@Article{info:doi/10.2196/57583, author="Parry, Monica and Huang, Tony and Clarke, Hance and Bj{\o}rnnes, Kristin Ann and Harvey, Paula and Parente, Laura and Norris, Colleen and Pilote, Louise and Price, Jennifer and Stinson, N. Jennifer and O'Hara, Arland and Fernando, Madusha and Watt-Watson, Judy and Nickerson, Nicole and Spiteri DeBonis, Vincenza and Hart, Donna and Faubert, Christine", title="Development and Systematic Evaluation of a Progressive Web Application for Women With Cardiac Pain: Usability Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="17", volume="12", pages="e57583", keywords="digital health", keywords="chatbot", keywords="women", keywords="cardiac pain", keywords="usability testing", keywords="self-management", keywords="artificial intelligence", keywords="AI", abstract="Background: Cardiac pain has been widely considered to be the primary indicator of coronary artery disease. The presentation of cardiac pain and associated symptoms vary in women, making it challenging to interpret as cardiac, possibly cardiac, or noncardiac. Women prefer to consult with family and friends instead of seeking immediate medical care. Objective: This study aimed to assess the user performance (ie, ease of use, efficiency, and errors) and user satisfaction (System Usability Scale; SUS) of a progressive web application for women with cardiac pain. Methods: Following ethics approval, a purposive sample of women aged >18 years with cardiac pain or associated symptoms lasting >3 months and able to speak and read English was recruited to participate in 2 iterative usability testing cycles. The first cycle assessed the performance of and satisfaction with at heart using a web application, and the second cycle assessed the performance of and satisfaction with at heart across various Android and iOS devices. In total, 2 investigators recorded user comments and documented problems. At the end of the testing session, the participants completed the SUS and 4 semistructured interview questions. Results: In total, 10 eligible women participated in usability testing from March 31, 2020, to April 17, 2020 (cycle 1), and from November 17, 2020, to November 30, 2020 (cycle 2). Women across usability testing cycles had a mean age of 55.6 (SD 7.3) years, and most (9/10, 90\%) were well educated. In total, 50\% (5/10) were employed full or part time, and 60\% (6/10) earned >CAD \$70,000 (US \$48,881.80) annually. Participants across 2 testing cycles reported the overall usability of the at heart progressive web application as highly acceptable (mean SUS score 81.75, SD 10.41). In total, 90\% (9/10) of participants rated the user-friendliness of at heart as good or excellent. All participants (10/10, 100\%) thought at heart was easy to use and efficient. Only 2 testing errors were noted as high priority; these were low contrast or small font and clarification that the chatbot was not a real person. User satisfaction was assessed using themes that emerged from the debrief and 4 semistructured interview questions; at heart was engaging, comprehensive, understandable, credible, relevant, affirming, personalized, and innovative. Conclusions: This study provides initial support for the at heart progressive web application for women living with cardiac pain and symptoms. Ongoing evaluations in phases 3 and 4 should aim to examine the feasibility and acceptability of and the extent of engagement with the at heart core feature set: Heart Check, Wellness Check, and the library. In addition to assessing effectiveness in the phase-4 effectiveness-implementation hybrid trial (type I), describing and better understanding the context for implementation (eg, race and ethnicity and geography) will be necessary. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-033092 ", doi="10.2196/57583", url="https://humanfactors.jmir.org/2025/1/e57583" } @Article{info:doi/10.2196/55430, author="de Fran{\c{c}}a, Galv{\~a}o Caroline Villela and Segalla, Boaro Paola and Reis, Assis Felipe Sebasti{\~a}o de and Pereira, Silveira Jos{\'e} Ricardo and de Mattos, Oliveira Alexandre and Ferron, Moura Roberta de and de Oliveira, Zanardo Cleyton and Borges, Bassani J{\'e}ssica and Hoffmann, Quintal Lilian and Caboclo, Giaimo Edmundo Di", title="Patients' and Physicians' Experience With and Acceptability of a Telemedicine Cabin: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="16", volume="12", pages="e55430", keywords="telemedicine cabin", keywords="telehealth", keywords="teleservice", keywords="e-health", keywords="connected offices", abstract="Background: Telemedicine represents an essential tool with the potential to reduce health costs, thus avoiding patient displacement and improving patient care outcomes, positioning it as a significant social technology. Objective: This study aims to analyze the implementation of a telehealth cabin at BP Hospital (A Benefic{\^e}ncia Portuguesa de S{\~a}o Paulo), focusing on the evaluation of the experiences of both patients and health care professionals, as well as the acceptability of this tool. Methods: A mixed methods study was conducted with 229 participants, divided into 2 phases. The first phase involved 40 apparently healthy individuals to assess the usability, experience, and satisfaction of this group for the later safe application in the group with clinical complaints. The second phase included 189 participants, with complaints to assess the usability, experience, and satisfaction of patients and doctors. In both phases, participants completed screening questionnaires (to assess the eligibility criteria), a socioeconomic demographic questionnaire before using the cabin, and a questionnaire including the System Usability Scale and the Net Promoter Score (NPS) after using the cabin. Results: The data analysis of the first phase showed high acceptance of the telehealth cabin, which supported the progression to the second phase. In the second phase, a high usability score was observed among participants with clinical complaints (mean System Usability Scale score of 85.97, SD 15.50) and a high favorability rating (NPS score of 9.4). Health care professionals also reported favorable results, with a usability score of 67.8 and an NPS of 8.0. Conclusions: The results of this study reinforce the potential for scaling up this practice based on usability outcomes, and highlight its relevance for the development of public policies aimed at expanding access to quality health care in Brazil. This approach improves the interaction of patients with the health care system, while providing professionals with an extended view of clinical conditions through integrated devices, particularly in areas with limited access to medical care. ", doi="10.2196/55430", url="https://humanfactors.jmir.org/2025/1/e55430" } @Article{info:doi/10.2196/65745, author="Munir, Mamoon Malik and Ahmed, Nabil", title="Using Social Media Platforms to Raise Health Awareness and Increase Health Education in Pakistan: Structural Equation Modeling Analysis and Questionnaire Study", journal="JMIR Hum Factors", year="2025", month="Apr", day="7", volume="12", pages="e65745", keywords="social media", keywords="health awareness", keywords="health education", keywords="innovation diffusion theory", keywords="structural equation modeling", keywords="disease burden", keywords="healthcare facilities", keywords="health professionals", keywords="misinformation", keywords="cost effective", abstract="Background: Current health care education methods in Pakistan use traditional media (eg, television and radio), community health workers, and printed materials, which often fall short of reach and engagement among most of the population. The health care sector in Pakistan has not yet used social media effectively to raise awareness and provide education about diseases. Research on the impact social media can have on health care education in Pakistan may expand current efforts, engage a wider audience, and reduce the disease burden on health care facilities. Objective: This study aims to evaluate the perceptions of health care professionals and paramedic staff regarding social media use to raise awareness and educate people about diseases as a potential means of reducing the disease burden in Pakistan. Methods: The study used two-stage structural equation modeling (SEM). Data analysis used AMOS 26.0 software, adopting scales from previous literature. Four-item scales for each social media usefulness and health awareness construct and 8-item scales for health care education constructs were adopted on the basis of their higher loading in alignment with psychometric literature. A 7-point Likert scale was used to measure each item. Data collection used convenience sampling, with questionnaires distributed to more than 450 health care professionals and paramedic staff from 2 private hospitals in Lahore, Pakistan. There were 389 useful responses received. However, 340 completed questionnaires were included in the data analysis. Results: The study found that all the squared multiple correlation (SMC) values were greater than 0.30. Furthermore, convergent validity was measured using (1) standardized factor loading (found greater than 0.5), (2) average variance explained (found greater than 0.5), and (3) composite reliability (found greater than 0.7). The confirmatory factor analysis (CFA) of the measurement model indicated the fitness of the constructs (Chi-square minimum [CMIN]=357.62; CMIN/degrees of freedom [DF]=1.80; Goodness of Fit [GFI]=0.90; Adjusted Goodness of Fit Index [AGFI]=0.89; Buntler-Bonett Normed Fit Index [NFI]=0:915; Comparative Fit Index [CFI]=0:93; Root Mean Square Residual [RMR]=0:075; Root Mean Square Error of Approximation [RMSEA]=0:055). Moreover, the structural model fitness was also confirmed (CMIN=488.6; CMIN/DF=1.85; GFI=0.861; AGFI=0.893; NFI=0.987; CFI=0.945; RMR=0:079; RMSEA=0.053). Hence, the results indicated that social media usefulness has a positive and significant effect on health awareness (hypothesis 1: $\beta$=.669, P<.001), and health awareness has a positive and significant effect on health care education in Pakistan (hypothesis 2: $\beta$=.557, P<.001). Conclusions: This study concludes that health care professionals and paramedic staff in private hospitals support the use of social media to raise awareness and provide health care education. It is considered an effective tool for reducing the disease burden in Pakistan. The study results also revealed that young health care professionals are more inclined toward social media usage and express the need for legislation to support it and establish a monitoring process to avoid misinformation. ", doi="10.2196/65745", url="https://humanfactors.jmir.org/2025/1/e65745" } @Article{info:doi/10.2196/55072, author="Wadman, Ruth and Walker, Lauren and Taylor, Olivia and Heron, Paul and Newbronner, Elizabeth and Spanakis, Panagiotis and Crosland, Suzanne and Peckham, Jane Emily", title="Patterns of Internet Use in People Diagnosed With Severe Mental Illness: Qualitative Interview Study", journal="J Med Internet Res", year="2025", month="Mar", day="28", volume="27", pages="e55072", keywords="severe mental illness", keywords="internet use", keywords="qualitative", keywords="typology", keywords="protective strategies", keywords="digital divide", abstract="Background: People with severe mental illness (SMI) face profound health inequalities, which may be exacerbated by increased rates of digital exclusion, especially as health services move to online provision. The activities that people carry out online can affect how they feel about the internet and may determine whether a person has a positive or negative experience when using the internet. This, in turn, could affect their mental health. To support people with SMI in using digital technology and the internet safely, it is important to understand the internet and digital technology use of those with SMI and their perceived positive or negative impact on their mental health. Objective: This study aimed to explore the internet and digital technology use of those with SMI, with particular focus on any association between greater use of the internet and poorer self-reported mental health. Methods: We carried out a qualitative interview study with 16 people with SMI. The sample was drawn from a wider investigation of the impact of the pandemic and its restrictions on the health and well-being of 367 people with SMI. We purposively sampled from the wider study based on age, gender, frequency of internet use, and self-reported mental health. The data were analyzed by 2 researchers using framework analysis. Results: Participant experiences fell into 3 broad categories: those who had a positive or neutral internet-based experience, those who had negative or difficult experiences, and low users or those with poor digital literacy. Those who had positive or neutral experiences could be broken down into 2 subcategories: first, those with positive or neutral experiences of the internet who were similar in terms of the activities participated in, feelings reported, and their concerns about the internet, and second, conscious users who were mindful of their interaction with the internet world. Participants with difficult experiences fell into 2 categories: those with worries and fears related to using the internet and those who had difficulty limiting their internet use. Conclusions: People with SMI, similarly the general population, are expected to conduct more of their activities of daily living online in the postpandemic world. This research shows that most internet users with SMI have positive or neutral experiences. However, our typology reveals subgroups of the population with SMI for whom there is a relationship between internet use and difficult feelings. These subgroups can be identified by asking questions about online activities; time spent online; feelings, difficulties, or issues experienced; and use of gambling, dating, adult content, and conspiracy theory websites. Our findings point to further work in collaboration with people with lived experience to modify and test this typology. ", doi="10.2196/55072", url="https://www.jmir.org/2025/1/e55072" } @Article{info:doi/10.2196/65391, author="Mishina, Kaisa and Baumel, Amit and Kinnunen, Malin and Ristkari, Terja and Heinonen, Emmi and Hinkka-Yli-Salom{\"a}ki, Susanna and Sourander, Andre", title="BePresent Universal Internet-Based Parenting Intervention: Single-Arm Pre-Post Intervention Study", journal="J Med Internet Res", year="2025", month="Mar", day="13", volume="27", pages="e65391", keywords="parent training", keywords="universal intervention", keywords="online intervention", keywords="irritability", keywords="conduct problems", keywords="hyperactivity", keywords="preschool", keywords="mental health", keywords="strongest families", keywords="positive parenting", keywords="parenting skills", keywords="parent-child relationships", keywords="parent satisfaction", keywords="BePresent", keywords="feasibility study", keywords="single-arm pre-post intervention study", abstract="Background: Internet-based parenting programs have great potential to promote positive parent-child relationships as well as to reach and engage parents. Objective: This study aimed to assess the universal internet-based BePresent parenting intervention for families with 3-year-old children and how it influences the child's behavior and daily-life situations assessed by parents. The first aim of the study was to assess the change from baseline to follow-up in child hyperactivity and conduct problems, affective reactivity, and daily activities. The second aim was to assess intervention completion rates. The third aim was to evaluate parent satisfaction with the intervention. The fourth aim was to assess all outcomes by comparing those who completed the intervention and those who did not. Methods: We conducted a single-arm pre- and postintervention study. Parents attending their child's 3-year health check-up were recruited from children's health clinics. The intervention was an unguided internet-based parenting program consisting of 5 modules. Self-reported measures were collected at baseline and at an 8-week follow-up. Linear mixed-effects models were used to analyze the changes from baseline to follow-up. Results: Altogether, 752 parents registered, and 515 started the intervention. Of those, 36\% (n=183) completed the intervention. Parents reported high satisfaction with the intervention: the majority (68.8\%--84.9\%) were satisfied with various aspects of the program, and 89.9\% said the intervention provided information about positive parenting skills. The findings show significant decreases with small effect sizes in parents' ratings of child hyperactivity (P=.03; d=0.12) and conduct problems (P=.001; d=0.20) between baseline and the 8-week follow-up. A similar finding was observed in the parent ratings of child irritability (P?.001; d=0.27) using the Affective Reactivity Index. Parents reported improvement in the daily functioning of their child when it was measured with a questionnaire adapted from the Barkley Home Situations Questionnaire (P=.01; d=0.14). Conclusions: Universal digital interventions have the potential to be implemented widely in community settings to improve knowledge and positive parenting skills. However, there is a need to assess the efficacy of digital universal interventions using randomized controlled designs and to examine additional ways to increase adherence to universal programs. ", doi="10.2196/65391", url="https://www.jmir.org/2025/1/e65391" } @Article{info:doi/10.2196/59686, author="Moody, Louise and Clarke, Samantha and Compton, Matt and Hughson-Gill, Rachael and Boardman, Felicity and Clark, Corinna and Holder, Pru and Bonham, R. James and Chudleigh, Jane", title="Development of an Online Scenario-Based Tool to Enable Research Participation and Public Engagement in Cystic Fibrosis Newborn Screening: Mixed Methods Study", journal="J Particip Med", year="2025", month="Mar", day="6", volume="17", pages="e59686", keywords="extended genetic testing", keywords="next-generation sequencing", keywords="cystic fibrosis", keywords="decision-making", keywords="engagement", abstract="Background: Newborn screening aims to identify babies affected by rare but serious genetic conditions. As technology advances, there is the potential to expand the newborn screening program following evaluation of the likely benefits and drawbacks. To inform these decisions, it is important to consider the family experience of screening and the views of the public. Engaging in public dialogue can be difficult. The conditions, screening processes, and associated moral and ethical considerations are complex. Objective: This study aims to develop a stand-alone online resource to enable a range of stakeholders to understand whether and how next-generation sequencing should be incorporated into the CF screening algorithm. Methods: Around 4 development workshops with policymakers, parents, and other stakeholders informed the design of an interactive activity, including the structure, content, and questions posed. Stakeholders were recruited to take part in the development workshops via purposeful and snowball sampling methods to achieve a diversity of views across roles and organizations, with email invitations sent to representative individuals with lived, clinical, and academic experience related to CF and screening. Ten stakeholders informed the development process including those with lived experience of CF (2/10, 20\%), clinicians (2/10, 20\%), and representatives from relevant government, charity, and research organizations (6/10, 60\%). Vignettes constructed using interview data and translated into scripts were recorded to provide short films to represent and provoke consideration of families' experiences. Participants were recruited (n=6, adults older than 18 years) to test the resulting resource. Study advertisements were circulated via physical posters and digital newsletters to recruit participants who self-identified as having a reading difficulty or having English as a second language. Results: An open access online resource, ``Cystic Fibrosis Newborn Screening: You Decide,'' was developed and usability and acceptability tested to provide the ``user'' (eg, a parent, the general public, or a health care professional) with an interactive scenario-based presentation of the potential outcomes of extended genetic testing, allowing them to visualize the impact on families. This included a learning workbook that explains key concepts and processes. The resulting tool facilitates public engagement with and understanding of complex genetic and screening concepts. Conclusions: Online resources such as the one developed during this work have the potential to help people form considered views and facilitate access to the perspectives of parents and the wider public on genetic testing. These may be otherwise difficult to obtain but are of importance to health care professionals and policymakers. Trial Registration: ClinicalTrials.gov NCT06299566; https://clinicaltrials.gov/study/NCT06299566 ", doi="10.2196/59686", url="https://jopm.jmir.org/2025/1/e59686", url="http://www.ncbi.nlm.nih.gov/pubmed/40053726" } @Article{info:doi/10.2196/49507, author="van der Smissen, Doris and Schreijer, A. Maud and van Gemert-Pijnen, C. Lisette J. E. W. and Verdaasdonk, M. Rudolf and van der Heide, Agnes and Korfage, J. Ida and Rietjens, C. Judith A.", title="Implementation of a Web-Based Program for Advance Care Planning and Evaluation of its Complexity With the Nonadoption, Abandonment, Scale-Up, Spread, And Sustainability (NASSS) Framework: Qualitative Evaluation Study", journal="JMIR Aging", year="2025", month="Mar", day="4", volume="8", pages="e49507", keywords="eHealth", keywords="web-based intervention", keywords="implementation", keywords="sustainability", keywords="advance care planning", keywords="NASSS framework", keywords="nonadoption, abandonment, scale-up, spread, and sustainability framework", keywords="health communication", keywords="patient education", keywords="patient-centered care", abstract="Background: The implementation of eHealth applications often fails. The NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework aims to identify complexities in eHealth applications; the more complex, the more risk of implementation failure. Objective: This study aimed to analyze the implementation of the web-based advance care planning (ACP) program ``Explore Your Preferences for Treatment and Care'' using the NASSS framework. Methods: The NASSS framework enables a systematic approach to improve the implementation of eHealth tools. It is aimed at generating a rich and situated analysis of complexities in multiple domains, based on thematic analysis of existing and newly collected data. It also aims at supporting individuals and organizations to handle these complexities. We used 6 of 7 domains of the NASSS framework (ie, condition, technology, value proposition, adopters, external context, and embedding and adaptation over time) leaving out ``organization,'' and analyzed the multimodal dataset of a web-based ACP program, its development and evaluation, including peer-reviewed publications, notes of stakeholder group meetings, and interviews with stakeholders. Results: This study showed that the web-based ACP program uses straightforward technology, is embedded in a well-established web-based health platform, and in general appears to generate a positive value for stakeholders. A complexity is the rather broad target population of the program. A potential complexity considers the limited insight into the extent to which health care professionals adopt the program. Awareness of the relevance of the web-based ACP program may still be improved among target populations of ACP and among health care professionals. Furthermore, the program may especially appeal to those who value individual autonomy, self-management, and an explicit and direct communicative approach. Conclusions: Relatively few complexities were identified considering the implementation of the web-based ACP program ``Explore Your Preferences for Treatment and Care.'' The program is evidence-based, freestanding, and well-maintained, with straightforward, well-understood technology. The program is expected to generate a positive value for different stakeholders. Complexities include the broad target population of the program and sociocultural factors. People with limited digital literacy may need support to use the program. Its uptake might be improved by increasing awareness of ACP and the program among a wider population of potential users and among health care professionals. Addressing these issues may guide future use and sustainability of the program. ", doi="10.2196/49507", url="https://aging.jmir.org/2025/1/e49507", url="http://www.ncbi.nlm.nih.gov/pubmed/40053753" } @Article{info:doi/10.2196/48370, author="Francis, Karlee and Francis, Julie and Latimer, Margot and Gould, Hayley and Blackmore, Shante and MacLeod, Emily", title="Development and Testing of the Kids Hurt App, a Web-Based, Pain Self-Report App for First Nations Youths: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="Mar", day="3", volume="12", pages="e48370", keywords="app", keywords="eHealth", keywords="pain", keywords="Indigenous", keywords="First Nations", keywords="children", keywords="youths", keywords="mobile phone", abstract="Background: First Nations children and youths may have unique ways to convey their health needs that have not been recognized by health providers. This may contribute to the disparity between high rates of mental health and physical pain and low rates of treatment for the conditions they experience. Evidence suggests that a colonial history has resulted in poor experiences with the health care system, lack of trust with health providers, and miscommunication between clinicians and patients. Contemporary ways, using both Indigenous and Western knowledge, are needed to bridge the gap in communicating pain. Objective: The aim of this qualitative study was to test the usability and clinical feasibility of the Kids Hurt App with First Nations youths and clinicians working with youths. Methods: Using a Two-Eyed Seeing approach, the Kids Hurt App was developed using concepts from validated mood and pain assessment apps combined with community-based research that gathered First Nations youths and clinicians perspectives on quality, intensity, and location of pain and hurt. The Kids Hurt App contains 16 screens accessible on any web-based device. Results: In total, 3 rounds of low-fidelity testing (n=19), 2 rounds of high-fidelity testing (n=20), and 2 rounds of clinical feasibility testing (n=10) were conducted with First Nations youths (10?19 years) to determine the relevance, validity, and usability of the Kids Hurt App. High-fidelity testing was also conducted with 15 clinicians after completing the high-fidelity youth sessions. Youths had constructive suggestions that were used to improve the app in subsequent rounds of version testing. There was one main discrepancy between youths and clinicians related to preference for how best to visually convey pain. The youth's preference was maintained in the app. Conclusions: All youths in all rounds of testing indicated that they would use the Kids Hurt App if it was available to them in a health care setting, with most clinicians noting that the app would be useful in practice. ", doi="10.2196/48370", url="https://humanfactors.jmir.org/2025/1/e48370" } @Article{info:doi/10.2196/59829, author="Reifegerste, Doreen and Wagner, M. Anna J. and Huber, Lisa and Fastuca, Manuel", title="Formative Evaluation of Suicide Prevention Websites for Men: Qualitative Study with Men at Risk of Suicide and with Potential Gatekeepers", journal="JMIR Form Res", year="2025", month="Feb", day="26", volume="9", pages="e59829", keywords="mental health", keywords="suicide prevention", keywords="men's health", keywords="evaluation", keywords="website", keywords="gatekeeper", keywords="suicide", keywords="male", keywords="suicide risk", keywords="digital communication", keywords="intervention", keywords="suicidal behavior", keywords="digital intervention", keywords="digital media", abstract="Background: The suicide rate among men exceeds that of women worldwide. One important measure in suicide prevention for men is digital communication interventions, as they enable easy and anonymous access to information resources. This is especially important for men who might not be reached by traditional, in-person prevention methods. Thus, as part of an interdisciplinary project on suicide prevention for men, two specific digital communication prevention measures were developed: (1) a website to inform men at risk about suicide prevention, and (2) a website to educate potential gatekeepers who are in contact with men at risk of suicide about appropriate life-saving measures. Both websites needed evaluation to explore how they are perceived by (1) men and by (2) potential gatekeepers of men at risk of suicide. This is crucial, as existing research lacks formative evaluation that informs the development of intervention communication materials. Objective: This study aimed to analyze whether these websites were perceived as (1) comprehensible and engaging, (2) authentic and trustworthy, as well as (3) useful by (potential) users. Furthermore, we examined (4) additional ideas for effective communication about suicide prevention. Methods: We conducted (1) individual videoconference interviews with 24 men to evaluate the website and (2) four focus groups with 8 gatekeepers in each group (32 participants) to evaluate the online education program. The focus group sample was equally distributed regarding gender and age. Recruitment was conducted together with a field research partner who posted adverts on Facebook and Instagram (Meta) to reach as many potential participants as possible in an efficient way. All participants were asked to evaluate the intervention materials using a fictitious scenario of a man experiencing a mental health crisis before the interviews or focus groups took place. Results: The videos were perceived as (1) catchy, comprehensible, and empathetic, but too long for a short introduction. A balanced mix of emotional and informative content was considered appropriate and helpful. The health information provided was perceived as (2) serious and trustworthy due to citing scientific institutions and video material of men who had experienced suicidal ideation. (3) The intervention's applicability for men experiencing acute crisis was critiqued, but it was regarded as very useful for comprehensive information. (4) Further communication channels and addressing other male subgroups or gender identities were presented as possible extensions of the program. Conclusions: Effective suicide prevention research should address both the groups at risk and their support network. Digital communication interventions can provide low-threshold access. Videos with personalized examples are important to give men someone to identify with, which validates their emotional responses and supports their self-esteem, while videos with experts provide relevant and credible information. ", doi="10.2196/59829", url="https://formative.jmir.org/2025/1/e59829" } @Article{info:doi/10.2196/58362, author="Junkins, Zachary and Zahan, Nusrath and Neyens, David", title="Examining Individuals' Use of the Internet for Health Care Activities Over Time: Results from the US National Health Interview Survey", journal="JMIR Hum Factors", year="2025", month="Feb", day="26", volume="12", pages="e58362", keywords="internet", keywords="web search", keywords="internet search", keywords="internet use", keywords="searching behavior", keywords="access to health information", keywords="telemedicine", keywords="telehealth", keywords="virtual care", keywords="virtual health", keywords="virtual medicine", keywords="logistic regression model", keywords="regression model", keywords="National Health Interview Survey", keywords="NHIS", abstract="Background: Telehealth is an increasingly important component of health care services. Telehealth services may present an opportunity to increase the equity, accessibility, and effectiveness of health care. As such, it is critical that telehealth design focuses on reducing the barriers to access and usability that may impair some telehealth users. Objective: Our goal was to identify different demographic characteristics, behaviors, or opinions that may predict groups who are likely to face a barrier to using telehealth services. Methods: We used data from the National Health Interview Survey and multiple logit regression models focused on different aspects of telehealth to examine three different avenues of telehealth service: looking up health information using the internet, scheduling an appointment using the internet, and communicating with a care provider through email using the internet in order to consider the ways in which different telehealth services may face different barriers. Results: Our results suggest that middle-aged (36-55 years old) and older adult (56-85 years old) respondents were significantly less likely to look up health information using the internet or schedule an appointment using the internet versus younger individuals (18-35 years old). Specifically, our analysis found that middle-aged adults were found to have a higher odds ratio than older adults (0.83 vs 0.65) for looking up health information using the internet. We also found that there were differences in age groups for using technology to perform health care--related tasks. In terms of searching for health information using the internet and scheduling appointments using the internet, we found differences between men and women, with women being significantly more likely than men to look up health information using the internet, schedule an appointment using the internet, and communicate with a care provider through email using the internet. Across all the investigated variables, we found that the rates of using the internet for looking up health information, scheduling an appointment, and communicating with a care provider over email increased substantially across the study period. The impact of costs was inconsistent across the different models in our analysis. We also found that there is a strong correlation between respondents' collaboration in their personal health and the likelihood that they would use telehealth services to meet these needs. Conclusions: This analysis provides an exploratory look at the data to highlight barriers that may impact a user's ability to access telehealth services in the context of other potential predictor variables to account for the real-world variability that these may present. Future work should examine the complex relationships of those variables and understand how these interactions are correlated with the respondents' use of telehealth. ", doi="10.2196/58362", url="https://humanfactors.jmir.org/2025/1/e58362" } @Article{info:doi/10.2196/63780, author="Evans, Kerrie and Ko, Jonathan and Ceprnja, Dragana and Maka, Katherine and Beales, Darren and Sterling, Michele and Bennell, L. Kim and Jull, Gwendolen and Hodges, W. Paul and McKay, J. Marnee and Rebbeck, J. Trudy", title="Development and Implementation of MyPainHub, a Web-Based Resource for People With Musculoskeletal Conditions and Their Health Care Professionals: Mixed Methods Study", journal="JMIR Form Res", year="2025", month="Feb", day="24", volume="9", pages="e63780", keywords="clinical pathways", keywords="allied health", keywords="self-management", keywords="health information", keywords="ehealth", keywords="co-design", abstract="Background: Musculoskeletal conditions, including low back pain (LBP), neck pain, and knee osteoarthritis, are the greatest contributors to years lived with disability worldwide. Resources aiming to aid both patients and health care professionals (HCPs) exist but are poorly implemented and adopted. Objective: We aimed to develop and implement MyPainHub, an evidence-based web-based resource designed to provide comprehensive, credible and accessible information for people with, and HCPs who manage, common musculoskeletal conditions. Methods: This mixed methods study adhered to the New South Wales Translational Research Framework and was evaluated against the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Consultation with key stakeholders (patients, HCPs, researchers, industry, consumer groups, and website developers) informed content, design, features, and functionality. Development then aimed to meet the identified need for a ``one-stop shop''---a central location for information about common musculoskeletal conditions tailored to a person's condition and risk of poor outcomes. MyPainHub was then developed through an iterative process and implementation strategies were tailored to different health care settings. Quantitative and qualitative evaluation occurred with patients and HCPs. Results: In total, 127 stakeholders participated in the development phase; initial consultation with them led to embedding 2 validated screening tools (the Short Form {\"O}rebro Musculoskeletal Pain Screening Questionnaire and the Keele STarT MSK tool) in MyPainHub to guide information tailoring for patients based on risk of poor outcomes. Development occurred in parallel and feedback from stakeholders informed design and content including structure, functionality, and phrasing and images to use to emphasize key points. Consultation resulted in information for patients being categorized using key guideline-based messages (general information, your pathway, exercise, and imaging) while information for clinicians was categorized into assessment, management, and prognosis. Implementation occurred in different health care settings with the most effective strategies being interactive education via webinars and workshops. The evaluation phase involved web-based questionnaires (patients: n=44; HCPs: n=29) and focus groups (patients: n=6; HCPs: n=6). Patients and HCPs found MyPainHub user-friendly, acceptable, credible, and potentially able to support self-management. Patient participants identified areas for improvement such as including more specific information on preventative measures and pain relief options. Despite positive feedback, only 35\% (10/29) of HCPs used MyPainHub with their patients. HCP participants identified challenges including insufficient training and lack of familiarity with using web-based resources in existing clinical workflows. Following implementation, the information contained on MyPainHub changed knowledge and practice for some patients and HCPs. Conclusions: Following extensive and iterative stakeholder engagement, MyPainHub was developed as an evidence-based web-based resource and perceived by patients and HCPs as user-friendly, credible, and acceptable. Active implementation strategies are required for adoption and implementation and greater training focusing on strategies to implement MyPainHub into clinical practice may be necessary. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000871145; https://tinyurl.com/438kkyt3 ", doi="10.2196/63780", url="https://formative.jmir.org/2025/1/e63780" } @Article{info:doi/10.2196/67962, author="Midgett, Aida and Doumas, M. Diana and Peralta, Claudia and Peck, Matt and Reilly, Blaine and Buller, K. Mary", title="Usability Testing of a Bystander Bullying Intervention for Rural Middle Schools: Mixed Methods Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="21", volume="12", pages="e67962", keywords="technology-based bullying intervention", keywords="STAC-T", keywords="usability testing", keywords="middle school", keywords="rural", abstract="Background: Targets of bullying are at high risk of negative socioemotional outcomes. Bullying programming in rural schools is important as bullying is more prevalent in those schools compared to urban schools. Comprehensive, school-wide bullying programs require resources that create significant barriers to implementation for rural schools. Because technology-based programs can reduce implementation barriers, the development of a technology-based program increases access to bullying prevention in rural settings. Objective: We aimed to conduct usability testing of a bystander bullying intervention (STAC-T). We assessed usability and acceptability of the STAC-T application and differences in usability between school personnel and students. We were also interested in qualitative feedback about usability, program features, and feasibility. Methods: A sample of 21 participants (n=10, 48\% school personnel; n=11, 52\% students) recruited from 2 rural middle schools in 2 states completed usability testing and a qualitative interview. We used descriptive statistics and 2-tailed independent-sample t tests to assess usability and program satisfaction. We used consensual qualitative research as a framework to extract themes about usefulness, relevance, needs, barriers, and feedback for intervention development. Results: Usability testing indicated that the application was easy to use, acceptable, and feasible. School personnel (mean score 96.0, SD 3.9) and students (mean score 88.6, SD 9.5) rated the application well above the standard cutoff score for above-average usability (68.0). School personnel (mean score 6.10, SD 0.32) and students (mean score 6.09, SD 0.30) gave the application high user-friendliness ratings (0-7 scale; 7 indicates highest user-friendliness). All 10 school personnel stated they would recommend the program to others, and 90\% (9/10) rated the program with 4 or 5 stars. Among students, 91\% (10/11) stated they would recommend the program to others, and 100\% (11/11) rated the program with 4 or 5 stars. There were no statistically significant differences in ratings between school personnel and students. Qualitative data revealed school personnel and students found the application useful, relevant, and appropriate while providing feedback about the importance of text narration and the need for teacher and parent training to accompany the student program. The data showed that school personnel and students found a tracker to report different types of bullying witnessed and strategies used to intervene by students a useful addition to STAC-T. School personnel reported perceiving the program to be practical and very likely to be adopted by schools, with time, cost, and accessibility being potential barriers. Overall, findings suggest that the STAC-T application has the potential to increase access to bullying prevention for students in rural communities. Conclusions: The results demonstrate high usability and acceptability of STAC-T and provide support for implementing a full-scale randomized controlled trial to test the efficacy of the application. ", doi="10.2196/67962", url="https://humanfactors.jmir.org/2025/1/e67962" } @Article{info:doi/10.2196/53087, author="Krewulak, Karla and Strayer, Kathryn and Jaworska, Natalia and Spence, Krista and Foster, Nadine and Kupsch, Scotty and Sauro, Khara and Fiest, M. Kirsten", title="Evaluation of the Quality of Delirium Website Content for Patient and Family Education: Cross-Sectional Study", journal="J Med Internet Res", year="2025", month="Feb", day="20", volume="27", pages="e53087", keywords="education", keywords="health information", keywords="internet", keywords="delirium", keywords="patient", keywords="caregiver", keywords="brain lesions", keywords="confusion", keywords="inattentiveness", keywords="disorientation", keywords="family education", keywords="information seeking", keywords="readability", keywords="high-quality websites", keywords="accessibility", abstract="Background: Patients and families who have experienced delirium may seek information about delirium online, but the quality and reliability of online delirium-related websites are unknown. Objective: This study aimed to identify and evaluate online delirium-related websites that could be used for patient and family education. Methods: We searched Microsoft Bing, Google, and Yahoo using the keywords ``delirium'' and the misspelled ``delerium'' to identify delirium-related websites created to inform patients, families, and members of the public about delirium. The quality of identified delirium-related website content was evaluated by 2 authors using the validated DISCERN tool and the JAMA (Journal of the American Medical Association) benchmark criteria. Readability was assessed with the Simple Measure of Gobbledygook, the Flesch Reading Ease score, and the Flesch Kincaid grade level. Each piece of website content was assessed for its delirium-related information using a checklist of items co-designed by a working group, which included patients, families, researchers, and clinicians. Results: We identified 106 websites targeted toward patients and families, with most hospital-affiliated (21/106, 20\%) from commercial websites (20/106, 19\%), government-affiliated organizations (19/106, 18\%), or from a foundation or advocacy group (16/106, 15\%). The median time since the last content update was 3 (IQR 2-5) years. Most websites' content (101/106, 95\%) was written at a reading level higher than the recommended grade 6 level. The median DISCERN total score was 42 (IQR 33-50), with scores ranging from 20 (very poor quality) to 78 (excellent quality). The median delirium-related content score was 8 (IQR 6-9), with scores ranging from 1 to 12. Many websites lacked information on the short- and long-term outcomes of delirium as well as how common it is. The median JAMA benchmark score was 1 (IQR 1-3), indicating the quality of the websites' content had poor transparency. Conclusions: We identified high-quality websites that could be used to educate patients, families, or the public about delirium. While most delirium-related website content generally meets quality standards based on DISCERN and JAMA benchmark criteria, high scores do not always ensure patient and family-friendliness. Many of the top-rated delirium content were text-heavy and complex in layout, which could be overwhelming for users seeking clear, concise information. Future efforts should prioritize the development of websites with patients and families, considering usability, accessibility, and cultural relevance to ensure they are truly effective for delirium education. ", doi="10.2196/53087", url="https://www.jmir.org/2025/1/e53087", url="http://www.ncbi.nlm.nih.gov/pubmed/39977019" } @Article{info:doi/10.2196/60315, author="Knowles, Kayla and Lee, Susan and Yapalater, Sophia and Taylor, Maria and Akers, Y. Aletha and Wood, Sarah and Dowshen, Nadia", title="Simulation of Contraceptive Access for Adolescents and Young Adults Using a Pharmacist-Staffed e-Platform: Development, Usability, and Pilot Testing Study", journal="JMIR Pediatr Parent", year="2025", month="Feb", day="19", volume="8", pages="e60315", keywords="adolescent", keywords="contraception", keywords="telemedicine", keywords="user-centered design", keywords="young adult", keywords="reproductive", keywords="design", keywords="usability", keywords="experience", keywords="mHealth", keywords="mobile health", keywords="app", keywords="youth", keywords="teenager", keywords="drug", keywords="pharmacology", keywords="pharmacotherapy", keywords="pharmaceutics", keywords="medication", keywords="pharmacy", keywords="digital health", keywords="platform", keywords="access", abstract="Background: Offering contraceptive methods at pharmacies without a prescription is an innovative solution to reduce the incidence of unintended pregnancies among adolescents and young adults (AYA). Pharmacy-prescribed contraception may increase the convenience, simplicity, and affordability of contraceptives. Objective: The aim of this study was to develop, pilot test, and evaluate the acceptability and feasibility of a telemedicine electronic platform app simulating pharmacist prescribing of contraceptives to AYA as well as assess agreement between pharmacist-simulated contraceptive approvals and contraception as prescribed in routine clinic visits. Methods: This study was conducted in two phases: (1) development and usability testing of a prototype app to simulate pharmacists prescribing contraceptives to AYA and (2) pilot testing the app in a simulation for AYA requesting contraception from a pharmacist with pharmacist review and request approval or rejection. Eligibility criteria in both phases included the following: assigned female sex at birth, age 15-21 years, seeking contraceptive services at an academic adolescent medicine clinic, prior history of or intention to have penile-vaginal intercourse in the next 12 months, smartphone ownership, and English language proficiency. Phase 1 (usability) involved a video-recorded ``think aloud'' interview to share feedback and technical issues while using the app prototype on a smartphone and the completion of sociodemographic, sexual history, and perception of the prototype surveys to further develop the app. Phase 2 (pilot) participants completed phase 1 surveys, tested the updated app in a simulation, and shared their experiences in an audio-recorded interview. Descriptive analyses were conducted for quantitative survey data, and thematic analyses were used for interview transcripts. Results: Of the 22 participants, 10 completed usability testing, with a mean age of 16.9 (SD 1.97) years, and 12 completed pilot testing, with a mean age of 18.25 (SD 1.48) years. Three issues with the prototype were identified during ``think aloud'' interviews: challenges in comprehension of medical language, prototype glitches, and graphic design suggestions for engagement. Usability testing guided the frontend and backend creation of the platform. Overall, participants agreed or strongly agreed that using an app to receive contraceptives would make it easier for teens to access (n=19, 86\%) and make contraceptive use less stigmatizing (n=19, 86\%). In addition, participants agreed that receiving contraception prescriptions from a pharmacist without a clinic visit would be safe (n=18, 82\%), convenient (n=19, 86\%), acceptable (n=18, 82\%), and easy (n=18, 82\%). Pharmacists and medical providers had 100\% agreement on the prescribed contraceptive method for pilot participants. Conclusions: AYA found contraceptive prescription by a pharmacist via an app to be highly acceptable and provided critical feedback to improve the design and delivery of the app. Additionally, pharmacist contraceptive approvals and contraception as prescribed in routine clinic visits were identical. ", doi="10.2196/60315", url="https://pediatrics.jmir.org/2025/1/e60315" } @Article{info:doi/10.2196/56038, author="Li, Xiancheng and Vaghi, Emanuela and Pasi, Gabriella and Coulson, S. Neil and De Simoni, Anna and Viviani, Marco and ", title="Understanding the Engagement and Interaction of Superusers and Regular Users in UK Respiratory Online Health Communities: Deep Learning--Based Sentiment Analysis", journal="J Med Internet Res", year="2025", month="Feb", day="13", volume="27", pages="e56038", keywords="social media", keywords="online health communities", keywords="social network analysis", keywords="sentiment analysis", keywords="bio-bidirectional encoder representations from transformers", keywords="asthma", keywords="chronic obstructive pulmonary disease", abstract="Background: Online health communities (OHCs) enable people with long-term conditions (LTCs) to exchange peer self-management experiential information, advice, and support. Engagement of ``superusers,'' that is, highly active users, plays a key role in holding together the community and ensuring an effective exchange of support and information. Further studies are needed to explore regular users' interactions with superusers, their sentiments during interactions, and their ultimate impact on the self-management of LTCs. Objective: This study aims to gain a better understanding of sentiment distribution and the dynamic of sentiment of posts from 2 respiratory OHCs, focusing on regular users' interaction with superusers. Methods: We conducted sentiment analysis on anonymized data from 2 UK respiratory OHCs hosted by Asthma UK (AUK), and the British Lung Foundation (BLF) charities between 2006-2016 and 2012-2016, respectively, using the Bio-Bidirectional Encoder Representation from Transformers (BioBERT), a pretrained language representation model. Given the scarcity of health-related labeled datasets, BioBERT was fine-tuned on the COVID-19 Twitter Dataset. Positive, neutral, and negative sentiments were categorized as 1, 0, and --1, respectively. The average sentiment of aggregated posts by regular users and superusers was then calculated. Superusers were identified based on a definition already used in our previous work (ie, ``the 1\% users with the largest number of posts over the observation period'') and VoteRank, (ie, users with the best spreading ability). Sentiment analyses of posts by superusers defined with both approaches were conducted for correlation. Results: The fine-tuned BioBERT model achieved an accuracy of 0.96. The sentiment of posts was predominantly positive (60\% and 65\% of overall posts in AUK and BLF, respectively), remaining stable over the years. Furthermore, there was a tendency for sentiment to become more positive over time. Overall, superusers tended to write shorter posts characterized by positive sentiment (63\% and 67\% of all posts in AUK and BLF, respectively). Superusers defined by posting activity or VoteRank largely overlapped (61\% in AUK and 79\% in BLF), showing that users who posted the most were also spreaders. Threads initiated by superusers typically encouraged regular users to reply with positive sentiments. Superusers tended to write positive replies in threads started by regular users whatever the type of sentiment of the starting post (ie, positive, neutral, or negative), compared to the replies by other regular users (62\%, 51\%, 61\% versus 55\%, 45\%, 50\% in AUK; 71\%, 62\%, 64\% versus 65\%, 56\%, 57\% in BLF, respectively; P<.001, except for neutral sentiment in AUK, where P=.36). Conclusions: Network and sentiment analyses provide insight into the key sustaining role of superusers in respiratory OHCs, showing they tend to write and trigger regular users' posts characterized by positive sentiment. ", doi="10.2196/56038", url="https://www.jmir.org/2025/1/e56038" } @Article{info:doi/10.2196/60652, author="Dupont, Charl{\`e}ss and Smets, Tinne and Potts, Courtney and Monnet, Fanny and Pivodic, Lara and De Vleminck, Aline and Van Audenhove, Chantal and Mulvenna, Maurice and Van den Block, Lieve", title="Uncovering Specific Navigation Patterns by Assessing User Engagement of People With Dementia and Family Caregivers With an Advance Care Planning Website: Quantitative Analysis of Web Log Data", journal="JMIR Aging", year="2025", month="Feb", day="11", volume="8", pages="e60652", keywords="dementia", keywords="advance care planning", keywords="user engagement", keywords="web-based tool", keywords="care", keywords="website", keywords="caregiver", keywords="communication", keywords="tool", keywords="online", abstract="Background: Web-based tools have gained popularity to inform and empower individuals in advance care planning. We have developed an interactive website tailored to the unique needs of people with dementia and their families to support advance care planning. This website aims to break away from the rigid pathways shown in other tools that support advance care planning, in which advance care planning is shown as a linear process from information to reflection, communication, and documentation. Objective: This study aimed to assess the website's usage by people with dementia and their family caregivers, identify distinct user engagement patterns, and visualize how users navigated the website. Methods: We analyzed the website's log data obtained from an 8-week evaluation study of the site. Interactions with the website were collected in log data files and included visited web pages or clicked-on hyperlinks. Distinct user engagement patterns were identified using K-means clustering process mining, a technique that extracts insights from log data to model and visualize workflows, was applied to visualize user pathways through the website. Results: A total of 52 participants, 21 individuals with dementia and their family caregivers as dyads and 10 family caregivers were included in the study. Throughout the 8-week study, users spent an average of 35.3 (SD 82.9) minutes over 5.5 (SD 3.4) unique days on the website. Family caregivers mostly used the website (alone or with a person with dementia) throughout the 8-week study. Only 3 people with dementia used it on their own. In total, 3 distinct engagement patterns emerged: low, moderate, and high. Low-engagement participants spent less time on the website during the 8 weeks, following a linear path from information to communication to documentation. Moderate- and high-engagement users showed more dynamic patterns, frequently navigating between information pages and communication tools to facilitate exploration of aspects related to advance care planning. Conclusions: The diverse engagement patterns underscore the need for personalized support in advance care planning and challenge the conventional linear advance care planning representations found in other web-based tools. ", doi="10.2196/60652", url="https://aging.jmir.org/2025/1/e60652" } @Article{info:doi/10.2196/67263, author="Gil-Hern{\'a}ndez, Eva and Carrillo, Irene and Martin-Delgado, Jimmy and Garc{\'i}a-Torres, Daniel and Mira, Joaqu{\'i}n Jos{\'e}", title="Development of a Web-Based Intervention for Middle Managers to Enhance Resilience at the Individual, Team, and Organizational Levels in Health Care Systems: Multiphase Study", journal="JMIR Hum Factors", year="2025", month="Feb", day="5", volume="12", pages="e67263", keywords="resilience", keywords="health care professionals", keywords="web-based intervention", keywords="middle management", keywords="well-being", keywords="patient safety", abstract="Background: Health care institutions face high systemic risk due to the inherent uncertainty and complexity of their operations. This often leads to stressful incidents impacting the well-being of health care professionals, which can compromise the effectiveness of health care systems. Enhancing resilience among health care professionals is essential for maintaining high-quality care and ensuring patient safety. The role of middle managers is essential to ensure the response capacity of individuals and teams. Objective: This study aims to develop a web-based intervention aimed at middle management to enhance individual, team, and organizational resilience. Methods: An observational study was conducted in 3 phases: design, validation, and pilot study. The study was initiated in February 2022 and concluded in June 2023. Phase 1 involved designing the content for the web-based tool based on a comprehensive review of critical elements around resilience. Phase 2 included validation by an international panel of experts who reviewed the tool and rated it according to a structured grid. They were also encouraged to highlight strengths and areas for improvement. Phase 3 involved piloting the tool with health care professionals in Ecuador to refine the platform and assess its effectiveness. A total of 458 people were invited to participate through the Institutional Course on Continuous Improvement in Health Care Quality and Safety offered by the Ministry of Public Health of Ecuador. Results: The tool, eResiliencia, was structured into 2 main blocks: individual and team resilience and organizational resilience. It included videos, images, PDFs, and links to dynamic graphics and additional texts. Furthermore, 13 (65\%) of the 20 experts validated the tool, rating content clarity at an average of 4.5 (SD 0.7) and utility at an average of 4.7 (SD 0.5) out of 5. The average overall satisfaction was 9.3 (SD 0.6) out of 10 points, and feedback on improvements was implemented. A total of 362 health care professionals began the intervention, of which 218 (60.2\%) completed preintervention and postintervention questionnaires, with significant knowledge increases (P<.001). Of the 362 health care professionals, 146 (40.3\%) completed the satisfaction questionnaire, where overall satisfaction was rated at an average of 9.4 (SD 1.1) out of 10 points. Conclusions: The eResiliencia web-based platform provides middle managers with resources to enhance resilience among their teams and their components, promoting better well-being and performance, even under highly stressful events. Future research should focus on long-term impacts and practical applications in diverse clinical settings. ", doi="10.2196/67263", url="https://humanfactors.jmir.org/2025/1/e67263" } @Article{info:doi/10.2196/53188, author="Bragg, A. Marie and Lutfeali, Samina and Gabler, Godoy Daniela and Quintana Licona, A. Diego and Harris, L. Jennifer", title="Latinx and White Adolescents' Preferences for Latinx-Targeted Celebrity and Noncelebrity Food Advertisements: Experimental Survey Study", journal="J Med Internet Res", year="2025", month="Jan", day="31", volume="27", pages="e53188", keywords="Latinx", keywords="Hispanic", keywords="adolescents", keywords="marketing", keywords="celebrities", keywords="Spanish", keywords="advertisements", keywords="products", keywords="brands", keywords="food", keywords="unhealthy", keywords="beverages", keywords="diet", keywords="nutrition", keywords="consumers", keywords="intention", keywords="purchasing", keywords="attitudes", keywords="perceptions", keywords="preferences", keywords="youth", abstract="Background: Exposure to food advertisements is a major driver of childhood obesity, and food companies disproportionately target Latinx youth with their least healthy products. This study assessed the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents. Objective: This web-based within-subjects study aims to assess the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents' preferences for the advertisements and featured products. Methods: Participants (N=903) were selected from a volunteer sample of adolescents, aged 13-17 years, who self-identified as Latinx or White, had daily internet access, and could read and write in English. They participated in a web-based Qualtrics study where each participant viewed 8 advertisements for novel foods and beverages, including 4 advertisements that featured Latinx celebrities and the same 4 advertisements that featured Latinx noncelebrities (matched on all other attributes), in addition to 2 neutral advertisements (featuring bland, nontargeted products and did not feature people). Primary outcomes were participants' ratings of 4 advertisements for food and beverage brands featuring a Latinx celebrity and the same 4 advertisements featuring a Latinx noncelebrity. Multilevel linear regression models compared the effects of celebrities and differences between Latinx and White participants on attitudes (advertisement likeability; positive affect; and brand perceptions) and behavioral intentions (consumption; social media engagement---``liking;'' following; commenting; tagging a friend). Results: Latinx (n=436; 48.3\%) and White (n=467; 51.7\%) participants rated advertisements featuring Latinx celebrities more positively than advertisements featuring noncelebrities on attitude measures except negative affect (Ps?.002), whereas only negative affect differed between Latinx and White participants. Two of the 5 behavioral intention measures differed by celebrity advertisement status (P=.02; P<.001). Additionally, the interaction between celebrity and participant ethnicity was significant for 4 behavioral intentions; Latinx, but not White, participants reported higher willingness to consume the product (P<.001), follow brands (P<.001), and tag friends (P<.001). While White and Latinx adolescents both reported higher likelihoods of ``liking'' advertisements on social media endorsed by Latinx celebrities versus noncelebrities, the effect was significantly larger among Latinx adolescents (P<.01). Conclusions: This study demonstrates the power of Latinx celebrities in appealing to both Latinx and White adolescents but may be particularly persuasive in shaping behavioral intentions among Latinx adolescents. These findings suggest an urgent need to reduce celebrity endorsements in ethnically targeted advertisements that promote unhealthy food products to communities disproportionately affected by obesity and diabetes. The food industry limits food advertising to children ages 12 years and younger, but industry self-regulatory efforts and policies should expand to include adolescents and address disproportionate marketing of unhealthy food to Latinx youth and celebrity endorsements of unhealthy products. ", doi="10.2196/53188", url="https://www.jmir.org/2025/1/e53188" } @Article{info:doi/10.2196/56941, author="Specht, Lisa and Scheible, Raphael and Boeker, Martin and Farin-Glattacker, Erik and Kampel, Nikolas and Schm{\"o}lz, Marina and Sch{\"o}pf-Lazzarino, Andrea and Schulz, Stefan and Schlett, Christian and Thomczyk, Fabian and Voigt-Radloff, Sebastian and Wegner, Constanze and Wollmann, Katharina and Maun, Andy", title="Evaluating the Acceptance and Usability of an Independent, Noncommercial Search Engine for Medical Information: Cross-Sectional Questionnaire Study and User Behavior Tracking Analysis", journal="JMIR Hum Factors", year="2025", month="Jan", day="23", volume="12", pages="e56941", keywords="medical information", keywords="health information", keywords="search engine", keywords="user behavior", keywords="health literacy", keywords="digital health literacy", keywords="navigational needs", keywords="information-seeking behavior", keywords="evidence-based content", keywords="Germany", abstract="Background: The internet is a key source of health information, but the quality of content from popular search engines varies, posing challenges for users---especially those with low health or digital health literacy. To address this, the ``tala-med'' search engine was developed in 2020 to provide access to high-quality, evidence-based content. It prioritizes German health websites based on trustworthiness, recency, user-friendliness, and comprehensibility, offering category-based filters while ensuring privacy by avoiding data collection and advertisements. Objective: This study aims to evaluate the acceptance and usability of this independent, noncommercial search engine from the users' perspectives and their actual use of the search engine. Methods: For the questionnaire study, a cross-sectional study design was used. In total, 802 participants were recruited through a web-based panel and were asked to interact with the new search engine before completing a web-based questionnaire. Descriptive statistics and multiple regression analyses were used to assess participants' acceptance and usability ratings, as well as predictors of acceptance. Furthermore, from October 2020 to June 2021, we used the open-source web analytics platform Matomo to collect behavior-tracking data from consenting users of the search engine. Results: The study indicated positive findings on the acceptance and usability of the search engine, with more than half of the participants willing to reuse (465/802, 58\%) and recommend it (507/802, 63.2\%). Of the 802 users, 747 (93.1\%) valued the absence of advertising. Furthermore, 92.3\% (518/561), 93.9\% (553/589), 94.7\% (567/599), and 96.5\% (600/622) of those users who used the filters agreed at least partially that the filter functions were helpful in finding trustworthy, recent, user-friendly, or comprehensible results. Participants criticized some of the search results regarding the selection of domains and shared ideas for potential improvements (eg, for a clearer design). Regression analyses showed that the search engine was especially well accepted among older users, frequent internet users, and those with lower educational levels, indicating an effective targeting of segments of the population with lower health literacy and digital health literacy. Tracking data analysis revealed 1631 sessions, comprising 3090 searches across 1984 unique terms. Users performed 1.64 (SD 1.31) searches per visit on average. They prioritized the search terms ``corona,'' ``back pain,'' and ``cough.'' Filter changes were common, especially for recency and trustworthiness, reflecting the importance that users placed on these criteria. Conclusions: User questionnaires and behavior tracking showed the platform was well received, particularly by older and less educated users, especially for its advertisement-free design and filtering system. While feedback highlighted areas for improvement in design and filter functionality, the search engine's focus on transparency, evidence-based content, and user privacy shows promise in addressing health literacy and navigational needs. Future updates and research will further refine its effectiveness and impact on promoting access to quality health information. ", doi="10.2196/56941", url="https://humanfactors.jmir.org/2025/1/e56941" } @Article{info:doi/10.2196/53456, author="Chang, You-Lung and Lin, Chi-Ying and Hsu, Jiun and Liao, Sui-Ling and Yu, Chun-Ti and Peng, Hung-Chueh and Chen, Chung-Yu and Ma, Huei-Ming Matthew and Hwang, Juey-Jen", title="Leveraging Smart Telemedicine Technology to Enhance Nursing Care Satisfaction and Revolutionize COVID-19 Care: Prospective Cohort Study", journal="JMIR Hum Factors", year="2025", month="Jan", day="21", volume="12", pages="e53456", keywords="COVID-19", keywords="telemedicine", keywords="smart home care", keywords="intelligent medical care", keywords="nursing care", keywords="medical care", keywords="remote monitoring", keywords="vital signs", keywords="quarantine", keywords="home-care", keywords="hospital-care", keywords="screening", keywords="treatment", keywords="mHealth", keywords="mobile health", keywords="digital health", keywords="health education", keywords="remote equipment", keywords="smartphone", keywords="video consultation", keywords="remote care", keywords="caregiver", keywords="patient", keywords="quality of care", keywords="medical staff", abstract="Background: Telemedicine has been utilized in the care of patients with COVID-19, allowing real-time remote monitoring of vital signs. This technology reduces the risk of transmission while providing high-quality care to both self-quarantined patients with mild symptoms and critically ill patients in hospitals. Objective: This study aims to investigate the application of telemedicine technology in the care of patients with COVID-19, specifically focusing on usability, effectiveness, and patient outcomes in both home isolation and hospital ward settings. Methods: The study was conducted between January 2022 and December 2022. More than 800 cases were monitored using the QOCA remote home care system, a telemedicine platform that enables remote monitoring of physiological data---including heart rate, blood pressure, temperature, and oxygen levels---through Internet of Things devices and a 4G-connected tablet. Of these, 27 patients participated in thie study: the QOCA remote home care system was deployed 36 times in the isolation ward and 21 times to those in home isolation. The QOCA remote care system monitored isolated cases through remote care packages and a 4G tablet. Case managers and physicians provided telemedicine appointments and medications. Innovative methods were developed to enhance usage, including online health education, remote care equipment instructions via QR core links, and video consultations for patients without smartphones. Results: A clinical nurse satisfaction survey revealed that most respondents found the content of the remote care package comprehensive and the interface easy to learn. They expressed a desire to continue using the system. The majority also agreed that using the remote care system and package would reduce their workload and that patients and caregivers could easily learn to use the package. While some respondents expressed concerns about network and Bluetooth connectivity, the majority (24/27, 89\%) agreed to include the remote device as part of their routine equipment, with an average score of 84.8 points. Conclusions: The integration of telemedicine technology improves the quality of care while reducing the workload and exposure of health care workers to viruses. ", doi="10.2196/53456", url="https://humanfactors.jmir.org/2025/1/e53456" } @Article{info:doi/10.2196/59181, author="Turcott, Alyssa and Kang, Ruthine and Yao, Christopher and O'Melinn, Colleen and Mahoney, Patricia and Barlow, Susan and Schmidt, Julia", title="The MyGuide Web-Based Self-Management Tool for Concussion Rehabilitation: Mixed Methods Cross-Sectional Study", journal="JMIR Rehabil Assist Technol", year="2025", month="Jan", day="7", volume="12", pages="e59181", keywords="concussion", keywords="self-management", keywords="health information technology", keywords="perceptions", keywords="concussion recovery", keywords="concussion management", keywords="concussion rehabilitation", keywords="rehabilitation", keywords="self-management tool", keywords="perception", keywords="digital health", keywords="e-health", keywords="mobile app", keywords="mhealth", keywords="web-based tool", abstract="Background: Web-based concussion self-management education programs for adolescents can improve functional outcomes, reduce concussion symptoms, and increase self-efficacy. However, there are a limited number of studies examining the perceptions and acceptance of these programs and the use of these tools in the adult concussion population. Objective: This study aimed to investigate the perceptions and acceptance of clinicians and adults with concussions using MyGuide Concussion (Vancouver Coastal Health), a web-based concussion self-management tool. Methods: Using a mixed methods sequential explanatory design, a convenience sample of 8 adults with concussions and 8 clinicians who used MyGuide Concussion over a 2-year period were interviewed, and their responses were analyzed. Results: Participants reported two key benefits of using the web-based self-management tool: (1) the tool's emphasis on the interconnectedness of physical and psychological symptoms, and (2) the ability to provide reassurance that symptom being experienced were a normal part of the concussion experience. Clinicians described the tool as being useful as a supplementary source of information for clients in addition to clinical sessions and believed the content was useful for increasing clients' independence in managing their own recovery. Conclusions: Overall, the evaluation of the MyGuide tool is an acceptable and well-perceived tool for adults with concussions who require a basic understanding of concussion recovery, particularly in the early stages of recovery. Future research may include optimizing MyGuide by targeting promotional strategies and addressing other barriers to use. ", doi="10.2196/59181", url="https://rehab.jmir.org/2025/1/e59181" } @Article{info:doi/10.2196/53057, author="Isaac, Mohsen Sarah and Dawes, Mark and Howell, Ruth Emily and Oladipo, Francis Antonia", title="Gender-Inclusive Language in Public-Facing Labor and Delivery Web Pages in the New York Tristate Area: Cross-Sectional Study", journal="JMIR Hum Factors", year="2025", month="Jan", day="6", volume="12", pages="e53057", keywords="OBGYN", keywords="transgender", keywords="nonbinary", keywords="pregnancy", keywords="maternity", keywords="transmasculine", keywords="observational study", keywords="gestational", keywords="perinatal care", keywords="communication", keywords="labor", keywords="USA", keywords="United States", keywords="New York City", keywords="sexual orientation", keywords="inclusion", keywords="parents", keywords="obstetrician gynecologist", keywords="delivery", abstract="Background: Transgender and nonbinary (TGNB) individuals are increasingly intentionally becoming pregnant to raise children, and hospital websites should reflect these trends. For prospective TGNB parents, a hospital website is the only way they can assess their safety from discrimination while receiving perinatal care. Cisnormativity enforced by communication gaps between medical institutions and TGNB patients can and has caused delays in receiving urgent care during their pregnancy. Objective: The aim of this study was to evaluate the current prevalence of gender-inclusive terminology among labor and delivery services in the New York tristate area. Methods: The labor and delivery web pages of 189 hospitals from New York, New Jersey, and Connecticut were examined for gender-inclusive language. ``Fully inclusive'' websites explicitly acknowledged lesbian, gay, bisexual, transgender, queer, intersex, and asexual plus other gender- and sexual-oriented (LGBTQIA+) parents, ``inclusive'' websites did not use gendered terminology for parents, and ``noninclusive'' websites used gendered terms at least once in the text reviewed. The hospitals' web pages were further stratified by Healthcare Equality Index scores and population classifications defined by the 2013 National Center for Health Statistics Urban-Rural classification given to the county that each hospital was located in. Results: Of the 300 hospital websites reviewed, only 189 websites met the criteria for inclusion. Overall, only 6.3\% (n=12) of labor and delivery web pages were ``inclusive'' or ``fully inclusive.'' No geographic areas (P=.61) or Healthcare Equality Index scores (P=.81) were associated with inclusive or fully inclusive language. Conclusions: Hospitals need to use inclusive language to help TGNB people identify hospitals where their existence and needs are acknowledged and thus feel more comfortable in their transition to parenthood. ", doi="10.2196/53057", url="https://humanfactors.jmir.org/2025/1/e53057" } @Article{info:doi/10.2196/60042, author="Radley, Jessica and Penhallow, Jessica and Wickersham, Alice and Morris, Anna and Colling, Craig and Downs, Johnny", title="Factors Affecting Usability and Acceptability of an Online Platform Used by Caregivers in Child and Adolescent Mental Health Services: Mixed Methods Study", journal="JMIR Pediatr Parent", year="2024", month="Dec", day="26", volume="7", pages="e60042", keywords="child mental health", keywords="caregivers", keywords="digital technology", keywords="digital health", keywords="technology use", keywords="digital skill", keywords="digital literacy", keywords="digital divides", keywords="online systems", keywords="online survey", keywords="pediatric", keywords="mental health", keywords="usability", keywords="platform", keywords="survey", keywords="questionnaire", keywords="children", keywords="youth", keywords="adolescent", keywords="informal care", keywords="family care", keywords="acceptability", keywords="System Usability Scale", keywords="SUS", keywords="mobile phone", abstract="Background: Young people and families endure protracted waits for specialist mental health support in the United Kingdom. Staff shortages and limited resources have led many organizations to develop digital platforms to improve access to support. myHealthE is a digital platform used by families referred to Child and Adolescent Mental Health Services in South London. It was initially designed to improve the collection of routine outcome measures and subsequently the ``virtual waiting room'' module was added, which includes information about child and adolescent mental health as well as signposting to supportive services. However, little is known about the acceptability or use of digital resources, such as myHealthE, or about sociodemographic inequalities affecting access to these resources. Objective: This study aimed to assess the usability and acceptability of myHealthE as well as investigating whether any digital divides existed among its userbase in terms of sociodemographic characteristics. Methods: A survey was sent to all myHealthE users (N=7337) in May 2023. Caregivers were asked about their usage of myHealthE, their levels of comfort with technology and the internet. They completed the System Usability Scale and gave open-ended feedback on their experiences of using myHealthE. Results: A total of 680 caregivers responded, of whom 45\% (n=306) were from a Black, Asian, or a minority ethnic background. Most (n=666, 98\%) used a mobile phone to access myHealthE, and many had not accessed the platform's full functionality, including the new ``virtual waiting room'' module. Household income was a significant predictor of caregivers' levels of comfort using technology; caregivers were 13\% more likely to be comfortable using technology with each increasing income bracket (adjusted odds ratio 1.13, 95\% CI 1.00?1.29). Themes generated from caregivers' feedback highlight strengths of digital innovation as well as ideas for improvement, such as making digital platforms more personalized and tailored toward an individual's needs. Conclusions: Technology can bring many benefits to health care; however, sole reliance on technology may result in many individuals being excluded. To enhance engagement, clinical services must ensure that digital platforms are mobile friendly, personalized, that users are alerted and directed to their full functionality, and that efforts are made to bridge digital divides. Enhancing dissemination practices and improving accessibility to informative resources on the internet is critical to provide fair access to all using Child and Adolescent Mental Health Services. ", doi="10.2196/60042", url="https://pediatrics.jmir.org/2024/1/e60042" } @Article{info:doi/10.2196/63334, author="Dorney, Edwina and Hammarberg, Karin and Rodgers, Raymond and Black, I. Kirsten", title="Optimization of a Web-Based Self-Assessment Tool for Preconception Health in People of Reproductive Age in Australia: User Feedback and User-Experience Testing Study", journal="JMIR Hum Factors", year="2024", month="Dec", day="24", volume="11", pages="e63334", keywords="technology", keywords="internet", keywords="eHealth", keywords="user experience", keywords="patient engagement", keywords="self-assessment tool", keywords="preconception", keywords="health communication", abstract="Background: Good preconception health reduces the incidence of preventable morbidity and mortality for women, their babies, and future generations. In Australia, there is a need to increase health literacy and awareness about the importance of good preconception health. Digital health tools are a possible enabler to increase this awareness at a population level. The Healthy Conception Tool (HCT) is an existing web-based, preconception health self-assessment tool, that has been developed by academics and clinicians. Objective: This study aims to optimize the HCT and to seek user feedback to increase the engagement and impact of the tool. Methods: In-depth interviews were held with women and men aged 18?41 years, who spoke and read English and were residing in Australia. Interview transcripts were analyzed, and findings were used to inform an enhanced HCT prototype. This prototype underwent user-experience testing and feedback from users to inform a final round of design changes to the tool. Results: A total of 20 women and 5 men were interviewed; all wanted a tool that was quick and easy to use with personalized results. Almost all participants were unfamiliar with the term ``preconception care'' and stated they would not have found this tool on the internet with its current title. User-experience testing with 6 women and 5 men identified 11 usability issues. These informed further changes to the tool's title, the information on how to use the tool, and the presentation of results. Conclusions: Web-based self-assessment tools need to be easy to find and should communicate health messages effectively. End users' feedback informed changes to improve the tool's acceptability, engagement, and impact. We expect that the revised tool will have greater reach and prompt more people to prepare well for pregnancy. ", doi="10.2196/63334", url="https://humanfactors.jmir.org/2024/1/e63334" } @Article{info:doi/10.2196/64343, author="Pearce, Eidenier Emily and Majid, Alina and Brown, Toniya and Shepherd, Forbes Rowan and Rising, Camella and Wilsnack, Catherine and Thompson, S. Ashley and Gilkey, B. Melissa and Ribisl, M. Kurt and Lazard, J. Allison and Han, KJ Paul and Werner-Lin, Allison and Hutson, P. Sadie and Savage, A. Sharon", title="``Crying in the Wilderness''---The Use of Web-Based Support in Telomere Biology Disorders: Thematic Analysis", journal="JMIR Form Res", year="2024", month="Dec", day="16", volume="8", pages="e64343", keywords="social media", keywords="dyskeratosis congenita", keywords="telomere biology disorder", keywords="health communication", keywords="qualitative", keywords="thematic analysis", keywords="web-based information", keywords="web-based support", keywords="telomere", keywords="biology disorder", keywords="social support", keywords="emotional support", keywords="genetic", keywords="internet-based", keywords="information-seeking", keywords="descriptive study", keywords="semistructured interview", keywords="adult", keywords="illness experience", keywords="psychosocial", keywords="digital health", keywords="health intervention", keywords="health informatics", abstract="Background: Web-based information and social support are commonly used in rare disease communities where geographic dispersion and limited provider expertise complicate in-person support. We examined web-based resource use among caregivers of individuals with telomere biology disorders (TBDs), which are rare genetic conditions with long diagnostic odysseys and uncertain prognoses including multiorgan system cancer risk. Objective: This study explored internet-based information-seeking and social support practices and perspectives of patients with TBDs and their caregivers. Methods: Our qualitative descriptive study used semistructured interviews of patients with TBDs and caregivers. Data were transcribed verbatim and thematically analyzed by an interdisciplinary team. Results: A total of 32 adults completed interviews. Participant ages ranged from 27 to 74 years. The majority (n=28, 88\%) were female, occupied multiple TBD roles (eg, patient and parent), and had undergone genetic testing. Most engaged in web-based information-seeking (n=29, 91\%) and TBD-specific social media (n=26, 81\%). Participants found web-based resources useful for information-seeking but reported privacy concerns and frustration with forming supportive relationships. Most participants described ambivalence toward web-based resource use, citing tensions between hunger for information versus distrust, empowerment versus overwhelm, disclosure versus privacy, and accessibility versus connection. Fluctuations in web-based support use arose from perceived harms, information saturation, or decreased relevance over the course of TBD illness experience. Conclusions: Individuals with TBDs and their caregivers reported frequent use of web-based informational and emotional support. However, ambivalence about the benefits and liabilities of web-based resources and persistent medical uncertainty may impact the adoption of and adherence to web-based support among patients with TBD and caregivers. Our findings suggest web-based psychosocial support should target long-term and multifaceted informational and emotional needs, be user-initiated, be offered alongside in-person formats, provide expert-informed information, and be attentive to personal privacy and evolving support needs of the TBD community. This study suggests web-based resources will be most effective in the TBD context when they achieve the following features: (1) offer a variety of ways to engage (eg, active and passive), (2) provide privacy protections in moderated ``safe spaces'' designed for personal disclosure, (3) offer separate venues for informational versus emotional support, (4) combine web-based relationship formation with opportunities for in-person gathering, (5) provide information that is reliable, easy to access, and informed by medical professionals, (6) remain mindful of user distress, and (7) are responsive to variations in levels and types of engagement. Additionally, advocacy organizations may wish to avoid traditional social media platforms when designing safe spaces for web-based emotional support, instead pivoting to internet-based tools that minimize privacy threats and limit the perpetual public availability of shared information. ", doi="10.2196/64343", url="https://formative.jmir.org/2024/1/e64343", url="http://www.ncbi.nlm.nih.gov/pubmed/39680438" } @Article{info:doi/10.2196/56567, author="Bunnell, E. Brian and Schuler, R. Kaitlyn and Ivanova, Julia and Flynn, Lea and Barrera, F. Janelle and Niazi, Jasmine and Turner, Dylan and Welch, M. Brandon", title="Expanding a Health Technology Solution to Address Therapist Challenges in Implementing Homework With Adult Clients: Mixed Methods Study", journal="JMIR Hum Factors", year="2024", month="Dec", day="12", volume="11", pages="e56567", keywords="mental health", keywords="mental illness", keywords="mental disease", keywords="mental disorder", keywords="homework", keywords="homework challenge", keywords="therapy", keywords="therapist", keywords="barriers", keywords="adult client", keywords="adult", keywords="technology-based solution", keywords="health technology", keywords="digital health", keywords="digital technology", keywords="digital intervention", keywords="mobile phone", abstract="Background: Homework is implemented with variable effectiveness in real-world therapy settings, indicating a need for innovative solutions to homework challenges. We developed Adhere.ly, a user-friendly, Health Insurance Portability and Accountability Act--compliant web-based platform to help therapists implement homework with youth clients and their caregivers. The initial version had limited functionality, was designed for youth clients and their caregivers, and required expanding available features and exercises to suit adult clients. Objective: The purpose of this study was to better understand barriers and potential solutions to homework implementation experienced by therapists seeing adult clients and obtain their input on new features and exercises that would enable Adhere.ly to better meet their needs when working with this population. Methods: This study used an exploratory, sequential mixed methods design that included 13 semistructured focus groups with mental health therapists and clinic leaders and a survey administered to 100 therapists. Analyses were performed using the NVivo qualitative analysis software and SPSS. Results: The findings revealed common barriers, such as clients and therapists being busy, forgetting to complete homework, managing multiple platforms and homework materials, and clients lacking motivation. Adhere.ly was perceived as a potential solution, particularly its user-friendly interface and SMS text-message based reminders. Therapists suggested integrating Adhere.ly with telemedicine and electronic health record platforms and adding more exercises to support manualized therapy protocols and therapy guides. Conclusions: This study highlights the importance of technology-based solutions in addressing barriers to homework implementation in mental health treatment with adult clients. Adhere.ly shows promise in addressing these challenges and has the potential to improve therapy efficiency and homework completion rates. The input from therapists informed the development of Adhere.ly, guiding the expansion of features and exercises to better meet the needs of therapists working with adult clients. ", doi="10.2196/56567", url="https://humanfactors.jmir.org/2024/1/e56567" } @Article{info:doi/10.2196/58014, author="Fox, S. Rina and Torres, K. Tara and Badger, A. Terry and Katsanis, Emmanuel and Yang, DerShung and Sanford, D. Stacy and Victorson, E. David and Yanez, Betina and Penedo, J. Frank and Antoni, H. Michael and Oswald, B. Laura", title="Delivering a Group-Based Quality of Life Intervention to Young Adult Cancer Survivors via a Web Platform: Feasibility Trial", journal="JMIR Cancer", year="2024", month="Dec", day="4", volume="10", pages="e58014", keywords="cancer survivors", keywords="survivorship", keywords="clinical trials", keywords="psychosocial intervention", keywords="usability testing", keywords="digital therapeutics", keywords="young adults", keywords="nonrandomized", abstract="Background: Young adult (YA) cancer survivors frequently report unmet health information and peer support needs, as well as poor health-related quality of life (HRQOL). YAs also have expressed a desire that behavioral interventions be convenient. In response to this, our team has developed a 10-week, group-based, supportive care intervention titled TOGETHER to improve YA cancer survivors' HRQOL. TOGETHER is delivered via videoconference and has shown initial feasibility, acceptability, and promise for improving HRQOL among YA survivors. Objective: In an effort to increase convenience, the goal of this 2-part study was to design and test a website to host the TOGETHER intervention for YA cancer survivors aged 18?39 years at the time of participation and aged 15?39 years at the time of initial cancer diagnosis. Methods: In part 1, we leveraged an existing web-based platform and adapted it to meet the needs of TOGETHER. We conducted 3 iterative waves of usability testing with 3 YAs per wave to refine the website. In part 2, we conducted a single-group feasibility trial of TOGETHER using the website. Primary outcomes were feasibility (ie, recruitment, retention, and attendance) and acceptability (ie, satisfaction). Results: Usability testing participants (n=9) indicated that the TOGETHER website was easy to use (mean 5.9, SD 1.3) and easy to learn (mean 6.5, SD 0.9; possible ranges 1?7). Qualitative feedback identified needed revisions to the aesthetics (eg, images), content (eg, session titles), function (eg, clarity of functionality), and structure (eg, expandable sections), which were implemented. In the feasibility trial, participants (n=7) were an average of 25 (SD 4.7) years old and mostly non-Hispanic White (n=4, 57\%). Recruitment (58\%) and retention (71\%) rates and average session attendance (mean 7.1 , SD 4.2) supported feasibility. Participant agreement with positive statements about TOGETHER and average satisfaction ratings (mean 5.06, SD 1.64; possible range: 1?7) demonstrated acceptability. Conclusions: Results supported the usability, feasibility, and acceptability of the TOGETHER program and website. By providing the content digitally, the program effectively addresses YAs' expressed preference for convenience. Future studies are needed to increase TOGETHER's efficiency and explore its efficacy for improving targeted outcomes. Trial Registration: NCT05597228, October 24, 2022; https://clinicaltrials.gov/study/NCT05597228 ", doi="10.2196/58014", url="https://cancer.jmir.org/2024/1/e58014" } @Article{info:doi/10.2196/50664, author="Wang, Difan and Lin, Bingyan and Zhang, Shuangxi and Xu, Wei and Liu, Xinying", title="Effectiveness of an Internet-Based Self-Help Acceptance and Commitment Therapy Program on Medical Students' Mental Well-Being: Follow-Up Randomized Controlled Trial", journal="J Med Internet Res", year="2024", month="Dec", day="4", volume="26", pages="e50664", keywords="internet-delivered self-help acceptance and commitment therapy", keywords="depression", keywords="anxiety", keywords="stress", keywords="psychological inflexibility", keywords="obsessive-compulsive symptoms", keywords="medical students", keywords="iACT 2.0 program", abstract="Background: Psychological distress is a growing problem among medical students worldwide. This highlights the need for psychological interventions to focus on mental health and improve well-being in this population. Objective: This study developed an internet-based, self-help, acceptance and commitment therapy program (iACT 2.0), aiming to examine its effectiveness in reducing depression, anxiety, stress, psychological inflexibility (PI), and obsessive-compulsive symptoms (OCSs) among medical students. Methods: A total of 520 Chinese postgraduate medical students were randomly assigned to either an iACT 2.0 intervention group (n=260; six online lessons, once every 5 days) or a control condition (n=260; without intervention). Participants completed questionnaires including the 21-item Depression Anxiety Stress Scale, the revised Obsessive-Compulsive Inventory, and the Multidimensional Psychological Flexibility Inventory at the preintervention (T1), postintervention (T2), and 1-month follow-up time points (T3). No therapist support was provided during the 1-month iACT 2.0 intervention period. Data were collected via an online platform and analyzed using repeated-measures ANOVA. Results: Participants in the intervention group demonstrated a significant decrease in depression, anxiety, stress, PI, and OCSs compared to the control group after the intervention (F=22.9-672.04, all P<.001). Specifically, the intervention group showed significant reductions in all measured outcomes from the preintervention to postintervention time point and at the 1-month follow-up (all P<.001). In contrast, no significant changes were observed in the control group over the same period (all P>.05). The groups did not differ significantly at baseline (all P>.05). Significant differences were noted at both the postintervention and follow-up time points (all P<.001). Conclusions: This study demonstrated that the newly developed iACT 2.0 was effective in reducing depression, anxiety, stress, PI, and OCSs. Notably, the positive effects of the intervention persisted at the 1-month follow-up. This program can offer a useful addition to existing mental illness treatment and lead to improvements in clinical and psychotherapy planning while simultaneously reducing the burden on traditional counseling and services. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300070725; https://tinyurl.com/2h75wx8n ", doi="10.2196/50664", url="https://www.jmir.org/2024/1/e50664" } @Article{info:doi/10.2196/52883, author="Wiita, Farah and Ho, K. Aileen and Weinstein, Netta", title="Web-Based Intervention Using Self-Compassionate Writing to Induce Positive Mood in Family Caregivers of Older Adults: Quantitative Study", journal="JMIR Form Res", year="2024", month="Nov", day="21", volume="8", pages="e52883", keywords="self-compassion", keywords="caregivers", keywords="mindfulness", keywords="intervention", keywords="writing", keywords="experimental", abstract="Background: Caregiver burden can impact the mental health of family caregivers, but self-compassion may help reduce this impact. Brief self-compassion interventions have been shown to be useful but have not been tested in family caregivers of older adults. Objective: This study aimed to test the effects of a brief self-compassion intervention and its components (self-kindness, common humanity, and mindfulness) on mental well-being and mood when reflecting on difficult family caregiving experiences. Methods: British caregivers were recruited through a web-based panel. Three experimental studies manipulated the self-compassion intervention. In study 1 (n=206) and study 2 (n=224), participants wrote about a difficult caregiving experience while focusing on 1 self-compassion component (self-kindness, common humanity, or mindfulness). In study 3 (n=222) participants focused on all components. Self-compassion, serenity, guilt, and sadness were measured. Results: In studies 1 and 2, condition effects showed mindfulness unexpectedly lowered mood. Inconsistent and modest benefits to affect were achieved by engagement in self-kindness and common humanity in study 1 (guilt [lowered]: P=.02 and sadness [lowered]: P=.04; serenity [nonsignificantly raised]: P=.20) and also in study 2 (sadness [nonsignificantly lowered]: P=.23 and guilt [nonsignificantly lowered]: P=.26; serenity [raised]: P=.33); significant benefits for self-compassion and mood were found in study 3 (serenity [raised]: P=.01, kindness [raised]: P=.003, and common humanity [raised]: P?.001; guilt [lowered]: P<.001 and sadness [lowered]: P?.001). More intensive efforts should be made to promote self-compassion in caregivers of older adults, with caution advised when relying primarily on mindfulness approaches. Conclusions: Self-compassionate writing may be beneficial for family caregivers, but more intensive interventions are needed. Further research is needed to determine the optimal dosage and content for achieving the greatest effects. ", doi="10.2196/52883", url="https://formative.jmir.org/2024/1/e52883" } @Article{info:doi/10.2196/54679, author="Keicher, Franca and Thomann, Julia and Erlenwein, Jana and Schottdorf, Mara and Reiter, Lennart Nils and Scholz-Schw{\"a}rzler, Patricia Nadine and Vogel, Barbara and Warlitz, Cordula and Stojanov, Silvia and Augustin, Silvia and Goldbrunner, Lola and Schanz, Linda and Dodel, Veronika and Zipper, Charlotte and Schiweck, Nicole and Jaeschke, Robert and Saramandic, Milica and Wiejaczka, Karolina and Eberhartinger, Maria and Dettmer, Kristina and Hattesohl, Ricardo Daniel Bruno and Englbrecht, Stephanie and Behrends, Uta and Spiegler, Juliane", title="Development and Implementation of an Online Patient Education Program for Children and Adolescents With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Their Parents, Siblings, and School Personnel: Protocol for the Prospective BAYNET FOR ME/CFS Study", journal="JMIR Res Protoc", year="2024", month="Nov", day="21", volume="13", pages="e54679", keywords="patient education", keywords="ME/CFS", keywords="children", keywords="adolescents", keywords="ModuS", keywords="parents", keywords="teachers", keywords="siblings", keywords="training", abstract="Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) presents significant challenges for affected children and adolescents, their social environment, and treating physicians, due to its profound impact on quality of life and the lack of causal therapeutic approaches. One crucial aspect of care that has been missing for these patients is comprehensive education for both them and their social circles. Objective: This study protocol aims to outline the goals, study design, execution, and evaluation of the subproject within the BAYNET FOR ME/CFS project. The focus is on developing online education programs for children and adolescents with ME/CFS, as well as for their parents, siblings, and school staff. These programs are designed to improve independent disease management, increase knowledge, and promote interaction with other affected individuals. Methods: In phase I, the group-based online education programs were developed by a multidisciplinary team based on the ModuS concept created by the Competence Network for Patient Education (KomPaS). These programs were then piloted and finalized. Phase II involved recruiting participants and implementing the finalized programs. Given the restricted physical and cognitive capacities of the affected individuals, the patient education programs were exclusively designed in a digital format to facilitate participation. In phase III, the programs will be evaluated for acceptance, completeness, and participant satisfaction. The qualitative assessment will focus on individual expectations and benefits derived from the training. Phase IV will further assess the programs in terms of improvements in disease knowledge, health-related quality of life, life satisfaction, and family burden. Results: The programs were developed, piloted, and finalized during phase I, which ran from December 2022 to May 2023. The pilot phase, from March to May 2023, led to adaptations in the program concept. In total, 8 patients and their parents, 5 siblings, and 59 school staff participated in the piloting. Adjustments were made to the format, content, duration, and schedule to better meet the needs of the affected individuals and their social circles. In phase II, participant recruitment for the patient education program took place from January to July 2023. The study successfully recruited 24 young patients with ME/CFS and their parents, along with 8 siblings and 51 school staff. Two program blocks for patients and parents and 2-3 blocks for siblings and school staff commenced in May 2023 and were completed within the same year. Phase III began after phase II and involves the evaluation of the programs, with the process expected to conclude by the end of 2024. Phase IV, planned for 2025-2026, will involve the rollout of the program to 150 children and their caretakers. This phase will focus on evaluating disease knowledge, health-related quality of life, life satisfaction, and family burden, as well as include longitudinal assessments. Conclusions: The data aim to support the development of a comprehensive, interprofessional care model for children and adolescents with ME/CFS. International Registered Report Identifier (IRRID): DERR1-10.2196/54679 ", doi="10.2196/54679", url="https://www.researchprotocols.org/2024/1/e54679", url="http://www.ncbi.nlm.nih.gov/pubmed/39570662" } @Article{info:doi/10.2196/59283, author="Loo, Guo Benny Kai and Toh, Hui Siao and Fadzully, Fadzlynn and Zainuddin, Ashik Mohammad and Abu Bakar, Alif Muhammad and Gao, Shumin Joanne and Teo, Chun Jing and Lim, Kai Ethel Jie and Tan, Zhong Beron Wei and Chia, Hwa Michael Yong and Chua, Kiong Terence Buan and Tan, Hian Kok", title="An Online Resource for Monitoring 24-Hour Activity in Children and Adolescents: Observational Analysis", journal="JMIR Pediatr Parent", year="2024", month="Nov", day="18", volume="7", pages="e59283", keywords="online", keywords="physical activity", keywords="sedentary behaviour", keywords="sleep", keywords="diet", keywords="24-hour activity", keywords="child", keywords="adolescent", abstract="Background: The Singapore integrated 24-hour activity guide for children and adolescents was introduced to promote healthy lifestyle behaviors, including physical activity, sedentary behavior, sleep, and diet, to enhance metabolic health and prevent noncommunicable diseases. To support the dissemination and implementation of these recommendations, a user-friendly online resource was created to help children and adolescents adopt these behaviors in Singapore. Objective: This study aimed to assess the acceptability of the online resource in the adoption of healthier lifestyle behaviors, and the change in the users' behaviors with the use of this online resource. Methods: Participants aged 7-17 years were required to log their activity levels of the past 7 days at the beginning and at the end of a 3-month period using the browser-based online resource, including information on the duration and frequency of moderate- to vigorous-intensity physical activity (MVPA), length of sedentary behavior, duration and regularity of sleep, and food portions. User satisfaction, on the length, ease of use, and relevance of the online resource, was also recorded using a 10-point Likert scale. Descriptive statistics and statistical analyses, including the Wilcoxon signed rank test and McNemar test, were carried out at baseline and at the end of 3 months. Results: A total of 46 participants were included for analysis. For physical activity, the number of days of MVPA increased from a median of 3 (IQR 2?5) days to 4 (IQR 2?5) days (P=.01). For sedentary behavior, the median daily average screen time decreased from 106 (IQR 60?142.5) minutes to 90 (IQR 60?185) minutes. For sleep, 10\% (5/46) more participants met the recommended duration, and the number of days with regular sleep increased from a median of 6 (IQR 5?7) days to 7 (IQR 5?7) days (P=.03). For diet, there was a decrease in the portion of carbohydrates consumed from a median of 42\% (IQR 30?50) to 40\% (IQR 30?48.5; P=.03), and the number of days of water and unsweetened beverage consumption remained stable at a median of 5 days but with a higher IQR of 4?7 days (P=.04). About 90\% (39-41/46) of the participants reported that the online resource was relevant and easy to use, and the rating for user satisfaction remained favorable at a median of 8 with a higher IQR of 7?9 (P=.005). Conclusions: The findings support the development of a dedicated online resource to assist the implementation of healthy lifestyle behaviors based on the Singapore integrated 24-hour activity guide for children and adolescents. This resource received favorable ratings and its use showed the adoption of healthier behaviors, including increased physical activity and sleep, as well as decreased sedentary time and carbohydrate consumption, at the end of a 3-month period. ", doi="10.2196/59283", url="https://pediatrics.jmir.org/2024/1/e59283" } @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/10.2196/58684, author="Turvey, Jake and McKay, Dana and Kaur, T. Sarah and Castree, Natasha and Chang, Shanton and Lim, C. Megan S.", title="Exploring the Feasibility and Acceptability of Technological Interventions to Prevent Adolescents' Exposure to Online Pornography: Qualitative Research", journal="JMIR Pediatr Parent", year="2024", month="Nov", day="5", volume="7", pages="e58684", keywords="pornography", keywords="sexual health", keywords="young people", keywords="co-design", keywords="online safety", keywords="age verification", keywords="adolescents", keywords="attitudes", keywords="acceptability", keywords="usability", keywords="feasibility", abstract="Background: Amid growing concern over children's access to online pornography, policy makers are looking toward new and emerging technological concepts for unexplored solutions including artificial intelligence and facial recognition. Objective: This study sought to explore and ideate emerging technological interventions that are feasible, acceptable, and effective in preventing and controlling the exposure of young people to online pornographic material. Methods: We conducted a series of qualitative co-design workshops with both adult (n=8; aged 32-53 years) and adolescent participants (n=4; aged 15-17 years) to ideate potential technological interventions that are feasible, acceptable, and effective at preventing and controlling the exposure of young people to online pornographic material. A story stem methodology was used to explore participants' attitudes toward two unique technological prototypes. Results: Participants expressed a generally favorable view of the proposed technological concepts but remained unconvinced of their overall utility and effectiveness in preventing the intentional viewing of pornography by young people. Age-appropriate parent-child conversations remained participants' preferred approach to mitigating potential harms from pornographic material, with parents also expressing a desire for more educational resources to help them better navigate these discussions. User privacy and data security were a primary concern for participants, particularly surrounding the use and collection of biometric data. Conclusions: Internationally, policy makers are taking action to use age assurance technologies to prevent children's access to online pornography. It is important to consider the needs and opinions of parents and young people in the use and implementation of these technologies. Participants in this study were generally supportive of new and emerging technologies as useful tools in preventing the accidental exposure of young people to online pornographic material. However, participants remained less convinced of their ability to avert intentional viewing, with substantial concerns regarding technological efficacy, adaptability, and user privacy. Further, co-design and prototype refinement are needed to better understand user acceptability and comfortability of these new technological interventions, alongside additional research exploring sociocultural differences in information needs and user experiences. ", doi="10.2196/58684", url="https://pediatrics.jmir.org/2024/1/e58684" } @Article{info:doi/10.2196/60165, author="Gentile, Alessandra and Kristian, Yan Yosua and Cini, Erica", title="Effectiveness of Computer-Based Psychoeducational Self-Help Platforms for Eating Disorders (With or Without an Associated App): Protocol for a Systematic Review", journal="JMIR Res Protoc", year="2024", month="Nov", day="4", volume="13", pages="e60165", keywords="self-help", keywords="online self-help", keywords="eating disorders", keywords="anorexia nervosa", keywords="psychoeducational intervention", keywords="psychoeducation", keywords="binge eating", keywords="anorexia", keywords="bulimia", keywords="access to care", keywords="patient education", keywords="patient self-help", abstract="Background: Access to psychological health care is extremely difficult, especially for individuals with severely stigmatized disorders such as eating disorders (EDs). There has been an increase in children, adolescents, and adults with ED symptoms and ED, especially following the COVID-19 pandemic. Computer-based self-help platforms ({\textpm} associated apps) allow people to bridge the treatment gap and receive support when in-person treatment is unavailable or not preferred. Objective: The aim of this systematic review is to evaluate the effectiveness of computer-based self-help platforms for EDs, some of which may have associated apps. Methods: The proposed systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. This review will report and evaluate the literature concerning the efficacy of self-help platforms for EDs. Articles were obtained from the Ovid MEDLINE, Embase, Global Health, and APA PsycInfo. The inclusion criteria included research with original data and gray literature; research evaluating the efficacy of web-based psychoeducational self-help platforms for EDs; people with an ED diagnosis, ED symptoms, at risk of developing EDs, or from the general population without ED-related behaviors; pre-- and post--computer-based {\textpm} associated apps intervention clinical outcome of ED symptoms; pre-- and post--computer-based {\textpm} associated apps intervention associated mental health difficulties; and literature in English. The exclusion criteria were solely guided self-help platforms, only in-person interventions with no computer-based {\textpm} associated apps comparison group, only in-person--delivered CBT, self-help platforms for conditions other than eating disorders, systematic reviews, meta-analyses, posters, leaflets, books, reviews, and research that only reported physical outcomes. Two independent authors used the search terms to conduct the initial search. The collated articles then were screened by their titles and abstracts, and finally, full-text screenings were conducted. The Cochrane Risk of Bias 2 tool will be used to assess the risks of bias in the included studies. Data extraction will be conducted, included studies will undergo narrative synthesis, and results will be presented in tables. The systematic review will be submitted to a peer-reviewed journal. Results: The authors conducted a database search for articles published by May 31, 2024. In total, 14 studies were included in the systematic review. Data charting, synthesis, and analysis were completed in Microsoft Excel by the end of July 2024. Results will be grouped based on the intervention stages. The results are expected to be published by the end of 2024. Overall, the systematic review found that computer-based self-help platforms are effective in reducing global ED psychopathology and ED-related behaviors. Conclusions: Self-help platforms are helpful first-stage resource in a tiered health care system. Trial Registration: PROSPERO CRD42024520866; https://tinyurl.com/5ys2unsw International Registered Report Identifier (IRRID): DERR1-10.2196/60165 ", doi="10.2196/60165", url="https://www.researchprotocols.org/2024/1/e60165", url="http://www.ncbi.nlm.nih.gov/pubmed/39495557" } @Article{info:doi/10.2196/53443, author="Lopez-Olivo, A. Maria and Suarez-Almazor, E. Maria and Duhon, F. Gabrielle and Cherry, McKenna and Lu, Huifang and Calabrese, Cassandra and Altan, Mehmet and Tawbi, Hussain and Meara, Alexa and Bingham, O. Clifton and Diab, Adi and Leal, B. Viola and Volk, J. Robert", title="Development of an Educational Website for Patients With Cancer and Preexisting Autoimmune Diseases Considering Immune Checkpoint Blockers: Usability and Acceptability Study", journal="JMIR Cancer", year="2024", month="Oct", day="25", volume="10", pages="e53443", keywords="immune checkpoint inhibitors", keywords="patient education", keywords="usability testing", keywords="cancer", keywords="autoimmune diseases", keywords="mobile phones", keywords="user testing", keywords="usability", keywords="user experience", keywords="immunotherapy", keywords="websites", keywords="development", keywords="acceptability", keywords="autoimmune", keywords="immunology", keywords="oncology", keywords="architecture", keywords="iterative", keywords="vasculitis", keywords="Crohn disease", keywords="Sjogren syndrome", keywords="educational", keywords="web-based resource", keywords="health information", keywords="rheumatology", keywords="arthritis", keywords="web design", keywords="eHealth", keywords="adverse events", keywords="patient care", keywords="treatment", abstract="Background: Patients with cancer and an underlying autoimmune disease who are considering immune checkpoint blockers (ICBs) need to know about the benefits and risks of severe immune-related adverse events and flares of the autoimmune condition. Objective: This study aims to develop and alpha test an educational website for patients with cancer. Methods: Learning topics, images, and website architecture (including flow and requirements) were developed and iteratively reviewed by members of a community scientist program, a patient advisory group, and content experts. Alpha testing was performed, measuring the site's usability using the Suitability Assessment of Materials and its acceptability using the Ottawa Acceptability Measure. Results: The website included a home page; general information about ICBs; comprehensive modules on the benefits and risks of ICBs for patients with cancer and preexisting autoimmune diseases; general wellness information; and features such as a quiz, additional resources, and a glossary. For the alpha testing, 9 users assessed the newly developed website. Patient reviewers (n=5) had rheumatoid arthritis, Crohn disease, Sjogren syndrome, or vasculitis. Health care provider reviewers (n=4) were medical oncologists or rheumatologists. The median Suitability Assessment of Materials rating was 75 (IQR 70-79; range 0-100) for patients versus 66 (IQR 57-72; range 0-100) for providers (scores ?70 indicate no substantial changes needed). Recommendations for improvement, mostly involving navigation and accessibility, were addressed. All participants expressed that the website was acceptable and balanced in terms of discussion of benefits and harms. Because half (2/4, 50\%) of the providers suggested we increase the amount of information, we extended the content on the impact of having an autoimmune disease when considering ICB treatment, the probability of flares, and the management of flares in this context. Conclusions: The feedback led to minor revisions to enhance readability, navigation, and accessibility, ensuring the website's suitability as a decision-making aid. The newly developed website could become a supporting tool to facilitate patient-physician discussion regarding ICBs. ", doi="10.2196/53443", url="https://cancer.jmir.org/2024/1/e53443" } @Article{info:doi/10.2196/53224, author="Savage, C. Leah and Soto-Cossio, Estefhany Luz and Minardi, Francesca and Beyrouty, Matthew and Schoonover, Julie and Musella, Jay and Frazier, Michaela and Villagra, N. Cristina and Sly, R. Jamilia and Erblich, Joel and Itzkowitz, H. Steven and Jandorf, H. Lina and Calman, S. Neil and Atreja, Ashish and Miller, J. Sarah", title="The Development of a Digital Patient Navigation Tool to Increase Colorectal Cancer Screening Among Federally Qualified Health Center Patients: Acceptability and Usability Testing", journal="JMIR Form Res", year="2024", month="Sep", day="25", volume="8", pages="e53224", keywords="digital navigation", keywords="digital health", keywords="Federally Qualified Health Center", keywords="colorectal cancer", keywords="cancer screening", keywords="mobile phone", abstract="Background: Federally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial. Objective: This study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests. Methods: We recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a ``think aloud'' exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website's acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website. Results: Survey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website's content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home. Conclusions: Based on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool's usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs. ", doi="10.2196/53224", url="https://formative.jmir.org/2024/1/e53224" } @Article{info:doi/10.2196/56486, author="Sun, Hui and Wu, Yanping and Sun, Jia and Zhou, Wu and Xu, Qian and Hu, Dandan", title="Nutrition Management Miniprograms in WeChat: Evaluation of Functionality and Quality", journal="JMIR Hum Factors", year="2024", month="Sep", day="12", volume="11", pages="e56486", keywords="nutrition management", keywords="WeChat mini-program", keywords="User Version of the Mobile Application Rating Scale", keywords="uMARS", keywords="function and quality evaluation", abstract="Background: With the rise in people's living standards and aging populations, a heightened emphasis has been placed in the field of medical and health care. In recent years, there has been a drastic increase in nutrition management in domestic research circles. The mobile nutritional health management platform based on WeChat miniprograms has been widely used to promote health and self-management and to monitor individual nutritional health status in China. Nevertheless, there has been a lack of comprehensive scientific evaluation regarding the functionality and quality of the diverse range of nutritional miniprograms that have surfaced in the market. Objective: This study aimed to evaluate the functionality and quality of China's WeChat nutrition management miniprogram by using the User Version of the Mobile Application Rating Scale (uMARS). Methods: This observational study involves quantitative methods. A keyword search for ``nutrition,'' ``diet,'' ``food,'' and ``meal'' in Chinese or English was conducted on WeChat, and all miniprograms pertaining to these keywords were thoroughly analyzed. Then, basic information including name, registration date, update date, service type, user scores, and functional scores was extracted from January 2017 to November 2023. Rating scores were provided by users based on their experience and satisfaction with the use of the WeChat miniprogram, and functional scores were integrated and summarized for the primary functions of each miniprogram. Moreover, the quality of nutrition management applets was evaluated by 3 researchers independently using the uMARS. Results: Initially, 27 of 891 miniprograms identified were relevant to nutrition management. Among them, 85.2\% (23/27) of them offered features for diet management, facilitating recording of daily dietary intake to evaluate nutritional status; 70.4\% (19/27) provided resources for nutrition education and classroom instruction; 59.3\% (16/27) included functionalities for exercise management, allowing users to record daily physical activity; and only 44.4\% (12/27) featured components for weight management. The total quality score on the uMARS ranged 2.85-3.88 (median 3.38, IQR 3.14-3.57). Engagement scores on the uMARS varied from 2.00 to 4.33 (median 3.00, IQR 2.67-3.67). Functional dimension scores ranged from 3.00 to 4.00 (median 3.33, IQR 3.33-3.67), with a lower score of 2.67 and a higher score of 4.33 outside the reference range. Aesthetic dimension scores ranged from 2.33 to 4.67 (median 3.67, IQR 3.33-4.00). Informational dimension scores ranged from 2.33 to 4.67 (median 3.33, IQR 2.67-3.67). Conclusions: Our findings from the uMARS highlight a predominant emphasis on health aspects over nutritional specifications in the app supporting WeChat miniprograms related to nutrition management. The quality of these miniprograms is currently at an average level, with considerable room for functional improvements in the future. ", doi="10.2196/56486", url="https://humanfactors.jmir.org/2024/1/e56486" } @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/10.2196/47733, author="Muehlensiepen, Felix and Petit, Pascal and Knitza, Johannes and Welcker, Martin and Vuillerme, Nicolas", title="Identification of Motivational Determinants for Telemedicine Use Among Patients With Rheumatoid Arthritis in Germany: Secondary Analysis of Data From a Nationwide Cross-Sectional Survey Study", journal="J Med Internet Res", year="2024", month="Aug", day="19", volume="26", pages="e47733", keywords="telemedicine", keywords="rheumatoid arthritis", keywords="rheumatology", keywords="primary care", keywords="health services research", keywords="eHealth", keywords="data analysis", keywords="survey", keywords="Germany", keywords="tool", keywords="care", keywords="willingness", keywords="sociodemographic", keywords="age", keywords="telehealth", keywords="digital transition", abstract="Background: Previous studies have demonstrated telemedicine to be an effective tool to complement rheumatology care and address workforce shortage. With the COVID-19 outbreak, telemedicine experienced a massive upswing. An earlier analysis revealed that the motivation of patients with rheumatic and musculoskeletal diseases to use telemedicine is closely connected to their disease. It remains unclear which factors are associated with patients' motivation to use telemedicine in certain rheumatic and musculoskeletal diseases groups, such as rheumatoid arthritis (RA). Objective: This study aims to identify factors that determine the willingness to try telemedicine among patients diagnosed with RA. Methods: We conducted a secondary analysis of data from a German nationwide cross-sectional survey among patients with RA. Bayesian univariate logistic regression analysis was applied to the data to determine which factors were associated with willingness to try telemedicine. Predictor variables (covariates) studied individually included sociodemographic factors (eg, age, sex) and health characteristics (eg, health status). All the variables positively and negatively associated with willingness to try telemedicine in the univariate analyses were then considered for Bayesian model averaging analysis after a selection based on the variance inflation factor (? 2.5) to identify determinants of willingness to try telemedicine. Results: Among 438 surveyed patients in the initial study, 210 were diagnosed with RA (47.9\%). Among them, 146 (69.5\%) answered either yes or no regarding willingness to try telemedicine and were included in the analysis. A total of 22 variables (22/55, 40\%) were associated with willingness to try telemedicine (region of practical equivalence \%?5). A total of 9 determinant factors were identified using Bayesian model averaging analysis. Positive determinants included desiring telemedicine services provided by a rheumatologist (odds ratio [OR] 13.7, 95\% CI 5.55-38.3), having prior knowledge of telemedicine (OR 2.91, 95\% CI 1.46-6.28), residing in a town (OR 2.91, 95\% CI 1.21-7.79) or city (OR 0.56, 95\% CI 0.23-1.27), and perceiving one's health status as moderate (OR 1.87, 95\% CI 0.94-3.63). Negative determinants included the lack of an electronic device (OR 0.1, 95\% CI 0.01-0.62), absence of home internet access (OR 0.1, 95\% CI 0.02-0.39), self-assessment of health status as bad (OR 0.44, 95\% CI 0.21-0.89) or very bad (OR 0.47, 95\% CI 0.06-2.06), and being aged between 60 and 69 years (OR 0.48, 95\% CI 0.22-1.04) or older than 70 years (OR 0.38, 95\% CI 0.16-0.85). Conclusions: The results suggest that some patients with RA will not have access to telemedicine without further support. Older patients, those not living in towns, those without adequate internet access, reporting a bad health status, and those not owning electronic devices might be excluded from the digital transformation in rheumatology and might not have access to adequate RA care. These patient groups certainly require support for the use of digital rheumatology care. ", doi="10.2196/47733", url="https://www.jmir.org/2024/1/e47733" } @Article{info:doi/10.2196/51672, author="Sehgal, R. Neil K. and Rader, Benjamin and Brownstein, S. John", title="Examining the Role of Physician Characteristics in Web-Based Verified Primary Care Physician Reviews: Observational Study", journal="J Med Internet Res", year="2024", month="Jul", day="29", volume="26", pages="e51672", keywords="patient review websites", keywords="patient online review", keywords="telemedicine", keywords="internet", keywords="online review", keywords="online reviews", keywords="rating", keywords="physician review", keywords="physician reviews", keywords="doctor review", keywords="doctor reviews", abstract="Background: Doctor review websites have become increasingly popular as a source of information for patients looking to select a primary care provider. Zocdoc is one such platform that allows patients to not only rate and review their experiences with doctors but also directly schedule appointments. This study examines how several physician characteristics including gender, age, race, languages spoken in a physician's office, education, and facial attractiveness impact the average numerical rating of primary care doctors on Zocdoc. Objective: The aim of this study was to investigate the association between physician characteristics and patient satisfaction ratings on Zocdoc. Methods: A data set of 1455 primary care doctor profiles across 30 cities was scraped from Zocdoc. The profiles contained information on the physician's gender, education, and languages spoken in their office. Age, facial attractiveness, and race were imputed from profile pictures using commercial facial analysis software. Each doctor profile listed an average overall satisfaction rating, bedside manner rating, and wait time rating from verified patients. Descriptive statistics, the Wilcoxon rank sum test, and multivariate logistic regression were used to analyze the data. Results: The average overall rating on Zocdoc was highly positive, with older age, lower facial attractiveness, foreign degrees, allopathic degrees, and speaking more languages negatively associated with the average rating. However, the effect sizes of these factors were relatively small. For example, graduates of Latin American medical schools had a mean overall rating of 4.63 compared to a 4.77 rating for US graduates (P<.001), a difference roughly equivalent to a 2.8\% decrease in appointments. On multivariate analysis, being Asian and having a doctor of osteopathic medicine degree were positively associated with higher overall ratings, while attending a South Asian medical school and speaking more European and Middle Eastern languages in the office were negatively associated with higher overall ratings. Conclusions: Overall, the findings suggest that age, facial attractiveness, education, and multilingualism do have some impact on web-based doctor reviews, but the numerical effect is small. Notably, bias may play out in many forms. For example, a physician's appearance or accent may impact a patient's trust, confidence, or satisfaction with their physician, which could in turn influence their take-up of preventative services and lead to either better or worse health outcomes. The study highlights the need for further research in how physician characteristics influence patient ratings of care. ", doi="10.2196/51672", url="https://www.jmir.org/2024/1/e51672" } @Article{info:doi/10.2196/50086, author="Espinoza Chamorro, Roberto and Santos, O. Luciano H. and Mori, Yukiko and Liu, Chang and Yamamoto, Goshiro and Kuroda, Tomohiro", title="Gamification Approach to Provide Support About the Deferral Experience in Blood Donation: Design and Feasibility Study", journal="JMIR Hum Factors", year="2024", month="Jun", day="14", volume="11", pages="e50086", keywords="blood donation", keywords="deferral experience", keywords="Theory of Planned Behavior", keywords="Self-Determination Theory", keywords="gamification", keywords="ICT design", keywords="motivation", keywords="patient education", keywords="prototype", keywords="feasibility", abstract="Background: Multiple studies have examined the impact of deferral on the motivation of prospective blood donors, proposing various policies and strategies to support individuals who undergo this experience. However, existing information and communications technology systems focused on blood donation have not yet integrated these ideas or provided options to assist with the deferral experience. Objective: This study aims to propose an initial gamified design aimed at mitigating the impact of the deferral experience by addressing the drivers of awareness and knowledge, interaction and validation, and motivation. Additionally, the study explores the feasibility of implementing such a system for potential users. Methods: We conducted a literature review focusing on the dynamics of motivation and intention related to blood donation, as well as the deferral situation and its impact on citizens. Through this review, we identified weak donor identity, lack of knowledge, and reduced motivation as key factors requiring support from appropriate interventions. These factors were then defined as our key drivers. Taking these into account, we proposed a gamification approach that incorporates concepts from the MDA framework. The aim is to stimulate the aforementioned drivers and expand the concept of contribution and identity in blood donation. For a preliminary evaluation, we designed a prototype to collect feedback on usability, usefulness, and interest regarding a potential implementation of our proposed gamification approach. Results: Among the participants, a total of 11 citizens interacted with the app and provided feedback through our survey. They indicated that interacting with the app was relatively easy, with an average score of 4.13 out of 5 when considering the 11 tasks of interaction. The SUS results yielded a final average score of 70.91 from the participants' answers. Positive responses were received when participants were asked about liking the concept of the app (3.82), being likely to download it (3.55), and being likely to recommend it to others (3.64). Participants expressed positivity about the implementation of the design but also highlighted current shortcomings and suggested possible improvements in both functionality and usability. Conclusions: Although deferral is a common issue in blood donation, there is a missed opportunity in existing ICT services regarding how to effectively handle such experiences. Our proposed design and implementation seem to have captured the interest of prospective users due to its perceived positive usefulness and potential. However, further confirmation is needed. Improving the design of activities that currently rely heavily on extrinsic motivation elements and integrating more social components to create an enhanced activity loop for intrinsic motivation could further increase the value of the proposed project. Future research could involve conducting a more specialized and longitudinal design evaluation with a larger sample size. ", doi="10.2196/50086", url="https://humanfactors.jmir.org/2024/1/e50086", url="http://www.ncbi.nlm.nih.gov/pubmed/38875005" } @Article{info:doi/10.2196/50557, author="Li, Hei Catherine Yan and Platkin, Charles and Chin, Jonathan and Khan, Asia and Bennett, Jaleel and Speck, Anna and Nielsen, Annette and Leung, May May", title="Web-Based Tool Designed to Encourage Supplemental Nutrition Assistance Program Use in Urban College Students: Usability Testing Study", journal="JMIR Form Res", year="2024", month="Jun", day="13", volume="8", pages="e50557", keywords="SNAP", keywords="SNAP eligibility screening", keywords="food insecurity", keywords="college students", keywords="web-based tool", keywords="think-aloud", keywords="system usability", keywords="user experience", keywords="student", keywords="college", keywords="chronic health", keywords="stress", keywords="anxiety", keywords="barrier", keywords="technology", keywords="tool", keywords="Supplemental Nutrition Assistance Program", keywords="usability", abstract="Background: Food insecurity continues to be a risk for college students in the United States. It is associated with numerous problems, such as chronic health conditions, increased stress and anxiety, and a lower grade point average. After COVID-19, the Supplemental Nutrition Assistance Program (SNAP) benefits were extended to college-aged students; however, there were some barriers to participation, which persisted such as lack of perceived food insecurity risk, lack of knowledge regarding the SNAP application process, the complexity of determining eligibility, and stigma associated with needing social assistance. A technology-enhanced tool was developed to address these barriers to SNAP enrollment and encourage at-risk college students to apply for SNAP. Objective: The purpose of this study was to test the usability and acceptability of a web-based SNAP screening tool designed for college-aged students. Methods: College students aged 18-25 years were recruited to participate in 2 rounds of usability testing during fall 2022. Participants tested the prototype of a web-based SNAP screener tool using a standardized think-aloud method. The usability and acceptability of the tool were assessed using a semistructured interview and a 10-item validated System Usability Scale questionnaire. Audio recordings and field notes were systematically reviewed by extracting and sorting feedback as positive or negative comments. System Usability Scale questionnaire data were analyzed using the Wilcoxon signed rank test and sign test. Results: A total of 12 students (mean age 21.8, SD 2.8 years; n=6, 50\% undergraduate; n=11, 92\% female; n=7, 58\% Hispanic or Black or African American; n=9, 78\% low or very low food security) participated in both rounds of user testing. Round 1 testing highlighted overall positive experiences with the tool, with most participants (10/12) stating that the website fulfills its primary objective as a support tool to encourage college students to apply for SNAP. However, issues related to user interface design, navigation, and wording of some questions in the screening tool were noted. Key changes after round 1 reflected these concerns, including improved design of response buttons and tool logo and improved clarity of screening questions. The overall system usability showed slight, but not statistically significant, improvement between round 1 and round 2 (91.25 vs 92.50; P=.10, respectively). Conclusions: Overall usability findings suggest that this web-based tool was highly usable and acceptable to urban college students and could be an effective and appealing approach as a support tool to introduce college students to the SNAP application process. The findings from this study will inform further development of the tool, which could eventually be disseminated publicly among various college campuses. ", doi="10.2196/50557", url="https://formative.jmir.org/2024/1/e50557", url="http://www.ncbi.nlm.nih.gov/pubmed/38869926" } @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/10.2196/53098, author="Greeley, Brian and Chung, Seohyeon Sally and Graves, Lorraine and Song, Xiaowei", title="Combating Barriers to the Development of a Patient-Oriented Frailty Website", journal="JMIR Aging", year="2024", month="May", day="28", volume="7", pages="e53098", keywords="frailty", keywords="frailty website", keywords="patient-oriented assessment", keywords="community-dwelling older adults", keywords="internet security", keywords="privacy", keywords="barrier", keywords="barriers", keywords="development", keywords="implementation", keywords="patient-oriented", keywords="internet", keywords="virtual health resource", keywords="community dwelling", keywords="older adult", keywords="older adults", keywords="health care professional", keywords="caregiver", keywords="caregivers", keywords="technology", keywords="real-time", keywords="monitoring", keywords="aging", keywords="ageing", doi="10.2196/53098", url="https://aging.jmir.org/2024/1/e53098" } @Article{info:doi/10.2196/54586, author="Brown, Katherine and Lucassen, G. Mathijs F. and N{\'u}{\~n}ez-Garc{\'i}a, Alicia and Rimes, A. Katharine and Wallace, M. Louise and Samra, Rajvinder", title="A Web-Based Intervention to Support the Mental Well-Being of Sexual and Gender Minority Young People: Mixed Methods Co-Design of Oneself", journal="JMIR Form Res", year="2024", month="May", day="21", volume="8", pages="e54586", keywords="sexual minority", keywords="gender minority", keywords="lesbian, gay, bisexual, transgender, queer", keywords="LGBTQ+", keywords="mental well-being", keywords="support", keywords="intervention", keywords="resilience", keywords="digital", keywords="co-design", keywords="sexual and gender minority youth", keywords="SGMY", keywords="mobile phone", abstract="Background: Sexual and gender minority youth are at greater risk of compromised mental health than their heterosexual and cisgender peers. This is considered to be due to an increased burden of stigma, discrimination, or bullying resulting in a heightened experience of daily stress. Given the increasing digital accessibility and a strong preference for web-based support among sexual and gender minority youth, digital interventions are a key means to provide support to maintain their well-being. Objective: This paper aims to explicate the co-design processes and underpinning logic of Oneself, a bespoke web-based intervention for sexual and gender minority youth. Methods: This study followed a 6-stage process set out by Hagen et al (identify, define, position, concept, create, and use), incorporating a systematic scoping review of existing evidence, focus groups with 4 stakeholder groups (ie, sexual and gender minority youth, professionals who directly support them, parents, and UK public health service commissioners), a series of co-design workshops and web-based consultations with sexual and gender minority youth, the appointment of a digital development company, and young adult sexual and gender minority contributors to create content grounded in authentic experiences. Results: Oneself features a welcome and home page, including a free accessible to all animation explaining the importance of using appropriate pronouns and the opportunity to create a user account and log-in to access further free content. Creating an account provides an opportunity (for the user and the research team) to record engagement, assess users' well-being, and track progress through the available content. There are three sections of content in Oneself focused on the priority topics identified through co-design: (1) coming out and doing so safely; (2) managing school, including homophobic, biphobic, or transphobic bullying or similar; and (3) dealing with parents and families, especially unsupportive family members, including parents or caregivers. Oneself's content focuses on identifying these as topic areas and providing potential resources to assist sexual and gender minority youth in coping with these areas. For instance, Oneself drew on therapeutic concepts such as cognitive reframing, stress reduction, and problem-solving techniques. There is also a section containing relaxation exercises, a section with links to other recommended support and resources, and a downloads section with more detailed techniques and strategies for improving well-being. Conclusions: This study contributes to research by opening up the black box of intervention development. It shows how Oneself is underpinned by a logic that can support future development and evaluation and includes diverse co-designers. More interactive techniques to support well-being would be beneficial for further development. Additional content specific to a wider range of intersecting identities (such as care-experienced Asian sexual and gender minority youth from a minority faith background) would also be beneficial in future Oneself developments. International Registered Report Identifier (IRRID): RR2-10.2196/31036 ", doi="10.2196/54586", url="https://formative.jmir.org/2024/1/e54586", url="http://www.ncbi.nlm.nih.gov/pubmed/38772025" } @Article{info:doi/10.2196/54007, author="Higashi, T. Robin and Etingen, Bella and Richardson, Eric and Palmer, Jennifer and Zocchi, S. Mark and Bixler, R. Felicia and Smith, Bridget and McMahon, Nicholas and Frisbee, L. Kathleen and Fortney, C. John and Turvey, Carolyn and Evans, Jennifer and Hogan, P. Timothy", title="Veteran Experiences With an mHealth App to Support Measurement-Based Mental Health Care: Results From a Mixed Methods Evaluation", journal="JMIR Ment Health", year="2024", month="May", day="10", volume="11", pages="e54007", keywords="measurement-based care", keywords="mobile health app", keywords="mental health", keywords="veteran", keywords="mHealth", keywords="support", keywords="mixed-methods evaluation", keywords="digital health", abstract="Background: Mental health conditions are highly prevalent among US veterans. The Veterans Health Administration (VHA) is committed to enhancing mental health care through the integration of measurement-based care (MBC) practices, guided by its Collect-Share-Act model. Incorporating the use of remote mobile apps may further support the implementation of MBC for mental health care. Objective: This study aims to evaluate veteran experiences with Mental Health Checkup (MHC), a VHA mobile app to support remote MBC for mental health. Methods: Our mixed methods sequential explanatory evaluation encompassed mailed surveys with veterans who used MHC and follow-up semistructured interviews with a subset of survey respondents. We analyzed survey data using descriptive statistics. We then compared responses between veterans who indicated having used MHC for ?3 versus <3 months using $\chi$2 tests. We analyzed interview data using thematic analysis. Results: We received 533 surveys (533/2631, for a 20\% response rate) and completed 20 interviews. Findings from these data supported one another and highlighted 4 key themes. (1) The MHC app had positive impacts on care processes for veterans: a majority of MHC users overall, and a greater proportion who had used MHC for ?3 months (versus <3 months), agreed or strongly agreed that using MHC helped them be more engaged in their health and health care (169/262, 65\%), make decisions about their treatment (157/262, 60\%), and set goals related to their health and health care (156/262, 60\%). Similarly, interviewees described that visualizing progress through graphs of their assessment data over time motivated them to continue therapy and increased self-awareness. (2) A majority of respondents overall, and a greater proportion who had used MHC for ?3 months (versus <3 months), agreed/strongly agreed that using MHC enhanced their communication (112/164, 68\% versus 51/98, 52\%; P=.009) and rapport (95/164, 58\% versus 42/98, 43\%; P=.02) with their VHA providers. Likewise, interviewees described how MHC helped focus therapy time and facilitated trust. (3) However, veterans also endorsed some challenges using MHC. Among respondents overall, these included difficulty understanding graphs of their assessment data (102/245, 42\%), not receiving enough training on the app (73/259, 28\%), and not being able to change responses to assessment questions (72/256, 28\%). (4) Interviewees offered suggestions for improving the app (eg, facilitating ease of log-in, offering additional reminder features) and for increasing adoption (eg, marketing the app and its potential advantages for veterans receiving mental health care). Conclusions: Although experiences with the MHC app varied, veterans were positive overall about its use. Veterans described associations between the use of MHC and engagement in their own care, self-management, and interactions with their VHA mental health providers. Findings support the potential of MHC as a technology capable of supporting the VHA's Collect-Share-Act model of MBC. ", doi="10.2196/54007", url="https://mental.jmir.org/2024/1/e54007", url="http://www.ncbi.nlm.nih.gov/pubmed/38728684" } @Article{info:doi/10.2196/53194, author="O'Donnell, A. Elizabeth and Van Citters, D. Aricca and Khayal, S. Inas and Wilson, M. Matthew and Gustafson, David and Barnato, E. Amber and Buccellato, C. Andrea and Young, Colleen and Holthoff, M. Megan and Korsunskiy, Eugene and Tomlin, C. Stephanie and Cullinan, M. Amelia and Steinbaugh, C. Alexandra and Hinson, J. Jennifer and Johnson, R. Kristen and Williams, Andrew and Thomson, M. Ruth and Haines, M. Janet and Holmes, B. Anne and Bradley, D. Ann and Nelson, C. Eugene and Kirkland, B. Kathryn", title="A Web-Based Peer Support Network to Help Care Partners of People With Serious Illness: Co-Design Study", journal="JMIR Hum Factors", year="2024", month="May", day="8", volume="11", pages="e53194", keywords="human-centered design", keywords="caregivers", keywords="care partners", keywords="serious illness", keywords="peer support", keywords="online support network", keywords="virtual network", keywords="online network", keywords="caregiver", keywords="unmet need", keywords="unmet needs", keywords="active care", keywords="bereaved care", keywords="bereavement", keywords="clinician", keywords="clinicians", keywords="function", keywords="functions", keywords="specification", keywords="information", keywords="emotional support", keywords="technical support", keywords="privacy protection", keywords="rural", keywords="viability", keywords="impact", keywords="engineering design", keywords="care provider", keywords="care providers", keywords="mortality", keywords="quality of life", keywords="tertiary care", keywords="caregiving", abstract="Background: Care partners of people with serious illness experience significant challenges and unmet needs during the patient's treatment period and after their death. Learning from others with shared experiences can be valuable, but opportunities are not consistently available. Objective: This study aims to design and prototype a regional, facilitated, and web-based peer support network to help active and bereaved care partners of persons with serious illness be better prepared to cope with the surprises that arise during serious illness and in bereavement. Methods: An 18-member co-design team included active care partners and those in bereavement, people who had experienced serious illness, regional health care and support partners, and clinicians. It was guided by facilitators and peer network subject-matter experts. We conducted design exercises to identify the functions and specifications of a peer support network. Co-design members independently prioritized network specifications, which were incorporated into an early iteration of the web-based network. Results: The team prioritized two functions: (1) connecting care partners to information and (2) facilitating emotional support. The design process generated 24 potential network specifications to support these functions. The highest priorities included providing a supportive and respectful community; connecting people to trusted resources; reducing barriers to asking for help; and providing frequently asked questions and responses. The network platform had to be simple and intuitive, provide technical support for users, protect member privacy, provide publicly available information and a private discussion forum, and be easily accessible. It was feasible to enroll members in the ConnectShareCare web-based network over a 3-month period. Conclusions: A co-design process supported the identification of critical features of a peer support network for care partners of people with serious illnesses in a rural setting, as well as initial testing and use. Further testing is underway to assess the long-term viability and impact of the network. ", doi="10.2196/53194", url="https://humanfactors.jmir.org/2024/1/e53194", url="http://www.ncbi.nlm.nih.gov/pubmed/38717809" } @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/10.2196/50747, author="Marier-Deschenes, Pascale and Pinard, Marie Anne and Jalbert, Laura and LeBlanc, Annie", title="Assessing the Feasibility and Preliminary Effects of a Web-Based Self-Management Program for Chronic Noncancer Pain: Mixed Methods Study", journal="JMIR Hum Factors", year="2024", month="May", day="3", volume="11", pages="e50747", keywords="persistent pain", keywords="eHealth", keywords="self-paced intervention", keywords="web-based program", keywords="evidence based", keywords="web based", keywords="self-management", keywords="pain", keywords="chronic pain", keywords="mixed methods study", keywords="pain treatment", keywords="pain education", abstract="Background: In Canada, adults with chronic noncancer pain face a persistent insufficiency of publicly funded resources, with the gold standard multidisciplinary pain treatment facilities unable to meet the high clinical demand. Web-based self-management programs cost-effectively increase access to pain management and can improve several aspects of physical and emotional functioning. Aiming to meet the demand for accessible, fully automated resources for individuals with chronic noncancer pain, we developed a French web- and evidence-based self-management program, Agir pour moi (APM). This program includes pain education and strategies to reduce stress, practice mindfulness, apply pacing, engage in physical activity, identify and manage thinking traps, sleep better, adapt diet, and sustain behavior change. Objective: This study aims to assess the APM self-management program's feasibility, acceptability, and preliminary effects in adults awaiting specialized services from a center of expertise in chronic pain management. Methods: We conducted a mixed methods study with an explanatory sequential design, including a web-based 1-arm trial and qualitative semistructured interviews. We present the results from both phases through integrative tables called joint displays. Results: Response rates were 70\% (44/63) at postintervention and 56\% (35/63) at 3-month follow-up among the 63 consenting participants who provided self-assessed information at baseline. In total, 46\% (29/63) of the participants completed the program. We interviewed 24\% (15/63) of the participants. The interview's first theme revolved around the overall acceptance, user-friendliness, and engaging nature of the program. The second theme emphasized the differentiation between microlevel and macrolevel engagements. The third theme delved into the diverse effects observed, potentially influenced by the macrolevel engagements. Participants highlighted the features that impacted their self-efficacy and the adoption of self-management strategies. We observed indications of improvement in self-efficacy, pain intensity, pain interference, depression, and catastrophizing. Interviewees described these and various other effects as potentially influenced by macrolevel engagement through behavioral change. Conclusions: These ?ndings provided preliminary evidence that the APM self-management program and research methods are feasible. However, some participants expressed the need for at least phone reminders and minimal support from a professional available to answer questions over the first few weeks of the program to engage. Recruitment strategies of a future randomized controlled trial should focus on attracting a broader representation of individuals with chronic pain in terms of gender and ethnicity. Trial Registration: ClinicalTrials.gov NCT05319652; https://clinicaltrials.gov/study/NCT05319652 ", doi="10.2196/50747", url="https://humanfactors.jmir.org/2024/1/e50747", url="http://www.ncbi.nlm.nih.gov/pubmed/38701440" } @Article{info:doi/10.2196/50385, author="Donkin, Liesje and Bidois-Putt, Marie-Claire and Wilson, Holly and Hayward, Penelope and Chan, Yan Amy Hai", title="An Exploration of the Goodness of Fit of Web-Based Tools for M?ori: Qualitative Study Using Interviews and Focus Groups", journal="JMIR Form Res", year="2024", month="May", day="2", volume="8", pages="e50385", keywords="Indigenous people", keywords="M?ori", keywords="eHealth", keywords="mental health", keywords="web-based intervention", keywords="digital intervention", abstract="Background: Indigenous communities often have poorer health outcomes and services under traditional models of care. In New Zealand, this holds true for M?ori people who are t?ngata whenua (the indigenous people). Several barriers exist that decrease the likelihood of indigenous communities often have poorer health outcomes and poor service fit under traditional models of care, including access issues, systemic and provider racism, and a lack of culturally safe and responsive services. Web-based interventions (WBIs) have been shown to be effective in supporting mental health and well-being and can overcome some of these barriers. Despite the large number of WBIs developed, more investigation is needed to know how well WBIs fit with an indigenous worldview and how they meet the needs of indigenous communities so that a digitally based future does not drive social and health inequities. Objective: This study aims to explore the goodness-of-fit of WBIs of M?ori individuals, the indigenous people of Aotearoa/New Zealand. Methods: We used interviews (n=3) and focus groups (n=5) with 30 M?ori participants to explore their views about WBIs. Interviews were analyzed using reflexive thematic analysis by members of the research team. Results: Overall, there was a perception that the design of WBIs did not align with the M?ori worldview, which centers around people, relationships, spirituality, and holistic views of well-being. A total of 4 key themes and several subthemes emerged, indicating that WBIs were generally considered a poor fit for M?ori. Specifically, the themes were as follows: (1) WBIs are disconnected from the core values of te ao M?ori (the M?ori worldview), (2) WBIs could be helpful in the right context, (3) there are significant barriers that may make it harder for M?ori to use WBIs than other groups, and (4) ways to improve WBIs to help engagement with M?ori. Conclusions: While WBIs are often considered a way to reduce barriers to care, they may not meet the needs of M?ori when used as a stand-alone intervention. If WBIs are continued to be offered, developers and researchers need to consider how to develop WBIs that are responsive and engaging to the needs of indigenous communities rather than driving inequities. Ideally, WBIs should be developed by the people they are intended for to fit with those populations' world views. ", doi="10.2196/50385", url="https://formative.jmir.org/2024/1/e50385", url="http://www.ncbi.nlm.nih.gov/pubmed/38696236" } @Article{info:doi/10.2196/53742, author="Abdulai, Abdul-Fatawu and Naghdali, Hasti and Noga, Heather and Yong, J. Paul", title="Patient-Centered Approaches for Designing Destigmatizing Sexual Pain-Related Web-Based Platforms: Qualitative Study", journal="JMIR Form Res", year="2024", month="Mar", day="15", volume="8", pages="e53742", keywords="stigma", keywords="digital health", keywords="sexual pain", keywords="destigmatizing", keywords="end user patients", abstract="Background: Sexual pain is a common but neglected disorder that affects approximately 3\% to 18\% of women and an unmeasured number of gender-diverse people worldwide. Despite its wide prevalence, many people feel reluctant to visit conventional health care services or disclose their symptoms due to the fear of stigmatization. To alleviate this stigma, various web-based interventions have been developed to complement and, in some cases, replace conventional sexual health interventions. However, the way these web-based interventions are developed could inadvertently reproduce, perpetuate, or exacerbate stigma among end user patients. Objective: The purpose of this study was to understand patients' perspectives on how sexual pain--related web platforms can be designed to alleviate stigma or prevent the unintended effects of stigma among patients who use web-based interventions. Methods: Individual semistructured interviews were conducted among 16 participants with lived experiences of painful sex in a large urban city in Western Canada. Participants were recruited via social media platforms, newsletters, and a provincial health volunteer website. Using a sample sexual pain website to provide context, participants were interviewed about their experiences of stigma and how they think web platforms could be designed to address stigma. The interviews were conducted via Zoom (Zoom Technologies Inc) and analyzed using thematic analysis. Results: The findings revealed 4 overarching themes that represented participants' perspectives on designing web platforms that may alleviate or prevent the unintended effects of stigma. These findings suggested the design of inclusive web platforms, having a nonprovocative and calming user interface, having features that facilitate connections among users and between users and providers, and displaying personal testimonials and experiences of sexual pain. Conclusions: This study highlighted patient-centered design approaches that could serve as a reference guide in developing web platforms that alleviate or prevent the unintended effects of stigma, particularly among nonheterosexual and gender-diverse people. While this study was conducted in the context of sexual pain, the results might also apply to web platforms on other potentially stigmatizing health-related disorders or conditions. ", doi="10.2196/53742", url="https://formative.jmir.org/2024/1/e53742", url="http://www.ncbi.nlm.nih.gov/pubmed/38488844" } @Article{info:doi/10.2196/48945, author="Calear, L. Alison and Batterham, J. Philip and McCallum, M. Sonia and Banfield, Michelle and Moore, Elizabeth and Johnson, Natalie and Morse, R. Alyssa", title="Designing a Web-Based Navigation Tool to Support Access to Youth Mental Health Services: Qualitative Study", journal="JMIR Form Res", year="2024", month="Jan", day="18", volume="8", pages="e48945", keywords="mental health services", keywords="youth", keywords="navigation tool", keywords="mental health", keywords="website", keywords="user experience", keywords="design", keywords="service", keywords="services", keywords="access", keywords="accessibility", keywords="health care system", abstract="Background: Many young people with mental health problems do not readily seek help or receive treatment and support. One way to address low help-seeking behavior is to improve access to information on mental health services and how to navigate the mental health system via a web-based tool. Seeking input from the end users (young people and parents or caregivers) on key features of the tool is imperative to ensure that it is relevant, engaging, and likely to meet their needs and expectations. Objective: This study aims to investigate young person and parent or caregiver views on the design, content, functioning, and user experience of a web-based mental health navigation tool to support connection to mental health services for children and young people aged up to 25 years. Methods: A total of 4 online focus groups were conducted: 2 with young people aged 16 years and older (total n=15) and 2 with parents or caregivers (total n=13). Focus groups were structured around a series of guiding questions to explore participants' views on content, features, user experience, and design of a mental health navigation website. Focus groups were audio recorded with detailed notes taken. In addition, 53 young people aged 16-25 years and 97 parents or caregivers completed an online survey, comprising closed- and open-ended questions; open-ended responses were included with the focus group data in the qualitative analysis. All qualitative data were analyzed using thematic analysis. Results: A total of 2 topic areas and 7 themes were developed. The first topic area covered the types of information needs of young people and parents. Identified themes concerned the scope of the navigation website, as well as the provision of up-to-date and practical information on how to navigate the whole help-seeking process. The second topic area covered website features that would be beneficial and included the consideration of the website design; search engines; supported navigation; and forums, reviews, and user accounts. Conclusions: This study provides important insights into the navigation needs of young people and parents or caregivers in seeking mental health services. Key findings identified through this research have directly informed the development of MindMap, a web-based youth navigation tool providing a searchable database of local services, including a clear description, their location, and potential wait times. The website can be navigated independently or with support. ", doi="10.2196/48945", url="https://formative.jmir.org/2024/1/e48945", url="http://www.ncbi.nlm.nih.gov/pubmed/38236625" } @Article{info:doi/10.2196/49718, author="McNaughton Reyes, Luz H. and Armora Langoni, G. Eliana and Sharpless, Laurel and Moracco, E. Kathryn and Benavides, Quetzabel and Foshee, A. Vangie", title="Web-Based Delivery of a Family-Based Dating Abuse Prevention Program for Adolescents Exposed to Interparental Violence: Feasibility and Acceptability Study", journal="JMIR Form Res", year="2023", month="Dec", day="1", volume="7", pages="e49718", keywords="dating violence", keywords="adolescents", keywords="family-based prevention", keywords="web-based delivery", keywords="feasibility and acceptability", keywords="mobile phone", abstract="Background: Numerous studies have demonstrated that exposure to caregiver intimate partner violence (IPV) can have cascading negative impacts on children that elevate the risk of involvement in dating abuse. This cascade may be prevented by programs that support the development of healthy relationships in children exposed to IPV. This paper describes the results of a study of the web-based adaptation of an evidence-based dating abuse prevention program for IPV-exposed youth and their maternal caregivers. Core information and activities from an evidence-based program, Moms and Teens for Safe Dates, were adapted to create the web-based program (e-MTSD), which comprises 1 module for mothers only and 5 modules for mother-adolescent dyads to complete together. Objective: The primary objective of this study was to evaluate the feasibility and acceptability of the e-MTSD program and the associated research processes. We also examined the practicability of randomizing mothers to receive SMS text message reminders and an action planning worksheet, which were intended to support engagement in the program. Methods: Mothers were recruited through community organizations and social media advertising and were eligible to participate if they had at least one adolescent aged 12 to 16 years of any gender identity who was willing to participate in the program with them, had experienced IPV after their adolescent was born, and were not currently living with an abusive partner. All mothers were asked to complete the program with their adolescent over a 6- to 8-week period. Participants were randomized to receive SMS text message reminders, action planning, or both using a 2{\texttimes}2 factorial design. Research feasibility was assessed by tracking recruitment, randomization, enrollment, and attrition rates. Program feasibility was assessed by tracking program uptake, completion, duration, and technical problems, and acceptability was assessed using web-based surveys. Results: Over a 6-month recruitment period, 101 eligible mother-adolescent dyads were enrolled in the study and were eligible for follow-up. The median age of the adolescent participants was 14 years; 57.4\% (58/101) identified as female, 32.7\% (33/101) identified as male, and 9.9\% (10/101) identified as gender diverse. All but one mother accessed the program website at least once; 87.1\% (88/101) completed at least one mother-adolescent program module, and 74.3\% (75/101) completed all 6 program modules. Both mothers and adolescents found the program to be highly acceptable; across all program modules, over 90\% of mothers and over 80\% of adolescents reported that the modules kept their attention, were enjoyable, were easy to do, and provided useful information. Conclusions: Findings suggest the feasibility of web-based delivery and evaluation of the e-MTSD program. Furthermore, average ratings of program acceptability were high. Future research is needed to assess program efficacy and identify the predictors and outcomes of program engagement. ", doi="10.2196/49718", url="https://formative.jmir.org/2023/1/e49718", url="http://www.ncbi.nlm.nih.gov/pubmed/38039070" } @Article{info:doi/10.2196/36324, author="Moon, Hui-Woun and Park, Me Da Som and Jung, Young Se", title="Use of the Smart Excretion Care System Linked to Electronic Medical Records to Alleviate Nursing Burden and Enhance Patient Convenience: Mixed Methods Study", journal="JMIR Form Res", year="2023", month="Oct", day="30", volume="7", pages="e36324", keywords="care", keywords="caregiving", keywords="instrument development", keywords="elderly", keywords="quality of life", keywords="ergonomics", keywords="focus groups", keywords="musculoskeletal", keywords="usability", keywords="feasibility", keywords="digital health intervention", keywords="digital health", keywords="health intervention", keywords="nursing", keywords="electronic medical record", abstract="Background: The surge in older demographics has inevitably resulted in a heightened demand for health care, and a shortage of nursing staff is impending. Consequently, there is a growing demand for the development of nursing robots to assist patients with urinary and bowel elimination. However, no study has examined nurses' opinions of smart devices that provide integrated nursing for patients' urinary and bowel elimination needs. Objective: This study aimed to evaluate the feasibility of the Smart Excretion Care System tethered to electronic medical records in a tertiary hospital and community care setting and discuss the anticipated reductions in the burden of nursing care. Methods: Focus group interviews were conducted using the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The interviews were conducted in March 2021 and involved 67 nurses who had worked at Seoul National University Bundang Hospital for more than 1 year and had experience in assisting patients with excretion care. Data were collected using purposive and snowball sampling methods. Results: A total of four themes relevant to the Smart Excretion Care System were found: (1) expected reductions in the burden of nursing care, (2) applicable indications (by departments and diseases), (3) preferred features/functions, and (4) expected benefits of using the Smart Excretion Care System in clinical facilities. Nurses from comprehensive nursing care wards had the highest burden when it came to excretion care. It was a common opinion that the Smart Excretion Care System would be very useful in intensive care units and should be applied first to patients with stroke or dementia. Conclusions: Excretion care is one of the most burdensome tasks for nurses, increasing their workload. The development of the Smart Excretion Care System as a digital health intervention could help improve nurses' work efficiency, reduce their burden, and extend to caregivers and guardians. ", doi="10.2196/36324", url="https://formative.jmir.org/2023/1/e36324", url="http://www.ncbi.nlm.nih.gov/pubmed/37902820" } @Article{info:doi/10.2196/42506, author="Au, Jessica and Falloon, Caitlin and Ravi, Ayngaran and Ha, Phil and Le, Suong", title="A Beta-Prototype Chatbot for Increasing Health Literacy of Patients With Decompensated Cirrhosis: Usability Study", journal="JMIR Hum Factors", year="2023", month="Aug", day="15", volume="10", pages="e42506", keywords="chronic liver disease", keywords="chatbot", keywords="artificial intelligence", keywords="health literacy", keywords="acceptability", abstract="Background: Health literacy is low among patients with chronic liver disease (CLD) and associated with poor health outcomes and increased health care use. Lucy LiverBot, an artificial intelligence chatbot was created by a multidisciplinary team at Monash Health, Australia, to improve health literacy and self-efficacy in patients with decompensated CLD. Objective: The aim of this study was to explore users' experience with Lucy LiverBot using an unmoderated, in-person, qualitative test. Methods: Lucy LiverBot is a simple, low cost, and scalable digital intervention, which was at the beta prototype development phase at the time of usability testing. The concept and prototype development was realized in 2 phases: concept development and usability testing. We conducted a mixed methods study to assess usability of Lucy LiverBot as a tool for health literacy education among ambulatory and hospitalized patients with decompensated CLD at Monash Health. Patients were provided with free reign to interact with Lucy LiverBot on an iPad device under moderator observation. A 3-part survey (preuser, user, and postuser) was developed using the Unified Acceptance Theory Framework to capture the user experience. Results: There were 20 participants with a median age of 55.5 (IQR 46.0-60.5) years, 55\% (n=11) of them were female, and 85\% (n=17) of them were White. In total, 35\% (n=7) of them reported having difficulty reading and understanding written medical information. Alcohol was the predominant etiology in 70\% (n=14) of users. Participants actively engaged with Lucy LiverBot and identified it as a potential educational tool and device that could act as a social companion to improve well-being. In total, 25\% (n=5) of them reported finding it difficult to learn about their health problems and 20\% (n=4) of them found it difficult to find medical information they could trust. Qualitative interviews revealed the conversational nature of Lucy LiverBot was considered highly appealing with improvement in mental health and well-being reported as an unintended benefit of Lucy LiverBot. Patients who had been managing their liver cirrhosis for several years identified that they would be less likely to use Lucy LiverBot, but that it would have been more useful at the time of their diagnosis. Overall, Lucy LiverBot was perceived as a reliable and trustworthy source of information. Conclusions: Lucy LiverBot was well received and may be used to improve health literacy and address barriers to health care provision in patients with decompensated CLD. The study revealed important feedback that has been used to further optimize Lucy LiverBot. Further acceptability and validation studies are being undertaken to investigate whether Lucy LiverBot can improve clinical outcomes and health related quality of life in patients with decompensated CLD. ", doi="10.2196/42506", url="https://humanfactors.jmir.org/2023/1/e42506", url="http://www.ncbi.nlm.nih.gov/pubmed/37581920" } @Article{info:doi/10.2196/44535, author="La Sala, Louise and Pirkis, Jane and Cooper, Charlie and Hill, M. Nicole T. and Lamblin, Michelle and Rajaram, Gowri and Rice, Simon and Teh, Zoe and Thorn, Pinar and Zahan, Rifat and Robinson, Jo", title="Acceptability and Potential Impact of the \#chatsafe Suicide Postvention Response Among Young People Who Have Been Exposed to Suicide: Pilot Study", journal="JMIR Hum Factors", year="2023", month="May", day="19", volume="10", pages="e44535", keywords="youth", keywords="suicide", keywords="social media", keywords="suicide postvention", keywords="suicide prevention", keywords="contagion", keywords="postvention", abstract="Background: Young people are more likely to be affected by suicide contagion, and there are concerns about the role social media plays in the development and maintenance of suicide clusters or in facilitating imitative suicidal behavior. However, social media also presents an opportunity to provide real-time and age-appropriate suicide prevention information, which could be an important component of suicide postvention activities. Objective: This study aimed to test an intervention designed to equip young people to communicate safely online about suicide (\#chatsafe) with a sample of young people who had recently been exposed to a suicide or suicide attempt, with a view to determining the role social media can play as part of a postvention response. Methods: A sample of 266 young people from Australia, aged 16 to 25 years, were recruited to participate in the study. They were eligible if they had been exposed to a suicide or knew of a suicide attempt in the past 2 years. All participants received the \#chatsafe intervention, which comprised 6 pieces of social media content that were sent to them weekly via direct message through Instagram, Facebook, or Snapchat. Participants were assessed on a range of outcome measures (social media use, willingness to intervene against suicide, internet self-efficacy, confidence, and safety when communicating about suicide on social media platforms) at baseline, immediately after the intervention, and at 4-week follow-up. Results: After the 6-week \#chatsafe intervention, participants reported substantial improvements in their willingness to intervene against suicide online, their internet self-efficacy, and their perceived confidence and safety when communicating about suicide online. Overall, the participants reported that it was appropriate to receive the \#chatsafe intervention via social media, and no iatrogenic effects were recorded. Conclusions: The findings suggest that it is safe and acceptable to disseminate suicide prevention information entirely via social media among young people who have recently been exposed to a suicide or suicide attempt. Interventions such as \#chatsafe could potentially mitigate the risk of distress and future suicidal behavior in young people by improving the quality and safety of online communication about suicide and, as such, can be an important component of delivering a postvention response to young people. ", doi="10.2196/44535", url="https://humanfactors.jmir.org/2023/1/e44535", url="http://www.ncbi.nlm.nih.gov/pubmed/37204854" } @Article{info:doi/10.2196/43129, author="Saly, Lauren and Provvidenza, Christine and Al-Hakeem, Hiba and Hickling, Andrea and Stevens, Sara and Kakonge, Lisa and Hunt, W. Anne and Bennett, Sheila and Martinussen, Rhonda and Scratch, E. Shannon", title="The Teach-ABI Professional Development Module for Educators About Pediatric Acquired Brain Injury: Mixed Method Usability Study", journal="JMIR Hum Factors", year="2023", month="May", day="15", volume="10", pages="e43129", keywords="acquired brain injury", keywords="educators", keywords="professional development", keywords="usability testing", keywords="satisfaction testing", keywords="knowledge translation", keywords="usability", keywords="death", keywords="disability", keywords="children", keywords="development", keywords="Ontario", keywords="research", keywords="online", keywords="school", abstract="Background: Acquired brain injury (ABI) is a leading cause of death and disability in children and can lead to lasting cognitive, physical, and psychosocial outcomes that affect school performance. Students with an ABI experience challenges returning to school due in part to lack of educator support and ABI awareness. A lack of knowledge and training contribute to educators feeling unprepared to support students with ABI. Teach-ABI, an online professional development module, was created to enhance educators' ABI knowledge and awareness to best support students. Using a case-based approach, Teach-ABI explains what an ABI is, identifies challenges for students with ABI in the classroom, discusses the importance of an individualized approach to supporting students with ABI, and describes how to support a student with an ABI in the classroom. Objective: This study aims to assess the usability of and satisfaction with Teach-ABI by elementary school educators. The following questions were explored: (1) Can elementary school teachers use and navigate Teach-ABI?, (2) Are the content and features of Teach-ABI satisfactory?, and (3) What modifications are needed to improve Teach-ABI? Methods: Elementary school educators currently employed or in training to be employed in Ontario elementary schools were recruited. Using Zoom, individual online meetings with a research team member were held, where educators actively reviewed Teach-ABI. Module usability was evaluated through qualitative analysis of think-aloud data and semistructured interviews, direct observation, user success rate during task completion, and the System Usability Scale (SUS) scores. The usability benchmark selected was 70\% of participants performing more than half of module tasks independently. Results: A total of 8 female educators participated in the study. Educators were classroom (n=7) and preservice (n=1) teachers from public (n=7) and private (n=1) school boards. In terms of task performance, more than 85\% of participants (ie, 7/8) independently completed 10 out of 11 tasks and 100\% of participants independently completed 7 out of 11 tasks, demonstrating achievement of the module usability goal. The average overall SUS score was 86.25, suggesting a high satisfaction level with the perceived usability of Teach-ABI. Overall, participants found Teach-ABI content valuable, useful, and aligned with the realities of their profession. Participants appreciated the visual design, organization, and varying use of education strategies within Teach-ABI. Opportunities for enhancement included broadening content case examples of students with ABI and enhancing the accessibility of the content. Conclusions: Validated usability measures combined with qualitative methodology revealed educators' high level of satisfaction with the design, content, and navigation of Teach-ABI. Educators engaged with the module as active participants in knowledge construction, as they reflected, questioned, and connected content to their experiences and knowledge. This study established strong usability and satisfaction with Teach-ABI and demonstrated the importance of usability testing in building online professional development modules. ", doi="10.2196/43129", url="https://humanfactors.jmir.org/2023/1/e43129", url="http://www.ncbi.nlm.nih.gov/pubmed/37184920" } @Article{info:doi/10.2196/43819, author="Clarkson, D. Melissa", title="Web-Based COVID-19 Dashboards and Trackers in the United States: Survey Study", journal="JMIR Hum Factors", year="2023", month="Mar", day="20", volume="10", pages="e43819", keywords="COVID-19", keywords="data visualization", keywords="data dashboard", keywords="public health reporting", keywords="human information interaction", keywords="transparency", keywords="trust", abstract="Background: The SARS-CoV-2 pandemic provided an opportunity to use public-facing web data visualization tools to help citizens understand the evolving status of the outbreak. Given the heterogeneity of data sources, developers, tools, and designs used in this effort, it raised questions about how visualizations were constructed during a time when daily batches of data were available, but issues of data quality and standardization were unresolved. Objective: This paper surveyed web-based COVID-19 dashboards and trackers that are likely to be used by the residents of the United States to monitor the spread of infection on a local, national, and global scale. This study is intended to provide insights that will help application developers increase the usefulness, transparency, and trustworthiness of dashboards and trackers for public health data in the future. Methods: Websites of coronavirus dashboards and trackers were identified in August 2020 using the Google search engine. They were examined to determine the data sources used, types of data presented, types of data visualizations, characteristics of the visualizations, and issues with messy data. The websites were surveyed 3 more times for changes in design and data sources with the final survey conducted in June 2022. Themes were developed to highlight the issues concerning challenges in presenting COVID-19 data and techniques of effective visualization. Results: In total, 111 websites were identified and examined (84 state focused, 11 nationwide, and 16 with global data), and this study found an additional 17 websites providing access to the state vaccination data. This study documents how data aggregators have played a central role in making data accessible to visualization developers. The designs of dashboards and tracker visualizations vary in type and quality, with some well-designed displays supporting the interpretation of the data and others obscuring the meaning of the data and potentially misleading the viewers. Five themes were identified to describe challenges in presenting COVID-19 data and techniques of effective visualization. Conclusions: This analysis reveals the extent to which dashboards and trackers informing the American public about the COVID-19 pandemic relied on an ad hoc pipeline of data sources and data aggregators. The dashboards and trackers identified in this survey offer an opportunity to compare different approaches for the display of similar data. ", doi="10.2196/43819", url="https://humanfactors.jmir.org/2023/1/e43819", url="http://www.ncbi.nlm.nih.gov/pubmed/36696270" } @Article{info:doi/10.2196/30258, author="Douze, Laura and Pelayo, Sylvia and Messaadi, Nassir and Grosjean, Julien and Kerdelhu{\'e}, Ga{\'e}tan and Marcilly, Romaric", title="Designing Formulae for Ranking Search Results: Mixed Methods Evaluation Study", journal="JMIR Hum Factors", year="2022", month="Mar", day="25", volume="9", number="1", pages="e30258", keywords="information retrieval", keywords="search engine", keywords="topical relevance", keywords="search result ranking", keywords="user testing", keywords="human factors", abstract="Background: A major factor in the success of any search engine is the relevance of the search results; a tool should sort the search results to present the most relevant documents first. Assessing the performance of the ranking formula is an important part of search engine evaluation. However, the methods currently used to evaluate ranking formulae mainly collect quantitative data and do not gather qualitative data, which help to understand what needs to be improved to tailor the formulae to their end users. Objective: This study aims to evaluate 2 different parameter settings of the ranking formula of LiSSa (the French acronym for scientific literature in health care; Department of Medical Informatics and Information), a tool that provides access to health scientific literature in French, to adapt the formula to the needs of the end users. Methods: To collect quantitative and qualitative data, user tests were carried out with representative end users of LiSSa: 10 general practitioners and 10 registrars. Participants first assessed the relevance of the search results and then rated the ranking criteria used in the 2 formulae. Verbalizations were analyzed to characterize each criterion. Results: A formula that prioritized articles representing a consensus in the field was preferred. When users assess an article's relevance, they judge its topic, methods, and value in clinical practice. Conclusions: Following the evaluation, several improvements were implemented to give more weight to articles that match the search topic and to downgrade articles that have less informative or scientific value for the reader. Applying a qualitative methodology generates valuable user inputs to improve the ranking formula and move toward a highly usable search engine. ", doi="10.2196/30258", url="https://humanfactors.jmir.org/2022/1/e30258", url="http://www.ncbi.nlm.nih.gov/pubmed/35333180" } @Article{info:doi/10.2196/31820, author="Man, Alice and van Ballegooie, Courtney", title="Assessment of the Readability of Web-Based Patient Education Material From Major Canadian Pediatric Associations: Cross-sectional Study", journal="JMIR Pediatr Parent", year="2022", month="Mar", day="16", volume="5", number="1", pages="e31820", keywords="health literacy", keywords="accessibility", keywords="online health information", keywords="pediatrics", keywords="patient education", abstract="Background: Web-based patient education materials (PEMs) are frequently written above the recommended reading level in North America. Poor PEM readability limits the accessibility of medical information for individuals with average literacy levels or lower. Pediatric hospital and association websites have not only been shown to be a preferred source of information among caregivers but have also become a necessity during the COVID-19 pandemic. The readability of Canadian pediatric association websites has not yet been assessed. Objective: The aim of this study is to determine if the content of PEMs from Canadian pediatric associations is written at a reading level that the majority of Canadians can understand. Methods: A total of 258 PEMs were extracted from 10 Canadian pediatric associations and evaluated for their reading level using 10 validated readability scales. The PEMs underwent a difficult word analysis and comparisons between PEMs from different associations were conducted. Results: Web-based PEMs were identified from 3 pediatric association websites, where the reading level (calculated as a grade level) was found to be an average of 8.8 (SD 1.8) for the Caring for Kids website, 9.5 (SD 2.2) for the Pediatric Endocrine Group website, and 13.1 (SD 2.1) for the Atlantic Pediatric Society website. The difficult word analysis identified that 19.9\% (SD 6.6\%) of words were unfamiliar, with 13.3\% (SD 5.3\%) and 31.9\% (SD 6.1\%) of words being considered complex (?3 syllables) and long (?6 letters), respectively. Conclusions: The web-based PEMs were found to be written above the recommended seventh-grade reading level for Canadians. Consideration should be made to create PEMs at an appropriate reading level for both patients and their caregivers to encourage health literacy and ultimately promote preventative health behaviors and improve child health outcomes. ", doi="10.2196/31820", url="https://pediatrics.jmir.org/2022/1/e31820", url="http://www.ncbi.nlm.nih.gov/pubmed/35293875" } @Article{info:doi/10.2196/33451, author="Simmons, Janie and Elliott, Luther and Bennett, S. Alex and Beletsky, Leo and Rajan, Sonali and Anders, Brad and Dastparvardeh, Nicole", title="Evaluation of an Experimental Web-based Educational Module on Opioid-related Occupational Safety Among Police Officers: Protocol for a Randomized Pragmatic Trial to Minimize Barriers to Overdose Response", journal="JMIR Res Protoc", year="2022", month="Feb", day="25", volume="11", number="2", pages="e33451", keywords="occupational health", keywords="law enforcement", keywords="police/education", keywords="naloxone", keywords="opioid overdose prevention and response training", keywords="online education", keywords="opioids", keywords="occupational risk", abstract="Background: As drug-related morbidity and mortality continue to surge, police officers are on the front lines of the North American overdose (OD) crisis. Drug law enforcement shapes health risks among people who use drugs (PWUD), while also impacting the occupational health and wellness of officers. Effective interventions to align law enforcement practices with public health and occupational safety goals remain underresearched. Objective: The Opioids and Police Safety Study (OPS) aims to shift police practices relating to PWUD. It adapts and evaluates the relative effectiveness of a curriculum that bundles content on public health promotion with occupational risk reduction (ORR) to supplement a web-based OD response and naloxone training platform (GetNaloxoneNow.org, or GNN). This novel approach has the potential to improve public health and occupational safety practices, including using naloxone to reverse ODs, referring PWUD to treatment and other supportive services, and avoiding syringe confiscation. Methods: This longitudinal study uses a randomized pragmatic trial design. A sample of 300 active-duty police officers from select counties in Pennsylvania, Vermont, and New Hampshire with high OD fatality rates will be randomized (n=150 each) to either the experimental arm (GNN + OPS) or the control arm (GNN + COVID-19 ORR). A pre- and posttraining survey will be administered to all 300 officers, after which they will be administered quarterly surveys for 12 months. A subsample of police officers will also be qualitatively followed in a simultaneous embedded mixed-methods approach. Research ethics approval was obtained from the New York University Institutional Review Board. Results: Results will provide an understanding of the experiences, knowledge, and perceptions of this sample of law enforcement personnel. Generalized linear models will be used to analyze differences in key behavioral outcomes between the participants in each of the 2 study arms and across multiple time points (anticipated minimum effect size to be detected, d=0.50). Findings will be disseminated widely, and the training products will be available nationally once the study is completed. Conclusions: The OPS is the first study to longitudinally assess the impact of a web-based opioid-related ORR intervention for law enforcement in the U.S. Our randomized pragmatic clinical trial aims to remove barriers to life-saving police engagement with PWUD/people who inject drugs by focusing both on the safety of law enforcement and evidence-based and best practices for working with persons at risk of an opioid OD. Our simultaneous embedded mixed-methods approach will provide empirical evaluation of the diffusion of the naloxone-based response among law enforcement. Trial Registration: ClinicalTrail.gov NCT05008523; https://clinicaltrials.gov/show/NCT05008523 International Registered Report Identifier (IRRID): DERR1-10.2196/33451 ", doi="10.2196/33451", url="https://www.researchprotocols.org/2022/2/e33451", url="http://www.ncbi.nlm.nih.gov/pubmed/35212639" } @Article{info:doi/10.2196/27750, author="Gale, James Jonathan and Black, Collin Kameron and Calvano, David Joshua and Fundingsland Jr, Lauritz Edwin and Lai, Deborah and Silacci, Sara and He, Shuhan", title="An Analysis of US Academic Medical Center Websites: Usability Study", journal="J Med Internet Res", year="2021", month="Dec", day="21", volume="23", number="12", pages="e27750", keywords="website usability", keywords="digital health", keywords="health care website", keywords="academic medical center", keywords="usability testing", keywords="web crawler", abstract="Background: Health care organizations are tasked with providing web-based health resources and information. Usability refers to the ease of user experience on a website. In this study, we conducted a usability analysis of academic medical centers in the United States, which, to the best of our knowledge, has not been previously carried out. Objective: The primary aims of the study were to the following: (1) adapt a preexisting usability scoring methodology to academic medical centers; (2) apply and test this methodology on a sample set of academic medical center websites; and (3) make recommendations from these results on potential areas of improvements for our sample of academic medical center websites. Methods: All website usability testing took place from June 1, 2020, to December 15, 2020. We replicated a methodology developed in previous literature and applied it to academic medical centers. Our sample included 73 US academic medical centers. Usability was split into four broad categories: accessibility (the ability of those with low levels of computer literacy to access and navigate the hospital's website); marketing (the ability of websites to be found through search engines and the relevance of descriptions to the links provided); content quality (grammar, frequency of information updates, material relevancy, and readability); and technology (download speed, quality of the programming code, and website infrastructure). Using these tools, we scored each website in each category. The composite of key factors in each category contributed to an overall ``general usability'' score for each website. An overall score was then calculated by applying a weighted percentage across all factors and was used for the final ``overall usability'' ranking. Results: The category with the highest average score was technology, with a 0.82 (SD 0.068, SE 0.008). The lowest-performing category was content quality, with an average of 0.22 (SD 0.069, SE 0.008). As these numbers reflect weighted percentages as an integer, the higher the score, the greater the overall usability in that category. Conclusions: Our data suggest that technology, on average, was the highest-scored variable among academic medical center websites. Because website functionality is essential to a user's experience, it is justified that academic medical centers invest in optimal website performance. The overall lowest-scored variable was content quality. A potential reason for this may be that academic medical center websites are usually larger in size, making it difficult to monitor the increased quantity of content. An easy way to improve this variable is to conduct more frequent website audits to assess readability, grammar, and relevance. Marketing is another area in which these organizations have potential for improvement. Our recommendation is that organizations utilize search engine optimization techniques to improve their online visibility and discoverability. ", doi="10.2196/27750", url="https://www.jmir.org/2021/12/e27750", url="http://www.ncbi.nlm.nih.gov/pubmed/34932015" } @Article{info:doi/10.2196/29748, author="Massanelli, Jackson and Sexton, W. Kevin and Lesher, T. Chris and Jensen, K. Hanna and Kimbrough, K. Mary and Privratsky, Anna and Taylor, R. John and Bhavaraju, Avi", title="Integration of Web Analytics Into Graduate Medical Education: Usability Study", journal="JMIR Form Res", year="2021", month="Dec", day="13", volume="5", number="12", pages="e29748", keywords="graduate medical education", keywords="website analysis", keywords="residency recruitment", keywords="medical education", keywords="website", keywords="analytics", keywords="usage", keywords="usability", keywords="user engagement", keywords="user-centered design", keywords="website design", abstract="Background: Web analytics is the measurement, collection, analysis, and reporting of website and web application usage data. While common in the e-commerce arena, web analytics is underutilized in graduate medical education (GME). Objective: The University of Arkansas for Medical Sciences Department of Surgery website was revamped with input from in-house surgeons in August 2017. This study investigated the use of web analytics to gauge the impact of our department's website redesign project. Methods: Google Analytics software was used to measure website performance before and after implementation of the new website. Eight-month matched periods were compared. Factors tracked included total users, new users, total sessions, sessions per user, pages per session, average session duration, total page views, and bounce rate (the percentage of visitors who visit a site and then leave [ie, bounce] without continuing to another page on the same site). Results: Analysis using a nonpaired Student t test demonstrated a statistically significant increase for total page views (before vs after: 33,065 vs 81,852; P<.001) and decrease for bounce rate (before vs after: 50.70\% vs 0.23\%; P<.001). Total users, new users, total sessions, sessions per user, and pages per session showed improvement. The average session duration was unchanged. Subgroup analysis showed that after the main page, the next 3 most frequently visited pages were related to GME programs in our department. Conclusions: Web analytics is a practical measure of a website's efficacy. Our data suggest that a modern website significantly improves user engagement. An up-to-date website is essential for contemporary GME recruitment, will likely enhance engagement of residency applicants with GME programs, and warrants further investigation. ", doi="10.2196/29748", url="https://formative.jmir.org/2021/12/e29748", url="http://www.ncbi.nlm.nih.gov/pubmed/34898459" } @Article{info:doi/10.2196/31843, author="Wray, B. Tyler and Chan, A. Philip and Kahler, W. Christopher", title="Game Plan, a Web-Based Intervention to Improve Adherence and Persistence to HIV Pre-exposure Prophylaxis and Reduce Heavy Drinking in Gay, Bisexual, and Other Men Who Have Sex With Men: Usability and User Experience Testing", journal="JMIR Form Res", year="2021", month="Nov", day="16", volume="5", number="11", pages="e31843", keywords="pre-exposure prophylaxis", keywords="HIV", keywords="HIV prevention", keywords="mHealth", keywords="mobile health", keywords="eHealth", keywords="mobile phone", abstract="Background: Encouraging consistent use of pre-exposure prophylaxis (PrEP) is essential for reducing HIV incidence, particularly among gay, bisexual, and other men who have sex with men (GBM), and especially those who engage in heavy drinking. Although practice guidelines recommend providing adherence counseling to PrEP patients, clinics and providers may not have the resources or expertise to provide it. Internet-facilitated interventions have been shown to improve HIV prevention outcomes, including medication and care adherence. Game Plan is a website we created to help users make a tangible plan for reducing their HIV risk. We designed additional components of Game Plan to address key individual level barriers to PrEP use. Objective: The aim of this mixed methods research is to test the usability and user experience of these components with intended users: GBM who drink heavily and are on PrEP. Methods: In study 1 (usability), we completed a detailed individual interview in which participants (n=10) walked through a prototype of the website, thinking aloud as they did, and completed a follow-up interview and web-based survey afterward. Study 2 (user experience) involved providing participants (n=40) with a link to the prototype website to explore on their own and asking them to complete the same follow-up survey afterward. Qualitative data were analyzed using thematic analysis, and descriptive statistics were used to analyze quantitative data. Results: Users in both studies gave the website excellent ratings for usability, overall satisfaction, and quality, and most often described the site as informative, helpful, and supportive. Users also rated the site's content and feel as respectful of them and their autonomy, empathetic, and they stated that it conveyed confidence in their ability to change. The study 1 interviews highlighted the importance of the website's esthetics to the participants' engagement with it and its credibility in prompting genuine reflection. Conclusions: GBM who reported heavy drinking and used PrEP generally found a website focused on helping them to create a plan to use PrEP consistently to be helpful. Adopting user-centered design methods and attending to the esthetics of mobile health interventions are important steps toward encouraging engagement and reducing at-risk behaviors. ", doi="10.2196/31843", url="https://formative.jmir.org/2021/11/e31843", url="http://www.ncbi.nlm.nih.gov/pubmed/34783662" } @Article{info:doi/10.2196/29558, author="Ziemssen, Tjalf and Giovannoni, Gavin and Alvarez, Enrique and Bhan, Virender and Hersh, Carrie and Hoffmann, Olaf and Oreja-Guevara, Celia and Robles-Cede{\~n}o, R. Rene and Trojano, Maria and Vermersch, Patrick and Dobay, Pamela and Khwaja, Mudeer and Stadler, Bianca and Rauser, Benedict and Hach, Thomas and Piani-Meier, Daniela and Burton, Jason", title="Multiple Sclerosis Progression Discussion Tool Usability and Usefulness in Clinical Practice: Cross-sectional, Web-Based Survey", journal="J Med Internet Res", year="2021", month="Oct", day="6", volume="23", number="10", pages="e29558", keywords="multiple sclerosis", keywords="relapsing remitting multiple sclerosis", keywords="secondary progressive multiple sclerosis", keywords="transition", keywords="progression", keywords="digital", keywords="usability", abstract="Background: A digital tool, Multiple Sclerosis Progression Discussion Tool (MSProDiscuss), was developed to facilitate discussions between health care professionals (HCPs) and patients in evaluating early, subtle signs of multiple sclerosis (MS) disease progression. Objective: The aim of this study is to report the findings on the usability and usefulness of MSProDiscuss in a real-world clinical setting. Methods: In this cross-sectional, web-based survey, HCPs across 34 countries completed an initial individual questionnaire (comprising 7 questions on comprehensibility, usability, and usefulness after using MSProDiscuss during each patient consultation) and a final questionnaire (comprising 13 questions on comprehensibility, usability, usefulness, and integration and adoption into clinical practice to capture the HCPs' overall experience of using the tool). The responses were provided on a 5-point Likert scale. All analyses were descriptive, and no statistical comparisons were made. Results: In total, 301 HCPs tested the tool in 6974 people with MS, of whom 77\% (5370/6974) had relapsing-remitting MS, including those suspected to be transitioning to secondary progressive MS. The time taken to complete MSProDiscuss was reported to be in the range of 1 to 4 minutes in 97.3\% (6786/6974; initial) to 98.2\% (269/274; final) of the cases. In 93.54\% (6524/6974; initial) to 97.1\% (266/274; final) of the cases, the HCPs agreed (4 or 5 on the Likert scale) that patients were able to comprehend the questions in the tool. The HCPs were willing to use the tool again in the same patient, 90.47\% (6310/6974; initial) of the cases. The HCPs reported MSProDiscuss to be useful in discussing MS symptoms and their impact on daily activities (6121/6974, 87.76\% initial and 252/274, 92\% final) and cognitive function (5482/6974, 78.61\% initial and 271/274, 79.2\% final), as well as in discussing progression in general (6102/6974, 87.49\% initial and 246/274, 89.8\% final). While completing the final questionnaire, 94.9\% (260/274) of the HCPs agreed that the questions were similar to those asked in regular consultation, and the tool helped to better understand the impact of MS symptoms on daily activities (249/274, 90.9\%) and cognitive function (220/274, 80.3\%). Overall, 92\% (252/274) of the HCPs reported that they would recommend MSProDiscuss to a colleague, and 85.8\% (235/274) were willing to integrate it into their clinical practice. Conclusions: MSProDiscuss is a usable and useful tool to facilitate a physician-patient discussion on MS disease progression in daily clinical practice. Most of the HCPs agreed that the tool is easy to use and were willing to integrate MSProDiscuss into their daily clinical practice. ", doi="10.2196/29558", url="https://www.jmir.org/2021/10/e29558", url="http://www.ncbi.nlm.nih.gov/pubmed/34612826" } @Article{info:doi/10.2196/28698, author="Myhre, Leren Enid and Garnweidner-Holme, Lisa and Dahl, Bente and Reigstad, Myhre Marte and Lukasse, Mirjam", title="Development of and Experiences With an Informational Website on Early Labor: Qualitative User Involvement Study", journal="JMIR Form Res", year="2021", month="Sep", day="27", volume="5", number="9", pages="e28698", keywords="early labor", keywords="latent phase", keywords="think aloud", keywords="usability", keywords="website", keywords="labor", keywords="pregnancy", keywords="user-friendliness", keywords="eHealth", keywords="user satisfaction", abstract="Background: The period of regular contractions before 4 cm of cervical dilatation is often referred to as the latent phase or early labor. Women find it challenging to prepare for and cope with this phase of labor, and easily accessed web-based information from reliable sources may be useful in this preparation. Objective: The aim of this study is to describe the development of a Norwegian website, Latens.no, for people seeking information on early labor and to explore users' experiences with the website to increase its user-friendliness. Methods: We developed a website using an iterative process involving a multidisciplinary research team, health personnel, users, a graphic designer, and an expert in software development. We explored the website's user-friendliness using semistructured individual interviews and the think-aloud method. All interviews were audio recorded and transcribed. We then analyzed the participants' feedback on the website. Results: Participants included women who had recently given birth to their first baby (n=2), women who were pregnant with their first baby (n=4), and their partners (n=2). Results from participants' experiences completing tasks included positive feedback related to the content of Latens.no, positive feedback related to the website's design, and suggestions for improvement. Participants wanted to find information on early labor on the internet. Moreover, they found the information on the website relevant, trustworthy, and easy to read, and the design was attractive and easy to use. Overall, the participants performed the tasks easily, with few clicks and minimal effort. Conclusions: The think-aloud method, while performing tasks, allowed for detailed feedback. The participants confirmed the user-friendliness of the website but at the same time provided information enabling improvement. We expect that changes made based on this user-centered design study will further increase the usability and acceptability of Latens.no. ", doi="10.2196/28698", url="https://formative.jmir.org/2021/9/e28698", url="http://www.ncbi.nlm.nih.gov/pubmed/34569940" } @Article{info:doi/10.2196/17913, author="Nowaskie, Z. Dustin", title="Development, Implementation, and Effectiveness of a Self-sustaining, Web-Based LGBTQ+ National Platform: A Framework for Centralizing Local Health Care Resources and Culturally Competent Providers", journal="JMIR Form Res", year="2021", month="Sep", day="22", volume="5", number="9", pages="e17913", keywords="cultural competency", keywords="disparities", keywords="e-health", keywords="healthcare", keywords="internet", keywords="LGBTQ+", keywords="online platform", keywords="providers", keywords="resources", keywords="eHealth", keywords="health care", abstract="Background: The lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) population has long faced substantial marginalization, discrimination, and health care disparities compared to the cisgender, heterosexual population. As the etiology of such disparities is multifaceted, finding concrete solutions for LGBTQ+ health care equity is challenging. However, the internet may offer the space to initiate an effective model. Objective: In an effort to make LGBTQ+ public resources and culturally competent providers transparent, modernize medical education, and promote cultural competency, OutCare Health---a nonprofit 501(c)(3) multidisciplinary, multicenter web-based platform---was created. Methods: The organization employs a cyclic, multidimensional framework to conduct needs assessments, identify resources and providers, promote these efforts on the website, and educate the next generation of providers. LGBTQ+ public health services are identified via the internet, email, and word of mouth and added to the Public Resource Database; culturally competent providers are recruited to the OutList directory via listservs, medical institutions, local organizations, and word of mouth; and mentors are invited to the Mentorship Program by emailing OutList providers. These efforts are replicated across nearly 30 states in the United States. Results: The organization has identified over 500 public health organizations across all states, recognized more than 2000 OutList providers across all states and 50 specialties, distributed hundreds of thousands of educational materials, received over 10,000 monthly website visits (with 83\% unique viewership), and formed nearly 30 state-specific teams. The total number of OutList providers and monthly website views has doubled every 12-18 months. The majority of OutList providers are trained in primary, first point-of-care specialties such as family medicine, infectious disease, internal medicine, mental health, obstetrics and gynecology, and pediatrics. Conclusions: A web-based LGBTQ+ platform is a feasible, effective model to identify public health resources, culturally competent providers, and mentors as well as provide cultural competency educational materials and education across the country. Such a platform also has the opportunity to reach self-perpetuating sustainability. The cyclic, multidisciplinary, multidimensional, multicenter framework presented here appears to be pivotal in achieving such growth and stability. Other organizations and medical institutions should heavily consider using this framework to reach their own communities with high-quality, culturally competent care for the LGBTQ+ population. ", doi="10.2196/17913", url="https://formative.jmir.org/2021/9/e17913", url="http://www.ncbi.nlm.nih.gov/pubmed/34550083" } @Article{info:doi/10.2196/31976, author="Hulbert-Williams, J. Nicholas and Leslie, Monica and Hulbert-Williams, Lee and Koczwara, Bogda and Watson, K. Eila and Hall, S. Peter and Ashley, Laura and Coulson, S. Neil and Jackson, Richard and Millington, Sue and and Beatty, Lisa", title="The Finding My Way UK Clinical Trial: Adaptation Report and Protocol for a Replication Randomized Controlled Efficacy Trial of a Web-Based Psychological Program to Support Cancer Survivors", journal="JMIR Res Protoc", year="2021", month="Sep", day="20", volume="10", number="9", pages="e31976", keywords="cancer", keywords="survivorship", keywords="psychosocial intervention", keywords="digital health", keywords="quality of life", keywords="protocol", keywords="mobile phone", abstract="Background: Cancer survivors frequently report a range of unmet psychological and supportive care needs; these often continue after treatment has finished and are predictive of psychological distress and poor health-related quality of life. Web-based interventions demonstrate good efficacy in addressing these concerns and are more accessible than face-to-face interventions. Finding My Way (FMW) is a web-based, psycho-educational, and cognitive behavioral therapy intervention for cancer survivors developed in Australia. Previous trials have demonstrated that FMW is acceptable, highly adhered to, and effective in reducing the impact of distress on quality of life while leading to cost savings through health resource use reduction. Objective: This study aims to adapt the Australian FMW website for a UK cancer care context and then undertake a single-blinded, randomized controlled trial of FMW UK against a treatment-as-usual waitlist control. Methods: To an extent, our trial design replicates the existing Australian randomized controlled trial of FMW. Following a comprehensive adaptation of the web resource, we will recruit 294 participants (147 per study arm) from across clinical sites in North West England and North Wales. Participants will have been diagnosed with cancer of any type in the last 6 months, have received anticancer treatment with curative intent, be aged ?16 years, be proficient in English, and have access to the internet and an active email address. Participants will be identified and recruited through the National Institute for Health Research clinical research network. Measures of distress, quality of life, and health economic outcomes will be collected using a self-report web-based questionnaire at baseline, midtreatment, posttreatment, and both 3- and 6-month follow-up. Quantitative data will be analyzed using intention-to-treat mixed model repeated measures analysis. Embedded semistructured qualitative interviews will probe engagement with, and experiences of using, FMW UK and suggestions for future improvements. Results: The website adaptation work was completed in January 2021. A panel of cancer survivors and health care professionals provided feedback on the test version of FMW UK. Feedback was positive overall, although minor updates were made to website navigation, inclusivity, terminology, and the wording of the Improving Communication and Sexuality and Intimacy content. Recruitment for the clinical trial commenced in April 2021. We aim to report on findings from mid-2023. Conclusions: Replication studies are an important aspect of the scientific process, particularly in psychological and clinical trial literature, especially in different geographical settings. Before replicating the FMW trial in the UK setting, content updating was required. If FMW UK now replicates Australian findings, we will have identified a novel and cost-effective method of psychosocial care delivery for cancer survivors in the United Kingdom. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 14317248; https://www.isrctn.com/ISRCTN14317248 International Registered Report Identifier (IRRID): DERR1-10.2196/31976 ", doi="10.2196/31976", url="https://www.researchprotocols.org/2021/9/e31976", url="http://www.ncbi.nlm.nih.gov/pubmed/34542420" } @Article{info:doi/10.2196/28349, author="Keyworth, Chris and O'Connor, Rory and Quinlivan, Leah and Armitage, J. Christopher", title="Acceptability of a Brief Web-Based Theory-Based Intervention to Prevent and Reduce Self-harm: Mixed Methods Evaluation", journal="J Med Internet Res", year="2021", month="Sep", day="14", volume="23", number="9", pages="e28349", keywords="self-harm", keywords="implementation intentions", keywords="acceptability", keywords="online", keywords="volitional help sheet", keywords="digital health", keywords="mental health", abstract="Background: The volitional help sheet (VHS) for self-harm equips people with a means of responding automatically to triggers for self-harm with coping strategies. Although there is some evidence of its efficacy, improving acceptability and making the intervention available in a web-based format may be crucial to increasing effectiveness and reach. Objective: This study aims to use the Theoretical Framework of Acceptability (TFA) to explore the acceptability of the VHS, examine for whom and under what circumstances this intervention is more or less acceptable, and develop a series of recommendations for how the VHS can be used to support people in reducing repeat self-harm. Methods: We explored acceptability in two phases. First, our patient and public involvement partners evaluated the original VHS from a lived experience perspective, which was subsequently translated into a web-based format. Second, a representative sample of adults in the United Kingdom who had previously self-harmed were recruited via a YouGov survey (N=514) and were asked to rate the acceptability of the VHS based on the seven constructs of the TFA, namely, affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Data were analyzed using descriptive statistics, one-tailed t tests, and binary logistic regression. A directed content analysis approach was used to analyze qualitative data. Results: Participants in the web-based survey rated the VHS as positive (affective attitude; t457=4.72; P<.001); were confident using it (self-efficacy; t457=9.54; P<.001); felt they did not have to give up any benefits, profits, or values when using it (opportunity costs; t439=?15.51; P<.001); understood it and how it worked (intervention coherence; t464=11.90; P<.001); and were confident that it would achieve its purpose (perceived effectiveness; t466=2.04; P=.04). The TFA domain burden appeared to be an important indicator of acceptability. Lower levels of perceived burden when using the VHS tool were more prevalent among younger adults aged 18-24 years (OR 3.63, 95\% CI 1.50-8.78), people of White ethnic background (OR 3.02, 95\% CI 1.06-8.613), and people without a long-term health condition (OR 1.53, 95\% CI 1.01-2.30). Perceived modifications to further improve acceptability included improved formatting (burden), the feature to add new situations and responses or amend existing ones (ethicality), and clearer instructions and further detail about the purpose of the VHS (intervention coherence). Conclusions: Our findings show high levels of acceptability among some people who have previously self-harmed, particularly among younger adults, people of White ethnic backgrounds, and people without long-term health conditions. Future research should aim to improve acceptability among older adults, people from minority ethnic groups, and people with long-term health conditions. ", doi="10.2196/28349", url="https://www.jmir.org/2021/9/e28349", url="http://www.ncbi.nlm.nih.gov/pubmed/34518153" } @Article{info:doi/10.2196/30237, author="Crawford, D. Natalie and Josma, Dorie and Harrington, V. Kristin R. and Morris, Joseph and Quamina, Alvan and Birkett, Michelle and Phillips II, Gregory", title="Using the Think-Aloud Method to Assess the Feasibility and Acceptability of Network Canvas Among Black Men Who Have Sex With Men and Transgender Persons: Qualitative Analysis", journal="JMIR Form Res", year="2021", month="Sep", day="9", volume="5", number="9", pages="e30237", keywords="think-aloud", keywords="egocentric networks", keywords="sociogram", keywords="social networks", keywords="MSM", keywords="transgender", keywords="network canvas", keywords="black MSM", keywords="infectious disease transmission", keywords="stigma", abstract="Background: Characteristics of an individual's social network have been important factors in understanding infectious disease transmission patterns. Social network data collection is generally time and resource intensive, yet it is crucial to our understanding of the complex epidemiologic landscape of human behaviors among stigmatized social groups. Objective: We sought to evaluate the feasibility and acceptability of a self-administered social network data collection tool, Network Canvas, among Black men who have sex with men (BMSM) and transgender persons using the think-aloud method, which is a robust and flexible research technique used to perform usability testing. Methods: We piloted a self-administered network interview within the Network Canvas Software Suite. Participants aged 18 years and older were recruited through a community-based organization in Atlanta, GA, and were included based upon their willingness to share information on sexual behaviors and drug use for themselves and their social networks. A semistructured interview guide was used to document cognitive decision-making processes while using the tool. Recorded interviews were transcribed verbatim, and thematic analyses were performed. Results: Among 7 BMSM and transgender participants, three main themes were identified from cognitive processes: (1) the utility, (2) navigation, and (3) intuitive design of Network Canvas. Overall, Network Canvas was described as ``easy to use,'' with suggestions mainly directed toward improving navigation tools and implementing an initial tutorial on the program prior to use. Participants were willing to use Network Canvas to document their social networks and characteristics. In general, observed verbal responses from participants matched their behavior, although there were some discrepancies between verbal affirmations of use and understanding versus external observation. Conclusions: We found Network Canvas to be a useful new tool to capture social network data. Self-administration allowed participants the opportunity to provide sensitive information about themselves and their social networks. Furthermore, automated name generation and visualization of an individuals' social network in the app has the potential to reduce cognitive burden during data collection. More efficient methods of social network data collection have the potential to provide epidemiologic information to guide prevention efforts for populations with stigmatized health conditions or behaviors. ", doi="10.2196/30237", url="https://formative.jmir.org/2021/9/e30237", url="http://www.ncbi.nlm.nih.gov/pubmed/34499040" } @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/10.2196/25168, author="Hatzioannou, Anna and Chatzittofis, Andreas and Koutroubas, Sunday Virginia and Papastavrou, Evridiki and Karanikola, Maria", title="Combined Use of Web-Based and In-Person Education on Ill Health Self-management Skills in Adults With Bipolar Disorder: Protocol for a Mixed Methods Study", journal="JMIR Res Protoc", year="2021", month="Sep", day="8", volume="10", number="9", pages="e25168", keywords="education", keywords="empowerment", keywords="bipolar disorders", keywords="self-management", keywords="bipolar", keywords="mental health", abstract="Background: Addressing the enhancement of ill health self-management skills in adults diagnosed with bipolar disorder may be considered an important intervention for health care systems worldwide. Objective: This protocol describes the study ``Management of my Bipolarity'' (MoB), which aims to develop an educational intervention for adults with bipolar disorder and assess its effectiveness. The objectives include (a) a literature review on bipolar disorder educational interventions; (b) a qualitative exploration of the educational needs of people with bipolar disorder; (c) development of an educational intervention based on objectives (a) and (b) (ie, the MoB educational intervention); and (d) exploration of the effectiveness of the intervention regarding participants' knowledge of their mental health condition and enhancement of their ill health self-management skills. The MoB educational intervention will consist of an in-person and a web-based intervention in the form of a digital platform. Methods: The proposed interventional study is a combination of a qualitative and a quantitative design (mixed methods study). A focus group and content analysis will be implemented for the qualitative assessment of the educational needs of adults with bipolar disorder. The intervention will be developed based on the qualitative data of the study and relevant literature. The effectiveness of the acquired knowledge and self-management skills will be assessed according to (a) substance use behavior, (b) health locus of control, (c) impulse control, (d) adherence to pharmacotherapy, (e) relapse prevention, (f) improvement of quality of life, and (g) bipolar disorder knowledge level via structured instruments in the quantitative part of the study using descriptive and inferential statistics (SPSS version 24.0). Results: A total of 13 patients with bipolar disorder have been interviewed (8 women, 5 men) to identify educational needs to be covered through the intervention. Moreover, a literature review on bipolar disorder educational interventions has been completed. These data have been incorporated in the design of the MoB in-person intervention and the digital platform. The digital platform is live, and the development of the MoB in-person intervention was completed at the end of 2020. The recruitment of the participants for the intervention (40 patients) and the control group (40 patients) began during the first semester of 2021. Moreover, by tracking the platform for 1.5 years, we have recorded that 2180 users have visited the platform with an average session duration of almost 2 minutes. Mobile and tablet devices are being used by 70\% of the visitors. Conclusions: Since new parameters regarding educational interventions will be explored, these findings are expected to provide evidence that participation in structured educational interventions offers patients the opportunity to improve adherence to pharmacotherapy and increase their quality of life. Trial Registration: ClinicalTrials.gov NCT04643210; https://clinicaltrials.gov/ct2/show/NCT04643210 International Registered Report Identifier (IRRID): DERR1-10.2196/25168 ", doi="10.2196/25168", url="https://www.researchprotocols.org/2021/9/e25168", url="http://www.ncbi.nlm.nih.gov/pubmed/34494969" } @Article{info:doi/10.2196/28878, author="Katiri, Roulla and Hall, A. Deborah and Hoare, J. Derek and Fackrell, Kathryn and Horobin, Adele and Buggy, N{\'o}ra and Hogan, Nicholas and Kitterick, T. P{\'a}draig and ", title="Redesigning a Web-Based Stakeholder Consensus Meeting About Core Outcomes for Clinical Trials: Formative Feedback Study", journal="JMIR Form Res", year="2021", month="Aug", day="19", volume="5", number="8", pages="e28878", keywords="COVID-19", keywords="nominal group technique", keywords="formative research", keywords="patient participation", keywords="persons with hearing impairments", keywords="mobile phone", abstract="Background: Clinical trials that assess the benefits and harms of an intervention do so by measuring and reporting outcomes. Inconsistent selection and diversity in the choice of outcomes make it challenging to directly compare interventions. To achieve an agreed core set of outcomes, a consensus methodology is recommended, comprising a web-based Delphi survey and a face-to-face consensus meeting. However, UK government regulations to control the pandemic prohibited plans for a face-to-face consensus meeting as part of the Core Rehabilitation Outcome Set for Single-Sided Deafness (CROSSSD) study. Objective: This study aims to evaluate the modifications made by the CROSSSD study team to achieve consensus using web-based methods, but with minimal deviation from the original study protocol. Methods: The study team worked with health care users and professionals to translate the planned face-to-face consensus meeting in a web-based format, preserving the key elements of the nominal group technique. A follow-up survey gathered evaluation feedback on the experiences of the 22 participating members. Feedback covered premeeting preparation, the process of facilitated discussions and voting, ability to contribute, and perceived fairness of the outcome. Results: Overall, 98\% (53/54) of feedback responses agreed or strongly agreed with the statements given, indicating that the web-based meeting achieved its original goals of open discussion, debate, and voting to agree with a core outcome set for single-sided deafness. Hearing-impaired participants were fully engaged, but there were some methodological challenges. For the participants, challenges included building rapport, understanding, and delivering the tasks in hand. For the study team, challenges included the need for thorough preparation and management of the unpredictability of tasks on the day. Conclusions: Sharing our experiences and lessons learned can benefit future core outcome set developers. Overcoming the challenges of delivering a web-based consensus exercise in the face of the pandemic can be applied more generally to maximize inclusiveness, enhance geographical access, and reduce research costs. ", doi="10.2196/28878", url="https://formative.jmir.org/2021/8/e28878", url="http://www.ncbi.nlm.nih.gov/pubmed/34420915" } @Article{info:doi/10.2196/26532, author="Tremblay, Melanie and Latulippe, Karine and Guay, Manon and Provencher, V{\'e}ronique and Gigu{\`e}re, Anick and Poulin, Val{\'e}rie and Dub{\'e}, V{\'e}ronique and Giroux, Dominique", title="Usability of a Co-designed eHealth Prototype for Caregivers: Combination Study of Three Frameworks", journal="JMIR Hum Factors", year="2021", month="Aug", day="18", volume="8", number="3", pages="e26532", keywords="usability evaluation", keywords="co-design", keywords="research methods", keywords="caregivers", keywords="service providers", keywords="product objectives", abstract="Background: Co-design (or the participation of users) has shown great potential in the eHealth domain, demonstrating positive results. Nevertheless, the co-design approach cannot guarantee the usability of the system designed, and usability assessment is a complex analysis to perform, as evaluation criteria will differ depending on the usability framework (or set of criteria) used. ISO (International Organization for Standardization) on usability (ISO 9241-210), Nielsen heuristic, and Garrett element of user experience inform different yet complementary aspects of usability. Objective: This study aims to assess the usability and user experience of a co-design prototype by combining 3 complementary frameworks. Methods: To help caregivers provide care for functionally impaired older people, an eHealth tool was co-designed with caregivers, health and social service professionals, and community workers assisting caregivers. The prototype was a website that aims to support the help-seeking process for caregivers (finding resources) and allow service providers to advertise their services (offering resources). We chose an exploratory study method to assess usability in terms of each objective. The first step was to assess users' first impressions of the website. The second was a task scenario with a think-aloud protocol. The final step was a semistructured interview. All steps were performed individually (with a moderator) in a single session. The data were analyzed using 3 frameworks. Results: A total of 10 participants were recruited, 5 for each objective of the website. We were able to identify several usability problems, most of which were located in the information design and interface design dimensions (Garrett framework). Problems in both dimensions were mainly coded as effectiveness and efficiency (ISO framework) and error prevention and match between the systemand the real world (Nielsen heuristic). Conclusions: Our study provided a novel contribution about usability analysis by combining the 3 different models to classify the problems found. This combination provided a holistic understanding of the usability improvements needed. It can also be used to analyze other eHealth products. International Registered Report Identifier (IRRID): RR2-10.2196/11634 ", doi="10.2196/26532", url="https://humanfactors.jmir.org/2021/3/e26532", url="http://www.ncbi.nlm.nih.gov/pubmed/34406123" } @Article{info:doi/10.2196/23834, author="Schoenmakers, Birgitte and Wens, Johan", title="Efficiency, Usability, and Outcomes of Proctored Next-Level Exams for Proficiency Testing in Primary Care Education: Observational Study", journal="JMIR Form Res", year="2021", month="Aug", day="16", volume="5", number="8", pages="e23834", keywords="primary care", keywords="education", keywords="graduate", keywords="medical education", keywords="testing", keywords="assessment", keywords="app", keywords="COVID-19", keywords="efficiency", keywords="accuracy", abstract="Background: The COVID-19 pandemic has affected education and assessment programs and has resulted in complex planning. Therefore, we organized the proficiency test for admission to the Family Medicine program as a proctored exam. To prevent fraud, we developed a web-based supervisor app for tracking and tracing candidates' behaviors. Objective: We aimed to assess the efficiency and usability of the proctored exam procedure and to analyze the procedure's impact on exam scores. Methods: The application operated on the following three levels to register events: the recording of actions, analyses of behavior, and live supervision. Each suspicious event was given a score. To assess efficiency, we logged the technical issues and the interventions. To test usability, we counted the number of suspicious students and behaviors. To analyze the impact that the supervisor app had on students' exam outcomes, we compared the scores of the proctored group and those of the on-campus group. Candidates were free to register for off-campus participation or on-campus participation. Results: Of the 593 candidates who subscribed to the exam, 472 (79.6\%) used the supervisor app and 121 (20.4\%) were on campus. The test results of both groups were comparable. We registered 15 technical issues that occurred off campus. Further, 2 candidates experienced a negative impact on their exams due to technical issues. The application detected 22 candidates with a suspicion rating of >1. Suspicion ratings mainly increased due to background noise. All events occurred without fraudulent intent. Conclusions: This pilot observational study demonstrated that a supervisor app that records and registers behavior was able to detect suspicious events without having an impact on exams. Background noise was the most critical event. There was no fraud detected. A supervisor app that registers and records behavior to prevent fraud during exams was efficient and did not affect exam outcomes. In future research, a controlled study design should be used to compare the cost-benefit balance between the complex interventions of the supervisor app and candidates' awareness of being monitored via a safe browser plug-in for exams. ", doi="10.2196/23834", url="https://formative.jmir.org/2021/8/e23834", url="http://www.ncbi.nlm.nih.gov/pubmed/34398786" } @Article{info:doi/10.2196/14951, author="Berninger, M. Nathalie and ten Hoor, A. Gill and Plasqui, Guy and Kok, Gerjo and Peters, Ygram Gjalt-Jorn and Ruiter, C. Robert A.", title="Sedentary Work in Desk-Dominated Environments: A Data-Driven Intervention Using Intervention Mapping", journal="JMIR Form Res", year="2020", month="Jul", day="20", volume="4", number="7", pages="e14951", keywords="intervention mapping", keywords="sedentary behavior", keywords="sedentary work", keywords="computer-based", keywords="occupational health", keywords="eHealth", keywords="mHealth", keywords="data-driven programs", abstract="Background: Since desk-dominated work environments facilitate sedentary behavior, office workers sit for 66\% of their working days and only 8\% succeed in interrupting their prolonged periods of sitting within the first 55 minutes. Yet stretches of long and uninterrupted sitting increase the likelihood of several chronic metabolic and cardiovascular diseases. Objective: We therefore developed a computer-based app designed to interrupt periods of prolonged sitting among office employees. Methods: When developing the intervention, we applied the intervention mapping protocol. This approach for the systematic design of theory and evidence-based behavior change programs consists of 6 steps: creation of a logic model of the problem, creation of a logic model of change, program design, program production, design of an implementation plan, and development of an evaluation plan. Results: Working through all 6 steps has resulted in an individually adaptable intervention to reduce sedentary behavior at work. The intervention, UPcomplish, consists of tailored, half-automatized motivational components delivered by a coach. To register sedentary behavior, the VitaBit (VitaBit Software International BV) toolkit, a wearable accelerometry-based monitoring device, is used. Among others, UPcomplish includes personalized goal setting, tailored suggestions to overcome hurdles, and weekly challenges. The VitaBit toolkit supports the participants to monitor their behavior in relation to self-set goals. Conclusions: Intervention mapping is a useful protocol not only for the systematic development of a comprehensive intervention to reduce sedentary behavior but also for planning program adherence, program implementation, and program maintenance. It facilitates obtaining the participation of relevant stakeholders at different ecological levels in the development process of the intervention and anticipating facilitators to and barriers of program implementation and maintenance. Trial Registration: Netherlands Trial Register NL7503; https://www.trialregister.nl/trial/7503 ", doi="10.2196/14951", url="http://formative.jmir.org/2020/7/e14951/", url="http://www.ncbi.nlm.nih.gov/pubmed/32706695" } @Article{info:doi/10.2196/18171, author="R{\o}ed, Margrethe and Vik, Nordg{\aa}rd Fr{\o}ydis and Hillesund, Rudjord Elisabet and Van Lippevelde, Wendy and Medin, Christine Anine and {\O}verby, Cecilie Nina", title="Process Evaluation of an eHealth Intervention (Food4toddlers) to Improve Toddlers' Diet: Randomized Controlled Trial", journal="JMIR Hum Factors", year="2020", month="Jul", day="6", volume="7", number="3", pages="e18171", keywords="toddler", keywords="mHealth", keywords="usability", keywords="eHealth", keywords="diet intervention", keywords="digital intervention", keywords="education difference", abstract="Background: Parents seek trustworthy information online to promote healthy eating for their toddlers. Such information must be perceived as relevant and easy to implement and use. Objective: The objectives of this study were to conduct a process evaluation of the electronic health (eHealth) intervention (Food4toddlers) targeting food environment, parental feeding practices, and toddlers' diet and to examine possible differences in these areas according to education and family composition. Methods: A 2-armed randomized controlled trial, including 298 parent--toddler dyads from Norway, was conducted in 2017. In total, 148 parents in the intervention group received access to an intervention website for 6 months. Data on website usage were retrieved from the learning management platform used (NEO). Participants' satisfaction with the intervention was asked for in a postintervention questionnaire. Chi-square and t tests were used to examine differences in usage and satisfaction between education and family composition groups. Results: Most participants were mothers (144/148, 97.2\%), lived in two-adult households (148/148, 100\%), and were born in Norway (132/148, 89.1\%). Mean parental age was 31.5 years (SD 4.2). More than 87.8\% (129/147) had a university education degree and 56.5\% (83/147) had over 4 years of university education. Most (128/148, 86.5\%) intervention participants entered the website at least once (mean days of access 7.4 [SD 7.1]). Most parents reported the website as appropriate to the child's age (71/83, 86\%) and self-explanatory (79/83, 95\%) and appreciated the interface (52/83, 63\%) and layout (46/83, 55\%). In total, 61\% (51/83) stated that they learned something new from the intervention. Parents with over 4 years of university education and in 1-child households used the intervention website more than those with 4 years or less of university education (8.4 vs 5.9 days in total, P=.04) and households with more than 1 child (8.3 vs 5.8 days in total, P=.04), respectively. Conclusions: The Food4toddlers intervention website was found to be relevant by most participants in the intervention group, although usage of the website differed according to educational level and family composition. For eHealth interventions to be effective, intervention materials such as websites must be used by the target group. Our results highlight the need to include users from different groups when developing interventions. Trial Registration: ISRCTN Registry ISRCTN92980420; http://www.isrctn.com/ISRCTN92980420 ", doi="10.2196/18171", url="https://humanfactors.jmir.org/2020/3/e18171", url="http://www.ncbi.nlm.nih.gov/pubmed/32628612" } @Article{info:doi/10.2196/15008, author="Hangh{\o}j, Signe and Boisen, A. Kirsten and Hjerming, Maiken and Elsbernd, Abbey and Pappot, Helle", title="Usability of a Mobile Phone App Aimed at Adolescents and Young Adults During and After Cancer Treatment: Qualitative Study", journal="JMIR Cancer", year="2020", month="Jan", day="2", volume="6", number="1", pages="e15008", keywords="AYA", keywords="adolescent and young adult", keywords="app", keywords="cancer", keywords="co-creation", keywords="mHealth", keywords="mobile phone", keywords="think-aloud test", keywords="usability", abstract="Background: Adolescent and young adult (AYA) cancer patients are seldom involved in the process of testing cancer-related apps. As such, knowledge about youth-specific content, functionalities, and design is sparse. As a part of a co-creation process of developing the mobile phone app Kr{\ae}ftv{\ae}rket, AYAs in treatment for cancer and in follow-up participated in a usability think-aloud test of a prototype of the app. Thus, the app was initiated, created, and evaluated by AYAs with cancer experience. Objective: The aim of this study was to explore the results of a think-aloud test administered to see how the prototype of the app Kr{\ae}ftv{\ae}rket was used by AYAs in treatment for cancer and in follow-up, and to investigate the strengths and weaknesses of the app. Methods: A total of 20 AYA cancer patients aged 16 to 29 years (n=10 on treatment, n=10 in follow-up) were provided with the first version of the co-created mobile phone app Kr{\ae}ftv{\ae}rket during a 6-week test period (April-May 2018). After the test period, 15 participated in individual usability think-aloud tests. The tests were video-recorded, transcribed verbatim, and analyzed using a thematic analysis approach. Results: The thematic analysis led to the following themes and subthemes: navigation (subthemes: intuition, features, buttons, home page, profile), visual and graphic design (subthemes: overview, text and colors, photos, videos, YouTube), and usefulness (subthemes: notifications, posts, adding). The analysis identified gender differences in app utilization---female participants seemed to be more familiar with parts of the app. The app seemed to be more relevant to AYAs receiving treatment due to app functions such as tracking symptoms and searching for relevant information. Lack of notifications and incorrect counting of posts were perceived as barriers to using the app. Conclusions: Usability testing is crucial to meet the needs of the AYA target audience. AYA cancer apps should preferably be relevant, targeted, and unique, and include a tracking function and AYA-produced videos. Notifications and correct marking and ordering of posts are critical to make apps engaging and dynamic. Further research is recommended to evaluate the Kr{\ae}ftv{\ae}rket app with the input of more AYAs. ", doi="10.2196/15008", url="https://cancer.jmir.org/2020/1/e15008", url="http://www.ncbi.nlm.nih.gov/pubmed/31895046" } @Article{info:doi/10.2196/14866, author="D'Alfonso, Simon and Phillips, Jessica and Valentine, Lee and Gleeson, John and Alvarez-Jimenez, Mario", title="Moderated Online Social Therapy: Viewpoint on the Ethics and Design Principles of a Web-Based Therapy System", journal="JMIR Ment Health", year="2019", month="Dec", day="4", volume="6", number="12", pages="e14866", keywords="Web-based intervention", keywords="social network", keywords="well-being", keywords="eudaimonia", keywords="persuasive technology", keywords="ethical design", doi="10.2196/14866", url="https://mental.jmir.org/2019/12/e14866", url="http://www.ncbi.nlm.nih.gov/pubmed/31799937" } @Article{info:doi/10.2196/12514, author="Bernard, Renaldo and Sabariego, Carla and Cieza, Alarcos", title="Difficulties Encountered by People With Depression and Anxiety on the Web: Qualitative Study and Web-Based Expert Survey", journal="J Med Internet Res", year="2019", month="Oct", day="31", volume="21", number="10", pages="e12514", keywords="World Wide Web", keywords="depression", keywords="anxiety", keywords="accessibility", keywords="interview", keywords="persona", keywords="expert study", keywords="eHealth", keywords="usability", keywords="user experience", keywords="facilitators", keywords="barriers", keywords="mental disorders", abstract="Background: Depression and anxiety are the most common mental health conditions, and they were identified as leading contributors to global disability in 2016. People with these conditions rely on Web-based resources as a source of accurate health information, convenient and effective treatment, and essential social support. However, a recent systematic review revealed several potentially limiting difficulties that this group experiences online and also suggested that there is a partial understanding of these difficulties as only difficulties associated with neurocognitive, but not sociocognitive, deficits were identified. Therefore, this study fills this knowledge gap and contributes to a more robust and fuller understanding of the difficulties this group experiences online. Objective: The objective of this study was to identify the difficulties people with depression and anxiety experience when using the Web and the Web activities that are most associated with the experience of difficulties. Methods: The study employed data triangulation using face-to-face semistructured interviews with 21 participants affected by depression and anxiety and a comparison group (7 participants) without mental disorders (study 1) as well as a persona-based expert online survey with 21 mental health practitioners (MHPs) who treated people with depression and anxiety (study 2). Framework analysis for both studies proceeded through 5 stages: (1) familiarization, (2) identifying a thematic framework, (3) indexing, (4) charting, and (5) mapping and interpretation. Results: In study 1, 167 difficulties were identified from the experiences of participants in the depression and anxiety group were discussed within the context of 81 Web activities, services, and features. From these, 4 themes and 12 subthemes describing the difficulties people with depression and anxiety experienced online were identified. Difficulties relating to the subtheme lack of control over access and usage were the most common difficulties experienced by participants in the depression and anxiety group (19/21). Sixteen difficulties identified from the experiences of participants in the comparison group were discussed within the context of 11 Web activities, services, and features. Most participants in the comparison group (6/7) contributed to the subtheme describing difficulties with unexpected and irrelevant content. In study 2, researchers identified 3 themes and 10 subthemes that described the perceived difficulties people with depression and anxiety might experience online as reported by MHPs. Practitioners linked these difficulties with 22 common impairments, limitations in activities of daily life, and diagnostic criteria associated with depression and anxiety. Conclusions: People with depression and anxiety also experience difficulties when using the Web that are related to the sociocognitive deficits associated with their conditions. MHPs have a good awareness of the difficulties that people with depression and anxiety are likely to experience when using the Web. This investigation has contributed to a fuller understanding of these difficulties and provides innovative guidance on how to remove and reduce them for people with depression and anxiety when using the Web. International Registered Report Identifier (IRRID): RR2-10.1007/978-3-319-21006-3\_3 ", doi="10.2196/12514", url="http://www.jmir.org/2019/10/e12514/", url="http://www.ncbi.nlm.nih.gov/pubmed/31674915" } @Article{info:doi/10.2196/13875, author="Turk, Amadea and Fairclough, Emma and Grason Smith, Gillian and Lond, Benjamin and Nanton, Veronica and Dale, Jeremy", title="Exploring the Perceived Usefulness and Ease of Use of a Personalized Web-Based Resource (Care Companion) to Support Informal Caring: Qualitative Descriptive Study", journal="JMIR Aging", year="2019", month="Aug", day="20", volume="2", number="2", pages="e13875", keywords="caregivers", keywords="information technology", keywords="internet", abstract="Background: Informal carers play an increasingly vital role in supporting the older population and the sustainability of health care systems. Care Companion is a theory-based and coproduced Web-based intervention to help support informal carers' resilience. It aims to provide personalized access to information and resources that are responsive to individuals' caring needs and responsibilities and thereby reduce the burdens associated with caregiving roles. Following the development of a prototype, it was necessary to undertake user acceptability testing to assess its suitability for wider implementation. Objective: This study aimed to undertake user acceptance testing to investigate the perceived usefulness and ease of use of Care Companion. The key objectives were to (1) explore how potential and actual users perceived its usefulness, (2) explore the barriers and facilitators to its uptake and use and (3) gather suggestions to inform plans for an area-wide implementation. Methods: We conducted user acceptance testing underpinned by principles of rapid appraisal using a qualitative descriptive approach. Focus groups, observations, and semistructured interviews were used in two phases of data collection. Participants were adult carers who were recruited through local support groups. Within the first phase, think-aloud interviews and observations were undertaken while the carers familiarized themselves with and navigated through the platform. In the second phase, focus group discussions were undertaken. Interested participants were then invited to trial Care Companion for up to 4 weeks and were followed up through semistructured telephone interviews exploring their experiences of using the platform. Thematic analysis was applied to the data, and a coding framework was developed iteratively with each phase of the study, informing subsequent phases of data collection and analysis. Results: Overall, Care Companion was perceived to be a useful tool to support caregiving activities. The key themes were related to its appearance and ease of use, the profile setup and log-in process, concerns related to the safety and confidentiality of personal information, potential barriers to use and uptake and suggestions for overcoming them, and suggestions for improving Care Companion. More specifically, these related to the need for personalized resources aimed specifically at the carers (instead of care recipients), the benefits of incorporating a Web-based journal, the importance of providing transparency about security and data usage, minimizing barriers to initial registration, offering demonstrations to support uptake by people with low technological literacy, and the need to develop a culturally sensitive approach. Conclusions: The findings identified ways of improving the ease of use and usefulness of Care Companion and demonstrated the importance of undertaking detailed user acceptance testing when developing an intervention for a diverse population, such as informal carers of older people. These findings have informed the further refinement of Care Companion and the strategy for its full implementation. ", doi="10.2196/13875", url="https://aging.jmir.org/2019/2/e13875", url="http://www.ncbi.nlm.nih.gov/pubmed/31518272" } @Article{info:doi/10.2196/13898, author="Hafiz, Pegah and Miskowiak, Woznica Kamilla and Kessing, Vedel Lars and Elleby Jespersen, Andreas and Obenhausen, Kia and Gulyas, Lorant and Zukowska, Katarzyna and Bardram, Eyvind Jakob", title="The Internet-Based Cognitive Assessment Tool: System Design and Feasibility Study", journal="JMIR Form Res", year="2019", month="Jul", day="26", volume="3", number="3", pages="e13898", keywords="screening", keywords="memory", keywords="executive function", keywords="bipolar disorder", keywords="depression", keywords="cognitive impairments", keywords="neuropsychological tests", keywords="computer software", keywords="speech recognition software", abstract="Background: Persistent cognitive impairment is prevalent in unipolar and bipolar disorders and is associated with decreased quality of life and psychosocial dysfunction. The screen for cognitive impairment in psychiatry (SCIP) test is a validated paper-and-pencil instrument for the assessment of cognition in affective disorders. However, there is no digital cognitive screening tool for the brief and accurate assessment of cognitive impairments in this patient group. Objective: In this paper, we present the design process and feasibility study of the internet-based cognitive assessment tool (ICAT) that is designed based on the cognitive tasks of the SCIP. The aims of this feasibility study were to perform the following tasks among healthy individuals: (1) evaluate the usability of the ICAT, (2) investigate the feasibility of the ICAT as a patient-administered cognitive assessment tool, and (3) examine the performance of automatic speech recognition (ASR) for the assessment of verbal recall. Methods: The ICAT was developed in a user-centered design process. The cognitive measures of the ICAT were immediate and delayed recall, working memory, and psychomotor speed. Usability and feasibility studies were conducted separately with 2 groups of healthy individuals (N=21 and N=19, respectively). ICAT tests were available in the English and Danish languages. The participants were asked to fill in the post study system usability questionnaire (PSSUQ) upon completing the ICAT test. Verbal recall in the ICAT was assessed using ASR, and the performance evaluation criterion was word error rate (WER). A Pearson 2-tailed correlation analysis significant at the .05 level was applied to investigate the association between the SCIP and ICAT scores. Results: The overall psychometric factors of PSSUQ for both studies gave scores above 4 (out of 5). The analysis of the feasibility study revealed a moderate to strong correlation between the total scores of the SCIP and ICAT (r=0.63; P=.009). There were also moderate to strong correlations between the SCIP and ICAT subtests for immediate verbal recall (r=0.67; P=.002) and psychomotor speed (r=0.71; P=.001). The associations between the respective subtests for working memory, executive function, and delayed recall, however, were not statistically significant. The corresponding WER for English and Danish responses were 17.8\% and 6.3\%, respectively. Conclusions: The ICAT is the first digital screening instrument modified from the SCIP using Web-based technology and ASR. There was good accuracy of the ASR for verbal memory assessment. The moderate correlation between the ICAT and SCIP scores suggests that the ICAT is a valid tool for assessing cognition, although this should be confirmed in a larger study with greater statistical power. Taken together, the ICAT seems to be a valid Web-based cognitive assessment tool that, after some minor modifications and further validation, may be used to screen for cognitive impairment in clinical settings. ", doi="10.2196/13898", url="http://formative.jmir.org/2019/3/e13898/", url="http://www.ncbi.nlm.nih.gov/pubmed/31350840" } @Article{info:doi/10.2196/11014, author="Moreno, A. Megan and D'Angelo, Jonathan", title="Social Media Intervention Design: Applying an Affordances Framework", journal="J Med Internet Res", year="2019", month="Mar", day="26", volume="21", number="3", pages="e11014", keywords="social media", keywords="health", keywords="adolescent", keywords="research", doi="10.2196/11014", url="http://www.jmir.org/2019/3/e11014/", url="http://www.ncbi.nlm.nih.gov/pubmed/30912754" } @Article{info:doi/10.2196/12393, author="Du Preez, Vikki and De La Harpe, Retha", title="Engaging Aging Individuals in the Design of Technologies and Services to Support Health and Well-Being: Constructivist Grounded Theory Study", journal="JMIR Aging", year="2019", month="Mar", day="20", volume="2", number="1", pages="e12393", keywords="technology", keywords="healthy aging", keywords="grounded theory", keywords="qualitative research", abstract="Background: Changes noted within the aging population are physical, cognitive, as well as emotional. Social isolation and loneliness are also serious problems that the aging population may encounter. As technology and apps become more accessible, many basic services, such as those offered by social services, well-being organizations, and health care institutions, have invested in the development of supportive devices, services, and Web-based interactions. Despite the perceived benefits that these devices and services offer, many aging individuals choose not to engage, or engage in a limited manner. To explore this phenomenon, we developed a theory to describe the condition for engagement. Objective: The main objective of this study was to understand the perceptions of an aging South African population regarding Web-based services and technologies that could support aging in place (AiP). Although the concept of AiP speaks to a great number of everyday activities, this paper explores aspects of health and well-being as being central to AiP. Methods: The study used a grounded theory (GT) methodology, relying on an iterative and simultaneous process of data collection, coding, category development, and data comparisons. Data were collected through qualitative methods, including interviews (13 participants aged between 64 and 85 years), 2 participatory workshops (15 participants), and observations. The study focused on Charmaz's approach to constructivist GT, which puts forward the premise that theory or knowledge cannot take shape in a purely objective manner. Instead, theory is constructed through the interaction of the researcher and research participant. Coding and data analysis were supported with ATLAS.ti (ATLAS.ti Scientific Software Development GmbH). Results: The study resulted in a substantive theory exploring the process of interaction and engaging factors through user insights and experiences. The emerging design theory, Ageing User Decision-Driven Engagement (AUDDE), explored the elements that support engagement with technology and supportive apps, which could offer access to required health and wellness services. Conclusions: In AUDDE, the perceived value of the interaction is a crucial catalyst for engagement. Aging users continuously make meaning of their experiences, which affects their current and future actions. ", doi="10.2196/12393", url="http://aging.jmir.org/2019/1/e12393/", url="http://www.ncbi.nlm.nih.gov/pubmed/31518258" } @Article{info:doi/10.2196/10449, author="Gibson, Colin Ryan and Bouamrane, Matt-Mouley and Dunlop, Mark", title="Design Requirements for a Digital Aid to Support Adults With Mild Learning Disabilities During Clinical Consultations: Qualitative Study With Experts", journal="JMIR Rehabil Assist Technol", year="2019", month="Mar", day="04", volume="6", number="1", pages="e10449", keywords="learning disabilities", keywords="intellectual disability", keywords="communicative disorder", keywords="augmentative and alternative communications systems", keywords="primary care", abstract="Background: Adults with mild learning disabilities (MLDs) face a plethora of obstacles when accessing effective health care. Central to many of these barriers is communication, with medical practitioners often remaining untrained on how to interact with patients who have learning disabilities (LDs). To date, research on how to promote this communication has largely centered on the development of low-tech aids. Objective: The objective of this study was to assess the feasibility of utilizing tablet technologies to promote communication between general practitioners and patients with MLDs. We achieved this by identifying a set of design requirements from experts in LDs. Methods: A set of design guidelines was formed during a 2-phase process. Phase 1 involved conducting a series of requirements-gathering interviews with 10 experts in LDs---the protocol of which emerged from the results of a separate scoping review. The interviews were subjected to a framework analysis to discern the key requirements discussed by the experts, and these were embedded within a technology probe. In phase 2, this probe was presented to a subset (n=4) of the experts during a round of usability studies, and the feedback received was used to update the requirements identified in phase 1. Results: An initial set of design requirements has been produced that may assist in the development of clinical Alternative and Augmentative Communication technologies for adults with MLDs. Factors that must be considered range from the health, physical and cognitive needs of stakeholders, to the more individual needs of users. Conclusions: The experts involved in the study were optimistic about the proposed app. They believe that such technologies can help to alleviate time constraints and promote communication by presenting information in a form understood by both practitioners and patients. ", doi="10.2196/10449", url="http://rehab.jmir.org/2019/1/e10449/", url="http://www.ncbi.nlm.nih.gov/pubmed/30829575" } @Article{info:doi/10.2196/10801, author="Tistad, Malin and Lundell, Sara and Wiklund, Maria and Nyberg, Andr{\'e} and Holmner, {\AA}sa and Wadell, Karin", title="Usefulness and Relevance of an eHealth Tool in Supporting the Self-Management of Chronic Obstructive Pulmonary Disease: Explorative Qualitative Study of a Cocreative Process", journal="JMIR Hum Factors", year="2018", month="Oct", day="26", volume="5", number="4", pages="e10801", keywords="COPD", keywords="eHealth", keywords="cocreation", keywords="self-management", keywords="primary care, chronic disease", abstract="Background: New strategies are urgently needed to support self-management for people with chronic obstructive pulmonary disease (COPD) in primary care. The use of electronic health (eHealth) solutions is promising. However, there is a lack of knowledge about how such eHealth tools should be designed in order to be perceived as relevant and useful and meet the needs and expectations of the health professionals as well as people with COPD and their relatives. Objective: The objective of this study was to explore the aspects of an eHealth tool design and content that make it relevant and useful for supporting COPD-related self-management strategies from the perspective of health care professionals, people with COPD and their relatives, and external researchers. Methods: Data were collected during the development of an eHealth tool. A cocreation process was carried out with participants from two primary care units in northern Sweden and external researchers. Individual interviews were performed with health care professionals (n=13) as well as people with COPD (n=6) and their relatives (n=2), and focus group discussions (n=9) were held with all groups of participants. Data were analyzed using qualitative content analysis. Results: The overarching theme, reinforcing existing support structures, reflects participant views that the eHealth tool needs to be directly applicable and create a sense of commitment in users. Moreover, participants felt that the tool needs to fit with existing routines and contexts and preferably should not challenge existing hierarchies between health care professionals and people with COPD. Important content for health care professionals and people with COPD included knowledge about self-management strategies. Videos were regarded as the most effective method for communicating such knowledge. Conclusions: The cocreation in the development process enables participant perspectives and priorities to be built into the eHealth tool. This is assumed to contribute to a tool that is useful and relevant and, therefore, adopted into clinical practice and everyday life. Findings from this study can inform the development of eHealth tools for people with COPD in other contexts, as well as the development of eHealth tools for self-management support of other chronic diseases. ", doi="10.2196/10801", url="http://humanfactors.jmir.org/2018/4/e10801/", url="http://www.ncbi.nlm.nih.gov/pubmed/30368440" } @Article{info:doi/10.2196/humanfactors.9541, author="Bromley, Sally and Drew, Michael and Talpey, Scott and McIntosh, Andrew and Finch, Caroline", title="Collecting Health and Exposure Data in Australian Olympic Combat Sports: Feasibility Study Utilizing an Electronic System", journal="JMIR Hum Factors", year="2018", month="Oct", day="09", volume="5", number="4", pages="e27", keywords="online", keywords="health", keywords="injury \& prevention", keywords="athletic performance", keywords="internet", keywords="mobile phone", abstract="Background: Electronic methods are increasingly being used to manage health-related data among sporting populations. Collection of such data permits the analysis of injury and illness trends, improves early detection of injuries and illnesses, collectively referred to as health problems, and provides evidence to inform prevention strategies. The Athlete Management System (AMS) has been employed across a range of sports to monitor health. Australian combat athletes train across the country without dedicated national medical or sports science teams to monitor and advocate for their health. Employing a Web-based system, such as the AMS, may provide an avenue to increase the visibility of health problems experienced by combat athletes and deliver key information to stakeholders detailing where prevention programs may be targeted. Objective: The objectives of this paper are to (1) report on the feasibility of utilizing the AMS to collect longitudinal injury and illness data of combat sports athletes and (2) describe the type, location, severity, and recurrence of injuries and illnesses that the cohort of athletes experience across a 12-week period. Methods: We invited 26 elite and developing athletes from 4 Olympic combat sports (boxing, judo, taekwondo, and wrestling) to participate in this study. Engagement with the AMS was measured, and collected health problems (injuries or illnesses) were coded using the Orchard Sports Injury Classification System (version 10.1) and International Classification of Primary Care (version 2). Results: Despite >160 contacts, athlete engagement with online tools was poor, with only 13\% compliance across the 12-week period. No taekwondo or wrestling athletes were compliant. Despite low overall engagement, a large number of injuries or illness were recorded across 11 athletes who entered data---22 unique injuries, 8 unique illnesses, 30 recurrent injuries, and 2 recurrent illnesses. The most frequent injuries were to the knee in boxing (n=41) and thigh in judo (n=9). In this cohort, judo players experienced more severe, but less frequent, injuries than boxers, yet judo players sustained more illnesses than boxers. In 97.0\% (126/130) of cases, athletes in this cohort continued to train irrespective of their health problems. Conclusions: Among athletes who reported injuries, many reported multiple conditions, indicating a need for health monitoring in Australian combat sports. A number of factors may have influenced engagement with the AMS, including access to the internet, the design of the system, coach views on the system, previous experiences with the system, and the existing culture within Australian combat sports. To increase engagement, there may be a requirement for sports staff to provide relevant feedback on data entered into the system. Until the barriers are addressed, it is not feasible to implement the system in its current form across a larger cohort of combat athletes. ", doi="10.2196/humanfactors.9541", url="http://humanfactors.jmir.org/2018/4/e27/", url="http://www.ncbi.nlm.nih.gov/pubmed/30305257" } @Article{info:doi/10.2196/jmir.7867, author="Pugatch, Jillian and Grenen, Emily and Surla, Stacy and Schwarz, Mary and Cole-Lewis, Heather", title="Information Architecture of Web-Based Interventions to Improve Health Outcomes: Systematic Review", journal="J Med Internet Res", year="2018", month="Mar", day="21", volume="20", number="3", pages="e97", keywords="information architecture", keywords="systematic review", keywords="health outcomes", keywords="behavior change", keywords="health behavior", abstract="Background: The rise in usage of and access to new technologies in recent years has led to a growth in digital health behavior change interventions. As the shift to digital platforms continues to grow, it is increasingly important to consider how the field of information architecture (IA) can inform the development of digital health interventions. IA is the way in which digital content is organized and displayed, which strongly impacts users' ability to find and use content. While many information architecture best practices exist, there is a lack of empirical evidence on the role it plays in influencing behavior change and health outcomes. Objective: Our aim was to conduct a systematic review synthesizing the existing literature on website information architecture and its effect on health outcomes, behavioral outcomes, and website engagement. Methods: To identify all existing information architecture and health behavior literature, we searched articles published in English in the following databases (no date restrictions imposed): ACM Digital Library, CINAHL, Cochrane Library, Google Scholar, Ebsco, and PubMed. The search terms used included information terms (eg, information architecture, interaction design, persuasive design), behavior terms (eg, health behavior, behavioral intervention, ehealth), and health terms (eg, smoking, physical activity, diabetes). The search results were reviewed to determine if they met the inclusion and exclusion criteria created to identify empirical research that studied the effect of IA on health outcomes, behavioral outcomes, or website engagement. Articles that met inclusion criteria were assessed for study quality. Then, data from the articles were extracted using a priori categories established by 3 reviewers. However, the limited health outcome data gathered from the studies precluded a meta-analysis. Results: The initial literature search yielded 685 results, which was narrowed down to three publications that examined the effect of information architecture on health outcomes, behavioral outcomes, or website engagement. One publication studied the isolated impact of information architecture on outcomes of interest (ie, website use and engagement; health-related knowledge, attitudes, and beliefs; and health behaviors), while the other two publications studied the impact of information architecture, website features (eg, interactivity, email prompts, and forums), and tailored content on these outcomes. The paper that investigated IA exclusively found that a tunnel IA improved site engagement and behavior knowledge, but it decreased users' perceived efficiency. The first study that did not isolate IA found that the enhanced site condition improved site usage but not the amount of content viewed. The second study that did not isolate IA found that a tailored site condition improved site usage, behavior knowledge, and some behavior outcomes. Conclusions: No clear conclusion can be made about the relationship between IA and health outcomes, given limited evidence in the peer-reviewed literature connecting IA to behavioral outcomes and website engagement. Only one study reviewed solely manipulated IA, and we therefore recommend improving the scientific evidence base such that additional empirical studies investigate the impact of IA in isolation. Moreover, information from the gray literature and expert opinion might be identified and added to the evidence base, in order to lay the groundwork for hypothesis generation to improve empirical evidence on information architecture and health and behavior outcomes. ", doi="10.2196/jmir.7867", url="http://www.jmir.org/2018/3/e97/", url="http://www.ncbi.nlm.nih.gov/pubmed/29563076" } @Article{info:doi/10.2196/humanfactors.8319, author="Dijkstra, Elske Nienke and Sino, Maria Carolina Geertruida and Heerdink, Rob Eibert and Schuurmans, Joanna Marieke", title="Development of eHOME, a Mobile Instrument for Reporting, Monitoring, and Consulting Drug-Related Problems in Home Care: Human-Centered Design Study", journal="JMIR Hum Factors", year="2018", month="Mar", day="07", volume="5", number="1", pages="e10", keywords="primary care", keywords="home care", keywords="eHealth", keywords="mHealth", abstract="Background: Home care patients often use many medications and are prone to drug-related problems (DRPs). For the management of problems related to drug use, home care could add to the multidisciplinary expertise of general practitioners (GPs) and pharmacists. The home care observation of medication-related problems by home care employees (HOME)-instrument is paper-based and assists home care workers in reporting potential DRPs. To facilitate the multiprofessional consultation, a digital report of DRPs from the HOME-instrument and digital monitoring and consulting of DRPs between home care and general practices and pharmacies is desired. Objective: The objective of this study was to develop an electronic HOME system (eHOME), a mobile version of the HOME-instrument that includes a monitoring and a consulting system for primary care. Methods: The development phase of the Medical Research Council (MRC) framework was followed in which an iterative human-centered design (HCD) approach was applied. The approach involved a Delphi round for the context of use and user requirements analysis of the digital HOME-instrument and the monitoring and consulting system followed by 2 series of pilots for testing the usability and redesign. Results: By using an iterative design approach and by involving home care workers, GPs, and pharmacists throughout the process as informants, design partners, and testers, important aspects that were crucial for system realization and user acceptance were revealed. Through the report webpage interface, which includes the adjusted content of the HOME-instrument and added home care practice--based problems, home care workers can digitally report observed DRPs. Furthermore, it was found that the monitoring and consulting webpage interfaces enable digital consultation between home care and general practices and pharmacies. The webpages were considered convenient, clear, easy, and usable. Conclusions: By employing an HCD approach, the eHOME-instrument was found to be an easy-to-use system. The systematic approach promises a valuable contribution for the future development of digital mobile systems of paper-based tools. ", doi="10.2196/humanfactors.8319", url="http://humanfactors.jmir.org/2018/1/e10/", url="http://www.ncbi.nlm.nih.gov/pubmed/29514771" } @Article{info:doi/10.2196/mental.9441, author="Radovic, Ana and Gmelin, Theresa and Hua, Jing and Long, Cassandra and Stein, D. Bradley and Miller, Elizabeth", title="Supporting Our Valued Adolescents (SOVA), a Social Media Website for Adolescents with Depression and/or Anxiety: Technological Feasibility, Usability, and Acceptability Study", journal="JMIR Ment Health", year="2018", month="Feb", day="26", volume="5", number="1", pages="e17", keywords="adolescent", keywords="adolescent health services", keywords="technology", keywords="depression", keywords="anxiety", abstract="Background: Supporting Our Valued Adolescents (SOVA), a social media website for adolescents, was designed to increase mental health literacy and address negative health beliefs toward depression and/or anxiety diagnosis and treatment. This stakeholder-informed site underwent iterative user testing to evolve into its current version with daily blog posts, round-the-clock site moderation, and Web-based peer interaction to create an online support community. Objective: The aim of this study was to evaluate the technological feasibility (at least 100 users on the site, logging in 12 to 18 times in the first 6 weeks) and acceptability of the SOVA site determined by the System Usability Scale (SUS). Methods: Adolescents and young adults (aged 14-26 years) with a self-reported history of depressive and/or anxiety symptoms were recruited to access the research website (sova.pitt.edu). Participants were screened out if they reported active suicidality or a prior suicide attempt. Baseline survey measures included demographics, symptomatology using the Patient Health Questionnaire-9 modified for adolescents (PHQ-9A) and Screen for Child Anxiety Related Disorders (SCARED-C), and mental health treatment history. The 6-week follow-up measures taken in addition to the symptomatology, included feasibility (total number of log-ins), usability, and acceptability of SOVA using SUS. Results: Most of the 96 participants identified as female (75\% [72/96]) and white (67\% [64/96]). Most participants (73\% [70/96]) reported having taken prior professional psychological help. The average PHQ-9A score was 11.8 (SD 5.5), and for SCARED-C, 85\% (80/94) of the participants reported a score consistent with being susceptible to a diagnosed anxiety disorder. There were 46\% (41/90) of eligible users who ever logged in. Out of the total users who ever logged in, the mean of total log-ins over the entire study was 4.1 (SD 6.9). Median number of users rated the user-friendliness of the site as ``good.'' The average SUS score was 71.2\% (SD 18.7), or a ``C-grade,'' which correlated to an acceptable range. The participants reported to have liked the ``easy-to-understand format'' and ``positive, helpful atmosphere,'' but they also reported a desire for greater social interaction. Iterative recruitment resulted in incremental improvements to the site. Conclusions: The SOVA site met feasibility goals of recruiting almost 100 users and establishing acceptable usability. Subsequent interventions are planned to increase site engagement and to evaluate efficacy in increasing uptake of primary care--recommended depression and/or anxiety treatment. ", doi="10.2196/mental.9441", url="http://mental.jmir.org/2018/1/e17/", url="http://www.ncbi.nlm.nih.gov/pubmed/29483067" } @Article{info:doi/10.2196/cancer.8250, author="Wilson, Carlene and Flight, Ingrid and Zajac, T. Ian and Turnbull, Deborah and Young, P. Graeme and Olver, Ian", title="Web-Based Communication Strategies Designed to Improve Intention to Minimize Risk for Colorectal Cancer: Randomized Controlled Trial", journal="JMIR Cancer", year="2018", month="Feb", day="12", volume="4", number="1", pages="e2", keywords="internet", keywords="randomized controlled trial", keywords="information seeking behavior", keywords="consumer health information", keywords="health communication", abstract="Background: People seek information on the Web for managing their colorectal cancer (CRC) risk but retrieve much personally irrelevant material. Targeting information pertinent to this cohort via a frequently asked question (FAQ) format could improve outcomes. Objective: We identified and prioritized colorectal cancer information for men and women aged 35 to 74 years (study 1) and built a website containing FAQs ordered by age and gender. In study 2, we conducted a randomized controlled trial (RCT) to test whether targeted FAQs were more influential on intention to act on CRC risk than the same information accessed via a generic topic list. Secondary analyses compared preference for information delivery, usability, relevance, and likelihood of recommendation of FAQ and LIST websites. Methods: Study 1 determined the colorectal cancer information needs of Australians (N=600) by sex and age group (35-49, 50-59, 60-74) through a Web-based survey. Free-text responses were categorized as FAQs: the top 5 issues within each of the 6 cohorts were identified. Study 2 (N=240) compared the impact of presentation as targeted FAQ links to information with links presented as a generic list (LIST) and a CONTROL (no information) condition. We also tested preference for presentation of access to information as FAQ or LIST by adding a CHOICE condition (a self-selected choice of FAQs or a list of information topics). Results: Study 1 showed considerable consistency in information priorities among all 6 cohorts with 2 main concerns: treatment of CRC and risk factors. Some differences included a focus on general risk factors, excluding diet and lifestyle, in the younger cohort, and on the existence of a test for CRC in the older cohorts. Study 2 demonstrated that, although respondents preferred information access ordered by FAQs over a list, presentation in this format had limited impact on readiness to act on colorectal cancer risk compared with the list or a no-information control (P=.06). Both FAQ and LIST were evaluated as equally usable. Those aged 35 to 49 years rated the information less relevant to them and others in their age group, and information ordered by FAQs was rated, across all age groups and both sexes, as less relevant to people outside the age group targeted within the FAQs. Conclusions: FAQs are preferred over a list as a strategy for presenting access to information about CRC. They may improve intention to act on risk, although further research is required. Future research should aim to identify better the characteristics of information content and presentation that optimize perceived relevance and fully engage the target audience. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12618000137291; https://www.anzctr.org. au/Trial/Registration/TrialReview.aspx?id=374129 (Archived by WebCite at http://www.webcitation.org/6x2Mr6rPC) ", doi="10.2196/cancer.8250", url="http://cancer.jmir.org/2018/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/29434013" } @Article{info:doi/10.2196/humanfactors.7882, author="Kurahashi, M. Allison and Stinson, N. Jennifer and van Wyk, Margaret and Luca, Stephanie and Jamieson, Trevor and Weinstein, Peter and Cafazzo, A. Joseph and Lokuge, Bhadra and Cohen, Eyal and Rapoport, Adam and Husain, Amna", title="The Perceived Ease of Use and Usefulness of Loop: Evaluation and Content Analysis of a Web-Based Clinical Collaboration System", journal="JMIR Hum Factors", year="2018", month="Jan", day="09", volume="5", number="1", pages="e2", keywords="patient-centered care", keywords="patient participation", keywords="chronic disease", keywords="communication", keywords="internet communication tools", keywords="usability testing", keywords="interdisciplinary communication", keywords="health communication", keywords="continuity of patient care", keywords="patient care team", keywords="inventions", abstract="Background: Patients with complex health care needs require the expertise of many health care providers. Communication, collaboration, and patient-centered care positively impact care quality and patient outcomes. Few technologies exist that facilitate collaboration between providers across settings of care and also engage the patient. We developed a Web-based clinical collaboration system, Loop, to address this gap. The likelihood of a technological system's uptake is associated with its perceived ease of use and perceived usefulness. We engaged stakeholders in the conceptualization and development of Loop in an effort to maximize its intuitiveness and utility. Objective: This study aimed to report end users' perceptions about the ease of use and usefulness of Loop captured during usability tests of Loop. Methods: Participants represented three user types (patients, caregivers, and health care providers) recruited from three populations (adults with cancer, adolescents and young adults with cancer, and children with medical complexity). We conducted usability testing over three iterative cycles of testing and development in both laboratory-based and off-site environments. We performed a content analysis of usability testing transcripts to summarize and describe participant perceptions about the ease of use and usefulness of Loop. Results: Participants enjoyed testing Loop and were able to use the core functions---composing, posting, and reading messages---with little difficulty. They had difficulty interpreting certain visual cues and design elements or the purpose of some features. This difficulty negatively impacted perceived ease of use but was primarily limited to auxiliary features. Participants predicted that Loop could improve the efficiency and effectiveness of communication between care team members; however, this perceived usefulness could be compromised by disruptions to personal workflow such as additional time or task requirements. Conclusions: Loop was perceived to have value as a collaboration system; however, usability testing findings indicate that some design and functional elements need to be addressed to improve ease of use. Additionally, participant concerns highlight the need to consider how a system can be implemented so as to minimize impact on workflow and optimize usefulness. ", doi="10.2196/humanfactors.7882", url="http://humanfactors.jmir.org/2018/1/e2/", url="http://www.ncbi.nlm.nih.gov/pubmed/29317386" } @Article{info:doi/10.2196/humanfactors.8387, author="Garvelink, Marjolein Mirjam and Jones, Allyson C. and Archambault, M. Patrick and Roy, No{\'e}mie and Blair, Louisa and L{\'e}gar{\'e}, France", title="Deciding How to Stay Independent at Home in Later Years: Development and Acceptability Testing of an Informative Web-Based Module", journal="JMIR Hum Factors", year="2017", month="Dec", day="14", volume="4", number="4", pages="e32", keywords="decision making", keywords="shared", keywords="housing for the elderly", keywords="decision support techniques", keywords="instruction films and videos", abstract="Background: Seniors with loss of autonomy may face decisions about whether they should stay at home or move elsewhere. Most seniors would prefer to stay home and be independent for as long as possible, but most are unaware of options that would make this possible. Objective: The study aimed to develop and test the acceptability of an interactive website for seniors, their caregivers, and health professionals with short interlinked videos presenting information about options for staying independent at home. Methods: The approach for design and data collection varied, involving a multipronged, user-centered design of the development process, qualitative interviews, and end-user feedback to determine content (ie, needs assessment) in phase I; module development (in English and French) in phase II; and survey to test usability and acceptability with end users in phase III. Phase I participants were a convenience sample of end users, that is, seniors, caregivers, and professionals with expertise in modifiable factors (eg, day centers, home redesign, equipment, community activities, and finances), enabling seniors to stay independent at home for longer in Quebec and Alberta, Canada. Phase II participants were bilingual actors; phase III participants included phase I participants and new participants recruited through snowballing. Qualitative interviews were thematically analyzed in phase II to determine relevant topics for the video-scripts, which were user-checked by interview participants. In phase III, the results of a usability questionnaire were analyzed using descriptive statistics. Results: In phase I, interviews with 29 stakeholders, including 4 seniors, 3 caregivers, and 22 professionals, showed a need for a one-stop information resource about options for staying independent at home. They raised issues relating to 6 categories: cognitive autonomy, psychological or mental well-being, functional autonomy, social autonomy, financial autonomy, and people involved. A script was developed and evaluated by participants. In phase II, after 4 days in a studio with 15 bilingual actors, 30 videos were made of various experts (eg, family doctor, home care nurse, and social worker) presenting options and guidance for the decision-making process. These were integrated into an interactive website, which included a comments tool for visitors to add information. In phase III (n=21), 8 seniors (7 women, mean age 75 years), 7 caregivers, and 6 professionals evaluated the acceptability of the module and suggested improvements. Clarity of the videos scored 3.6 out of 4, length was considered right by 17 (separate videos) and 13 participants (all videos together), and 18 participants considered the module acceptable. They suggested that information should be tailored more, and that seniors may need someone to help navigate it. Conclusions: Our interactive website with interlinked videos presenting information about options for staying independent at home was deemed acceptable and potentially helpful by a diverse group of stakeholders. ", doi="10.2196/humanfactors.8387", url="http://humanfactors.jmir.org/2017/4/e32/", url="http://www.ncbi.nlm.nih.gov/pubmed/29242178" } @Article{info:doi/10.2196/jmir.8424, author="Srikesavan, Swarnalatha Cynthia and Williamson, Esther and Eldridge, Lucy and Heine, Peter and Adams, Jo and Cranston, Tim and Lamb, E. Sarah", title="A Web-Based Training Resource for Therapists to Deliver an Evidence-Based Exercise Program for Rheumatoid Arthritis of the Hand (iSARAH): Design, Development, and Usability Testing", journal="J Med Internet Res", year="2017", month="Dec", day="13", volume="19", number="12", pages="e411", keywords="hand function", keywords="hand exercises", keywords="rheumatoid arthritis", keywords="online training", keywords="implementation", abstract="Background: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) is a tailored, progressive exercise program for people having difficulties with wrist and hand function due to rheumatoid arthritis (RA). The program was evaluated in a large-scale clinical trial and was found to improve hand function, was safe to deliver, and was cost-effective. These findings led to the SARAH program being recommended in the UK National Institute for Health and Care Excellence guidelines for the management of adults with RA. To facilitate the uptake of this evidence-based program by clinicians, we proposed a Web-based training program for SARAH (iSARAH) to educate and train physiotherapists and occupational therapists on delivering the SARAH program in their practice. The overall iSARAH implementation project was guided by the 5 phases of the analysis, design, development, implementation, and evaluation (ADDIE) system design model. Objective: The objective of our study was to conduct the first 3 phases of the model in the development of the iSARAH project. Methods: Following publication of the trial, the SARAH program materials were made available to therapists to download from the trial website for use in clinical practice. A total of 35 therapists who downloaded these materials completed an online survey to provide feedback on practice trends in prescribing hand exercises for people with RA, perceived barriers and facilitators to using the SARAH program in clinical practice, and their preferences for the content and Web features of iSARAH. The development and design of iSARAH were further guided by a team of multidisciplinary health professionals (n=17) who took part in a half-day development meeting. We developed the preliminary version of iSARAH and tested it among therapists (n=10) to identify and rectify usability issues and to produce the final version. Results: The major recommendations made by therapists and the multidisciplinary team were having a simple Web design and layout, clear exercise pictures and videos, and compatibility of iSARAH on various browsers and devices. We rectified all usability issues in the preliminary version to develop the final version of iSARAH, which included 4 short modules and additional sections on self-assessment, frequently asked questions, and a resource library. Conclusions: The use of the ADDIE design model and engagement of end users in the development and evaluation phases have rendered iSARAH a convenient, easy-to-use, and effective Web-based learning resource for therapists on how to deliver the SARAH program. There is also huge potential for adapting iSARAH across different cultures and languages, thus opening more opportunities for wider uptake and application of the SARAH program into practice. ", doi="10.2196/jmir.8424", url="http://www.jmir.org/2017/12/e411/", url="http://www.ncbi.nlm.nih.gov/pubmed/29237581" } @Article{info:doi/10.2196/jmir.6673, author="Lauritsen, Lise and Andersen, Louise and Olsson, Emilia and S{\o}ndergaard, Rauff Stine and N{\o}rregaard, Benn Lasse and L{\o}ventoft, Kaare Philip and Svendsen, Dunker Signe and Fr{\o}kj{\ae}r, Erik and Jensen, M{\o}rch Hans and Hageman, Ida and Kessing, Vedel Lars and Martiny, Klaus", title="Usability, Acceptability, and Adherence to an Electronic Self-Monitoring System in Patients With Major Depression Discharged From Inpatient Wards", journal="J Med Internet Res", year="2017", month="Apr", day="21", volume="19", number="4", pages="e123", keywords="depressive disorder, major", keywords="electronic monitoring", keywords="graph drawing", keywords="sleep", keywords="self-assessment", keywords="observational study", keywords="inpatients", keywords="patient participation", keywords="chronotherapeutics", abstract="Background: Patients suffering from depression have a high risk of relapse and readmission in the weeks following discharge from inpatient wards. Electronic self-monitoring systems that offer patient-communication features are now available to offer daily support to patients, but the usability, acceptability, and adherence to these systems has only been sparsely investigated. Objective: We aim to test the usability, acceptability, adherence, and clinical outcome of a newly developed computer-based electronic self-assessment system (the Daybuilder system) in patients suffering from depression, in the period from discharge until commencing outpatient treatment in the Intensive Outpatient Unit for Affective Disorders. Methods: Patients suffering from unipolar major depression that were referred from inpatient wards to an intensive outpatient unit were included in this study before their discharge, and were followed for four weeks. User satisfaction was assessed using semiqualitative questionnaires and the System Usability Scale (SUS). Patients were interviewed at baseline and at endpoint with the Hamilton depression rating scale (HAM-D17), the Major Depression Inventory (MDI), and the 5-item World Health Organization Well-Being Index (WHO-5). In this four-week period patients used the Daybuilder system to self-monitor mood, sleep, activity, and medication adherence on a daily basis. The system displayed a graphical representation of the data that was simultaneously displayed to patients and clinicians. Patients were phoned weekly to discuss their data entries. The primary outcomes were usability, acceptability, and adherence to the system. The secondary outcomes were changes in: the electronically self-assessed mood, sleep, and activity scores; and scores from the HAM-D17, MDI, and WHO-5 scales. Results: In total, 76\% of enrolled patients (34/45) completed the four-week study. Five patients were readmitted due to relapse. The 34 patients that completed the study entered data for mood on 93.8\% of the days (872/930), sleep on 89.8\% of the days (835/930), activity on 85.6\% of the days (796/930), and medication on 88.0 \% of the days (818/930). SUS scores were 86.2 (standard deviation [SD] 9.7) and 79\% of the patients (27/34) found that the system lived up to their expectations. A significant improvement in depression severity was found on the HAM-D17 from 18.0 (SD 6.5) to 13.3 (SD 7.3; P<.01), on the MDI from 27.1 (SD 13.1) to 22.1 (SD 12.7; P=.006), and in quality of life on the WHO-5 from 31.3 (SD 22.9) to 43.4 (SD 22.1; P<.001) scales, but not on self-assessed mood (P=.08). Mood and sleep parameters were highly variable from day-to-day. Sleep-offset was significantly delayed from baseline, averaging 48 minutes (standard error 12 minutes; P<.001). Furthermore, when estimating delay of sleep-onset (with sleep quality included in the model) during the study period, this showed a significant negative effect on mood (P=.03) Conclusions: The Daybuilder systems performed well technically, and patients were satisfied with the system and had high adherence to self-assessments. The dropout rate and the gradual delay in sleep emphasize the need for continued clinical support for these patients, especially when considering sleep guidance. ", doi="10.2196/jmir.6673", url="http://www.jmir.org/2017/4/e123/", url="http://www.ncbi.nlm.nih.gov/pubmed/28432040" } @Article{info:doi/10.2196/publichealth.6949, author="Munro, Sarah and Hui, Amber and Salmons, Vanessa and Solomon, Carolyn and Gemmell, Emily and Torabi, Nahal and Janssen, A. Patricia", title="SmartMom Text Messaging for Prenatal Education: A Qualitative Focus Group Study to Explore Canadian Women's Perceptions", journal="JMIR Public Health Surveill", year="2017", month="Feb", day="07", volume="3", number="1", pages="e7", keywords="pregnancy", keywords="text messaging", keywords="prenatal education", keywords="health behavior", abstract="Background: We engaged Canadian women in the development of a prenatal education program delivered via one-way text messaging called SmartMom. SmartMom is the first peer-reviewed, evidence-based mHealth program for prenatal education in Canada and the first to be endorsed by the Society of Obstetricians and Gynaecologists of Canada. Objective: To explore women's preferences for a prenatal education program by text messaging. Methods: We conducted a qualitative focus group study in three Canadian communities in the Northern Health Authority. Women completed a demographic questionnaire, participated in a guided discussion about their pregnancy information-seeking behavior, reviewed a printed copy of the SmartMom text messages, and then engaged in a moderated discussion about their perceptions of the usability of the SmartMom program. Open-ended questions explored women's perceptions regarding the message content, acceptability of receiving information by text message, positive health behaviors they might engage in after receiving a message, modifiable program factors, and intention to use the program. Thematic analysis of transcribed audio recordings was undertaken and modifications were made to the SmartMom program based on these findings. Results: A total of 40 women participated in seven focus groups in three rural northern communities. The vast majority had a mobile phone (39/40, 98\%), used text messages ``all the time'' (28/40, 70\%), and surfed the Internet on their phone (37/40, 93\%). Participants perceived SmartMom to be highly acceptable and relevant. The text message modality reflected how participants currently sought pregnancy-related information and provided them with local information tailored to their gestational age, which they had not received through other pregnancy resources. Women recommended adding the opportunity to receive supplemental streams of messages tailored to their individual needs, for example, depression, pregnancy after previous cesarean, >35 years of age, new immigrants, and harm reduction for smoking and alcohol. Conclusions: This formative qualitative evaluation provides evidence that a prenatal education program by text messaging, SmartMom, is acceptable to the end users. These findings support the usability of the SmartMom program at a population level and the development of an evaluation program exploring the effects of the text messages on adoption of health-promoting behaviors and maternal-child health outcomes. ", doi="10.2196/publichealth.6949", url="http://publichealth.jmir.org/2017/1/e7/", url="http://www.ncbi.nlm.nih.gov/pubmed/28174149" }