%0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e64079 %T Best Practice Guide for Reducing Barriers to Video Call–Based Telehealth: Modified Delphi Study Among Health Care Professionals %A Rettinger,Lena %A Aichinger,Lea %A Ertelt-Bach,Veronika %A Huber,Andreas %A Javorszky,Susanne Maria %A Maul,Lukas %A Putz,Peter %A Sargis,Sevan %A Werner,Franz %A Widhalm,Klaus %A Kuhn,Sebastian %+ Research Center Digital Health and Care, FH Campus Wien, University of Applied Sciences Vienna, Favoritenstrasse 226, Vienna, 1100, Austria, 43 6066977 ext 4382, lena.rettinger@fh-campuswien.ac.at %K telehealth %K best practices %K video call %K Delphi study %K health communication %K barriers %K health care professionals %K qualitative interviews %K web-based survey %K physiotherapists %K speech therapists %K language therapists %K dietitians %K midwife %D 2025 %7 26.3.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Telehealth has grown, especially during the COVID-19 pandemic, improving access for those in remote or underserved areas. However, its implementation faces technological, practical, and interpersonal barriers. Objective: The aim of this study was to identify and consolidate best practices for telehealth delivery, specifically for video call sessions, by synthesizing the insights of health care professionals across various disciplines. Methods: We first identified 15 common telehealth barriers from a preceding scoping review. Subsequently, a modified Delphi method was used, involving 9 health care professionals (physiotherapists, speech and language therapists, dietitians, and midwife) with telehealth experience in qualitative interviews and 2 iterative rounds of web-based surveys to form consensus. Results: This study addressed 15 telehealth barriers and identified 105 best practices. Among these, 20 are technology-related and 85 concern health care practices. Emphasis was placed on setting up telehealth environments, ensuring safety, building relationships and trust, using nonmanual methods, and enhancing observation and assessment skills. Best practice recommendations for dealing with patients or caregiver skepticism or lack of telehealth-specific knowledge were developed. Further, approaches for unstable networks and privacy and IT security issues were identified. Areas with fewer best practices were the lack of technology skills or technology access, unreliability of hardware and software, increased workload, and a lack of caregiver support. Conclusions: This guide of best practices serves as an actionable resource for health care providers to navigate the complexities of telehealth. Despite a small participant sample and the potential for profession-specific biases, the findings provide a foundation for improving telehealth services and inform future research for its application and education. %M 40138694 %R 10.2196/64079 %U https://humanfactors.jmir.org/2025/1/e64079 %U https://doi.org/10.2196/64079 %U http://www.ncbi.nlm.nih.gov/pubmed/40138694 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e67634 %T Authors’ Reply: Promoting Oral Health Literacy Among UAE Public Sector Employees %A Carrouel,Florence %A du Sartz de Vigneulles,Benjamin %A Clément,Céline %A Lvovschi,Virginie-Eve %A Verot,Elise %A Tantardini,Valeria %A Lamure,Michel %A Bourgeois,Denis %A Dussart,Claude %A Lan,Romain %K health literacy %K oral health literacy %K workplace %K civil servant %K health promotion %K prevention %K United Arab Emirates %D 2024 %7 12.11.2024 %9 %J JMIR Public Health Surveill %G English %X %R 10.2196/67634 %U https://publichealth.jmir.org/2024/1/e67634 %U https://doi.org/10.2196/67634 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e66452 %T Promoting Oral Health Literacy Among UAE Public Sector Employees %A Nair,Satish C %K health literacy %K Gulf countries %K oral health literacy %K health promotion %K United Arab Emirates %K workplace %D 2024 %7 12.11.2024 %9 %J JMIR Public Health Surveill %G English %X %R 10.2196/66452 %U https://publichealth.jmir.org/2024/1/e66452 %U https://doi.org/10.2196/66452 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e63390 %T Gamification in the Design of Virtual Patients for Swedish Military Medics to Support Trauma Training: Interaction Analysis and Semistructured Interview Study %A Stathakarou,Natalia %A Kononowicz,Andrzej A %A Mattsson,Erik %A Karlgren,Klas %+ Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Tomtebodavägen 18A, Solna, Stockholm, 171 77, Sweden, 46 707799671, natalia.stathakarou@ki.se %K military trauma %K gamification %K game elements %K serious games %K virtual patients %K trauma %K medical training %K medical education %K medical assessment %K emergency care %K first aid %K basic life support %K trauma care %K medics %K military %D 2024 %7 22.10.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: This study explores gamification in the design of virtual patients (VPs) to enhance the training of Swedish military medics in trauma care. The challenges related to prehospital trauma care faced on the battlefield require tailored educational tools that support military medics’ education and training. Objective: The aim of the study is to investigate how to design VPs with game elements for Swedish military medics to support learning in military trauma care. By understanding the reasoning and perceptions of military medics when interacting with VPs, this study aims to provide insights and recommendations for designing VPs with game elements that are specifically tailored to their needs. Methods: The study involved 14 Swedish military medics of the Home Guard–National Security Forces participating in a tactical combat care course. Participants interacted with 3 different VP cases designed to simulate military trauma scenarios. Data were collected through think-aloud sessions and semistructured interviews. The data were analyzed using interaction analysis, structured by the unawareness, problem identification, explanation, and alternative strategies or solutions (uPEA) framework, and reflexive thematic analysis to explore participants’ reasoning processes and perceptions and identify possible game elements to inform the VP design. Results: Mapping the military medics’ reasoning to the uPEA framework revealed that study participants became more creative after making a mistake followed by feedback and after receiving a prompt to make a new decision. The thematic analysis revealed 6 themes: motivation, “keep on trying”; agency in interaction with VPs; realistic tactical experience; confidence, “I know that the knowledge I have works”; social influence on motivation; and personalized learning. Participants suggested that game elements such as scoring; badges; virtual goods; progress bars; performance tables; content unlocking; hints; challenge; control; imposed choice; narrative; avatars; sensation; randomness; difficulty adapting; competition; leaderboards; social pressure; progression; and renovation can promote engagement, motivation, and support confidence in decision-making. Conclusions: Gamification in the design of VPs represents a promising approach to military medical training, offering a platform for medics to practice medical and tactical decision-making in a risk-free environment. The insights gained by the study may encourage designing VPs with game elements, as well as including possibly wrong decisions, their consequences, and relevant feedback, that may support military medics’ reflections and decision-making. %M 39436692 %R 10.2196/63390 %U https://games.jmir.org/2024/1/e63390 %U https://doi.org/10.2196/63390 %U http://www.ncbi.nlm.nih.gov/pubmed/39436692 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e53793 %T Predicting Adherence to Computer-Based Cognitive Training Programs Among Older Adults: Study of Domain Adaptation and Deep Learning %A Singh,Ankita %A Chakraborty,Shayok %A He,Zhe %A Pang,Yuanying %A Zhang,Shenghao %A Subedi,Ronast %A Lustria,Mia Liza %A Charness,Neil %A Boot,Walter %K domain adaptation %K adherence %K cognitive training %K deep neural networks %K early detection of cognitive decline %D 2024 %7 16.9.2024 %9 %J JMIR Aging %G English %X Background: Cognitive impairment and dementia pose a significant challenge to the aging population, impacting the well-being, quality of life, and autonomy of affected individuals. As the population ages, this will place enormous strain on health care and economic systems. While computerized cognitive training programs have demonstrated some promise in addressing cognitive decline, adherence to these interventions can be challenging. Objective: The objective of this study is to improve the accuracy of predicting adherence lapses to ultimately develop tailored adherence support systems to promote engagement with cognitive training among older adults. Methods: Data from 2 previously conducted cognitive training intervention studies were used to forecast adherence levels among older participants. Deep convolutional neural networks were used to leverage their feature learning capabilities and predict adherence patterns based on past behavior. Domain adaptation (DA) was used to address the challenge of limited training data for each participant, by using data from other participants with similar playing patterns. Time series data were converted into image format using Gramian angular fields, to facilitate clustering of participants during DA. To the best of our knowledge, this is the first effort to use DA techniques to predict older adults’ daily adherence to cognitive training programs. Results: Our results demonstrated the promise and potential of deep neural networks and DA for predicting adherence lapses. In all 3 studies, using 2 independent datasets, DA consistently produced the best accuracy values. Conclusions: Our findings highlight that deep learning and DA techniques can aid in the development of adherence support systems for computerized cognitive training, as well as for other interventions aimed at improving health, cognition, and well-being. These techniques can improve engagement and maximize the benefits of such interventions, ultimately enhancing the quality of life of individuals at risk for cognitive impairments. This research informs the development of more effective interventions, benefiting individuals and society by improving conditions associated with aging. %R 10.2196/53793 %U https://aging.jmir.org/2024/1/e53793 %U https://doi.org/10.2196/53793 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58942 %T Promoting Health Literacy in the Workplace Among Civil Servants: Cross-Sectional Study %A Carrouel,Florence %A du Sartz de Vigneulles,Benjamin %A Clément,Céline %A Lvovschi,Virginie-Eve %A Verot,Elise %A Tantardini,Valeria %A Lamure,Michel %A Bourgeois,Denis %A Lan,Romain %A Dussart,Claude %K health literacy %K oral health literacy %K workplace %K civil servant %K health promotion %K prevention %D 2024 %7 15.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: In 2022, the World Health Organization highlighted the alarming state of oral health (OH) worldwide and urged action to include OH in initiatives on noncommunicable diseases. The population needs improved OH skills and attitudes and an adequate level of OH literacy (OHL) and general health literacy (HL). The implementation of health promotion actions in the workplace, which is a part of most people’s lives, appears to be an opportunity. In France, civil servants have several socioprofessional levels and represent an excellent model with results transposable to the population. Objective: This study aimed at determining the OHL and HL level of civil servants in France in order to implement specific prevention actions in their workplaces. Methods: A cross-sectional study of French civil servants was conducted in France from October 2023 to February 2024. Participants completed three validated questionnaires in French: (1) a questionnaire on OH knowledge, (2) the Oral Health Literacy Instrument, French version (OHLI-F; this is composed of reading comprehension and numeracy sections) to assess the OHL level, and (3) the Short Test of Functional Health Literacy in Adults, French version (s-TOFHLA-F) to assess the HL level. The scores for OH knowledge, the OHLI-F, and the s-TOFHLA-F were reported as means (SD) and the 95% CI. These scores were classified into 3 categories: adequate (75-100), marginal (60-74) and inadequate (0-59). ANOVA and binary logistic regression were performed. The OHLI-F reading comprehension and OHLI-F numeracy scores were compared using the Welch 2-sample t test and a paired t test (both 2-tailed). For the correlation matrix, the Pearson correlation and related tests were computed. Results: A total of 1917 persons completed the 3 questionnaires, with adequate levels of OHL (n=1610, 84%), OH knowledge (n=1736, 90.6%), and HL (n=1915, 99.9%). The scores on the s-TOFHLA-F (mean 98.2, SD 2.8) were higher than the OHLI-F (mean 80.9, SD 7.9) and OH knowledge (mean 87.6, SD 10.5). The OHLI-F was highly correlated with OH knowledge (P<.001), but the OHLI-F and OH knowledge had a low correlation with s-TOFHLA-F (P=.43). The OHLI-F reading comprehension score was significantly higher than the OHLI-F numeracy score (P<.001). Age, education level, and professional category impacted the 3 scores (P<.001). The professional category was a determinant of adequate OHLI-F and OH knowledge scores. Conclusions: Some French civil servants had inadequate or marginal levels of OH knowledge (n=181, 9.5%) and OHL (n=307, 16%) but none had an inadequate level of HL. Results highlighted the relevance of implementing OH promotion programs in the workplace. They should be nonstandardized, adapted to the literacy level of professional categories of workers, and focused on numeracy skills. Thus, appropriate preventive communication and improved literacy levels are the means to achieve greater disease equity and combat the burden of noncommunicable diseases. %R 10.2196/58942 %U https://publichealth.jmir.org/2024/1/e58942 %U https://doi.org/10.2196/58942 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57586 %T Training Service Users in the Use of Telehealth: Scoping Review %A Galvin,Emer %A Desselle,Shane %A Gavin,Blánaid %A McNicholas,Fiona %A Cullinan,Shane %A Hayden,John %+ School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, 111 St Stephen's Green, Dublin, D02 YN77, Ireland, 353 1 402 2100, emergalvin20@rcsi.ie %K telehealth %K video consultations %K training %K education %K older adults %K digital divide %K digital literacy %K review %K scoping review %K modality of care %K training service %K user %K users %K older adult %K gerontology %K geriatric %K geriatrics %K caregiver %K caregivers %K consultation %K consultations %K health care professional %K health care professionals %K PRISMA-ScR %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews %K data extraction %K phone %K phones %K telemonitoring %D 2024 %7 31.7.2024 %9 Review %J J Med Internet Res %G English %X Background: The use of telehealth has rapidly increased, yet some populations may be disproportionally excluded from accessing and using this modality of care. Training service users in telehealth may increase accessibility for certain groups. The extent and nature of these training activities have not been explored. Objective: The objective of this scoping review is to identify and describe activities for training service users in the use of telehealth. Methods: Five databases (MEDLINE [via PubMed], Embase, CINAHL, PsycINFO, and Web of Science) were searched in June 2023. Studies that described activities to train service users in the use of synchronous telehealth consultations were eligible for inclusion. Studies that focused on health care professional education were excluded. Papers were limited to those published in the English language. The review followed the Joanna Briggs Institute guidelines for scoping reviews and was reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Titles and abstracts were screened by 1 reviewer (EG). Full texts were screened by 2 reviewers (EG and JH or SC). Data extraction was guided by the research question. Results: The search identified 8087 unique publications. In total, 13 studies met the inclusion criteria. Telehealth training was commonly described as once-off preparatory phone calls to service users before a telehealth visit, facilitated primarily by student volunteers, and accompanied by written instructions. The training content included guidance on how to download and install software, troubleshoot technical issues, and adjust device settings. Older adults were the most common target population for the training. All but 1 of the studies were conducted during the COVID-19 pandemic. Overall, training was feasible and well-received by service users, and studies mostly reported increased rates of video visits following training. There was limited and mixed evidence that training improved participants’ competency with telehealth. Conclusions: The review mapped the literature on training activities for service users in telehealth. The common features of telehealth training for service users included once-off preparatory phone calls on the technical elements of telehealth, targeted at older adults. Key issues for consideration include the need for co-designed training and improving the broader digital skills of service users. There is a need for further studies to evaluate the outcomes of telehealth training activities in geographically diverse areas. %M 39083789 %R 10.2196/57586 %U https://www.jmir.org/2024/1/e57586 %U https://doi.org/10.2196/57586 %U http://www.ncbi.nlm.nih.gov/pubmed/39083789 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56138 %T An e-Learning Course to Train General Practitioners in Planetary Health: Pilot Intervention Study %A Tourrette,Cédric %A Tostain,Jean-Baptiste %A Kozub,Eva %A Badreddine,Maha %A James,Julia %A Noraz,Aurore %A De Choudens,Charlotte %A Moulis,Lionel %A Duflos,Claire %A Carbonnel,Francois %+ Desbrest Institute of Epidemiology and Public Health, Montpellier University, INSERM, Campus Sante, IURC, 641 Avenue du Doyen Gaston Giraud, Montpellier, 34093, France, 33 684014834, francois.carbonnel@umontpellier.fr %K planetary health %K One Health %K medical education %K environmental health %K education %K e-learning %K general practitioner %K pilot study %K climate change %K training %K environmental %K e-learning module %K behavior change %K ecosystem %K questionnaire %K behavior %K self-assessment %K e-learning intervention %K environment %D 2024 %7 14.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: According to the World Health Organization, climate and ecological emergencies are already major threats to human health. Unabated climate change will cause 3.4 million deaths per year by the end of the century, and health-related deaths in the population aged ≥65 years will increase by 1540%. Planetary health (PH) is based on the understanding that human health and human civilization depend on flourishing natural systems and the wise stewardship of those natural systems. Health care systems collectively produce global emissions equivalent to those of the fifth largest country on earth, and they should take steps to reduce their environmental impact. Primary care in France accounts for 23% of greenhouse gas emissions in the health care sector. General practitioners (GPs) have an important role in PH. The course offers first-year GP residents of the Montpellier-Nîmes Faculty of Medicine a blended-learning course on environmental health. An e-learning module on PH, lasting 30 to 45 minutes, has been introduced in this course. Objective: The objective of this study was to assess the impact of the e-learning module on participants’ knowledge and behavior change. Methods: This was a before-and-after study. The module consisted of 3 parts: introduction, degradation of ecosystems and health (based on the Intergovernmental Panel on Climate Change report and planetary limits), and ecoresponsibility (based on the Shift Project report on the impact of the health care system on the environment). The questionnaire used Likert scales to self-assess 10 points of knowledge and 5 points of PH-related behavior. Results: A total of 95 participants completed the pre- and posttest questionnaires (response rate 55%). The mean scores for participants’ pretest knowledge and behaviors were 3.88/5 (SD 0.362) and 3.45/5 (SD 0.705), respectively. There was no statistically significant variation in the results according to age or gender. The pretest mean score of participants who had already taken PH training was statistically better than those who had not taken the PH training before this course (mean 4.05, SD 0.16 vs mean 3.71, SD 0.374; P<.001). Conclusions: The PH module of the Primary Care Environment and Health course significantly improved self-assessment knowledge scores and positively modified PH behaviors among GP residents. Further work is needed to study whether these self-declared behaviors are translated into practice. %M 38743463 %R 10.2196/56138 %U https://formative.jmir.org/2024/1/e56138 %U https://doi.org/10.2196/56138 %U http://www.ncbi.nlm.nih.gov/pubmed/38743463 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e54230 %T Perspectives of Medical Students and Developers Regarding Virtual Reality, Augmented Reality, Mixed Reality, and 3D Printing Technologies: Survey Study %A Yun,Young Hyun %A Shin,Dong Hoon %A Choi,Hyung Jin %+ Department of Anatomy and Cell Biology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 27408204, hjchoi@snu.ac.kr %K medical student %K developer %K virtual reality %K augmented reality %K mixed reality %K 3D printing %K perspective %K survey %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR XR Spatial Comput %G English %X 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. %R 10.2196/54230 %U https://xr.jmir.org/2024/1/e54230 %U https://doi.org/10.2196/54230 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52929 %T Inhibitory Control Training for Anxiety and Math Achievement in Primary School Children: Protocol for a Proof-of-Concept Study %A Edwards,Elizabeth %A Chu,Khanh Linh %A Carroll,Annemaree %+ The University of Queensland, School of Education, St Lucia, Q 4072, Australia, 61 0481906968, elizabeth.edwards@uq.edu.au %K cognitive control training %K anxiety %K inhibitory control %K math achievement %D 2024 %7 13.3.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cognitive control training (CCT) has shown potential to reduce emotional vulnerability in adults and adolescents. However, there is scant literature testing the efficacy of CCT for the reduction of anxiety and transferring the effects to educational outcomes in children. Building on the evidence that a greater ability to suppress a prepotent response (inhibitory control) is associated with higher math achievement in children, it is plausible that training inhibitory processes using a CCT paradigm may be beneficial for reducing anxiety, improving inhibitory control, and in turn increasing math achievement. Objective: This proof-of-concept study aims to investigate the efficacy of 15 sessions of inhibitory control training for reduction in anxiety and improvement in math achievement in primary school children. Methods: We will use a 2 (group: CCT, adaptive Go/No-Go vs active control, low-load task) multiplied by 4 (time: pre- vs posttraining vs 1-month vs 3-month follow-up) randomized design in a nonselected sample of 100 children aged 8-10 years. Both groups will complete 10 minutes of daily training for 3 weeks at school. The dependent variables will be anxiety and correlates (Spence Children’s Anxiety Scale, Penn State Worry Questionnaire for Children, Revised Children’s Anxiety and Depression Scale, Child Response Style Questionnaire, and Modified Abbreviated Math Anxiety Scale), inhibitory control (Go/No-Go task), shifting (color-shape shifting task), updating (n-back task), and math achievement (Applied Problems, Calculation, and Math Facts Fluency subtests from the Woodcock-Johnson IV Tests of Achievement). Results: We opened enrollment in September 2023. The initial results are expected to be published in late 2024. We predict that children in the CCT group will show a reduction in emotional symptoms; improvements in inhibition, shifting, and updating performance; and advances in math achievement from pre- to posttraining, and that these effects will be maintained at 1- and 3-month follow-ups, compared to children in the active control group. Conclusions: The CCT paradigm used in our study will provide a greater understanding of the emotional and cognitive transfer effects on children and inform future work. Specifically, the findings will advance the knowledge of deploying inhibitory control training with children and provide valuable insights into its use for reducing anxiety and advancing math achievement. Trial Registration: Open Science Framework ofs.io/de2qa; https://doi.org/10.17605/OSF.IO/DE2QA International Registered Report Identifier (IRRID): PRR1-10.2196/52929 %M 38477976 %R 10.2196/52929 %U https://www.researchprotocols.org/2024/1/e52929 %U https://doi.org/10.2196/52929 %U http://www.ncbi.nlm.nih.gov/pubmed/38477976 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50798 %T Effectiveness of Interventions to Improve Digital Health Literacy in Forced Migrant Populations: Protocol for a Mixed Methods Systematic Review %A Yameogo,Achille Roghemrazangba %A Délétroz,Carole %A Sasseville,Maxime %A Amil,Samira %A Da,Sié Mathieu Aymar Romaric %A Bodenmann,Patrick %A Gagnon,Marie-Pierre %+ Faculté des Sciences Infirmières, Université Laval, 1050, Avenue de la Médecine, Québec, QC, R-G1V 0A6, Canada, 1 5819936002, achillosyam@gmail.com %K intervention %K digital health literacy %K forced migrant populations %K health literacy %K digital literacy %K migrant %K migrants %K immigrant %K immigrants %K knowledge synthesis %K review methods %K review methodology %K systematic %K eHealth literacy %D 2023 %7 2.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Digital health literacy is considered a health determinant that can influence improved health and well-being, health equity, and the reduction of social health inequalities. Therefore, it serves as an asset for individuals to promote their health. However, low digital health literacy is a major problem among forced migrant populations. They do not always have the capacity and skills to access digital health resources and use them appropriately. To our knowledge, no studies are currently available to examine effective interventions for improving digital health literacy among forced migrant populations. Objective: This paper presents the protocol for a systematic review that aims to assess the effectiveness of digital health literacy interventions among forced migrant populations. With this review, our objectives are as follows: (1) identify interventions designed to improve digital health literacy among forced migrant populations, including interventions aimed at creating enabling conditions or environments that cater to the needs and expectations of forced migrants limited by low levels of digital health literacy, with the goal of facilitating their access to and use of eHealth resources; (2) define the categories and describe the characteristics of these interventions, which are designed to enhance the abilities of forced migrants or adapt digital health services to meet the needs and expectations of forced migrant populations. Methods: A mixed methods systematic review will be conducted according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) checklist. The research will be conducted in an iterative process among the different authors. With the help of a medical information specialist, a specific search strategy will be formulated for the 6 most relevant databases (ie, MEDLINE, Embase, CINAHL, Web of Science, Academic Search Premier, PsycINFO, and the Google Scholar search engine). A literature search covering studies published between 2000 and 2022 has already been conducted. Two reviewers then proceeded, individually and independently, to conduct a double selection of titles, abstracts, and then full texts. Data extraction will be conducted by a reviewer and validated by a senior researcher. We will use the narrative synthesis method (ie, structured narrative summaries of key themes) to present a comprehensive picture of effective digital health literacy interventions among forced migrant populations and the success factors of these interventions. Results: The search strategy and literature search were completed in December 2022. A total of 1232 articles were identified. The first selection was completed in July 2023. The second selection is still in progress. The publication of the systematic review is scheduled for December 2023. Conclusions: This mixed methods systematic review will provide comprehensive knowledge on effective interventions for digital literacy among forced migrant populations. The evidence generated will further inform stakeholders and aid decision makers in promoting equitable access to and use of digital health resources for forced migrant populations and the general population in host countries. International Registered Report Identifier (IRRID): DERR1-10.2196/50798 %M 37917139 %R 10.2196/50798 %U https://www.researchprotocols.org/2023/1/e50798 %U https://doi.org/10.2196/50798 %U http://www.ncbi.nlm.nih.gov/pubmed/37917139 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e49675 %T The Impact of Feedback Modalities and the Influence of Cognitive Load on Interpersonal Communication in Nonclinical Settings: Experimental Study Design %A Rego,Chryselle %A Montague,Enid %+ Jarvis College of Computing and Digital Media, DePaul University, 1 E Jackson Blvd, Chicago, IL, 60604, United States, 1 3126873958, crego@depaul.edu %K physician-patient interaction %K cognitive load %K visual feedback %K haptic feedback %K postsession feedback %D 2023 %7 5.10.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The escalating demands of modern health care systems, combined with the emotional toll of patient care, have led to an alarming increase in physician burnout rates. This burnout, characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment, can hinder doctors’ ability to connect with patients effectively. Moreover, the cognitive load arising from information overload and the need for multitasking can further hinder doctors’ ability to connect with patients effectively. Understanding the complex relationship between physician burnout and cognitive load is crucial for devising targeted interventions that enhance physician well-being and promote effective physician-patient interactions. Implementing strategies to alleviate burnout and cognitive load can lead to improved health care experiences and patient outcomes. Objective: Our study explores the interplay between physician burnout and its potential impact on interpersonal communication, particularly focusing on the role of cognitive load using a pilot study in a nonclinical setting involving nonclinical participants. Methods: This study uses an experimental design to evaluate 3 feedback tools (haptic, visual, and postvisit summary) and measure the cognitive load they impose on nonclinical participants in a nonclinical environment. The NASA Task Load Index, a widely accepted measure of cognitive load, was used to quantify the cognitive load associated with the feedback tools. The study used a within-subject design, meaning participants experienced all 3 feedback methods. A sample of 18 nonclinical participants was selected using counterbalancing techniques. Results: Postsession feedback not only enhancing performance but also mitigating the influence of cognitive load as compared with real-time feedback (haptic+visual). Participants with interview experience showed lower cognitive load levels when exposed to real-time feedback as compared with novice users. In contrast, postsession feedback was more effective for novice users. In addition, cognitive workload emerged as a moderating factor in the relationship between feedback tools and their impact on performance, particularly in terms of speaking balance and pace. This moderating effect suggests that the correlation between feedback tool efficacy and performance varies based on an individual’s cognitive load while using the feedback tool. The comparison of postfeedback with haptic feedback yielded a Z score of −3.245 and a P value of .001, while the comparison with visual feedback resulted in a Z score of −2.940 and a P value of .003. These outcomes underscore a significant disparity in the means between postsession feedback and real-time feedback (haptic+visual), with postsession feedback indicating the lowest mean score. Conclusions: Through the examination of various feedback tools, this study yields significant and insightful comparisons regarding their usability and appropriateness in nonclinical settings. To enhance the applicability of these findings to clinical environments, further research encompassing diverse participant cohorts and clinical scenarios is warranted. %M 37796596 %R 10.2196/49675 %U https://humanfactors.jmir.org/2023/1/e49675 %U https://doi.org/10.2196/49675 %U http://www.ncbi.nlm.nih.gov/pubmed/37796596 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 8 %P e37952 %T Digital Patient Experience: Umbrella Systematic Review %A Wang,Tingting %A Giunti,Guido %A Melles,Marijke %A Goossens,Richard %+ Industrial Design Engineering, Delft University of Technology, Gebouw 32, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 623018218, t.wang-8@tudelft.nl %K digital health %K eHealth %K telemedicine %K telehealth %K mobile health %K mHealth %K patient experience %K user experience %K influencing factors %K user-centered design %K human-computer interaction %D 2022 %7 4.8.2022 %9 Review %J J Med Internet Res %G English %X Background: The adoption and use of technology have significantly changed health care delivery. Patient experience has become a significant factor in the entire spectrum of patient-centered health care delivery. Digital health facilitates further improvement and empowerment of patient experiences. Therefore, the design of digital health is served by insights into the barriers to and facilitators of digital patient experience (PEx). Objective: This study aimed to systematically review the influencing factors and design considerations of PEx in digital health from the literature and generate design guidelines for further improvement of PEx in digital health. Methods: We performed an umbrella systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. We searched Scopus, PubMed, and Web of Science databases. Two rounds of small random sampling (20%) were independently reviewed by 2 reviewers who evaluated the eligibility of the articles against the selection criteria. Two-round interrater reliability was assessed using the Fleiss-Cohen coefficient (k1=0.88 and k2=0.80). Thematic analysis was applied to analyze the extracted data based on a small set of a priori categories. Results: The search yielded 173 records, of which 45 (26%) were selected for data analysis. Findings and conclusions showed a great diversity; most studies presented a set of themes (19/45, 42%) or descriptive information only (16/45, 36%). The digital PEx–related influencing factors were classified into 9 categories: patient capability, patient opportunity, patient motivation, intervention technology, intervention functionality, intervention interaction design, organizational environment, physical environment, and social environment. These can have three types of impacts: positive, negative, or double edged. We captured 4 design constructs (personalization, information, navigation, and visualization) and 3 design methods (human-centered or user-centered design, co-design or participatory design, and inclusive design) as design considerations. Conclusions: We propose the following definition for digital PEx: “Digital patient experience is the sum of all interactions affected by a patient’s behavioral determinants, framed by digital technologies, and shaped by organizational culture, that influence patient perceptions across the continuum of care channeling digital health.” In this study, we constructed a design and evaluation framework that contains 4 phases—define design, define evaluation, design ideation, and design evaluation—and 9 design guidelines to help digital health designers and developers address digital PEx throughout the entire design process. Finally, our review suggests 6 directions for future digital PEx–related research. %M 35925651 %R 10.2196/37952 %U https://www.jmir.org/2022/8/e37952 %U https://doi.org/10.2196/37952 %U http://www.ncbi.nlm.nih.gov/pubmed/35925651 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e31464 %T Overcoming Decisional Gaps in High-Risk Prescribing by Junior Physicians Using Simulation-Based Training: Protocol for a Randomized Controlled Trial %A Lauffenburger,Julie C %A DiFrancesco,Matthew F %A Barlev,Renee A %A Robertson,Ted %A Kim,Erin %A Coll,Maxwell D %A Haff,Nancy %A Fontanet,Constance P %A Hanken,Kaitlin %A Oran,Rebecca %A Avorn,Jerry %A Choudhry,Niteesh K %+ Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street Suite 3030, Boston, MA, 02120, United States, 1 6175258865, jlauffenburger@bwh.harvard.edu %K pragmatic trial %K behavioral science %K prescribing %K benzodiazepines %K antipsychotics %K impact evaluation %D 2022 %7 27.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Gaps between rational thought and actual decisions are increasingly recognized as a reason why people make suboptimal choices in states of heightened emotion, such as stress. These observations may help explain why high-risk medications continue to be prescribed to acutely ill hospitalized older adults despite widely accepted recommendations against these practices. Role playing and other efforts, such as simulation training, have demonstrated benefits to help people avoid decisional gaps but have not been tested to reduce overprescribing of high-risk medications. Objective: This study aims to evaluate the impact of a simulation-based training program designed to address decisional gaps on prescribing of high-risk medications compared with control. Methods: In this 2-arm pragmatic trial, we are randomizing at least 36 first-year medical resident physicians (ie, interns) who provide care on inpatient general medicine services at a large academic medical center to either intervention (simulation-based training) or control (online educational training). The intervention comprises a 40-minute immersive individual simulation training consisting of a reality-based patient care scenario in a simulated environment at the beginning of their inpatient service rotation. The simulation focuses on 3 types of high-risk medications, including benzodiazepines, antipsychotics, and sedative hypnotics (Z-drugs), in older adults, and is specifically designed to help the physicians identify their reactions and prescribing decisions in stressful situations that are common in the inpatient setting. The simulation scenario is followed by a semistructured debriefing with an expert facilitator. The trial’s primary outcome is the number of medication doses for any of the high-risk medications prescribed by the interns to patients aged 65 years or older who were not taking one of the medications upon admission. Secondary outcomes include prescribing by all providers on the care team, being discharged on 1 of the medications, and prescribing of related medications (eg, melatonin, trazodone), or the medications of interest for the control intervention. These outcomes will be measured using electronic health record data. Results: Recruitment of interns began on March 29, 2021. Recruitment for the trial ended in Q42021, with follow-up completed by Q12022. Conclusions: This trial will evaluate the impact of a simulation-based training program designed using behavioral science principles on prescribing of high-risk medications by junior physicians. If the intervention is shown to be effective, this approach could potentially be reproducible by others and for a broader set of behaviors. Trial Registration: ClinicalTrials.gov NCT04668248; https://clinicaltrials.gov/ct2/show/NCT04668248 International Registered Report Identifier (IRRID): PRR1-10.2196/31464 %M 35475982 %R 10.2196/31464 %U https://www.researchprotocols.org/2022/4/e31464 %U https://doi.org/10.2196/31464 %U http://www.ncbi.nlm.nih.gov/pubmed/35475982 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 7 %N 1 %P e32162 %T Implementation of Teleophthalmology to Improve Diabetic Retinopathy Surveillance: Qualitative Interview Study of Clinical Staff Informed by Implementation Science Frameworks %A Ramchandran,Rajeev S %A Yousefi-Nooraie,Reza %A Dadgostar,Porooshat %A Yilmaz,Sule %A Basant,Jesica %A Dozier,Ann M %+ Flaum Eye Institute, University of Rochester Medical Center, 601 Elmwood Ave Box 659, Rochester, NY, 14642, United States, 1 5853760361, Rajeev_Ramchandran@URMC.Rochester.edu %K Consolidated Framework for Implementation Research %K teleophthalmology %K diabetic retinopathy %K implementation %K qualitative study %K Practical, Robust Implementation and Sustainability Model %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Diabetes %G English %X Background: The store-and-forward camera-based evaluation of the eye, or teleophthalmology, is an effective way to identify diabetic retinopathy, the leading cause of blindness in the United States, but uptake has been slow. Understanding the barriers to and facilitators of implementing teleophthalmology programs from those actively adopting, running, and sustaining such programs is important for widespread adoption. Objective: This study aims to understand the factors that are important in introducing teleophthalmology to improve access to diagnostic eye care for patients with diabetes in primary care clinics by using implementation science. Methods: This qualitative study in 3 urban, low-income, largely racial and ethnic minority–serving safety-net primary care clinics in Rochester, New York, interviewed nurses and physicians on implementing a teleophthalmology program by using questions informed by the Practical, Robust Implementation and Sustainability Model and the Consolidated Framework for Implementation Research. Results: Primary care nurses operationalizing the program in their clinics saw increased work burden and a lack of self-efficacy as barriers. Continuous training on the teleophthalmology process for nurses, physicians, and administrative staff through in-service and peer training by champions and superusers were identified by interviewees as needs. Facilitators included the perceived convenience for the patient and a perceived educational advantage to the program, as it gave an opportunity for providers to discuss the importance of eye care with patients. Concerns in making and tracking referrals to ophthalmology because of challenges related to care coordination were highlighted. The financial aspects of the program (eg, patient coverage and care provider reimbursement) were unclear to many staff members, influencing adoption and sustainability. Conclusions: Streamlining processes and workflows, training and assigning adequate staff, effectively coordinating care between primary care and eye care to improve follow-ups, and ensuring financial viability can all help streamline the adoption of teleophthalmology. %M 35353038 %R 10.2196/32162 %U https://diabetes.jmir.org/2022/1/e32162 %U https://doi.org/10.2196/32162 %U http://www.ncbi.nlm.nih.gov/pubmed/35353038 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30883 %T Applications and User Perceptions of Smart Glasses in Emergency Medical Services: Semistructured Interview Study %A Zhang,Zhan %A Joy,Karen %A Harris,Richard %A Ozkaynak,Mustafa %A Adelgais,Kathleen %A Munjal,Kevin %+ School of Computer Science and Information Systems, Pace University, 163 William Street, New York, NY, 10078, United States, 1 2123461897, zzhang@pace.edu %K smart glasses %K hands-free technologies %K emergency medical services %K user studies %K mobile phone %D 2022 %7 28.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Smart glasses have been gaining momentum as a novel technology because of their advantages in enabling hands-free operation and see-what-I-see remote consultation. Researchers have primarily evaluated this technology in hospital settings; however, limited research has investigated its application in prehospital operations. Objective: The aim of this study is to understand the potential of smart glasses to support the work practices of prehospital providers, such as emergency medical services (EMS) personnel. Methods: We conducted semistructured interviews with 13 EMS providers recruited from 4 hospital-based EMS agencies in an urban area in the east coast region of the United States. The interview questions covered EMS workflow, challenges encountered, technology needs, and users’ perceptions of smart glasses in supporting daily EMS work. During the interviews, we demonstrated a system prototype to elicit more accurate and comprehensive insights regarding smart glasses. Interviews were transcribed verbatim and analyzed using the open coding technique. Results: We identified four potential application areas for smart glasses in EMS: enhancing teleconsultation between distributed prehospital and hospital providers, semiautomating patient data collection and documentation in real time, supporting decision-making and situation awareness, and augmenting quality assurance and training. Compared with the built-in touch pad, voice commands and hand gestures were indicated as the most preferred and suitable interaction mechanisms. EMS providers expressed positive attitudes toward using smart glasses during prehospital encounters. However, several potential barriers and user concerns need to be considered and addressed before implementing and deploying smart glasses in EMS practice. They are related to hardware limitations, human factors, reliability, workflow, interoperability, and privacy. Conclusions: Smart glasses can be a suitable technological means for supporting EMS work. We conclude this paper by discussing several design considerations for realizing the full potential of this hands-free technology. %M 35225816 %R 10.2196/30883 %U https://humanfactors.jmir.org/2022/1/e30883 %U https://doi.org/10.2196/30883 %U http://www.ncbi.nlm.nih.gov/pubmed/35225816 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e29073 %T Peer Support Specialists’ Perspectives of a Standard Online Research Ethics Training: Qualitative Study %A Fortuna,Karen L %A Marceau,Skyla R %A Kadakia,Arya %A Pratt,Sarah I %A Varney,Joy %A Walker,Robert %A Myers,Amanda L %A Thompson,Shavon %A Carter,Katina %A Greene,Kaycie %A Pringle,Willie %+ Department of Psychiatry, Geisel School of Medicine, Dartmouth College, 46 Centerra Pkwy, Lebanon, NH, 03766, United States, 1 6037225727, karen.l.fortuna@dartmouth.edu %K peer support specialists %K community engagement %K research ethics %K mental health %K peer support %K codebook %K online health %K online training %K education %K ethics %D 2022 %7 1.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Certified peer support specialists (CPS) have a mental health condition and are trained and certified by their respective state to offer Medicaid reimbursable peer support services. CPS are increasingly involved as partners in research studies. However, most research ethics training in the protection of human subjects is designed for people who, unlike CPS, have had exposure to prior formal research training. Objective: The aim of this study is to explore the perspectives of CPS in completing the Collaborative Institutional Training Initiative Social and Behavioral Responsible Conduct of Research online training. Methods: A total of 5 CPS were recruited using a convenience sample framework through the parent study, a patient-centered outcomes research study that examined the comparative effectiveness of two chronic health disease management programs for people with serious mental illness. Participants independently completed the Collaborative Institutional Training Initiative Social and Behavioral Responsible Conduct of Research online training. All participants completed 15 online modules in approximately 7-9 hours and also filled out a self-report measure of executive functioning (the Adult Executive Functioning Inventory [ADEXI]). Qualitative data were collected from a 1-hour focus group and qualitative analysis was informed by the grounded theory approach. The codebook consisted of codes inductively derived from the data. Codes were independently assigned to text, grouped, and checked for themes. Thematic analysis was used to organize themes. Results: Passing scores for each module ranged from 81%-89%, with an average of 85.4% and a median of 86%. The two themes that emerged from the focus group were the following: comprehension (barrier) and opportunity (facilitator). Participants had a mean score of 27.4 on the ADEXI. Conclusions: The CPS perceived the research ethics online training as an opportunity to share their lived experience expertise to enhance current research efforts by nonpeer scientists. Although the CPS completed the online research ethics training, the findings indicate CPS experienced difficulty with comprehension of the research ethics online training materials. Adaptations may be needed to facilitate uptake of research ethics online training by CPS and create a workforce of CPS to offer their lived experience expertise alongside peer and nonpeer researchers. %M 35103606 %R 10.2196/29073 %U https://formative.jmir.org/2022/2/e29073 %U https://doi.org/10.2196/29073 %U http://www.ncbi.nlm.nih.gov/pubmed/35103606 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e24027 %T Medical Data Mining Course Development in Postgraduate Medical Education: Web-Based Survey and Case Study %A Yang,Lin %A Zheng,Si %A Xu,Xiaowei %A Sun,Yueping %A Wang,Xuwen %A Li,Jiao %+ Institute of Medical Information and Library, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 3, Yabao Rd., Chaoyang District, Beijing, 100020, China, 86 18618461596, li.jiao@imicams.ac.cn %K medical data mining %K course development %K online teaching %K postgraduate medical education %D 2021 %7 1.10.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Medical postgraduates’ demand for data capabilities is growing, as biomedical research becomes more data driven, integrative, and computational. In the context of the application of big data in health and medicine, the integration of data mining skills into postgraduate medical education becomes important. Objective: This study aimed to demonstrate the design and implementation of a medical data mining course for medical postgraduates with diverse backgrounds in a medical school. Methods: We developed a medical data mining course called “Practical Techniques of Medical Data Mining” for postgraduate medical education and taught the course online at Peking Union Medical College (PUMC). To identify the background knowledge, programming skills, and expectations of targeted learners, we conducted a web-based questionnaire survey. After determining the instructional methods to be used in the course, three technical platforms—Rain Classroom, Tencent Meeting, and WeChat—were chosen for online teaching. A medical data mining platform called Medical Data Mining - R Programming Hub (MedHub) was developed for self-learning, which could support the development and comprehensive testing of data mining algorithms. Finally, we carried out a postcourse survey and a case study to demonstrate that our online course could accommodate a diverse group of medical students with a wide range of academic backgrounds and programming experience. Results: In total, 200 postgraduates from 30 disciplines participated in the precourse survey. Based on the analysis of students’ characteristics and expectations, we designed an optimized course structured into nine logical teaching units (one 4-hour unit per week for 9 weeks). The course covered basic knowledge of R programming, machine learning models, clinical data mining, and omics data mining, among other topics, as well as diversified health care analysis scenarios. Finally, this 9-week course was successfully implemented in an online format from May to July in the spring semester of 2020 at PUMC. A total of 6 faculty members and 317 students participated in the course. Postcourse survey data showed that our course was considered to be very practical (83/83, 100% indicated “very positive” or “positive”), and MedHub received the best feedback, both in function (80/83, 96% chose “satisfied”) and teaching effect (80/83, 96% chose “satisfied”). The case study showed that our course was able to fill the gap between student expectations and learning outcomes. Conclusions: We developed content for a data mining course, with online instructional methods to accommodate the diversified characteristics of students. Our optimized course could improve the data mining skills of medical students with a wide range of academic backgrounds and programming experience. %M 34596575 %R 10.2196/24027 %U https://mededu.jmir.org/2021/4/e24027 %U https://doi.org/10.2196/24027 %U http://www.ncbi.nlm.nih.gov/pubmed/34596575 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e23367 %T Patients With Cancer Searching for Cancer- or Health-Specific Web-Based Information: Performance Test Analysis %A Lange-Drenth,Lukas %A Schulz,Holger %A Endsin,Gero %A Bleich,Christiane %+ Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany, 49 040741056811, lu.lange@uke.de %K telemedicine %K eHealth %K eHealth literacy %K digital literacy %K internet %K web-based %K health information %K health education %K cancer %K mobile phone %D 2021 %7 16.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Searching the internet for cancer-related information helps patients with cancer satisfy their unmet information needs and empowers them to play a more active role in the management of their disease. However, to benefit from the search, patients need a sufficient level of skill to search, select, appraise, and apply web-based health information. Objective: We aim to study the operational, navigational, information, and evaluation skills and problems of patients with cancer performing cancer-related search tasks using the internet. Methods: A total of 21 patients with cancer were recruited during their stay at the rehabilitation clinic for oncological rehabilitation. Participants performed eight cancer-related search tasks using the internet. The participants were asked to think aloud while performing the tasks, and the screen activities were recorded. The types and frequencies of performance problems were identified and coded into categories following an inductive coding process. In addition, the performance and strategic characteristics of task execution were summarized descriptively. Results: All participants experienced problems or difficulties in executing the tasks, and a substantial percentage of tasks (57/142, 40.1%) could not be completed successfully. The participants’ performance problems were coded into four categories, namely operating the computer and web browser, navigating and orientating, using search strategies, and evaluating the relevance and reliability of web-based information. The most frequent problems occurred in the third and fourth categories. A total of 90% (19/21) of participants used nontask-related search terms or nonspecific search terms. A total of 95% (20/21) of participants did not control for the source or topicality of the information found. In addition, none of the participants verified the information on 1 website with that on another website for each task. Conclusions: A substantial group of patients with cancer did not have the necessary skills to benefit from cancer-related internet searches. Future interventions are needed to support patients in the development of sufficient internet-searching skills, focusing particularly on information and evaluation skills. %M 34398801 %R 10.2196/23367 %U https://www.jmir.org/2021/8/e23367 %U https://doi.org/10.2196/23367 %U http://www.ncbi.nlm.nih.gov/pubmed/34398801 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e25481 %T Current Competencies of Game Facilitators and Their Potential Optimization in Higher Education: Multimethod Study %A Baalsrud Hauge,Jannicke %A Söbke,Heinrich %A Bröker,Thomas %A Lim,Theodore %A Luccini,Angelo Marco %A Kornevs,Maksims %A Meijer,Sebastiaan %+ Bauhaus-Universität Weimar, Goetheplatz 7/8, Weimar, 99423, Germany, 49 151 1445 2482, heinrich.soebke@uni-weimar.de %K facilitation %K higher education %K competency %K simulation %K gaming %K educational games %D 2021 %7 5.5.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Serious games can be a powerful learning tool in higher education. However, the literature indicates that the learning outcome in a serious game depends on the facilitators’ competencies. Although professional facilitators in commercial game-based training have undergone specific instruction, facilitators in higher education cannot rely on such formal instruction, as game facilitation is only an occasional part of their teaching activities. Objective: This study aimed to address the actual competencies of occasional game facilitators and their perceived competency deficits. Methods: Having many years of experience as professional and occasional facilitators, we (n=7) defined requirements for the occasional game facilitator using individual reflection and focus discussion. Based on these results, guided interviews were conducted with additional occasional game facilitators (n=4) to check and extend the requirements. Finally, a group of occasional game facilitators (n=30) answered an online questionnaire based on the results of the requirement analysis and existing competency models. Results: Our review produced the following questions: Which competencies are needed by facilitators and what are their training needs? What do current training courses for occasional game facilitators in higher education look like? How do the competencies of occasional game facilitators differ from other competencies required in higher education? The key findings of our analysis are that a mix of managerial and technical competencies is required for facilitating serious games in higher educational contexts. Further, there is a limited or no general competence model for game facilitators, and casual game facilitators rarely undergo any specific, formal training. Conclusions: The results identified the competencies that game facilitators require and a demand for specific formal training. Thus, the study contributes to the further development of a competency model for game facilitators and enhances the efficiency of serious games. %M 33949956 %R 10.2196/25481 %U https://games.jmir.org/2021/2/e25481 %U https://doi.org/10.2196/25481 %U http://www.ncbi.nlm.nih.gov/pubmed/33949956 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e27640 %T Feasibility, Acceptability, and Efficacy of Virtual Reality Training for Older Adults and People With Disabilities: Single-Arm Pre-Post Study %A Chau,Pui Hing %A Kwok,Yan Yan Jojo %A Chan,Mee Kie Maggie %A Kwan,Ka Yu Daniel %A Wong,Kam Lun %A Tang,Ying Ho %A Chau,Kan Lung Peter %A Lau,Sheung Wa Matthew %A Yiu,Yan Yan Yannex %A Kwong,Mei Yan Fanny %A Lai,Wai Ting Thomas %A Leung,Mun Kit %+ School of Nursing, The University of Hong Kong, 4/F, William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong, China, 852 3917 6626, phchau@graduate.hku.hk %K virtual reality %K rehabilitation %K older adults, people with disabilities %K evaluation %D 2021 %7 4.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Unlike most virtual reality (VR) training programs that are targeted at homogenous populations, a set of VR games for rehabilitation purposes targeted at a heterogeneous group of users was developed. The VR games covered physical training, cognitive training (classification and reality orientation), community-living skills training, and relaxing scenery experiences. Special considerations for local older adults and people with disabilities were made in terms of hardware choice and software design. Objective: This study aimed to evaluate the feasibility, acceptance, and efficacy of VR training among users with varying abilities. Methods: A single-arm pretest-posttest evaluation study was conducted. The participants of the evaluation study were encouraged to undergo 30-minute VR training three times a week for 6 weeks. The 30-minute session consisted of 10 minutes of upper-limb motion games, 10 minutes of lower-limb motion games, and 10 minutes of cognitive games/community-living skills training/relaxing scenery experiences, as appropriate. On completion of each session, usage statistics were documented via the built-in VR software, whereas feedback on the experience of the VR games and adverse events was collected via self-reports and staff observations. Feasibility was reflected by usage statistics, and acceptance was reflected by positive feedback. In addition, health outcomes, including upper-limb dexterity, functional mobility, cognitive function, and happiness, were assessed at baseline, as well as 6 weeks and 3 months after baseline. The primary outcomes were upper-limb dexterity and acceptance of playing VR games. Results: A total of 135 participants with a mean age of 62.7 years (SD 21.5) were recruited from May 2019 to January 2020, and 124 (91.9%) completed at least one follow-up. Additionally, 76.3% (103/135) of the participants could attend at least 70% of the proposed 18 sessions, and 72.5% (1382/1906) of the sessions had a training time of at least 20 minutes. Linear mixed effect models showed statistically significant effects in terms of upper-limb dexterity (small effect) and cognitive function (moderate effect). Among the 135 participants, 88 provided positive comments. Additionally, 10.4% (14/135) reported mild discomfort, such as dizziness, and none reported severe discomfort. Conclusions: A set of VR training games for rehabilitation could be applied to users with heterogeneous abilities. Our VR games were acceptable to local older adults and those with different disabilities. Benefits in upper-limb dexterity and cognitive function were observed despite partial compliance to the training protocol. Service providers could refer to our experiences when developing VR training systems for their clients. %M 33944795 %R 10.2196/27640 %U https://www.jmir.org/2021/5/e27640 %U https://doi.org/10.2196/27640 %U http://www.ncbi.nlm.nih.gov/pubmed/33944795 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e25054 %T Impact of an Educational Comic to Enhance Patient-Physician–Electronic Health Record Engagement: Prospective Observational Study %A Alkureishi,Maria A %A Johnson,Tyrone %A Nichols,Jacqueline %A Dhodapkar,Meera %A Czerwiec,M K %A Wroblewski,Kristen %A Arora,Vineet M %A Lee,Wei Wei %+ Department of Academic Pediatrics, University of Chicago, 5841 S Maryland Ave, MC 6082 Rm C124, Chicago, IL, 60637, United States, 1 773 834 8927, malkureishi@peds.bsd.uchicago.edu %K electronic health records %K patient %K comic %K education %K engagement %D 2021 %7 28.4.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Electronic health record (EHR) use can impede or augment patient-physician communication. However, little research explores the use of an educational comic to improve patient-physician-EHR interactions. Objective: To evaluate the impact of an educational comic on patient EHR self-advocacy behaviors to promote patient engagement with the EHR during clinic visits. Methods: We conducted a prospective observational study with adult patients and parents of pediatric patients at the University of Chicago General Internal Medicine (GIM) and Pediatric Primary Care (PPC) clinics. We developed an educational comic highlighting EHR self-advocacy behaviors and distributed it to study participants during check-in for their primary care visits between May 2017 and May 2018. Participants completed a survey immediately after their visit, which included a question on whether they would be interested in a follow-up telephone interview. Of those who expressed interest, 50 participants each from the adult and pediatric parent cohorts were selected at random for follow-up telephone interviews 8 months (range 3-12 months) post visit. Results: Overall, 71.0% (115/162) of adult patients and 71.6% (224/313) of pediatric parents agreed the comic encouraged EHR involvement. African American and Hispanic participants were more likely to ask to see the screen and become involved in EHR use due to the comic (adult P=.01, P=.01; parent P=.02, P=.006, respectively). Lower educational attainment was associated with an increase in parents asking to see the screen and to be involved (ρ=−0.18, P=.003; ρ=−0.19, P<.001, respectively) and in adults calling for physician attention (ρ=−0.17, P=.04), which was confirmed in multivariate analyses. Female GIM patients were more likely than males to ask to be involved (median 4 vs 3, P=.003). During follow-up phone interviews, 90% (45/50) of adult patients and all pediatric parents (50/50) remembered the comic. Almost half of all participants (GIM 23/50, 46%; PPC 21/50, 42%) recalled at least one best-practice behavior. At subsequent visits, adult patients reported increases in asking to see the screen (median 3 vs 4, P=.006), and pediatric parents reported increases in asking to see the screen and calling for physician attention (median 3 vs 4, Ps<.001 for both). Pediatric parents also felt that the comic had encouraged them to speak up and get more involved with physician computer use since the index visit (median 4 vs 4, P=.02) and that it made them feel more empowered to get involved with computer use at future visits (median 3 vs 4, P<.001). Conclusions: Our study found that an educational comic may improve patient advocacy for enhanced patient-physician-EHR engagement, with higher impacts on African American and Hispanic patients and patients with low educational attainment. %M 33908891 %R 10.2196/25054 %U https://humanfactors.jmir.org/2021/2/e25054 %U https://doi.org/10.2196/25054 %U http://www.ncbi.nlm.nih.gov/pubmed/33908891 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e27397 %T Preparing Patients and Clinicians for Open Notes in Mental Health: Qualitative Inquiry of International Experts %A Blease,Charlotte %A Torous,John %A Kharko,Anna %A DesRoches,Catherine M %A Harcourt,Kendall %A O'Neill,Stephen %A Salmi,Liz %A Wachenheim,Deborah %A Hägglund,Maria %+ Division of General Medicine, Beth Israel Deaconess Medical Center, 133 Brookline Avenue, Boston, MA, 02115, United States, 1 16173201281, charlotteblease@gmail.com %K open notes %K electronic health records %K attitudes %K survey %K mental health %K psychiatry %K psychotherapy %K qualitative research %K mobile phone %D 2021 %7 16.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: In a growing number of countries worldwide, clinicians are sharing mental health notes, including psychiatry and psychotherapy notes, with patients. Objective: The aim of this study is to solicit the views of experts on provider policies and patient and clinician training or guidance in relation to open notes in mental health care. Methods: In August 2020, we conducted a web-based survey of international experts on the practice of sharing mental health notes. Experts were identified as informaticians, clinicians, chief medical information officers, patients, and patient advocates who have extensive research knowledge about or experience of providing access to or having access to mental health notes. This study undertook a qualitative descriptive analysis of experts’ written responses and opinions (comments) to open-ended questions on training clinicians, patient guidance, and suggested policy regulations. Results: A total of 70 of 92 (76%) experts from 6 countries responded. We identified four major themes related to opening mental health notes to patients: the need for clarity about provider policies on exemptions, providing patients with basic information about open notes, clinician training in writing mental health notes, and managing patient-clinician disagreement about mental health notes. Conclusions: This study provides timely information on policy and training recommendations derived from a wide range of international experts on how to prepare clinicians and patients for open notes in mental health. The results of this study point to the need for further refinement of exemption policies in relation to sharing mental health notes, guidance for patients, and curricular changes for students and clinicians as well as improvements aimed at enhancing patient and clinician-friendly portal design. %M 33861202 %R 10.2196/27397 %U https://mental.jmir.org/2021/4/e27397 %U https://doi.org/10.2196/27397 %U http://www.ncbi.nlm.nih.gov/pubmed/33861202 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 1 %P e25828 %T The Impact of Electronic Health Record–Based Simulation During Intern Boot Camp: Interventional Study %A Miller,Matthew E %A Scholl,Gretchen %A Corby,Sky %A Mohan,Vishnu %A Gold,Jeffrey A %+ Division of Pulmonary and Critical Care Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Mail code UHN67, Portland, OR, 97239, United States, 1 5034181496, goldje@ohsu.edu %K electronic health records %K medical education %K simulation %K usability %K training %D 2021 %7 9.3.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Accurate data retrieval is an essential part of patient care in the intensive care unit (ICU). The electronic health record (EHR) is the primary method for data storage and data review. We previously reported that residents participating in EHR-based simulations have varied and nonstandard approaches to finding data in the ICU, with subsequent errors in recognizing patient safety issues. We hypothesized that a novel EHR simulation-based training exercise would decrease EHR use variability among intervention interns, irrespective of prior EHR experience. Objective: This study aims to understand the impact of a novel, short, high-fidelity, simulation-based EHR learning activity on the intern data gathering workflow and satisfaction. Methods: A total of 72 internal medicine interns across the 2018 and 2019 academic years underwent a dedicated EHR training session as part of a week-long boot camp early in their training. We collected data on previous EHR and ICU experience for all subjects. Training consisted of 1 hour of guided review of a high-fidelity, simulated ICU patient chart focusing on best navigation practices for data retrieval. Specifically, the activity focused on using high- and low-yield data visualization screens determined by expert consensus. The intervention group interns then had 20 minutes to review a new simulated patient chart before the group review. EHR screen navigation was captured using screen recording software and compared with data from existing ICU residents performing the same task on the same medical charts (N=62). Learners were surveyed immediately and 6 months after the activity to assess satisfaction and preferred EHR screen use. Results: Participants found the activity useful and enjoyable immediately and after 6 months. Intervention interns used more individual screens than reference residents (18 vs 20; P=.008), but the total number of screens used was the same (35 vs 38; P=.30). Significantly more intervention interns used the 10 most common screens (73% vs 45%; P=.001). Intervention interns used high-yield screens more often and low-yield screens less often than the reference residents, which are persistent on self-report 6 months later. Conclusions: A short, high-fidelity, simulation-based learning activity focused on provider-specific data gathering was found to be enjoyable and to modify navigation patterns persistently. This suggests that workflow-specific simulation-based EHR training throughout training is of educational benefit to residents. %M 33687339 %R 10.2196/25828 %U https://mededu.jmir.org/2021/1/e25828 %U https://doi.org/10.2196/25828 %U http://www.ncbi.nlm.nih.gov/pubmed/33687339 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e20812 %T Telemedicine Awareness, Knowledge, Attitude, and Skills of Health Care Workers in a Low-Resource Country During the COVID-19 Pandemic: Cross-sectional Study %A Elhadi,Muhammed %A Elhadi,Ahmed %A Bouhuwaish,Ahmad %A Bin Alshiteewi,Fatimah %A Elmabrouk,Amna %A Alsuyihili,Ali %A Alhashimi,Ayiman %A Khel,Samer %A Elgherwi,Alsafa %A Alsoufi,Ahmed %A Albakoush,Ahmed %A Abdulmalik,Abdulmuez %+ Faculty of Medicine, University of Tripoli, University Road, Furnaj, Tripoli, 13275, Libyan Arab Jamahiriya, 218 945196407, muhammed.elhadi.uot@gmail.com %K attitude %K awareness %K coronavirus %K COVID-19 %K knowledge %K pandemic %K skills %K telemedicine %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the onset of the COVID-19 pandemic, several health care programs intended to provide telemedicine services have been introduced in Libya. Many physicians have used these services to provide care and advice to their patients remotely. Objective: This study aimed to provide an overview of physicians’ awareness, knowledge, attitude, and skill in using telehealth services in Libya. Methods: In this cross-sectional study, we administered a web-based survey to health care workers in Libya in May 2020. The questionnaire collected information on physicians’ general demographic characteristics, ability to use a computer, and telemedicine awareness, knowledge, attitude, and skills. Results: Among 673 health care workers who responded to the survey, 377 (56%) and 248 (36.8%) reported high awareness and high computer skill scores, respectively, for telemedicine. Furthermore, 582 (86.5%) and 566 (82.6%) health care workers reported high knowledge and high attitude scores, respectively. We observed no significant differences in awareness, knowledge, attitude, and skill scores among physicians employed at public, private, or both types of hospitals. We observed significant differences in the mean awareness (P<.001), attitude (P=.001), and computer skill scores (P<.001) , where the score distribution of the groups based on the ability to use computers was not similar. Knowledge scores did not significantly differ among the three groups (P=.37). Respondents with professional computer skills had significantly higher awareness (χ23=14.5; P<.001) and attitude (χ23=13.5; P=.001) scores than those without professional computer skills. We observed significant differences in the mean computer skill scores of the groups (χ23=199.6; P<.001). Conclusions: The consequences of the COVID-19 pandemic are expected to persist for a long time. Hence, policy programs such as telemedicine services, which aim to address the obstacles to medical treatment owing to physical distancing measures, will likely continue for a long time. Therefore, there is a need to train and support health care workers and initiate government programs that provide adequate and supportive health care services to patients in transitional countries. %M 33600350 %R 10.2196/20812 %U https://www.jmir.org/2021/2/e20812 %U https://doi.org/10.2196/20812 %U http://www.ncbi.nlm.nih.gov/pubmed/33600350 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e24691 %T An Education Framework for Effective Implementation of a Health Information System: Scoping Review %A Jeyakumar,Tharshini %A McClure,Sarah %A Lowe,Mandy %A Hodges,Brian %A Fur,Katharine %A Javier-Brozo,Mariquita %A Tassone,Maria %A Anderson,Melanie %A Tripp,Tim %A Wiljer,David %+ University Health Network, 190 Elizabeth Street, R. Fraser Elliot Building RFE 3S-441, Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 6322, David.wiljer@uhn.ca %K health information system %K health care providers %K education %K learning %K patient care %D 2021 %7 24.2.2021 %9 Review %J J Med Internet Res %G English %X Background: To optimize their use of a new Health Information System (HIS), supporting health care providers require effective HIS education. Failure to provide this education can significantly hinder an organization’s HIS implementation and sustainability efforts. Objective: The aim of this review is to understand the most effective educational strategies and approaches to enable health care providers to optimally use an HIS. Methods: Ovid MEDLINE, Ovid Embase, EBSCO Cumulative Index to Nursing and Allied Health Literature, and EBSCO Education Resources Information Center were searched to identify relevant papers. Relevant studies were systematically reviewed and analyzed using a qualitative thematic analysis approach. Results: Of the 3539 studies screened, 17 were included for data extraction. The literature on the most effective approaches to enable health care providers to optimally use an HIS emphasized the importance of investing in engaging and understanding learners in the clinical context, maximizing the transfer of learning to care, and designing continuous and agile evaluation to meet the emerging demands of the clinical environment. Conclusions: This review supports the advancement of a new HIS learning framework that organizational leaders and educators can use to guide HIS education design and development. Future research should examine how this framework can be translated into practice. %M 33625370 %R 10.2196/24691 %U https://www.jmir.org/2021/2/e24691 %U https://doi.org/10.2196/24691 %U http://www.ncbi.nlm.nih.gov/pubmed/33625370 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 4 %P e22532 %T Internet-of-Things Skills Among the General Population: Task-Based Performance Test Using Activity Trackers %A de Boer,Pia S %A van Deursen,Alexander J A M %A van Rompay,Thomas J L %+ Department of Communication Science, University of Twente, Drienerlolaan 5, Cubicus Building, Enschede, 7500AE, Netherlands, 31 534897950, p.s.deboer@utwente.nl %K internet of things %K activity tracker %K mobile phone %K skills %K digital divide %K performance test %D 2020 %7 18.11.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The health internet-of-things (IoT) can potentially provide insights into the present health condition, potential pitfalls, and support of a healthier lifestyle. However, to enjoy these benefits, people need skills to use the IoT. These IoT skills are expected to differ across the general population, thereby causing a new digital divide. Objective: This study aims to assess whether a sample of the general Dutch population can use health IoT by focusing on data and strategic IoT skills. Furthermore, we determine the role of gender, age, and education, and traditional internet skills. Methods: From April 1, 2019, to December 12, 2019, 100 individuals participated in this study. Participants were recruited via digital flyers and door-to-door canvassing. A selective quota sample was divided into equal subsamples of gender, age, and education. Additional inclusion criteria were smartphone possession and no previous experience of using activity trackers. This study was conducted in 3 waves over a period of 2 weeks. In wave 1, a questionnaire was administered to measure the operational, mobile, and information internet skills of the participants, and the participants were introduced to the activity tracker. After 1 week of getting acquainted with the activity tracker, a task-based performance test was conducted in wave 2 to measure the levels of data IoT skills and the strategic IoT skill component—action plan construction. A week after the participants were asked to use the activity tracker more deliberately, a performance test was then conducted in wave 3 to measure the level of the strategic IoT skill component—action plan execution. Results: The participants successfully completed 54% (13.5/25) of the data IoT skill tasks. Regarding strategic IoT tasks, the completion rates were 56% (10.1/18) for action plan construction and 43% (3.9/9) for action plan execution. None of the participants were able to complete all the data IoT skill tasks, and none of the participants were able to complete all the strategic IoT skill tasks regarding action plan construction or its execution. Age and education were important determinants of the IoT skill levels of the participants, except for the ability to execute an action plan strategically. Furthermore, the level of information internet skills of the participants contributed to their level of data IoT skills. Conclusions: This study found that data and strategic IoT skills of Dutch citizens are underdeveloped with regard to health purposes. In particular, those who could benefit the most from health IoT were those who had the most trouble using it, that is, the older and lower-educated individuals. %M 33206049 %R 10.2196/22532 %U http://humanfactors.jmir.org/2020/4/e22532/ %U https://doi.org/10.2196/22532 %U http://www.ncbi.nlm.nih.gov/pubmed/33206049 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19827 %T Perceptions of Digital Health Education Among European Medical Students: Mixed Methods Survey %A Machleid,Felix %A Kaczmarczyk,Robert %A Johann,Doreen %A Balčiūnas,Justinas %A Atienza-Carbonell,Beatriz %A von Maltzahn,Finn %A Mosch,Lina %+ Charité - Universitätsmedizin Berlin (corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health), Charitéplatz 1, Berlin, 10117, Germany, 49 15757206906, lina.mosch@charite.de %K medical students %K medical education %K eHealth %K mixed method %K health workforce %K digital literacy %K curriculum %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health technologies hold promise to enhance patient-related outcomes, to support health care staff by reducing their workload, and to improve the coordination of care. As key users of digital health technologies, health care workers are crucial to enable a meaningful digital transformation of health care. Digital health literacy and digital skills should become prerequisite competencies for health professionals to facilitate the implementation and leverage the potential of digital technologies to improve health. Objective: We aimed to assess European medical students’ perceived knowledge and opinions toward digital health, the status of digital health implementation in medical education, and the students’ most pressing needs. Methods: The explanatory design of our mixed methods study was based on an online, anonymous, self-administered survey targeted toward European medical students. A linear regression analysis was used to identify the influence of the year of medical studies on the responses. Additional analysis was performed by grouping the responses by the self-evaluated frequency of eHealth technology use. Written responses to four qualitative questions in the survey were analyzed using an inductive approach. Results: The survey received a total of 451 responses from 39 European countries, and there were respondents for every year of medical studies. The majority of respondents saw advantages in the use of digital health. While 40.6% (183/451) felt prepared to work in a digitized health care system, more than half (240/451, 53.2%) evaluated their eHealth skills as poor or very poor. Medical students considered lack of education to be the reason for this, with 84.9% (383/451) agreeing or strongly agreeing that more digital health education should be implemented in the medical curriculum. Students demanded introductory and specific eHealth courses covering data management, ethical aspects, legal frameworks, research and entrepreneurial opportunities, role in public health and health systems, communication skills, and practical training. The emphasis lay on tailoring learning to future job requirements and interprofessional education. Conclusions: This study shows a lack of digital health-related formats in medical education and a perceived lack of digital health literacy among European medical students. Our findings indicate a gap between the willingness of medical students to take an active role by becoming key players in the digital transformation of health care and the education that they receive through their faculties. %M 32667899 %R 10.2196/19827 %U http://www.jmir.org/2020/8/e19827/ %U https://doi.org/10.2196/19827 %U http://www.ncbi.nlm.nih.gov/pubmed/32667899 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e15630 %T Identification of Factors Influencing the Adoption of Health Information Technology by Nurses Who Are Digitally Lagging: In-Depth Interview Study %A De Leeuw,Jacqueline A %A Woltjer,Hetty %A Kool,Rudolf B %+ Department of Information Management, Radboud University Medical Center, PO Box 9100, Nijmegen, 6500HB, Netherlands, 31 643914595, jacqueline.deleeuw@radboudumc.nl %K qualitative research %K semi-structured interview %K purposive sampling %K health information systems %K computer user training %K professional education %K professional competence %K registered nurses %K nursing informatics %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The introduction of health information technology (HIT) has drastically changed health care organizations and the way health care professionals work. Some health care professionals have trouble coping efficiently with the demands of HIT and the personal and professional changes it requires. Lagging in digital knowledge and skills hampers health care professionals from adhering to professional standards regarding the use of HIT and may cause professional performance problems, especially in the older professional population. It is important to gain more insight into the reasons and motivations behind the technology issues experienced by these professionals, as well as to explore what could be done to solve them. Objective: Our primary research objective was to identify factors that influence the adoption of HIT in a sample of nurses who describe themselves as digitally lagging behind the majority of their colleagues in their workplaces. Furthermore, we aimed to formulate recommendations for practice and leadership on how to help and guide these nurses through ongoing digital transformations in their health care work settings. Methods: In a Dutch university medical center, 10 face-to-face semi-structured interviews were performed with registered nurses (RN). Ammenwerth’s FITT-framework (fit between the Individual, Task, and Technology) was used to guide the interview topic list and to formulate themes to explore. Thematic analysis was used to analyze the interview data. The FITT-framework was also used to further interpret and clarify the interview findings. Results: Analyses of the interview data uncovered 5 main categories and 12 subthemes. The main categories were: (1) experience with digital working, (2) perception and meaning, (3) barriers, (4) facilitators, and (5) future perspectives. All participants used electronic devices and digital systems, including the electronic health record. The latter was experienced by some as user-unfriendly, time-consuming, and not supportive in daily professional practice. Most of the interviewees described digital working as “no fun at all,” “working in a fake world,” “stressful,” and “annoying.” There was a lack of general digital knowledge and little or no formal basic digital training or education. A negative attitude toward computer use and a lack of digital skills contributed to feelings of increased incompetency and postponement or avoidance of the use of HIT, both privately and professionally. Learning conditions of digital training and education did not meet personal learning needs and learning styles. A positive impact was seen in the work environment when colleagues and nurse managers were aware and sensitive to the difficulties participants experienced in developing digital skills, and when there was continuous training on the job and peer support from digitally savvy colleagues. The availability of a digital play environment combined with learning on the job and support of knowledgeable peers was experienced as helpful and motivating by participants. Conclusions: Nurses who are digitally lagging often have had insufficient and ineffective digital education. This leads to stress, frustration, feelings of incompetency, and postponement or avoidance of HIT use. A digital training approach tailored to the learning needs and styles of these nurses is needed, as well as an on-the-job training structure and adequate peer support. Hospital management and nurse leadership should be informed about the importance of the fit between technology, task, and the individual for adequate adoption of HIT. %M 32663142 %R 10.2196/15630 %U http://www.jmir.org/2020/8/e15630/ %U https://doi.org/10.2196/15630 %U http://www.ncbi.nlm.nih.gov/pubmed/32663142 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e15491 %T The Use of Internet-Based Health and Care Services by Elderly People in Europe and the Importance of the Country Context: Multilevel Study %A Merkel,Sebastian %A Hess,Moritz %+ Faculty of Social Sciences, Ruhr-University Bochum, Universitätsstraße 150, Bochum, 44801, Germany, 49 0234 32254, sebastian.merkel@ruhr-uni-bochum.de %K eHealth %K Europe %K elderly people %D 2020 %7 3.6.2020 %9 Original Paper %J JMIR Aging %G English %X Background: Digital health care is becoming increasingly important, but it has the risk of further increasing the digital divide, as not all individuals have the opportunity, skills, and knowledge to fully benefit from potential advantages. In particular, elderly people have less experience with the internet, and hence, they are in danger of being excluded. Knowledge on the influences of the adoption of internet-based health and care services by elderly people will help to develop and promote strategies for decreasing the digital divide. Objective: This study examined if and how elderly people are using digital services to access health and social care. Moreover, it examined what personal characteristics are associated with using these services and if there are country differences. Methods: Data for this study were obtained from the Special Eurobarometer 460 (SB 460), which collected data on Europeans’ handling of and attitudes toward digital technologies, robots, and artificial intelligence, including data on the use of internet-based health and social care services, among 27,901 EU citizens aged 15 years or older. Multilevel logistic regression models were adopted to analyze the association of using the internet for health and social care services with several individual and country-level variables. Results: At the individual level, young age, high education, high social class, and living in an urban area were positively associated with a high probability of using internet-based health and social services. At the country level, the proportion of elderly people who participated in any training activity within the last month was positively associated with the proportion of elderly people using these services. Conclusions: The probability of using internet-based health and social services and their accompanying advantages strongly depend on the socioeconomic background. Training and educational programs might be helpful to mitigate these differences. %M 32490837 %R 10.2196/15491 %U http://aging.jmir.org/2020/1/e15491/ %U https://doi.org/10.2196/15491 %U http://www.ncbi.nlm.nih.gov/pubmed/32490837 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e16513 %T Building Capacity and Training for Digital Health: Challenges and Opportunities in Latin America %A Curioso,Walter H %+ Department of Biomedical Informatics and Medical Education, University of Washington, Box 358047, Seattle, WA 98195, United States, wcurioso@uw.edu %K digital health %K capacity building %K training program %K education %K public health %K telehealth %K Peru %K Latin America %D 2019 %7 18.12.2019 %9 Viewpoint %J J Med Internet Res %G English %X Tackling global health challenges demands the appropriate use of available technologies. Although digital health could significantly improve health care access, use, quality, and outcomes, realizing this possibility requires personnel trained in digital health. There is growing evidence of the benefits of digital health for improving the performance of health systems and outcomes in developed countries. However, significant gaps remain in resource-constrained settings. Technological and socio-cultural disparities between different regions or between provinces within the same country are prevalent. Rural areas, where the promise and need are highest, are particularly deprived. In Latin America, there is an unmet need for training and building the capacity of professionals in digital health. This viewpoint paper aims to present a selection of experiences in building digital health capacity in Latin America to illustrate a series of challenges and opportunities for strengthening digital health training programs in resource-constrained environments. These describe how a successful digital health ecosystem for Latin America requires culturally relevant and collaborative research and training programs in digital health. These programs should be responsive to the needs of all relevant regional stakeholders, including government agencies, non–governmental organizations, industry, academic or research entities, professional societies, and communities. This paper highlights the role that collaborative partnerships can play in sharing resources, experiences, and lessons learned between countries to optimize training and research opportunities in Latin America. %M 31850849 %R 10.2196/16513 %U http://www.jmir.org/2019/12/e16513/ %U https://doi.org/10.2196/16513 %U http://www.ncbi.nlm.nih.gov/pubmed/31850849 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 7 %N 4 %P e12648 %T Navigating Through Electronic Health Records: Survey Study on Medical Students’ Perspectives in General and With Regard to a Specific Training %A Herrmann-Werner,Anne %A Holderried,Martin %A Loda,Teresa %A Malek,Nisar %A Zipfel,Stephan %A Holderried,Friederike %+ Department of Psychosomatic Medicine and Psychotherapy, Internal Medicine, University Hospital Tübingen, Osianderstr 5, Tübingen, 72076, Germany, 49 070712980129, teresa.loda@med.uni-tuebingen.de %K medical students %K electronic health records %K eHealth %K simulation %D 2019 %7 12.11.2019 %9 Original Paper %J JMIR Med Inform %G English %X Background: An electronic health record (EHR) is the state-of-the-art method for ensuring all data concerning a given patient are up to date for use by multidisciplinary hospital teams. Therefore, medical students need to be trained to use health information technologies within this environment from the early stages of their education. Objective: As little is known about the effects of specific training within the medical curriculum, this study aimed to develop a course module and evaluate it to offer best practice teaching for today’s students. Moreover, we looked at the acceptance of new technologies such as EHRs. Methods: Fifth-year medical students (N=104) at the University of Tübingen took part in a standardized two-day training procedure about the advantages and risks of EHR use. After the training, students performed their own EHR entries on hypothetical patient cases in a safe practice environment. In addition, questionnaires—standardized and with open-ended questions—were administered to assess students’ experiences with a new teaching module, a newly developed EHR simulator, the acceptance of the health technology, and their attitudes toward it before and after training. Results: After the teaching, students rated the benefit of EHR training for medical knowledge significantly higher than before the session (mean 3.74, SD 1.05). However, they also had doubts about the long-term benefit of EHRs for multidisciplinary coworking after training (mean 1.96, SD 0.65). The special training with simulation software was rated as helpful for preparing students (88/102, 86.2%), but they still did not feel safe in all aspects of EHR. Conclusions: A specific simulated training on using EHRs helped students improve their knowledge and become more aware of the risks and challenges of such a system. Overall, students welcomed the new training module and supported the integration of EHR teaching into the medical curriculum. Further studies are needed to optimize training modules and make use of long-term feedback opportunities a simulated system offers. %M 31714247 %R 10.2196/12648 %U http://medinform.jmir.org/2019/4/e12648/ %U https://doi.org/10.2196/12648 %U http://www.ncbi.nlm.nih.gov/pubmed/31714247 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 9 %P e13238 %T Comparison of On-Site Versus Remote Mobile Device Support in the Framingham Heart Study Using the Health eHeart Study for Digital Follow-up: Randomized Pilot Study Set Within an Observational Study Design %A Spartano,Nicole L %A Lin,Honghuang %A Sun,Fangui %A Lunetta,Kathryn L %A Trinquart,Ludovic %A Valentino,Maureen %A Manders,Emily S %A Pletcher,Mark J %A Marcus,Gregory M %A McManus,David D %A Benjamin,Emelia J %A Fox,Caroline S %A Olgin,Jeffrey E %A Murabito,Joanne M %+ Section of Endocrinology, Diabetes, Nutrition, and Weight Management, Boston University School of Medicine, 720 Harrison Ave, Suite 8100, Boston, MA, United States, 1 3154152040, spartano@bu.edu %K wearable electronic devices %K cell phone %K fitness trackers %K electrocardiography %K epidemiology %D 2019 %7 30.9.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: New electronic cohort (e-Cohort) study designs provide resource-effective methods for collecting participant data. It is unclear if implementing an e-Cohort study without direct, in-person participant contact can achieve successful participation rates. Objective: The objective of this study was to compare 2 distinct enrollment methods for setting up mobile health (mHealth) devices and to assess the ongoing adherence to device use in an e-Cohort pilot study. Methods: We coenrolled participants from the Framingham Heart Study (FHS) into the FHS–Health eHeart (HeH) pilot study, a digital cohort with infrastructure for collecting mHealth data. FHS participants who had an email address and smartphone were randomized to our FHS-HeH pilot study into 1 of 2 study arms: remote versus on-site support. We oversampled older adults (age ≥65 years), with a target of enrolling 20% of our sample as older adults. In the remote arm, participants received an email containing a link to enrollment website and, upon enrollment, were sent 4 smartphone-connectable sensor devices. Participants in the on-site arm were invited to visit an in-person FHS facility and were provided in-person support for enrollment and connecting the devices. Device data were tracked for at least 5 months. Results: Compared with the individuals who declined, individuals who consented to our pilot study (on-site, n=101; remote, n=93) were more likely to be women, highly educated, and younger. In the on-site arm, the connection and initial use of devices was ≥20% higher than the remote arm (mean percent difference was 25% [95% CI 17-35] for activity monitor, 22% [95% CI 12-32] for blood pressure cuff, 20% [95% CI 10-30] for scale, and 43% [95% CI 30-55] for electrocardiogram), with device connection rates in the on-site arm of 99%, 95%, 95%, and 84%. Once connected, continued device use over the 5-month study period was similar between the study arms. Conclusions: Our pilot study demonstrated that the deployment of mobile devices among middle-aged and older adults in the context of an on-site clinic visit was associated with higher initial rates of device use as compared with offering only remote support. Once connected, the device use was similar in both groups. %M 31573928 %R 10.2196/13238 %U https://mhealth.jmir.org/2019/9/e13238 %U https://doi.org/10.2196/13238 %U http://www.ncbi.nlm.nih.gov/pubmed/31573928 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 2 %P e13939 %T An Intergenerational Information and Communications Technology Learning Project to Improve Digital Skills: User Satisfaction Evaluation %A López Seguí,Francesc %A de San Pedro,Marc %A Aumatell Verges,Eva %A Simó Algado,Salvador %A Garcia Cuyàs,Francesc %+ Sant Joan de Déu Hospital, C/ Santa Rosa, 39-57, Esplugues de Llobregat, Barcelona, 08950, Spain, 34 638681367, 31557fgc@gmail.com %K active aging %K digital inclusion %K ICT program %K intergenerational relationships %K civic participation %K community service %D 2019 %7 09.08.2019 %9 Original Paper %J JMIR Aging %G English %X Background: “Digital Partners” is an intergenerational information and communications technology learning project carried out in the municipalities of Vic and Centelles (Catalonia) from April to May 2018. Within the framework of the introduction of community service as a subject in secondary education, the Centre for Health and Social Studies (University of Vic) created a training space with 38 intergenerational partners (aged 14-15 years and >65 years), with the aim of improving the senior users’ digital skills in terms of use of smartphones and tablets, thus helping reduce the digital divide in the territory. Objective: The aim of this paper is to evaluate the satisfaction of both junior and senior participants toward the intervention and to explore its main drivers. Methods: Participants who volunteered to participate in the study were interviewed. Quantitative and qualitative data gathered in paper-based ad hoc surveys were used to assess participants’ satisfaction. Results: The experience shows a broad satisfaction of both junior and senior users. The project’s strengths include the format of working in couples; randomly pairing individuals by operating system; the ability to practice with the device itself; individuals’ free choice to decide what they wish to learn, develop, or practice; and the availability of voluntary practice material that facilitates communication and learning. With regard to aspects that could be improved, there is a need to review the timetabling flexibility of meetings to avoid hurrying the elderly and to extend the project’s duration, if necessary. Conclusions: This activity can serve to create mutual learning through the use of mobile devices and generate security and motivation on the part of the seniors, thus reducing the digital divide and improving social inclusion. %M 31518276 %R 10.2196/13939 %U http://aging.jmir.org/2019/2/e13939/ %U https://doi.org/10.2196/13939 %U http://www.ncbi.nlm.nih.gov/pubmed/31518276 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 2 %N 1 %P e14279 %T Nurses as Stakeholders in the Adoption of Mobile Technology in Australian Health Care Environments: Interview Study %A Mather,Carey %A Cummings,Elizabeth %A Gale,Fred %+ College of Health and Medicine, School of Nursing, University of Tasmania, Building J, Newnham Drive, Launceston, 7248, Australia, 61 363243149, Carey.Mather@utas.edu.au %K digital %K health policy %K digital professionalism %K nursing education %D 2019 %7 09.08.2019 %9 Original Paper %J JMIR Nursing %G English %X Background: The 2017 Australian Digital Health Agency (ADHA) Strategy is based on the underlying assumption that digital technology in health care environments is ubiquitous. The ADHA Strategy views health professionals, especially nurses, as grappling with the complexity of installing and using digital technologies to facilitate personalized and sustainable person-centered care. Yet, ironically, the 2018 debate over how to enroll Australians into the national electronic health record system and its alteration from an opt-in to an opt-out model heightened public and professional concern over what constituted a “safe, seamless and secure” health information system. What can be termed a digital technology paradox has emerged where, although it is widely acknowledged that there are benefits from deploying and using digital technology in the workplace, the perception of risk renders it unavailable or inaccessible at point of care. The inability of nurses to legitimately access and use mobile technology is impeding the diffusion of digital technology in Australian health care environments and undermining the 2017 ADHA Strategy. Objective: This study explored the nature and scope of usability of mobile technology at point of care, in order to understand how current governance structures impacted on access and use of digital technology from an organizational perspective. Methods: Individual semistructured interviews were conducted with 6 representatives from professional nursing organizations. A total of 10 interview questions focused on factors that impacted the use of mobile technology for learning at point of care. Seven national organizations and 52 members from the Coalition of National Nursing and Midwifery Organisations were invited to participate. Interviews were recorded and transcribed verbatim. Data analysis was systematic and organized, consisting of trial coding; member checking was undertaken to ensure rigor. A codebook was developed to provide a framework for analysis to identify the themes latent in the transcribed data. Nurses as stakeholders emerged as a key theme. Results: Out of 6 participants, 4 female (67%) and 2 male (33%) senior members of the nursing profession were interviewed. Each interview lasted between 17 and 54 minutes, which reflected the knowledge of participants regarding the topic of interest and their availability. Two subthemes, coded as ways of thinking and ways of acting, emerged from the open codes. Participants provided examples of the factors that impacted the capacity of nurses to adopt digital technology from an emic perspective. There were contributing factors that related to actions, including work-arounds, attentiveness, and experiences. Nurses also indicated that there were attitudes and influences that impacted thinking regarding access and use of mobile technology at point of care. Conclusions: Nurses are inadequately prepared for the digital future that has now arrived in health care environments. Nurses do not perceive that they are leaders in decision making regarding digital technology adoption, nor are they able to facilitate digital literacy or model digital professionalism. %M 34345771 %R 10.2196/14279 %U https://nursing.jmir.org/2019/1/e14279/ %U https://doi.org/10.2196/14279 %U http://www.ncbi.nlm.nih.gov/pubmed/34345771 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e12638 %T Clinician Job Searches in the Internet Era: Internet-Based Study %A Gillum,Shalu %A Williams,Natasha %A Brink,Brittany %A Ross,Edward %+ College of Medicine, University of Central Florida, 6850 Lake Nona Blvd, Orlando, FL,, United States, 1 407 266 1060, edward.ross@ucf.edu %K personnel selection %K internet %K academic medical centers %D 2019 %7 05.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Traditional methods using print media and commercial firms for clinician recruiting are often limited by cost, slow pace, and suboptimal results. An efficient and fiscally sound approach is needed for searching online to recruit clinicians. Objective: The aim of the study was to assess the Web-based methods by which clinicians might be searching for jobs in a broad range of specialties and how academic medical centers can advertise clinical job openings to prominently appear on internet searches that would yield the greatest return on investment. Methods: We used a search engine (Google) to identify 8 query terms for each of the specialties and specialists (eg, dermatology and dermatologist) to determine internet job search methodologies for 12 clinical disciplines. Searches were conducted, and the data used for analysis were the first 20 results. Results: In total, 176 searches were conducted at varying times over the course of several months, and 3520 results were recorded. The following 4 types of websites appeared in the top 10 search results across all specialties searched, accounting for 52.27% (920/1760) of the results: (1) a single no-cost job aggregator (229/1760, 13.01%); (2) 2 prominent journal-based paid digital job listing services (157/1760, 8.92% and 91/1760, 5.17%, respectively); (3) a fee-based Web-based agency (137/1760, 7.78%) offering candidate profiles; and (4) society-based paid advertisements (totaling 306/1760, 17.38%). These sites accounted for 75.45% (664/880) of results limited to the top 5 results. Repetitive short-term testing yielded similar results with minor changes in the rank order. Conclusions: On the basis of our findings, we offer a specific financially prudent internet strategy for both clinicians searching the internet for employment and employers hiring clinicians in academic medical centers. %M 31278735 %R 10.2196/12638 %U https://www.jmir.org/2019/7/e12638/ %U https://doi.org/10.2196/12638 %U http://www.ncbi.nlm.nih.gov/pubmed/31278735 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 5 %P e13480 %T Web-Based Skin Cancer Prevention Training for Massage Therapists: Protocol for the Massage Therapists Skin Health Awareness, Referral, and Education Study %A Loescher,Lois J %A Heslin,Kelly M %A Szalacha,Laura A %A Silva,Graciela E %A Muramoto,Myra L %+ College of Nursing, University of Arizona, 1305 N Martin Ave, Tucson, AZ,, United States, 1 (520) 626 6196, loescher@email.arizona.edu %K skin cancer %K primary prevention %K secondary prevention %K health education %K e-learning %K massage %K web-based learning %K massage therapists %D 2019 %7 15.05.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Skin cancer, the most common cancer in the United States, is costly and potentially deadly. Its burden can be reduced by early detection and prevention activities. The scope of skin cancer requires going beyond traditional health care providers to promote risk reduction. Partnering with the nonbiomedical workforce, such as massage therapists (MTs), may reach more individuals at risk. MTs see much of their clients’ skin and are amenable to performing skin cancer risk reduction activities during massage appointments. Objective: The objective of this study is to describe the Massage Therapists Skin Health Awareness, Referral, and Education protocol, presenting an overview of our systematic approach to developing rigorous e-training for MTs to enable them to be partners in skin cancer risk reduction. We also describe procedures for usability and feasibility testing of the training. Methods: We developed an integrated electronic learning system that includes electronic training (e-training) technology, simulated client interactions, online data collection instruments, and in-person assessment of MTs’ application of their training. Results: A total of 20 participants nationally scored the e-training as high for usability and satisfaction. We have screened an additional 77 MTs in Arizona for interest and eligibility, and currently have 37 enrolled participants, of whom 32 have completed the Web-based training. Conclusions: The structured and rigorous development approach for this skin cancer risk reduction and brief behavioral intervention e-training for MTs begins to fill a gap in skin cancer risk reduction research. Iterative usability testing of our asynchronous Web-based training resulted in positive participant response. Our e-training approach offers greater learner accessibility, increased convenience, and greater scalability than the few existing programs and has the potential to reach many MTs nationally. International Registered Report Identifier (IRRID): DERR1-10.2196/13480 %M 31094348 %R 10.2196/13480 %U http://www.researchprotocols.org/2019/5/e13480/ %U https://doi.org/10.2196/13480 %U http://www.ncbi.nlm.nih.gov/pubmed/31094348 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e13446 %T Internet-Based Cognitive Therapy for Social Anxiety Disorder in Hong Kong: Therapist Training and Dissemination Case Series %A Thew,Graham R %A Powell,Candice LYM %A Kwok,Amy PL %A Lissillour Chan,Mandy H %A Wild,Jennifer %A Warnock-Parkes,Emma %A Leung,Patrick WL %A Clark,David M %+ Department of Experimental Psychology, University of Oxford, The Old Rectory, Paradise Square, Oxford, OX1 1TW, United Kingdom, 44 01865 618600, graham.thew@psy.ox.ac.uk %K anxiety %K social phobia %K internet %K cognitive therapy %K clinical competence %K cross-cultural comparison %K Hong Kong %K benchmarking %K psychology, clinical %K mental health %D 2019 %7 15.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Guided internet-based psychological interventions show substantial promise for expanding access to evidence-based mental health care. However, this can only be achieved if results of tightly controlled studies from the treatment developers can also be achieved in other independent settings. This dissemination depends critically on developing efficient and effective ways to train professionals to deliver these interventions. Unfortunately, descriptions of therapist training and its evaluation are often limited or absent within dissemination studies. Objective: This study aimed to describe and evaluate a program of therapist training to deliver internet-based Cognitive Therapy for social anxiety disorder (iCT-SAD). As this treatment was developed in the United Kingdom and this study was conducted in Hong Kong with local therapists, an additional objective was to examine the feasibility, acceptability, and initial efficacy of iCT-SAD in this cultural context, based on data from a pilot case series. Methods: Training in iCT-SAD was provided to 3 therapists and included practice of the face-to-face format of therapy under clinical supervision, training workshops, and treating 6 patients with the iCT-SAD program. Training progress was evaluated using standardized and self-report measures and by reviewing patient outcomes. In addition, feedback from patients and therapists was sought regarding the feasibility and acceptability of the program. Results: The training program was effective at increasing therapists’ iCT-SAD knowledge and skills, resulting in levels of competence expected of a specialist Cognitive Behavioral Therapy practitioner. The 6 patients treated by the trainees all completed their treatment and achieved a mean pre- to posttreatment change of 53.8 points (SD 39.5) on the primary patient outcome measure, the Liebowitz Social Anxiety Scale. The within-group effect size (Cohen d) was 2.06 (95% CI 0.66-3.46). There was evidence to suggest that the patients’ clinical outcomes were sustained at 3-month follow-up. These clinical results are comparable to those achieved by UK patients treated by the developers of the internet program. Patient and therapist feedback did not identify any major cultural barriers to implementing iCT-SAD in Hong Kong; some modest language suggestions were made to assist understanding. Conclusions: The therapist training implemented here facilitated the successful dissemination of an effective UK-developed internet intervention to Hong Kong. The treatment appeared feasible and acceptable in this setting and showed highly promising initial efficacy. A randomized controlled trial is now required to examine this more robustly. As therapist training is critical to the successful dissemination of internet interventions, further research to develop, describe, and evaluate therapist training procedures is recommended. %M 31094320 %R 10.2196/13446 %U http://formative.jmir.org/2019/2/e13446/ %U https://doi.org/10.2196/13446 %U http://www.ncbi.nlm.nih.gov/pubmed/31094320 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e11480 %T The Effect of Age on Electronic Health Literacy: Mixed-Method Study %A Hsu,Wan-Chen %+ Center for Teaching and Learning Development, National Kaohsiung University of Science and Technology, No 415, Jiangong Rd, Sanmin Dist, Kaohsiung, 80778, Taiwan, 886 73814526 ext 31171, wanchen@nkust.edu.tw %K eHealth literacy %K intergenerational relations %K traditional college students %K older adult students %K mixed method %D 2019 %7 21.4.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The world’s internet penetration rate is increasing yearly; approximately 25% of the world’s population are internet users. In Asia, Taiwan has the fifth highest internet usage, and has an internet penetration rate higher than the world average. Electronic health (eHealth) literacy is the ability to read, understand, and utilize Web health information. eHealth literacy is gaining attention worldwide. Objective: This study aimed compare the differences in eHealth literacy between traditional college students (aged between 18 and 22 years) and older adult students (aged between 55 and 72 years). It also summarizes the experiences and performances of these 2 groups in terms of searching online health-related information. Methods: A mixed-method approach was used, including questionnaire surveys and interviews. A total of 208 respondents were interviewed: 65 traditional college students (31.3%) and 143 older adult students (68.7%). The results of the interviews were used to compare the eHealth literacy scores of the 2 groups. Results: There were significant differences in the overall eHealth literacy scores (t207=2.98; P=.001) and the functional eHealth literacy dimension (t207=12.17; P<.001). The findings showed a significant gap in eHealth literacy between the 2 groups. Most participants believed that online health information could be largely read and understood. However, they were skeptical about the quality of the information and noted that it consisted of either subjective judgments or objective standards. Conclusions: Traditional college students preferred esthetically pleasing health information, whereas older adult students focused on its promotion. Furthermore, the first group often used websites for solving health problems, whereas the second group forwarded health information through communication software. %M 31066696 %R 10.2196/11480 %U http://humanfactors.jmir.org/2019/2/e11480/ %U https://doi.org/10.2196/11480 %U http://www.ncbi.nlm.nih.gov/pubmed/31066696 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e8423 %T Differences in the Level of Electronic Health Literacy Between Users and Nonusers of Digital Health Services: An Exploratory Survey of a Group of Medical Outpatients %A Holt,Kamila Adellund %A Karnoe,Astrid %A Overgaard,Dorthe %A Nielsen,Sidse Edith %A Kayser,Lars %A Røder,Michael Einar %A From,Gustav %+ Department of Nursing, Faculty of Health, University College Copenhagen, Tagensvej 86, Copenhagen N, 2200, Denmark, 45 26822657, kamh@kp.dk %K health literacy %K computer literacy %K questionnaires %K telemedicine %K consumer health informatics %D 2019 %7 05.04.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Digitalization of health services ensures greater availability of services and improved contact to health professionals. To ensure high user adoption rates, we need to understand the indicators of use and nonuse. Traditionally, these have included classic sociodemographic variables such as age, sex, and educational level. Electronic health literacy (eHL) describes knowledge, skills, and experiences in the interaction with digital health services and technology. With our recent introduction of 2 new multidimensional instruments to measure eHL, the eHL questionnaire (eHLQ) and the eHL assessment (eHLA) toolkit, eHL provides a multifaceted approach to understand use and nonuse of digital health solutions in detail. Objective: The aim of this study was to investigate how users and nonusers of digital services differ with respect to eHL, in a group of patients with regular contact to a hospital outpatient clinic. Furthermore, to examine how usage and nonusage, and eHL levels are associated with factors such as age, sex, educational level, and self-rated health. Methods: Outpatients were asked to fill out a survey comprising items about usage of digital services, including digital contact to general practitioner (GP) and communication via the national health portal sundhed.dk, the eHLQ, and the eHLA toolkit, as well as items on age, sex, education, and self-rated health. In total, 246 patients completed the survey. A Mann-Whitney test was used to test for differences between users and nonusers of digital services. Correlation tests described correlations between eHL scales (eHEALSs) and age, education, and self-rated health. A significance level of .0071 was used to reject the null hypothesis in relation to the eHEALSs and usage of digital services. Results: In total, 95.1% (234/246) of the participants used their personal digital ID (NemID), 57.7% (142/246) were in contact with their GPs electronically, and 54.0% (133/246) had used the national health portal (sundhed.dk) within the last 3 months. There were no differences between users and nonusers of sundhed.dk with respect to age, sex, educational level, and self-rated health. Users of NemID scored higher than nonusers in 6 of the 7 dimensions of eHLQ, the only one which did not differ was dimension 2: Understanding of health concepts and language. Sundhed.dk users had a higher score in all of the 7 dimensions except for dimension 4: Feel safe and in control. The eHLA toolkit showed that users of sundhed.dk and NemID had higher levels of eHL with regard to tools 2, 5, 6, and 7. Furthermore, users of sundhed.dk had higher levels of eHL with regard to tools 3 and 4. Conclusions: Information about patients’ eHL may provide clinicians an understanding of patients’ reasons for not using digital health services, better than sociodemographic data or self-rated health. %M 30950809 %R 10.2196/ijmr.8423 %U http://www.i-jmr.org/2019/2/e8423/ %U https://doi.org/10.2196/ijmr.8423 %U http://www.ncbi.nlm.nih.gov/pubmed/30950809 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e12349 %T Impact of Training and Integration of Apps Into Dietetic Practice on Dietitians’ Self-Efficacy With Using Mobile Health Apps and Patient Satisfaction %A Chen,Juliana %A Allman-Farinelli,Margaret %+ The University of Sydney, Charles Perkins Centre, Discipline of Nutrition and Dietetics, School of Life and Environmental Sciences, Level 4 East, Charles Perkins Centre (D17), John Hopkins Drive, The University of Sydney, Camperdown, 2006, Australia, 61 2 8627 0843, jche6526@uni.sydney.edu.au %K dietetics %K medical nutrition therapy %K mHealth %K patient satisfaction %K smartphone %D 2019 %7 04.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The use of mobile health (mHealth) apps in dietetic practice could support the delivery of nutrition care in medical nutrition therapy. However, apps are underutilized by dietitians in patient care. Objective: This study aimed to determine the feasibility of an intervention consisting of education, training, and integration of apps in improving dietitians’ perceived self-efficacy with using mHealth apps. Methods: Private practice Accredited Practising Dietitians who were not regular users or recommenders of mHealth apps were recruited into the intervention. The intervention consisted of 2 phases: (1) a workshop that incorporated an educational lecture and skill-building activities to target self-efficacy, capability, opportunity, and motivation factors and (2) a 12-week intervention phase allowing for the integration of an app into dietetic practice via an app platform. During the 12-week intervention phase, dietitians prescribed an Australian commercial nutrition app to new (intervention) patients receiving nutrition care. Existing (control) patients were also recruited to provide a measure of patient satisfaction before the apps were introduced. New patients completed their patient satisfaction surveys at the end of the 12 weeks. Usability feedback about the app and app platform was gathered from intervention patients and dietitians. Results: A total of 5 dietitians participated in the study. On the basis of an analysis of variance with the Tukey post hoc tests, the educational and skills training workshop component of the intervention produced immediate improvements in mean ratings for dietitians’ self-efficacy with using mHealth apps compared with baseline (P=.02), particularly with regard to familiarity with apps factor (P<.001). The self-efficacy factor integration into dietetic work systems achieved significant improvements from baseline to 12 weeks (P=.03). Patient satisfaction with dietetic services did not differ significantly between intervention (n=17) and control patients (n=13). Overall, dietitians and their patients indicated that they would continue using the app platform and app, respectively, and would recommend it to others. To improve usability, enhancing patient-dietitian communication mediums in the app platform and reducing the burden of entering in meals cooked at home should be considered. Conclusions: Administering an educational and skills training workshop in conjunction with integrating an app platform into dietetic practice was a feasible method for improving the self-efficacy of dietitians toward using mHealth apps. Further translational research will be required to determine how the broader dietetic profession responds to this intervention. %M 30829577 %R 10.2196/12349 %U http://mhealth.jmir.org/2019/3/e12349/ %U https://doi.org/10.2196/12349 %U http://www.ncbi.nlm.nih.gov/pubmed/30829577 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 4 %P e30 %T An Optimization Program to Help Practices Assess Data Quality and Workflow With Their Electronic Medical Records: Observational Study %A Jones,Mavis %A Talebi,Reza %A Littlejohn,Jennifer %A Bosnic,Olivera %A Aprile,Jason %+ OntarioMD, Suite 900, 150 Bloor Street West, Toronto, ON, M5S 3C1, Canada, 1 4166231248 ext 5388, mavis.jones@ontariomd.com %K chronic disease %K electronic medical records %K primary care %K quality improvement %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Electronic medical record (EMR) adoption among Canadian primary care physicians continues to grow. In Ontario, >80% of primary care providers now use EMRs. Adopting an EMR does not guarantee better practice management or patient care; however, EMR users must understand how to effectively use it before they can realize its full benefit. OntarioMD developed an EMR Practice Enhancement Program (EPEP) to overcome challenges of clinicians and staff in finding time to learn a new technology or workflow. EPEP deploys practice consultants to work with clinicians onsite to harness their EMR toward practice management and patient care goals. Objective: This paper aims to illustrate the application of the EPEP approach to address practice-level factors that impede or enhance the effective use of EMRs to support patient outcomes and population health. The secondary objective is to draw attention to the potential impact of this practice-level work to population health (system-level), as priority population health indicators are addressed by quality improvement work at the practice-level. Methods: EPEP’s team of practice consultants work with clinicians to identify gaps in their knowledge of EMR functionality, analyze workflow, review EMR data quality, and develop action plans with achievable tasks. Consultants establish baselines for data quality in key clinical indicators and EMR proficiency using OntarioMD-developed maturity assessment tools. We reassessed and compared postengagement, data quality, and maturity. Three examples illustrating the EPEP approach and results are presented to illuminate strengths, limitations, and implications for further analysis. In each example, a different consultant was responsible for engaging with the practice to conduct the EPEP method. No standard timeframe exists for an EPEP engagement, as requirements differ from practice to practice, and EPEP tailors its approach and timeframe according to the needs of the practice. Results: After presenting findings of the initial data quality review, workflow, and gap analysis to the practice, consultants worked with practices to develop action plans and begin implementing recommendations. Each practice had different objectives in engaging the EPEP; here, we compared improvements across measures that were common priorities among all 3—screening (colorectal, cervical, and breast), diabetes diagnosis, and documentation of the smoking status. Consultants collected postengagement data at intervals (approximately 6, 12, and 18 months) to assess the sustainability of the changes. The postengagement assessment showed data quality improvements across several measures, and new confidence in their data enabled practices to implement more advanced functions (such as toolbars) and targeted initiatives for subpopulations of patients. Conclusions: Applying on-site support to analyze gaps in EMR knowledge and use, identify efficiencies to improve workflow, and correct data quality issues can make dramatic improvements in a practice’s EMR proficiency, allowing practices to experience greater benefit from their EMR, and consequently, improve their patient care. %M 30578203 %R 10.2196/humanfactors.9889 %U http://humanfactors.jmir.org/2018/4/e30/ %U https://doi.org/10.2196/humanfactors.9889 %U http://www.ncbi.nlm.nih.gov/pubmed/30578203 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e147 %T Self-Management of Chronic Diseases Among Older Korean Adults: An mHealth Training, Protocol, and Feasibility Study %A Kim,Heejung %A Park,Eunhee %A Lee,Sangeun %A Kim,Mijung %A Park,Eun Jeong %A Hong,Soyun %+ College of Nursing, Yonsei University, Room #407 College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic Of Korea, 82 10 7298 6706, rnsoyun@gmail.com %K mobile health %K feasibility study %K chronic disease %K eHealth Enhanced Chronic Care Model %K elderly %K community health service %D 2018 %7 29.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Most training programs for self-management of chronic diseases in Korea currently involve face-to-face interactions primarily in a health care setting. Therefore, older Koreans living in the community continue to seek other training opportunities for the management of chronic diseases. This has led to the development of new training methods, such as mobile health (mHealth) care, which are valuable in community centers and homes. Objective: This feasibility study (1) developed an mHealth training protocol to empower community-dwelling elderly individuals to manage their chronic diseases; (2) examined the feasibility of delivering this mHealth training protocol to elderly individuals through mobile tablets and applications (apps); and (3) discussed the contextual and methodological challenges associated with the development of this protocol. Methods: The mHealth training protocol was developed based on the eHealth Enhanced Chronic Care Model and comprised of four phases. Phase 1 included standardized technology (mobile tablets) training using guidebooks, demonstrations, and guided practice. Phase 2 included provision of standardized information about disease management that was obtained from governmental and professional health care organizations. Phase 3 included provision of training on the use of high-quality mHealth apps that were selected based on individual diagnoses. Phase 4 included encouraging the patients to practice using self-selected mHealth apps based on their individual needs. Quantitative descriptive statistics and qualitative content analyses of user evaluations were used to assess the feasibility and user acceptance of this protocol. Results: Of the 27 older adults included in this study, 25 completed all 4 weeks of the mHealth training. The attrition rate was 7% (2/27), and the reasons included time conflicts, emotional distress, and/or family discouragement. The men required little or no training for Phase 1, and in comparison with men, women seemed to depend more on the mHealth trainers in Phase 3. Gender, level of education, and previous experience of using smartphones were associated with the speed of learning, level of confidence, and overall competence. Conclusions: A tailored and personalized approach is required to develop mHealth training protocols for older adults. Self-management of chronic diseases via mHealth training requires careful consideration of the complex nature of human behavior, emotional responses, and familial influences. Therefore, integration of a theoretical, clinical, and technical approach is necessary for the successful development and implementation of an mHealth training program that targets older adults with chronic diseases in a community setting. %M 29959109 %R 10.2196/mhealth.9988 %U http://mhealth.jmir.org/2018/6/e147/ %U https://doi.org/10.2196/mhealth.9988 %U http://www.ncbi.nlm.nih.gov/pubmed/29959109 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 2 %P e18 %T Enhancing Home Health Mobile Phone App Usability Through General Smartphone Training: Usability and Learnability Case Study %A Harte,Richard %A Hall,Tony %A Glynn,Liam %A Rodríguez-Molinero,Alejandro %A Scharf,Thomas %A Quinlan,Leo R %A ÓLaighin,Gearóid %+ Physiology, School of Medicine, NUI Galway, University Road, Galway,, Ireland, 353 91493710, leo.quinlan@nuigalway.ie %K smartphone %K aged %K elderly %K wearable electronic devices %K telemedicine %K user-computer interface %K education %K user centered-design %K usability %K connected health %K human factors %K falls detection %D 2018 %7 26.04.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Each year, millions of older adults fall, with more than 1 out of 4 older people experiencing a fall annually, thereby causing a major social and economic impact. Falling once doubles one’s chances of falling again, making fall prediction an important aspect of preventative strategies. In this study, 22 older adults aged between 65 and 85 years were trained in the use of a smartphone-based fall prediction system. The system is designed to continuously assess fall risk by measuring various gait and balance parameters using a smart insole and smartphone, and is also designed to detect falls. The use case of the fall prediction system in question required the users to interact with the smartphone via an app for device syncing, data uploads, and checking system status. Objective: The objective of this study was to observe the effect that basic smartphone training could have on the user experience of a group that is not technically proficient with smartphones when using a new connected health system. It was expected that even short rudimentary training could have a large effect on user experience and therefore increase the chances of the group accepting the new technology. Methods: All participants received training on how to use the system smartphone app; half of the participants (training group) also received extra training on how to use basic functions of the smartphone, such as making calls and sending text messages, whereas the other half did not receive this extra training (no extra training group). Comparison of training group and no extra training group was carried out using metrics such as satisfaction rating, time taken to complete tasks, cues required to complete tasks, and errors made during tasks. Results: The training group fared better in the first 3 days of using the system. There were significant recorded differences in number of cues required and errors committed between the two groups. By the fourth and fifth day of use, both groups were performing at the same level when using the system. Conclusions: Supplementary basic smartphone training may be critical in trials where a smartphone app–based system for health intervention purposes is being introduced to a population that is not proficient with technology. This training could prevent early technology rejection and increase the engagement of older participants and their overall user experience with the system. %M 29699969 %R 10.2196/humanfactors.7718 %U http://humanfactors.jmir.org/2018/2/e18/ %U https://doi.org/10.2196/humanfactors.7718 %U http://www.ncbi.nlm.nih.gov/pubmed/29699969 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 5 %P e116 %T Effects of Improving Primary Health Care Workers’ Knowledge About Public Health Services in Rural China: A Comparative Study of Blended Learning and Pure E-Learning %A Zhan,Xingxin %A Zhang,Zhixia %A Sun,Fang %A Liu,Qian %A Peng,Weijun %A Zhang,Heng %A Yan,Weirong %+ Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science & Technology, No.13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 (027)83650713, weirong.yan@hust.edu.cn %K blended learning %K e-learning %K primary health care workers %K public health services %D 2017 %7 01.05.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Primary health care workers (PHCWs) are a major force in delivering basic public health services (BPHS) in rural China. It is necessary to take effective training approaches to improve PHCWs’ competency on BPHS. Both electronic learning (e-learning) and blended learning have been widely used in the health workers’ education. However, there is limited evidence on the effects of blended learning in comparison with pure e-learning. Objective: The aim of this study was to evaluate the effects of a blended-learning approach for rural PHCWs in improving their knowledge about BPHS as well as training satisfaction in comparison with a pure e-learning approach. Methods: The study was conducted among PHCWs in 6 rural counties of Hubei Province, China, between August 2013 and April 2014. Three counties were randomly allocated blended-learning courses (29 township centers or 612 PHCWs—the experimental group), and three counties were allocated pure e-learning courses (31 township centers or 625 PHCWs—the control group). Three course modules were administered for 5 weeks, with assessments at baseline and postcourse. Primary outcomes were score changes in courses’ knowledge. Secondary outcome was participant satisfaction (5-point Likert scale anchored between 1 [strongly agree] and 5 [strongly disagree]). Results: The experimental group had higher mean scores than the control group in knowledge achievement in three course modules: (1) module 1: 93.21 (95% CI 92.49-93.93) in experimental group versus 88.29 (95% CI 87.19-89.40) in the control group; adjusted difference, 4.92 (95% CI 2.61-7.24; P<.001); (2) module 2: 94.05 (95% CI 93.37-94.73) in the experimental group vs 90.22 (95% CI 89.12-91.31) in the control group; adjusted difference, 3.67 (95% CI 1.17-6.18; P=.004); (3) module 3: 93.88 (95% CI 93.08-94.68) in the experimental group versus 89.09 (95% CI 87.89-90.30) in control group; adjusted difference, 4.63 (95% CI 2.12-7.14; P<.001). The participants in the experimental learning group gave more positive responses with the four issues than control group participants: (1) the increase of interest in learning, 1.85 (95% CI 1.22-2.80; P=.003); (2) the increase of interaction with others, 1.77 (95% CI 1.20-2.60; P=.004); (3) the satisfaction with learning experience, 1.78 (95% CI 1.11-2.88; P=.02); and (4) achievement of learning objectives, 1.63 (95% CI 1.08-2.48; P=.02). Conclusions: Among PHCWs in rural China, a blended-learning approach to BPHS training could result in a higher knowledge achievement and satisfaction level compared with a pure e-learning approach. The findings of the study will contribute knowledge to improve the competency of PHCWs in similar settings. %M 28461286 %R 10.2196/jmir.6453 %U http://www.jmir.org/2017/5/e116/ %U https://doi.org/10.2196/jmir.6453 %U http://www.ncbi.nlm.nih.gov/pubmed/28461286 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e4 %T eHealth Literacy: Predictors in a Population With Moderate-to-High Cardiovascular Risk %A Richtering,Sarah S %A Hyun,Karice %A Neubeck,Lis %A Coorey,Genevieve %A Chalmers,John %A Usherwood,Tim %A Peiris,David %A Chow,Clara K %A Redfern,Julie %+ The George Institute for Global Health, 83/117 Missenden Road, Camperdown, Sydney, 2050, Australia, 61 299934500, jredfern@georgeinstitute.org.au %K eHealth %K socioeconomic factors %K health literacy %K cardiovascular system %K chronic disease %K Internet %D 2017 %7 27.01.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Electronic health (eHealth) literacy is a growing area of research parallel to the ongoing development of eHealth interventions. There is, however, little and conflicting information regarding the factors that influence eHealth literacy, notably in chronic disease. We are similarly ill-informed about the relationship between eHealth and health literacy, 2 related yet distinct health-related literacies. Objective: The aim of our study was to investigate the demographic, socioeconomic, technology use, and health literacy predictors of eHealth literacy in a population with moderate-to-high cardiovascular risk. Methods: Demographic and socioeconomic data were collected from 453 participants of the CONNECT (Consumer Navigation of Electronic Cardiovascular Tools) study, which included age, gender, education, income, cardiovascular-related polypharmacy, private health care, main electronic device use, and time spent on the Internet. Participants also completed an eHealth Literacy Scale (eHEALS) and a Health Literacy Questionnaire (HLQ). Univariate analyses were performed to compare patient demographic and socioeconomic characteristics between the low (eHEALS<26) and high (eHEALS≥26) eHealth literacy groups. To then determine the predictors of low eHealth literacy, multiple-adjusted generalized estimating equation logistic regression model was used. This technique was also used to examine the correlation between eHealth literacy and health literacy for 4 predefined literacy themes: navigating resources, skills to use resources, usefulness for oneself, and critical evaluation. Results: The univariate analysis showed that patients with lower eHealth literacy were older (68 years vs 66 years, P=.01), had lower level of education (P=.007), and spent less time on the Internet (P<.001). However, multiple-adjusted generalized estimating equation logistic regression model demonstrated that only the time spent on the Internet (P=.01) was associated with the level of eHealth literacy. Regarding the comparison between the eHEALS items and HLQ scales, a positive linear relationship was found for the themes “usefulness for oneself” (P=.049) and “critical evaluation” (P=.01). Conclusions: This study shows the importance of evaluating patients’ familiarity with the Internet as reflected, in part, by the time spent on the Internet. It also shows the importance of specifically assessing eHealth literacy in conjunction with a health literacy assessment in order to assess patients’ navigational knowledge and skills using the Internet, specific to the use of eHealth applications. %M 28130203 %R 10.2196/humanfactors.6217 %U http://humanfactors.jmir.org/2017/1/e4/ %U https://doi.org/10.2196/humanfactors.6217 %U http://www.ncbi.nlm.nih.gov/pubmed/28130203 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e27 %T Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills %A van der Vaart,Rosalie %A Drossaert,Constance %+ Department of Psychology, Health and Technology, Faculty of Behavioural, Management and Social Sciences, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 053 489 6049, c.h.c.drossaert@utwente.nl %K digital health literacy skills %K eHealth literacy %K measurement %K validity %K performance-based instrument %D 2017 %7 24.01.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: With the digitization of health care and the wide availability of Web-based applications, a broad set of skills is essential to properly use such facilities; these skills are called digital health literacy or eHealth literacy. Current instruments to measure digital health literacy focus only on information gathering (Health 1.0 skills) and do not pay attention to interactivity on the Web (Health 2.0). To measure the complete spectrum of Health 1.0 and Health 2.0 skills, including actual competencies, we developed a new instrument. The Digital Health Literacy Instrument (DHLI) measures operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content, and protecting privacy. Objective: Our objective was to study the distributional properties, reliability, content validity, and construct validity of the DHLI’s self-report scale (21 items) and to explore the feasibility of an additional set of performance-based items (7 items). Methods: We used a paper-and-pencil survey among a sample of the general Dutch population, stratified by age, sex, and educational level (T1; N=200). The survey consisted of the DHLI, sociodemographics, Internet use, health status, health literacy and the eHealth Literacy Scale (eHEALS). After 2 weeks, we asked participants to complete the DHLI again (T2; n=67). Cronbach alpha and intraclass correlation analysis between T1 and T2 were used to investigate reliability. Principal component analysis was performed to determine content validity. Correlation analyses were used to determine the construct validity. Results: Respondents (107 female and 93 male) ranged in age from 18 to 84 years (mean 46.4, SD 19.0); 23.0% (46/200) had a lower educational level. Internal consistencies of the total scale (alpha=.87) and the subscales (alpha range .70-.89) were satisfactory, except for protecting privacy (alpha=.57). Distributional properties showed an approximately normal distribution. Test-retest analysis was satisfactory overall (total scale intraclass correlation coefficient=.77; subscale intraclass correlation coefficient range .49-.81). The performance-based items did not together form a single construct (alpha=.47) and should be interpreted individually. Results showed that more complex skills were reflected in a lower number of correct responses. Principal component analysis confirmed the theoretical structure of the self-report scale (76% explained variance). Correlations were as expected, showing significant relations with age (ρ=–.41, P<.001), education (ρ=.14, P=.047), Internet use (ρ=.39, P<.001), health-related Internet use (ρ=.27, P<.001), health status (ρ range .17-.27, P<.001), health literacy (ρ=.31, P<.001), and the eHEALS (ρ=.51, P<.001). Conclusions: This instrument can be accepted as a new self-report measure to assess digital health literacy, using multiple subscales. Its performance-based items provide an indication of actual skills but should be studied and adapted further. Future research should examine the acceptability of this instrument in other languages and among different populations. %M 28119275 %R 10.2196/jmir.6709 %U http://www.jmir.org/2017/1/e27/ %U https://doi.org/10.2196/jmir.6709 %U http://www.ncbi.nlm.nih.gov/pubmed/28119275 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e169 %T Effect of Performance Feedback on Community Health Workers’ Motivation and Performance in Madhya Pradesh, India: A Randomized Controlled Trial %A Kaphle,Sangya %A Matheke-Fischer,Michael %A Lesh,Neal %+ Dimagi Software Innovations, 585 Massachusetts Ave #3, Cambridge, MA, 02139, United States, 1 617 649 2214, sangyakaphle@gmail.com %K community health workers %K performance feedback %K motivation %K supportive supervision %K mHealth apps %D 2016 %7 07.12.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Small-scale community health worker (CHW) programs provide basic health services and strengthen health systems in resource-poor settings. This paper focuses on improving CHW performance by providing individual feedback to CHWs working with an mHealth program to address malnutrition in children younger than 5 years. Objective: The paper aims to evaluate the immediate and retention effects of providing performance feedback and supportive supervision on CHW motivation and performance for CHWs working with an mHealth platform to reduce malnutrition in five districts of Madhya Pradesh, India. We expected a positive impact on CHW performance for the indicator they received feedback on. Performance on indicators the CHW did not receive feedback on was not expected to change. Methods: In a randomized controlled trial, 60 CHWs were randomized into three treatment groups based on overall baseline performance ranks to achieve balanced treatment groups. Data for each treatment indicator were analyzed with the other two treatments acting as the control. In total, 10 CHWs were lost to follow-up. There were three performance indicators: case activity, form submissions, and duration of counseling. Each group received weekly calls to provide performance targets and discuss their performance on the specific indicator they were allocated to as well as any challenges or technical issues faced during the week for a 6-week period. Data were collected for a further 4 weeks to assess intertemporal sustained effects of the intervention. Results: We found positive and significant impacts on duration of counseling, whereas case activity and number of form submissions did not show significant improvements as a result of the intervention. We found a moderate to large effect (Glass’s delta=0.97, P=.004) of providing performance feedback on counseling times in the initial 6 weeks. These effects were sustained in the postintervention period (Glass’s delta=1.69, P<.001). The counseling times decreased slightly from the intervention to postintervention period by 2.14 minutes (P=.01). Case activity improved for all CHWs after the intervention. We also performed the analysis by replacing the CHWs lost to follow-up with those in their treatment groups with the closest ranks in baseline performance and found similar results. Conclusions: Calls providing performance feedback are effective in improving CHW motivation and performance. Providing feedback had a positive effect on performance in the case of duration of counseling. The results suggest that difficulty in achieving the performance target can affect results of performance feedback. Regardless of the performance information disclosed, calls can improve performance due to elements of supportive supervision included in the calls encouraging CHW motivation. %M 27927607 %R 10.2196/publichealth.3381 %U http://publichealth.jmir.org/2016/2/e169/ %U https://doi.org/10.2196/publichealth.3381 %U http://www.ncbi.nlm.nih.gov/pubmed/27927607 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 7 %P e180 %T The Effect of a Freely Available Flipped Classroom Course on Health Care Worker Patient Safety Culture: A Prospective Controlled Study %A Ling,Lowell %A Gomersall,Charles David %A Samy,Winnie %A Joynt,Gavin Matthew %A Leung,Czarina CH %A Wong,Wai-Tat %A Lee,Anna %+ The Chinese University of Hong Kong, Department of Anaesthesia and Intensive Care, 4th Floor, Main Clinical Block and Trauma Centre, Prince of Wales Hospital, Shatin,, China (Hong Kong), 852 2632 2735, annalee@cuhk.edu.hk %K patient safety %K critical care %K education, professional %K education, distance %K safety culture %D 2016 %7 05.07.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient safety culture is an integral aspect of good standard of care. A good patient safety culture is believed to be a prerequisite for safe medical care. However, there is little evidence on whether general education can enhance patient safety culture. Objective: Our aim was to assess the impact of a standardized patient safety course on health care worker patient safety culture. Methods: Health care workers from Intensive Care Units (ICU) at two hospitals (A and B) in Hong Kong were recruited to compare the changes in safety culture before and after a patient safety course. The BASIC Patient Safety course was administered only to staff from Hospital A ICU. Safety culture was assessed in both units at two time points, one before and one after the course, by using the Hospital Survey on Patient Safety Culture questionnaire. Responses were coded according to the Survey User’s Guide, and positive response percentages for each patient safety domain were compared to the 2012 Agency for Healthcare Research and Quality ICU sample of 36,120 respondents. Results: We distributed 127 questionnaires across the two hospitals with an overall response rate of 74.8% (95 respondents). After the safety course, ICU A significantly improved on teamwork within hospital units (P=.008) and hospital management support for patient safety (P<.001), but decreased in the frequency of reporting mistakes compared to the initial survey (P=.006). Overall, ICU A staff showed significantly greater enhancement in positive responses in five domains than staff from ICU B. Pooled data indicated that patient safety culture was poorer in the two ICUs than the average ICU in the Agency for Healthcare Research and Quality database, both overall and in every individual domain except hospital management support for patient safety and hospital handoffs and transitions. Conclusions: Our study demonstrates that a structured, reproducible short course on patient safety may be associated with an enhancement in several domains in ICU patient safety culture. %M 27381876 %R 10.2196/jmir.5378 %U http://www.jmir.org/2016/7/e180/ %U https://doi.org/10.2196/jmir.5378 %U http://www.ncbi.nlm.nih.gov/pubmed/27381876 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 3 %N 1 %P e9 %T How Does Learnability of Primary Care Resident Physicians Increase After Seven Months of Using an Electronic Health Record? A Longitudinal Study %A Clarke,Martina A %A Belden,Jeffery L %A Kim,Min Soon %+ Department of Health Management and Informatics, University of Missouri, CE728 Clinical Support & Education, DC006.00, 5 Hospital Drive, Columbia, MO, , United States, 1 573 884 0115, kimms@health.missouri.edu %K primary care, physicians, usability, electronic health records, computerized physician order entry, user-computer interface %D 2016 %7 15.02.2016 %9 Original Paper %J JMIR Human Factors %G English %X Background: Electronic health records (EHRs) with poor usability present steep learning curves for new resident physicians, who are already overwhelmed in learning a new specialty. This may lead to error-prone use of EHRs in medical practice by new resident physicians. Objective: The study goal was to determine learnability gaps between expert and novice primary care resident physician groups by comparing performance measures when using EHRs. Methods: We compared performance measures after two rounds of learnability tests (November 12, 2013 to December 19, 2013; February 12, 2014 to April 22, 2014). In Rounds 1 and 2, 10 novice and 6 expert physicians, and 8 novice and 4 expert physicians participated, respectively. Laboratory-based learnability tests using video analyses were conducted to analyze learnability gaps between novice and expert physicians. Physicians completed 19 tasks, using a think-aloud strategy, based on an artificial but typical patient visit note. We used quantitative performance measures (percent task success, time-on-task, mouse activities), a system usability scale (SUS), and qualitative narrative feedback during the participant debriefing session. Results: There was a 6-percentage-point increase in novice physicians’ task success rate (Round 1: 92%, 95% CI 87-99; Round 2: 98%, 95% CI 95-100) and a 7-percentage-point increase in expert physicians’ task success rate (Round 1: 90%, 95% CI 83-97; Round 2: 97%, 95% CI 93-100); a 10% decrease in novice physicians’ time-on-task (Round 1: 44s, 95% CI 32-62; Round 2: 40s, 95% CI 27-59) and 21% decrease in expert physicians’ time-on-task (Round 1: 39s, 95% CI 29-51; Round 2: 31s, 95% CI 22-42); a 20% decrease in novice physicians mouse clicks (Round 1: 8 clicks, 95% CI 6-13; Round 2: 7 clicks, 95% CI 4-12) and 39% decrease in expert physicians’ mouse clicks (Round 1: 8 clicks, 95% CI 5-11; Round 2: 3 clicks, 95% CI 1-10); a 14% increase in novice mouse movements (Round 1: 9247 pixels, 95% CI 6404-13,353; Round 2: 7991 pixels, 95% CI 5350-11,936) and 14% decrease in expert physicians’ mouse movements (Round 1: 7325 pixels, 95% CI 5237-10,247; Round 2: 6329 pixels, 95% CI 4299-9317). The SUS measure of overall usability demonstrated only minimal change in the novice group (Round 1: 69, high marginal; Round 2: 68, high marginal) and no change in the expert group (74; high marginal for both rounds). Conclusions: This study found differences in novice and expert physicians’ performance, demonstrating that physicians’ proficiency increased with EHR experience. Our study may serve as a guideline to improve current EHR training programs. Future directions include identifying usability issues faced by physicians when using EHRs, through a more granular task analysis to recognize subtle usability issues that would otherwise be overlooked. %M 27025237 %R 10.2196/humanfactors.4601 %U http://humanfactors.jmir.org/2016/1/e9/ %U https://doi.org/10.2196/humanfactors.4601 %U http://www.ncbi.nlm.nih.gov/pubmed/27025237 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 2 %N 1 %P e4 %T Knowledge and Utilization of Computers Among Health Professionals in a Developing Country: A Cross-Sectional Study %A Alwan,Kalid %A Awoke,Tadesse %A Tilahun,Binyam %+ Institute of Medical Informatics, University of Münster, Albert-Schweitzer-Campus 1, Gebäude A11, Münster, , Germany, 49 251 83 58368, binyam.tilahun@uni-muenster.de %K computer literacy %K health professionals %K eHealth success %K Ethiopia %D 2015 %7 26.03.2015 %9 Original Paper %J JMIR Human Factors %G English %X Background: Incorporation of information communication technology in health care has gained wide acceptance in the last two decades. Developing countries are also incorporating information communication technology into the health system including the implementation of electronic medical records in major hospitals and the use of mobile health in rural community-based health interventions. However, the literature on the level of knowledge and utilization of information communication technology by health professionals in those settings is scarce for proper implementation planning. Objective: The objective of this study is to assess knowledge, computer utilization, and associated factors among health professionals in hospitals and health institutions in Ethiopia. Methods: A quantitative cross-sectional study was conducted on 554 health professionals working in 7 hospitals, 19 primary health centers, and 10 private clinics in the Harari region of Ethiopia. Data were collected using a semi-structured, self-administered, and pre-tested questionnaire. Descriptive and logistic regression techniques using SPSS version 16.0 (IBM Corporation) were applied to determine the level of knowledge and identify determinants of utilization of information communication technology. Results: Out of 554 participants, 482 (87.0%) of them responded to the questionnaire. Among them, 90 (18.7%) demonstrated good knowledge of computers while 142 (29.5%) demonstrated good utilization habits. Health professionals who work in the primary health centers were found to have lower knowledge (3.4%) and utilization (18.4%). Age (adjusted odds ratio [AOR]=3.06, 95% CI 0.57-5.37), field of study (AOR=3.08, 95% CI 1.65-5.73), level of education (AOR=2.78, 95% CI 1.43-5.40), and previous computer training participation (AOR=3.65, 95% CI 1.62-8.21) were found to be significantly associated with computer utilization habits of health professionals. Conclusions: Computer knowledge and utilization habits of health professionals, especially those who work in primary health centers, were found to be low. Providing trainings and continuous follow-up are necessary measures to increase the likelihood of the success of implemented eHealth systems in those settings. %M 27025996 %R 10.2196/humanfactors.4184 %U http://humanfactors.jmir.org/2015/1/e4/ %U https://doi.org/10.2196/humanfactors.4184 %U http://www.ncbi.nlm.nih.gov/pubmed/27025996 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 1 %N 1 %P e1 %T Narrowing the Skills Gap for Innovation: An Empirical Study in the Hospital Sector %A Dias,Casimiro %A Escoval,Ana %+ World Health Organization, Health Systems and Public Health, UN City, Marmorvej 51, Copenhagen, DK-2100, Denmark, 45 45 33 66 39, diasc@who.int %K hospital administration %K organizational innovation %K management information systems %K clinical skills %K staff development %K personnel management %D 2014 %7 23.09.2014 %9 Original Paper %J JMIR Human Factors %G English %X Background: The current financial crisis and the increasing burden of chronic diseases are challenging hospitals to enhance their innovation capacity to deliver new and more effective health services. However, the shortage of skills has been widely recognized as a key obstacle for innovation. Ensuring the presence of a skilled workforce has become a priority for the health system in Portugal and across Europe. Objective: The aim of this study was to examine the demand of new skills and their influence in both investments in innovation and development of skills. Methods: We used a mixed-methods approach combining statistical analysis of data survey and content analysis of semistructured interviews with the Administration Boards of hospitals, using a nominal group technique. Results: The results illustrate an increasing demand of a broad range of skills for innovation development, including responsibility and quality consciousness (with a significant increase of 55%, 52/95), adaptation skills (with an increase of 44%, 42/95) and cooperation and communication skills (with an increase of 55%, 52/95). Investments in the development of skills for innovation are mainly focused on aligning professional training with an organizational strategy (69%, 66/95) as well as collaboration in taskforces (61%, 58/95) and cross-department teams (60%, 57/95). However, the dynamics between the supply and demand of skills for innovation are better explained through a broader perspective of organizational changes towards enhancing learning opportunities and engagement of health professionals to boost innovation. Conclusions: The results of this study illustrate that hospitals are unlikely to enhance their innovation capacity if they pursue strategies failing to match the skills needed. Within this context, hospitals with high investments in innovation tend to invest more in skills development. The demand of skills and investments in training are influenced by many other factors, including the hospital’s strategies, as well as changes in the work organization. Relevant implications for managers and policy makers can be drawn from the empirical findings of this paper, building on the current efforts from leading innovating hospitals that are already defining the future of health care. %M 27025197 %R 10.2196/humanfactors.3598 %U http://humanfactors.jmir.org/2014/1/e1/ %U https://doi.org/10.2196/humanfactors.3598 %U http://www.ncbi.nlm.nih.gov/pubmed/27025197