords="fluoride", keywords="disinformation", keywords="randomized controlled trial", keywords="social media", keywords="internet", abstract="Background: False messages on the internet continually propagate possible adverse effects of fluoridated oral care products and water, despite their essential role in preventing and controlling dental caries. Objective: This study aims to evaluate the patterns of psychophysiological reactions of adults after the consumption of internet-based fluoride-related information and disinformation. Methods: A 2-armed, single-blinded, parallel, and randomized controlled trial will be conducted with 58 parents or caregivers of children who attend the Clinics of Pediatric Dentistry at the Bauru School of Dentistry, considering an attrition of 10\% and a significance level of 5\%. The participants will be randomized into test and intervention groups, being respectively exposed to fluoride-related information and disinformation presented on a computer with simultaneous monitoring of their psychophysiological reactions, including analysis of their heart rates (HRs) and 7 facial features (mouth outer, mouth corner, eye area, eyebrow activity, face area, face motion, and facial center of mass). Then, participants will respond to questions about the utility and truthfulness of content, their emotional state after the experiment, eHealth literacy, oral health knowledge, and socioeconomic characteristics. The Shapiro-Wilk and Levene tests will be used to determine the normality and homogeneity of the data, which could lead to further statistical analyses for elucidating significant differences between groups, using parametric (Student t test) or nonparametric (Mann-Whitney U test) analyses. Moreover, multiple logistic regression models will be developed to evaluate the association of distinct variables with the psychophysiological aspects. Only factors with significant Wald statistics in the simple analysis will be included in the multiple models (P<.2). Furthermore, receiver operating characteristic curve analysis will be performed to determine the accuracy of the remote HR with respect to the measured HR. For all analyses, P<.05 will be considered significant. Results: From June 2022, parents and caregivers who frequent the Clinics of Pediatric Dentistry at the Bauru School of Dentistry will be invited to participate in the study and will be randomized into 1 of the 2 groups (control or intervention). Data collection is expected to be completed in December 2023. Subsequently, the authors will analyze the data and publish the findings of the clinical trial by June 2024. Conclusions: This randomized controlled trial aims to elucidate differences between psychophysiological patterns of adults exposed to true or false oral health content. This evidence may support the development of further studies and digital strategies, such as neural network models to automatically detect disinformation available on the internet. Trial Registration: Brazilian Clinical Trials Registry (RBR-7q4ymr2) U1111-1263-8227; https://tinyurl.com/2kf73t3d International Registered Report Identifier (IRRID): PRR1-10.2196/39133 ", doi="10.2196/39133", url="https://www.researchprotocols.org/2022/6/e39133", url="http://www.ncbi.nlm.nih.gov/pubmed/35708767" } @Article{info:doi/10.2196/33967, author="Brown, G. Ethan and Schleimer, Erica and Bledsoe, O. Ian and Rowles, William and Miller, A. Nicolette and Sanders, J. Stephan and Rankin, P. Katherine and Ostrem, L. Jill and Tanner, M. Caroline and Bove, Riley", title="Enhancing Clinical Information Display to Improve Patient Encounters: Human-Centered Design and Evaluation of the Parkinson Disease-BRIDGE Platform", journal="JMIR Hum Factors", year="2022", month="May", day="6", volume="9", number="2", pages="e33967", keywords="human-centered design", keywords="personal health record", keywords="visualization in eHealth", keywords="Parkinson disease", keywords="digital health", abstract="Background: People with Parkinson disease (PD) have a variety of complex medical problems that require detailed review at each clinical encounter for appropriate management. Care of other complex conditions has benefited from digital health solutions that efficiently integrate disparate clinical information. Although various digital approaches have been developed for research and care in PD, no digital solution to personalize and improve communication in a clinical encounter is readily available. Objective: We intend to improve the efficacy and efficiency of clinical encounters with people with PD through the development of a platform (PD-BRIDGE) with personalized clinical information from the electronic health record (EHR) and patient-reported outcome (PRO) data. Methods: Using human-centered design (HCD) processes, we engaged clinician and patient stakeholders in developing PD-BRIDGE through three phases: an inspiration phase involving focus groups and discussions with people having PD, an ideation phase generating preliminary mock-ups for feedback, and an implementation phase testing the platform. To qualitatively evaluate the platform, movement disorders neurologists and people with PD were sent questionnaires asking about the technical validity, usability, and clinical relevance of PD-BRIDGE after their encounter. Results: The HCD process led to a platform with 4 modules. Among these, 3 modules that pulled data from the EHR include a longitudinal module showing motor ratings over time, a display module showing the most recently collected clinical rating scales, and another display module showing relevant laboratory values and diagnoses; the fourth module displays motor symptom fluctuation based on an at-home diary. In the implementation phase, PD-BRIDGE was used in 17 clinical encounters for patients cared for by 1 of 11 movement disorders neurologists. Most patients felt that PD-BRIDGE facilitated communication with their clinician (n=14, 83\%) and helped them understand their disease trajectory (n=11, 65\%) and their clinician's recommendations (n=11, 65\%). Neurologists felt that PD-BRIDGE improved their ability to understand the patients' disease course (n=13, 75\% of encounters), supported clinical care recommendations (n=15, 87\%), and helped them communicate with their patients (n=14, 81\%). In terms of improvements, neurologists noted that data in PD-BRIDGE were not exhaustive in 62\% (n=11) of the encounters. Conclusions: Integrating clinically relevant information from EHR and PRO data into a visually efficient platform (PD-BRIDGE) can facilitate clinical encounters with people with PD. Developing new modules with more disparate information could improve these complex encounters even further. ", doi="10.2196/33967", url="https://humanfactors.jmir.org/2022/2/e33967", url="http://www.ncbi.nlm.nih.gov/pubmed/35522472" } @Article{info:doi/10.2196/30962, author="Lungu, Adrian Daniel and R{\o}islien, Jo and Wiig, Siri and Shortt, Therese Marie and Ferr{\`e}, Francesca and Berg, Hilde Siv and Thune, Henriette and Br{\o}nnick, Kallesten Kolbj{\o}rn", title="The Role of Recipient Characteristics in Health Video Communication Outcomes: Scoping Review", journal="J Med Internet Res", year="2021", month="Dec", day="30", volume="23", number="12", pages="e30962", keywords="health communication", keywords="video communication", keywords="communication outcomes", keywords="recipient characteristics", keywords="recipient factors", keywords="health video communication", abstract="Background: The importance of effective communication during public health emergencies has been highlighted by the World Health Organization, and it has published guidelines for effective communication in such situations. With video being a popular medium, video communication has been a growing area of study over the past decades and is increasingly used across different sectors and disciplines, including health. Health-related video communication gained momentum during the SARS-CoV-2 pandemic, and video was among the most frequently used modes of communication worldwide. However, although much research has been done regarding different characteristics of video content (the message) and its delivery (the messenger), there is a lack of knowledge about the role played by the characteristics of the recipients for the creation of effective communication. Objective: The aim of this review is to identify how health video communication outcomes are shaped by recipient characteristics, as such characteristics might affect the effectiveness of communication. The main research question of the study is as follows: do the characteristics of the recipients of health videos affect the outcomes of the communication? Methods: A scoping review describing the existing knowledge within the field was conducted. We searched for literature in 3 databases (PubMed, Scopus, and Embase) and defined eligibility criteria based on the relevance to the research question. Recipient characteristics and health video communication outcomes were identified and classified. Results: Of the 1040 documents initially identified, 128 (12.31\%) met the criteria for full-text assessment, and 39 (3.75\%) met the inclusion criteria. The included studies reported 56 recipient characteristics and 42 communication outcomes. The reported associations between characteristics and outcomes were identified, and the potential research opportunities were discussed. Contributions were made to theory development by amending the existing framework of the Integrated-Change model, which is an integrated model of motivational and behavioral change. Conclusions: Although several recipient characteristics and health video communication outcomes were identified, there is a lack of robust empirical evidence on the association between them. Further research is needed to understand how the preceding characteristics of the recipients might affect the various outcomes of health video communication. ", doi="10.2196/30962", url="https://www.jmir.org/2021/12/e30962", url="http://www.ncbi.nlm.nih.gov/pubmed/34967758" } @Article{info:doi/10.2196/30603, author="Alvarez-Perez, Yolanda and Perestelo-Perez, Lilisbeth and Rivero-Santana, Amado and Wagner, M. Ana and Torres-Casta{\~n}o, Alezandra and Toledo-Ch{\'a}varri, Ana and Duarte-D{\'i}az, Andrea and Alvarado-Martel, D{\'a}cil and Piccini, Barbara and Van den Broucke, Stephan and Vandenbosch, Jessica and Gonz{\'a}lez-Gonz{\'a}lez, Carina and Perello, Michelle and Serrano-Aguilar, Pedro and ", title="Cocreation of Massive Open Online Courses to Improve Digital Health Literacy in Diabetes: Pilot Mixed Methods Study", journal="JMIR Diabetes", year="2021", month="Dec", day="13", volume="6", number="4", pages="e30603", keywords="diabetes", keywords="digital health literacy", keywords="health education", keywords="MOOC", abstract="Background: Self-management education is a fundamental aspect in the health care of people with diabetes to develop the necessary skills for the improvement of health outcomes. Patients are required to have the competencies to manage electronic information resources---that is, an appropriate level of digital health literacy. The European project IC-Health aimed to improve digital health literacy among people with diabetes through the cocreation of massive open online courses (MOOCs). Objective: We report the preliminary results obtained in 3 participating countries in the IC-Health project (Italy, Spain, and Sweden) regarding (1) experience of the participants during the cocreation process of MOOCs, (2) perceived changes in their digital health literacy level after using MOOCs, and (3) a preliminary assessment of the acceptability of MOOCs. Methods: The cocreation of the MOOCs included focus groups with adults and adolescents with diabetes and the creation of independent communities of practice for type 1 diabetes and type 2 diabetes participants aimed to co-design the MOOCs. Quantitative measures of the acceptability of MOOCs, experience in the cocreation process, and increase in digital health literacy (dimensions of finding, understanding, and appraisal) were assessed. Results: A total of 28 participants with diabetes participated in focus groups. Adults and adolescents agreed that the internet is a secondary source of health-related information. A total of 149 participants comprised the diabetes communities of practice. A total of 9 MOOCs were developed. Acceptability of the MOOCs and the cocreation experience were positively valued. There was a significant improvement in digital health literacy in both adults and adolescents after using MOOCs (P<.001). Conclusions: Although the results presented on self-perceived digital health literacy are preliminary and exploratory, this pilot study suggests that IC-Health MOOCs represent a promising tool for the medical care of diabetes, being able to help reduce the limitations associated with low digital health literacy and other communication barriers in the diabetes population. ", doi="10.2196/30603", url="https://diabetes.jmir.org/2021/4/e30603", url="http://www.ncbi.nlm.nih.gov/pubmed/34898453" } @Article{info:doi/10.2196/21681, author="Claflin, B. Suzi and Campbell, A. Julie and Doherty, Kathleen and Farrow, Maree and Bessing, Barnabas and Taylor, V. Bruce", title="Evaluating Course Completion, Appropriateness, and Burden in the Understanding Multiple Sclerosis Massive Open Online Course: Cohort Study", journal="J Med Internet Res", year="2021", month="Dec", day="7", volume="23", number="12", pages="e21681", keywords="multiple sclerosis", keywords="massive open online course", keywords="health promotion", keywords="eHealth education", keywords="mobile phone", abstract="Background: Massive open online course (MOOC) research is an emerging field; to date, most research in this area has focused on participant engagement. Objective: The aim of this study is to evaluate both participant engagement and measures of satisfaction, appropriateness, and burden for a MOOC entitled Understanding Multiple Sclerosis (MS) among a cohort of 3518 international course participants. Methods: We assessed the association of key outcomes with participant education level, MS status, caregiver status, sex, and age using summary statistics, and 2-tailed t tests, and chi-square tests. Results: Of the 3518 study participants, 928 (26.37\%) were people living with MS. Among the 2590 participants not living with MS, 862 (33.28\%) identified as formal or informal caregivers. Our key findings were as follows: the course completion rate among study participants was 67.17\% (2363/3518); the course was well received, with 96.97\% (1502/1549) of participants satisfied, with an appropriate pitch and low burden (a mean of 2.2 hours engagement per week); people living with MS were less likely than those not living with MS to complete the course; and people with a recent diagnosis of MS, caregivers, and participants without a university education were more likely to apply the material by course completion. Conclusions: The Understanding MS MOOC is fit for purpose; it presents information in a way that is readily understood by course participants and is applicable in their lives. ", doi="10.2196/21681", url="https://www.jmir.org/2021/12/e21681", url="http://www.ncbi.nlm.nih.gov/pubmed/34878985" } @Article{info:doi/10.2196/26252, author="Pant, Ichhya and Rimal, Rajiv and Yilma, Hagere and Bingenheimer, Jeffrey and Sedlander, Erica and Behera, Sibabrata", title="mHealth for Anemia Reduction: Protocol for an Entertainment Education--Based Dual Intervention", journal="JMIR Res Protoc", year="2021", month="Nov", day="22", volume="10", number="11", pages="e26252", keywords="mHealth", keywords="interactive", keywords="voice response", keywords="entertainment", keywords="education", keywords="rural", keywords="anemia", keywords="bystander", keywords="violence against women", abstract="Background: More than half of the women of reproductive age (aged 15-49 years) are anemic in India. The uptake of and adherence to iron folic acid (IFA) supplements remain low despite sustained efforts to increase their use. With India's burgeoning digital environment, mobile phones offer a potential medium for increasing their uptake, especially when combined with interactive voice messages that deliver entertaining stories infused with norms-based educational messages. Objective: This study aims to investigate whether a norms-based entertainment education mobile health intervention can increase self-efficacy for IFA adherence among women of reproductive age in Odisha, India. Methods: Mobile reduction in anemia through normative innovations (mRANI) is a randomized 2-arm study that includes assessments before and after the intervention. All study participants will be recruited from the intervention arm of the parent reduction in anemia through normative innovations trial only. Although the usual practice is to randomize participants either to a treatment arm or a usual care control arm, we will assign the mRANI control group to another entertainment education--based treatment group that is designed to improve bystander intervention to reduce violence against women. Data collection for the mRANI study is embedded in the parent trial and will include baseline and end line assessments. The primary outcomes are self-efficacy for IFA adherence and violence against women--related bystander intervention. The inclusion criteria for the mRANI study are participation in the parent trial and phone ownership. Women (approximately n=400) who meet the mRANI inclusion criteria will be randomly assigned to the IFA arm or the bystander arm. Ordinary least squares regression with robust SEs will be conducted to assess between-group comparisons at the end line. A mediation analysis will be conducted to examine whether social norms and interactivity mediate the relationship between intervention exposure and primary outcomes in both arms. Real-time monitoring data will offer insights into intervention receptivity and audience engagement. Results: Data collection for the mRANI study is integrated within the parent trial. Household surveys were conducted between February and March of 2021. Responses on the mRANI study's primary and secondary outcomes were collected from 381 participants. The data analysis is expected to be completed by October 2021. Conclusions: This study will provide evidence on whether a mobile health norms--based entertainment education intervention can increase self-efficacy for IFA adherence and violence against women--related bystander intervention. International Registered Report Identifier (IRRID): PRR1-10.2196/26252 ", doi="10.2196/26252", url="https://www.researchprotocols.org/2021/11/e26252", url="http://www.ncbi.nlm.nih.gov/pubmed/34812735" } @Article{info:doi/10.2196/19915, author="Tian, Xu and Yi, Li-Juan and Han, Yang and Chen, Hui and Liu, Xiao-Ling and Chen, Wei-Qing and Jim{\'e}nez-Herrera, F. Maria", title="Comparative Effectiveness of Enhanced Patient Instructions for Bowel Preparation Before Colonoscopy: Network Meta-analysis of 23 Randomized Controlled Trials", journal="J Med Internet Res", year="2021", month="Oct", day="25", volume="23", number="10", pages="e19915", keywords="colonoscopy", keywords="bowel preparation", keywords="patient instruction", keywords="systematic review", keywords="network meta-analysis", abstract="Background: Various enhanced patient instructions (EPIs) have been used for bowel preparation (BP) and our previous meta-analysis also demonstrated the efficacy of EPIs in increasing the colonic polyp and adenoma detection rates; however, the optimal method for adequate BP has not yet been developed. Objective: We performed a network meta-analysis to determine the optimal instructions. Methods: We searched for randomized controlled trials (RCTs) comparing the effectiveness of EPIs with each other or standard patient instructions (SPIs) for BP. We performed direct and Bayesian network meta-analyses for all instructions and used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria to appraise the quality of evidence. Results: We included 23 RCTs (7969 patients) comparing 10 different instructions. In direct meta-analyses, most of the EPIs, except visual aids and mobile apps, increased the adequate preparation rate (APR). Network meta-analyses showed that additional explanations were superior to visual aids (odds ratio [OR] 0.35, 95\% CI 0.19-0.59), telephone calls (OR 0.62, 95\% CI 0.37-0.99), educational videos (OR 0.79, 95\% CI 0.5-0.77), and mobile apps (OR 0.33, 95\% CI 0.14-0.68) with low-to-high-quality evidence; newly designed booklets (OR 3.28, 95\% CI 1.59-6.16), SMS text messaging (OR 2.33, 95\% CI 1.28-3.91), telephone calls (OR 1.86, 95\% CI 1.03-1.78), educational videos (OR 2.33, 95\% CI 1.40-3.65), and social media applications (OR 2.42, 95\% CI 1.4-3.93) were superior to visual aids and mobile apps with low-to-high-quality evidence. SMS text messaging, telephone calls, and social media applications increase adherence to and satisfaction with the BP regime. Social media applications reduce the risk of adverse events (AEs). Telephone calls and social media applications increase the polyp detection rate (PDR). Conclusions: Newly designed booklets, telephone calls, educational videos, and social media applications can improve the quality of BP. Telephone calls and social media applications improve adherence to and satisfaction with the BP regime, reduce the risk of AEs, and increase the PDR. Trial Registration: INPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols) INPLASY2020120103; https://inplasy.com/inplasy-2020-12-0103/ ", doi="10.2196/19915", url="https://www.jmir.org/2021/10/e19915", url="http://www.ncbi.nlm.nih.gov/pubmed/34694227" } @Article{info:doi/10.2196/32921, author="Xiao, Jin and Luo, Jiebo and Ly-Mapes, Oriana and Wu, Tong Tong and Dye, Timothy and Al Jallad, Nisreen and Hao, Peirong and Ruan, Jinlong and Bullock, Sherita and Fiscella, Kevin", title="Assessing a Smartphone App (AICaries) That Uses Artificial Intelligence to Detect Dental Caries in Children and Provides Interactive Oral Health Education: Protocol for a Design and Usability Testing Study", journal="JMIR Res Protoc", year="2021", month="Oct", day="22", volume="10", number="10", pages="e32921", keywords="artificial intelligence", keywords="smartphone app", keywords="mDentistry", keywords="dental caries", keywords="underserved population", keywords="mobile dentistry", abstract="Background: Early childhood caries (ECC) is the most common chronic childhood disease, with nearly 1.8 billion new cases per year worldwide. ECC afflicts approximately 55\% of low-income and minority US preschool children, resulting in harmful short- and long-term effects on health and quality of life. Clinical evidence shows that caries is reversible if detected and addressed in its early stages. However, many low-income US children often have poor access to pediatric dental services. In this underserved group, dental caries is often diagnosed at a late stage when extensive restorative treatment is needed. With more than 85\% of lower-income Americans owning a smartphone, mobile health tools such as smartphone apps hold promise in achieving patient-driven early detection and risk control of ECC. Objective: This study aims to use a community-based participatory research strategy to refine and test the usability of an artificial intelligence--powered smartphone app, AICaries, to be used by children's parents/caregivers for dental caries detection in their children. Methods: Our previous work has led to the prototype of AICaries, which offers artificial intelligence--powered caries detection using photos of children's teeth taken by the parents' smartphones, interactive caries risk assessment, and personalized education on reducing children's ECC risk. This AICaries study will use a two-step qualitative study design to assess the feedback and usability of the app component and app flow, and whether parents can take photos of children's teeth on their own. Specifically, in step 1, we will conduct individual usability tests among 10 pairs of end users (parents with young children) to facilitate app module modification and fine-tuning using think aloud and instant data analysis strategies. In step 2, we will conduct unmoderated field testing for app feasibility and acceptability among 32 pairs of parents with their young children to assess the usability and acceptability of AICaries, including assessing the number/quality of teeth images taken by the parents for their children and parents' satisfaction. Results: The study is funded by the National Institute of Dental and Craniofacial Research, United States. This study received institutional review board approval and launched in August 2021. Data collection and analysis are expected to conclude by March 2022 and June 2022, respectively. Conclusions: Using AICaries, parents can use their regular smartphones to take photos of their children's teeth and detect ECC aided by AICaries so that they can actively seek treatment for their children at an early and reversible stage of ECC. Using AICaries, parents can also obtain essential knowledge on reducing their children's caries risk. Data from this study will support a future clinical trial that evaluates the real-world impact of using this smartphone app on early detection and prevention of ECC among low-income children. International Registered Report Identifier (IRRID): PRR1-10.2196/32921 ", doi="10.2196/32921", url="https://www.researchprotocols.org/2021/10/e32921", url="http://www.ncbi.nlm.nih.gov/pubmed/34529582" } @Article{info:doi/10.2196/28136, author="Kruglova, Katya and O'Connell, Laura Siobhan Bernadette and Dawadi, Shrinkhala and Gelgoot, Noah Eden and Miner, A. Skye and Robins, Stephanie and Schinazi, Joy and Zelkowitz, Phyllis", title="An mHealth App to Support Fertility Patients Navigating the World of Infertility (Infotility): Development and Usability Study", journal="JMIR Form Res", year="2021", month="Oct", day="12", volume="5", number="10", pages="e28136", keywords="mHealth app", keywords="mHealth development process", keywords="infertility", keywords="intervention design", keywords="mobile phone", abstract="Background: The experience of infertility and its treatment engenders considerable stress and is often described as an emotional rollercoaster. A mobile health (mHealth) app may be a novel solution to address the psychoeducational and psychosocial support needs of fertility patients because of its potential to reduce stress and increase patient empowerment. There are a few fertility-related apps that provide information and support to both men and women undergoing fertility treatment; however, none have documented their development and evaluation process. Objective: This study aims to describe the development and evaluation process of a bilingual mHealth app, Infotility, designed to meet the psychoeducational and psychosocial support needs of men and women undergoing fertility treatment. Methods: To develop the Infotility app, we adhered to the Medical Research Council guidelines for the development and evaluation of complex interventions. First, we conducted literature reviews and needs assessment surveys of fertility patients and health care providers who informed the content and design of the app. Second, we tested the intervention with a small group of end users who provided feedback on the design and appropriateness of the app's content. Third, we evaluated the uptake and usability of the app using a pre-post study design. Finally, we updated the app's content based on participants' feedback and searched for partners to disseminate the app to the broader public. Results: This study is the first to describe the development and evaluation process of an mHealth app for men and women undergoing fertility treatment. The app met its goal in providing fertility patients with a clinician-approved, portable resource for reliable information about medical and psychosocial aspects of infertility and its treatments and a confidential peer support forum monitored by trained peer supporters. Participants rated the engagement, functionality, information, and esthetics of the app positively, with an overall app quality mean score of 3.75 (SD 0.53) and a star rating of 3.43 (SD 0.75), with a total possible score and star rating of 5.00. Conclusions: By documenting the systematic development and evaluation of the mHealth app for men and women undergoing fertility treatment, this paper can facilitate the replication of the study intervention and the development of similar mHealth apps. ", doi="10.2196/28136", url="https://formative.jmir.org/2021/10/e28136", url="http://www.ncbi.nlm.nih.gov/pubmed/34636741" } @Article{info:doi/10.2196/26732, author="Kovoor, G. Joshua and McIntyre, Daniel and Chik, B. William W. and Chow, K. Clara and Thiagalingam, Aravinda", title="Clinician-Created Educational Video Resources for Shared Decision-making in the Outpatient Management of Chronic Disease: Development and Evaluation Study", journal="J Med Internet Res", year="2021", month="Oct", day="11", volume="23", number="10", pages="e26732", keywords="Shared decision-making", keywords="chronic disease", keywords="outpatients", keywords="audiovisual aids", keywords="atrial fibrillation", keywords="educational technology", keywords="teaching materials", keywords="referral and consultation", keywords="physician-patient relations", keywords="physicians", abstract="Background: The provision of reliable patient education is essential for shared decision-making. However, many clinicians are reluctant to use commonly available resources, as they are generic and may contain information of insufficient quality. Clinician-created educational materials, accessed during the waiting time prior to consultation, can potentially benefit clinical practice if developed in a time- and resource-efficient manner. Objective: The aim of this study is to evaluate the utility of educational videos in improving patient decision-making, as well as consultation satisfaction and anxiety, within the outpatient management of chronic disease (represented by atrial fibrillation). The approach involves clinicians creating audiovisual patient education in a time- and resource-efficient manner for opportunistic delivery, using mobile smart devices with internet access, during waiting time before consultation. Methods: We implemented this educational approach in outpatient clinics and collected patient responses through an electronic survey. The educational module was a web-based combination of 4 short videos viewed sequentially, followed by a patient experience survey using 5-point Likert scales and 0-100 visual analogue scales. The clinician developed the audiovisual module over a 2-day span while performing usual clinical tasks, using existing hardware and software resources (laptop and tablet). Patients presenting for the outpatient management of atrial fibrillation accessed the module during waiting time before their consultation using either a URL or Quick Response (QR) code on a provided tablet or their own mobile smart devices. The primary outcome of the study was the module's utility in improving patient decision-making ability, as measured on a 0-100 visual analogue scale. Secondary outcomes were the level of patient satisfaction with the videos, measured with 5-point Likert scales, in addition to the patient's value for clinician narration and the module's utility in improving anxiety and long-term treatment adherence, as represented on 0-100 visual analogue scales. Results: This study enrolled 116 patients presenting for the outpatient management of atrial fibrillation. The proportion of responses that were ``very satisfied'' with the educational video content across the 4 videos ranged from 93\% (86/92) to 96.3\% (104/108) and this was between 98\% (90/92) and 99.1\% (107/108) for ``satisfied'' or ``very satisfied.'' There were no reports of dissatisfaction for the first 3 videos, and only 1\% (1/92) of responders reported dissatisfaction for the fourth video. The median reported scores (on 0-100 visual analogue scales) were 90 (IQR 82.5-97) for improving patient decision-making, 89 (IQR 81-95) for reducing consultation anxiety, 90 (IQR 81-97) for improving treatment adherence, and 82 (IQR 70-90) for the clinician's narration adding benefit to the patient experience. Conclusions: Clinician-created educational videos for chronic disease management resulted in improvements in patient-reported informed decision-making ability and expected long-term treatment adherence, as well as anxiety reduction. This form of patient education was also time efficient as it used the sunk time cost of waiting time to provide education without requiring additional clinician input. ", doi="10.2196/26732", url="https://www.jmir.org/2021/10/e26732", url="http://www.ncbi.nlm.nih.gov/pubmed/34633292" } @Article{info:doi/10.2196/28163, author="MacPherson, Megan and Cranston, Kaela and Johnston, Cara and Locke, Sean and Jung, E. Mary", title="Evaluation and Refinement of a Bank of SMS Text Messages to Promote Behavior Change Adherence Following a Diabetes Prevention Program: Survey Study", journal="JMIR Form Res", year="2021", month="Aug", day="27", volume="5", number="8", pages="e28163", keywords="text messaging", keywords="prediabetic state", keywords="telemedicine", keywords="telecommunications", keywords="exercise", keywords="diet", keywords="preventive medicine", keywords="mHealth", keywords="intervention development", keywords="behavior change", keywords="mobile phone", abstract="Background: SMS text messaging is a low-cost and far-reaching modality that can be used to augment existing diabetes prevention programs and improve long-term diet and exercise behavior change adherence. To date, little research has been published regarding the process of SMS text message content development. Understanding how interventions are developed is necessary to evaluate their evidence base and to guide the implementation of effective and scalable mobile health interventions in public health initiatives and in future research. Objective: This study aims to describe the development and refinement of a bank of SMS text messages targeting diet and exercise behavior change to be implemented following a diabetes prevention program. Methods: A bank of 124 theory-based SMS text messages was developed using the Behaviour Change Wheel and linked to active intervention components (behavior change techniques [BCTs]). The Behaviour Change Wheel is a theory-based framework that provides structure to intervention development and can guide the use of evidence-based practices in behavior change interventions. Once the messages were written, 18 individuals who either participated in a diabetes prevention program or were a diabetes prevention coach evaluated the messages on their clarity, utility, and relevance via survey using a 5-point Likert scale. Messages were refined according to participant feedback and recoded to obtain an accurate representation of BCTs in the final bank. Results: 76/124 (61.3\%) messages were edited, 4/124 (3.2\%) were added, and 8/124 (6.5\%) were removed based on participant scores and feedback. Of the edited messages, 43/76 (57\%) received minor word choice and grammar alterations while retaining their original BCT code; the remaining 43\% (33/76, plus the 4 newly written messages) were recoded by a reviewer trained in BCT identification. Conclusions: This study outlines the process used to develop and refine a bank of SMS text messages to be implemented following a diabetes prevention program. This resulted in a bank of 120 theory-based, user-informed SMS text messages that were overall deemed clear, useful, and relevant by both individuals who will be receiving and delivering them. This formative development process can be used as a blueprint in future SMS text messaging development to ensure that message content is representative of the evidence base and is also grounded in theory and evaluated by key knowledge users. ", doi="10.2196/28163", url="https://formative.jmir.org/2021/8/e28163", url="http://www.ncbi.nlm.nih.gov/pubmed/34448713" } @Article{info:doi/10.2196/28855, author="Artieta-Pinedo, Isabel and Paz-Pascual, Carmen and Bully, Paola and Espinosa, Maite and ", title="Design of the Maternal Website EMAeHealth That Supports Decision-Making During Pregnancy and in the Postpartum Period: Collaborative Action Research Study", journal="JMIR Form Res", year="2021", month="Aug", day="9", volume="5", number="8", pages="e28855", keywords="prenatal education", keywords="women", keywords="patient decision aid", keywords="decision-making", keywords="clinical decision support systems", keywords="action research and pregnancy", keywords="implementation science", keywords="health service needs and demands", abstract="Background: Despite the benefit maternal education has for women, it needs new tools to increase its effectiveness and scope, in tune with the needs of current users. Objective: We attempted to develop a multifunctional personalized eHealth platform aimed at the self-management of health in relation to maternity, which can be considered a flexible and adaptable maternal education tool. Methods: The International Patient Decision Aid Standards (IPDAS) were applied. A website prototype was developed for implementation in the public health system using a collaborative action research process, in which experts and patients participate, with qualitative research techniques, as well as focus groups, prioritization, and consensus techniques. Results: We have proposed a website that includes (1) systematically updated information related to clinical practice guidelines, (2) interaction between peers and users/professionals, (3) instruments for self-assessment of health needs as a basis for working on counseling, agreement on actions, help in the search for resources, support in decision-making, and monitoring and evaluation of results, and (4) access for women to their clinical data and the option of sharing the data with other health agents. These components, with different access requirements, would be reviewed through iterative cycles depending on the frequency and effectiveness resulting from their use and would be accessible from any digital device. Conclusions: A website that supports maternal education should contain not only information, but also resources for individual attention and social support. Its usefulness for the health and satisfaction of women should be evaluated in various different environments. ", doi="10.2196/28855", url="https://formative.jmir.org/2021/8/e28855", url="http://www.ncbi.nlm.nih.gov/pubmed/34383670" } @Article{info:doi/10.2196/29322, author="Miller, C. William and Mohammadi, Somayyeh and Watson, Wendy and Crocker, Morag and Westby, Marie", title="The Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER) as an eHealth Approach to Presurgical Hip Replacement Education: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="Jul", day="6", volume="10", number="7", pages="e29322", keywords="total hip replacement", keywords="osteoarthritis", keywords="eHealth", keywords="prehabiliatation", keywords="preoperative education", keywords="randomized controlled trial", keywords="evaluation", keywords="feasibility", keywords="rehabilitation", keywords="recovery", keywords="hip", keywords="bone", keywords="surgery", keywords="education", abstract="Background: Osteoarthritis (OA), leading to hip replacement (THR), is a primary contributor to global mobility impairment. In 2018, more than 59,000 THR surgeries were performed in Canada. Health promotion education, such as prehabilitation, is vital to optimizing surgical outcomes. Objective: This study aims to evaluate the feasibility of the Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER), an eHealth approach to prehabilitation education. Methods: A single-blind (assessor-blind), 2-arm, feasibility randomized controlled trial will be conducted. We will recruit 40 (HIPPER group, n=20; control group, n=20) older adults with hip OA and on a waitlist for a THR. The HIPPER intervention consists of 12 online, interactive modules. The control group will receive the current standard practice consisting of 2 online educational sessions lasting 2 hours each (webinars). Feasibility outcomes (eg, recruitment and retention rates) will be evaluated. Results: Recruitment started in March 2021. As of April 20, 2021, 18 participants were recruited. All 18 completed T1 measures. Only 1 participant has been scheduled to have a surgery and therefore has been scheduled to complete T2 measures. The remainder of the participants are waiting to be notified of their surgery date. This project was funded by a Canadian Institutes of Health Research Project Grant. Our institute's research ethics board approved this study in November 2016. Conclusions: Results will lead to refinement of the HIPPER protocol in order to evaluate a standardized and geographically accessible prehabilitation program. Trial Registration: ClinicalTrials.gov NCT02969512; https://clinicaltrials.gov/ct2/show/NCT02969512 International Registered Report Identifier (IRRID): DERR1-10.2196/29322 ", doi="10.2196/29322", url="https://www.researchprotocols.org/2021/7/e29322", url="http://www.ncbi.nlm.nih.gov/pubmed/34255722" } @Article{info:doi/10.2196/25343, author="Vandormael, Alain and Adam, Maya and Hachaturyan, Violetta and Greuel, Merlin and Favaretti, Caterina and Gates, Jennifer and Baernighausen, Till", title="Reactance to Social Authority in Entertainment-Education Media: Protocol for a Web-Based Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="May", day="28", volume="10", number="5", pages="e25343", keywords="entertainment-education", keywords="sugar reduction", keywords="reactance", keywords="animated video", keywords="list experiment", abstract="Background: Entertainment-education media can be an effective strategy for influencing health behaviors. To improve entertainment-education effectiveness, we seek to investigate whether the social authority of a person delivering a health message arouses the motivation to reject that message---a phenomenon known as reactance. Objective: In this study, using a short animated video, we aim to measure reactance to a sugar reduction message narrated by a child (low social authority), the child's mother (equivalent social authority to the target audience), and a family physician (high social authority). The aims of the study are to determine the effect of the narrator's perceived social authority on reactance to the sugar reduction message, establish the effectiveness of the video in improving behavioral intent to reduce the intake of added sugars, and quantify participants' interest in watching the entertainment-education intervention video. Methods: This is a parallel group, randomized controlled trial comparing an intervention video narrated by a low, equivalent, or high social authority against a content placebo video and a placebo video. Using a web-based recruitment platform, we plan to enroll 4000 participants aged between 18 and 59 years who speak English and reside in the United Kingdom. The primary end points will include measures of the antecedents to reactance (proneness to reactance and threat level of the message), its components (anger and negative cognition), and attitudinal and behavioral intent toward sugar intake. We will measure behavioral intent using list experiments. Participants randomized to the placebo videos will be given a choice to watch one of the sugar-intervention videos at the end of the study to assess participant engagement with the entertainment-education video. Results: The study was approved by the ethics committee of Heidelberg University on March 18, 2020 (S-088/2020). Participant recruitment and data collection were completed in December 2020. The data analysis was completed in April 2021, and the final results are planned to be published by August 2021. Conclusions: In this trial, we will use several randomization procedures, list experimentation methods, and new web-based technologies to investigate the effect of perceived social authority on reactance to a message about reducing sugar intake. Our results will inform the design of future entertainment-education videos for public health promotion needs. Trial Registration: German Clinical Trials Registry DRKS00022340: https://www.drks.de/drks\_web/navigate.do?navigationId=trial.HTML\&TRIAL\_ID=DRKS00022340. International Registered Report Identifier (IRRID): DERR1-10.2196/25343 ", doi="10.2196/25343", url="https://www.researchprotocols.org/2021/5/e25343", url="http://www.ncbi.nlm.nih.gov/pubmed/34047702" } @Article{info:doi/10.2196/27088, author="Elling, Mathis Jan and Crutzen, Rik and Talhout, Reinskje and de Vries, Hein", title="Effects of Providing Tailored Information About e-Cigarettes in a Web-Based Smoking Cessation Intervention: Protocol for a Randomized Controlled Trial", journal="JMIR Res Protoc", year="2021", month="May", day="14", volume="10", number="5", pages="e27088", keywords="digital health", keywords="eHealth", keywords="mHealth", keywords="electronic cigarette", keywords="e-cigarette", keywords="electronic nicotine delivery system", keywords="ENDS", keywords="smoking", keywords="smoking cessation", keywords="computer tailoring", abstract="Background: There is an ongoing debate whether electronic cigarettes (e-cigarettes) should be advocated for smoking cessation. Because of this uncertainty, information about the use of e-cigarettes for smoking cessation is usually not provided in governmental smoking cessation communications. However, there is an information need among smokers because despite this uncertainty, e-cigarettes are used by many smokers to reduce and quit tobacco smoking. Objective: The aim of this study is to describe the protocol of a randomized controlled trial that assesses the effect of providing tailored information about e-cigarettes compared to not providing this information on determinants of decision making and smoking reduction and abstinence. This information is provided in the context of a digital smoking cessation intervention. Methods: A randomized controlled trial with a 6-month follow-up period will be conducted among adult smokers motivated to quit smoking within 5 years. Participants will be 1:1 randomized into either the intervention condition or control condition. In this trial, which is grounded on the I-Change model, participants in both conditions will receive tailored feedback on attitude, social influence, preparatory plans, self-efficacy, and coping plans. Information on 6 clusters of smoking cessation methods (face-to-face counselling, eHealth interventions, telephone counselling, group-based programs, nicotine replacement therapy, and prescription medication) will be provided in both conditions. Smokers in the intervention condition will also receive detailed tailored information on e-cigarettes, while smokers in the control condition will not receive this information. The primary outcome measure will be the number of tobacco cigarettes smoked in the past 7 days. Secondary outcome measures will include 7-day point prevalence tobacco abstinence, 7-day point prevalence e-cigarette abstinence, and determinants of decision making (ie, knowledge and attitude regarding e-cigarettes). All outcomes will be self-assessed through web-based questionnaires. Results: This project is supported by a research grant of the National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu). Ethical approval was granted by the Ethics Review Committee Health, Medicine and Life Sciences at Maastricht University (FHML-REC/2019/072). Recruitment began in March 2020 and was completed by July 2020. We enrolled 492 smokers in this study. The results are expected to be published in June 2021. Conclusions: The experimental design of this study allows conclusions to be formed regarding the effects of tailored information about e-cigarettes on decision making and smoking behavior. Our findings can inform the development of future smoking cessation interventions. Trial Registration: Dutch Trial Register Trial NL8330; https://www.trialregister.nl/trial/8330 International Registered Report Identifier (IRRID): DERR1-10.2196/27088 ", doi="10.2196/27088", url="https://www.researchprotocols.org/2021/5/e27088", url="http://www.ncbi.nlm.nih.gov/pubmed/33988520" } @Article{info:doi/10.2196/29161, author="Leitch, Sharon and Smith, Alesha and Zeng, Jiaxu and Stokes, Tim", title="Using an Information Package to Reduce Patients' Risk of Renal Damage: Protocol for a Randomized Feasibility Trial", journal="JMIR Res Protoc", year="2021", month="Apr", day="30", volume="10", number="4", pages="e29161", keywords="triple whammy", keywords="medication safety", keywords="patient education", keywords="general practice", keywords="NSAID", keywords="digital intervention", keywords="primary care", keywords="safety", keywords="protocol", keywords="feasibility", keywords="randomized controlled trial", keywords="risk", keywords="kidney", keywords="renal", keywords="information", keywords="acceptability", abstract="Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are a common cause of renal damage, especially when taken together with angiotensin-converting enzyme inhibitors (ACE-i) or angiotensin II receptor blockers (ARBs) plus a diuretic --- a combination known as the ``triple whammy.'' New Zealand patients are at high risk of the ``triple whammy'' because they can easily purchase NSAIDs without a prescription and in nonpharmacy retail settings (eg, the supermarket), there is no legal requirement to include patient information sheets with medication, and direct-to-consumer drug advertising is permitted. A patient information package has been developed for those at greatest risk of the ``triple whammy,'' consisting of a printable PDF and an interactive online learning activity. This information package aims to inform patients about their elevated risk of harm from NSAIDS and discourage use of NSAIDs. A randomized control trial was planned to assess the effect of the information package. Objective: This study aims to pilot the trial procedures for recruiting patients and providing patient information online and to assess the acceptability of the patient information package. Methods: A two-armed randomized feasibility trial will be undertaken in Northland, New Zealand. We will recruit 50 patients who are at least 18 years old from those who have signed up to receive email alerts through their general practice. Patients eligible for this study have been prescribed an ACE-i or ARB plus a diuretic in the past 3 months. They will be randomly allocated to 2 study arms. The intervention arm will receive access to an information package plus usual care; the control arm will receive usual care alone. Online surveys will be used to assess NSAID knowledge and NSAID use at baseline and after 2 weeks for both arms. The intervention arm will also evaluate the information package in an additional survey based on Normalization Process Theory (NPT) concepts. We will report the number and proportion of participants who are eligible and consent to participate in the trial. Response and drop-out rates will be reported for each trial arm. The numbers of patients who interact with the education package will be reported together with the patient evaluation of it. Results: Funding has been obtained from the Health Research Council of New Zealand (HRC 18-031). The University of Otago Human Research Ethics Committee (H21/016) has approved this trial. Consultation has been undertaken with The Ngai Tahu research consultation committee. The trial commenced on April 12, 2021. Conclusions: This feasibility trial will test the study processes prior to commencing a randomized controlled trial and will determine the acceptability of the patient information package. We anticipate this work will provide useful information for other researchers attempting similar work. International Registered Report Identifier (IRRID): PRR1-10.2196/29161 ", doi="10.2196/29161", url="https://www.researchprotocols.org/2021/4/e29161", url="http://www.ncbi.nlm.nih.gov/pubmed/33929338" } @Article{info:doi/10.2196/26939, author="McCall, C. Hugh and Hadjistavropoulos, D. Heather and Sundstr{\"o}m, Francis Christopher Richard", title="Exploring the Role of Persuasive Design in Unguided Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety Among Adults: Systematic Review, Meta-analysis, and Meta-regression", journal="J Med Internet Res", year="2021", month="Apr", day="29", volume="23", number="4", pages="e26939", keywords="ICBT", keywords="internet", keywords="depression", keywords="anxiety", keywords="persuasive design", keywords="eHealth", abstract="Background: Internet-delivered cognitive behavioral therapy (ICBT) is an effective treatment that can overcome barriers to mental health care. Various research groups have suggested that unguided ICBT (ie, ICBT without therapist support) and other eHealth interventions can be designed to enhance user engagement and thus outcomes. The persuasive systems design framework captures most design recommendations for eHealth interventions, but there is little empirical evidence that persuasive design is related to clinical outcomes in unguided ICBT. Objective: This study aims to provide an updated meta-analysis of randomized controlled trials of unguided ICBT for depression and anxiety, describe the frequency with which various persuasive design principles are used in such interventions, and use meta-regression to explore whether a greater number of persuasive design elements predicts efficacy in unguided ICBT for depression and anxiety. Methods: We conducted a systematic review of 5 databases to identify randomized controlled trials of unguided ICBT for depression and anxiety. We conducted separate random effects meta-analyses and separate meta-regressions for depression and anxiety interventions. Each meta-regression included 2 steps. The first step included, as a predictor, whether each intervention was transdiagnostic. For the meta-regression of ICBT for depression, the first step also included the type of control condition. The number of persuasive design principles identified for each intervention was added as a predictor in the second step to reveal the additional variance in effect sizes explained by persuasive design. Results: Of the 4471 articles we identified in our search, 46 (1.03\%) were eligible for inclusion in our analyses. Our meta-analyses showed effect sizes (Hedges g) ranging from 0.22 to 0.31 for depression interventions, depending on the measures taken to account for bias in the results. We found a mean effect size of 0.45 (95\% CI 0.33-0.56) for anxiety interventions, with no evidence that the results were inflated by bias. Included interventions were identified as using between 1 and 13 persuasive design principles, with an average of 4.95 (SD 2.85). The meta-regressions showed that a greater number of persuasive design principles predicted greater efficacy in ICBT for depression (R2 change=0.27; B=0.04; P=.02) but not anxiety (R2 change=0.05; B=0.03; P=.17). Conclusions: These findings show wide variability in the use of persuasive design in unguided ICBT for depression and anxiety and provide preliminary support for the proposition that more persuasively designed interventions are more efficacious, at least in the treatment of depression. Further research is needed to clarify the role of persuasive design in ICBT. ", doi="10.2196/26939", url="https://www.jmir.org/2021/4/e26939", url="http://www.ncbi.nlm.nih.gov/pubmed/33913811" } @Article{info:doi/10.2196/23568, author="Lindsay, Sally and Kolne, Kendall and Barker, J. Donna and Colantonio, Angela and Stinson, Jennifer and Moll, Sandra and Thomson, Nicole", title="Exploration of Gender-Sensitive Care in Vocational Rehabilitation Providers Working With Youth With Disabilities: Codevelopment of an Educational Simulation", journal="JMIR Form Res", year="2021", month="Mar", day="15", volume="5", number="3", pages="e23568", keywords="continuing education", keywords="gender-identity", keywords="gender-sensitive care", keywords="rehabilitation", abstract="Background: Although research shows that there is a need for gender-specific vocational support to help youth with disabilities find employment, health care providers often report needing more training in this area. Currently, there are no existing educational simulations of gender-sensitive care within vocational rehabilitation for clinicians who provide care to youth with disabilities. Therefore, developing further educational tools that address gender-sensitive care could help them enhance the care they provide while optimizing patient outcomes. Objective: This study aims to codevelop an educational simulation and identify issues relevant to providing gender-sensitive care within the context of vocational rehabilitation for youth with disabilities. Methods: We used a qualitative co-design approach with a purposive sampling strategy that involved focus group discussions and journal reflections to understand and address issues relevant to gender-sensitive care within vocational rehabilitation for those working with youth with disabilities. A total of 10 rehabilitation providers participated in two sessions (5 participants per session) to design the web-based simulation tool. The sessions (2.5 hours each) were audio recorded, transcribed, and analyzed thematically. Results: Two main themes arose from our analysis of codeveloping a simulation focusing on gender-sensitive care. The first theme involved the relevance of gender within clinical practice; responses varied from hesitance to acknowledging but not talking about it to those who incorporated gender into their practice. The second theme focused on creating a comfortable and safe space to enable gender-sensitive care (ie, included patient-centered care, effective communication and rapport building, appropriate language and pronoun use, respecting gender identity, awareness of stereotypes, and responding to therapeutic ruptures). Conclusions: Our web-based gender-sensitive care simulation that addressed vocational rehabilitation among youth with disabilities was cocreated with clinicians. The simulation highlights many issues relevant to clinical practice and has potential as an educational tool for those working with young people with disabilities. ", doi="10.2196/23568", url="https://formative.jmir.org/2021/3/e23568", url="http://www.ncbi.nlm.nih.gov/pubmed/33720023" } @Article{info:doi/10.2196/25583, author="Moreno, Georgina and van Mierlo, Trevor", title="A Digital Health Tool to Understand and Prevent Cannabis-Impaired Driving Among Youth: A Cross-sectional Study of Responses to a Brief Intervention for Cannabis Use", journal="JMIR Form Res", year="2021", month="Mar", day="2", volume="5", number="3", pages="e25583", keywords="cannabis use", keywords="driving after cannabis use", keywords="internet", keywords="intervention", keywords="online intervention", keywords="digital health", keywords="cannabis", keywords="drug", keywords="online tool", keywords="youth", keywords="adolescent", keywords="Canada", abstract="Background: Cannabis legalization has raised concern about an increased risk of cannabis-impaired driving, particularly among youth. Youth advocates and policy makers require cost-effective tools to target educational resources to promote responsible cannabis use. Objective: The objective of this paper is threefold. First, it describes how a youth advocacy organization disseminated a low-cost digital brief intervention to educate and inform young people about responsible cannabis use. Second, it illustrates how digital tools can help promote understanding about attitudes and behaviors toward cannabis while simultaneously offering tailored education. Finally, this paper contributes to examining behavioral factors associated with youth cannabis-impaired driving by quantifying relationships between cannabis users' willingness to drive impaired and self-reported demographic and behavioral factors. Methods: This paper analyzed data from 1110 completed Check Your Cannabis (CYC) brief interventions between March 2019 and October 2020. The CYC asks respondents a brief set of questions about their cannabis use and their personal beliefs and behaviors. Respondents receive comprehensive feedback about their cannabis use and how it compares with others. They also receive a summary of reported behaviors with brief advice. An ordered probit model was used to test relationships between cannabis use, demographics, and driving behaviors to gain further insights. Results: The vast majority (817/1110, 73.6\%) of respondents reported using cannabis. However, a much smaller share of respondents reported problems associated with their cannabis use (257/1110, 23.2\%) or driving after cannabis use (342/1110, 30.8\%). We found statistically significant relationships between driving after cannabis use and age; Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) risk score; and polysubstance use. However, we did not find gender to be a significant determinant of driving after cannabis use. We estimated that every 10-point increase in the ASSIST score increased the probability of sometimes driving after cannabis use by 7.3\% (P<.001). Relative to respondents who reported never drinking alcohol or using other substances with cannabis, those who sometimes drink or use other substances with cannabis were 13\% (P<.001) more likely to sometimes or always drive after using cannabis. Conclusions: The digital health tool cost the youth advocacy organization approximately Can \$0.90 (US \$0.71) per use. Due to the tool's unlimited use structure, the per-use cost would further decrease with increased use by the organization's target population. Based on our results, public health campaigns and other interventions may consider tailoring resources to frequent cannabis users, youth with high ASSIST scores, and those with polysubstance abuse. The cost-effectiveness of delivering digital brief interventions with unlimited use is attractive, as increased use decreases the per-user cost. Further research examining the efficacy of digital health interventions targeting problematic cannabis use is required. ", doi="10.2196/25583", url="https://formative.jmir.org/2021/3/e25583", url="http://www.ncbi.nlm.nih.gov/pubmed/33650982" } @Article{info:doi/10.2196/20694, author="Willems, J. Stijn and Coppieters, W. Michel and Pronk, Yvette and Diks, F. Miranda J. and van der Heijden, P. Klaas W. A. and Rooker, Servan and Scholten-Peeters, M. Gwendolyne G.", title="A Clinical Journey Mobile Health App for Perioperative Patients: Cross-sectional Study", journal="JMIR Hum Factors", year="2021", month="Feb", day="8", volume="8", number="1", pages="e20694", keywords="eHealth", keywords="mHealth", keywords="applications", keywords="musculoskeletal", keywords="user-friendliness", keywords="rehabilitation", keywords="usability", keywords="patient education", keywords="technology", keywords="disability", keywords="feasibility", keywords="adherence", abstract="Background: Mobile eHealth apps are important tools in personal health care management. The Patient Journey app was developed to inform patients with musculoskeletal disorders during their perioperative period. The app contains timely information, video exercises, and functional tasks. Although the Patient Journey app and other health apps are widely used, little research is available on how patients appreciate these apps. Objective: The primary aim of this study was to evaluate the user-friendliness of the Patient Journey app in terms of its usability and the attitudes of users toward the app. The secondary aim was to evaluate positive and negative user experiences. Methods: A web-based questionnaire was sent to 2114 patients scheduled for surgery for a musculoskeletal disorder. Primary outcomes were usability (measured with the System Usability Scale) and user attitudes regarding the Patient Journey app (assessed with the second part of the eHealth Impact Questionnaire). The secondary outcomes were evaluated with multiple choice questions and open-ended questions, which were analyzed via inductive thematic content analyses. Results: Of the 940 patients who responded, 526 used the Patient Journey app. The usability of the app was high (System Usability Scale: median 85.0, IQR 72.5-92.5), and users had a positive attitude toward the Information and Presentation provided via the app (eHealth Impact Questionnaire: median 78.0, IQR 68.8-84.4). The app did not adequately improve the users' confidence in discussing health with others (eHealth Impact Questionnaire: median 63.9, IQR 50.0-75.0) or motivation to manage health (eHealth Impact Questionnaire: median 61.1, IQR 55.6-72.2). Three core themes emerged regarding positive and negative user experiences: (1) content and information, (2) expectations and experiences, and (3) technical performance. Users experienced timely information and instructions positively and found that the app prepared and guided them optimally through the perioperative period. Negative user experiences were overly optimistic information, scarcely presented information about pain (medication), lack of reference data, insufficient information regarding clinical course deviations and complications, and lack of interaction with clinicians. Conclusions: The Patient Journey app is a usable, informative, and presentable tool to inform patients with musculoskeletal disorders during their perioperative period. The qualitative analyses identified aspects that can further improve the user experiences of the app. ", doi="10.2196/20694", url="http://humanfactors.jmir.org/2021/1/e20694/", url="http://www.ncbi.nlm.nih.gov/pubmed/33555262" } @Article{info:doi/10.2196/22450, author="Jackowich, A. Robyn and Mooney, M. Kayla and Hecht, Evelyn and Pukall, F. Caroline", title="Online Pelvic Floor Group Education Program for Women With Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia: Descriptive Feasibility Study", journal="JMIR Form Res", year="2021", month="Jan", day="11", volume="5", number="1", pages="e22450", keywords="persistent genital arousal disorder", keywords="genitopelvic dysesthesia", keywords="online program", keywords="pelvic floor", keywords="pilot", abstract="Background: Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing yet poorly understood condition characterized by persistent genito-pelvic sensations, often described as ``genital arousal,'' which occur in the absence of sexual desire. PGAD/GPD is associated with significant impairment in psychosocial and daily functioning; however, there are currently no empirically validated treatment algorithms for PGAD/GPD. Pelvic floor physical therapy exercises have been found to be effective at reducing other forms of genito-pelvic discomfort, such as vulvodynia, and may also be beneficial to those experiencing PGAD/GPD. Many individuals with PGAD/GPD report difficulty finding a health care provider who is knowledgeable about PGAD/GPD; therefore, pelvic floor education and exercises in an online format may have the potential to reach more individuals in need. Objective: This study examined the feasibility of an online pelvic floor group education program; descriptively assessed outcomes related to distress, discomfort, catastrophizing, and mood; and obtained feedback from participants in order to inform the development of improved online group programs. Methods: Fourteen women with current symptoms of PGAD/GPD attended an online, 8-session pelvic floor group education program. Participants completed questionnaires of symptoms (ie, symptom distress, discomfort) and psychosocial well-being (ie, depression, anxiety, symptom catastrophizing) prior to the group sessions (Time 1), immediately after the final group session (Time 2), and 6 months following the final group session (Time 3). Participants also completed an anonymous feedback questionnaire immediately following the group program. Results: Overall, participants who attended a larger number of the group sessions (>5 sessions, n=7) appeared to report lower baseline (Time 1) symptoms and psychosocial impairment than those who attended fewer sessions (<5 sessions, n=7). A pattern of small improvements was seen following the group sessions on symptom and psychosocial outcomes. In the feedback questionnaire, breathing and relaxation exercises were described to be the most helpful home practice exercises, and participants rated sessions on (1) the relationship between emotions and PGAD/GPD symptoms and (2) relaxation exercises to be the most helpful. A number of barriers to participation in the group program were also identified, including comorbid health concerns and lack of personal time to complete the program/exercises. Conclusions: Online interventions provide an opportunity to reach international participants who may otherwise struggle to access a knowledgeable provider for their PGAD/GPD symptoms. Addressing barriers may help to increase participants' abilities to engage in the program. Future programs may seek to integrate a greater focus on relaxation strategies and cognitive-affective strategies for managing PGAD/GPD symptoms. ", doi="10.2196/22450", url="http://formative.jmir.org/2021/1/e22450/", url="http://www.ncbi.nlm.nih.gov/pubmed/33427673" } @Article{info:doi/10.2196/15913, author="Monkman, Helen and Kushniruk, W. Andre and Borycki, M. Elizabeth and Sheets, J. Debra and Barnett, Jeffrey", title="Differences in Memory, Perceptions, and Preferences of Multimedia Consumer Medication Information: Experimental Performance and Self-Report Study", journal="JMIR Hum Factors", year="2020", month="Dec", day="1", volume="7", number="4", pages="e15913", keywords="consumer medication information", keywords="medication guides", keywords="patient medication information", keywords="prescription drug information leaflet", keywords="patient information leaflets", keywords="multimedia learning", keywords="health literacy", keywords="eHealth literacy", keywords="consumer health informatics", keywords="cognitive theory of multimedia learning", abstract="Background: Electronic health resources are becoming prevalent. However, consumer medication information (CMI) is still predominantly text based. Incorporating multimedia into CMI (eg, images, narration) may improve consumers' memory of the information as well as their perceptions and preferences of these materials. Objective: This study examined whether adding images and narration to CMI impacted patients' (1) memory, (2) perceptions of comprehensibility, utility, or design quality, and (3) overall preferences. Methods: We presented 36 participants with CMI in 3 formats: (1) text, (2) text + images, and (3) narration + images, and subsequently asked them to recall information. After seeing all 3 CMI formats, participants rated the formats in terms of comprehensibility, utility, and design quality, and ranked them from most to least favorite. Results: Interestingly, no significant differences in memory were observed (F2,70=0.1, P=0.901). Thus, this study did not find evidence to support multimedia or modality principles in the context of CMI. Despite the absence of effects on memory, the CMI format significantly impacted perceptions of the materials. Specifically, participants rated the text + images format highest in terms of comprehensibility ($\chi$22=26.5, P<.001) and design quality ($\chi$22=35.69, P<.001). Although the omnibus test suggested a difference in utility ratings as well ($\chi$22=8.21, P=.016), no significant differences were found after correcting for multiple comparisons. Consistent with perception findings, the preference ranks yielded a significant difference ($\chi$22=26.00, P<.001), whereby participants preferred the text + images format overall. Indeed, 75\% (27/36) of participants chose the text + images format as their most favorite. Thus, although there were no objective memory differences between the formats, we observed subjective differences in comprehensibility, design quality, and overall preferences. Conclusions: This study revealed that although multimedia did not appear to influence memory of CMI, it did impact participants' opinions about the materials. The lack of observed differences in memory may have been due to ceiling effects, memory rather than understanding as an index of learning, the fragmented nature of the information in CMI itself, or the size or characteristics of the sample (ie, young, educated subjects with adequate health literacy skills). The differences in the subjective (ie, perceptions and preferences) and objective (ie, memory) results highlight the value of using both types of measures. Moreover, findings from this study could be used to inform future research on how CMI could be designed to better suit the preferences of consumers and potentially increase the likelihood that CMI is used. Additional research is warranted to explore whether multimedia impacts memory of CMI under different conditions (eg, older participants, subjects with lower levels of health literacy, more difficult stimuli, or extended time for decay). ", doi="10.2196/15913", url="http://humanfactors.jmir.org/2020/4/e15913/", url="http://www.ncbi.nlm.nih.gov/pubmed/33258780" }