@Article{info:doi/10.2196/58095,
author="Benavent, Diego
and Iniesta-Chamorro, M. Jose
and Novella-Navarro, Marta
and P{\'e}rez-Mart{\'i}nez, Miguel
and Mart{\'i}nez-S{\'a}nchez, Nuria
and Kaffati, M{\'o}nica
and Ju{\'a}rez-Garc{\'i}a, Manuel
and Molinari-P{\'e}rez, Marina
and Gonz{\'a}lez-Torbay, Andrea
and Guti{\'e}rrez, Mariana
and L{\'o}pez-Juanes, Natalia
and Navarro-Comp{\'a}n, Victoria
and Monjo-Henry, Irene
and Rodr{\'i}guez-Rosales, Germ{\'a}n
and Bachiller, Javier
and Calvo-Aranda, Enrique
and Michelena, Xabier
and Berbel-Arcob{\'e}, Laura
and Balsa, Alejandro
and 
and G{\'o}mez, J. Enrique
and Plasencia-Rodr{\'i}guez, Chamaida",
title="Digital Health Intervention for Patient Monitoring in Immune-Mediated Inflammatory Diseases: Cocreation and Feasibility Study of the IMIDoc Platform",
journal="JMIR Hum Factors",
year="2025",
month="Apr",
day="21",
volume="12",
pages="e58095",
keywords="immune-mediated inflammatory diseases",
keywords="cocreation",
keywords="health care provider",
keywords="digital health solution",
keywords="inflammatory",
keywords="inflammatory disease",
keywords="monitoring",
keywords="care model",
keywords="patient care",
keywords="development",
keywords="app",
keywords="user centered",
keywords="patient monitoring",
keywords="decision-making",
keywords="user needs",
abstract="Background: Immune-mediated inflammatory diseases, such as rheumatoid arthritis and spondyloarthritis, pose challenges due to recurrent flares and gaps in patient monitoring. Traditional health care models often fail to capture disease progression effectively. Objective: This study aimed to describes the structured cocreation of the IMIDoc platform, an interdisciplinary initiative aimed at improving patient monitoring, education, and health care provider decision-making. Methods: IMIDoc was cocreated through an interdisciplinary team involving clinical experts, biomedical engineers, and technical developers, using user-centered design principles. The development process included the identification of unmet clinical needs, user-centered app design, implementation of medication management features, patient data recording capabilities, and educational content. A 3-month feasibility and functionality testing was performed to evaluate the usability and technical performance of the apption. Results: During the feasibility testing, 111 entries were logged for the patient mobile app, comprising 76 errors identified and corrected, 16 improvements addressing functionality, usability, and performance, and 10 evolutionary suggestions. The professional interface received 45 entries, identifying 40 errors and 5 evolutionary suggestions. Ten iterative updates significantly enhanced the user interface intuitiveness and medication reminder functionality, aligning the solution closely with clinical workflows and user needs. Conclusions: The IMIDoc platform, developed by a multidisciplinary cocreation methodology, shows potential to improve the management of immune-mediated inflammatory diseases ithrough enhanced communication and monitoring. A multicenter clinical study with 360 patients across 5 Spanish hospitals will further evaluate its impact. Trial Registration: ClinicalTrials.gov NCT06273306; https://tinyurl.com/4t6ubcsf ",
doi="10.2196/58095",
url="https://humanfactors.jmir.org/2025/1/e58095"
}


@Article{info:doi/10.2196/67484,
author="Xing, Yiqing
and Liu, Xuejiao
and Zhang, Liang
and He, Ruibo",
title="The Association Between Internet Use and Co-occurring Health Care Needs: Cross-Sectional Study in China",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="17",
volume="27",
pages="e67484",
keywords="internet use",
keywords="co-occurring health care needs",
keywords="physical exercise",
keywords="health status",
keywords="Chinese residents",
abstract="Background: The need for health care underpins health care service provision and serves as the foundation for enhancing service capacity and allocating resources. Health care needs are influenced by health, social, and economic conditions and may exhibit different characteristics over time. However, previous studies have primarily focused on specific populations or types of needs, overlooking the diversity and complexity of residents' health care requirements. Furthermore, as informatization becomes a defining aspect of modern social development, the impact of internet utilization on the co-occurrence of health care needs remains unclear. Objective: This study aims to determine the co-occurrence of health care needs among residents in China, explore the relationship between internet use frequency and co-occurring health care needs, and analyze the potential pathways of influence. Methods: Data were obtained from the ``Survey on Chinese Residents' Health Services Needs in the New Era,'' conducted from July to August 2018, yielding a sample of 12,513 individuals. An association rule learning algorithm was used to analyze the characteristics of co-occurring health care needs among Chinese residents, while a generalized linear model was used to examine the relationship between internet use frequency and co-occurring health care needs. Additionally, physical exercise and health status were selected as mediating variables, and their mediating effects were assessed using a path analysis model. Results: A substantial proportion of the surveyed population (8601/12,513, 68.74\%) had 2 or more co-occurring health care needs, with a lower percentage among rural residents (4045/6053, 66.83\%) compared with urban residents (4556/6460, 70.53\%). Frequent internet users tended to have more co-occurring health care needs ($\beta$=.895, SE 0.019, P<.001). The results indicated a positive relationship between internet use frequency and both improved physical exercise ($\beta$=.121, P<.001) and health status ($\beta$=.026, P<.001). Notably, a high level of physical exercise was associated with an increase in co-occurring health care needs ($\beta$=.087, P<.001). By contrast, a significant negative correlation was observed between health status and co-occurring health care needs ($\beta$=-.787, P<.001), indicating that these needs decreased as health status improved. Conclusions: The findings highlight the need for health policy makers and health care providers to address evolving health care needs and the impact of information technology on these needs. Furthermore, health care providers must adapt their services and delivery methods to meet residents' co-occurring health care needs. Meanwhile, policy makers and service managers should ensure that service delivery keeps pace with residents' changing needs through resource allocation, health insurance payment reforms, and performance incentives. ",
doi="10.2196/67484",
url="https://www.jmir.org/2025/1/e67484"
}


@Article{info:doi/10.2196/58377,
author="Alhumaid, Khadija
and Ayoubi, Kevin
and Khalifa, Maha
and Salloum, Said",
title="Factors Determining Acceptance of Internet of Things in Medical Education: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2025",
month="Apr",
day="10",
volume="12",
pages="e58377",
keywords="collaborative learning",
keywords="student",
keywords="college",
keywords="university",
keywords="education",
keywords="Internet of Things",
keywords="IoT",
keywords="technology acceptance model",
keywords="technology optimism",
keywords="TAM",
keywords="experience",
keywords="attitude",
keywords="opinion",
keywords="perception",
keywords="perspective",
keywords="acceptance",
keywords="adoption",
keywords="survey",
keywords="questionnaire",
keywords="ANN",
keywords="deep learning",
keywords="structural equation modeling",
keywords="neural network",
keywords="intent",
keywords="use",
keywords="medical education",
keywords="artificial neural network",
keywords="technology innovation",
abstract="Background: The global increase in the Internet of Things (IoT) adoption has sparked interest in its application within the educational sector, particularly in colleges and universities. Previous studies have often focused on individual attitudes toward IoT without considering a multiperspective approach and have overlooked the impact of IoT on the technology acceptance model outside the educational domain. Objective: This study aims to bridge the research gap by investigating the factors influencing IoT adoption in educational settings, thereby enhancing the understanding of collaborative learning through technology. It seeks to elucidate how IoT can facilitate learning processes and technology acceptance among college and university students in the United Arab Emirates. Methods: A questionnaire was distributed to students across various colleges and universities in the United Arab Emirates, garnering 463 participants. The data collected were analyzed using a hybrid approach that integrates structural equation modeling (SEM) and artificial neural network (ANN), along with importance-performance map analysis to evaluate the significance and performance of each factor affecting IoT adoption. Results: The study, involving 463 participants, identifies 2 primary levels at which factors influence the intention to adopt IoT technologies. Initial influences include technology optimism (TOP), innovation, and learning motivation, crucial for application engagement. Advanced influences stem from technology acceptance model constructs, particularly perceived ease of use (PE) and perceived usefulness (PU), which directly enhance adoption intentions. Detailed statistical analysis using partial least squares--SEM reveals significant relationships: TOP and innovativeness impact PE ($\beta$=.412, P=.04; $\beta$=.608, P=.002, respectively), and PU significantly influences TOP ($\beta$=.381, P=.04), innovativeness ($\beta$=.557, P=.003), and learning motivation ($\beta$=.752, P<.001). These results support our hypotheses (H1, H2, H3, H4, and H5). Further, the intention to use IoT is significantly affected by PE and usefulness ($\beta$=.619, P<.001; $\beta$=.598, P<.001, respectively). ANN modeling enhances these findings, showing superior predictive power (R2=89.7\%) compared to partial least squares--SEM (R2=86.3\%), indicating a more effective identification of nonlinear associations. Importance-performance map analysis corroborates these results, demonstrating the importance and performance of PU as most critical, followed by technology innovativeness and optimism, in shaping behavioral intentions to use IoT. Conclusions: This research contributes methodologically by leveraging deep ANN architecture to explore nonlinear relationships among factors influencing IoT adoption in education. The study underscores the importance of both intrinsic motivational factors and perceived technological attributes in fostering IoT adoption, offering insights for educational institutions considering IoT integration into their learning environments. ",
doi="10.2196/58377",
url="https://humanfactors.jmir.org/2025/1/e58377"
}


@Article{info:doi/10.2196/65788,
author="W{\"u}llner, Sarah
and Hermenau, Katharin
and Hecker, Tobias
and Siniatchkin, Michael",
title="The Use of Mobile Apps in Adolescent Psychotherapy: Assessment of Psychotherapists' Perspectives",
journal="JMIR Form Res",
year="2025",
month="Apr",
day="8",
volume="9",
pages="e65788",
keywords="mental health app",
keywords="psychotherapy",
keywords="adolescent",
keywords="mHealth",
keywords="youth",
keywords="feasibility",
keywords="implementation",
keywords="app features",
keywords="barriers",
keywords="drivers",
abstract="Background: Therapy-accompanying mental health apps can play an important role in the psychotherapeutic treatment of adolescents. They can enhance adolescents' engagement and autonomy, provide immediate support in critical situations, and positively influence the therapeutic working alliance. Nevertheless, mental health apps are rarely used by psychotherapists. Furthermore, due to the limited or nonexistent use of apps in psychotherapy, little is known about the actual barriers and drivers affecting their integration into psychotherapists' daily routines. To better understand how mental health apps should be designed for practical use, it is essential to explore psychotherapists' perspectives on key app features and characteristics, as well as the factors influencing their integration into clinical practice. Objective: This study aims to analyze which app features and characteristics are essential for psychotherapists to use a mobile app in psychotherapy with adolescents and to identify the key drivers and barriers influencing the integration of a psychotherapeutic app from the psychotherapists' perspectives. Methods: We conducted 3 feasibility studies using Steps, a transdiagnostic, therapy-accompanying app for adolescents, across 3 different psychotherapeutic treatment contexts: inpatient treatment, treatment in psychiatric outpatient clinics, and outpatient treatment with psychotherapists in private practice. All studies followed a qualitative quasi-experimental design. Participants provided information on their age, occupation, years of work experience, media affinity, attitudes toward psychotherapeutic apps, perceived app quality and feasibility, and the implementation process of the therapy-accompanying app. Qualitative data were analyzed using deductive qualitative content analysis. A total of 40 mental health professionals participated across the 3 studies (study 1: n=18; study 2: n=13; study 3: n=9). Results: Study participation and app usage rates were low across all studies. Six core features for a transdiagnostic, therapy-accompanying app were identified: mood checks, library, reminders, goals and tasks, emergency kit, and questionnaires. Additionally, the integration of mental health apps into daily routines was influenced by various drivers and barriers. The most significant barriers included technological issues and practical constraints, such as limited time and resources. The most important driver was the perceived improvement in treatment quality. Conclusions: Overall, psychotherapists were generally open to using a therapy-accompanying mental health app. However, study participation and app usage remained low. As psychotherapists act as gatekeepers for patients' use of mental health apps, their needs should be prioritized in the development and implementation of such apps. Trial Registration: German Clinical Trials Register DRKS00031258; https://drks.de/search/en/trial/DRKS00031258/details ",
doi="10.2196/65788",
url="https://formative.jmir.org/2025/1/e65788"
}


@Article{info:doi/10.2196/59807,
author="Thorup, Brun Charlotte
and Uitto, Mika
and Butler-Henderson, Kerryn
and Wamala-Andersson, Sarah
and Hoffr{\'e}n-Mikkola, Merja
and Schack Thoft, Diana
and Korsbakke Emtek{\ae}r H{\ae}sum, Lisa
and Irrazabal, Gabriela
and Pruneda Gonz{\'a}lez, Laura
and Valkama, Katja",
title="Choosing the Best Digital Health Literacy Measure for Research: Mixed Methods Study",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="8",
volume="27",
pages="e59807",
keywords="digital health literacy",
keywords="digital literacy",
keywords="Horizon Europe",
keywords="EU",
keywords="health technology",
keywords="life expectancy",
keywords="health literacy",
keywords="chronic disease",
keywords="digitalization",
keywords="digital health service",
keywords="digital health intervention",
keywords="technology",
keywords="healthcare",
abstract="Background: The global demographic shift towards longer life expectancy and complex health needs is increasing the number of people with chronic diseases, placing pressure on health and care systems. With the digitalization of healthcare, digital Health Literacy (dHL), or the use of digital skills in health, is gaining importance. It involves navigating digital health information, using digital tools effectively, and making informed health decisions. Measuring dHL can help identify gaps and develop strategies to improve dHL and health, ensuring citizens equal opportunity to participate in a digital healthcare system. The European project ``The Improving Digital Empowerment for Active and Healthy Living (IDEAHL)'' with the objective to empower European Union citizens to use digital instruments to take a more active role in managing their health and well-being creates the base for this overview Objective: This paper aims to conduct an overview of existing assessment tools for measuring dHL and recommend strategies for choosing relevant assessment tools. Methods: This study was carried out as a mixed method study initiated by a scoping review (10 scientific databases, 14 databases with grey literature and 14 predefined reports) in addition to three papers published after finalisations the literature search in IDEAHL, followed by a qualitative workshop study and a final analysis combining results. Results: The literature search resulted in 33 papers on dHL instruments, that was analyzed together with three recently published reviews and findings from a workshop with 13 champions (understood as professionals with expertise in HL and dHL) from five countries (Spain, Denmark, Sweden, Australia, and Germany) representing the health sector or health literacy research. Future tools should adapt to the latest trends and technologies, considering attitudes towards digital health and trust in its services. They should identify beneficiaries of digital health services, measure the impact of dHL interventions, and objectively evaluate functional skills. These tools should be evidence-based, validate instruments, interpret dHL results, and capture diverse experiences to reveal health behaviour changes. Conclusions: The eHealth Literacy Scale (eHEALS), despite being the most frequently utilized tool, has limitations in scope and adaptability. Future tools need to reflect digital trends, encompassing individual skills. However, it is important to note that the `adequacy' of dHL is context-specific and relies on healthcare systems and the technology provided, particularly the user interface. The focus should be on health improvement, not just elevating dHL levels. A comprehensive approach to dHL assessments addressing diversity and relevance is crucial. Ethical considerations in dHL, including privacy and data security, are important due to potential feelings of shame among those with low literacy levels. ",
doi="10.2196/59807",
url="https://www.jmir.org/2025/1/e59807"
}


@Article{info:doi/10.2196/62732,
author="Zheng, Rui
and Jiang, Xiao
and Shen, Li
and He, Tianrui
and Ji, Mengting
and Li, Xingyi
and Yu, Guangjun",
title="Investigating Clinicians' Intentions and Influencing Factors for Using an Intelligence-Enabled Diagnostic Clinical Decision Support System in Health Care Systems: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="7",
volume="27",
pages="e62732",
keywords="artificial intelligence",
keywords="clinical decision support systems",
keywords="task-technology fit",
keywords="technology acceptance model",
keywords="perceived risk",
keywords="performance expectations",
keywords="intention to use",
abstract="Background: An intelligence-enabled clinical decision support system (CDSS) is a computerized system that integrates medical knowledge, patient data, and clinical guidelines to assist health care providers make clinical decisions. Research studies have shown that CDSS utilization rates have not met expectations. Clinicians' intentions and their attitudes determine the use and promotion of CDSS in clinical practice. Objective: The aim of this study was to enhance the successful utilization of CDSS by analyzing the pivotal factors that influence clinicians' intentions to adopt it and by putting forward targeted management recommendations. Methods: This study proposed a research model grounded in the task-technology fit model and the technology acceptance model, which was then tested through a cross-sectional survey. The measurement instrument comprised demographic characteristics, multi-item scales, and an open-ended query regarding areas where clinicians perceived the system required improvement. We leveraged structural equation modeling to assess the direct and indirect effects of ``task-technology fit'' and ``perceived ease of use'' on clinicians' intentions to use the CDSS when mediated by ``performance expectation'' and ``perceived risk.'' We collated and analyzed the responses to the open-ended question. Results: We collected a total of 247 questionnaires. The model explained 65.8\% of the variance in use intention. Performance expectations ($\beta$=0.228; P<.001) and perceived risk ($\beta$=--0.579; P<.001) were both significant predictors of use intention. Task-technology fit ($\beta$=--0.281; P<.001) and perceived ease of use ($\beta$=--0.377; P<.001) negatively affected perceived risk. Perceived risk ($\beta$=--0.308; P<.001) negatively affected performance expectations. Task-technology fit positively affected perceived ease of use ($\beta$=0.692; P<.001) and performance expectations ($\beta$=0.508; P<.001). Task characteristics ($\beta$=0.168; P<.001) and technology characteristics ($\beta$=0.749; P<.001) positively affected task-technology fit. Contrary to expectations, perceived ease of use ($\beta$=0.108; P=.07) did not have a significant impact on use intention. From the open-ended question, 3 main themes emerged regarding clinicians' perceived deficiencies in CDSS: system security risks, personalized interaction, seamless integration. Conclusions: Perceived risk and performance expectations were direct determinants of clinicians' adoption of CDSS, significantly influenced by task-technology fit and perceived ease of use. In the future, increasing transparency within CDSS and fostering trust between clinicians and technology should be prioritized. Furthermore, focusing on personalized interactions and ensuring seamless integration into clinical workflows are crucial steps moving forward. ",
doi="10.2196/62732",
url="https://www.jmir.org/2025/1/e62732"
}


@Article{info:doi/10.2196/68544,
author="Bakhti, Rinad
and Daler, Harmani
and Ogunro, Hephzibah
and Hope, Steven
and Hargreaves, Dougal
and Nicholls, Dasha",
title="Exploring Engagement With and Effectiveness of Digital Mental Health Interventions in Young People of Different Ethnicities: Systematic Review",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="7",
volume="27",
pages="e68544",
keywords="digital mental health interventions",
keywords="young people",
keywords="ethnicity",
keywords="engagement",
keywords="effectiveness",
keywords="artificial intelligence",
keywords="AI",
abstract="Background: The prevalence of mental health difficulties among young people has risen in recent years, with 75\% of mental disorders emerging before the age of 24 years. The identification and treatment of mental health issues earlier in life improves later-life outcomes. The COVID-19 pandemic spurred the growth of digital mental health interventions (DMHIs), which offer accessible support. However, young people of different ethnicities face barriers to DMHIs, such as socioeconomic disadvantage and cultural stigma. Objective: This review aimed to summarize and evaluate the engagement with and effectiveness of DMHIs among young people of different ethnicities. Methods: A systematic search was conducted in MEDLINE, Embase, and PsycINFO for studies published between January 2019 and May 2024, with an update in September 2024. The inclusion criteria were participants aged <25 years using DMHIs from various ethnic backgrounds. Three reviewers independently screened and selected the studies. Data on engagement (eg, use and uptake) and effectiveness (eg, clinical outcomes and symptom improvement) were extracted and synthesized to compare findings. Studies were assessed for quality using the Mixed Methods Appraisal Tool. Results: The final search yielded 67 studies, of which 7 (10\%) met inclusion criteria. There were 1853 participants across the 7 studies, all from high-income countries. Participants were predominantly aged 12 to 25 years, with representation of diverse ethnic identities, including Black, Asian, Hispanic, mixed race, and Aboriginal individuals. Engagement outcomes varied, with culturally relatable, low-cost interventions showing higher retention and user satisfaction. Linguistic barriers and country of origin impeded the effectiveness of some interventions, while near-peer mentorship, coproduction, and tailored content improved the effectiveness of DMHIs. While initial results are promising, small sample sizes, heterogeneity in outcome assessments, and a paucity of longitudinal data impeded robust comparisons and generalizability. Conclusions: DMHIs show potential as engaging and effective mental health promotional tools for young people of different ethnicities, especially when coproduced and culturally relatable. Initial data suggest that interventions facilitating near-peer mentoring, linguistic adaptation, low cost, and cultural relatability have improved engagement and effectiveness. Future research should focus on developing a consensus definition of DMHIs, exploring DMHIs in children aged <12 years, and conducting detailed qualitative and quantitative research on use factors and treatment efficacy of DMHIs for young people of different ethnicities. Trial Registration: PROSPERO CRD42024544364; https://tinyurl.com/yk5jt8yk ",
doi="10.2196/68544",
url="https://www.jmir.org/2025/1/e68544"
}


@Article{info:doi/10.2196/64796,
author="Abou Malham, Sabina
and Traor{\'e}, Doufain
and Dicko, Fatoumata
and Blouin Genest, Gabriel
and Boudreau, Jennyfer
and Sidib{\'e}, Mansa Drissa
and Sidib{\'e}, Souleymane
and Go{\"i}ta, Souleymane Issa
and Sangar{\'e}, Aminata
and Togo, Mohamed
and Diarra, Delphine
and Rietmann, Mich{\`e}le
and Ma{\"i}ga, Mahamoudou Mahamane
and Boulanger, Suzie
and Gr{\'e}goire, Isabelle Ann
and Milot, David-Martin
and Berbiche, Djamal
and Stecko, Sarah",
title="Assessment of Community Stakeholders' and Health Educators and Professionals' Needs for the Continuous Enhancement of Sexual and Reproductive Health and Rights in Mali (Project CLEFS): Protocol for a Convergent Mixed Methods Study",
journal="JMIR Res Protoc",
year="2025",
month="Apr",
day="1",
volume="14",
pages="e64796",
keywords="mixed methods study",
keywords="protocol",
keywords="sexual and reproductive health and rights",
keywords="Mali",
keywords="primary health care providers",
keywords="women and girls' health needs",
abstract="Background: In Mali, a lack of qualified human resources in primary health care and sexual and reproductive health and rights (SRHR) is one of the greatest barriers to the population's access to standard health services. Frontline professional training must be strengthened to respond to the needs of the population, particularly those of women and girls. Training must be conducted using an interdisciplinary and adapted approach to promote gender equality. Objective: This study aims to identify the SRHR training needs among the community, educational actors, and primary health care providers. Methods: A concurrent mixed methods design was adopted, using 2 methods. A quantitative method, through a cross-sectional analytical survey, will be conducted at the community level with university community health centers (CSCom-U) users and adolescents in CSCom-U health areas, as well as at the health education institution and community health centers levels with teachers, students, and interdisciplinary professional groups within the CSCom-U and district hospital maternity. Descriptive and inferential analyses will be conducted to process quantitative data. This research is at the stage of data analysis and interpretation. A qualitative method, based on 3 sources of data (focus groups, individual semistructured interviews, and document analysis), which involved the same targets as the quantitative component, with additional community actors such as Community Health Associations (Associations de sant{\'e} communautaire) and Women's Service User Communities. A thematic analysis of the qualitative data using a mixed deductive and inductive method will be performed. Results: : Field data collection took place from March to April 2022. Quantitative data from 3153 participants are being analyzed using SPSS. Qualitative data from 11 interviews and 27 focus groups were processed with Qualitative Data Analysis Miner. Data analysis is still ongoing. Conclusions: This study will provide a better understanding of adolescents and SRHR user's service needs in terms of health services availability and quality and SRHR knowledge, issues related to student training quality, the level of adequacy between the training offered and the actual needs of the service recipients, and the level of preparation and ability of teachers to provide quality teaching taking gender equity into account. The recommendations drawn from this assessment will propose concrete actions to improve women and girls' health services provided by professionals, and to better adapt the future health professionals' profiles to the needs of communities, particularly those of women and girls. International Registered Report Identifier (IRRID): DERR1-10.2196/64796 ",
doi="10.2196/64796",
url="https://www.researchprotocols.org/2025/1/e64796"
}


@Article{info:doi/10.2196/68061,
author="Lee, Man-Sin Maggie
and Yeoh, Eng-Kiong
and Wong, Lai-Yi Eliza",
title="Employers' Perspectives of Caregiver-Friendly Workplace Policies for Caregiver-Employees Caring for Older Adults in Hong Kong: Thematic Analysis",
journal="JMIR Aging",
year="2025",
month="Mar",
day="31",
volume="8",
pages="e68061",
keywords="caregiver",
keywords="aging",
keywords="burnout",
keywords="stress",
keywords="mental health",
keywords="employees",
abstract="Background: Caregiver-friendly workplace policies (CFWPs) are rare in Hong Kong. With Hong Kong facing a ``silver tsunami'' in the near future, it is important to understand the need for such policies and the views of employers for future facilitation. Objective: This study aimed to identify the support that is currently provided or that could be provided to caregiver-employees (CEs) caring for older adults in Hong Kong and assess the challenge and facilitative support for employers to adopt CFWPs in the specific context of Hong Kong. Methods: A qualitative research design with semistructured individual in-depth interviews with employers from Hong Kong was adopted for this study. A purposive snowball sampling method was used to recruit participants from the 7 primary industries mentioned in the Hong Kong census and from all 3 employer types (private, public, and nongovernmental organizations), which allowed the inclusion of participants sensitized to the idea and potential of CFWPs. Thematic framework analysis was used to evaluate the data collected during the interviews. Results: We interviewed 17 employers and managers from 7 major industries in Hong Kong (2.5 to 120,000 employees). There were 4 (24\%) male and 13 (76\%) female participants, and the participant age ranged from 30 to 50 years. All participants held managerial positions at the time of the interview. Of the 17 participants, 13 were from private companies, 2 were from public institutions, and 2 were from nongovernmental organizations. Four of the companies had a global presence. Four main themes were identified: (1) current support and potential support for CEs (which was limited to discretionary annual leave and unpaid leave when annual leave was exhausted), (2) challenges in adopting CFWPs, (3) facilitating support for adopting CFWPs, and (4) incentives for adopting CFWPs. The participants rated information and resources for CEs (mean 8.56, SD 0.37), bereavement leave (mean 8.47, SD 0.63), flexible working hours (mean 8.32, SD 0.48), and caregiver-inclusive corporate culture (mean 8.32, SD 0.48) as essential CFWPs for CEs in Hong Kong. Conclusions: While several studies have reported the types of CFWPs and their impacts on CEs, stakeholders' perspectives on CFWPs have been rarely investigated. This study found that although employers consider CFWPs as necessary and see them as a catalyst for a long-term win-win situation, the current support for CEs is discretionary and industry-specific. Government leadership is critical for formulating, piloting, and implementing CFWPs to create a friendly environment that encourages disclosure with trust and respect across industrial sectors in Hong Kong. This study identified the current unmet needs and demands of CEs from the employer's perspective, the barriers to large-scale adoption of CFWPs, and the path forward to inform further discourse and policy formulation in Hong Kong. ",
doi="10.2196/68061",
url="https://aging.jmir.org/2025/1/e68061"
}


@Article{info:doi/10.2196/66117,
author="Stephen, Anna Divya
and Nordin, Anna
and Johansson, Unn-Britt
and Nilsson, Jan",
title="eHealth Literacy and Its Association With Demographic Factors, Disease-Specific Factors, and Well-Being Among Adults With Type 1 Diabetes: Cross-Sectional Survey Study",
journal="JMIR Diabetes",
year="2025",
month="Mar",
day="31",
volume="10",
pages="e66117",
keywords="cross-sectional studies",
keywords="diabetes mellitus, type 1",
keywords="digital technology",
keywords="eHealth literacy",
keywords="health literacy",
abstract="Background: The use of digital health technology in diabetes self-care is increasing, making eHealth literacy an important factor to consider among people with type 1 diabetes. There are very few studies investigating eHealth literacy among adults with type 1 diabetes, highlighting the need to explore this area further. Objective: The aim of this study was to explore associations between eHealth literacy and demographic factors, disease-specific factors, and well-being among adults with type 1 diabetes. Methods: The study used data from a larger cross-sectional survey conducted among adults with type 1 diabetes in Sweden (N=301). Participants were recruited using a convenience sampling method primarily through advertisements on social media. Data were collected between September and November 2022 primarily through a web-based survey, although participants could opt to answer a paper-based survey. Screening questions at the beginning of the survey determined eligibility to participate. In this study, eHealth literacy was assessed using the Swedish version of the eHealth Literacy Scale (Sw-eHEALS). The predictor variables, well-being was assessed using the World Health Organization-5 Well-Being Index and psychosocial self-efficacy using the Swedish version of the Diabetes Empowerment Scale. The survey also included research group--developed questions on demographic and disease-specific variables as well as digital health technology use. Data were analyzed using multiple linear regression presented as nested models. A sample size of 270 participants was required in order to detect an association between the dependent and predictor variables using a regression model based on an F test. The final sample size included in the nested regression model was 285. Results: The mean Sw-eHEALS score was 33.42 (SD 5.32; range 8?40). The model involving both demographic and disease-specific variables explained 31.5\% of the total variation in eHealth literacy and was deemed the best-fitting model. Younger age (P=.01; B=--0.07, SE=0.03;95\% CI --0.12 to --0.02), lower self-reported glycated hemoglobin levels (P=.04; B=--0.06, SE=0.03; 95\% CI --0.12 to 0.00), and higher psychosocial self-efficacy (P<.001; B=3.72, SE=0.53; 95\% CI 2.68-4.75) were found associated with higher Sw-eHEALS scores when adjusted for demographic and disease-specific variables in this model. Well-being was not associated with eHealth literacy in this study. Conclusions: The demographic and disease-specific factors explained the variation in eHealth literacy in this sample. Further studies in this area using newer eHealth literacy tools are important to validate our findings. The study highlights the importance of development and testing of interventions to improve eHealth literacy in this population for better glucose control. These eHealth literacy interventions should be tailored to meet the needs of people in varying age groups and with differing levels of psychosocial self-efficacy. ",
doi="10.2196/66117",
url="https://diabetes.jmir.org/2025/1/e66117"
}


@Article{info:doi/10.2196/56666,
author="May, Susann
and Seifert, Frances
and Bruch, Dunja
and Heinze, Martin
and Spethmann, Sebastian
and Muehlensiepen, Felix",
title="Insights Into How mHealth Applications Could Be Introduced Into Standard Hypertension Care in Germany: Qualitative Study With German Cardiologists and General Practitioners",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Mar",
day="28",
volume="13",
pages="e56666",
keywords="hypertension",
keywords="mHealth apps",
keywords="physicians",
keywords="qualitative study",
keywords="digitalization",
keywords="app",
keywords="application",
keywords="Germany",
keywords="blood pressure",
keywords="cardiologists",
keywords="thematic analysis",
keywords="general practitioner",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) apps provide innovative solutions for improving treatment adherence, facilitating lifestyle modifications, and optimizing blood pressure control in patients with hypertension. Despite their potential benefits, the adoption and recommendation of mHealth apps by physicians in Germany remain limited. This reluctance may be due to a lack of understanding of the factors influencing physicians' willingness to incorporate these digital tools into routine clinical practice. Understanding these factors is crucial for fostering greater integration of mHealth apps in hypertension care. Objective: The aim of this study was to explore the relationship between physicians' information needs and acceptance factors, and how these elements can support the effective integration of mHealth apps into daily medical routines. Methods: We conducted a qualitative study involving 24 semistructured telephone interviews with physicians, including 14 cardiologists and 10 general practitioners, who are involved in the treatment of hypertensive patients. Participants were selected through purposive sampling to ensure a diverse range of perspectives. Thematic analysis was conducted using MAXQDA software (Verbi GmbH) to identify key themes and subthemes related to the acceptance and use of mHealth apps. Results: The analysis revealed significant variability in physicians' information needs regarding mHealth apps, particularly concerning their functionalities, clinical benefits, and potential impact on patient outcomes. These informational gaps play a critical role in determining whether physicians are willing to recommend mHealth apps to their patients. Key determinants influencing acceptance were identified, including the availability of robust knowledge about the apps, high-quality and reliable data, generational shifts within the medical profession, solid evidence supporting the effectiveness of the mHealth apps, and clearly defined areas of application and responsibilities within the physician-patient relationship. The study found that acceptance of mHealth apps could be significantly increased through targeted educational initiatives, enhanced data quality, and better integration of these tools into existing clinical workflows. Furthermore, younger physicians, more familiar with digital technologies, demonstrated greater openness to using mHealth apps, suggesting that generational changes may drive future increases in adoption. Conclusions: The successful integration of mHealth apps into hypertension management requires a multifaceted approach that addresses both the informational and practical concerns of physicians. By disseminating comprehensive knowledge about the variety, functionality, and proven efficacy of hypertension-related mHealth apps, health care providers can be better equipped to use these tools effectively. This approach necessitates the implementation of various knowledge transfer strategies, such as targeted training programs, peer learning opportunities, and active engagement with digital health technologies. As physicians become more informed and confident in the use of mHealth apps, their acceptance and recommendation of these tools are likely to increase, leading to more widespread adoption. Overcoming current barriers related to information deficits and data quality is essential for ensuring that mHealth apps are optimally used in routine hypertension care, ultimately improving patient outcomes and enhancing the overall quality of care. Trial Registration: German Clinical Trials Register DRKS00029761; https://drks.de/search/de/trial/DRKS00029761 International Registered Report Identifier (IRRID): RR2-10.3389/fcvm.2022.1089968 ",
doi="10.2196/56666",
url="https://mhealth.jmir.org/2025/1/e56666"
}


@Article{info:doi/10.2196/64079,
author="Rettinger, Lena
and Aichinger, Lea
and Ertelt-Bach, Veronika
and Huber, Andreas
and Javorszky, Maria Susanne
and Maul, Lukas
and Putz, Peter
and Sargis, Sevan
and Werner, Franz
and Widhalm, Klaus
and Kuhn, Sebastian",
title="Best Practice Guide for Reducing Barriers to Video Call--Based Telehealth: Modified Delphi Study Among Health Care Professionals",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="26",
volume="12",
pages="e64079",
keywords="telehealth",
keywords="best practices",
keywords="video call",
keywords="Delphi study",
keywords="health communication",
keywords="barriers",
keywords="health care professionals",
keywords="qualitative interviews",
keywords="web-based survey",
keywords="physiotherapists",
keywords="speech therapists",
keywords="language therapists",
keywords="dietitians",
keywords="midwife",
abstract="Background: Telehealth has grown, especially during the COVID-19 pandemic, improving access for those in remote or underserved areas. However, its implementation faces technological, practical, and interpersonal barriers. Objective: The aim of this study was to identify and consolidate best practices for telehealth delivery, specifically for video call sessions, by synthesizing the insights of health care professionals across various disciplines. Methods: We first identified 15 common telehealth barriers from a preceding scoping review. Subsequently, a modified Delphi method was used, involving 9 health care professionals (physiotherapists, speech and language therapists, dietitians, and midwife) with telehealth experience in qualitative interviews and 2 iterative rounds of web-based surveys to form consensus. Results: This study addressed 15 telehealth barriers and identified 105 best practices. Among these, 20 are technology-related and 85 concern health care practices. Emphasis was placed on setting up telehealth environments, ensuring safety, building relationships and trust, using nonmanual methods, and enhancing observation and assessment skills. Best practice recommendations for dealing with patients or caregiver skepticism or lack of telehealth-specific knowledge were developed. Further, approaches for unstable networks and privacy and IT security issues were identified. Areas with fewer best practices were the lack of technology skills or technology access, unreliability of hardware and software, increased workload, and a lack of caregiver support. Conclusions: This guide of best practices serves as an actionable resource for health care providers to navigate the complexities of telehealth. Despite a small participant sample and the potential for profession-specific biases, the findings provide a foundation for improving telehealth services and inform future research for its application and education. ",
doi="10.2196/64079",
url="https://humanfactors.jmir.org/2025/1/e64079"
}


@Article{info:doi/10.2196/59527,
author="Immel, Diana
and Hilpert, Bernhard
and Schwarz, Patricia
and Hein, Andreas
and Gebhard, Patrick
and Barton, Simon
and Hurlemann, Ren{\'e}",
title="Patients' and Health Care Professionals' Expectations of Virtual Therapeutic Agents in Outpatient Aftercare: Qualitative Survey Study",
journal="JMIR Form Res",
year="2025",
month="Mar",
day="26",
volume="9",
pages="e59527",
keywords="socially interactive agent",
keywords="e-mental health",
keywords="mental illness",
keywords="mental disorder",
keywords="depression",
keywords="major depressive disorder",
keywords="suicide prevention",
keywords="suicidal ideation",
keywords="outpatient aftercare",
keywords="artificial intelligence",
keywords="virtual therapeutic assistant",
keywords="public health",
keywords="digital technology",
keywords="digital intervention",
keywords="digital health care",
abstract="Background: Depression is a serious mental health condition that can have a profound impact on the individual experiencing the disorder and those providing care. While psychotherapy and medication can be effective, there are gaps in current approaches, particularly in outpatient care. This phase is often associated with a high risk of relapse and readmission, and patients often report a lack of support. Socially interactive agents represent an innovative approach to the provision of assistance. Often powered by artificial intelligence, these virtual agents can interact socially and elicit humanlike emotions. In health care, they are used as virtual therapeutic assistants to fill gaps in outpatient aftercare. Objective: We aimed to explore the expectations of patients with depression and health care professionals by conducting a qualitative survey. Our analysis focused on research questions related to the appearance and role of the assistant, the assistant-patient interaction (time of interaction, skills and abilities of the assistant, and modes of interaction) and the therapist-assistant interaction. Methods: A 2-part qualitative study was conducted to explore the perspectives of the 2 groups (patients and care providers). In the first step, care providers (n=30) were recruited during a regional offline meeting. After a short presentation, they were given a link and were asked to complete a semistructured web-based questionnaire. Next, patients (n=20) were recruited from a clinic and were interviewed in a semistructured face-to-face interview. Results: The survey findings suggested that the assistant should be a multimodal communicator (voice, facial expressions, and gestures) and counteract negative self-evaluation. Most participants preferred a female assistant or wanted the option to choose the gender. In total, 24 (80\%) health care professionals wanted a selectable option, while patients exhibited a marked preference for a female or diverse assistant. Regrading patient-assistant interaction, the assistant was seen as a proactive recipient of information, and the patient as a passive one. Gaps in aftercare could be filled by the unlimited availability of the assistant. However, patients should retain their autonomy to avoid dependency. The monitoring of health status was viewed positively by both groups. A biofeedback function was desired to detect early warning signs of disease. When appropriate to the situation, a sense of humor in the assistant was desirable. The desired skills of the assistant can be summarized as providing structure and emotional support, especially warmth and competence to build trust. Consistency was important for the caregiver to appear authentic. Regarding the assistant--care provider interaction, 3 key areas were identified: objective patient status measurement, emergency suicide prevention, and an information tool and decision support system for health care professionals. Conclusions: Overall, the survey conducted provides innovative guidelines for the development of virtual therapeutic assistants to fill the gaps in patient aftercare. ",
doi="10.2196/59527",
url="https://formative.jmir.org/2025/1/e59527"
}


@Article{info:doi/10.2196/63671,
author="Yu, Yao
and Liang, Zhenning
and Zhou, Qingping
and Tuersun, Yusupujiang
and Liu, Siyuan
and Wang, Chenxi
and Xie, Yuying
and Wang, Xinyu
and Wu, Zhuotong
and Qian, Yi",
title="Decomposition and Comparative Analysis of Urban-Rural Disparities in eHealth Literacy Among Chinese University Students: Cross-Sectional Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="26",
volume="27",
pages="e63671",
keywords="university students",
keywords="eHealth literacy",
keywords="urban-rural disparities",
keywords="Fairlie decomposition model",
keywords="health equity",
abstract="Background: Mobile health care is rapidly expanding in China, making the enhancement of eHealth literacy a crucial strategy for improving public health. However, the persistent urban-rural divide may contribute to disparities in eHealth literacy between urban and rural university students, potentially affecting their health-related behaviors and outcomes. Objective: This study aims to examine disparities in eHealth literacy between university students in urban and rural China, identifying key influencing factors and their contributions. The findings will help bridge these gaps, promote social equity, enhance overall health and well-being, and inform future advancements in the digital health era. Methods: The eHealth Literacy Scale (eHEALS) was used to assess eHealth literacy levels among 7230 university students from diverse schools and majors across 10 regions, including Guangdong Province, Shanghai Municipality, and Jiangsu Province. Descriptive statistics summarized demographic, sociological, and lifestyle characteristics. Chi-square tests examined the distribution of eHealth literacy between urban and rural students. A binary logistic regression model identified key influencing factors, while a Fairlie decomposition model quantified their contributions to the observed disparities. Results: The average eHealth literacy score among Chinese university students was 29.22 (SD 6.68), with 4135 out of 7230 (57.19\%) scoring below the passing mark. Rural students had a significantly higher proportion of inadequate eHealth literacy (2837/4510, 62.90\%) compared with urban students (1298/2720, 47.72\%; P<.001). The Fairlie decomposition analysis showed that 71.4\% of the disparity in eHealth literacy was attributable to urban-rural factors and unobserved variables, while 28.6\% resulted from observed factors. The primary contributors were monthly per capita household income (13.4\%), exercise habits (11.7\%), and 9-item Patient Health Questionnaire (PHQ-9) scores (2.1\%). Conclusions: Rural university students exhibit lower eHealth literacy levels than their urban counterparts, a disparity influenced by differences in socioeconomic status, individual lifestyles, and personal health status. These findings highlight the need for targeted intervention strategies, including (1) improving access to eHealth resources in rural and underserved areas; (2) fostering an environment that encourages physical activity to promote healthy behaviors; (3) expanding school-based mental health services to enhance health information processing capacity; and (4) implementing systematic eHealth literacy training with ongoing evaluation. These strategies will support equitable access to and utilization of eHealth resources for all students, regardless of their geographic location. ",
doi="10.2196/63671",
url="https://www.jmir.org/2025/1/e63671"
}


@Article{info:doi/10.2196/67128,
author="Portela Dos Santos, Omar
and Alves, Pereira Paulo Jorge
and Verloo, Henk",
title="Exploring Climate Change's Impact on the Cardiopulmonary Health of Adults Living in the Canton of Valais, Switzerland: Protocol for a Development and Usability Pilot Study",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="25",
volume="14",
pages="e67128",
keywords="climate change",
keywords="global warming",
keywords="emergency department",
keywords="emergency nursing",
keywords="sustainable care",
keywords="ecological medicine",
keywords="cardiopulmonary",
keywords="cardio health",
keywords="Valais",
keywords="Switzerland",
keywords="pilot study",
keywords="study protocol",
keywords="humanity",
keywords="air pollution",
keywords="impact",
keywords="comorbidities",
keywords="adults",
keywords="mixed methods design",
keywords="feasibility",
keywords="health promotion",
keywords="disease prevention",
keywords="acceptability",
abstract="Background: Climate change is affecting public health and well-being. In 2016, Swiss emergency departments (EDs) treated 1,722,000 cases, with 4718 daily admissions. In 2023, the ED of Sion Regional Hospital recorded 75,000 consultations. The links between climate change and health are complex, necessitating urgent research on its impact on cardiopulmonary health in Valais, Switzerland. Raising awareness among frontline professionals is crucial for developing health promotion and disease prevention strategies. Objective: This study explores the preliminary effects of climate change on cardiopulmonary health in Valais and assesses adult patients' knowledge of its health consequences. Findings will inform adaptations in patient care, health promotion, and disease prevention at Sion Hospital's ED. The feasibility of patient selection and data collection will also be evaluated. Methods: Using a convergent, parallel, mixed methods design, data will be collected from September 21, 2024, to September 20, 2025, with a target sample of 60 patients. The quantitative phase will examine patient recruitment feasibility, consultation reasons, and triage levels, correlating them with climate variables (temperature, nitrogen dioxide, particulate matter, sulfur dioxide, and ozone). It will also analyze sociodemographic profiles. The qualitative phase will explore patients' knowledge of climate change and its potential links to their ED visits. The feasibility and acceptability of the study process will be assessed. The protocol follows the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) Extension for Pilot and Feasibility Trials. Results: Data collection started on September 21, 2024, following the approval by the ethical commission. Data collection will take place over 1 year, until September 20, 2025. Conclusions: This study will test the feasibility of a larger investigation and examine potential associations between Valais' changing microclimate and population health. Findings will establish patient profiles and explore their perceptions and knowledge of climate change, informing future health interventions. International Registered Report Identifier (IRRID): DERR1-10.2196/67128 ",
doi="10.2196/67128",
url="https://www.researchprotocols.org/2025/1/e67128"
}


@Article{info:doi/10.2196/60582,
author="Rivas, Vincent Eric
and Lesley, Ulf
and Davoody, Nadia",
title="Health Care Professionals' Perspectives on Using eHealth Tools in Advanced Home Care: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="24",
volume="12",
pages="e60582",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="advanced home care",
keywords="content analysis",
keywords="nurse",
keywords="staff-patient relationship",
keywords="aging population",
keywords="patient engagement",
keywords="personalized care",
keywords="patient experience",
abstract="Background: The rising demand for advanced home care services, driven by an aging population and the preference for aging in place, presents both challenges and opportunities. While advanced home care can improve cost-effectiveness and patient outcomes, gaps remain in understanding how eHealth technologies can optimize these services. eHealth tools have the potential to offer personalized, coordinated care that increases patient engagement. However, research exploring health care professionals' (HCPs) perspectives on the use of eHealth tools in advanced home care and their impact on the HCP-patient relationship is limited. Objective: This study aims to explore HCPs' perspectives on using eHealth tools in advanced home care and these tools' impact on HCP-patient relationships. Methods: In total, 20 HCPs from 9 clinics specializing in advanced home care were interviewed using semistructured interviews. The discussions focused on their experiences with 2 eHealth tools: a mobile documentation tool and a mobile preconsultation form. The data were analyzed using content analysis to identify recurring themes. Results: The data analysis identified one main theme: optimizing health care with eHealth; that is, enhancing care delivery and overcoming challenges for future health care. Two subthemes emerged: (1) enhancing care delivery, collaboration, and overcoming adoption barriers and (2) streamlining implementation and advancing eHealth tools for future health care delivery. Five categories were also identified: (1) positive experiences and benefits, (2) interactions between HCPs and patients, (3) challenges and difficulties with eHealth tools, (4) integration into the daily workflow, and (5) future directions. Most HCPs expressed positive experiences with the mobile documentation tool, highlighting improved efficiency, documentation quality, and patient safety. While all found the mobile preconsultation form beneficial, patient-related factors limited its utility. Regarding HCP-patient relationships, interactions with patients remained unchanged with the implementation of both tools. HCPs successfully maintained their interpersonal skills and patient-centered approach while integrating eHealth tools into their practice. The tools allowed more focused, in-depth discussions, enhancing patient engagement without affecting relationships. Difficulties with the tools originated from tool-related issues, organizational challenges, or patient-related complexities, occasionally affecting the time available for direct patient interaction. Conclusions: The study underscores the importance of eHealth tools in enhancing advanced home care while maintaining the HCP-patient relationship. While eHealth tools modify care delivery techniques, they do not impact the core dynamics of the relationships between HCPs and patients. While most of the HCPs in the study had a positive attitude toward using the eHealth tools, understanding the challenges they encounter is crucial for improving user acceptance and success in implementation. Future development should focus on features that not only improve efficiency but also actively enhance HCP-patient relationships, such as facilitating more meaningful interactions and supporting personalized care in the advanced home care setting. ",
doi="10.2196/60582",
url="https://humanfactors.jmir.org/2025/1/e60582"
}


@Article{info:doi/10.2196/65373,
author="Gao, Lu
and Chen, Meilian
and Wei, Jingxin
and Wang, Jinni
and Liao, Xiaoyan",
title="The Chinese Version of the DigiHealthCom (Digital Health Competence) Instrument for Assessing Digital Health Competence of Health Care Professionals: Translation, Adaptation, and Validation Study",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="21",
volume="12",
pages="e65373",
keywords="competence",
keywords="digital health",
keywords="health care professionals",
keywords="instrument",
keywords="reliability",
keywords="validity",
abstract="Background: Digital health competence is increasingly recognized as a core competence for health care professionals. A comprehensive evaluation of knowledge, skills, performance, values, and attitudes necessary to adapt to evolving digital health technologies is essential. DigiHealthCom (Digital Health Competence) is a well-established instrument designed to assess digital health competence across diverse health care professionals. Objective: This study aimed to translate and culturally adapt DigiHealthCom into simplified Chinese (Mandarin) and verify its reliability and validity in assessing digital health competence of Chinese health care professionals. Methods: DigiHealthCom was translated into Chinese following the guideline proposed by its original developers. The cultural adaptation involved expert review and cognitive interviewing. Internal consistency, test-retest reliability, content validity, convergent validity, discriminant validity, and factor structure were examined. Item analysis tested item discrimination, item correlation, and item homogeneity. Internal consistency was assessed using Cronbach $\alpha$, and test-retest reliability was measured using the intraclass correlation coefficient. Content validity was assessed through both item and scale content validity indices. Convergent validity was measured by the Average Variance Extracted and Composite Reliability, while discriminant validity was measured by the heterotrait-monotrait ratio. A five-dimension model of DigiHealthCom was confirmed using confirmatory factor analysis. Results: The finalized Chinese version of the DigiHealthCom was completed after addressing differences between the back-translations and the original version. No discrepancies affecting item clarity were reported during cognitive interviewing. The validation process involved 398 eligible health care professionals from 36 cities across 15 provinces in China, with 43 participants undergoing a retest after a 2-week interval. Critical ratio values (range 16.05?23.77, P<.001), item-total correlation coefficients (range 0.69?0.89), and Cronbach $\alpha$ if the item deleted (range 0.91?0.96) indicated satisfactory item discrimination, item correlation, and item homogeneity. Cronbach $\alpha$ for dimensions and the scale ranged from 0.94 to 0.98, indicating good internal consistency. The intraclass correlation coefficient was 0.90 (95\% CI 0.81?0.95), indicating good test-retest reliability. Item content validity index ranged from 0.82 to 1.00, and the scale content validity index was 0.97, indicating satisfactory content validity. Convergent validity (average variance extracted: 0.60?0.79; composite reliability: 0.94?0.95) and divergent validity (heterotrait-monotrait ratio: 0.72?0.89) were satisfactory. Confirmatory factor analysis confirmed a well-fit five-dimension model (robust chi-square to df ratio=3.10, comparative fit index=0.91, Tucker-Lewis index=0.90, incremental fit index=0.91, root-mean-square error of approximation=0.07, standardized root-mean-square residual=0.05), with each item having a factor loading exceeding 0.40. Conclusions: The Chinese version of DigiHealthCom has been proved to be reliable and valid. It is now available for assessing digital health competence among Chinese health care professionals. This assessment can be used to guide health care policy makers and educators in designing comprehensive and implementable educational programs and interventions. ",
doi="10.2196/65373",
url="https://humanfactors.jmir.org/2025/1/e65373"
}


@Article{info:doi/10.2196/48221,
author="Valkonen, Paula
and H{\"o}ls{\"a}, Sini
and Viitanen, Johanna
and Leinonen, Sini
and Karisalmi, Nina
and Rauta, Virpi",
title="Illustrating User Needs for eHealth With Experience Map: Interview Study With Chronic Kidney Disease Patients",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="18",
volume="12",
pages="e48221",
keywords="user need",
keywords="chronic illness",
keywords="kidney disease",
keywords="older adult",
keywords="eHealth",
keywords="experience map",
keywords="human-centered design",
keywords="home dialysis",
abstract="Background: Chronic kidney disease (CKD) is a common condition worldwide and home dialysis (HD) provides economic, quality of life, and clinical advantages compared to other dialysis modalities. Human-centered design aims to support the development of eHealth solutions with high usability and user experience. However, research on the eHealth needs of patients using HD is scarce. Objective: This study aimed to support the design of eHealth for patients with CKD, particularly for patients using HD, by developing a kidney disease experience map that illustrates user needs, concerns, and barriers. The research questions were (1) what experiences do patients, particularly older adults, have in their everyday lives with CKD? (2) what user needs do patients with CKD have for HD eHealth? (3) how can these needs be illustrated using the experience map technique? The study focused on patients aged >60 years, as they are at a higher risk of chronic conditions. The study was conducted as part of the eHealth in HD project, coordinated by Hospital District of Helsinki and Uusimaa, Finland. Methods: In total, 18 patients in different care modalities participated in retrospective interviews conducted between October 2020 and April 2021. The interviews included a preliminary task with patient journey illustrations and questions about their experiences and everyday lives with CKD. The data analysis was conducted using a thematic analysis approach and the process included several phases. Results: On the basis of the thematic analysis, 5 categories were identified: healthy habits, concerns about and barriers to eHealth use, digital communication, patients' emotions, and everyday life with CKD. These were illustrated in the first version of the kidney disease experience map. The patients had different healthy habits regarding social life, sports, and other activities. They had challenges with poorly functioning eHealth software and experienced other factors, such as a lack of interest and lack of skills for eHealth use. Technical devices do not always meet the emotional or physical needs of their users. This caused feelings of frustration, worry, and fear in patients, yet also fostered situational awareness and hope. Conclusions: The experience map is a promising method for illustrating user needs and communicating the patient's voice for eHealth development. eHealth offers possibilities to support patient's everyday life with chronic disease. The patient's situation and capacity to use eHealth solutions vary with their everyday challenges, opportunities, and their current stage of treatment. The kidney disease experience map will be used and further developed in the ongoing research project ``Better Health at Home---Optimized Human-Centered Care of Predialysis and Home Dialysis Patients'' (2022 to 2026). ",
doi="10.2196/48221",
url="https://humanfactors.jmir.org/2025/1/e48221"
}


@Article{info:doi/10.2196/60424,
author="Dol{\'o}n-Poza, Mar{\'i}a
and Gabald{\'o}n-P{\'e}rez, Ana-Marta
and Berrezueta-Guzman, Santiago
and L{\'o}pez Gracia, David
and Mart{\'i}n-Ruiz, Mar{\'i}a-Luisa
and Pau De La Cruz, Iv{\'a}n",
title="Enhancing Early Language Disorder Detection in Preschools: Evaluation and Future Directions for the Gades Platform",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="14",
volume="12",
pages="e60424",
keywords="developmental language disorder",
keywords="simple language delay",
keywords="adaptive screening system",
keywords="early childhood education",
keywords="pervasive therapy",
abstract="Background: Language acquisition is a critical developmental milestone, with notable variability during the first 4 years of life. Developmental language disorder (DLD) often overlaps with other neurodevelopmental disorders or simple language delay (SLD), making early detection challenging, especially for primary caregivers. Objective: We aimed to evaluate the effectiveness of the Gades platform, an adaptive screening tool that enables preschool teachers to identify potential language disorders without direct support from nursery school language therapists (NSLTs). Methods: The study took place in a nursery school and an early childhood educational and psychopedagogical center in Madrid, Spain, involving 218 children aged 6 to 36 months, 24 preschool teachers, and 2 NSLTs. Initially, NSLTs conducted informational sessions to familiarize teachers with DLDs and how to identify them. Following this, the teachers used the Gades platform to conduct language screenings independently, without ongoing support from NSLTs. The Gades platform was enhanced to collect detailed profiles of each child and implemented an adaptive screening model tailored to account for variability in language development. This setup allowed preschool teachers, who are not language experts, to observe and assess language development effectively in natural, unsupervised educational environments. The study assessed the platform's utility in guiding teachers through these observations and its effectiveness in such settings. Results: Gades identified language difficulties in 19.7\% (43/218) of the children, with a higher prevalence in boys (29/218, 13.3\%) than in girls (14/218, 6.4\%). These challenges were most frequently observed in children aged 15 to 27 months. The platform demonstrated a high accuracy rate of 97.41\%, with evaluators largely agreeing with its recommendations. Teachers also found Gades to be user friendly and a valuable tool for supporting language development observations in everyday educational settings. Conclusions: Gades demonstrates potential as a reliable and accessible tool for early detection of language disorders, empowering educators to identify DLD and SLD in the absence of NSLTs. However, further refinement of the platform is required to effectively differentiate between DLD and SLD. By integrating Gades into routine preschool assessments, educators can facilitate timely interventions, bridging gaps in early childhood education and therapy. Trial Registration: Pan-African Clinical Trial Registry (PACTR) PACTR202210657553944; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=24051 ",
doi="10.2196/60424",
url="https://humanfactors.jmir.org/2025/1/e60424"
}


@Article{info:doi/10.2196/66683,
author="Li, Hongmin
and Li, Dongxu
and Zhai, Min
and Lin, Li
and Cao, ZhiHeng",
title="Associations Among Online Health Information Seeking Behavior, Online Health Information Perception, and Health Service Utilization: Cross-Sectional Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="14",
volume="27",
pages="e66683",
keywords="online health information seeking (OHIS)",
keywords="online health information perception (OHIP)",
keywords="mediating effect",
keywords="health service utilization",
keywords="health information",
keywords="health perception",
keywords="data",
keywords="China",
keywords="Chinese General Social Survey (CGSS)",
keywords="database",
keywords="medical information",
keywords="survey",
abstract="Background: Seeking online health information can empower individuals to better understand their health concerns, facilitating their ability to manage their health conditions more effectively. It has the potential to change the likelihood and frequency of health service usage. Although existing literature has demonstrated the prevalence of seeking online health information among different populations, the factors affecting online health information perception and discussions on the associations between seeking online health information and health service utilization are limited. Objective: We analyzed the associations between online health information seeking behavior and health service utilization, as well as the online health information perception delivery mechanism. Methods: We analyzed data from the Chinese General Social Survey, the first national representative survey conducted in mainland China. The independent variable was the online health information seeking behavior. The outcome variable was health service utilization by the respondents, and online health information perception was selected as the mediating variable in this analysis. Factor analysis was conducted to obtain online health information perception. Multiple regressions were performed to investigate the effect of online health information seeking behavior on physician visits. Bootstrap methods were conducted to test the mediation effects of online health information perception. Results: This analysis included 1475 cases. Among the participants, 939 (63.66\%) sought online health information in the last 12 months. The mean age of the respondents was 46.72 (SD 15.86) years, and 794 (53.83\%) were females. After controlling for other variables, individuals with online health information seeking behaviors showed 0.289 times more outpatient visits (P=.003), 0.131 times more traditional Chinese medicine outpatient visits (P=.01), and 0.158 times more Western medicine outpatient visits (P=.007) over the past year compared to those who did not seek health information online. Additionally, multiple regression analyses revealed statistically significant effects of gender, age, and health status on physician visits. The total effect revealed that seeking online health information significantly influenced the total physician visits ($\beta$=0.290; P=.003), indicating a certain correlation between online health information seeking behavior and physician visits. Seeking online health information had a significant positive impact on the perception ($\beta$=0.265; P<.001). The mediation effects analysis identified that online health information perception led to a significant increase in physician visits with the increase in the online health information seeking behaviors ($\beta$=0.232; P=.02). Conclusions: The online health information perception of an individual influences the effect online health information seeking has on the frequency of physician visits. The online health information seeking behavior impacts outpatient service utilization both directly and indirectly through online health information perception and significantly increases the frequency of clinic visits after controlling for other variables. Interventions can be explored to improve the health utilization of residents by increasing their online health information perception. ",
doi="10.2196/66683",
url="https://www.jmir.org/2025/1/e66683"
}


@Article{info:doi/10.2196/64249,
author="Ghorbanian Zolbin, Maedeh
and Kujala, Sari
and Huvila, Isto",
title="Experiences and Expectations of Immigrant and Nonimmigrant Older Adults Regarding eHealth Services: Qualitative Interview Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="14",
volume="27",
pages="e64249",
keywords="eHealth services",
keywords="older adults",
keywords="immigrant",
keywords="usability",
keywords="user experience",
keywords="emotion",
keywords="self-determination theory",
abstract="Background: The emergence of eHealth services could contribute to improving individuals' quality of life by optimizing effective and efficient care. However, various challenges might limit some older adults' use of eHealth services. Objective: This study aimed to understand the perspectives of older adults (aged ?65 years) of different backgrounds regarding eHealth services. We explored the experiences of Iranian immigrant and nonimmigrant older adults with eHealth services to identify their perceived challenges, emotions, and wishes. Immigrants face more challenges, and there is a need to understand their perspectives in addition to those of nonimmigrants. Iranians are one important immigrant group, as their number is limited and their specific needs are less well understood compared to those of the bigger immigrant groups. Methods: This study used a qualitative explorative research design. Semistructured interviews were conducted between February 2023 and May 2023. The participants were 25 older adults: nonimmigrants residing in cities (n=8, 32\%), nonimmigrants residing in rural areas (n=9, 36\%), and Iranian immigrants residing in cities (n=8, 32\%). Data were analyzed through inductive and deductive content analysis and interpreted through self-determination theory. Results: Interacting with eHealth services was challenging for some older adults. They perceived several difficulties, with the most obvious ones being related to values and preferences, as some older adults did not value eHealth services (16/25, 64\%), had insufficient digital skills (15/25, 60\%), and experienced usability issues (15/25, 60\%). The first two challenges were more pronounced among immigrants. In contrast, nonimmigrants from cities, being more familiar with the services, shared more usability issues. These identified challenges prevented older adults from satisfying their basic psychological needs of being competent and autonomous users and having a sense of belonging (aspects of self-determination theory), which were the main source of negative emotions. A common negative feeling was confusion (16/25, 64\%) among those with limited experience using smart devices and those with poor self-reported digital skills. Conversely, older adults' interaction with eHealth services generated positive emotions that were connected to the satisfaction of their basic psychological needs. Being interested in using eHealth services was a common feeling among most participants regardless of their background and was connected to satisfying their need for being competent and autonomous. The positive emotions could be supported by applying older adults' needs to the design of eHealth services (10/25, 40\%) and by supporting their digital skills (19/25, 76\%). Conclusions: Some older adults value eHealth services and see their added benefits. However, various challenges limit their use of these services. The analysis of older adults' needs yielded several practical ideas that could improve the user-friendliness of the services and highlighted the importance of sufficient support services tailored to the cultural needs of specific groups of older adults. ",
doi="10.2196/64249",
url="https://www.jmir.org/2025/1/e64249"
}


@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/10.2196/52544,
author="May, Susann
and Muehlensiepen, Felix
and Wengemuth, Eileen
and Seifert, Frances
and Heinze, Martin
and Bruch, Dunja
and Spethmann, Sebastian",
title="Benefits and Barriers to mHealth in Hypertension Care: Qualitative Study With German Health Care Professionals",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="10",
volume="12",
pages="e52544",
keywords="hypertension",
keywords="mHealth apps",
keywords="digital health",
keywords="physicians",
keywords="nurses",
keywords="HCP",
keywords="qualitative interviews",
keywords="health care professional",
keywords="cardiologists",
keywords="mHealth",
keywords="Germany",
keywords="general practitioners",
keywords="blood pressure monitoring",
keywords="qualitative study",
keywords="qualitative content analysis",
abstract="Background: Digital health technologies, particularly mobile health (mHealth) apps and wearable devices, have emerged as crucial assets in the battle against hypertension. By enabling lifestyle modifications, facilitating home blood pressure monitoring, and promoting treatment adherence, these technologies have significantly enhanced hypertension treatment. Objective: This study aims to explore the perspectives of health care professionals (HCPs) regarding the perceived benefits and barriers associated with the integration of mHealth apps into routine hypertension care. Additionally, strategies for overcoming these barriers will be identified. Methods: Through qualitative analysis via semistructured interviews, general practitioners (n=10), cardiologists (n=14), and nurses (n=3) were purposefully selected between October 2022 and March 2023. Verbatim transcripts were analyzed using qualitative content analysis. Results: The results unveiled 3 overarching themes highlighting the benefits of mHealth apps in hypertension care from the perspective of HCPs. First, these technologies possess the potential to enhance patient safety by facilitating continuous monitoring and early detection of abnormalities. Second, they can empower patients, fostering autonomy in managing their health conditions, thereby promoting active participation in their care. Lastly, mHealth apps may provide valuable support to medical care by offering real-time data that aids in decision-making and treatment adjustments. Despite these benefits, the study identified several barriers hindering the seamless integration of mHealth apps into hypertension care. Challenges predominantly revolved around data management, communication contexts, daily routines, and system handling. HCPs underscored the necessity for structural and procedural modifications in their daily practices to effectively address these challenges. Conclusions: In conclusion, the effective usage of digital tools such as mHealth apps necessitates overcoming various obstacles. This entails meeting the information needs of both HCPs and patients, tackling interoperability issues to ensure seamless data exchange between different systems, clarifying uncertainties surrounding reimbursement policies, and establishing the specific clinical benefits of these technologies. Active engagement of users throughout the design and implementation phases is crucial for ensuring the usability and acceptance of mHealth apps. Moreover, enhancing knowledge accessibility through the provision of easily understandable information about mHealth apps is essential for eliminating barriers and fostering their widespread adoption in hypertension care. Trial Registration: German Clinical Trials Register DRKS00029761; https://drks.de/search/de/trial/DRKS00029761 International Registered Report Identifier (IRRID): RR2-10.3389/fcvm.2022.1089968 ",
doi="10.2196/52544",
url="https://humanfactors.jmir.org/2025/1/e52544"
}


@Article{info:doi/10.2196/71439,
author="Watanabe, Seiya
and Kizaki, Hayato
and Hori, Satoko",
title="Development of a Patient-Centered Symptom-Reporting Application in Pharmacy Settings Using a Hierarchical Patient-Friendly Symptom List: Developmental and Usability Study",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="6",
volume="12",
pages="e71439",
keywords="patient symptom monitoring",
keywords="hierarchical symptom list",
keywords="community pharmacy",
keywords="interview survey",
keywords="mobile application",
abstract="Background: Effective symptom identification, a key responsibility for community pharmacists, requires patients to describe their symptoms accurately and comprehensively. However, current practices in pharmacies may be insufficient in capturing patient-reported symptoms comprehensively, potentially affecting the quality of pharmaceutical care and patient safety. Objective: This study aimed to construct a new, hierarchical symptom list derived from the Patient-Friendly Term List of the Medical Dictionary for Regulatory Activities (MedDRA) and to develop and evaluate a mobile app incorporating this list for facilitating symptom reporting by patients in pharmacy settings. The study also aimed to assess the usability and acceptance of this app among potential users. Methods: Subjective symptom-related terms were extracted from the Patient-Friendly Term List version 23.0 of the MedDRA. These terms were systematically consolidated and organized into a hierarchical, user-friendly symptom list. A mobile app incorporating this list was developed for pharmacy settings, featuring a symptom selection interface and a free-text input field for additional symptoms. The app included an instructional video explaining the importance of symptom reporting and guidance on navigation. Usability tests and semistructured interviews were conducted with participants aged >20 years. Interview transcripts were analyzed using the Unified Theory of Acceptance and Use of Technology (UTAUT) model to evaluate factors influencing the acceptance of technology. Results: From the initial 1440 terms in the Patient-Friendly Term List, 795 relevant terms were selected and organized into 40 site-specific subcategories, which were then grouped into broader site categories (mental, head, trunk, upper limb, lower limb, physical condition, and others). These terms were further consolidated into 211 patient-friendly symptom terms, forming a hierarchical symptom list. The app's interface design limited options to 10 items per screen to assist with decision-making. A total of 5 adults participated in the usability test. Participants found the interface intuitive and easy to use, requiring minimal effort, and provided positive feedback regarding the potential utility of the app in pharmacy settings. The UTAUT analysis identified several facilitating factors, including ease of use and the potential for enhanced pharmacist-patient communication. However, concerns were raised about usability for older adults and the need for simplified technical terminology. Conclusions: The user-friendly app with a hierarchically structured symptom list and complementary free-text entry has potential benefits for improving the accuracy and efficiency of symptom reporting in pharmacy settings. The positive user acceptance and identified areas for improvement provide a foundation for further development and implementation of this technology to enhance communication between patients and pharmacists. Future improvements should focus on addressing usability for older adults and simplifying technical terminology. ",
doi="10.2196/71439",
url="https://humanfactors.jmir.org/2025/1/e71439",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053749"
}


@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/10.2196/63805,
author="Jin, Xiaorong
and Zhang, Yimei
and Zhou, Min
and Mei, Qian
and Bai, Yangjuan
and Hu, Qiulan
and Wei, Wei
and Zhang, Xiong
and Ma, Fang",
title="An Actor-Partner Interdependence Mediation Model for Assessing the Association Between Health Literacy and mHealth Use Intention in Dyads of Patients With Chronic Heart Failure and Their Caregivers: Cross-Sectional Study",
journal="JMIR Mhealth Uhealth",
year="2025",
month="Mar",
day="6",
volume="13",
pages="e63805",
keywords="chronic heart failure",
keywords="caregivers",
keywords="health literacy",
keywords="mHealth",
keywords="actor-partner interdependence mediation model",
keywords="mobile health",
abstract="Background: Chronic heart failure (CHF) has become a serious threat to the health of the global population. Self-management is the key to treating CHF, and the emergence of mobile health (mHealth) has provided new ideas for the self-management of CHF. Despite the many potential benefits of mHealth, public utilization of mHealth apps is low, and poor health literacy (HL) is a key barrier to mHealth use. However, the mechanism of the influence is unclear. Objective: The aim of this study is to explore the dyadic associations between HL and mHealth usage intentions in dyads of patients with CHF and their caregivers, and the mediating role of mHealth perceived usefulness and perceived ease of use in these associations. Methods: This study had a cross-sectional research design, with a sample of 312 dyads of patients with CHF who had been hospitalized in the cardiology departments of 2 tertiary care hospitals in China from March to October 2023 and their caregivers. A general information questionnaire, the Chinese version of the Heart Failure-Specific Health Literacy Scale, and the mHealth Intention to Use Scale were used to conduct the survey; the data were analyzed using the actor-partner interdependence mediation model. Results: The results of the actor-partner interdependent mediation analysis of HL, perceived usefulness of mHealth, and mHealth use intention among patients with CHF and their caregivers showed that all of the model's actor effects were valid ($\beta$=.26?0.45; P<.001), the partner effects were partially valid ($\beta$=.08?0.20; P<.05), and the mediation effects were valid ($\beta$=.002?0.242, 95\% CI 0.003?0.321; P<.05). Actor-partner interdependent mediation analyses of HL, perceived ease of use of mHealth, and mHealth use intention among patients with CHF and caregivers showed that the model's actor effect partially held ($\beta$=.17?0.71; P<.01), the partner effect partially held ($\beta$=.15; P<.01), and the mediation effect partially held ($\beta$=.355?0.584, 95\% CI 0.234?0.764; P<.001). Conclusions: Our study proposes that the HL of patients with CHF and their caregivers positively contributes to their own intention to use mHealth, suggesting that the use of mHealth by patients with CHF can be promoted by improving the HL of patients and caregivers. Our findings also suggest that the perceived usefulness of patients with CHF and caregivers affects patients' mHealth use intention, and therefore patients with CHF and their caregivers should be involved throughout the mHealth development process to improve the usability of mHealth for both patients and caregivers. This study emphasizes the key role of patients' perception that mHealth is easy to use in facilitating their use of mHealth. Therefore, it is recommended that the development of mHealth should focus on simplifying operational procedures and providing relevant operational training according to the needs of the patients when necessary. ",
doi="10.2196/63805",
url="https://mhealth.jmir.org/2025/1/e63805"
}


@Article{info:doi/10.2196/66464,
author="Abdullayev, Kamilla
and Chico, A. Tim J.
and Canson, Jiana
and Mantelow, Matthew
and Buckley, Oli
and Condell, Joan
and Van Arkel, J. Richard
and Diaz-Zuccarini, Vanessa
and Matcham, Faith",
title="Exploring Stakeholder Perspectives on the Barriers and Facilitators of Implementing Digital Technologies for Heart Disease Diagnosis: Qualitative Study",
journal="JMIR Cardio",
year="2025",
month="Mar",
day="5",
volume="9",
pages="e66464",
keywords="heart disease",
keywords="digital technologies",
keywords="stakeholder perspectives",
keywords="qualitative research",
keywords="digital technology",
keywords="health technology",
keywords="heart",
keywords="cardio",
keywords="cardiology",
keywords="cardiovascular",
keywords="qualitative",
keywords="focused group",
keywords="quality of care",
keywords="efficiency",
keywords="digital health",
keywords="mobile phone",
keywords="artificial intelligence",
keywords="AI",
abstract="Background: Digital technologies are increasingly being implemented in health care to improve the quality and efficiency of care for patients. However, the rapid adoption of health technologies over the last 5 years has failed to adequately consider patient and clinician needs, which results in ineffective implementation. There is also a lack of consideration for the differences between patient and clinician needs, resulting in overgeneralized approaches to the implementation and use of digital health technologies. Objective: This study aimed to explore barriers and facilitators of the implementation of digital technologies in the diagnosis of heart disease for both patients and clinicians, and to provide recommendations to increase the acceptability of novel health technologies. Methods: We recruited 32 participants from across the United Kingdom, including 23 (72\%) individuals with lived experience of heart disease and 9 (28\%) clinicians involved in diagnosing heart disease. Participants with experience of living with heart disease took part in semistructured focused groups, while clinicians contributed to one-to-one semistructured interviews. Inductive thematic analysis using a phenomenological approach was conducted to analyze the resulting qualitative data and to identify themes. Results were discussed with a cardiovascular patient advisory group to enhance the rigor of our interpretation of the data. Results: Emerging themes were separated into facilitators and barriers and categorized into resource-, technology-, and user-related themes. Resource-related barriers and facilitators related to concerns around increased clinician workload, the high cost of digital technologies, and systemic limitations within health care systems such as outdated equipment and limited support. Technology-related barriers and facilitators included themes related to reliability, accuracy, safety parameters, data security, ease of use, and personalization, all of which can impact engagement and trust with digital technologies. Finally, the most prominent themes were the user-related barriers and facilitators, which encompassed user attitudes, individual-level variation in preferences and capabilities, and impact on quality of health care experiences. This theme captured a wide variety of perspectives among the sample and revealed how patient and clinician attitudes and personal experiences substantially impact engagement with digital health technologies across the cardiovascular care pathway. Conclusions: Our findings highlight the importance of considering both patient and clinician needs and preferences when investigating the barriers and facilitators to effective implementation of digital health technologies. Facilitators to technology adoption include the need for cost-effective, accurate, reliable, and easy-to-use systems as well as adequate setup support and personalization to meet individual needs. Positive user attitudes, perceived improvement in care quality, and increased involvement in the care process also enhance engagement. While both clinicians and patients acknowledge the potential benefits of digital technologies, effective implementation hinges on addressing these barriers and leveraging facilitators to ensure that the technologies are perceived as useful, safe, and supportive of health care outcomes. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2023-072952 ",
doi="10.2196/66464",
url="https://cardio.jmir.org/2025/1/e66464",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053721"
}


@Article{info:doi/10.2196/66804,
author="Yan, Mengyao
and Sun, Wendi
and Tan, Cheng
and Wu, Yibo
and Liu, Yuanli",
title="Analysis of Factors Influencing the Willingness of Chinese Older Adults to Use mHealth Devices: Nationwide Cross-Sectional Survey Study",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="4",
volume="27",
pages="e66804",
keywords="older adults",
keywords="mobile health devices",
keywords="health management",
keywords="medical services",
keywords="mobile phone",
abstract="Background: In addition to standard older adult care services, mobile medical devices have proved to be an effective tool for controlling the health of older adults. However, little is known about the variables driving the acceptance of these gadgets and the willingness of older adults in China to use them. Objective: This study aims to explore the factors that affect the use of mobile health (mHealth) devices by older adults in China, focusing on individual, social, and family influences. Methods: The Psychology and Behavior Investigation of Chinese Residents survey database provided the data for this study. The survey was conducted in 148 Chinese cities between June 20 and August 31, 2022. The parameters linked to older persons' desire to use mobile medical devices were determined by this study using a combination model of multiple stepwise linear regression and a classification and regression tree decision tree. Results: In total, 4085 older adults took part in the poll. On a scale of 0 to 100, the average score for willingness to adopt mHealth devices was 63.70 (SD 25.11). The results of the multiple stepwise linear regression showed that having a postgraduate degree and higher ($\beta$=.040; P=.007), being unemployed ($\beta$=.037; P=.02), having a high social status ($\beta$=.085; P<.001), possessing high health literacy ($\beta$=.089; P<.001), demonstrating high self-efficacy ($\beta$=.043; P=.02), not living with children ($\beta$=.0340; P=.02), having a household per capita monthly income of >Y4000 (US \$550) ($\beta$=.048; P=.002), experiencing high perceived social support ($\beta$=.096; P<.001), reporting a high quality of life ($\beta$=.149; P<.001), having higher levels of family communication ($\beta$=--.071; P<.001), having an identity bubble ($\beta$=.085; P<.001), not having chronic diseases ($\beta$=.049; P=.001), and experiencing mild depression ($\beta$=--.035; P=.02) were associated with older adults' willingness to use mHealth devices. The classification and regression tree decision tree model's findings demonstrated that the primary determinants of older adults' desire to use mHealth devices are quality of life, identity bubble, social status, health literacy, family health, and perceived social support. Conclusions: This study uses the Andersen Healthcare Utilization Model to investigate the effects of demand variables, enabling resources, and predisposing traits on older persons' propensity to use mHealth devices. These results offer reference data for the marketing and use of mHealth devices for older individuals in the future. The ultimate goal of this strategy is to create a balanced and harmonious integration of technology and humanistic care. ",
doi="10.2196/66804",
url="https://www.jmir.org/2025/1/e66804",
url="http://www.ncbi.nlm.nih.gov/pubmed/40053781"
}


@Article{info:doi/10.2196/60096,
author="de Thurah, Lena
and Kiekens, Glenn
and Weermeijer, Jeroen
and Uyttebroek, Lotte
and Wampers, Martien
and Bonnier, Rafa{\"e}l
and Myin-Germeys, Inez",
title="Understanding Appropriation of Digital Self-Monitoring Tools in Mental Health Care: Qualitative Analysis",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="3",
volume="12",
pages="e60096",
keywords="digital self-monitoring",
keywords="technology appropriation",
keywords="experience sampling method",
keywords="mental health care",
keywords="mental health",
keywords="self-monitoring",
keywords="digital health",
keywords="adoption",
keywords="implementation",
keywords="thematic",
keywords="usability",
keywords="interview",
keywords="experience",
keywords="attitude",
keywords="opinion",
keywords="perception",
keywords="perspective",
keywords="acceptance",
abstract="Background: Digital self-monitoring tools, such as the experience sampling method (ESM), enable individuals to collect detailed information about their mental health and daily life context and may help guide and support person-centered mental health care. However, similar to many digital interventions, the ESM struggles to move from research to clinical integration. To guide the implementation of self-monitoring tools in mental health care, it is important to understand why and how clinicians and clients adopted, adapted, and incorporated these tools in practice. Objective: Therefore, this study examined how clinicians and clients within a psychiatric center appropriated an ESM-based self-monitoring tool within their therapy. Methods: Twelve clinicians and 24 clients participated in the piloting of the ESM tool, IMPROVE. After utilizing the tool, 7 clinicians and 11 clients took part in semistructured interviews. A thematic framework analysis was performed focusing on participants' prior knowledge and expectations, actual use in practice, and potential future use of ESM tools. Results: Many participants experienced that the ESM tool provided useful information about clients' mental health, especially when clinicians and clients engaged in collaborative data interpretation. However, clinicians experienced several mismatches between system usability and their technical competencies, and many clients found it difficult to comply with the self-assessments. Importantly, most participants wanted to use digital self-monitoring tools in the future. Conclusions: Clinicians' and clients' choice to adopt and integrate self-monitoring tools in their practice seems to depend upon the perceived balance between the added benefits and the effort required to achieve them. Enhancing user support or redesigning ESM tools to reduce workload and data burden could help overcome implementation barriers. Future research should involve end users in the development of ESM self-monitoring tools for mental health care and further investigate the perspectives of nonadopters. ",
doi="10.2196/60096",
url="https://humanfactors.jmir.org/2025/1/e60096"
}


@Article{info:doi/10.2196/59458,
author="Lochhead, Chris
and Fisher, B. Robert",
title="On the Necessity of Multidisciplinarity in the Development of at-Home Health Monitoring Platforms for Older Adults: Systematic Review",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="27",
volume="12",
pages="e59458",
keywords="multi-disciplinarity",
keywords="gait assessment",
keywords="machine learning",
keywords="at-home health monitoring",
keywords="older adults",
keywords="elderly",
keywords="artificial intelligence",
keywords="AI",
keywords="gait",
keywords="development",
keywords="health monitoring",
keywords="monitoring",
keywords="systematic review",
keywords="monitoring system",
keywords="barriers",
keywords="caregiver",
keywords="efficiency",
keywords="effectiveness",
abstract="Background: The growth of aging populations globally has increased the demand for new models of care. At-home, computerized health care monitoring is a growing paradigm, which explores the possibility of reducing workloads, lowering the demand for resource-intensive secondary care, and providing more precise and personalized care. Despite the potential societal benefit of autonomous monitoring systems when implemented properly, uptake in health care institutions is slow, and a great volume of research across disciplines encounters similar common barriers to real-world implementation. Objective: The goal of this systematic review was to construct an evaluation framework that can assess research in terms of how well it addresses already identified barriers to application and then use that framework to analyze the literature across disciplines and identify trends between multidisciplinarity and the likelihood of research being developed robustly. Methods: This paper introduces a scoring framework for evaluating how well individual pieces of research address key development considerations using 10 identified common barriers to uptake found during meta-review from different disciplines across the domain of health care monitoring. A scoping review is then conducted using this framework to identify the impact that multidisciplinarity involvement has on the effective development of new monitoring technologies. Specifically, we use this framework to measure the relationship between the use of multidisciplinarity in research and the likelihood that a piece of research will be developed in a way that gives it genuine practical application. Results: We show that viewpoints of multidisciplinarity; namely across computer science and medicine alongside public and patient involvement (PPI) have a significant positive impact in addressing commonly encountered barriers to application research and development according to the evaluation criteria. Using our evaluation metric, multidisciplinary teams score on average 54.3\% compared with 35\% for teams made up of medical experts and social scientists, and 2.68 for technical-based teams, encompassing computer science and engineering. Also identified is the significant effect that involving either caregivers or end users in the research in a co-design or PPI-based capacity has on the evaluation score (29.3\% without any input and between 48.3\% and 36.7\% for end user or caregiver input respectively, on average). Conclusions: This review recommends that, to limit the volume of novel research arbitrarily re-encountering the same issues in the limitations of their work and hence improve the efficiency and effectiveness of research, multidisciplinarity should be promoted as a priority to accelerate the rate of advancement in this field and encourage the development of more technology in this domain that can be of tangible societal benefit. ",
doi="10.2196/59458",
url="https://humanfactors.jmir.org/2025/1/e59458"
}


@Article{info:doi/10.2196/68221,
author="Nagra, Harpreet
and Mines, A. Robert
and Dana, Zara",
title="Exploring the Impact of Digital Peer Support Services on Meeting Unmet Needs Within an Employee Assistance Program: Retrospective Cohort Study",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="25",
volume="12",
pages="e68221",
keywords="digital peer support",
keywords="peer support",
keywords="EAPs",
keywords="cost-effectiveness",
keywords="SROI",
abstract="Background: The World Health Organization estimates that 1 in 4 people worldwide will experience a mental disorder in their lifetime, highlighting the need for accessible support. Objective: This study evaluates the integration of digital peer support (DPS) into an employee assistance program (EAP), testing 3 hypotheses: (1) DPS may be associated with changes in EAP counseling utilization within a 5-session model; (2) DPS users experience reduced sadness, loneliness, and stress; and (3) DPS integration generates a positive social return on investment (SROI). Methods: The study analyzed EAP utilization within a 5-session model using pre-post analysis, sentiment changes during DPS chats via natural language processing models, and SROI outcomes. Results: Among 587 DPS chats, 432 (73.6\%) occurred after business hours, emphasizing the importance of 24/7 availability. A matched cohort analysis (n=72) showed that DPS reduced therapy sessions by 2.07 per participant (P<.001; Cohen d=1.77). Users' messages were evaluated for sentiments of sadness, loneliness, and stress on a 1-10 scale. Significant reductions were observed: loneliness decreased by 55.04\% (6.91 to 3.11), sadness by 57.5\% (6.84 to 2.91), and stress by 56.57\% (6.78 to 2.95). SROI analysis demonstrated value-to-investment ratios of US \$1.66 (loneliness), US \$2.50 (stress), and US \$2.58 (sadness) per dollar invested. Conclusions: Integrating DPS into EAPs provides significant benefits, including increased access, improved emotional outcomes, and a high SROI, reinforcing its value within emotional health support ecosystems. ",
doi="10.2196/68221",
url="https://humanfactors.jmir.org/2025/1/e68221",
url="http://www.ncbi.nlm.nih.gov/pubmed/39998863"
}


@Article{info:doi/10.2196/65056,
author="Szekely, Raul
and Holloway, Catherine
and Bandukda, Maryam",
title="Understanding the Psychosocial Impact of Assistive Technologies for People With Visual Impairments: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2025",
month="Feb",
day="13",
volume="14",
pages="e65056",
keywords="assistive technology",
keywords="psychosocial impact",
keywords="quality of life",
keywords="visual impairment",
keywords="scoping review protocol",
keywords="mobile phone",
abstract="Background: There has been a rapid growth in the literature on the design and evaluation of assistive technologies for people with visual impairments; yet, there is a lack of a comprehensive analysis of the existing literature on the classification of immediate-, short-, medium-, and long-term psychosocial impact of assistive technologies on the quality of life of people with visual impairments. Objective: This protocol outlines the methodology for a scoping review aimed at identifying and synthesizing the existing literature on the psychosocial impact of assistive technologies on the quality of life of people with visual impairments. Methods: The review will include primary research studies published in English between 2019 and 2024 that focus on the psychosocial outcomes of assistive technologies for people with visual impairments. Eligible studies will involve participants with visual impairments, of all ages and across various settings, examining psychological (eg, emotional well-being and self-esteem) and social outcomes (eg, social participation and support). Searches will be conducted across 7 electronic research databases: CINAHL (EBSCO), PsycINFO (EBSCO), ACM Digital Library, IEEE Xplore, Scopus, Web of Science, and Google Scholar (first 100 records). Studies will undergo screening and selection based on predefined eligibility criteria, with data extraction focusing on publication details, study design, population characteristics, type of assistive technology, and psychosocial impacts. Results will be summarized using descriptive statistics, charts, and narrative synthesis. Results: The database search, conducted in July 2024, identified 1145 records, which will be screened and analyzed in subsequent stages of the review process. This protocol outlines the planned approach for identifying, categorizing, and synthesizing evidence. The study findings are anticipated to be finalized and submitted for publication in a peer-reviewed journal by February 2025. Conclusions: This study will synthesize the recent body of work on the psychosocial impact of assistive technologies for people with visual impairments and recommendations for researchers and designers interested in this research area. Trial Registration: Open Science Framework 10.17605/OSF.IO/SK7N8; https://osf.io/4gc5t International Registered Report Identifier (IRRID): DERR1-10.2196/65056 ",
doi="10.2196/65056",
url="https://www.researchprotocols.org/2025/1/e65056"
}


@Article{info:doi/10.2196/41169,
author="Joshi, Ashish
and Mohan, Krishna Surapaneni
and Pandya, Kumar Apurva
and Grover, Ashoo
and Kaur, Harpreet
and Gupta, Mansi
and Aurora, Heemanshu
and Bhatt, Ashruti",
title="Improving the Health and Well-Being of Individuals by Addressing Social, Economic, and Health Inequities (Healthy Eating Active Living): Protocol for a Cohort Study",
journal="JMIR Res Protoc",
year="2025",
month="Feb",
day="13",
volume="14",
pages="e41169",
keywords="health inequity",
keywords="health",
keywords="well-being",
keywords="digital interventions",
keywords="social health",
keywords="lifestyle",
abstract="Background: Health inequity is interlinked with the good health and well-being of an individual. Health inequity can be due to various socioeconomic factors like income levels or social status. Digital health interventions have the potential to reduce the existing health inequities. Objective: This study aims to identify determinants of social, economic, and health inequity in diverse settings to enhance healthy eating and active living. It further aims to design and develop a digital health intervention HEAL (Healthy Eating Active Living) that incorporates a human-centered design framework in order to improve healthy eating and active living among rural and urban population groups in Chennai, Tamil Nadu, India. Methods: A prospective, 3-year cohort study will be conducted. This study aims to recruit 6350 individuals across rural and urban settings of Chennai. A total of 11 sites have been selected for participation in the study. Data on sociodemographic characteristics; economic inequity; HEAL profile; depression, anxiety, and stress; well-being; sources of health information; perceived access to health care; health literacy; navigation of health literacy; and satisfaction with the health system will be gathered. This study would help to explore the determinants of social, economic, and health inequity across multiple sites. SAS (version 9.3; SAS Institute Inc) will be used for data analysis, and results will be reported as 95\% CI and P values. This study's findings will guide the design and development of a tailored, human-centered digital health intervention to enhance the health and well-being of Chennai's population groups. Results: As of December 2024, the literature review for the development of the intervention has been completed. The recruitment for the baseline data collection will begin shortly, followed by the development of HEAL intervention. Conclusions: The proposed study will help in examining the role of the proposed HEAL intervention to enhance the health and well-being of the population groups of Chennai. International Registered Report Identifier (IRRID): PRR1-10.2196/41169 ",
doi="10.2196/41169",
url="https://www.researchprotocols.org/2025/1/e41169"
}


@Article{info:doi/10.2196/65923,
author="She, Jou Wan
and Siriaraya, Panote
and Iwakoshi, Hibiki
and Kuwahara, Noriaki
and Senoo, Keitaro",
title="An Explainable AI Application (AF'fective) to Support Monitoring of Patients With Atrial Fibrillation After Catheter Ablation: Qualitative Focus Group, Design Session, and Interview Study",
journal="JMIR Hum Factors",
year="2025",
month="Feb",
day="13",
volume="12",
pages="e65923",
keywords="atrial fibrillation",
keywords="explainable artificial intelligence",
keywords="explainable AI",
keywords="user-centered design",
keywords="prevention",
keywords="postablation monitoring",
abstract="Background: The opaque nature of artificial intelligence (AI) algorithms has led to distrust in medical contexts, particularly in the treatment and monitoring of atrial fibrillation. Although previous studies in explainable AI have demonstrated potential to address this issue, they often focus solely on electrocardiography graphs and lack real-world field insights. Objective: We addressed this gap by incorporating standardized clinical interpretation of electrocardiography graphs into the system and collaborating with cardiologists to co-design and evaluate this approach using real-world patient cases and data. Methods: We conducted a 3-stage iterative design process with 23 cardiologists to co-design, evaluate, and pilot an explainable AI application. In the first stage, we identified 4 physician personas and 7 explainability strategies, which were reviewed in the second stage. A total of 4 strategies were deemed highly effective and feasible for pilot deployment. On the basis of these strategies, we developed a progressive web application and tested it with cardiologists in the third stage. Results: The final progressive web application prototype received above-average user experience evaluations and effectively motivated physicians to adopt it owing to its ease of use, reliable information, and explainable functionality. In addition, we gathered in-depth field insights from cardiologists who used the system in clinical contexts. Conclusions: Our study identified effective explainability strategies, emphasized the importance of curating actionable features and setting accurate expectations, and suggested that many of these insights could apply to other disease care contexts, paving the way for future real-world clinical evaluations. ",
doi="10.2196/65923",
url="https://humanfactors.jmir.org/2025/1/e65923"
}


@Article{info:doi/10.2196/62936,
author="Bergh, Sverre
and Benth, {\vS}altyt? J?rat?
and H{\o}gset, Dyrendal Lisbeth
and Rydjord, Britt
and Kayser, Lars",
title="Assessment of Technology Readiness in Norwegian Older Adults With Long-Term Health Conditions Receiving Home Care Services: Cross-Sectional Questionnaire Study",
journal="JMIR Aging",
year="2025",
month="Feb",
day="7",
volume="8",
pages="e62936",
keywords="eHealth literacy",
keywords="digital health services",
keywords="technology readiness",
keywords="Readiness and Enablement Index for Health Technology",
keywords="READHY",
keywords="chronic conditions",
abstract="Background: With the increasing number of older adults globally, there is a constant search for new ways to organize health care services. Digital health services are promising and may reduce workload and at the same time improve patient well-being. A certain level of eHealth literacy is needed to be able to use digital health services. However, knowledge of technology readiness in this target group of older adults is unclear. Objective: The aim of this study was to understand the technology readiness level of a group of older adults who were provided home care services in order to address the present and future needs of this group in relation to the implementation of digital health care services. Methods: This quantitative cross-sectional study included 149 older adults from Norway receiving home care services. The participants completed the Readiness and Enablement Index for Health Technology (READHY) instrument, assessments of well-being (World Health Organization-Five Well-Being Index [WHO-5]), and assessments of demographic and clinical variables (sex, age, education, living situation, comorbidity, use of digital devices, and use of IT). Cluster analyses were used to group the users according to their technology readiness. Results: The mean participant age was 78.6 (SD 8.0) years, and 55.7\% (83/149) were women. There was good consistency within the assumed READHY scales (Cronbach $\alpha$=.61-.91). The participants were grouped into 4 clusters, which differed in terms of READHY scores, demographic variables, and the use of IT in daily life. Participants in cluster 1 (n=40) had the highest scores on the READHY scales, were younger, had a larger proportion of men, had higher education, and had better access to digital devices and IT. Participants in cluster 4 (n=16) scored the lowest on eHealth literacy knowledge. Participants in cluster 1 had relatively high levels of eHealth literacy knowledge and were expected to benefit from digital health services, while participants in cluster 4 had the lowest level of eHealth literacy and would not easily be able to start using digital health services. Conclusions: The technology readiness level varied in our cohort of Norwegian participants receiving home care. Not all elderly people have the eHealth literacy to fully benefit from digital health services. Participants in cluster 4 (n=16) had the lowest scores in the eHealth Literacy Questionnaire scales in the READHY instrument and should be offered nondigital services or would need extensive management support. The demographic differences between the 4 clusters may inform stakeholders about which older people need the most training and support to take advantage of digital health care services. ",
doi="10.2196/62936",
url="https://aging.jmir.org/2025/1/e62936",
url="http://www.ncbi.nlm.nih.gov/pubmed/39918862"
}


@Article{info:doi/10.2196/60825,
author="Amhaz, Haneen
and Chen, Xuanping Sally
and Elchehimi, Amanee
and Han, Jialin Kylin
and Gil, Morales Jade
and Yao, Lu
and Vidler, Marianne
and Berry-Einarson, Kathryn
and Dewar, Kathryn
and Tuason, May
and Prestley, Nicole
and Doan, Quynh
and van Rooij, Tibor
and Costa, Tina
and Ogilvie, Gina
and Payne, A. Beth",
title="The Research Agenda for Perinatal Innovation and Digital Health Project: Human-Centered Approach to Multipartner Research Agenda Codevelopment",
journal="JMIR Hum Factors",
year="2025",
month="Jan",
day="30",
volume="12",
pages="e60825",
keywords="digital health",
keywords="co-design",
keywords="digital strategy",
keywords="human-centered design",
keywords="eHealth",
keywords="cocreation",
keywords="codevelopment",
keywords="perinatal intervention",
keywords="quality of care",
keywords="digital tools",
keywords="pregnancy",
keywords="patient autonomy",
keywords="patient support",
keywords="mobile phone",
abstract="Background: Digital health innovations provide an opportunity to improve access to care, information, and quality of care during the perinatal period, a critical period of health for mothers and infants. However, research to develop perinatal digital health solutions needs to be informed by actual patient and health system needs in order to optimize implementation, adoption, and sustainability. Objective: Our aim was to co-design a research agenda with defined research priorities that reflected health system realities and patient needs. Methods: Co-design of the research agenda involved a series of activities: (1) review of the provincial Digital Health Strategy and Maternity Services Strategy to identify relevant health system priorities, (2) anonymous survey targeting perinatal care providers to ascertain their current use and perceived need for digital tools, (3) engagement meetings using human-centered design methods with multilingual patients who are currently or recently pregnant to understand their health experiences and needs, and (4) a workshop that brought together patients and other project partners to prioritize identified challenges and opportunities for perinatal digital health in a set of research questions. These questions were grouped into themes using a deductive analysis approach starting with current BC Digital Health Strategy guiding principles. Results: Between September 15, 2022, and August 31, 2023, we engaged with more than 150 perinatal health care providers, researchers, and health system stakeholders and a patient advisory group of women who were recently pregnant to understand the perceived needs and priorities for digital innovation in perinatal care in British Columbia, Canada. As a combined group, partners were able to define 12 priority research questions in 3 themes. The themes prioritized are digital innovation for (1) patient autonomy and support, (2) standardized educational resources for patients and providers, and (3) improved access to health information. Conclusions: Our research agenda highlights the needs for perinatal digital health research to support improvements in the quality of care in British Columbia. By using a human-centered design approach, we were able to co-design research priorities that are meaningful to patients and health system stakeholders. The identified priority research questions are merely a stepping stone in the research process and now need to be actioned by research teams and health systems partners. ",
doi="10.2196/60825",
url="https://humanfactors.jmir.org/2025/1/e60825"
}


@Article{info:doi/10.2196/59414,
author="Saleem, Maham
and Zafar, Shamsa
and Klein, Thomas
and Koesters, Markus
and Bashir, Adnan
and Fuhr, C. Daniela
and Sikander, Siham
and Zeeb, Hajo",
title="A Digital Tool (Technology-Assisted Problem Management Plus) for Lay Health Workers to Address Common Mental Health Disorders: Co-production and Usability Study in Pakistan",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="28",
volume="9",
pages="e59414",
keywords="digital mental health",
keywords="digital technology",
keywords="digital intervention",
keywords="Problem Management Plus",
keywords="lay health worker programme",
keywords="common mental health disorders",
keywords="low- and middle-income countries",
keywords="co-production",
abstract="Background: Mental health remains among the top 10 leading causes of disease burden globally, and there is a significant treatment gap due to limited resources, stigma, limited accessibility, and low perceived need for treatment. Problem Management Plus, a World Health Organization--endorsed brief psychological intervention for mental health disorders, has been shown to be effective and cost-effective in various countries globally but faces implementation challenges, such as quality control in training, supervision, and delivery. While digital technologies to foster mental health care have the potential to close treatment gaps and address the issues of quality control, their development requires context-specific, interdisciplinary, and participatory approaches to enhance impact and acceptance. Objective: We aimed to co-produce Technology-Assisted Problem Management Plus (TA-PM+) for ``lady health workers'' (LHWs; this is the terminology used by the Lady Health Worker Programme for lay health workers) to efficiently deliver sessions to women with symptoms of common mental health disorders within the community settings of Pakistan and conducted usability testing in community settings. Methods: A 3-stage framework was used for co-producing and prototyping the intervention. Stage 1 (evidence review and stakeholder consultation) included 3 focus group discussions with 32 LHWs and 7 in-depth interviews with key stakeholders working in the health system or at the health policy level. Thematic analyses using the Capability, Opportunity, and Motivation for Behavioral Change (COM-B) model were conducted. Stage 2 included over eight online workshops, and a multidisciplinary intervention development group co-produced TA-PM+. Stage 3 (prototyping) involved 2 usability testing rounds. In round 1 conducted in laboratory settings, 6 LHWs participated in role plays and completed the 15-item mHealth Usability App Questionnaire (MUAQ) (score range 0-7). In round 2 conducted in community settings, trained LHWs delivered the intervention to 6 participants screened for depression and anxiety. Data were collected using the MUAQ completed by LHWs and the Patient Satisfaction Questionnaire (PSQ) (score range 0-46) completed by participants. Results: Qualitative analysis indicated that a lack of digital skills among LHWs, high workload, resource scarcity for digitization (specifically internet bandwidth in the community), and need for comprehensive training were barriers for TA-PM+ implementation in the community through LHWs. Training, professional support, user guidance, an easy and automated interface, offline functionalities, incentives, and strong credibility among communities were perceived to enhance the capability, opportunity, and motivation of LHWs to implement TA-PM+. TA-PM+ was co-produced with features like an automated interface, a personal dashboard, guidance videos, and a connected supervisory panel. The mean MUAQ score was 5.62 in round 1 of usability testing and improved to 5.96 after incorporating LHW feedback in round 2. The mean PSQ score for TA-PM+ was 40 in round 2. Conclusions: Co-production of TA-PM+ for LHWs balanced context and evidence. The 3-stage iterative development approach resulted in high usability and acceptability of TA-PM+ for LHWs and participants. ",
doi="10.2196/59414",
url="https://formative.jmir.org/2025/1/e59414",
url="http://www.ncbi.nlm.nih.gov/pubmed/39874072"
}


@Article{info:doi/10.2196/60829,
author="Karasek, Deborah
and Williams, C. Jazzmin
and Taylor, A. Michaela
and De La Cruz, M. Monica
and Arteaga, Stephanie
and Bell, Sabra
and Castillo, Esperanza
and Chand, A. Maile
and Coats, Anjeanette
and Hubbard, M. Erin
and Love-Goodlett, Latriece
and Powell, Breezy
and Spellen, Solaire
and Malawa, Zea
and Gomez, Manchikanti Anu",
title="Designing the First Pregnancy Guaranteed Income Program in the United States: Qualitative Needs Assessment and Human-Centered Design to Develop the Abundant Birth Project",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="27",
volume="9",
pages="e60829",
keywords="maternal and child health",
keywords="economics",
keywords="public health",
keywords="qualitative research methods",
keywords="programs (evaluation and funding)",
keywords="community-centered",
keywords="pregnancy",
keywords="first pregnancy",
keywords="behavioral interventions",
keywords="racial health",
keywords="financial stress",
keywords="Abundant Birth Project",
keywords="infant health",
keywords="infant",
keywords="Black",
abstract="Background: Racial inequities in pregnancy outcomes persist despite investments in clinical, educational, and behavioral interventions, indicating that a new approach is needed to address the root causes of health disparities. Guaranteed income during pregnancy has the potential to narrow racial health inequities for birthing people and infants by alleviating financial stress. Objective: We describe community-driven formative research to design the first pregnancy-guaranteed income program in the United States---the Abundant Birth Project (ABP). Informed by birth equity and social determinants of health perspectives, ABP targets upstream structural factors to improve racial disparities in maternal and infant health. Methods: The research team included community researchers, community members with lived experience as Black or Pacific Islander pregnant, and parenting people in the San Francisco Bay Area. The team conducted needs assessment interviews and facilitated focus groups with participants using human-centered design methods. Needs assessment participants later served as co-designers of the ABP program and research, sharing their experiences with financial hardships and government benefits programs and providing recommendations on key program elements, including fund disbursement, eligibility, and amount. Results: Housing affordability and the high cost of living in San Francisco emerged as significant sources of stress in pregnancy. Participants reported prohibitively low income eligibility thresholds and burdensome enrollment processes as challenges or barriers to existing social services. These insights guided the design of prototypes of ABP's program components, which were used in a design sprint to determine the final components. Based on this design process, the ABP program offered US \$1000/month for 12 months to pregnant Black and Pacific Islander people, selected through a lottery called an abundance drawing. Conclusions: The formative design process maximized community input and shared decision-making to co-design a guaranteed income program for Black and Pacific Islander women and people. Our upstream approach and community research model can inform the development of public health and social service programs. ",
doi="10.2196/60829",
url="https://formative.jmir.org/2025/1/e60829"
}


@Article{info:doi/10.2196/64763,
author="Shade, Marcia
and Yan, Changmin
and Jones, K. Valerie
and Boron, Julie",
title="Evaluating Older Adults' Engagement and Usability With AI-Driven Interventions: Randomized Pilot Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="24",
volume="9",
pages="e64763",
keywords="voice assistant",
keywords="interventions",
keywords="usability",
keywords="engagement",
keywords="personality",
keywords="older adults",
keywords="aging",
keywords="technology",
keywords="artificial intelligence",
keywords="AI",
keywords="self-management",
keywords="pilot trial",
keywords="chronic",
keywords="musculoskeletal pain",
keywords="AI assistant",
keywords="Alexa",
keywords="user experience",
keywords="digital health",
keywords="digital intervention",
keywords="mobile phone",
abstract="Background: Technologies that serve as assistants are growing more popular for entertainment and aiding in daily tasks. Artificial intelligence (AI) in these technologies could also be helpful to deliver interventions that assist older adults with symptoms or self-management. Personality traits may play a role in how older adults engage with AI technologies. To ensure the best intervention delivery, we must understand older adults' engagement with and usability of AI-driven technologies. Objective: This study aimed to describe how older adults engaged with routines facilitated by a conversational AI assistant. Methods: A randomized pilot trial was conducted for 12-weeks in adults aged 60 years or older, self-reported living alone, and having chronic musculoskeletal pain. Participants (N=50) were randomly assigned to 1 of 2 intervention groups (standard vs enhanced) to engage with routines delivered by the AI assistant Alexa (Amazon). Participants were encouraged to interact with prescribed routines twice daily (morning and evening) and as needed. Data were collected and analyzed on routine engagement characteristics and perceived usability of the AI assistant. An analysis of the participants' personality traits was conducted to describe how personality may impact engagement and usability of AI technologies as interventions. Results: The participants had a mean age of 79 years, with moderate to high levels of comfort and trust in technology, and were predominately White (48/50, 96\%) and women (44/50, 88\%). In both intervention groups, morning routines (n=62, 74\%) were initiated more frequently than evening routines (n=52, 62\%; z=?2.81, P=.005). Older adult participants in the enhanced group self-reported routine usability as good (mean 74.50, SD 11.90), and those in the standard group reported lower but acceptable usability scores (mean 66.29, SD 6.94). Higher extraversion personality trait scores predicted higher rates of routine initiation throughout the whole day and morning in both groups (standard day: B=0.47, P=.004; enhanced day: B=0.44, P=.045; standard morning: B=0.50, P=.03; enhanced morning: B=0.53, P=.02). Higher agreeableness (standard: B=0.50, P=.02; enhanced B=0.46, P=.002) and higher conscientiousness (standard: B=0.33, P=.04; enhanced: B=0.38, P=.006) personality trait scores predicted better usability scores in both groups. Conclusions: he prescribed interactive routines delivered by an AI assistant were feasible to use as interventions with older adults. Engagement and usability by older adults may be influenced by personality traits such as extraversion, agreeableness, and conscientiousness. While integrating AI-driven interventions into health care, it is important to consider these factors to promote positive outcomes. Trial Registration: ClinicalTrials.gov NCT05387447; https://clinicaltrials.gov/study/NCT05387447 ",
doi="10.2196/64763",
url="https://formative.jmir.org/2025/1/e64763"
}


@Article{info:doi/10.2196/60160,
author="G{\'o}mez-Gonz{\'a}lez, Antonia Marta
and Cordero Tous, Nicolas
and De la Cruz Sabido, Javier
and S{\'a}nchez Corral, Carlos
and Lechuga Carrasco, Beatriz
and L{\'o}pez-Vicente, Marta
and Olivares Granados, Gonzalo",
title="Following Up Patients With Chronic Pain Using a Mobile App With a Support Center: Unicenter Prospective Study",
journal="JMIR Hum Factors",
year="2025",
month="Jan",
day="22",
volume="12",
pages="e60160",
keywords="pain management",
keywords="mobile health",
keywords="mHealth",
keywords="eHealth",
keywords="chronic pain",
keywords="support center",
keywords="mobile phone app",
keywords="survey",
keywords="follow-up",
keywords="pain control",
keywords="prospective study",
abstract="Background: Chronic pain is among the most common conditions worldwide and requires a multidisciplinary treatment approach. Spinal cord stimulation is a possible treatment option for pain management; however, patients undergoing this intervention require close follow-up, which is not always feasible. eHealth apps offer opportunities for improved patient follow-up, although adherence to these apps tends to decrease over time, with rates dropping to approximately 60\%. To improve adherence to remote follow-up, we developed a remote follow-up system consisting of a mobile app for patients, a website for health care professionals, and a remote support center. Objective: Our objective was to evaluate patient adherence to remote follow-up using a system that includes a mobile app and a remote support center. Methods: After review of the literature and approval of the design of the follow-up system by a multidisciplinary committee, a team of experts developed a system based on a mobile app, a website for health care professionals, and a remote support center. The system was developed in collaboration with health care professionals and uses validated scales to capture patients' clinical data at each stage of treatment (ie, pretreatment phase, trial phase, and implantation phase). Data were collected prospectively between January 2020 to August 2023, including the number of total surveys sent, surveys completed, SMS text message reminders sent, and reminder calls made. Results: A total of 64 patients were included (n=40 women, 62.5\%) in the study. By the end of the study, 19 (29.7\%) patients remained in the pretreatment phase, 8 (12.5\%) patients had completed the trial phase, and 37 (57.8\%) reached the implantation phase. The mean follow-up period was 15.30 (SD 9.43) months. A total of 1574 surveys were sent, along with 488 SMS text message reminders and 53 reminder calls. The mean adherence rate decreased from 94.53\% (SD 20.63\%) during the pretreatment phase to 65.68\% (SD 23.49\%) in the implantation phase, with an overall mean adherence rate of 87.37\% (SD 15.37\%) for the app. ANOVA showed that adherence was significantly higher in the earlier phases of treatment (P<.001). Conclusions: Our remote follow-up system, supported by a remote support center improves adherence to follow-up in later phases of treatment, although adherence decreased over time. Further studies are needed to investigate the relationship between adherence to the app and pain management. ",
doi="10.2196/60160",
url="https://humanfactors.jmir.org/2025/1/e60160"
}


@Article{info:doi/10.2196/59625,
author="Huijgens, Fiorella
and Kwakman, Pascale
and Hillen, Marij
and van Weert, Julia
and Jaspers, Monique
and Smets, Ellen
and Linn, Annemiek",
title="How Patients With Cancer Use the Internet to Search for Health Information: Scenario-Based Think-Aloud Study",
journal="JMIR Infodemiology",
year="2025",
month="Jan",
day="16",
volume="5",
pages="e59625",
keywords="web-based health information seeking",
keywords="think aloud",
keywords="scenario based",
keywords="cancer",
keywords="patient evaluation",
keywords="information seeking",
keywords="web-based information",
keywords="health information",
keywords="internet",
keywords="pattern",
keywords="motivation",
keywords="cognitive",
keywords="emotional",
keywords="response",
keywords="patient",
keywords="survivor",
keywords="caregiver",
keywords="interview",
keywords="scenario",
keywords="women",
keywords="men",
abstract="Background: Patients with cancer increasingly use the internet to seek health information. However, thus far, research treats web-based health information seeking (WHIS) behavior in a rather dichotomous manner (ie, approaching or avoiding) and fails to capture the dynamic nature and evolving motivations that patients experience when engaging in WHIS throughout their disease trajectory. Insights can be used to support effective patient-provider communication about WHIS and can lead to better designed web-based health platforms. Objective: This study explored patterns of motivations and emotions behind the web-based information seeking of patients with cancer at various stages of their disease trajectory, as well as the cognitive and emotional responses evoked by WHIS via a scenario-based, think-aloud approach. Methods: In total, 15 analog patients were recruited, representing patients with cancer, survivors, and informal caregivers. Imagining themselves in 3 scenarios---prediagnosis phase (5/15, 33\%), treatment phase (5/15, 33\%), and survivor phase (5/15, 33\%)---patients were asked to search for web-based health information while being prompted to verbalize their thoughts. In total, 2 researchers independently coded the sessions, categorizing the codes into broader themes to comprehend analog patients' experiences during WHIS. Results: Overarching motives for WHIS included reducing uncertainty, seeking reassurance, and gaining empowerment. At the beginning of the disease trajectory, patients mainly showed cognitive needs, whereas this shifted more toward affective needs in the subsequent disease stages. Analog patients' WHIS approaches varied from exploratory to focused or a combination of both. They adapted their search strategy when faced with challenging cognitive or emotional content. WHIS triggered diverse emotions, fluctuating throughout the search. Complex, confrontational, and unexpected information mainly induced negative emotions. Conclusions: This study provides valuable insights into the motivations of patients with cancer underlying WHIS and the emotions experienced at various stages of the disease trajectory. Understanding patients' search patterns is pivotal in optimizing web-based health platforms to cater to specific needs. In addition, these findings can guide clinicians in accommodating patients' specific needs and directing patients toward reliable sources of web-based health information. ",
doi="10.2196/59625",
url="https://infodemiology.jmir.org/2025/1/e59625"
}


@Article{info:doi/10.2196/59601,
author="Kip, Hanneke
and Beerlage-de Jong, Nienke
and van Gemert-Pijnen, C. Lisette J. E. W.
and Kelders, M. Saskia",
title="The CeHRes Roadmap 2.0: Update of a Holistic Framework for Development, Implementation, and Evaluation of eHealth Technologies",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="13",
volume="27",
pages="e59601",
keywords="eHealth development",
keywords="eHealth implementation",
keywords="CeHRes Roadmap",
keywords="participatory development",
keywords="human-centered design",
keywords="persuasive design",
keywords="eHealth framework",
doi="10.2196/59601",
url="https://www.jmir.org/2025/1/e59601"
}


@Article{info:doi/10.2196/62824,
author="Valla, Guido Luca
and Rossi, Michele
and Gaia, Alessandra
and Guaita, Antonio
and Rolandi, Elena",
title="The Impact of the COVID-19 Pandemic on Oldest-Old Social Capital and Health and the Role of Digital Inequalities: Longitudinal Cohort Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="9",
volume="27",
pages="e62824",
keywords="older adults",
keywords="information and communication technology",
keywords="ICT",
keywords="ICT use",
keywords="COVID-19",
keywords="social capital",
keywords="health",
keywords="mental health",
keywords="digital divide",
abstract="Background: During the COVID-19 pandemic, information and communication technology (ICT) became crucial for staying connected with loved ones and accessing health services. In this scenario, disparities in ICT use may have exacerbated other forms of inequality, especially among older adults who were less familiar with technology and more vulnerable to severe COVID-19 health consequences. Objective: This study investigated changes in ICT use, psychological and physical health, and social capital before and after the pandemic among the oldest old population (aged 80 years or older after the pandemic) and explored how internet use influenced these changes. Methods: We leveraged data from the InveCe.Ab study, a population-based longitudinal cohort of people born between 1935 and 1939 and living in Abbiategrasso, a municipality on the outskirts of Milan, Italy. Participants underwent multidimensional assessment at baseline (2010) and after 2, 4, 8, and 12 years. We restricted our analysis to cohort members who participated in the last wave (ie, 2022) and who did not have a diagnosis of dementia (n=391). We used linear mixed models to assess the impact of COVID-19 and time on changes in social capital, physical and psychological health, and ICT use in a discontinuity regression design while controlling for age, sex, education, and income satisfaction. Then, we assessed the influence of internet use and its interaction with COVID-19 on these changes. Results: COVID-19 had a significant impact on social relationships ($\beta$=--4.35, 95\% CI 6.38 to --2.32; P<.001), cultural activities ($\beta$=--.55, 95\% CI --0.75 to --0.35; P<.001), cognitive functioning ($\beta$=--1.00, 95\% CI --1.28 to --0.72; P<.001), depressive symptoms ($\beta$=.42, 95\% CI 0.10-0.74; P=.009), physical health ($\beta$=.07, 95\% CI 0.04-0.10; P<.001), and ICT use ($\beta$=--.11, 95\% CI --0.18 to --0.03; P=.008). Internet use predicts reduced depressive symptoms ($\beta$=--.56, 95\% CI --1.07 to --0.06; P=.03) over time. The interaction between internet use and COVID-19 was significant for cultural activities ($\beta$=--.73, 95\% CI --1.22 to --0.24; P=.003) and cognitive functioning ($\beta$=1.36, 95\% CI 0.67-2.05; P<.001). Conclusions: The pandemic had adverse effects on older adults' health and social capital. Contrary to expectations, even ICT use dropped significantly after the pandemic. Internet users maintained higher psychological health regardless of time and COVID-19 status. However, COVID-19 was associated with a steeper decline in cognitive functioning among internet nonusers. Policy makers may develop initiatives to encourage ICT adoption among older adults or strengthen their digital skills. Trial Registration: ClinicalTrials.gov NCT01345110; https://clinicaltrials.gov/study/NCT01345110 ",
doi="10.2196/62824",
url="https://www.jmir.org/2025/1/e62824"
}


@Article{info:doi/10.2196/50329,
author="Valkonen, Paula
and Kujala, Sari
and Savolainen, Kaisa
and Helminen, Riina-Riitta",
title="Exploring Older Adults' Needs for a Healthy Life and eHealth: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2025",
month="Jan",
day="8",
volume="12",
pages="e50329",
keywords="older adults",
keywords="eHealth",
keywords="needs",
keywords="retirement",
keywords="well-being",
keywords="cultural probes",
keywords="sentence completion",
keywords="human-computer interaction",
abstract="Background: Aging brings physical and life changes that could benefit from eHealth services. eHealth holistically combines technology, tasks, individuals, and contexts, and all these intertwined elements should be considered in eHealth development. As users' needs change with life situations, including aging and retirement, it is important to identify these needs at different life stages to develop eHealth services for well-being and active, healthy lives. Objective: This study aimed to (1) understand older adults' everyday lives in terms of well-being and health, (2) investigate older adults' needs for eHealth services, and (3) create design recommendations based on the findings. Methods: A total of 20 older adults from 2 age groups (55 to 74 years: n=12, 60\%; >75 years: n=8, 40\%) participated in this qualitative interview study. The data were collected remotely using a cultural probes package that included diary-based tasks, sentence completion tasks, and 4 background questionnaires; we also performed remote, semistructured interviews. The data were gathered between the fall of 2020 and the spring of 2021 in Finland as a part of the Toward a Socially Inclusive Digital Society: Transforming Service Culture (DigiIN) project (2019 to 2025). Results: In the daily lives of older adults, home-based activities, such as exercising (72/622, 11.6\% of mentions), sleeping (51/622, 8.2\% of mentions), and dining and cooking (96/622, 15.4\% of mentions), promoted well-being and health. When discussing their needs for eHealth services, participants highlighted a preference for a chat function. However, they frequently mentioned barriers and concerns such as the lack of human contact, inefficiency, and difficulties using eHealth systems. Older adults value flexibility; testing possibilities (eg, trial versions); support for digital services; and relevant, empathetically offered content with eHealth services on short-term and long-term bases in their changing life situations. Conclusions: Many older adults value healthy routines and time spent at home. The diversity of older adults' needs should be considered by making it possible for them to manage their health safely and flexibly on different devices and channels. eHealth services should adapt to older adults' life changes through motivation, personalized content, and appropriate functions. Importantly, older adults should still have the option to not use eHealth services. ",
doi="10.2196/50329",
url="https://humanfactors.jmir.org/2025/1/e50329"
}


@Article{info:doi/10.2196/65065,
author="Jin, Hengjiang
and Qu, Ying",
title="Association Between Intergenerational Support, Technology Perception and Trust, and Intention to Seek Medical Care on the Internet Among Chinese Older Adults: Cross-Sectional Questionnaire Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="6",
volume="27",
pages="e65065",
keywords="intergenerational support",
keywords="older adults",
keywords="internet medical intentions",
keywords="perceived technology",
keywords="trust",
abstract="Background: Avoiding technological innovation does not simplify life. In fact, using internet-based medical services can enhance the quality of life for older adults. In the context of an aging population and the growing integration of information technology, the demand for internet-based medical services among older adults is gaining increased attention. While scholars have highlighted the important role of intergenerational support in promoting digital inclusion for older adults, research on the relationship between intergenerational support and older adults' intentions to seek online care remains limited. Objective: This study aims (1) to explore the association between intergenerational support, online medical information, and older adults' intention to seek medical care online, and (2) to examine the mediating role of technology perception and trust, as well as the moderating role of eHealth literacy. Methods: A cross-sectional survey was conducted in China, collecting 958 valid responses from older adults aged 60 years and above. A vast majority of participants were between the ages of 60 and 75 years (771/958, 80.5\%). Of the 958 participants, 559 (58.4\%) resided in rural areas, while 399 (41.6\%) lived in urban areas. The survey included questions on intergenerational support, perceived usefulness, perceived ease of use, trust, online medical information, eHealth literacy, and the intention to seek medical care online. Structural equation modeling and linear regression analysis were applied to explore the relationship between intergenerational support and the intention to seek medical care on the internet. Results: Intergenerational support was positively associated with perceived ease of use ($\beta$=.292, P<.001), perceived usefulness ($\beta$=.437, P<.001), trust ($\beta$=.322, P<.001), and the intention to seek medical care online ($\beta$=.354, P<.001). Online medical information also positively affected the intention to seek medical care online among older adults ($\beta$=.109, P<.001). Perceived ease of use ($\beta$=.029, 95\% CI 0.009-0.054), perceived usefulness ($\beta$=.089, 95\% CI 0.050-0.130), and trust ($\beta$=.063, 95\% CI 0.036-0.099) partially mediated the association between intergenerational support and the intention to seek medical care online. Further analysis found that perceived ease of use, perceived usefulness, and trust played a chain mediating role between intergenerational support and the intention to seek medical care online ($\beta$=.015, 95\% CI 0.008-0.027; $\beta$=.022, 95\% CI 0.012-0.036). Additionally, eHealth literacy played a moderating role in the relationship between intergenerational support and perceived ease of use ($\beta$=.177, P<.001), perceived usefulness ($\beta$=.073, P<.05), trust ($\beta$=.090, P<.01), and the intention to seek medical care online ($\beta$=.124, P<.001). Conclusions: An integrated model of health communication effects was constructed and validated, providing empirical support for the intention to seek medical care online and for the impact of health communication. This model also helps promote the role of technology in empowering the lives of seniors. ",
doi="10.2196/65065",
url="https://www.jmir.org/2025/1/e65065"
}


@Article{info:doi/10.2196/63034,
author="Tartaglia, Julia
and Jaghab, Brendan
and Ismail, Mohamed
and H{\"a}nsel, Katrin
and Meter, Van Anna
and Kirschenbaum, Michael
and Sobolev, Michael
and Kane, M. John
and Tang, X. Sunny",
title="Assessing Health Technology Literacy and Attitudes of Patients in an Urban Outpatient Psychiatry Clinic: Cross-Sectional Survey Study",
journal="JMIR Ment Health",
year="2024",
month="Dec",
day="30",
volume="11",
pages="e63034",
keywords="digital literacy",
keywords="attitudes",
keywords="mental health",
keywords="digital health technology",
keywords="cluster analysis",
keywords="psychiatry",
keywords="mobile phone",
abstract="Background: Digital health technologies are increasingly being integrated into mental health care. However, the adoption of these technologies can be influenced by patients' digital literacy and attitudes, which may vary based on sociodemographic factors. This variability necessitates a better understanding of patient digital literacy and attitudes to prevent a digital divide, which can worsen existing health care disparities. Objective: This study aimed to assess digital literacy and attitudes toward digital health technologies among a diverse psychiatric outpatient population. In addition, the study sought to identify clusters of patients based on their digital literacy and attitudes, and to compare sociodemographic characteristics among these clusters. Methods: A survey was distributed to adult psychiatric patients with various diagnoses in an urban outpatient psychiatry program. The survey included a demographic questionnaire, a digital literacy questionnaire, and a digital health attitudes questionnaire. Multiple linear regression analyses were used to identify predictors of digital literacy and attitudes. Cluster analysis was performed to categorize patients based on their responses. Pairwise comparisons and one-way ANOVA were conducted to analyze differences between clusters. Results: A total of 256 patients were included in the analysis. The mean age of participants was 32 (SD 12.6, range 16-70) years. The sample was racially and ethnically diverse: White (100/256, 38.9\%), Black (39/256, 15.2\%), Latinx (44/256, 17.2\%), Asian (59/256, 23\%), and other races and ethnicities (15/256, 5.7\%). Digital literacy was high for technologies such as smartphones, videoconferencing, and social media (items with >75\%, 193/256 of participants reporting at least some use) but lower for health apps, mental health apps, wearables, and virtual reality (items with <42\%, 108/256 reporting at least some use). Attitudes toward using technology in clinical care were generally positive (9 out of 10 items received >75\% positive score), particularly for communication with providers and health data sharing. Older age (P<.001) and lower educational attainment (P<.001) negatively predicted digital literacy scores, but no demographic variables predicted attitude scores. Cluster analysis identified 3 patient groups. Relative to the other clusters, cluster 1 (n=30) had lower digital literacy and intermediate acceptance of digital technology. Cluster 2 (n=50) had higher literacy and lower acceptance. Cluster 3 (n=176) displayed both higher literacy and acceptance. Significant between-cluster differences were observed in mean age and education level between clusters (P<.001), with cluster 1 participants being older and having lower levels of formal education. Conclusions: High digital literacy and acceptance of digital technologies were observed among our patients, indicating a generally positive outlook for digital health clinics. Our results also found that patients of older age and lower formal levels of educational attainment had lower digital literacy, highlighting the need for targeted interventions to support those who may struggle with adopting digital health tools. ",
doi="10.2196/63034",
url="https://mental.jmir.org/2024/1/e63034"
}


@Article{info:doi/10.2196/57204,
author="Hoffman, Jane
and Hattingh, Laetitia
and Shinners, Lucy
and Angus, L. Rebecca
and Richards, Brent
and Hughes, Ian
and Wenke, Rachel",
title="Allied Health Professionals' Perceptions of Artificial Intelligence in the Clinical Setting: Cross-Sectional Survey",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="30",
volume="8",
pages="e57204",
keywords="allied health",
keywords="artificial intelligence",
keywords="hospital",
keywords="digital health",
keywords="impact",
keywords="AI",
keywords="mHealth",
keywords="cross sectional",
keywords="survey",
keywords="health professional",
keywords="medical professional",
keywords="perception",
keywords="clinical setting",
keywords="opportunity",
keywords="challenge",
keywords="healthcare",
keywords="delivery",
keywords="Australia",
keywords="clinician",
keywords="confirmatory factor analysis",
keywords="linear regression",
abstract="Background: Artificial intelligence (AI) has the potential to address growing logistical and economic pressures on the health care system by reducing risk, increasing productivity, and improving patient safety; however, implementing digital health technologies can be disruptive. Workforce perception is a powerful indicator of technology use and acceptance, however, there is little research available on the perceptions of allied health professionals (AHPs) toward AI in health care. Objective: This study aimed to explore AHP perceptions of AI and the opportunities and challenges for its use in health care delivery. Methods: A cross-sectional survey was conducted at a health service in, Queensland, Australia, using the Shinners Artificial Intelligence Perception tool. Results: A total of 231 (22.1\%) participants from 11 AHPs responded to the survey. Participants were mostly younger than 40 years (157/231, 67.9\%), female (189/231, 81.8\%), working in a clinical role (196/231, 84.8\%) with a median of 10 years' experience in their profession. Most participants had not used AI (185/231, 80.1\%), had little to no knowledge about AI (201/231, 87\%), and reported workforce knowledge and skill as the greatest challenges to incorporating AI in health care (178/231, 77.1\%). Age (P=.01), profession (P=.009), and AI knowledge (P=.02) were strong predictors of the perceived professional impact of AI. AHPs generally felt unprepared for the implementation of AI in health care, with concerns about a lack of workforce knowledge on AI and losing valued tasks to AI. Prior use of AI (P=.02) and years of experience as a health care professional (P=.02) were significant predictors of perceived preparedness for AI. Most participants had not received education on AI (190/231, 82.3\%) and desired training (170/231, 73.6\%) and believed AI would improve health care. Ideas and opportunities suggested for the use of AI within the allied health setting were predominantly nonclinical, administrative, and to support patient assessment tasks, with a view to improving efficiencies and increasing clinical time for direct patient care. Conclusions: Education and experience with AI are needed in health care to support its implementation across allied health, the second largest workforce in health. Industry and academic partnerships with clinicians should not be limited to AHPs with high AI literacy as clinicians across all knowledge levels can identify many opportunities for AI in health care. ",
doi="10.2196/57204",
url="https://formative.jmir.org/2024/1/e57204"
}


@Article{info:doi/10.2196/57833,
author="Doyle, A. Tom
and Vershaw, L. Samantha
and Conboy, Erin
and Halverson, E. Colin M.",
title="Improving Social Media-Based Support Groups for the Rare Disease Community: Interview Study With Patients and Parents of Children with Rare and Undiagnosed Diseases",
journal="JMIR Hum Factors",
year="2024",
month="Dec",
day="30",
volume="11",
pages="e57833",
keywords="social media",
keywords="rare disease",
keywords="support groups",
keywords="pediatric rare disease",
keywords="Ehlers-Danlos syndrome",
keywords="collagen disease",
keywords="fibrillar collagen",
keywords="cutis elastica",
keywords="connective tissue disorders",
keywords="hyperelasticity",
keywords="hypermobility of joints, inherited",
keywords="genetic disorder",
keywords="genetics",
keywords="pediatric",
abstract="Background: The rarity that is inherent in rare disease (RD) often means that patients and parents of children with RDs feel uniquely isolated and therefore are unprepared or unsupported in their care. To overcome this isolation, many within the RD community turn to the internet, and social media groups in particular, to gather useful information about their RDs. While previous research has shown that social media support groups are helpful for those affected by RDs, it is unclear what these groups are particularly useful or helpful for patients and parents of children with RDs. Objective: This study aimed to identify what specific features of disease-related support groups (DRSGs) the RD community finds particularly useful or supportive and provide a set of recommendations to improve social media--based RD support groups based on this information. Methods: Semistructured qualitative interviews were performed with patients and parents of patients with RDs. Interview participants had to be at least 18 years of age at the time of the interview, be seen by a genetics specialist at a partner health care institution and be proficient in the English language. Social media use was not a prerequisite for participation, so interview participants ranged from extensive users of social media to those who chose to remain off all social media. All interviews were conducted by phone, recorded, and then transcribed. Interview transcripts were then coded using the 6 steps outlined by Braun and Clarke. Three researchers (TAD, SLV, and CMEH) performed initial coding. After this, the study team conducted a review of themes and all members of the team agreed upon a final analysis and presentation of data. Results: We conducted 31 interviews (mean age 40, SD 10.04 years; n=27, 87\% were women; n=30, 97\% were non-Hispanic White). Thematic analysis revealed that social media DRSG users identified the informational usefulness of these groups as being related to the gathering and sharing of specific information about an RD, clarification about the importance and meaning of certain symptoms, and obtaining insight into an RD's progression and prognosis. Participants also identified that DRSGs were useful sources of practical information, such as tips and tricks about managing RD-related issues and concerns. In addition, participants found DRSGs to be a useful space for sharing their disease-related stories but also highlighted a feeling of exhaustion from overexposure and overuse of DRSGs. Conclusions: This study identifies the usefulness of DRSGs for the RD community and provides a set of recommendations to improve future instances of DRSGs. These recommendations can be used to create DRSGs that are less prone to splintering into other DRSGs, thus minimizing the risk of having important RD-related information unhelpfully dispersed amongst a multitude of support groups. ",
doi="10.2196/57833",
url="https://humanfactors.jmir.org/2024/1/e57833",
url="http://www.ncbi.nlm.nih.gov/pubmed/39752188"
}


@Article{info:doi/10.2196/60176,
author="Benjamin, Ellen
and Giuliano, K. Karen",
title="Work Systems Analysis of Emergency Nurse Patient Flow Management Using the Systems Engineering Initiative for Patient Safety Model: Applying Findings From a Grounded Theory Study",
journal="JMIR Hum Factors",
year="2024",
month="Dec",
day="10",
volume="11",
pages="e60176",
keywords="patient flow",
keywords="throughput",
keywords="emergency department",
keywords="nursing",
keywords="emergency nursing",
keywords="organizing work",
keywords="cognitive work",
keywords="human factors",
keywords="ergonomics",
keywords="SEIPS model",
abstract="Background: Emergency nurses actively manage the flow of patients through emergency departments. Patient flow management is complex, cognitively demanding work that shapes the timeliness, efficiency, and safety of patient care. Research exploring nursing patient flow management is limited. A comprehensive analysis of emergency nursing work systems is needed to improve patient flow work processes. Objective: The aim of this paper is to describe the work system factors that impact emergency nurse patient flow management using the System Engineering Initiative for Patient Safety model. Methods: This study used grounded theory methodologies. Data were collected through multiple rounds of focus groups and interviews with 27 emergency nurse participants and 64 hours of participant observation across 4 emergency departments between August 2022 and February 2023. Data were analyzed using coding, constant comparative analysis, and memo-writing. Emergent themes were organized according to the first component of the System Engineering Initiative for Patient Safety model, the work system. Results: Patient flow management is impacted by diverse factors, including personal nursing characteristics; tools and technology; external factors; and the emergency department's physical and socio-organizational environment. Participants raised concerns about the available technology's functionality, usability, and accessibility; departmental capacity and layout; resource levels across the health care system; and interdepartmental teamwork. Other noteworthy findings include obscurity and variability across departments' staff roles titles, functions, and norms; the degree of provider involvement in patient flow management decisions; and management's enforcement of timing metrics. Conclusions: There are significant barriers to the work of emergency patient flow management. More research is needed to measure the impact of these human factors on patient flow outcomes. Collaboration between health care administrators, human factors engineers, and nurses is needed to improve emergency nurse work systems. ",
doi="10.2196/60176",
url="https://humanfactors.jmir.org/2024/1/e60176"
}


@Article{info:doi/10.2196/64367,
author="Dermody, Gordana
and Wadsworth, Daniel
and Dunham, Melissa
and Glass, Courtney
and Fritz, Roschelle",
title="Factors Affecting Clinician Readiness to Adopt Smart Home Technology for Remote Health Monitoring: Systematic Review",
journal="JMIR Aging",
year="2024",
month="Dec",
day="5",
volume="7",
pages="e64367",
keywords="clinician",
keywords="provider",
keywords="health professional",
keywords="smart home",
keywords="remote monitoring",
keywords="technology",
keywords="readiness",
keywords="adoption",
keywords="preparedness",
abstract="Background: The population of older adults worldwide continues to increase, placing higher demands on primary health care and long-term care. The costs of housing older people in care facilities have economic and societal impacts that are unsustainable without innovative solutions. Many older people wish to remain independent in their homes and age in place. Assistive technology such as health-assistive smart homes with clinician monitoring could be a widely adopted alternative to aged-care facilities in the future. While studies have found that older persons have demonstrated a readiness to adopt health-assistive smart homes, little is known about clinician readiness to adopt this technology to support older adults to age as independently as possible. Objective: The purpose of this systematic review was to identify the factors that affect clinician readiness to adopt smart home technology for remote health monitoring. Methods: This review was conducted in accordance with the Joanna Briggs Institute methodology for systematic Reviews and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting. Results: Several factors affected clinicians' perspectives on their readiness to adopt smart home technology for remote health monitoring, including challenges such as patient privacy and dignity, data security, and ethical use of ``invasive'' technologies. Perceived benefits included enhancing the quality of care and outcomes. Conclusions: Clinicians, including nurses, reported both challenges and benefits of adopting smart home technology for remote health monitoring. Clear strategies and frameworks to allay fears and overcome professional concerns and misconceptions form key parts of the Readiness for Adoption Pathway proposed. The use of more rigorous scientific methods and reporting is needed to advance the state of the science. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020195989; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=195989 ",
doi="10.2196/64367",
url="https://aging.jmir.org/2024/1/e64367",
url="http://www.ncbi.nlm.nih.gov/pubmed/39012852"
}


@Article{info:doi/10.2196/65730,
author="Kokorelias, M. Kristina
and Valentine, Dean
and Dove, M. Erica
and Brown, Paige
and McKinlay, Stuart
and Sheppard, L. Christine
and Singh, Hardeep
and Eaton, D. Andrew
and Jamieson, Laura
and Wasilewski, B. Marina
and Zhabokritsky, Alice
and Flanagan, Ashley
and Abdelhalim, Reham
and Zewude, Rahel
and Parpia, Rabea
and Walmsley, Sharon
and Sirisegaram, Luxey",
title="Exploring the Perspectives of Older Adults Living With HIV on Virtual Care: Qualitative Study",
journal="JMIR Aging",
year="2024",
month="Dec",
day="4",
volume="7",
pages="e65730",
keywords="HIV",
keywords="human immunodeficiency virus",
keywords="perspective",
keywords="telemedicine",
keywords="telehealth",
keywords="virtual care",
keywords="virtual health",
keywords="virtual medicine",
keywords="qualitative",
keywords="gerontology",
keywords="geriatrics",
keywords="older adult",
keywords="older people",
keywords="aging",
abstract="Background: As the population of individuals with HIV ages rapidly due to advancements in antiretroviral therapy, virtual care has become an increasingly vital component in managing their complex health needs. However, little is known about perceptions of virtual care among older adults living with HIV. Objective: This study aimed to understand the perceptions of older adults living with HIV regarding virtual care. Methods: Using an interpretive, qualitative, descriptive methodology, semistructured interviews were conducted with 14 diverse older adults living with HIV. The participants lived in Ontario, Canada, self-identified as HIV-positive, and were aged 50 years or older. Efforts were made to recruit individuals with varying experience with virtual health care. Reflexive thematic analysis was conducted with the interview transcripts to identify prevalent themes. Results: The identified themes included (1) the importance of relationships in virtual care for older adults living with HIV; (2) privacy and confidentiality in virtual care; and (3) challenges and solutions related to access and technological barriers in virtual care. These themes highlight the perceptions of diverse older adults living with HIV concerning virtual care, emphasizing the fundamental role of trust, privacy, and technology access. Conclusions: By embracing the unique perspectives and experiences of this population, we can work toward building more inclusive and responsive health care systems that meet the needs of all individuals, regardless of age, HIV status, or other intersecting identities. ",
doi="10.2196/65730",
url="https://aging.jmir.org/2024/1/e65730"
}


@Article{info:doi/10.2196/52715,
author="H{\"a}rk{\"o}nen, Henna
and Myllykangas, Kirsi
and K{\"a}rpp{\"a}, Mikko
and Rasmus, Maaria Kirsi
and Gomes, Francis Julius
and Immonen, Milla
and Hyv{\"a}m{\"a}ki, Piia
and Jansson, Miia",
title="Perspectives of Clients and Health Care Professionals on the Opportunities for Digital Health Interventions in Cerebrovascular Disease Care: Qualitative Descriptive Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="2",
volume="26",
pages="e52715",
keywords="cerebrovascular disease",
keywords="stroke",
keywords="digitalization",
keywords="interventions",
keywords="health care professional",
keywords="client",
keywords="patient",
keywords="mHealth",
keywords="mobile health",
keywords="application",
keywords="digital health",
keywords="smartphones",
keywords="health system",
keywords="qualitative",
keywords="descriptive study",
keywords="brain",
keywords="blood vessel disease",
keywords="cerebrovascular disorder",
keywords="Finland",
keywords="interviews",
keywords="efficiency",
keywords="information",
keywords="quality",
keywords="accountability",
keywords="neurology",
keywords="neuroscience",
keywords="brain injury",
keywords="mobile phone",
abstract="Background: Cerebrovascular diseases (CVDs) are a major and potentially increasing burden to public health. Digital health interventions (DHIs) could support access to and provision of high-quality health care (eg, outcomes, safety, and satisfaction), but the design and development of digital solutions and technologies lack the assessment of user needs. Research is needed to identify opportunities to address health system challenges and improve CVD care with primary users of services as the key informants of everyday requirements. Objective: This study aims to identify opportunities for DHIs from clients' and health care professionals' perspectives to address health system challenges and improve CVD care. Methods: This study used a qualitative, descriptive approach. Semistructured, in-person interviews were conducted with 22 clients and 26 health care professionals in a single tertiary-level hospital in Finland between August 2021 and March 2022. The data were analyzed using a deductive and inductive content analysis. Results: Identified opportunities for DHIs in CVD care were organized according to clients, health care professionals, and data services and classified into 14 main categories and 27 generic categories, with 126 subcategories of requirements. DHIs for clients could support the long-term management of health and life changes brought on by CVD. They could provide access to personal health data and offer health information, support, and communication possibilities for clients and their caregivers. Health care professionals would benefit from access to relevant patient data, along with systems and tools that support competence and decision-making. Intersectoral and professional collaboration could be promoted with digital platforms and care pathways. DHIs for data services could enhance care planning and coordination with novel predictive data and interoperable systems for data exchange. Conclusions: The combined study of client and health care professional perspectives identified several opportunities and requirements for DHIs that related to the information, availability, quality, acceptability, utilization, efficiency, and accountability challenges of health systems. These findings provide valuable social insights into digital transformation and the emerging design, development, and use of user-centered technologies and applications to address challenges and improve CVD care and health care. ",
doi="10.2196/52715",
url="https://www.jmir.org/2024/1/e52715",
url="http://www.ncbi.nlm.nih.gov/pubmed/39622027"
}


@Article{info:doi/10.2196/57301,
author="Chen, Bowen
and Yang, Chun
and Ren, Shanshan
and Li, Penggao
and Zhao, Jin",
title="Relationship Between Internet Use and Cognitive Function Among Middle-Aged and Older Chinese Adults: 5-Year Longitudinal Study",
journal="J Med Internet Res",
year="2024",
month="Dec",
day="2",
volume="26",
pages="e57301",
keywords="aging",
keywords="cognitive function",
keywords="internet use",
keywords="longitudinal study",
keywords="fixed effects model",
abstract="Background: Cognitive decline poses one of the greatest global challenges for health and social care, particularly in China, where the burden on the older adult population is most pronounced. Despite the rapid expansion of internet access, there is still limited understanding of the long-term cognitive impacts of internet use among middle-aged and older adults. Objective: This study aims to explore the association between internet use and age-related cognitive decline among middle-aged and older Chinese adults. To gain a more comprehensive understanding of the effects of internet use, we also focused on assessing the impact of both the frequency of internet use and the types of internet devices on cognition. Moreover, we assessed the mediating role of internet use on cognitive function for characteristics significantly linked to cognition in stratified analysis. Methods: We analyzed data based on 12,770 dementia-free participants aged ?45 years from the China Health and Retirement Longitudinal Study. We used a fixed effects model to assess the relationship between internet use and cognitive decline and further validated it using multiple linear regression analysis, generalized estimating equations, propensity score matching, inverse probability of treatment weighting, and overlap weighting. We further examined the varying effects of internet device type and frequency on cognitive function using fixed effects models and Spearman rank correlations. The Karlson-Holm-Breen method was used to estimate the mediating role of internet use in the urban-rural cognitive gap. Results: Participants using the internet (n=1005) were younger, more likely to be male, more educated, married, retired and living in an urban area and had higher cognitive assessment scores than nonusers (n=11,765). After adjusting for demographic and health-related risk factors, there was a positive correlation between internet use and cognitive function ($\beta$=0.551, 95\% CI 0.391-0.710). Over the follow-up period, persistent internet users had a markedly lower 5-year incidence of neurodegenerative diseases, at 2.2\% (15/671), compared with nonusers, at 5.3\% (379/7099; P<.001). The negative impact of aging (>50 years) on cognitive function was consistently less pronounced among internet users than among nonusers. Furthermore, increased frequency of internet use was associated with greater cognitive benefits for middle-aged and older adults (rs=0.378, P<.001). Among digital devices used for internet access, cell phones ($\beta$=0.398, 95\% CI 0.283-0.495) seemed to have a higher level of cognitive protection than computers ($\beta$=0.147, 95\% CI 0.091-0.204). The urban-rural disparity in cognitive function was partially attributed to the disparity in internet use (34.2\% of the total effect, P<.001). Conclusions: This study revealed that the use of internet by individuals aged 45 years and older is associated with a reduced risk of cognitive decline. Internet use?has the potential to be a viable, cost-effective, nonpharmacological intervention for?cognitive decline among middle-aged and older adults. ",
doi="10.2196/57301",
url="https://www.jmir.org/2024/1/e57301",
url="http://www.ncbi.nlm.nih.gov/pubmed/39539034"
}


@Article{info:doi/10.2196/59442,
author="Kang, Aimei
and Wu, XiuLi",
title="Assessing Visitor Expectations of AI Nursing Robots in Hospital Settings: Cross-Sectional Study Using the Kano Model",
journal="JMIR Nursing",
year="2024",
month="Nov",
day="27",
volume="7",
pages="e59442",
keywords="nursing robot",
keywords="artificial intelligence",
keywords="Kano model",
keywords="demand survey",
keywords="nursing",
keywords="care robots",
keywords="nursing management",
abstract="Background: Globally, the rates at which the aging population and the prevalence of chronic diseases are increasing are substantial. With declining birth rates and a growing percentage of older individuals, the demand for nursing staff is steadily rising. However, the shortage of nursing personnel has been a long-standing issue. In recent years, numerous researchers have advocated for the implementation of nursing robots as a substitute for traditional human labor. Objective: This study analyzes hospital visitors' attitudes and priorities regarding the functional areas of artificial intelligence (AI) nursing robots based on the Kano model. Building on this analysis, recommendations are provided for the functional optimization of AI nursing robots, aiming to facilitate their adoption in the nursing field. Methods: Using a random sampling method, 457 hospital visitors were surveyed between December 2023 and March 2024 to compare the differences in demand for AI nursing robot functionalities among the visitors. Results: A comparative analysis of the Kano attribute quadrant diagrams showed that visitors seeking hospitalization prioritized functional aspects that enhance medical activities. In contrast, visitors attending outpatient examinations focused more on functional points that assist in medical treatment. Additionally, visitors whose purpose was companionship and care emphasized functional aspects that offer psychological and life support to patients. Conclusions: AI nursing robots serve various functional areas and cater to diverse audience groups. In the future, it is essential to thoroughly consider users' functional needs and implement targeted functional developments to maximize the effectiveness of AI nursing robots. ",
doi="10.2196/59442",
url="https://nursing.jmir.org/2024/1/e59442"
}


@Article{info:doi/10.2196/58613,
author="Al-Hamad, Areej
and Yasin, Mohammad Yasin
and Metersky, Kateryna
and Guruge, Sepali
and Jung, Grace
and Mahsud, Khadija",
title="Homestay Hosting Dynamics and Refugee Well-Being: Scoping Review",
journal="Interact J Med Res",
year="2024",
month="Nov",
day="25",
volume="13",
pages="e58613",
keywords="homestay",
keywords="host-guest relationship",
keywords="hospitality",
keywords="hosting",
keywords="well-being",
keywords="homestay accommodation",
keywords="host-refugee relation",
keywords="refugee",
keywords="scoping review",
keywords="review",
abstract="Background: Homestay accommodations aim to support a smoother transition for refugees; yet, the intricate nature of relationships between refugees and their hosting families can make this process complex, which, in turn, can affect their health and well-being. It is crucial to grasp the experiences of both refugees and their host families in order to foster effective settlement, integration, and well-being. Objective: The purpose of this scoping review is to explore the dynamics of homestay or hosting with a focus on understanding the experiences of both refugees and their hosting families to identify gaps in the literature and propose directions for future research. Methods: We used the Joanna Briggs Institute methodology and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to guide this scoping review. Searches were conducted in MEDLINE via EBSCO, Scopus via OVID, CINAHL, SOCIndex, Web of Science Core Collection, ProQuest Dissertations and Theses, the SciELO Citation Index, and APA PsycInfo. Literature written in English and published from 2011 to 2024 that focused on homestay hosting contexts for refugees was included. Results: The results of this review illuminate the multifaceted and dynamic nature of homestay hosting for refugees. The findings include motivations and barriers for homestay hosting, factors influencing host-refugee relations, and psychological and social outcomes of homestay hosting. Conclusions: The results of this scoping review demonstrated the need for tailored support for refugees to improve homestay programs for the benefit of both refugees and host families and highlighted the need of more inclusive, supportive, and effective strategies for the hosting, resettlement, and integration of refugees. International Registered Report Identifier (IRRID): RR2-10.2196/56242 ",
doi="10.2196/58613",
url="https://www.i-jmr.org/2024/1/e58613"
}


@Article{info:doi/10.2196/60574,
author="Charles, Lesley
and Tang, Eileen
and Tian, Jaminal Peter George
and Chan, Karenn
and Br{\'e}mault-Phillips, Suzette
and Dobbs, Bonnie
and Vokey, Camelia
and Polard, Sharna
and Parmar, Jasneet",
title="Characteristics, Barriers, and Facilitators of Virtual Decision-Making Capacity Assessments During the COVID-19 Pandemic: Online Survey",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="25",
volume="8",
pages="e60574",
keywords="decision making capacity",
keywords="mental competency",
keywords="aged",
keywords="mobile applications",
keywords="mobile phone",
keywords="Canada",
keywords="covid-19",
keywords="pandemics",
keywords="dementia",
keywords="survey",
keywords="virtual capacity assessment",
keywords="characteristics",
keywords="barriers",
keywords="facilitators",
keywords="virtual decision making",
keywords="assessment",
abstract="Background: With a growing older adult population, the number of persons with dementia is expected to rise. Consequently, the number of persons needing decision-making capacity assessments (DMCA) will increase. The COVID-19 pandemic has impacted how we deliver patient care including DMCAs with a much more rapid shift to virtual assessments. Virtual DMCAs offer patients and health care professionals distinct advantages over in-person delivery by improving reach, access, and timely provision of health care. However, questions have arisen as to whether DMCAs can be effectively conducted virtually. Objective: This study aimed to determine the characteristics, barriers, and facilitators of conducting virtual DMCA during the COVID-19 pandemic. Methods: We conducted an online survey among health care providers who perform DMCAs in Alberta from March 2022 to February 2023. The survey consisted of 25 questions on demographics, preferences, and experience in conducting DMCAs virtually, and risks and barriers to doing virtual DMCAs. The data were analyzed using descriptive statistics. Results: There were 31 respondents with a mean age of 51.1 (SD 12.7) years. The respondents consisted of physicians (45.2\%, 14/31), occupational therapists (29\%, 9/31), and social workers (16.1\%, 5/31), with a majority (93.6\%, 29/31) based in Edmonton. The mean number of years of experience conducting DMCAs was 12.3 (SD 10.7), with a median of 8 DMCAs (IQR 18.5) conducted per year. Most respondents conduct capacity interviews, with a majority (55.2\%, 16/29) being associated primarily with acute care services. Furthermore, 54.8\% (17/31) were interested in conducting DMCAs virtually; however, only 25.8\% (8/31) had administered DMCAs virtually. Barriers and facilitators to virtual DMCAs relate to patients' characteristics and environment (such as communication difficulties, hearing or visual impairment, language barriers, ease of use of technology, or cognitive impairment), technology and technical support (need for technical support in both the client's and assessor's sides, the unreliability of internet connection in rural settings, and the availability of high-fidelity equipment), and assessors' ability to perform DMCA's virtually (ability to observe body language, interact with the client physically when needed, and build rapport can all be affected when conducting a DMCA virtually). In terms of implications for clinical practice, it is recommended that the patient or caregiver be familiar with technology, have a stable internet connection, use a private room, not be recorded, use a standardized assessment template, and have a backup plan in case of technical difficulties. Conclusions: Conducting DMCAs virtually is a relatively infrequent undertaking. Barriers and facilitators to adequate assessment need to be addressed given that virtual assessments are time-saving and expand reach. ",
doi="10.2196/60574",
url="https://formative.jmir.org/2024/1/e60574",
url="http://www.ncbi.nlm.nih.gov/pubmed/39585735"
}


@Article{info:doi/10.2196/52703,
author="Schmidt, Simone
and Boulton, Adam
and Butler, Benita
and Fazio, Timothy",
title="Exploring Patient, Proxy, and Clinician Perspectives on the Value and Impact of an Inpatient Portal: A Reflexive Thematic Analysis",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="20",
volume="11",
pages="e52703",
keywords="inpatient portal",
keywords="patient perspective",
keywords="clinician perspective",
keywords="information sharing",
keywords="clinician-patient relationship",
keywords="person-centered care",
keywords="reflexive thematic analysis",
keywords="qualitative research",
keywords="mobile phone",
abstract="Background: Research exploring perspectives on inpatient portals reports that patients desire the information affordances of inpatient portals, and clinicians recognize their value for improving patient experience but also express caution regarding sharing aspects of the medical record. This study contributed to the?existing literature on inpatient portals by considering the psychosocial dimension of clinician resistance to information sharing with inpatients and the power dynamic associated with clinician-patient information asymmetry. Along with the information affordances commonly discussed in this area, this study explored perspectives on the novel option to audio record consultations via an inpatient portal. Objective: This study aims to understand patient, proxy, and clinician perspectives on the value and impact of an inpatient portal within the Australian context. It explores clinician resistance and receptivity to sharing aspects of the medical record with patients and the power dynamic that characterizes the relationship between clinician and patient. It considers how an inpatient portal might assist in the transformation of this relationship such that this relationship could be characterized by greater information symmetry. Methods: Interviews were conducted with patients (n=20), proxies (n=4), and clinicians (n=21) recruited from 3 areas within the Royal Melbourne Hospital, where the portal would later be implemented. A largely inductive reflexive thematic analysis was conducted. Results: Patient and proxy participants reported that they wanted to understand what is happening in their care for peace of mind and that an inpatient portal could support this understanding. Clinician participants reflected on how they might transform their information-sharing practice to provide greater transparency in their relationship with patients. Participants considered the types of information that could be shared and how this information could be shared via an inpatient portal. Four key themes were generated: (1) affording the patient and proxy awareness, control, and reassurance through sharing accessible and meaningful information; (2) protecting the clinician and safeguarding quality health care in information sharing; (3) flexibly deploying the functions depending upon clinician, patient, proxy, and context; and (4) moving toward person-centered care: empowerment and equity via an inpatient portal. Conclusions: An inpatient portal provides an opportunity to reconceptualize the medical record and how this information might be shared with patients while they are admitted to the?hospital, such that they have more understanding as to what is happening in their care, which ultimately supports their well-being. The transition to a more transparent information-sharing culture in the Australian hospital context will take time. An inpatient portal is a critical step in facilitating this transition and creating more informational symmetry in the clinician-patient relationship. ",
doi="10.2196/52703",
url="https://humanfactors.jmir.org/2024/1/e52703"
}


@Article{info:doi/10.2196/56473,
author="Alomar, Dalia
and Almashmoum, Maryam
and Eleftheriou, Iliada
and Whelan, Pauline
and Ainsworth, John",
title="The Impact of Patient Access to Electronic Health Records on Health Care Engagement: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="20",
volume="26",
pages="e56473",
keywords="electronic health records",
keywords="personal health record",
keywords="health care engagement",
keywords="empowerment",
keywords="patient experience",
keywords="patient satisfaction",
keywords="health care services",
keywords="systematic review",
abstract="Background: Health information technologies, including electronic health records (EHRs), have revolutionized health care delivery. These technologies promise to enhance the efficiency and quality of care through improved patient health information management. Despite the transformative potential of EHRs, the extent to which patient access contributes to increased engagement with health care services within different clinical setting remains a distinct and underexplored facet. Objective: This systematic review aims to investigate the impact of patient access to EHRs on health care engagement. Specifically, we seek to determine whether providing patients with access to their EHRs contributes to improved engagement with health care services. Methods: A comprehensive systematic review search was conducted across various international databases, including Ovid MEDLINE, Embase, PsycINFO, and CINAHL, to identify relevant studies published from January 1, 2010, to November 15, 2023. The search on these databases was conducted using a combination of keywords and Medical Subject Heading terms related to patient access to electronic health records, patient engagement, and health care services. Studies were included if they assessed the impact of patient access to EHRs on health care engagement and provided evidence (quantitative or qualitative) for that. The guidelines of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 statement were followed for study selection, data extraction, and quality assessment. The included studies were assessed for quality using the Mixed Methods Appraisal Tool, and the results were reported using a narrative synthesis. Results: The initial search from the databases yielded 1737 studies, to which, after scanning their reference lists, we added 10 studies. Of these 1747 studies, 18 (1.03\%) met the inclusion criteria for the final review. The synthesized evidence from these studies revealed a positive relationship between patient access to EHRs and health care engagement, addressing 6 categories of health care engagement dimensions and outcomes, including treatment adherence and self-management, patient involvement and empowerment, health care communication and relationship, patient satisfaction and health outcomes, use of health care resources, and usability concerns and barriers. Conclusions: The findings suggested a positive association between patient access to EHRs and health care engagement. The implications of these findings for health care providers, policy makers, and patients should be considered, highlighting the potential benefits and challenges associated with implementing and promoting patient access to EHRs. Further research directions have been proposed to deepen our understanding of this dynamic relationship. ",
doi="10.2196/56473",
url="https://www.jmir.org/2024/1/e56473"
}


@Article{info:doi/10.2196/58277,
author="Malkani, Melina
and Madan, Eesha
and Malkani, Dillon
and Madan, Arav
and Singh, Neel
and Bamji, Tara
and Sabharwal, Harman",
title="Rank Ordered Design Attributes for Health Care Dashboards Including Artificial Intelligence: Usability Study",
journal="Online J Public Health Inform",
year="2024",
month="Nov",
day="20",
volume="16",
pages="e58277",
keywords="data visualization",
keywords="dashboards",
keywords="public health",
keywords="population health",
keywords="informed decisions",
keywords="consumer decision-making",
keywords="health data",
keywords="usability",
abstract="Background: On average, people in the United States visit a doctor 4 times a year, and many of them have chronic illnesses. Because of the increased use of technology, people frequently rely on the internet to access health information and statistics. People use health care information to make better-educated decisions for themselves and others. Health care dashboards should provide pertinent and easily understood data, such as information on timely cancer screenings, so the public can make better-informed decisions. In order to enhance health outcomes, effective dashboards should provide precise data in an accessible and easily digestible manner. Objective: This study identifies the top 15 attributes of a health care dashboard. The objective of this research is to enhance health care dashboards to benefit the public by making better health care information available for more informed decisions by the public and to improve population-level health care outcomes. Methods: The authors conducted a survey of health care dashboards with 218 individuals identifying the best practices to consider when creating a public health care dashboard. The data collection was conducted from June 2023 to August 2023. The analyses performed were descriptive statistics, frequencies, and a comparison to a prior study. Results: From May 2023 to June 2023, we collected 3259 responses in multiple different states around the United States from 218 people aged 18 years or older. The features ranking in descending order of importance are as follows: (1) easy navigation, (2) historical data, (3) simplicity of design, (4) high usability, (5) use of clear descriptions, (6) consistency of data, (7) use of diverse chart types, (8) compliance with the Americans with Disabilities Act, (9) incorporated user feedback, (10) mobile compatibility, (11) comparison data with other entities, (12) storytelling, (13) predictive analytics with artificial intelligence, (14) adjustable thresholds, and (15) charts with tabulated data. Conclusions: Future studies can extend the research to other types of dashboards such as bioinformatics, financial, and managerial dashboards as well as confirm these top 15 best practices for medical dashboards with further evidentiary support. The medical informatics community may benefit from standardization to improve efficiency and effectiveness as dashboards can communicate vital information to patients worldwide on critically prominent issues. Furthermore, health care professionals should use these best practices to help increase population health care outcomes by informing health care consumers to make better decisions with better data. ",
doi="10.2196/58277",
url="https://ojphi.jmir.org/2024/1/e58277",
url="http://www.ncbi.nlm.nih.gov/pubmed/39566038"
}


@Article{info:doi/10.2196/57628,
author="Tandon, Animesh
and Cobb, Bryan
and Centra, Jacob
and Izmailova, Elena
and Manyakov, V. Nikolay
and McClenahan, Samantha
and Patel, Smit
and Sezgin, Emre
and Vairavan, Srinivasan
and Vrijens, Bernard
and Bakker, P. Jessie
and ",
title="Human Factors, Human-Centered Design, and Usability of Sensor-Based Digital Health Technologies: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="15",
volume="26",
pages="e57628",
keywords="digital health",
keywords="remote",
keywords="decentralized",
keywords="sensors",
keywords="connected care",
keywords="usability",
keywords="ergonomics",
keywords="human-centered design",
keywords="user experience",
keywords="systematic scoping review",
keywords="human factors",
keywords="screening",
keywords="clinicians",
keywords="wearable",
keywords="mobile phone",
abstract="Background: Increasing adoption of sensor-based digital health technologies (sDHTs) in recent years has cast light on the many challenges in implementing these tools into clinical trials and patient care at scale across diverse patient populations; however, the methodological approaches taken toward sDHT usability evaluation have varied markedly. Objective: This review aims to explore the current landscape of studies reporting data related to sDHT human factors, human-centered design, and usability, to inform our concurrent work on developing an evaluation framework for sDHT usability. Methods: We conducted a scoping review of studies published between 2013 and 2023 and indexed in PubMed, in which data related to sDHT human factors, human-centered design, and usability were reported. Following a systematic screening process, we extracted the study design, participant sample, the sDHT or sDHTs used, the methods of data capture, and the types of usability-related data captured. Results: Our literature search returned 442 papers, of which 85 papers were found to be eligible and 83 papers were available for data extraction and not under embargo. In total, 164 sDHTs were evaluated; 141 (86\%) sDHTs were wearable tools while the remaining 23 (14\%) sDHTs were ambient tools. The majority of studies (55/83, 66\%) reported summative evaluations of final-design sDHTs. Almost all studies (82/83, 99\%) captured data from targeted end users, but only 18 (22\%) out of 83 studies captured data from additional users such as care partners or clinicians. User satisfaction and ease of use were evaluated for 83\% (136/164) and 91\% (150/164) of sDHTs, respectively; however, learnability, efficiency, and memorability were reported for only 11 (7\%), 4 (2\%), and 2 (1\%) out of 164 sDHTs, respectively. A total of 14 (9\%) out of 164 sDHTs were evaluated according to the extent to which users were able to understand the clinical data or other information presented to them (understandability) or the actions or tasks they should complete in response (actionability). Notable gaps in reporting included the absence of a sample size rationale (reported for 21/83, 25\% of all studies and 17/55, 31\% of summative studies) and incomplete sociodemographic descriptive data (complete age, sex/gender, and race/ethnicity reported for 14/83, 17\% of studies). Conclusions: Based on our findings, we suggest four actionable recommendations for future studies that will help to advance the implementation of sDHTs: (1) consider an in-depth assessment of technology usability beyond user satisfaction and ease of use, (2) expand recruitment to include important user groups such as clinicians and care partners, (3) report the rationale for key study design considerations including the sample size, and (4) provide rich descriptive statistics regarding the study sample to allow a complete understanding of generalizability to other patient populations and contexts of use. ",
doi="10.2196/57628",
url="https://www.jmir.org/2024/1/e57628"
}


@Article{info:doi/10.2196/54200,
author="Chen, Xing-Ling
and Li, Jin
and Sun, Shu-Ning
and Zhao, Qiang-Qiang
and Lin, Sheng-Rong
and Wang, Ling-Jun
and Yang, Zhong-Qi
and Ni, Shi-Hao
and Lu, Lu",
title="Association Between Daily Internet Use and Intrinsic Capacity Among Middle-Aged and Older Adults in China: Large Prospective Cohort Study",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="12",
volume="26",
pages="e54200",
keywords="daily internet use",
keywords="intrinsic capacity",
keywords="IC",
keywords="middle-aged and older adult",
keywords="healthy aging",
keywords="social participation",
abstract="Background: Intrinsic capacity (IC), as a comprehensive measure of an individual's functional ability, has gained prominence in the framework for healthy aging introduced by the World Health Organization (WHO). As internet usage continues to integrate into daily life, it is imperative to scrutinize the association between internet use and IC to effectively promote healthy aging among the middle-aged and older population. Objective: This study aimed to investigate whether daily internet use in middle-aged and older adults delays or accelerates the decline in IC. Methods: Participants included in the China Health and Retirement Longitudinal Study (CHARLS) comprised individuals aged ?45 years residing in China. We analyzed 4 years of CHARLS data from the first wave (May 2011-March 2012) to the third wave (July 2015-January 2016). Data from the first and third waves were used for longitudinal studies. Self-reported data encompassed internet use, frequency of use, and demographic baseline characteristics. In addition, the IC evaluation involved physical examination and blood test data. Initially, linear regression was used to assess the relationship between daily internet use and IC, followed by regression splines to explore potential nonlinear associations. Subgroup and sensitivity analyses were used to investigate the heterogeneity of IC in specific conditions and the robustness of our results. Mediation effect analysis was conducted to identify the factors that mediate the relationship between daily internet use and IC, focusing on social participation, physical activity, and health status. Results: Among the 12,826 participants included in the longitudinal analyses, 12,305 (95.9\%) did not use the internet, while 521 (4.1\%) reported daily internet use with a mean age of 52.62 (SD 7.67) years. After adjusting for demographic variables, socioeconomic factors, lifestyle behaviors, and health conditions and examining the impact of daily internet use and frequency on changes in IC, our findings indicated important associations. Specifically, daily internet use is significantly linked to a slower decline in IC over time (marginal effect 1.58, 95\% CI 1.03-2.12; P<.001). Individuals with moderate and regular internet use frequency exhibit higher levels of maintenance in IC (marginal effect 0.74, 95\% CI 0.45-1.03, P<.001). In addition, the relationship between IC changes and internet use frequency demonstrated a nonlinear inverted U-shaped curve (nonlinear P=.003). Subgroup analysis further revealed that improvements in IC vary based on age and gender. Furthermore, mediation analysis denoted that more than 28.78\% (95\% CI 21.24-40.33) of the observed association is mediated by social participation (P<.001). Conclusions: The findings of our research underscore the potential benefits of consistent and moderate internet use in promoting and preserving IC, particularly in cognitive capacity, sensory, vitality, and locomotion. The observed effects may be related to social participation. These insights offer valuable guidance for crafting strategies aimed at fostering healthy aging within the middle-aged and older adult demographics. ",
doi="10.2196/54200",
url="https://www.jmir.org/2024/1/e54200"
}


@Article{info:doi/10.2196/59908,
author="Yang, Yanrong
and Tavares, Jorge
and Oliveira, Tiago",
title="A New Research Model for Artificial Intelligence--Based Well-Being Chatbot Engagement: Survey Study",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="11",
volume="11",
pages="e59908",
keywords="artificial intelligence--based chatbot",
keywords="AI-based chatbot",
keywords="mental well-being",
keywords="intention to engage",
keywords="engagement behavior",
keywords="theoretical models",
keywords="mobile phone",
abstract="Background: Artificial intelligence (AI)--based chatbots have emerged as potential tools to assist individuals in reducing anxiety and supporting well-being. Objective: This study aimed to identify the factors that impact individuals' intention to engage and their engagement behavior with AI-based well-being chatbots by using a novel research model to enhance service levels, thereby improving user experience and mental health intervention effectiveness. Methods: We conducted a web-based questionnaire survey of adult users of well-being chatbots in China via social media. Our survey collected demographic data, as well as a range of measures to assess relevant theoretical factors. Finally, 256 valid responses were obtained. The newly applied model was validated through the partial least squares structural equation modeling approach. Results: The model explained 62.8\% (R2) of the variance in intention to engage and 74\% (R2) of the variance in engagement behavior. Affect ($\beta$=.201; P=.002), social factors ($\beta$=.184; P=.007), and compatibility ($\beta$=.149; P=.03) were statistically significant for the intention to engage. Habit ($\beta$=.154; P=.01), trust ($\beta$=.253; P<.001), and intention to engage ($\beta$=.464; P<.001) were statistically significant for engagement behavior. Conclusions: The new extended model provides a theoretical basis for studying users' AI-based chatbot engagement behavior. This study highlights practical points for developers of AI-based well-being chatbots. It also highlights the importance of AI-based well-being chatbots to create an emotional connection with the users. ",
doi="10.2196/59908",
url="https://humanfactors.jmir.org/2024/1/e59908"
}


@Article{info:doi/10.2196/58641,
author="Leong, Ying Qiao
and Lee, Vien V.
and Ng, Ying Wei
and Vijayakumar, Smrithi
and Lau, Yin Ni
and Mauritzon, Ingela
and Blasiak, Agata
and Ho, Dean",
title="Older Adults' Perspectives and Experiences With Digital Health in Singapore: Qualitative Study",
journal="JMIR Hum Factors",
year="2024",
month="Nov",
day="11",
volume="11",
pages="e58641",
keywords="digital health",
keywords="gerontology",
keywords="geriatrics",
keywords="elder",
keywords="aging",
keywords="Singapore",
keywords="qualitative",
keywords="mHealth",
keywords="mobile health",
keywords="experience",
keywords="technology use",
keywords="interview",
keywords="perspective",
keywords="acceptance",
keywords="technology adoption",
abstract="Background: Technology use among older adults is increasingly common. Even though there is potential in leveraging technology to help them manage their health, only a small fraction of them use it for health-related purposes. Objective: This study seeks to understand the perspectives of and experiences with digital health (DH) among older adults in Singapore. Methods: A total of 16 participants (age range 60-80 years; n=11, 69\% female) were interviewed for approximately an hour (range 27-64 minutes) about their health, DH use, and DH experiences. The interviews were recorded, transcribed verbatim, and thematically analyzed. Results: Five main themes emerged from the interview: support in developing DH literacy, credibility, cost and benefit considerations, intrinsic drive to be healthy, and telehealth. Older adults need support in familiarizing themselves with DH. When considering DH options, older adults often relied on credible sources and preferred DH to be free. Monetary incentives were brought up as motivators. The intrinsic drive to live longer and healthily was expressed to be a huge encouragement to use DH to help obtain health-related knowledge and achieve healthy living goals. The idea of telehealth was also appealing among older adults but was seen to be more suited for individuals who have issues accessing a physical clinic. Conclusions: Our findings offer insights into the various aspects that matter to older adults in the adoption of DH, which in turn can help reshape their health-seeking behavior and lifestyle. As such, policy makers and DH implementors are encouraged to take these into consideration and align their strategies accordingly. ",
doi="10.2196/58641",
url="https://humanfactors.jmir.org/2024/1/e58641"
}


@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/10.2196/59158,
author="Straand, J. Ingjerd
and F{\o}lstad, Asbj{\o}rn
and W{\"u}nsche, C. Burkhard",
title="A Web-Based Intervention to Support a Growth Mindset and Well-Being in Unemployed Young Adults: Development Study",
journal="JMIR Form Res",
year="2024",
month="Nov",
day="8",
volume="8",
pages="e59158",
keywords="web-based intervention",
keywords="positive psychology",
keywords="mental health",
keywords="user experience",
keywords="persuasive design",
abstract="Background: Engaging young adults in the labor market is vital for economic growth and well-being. However, the path to employment often presents setbacks that impact motivation and psychological functioning. Research suggests exploring positive psychology interventions in job-seeking and scaling the delivery of these using technology. However, dropout rates are high for self-administered psychological interventions on digital platforms. This challenge needs to be addressed for such platforms to be effective conveyors of psychological interventions. This study addresses this challenge by exploring user-oriented methods and proposes persuasive features for the design and development of a new web-based intervention targeting young unemployed adults. Objective: This study aims to provide an overview of a new positive psychology wise intervention, including its theoretical underpinnings and human-centered design methodology, targeting young, unemployed adults. Methods: Researchers collaborated with designers, developers, and stakeholders to design a web-based positive psychology intervention that leverages evidence-based wise interventions. Key improvements and adaptations were explored through formative usability testing with 13 unemployed young adults aged between 18 and 25 years (the target population). Qualitative usability testing data were collected, analyzed, and integrated into the ongoing design process as iterative improvements. Results: The result of this study is a modular intervention web application named R{\O}ST, designed to align with the user needs and the preferences of the specific end-user group of unemployed young adults. During the project, this application evolved from early concept sketches and prototypes into a developed solution ready for further testing and use. Insights from both end-user feedback and rich user observation gained in the study were used to refine the content and the design. To increase targeted end users' motivation, persuasive design features including praise, rewards, and reminders were added. The web application was designed primarily to be used on mobile phones using text messaging for reminders. The development process included technical and data protection considerations. Conclusions: This study offers valuable insights into developing psychological or behavioral interventions to support unemployed young adults by documenting the design process and the adaptation and combination of diverse theoretical and empirical foundations. Involving stakeholders and end users in the development enabled relatable content development and resolved potential usability problems. An essential implication is the finding that end-user feedback and insights are crucial in shaping interventions. However, we experienced tensions between the evidence-based interventions and the human-centered design approaches. These tensions were not resolved and highlighted a need for ongoing user motivation support through monetary rewards, which were incorporated into the final web app design. ",
doi="10.2196/59158",
url="https://formative.jmir.org/2024/1/e59158"
}


@Article{info:doi/10.2196/59360,
author="Menschik, Christian
and Kunze, Christophe
and Renner, Gregor
and Etges, Theresa",
title="Mainstream Technologies in Facilities for People With Intellectual Disabilities: Multiple-Methods Study Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability Framework",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Nov",
day="5",
volume="11",
pages="e59360",
keywords="intellectual disabilities",
keywords="mainstream technology",
keywords="technology adoption",
keywords="technology implementation",
keywords="NASSS",
keywords="digital competencies",
keywords="facility for people with disabilities",
keywords="mobile phone",
abstract="Background: People with intellectual disabilities in residential or outpatient facilities for people with disabilities run the risk of being digitally excluded by not having opportunities for taking advantage of digitalization possibilities. Objective: We aimed to investigate how disability caregivers and managers describe barriers and facilitating factors to implement and adopt mainstream technology for people with intellectual disabilities in residential or outpatient facilities and how the competencies and capabilities of the caregivers are assessed in the process. Methods: For this reason, we conducted a multiple-methods study applying the nonadoption, abandonment, scale-up, spread, and sustainability framework. Results: As a result, we identified barriers and facilitators across the nonadoption, abandonment, scale-up, spread, and sustainability framework domains: (1) condition---people with intellectual disabilities are a diverse group, where the individual condition of the person and, for example, their communication skills were seen as a prerequisite for implementing mainstream technologies; (2) technology---the extent to which mainstream technology fits the individual needs and demands contributed to the implementation process; (3) value proposition---communication was seen as a life area where mainstream technology can add value; (4) adopters---the caregivers needed competencies and capabilities to accompany their care recipients' technology use; (5) organization---missing legal regulations and lack of personnel resources were described as barriers; (6) wider context---funding opportunities were seen as unclear in disability services as mainstream technologies could not be financed as participation benefits; (7) embedding and adaptation over time---the COVID-19 pandemic forced facilities to become digitalized to some extent. Conclusions: The disability services investigated were still in need of standardized procedures to promote the digital participation of their residents. ",
doi="10.2196/59360",
url="https://rehab.jmir.org/2024/1/e59360"
}


@Article{info:doi/10.2196/56923,
author="Cotter, M. Lynne
and Shah, Dhavan
and Brown, Kaitlyn
and Mares, Marie-Louise
and Landucci, Gina
and Saunders, Sydney
and Johnston, C. Darcie
and Pe-Romashko, Klaren
and Gustafson, David
and Maus, Adam
and Thompson, Kasey
and Gustafson, H. David",
title="Decoding the Influence of eHealth on Autonomy, Competence, and Relatedness in Older Adults: Qualitative Analysis of Self-Determination Through the Motivational Technology Model",
journal="JMIR Aging",
year="2024",
month="Oct",
day="30",
volume="7",
pages="e56923",
keywords="self-determination theory",
keywords="usability",
keywords="mobile technology model",
keywords="aging",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="smart displays",
keywords="video calls",
keywords="older adult",
keywords="chronic conditions",
keywords="mobile phone",
abstract="Background: Older adults adopt and use eHealth systems to build autonomy, competence, and relatedness and engage in healthy behaviors. The motivational technology model posits that technology features, such as those on websites, smart displays, and mobile phones, must allow for navigability, interactivity, and customizability, which spur feelings of self-determination and intrinsic motivation. We studied ElderTree, an online system for older adults that provides on-demand videos of healthy living content, self-monitoring, and weekly researcher-hosted video meetings. Objective: We aimed to understand the theoretical crossover between the motivational technology model and self-determination theory using features of ElderTree to understand the usability of the technology and how it may support older adults' autonomy, competence, and relatedness. Methods: Drawing participants from a randomized controlled trial of a mobile health app for older adults with multiple chronic conditions, we conducted qualitative interviews with 22 older adults about their use of the app; the interviews were coded using qualitative thematic analysis. Results: Older adults did find that features within ElderTree such as content available on demand, good navigation, and weekly researcher-led video calls supported feelings of autonomy, competence, and relatedness, respectively. Individual differences such as a background using computers also influenced participants' experiences with the smart displays. Conclusions: Participants confirmed the features that increased internal motivation, such as interactivity correlating with feelings of relatedness, but they also found other ways to support autonomous health behavior change beyond narrow views of navigability, interactivity, and customization. ",
doi="10.2196/56923",
url="https://aging.jmir.org/2024/1/e56923"
}


@Article{info:doi/10.2196/57393,
author="Premanandan, Shweta
and Ahmad, Awais
and Cajander, {\AA}sa
and {\AA}gerfalk, P{\"a}r
and van Gemert-Pijnen, Lisette",
title="Designing and Evaluating IT Applications for Informal Caregivers: Scoping Review",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="23",
volume="26",
pages="e57393",
keywords="burnout",
keywords="caregiver",
keywords="design guidelines",
keywords="design recommendations",
keywords="evaluation",
keywords="health care services",
keywords="implementation",
keywords="informal caregiver",
keywords="long-term care",
keywords="mobile app",
keywords="facilitators",
keywords="barriers",
keywords="usability",
keywords="work-life balance",
abstract="Background: Informal caregivers, often family members or friends, play a crucial role in supporting individuals with chronic illnesses, disabilities, or age-related needs. However, the demands of caregiving can be overwhelming, leading to stress, burnout, and negative impacts on caregivers' well-being. IT applications have emerged as potential solutions to support informal caregivers, but their design and evaluation often lack a comprehensive understanding of caregivers' needs and preferences. By understanding caregivers' perspectives on these issues, this review aimed to inform the development of more effective and user-centered IT solutions that truly support caregivers' needs. Objective: The purpose of this study was to conduct a scoping review to outline design recommendations for IT applications gathered from informal caregivers. In addition, this study presents evaluations of the use of IT applications by informal caregivers. Methods: A five-step scoping review methodology was used to map relevant literature in the following manner: (1) research question identification, (2) relevant study identification, (3) selection of pertinent studies for review, (4) data charting from the selected literature, and (5) summarization and reporting of results. A structured search was conducted across the PubMed, Scopus, IEEE Xplore Digital Library, Web of Science, and ACM Digital Library databases. In addition, reference list hand searches and keyword searches in Google Scholar were undertaken. The inclusion criteria comprised research articles (journal and conference) focusing on IT applications tailored for informal caregivers, primarily qualitative studies. Two reviewers independently identified articles for review and extracted the data. Conflicts were resolved through discussion, with a third reviewer consulted if consensus could not be attained. Thematic analysis was used to analyze the data. Results: A total of 82 articles were selected for the scoping review---44 (54\%) related to design and 39 (48\%) related to evaluation of IT applications. Six overarching themes emerged related to designing IT applications: information access, support systems, streamlining care-related tasks, fostering informal caregivers' well-being, communication with formal health care professionals, and task support. Furthermore, 3 broad themes emerged related to the evaluation of IT applications for informal caregivers: facilitators of using IT applications, barriers to using IT applications, and suggestions for improving IT applications for informal caregivers. Conclusions: To our knowledge, this is the first study to map the literature on the design and evaluation of IT applications for informal caregivers. This scoping review outlines current practices and recommendations for designing and evaluating the use of IT applications for informal caregivers. It identifies 6 key design themes and 3 evaluation themes, offering valuable insights for future development in this field. These findings provide a road map for enhancing user-centric IT solutions in informal caregiver support technologies. International Registered Report Identifier (IRRID): RR2-10.2196/47650 ",
doi="10.2196/57393",
url="https://www.jmir.org/2024/1/e57393"
}


@Article{info:doi/10.2196/54916,
author="Pack, P. Allison
and Bailey, C. Stacy
and O'Conor, Rachel
and Velazquez, Evelyn
and Wismer, Guisselle
and Yeh, Fangyu
and Curtis, M. Laura
and Alcantara, Kenya
and Wolf, S. Michael",
title="Phenotyping Adherence Through Technology-Enabled Reports and Navigation (the PATTERN Study): Qualitative Study for Intervention Adaptation Using the Exploration, Preparation, Implementation, and Sustainment Framework",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="17",
volume="8",
pages="e54916",
keywords="older adults",
keywords="polypharmacy",
keywords="medication adherence",
keywords="intervention development",
keywords="qualitative research",
abstract="Background: Older adults with multiple chronic conditions (MCC) and polypharmacy often face challenges with medication adherence. Nonadherence can lead to suboptimal treatment outcomes, adverse drug events, and poor quality of life. Objective: To facilitate medication adherence among older adults with MCC and polypharmacy in primary care, we are adapting a technology-enabled intervention previously implemented in a specialty clinic. The objective of this study was to obtain multilevel feedback to inform the adaptation of the proposed intervention (Phenotyping Adherence Through Technology-Enabled Reports and Navigation [PATTERN]). Methods: We conducted a formative qualitative study among patients, clinicians, and clinic administrators affiliated with a large academic health center in Chicago, Illinois. Patient eligibility included being aged 65 years or older, living with MCC, and contending with polypharmacy. Eligibility criteria for clinicians and administrators included being employed by any primary care clinic affiliated with the participating health center. Individual semistructured interviews were conducted remotely by a trained member of the study team using interview guides informed by the Exploration, Preparation, Implementation, and Sustainment Framework. Thematic analysis of interview audio recordings drew from the Rapid Identification of Themes from Audio Recordings procedures. Results: In total, we conducted 25 interviews, including 12 with clinicians and administrators, and 13 with patients. Thematic analysis revealed participants largely found the idea of technology-based medication adherence monitoring to be acceptable and appropriate for the target population in primary care, although several concerns were raised; we discuss these in detail. Conclusions: Our medication adherence monitoring intervention, adapted from specialty care, will be implemented in primary care. Formative interviews, informed by the Exploration, Preparation, Implementation, and Sustainment Framework and conducted among patients, clinicians, and administrators, have identified intervention adaptation needs. Results from this study could inform other interventions using the patient portal with older adults. ",
doi="10.2196/54916",
url="https://formative.jmir.org/2024/1/e54916",
url="http://www.ncbi.nlm.nih.gov/pubmed/39418094"
}


@Article{info:doi/10.2196/53705,
author="Sze, Ping Kai
and Fong, Wei Qi
and De Roza, Giovanna Jacqueline
and Lee, Sing Eng
and Tan, Yun Shu",
title="Exploring Physicians' Perceptions of Digital Health's Impact on the Patient-Physician Relationship in the Primary Health Care Setting: Qualitative Descriptive Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="15",
volume="26",
pages="e53705",
keywords="patient-physician relationship",
keywords="patient communication",
keywords="trust",
keywords="primary care medicine",
keywords="digital health",
keywords="primary care",
keywords="longitudinal care",
keywords="policy",
keywords="implementation",
abstract="Background: Digital health has become essential for effective clinical practice. However, the successful adoption of digital health is dependent on the strength of the patient-physician relationship. The patient-physician relationship shapes the quality of care and impacts health care outcomes, especially in primary care. However, the impact of the increasing use of digital health on the patient-physician relationship is uncertain. Objective: This study aims to explore the types of digital health primary care physicians use and understand their impact on the patient-physician relationship from their perspective. Methods: This exploratory qualitative descriptive study used individual in-depth interviews guided by a semistructured topic guide. We purposively sampled physicians from 6 general primary care clinics in Singapore and used thematic analysis to identify emergent themes. Results: We conducted 12 interviews. We found that primary care physicians in Singapore had minimal exposure to digital health beyond the scope of institutional implementation. The three key themes that emerged were as follows: (1) evolving roles of both physicians and patients; (2) impact on trust, knowledge acquisition, and longitudinal care; and (3) adoption and use factors of digital health impacting patient-physician relationships. The adoption and use factors comprised ``social and personal,'' ``technical and material,'' and ``organization and policy'' factors. Conclusions: The study identified that, while primary care physicians held mostly positive views on adopting digital health in improving the patient-physician relationship, they were concerned that digital health might erode trust, hinder proper knowledge acquisition, and reduce humanistic interaction. These concerns called for a nuanced approach to ensure that digital health would not compromise the patient-physician relationship. This could be achieved by ensuring that physicians possess the necessary skills, knowledge, and positive attitude, while health care organizations would provide robust IT capabilities and support. We recommend that education be refined and government policies on digital health adoption and use be revised to align with the goal of strengthening the patient-physician relationship. ",
doi="10.2196/53705",
url="https://www.jmir.org/2024/1/e53705"
}


@Article{info:doi/10.2196/60589,
author="Cross, Shane
and Bell, Imogen
and Nicholas, Jennifer
and Valentine, Lee
and Mangelsdorf, Shaminka
and Baker, Simon
and Titov, Nick
and Alvarez-Jimenez, Mario",
title="Use of AI in Mental Health Care: Community and Mental Health Professionals Survey",
journal="JMIR Ment Health",
year="2024",
month="Oct",
day="11",
volume="11",
pages="e60589",
keywords="mental health",
keywords="health care",
keywords="AI",
keywords="community members",
keywords="mental health professional",
keywords="web-based survey",
keywords="Australia",
keywords="descriptive statistic",
keywords="thematic analysis",
keywords="cost reduction",
keywords="data security",
keywords="digital health",
keywords="digital intervention",
keywords="artificial intelligence",
abstract="Background: Artificial intelligence (AI) has been increasingly recognized as a potential solution to address mental health service challenges by automating tasks and providing new forms of support. Objective: This study is the first in a series which aims to estimate the current rates of AI technology use as well as perceived benefits, harms, and risks experienced by community members (CMs) and mental health professionals (MHPs). Methods: This study involved 2 web-based surveys conducted in Australia. The surveys collected data on demographics, technology comfort, attitudes toward AI, specific AI use cases, and experiences of benefits and harms from AI use. Descriptive statistics were calculated, and thematic analysis of open-ended responses were conducted. Results: The final sample consisted of 107 CMs and 86 MHPs. General attitudes toward AI varied, with CMs reporting neutral and MHPs reporting more positive attitudes. Regarding AI usage, 28\% (30/108) of CMs used AI, primarily for quick support (18/30, 60\%) and as a personal therapist (14/30, 47\%). Among MHPs, 43\% (37/86) used AI; mostly for research (24/37, 65\%) and report writing (20/37, 54\%). While the majority found AI to be generally beneficial (23/30, 77\% of CMs and 34/37, 92\% of MHPs), specific harms and concerns were experienced by 47\% (14/30) of CMs and 51\% (19/37) of MHPs. There was an equal mix of positive and negative sentiment toward the future of AI in mental health care in open feedback. Conclusions: Commercial AI tools are increasingly being used by CMs and MHPs. Respondents believe AI will offer future advantages for mental health care in terms of accessibility, cost reduction, personalization, and work efficiency. However, they were equally concerned about reducing human connection, ethics, privacy and regulation, medical errors, potential for misuse, and data security. Despite the immense potential, integration into mental health systems must be approached with caution, addressing legal and ethical concerns while developing safeguards to mitigate potential harms. Future surveys are planned to track use and acceptability of AI and associated issues over time. ",
doi="10.2196/60589",
url="https://mental.jmir.org/2024/1/e60589"
}


@Article{info:doi/10.2196/52639,
author="Hesso, Iman
and Zacharias, Lithin
and Kayyali, Reem
and Charalambous, Andreas
and Lavdaniti, Maria
and Stalika, Evangelia
and Ajami, Tarek
and Acampa, Wanda
and Boban, Jasmina
and Nabhani-Gebara, Shereen",
title="Artificial Intelligence for Optimizing Cancer Imaging: User Experience Study",
journal="JMIR Cancer",
year="2024",
month="Oct",
day="10",
volume="10",
pages="e52639",
keywords="artificial intelligence",
keywords="cancer",
keywords="cancer imaging",
keywords="UX design workshops",
keywords="Delphi method",
keywords="INCISIVE AI toolbox",
keywords="user experience",
abstract="Background: The need for increased clinical efficacy and efficiency has been the main force in developing artificial intelligence (AI) tools in medical imaging. The INCISIVE project is a European Union--funded initiative aiming to revolutionize cancer imaging methods using AI technology. It seeks to address limitations in imaging techniques by developing an AI-based toolbox that improves accuracy, specificity, sensitivity, interpretability, and cost-effectiveness. Objective: To ensure the successful implementation of the INCISIVE AI service, a study was conducted to understand the needs, challenges, and expectations of health care professionals (HCPs) regarding the proposed toolbox and any potential implementation barriers. Methods: A mixed methods study consisting of 2 phases was conducted. Phase 1 involved user experience (UX) design workshops with users of the INCISIVE AI toolbox. Phase 2 involved a Delphi study conducted through a series of sequential questionnaires. To recruit, a purposive sampling strategy based on the project's consortium network was used. In total, 16 HCPs from Serbia, Italy, Greece, Cyprus, Spain, and the United Kingdom participated in the UX design workshops and 12 completed the Delphi study. Descriptive statistics were performed using SPSS (IBM Corp), enabling the calculation of mean rank scores of the Delphi study's lists. The qualitative data collected via the UX design workshops was analyzed using NVivo (version 12; Lumivero) software. Results: The workshops facilitated brainstorming and identification of the INCISIVE AI toolbox's desired features and implementation barriers. Subsequently, the Delphi study was instrumental in ranking these features, showing a strong consensus among HCPs (W=0.741, P<.001). Additionally, this study also identified implementation barriers, revealing a strong consensus among HCPs (W=0.705, P<.001). Key findings indicated that the INCISIVE AI toolbox could assist in areas such as misdiagnosis, overdiagnosis, delays in diagnosis, detection of minor lesions, decision-making in disagreement, treatment allocation, disease prognosis, prediction, treatment response prediction, and care integration throughout the patient journey. Limited resources, lack of organizational and managerial support, and data entry variability were some of the identified barriers. HCPs also had an explicit interest in AI explainability, desiring feature relevance explanations or a combination of feature relevance and visual explanations within the toolbox. Conclusions: The results provide a thorough examination of the INCISIVE AI toolbox's design elements as required by the end users and potential barriers to its implementation, thus guiding the design and implementation of the INCISIVE technology. The outcome offers information about the degree of AI explainability required of the INCISIVE AI toolbox across the three services: (1) initial diagnosis; (2) disease staging, differentiation, and characterization; and (3) treatment and follow-up indicated for the toolbox. By considering the perspective of end users, INCISIVE aims to develop a solution that effectively meets their needs and drives adoption. ",
doi="10.2196/52639",
url="https://cancer.jmir.org/2024/1/e52639"
}


@Article{info:doi/10.2196/53146,
author="Hong, Minji
and Rajaguru, Vasuki
and Kim, KyungYi
and Jang, Suk-Yong
and Lee, Gyu Sang",
title="Menstrual Cycle Management and Period Tracker App Use in Millennial and Generation Z Individuals: Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="10",
volume="26",
pages="e53146",
keywords="menstruation",
keywords="dysmenorrhea",
keywords="period tracker app, menstrual cycle management, health care application, millennial",
keywords="Gen Z",
keywords="mobile phone",
abstract="Background: Menstruation is a physical symptom that occurs in women of reproductive age. It has a significant impact on the daily life and health of women when their academic and social activities are most active. Since many women experience difficulties in daily life because of premenstrual syndrome and dysmenorrhea, it is important to identify, prepare for, and manage the menstrual cycle in advance. Objective: This study aimed to investigate the relationship between menstruation-related experiences and the use of mobile-based period tracker apps by millennial and generation Z (gen Z) individuals. The objectives of this study are to investigate (1) menstrual cycle management, (2) factors affecting app usage (3) factors affecting cycle management, and (4) motivators and barriers to using period tracker apps, in millennial and gen Z women. Methods: A mixed methods design was used for this study. The participants were young women aged 20-39 years and recruited via the Ovey application. Data were collected through surveys and focus group interviews. The survey was conducted among 700 women, and 8 of them participated in the focus group interviews. Results: In total, 431 (62.3\%) participants used period tracker apps primarily to predict their next menstrual cycle. Factors affecting app usage included childbirth experience (odds ratio [OR] 0.475, P<.05), number of dysmenorrhea symptoms (OR 1.136, P<.05), and cycle management level (OR 2.279, P<.001). Additionally, education level (OR 1.122, P<.05 [university level compared high school level]) and the number of dysmenorrhea symptoms (OR 1.024, P<.05) showed a positive association with the cycle management level. However, childbirth experience (OR 0.902, P<.05) and period irregularity (OR 0.929, P<.001) were negatively associated with the cycle management level. Conclusions: Period tracker apps are becoming the new normal among millennials and gen Z individuals for managing their menstrual cycles. The use of a period tracker app empowers women by helping them gain a better understanding of their bodies, ultimately enhancing their social, academic, and health-related lives. Improving the accuracy and literacy of the app is an ongoing task for period-tracking apps, and it is important to provide added value tailored to users' needs. Therefore, the findings of this study should be considered when designing or upgrading period tracker apps to facilitate the adoption of digital technology among young women, thereby promoting their overall well-being and reproductive health. ",
doi="10.2196/53146",
url="https://www.jmir.org/2024/1/e53146"
}


@Article{info:doi/10.2196/54736,
author="Pani, Jasmine
and Lorusso, Letizia
and Toccafondi, Lara
and D'Onofrio, Grazia
and Ciccone, Filomena
and Russo, Sergio
and Giuliani, Francesco
and Sancarlo, Daniele
and Calamida, Novella
and Vignani, Gianna
and Pihl, Tarmo
and Rovini, Erika
and Cavallo, Filippo
and Fiorini, Laura",
title="How Time, Living Situation, and Stress Related to Technology Influence User Acceptance and Usability of a Socialization Service for Older Adults and Their Formal and Informal Caregivers: Six-Month Pilot Study",
journal="JMIR Aging",
year="2024",
month="Oct",
day="9",
volume="7",
pages="e54736",
keywords="active aging",
keywords="longitudinal study",
keywords="technostress",
keywords="technology usability and acceptance",
keywords="scaling up",
abstract="Background: Considering the growing population of older adults, addressing the influence of loneliness among this demographic group has become imperative, especially due to the link between social isolation and deterioration of mental and physical well-being. Technology has the potential to be used to create innovative solutions to increase socialization and potentially promote healthy aging. Objective: This 6-month study examined the usability and acceptability of a technology-based socialization service and explored how stress and living situation affect older adults' and their ecosystem's perceptions of technology, investigating cross-sectional and longitudinal differences among and across user groups. Methods: Participants were recruited in Tuscany and Apulia (Italy) through a network of social cooperatives and a research hospital, respectively. A total of 20 older adults were provided with the same technology installed on a tablet and on a smart television. The technology has three functionalities: video calling, playing games, and sharing news. Additionally, 20 informal caregivers (IC) and 13 formal caregivers (FC) connected to the older adults were included in the study. After both initial training in the use of the system (T0) and 6 months of using the system (T6), questionnaires on usability, acceptability, and technostress were filled in by older adults, IC, and FC. Nonparametric or parametric tests were conducted to investigate group differences at both time points and changes over time. Additional analyses on older adults were done to assess whether differences in usability and acceptability were related to living situation (ie, alone or with someone). Furthermore, correlation analyses were performed between usability, acceptability, and stress toward technology at T0 and T6. Results: At both T0 and T6, older adults had lower usability scores than IC and FC and higher anxiety than IC. Over time, there was a significant decrease in older adults' attitudes toward technology score, depicting a negative attitude over time (T0 median 4.2, IQR 0.5; T6 median 3.7, IQR 0.8; Cohen d=0.7), while there was no change for IC and FC. At T0, those living alone had lower acceptability than those living with someone but this difference disappeared at T6. People or participants living with someone had a decline in anxiety, attitudes toward technology, enjoyment, and perceived usefulness. Stress toward technology affected usability and acceptability in the older adult group entering the study ($\rho$=?.85) but this was not observed after 6 months. In the IC group, stress affected trust at T0 ($\rho$=?.23) but not at T6. Conclusions: At the start of the study, older adults judged the system to be less usable and more stressful than did the caregivers. Indeed, at first, technostress was correlated with usability and acceptability; however, with repeated use, technostress did not influence the perception of technology. Overall, getting accustomed to technology decreased anxiety and stress toward technology. ",
doi="10.2196/54736",
url="https://aging.jmir.org/2024/1/e54736"
}


@Article{info:doi/10.2196/53557,
author="Ditmore, H. Melissa
and Florez-Arango, Fernando Jose",
title="User-Centered Design for Designing and Evaluating a Prototype of a Data Collection Tool to Submit Information About Incidents of Violence Against Sex Workers: Multiple Methods Approach",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="9",
volume="11",
pages="e53557",
keywords="mobile health",
keywords="sex worker",
keywords="user-centered design methods",
keywords="usability",
keywords="heuristic analysis",
keywords="cognitive walkthrough",
keywords="aggression",
keywords="abuse",
keywords="occupational health",
keywords="reporting",
keywords="prototype",
keywords="heuristics",
keywords="human-centered design",
keywords="implementation",
keywords="barriers",
keywords="enablers",
keywords="data collection",
keywords="digital health",
keywords="underreporting",
abstract="Background: Sex workers face an epidemic of violence in the United States. However, violence against sex workers in the United States is underreported. Sex workers hesitate to report it to the police because they are frequently punished themselves; therefore, an alternative for reporting is needed. Objective: We aim to apply human-centered design methods to create and evaluate the usability of the prototype interface for ReportVASW (violence against sex worker, VASW) and identify opportunities for improvement. Methods: This study explores ways to improve the prototype of ReportVASW, with particular attention to ways to improve the data collection tool. Evaluation methods included cognitive walkthrough, system usability scale, and heuristic evaluation. Results: End users were enthusiastic about the idea of a website to document violence against sex workers. ReportVASW scored 90 on the system usability scale. The tool scored neutral on consistency, and all other responses were positive toward the app, with most being strong. Conclusions: Many opportunities to improve the interface were identified. Multiple methods identified multiple issues to address. Most changes are not overly complex, and the majority were aesthetic or minor. Further development of the ReportVASW data collection tool is worth pursuing. ",
doi="10.2196/53557",
url="https://humanfactors.jmir.org/2024/1/e53557"
}


@Article{info:doi/10.2196/63222,
author="Wegener, Kauffeldt Emilie
and M Bergsch{\"o}ld, Jenny
and Kramer, Tina
and Schmidt, Wong Camilla
and Borgnakke, Karen",
title="Co-Designing a Conversational Agent With Older Adults With Chronic Obstructive Pulmonary Disease Who Age in Place: Qualitative Study",
journal="JMIR Hum Factors",
year="2024",
month="Oct",
day="8",
volume="11",
pages="e63222",
keywords="eHealth",
keywords="aging in place",
keywords="digital health technology",
keywords="health literacy",
keywords="everyday life",
keywords="co-design",
keywords="co-designing",
keywords="conversational agent",
keywords="older adults",
keywords="elderly",
keywords="COPD",
keywords="thematic analysis",
keywords="design",
keywords="development",
keywords="interview data",
keywords="cocreation",
keywords="chronic obstructive pulmonary disease",
keywords="mobile phone",
abstract="Background: As a reaction to the global demographic increase in older adults (aged 60+ years), policy makers call for initiatives to enable healthy aging. This includes a focus on person-centered care and access to long-term care for older adults, such as developing different services and digital health technologies. This can enable patients to engage in their health and reduce the burden on the health care systems and health care professionals. The European Union project Smart Inclusive Living Environments (SMILE) focuses on well-being and aging in place using new digital health technologies. The novelty of the SMILE project is the use of a cocreational approach focused on the needs and preferences of older adults with chronic obstructive pulmonary disease (COPD) in technology development, to enhance access, adaptation, and usability and to reduce stigma. Objective: The study aimed to describe the perspective, needs, and preferences of older adults living with COPD in the context of the design and development of a conversational agent. Methods: This study carried out a data-driven thematic analysis of interview data from 11 cocreation workshops with 33 older adults living with COPD. Results: The three particular features that the workshop participants wanted to implement in a new technology were (1) a ``my health'' function, to use technology to manage and learn more about their condition; (2) a ``daily activities'' function, including an overview and information about social and physical activities in their local area; and (3) a ``sleep'' function, to manage circadian rhythm and enhance sleep quality, for example, through online video guides. In total, 2 overarching themes were identified for the 3 functions: measurements, which were actively discussed and received mixed interest among the participants, and health literacy, due to an overall interest in learning more about their condition in relation to everyday life. Conclusions: The future design of digital health technology must embrace the complexities of the everyday life of an older adult living with COPD and cater to their needs and preferences. Measurements should be optional and personalized, and digital solutions should be used as a supplement to health care professionals, not as substitute. ",
doi="10.2196/63222",
url="https://humanfactors.jmir.org/2024/1/e63222",
url="http://www.ncbi.nlm.nih.gov/pubmed/39378067"
}


@Article{info:doi/10.2196/56872,
author="Stein, Alexandra
and Blasini, Romina
and Strantz, Cosima
and Fitzer, Kai
and Gulden, Christian
and Leddig, Torsten
and Hoffmann, Wolfgang",
title="User Requirements for an Electronic Patient Recruitment System: Semistructured Interview Analysis After First Implementation in 3 German University Hospitals",
journal="JMIR Hum Factors",
year="2024",
month="Sep",
day="27",
volume="11",
pages="e56872",
keywords="patient recruitment system",
keywords="clinical trial recruitment support system",
keywords="clinical trials",
keywords="recruit",
keywords="recruitment",
keywords="recruiting",
keywords="participant",
keywords="participants",
keywords="research",
keywords="digital health",
keywords="usability",
keywords="interview",
keywords="interviews",
keywords="qualitative",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="database",
keywords="databases",
keywords="information system",
keywords="information systems",
keywords="search",
keywords="searches",
keywords="searching",
keywords="retrieval",
abstract="Background: Clinical trials are essential for medical research and medical progress. Nevertheless, trials often fail to reach their recruitment goals. Patient recruitment systems aim to support clinical trials by providing an automated search for eligible patients in the databases of health care institutions like university hospitals. To integrate patient recruitment systems into existing workflows, previous works have assessed user requirements for these tools. In this study, we tested patient recruitment systems KAS+ and recruIT as part of the MIRACUM (Medical Informatics in Research and Care in University Medicine) project. Objective: Our goal was to investigate whether and to what extent the 2 different evaluated tools can meet the requirements resulting from the first requirements analysis, which was performed in 2018-2019. A user survey was conducted to determine whether the tools are usable in practice and helpful for the trial staff. Furthermore, we investigated whether the test phase revealed further requirements for recruitment tools that were not considered in the first place. Methods: We performed semistructured interviews with 10 participants in 3 German university hospitals who used the patient recruitment tools KAS+ or recruIT for at least 1 month with currently recruiting trials. Thereafter, the interviews were transcribed and analyzed by Meyring method. The identified statements of the interviewees were categorized into 5 groups of requirements and sorted by their frequency. Results: The evaluated recruIT and KAS+ tools fulfilled 7 and 11 requirements of the 12 previously identified requirements, respectively. The interviewed participants mentioned the need for different notification schedules, integration into their workflow, different patient characteristics, and pseudonymized screening lists. This resulted in a list of new requirements for the implementation or enhancement of patient recruitment systems. Conclusions: Trial staff report a huge need of support for the identification of eligible trial participants. Moreover, the workflows in patient recruitment differ across trials. For better suitability of the recruitment systems in the workflow of different kinds of trials, we recommend the implementation of an adjustable notification schedule for screening lists, a detailed workflow analysis, broad patient filtering options, and the display of all information needed to identify the persons on the list. Despite criticisms, all participants confirmed to use the patient recruitment systems again. ",
doi="10.2196/56872",
url="https://humanfactors.jmir.org/2024/1/e56872"
}


@Article{info:doi/10.2196/45826,
author="Oluokun, Oluwatosin Emmanuel
and Adedoyin, Fatai Festus
and Dogan, Huseyin
and Jiang, Nan",
title="Co-Designing Digital Health Intervention for Monitoring Medication and Consultation Among Transgender People in Underserved Communities: Collaborative Approach",
journal="JMIR Hum Factors",
year="2024",
month="Sep",
day="12",
volume="11",
pages="e45826",
keywords="digital health",
keywords="HIV/AIDS medication",
keywords="data-driven health care",
keywords="ART",
keywords="transgender",
keywords="LGTBQI+",
keywords="interactive management",
abstract="Background: In many parts of the world, men who have sex with men and transgender individuals face criminalization and discrimination. As a result, they are less likely to seek medical help, despite experiencing higher rates of HIV/AIDS, mental health issues, and other health problems. Reaching key populations (KPs) with essential testing, care, and treatment services can be challenging, as they often have a higher likelihood of contracting and spreading the virus. They have limited access to antiretroviral (ARV) therapy (ART) services, which means that KPs may continue to serve as reservoirs for new HIV infections if they do not receive effective HIV programming. This ongoing issue complicates efforts to control the epidemic. Therefore, modeling a digital health system to track ARV medication access and use is crucial. This paper advocates for the use of digital interventions to manage the health of KPs in underserved regions, using Nigeria as a case study. Objective: This study aims to assess digital health interventions for monitoring medication and consultations among transgender people in underserved communities. It also sought to determine whether a system exists that could support ART adherence in Nigeria. Additionally, the study evaluated design strategies to address privacy and confidentiality concerns, aiming to reduce nonadherence to ARV medications among KPs in Nigeria. Methods: A qualitative approach was adopted for this research, involving a thematic analysis of information collected from interviews with clinicians and other health practitioners who work directly with these communities, as well as from an interactive (virtual) workshop. Results: The findings from the thematic analysis indicate a need to increase attendance at ART therapy sessions through the implementation of an intensive care web app. Unlike previous solutions, this study highlights the importance of incorporating a reminder feature that integrates with an in-app telemedicine consultancy platform. This platform would facilitate discussions about client challenges, such as adverse drug effects, counseling sessions with clinical psychologists, and the impact of identity discrimination on mental health. Other data-driven health needs identified in the study are unique drug request nodes, client-led viral load calculators, remote requests, and drug delivery features within the web app. Participants also emphasized the importance of monitoring medication compliance and incorporating user feedback mechanisms, such as ratings and encouragement symbols (eg, stars, checkmarks), to motivate adherence. Conclusions: The study concludes that technology-driven solutions could enhance ART adherence and reduce HIV transmission among transgender people. It also recommends that local governments and international organizations collaborate and invest in health management services that prioritize health needs over identity. ",
doi="10.2196/45826",
url="https://humanfactors.jmir.org/2024/1/e45826"
}


@Article{info:doi/10.2196/51525,
author="Fareed, Naleef
and Olvera, G. Ramona
and Wang, Yiting
and Hayes, Michael
and Larimore, Liz Elizabeth
and Balvanz, Peter
and Langley, Ronald
and Noel, A. Corinna
and Rock, Peter
and Redmond, Daniel
and Neufeld, Jessica
and Kosakowski, Sarah
and Harris, Daniel
and LaRochelle, Marc
and Huerta, R. Timothy
and Glasgow, LaShawn
and Oga, Emmanuel
and Villani, Jennifer
and Wu, Elwin",
title="Lessons Learned From Developing Dashboards to Support Decision-Making for Community Opioid Response by Community Stakeholders: Mixed Methods and Multisite Study",
journal="JMIR Hum Factors",
year="2024",
month="Sep",
day="9",
volume="11",
pages="e51525",
keywords="data visualizations",
keywords="dashboards",
keywords="public health",
keywords="overdose epidemic",
keywords="human-centered design",
abstract="Background: Data dashboards are published tools that present visualizations; they are increasingly used to display data about behavioral health, social determinants of health, and chronic and infectious disease risks to inform or support public health endeavors. Dashboards can be an evidence-based approach used by communities to influence decision-making in health care for specific populations. Despite widespread use, evidence on how to best design and use dashboards in the public health realm is limited. There is also a notable dearth of studies that examine and document the complexity and heterogeneity of dashboards in community settings. Objective: Community stakeholders engaged in the community response to the opioid overdose crisis could benefit from the use of data dashboards for decision-making. As part of the Communities That HEAL (CTH) intervention, community data dashboards were created for stakeholders to support decision-making. We assessed stakeholders' perceptions of the usability and use of the CTH dashboards for decision-making. Methods: We conducted a mixed methods assessment between June and July 2021 on the use of CTH dashboards. We administered the System Usability Scale (SUS) and conducted semistructured group interviews with users in 33 communities across 4 states of the United States. The SUS comprises 10 five-point Likert-scale questions measuring usability, each scored from 0 to 4. The interview guides were informed by the technology adoption model (TAM) and focused on perceived usefulness, perceived ease of use, intention to use, and contextual factors. Results: Overall, 62 users of the CTH dashboards completed the SUS and interviews. SUS scores (grand mean 73, SD 4.6) indicated that CTH dashboards were within the acceptable range for usability. From the qualitative interview data, we inductively created subthemes within the 4 dimensions of the TAM to contextualize stakeholders' perceptions of the dashboard's usefulness and ease of use, their intention to use, and contextual factors. These data also highlighted gaps in knowledge, design, and use, which could help focus efforts to improve the use and comprehension of dashboards by stakeholders. Conclusions: We present a set of prioritized gaps identified by our national group and list a set of lessons learned for improved data dashboard design and use for community stakeholders. Findings from our novel application of both the SUS and TAM provide insights and highlight important gaps and lessons learned to inform the design of data dashboards for use by decision-making community stakeholders. Trial Registration: ClinicalTrials.gov NCT04111939; https://clinicaltrials.gov/study/NCT04111939 ",
doi="10.2196/51525",
url="https://humanfactors.jmir.org/2024/1/e51525",
url="http://www.ncbi.nlm.nih.gov/pubmed/39250216"
}


@Article{info:doi/10.2196/60773,
author="He, Yunfan
and Chen, Han
and Xiang, Peng
and Zhao, Min
and Li, Yingjun
and Liu, Yongcheng
and Wang, Tong
and Liang, Jun
and Lei, Jianbo",
title="Establishing an Evaluation Indicator System for User Satisfaction With Hypertension Management Apps: Combining User-Generated Content and Analytic Hierarchy Process",
journal="J Med Internet Res",
year="2024",
month="Sep",
day="3",
volume="26",
pages="e60773",
keywords="hypertension management",
keywords="mobile health",
keywords="user satisfaction",
keywords="evaluation indicator system",
keywords="analytic hierarchy process",
abstract="Background: Hypertension management apps (HMAs) can be effective in controlling blood pressure, but their actual impact is often suboptimal. Establishing a user satisfaction evaluation indicator system for HMAs can assist app developers in enhancing app design and functionality, while also helping users identify apps that best meet their needs. This approach aims to improve the overall effectiveness of app usage. Objective: This study aims to systematically collect data on HMAs and their user reviews in the United States and China. It analyzes app usage patterns and functional characteristics, identifies factors influencing user satisfaction from existing research, and develops a satisfaction evaluation indicator system to provide more accurate recommendations for improving user satisfaction. Methods: We conducted a descriptive statistical analysis to assess the development status of HMAs in both countries and applied the task-technology fit model to evaluate whether the app functionalities align with business needs. We separately summarized the factors influencing user satisfaction in both countries from previous research, utilized the analytic hierarchy process to develop an evaluation indicator system for HMA user satisfaction, and calculated satisfaction levels. Based on these findings, we propose improvements to enhance app functionality and user satisfaction. Results: In terms of current development status, there were fewer HMAs and user reviews in China compared with the United States. Regarding app functional availability, fewer than 5\% (4/91) of the apps achieved a demand fulfillment rate exceeding 80\% (8/10). Overall, user satisfaction in both countries was low. Conclusions: In the United States, user satisfaction was lowest for advertising distribution, data synchronization, and reliability. By contrast, Chinese apps need improvements in cost efficiency and compatibility. ",
doi="10.2196/60773",
url="https://www.jmir.org/2024/1/e60773",
url="http://www.ncbi.nlm.nih.gov/pubmed/39226103"
}


@Article{info:doi/10.2196/57172,
author="Reinders, Patrick
and Augustin, Matthias
and Fleyder, Anastasia
and Otten, Marina",
title="Exploring Acceptability, Barriers, and Facilitators for Digital Health in Dermatology: Qualitative Focus Groups With Dermatologists, Nurses, and Patients",
journal="JMIR Dermatol",
year="2024",
month="Sep",
day="3",
volume="7",
pages="e57172",
keywords="digitalization",
keywords="digital health interventions",
keywords="UTAUT",
keywords="unified theory of acceptance and use of technology",
keywords="barriers and facilitators",
keywords="dermatology",
keywords="qualitative research",
keywords="focus groups",
keywords="mobile phone",
abstract="Background: Although several digital health interventions (DHIs) have shown promise in the care of skin diseases their uptake in Germany has been limited. To fully understand the reasons for the low uptake, an in-depth analysis of patients' and health care providers' barriers and facilitators in dermatology is needed. Objective: The objective of this study was to explore and compare attitudes, acceptability, barriers, and facilitators of patients, dermatologists, and nurses toward DHIs in dermatology. Methods: We conducted 6 web-based focus groups each with patients (n=34), dermatologists (n=30), and nurses (n=30) using a semistructured interview guide with short descriptions of DHIs described in the literature. A content analysis was performed using deductive constructs, following the unified theory of acceptance and use of technology framework, and inductive categories. Results: Patients identified many positive performance expectancies, such as reduced travel times and improvement in follow-up appointments. Dermatologists also stated positive effects (eg, promotion of standardized care), but also negative implications of health care digitalization (eg, increased workload). All stakeholders reported that a DHI should bring additional value to all stakeholders. A lack of digital competence among patients was identified as the major barrier to adoption by all 3 groups. Nurses and dermatologists want apps that are easy to use and easy to implement into their daily routines. Trust in selected institutions, colleagues, and physicians was identified as a facilitator. Patients reported their dependence on the dermatologists' acceptance. All groups expressed concerns about data privacy risks and dermatologists stated insecurities toward data privacy laws. Conclusions: To ensure successful digitalization in dermatology, apps should be user-friendly, adapted to users' skill levels, and beneficial for all stakeholders. The incorporation of dermatologists' perspectives is especially important as their acceptance may impact use among patients and nurses. DHIs should ensure and be transparent about data privacy. The found barriers and facilitators can be used for implementation strategies. ",
doi="10.2196/57172",
url="https://derma.jmir.org/2024/1/e57172",
url="http://www.ncbi.nlm.nih.gov/pubmed/39226097"
}


@Article{info:doi/10.2196/48584,
author="Nare, Matthew
and Jurewicz, Katherina",
title="Assessing Patient Trust in Automation in Health Care Systems: Within-Subjects Experimental Study",
journal="JMIR Hum Factors",
year="2024",
month="Aug",
day="6",
volume="11",
pages="e48584",
keywords="automation",
keywords="emergency department",
keywords="trust",
keywords="health care",
keywords="artificial intelligence",
keywords="emergency",
keywords="perceptions",
keywords="attitude",
keywords="opinions",
keywords="belief",
keywords="automated",
keywords="trust ratings",
abstract="Background: Health care technology has the ability to change patient outcomes for the betterment when designed appropriately. Automation is becoming smarter and is increasingly being integrated into health care work systems. Objective: This study focuses on investigating trust between patients and an automated cardiac risk assessment tool (CRAT) in a simulated emergency department setting. Methods: A within-subjects experimental study was performed to investigate differences in automation modes for the CRAT: (1) no automation, (2) automation only, and (3) semiautomation. Participants were asked to enter their simulated symptoms for each scenario into the CRAT as instructed by the experimenter, and they would automatically be classified as high, medium, or low risk depending on the symptoms entered. Participants were asked to provide their trust ratings for each combination of risk classification and automation mode on a scale of 1 to 10 (1=absolutely no trust and 10=complete trust). Results: Results from this study indicate that the participants significantly trusted the semiautomation condition more compared to the automation-only condition (P=.002), and they trusted the no automation condition significantly more than the automation-only condition (P=.03). Additionally, participants significantly trusted the CRAT more in the high-severity scenario compared to the medium-severity scenario (P=.004). Conclusions: The findings from this study emphasize the importance of the human component of automation when designing automated technology in health care systems. Automation and artificially intelligent systems are becoming more prevalent in health care systems, and this work emphasizes the need to consider the human element when designing automation into care delivery. ",
doi="10.2196/48584",
url="https://humanfactors.jmir.org/2024/1/e48584",
url="http://www.ncbi.nlm.nih.gov/pubmed/39106096"
}


@Article{info:doi/10.2196/53134,
author="He, Linwei
and Basar, Erkan
and Krahmer, Emiel
and Wiers, Reinout
and Antheunis, Marjolijn",
title="Effectiveness and User Experience of a Smoking Cessation Chatbot: Mixed Methods Study Comparing Motivational Interviewing and Confrontational Counseling",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="6",
volume="26",
pages="e53134",
keywords="chatbot",
keywords="smoking cessation",
keywords="counseling",
keywords="motivational interviewing",
keywords="confrontational counseling",
keywords="user experience",
keywords="engagement",
abstract="Background: Cigarette smoking poses a major public health risk. Chatbots may serve as an accessible and useful tool to promote cessation due to their high accessibility and potential in facilitating long-term personalized interactions. To increase effectiveness and acceptability, there remains a need to identify and evaluate counseling strategies for these chatbots, an aspect that has not been comprehensively addressed in previous research. Objective: This study aims to identify effective counseling strategies for such chatbots to support smoking cessation. In addition, we sought to gain insights into smokers' expectations of and experiences with the chatbot. Methods: This mixed methods study incorporated a web-based experiment and semistructured interviews. Smokers (N=229) interacted with either a motivational interviewing (MI)--style (n=112, 48.9\%) or a confrontational counseling--style (n=117, 51.1\%) chatbot. Both cessation-related (ie, intention to quit and self-efficacy) and user experience--related outcomes (ie, engagement, therapeutic alliance, perceived empathy, and interaction satisfaction) were assessed. Semistructured interviews were conducted with 16 participants, 8 (50\%) from each condition, and data were analyzed using thematic analysis. Results: Results from a multivariate ANOVA showed that participants had a significantly higher overall rating for the MI (vs confrontational counseling) chatbot. Follow-up discriminant analysis revealed that the better perception of the MI chatbot was mostly explained by the user experience--related outcomes, with cessation-related outcomes playing a lesser role. Exploratory analyses indicated that smokers in both conditions reported increased intention to quit and self-efficacy after the chatbot interaction. Interview findings illustrated several constructs (eg, affective attitude and engagement) explaining people's previous expectations and timely and retrospective experience with the chatbot. Conclusions: The results confirmed that chatbots are a promising tool in motivating smoking cessation and the use of MI can improve user experience. We did not find extra support for MI to motivate cessation and have discussed possible reasons. Smokers expressed both relational and instrumental needs in the quitting process. Implications for future research and practice are discussed. ",
doi="10.2196/53134",
url="https://www.jmir.org/2024/1/e53134",
url="http://www.ncbi.nlm.nih.gov/pubmed/39106097"
}


@Article{info:doi/10.2196/56275,
author="Palmeirim, S. Marta
and Houngbedji, A. Clarisse
and Barth-Jaeggi, Tanja
and Kouam{\'e}, Y. Jean-Pierre
and Krouman, Aboubakar
and Coulibaly, Daouda
and Wyss, Kaspar",
title="Key Characteristics and Perception of Different Outbreak Surveillance Systems in C{\^o}te d'Ivoire: Cross-Sectional Survey Among Users",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="30",
volume="10",
pages="e56275",
keywords="outbreak surveillance system",
keywords="COVID-19",
keywords="C{\^o}te d'Ivoire",
keywords="SORMAS",
keywords="MAGPI",
keywords="DHIS2",
keywords="outbreak surveillance",
keywords="key characteristics",
keywords="users' perception",
keywords="infectious disease",
keywords="infectious diseases",
keywords="public health",
keywords="disease surveillance",
keywords="policy decision",
keywords="cross-sectional study",
keywords="descriptively analysis",
keywords="Policymakers",
keywords="health officials",
keywords="healthcare system",
keywords="Surveillance Outbreak Response Management and Analysis System",
keywords="District Health Information Software 2",
keywords="policy makers",
keywords="health care system",
abstract="Background: Accurate and timely infectious disease surveillance is pivotal for effective public health responses. An important component of this is the disease surveillance tools used. Understanding views and experiences of users is crucial for informing policy decisions and ensuring the seamless functioning of surveillance systems. Objective: In this study, we aimed to assess the user perceptions of 3 disease surveillance tools used in C{\^o}te d'Ivoire, namely, MAGPI, District Health Information Software 2 (DHIS2), and Surveillance Outbreak Response Management and Analysis System (SORMAS), the latter was implemented in 2021 within a pilot scheme. Methods: We conducted interviews and a web-based survey distributed to users of the 3 surveillance tools. The survey assessed users' views of the surveillance tools' usefulness, ease of use, feelings toward the tool, conditions that may influence the use, and other characteristics. The descriptive analysis compared responses from SORMAS, MAGPI, and DHIS2 users, providing a comprehensive evaluation of their experiences. Results: Among the 159 respondents who actively use one of the systems, MAGPI was the most widely used surveillance tool among respondents (n=127, 79.9\%), followed by DHIS2 (n=108, 67.9\%), and SORMAS (n=25, 15.7\%). In terms of users' perceptions, SORMAS, despite its limited implementation, emerged as a tool that allows for data analysis and had the most comprehensive set of functionalities. DHIS2 was appreciated for its frequency of report provision, although users reported occasional IT system failures. MAGPI was recognized for its ease of use but was reported to lack certain functionalities offered by the other surveillance systems. Conclusions: This study offers valuable insights into the perceptions of disease surveillance tools users in C{\^o}te d'Ivoire. While all systems were positively regarded, each exhibited strengths and weaknesses addressing different needs and functionalities. Policy makers and health officials can use these findings to enhance existing tools or consider a unified approach for infectious disease surveillance systems. Understanding users' perspectives allows them to optimize the choice of surveillance tools, ultimately strengthening public health responses in C{\^o}te d'Ivoire and potentially serving as a model for other countries facing similar decisions in their health care systems. ",
doi="10.2196/56275",
url="https://publichealth.jmir.org/2024/1/e56275"
}


@Article{info:doi/10.2196/48139,
author="Al-Aboosi, Mustafa Ahmad
and Sheikh Abdullah, Huda Siti Norul
and Ismail, Rozmi
and Abdul Maulud, Nizam Khairul
and Nahar, Lutfun
and Zainol Ariffin, Akram Khairul
and Lam, Chun Meng
and bin Talib, Lazim Muhamad
and Wahab, Suzaily
and Elias, Mahadzir",
title="A Geospatial Drug Abuse Risk Assessment and Monitoring Dashboard Tailored for School Students: Development Study With Requirement Analysis and Acceptance Evaluation",
journal="JMIR Hum Factors",
year="2024",
month="Jul",
day="30",
volume="11",
pages="e48139",
keywords="geospatial",
keywords="statistics",
keywords="map",
keywords="youth",
keywords="drugs",
keywords="dashboard",
keywords="evaluation",
keywords="drug abuse",
keywords="monitoring",
keywords="risk assessment",
abstract="Background: The enormous consequences of drugs include suicides, traffic accidents, and violence, affecting the individual, family, society, and country. Therefore, it is necessary to constantly identify and monitor the drug abuse rate among school-going youth. A geospatial dashboard is vital for the monitoring of drug abuse and related crime incidence in a decision support system. Objective: This paper mainly focuses on developing MyAsriGeo, a geospatial drug abuse risk assessment and monitoring dashboard tailored for school students. It introduces innovative functionality, seamlessly orchestrating the assessment of drug abuse usage patterns and risks using multivariate student data. Methods: A geospatial drug abuse dashboard for monitoring and analysis was designed and developed in this study based on agile methodology and prototyping. Using focus group and interviews, we first examined and gathered the requirements, feedback, and user approval of the MyAsriGeo dashboard. Experts and stakeholders such as the National Anti-Drugs Agency, police, the Federal Department of Town and Country Planning, school instructors, students, and researchers were among those who responded. A total of 20 specialists were involved in the requirement analysis and acceptance evaluation of the pilot and final version of the dashboard. The evaluation sought to identify various user acceptance aspects, such as ease of use and usefulness, for both the pilot and final versions, and 2 additional factors based on the Post-Study System Usability Questionnaire and Task-Technology Fit models were enlisted to assess the interface quality and dashboard sufficiency for the final version. Results: The MyAsriGeo geospatial dashboard was designed to meet the needs of all user types, as identified through a requirement gathering process. It includes several key functions, such as a geospatial map that shows the locations of high-risk areas for drug abuse, data on drug abuse among students, tools for assessing the risk of drug abuse in different areas, demographic information, and a self-problem test. It also includes the Alcohol, Smoking, and Substance Involvement Screening Test and its risk assessment to help users understand and interpret the results of student risk. The initial prototype and final version of the dashboard were evaluated by 20 experts, which revealed a significant improvement in the ease of use (P=.047) and usefulness (P=.02) factors and showed a high acceptance mean scores for ease of use (4.2), usefulness (4.46), interface quality (4.29), and sufficiency (4.13). Conclusions: The MyAsriGeo geospatial dashboard is useful for monitoring and analyzing drug abuse among school-going youth in Malaysia. It was developed based on the needs of various stakeholders and includes a range of functions. The dashboard was evaluated by a group of experts. Overall, the MyAsriGeo geospatial dashboard is a valuable resource for helping stakeholders understand and respond to the issue of drug abuse among youth. ",
doi="10.2196/48139",
url="https://humanfactors.jmir.org/2024/1/e48139",
url="http://www.ncbi.nlm.nih.gov/pubmed/39078685"
}


@Article{info:doi/10.2196/51086,
author="Wu, Fei Philip
and Summers, Charlotte
and Panesar, Arjun
and Kaura, Amit
and Zhang, Li",
title="AI Hesitancy and Acceptability---Perceptions of AI Chatbots for Chronic Health Management and Long COVID Support: Survey Study",
journal="JMIR Hum Factors",
year="2024",
month="Jul",
day="23",
volume="11",
pages="e51086",
keywords="AI hesitancy",
keywords="chatbot",
keywords="long COVID",
keywords="diabetes",
keywords="chronic disease management",
keywords="technology acceptance",
keywords="post--COVID-19 condition",
keywords="artificial intelligence",
abstract="Background: Artificial intelligence (AI) chatbots have the potential to assist individuals with chronic health conditions by providing tailored information, monitoring symptoms, and offering mental health support. Despite their potential benefits, research on public attitudes toward health care chatbots is still limited. To effectively support individuals with long-term health conditions like long COVID (or post--COVID-19 condition), it is crucial to understand their perspectives and preferences regarding the use of AI chatbots. Objective: This study has two main objectives: (1) provide insights into AI chatbot acceptance among people with chronic health conditions, particularly adults older than 55 years and (2) explore the perceptions of using AI chatbots for health self-management and long COVID support. Methods: A web-based survey study was conducted between January and March 2023, specifically targeting individuals with diabetes and other chronic conditions. This particular population was chosen due to their potential awareness and ability to self-manage their condition. The survey aimed to capture data at multiple intervals, taking into consideration the public launch of ChatGPT, which could have potentially impacted public opinions during the project timeline. The survey received 1310 clicks and garnered 900 responses, resulting in a total of 888 usable data points. Results: Although past experience with chatbots (P<.001, 95\% CI .110-.302) and online information seeking (P<.001, 95\% CI .039-.084) are strong indicators of respondents' future adoption of health chatbots, they are in general skeptical or unsure about the use of AI chatbots for health care purposes. Less than one-third of the respondents (n=203, 30.1\%) indicated that they were likely to use a health chatbot in the next 12 months if available. Most were uncertain about a chatbot's capability to provide accurate medical advice. However, people seemed more receptive to using voice-based chatbots for mental well-being, health data collection, and analysis. Half of the respondents with long COVID showed interest in using emotionally intelligent chatbots. Conclusions: AI hesitancy is not uniform across all health domains and user groups. Despite persistent AI hesitancy, there are promising opportunities for chatbots to offer support for chronic conditions in areas of lifestyle enhancement and mental well-being, potentially through voice-based user interfaces. ",
doi="10.2196/51086",
url="https://humanfactors.jmir.org/2024/1/e51086"
}


@Article{info:doi/10.2196/55718,
author="Morrison, Lisa
and Saynor, Louise Zoe
and Kirk, Alison
and McCann, Lisa",
title="Revolutionizing Care: Unleashing the Potential of Digital Health Technology in Physiotherapy Management for People With Cystic Fibrosis",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Jul",
day="15",
volume="11",
pages="e55718",
keywords="cystic fibrosis",
keywords="physiotherapy",
keywords="digital technology",
keywords="telehealth",
keywords="cystic fibrosis transmembrane regulator modulators",
keywords="telemedicine",
keywords="digital health technology",
keywords="DHTs",
keywords="digital health",
keywords="physical therapy",
keywords="physical activity",
keywords="exercise",
keywords="monitoring",
keywords="physiotherapists",
keywords="user",
keywords="experience",
keywords="remote",
keywords="virtual care",
keywords="consultation",
keywords="consultations",
keywords="eConsultations",
keywords="preferences",
keywords="digital divide",
keywords="access",
keywords="accessible",
keywords="accessibility",
keywords="attitude",
keywords="perception",
keywords="attitudes",
keywords="opinion",
keywords="perceptions",
keywords="perspectives",
keywords="eHealth",
keywords="online health",
keywords="therapy",
doi="10.2196/55718",
url="https://rehab.jmir.org/2024/1/e55718"
}


@Article{info:doi/10.2196/56881,
author="Stimpson, P. Jim
and Park, Sungchul
and Wilson, A. Fernando
and Ortega, N. Alexander",
title="Variations in Unmet Health Care Needs by Perceptions of Social Media Health Mis- and Disinformation, Frequency of Social Media Use, Medical Trust, and Medical Care Discrimination: Cross-Sectional Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Jul",
day="11",
volume="10",
pages="e56881",
keywords="United States",
keywords="cross-sectional study",
keywords="trust",
keywords="consumer health information",
keywords="misinformation",
keywords="disinformation",
keywords="perceived discrimination",
keywords="social media",
keywords="unmet need",
keywords="unmet needs",
keywords="health care",
keywords="discrimination",
keywords="racism",
keywords="adult",
keywords="adults",
keywords="medical care",
keywords="frequency",
keywords="multivariable regression",
keywords="user",
keywords="users",
keywords="cross-sectional",
keywords="survey",
keywords="surveys",
keywords="questionnaire",
keywords="questionnaires",
keywords="HINTS",
keywords="Health Information National Trends Survey",
abstract="Background: Unmet need for health care is defined as choosing to postpone or completely avoid necessary medical treatment despite having a need for it, which can worsen current conditions or contribute to new health problems. The emerging infodemic can be a barrier that prevents people from accessing quality health information, contributing to lower levels of seeking medical care when needed. Objective: We evaluated the association between perceptions of health mis- and disinformation on social media and unmet need for health care. In addition, we evaluated mechanisms for this relationship, including frequency of social media use, medical trust, and medical care discrimination. Methods: Data from 3964 active adult social media users responding to the 2022 Health Information National Trends Survey 6 (HINTS 6), a nationally representative survey, were analyzed. The outcome was unmet need for medical care, defined as delaying or not getting the necessary medical care. The predictor variables were perception of social media health mis- and disinformation, frequency of social media use, level of trust in the health care system, and perceived racial and ethnic discrimination when receiving health care. Results: Multivariable logistic regression models indicated that perception of substantial social media health mis- and disinformation (odds ratio [OR] 1.40, 95\% CI 1.07?1.82), daily use of social media (OR 1.34, 95\% CI 1.01?1.79), low medical trust (OR 1.46, 95\% CI 1.06?2.01), and perceived discrimination (OR 2.24, 95\% CI 1.44?3.50) were significantly associated with a higher likelihood of unmet need for medical care. Unmet need among adults who did not use social media daily and who did not perceive substantial mis- and disinformation (24\%; 95\% CI 19\%?30\%) was lower compared to daily social media users who perceived substantial mis- and disinformation (38\%; 95\% CI 32\%?43\%). Adults who perceived substantial mis- and disinformation and had low trust in health care had the highest probability of reporting unmet need (43\%; 95\% CI 38\%?49\%) compared to the other three groups. Adults who perceived substantial mis- and disinformation and experienced medical care discrimination had a statistically significant higher probability of reporting unmet need (51\%; 95\% CI 40\%?62\%) compared to adults who did not experience medical care discrimination and did not perceive substantial mis- and disinformation (29\%; 95\% CI 26\%?32\%). Conclusions: Unmet need for medical care was higher among individuals who perceived a substantial degree of social media mis- and disinformation, especially among those who used social media daily, did not trust the health care system, and experienced racial or ethnic discrimination when receiving health care. To counter the negative effects of social media mis- and disinformation on unmet need for health care, public health messaging must focus on daily social media users as well as improving trust and reducing structural racism in the health care system. ",
doi="10.2196/56881",
url="https://publichealth.jmir.org/2024/1/e56881"
}


@Article{info:doi/10.2196/54532,
author="Syed, Ahmed Toufeeq
and Thompson, L. Erika
and Johnson, Jason
and Latif, Zainab
and Kennedy, Nan
and Javier, Damaris
and Stinson, Katie
and Vishwanatha, K. Jamboor",
title="A/B Testing of User Enrollment Forms to Enhance Diversity in the Biomedical Workforce via the National Research Mentoring Network: User-Centered Design Case Study",
journal="JMIR Hum Factors",
year="2024",
month="Jul",
day="2",
volume="11",
pages="e54532",
keywords="diversity",
keywords="mentoring",
keywords="health workforce",
keywords="underrepresented groups",
keywords="online platform",
keywords="user-computer interface",
keywords="A/B testing",
keywords="split testing",
keywords="recommendation algorithm",
keywords="network of mentors",
keywords="groups",
keywords="enrollment",
abstract="Background: The National Research Mentoring Network (NRMN) is a National Institutes of Health--funded program for diversifying the science, technology, engineering, math, and medicine research workforce through the provision of mentoring, networking, and professional development resources. The NRMN provides mentoring resources to members through its online platform---MyNRMN. Objective: MyNRMN helps members build a network of mentors. Our goal was to expand enrollment and mentoring connections, especially among those who have been historically underrepresented in biomedical training and the biomedical workforce. Methods: To improve the ease of enrollment, we implemented the split testing of iterations of our user interface for platform registration. To increase mentoring connections, we developed multiple features that facilitate connecting via different pathways. Results: Our improved user interface yielded significantly higher rates of completed registrations (P<.001). Our analysis showed improvement in completed enrollments that used the version 1 form when compared to those that used the legacy form (odds ratio 1.52, 95\% CI 1.30-1.78). The version 2 form, with its simplified, 1-step process and fewer required fields, outperformed the legacy form (odds ratio 2.18, 95\% CI 1.90-2.50). By improving the enrollment form, the rate of MyNRMN enrollment completion increased from 57.3\% (784/1368) with the legacy form to 74.5\% (2016/2706) with the version 2 form. Our newly developed features delivered an increase in connections between members. Conclusions: Our technical efforts expanded MyNRMN's membership base and increased connections between members. Other platform development teams can learn from these efforts to increase enrollment among underrepresented groups and foster continuing, successful engagement. ",
doi="10.2196/54532",
url="https://humanfactors.jmir.org/2024/1/e54532"
}


@Article{info:doi/10.2196/53131,
author="Schmidt, Wong Camilla
and Borgnakke, Karen
and Fr{\o}lich, Anne
and Kayser, Lars",
title="Preferences, Needs, and Values of Patients With Chronic Obstructive Pulmonary Disease Attending a Telehealth Service: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="21",
volume="11",
pages="e53131",
keywords="people with long-term health condition",
keywords="patient education",
keywords="COPD",
keywords="digital health",
keywords="ethnography",
keywords="inductive",
keywords="ethnographic",
keywords="chronic",
keywords="lung",
keywords="lungs",
keywords="pulmonary",
keywords="respiratory",
keywords="self-management",
keywords="interview",
keywords="interviews",
keywords="qualitative",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="acceptance",
abstract="Background: Digitally assisted health care services and technologies are gaining popularity. They assist patients in managing their conditions, thereby reducing the burden on health care staff. Digital health care enables individuals to receive care that is more tailored to their needs and preferences. When implemented properly, it can promote equity by considering each person's opportunities and limitations in the context of health care needs, preferences, values, and capabilities. Objective: This study aims to understand the needs, values, and preferences of individuals with chronic obstructive pulmonary disease (COPD) who are provided with a 24/7 digital health care service. Furthermore, we aim to understand the dynamics of the communities to which they belong and how these communities intersect. This will provide us with the essential knowledge to establish new methods of providing education, including the development of educational activities for health professionals to engage, train, and empower people living with COPD. Methods: The study included 7 informants diagnosed with COPD who received 24/7 digital health care service support from a regional project in Region Zealand, Denmark. The informants were visited 4 times during 2 months, including a ``Hello'' visit, a day with a semistructured interview, and 2 days with field observations. The informants participated in a semistructured interview, following participant observation and an ethnographic approach. The interview content was analyzed using an inductive methodology to categorize the empirical data. Results: Using the inductive approach, we identified 3 main categories related to the informants' needs, values, and preferences: (1) Health, (2) Value Creation, and (3) Resources. These 3 main categories were based on 9 subcategories: (1) health and barriers, (2) self-monitoring, (3) medication, (4) behavior, (5) motivation, (6) hobbies, (7) social networks, (8) health professionals, and (9) technology. These findings revealed that the informants placed value on maintaining their daily activities and preserving their sense of identity before the onset of COPD. Furthermore, they expressed a desire not to be defined by their COPD, as conversations about COPD often shifted away from the topic. Conclusions: Digital health solutions and the health care professionals who offer them should prioritize the individuals they serve, considering their needs, values, and preferences rather than solely focusing on the medical condition. This approach ensures the highest level of daily living and empowerment for those living with long-term health conditions. The communities surrounding individuals must engage in constant interaction and collaboration. They should work together to incorporate people's needs, values, and preferences into future digital health services, thereby promoting empowerment and self-management. New educational programs aimed at developing the digital health service competencies of registered nurses should facilitate collaboration between the 2 communities. This collaboration is essential for supporting patients with long-term health conditions in their daily activities. ",
doi="10.2196/53131",
url="https://humanfactors.jmir.org/2024/1/e53131"
}


@Article{info:doi/10.2196/56357,
author="Chien, Shih-Ying
and Wong, MK Alice
and Wu, Ching-Yi
and Beckman, L. Sara",
title="Interactive Electronic Pegboard for Enhancing Manual Dexterity and Cognitive Abilities: Instrument Usability Study",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="21",
volume="11",
pages="e56357",
keywords="interactive electronic pegboard",
keywords="stroke",
keywords="hand dexterity",
keywords="cognitive rehabilitation",
keywords="system",
abstract="Background: Strokes pose a substantial health burden, impacting 1 in 6 people globally. One-tenth of patients will endure a second, often more severe, stroke within a year. Alarmingly, a younger demographic is being affected due to recent lifestyle changes. As fine motor and cognitive issues arise, patient disability as well as the strain on caregivers and health care resources is exacerbated. Contemporary occupational therapy assesses manual dexterity and cognitive functions through object manipulation and pen-and-paper recordings. However, these assessments are typically isolated, which makes it challenging for therapists to comprehensively evaluate specific patient conditions. Furthermore, the reliance on one-on-one training and assessment approaches on manual documentation is inefficient and prone to transcription errors. Objective: This study examines the feasibility of using an interactive electronic pegboard for stroke rehabilitation in clinical settings. Methods: A total of 10 patients with a history of stroke and 10 healthy older individuals were recruited. With a limit of 10 minutes, both groups of participants underwent a series of challenges involving tasks related to manual operation, shape recognition, and color discrimination. All participants underwent the Box and Block Test and the Purdue Pegboard Test to assess manual dexterity, as well as an array of cognitive assessments, including the Trail Making Test and the Mini-Mental Status Examination, which served as a basis to quantify participants' attention, executive functioning, and cognitive abilities. Results: The findings validate the potential application of an interactive electronic pegboard for stroke rehabilitation in clinical contexts. Significant statistical differences (P<.01) were observed across all assessed variables, including age, Box and Block Test results, Purdue Pegboard Test outcomes, Trail Making Test-A scores, and Mini-Mental Status Examination performance, between patients with a history of stroke and their healthy older counterparts. Functional and task testing, along with questionnaire interviews, revealed that patients with a history of stroke demonstrated prolonged completion times and slightly inferior performance. Nonetheless, most patients perceived the prototype as user-friendly and engaging. Thus, in the context of patient rehabilitation interventions or the evaluation of patient cognition, physical functioning, or manual dexterity assessments, the developed pegboard could potentially serve as a valuable tool for hand function, attention, and cognitive rehabilitation, thereby mitigating the burden on health care professionals. Conclusions: Health care professionals can use digital electronic pegboards not only as a precise one-on-one training tool but also as a flexible system that can be configured for online or offline, single-player or multiplayer use. Through data analysis, a more informed examination of patients' cognitive and functional issues can be conducted. Importantly, patient records will be fully retained throughout practices, exercises, or tests, and by leveraging the characteristics of big data, patients can receive the most accurate rehabilitation prescriptions, thereby assisting them in obtaining optimal care. ",
doi="10.2196/56357",
url="https://humanfactors.jmir.org/2024/1/e56357",
url="http://www.ncbi.nlm.nih.gov/pubmed/38904991"
}


@Article{info:doi/10.2196/50195,
author="Buffey, John Aidan
and Langley, Kate Christina
and Carson, P. Brian
and Donnelly, E. Alan
and Salsberg, Jon",
title="Participatory Approaches in the Context of Research Into Workplace Health Promotion to Improve Physical Activity Levels and Reduce Sedentary Behavior Among Office-Based Workers: Scoping Review",
journal="JMIR Public Health Surveill",
year="2024",
month="Jun",
day="19",
volume="10",
pages="e50195",
keywords="participatory research approach",
keywords="workplace health promotion",
keywords="physical activity",
keywords="sedentary behavior",
keywords="end user involvement",
keywords="office based",
keywords="desk based",
keywords="intervention",
keywords="cocreation",
keywords="public and patient involvement",
abstract="Background: Participatory research (PR) involves engaging in cocreation with end users and relevant stakeholders throughout the research process, aiming to distribute power equitably between the end users and research team. Engagement and adherence in previous workplace health promotion (WHP) studies have been shown to be lacking. By implementing a PR approach, the insights of end users and stakeholders are sought in the co-design of feasible and acceptable intervention strategies, thereby increasing the relevance of the research. Objective: This scoping review aims to explore, identify, and map PR techniques and their impact when used in office-based WHP interventions designed to improve physical activity (PA) or reduce sedentary behavior (SB). Methods: The reporting of this scoping review followed the PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). A systematic literature search of 5 electronic databases---Web of Science, PubMed, Scopus, Google Scholar, and OpenGrey---was conducted, searching from January 1, 1995, to February 8, 2023. In total, 2 independent reviewers first screened the retrieved articles by title and abstract, and then assessed the full texts based on the inclusion and exclusion criteria. The search strategy and eligibility criteria were developed and guided by an a priori population (office-based working adults), intervention (a PA WHP intervention that took a PR approach), comparison (no comparison required), and outcome (PA or SB) framework. Data were charted and discussed via a narrative synthesis, and a thematic analysis was conducted. The included studies were evaluated regarding the degree of end user engagement throughout the research process and power shared by the researchers, using Arnstein's ladder of citizen participation. Results: The search retrieved 376 records, of which 8 (2.1\%) met the inclusion criteria. Four key strategies were identified: (1) end user focus groups, (2) management involvement, (3) researcher facilitators, and (4) workplace champions. The degree of engagement and power shared was relatively low, with 25\% (2/8) of the studies determined to be nonparticipation studies, 25\% (2/8) determined to be tokenistic, and 50\% (4/8) determined to provide citizen power. Conclusions: This review provides a foundation of evidence on the current practices when taking a PR approach, highlighting that previous office-based PA WHP studies have been largely tokenistic or nonparticipative, and identified that the end user is only engaged with in the conception and implementation of the WHP studies. However, a positive improvement in PA and reduction in SB were observed in the included studies, which were largely attributed to implementing a PR approach and including the end user in the design of the WHP intervention. Future studies should aim to collaborate with workplaces, building capacity and empowering the workforce by providing citizen control and letting the end users ``own'' the research for a sustainable WHP intervention. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-054402 ",
doi="10.2196/50195",
url="https://publichealth.jmir.org/2024/1/e50195",
url="http://www.ncbi.nlm.nih.gov/pubmed/38896458"
}


@Article{info:doi/10.2196/49992,
author="Depauw, Tanguy
and Boasen, Jared
and L{\'e}ger, Pierre-Majorique
and S{\'e}n{\'e}cal, Sylvain",
title="Assessing the Relationship Between Digital Trail Making Test Performance and IT Task Performance: Empirical Study",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="14",
volume="11",
pages="e49992",
keywords="Trail Making Test",
keywords="user experience",
keywords="cognitive profile",
keywords="information technology",
keywords="task performance",
keywords="cognitive assessment",
keywords="human factors",
keywords="cognitive function",
keywords="CAPTCHA",
abstract="Background: Cognitive functional ability affects the accessibility of IT and is thus something that should be controlled for in user experience (UX) research. However, many cognitive function assessment batteries are long and complex, making them impractical for use in conventional experimental time frames. Therefore, there is a need for a short and reliable cognitive assessment that has discriminant validity for cognitive functions needed for general IT tasks. One potential candidate is the Trail Making Test (TMT). Objective: This study investigated the usefulness of a digital TMT as a cognitive profiling tool in IT-related UX research by assessing its predictive validity on general IT task performance and exploring its discriminant validity according to discrete cognitive functions required to perform the IT task. Methods: A digital TMT (parts A and B) named Axon was administered to 27 healthy participants, followed by administration of 5 IT tasks in the form of CAPTCHAs (Completely Automated Public Turing tests to Tell Computers and Humans Apart). The discrete cognitive functions required to perform each CAPTCHA were rated by trained evaluators. To further explain and cross-validate our results, the original TMT and 2 psychological assessments of visuomotor and short-term memory function were administered. Results: Axon A and B were administrable in less than 5 minutes, and overall performance was significantly predictive of general IT task performance (F5,19=6.352; P=.001; $\Lambda$=0.374). This result was driven by performance on Axon B (F5,19=3.382; P=.02; $\Lambda$=0.529), particularly for IT tasks involving the combination of executive processing with visual object and pattern recognition. Furthermore, Axon was cross-validated with the original TMT (Pcorr=.001 and Pcorr=.017 for A and B, respectively) and visuomotor and short-term memory tasks. Conclusions: The results demonstrate that variance in IT task performance among an age-homogenous neurotypical population can be related to intersubject variance in cognitive function as assessed by Axon. Although Axon's predictive validity seemed stronger for tasks involving the combination of executive function with visual object and pattern recognition, these cognitive functions are arguably relevant to the majority of IT interfaces. Considering its short administration time and remote implementability, the Axon digital TMT demonstrates the potential to be a useful cognitive profiling tool for IT-based UX research. ",
doi="10.2196/49992",
url="https://humanfactors.jmir.org/2024/1/e49992",
url="http://www.ncbi.nlm.nih.gov/pubmed/38875007"
}


@Article{info:doi/10.2196/58355,
author="Moldt, Julia-Astrid
and Festl-Wietek, Teresa
and Fuhl, Wolfgang
and Zabel, Susanne
and Claassen, Manfred
and Wagner, Samuel
and Nieselt, Kay
and Herrmann-Werner, Anne",
title="Assessing AI Awareness and Identifying Essential Competencies: Insights From Key Stakeholders in Integrating AI Into Medical Education",
journal="JMIR Med Educ",
year="2024",
month="Jun",
day="12",
volume="10",
pages="e58355",
keywords="AI in medicine",
keywords="artificial intelligence",
keywords="medical education",
keywords="medical students",
keywords="qualitative approach",
keywords="qualitative analysis",
keywords="needs assessment",
abstract="Background: The increasing importance of artificial intelligence (AI) in health care has generated a growing need for health care professionals to possess a comprehensive understanding of AI technologies, requiring an adaptation in medical education. Objective: This paper explores stakeholder perceptions and expectations regarding AI in medicine and examines their potential impact on the medical curriculum. This study project aims to assess the AI experiences and awareness of different stakeholders and identify essential AI-related topics in medical education to define necessary competencies for students. Methods: The empirical data were collected as part of the T{\"u}KITZMed project between August 2022 and March 2023, using a semistructured qualitative interview. These interviews were administered to a diverse group of stakeholders to explore their experiences and perspectives of AI in medicine. A qualitative content analysis of the collected data was conducted using MAXQDA software. Results: Semistructured interviews were conducted with 38 participants (6 lecturers, 9 clinicians, 10 students, 6 AI experts, and 7 institutional stakeholders). The qualitative content analysis revealed 6 primary categories with a total of 24 subcategories to answer the research questions. The evaluation of the stakeholders' statements revealed several commonalities and differences regarding their understanding of AI. Crucial identified AI themes based on the main categories were as follows: possible curriculum contents, skills, and competencies; programming skills; curriculum scope; and curriculum structure. Conclusions: The analysis emphasizes integrating AI into medical curricula to ensure students' proficiency in clinical applications. Standardized AI comprehension is crucial for defining and teaching relevant content. Considering diverse perspectives in implementation is essential to comprehensively define AI in the medical context, addressing gaps and facilitating effective solutions for future AI use in medical studies. The results provide insights into potential curriculum content and structure, including aspects of AI in medicine. ",
doi="10.2196/58355",
url="https://mededu.jmir.org/2024/1/e58355"
}


@Article{info:doi/10.2196/56529,
author="Rubin, Matan
and Arnon, Hadar
and Huppert, D. Jonathan
and Perry, Anat",
title="Considering the Role of Human Empathy in AI-Driven Therapy",
journal="JMIR Ment Health",
year="2024",
month="Jun",
day="11",
volume="11",
pages="e56529",
keywords="empathy",
keywords="empathetic",
keywords="empathic",
keywords="artificial empathy",
keywords="AI",
keywords="artificial intelligence",
keywords="mental health",
keywords="machine learning",
keywords="algorithm",
keywords="algorithms",
keywords="predictive model",
keywords="predictive models",
keywords="predictive analytics",
keywords="predictive system",
keywords="practical model",
keywords="practical models",
keywords="model",
keywords="models",
keywords="therapy",
keywords="mental illness",
keywords="mental illnesses",
keywords="mental disease",
keywords="mental diseases",
keywords="mood disorder",
keywords="mood disorders",
keywords="emotion",
keywords="emotions",
keywords="e-mental health",
keywords="digital mental health",
keywords="internet-based therapy",
doi="10.2196/56529",
url="https://mental.jmir.org/2024/1/e56529",
url="http://www.ncbi.nlm.nih.gov/pubmed/38861302"
}


@Article{info:doi/10.2196/47810,
author="Hawrysz, Liliana
and Kludacz-Alessandri, Magdalena
and Walczak, Renata",
title="Predictive Factors of Physicians' Satisfaction and Quality of Work Under Teleconsultation Conditions: Structural Equation Analysis",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="10",
volume="11",
pages="e47810",
keywords="perceived ease of use",
keywords="perceived usefulness",
keywords="physicians' satisfaction",
keywords="behavioral intention to use telemedicine",
keywords="health care quality",
keywords="technology acceptance model",
keywords="TAM",
keywords="COVID-19: telemedicine",
abstract="Background: The COVID-19 pandemic contributed to an increase in teleconsultation adoption in the Polish primary health care system. It is expected that in the long run, teleconsultations will successfully replace a significant part of face-to-face visits. Therefore, a significant challenge facing primary health care facilities (PHCs) is the acceptance of teleconsultations by their users, especially physicians. Objective: This study aimed to explore physicians' acceptance of teleconsultations during the COVID-19 pandemic in Poland. Methods: A representative survey was conducted among 361 physicians of PHCs across Poland in 2021. For the purposes of the study, we developed a modified Technology Acceptance Model (TAM) model. Based on the modified TAM, we analyzed the impact of perceived usefulness (PU), perceived ease of use (PEU), and intention to use teleconsultation (INT) on physicians' satisfaction (SAT) and quality of work (Q). The psychometric properties of the research instrument were examined using exploratory factor analysis. Finally, structural equation modeling was used for data analysis. Results: The results indicated a generally high level of PU (mean 3.85-4.36, SD 0.87-1.18), PEU (mean 3.81-4.60, SD 0.60-1.42), INT (mean 3.87-4.22, SD 0.89-1.12), and SAT (mean 3.55-4.13, SD 0.88-1.16); the lowest rated dimension in TAM was Q (mean 3.28-3.73, SD 1.06-1.26). The most important independent variable was PU. The influence of PU on INT (estimate=0.63, critical ratio [CR]=15.84, P<.001) and of PU on SAT (estimate=0.44, CR= 9.53, P<.001) was strong. INT was also a key factor influencing SAT (estimate=0.4, CR=8.57, P<.001). A weaker relationship was noted in the effect of PEU on INT (estimate=0.17, CR=4.31, P<.001). In turn, Q was positively influenced by INT (estimate=0.179, CR=3.64, P<.001), PU (estimate=0.246, CR=4.79, P<.001), PEU (estimate=0.18, CR=4.93, P<.001), and SAT (estimate=0.357, CR=6.97, P<.001). All paths between the constructs (PU, PEU, INT, SAT, and Q) were statistically significant, which highlights the multifaceted nature of the adoption of teleconsultations among physicians. Conclusions: Our findings provide strong empirical support for the hypothesized relationships in TAM. The findings suggest that the PU and PEU of teleconsultation have a significant impact on the intention of physicians to adopt teleconsultation. This results in an improvement in the satisfaction of Polish physicians with the use of teleconsultation and an increase in Q. The study contributes to both theory and practice by identifying important prognostic factors affecting physicians' acceptance of teleconsultation systems. ",
doi="10.2196/47810",
url="https://humanfactors.jmir.org/2024/1/e47810",
url="http://www.ncbi.nlm.nih.gov/pubmed/38857081"
}


@Article{info:doi/10.2196/53976,
author="Kabukye, K. Johnblack
and Namagembe, Rosemary
and Nakku, Juliet
and Kiberu, Vincent
and Sj{\"o}linder, Marie
and Nilsson, Susanne
and Wamala-Larsson, Caroline",
title="Implementing a Hospital Call Center Service for Mental Health in Uganda: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="6",
volume="11",
pages="e53976",
keywords="mHealth",
keywords="mobile health",
keywords="digital health",
keywords="digital solution",
keywords="digital solutions",
keywords="digital intervention",
keywords="digital interventions",
keywords="mental health",
keywords="awareness",
keywords="Uganda",
keywords="Africa",
keywords="African",
keywords="user centred",
keywords="user centered",
keywords="design",
keywords="qualitative",
keywords="focus group",
keywords="focus groups",
keywords="call centre",
keywords="call centres",
keywords="call center",
keywords="call centers",
keywords="mental",
keywords="experience",
keywords="experiences",
keywords="attitude",
keywords="attitudes",
keywords="opinion",
keywords="perception",
keywords="perceptions",
keywords="perspective",
keywords="perspectives",
keywords="cocreated",
keywords="cocreation",
keywords="service",
keywords="services",
keywords="mobile phone",
abstract="Background: Mental health conditions are a significant public health problem globally, responsible for >8 million deaths per year. In addition, they lead to lost productivity, exacerbate physical illness, and are associated with stigma and human rights violations. Uganda, like many low- and middle-income countries, faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions. Objective: This study aims to describe the development and formative evaluation of a digital health intervention for improving access to mental health care in Uganda. Methods: This qualitative study used user-centered design and design science research principles. Stakeholders, including patients, caregivers, mental health care providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants' experience of mental illness and mental health care, experience with digital interventions, and opinions about a proposed digital mental health service. Data were analyzed using the Consolidated Framework for Implementation Research to derive requirements for the digital solution, which was iteratively cocreated with users and piloted. Results: Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants' enthusiasm about digital solutions as a feasible, acceptable, and convenient method for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, and available 24{\texttimes}7 and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in 2 languages through interactive voice response and live calls with health care professionals and peer support workers (recovering patients). In the 4 months after launch, 456 calls, from 236 unique numbers, were made to the system, of which 99 (21.7\%) calls went to voicemails (out-of-office hours). Of the remaining 357 calls, 80 (22.4\%) calls stopped at the interactive voice response, 231 (64.7\%) calls were answered by call agents, and 22 (6.2\%) calls were not answered. User feedback was positive, with callers appreciating the inclusion of peer support workers who share their recovery journeys. However, some participant recommendations (eg, adding video call options) or individualized needs (eg, prescriptions) could not be accommodated due to resource limitations or technical feasibility. Conclusions: This study demonstrates a systematic and theory-driven approach to developing contextually appropriate digital solutions for improving mental health care in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations and evaluate clinical outcomes of long-term adoption. ",
doi="10.2196/53976",
url="https://humanfactors.jmir.org/2024/1/e53976",
url="http://www.ncbi.nlm.nih.gov/pubmed/38843515"
}


@Article{info:doi/10.2196/52251,
author="Narang, Gaurav
and Chen, J. Yaozhu
and Wedel, Nicole
and Wu, Melody
and Luo, Michelle
and Atreja, Ashish",
title="Development of a Digital Patient Assistant for the Management of Cyclic Vomiting Syndrome: Patient-Centric Design Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="6",
volume="8",
pages="e52251",
keywords="cyclic vomiting syndrome",
keywords="vomiting",
keywords="vomit",
keywords="emetic",
keywords="emesis",
keywords="gut",
keywords="GI",
keywords="gastrointestinal",
keywords="internal medicine",
keywords="prototype",
keywords="prototypes",
keywords="iterative",
keywords="self-management",
keywords="disease management",
keywords="gut-brain interaction",
keywords="gut-brain",
keywords="artificial intelligence",
keywords="digital patient assistant",
keywords="assistant",
keywords="assistants",
keywords="design thinking",
keywords="design",
keywords="patient-centric",
keywords="patient centred",
keywords="patient centered",
keywords="patient-centric approach",
keywords="System Usability Scale",
keywords="symptom tracking",
keywords="digital health solution",
keywords="user experience",
keywords="usability",
keywords="symptom",
keywords="symptoms",
keywords="tracking",
keywords="monitoring",
keywords="participatory",
keywords="co-design digital health technology",
keywords="patient assistance",
keywords="patient experience",
keywords="mobile phone",
abstract="Background: Cyclic vomiting syndrome (CVS) is an enigmatic and debilitating disorder of gut-brain interaction that is characterized by recurrent episodes of severe vomiting and nausea. It significantly impairs patients' quality of life and can lead to frequent medical visits and substantial health care costs. The diagnosis for CVS is often protracted and complex, primarily due to its exclusionary diagnosis nature and the lack of specific biomarkers. This typically leads to a considerable delay in accurate diagnosis, contributing to increased patient morbidity. Additionally, the absence of approved therapies for CVS worsens patient hardship and reflects the urgent need for innovative, patient-centric solutions to improve CVS management. Objective: We aim to develop a digital patient assistant (DPA) for patients with CVS to address their unique needs, and iteratively enhance the technical features and user experience on the initial DPA versions. Methods: The development of the DPA for CVS used a design thinking approach, prioritizing user needs. A literature review and Patient Advisory Board shaped the initial prototype, focusing on diagnostic support and symptom tracking. Iterative development, informed by the design thinking approach and feedback from patients with CVS and caregivers through interviews and smartphone testing, led to significant enhancements in user interaction and artificial intelligence integration. The final DPA's effectiveness was validated using the System Usability Scale and feedback questions, ensuring it met the specific needs of the CVS community. Results: The DPA developed for CVS integrates an introductory bot, daily and weekly check-in bots, and a knowledge hub, all accessible via a patient dashboard. This multicomponent solution effectively addresses key unmet needs in CVS management: efficient symptom and impacts tracking, access to comprehensive disease information, and a digital health platform for disease management. Significant improvements, based on user feedback, include the implementation of artificial intelligence features like intent recognition and data syncing, enhancing the bot interaction and reducing the burden on patients. The inclusion of the knowledge hub provides educational resources, contributing to better disease understanding and management. The DPA achieved a System Usability Scale score of 80 out of 100, indicating high ease of use and relevance. Patient feedback highlighted the DPA's potential in disease management and suggested further applications, such as integration into health care provider recommendations for patients with suspected or confirmed CVS. This positive response underscores the DPA's role in enhancing patient engagement and disease management through a patient-centered digital solution. Conclusions: The development of this DPA for patients with CVS, via an iterative design thinking approach, offers a patient-centric solution for disease management. The DPA development framework may also serve to guide future patient digital support and research scenarios. ",
doi="10.2196/52251",
url="https://formative.jmir.org/2024/1/e52251",
url="http://www.ncbi.nlm.nih.gov/pubmed/38842924"
}


@Article{info:doi/10.2196/53918,
author="Li, Ming
and Xiong, XiaoMin
and Xu, Bo
and Dickson, Conan",
title="Chinese Oncologists' Perspectives on Integrating AI into Clinical Practice: Cross-Sectional Survey Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="5",
volume="8",
pages="e53918",
keywords="artificial intelligence",
keywords="AI",
keywords="machine learning",
keywords="oncologist",
keywords="concern",
keywords="clinical practice",
abstract="Background: The rapid development of artificial intelligence (AI) has brought significant interest to its potential applications in oncology. Although AI-powered tools are already being implemented in some Chinese hospitals, their integration into clinical practice raises several concerns for Chinese oncologists. Objective: This study aims to explore the concerns of Chinese oncologists regarding the integration of AI into clinical practice and to identify the factors influencing these concerns. Methods: A total of 228 Chinese oncologists participated in a cross-sectional web-based survey from April to June in 2023 in mainland China. The survey gauged their worries about AI with multiple-choice questions. The survey evaluated their views on the statements of ``The impact of AI on the doctor-patient relationship'' and ``AI will replace doctors.'' The data were analyzed using descriptive statistics, and variate analyses were used to find correlations between the oncologists' backgrounds and their concerns. Results: The study revealed that the most prominent concerns were the potential for AI to mislead diagnosis and treatment (163/228, 71.5\%); an overreliance on AI (162/228, 71\%); data and algorithm bias (123/228, 54\%); issues with data security and patient privacy (123/228, 54\%); and a lag in the adaptation of laws, regulations, and policies in keeping up with AI's development (115/228, 50.4\%). Oncologists with a bachelor's degree expressed heightened concerns related to data and algorithm bias (34/49, 69\%; P=.03) and the lagging nature of legal, regulatory, and policy issues (32/49, 65\%; P=.046). Regarding AI's impact on doctor-patient relationships, 53.1\% (121/228) saw a positive impact, whereas 35.5\% (81/228) found it difficult to judge, 9.2\% (21/228) feared increased disputes, and 2.2\% (5/228) believed that there is no impact. Although sex differences were not significant (P=.08), perceptions varied---male oncologists tended to be more positive than female oncologists (74/135, 54.8\% vs 47/93, 50\%). Oncologists with a bachelor's degree (26/49, 53\%; P=.03) and experienced clinicians (?21 years; 28/56, 50\%; P=.054). found it the hardest to judge. Those with IT experience were significantly more positive (25/35, 71\%) than those without (96/193, 49.7\%; P=.02). Opinions regarding the possibility of AI replacing doctors were diverse, with 23.2\% (53/228) strongly disagreeing, 14\% (32/228) disagreeing, 29.8\% (68/228) being neutral, 16.2\% (37/228) agreeing, and 16.7\% (38/228) strongly agreeing. There were no significant correlations with demographic and professional factors (all P>.05). Conclusions: Addressing oncologists' concerns about AI requires collaborative efforts from policy makers, developers, health care professionals, and legal experts. Emphasizing transparency, human-centered design, bias mitigation, and education about AI's potential and limitations is crucial. Through close collaboration and a multidisciplinary strategy, AI can be effectively integrated into oncology, balancing benefits with ethical considerations and enhancing patient care. ",
doi="10.2196/53918",
url="https://formative.jmir.org/2024/1/e53918",
url="http://www.ncbi.nlm.nih.gov/pubmed/38838307"
}


@Article{info:doi/10.2196/53406,
author="Sawyer, Chelsea
and Carney, Rebekah
and Hassan, Lamiece
and Bucci, Sandra
and Sainsbury, John
and Lovell, Karina
and Torous, John
and Firth, Joseph",
title="Digital Lifestyle Interventions for Young People With Mental Illness: A Qualitative Study Among Mental Health Care Professionals",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="5",
volume="11",
pages="e53406",
keywords="digital health",
keywords="behavior change",
keywords="mental health care professionals",
keywords="physical health",
keywords="lifestyle intervention",
keywords="qualitative",
keywords="thematic analysis",
keywords="service optimization",
keywords="mobile phone",
abstract="Background: Given the physical health disparities associated with mental illness, targeted lifestyle interventions are required to reduce the risk of cardiometabolic disease. Integrating physical health early in mental health treatment among young people is essential for preventing physical comorbidities, reducing health disparities, managing medication side effects, and improving overall health outcomes. Digital technology is increasingly used to promote fitness, lifestyle, and physical health among the general population. However, using these interventions to promote physical health within mental health care requires a nuanced understanding of the factors that affect their adoption and implementation. Objective: Using a qualitative design, we explored the attitudes of mental health care professionals (MHCPs) toward digital technologies for physical health with the goal of illuminating the opportunities, development, and implementation of the effective use of digital tools for promoting healthier lifestyles in mental health care. Methods: Semistructured interviews were conducted with MHCPs (N=13) using reflexive thematic analysis to explore their experiences and perspectives on using digital health to promote physical health in youth mental health care settings. Results: Three overarching themes from the qualitative analysis are reported: (1) motivation will affect implementation, (2) patients' readiness and capability, and (3) reallocation of staff roles and responsibilities. The subthemes within, and supporting quotes, are described. Conclusions: The use of digital means presents many opportunities for improving the provision of physical health interventions in mental health care settings. However, given the limited experience of many MHCPs with these technologies, formal training and additional support may improve the likelihood of implementation. Factors such as patient symptomatology, safety, and access to technology, as well as the readiness, acceptability, and capability of both MHCPs and patients to engage with digital tools, must also be considered. In addition, the potential benefits of data integration must be carefully weighed against the associated risks. ",
doi="10.2196/53406",
url="https://humanfactors.jmir.org/2024/1/e53406",
url="http://www.ncbi.nlm.nih.gov/pubmed/38837191"
}


@Article{info:doi/10.2196/51666,
author="Heitkemper, Elizabeth
and Hulse, Scott
and Bekemeier, Betty
and Schultz, Melinda
and Whitman, Greg
and Turner, M. Anne",
title="The Solutions in Health Analytics for Rural Equity Across the Northwest (SHARE-NW) Dashboard for Health Equity in Rural Public Health: Usability Evaluation",
journal="JMIR Hum Factors",
year="2024",
month="Jun",
day="5",
volume="11",
pages="e51666",
keywords="data dashboard",
keywords="rural health",
keywords="health equity",
keywords="usability",
keywords="nursing informatics",
keywords="dashboard",
keywords="rural",
keywords="informatics",
keywords="satisfaction",
keywords="think aloud",
keywords="content analysis",
keywords="user experience",
keywords="public health",
keywords="visualization",
keywords="information systems",
abstract="Background: Given the dearth of resources to support rural public health practice, the solutions in health analytics for rural equity across the northwest dashboard (SHAREdash) was created to support rural county public health departments in northwestern United States with accessible and relevant data to identify and address health disparities in their jurisdictions. To ensure the development of useful dashboards, assessment of usability should occur at multiple stages throughout the system development life cycle. SHAREdash was refined via user-centered design methods, and upon completion, it is critical to evaluate the usability of SHAREdash. Objective: This study aims to evaluate the usability of SHAREdash based on the system development lifecycle stage 3 evaluation goals of efficiency, satisfaction, and validity. Methods: Public health professionals from rural health departments from Washington, Idaho, Oregon, and Alaska were enrolled in the usability study from January to April 2022. The web-based evaluation consisted of 2 think-aloud tasks and a semistructured qualitative interview. Think-aloud tasks assessed efficiency and effectiveness, and the interview investigated satisfaction and overall usability. Verbatim transcripts from the tasks and interviews were analyzed using directed content analysis. Results: Of the 9 participants, all were female and most worked at a local health department (7/9, 78\%). A mean of 10.1 (SD 1.4) clicks for task 1 (could be completed in 7 clicks) and 11.4 (SD 2.0) clicks for task 2 (could be completed in 9 clicks) were recorded. For both tasks, most participants required no prompting---89\% (n=8) participants for task 1 and 67\% (n=6) participants for task 2, respectively. For effectiveness, all participants were able to complete each task accurately and comprehensively. Overall, the participants were highly satisfied with the dashboard with everyone remarking on the utility of using it to support their work, particularly to compare their jurisdiction to others. Finally, half of the participants stated that the ability to share the graphs from the dashboard would be ``extremely useful'' for their work. The only aspect of the dashboard cited as problematic is the amount of missing data that was present, which was a constraint of the data available about rural jurisdictions. Conclusions: Think-aloud tasks showed that the SHAREdash allows users to complete tasks efficiently. Overall, participants reported being very satisfied with the dashboard and provided multiple ways they planned to use it to support their work. The main usability issue identified was the lack of available data indicating the importance of addressing the ongoing issues of missing and fragmented public health data, particularly for rural communities. ",
doi="10.2196/51666",
url="https://humanfactors.jmir.org/2024/1/e51666",
url="http://www.ncbi.nlm.nih.gov/pubmed/38837192"
}


@Article{info:doi/10.2196/55918,
author="Hurtado, Lidia
and Gonzalez Concepcion, Melinda
and Flix-Valle, Aida
and Ruiz-Romeo, Marina
and Gonzalez-Rodriguez, Sonia
and Pe{\~n}a, Marta
and Paviglianiti, Annalisa
and Pera Jambrina, Angeles Maria
and Sureda, Anna
and Ochoa-Arnedo, Cristian
and Mussetti, Alberto",
title="Telemedicine With Wearable Technologies in Patients Undergoing Hematopoietic Cell Transplantation and Chimeric Antigen Receptor T-Cell Therapy (TEL-HEMATO Study): Prospective Noninterventional Single-Center Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="4",
volume="8",
pages="e55918",
keywords="hematology",
keywords="hematopoietic cell transplantation",
keywords="telemedicine",
keywords="wearables",
keywords="chimeric antigen receptor T",
keywords="CART",
keywords="wearable",
keywords="hematopoietic",
keywords="transplantation",
keywords="transplant",
keywords="pilot study",
keywords="hematological",
keywords="HCT",
keywords="telehealth",
keywords="therapy",
keywords="device",
keywords="quality of life",
keywords="digital health",
keywords="smartphone",
keywords="app",
keywords="patient",
keywords="teenager",
keywords="youth",
keywords="noninterventional",
abstract="Background: Patients with hematological malignancies receiving hematopoietic cell transplantation (HCT) or chimeric antigen receptor (CAR) T-cell therapy are at risk of developing serious clinical complications after discharge. Objective: The aim of the TEL-HEMATO study was to improve our telehealth platform for the follow-up of patients undergoing HCT or CAR T-cell therapy during the first 3 months after discharge with the addition of wearable devices. Methods: Eleven patients who received autologous (n=2) or allogeneic (n=5) HCT or CAR T-cell therapy (n=4) for hematological malignancies were screened from November 2022 to July 2023. Two patients discontinued the study after enrollment. The telehealth platform consisted of the daily collection of vital signs, physical symptoms, and quality of life assessment up to 3 months after hospital discharge. Each patient received a clinically validated smartwatch (ScanWatch) and a digital thermometer, and a dedicated smartphone app was used to collect these data. Daily revision of the data was performed through a web-based platform by a hematologist or a nurse specialized in HCT and CAR T-cell therapy. Results: Vital signs measured through ScanWatch were successfully collected with medium/high adherence: heart rate was recorded in 8/9 (89\%) patients, oxygen saturation and daily steps were recorded in 9/9 (100\%) patients, and sleeping hours were recorded in 7/9 (78\%) patients. However, temperature recorded manually by the patients was associated with lower compliance, which was recorded in 5/9 (55\%) patients. Overall, 5/9 (55\%) patients reported clinical symptoms in the app. Quality of life assessment was completed by 8/9 (89\%) patients at study enrollment, which decreased to 3/9 (33\%) at the end of the third month. Usability was considered acceptable through ratings provided on the System Usability Scale. However, technological issues were reported by the patients. Conclusions: While the addition of wearable devices to a telehealth clinical platform could have potentially synergic benefits for HCT and CAR T-cell therapy patient monitoring, noncomplete automation of the platform and the absence of a dedicated telemedicine team still represent major limitations to be overcome. This is especially true in our real-life setting where the target population generally comprises patients of older age with a low digital education level. ",
doi="10.2196/55918",
url="https://formative.jmir.org/2024/1/e55918",
url="http://www.ncbi.nlm.nih.gov/pubmed/38833696"
}


@Article{info:doi/10.2196/50715,
author="Alhammad, Nasser
and Alajlani, Mohannad
and Abd-alrazaq, Alaa
and Epiphaniou, Gregory
and Arvanitis, Theodoros",
title="Patients' Perspectives on the Data Confidentiality, Privacy, and Security of mHealth Apps: Systematic Review",
journal="J Med Internet Res",
year="2024",
month="May",
day="31",
volume="26",
pages="e50715",
keywords="mobile health apps",
keywords="mHealth apps",
keywords="mobile health",
keywords="privacy",
keywords="confidentiality",
keywords="security",
keywords="awareness",
keywords="perspectives",
keywords="mobile phone",
abstract="Background: Mobile health (mHealth) apps have the potential to enhance health care service delivery. However, concerns regarding patients' confidentiality, privacy, and security consistently affect the adoption of mHealth apps. Despite this, no review has comprehensively summarized the findings of studies on this subject matter. Objective: This systematic review aims to investigate patients' perspectives and awareness of the confidentiality, privacy, and security of the data collected through mHealth apps. Methods: Using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a comprehensive literature search was conducted in 3 electronic databases: PubMed, Ovid, and ScienceDirect. All the retrieved articles were screened according to specific inclusion criteria to select relevant articles published between 2014 and 2022. Results: A total of 33 articles exploring mHealth patients' perspectives and awareness of data privacy, security, and confidentiality issues and the associated factors were included in this systematic review. Thematic analyses of the retrieved data led to the synthesis of 4 themes: concerns about data privacy, confidentiality, and security; awareness; facilitators and enablers; and associated factors. Patients showed discordant and concordant perspectives regarding data privacy, security, and confidentiality, as well as suggesting approaches to improve the use of mHealth apps (facilitators), such as protection of personal data, ensuring that health status or medical conditions are not mentioned, brief training or education on data security, and assuring data confidentiality and privacy. Similarly, awareness of the subject matter differed across the studies, suggesting the need to improve patients' awareness of data security and privacy. Older patients, those with a history of experiencing data breaches, and those belonging to the higher-income class were more likely to raise concerns about the data security and privacy of mHealth apps. These concerns were not frequent among patients with higher satisfaction levels and those who perceived the data type to be less sensitive. Conclusions: Patients expressed diverse views on mHealth apps' privacy, security, and confidentiality, with some of the issues raised affecting technology use. These findings may assist mHealth app developers and other stakeholders in improving patients' awareness and adjusting current privacy and security features in mHealth apps to enhance their adoption and use. Trial Registration: PROSPERO CRD42023456658; https://tinyurl.com/ytnjtmca ",
doi="10.2196/50715",
url="https://www.jmir.org/2024/1/e50715",
url="http://www.ncbi.nlm.nih.gov/pubmed/38820572"
}


@Article{info:doi/10.2196/53141,
author="Cohen Elimelech, Ortal
and Rosenblum, Sara
and Tsadok-Cohen, Michal
and Meyer, Sonya
and Ferrante, Simona
and Demeter, Naor",
title="Three Perspectives on Older Adults' Daily Performance, Health, and Technology Use During COVID-19: Focus Group Study",
journal="JMIR Aging",
year="2024",
month="May",
day="30",
volume="7",
pages="e53141",
keywords="daily activity",
keywords="health",
keywords="technology use",
keywords="older adult",
keywords="qualitative study",
keywords="focus group",
keywords="COVID-19",
abstract="Background: During COVID-19 lockdowns, older adults' engagement in daily activities was severely affected, causing negative physical and mental health implications. Technology flourished as a means of performing daily activities in this complex situation; however, older adults often struggled to effectively use these opportunities. Despite the important role of older adults' social environments---including their families and health professionals---in influencing their technology use, research into their unique perspectives is lacking. Objective: This study aimed to explore the daily activity performance, health, and technology use experiences of healthy independent Israeli adults (aged ?65 years) during COVID-19 from a 3-dimensional perspective: older adults, older adults' family members, and health professionals. Methods: Nine online focus groups, averaging 6-7 participants per group, were conducted with older adults, family members, and health professionals (N=59). Data were analyzed using thematic analysis and constant comparative methods. Results: The intertwining of daily activity performance and health emerged as a central theme, with differences between the groups. Older adults prioritized their self-fulfilling routines based on motivation and choice, especially in social-familial activities. In contrast, family members and health professionals focused on serious physical and mental health COVID-19--related consequences. A consensus among all three groups revealed the meaningful role of technology use during this period in bridging functional limitations. Participants delved into technology's transformative power, focusing on the need for technology to get engaged in daily activities. Conclusions: This study illustrates the profound interplay between daily activity performances, physical and mental health, and technology use, using a 3-dimensional approach. Its focus on technology's uses and benefits sheds light on what older adults need to increase their technology use. Interventions for improving digital activity performance can be tailored to meet older adults' needs and preferences by focusing on motivational and preference-related activities. ",
doi="10.2196/53141",
url="https://aging.jmir.org/2024/1/e53141"
}


@Article{info:doi/10.2196/55399,
author="Choudhury, Avishek
and Shamszare, Hamid",
title="The Impact of Performance Expectancy, Workload, Risk, and Satisfaction on Trust in ChatGPT: Cross-Sectional Survey Analysis",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="27",
volume="11",
pages="e55399",
keywords="ChatGPT",
keywords="chatbots",
keywords="health care",
keywords="health care decision-making",
keywords="health-related decision-making",
keywords="health care management",
keywords="decision-making",
keywords="user perception",
keywords="usability",
keywords="usable",
keywords="usableness",
keywords="usefulness",
keywords="artificial intelligence",
keywords="algorithms",
keywords="predictive models",
keywords="predictive analytics",
keywords="predictive system",
keywords="practical models",
keywords="deep learning",
keywords="cross-sectional survey",
abstract="Background: ChatGPT (OpenAI) is a powerful tool for a wide range of tasks, from entertainment and creativity to health care queries. There are potential risks and benefits associated with this technology. In the discourse concerning the deployment of ChatGPT and similar large language models, it is sensible to recommend their use primarily for tasks a human user can execute accurately. As we transition into the subsequent phase of ChatGPT deployment, establishing realistic performance expectations and understanding users' perceptions of risk associated with its use are crucial in determining the successful integration of this artificial intelligence (AI) technology. Objective: The aim of the study is to explore how perceived workload, satisfaction, performance expectancy, and risk-benefit perception influence users' trust in ChatGPT. Methods: A semistructured, web-based survey was conducted with 607 adults in the United States who actively use ChatGPT. The survey questions were adapted from constructs used in various models and theories such as the technology acceptance model, the theory of planned behavior, the unified theory of acceptance and use of technology, and research on trust and security in digital environments. To test our hypotheses and structural model, we used the partial least squares structural equation modeling method, a widely used approach for multivariate analysis. Results: A total of 607 people responded to our survey. A significant portion of the participants held at least a high school diploma (n=204, 33.6\%), and the majority had a bachelor's degree (n=262, 43.1\%). The primary motivations for participants to use ChatGPT were for acquiring information (n=219, 36.1\%), amusement (n=203, 33.4\%), and addressing problems (n=135, 22.2\%). Some participants used it for health-related inquiries (n=44, 7.2\%), while a few others (n=6, 1\%) used it for miscellaneous activities such as brainstorming, grammar verification, and blog content creation. Our model explained 64.6\% of the variance in trust. Our analysis indicated a significant relationship between (1) workload and satisfaction, (2) trust and satisfaction, (3) performance expectations and trust, and (4) risk-benefit perception and trust. Conclusions: The findings underscore the importance of ensuring user-friendly design and functionality in AI-based applications to reduce workload and enhance user satisfaction, thereby increasing user trust. Future research should further explore the relationship between risk-benefit perception and trust in the context of AI chatbots. ",
doi="10.2196/55399",
url="https://humanfactors.jmir.org/2024/1/e55399",
url="http://www.ncbi.nlm.nih.gov/pubmed/38801658"
}


@Article{info:doi/10.2196/54101,
author="Teh, Pei-Lee
and Kwok, J. Andrei O.
and Cheong, Loong Wing
and Lee, Shaun",
title="Insights Into the Use of a Digital Healthy Aging Coach (AGATHA) for Older Adults From Malaysia: App Engagement, Usability, and Impact Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="21",
volume="8",
pages="e54101",
keywords="digital health",
keywords="older adults",
keywords="digital divide",
keywords="aging",
keywords="pilot",
keywords="Malaysia",
keywords="coach",
keywords="digital access",
keywords="social barrier",
keywords="virtual",
keywords="virtual coach",
keywords="digital tool",
keywords="tool",
keywords="engagement",
keywords="gamification",
keywords="user experience",
keywords="app",
keywords="technology tool",
keywords="digital literacy",
keywords="user experience design",
keywords="decision support",
keywords="support",
abstract="Background: Digital inclusion is considered a pivotal social determinant of health, particularly for older adults who may face significant barriers to digital access due to physical, sensory, and social limitations. Avatar for Global Access to Technology for Healthy Aging (AGATHA) is a virtual healthy aging coach developed by the World Health Organization to address these challenges. Designed as a comprehensive virtual coach, AGATHA comprises a gamified platform that covers multiple health-related topics and modules aimed at fostering user engagement and promoting healthy aging. Objective: The aim of this study was to explore the perception and user experience of Malaysian older adults in their interactions with the AGATHA app and its avatar. The focus of this study was to examine the engagement, usability, and educational impact of the app on health literacy and digital skills. Methods: We performed a qualitative study among adults 60 years and older from suburban and rural communities across six states in Malaysia. Participants were purposefully recruited to ensure representation across various socioeconomic and cultural backgrounds. Each participant attended a 1-hour training session to familiarize themselves with the interface and functionalities of AGATHA. Subsequently, all participants were required to engage with the AGATHA app two to three times per week for up to 2 weeks. Upon completion of this trial phase, an in-depth interview session was conducted to gather detailed feedback on their experiences. Results: Overall, the participants found AGATHA to be highly accessible and engaging. The content was reported to have a comprehensive structure and was delivered in an easily understandable and informative manner. Moreover, the participants found the app to be beneficial in enhancing their understanding pertaining to health-related issues in aging. Some key feedback gathered highlighted the need for increased interactive features that would allow for interaction with peers, better personalization of content tailored to the individual's health condition, and improvement in the user-experience design to accommodate older users' specific needs. Furthermore, enhancements in decision-support features within the app were suggested to better assist users in making health decisions. Conclusions: The prototype digital health coaching program AGATHA was well received as a user-friendly tool suitable for beginners, and was also perceived to be useful to enhance older adults' digital literacy and confidence. The findings of this study offer important insights for designing other digital health tools and interventions targeting older adults, highlighting the importance of a user-centered design and personalization to improve the adoption of digital health solutions among older adults. This study also serves as a useful starting point for further development and refinement of digital health programs aimed at fostering an inclusive, supportive digital environment for older adults. ",
doi="10.2196/54101",
url="https://formative.jmir.org/2024/1/e54101",
url="http://www.ncbi.nlm.nih.gov/pubmed/38772022"
}


@Article{info:doi/10.2196/56125,
author="Kauppinen, Kaisa
and Keikhosrokiani, Pantea
and Khan, Sehrish",
title="Human-Centered Design and Benefit Realization Management in Digital Health Care Solution Development: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="21",
volume="13",
pages="e56125",
keywords="human-centered design",
keywords="digital health care solution",
keywords="electronic health record",
keywords="benefit realization management",
keywords="digital health care",
keywords="health care software",
keywords="digital health",
keywords="information technology",
keywords="IT",
keywords="usability",
abstract="Background: Earlier research shows that a significant number of resources are wasted on software projects delivering less than the planned benefits. It has, however, been evidenced that adopting a human-centered design approach when designing health devices can be beneficial. This understanding from earlier research has raised our interest in investigating how human-centered design might contribute to realizing the potential benefits of health care software projects. To our current knowledge, this intersection of human-centered design and benefit realization management has not yet comprehensively and consistently been researched within the context of digital health care solutions. Therefore, there is a need for evidence synthesis using systematic reviews to address this potential research gap. Objective: The objective of this study is to examine if human-centered design helps benefit realization management processes in the development of digital health care solutions and thereby enables better benefit realization. We explore the evidence of assumed or confirmed benefits of using human-centered design in the health care domain and whether better results have been reported when the benefit realization management process is followed. Methods: This protocol was developed following the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) guidelines. The proposed review would use a planned and systematic approach to identify, evaluate, and synthesize relevant and recent studies (reported in English) to see if there is evidence that using human-centered design and benefit realization management has a positive effect on realizing set benefits in those projects. We will commence a systematic literature search using human-centered design, benefit realization management, and health care--related search terms within 5 repositories (ACM Digital Library, PubMed Central, Scopus, PubMed, and Web of Science). After removing duplicate results, a preliminary scan for titles and abstracts will be done by at least 2 reviewers. Any incongruities regarding whether to include articles for full-text review will be resolved by a third reviewer based on the predefined criteria. Results: Initial queries of 2086 records have been executed and papers are being prescreened for inclusion. The search was initiated in December 2023 and the results are expected in 2024. We anticipate finding evidence of the use of human-centered design in the development of digital health care solutions. However, we expect evidence of benefitting from both human-centered design and benefit realization management in this context to be scarce. Conclusions: This protocol will guide the review of existing literature on the use of human-centered design and benefit realization management when developing digital health care solutions. The review will specifically focus on finding evidence of confirmed benefits derived from the use of human-centered design and benefit realization management. There may be an opportunity to gain a broader understanding of the tools or approaches that provide evidence of increased benefit realization within the health care domain. International Registered Report Identifier (IRRID): DERR1-10.2196/56125 ",
doi="10.2196/56125",
url="https://www.researchprotocols.org/2024/1/e56125",
url="http://www.ncbi.nlm.nih.gov/pubmed/38772023"
}


@Article{info:doi/10.2196/51952,
author="Ray, Jessica
and Finn, Benjamin Emily
and Tyrrell, Hollyce
and Aloe, F. Carlin
and Perrin, M. Eliana
and Wood, T. Charles
and Miner, S. Dean
and Grout, Randall
and Michel, J. Jeremy
and Damschroder, J. Laura
and Sharifi, Mona",
title="User-Centered Framework for Implementation of Technology (UFIT): Development of an Integrated Framework for Designing Clinical Decision Support Tools Packaged With Tailored Implementation Strategies",
journal="J Med Internet Res",
year="2024",
month="May",
day="21",
volume="26",
pages="e51952",
keywords="user-centered design",
keywords="implementation science",
keywords="clinical decision support",
keywords="human factors",
keywords="implementation",
keywords="decision support",
keywords="develop",
keywords="development",
keywords="framework",
keywords="frameworks",
keywords="design",
keywords="user-centered",
keywords="digital health",
keywords="health technology",
keywords="health technologies",
keywords="need",
keywords="needs",
keywords="tailor",
keywords="tailoring",
keywords="guidance",
keywords="guideline",
keywords="guidelines",
keywords="pediatric",
keywords="pediatrics",
keywords="child",
keywords="children",
keywords="obese",
keywords="obesity",
keywords="weight",
keywords="overweight",
keywords="primary care",
abstract="Background: Electronic health record--based clinical decision support (CDS) tools can facilitate the adoption of evidence into practice. Yet, the impact of CDS beyond single-site implementation is often limited by dissemination and implementation barriers related to site- and user-specific variation in workflows and behaviors. The translation of evidence-based CDS from initial development to implementation in heterogeneous environments requires a framework that assures careful balancing of fidelity to core functional elements with adaptations to ensure compatibility with new contexts. Objective: This study aims to develop and apply a framework to guide tailoring and implementing CDS across diverse clinical settings. Methods: In preparation for a multisite trial implementing CDS for pediatric overweight or obesity in primary care, we developed the User-Centered Framework for Implementation of Technology (UFIT), a framework that integrates principles from user-centered design (UCD), human factors/ergonomics theories, and implementation science to guide both CDS adaptation and tailoring of related implementation strategies. Our transdisciplinary study team conducted semistructured interviews with pediatric primary care clinicians and a diverse group of stakeholders from 3 health systems in the northeastern, midwestern, and southeastern United States to inform and apply the framework for our formative evaluation. Results: We conducted 41 qualitative interviews with primary care clinicians (n=21) and other stakeholders (n=20). Our workflow analysis found 3 primary ways in which clinicians interact with the electronic health record during primary care well-child visits identifying opportunities for decision support. Additionally, we identified differences in practice patterns across contexts necessitating a multiprong design approach to support a variety of workflows, user needs, preferences, and implementation strategies. Conclusions: UFIT integrates theories and guidance from UCD, human factors/ergonomics, and implementation science to promote fit with local contexts for optimal outcomes. The components of UFIT were used to guide the development of Improving Pediatric Obesity Practice Using Prompts, an integrated package comprising CDS for obesity or overweight treatment with tailored implementation strategies. Trial Registration: ClinicalTrials.gov NCT05627011; https://clinicaltrials.gov/study/NCT05627011 ",
doi="10.2196/51952",
url="https://www.jmir.org/2024/1/e51952",
url="http://www.ncbi.nlm.nih.gov/pubmed/38771622"
}


@Article{info:doi/10.2196/53206,
author="Bozorgmehr, Arezoo
and Thiem, Simon-Konstantin
and Wild, Dorothea
and Reinsdorff, Melanie
and Vollmar, Christian Horst
and Kappernagel, Annika
and Schloessler, Kathrin
and Weissbach, Sabine
and Pentzek, Michael
and Dehnen, Dorothea
and Drexler, Julia
and Mueller, Sigrid Beate
and Pilic, Larisa
and Lehmann, Lion
and Loescher, Susanne
and Hohmann, Darinka Elena
and Frank, Friederike
and Ates, G{\"u}lay
and Kersten, Susanne
and Mortsiefer, Achim
and Aretz, Benjamin
and Weltermann, Birgitta",
title="Use of the FallAkte Plus System as an IT Infrastructure for the North Rhine-Westphalian General Practice Research Network: Mixed Methods Usability Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="20",
volume="8",
pages="e53206",
keywords="primary care",
keywords="general practice research network",
keywords="physicians",
keywords="feasibility study",
keywords="IT infrastructure",
keywords="usability",
keywords="FallAkte",
keywords="FallAkte Plus system",
keywords="mixed methods usability study",
keywords="North Rhine-Westphalian general practice research network",
keywords="NRW-GPRN",
keywords="Germany",
keywords="German",
keywords="universities",
keywords="survey",
keywords="questionnaire",
keywords="participants",
abstract="Background: Primary care research networks can generate important information in the setting where most patients are seen and treated. However, this requires a suitable IT infrastructure (ITI), which the North Rhine-Westphalian general practice research network is looking to implement. Objective: This mixed methods research study aims to evaluate (study 1) requirements for an ITI and (study 2) the usability of an IT solution already available on the market, the FallAkte Plus (FA+) system for the North Rhine-Westphalian general practice research network, which comprises 8 primary care university institutes in Germany's largest state. Methods: In study 1, a survey was conducted among researchers from the institutes to identify the requirements for a suitable ITI. The questionnaire consisted of standardized questions with open-ended responses. In study 2, a mixed method approach combining a think-aloud approach and a quantitative survey was used to evaluate the usability and acceptance of the FA+ system among 3 user groups: researchers, general practitioners, and practice assistants. Respondents were asked to assess the usability with the validated system usability scale and to test a short questionnaire on vaccination management through FA+. Results: In study 1, five of 8 institutes participated in the requirements survey. A total of 32 user requirements related primarily to study management were identified, including data entry, data storage, and user access management. In study 2, a total of 36 participants (24 researchers and 12 general practitioners or practice assistants) were surveyed in the mixed methods study of an already existing IT solution. The tutorial video and handouts explaining how to use the FA+ system were well received. Researchers, unlike practice personnel, were concerned about data security and data protection regarding the system's emergency feature, which enables access to all patient data. The median overall system usability scale rating was 60 (IQR 33.0-85.0), whereby practice personnel (median 82, IQR 58.0-94.0) assigned higher ratings than researchers (median 44, IQR 14.0-61.5). Users appreciated the option to integrate data from practices and other health care facilities. However, they voted against the use of the FA+ system due to a lack of support for various study formats. Conclusions: Usability assessments vary markedly by professional group and role. In its current stage of development, the FA+ system does not fully meet the requirements for a suitable ITI. Improvements in the user interface, performance, interoperability, security, and advanced features are necessary to make it more effective and user-friendly. Collaborating with end users and incorporating their feedback are crucial for the successful development of any practice network research ITI. ",
doi="10.2196/53206",
url="https://formative.jmir.org/2024/1/e53206",
url="http://www.ncbi.nlm.nih.gov/pubmed/38767942"
}


@Article{info:doi/10.2196/53691,
author="Aspelund, Anna
and Valkonen, Paula
and Viitanen, Johanna
and Rauta, Virpi",
title="Designing for Improved Patient Experiences in Home Dialysis: Usability and User Experience Findings From User-Based Evaluation Study With Patients With Chronic Conditions",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="14",
volume="11",
pages="e53691",
keywords="usability",
keywords="UX",
keywords="user experience",
keywords="PX",
keywords="patient experience",
keywords="user-based evaluation",
keywords="patients",
keywords="eHealth",
keywords="digital health solution",
keywords="kidney disease",
keywords="home dialysis",
abstract="Background: Chronic kidney disease affects 10\% of the population worldwide, and the number of patients receiving treatment for end-stage kidney disease is forecasted to increase. Therefore, there is a pressing need for innovative digital solutions that increase the efficiency of care and improve patients' quality of life. The aim of the eHealth in Home Dialysis project is to create a novel eHealth solution, called eC4Me, to facilitate predialysis and home dialysis care for patients with chronic kidney disease. Objective: Our study aimed to evaluate the usability, user experience (UX), and patient experience (PX) of the first version of the eC4Me solution. Methods: We used a user-based evaluation approach involving usability testing, questionnaire, and interview methods. The test sessions were conducted remotely with 10 patients with chronic kidney disease, 5 of whom had used the solution in their home environment before the tests, while the rest were using it for the first time. Thematic analysis was used to analyze user test and questionnaire data, and descriptive statistics were calculated for the UMUX (Usability Metric for User Experience) scores. Results: Most usability problems were related to navigation, the use of terminology, and the presentation of health-related data. Despite usability challenges, UMUX ratings of the solution were positive overall. The results showed noteworthy variation in the expected benefits and perceived effort of using the solution. From a PX perspective, it is important that the solution supports patients' own health-related goals and fits with the needs of their everyday lives with the disease. Conclusions: A user-based evaluation is a useful and necessary part of the eHealth solution development process. Our study findings can be used to improve the usability and UX of the evaluated eC4Me solution. Patients should be actively involved in the solution development process when specifying what information is relevant for them. Traditional usability tests complemented with questionnaire and interview methods can serve as a meaningful methodological approach for gaining insight not only into usability but also into UX- and PX-related aspects of digital health solutions. ",
doi="10.2196/53691",
url="https://humanfactors.jmir.org/2024/1/e53691",
url="http://www.ncbi.nlm.nih.gov/pubmed/38743476"
}


@Article{info:doi/10.2196/45115,
author="Schnoor, Kyma
and Talboom-Kamp, A. Esther P. W.
and Hajti{\'c}, Muamer
and Chavannes, H. Niels
and Versluis, Anke",
title="Facilitators of and Barriers to the Use of a Digital Self-Management Service for Diagnostic Testing: Focus Group Study With Potential Users",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="10",
volume="11",
pages="e45115",
keywords="eHealth",
keywords="usability",
keywords="self-management",
keywords="diagnostic test service",
keywords="diagnostic",
keywords="testing",
keywords="test service",
keywords="perspective",
keywords="focus group",
keywords="user need",
keywords="user testing",
keywords="implementation",
keywords="qualitative",
keywords="test result",
keywords="laboratory test",
keywords="laboratory result",
abstract="Background: Health care lags in digital transformation, despite the potential of technology to improve the well-being of individuals. The COVID-19 pandemic has accelerated the uptake of technology in health care and increased individuals' willingness to perform self-management using technology. A web-based service, Directlab Online, provides consumers with direct digital access to diagnostic test packages, which can digitally support the self-management of health. Objective: This study aims to identify the facilitators, barriers, and needs of Directlab Online, a self-management service for web-based access to diagnostic testing. Methods: A qualitative method was used from a potential user's perspective. The needs and future needs for, facilitators of, and barriers to the use of Directlab Online were evaluated. Semistructured focus group meetings were conducted in 2022. Two focus groups were focused on sexually transmitted infection test packages and 2 were focused on prevention test packages. Data analysis was performed according to the principles of the Framework Method. The Consolidated Framework for Implementation Research was used to categorize the facilitators and barriers. Results: In total, 19 participants, with a mean age of 34.32 (SD 14.70) years, participated in the focus groups. Important barriers were a lack of privacy information, too much and difficult information, and a commercial appearance. Important facilitators were the right amount of information, the right kind of tests, and the involvement of a health care professional. The need for a service such as Directlab Online was to ensure its availability for users' health and to maintain their health. Conclusions: According to the participants, facilitators and barriers were comprehension of the information, the goal of the website, and the overall appearance of the service. Although the service was developed in cocreation with health care professionals and users, the needs did not align. The users preferred understandable and adequate, but not excessive, information. In addition, they preferred other types of tests to be available on the service. For future research, it would be beneficial to focus on cocreation between the involved medical professionals and users to develop, improve, and implement a service such as Directlab Online. ",
doi="10.2196/45115",
url="https://humanfactors.jmir.org/2024/1/e45115",
url="http://www.ncbi.nlm.nih.gov/pubmed/38728071"
}


@Article{info:doi/10.2196/53890,
author="Rizzi, Silvia
and Poggianella, Stefania
and Pavesi, Chiara Maria
and Gios, Lorenzo
and Bincoletto, Giorgia
and Scolari, Isabella
and Paoli, Claudia
and Marroni, Debora
and Tassinari, Irene
and Baietti, Barbara
and Gianatti, Anna
and Albertini, Veronica
and Burlon, Barbara
and Chiodega, Vanda
and Endrizzi, Barbara
and Benini, Elena
and Guella, Chiara
and Gadotti, Erik
and Forti, Stefano
and Taddei, Fabrizio",
title="A Mindfulness-Based App Intervention for Pregnant Women: Protocol for a Pilot Feasibility Study",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="10",
volume="13",
pages="e53890",
keywords="mindfulness",
keywords="promoting well-being",
keywords="pregnancy",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="mobile apps",
keywords="development",
keywords="usability",
keywords="user-centered design",
keywords="mindfulness based",
keywords="intervention",
keywords="pregnant women",
keywords="pregnant",
keywords="feasibility study",
keywords="well-being",
keywords="women",
keywords="quality of life",
keywords="psychological symptoms",
keywords="digital solution",
keywords="virtual coach",
keywords="smartphone",
keywords="mobile phone",
abstract="Background: Pregnancy is a complex time characterized by major transformations in a woman, which impact her physical, mental, and social well-being. How a woman adapts to these changes can affect her quality of life and psychological well-being. The literature indicates that pregnant women commonly experience psychological symptoms, with anxiety, stress, and depression being among the most frequent. Hence, promoting a healthy lifestyle focused on women's psychological well-being is crucial. Recently developed digital solutions have assumed a crucial role in supporting psychological well-being in physiologically pregnant women. Therefore, the need becomes evident for the development and implementation of digital solutions, such as a virtual coach implemented in a smartphone, as a support for the psychological well-being of pregnant women who do not present psychological and psychiatric disorders. Objective: This study aims to assess the feasibility, acceptability, and utility of a mindfulness-based mobile app. The primary objective is to explore the feasibility of using a virtual coach, Maia, developed within the TreC Mamma app to promote women's psychological well-being during pregnancy through a psychoeducational module based on mindfulness. Finally, through the delivery of this module, the level of psychological well-being will be explored as a secondary objective. Methods: This is a proof-of-concept study in which a small sample (N=50) is sufficient to achieve the intended purposes. Recruitment will occur within the group of pregnant women belonging to the pregnancy care services of the Trento Azienda Provinciale per i Servizi Sanitari di Trento. The convenience sampling method will be used. Maia will interact with the participating women for 8 weeks, starting from weeks 24 and 26 of pregnancy. Specifically, there will be 2 sessions per week, which the woman can choose, to allow more flexibility toward her needs. Results: The psychoeducational pathway is expected to lead to significant results in terms of usability and engagement in women's interactions with Maia. Furthermore, it is anticipated that there will be improvements in psychological well-being and overall quality of life. The analysis of the data collected in this study will be mainly descriptive, orientated toward assessing the achievement of the study objectives. Conclusions: Literature has shown that women preferred web-based support during the perinatal period, suggesting that implementing digital interventions can overcome barriers to social stigma and asking for help. Maia can be a valuable resource for regular psychoeducational support for women during pregnancy. International Registered Report Identifier (IRRID): RR1-10.2196/53890 ",
doi="10.2196/53890",
url="https://www.researchprotocols.org/2024/1/e53890",
url="http://www.ncbi.nlm.nih.gov/pubmed/38567964"
}


@Article{info:doi/10.2196/57155,
author="Smith, A. Katharine
and Hardy, Amy
and Vinnikova, Anastasia
and Blease, Charlotte
and Milligan, Lea
and Hidalgo-Mazzei, Diego
and Lambe, Sin{\'e}ad
and Marzano, Lisa
and Uhlhaas, J. Peter
and Ostinelli, G. Edoardo
and Anmella, Gerard
and Zangani, Caroline
and Aronica, Rosario
and Dwyer, Bridget
and Torous, John
and Cipriani, Andrea",
title="Digital Mental Health for Schizophrenia and Other Severe Mental Illnesses: An International Consensus on Current Challenges and Potential Solutions",
journal="JMIR Ment Health",
year="2024",
month="May",
day="8",
volume="11",
pages="e57155",
keywords="digital",
keywords="mental health",
keywords="severe mental illness",
keywords="consensus",
keywords="lived experience",
keywords="ethics",
keywords="user-centered design",
keywords="patient and public involvement",
keywords="mobile phone",
abstract="Background: Digital approaches may be helpful in augmenting care to address unmet mental health needs, particularly for schizophrenia and severe mental illness (SMI). Objective: An international multidisciplinary group was convened to reach a consensus on the challenges and potential solutions regarding collecting data, delivering treatment, and the ethical challenges in digital mental health approaches for schizophrenia and SMI. Methods: The consensus development panel method was used, with an in-person meeting of 2 groups: the expert group and the panel. Membership was multidisciplinary including those with lived experience, with equal participation at all stages and coproduction of the consensus outputs and summary. Relevant literature was shared in advance of the meeting, and a systematic search of the recent literature on digital mental health interventions for schizophrenia and psychosis was completed to ensure that the panel was informed before the meeting with the expert group. Results: Four broad areas of challenge and proposed solutions were identified: (1) user involvement for real coproduction; (2) new approaches to methodology in digital mental health, including agreed standards, data sharing, measuring harms, prevention strategies, and mechanistic research; (3) regulation and funding issues; and (4) implementation in real-world settings (including multidisciplinary collaboration, training, augmenting existing service provision, and social and population-focused approaches). Examples are provided with more detail on human-centered research design, lived experience perspectives, and biomedical ethics in digital mental health approaches for SMI. Conclusions: The group agreed by consensus on a number of recommendations: (1) a new and improved approach to digital mental health research (with agreed reporting standards, data sharing, and shared protocols), (2) equal emphasis on social and population research as well as biological and psychological approaches, (3) meaningful collaborations across varied disciplines that have previously not worked closely together, (4) increased focus on the business model and product with planning and new funding structures across the whole development pathway, (5) increased focus and reporting on ethical issues and potential harms, and (6) organizational changes to allow for true communication and coproduction with those with lived experience of SMI. This study approach, combining an international expert meeting with patient and public involvement and engagement throughout the process, consensus methodology, discussion, and publication, is a helpful way to identify directions for future research and clinical implementation in rapidly evolving areas and can be combined with measurements of real-world clinical impact over time. Similar initiatives will be helpful in other areas of digital mental health and similarly fast-evolving fields to focus research and organizational change and effect improved real-world clinical implementation. ",
doi="10.2196/57155",
url="https://mental.jmir.org/2024/1/e57155",
url="http://www.ncbi.nlm.nih.gov/pubmed/38717799"
}


@Article{info:doi/10.2196/54230,
author="Yun, Hyun Young
and Shin, Hoon Dong
and Choi, Jin Hyung",
title="Perspectives of Medical Students and Developers Regarding Virtual Reality, Augmented Reality, Mixed Reality, and 3D Printing Technologies: Survey Study",
journal="JMIR XR Spatial Comput",
year="2024",
month="May",
day="7",
volume="1",
pages="e54230",
keywords="medical student",
keywords="developer",
keywords="virtual reality",
keywords="augmented reality",
keywords="mixed reality",
keywords="3D printing",
keywords="perspective",
keywords="survey",
abstract="Background: Emerging technologies, such as virtual reality (VR), augmented reality (AR), mixed reality (MR), and 3D printing (3DP), have transformative potential in education and health care. However, complete integration has not yet been achieved, and routine use is limited. There may exist gaps in the perspectives of these technologies between users and developers, and improvement may be necessary in developing such technologies. Objective: The purpose of this study was to investigate the gaps in perspectives between medical students and developers in medical education regarding satisfaction and anticipated future use of VR, AR, MR, and 3DP technologies, as well as developers' perspectives on their advantages and current challenges. Methods: This retrospective survey study was conducted during a 4-hour elective course over a period of 4 weeks. In this course, computed tomography scans of congenital heart disease patients, medical image processing software, head-mounted displays, and a virtual table were used. Student pre- and postsurveys and the developer survey included demographic and other characteristics, satisfaction, and anticipated future use of VR, AR, MR, and 3DP technologies. The advantages and current challenges of these technologies were only assessed in the developer survey. Results: The study enrolled 41 participants, including 15 first-year medical students and 26 software and content developers. Students were more satisfied than developers across AR, VR, and 3DP in terms of overall satisfaction (VR and AR: P<.001; 3DP: P=.002), esthetics (VR: all P<.001; AR: vividness, P=.006 and design, P<.001; 3DP: vividness, P=.001 and design, P=.002), and continuous use intention (VR: repetition, P=.04 and continuous use, P=.02). Particularly in VR, satisfaction with reality was higher among students than among developers (real world, P=.006). Developers anticipated future use of MR for educating medical students and residents, individual and collaborative surgical planning, and performing surgery on patients. In contrast, students anticipated future use of VR primarily for student education, 3DP for resident education and individual surgical planning, and AR for collaborative surgical planning and performing surgery on patients. Developers perceived the inherent capabilities of VR, AR, and MR technologies as strengths, with hardware performance identified as a drawback. For 3DP, the possibility of customized product manufacturing was seen as an advantage, while cost was seen as a disadvantage. Conclusions: This study elucidated the different perspectives between medical students and developers regarding 3D technologies, highlighting the discrepancy in potential applications and challenges within the medical field. These findings will guide the integration of 3D technologies in education and health care to fulfill the needs and goals of both medical students and developers. ",
doi="10.2196/54230",
url="https://xr.jmir.org/2024/1/e54230"
}


@Article{info:doi/10.2196/54120,
author="Ausserhofer, Dietmar
and Piccoliori, Giuliano
and Engl, Adolf
and Mahlknecht, Angelika
and Plagg, Barbara
and Barbieri, Verena
and Colletti, Nicoletta
and Lombardo, Stefano
and G{\"a}rtner, Timon
and Tappeiner, Waltraud
and Wieser, Heike
and Wiedermann, Josef Christian",
title="Community-Dwelling Older Adults' Readiness for Adopting Digital Health Technologies: Cross-Sectional Survey Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="30",
volume="8",
pages="e54120",
keywords="frail older adults",
keywords="Italy",
keywords="Italian",
keywords="Europe",
keywords="European",
keywords="digital health",
keywords="health technologies",
keywords="health technology",
keywords="telemedicine",
keywords="telehealth",
keywords="eHealth",
keywords="e-health",
keywords="adoption",
keywords="readiness",
keywords="usage",
keywords="survey",
keywords="surveys",
keywords="questionnaire",
keywords="questionnaires",
keywords="robotics",
keywords="cross-sectional study",
keywords="population-based survey",
keywords="stratified probabilistic sampling",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adult",
keywords="older adults",
keywords="elder",
keywords="elderly",
keywords="older person",
keywords="older people",
keywords="ageing",
keywords="aging",
abstract="Background: Digital health technologies offer the potential to improve the daily lives of older adults, maintain their health efficiently, and allow aging in place. Despite increasing evidence of benefits and advantages, readiness for adopting digital interventions among older people remains underexplored. Objective: This study aims to explore the relationships between sociodemographic-, health-, and lifestyle-related factors and technology use in everyday life and community-dwelling older adults' readiness to adopt telemedicine, smartphones with texting apps, wearables, and robotics. Methods: This was a cross-sectional, population-based survey study with a stratified probabilistic sample of adults aged 75 years or older living in South Tyrol (autonomous province of Bolzano/Bozen, Italy). A random sample of 3600 community-dwelling older adults living at home was invited to complete a questionnaire including single items (older adults' readiness to use health technology) and scales (PRISMA-7; Program of Research on Integration of Services for the Maintenance of Autonomy). Descriptive and logistic regression analyses were performed to analyze the data. Results: In total, 1695 community-dwelling older adults completed the survey (for a response rate of 47\%). In terms of potential digital health technology adoption, wearable devices were favored by 33.7\% (n=571), telemedicine by 30.1\% (n=510), smartphones and texting apps by 24.5\% (n=416), and assistant robots by 13.7\% (n=232). Sociodemographic-, health- and lifestyle-related factors, as well as the use of technology in everyday life, played a significant role in explaining readiness to adopt digital health technologies. For telemedicine, age ?85 years (odds ratio [OR] 0.74, 95\% CI 0.56-0.96), financial constraints (OR 0.68, 95\% CI 0.49-0.95), and less than 2 hours of physical activity per week (OR 0.75, 95\% CI 0.58-0.98) were associated with nonreadiness, while Italian-speaking participants (OR 1.54, 95\% CI 1.16-2.05) and those regularly using computers (OR 1.74, 95\% CI 1.16-2.60), smartphones (OR 1.69, 95\% CI 1.22-2.35), and the internet (OR 2.26, 95\% CI 1.47-3.49) reported readiness for adoption. Conclusions: Community-dwelling older adults display varied readiness toward the adoption of digital health technologies, influenced by age, mother tongue, living situation, financial resources, physical activity, and current use of technology. The findings underscore the need for tailored interventions and educational programs to boost digital health technology adoption among community-dwelling older adults. ",
doi="10.2196/54120",
url="https://formative.jmir.org/2024/1/e54120",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687989"
}


@Article{info:doi/10.2196/51587,
author="Fink, Franziska
and Kalter, Ivonne
and Steindorff, Jenny-Victoria
and Helmbold, Konrad Hans
and Paulicke, Denny
and Jahn, Patrick",
title="Identifying Factors of User Acceptance of a Drone-Based Medication Delivery: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="30",
volume="11",
pages="e51587",
keywords="human-drone interaction",
keywords="medical supplies",
keywords="participative research",
keywords="user-centered design",
keywords="technology acceptance",
abstract="Background: The use of drones in the health care sector is increasingly being discussed against the background of the aging population and the growing shortage of skilled workers. In particular, the use of drones to provide medication in rural areas could bring advantages for the care of people with and without a need for care. However, there are hardly any data available that focus on the interaction between humans and drones. Objective: This study aims to disclose and analyze factors associated with user acceptance of drone-based medication delivery to derive practice-relevant guidance points for participatory technology development (for apps and drones). Methods: A controlled mixed methods study was conducted that supports the technical development process of an app design for drone-assisted drug delivery based on a participatory research design. For the quantitative analysis, established and standardized survey instruments to capture technology acceptance, such as the System Usability Scale; Technology Usage Inventory (TUI); and the Motivation, Engagement, and Thriving in User Experience model, were used. To avoid possible biasing effects from a continuous user development (eg, response shifts and learning effects), an ad hoc group was formed at each of the 3 iterative development steps and was subsequently compared with the consisting core group, which went through all 3 iterations. Results: The study found a positive correlation between the usability of a pharmacy drone app and participants' willingness to use it (r=0.833). Participants' perception of usefulness positively influenced their willingness to use the app (r=0.487; TUI). Skepticism had a negative impact on perceived usability and willingness to use it (r=?0.542; System Usability Scale and r=?0.446; TUI). The study found that usefulness, skepticism, and curiosity explained most of the intention to use the app (F3,17=21.12; P<.001; R2=0.788; adjusted R2=0.751). The core group showed higher ratings on the intention to use the pharmacy drone app than the ad hoc groups. Results of the 2-tailed t tests showed a higher rating on usability for the third iteration of the core group compared with the first iteration. Conclusions: With the help of the participatory design, important aspects of acceptance could be revealed by the people involved in relation to drone-assisted drug delivery. For example, the length of time spent using the technology is an important factor for the intention to use the app. Technology-specific factors such as user-friendliness or curiosity are directly related to the use acceptance of the drone app. Results of this study showed that the more participants perceived their own competence in handling the app, the more they were willing to use the technology and the more they rated the app as usable. ",
doi="10.2196/51587",
url="https://humanfactors.jmir.org/2024/1/e51587",
url="http://www.ncbi.nlm.nih.gov/pubmed/38687589"
}


@Article{info:doi/10.2196/54645,
author="Asano, Masaki
and Imai, Shungo
and Shimizu, Yuri
and Kizaki, Hayato
and Ito, Yukiko
and Tsuchiya, Makoto
and Kuriyama, Ryoko
and Yoshida, Nao
and Shimada, Masanori
and Sando, Takanori
and Ishijima, Tomo
and Hori, Satoko",
title="Factor Analysis of Patients Who Find Tablets or Capsules Difficult to Swallow Due to Their Large Size: Using the Personal Health Record Infrastructure of Electronic Medication Notebooks",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="24",
volume="26",
pages="e54645",
keywords="tablet",
keywords="tablets",
keywords="capsules",
keywords="capsule",
keywords="size",
keywords="personal health record",
keywords="electronic medication notebook",
keywords="patient preference",
keywords="drug",
keywords="drugs",
keywords="pharmacy",
keywords="pharmacies",
keywords="pharmacology",
keywords="pharmacotherapy",
keywords="pharmaceutic",
keywords="pharmaceutics",
keywords="pharmaceuticals",
keywords="pharmaceutical",
keywords="medication",
keywords="medications",
keywords="preference",
keywords="preferences",
keywords="pill",
keywords="pills",
keywords="machine learning",
keywords="decision tree",
keywords="swallow",
keywords="swallowing",
keywords="throat",
keywords="pharynx",
keywords="risk",
keywords="risks",
keywords="dysphagia",
keywords="speech",
keywords="mobile phone",
abstract="Background: Understanding patient preference regarding taking tablet or capsule formulations plays a pivotal role in treatment efficacy and adherence. Therefore, these preferences should be taken into account when designing formulations and prescriptions. Objective: This study investigates the factors affecting patient preference in patients who have difficulties swallowing large tablets or capsules and aims to identify appropriate sizes for tablets and capsules. Methods: A robust data set was developed based on a questionnaire survey conducted from December 1, 2022, to December 7, 2022, using the harmo smartphone app operated by harmo Co, Ltd. The data set included patient input regarding their tablet and capsule preferences, personal health records (including dispensing history), and drug formulation information (available from package inserts). Based on the medication formulation information, 6 indices were set for each of the tablets or capsules that were considered difficult to swallow owing to their large size and concomitant tablets or capsules (used as controls). Receiver operating characteristic (ROC) analysis was used to evaluate the performance of each index. The index demonstrating the highest area under the curve of the ROC was selected as the best index to determine the tablet or capsule size that leads to swallowing difficulties. From the generated ROCs, the point with the highest discriminative performance that maximized the Youden index was identified, and the optimal threshold for each index was calculated. Multivariate logistic regression analysis was performed to identify the risk factors contributing to difficulty in swallowing oversized tablets or capsules. Additionally, decision tree analysis was performed to estimate the combined risk from several factors, using risk factors that were significant in the multivariate logistic regression analysis. Results: This study analyzed 147 large tablets or capsules and 624 control tablets or capsules. The ``long diameter + short diameter + thickness'' index (with a 21.5 mm threshold) was identified as the best indicator for causing swallowing difficulties in patients. The multivariate logistic regression analysis (including 132 patients with swallowing difficulties and 1283 patients without) results identified the following contributory risk factors: aged <50 years (odds ratio [OR] 1.59, 95\% CI 1.03-2.44), female (OR 2.54, 95\% CI 1.70-3.78), dysphagia (OR 3.54, 95\% CI 2.22-5.65), and taking large tablets or capsules (OR 9.74, 95\% CI 5.19-18.29). The decision tree analysis results suggested an elevated risk of swallowing difficulties for patients with taking large tablets or capsules. Conclusions: This study identified the most appropriate index and threshold for indicating that a given tablet or capsule size will cause swallowing difficulties, as well as the contributory risk factors. Although some sampling biases (eg, only including smartphone users) may exist, our results can guide the design of patient-friendly formulations and prescriptions, promoting better medication adherence. ",
doi="10.2196/54645",
url="https://www.jmir.org/2024/1/e54645",
url="http://www.ncbi.nlm.nih.gov/pubmed/38657229"
}


@Article{info:doi/10.2196/53053,
author="Elkefi, Safa
and Asan, Onur",
title="Validating the Effectiveness of the Patient-Centered Cancer Care Framework by Assessing the Impact of Work System Factors on Patient-Centered Care and Quality of Care: Interview Study With Newly Diagnosed Cancer Patients",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="24",
volume="11",
pages="e53053",
keywords="cancer",
keywords="communication",
keywords="trust",
keywords="satisfaction",
keywords="technology",
keywords="workload",
keywords="work system factors",
abstract="Background: Patients with cancer who have recently been diagnosed have distinct requirements compared to cancer survivors. It is crucial to take into account their unique needs to ensure that they make informed decisions and are receptive to the care provided. Objective: This study suggested a framework titled Effectiveness of Patient-Centered Cancer Care that considers the needs of newly diagnosed patients with cancer and related work system factors. This study investigated how work system factors influence the perceptions of patient-centered care, quality of care, and associated outcomes among newly diagnosed patients with cancer. Patient-centered care is defined in terms of workload and communication considerations, whereas the quality of care is assessed through indicators such as trust in physicians, satisfaction with care, and perceptions of technology. Methods: This study used qualitative data collected through interviews with newly diagnosed patients with cancer (N=20) right after their first visits with their physicians. Thematic analysis was conducted to validate the 5 hypotheses of the framework, mapping the interactions among quality of care, patient-centered care, and work system factors. Results: We found that workload and patient-centered communication impact the quality of care and that the work system elements impact the patient-centeredness (workload and communication) and the quality of care (trust in physicians, satisfaction with care, and perception of technology use). Conclusions: Qualitatively validating the proposed Effectiveness of Patient-Centered Cancer Care framework, this study demonstrated its efficacy in elucidating the interplay of various factors. The framework holds promise for informing interventions geared toward enhancing patients' experiences during their initial visits after diagnosis. There is a pressing need for heightened attention to the organizational design, patient processes, and collaborative efforts among diverse stakeholders and providers to optimize the overall patient experience. ",
doi="10.2196/53053",
url="https://humanfactors.jmir.org/2024/1/e53053",
url="http://www.ncbi.nlm.nih.gov/pubmed/38656776"
}


@Article{info:doi/10.2196/53362,
author="?erne, Tina
and Turk, Eva
and Mirosevic, Spela
and Rotar Pavli{\v c}, Danica",
title="Needs and Experiences With Health Care Providers of Adult Rare Disease Patients and Caregivers of People With Rare Diseases: Protocol for a Qualitative Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="22",
volume="13",
pages="e53362",
keywords="rare diseases",
keywords="patients",
keywords="caregivers",
keywords="needs",
keywords="barriers",
keywords="access to health care",
abstract="Background: Rare diseases in Europe are defined as diseases with a prevalence of less than 5 per 10,000 people. Despite their individual rarity, the total number of rare diseases is considerable. Rare diseases are often chronic and complex, affecting physical, mental, and neurological health. People with rare diseases face challenges such as delayed diagnosis, limited medical support, and financial burden. Caregivers, usually family members, bear significant physical and emotional burdens. Understanding the experiences of patients with rare disease and their caregivers is critical to effective care, but this is still underresearched. Better support and understanding of the challenges faced by both patients and caregivers is clearly needed. Our study will explore the experiences and needs of people with rare diseases and caregivers of people with rare diseases in relation to accessing health services. Objective: This study aims to explore the experiences of patients with rare disease and their caregivers with Slovenian health care providers and to create a theoretical model of needs and experiences. Methods: This is a qualitative thematic analysis study, using the codebook approach. The study will conduct semi--open-ended interviews to understand the experiences and needs of people with rare diseases and caregivers of people with rare diseases in relation to accessing health services. The interview questions will be based on an extensive literature review. Data from the interviews will be analyzed using thematic analysis to identify patterns and build a thematic map. Data will be analyzed by at least 2 coders. To ensure reliability, respondent validation will be conducted and negative cases investigated. Any discrepancies will be resolved by consulting the entire research team until a consensus is reached. Results: This study was not specifically funded. However, author T? is supported by grant number P3-0339 from the Slovenian Agency for Research and Innovation. This study was approved by the Medical Ethics Committee of the Republic of Slovenia (0120-47/2022/3), and recruitment is expected to begin in May 2024, with data analysis results anticipated by the end of 2025. Conclusions: This study will fill an important research gap in Slovenia by exploring the needs and experiences of people living with rare diseases and their caregivers. The results will contribute to the broader field of rare diseases and add knowledge that can inform future research processes and intervention strategies. It also aims to identify neglected areas that have a significant impact on the lives of people with rare diseases. This study is important not only because it addresses the immediate needs of the Slovenian rare disease community, but also because it contributes to a discussion on patient-centered care, health policy design, and the inclusion of psychosocial components in health care. International Registered Report Identifier (IRRID): PRR1-10.2196/53362 ",
doi="10.2196/53362",
url="https://www.researchprotocols.org/2024/1/e53362",
url="http://www.ncbi.nlm.nih.gov/pubmed/38648088"
}


@Article{info:doi/10.2196/51779,
author="Robertson, Ciara
and Hibberd, Carina
and Shepherd, Ashley
and Johnston, Gordon",
title="How a National Organization Works in Partnership With People Who Have Lived Experience in Mental Health Improvement Programs: Protocol for an Exploratory Case Study",
journal="JMIR Res Protoc",
year="2024",
month="Apr",
day="19",
volume="13",
pages="e51779",
keywords="partnership",
keywords="engagement",
keywords="case study",
keywords="mental health",
keywords="improvement",
keywords="national program",
keywords="quality improvement",
abstract="Background: This is a research proposal for a case study to explore how a national organization works in partnership with people with lived experience in national mental health improvement programs. Quality improvement is considered a key solution to addressing challenges within health care, and in Scotland, there are significant efforts to use quality improvement as a means of improving health and social care delivery. In 2016, Healthcare Improvement Scotland (HIS) established the improvement hub, whose purpose is to lead national improvement programs that use a range of approaches to support teams and services. Working in partnership with people with lived experience is recognized as a key component of such improvement work. There is, however, little understanding of how this is manifested in practice in national organizations. To address gaps in evidence and strengthen a consistent approach, a greater understanding is required to improve partnership working. Objective: The aim of this study is to better understand how a national organization works in partnership with people who have lived experience with improvement programs in mental health services, exploring people's experiences of partnership working in a national organization. An exploratory case study approach will be used to address the research questions in relation to the Personality Disorder (PD) Improvement Programme: (1) How is partnership working described in the PD Improvement Programme? (2) How is partnership working manifested in practice in the PD Improvement Programme? and (3) What factors influence partnership working in the PD Improvement Programme? Methods: An exploratory case study approach will be used in relation to the PD Improvement Programme, led by HIS. This research will explore how partnership working with people with lived experience is described and manifested in practice, outlining factors influencing partnership working. Data will be gathered from various qualitative sources, and analysis will deepen an understanding of partnership working. Results: This study is part of a clinical doctorate program at the University of Stirling and is unfunded. Data collection was completed in October 2023; analysis is expected to be completed and results will be published in January 2025. Conclusions: This study will produce new knowledge on ways of working with people with lived experience and will have practical implications for all improvement-focused interventions. Although the main focus of the study is on national improvement programs, it is anticipated that this study will contribute to the understanding of how all national public service organizations work in partnership with people with lived experience of mental health care. International Registered Report Identifier (IRRID): DERR1-10.2196/51779 ",
doi="10.2196/51779",
url="https://www.researchprotocols.org/2024/1/e51779",
url="http://www.ncbi.nlm.nih.gov/pubmed/38640479"
}


@Article{info:doi/10.2196/50219,
author="Bults, Marloes
and van Leersum, Margaretha Catharina
and Olthuis, Josef Theodorus Johannes
and Siebrand, Egbert
and Malik, Zohrah
and Liu, Lili
and Miguel-Cruz, Antonio
and Jukema, Seerp Jan
and den Ouden, Maria Marjolein Elisabeth",
title="Acceptance of a Digital Assistant (Anne4Care) for Older Adult Immigrants Living With Dementia: Qualitative Descriptive Study",
journal="JMIR Aging",
year="2024",
month="Apr",
day="19",
volume="7",
pages="e50219",
keywords="assistive technology",
keywords="technology acceptance",
keywords="immigrant",
keywords="dementia",
keywords="marginalized older adults",
abstract="Background: There is a need to develop and coordinate dementia care plans that use assistive technology for vulnerable groups such as immigrant populations. However, immigrant populations are seldom included in various stages of the development and implementation of assistive technology, which does not optimize technology acceptance. Objective: This study aims to gain an in-depth understanding of the acceptance of a digital personal assistant, called Anne4Care, by older adult immigrants living with dementia in their own homes. Methods: This study used a qualitative descriptive research design with naturalistic inquiry. A total of 13 older adults participated in this study. The participants were invited for 2 interviews. After an introduction of Anne4Care, the first interview examined the lives and needs of participants, their expectations, and previous experiences with assistive technology in daily life. Four months later, the second interview sought to understand facilitators and barriers, suggestions for modifications, and the role of health care professionals. Three semistructured interviews were conducted with health care professionals to examine the roles and challenges they experienced in the use and implementation of Anne4Care. Content analysis, using NVivo11, was performed on all transcripts. Results: All 13 participants had an immigration background. There were 10 male and 3 female participants, with ages ranging from 52 to 83 years. Participants were diagnosed with an early-stage form of dementia or acquired brain injury. None of the older adult participants knew or used digital assistive technology at the beginning. They obtained assistance from health care professionals and family caregivers who explained and set up the technology. Four themes were found to be critical aspects of the acceptance of the digital personal assistant Anne4Care: (1) use of Anne4Care, (2) positive aspects of Anne4Care, (3) challenges with Anne4Care, and (4) expectations. Assistance at first increased the burden on health care professionals and families. After the initial effort, most health care professionals and families experienced that Anne4Care reduced their tasks and stress. Contributions of Anne4Care included companionship, help with daily tasks, and opportunities to communicate in multiple languages. On the other hand, some participants expressed anxiety toward the use of Anne4Care. Furthermore, the platform required an internet connection at home and Anne4Care could not be used outside the home. Conclusions: Although older adult immigrants living with dementia had no previous experience with digital assistive technology specifically, the acceptance of the digital personal assistant, called Anne4Care, by older adult immigrants living with dementia was rather high. The digital assistant can be further developed to allow for interactive conversations and for use outside of one's home. Participation of end users during various stages of the development, refinement, and implementation of health technology innovations is of utmost importance to maximize technology acceptance. ",
doi="10.2196/50219",
url="https://aging.jmir.org/2024/1/e50219",
url="http://www.ncbi.nlm.nih.gov/pubmed/38639994"
}


@Article{info:doi/10.2196/48793,
author="Wahl, J. Kate
and Brooks, Melissa
and Trenaman, Logan
and Desjardins-Lorimer, Kirsten
and Bell, M. Carolyn
and Chokmorova, Nazgul
and Segall, Romy
and Syring, Janelle
and Williams, Aleyah
and Li, C. Linda
and Norman, V. Wendy
and Munro, Sarah",
title="User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study",
journal="J Med Internet Res",
year="2024",
month="Apr",
day="16",
volume="26",
pages="e48793",
keywords="family planning",
keywords="abortion",
keywords="shared decision-making",
keywords="patient decision aid",
keywords="qualitative",
keywords="evaluation",
keywords="Canada",
keywords="health equity",
abstract="Background: People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive---there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices. Objective: We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction. Methods: We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers' decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy (``patient'' participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses. Results: A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100\%; health care professionals: n=22, 88\%), was not missing information (patients: n=21, 84\%; health care professionals: n=18, 72\%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92\%; health care professionals: n=23, 92\%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly. Conclusions: We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making. ",
doi="10.2196/48793",
url="https://www.jmir.org/2024/1/e48793",
url="http://www.ncbi.nlm.nih.gov/pubmed/38625731"
}


@Article{info:doi/10.2196/49751,
author="Lyzwinski, Nathalie Lynnette
and Elgendi, Mohamed
and Menon, Carlo",
title="Users' Acceptability and Perceived Efficacy of mHealth for Opioid Use Disorder: Scoping Review",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Apr",
day="11",
volume="12",
pages="e49751",
keywords="acceptability",
keywords="addict",
keywords="addiction",
keywords="addictions",
keywords="app",
keywords="app-based",
keywords="application",
keywords="applications",
keywords="apps",
keywords="barrier",
keywords="barriers",
keywords="challenge",
keywords="challenges",
keywords="messaging",
keywords="mHealth",
keywords="mobile health",
keywords="monitoring",
keywords="opioid",
keywords="opioids",
keywords="overdose",
keywords="overdosing",
keywords="pharmacology",
keywords="review methodology",
keywords="review methods",
keywords="scoping",
keywords="sensor",
keywords="sensors",
keywords="SMS",
keywords="substance abuse",
keywords="substance use",
keywords="text message",
keywords="wearable technology",
keywords="wearable",
keywords="wearables",
abstract="Background: The opioid crisis continues to pose significant challenges to global public health, necessitating the development of novel interventions to support individuals in managing their substance use and preventing overdose-related deaths. Mobile health (mHealth), as a promising platform for addressing opioid use disorder, requires a comprehensive understanding of user perspectives to minimize barriers to care and optimize the benefits of mHealth interventions. Objective: This study aims to synthesize qualitative insights into opioid users' acceptability and perceived efficacy of mHealth and wearable technologies for opioid use disorder. Methods: A scoping review of PubMed (MEDLINE) and Google Scholar databases was conducted to identify research on opioid user perspectives concerning mHealth-assisted interventions, including wearable sensors, SMS text messaging, and app-based technology. Results: Overall, users demonstrate a high willingness to engage with mHealth interventions to prevent overdose-related deaths and manage opioid use. Users perceive mHealth as an opportunity to access care and desire the involvement of trusted health care professionals in these technologies. User comfort with wearing opioid sensors emerged as a significant factor. Personally tailored content, social support, and encouragement are preferred by users. Privacy concerns and limited access to technology pose barriers to care. Conclusions: To maximize benefits and minimize risks for users, it is crucial to implement robust privacy measures, provide comprehensive user training, integrate behavior change techniques, offer professional and peer support, deliver tailored messages, incorporate behavior change theories, assess readiness for change, design stigma-reducing apps, use visual elements, and conduct user-focused research for effective opioid management in mHealth interventions. mHealth demonstrates considerable potential as a tool for addressing opioid use disorder and preventing overdose-related deaths, given the high acceptability and perceived benefits reported by users. ",
doi="10.2196/49751",
url="https://mhealth.jmir.org/2024/1/e49751",
url="http://www.ncbi.nlm.nih.gov/pubmed/38602751"
}


@Article{info:doi/10.2196/45978,
author="Haslam-Larmer, Lynn
and Grigorovich, Alisa
and Shum, Leia
and Bianchi, Andria
and Newman, Kristine
and Iaboni, Andrea
and McMurray, Josephine",
title="Factors That Influence Successful Adoption of Real-Time Location Systems for Use in a Dementia Care Setting: Mixed Methods Study",
journal="JMIR Aging",
year="2024",
month="Apr",
day="8",
volume="7",
pages="e45978",
keywords="remote sensing technologies",
keywords="dementia",
keywords="real-time location systems",
keywords="Fit between Individuals, Tasks, and Technology framework",
keywords="FITT framework",
keywords="technology implementation",
abstract="Background: Technology has been identified as a potential solution to alleviate resource gaps and augment care delivery in dementia care settings such as hospitals, long-term care, and retirement homes. There has been an increasing interest in using real-time location systems (RTLS) across health care settings for older adults with dementia, specifically related to the ability to track a person's movement and location. Objective: In this study, we aimed to explore the factors that influence the adoption or nonadoption of an RTLS during its implementation in a specialized inpatient dementia unit in a tertiary care rehabilitation hospital. Methods: The study included data from a brief quantitative survey and interviews from a convenience sample of frontline participants. Our deductive analysis of the interview used the 3 categories of the Fit Between Individuals, Task, and Technology framework as follows: individual and task, individual and technology, and task and technology. The purpose of using this framework was to assess the quality of the fit between technology attributes and an individual's self-reported intentions to adopt RTLS technology. Results: A total of 20 health care providers (HCPs) completed the survey, of which 16 (80\%) participated in interviews. Coding and subsequent analysis identified 2 conceptual subthemes in the individual-task fit category, including the identification of the task and the perception that participants were missing at-risk patient events. The task-technology fit category consisted of 3 subthemes, including reorganization of the task, personal control in relation to the task, and efficiency or resource allocation. A total of 4 subthemes were identified in the individual-technology fit category, including privacy and personal agency, trust in the technology, user interfaces, and perceptions of increased safety. Conclusions: By the end of the study, most of the unit's HCPs were using the tablet app based on their perception of its usefulness, its alignment with their comfort level with technology, and its ability to help them perform job responsibilities. HCPs perceived that they were able to reduce patient search time dramatically, yet any improvements in care were noted to be implied, as this was not measured. There was limited anecdotal evidence of reduced patient risk or adverse events, but greater reported peace of mind for HCPs overseeing patients' activity levels. ",
doi="10.2196/45978",
url="https://aging.jmir.org/2024/1/e45978",
url="http://www.ncbi.nlm.nih.gov/pubmed/38587884"
}


@Article{info:doi/10.2196/46811,
author="Medina-Garc{\'i}a, Rodrigo
and L{\'o}pez-Rodr{\'i}guez, A. Juan
and Lozano-Hern{\'a}ndez, Mar{\'i}a Cristina
and Ruiz Bejerano, Ver{\'o}nica
and Criscio, Paride
and Del Cura-Gonz{\'a}lez, Isabel
and ",
title="A Technological Tool Aimed at Self-Care in Patients With Multimorbidity: Cross-Sectional Usability Study",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="5",
volume="11",
pages="e46811",
keywords="user-centered design",
keywords="multimorbidity",
keywords="comorbid",
keywords="self-care",
keywords="medical informatics",
keywords="primary health care",
keywords="chronic disease",
keywords="chronic condition",
keywords="chronic illness",
keywords="primary care",
keywords="usability",
keywords="telemedicne",
keywords="telehealth",
keywords="information and communication technologies",
keywords="ICT",
keywords="digital health",
keywords="eHealth",
keywords="human-computer interaction",
abstract="Background: Information and communication technologies (ICTs) have been positioned as useful tools to facilitate self-care. The interaction between a patient and technology, known as usability, is particularly important for achieving positive health outcomes. Specific characteristics of patients with chronic diseases, including multimorbidity, can affect their interaction with different technologies. Thus, studying the usability of ICTs in the field of multimorbidity has become a key element to ensure their relevant role in promoting self-care. Objective: The aim of this study was to analyze the usability of a technological tool dedicated to health and self-care in patients with multimorbidity in primary care. Methods: A descriptive observational cross-sectional usability study was performed framed in the clinical trial in the primary care health centers of Madrid Health Service of the TeNDER (Affective Based Integrated Care for Better Quality of Life) project. The TeNDER technological tool integrates sensors for monitoring physical and sleep activity along with a mobile app for consulting the data collected and working with self-management tools. This project included patients over 60 years of age who had one or more chronic diseases, at least one of which was mild-moderate cognitive impairment, Parkinson disease, or cardiovascular disease. From the 250 patients included in the project, 38 agreed to participate in the usability study. The usability variables investigated were effectiveness, which was determined by the degree of completion and the total number of errors per task; efficiency, evaluated as the average time to perform each task; and satisfaction, quantified by the System Usability Scale. Five tasks were evaluated based on real case scenarios. Usability variables were analyzed according to the sociodemographic and clinical characteristics of patients. A logistic regression model was constructed to estimate the factors associated with the type of support provided for task completion. Results: The median age of the 38 participants was 75 (IQR 72.0-79.0) years. There was a slight majority of women (20/38, 52.6\%) and the participants had a median of 8 (IQR 7.0-11.0) chronic diseases. Thirty patients completed the usability study, with a usability effectiveness result of 89.3\% (134/150 tasks completed). Among the 30 patients, 66.7\% (n=20) completed all tasks and 56.7\% (17/30) required personalized help on at least one task. In the multivariate analysis, educational level emerged as a facilitating factor for independent task completion (odds ratio 1.79, 95\% CI 0.47-6.83). The median time to complete the total tasks was 296 seconds (IQR 210.0-397.0) and the median satisfaction score was 55 (IQR 45.0-62.5) out of 100. Conclusions: Although usability effectiveness was high, the poor efficiency and usability satisfaction scores suggest that there are other factors that may interfere with the results. Multimorbidity was not confirmed to be a key factor affecting the usability of the technological tool. Trial Registration: Clinicaltrials.gov NCT05681065; https://clinicaltrials.gov/study/NCT05681065 ",
doi="10.2196/46811",
url="https://humanfactors.jmir.org/2024/1/e46811",
url="http://www.ncbi.nlm.nih.gov/pubmed/38578675"
}


@Article{info:doi/10.2196/51848,
author="Yoon, Sungwon
and Tan, Min Chao
and Phang, Kie Jie
and Liu, Xi Venice
and Tan, Boon Wee
and Kwan, Heng Yu
and Low, Leng Lian",
title="Exploring the Implementation of Shared Decision-Making Involving Health Coaches for Diabetes and Hypertension Self-Management: Qualitative Study",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="4",
volume="8",
pages="e51848",
keywords="decision-making",
keywords="diabetes",
keywords="health coach",
keywords="health coaching",
keywords="healthcare professional",
keywords="hypertension",
keywords="patient",
keywords="patient-centered care",
keywords="person-centered care",
keywords="qualitative research",
keywords="self-management",
keywords="shared decision-making",
abstract="Background: An emerging focus on person-centered care has prompted the need to understand how shared decision-making (SDM) and health coaching could support self-management of diabetes and hypertension. Objective: This study aims to explore preferences for the scope of involvement of health coaches and health care professionals (HCPs) in SDM and the factors that may influence optimal implementation of SDM from the perspectives of patients and HCPs. Methods: We conducted focus group discussions with 39 patients with diabetes and hypertension and 45 HCPs involved in their care. The main topics discussed included the roles of health coaches and HCPs in self-management, views toward health coaching and SDM, and factors that should be considered for optimal implementation of SDM that involves health coaches. All focus group discussions were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Results: Participants agreed that the main responsibility of HCPs should be identifying the patient's stage of change and medication education, while health coaches should focus on lifestyle education, monitoring, and motivational conversation. The health coach was seen to be more effective in engaging patients in lifestyle education and designing goal management plans as health coaches have more time available to spend with patients. The importance of a health coach's personal attributes (eg, sufficient knowledge of both medical and psychosocial management of disease conditions) and credentials (eg, openness, patience, and empathy) was commonly emphasized. Participants viewed that addressing the following five elements would be necessary for the optimal implementation of SDM: (1) target population (newly diagnosed and less stable patients), (2) commitment of all stakeholders (discrepancy on targeted times and modality), (3) continuity of care (familiar faces), (4) philosophy of care (person-centered communication), and (5) faces of legitimacy (physician as the ultimate authority). Conclusions: The findings shed light on the appropriate roles of health coaches vis-{\`a}-vis HCPs in SDM as perceived by patients and HCPs. Findings from this study also contribute to the understanding of SDM on self-management strategies for patients with diabetes and hypertension and highlight potential opportunities for integrating health coaches into the routine care process. ",
doi="10.2196/51848",
url="https://formative.jmir.org/2024/1/e51848",
url="http://www.ncbi.nlm.nih.gov/pubmed/38573763"
}


@Article{info:doi/10.2196/46979,
author="Dang, Ha Thu
and Wickramasinghe, Nilmini
and Forkan, Mohammad Abdur Rahim
and Jayaraman, Prakash Prem
and Burbury, Kate
and O'Callaghan, Clare
and Whitechurch, Ashley
and Schofield, Penelope",
title="Co-Design, Development, and Evaluation of a Mobile Solution to Improve Medication Adherence in Cancer: Design Science Research Approach",
journal="JMIR Cancer",
year="2024",
month="Apr",
day="3",
volume="10",
pages="e46979",
keywords="cancer",
keywords="behavioral science",
keywords="design science research",
keywords="digital",
keywords="medication adherence",
keywords="mobile solution",
keywords="Safety and Adherence to Medication and Self-Care Advice in Oncology",
keywords="SAMSON",
keywords="mobile phone",
abstract="Background: Medication nonadherence negatively impacts the health outcomes of people with cancer as well as health care costs. Digital technologies present opportunities to address this health issue. However, there is limited evidence on how to develop digital interventions that meet the needs of people with cancer, are perceived as useful, and are potentially effective in improving medication adherence. Objective: The objective of this study was to co-design, develop, and preliminarily evaluate an innovative mobile health solution called Safety and Adherence to Medication and Self-Care Advice in Oncology (SAMSON) to improve medication adherence among people with cancer. Methods: Using the 4 cycles and 6 processes of design science research methodology, we co-designed and developed a medication adherence solution for people with cancer. First, we conducted a literature review on medication adherence in cancer and a systematic review of current interventions to address this issue. Behavioral science research was used to conceptualize the design features of SAMSON. Second, we conducted 2 design phases: prototype design and final feature design. Last, we conducted a mixed methods study on patients with hematological cancer over 6 weeks to evaluate the mobile solution. Results: The developed mobile solution, consisting of a mobile app, a web portal, and a cloud-based database, includes 5 modules: medication reminder and acknowledgment, symptom assessment and management, reinforcement, patient profile, and reporting. The quantitative study (n=30) showed that SAMSON was easy to use (21/27, 78\%). The app was engaging (18/27, 67\%), informative, increased user interactions, and well organized (19/27, 70\%). Most of the participants (21/27, 78\%) commented that SAMSON's activities could help to improve their adherence to cancer treatments, and more than half of them (17/27, 63\%) would recommend the app to their peers. The qualitative study (n=25) revealed that SAMSON was perceived as helpful in terms of reminding, supporting, and informing patients. Possible barriers to using SAMSON include the app glitches and users' technical inexperience. Further needs to refine the solution were also identified. Technical improvements and design enhancements will be incorporated into the subsequent iteration. Conclusions: This study demonstrates the successful application of behavioral science research and design science research methodology to design and develop a mobile solution for patients with cancer to be more adherent. The study also highlights the importance of applying rigorous methodologies in developing effective and patient-centered digital intervention solutions. ",
doi="10.2196/46979",
url="https://cancer.jmir.org/2024/1/e46979",
url="http://www.ncbi.nlm.nih.gov/pubmed/38569178"
}


@Article{info:doi/10.2196/52561,
author="Brown, Rushell Tashalee
and Amir, Habiba
and Hirsch, Drew
and Jansen, Owens Madeline",
title="Designing a Novel Digitally Delivered Antiracism Intervention for Mental Health Clinicians: Exploratory Analysis of Acceptability",
journal="JMIR Hum Factors",
year="2024",
month="Apr",
day="3",
volume="11",
pages="e52561",
keywords="acceptability",
keywords="antiracism",
keywords="clinicians",
keywords="intervention",
keywords="interview study",
keywords="mental health",
keywords="psychiatry residents",
keywords="racism",
keywords="social workers",
keywords="web-based technology",
abstract="Background: There is a great need for evidence-based antiracism interventions targeting mental health clinicians to help mitigate mental health disparities in racially and ethnically minoritized groups. Objective: This study provides an exploratory analysis of mental health clinicians' perspectives on the acceptability of a web-based antiracism intervention. Methods: Mental health clinicians were recruited from a single academic medical center through outreach emails. Data were collected through individual 30-minute semistructured remote video interviews with participants, then recorded, transcribed, and analyzed using content analysis. Results: A total of 12 mental health clinicians completed the study; 10 out of 12 (83\%) were female candidates. Over half (7/12, 58\%) of the respondents desired more robust antiracism training in mental health care. Regarding the web-based antiracism intervention, (8/12, 67\%) enjoyed the digitally delivered demo module, (7/12, 58\%) of respondents suggested web-based content would be further enhanced with the addition of in-person or online group components. Conclusions: Our results suggest a strong need for additional antiracist training for mental health clinicians. Overall, participants responded favorably to novel web-based delivery methods for an antiracism intervention. These findings provide important support for future development and pilot testing of a large-scale digitally enhanced antiracist curriculum targeting mental health clinicians. ",
doi="10.2196/52561",
url="https://humanfactors.jmir.org/2024/1/e52561",
url="http://www.ncbi.nlm.nih.gov/pubmed/38568730"
}


@Article{info:doi/10.2196/51511,
author="Linggonegoro, Danny
and Williams, Kathryn
and Hlobik, Madeline
and Huang, Jennifer",
title="Inequities in Technology Access and Digital Health Literacy Among Patients With Dermatologic Conditions: Cross-Sectional Analysis of the National Health Interview Survey",
journal="JMIR Dermatol",
year="2024",
month="Mar",
day="22",
volume="7",
pages="e51511",
keywords="teledermatology",
keywords="telemedicine",
keywords="telehealth",
keywords="health care research",
keywords="health care disparities",
keywords="digital health literacy",
keywords="technology access",
keywords="access",
keywords="accessibility",
keywords="health literacy",
keywords="digital literacy",
keywords="disparities",
keywords="disparity",
keywords="equity",
keywords="inequity",
keywords="inequities",
keywords="dermatology",
keywords="dermatological",
keywords="skin",
keywords="cross-sectional",
keywords="survey",
keywords="surveys",
keywords="national",
keywords="HINTS",
keywords="digital divide",
doi="10.2196/51511",
url="https://derma.jmir.org/2024/1/e51511",
url="http://www.ncbi.nlm.nih.gov/pubmed/38517468"
}


@Article{info:doi/10.2196/51667,
author="Dimitropoulos, Gina
and Lindenbach, David
and Potestio, Melissa
and Mogan, Tom
and Richardson, Amanda
and Anderson, Alida
and Heintz, Madison
and Moskovic, Karen
and Gondziola, Jason
and Bradley, Jessica
and LaMonica, M. Haley
and Iorfino, Frank
and Hickie, Ian
and Patten, B. Scott
and Arnold, D. Paul",
title="Using a Rapid Learning Health System for Stratified Care in Emerging Adult Mental Health Services: Protocol for the Implementation of Patient-Reported Outcome Measures",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="20",
volume="13",
pages="e51667",
keywords="learning health system",
keywords="stratified care",
keywords="patient-reported outcome measures",
keywords="mental health",
keywords="emerging adults",
keywords="protocol papers",
keywords="pragmatic clinical trials",
keywords="e-mental health",
keywords="RE-AIM",
keywords="Reach, Effectiveness, Adoption, Implementation, and Maintenance",
keywords="implementation science",
keywords="adult",
keywords="health system",
keywords="treatment",
keywords="implementation",
keywords="acceptability",
keywords="measurement-based care",
abstract="Background: Mental illness among emerging adults is often difficult to ameliorate due to fluctuating symptoms and heterogeneity. Recently, innovative approaches have been developed to improve mental health care for emerging adults, including (1) implementing patient-reported outcome measures (PROMs) to assess illness severity and inform stratified care to assign emerging adults to a treatment modality commensurate with their level of impairment and (2) implementing a rapid learning health system in which data are continuously collected and analyzed to generate new insights, which are then translated to clinical practice, including collaboration among clients, health care providers, and researchers to co-design and coevaluate assessment and treatment strategies. Objective: The aim of the study is to determine the feasibility and acceptability of implementing a rapid learning health system to enable a measurement-based, stratified care treatment strategy for emerging adults. Methods: This study takes place at a specialty clinic serving emerging adults (age 16-24 years) in Calgary, Canada, and involves extensive collaboration among researchers, providers, and youth. The study design includes six phases: (1) developing a transdiagnostic platform for PROMs, (2) designing an initial stratified care model, (3) combining the implementation of PROMs with stratified care, (4) evaluating outcomes and disseminating results, (5) modification of stratified care based on data derived from PROMs, and (6) spread and scale to new sites. Qualitative and quantitative feedback will be collected from health care providers and youth throughout the implementation process. These data will be analyzed at regular intervals and used to modify the way future services are delivered. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is used to organize and evaluate implementation according to 3 key objectives: improving treatment selection, reducing average wait time and treatment duration, and increasing the value of services. Results: This project was funded through a program grant running from 2021 to 2026. Ethics approval for this study was received in February 2023. Presently, we have developed a system of PROMs and organized clinical services into strata of care. We will soon begin using PROMs to assign clients to a stratum of care and using feedback from youth and clinicians to understand how to improve experiences and outcomes. Conclusions: This study has key implications for researchers and clinicians looking to understand how to customize emerging adult mental health services to improve the quality of care and satisfaction with care. This study has significant implications for mental health care systems as part of a movement toward value-based health care. International Registered Report Identifier (IRRID): PRR1-10.2196/51667 ",
doi="10.2196/51667",
url="https://www.researchprotocols.org/2024/1/e51667",
url="http://www.ncbi.nlm.nih.gov/pubmed/38506921"
}


@Article{info:doi/10.2196/49808,
author="Veneman, Tim
and Koopman, Sophia Fieke
and Oorschot, Sander
and Koomen, G. Pien
and Nollet, Frans
and Voorn, L. Eric",
title="A Mobile Health App to Support Home-Based Aerobic Exercise in Neuromuscular Diseases: Usability Study",
journal="JMIR Hum Factors",
year="2024",
month="Mar",
day="15",
volume="11",
pages="e49808",
keywords="neuromuscular disorders",
keywords="endurance training",
keywords="home-based exercise",
keywords="eHealth",
keywords="tele-rehabilitation",
keywords="app",
keywords="exercise",
keywords="aerobic exercise",
keywords="mhealth",
keywords="mobile app",
keywords="neuromuscular disease",
keywords="usability",
abstract="Background: Home-based aerobic exercise in people with neuromuscular diseases (NMDs) has benefits compared to exercise in the hospital or a rehabilitation center because traveling is often cumbersome due to mobility limitations, and societal costs are lower. Barriers to home-based aerobic exercise include reduced possibilities for monitoring and lack of motivation. To overcome these and other barriers, we developed a mobile health app: Keep on training with ReVi (hereafter referred to as ReVi). Objective: We aimed to determine the usability of the ReVi app. Methods: Patients followed a 4-month, polarized, home-based aerobic exercise program on a cycle or rowing ergometer, with 2 low-intensity sessions and 1 high-intensity session per week supported by the ReVi app. The app collected training data, including heart rate and ratings of perceived exertion, provided real-time feedback on reaching target intensity zones, and enabled monitoring via an online dashboard. Physiotherapists instructed patients on how to use the ReVi app and supervised them during their training program. Patients and physiotherapists separately evaluated usability with self-developed questionnaires, including 9 questions on a 5-point Likert scale, covering the usability elements efficiency, effectiveness, and satisfaction. Results: Twenty-nine ambulatory adult patients (n=19 women; mean age 50.4, SD 14.2 years) with 11 different slowly progressive NMDs participated. Both patients and physiotherapists (n=10) reported that the app, in terms of its efficiency, was easy to use and had a rapid learning curve. Sixteen patients (55\%) experienced 1 or more technical issue(s) during the course of the exercise program. In the context of effectiveness, 23 patients (81\%) indicated that the app motivated them to complete the program and that it helped them to exercise within the target intensity zones. Most patients (n=19, 70\%) and physiotherapists (n=6, 60\%) were satisfied with the use of the app. The median attendance rate was 88\% (IQR 63\%-98\%), with 76\% (IQR 69\%-82\%) of time spent within the target intensity zones. Four adverse events were reported, 3 of which were resolved without discontinuation of the exercise program. Conclusions: The usability of the ReVi app was high, despite the technical issues that occurred. Further development of the app to resolve these issues is warranted before broader implementation into clinical practice. ",
doi="10.2196/49808",
url="https://humanfactors.jmir.org/2024/1/e49808",
url="http://www.ncbi.nlm.nih.gov/pubmed/38488838"
}


@Article{info:doi/10.2196/52048,
author="Nkabane-Nkholongo, Elizabeth
and Mpata-Mokgatle, Mathildah
and Jack, W. Brian
and Julce, Clevanne
and Bickmore, Timothy",
title="Usability and Acceptability of a Conversational Agent Health Education App (Nthabi) for Young Women in Lesotho: Quantitative Study",
journal="JMIR Hum Factors",
year="2024",
month="Mar",
day="12",
volume="11",
pages="e52048",
keywords="preconception care",
keywords="conversational agent technology",
keywords="women's health education",
keywords="mHealth adaptation",
keywords="health information technology",
keywords="health education in Africa",
keywords="education",
keywords="women's health",
keywords="women",
keywords="woman",
keywords="health information",
keywords="young women",
keywords="survey",
keywords="usability",
keywords="acceptability",
keywords="application",
keywords="applications",
keywords="app",
keywords="health promotion",
abstract="Background: Young women in Lesotho face myriad sexual and reproductive health problems. There is little time to provide health education to women in low-resource settings with critical shortages of human resources for health. Objective: This study aims to determine the acceptability and usability of a conversational agent system, the Nthabi health promotion app, which was culturally adapted for use in Lesotho. Methods: We conducted a descriptive quantitative study, using a 22-item Likert scale survey to assess the perceptions of the usability and acceptability of 172 young women aged 18-28 years in rural districts of Lesotho, who used the system on either smartphones or tablets for up to 6 weeks. Descriptive statistics were used to calculate the averages and frequencies of the variables. $\chi$2 tests were used to determine any associations among variables. Results: A total of 138 participants were enrolled and completed the survey. The mean age was 22 years, most were unmarried, 56 (40.6\%) participants had completed high school, 39 (28.3\%) participants were unemployed, and 88 (63.8\%) participants were students. Respondents believed the app was helpful, with 134 (97.1\%) participants strongly agreeing or agreeing that the app was ``effective in helping them make decisions'' and ``could quickly improve health education and counselling.'' In addition, 136 (98.5\%) participants strongly agreed or agreed that the app was ``simple to use,'' 130 (94.2 \%) participants reported that Nthabi could ``easily repeat words that were not well understood,'' and 128 (92.7\%) participants reported that the app ``could quickly load the information on the screen.'' Respondents were generally satisfied with the app, with 132 (95.6\%) participants strongly agreeing or agreeing that the health education content delivered by the app was ``well organised and delivered in a timely way,'' while 133 (96.4\%) participants ``enjoyed using the interface.'' They were satisfied with the cultural adaptation, with 133 (96.4\%) participants strongly agreeing or agreeing that the app was ``culturally appropriate and that it could be easily shared with a family or community members.'' They also reported that Nthabi was worthwhile, with 127 (92\%) participants reporting that they strongly agreed or agreed that they were ``satisfied with the application and intended to continue using it,'' while 135 (97.8\%) participants would ``encourage others to use it.'' Participants aged 18-24 years (vs those aged 25-28 years) agreed that the ``Nthabi app was simple to use'' (106/106, 100\% vs 30/32, 98.8\%; P=.01), and agreed that ``the educational content was well organised and delivered in a timely way'' (104/106, 98.1\% vs 28/32, 87.5\%; P=.01). Conclusions: These results support further study of conversational agent systems as alternatives to traditional face-to-face provision of health education services in Lesotho, where there are critical shortages of human resources for health. Trial Registration: ClinicalTrials.gov NCT04354168; https://www.clinicaltrials.gov/study/NCT04354168 ",
doi="10.2196/52048",
url="https://humanfactors.jmir.org/2024/1/e52048",
url="http://www.ncbi.nlm.nih.gov/pubmed/38470460"
}


@Article{info:doi/10.2196/45275,
author="Savolainen, Kaisa
and Kujala, Sari",
title="Testing Two Online Symptom Checkers With Vulnerable Groups: Usability Study to Improve Cognitive Accessibility of eHealth Services",
journal="JMIR Hum Factors",
year="2024",
month="Mar",
day="8",
volume="11",
pages="e45275",
keywords="eHealth",
keywords="online symptom checkers",
keywords="usability",
keywords="cognitive accessibility",
keywords="web accessibility",
keywords="qualitative research",
abstract="Background: The popularity of eHealth services has surged significantly, underscoring the importance of ensuring their usability and accessibility for users with diverse needs, characteristics, and capabilities. These services can pose cognitive demands, especially for individuals who are unwell, fatigued, or experiencing distress. Additionally, numerous potentially vulnerable groups, including older adults, are susceptible to digital exclusion and may encounter cognitive limitations related to perception, attention, memory, and language comprehension. Regrettably, many studies overlook the preferences and needs of user groups likely to encounter challenges associated with these cognitive aspects. Objective: This study primarily aims to gain a deeper understanding of cognitive accessibility in the practical context of eHealth services. Additionally, we aimed to identify the specific challenges that vulnerable groups encounter when using eHealth services and determine key considerations for testing these services with such groups. Methods: As a case study of eHealth services, we conducted qualitative usability testing on 2 online symptom checkers used in Finnish public primary care. A total of 13 participants from 3 distinct groups participated in the study: older adults, individuals with mild intellectual disabilities, and nonnative Finnish speakers. The primary research methods used were the thinking-aloud method, questionnaires, and semistructured interviews. Results: We found that potentially vulnerable groups encountered numerous issues with the tested services, with similar problems observed across all 3 groups. Specifically, clarity and the use of terminology posed significant challenges. The services overwhelmed users with excessive information and choices, while the terminology consisted of numerous complex medical terms that were difficult to understand. When conducting tests with vulnerable groups, it is crucial to carefully plan the sessions to avoid being overly lengthy, as these users often require more time to complete tasks. Additionally, testing with vulnerable groups proved to be quite efficient, with results likely to benefit a wider audience as well. Conclusions: Based on the findings of this study, it is evident that older adults, individuals with mild intellectual disability, and nonnative speakers may encounter cognitive challenges when using eHealth services, which can impede or slow down their use and make the services more difficult to navigate. In the worst-case scenario, these challenges may lead to errors in using the services. We recommend expanding the scope of testing to include a broader range of eHealth services with vulnerable groups, incorporating users with diverse characteristics and capabilities who are likely to encounter difficulties in cognitive accessibility. ",
doi="10.2196/45275",
url="https://humanfactors.jmir.org/2024/1/e45275",
url="http://www.ncbi.nlm.nih.gov/pubmed/38457214"
}


@Article{info:doi/10.2196/51150,
author="Chien, Shih-Ying
and Wong, May-Kuen Alice
and Tseng, Winston
and Hu, Han-Chung
and Cho, Hsiu-Ying",
title="Feasibility and Design Factors for Home-Based Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease and Chronic Lung Diseases Based on a People-Object-Environment Framework: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2024",
month="Mar",
day="7",
volume="11",
pages="e51150",
keywords="chronic lung diseases",
keywords="home-based pulmonary rehabilitation",
keywords="telehealth",
keywords="remote health care",
abstract="Background: The feasibility of implementing home-based pulmonary rehabilitation (PR) can be assessed from the perspectives of patients with chronic lung disease and health care professionals involved in PR. Objective: Through a qualitative inquiry using interviews and the adoption of the people-object-environment framework, this study aims to understand the influences of interpersonal, environmental, and situational factors on the perceptions and considerations of individuals involved in home-based PR for patients with chronic lung disease. Methods: One-on-one interviews were conducted with 20 patients with chronic lung disease and 20 health care professionals for investigating their attitudes and opinions based on their experiences regarding home-based PR as well as for identifying the key factors affecting the benefits and drawbacks of such therapies. This study further evaluates the feasibility of using digital tools for medical diagnosis and treatment by examining the technology usage of both parties. Results: The 4 key issues that all participants were the most concerned about were as follows: distance to outpatient medical care, medical efficiency, internet connectivity and equipment, and physical space for diagnosis and treatment. Interviews with patients and health care professionals revealed that the use of technology and internet was perceived differently depending on age and area of residence. Most participants reported that digital tools and internet connectivity had many benefits but still could not solve all the problems; moreover, these same digital tools and network transmission could lead to problems such as information security and digital divide concerns. This study also emphasizes the significant impact of human behavior and thinking on shaping the design of health care interventions and technologies. Understanding user perspectives and experiences is crucial for developing effective solutions for unmet needs. Conclusions: The results of this study indicate that despite the different perspectives of patients and health care professionals, their considerations of the key issues are very similar. Therefore, the implementation of plans related to telemedicine diagnosis, treatment, or rehabilitation should take the suggestions and considerations of both parties into account as crucial factors for telehealth care design. ",
doi="10.2196/51150",
url="https://humanfactors.jmir.org/2024/1/e51150",
url="http://www.ncbi.nlm.nih.gov/pubmed/38452366"
}


@Article{info:doi/10.2196/48292,
author="Kirby, Pippa
and Lai, Helen
and Horrocks, Sophie
and Harrison, Matthew
and Wilson, Danielle
and Daniels, Sarah
and Calvo, A. Rafael
and Sharp, J. David
and Alexander, M. Caroline",
title="Patient and Public Involvement in Technology-Related Dementia Research: Scoping Review",
journal="JMIR Aging",
year="2024",
month="Mar",
day="4",
volume="7",
pages="e48292",
keywords="dementia",
keywords="technology",
keywords="patient and public involvement and engagement",
keywords="co-design",
keywords="coproduction",
abstract="Background: Technology-related research on people with dementia and their carers often aims to enable people to remain living at home for longer and prevent unnecessary hospital admissions. To develop person-centered, effective, and ethical research, patient and public involvement (PPI) is necessary, although it may be perceived as more difficult with this cohort. With recent and rapid expansions in health and care--related technology, this review explored how and with what impact collaborations between researchers and stakeholders such as people with dementia and their carers have taken place. Objective: This review aims to describe approaches to PPI used to date in technology-related dementia research, along with the barriers and facilitators and impact of PPI in this area. Methods: A scoping review of literature related to dementia, technology, and PPI was conducted using MEDLINE, PsycINFO, Embase, and CINAHL. Papers were screened for inclusion by 2 authors. Data were then extracted using a predesigned data extraction table by the same 2 authors. A third author supported the resolution of any conflicts at each stage. Barriers to and facilitators of undertaking PPI were then examined and themed. Results: The search yielded 1694 papers, with 31 (1.83\%) being analyzed after screening. Most (21/31, 68\%) did not make clear distinctions between activities undertaken as PPI and those undertaken by research participants, and as such, their involvement did not fit easily into the National Institute for Health and Care Research definition of PPI. Most of this mixed involvement focused on reviewing or evaluating technology prototypes. A range of approaches were described, most typically using focus groups or co-design workshops. In total, 29\% (9/31) described involvement at multiple stages throughout the research cycle, sometimes with evidence of sharing decision-making power. Some (23/31, 74\%) commented on barriers to or facilitators of effective PPI. The challenges identified often regarded issues of working with people with significant cognitive impairments and pressures on time and resources. Where reported, the impact of PPI was largely reported as positive, including the experiences for patient and public partners, the impact on research quality, and the learning experience it provided for researchers. Only 4 (13\%) papers used formal methods for evaluating impact. Conclusions: Researchers often involve people with dementia and other stakeholders in technology research. At present, involvement is often limited in scope despite aspirations for high levels of involvement and partnership working. Involving people with dementia, their carers, and other stakeholders can have a positive impact on research, patient and public partners, and researchers. Wider reporting of methods and facilitative strategies along with more formalized methods for recording and reporting on meaningful impact would be helpful so that all those involved---researchers, patients, and other stakeholders---can learn how we can best conduct research together. ",
doi="10.2196/48292",
url="https://aging.jmir.org/2024/1/e48292",
url="http://www.ncbi.nlm.nih.gov/pubmed/38437014"
}


@Article{info:doi/10.2196/48573,
author="Bergers, HK Juno
and Wessels-Wynia, Hester
and Seute, Tatjana
and Janssens, Astrid
and van Delden, JM Johannes",
title="Getting to Know Your Patient: Content Analysis of Patients' Answers to a Questionnaire for Promoting Person-Centered Care",
journal="J Particip Med",
year="2024",
month="Mar",
day="4",
volume="16",
pages="e48573",
keywords="person-centered care",
keywords="shared decision-making",
keywords="patient engagement",
keywords="positive health",
abstract="Background: Person-centered care (PCC) encourages patients to actively participate in health care, thus facilitating care that fits the life of the patient. Therefore, health care professionals (HCPs) need to know the patient. As part of a broad policy for improving PCC, a digital questionnaire (``We would like to know you'') consisting of 5 questions has previously been developed to help HCPs to get to know the patient with the help of patient and staff involvement. Objective: The purpose of this study was to provide insight into the content and aims of the questionnaire to understand its potential and usability. Methods: We conducted a qualitative, retrospective content analysis of patients' answers using NVivo Pro (QSR International). The questionnaire was used in the outpatient neuro-oncology department of a Dutch academic hospital. Results: Of 374 invited patients, 78 (20.9\%) completed the questionnaire. We selected a sample of 42 (54\%) of the 78 patients. Patients used a median of 16 (IQR 7-27) words per question, and most answers were easily interpretable. When asked about important activities, social activities, sports, or maintaining a normal life were most frequently mentioned. Patients wrote about fear of the disease, its possible influence on life, or fear of the future in general. Patients wanted HCPs to know about their care and communication preferences or shared personal information. They formulated expectations about effective treatment, communication, and the care process. Conclusions: The questionnaire seems usable because patients provide interpretable answers that take little time to read, which HCPs can use to personalize care. Our study shows the potential of the questionnaire to help deliver PCC. ",
doi="10.2196/48573",
url="https://jopm.jmir.org/2024/1/e48573",
url="http://www.ncbi.nlm.nih.gov/pubmed/38437017"
}


@Article{info:doi/10.2196/51231,
author="Chmielewski, Marta
and Meyer, J. Matthew",
title="Discussions With End Users to Inform the Vision for a Shared Care Record in Ontario: Qualitative Interview Study",
journal="Online J Public Health Inform",
year="2024",
month="Feb",
day="27",
volume="16",
pages="e51231",
keywords="population health management",
keywords="shared care record",
keywords="health information exchange",
abstract="Background: Improving the health outcomes of populations of individuals through population health management requires the use of electronic health records that can exchange real-time digital information using an accurate and complete shared care record that is accessible to health care providers, services, and patients. Objective: The aims of this study were to understand end users' (health care providers) experiences, attitudes, and insights using current electronic health records; their expectations of what is required to establish a shared care record; and how they anticipate adapting to the use of a shared care record in daily practice. This work is the result of a quality improvement initiative deemed not to require ethics approval according to the Western research ethics board checklist. Methods: Clinicians were contacted using?voluntary response sampling and?interviewed?via Zoom (Zoom Video Communications) between June 2022 and July 2022.?The participants were from various health care sectors and at various stages of career development. Results: Overall, adaptation to the use of a shared care record was viewed positively by health care providers, highlighting the benefits of a centralized, shared, and accessible location for real-time data, promoting patient continuity of care. The main concerns included the privacy, confidentiality, and security of the record along with patients' ability to interpret their own medical information found in a patient portal. The resources requested by end users included multifaceted ongoing training on the use of a shared care record. Conclusions: This study provides practical findings that will help emphasize factors that facilitate clinicians' practical use and process of adaptation to the use of a shared care record. ",
doi="10.2196/51231",
url="https://ojphi.jmir.org/2024/1/e51231",
url="http://www.ncbi.nlm.nih.gov/pubmed/384"
}


@Article{info:doi/10.2196/48729,
author="Ipsen, Ammundsen Jonas
and Sandal, Fleng Louise
and Chang, Siu Natalie Hong
and Schi{\o}ttz-Christensen, Berit
and S{\o}gaard, Karen
and Hansen, Anders",
title="Interest in mHealth Among Patients With Low Back Pain: Cross-Sectional Study",
journal="JMIR Hum Factors",
year="2024",
month="Feb",
day="12",
volume="11",
pages="e48729",
keywords="low back pain",
keywords="mHealth solutions",
keywords="mobile health",
keywords="characteristics",
keywords="patient interest",
keywords="transferability",
keywords="representativeness",
abstract="Background: Digitally supported self-management tailored to an individual's need, in addition to usual care, may reduce pain-related disability compared to usual care alone, and patients with low back pain (LBP) using mobile health (mHealth) solutions express positive experiences. Hence, implementing mHealth solutions designed to support self-management is desirable from a clinical and patient perspective. Easily accessible mHealth solutions that can support the self-management of patients with LBP are available, but interest may be subgroup specific. Understanding the characteristics and preferences of patients with LBP labeled as interested may help to reach relevant LBP patient groups and inform the development and implementation of effective interventions with mHealth for patients with LBP. Objective: This study aims to explore the proportion of patients with LBP labeled as interested in testing an mHealth solution designed to support self-management in addition to usual care and to assess how these patients differ from those who were labeled as not interested. Methods: This exploratory cross-sectional study analyzed demographic and patient-reported outcomes from the SpineData registry, a Danish registry of patients with LBP in an outpatient setting. Between February and December 2019, the SpineData registry was used to assess the preliminary eligibility of patients for a clinical trial (selfBACK). Patients were labeled as interested or uninterested depending on if they responded to an invitation to be tested for eligibility for the trial Outcomes were selected from the International Classification of Functioning core set of LBP using a clinical approach. Associations were assessed in a backward selection process, and the proportion of variance explained was assessed with pseudo-R2 statistic. Results: This study included 843 patients, with 181 (21\%) individuals labeled as interested in participating in the selfBACK trial. Notably, the cohort labeled as interested differed from their uninterested counterparts in two key aspects: age (36-65 years: 116/181, 64.1\% vs 347/662, 52.4\%; P=.003) and smoking status (smokers: 22/181, 12.5\% vs 174/662, 26.6\%; P<.001). Those aged 36-65 years had higher odds of being labeled as interested compared to individuals aged 18-35 years (odds ratio [OR] 0.43, 95\% CI 0.26-0.71) and those 65 years or older (OR 0.77, 95\% CI 0.53-1.15). Nevertheless, age accounted for only a modest proportion of variance (R2=0.014). Smokers demonstrated lower odds of being labeled as interested (OR 0.39, 95\% CI 0.24-0.64), with smoking status explaining a similarly small proportion of variance (R2=0.019). Collectively, age and smoking status accounted for 3.3\% of the variance. Conclusions: Our investigation revealed that 181 (21\%) individuals with LBP invited to participate in the mHealth solution trial for self-management expressed interest. Generally, the characteristics of those labeled as interested and uninterested were comparable. Of note, patients aged 36-65 years had a higher frequency of being labeled as interested compared to their younger and older counterparts. ",
doi="10.2196/48729",
url="https://humanfactors.jmir.org/2024/1/e48729",
url="http://www.ncbi.nlm.nih.gov/pubmed/38345837"
}


@Article{info:doi/10.2196/54138,
author="Zhu, Di
and Al Mahmud, Abdullah
and Liu, Wei",
title="Digital Storytelling Intervention for Enhancing the Social Participation of People With Mild Cognitive Impairment: Co-Design and Usability Study",
journal="JMIR Aging",
year="2024",
month="Jan",
day="17",
volume="7",
pages="e54138",
keywords="co-design",
keywords="digital storytelling",
keywords="people with mild cognitive impairment",
keywords="MCI",
keywords="technology-based intervention development",
keywords="dementia",
keywords="mobile phone",
abstract="Background: Community-based social participation has shown promise in delaying cognitive decline in older adults with mild cognitive impairment (MCI) who are at risk of developing dementia. Although group storytelling interventions have proven effective, the need for a skilled workforce to support people with MCI can limit broader community implementation. Technology-based interventions may offer a solution to this limitation by replicating the abilities of therapists. Objective: This study aims to co-design a digital storytelling intervention and evaluate its usability. Methods: This co-design process involved 3 stages, engaging people with MCI (n=12), their caregivers (n=4), and therapists (n=5) in Beijing, China. In the first stage, we used card sorting and voting methods to identify potential incentives for social participation and target the specific abilities that people with MCI wanted to enhance. In the second stage, we conducted brainstorming sessions with people with MCI and their caregivers to identify the potential features of a digital storytelling application named Huiyou (``meeting new friends'' in Chinese). Finally, we assessed Huiyou's usability with people with MCI and therapists, leading to iterative improvements based on the usability findings. Results: We uncovered a crucial link between boosting the self-confidence of people with MCI and their ability to address social participation challenges. Notably, we identified memory improvement and enhanced language expression as key factors for effective communication with grandchildren. Subsequently, participants suggested features and interfaces to address these challenges, leading to the development of Huiyou, a group-based digital storytelling application featuring functions such as generating story materials, conducting memory retrieval activities, and sharing stories. It received an ``excellent'' rating in the User Experience Questionnaire benchmark, displaying high levels of attractiveness, dependability, stimulation, and novelty. People with MCI achieved an average task completion rate of 87\% (n=19; SD 0.13) of the 22 tasks. However, feedback from people with MCI and therapists highlighted usability issues in navigation, activity management, user interface, and feature optimization, indicating a need for improved accessibility and efficiency. Conclusions: The co-design approach contributed to developing the Huiyou prototype, supporting community-based social participation. User feedback highlighted the potential of Huiyou to enhance well-being and facilitate meaningful social interactions while maintaining crucial existing relationships. ",
doi="10.2196/54138",
url="https://aging.jmir.org/2024/1/e54138",
url="http://www.ncbi.nlm.nih.gov/pubmed/38231541"
}


@Article{info:doi/10.2196/50413,
author="Luo, Yuanyuan
and Weng, Huiting
and Yang, Li
and Ding, Ziwei
and Wang, Qin",
title="College Students' Employability, Cognition, and Demands for ChatGPT in the AI Era Among Chinese Nursing Students: Web-Based Survey",
journal="JMIR Form Res",
year="2023",
month="Dec",
day="22",
volume="7",
pages="e50413",
keywords="college students' employability",
keywords="artificial intelligence quotient",
keywords="ChatGPT",
keywords="nursing students",
keywords="China",
keywords="college student",
keywords="AI",
keywords="artificial intelligence",
abstract="Background: With the rapid development of artificial intelligence (AI) and the widespread use of ChatGPT, nursing students' artificial intelligence quotient (AIQ), employability, cognition, and demand for ChatGPT are worthy of attention. Objective: We aimed to investigate Chinese nursing students' AIQ and employability status as well as their cognition and demand for the latest AI tool---ChatGPT. This study was conducted to guide future initiatives in nursing intelligence education and to improve the employability of nursing students. Methods: We used a cross-sectional survey to understand nursing college students' AIQ, employability, cognition, and demand for ChatGPT. Using correlation analysis and multiple hierarchical regression analysis, we explored the relevant factors in the employability of nursing college students. Results: In this study, out of 1788 students, 1453 (81.30\%) had not used ChatGPT, and 1170 (65.40\%) had never heard of ChatGPT before this survey. College students' employability scores were positively correlated with AIQ, self-regulation ability, and their home location and negatively correlated with school level. Additionally, men scored higher on college students' employability compared to women. Furthermore, 76.5\% of the variance was explained by the multiple hierarchical regression model for predicting college students' employability scores. Conclusions: Chinese nursing students have limited familiarity and experience with ChatGPT, while their AIQ remains intermediate. Thus, educators should pay more attention to cultivating nursing students' AIQ and self-regulation ability to enhance their employability. Employability, especially for female students, those from rural backgrounds, and students in key colleges, deserves more attention in future educational efforts. ",
doi="10.2196/50413",
url="https://formative.jmir.org/2023/1/e50413",
url="http://www.ncbi.nlm.nih.gov/pubmed/38133923"
}


@Article{info:doi/10.2196/51691,
author="Safiee, Ladan
and Rough, Daniel
and George, Priya
and Mudenha, Roselyn",
title="Baseline Perceptions of Women With Gestational Diabetes Mellitus and Health Care Professionals About Digital Gestational Diabetes Mellitus Self-Management Health Care Technologies: Interview Study Among Patients and Health Care Professionals",
journal="JMIR Hum Factors",
year="2023",
month="Dec",
day="19",
volume="10",
pages="e51691",
keywords="gestational diabetes",
keywords="self-management",
keywords="mobile health",
keywords="mHealth",
keywords="qualitative study",
keywords="mobile phone",
abstract="Background: Gestational diabetes mellitus (GDM) is a significant medical complication of pregnancy that requires close monitoring by a multidisciplinary health care team. The growing sophistication of mobile health (mHealth) technology could play a significant supporting role for women with GDM and health professionals (HPs) regarding GDM management. Objective: This study included 2 phases. The aim of phase 1 was to explore the perceptions of HPs and women with GDM regarding the use of mHealth for GDM self-management and to identify their needs from these technologies. The aim of phase 2 was to explore the perceptions of women with GDM about their experiences with a state-of-the-art app for managing GDM that was offered to them during the COVID-19 lockdown. This phase aimed to understand the impact that COVID-19 has had on women's perceptions about using technology to manage their GDM. By combining both phases, the overall aim was to establish how perceptions about GDM self-management technology have changed owing to the pandemic restrictions and experience of using such technology. Methods: In total, 26 semistructured interviews were conducted in 2 phases. In phase 1, overall, 62\% (16/26) of the participants, including 44\% (7/16) of HPs, 50\% (8/16) of women with GDM, and 6\% (1/16) of women in the postpartum period with GDM history participated in the interviews. In phase 2, overall, 38\% (10/26) of women with GDM participated in the interviews. NVivo (QSR International) was used to extract qualitative data, which were subjected to thematic analysis. Results: Phase 1 identified 3 themes from the interviews with women with GDM: fitting with women's lifestyle constraints, technology's design not meeting women's needs, and optimizing the technology's design to meet women's needs. Overall, 3 themes were derived from the interviews with HPs: optimizing the technology's design to improve the quality of care, technology to support women's independence, and limitations in the care system and facilities. Analysis of phase-2 interviews identified 2 further themes: enhancing the information and functionalities and optimizing the interface design. In both phases, participants emphasized a simple and user-friendly interface design as the predominant positive influence on their use of technology for GDM management. Conclusions: The combined findings underlined similar points. Poor usability, data visualization limitations, lack of personalization, limited information, and lack of communication facilities were the prime issues of current GDM self-management mHealth technology that need to be addressed. The analysis also revealed how women with GDM should play a vital role in gathering the requirements for GDM self-management technology; some needs were identified from in-depth discussion with women with GDM that would be missed without their involvement. ",
doi="10.2196/51691",
url="https://humanfactors.jmir.org/2023/1/e51691",
url="http://www.ncbi.nlm.nih.gov/pubmed/38113070"
}


@Article{info:doi/10.2196/50636,
author="van Doorn, Marilon
and Monsanto, Anne
and Wang, Lu Chen
and Verfaillie, J. Sander C.
and van Amelsvoort, J. Th{\'e}r{\`e}se A. M.
and Popma, Arne
and Jaspers, M. Monique W.
and {\"O}ry, Ferko
and Alvarez-Jimenez, Mario
and Gleeson, F. John
and Nieman, H. Dorien",
title="The Effects of a Digital, Transdiagnostic, Clinically and Peer-Moderated Treatment Platform for Young People With Emerging Mental Health Complaints: Repeated Measures Within-Subjects Study",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Dec",
day="13",
volume="11",
pages="e50636",
keywords="indicative prevention",
keywords="youth mental health",
keywords="Moderated Online Social Therapy",
keywords="MOST+",
keywords="eHealth",
keywords="well-being",
keywords="early detection and intervention",
keywords="Engage Young People Early",
keywords="ENYOY",
abstract="Background: To address the growing prevalence of youth mental health problems, early intervention is crucial to minimize individual, societal, and economic impacts. Indicative prevention aims to target emerging mental health complaints before the onset of a full-blown disorder. When intervening at this early stage, individuals are more responsive to treatment, resulting in cost-effective outcomes. The Moderated Online Social Therapy platform, which was successfully implemented and proven effective in Australia, is a digital, peer- and clinically moderated treatment platform designed for young people. The Netherlands was the first country outside Australia to implement this platform, under the name Engage Young People Early (ENYOY). It has the potential to reduce the likelihood of young people developing serious mental health disorders. Objective: This study aims to investigate the effects on young people using the ENYOY-platform in relation to psychological distress, psychosocial functioning, and positive health parameters. Methods: Dutch-speaking young people with emerging mental health complaints (N=131) participated in the ENYOY-platform for 6 months in a repeated measures within-subjects study. Psychological distress, psychosocial functioning, and positive health parameters were assessed at baseline and 3, 6, and 12 months. Repeated measures ANOVA was conducted and adjusted for age, sex, therapy, and community activity. The Reliable Change Index and Clinically Significant Index were computed to compare the baseline with the 6- and 12-month measurements. The missing data rate was 22.54\% and the dropout rate 62.6\% (82/131). Results: The primary analysis (77/131, 58.8\%) showed that psychological distress decreased and psychosocial functioning improved over time with large effect sizes (P<.001 in both cases; $\eta$p2=0.239 and 0.318, respectively) independent of age (P=.76 for psychological distress and P=.48 for psychosocial functioning), sex (P=.24 and P=.88, respectively), therapy activity (P=.49 and P=.80, respectively), or community activity (P=.59 and P=.48, respectively). Similarly, secondary analyses (51/131, 38.9\%) showed significant effects of time on the quality of life, well-being, and meaningfulness positive health parameters (P<.05; $\eta$p2=0.062, 0.140, and 0.121, respectively). Improvements in all outcome measures were found between baseline and 3 and 6 months (P?.001-.01; d=0.23-0.62) and sustained at follow-up (P=.18-.97; d=0.01-0.16). The Reliable Change Index indicated psychological distress improvements in 38\% (39/102) of cases, no change in 54.9\% (56/102) of cases, and worsening in 5.9\% (6/102) of cases. Regarding psychosocial functioning, the percentages were 50\% (51/102), 43.1\% (44/102), and 6.9\% (7/102), respectively. The Clinically Significant Index demonstrated clinically significant changes in 75.5\% (77/102) of cases for distress and 89.2\% (91/102) for functioning. Conclusions: This trial demonstrated that the ENYOY-platform holds promise as a transdiagnostic intervention for addressing emerging mental health complaints among young people in the Netherlands and laid the groundwork for further clinical research. It would be of great relevance to expand the population on and service delivery of the platform. International Registered Report Identifier (IRRID): RR2-10.1186/s12888-021-03315-x ",
doi="10.2196/50636",
url="https://mhealth.jmir.org/2023/1/e50636",
url="http://www.ncbi.nlm.nih.gov/pubmed/38090802"
}


@Article{info:doi/10.2196/44993,
author="Mahmoodi Kahriz, Bahram
and Snuggs, Sarah
and Sah, Anumeha
and Clot, Sophie
and Lamport, Daniel
and Forrest, Joseph
and Helme-Guizon, Agnes
and Wilhelm, Marie-Claire
and Caldara, Cindy
and Anin, Valentine Camille
and Vogt, Julia",
title="Unveiling Consumer Preferences and Intentions for Cocreated Features of a Combined Diet and Physical Activity App: Cross-Sectional Study in 4 European Countries",
journal="JMIR Hum Factors",
year="2023",
month="Dec",
day="11",
volume="10",
pages="e44993",
keywords="mobile apps",
keywords="healthy eating and physical activity",
keywords="attitude",
keywords="BMI and self-efficacy",
abstract="Background: Numerous mobile health apps are marketed globally, and these have specific features including physical activity tracking, motivational feedback, and recipe provision. It is important to understand which features individuals prefer and whether these preferences differ between consumer groups. Objective: In this study, we aimed to identify consumers' most preferred features and rewards for a mobile app that targets healthy eating and physical activity and to reduce the number of individual mobile health app features to a smaller number of key categories as perceived by consumers. In addition, we investigated the impact of differences in consumers' BMI and self-efficacy on their intention to use and willingness to pay for such an app. Finally, we identified the characteristics of different target groups of consumers and their responses toward app features via cluster analysis. Methods: A total of 212 participants from France, Italy, the United Kingdom, and Germany were recruited via the web to answer questions about app features, motivation, self-efficacy, demographics, and geographic factors. It is important to note that our study included an evenly distributed sample of people in the age range of 23 to 50 years (23-35 and 35-50 years). The app features in question were generated from a 14-day cocreation session by a group of consumers from the United Kingdom and the Republic of Ireland. Results: ``Home work out suggestions,'' ``exercise tips,'' and ``progress charts'' were the most preferred app features, whereas ``gift vouchers'' and ``shopping discounts'' were the most preferred rewards. ``Connections with other communication apps'' was the least preferred feature, and ``charitable giving'' was the least preferred reward. Importantly, consumers' positive attitude toward the ``social support and connectedness and mindfulness'' app feature predicted willingness to pay for such an app ($\beta$=.229; P=.004). Differences in consumers' health status, motivational factors, and basic demographics moderated these results and consumers' intention to use and willingness to pay for such an app. Notably, younger and more motivated consumers with more experience and knowledge about health apps indicated more positive attitudes and intentions to use and willingness to pay for this type of app. Conclusions: This study indicated that consumers tend to prefer app features that are activity based and demonstrate progress. It also suggested a potential role for monetary rewards in promoting healthy lifestyle behaviors. Moreover, the results highlighted the role of consumers' health status, motivational factors, and socioeconomic status in predicting their app use. These results provide up-to-date, practical, and pragmatic information for the future design and operation of mobile health apps. ",
doi="10.2196/44993",
url="https://humanfactors.jmir.org/2023/1/e44993",
url="http://www.ncbi.nlm.nih.gov/pubmed/38079197"
}


@Article{info:doi/10.2196/41974,
author="Tacey, Alexander
and Behne, Jack
and Patten, K. Rhiannon
and Ngo, Truc Minh
and Thomas, Rees
and Ancilleri, Jessica
and Bone, Chelsea
and Paredes Castro, Angela
and McCarthy, Helen
and Harkin, Katherine
and Gilmartin-Thomas, FM Julia
and Takla, Amir
and Downie, Calum
and Mulcahy, Jane
and Ball, Michelle
and Sharples, Jenny
and Dash, Sarah
and Lawton, Amy
and Wright, Breanna
and Sleeth, Peter
and Kostecki, Tina
and Sonn, Christopher
and McKenna, J. Michael
and Apostolopoulos, Vasso
and Lane, Rebecca
and Said, M. Catherine
and De Gori, Mary
and McAinch, Andrew
and Tran, Phong
and Levinger, Itamar
and Parker, Alexandra
and Woessner, N. Mary
and Pascoe, Michaela",
title="Development of a Digital Health Intervention to Support Patients on a Waitlist for Orthopedic Specialist Care: Co-Design Study",
journal="JMIR Form Res",
year="2023",
month="Dec",
day="8",
volume="7",
pages="e41974",
keywords="osteoarthritis",
keywords="web intervention",
keywords="eHealth",
keywords="orthopedic waitlist",
keywords="human-centered design",
keywords="self-management",
keywords="knee pain",
keywords="hip pain",
keywords="mobile phone",
abstract="Background: The demand for orthopedic specialist consultations for patients with osteoarthritis in public hospitals is high and continues to grow. Lengthy waiting times are increasingly affecting patients from low socioeconomic and culturally and linguistically diverse backgrounds who are more likely to rely on public health care. Objective: This study aimed to co-design a digital health intervention for patients with OA who are waiting for an orthopedic specialist consultation at a public health service, which is located in local government areas (LGAs) of identified social and economic disadvantage. Methods: The stakeholders involved in the co-design process included the research team; end users (patients); clinicians; academic experts; senior hospital staff; and a research, design, and development agency. The iterative co-design process comprised several key phases, including the collation and refinement of evidence-based information by the research team, with assistance from academic experts. Structured interviews with 16 clinicians (female: n=10, 63\%; male: n=6, 38\%) and 11 end users (age: mean 64.3, SD 7.2 y; female: n=7, 64\%; male: n=4, 36\%) of 1-hour duration were completed to understand the requirements for the intervention. Weekly workshops were held with key stakeholders throughout development. A different cohort of 15 end users (age: mean 61.5, SD 9.7 y; female: n=12, 80\%; male: n=3, 20\%) examined the feasibility of the study during a 2-week testing period. The System Usability Scale was used as the primary measure of intervention feasibility. Results: Overall, 7 content modules were developed and refined over several iterations. Key themes highlighted in the clinician and end user interviews were the diverse characteristics of patients, the hierarchical structure with which patients view health practitioners, the importance of delivering information in multiple formats (written, audio, and visual), and access to patient-centered information as early as possible in the health care journey. All content was translated into Vietnamese, the most widely spoken language following English in the local government areas included in this study. Patients with hip and knee osteoarthritis from culturally and linguistically diverse backgrounds tested the feasibility of the intervention. A mean System Usability Scale score of 82.7 (SD 16) was recorded for the intervention, placing its usability in the excellent category. Conclusions: Through the co-design process, we developed an evidence-based, holistic, and patient-centered digital health intervention. The intervention was specifically designed to be used by patients from diverse backgrounds, including those with low health, digital, and written literacy levels. The effectiveness of the intervention in improving the physical and mental health of patients will be determined by a high-quality randomized controlled trial. ",
doi="10.2196/41974",
url="https://formative.jmir.org/2023/1/e41974",
url="http://www.ncbi.nlm.nih.gov/pubmed/38064257"
}


@Article{info:doi/10.2196/48623,
author="Praha, Nattaya
and Sriyuktasuth, Aurawamon
and Puwarawuttipanit, Wimolrat
and Chuengsaman, Piyatida
and Kusakunniran, Worapan",
title="Factors Influencing Telehealth Service Use and Health Outcomes in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis: Cross-Sectional Study",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="5",
volume="25",
pages="e48623",
keywords="acceptance",
keywords="cross-sectional study",
keywords="health system and access",
keywords="mHealth",
keywords="mobile health",
keywords="peritoneal dialysis",
keywords="telehealth",
abstract="Background: Several studies have demonstrated the efficacy and user acceptance of telehealth in managing patients with chronic conditions, including continuous ambulatory peritoneal dialysis (CAPD). However, the rates of telehealth service use in various patient groups have been low and have declined over time, which may affect important health outcomes. Telehealth service use in patients undergoing CAPD has been recognized as a key challenge that needs to be examined further. Objective: This study aimed to explore the rates of telehealth service use over 4 months, identify factors influencing its use, and examine the relationship between telehealth service use and health outcomes in Thai people undergoing CAPD. Methods: This cross-sectional study, which was a part of a pragmatic randomized controlled trial study, was conducted at a dialysis center in Bangkok, Thailand. The study included patients who were undergoing CAPD. These patients were randomly enrolled in the intervention group to receive telehealth service and additional standard care for 4 months. Data were collected using self-reported questionnaires, including a demographic form, Functional, Communicative, and Critical Health Literacy Scale, Perceived Usefulness Questionnaire, Brief Illness Perception Questionnaire, Patient-Doctor Relationship Questionnaire, and Kidney Disease Quality of Life 36 Questionnaire. Additionally, Google Analytics was used to obtain data on the actual use of the telehealth service. These data were analyzed using descriptive statistics, repeated-measures ANOVA, and regression analyses. Results: A total of 159 patients were included in this study. The mean rate of telehealth service use throughout the period of 4 months was 62.06 (SD 49.71) times. The rate of telehealth service use was the highest in the first month (mean 23.48, SD 16.28 times) and the lowest in the third month (mean 11.09, SD 11.48 times). Independent variables explained 27.6\% of the sample variances in telehealth service use. Older age ($\beta$=.221; P=.002), higher perceived usefulness ($\beta$=.414; P<.001), unemployment ($\beta$=?.155; P=.03), and positive illness perception ($\beta$=?.205; P=.004) were associated with a significantly higher rate of telehealth service use. Regarding the relationship between telehealth service use and health outcomes, higher rates of telehealth service use were linked to better quality of life ($\beta$=.241; P=.002) and lower peritonitis (odds ratio 0.980, 95\% CI 0.962-0.997; P=.03). Conclusions: This study provides valuable insights into factors impacting telehealth service use, which in turn affect health outcomes in patients undergoing CAPD. ",
doi="10.2196/48623",
url="https://www.jmir.org/2023/1/e48623",
url="http://www.ncbi.nlm.nih.gov/pubmed/38051557"
}


@Article{info:doi/10.2196/47103,
author="Alluhaidan, Saleh Ala
and Chatterjee, Samir
and Drew, E. David
and Ractham, Peter
and Kaewkitipong, Laddawan",
title="Empowerment Enabled by Information and Communications Technology and Intention to Sustain a Healthy Behavior: Survey of General Users",
journal="JMIR Hum Factors",
year="2023",
month="Nov",
day="22",
volume="10",
pages="e47103",
keywords="empowerment",
keywords="behavior change",
keywords="information and communications technology",
keywords="ICT",
keywords="sustaining health behavior",
keywords="long-term health behavior",
keywords="mobile phone",
abstract="Background: Most people with chronic conditions fail to adhere to self-management behavioral guidelines. In the last 2 decades, several mobile health apps and IT-based systems have been designed and developed to help patients change and sustain their healthy behaviors. However, these systems often lead to short-term behavior change or adherence while the goal is to engage the population toward long-term behavior change. Objective: This study aims to contribute to the development of long-term health behavior changes or to help people sustain their healthy behavior. For this purpose, we built and tested a theoretical model that includes enablers of empowerment and an intention to sustain a healthy behavior when patients are assisted by information and communications technology. Methods: Structural equation modeling was used to analyze 427 survey returns collected from a diverse population of participants and patients. Notably, the model testing was performed for physical activity as a generally desirable healthy goal. Results: Message aligned with personal goals, familiarity with technology tools, high self-efficacy, social connection, and community support played a significant role (P<.001) in empowering individuals to maintain a healthy behavior. The feeling of being empowered exhibited a strong influence, with a path coefficient of 0.681 on an intention to sustain healthy behavior. Conclusions: The uniqueness of this model is its recognition of needs (ie, social connection, community support, and self-efficacy) to sustain a healthy behavior. Individuals are empowered when they are assisted by family and community, specifically when they possess the knowledge, skills, and self-awareness to ascertain and achieve their goals. This nascent theory explains what might lead to more sustainable behavior change and is meant to help designers build better apps that enable people to conduct self-care routines and sustain their behavior. ",
doi="10.2196/47103",
url="https://humanfactors.jmir.org/2023/1/e47103",
url="http://www.ncbi.nlm.nih.gov/pubmed/37991814"
}


@Article{info:doi/10.2196/50038,
author="Premanandan, Shweta
and Ahmad, Awais
and Cajander, {\AA}sa
and {\AA}gerfalk, P{\"a}r
and Dolezel, Michal
and van Gemert-Pijnen, Lisette",
title="Designing a Mobile e-Coaching App for Immigrant Informal Caregivers: Qualitative Study Using the Persuasive System Design Model",
journal="JMIR Mhealth Uhealth",
year="2023",
month="Nov",
day="9",
volume="11",
pages="e50038",
keywords="e-coaching",
keywords="mobile health",
keywords="mHealth",
keywords="immigrant informal caregivers",
keywords="designing app",
keywords="persuasive system design",
keywords="user needs",
keywords="caregiver",
keywords="app",
keywords="design",
keywords="users",
keywords="aging",
keywords="development",
keywords="diversity",
keywords="language barrier",
keywords="inclusion",
keywords="training",
keywords="mental health",
keywords="mobile phone",
abstract="Background: Informal caregivers are vital in caring for their family and friends at home who may have illnesses or disabilities. In particular, the demands for caregiving can be even more challenging for those with limited resources, support systems, and language barriers, such as immigrant informal caregivers. They face complex challenges in providing care for their relatives. These challenges can be related to sociocultural diversity, language barriers, and health care system navigation. Acknowledging the global context of the increasing number of immigrants is essential in designing inclusive mobile health apps. Objective: This study aims to investigate the needs of immigrant informal caregivers in Sweden and discuss the application of the Persuasive System Design Model (PSDM) to develop an e-coaching prototype. By addressing the unique challenges faced by immigrant informal caregivers, this study will contribute to the development of more effective and inclusive mobile health apps. Methods: The participants were considered immigrants and included in the study if they and their parents were born outside of Sweden. Through various channels, such as the National Association of Relatives, rehabilitation departments at municipalities, and immigrant groups, we recruited 13 immigrant informal caregivers. These immigrant informal caregivers were primarily women aged 18 to 40 years. Most participants belonged to the Middle Eastern region whereas some were from North Africa. However, all of them spoke Arabic. We used semistructured interviews to gather data from the participants in Arabic, which were translated into English. Data were analyzed using thematic analysis and discussed in relation to the extended PSDM. The needs of the caregivers were compared with the description of persuasive design principles, and a design principle was chosen based on the match. The PSDM was extended if the need description did not match any principles. Several brainstorming and prototyping sessions were conducted to design the mobile e-coaching app. Results: Immigrant informal caregivers have various needs in their caregiving role. They reported a need for training on the illness and future caregiving needs, assistance with understanding the Swedish language and culture, and help with accessing internet-based information and services. They also required recognition and appreciation for their efforts, additional informal support, and easy access to health care services, which can be important for their mental health. The PSDM was adapted to the informal caregiving context by adding ``facilitating conditions'' and ``verbal encouragement'' as additional persuasive design principles. This study also presents the subsequent mobile e-coaching app for immigrant informal caregivers in Sweden. Conclusions: This study revealed important immigrant informal caregivers' needs based on which design suggestions for a mobile e-coaching app were presented. We also proposed an adapted PSDM, for the informal caregiving context. The adapted PSDM can be further used to design digital interventions for caregiving. ",
doi="10.2196/50038",
url="https://mhealth.jmir.org/2023/1/e50038",
url="http://www.ncbi.nlm.nih.gov/pubmed/37943598"
}


@Article{info:doi/10.2196/48804,
author="Seidler, E. Zac
and Benakovic, Ruben
and Wilson, J. Michael
and Fletcher, Justine
and Oliffe, L. John
and Owen, Jesse
and Rice, M. Simon",
title="Supporting Clinical Competencies in Men's Mental Health Using the Men in Mind Practitioner Training Program: User Experience Study",
journal="JMIR Med Educ",
year="2023",
month="Nov",
day="7",
volume="9",
pages="e48804",
keywords="e-learning",
keywords="mental health services",
keywords="psychotherapy",
keywords="men's mental health",
keywords="masculinity",
abstract="Background: Engaging men in psychotherapy is essential in male suicide prevention efforts, yet to date, efforts to upskill mental health practitioners in delivering gender-sensitized therapy for men have been lacking. To address this, we developed Men in Mind, an e-learning training program designed to upskill mental health practitioners in engaging men in therapy. Objective: This study involves an in-depth analysis of the user experience of the Men in Mind intervention, assessed as part of a randomized controlled trial of the efficacy of the intervention. Methods: Following completion of the intervention, participants provided qualitative (n=392) and quantitative (n=395) user experience feedback, focused on successes and suggested improvements to the intervention and improvements to their confidence in delivering therapy with specific subpopulations of male clients. We also assessed practitioner learning goals (n=242) and explored the extent to which participants had achieved these goals at follow-up. Results: Participants valued the inclusion of video demonstrations of skills in action alongside the range of evidence-based content dedicated to improving their insight into the engagement of men in therapy. Suggested improvements most commonly reflected the desire for more or more diverse content, alongside the necessary adaptations to improve the learning and user experience. Participants also commonly reported improved confidence in assisting men with difficulty articulating their emotions in therapy and suicidal men. Conclusions: The evidence obtained from this study aids in plans to scale Men in Mind and informs the future development of practitioner training interventions in men's mental health. International Registered Report Identifier (IRRID): RR2-10.1186/s40359-022-00875-9 ",
doi="10.2196/48804",
url="https://mededu.jmir.org/2023/1/e48804",
url="http://www.ncbi.nlm.nih.gov/pubmed/37934579"
}


@Article{info:doi/10.2196/50798,
author="Yameogo, Roghemrazangba Achille
and D{\'e}l{\'e}troz, Carole
and Sasseville, Maxime
and Amil, Samira
and Da, Romaric Si{\'e} Mathieu Aymar
and Bodenmann, Patrick
and Gagnon, Marie-Pierre",
title="Effectiveness of Interventions to Improve Digital Health Literacy in Forced Migrant Populations: Protocol for a Mixed Methods Systematic Review",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="2",
volume="12",
pages="e50798",
keywords="intervention",
keywords="digital health literacy",
keywords="forced migrant populations",
keywords="health literacy",
keywords="digital literacy",
keywords="migrant",
keywords="migrants",
keywords="immigrant",
keywords="immigrants",
keywords="knowledge synthesis",
keywords="review methods",
keywords="review methodology",
keywords="systematic",
keywords="eHealth literacy",
abstract="Background: Digital health literacy is considered a health determinant that can influence improved health and well-being, health equity, and the reduction of social health inequalities. Therefore, it serves as an asset for individuals to promote their health. However, low digital health literacy is a major problem among forced migrant populations. They do not always have the capacity and skills to access digital health resources and use them appropriately. To our knowledge, no studies are currently available to examine effective interventions for improving digital health literacy among forced migrant populations. Objective: This paper presents the protocol for a systematic review that aims to assess the effectiveness of digital health literacy interventions among forced migrant populations. With this review, our objectives are as follows: (1) identify interventions designed to improve digital health literacy among forced migrant populations, including interventions aimed at creating enabling conditions or environments that cater to the needs and expectations of forced migrants limited by low levels of digital health literacy, with the goal of facilitating their access to and use of eHealth resources; (2) define the categories and describe the characteristics of these interventions, which are designed to enhance the abilities of forced migrants or adapt digital health services to meet the needs and expectations of forced migrant populations. Methods: A mixed methods systematic review will be conducted according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) checklist. The research will be conducted in an iterative process among the different authors. With the help of a medical information specialist, a specific search strategy will be formulated for the 6 most relevant databases (ie, MEDLINE, Embase, CINAHL, Web of Science, Academic Search Premier, PsycINFO, and the Google Scholar search engine). A literature search covering studies published between 2000 and 2022 has already been conducted. Two reviewers then proceeded, individually and independently, to conduct a double selection of titles, abstracts, and then full texts. Data extraction will be conducted by a reviewer and validated by a senior researcher. We will use the narrative synthesis method (ie, structured narrative summaries of key themes) to present a comprehensive picture of effective digital health literacy interventions among forced migrant populations and the success factors of these interventions. Results: The search strategy and literature search were completed in December 2022. A total of 1232 articles were identified. The first selection was completed in July 2023. The second selection is still in progress. The publication of the systematic review is scheduled for December 2023. Conclusions: This mixed methods systematic review will provide comprehensive knowledge on effective interventions for digital literacy among forced migrant populations. The evidence generated will further inform stakeholders and aid decision makers in promoting equitable access to and use of digital health resources for forced migrant populations and the general population in host countries. International Registered Report Identifier (IRRID): DERR1-10.2196/50798 ",
doi="10.2196/50798",
url="https://www.researchprotocols.org/2023/1/e50798",
url="http://www.ncbi.nlm.nih.gov/pubmed/37917139"
}


@Article{info:doi/10.2196/49892,
author="Pelly, Louise Melissa
and Fatehi, Farhad
and Liew, Danny
and Verdejo-Garcia, Antonio",
title="Digital Health Secondary Prevention Using Co-Design Procedures: Focus Group Study With Health Care Providers and Patients With Myocardial Infarction",
journal="JMIR Cardio",
year="2023",
month="Oct",
day="30",
volume="7",
pages="e49892",
keywords="co-design",
keywords="digital health",
keywords="myocardial infarction",
keywords="qualitative",
keywords="participatory",
keywords="mobile health",
abstract="Background: Myocardial infarction (MI) is a debilitating condition and a leading cause of morbidity and mortality worldwide. Digital health is a promising approach for delivering secondary prevention to support patients with a history of MI and for reducing risk factors that can lead to a future event. However, its potential can only be fulfilled when the technology meets the needs of the end users who will be interacting with this secondary prevention. Objective: We aimed to gauge the opinions of patients with a history of MI and health professionals concerning the functions, features, and characteristics of a digital health solution to support post-MI care. Methods: Our approach aligned with the gold standard participatory co-design procedures enabling progressive refinement of feedback via exploratory, confirmatory, and prototype-assisted feedback from participants. Patients with a history of MI and health professionals from Australia attended focus groups over a videoconference system. We engaged with 38 participants across 3 rounds of focus groups using an iterative co-design approach. Round 1 included 8 participants (4 patients and 4 health professionals), round 2 included 24 participants (11 patients and 13 health professionals), and round 3 included 22 participants (14 patients and 8 health professionals). Results: Participants highlighted the potential of digital health in addressing the unmet needs of post-MI care. Both patients with a history of MI and health professionals agreed that mental health is a key concern in post-MI care that requires further support. Participants agreed that family members can be used to support postdischarge care and require support from the health care team. Participants agreed that incorporating simple games with a points system can increase long-term engagement. However, patients with a history of MI emphasized a lack of support from their health care team, family, and community more strongly than health professionals. They also expressed some openness to using artificial intelligence, whereas health professionals expressed that users should not be aware of artificial intelligence use. Conclusions: These results provide valuable insights into the development of digital health secondary preventions aimed at supporting patients with a history of MI. Future research can implement a pilot study in the population with MI to trial these recommendations in a real-world setting. ",
doi="10.2196/49892",
url="https://cardio.jmir.org/2023/1/e49892",
url="http://www.ncbi.nlm.nih.gov/pubmed/37902821"
}


@Article{info:doi/10.2196/49319,
author="Sharma, Nikita
and Braakman-Jansen, A. Louise M.
and Oinas-Kukkonen, Harri
and Croockewit, Hendrik Jan
and Gemert-Pijnen, van JEWC",
title="Exploring the Needs and Requirements of Informal Caregivers of Older Adults With Cognitive Impairment From Sensor-Based Care Solutions: Multimethod Study",
journal="JMIR Aging",
year="2023",
month="Oct",
day="25",
volume="6",
pages="e49319",
keywords="informal caregiving",
keywords="cognitive impairment",
keywords="unobtrusive sensing solutions",
keywords="in-home care",
keywords="aging in place",
keywords="assistive technologies",
abstract="Background: With the increase in the older adult population, sensor-based care solutions that can monitor the deviations in physical, emotional, and physiological activities in real-time from a distance are demanded for prolonging the stay of community-dwelling older adults with cognitive impairment. To effectively develop and implement these care solutions, it is important to understand the current experiences, future expectations, perceived usefulness (PU), and communication needs of the informal caregivers of older adults with cognitive impairment regarding such solutions. Objective: This comprehensive study with informal caregivers of older adults with cognitive impairment aims to (1) highlight current experiences with (if any) and future expectations from general sensor-based care solutions, (2) explore PU specifically toward unobtrusive sensing solutions (USSs), (3) determine the information communication (IC) needs and requirements for communicating the information obtained through USSs in different care scenarios (fall, nocturnal unrest, agitation, and normal daily life), and (4) elicit the design features for designing the interaction platform in accordance with the persuasive system design (PSD) model. Methods: A multimethod research approach encompassing a survey (N=464) and in-depth interviews (10/464, 2.2\%) with informal caregivers of older adults with cognitive impairment was used. The insights into past experiences with and future expectations from the sensor-based care solutions were obtained through inductive thematic analysis of the interviews. A convergent mixed methods approach was used to explore PU and gather the IC needs from USSs by using scenario-specific questions in both survey and interviews. Finally, the design features were elicited by using the PSD model on the obtained IC needs and requirements. Results: Informal caregivers expect care infrastructure to consider centralized and empathetic care approaches. Specifically, sensor-based care solutions should be adaptable to care needs, demonstrate trust and reliability, and ensure privacy and safety. Most informal caregivers found USSs to be useful for emergencies (mean 4.09, SD 0.04) rather than for monitoring normal daily life activities (mean 3.50, SD 0.04). Moreover, they display variations in information needs including mode, content, time, and stakeholders involved based on the care scenario at hand. Finally, PSD features, namely, reduction, tailoring, personalization, reminders, suggestions, trustworthiness, and social learning, were identified for various care scenarios. Conclusions: From the obtained results, it can be concluded that the care scenario at hand drives PU and IC design needs and requirements toward USSs. Therefore, future technology developers are recommended to develop technology that can be easily adapted to diverse care scenarios, whereas designers of such sensor-driven platforms are encouraged to go beyond tailoring and strive for strong personalization while maintaining the privacy of the users. ",
doi="10.2196/49319",
url="https://aging.jmir.org/2023/1/e49319",
url="http://www.ncbi.nlm.nih.gov/pubmed/37878353"
}


@Article{info:doi/10.2196/49025,
author="Ranusch, Allison
and Lin, Ying-Jen
and Dorsch, P. Michael
and Allen, L. Arthur
and Spoutz, Patrick
and Seagull, Jacob F.
and Sussman, B. Jeremy
and Barnes, D. Geoffrey",
title="Role of Individual Clinician Authority in the Implementation of Informatics Tools for Population-Based Medication Management: Qualitative Semistructured Interview Study",
journal="JMIR Hum Factors",
year="2023",
month="Oct",
day="24",
volume="10",
pages="e49025",
keywords="direct oral anticoagulant",
keywords="population management",
keywords="implementation science",
keywords="medical informatics",
keywords="individual clinician authority",
keywords="electronic health record",
keywords="health records",
keywords="EHR",
keywords="EHRs",
keywords="implementation",
keywords="clotting",
keywords="clot",
keywords="clots",
keywords="anticoagulant",
keywords="anticoagulants",
keywords="dashboard",
keywords="DOAC",
keywords="satisfaction",
keywords="interview",
keywords="interviews",
keywords="pharmacist",
keywords="pharmacy",
keywords="pharmacology",
keywords="medication",
keywords="prescribe",
keywords="prescribing",
abstract="Background: Direct oral anticoagulant (DOAC) medications are frequently associated with inappropriate prescribing and adverse events. To improve the safe use of DOACs, health systems are implementing population health tools within their electronic health record (EHR). While EHR informatics tools can help increase awareness of inappropriate prescribing of medications, a lack of empowerment (or insufficient empowerment) of nonphysicians to implement change is a key barrier. Objective: This study examined how the individual authority of clinical pharmacists and anticoagulation nurses is impacted by and changes the implementation success of an EHR DOAC Dashboard for safe DOAC medication prescribing. Methods: We conducted semistructured interviews with pharmacists and nurses following the implementation of the EHR DOAC Dashboard at 3 clinical sites. Interview transcripts were coded according to the key determinants of implementation success. The intersections between individual clinician authority and other determinants were examined to identify themes. Results: A high level of individual clinician authority was associated with high levels of key facilitators for effective use of the DOAC Dashboard (communication, staffing and work schedule, job satisfaction, and EHR integration). Conversely, a lack of individual authority was often associated with key barriers to effective DOAC Dashboard use. Positive individual authority was sometimes present with a negative example of another determinant, but no evidence was found of individual authority co-occurring with a positive instance of another determinant. Conclusions: Increased individual clinician authority is a necessary antecedent to the effective implementation of an EHR DOAC Population Management Dashboard and positively affects other aspects of implementation. International Registered Report Identifier (IRRID): RR2-10.1186/s13012-020-01044-5 ",
doi="10.2196/49025",
url="https://humanfactors.jmir.org/2023/1/e49025",
url="http://www.ncbi.nlm.nih.gov/pubmed/37874636"
}


@Article{info:doi/10.2196/46909,
author="Medich, Melissa
and Cannedy, L. Shay
and Hoffmann, C. Lauren
and Chinchilla, Y. Melissa
and Pila, M. Jose
and Chassman, A. Stephanie
and Calderon, A. Ronald
and Young, S. Alexander",
title="Clinician and Patient Perspectives on the Use of Passive Mobile Monitoring and Self-Tracking for Patients With Serious Mental Illness: User-Centered Approach",
journal="JMIR Hum Factors",
year="2023",
month="Oct",
day="24",
volume="10",
pages="e46909",
keywords="serious mental illness",
keywords="mobile health",
keywords="mental health",
keywords="passive sensing",
keywords="health informatics",
keywords="behavior",
keywords="self-tracking",
keywords="monitoring",
keywords="mental illness",
keywords="prevention",
keywords="acceptability",
keywords="usability",
keywords="usefulness",
keywords="application",
keywords="tool",
keywords="management",
keywords="mobile phone",
abstract="Background: Early intervention in mental health crises can prevent negative outcomes. A promising new direction is remote mental health monitoring using smartphone technology to passively collect data from individuals to rapidly detect the worsening of serious mental illness (SMI). This technology may benefit patients with SMI, but little is known about health IT acceptability among this population or their mental health clinicians. Objective: We used the Health Information Technology Acceptability Model to analyze the acceptability and usability of passive mobile monitoring and self-tracking among patients with serious mental illness and their mental health clinicians. Methods: Data collection took place between December 2020 and June 2021 in 1 Veterans Administration health care system. Interviews with mental health clinicians (n=16) assessed the acceptability of mobile sensing, its usefulness as a tool to improve clinical assessment and care, and recommendations for program refinements. Focus groups with patients with SMI (n=3 groups) and individual usability tests (n=8) elucidated patient attitudes about engaging in health IT and perceptions of its usefulness as a tool for self-tracking and improving mental health assessments. Results: Clinicians discussed the utility of web-based data dashboards to monitor patients with SMI health behaviors and receiving alerts about their worsening health. Potential benefits included improving clinical care, capturing behaviors patients do not self-report, watching trends, and receiving alerts. Clinicians' concerns included increased workloads tied to dashboard data review, lack of experience using health IT in clinical care, and how SMI patients' associated paranoia and financial instability would impact patient uptake. Despite concerns, all mental health clinicians stated that they would recommend it. Almost all patients with SMI were receptive to using smartphone dashboards for self-monitoring and having behavioral change alerts sent to their mental health clinicians. They found the mobile app easy to navigate and dashboards easy to find and understand. Patient concerns centered on privacy and ``government tracking,'' and their phone's battery life and data plans. Despite concerns, most reported that they would use it. Conclusions: Many people with SMI would like to have mobile informatics tools that can support their illness and recovery. Similar to other populations (eg, older adults, people experiencing homelessness) this population presents challenges to adoption and implementation. Health care organizations will need to provide resources to address these and support successful illness management. Clinicians are supportive of technological approaches, with adapting informatics data into their workflow as the primary challenge. Despite clear challenges, technological developments are increasingly designed to be acceptable to patients. The research development--clinical deployment gap must be addressed by health care systems, similar to computerized cognitive training. It will ensure clinicians operate at the top of their skill set and are not overwhelmed by administrative tasks, data summarization, or reviewing data that do not indicate a need for intervention. International Registered Report Identifier (IRRID): RR2-10.2196/39010 ",
doi="10.2196/46909",
url="https://humanfactors.jmir.org/2023/1/e46909",
url="http://www.ncbi.nlm.nih.gov/pubmed/37874639"
}


@Article{info:doi/10.2196/50584,
author="Henson, Connie
and Chapman, Felicity
and Shepherd, Gina
and Carlson, Bronwyn
and Rambaldini, Boe
and Gwynne, Kylie",
title="Amplifying Older Aboriginal and Torres Strait Islander Women's Perspectives to Promote Digital Health Equity: Co-Designed Qualitative Study",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="17",
volume="25",
pages="e50584",
keywords="digital health",
keywords="Aboriginal and Torres Strait Islander",
keywords="Indigenous",
keywords="health technology",
keywords="co-design",
keywords="cultural safety",
keywords="older Indigenous women",
keywords="social media",
keywords="wearables",
keywords="mobile phone",
abstract="Background: Digital health is becoming ubiquitous, and we must ensure equity in access. Indigenous people across most high-income countries typically have not benefited as much as other citizens from usual health care systems and technologies. Despite Aboriginal and Torres Strait Islander people's clear interest in, and enthusiastic use of, new technologies, little research has examined the needs or interests of older Aboriginal and Torres Strait Islander women. Objective: This study prioritizes the perspectives of older Aboriginal and Torres Strait Islander women, tapping into their expertise associated with Indigenous ways of knowing, being, and doing, as well as their unique position within their families and communities, to design a model for using digital technologies to improve health for themselves and their families as well as their communities. Methods: Older Aboriginal and Torres Strait Islander women from 4 partner organizations were recruited for this study. This co-designed qualitative research included citizen scientists in shaping the protocol as well as collecting, analyzing, and interpreting data. We used yarning, an Indigenous research method validated for use in health research with Indigenous people and seen as respectful and culturally safe, as a primary research tool. The use of Indigenous methodologies and our iterative process enabled us to deeply explore and incorporate perspectives from all participants and ensure that the perspectives of Indigenous citizen scientists with lived experience were privileged. The data-checking methods also used a yarning methodology, which ensured that the findings and translational model derived from the findings were validated by the participants. Results: Participants comprised 24 Aboriginal and Torres Strait Islander women aged ?41 years and including 3 generations that did not grow up with the internet: seniors, baby boomers, and Generation X. The key findings in this research were that older women use various digital technologies to improve health and well-being for themselves and their families as well as their communities. Older Aboriginal women want a culturally sensitive cyberspace that caters specifically to their needs and includes relevant content and functionality that are accessible and efficient. Our translational model highlights the conditions necessary for anyone to use digital health technologies, summarizes the essential elements needed to promote equity in digital health, and illuminates the unmet needs and requirements for older Aboriginal and Torres Strait Islander women to fully benefit from digital health technologies. Conclusions: Health is a fundamental right. As we move toward greater reliance on digital health solutions, we must recognize and address the concerns of the smaller populations of people who differ in their needs. We must urgently address the financial, connectivity, and other limiting factors highlighted by older Aboriginal and Torres Strait Islander women in this study that limit equitable access to digital health tools. International Registered Report Identifier (IRRID): RR2-10.1177/20552076221084469 ",
doi="10.2196/50584",
url="https://www.jmir.org/2023/1/e50584",
url="http://www.ncbi.nlm.nih.gov/pubmed/37847550"
}


@Article{info:doi/10.2196/41035,
author="Stara, Vera
and Soraci, Luca
and Takano, Eiko
and Kondo, Izumi
and M{\"o}ller, Johanna
and Maranesi, Elvira
and Luzi, Riccardo
and Riccardi, Renato Giovanni
and Browne, Ryan
and Dacunha, S{\'e}bastien
and Palmier, Cecilia
and Wieching, Rainer
and Ogawa, Toshimi
and Bevilacqua, Roberta",
title="Intrinsic Capacity and Active and Healthy Aging Domains Supported by Personalized Digital Coaching: Survey Study Among Geriatricians in Europe and Japan on eHealth Opportunities for Older Adults",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="12",
volume="25",
pages="e41035",
keywords="intrinsic capacity",
keywords="functional ability, active and healthy aging",
keywords="digital coaching",
keywords="eHealth interventions",
keywords="older adults",
abstract="Background: The worldwide aging trend requires conceptually new prevention, care, and innovative living solutions to support human-based care using smart technology, and this concerns the whole world. Enabling access to active and healthy aging through personalized digital coaching services like physical activity coaching, cognitive training, emotional well-being, and social connection for older adults in real life could offer valuable advantages to both individuals and societies. A starting point might be the analysis of the perspectives of different professionals (eg, geriatricians) on such technologies. The perspectives of experts in the sector may allow the individualization of areas of improvement of clinical interventions, supporting the positive perspective pointed out by the intrinsic capacity framework. Objective: The overall aim of this study was to explore the cross-national perspectives and experiences of different professionals in the field of intrinsic capacity, and how it can be supported by eHealth interventions. To our knowledge, this is the first study to explore geriatric care providers' perspectives about technology-based interventions to support intrinsic capacity. Methods: A survey involving 20 geriatricians or clinical experts in the fields of intrinsic capacity and active and healthy aging was conducted in Italy, France, Germany, and Japan between August and September 2021. Results: The qualitative findings pointed out relevant domains for eHealth interventions and provided examples for successful practices that support subjective well-being under the intrinsic capacity framework (the benefits offered by personalized interventions, especially by promoting health literacy but avoiding intrusiveness). Moreover, eHealth interventions could be used as a bridge that facilitates and enables social engagement; an instrument that facilitates communication between doctors and patients; and a tool to enrich the monitoring actions of medical staff. Conclusions: There is an unexplored and significant role for such geriatric perspectives to help the development process and evaluate the evidence-based results on the effectiveness of technologies for older people. This is possible only when clinicians collaborate with data scientists, engineers, and developers in order to match the complex daily needs of older adults. ",
doi="10.2196/41035",
url="https://www.jmir.org/2023/1/e41035",
url="http://www.ncbi.nlm.nih.gov/pubmed/37824183"
}


@Article{info:doi/10.2196/49675,
author="Rego, Chryselle
and Montague, Enid",
title="The Impact of Feedback Modalities and the Influence of Cognitive Load on Interpersonal Communication in Nonclinical Settings: Experimental Study Design",
journal="JMIR Hum Factors",
year="2023",
month="Oct",
day="5",
volume="10",
pages="e49675",
keywords="physician-patient interaction",
keywords="cognitive load",
keywords="visual feedback",
keywords="haptic feedback",
keywords="postsession feedback",
abstract="Background: The escalating demands of modern health care systems, combined with the emotional toll of patient care, have led to an alarming increase in physician burnout rates. This burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, can hinder doctors' ability to connect with patients effectively. Moreover, the cognitive load arising from information overload and the need for multitasking can further hinder doctors' ability to connect with patients effectively. Understanding the complex relationship between physician burnout and cognitive load is crucial for devising targeted interventions that enhance physician well-being and promote effective physician-patient interactions. Implementing strategies to alleviate burnout and cognitive load can lead to improved health care experiences and patient outcomes. Objective: Our study explores the interplay between physician burnout and its potential impact on interpersonal communication, particularly focusing on the role of cognitive load using a pilot study in a nonclinical setting involving nonclinical participants. Methods: This study uses an experimental design to evaluate 3 feedback tools (haptic, visual, and postvisit summary) and measure the cognitive load they impose on nonclinical participants in a nonclinical environment. The NASA Task Load Index, a widely accepted measure of cognitive load, was used to quantify the cognitive load associated with the feedback tools. The study used a within-subject design, meaning participants experienced all 3 feedback methods. A sample of 18 nonclinical participants was selected using counterbalancing techniques. Results: Postsession feedback not only enhancing performance but also mitigating the influence of cognitive load as compared with real-time feedback (haptic+visual). Participants with interview experience showed lower cognitive load levels when exposed to real-time feedback as compared with novice users. In contrast, postsession feedback was more effective for novice users. In addition, cognitive workload emerged as a moderating factor in the relationship between feedback tools and their impact on performance, particularly in terms of speaking balance and pace. This moderating effect suggests that the correlation between feedback tool efficacy and performance varies based on an individual's cognitive load while using the feedback tool. The comparison of postfeedback with haptic feedback yielded a Z score of ?3.245 and a P value of .001, while the comparison with visual feedback resulted in a Z score of ?2.940 and a P value of .003. These outcomes underscore a significant disparity in the means between postsession feedback and real-time feedback (haptic+visual), with postsession feedback indicating the lowest mean score. Conclusions: Through the examination of various feedback tools, this study yields significant and insightful comparisons regarding their usability and appropriateness in nonclinical settings. To enhance the applicability of these findings to clinical environments, further research encompassing diverse participant cohorts and clinical scenarios is warranted. ",
doi="10.2196/49675",
url="https://humanfactors.jmir.org/2023/1/e49675",
url="http://www.ncbi.nlm.nih.gov/pubmed/37796596"
}


@Article{info:doi/10.2196/48220,
author="Dart, Martin
and Ahmed, Mohiuddin",
title="Evaluating Staff Attitudes, Intentions, and Behaviors Related to Cyber Security in Large Australian Health Care Environments: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2023",
month="Oct",
day="4",
volume="10",
pages="e48220",
keywords="computer security",
keywords="cyber security",
keywords="surveys",
keywords="governance",
keywords="mixed methods",
keywords="Australia",
keywords="delivery of health care",
abstract="Background: Previous studies have identified that the effective management of cyber security in large health care environments is likely to be significantly impacted by human and social factors, as well as by technical controls. However, there have been limited attempts to confirm this by using measured and integrated studies to identify specific user motivations and behaviors that can be managed to achieve improved outcomes. Objective: This study aims to document and analyze survey and interview data from a diverse range of health care staff members, to determine the primary motivations and behaviors that influence their acceptance and application of cyber security messaging and controls. By identifying these issues, recommendations can be made to positively influence future cyber security governance in health care. Methods: An explanatory sequential mixed methods approach was undertaken to analyze quantitative data from a web-based staff survey (N=103), with a concurrent qualitative investigation applied to data gathered via in-depth staff interviews (N=9). Data from both stages of this methodology were mapped to descriptive variables based on a modified version of the Technology Acceptance Model (TAM; TAM2). After normalization, the quantitative data were verified and analyzed using descriptive statistics, distribution and linearity measures, and a bivariate correlation of the TAM variables to identify the Pearson coefficient (r) and significance (P) values. Finally, after confirming Cronbach $\alpha$, the determinant score for multicollinearity, and the Kaiser-Meyer-Olkin measure, and applying the Bartlett test of sphericity ($\chi$2), an exploratory factor analysis (EFA) was conducted to identify the primary factors with an eigenvalue ($\lambda$) >1.0. Comments captured during the qualitative interviews were coded using NVivo software (QSR International) to create an emic-to-etic understanding, which was subsequently integrated with the quantitative results to produce verified conclusions. Results: Using the explanatory sequential methodology, this study showed that the perceived usefulness of security controls emerged as the most significant factor influencing staff beliefs and behaviors. This variable represented 24\% of all the variances measured in the EFA and was also the most common category identified across all coded interviews (281/692, 40.6\%). The word frequency analysis showed that systems, patients, and people represented the top 3 recurring themes reported by the interviewees. Conclusions: To improve cyber security governance in large health care environments, efforts should be focused on demonstrating how confidentiality, integrity, availability, policies, and cloud or vendor-based controls (the main contributors of usefulness measured by the EFA) can directly improve outcomes for systems, staff, and patients. Further consideration also needs to be given to how clinicians should share data and collaborate on patient care, with tools and processes provided to support and manage data sharing securely and to achieve a consistent baseline of secure and normalized behaviors. ",
doi="10.2196/48220",
url="https://humanfactors.jmir.org/2023/1/e48220",
url="http://www.ncbi.nlm.nih.gov/pubmed/37792450"
}


@Article{info:doi/10.2196/46491,
author="Green, B. James
and Rodriguez, Joey
and Keshavan, Matcheri
and Lizano, Paulo
and Torous, John",
title="Implementing Technologies to Enhance Coordinated Specialty Care Framework: Implementation Outcomes From a Development and Usability Study",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="3",
volume="7",
pages="e46491",
keywords="psychosis",
keywords="digital health",
keywords="digital mental health",
keywords="coordinated specialty care",
keywords="digital navigator",
keywords="clinical high risk",
keywords="schizophrenia",
keywords="implementation science",
keywords="technology",
keywords="mobile phone",
abstract="Background: Coordinated specialty care (CSC) has demonstrated efficacy in improving outcomes in individuals at clinical high risk for psychosis and individuals with first-episode psychosis. Given the limitations of scalability and staffing needs, the augmentation of services using digital mental health interventions (DMHIs) may be explored to help support CSC service delivery. Objective: In this study, we aimed to understand the methods to implement and support technology in routine CSC and offered insights from a quality improvement study assessing the implementation outcomes of DMHIs in CSC. Methods: Patients and clinicians including psychiatrists, therapists, and supported education and employment specialists from a clinical-high-risk-for-psychosis clinic (Center for Early Detection Assessment and Response to Risk [CEDAR]) and a first-episode--psychosis clinic (Advancing Services for Psychosis Integration and Recovery [ASPIRE]) participated in a quality improvement project exploring the feasibility of DMHIs following the Access, Alignment, Connection, Care, and Scalability framework to implement mindLAMP, a flexible and evidenced-based DMHI. Digital navigators were used at each site to assist clinicians and patients in implementing mindLAMP. To explore the differences in implementation outcomes associated with the app format, a menu-style format was delivered at CEDAR, and a modular approach was used at ASPIRE. Qualitative baseline and follow-up data were collected to assess the specific implementation outcomes. Results: In total, 5 patients (ASPIRE: n=3, 60\%; CEDAR: n=2, 40\%) were included: 3 (60\%) White individuals, 2 (40\%) male and 2 (40\%) female patients, and 1 (20\%) transgender man, with a mean age of 19.6 (SD 2.05) years. Implementation outcome data revealed that patients and clinicians demonstrated high accessibility, acceptability, interest, and belief in the sustainability of DMHIs. Clinicians and patients presented a wide range of interest in unique use cases of DMHI in CSC and expressed variable feasibility and appropriateness associated with nuanced barriers and needs. In addition, the results suggest that adoption, penetration, feasibility, and appropriateness outcomes were moderate and might continue to be explored and targeted. Conclusions: Implementation outcomes from this project suggest the need for a patient- and clinician-centered approach that is guided by digital navigators and provides versatility, autonomy, and structure. Leveraging these insights has the potential to build on growing research regarding the need for versatility, autonomy, digital navigator support, and structured applications. We anticipate that by continuing to research and improve implementation barriers impeding the adoption and penetration of DMHIs in CSC, accessibility and uptake of DMHIs will improve, therefore connecting patients to the demonstrated benefits of technology-augmented care. ",
doi="10.2196/46491",
url="https://formative.jmir.org/2023/1/e46491",
url="http://www.ncbi.nlm.nih.gov/pubmed/37788066"
}


@Article{info:doi/10.2196/44028,
author="Metting, Esther
and van Luenen, Sanne
and Baron, Anna-Jetske
and Tran, Anthony
and van Duinhoven, Stijn
and Chavannes, H. Niels
and Hevink, Maud
and L{\"u}ers, Jos
and Kocks, Janwillem",
title="Overcoming the Digital Divide for Older Patients With Respiratory Disease: Focus Group Study",
journal="JMIR Form Res",
year="2023",
month="Oct",
day="3",
volume="7",
pages="e44028",
keywords="elderly people",
keywords="usability",
keywords="asthma",
keywords="chronic obstructive pulmonary disease",
keywords="website",
keywords="navigation",
abstract="Background: The need for and adoption of eHealth programs are growing worldwide. However, access can be limited among patients with low socioeconomic backgrounds, often resulting in a so-called ``digital divide'' due to a mismatch between eHealth and target populations that can gain benefit. This digital divide can result in unsuccessful eHealth implementations, which is of critical importance to health care. Objective: This study evaluated the opinions of elderly patients with asthma and chronic obstructive pulmonary disease (COPD) about an existing pharmacy-based personalized patient web portal that provides medication overview and information on associated diagnoses. The aim was to obtain insights on the common barriers of elderly people when using health-related websites, which can help to improve accessibility. Methods: This was a cross-sectional qualitative study of a patient panel of the Groningen Research Institute for Asthma and COPD in primary care. Participants were required to be older than 55 years, be Dutch speaking, have no prior experience with the study website, and be diagnosed with a chronic respiratory illness. Two focus groups were created, and they completed a 45-minute session for testing the website and a 120-minute session for semistructured interviews. The focus group sessions were recorded, transcribed verbatim, and analyzed by content analysis. Results: We enrolled 11 patients (9 women) with a mean age of 66 (SD 9) years. Of these, 5 had asthma, 3 had COPD, 2 had asthma-COPD overlap syndrome, and 1 had bronchiectasis. Participants were generally positive about the website, especially the areas providing disease-related information and the medication overview. They appreciated that the website would enable them to share this information with other health care providers. However, some difficulties were reported with navigation, such as opening a new tab, and others reported that the layout of the website was difficult either because of visual impairments or problems with navigation. It was also felt that monitoring would only be relevant if it is also checked by health care professionals as part of a treatment plan. Participants mentioned few privacy or safety concerns. Conclusions: It is feasible to develop websites for elderly patients; however, developers must take the specific needs and limitations of elderly people into account (eg, navigation problems, poor vision, or poor hand-eye coordination). The provision of information appears to be the most important aspect of the website, and as such, we should endeavor to ensure that the layout and navigation remain basic and accessible. Patients are only motivated to use self-management applications if they are an integrated part of their treatment. The usability of the website can be improved by including older people during development and by implementing design features that can improve accessibility in this group. ",
doi="10.2196/44028",
url="https://formative.jmir.org/2023/1/e44028",
url="http://www.ncbi.nlm.nih.gov/pubmed/37788072"
}


@Article{info:doi/10.2196/44885,
author="van der Ven, Jeffrey
and van den Bemt, F. Bart J.
and van Dijk, Liset
and Opdam, Merel
and Haegens, L. Lex
and Vriezekolk, E. Johanna
and Verhoef, M. Lise",
title="Preferences of Patients With Musculoskeletal Disorders Regarding the Timing and Channel of eHealth and Factors Influencing Its Use: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2023",
month="Sep",
day="27",
volume="10",
pages="e44885",
keywords="eHealth",
keywords="telehealth",
keywords="telemedicine",
keywords="chronic diseases",
keywords="chronic illness",
keywords="musculoskeletal disorders",
keywords="multiple methods",
keywords="perspectives",
keywords="preferences",
keywords="citizen science",
keywords="digital hospital services",
keywords="musculoskeletal",
keywords="orthopedic",
keywords="citizen",
keywords="civic",
keywords="society",
keywords="health tech",
keywords="Capability, Opportunity, Motivation and Behavior Model",
keywords="COM-B",
keywords="focus group",
keywords="rheumatoid arthritis",
keywords="arthritis",
keywords="rehabilitation",
keywords="kinesio",
keywords="physio",
keywords="rheuma",
keywords="thematic analysis",
keywords="semistructured interview",
abstract="Background: Implementation of eHealth is progressing slowly. In-depth insight into patients' preferences and needs regarding eHealth might improve its use. Objective: This study aimed to describe when patients want to use eHealth, how patients want to communicate and receive information digitally, and what factors influence the use of eHealth in clinical practice. Methods: A multimethod study was conducted. Two meetings of {\textasciitilde}5.5 hours with plenary information sessions and focus groups were held with 22 patients from the rheumatology, orthopedics, and rehabilitation departments of a Dutch hospital specialized in musculoskeletal disorders. Assignments were performed during the focus groups in which qualitative (eg, semistructured interview questions) and quantitative (ie, voting and ranking factors) data were collected. Results: The way patients want to use eHealth varies between patients and moments of a patient's care pathway. Patients' digital channel preferences depended on the need for interaction with a health care provider (HCP). The interaction need is in turn influenced by the degree to which information or communication is specific to an individual patient and leads to consequences for the patient. The 5 most important factors influencing the use of eHealth were access to medical information (eg, electronic health records), perceived control over disease management, correctness and completeness of information, data security, and access to information or an HCP at any time. The 5 least important factors influencing eHealth use were help with using digital devices, having internet or equipment, digital skills, attitude or emotions toward eHealth, and societal benefits. Conclusions: Patients identified opportunities for using eHealth during all moments of their care pathway. However, preferences for eHealth varied between patients and phases in the care pathway. As a consequence, eHealth should be tailored to fit individual patients' preferences but also the need for interaction regarding different topics by offering a variety of digital channels with a gradient of interaction possibilities. Furthermore, digital skills and access to the internet might become less important to focus on in the future. Improving eHealth use by patients may be achieved by providing patients access to correct and safe (medical) information and more control over their care. ",
doi="10.2196/44885",
url="https://humanfactors.jmir.org/2023/1/e44885",
url="http://www.ncbi.nlm.nih.gov/pubmed/37756049"
}


@Article{info:doi/10.2196/46056,
author="Fischer, Ann-Kathrin
and M{\"u}hlbacher, C. Axel",
title="Patient and Public Acceptance of Digital Technologies in Health Care: Protocol for a Discrete Choice Experiment",
journal="JMIR Res Protoc",
year="2023",
month="Aug",
day="10",
volume="12",
pages="e46056",
keywords="health preference research",
keywords="stated preference survey",
keywords="discrete choice experiment",
keywords="study protocol",
keywords="digital transformation",
keywords="digital technologies",
keywords="digital interventions",
keywords="health care",
keywords="rehabilitation",
keywords="stroke",
keywords="mobile phone",
abstract="Background: Strokes pose a particular challenge to the health care system. Although stroke-related mortality has declined in recent decades, the absolute number of new strokes (incidence), stroke deaths, and survivors of stroke has increased. With the increasing need of neurorehabilitation and the decreasing number of professionals, innovations are needed to ensure adequate care. Digital technologies are increasingly used to meet patients' unfilled needs during their patient journey. Patients must adhere to unfamiliar digital technologies to engage in health interventions. Therefore, the acceptance of the benefits and burdens of digital technologies in health interventions is a key factor in implementing these innovations. Objective: This study aims to describe the development of a discrete choice experiment (DCE) to weigh criteria that impact patient and public acceptance. Secondary study objectives are a benefit-burden assessment (estimation of the maximum acceptable burden of technical features and therapy-related characteristics for the patient or individual, eg, no human contact), overall comparison (assessment of the relative importance of attributes for comparing digital technologies), and adherence (identification of key attributes that influence patient adherence). The exploratory objectives include heterogeneity assessment and subgroup analysis. The methodological aims are to investigate the use of DCE. Methods: To obtain information on the criteria impacting acceptance, a DCE will be conducted including 7 attributes based on formative qualitative research. Patients with stroke (experimental group) and the general population (control group) are surveyed. The final instrument includes 6 best-best choice tasks in partial design. The experimental design is a fractional-factorial efficient Bayesian design (D-error). A conditional logit regression model and mixed logistic regression models will be used for analysis. To consider the heterogeneity of subgroups, a latent class analysis and an analysis of heteroscedasticity will be performed. Results: The literature review, qualitative preliminary study, survey development, and pretesting were completed. Data collection and analysis will be completed in the last quarter of 2023. Conclusions: Our results will inform decision makers about patients' and publics' acceptance of digital technologies used in innovative interventions. The patient preference information will improve decisions regarding the development, adoption, and pricing of innovative interventions. The behavioral changes in the choice of digital intervention alternatives are observable and can therefore be statistically analyzed. They can be translated into preferences, which define the value. This study will investigate the influences on the acceptance of digital interventions and thus support decisions and future research. International Registered Report Identifier (IRRID): DERR1-10.2196/46056 ",
doi="10.2196/46056",
url="https://www.researchprotocols.org/2023/1/e46056",
url="http://www.ncbi.nlm.nih.gov/pubmed/37561559"
}


@Article{info:doi/10.2196/45602,
author="Zhang, Jinghui
and Peng, Sha
and Hou, Jianmei
and Ma, Guiyuan
and Liu, Yanhui
and Fan, Yuhua
and Luo, Lingxia
and Shi, Zhengkun",
title="Nurses' Willingness and Demand for Internet+Home Care Services and the Associated Factors in Municipal Hospitals in China: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2023",
month="Aug",
day="4",
volume="25",
pages="e45602",
keywords="Internet+home care services",
keywords="willingness",
keywords="demand",
keywords="clinical nurses",
keywords="municipal hospitals",
abstract="Background: Developing Internet+home care (IHC) services is a promising way to address the problems related to population aging, which is an important global issue. However, IHC services are in their infancy in China. Limited studies have investigated the willingness and demand of nurses in municipal hospitals to provide IHC services. Objective: This study aims to investigate the willingness and demand of nurses in municipal hospitals in China to provide IHC services and analyze the factors to promote IHC development in China. Methods: This cross-sectional study used multistage sampling to recruit 9405 nurses from 10 hospitals in 5 regions of China. A self-designed questionnaire with good reliability and validity was used to measure nurses' willingness and demand for providing IHC services. Data analysis used the chi-square test, Welch t test, binary logistic regression analysis, and multiple linear regression analysis. Results: Nurses were highly willing to provide IHC services and preferred service distances of <5 km and times from 8 AM to 6 PM. An individual share >60\% was the expected service pay sharing. Job title, educational level, monthly income, and marital status were associated with nurses' willingness to provide IHC services in binary logistic regression analysis. Supervising nurses were 1.177 times more likely to express a willingness to provide IHC services than senior nurses. Nurses with a bachelor's degree had a 1.167 times higher likelihood of expressing willingness to provide IHC services than those with a junior college education or lower. Married nurses were 1.075 times more likely to express a willingness than unmarried nurses. A monthly income >{\textyen}10,000 increased the likelihood of nurses' willingness to provide IHC services, by 1.187 times, compared with an income <{\textyen}5000. Nurses' total mean demand score for IHC services was 17.38 (SD 3.67), with the highest demand being privacy protection. Multiple linear regression analysis showed that job title, monthly income, and educational level were associated with nurses' demand for IHC services. Supervising nurses (B=1.058, P<.001) and co-chief nurses or those with higher positions (B=2.574, P<.001) reported higher demand scores than senior nurses. Monthly incomes of {\textyen}5000 to {\textyen}10,000 (B=0.894, P<.001) and >{\textyen}10,000 (B=1.335, P<.001), as well as a bachelor's degree (B=0.484, P=.002) and at least a master's degree (B=1.224, P=.02), were associated with higher demand scores compared with a monthly income <{\textyen}5000 and junior college education or lower, respectively. Conclusions: Nurses in municipal hospitals showed a high willingness and demand to provide IHC services, with differences in willingness and demand by demographic characteristics. Accordingly, government and hospitals should regulate the service period, service distance, and other characteristics according to nurses' willingness and demand and establish relevant laws and regulations to ensure the steady and orderly development of IHC services. ",
doi="10.2196/45602",
url="https://www.jmir.org/2023/1/e45602",
url="http://www.ncbi.nlm.nih.gov/pubmed/37540546"
}


@Article{info:doi/10.2196/40891,
author="Weis, Joachim
and Wolf, Raphaela Lucy
and Boerries, Melanie
and Kassahn, Daniela
and Boeker, Martin
and Dresch, Carolin",
title="Identification of the Needs and Preferences of Patients With Cancer for the Development of a Clinic App: Qualitative Study",
journal="JMIR Cancer",
year="2023",
month="Jul",
day="27",
volume="9",
pages="e40891",
keywords="cancer",
keywords="mobile app",
keywords="mHealth",
keywords="mobile health",
keywords="needs assessment",
keywords="patient-centered care",
keywords="PROM",
keywords="patient-reported outcome measures",
keywords="qualitative methods",
abstract="Background: Mobile health (mHealth) tools were developed during the past decades and are increasingly used by patients in cancer care too. Scientific research in the development of mHealth services is required in order to meet the various needs of patients and test usability. Objective: The aim of this study is to assess patients' needs, preferences, and usability of an app (My University Clinic [MUC] app) developed by the Comprehensive Cancer Center Freiburg (CCCF) Germany. Methods: Based on a qualitative cross-sectional approach, we conducted semistructured interviews with patients with cancer, addressing their needs, preferences, and usability of the designed MUC app. Patients treated by the CCCF were recruited based on a purposive sampling technique focusing on age, sex, cancer diagnoses, and treatment setting (inpatient, outpatient). Data analysis followed the qualitative content analysis according to Kuckartz and was performed using computer-assisted software (MAXQDA). Results: For the interviews, 17 patients with cancer were selected, covering a broad range of sampling parameters. The results showed that patients expect benefits in terms of improved information about the disease and communication with the clinic staff. Demands for additional features were identified (eg, a list of contact persons and medication management). The most important concerns referred to data security and the potential restriction of personal contacts with health care professionals of the clinical departments of the CCCF. In addition, some features for improving the design of the MUC app with respect to usability or for inclusion of interacting tools were suggested by the patients. Conclusions: The results of this qualitative study were discussed within the multidisciplinary team and the MUC app providers. Patients' perspectives and needs will be included in further development of the MUC app. There will be a second study phase in which patients will receive a test version of the MUC app and will be asked about their experiences with it. Trial Registration: Deutsches Register Klinischer Studien DRKS00022162; https://drks.de/search/de/trial/DRKS00022162 ",
doi="10.2196/40891",
url="https://cancer.jmir.org/2023/1/e40891",
url="http://www.ncbi.nlm.nih.gov/pubmed/37498653"
}


@Article{info:doi/10.2196/42768,
author="McCue, Maggie
and Khatib, Rasha
and Kabir, Christopher
and Blair, Chris
and Fehnert, Ben
and King, James
and Spalding, Alexander
and Zaki, Lara
and Chrones, Lambros
and Roy, Anit
and Kemp, E. David",
title="User-Centered Design of a Digitally Enabled Care Pathway in a Large Health System: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2023",
month="Jul",
day="26",
volume="10",
pages="e42768",
keywords="depression",
keywords="major depressive disorder",
keywords="depression management",
keywords="patient engagement",
keywords="user-centered design",
keywords="mobile app",
keywords="digital platform",
keywords="qualitative research",
keywords="shared decision-making",
keywords="measurement-based care",
keywords="mobile phone",
abstract="Background: Major depressive disorder (MDD) is a leading cause of disability worldwide. Management of chronic conditions such as MDD can be improved by enhanced patient engagement, measurement-based care (MBC), and shared decision-making (SDM). A user-centered design approach can improve the understanding of the patient journey and care team workflows and thus aid the development of digital health care innovations optimized for the needs of patients living with MDD and their primary care teams. Objective: This study aims to use qualitative research methods for the user-centered design of a digitally enabled MDD care platform, PathwayPlatform, intended to enhance patient engagement, MBC, and SDM. Methods: Insights were gathered through 2 stages of qualitative interviews by a study team with expertise in qualitative research and user-centered design methods. Thematic analysis was used to generate an overarching understanding of a set of shared experiences, thoughts, or behaviors across a broad qualitative data set, including transcripts of interviews, to allow both inductive and deductive insights to emerge. Thematic analysis of interviews was supported by Dedoose (SocioCultural Research Consultants, LLC), a qualitative data analysis software tool that enables systematized coding. Findings and insights were presented based on code frequency, salience, and relevance to the research project. Results: In stage 1, interviews were conducted with 20 patients living with MDD and 15 health care providers from September 2018 to January 2019 to understand the experiences with and perceptions about the initial functionality of the Pathway app while also exploring the perceptions about potential additional features and functionality. Feedback about care team workflows and treatment approaches was collected in stage-2 interviews with 36 health care providers at 8 primary care sites. Inductive and deductive thematic analyses revealed several themes related to app functionality, patient-provider engagement, workflow integration, and patient education. Both patients and their care teams perceived the remote tracking of patient-reported outcomes via digital tools to be clinically useful and reliable and to promote MBC and SDM. However, there was emphasis on the need to enhance the flow of real-time data shared with the care team, improve trend visualizations, and integrate the data within the existing clinical workflow and educational programs for patients and their care teams. User feedback was incorporated into the iterative development of the Pathway app. Conclusions: Ongoing communication with patients living with MDD and their care teams provided an opportunity for user-centric developmental iterations of the Pathway Platform. Key insights led to further development of the patient-facing and care team--facing visit preparation features, collaborative goal-setting and goal-tracking features, patient-reported outcome summaries, and trend visualizations. The result is an enhanced digital platform with the potential to improve treatment outcomes and provide patients living with MDD additional support throughout their treatment journey. ",
doi="10.2196/42768",
url="https://humanfactors.jmir.org/2023/1/e42768",
url="http://www.ncbi.nlm.nih.gov/pubmed/37494099"
}


@Article{info:doi/10.2196/41032,
author="Groeneveld, M. Sjors W.
and den Ouden, M. Marjolein E.
and van Gemert-Pijnen, C. J. E. W.
and Verdaasdonk, M. Rudolph
and van Os-Medendorp, Harmieke",
title="Underestimated Factors Regarding the Use of Technology in Daily Practice of Long-Term Care: Qualitative Study Among Health Care Professionals",
journal="JMIR Nursing",
year="2023",
month="Jul",
day="26",
volume="6",
pages="e41032",
keywords="health technology",
keywords="eHealth",
keywords="digital health",
keywords="nurse",
keywords="nurse assistant",
keywords="health care professionals",
keywords="implementation",
keywords="adoption",
keywords="acceptance",
keywords="competencies",
abstract="Background: Increasing life expectancy is resulting in a growing demand for long-term care; however, there is a shortage of qualified health care professionals (HCPs) to deliver it. If used optimally, technology can provide a solution to this challenge. HCPs play an important role in the use of technology in long-term care. However, technology influences several core aspects of the work that HCPs do, and it is therefore important to have a good understanding of their viewpoint regarding the use of technology in daily practice of long-term care. Objective: The aim of this study was to identify the factors that HCPs consider as relevant for using technology in daily practice of long-term care. Methods: In this qualitative study, 11 focus groups were organized with 73 HCPs. The focus group discussions were guided by an innovative game, which was specifically developed for this study. The content of the game was categorized into 4 categories: health care technology and me; health care technology, the patient, and me; health care technology, the organization, and me; and facilitating conditions. The perspectives of HCPs about working with technology were discussed based on this game. The focus groups were recorded and transcribed, followed by an inductive thematic analysis using ATLAS.ti 9x (ATLAS.ti Scientific Software Development GmbH). Results: Overall, 2 main domain summaries were developed from the data: technology should improve the quality of care and acceptance and use of technology in care. The first factor indicates the need for tailored and personalized care and balance between human contact and technology. The second factor addresses several aspects regarding working with technology such as trusting technology, learning to work with technology, and collaboration with colleagues. Conclusions: HCPs are motivated to use technology in daily practice of long-term care when it adds value to the quality of care and there is sufficient trust, expertise, and collaboration with colleagues. Their perspectives need to be considered as they play a crucial part in the successful use of technology, transcending their role as an actor in implementation. On the basis of the findings from this study, we recommend focusing on developing technology for situations where both efficiency and quality of care can be improved; redefining the roles of HCPs and the impact of technology hereon; involving HCPs in the design process of technology to enable them to link it to their daily practice; and creating ambassadors in care teams who are enthusiastic about working with technology and can support and train their colleagues. ",
doi="10.2196/41032",
url="https://nursing.jmir.org/2023/1/e41032",
url="http://www.ncbi.nlm.nih.gov/pubmed/37494092"
}


@Article{info:doi/10.2196/46590,
author="Veldmeijer, Lars
and Terlouw, Gijs
and Van Os, Jim
and Van Dijk, Olga
and Van 't Veer, Job
and Boonstra, Nynke",
title="The Involvement of Service Users and People With Lived Experience in Mental Health Care Innovation Through Design: Systematic Review",
journal="JMIR Ment Health",
year="2023",
month="Jul",
day="25",
volume="10",
pages="e46590",
keywords="design approaches",
keywords="innovation",
keywords="psychiatry",
keywords="mental health care",
keywords="involvement",
keywords="service users",
keywords="people with lived experience",
keywords="cocreation",
keywords="mobile phone",
abstract="Background: Mental health care faces challenges that not only necessitate innovation but also require the involvement of service users and people with lived experience in developing and evaluating mental health care services. As the development of digital interventions is becoming more prevalent, design approaches are increasingly finding their way into mental health. There is evidence that these approaches can successfully integrate user experience into mental health services. However, there is no clear overview of the studies conducted and the lessons learned concerning the involvement of service users and people with lived experience. Objective: In this systematic review, we aimed to provide an overview of the involvement of service users and people with lived experience in mental health care services through design approaches and to synthesize the advantages of design approaches in mental health care. Methods: The following 5 databases were searched for relevant abstracts: PsycINFO, PubMed, Web of Science, Scopus, and Embase. In addition, 2 health design journal archives, Design for Health and The Journal of Health Design, were searched. To categorize the results, we collected the reported added value from the included articles and conducted a thematic synthesis in which the themes were developed from the retrieved data. The themes were discussed, revised, and checked until saturation was achieved. Results: We included and categorized 33 papers. Most studies involved service users, primarily adults, and used various design approaches. Most of these studies aimed to design or evaluate digital interventions. Service users and people with lived experience were involved in different roles but never as decision makers. Studies that used co-design approaches exhibited the highest levels of involvement. Various added values were reported, including tailoring and testing interventions and digital interventions, improving engagement and collaboration, gathering the needs of stakeholders, and empowering participants as resourceful actors. The challenges reported were maintaining participants' continued participation throughout the study, managing the iterative nature of design, providing a safe space, balancing insights from design and medical science, and navigating design processes in medical environments. Conclusions: This systematic review provides an overview of the studies that used design approaches to involve service users and people with lived experience in mental health care innovation. Design approaches have advantages in mental health care innovation, offering added value and having manageable challenges. Future studies using design approaches in mental health care should involve participants as partners and decision makers and report on collaboration in a systematic and clear manner. ",
doi="10.2196/46590",
url="https://mental.jmir.org/2023/1/e46590",
url="http://www.ncbi.nlm.nih.gov/pubmed/37490326"
}


@Article{info:doi/10.2196/45099,
author="Wong, K. Alex W.
and Fong, M. Mandy W.
and Munsell, S. Elizabeth G.
and Metts, L. Christopher
and Lee, I. Sunghoon
and Nicol, E. Ginger
and DePaul, Olivia
and Tomazin, E. Stephanie
and Kaufman, J. Katherine
and Mohr, C. David",
title="Using Intervention Mapping and Behavior Change Techniques to Develop a Digital Intervention for Self-Management in Stroke: Development Study",
journal="JMIR Hum Factors",
year="2023",
month="Jul",
day="24",
volume="10",
pages="e45099",
keywords="mobile health",
keywords="digital intervention",
keywords="technology",
keywords="SMS text messaging",
keywords="intervention mapping",
keywords="behavior change",
keywords="self-management",
keywords="stroke",
keywords="rehabilitation",
keywords="mobile phone",
abstract="Background: Digital therapeutics, such as interventions provided via smartphones or the internet, have been proposed as promising solutions to support self-management in persons with chronic conditions. However, the evidence supporting self-management interventions through technology in stroke is scarce, and the intervention development processes are often not well described, creating challenges in explaining why and how the intervention would work. Objective: This study describes a specific use case of using intervention mapping (IM) and the taxonomy of behavior change techniques (BCTs) in designing a digital intervention to manage chronic symptoms and support daily life participation in people after stroke. IM is an implementation science framework used to bridge the gap between theories and practice to ensure that the intervention can be implemented in real-world settings. The taxonomy of BCTs consists of a set of active ingredients designed to change self-management behaviors. Methods: We used the first 4 steps of the IM process to develop a technology-supported self-management intervention, interactive Self-Management Augmented by Rehabilitation Technologies (iSMART), adapted from a face-to-face stroke-focused psychoeducation program. Planning group members were involved in adapting the intervention. They also completed 3 implementation measures to assess the acceptability, appropriateness, and feasibility of iSMART. Results: In step 1, we completed a needs assessment consisting of assembling a planning group to codevelop the intervention, conducting telephone surveys of people after stroke (n=125) to identify service needs, and performing a systematic review of randomized controlled trials to examine evidence of the effectiveness of digital self-management interventions to improve patient outcomes. We identified activity scheduling, symptom management, stroke prevention, access to care resources, and cognitive enhancement training as key service needs after a stroke. The review suggested that digital self-management interventions, especially those using cognitive behavioral theory, effectively reduce depression, anxiety, and fatigue and enhance self-efficacy in neurological disorders. Step 2 identified key determinants, objectives, and strategies for self-management in iSMART, including knowledge, behavioral regulation, skills, self-efficacy, motivation, negative and positive affect, and social and environmental support. In step 3, we generated the intervention components underpinned by appropriate BCTs. In step 4, we developed iSMART with the planning group members. Especially, iSMART simplified the original psychoeducation program and added 2 new components: SMS text messaging and behavioral coaching, intending to increase the uptake by people after stroke. iSMART was found to be acceptable (mean score 4.63, SD 0.38 out of 5), appropriate (mean score 4.63, SD 0.38 out of 5), and feasible (mean score 4.58, SD 0.34 out of 5). Conclusions: We describe a detailed example of using IM and the taxonomy of BCTs for designing and developing a digital intervention to support people after stroke in managing chronic symptoms and maintaining active participation in daily life. ",
doi="10.2196/45099",
url="https://humanfactors.jmir.org/2023/1/e45099",
url="http://www.ncbi.nlm.nih.gov/pubmed/37486748"
}


@Article{info:doi/10.2196/46298,
author="Li, Peiyi
and Zhang, Chenyang
and Gao, Shuanliang
and Zhang, Yanbo
and Liang, Xiaolong
and Wang, Chengdi
and Zhu, Tao
and Li, Weimin",
title="Association Between Daily Internet Use and Incidence of Chronic Diseases Among Older Adults: Prospective Cohort Study",
journal="J Med Internet Res",
year="2023",
month="Jul",
day="17",
volume="25",
pages="e46298",
keywords="daily internet use",
keywords="chronic disease",
keywords="disease prevention",
keywords="middle-aged and older adult",
keywords="usage",
keywords="internet use",
keywords="technology use",
keywords="chronic illness",
keywords="association",
keywords="incidence",
keywords="middle age",
keywords="older adult",
keywords="gerontology",
keywords="geriatric",
keywords="aging",
keywords="elder",
keywords="national survey",
abstract="Background: Chronic disease incidence among the elderly is increasing, which is correlated with the acceleration of population aging. Evolving internet technologies may help prevent and provide interventions for chronic diseases in an accelerating aging process. However, the impact of daily internet use on the incidence of chronic diseases is not well understood. Objective: This study aims to investigate whether daily internet use by middle-aged and older adults may inhibit or promote the occurrence of chronic diseases. Methods: We included participants from the China Health and Retirement Longitudinal Study (CHARLS), a longitudinal survey of Chinese residents aged ?45 years. We assessed 8-year data from wave 1 (June 2011-March 2012) to wave 4 (July-September 2018) in CHARLS. Data from wave 4 were used for a cross-sectional study, and data from all 4 waves were used for a longitudinal study. Self-reported data were used to track variables, including internet use, use frequency, and the incidence of different chronic diseases. Cox proportional hazards modeling was applied in the longitudinal study to examine the relationship between daily internet use and chronic diseases among middle-aged and older adults, while adjusting for sociodemographic characteristics and health behaviors. In addition, longitudinal data were used to analyze internet usage trends, and cross-sectional data were used to analyze the factors influencing internet use. Results: Among the 20,113 participants included in the longitudinal analyses, internet use increased significantly, from 2\% to 12.3\%, between 2011 and 2018. The adjusted model found statistically significant relationships between daily internet use and a lower incidence of the following chronic diseases: hypertension (hazard ratio [HR] 0.78, 95\% CI 0.65-0.95, P=.01), chronic lung disease (HR 0.74, 95\% CI 0.57-0.97, P=.03), stroke (HR 0.69, 95\% CI 0.50-0.94, P=.02), digestive disease (HR 0.73, 95\% CI 0.58-0.91, P=.005), memory-related disorders (HR 0.58, 95\% CI 0.37-0.91, P=.02), arthritis or rheumatism (HR 0.60, 95\% CI 0.48-0.76, P<.001), asthma (HR 0.52, 95\% CI 0.33-0.84, P=.007), depression (HR 0.80, 95\% CI 0.71-0.89, P<.001), and vision impairment (HR 0.83, 95\% CI 0.74-0.93, P=.004). Moreover, our study also showed that with increasing frequency of internet use, the risk of some chronic diseases decreases. Conclusions: This study found that middle-aged and older adults who use the internet have a reduced risk of developing chronic diseases versus those who do not use the internet. The increasing prevalence of daily internet use among middle-aged and older adults may stimulate contemplation of the potential role of internet platforms in future research on chronic disease prevention. ",
doi="10.2196/46298",
url="https://www.jmir.org/2023/1/e46298",
url="http://www.ncbi.nlm.nih.gov/pubmed/37459155"
}


@Article{info:doi/10.2196/44681,
author="Lukka, Lauri
and Karhulahti, Veli-Matti
and Palva, Matias J.",
title="Factors Affecting Digital Tool Use in Client Interaction According to Mental Health Professionals: Interview Study",
journal="JMIR Hum Factors",
year="2023",
month="Jul",
day="10",
volume="10",
pages="e44681",
keywords="clinical practice",
keywords="digital mental health interventions",
keywords="intervention design",
keywords="mental health applications",
keywords="mental health professionals",
keywords="teletherapy",
keywords="mobile phone",
abstract="Background: Digital tools and interventions are being increasingly developed in response to the growing mental health crisis, and mental health professionals (MHPs) considerably influence their adoption in client practice. However, how MHPs use digital tools in client interaction is yet to be sufficiently understood, which poses challenges to their design, development, and implementation. Objective: This study aimed to create a contextual understanding of how MHPs use different digital tools in clinical client practice and what characterizes the use across tools. Methods: A total of 19 Finnish MHPs participated in semistructured interviews, and the data were transcribed, coded, and inductively analyzed. Results: We found that MHP digital tool use was characterized by 3 distinct functions: communication, diagnosis and evaluation, and facilitating therapeutic change. The functions were addressed using analog tools, digitized tools that mimic their analog counterparts, and digital tools that use the possibilities native to digital. The MHP-client communication included various media alongside face-to-face meetings, the MHPs increasingly used digitized tools in client evaluation, and the MHPs actively used digitized materials to facilitate therapeutic change. MHP tool use was generally characterized by adaptability---it was negotiated in client interactions. However, there was considerable variance in the breadth of MHPs' digital toolbox. The existing clinical practices emphasized MHP-client interaction and invited incremental rather than radical developments, which challenged the achievement of the scalability benefits expected from digital tools. Conclusions: MHPs use digitized and digital tools in client practice. Our results contribute to the user-centered research, development, and implementation of new digital solutions in mental health care by classifying them according to their function and medium and describing how MHPs use and do not use them. ",
doi="10.2196/44681",
url="https://humanfactors.jmir.org/2023/1/e44681",
url="http://www.ncbi.nlm.nih.gov/pubmed/37428520"
}


@Article{info:doi/10.2196/42283,
author="Darwich, S. Adam
and Bostr{\"o}m, Anne-Marie
and Guidetti, Susanne
and Raghothama, Jayanth
and Meijer, Sebastiaan",
title="Investigating the Connections Between Delivery of Care, Reablement, Workload, and Organizational Factors in Home Care Services: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2023",
month="Jun",
day="30",
volume="10",
pages="e42283",
keywords="aging",
keywords="intervention",
keywords="health policy",
keywords="health services administration and management",
keywords="health care intervention",
keywords="home care",
keywords="home support",
keywords="in-home assistance",
keywords="personal care",
keywords="policy",
keywords="reablement",
keywords="rehabilitation",
keywords="rehabilitation medicine",
keywords="social support",
keywords="stress",
keywords="support",
keywords="systems thinking",
keywords="user",
abstract="Background: Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use. Objective: The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems. Methods: The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods. Results: The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements ``workload'' and ``distress'' were important determinants of home care staff health, provision, and quality of care. Conclusions: The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored. ",
doi="10.2196/42283",
url="https://humanfactors.jmir.org/2023/1/e42283",
url="http://www.ncbi.nlm.nih.gov/pubmed/37389904"
}


@Article{info:doi/10.2196/39249,
author="Patel, Milan
and Berlin, Hanna
and Rajkumar, Abishek
and Krein, L. Sarah
and Miller, Rebecca
and DeVito, Jessie
and Roy, Jake
and Punch, Margaret
and Ellimootti, Chad
and Peahl, F. Alex",
title="Barriers to Telemedicine Use: Qualitative Analysis of Provider Perspectives During the COVID-19 Pandemic",
journal="JMIR Hum Factors",
year="2023",
month="Jun",
day="26",
volume="10",
pages="e39249",
keywords="telehealth",
keywords="virtual visits",
keywords="public health crisis",
keywords="barriers and facilitators",
keywords="provider perspectives",
keywords="implementation",
keywords="access",
keywords="health care",
keywords="patient care",
abstract="Background: Though telemedicine is a promising approach for removing barriers to care and improving access for patients, telemedicine use for many medical specialties has decreased from its peak during the acute COVID-19 public health crisis. Understanding the barriers and facilitators to the maintenance of web-based visits---one key component of telemedicine---is critical for ensuring the continuous availability of this service for patients. Objective: The purpose of this study is to describe medical providers' perceived barriers and facilitators to the continued use of web-based visits to inform quality improvement efforts and promote sustainability. Methods: We performed a qualitative content analysis of free-text responses from a survey of medical providers administered from February 5-14, 2021, at a large, midwestern academic institution, including all providers from medical professions that offered telemedicine (eg, physicians, residents or fellows, nurse practitioners, physicians assistants, or nurses) who completed at least 1 web-based visit from March 20, 2020, to February 14, 2021. The primary outcome was the experience of providing web-based visits, including barriers and facilitators to continued usage of web-based visits. Survey questions included 3 major domains: quality of care, technology, and satisfaction. Responses were coded using qualitative content analysis and further analyzed through a matrix analysis to understand the providers' perspectives and elucidate key barriers and facilitators of web-based visit usage. Results: Of 2692 eligible providers, 1040 (38.6\%) completed the survey, of whom 702 were providers from medical professions that offered telemedicine. These providers spanned 7 health care professions and 47 clinical departments. The most common professions represented were physicians (486/702, 46.7\%), residents or fellows (85/702, 8.2\%), and nurse practitioners (81/702, 7.8\%), while the most common clinical departments were internal medicine (69/702, 6.6\%), psychiatry (69/702, 6.6\%), and physical medicine and rehabilitation (67/702, 6.4\%). The following 4 overarching categories of provider experience with web-based visits emerged: quality of care, patient rapport, visit flow, and equity. Though many providers saw web-based visits as a tool for improving care access, quality, and equity, others shared how appropriate selection of web-based visits, support (eg, patient training, home devices, and broadband access), and institutional and nationwide optimization (eg, relaxation of licensing requirements across state borders and reimbursement for phone-only modalities) were needed to sustain web-based visits. Conclusions: Our findings demonstrate key barriers to the maintenance of telemedicine services following the acute public health crisis. These findings can help prioritize the most impactful methods of sustaining and expanding telemedicine availability for patients who prefer this method of care delivery. ",
doi="10.2196/39249",
url="https://humanfactors.jmir.org/2023/1/e39249",
url="http://www.ncbi.nlm.nih.gov/pubmed/37358887"
}


@Article{info:doi/10.2196/47263,
author="Forcino, C. Rachel
and Rotenberg, Sivan
and Morrissette, J. Kali
and Godzik, M. Cassandra
and Lichtenstein, D. Jonathan
and Schiffelbein, E. Jenna
and Stevens, J. Courtney
and Sundar, Vidya
and Brucker, L. Debra
and Connolly, Deirdre
and Keysor, Julie
and Lyons, Doyle Kathleen",
title="Exploring Acceptability of Employment Interventions to Support People Living With Cancer: Qualitative Study of Cancer Survivors, Health Care Providers, and Employers",
journal="JMIR Form Res",
year="2023",
month="Jun",
day="26",
volume="7",
pages="e47263",
keywords="cancer",
keywords="employment",
keywords="intervention development",
keywords="intervention",
keywords="people living with cancer",
keywords="cancer survivor",
keywords="health care provider",
abstract="Background: Employment contributes to cancer survivors' quality of life, but this population faces a variety of challenges when working during and after treatment. Factors associated with work outcomes among cancer survivors include disease and treatment status, work environment, and social support. While effective employment interventions have been developed in other clinical contexts, existing interventions have demonstrated inconsistent effectiveness in supporting cancer survivors at work. We conducted this study as a preliminary step toward program development for employment support among survivors at a rural comprehensive cancer center. Objective: We aimed (1) to identify supports and resources that stakeholders (cancer survivors, health care providers, and employers) suggest may help cancer survivors to maintain employment and (2) to describe stakeholders' views on the advantages and disadvantages of intervention delivery models that incorporate those supports and resources. Methods: We conducted a descriptive study collecting qualitative data from individual interviews and focus groups. Participants included adult cancer survivors, health care providers, and employers living or working in the Vermont--New Hampshire catchment area of the Dartmouth Cancer Center in Lebanon, New Hampshire. We grouped interview participants' recommended supports and resources into 4 intervention delivery models, which ranged on a continuum from less to more intensive to deliver. We then asked focus group participants to discuss the advantages and disadvantages of each of the 4 delivery models. Results: Interview participants (n=45) included 23 cancer survivors, 17 health care providers, and 5 employers. Focus group participants (n=12) included 6 cancer survivors, 4 health care providers, and 2 employers. The four delivery models were (1) provision of educational materials, (2) individual consultation with cancer survivors, (3) joint consultation with both cancer survivors and their employers, and (4) peer support or advisory groups. Each participant type acknowledged the value of providing educational materials, which could be crafted to improve accommodation-related interactions between survivors and employers. Participants saw usefulness in individual consultation but expressed concern about the costs of program delivery and potential mismatches between consultant recommendations and the limits of what employers can provide. For joint consultation, employers liked being part of the solution and the possibility of enhanced communication. Potential drawbacks included additional logistical burden and its perceived generalizability to all types of workers and workplaces. Survivors and health care providers viewed the efficiency and potency of peer support as benefits of a peer advisory group but acknowledged the sensitivity of financial topics as a possible disadvantage of addressing work challenges in a group setting. Conclusions: The 3 participant groups identified both common and unique advantages and disadvantages of the 4 delivery models, reflecting varied barriers and facilitators to their potential implementation in practice. Theory-driven strategies to address implementation barriers should play a central role in further intervention development. ",
doi="10.2196/47263",
url="https://formative.jmir.org/2023/1/e47263",
url="http://www.ncbi.nlm.nih.gov/pubmed/37358907"
}


@Article{info:doi/10.2196/41429,
author="Koo, Hyuk Jun
and Park, Hyun You
and Kang, Ryong Dae",
title="Factors Predicting Older People's Acceptance of a Personalized Health Care Service App and the Effect of Chronic Disease: Cross-Sectional Questionnaire Study",
journal="JMIR Aging",
year="2023",
month="Jun",
day="21",
volume="6",
pages="e41429",
keywords="environmental risk factor",
keywords="personalized health care service app",
keywords="chronic disease",
keywords="unified theory of acceptance and use of technology",
keywords="structural equation modeling",
keywords="older adult",
keywords="acceptance",
keywords="adoption",
keywords="technology use",
keywords="mHealth",
keywords="mobile health",
keywords="mobile app",
keywords="health app",
keywords="gerontology",
keywords="personalized",
keywords="health care service",
keywords="intention to use",
abstract="Background: Mobile health (mHealth) services enable real-time measurement of information on individuals' biosignals and environmental risk factors; accordingly, research on health management using mHealth is being actively conducted. Objective: The study aims to identify the predictors of older people's intention to use mHealth in South Korea and verify whether chronic disease moderates the effect of the identified predictors on behavioral intentions. Methods: A cross-sectional questionnaire study was conducted among 500 participants aged 60 to 75 years. The research hypotheses were tested using structural equation modeling, and indirect effects were verified through bootstrapping. Bootstrapping was performed 10,000 times, and the significance of the indirect effects was confirmed through the bias-corrected percentile method. Results: Of 477 participants, 278 (58.3\%) had at least 1 chronic disease. Performance expectancy ($\beta$=.453; P=.003) and social influence ($\beta$=.693; P<.001) were significant predictors of behavioral intention. Bootstrapping results showed that facilitating conditions ($\beta$=.325; P=.006; 95\% CI 0.115-0.759) were found to have a significant indirect effect on behavioral intention. Multigroup structural equation modeling testing the presence or absence of chronic disease revealed a significant difference in the path of device trust to performance expectancy (critical ratio=--2.165). Bootstrapping also confirmed that device trust ($\beta$=.122; P=.039; 95\% CI 0.007-0.346) had a significant indirect effect on behavioral intention in people with chronic disease. Conclusions: This study, which explored the predictors of the intention to use mHealth through a web-based survey of older people, suggests similar results to those of other studies that applied the unified theory of acceptance and use of technology model to the acceptance of mHealth. Performance expectancy, social influence, and facilitating conditions were revealed as predictors of accepting mHealth. In addition, trust in a wearable device for measuring biosignals was investigated as an additional predictor in people with chronic disease. This suggests that different strategies are needed, depending on the characteristics of users. ",
doi="10.2196/41429",
url="https://aging.jmir.org/2023/1/e41429",
url="http://www.ncbi.nlm.nih.gov/pubmed/37342076"
}


@Article{info:doi/10.2196/42843,
author="Monkman, Helen
and Griffith, Janessa
and MacDonald, Leah
and Lesselroth, Blake",
title="Consumers' Needs for Laboratory Results Portals: Questionnaire Study",
journal="JMIR Hum Factors",
year="2023",
month="Jun",
day="12",
volume="10",
pages="e42843",
keywords="consumer health information",
keywords="user-centered design",
keywords="clinical laboratory information systems",
keywords="laboratory test result",
keywords="patient portal",
keywords="laboratory result",
keywords="facilitator",
keywords="barrier",
keywords="information system",
keywords="questionnaire",
keywords="usability",
abstract="Background: Over the last decade, there has been an increase in the number of health care consumers (ie, patients, citizens, and laypeople) with access to their laboratory results through portals. However, many portals are not designed with the consumer in mind, which can limit communication effectiveness and consumer empowerment. Objective: We aimed to study design facilitators and barriers affecting consumer use of a laboratory results portal. We sought to identify modifiable design attributes to inform future interface specifications and improve patient safety. Methods: A web-based questionnaire with open- and closed-ended items was distributed to consumers in British Columbia, Canada. Open-ended items with affinity diagramming and closed-ended questions with descriptive statistics were analyzed. Results: Participants (N=30) preferred reviewing their laboratory results through portals rather than waiting to see their provider. However, respondents were critical of the interface design (ie, interface usability, information completeness, and display clarity). Scores suggest there are display issues impacting communication that require urgent attention. Conclusions: There are modifiable usability, content, and display issues associated with laboratory results portals that, if addressed, could arguably improve communication effectiveness, patient empowerment, and health care safety. ",
doi="10.2196/42843",
url="https://humanfactors.jmir.org/2023/1/e42843",
url="http://www.ncbi.nlm.nih.gov/pubmed/37307049"
}


@Article{info:doi/10.2196/43125,
author="Ek, Charlott
and Liljegren, Per-Daniel
and Edin-Liljegren, Anette",
title="Patients With Cardiovascular Disease Revisiting Specialist Physicians via Remote Treatment: Interview Study of Experiences",
journal="JMIR Hum Factors",
year="2023",
month="Jun",
day="1",
volume="10",
pages="e43125",
keywords="remote treatment",
keywords="sparsely populated region",
keywords="telemedicine",
keywords="content analysis",
keywords="experiences",
keywords="person-centered care",
keywords="rural",
keywords="eHealth",
keywords="mobile phone",
abstract="Background: Access to health care for an aging population with growing needs presents major challenges in northern Sweden's sparsely populated regions. Few people, the lack of professionals, and long distances make it difficult to provide health care on equitable terms according to the Swedish legislation. Remote treatment (RT) using information and communication technology has been suggested to overcome these difficulties, and person-centered care (PCC) is a desired philosophy to improve the quality of health care. However, there is scarce knowledge about how patients experience RT meetings. Objective: This study aimed to describe the experiences of patients with cardiovascular disease revisiting specialist physicians via RT guided by a PCC perspective in northern Sweden's sparsely populated regions. Methods: A qualitative study was conducted based on interviews with 8 patients with cardiovascular disease revisiting their physician through RT, from a digital health room to a health care center or from a health care center to a hospital. The interviews were recorded, transcribed verbatim, and analyzed using inductive content analysis. The results are discussed from a PCC perspective. Results: The analysis resulted in 6 categories: good accessibility, safety with good relationships, proximity and distance with technology, habit and quality of the technology facilitating the meeting, cherishing personal integrity, and participation in own care. These categories were interpreted as the theme, participation and relationships are important for good and close care via RT. Conclusions: The study shows that participation and relationships are important for good and close care via RT. To improve the quality of an RT meeting, PCC can be applied but needs to be extended to the digital domain---electronic PCC, especially the communication component, as it is the most salient difference from a face-to-face meeting. Important factors that should be considered before, during, and after the RT meeting have been identified. ",
doi="10.2196/43125",
url="https://humanfactors.jmir.org/2023/1/e43125",
url="http://www.ncbi.nlm.nih.gov/pubmed/37261892"
}


@Article{info:doi/10.2196/45819,
author="van Calis, E. Julia F.
and Bevelander, E. Kirsten
and van der Cruijsen, C. Anneke W.
and Leusink, L. Geraline
and Naaldenberg, Jenneken",
title="Toward Inclusive Approaches in the Design, Development, and Implementation of eHealth in the Intellectual Disability Sector: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="May",
day="30",
volume="25",
pages="e45819",
keywords="eHealth",
keywords="digital health",
keywords="intellectual disability",
keywords="inclusive research",
keywords="involvement",
keywords="participatory development",
keywords="scoping review",
keywords="Centre for eHealth Research and Disease management",
keywords="CeHRes roadmap",
keywords="Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability framework",
keywords="NASSS",
keywords="review method",
keywords="inclusive",
keywords="inclusivity",
keywords="accessibility",
keywords="participatory",
keywords="iterative",
keywords="design",
keywords="develop",
keywords="intellectually disabled",
abstract="Background: The use of eHealth is more challenging for people with intellectual disabilities (IDs) than for the general population because the technologies often do not fit the complex needs and living circumstances of people with IDs. A translational gap exists between the developed technology and users' needs and capabilities. User involvement approaches have been developed to overcome this mismatch during the design, development, and implementation processes of the technology. The effectiveness and use of eHealth have received much scholarly attention, but little is known about user involvement approaches. Objective: In this scoping review, we aimed to identify the inclusive approaches currently used for the design, development, and implementation of eHealth for people with IDs. We reviewed how and in what phases people with IDs and other stakeholders were included in these processes. We used 9 domains identified from the Centre for eHealth Research and Disease management road map and the Nonadoption, Abandonment, and challenges to the Scale-up, Spread, and Sustainability framework to gain insight into these processes. Methods: We identified both scientific and gray literature through systematic searches in PubMed, Embase, PsycINFO, CINAHL, Cochrane, Web of Science, Google Scholar, and (websites of) relevant intermediate (health care) organizations. We included studies published since 1995 that showed the design, development, or implementation processes of eHealth for people with IDs. Data were analyzed along 9 domains: participatory development, iterative process, value specification, value proposition, technological development and design, organization, external context, implementation, and evaluation. Results: The search strategy resulted in 10,639 studies, of which 17 (0.16\%) met the inclusion criteria. Various approaches were used to guide user involvement (eg, human or user-centered design and participatory development), most of which applied an iterative process mainly during technological development. The involvement of stakeholders other than end users was described in less detail. The literature focused on the application of eHealth at an individual level and did not consider the organizational context. Inclusive approaches in the design and development phases were well described; however, the implementation phase remained underexposed. Conclusions: The participatory development, iterative process, and technological development and design domains showed inclusive approaches applied at the start of and during the development, whereas only a few approaches involved end users and iterative processes at the end of the process and during implementation. The literature focused primarily on the individual use of the technology, and the external, organizational, and financial contextual preconditions received less attention. However, members of this target group rely on their (social) environment for care and support. More attention is needed for these underrepresented domains, and key stakeholders should be included further on in the process to reduce the translational gap that exists between the developed technologies and user needs, capabilities, and context. ",
doi="10.2196/45819",
url="https://www.jmir.org/2023/1/e45819",
url="http://www.ncbi.nlm.nih.gov/pubmed/37252756"
}


@Article{info:doi/10.2196/46371,
author="Lee, Hocheol
and Koh, Baek Sang
and Jo, Sug Heui
and Lee, Ho Tae
and Nam, Kweun Hae
and Zhao, Bo
and Lim, Subeen
and Lim, Aeh Joo
and Lee, Hee Ho
and Hwang, Seong Yu
and Kim, Hyun Dong",
title="Evaluating the Effectiveness of Rural Digital Social Prescribing in Korea: Protocol for a Cohort Study",
journal="JMIR Res Protoc",
year="2023",
month="May",
day="24",
volume="12",
pages="e46371",
keywords="digital health",
keywords="digital social prescribing",
keywords="elderly health",
keywords="community health",
keywords="digital health intervention",
abstract="Background: The UK National Health Service (NHS) has introduced a digital social prescribing (DSP) system to improve the mental health of the aging population. In Korea, an ongoing pilot social prescribing project has been implemented for older individuals in rural areas since 2019. Objective: This research aims to develop a DSP program and to evaluate the effectiveness of the digital platform in rural areas of Korea. Methods: This study was designed as a prospective cohort method for the development and effectiveness evaluation of rural DSP in Korea. The study divided participants into four groups. Group 1 will continuously implement the existing social prescribing program, group 2 implemented the existing social prescribing program but was switched to DSP in 2023, group 3 newly started the DSP, and the remaining group is the control. The research area of this study is Gangwon Province in Korea. The study is being conducted in Wonju, Chuncheon, and Gangneung. This study will use indicators to measure depression, anxiety, loneliness, cognitive function, and digital literacy. In the future, the interventions will implement the digital platform and the Music Story Telling program. This study will evaluate the effectiveness of DSP using difference-in-differences regression and cost-benefit analysis. Results: This study was approved for funding from the National Research Foundation of Korea funded by the Ministry of Education in October 2022. The results of the data analysis are expected to be available in September 2023. Conclusions: The platform will be spread to rural areas in Korea and will serve as the foundation for effectively managing the feelings of solitude and depression among older individuals. This study will provide vital evidence for disseminating DSP in Asian countries such as Japan, China, Singapore, and Taiwan as well as for studying DSP in Korea. International Registered Report Identifier (IRRID): PRR1-10.2196/46371 ",
doi="10.2196/46371",
url="https://www.researchprotocols.org/2023/1/e46371",
url="http://www.ncbi.nlm.nih.gov/pubmed/37223972"
}


@Article{info:doi/10.2196/46020,
author="Tanaka, Masashi
and Matsumura, Shinji
and Bito, Seiji",
title="Roles and Competencies of Doctors in Artificial Intelligence Implementation: Qualitative Analysis Through Physician Interviews",
journal="JMIR Form Res",
year="2023",
month="May",
day="18",
volume="7",
pages="e46020",
keywords="artificial intelligence",
keywords="shared decision-making",
keywords="competency",
keywords="decision-making, qualitative research",
keywords="patient-physician",
keywords="medical field",
keywords="AI services",
keywords="AI technology",
abstract="Background: Artificial intelligence (AI) is a term used to describe the use of computers and technology to emulate human intelligence mechanisms. Although AI is known to affect health services, the impact of information provided by AI on the patient-physician relationship in actual practice is unclear. Objective: The purpose of this study is to investigate the effect of introducing AI functions into the medical field on the role of the physician or physician-patient relationship, as well as potential concerns in the AI era. Methods: We conducted focus group interviews in Tokyo's suburbs with physicians recruited through snowball sampling. The interviews were conducted in accordance with the questions listed in the interview guide. A verbatim transcript recording of all interviews was qualitatively analyzed using content analysis by all authors. Similarly, extracted code was grouped into subcategories, categories, and then core categories. We continued interviewing, analyzing, and discussing until we reached data saturation. In addition, we shared the results with all interviewees and confirmed the content to ensure the credibility of the analysis results. Results: A total of 9 participants who belonged to various clinical departments in the 3 groups were interviewed. The same interviewers conducted the interview as the moderator each time. The average group interview time for the 3 groups was 102 minutes. Content saturation and theme development were achieved with the 3 groups. We identified three core categories: (1) functions expected to be replaced by AI, (2) functions still expected of human physicians, and (3) concerns about the medical field in the AI era. We also summarized the roles of physicians and patients, as well as the changes in the clinical environment in the age of AI. Some of the current functions of the physician were primarily replaced by AI functions, while others were inherited as the functions of the physician. In addition, ``functions extended by AI'' obtained by processing massive amounts of data will emerge, and a new role for physicians will be created to deal with them. Accordingly, the importance of physician functions, such as responsibility and commitment based on values, will increase, which will simultaneously increase the expectations of the patients that physicians will perform these functions. Conclusions: We presented our findings on how the medical processes of physicians and patients will change as AI technology is fully implemented. Promoting interdisciplinary discussions on how to overcome the challenges is essential, referring to the discussions being conducted in other fields. ",
doi="10.2196/46020",
url="https://formative.jmir.org/2023/1/e46020",
url="http://www.ncbi.nlm.nih.gov/pubmed/37200074"
}


@Article{info:doi/10.2196/44564,
author="Schroeder, Tanja
and Dodds, Laura
and Georgiou, Andrew
and Gewald, Heiko
and Siette, Joyce",
title="Older Adults and New Technology: Mapping Review of the Factors Associated With Older Adults' Intention to Adopt Digital Technologies",
journal="JMIR Aging",
year="2023",
month="May",
day="16",
volume="6",
pages="e44564",
keywords="technology adoption",
keywords="digital technology",
keywords="older adults",
keywords="seniors",
keywords="intention to use digital technologies",
abstract="Background: Ongoing advancements in digital solutions support older adults' healthy aging and well-being. However, a unified synthesis of sociodemographic, cognitive, attitudinal, emotional, and environmental factors that influence older adults' intention to use these new digital technologies is still lacking. Understanding the salient factors that influence older adults' intention to use digital technologies will help to ensure that technology is developed appropriately and contextually. This understanding is also likely to contribute to developing technology acceptance models specifically for the aging generation, by reorganizing principles and constructing objectivity criteria for future research studies. Objective: This review aims to identify the key factors associated with older adults' intention to use digital technologies and to provide a comprehensive conceptual framework to describe the relationships between these key factors and older adults' intention to use digital technologies. Methods: A mapping review was conducted using 9 databases from inception to November 2022. Articles were selected for review if they had an evaluative component of older adults' intention to use digital technologies. Three researchers independently reviewed the articles and extracted the data. Data synthesis was performed via narrative review and quality appraisal was measured using 3 different tools based on each article's study design. Results: We identified a total of 59 articles investigating older adults' intention to use digital technologies. The majority (40/59, 68\%) of articles did not use an existing framework or model for technology acceptance. Studies mostly adopted a quantitative research design (27/59, 46\%). We found 119 unique factors reported to influence older adults' intention to use digital technologies. These were categorized into 6 distinct themes: Demographics and Health Status, Emotional Awareness and Needs, Knowledge and Perception, Motivation, Social Influencers, and Technology Functional Features. Conclusions: Given the importance of global demographic change toward an aging society, there is surprisingly limited research on the factors that influence older adults' intention to use digital technologies. Our identification of the key factors across different types of digital technology and models supports the future integration of a comprehensive perspective encompassing environmental, psychological, and social determinants for older adults' intention to use digital technologies. ",
doi="10.2196/44564",
url="https://aging.jmir.org/2023/1/e44564",
url="http://www.ncbi.nlm.nih.gov/pubmed/37191976"
}


@Article{info:doi/10.2196/42287,
author="Heponiemi, Tarja
and Kainiemi, Emma
and Virtanen, Lotta
and Saukkonen, Petra
and Sainio, P{\"a}ivi
and Koponen, P{\"a}ivikki
and Koskinen, Seppo",
title="Predicting Internet Use and Digital Competence Among Older Adults Using Performance Tests of Visual, Physical, and Cognitive Functioning: Longitudinal Population-Based Study",
journal="J Med Internet Res",
year="2023",
month="May",
day="5",
volume="25",
pages="e42287",
keywords="internet services",
keywords="digital exclusion",
keywords="digital skills",
keywords="older adults",
keywords="physical and cognitive decline",
keywords="mobile phone",
abstract="Background: The rapidly increasing role of the internet in obtaining basic services poses challenges, especially for older adults' capabilities of getting the services they need. Research on the predictors of older adults' internet use and digital competence is especially relevant given that people are living longer than before, and the age profile of many societies is changing rapidly. Objective: We aimed to examine the associations of objective measures of physical and cognitive impairment with the nonuse of the internet for services and low digital competence among older adults. Methods: A longitudinal population-based design was used that combined data from performance tests and self-rated questionnaires. Data were gathered in 2017 and 2020 among 1426 older adults aged between 70 and 100 years in Finland. Logistic regression analyses were used to examine the associations. Results: Those who had poor near (odds ratio [OR] 1.90, 95\% CI 1.36-2.66) or distant vision (OR 1.81, 95\% CI 1.21-2.71), restricted or failed abduction of upper arms (OR 1.81, 95\% CI 1.28-2.85), and poor results from the word list memory (OR 3.77, 95\% CI 2.65-5.36) or word list delayed recall (OR 2.12, 95\% CI 1.48-3.02) tests had greater odds for nonuse of the internet for services than their counterparts. Moreover, those who had poor near (OR 2.18, 95\% CI 1.57-3.02) or distant vision (OR 2.14, 95\% CI 1.43-3.19), poor results from the chair stand test (OR 1.57, 95\% CI 1.06-2.31), restricted or failed abduction of upper arms (OR 1.74, 95\% CI 1.10-2.76), and poor results from the word list memory (OR 3.41, 95\% CI 2.32-5.03) or word list delayed recall (OR 2.05, 95\% CI 1.39-3.04) tests had greater odds of low digital competence than their counterparts. Conclusions: According to our results, older adults' impaired physical and cognitive functioning may hamper their possibilities of accessing internet services such as digital health care services. Our results should be considered when planning digital health care services intended to be used by older adults; that is, digital solutions should also be suitable for older adults with impairments. Furthermore, face-to-face services should be provided for those who cannot use digital services, even if they are assisted properly. ",
doi="10.2196/42287",
url="https://www.jmir.org/2023/1/e42287",
url="http://www.ncbi.nlm.nih.gov/pubmed/37145836"
}


@Article{info:doi/10.2196/42868,
author="Xing, Zhaoquan
and Ji, Meng
and Dong, Zhaogang
and Xu, Xiaofei
and Shan, Yi",
title="Factors Associated With Limited Digital Health Literacy Among Chinese Male Populations: Cross-sectional Study",
journal="JMIR Form Res",
year="2023",
month="Apr",
day="19",
volume="7",
pages="e42868",
keywords="factor",
keywords="older age",
keywords="lower education attainment",
keywords="lower functional, communicative, and critical health literacy",
keywords="weaker belief and self-confidence",
keywords="limited eHealth literacy",
keywords="Chinese population",
keywords="logistic regression",
abstract="Background: eHealth resources and interventions promise to promote favorable behavior change, self-efficacy, and knowledge acquisition, thereby improving health literacy. However, individuals with limited eHealth literacy may find it difficult to identify, understand, and benefit from eHealth use. It is necessary to identify the self-assessed eHealth literacy of those who use eHealth resources to classify their eHealth literacy levels and to determine the demographic characteristics associated with higher and lower eHealth literacy skills. Objective: This study aimed to identify notable factors closely associated with limited eHealth literacy among Chinese male populations to provide some implications for clinical practice, health education, medical research, and public health policy making. Methods: We hypothesized that participants' eHealth literacy status was associated with various demographic characteristics. Therefore, we elicited the following information in the questionnaire: age and education, self-assessed disease knowledge, 3 well-developed health literacy assessment tools (ie, the All Aspects of Health Literacy Scale, eHealth Literacy Scale, and General Health Numeracy Test), and the 6 Internal items on health beliefs and self-confidence in the Multidimensional Health Locus of Control Scales. Using randomized sampling, we recruited survey participants from Qilu Hospital of Shandong University, China. After validating the data collected through a web-based questionnaire survey via wenjuanxing, we coded all valid data according to predefined coding schemes of Likert scales with different point (score) ranges. We then calculated the total scores of the subsections of the scales or the entire scale. Finally, we used logistic regression modeling to associate the scores of the eHealth Literacy Scale with the scores of the All Aspects of Health Literacy Scale, the General Health Numeracy Test-6, and age and education to ascertain factors considerably associated with limited eHealth literacy among Chinese male populations. Results: All data from the 543 returned questionnaires were valid according to the validation criteria. By interpreting these descriptive statistics, we found that 4 factors were significantly correlated with participants' limited eHealth literacy: older age, lower education attainment, lower levels of all aspects of health literacy (functional, communicative, and critical), and weaker beliefs and self-confidence in internal drivers and strengths to stay healthy. Conclusions: By applying logistic regression modeling, we ascertained 4 factors that were significantly correlated with limited eHealth literacy among Chinese male populations. These relevant factors identified can inform stakeholders engaging in clinical practice, health education, medical research, and health policy making. ",
doi="10.2196/42868",
url="https://formative.jmir.org/2023/1/e42868",
url="http://www.ncbi.nlm.nih.gov/pubmed/37074760"
}


@Article{info:doi/10.2196/39826,
author="Soares-Pinto, Igor
and Braga, Pinto Ana Margarida
and Santos, Araujo Isabel Maria Ribeiro Morais
and Ferreira, Gomes Nat{\'a}lia Maria Ribeiro
and Silva, e. Sandra Cristina da Rocha
and Alves, Jorge Paulo",
title="eHealth Promoting Stoma Self-care for People With an Elimination Ostomy: Focus Group Study",
journal="JMIR Hum Factors",
year="2023",
month="Mar",
day="13",
volume="10",
pages="e39826",
keywords="self-care",
keywords="ostomy",
keywords="nurses",
keywords="health education",
keywords="telemedicine",
keywords="eHealth",
abstract="Background: The construction of an elimination stoma has a physical, psychological, and social impact on the person. The development of stoma self-care competence contributes to the adaptation to a new health condition and improvement of quality of life. eHealth refers to everything associated with information and communication technology and health care, including telemedicine, mobile health, and health informatics. The use of eHealth platforms by the person with an ostomy, as a digital application that includes websites and mobile phone apps, can bring scientific knowledge and well-informed practices to individuals, families, and communities. It also allows functionalities that enable the person to describe and identify early signs and symptoms and precursors of complications and to be guided to an adequate health response for their problems. Objective: This study aimed to define the most relevant content and features to promote ostomy self-care integrated into an eHealth platform as a digital app or website to be used by patients for self-management of stoma care. Methods: We developed a descriptive, exploratory study with a qualitative approach using the focus group methodology, which was oriented to reach a consensus of at least 80\%. A convenience sample of 7 participants consisting of stomatherapy nurses was used. The focus group discussion was recorded, and field notes were taken. The focus group meeting was fully transcribed, and a qualitative analysis was performed. The research question was: Which content and features for ostomy self-care promotion should be integrated into an eHealth platform as a digital app or website? Results: An eHealth platform, which can be a smartphone app or website, for people with ostomy should provide content aimed at promoting self-care, namely in the field of knowledge and self-monitoring, as well as the possibility of interacting with a stomatherapy care nurse. Conclusions: The stomatherapy nurse has a decisive role in promoting adaptation to life with a stoma, namely through the promotion of stoma self-care. Technological evolution has emerged as a useful tool to enhance nursing interventions and promote self-care competence. The development of an eHealth platform aimed at promoting ostomy self-care should include the capabilities for telehealth and help with decision-making regarding self-monitoring and seeking differentiated care. ",
doi="10.2196/39826",
url="https://humanfactors.jmir.org/2023/1/e39826",
url="http://www.ncbi.nlm.nih.gov/pubmed/36912879"
}


@Article{info:doi/10.2196/40634,
author="Haun, N. Jolie
and Melillo, Christine
and Schneider, Tali
and Merzier, M. Marie
and Klanchar, Angelina S.
and Fowler, A. Christopher
and Benzinger, C. Rachel",
title="User Testing of the Veteran Delegation Tool: Qualitative Inquiry",
journal="J Med Internet Res",
year="2023",
month="Feb",
day="23",
volume="25",
pages="e40634",
keywords="electronic health portal",
keywords="human-centered design",
keywords="delegate",
keywords="electronic resources",
keywords="delegation",
keywords="care partner",
keywords="veteran",
keywords="Veteran Delegation Tool",
keywords="Veterans Health Administration",
abstract="Background: Informal caregivers, or care partners, provide critical support to care recipients when managing health care. Veterans Health Administration (VHA) priorities identify care partners as vital in supporting veterans' care management. The Veteran Delegation Tool (VDT) is VHA's Health Insurance Portability and Accountability Act--compliant solution for care partners to comanage veterans' care through VHA's electronic health portal. Human-centered design approaches in VDT development are needed to inform enhancements aimed at promoting uptake and sustained use. Objective: The objective of this prospective descriptive quality improvement project was to use a human-centered design approach to examine VDT use perceptions and practical experiences. Methods: This project was conducted using a 4-phase approach: frame, discover, design, and deliver. The frame phase designed the protocol and prepared the VDT system for testing. This paper reports on the discover phase, which used semistructured and follow-up interviews and user testing to examine VDT's benefits, facilitators, and barriers. The discover phase data informed the design and deliver phases, which are underway. Results: Veterans (24/54, 44\%), care partners (21/54, 39\%), and individuals who represented dual roles (9/54, 17\%)---namely veteran care partner (4/54, 7\%), veteran clinical provider (2/54, 4\%), and care partner provider (3/54, 6\%)---participated in semistructured interviews in the discover phase. A subsample of these participants (3/54, 6\%) participated in the follow-up interviews and user testing. Analysis of the semistructured interviews indicated convergence on the respondents' perceptions of VDT's benefits, facilitators, and barriers and recommendations for improving VDT. The perceived benefits were authorized access, comanagement of care needs on the web, communication with the clinical team, access to resources, and ease of burden. Perceived barriers were nonrecognition of the benefits of VDT, technical literacy access issues, increased stress in or burden on care partners, and personal health information security. Participant experiences across 4 VDT activity domains were upgrade to My HealtheVet Premium account, registration, sign-in, and use. User testing demonstrated users' challenges to register, navigate, and use VDT. Findings informed VDT development enhancements and recommendations. Conclusions: Care partners need Health Insurance Portability and Accountability Act--compliant access to electronic health portals to assist with care management. VDT is VHA's solution, allowing communication among delegates, veterans, and clinical care teams. Users value VDT's potential use and benefits, while access and navigation improvements to ensure uptake and sustained use are needed. Future efforts need to iteratively evaluate the human-centered phases, design and deliver, of VDT to target audiences. Continued efforts to understand and respond to care partners' needs are warranted. ",
doi="10.2196/40634",
url="https://www.jmir.org/2023/1/e40634",
url="http://www.ncbi.nlm.nih.gov/pubmed/36821364"
}


@Article{info:doi/10.2196/40645,
author="Ayre, Julie
and Bonner, Carissa
and Muscat, M. Danielle
and Dunn, G. Adam
and Harrison, Eliza
and Dalmazzo, Jason
and Mouwad, Dana
and Aslani, Parisa
and Shepherd, L. Heather
and McCaffery, J. Kirsten",
title="Multiple Automated Health Literacy Assessments of Written Health Information: Development of the SHeLL (Sydney Health Literacy Lab) Health Literacy Editor v1",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="14",
volume="7",
pages="e40645",
keywords="health literacy",
keywords="comprehension",
keywords="health education",
keywords="health communication",
keywords="medicine information",
keywords="readability",
doi="10.2196/40645",
url="https://formative.jmir.org/2023/1/e40645",
url="http://www.ncbi.nlm.nih.gov/pubmed/36787164"
}


@Article{info:doi/10.2196/39391,
author="Wathne, Hege
and Morken, Margreta Ingvild
and Storm, Marianne
and Huseb{\o}, Lunde Anne Marie",
title="Designing a Future eHealth Service for Posthospitalization Self-management Support in Long-term Illness: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2023",
month="Feb",
day="6",
volume="10",
pages="e39391",
keywords="colorectal cancer",
keywords="eHealth service",
keywords="heart failure",
keywords="noncommunicable diseases",
keywords="self-management",
keywords="qualitative research",
keywords="mobile phone",
abstract="Background: For patients with noncommunicable diseases (NCDs; eg, heart failure [HF] and colorectal cancer [CRC]), eHealth interventions could meet their posthospital discharge needs and strengthen their ability to self-manage. However, inconclusive evidence exists regarding how to design eHealth services to meet the complex needs of patients. To foster patient acceptability and ensure the successful development and implementation of eHealth solutions, it is beneficial to include different stakeholders (ie, patients and health care professionals) in the design and development phase of such services. The involvement of different stakeholders could contribute to ensuring feasible, acceptable, and usable solutions and that eHealth services are developed in response to users' supportive care needs when transitioning to home after hospitalization. This study is the first step of a larger complex intervention study aimed at meeting the postdischarge needs of 2 NCD populations. Objective: This study aimed to explore the perspectives of patients with HF and CRC and health care professionals on patient self-management needs following hospital discharge and investigate how a future nurse-assisted eHealth service could be best designed to foster patient acceptability, support self-management, and smooth the transition from hospital to home. Methods: A qualitative, explorative, and descriptive approach was used. We conducted 38 semistructured interviews with 10 patients with HF, 9 patients surgically treated for CRC with curative intent, 6 registered nurses recruited as nurse navigators of a planned eHealth service, and 13 general practitioners experienced in HF and CRC treatment and follow-up care. Patients were recruited conveniently from HF and CRC outpatient clinics, and the nurses were recruited from the cardiology and gastro-surgical departments at a university hospital in the southwest of Norway. The general practitioners were recruited from primary care in surrounding municipalities. Semistructured interview guides were used for data collection, and the data were analyzed using thematic analysis. Results: In total, 3 main themes were derived from the data analysis: expecting information, reassurance, and guidance when using eHealth for HF and CRC self-management; expecting eHealth to be comprehensible, supportive, and knowledge promoting; and recognizing both the advantages and disadvantages of eHealth for HF and CRC self-management. The data generated from this interview study depicted the diverse needs for self-management support of patients with CRC and HF after hospital discharge. In addition, valuable suggestions were identified regarding the design and content of the eHealth service. However, participants described both possible advantages and disadvantages of a remote eHealth service. Conclusions: This study is the first step in the development of an eHealth service for posthospitalization self-management support for long-term illnesses. It concerns patients' supportive care needs and user requirements of an eHealth service. The findings of this study may add value to the planning and development of eHealth interventions for patients with NCDs. ",
doi="10.2196/39391",
url="https://humanfactors.jmir.org/2023/1/e39391",
url="http://www.ncbi.nlm.nih.gov/pubmed/36745492"
}


@Article{info:doi/10.2196/41788,
author="Ma, Kwan Kris Pui
and Stephens, A. Kari
and Geyer, E. Rachel
and Prado, G. Maria
and Mollis, L. Brenda
and Zbikowski, M. Susan
and Waters, Deanna
and Masterson, Jo
and Zhang, Ying",
title="Developing Digital Therapeutics for Chronic Pain in Primary Care: A Qualitative Human-Centered Design Study of Providers' Motivations and Challenges",
journal="JMIR Form Res",
year="2023",
month="Feb",
day="3",
volume="7",
pages="e41788",
keywords="chronic pain",
keywords="pain management",
keywords="primary care",
keywords="digital therapeutics",
keywords="mHealth",
keywords="mobile health",
keywords="human-centered design",
keywords="digital health",
keywords="pain",
keywords="qualitative",
keywords="interview",
keywords="challenge",
keywords="perspective",
keywords="health care provider",
keywords="physician",
keywords="doctor",
abstract="Background: Digital therapeutics are growing as a solution to manage pain for patients; yet, they are underused in primary care where over half of the patients with chronic pain seek care. Little is known about how to successfully engage primary care providers in recommending digital therapeutics to their patients. Exploring provider motivations in chronic pain management would potentially help to improve their engagement and inform the development of digital therapeutics. Objective: This study examined primary care providers' motivations for chronic pain management, including their strategies and challenges, to inform the future development of chronic pain-related digital therapeutics tailored to primary care settings. Methods: We conducted qualitative semistructured interviews with health care providers recruited from 3 primary care clinics in Washington and 1 clinic in Colorado between July and October 2021. The sample (N=11) included 7 primary care physicians, 2 behavioral health providers, 1 physician assistant, and 1 nurse. Most providers worked in clinics affiliated with urban academic health systems. Guided by the human-centered design approach and Christensen's Job-to-be-Done framework, we asked providers their goals and priorities in chronic pain management, their experiences with challenges and strategies used to care for patients, and their perceptions of applying digital therapeutics in clinical practice. Transcripts were analyzed using a thematic analysis approach. Results: We found that primary care providers were motivated but challenged to strengthen the patient-provider alliance, provide team-based care, track and monitor patients' progress, and address social determinants of health in chronic pain management. Specifically, providers desired additional resources to improve patient-centered communication, pain education and counseling, and goal setting with patients. Providers also requested greater accessibility to multidisciplinary care team consultations and nonpharmacological pain treatments. When managing chronic pain at the population level, providers need infrastructure and systems to systematically track and monitor patients' pain and provide wraparound health and social services for underserved patients. Recommendations on digital therapeutic features that might address provider challenges in achieving these motivations were discussed. Conclusions: Given the findings, to engage primary care providers, digital therapeutics for chronic pain management need to strengthen the patient-provider alliance, increase access to nonpharmacological treatment options, support population health tracking and management, and provide equitable reach. Leveraging digital therapeutics in a feasible, appropriate, and acceptable way to aid primary care providers in chronic pain management may require multimodal features that address provider motivations at an individual care and clinic or system level. ",
doi="10.2196/41788",
url="https://formative.jmir.org/2023/1/e41788",
url="http://www.ncbi.nlm.nih.gov/pubmed/36735284"
}


@Article{info:doi/10.2196/25361,
author="Verma, Neha
and Lehmann, Harold
and Alam, Afroz Amal
and Yazdi, Youseph
and Acharya, Soumyadipta",
title="Development of a Digital Assistant to Support Teleconsultations Between Remote Physicians and Frontline Health Workers in India: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2023",
month="Feb",
day="2",
volume="10",
pages="e25361",
keywords="telemedicine",
keywords="telehealth",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="community health workers",
keywords="frontline health workers",
keywords="digital health assistant",
keywords="task shifting",
abstract="Background: Many low- and middle-income countries have adopted telemedicine programs that connect frontline health workers (FHWs) such as nurses, midwives, or community health workers in rural and remote areas with physicians in urban areas to deliver care to patients. By leveraging technology to reduce temporal, financial, and geographical barriers, these health worker--to-physician telemedicine programs have the potential to increase health care quality, expand the specialties available to patients, and reduce the time and cost required to deliver care. Objective: We aimed to identify, validate, and prioritize unmet needs in the health care space of health worker--to-physician telemedicine programs and develop and refine a solution that addresses those needs. Methods: We collected information regarding user needs through ethnographic research, direct observation, and semistructured interviews with 37 stakeholders (n=5, 14\% physicians; n=1, 3\% public health program manager; n=12, 32\% community health workers; and n=19, 51\% patients) at 2 telemedicine clinics in rural West Bengal, India. We used the Spiral-Iterative Innovation Model to design and develop a prototype solution to meet these needs. Results: We identified 74 unmet needs through our immersion in health worker--to-physician telemedicine programs. We identified a critical unmet need that achieving optimal teleconsultations in low- and middle-income countries often requires shifting tasks such as history taking and physical examination from high-skilled remote physicians to FHWs. To meet this need, we developed a prototype digital assistant that would allow FHWs to assume some of the tasks carried out by remote clinicians. The user needs of multiple stakeholder groups (patients, FHWs, physicians, and health organizations) were incorporated into the design and features of the task-shifting tool. The final prototype was shared with the health workers, physicians, and public health program managers who expressed that the tool would be useful and valuable. Conclusions: The final prototype that was developed was released as an open-source digital public good and may improve the quality and efficiency of care delivery in health worker--to-physician telemedicine programs. ",
doi="10.2196/25361",
url="https://humanfactors.jmir.org/2023/1/e25361",
url="http://www.ncbi.nlm.nih.gov/pubmed/36729578"
}


@Article{info:doi/10.2196/40105,
author="Deshpande, Nikita
and Arora, M. Vineet
and Vollbrecht, Hanna
and Meltzer, O. David
and Press, Valerie",
title="eHealth Literacy and Patient Portal Use and Attitudes: Cross-sectional Observational Study",
journal="JMIR Hum Factors",
year="2023",
month="Jan",
day="27",
volume="10",
pages="e40105",
keywords="health literacy",
keywords="patient portal",
keywords="COVID-19",
keywords="health technology",
keywords="inpatients",
keywords="digital health literacy",
keywords="awareness",
keywords="use",
keywords="engagement",
keywords="attitudes",
keywords="hospitalized patients",
keywords="access",
keywords="accessibility",
keywords="perception",
keywords="health care delivery",
abstract="Background: Throughout the COVID-19 pandemic, patient portals have become more widely used tools of patient care delivery. However, not all individuals have equivalent access or ability to use patient portals. Objective: The aim of this study is to evaluate the relationships between eHealth literacy (eHL) and patient portal awareness, use, and attitudes among hospitalized patients. Methods: Inpatients completed patient portal surveys; eHL was assessed (eHealth Literacy Scale). Multivariable logistic regression analyses adjusted for age, self-reported race, gender, and educational attainment were completed with significance at P<.006 (Bonferroni correction). Results: Among 274 participants, most identified as Black (n=166, 61\%) and female (n=140, 51\%), mean age was 56.5 (SD 16.7) years, and 178 (65\%) reported some college or higher educational attainment. One-quarter (n=79, 28\%) had low eHL (mean 27, SD 9.5), which was associated with lower odds of portal access awareness (odds ratio 0.11, 95\% CI 0.05-0.23; P<.001), having ever used portals (odds ratio 0.19, 95\% CI 0.10-0.36; P<.001), less perceived usefulness of portals (odds ratio 0.20, 95\% CI 0.10-0.38; P=.001), and lower likelihood of planning to use portals in the coming years (odds ratio 0.12, 95\% CI 0.06-0.25; P<.001). As time through the COVID-19 pandemic passed, there was a trend toward increased perceived usefulness of patient portals (53\% vs 62\%, P=.08), but average eHL did not increase through time (P=.81). Conclusions: Low eHL was associated with less awareness, use, and perceived usefulness of portals. Perceived usefulness of portals likely increased through the COVID-19 pandemic, but patients' eHL did not. Interventions tailored for patients with low eHL could ensure greater equity in health care delivery through the COVID-19 pandemic. ",
doi="10.2196/40105",
url="https://humanfactors.jmir.org/2023/1/e40105",
url="http://www.ncbi.nlm.nih.gov/pubmed/36705947"
}


@Article{info:doi/10.2196/37785,
author="Wegener, Kauffeldt Emilie
and Bergsch{\"o}ld, M. Jenny
and Whitmore, Carly
and Winters, Marjolein
and Kayser, Lars",
title="Involving Older People With Frailty or Impairment in the Design Process of Digital Health Technologies to Enable Aging in Place: Scoping Review",
journal="JMIR Hum Factors",
year="2023",
month="Jan",
day="27",
volume="10",
pages="e37785",
keywords="eHealth",
keywords="cognitive decline",
keywords="frail",
keywords="aging",
keywords="cocreation",
keywords="user involvement",
keywords="mobile phone",
abstract="Background: With an increase in life expectancy globally, the focus on digital health technologies that can enhance physical and mental health among older people with frailty and impairment has increased. Similarly, research interest in how digital health technology can promote well-being and self-management of health in older age has increased, including an increased focus on methods for designing digital health technologies that meet the various medical, psychological, and social needs of older population. Despite the increased focus, there remains a necessity to further understand the needs of this population group to ensure uptake and to avoid introduction of additional challenges when introducing technologies, for example, because of poor technological design. The scope is limited to digital health technologies meant to enable older people with frailty and impairment to age in place. Objective: In this study, we aimed to explore how older people with frailty and impairment are involved in various parts of the design processes of digital health technologies and identify gaps or neglected steps in a user-involving design process. This included a focus on recruitment strategies, contributions, and methods used to address the perspectives, needs, and desires of older people with frailty and impairment in the development of digital health technologies. Methods: A scoping review was conducted in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting from February 2021 to April 2021. Literature searches were conducted in PubMed, Scopus, Embase, and IEEE using a search string covering the concepts of health technology, older people, frailty and impairment, user-centered design, and self-management. Results: In total, 1891 studies were imported for screening from the initial search. A total of 22 studies were included in this review after full-text screening and manual search. Invitation through partners was the most reported recruitment strategy to involve older people with frailty and impairment in the design process of digital health technologies. Furthermore, they were commonly involved in the final evaluation of the development process. Three main gaps identified were the use of outreach approaches to recruit older people with frailty and impairment in the design process of digital health technologies, description of the value of involvement and outcome of the contribution of participants, and knowledge regarding involvement in all parts of the design process. Conclusions: Although there is literature on methods for involving older people with frailty and impairment in the design of digital health technology, there is little methodological dialogue on the nuances of how different methods for involvement relate to and shape the outcome of the development process. ",
doi="10.2196/37785",
url="https://humanfactors.jmir.org/2023/1/e37785",
url="http://www.ncbi.nlm.nih.gov/pubmed/36705959"
}


@Article{info:doi/10.2196/38096,
author="Davat, Ambre
and Martin-Juchat, Fabienne",
title="Patients' Information Needs Related to a Monitoring Implant for Heart Failure: Co-designed Study Based on Affect Stories",
journal="JMIR Hum Factors",
year="2023",
month="Jan",
day="23",
volume="10",
pages="e38096",
keywords="co-design",
keywords="affect stories",
keywords="mixed methods study",
keywords="heart failure",
keywords="medical implantable device",
keywords="mobile health",
keywords="mHealth",
keywords="remote monitoring",
keywords="quantified self",
keywords="telehealth",
abstract="Background: RealWorld4Clinic is a European consortium that is currently developing an implantable monitoring device for acute heart failure prevention. Objective: This study aimed to identify the main issues and information needs related to this new cardiac implant from the patients' perspective. Methods: A total of 3 patient collaborators were recruited to help us design the study. During 4 remotely held meetings (each lasting for 2 hours), we defined the main questions and hypotheses together. Next, 26 additional interviews were conducted remotely to test these hypotheses. During both phases, we used affect stories, which are life narratives focusing on affect and the relationship between patients and the care ecosystem, to highlight the main social issues that should be addressed by the research according to the patients. Results: Context of diagnosis, age, and severity of illness strongly influence patient experience. However, these variables do not seem to influence the choice regarding being implanted, which relies mostly on the individual patient's trust in their physicians. It seems that the major cause of anxiety for the patient is not the implant but the disease itself, although some people may initially be concerned over the idea of becoming a cyborg. Remote monitoring of cardiac implants should draw on existing remote disease management programs focusing on a long-term relationship between the patient and their medical team. Conclusions: Co-design with affect stories is a useful method for quickly identifying the main social issues related to information about a new health technology. ",
doi="10.2196/38096",
url="https://humanfactors.jmir.org/2023/1/e38096",
url="http://www.ncbi.nlm.nih.gov/pubmed/36689266"
}


@Article{info:doi/10.2196/39646,
author="Rizvi, F. Rubina
and VanHouten, B. Courtney
and Willis, C. Van
and Rosario, L. Bedda
and South, R. Brett
and Sands-Lincoln, Megan
and Brotman, David
and Lenert, Jeffery
and Snowdon, L. Jane
and Jackson, P. Gretchen",
title="Understanding a Care Management System's Role in Influencing a Transitional-Aged Youth Program's Practice: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2022",
month="Dec",
day="16",
volume="9",
number="4",
pages="e39646",
keywords="care management solution",
keywords="foster care youth",
keywords="mixed methods study",
keywords="interviews",
keywords="qualitative data",
keywords="quantitative data",
keywords="process improvement",
abstract="Background: Extended foster care programs help prepare transitional-aged youth (TAY) to step into adulthood and live independent lives. Aspiranet, one of California's largest social service organizations, used a social care management solution (SCMS) to meet TAY's needs. Objective: We aimed to investigate the impact of an SCMS, IBM Watson Care Manager (WCM), in transforming foster program service delivery and improving TAY outcomes. Methods: We used a mixed methods study design by collecting primary data from stakeholders through semistructured interviews in 2021 and by pulling secondary data from annual reports, system use logs, and data repositories from 2014 to 2021. Thematic analysis based on grounded theory was used to analyze qualitative data using NVivo software. Descriptive analysis of aggregated outcome metrics in the quantitative data was performed and compared across 2 periods: pre-SCMS implementation (before October 31, 2016) and post-SCMS implementation (November 1, 2016, and March 31, 2021). Results: In total, 6 Aspiranet employees (4 leaders and 2 life coaches) were interviewed, with a median time of 56 (IQR 53-67) minutes. The majority (5/6, 83\%) were female, over 30 years of age (median 37, IQR 32-39) with a median of 6 (IQR 5-10) years of experience at Aspiranet and overall field experience of 10 (IQR 7-14) years. Most (4/6, 67\%) participants rated their technological skills as expert. Thematic analysis of participants' interview transcripts yielded 24 subthemes that were grouped into 6 superordinate themes: study context, the impact of the new tool, key strengths, commonly used features, expectations with WCM, and limitations and recommendations. The tool met users' initial expectations of streamlining tasks and adopting essential functionalities. Median satisfaction scores around pre- and post-WCM workflow processes remained constant between 2 life coaches (3.25, IQR 2.5-4); however, among leaders, post-WCM scores (median 4, IQR 4-5) were higher than pre-WCM scores (median 3, IQR 3-3). Across the 2 study phases, Aspiranet served 1641 TAY having consistent population demographics (median age of 18, IQR 18-19 years; female: 903/1641, 55.03\%; race and ethnicity: Hispanic or Latino: 621/1641, 37.84\%; Black: 470/1641, 28.64\%; White: 397/1641, 24.19\%; Other: 153/1641, 9.32\%). Between the pre- and post-WCM period, there was an increase in full-time school enrollment (359/531, 67.6\% to 833/1110, 75.04\%) and a reduction in part-time school enrollment (61/531, 11.5\% to 91/1110, 8.2\%). The median number of days spent in the foster care program remained the same (247, IQR 125-468 years); however, the number of incidents reported monthly per hundred youth showed a steady decline, even with an exponentially increasing number of enrolled youth and incidents. Conclusions: The SCMS for coordinating care and delivering tailored services to TAY streamlined Aspiranet's workflows and processes and positively impacted youth outcomes. Further enhancements are needed to better align with user and youth needs. ",
doi="10.2196/39646",
url="https://humanfactors.jmir.org/2022/4/e39646",
url="http://www.ncbi.nlm.nih.gov/pubmed/36525294"
}


@Article{info:doi/10.2196/40360,
author="Seah, L. Cassandra E.
and Zhang, Zheyuan
and Sun, Sijin
and Wiskerke, Esther
and Daniels, Sarah
and Porat, Talya
and Calvo, A. Rafael",
title="Designing Mindfulness Conversational Agents for People With Early-Stage Dementia and Their Caregivers: Thematic Analysis of Expert and User Perspectives",
journal="JMIR Aging",
year="2022",
month="Dec",
day="6",
volume="5",
number="4",
pages="e40360",
keywords="mindfulness",
keywords="dyadic",
keywords="dementia",
keywords="caregivers",
keywords="user needs",
keywords="intervention",
keywords="user",
keywords="feedback",
keywords="design",
keywords="accessibility",
keywords="relationships",
keywords="mindset",
keywords="essential",
abstract="Background: The number of people with dementia is expected to grow worldwide. Among the ways to support both persons with early-stage dementia and their caregivers (dyads), researchers are studying mindfulness interventions. However, few studies have explored technology-enhanced mindfulness interventions for dyads and the needs of persons with dementia and their caregivers. Objective: The main aim of this study was to elicit essential needs from people with dementia, their caregivers, dementia experts, and mindfulness experts to identify themes that can be used in the design of mindfulness conversational agents for dyads. Methods: Semistructured interviews were conducted with 5 dementia experts, 5 mindfulness experts, 5 people with early-stage dementia, and 5 dementia caregivers. Interviews were transcribed and coded on NVivo (QSR International) before themes were identified through a bottom-up inductive approach. Results: The results revealed that dyadic mindfulness is preferred and that implementation formats such as conversational agents have potential. A total of 5 common themes were also identified from expert and user feedback, which should be used to design mindfulness conversational agents for persons with dementia and their caregivers. The 5 themes included enhancing accessibility, cultivating positivity, providing simplified tangible and thought-based activities, encouraging a mindful mindset shift, and enhancing relationships. Conclusions: In essence, this research concluded with 5 themes that mindfulness conversational agents could be designed based on to meet the needs of persons with dementia and their caregivers. ",
doi="10.2196/40360",
url="https://aging.jmir.org/2022/4/e40360",
url="http://www.ncbi.nlm.nih.gov/pubmed/36472897"
}


@Article{info:doi/10.2196/39973,
author="Lear, Rachael
and Freise, Lisa
and Kybert, Matthew
and Darzi, Ara
and Neves, Luisa Ana
and Mayer, K. Erik",
title="Perceptions of Quality of Care Among Users of a Web-Based Patient Portal: Cross-sectional Survey Analysis",
journal="J Med Internet Res",
year="2022",
month="Nov",
day="17",
volume="24",
number="11",
pages="e39973",
keywords="electronic health records",
keywords="personal health records",
keywords="patient participation",
keywords="patient safety",
keywords="care quality",
keywords="digital health literacy",
abstract="Background: Web-based patient portals enable patients access to, and interaction with, their personal electronic health records. However, little is known about the impact of patient portals on quality of care. Users of patient portals can contribute important insights toward addressing this knowledge gap. Objective: We aimed to describe perceived changes in the quality of care among users of a web-based patient portal and to identify the characteristics of patients who perceive the greatest benefit of portal use. Methods: A cross-sectional web-based survey study was conducted to understand patients' experiences with the Care Information Exchange (CIE) portal. Patient sociodemographic data were collected, including age, sex, ethnicity, educational level, health status, geographic location, motivation to self-manage, and digital health literacy (measured by the eHealth Literacy Scale). Patients with experience using CIE, who specified both age and sex, were included in these analyses. Relevant survey items (closed-ended questions) were mapped to the Institute of Medicine's 6 domains of quality of care. Users' responses were examined to understand their perceptions of how portal use has changed the overall quality of their care, different aspects of care related to the 6 domains of care quality, and patient's satisfaction with care. Multinomial logistic regression analyses were performed to identify patient characteristics associated with perceived improvements in overall care quality and greater satisfaction with care. Results: Of 445 CIE users, 38.7\% (n=172) reported that the overall quality of their care was better; 3.2\% (n=14) said their care was worse. In the patient centeredness domain, 61.2\% (273/445) of patients felt more in control of their health care, and 53.9\% (240/445) felt able to play a greater role in decision-making. Regarding timeliness, 40.2\% (179/445) of patients reported they could access appointments, diagnoses, and treatment more quickly. Approximately 30\% of CIE users reported better care related to the domains of effectiveness (123/445, 27.6\%), safety (138/445, 31\%), and efficiency (174/445, 28.6\%). Regarding equity, patients self-reporting higher digital health literacy (odds ratio 2.40, 95\% CI 1.07-5.42; P=.03) and those belonging to ethnic minority groups (odds ratio 2.27, 95\% CI 1.26-3.73; P<.005) were more likely to perceive improvements in care quality. Across ethnic groups, Asian and British Asian patients perceived the greatest benefits. Increased frequency of CIE use also predicted perceived better care quality and greater satisfaction with care. Conclusions: A large proportion of CIE users perceived better care quality and greater satisfaction with care, although many portal users reported no change. The most favorable perceived improvements related to the domain of patient centeredness. With national policy directed toward addressing health disparities, patient portals could be valuable in improving care quality for ethnic minority groups. Future research should test the causal relationship between patient portal use and care quality. ",
doi="10.2196/39973",
url="https://www.jmir.org/2022/11/e39973",
url="http://www.ncbi.nlm.nih.gov/pubmed/36394922"
}


@Article{info:doi/10.2196/39059,
author="Marzouk, Sammer
and He, Shuhan
and Lee, Jarone",
title="Emoji Education: How Students Can Help Increase Health Awareness by Making Emojis",
journal="JMIR Med Educ",
year="2022",
month="Nov",
day="11",
volume="8",
number="4",
pages="e39059",
keywords="emoji",
keywords="medical education",
keywords="technology, education",
keywords="medical students",
keywords="creativity",
keywords="student",
keywords="health awareness",
keywords="health",
keywords="awareness",
keywords="medical",
keywords="society",
keywords="innovation",
keywords="communication",
keywords="medical communication",
keywords="electronic",
keywords="artistic",
keywords="representation",
doi="10.2196/39059",
url="https://mededu.jmir.org/2022/4/e39059",
url="http://www.ncbi.nlm.nih.gov/pubmed/36367758"
}


@Article{info:doi/10.2196/41143,
author="Fischer-Su{\'a}rez, Natalia
and Lozano-Paniagua, David
and Garc{\'i}a-Duarte, Sonia
and Castro-Luna, Gracia
and Parr{\'o}n-Carre{\~n}o, Tesif{\'o}n
and Nievas-Soriano, Jos{\'e} Bruno",
title="Using QR Codes as a Form of eHealth to Promote Health Among Women in a Pandemic: Cross-sectional Study",
journal="JMIR Hum Factors",
year="2022",
month="Nov",
day="8",
volume="9",
number="4",
pages="e41143",
keywords="eHealth",
keywords="QR code",
keywords="women",
keywords="health promotion",
keywords="public health",
keywords="healthcare sector",
keywords="women's health",
keywords="gynecology",
keywords="gynecologist",
keywords="gynecological",
keywords="obstetrician",
keywords="obstetric",
keywords="healthcare",
keywords="health care",
keywords="pandemic",
keywords="questionnaire",
keywords="validation",
keywords="validate",
keywords="development",
keywords="cross sectional",
keywords="factorial analysis",
abstract="Background: QR codes have played an integral role during the pandemic in many sectors, but their use has been limited in the health care sector, especially by patients. Although some authors have stated that developing specific content for women on how to cope with health problems could be an effective way to prevent problems, especially during pandemics, there is little research regarding the use of QR codes to promote health during a pandemic, and even fewer studies are focused on women. Moreover, although the importance of assessing these interventions from the users' perspective has been stated, research carried out from this point of view is still scarce. Objective: This study aimed to assess the usefulness of using QR codes with information to promote women's health in the context of a pandemic. We also sought to design and validate a questionnaire to assess this. Methods: A cross-sectional study was conducted among women in the gynecology waiting rooms of a reference hospital. Exploratory factorial analysis with the split-half method and Cronbach $\alpha$ values was performed for questionnaire validation. Univariant and bivariant analyses were performed to analyze the data obtained. Results: In total, 186 women took part in the study. Exploratory factor analysis identified 2 domains: usability and applicability in medical practice. The Cronbach $\alpha$ value was .81. Overall, 83.7\% of the answers to the first domain and 56.4\% of those to the second were favorable. Women with university education or those who had used QR codes before scored better in the usability domain, while no differences were observed in the applicability scores. Conclusions:  Using QR codes in the gynecology clinics' waiting rooms can help promote women's health during a pandemic, regardless of their education level or whether they have used QR codes before. The questionnaire developed herein is a helpful tool to assess this. These findings are important for clinical practice. This research can be performed in other ambits, specialties, or countries. ",
doi="10.2196/41143",
url="https://humanfactors.jmir.org/2022/4/e41143",
url="http://www.ncbi.nlm.nih.gov/pubmed/36346657"
}


@Article{info:doi/10.2196/41499,
author="Murshidi, Rand
and Hammouri, Muhammad
and Taha, Hana
and Kitaneh, Razi
and Alshneikat, Mahmoud
and Al-Qawasmeh, Abdallah
and Al-Oleimat, Ahmad
and Al-Huneidy, Leen
and Al-Huneidy, Yazan
and Al-Ani, Abdallah",
title="Knowledge, Attitudes, and Perceptions of Jordanians Toward Adopting and Using Telemedicine: National Cross-sectional Study",
journal="JMIR Hum Factors",
year="2022",
month="Nov",
day="4",
volume="9",
number="4",
pages="e41499",
keywords="Jordan",
keywords="telemedicine",
keywords="KAP study",
keywords="COVID-19",
keywords="telehealth",
keywords="regression model",
keywords="user perception",
keywords="online survey",
keywords="privacy",
keywords="health care system",
abstract="Background: Due to the upsurge of COVID-19, nations are increasingly adopting telemedicine programs in anticipation of similar crises. Similar to all nations worldwide, Jordan is implementing efforts to adopt such technologies, yet it is far from complete. Objective: This study aims to assess the knowledge, attitudes, and perceptions of Jordanians toward telemedicine, to identify key factors predisposing individuals to its use or acting as barriers to its implementation. Methods: We implemented a cross-sectional design using an online, self-administered questionnaire executed in Google Forms and distributed through social media. Differences in knowledge and attitude scores were examined using independent sample t tests and ANOVA. A multivariate linear regression model was computed to assess predictors of awareness toward telemedicine. Results: A total of 1201 participants fully completed the questionnaire. Participants were characterized by a mean age of 36.3 (SD 14.4) years and a male-to-female ratio of nearly 1:1. About 50\% (619/1201, 51.5\%) of our studied population were aware of telemedicine, while nearly 25\% (299/1201, 24.9\%) declared they had observed it in action. Approximatively 68\% (814/1201, 67.8\%) of respondents were willing to use telemedicine. The majority of the sample portrayed favorable and positive views toward telemedicine. Higher educational degrees, living in urban districts, and having a higher perception of electronic usage ability were associated with higher knowledge and better attitudes toward telemedicine (all P<.05). The multivariate linear regression analysis demonstrated that perceived ability to use electronics was associated with positive attitudes ($\beta$=0.394; 95\% CI 0.224 to 0.563), while living in Southern Jordan predicted poor attitudes toward telemedicine ($\beta$=--2.896; 95\% CI --4.873 to --0.919). Conclusions: Jordanians portray favorable perceptions of telemedicine. Nonetheless, concerns with regards to privacy, medical errors, and capacity for accurate diagnoses are prevalent. Furthermore, Jordanians believe that integrating telemedicine within the health care system is not applicable due to limited resources. ",
doi="10.2196/41499",
url="https://humanfactors.jmir.org/2022/4/e41499",
url="http://www.ncbi.nlm.nih.gov/pubmed/36257609"
}


@Article{info:doi/10.2196/39584,
author="Fjells{\aa}, Hunsbedt Hilde Marie
and Huseb{\o}, Lunde Anne Marie
and Storm, Marianne",
title="eHealth in Care Coordination for Older Adults Living at Home: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="18",
volume="24",
number="10",
pages="e39584",
keywords="eHealth",
keywords="care coordination",
keywords="older adults",
keywords="primary health care",
keywords="mobile phone",
abstract="Background: The population of older adults is projected to increase, potentially resulting in more older adults living with chronic illnesses or multimorbidity. Living with chronic illnesses increases the need for coordinated health care services. Older adults want to manage their illnesses themselves, and many are positive about using eHealth for care coordination (CC). CC can help older adults navigate the health care system and improve information sharing. Objective: This study aimed to map the research literature on eHealth used in CC for older adults living at home. This study assessed CC activities, outcomes, and factors influencing the use of eHealth in CC reported by older adults and health care professionals. Methods: We used a scoping review methodology. We searched four databases---MEDLINE, CINAHL, Academic Scoping Premier, and Scopus---from 2009 to 2021 for research articles. We screened 630 records using the inclusion criteria (older adults aged >65 years, primary health care setting, description of an eHealth program or intervention or measure or experiences with the use of eHealth, and inclusion of CC or relevant activities as described in the Care Coordination Atlas). The analysis of the included articles consisted of both a descriptive and thematic analysis. Results: A total of 16 studies were included in this scoping review. Of these 16 studies, 12 (75\%) had a quantitative design, and the samples of the included studies varied in size. The categories of eHealth used for CC among older adults living at home were electronic health records and patient portals, telehealth monitoring solutions, and telephone only. The CC activity communication was evident in all studies (16/16, 100\%). The results on patient- and system-level outcomes were mixed; however, most studies (7/16, 44\%) reported improved mental and physical health and reduced rehospitalization and hospital admission rates. Observing changes in patients' health was a facilitator for health care professionals using eHealth in CC. When using eHealth in CC, available support to the patient, personal continuity, and a sense of security and safety were facilitators for older adults. Individual characteristics and lack of experience, confidence, and knowledge were barriers to older adults' use of eHealth. Health care professionals reported barriers such as increased workload and hampered communication. Conclusions: We mapped the research literature on eHealth-enabled CC for older adults living at home. We did not map the gray literature as we aimed to map the research literature (peer-reviewed research articles published in academic journals). The study results showed that using eHealth to coordinate care for older adults who live at home is promising. To ensure the successful use of eHealth in CC, we recommend customized eHealth-enabled health care services for older adults, including individualized education and support. ",
doi="10.2196/39584",
url="https://www.jmir.org/2022/10/e39584",
url="http://www.ncbi.nlm.nih.gov/pubmed/36256831"
}


@Article{info:doi/10.2196/37772,
author="Tran-Nguyen, Kevin
and Berger, Caroline
and Bennett, Roxanne
and Wall, Michelle
and Morin, N. Suzanne
and Rajabiyazdi, Fateme",
title="Mobile App Prototype in Older Adults for Postfracture Acute Pain Management: User-Centered Design Approach",
journal="JMIR Aging",
year="2022",
month="Oct",
day="17",
volume="5",
number="4",
pages="e37772",
keywords="older adults",
keywords="mobile app",
keywords="skeletal fracture",
keywords="usability",
keywords="patient-centered",
keywords="human-centered design",
keywords="digital health",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="acute pain self-management",
keywords="mobile phone",
abstract="Background: Postfracture acute pain is often inadequately managed in older adults. Mobile health (mHealth) technologies can offer opportunities for self-management of pain; however, insufficient apps exist for acute pain management after a fracture, and none are designed for an older adult population. Objective: This study aims to design, develop, and evaluate an mHealth app prototype using a human-centered design approach to support older adults in the self-management of postfracture acute pain. Methods: This study used a multidisciplinary and user-centered design approach. Overall, 7 stakeholders (ie, 1 clinician-researcher specialized in internal medicine, 2 user experience designers, 1 computer science researcher, 1 clinical research assistant researcher, and 2 pharmacists) from the project team, together with 355 external stakeholders, were involved throughout our user-centered development process that included surveys, requirement elicitation, participatory design workshops, mobile app design and development, mobile app content development, and usability testing. We completed this study in 3 phases. We analyzed data from prior surveys administered to 305 members of the Canadian Osteoporosis Patient Network and 34 health care professionals to identify requirements for designing a low-fidelity prototype. Next, we facilitated 4 participatory design workshops with 6 participants for feedback on content, presentation, and interaction with our proposed low-fidelity prototype. After analyzing the collected data using thematic analysis, we designed a medium-fidelity prototype. Finally, to evaluate our medium-fidelity prototype, we conducted usability tests with 10 participants. The results informed the design of our high-fidelity prototype. Throughout all the phases of this development study, we incorporated inputs from health professionals to ensure the accuracy and validity of the medical content in our prototypes. Results: We identified 3 categories of functionalities necessary to include in the design of our initial low-fidelity prototype: the need for support resources, diary entries, and access to educational materials. We then conducted a thematic analysis of the data collected in the design workshops, which revealed 4 themes: feedback on the user interface design and usability, requests for additional functionalities, feedback on medical guides and educational materials, and suggestions for additional medical content. On the basis of these results, we designed a medium-fidelity prototype. All the participants in the usability evaluation tests found the medium-fidelity prototype useful and easy to use. On the basis of the feedback and difficulties experienced by participants, we adjusted our design in preparation for the high-fidelity prototype. Conclusions: We designed, developed, and evaluated an mHealth app to support older adults in the self-management of pain after a fracture. The participants found our proposed prototype useful for managing acute pain and easy to interact with and navigate. Assessment of the clinical outcomes and long-term effects of our proposed mHealth app will be evaluated in the future. ",
doi="10.2196/37772",
url="https://aging.jmir.org/2022/4/e37772",
url="http://www.ncbi.nlm.nih.gov/pubmed/36251348"
}


@Article{info:doi/10.2196/38977,
author="Kopka, Marvin
and Feufel, A. Markus
and Balzer, Felix
and Schmieding, L. Malte",
title="The Triage Capability of Laypersons: Retrospective Exploratory Analysis",
journal="JMIR Form Res",
year="2022",
month="Oct",
day="12",
volume="6",
number="10",
pages="e38977",
keywords="digital health",
keywords="triage",
keywords="self-triage",
keywords="urgency assessment",
keywords="patient-centered care",
keywords="care navigation",
keywords="decision support",
keywords="symptom checker",
keywords="care",
keywords="support",
keywords="medical",
keywords="health professional",
keywords="patient",
keywords="self-assessment",
keywords="decision",
keywords="accuracy",
keywords="error",
keywords="sensitivity",
keywords="emergency",
keywords="female",
keywords="male",
abstract="Background: Although medical decision-making may be thought of as a task involving health professionals, many decisions, including critical health--related decisions are made by laypersons alone. Specifically, as the first step to most care episodes, it is the patient who determines whether and where to seek health care (triage). Overcautious self-assessments (ie, overtriaging) may lead to overutilization of health care facilities and overcrowded emergency departments, whereas imprudent decisions (ie, undertriaging) constitute a risk to the patient's health. Recently, patient-facing decision support systems, commonly known as symptom checkers, have been developed to assist laypersons in these decisions. Objective: The purpose of this study is to identify factors influencing laypersons' ability to self-triage and their risk averseness in self-triage decisions. Methods: We analyzed publicly available data on 91 laypersons appraising 45 short fictitious patient descriptions (case vignettes; N=4095 appraisals). Using signal detection theory and descriptive and inferential statistics, we explored whether the type of medical decision laypersons face, their confidence in their decision, and sociodemographic factors influence their triage accuracy and the type of errors they make. We distinguished between 2 decisions: whether emergency care was required (decision 1) and whether self-care was sufficient (decision 2). Results: The accuracy of detecting emergencies (decision 1) was higher (mean 82.2\%, SD 5.9\%) than that of deciding whether any type of medical care is required (decision 2, mean 75.9\%, SD 5.25\%; t>90=8.4; P<.001; Cohen d=0.9). Sensitivity for decision 1 was lower (mean 67.5\%, SD 16.4\%) than its specificity (mean 89.6\%, SD 8.6\%) whereas sensitivity for decision 2 was higher (mean 90.5\%, SD 8.3\%) than its specificity (mean 46.7\%, SD 15.95\%). Female participants were more risk averse and overtriaged more often than male participants, but age and level of education showed no association with participants' risk averseness. Participants' triage accuracy was higher when they were certain about their appraisal (2114/3381, 62.5\%) than when being uncertain (378/714, 52.9\%). However, most errors occurred when participants were certain of their decision (1267/1603, 79\%). Participants were more commonly certain of their overtriage errors (mean 80.9\%, SD 23.8\%) than their undertriage errors (mean 72.5\%, SD 30.9\%; t>89=3.7; P<.001; d=0.39). Conclusions: Our study suggests that laypersons are overcautious in deciding whether they require medical care at all, but they miss identifying a considerable portion of emergencies. Our results further indicate that women are more risk averse than men in both types of decisions. Layperson participants made most triage errors when they were certain of their own appraisal. Thus, they might not follow or even seek advice (eg, from symptom checkers) in most instances where advice would be useful. ",
doi="10.2196/38977",
url="https://formative.jmir.org/2022/10/e38977",
url="http://www.ncbi.nlm.nih.gov/pubmed/36222793"
}


@Article{info:doi/10.2196/37341,
author="van Velsen, Lex
and Ludden, Geke
and Gr{\"u}nloh, Christiane",
title="The Limitations of User-and Human-Centered Design in an eHealth Context and How to Move Beyond Them",
journal="J Med Internet Res",
year="2022",
month="Oct",
day="5",
volume="24",
number="10",
pages="e37341",
keywords="user-centered design",
keywords="human-centered design",
keywords="eHealth, value-sensitive design",
keywords="citizen science",
doi="10.2196/37341",
url="https://www.jmir.org/2022/10/e37341",
url="http://www.ncbi.nlm.nih.gov/pubmed/36197718"
}


@Article{info:doi/10.2196/38265,
author="Kheirinejad, Saba
and Alorwu, Andy
and Visuri, Aku
and Hosio, Simo",
title="Contrasting the Expectations and Experiences Related to Mobile Health Use for Chronic Pain: Questionnaire Study",
journal="JMIR Hum Factors",
year="2022",
month="Sep",
day="6",
volume="9",
number="3",
pages="e38265",
keywords="mobile health",
keywords="mHealth",
keywords="m-Health",
keywords="wearable devices",
keywords="mobile apps",
keywords="self-management",
keywords="digital health",
keywords="chronic pain",
keywords="pain",
keywords="wearable",
keywords="questionnaire",
keywords="crowdsourcing",
keywords="crowdsourced",
keywords="user feedback",
keywords="usage pattern",
keywords="patient feedback",
keywords="perception",
keywords="attitude",
keywords="user experience",
abstract="Background: Chronic pain is a prolonged condition that deteriorates one's quality of life. Treating chronic pain requires a multicomponent approach, and in many cases, there are no ``silver bullet'' solutions. Mobile health (mHealth) is a rapidly expanding category of solutions in digital health with proven potential in chronic pain management. Objective: This study aims to contrast the viewpoints of 2 groups of people with chronic pain concerning mHealth: people who have adopted the use of mHealth and those who have not. We highlight the benefits of mHealth solutions for people with chronic pain and the perceived obstacles to their increased adoption. We also provide recommendations to encourage people to try mHealth solutions as part of their self-care. Methods: The Prolific crowdsourcing platform was used to collect crowdsourced data. A prescreening questionnaire was released to determine what type of pain potential participants have and whether they are currently using mHealth solutions for chronic pain. The participants were invited based on their experience using mHealth to manage their pain. Similar questions were presented to mHealth users and nonusers. Qualitative and quantitative analyses were performed to determine the outcomes of this study. Results: In total, 31 responses were collected from people (aged 19-63 years, mean 31.4, SD 12.1) with chronic pain who use mHealth solutions. Two-thirds (n=20, 65\%) of the users identified as female and 11 (35\%) as male. We matched these mHealth users with an equal number of nonusers: 31 responses from the pool of 361 participants in the prescreening questionnaire. The nonusers' ages ranged from 18 to 58 years (mean 30.8, SD 11.09), with 15 (50\%) identifying as female and 15 (50\%) as male. Likert-scale questions were analyzed using the Mann-Whitney-Wilcoxon (MWW) test. Results showed that the 2 groups differed significantly on 10 (43\%) of 23 questions and shared similar views in the remaining 13 (57\%). The most significant differences were related to privacy and interactions with health professionals. Of the 31 mHealth users, 12 (39\%) declared that using mHealth solutions has made interacting with health or social care professionals easier (vs n=22, 71\%, of nonusers). The majority of the nonusers (n=26, 84\%) compared with about half of the users (n=15, 48\%) expressed concern about sharing their data with, for example, third parties. Conclusions: This study investigated how mHealth is currently used in the context of chronic pain and what expectations mHealth nonusers have for mHealth as a future chronic pain management tool. Analysis revealed contrasts between mHealth use expectations and actual usage experiences, highlighting privacy concerns toward mHealth solutions. Generally, the results showed that nonusers are more concerned about data privacy and expect mHealth to facilitate interacting with health professionals. The users, in contrast, feel that such connections do not exist. ",
doi="10.2196/38265",
url="https://humanfactors.jmir.org/2022/3/e38265",
url="http://www.ncbi.nlm.nih.gov/pubmed/36066960"
}


@Article{info:doi/10.2196/36414,
author="Longhini, Jessica
and Rossettini, Giacomo
and Palese, Alvisa",
title="Digital Health Competencies Among Health Care Professionals: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="18",
volume="24",
number="8",
pages="e36414",
keywords="eHealth literacy",
keywords="eHealth competencies",
keywords="digital health",
keywords="competencies",
keywords="eHealth",
keywords="health literacy",
keywords="digital technology",
keywords="health care professionals",
keywords="health care workers",
keywords="review",
keywords="systematic review",
abstract="Background: Digitalization is not fully implemented in clinical practice, and several factors have been identified as possible barriers, including the competencies of health care professionals. However, no summary of the available evidence has been provided to date to depict digital health competencies that have been investigated among health care professionals, the tools used in assessing such competencies, and the effective interventions to improve them. Objective: This review aims to summarize digital health competencies investigated to date and the tools used to assess them among health care professionals. Methods: A systematic review based on the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist was performed. The MEDLINE, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and Scopus databases were accessed up to September 4, 2021. Studies assessing digital health competencies with quantitative designs, targeting health care professionals, and written in English were included. The methodological quality of included studies was evaluated using the Joanna Briggs Institute tools. Results: A total of 26 studies, published from 1999 to 2021, met the inclusion criteria, and the majority were cross sectional in design, while only 2 were experimental study designs. Most studies were assessed with moderate to low methodological quality; 4 categories and 9 subcategories of investigated digital health competencies have been identified. The most investigated category was ``Self-rated competencies,'' followed by ``Psychological and emotional aspects toward digital technologies,'' ``Use of digital technologies,'' and ``Knowledge about digital technologies.'' In 35\% (9/26) of the studies, a previously validated tool was used to measure the competencies assessed, while others developed ad hoc questionnaires. Conclusions: Mainly descriptive studies with issues regarding methodology quality have been produced to date investigating 4 main categories of digital health competencies mostly with nonvalidated tools. Competencies investigated might be considered while designing curricula for undergraduate, postgraduate, and continuing education processes, whereas the methodological lacks detected might be addressed with future research. There is a need to expand research on psychological and emotional elements and the ability to use digital technology to self-learn and teach others. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021282775; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=282775 ",
doi="10.2196/36414",
url="https://www.jmir.org/2022/8/e36414",
url="http://www.ncbi.nlm.nih.gov/pubmed/35980735"
}


@Article{info:doi/10.2196/36069,
author="Levine, Susan
and Gupta, Richa
and Alkwatli, Kenda
and Almoushref, Allaa
and Cherian, Saira
and Jimenez, Feterman Dominique
and Cordero Baez, Nicole Greishka
and Hart, Angela
and Weinstock, Clara",
title="Telehealth Perceptions Among US Immigrant Patients at an Academic Internal Medicine Practice: Cross-sectional Study",
journal="JMIR Hum Factors",
year="2022",
month="Aug",
day="10",
volume="9",
number="3",
pages="e36069",
keywords="telemedicine",
keywords="immigrant patient",
keywords="immigrant",
keywords="ethnic minority",
keywords="cultural minority",
keywords="patient satisfaction",
keywords="telehealth",
keywords="satisfaction",
keywords="health care",
keywords="health equity",
keywords="digital health",
keywords="patient experience",
abstract="Background: The use of telemedicine has increased dramatically through the COVID-19 pandemic. Although data are available about patient satisfaction with telemedicine, little is known about immigrant patients' experience. Objective: We sought to investigate patients' experiences with telehealth compared to in- person visits between immigrants and nonimmigrants. We wanted to identify and describe next visit preferences within the Farmington University of Connecticut Internal Medicine practice to ultimately guide suggestions for more equitable use and accessibility of visit options. Methods: A total of 270 patients including 122 immigrants and 148 nonimmigrants were seen by 4 Internal Medicine providers in an in-person (n=132) or telemedicine (n=138) university practice setting. Patients were queried between February and April 2021, using an adaptation of a previously validated patient satisfaction survey that contained standard questions developed by the Consumer Assessment of Healthcare Providers and Systems Program. Patients seen via in-person visits completed a paper copy of the survey. The same survey was administered by a follow-up phone call for telemedicine visits. Patients surveyed spoke English, Spanish, or Arabic and were surveyed in their preferred language. For televisits, the same survey was read to the patient by a certified translator. The survey consisted of 10 questions on a Likert scale of 1-5. Of them, 9 questions assessed patient satisfaction under the categories of access to care, interpersonal interaction, and quality of care. An additional question asked patients to describe and explain the reasons behind next visit preferences. Survey question responses were compared by paired t tests. Results: Across both immigrant and nonimmigrant patient populations, satisfaction with perceived quality of care was high, regardless of visit type (P=.80, P=.60 for televisits and P=.76, P=.37 for in-person visits). During televisits, immigrants were more likely to feel providers spent sufficient time with them (P<.001). Different perceptions were noted among nonimmigrant patients. Nonimmigrants tended to perceive more provider time during in-person visits (P=.006). When asked to comment on reasons behind next televisit preference, nonimmigrant patients prioritized convenience, whereas immigrants noted not having to navigate office logistics. For those who chose in-person visits, both groups prioritized the need for a physical exam. Conclusions: Although satisfaction was high for both telemedicine and in-person visits across immigrant and nonimmigrant populations, significant differences in patient priorities were identified. Immigrants found televisits desirable because they felt they spent more time with providers and were able to avoid additional office logistics that are often challenging barriers for non-English speakers. This suggests opportunities to use information technology to provide cultural and language-appropriate information throughout immigrants' in-person and telemedicine visit experience. A focus on diminishing these barriers will help reduce health care inequities among immigrant patients. ",
doi="10.2196/36069",
url="https://humanfactors.jmir.org/2022/3/e36069",
url="http://www.ncbi.nlm.nih.gov/pubmed/35947438"
}


@Article{info:doi/10.2196/34514,
author="Ma, S. Jennifer
and O'Riordan, Megan
and Mazzer, Kelly
and Batterham, J. Philip
and Bradford, Sally
and K{\~o}lves, Kairi
and Titov, Nickolai
and Klein, Britt
and Rickwood, J. Debra",
title="Consumer Perspectives on the Use of Artificial Intelligence Technology and Automation in Crisis Support Services: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2022",
month="Aug",
day="5",
volume="9",
number="3",
pages="e34514",
keywords="consumer",
keywords="community",
keywords="help-seeker",
keywords="perspective",
keywords="technology",
keywords="artificial intelligence",
keywords="crisis",
keywords="support",
keywords="acceptability",
abstract="Background: Emerging technologies, such as artificial intelligence (AI), have the potential to enhance service responsiveness and quality, improve reach to underserved groups, and help address the lack of workforce capacity in health and mental health care. However, little research has been conducted on the acceptability of AI, particularly in mental health and crisis support, and how this may inform the development of responsible and responsive innovation in the area. Objective: This study aims to explore the level of support for the use of technology and automation, such as AI, in Lifeline's crisis support services in Australia; the likelihood of service use if technology and automation were implemented; the impact of demographic characteristics on the level of support and likelihood of service use; and reasons for not using Lifeline's crisis support services if technology and automation were implemented in the future. Methods: A mixed methods study involving a computer-assisted telephone interview and a web-based survey was undertaken from 2019 to 2020 to explore expectations and anticipated outcomes of Lifeline's crisis support services in a nationally representative community sample (n=1300) and a Lifeline help-seeker sample (n=553). Participants were aged between 18 and 93 years. Quantitative descriptive analysis, binary logistic regression models, and qualitative thematic analysis were conducted to address the research objectives. Results: One-third of the community and help-seeker participants did not support the collection of information about service users through technology and automation (ie, via AI), and approximately half of the participants reported that they would be less likely to use the service if automation was introduced. Significant demographic differences were observed between the community and help-seeker samples. Of the demographics, only older age predicted being less likely to endorse technology and automation to tailor Lifeline's crisis support service and use such services (odds ratio 1.48-1.66, 99\% CI 1.03-2.38; P<.001 to P=.005). The most common reason for reluctance, reported by both samples, was that respondents wanted to speak to a real person, assuming that human counselors would be replaced by automated robots or machine services. Conclusions: Although Lifeline plans to always have a real person providing crisis support, help-seekers automatically fear this will not be the case if new technology and automation such as AI are introduced. Consequently, incorporating innovative use of technology to improve help-seeker outcomes in such services will require careful messaging and assurance that the human connection will continue. ",
doi="10.2196/34514",
url="https://humanfactors.jmir.org/2022/3/e34514",
url="http://www.ncbi.nlm.nih.gov/pubmed/35930334"
}


@Article{info:doi/10.2196/39280,
author="Walker, Elizabeth Ruth
and Quong, Sara
and Olivier, Patrick
and Wu, Ling
and Xie, Jue
and Boyle, Jacqueline",
title="Understanding Preconception Women's Needs and Preferences for Digital Health Resources: Qualitative Study",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="5",
volume="6",
number="8",
pages="e39280",
keywords="digital health",
keywords="preconception",
keywords="health promotion",
keywords="behavior change",
keywords="women's health",
keywords="maternal health",
keywords="digital health resource",
keywords="healthy life style",
keywords="qualitative analysis",
keywords="online health information",
abstract="Background: Improving preconception health can benefit all women, their children, and their families regardless of their individual pregnancy intentions. Rapidly increasing access to information technology and online engagement have created opportunities to use digital health resources to engage with preconception women regarding lifestyle behaviors. Objective: This study explores how preconception women engage with digital health resources and online platforms to inform the design and development of a digital health resource to support women to make positive behavior change for their preconception health. Methods: This codesign research followed the Double Diamond process, which focuses on contextualization and explorative processes in phase 1 and ideation and development processes in phase 2. Phase 1 is reported on in this study and was undertaken via a series of 1-on-1 in-depth interviews with female participants (N=12) aged 18-45 years over 3 months. Interviews were designed to explore participants' lived experiences in relation to their health and desired supports for healthy lifestyle behaviors. The first interview focused on participants' perceptions of health and health behaviors, the second interview focused on social connections for health, and the third interview focused on digital health information and supports. Conversations from the first interview informed the development of the second interview, and conversations from the second interview informed the development of the third interview. Community advisors (N=8) met to provide feedback and advice to the researchers throughout the interview process. Qualitative analyses of transcripts from interviews were undertaken by 2 researchers before a deductive process identified themes mapped to the capability, opportunity, motivation, and behavior (COM-B) framework. Results: In total, 9 themes and 8 subthemes were identified from 124 codes. In relation to digital health resources, specifically, participants were already engaging with a range of digital health resources and had high expectations of these. Digital health resources needed to be easy to access, make women's busy lives easier, be evidence based, and be reputable. Social connectedness was also highly important to our participants, with information and advice from peers with similar experiences being preferred over yet more online health information. Online communities facilitated these social interactions. Participants were open to the idea of chatbots and virtual assistants but acknowledged that they would not replace authentic social interactions. Conclusions: Codesigned digital health resources should be evidence based, reputable, and easy to access. Social connections were considered highly important to women, and designers of digital health resources should consider how they can increase opportunities for women to connect and learn from each other to promote health behaviors. ",
doi="10.2196/39280",
url="https://formative.jmir.org/2022/8/e39280",
url="http://www.ncbi.nlm.nih.gov/pubmed/35930344"
}


@Article{info:doi/10.2196/33770,
author="Benoit, Britney
and Cassidy, Christine
and van Wijlen, Jacqueline
and Correll, Quinn
and Campbell-Yeo, Marsha
and Hendra, Sionnach
and Martin-Misener, Ruth
and MacDougall, Jennifer
and Cameron, Ashley",
title="Codevelopment of Implementation Interventions to Support Parent-Led Care for Pain in Infants: Protocol for a Qualitative Descriptive Study",
journal="JMIR Res Protoc",
year="2022",
month="Aug",
day="5",
volume="11",
number="8",
pages="e33770",
keywords="breastfeeding",
keywords="chestfeeding",
keywords="skin-to-skin contact",
keywords="infant pain",
keywords="implementation",
keywords="qualitative",
abstract="Background: Untreated pain in infants is associated with adverse health outcomes. Despite strong evidence for accessible, effective, and low-cost parent-led pain-relieving interventions such as breastfeeding or chestfeeding and skin-to-skin contact, these interventions are not routinely used. Objective: The objective of this study is to support the implementation of parent-led pain interventions by identifying barriers to and facilitators of parent-led, evidence-informed pain care in infants during acute procedures. In addition, this study aims to develop theory-informed, contextually relevant implementation interventions for supporting the use of parent-led pain care for infants in hospital and community contexts. Methods: This study will consist of 2 phases that follow a systematic, theoretically informed approach guided by the Theoretical Domains Framework and Behavior Change Wheel. In phase 1, we will use a qualitative descriptive design to explore barriers and facilitators to using parent-led pain care in infants from the perspectives of hospital and community-based clinicians, clinical leaders, and families. In phase 2, we will use the Behavior Change Wheel to design tailored implementation interventions that have evidence for effectively addressing identified barriers in collaboration with an advisory committee of administrative, clinical, and family leaders. Results: Ethics approval for this study was obtained in December 2020. As of May 2022, a total of 15 participants have been enrolled in phase 1. The results from all phases will be reported in 2023. Conclusions: Following the completion of this study, we will have co-designed theoretically informed implementation interventions that can be pilot-tested and experimentally applied. The findings will be used to implement parent-led interventions that improve patient safety and health outcomes for diverse families. International Registered Report Identifier (IRRID): DERR1-10.2196/33770 ",
doi="10.2196/33770",
url="https://www.researchprotocols.org/2022/8/e33770",
url="http://www.ncbi.nlm.nih.gov/pubmed/35930339"
}


@Article{info:doi/10.2196/37952,
author="Wang, Tingting
and Giunti, Guido
and Melles, Marijke
and Goossens, Richard",
title="Digital Patient Experience: Umbrella Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="4",
volume="24",
number="8",
pages="e37952",
keywords="digital health",
keywords="eHealth",
keywords="telemedicine",
keywords="telehealth",
keywords="mobile health",
keywords="mHealth",
keywords="patient experience",
keywords="user experience",
keywords="influencing factors",
keywords="user-centered design",
keywords="human-computer interaction",
abstract="Background: The adoption and use of technology have significantly changed health care delivery. Patient experience has become a significant factor in the entire spectrum of patient-centered health care delivery. Digital health facilitates further improvement and empowerment of patient experiences. Therefore, the design of digital health is served by insights into the barriers to and facilitators of digital patient experience (PEx). Objective: This study aimed to systematically review the influencing factors and design considerations of PEx in digital health from the literature and generate design guidelines for further improvement of PEx in digital health. Methods: We performed an umbrella systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. We searched Scopus, PubMed, and Web of Science databases. Two rounds of small random sampling (20\%) were independently reviewed by 2 reviewers who evaluated the eligibility of the articles against the selection criteria. Two-round interrater reliability was assessed using the Fleiss-Cohen coefficient (k1=0.88 and k2=0.80). Thematic analysis was applied to analyze the extracted data based on a small set of a priori categories. Results: The search yielded 173 records, of which 45 (26\%) were selected for data analysis. Findings and conclusions showed a great diversity; most studies presented a set of themes (19/45, 42\%) or descriptive information only (16/45, 36\%). The digital PEx--related influencing factors were classified into 9 categories: patient capability, patient opportunity, patient motivation, intervention technology, intervention functionality, intervention interaction design, organizational environment, physical environment, and social environment. These can have three types of impacts: positive, negative, or double edged. We captured 4 design constructs (personalization, information, navigation, and visualization) and 3 design methods (human-centered or user-centered design, co-design or participatory design, and inclusive design) as design considerations. Conclusions: We propose the following definition for digital PEx: ``Digital patient experience is the sum of all interactions affected by a patient's behavioral determinants, framed by digital technologies, and shaped by organizational culture, that influence patient perceptions across the continuum of care channeling digital health.'' In this study, we constructed a design and evaluation framework that contains 4 phases---define design, define evaluation, design ideation, and design evaluation---and 9 design guidelines to help digital health designers and developers address digital PEx throughout the entire design process. Finally, our review suggests 6 directions for future digital PEx--related research. ",
doi="10.2196/37952",
url="https://www.jmir.org/2022/8/e37952",
url="http://www.ncbi.nlm.nih.gov/pubmed/35925651"
}


@Article{info:doi/10.2196/38193,
author="Bonnell, Jarvis Tyler
and Revere, Debra
and Baseman, Janet
and Hills, Rebecca
and Karras, Thomas Bryant",
title="Equity and Accessibility of Washington State's COVID-19 Digital Exposure Notification Tool (WA Notify): Survey and Listening Sessions Among Community Leaders",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="3",
volume="6",
number="8",
pages="e38193",
keywords="COVID-19 exposure notifications",
keywords="digital public health",
keywords="health equity",
keywords="mHealth",
keywords="mobile health",
keywords="mHealth equity",
keywords="digital health tool",
keywords="public health",
keywords="surveillance",
keywords="COVID-19",
keywords="smartphone",
keywords="health inequity",
keywords="sociodemographic factor",
keywords="epidemiology",
abstract="Background: In November 2020, WA Notify, Washington State's COVID-19 digital exposure notification tool, was launched statewide to mitigate ongoing COVID-19 transmission. WA Notify uses the Bluetooth proximity--triggered, Google/Apple Exposure Notification Express framework to distribute notifications to users who have added or activated this tool on their smartphones. This smartphone-based tool relies on sufficient population-level activation to be effective; however, little is known about its adoption among communities disproportionately impacted by the COVID-19 pandemic or what barriers might limit its adoption and use among diverse populations. Objective: We sought to (1) conduct a formative exploration of equity-related issues that may influence the access, adoption, and use of WA Notify, as perceived by community leaders of populations disproportionately impacted by the COVID-19 pandemic; and (2) generate recommendations for promoting the equitable access to and impact of this novel intervention for these communities. Methods: We used a 2-step data collection process to gather the perspectives of community leaders across Washington regarding the launch and implementation of WA Notify in their communities. A web-based, brief, and informational survey measured the perceptions of the community-level familiarity and effectiveness of WA Notify at slowing the spread of COVID-19 and identified potential barriers and concerns to accessing and adopting WA Notify (n=17). Semistructured listening sessions were conducted to expand upon survey findings and explore the community-level awareness, barriers, facilitators, and concerns related to activating WA Notify in greater depth (n=13). Results: Our findings overlap considerably with those from previous mobile health equity studies. Digital literacy, trust, information accessibility, and misinformation were highlighted as key determinants of the adoption and use of WA Notify. Although WA Notify does not track users or share data, community leaders expressed concerns about security, data sharing, and personal privacy, which were cited as outweighing the potential benefits to adoption. Both the survey and informational sessions indicated low community-level awareness of WA Notify. Community leaders recommended the following approaches to improve engagement: tailoring informational materials for low-literacy levels, providing technology navigation, describing more clearly that WA Notify can help the community, and using trusted messengers who are already engaged with the communities to communicate about WA Notify. Conclusions: As digital public health tools, such as WA Notify, emerge to address public health problems, understanding the key determinants of adoption and incorporating equity-focused recommendations into the development, implementation, and communication efforts around these tools will be instrumental to their adoption, use, and retention. ",
doi="10.2196/38193",
url="https://formative.jmir.org/2022/8/e38193",
url="http://www.ncbi.nlm.nih.gov/pubmed/35787520"
}


@Article{info:doi/10.2196/36323,
author="Viola, S. Adrienne
and Levonyan-Radloff, Kristine
and Masterson, Margaret
and Manne, L. Sharon
and Hudson, V. Shawna
and Devine, A. Katie",
title="Development of a Self-management and Peer-Mentoring Intervention to Improve Transition Readiness Among Young Adult Survivors of Pediatric Cancer: Formative Qualitative Research Study",
journal="JMIR Form Res",
year="2022",
month="Aug",
day="3",
volume="6",
number="8",
pages="e36323",
keywords="self-management",
keywords="peer mentoring",
keywords="cancer survivorship",
keywords="long-term follow-up care",
abstract="Background: Childhood cancer survivors require lifelong risk-based follow-up care. It should be noted that less than one-third of adult survivors of childhood cancer report any survivor-focused care, and fewer than 1 in 5 obtain risk-based follow-up care. It is thought that this may be due to inadequate transition readiness, including low levels of knowledge, skills, motivation, and resources to make the transition to independent self-management of follow-up care. Interventions that focus specifically on improving the transition from parent-managed to self-managed care are needed. Theory and prior research suggest that targeting self-management skills and using peer mentoring may be innovative strategies to improve transition readiness. Objective: This study aims to identify the content of a self-management intervention to improve transition readiness among adolescent and young adult (AYA) survivors. Methods: Intervention development occurred in 3 stages: formative research with AYA survivors to identify barriers and facilitators to obtaining risk-based survivorship care, content development using feedback from multiple stakeholders (AYA survivors, parents, and providers), and content refinement (usability testing) of the initial proposed educational modules for the program. Content analysis, guided by the social-ecological model of AYA readiness for transition, was used to identify themes and develop and refine the content for the intervention. Results: A total of 19 AYA survivors participated in the formative research stage, and 10 AYA survivors, parents, and health care providers participated in the content development and refinement stages. The major barrier and facilitator themes identified included knowledge of cancer history and risks; relationships with health care providers; relationships with family members involved in care; emotions about health, follow-up care, and transfer of care; and lifestyle behaviors and life transitions. These themes were translated into 5 self-management modules: understanding treatment history and the survivorship care plan, managing health care logistics and insurance, communicating with health care providers and family members involved in care, dealing with emotions, and staying healthy in the context of life transitions. Feedback from the key stakeholders indicated that the content was relevant but should include participative elements (videos and tailored feedback) to make the intervention more engaging. The AYA survivors were receptive to the idea of working with a peer mentor and expressed a preference for using SMS text messaging, telephone calls, or videoconference to communicate with their mentor. Conclusions: Incorporating AYA survivors, parents, and providers in the design was essential to developing the content of a self-management and peer-mentoring intervention. AYA survivors confirmed the important targets for the intervention and facilitated design decisions in line with our target users' preferences. The next step will be to conduct a single-arm trial to determine the feasibility and acceptability of the proposed intervention among AYA survivors of childhood cancer. ",
doi="10.2196/36323",
url="https://formative.jmir.org/2022/8/e36323",
url="http://www.ncbi.nlm.nih.gov/pubmed/35921137"
}


@Article{info:doi/10.2196/35591,
author="Vial, St{\'e}phane
and Boudhra{\^a}, Sana
and Dumont, Mathieu",
title="Human-Centered Design Approaches in Digital Mental Health Interventions: Exploratory Mapping Review",
journal="JMIR Ment Health",
year="2022",
month="Jun",
day="7",
volume="9",
number="6",
pages="e35591",
keywords="design",
keywords="human-centered design",
keywords="user experience",
keywords="mental health",
keywords="digital mental health",
abstract="Background: Digital mental health interventions have a great potential to alleviate mental illness and increase access to care. However, these technologies face significant challenges, especially in terms of user engagement and adoption. It has been suggested that this issue stems from a lack of user perspective in the development process; accordingly, several human-centered design approaches have been developed over the years to consider this important aspect. Yet, few human-centered design approaches to digital solutions exist in the field of mental health, and rarely are end users involved in their development. Objective: The main objective of this literature review is to understand how human-centered design is considered in e-mental health intervention research. Methods: An exploratory mapping review was conducted of mental health journals with the explicit scope of covering e-mental health technology. The human-centered design approaches reported and the core elements of design activity (ie, object, context, design process, and actors involved) were examined among the eligible studies. Results: A total of 30 studies met the inclusion criteria, of which 22 mentioned using human-centered design approaches or specific design methods in the development of an e-mental health solution. Reported approaches were classified as participatory design (11/27, 41\%), codesign (6/27, 22\%), user-centered design (5/27, 19\%), or a specific design method (5/27, 19\%). Just over half (15/27, 56\%) of the approaches mentioned were supported by references. End users were involved in each study to some extent but not necessarily in designing. About 27\% (8/30) of all the included studies explicitly mentioned the presence of designers on their team. Conclusions: Our results show that some attempts have indeed been made to integrate human-centered design approaches into digital mental health technology development. However, these attempts rely very little on designers and design research. Researchers from other domains and technology developers would be wise to learn the underpinnings of human-centered design methods before selecting one over another. Inviting designers for assistance when implementing a particular approach would also be beneficial. To further motivate interest in and use of human-centered design principles in the world of e-mental health, we make nine suggestions for better reporting of human-centered design approaches in future research. ",
doi="10.2196/35591",
url="https://mental.jmir.org/2022/6/e35591",
url="http://www.ncbi.nlm.nih.gov/pubmed/35671081"
}


@Article{info:doi/10.2196/37438,
author="Kujala, Sari
and H{\"o}rhammer, Iiris
and V{\"a}yrynen, Akseli
and Holmroos, Mari
and N{\"a}ttiaho-R{\"o}nnholm, Mirva
and H{\"a}gglund, Maria
and Johansen, Alise Monika",
title="Patients' Experiences of Web-Based Access to Electronic Health Records in Finland: Cross-sectional Survey",
journal="J Med Internet Res",
year="2022",
month="Jun",
day="6",
volume="24",
number="6",
pages="e37438",
keywords="patient portals",
keywords="EHR",
keywords="electronic health record",
keywords="open notes",
keywords="patient access",
keywords="self-management",
keywords="national survey",
abstract="Background: Patient portals that provide access to electronic health records offer a means for patients to better understand and self-manage their health. Yet, patient access to electronic health records raises many concerns among physicians, and little is known about the use practices and experiences of patients who access their electronic health records via a mature patient portal that has been available for citizens for over five years. Objective: We aimed to identify patients' experiences using a national patient portal to access their electronic health records. In particular, we focused on understanding usability-related perceptions and the benefits and challenges of reading clinical notes written by health care professionals. Methods: Data were collected from 3135 patient users of the Finnish My Kanta patient portal through a web-based survey in June 2021 (response rate: 0.7\%). Patients received an invitation to complete the questionnaire when they logged out of the patient portal. Respondents were asked to rate the usability of the patient portal, and the ratings were used to calculate approximations of the System Usability Scale score. Patients were also asked about the usefulness of features, and whether they had discussed the notes with health professionals. Open-ended questions were used to ask patients about their experiences of the benefits and challenges related to reading health professionals' notes. Results: Overall, patient evaluations of My Kanta were positive, and its usability was rated as good (System Usability Scale score approximation: mean 72.7, SD 15.9). Patients found the portal to be the most useful for managing prescriptions and viewing the results of examinations and medical notes. Viewing notes was the most frequent reason (978/3135, 31.2\%) for visiting the portal. Benefits of reading the notes mentioned by patients included remembering and understanding what was said by health professionals and the instructions given during an appointment, the convenience of receiving information about health and care, the capability to check the accuracy of notes, and using the information to support self-management. However, there were challenges related to difficulty in understanding medical terminology, incorrect or inadequate notes, missing notes, and usability. Conclusions: Patients actively used medical notes to receive information to follow professionals' instructions to take care of their health, and patient access to electronic health records can support self-management. However, for the benefits to be realized, improvements in the quality and availability of medical professionals' notes are necessary. Providing a standard information structure could help patients find the information they need. Furthermore, linking notes to vocabularies and other information sources could also improve the understandability of medical terminology; patient agency could be supported by allowing them to add comments to their notes, and patient trust of the system could be improved by allowing them to control the visibility of the professionals' notes. ",
doi="10.2196/37438",
url="https://www.jmir.org/2022/6/e37438",
url="http://www.ncbi.nlm.nih.gov/pubmed/35666563"
}


@Article{info:doi/10.2196/35478,
author="Kj{\"o}rk, K. Emma
and Sunnerhagen, S. Katharina
and Lundgren-Nilsson, {\AA}sa
and Andersson, K. Anders
and Carlsson, Gunnel",
title="Development of a Digital Tool for People With a Long-Term Condition Using Stroke as a Case Example: Participatory Design Approach",
journal="JMIR Hum Factors",
year="2022",
month="Jun",
day="3",
volume="9",
number="2",
pages="e35478",
keywords="eHealth",
keywords="digital tool",
keywords="Strokeh{\"a}lsa",
keywords="follow-up",
keywords="chronic care",
keywords="stroke",
keywords="Post-Stroke Checklist",
keywords="health literacy",
keywords="co-design",
keywords="shared decision making",
abstract="Background: In patient care, demand is growing for digital health tools to enable remote services and enhance patient involvement. People with chronic conditions often have multiple health problems, and long-term follow-up is recommended to meet their needs and enable access to appropriate support. A digital tool for previsit preparation could enhance time efficiency and guide the conversation during the visit toward the patient's priorities. Objective: This study aims to develop a digital previsit tool and explore potential end user's perceptions, using a participatory approach with stroke as a case example. Methods: The digital tool was developed and prototyped according to service design principles, informed by qualitative participant data and feedback from an expert panel. All features were processed in workshops with a team that included a patient partner. The resulting tool presented questions about health problems and health information. Study participants were people with stroke recruited from an outpatient clinic and patient organizations in Sweden. Development and data collection were conducted in parallel. For conceptualization, the initial prototype was based on the Post-Stroke Checklist and research. Needs and relevance were explored in focus groups, and we used a web survey and individual interviews to explore perceived utility, ease of use, and acceptance. Data were thematically analyzed following the Framework Method. Results: The development process included 22 participants (9 women) with a median age of 59 (range 42-83) years and a median of 51 (range 4-228) months since stroke. Participants were satisfied or very satisfied with using the tool and recommended its use in clinical practice. Three main themes were constructed based on focus group data (n=12) and interviews (n=10). First, valuable accessible information illuminated the need for information to confirm experiences, facilitate responses, and invite engagement in their care. Amendments to the information in turn reconfigured their expectations. Second, utility and complexity in answering confirmed that the questions were relevant and comprehensible. Some participants perceived the answer options as limiting and suggested additional space for free text. Third, capturing needs and value of the tool highlighted the tool's potential to identify health problems and the importance of encouraging further dialog. The resulting digital tool, Strokeh{\"a}lsa [Strokehealth] version 1.0, is now incorporated into a national health platform. Conclusions: The participatory approach to tool development yielded a previsit digital tool that the study group perceived as useful. The holistic development process used here, which integrated health information, validated questions, and digital functionality, offers an example that could be applicable in the context of other long-term conditions. Beyond its potential to identify care needs, the tool offers information that confirms experiences and supports answering the questions in the tool. The tool is freely shared for adaptation in different contexts. Trial Registration: researchweb 236341; https://www.researchweb.org/is/vgr/project/236341 ",
doi="10.2196/35478",
url="https://humanfactors.jmir.org/2022/2/e35478",
url="http://www.ncbi.nlm.nih.gov/pubmed/35657650"
}


@Article{info:doi/10.2196/37372,
author="Asbj{\o}rnsen, Aune Rikke
and Hjelmes{\ae}th, J{\o}ran
and Smedsr{\o}d, Lien Mirjam
and Wentzel, Jobke
and Ollivier, Marianne
and Clark, M. Matthew
and van Gemert-Pijnen, C. Julia E. W.
and Solberg Nes, Lise",
title="Combining Persuasive System Design Principles and Behavior Change Techniques in Digital Interventions Supporting Long-term Weight Loss Maintenance: Design and Development of eCHANGE",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="27",
volume="9",
number="2",
pages="e37372",
keywords="eHealth",
keywords="weight loss maintenance",
keywords="behavior change",
keywords="persuasive technology",
keywords="digital health interventions",
keywords="design thinking",
keywords="co-design",
keywords="Agile development",
keywords="human-centered design",
keywords="mobile phone",
abstract="Background: Long-term weight maintenance after weight loss is challenging, and innovative solutions are required. Digital technologies can support behavior change and, therefore, have the potential to be an effective tool for weight loss maintenance. However, to create meaningful and effective digital behavior change interventions that support end user values and needs, a combination of persuasive system design (PSD) principles and behavior change techniques (BCTs) might be needed. Objective: This study aimed to investigate how an evidence-informed digital behavior change intervention can be designed and developed by combining PSD principles and BCTs into design features to support end user values and needs for long-term weight loss maintenance. Methods: This study presents a concept for how PSD principles and BCTs can be translated into design features by combining design thinking and Agile methods to develop and deliver an evidence-informed digital behavior change intervention aimed at supporting weight maintenance. Overall, 45 stakeholders participated in the systematic and iterative development process comprising co-design workshops, prototyping, Agile development, and usability testing. This included prospective end users (n=17, 38\%; ie, people with obesity who had lost ?8\% of their weight), health care providers (n=9, 20\%), healthy volunteers (n=4, 9\%), a service designer (n=1, 2\%), and stakeholders from the multidisciplinary research and development team (n=14, 31\%; ie, software developers; digital designers; and eHealth, behavior change, and obesity experts). Stakeholder input on how to operationalize the design features and optimize the technology was examined through formative evaluation and qualitative analyses using rapid and in-depth analysis approaches. Results: A total of 17 design features combining PSD principles and BCTs were identified as important to support end user values and needs based on stakeholder input during the design and development of eCHANGE, a digital intervention to support long-term weight loss maintenance. The design features were combined into 4 main intervention components: Week Plan, My Overview, Knowledge and Skills, and Virtual Coach and Smart Feedback System. To support a healthy lifestyle and continued behavior change to maintain weight, PSD principles such as tailoring, personalization, self-monitoring, reminders, rewards, rehearsal, praise, and suggestions were combined and implemented into the design features together with BCTs from the clusters of goals and planning, feedback and monitoring, social support, repetition and substitution, shaping knowledge, natural consequences, associations, antecedents, identity, and self-belief. Conclusions: Combining and implementing PSD principles and BCTs in digital interventions aimed at supporting sustainable behavior change may contribute to the design of engaging and motivating interventions in line with end user values and needs. As such, the design and development of the eCHANGE intervention can provide valuable input for future design and tailoring of evidence-informed digital interventions, even beyond digital interventions in support of health behavior change and long-term weight loss maintenance. Trial Registration: ClinicalTrials.gov NCT04537988; https://clinicaltrials.gov/ct2/show/NCT04537988 ",
doi="10.2196/37372",
url="https://humanfactors.jmir.org/2022/2/e37372",
url="http://www.ncbi.nlm.nih.gov/pubmed/35622394"
}


@Article{info:doi/10.2196/36962,
author="Cao, Li
and Chongsuvivatwong, Virasakdi
and McNeil, B. Edward",
title="The Sociodemographic Digital Divide in Mobile Health App Use Among Clients at Outpatient Departments in Inner Mongolia, China: Cross-sectional Survey Study",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="19",
volume="9",
number="2",
pages="e36962",
keywords="digital divide",
keywords="mHealth",
keywords="app",
keywords="structural equation modeling",
keywords="client",
abstract="Background: Mobile health (mHealth) apps have become part of the infrastructure for access to health care in hospitals, especially during the COVID-19 pandemic. However, little is known about the effects of sociodemographic characteristics on the digital divide regarding the use of hospital-based mHealth apps and their benefits to patients and caregivers. Objective: The aim of this study was to document the cascade of potential influences from digital access to digital use and then to mHealth use, as well as the potential influence of sociodemographic variables on elements of the cascade. Methods: A cross-sectional survey was conducted from January to February 2021 among adult clients at outpatient departments in 12 tertiary hospitals of Inner Mongolia, China. Structural equation modeling was conducted after the construct comprising digital access, digital use, and mHealth use was validated. Results: Of 2115 participants, the $\beta$ coefficients (95\% CI) of potential influence of digital access on digital use, and potential influence of digital use on mHealth use, were 0.28 (95\% CI 0.22-0.34) and 0.51 (95\% CI 0.38-0.64), respectively. Older adults were disadvantaged with regard to mHealth access and use ($\beta$=--0.38 and $\beta$=--0.41), as were less educated subgroups ($\beta$=--0.24 and $\beta$=--0.27), and these two factors had nonsignificant direct effects on mHealth use. Conclusions: To overcome the mHealth use divide, it is important to improve digital access and digital use among older adults and less educated groups. ",
doi="10.2196/36962",
url="https://humanfactors.jmir.org/2022/2/e36962",
url="http://www.ncbi.nlm.nih.gov/pubmed/35587367"
}


@Article{info:doi/10.2196/32456,
author="Tendedez, Helena
and Ferrario, Maria-Angela
and McNaney, Roisin
and Gradinar, Adrian",
title="Exploring Human-Data Interaction in Clinical Decision-making Using Scenarios: Co-design Study",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="6",
volume="9",
number="2",
pages="e32456",
keywords="data-supported decision-making",
keywords="health care professionals",
keywords="respiratory care",
keywords="scenario-based design",
keywords="clinical decision-making",
keywords="decision support",
keywords="COPD",
keywords="respiratory conditions",
keywords="digital health",
keywords="user-centered design",
keywords="health technologies",
abstract="Background: When caring for patients with chronic conditions such as chronic obstructive pulmonary disease (COPD), health care professionals (HCPs) rely on multiple data sources to make decisions. Collating and visualizing these data, for example, on clinical dashboards, holds the potential to support timely and informed decision-making. Most studies on data-supported decision-making (DSDM) technologies for health care have focused on their technical feasibility or quantitative effectiveness. Although these studies are an important contribution to the literature, they do not further our limited understanding of how HCPs engage with these technologies and how they can be designed to support specific contexts of use. To advance our knowledge in this area, we must work with HCPs to explore this space and the real-world complexities of health care work and service structures. Objective: This study aimed to qualitatively explore how DSDM technologies could support HCPs in their decision-making regarding COPD care. We created a scenario-based research tool called Respire, which visualizes HCPs' data needs about their patients with COPD and services. We used Respire with HCPs to uncover rich and nuanced findings about human-data interaction in this context, focusing on the real-world challenges that HCPs face when carrying out their work and making decisions. Methods: We engaged 9 respiratory HCPs from 2 collaborating health care organizations to design Respire. We then used Respire as a tool to investigate human-data interaction in the context of decision-making about COPD care. The study followed a co-design approach that had 3 stages and spanned 2 years. The first stage involved 5 workshops with HCPs to identify data interaction scenarios that would support their work. The second stage involved creating Respire, an interactive scenario-based web app that visualizes HCPs' data needs, incorporating feedback from HCPs. The final stage involved 11 one-to-one sessions with HCPs to use Respire, focusing on how they envisaged that it could support their work and decisions about care. Results: We found that HCPs trust data differently depending on where it came from and who recorded it, sporadic and subjective data generated by patients have value but create challenges for decision-making, and HCPs require support in interpreting and responding to new data and its use cases. Conclusions: Our study uncovered important lessons for the design of DSDM technologies to support health care contexts. We show that although DSDM technologies have the potential to support patient care and health care delivery, important sociotechnical and human-data interaction challenges influence the design and deployment of these technologies. Exploring these considerations during the design process can ensure that DSDM technologies are designed with a holistic view of how decision-making and engagement with data occur in health care contexts. ",
doi="10.2196/32456",
url="https://humanfactors.jmir.org/2022/2/e32456",
url="http://www.ncbi.nlm.nih.gov/pubmed/35522463"
}


@Article{info:doi/10.2196/35094,
author="Pit, Sabrina
and Ramsden, Robyn
and Tan, JH Aaron
and Payne, Kristy
and Barr, James
and Eames, Benjamin
and Edwards, Mike
and Colbran, Richard",
title="Persuasive Design Techniques and App Design Recommendations to Improve Health Workforce Capability in Rural Health Professionals: What Do Users Want and How Does an App Help?",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="2",
volume="9",
number="2",
pages="e35094",
keywords="health",
keywords="wellness",
keywords="mobile apps",
keywords="persuasive strategies",
keywords="behavior change",
keywords="review",
keywords="health workforce",
keywords="capability",
keywords="career",
keywords="employment",
keywords="rural",
keywords="workforce planning",
keywords="mHealth",
keywords="mobile health",
keywords="digital health",
keywords="health professional",
keywords="user experience",
keywords="health application",
keywords="task support",
keywords="social support",
keywords="dialog support",
abstract="Background: Health professionals' perceptions of persuasive design techniques for use in technological solutions to improve health workforce capability have not been previously explored. Objective: This study aims to explore rural health professionals' perceptions of health workforce capability and persuasive design techniques; and translate these into recommendations for designing a health workforce capability app to increase their impact and usefulness. Methods: Qualitative interviews with 13 rural health professionals were conducted. Subsequently, 32 persuasive techniques were used as a framework to deductively analyze the data. Persuasive design technique domains were Primary Task Support, Dialog Support, System Credibility Support, Social Support, and Cialdini's Principles of Persuasion. Results: Persuasive design techniques can be applied across the factors that influence health workforce capability including health and personal qualities; competencies and skills; values, attitudes, and motivation; and factors that operate outside of work and at the team, organizational, and labor market levels. The majority of the 32 persuasive design techniques were reflected in the data from the interviews and led to recommendations as to how these could be translated into practice, with the exception of scarcity. Many suggestions and persuasive design techniques link back to the need for tailored and localized solutions such as the need for country-specific--based evidence, the wish for localized communities of practice, learning from other rural health professionals, and referral pathways to other clinicians. Participants identified how persuasive design techniques can optimize the user experience to help meet rural health professionals needs for more efficient systems to improve patient access to care, quality care, and to enable working in interprofessional team-based care. Social inclusion plays a vital role for health professionals, indicating the importance of the Social Support domain of persuasive techniques. Overall, health professionals were open to self-monitoring of their work performance and some professionals used wearables to monitor their health. Conclusions: Rural health professionals' perceptions of health workforce capability informed which persuasive design techniques can be used to optimize the user experience of an app. These were translated into recommendations for designing a health workforce capability app to increase likelihood of adoption. This study has also contributed to the further validation of the Persuasive Systems Design model through empirically aligning elements of the model to increase persuasive system content and functionality with real-world applied data, in this case the health workforce capability of rural health professionals. Our findings confirm that these techniques can be used to develop a future prototype of an app that may assist health professionals in improving or maintaining their health workforce capability which in turn may increase recruitment and retention in rural areas. Health professionals need to be central during the design phase. Interventions are needed to provide a supportive environment to rural and remote health professionals to increase their rural health workforce capability. ",
doi="10.2196/35094",
url="https://humanfactors.jmir.org/2022/2/e35094",
url="http://www.ncbi.nlm.nih.gov/pubmed/35499866"
}


@Article{info:doi/10.2196/29780,
author="Kayser, Lars
and Karnoe, Astrid
and Duminski, Emily
and Jakobsen, Svend
and Terp, Rikke
and Dansholm, Susanne
and Roeder, Michael
and From, Gustav",
title="Health Professionals' eHealth Literacy and System Experience Before and 3 Months After the Implementation of an Electronic Health Record System: Longitudinal Study",
journal="JMIR Hum Factors",
year="2022",
month="Apr",
day="29",
volume="9",
number="2",
pages="e29780",
keywords="health care professionals",
keywords="eHealth literacy",
keywords="electronic health record",
keywords="implementation",
keywords="digital health",
keywords="eHealth",
keywords="health literacy",
keywords="health records",
keywords="eHealth records",
keywords="patient care",
abstract="Background: The implementation of an integrated electronic health record (EHR) system can potentially provide health care providers with support standardization of patient care, pathways, and workflows, as well as provide medical staff with decision support, easier access, and the same interface across features and subsystems. These potentials require an implementation process in which the expectations of the medical staff and the provider of the new system are aligned with respect to the medical staff's knowledge and skills, as well as the interface and performance of the system. Awareness of the medical staff's level of eHealth literacy may be a way of understanding and aligning these expectations and following the progression of the implementation process. Objective: The objective of this study was to investigate how a newly developed and modified instrument measuring the medical staff's eHealth literacy (staff eHealth Literacy Questionnaire [eHLQ]) can be used to inform the system provider and the health care organization in the implementation process and evaluate whether the medical staff's perceptions of the ease of use change and how this may be related to their level of eHealth literacy. Methods: A modified version of the eHLQ was distributed to the staff of a medical department in Denmark before and 3 months after the implementation of a new EHR system. The survey also included questions related to users' perceived ease of use and their self-reported information technology skills. Results: The mean age of the 194 participants before implementation was 43.1 (SD 12.4) years, and for the 198 participants after implementation, it was 42.3 (SD 12.5) years. After the implementation, the only difference compared with the preimplementation data was a small decrease in staff eHLQ5 (motivated to engage with digital services; unpaired 2-tailed t test; P=.009; effect size 0.267), and the values of the scales relating to the medical staff's knowledge and skills (eHLQ1-3) were approximately ?3 both before and after implementation. The range of scores was narrower after implementation, indicating that some of those with the lowest ability benefited from the training and new experiences with the EHR. There was an association between perceived ease of use and the 3 tested staff eHLQ scales, both before and after implementation. Conclusions: The staff eHLQ may be a good candidate for monitoring the medical staff's digital competence in and response to the implementation of new digital solutions. This may enable those responsible for the implementation to tailor efforts to the specific needs of segments of users and inform them if the process is not going according to plan with respect to the staff's information technology--related knowledge and skills, trust in data security, motivation, and experience of a coherent system that suits their needs and supports the workflows and data availability. ",
doi="10.2196/29780",
url="https://humanfactors.jmir.org/2022/2/e29780",
url="http://www.ncbi.nlm.nih.gov/pubmed/35486414"
}


@Article{info:doi/10.2196/35671,
author="Meheli, Saha
and Sinha, Chaitali
and Kadaba, Madhura",
title="Understanding People With Chronic Pain Who Use a Cognitive Behavioral Therapy--Based Artificial Intelligence Mental Health App (Wysa): Mixed Methods Retrospective Observational Study",
journal="JMIR Hum Factors",
year="2022",
month="Apr",
day="27",
volume="9",
number="2",
pages="e35671",
keywords="chronic pain",
keywords="digital mental health",
keywords="mobile health",
keywords="mHealth",
keywords="pain management",
keywords="artificial intelligence",
keywords="cognitive behavioral therapy",
keywords="conversational agent",
keywords="software agent",
keywords="pain conditions",
keywords="depression",
keywords="anxiety",
abstract="Background: Digital health interventions can bridge barriers in access to treatment among individuals with chronic pain. Objective: This study aimed to evaluate the perceived needs, engagement, and effectiveness of the mental health app Wysa with regard to mental health outcomes among real-world users who reported chronic pain and engaged with the app for support. Methods: Real-world data from users (N=2194) who reported chronic pain and associated health conditions in their conversations with the mental health app were examined using a mixed methods retrospective observational study. An inductive thematic analysis was used to analyze the conversational data of users with chronic pain to assess perceived needs, along with comparative macro-analyses of conversational flows to capture engagement within the app. Additionally, the scores from a subset of users who completed a set of pre-post assessment questionnaires, namely Patient Health Questionnaire-9 (PHQ-9) (n=69) and Generalized Anxiety Disorder Assessment-7 (GAD-7) (n=57), were examined to evaluate the effectiveness of Wysa in providing support for mental health concerns among those managing chronic pain. Results: The themes emerging from the conversations of users with chronic pain included health concerns, socioeconomic concerns, and pain management concerns. Findings from the quantitative analysis indicated that users with chronic pain showed significantly greater app engagement (P<.001) than users without chronic pain, with a large effect size (Vargha and Delaney A=0.76-0.80). Furthermore, users with pre-post assessments during the study period were found to have significant improvements in group means for both PHQ-9 and GAD-7 symptom scores, with a medium effect size (Cohen d=0.60-0.61). Conclusions: The findings indicate that users look for tools that can help them address their concerns related to mental health, pain management, and sleep issues. The study findings also indicate the breadth of the needs of users with chronic pain and the lack of support structures, and suggest that Wysa can provide effective support to bridge the gap. ",
doi="10.2196/35671",
url="https://humanfactors.jmir.org/2022/2/e35671",
url="http://www.ncbi.nlm.nih.gov/pubmed/35314422"
}


@Article{info:doi/10.2196/34606,
author="Gooch, Daniel
and Mehta, Vikram
and Stuart, Avelie
and Katz, Dmitri
and Bennasar, Mohamed
and Levine, Mark
and Bandara, Arosha
and Nuseibeh, Bashar
and Bennaceur, Amel
and Price, Blaine",
title="Designing Tangibles to Support Emotion Logging for Older Adults: Development and Usability Study",
journal="JMIR Hum Factors",
year="2022",
month="Apr",
day="27",
volume="9",
number="2",
pages="e34606",
keywords="older adults",
keywords="health",
keywords="emotion",
keywords="affect",
keywords="well-being",
keywords="tangible interaction",
keywords="TUI",
abstract="Background: The global population is aging, leading to shifts in health care needs. In addition to developing technology to support physical health, there is an increasing recognition of the need to consider how technology can support emotional health. This raises the question of how to design devices that older adults can interact with to log their emotions. Objective: We designed and developed 2 novel tangible devices, inspired by existing paper-based scales of emotions. The findings from a field trial of these devices with older adults are reported. Methods: Using interviews, field deployment, and fixed logging tasks, we assessed the developed devices. Results: Our results demonstrate that the tangible devices provided data comparable with standardized psychological scales of emotion. The participants developed their own patterns of use around the devices, and their experience of using the devices uncovered a variety of design considerations. We discuss the difficulty of customizing devices for specific user needs while logging data comparable to psychological scales of emotion. We also highlight the value of reflecting on sparse emotional data. Conclusions: Our work demonstrates the potential for tangible emotional logging devices. It also supports further research on whether such devices can support the emotional health of older adults by encouraging reflection of their emotional state. ",
doi="10.2196/34606",
url="https://humanfactors.jmir.org/2022/2/e34606",
url="http://www.ncbi.nlm.nih.gov/pubmed/35475781"
}


@Article{info:doi/10.2196/34522,
author="Kunkes, Taylor
and Makled, Basiel
and Norfleet, Jack
and Schwaitzberg, Steven
and Cavuoto, Lora",
title="Understanding the Cognitive Demands, Skills, and Assessment Approaches for Endotracheal Intubation: Cognitive Task Analysis",
journal="JMIR Perioper Med",
year="2022",
month="Apr",
day="21",
volume="5",
number="1",
pages="e34522",
keywords="knowledge elicitation",
keywords="knowledge acquisition",
keywords="medical simulation",
keywords="medical training",
keywords="medical assessment",
keywords="critical care",
keywords="cognitive task analysis",
keywords="qualitative methods",
keywords="qualitative",
keywords="endotracheal intubation",
keywords="preoperative",
keywords="training",
keywords="health care professional",
keywords="medical education",
keywords="cognitive skill",
abstract="Background: Proper airway management is an essential skill for hospital personnel and rescue services to learn, as it is a priority for the care of patients who are critically ill. It is essential that providers be properly trained and competent in performing endotracheal intubation (ETI), a widely used technique for airway management. Several metrics have been created to measure competence in the ETI procedure. However, there is still a need to improve ETI training and evaluation, including a focus on collaborative research across medical specialties, to establish greater competence-based training and assessments. Training and evaluating ETI should also incorporate modern, evidence-based procedural training methodologies. Objective: This study aims to use the cognitive task analysis (CTA) framework to identify the cognitive demands and skills needed to proficiently perform a task, elucidate differences between novice and expert performance, and provide an understanding of the workload associated with a task. The CTA framework was applied to ETI to capture a broad view of task and training requirements from the perspective of multiple medical specialties. Methods: A CTA interview was developed based on previous research into the tasks and evaluation methods of ETI. A total of 6 experts from across multiple medical specialties were interviewed to capture the cognitive skills required to complete this task. Interviews were coded for main themes, subthemes in each category, and differences among specialties. These findings were compiled into a skills tree to identify the training needs and cognitive requirements of each task. Results: The CTA revealed that consistency in equipment setup and planning, through talk or think-aloud methods, is critical to successfully mastering ETI. These factors allow the providers to avoid errors due to patient characteristics and environmental factors. Variation among specialties derived primarily from the environment in which ETI is performed, subsequent treatment plans, and available resources. Anesthesiology typically represented the most ideal cases with a large potential for training, whereas paramedics faced the greatest number of constraints based on the environment and available equipment. Conclusions: Although the skills tree cannot perfectly capture the complexity and detail of all potential cases, it provided insight into the nuanced skills and training techniques used to prepare novices for the variability they may find in practice. Importantly, the CTA identified ways in which challenges faced by novices may be overcome and how this training can be applied to future cases. By making these implicit skills and points of variation explicit, they can be better translated into teachable details. These findings are consistent with previous studies looking at developing improved assessment metrics for ETI and expanding upon their work by delving into methods of feedback and strategies to assist novices. ",
doi="10.2196/34522",
url="https://periop.jmir.org/2022/1/e34522",
url="http://www.ncbi.nlm.nih.gov/pubmed/35451970"
}


@Article{info:doi/10.2196/29492,
author="Aronoff-Spencer, Eliah
and McComsey, Melanie
and Chih, Ming-Yuan
and Hubenko, Alexandra
and Baker, Corey
and Kim, John
and Ahern, K. David
and Gibbons, Christopher Michael
and Cafazzo, A. Joseph
and Nyakairu, Pia
and Vanderpool, C. Robin
and Mullett, W. Timothy
and Hesse, W. Bradford",
title="Designing a Framework for Remote Cancer Care Through Community Co-design: Participatory Development Study",
journal="J Med Internet Res",
year="2022",
month="Apr",
day="12",
volume="24",
number="4",
pages="e29492",
keywords="cancer care",
keywords="distress screening",
keywords="human-centered design",
keywords="participatory design",
keywords="Appalachia",
keywords="mobile phone",
abstract="Background: Recent shifts to telemedicine and remote patient monitoring demonstrate the potential for new technology to transform health systems; yet, methods to design for inclusion and resilience are lacking. Objective: The aim of this study is to design and implement a participatory framework to produce effective health care solutions through co-design with diverse stakeholders. Methods: We developed a design framework to cocreate solutions to locally prioritized health and communication problems focused on cancer care. The framework is premised on the framing and discovery of problems through community engagement and lead-user innovation with the hypothesis that diversity and inclusion in the co-design process generate more innovative and resilient solutions. Discovery, design, and development were implemented through structured phases with design studios at various locations in urban and rural Kentucky, including Appalachia, each building from prior work. In the final design studio, working prototypes were developed and tested. Outputs were assessed using the System Usability Scale as well as semistructured user feedback. Results: We co-designed, developed, and tested a mobile app (myPath) and service model for distress surveillance and cancer care coordination following the LAUNCH (Linking and Amplifying User-Centered Networks through Connected Health) framework. The problem of awareness, navigation, and communication through cancer care was selected by the community after framing areas for opportunity based on significant geographic disparities in cancer and health burden resource and broadband access. The codeveloped digital myPath app showed the highest perceived combined usability (mean 81.9, SD 15.2) compared with the current gold standard of distress management for patients with cancer, the paper-based National Comprehensive Cancer Network Distress Thermometer (mean 74.2, SD 15.8). Testing of the System Usability Scale subscales showed that the myPath app had significantly better usability than the paper Distress Thermometer (t63=2.611; P=.01), whereas learnability did not differ between the instruments (t63=--0.311; P=.76). Notable differences by patient and provider scoring and feedback were found. Conclusions: Participatory problem definition and community-based co-design, design-with methods, may produce more acceptable and effective solutions than traditional design-for approaches. ",
doi="10.2196/29492",
url="https://www.jmir.org/2022/4/e29492",
url="http://www.ncbi.nlm.nih.gov/pubmed/35412457"
}


@Article{info:doi/10.2196/35641,
author="Borghouts, Judith
and Neary, Martha
and Palomares, Kristina
and De Leon, Cinthia
and Schueller, M. Stephen
and Schneider, Margaret
and Stadnick, Nicole
and Mukamel, B. Dana
and Sorkin, H. Dara
and Brown, Dakota
and McCleerey-Hooper, Shannon
and Moriarty, Gloria
and Eikey, V. Elizabeth",
title="Understanding the Potential of Mental Health Apps to Address Mental Health Needs of the Deaf and Hard of Hearing Community: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2022",
month="Apr",
day="11",
volume="9",
number="2",
pages="e35641",
keywords="mental health",
keywords="deaf and hard of hearing community",
keywords="mHealth",
keywords="digital health",
keywords="needs assessment",
keywords="deaf",
keywords="hard of hearing",
keywords="hearing",
keywords="focus group",
keywords="survey",
keywords="mixed methods",
keywords="intervention",
keywords="health app",
keywords="user needs",
abstract="Background: Mental health concerns are a significant issue among the deaf and hard of hearing (D/HH) community, but community members can face several unique challenges to accessing appropriate resources. Objective: The aim of this study was to investigate the mental health needs of the D/HH community and how mental health apps may be able to support these needs. Methods: A total of 10 members of the D/HH community participated in a focus group and survey to provide their perspectives and experiences. Participants were members of the Center on Deafness Inland Empire team, which comprises people with lived experience as members of and advocates for the D/HH community. Results: Findings identified a spectrum of needs for mental health apps, including offering American Sign Language and English support, increased education of mental health to reduce stigma around mental health, direct communication with a Deaf worker, and apps that are accessible to a range of community members in terms of culture, resources required, and location. Conclusions: These findings can inform the development of digital mental health resources and outreach strategies that are appropriate for the D/HH community. ",
doi="10.2196/35641",
url="https://humanfactors.jmir.org/2022/2/e35641",
url="http://www.ncbi.nlm.nih.gov/pubmed/35404259"
}


@Article{info:doi/10.2196/24680,
author="Tamori, Honoka
and Yamashina, Hiroko
and Mukai, Masami
and Morii, Yasuhiro
and Suzuki, Teppei
and Ogasawara, Katsuhiko",
title="Acceptance of the Use of Artificial Intelligence in Medicine Among Japan's Doctors and the Public: A Questionnaire Survey",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="16",
volume="9",
number="1",
pages="e24680",
keywords="artificial intelligence",
keywords="technology acceptance",
keywords="surveys and questionnaires",
keywords="doctors vs public",
abstract="Background: The use of artificial intelligence (AI) in the medical industry promises many benefits, so AI has been introduced to medical practice primarily in developed countries. In Japan, the government is preparing for the rollout of AI in the medical industry. This rollout depends on doctors and the public accepting the technology. Therefore it is necessary to consider acceptance among doctors and among the public. However, little is known about the acceptance of AI in medicine in Japan. Objective: This study aimed to obtain detailed data on the acceptance of AI in medicine by comparing the acceptance among Japanese doctors with that among the Japanese public. Methods: We conducted an online survey, and the responses of doctors and members of the public were compared. AI in medicine was defined as the use of AI to determine diagnosis and treatment without requiring a doctor. A questionnaire was prepared referred to as the unified theory of acceptance and use of technology, a model of behavior toward new technologies. It comprises 20 items, and each item was rated on a five-point scale. Using this questionnaire, we conducted an online survey in 2018 among 399 doctors and 600 members of the public. The sample-wide responses were analyzed, and then the responses of the doctors were compared with those of the public using t tests. Results: Regarding the sample-wide responses (N=999), 653 (65.4\%) of the respondents believed, in the future, AI in medicine would be necessary, whereas only 447 (44.7\%) expressed an intention to use AI-driven medicine. Additionally, 730 (73.1\%) believed that regulatory legislation was necessary, and 734 (73.5\%) were concerned about where accountability lies. Regarding the comparison between doctors and the public, doctors (mean 3.43, SD 1.00) were more likely than members of the public (mean 3.23, SD 0.92) to express intention to use AI-driven medicine (P<.001), suggesting that optimism about AI in medicine is greater among doctors compared to the public. Conclusions: Many of the respondents were optimistic about the role of AI in medicine. However, when asked whether they would like to use AI-driven medicine, they tended to give a negative response. This trend suggests that concerns about the lack of regulation and about accountability hindered acceptance. Additionally, the results revealed that doctors were more enthusiastic than members of the public regarding AI-driven medicine. For the successful implementation of AI in medicine, it would be necessary to inform the public and doctors about the relevant laws and to take measures to remove their concerns about them. ",
doi="10.2196/24680",
url="https://humanfactors.jmir.org/2022/1/e24680",
url="http://www.ncbi.nlm.nih.gov/pubmed/35293878"
}


@Article{info:doi/10.2196/24172,
author="ten Klooster, Iris
and Wentzel, Jobke
and Sieverink, Floor
and Linssen, Gerard
and Wesselink, Robin
and van Gemert-Pijnen, Lisette",
title="Personas for Better Targeted eHealth Technologies: User-Centered Design Approach",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="15",
volume="9",
number="1",
pages="e24172",
keywords="personas",
keywords="clustering",
keywords="heart failure",
keywords="eHealth",
keywords="user-centered design",
abstract="Background: The full potential of eHealth technologies to support self-management and disease management for patients with chronic diseases is not being reached. A possible explanation for these lacking results is that during the development process, insufficient attention is paid to the needs, wishes, and context of the prospective end users. To overcome such issues, the user-centered design practice of creating personas is widely accepted to ensure the fit between a technology and the target group or end users throughout all phases of development. Objective: In this study, we integrate several approaches to persona development into the Persona Approach Twente to attain a more holistic and structured approach that aligns with the iterative process of eHealth development. Methods: In 3 steps, a secondary analysis was carried out on different parts of the data set using the Partitioning Around Medoids clustering method. First, we used health-related electronic patient record data only. Second, we added person-related data that were gathered through interviews and questionnaires. Third, we added log data. Results: In the first step, 2 clusters were found, with average silhouette widths of 0.12 and 0.27. In the second step, again 2 clusters were found, with average silhouette widths of 0.08 and 0.12. In the third step, 3 clusters were identified, with average silhouette widths of 0.09, 0.12, and 0.04. Conclusions: The Persona Approach Twente is applicable for mixed types of data and allows alignment of this user-centered design method to the iterative approach of eHealth development. A variety of characteristics can be used that stretches beyond (standardized) medical and demographic measurements. Challenges lie in data quality and fitness for (quantitative) clustering. ",
doi="10.2196/24172",
url="https://humanfactors.jmir.org/2022/1/e24172",
url="http://www.ncbi.nlm.nih.gov/pubmed/35289759"
}


@Article{info:doi/10.2196/34452,
author="Chen, Jinying
and Wijesundara, G. Jessica
and Enyim, E. Gabrielle
and Lombardini, M. Lisa
and Gerber, S. Ben
and Houston, K. Thomas
and Sadasivam, S. Rajani",
title="Understanding Patients' Intention to Use Digital Health Apps That Support Postdischarge Symptom Monitoring by Providers Among Patients With Acute Coronary Syndrome: Survey Study",
journal="JMIR Hum Factors",
year="2022",
month="Mar",
day="7",
volume="9",
number="1",
pages="e34452",
keywords="coronary",
keywords="monitor",
keywords="elder",
keywords="health app",
keywords="symptom",
keywords="eHealth",
keywords="mobile health",
keywords="intention",
keywords="barrier",
keywords="facilitator",
abstract="Background: After hospital discharge, patients with acute coronary syndrome (ACS) often experience symptoms that prompt them to seek acute medical attention. Early evaluation of postdischarge symptoms by health care providers may reduce unnecessary acute care utilization. However, hospital-initiated follow-up encounters are insufficient for timely detection and assessment of symptoms. While digital health tools can help address this issue, little is known about the intention to use such tools in ACS patients. Objective: This study aimed to assess ACS patients' intention to use digital health apps that support postdischarge symptom monitoring by health care providers and identify patient-perceived facilitators and barriers to app use. Methods: Using email invitations or phone calls, we recruited ACS patients discharged from a central Massachusetts health care system between December 2020 and April 2021, to participate in the study. Surveys were delivered online or via phone to individual participants. Demographics and access to technology were assessed. The intention to use a symptom monitoring app was assessed using 5-point Likert-type (from strongly agree to strongly disagree) items, such as ``If this app were available to me, I would use it.'' Responses were compared across demographic subgroups and survey delivery methods. Two open-ended questions assessed perceived facilitators and barriers to app use, with responses analyzed using qualitative content analysis. Results: Among 100 respondents (response rate 8.1\%), 45 (45\%) completed the survey by phone. The respondents were on average 68 years old (SD 13 years), with 90\% (90/100) White, 39\% (39/100) women, and 88\% (88/100) having access to the internet or a mobile phone. Most participants (65/100, 65\%) agreed or strongly agreed that they would use the app, among which 53 (82\%) would use the app as often as possible. The percentage of participants with the intention to use the app was 75\% among those aged 65-74 years and dropped to 44\% among those older than 75 years. The intention to use was higher in online survey respondents (vs phone survey respondents; odds ratio 3.07, 95\% CI 1.20-7.88) after adjusting for age and access to technology. The analysis of open-ended questions identified the following 4 main facilitators (motivations): (1) easily reaching providers, (2) accessing or providing information, (3) quickly reaching providers, and (4) consulting providers for symptoms, and the following 4 main barriers: (1) privacy/security concerns, (2) uncomfortable using technology, (3) user-unfriendly app interface, and (4) preference for in-person/phone care. Conclusions: There was a strong intention to use a symptom monitoring app postdischarge among ACS patients. However, this intent decreased in patients older than 75 years. The survey identified barriers related to technology use, privacy/security, and the care delivery mode. Further research is warranted to determine if such intent translates into app use, and better symptom management and health care quality. ",
doi="10.2196/34452",
url="https://humanfactors.jmir.org/2022/1/e34452",
url="http://www.ncbi.nlm.nih.gov/pubmed/35254269"
}


@Article{info:doi/10.2196/30512,
author="P{\'e}rez-Mart{\'i}, Montserrat
and Casad{\'o}-Mar{\'i}n, Lina
and Guill{\'e}n-Villar, Abraham",
title="Electronic Records With Tablets at the Point of Care in an Internal Medicine Unit: Before-After Time Motion Study",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="10",
volume="9",
number="1",
pages="e30512",
keywords="electronic health records",
keywords="nursing",
keywords="computer handheld",
keywords="equipment and supplies (devices tablets mobile phones, devices and technologies)",
keywords="workflow",
abstract="Background: There are many benefits of nursing professionals being able to consult electronic health records (EHRs) at the point of care. It promotes quality and patient security, communication, continuity of care, and time dedicated to records. Objective: The aim of this study was to evaluate whether making EHRs available at the point of care with tablets reduces nurses' time spent on records compared with the current system. The analysis included sociodemographic and qualitative variables, time spent per patient, and work shift. This time difference can be used for direct patient care. Methods: A before-after time motion study was carried out in the internal medicine unit. There was a total of 130 observations of 2 hours to 3 hours in duration of complete patient records that were carried out at the beginning of the nurses' work shifts. We calculated the time dedicated to measuring vital signs, patient evaluation, and EHR recording. The main variable was time spent per patient. Results: The average time spent per patient (total time/patients admitted) was lower with the tablet group (mean 4.22, SD 0.14 minutes) than with the control group (mean 4.66, SD 0.12 minutes); there were statistically significant differences (W=3.20, P=.001) and a low effect (d=.44) between groups. The tablet group saved an average of 0.44 (SD 0.13) minutes per patient. Similar results were obtained for the afternoon shift, which saved an average of 0.60 (SD 0.15) minutes per patient (t34=3.82, P=.01) and high effect (d=.77). However, although there was a mean difference of 0.26 (SD 0.22) minutes per patient for the night shift, this was not statistically significant (t29=1.16, P=.25). The ``nonparticipating'' average age was higher (49.57, SD 2.92 years) compared with the ``afternoon shift participants'' and ``night shift participants'' (P=.007). ``Nonparticipants'' of the night shift had a worse perception of the project. Conclusions: This investigation determined that, with EHRs at the point of care, the time spent for registration by the nursing staff decreases, because of reduced movements and avoiding data transcription. It eliminates unnecessary work that does not add value, and therefore, care is improved. So, we think EHRs at the point of care should be the future or natural method for nursing to undertake. However, variables that could have a negative effect include age, night shift, and nurses' perceptions. Therefore, it is proposed that training in the different work platforms and the participation of nurses are fundamental axes that any institution should consider before their implementation. ",
doi="10.2196/30512",
url="https://humanfactors.jmir.org/2022/1/e30512",
url="http://www.ncbi.nlm.nih.gov/pubmed/35142624"
}


@Article{info:doi/10.2196/30804,
author="Nigusie, Adane
and Endehabtu, F. Berhanu
and Angaw, Abebaw Dessie
and Teklu, Alemayehu
and Mekonnen, Abebaw Zeleke
and Feletto, Marta
and Assan, Abraham
and Samuel, Assegid
and Sheikh, Kabir
and Tilahun, Binyam",
title="Status of Compassionate, Respectful, and Caring Health Service Delivery: Scoping Review",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="7",
volume="9",
number="1",
pages="e30804",
keywords="compassionate",
keywords="respectful",
keywords="caring",
keywords="CRC",
keywords="health care delivery",
abstract="Background: A compassionate, respectful, and caring (CRC) health professional is very important for human-centered care, serving clients ethically and with respect, adhering to the professional oath, and serving as a model for young professionals. As countries try to achieve universal health coverage (UHC), quality delivery of health services is crucial. CRC health care is an initiative around the need to provide quality care services to clients and patients. However, there is an evidence gap on the status of CRC health care service delivery. Objective: This scoping review aimed to map global evidence on the status of CRC health service delivery practice. Methods: An exhaustive literature review and Delphi technique were used to answer the 2 research questions: ``What is the current status of CRC health care practices among health workers?'' and ``Is it possible for health professionals, health managers, administrators, and policy makers to incorporate it into their activity while designing strategies that could improve the humanistic and holistic approach to health care provision?'' The studies were searched from the year 2014 to September 2020 using electronic databases such as MEDLINE (PubMed), Cochrane Library, Web of Science, Hinari, and the World Health Organization (WHO) library. Additionally, grey literature such as Google, Google Scholar, and WorldWideScience were scrutinized. Studies that applied any study design and data collection and analysis methods related to CRC care were included. Two authors extracted the data and compared the results. Discrepancies were resolved by discussion, or the third reviewer made the decision. Findings from the existing literature were presented using thematic analysis. Results: A total of 1193 potentially relevant studies were generated from the initial search, and 20 studies were included in the final review. From this review, we identified 5 thematic areas: the status of CRC implementation, facilitators for CRC health care service delivery, barriers to CRC health care delivery, disrespectful and abusive care encountered by patients, and perspectives on CRC. The findings of this review indicated that improving the mechanisms for monitoring health facilities, improving accountability, and becoming aware of the consequences of maltreatment within facilities are critical steps to improving health care delivery practices. Conclusions: This scoping review identified that there is limited CRC service provision. Lack of training, patient flow volume, and bed shortages were found to be the main contributors of CRC health care delivery. Therefore, the health care system should consider the components of CRC in health care delivery during in-service training, pre-service training, monitoring and evaluation, community engagement, workload division, and performance appraisal. ",
doi="10.2196/30804",
url="https://humanfactors.jmir.org/2022/1/e30804",
url="http://www.ncbi.nlm.nih.gov/pubmed/35129450"
}


@Article{info:doi/10.2196/28252,
author="Marsall, Matthias
and Engelmann, Gerrit
and Skoda, Eva-Maria
and Teufel, Martin
and B{\"a}uerle, Alexander",
title="Measuring Electronic Health Literacy: Development, Validation, and Test of Measurement Invariance of a Revised German Version of the eHealth Literacy Scale",
journal="J Med Internet Res",
year="2022",
month="Feb",
day="2",
volume="24",
number="2",
pages="e28252",
keywords="eHealth",
keywords="eHeals",
keywords="health literacy",
keywords="factor analysis",
keywords="validation",
keywords="measurement invariance",
keywords="internet",
keywords="health information",
abstract="Background: The World Wide Web has become an essential source of health information. Nevertheless, the amount and quality of information provided may lead to information overload. Therefore, people need certain skills to search for, identify, and evaluate information from the internet. In the context of health information, these competencies are summarized as the construct of eHealth literacy. Previous research has highlighted the relevance of eHealth literacy in terms of health-related outcomes. However, the existing instrument assessing eHealth literacy in the German language reveals methodological limitations regarding test development and validation. The development and validation of a revised scale for this important construct is highly relevant. Objective: The objective of this study was the development and validation of a revised German eHealth literacy scale. In particular, this study aimed to focus on high methodological and psychometric standards to provide a valid and reliable instrument for measuring eHealth literacy in the German language. Methods: Two internationally validated instruments were merged to cover a wide scope of the construct of eHealth literacy and create a revised eHealth literacy scale. Translation into the German language followed scientific guidelines and recommendations to ensure content validity. Data from German-speaking people (n=470) were collected in a convenience sample from October to November 2020. Validation was performed by factor analyses. Further, correlations were performed to examine convergent, discriminant, and criterion validity. Additionally, analyses of measurement invariance of gender, age, and educational level were conducted. Results: Analyses revealed a 2-factorial model of eHealth literacy. By item-reduction, the 2 factors information seeking and information appraisal were measured with 8 items reaching acceptable-to-good model fits (comparative fit index [CFI]: 0.942, Tucker Lewis index [TLI]: 0.915, root mean square error of approximation [RMSEA]: 0.127, and standardized root mean square residual [SRMR]: 0.055). Convergent validity was comprehensively confirmed by significant correlations of information seeking and information appraisal with health literacy, internet confidence, and internet anxiety. Discriminant and criterion validity were examined by correlation analyses with various scales and could partly be confirmed. Scalar level of measurement invariance for gender (CFI: 0.932, TLI: 0.923, RMSEA: 0.122, and SRMR: 0.068) and educational level (CFI: 0.937, TLI: 0.934, RMSEA: 0.112, and SRMR: 0.063) were confirmed. Measurement invariance of age was rejected. Conclusions: Following scientific guidelines for translation and test validation, we developed a revised German eHealth Literacy Scale (GR-eHEALS). Our factor analyses confirmed an acceptable-to-good model fit. Construct validation in terms of convergent, discriminant, and criterion validity could mainly be confirmed. Our findings provide evidence for measurement invariance of the instrument regarding gender and educational level. The newly revised GR-eHEALS questionnaire represents a valid instrument to measure the important health-related construct eHealth literacy. ",
doi="10.2196/28252",
url="https://www.jmir.org/2022/2/e28252",
url="http://www.ncbi.nlm.nih.gov/pubmed/35107437"
}


@Article{info:doi/10.2196/32112,
author="Agachi, Elena
and Bijmolt, A. Tammo H.
and Mierau, O. Jochen
and van Ittersum, Koert",
title="Adoption of the Website and Mobile App of a Preventive Health Program Across Neighborhoods With Different Socioeconomic Conditions in the Netherlands: Longitudinal Study",
journal="JMIR Hum Factors",
year="2022",
month="Feb",
day="2",
volume="9",
number="1",
pages="e32112",
keywords="eHealth",
keywords="mHealth",
keywords="mobile health",
keywords="mobile app",
keywords="internet",
keywords="preventive health program",
keywords="health disparities",
keywords="NSES",
keywords="program adoption",
keywords="survival analysis",
abstract="Background: Socioeconomic disparities in the adoption of preventive health programs represent a well-known challenge, with programs delivered via the web serving as a potential solution. The preventive health program examined in this study is a large-scale, open-access web-based platform operating in the Netherlands, which aims to improve the health behaviors and wellness of its participants. Objective: This study aims to examine the differences in the adoption of the website and mobile app of a web-based preventive health program across socioeconomic groups. Methods: The 83,466 participants in this longitudinal, nonexperimental study were individuals who had signed up for the health program between July 2012 and September 2019. The rate of program adoption per delivery means was estimated using the Prentice, Williams, and Peterson Gap--Time model, with the measure of neighborhood socioeconomic status (NSES) used to distinguish between population segments with different socioeconomic characteristics. Registration to the health program was voluntary and free, and not within a controlled study setting, allowing the observation of the true rate of adoption. Results: The estimation results indicate that program adoption across socioeconomic groups varies depending on the program's delivery means. For the website, higher NSES groups have a higher likelihood of program adoption compared with the lowest NSES group (hazard ratio 1.03, 95\% CI 1.01-1.05). For the mobile app, the opposite holds: higher NSES groups have a lower likelihood of program adoption compared with the lowest NSES group (hazard ratio 0.94, 95\% CI 0.91-0.97). Conclusions: Promoting preventive health programs using mobile apps can help to increase program adoption among the lowest socioeconomic segments. Given the increasing use of mobile phones among disadvantaged population groups, structuring future health interventions to include mobile apps as means of delivery can support the stride toward diminishing health disparities. ",
doi="10.2196/32112",
url="https://humanfactors.jmir.org/2022/1/e32112",
url="http://www.ncbi.nlm.nih.gov/pubmed/35107433"
}


@Article{info:doi/10.2196/28870,
author="Neher, Margit
and Nyg{\aa}rdh, Annette
and Brostr{\"o}m, Anders
and Lundgren, Johan
and Johansson, Peter",
title="Perspectives of Policy Makers and Service Users Concerning the Implementation of eHealth in Sweden: Interview Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="28",
volume="24",
number="1",
pages="e28870",
keywords="clients",
keywords="computer-assisted therapy",
keywords="consultation telehealth",
keywords="decision-makers",
keywords="implementation",
keywords="patients",
keywords="politicians",
keywords="qualitative methods",
keywords="remote",
keywords="mobile phone",
abstract="Background: Increasing life spans of populations and a growing demand for more advanced care make effective and cost-efficient provision of health care necessary. eHealth technology is often proposed, although research on barriers to and facilitators of the implementation of eHealth technology is still scarce and fragmented. Objective: The aim of this study is to explore the perceptions concerning barriers to and facilitators of the implementation of eHealth among policy makers and service users and explore the ways in which their perceptions converge and differ. Methods: This study used interview data from policy makers at different levels of health care (n=7) and service users enrolled in eHealth interventions (n=25). The analysis included separate qualitative content analyses for the 2 groups and then a second qualitative content analysis to explore differences and commonalities. Results: Implementation barriers perceived by policy makers were that not all service users benefit from eHealth and that there is uncertainty about the impact of eHealth on the work of health care professionals. Policy makers also perceived political decision-making as complex; this included problems related to provision of technical infrastructure and lack of extra resources for health care digitalization. Facilitators were policy makers' conviction that eHealth is what citizens want, their belief in eHealth solutions as beneficial for health care practice, and their belief in the importance of health care digitalization. Barriers for service users comprised capability limitations and varied preferences of service users and a mismatch of technology with user needs, lack of data protection, and their perception of eHealth as being more time consuming. Facilitators for service users were eHealth technology design and match with their skill set, personal feedback and staff support, a sense of privacy, a credible sender, and flexible use of time.There were several commonalities between the 2 stakeholder groups. Facilitators for both groups were the strong impetus toward technology adoption in society and expectations of time flexibility. Both groups perceived barriers in the difficulties of tailoring eHealth, and both groups expressed uncertainty about the care burden distribution. There were also differences: policy makers perceived that their decision-making was very complex and that resources for implementation were limited. Service users highlighted their need to feel that their digital data were protected and that they needed to trust the eHealth sender. Conclusions: Perceptions about barriers to and facilitators of eHealth implementation varied among stakeholders in different parts of the health care system. The study points to the need to reach an enhanced mutual understanding of priorities and overcome challenges at both the micro and macro levels of the health care system. More well-balanced decisions at the policy-maker level may lead to more effective and sustainable development and future implementation of eHealth. ",
doi="10.2196/28870",
url="https://www.jmir.org/2022/1/e28870",
url="http://www.ncbi.nlm.nih.gov/pubmed/35089139"
}


@Article{info:doi/10.2196/29367,
author="Rolnick, Joshua
and Ward, Robin
and Tait, Gordon
and Patel, Neha",
title="Early Adopters of Apple Health Records at a Large Academic Medical Center: Cross-sectional Survey of Users",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="25",
volume="24",
number="1",
pages="e29367",
keywords="Apple Health Records",
keywords="personal health record",
keywords="electronic health record",
keywords="patient satisfaction",
keywords="early adopters",
keywords="cross-sectional survey",
abstract="Background: Mobile applications offer a new approach to personal health records, which are internet-based tools for patients to consolidate and manage their health information. The University of Pennsylvania Health System (UPHS) was one of the first health systems to participate in Apple Health Records (AHR), a prominent example of this new generation of personal health records. Objective: This study aimed to characterize early adoption of AHR among UPHS patients and understand user perspectives. Methods: An email-based survey with fixed answer, Likert scale, and open-ended questions was administered to all UPHS patients using AHR in the first 10 months of enrollment. Survey data linked to the UPHS electronic health record system were used to analyze responses. Multivariable logistic regression modeled the association of patient characteristics with user ratings. Content analysis was used to analyze open-ended questions. Results: At the time of the survey, a total of 1458 patients had used AHR at least once. Mean age of AHR users was 47.5 years, 66.3\% (967/1458) were male, 70.9\% (1033/1458) were white, and 80.8\% (1178/1458) had private insurance. Response rate was 26.8\% (391/1458); 46.3\% (180/389) were very satisfied with AHR, and 67.7\% (264/390) described it as very easy to use. The most commonly utilized features were lab results (324/391, 82.9\%), clinical vitals (264/391, 67.5\%), and medications (253/391, 64.7\%). No patient characteristics were associated with reporting high satisfaction or ease of use. The most common reason for using AHR was convenience/ease of use, and 58.2\% (160/275) of users reported allowing no other apps to access their health information, citing privacy as one consideration. Conclusions: Early adopters of AHR were demographically white, male, and privately insured. Convenience was an important facilitator, and users were selective in which apps they allowed to access their health information. ",
doi="10.2196/29367",
url="https://www.jmir.org/2022/1/e29367",
url="http://www.ncbi.nlm.nih.gov/pubmed/35076397"
}


@Article{info:doi/10.2196/22586,
author="Hoang, Victor
and Parekh, Amit
and Sagers, Kevin
and Call, Trevor
and Howard, Shain
and Hoffman, Jason
and Lee, Daniel",
title="Patient Utilization of Online Information and its Influence on Orthopedic Surgeon Selection: Cross-sectional Survey of Patient Beliefs and Behaviors",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="19",
volume="6",
number="1",
pages="e22586",
keywords="orthopedics",
keywords="practice management",
keywords="physician selection",
keywords="internet reviews",
keywords="patient decision",
keywords="practice",
keywords="patient online review",
keywords="social media",
keywords="physician perception",
keywords="patient choice",
keywords="health literacy",
abstract="Background: Patient attitudes and behavior are critical to understand owing to the increasing role of patient choice. There is a paucity of investigation into the perceived credibility of online information and whether such information impacts how patients choose their surgeons. Objective: The purpose of this study was to explore the attitudes and behavior of patients regarding online information and orthopedic surgeon selection. Secondary purposes included gaining insight into the relative importance of provider selection factors, and their association with patient age and education level. Methods: This was a cross-sectional study involving five multispecialty orthopedic surgery groups. A total of 329 patients who sought treatment by six different orthopedic surgeons were asked to anonymously answer a questionnaire consisting of 25 questions. Four questions regarded demographic information, 10 questions asked patients to rate the importance of specific criteria regarding the selection of their orthopedic surgeon (on a 4-point Likert scale), and 6 questions were designed to determine patient attitude and behaviors related to online information. Results: Patient-reported referral sources included the emergency room (29/329, 8.8\%), friend (42/329, 12.8\%), insurance company (47/329, 14.3\%), internet search/website (28/329, 8.5\%), primary care physician (148/329, 45.0\%), and other (34/329, 10.3\%). Among the 329 patients, 130 (39.5\%) reported that they searched the internet for information before their first visit. There was a trend of increased belief in online information to be accurate and complete in younger age groups (P=.02). There was an increased relative frequency in younger groups to perceive physician rating websites to be unbiased (P=.003), provide sufficient patient satisfaction information (P=.01), and information about physician education and training (P=.03). There was a significant trend for patients that found a surgeon's website to be useful (P<.001), with the relative frequency increased in younger age groups. Conclusions: This study shows that insurance network, physician referrals, appointment availability, and office location are important to patients, whereas advertising and internet reviews by other patients were considered to be not as helpful in choosing an orthopedic surgeon. Future studies may seek to identify obstacles to patients in integrating online resources for decision-making and strategies to improve health-seeking behaviors. ",
doi="10.2196/22586",
url="https://formative.jmir.org/2022/1/e22586",
url="http://www.ncbi.nlm.nih.gov/pubmed/35044319"
}


@Article{info:doi/10.2196/27431,
author="Gullslett, Knudsen Monika
and Strand Bergmo, Trine",
title="Implementation of E-prescription for Multidose Dispensed Drugs: Qualitative Study of General Practitioners' Experiences",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="17",
volume="9",
number="1",
pages="e27431",
keywords="e-prescribing of multidose drug dispensing (eMDD)",
keywords="pharmacy",
keywords="start-up",
keywords="general practitioner (GP)",
keywords="Norway",
keywords="digital health",
keywords="digital tools",
keywords="e-prescriptions",
keywords="physicians",
keywords="qualitative study",
abstract="Background: Increased use of pharmaceuticals challenges both capacity and safety related to medication management for patients and changes in how general practitioners (GPs) and other health personnel interact with and follow up with patients. E-prescribing of multidose drug dispensing (eMDD) is 1 of the national measures being tested in Norway. Objective: The objective of this study is to explore GPs' experiences with the challenges and benefits of implementing eMDD in Norway. Methods: Qualitative in-depth and group interviews were conducted with a total of 25 GPs between 2018 and 2020. Transcribed files were saved in NVivo to conduct a step-by-step content analysis. NVivo is a software tool for organizing, managing, and analyzing qualitative data. Results: The study revealed that eMDD offers many benefits. At the same time, there are several challenges related to information, training, and initiation, as well as to the responsibility for the medication, interactions, and the risk of incorrect medication. An important activity in the start-up phase was an information meeting with pharmacies and technology suppliers, as well as exchanging information and instructions with pharmacies on how to get started. Four analytic themes emerged through the extraction of data: (1) start-up with eMDD (``Be patient''); (2) the need for training; (3) interaction, safety, and efficiency; and (4) the working day with eMDD. Conclusions: There is a variation in different GPs' needs regarding training and information, and considerable variation in competence and motivation related to the use of digital tools. There are also different degrees of understanding the everyday work of the other actors in the medication chain. In particular, the harmonization of medication lists related to the use of time, expenditures, and challenges with technological solutions in the introduction phase was emphasized as a challenge. Overall, GPs who have started using the system report great benefits; these are largely related to an increased overview of patients' total medication lists, less time spent on prescribing prescriptions, and increased collaboration with pharmacies and nurses, both in service from providers in homes and in nursing homes. ",
doi="10.2196/27431",
url="https://humanfactors.jmir.org/2022/1/e27431",
url="http://www.ncbi.nlm.nih.gov/pubmed/35037881"
}


@Article{info:doi/10.2196/29302,
author="Mattila, Elina
and Hansen, Susanne
and Bundgaard, Lise
and Ramsey, Lauren
and Dunning, Alice
and Silva, N. Marlene
and Harjumaa, Marja
and Ermes, Miikka
and Marques, M. Marta
and Matos, Marcela
and Larsen, C. Sofus
and Encantado, Jorge
and Santos, In{\^e}s
and Horgan, Graham
and O'Driscoll, Ruairi
and Turicchi, Jake
and Duarte, Cristiana
and Palmeira, L. Ant{\'o}nio
and Stubbs, James R.
and Heitmann, Lilienthal Berit
and L{\"a}hteenm{\"a}ki, Liisa",
title="Users' Experiences With the NoHoW Web-Based Toolkit With Weight and Activity Tracking in Weight Loss Maintenance: Long-term Randomized Controlled Trial",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="10",
volume="24",
number="1",
pages="e29302",
keywords="digital behavior change intervention",
keywords="user experience",
keywords="technology acceptance",
keywords="weight-loss maintenance",
keywords="focus groups",
keywords="mixed methods",
keywords="mobile phone",
abstract="Background: Digital behavior change interventions (DBCIs) offer a promising channel for providing health promotion services. However, user experience largely determines whether they are used, which is a precondition for effectiveness. Objective: The primary aim of this study is to evaluate user experiences with the NoHoW Toolkit (TK)---a DBCI that targets weight loss maintenance---over a 12-month period by using a mixed methods approach and to identify the main strengths and weaknesses of the TK and the external factors affecting its adoption. The secondary aim is to objectively describe the measured use of the TK and its association with user experience. Methods: An 18-month, 2{\texttimes}2 factorial randomized controlled trial was conducted. The trial included 3 intervention arms receiving an 18-week active intervention and a control arm. The user experience of the TK was assessed quantitatively through electronic questionnaires after 1, 3, 6, and 12 months of use. The questionnaires also included open-ended items that were thematically analyzed. Focus group interviews were conducted after 6 months of use and thematically analyzed to gain deeper insight into the user experience. Log files of the TK were used to evaluate the number of visits to the TK, the total duration of time spent in the TK, and information on intervention completion. Results: The usability level of the TK was rated as satisfactory. User acceptance was rated as modest; this declined during the trial in all the arms, as did the objectively measured use of the TK. The most appreciated features were weekly emails, graphs, goal setting, and interactive exercises. The following 4 themes were identified in the qualitative data: engagement with features, decline in use, external factors affecting user experience, and suggestions for improvements. Conclusions: The long-term user experience of the TK highlighted the need to optimize the technical functioning, appearance, and content of the DBCI before and during the trial, similar to how a commercial app would be optimized. In a trial setting, the users should be made aware of how to use the intervention and what its requirements are, especially when there is more intensive intervention content. Trial Registration: ISRCTN Registry ISRCTN88405328; https://www.isrctn.com/ISRCTN88405328 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-029425 ",
doi="10.2196/29302",
url="https://www.jmir.org/2022/1/e29302",
url="http://www.ncbi.nlm.nih.gov/pubmed/35006081"
}


@Article{info:doi/10.2196/30565,
author="Burn, Anne-Marie
and Ford, J. Tamsin
and Stochl, Jan
and Jones, B. Peter
and Perez, Jesus
and Anderson, K. Joanna",
title="Developing a Web-Based App to Assess Mental Health Difficulties in Secondary School Pupils: Qualitative User-Centered Design Study",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="10",
volume="6",
number="1",
pages="e30565",
keywords="mental health",
keywords="assessment",
keywords="young people",
keywords="youth",
keywords="schools",
keywords="computerized adaptive testing",
keywords="mobile apps",
keywords="user-centered design",
keywords="coproduction",
keywords="qualitative study",
abstract="Background: Secondary schools are an ideal setting to identify young people experiencing mental health difficulties such as anxiety or depression. However, current methods of identification rely on cumbersome paper-based assessments, which are lengthy and time-consuming to complete and resource-intensive for schools to manage. Artemis-A is a prototype web app that uses computerized adaptive testing technology to shorten the length of the assessment and provides schools with a simple and feasible solution for mental health assessment. Objective: The objectives of this study are to coproduce the main components of the Artemis-A app with stakeholders to enhance the user interface, to carry out usability testing and finalize the interface design and functionality, and to explore the acceptability and feasibility of using Artemis-A in schools. Methods: This study involved 2 iterative design feedback cycles---an initial stakeholder consultation to inform the app design and user testing. Using a user-centered design approach, qualitative data were collected through focus groups and interviews with secondary school pupils, parents, school staff, and mental health professionals (N=48). All transcripts were thematically analyzed. Results: Initial stakeholder consultations provided feedback on preferences for the user interface design, school administration of the assessment, and outcome reporting. The findings informed the second iteration of the app design and development. The unmoderated usability assessment indicated that young people found the app easy to use and visually appealing. However, school staff suggested that additional features should be added to the school administration panel, which would provide them with more flexibility for data visualization. The analysis identified four themes relating to the implementation of the Artemis-A in schools, including the anticipated benefits and drawbacks of the app. Actionable suggestions for designing mental health assessment apps are also provided. Conclusions: Artemis-A is a potentially useful tool for secondary schools to assess the mental health of their pupils that requires minimal staff input and training. Future research will evaluate the feasibility and effectiveness of Artemis-A in a range of UK secondary schools. ",
doi="10.2196/30565",
url="https://formative.jmir.org/2022/1/e30565",
url="http://www.ncbi.nlm.nih.gov/pubmed/35006079"
}


@Article{info:doi/10.2196/27809,
author="Han, Sang Jae
and Park, Yong-Ho
and Song, Jae-Jun
and Moon, Joon Il
and Lee, Woojoo
and Kim, Yoonjoong
and Cho, Sang Young
and Seo, Jae-Hyun
and Park, Kyun Moo",
title="Knowledge and Expectations of Hearing Aid Apps Among Smartphone Users and Hearing Professionals: Cross-sectional Survey",
journal="JMIR Mhealth Uhealth",
year="2022",
month="Jan",
day="7",
volume="10",
number="1",
pages="e27809",
keywords="smartphone",
keywords="hearing aids",
keywords="app",
keywords="perception",
keywords="survey",
keywords="hearing loss",
keywords="mobile phone",
abstract="Background: Despite the increasing prevalence of hearing loss, the cost and psychological barriers to the use of hearing aids may prevent their use in individuals with hearing loss. Patients with hearing loss can benefit from smartphone-based hearing aid apps (SHAAs), which are smartphone apps that use a mobile device as a sound amplifier. Objective: The aim of this study is to determine how ear, nose, and throat outpatients perceive SHAAs, analyze the factors that affect their perceptions, and estimate the costs of an annual subscription to an app through a self-administered questionnaire survey of smartphone users and hearing specialists. Methods: This study used a cross-sectional, multicenter survey of both ear, nose, and throat outpatients and hearing specialists. The questionnaire was designed to collect personal information about the respondents and their responses to 18 questions concerning SHAAs in five domains: knowledge, needs, cost, expectations, and information. Perception questions were rated on a scale of 1 (strongly disagree) to 5 (strongly agree). Questions about the expected cost of SHAAs were included in the questionnaire distributed to hearing experts. Results: Among the 219 smartphone users and 42 hearing specialists, only 8 (3.7\%) respondents recognized SHAAs, whereas 18\% (47/261) of respondents reported considering the use of an assistive device to improve their hearing capacity. The average perception score was 2.81 (SD 1.22). Among the factors that shaped perceptions of SHAAs, the needs category received the lowest scores (2.02, SD 1.42), whereas the cost category received the highest scores (3.29, SD 1.14). Age was correlated with the information domain (P<.001), and an increased level of hearing impairment resulted in significantly higher points in the needs category (P<.001). Patients expected the cost of an annual app subscription to an SHAA to be approximately US \$86, and the predicted cost was associated with economic status (P=.02) and was higher than the prices expected by hearing specialists (P<.001). Conclusions: Outpatients expected SHAAs to cost more than hearing specialists. However, the perception of the SHAA was relatively low. In this regard, enhanced awareness is required to popularize SHAAs. ",
doi="10.2196/27809",
url="https://mhealth.jmir.org/2022/1/e27809",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994699"
}


@Article{info:doi/10.2196/27689,
author="Rao, Nema
and Perdomo, Sophy
and Jonassaint, Charles",
title="A Novel Method for Digital Pain Assessment Using Abstract Animations: Human-Centered Design Approach",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="7",
volume="9",
number="1",
pages="e27689",
keywords="pain",
keywords="pain measurement",
keywords="chronic pain",
keywords="animations",
keywords="mobile apps",
keywords="human-centered design",
abstract="Background: Patients with chronic pain face several challenges in using clinical tools to help them monitor, understand, and make meaningful decisions about their pain conditions. Our group previously presented data on Painimation, a novel electronic tool for communicating and assessing pain. Objective: This paper describes the human-centered design and development approach (inspiration, ideation, and implementation) that led to the creation of Painimation. Methods: We planned an iterative and cyclical development process that included stakeholder engagement and feedback from users. Stakeholders included patients with acute and chronic pain, health care providers, and design students. Target users were adults with acute or chronic pain who needed clinical assessment and tracking of the course of their pain over time. Phase I (inspiration) consisted of empathizing with users, understanding how patients experience pain, and identifying the barriers to accurately expressing and assessing pain. This phase involved understanding how patients communicate pain symptoms to providers, as well as defining limitations of current models of clinical pain assessment tools. In Phase II (ideate) we conceptualized and evaluated different approaches to expressing and assessing pain. The most promising concept was developed through an iterative process that involved end users and stakeholders. In Phase III (implementation), based on stakeholder feedback from initial designs and prototypes of abstract pain animations (painimations), we incorporated all concepts to test a minimally viable product, a fully functioning pain assessment app. We then gathered feedback through an agile development process and applied this feedback to finalizing a testable version of the app that could ultimately be used in a pain clinic. Results: Engaging intended users and stakeholders in an iterative, human-centered design process identified 5 criteria that a pain assessment tool would need to meet to be effective in the medical setting. These criteria were used as guiding design principles to generate a series of pain assessment concept ideas. This human-centered approach generated 8 highly visual painimations that were found to be acceptable and useable for communicating pain with medical providers, by both patients with general pain and patients with sickle cell disease (SCD). While these initial steps continued refinement of the tool, further data are needed. Agile development will allow us to continue to incorporate precision medicine tools that are validated in the clinical research arena. Conclusions: A multiphase, human-centered design approach successfully resulted in the development of an innovation that has potential to improve the quality of medical care, particularly for underserved populations. The use of Painimation may especially benefit the medical care of minority populations with chronic and difficult-to-treat pain, such as adults with SCD. The insights generated from this study can be applied to the development of patient-reported outcomes tools that are more patient-centered, engaging, and effective. ",
doi="10.2196/27689",
url="https://humanfactors.jmir.org/2022/1/e27689",
url="http://www.ncbi.nlm.nih.gov/pubmed/34994697"
}


@Article{info:doi/10.2196/31246,
author="Cresswell, Kathrin
and Dom{\'i}nguez Hern{\'a}ndez, Andr{\'e}s
and Williams, Robin
and Sheikh, Aziz",
title="Key Challenges and Opportunities for Cloud Technology in Health Care: Semistructured Interview Study",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="6",
volume="9",
number="1",
pages="e31246",
keywords="cloud technology",
keywords="qualitative",
keywords="adoption",
keywords="implementation",
keywords="digital health",
keywords="data processing",
keywords="health care",
keywords="risk assessment",
keywords="user engagement",
abstract="Background: The use of cloud computing (involving storage and processing of data on the internet) in health care has increasingly been highlighted as having great potential in facilitating data-driven innovations. Although some provider organizations are reaping the benefits of using cloud providers to store and process their data, others are lagging behind. Objective: We aim to explore the existing challenges and barriers to the use of cloud computing in health care settings and investigate how perceived risks can be addressed. Methods: We conducted a qualitative case study of cloud computing in health care settings, interviewing a range of individuals with perspectives on supply, implementation, adoption, and integration of cloud technology. Data were collected through a series of in-depth semistructured interviews exploring current applications, implementation approaches, challenges encountered, and visions for the future. The interviews were transcribed and thematically analyzed using NVivo 12 (QSR International). We coded the data based on a sociotechnical coding framework developed in related work. Results: We interviewed 23 individuals between September 2020 and November 2020, including professionals working across major cloud providers, health care provider organizations, innovators, small and medium-sized software vendors, and academic institutions. The participants were united by a common vision of a cloud-enabled ecosystem of applications and by drivers surrounding data-driven innovation. The identified barriers to progress included the cost of data migration and skill gaps to implement cloud technologies within provider organizations, the cultural shift required to move to externally hosted services, a lack of user pull as many benefits were not visible to those providing frontline care, and a lack of interoperability standards and central regulations. Conclusions: Implementations need to be viewed as a digitally enabled transformation of services, driven by skill development, organizational change management, and user engagement, to facilitate the implementation and exploitation of cloud-based infrastructures and to maximize returns on investment. ",
doi="10.2196/31246",
url="https://humanfactors.jmir.org/2022/1/e31246",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989688"
}


@Article{info:doi/10.2196/27418,
author="Kenny, Lorna
and Moore, Kevin
and O' Riordan, Cl{\'i}ona
and Fox, Siobhan
and Barton, John
and Tedesco, Salvatore
and Sica, Marco
and Crowe, Colum
and Alam{\"a}ki, Antti
and Condell, Joan
and Nordstr{\"o}m, Anna
and Timmons, Suzanne",
title="The Views and Needs of People With Parkinson Disease Regarding Wearable Devices for Disease Monitoring: Mixed Methods Exploration",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="6",
volume="6",
number="1",
pages="e27418",
keywords="Parkinson disease",
keywords="wearable devices",
keywords="technology",
keywords="mixed method",
keywords="focus group",
keywords="survey",
keywords="mobile phone",
abstract="Background: Wearable devices can diagnose, monitor, and manage neurological disorders such as Parkinson disease. With a growing number of wearable devices, it is no longer a case of whether a wearable device can measure Parkinson disease motor symptoms, but rather which features suit the user. Concurrent with continued device development, it is important to generate insights on the nuanced needs of the user in the modern era of wearable device capabilities. Objective: This study aims to understand the views and needs of people with Parkinson disease regarding wearable devices for disease monitoring and management. Methods: This study used a mixed method parallel design, wherein survey and focus groups were concurrently conducted with people living with Parkinson disease in Munster, Ireland. Surveys and focus group schedules were developed with input from people with Parkinson disease. The survey included questions about technology use, wearable device knowledge, and Likert items about potential device features and capabilities. The focus group participants were purposively sampled for variation in age (all were aged >50 years) and sex. The discussions concerned user priorities, perceived benefits of wearable devices, and preferred features. Simple descriptive statistics represented the survey data. The focus groups analyzed common themes using a qualitative thematic approach. The survey and focus group analyses occurred separately, and results were evaluated using a narrative approach. Results: Overall, 32 surveys were completed by individuals with Parkinson disease. Four semistructured focus groups were held with 24 people with Parkinson disease. Overall, the participants were positive about wearable devices and their perceived benefits in the management of symptoms, especially those of motor dexterity. Wearable devices should demonstrate clinical usefulness and be user-friendly and comfortable. Participants tended to see wearable devices mainly in providing data for health care professionals rather than providing feedback for themselves, although this was also important. Barriers to use included poor hand function, average technology confidence, and potential costs. It was felt that wearable device design that considered the user would ensure better compliance and adoption. Conclusions: Wearable devices that allow remote monitoring and assessment could improve health care access for patients living remotely or are unable to travel. COVID-19 has increased the use of remotely delivered health care; therefore, future integration of technology with health care will be crucial. Wearable device designers should be aware of the variability in Parkinson disease symptoms and the unique needs of users. Special consideration should be given to Parkinson disease--related health barriers and the users' confidence with technology. In this context, a user-centered design approach that includes people with Parkinson disease in the design of technology will likely be rewarded with improved user engagement and the adoption of and compliance with wearable devices, potentially leading to more accurate disease management, including self-management. ",
doi="10.2196/27418",
url="https://formative.jmir.org/2022/1/e27418",
url="http://www.ncbi.nlm.nih.gov/pubmed/34989693"
}


@Article{info:doi/10.2196/23236,
author="Ogundaini, Oluwamayowa
and de la Harpe, Retha",
title="The Interplay Between Technology Performativity and Health Care Professionals in Hospital Settings: Service Design Approach",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="4",
volume="6",
number="1",
pages="e23236",
keywords="agency",
keywords="health care professionals",
keywords="technology performativity",
keywords="sub-Saharan Africa",
keywords="service design",
keywords="work activities",
keywords="mobile phone",
abstract="Background: The unexpected outbreak of the COVID-19 pandemic and the preventive measures of physical distancing have further necessitated the application of information and communication technologies (ICTs) to enhance the efficiency of work activities in health care. Although the interplay between human agency and technology performativity is critical to the success or failure of ICTs use in routine practice, it is rarely explored when designing health ICTs for hospital settings within the sub-Saharan Africa context. Objective: The objective of this study is to explore how the service delivery quality is being influenced by the technology-enabled activities of health care professionals at points of care using a service design strategy. Methods: An interpretivist stance was assumed to understand the socially constructed realities of health care professionals at points of care in a hospital setting. A service design strategy was identified as suitable for engaging health care professionals in co-design sessions to collect data. A purposive sampling technique was used to identify the participants. Open-ended questions were administered to gain insights into the work activities of physicians and nurses at points of care. Qualitative (textual) data were analyzed using thematic analysis. Ethical concerns about the safety and privacy of participants' data were addressed as per the university ethics review committee and provincial department of health. Results: The findings show that the attributes of human agency and technology features that drive technology performativity result in an interplay between social concepts and technical features that influence the transformation of human-machine interactions. In addition, the interplay of the double dance of agency model can be divided into 2 successive phases: intermediate and advanced. Intermediate interplay results in the perceived suitability or discomfort of health ICTs as experienced by health care professionals at initial interactions during the execution of work activities. Subsequently, the advanced interplay determines the usefulness and effectiveness of health ICTs in aiding task performance, which ultimately leads to either the satisfaction or dissatisfaction of health care professionals in the completion of their work activities at points of care. Conclusions: The adopted service design strategy revealed that the interaction moments of the tasks performed by health care professionals during the execution of their work activities at point of care determine the features of health ICTs relevant to work activities. Consequently, the ensuing experience of health care professionals at the completion of their work activities influences the use or discontinuation of health ICTs. Health care professionals consider the value-added benefits from the automation of their work activities to ultimately influence the quality of service delivery. The major knowledge contribution of this study is the awareness drawn to both the intermediate and advanced interplay of human-machine interaction when designing health ICTs. ",
doi="10.2196/23236",
url="https://formative.jmir.org/2022/1/e23236",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982713"
}


@Article{info:doi/10.2196/29969,
author="Wang, Hua
and Gupta, Sneha
and Singhal, Arvind
and Muttreja, Poonam
and Singh, Sanghamitra
and Sharma, Poorva
and Piterova, Alice",
title="An Artificial Intelligence Chatbot for Young People's Sexual and Reproductive Health in India (SnehAI): Instrumental Case Study",
journal="J Med Internet Res",
year="2022",
month="Jan",
day="3",
volume="24",
number="1",
pages="e29969",
keywords="artificial intelligence",
keywords="chatbot",
keywords="Facebook",
keywords="affordance",
keywords="sex education",
keywords="sexual and reproductive health",
keywords="contraception",
keywords="case study",
keywords="young people",
keywords="India",
keywords="transmedia",
keywords="mobile apps",
keywords="mobile health",
keywords="technology design",
keywords="user engagement",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Leveraging artificial intelligence (AI)--driven apps for health education and promotion can help in the accomplishment of several United Nations sustainable development goals. SnehAI, developed by the Population Foundation of India, is the first Hinglish (Hindi + English) AI chatbot, deliberately designed for social and behavioral changes in India. It provides a private, nonjudgmental, and safe space to spur conversations about taboo topics (such as safe sex and family planning) and offers accurate, relatable, and trustworthy information and resources. Objective: This study aims to use the Gibson theory of affordances to examine SnehAI and offer scholarly guidance on how AI chatbots can be used to educate adolescents and young adults, promote sexual and reproductive health, and advocate for the health entitlements of women and girls in India. Methods: We adopted an instrumental case study approach that allowed us to explore SnehAI from the perspectives of technology design, program implementation, and user engagement. We also used a mix of qualitative insights and quantitative analytics data to triangulate our findings. Results: SnehAI demonstrated strong evidence across fifteen functional affordances: accessibility, multimodality, nonlinearity, compellability, queriosity, editability, visibility, interactivity, customizability, trackability, scalability, glocalizability, inclusivity, connectivity, and actionability. SnehAI also effectively engaged its users, especially young men, with 8.2 million messages exchanged across a 5-month period. Almost half of the incoming user messages were texts of deeply personal questions and concerns about sexual and reproductive health, as well as allied topics. Overall, SnehAI successfully presented itself as a trusted friend and mentor; the curated content was both entertaining and educational, and the natural language processing system worked effectively to personalize the chatbot response and optimize user experience. Conclusions: SnehAI represents an innovative, engaging, and educational intervention that enables vulnerable and hard-to-reach population groups to talk and learn about sensitive and important issues. SnehAI is a powerful testimonial of the vital potential that lies in AI technologies for social good. ",
doi="10.2196/29969",
url="https://www.jmir.org/2022/1/e29969",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982034"
}


@Article{info:doi/10.2196/30474,
author="Mariakakis, Alex
and Karkar, Ravi
and Patel, N. Shwetak
and Kientz, A. Julie
and Fogarty, James
and Munson, A. Sean",
title="Using Health Concept Surveying to Elicit Usable Evidence: Case Studies of a Novel Evaluation Methodology",
journal="JMIR Hum Factors",
year="2022",
month="Jan",
day="3",
volume="9",
number="1",
pages="e30474",
keywords="mobile health",
keywords="survey instrument",
keywords="health screening",
keywords="health belief model",
keywords="path analysis",
keywords="user design",
keywords="health technology",
keywords="health intervention technology",
keywords="digital health",
keywords="mobile phone",
abstract="Background: Developers, designers, and researchers use rapid prototyping methods to project the adoption and acceptability of their health intervention technology (HIT) before the technology becomes mature enough to be deployed. Although these methods are useful for gathering feedback that advances the development of HITs, they rarely provide usable evidence that can contribute to our broader understanding of HITs. Objective: In this research, we aim to develop and demonstrate a variation of vignette testing that supports developers and designers in evaluating early-stage HIT designs while generating usable evidence for the broader research community. Methods: We proposed a method called health concept surveying for untangling the causal relationships that people develop around conceptual HITs. In health concept surveying, investigators gather reactions to design concepts through a scenario-based survey instrument. As the investigator manipulates characteristics related to their HIT, the survey instrument also measures proximal cognitive factors according to a health behavior change model to project how HIT design decisions may affect the adoption and acceptability of an HIT. Responses to the survey instrument were analyzed using path analysis to untangle the causal effects of these factors on the outcome variables. Results: We demonstrated health concept surveying in 3 case studies of sensor-based health-screening apps. Our first study (N=54) showed that a wait time incentive could influence more people to go see a dermatologist after a positive test for skin cancer. Our second study (N=54), evaluating a similar application design, showed that although visual explanations of algorithmic decisions could increase participant trust in negative test results, the trust would not have been enough to affect people's decision-making. Our third study (N=263) showed that people might prioritize test specificity or sensitivity depending on the nature of the medical condition. Conclusions: Beyond the findings from our 3 case studies, our research uses the framing of the Health Belief Model to elicit and understand the intrinsic and extrinsic factors that may affect the adoption and acceptability of an HIT without having to build a working prototype. We have made our survey instrument publicly available so that others can leverage it for their own investigations. ",
doi="10.2196/30474",
url="https://humanfactors.jmir.org/2022/1/e30474",
url="http://www.ncbi.nlm.nih.gov/pubmed/34982038"
}


@Article{info:doi/10.2196/25743,
author="Aguayo, A. Gloria
and Goetzinger, Catherine
and Scibilia, Renza
and Fischer, Aur{\'e}lie
and Seuring, Till
and Tran, Viet-Thi
and Ravaud, Philippe
and Bereczky, Tam{\'a}s
and Huiart, Laetitia
and Fagherazzi, Guy",
title="Methods to Generate Innovative Research Ideas and Improve Patient and Public Involvement in Modern Epidemiological Research: Review, Patient Viewpoint, and Guidelines for Implementation of a Digital Cohort Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="23",
volume="23",
number="12",
pages="e25743",
keywords="patient and public involvement",
keywords="workshops",
keywords="surveys",
keywords="focus groups",
keywords="co-design",
keywords="digital cohort study",
keywords="digital epidemiology",
keywords="social media",
keywords="mobile phone",
abstract="Background: Patient and public involvement (PPI) in research aims to increase the quality and relevance of research by incorporating the perspective of those ultimately affected by the research. Despite these potential benefits, PPI is rarely included in epidemiology protocols. Objective: The aim of this study is to provide an overview of methods used for PPI and offer practical recommendations for its efficient implementation in epidemiological research. Methods: We conducted a review on PPI methods. We mirrored it with a patient advocate's viewpoint about PPI. We then identified key steps to optimize PPI in epidemiological research based on our review and the viewpoint of the patient advocate, taking into account the identification of barriers to, and facilitators of, PPI. From these, we provided practical recommendations to launch a patient-centered cohort study. We used the implementation of a new digital cohort study as an exemplary use case. Results: We analyzed data from 97 studies, of which 58 (60\%) were performed in the United Kingdom. The most common methods were workshops (47/97, 48\%); surveys (33/97, 34\%); meetings, events, or conferences (28/97, 29\%); focus groups (25/97, 26\%); interviews (23/97, 24\%); consensus techniques (8/97, 8\%); James Lind Alliance consensus technique (7/97, 7\%); social media analysis (6/97, 6\%); and experience-based co-design (3/97, 3\%). The viewpoint of a patient advocate showed a strong interest in participating in research. The most usual PPI modalities were research ideas (60/97, 62\%), co-design (42/97, 43\%), defining priorities (31/97, 32\%), and participation in data analysis (25/97, 26\%). We identified 9 general recommendations and 32 key PPI-related steps that can serve as guidelines to increase the relevance of epidemiological studies. Conclusions: PPI is a project within a project that contributes to improving knowledge and increasing the relevance of research. PPI methods are mainly used for idea generation. On the basis of our review and case study, we recommend that PPI be included at an early stage and throughout the research cycle and that methods be combined for generation of new ideas. For e-cohorts, the use of digital tools is essential to scale up PPI. We encourage investigators to rely on our practical recommendations to extend PPI in future epidemiological studies. ",
doi="10.2196/25743",
url="https://www.jmir.org/2021/12/e25743",
url="http://www.ncbi.nlm.nih.gov/pubmed/34941554"
}


@Article{info:doi/10.2196/31737,
author="Curtis, G. Rachel
and Bartel, Bethany
and Ferguson, Ty
and Blake, T. Henry
and Northcott, Celine
and Virgara, Rosa
and Maher, A. Carol",
title="Improving User Experience of Virtual Health Assistants: Scoping Review",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="21",
volume="23",
number="12",
pages="e31737",
keywords="virtual assistant",
keywords="conversational agent",
keywords="chatbot",
keywords="eHealth",
keywords="digital health",
keywords="design",
keywords="user experience",
keywords="mobile phone",
abstract="Background: Virtual assistants can be used to deliver innovative health programs that provide appealing, personalized, and convenient health advice and support at scale and low cost. Design characteristics that influence the look and feel of the virtual assistant, such as visual appearance or language features, may significantly influence users' experience and engagement with the assistant. Objective: This scoping review aims to provide an overview of the experimental research examining how design characteristics of virtual health assistants affect user experience, summarize research findings of experimental research examining how design characteristics of virtual health assistants affect user experience, and provide recommendations for the design of virtual health assistants if sufficient evidence exists. Methods: We searched 5 electronic databases (Web of Science, MEDLINE, Embase, PsycINFO, and ACM Digital Library) to identify the studies that used an experimental design to compare the effects of design characteristics between 2 or more versions of an interactive virtual health assistant on user experience among adults. Data were synthesized descriptively. Health domains, design characteristics, and outcomes were categorized, and descriptive statistics were used to summarize the body of research. Results for each study were categorized as positive, negative, or no effect, and a matrix of the design characteristics and outcome categories was constructed to summarize the findings. Results: The database searches identified 6879 articles after the removal of duplicates. We included 48 articles representing 45 unique studies in the review. The most common health domains were mental health and physical activity. Studies most commonly examined design characteristics in the categories of visual design or conversational style and relational behavior and assessed outcomes in the categories of personality, satisfaction, relationship, or use intention. Over half of the design characteristics were examined by only 1 study. Results suggest that empathy and relational behavior and self-disclosure are related to more positive user experience. Results also suggest that if a human-like avatar is used, realistic rendering and medical attire may potentially be related to more positive user experience; however, more research is needed to confirm this. Conclusions: There is a growing body of scientific evidence examining the impact of virtual health assistants' design characteristics on user experience. Taken together, data suggest that the look and feel of a virtual health assistant does affect user experience. Virtual health assistants that show empathy, display nonverbal relational behaviors, and disclose personal information about themselves achieve better user experience. At present, the evidence base is broad, and the studies are typically small in scale and highly heterogeneous. Further research, particularly using longitudinal research designs with repeated user interactions, is needed to inform the optimal design of virtual health assistants. ",
doi="10.2196/31737",
url="https://www.jmir.org/2021/12/e31737",
url="http://www.ncbi.nlm.nih.gov/pubmed/34931997"
}


@Article{info:doi/10.2196/27991,
author="Majid, Shazmin
and Reeves, Stuart
and Figueredo, Grazziela
and Brown, Susan
and Lang, Alexandra
and Moore, Matthew
and Morriss, Richard",
title="The Extent of User Involvement in the Design of Self-tracking Technology for Bipolar Disorder: Literature Review",
journal="JMIR Ment Health",
year="2021",
month="Dec",
day="20",
volume="8",
number="12",
pages="e27991",
keywords="user-centered design",
keywords="participatory design",
keywords="human-computer interaction",
keywords="patient and public involvement",
keywords="self-monitoring technology",
keywords="bipolar disorder",
keywords="mobile phone",
abstract="Background: The number of self-monitoring apps for bipolar disorder (BD) is increasing. The involvement of users in human-computer interaction (HCI) research has a long history and is becoming a core concern for designers working in this space. The application of models of involvement, such as user-centered design, is becoming standardized to optimize the reach, adoption, and sustained use of this type of technology. Objective: This paper aims to examine the current ways in which users are involved in the design and evaluation of self-monitoring apps for BD by investigating 3 specific questions: are users involved in the design and evaluation of technology? If so, how does this happen? And what are the best practice ingredients regarding the design of mental health technology? Methods: We reviewed the available literature on self-tracking technology for BD and make an overall assessment of the level of user involvement in design. The findings were reviewed by an expert panel, including an individual with lived experience of BD, to form best practice ingredients for the design of mental health technology. This combines the existing practices of patient and public involvement and HCI to evolve from the generic guidelines of user-centered design and to those that are tailored toward mental health technology. Results: For the first question, it was found that out of the 11 novel smartphone apps included in this review, 4 (36\%) self-monitoring apps were classified as having no mention of user involvement in design, 1 (9\%) self-monitoring app was classified as having low user involvement, 4 (36\%) self-monitoring apps were classified as having medium user involvement, and 2 (18\%) self-monitoring apps were classified as having high user involvement. For the second question, it was found that despite the presence of extant approaches for the involvement of the user in the process of design and evaluation, there is large variability in whether the user is involved, how they are involved, and to what extent there is a reported emphasis on the voice of the user, which is the ultimate aim of such design approaches. For the third question, it is recommended that users are involved in all stages of design with the ultimate goal of empowering and creating empathy for the user. Conclusions: Users should be involved early in the design process, and this should not just be limited to the design itself, but also to associated research ensuring end-to-end involvement. Communities in health care--based design and HCI design need to work together to increase awareness of the different methods available and to encourage the use and mixing of the methods as well as establish better mechanisms to reach the target user group. Future research using systematic literature search methods should explore this further. ",
doi="10.2196/27991",
url="https://mental.jmir.org/2021/12/e27991",
url="http://www.ncbi.nlm.nih.gov/pubmed/34931992"
}


@Article{info:doi/10.2196/27599,
author="van Wier, F. Marieke
and Urry, Emily
and Lissenberg-Witte, I. Birgit
and Kramer, E. Sophia",
title="A Comparison of the Use of Smart Devices, Apps, and Social Media Between Adults With and Without Hearing Impairment: Cross-sectional Web-Based Study",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="20",
volume="23",
number="12",
pages="e27599",
keywords="hearing impairment",
keywords="social media use",
keywords="app use",
keywords="benefits from social media",
keywords="eHealth",
keywords="mobile phone",
abstract="Background: eHealth and social media could be of particular benefit to adults with hearing impairment, but it is unknown whether their use of smart devices, apps, and social media is similar to that of the general population. Objective: Our aim is to study whether adults with normal hearing and those with impaired hearing differ in their weekly use of smart devices, apps, and social media; reasons for using social media; and benefits from using social media. Methods: We used data from a Dutch cohort, the National Longitudinal Study on Hearing. Data were collected from September 2016 to April 2020 using a web-based questionnaire and speech-in-noise test. The results from this test were used to categorize normal hearing and hearing impairment. Outcomes were compared using (multiple) logistic regression models. Results: Adults with impaired hearing (n=384) did not differ from normal hearing adults (n=341) in their use of a smartphone or tablet. They were less likely to make use of social media apps on a smartphone, tablet, or smartwatch (age-adjusted odds ratio [OR] 0.67, 95\% CI 0.48-0.92; P=.02). Use of social media on all devices and use of other apps did not differ. Adults with hearing impairment were more likely to agree with using social media to stay in touch with family members (OR 1.54, 95\% CI 1.16-2.07; P=.003) and friends (age-adjusted OR 1.35, 95\% CI 1.01-1.81; P=.046). Furthermore, they were more likely to agree with using social media to perform their work (age-adjusted OR 1.51, 95\% CI 1.04-2.18; P=.03). There were no differences in the experienced benefits from social media. Conclusions: The potential for eHealth is confirmed because adults with hearing impairment are not less likely to use smart devices than their normal hearing peers. Adults with hearing impairment are less likely to use social media apps on a smart device but not less likely to use social media on all types of internet-connected devices. This warrants further research on the types of social media platforms that adults with hearing impairment use and on the type of device on which they prefer to use social media. Given that participants with hearing impairment are more likely than their normal hearing peers to use social media to perform their work, use of social media may be seen as an opportunity to enhance vocational rehabilitation services for persons with hearing impairment. ",
doi="10.2196/27599",
url="https://www.jmir.org/2021/12/e27599",
url="http://www.ncbi.nlm.nih.gov/pubmed/34932013"
}


@Article{info:doi/10.2196/26002,
author="Alodhayani, A. Abdulaziz
and Hassounah, Mazen Marwah
and Qadri, R. Fatima
and Abouammoh, A. Noura
and Ahmed, Zakiuddin
and Aldahmash, M. Abdullah",
title="Culture-Specific Observations in a Saudi Arabian Digital Home Health Care Program: Focus Group Discussions With Patients and Their Caregivers",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="8",
volume="23",
number="12",
pages="e26002",
keywords="connected health",
keywords="digital health",
keywords="telehealth",
keywords="telemedicine",
keywords="culture",
keywords="Islam",
keywords="Arab",
keywords="mobile phone",
abstract="Background: There is growing evidence of the need to consider cultural factors in the design and implementation of digital health interventions. However, there is still inadequate knowledge pertaining to the aspects of the Saudi Arabian culture that need to be considered in the design and implementation of digital health programs, especially in the context of home health care services for patients who are chronically and terminally ill. Objective: This study aims to explore the specific cultural factors related to patients and their caregivers from the perspective of physicians, nurses, and trainers that have influenced the pilot implementation of Remotely Accessible Healthcare At Home, a connected health program in the Home Health Care department at King Saud University Medical City, Riyadh, Saudi Arabia. Methods: A qualitative study design was adopted to conduct a focus group discussion in July 2019 using a semistructured interview guide with 3 female and 4 male participants working as nurses, family physicians, and information technologists. Qualitative data obtained were analyzed using a thematic framework analysis. Results: A total of 2 categories emerged from the focus group discussion that influenced the experiences of digital health program intervention: first, culture-related factors including language and communication, cultural views on using cameras during consultation, nonadherence to web-based consultations, and family role and commitment and second, caregiver characteristics in telemedicine that includes their skills and education and electronic literacy. Participants of this study revealed that indirect contact with patients and their family members may work as a barrier to proper communication through the Remotely Accessible Healthcare At Home program. Conclusions: We recommend exploring the use of interpreters in digital health, creating awareness among the local population regarding privacy in digital health, and actively involving direct family members with the health care providers. ",
doi="10.2196/26002",
url="https://www.jmir.org/2021/12/e26002",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889740"
}


@Article{info:doi/10.2196/28102,
author="G{\"o}ttgens, Irene
and Oertelt-Prigione, Sabine",
title="The Application of Human-Centered Design Approaches in Health Research and Innovation: A Narrative Review of Current Practices",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Dec",
day="6",
volume="9",
number="12",
pages="e28102",
keywords="human-centered design",
keywords="design thinking",
keywords="user-centered design",
keywords="design-based research",
keywords="methodology",
keywords="review",
keywords="mobile phone",
abstract="Background: Human-centered design (HCD) approaches to health care strive to support the development of innovative, effective, and person-centered solutions for health care. Although their use is increasing, there is no integral overview describing the details of HCD methods in health innovations. Objective: This review aims to explore the current practices of HCD approaches for the development of health innovations, with the aim of providing an overview of the applied methods for participatory and HCD processes and highlighting their shortcomings for further research. Methods: A narrative review of health research was conducted based on systematic electronic searches in the PubMed, CINAHL, Embase, Cochrane Library, Web of Science, PsycINFO, and Sociological Abstracts (2000-2020) databases using keywords related to human-centered design, design thinking (DT), and user-centered design (UCD). Abstracts and full-text articles were screened by 2 reviewers independently based on predefined inclusion criteria. Data extraction focused on the methodology used throughout the research process, the choice of methods in different phases of the innovation cycle, and the level of engagement of end users. Results: This review summarizes the application of HCD practices across various areas of health innovation. All approaches prioritized the user's needs and the participatory and iterative nature of the design process. The design processes comprised several design cycles during which multiple qualitative and quantitative methods were used in combination with specific design methods. HCD- and DT-based research primarily targeted understanding the research context and defining the problem, whereas UCD-based work focused mainly on the direct generation of solutions. Although UCD approaches involved end users primarily as testers and informants, HCD and DT approaches involved end users most often as design partners. Conclusions: We have provided an overview of the currently applied methodologies and HCD guidelines to assist health care professionals and design researchers in their methodological choices. HCD-based techniques are challenging to evaluate using traditional biomedical research methods. Previously proposed reporting guidelines are a step forward but would require a level of detail that is incompatible with the current publishing landscape. Hence, further development is needed in this area. Special focus should be placed on the congruence between the chosen methods, design strategy, and achievable outcomes. Furthermore, power dimensions, agency, and intersectionality need to be considered in co-design sessions with multiple stakeholders, especially when including vulnerable groups. ",
doi="10.2196/28102",
url="https://mhealth.jmir.org/2021/12/e28102",
url="http://www.ncbi.nlm.nih.gov/pubmed/34874893"
}


@Article{info:doi/10.2196/25012,
author="Newton, S. Amanda
and March, Sonja
and Gehring, D. Nicole
and Rowe, K. Arlen
and Radomski, D. Ashley",
title="Establishing a Working Definition of User Experience for eHealth Interventions of Self-reported User Experience Measures With eHealth Researchers and Adolescents: Scoping Review",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="2",
volume="23",
number="12",
pages="e25012",
keywords="eHealth",
keywords="internet",
keywords="design",
keywords="development",
keywords="user experience",
keywords="health care",
keywords="scoping review",
keywords="Delphi",
abstract="Background: Across eHealth intervention studies involving children, adolescents, and their parents, researchers have measured user experience to assist with intervention development, refinement, and evaluation. To date, no widely accepted definitions or measures of user experience exist to support a standardized approach for evaluation and comparison within or across interventions. Objective: We conduct a scoping review with subsequent Delphi consultation to identify how user experience is defined and measured in eHealth research studies, characterize the measurement tools used, and establish working definitions for domains of user experience that could be used in future eHealth evaluations. Methods: We systematically searched electronic databases for published and gray literature available from January 1, 2005, to April 11, 2019. We included studies assessing an eHealth intervention that targeted any health condition and was designed for use by children, adolescents, and their parents. eHealth interventions needed to be web-, computer-, or mobile-based, mediated by the internet with some degree of interactivity. We required studies to report the measurement of user experience as first-person experiences, involving cognitive and behavioral factors reported by intervention users. We appraised the quality of user experience measures in included studies using published criteria: well-established, approaching well-established, promising, or not yet established. We conducted a descriptive analysis of how user experience was defined and measured in each study. Review findings subsequently informed the survey questions used in the Delphi consultations with eHealth researchers and adolescent users for how user experience should be defined and measured. Results: Of the 8634 articles screened for eligibility, 129 articles and 1 erratum were included in the review. A total of 30 eHealth researchers and 27 adolescents participated in the Delphi consultations. On the basis of the literature and consultations, we proposed working definitions for 6 main user experience domains: acceptability, satisfaction, credibility, usability, user-reported adherence, and perceived impact. Although most studies incorporated a study-specific measure, we identified 10 well-established measures to quantify 5 of the 6 domains of user experience (all except for self-reported adherence). Our adolescent and researcher participants ranked perceived impact as one of the most important domains of user experience and usability as one of the least important domains. Rankings between adolescents and researchers diverged for other domains. Conclusions: Findings highlight the various ways in which user experience has been defined and measured across studies and what aspects are most valued by researchers and adolescent users. We propose incorporating the working definitions and available measures of user experience to support consistent evaluation and reporting of outcomes across studies. Future studies can refine the definitions and measurement of user experience, explore how user experience relates to other eHealth outcomes, and inform the design and use of human-centered eHealth interventions. ",
doi="10.2196/25012",
url="https://www.jmir.org/2021/12/e25012",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860671"
}


@Article{info:doi/10.2196/24144,
author="Huang, Ling Chiao
and Chiang, Chia-Hsun
and Yang, Ching Shu",
title="eHealth Literacy and Beliefs About Medicines Among Taiwanese College Students: Cross-sectional Study",
journal="JMIR Med Inform",
year="2021",
month="Nov",
day="30",
volume="9",
number="11",
pages="e24144",
keywords="beliefs about medicines",
keywords="college student",
keywords="eHealth literacy",
keywords="health education",
abstract="Background: Good eHealth literacy and correct beliefs about medicines are beneficial for making good health care decisions and may further influence an individual's quality of life. However, few studies have discussed these two factors simultaneously. Moreover, gender differences are associated with health literacy and beliefs about medicines. Therefore, it is important to examine the multiple relationships between college students' eHealth literacy and beliefs about medicines, as well as gender differences. Objective: This study aims to (1) examine the multiple relationships between eHealth literacy and beliefs about medicines and (2) analyze gender differences in eHealth literacy and beliefs about medicines with Taiwanese college students. Methods: We used a paper-and-pencil questionnaire that included age, gender, 3-level eHealth literacy, and beliefs about medicines to collect data. In total, 475 data points were obtained and analyzed through independent t tests and canonical correlation analyses. Results: The t test (t473=3.73; P<.001; t473=--2.10; P=.04) showed that women had lower functional eHealth literacy and more specific concerns about medicines than men. Canonical correlation analyses indicated that the first and second canonical correlation coefficients between eHealth literacy and beliefs about medicines reached a significant level, implying that a multivariate relationship indeed existed. Conclusions: These findings reveal that women in Taiwan have lower functional eHealth literacy and stronger concerns about medicines than men. In addition, students with higher eHealth literacy have more positive perceptions of and beliefs about medicines. ",
doi="10.2196/24144",
url="https://medinform.jmir.org/2021/11/e24144",
url="http://www.ncbi.nlm.nih.gov/pubmed/34851301"
}


@Article{info:doi/10.2196/32609,
author="Santos, D. Amanda
and Caine, Vera
and Robson, J. Paula
and Watson, Linda
and Easaw, C. Jacob
and Petrovskaya, Olga",
title="Oncology Patients' Experiences With Novel Electronic Patient Portals to Support Care and Treatment: Qualitative Study With Early Users and Nonusers of Portals in Alberta, Canada",
journal="JMIR Cancer",
year="2021",
month="Nov",
day="24",
volume="7",
number="4",
pages="e32609",
keywords="patient portal",
keywords="MyChart",
keywords="health information and communication technology",
keywords="eHealth",
keywords="personal health information",
keywords="oncology",
keywords="cancer care",
keywords="Canada",
keywords="qualitative",
keywords="context of technology implementation",
abstract="Background: With the current proliferation of clinical information technologies internationally, patient portals are increasingly being adopted in health care. Research, conducted mostly in the United States, shows that oncology patients have a keen interest in portals to gain access to and track comprehensive personal health information. In Canada, patient portals are relatively new and research into their use and effects is currently emerging. There is a need to understand oncology patients' experiences of using eHealth tools and to ground these experiences in local sociopolitical contexts of technology implementation, while seeking to devise strategies to enhance portal benefits. Objective: The purpose of this study was to explore the experiences of oncology patients and their family caregivers when using electronic patient portals to support their health care needs. We focused on how Alberta's unique, 2-portal context shapes experiences of early portal adopters and nonadopters, in anticipation of a province-wide rollout of a clinical information system in oncology facilities. Methods: This qualitative descriptive study employed individual semistructured interviews and demographic surveys with 11 participants. Interviews were audio-recorded and transcribed verbatim. Data were analyzed thematically. The study was approved by the University of Alberta Human Research Ethics Board. Results: Participants currently living with nonactive cancer discussed an online patient portal as one among many tools (including the internet, phone, videoconferencing, print-out reports) available to make sense of their diagnosis and treatment, maintain connections with health care providers, and engage with information. In the Fall of 2020, most participants had access to 1 of 2 of Alberta's patient portals and identified ways in which this portal was supportive (or not) of their ongoing health care needs. Four major themes, reflecting the participants' broader concerns within which the portal use was occurring, were generated from the data: (1) experiencing doubt and the desire for transparency; (2) seeking to become an informed and active member of the health care team; (3) encountering complexity; and (4) emphasizing the importance of the patient--provider relationship. Conclusions: Although people diagnosed with cancer and their family caregivers considered an online patient portal as beneficial, they identified several areas that limit how portals support their oncology care. Providers of health care portals are invited to recognize these limitations and work toward addressing them. ",
doi="10.2196/32609",
url="https://cancer.jmir.org/2021/4/e32609",
url="http://www.ncbi.nlm.nih.gov/pubmed/34822338"
}


@Article{info:doi/10.2196/32320,
author="Robinson, A. Stephanie
and Netherton, Dane
and Zocchi, Mark
and Purington, Carolyn
and Ash, S. Arlene
and Shimada, L. Stephanie",
title="Differences in Secure Messaging, Self-management, and Glycemic Control Between Rural and Urban Patients: Secondary Data Analysis",
journal="JMIR Diabetes",
year="2021",
month="Nov",
day="19",
volume="6",
number="4",
pages="e32320",
keywords="diabetes",
keywords="secure messaging",
keywords="rural",
keywords="self-management",
keywords="patient portal",
keywords="urban",
keywords="data",
keywords="access",
keywords="risk",
keywords="portal",
keywords="eHealth",
keywords="digital health",
keywords="messaging",
keywords="support",
keywords="accessible",
keywords="cross-sectional",
keywords="veteran",
abstract="Background: Rural patients with diabetes have difficulty accessing care and are at higher risk for poor diabetes management. Sustained use of patient portal features such as secure messaging (SM) can provide accessible support for diabetes self-management. Objective: This study explored whether rural patients' self-management and glycemic control was associated with the use of SM. Methods: This secondary, cross-sectional, mixed methods analysis of 448 veterans with diabetes used stratified random sampling to recruit a diverse sample from the United States (rural vs urban and good vs poor glycemic control). Administrative, clinical, survey, and interview data were used to determine patients' rurality, use of SM, diabetes self-management behaviors, and glycemic control. Moderated mediation analyses assessed these relationships. Results: The sample was 51\% (n=229) rural and 49\% (n=219) urban. Mean participant age was 66.4 years (SD 7.7 years). More frequent SM use was associated with better diabetes self-management (P=.007), which was associated with better glycemic control (P<.001). Among rural patients, SM use was indirectly associated with better glycemic control through improved diabetes self-management (95\% CI 0.004-0.927). These effects were not observed among urban veterans with diabetes (95\% CI --1.039 to 0.056). Rural patients were significantly more likely than urban patients to have diabetes-related content in their secure messages (P=.01). Conclusions: More frequent SM use is associated with engaging in diabetes self-management, which, in turn, is associated with better diabetes control. Among rural patients with diabetes, SM use is indirectly associated with better diabetes control. Frequent patient-team communication through SM about diabetes-related content may help rural patients with diabetes self-management, resulting in better glycemic control. ",
doi="10.2196/32320",
url="https://diabetes.jmir.org/2021/4/e32320",
url="http://www.ncbi.nlm.nih.gov/pubmed/34807834"
}


@Article{info:doi/10.2196/30420,
author="Pan, Jing
and Dong, Hua
and Bryan-Kinns, Nick",
title="Perception and Initial Adoption of Mobile Health Services of Older Adults in London: Mixed Methods Investigation",
journal="JMIR Aging",
year="2021",
month="Nov",
day="19",
volume="4",
number="4",
pages="e30420",
keywords="older adults",
keywords="mHealth",
keywords="initial adoption",
keywords="technology acceptance",
keywords="design",
keywords="mobile phone",
abstract="Background: Advances in mobile technology and public needs have resulted in the emergence of mobile health (mHealth) services. Despite the potential benefits of mHealth apps, older adults face challenges and barriers in adopting them. Objective: The aims of this study are to understand older adults' perception of mHealth services and to discover the barriers that older adults face in the initial adoption of mHealth apps. Methods: This paper systematically analyzed main determinants related to mHealth services and investigated them through questionnaires, interviews, and a workshop. Two studies were carried out in London. In study 1, the questionnaires with follow-up interviews were conducted based on the literature review to uncover older adults' perception (including perceived usefulness, perceived ease of use, and perceived behavioral control) of mHealth services. Study 2 was a workshop helping older adults to trial selected mHealth apps. The workshop was conducted by the first author (JP) with assistance from 5 research students. The barriers that older adults faced in the initial adoption period were observed. The interviews and workshop were audiotaped and transcribed. Descriptive statistics and the thematic analysis technique were used for data analysis. Results: In total, 30 older adults in London completed the questionnaires and interviews in study 1. The results of study 1 show that the lack of obvious advantage, low reliability, scary information, and the risk of privacy leakage would decrease older adults' perceived usefulness of mHealth services; the design of app interface would directly affect the perceived ease of use; and aging factors, especially the generation gap, would create barriers for older users. In total, 12 participants took part in the workshop of study 2, including 8 who took part in study 1. The results of study 2 identified that access to technology, the way of interaction, the risk of money loss, heavy workload of using an mHealth app, and different lifestyle are influential factors to older adults' adoption of mHealth services. Conclusions: The perceptions of mHealth services of older adults were investigated; the barriers that older adults may face in the initial adoption stage were identified. On the basis of the synthesis of these results, design suggestions were proposed, including technical improvement, free trial, information clarification, and participatory design. They will help inform the design of mHealth services to benefit older adults. ",
doi="10.2196/30420",
url="https://aging.jmir.org/2021/4/e30420",
url="http://www.ncbi.nlm.nih.gov/pubmed/34807836"
}


@Article{info:doi/10.2196/29207,
author="Alessa, Tourkiah
and Hawley, Mark
and de Witte, Luc",
title="Identification of the Most Suitable App to Support the Self-Management of Hypertension: Systematic Selection Approach and Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2021",
month="Nov",
day="17",
volume="9",
number="11",
pages="e29207",
keywords="app",
keywords="hypertension",
keywords="self-management",
keywords="mHealth",
keywords="blood pressure",
keywords="support",
keywords="Saudi Arabia",
keywords="cardiology",
keywords="heart",
keywords="effective",
keywords="security",
abstract="Background: Smartphone apps are increasingly being used to aid in hypertension self-management, and a large and ever-growing number of self-management apps have been commercially released. However, very few of these are potentially effective and secure, and researchers have yet to establish the suitability of specific hypertension apps to particular contexts. Objective: The aim of this study is to identify the most suitable hypertension app in the context of Saudi Arabia and its health system. Methods: This study used a 2-stage approach to selecting the most suitable app for hypertension self-management. First, a systematic selection approach was followed to identify a shortlist of the most suitable apps according to the criteria of potential effectiveness, theoretical underpinning, and privacy and security. Second, an exploratory qualitative study was conducted to select the most suitable from the shortlist: 12 doctors were interviewed, and 22 patients participated in 4 focus groups. These explored participants' attitudes towards self-management apps in general, and their views towards the apps identified via the systematic selection process. The qualitative data were analyzed using framework analysis. Results: In the first stage, only 5 apps were found to be potentially effective while also having a theoretical underpinning and protecting users' data. In the second stage, both doctors and patients were generally interested in using hypertension apps, but most had no experience with these apps due to a lack of awareness of their availability and suitability. Patients and doctors liked apps that combine intuitive interfaces with a pleasant and clear visual design, in-depth features (eg, color-coded feedback accompanied with textual explanations), activity-specific reminders, and educational content regarding hypertension and potential complications. When the pros and cons of the 5 apps were discussed, 3 apps were identified as being more suitable, with Cora Health rated the highest by the participants. Conclusions: Only 5 apps were deemed potentially effective and secure. Patients' and doctors' discussions of the pros and cons of these 5 apps revealed that 3 out of the 5 are clearly more suitable, with the Cora Health app being judged most suitable overall. ",
doi="10.2196/29207",
url="https://mhealth.jmir.org/2021/11/e29207",
url="http://www.ncbi.nlm.nih.gov/pubmed/34787586"
}


@Article{info:doi/10.2196/30350,
author="Malamsha, Proches Maria
and Sauli, Elingarami
and Luhanga, Talina Edith",
title="Development and Validation of a Mobile Game for Culturally Sensitive Child Sexual Abuse Prevention Education in Tanzania: Mixed Methods Study",
journal="JMIR Serious Games",
year="2021",
month="Nov",
day="8",
volume="9",
number="4",
pages="e30350",
keywords="child sexual abuse",
keywords="social cultural belief",
keywords="ecological setting",
keywords="prevention",
keywords="parents",
keywords="caretakers",
keywords="child experts",
keywords="mobile game",
abstract="Background: Globally, 3 out of 20 children experience sexual abuse before the age of 18 years. Educating children about sexual abuse and prevention is an evidence-based strategy that is recommended for ending child sexual abuse. Digital games are increasingly being used to influence healthy behaviors in children and could be an efficient and friendly approach to educating children about sexual abuse prevention. However, little is known on the best way to develop a culturally sensitive game that targets children in Africa---where sexual education is still taboo---that would be engaging, effective, and acceptable to parents and caretakers. Objective: This study aimed to develop a socioculturally appropriate, mobile-based game for educating young children (<5 years) and parents and caretakers in Tanzania on sexual abuse prevention. Methods: ?HappyToto children's game was co-designed with 111 parents and caretakers (females: n=58, 52.3\%; male: n=53, 47.7\%) of children below 18 years of age and 24 child experts in Tanzania through surveys and focus group discussions conducted from March 2020 to April 2020. From these, we derived an overview of topics, sociocultural practices, social environment, and game interface designs that should be considered when designing child sexual abuse prevention (CSAP) education interventions. We also conducted paper prototyping and storyboarding sessions for the game's interface, storylines, and options. To validate the application's prototype, 32 parents (females: n=18, 56\%; males: n=14, 44\%) of children aged 3-5 years and 5 children (females: n=2, 40\%; males: n=3, 60\%) of the same age group played the game for half an hour on average. The parents undertook a pre-post intervention assessment on confidence and ability to engage in CSAP education conversations, as well as exit surveys on the usability and sociocultural acceptability of the game, while children were quizzed on the topics covered and their enjoyment of the game. Results: Parents and caregivers showed interest in the developed game during the conducted surveys, and each parent on average navigated through all the parts of the game. The confidence level of parents in talking about CSAP increased from an average of 3.56 (neutral) before using the game to 4.9 (confident) after using the game. The ability scores, calculated based on a range of topics included in CSAP education talks with children, also increased from 5.67 (out of 10) to 8.8 (out of 10) after the game was played. Both confidence level and ability scores were statistically significant (P<.001). All 5 children were interested in the game and enjoyed the game-provided activities. Conclusions: The HappyToto game can thus be an effective technology-based intervention for improving the knowledge and skills of parents and children in CSAP education. ",
doi="10.2196/30350",
url="https://games.jmir.org/2021/4/e30350",
url="http://www.ncbi.nlm.nih.gov/pubmed/34747703"
}


@Article{info:doi/10.2196/29951,
author="Walker, Jan
and Leveille, Suzanne
and Kriegel, Gila
and Lin, Chen-Tan
and Liu, K. Stephen
and Payne, H. Thomas
and Harcourt, Kendall
and Dong, Zhiyong
and Fitzgerald, Patricia
and Germak, Matthew
and Markson, Lawrence
and Jackson, L. Sara
and Shucard, Hannah
and Elmore, G. Joann
and Delbanco, Tom",
title="Patients Contributing to Visit Notes: Mixed Methods Evaluation of OurNotes",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="8",
volume="23",
number="11",
pages="e29951",
keywords="electronic health record",
keywords="previsit information",
keywords="physician-patient relations",
keywords="patient portal",
keywords="mobile phone",
abstract="Background: Secure patient portals are widely available, and patients use them to view their electronic health records, including their clinical notes. We conducted experiments asking them to cogenerate notes with their clinicians, an intervention called OurNotes. Objective: This study aims to assess patient and provider experiences and attitudes after 12 months of a pilot intervention. Methods: Before scheduled primary care visits, patients were asked to submit a word-constrained, unstructured interval history and an agenda for what they would like to discuss at the visit. Using site-specific methods, their providers were invited to incorporate the submissions into notes documenting the visits. Sites served urban, suburban, and rural patients in primary care practices in 4 academic health centers in Boston (Massachusetts), Lebanon (New Hampshire), Denver (Colorado), and Seattle (Washington). Each practice offered electronic access to visit notes (open notes) to its patients for several years. A mixed methods evaluation used tracking data and electronic survey responses from patients and clinicians. Participants were 174 providers and 1962 patients who submitted at least 1 previsit form. We asked providers about the usefulness of the submissions, effects on workflow, and ideas for the future. We asked patients about difficulties and benefits of providing the requested information and ideas for future improvements. Results: Forms were submitted before 9.15\% (5365/58,652) eligible visits, and 43.7\% (76/174) providers and 26.76\% (525/1962) patients responded to the postintervention evaluation surveys; 74 providers and 321 patients remembered receiving and completing the forms and answered the survey questions. Most clinicians thought interim patient histories (69/74, 93\%) and patient agendas (72/74, 97\%) as good ideas, 70\% (52/74) usually or always incorporated them into visit notes, 54\% (40/74) reported no change in visit length, and 35\% (26/74) thought they saved time. Their most common suggestions related to improving notifications when patient forms were received, making it easier to find the form and insert it into the note, and educating patients about how best to prepare their submissions. Patient respondents were generally well educated, most found the history (259/321, 80.7\%) and agenda (286/321, 89.1\%) questions not difficult to answer; more than 92.2\% (296/321) thought sending answers before the visit a good idea; 68.8\% (221/321) thought the questions helped them prepare for the visit. Common suggestions by patients included learning to write better answers and wanting to know that their submissions were read by their clinicians. At the end of the pilot, all participating providers chose to continue the OurNotes previsit form, and sites considered expanding the intervention to more clinicians and adapting it for telemedicine visits. Conclusions: OurNotes interests patients, and providers experience it as a positive intervention. Participation by patients, care partners, clinicians, and electronic health record experts will facilitate further development. ",
doi="10.2196/29951",
url="https://www.jmir.org/2021/11/e29951",
url="http://www.ncbi.nlm.nih.gov/pubmed/34747710"
}


@Article{info:doi/10.2196/24110,
author="ter Stal, Silke
and Sloots, Joanne
and Ramlal, Aniel
and op den Akker, Harm
and Lenferink, Anke
and Tabak, Monique",
title="An Embodied Conversational Agent in an eHealth Self-management Intervention for Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Exploratory Study in a Real-life Setting",
journal="JMIR Hum Factors",
year="2021",
month="Nov",
day="4",
volume="8",
number="4",
pages="e24110",
keywords="embodied conversational agent",
keywords="eHealth",
keywords="self-management",
keywords="design",
keywords="daily life evaluation",
abstract="Background: Embodied conversational agents (ECAs) have the potential to stimulate actual use of eHealth apps. An ECA's design influences the user's perception during short interactions, but daily life evaluations of ECAs in health care are scarce. Objective: This is an exploratory, long-term study on the design of ECAs for eHealth. The study investigates how patients perceive the design of the ECA over time with regard to the ECA's characteristics (friendliness, trustworthiness, involvement, expertise, and authority), small talk interaction, and likeliness of following the agent's advice. Methods: We developed an ECA within an eHealth self-management intervention for patients with both chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF), which we offered for 4 months. Patients rated 5 agent characteristics and likeliness of following the agent's advice before use and after 3 and 9 weeks of use. The amount of patients' small talk interaction was assessed by log data. Lastly, individual semistructured interviews were used to triangulate results. Results: Eleven patients (7 male and 4 female) with COPD and CHF participated (median age 70 years). Patients' perceptions of the agent characteristics did not change over time (P>.05 for all characteristics) and only 1 participant finished all small talk dialogues. After 3 weeks of use, the patients were less likely to follow the agent's advice (P=.01). The agent's messages were perceived as nonpersonalized and the feedback as inappropriate, affecting the agent's perceived reliability. Conclusions: This exploratory study provides first insights into ECA design for eHealth. The first impression of an ECA's design seems to remain during long-term use. To investigate future added value of ECAs in eHealth, perceived reliability should be improved by managing users' expectations of the ECA's capabilities and creating ECA designs fitting individual needs. Trial Registration: Netherlands Trial Register NL6480; https://www.trialregister.nl/trial/6480 ",
doi="10.2196/24110",
url="https://humanfactors.jmir.org/2021/4/e24110",
url="http://www.ncbi.nlm.nih.gov/pubmed/34734824"
}


@Article{info:doi/10.2196/29386,
author="Woodcock, Claire
and Mittelstadt, Brent
and Busbridge, Dan
and Blank, Grant",
title="The Impact of Explanations on Layperson Trust in Artificial Intelligence--Driven Symptom Checker Apps: Experimental Study",
journal="J Med Internet Res",
year="2021",
month="Nov",
day="3",
volume="23",
number="11",
pages="e29386",
keywords="symptom checker",
keywords="chatbot",
keywords="artificial intelligence",
keywords="explanations",
keywords="trust",
keywords="knowledge",
keywords="clinical communication",
keywords="mHealth",
keywords="digital health",
keywords="eHealth",
keywords="conversational agent",
keywords="virtual health care",
keywords="symptoms",
keywords="diagnostics",
keywords="mobile phone",
abstract="Background: Artificial intelligence (AI)--driven symptom checkers are available to millions of users globally and are advocated as a tool to deliver health care more efficiently. To achieve the promoted benefits of a symptom checker, laypeople must trust and subsequently follow its instructions. In AI, explanations are seen as a tool to communicate the rationale behind black-box decisions to encourage trust and adoption. However, the effectiveness of the types of explanations used in AI-driven symptom checkers has not yet been studied. Explanations can follow many forms, including why-explanations and how-explanations. Social theories suggest that why-explanations are better at communicating knowledge and cultivating trust among laypeople. Objective: The aim of this study is to ascertain whether explanations provided by a symptom checker affect explanatory trust among laypeople and whether this trust is impacted by their existing knowledge of disease. Methods: A cross-sectional survey of 750 healthy participants was conducted. The participants were shown a video of a chatbot simulation that resulted in the diagnosis of either a migraine or temporal arteritis, chosen for their differing levels of epidemiological prevalence. These diagnoses were accompanied by one of four types of explanations. Each explanation type was selected either because of its current use in symptom checkers or because it was informed by theories of contrastive explanation. Exploratory factor analysis of participants' responses followed by comparison-of-means tests were used to evaluate group differences in trust. Results: Depending on the treatment group, two or three variables were generated, reflecting the prior knowledge and subsequent mental model that the participants held. When varying explanation type by disease, migraine was found to be nonsignificant (P=.65) and temporal arteritis, marginally significant (P=.09). Varying disease by explanation type resulted in statistical significance for input influence (P=.001), social proof (P=.049), and no explanation (P=.006), with counterfactual explanation (P=.053). The results suggest that trust in explanations is significantly affected by the disease being explained. When laypeople have existing knowledge of a disease, explanations have little impact on trust. Where the need for information is greater, different explanation types engender significantly different levels of trust. These results indicate that to be successful, symptom checkers need to tailor explanations to each user's specific question and discount the diseases that they may also be aware of. Conclusions: System builders developing explanations for symptom-checking apps should consider the recipient's knowledge of a disease and tailor explanations to each user's specific need. Effort should be placed on generating explanations that are personalized to each user of a symptom checker to fully discount the diseases that they may be aware of and to close their information gap. ",
doi="10.2196/29386",
url="https://www.jmir.org/2021/11/e29386",
url="http://www.ncbi.nlm.nih.gov/pubmed/34730544"
}


@Article{info:doi/10.2196/28924,
author="Fujioka, Keiko Jamie
and Bickford, Julia
and Gritke, Jennifer
and Stamenova, Vess
and Jamieson, Trevor
and Bhatia, Sacha R.
and Desveaux, Laura",
title="Implementation Strategies to Improve Engagement With a Multi-Institutional Patient Portal: Multimethod Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="28",
volume="23",
number="10",
pages="e28924",
keywords="patient portal",
keywords="electronic health record",
keywords="patient health record",
keywords="digital health",
abstract="Background: Comprehensive multi-institutional patient portals that provide patients with web-based access to their data from across the health system have been shown to improve the provision of patient-centered and integrated care. However, several factors hinder the implementation of these portals. Although barriers and facilitators to patient portal adoption are well documented, there is a dearth of evidence examining how to effectively implement multi-institutional patient portals that transcend traditional boundaries and disparate systems. Objective: This study aims to explore how the implementation approach of a multi-institutional patient portal impacted the adoption and use of the technology and to identify the lessons learned to guide the implementation of similar patient portal models. Methods: This multimethod study included an analysis of quantitative and qualitative data collected during an evaluation of the multi-institutional MyChart patient portal that was deployed in Southwestern Ontario, Canada. Descriptive statistics were performed to understand the use patterns during the first 15 months of implementation (between August 2018 and October 2019). In addition, 42 qualitative semistructured interviews were conducted with 18 administrative stakeholders, 16 patients, 7 health care providers, and 1 informal caregiver to understand how the implementation approach influenced user experiences and to identify strategies for improvement. Qualitative data were analyzed using an inductive thematic analysis approach. Results: Between August 2018 and October 2019, 15,271 registration emails were sent, with 67.01\% (10,233/15,271) registered for an account across 38 health care sites. The median number of patients registered per site was 19, with considerable variation (range 1-2114). Of the total number of sites, 55\% (21/38) had ?30 registered patients, whereas only 2 sites had over 1000 registered patients. Interview participants perceived that the patient experience of the portal would have been improved by enhancing the data comprehensiveness of the technology. They also attributed the lack of enrollment to the absence of a broad rollout and marketing strategy across sites. Participants emphasized that provider engagement, change management support, and senior leadership endorsement were central to fostering uptake. Finally, many stated that regional alignment and policy support should have been sought to streamline implementation efforts across participating sites. Conclusions: Without proper management and planning, multi-institutional portals can suffer from minimal adoption. Data comprehensiveness is the foundational component of these portals and requires aligned policies and a key base of technology infrastructure across all participating sites. It is important to look beyond the category of the technology (ie, patient portal) and consider its functionality (eg, data aggregation, appointment scheduling, messaging) to ensure that it aligns with the underlying strategic priorities of the deployment. It is also critical to establish a clear vision and ensure buy-ins from organizational leadership and health care providers to support a cultural shift that will enable a meaningful and widespread engagement. ",
doi="10.2196/28924",
url="https://www.jmir.org/2021/10/e28924",
url="http://www.ncbi.nlm.nih.gov/pubmed/34709195"
}


@Article{info:doi/10.2196/27966,
author="Luo, Yan
and Dozier, Krystal
and Ikenberg, Carin",
title="Human-Technology Interaction Factors Associated With the Use of Electronic Personal Health Records Among Younger and Older Adults: Secondary Data Analysis",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="26",
volume="23",
number="10",
pages="e27966",
keywords="electronic personal health records",
keywords="human-technology interaction factors",
keywords="clinical notes",
keywords="smartphone app",
keywords="ease of understanding",
abstract="Background: An electronic personal health record (ePHR), also known as a personal health record (PHR), has been broadly defined as an electronic application through which individuals can access, manage, and share their health information in a secure and confidential environment. Although ePHRs can benefit individuals as well as caregivers and health care providers, the use of ePHRs among individuals continues to remain low. Objective: The current study aims to examine the relationship between human-technology interaction factors and ePHR use among adults and then to compare the different effects of human-technology interaction factors on ePHR use between younger adults (18-54 years old) and older adults (55 years of age and over). Methods: We analyzed data from the Health Information National Trends Survey (HINTS 5 cycle 3) collected from US adults aged 18 years old and over in 2019. Descriptive analysis was conducted for all variables and each item of ePHR use. Bivariate tests (Pearson correlation coefficient for categorical variable and F test for continuous variables) were conducted over 2 age groups. Finally, after adjustments were made for sociodemographics and health care resources, a weighted multiple linear regression was conducted to examine the relationship between human-technology interaction factors and ePHR use. Results: The final sample size of 1363 (average age 51.19) was divided into 2 age groups: 18 to 54 years old and 55 years old and older. The average level of ePHR use was low (mean 2.76, range 0-8). There was no significant difference in average ePHR use between the 2 age groups. Including clinical notes was positively related to ePHR use in both groups: 18 to 54 years old ($\beta$=.28, P=.005), 55 years old and older ($\beta$=.15, P=.006). Although accessing ePHRs using a smartphone app was only associated with ePHR use among younger adults ($\beta$=.29; P<.001), ease of understanding health information in ePHRs was positively linked to ePHR use only among older adults ($\beta$=.13; P=.003). Conclusions: This study found that including clinical notes was positively related to ePHR use in both age groups, which suggested that including clinical notes as a part of ePHRs might improve the effective use of ePHRs among patients. Moreover, accessing ePHRs using a smartphone app was associated with higher ePHR use among younger adults while ease of understanding health information in ePHRs was linked to higher ePHR use among older adults. The design of ePHRs should provide the option of being accessible through mobile devices to promote greater ePHR use among young people. For older adults, providers could add additional notes to explain the health information recorded in the ePHRs. ",
doi="10.2196/27966",
url="https://www.jmir.org/2021/10/e27966",
url="http://www.ncbi.nlm.nih.gov/pubmed/34698646"
}


@Article{info:doi/10.2196/31582,
author="Yousef, Cheriece Consuela
and Salgado, M. Teresa
and Farooq, Ali
and Burnett, Keisha
and McClelland, E. Laura
and Abu Esba, Carolina Laila
and Alhamdan, Solaiman Hani
and Khoshhal, Sahal
and Aldossary, Fahad Ibrahim
and Alyas, Anwar Omar
and DeShazo, P. Jonathan",
title="Health Care Providers' Acceptance of a Personal Health Record: Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="21",
volume="23",
number="10",
pages="e31582",
keywords="personal health records",
keywords="patient portals",
keywords="Ministry of National Guard Health Affairs",
keywords="UTAUT",
keywords="eHealth",
keywords="Middle East",
abstract="Background: Personal health records (PHRs) are eHealth tools designed to support patient engagement, patient empowerment, and patient- and person-centered care. Endorsement of a PHR by health care providers (HCPs) facilitates patient acceptance. As health care organizations in the Kingdom of Saudi Arabia begin to adopt PHRs, understanding the perspectives of HCPs is important because it can influence patient adoption. However, no studies evaluated HCPs' acceptance of PHRs in the Kingdom of Saudi Arabia. Objective: The aim of this study was to identify predictors of HCPs' acceptance of PHRs using behavioral intention to recommend as a proxy for adoption. Methods: This cross-sectional study was conducted among HCPs (physicians, pharmacists, nurses, technicians, others) utilizing a survey based on the Unified Theory of Acceptance and Use of Technology. The main theory constructs of performance expectancy, effort expectancy, social influence, facilitating conditions, and positive attitude were considered independent variables. Behavioral intention was the dependent variable. Age, years of experience, and professional role were tested as moderators between the main theory constructs and behavioral intention using partial least squares structural equation modeling. Results: Of the 291 participants, 246 were included in the final analysis. Behavioral intention to support PHR use among patients was significantly influenced by performance expectancy ($\beta$=.17, P=.03) and attitude ($\beta$=.61, P<.01). No moderating effects were present. Conclusions: This study identified performance expectancy and attitude as predictors of HCPs' behavioral intention to recommend PHR to patients. To encourage HCPs to endorse PHRs, health care organizations should involve HCPs in the implementation and provide training on the features available as well as expected benefits. Future studies should be conducted in other contexts and include other potential predictors. ",
doi="10.2196/31582",
url="https://www.jmir.org/2021/10/e31582",
url="http://www.ncbi.nlm.nih.gov/pubmed/34569943"
}


@Article{info:doi/10.2196/29764,
author="Morton, Emma
and Ho, Kendall
and Barnes, J. Steven
and Michalak, E. Erin",
title="Digital Health Literacy in Bipolar Disorder: International Web-Based Survey",
journal="JMIR Ment Health",
year="2021",
month="Oct",
day="19",
volume="8",
number="10",
pages="e29764",
keywords="eHealth",
keywords="health literacy",
keywords="bipolar disorder",
keywords="self-management",
abstract="Background: Web-based resources can support people with bipolar disorder (BD) to improve their knowledge and self-management. However, publicly available resources are heterogeneous in terms of their quality and ease of use. Characterizing digital health literacy (the skillset that enable people to navigate and make use of health information in a web-based context) in BD will support the development of educational resources. Objective: The aim of this study was to develop understanding of digital health literacy and its predictors in people with BD. Methods: A web-based survey was used to explore self-reported digital health literacy (as measured by the e-Health Literacy Scale [eHEALS]) in people with BD. Multiple regression analysis was used to evaluate potential predictors, including demographic/clinical characteristics and technology use. Results: A total of 919 respondents (77.9\% female; mean age 36.9 years) completed the survey. Older age ($\beta$=0.09; P=.01), postgraduate education ($\beta$=0.11; P=.01), and current use of self-management apps related to BD ($\beta$=0.13; P<.001) were associated with higher eHEALS ratings. Conclusions: Levels of self-reported digital health literacy were comparable or higher than other studies in the general population and specific physical/mental health conditions. However, individuals with BD who are younger, have completed less education, or are less familiar with mental health apps may require extra support to safely and productively navigate web-based health resources. Relevant educational initiatives are discussed. Future studies should evaluate skill development interventions for less digitally literate groups. ",
doi="10.2196/29764",
url="https://mental.jmir.org/2021/10/e29764",
url="http://www.ncbi.nlm.nih.gov/pubmed/34665143"
}


@Article{info:doi/10.2196/27122,
author="Zhai, Huiwen
and Yang, Xin
and Xue, Jiaolong
and Lavender, Christopher
and Ye, Tiantian
and Li, Ji-Bin
and Xu, Lanyang
and Lin, Li
and Cao, Weiwei
and Sun, Ying",
title="Radiation Oncologists' Perceptions of Adopting an Artificial Intelligence--Assisted Contouring Technology: Model Development and Questionnaire Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="30",
volume="23",
number="9",
pages="e27122",
keywords="artificial intelligence",
keywords="technology acceptance model",
keywords="intension",
keywords="resistance",
abstract="Background: An artificial intelligence (AI)--assisted contouring system benefits radiation oncologists by saving time and improving treatment accuracy. Yet, there is much hope and fear surrounding such technologies, and this fear can manifest as resistance from health care professionals, which can lead to the failure of AI projects. Objective: The objective of this study was to develop and test a model for investigating the factors that drive radiation oncologists' acceptance of AI contouring technology in a Chinese context. Methods: A model of AI-assisted contouring technology acceptance was developed based on the Unified Theory of Acceptance and Use of Technology (UTAUT) model by adding the variables of perceived risk and resistance that were proposed in this study. The model included 8 constructs with 29 questionnaire items. A total of 307 respondents completed the questionnaires. Structural equation modeling was conducted to evaluate the model's path effects, significance, and fitness. Results: The overall fitness indices for the model were evaluated and showed that the model was a good fit to the data. Behavioral intention was significantly affected by performance expectancy ($\beta$=.155; P=.01), social influence ($\beta$=.365; P<.001), and facilitating conditions ($\beta$=.459; P<.001). Effort expectancy ($\beta$=.055; P=.45), perceived risk ($\beta$=?.048; P=.35), and resistance bias ($\beta$=?.020; P=.63) did not significantly affect behavioral intention. Conclusions: The physicians' overall perceptions of an AI-assisted technology for radiation contouring were high. Technology resistance among Chinese radiation oncologists was low and not related to behavioral intention. Not all of the factors in the Venkatesh UTAUT model applied to AI technology adoption among physicians in a Chinese context. ",
doi="10.2196/27122",
url="https://www.jmir.org/2021/9/e27122",
url="http://www.ncbi.nlm.nih.gov/pubmed/34591029"
}


@Article{info:doi/10.2196/19794,
author="Toonders, Johanna Suze Adriana
and van Westrienen, Elisabeth Paula
and Konings, Sophie
and Nieboer, E. Marianne
and Veenhof, Cindy
and Pisters, F. Martijn",
title="Patients' Perspectives on the Usability of a Blended Approach to an Integrated Intervention for Patients With Medically Unexplained Physical Symptoms: Mixed Methods Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="28",
volume="23",
number="9",
pages="e19794",
keywords="usability",
keywords="medically unexplained physical symptoms",
keywords="blended care",
abstract="Background: Medically unexplained physical symptoms are physical symptoms, such as pain, fatigue, and dizziness, that persist for more than a few weeks and cannot be explained after adequate medical examination. Treatment for preventing the chronicity of symptoms is recommended. A promising approach is identifying patients who are at risk and subsequently offering a blended care intervention that focuses on promoting self-management while using eHealth as a supportive tool. When these interventions match with a patient's expectations, their effectiveness grows. Objective: This study aimed to obtain more insights into usability from the patient perspective to improve future interventions. Methods: A mixed methods design (ie, the use of qualitative and quantitative data) was used. Through semistructured interviews, in-depth insights were gained into patients' perspectives on usability. The analysis process was continuous and iterative. Data were synthesized and categorized into different themes. The System Usability Scale, which measures the usability of a system, was used to compare participants that found usability to be low, medium, or high. This study was approved by the Medical Ethical Committee Utrecht (approval number: 17-391/C). Results: Saturation was reached after interviewing 13 participants. The following four themes emerged from the interviews: motivations and expectations prior to participating in the program, the applicability of e-coaching, the role of health care professionals, and the integrated design of the blended approach. Conclusions: The successful implementation of integrated blended care interventions based on patients' perspectives requires matching treatments to patients' individual situations and motivations. Furthermore, personalizing the relative frequency of face-to-face appointments and e-coaching can improve usability. ",
doi="10.2196/19794",
url="https://www.jmir.org/2021/9/e19794",
url="http://www.ncbi.nlm.nih.gov/pubmed/34581674"
}


@Article{info:doi/10.2196/26721,
author="Xu, Huan Richard
and Zhou, Ling-Ming
and Wong, Lai-Yi Eliza
and Wang, Dong",
title="The Association Between Patients' eHealth Literacy and Satisfaction With Shared Decision-making and Well-being: Multicenter Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="24",
volume="23",
number="9",
pages="e26721",
keywords="eHealth literacy",
keywords="shared decision-making",
keywords="well-being",
keywords="eHEALS",
keywords="ICECAP-A",
abstract="Background: Although previous studies have shown that a high level of health literacy can improve patients' ability to engage in health-related shared decision-making (SDM) and improve their quality of life, few studies have investigated the role of eHealth literacy in improving patient satisfaction with SDM (SSDM) and well-being. Objective: This study aims to assess the relationship between patients' eHealth literacy and their socioeconomic determinants and to investigate the association between patients' eHealth literacy and their SSDM and well-being. Methods: The data used in this study were obtained from a multicenter cross-sectional survey in China. The eHealth Literacy Scale (eHEALS) and Investigating Choice Experiments Capability Measure for Adults were used to measure patients' eHealth literacy and capability well-being, respectively. The SSDM was assessed by using a self-administered questionnaire. The Kruskal-Wallis one-way analysis of variance and Wilcoxon signed-rank test were used to compare the differences in the eHEALS, SSDM, and Investigating Choice Experiments Capability Measure for Adults scores of patients with varying background characteristics. Ordinary least square regression models were used to assess the relationship among eHealth literacy, SSDM, and well-being adjusted by patients' background characteristics. Results: A total of 569 patients completed the questionnaire. Patients who were male, were highly educated, were childless, were fully employed, were without chronic conditions, and indicated no depressive disorder reported a higher mean score on the eHEALS. Younger patients (SSDM?61 years=88.6 vs SSDM16-30 years=84.2) tended to show higher SSDM. Patients who were rural residents and were well paid were more likely to report good capability well-being. Patients who had a higher SSDM and better capability well-being reported a significantly higher level of eHealth literacy than those who had lower SSDM and poorer capability well-being. The regression models showed a positive relationship between eHealth literacy and both SSDM ($\beta$=.22; P<.001) and well-being ($\beta$=.26; P<.001) after adjusting for patients' demographic, socioeconomic status, lifestyle, and health status variables. Conclusions: This study showed that patients with a high level of eHealth literacy are more likely to experience optimal SDM and improved capability well-being. However, patients' depressive status may alter the relationship between eHealth literacy and SSDM. ",
doi="10.2196/26721",
url="https://www.jmir.org/2021/9/e26721",
url="http://www.ncbi.nlm.nih.gov/pubmed/34559062"
}


@Article{info:doi/10.2196/31627,
author="Liu, Hua-Xuan
and Chow, Bik-Chu
and Liang, Wei
and Hassel, Holger
and Huang, Wendy YaJun",
title="Measuring a Broad Spectrum of eHealth Skills in the Web 3.0 Context Using an eHealth Literacy Scale: Development and Validation Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="23",
volume="23",
number="9",
pages="e31627",
keywords="eHealth literacy",
keywords="scale development",
keywords="validation",
keywords="college students",
abstract="Background: eHealth literacy (EHL) refers to a variety of capabilities that enable individuals to obtain health information from electronic resources and apply it to solve health problems. With the digitization of health care and the wide availability of health apps, a more diverse range of eHealth skills is required to properly use such health facilities. Existing EHL measurements focus mainly on the skill of obtaining health information (Web 1.0), whereas skills for web-based interactions (Web 2.0) and self-managing health data and applying information (Web 3.0) have not been well measured. Objective: This study aims to develop an EHL scale (eHLS) termed eHLS-Web3.0 comprising a comprehensive spectrum of Web 1.0, 2.0, and 3.0 skills to measure EHL, and evaluate its validity and reliability along with the measurement invariance among college students. Methods: In study 1, 421 Chinese college students (mean age 20.5, SD 1.4 years; 51.8\% female) and 8 health experts (mean age 38.3, SD 5.9 years; 87.5\% female) were involved to develop the eHLS-Web3.0. The scale development included three steps: item pool generation, content validation, and exploratory factor analysis. In study 2, 741 college students (mean age 21.3, SD 1.4 years; 52.2\% female) were recruited from 4 Chinese cities to validate the newly developed eHLS-Web3.0. The construct validity, convergent validity, concurrent validity, internal consistency reliability, test-retest reliability, and measurement invariance across genders, majors, and regions were examined by a series of statistical analyses, including confirmatory factor analysis (CFA) and multigroup CFAs using SPSS and Mplus software packages. Results: Based on the item pool of 374 statements collected during the conceptual development, 24 items (4-10 items per subscale) were generated and adjusted after cognitive testing and content validity examination. Through exploratory factor analysis, a 3-factor eHLS-Web3.0 was finally developed, and it included acquisition (8 items), verification (6 items), and application (10 items). In study 2, CFAs supported the construct validity of the 24-item 3D eHLS-Web3.0 ($\chi$2244=903.076, $\chi$2244=3.701, comparative fit index=0.924, Tucker-Lewis index=0.914, root mean square error of approximation [RMSEA]=0.06, and standardized root mean residual [SRMR]=0.051). The average variance extracted (AVE) value of 0.58 and high correlation between eHLS-Web3.0 subscales and the eHealth Literacy Scale (r=0.725-0.880, P<.001) indicated the convergent validity and concurrent validity of the eHLS-Web3.0. The results also indicated satisfactory internal consistency reliability ($\alpha$=.976, $\rho$=0.934-0.956) and test-retest reliability (r=0.858, P<.001) of the scale. Multigroup CFA demonstrated the 24-item eHLS-Web3.0 to be invariant at all configural, metric, strength, and structural levels across genders (female and male), majors (sport-related, medical, and general), and regions (Yinchuan, Kunming, Xiamen, and Beijing). Conclusions: The 24-item 3D eHLS-Web3.0 proved to be a reliable and valid measurement tool for EHL in the Web 3.0 context among Chinese college students. ",
doi="10.2196/31627",
url="https://www.jmir.org/2021/9/e31627",
url="http://www.ncbi.nlm.nih.gov/pubmed/34554098"
}


@Article{info:doi/10.2196/28976,
author="H{\"o}rhammer, Iiris
and Kujala, Sari
and Hilama, Pirjo
and Heponiemi, Tarja",
title="Building Primary Health Care Personnel's Support for a Patient Portal While Alleviating eHealth-Related Stress: Survey Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="22",
volume="23",
number="9",
pages="e28976",
keywords="patient portal",
keywords="implementation",
keywords="adoption",
keywords="health care personnel",
keywords="eHealth-related stress",
abstract="Background: Health care personnel's (HCP) engagement in patient portal implementation is necessary in embedding the use of the portal in everyday practices of a health care organization. While portal implementation may raise personnel's positive expectations of the benefits in patient care, it is often also stressful for them due to increased workloads and disruptions in clinical workflows. An understanding of social and technical factors that build personnel's support for patient portal implementation and alleviate their eHealth-related stress is therefore needed to realize the full potential of portals. Objective: The aim of this study was to explore the influence of managerial implementation practices, information technology (IT) usability, and personnel's eHealth competences on support for patient portal implementation and eHealth-related stress among primary HCP. Methods: The data were collected through a survey of 919 members at 2 health organizations in Finland. Linear and logistic regression models were fitted to study the associations between the variables. Results: Professionals' eHealth competence ($\beta$=.15, P<.001), usability ($\beta$=.11, P<.001), and implementation practices ($\beta$=.07, P<.001) were positively associated with professionals' support and negatively associated with professionals eHealth-related stress ($\beta$=?.07, P=.010; $\beta$=?.27, P<.001; and $\beta$=?.14, P<.001, respectively). Professionals' support was associated with their promotion of the portal to the patients (odds ratio 1.22, 95\% CI 1.07-1.40). Conclusions: The adoption of appropriate implementation practices and the usability of the technology can build personnel's support for a patient portal and alleviate their stress related to eHealth. Personnel's support is manifested in their promotion of the portal to patients. Health care managers are encouraged to consider the usability of the technology and the good implementation practices, such as proper informing, engagement of the personnel in planning the services, and allocation of resources to improve eHealth competence, as prerequisites for meaningful and sustainable use of patient portals. ",
doi="10.2196/28976",
url="https://www.jmir.org/2021/9/e28976",
url="http://www.ncbi.nlm.nih.gov/pubmed/34550087"
}


@Article{info:doi/10.2196/25472,
author="Neves, Lu{\'i}sa Ana
and J{\'a}come, Cristina
and Taveira-Gomes, Tiago
and Pereira, Margarida Ana
and Almeida, Rute
and Amaral, Rita
and Alves-Correia, Magna
and Mendes, Sandra
and Chaves-Loureiro, Cl{\'a}udia
and Val{\'e}rio, Margarida
and Lopes, Cristina
and Carvalho, Joana
and Mendes, Ana
and Ribeiro, Carmelita
and Prates, Sara
and Ferreira, Alberto Jos{\'e}
and Teixeira, Fernanda Maria
and Branco, Joana
and Santalha, Marta
and Vasconcelos, Jo{\~a}o Maria
and Lozoya, Carlos
and Santos, Natacha
and Cardia, Francisca
and Moreira, Sofia Ana
and Taborda-Barata, Lu{\'i}s
and Pinto, Sofia Cl{\'a}udia
and Ferreira, Ros{\'a}rio
and Morais Silva, Pedro
and Monteiro Ferreira, Tania
and C{\^a}mara, Raquel
and Lobo, Rui
and Bordalo, Diana
and Guimar{\~a}es, Cristina
and Esp{\'i}rito Santo, Maria
and Ferraz de Oliveira, Jos{\'e}
and C{\'a}lix Augusto, Jos{\'e} Maria
and Gomes, Ricardo
and Vieira, In{\^e}s
and da Silva, Sofia
and Marques, Maria
and Cardoso, Jo{\~a}o
and Morete, Ana
and Aroso, Margarida
and Cruz, Margarida Ana
and Nunes, Carlos
and C{\^a}mara, Rita
and Rodrigues, Natalina
and Abreu, Carmo
and Albuquerque, Lu{\'i}sa Ana
and Vieira, Cla{\'u}dia
and Santos, Carlos
and P{\'a}scoa, Ros{\'a}lia
and Chaves-Loureiro, Carla
and Alves, Adelaide
and Neves, {\^A}ngela
and Varanda Marques, Jos{\'e}
and Reis, Bruno
and Ferreira-Magalh{\~a}es, Manuel
and Almeida Fonseca, Jo{\~a}o",
title="Determinants of the Use of Health and Fitness Mobile Apps by Patients With Asthma: Secondary Analysis of Observational Studies",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="22",
volume="23",
number="9",
pages="e25472",
keywords="mobile apps",
keywords="smartphone",
keywords="patient participation",
keywords="self-management",
keywords="asthma",
abstract="Background: Health and fitness apps have potential benefits to improve self-management and disease control among patients with asthma. However, inconsistent use rates have been reported across studies, regions, and health systems. A better understanding of the characteristics of users and nonusers is critical to design solutions that are effectively integrated in patients' daily lives, and to ensure that these equitably reach out to different groups of patients, thus improving rather than entrenching health inequities. Objective: This study aimed to evaluate the use of general health and fitness apps by patients with asthma and to identify determinants of usage. Methods: A secondary analysis of the INSPIRERS observational studies was conducted using data from face-to-face visits. Patients with a diagnosis of asthma were included between November 2017 and August 2020. Individual-level data were collected, including age, gender, marital status, educational level, health status, presence of anxiety and depression, postcode, socioeconomic level, digital literacy, use of health services, and use of health and fitness apps. Multivariate logistic regression was used to model the probability of being a health and fitness app user. Statistical analysis was performed in R. Results: A total of 526 patients attended a face-to-face visit in the 49 recruiting centers and 514 had complete data. Most participants were ?40 years old (66.4\%), had at least 10 years of education (57.4\%), and were in the 3 higher quintiles of the socioeconomic deprivation index (70.1\%). The majority reported an overall good health status (visual analogue scale [VAS] score>70 in 93.1\%) and the prevalence of anxiety and depression was 34.3\% and 11.9\%, respectively. The proportion of participants who reported using health and fitness mobile apps was 41.1\% (n=211). Multivariate models revealed that single individuals and those with more than 10 years of education are more likely to use health and fitness mobile apps (adjusted odds ratio [aOR] 2.22, 95\%CI 1.05-4.75 and aOR 1.95, 95\%CI 1.12-3.45, respectively). Higher digital literacy scores were also associated with higher odds of being a user of health and fitness apps, with participants in the second, third, and fourth quartiles reporting aORs of 6.74 (95\%CI 2.90-17.40), 10.30 (95\%CI 4.28-27.56), and 11.52 (95\%CI 4.78-30.87), respectively. Participants with depression symptoms had lower odds of using health and fitness apps (aOR 0.32, 95\%CI 0.12-0.83). Conclusions: A better understanding of the barriers and enhancers of app use among patients with lower education, lower digital literacy, or depressive symptoms is key to design tailored interventions to ensure a sustained and equitable use of these technologies. Future studies should also assess users' general health-seeking behavior and their interest and concerns specifically about digital tools. These factors may impact both initial engagement and sustained use. ",
doi="10.2196/25472",
url="https://www.jmir.org/2021/9/e25472",
url="http://www.ncbi.nlm.nih.gov/pubmed/34550077"
}


@Article{info:doi/10.2196/27447,
author="Kim, Sunyoung
and Park, Yunoh
and Ackerman, K. Matthew",
title="Designing an Indoor Air Quality Monitoring App for Asthma Management in Children: User-Centered Design Approach",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="22",
volume="5",
number="9",
pages="e27447",
keywords="asthma",
keywords="children",
keywords="indoor air quality",
keywords="mobile app",
keywords="smartphone",
keywords="user-centered design",
abstract="Background: Indoor air pollution is a well-known risk factor that triggers and exacerbates asthma, the most common pediatric chronic disease. Using a mobile app to monitor indoor air quality could be promising in engaging children in keeping their indoor air quality clean and healthy as secondary environmental prevention for asthma management. However, no app is available to allow children to monitor, assess, and improve their indoor air quality. Objective: This study aims to design a mobile app that encourages children to monitor indoor air quality and track their asthma conditions through a user-centered, iterative design approach. Methods: We reviewed existing apps for indoor air quality monitoring or asthma management for children and conducted two sets of semistructured interviews with 12 children with asthma. We then iteratively created prototypes and evaluated and revised them. Results: Participants raised a series of outstanding questions on the prototype features and content that described their needs and perspectives, which informed the final designs. Following the identified requirements and recommendations, we developed two versions of the app: AirBuddy for presenting concrete information for indoor air quality and AirPet for gamifying the practice of monitoring indoor air quality. Conclusions: By following an iterative, user-centered design process, we developed two versions of an app to encourage children with asthma to monitor indoor air quality and track their asthma condition. The user-centered design approach revealed two crucial aspects that require deeper consideration when creating a child-friendly app, including balancing brevity and expressivity and considering the longitudinal effects of gamification. As a next step, we plan to conduct a longitudinal deployment study to evaluate the real-world effects of our apps. ",
doi="10.2196/27447",
url="https://formative.jmir.org/2021/9/e27447",
url="http://www.ncbi.nlm.nih.gov/pubmed/34550080"
}


@Article{info:doi/10.2196/28797,
author="Ingle, Pilar M.
and Valdovinos, Cristina
and Ford, L. Kelsey
and Zhou, Shou
and Bull, Sheana
and Gornail, Starlynne
and Zhang, Xuhong
and Moore, Susan
and Portz, Jennifer",
title="Patient Portals to Support Palliative and End-of-Life Care: Scoping Review",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="16",
volume="23",
number="9",
pages="e28797",
keywords="patient portal",
keywords="electronic health record",
keywords="digital health",
keywords="palliative care",
keywords="end-of-life care",
abstract="Background: Although patient portals are widely used for health promotion, little is known about the use of palliative care and end-of-life (PCEOL) portal tools available for patients and caregivers. Objective: This study aims to identify and assess the user perspectives of PCEOL portal tools available to patients and caregivers described and evaluated in the literature. Methods: We performed a scoping review of the academic literature directed by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) extension for Scoping Review and searched three databases. Sources were included if they reported the development or testing of a feature, resource, tool, or intervention; focused on at least one PCEOL domain defined by the National Coalition for Hospice and Palliative Care; targeted adults with serious illness or caregivers; and were offered via a patient portal tethered to an electronic medical record. We independently screened the titles and abstracts (n=796) for eligibility. Full-text (84/796, 10.6\%) sources were reviewed. We abstracted descriptions of the portal tool name, content, targeted population, and reported user acceptability for each tool from included sources (n=19). Results: In total, 19 articles describing 12 tools were included, addressing the following PCEOL domains: ethical or legal (n=5), physical (n=5), and psychological or psychiatric (n=2). No tools for bereavement or hospice care were identified. Studies have reported high acceptability of tools among users; however, few sources commented on usability among older adults. Conclusions: PCEOL patient portal tools are understudied. As medical care increasingly moves toward virtual platforms, future research should investigate the usability and acceptability of PCEOL patient portal resources and evaluate their impact on health outcomes. ",
doi="10.2196/28797",
url="https://www.jmir.org/2021/9/e28797",
url="http://www.ncbi.nlm.nih.gov/pubmed/34528888"
}


@Article{info:doi/10.2196/30162,
author="Kozlov, Elissa
and McDarby, Meghan
and Prescott, Maximo
and Altman, Myra",
title="Assessing the Care Modality Preferences and Predictors for Digital Mental Health Treatment Seekers in a Technology-Enabled Stepped Care Delivery System: Cross-sectional Study",
journal="JMIR Form Res",
year="2021",
month="Sep",
day="15",
volume="5",
number="9",
pages="e30162",
keywords="stepped care",
keywords="technology",
keywords="mental health care",
keywords="patient-centered care",
abstract="Background: Access to mental health services continues to be a systemic problem in the United States and around the world owing to a variety of barriers including the limited availability of skilled providers and lack of mental health literacy among patients. Individuals seeking mental health treatment may not be aware of the multiple modalities of digital mental health care available to address their problems (eg, self-guided and group modalities, or one-to-one care with a provider). In fact, one-to-one, in-person treatment is the dominant care model with a masters- or doctoral-level trained mental health provider, and it may or may not be the appropriate or preferred level of care for an individual. Technology-enabled mental health platforms may be one way to improve access to mental health care by offering stepped care, but more research is needed to understand the care modality preferences of digital mental health care seekers because additional modalities become increasingly validated as effective treatment options. Objective: The purpose of this study was to describe and evaluate the predictors of care modality preferences among individuals enrolled in a technology-enabled stepped mental health care platform. Methods: This exploratory, cross-sectional study used employee data from the 2021 Modern Health database, an employer-sponsored mental health benefit that uses a technology-enabled platform to optimize digital mental health care delivery. Chi-square tests and one-way analysis of variance (ANOVA) were conducted to evaluate associations among the categorical and continuous factors of interest and the preferred care modality. Bivariate logistic regression models were constructed to estimate the odds ratios (ORs) of preferring a one-on-one versus self-guided group, or no preference for digital mental health care modalities. Results: Data were analyzed for 3661 employees. The most common modality preference was one-on-one care (1613/3661, 44.06\%). Approximately one-fourth of the digital mental health care seekers (881/3661, 24.06\%) expressed a preference for pursuing self-guided care, and others (294/3661, 8.03\%) expressed a preference for group care. The ORs indicated that individuals aged 45 years and above were significantly more likely to express a preference for self-guided care compared to individuals aged between 18 and 24 years (OR 2.47, 95\% CI 1.70-3.59; P<.001). Individuals screening positive for anxiety (OR 0.73, 95\% CI 0.62-0.86; P<.001) or depression (OR 0.79, 95\% CI 0.66-0.95; P=.02) were more likely to prefer one-on-one care. Conclusions: Our findings elucidated that care modality preferences vary and are related to clinical severity factors and demographic variables among individuals seeking digital mental health care. ",
doi="10.2196/30162",
url="https://formative.jmir.org/2021/9/e30162",
url="http://www.ncbi.nlm.nih.gov/pubmed/34343965"
}


@Article{info:doi/10.2196/28356,
author="Karpathakis, Kassandra
and Libow, Gene
and Potts, W. Henry W.
and Dixon, Simon
and Greaves, Felix
and Murray, Elizabeth",
title="An Evaluation Service for Digital Public Health Interventions: User-Centered Design Approach",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="8",
volume="23",
number="9",
pages="e28356",
keywords="digital health",
keywords="internet-based interventions",
keywords="mHealth",
keywords="evaluation studies",
keywords="public health",
keywords="human-centered design",
keywords="service design",
keywords="mobile phone",
abstract="Background: Digital health interventions (DHIs) have the potential to improve public health by combining effective interventions and population reach. However, what biomedical researchers and digital developers consider an effective intervention differs, thereby creating an ongoing challenge to integrating their respective approaches when evaluating DHIs. Objective: This study aims to report on the Public Health England (PHE) initiative set out to operationalize an evaluation framework that combines biomedical and digital approaches and demonstrates the impact, cost-effectiveness, and benefit of DHIs on public health. Methods: We comprised a multidisciplinary project team including service designers, academics, and public health professionals and used user-centered design methods, such as qualitative research, engagement with end users and stakeholders, and iterative learning. The iterative approach enabled the team to sequentially define the problem, understand user needs, identify opportunity areas, develop concepts, test prototypes, and plan service implementation. Stakeholders, senior leaders from PHE, and a working group critiqued the outputs. Results: We identified 26 themes and 82 user needs from semistructured interviews (N=15), expressed as 46 Jobs To Be Done, which were then validated across the journey of evaluation design for a DHI. We identified seven essential concepts for evaluating DHIs: evaluation thinking, evaluation canvas, contract assistant, testing toolkit, development history, data hub, and publish health outcomes. Of these, three concepts were prioritized for further testing and development, and subsequently refined into the proposed PHE Evaluation Service for public health DHIs. Testing with PHE's Couch-to-5K app digital team confirmed the viability, desirability, and feasibility of both the evaluation approach and the Evaluation Service. Conclusions: An iterative, user-centered design approach enabled PHE to combine the strengths of academic and biomedical disciplines with the expertise of nonacademic and digital developers for evaluating DHIs. Design-led methodologies can add value to public health settings. The subsequent service, now known as Evaluating Digital Health Products, is currently in use by health bodies in the United Kingdom and is available to others for tackling the problem of evaluating DHIs pragmatically and responsively. ",
doi="10.2196/28356",
url="https://www.jmir.org/2021/9/e28356",
url="http://www.ncbi.nlm.nih.gov/pubmed/34494965"
}


@Article{info:doi/10.2196/26881,
author="AshaRani, PV
and Jue Hua, Lau
and Roystonn, Kumarasan
and Siva Kumar, Devi Fiona
and Peizhi, Wang
and Ying Jie, Soo
and Shafie, Saleha
and Chang, Sherilyn
and Jeyagurunathan, Anitha
and Boon Yiang, Chua
and Abdin, Edimansyah
and Ajit Vaingankar, Janhavi
and Sum, Fang Chee
and Lee, Sing Eng
and Chong, Ann Siow
and Subramaniam, Mythily",
title="Readiness and Acceptance of eHealth Services for Diabetes Care in the General Population: Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="2",
volume="23",
number="9",
pages="e26881",
keywords="eHealth",
keywords="diabetes",
keywords="general population",
keywords="acceptance",
keywords="readiness",
abstract="Background: Diabetes management is a growing health care challenge worldwide. eHealth can revolutionize diabetes care, the success of which depends on end user acceptance. Objective: This study aims to understand the readiness and acceptance of eHealth services for diabetes care among the general population, perceived advantages and disadvantages of eHealth, and factors associated with eHealth readiness and acceptance in a multiethnic Asian country. Methods: In this cross-sectional epidemiological study, participants (N=2895) were selected through disproportionate stratified random sampling from a population registry. Citizens or permanent residents of Singapore aged >18 years were recruited. The data were captured through computer-assisted personal interviews. An eHealth questionnaire was administered in one of four local languages (English, Chinese, Malay, or Tamil), as preferred by the participant. Bivariate chi-square analyses were performed to compare the sociodemographic characteristics and perception of advantages and disadvantages of eHealth services between the diabetes and nondiabetes groups. Multivariable logistic regression models were used to determine factors associated with eHealth readiness and acceptance. All analyses were weighted using survey weights to account for the complex survey design. Results: The sample comprised participants with (n=436) and without (n=2459) diabetes. eHealth readiness was low, with 47.3\% of the overall sample and 75.7\% of the diabetes group endorsing that they were not ready for eHealth (P<.001). The most acceptable eHealth service overall was booking appointments (67.4\%). There was a significantly higher preference in the diabetes group for face-to-face sessions for consultation with the clinician (nondiabetes: 83.5\% vs diabetes: 92.6\%; P<.001), receiving prescriptions (61.9\% vs 79.3\%; P<.001), referrals to other doctors (51.4\% vs 72.2\%; P<.001), and receiving health information (34\% vs 63.4\%; P<.001). The majority of both groups felt that eHealth requires users to be computer literate (90.5\% vs 94.3\%), does not build clinician-patient rapport compared with face-to-face sessions (77.5\% vs 81\%), and might not be credible (56.8\% vs 64.2\%; P=.03). Age (?35 years), ethnicity (Indian), and lower education status had lower odds of eHealth readiness. Age (?35 years), ethnicity (Indian), lower education status (primary school), BMI (being underweight), and marital status (being single) were associated with a lower likelihood of eHealth acceptance. Among only those with diabetes, a longer duration of diabetes (4-18 years), higher education (degree or above), and younger age (23-49 years) were associated with eHealth readiness, whereas younger age and income (SGD 2000-3999 [US \$1481-\$2961]) were associated with acceptance. Conclusions: Overall, an unfavorable attitude toward eHealth was observed, with a significantly higher number of participants with diabetes reporting their unwillingness to use these services for their diabetes care. Sociodemographic factors associated with acceptance and readiness identified a group of people who were unlikely to accept the technology and thus need to be targeted for eHealth literacy programs to avoid health care disparity. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-037125 ",
doi="10.2196/26881",
url="https://www.jmir.org/2021/9/e26881",
url="http://www.ncbi.nlm.nih.gov/pubmed/34473062"
}


@Article{info:doi/10.2196/28045,
author="van Rijt, Mattheus Antonius
and Hulter, Pauline
and Weggelaar-Jansen, Marie Anne
and Ahaus, Kees
and Pluut, Bettine",
title="Mental Health Care Professionals' Appraisal of Patients' Use of Web-Based Access to Their Electronic Health Record: Qualitative Study",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="27",
volume="23",
number="8",
pages="e28045",
keywords="patient portals",
keywords="eHealth",
keywords="mental health care professionals",
keywords="mental health",
keywords="eMental health",
keywords="mental health care",
keywords="patient-accessible",
keywords="electronic health records",
keywords="Open Notes",
keywords="normalization process theory",
keywords="NPT",
abstract="Background: Patients in a range of health care sectors can access their medical health records using a patient portal. In mental health care, the use of patient portals among mental health care professionals remains low. Mental health care professionals are concerned that patient access to electronic health records (EHRs) will negatively affect the patient's well-being and privacy as well as the professional's own workload.  Objective: This study aims to provide insights into the appraisal work of mental health care professionals to assess and understand patient access to their EHRs through a patient portal. Methods: We conducted a qualitative study that included 10 semistructured interviews (n=11) and a focus group (n=10). Participants in both the interviews and the focus group were mental health care professionals from different professional backgrounds and staff employees (eg, team leaders and communication advisors). We collected data on their opinions and experiences with the recently implemented patient portal and their attempts to modify work practices. Results: Our study provides insights into mental health care professionals' appraisal work to assess and understand patient access to the EHR through a patient portal. A total of four topics emerged from our data analysis: appraising the effect on the patient-professional relationship, appraising the challenge of sharing and registering delicate information, appraising patient vulnerability, and redefining consultation routines and registration practices. Conclusions: Mental health care professionals struggle with the effects of web-based patient access and are searching for the best ways to modify their registration and consultation practices. Our participants seem to appraise the effects of web-based patient access individually. Our study signals the lack of systematization and communal appraisal. It also suggests various solutions to the challenges faced by mental health care professionals. To optimize the effects of web-based patient access to EHRs, mental health care professionals need to be involved in the process of developing, implementing, and embedding patient portals. ",
doi="10.2196/28045",
url="https://www.jmir.org/2021/8/e28045",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448705"
}


@Article{info:doi/10.2196/19820,
author="Kinney, P. Aaron
and Sankaranarayanan, Balaji",
title="Effects of Patient Portal Use on Patient Satisfaction: Survey and Partial Least Squares Analysis",
journal="J Med Internet Res",
year="2021",
month="Aug",
day="27",
volume="23",
number="8",
pages="e19820",
keywords="patient portal",
keywords="patient satisfaction",
keywords="gratification",
keywords="health self-awareness",
keywords="post-adoptive use",
keywords="health perceptions",
abstract="Background: With digital delivery of health care services gaining prominence, patient portals have become a mainstay of many health care organizations. Despite the importance of patient portals, inconclusive data exist regarding the effect of patient portal use on patient satisfaction. Objective: The aim of this study is to understand the relationship between the postadoptive use of patient portals and patient satisfaction outcomes. Methods: Postadoptive use of patient portals has a positive relationship with the 3 dimensions of patient satisfaction, mediated by gratification, health self-awareness, and health perceptions. A total of 504 valid patient portal user responses were collected, and partial least squares analysis was performed to analyze the data. Results: Patient satisfaction was captured using three dimensions: care team interaction, atmosphere, and instruction effectiveness. The results show that postadoptive use of patient portals has a positive influence on all 3 dimensions of patient satisfaction through the mediating variables of gratification, health self-awareness, and health perceptions. Specifically, postadoptive use had significant positive influence on gratification, health self-awareness, and health perceptions. Each of the 3 patient perceptions had significant positive influence on all 3 dimensions of patient satisfaction: care team interaction, atmosphere, and instruction effectiveness. Specifically, our model explained 31.8\% of the care team interaction, 40.6\% of the atmosphere, and 39.1\% of the instruction effectiveness. Conclusions: Our model shows that patient portal use can influence patient satisfaction through the mediating effects of gratification, health self-awareness, and health perception. Patient satisfaction is an important outcome for health care organizations. Therefore, by promoting effective patient portal use and fostering patient perceptions, health care organizations can improve patient satisfaction. ",
doi="10.2196/19820",
url="https://www.jmir.org/2021/8/e19820",
url="http://www.ncbi.nlm.nih.gov/pubmed/34448712"
}


@Article{info:doi/10.2196/27477,
author="Col{\'o}n-Morales, M. Coralys
and Giang, W. Wayne C.
and Alvarado, Michelle",
title="Informed Decision-making for Health Insurance Enrollment: Survey Study",
journal="JMIR Form Res",
year="2021",
month="Aug",
day="12",
volume="5",
number="8",
pages="e27477",
keywords="health insurance",
keywords="information",
keywords="sources",
keywords="survey",
keywords="literacy",
abstract="Background: Health insurance enrollment is a difficult financial decision with large health impacts. Challenges such as low health insurance literacy and lack of knowledge about choosing a plan further complicate this decision-making process. Therefore, to support consumers in their choice of a health insurance plan, it is essential to understand how individuals go about making this decision. Objective: This study aims to understand the sources of information used by individuals to support their employer-provided health insurance enrollment decisions. It seeks to describe how individual descriptive factors lead to choosing a particular type of information source. Methods: An introduction was presented on health insurance plan selection and the sources of information used to support these decisions from the 1980s to the present. Subsequently, an electronic survey of 151 full-time faculty and staff members was conducted. The survey consisted of four sections: demographics, sources of information, health insurance literacy, and technology acceptance. Descriptive statistics were used to show the demographic characteristics of the 126 eligible respondents and to study the response behaviors in the remaining survey sections. Proportion data analysis was performed using the Cochran-Armitage trend test to understand the strength of the association between our variables and the types of sources used by the respondents. Results: In terms of demographics, most of the respondents were women (103/126, 81.7\%), represented a small household (1-2 persons; 87/126, 69\%), and used their insurance 3-12 times a year (52/126, 41.3\%). They assessed themselves as having moderate to high health insurance literacy and high acceptance of technology. The most selected and top-ranked sources were Official employer or state websites and Official Human Resources Virtual Benefits Counselor Alex. From our data analysis, we found that the use of official primary sources was constant across age groups and health insurance use groups. Meanwhile, the use of friends or family as a primary source slightly decreased as age and use increased. Conclusions: In this exploratory study, we identified the main sources of health insurance information among full-time employees from a large state university and found that most of the respondents needed 2-3 sources to gather all the information that they desired. We also studied and identified the relationships between individual factors (such as age, gender, and literacy) and 2 dependent variables on the types of primary sources of information. We encountered several limitations, which will be addressed in future studies. ",
doi="10.2196/27477",
url="https://formative.jmir.org/2021/8/e27477",
url="http://www.ncbi.nlm.nih.gov/pubmed/34387555"
}


@Article{info:doi/10.2196/27452,
author="Rogers, C. Courtney
and Moutinho Jr, J. Thomas
and Liu, Xiaoyue
and Valdez, S. Rupa",
title="Designing Consumer Health Information Technology to Support Biform and Articulation Work: A Qualitative Study of Diet and Nutrition Management as Patient Work",
journal="JMIR Hum Factors",
year="2021",
month="Aug",
day="10",
volume="8",
number="3",
pages="e27452",
keywords="Crohn disease",
keywords="inflammatory bowel diseases",
keywords="chronic disease",
keywords="self-management",
keywords="consumer health information technology",
keywords="qualitative research",
keywords="user-centered design",
keywords="patient work",
keywords="context",
keywords="articulation work",
keywords="diet",
keywords="nutrition",
abstract="Background: Diet and nutrition management is an integral component of Crohn disease (CD) management. This type of management is highly variable and individualized and, thus, requires personalized approaches. Consumer health information technology (CHIT) designed to support CD management has typically supported this task as everyday life work and, not necessarily, as illness work. Moreover, CHIT has rarely supported the ways in which diet and nutrition management requires coordination between multiple forms of patient work. Objective: The purpose of this study was to investigate diet and nutrition management as biform work, identify components of articulation work, and provide guidance on how to design CHIT to support this work. Methods: We performed a qualitative study in which we recruited participants from CD-related Facebook pages and groups. Results: Semistructured interviews with 21 individuals showed that diet and nutrition management strategies were highly individualized and variable. Four themes emerged from the data, emphasizing the interactions of diet and nutrition with physical, emotional, information, and technology-enabled management. Conclusions: This study shows that the extent to which diet and nutrition management is biform work fluctuates over time and that articulation work can be continuous and unplanned. The design guidance specifies the need for patient-facing technologies to support interactions among diet and nutrition and other management activities such as medication intake, stress reduction, and information seeking, as well as to respond to the ways in which diet and nutrition management needs change over time. ",
doi="10.2196/27452",
url="https://humanfactors.jmir.org/2021/3/e27452",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383664"
}


@Article{info:doi/10.2196/19191,
author="Clarke, A. Martina
and Fruhling, L. Ann
and Lyden, L. Elizabeth
and Tarrell, E. Alvin
and Bernard, L. Tamara
and Windle, R. John",
title="The Role of Computer Skills in Personal Health Record Adoption Among Patients With Heart Disease: Multidimensional Evaluation of Users Versus Nonusers",
journal="JMIR Hum Factors",
year="2021",
month="Jul",
day="26",
volume="8",
number="3",
pages="e19191",
keywords="patient portal",
keywords="communication",
keywords="patients",
keywords="precision medicine",
keywords="health literacy",
abstract="Background: In the era of precision medicine, it is critical for health communication efforts to prioritize personal health record (PHR) adoption. Objective: The objective of this study was to describe the characteristics of patients with heart disease that choose to adopt a PHR. Methods: A total of 79 patients with chronic cardiovascular disease participated in this study: 48 PHR users and 31 nonusers. They completed 5 surveys related to their choice to use or not use the PHR: demographics, patient activation, medication adherence, health literacy, and computer self-efficacy (CSE). Results: There was a significant difference between users and nonusers in the sociodemographic measure education (P=.04). There was no significant difference between users and nonusers in other sociodemographic measures: age (P=.20), sex (P=.35), ethnicity (P=.43), race (P=.42), and employment (P=.63). There was a significant difference between PHR users and PHR nonusers in CSE (P=.006). Conclusions: In this study, we demonstrate that sociodemographic characteristics were not an important factor in patients' use of their PHR, except for education. This study had a small sample size and may not have been large enough to detect differences between groups. Our results did demonstrate that there is a difference between PHR users and nonusers related to their CSE. This work suggests that incorporating CSE into the design of PHRs is critical. The design of patient-facing tools must take into account patients' preferences and abilities when developing effective user-friendly health information technologies. ",
doi="10.2196/19191",
url="https://humanfactors.jmir.org/2021/3/e19191",
url="http://www.ncbi.nlm.nih.gov/pubmed/34309574"
}


@Article{info:doi/10.2196/28083,
author="Duffy, Anthony
and Christie, Greg
and Moreno, Sylvain",
title="Examining Challenges to the Incorporation of End Users in the Design of Digital Health Interventions: Protocol for a Systematic Review",
journal="JMIR Res Protoc",
year="2021",
month="Jul",
day="26",
volume="10",
number="7",
pages="e28083",
keywords="digital health",
keywords="end user(s)",
keywords="user experience",
keywords="UX",
keywords="health behavior",
keywords="intervention",
keywords="co-design",
keywords="mobile health",
keywords="mHealth",
abstract="Background: The process of designing a digital health intervention (DHI)---also referred to as mobile health or eHealth---spans needs assessments, technical functionality and feasibility, user satisfaction, effectiveness, impact, and value. These interventions are causing a rapid evolution in the landscape of health care. Multiple studies have shown their propensity to extend both the quality and reach of interventions. However, failure to improve DHI design is linked to failed uptake and health outcomes. This dilemma is further conflicted by the colliding backdrops of the digital and health industries, both of which approach, understand, and involve end users differently in the framing of a DHI. Objective: The objective of this systematic review is to assess the challenges to incorporating end users in the design stage of digital health interventions, to identify key pain points, and to identify limitations and gaps for areas of future investigation. Methods: The PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols) checklist will be used to structure this protocol. A systematic search of the PsycINFO, PubMed (MEDLINE), Web of Science, CINAHL, Scopus, and IEEE Xplore databases will be conducted. Additionally, the PerSPEcTiF guidelines for complex interventions will be consulted. Two reviewers will independently screen the titles and abstracts of the identified references and select studies according to the eligibility criteria. Any discrepancies will then be discussed and resolved. Two reviewers will independently extract and validate data from the included studies into a standardized form and conduct quality appraisal. Results: As of February 2021, we have completed a preliminary literature search examining challenges to the incorporation of end users in the design stage of DHIs. Systematic searches, data extraction and analysis, and writing of the systematic review are expected to be completed by December 2021. Conclusions: This systematic review aims to provide an effective summary of key pain points toward incorporating end users in DHIs. Results from this review will provide an evidence base for a better approach to end user involvement in the interest of improving efficacy and uptake of DHIs. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42021238164; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=238164 International Registered Report Identifier (IRRID): PRR1-10.2196/28083 ",
doi="10.2196/28083",
url="https://www.researchprotocols.org/2021/7/e28083",
url="http://www.ncbi.nlm.nih.gov/pubmed/34309578"
}


@Article{info:doi/10.2196/27094,
author="Primholdt Christensen, Nina
and Skou, Emilie Karen
and Boe Danbj{\o}rg, Dorthe",
title="Health Care Professionals' Experiences With the Use of Video Consultation: Qualitative Study",
journal="JMIR Form Res",
year="2021",
month="Jul",
day="21",
volume="5",
number="7",
pages="e27094",
keywords="video consultation",
keywords="hematology",
keywords="outpatient clinic",
keywords="telehealth",
keywords="doctor's perspective",
abstract="Background: The number of remote video consultations between doctors and patients has increased during the last few years and especially during the COVID-19 pandemic. The health care service is faced with rising rates of chronic illness and many patients who are more confident in self-management of their illnesses. In addition, there is an improved long-term outlook for serious conditions, such as cancer, that might require flexibility in everyday life. Objective: This study aimed to investigate how medical doctors in the outpatient clinic use and experience the use of video consultations with hematological patients, with a focus on relational and organizational aspects. Methods: The study was designed as an explorative and qualitative study. Data were collected via participant observations and focus group interviews with medical doctors. Results: The study identified possibilities and barriers in relation to adapting to the alternative way of meeting patients in the clinical setting. One of the main findings in this study is that the medical doctors were afraid that they missed important observations, as they were not able to perform a physical examination, if needed. They also emphasized that handshake and eye contact were important in order to get an overall impression of the patient's situation. It also became clear that the medical doctors used body language a lot more during video consultation compared with consultation in a physical setting. The medical doctors found the contact with the patients via the screen to be good, and the fact that the technology was working well made them feel comfortable with the video consultation. Conclusions: In this study, we found that the medical doctors were able to maintain good contact with the patients despite the screen and were able to assess the patients in a satisfying manner. However, there were still uncertainties among some doctors about the fact that they could not examine the patients physically. New knowledge about how to use gestures and body language during video consultation was obtained. ",
doi="10.2196/27094",
url="https://formative.jmir.org/2021/7/e27094",
url="http://www.ncbi.nlm.nih.gov/pubmed/34287207"
}


@Article{info:doi/10.2196/26003,
author="Kong, Qingxia
and Riedewald, Danique
and Askari, Marjan",
title="Factors Affecting Portal Usage Among Chronically Ill Patients During the COVID-19 Pandemic in the Netherlands: Cross-sectional Study",
journal="JMIR Hum Factors",
year="2021",
month="Jul",
day="19",
volume="8",
number="3",
pages="e26003",
keywords="COVID-19",
keywords="pandemic",
keywords="digital technology",
keywords="eHealth",
keywords="patient portals",
keywords="chronically ill patients",
keywords="portal responsiveness",
keywords="portal awareness",
abstract="Background: The COVID-19 pandemic has impacted the capacity of the regular health care system, which is reflected in limited access to nonurgent care for patients who are chronically ill in the Dutch health care system. Nevertheless, many of them still depend on health care assistance to manage their illnesses. Patient portals are used to provide continued health care (remotely) and offer self-management tools during COVID-19 and potentially after. However, little is known about the factors influencing portal use and users' satisfaction among patients who are chronically ill during the COVID-19 pandemic. Objective: This study aims to examine predictors of patient portal use among patients who are chronically ill, the willingness to recommend the portal to others, and the likelihood of future use among portal nonusers. Methods: An online self-administered questionnaire was distributed among patients who are chronically ill via social media in May 2020. The questionnaire consisted of four parts: (1) demographics including age and hours of daily internet use; (2) physical health status including COVID-19 infection, perceived level of control, and hospital visits; (3) mental health status including depression and life satisfaction; and (4) portal use including response waiting time and awareness. Descriptive, correlation, univariate, and multivariate analyses were conducted to identify factors that affect portal use, users' willingness to recommend, and nonusers' likelihood of future portal use. Results: A total of 652 patients responded, and 461 valid questionnaires were included. Among the 461 patients, 67\% (n=307) were identified as patient portal users. Of the nonusers, 55\% (85/154) reported not being aware of the existence of a patient portal at their hospital. Significant predictors of portal use include level of control (P=.04), hospital visit time (P=.03), depression scale (P=.03), and status of life satisfaction (P=.02). Among portal users, waiting time to get a response via the portal (P<.001) and maximum acceptable waiting time (P<.001) were the strongest predictors for willingness to recommend the portal; among nonusers, the model predicted that those who were not aware of patient portals (P<.001) and were willing to wait moderately long (P<.001) were most likely to use the portal in the future. Conclusions: This study provides insights into factors that influence portal use and willingness to recommend, based on which health care providers can improve the adoption of patient portals and their services. It suggests that health care providers should leverage efficient operations management to improve responsiveness and reduce waiting time to enhance user satisfaction and willingness to recommend use. Health care organizations need to increase portal awareness among nonusers and train their patients to increase both use and longer adoption of patient portals. Factors including depression and life satisfaction can influence portal use; therefore, future studies on determinants of portal use and nonuse in this specific population are needed. ",
doi="10.2196/26003",
url="https://humanfactors.jmir.org/2021/3/e26003",
url="http://www.ncbi.nlm.nih.gov/pubmed/34003762"
}


@Article{info:doi/10.2196/27528,
author="Marsh, Harrison
and Almekdash, Hasan Mhd
and Rossettie, Stephen
and John, Albin
and Pelham, Kassie
and Magers, Brent",
title="Implications of Age on Social Media Utilization in Health Care Practice Development: Cross-sectional Survey Study",
journal="JMIR Hum Factors",
year="2021",
month="Jul",
day="15",
volume="8",
number="3",
pages="e27528",
keywords="social media",
keywords="health care",
keywords="age",
keywords="medical practice development",
keywords="patient acquisition",
keywords="health care delivery",
keywords="patient education",
keywords="target patient population",
abstract="Background: Medical practices, which are businesses through which one or more physicians treat patients, have likely not yet taken full advantage of the reach of social media. This study analyzed data collected using an anonymous survey to assess the potential utilization of large, established social media platforms in health care. The survey collected data from a diverse population of health care professional students, faculty, and physicians affiliated with the Texas Tech University Health Sciences Center (TTUHSC). This study provides significant, actionable data to more efficiently implement a social media strategy focused on age to help developing private practices and outpatient clinics from the perspective of those with experience in the field of medicine. Objective: This cross-sectional, exploratory, descriptive study aims to explore the most effective strategies to use social media based on patient age to bring further success to a medical practice. Methods: Data were gathered from an anonymous, peer-validated Qualtrics survey created by the corresponding authors based on the recommendations from a panel of experts including executive leadership at TTUHSC. The survey used a variety of question styles to measure differences between social media platforms, including frequency of use, current and future implications in medicine, and comfort in a health care setting. The sample population included students, interns, faculty, and physicians affiliated with the TTUHSC located throughout West Texas. Results: The anonymous survey included 673 individuals from several different age groups predetermined at the beginning of the study. There were 154 respondents aged between 18 and 25 years, 171 aged between 26 and 35 years, 133 aged between 36 and 45 years, 104 aged between 46 and 55 years, and 111 aged between 56 and 89 years. The sample population also has a variety of educational achievements. The respondents were grouped based on the highest level of education attained, and this included 23.5\% (n=158) of respondents who earned a high school diploma, 42\% (n=283) who earned a bachelor's degree, 17.1\% (n=115) who earned a master's degree, and 17.4\% (n=117) who earned a doctorate degree. Conclusions: As social media continues to gain momentum, efficient utilization of the available platforms can help medical practices achieve larger patient populations and deliver more personalized care. However, privacy and security concerns should be considered while using social media in health care settings. Although this study demonstrated overwhelming interest in using social media in the medical field across all age groups, adoption willingness appears to be higher in younger respondents than in older respondents. Facebook was the most widely accepted social media platform in health care settings among all age groups. Nonetheless, other social media platforms could potentially be used more effectively depending on the age range of the targeted patient population. ",
doi="10.2196/27528",
url="https://humanfactors.jmir.org/2021/3/e27528",
url="http://www.ncbi.nlm.nih.gov/pubmed/34010138"
}


@Article{info:doi/10.2196/26012,
author="Willis, Matthew
and Brand Hein, Leah
and Hu, Zhaoxian
and Saran, Rajiv
and Argentina, Marissa
and Bragg-Gresham, Jennifer
and Krein, L. Sarah
and Gillespie, Brenda
and Zheng, Kai
and Veinot, C. Tiffany",
title="Usability Evaluation of a Tablet-Based Intervention to Prevent Intradialytic Hypotension in Dialysis Patients During In-Clinic Dialysis: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2021",
month="Jun",
day="14",
volume="8",
number="2",
pages="e26012",
keywords="user interaction",
keywords="dialysis",
keywords="usability",
keywords="informatics intervention",
abstract="Background: Patients on hemodialysis receive dialysis thrice weekly for about 4 hours per session. Intradialytic hypotension (IDH)---low blood pressure during hemodialysis---is a serious but common complication of hemodialysis. Although patients on dialysis already participate in their care, activating patients toward IDH prevention may reduce their risk of IDH. Interactive, technology-based interventions hold promise as a platform for patient activation. However, little is known about the usability challenges that patients undergoing hemodialysis may face when using tablet-based informatics interventions, especially while dialyzing. Objective: This study aims to test the usability of a patient-facing, tablet-based intervention that includes theory-informed educational modules and motivational interviewing--based mentoring from patient peers via videoconferencing. Methods: We conducted a cross-sectional, mixed methods usability evaluation of the tablet-based intervention by using think-aloud methods, field notes, and structured observations. These qualitative data were evaluated by trained researchers using a structured data collection instrument to capture objective observational data. We calculated descriptive statistics for the quantitative data and conducted inductive content analysis using the qualitative data. Results: Findings from 14 patients cluster around general constraints such as the use of one arm, dexterity issues, impaired vision, and lack of experience with touch screen devices. Our task-by-task usability results showed that specific sections with the greatest difficulty for users were logging into the intervention (difficulty score: 2.08), interacting with the quizzes (difficulty score: 1.92), goal setting (difficulty score: 2.28), and entering and exiting videoconference rooms (difficulty score: 2.07) that are used to engage with peers during motivational interviewing sessions. Conclusions: In this paper, we present implications for designing informatics interventions for patients on dialysis and detail resulting changes to be implemented in the next version of this intervention. We frame these implications first through the context of the role the patients' physical body plays when interacting with the intervention and then through the digital considerations for software and interface interaction. ",
doi="10.2196/26012",
url="https://humanfactors.jmir.org/2021/2/e26012",
url="http://www.ncbi.nlm.nih.gov/pubmed/34121664"
}


@Article{info:doi/10.2196/23884,
author="Donevant, Sara
and Heiney, P. Sue
and Wineglass, Cassandra
and Schooley, Benjamin
and Singh, Akanksha
and Sheng, Jingxi",
title="Perceptions of Endocrine Therapy in African-American Breast Cancer Survivors: Mixed Methods Study",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="11",
volume="5",
number="6",
pages="e23884",
keywords="mHealth",
keywords="breast cancer survivors",
keywords="medication adherence",
keywords="cultural considerations",
keywords="mobile health applications",
abstract="Background: Although the incidence of breast cancer is lower in African-American women than in White women, African-American women have a decreased survival rate. The difference in survival rate may stem from poor endocrine therapy adherence, which increases breast cancer recurrence. Therefore, accessible and culturally sensitive interventions to increase endocrine therapy adherence are necessary. Objective: The purpose of this concurrent convergent mixed methods study was to provide further data to guide the development of the proposed culturally sensitive mHealth app, STORY+ for African-American women with breast cancer. Methods: We recruited 20 African-American women diagnosed with estrogen-positive breast cancer and currently prescribed endocrine therapy. We used a concurrent convergent data collection method to (1) assess the use of smartphones and computers related to health care and (2) identify foundational aspects to support endocrine therapy adherence for incorporation in a mobile health app. Results: Overwhelmingly, the participants preferred using smartphones to using computers for health care. Communicating with health care providers and pharmacies was the most frequent health care use of smartphones, followed by exercise tracking, and accessing the patient portal. We identified 4 aspects of adherence to endocrine therapy and smartphone use for incorporation in app development. The factors that emerged from the integrated qualitative and quantitative data were (1) willingness to use, (2) side effects, (3) social connection, and (4) beliefs about endocrine therapy. Conclusions: Further research is needed to develop a culturally sensitive app for African-American women with breast cancer to improve adherence to endocrine therapy. Our work strongly suggests that this population would use the app to connect with other African-American breast cancer survivors and manage endocrine therapy. ",
doi="10.2196/23884",
url="https://formative.jmir.org/2021/6/e23884",
url="http://www.ncbi.nlm.nih.gov/pubmed/34114955"
}


@Article{info:doi/10.2196/27022,
author="Stafford, Elizabeth
and Brister, Teri
and Duckworth, Ken
and Rauseo-Ricupero, Natali
and Lagan, Sarah",
title="Needs and Experiences of Users of Digital Navigation Tools for Mental Health Treatment and Supportive Services: Survey Study",
journal="JMIR Ment Health",
year="2021",
month="Jun",
day="9",
volume="8",
number="6",
pages="e27022",
keywords="mental health",
keywords="supportive services",
keywords="perception",
keywords="quality",
keywords="satisfaction",
keywords="needs",
keywords="digital tools",
keywords="directories",
keywords="navigation",
abstract="Background: Despite a recent proliferation in web-based and digital resources that are designed to assist users in finding appropriate mental health treatment and supportive services, it can be overwhelming, confusing, and difficult for an individual or family member to access and use an appropriate navigation tool. As digital resources are increasingly sought after, there is an urgent need for a clearer understanding of digital navigation tools in order to help link individuals with the tool that is best suited to their needs. Objective: The objective of this study was to determine the needs of individuals seeking mental health treatment and supportive services and to quantify their experiences and satisfaction with available digital navigation tools. Methods: A survey was offered via an email newsletter and social media posting throughout the extended membership of the National Alliance on Mental Illness, which includes both individuals with a mental health condition and their family members and support networks. A 13-item anonymous survey, which consisted of multiple-choice and open response options, was developed to measure participants' past use of and experiences with web-based, mobile, and phone-based navigation tools. The survey was available from April 9 through May 21, 2020. Results: A total of 478 respondents completed the survey; the majority of respondents were female (397/478, 83.1\%) and aged ?35 years (411/478, 86\%). Younger respondents were more likely to report seeking mental health services for themselves, while older respondents were more likely to be searching for such services on behalf of a family member. The majority of respondents seeking such services on behalf of a family member (113/194, 58.2\%) required a combination of mental health treatment and supportive services. Furthermore, two-thirds of respondents (322/478, 67.4\%) used a navigation tool to find treatment or services. The majority of respondents who provided feedback about their experiences with navigation tools (224/280, 80\%) reported difficulties, with data availability and accuracy being the most commonly reported issues. Conclusions: The survey results suggest that issues with data availability and accuracy in available navigation tools remain a major barrier for locating timely and appropriate mental health treatment and supportive services within the population of individuals seeking such services. Particularly for individuals seeking care on behalf of a family member, improving the accuracy of and users' experiences with navigation tools could have a major impact on effectively connecting people to treatment and support services. ",
doi="10.2196/27022",
url="https://mental.jmir.org/2021/6/e27022",
url="http://www.ncbi.nlm.nih.gov/pubmed/34106079"
}


@Article{info:doi/10.2196/17604,
author="Yeng, Kandabongee Prosper
and Szekeres, Adam
and Yang, Bian
and Snekkenes, Arthur Einar",
title="Mapping the Psychosocialcultural Aspects of Healthcare Professionals' Information Security Practices: Systematic Mapping Study",
journal="JMIR Hum Factors",
year="2021",
month="Jun",
day="9",
volume="8",
number="2",
pages="e17604",
keywords="information security",
keywords="psychological",
keywords="sociocultural",
keywords="health care professionals",
abstract="Background: Data breaches in health care are on the rise, emphasizing the need for a holistic approach to mitigation efforts. Objective: The purpose of this study was to develop a comprehensive framework for modeling and analyzing health care professionals' information security practices related to their individual characteristics, such as their psychological, social, and cultural traits. Methods: The study area was a hospital setting under an ongoing project called the Healthcare Security Practice Analysis, Modeling, and Incentivization (HSPAMI) project. A literature review was conducted for relevant theories and information security practices. The theories and security practices were used to develop an ontology and a comprehensive framework consisting of psychological, social, cultural, and demographic variables. Results: In the review, a number of psychological, social, and cultural theories were identified, including the health belief model, protection motivation theory, theory of planned behavior, and social control theory, in addition to some social demographic variables, to form a comprehensive set of health care professionals' characteristics. Furthermore, an ontology was developed from these theories to systematically organize the concepts. The framework, called the psychosociocultural (PSC) framework, was then developed from the various combined psychological and sociocultural attributes of the ontology. The Human Aspect of Information Security Questionnaire was adopted as a comprehensive tool for gathering staff security practices as mediating variables in the framework. Conclusions: Data breaches occur often in health care today. This frequency has been attributed to the lack of experience of health care professionals in information security, the lack of development of conscious care security practices, and the lack of motivation to incentivize health care professionals. The frequent data breaches in health care threaten the mutual trust between health care professionals and patients, which implicitly impacts the quality of the health care service. The modeling and analysis of health care professionals' security practices can be conducted with the PSC framework by combining methods of statistical survey, observations, and interviews in relation to PSC variables, such as perceptions (perceived benefits, perceived threats, and perceived barriers) or psychological traits, social factors, cultural factors, and social demographics. ",
doi="10.2196/17604",
url="https://humanfactors.jmir.org/2021/2/e17604",
url="http://www.ncbi.nlm.nih.gov/pubmed/34106077"
}


@Article{info:doi/10.2196/25083,
author="Hoffman, Aubri
and Crocker, Laura
and Mathur, Aakrati
and Holman, Deborah
and Weston, June
and Campbell, Sukhkamal
and Housten, Ashley
and Bradford, Andrea
and Agrawala, Shilpi
and Woodard, L. Terri",
title="Patients' and Providers' Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment",
journal="JMIR Form Res",
year="2021",
month="Jun",
day="7",
volume="5",
number="6",
pages="e25083",
keywords="cancer",
keywords="decision support techniques",
keywords="fertility preservation",
keywords="oncofertility",
keywords="oncology",
keywords="needs assessment",
keywords="patient decision aids",
keywords="patient needs",
keywords="shared decision making",
abstract="Background: As cancer treatments continue to improve, it is increasingly important that women of reproductive age have an opportunity to decide whether they want to undergo fertility preservation treatments to try to protect their ability to have a child after cancer. Clinical practice guidelines recommend that providers offer fertility counseling to all young women with cancer; however, as few as 12\% of women recall discussing fertility preservation. The long-term goal of this program is to develop an interactive web-based patient decision aid to improve awareness, access, knowledge, and decision making for all young women with cancer. The International Patient Decision Aid Standards collaboration recommends a formal decision-making needs assessment to inform and guide the design of understandable, meaningful, and usable patient decision aid interventions. Objective: This study aims to assess providers' and survivors' fertility preservation decision-making experiences, unmet needs, and initial design preferences to inform the development of a web-based patient decision aid. Methods: Semistructured interviews and an ad hoc focus group assessed current decision-making experiences, unmet needs, and recommendations for a patient decision aid. Two researchers coded and analyzed the transcripts using NVivo (QSR International). A stakeholder advisory panel guided the study and interpretation of results. Results: A total of 51 participants participated in 46 interviews (18 providers and 28 survivors) and 1 ad hoc focus group (7 survivors). The primary themes included the importance of fertility decisions for survivorship, the existence of significant but potentially modifiable barriers to optimal decision making, and a strong support for developing a carefully designed patient decision aid website. Providers reported needing an intervention that could quickly raise awareness and facilitate timely referrals. Survivors reported needing understandable information and help with managing uncertainty, costs, and pressures. Design recommendations included providing tailored information (eg, by age and cancer type), optional interactive features, and multimedia delivery at multiple time points, preferably outside the consultation. Conclusions: Decision making about fertility preservation is an important step in providing high-quality comprehensive cancer care and a priority for many survivors' optimal quality of life. Decision support interventions are needed to address gaps in care and help women quickly navigate toward an informed, values-congruent decision. Survivors and providers support developing a patient decision aid website to make information directly available to women outside of the consultation and to provide self-tailored content according to women's clinical characteristics and their information-seeking and deliberative styles. ",
doi="10.2196/25083",
url="https://formative.jmir.org/2021/6/e25083",
url="http://www.ncbi.nlm.nih.gov/pubmed/34096871"
}


@Article{info:doi/10.2196/22915,
author="McMaughan, Jones Darcy
and Lin, Sherry
and Ozmetin, Jennifer
and Beverly, Gayle Judith
and Brog, Joshua
and Naiser, Emily",
title="A Provider-Facing eHealth Tool for Transitioning Youth With Special Health Care Needs From Pediatric to Adult Care: Mixed Methods, User-Engaged Usability Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="25",
volume="5",
number="5",
pages="e22915",
keywords="youth with special health care needs",
keywords="health care transitions",
keywords="eHealth",
keywords="usability",
keywords="concurrent think aloud method",
abstract="Background: There is a need for medical education on health care transitions for youth with special health care needs. The Texas Transition Toolkit (the tool) supports providers through a one-stop shop for researching literature on care transitions, a catalog of care transition tools, and guides for developing care transition programs. Objective: This study aims to assess the functionality and usability of the tool with providers working with transition-aged children and youth with special health care needs (representative users). Methods: The tool was evaluated using a triangulated mixed methods case study approach consisting of a concurrent think-aloud phase, a satisfaction survey, and a survey of problem relevance and task performance to operationalize and capture functionality and usability. Our mixed methods deep dive into the functionality and usability of the tool focused on 10 representative users from one medical home in Texas and 5 website design experts. Results: Representative users found the tool to be highly relevant, as demonstrated by the satisfaction score for relevance (138/150, 92\%). According to the users, the tool provided comprehensive information related to health care transitions for youth with special health care needs, with a satisfaction score of 87.3\% (131/150) for comprehensive. Overall satisfaction with the tool was high at 81.92\% (1065/1300) with a cutoff score of 73.33\% (953.4/1300) indicating high satisfaction, but users reported relatively lower satisfaction with search (114/150, 76\%) and navigation (ease of use: 114/150, 76\%; hyperlinks: 163/200, 81.5\%; structure: 159/200, 79.5\%). They experienced search- and navigation-related problems (total problems detected: 21/31, 68\%) and, based on quality checks, had a relatively low task completion rate for tasks involving finding information (60/80, 75\%), which required searching and navigation. The problems identified around search and navigation functionality were relevant (relevance scores ranging from 14.5 to 22, with a cutoff score of 11.7 indicating relevance). Conclusions: The tool may help bridge the gaps in training on health care transitions for youth with special health care needs in US medical education. The tool can be used to create structured protocols to help improve provider knowledge, collaboration across pediatric and adult care providers, and the continuity of care as youth with special health care needs transition from pediatric to adult care. The results provided a road map for optimizing the tool and highlighted the importance of evaluating eHealth technologies with representative users. ",
doi="10.2196/22915",
url="https://formative.jmir.org/2021/5/e22915",
url="http://www.ncbi.nlm.nih.gov/pubmed/34032579"
}


@Article{info:doi/10.2196/27005,
author="Terp, Rikke
and Kayser, Lars
and Lindhardt, Tove",
title="Older Patients' Competence, Preferences, and Attitudes Toward Digital Technology Use: Explorative Study",
journal="JMIR Hum Factors",
year="2021",
month="May",
day="14",
volume="8",
number="2",
pages="e27005",
keywords="eHealth literacy",
keywords="eHealth",
keywords="self-management",
keywords="older patients",
keywords="explorative study",
abstract="Background: Malnutrition is prevalent in older patients, which is associated with severe consequences such as a decline in functional status, increased risk of readmission, and increased mortality. A tablet-based eHealth solution (Food`n'Go) was recently developed and introduced at our clinic to support older patients' involvement in nutritional interventions during their hospitalization, thereby enhancing their awareness and motivation for choosing the right food to obtain sufficient calorie and protein intake. To reap the full benefits from the eHealth solution, the technology should be introduced and accompanied by support that targets the end users' competence level and needs. Objective: In this study, we aimed to explore older patients' readiness (ie, competence, preferences, and attitudes) toward the use of information and communication technology (ICT), and to identify the factors that may act as barriers or facilitators for their engagement with health technology. Methods: A descriptive and explorative study was performed using triangulation of data derived from semistructured interviews and questionnaires (based on the Readiness and Enablement Index for Health Technology [READHY] instrument). Older hospitalized patients (age ?65 years; N=25) were included from two hospitals in Denmark. Results: The majority (16/25, 64\%) of the older patients (median age 81 years) were users of ICT. The qualitative findings revealed that their experiences of benefits related to the use of ICT facilitated usage. Barriers for use of ICT were health-related challenges, limited digital literacy, and low self-efficacy related to ICT use due to age-related prejudices by their relatives and themselves. The qualitative findings were also reflected in the low median scores on the eHealth Literacy Questionnaire (eHLQ) READHY scales within dimensions addressing the user's knowledge and skills (eHLQ1:1.8; eHLQ3: 2.0), and the user experience (eHLQ6: 2.0; eHLQ7: 1.5). Conclusions: Older patients are potential users of ICT, but experience a variety of barriers for using eHealth. When introducing older patients to eHealth, it is important to emphasize the possible benefits, and to offer support targeting their knowledge, skills, and motivation. ",
doi="10.2196/27005",
url="https://humanfactors.jmir.org/2021/2/e27005",
url="http://www.ncbi.nlm.nih.gov/pubmed/33988512"
}


@Article{info:doi/10.2196/28668,
author="Petrocchi, Serena
and Filipponi, Chiara
and Montagna, Giacomo
and Bonollo, Marta
and Pagani, Olivia
and Meani, Francesco",
title="A Breast Cancer Smartphone App to Navigate the Breast Cancer Journey: Mixed Methods Study",
journal="JMIR Form Res",
year="2021",
month="May",
day="10",
volume="5",
number="5",
pages="e28668",
keywords="breast cancer",
keywords="decision-making process",
keywords="breast cancer patient",
keywords="smartphone app",
keywords="empowerment",
keywords="breast cancer journey",
keywords="mobile app",
abstract="Background: Several mobile apps have been designed for patients with a diagnosis of cancer. Unfortunately, despite the promising potential and impressive spread, their effectiveness often remains unclear. Most mobile apps are developed without any medical professional involvement and quality evidence-based assessment. Furthermore, they are often implemented in clinical care before any research is performed to confirm usability, appreciation, and clinical benefits for patients. Objective: We aimed to develop a new smartphone app (Centro di Senologia della Svizzera Italiana [CSSI]) specifically designed by breast care specialists and patients together to help breast cancer patients better understand and organize their journey through the diagnosis and treatment of cancer. We describe the development of the app and present assessments to evaluate its feasibility, usefulness, and capability to improve patient empowerment. Methods: A mixed method study with brief longitudinal quantitative data collection and subsequent qualitative semistructured interviews was designed. Twenty breast cancer patients participated in the study (mean age 51 years, SD 10 years). The usability of the app, the user experience, and empowerment were measured after 1 month. The semistructured interviews measured the utility of the app and the necessary improvements. Results: The app received good responses from the patients in terms of positive perception of the purpose of the app (7/20, 35\%), organizing the cure path and being aware of the steps in cancer management (5/20, 25\%), facilitating doctor-patient communication (4/20, 20\%), and having detailed information about the resources offered by the hospital (2/20, 10\%). Correlation and regression analyses showed that user experience increased the level of empowerment of patients (B=0.31, 95\% CI 0.22-0.69; P=.009). The interviews suggested the need to constantly keep the app updated and to synchronize it with the hospital's electronic agenda, and carefully selecting the best time to offer the tool to final users was considered crucial. Conclusions: Despite the very small number of participants in this study, the findings demonstrate the potential of the app and support a fully powered trial to evaluate the empowering effect of the mobile health app. More data will be gathered with an improved version of the app in the second phase involving a larger study sample. ",
doi="10.2196/28668",
url="https://formative.jmir.org/2021/5/e28668",
url="http://www.ncbi.nlm.nih.gov/pubmed/33970120"
}


@Article{info:doi/10.2196/25980,
author="Soberg, Lundgaard Helene
and Moksnes, {\O}greid H{\aa}kon
and Anke, Audny
and R{\o}ise, Olav
and R{\o}e, Cecilie
and Aas, Eline
and Sveen, Unni
and Gaarder, Christine
and N{\ae}ss, Aksel P{\aa}l
and Helseth, Eirik
and Dahl, Margrete Hilde
and Becker, Frank
and L{\o}vstad, Marianne
and Bartnes, Kristian
and Sch{\"a}fer, Christoph
and Rasmussen, S. Mari
and Perrin, Paul
and Lu, Juan
and Hellstr{\o}m, Torgeir
and Andelic, Nada",
title="Rehabilitation Needs, Service Provision, and Costs in the First Year Following Traumatic Injuries: Protocol for a Prospective Cohort Study",
journal="JMIR Res Protoc",
year="2021",
month="Apr",
day="14",
volume="10",
number="4",
pages="e25980",
keywords="trauma",
keywords="rehabilitation needs",
keywords="health services",
keywords="costs",
keywords="rehabilitation",
keywords="traumatic injury",
keywords="injury",
abstract="Background: Traumatic injuries, defined as physical injuries with sudden onset, are a major public health problem worldwide. There is a paucity of knowledge regarding rehabilitation needs and service provision for patients with moderate and major trauma, even if rehabilitation research on a spectrum of specific injuries is available. Objective: This study aims to describe the prevalence of rehabilitation needs, the provided services, and functional outcomes across all age groups, levels of injury severity, and geographical regions in the first year after trauma. Direct and indirect costs of rehabilitation provision will also be assessed. The overarching aim is to better understand where to target future efforts. Methods: This is a population-based prospective follow-up study. It encompasses patients of all ages with moderate and severe acute traumatic injury (New Injury Severity Score >9) admitted to the regional trauma centers in southeastern and northern Norway over a 1-year period (2020). Sociodemographic and injury data will be collected. Upon hospital discharge, rehabilitation physicians estimate rehabilitation needs. Rehabilitation needs are assessed by the Rehabilitation Complexity Scale Extended--Trauma (RCS E--Trauma; specialized inpatient rehabilitation), Needs and Provision Complexity Scale (NPCS; community-based rehabilitation and health care service delivery), and Family Needs Questionnaire--Pediatric Version (FNQ-P). Patients, family caregivers, or both will complete questionnaires at 6- and 12-month follow-ups, which are supplemented by telephone interviews. Data on functioning and disability, mental health, health-related quality of life measured by the EuroQol Questionnaire (EQ-5D), and needs and provision of rehabilitation and health care services are collected by validated outcome measures. Unmet needs are represented by the discrepancies between the estimates of the RCS E--Trauma and NPCS at the time of a patient's discharge and the rehabilitation services the patient has actually received. Formal service provision (including admission to inpatient- or outpatient-based rehabilitation), informal care, and associated costs will be collected. Results: The project was funded in December 2018 and approved by the Regional Committee for Medical and Health Research Ethics in October 2019. Inclusion of patients began at Oslo University Hospital on January 1, 2020, and at the University Hospital of North Norway on February 1, 2020. As of February 2021, we have enrolled 612 patients, and for 286 patients the 6-month follow-up has been completed. Papers will be drafted for publication throughout 2021 and 2022. Conclusions: This study will improve our understanding of existing service provision, the gaps between needs and services, and the associated costs for treating patients with moderate and major trauma. This may guide the improvement of rehabilitation and health care resource planning and allocation. International Registered Report Identifier (IRRID): DERR1-10.2196/25980 ",
doi="10.2196/25980",
url="https://www.researchprotocols.org/2021/4/e25980",
url="http://www.ncbi.nlm.nih.gov/pubmed/33688841"
}


@Article{info:doi/10.2196/18764,
author="Jung, Young Se
and Hwang, Hee
and Lee, Keehyuck
and Lee, Donghyun
and Yoo, Sooyoung
and Lim, Kahyun
and Lee, Ho-Young
and Kim, Eric",
title="User Perspectives on Barriers and Facilitators to the Implementation of Electronic Health Records in Behavioral Hospitals: Qualitative Study",
journal="JMIR Form Res",
year="2021",
month="Apr",
day="8",
volume="5",
number="4",
pages="e18764",
keywords="electronic health records",
keywords="mental health care",
keywords="qualitative study",
keywords="mobile phone",
abstract="Background: Despite the rapid adoption of electronic health records (EHRs) resulting from the reimbursement program of the US government, EHR adoption in behavioral hospitals is still slow, and there remains a lack of evidence regarding barriers and facilitators to the implementation of mental health care EHRs.  Objective: The aim of this study is to analyze the experience of mental health professionals to explore the perceived barriers, facilitators, and critical ideas influencing the implementation and usability of a mental health care EHR.  Methods: In this phenomenological qualitative study, we interviewed physicians, nurses, pharmacists, mental health clinicians, and administrative professionals separately at 4 behavioral hospitals in the United States. We conducted semistructured interviews (N=43) from behavioral hospitals involved in the adoption of the mental health care EHR. Purposeful sampling was used to maximize the diversity. Transcripts were coded and analyzed for emergent domains. An exploratory data analysis was conducted. Results: Content analyses revealed 7 barriers and 4 facilitators. The most important barriers to implementing the mental health care EHR were the low levels of computer proficiency among nurses, complexity of the system, alert fatigue, and resistance because of legacy systems. This led to poor usability, low acceptability, and distrust toward the system. The major facilitators to implementing the mental health care EHR were well-executed training programs, improved productivity, better quality of care, and the good usability of the mental health care EHR.  Conclusions: Health care professionals expected to enhance their work productivity and interprofessional collaboration by introducing the mental health care EHR. Routine education for end users is an essential starting point for the successful implementation of mental health care EHR electronic decision support. When adopting the mental health care EHR, managers need to focus on common practices in behavioral hospitals, such as documenting structured data in their organizations and adopting a seamless workflow of mental health care into the system. ",
doi="10.2196/18764",
url="https://formative.jmir.org/2021/4/e18764",
url="http://www.ncbi.nlm.nih.gov/pubmed/33830061"
}


@Article{info:doi/10.2196/21109,
author="Dimitrovski, Tomi
and Bath, A. Peter
and Ketikidis, Panayiotis
and Lazuras, Lambros",
title="Factors Affecting General Practitioners' Readiness to Accept and Use an Electronic Health Record System in the Republic of North Macedonia: A National Survey of General Practitioners",
journal="JMIR Med Inform",
year="2021",
month="Apr",
day="5",
volume="9",
number="4",
pages="e21109",
keywords="general practitioner",
keywords="eHealth",
keywords="technology acceptance",
keywords="electronic health record",
abstract="Background: Electronic health records (EHRs) represent an important aspect of digital health care, and to promote their use further, we need to better understand the drivers of their acceptance among health care professionals. EHRs are not simple computer applications; they should be considered as a highly integrated set of systems. Technology acceptance theories can be used to better understand users' intentions to use EHRs. It is recommended to assess factors that determine the future acceptance of a system before it is implemented. Objective: This study uses a modified version of the Unified Theory of Acceptance and Use of Technology with the aim of examining the factors associated with intentions to use an EHR application among general practitioners (GPs) in the Republic of North Macedonia, a country that has been underrepresented in extant literature. More specifically, this study aims to assess the role of technology acceptance predictors such as performance expectancy, effort expectancy, social influence, facilitating conditions, job relevance, descriptive norms, and satisfaction with existing eHealth systems already implemented in the country. Methods: A web-based invitation was sent to 1174 GPs, of whom 458 completed the questionnaire (response rate=40.2\%). The research instrument assessed performance expectancy, effort expectancy, facilitating conditions, and social influence in relation to the GPs' intentions to use future EHR systems. Job relevance, descriptive norms, satisfaction with currently used eHealth systems in the country, and computer/internet use were also measured. Results: Hierarchical linear regression analysis showed that effort expectancy, descriptive norms, social influence, facilitating conditions, and job relevance were significantly associated with intentions to use the future EHR system, but performance expectance was not. Multiple mediation modeling analyses further showed that social influence (z=2.64; P<.001), facilitating conditions (z=4.54; P<.001), descriptive norms (z=4.91; P<.001), and effort expectancy (z=5.81; P=.008) mediated the association between job relevance and intentions. Finally, moderated regression analysis showed that the association between social influence and usage intention was significantly moderated (P=.02) by experience (Bexperience{\texttimes}social influence=.005; 95\% CI 0.001 to 0.010; $\beta$=.080). In addition, the association between social influence and intentions was significantly moderated (P=.02) by age (Bage{\texttimes}social influence=.005; 95\% CI 0.001 to 0.010; $\beta$=.077). Conclusions: Expectations of less effort in using EHRs and perceptions on supportive infrastructures for enabling EHR use were significantly associated with the greater acceptance of EHRs among GPs. Social norms were also associated with intentions, even more so among older GPs and those with less work experience. The theoretical and practical implications of these findings are also discussed. ",
doi="10.2196/21109",
url="https://medinform.jmir.org/2021/4/e21109",
url="http://www.ncbi.nlm.nih.gov/pubmed/33818399"
}


@Article{info:doi/10.2196/25148,
author="Otokiti, Umar Ahmed
and Craven, K. Catherine
and Shetreat-Klein, Avniel
and Cohen, Stacey
and Darrow, Bruce",
title="Beyond Getting Rid of Stupid Stuff in the Electronic Health Record (Beyond-GROSS): Protocol for a User-Centered, Mixed-Method Intervention to Improve the Electronic Health Record System",
journal="JMIR Res Protoc",
year="2021",
month="Mar",
day="16",
volume="10",
number="3",
pages="e25148",
keywords="electronic health records",
keywords="burnout, psychological",
keywords="user-centered design",
keywords="usability",
keywords="EHR optimization",
abstract="Background: Up to 60\% of health care providers experience one or more symptoms of burnout. Perceived clinician burden resulting in burnout arises from factors such as electronic health record (EHR) usability or lack thereof, perceived loss of autonomy, and documentation burden leading to less clinical time with patients. Burnout can have detrimental effects on health care quality and contributes to increased medical errors, decreased patient satisfaction, substance use, workforce attrition, and suicide. Objective: This project aims to improve the user-centered design of the EHR by obtaining direct input from clinicians about deficiencies. Fixing identified deficiencies via user-centered design has the potential to improve usability, thereby increasing satisfaction by reducing EHR-induced burnout. Methods: Quantitative and qualitative data will be obtained from clinician EHR users. The input will be received through a form built in a REDCap database via a link embedded in the home page of the EHR. The REDCap data will be analyzed in 2 main dimensions, based on nature of the input, what section of the EHR is affected, and what is required to fix the issue(s). Identified issues will be escalated to relevant stakeholders responsible for rectifying the problems identified. Data analysis, project evaluation, and lessons learned from the evaluation will be incorporated in a Plan-Do-Study-Act (PDSA) manner every 4-6 weeks. Results: The pilot phase of the study began in October 2020 in the Gastroenterology Division at Mount Sinai Hospital, New York City, NY, which includes 39 physicians and 15 nurses. The pilot is expected to run over a 4-6--month period. The results of the REDCap data analysis will be reported within 1 month of completing the pilot phase. We will analyze the nature of requests received and the impact of rectified issues on the clinician EHR user. We expect that the results will reveal which sections of the EHR have the highest deficiencies while also highlighting issues about workflow difficulties. Perceived impact of the project on provider engagement, patient safety, and workflow efficiency will also be captured by evaluation survey and other qualitative methods where possible. Conclusions: The project aims to improve user-centered design of the EHR by soliciting direct input from clinician EHR users. The ultimate goal is to improve efficiency, reduce EHR inefficiencies with the possibility of improving staff engagement, and lessen EHR-induced clinician burnout. Our project implementation includes using informatics expertise to achieve the desired state of a learning health system as recommended by the National Academy of Medicine as we facilitate feedback loops and rapid cycles of improvement. International Registered Report Identifier (IRRID): PRR1-10.2196/25148 ",
doi="10.2196/25148",
url="https://www.researchprotocols.org/2021/3/e25148",
url="http://www.ncbi.nlm.nih.gov/pubmed/33724202"
}


@Article{info:doi/10.2196/17856,
author="Park, Eunhee
and Kwon, Misol",
title="Testing the Digital Health Literacy Instrument for Adolescents: Cognitive Interviews",
journal="J Med Internet Res",
year="2021",
month="Mar",
day="15",
volume="23",
number="3",
pages="e17856",
keywords="adolescent",
keywords="digital health literacy",
keywords="ehealth literacy",
keywords="cognitive interview",
abstract="Background: Despite the increasing number of youth seeking health information on the internet, few studies have been conducted to measure digital health literacy in this population. The digital health literacy instrument (DHLI) is defined as a scale that measures the ability to operate digital devices and read and write in web-based modes, and it assesses seven subconstructs: operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content to a web-based app, and protecting privacy. Currently, there is no validation process of this instrument among adolescents. Objective: This study aims to explore the usability and content validity of DHLI. Methods: Upon the approval of institutional review board protocol, cognitive interviews were conducted. A total of 34 adolescents aged 10-18 years (n=17, 50\% female) participated in individual cognitive interviews. Two rounds of concurrent cognitive interviews were conducted to assess the content validity of DHLI using the thinking aloud method and probing questions. Results: Clarity related to unclear wording, undefined technical terms, vague terms, and difficult vocabularies was a major issue identified. Problems related to potentially inappropriate assumptions were also identified. In addition, concerns related to recall bias and socially sensitive phenomena were raised. No issues regarding response options or instrument instructions were noted. Conclusions: The initial round of interviews provided a potential resolution to the problems identified with comprehension and communication, whereas the second round prompted improvement in content validity. Dual rounds of cognitive interviews provided substantial insights into survey interpretation when introduced to US adolescents. This study examined the validity of the DHLI and suggests revision points for assessing adolescent digital health literacy. ",
doi="10.2196/17856",
url="https://www.jmir.org/2021/3/e17856",
url="http://www.ncbi.nlm.nih.gov/pubmed/33720031"
}


@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/10.2196/15858,
author="Theis, Sabine
and Sch{\"a}fer, Katharina
and Sch{\"a}fer, Dajana
and Jochems, Nicole
and Nitsch, Verena
and Mertens, Alexander",
title="The Relationship Between Individual Coping and the Need to Have and Seek Health Information Among Older Adults: Exploratory Mixed Methods Study",
journal="JMIR Hum Factors",
year="2021",
month="Feb",
day="1",
volume="8",
number="1",
pages="e15858",
keywords="health",
keywords="information science",
keywords="systems analysis",
keywords="eHealth",
keywords="engineering",
keywords="gerontology",
keywords="information technology",
keywords="mobile phone",
abstract="Background: The need to have and seek information shapes the context of computing systems. When it comes to health, individual coping influences human behavior. Therefore, the relationship between individual coping and the need to have and seek health information plays a crucial role in the development of digital health systems. Objective: This study aims to examine the relationship between individual coping and the need to have and seek health information among older adults. Methods: Questionnaires and semistructured interviews investigated the health information need (HIN) and health information--seeking behavior (HISB) in relation to the individual coping strategies of 26 older Germans. Results: The mean age of the interviewed group was 71 years (SD 7). Quantitatively, a trend was found for a negative correlation between the avoidance-oriented coping and HIN (rs=?0.37895; bias-corrected and accelerated bootstrap 95\% BCa CI ?0.730 to 0.092; P=.05). The qualitative results supported this finding. For some participants, information and exchange was part of dealing with their health situation, whereas others wanted to learn as little as possible to avoid a decline in their health status. The older adults acquired, collected, and exchanged paper-based health data to augment clinical information sources and support information exchange with professionals. Conclusions: Individual coping strategies are relevant for the design of digital health systems. They can support older adults in coping with their health situation, although it remains unclear how systems must be designed for people with an avoidance coping strategy to achieve the same acceptance. ",
doi="10.2196/15858",
url="https://humanfactors.jmir.org/2021/1/e15858",
url="http://www.ncbi.nlm.nih.gov/pubmed/33522973"
}


@Article{info:doi/10.2196/14088,
author="Lee, Yun Hee
and Jin, Won Seok
and Henning-Smith, Carrie
and Lee, Jongwook
and Lee, Jaegoo",
title="Role of Health Literacy in Health-Related Information-Seeking Behavior Online: Cross-sectional Study",
journal="J Med Internet Res",
year="2021",
month="Jan",
day="27",
volume="23",
number="1",
pages="e14088",
keywords="digital divide",
keywords="health literacy",
keywords="internet",
keywords="technology",
keywords="access",
abstract="Background: The internet has emerged as a main venue of health information delivery and health-related activities. However, few studies have examined how health literacy determines online health-related behavior. Objective: The aim of this study was to investigate the current level of health-related information-seeking using the internet and how health literacy, access to technology, and sociodemographic characteristics impact health-related information-seeking behavior. Methods: We conducted a cross-sectional study through a survey with Minnesotan adults (N=614) to examine their health literacy, access to technology, and health-related information-seeking internet use. We used multivariate regression analysis to assess the relationship between health-related information-seeking on the internet and health literacy and access to technology, controlling for sociodemographic characteristics. Results: Better health literacy ($\beta$=.35, SE 0.12) and greater access to technological devices (eg, mobile phone and computer or tablet PC; $\beta$=.06, SE 0.19) were both associated with more health-related information-seeking behavior on the internet after adjusting for all other sociodemographic characteristics. Possession of a graduate degree ($\beta$=.28, SE 0.07), female gender ($\beta$=.15, SE 0.05), poor health ($\beta$=.22, SE 0.06), participation in social groups ($\beta$=.13, SE 0.05), and having an annual health exam ($\beta$=.35, SE 0.12) were all associated with online health-related information-seeking. Conclusions: Our findings indicate that access to online health-related information is not uniformly distributed throughout the population, which may exacerbate disparities in health and health care. Research, policy, and practice attention are needed to address the disparities in access to health information as well as to ensure the quality of the information and improve health literacy. ",
doi="10.2196/14088",
url="http://www.jmir.org/2021/1/e14088/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33502332"
}


@Article{info:doi/10.2196/18999,
author="Chen, Yi-Wen
and Wei, Jeng
and Chen, Hwei-Ling
and Cheng, Ching-Hui
and Hou, I-Ching",
title="Developing a Heart Transplantation Self-Management Support Mobile Health App in Taiwan: Qualitative Study",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Aug",
day="19",
volume="8",
number="8",
pages="e18999",
keywords="heart transplantation",
keywords="mobile health app",
keywords="self-management",
abstract="Background: Heart transplantation (HTx) is the most effective treatment for end-stage heart failure patients. After transplantation, patients face physiological, psychological, social, and other health care problems. Mobile health (mHealth) apps can change the delivery of conventional health care to ubiquitous care and improve health care quality. However, a dearth of mHealth apps exists for patients with HTx worldwide, including in Taiwan. Objective: The aim of this study was to investigate the information needed and to develop a preliminary framework for an mHealth app for post-HTx patients. Methods: A qualitative approach with individual in-depth interviews was conducted at a heart center in the regional hospital of northern Taiwan from June to November 2017. Patients that had undergone HTx and their health professionals were recruited for purposeful sampling. A semistructured interview guideline was used for individual interviews and transcribed. Thematic analysis was used for data analysis. Results: A total of 21 subjects, including 17 patients and 4 health professionals, were recruited for the study. The following five major themes were identified: reminding, querying, experience sharing, diet, and expert consulting. Minor themes included a desire to use the app with artificial intelligence and integration with professional management. Conclusions: An intelligent mHealth app that addresses the five main themes and integrates the processes of using a mobile app could facilitate HTx self-management for Taiwanese patients. ",
doi="10.2196/18999",
url="http://mhealth.jmir.org/2020/8/e18999/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32812883"
}


@Article{info:doi/10.2196/15780,
author="Hou, I-Ching
and Lan, Min-Fang
and Shen, Shan-Hsiang
and Tsai, Yu Pei
and Chang, Jen King
and Tai, Hao-Chih
and Tsai, Ay-Jen
and Chang, Polun
and Wang, Tze-Fang
and Sheu, Shuh-Jen
and Dykes, C. Patricia",
title="The Development of a Mobile Health App for Breast Cancer Self-Management Support in Taiwan: Design Thinking Approach",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Apr",
day="30",
volume="8",
number="4",
pages="e15780",
keywords="breast cancer",
keywords="mobile health application",
keywords="self-management",
keywords="design thinking",
abstract="Background: Evidence has shown that breast cancer self-management support from mobile health (mHealth) apps can improve the quality of life of survivors. Although many breast cancer self-management support apps exist, few papers have documented the procedure for the development of a user-friendly app from the patient's perspective. Objective: This study aimed to investigate the information needs of Taiwanese women with breast cancer to inform the development of a self-management support mHealth app. Methods: A 5-step design thinking approach, comprising empathy, define, ideate, prototype, and test steps, was used in the focus groups and individual interviews conducted to collect information on the requirements and expectations of Taiwanese women with breast cancer with respect to the app. A thematic analysis was used to identify information needs. Results: A total of 8 major themes including treatment, physical activity, diet, emotional support, health records, social resources, experience sharing, and expert consultation were identified. Minor themes included the desire to use the app under professional supervision and a trustworthy app manager to ensure the credibility of information. Conclusions: The strengths of the design thinking approach were user-centered design and cultural sensitivity. The results retrieved from each step contributed to the development of the app and reduction of the gap between end users and developers. An mHealth app that addresses these 8 main themes can facilitate disease self-management for Taiwanese women with breast cancer. ",
doi="10.2196/15780",
url="http://mhealth.jmir.org/2020/4/e15780/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32352390"
}


@Article{info:doi/10.2196/16101,
author="Hodges, William Paul
and Setchell, Jenny
and Nielsen, Mandy",
title="An Internet-Based Consumer Resource for People with Low Back Pain (MyBackPain): Development and Evaluation",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Mar",
day="31",
volume="7",
number="1",
pages="e16101",
keywords="back pain",
keywords="patient education",
keywords="patient internet portals",
keywords="evidence-based health care",
keywords="patient involvement",
keywords="service user involvement",
doi="10.2196/16101",
url="http://rehab.jmir.org/2020/1/e16101/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32229467"
}


@Article{info:doi/10.2196/15962,
author="Park, Young Sun
and Andalibi, Nazanin
and Zou, Yikai
and Ambulkar, Siddhant
and Huh-Yoo, Jina",
title="Understanding Students' Mental Well-Being Challenges on a University Campus: Interview Study",
journal="JMIR Form Res",
year="2020",
month="Mar",
day="5",
volume="4",
number="3",
pages="e15962",
keywords="emerging adults",
keywords="university students",
keywords="life events",
keywords="mental wellbeing",
keywords="mental wellness",
keywords="mental health",
keywords="social support",
abstract="Background: Research shows that emerging adults face numerous stressors as they transition from adolescence to adulthood. This paper investigates university students' lived experiences of maintaining mental well-being during major life events and challenges associated with this transitional period. As we continue to design health technology to support students' mental health needs, it is imperative to understand the fundamental needs and issues particular to this phase of their life to effectively engage and lower the barriers to seeking help. Objective: This study first aimed to understand how university students currently seek and receive support to maintain their mental well-being while going through frequent life events during this period of emerging adulthood. The study then aimed to provide design requirements for how social and technical systems should support the students' mental well-being maintenance practice. Methods: Semistructured interviews with 19 students, including graduate and undergraduate students, were conducted at a large university in the Midwest in the United States. Results: This study's findings identified three key needs: students (1) need to receive help that aligns with the perceived severity of the problem caused by a life event, (2) have to continuously rebuild relationships with support givers because of frequent life events, and (3) negotiate tensions between the need to disclose and the stigma associated with disclosure. The study also identified three key factors related to maintaining mental well-being: time, audience, and disclosure. Conclusions: On the basis of this study's empirical findings, we discuss how and when help should be delivered through technology to better address university students' needs for maintaining their mental well-being, and we argue for reconceptualizing seeking and receiving help as a colearning process. ",
doi="10.2196/15962",
url="http://formative.jmir.org/2020/3/e15962/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32134393"
}


@Article{info:doi/10.2196/14095,
author="Chung, Kyungmi
and Cho, Young Hee
and Kim, Ran Young
and Jhung, Kyungun
and Koo, Seon Hwa
and Park, Young Jin",
title="Medical Help-Seeking Strategies for Perinatal Women With Obstetric and Mental Health Problems and Changes in Medical Decision Making Based on Online Health Information: Path Analysis",
journal="J Med Internet Res",
year="2020",
month="Mar",
day="4",
volume="22",
number="3",
pages="e14095",
keywords="perinatal care",
keywords="obstetrics",
keywords="mental health",
keywords="information seeking behavior",
keywords="help-seeking behavior",
keywords="self efficacy",
keywords="health literacy",
keywords="consultation",
keywords="decision making",
keywords="internet",
abstract="Background: Previous studies have revealed that most pregnant women rarely discuss informal information found on the internet with health professionals and have frequently expressed concerns for medical experts' reactions to the online information they shared, as well as the lack of time to consult the medical experts in general. To date, little information is available on the effect of individual differences in utilizing medical help-seeking strategies on their medical decisions during the perinatal period. Objective: The objectives of this study were (1) to determine associations among perinatal women's medical help-seeking strategies, changes in medical decision making, and online health information utilization with a focus on the mediating effect of self-efficacy in perinatal health literacy on the intent to consult health professionals, and (2) to clarify these associations in perinatal women with two different medical problems: obstetric and mental health. Methods: A total of 164 perinatal women aged 24 to 47 years (mean 34.64, SD 3.80) repeatedly completed the Problem Solving in Medicine and Online Health Information Utilization questionnaires to examine the moderating effect of two types of medical problems on their decision-making processes. To validate the hypothesized relationships in the proposed conceptual model encompassing obstetric and mental health problem-solving models, path analyses were performed. Results: This study found that some perinatal women, who use an online informal medical help-seeking (OIMH) strategy, would be more likely to change their medical decisions based only on internet-based information without consulting health professionals (P<.001), compared to other women using different medical help-seeking strategies. Particularly, this concern is significantly prevalent when encountering obstetric problems during the perinatal period (obstetric problem-solving: P<.001; mental health problem-solving: P=.02). Furthermore, perinatal women with mental health issues using the OIMH strategy showed a significant difference in intent to consult health professionals based on online health information when the medical problem they had to solve was different (obstetric problem-solving: P=.94; mental health problem-solving: P=.003). Conclusions: Despite the positive mediating effects of perinatal women's enhanced health literacy on the intent to discuss personal medical issues with health professionals based on online health information, the strategy used is of fundamental importance for understanding their help-seeking and decision-making processes during the perinatal period. Beyond a short consultation to steer patients quickly and authoritatively towards an obstetric doctor's choice of action, it is recommended in this study that obstetricians attempt to provide their patients with needed context for the information found online. To fully explain this information with an open mind, they should actively develop or support information and communications technology (ICT)-based health information services. ",
doi="10.2196/14095",
url="https://www.jmir.org/2020/3/e14095",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130139"
}


@Article{info:doi/10.2196/14698,
author="Hadjistavropoulos, D. Heather
and Gullickson, M. Kirsten
and Adrian-Taylor, Shelley
and Wilhelms, Andrew
and Sundstr{\"o}m, Christopher
and Nugent, Marcie",
title="Stakeholder Perceptions of Internet-Delivered Cognitive Behavior Therapy as a Treatment Option for Alcohol Misuse: Qualitative Analysis",
journal="JMIR Ment Health",
year="2020",
month="Mar",
day="3",
volume="7",
number="3",
pages="e14698",
keywords="internet intervention",
keywords="cognitive behavioral therapy",
keywords="alcohol consumption",
keywords="stakeholder participation",
keywords="qualitative research",
keywords="implementation science",
abstract="Background: Internet-delivered cognitive behavior therapy (ICBT) has been found to be effective for treating alcohol misuse in research trials, but it is not available as part of routine care in Canada. Recent recommendations in the literature highlight the importance of integrating perspectives from both patient and health care stakeholders when ICBT is being implemented in routine practice settings. Objective: This study aimed to gain an understanding of how ICBT is perceived as a treatment option for alcohol misuse by interviewing diverse stakeholders. Specifically, the objectives were to (1) learn about the perceived advantages and disadvantages of ICBT for alcohol misuse and (2) elicit recommendations to inform implementation efforts in routine practice. Methods: A total of 30 participants representing six stakeholder groups (ie, patients, family members, academic experts, frontline managers, service providers, and health care decision makers) participated in semistructured interviews. To be included in the study, stakeholders had to reside in Saskatchewan, Canada, and have personal or professional experience with alcohol misuse. Interviews were transcribed verbatim, anonymized, and analyzed using thematic analysis. Results: Stakeholders identified numerous advantages of ICBT for alcohol misuse (eg, accessibility, convenience, privacy, relevance to technology-based culture, and fit with stepped care) and several disadvantages (eg, lack of internet access and technological literacy, isolation, less accountability, and unfamiliarity with ICBT). Stakeholders also provided valuable insight into factors to consider when implementing ICBT for alcohol misuse in routine practice. In terms of intervention design, stakeholders recommended a 6- to 8-week guided program that uses Web-based advertising, point-of-sale marketing, and large-scale captive audiences to recruit participants. With regard to treatment content, stakeholders recommended that the program focus on harm reduction rather than abstinence; be evidence based; appeal to the diverse residents of Saskatchewan; and use language that is simple, encouraging, and nonjudgmental. Finally, in terms of population characteristics, stakeholders felt that several features of the alcohol misuse population, such as psychiatric comorbidity, readiness for change, and stigma, should be considered when developing an ICBT program for alcohol misuse. Conclusions: Stakeholders' insights will help maximize the acceptability, appropriateness, and adoption of ICBT for alcohol misuse and in turn contribute to implementation success. The methodology and findings from this study could be of benefit to others who are seeking to implement ICBT in routine practice. ",
doi="10.2196/14698",
url="https://mental.jmir.org/2020/3/e14698",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130151"
}


@Article{info:doi/10.2196/15924,
author="Castro, R. Aimee
and Chougui, Khadidja
and Bilodeau, Claudette
and Tsimicalis, Argerie",
title="Exploring the Views of Osteogenesis Imperfecta Caregivers on Internet-Based Technologies: Qualitative Descriptive Study",
journal="J Med Internet Res",
year="2019",
month="Dec",
day="18",
volume="21",
number="12",
pages="e15924",
keywords="smartphone",
keywords="caregivers",
keywords="pediatrics",
keywords="rare diseases",
keywords="telemedicine",
keywords="quality improvement",
keywords="social media",
keywords="chronic disease",
keywords="osteogenesis imperfecta",
abstract="Background: Osteogenesis imperfecta (OI) is a rare genetic condition that can lead to frequent debilitating bone fractures. Family caregivers of children with OI face unique challenges in providing care, which may include limited access to information about the condition, feelings of distress, and experiences of social isolation. Internet-based technologies (IBTs) have been useful for supporting other types of caregivers. However, the views of OI caregivers on IBTs have not been explored. Objective: This study aimed to explore the views of OI caregivers on the uses of IBTs to support them in caring for their children with OI. Methods: A qualitative descriptive study was conducted. Caregivers of children with OI were recruited at a pediatric hospital in Montreal, Canada. Interviews were used to explore each caregiver's views on the applicability of IBTs in supporting their caregiving needs. The interviews were transcribed verbatim and thematically analyzed. Results: A total of 18 caregivers participated. The caregivers shared that IBTs were useful for facilitating the following activities: daily activities of caregiving (such as providing physical care, supporting relationships, supporting self-care and hope, and managing the logistics of caregiving), OI medical information seeking, and OI social networking. However, they also revealed concerns about the health consequences of IBT use and the quality of IBT content. Concerns regarding IBTs varied somewhat with caregivers' geographies. Caregivers offered suggestions and strategies for how IBTs can be optimized for caregiving. Conclusions: Family caregivers of children with OI face unique challenges in providing care, which may include lacking access to information about the rare condition and feeling socially isolated. OI caregivers use IBTs to overcome some of these challenges and to support their specific caregiving needs. These findings contribute to the paucity of knowledge by offering varied IBT strategies to support caregiving activities, which may be beneficial for other caregivers. Participants' suggestions for IBT services can inform the development of new resources for OI caregivers and potentially for other caregivers of children living with rare conditions. ",
doi="10.2196/15924",
url="http://www.jmir.org/2019/12/e15924/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31850851"
}


@Article{info:doi/10.2196/13472,
author="Safi, Sabur
and Danzer, Gerhard
and Schmailzl, JG Kurt",
title="Empirical Research on Acceptance of Digital Technologies in Medicine Among Patients and Healthy Users: Questionnaire Study",
journal="JMIR Hum Factors",
year="2019",
month="Nov",
day="29",
volume="6",
number="4",
pages="e13472",
keywords="innovative health care applications",
keywords="e-Health",
keywords="Technology Acceptance Model",
keywords="health care innovation",
keywords="electronic medical records",
keywords="ePatient Survey",
keywords="sex differences",
keywords="medical technology",
abstract="Background: In recent years, interest in digital technologies such as electronic health, mobile health, telemedicine, big data, and health apps has been increasing in the health care sector. Acceptance and sustainability of these technologies play a considerable role for innovative health care apps. Objective: This study aimed to identify the spread of and experience with new digital technologies in the medical sector in Germany. Methods: We analyzed the acceptance of new health care technologies by applying the Technology Acceptance Model to data obtained in the German ePatient Survey 2018. This survey used standardized questionnaires to gain insight into the prevalence, impact, and development of digital health applications in a study sample of 9621 patients with acute and chronic conditions and healthy users. We extracted sociodemographic data and details on the different health app types used in Germany and conducted an evaluation based on the Technology Acceptance Model. Results: The average age of the respondents was 59.7 years, with a standard deviation of 16 years. Digital health care apps were generally accepted, but differences were observed among age groups and genders of the respondents. Men were more likely to accept digital technologies, while women preferred coaching and consultation apps. Analysis of the user typology revealed that most users were patients (n=4041, 42\%), followed by patients with acute conditions (n=3175, 33\%), and healthy users (n=2405, 25\%). The majority (n=6542, 68\%) discovered coaching or medication apps themselves on the internet, while more than half of the users faced initial difficulties operating such apps. The time of use of the same app or program ranged from a few days (n=1607, 37\%) and several months (n=1694, 39\%) to ?1 year (n=1042, 24\%). Most respondents (n=6927, 72\%) stated that they would like to receive customized health care apps from their physician. Conclusions: The acceptance of digital technologies in the German health care sector varies depending on age and gender. The broad acceptance of medical digital apps could potentially improve individualized health care solutions and warrants governance. ",
doi="10.2196/13472",
url="http://humanfactors.jmir.org/2019/4/e13472/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31782741"
}


@Article{info:doi/10.2196/13022,
author="Scott Duncan, Therese
and Riggare, Sara
and Koch, Sabine
and Sharp, Lena
and H{\"a}gglund, Maria",
title="From Information Seekers to Innovators: Qualitative Analysis Describing Experiences of the Second Generation of E-Patients",
journal="J Med Internet Res",
year="2019",
month="Aug",
day="15",
volume="21",
number="8",
pages="e13022",
keywords="consumer health informatics",
keywords="eHealth",
keywords="qualitative research",
keywords="self-care",
keywords="motivation",
abstract="Background: Current health care systems are rarely designed to meet the needs of people living with chronic conditions. However, some patients and informal caregivers are not waiting for the health care system to redesign itself. These individuals are sometimes referred to as e-patients. The first generation of e-patients used the internet for finding information and for communicating with peers. Compared with the first generation, the second generation of e-patients collects their own health data and appears to be more innovative. Objective: The aim of this study was to describe the second generation of e-patients through exploration of their active engagement in their self-care and health care. Methods: Semistructured interviews were conducted with 10 patients with chronic conditions and 5 informal caregivers. They were all recruited through a Web-based advertisement. Data were analyzed according to the framework analysis approach, using the 3 concepts of the self-determination theory---autonomy, relatedness, and competence---at the outset. Results: Study participants were actively engaged in influencing their self-care and the health care system to improve their own health, as well as the health of others. This occurred at different levels, such as using their own experience when giving presentations and lectures to health care professionals and medical students, working as professional peers in clinical settings, performing self-tracking, contributing with innovations, and being active on social media. When interaction with health care providers was perceived as being insufficient, the participants sought support through their peers, which showed strong relatedness. Competence increased through the use of technology and learning experiences with peers. Their autonomy was important but was sometimes described as involuntary and to give up was not an option for them. Conclusions: Like the first generation of e-patients, the participants frequently searched for Web-based information. However, the second generation of e-patients also produce their own health data, which they learn from and share. They also engage in the innovation of digital tools to meet health-related needs. Utilizing technological developments comes naturally to the second generation of e-patients, even if the health care system is not prepared to support them under these new circumstances. ",
doi="10.2196/13022",
url="http://www.jmir.org/2019/8/e13022/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31418421"
}


@Article{info:doi/10.2196/12242,
author="Sewitch, J. Maida
and Fallone, A. Carlo
and Ghali, Peter
and Lee, Eun Ga",
title="What Patients Want in a Smartphone App That Supports Colonoscopy Preparation: Qualitative Study to Inform a User-Centered Smartphone App",
journal="JMIR Mhealth Uhealth",
year="2019",
month="Jul",
day="02",
volume="7",
number="7",
pages="e12242",
keywords="colonoscopy",
keywords="early detection of cancer",
keywords="mobile health technology",
keywords="qualitative research",
keywords="smartphone",
keywords="user-centered",
abstract="Background: The preparation for colonoscopy is elaborate and complex. In the context of colorectal cancer screening, up to 11\% of patients do not keep their colonoscopy appointments and up to 33\% of those attending their appointments have inadequately cleansed bowels that can delay cancer diagnosis and treatment. A smartphone app may be an acceptable and wide-reaching tool to improve patient adherence to colonoscopy. Objective: The aim of this qualitative study was to employ a user-centered approach to design the content and features of a smartphone app called colonAPPscopy to support individuals preparing for their colonoscopy appointments. Methods: We conducted 2 focus group discussions (FGDs) with gastroenterology patients treated at the McGill University Health Centre in Montreal, Canada. Patients were aged 50 to 75 years, were English- or French-speaking, and had undergone outpatient colonoscopy in the previous 3 months; they did not have inflammatory bowel disease or colorectal cancer. FGDs were 75 to 90 min, conducted by a trained facilitator, and audiotaped. Participants discussed the electronic health support tools they might use to help them prepare for the colonoscopy, the content needed for colonoscopy preparation, and the features that would make the smartphone app useful. Recordings of FGDs were transcribed and analyzed using thematic analysis to identify key user-defined content and features to inform the design of colonAPPscopy. Results: A total of 9 patients (7 male and 2 female) participated in one of 2 FGDs. Main content areas focused on bowel preparation instructions, medication restrictions, appointment logistics, communication, and postcolonoscopy expectations. Design features to make the app useful and engaging included minimization of data input, reminders and alerts for up to 7 days precolonoscopy, and visual aids. Participants wanted a smartphone app that comes from a trusted source, sends timely and tailored messages, provides reassurance, provides clear instructions, and is simple to use. Conclusions: Participants identified the need for postcolonoscopy information as well as reminders and alerts in the week before colonoscopy, novel content, and features that had not been included in previous smartphone-based strategies for colonoscopy preparation. The ability to tailor instructions made the smartphone app preferable to other modes of delivery. Study findings recognize the importance of including potential users in the development phase of building a smartphone app. ",
doi="10.2196/12242",
url="https://mhealth.jmir.org/2019/7/e12242/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31125310"
}


@Article{info:doi/10.2196/13387,
author="Gill, Roopan
and Ogilvie, Gina
and Norman, V. Wendy
and Fitzsimmons, Brian
and Maher, Ciana
and Renner, Regina",
title="Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care in British Columbia: Phase I",
journal="J Med Internet Res",
year="2019",
month="May",
day="29",
volume="21",
number="5",
pages="e13387",
keywords="mHealth",
keywords="family planning",
keywords="abortion, induced",
keywords="sexual health",
keywords="digital health",
keywords="user-centered design",
abstract="Background: Over 30\% of women in Canada undergo an abortion. Despite the prevalence of the procedure, stigma surrounding abortion in Canada leads to barriers for women to access this service. The vast majority of care is concentrated in urban settings. There is evidence to support utilization of innovative mobile and other technology solutions to empower women to safely and effectively self-manage aspects of the abortion process. This study is part 1 of a 3-phase study that utilizes user-centered design methodology to develop a digital health solution to specifically support follow-up after an induced surgical abortion. Objective: This study aimed to (1) understand how women at 3 surgical abortion clinics in an urban center of British Columbia utilize their mobile phones to access health care information and (2) understand women's preferences of content and design of an intervention that will support follow-up care after an induced abortion, including contraceptive use. Methods: The study design was based on development-evaluation-implementation process from Medical Research Council Framework for Complex Medical Interventions. This was a mixed-methods formative study. Women (aged 14-45 years) were recruited from 3 urban abortion facilities in British Columbia who underwent an induced abortion. Adaptation of validated surveys and using the technology acceptance model and theory of reasoned action, a cross-sectional survey was designed. Interview topics included demographic information; type of wireless device used; cell phone usage; acceptable information to include in a mobile intervention to support women's abortion care; willingness to use a mobile phone to obtain reproductive health information; optimal strategies to use a mobile intervention to support women; understand preferences for health information resources; and design qualities in a mobile intervention important for ease of use, privacy, and security. Responses to questions in the survey were summarized using descriptive statistics. Qualitative analysis was conducted with NVivo using a thematic analysis approach. This study was approved by the local ethics board. Results: A waiting-room survey was completed by 50 participants, and semistructured interviews were completed with 8 participants. The average age of participants was 26 years. Furthermore, 94\% (47/50) owned a smartphone, 85\% (41/48) used their personal phones to go online, and 85\% would use their cell phone to assist in clinical care. Qualitative analysis demonstrated that women prefer a comprehensive website that included secure email or text notifications to provide tools and resources for emotional well-being, contraceptive decision making, general sexual health, and postprocedure care. Conclusions: A community-based mixed-methods approach allowed us to understand how women use their cell phones and what women desire in a mobile intervention to support their postabortion care. The findings from this formative phase will assist in the development and testing of a mobile intervention to support follow-up care after an induced surgical abortion. ",
doi="10.2196/13387",
url="http://www.jmir.org/2019/5/e13387/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31144668"
}


@Article{info:doi/10.2196/13064,
author="Poncette, Akira-Sebastian
and Spies, Claudia
and Mosch, Lina
and Schieler, Monique
and Weber-Carstens, Steffen
and Krampe, Henning
and Balzer, Felix",
title="Clinical Requirements of Future Patient Monitoring in the Intensive Care Unit: Qualitative Study",
journal="JMIR Med Inform",
year="2019",
month="Apr",
day="30",
volume="7",
number="2",
pages="e13064",
keywords="patient monitoring",
keywords="digital health",
keywords="qualitative research",
keywords="intensive care unit",
keywords="intensive care medicine",
keywords="multidisciplinary",
keywords="user-centered design",
keywords="design thinking",
keywords="digital literacy",
keywords="grounded theory",
abstract="Background: In the intensive care unit (ICU), continuous patient monitoring is essential to detect critical changes in patients' health statuses and to guide therapy. The implementation of digital health technologies for patient monitoring may further improve patient safety. However, most monitoring devices today are still based on technologies from the 1970s. Objective: The aim of this study was to evaluate statements by ICU staff on the current patient monitoring systems and their expectations for future technological developments in order to investigate clinical requirements and barriers to the implementation of future patient monitoring. Methods: This prospective study was conducted at three intensive care units of a German university hospital. Guideline-based interviews with ICU staff---5 physicians, 6 nurses, and 4 respiratory therapists---were recorded, transcribed, and analyzed using the grounded theory approach. Results: Evaluating the current monitoring system, ICU staff put high emphasis on usability factors such as intuitiveness and visualization. Trend analysis was rarely used; inadequate alarm management as well as the entanglement of monitoring cables were rated as potential patient safety issues. For a future system, the importance of high usability was again emphasized; wireless, noninvasive, and interoperable monitoring sensors were desired; mobile phones for remote patient monitoring and alarm management optimization were needed; and clinical decision support systems based on artificial intelligence were considered useful. Among perceived barriers to implementation of novel technology were lack of trust, fear of losing clinical skills, fear of increasing workload, and lack of awareness of available digital technologies. Conclusions: This qualitative study on patient monitoring involves core statements from ICU staff. To promote a rapid and sustainable implementation of digital health solutions in the ICU, all health care stakeholders must focus more on user-derived findings. Results on alarm management or mobile devices may be used to prepare ICU staff to use novel technology, to reduce alarm fatigue, to improve medical device usability, and to advance interoperability standards in intensive care medicine. For digital transformation in health care, increasing the trust and awareness of ICU staff in digital health technology may be an essential prerequisite. Trial Registration: ClinicalTrials.gov NCT03514173; https://clinicaltrials.gov/ct2/show/NCT03514173 (Archived by WebCite at http://www.webcitation.org/77T1HwOzk) ",
doi="10.2196/13064",
url="http://medinform.jmir.org/2019/2/e13064/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31038467"
}


@Article{info:doi/10.2196/ijmr.8423,
author="Holt, Adellund Kamila
and Karnoe, Astrid
and Overgaard, Dorthe
and Nielsen, Edith Sidse
and Kayser, Lars
and R{\o}der, Einar Michael
and From, Gustav",
title="Differences in the Level of Electronic Health Literacy Between Users and Nonusers of Digital Health Services: An Exploratory Survey of a Group of Medical Outpatients",
journal="Interact J Med Res",
year="2019",
month="Apr",
day="05",
volume="8",
number="2",
pages="e8423",
keywords="health literacy",
keywords="computer literacy",
keywords="questionnaires",
keywords="telemedicine",
keywords="consumer health informatics",
abstract="Background: Digitalization of health services ensures greater availability of services and improved contact to health professionals. To ensure high user adoption rates, we need to understand the indicators of use and nonuse. Traditionally, these have included classic sociodemographic variables such as age, sex, and educational level. Electronic health literacy (eHL) describes knowledge, skills, and experiences in the interaction with digital health services and technology. With our recent introduction of 2 new multidimensional instruments to measure eHL, the eHL questionnaire (eHLQ) and the eHL assessment (eHLA) toolkit, eHL provides a multifaceted approach to understand use and nonuse of digital health solutions in detail. Objective: The aim of this study was to investigate how users and nonusers of digital services differ with respect to eHL, in a group of patients with regular contact to a hospital outpatient clinic. Furthermore, to examine how usage and nonusage, and eHL levels are associated with factors such as age, sex, educational level, and self-rated health. Methods: Outpatients were asked to fill out a survey comprising items about usage of digital services, including digital contact to general practitioner (GP) and communication via the national health portal sundhed.dk, the eHLQ, and the eHLA toolkit, as well as items on age, sex, education, and self-rated health. In total, 246 patients completed the survey. A Mann-Whitney test was used to test for differences between users and nonusers of digital services. Correlation tests described correlations between eHL scales (eHEALSs) and age, education, and self-rated health. A significance level of .0071 was used to reject the null hypothesis in relation to the eHEALSs and usage of digital services. Results: In total, 95.1\% (234/246) of the participants used their personal digital ID (NemID), 57.7\% (142/246) were in contact with their GPs electronically, and 54.0\% (133/246) had used the national health portal (sundhed.dk) within the last 3 months. There were no differences between users and nonusers of sundhed.dk with respect to age, sex, educational level, and self-rated health. Users of NemID scored higher than nonusers in 6 of the 7 dimensions of eHLQ, the only one which did not differ was dimension 2: Understanding of health concepts and language. Sundhed.dk users had a higher score in all of the 7 dimensions except for dimension 4: Feel safe and in control. The eHLA toolkit showed that users of sundhed.dk and NemID had higher levels of eHL with regard to tools 2, 5, 6, and 7. Furthermore, users of sundhed.dk had higher levels of eHL with regard to tools 3 and 4. Conclusions: Information about patients' eHL may provide clinicians an understanding of patients' reasons for not using digital health services, better than sociodemographic data or self-rated health. ",
doi="10.2196/ijmr.8423",
url="http://www.i-jmr.org/2019/2/e8423/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30950809"
}


@Article{info:doi/10.2196/12139,
author="M{\"u}ssener, Ulrika
and Linderoth, Catharina
and Bendtsen, Marcus",
title="Exploring the Experiences of Individuals Allocated to a Control Setting: Findings From a Mobile Health Smoking Cessation Trial",
journal="JMIR Hum Factors",
year="2019",
month="Apr",
day="02",
volume="6",
number="2",
pages="e12139",
keywords="tobacco smoking",
keywords="smoking cessation",
keywords="students",
keywords="text messaging",
keywords="mobile phones",
keywords="cell phone",
keywords="control groups",
abstract="Background: Tobacco smoking is the primary cause of preventable premature disease and death worldwide. Evidence of the efficacy of text messaging interventions to reduce smoking behavior is well established, but there is still a need for studies targeting young people, especially because young adult smokers are less likely to seek treatment than older adults. A mobile health intervention, Nicotine Exit (NEXit), targeting smoking among university students was developed to support university students to quit smoking. Short-term effectiveness was measured through a randomized controlled trial, which found that immediately after the 12-week intervention, 26\% of smokers in the intervention group had prolonged abstinence compared with 15\% in the control group. Objective: The objective of this study was to explore the experience of being allocated to the control group in the NEXit smoking cessation intervention. Methods: We asked students who were allocated to the control group in the main NEXit randomized controlled trial to report their experiences. An email was sent to the participants with an electronic link to a short questionnaire. We assessed the distribution of the responses to the questionnaire by descriptive analysis. We analyzed free-text comments to 4 questions. Results: The response rate for the questionnaire was 33.8\% (258/763), and we collected 143 free-text comments. Of the responders, 60.9\% (157/258) experienced frustration, disappointment, and irritation about being allocated to the control group; they felt they were being denied support by having to wait for the intervention. Monthly text messages during the waiting period thanking them for taking part in the trial were perceived as negative by 72.3\% (189/258), but for some the messages served as a reminder about the decision to quit smoking. Of the responders, 61.2\% (158/258) chose to wait to quit smoking until they had access to the intervention, and 29.8\% (77/258) decided to try to quit smoking without support. Of the respondents, 77.5\% (200/258) claimed they were still smoking and had signed up or were thinking about signing up for the smoking cessation program at the time of the questionnaire. Conclusions: Most of the respondents reported negative feelings about having to wait for the support of the intervention and that they had decided to continue smoking. A similar number decided to wait to quit smoking until they had access to the intervention, and these respondents reported a high interest in the intervention. Free-text comments indicated that some control group participants believed that they had been excluded from the trial, while others were confused when asked to sign up for the intervention again. Trial Registration: ISRCTN Registry ISRCTN75766527; http://www.isrctn.com/ISRCTN75766527 (Archived by WebCite at http://www.webcitation.org/7678sUKbR) ",
doi="10.2196/12139",
url="https://humanfactors.jmir.org/2019/2/e12139/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30938682"
}


@Article{info:doi/10.2196/13205,
author="Ledel Solem, Konstanse Ingrid
and Varsi, Cecilie
and Eide, Hilde
and Kristjansdottir, Birna Ol{\"o}f
and Mirkovic, Jelena
and B{\o}r{\o}sund, Elin
and Haaland-{\O}verby, Mette
and Heldal, Karina
and Schreurs, MG Karlein
and Waxenberg, B. Lori
and Weiss, Elizabeth Karen
and Morrison, J. Eleshia
and Solberg Nes, Lise",
title="Patients' Needs and Requirements for eHealth Pain Management Interventions: Qualitative Study",
journal="J Med Internet Res",
year="2019",
month="Apr",
day="01",
volume="21",
number="4",
pages="e13205",
keywords="chronic pain",
keywords="eHealth",
keywords="self-management",
keywords="qualitative methods",
keywords="intervention development",
keywords="user-centered design",
abstract="Background: A growing body of evidence supports the potential effectiveness of electronic health (eHealth) interventions in managing chronic pain. However, research on the needs and preferences of patients with chronic pain in relation to eHealth interventions is scarce. Eliciting user input in the development of eHealth interventions may be a crucial step toward developing meaningful interventions for patients for potentially improving treatment outcomes. Objective: This study aimed to explore the experiences of patients with chronic pain with regard to information and communication technology, understand how an eHealth intervention can support the everyday needs and challenges of patients with chronic pain, and identify possible facilitators and barriers for patients' use of an eHealth pain management intervention. Methods: Twenty patients living with chronic pain and five spouses participated in individual interviews. Semistructured interview guides were used to explore participants' needs, experiences, and challenges in daily life as well as their information and communication technology experiences and preferences for eHealth support interventions. Spouses were recruited and interviewed to gain additional insight into the patients' needs. The study used qualitative thematic analysis. Results: The participants were generally experienced technology users and reported using apps regularly. They were mainly in favor of using an eHealth self-management intervention for chronic pain and considered it a potentially acceptable way of gathering knowledge and support for pain management. The participants expressed the need for obtaining more information and knowledge, establishing a better balance in everyday life, and receiving support for improving communication and social participation. They provided suggestions for the eHealth intervention content and functionality to address these needs. Accessibility, personalization, and usability were emphasized as important elements for an eHealth support tool. The participants described an ideal eHealth intervention as one that could be used for support and distraction from pain, at any time or in any situation, regardless of varying pain intensity and concentration capacity. Conclusions: This study provides insight into user preferences for eHealth interventions aiming to address self-management for chronic pain. Participants highlighted important factors to be considered when designing and developing eHealth interventions for self-management of chronic pain, illustrating the importance and benefit of including users in the development of eHealth interventions. Trial Registration: ClinicalTrials.gov NCT03705104; https://clinicaltrials.gov/ct2/show/NCT03705104. ",
doi="10.2196/13205",
url="https://www.jmir.org/2019/4/e13205/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30877780"
}


@Article{info:doi/10.2196/11240,
author="Madrigal, Lillian
and Escoffery, Cam",
title="Electronic Health Behaviors Among US Adults With Chronic Disease: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2019",
month="Mar",
day="05",
volume="21",
number="3",
pages="e11240",
keywords="information seeking behavior",
keywords="chronic disease",
keywords="health promotion",
keywords="eHealth",
keywords="mobile apps",
keywords="patient portals",
abstract="Background: With increased access to technology and the internet, there are many opportunities for utilizing electronic health (eHealth), internet, or technology-delivered health services and information for the prevention and management of chronic diseases. Objective: The aim of this paper was to explore (1) the differences in technology use, (2) Web-based health information seeking and use behaviors, (3) attitudes toward seeking health information on the Web, and (4) the level of eHealth literacy between adults aged 18 and 64 years with and without chronic disease. Methods: A cross-sectional internet survey was conducted in March 2017 with 401 US adults. Participant responses were examined to understand associations between chronic disease status and eHealth behaviors such as internet health-seeking behaviors and Web-based behaviors related to health, tracking health indicators with a mobile app, patient portal use, and preferences for health information. Results: About 1 in 3 (252/401, 37.2\%) participants reported at least 1 chronic disease diagnosis. Seventy-five percent (301/401) of all participants reported having ever searched for health information on the Web. Participants with a chronic disease reported significantly higher instances of visiting and talking to a health care provider based on health information found on the Web (40.0\% [48/120] vs 25.8\% [46/178], $\chi$22=6.7; P=.01; 43.3\% [52/120] vs 27.9\% [50/179]; $\chi$22=7.6; P=.006). The uses of health information found on the Web also significantly differed between participants with and without chronic diseases in affecting a decision about how to treat an illness or condition (49.2\% [59/120] vs 35.0\% [63/180], $\chi$23=6.7; P=.04), changing the way they cope with a chronic condition or manage pain (40.8\% [49/120] vs 19.4\% [35/180], $\chi$22=16.3; P<.001), and leading them to ask a doctor new questions or get a second opinion (37.5\% [45/120] vs 19.6\% [35/179], $\chi$22=11.8; P<.001). Chronic disease participants were significantly more likely to be tracking health indicators (43.9\% [65/148] vs 28.3\%, [71/251] $\chi$22=10.4; P=.006). In addition, participants with chronic disease diagnosis reported significantly higher rates of patient portal access (55.0\% [82/149] vs 42.1\% [106/252], $\chi$22=6.3; P=.01) and use (40.9\% [61/149] vs 21.0\% [53/252], $\chi$22=18.2; P<.001). Finally, both groups reported similar perceived skills in using the internet for health information on the eHealth Literacy Scale (eHEALS). The majority of participants responded positively when asked about the usefulness of health information and importance of accessing health resources on the Web. Conclusions: The high rates of reported information seeking and use of internet-based health technology among participants with chronic disease may reflect the uptake in eHealth to help manage chronic disease conditions. Health care providers and educators should continue to seek ways to interact and support patients in their management of chronic disease through eHealth platforms, including capitalizing on Web-based resources, patient portals, and mobile phone apps for disease education and monitoring. ",
doi="10.2196/11240",
url="https://www.jmir.org/2019/3/e11240/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30835242"
}


@Article{info:doi/10.2196/11694,
author="Andrews, A. Jacob
and Brown, JE Laura
and Hawley, S. Mark
and Astell, J. Arlene",
title="Older Adults' Perspectives on Using Digital Technology to Maintain Good Mental Health: Interactive Group Study",
journal="J Med Internet Res",
year="2019",
month="Feb",
day="13",
volume="21",
number="2",
pages="e11694",
keywords="mental health",
keywords="older adults",
keywords="technology",
keywords="digital technology",
keywords="Internet",
keywords="apps",
abstract="Background: A growing number of apps to support good mental health and well-being are available on digital platforms. However, very few studies have examined older adults' attitudes toward the use of these apps, despite increasing uptake of digital technologies by this demographic. Objective: This study sought to explore older adults' perspectives on technology to support good mental health. Methods: A total of 15 older adults aged 50 years or older, in two groups, participated in sessions to explore the use of digital technologies to support mental health. Interactive activities were designed to capture participants' immediate reactions to apps and websites designed to support mental health and to explore their experiences of using technology for these purposes in their own lives. Template analysis was used to analyze transcripts of the group discussions. Results: Older adults were motivated to turn to technology to improve mood through mechanisms of distraction, normalization, and facilitated expression of mental states, while aiming to reduce burden on others. Perceived barriers to use included fear of consequences and the impact of low mood on readiness to engage with technology, as well as a lack of prior knowledge applicable to digital technologies. Participants were aware of websites available to support mental health, but awareness alone did not motivate use. Conclusions: Older adults are motivated to use digital technologies to improve their mental health, but barriers remain that developers need to address for this population to access them. ",
doi="10.2196/11694",
url="http://www.jmir.org/2019/2/e11694/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30758292"
}


@Article{info:doi/10.2196/10284,
author="Holzmann, Laura Sophie
and Dischl, Felicitas
and Sch{\"a}fer, Hanna
and Groh, Georg
and Hauner, Hans
and Holzapfel, Christina",
title="Digital Gaming for Nutritional Education: A Survey on Preferences, Motives, and Needs of Children and Adolescents",
journal="JMIR Form Res",
year="2019",
month="Feb",
day="13",
volume="3",
number="1",
pages="e10284",
keywords="adolescents",
keywords="children",
keywords="communication",
keywords="motives",
keywords="mobile phone",
keywords="needs",
keywords="nutrition",
keywords="obesity",
keywords="overweight",
keywords="preferences",
keywords="serious games",
keywords="survey",
abstract="Background: Use of novel information and communication technologies are frequently discussed as promising tools to prevent and treat overweight and obesity in children and adolescents. Objective: This survey aims to describe the preferences, motives, and needs of children and adolescents regarding nutrition and digital games. Methods: We conducted a survey in 6 secondary schools in the southern region of Germany using a 43-item questionnaire. Questions referred to preferences, motives, and needs of children and adolescents regarding nutrition and digital games. In addition, knowledge regarding nutrition was assessed with 4 questions. We collected self-reported sociodemographic and anthropometric data. Descriptive statistical analyses were performed using SPSS. Results: In total, 293 children and adolescents participated in the study, with ages 12-18 years (137 girls, 46.8\%), weight 30.0-120.0 (mean 60.2 [SD 13.2]) kg, and height 1.4-2.0 (mean 1.7 [SD 0.1]) m. A total of 5.5\% (16/290) correctly answered the 4 questions regarding nutrition knowledge. Study participants acquired digital nutritional information primarily from the internet (166/291, 57.0\%) and television (97/291, 33.3\%), while school education (161/291, 55.3\%) and parents or other adults (209/291, 71.8\%) were the most relevant nondigital information sources. Most participants (242/283, 85.5\%) reported that they regularly play digital games. More than half (144/236, 61.0\%) stated that they play digital games on a daily basis on their smartphones or tablets, and almost 70\% (151/282, 66.5\%) reported playing digital games for ?30 minutes without any interruption. One-half of respondents (144/280, 51.4\%) also stated that they were interested in receiving information about nutrition while playing digital games. Conclusions: This survey suggests that nutrition knowledge in children and adolescents might be deficient. Most children and adolescents play digital games and express interest in acquiring nutritional information during digital gameplay. A digital game with a focus on sound nutrition could be a potential educational tool for imparting nutrition knowledge and promoting healthier nutrition behaviors in children and adolescents. ",
doi="10.2196/10284",
url="http://formative.jmir.org/2019/1/e10284/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30758290"
}


@Article{info:doi/10.2196/10510,
author="van Ommeren, L. Anne
and Smulders, C. Laura
and Prange-Lasonder, B. Gerdienke
and Buurke, H. Jaap
and Veltink, H. Peter
and Rietman, S. Johan",
title="Assistive Technology for the Upper Extremities After Stroke: Systematic Review of Users' Needs",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Nov",
day="29",
volume="5",
number="2",
pages="e10510",
keywords="user perspectives",
keywords="stroke",
keywords="upper limb",
keywords="assistive technology",
keywords="user-centered design",
abstract="Background: Technical innovations have the potential to compensate for loss of upper-limb motor functions after stroke. However, majority of the designs do not completely meet the needs and preferences of the end users. User-centered design methods have shown that the attention to user perspectives during development of assistive technology leads to devices that better suit the needs of the users. Objective: To get more insight into the factors that can bring the design of assistive technology to higher levels of satisfaction and acceptance, studies about user perspectives on assistive technology for the upper limb after stroke are systematically reviewed. Methods: A database search was conducted in PubMed, EMBASE, CINAHL, PsycINFO, and Scopus from inception to August 2017, supplemented with a search of reference lists. Methodological quality of the included studies was appraised. User perspectives of stroke survivors, carers, and health care professionals were extracted. A total of 35 descriptive themes were identified, from which 5 overarching themes were derived. Results: In total, 9 studies with information gathered from focus groups, questionnaires, and interviews were included. Barriers and enablers influencing the adoption of assistive technology for the upper limb after stroke emerged within 5 overarching but highly interdependent themes: (1) promoting hand and arm performance; (2) attitude toward technology; (3) decision process; (4) usability; and (5) practical applicability. Conclusions: Expected use of an assistive technology is facilitated when it has a clear therapeutic base (expected benefit in enhancing function), its users (patients and health care professionals) have a positive attitude toward technology, sufficient information about the assistive technology is available, and usability and practical applicability have been addressed successfully in its design. The interdependency of the identified themes implies that all aspects influencing user perspectives of assistive technology need to be considered when developing assistive technology to enhance its chance of acceptance. The importance of each factor may vary depending on personal factors and the use context, either at home as an assistive aid or for rehabilitation at a clinic. ",
doi="10.2196/10510",
url="http://rehab.jmir.org/2018/2/e10510/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30497993"
}


@Article{info:doi/10.2196/formative.8822,
author="Metting, Esther
and Schrage, Jantine Aaltje
and Kocks, WH Janwillem
and Sanderman, Robbert
and van der Molen, Thys",
title="Assessing the Needs and Perspectives of Patients With Asthma and Chronic Obstructive Pulmonary Disease on Patient Web Portals: Focus Group Study",
journal="JMIR Formativ Res",
year="2018",
month="Nov",
day="22",
volume="2",
number="2",
pages="e22",
keywords="asthma",
keywords="chronic obstructive pulmonary disease",
keywords="health care",
keywords="health literacy",
keywords="internet",
keywords="electronic medical record",
keywords="self-management",
abstract="Background: As accessibility to the internet has increased in society, many health care organizations have developed patient Web portals (PWPs), which can provide a range of self-management options to improve patient access. However, the available evidence suggests that they are used inefficiently and do not benefit patients with low health literacy. Asthma and chronic obstructive pulmonary disease (COPD) are common chronic diseases that require ongoing self-management. Moreover, patients with COPD are typically older and have lower health literacy. Objective: This study aimed to obtain and present an overview of patients' perspectives of PWPs to facilitate the development of a portal that better meets the needs of patients with asthma and COPD. Methods: We performed a focus group study using semistructured interviews in 3 patient groups from the north of the Netherlands who were recruited through the Dutch Lung Foundation. Each group met 3 times for 2 hours each at a 1-week interval. Data were analyzed with coding software, and patient descriptors were analyzed with nonparametric tests. The consolidated criteria for reporting qualitative research were followed when conducting the study. Results: We included 29 patients (16/29, 55\% male; mean age 65 [SD 10] years) with COPD (n=14), asthma-COPD overlap (n=4), asthma (n=10), or other respiratory disease (n=1). There was a large variation in the internet experience; some patients hardly used the internet (4/29, 14\%), whereas others used internet >3 times a week (23/29, 79\%). In general, patients were positive about having access to a PWP, considering access to personal medical records as the most important option, though only after discussion with their physician. A medication overview was considered a useful option. We found that communication between health care professionals could be improved if patients could use the PWP to share information with their health care professionals. However, as participants were worried about the language and usability of portals, it was recommended that language should be adapted to the patient level. Another concern was that disease monitoring through Web-based questionnaire use would only be useful if the results were discussed with health care professionals. Conclusions: Participants were positive about PWPs and considered them a logical step. Today, most patients tend to be better educated and have internet access, while also being more assertive and better informed about their disease. A PWP could support these patients. Our participants also provided practical suggestions for implementation in current and future PWP developments. The next step will be to develop a portal based on these recommendations and assess whether it meets the needs of patients and health care providers. ",
doi="10.2196/formative.8822",
url="http://formative.jmir.org/2018/2/e22/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30684436"
}


@Article{info:doi/10.2196/humanfactors.9787,
author="AlJaberi, Hana",
title="Developing Culturally Sensitive mHealth Apps for Caribbean Immigrant Women to Use During Pregnancy: Focus Group Study",
journal="JMIR Hum Factors",
year="2018",
month="Oct",
day="10",
volume="5",
number="4",
pages="e29",
keywords="mHealth",
keywords="human computer interaction",
keywords="prenatal health",
keywords="Caribbean",
keywords="immigrant women",
keywords="mobile phone",
abstract="Background: A valuable addition to the mobile health (mHealth) space is an exploration of the context of minorities in developed countries. The transition period postmigration, culture, and socioeconomic uniqueness of migratory groups can shed light on the problems with existing prenatal mHealth apps. Objective: The objectives of this study were to (1) use the theoretical concept of pregnancy ecology to understand the emotional, physical, information, and social challenges affecting low-income Caribbean immigrant women's prenatal well-being practices and (2) develop a deep understanding of challenges worthy of consideration in mHealth design for these women. Methods: This qualitative interpretive approach using analytical induction presents the findings of 3 focus group sessions with 12 Caribbean immigrant women living in South Florida in the United States. The study took place from April to September 2015. Results: The participants revealed problematic tiers and support needs within the pregnancy ecology including emotional stressors caused by family separation, physical challenges, information gaps, and longing for social support. Conclusions: mHealth interventions for low-income Caribbean immigrant women must be designed beyond the conventional way of focusing on the events surrounding the unborn child. It can be tailored to the needs of the expecting mother. Pregnancy information should be customized on the basis of the variability of lifestyle, cultural practices, socioeconomic status, and social ties while still being able to deliver appropriate guidelines and clear cultural misconceptions. ",
doi="10.2196/humanfactors.9787",
url="http://humanfactors.jmir.org/2018/4/e29/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30305256"
}


@Article{info:doi/10.2196/10426,
author="Wolfe, Leah
and Chisolm, Smith Margaret
and Bohsali, Fuad",
title="Clinically Excellent Use of the Electronic Health Record: Review",
journal="JMIR Hum Factors",
year="2018",
month="Oct",
day="05",
volume="5",
number="4",
pages="e10426",
keywords="clinical excellence",
keywords="electronic health record",
keywords="electronic medical record",
keywords="technology",
keywords="communication skills",
keywords="interpersonal skills",
keywords="professionalism",
keywords="humanism",
keywords="patient care",
abstract="Background: The transition to the electronic health record (EHR) has brought forth a rapid cultural shift in the world of medicine, presenting both new challenges as well as opportunities for improving health care. As clinicians work to adapt to the changes imposed by the EHR, identification of best practices around the clinically excellent use of the EHR is needed. Objective: Using the domains of clinical excellence previously defined by the Johns Hopkins Miller Coulson Academy of Clinical Excellence, this review aims to identify best practices around the clinically excellent use of the EHR. Methods: The authors searched the PubMed database, using keywords related to clinical excellence domains and the EHR, to capture the English-language, peer-reviewed literature published between January 1, 2000, and August 2, 2016. One author independently reviewed each article and extracted relevant data. Results: The search identified 606 titles, with the majority (393/606, 64.9\%) in the domain of communication and interpersonal skills. Twenty-eight of the 606 (4.6\%) titles were excluded from full-text review, primarily due to lack of availability of the full-text article. The remaining 578 full-text articles reviewed were related to clinical excellence generally (3/578, 0.5\%) or the specific domains of communication and interpersonal skills (380/578, 65.7\%), diagnostic acumen (31/578, 5.4\%), skillful negotiation of the health care system (4/578, 0.7\%), scholarly approach to clinical practice (41/578, 7.1\%), professionalism and humanism (2/578, 0.4\%), knowledge (97/578, 16.8\%), and passion for clinical medicine (20/578, 3.5\%). Conclusions: Results suggest that as familiarity and expertise are developed, clinicians are leveraging the EHR to provide clinically excellent care. Best practices identified included deliberate physical configuration of the clinical space to involve sharing the screen with patients and limiting EHR use during difficult and emotional topics. Promising horizons for the EHR include the ability to augment participation in pragmatic trials, identify adverse drug effects, correlate genomic data to clinical outcomes, and follow data-driven guidelines. Clinician and patient satisfaction with the EHR has generally improved with time, and hopefully continued clinician, and patient input will lead to a system that satisfies all. ",
doi="10.2196/10426",
url="https://humanfactors.jmir.org/2018/4/e10426/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30291099"
}


@Article{info:doi/10.2196/jmir.9497,
author="Van den Bulck, Alfons Steve
and Hermens, Rosella
and Slegers, Karin
and Vandenberghe, Bert
and Goderis, Geert
and Vankrunkelsven, Patrik",
title="Designing a Patient Portal for Patient-Centered Care: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2018",
month="Oct",
day="1",
volume="20",
number="10",
pages="e269",
keywords="cross-sectional studies",
keywords="consumer health informatics",
keywords="electronic health record",
keywords="patient portal",
keywords="personal health records",
abstract="Background: In recent literature, patient portals are considered as important tools for the delivery of patient-centered care. To date, it is not clear how patients would conceptualize a patient portal and which health information needs they have when doing so. Objective: This study aimed (1) to investigate health information needs, expectations, and attitudes toward a patient portal and (2) to assess whether determinants, such as patient characteristics, health literacy, and empowerment status, can predict two different variables, namely the importance people attribute to obtaining health information when using a patient portal and the expectations concerning personal health care when using a patient portal. Methods: We conducted a cross-sectional survey of the Flemish population on what patients prefer to know about their digital health data and their expectations and attitudes toward using a patient portal to access their electronic health record. People were invited to participate in the survey through newsletters, social media, and magazines. We used a questionnaire including demographics, health characteristics, health literacy, patient empowerment, and patient portal characteristics. Results: We received 433 completed surveys. The health information needs included features such as being notified when one's health changes (371/396, 93.7\%), being notified when physical parameters increase to dangerous levels (370/395, 93.7\%), observing connections between one's symptoms or diseases or biological parameters (339/398, 85.2\%), viewing the evolution of one's health in function of time (333/394, 84.5\%), and viewing information about the expected effect of treatment (349/395, 88.4\%). Almost 90\% (369/412) of respondents were interested in using a patient portal. Determinants of patients' attachment for obtaining health information on a patient portal were (1) age between 45 and 54 years (P=.05); (2) neutral (P=.03) or interested attitude (P=.008) toward shared decision making; and (3) commitment to question physicians' decisions (P=.03, R2=0.122). Determinants of patients' expectations on improved health care by accessing a patient portal were (1) lower education level (P=.04); (2) neutral (P=.03) or interested attitude (P=.008) toward shared decision making; and (3) problems in understanding health information (P=.04; R2=0.106). Conclusions: The interest in using a patient portal is considerable in Flanders. People would like to receive alerts or some form of communication from a patient portal in case they need to act to manage their health. Determinants such as education, attached importance to shared decision making, difficulties in finding relevant health information, and the attached importance in questioning the decisions of physicians need to be considered in the design of a patient portal. ",
doi="10.2196/jmir.9497",
url="http://www.jmir.org/2018/10/e269/"
}


@Article{info:doi/10.2196/11400,
author="Zhang, Yiyu
and Li, Xia
and Luo, Shuoming
and Liu, Chaoyuan
and Liu, Fang
and Zhou, Zhiguang",
title="Exploration of Users' Perspectives and Needs and Design of a Type 1 Diabetes Management Mobile App: Mixed-Methods Study",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Sep",
day="21",
volume="6",
number="9",
pages="e11400",
keywords="diabetes mellitus, type 1",
keywords="mobile applications",
keywords="qualitative research",
keywords="surveys and questionnaires",
abstract="Background: With the popularity of mobile phones, mobile apps have great potential for the management of diabetes, but the effectiveness of current diabetes apps for type 1 diabetes mellitus (T1DM) is poor. No study has explored the reasons for this deficiency from the users' perspective. Objective: The aims of this study were to explore the perspectives and needs of T1DM patients and diabetes experts concerning a diabetes app and to design a new T1DM management mobile app. Methods: A mixed-methods design combining quantitative surveys and qualitative interviews was used to explore users' needs and perspectives. Experts were surveyed at 2 diabetes conferences using paper questionnaires. T1DM patients were surveyed using Sojump (Changsha ran Xing InfoTech Ltd) on a network. We conducted semistructured, in-depth interviews with adult T1DM patients or parents of child patients who had ever used diabetes apps. The interviews were audio-recorded, transcribed, and coded for theme identification. Results: The expert response rate was 63.5\% (127/200). The respondents thought that the reasons for app invalidity were that patients did not continue using the app (76.4\%, 97/127), little guidance was received from health care professionals (HCPs; 73.2\%, 93/127), diabetes education knowledge was unsystematic (52.8\%, 67/127), and the app functions were incomplete (44.1\%, 56/127). A total of 245 T1DM patient questionnaires were collected, of which 21.2\% (52/245) of the respondents had used diabetes apps. The reasons for their reluctance to use an app were limited time (39\%, 20/52), complicated operations (25\%, 13/52), uselessness (25\%, 13/52), and cost (25\%, 13/52). Both the experts and patients thought that the most important functions of the app were patient-doctor communication and the availability of a diabetes diary. Two themes that were useful for app design were identified from the interviews: (1) problems with patients' diabetes self-management and (2) problems with current apps. In addition, needs and suggestions for a diabetes app were obtained. Patient-doctor communication, diabetes diary, diabetes education, and peer support were all considered important by the patients, which informed the development of a prototype multifunctional app. Conclusions: Patient-doctor communication is the most important function of a diabetes app. Apps should be integrated with HCPs rather than stand-alone. We advocate that doctors follow up with their patients using a diabetes app. Our user-centered method explored comprehensively and deeply why the effectiveness of current diabetes apps for T1DM was poor and what T1DM patients needed for a diabetes app and provided meaningful guidance for app design. ",
doi="10.2196/11400",
url="http://mhealth.jmir.org/2018/9/e11400/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30249580"
}


@Article{info:doi/10.2196/10958,
author="Breakey, R. Vicky
and Bouskill, Vanessa
and Nguyen, Cynthia
and Luca, Stephanie
and Stinson, N. Jennifer
and Ahola Kohut, Sara",
title="Online Peer-to-Peer Mentoring Support for Youth with Hemophilia: Qualitative Needs Assessment",
journal="JMIR Pediatr Parent",
year="2018",
month="Jul",
day="10",
volume="1",
number="2",
pages="e10958",
keywords="hemophilia",
keywords="adolescents",
keywords="transition",
keywords="self-management",
keywords="education",
keywords="internet",
keywords="mentoring",
abstract="Background: To support adolescents through transition from pediatrics to adult care, health care providers and families help teens gain knowledge and develop self-management skills. Peer mentoring can provide meaningful support and has been associated with improved health outcomes in patients with other chronic conditions. Peer mentoring is an appealing way to provide support, but it is imperative to consider the unique needs of adolescents to ensure its success. Objective: The objective of our study was to identify the peer mentoring wants and needs of youth with hemophilia in order to guide the development of a new program. Methods: In this qualitative study, we interviewed a convenience sample of youth with hemophilia from 2 Canadian hemophilia treatment centers. Two iterative cycles of audiorecorded, semistructured individual interviews were conducted. Descriptive statistics and content analyses were used to organize data into categories that reflected emerging themes. Results: In total, we recruited 23 participants aged 12-20 years, with a mean age of 14.91 (2.57) years. When asked about program design, participants weighed the importance of flexibility in delivery (eg, Web-based, in person, text messaging [short message service]), content (eg, structured vs unstructured), frequency of sessions, and length of the program. Participants identified some potential challenges such as scheduling issues, comfort level for disease discussion, and discordant mentor-mentee personality types. The program was viewed as a positive medium for connecting peers with hemophilia. Conclusions: Adolescents with hemophilia expressed interest in a peer mentoring program and provided valuable insight that will be applied in the development of a peer mentoring program for youth with hemophilia. ",
doi="10.2196/10958",
url="http://pediatrics.jmir.org/2018/2/e10958/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31518296"
}


@Article{info:doi/10.2196/jmir.9181,
author="Walsh, MJ Deirdre
and Moran, Kieran
and Cornelissen, V{\'e}ronique
and Buys, Roselien
and Cornelis, Nils
and Woods, Catherine",
title="Electronic Health Physical Activity Behavior Change Intervention to Self-Manage Cardiovascular Disease: Qualitative Exploration of Patient and Health Professional Requirements",
journal="J Med Internet Res",
year="2018",
month="May",
day="08",
volume="20",
number="5",
pages="e163",
keywords="telemedicine",
keywords="exercise",
keywords="cardiovascular diseases",
keywords="rehabilitation",
abstract="Background: Cardiovascular diseases are a leading cause of premature death worldwide. International guidelines recommend routine delivery of all phases of cardiac rehabilitation. Uptake of traditional cardiac rehabilitation remains suboptimal, as attendance at formal hospital-based cardiac rehabilitation programs is low, with community-based cardiac rehabilitation rates and individual long-term exercise maintenance even lower. Home-based cardiac rehabilitation programs have been shown to be equally effective in clinical and health-related quality of life outcomes and yet are not readily available. Objective: Given the potential that home-based cardiac rehabilitation programs have, it is important to explore how to appropriately design any such intervention in conjunction with key stakeholders. The aim of this study was to engage with individuals with cardiovascular disease and other professionals within the health ecosystem to (1) understand the personal, social, and physical factors that inhibit or promote their capacity to engage with physical activity and (2) explore their technology competencies, needs, and wants in relation to an eHealth intervention. Methods: Fifty-four semistructured interviews were conducted across two countries. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Barriers to the implementation of PATHway were also explored specifically in relation to physical capability and safety as well as technology readiness and further mapped onto the COM-B model for future intervention design. Results: Key recommendations included collection of patient data and use of measurements, harnessing hospital based social connections, and advice to utilize a patient-centered approach with personalization and tailoring to facilitate optimal engagement. Conclusions: In summary, a multifaceted, personalizable intervention with an inclusively designed interface was deemed desirable for use among cardiovascular disease patients both by end users and key stakeholders. In-depth understanding of core needs of the population can aid intervention development and acceptability. ",
doi="10.2196/jmir.9181",
url="http://www.jmir.org/2018/5/e163/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29739740"
}


@Article{info:doi/10.2196/mhealth.8236,
author="Floch, Jacqueline
and Zettl, Annabel
and Fricke, Lena
and Weisser, Tina
and Grut, Lisbet
and Vilarinho, Thomas
and Stav, Erlend
and Ascolese, Antonio
and Schauber, Cornelia",
title="User Needs in the Development of a Health App Ecosystem for Self-Management of Cystic Fibrosis: User-Centered Development Approach",
journal="JMIR Mhealth Uhealth",
year="2018",
month="May",
day="08",
volume="6",
number="5",
pages="e113",
keywords="self-management",
keywords="cystic fibrosis",
keywords="mobile health",
keywords="user centered design",
abstract="Background: Digital self-management in cystic fibrosis (CF) is foreseen as a means toward better understanding of the disease and its treatment and better adherence to the treatment. Mobile apps hold the potential to provide access to information, motivate, and strengthen compliance. However, to deliver high-quality apps, the development should be based on thorough knowledge about user needs. Empirical research on the user-centered development of mobile apps for health care is, however, still limited. Objective: The aim of this research is to develop and evaluate an app ecosystem for self-management in CF. It targets not only those directly affected by CF but also parents and health care professionals involved in the treatment. This paper covers the first step of the design process that aims to analyze the context and the user requirements. The primary research question is as follows: what digital support has the potential to usefully support persons with CF and their caregivers in the CF care? To answer this question, we address two preliminary questions: what important factors in everyday life affect the care of persons with CF? and how is the CF care delivered today and what are the limitations of CF care services? Methods: The overall research adopts a user-centered design approach in which future users are involved in the development process from the very beginning to ensure that the apps developed best suit the potential users. The research presented in the paper follows an interpretative case study research strategy seeking to understand the concerns and needs of persons with CF and their caregivers. Data were collected through semistructured qualitative interviews involving 74 participants in seven European countries and from internet forums. Results: The results of the analysis phase show a strong need for individuality of the digital support, as well as for its adaptability to different contexts. The paper presents the concerns and needs of the participants in the study and extracts a set of relevant features for a self-management app ecosystem. Education, enzyme dosage calculation, nutrition management, treatment organization, health diary, treatment follow-up, practical guidelines for treatment, communication with doctors, and communication with peers are foreseen as useful features. Conclusions: The results indicate the readiness for self-management in the CF care even in countries that provide well-functioning health care services for CF care. The large diversity of user requirements identified reflects the crucial role user integration plays in developing apps for a chronic condition such as CF. The need for personalization stemming from the individuality of the patients and the need for communication with health care professionals support the idea of an app ecosystem for the self-management of CF. ",
doi="10.2196/mhealth.8236",
url="http://mhealth.jmir.org/2018/5/e113/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29739742"
}


@Article{info:doi/10.2196/humanfactors.8246,
author="Bosak, Kelly
and Park, Hye Shin",
title="Characteristics of Adults Seeking Health Care Provider Support Facilitated by Mobile Technology: Secondary Data Analysis",
journal="JMIR Hum Factors",
year="2017",
month="Dec",
day="21",
volume="4",
number="4",
pages="e33",
keywords="health technology",
keywords="health behavior",
keywords="health care provider",
keywords="cohort analysis",
abstract="Background: Mobile health technology is rapidly evolving with the potential to transform health care. Self-management of health facilitated by mobile technology can maximize long-term health trajectories of adults. Little is known about the characteristics of adults seeking Web-based support from health care providers facilitated by mobile technology. Objective: This study aimed to examine the following: (1) the characteristics of adults who seek human support from health care providers for health concerns using mobile technology rather than from family members and friends or others with similar health conditions and (2) the use of mobile health technology among adults with chronic health conditions. Findings of this study were interpreted in the context of the Efficiency Model of Support. Methods: We first described characteristics of adults seeking Web-based support from health care providers. Using chi-square tests for categorical variables and t test for the continuous variable of age, we compared adults seeking Web-based and conventional support by demographics. The primary aim was analyzed using multivariate logistic regression to examine whether chronic health conditions and demographic factors (eg, sex, income, employment status, race, ethnicity, education, and age) were associated with seeking Web-based support from health care providers. Results: The sample included adults (N=1453), the majority of whom were female 57.60\% (837/1453), white 75.02\% (1090/1453), and non-Hispanic 89.13\% (1295/1453). The age of the participants ranged from 18 to 92 years (mean 48.6, standard deviation [SD] 16.8). The majority 76.05\% (1105/1453) of participants reported college or higher level of education. A disparity was found in access to health care providers via mobile technology based on socioeconomic status. Adults with annual income of US \$30,000 to US \$100,000 were 1.72 times more likely to use Web-based methods to contact a health care provider, and adults with an annual income above US \$100,000 were 2.41 to 2.46 times more likely to access health care provider support on the Web, compared with those with an annual income below US \$30,000. After adjusting for other demographic covariates and chronic conditions, age was not a significant factor in Web-based support seeking. Conclusions: In this study, the likelihood of seeking Web-based support increased when adults had any or multiple chronic health conditions. A higher level of income and education than the general population was found to be related to the use of mobile health technology among adults in this survey. Future study is needed to better understand the disparity in Web-based support seeking for health issues and the clinicians' role in promoting access to and use of mobile health technology. ",
doi="10.2196/humanfactors.8246",
url="http://humanfactors.jmir.org/2017/4/e33/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29269337"
}


@Article{info:doi/10.2196/diabetes.8315,
author="Ng, H. Ashley
and Crowe, C. Timothy
and Ball, Kylie
and Rasmussen, Bodil",
title="Transitional Needs of Australian Young Adults With Type 1 Diabetes: Mixed Methods Study",
journal="JMIR Diabetes",
year="2017",
month="Nov",
day="30",
volume="2",
number="2",
pages="e29",
keywords="type 1 diabetes",
keywords="mHealth",
keywords="young adults",
keywords="transition",
abstract="Background: Young adulthood is marked by transitions that impact diabetes self-management behaviors, which require ongoing diabetes education and support. Traditional diabetes education programs and services currently do not meet the needs of many young adults with type 1 diabetes mellitus (T1DM) as they continue to fall through the cracks of clinical services. Age-centered diabetes education programs and services present an opportunity for young adults to meet in a supportive environment and gain a better understanding about diabetes management. Objective: The aim of the study was to identify the health and well-being needs of Australian young adults aged between 18 and 35 years with T1DM to develop appropriate solutions to keep them engaged with diabetes self-management. Methods: In total, 13 semistructured individual interviews and self-reported surveys were obtained to understand participants' experiences with diabetes education programs and services. Together with survey data, transcribed interviews were analyzed into themes and categories using comparative analysis to identify the health and well-being needs of young adults with T1DM during young adulthood. Results: Diabetes education and service needs for young adults with T1DM related to improving access to existing diabetes education programs and services, having credible informational resources, as well as having personalized diabetes management advice. Participants especially valued relevant and real-time information and opportunities for peer support, mostly sourced from Web-based platforms. Conclusions: There is a need for diabetes education programs and services to be age-appropriate and easily accessible, to provide relevant and credible information, and to provide opportunities for peer support to better support young adults with T1DM. These findings also support the use of diabetes education programs or services delivered online through mHealth systems in this population. ",
doi="10.2196/diabetes.8315",
url="http://diabetes.jmir.org/2017/2/e29/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30291076"
}


@Article{info:doi/10.2196/mhealth.7927,
author="Gray, Justin
and Beatty, R. Jessica
and Svikis, S. Dace
and Puder, S. Karoline
and Resnicow, Ken
and Konkel, Janine
and Rice, Shetoya
and McGoron, Lucy
and Ondersma, J. Steven",
title="Electronic Brief Intervention and Text Messaging for Marijuana Use During Pregnancy: Initial Acceptability of Patients and Providers",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Nov",
day="08",
volume="5",
number="11",
pages="e172",
keywords="pregnancy",
keywords="marijuana",
keywords="intervention study",
keywords="text messaging",
abstract="Background: Marijuana is the most widely used illicit substance during pregnancy. Technology-delivered brief interventions and text messaging have shown promise in general and pregnant samples but have not yet been applied to marijuana use in pregnancy. Objective: The objective of the study was to evaluate, among pregnant women and prenatal care providers, the acceptability of an electronic brief intervention and text messaging plan for marijuana use in pregnancy. Methods: Participants included patients (n=10) and medical staff (n=12) from an urban prenatal clinic. Patient-participants were recruited directly during a prenatal care visit. Those who were eligible reviewed the interventions individually and provided quantitative and qualitative feedback regarding software acceptability and helpfulness during a one-on-one interview with research staff. Provider-participants took part in focus groups in which the intervention materials were reviewed and discussed. Qualitative and focus group feedback was transcribed, coded manually, and classified by category and theme. Results: Patient-participants provided high ratings for satisfaction, with mean ratings for respectfulness, interest, ease of use, and helpfulness ranging between 4.4 and 4.7 on a 5-point Likert scale. Of the 10 participants, 5 reported that they preferred working with the program versus their doctor, and 9 of 10 said the intervention made them more likely to reduce their marijuana use. Provider-participants received the program favorably, stating the information presented was both relevant and important for their patient population. Conclusions: The findings support the acceptability of electronic brief intervention and text messaging for marijuana use during pregnancy. This, combined with their ease of use and low barrier to initiation, suggests that further evaluation in a randomized trial is appropriate. ",
doi="10.2196/mhealth.7927",
url="http://mhealth.jmir.org/2017/11/e172/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29117931"
}


@Article{info:doi/10.2196/jmir.7415,
author="Da Costa, Deborah
and Zelkowitz, Phyllis
and Letourneau, Nicole
and Howlett, Andrew
and Dennis, Cindy-Lee
and Russell, Brian
and Grover, Steven
and Lowensteyn, Ilka
and Chan, Peter
and Khalif{\'e}, Samir",
title="HealthyDads.ca: What Do Men Want in a Website Designed to Promote Emotional Wellness and Healthy Behaviors During the Transition to Parenthood?",
journal="J Med Internet Res",
year="2017",
month="Oct",
day="11",
volume="19",
number="10",
pages="e325",
keywords="expectant fathers",
keywords="mental health",
keywords="needs assessment",
abstract="Background: Up to 18\% of men experience depression and/or anxiety during the transition to parenthood. Interventions designed specifically to promote the mental health of men during the transition to parenthood are scarce. Internet-delivered interventions may be acceptable and far-reaching in enhancing mental health, parenting knowledge, and healthy behaviors in expectant or new fathers. Objective: To guide the development of Healthydads.ca, a website designed to enhance mental health and healthy behaviors in expectant fathers, a needs assessment was conducted to identify fathers' perspectives of barriers to seeking help for emotional wellness, informational needs, and factors affecting the decision to visit such a website. Methods: One hundred and seventy-four men whose partners were expecting, or had recently given birth, in 3 Canadian provinces (Quebec, Ontario, and Alberta) completed a Web-based survey inquiring about information needs related to psychosocial aspects of the transition to parenthood, lifestyle behaviors, parenting, and factors associated with the decision to visit a father-focused website. Results: Most men (155/174, 89.1\%) reported accessing the Internet to obtain information on pregnancy and spent an average of 6.2 hours online per month. Seeking information about parenting on the Internet was reported by 67.2\% (117/174) of men, with a mean of 4.4 hours per month of online searching. Top barriers to seeking help to improve emotional wellness during the perinatal period were: no time to seek help/assistance (130/174, 74.7\%), lack of resources available in the health care system (126/174, 72.4\%), financial costs associated with services (118/174, 67.8\%), and feeling that one should be able to do it alone (113/174, 64.9\%). Information needs that were rated highly included: parenting/infant care (52.9-81.6\%), supporting (121/174, 69.5\%) and improving (124/174, 71.3\%) relationship with their partner, work-family balance (120/174, 69.0\%), improving sleep (100/174, 57.5\%), and managing stress (98/174, 56.3\%). Perceiving the website as personally relevant (151/174, 86.8\%), credible (141/174, 81.0\%), effective (140/145, 80.5\%), and having an easy navigation structure (141/174, 81.0\%) were identified as important factors related to a first website visit. Providing useful (134/174, 77.0\%) and easy to understand (158/174, 90.8\%) information, which was also free of charge (156/174, 89.7\%), were considered important for deciding to prolong a website visit. Providing the possibility to post questions to a health professional (133/174, 76.4\%), adding new content regularly (119/174, 68.4\%), and personal motivation (111/174, 63.8\%) were factors identified that would encourage a revisit. Conclusions: Our findings demonstrate that there is substantial interest among expectant and new fathers for using Internet-delivered strategies to prepare for the transition to parenthood and support their mental health. Specific user and website features were identified to optimize the use of father-focused websites. ",
doi="10.2196/jmir.7415",
url="http://www.jmir.org/2017/10/e325/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29021126"
}


@Article{info:doi/10.2196/humanfactors.7196,
author="Vorrink, Sigrid
and Huisman, Chantal
and Kort, Helianthe
and Troosters, Thierry
and Lammers, Jan-Willem",
title="Perceptions of Patients With Chronic Obstructive Pulmonary Disease and Their Physiotherapists Regarding the Use of an eHealth Intervention",
journal="JMIR Hum Factors",
year="2017",
month="Sep",
day="19",
volume="4",
number="3",
pages="e20",
keywords="telemedicine",
keywords="self care",
keywords="physical therapists",
keywords="pulmonary disease, chronic obstructive",
abstract="Background: If eHealth interventions are not used (properly), their potential benefits cannot be fulfilled. User perceptions of eHealth are an important determinant of its successful implementation. This study examined how patients with chronic obstructive pulmonary disease (COPD) and their physiotherapists (PHTs) value an eHealth self-management intervention following a period of use. Objective: The study aimed to evaluate the perceptions of COPD patients and their PHTs as eHealth users. Methods: In this study, an eHealth self-management intervention (website and mobile phone app) aimed at stimulating physical activity (PA) in COPD patients was evaluated by its users (patients and PHTs). As participants in a randomized controlled trial (RCT), they were asked how they valued the eHealth intervention after 6 months' use. Interview requests were made to 33 PHTs from 26 participating practices, and a questionnaire was sent to 76 patients. The questionnaire was analyzed in Excel (Microsoft). The interviews with the PHTs and text messages (short message service, SMS) sent between patients and PHTs were transcribed and independently coded in MAXQDA 10 for Windows (VERBI GmbH). Results: A total of 60 patients with COPD filled out the questionnaire, and 24 PHTs were interviewed. The mobile phone app was used 89.0\% (160.2/180 days) (standard deviation [SD] 18.5) of the time by patients; 53\% (13/24) of PHTs reported low or no use. Patients scored the ease of use of the app 5.09 (SD 1.14) (on a 7-point scale). They found the presentation of the PA information in the app to be clear, insightful, and stimulating. All PHTs judged the website as explicit and user-friendly but had trouble devising a new PA goal for their patients. Patients mostly sent informative, neutral messages concerning the PA goal, and PHTs sent mostly motivating, positive messages concerning the PA goal. Messages were not perceived as supportive in reaching the PA goal according to the patients. Perceived usefulness of the intervention for the PHTs was the objective measurement of PA, the ability to see PA patterns over time, and the ability to use the intervention as a tool to give their patients insight into their PA. For patients, it was that the intervention supported them in increasing their PA and that it made them feel fitter. Barriers to use of the intervention according to the PHTs were time constraints and financial reasons. Seventy-nine percent (19/24) of the PHTs and 58\% (35/60) of the patients mentioned they would be interested in using the intervention in the future. Conclusions: PHTs and COPD patients had positive feelings regarding the functionality and potential of the eHealth self-management intervention. This paper addresses a number of topics that may aid in the successful development and implementation of these types of eHealth interventions in the future. ",
doi="10.2196/humanfactors.7196",
url="http://humanfactors.jmir.org/2017/3/e20/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28928110"
}


@Article{info:doi/10.2196/resprot.7224,
author="Velu, V. Adeline
and van Beukering, DM Monique
and Schaafsma, G. Frederieke
and Frings-Dresen, HW Monique
and Mol, WJ Ben
and van der Post, AM Joris
and Kok, Marjolein",
title="Barriers and Facilitators for the Use of a Medical Mobile App to Prevent Work-Related Risks in Pregnancy: A Qualitative Analysis",
journal="JMIR Res Protoc",
year="2017",
month="Aug",
day="22",
volume="6",
number="8",
pages="e163",
keywords="qualitative research",
keywords="mobile app",
keywords="smartphone",
keywords="pregnancy",
keywords="work",
keywords="occupation",
keywords="exposure",
keywords="eHealth",
keywords="mHealth",
abstract="Background: The number of women participating in the labor market in Europe has increased over the last several decades. At the same time, there is growing evidence that certain conditions of employment during pregnancy may have a negative influence on pregnancy outcomes. In order to better inform pregnant women, we aim to develop an app to help assess the health risk as a result of personal and work-related factors and provide personal advice for these women and their health care providers. Objective: The aim of this study was to compose a thematic overview of the perceived facilitators and barriers according to pregnant women, medical professionals, and employers for the use of a mobile app in obstetrical care to prevent occupational-related pregnancy complications. Methods: Two multidisciplinary focus group meetings with in total 14 participants were conducted with pregnant women, occupational physicians, general practitioners, midwives, obstetricians, and representatives of trade unions and employer organizations. Transcripts were analyzed by qualitatively coding procedures and constant comparative methods. Results: We identified 24 potential facilitators and 12 potential barriers for the use of the app in 4 categories: content of the app, the app as a mean to provide information, ease of use, and external factors. The 3 main facilitators identified were the need for a good interaction between the app and the user, apps were viewed as a more practical source of information, and the information should be understandable, according to the existing guidelines, and well-dosed. The 2 main barriers for use were extensive battery and memory use of the smartphone and sending frequent push notifications. Conclusions: The results of this study are important considerations in the developing process of a medical app implementing a guideline or evidence-based information in practice. ",
doi="10.2196/resprot.7224",
url="http://www.researchprotocols.org/2017/8/e163/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28830851"
}


@Article{info:doi/10.2196/mhealth.7834,
author="Van Dijk, R. Matthijs
and Koster, PH Maria
and Rosman, N. Ageeth
and Steegers-Theunissen, PM Regine",
title="Opportunities of mHealth in Preconception Care: Preferences and Experiences of Patients and Health Care Providers and Other Involved Professionals",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Aug",
day="17",
volume="5",
number="8",
pages="e123",
keywords="Focus group",
keywords="Lifestyle",
keywords="mHealth",
keywords="Nutrition",
keywords="Personalized medicine",
keywords="Preconception care",
abstract="Background: The importance of the preconception period and preconception care (PCC) are broadly acknowledged and the potential benefits regarding health promotion have been studied extensively. PCC provides the opportunity to identify, prevent, and treat modifiable and nonmodifiable risk factors to optimize the health of couples trying to become pregnant. The prevalence of modifiable and nonmodifiable risk factors in these couples is high, but the uptake of PCC remains low. Objective: The aim of this study is to identify the preferences and experiences of women and men (patients) trying to become pregnant and of health care providers and other involved professionals regarding mobile health (mHealth), in particular the coaching platform Smarter Pregnancy, and its potential role in PCC. Methods: Patients who participated in the Smarter Pregnancy randomized controlled trial (RCT) and health care providers and professionals also involved in PCC were invited to participate in a qualitative study. The barriers, benefits, and opportunities of big data collection by mHealth were discussed in focus group sessions, prompted with statements regarding PCC. Results: We composed five focus groups, consisting of 27 patients in total (23 women and 4 men), who participated in the RCT, and nine health care providers and other professionals. Of the patients, 67\% (18/27) were familiar with the concept of PCC, but only 15\% (4/27) received any form of PCC. A majority of 56\% (combined percentages of statements 1 [n=18], 2 [n=11], and 3 [n=16]) of the patients believed in the benefit of receiving PCC, and all agreed that men should be involved in PCC as well. Patients did not have a problem using anonymized data obtained from mHealth tools for scientific purposes. Patients and health care providers and other professionals both acknowledged the lack of awareness regarding the importance of PCC and stated that mHealth provides several opportunities to support clinical PCC. Conclusions: Our findings substantiate previous studies addressing the low uptake of PCC due to unawareness or lack of perception of its relevance by couples who are trying to become pregnant. The positive judgment and experiences with mHealth, in particular Smarter Pregnancy, will stimulate future research and further development of effective and cost-effective personalized mHealth apps for patients, health care providers, and other professionals as an add-on to clinical PCC. ",
doi="10.2196/mhealth.7834",
url="http://mhealth.jmir.org/2017/8/e123/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28818820"
}


@Article{info:doi/10.2196/cancer.6996,
author="Hartkopf, D. Andreas
and Graf, Joachim
and Simoes, Elisabeth
and Keilmann, Lucia
and Sickenberger, Nina
and Gass, Paul
and Wallwiener, Diethelm
and Matthies, Lina
and Taran, Florin-Andrei
and Lux, P. Michael
and Wallwiener, Stephanie
and Belleville, Eric
and Sohn, Christof
and Fasching, A. Peter
and Schneeweiss, Andreas
and Brucker, Y. Sara
and Wallwiener, Markus",
title="Electronic-Based Patient-Reported Outcomes: Willingness, Needs, and Barriers in Adjuvant and Metastatic Breast Cancer Patients",
journal="JMIR Cancer",
year="2017",
month="Aug",
day="07",
volume="3",
number="2",
pages="e11",
keywords="breast cancer",
keywords="patient-reported outcome measures",
keywords="electronic patient- reported outcome",
keywords="technical skills",
keywords="willingness to use",
keywords="needs and barriers",
abstract="Background: Patient-reported outcomes (PROs) play an increasingly important role as an adjunct to clinical outcome parameters in measuring health-related quality of life (HRQoL). In fact, PROs are already the accepted gold standard for collecting data about patients' subjective perception of their own state of health. Currently, paper-based surveys of PRO still predominate; however, knowledge regarding the feasibility of and barriers to electronic-based PRO (ePRO) acceptance remains limited. Objective: The objective of this trial was to analyze the willingness, specific needs, and barriers of adjuvant breast cancer (aBC) and metastatic breast cancer (mBC) patients in nonexposed (no exposure to electronic assessment) and exposed (after exposure to electronic assessment decision, whether a tablet-based questionnaire is favored) settings before implementing digital ePRO assessment in relation to health status. We also investigated whether providing support can increase the patients' willingness to participate in such programs. Methods: The nonexposed patients only answered a paper-based questionnaire, whereas the exposed patients filled out both paper- and tablet-based questionnaires. The assessment comprised socioeconomic variables, HRQoL, preexisting technical skills, general attitude toward electronic-based surveys, and potential barriers in relation to health status. Furthermore, nonexposed patients were asked about the existing need for technological support structures. In the course of data evaluation, we performed a frequency analysis as well as chi-square tests and Wilcoxon signed-rank tests. Subsequently, relative risks analysis, univariate categorical regression (CATREG), and mediation analyses (Hayes' bias-corrected bootstrap) were performed. Results: A total of 202 female breast cancer patients completed the PRO assessment (nonexposed group: n=96 patients; exposed group: n=106 patients). Self-reported technical skills were higher in exposed patients (2.79 vs 2.33, P ?.001). Significant differences were found in relation to willingness to use ePRO (92.3\% in the exposed group vs 59\% in the nonexposed group; P=.001). Multiple barriers were identified, and most of them showed statistically significant differences in favor of the exposed patients (ie, data security [13\% in the exposed patients vs 30\% in the nonexposed patients; P=.003] and no prior technology usage [5\% in the exposed group vs 15\% in the nonexposed group; P=.02]), whereas the differences in disease burden (somatic dimension: 4\% in the exposed group vs 9\% in the nonexposed group; P=.13) showed no significance. In nonexposed patients, requests for support services were identified, which could increase their ePRO willingness. Conclusions: Significant barriers in relation to HRQoL, cancer-related restrictions, and especially the setting of the survey were identified in this trial. Thus, it is necessary to address and eliminate these barriers to ensure data accuracy and reliability for future ePRO assessments. Exposure seems to be a potential option to increase willingness to use ePRO and to reduce barriers. ",
doi="10.2196/cancer.6996",
url="http://cancer.jmir.org/2017/2/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28784595"
}


@Article{info:doi/10.2196/humanfactors.6857,
author="St-Maurice, D. Justin
and Burns, M. Catherine",
title="Modeling Patient Treatment With Medical Records: An Abstraction Hierarchy to Understand User Competencies and Needs",
journal="JMIR Hum Factors",
year="2017",
month="Jul",
day="28",
volume="4",
number="3",
pages="e16",
keywords="clinical decision-making",
keywords="health services research",
keywords="qualitative research",
keywords="primary health care",
keywords="medical records systems, computerized",
abstract="Background: Health care is a complex sociotechnical system. Patient treatment is evolving and needs to incorporate the use of technology and new patient-centered treatment paradigms. Cognitive work analysis (CWA) is an effective framework for understanding complex systems, and work domain analysis (WDA) is useful for understanding complex ecologies. Although previous applications of CWA have described patient treatment, due to their scope of work patients were previously characterized as biomedical machines, rather than patient actors involved in their own care. Objective: An abstraction hierarchy that characterizes patients as beings with complex social values and priorities is needed. This can help better understand treatment in a modern approach to care. The purpose of this study was to perform a WDA to represent the treatment of patients with medical records. Methods: The methods to develop this model included the analysis of written texts and collaboration with subject matter experts. Our WDA represents the ecology through its functional purposes, abstract functions, generalized functions, physical functions, and physical forms. Results: Compared with other work domain models, this model is able to articulate the nuanced balance between medical treatment, patient education, and limited health care resources. Concepts in the analysis were similar to the modeling choices of other WDAs but combined them in as a comprehensive, systematic, and contextual overview. The model is helpful to understand user competencies and needs. Future models could be developed to model the patient's domain and enable the exploration of the shared decision-making (SDM) paradigm. Conclusion: Our work domain model links treatment goals, decision-making constraints, and task workflows. This model can be used by system developers who would like to use ecological interface design (EID) to improve systems. Our hierarchy is the first in a future set that could explore new treatment paradigms. Future hierarchies could model the patient as a controller and could be useful for mobile app development. ",
doi="10.2196/humanfactors.6857",
url="http://humanfactors.jmir.org/2017/3/e16/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28754650"
}


@Article{info:doi/10.2196/resprot.5886,
author="Mirk, M. Sean
and Wegrzyn, Marie Nicole",
title="Apps for Health-Related Education in Pharmacy Practice: Needs Assessment Survey Among Patients Within a Large Metropolitan Area",
journal="JMIR Res Protoc",
year="2017",
month="Jul",
day="19",
volume="6",
number="7",
pages="e133",
keywords="patient education",
keywords="mHealth",
keywords="health information management",
keywords="user-centered design",
abstract="Background: Patient education resources are crucial to the effectiveness of prescribed pharmacotherapy. However, user interest and patient preference for these materials is lacking. Regardless of the field, nearly every article on designing mHealth apps references the lack of end-user involvement as a key flaw to sustainable design. The traditional paper-based methods of patient education are difficult to tailor to a patient's specific needs and learning styles, but a customizable app might be beneficial. Objective: Regarding a mobile app for patient education, the objectives of the study were to (1) quantify patient interest, (2) determine desirable features, and (3) determine if a relationship exists between patient variables and interest in an iPad app for patient education. Methods: A paper-based questionnaire was developed and administered to consenting patients receiving care within three sites: two suburban outpatient sites where ambulatory care services are provided and one urban hospital site where ambulatory care transition services are provided. Results: A total of 121 surveys were completed. Most respondents were female (64/120, 53.3\%), between 50 and 70 years of age, white/Caucasian (94/120, 78.3\%), owned at least one technology device, and knew what an iPad was. Diabetes was the most common disease state (43/120, 35.8\%), followed by heart failure (27/120, 22.5\%), history of venous thromboembolism (VTE) (21/120, 17.5\%), and asthma/chronic obstructive pulmonary disease (17/120, 14.2\%). Overall interest in a mobile health app for patient education was 63.7\% (72/113). Interest increased to 68.4\% (78/114) if a health care provider recommended it. Respondents with one chronic health condition were more likely to be interested in an app compared to those with two or more. Respondents with a history of VTE were mostly likely to be interested in using an app on their own accord, while respondents with diabetes were mostly likely to be interested if their health care provider recommended it. Conclusions: This preliminary needs assessment identified that patients are interested in using mHealth apps for health-related education in pharmacy practice, particularly if their health care provider recommends it. ",
doi="10.2196/resprot.5886",
url="http://www.researchprotocols.org/2017/7/e133/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28724511"
}


@Article{info:doi/10.2196/jmir.7760,
author="Nightingale, Ruth
and Hall, Andrew
and Gelder, Carole
and Friedl, Simone
and Brennan, Eileen
and Swallow, Veronica",
title="Desirable Components for a Customized, Home-Based, Digital Care-Management App for Children and Young People With Long-Term, Chronic Conditions: A Qualitative Exploration",
journal="J Med Internet Res",
year="2017",
month="Jul",
day="04",
volume="19",
number="7",
pages="e235",
keywords="child",
keywords="adolescent",
keywords="long-term condition",
keywords="chronic condition",
keywords="self-management",
keywords="self-care",
keywords="mobile apps",
keywords="apps",
keywords="qualitative",
abstract="Background: Mobile apps for mobile phones and tablet devices are widely used by children and young people aged 0-18 years with long-term health conditions, such as chronic kidney disease (CKD), and their healthy peers for social networking or gaming. They are also poised to become a major source of health guidance. However, app development processes that are coproduced, rigorously developed, and evaluated to provide tailored, condition-specific, practical advice on day-to-day care management are seldom systematic or sufficiently described to enable replication. Furthermore, attempts to extrapolate to the real world are hampered by a poor understanding of the effects of key elements of app components. Therefore, effective and cost-effective novel, digital apps that will effectively and safely support care management are critical and timely. To inform development of such an app for children with CKD, a user requirements-gathering exercise was first needed. Objective: To explore the views of children with CKD, their parents, and health care professionals to inform future development of a child-focused, care-management app. Methods: Using age- and developmentally appropriate methods, we interviewed 36 participants: 5-10-year-olds (n=6), 11-14-year-olds (n=6), 15-18-year-olds (n=5), mothers (n=10), fathers (n=2), and health care professionals (n=7). Data were analyzed using Framework Analysis and behavior change theories. Results: Of the 27 interviews, 19 (70\%) interviews were individual and 8 (30\%) were joint---5 out of 8 (63\%) joint interviews were with a child or young person and their parent, 1 out of 8 (13\%) were with a child and both parents, and 2 out of 8 (25\%) were with 2 professionals. Three key themes emerged to inform development of a software requirement specification for a future home-based, digital care-management app intervention: (1) Gaps in current online information and support, (2) Difficulties experienced by children with a long-term condition, and (3) Suggestions for a digital care-management app. Reported gaps included the fact that current online information is not usually appropriate for children as it is ``dry'' and ``boring,'' could be ``scary,'' and was either hard to understand or not relevant to individuals' circumstances. For children, searching online was much less accessible than using a professional-endorsed mobile app. Children also reported difficulty explaining their condition to others, maintaining treatment adherence, coping with feeling isolated, and with trying to live a ``normal'' life. There was recognition that a developmentally appropriate, CKD-specific app could support the process of explaining the condition to healthy peers, reducing isolation, adhering to care-management plans, and living a ``normal'' life. Participants recommended a range of media and content to include in a tailored, interactive, age- and developmentally appropriate app. For example, the user would be able to enter their age and diagnosis so that only age-appropriate and condition-specific content is displayed. Conclusions: Future development of a digital app that meets the identified information and support needs and preferences of children with CKD will maximize its utility, thereby augmenting CKD caregiving and optimizing outcomes. ",
doi="10.2196/jmir.7760",
url="http://www.jmir.org/2017/7/e235/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28676470"
}


@Article{info:doi/10.2196/biomedeng.7143,
author="Prinable, Barry Joseph
and Foster, M. Juliet
and McEwan, L. Alistair
and Young, M. Paul
and Tovey, Euan
and Thamrin, Cindy",
title="Motivations and Key Features for a Wearable Device for Continuous Monitoring of Breathing: A Web-Based Survey",
journal="JMIR Biomed Eng",
year="2017",
month="Jun",
day="26",
volume="2",
number="1",
pages="e1",
keywords="asthma",
keywords="wearable",
keywords="breathing",
keywords="e-health",
abstract="Background: Analysis of patterns of breathing over time may provide novel information on respiratory function and dysfunction. Devices that continuously record and analyze breathing rates may provide new options for the management of respiratory diseases. However, there is a lack of information about design characteristics that would make such devices user-friendly and suitable for this purpose. Objective: Our aim was to determine key device attributes and user requirements for a wearable device to be used for long-term monitoring of breathing. Methods: An online survey was conducted between June and July 2016. Participants were predominantly recruited via the Woolcock Institute of Medical Research database of volunteers, as well as staff and students. Information regarding the survey, a consent form, and a link to a Web-based questionnaire were sent to participants via email. All participants received an identical survey; those with doctor-diagnosed asthma completed an extra questionnaire on asthma control (Asthma Control Test). Survey responses were examined as a group using descriptive statistics. Responses were compared between those with and without asthma using the chi-square test. Results: The survey was completed by 134 participants (males: 39\%, median age group: 50-59 years, asthma: 57\%). Of those who completed the Asthma Control Test, 61\% (47/77) had suboptimal asthma control. Of the 134 participants, 61.9\% (83/134) would be willing to wear a device to monitor their breathing, in contrast to 6.7\% (9/134) who would not. The remaining 31.3\% (42/134) stated that their willingness depended on specific factors. Participants with asthma most commonly cited their asthma as motivation for using a wearable; the most common motivation for use in those without asthma was curiosity. More than 90\% of total participants would use the device during the day, night, or both day and night. Design preferences among all users included a wrist watch (nominated by 92.5\% [124/134] for both day and night use, out of four body sites), the ability to synchronize breathing data with a mobile phone or tablet (81.3\%, 109/134), overnight power charging (33.6\%, 45/134), and a cost of ?Aus \$100 (53.7\%, 72/134). Conclusions: We have explored the motivations and likelihood for adopting wearable technologies for the purpose of monitoring breathing and identified user preferences for key design features. We found participants were motivated to adopt a wearable breathing monitor irrespective of health status, though rationale for use differed between those with and without asthma. These findings will help inform the design of a user-acceptable wearable device that will facilitate its eventual uptake in both healthy and asthma populations. ",
doi="10.2196/biomedeng.7143",
url="http://biomedeng.jmir.org/2017/1/e1/"
}


@Article{info:doi/10.2196/mhealth.7689,
author="Kessel, Anne Kerstin
and Vogel, ME Marco
and Kessel, Carmen
and Bier, Henning
and Biedermann, Tilo
and Friess, Helmut
and Herschbach, Peter
and von Eisenhart-Rothe, R{\"u}diger
and Meyer, Bernhard
and Kiechle, Marion
and Keller, Ulrich
and Peschel, Christian
and Schmid, M. Roland
and Combs, E. Stephanie",
title="Mobile Health in Oncology: A Patient Survey About App-Assisted Cancer Care",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jun",
day="14",
volume="5",
number="6",
pages="e81",
keywords="clinical oncology",
keywords="surveys and questionnaires",
keywords="mobile apps",
keywords="mHealth",
keywords="eHealth",
abstract="Background: In the last decade, the health care sector has been enriched by numerous innovations such as apps and connected devices that assist users in weight reduction and diabetes management. However, only a few native apps in the oncological context exist, which support patients during treatment and aftercare. Objective: The objective of this study was to analyze patients' acceptance regarding app use and to investigate the functions of an oncological app that are most required, and the primary reasons for patients to refuse app-assisted cancer care. Methods: We designed and conducted a survey with 23 questions, inquiring patients about their technical knowledge and equipment, as well as the possible advantages and disadvantages, data transfer, and general functionality of an app. Results: A total of 375 patients participated; the participation rate was 60.7\% (375/618). Gender distribution was about 3:4 (female:male) with a median age of 59 years (range 18-92 years). Whereas 69.6\% (261/375) of patients used mobile devices, 16.3\% (61/375) did not own one, and 9.1\% (34/375) only used a personal computer (PC). About half of the patients rated their usability skills as very good and good (18.9\% 71/375; 35.2\% 132/375), 23.5\% (88/375) described their skills as intermediate, and 14.4\% (54/375) as bad. Of all patients, 182 (48.5\%, 182/375) were willing to send data to their treating clinic via an app, that is, to a server (61.0\% 111/182) or as email (33.5\%, 61/182). About two-thirds (68.7\%, 125/182) believed that additional and regularly sent data would be an ideal complement to the standard follow-up procedure. Additionally, 86.8\% (158/182) wished to be contacted by a physician when entered data showed irregularities. Because of lack of skills (34.4\%, 56/163), concerns about the use of data (35.0\%, 57/163), lack of capable devices (25.8\%, 42/163), and the wish for personal contact with the treating physician (47.2\%, 77/163), a total of 163 (43.5\%, 163/375) patients refused to use an app. Pearson correlation showed a significant but mild relationship between age and app use (P=.03, r=?.12), favoring younger age; male gender correlated as well (P=.04; r=?.11). Conclusions: The results show that the introduction of mobile apps needs to follow different strategies depending on the patients' attitude. Age and gender seem to be the strongest predictive factors. For oncology patients, our survey showed that about half of the patients were willing to send data via an app supporting their treatment. In the future, clinical data such as quality of life and treatment satisfaction recorded by mobile health (mHealth) devices could be used to evaluate and improve therapy workflow. Furthermore, apps could support classical visits, document adverse effects, and remind patients of treatment dates or drug intake. ",
doi="10.2196/mhealth.7689",
url="http://mhealth.jmir.org/2017/6/e81/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28615159"
}


@Article{info:doi/10.2196/jmir.6668,
author="Baumann, Eva
and Czerwinski, Fabian
and Reifegerste, Doreen",
title="Gender-Specific Determinants and Patterns of Online Health Information Seeking: Results From a Representative German Health Survey",
journal="J Med Internet Res",
year="2017",
month="Apr",
day="04",
volume="19",
number="4",
pages="e92",
keywords="health information seeking",
keywords="social media",
keywords="gender differences",
keywords="frequency of seeking",
keywords="Internet",
abstract="Background: Online health information-seeking behavior (OHISB) is currently a widespread and common behavior that has been described as an important prerequisite of empowerment and health literacy. Although demographic factors such as socioeconomic status (SES), age, and gender have been identified as important determinants of OHISB, research is limited regarding the gender-specific motivational determinants of OHISB and differences between women and men in the use of online resources for health information purposes. Objective: The aim of this study was to identify gender-specific determinants and patterns of OHISB by analyzing data from a representative German sample of adults (N=1728) with special attention to access and frequency of use as well as topics and sources of OHISB. Methods: We employed a 2-step analysis, that is, after exploring differences between users and nonusers of online health information using logistic regression models, we highlighted gender-specific determinants of the frequency of OHISB by applying zero-truncated negative binomial models. Results: Age (odds ratio, OR for females=0.97, 95\% CI 0.96-0.99) and degree of satisfaction with one's general practitioner (GP) (OR for males=0.73, 95\% CI 0.57-0.92) were gender-specific determinants of access to OHISB. Regarding the frequency of OHISB, daily Internet use (incidence rate ratio, IRR=1.67, 95\% CI 1.19-2.33) and a strong interest in health topics (IRR=1.45, 95\% CI 1.19-1.77) were revealed to be more important predictors than SES (IRR for high SES=1.25, 95\% CI 0.91-1.73). Conclusions: Users indicate that the Internet seems to be capable of providing a valuable source of informational support and patient empowerment. Increasing the potential value of the Internet as a source for health literacy and patient empowerment requires need-oriented and gender-specific health communication efforts, media, and information strategies. ",
doi="10.2196/jmir.6668",
url="http://www.jmir.org/2017/4/e92/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28377367"
}


@Article{info:doi/10.2196/mhealth.6192,
author="Van Kessel, Kirsten
and Babbage, R. Duncan
and Reay, Nicholas
and Miner-Williams, M. Warren
and Kersten, Paula",
title="Mobile Technology Use by People Experiencing Multiple Sclerosis Fatigue: Survey Methodology",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Feb",
day="28",
volume="5",
number="2",
pages="e6",
keywords="mobile phone technology",
keywords="multiple sclerosis",
keywords="app",
keywords="fatigue",
keywords="symptoms",
keywords="cognitive behavioral therapy",
keywords="intervention",
abstract="Background: Fatigue is one of the most commonly reported symptoms of multiple sclerosis (MS). It has a profound impact on all spheres of life, for people with MS and their relatives. It is one of the key precipitants of early retirement. Individual, group, and Internet cognitive behavioral therapy--based approaches to supporting people with MS to manage their fatigue have been shown to be effective. Objective: The aim of this project was to (1) survey the types of mobile devices and level of Internet access people with MS use or would consider using for a health intervention and (2) characterize the levels of fatigue severity and their impact experienced by the people in our sample to provide an estimate of fatigue severity of people with MS in New Zealand. The ultimate goal of this work was to support the future development of a mobile intervention for the management of fatigue for people with MS. Methods: Survey methodology using an online questionnaire was used to assess people with MS. A total of 51 people with MS participated. The average age was 48.5 years, and the large majority of the sample (77\%) was female. Results: Participants reported significant levels of fatigue as measured with the summary score of the Neurological Fatigue Index (mean 31.4 [SD 5.3]). Most (84\%) respondents scored on average more than 3 on the fatigue severity questions, reflecting significant fatigue. Mobile phone usage was high with 86\% of respondents reporting having a mobile phone; apps were used by 75\% of respondents. Most participants (92\%) accessed the Internet from home. Conclusions: New Zealand respondents with MS experienced high levels of both fatigue severity and fatigue impact. The majority of participants have a mobile device and access to the Internet. These findings, along with limited access to face-to-face cognitive behavioral therapy--based interventions, create an opportunity to develop a mobile technology platform for delivering a cognitive behavioral therapy--based intervention to decrease the severity and impact of fatigue in people with MS. ",
doi="10.2196/mhealth.6192",
url="http://mhealth.jmir.org/2017/2/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28246073"
}


@Article{info:doi/10.2196/mhealth.6021,
author="Jung, Young Se
and Lee, Keehyuck
and Hwang, Hee
and Yoo, Sooyoung
and Baek, Young Hyun
and Kim, Jeehyoung",
title="Support for Sustainable Use of Personal Health Records: Understanding the Needs of Users as a First Step Towards Patient-Driven Mobile Health",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Feb",
day="23",
volume="5",
number="2",
pages="e19",
keywords="electronic health record",
keywords="medical informatics",
keywords="personal health record",
keywords="hospital information systems",
abstract="Background: The tethering of a personal health record (PHR) to an electronic medical record (EMR) may serve as a catalyst in accelerating the distribution of integrated PHRs. Creating shared health records for patients and their health care professionals using self-administered functions of EMR-tethered PHRs is crucial to support sustainable use of the system. Objective: This study assesses the factors related to active use of a self-administered function (Health Notes) in an EMR-tethered PHR (Health4U) in a tertiary academic hospital. Methods: This research is a cross-sectional study conducted in a tertiary academic hospital in South Korea. The enrollees included adults aged 19 years and older with experience accessing Health4U in the 13-month period after June 2013. The primary outcome was the adoption of Health Notes in accordance with the number of chronic diseases. Socio-demographic variables were included as confounding factors. Results: Subjects 71 years of age and older were less likely to become active users of Health Notes than those 30 years and younger. Moreover, compared with men, women had 44\% and 40\% lower tendencies to become Health Notes users and active users, respectively. Those who accessed the desktop page and/or mobile page had higher tendencies to become users of Health Notes. We found a consistent increase in the odds ratio as the number of chronic diseases increased in the active users. When considering specific diseases, patients who had cancer or chronic kidney disease had higher tendencies to become users of Health Notes. Conclusions: Patients with a greater number of chronic diseases tended to use PHR more actively, and used the self-administered function. Women and the elderly may have lower tendencies to actively use PHR. Therefore, items specific to the health of each demographic---women, the elderly, and those with chronic diseases---should be carefully considered to support sustainable use of PHRs. ",
doi="10.2196/mhealth.6021",
url="http://mhealth.jmir.org/2017/2/e19/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28232300"
}


@Article{info:doi/10.2196/diabetes.6643,
author="Lithgow, Kirstie
and Edwards, Alun
and Rabi, Doreen",
title="Smartphone App Use for Diabetes Management: Evaluating Patient Perspectives",
journal="JMIR Diabetes",
year="2017",
month="Jan",
day="23",
volume="2",
number="1",
pages="e2",
keywords="type 1 diabetes",
keywords="mobile health",
keywords="smartphone",
abstract="Background: Finding novel ways to engage patients in chronic disease management has led to increased interest in the potential of mobile health technologies for the management of diabetes. There is currently a wealth of smartphone apps for diabetes management that are available for free download or purchase. However, the usability and desirability of these apps has not been extensively studied. These are important considerations, as these apps must be accepted by the patient population at a practical level if they are to be utilized. Objective: The purpose of this study was to gain insight into patient experiences related to the use of smartphone apps for the management of type 1 diabetes. Methods: Adults with type 1 diabetes who had previously (or currently) used apps to manage their diabetes were eligible to participate. Participants (n=12) completed a questionnaire in which they were required to list the names of preferred apps and indicate which app functions they had used. Participants were given the opportunity to comment on app functions that they perceived to be missing from the current technology. Participants were also asked whether they had previously paid for an app and whether they would be willing to do so. Results: MyFitnessPal and iBGStar were the apps most commonly listed as the best available on the market. Blood glucose tracking, carbohydrate counting, and activity tracking were the most commonly used features. Ten participants fulfilled all eligibility criteria, and indicated that they had not encountered any one app that included all of the functions that they had used. The ability to synchronize an app with a glucometer or insulin pump was the most common function that participants stated was missing from current app technology. One participant had previously paid for a diabetes-related app and the other 9 participants indicated that they would be willing to pay. Conclusions: Despite dissatisfaction with the currently available apps, there is interest in using these tools for diabetes management. Adapting existing technology to better meet the needs of this patient population may allow these apps to become more widely utilized. ",
doi="10.2196/diabetes.6643",
url="http://diabetes.jmir.org/2017/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30291051"
}


@Article{info:doi/10.2196/humanfactors.6778,
author="Iwamoto, Rikako
and Rodrigues Santos, Laura Ana
and Chavannes, Niels
and Reis, Ria
and Diehl, Carel Jan",
title="Considerations for an Access-Centered Design of the Fever Thermometer in Low-Resource Settings: A Literature Review",
journal="JMIR Hum Factors",
year="2017",
month="Jan",
day="18",
volume="4",
number="1",
pages="e3",
keywords="fever diagnostics",
keywords="sub-Saharan Africa",
keywords="thermometer",
keywords="low-resource settings",
keywords="design",
keywords="patient journey",
keywords="product-service system",
abstract="Background: The lack of adequate information about fever in low-resource settings, its unreliable self-assessment, and poor diagnostic practices may result in delayed care and under-or-overdiagnosis of diseases such as malaria. The mismatches of existing fever thermometers in the context of use imply that the diagnostic tools and connected services need to be studied further to address the challenges of fever-related illnesses and their diagnostics. Objective: This study aims to inform a product-service system approach to design a reliable and accessible fever thermometer and connected services, as well as contribute to the identification of innovative opportunities to improve health care in low-resource settings. Methods: To determine what factors impede febrile people seeking health care to access adequate fever diagnostics, a literature search was conducted in Google Scholar and PubMed with relevant keywords. Next, these factors were combined with a patient journey model to design a new product-service system for fever diagnostics in low-resource settings. Results: In total, 37 articles were reviewed. The five As framework was used to categorize the identified barriers. The results indicate that there is a poor distribution of reliable fever diagnostic practices among remote communities. This paper speaks to the global public health and design communities. Three complementary considerations are discussed that support the idea of a more holistic approach to the design of fever diagnostics: (1) understanding of the fever diagnostics patient journey, (2) identifying user groups of the thermometers in a specific health care system, and (3) assessing different needs and interests of the different users. Conclusions: Access to basic, primary health care may be enhanced with better information and technology design made through the involvement of system users. ",
doi="10.2196/humanfactors.6778",
url="http://humanfactors.jmir.org/2017/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28100439"
}


@Article{info:doi/10.2196/humanfactors.6523,
author="Neter, Efrat
and Brainin, Esther",
title="Perceived and Performed eHealth Literacy: Survey and Simulated Performance Test",
journal="JMIR Hum Factors",
year="2017",
month="Jan",
day="17",
volume="4",
number="1",
pages="e2",
keywords="eHealth",
keywords="literacy",
keywords="performance",
abstract="Background: Electronic health (eHealth) literacy of consumers is essential in order to improve information and communication technology (ICT) use for health purposes by ordinary citizens. However, performed eHealth literacy is seldom studied. Therefore, the present study assessed perceived and performed eHealth literacy using the recent conceptualization of health literacy skills. Objective: The aim of this paper was to examine the association between perceived and performed eHealth literacies. Methods: In total, 82 Israeli adults participated in the study, all 50 years and older, with a mean age of 67 (SD 11). Of the participants, 60\% (49/82) were women and 72\% (59/82) had a post-secondary education. The participants were first surveyed and then tested in a computer simulation of health-related Internet tasks. Performed, perceived (eHealth Literacy Scale, eHEALS), and evaluated eHealth literacy were assessed, and performed eHealth literacy was also recorded and re-evaluated later. Performance was scored for successful completion of tasks, and was also assessed by two researchers for motivation, confidence, and amount of help provided. Results: The skills of accessing, understanding, appraising, applying, and generating new information had decreasing successful completion rates. Generating new information was least correlated with other skills. Perceived and performed eHealth literacies were moderately correlated (r=.34, P=.01) while facets of performance (ie, digital literacy and eHealth literacy) were highly correlated (r=.82, P<.001). Participants low and high in performed eHealth literacy were significantly different: low performers were older and had used the Internet for less time, required more assistance, and were less confident in their conduct than high performers. Conclusions: The moderate association between perceived and performed eHealth literacy indicates that the latter should be assessed separately. In as much, the assessment of performed eHealth literacy in clinical settings should entail the structuring of tasks as well as shortening and automatizing the assessment. ",
doi="10.2196/humanfactors.6523",
url="http://humanfactors.jmir.org/2017/1/e2/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28096068"
}


@Article{info:doi/10.2196/humanfactors.6221,
author="Rotondi, J. Armando
and Spring, R. Michael
and Hanusa, H. Barbara
and Eack, M. Shaun
and Haas, L. Gretchen",
title="Designing eHealth Applications to Reduce Cognitive Effort for Persons With Severe Mental Illness: Page Complexity, Navigation Simplicity, and Comprehensibility",
journal="JMIR Hum Factors",
year="2017",
month="Jan",
day="05",
volume="4",
number="1",
pages="e1",
keywords="Internet technology",
keywords="mobile application",
keywords="cognitive impairment",
keywords="eHealth",
keywords="eHealth design",
keywords="e-mental health",
keywords="schizophrenia",
keywords="severe mental illness",
keywords="usability",
keywords="website design",
abstract="Background: eHealth technologies offer great potential for improving the use and effectiveness of treatments for those with severe mental illness (SMI), including schizophrenia and schizoaffective disorder. This potential can be muted by poor design. There is limited research on designing eHealth technologies for those with SMI, others with cognitive impairments, and those who are not technology savvy. We previously tested a design model, the Flat Explicit Design Model (FEDM), to create eHealth interventions for individuals with SMI. Subsequently, we developed the design concept page complexity, defined via the design variables we created of distinct topic areas, distinct navigation areas, and number of columns used to organize contents and the variables of text reading level, text reading ease (a newly added variable to the FEDM), and the number of hyperlinks and number of words on a page. Objective: The objective of our study was to report the influence that the 19 variables of the FEDM have on the ability of individuals with SMI to use a website, ratings of a website's ease of use, and performance on a novel usability task we created termed as content disclosure (a measure of the influence of a homepage's design on the understanding user's gain of a website). Finally, we assessed the performance of 3 groups or dimensions we developed that organize the 19 variables of the FEDM, termed as page complexity, navigational simplicity, and comprehensibility. Methods: We measured 4 website usability outcomes: ability to find information, time to find information, ease of use, and a user's ability to accurately judge a website's contents. A total of 38 persons with SMI (chart diagnosis of schizophrenia or schizoaffective disorder) and 5 mental health websites were used to evaluate the importance of the new design concepts, as well as the other variables in the FEDM. Results: We found that 11 of the FEDM's 19 variables were significantly associated with all 4 usability outcomes. Most other variables were significantly related to 2 or 3 of these usability outcomes. With the 5 tested websites, 7 of the 19 variables of the FEDM overlapped with other variables, resulting in 12 distinct variable groups. The 3 design dimensions had acceptable coefficient alphas. Both navigational simplicity and comprehensibility were significantly related to correctly identifying whether information was available on a website. Page complexity and navigational simplicity were significantly associated with the ability and time to find information and ease-of-use ratings. Conclusions: The 19 variables and 3 dimensions (page complexity, navigational simplicity, and comprehensibility) of the FEDM offer evidence-based design guidance intended to reduce the cognitive effort required to effectively use eHealth applications, particularly for persons with SMI, and potentially others, including those with cognitive impairments and limited skills or experience with technology. The new variables we examined (topic areas, navigational areas, columns) offer additional and very simple ways to improve simplicity. ",
doi="10.2196/humanfactors.6221",
url="http://humanfactors.jmir.org/2017/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28057610"
}


@Article{info:doi/10.2196/jmir.5594,
author="Whealin, M. Julia
and Jenchura, C. Emily
and Wong, C. Ava
and Zulman, M. Donna",
title="How Veterans With Post-Traumatic Stress Disorder and Comorbid Health Conditions Utilize eHealth to Manage Their Health Care Needs: A Mixed-Methods Analysis",
journal="J Med Internet Res",
year="2016",
month="Oct",
day="26",
volume="18",
number="10",
pages="e280",
keywords="stress disorders, post-traumatic",
keywords="telemedicine",
keywords="electronic mail",
keywords="social media",
keywords="self-care",
keywords="computer literacy",
abstract="Background: Mental health conditions are prevalent among US veterans and pose a number of self-management and health care navigation challenges. Post-Traumatic Stress Disorder (PTSD) with comorbid chronic medical conditions (CMCs) is especially common, in both returning Iraq or Afghanistan and earlier war-era veterans. Patient-facing electronic health (eHealth) technology may offer innovative strategies to support these individuals' needs. Objective: This study was designed to identify the types of eHealth tools that veterans with PTSD and comorbid CMCs use, understand how they currently use eHealth technology to self-manage their unique health care needs, and identify new eHealth resources that veterans feel would empower them to better manage their health care. Methods: A total of 119 veterans with PTSD and at least one CMC who have used the electronic personal health record system of the US Department of Veterans Affairs (VA) responded to a mailed survey about their chronic conditions and preferences related to the use of technology. After the survey, 2 focus groups, stratified by sex, were conducted with a subgroup of patients to explore how veterans with PTSD and comorbid CMCs use eHealth technology to support their complex health care needs. Focus groups were transcribed verbatim and analyzed using standard content analysis methods for coding textual data, guided by the ``Fit between Individual, Task, and Technology'' framework. Results: Survey respondents had a mean age of 64.0 (SD 12.0) years, 85.1\% (97/114) were male, 72.4\% (84/116) were white, and 63.1\% (70/111) had an annual household income of < US \$50,000. Mean score on a measure of eHealth literacy was 27.7 (SD 9.8). Of the respondents, 44.6\% (50/112) used health-related technology 1 to 3 times per month and 21.4\% (24/112) used technology less than once per month. Veterans reported using technology most often to search for health information (78.9\%, 90/114), communicate with providers (71.1\%, 81/114), and track medications (64.9\%, 74/114). Five major themes emerged that describe how eHealth technology influences veterans with PTSD and comorbid CMCs: (1) interactions with social support, (2) condition management, (3) access to and communication with providers, (4) information access, and (5) coordination of care. Conclusions: The ``Fit between Individual, Task, and Technology'' model provided a useful framework to examine the clinical tasks that arose for veterans and their resourceful adoption of eHealth tools. This study suggests that veterans who use the Web are eager to incorporate eHealth technology into their care and self-management activities. Findings illustrate a number of ways in which the VA and eHealth technology developers can refine existing applications, develop new resources, and better promote tools that address challenges experienced by veterans with PTSD and comorbid CMCs. ",
doi="10.2196/jmir.5594",
url="http://www.jmir.org/2016/10/e280/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27784650"
}


@Article{info:doi/10.2196/humanfactors.5364,
author="Kunz, Aline
and Pohlmann, Sabrina
and Heinze, Oliver
and Brandner, Antje
and Rei{\ss}, Christina
and Kamradt, Martina
and Szecsenyi, Joachim
and Ose, Dominik",
title="Strengthening Interprofessional Requirements Engineering Through Action Sheets: A Pilot Study",
journal="JMIR Hum Factors",
year="2016",
month="Oct",
day="18",
volume="3",
number="2",
pages="e25",
keywords="personal electronic health record",
keywords="requirements engineering",
keywords="interprofessional cooperation",
keywords="software development",
keywords="scrum",
abstract="Background: The importance of information and communication technology for healthcare is steadily growing. Newly developed tools are addressing different user groups: physicians, other health care professionals, social workers, patients, and family members. Since often many different actors with different expertise and perspectives are involved in the development process it can be a challenge to integrate the user-reported requirements of those heterogeneous user groups. Nevertheless, the understanding and consideration of user requirements is the prerequisite of building a feasible technical solution. In the course of the presented project it proved to be difficult to gain clear action steps and priorities for the development process out of the primary requirements compilation. Even if a regular exchange between involved teams took place there was a lack of a common language. Objective: The objective of this paper is to show how the already existing requirements catalog was subdivided into specific, prioritized, and coherent working packages and the cooperation of multiple interprofessional teams within one development project was reorganized at the same time. In the case presented, the manner of cooperation was reorganized and a new instrument called an Action Sheet was implemented. This paper introduces the newly developed methodology which was meant to smooth the development of a user-centered software product and to restructure interprofessional cooperation. Methods: There were 10 focus groups in which views of patients with colorectal cancer, physicians, and other health care professionals were collected in order to create a requirements catalog for developing a personal electronic health record. Data were audio- and videotaped, transcribed verbatim, and thematically analyzed. Afterwards, the requirements catalog was reorganized in the form of Action Sheets which supported the interprofessional cooperation referring to the development process of a personal electronic health record for the Rhine-Neckar region. Results: In order to improve the interprofessional cooperation the idea arose to align the requirements arising from the implementation project with the method of software development applied by the technical development team. This was realized by restructuring the original requirements set in a standardized way and under continuous adjustment between both teams. As a result not only the way of displaying the user demands but also of interprofessional cooperation was steered in a new direction. Conclusions: User demands must be taken into account from the very beginning of the development process, but it is not always obvious how to bring them together with IT knowhow and knowledge of the contextual factors of the health care system. Action Sheets seem to be an effective tool for making the software development process more tangible and convertible for all connected disciplines. Furthermore, the working method turned out to support interprofessional ideas exchange. ",
doi="10.2196/humanfactors.5364",
url="http://humanfactors.jmir.org/2016/2/e25/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27756716"
}


@Article{info:doi/10.2196/resprot.5467,
author="Garne, Kristina
and Br{\o}dsgaard, Anne
and Zachariassen, Gitte
and Clemensen, Jane",
title="Telemedicine in Neonatal Home Care: Identifying Parental Needs Through Participatory Design",
journal="JMIR Res Protoc",
year="2016",
month="Jul",
day="08",
volume="5",
number="3",
pages="e100",
keywords="preterm infant",
keywords="telemedicine",
keywords="participatory design",
keywords="neonatal home care",
abstract="Background: For the majority of preterm infants, the last weeks of hospital admission mainly concerns tube feeding and establishment of breastfeeding. Neonatal home care (NH) was developed to allow infants to remain at home for tube feeding and establishment of breastfeeding with regular home visits from neonatal nurses. For hospitals covering large regions, home visits may be challenging, time consuming, and expensive and alternative approaches must be explored. Objective: To identify parental needs when wanting to provide neonatal home care supported by telemedicine. Methods: The study used participatory design and qualitative methods. Data were collected from observational studies, individual interviews, and focus group interviews. Two neonatal units participated. One unit was experienced in providing neonatal home care with home visits, and the other planned to offer neonatal home care with telemedicine support. A total of 9 parents with preterm infants assigned to a neonatal home care program and 10 parents with preterm infants admitted to a neonatal unit participated in individual interviews and focus group interviews, respectively. Results: Three overall themes were identified: being a family, parent self-efficacy, and nurse-provided security. Parents expressed desire for the following: (1) a telemedicine device to serve as a ``bell cord'' to the neonatal unit, giving 24-hour access to nurses, (2) video-conferencing to provide security at home, (3) timely written email communication with the neonatal unit, and (4) an online knowledge base on preterm infant care, breastfeeding, and nutrition. Conclusions: Our findings highlight the importance of neonatal home care. NH provides parents with a feeling of being a family, supports their self-efficacy, and gives them a feeling of security when combined with nursing guidance. Parents did not request hands-on support for infant care, but instead expressed a need for communication and guidance, which could be met using telemedicine. ",
doi="10.2196/resprot.5467",
url="http://www.researchprotocols.org/2016/3/e100/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27392576"
}


@Article{info:doi/10.2196/mededu.5392,
author="Bull, Preston Tyler
and Dewar, Roxanne Alexis
and Malvey, M. Donna
and Szalma, Leo James",
title="Considerations for the Telehealth Systems of Tomorrow: An Analysis of Student Perceptions of Telehealth Technologies",
journal="JMIR Med Educ",
year="2016",
month="Jul",
day="08",
volume="2",
number="2",
pages="e11",
keywords="telehealth systems",
keywords="younger adults",
keywords="telehealth advantages",
keywords="telehealth disadvantages",
keywords="thematic analysis",
abstract="Background: While much is known about factors that facilitate telehealth adoption, less is known about why adoption does or does not occur in specific populations, such as students. Objective: This study aims to examine the perceptions of telehealth systems within a large student sample. Methods: Undergraduate students (N=315) participated in a survey of the perceived advantages and disadvantages of telehealth technologies. The responses to the survey were analyzed using thematic analysis. Results: We found that students were likely to adopt telehealth systems for the following reasons: (1) the system worked efficiently, (2) the convenience of telehealth, and (3) to gain access to health services. Students also perceived several disadvantages to telehealth systems, such as issues of trust (ie, security, privacy), the impersonal nature of telehealth systems, and they were concerned about the potential for major system errors. Conclusion: By understanding the current barriers to telehealth adoption in a cohort of students, we can not only better anticipate the future needs of this group, but also incorporate such needs into the design of future telehealth systems. ",
doi="10.2196/mededu.5392",
url="http://mededu.jmir.org/2016/2/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27731865"
}


@Article{info:doi/10.2196/mhealth.5243,
author="Micallef, Christianne
and McLeod, Monsey
and Castro-S{\'a}nchez, Enrique
and Gharbi, Myriam
and Charani, Esmita
and Moore, SP Luke
and Gilchrist, Mark
and Husson, Fran
and Costelloe, Ceire
and Holmes, H. Alison",
title="An Evidence-Based Antimicrobial Stewardship Smartphone App for Hospital Outpatients: Survey-based Needs Assessment Among Patients",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jul",
day="06",
volume="4",
number="3",
pages="e83",
keywords="mobile electronic devices",
keywords="mHealth",
keywords="mobile health",
keywords="antimicrobial resistance",
keywords="patient involvement",
abstract="Background: Current advances in modern technology have enabled the development and utilization of electronic medical software apps for both mobile and desktop computing devices. A range of apps on a large variety of clinical conditions for patients and the public are available, but very few target antimicrobials or infections. Objective: We sought to explore the use of different antimicrobial information resources with a focus on electronic platforms, including apps for portable devices, by outpatients at two large, geographically distinct National Health Service (NHS) teaching hospital trusts in England. We wanted to determine whether there is demand for an evidence-based app for patients, to garner their perceptions around infections/antimicrobial prescribing, and to describe patients' experiences of their interactions with health care professionals in relation to this topic. Methods: A cross-sectional survey design was used to investigate aspects of antimicrobial prescribing and electronic devices experienced by patients at four hospitals in London and a teaching hospital in the East of England. Results: A total of 99 surveys were completed and analyzed. A total of 82\% (80/98) of respondents had recently been prescribed antimicrobials; 87\% (85/98) of respondents were prescribed an antimicrobial by a hospital doctor or through their general practitioner (GP) in primary care. Respondents wanted information on the etiology (42/65, 65\%) and prevention and/or management (32/65, 49\%) of their infections, with the infections reported being upper and lower respiratory tract, urinary tract, oral, and skin and soft tissue infections. All patients (92/92, 100\%) desired specific information on the antimicrobial prescribed. Approximately half (52/95, 55\%) stated it was ``fine'' for doctors to use a mobile phone/tablet computer during the consultation while 13\% (12/95) did not support the idea of doctors accessing health care information in this way. Although only 30\% (27/89) of respondents reported on the use of health care apps, 95\% (81/85) offered information regarding aspects of antimicrobials or infections that could be provided through a tailored app for patients. Analysis of the comments revealed the following main global themes: knowledge, technology, and patient experience. Conclusions: The majority of respondents in our study wanted to have specific etiological and/or infection management advice. All required antimicrobial-related information. Also, most supported the use of electronic resources of information, including apps, by their doctors. While a minority of people currently use health apps, many feel that apps could be used to provide additional support/information related to infections and appropriate use of antimicrobials. In addition, we found that there is a need for health care professionals to engage with patients and help address common misconceptions around the generation of antimicrobial resistance. ",
doi="10.2196/mhealth.5243",
url="http://mhealth.jmir.org/2016/3/e83/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27383743"
}


@Article{info:doi/10.2196/mhealth.5341,
author="Koldijk, Saskia
and Kraaij, Wessel
and Neerincx, A. Mark",
title="Deriving Requirements for Pervasive Well-Being Technology From Work Stress and Intervention Theory: Framework and Case Study",
journal="JMIR Mhealth Uhealth",
year="2016",
month="Jul",
day="05",
volume="4",
number="3",
pages="e79",
keywords="psychological stress",
keywords="professional burn-out",
keywords="behavioral symptoms",
keywords="self-management",
keywords="health technology",
keywords="early medical intervention",
abstract="Background: Stress in office environments is a big concern, often leading to burn-out. New technologies are emerging, such as easily available sensors, contextual reasoning, and electronic coaching (e-coaching) apps. In the Smart Reasoning for Well-being at Home and at Work (SWELL) project, we explore the potential of using such new pervasive technologies to provide support for the self-management of well-being, with a focus on individuals' stress-coping. Ideally, these new pervasive systems should be grounded in existing work stress and intervention theory. However, there is a large diversity of theories and they hardly provide explicit directions for technology design. Objective: The aim of this paper is to present a comprehensive and concise framework that can be used to design pervasive technologies that support knowledge workers to decrease stress. Methods: Based on a literature study we identify concepts relevant to well-being at work and select different work stress models to find causes of work stress that can be addressed. From a technical perspective, we then describe how sensors can be used to infer stress and the context in which it appears, and use intervention theory to further specify interventions that can be provided by means of pervasive technology. Results: The resulting general framework relates several relevant theories: we relate ``engagement and burn-out'' to ``stress'', and describe how relevant aspects can be quantified by means of sensors. We also outline underlying causes of work stress and how these can be addressed with interventions, in particular utilizing new technologies integrating behavioral change theory. Based upon this framework we were able to derive requirements for our case study, the pervasive SWELL system, and we implemented two prototypes. Small-scale user studies proved the value of the derived technology-supported interventions. Conclusions: The presented framework can be used to systematically develop theory-based technology-supported interventions to address work stress. In the area of pervasive systems for well-being, we identified the following six key research challenges and opportunities: (1) performing multi-disciplinary research, (2) interpreting personal sensor data, (3) relating measurable aspects to burn-out, (4) combining strengths of human and technology, (5) privacy, and (6) ethics. ",
doi="10.2196/mhealth.5341",
url="http://mhealth.jmir.org/2016/3/e79/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27380749"
}


@Article{info:doi/10.2196/resprot.5122,
author="Zide, Mary
and Caswell, Kaitlyn
and Peterson, Ellen
and Aberle, R. Denise
and Bui, AT Alex
and Arnold, W. Corey",
title="Consumers' Patient Portal Preferences and Health Literacy: A Survey Using Crowdsourcing",
journal="JMIR Res Protoc",
year="2016",
month="Jun",
day="08",
volume="5",
number="2",
pages="e104",
keywords="consumer health information",
keywords="health literacy",
keywords="eHealth",
keywords="patient portal",
abstract="Background: eHealth apps have the potential to meet the information needs of patient populations and improve health literacy rates. However, little work has been done to document perceived usability of portals and health literacy of specific topics. Objective: Our aim was to establish a baseline of lung cancer health literacy and perceived portal usability. Methods: A survey based on previously validated instruments was used to assess a baseline of patient portal usability and health literacy within the domain of lung cancer. The survey was distributed via Amazon's Mechanical Turk to 500 participants. Results: Our results show differences in preferences and literacy by demographic cohorts, with a trend of chronically ill patients having a more positive reception of patient portals and a higher health literacy rate of lung cancer knowledge (P<.05). Conclusions: This article provides a baseline of usability needs and health literacy that suggests that chronically ill patients have a greater preference for patient portals and higher level of health literacy within the domain of lung cancer. ",
doi="10.2196/resprot.5122",
url="http://www.researchprotocols.org/2016/2/e104/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27278634"
}


@Article{info:doi/10.2196/humanfactors.5106,
author="Price, M. Margaux
and Crumley-Branyon, J. Jessica
and Leidheiser, R. William
and Pak, Richard",
title="Effects of Information Visualization on Older Adults' Decision-Making Performance in a Medicare Plan Selection Task: A Comparative Usability Study",
journal="JMIR Hum Factors",
year="2016",
month="Jun",
day="01",
volume="3",
number="1",
pages="e16",
keywords="Information visualization",
keywords="aging",
keywords="health-related websites",
keywords="working memory",
abstract="Background: Technology gains have improved tools for evaluating complex tasks by providing environmental supports (ES) that increase ease of use and improve performance outcomes through the use of information visualizations (info-vis). Complex info-vis emphasize the need to understand individual differences in abilities of target users, the key cognitive abilities needed to execute a decision task, and the graphical elements that can serve as the most effective ES. Older adults may be one such target user group that would benefit from increased ES to mitigate specific declines in cognitive abilities. For example, choosing a prescription drug plan is a necessary and complex task that can impact quality of life if the wrong choice is made. The decision to enroll in one plan over another can involve comparing over 15 plans across many categories. Within this context, the large amount of complex information and reduced working memory capacity puts older adults' decision making at a disadvantage. An intentionally designed ES, such as an info-vis that reduces working memory demand, may assist older adults in making the most effective decision among many options. Objective: The objective of this study is to examine whether the use of an info-vis can lower working memory demands and positively affect complex decision-making performance of older adults in the context of choosing a Medicare prescription drug plan. Methods: Participants performed a computerized decision-making task in the context of finding the best health care plan. Data included quantitative decision-making performance indicators and surveys examining previous history with purchasing insurance. Participants used a colored info-vis ES or a table (no ES) to perform the decision task. Task difficulty was manipulated by increasing the number of selection criteria used to make an accurate decision. A repeated measures analysis was performed to examine differences between the two table designs. Results: Twenty-three older adults between the ages of 66 and 80 completed the study. There was a main effect for accuracy such that older adults made more accurate decisions in the color info-vis condition than the table condition. In the low difficulty condition, participants were more successful at choosing the correct answer when the question was about the gap coverage attribute in the info-vis condition. Participants also made significantly faster decisions in the info-vis condition than in the table condition. Conclusions: Reducing the working memory demand of the task through the use of an ES can improve decision accuracy, especially when selection criteria is only focused on a single attribute of the insurance plan. ",
doi="10.2196/humanfactors.5106",
url="http://humanfactors.jmir.org/2016/1/e16/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27251110"
}


@Article{info:doi/10.2196/mhealth.5181,
author="McClure, B. Jennifer
and Hartzler, L. Andrea
and Catz, L. Sheryl",
title="Design Considerations for Smoking Cessation Apps: Feedback From Nicotine Dependence Treatment Providers and Smokers",
journal="JMIR mHealth uHealth",
year="2016",
month="Feb",
day="12",
volume="4",
number="1",
pages="e17",
keywords="tobacco use cessation",
keywords="smoking",
keywords="mobile health",
keywords="smartphone",
abstract="Background: Hundreds of smoking cessation apps are commercially available, but most are not theory-based or designed to take advantage of mobile technology in ways that could make them more engaging and possibly more effective. Considering input from both clinical experts (who understand best practice nicotine dependence treatment requirements) to inform appropriate content and from smokers (the end users) to express their preferences is important in designing these programs in the future. Objective: To assess and compare the opinions of nicotine dependence treatment providers and smokers regarding the design of future smoking cessation apps. Methods: We surveyed providers (n=264) and smokers who own smartphones (n=40) to assess their opinions on the importance of 21 app design features. Features represented 5 domains: cost, reputation, privacy and security, content and user experience, and communication. Domains were chosen to reflect best practice treatment, leverage mobile technology to support smoking cessation, and elicit important user preferences. Data were collected between June and July 2015. Results: Most providers agreed that mHealth apps hold promise for helping people quit smoking (203/264, 76.9\%) and would recommend them to their clients/patients (201/264, 76.1\%), especially if the app were empirically validated (236/264, 89.4\%). Few providers believe effective cessation apps currently exist (112/264, 42.4\%). Few smokers (5/40, 13\%) had ever downloaded a smoking cessation app; of the ones who had not, most said they would consider doing so (29/35, 83\%). Both respondent groups indicated the following features were very to extremely important to include in cessation apps: free or low cost, keeps information private, matches individual needs and interests, adapts as one's needs and interests change, helps to manage nicotine withdrawal symptoms and medication side effects, and allows users to track their progress. Providers and smokers also indicated gaming and social media connectivity were less important than other features. Despite these similarities, the groups had significantly different opinions about the relative importance of various features. In particular, providers rated privacy as the most important feature, whereas smokers rated low cost and the ability to adaptively tailor content as the most important features. Conclusions: Smoking cessation apps hold great promise as intervention tools but only if they engage users and appropriately treat nicotine dependence. Intervention development should take into consideration the perspectives of both treatment experts and smokers. This paper highlights important perspectives from each of these groups to be considered when designing future app-based smoking cessation programs. ",
doi="10.2196/mhealth.5181",
url="http://mhealth.jmir.org/2016/1/e17/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26872940"
}


@Article{info:doi/10.2196/cancer.5247,
author="Martin, C. Emily
and Basen-Engquist, Karen
and Cox, G. Matthew
and Lyons, J. Elizabeth
and Carmack, L. Cindy
and Blalock, A. Janice
and Demark-Wahnefried, Wendy",
title="Interest in Health Behavior Intervention Delivery Modalities Among Cancer Survivors: A Cross-Sectional Study",
journal="JMIR Cancer",
year="2016",
month="Feb",
day="11",
volume="2",
number="1",
pages="e1",
keywords="cancer survivor",
keywords="technology",
keywords="smartphone",
keywords="behavioral intervention",
keywords="physical activity",
keywords="diet",
abstract="Background: Effective, broad-reaching channels are important for the delivery of health behavior interventions in order to meet the needs of the growing population of cancer survivors in the United States. New technology presents opportunities to increase the reach of health behavior change interventions and therefore their overall impact. However, evidence suggests that older adults may be slower in their adoption of these technologies than the general population. Survivors' interest for more traditional channels of delivery (eg, clinic) versus new technology-based channels (eg, smartphones) may depend on a variety of factors, including demographics, current health status, and the behavior requiring intervention. Objective: The aim of this study was to determine the factors that predict cancer survivors' interest in new technology-based health behavior intervention modalities versus traditional modalities. Methods: Surveys were mailed to 1871 survivors of breast, prostate, and colorectal cancer. Participants' demographics, diet and physical activity behaviors, interest in health behavior interventions, and interest in intervention delivery modalities were collected. Using path analysis, we explored the relationship between four intervention modality variables (ie, clinic, telephone, computer, and smartphone) and potential predictors of modality interest. Results: In total, 1053 respondents to the survey (56.3\% response rate); 847 provided complete data for this analysis. Delivery channel interest was highest for computer-based interventions (236/847, 27.9\% very/extremely interested) and lowest for smartphone--based interventions (73/847, 8.6\%), with interest in clinic-based (147/847, 17.3\%) and telephone-delivered (143/847, 16.9\%) falling in between. Use of other technology platforms, such as Web cameras and social networking sites, was positively predictive of interest in technology-based delivery channels. Older survivors were less likely to report interest in smartphone--based diet interventions. Physical activity, fruit and vegetable consumption, weight status, and age moderated relationships between interest in targeted intervention behavior and modality. Conclusions: This study identified several predictors of survivor interest in various health behavior intervention delivery modalities. Overall, computer-based interventions were found to be most acceptable, while smartphones were the least. Factors related to survivors' current technology use and health status play a role in their interest for technology-based intervention versus more traditional delivery channels. Future health behavior change research in this population should consider participants' demographic, clinical, and lifestyle characteristics when selecting a delivery channel. Furthermore, current health behavior interventions for older cancer survivors may be best delivered over the Internet. Smartphone interventions may be feasible in the future following further adoption and familiarization by this particular population. ",
doi="10.2196/cancer.5247",
url="http://cancer.jmir.org/2016/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28410164"
}


@Article{info:doi/10.2196/humanfactors.4765,
author="Chan, KY Jade
and Farrer, M. Louise
and Gulliver, Amelia
and Bennett, Kylie
and Griffiths, M. Kathleen",
title="University Students' Views on the Perceived Benefits and Drawbacks of Seeking Help for Mental Health Problems on the Internet: A Qualitative Study",
journal="JMIR Human Factors",
year="2016",
month="Jan",
day="19",
volume="3",
number="1",
pages="e3",
keywords="online",
keywords="mental health",
keywords="help seeking",
keywords="university",
keywords="students",
keywords="qualitative",
abstract="Background: University students experience high levels of mental health problems yet very few seek professional help. Web-based mental health interventions may be useful for the university student population. However, there are few published qualitative studies that have examined the perceived benefits and drawbacks of seeking help for mental health problems on the Internet from the perspective of university students. Objective: To investigate the attitudes of university students on mental health help-seeking on the Internet. Methods: A total of 19 university students aged 19-24 years participated in 1 of 4 focus groups to examine their views toward help-seeking for mental health problems on the Internet. Results: Perceived concerns about Web-based help-seeking included privacy and confidentiality, difficulty communicating on the Internet, and the quality of Web-based resources. Potential benefits included anonymity/avoidance of stigma, and accessibility. Participants reported mixed views regarding the ability of people with similar mental health issues to interact on the Internet. Conclusions: These factors should be considered in the development of Web-based mental health resources to increase acceptability and engagement from university students. ",
doi="10.2196/humanfactors.4765",
url="http://humanfactors.jmir.org/2016/1/e3/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27026140"
}


@Article{info:doi/10.2196/mhealth.4924,
author="Krebs, Paul
and Duncan, T. Dustin",
title="Health App Use Among US Mobile Phone Owners: A National Survey",
journal="JMIR mHealth uHealth",
year="2015",
month="Nov",
day="04",
volume="3",
number="4",
pages="e101",
keywords="cell phones",
keywords="mobile apps",
keywords="telemedicine",
abstract="Background: Mobile phone health apps may now seem to be ubiquitous, yet much remains unknown with regard to their usage. Information is limited with regard to important metrics, including the percentage of the population that uses health apps, reasons for adoption/nonadoption, and reasons for noncontinuance of use. Objective: The purpose of this study was to examine health app use among mobile phone owners in the United States. Methods: We conducted a cross-sectional survey of 1604 mobile phone users throughout the United States. The 36-item survey assessed sociodemographic characteristics, history of and reasons for health app use/nonuse, perceived effectiveness of health apps, reasons for stopping use, and general health status. Results: A little over half (934/1604, 58.23\%) of mobile phone users had downloaded a health-related mobile app. Fitness and nutrition were the most common categories of health apps used, with most respondents using them at least daily. Common reasons for not having downloaded apps were lack of interest, cost, and concern about apps collecting their data. Individuals more likely to use health apps tended to be younger, have higher incomes, be more educated, be Latino/Hispanic, and have a body mass index (BMI) in the obese range (all P<.05). Cost was a significant concern among respondents, with a large proportion indicating that they would not pay anything for a health app. Interestingly, among those who had downloaded health apps, trust in their accuracy and data safety was quite high, and most felt that the apps had improved their health. About half of the respondents (427/934, 45.7\%) had stopped using some health apps, primarily due to high data entry burden, loss of interest, and hidden costs. Conclusions: These findings suggest that while many individuals use health apps, a substantial proportion of the population does not, and that even among those who use health apps, many stop using them. These data suggest that app developers need to better address consumer concerns, such as cost and high data entry burden, and that clinical trials are necessary to test the efficacy of health apps to broaden their appeal and adoption. ",
doi="10.2196/mhealth.4924",
url="http://mhealth.jmir.org/2015/4/e101/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26537656"
}


@Article{info:doi/10.2196/resprot.3806,
author="Patel, Vishal
and Hale, M. Timothy
and Palakodeti, Sandeep
and Kvedar, C. Joseph
and Jethwani, Kamal",
title="Prescription Tablets in the Digital Age: A Cross-Sectional Study Exploring Patient and Physician Attitudes Toward the Use of Tablets for Clinic-Based Personalized Health Care Information Exchange",
journal="JMIR Res Protoc",
year="2015",
month="Oct",
day="19",
volume="4",
number="4",
pages="e116",
keywords="electronic health records",
keywords="tablets",
keywords="health education",
keywords="self-management",
keywords="primary care",
keywords="physician patient relationship",
keywords="digital health",
keywords="iPad",
keywords="patient-reported outcome measures",
abstract="Background: To reduce the cost of health care while increasing efficiency and quality, health systems are seeking innovative means to engage and empower patients. Improved use of information technology and electronic health record (EHR) infrastructure is essential, and required for ``meaningful use'' as mandated by the federal government. Providing personalized health information using tablets at the point of care could enhance the clinical experience and enable efficient collection of patient reported outcome measures to guide clinical decision making. Objective: The aim of this study is to explore patient and provider attitudes and interest in a proposed clinic-based tablet system for personal health information exchange. To provide a context to understand patients' use of tablets during their clinic visit, we also examine patients' current activities and time spent in the waiting room, and their use of health information resources. Methods: Surveys were administered to 84 patients in the waiting room of a community health center affiliated with Massachusetts General Hospital (MGH) in Boston, MA. This survey included a vignette and illustration describing a proposed tablet-based system in which the patient, upon sign in at the clinic, receives a tablet loaded with personalized information tailored to their specific medical conditions and preferences. Patients were queried about their interest in such a system in comparison to traditional forms of patient education as well as their current health information seeking behaviors and activities and time spent in the waiting room.  Interviews with five MGH-affiliated health care providers were conducted to assess their opinions regarding the proposed tablet system. Results: The majority (>60\%) of patients were ``very'' or ``extremely'' interested in the proposed tablet system and thought it would improve their knowledge about their medical condition (60\%), assist them in making healthy choices (57\%), and help them to feel more comfortable talking with their provider (55\%). Patients thought the system would be more motivating, informative, and engaging than traditional printed health education materials. The tablet system was not considered more effective than face-to-face interaction with providers, though 44\% thought it would improve their relationship with their physician. Overall, 91\% of respondents were willing to learn how to use a tablet and 75\% reported being ``very'' or ``extremely'' confident they could use one. Four of the five providers believed that the proposed tablet system would improve clinical workflow and patient education. Patients and providers were concerned about privacy and security of data collected using the tablets. Conclusions: Both patients and providers were highly amenable to integrating tablets into the clinical experience, and tablets may be useful in improving patients' health knowledge, the collection of patient reported outcome measures, and improved patient-provider communication. Further research into operationalizing such systems and their validation is necessary before integration into standard clinical practice. ",
doi="10.2196/resprot.3806",
url="http://www.researchprotocols.org/2015/4/e116/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26481906"
}


@Article{info:doi/10.2196/humanfactors.3696,
author="Kayser, Lars
and Kushniruk, Andre
and Osborne, H. Richard
and Norgaard, Ole
and Turner, Paul",
title="Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy: A Framework for Understanding Users' Needs",
journal="JMIR Human Factors",
year="2015",
month="May",
day="20",
volume="2",
number="1",
pages="e9",
keywords="eHealth literacy",
keywords="requirements",
keywords="user involvement",
abstract="Background: eHealth systems and applications are increasingly focused on supporting consumers to directly engage with and use health care services. Involving end users in the design of these systems is critical to ensure a generation of usable and effective eHealth products and systems. Often the end users engaged for these participatory design processes are not actual representatives of the general population, and developers may have limited understanding about how well they might represent the full range of intended users of the eHealth products. As a consequence, resulting information technology (IT) designs may not accommodate the needs, skills, cognitive capacities, and/or contexts of use of the intended broader population of health consumers. This may result in challenges for consumers who use the health IT systems, and could lead to limitations in adoption if the diversity of user attributes has not been adequately considered by health IT designers. Objective: The objective of this paper is to propose how users' needs and competences can be taken into account when designing new information and communications technology solutions in health care by expanding the user-task-context matrix model with the domains of a new concept of eHealth literacy. Methods: This approach expands an existing method for supporting health IT  system development, which advocates use of a three-dimensional user-task-context matrix to comprehensively identify the users of health IT  systems, and what their needs and requirements are under differing contexts of use. The extension of this model involved including knowledge about users' competences within the seven domains of eHealth literacy, which had been identified based on systematic engagement with computer scientists, academics, health professionals, and patients recruited from various patient organizations and primary care. A concept map was constructed based on a structured brainstorm procedure, card sorting, and computational analysis. Results: The new eHealth literacy concept (based on 7 domains) was incorporated as a key factor in expanding the user-task-context matrix to describe and qualify user requirements and understanding related to eHealth literacy. This resulted in an expanded framework and a five-step process, which can support health IT designers in understanding and more accurately addressing end-users' needs, capabilities, and contexts to improve effectiveness and broader applicability of consumer-focused health IT systems. It is anticipated that the framework will also be useful for policy makers involved in the planning, procuring, and funding of eHealth infrastructure, applications, and services. Conclusions: Developing effective eHealth products requires complete understanding of the end-users' needs from multiple perspectives. In this paper, we have proposed and detailed a framework for modeling users' needs for designing eHealth systems that merges prior work in development of a user-task-context matrix with the emerging area of eHealth literacy. This framework is intended to be used to guide design of eHealth technologies and to make requirements explicitly related to eHealth literacy, enabling a generation of well-targeted, fit-for-purpose, equitable, and effective products and systems. ",
doi="10.2196/humanfactors.3696",
url="http://humanfactors.jmir.org/2015/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27025228"
}