%0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 2 %P e21639 %T Developing Patient-Centered Inflammatory Bowel Disease–Related Educational Videos Optimized for Social Media: Qualitative Research Study %A Khalil,Carine %A Van Deen,Welmoed %A Dupuy,Taylor %A Bonthala,Nirupama %A Almario,Christopher %A Spiegel,Brennan %+ Division of Health Services Research, Center for Outcomes Research and Education, Cedars-Sinai Medical Center, 116 N Robertson PACT Building, Los Angeles, CA, 90048, United States, 1 2133361585, carine.khalil@cshs.org %K inflammatory bowel disease %K educational videos %K patient education %K design thinking %K qualitative research %K mobile phone %D 2020 %7 20.10.2020 %9 Original Paper %J JMIR Med Educ %G English %X Background: Important knowledge gaps have been identified related to the causes and symptoms of inflammatory bowel disease (IBD) and medical treatments and their side effects. Patients with IBD turn to social media to learn more about their disease. However, such information found on the web is misleading and often of low quality. Objective: This study aims to gain an in-depth understanding of the unmet educational needs of patients with IBD and to use the resulting insights to develop a collection of freely available, evidence-based educational videos optimized for dissemination through social media. Methods: We used design thinking, a human-centered approach, to guide our qualitative research methodology. We performed focus groups and interviews with a diverse sample of 29 patients with IBD. Data collection was performed in 3 phases (inspiration, ideation, and implementation) based on IDEO design thinking. Phase 1 offered insights into the needs of patients with IBD, whereas phases 2 and 3 involved ideation, prototyping, and video testing. A thematic analysis was performed to analyze the resulting data. Results: Patients emphasized the need for educational videos that address their challenges, needs, and expectations. From the data analysis, 5 video topics and their content emerged: IBD treatments’ risks and benefits; how to be a self-advocate; how to stay healthy with IBD; how to cope with IBD; and educating families, friends, and colleagues about experiences of patients with IBD. Conclusions: Design thinking offers a deep understanding and recognition of the unmet educational needs of patients with IBD; this approach informed the development of 5 evidence-based educational videos. Future research will formally test and disseminate these freely available videos through social media. %M 33079065 %R 10.2196/21639 %U http://mededu.jmir.org/2020/2/e21639/ %U https://doi.org/10.2196/21639 %U http://www.ncbi.nlm.nih.gov/pubmed/33079065 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 10 %P e21075 %T Examining an App-Based Mental Health Self-Care Program, IntelliCare for College Students: Single-Arm Pilot Study %A Lattie,Emily %A Cohen,Katherine A %A Winquist,Nathan %A Mohr,David C %+ Department of Medical Social Sciences, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 3125033741, emily.lattie@northwestern.edu %K mHealth %K college students %K depression %K anxiety %K mobile phone %D 2020 %7 10.10.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: In recent years, there has been an increase in symptoms of depression, anxiety, and other mental illnesses in college student populations alongside a steady rise in the demand for counseling services. Digital mental health programs, such as those delivered through mobile apps, can add to the array of available services but must be tested for usability and acceptability before implementation. Objective: This study aims to examine how students used IntelliCare for College Students over an 8-week period to examine the preliminary associations between app use and psychosocial targets and to gather user feedback about usability issues that need to be remedied before a larger implementation study. Methods: IntelliCare for College Students is an app-based platform that provides symptom assessments with personalized feedback, information about campus resources, lessons on mental health and wellness topics, and access to the suite of interactive skill–focused IntelliCare apps. A total of 20 students were recruited to participate in an 8-week study. To test for a broad range of potential users, we recruited a mixed sample of students with elevated symptoms of depression or anxiety and students without elevated symptoms. Participants completed psychosocial questionnaires at baseline, week 4, and week 8. Participants also completed user feedback interviews at weeks 4 and 8 in which they provided feedback on their experience using the app and suggestions for changes they would like to be made to the app. Results: Of the 20 students who downloaded the app, 19 completed the study, indicating a high rate of retention. Over the study period, participants completed an average of 5.85 (SD 2.1; range 1-8) symptom assessments. Significant improvements were observed in the Anxiety Literacy Questionnaire scores (Z=−2.006; P=.045) and in the frequency with which participants used both cognitive (Z=−2.091; P=.04) and behavioral (Z=−2.249; P=.03) coping skills. In the feedback interviews, we identified a high degree of usability with minor bugs in the app software, which were quickly fixed. Furthermore, in feedback interviews, we identified that users found the app to be convenient and appreciated the ability to use the program in short bursts of time. Conclusions: The findings indicate that the IntelliCare for College Students program was perceived as largely usable and engaging. Although the program demonstrated usability and preliminary benefits to students, further testing is needed to determine its clinical utility among college students. Trial Registration: ClinicalTrials.gov NCT04035577; https://clinicaltrials.gov/ct2/show/NCT04035577 %M 33037874 %R 10.2196/21075 %U http://mental.jmir.org/2020/10/e21075/ %U https://doi.org/10.2196/21075 %U http://www.ncbi.nlm.nih.gov/pubmed/33037874 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e18140 %T User Perspectives of Mood-Monitoring Apps Available to Young People: Qualitative Content Analysis %A Widnall,Emily %A Grant,Claire Ellen %A Wang,Tao %A Cross,Lauren %A Velupillai,Sumithra %A Roberts,Angus %A Stewart,Robert %A Simonoff,Emily %A Downs,Johnny %+ Institute of Psychiatry, Psychology and Neuroscience, Kings College London, 16 De Crespigny Park, London, United Kingdom, 44 7730683269, emily.widnall@kcl.ac.uk %K mood monitoring %K engagement %K mobile applications %K mHealth %K mental health %K smartphone %K qualitative research %K mobile phone %D 2020 %7 10.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health apps are increasingly available and used in a clinical context to monitor young people’s mood and mental health. Despite the benefits of accessibility and cost-effectiveness, consumer engagement remains a hurdle for uptake and continued use. Hundreds of mood-monitoring apps are publicly available to young people on app stores; however, few studies have examined consumer perspectives. App store reviews held on Google and Apple platforms provide a large, rich source of naturally generated, publicly available user reviews. Although commercial developers use these data to modify and improve their apps, to date, there has been very little in-depth evaluation of app store user reviews within scientific research, and our current understanding of what makes apps engaging and valuable to young people is limited. Objective: This study aims to gain a better understanding of what app users consider useful to encourage frequent and prolonged use of mood-monitoring apps appropriate for young people. Methods: A systematic approach was applied to the selection of apps and reviews. We identified mood-monitoring apps (n=53) by a combination of automated application programming interface (API) methods. We only included apps appropriate for young people based on app store age categories (apps available to those younger than 18 years). We subsequently downloaded all available user reviews via API data scraping methods and selected a representative subsample of reviews (n=1803) for manual qualitative content analysis. Results: The qualitative content analysis revealed 8 main themes: accessibility (34%), flexibility (21%), recording and representation of mood (18%), user requests (17%), reflecting on mood (16%), technical features (16%), design (13%), and health promotion (11%). A total of 6 minor themes were also identified: notification and reminders; recommendation; privacy, security, and transparency; developer; adverts; and social/community. Conclusions: Users value mood-monitoring apps that can be personalized to their needs, have a simple and intuitive design, and allow accurate representation and review of complex and fluctuating moods. App store reviews are a valuable repository of user engagement feedback and provide a wealth of information about what users value in an app and what user needs are not being met. Users perceive mood-monitoring apps positively, but over 20% of reviews identified the need for improvement. %M 33037875 %R 10.2196/18140 %U http://mhealth.jmir.org/2020/10/e18140/ %U https://doi.org/10.2196/18140 %U http://www.ncbi.nlm.nih.gov/pubmed/33037875 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e18514 %T Help-Seeking Behaviors of Transition-Aged Youth for Mental Health Concerns: Qualitative Study %A Stunden,Chelsea %A Zasada,Julie %A VanHeerwaarden,Nicole %A Hollenberg,Elisa %A Abi-Jaoudé,Alexxa %A Chaim,Gloria %A Cleverley,Kristin %A Henderson,Joanna %A Johnson,Andrew %A Levinson,Andrea %A Lo,Brian %A Robb,Janine %A Shi,Jenny %A Voineskos,Aristotle %A Wiljer,David %+ Education, Technology & Innovation, University Health Network, R. Fraser Elliot Building RFE 3E-411, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 6322, David.Wiljer@uhn.ca %K mental health %K students %K adolescent %K substance abuse %K eHealth %K mHealth %K mobile apps %K help-seeking behavior %K social stigma %K social support %D 2020 %7 5.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Transition-aged youth are particularly vulnerable to mental health problems, yet they are one of the least likely demographic groups to seek help. Objective: The aim of this study is to explore the influences on and patterns in help-seeking for mental health concerns among transition-aged youth who attend postsecondary schools in Canada. Methods: A qualitative research design was used, involving 12 semistructured focus groups with transition-aged youth (17-29 years) who attended postsecondary schools in Canada. A thematic analysis was conducted to code the transcripts and develop themes. Results: Four main themes and subthemes regarding the process and experience of help-seeking were generated: (1) the influence of formal service providers (accessibility and experiences), (2) the influence of social factors (system navigation and stigma), (3) the influence of health literacy (symptom recognition, acting on symptoms, digital tools and the internet, and mental health awareness campaigns), and (4) the influence of low-intensity sources of support, namely, self-help. Conclusions: Transition-aged youth seek help for mental health problems in different ways. Despite efforts to improve access to mental health services, transition-aged youth continue to face barriers to accessing these services, especially formal sources of support. The factors identified in this study that either hinder or facilitate help-seeking have pragmatic implications for developing help-seeking interventions and delivering mental health services for this population. In addition to other facilitators, family physicians are an important resource in the help-seeking process. Furthermore, digital help-seeking tools have unique characteristics that may make them an important source of support for transition-aged youth. %M 33016882 %R 10.2196/18514 %U https://www.jmir.org/2020/10/e18514 %U https://doi.org/10.2196/18514 %U http://www.ncbi.nlm.nih.gov/pubmed/33016882 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e18556 %T Research Participants’ Perspectives on Using an Electronic Portal for Engagement and Data Collection: Focus Group Results From a Large Epidemiologic Cohort %A Rees-Punia,Erika %A Patel,Alpa V %A Beckwitt,Asher %A Leach,Corinne R %A Gapstur,Susan M %A Smith,Tenbroeck G %+ American Cancer Society, 250 Williams St, Atlanta, GA, 30303, United States, 1 4049823684, erika.rees-punia@cancer.org %K focus groups %K health information technology %K epidemiologic studies %D 2020 %7 1.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Epidemiologic cohort studies have begun to leverage electronic research participant portals to facilitate data collection, integrate wearable technologies, lower costs, and engage participants. However, little is known about the acceptability of portal use by research participants. Objective: The aim of this study is to conduct focus groups among a sample of Cancer Prevention Study-3 (CPS-3) participants to better understand their preferences and concerns about research portals. Methods: CPS-3 participants were stratified based on sex, race and ethnicity, age, and cancer status, and randomly invited to participate. Focus groups used an exploratory case design with semistructured guides to prompt discussion. Using a constant comparison technique, transcripts were assigned codes to identify themes. Results: Participants (31/59, 52% women; 52/59, 88% White/non-Latinx) were favorably disposed toward using a research participant portal to take surveys, communicate with the study staff, and upload data. Most participants indicated that a portal would be beneficial and convenient but expressed concerns over data safety. Participants stressed the importance of an easy-to-use and trustworthy portal that is compatible with mobile devices. Conclusions: In addition to being beneficial to researchers, portals may also benefit participants as long as the portals are secure and simple. Participants believe that portals can provide convenient ways to report data and remain connected to the study. %M 33001033 %R 10.2196/18556 %U https://www.jmir.org/2020/10/e18556 %U https://doi.org/10.2196/18556 %U http://www.ncbi.nlm.nih.gov/pubmed/33001033 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e17880 %T Exploring Participants’ Experiences of a Web-Based Program for Bulimia and Binge Eating Disorder: Qualitative Study %A Yim,See Heng %A Bailey,Emma %A Gordon,Gemma %A Grant,Nina %A Musiat,Peter %A Schmidt,Ulrike %+ King's College London, Institute of Psychiatry, Psychology and Neuroscience , PO Box 59, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 2078480160, see.yim@hmc.ox.ac.uk %K eHealth %K self-help %K eating disorders %K bulimia %K binge eating disorder %K internet-based intervention %K qualitative research %D 2020 %7 23.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Guided cognitive behavioral self-help is a recommended first-line treatment for eating disorders (EDs) such as bulimia nervosa (BN) or binge eating disorder (BED). Online versions of such self-help programs are increasingly being studied in randomized controlled trials (RCTs), with some evidence that they can reduce ED symptoms, although intervention dropout is variable across interventions. However, in-depth research into participants’ experiences and views on the acceptability of web-based interventions is limited. Objective: This is a qualitative process study of participants’ experiences of everyBody Plus, a web-based cognitive behavioral intervention, integrated into a large RCT to aid the interpretation of the main trial’s results. To our knowledge, this is the first such study in digital intervention for EDs research to include real-time feedback into the qualitative analysis. This study aims to build upon the emerging literature by qualitatively exploring participants’ experiences of a web-based intervention for BN and BED. Methods: Participants were those who took part in the UK arm of a larger RCT investigating the efficacy of the everyBody Plus intervention. Reflexive thematic analysis was completed on 2 sources of data from the online platform: real-time feedback quotes provided at the end of completing a module on the platform (N=104) and semistructured telephone interview transcripts (n=12). Results: Four main themes were identified. The first theme identified positive and negative user experiences, with a desire for a more customized and personalized intervention. Another theme positively reflected on how flexible and easy the intervention was to embed into daily life, compared with the silo of face-to-face therapy. The third theme identified how the intervention had a holistic impact cognitively, emotionally, interpersonally, and behaviorally. The final theme was related to how the intervention was not a one size fits all and how the perceived usefulness and relevance were often dependent on participants’ demographic and clinical characteristics. Conclusions: Overall, participants reported positive experiences with the use of the everyBody Plus web-based intervention, including flexibility of use and the potential to holistically impact people’s lives. The participants also provided valuable suggestions for how similar future web-based interventions could be improved and, in the context of EDs, how programs can be designed to be more inclusive of people by encompassing different demographic and clinical characteristics. %M 32965235 %R 10.2196/17880 %U http://www.jmir.org/2020/9/e17880/ %U https://doi.org/10.2196/17880 %U http://www.ncbi.nlm.nih.gov/pubmed/32965235 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e18867 %T Breast Cancer Survivors’ Perspectives on Motivational and Personalization Strategies in Mobile App–Based Physical Activity Coaching Interventions: Qualitative Study %A Monteiro-Guerra,Francisco %A Signorelli,Gabriel Ruiz %A Rivera-Romero,Octavio %A Dorronzoro-Zubiete,Enrique %A Caulfield,Brian %+ Salumedia Tecnologías, Avda. República Argentina, nº 24 Edificio Torre de los Remedios, 5ª planta - módulo A, Seville, 41011, Spain, 34 672787858, francisco.guerra@ucdconnect.ie %K mHealth %K mobile app %K mobile phone %K coaching %K physical activity %K breast cancer %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite growing evidence supporting the vital benefits of physical activity (PA) for breast cancer survivors, the majority do not meet the recommended levels of activity. Mobile app–based PA coaching interventions might be a feasible strategy to facilitate adherence of breast cancer survivors to the PA guidelines. To engage these individuals, PA apps need to be specifically designed based on their needs and preferences and to provide targeted support and motivation. However, more information is needed to understand how these technologies can provide individual and relevant experiences that have the ability to increase PA adherence and retain the individual’s interest in the long term. Objective: The aim of this study is to explore insights from breast cancer survivors on motivational and personalization strategies to be used in PA coaching apps and interventions. Methods: A qualitative study was conducted, using individual semistructured interviews, with 14 breast cancer survivors. The moderator asked open-ended questions and made use of a slideshow presentation to elicit the participants’ perspectives on potential mobile app–based intervention features. Transcribed interviews were evaluated by 3 reviewers using thematic content analysis. Results: Participants (mean age 53.3, SD 8.7 years) were White women. In total, 57% (8/14) of the participants did not adhere to the PA guidelines. In general, participants had access to and were interested in using technology. The identified themes included (1) barriers to PA, (2) psychological mediators of PA motivation, (3) needs and suggestions for reinforcing motivation support, (4) personalization aspects of the PA coaching experience, and (5) technology trustworthiness. Motivational determinants included perceived control, confidence and perceived growth, and connectedness. Participants were interested in having a straightforward app for monitoring and goal setting, which would include a prescribed activity program and schedule, and positive communication. Opinions varied in terms of social and game-like system possibilities. In addition, they expressed a desire for a highly personalized coaching experience based on as much information collected from them as possible (eg, disease stage, physical limitations, preferences) to provide individualized progress information, dynamic adjustment of the training plan, and context-aware activity suggestions (eg, based on weather and location). Participants also wanted the app to be validated or backed by professionals and were willing to share their data in exchange for a more personalized experience. Conclusions: This work suggests the need to develop simple, guiding, encouraging, trustworthy, and personalized PA coaching apps. The findings are in line with behavioral and personalization theories and methods that can be used to inform intervention design decisions. This paper opens new possibilities for the design of personalized and motivating PA coaching app experiences for breast cancer survivors, which might ultimately facilitate the sustained adherence of these individuals to the recommended levels of activity. %M 32955446 %R 10.2196/18867 %U https://mhealth.jmir.org/2020/9/e18867 %U https://doi.org/10.2196/18867 %U http://www.ncbi.nlm.nih.gov/pubmed/32955446 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e17563 %T Implementing Facilitated Access to a Text Messaging, Smoking Cessation Intervention Among Swedish Patients Having Elective Surgery: Qualitative Study of Patients’ and Health Care Professionals’ Perspectives %A Thomas,Kristin %A Bendtsen,Marcus %A Linderoth,Catharina %A Bendtsen,Preben %+ Department of Health, Medicine and Caring Sciences, Linköping University, 58381, Linköping, , Sweden, 46 13282546, kristin.thomas@liu.se %K mHealth %K mobile health %K text messages %K health care %K smoking cessation %K patients with elective surgery %K implementation %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: There is strong evidence that short-term smoking cessation before surgery can reduce postoperative morbidity. There are, however, several structural problems in health care systems concerning how to implement smoking cessation interventions in routine practice for preoperative patients. Objective: This study aimed to analyze the implementation of a text messaging, smoking cessation intervention targeting patients having elective surgery. Implementation of facilitated access (ie, referral from practitioners) and the perceived usefulness among patients were investigated. Elective surgery is defined as scheduled, nonacute surgery. Methods: A qualitative study was carried out at two medium-sized hospitals in the south of Sweden. The implementation of facilitated access was investigated during a 12-month period from April 2018 to April 2019. Facilitated access was conceptualized as specialists recommending the text messaging intervention to patients having elective surgery. Implementation was explored in terms of perceptions about the intervention and behaviors associated with implementation; that is, how patients used the intervention and how specialists behaved in facilitating usage among patients. Two focus groups with smoking cessation specialists and 10 individual interviews with patients were carried out. Qualitative content analysis was used to analyze the data. Results: Two main categories were identified from the focus group data with smoking cessation specialists: implementation approach and perceptions about the intervention. The first category, implementation approach, referred to how specialists adapted their efforts to situational factors and to the needs and preferences of patients, and how building of trust with patients was prioritized. The second category, perceptions about the intervention, showed that specialists thought the content and structure of the text messaging intervention felt familiar and worked well as a complement to current practice. Two categories were identified from the patient interview data: incorporating new means of support from health care and determinants of use. The first category referred to how patients adopted and incorporated the intervention into their smoking cessation journey. Patients were receptive, shared the text messages with friends and family, humanized the text messages, and used the messages as a complement to other strategies to quit smoking. The second category, determinants of use, referred to aspects that influenced how and when patients used the intervention and included the following: timing of the intervention and text messages, motivation to change, and perceptions of the mobile phone medium. Conclusions: Smoking cessation specialists adopted an active role in implementing the intervention by adapting their approach and fitting the intervention into existing routines. Patients showed strong motivation to change and openness to incorporate the intervention into their behavior change journey; however, the timing of the intervention and messages were important in optimizing the support. A text messaging, smoking cessation intervention can be a valuable and feasible way to reach smoking patients having elective surgery. %M 32945772 %R 10.2196/17563 %U https://mhealth.jmir.org/2020/9/e17563 %U https://doi.org/10.2196/17563 %U http://www.ncbi.nlm.nih.gov/pubmed/32945772 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e15492 %T Understanding the Attitudes of Clinicians and Patients Toward a Self-Management eHealth Tool for Atrial Fibrillation: Qualitative Study %A Cher,Boon Piang %A Kembhavi,Gayatri %A Toh,Kai Yee %A Audimulam,Jananie %A Chia,Wei-Yan Aloysius %A Vrijhoef,Hubertus JM %A Lim,Yee Wei %A Lim,Toon Wei %+ Department of Cardiology, National University Heart Centre, National University Hospital, Singapore (NUHCS), 1E Kent Ridge Road, NUHS Tower Block, Level 9, 119228, 65 67725286, toon_wei_lim@nuhs.edu.sg %K mHealth %K qualitative research %K atrial fibrillation %K self-management %K chronic disease %K mobile phone %D 2020 %7 17.9.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Atrial fibrillation (AF) is the most common heart rhythm disorder and poses a growing disease burden worldwide because of an aging population. A multidisciplinary approach with an emphasis on patient education and self-management has been demonstrated to improve outcomes for AF through the engagement of patients in their own care. Although electronic tools (e-tools) such as apps have been proposed to provide patient education and facilitate self-management, there have been few studies to guide the development of these tools for patients with AF. Objective: This study aims to explore the perceptions of patients and health care providers (HCPs) and their attitudes toward the use of e-tools for the self-management of AF. It also seeks to elicit the factors that contribute to these attitudes. Methods: Semistructured qualitative interviews with HCPs and patients were conducted to understand the interpretations and expectations of an e-tool that would be used for the self-management of AF. Interview data were analyzed using an exploratory thematic analysis approach to uncover emergent themes and infer ideas of preferred features in a device. A modified technology acceptance model was developed as a framework to help interpret these findings. Data from the HCPs and patients were compared and contrasted. Results: Both patients and HCPs thought that an e-tool would be useful in the self-management of AF. Although both groups favored educational content and monitoring of blood pressure, patients expressed more passivity toward self-care and an ambivalence toward the use of technology to monitor their medical condition. This appears to be related to factors such as a patient’s age, social support, and their attitudes toward technology. Instead, they favored using the app to contact their HCPs. Conclusions: This study provides insights into significant differences in the attitudes of patients and HCPs toward the use of e-tools for self-care against their priorities. Understanding patients’ motivations and their needs are key to ensuring higher acceptance of such tools. %M 32940611 %R 10.2196/15492 %U http://humanfactors.jmir.org/2020/3/e15492/ %U https://doi.org/10.2196/15492 %U http://www.ncbi.nlm.nih.gov/pubmed/32940611 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19256 %T Digital Health Tools and Patients With Drug Use Disorders: Qualitative Patient Experience Study of the Electronic Case-Finding and Help Assessment Tool (eCHAT) %A Choy,Melinda Ada %A Sturgiss,Elizabeth %A Goodyear-Smith,Felicity %A Smith,Gavin JD %+ Academic Unit of General Practice, College of Health and Medicine, The Australian National University, Building 4, Level 2, The Canberra Hospital, Garran, 2605, Australia, 61 5124 5592, melinda.choy@anu.edu.au %K eCHAT %K eHealth %K mHealth %K digital health %K drug use disorders %K patient experience %K stigma %K patient experience %K family medicine %K general practice %D 2020 %7 14.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: One of the promises of digital health is to better engage patients and improve care for vulnerable populations. Patients with drug use disorders are a vulnerable population who often do not receive the care they need, both for their drug use disorders as well as their other health care needs. Appropriate primary care for patients with drug use disorders needs to be patient-centered, holistic, highly accessible, and engaging. The electronic Case-finding and Help Assessment Tool (eCHAT) was designed as a patient-centered tool for the identification and measurement of problematic health behaviors and mood states. Objective: The aim of this study was to explore the patient experience of eCHAT at an Australian family medicine clinic for patients with drug use disorders. Methods: A total of 12 semistructured interviews were conducted with patients, two interviews were conducted with doctors, and one focus group was conducted with patient advocates who were former patients of the clinic where the study took place. The transcripts were analyzed using inductive thematic analysis. Results: The key themes identified from the interviews and the focus group were as follows: (1) eCHAT helped reduce stigma related to drug use in the doctor-patient consultation, (2) restricted answer options impacted the ability of patients to tell their stories, (3) patient-related response factors, (4) increased efficiency in the consultation process, and (5) divergence in level of concern around security and privacy. Conclusions: eCHAT has the potential to help vulnerable patients in primary care to engage more with their doctors and reduce experiences of stigma. eCHAT may be a useful digital health intervention in a family medicine clinic for patients with drug use disorders. It has the potential to improve patient engagement and access to health care, which are crucial areas of need in this vulnerable population. However, it is important to clearly communicate the privacy risk of digital health tools and to implement eCHAT such that it will add value to, rather than displace, in-person consultations with the family doctor. %M 32924959 %R 10.2196/19256 %U http://www.jmir.org/2020/9/e19256/ %U https://doi.org/10.2196/19256 %U http://www.ncbi.nlm.nih.gov/pubmed/32924959 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e17919 %T Design and Development of a Digital Weight Management Intervention (ToDAy): Qualitative Study %A Shoneye,Charlene L %A Mullan,Barbara %A Begley,Andrea %A Pollard,Christina M %A Jancey,Jonine %A Kerr,Deborah A %+ School of Public Health, Curtin University, GPO Box U1987, Perth, Western Australia, Australia, 61 61892664122, D.Kerr@curtin.edu.au %K obesity %K diet %K physical activity %K sedentary behavior %K digital behavioral interventions %K health behavior %K wearable activity monitor %K health %K mobile food record %K clinical trial %K focus group %K qualitative research %K mobile phone %D 2020 %7 9.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The Tailored Diet and Activity (ToDAy) study aims to build on the campaign by adding a digital intervention with the potential to provide wide-reaching, cost-effective weight management support. Objective: The ToDAy study aims to build a tailored intervention using mobile technology to improve diet and physical activity behaviours in adults with overweight and obesity. The main objectives were to identify behavior change techniques for diet and physical activity (PA) change for weight loss and explore preferences for digital intervention features that would be effective in changing diet and PA behaviors. Methods: This qualitative study uses the principles of a person-based approach to intervention development; the behavioral intervention technology framework; and the capability, opportunity, motivation, and behavior (COM-B) framework. Focus groups and telephone interviews were conducted with 56 adults in Western Australia. Open-ended questions and example intervention features were used to explore the usability and acceptability of the self-monitoring tools, knowledge about effective weight-loss strategies, and acceptability of tailored feedback. Findings from the focus groups and interviews were analyzed using thematic analysis. Results: Qualitative findings revealed an awareness of key public health messages but a lack of confidence in how to perform these behaviors to help manage their weight. A total of 4 major themes were identified and mapped to the domains of the COM-B framework: (1) misinformation, (2) environmental support, (3) social norms, and (4) confidence. Conclusions: This study explores users’ capability, opportunity, and motivation to perform the target behaviors for weight loss. The findings suggested that a digital weight management intervention using a mobile food record and activity trackers to inform tailored feedback may be acceptable and feasible. Participants expressed a preference for simple expert advice, digital self-monitoring tools, and visual feedback. International Registered Report Identifier (IRRID): RR2-10.2196/12782 %M 32641284 %R 10.2196/17919 %U https://mhealth.jmir.org/2020/9/e17919 %U https://doi.org/10.2196/17919 %U http://www.ncbi.nlm.nih.gov/pubmed/32641284 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e17785 %T Guiding Glucose Management Discussions Among Adults With Type 2 Diabetes in General Practice: Development and Pretesting of a Clinical Decision Support Tool Prototype Embedded in an Electronic Medical Record %A Kunstler,Breanne E %A Furler,John %A Holmes-Truscott,Elizabeth %A McLachlan,Hamish %A Boyle,Douglas %A Lo,Sean %A Speight,Jane %A O'Neal,David %A Audehm,Ralph %A Kilov,Gary %A Manski-Nankervis,Jo-Anne %+ Department of General Practice, University of Melbourne, Melbourne, Victoria, Australia, 61 3 8344 7276, j.furler@unimelb.edu.au %K type 2 diabetes %K shared decision making %K clinical decision support %K general practice %K primary care %D 2020 %7 2.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Managing type 2 diabetes (T2D) requires progressive lifestyle changes and, sometimes, pharmacological treatment intensification. General practitioners (GPs) are integral to this process but can find pharmacological treatment intensification challenging because of the complexity of continually emerging treatment options. Objective: This study aimed to use a co-design method to develop and pretest a clinical decision support (CDS) tool prototype (GlycASSIST) embedded within an electronic medical record, which uses evidence-based guidelines to provide GPs and people with T2D with recommendations for setting glycated hemoglobin (HbA1c) targets and intensifying treatment together in real time in consultations. Methods: The literature on T2D-related CDS tools informed the initial GlycASSIST design. A two-part co-design method was then used. Initial feedback was sought via interviews and focus groups with clinicians (4 GPs, 5 endocrinologists, and 3 diabetes educators) and 6 people with T2D. Following refinements, 8 GPs participated in mock consultations in which they had access to GlycASSIST. Six people with T2D viewed a similar mock consultation. Participants provided feedback on the functionality of GlycASSIST and its role in supporting shared decision making (SDM) and treatment intensification. Results: Clinicians and people with T2D believed that GlycASSIST could support SDM (although this was not always observed in the mock consultations) and individualized treatment intensification. They recommended that GlycASSIST includes less information while maintaining relevance and credibility and using graphs and colors to enhance visual appeal. Maintaining clinical autonomy was important to GPs, as they wanted the capacity to override GlycASSIST’s recommendations when appropriate. Clinicians requested easier screen navigation and greater prescribing guidance and capabilities. Conclusions: GlycASSIST was perceived to achieve its purpose of facilitating treatment intensification and was acceptable to people with T2D and GPs. The GlycASSIST prototype is being refined based on these findings to prepare for quantitative evaluation. %M 32876576 %R 10.2196/17785 %U https://formative.jmir.org/2020/9/e17785 %U https://doi.org/10.2196/17785 %U http://www.ncbi.nlm.nih.gov/pubmed/32876576 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e20312 %T Perceptions and Attitudes Toward Mobile Health in Development of an Exclusive Breastfeeding Tool: Focus Group Study With Caregivers and Health Promoters in the Dominican Republic %A Casilang,Clarisse G %A Stonbraker,Samantha %A Japa,Ingrid %A Halpern,Mina %A Messina,Luz %A Steenhoff,Andrew P %A Lowenthal,Elizabeth D %A Fleisher,Linda %+ Department of Pediatrics, Global Health Center, The Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Philadelphia, PA, 19146, United States, 1 267 426 6298, casilangc@email.chop.edu %K global health %K breast feeding %K mHealth %K mobile phone %D 2020 %7 21.8.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Despite growing interest in the use of technology to improve health outcomes in low- and middle-income countries (LMICs), local attitudes toward mobile health (mHealth) use in these settings are minimally understood. This is especially true in the Dominican Republic, where mHealth interventions are starting to emerge. This information is critical for developing effective mHealth interventions to address public health issues, such as low exclusive breastfeeding (EBF) rates, which can lead to poor outcomes. With an EBF rate of 5% in the first 6 months of life, the Dominican Republic has one of the lowest EBF rates worldwide. Objective: This study aims to describe the current use of information and communication technology (ICT) and to analyze the attitudes and perceptions related to using mHealth interventions among caregivers of children aged ≤5 years and health promoters in the Dominican Republic. Findings can inform mHealth strategies aimed at improving EBF in this, and other, LMICs. Methods: Participants were recruited from 3 outpatient sites: the Niños Primeros en Salud program at Centro de Salud Divina Providencia in Consuelo (rural setting) and Clínica de Familia La Romana and its program Módulo de Adolescentes Materno Infantil in La Romana (urban setting). Focus groups were conducted with caregivers and community health promoters to identify the use, attitudes, perceptions, and acceptability of mHealth as well as barriers to EBF. Discussions were conducted in Spanish, guided by semistructured interview guides. All sessions were audio-recorded and later transcribed. Thematic content analysis was conducted in Spanish by two bilingual researchers and was structured around a hybrid behavioral theory framework to identify salient themes. Results: All participants (N=35) reported having a mobile phone, and 29 (83%) participants had a smartphone. Sources for obtaining health information included the internet, physicians and clinic, family and friends, health promoters, and television. Barriers to mHealth use included the cost of internet service, privacy concerns, and perceived credibility of information sources. Participants indicated the desire for, and willingness to use, an mHealth intervention to support breastfeeding. The desired features of a possible mHealth intervention included offering diverse methods of information delivery such as images and video content, text messages, and person-to-person interaction as well as notifications for appointments, vaccines, and feeding schedules. Other important considerations were internet-free access and content that included maternal and child health self-management topics beyond breastfeeding. Conclusions: There is a high level of acceptance of ICT tools for breastfeeding promotion among caregivers in urban and rural areas of the Dominican Republic. As mHealth tools can contribute to increased breastfeeding self-efficacy, identifying desirable features of such a tool is necessary to create an effective intervention. Participants wanted to receive trusted and reliable information through various formats and were interested in information beyond breastfeeding. %M 32821063 %R 10.2196/20312 %U http://pediatrics.jmir.org/2020/2/e20312/ %U https://doi.org/10.2196/20312 %U http://www.ncbi.nlm.nih.gov/pubmed/32821063 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e20300 %T Virtual Reality Cognitive Therapy in Inpatient Psychiatric Wards: Protocol for a Qualitative Investigation of Staff and Patient Views Across Multiple National Health Service Sites %A Brown,Poppy %A Waite,Felicity %A Lambe,Sinéad %A Rosebrock,Laina %A Freeman,Daniel %+ Department of Psychiatry, University of Oxford, Warneford Hospital, Warneford Lane, Oxford, OX3 7JX, United Kingdom, 44 (0)1865 618262, poppy.brown@psych.ox.ac.uk %K virtual reality %K therapy %K inpatient psychiatric care %K implementation %D 2020 %7 20.8.2020 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Patients in psychiatric wards typically have very limited access to individual psychological therapy. Inpatients often have significant time available, and an important transition back to everyday life to prepare for—but historically, there have been few trained therapists available on wards for the delivery of evidence-based therapy. Automated virtual reality (VR) therapy may be one route to increase the provision of powerful psychological treatments in psychiatric hospitals. The gameChange automated VR cognitive therapy is targeted at helping patients overcome anxious avoidance and re-engage in everyday situations (such as walking down the street, taking a bus, or going to a shop). This treatment target may fit well for many patients preparing for discharge. However, little is known about how VR therapy may be viewed in this setting. Objective: The objectives of the study are to explore psychiatric hospital staff and patients’ initial expectations of VR therapy, to gather patient and staff views of an automated VR cognitive therapy (gameChange) after briefly experiencing it, and to identify potential differences across National Health Service (NHS) mental health trusts for implementation. Guided by an implementation framework, the knowledge gained from this study will be used to assess the feasibility of VR treatment adoption into psychiatric hospitals. Methods: Focus groups will be conducted with NHS staff and patients in acute psychiatric wards at 5 NHS mental health trusts across England. Staff and patients will be interviewed in separate groups. Individual interviews will also be conducted when preferred by a participant. Within each of the 5 trusts, 1 to 2 wards will be visited. A total of 8-15 staff and patients per ward will be recruited, with a minimum total of 50 staff and patients recruited across all sites. Focus group questions have been derived from the nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability (NASSS) framework. Focus groups will discuss expectations of VR therapy before participants are given the opportunity to briefly try the gameChange VR therapy. Questions will then focus on opinions about the therapy and investigate feasibility of adoption, with particular consideration given to site specific issues. A thematic analysis will be conducted. Results: As of May 15, 2020, 1 patient focus group has been conducted. Conclusions: The study will provide unique insight from patients and staff into the potential for implementing automated VR therapy in psychiatric wards. Perspectives will be captured both on the use of immersive technology hardware and therapy-specific issues in such settings. International Registered Report Identifier (IRRID): DERR1-10.2196/20300 %M 32667897 %R 10.2196/20300 %U http://www.researchprotocols.org/2020/8/e20300/ %U https://doi.org/10.2196/20300 %U http://www.ncbi.nlm.nih.gov/pubmed/32667897 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17504 %T Patients’ and Health Care Professionals’ Perceptions of the Potential of Using the Digital Diabetes Questionnaire to Prepare for Diabetes Care Meetings: Qualitative Focus Group Interview Study %A Eeg-Olofsson,Katarina %A Johansson,Unn-Britt %A Linder,Ebba %A Leksell,Janeth %+ Sahlgrenska University Hospital, Blå Stråket 5, Gothenburg, 413 45, Sweden, 46 313421000, katarina.eeg-olofsson@vgregion.se %K Digital questionnaire %K health care professionals %K diabetes care %K focus group interview %K qualitative research %K eHealth  %D 2020 %7 19.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In effective diabetes management, it is important that providers and health care systems prioritize the delivery of patient-centered care and that they are respectful of and responsive to individual patient preferences and barriers. Objective: The objective of the study was to conduct focus group interviews to capture patients’ and health care professionals’ perceptions and attitudes regarding digital technology and to explore how the digital Diabetes Questionnaire can be used to support patient participation in diabetes care, as a basis for an implementation study. Methods: A qualitative study was conducted with six focus group discussions with diabetes specialist nurses and medical doctors (n=29) and four focus group discussions with individuals with diabetes (n=23). A semistructured focus group interview guide was developed, including probing questions. The data were transcribed verbatim, and qualitative content analysis was performed using an inductive approach. Results: Two main categories were revealed by the qualitative analysis: perceptions of digital technology and the digital questionnaire in diabetes management and care and perceptions of participation in diabetes care. An overarching theme that emerged from the focus group interviews was patients’ and professionals’ involvement in diabetes care using digital tools. Conclusions: The analysis identified important factors to consider when introducing the digital Diabetes Questionnaire in clinical use. Both professionals and patients need support and training in the practical implementation of the digital questionnaire, as well as the opportunity to provide feedback on the questionnaire answers. %M 32812884 %R 10.2196/17504 %U https://www.jmir.org/2020/8/e17504 %U https://doi.org/10.2196/17504 %U http://www.ncbi.nlm.nih.gov/pubmed/32812884 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e19433 %T Developing a Mobile App (iGAM) to Promote Gingival Health by Professional Monitoring of Dental Selfies: User-Centered Design Approach %A Tobias,Guy %A Spanier,Assaf B %+ Department of Community Dentistry, Faculty of Dental Medicine, The Hebrew University - Hadassah School of Dental Medicine, Ein Kerem, Jerusalem, 91120, Israel, 972 527052333, guy.tobias@mail.huji.ac.il %K mHealth %K telemedicine %K public health %K oral health promotion %K gum health %K flow of information %K COVID-19 %D 2020 %7 14.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Dental visits are unpleasant; sometimes, patients only seek treatment when they are in intolerable pain. Recently, the novel coronavirus (COVID-19) pandemic has highlighted the need for remote communication when patients and dentists cannot meet in person. Gingivitis is very common and characterized by red, swollen, bleeding gums. Gingivitis heals within 10 days of professional care and with daily, thorough oral hygiene practices. If left untreated, however, its progress may lead to teeth becoming mobile or lost. Of the many medical apps currently available, none monitor gingivitis. Objective: This study aimed to present a characterization and development model of a mobile health (mHealth) app called iGAM, which focuses on periodontal health and improves the information flow between dentists and patients. Methods: A focus group discussed the potential of an app to monitor gingivitis, and 3 semistructured in-depth interviews were conducted on the use of apps for monitoring gum infections. We used a qualitative design process based on the Agile approach, which incorporated the following 5 steps: (1) user story, (2) use cases, (3) functional requirements, (4) nonfunctional requirements, and (5) Agile software development cycles. In a pilot study with 18 participants aged 18-45 years and with different levels of health literacy, participants were given a toothbrush, toothpaste, mouthwash, toothpicks, and dental floss. After installing iGAM, they were asked to photograph their gums weekly for 4 weeks. Results: All participants in the focus group believed in the potential of a mobile app to monitor gingivitis and reduce its severity. Concerns about security and privacy issues were discussed. From the interviews, 2 themes were derived: (1) “what's in it for me?” and (2) the need for a take-home message. The 5 cycles of development highlighted the importance of communication between dentists, app developers, and the pilot group. Qualitative analysis of the data from the pilot study showed difficulty with: (1) the camera, which was alleviated with the provision of mouth openers, and (2) the operation of the phone, which was alleviated by changing the app to be fully automated, with a weekly reminder and an instructions document. Final interviews showed satisfaction. Conclusions: iGAM is the first mHealth app for monitoring gingivitis using self-photography. iGAM facilitates the information flow between dentists and patients between checkups and may be useful when face-to-face consultations are not possible (such as during the COVID-19 pandemic). %M 32795985 %R 10.2196/19433 %U http://mhealth.jmir.org/2020/8/e19433/ %U https://doi.org/10.2196/19433 %U http://www.ncbi.nlm.nih.gov/pubmed/32795985 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e18292 %T The Evolving Family Mealtime: Findings From Focus Group Interviews With Hispanic Mothers %A Hammons,Amber Jean %A Villegas,Elizabeth %A Olvera,Norma %A Greder,Kimberly %A Fiese,Barbara %A Teran-Garcia,Margarita %A , %+ California State University, 5241 N Maple Ave, Fresno, CA, , United States, 1 5592781158 ext 1158, ahammons@csufresno.edu %K family mealtimes %K healthy eating %K technology at the table %K parenting and mealtimes %K Hispanic culture %K obesity prevention %D 2020 %7 10.8.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Given the protective effects of shared family mealtimes and the importance of family in the Hispanic culture, this context should be explored further to determine how it can be leveraged and optimized for interventions. Objective: This study aimed to explore contextual factors associated with family mealtimes in Mexican and Puerto Rican families. Methods: A total of 63 mothers participated in 13 focus group interviews across 4 states. Thematic analysis was used to analyze transcripts. Results: Seven overarching themes were identified through the thematic analysis. Themes reflected who was present at the mealtime, what occurs during mealtime, the presence of television, the influence of technology during mealtime, and how mealtimes have changed since the mothers were children. Conclusions: Hispanic mothers may be adapting family mealtimes to fit their current situations and needs, keeping the television and other devices on during mealtimes, and making additional meals for multiple family members to appease everyone’s tastes. All of these are areas that can be incorporated into existing culturally tailored obesity prevention programs to help families lead healthier lives. %M 32576547 %R 10.2196/18292 %U http://pediatrics.jmir.org/2020/2/e18292/ %U https://doi.org/10.2196/18292 %U http://www.ncbi.nlm.nih.gov/pubmed/32576547 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 8 %P e18347 %T Perceptions and Attitudes Toward a Mobile Phone App for Mental Health for College Students: Qualitative Focus Group Study %A Holtz,Bree E %A McCarroll,Alexis M %A Mitchell,Katharine M %+ Michigan State University, 404 Wilson Road, Room 309, East Lansing, MI, United States, 1 5178844537, bholtz@msu.edu %K mental health %K mobile phone %K mHealth %D 2020 %7 7.8.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Many college students who have mental health issues do not receive professional care for various reasons. Students who do not receive help often have both short- and long-term adverse health outcomes. Mobile apps for mental health services such as MySSP, a service provided to college students through their university, may help eliminate barriers to seeking mental health care and result in more positive outcomes for college students. Objective: This qualitative study aims to better understand college students’ perceptions and attitudes toward the adoption and use of a mobile phone app for mental health, MySSP, using the technology acceptance model (TAM). Methods: A series of nine focus groups were conducted with college students (N=30) between February and May 2019 at a large, public Midwestern university. The moderator’s guide was based on the TAM, and focus group sessions primarily focused on the use and knowledge of apps for mental health, specifically, MySSP. The focus group transcriptions were hand-coded to develop a set of themes that encompassed students’ perceptions and attitudes toward MySSP. Results: The analysis of the focus groups suggested the following themes: (1) existing awareness of the app, (2) perceived usefulness, (3) perceived ease of use, (4) attitudes toward apps for mental health and MySSP, and (5) social influence. Conclusions: The results of this study provide deeper insights into the perceptions of a mobile app for mental health among college students. Future research should explore the specific contexts in which an app for mental health will be most effective for college students. %M 32667892 %R 10.2196/18347 %U https://formative.jmir.org/2020/8/e18347 %U https://doi.org/10.2196/18347 %U http://www.ncbi.nlm.nih.gov/pubmed/32667892 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 7 %P e19008 %T Assessing Digital Risk in Psychiatric Patients: Mixed Methods Study of Psychiatry Trainees’ Experiences, Views, and Understanding %A Aref-Adib,Golnar %A Landy,Gabriella %A Eskinazi,Michelle %A Sommerlad,Andrew %A Morant,Nicola %A Johnson,Sonia %A Graham,Richard %A Osborn,David %A Pitman,Alexandra %+ Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom, 44 7968035509, a.pitman@ucl.ac.uk %K risk assessment %K internet %K suicide %K self-injurious behavior %K mental health %K psychiatrists %K mixed methods %K mobile phone %D 2020 %7 29.7.2020 %9 Original Paper %J JMIR Ment Health %G English %X Background: The use of digital technology can help people access information and provide support for their mental health problems, but it can also expose them to risk, such as bullying or prosuicide websites. It may be important to consider internet-related risk behavior (digital risk) within a generic psychiatric risk assessment, but no studies have explored the practice or acceptability of this among psychiatrists. Objective: This study aimed to explore psychiatry trainees’ experiences, views, and understanding of digital risk in psychiatry. We predicted that clinician awareness would be highest among trainees who work in child and adolescent mental health services. Methods: We conducted a cross-sectional survey of psychiatry trainees attending a UK regional trainees’ conference to investigate how they routinely assess patients’ internet use and related risk of harm and their experience and confidence in assessing these risks. We conducted focus groups to further explore trainees’ understandings and experiences of digital risk assessment. Descriptive statistics and chi-squared tests were used to present the quantitative data. A thematic analysis was used to identify the key themes in the qualitative data set. Results: The cross-sectional survey was completed by 113 out of 312 psychiatry trainees (response rate 36.2%), from a range of subspecialties and experience levels. Half of the trainees (57/113, 50.4%) reported treating patients exposed to digital risk, particularly trainees subspecializing in child and adolescent psychiatry (17/22, 77% vs 40/91, 44%;P=.02). However, 67.3% (76/113) reported not feeling competent to assess digital risk. Child and adolescent psychiatrists were more likely than others to ask patients routinely about specific digital risk domains, including reckless web-based behavior (18/20, 90% vs 54/82, 66%; P=.03), prosuicide websites (20/21, 95% vs 57/81, 70%; P=.01), and online sexual behavior (17/21, 81% vs 44/81, 54%; P=.02). Although 84.1% (95/113) of the participants reported using a proforma to record general risk assessment, only 5% (5/95) of these participants prompted an assessment of internet use. Only 9.7% (11/113) of the trainees had received digital risk training, and 73.5% (83/113) reported that they would value this. Our thematic analysis of transcripts from 3 focus groups (comprising 11 trainees) identified 2 main themes: barriers to assessment and management of digital risk, and the double-edged sword of web use. Barriers reported included the novelty and complexity of the internet, a lack of confidence and guidance in addressing internet use directly, and ongoing tension between assessment and privacy. Conclusions: Although it is common for psychiatrists to encounter patients subject to digital risk, trainee psychiatrists lack competence and confidence in their assessment. Training in digital risk and the inclusion of prompts in standardized risk proformas would promote good clinical practice and prevent a potential blind spot in general risk assessment. %M 32726288 %R 10.2196/19008 %U http://mental.jmir.org/2020/7/e19008/ %U https://doi.org/10.2196/19008 %U http://www.ncbi.nlm.nih.gov/pubmed/32726288 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18779 %T Development and Usability Evaluation of a Facebook-Based Intervention Program for Childhood Cancer Patients: Mixed Methods Study %A Park,Bu Kyung %A Kim,Ji Yoon %A Rogers,Valerie E %+ College of Nursing, Research Institute of Nursing Science, Kyungpook National University, 680 Gukchaegosang-ro, Jung-gu, Daegu, 41944, Republic of Korea, 82 53 420 4929, bukpark@knu.ac.kr %K pediatric cancer patients %K childhood cancer %K social network site %K Facebook %K usability %D 2020 %7 28.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Childhood cancers previously considered to be incurable now have 5-year survival rates up to 84%. Nevertheless, these patients remain at risk of morbidity and mortality from therapy-related complications. Thus, patient education and self-management strategies for promoting a healthy lifestyle are of tantamount importance for improving short- and long-term health outcomes. A Facebook-based “Healthy Teens for Soaam” (a Korean term for childhood cancers) program was developed to help improve knowledge and self-management practices of teens with cancer related to their disease and treatment. Objective: The two-fold purpose of this usability study was (1) to describe the process of developing an 8-week Facebook-based intervention program for teens with cancer, and (2) to evaluate its usability to refine the program. Methods: Multiple phases and methods were employed to develop and evaluate the usability of the program. Study phases included: (1) needs assessment through focus group interviews and qualitative content analysis, (2) development of module content, (3) expert review and feedback on module content, (4) Facebook-based program development, (5) usability evaluation by heuristic evaluation, (6) usability evaluation by targeted end-user testing, and (7) modification and final version of the program. Usability of the final version was confirmed through feedback loops of these phases. Results: Based on 6 focus group discussion sessions, it was determined that teens with cancer were interested in seeing stories of successful childhood cancer cases and self-management after discharge, and preferred multimedia content over text. Therefore, each Facebook module was redesigned to include multimedia materials such as relevant video clips tailored for teens. Usability assessed by heuristic evaluation and user testing revealed several critical usability issues, which were then revised. Potential end users tested the final program and perceived it to be usable and useful for teens with cancer. Conclusions: To our knowledge, “Healthy Teens for Soaam” is the first Facebook-based intervention program for teens with cancer. We actively worked with current childhood cancer patients and survivors to develop and improve this program, achieved good usability, and met the expressed needs and preferences of target end users. This 8-week Facebook-based educational program for teens with cancer, developed as the first step of an upcoming intervention study, will be useful for improving knowledge and self-management strategies of teens. %M 32720897 %R 10.2196/18779 %U http://www.jmir.org/2020/7/e18779/ %U https://doi.org/10.2196/18779 %U http://www.ncbi.nlm.nih.gov/pubmed/32720897 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16856 %T Perceptions and Acceptability of Digital Interventions Among Tuberculosis Patients in Cambodia: Qualitative Study of Video-Based Directly Observed Therapy %A Rabinovich,Lila %A Molton,James Steven %A Ooi,Wei Tsang %A Paton,Nicholas Iain %A Batra,Shelly %A Yoong,Joanne %+ Center for Economic and Social Research, University of Southern California, 1090 Vermont Avenue, NW, Washington, DC, 20005, United States, 1 2138210537, lilarabi@usc.edu %K directly observed therapy %K video recording %K telemedicine %K mobile health %K mHealth %K tuberculosis %K low-income settings %K developing countries %K patient acceptance of health care %K patient acceptability %K Cambodia %D 2020 %7 27.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the development of effective drugs for treatment, tuberculosis remains one of the leading causes of death from an infectious disease worldwide. One of the greatest challenges to tuberculosis control is patient adherence to treatment. Recent research has shown that video-based directly observed therapy is a feasible and effective approach to supporting treatment adherence in high-income settings. However, few studies have explored the potential for such a solution in a low- or middle-income country setting. Globally, these countries’ rapidly rising rate of mobile penetration suggests that the potential for translation of these results may be high. Objective: We sought to examine patient perceptions related to the use of mobile health, and specifically video-based directly observed therapy, in a previously unstudied patient demographic: patients with tuberculosis in a low-income country setting (Cambodia). Methods: We conducted a cross-sectional qualitative study in urban and periurban areas in Cambodia, consisting of 6 focus groups with tuberculosis patients who were receiving treatment (standard directly observed therapy) through a nongovernmental organization. Results: Familiarity with mobile technology and apps was widespread in this population, and overall willingness to consider a mobile app for video-based directly observed therapy was high. However, we identified potential challenges. First, patients very much valued their frequent in-person interactions with their health care provider, which may be reduced with the video-based directly observed therapy intervention. Second, there may be technical issues to address, including how to make the app suitable for illiterate participants. Conclusions: While video-based directly observed therapy is a promising technology, even in country settings where mobile penetration is reportedly almost universal, it should be introduced with caution. However, the results were generally promising and yielded important insights that not only will be translated into the further adaptation of key features of video-based directly observed therapy for tuberculosis patients in Cambodia, but also can inform the future design and successful implementation of video-based directly observed therapy interventions in low- and middle-income settings more generally. %M 32716309 %R 10.2196/16856 %U https://www.jmir.org/2020/7/e16856 %U https://doi.org/10.2196/16856 %U http://www.ncbi.nlm.nih.gov/pubmed/32716309 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e18437 %T A Community-Engaged Approach to Creating a Mobile HIV Prevention App for Black Women: Focus Group Study to Determine Preferences via Prototype Demos %A Chandler,Rasheeta %A Hernandez,Natalie %A Guillaume,Dominique %A Grandoit,Shanaika %A Branch-Ellis,Desiré %A Lightfoot,Marguerita %+ Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA, 30322, United States, 1 404 727 8164, r.d.chandler@emory.edu %K mHealth app %K mobile technology %K Black women %K HIV prevention %K reproductive health %K women’s health %D 2020 %7 24.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Black women are an important but relatively overlooked at-risk group in HIV prevention efforts. Although there is an aggregate decline of HIV diagnoses among women in the United States, there are persistent disparate rates of new HIV infections among Black women compared to any other cisgender female subgroup. Strategies to end the HIV epidemic—as outlined in the Ending the HIV Epidemic initiative—for all communities must consider HIV prevention messaging and message delivery mediums that are created with community input. Although mobile health (mHealth) is a popular platform for delivering HIV interventions, there are currently no mobile apps that consider cisgender Black women with the goal of promoting a comprehensive women’s reproductive health and HIV prevention lifestyle. Previous research recommends inclusion of the target population from project inception and iteratively throughout development, to promote use of the intervention. Objective: The purpose of this study is to understand cisgender Black women’s preferences for functionality, format, and design of a mobile HIV prevention app and to examine their willingness to use an app for HIV prevention. Methods: We conducted a series of four focus groups with 23 Black cisgender women. Focus groups included discussion and demonstration elements to address cisgender women’s general preference for apps, HIV prevention content that would be useful in an app, and preferred app features that would promote use of an HIV-centric app. During focus group discussions, participants were shown narrated, custom wireframes of HIV prevention app prototypes to demonstrate potential app function. Results: Findings indicated the presence of eight subthemes within the coding structure of three overall themes: (1) health content within the mobile app, (2) mobile app functionality, format, and design, and (3) other suggested features. Specifically, participants detailed preferred educational content, content distribution, app aesthetics, privacy considerations, and marketing of the app. Conclusions: Findings suggest that Black cisgender women preferred an app that integrated HIV prevention and optimal sexual health promotion. Participants provided a range of preferences for content integration and facilitators of app engagement with an HIV prevention app. Preferences centered on gender and cultural congruency of information and content, evidenced by visuals, language, and resources. Black cisgender women are viable consumers for a mobile app–based HIV prevention intervention. %M 32706723 %R 10.2196/18437 %U http://mhealth.jmir.org/2020/7/e18437/ %U https://doi.org/10.2196/18437 %U http://www.ncbi.nlm.nih.gov/pubmed/32706723 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 2 %P e14078 %T The Mobile Alliance for Maternal Action Text Message–Based mHealth Intervention for Maternal Care in South Africa: Qualitative User Study %A Coleman,Jesse %A Eriksen,Jaran %A Black,Vivian %A Thorson,Anna %A Hatcher,Abigail %+ Wits Reproductive Health & HIV Institute, School of Medicine, University of Witwatersrand, 22 Esselen Street, Hillbrow, Johannesburg, 2001, South Africa, 27 833991066, denots@gmail.com %K maternal health %K text messaging %K focus groups %K South Africa %K mHealth %K reproductive health %K limited resource settings %K public health %K prenatal care %K postnatal care %D 2020 %7 29.6.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Using mobile technology to support health care (mobile health [mHealth]) has been shown to improve health outcomes across a multitude of health specialties and across the world. Exploring mHealth user experiences can aid in understanding how and why an intervention was successful. The Mobile Alliance for Maternal Action (MAMA) was a free maternal mHealth SMS text messaging service that was offered to pregnant women in Johannesburg, South Africa, with the goal of improving maternal, fetal, and infant health outcomes. We conducted focus group discussions with MAMA users to learn about their experiences with the program. Objective: The aim of this qualitative study was to gather opinions of participants of the MAMA maternal mHealth service regarding health care atmosphere, intervention use, and intervention feedback. Methods: Prenatal and postnatal women (N=15) from public antenatal and postnatal care sites in central Johannesburg who were receiving free maternal health text messages (MAMA) participated in 3 focus group discussions. Predefined discussion topics included personal background, health care system experiences, MAMA program recruitment, acceptability, participant experiences, and feedback. Results: The feedback regarding experiences with the health system were comprised of a few reports of positive experiences and many more reports of negative experiences such as long wait times, understaffed facilities, and poor service. Overall acceptability for the maternal text message intervention was high. Participants reflected that the messages were timely, written clearly, and felt supportive. Participants also reported sharing messages with friends and family. Conclusions: These findings suggest that maternal mHealth interventions delivered through text messages can provide timely, relevant, useful, and supportive information to pregnant women and new mothers especially in settings where there may be mistrust of the health care system. %M 32459628 %R 10.2196/14078 %U http://humanfactors.jmir.org/2020/2/e14078/ %U https://doi.org/10.2196/14078 %U http://www.ncbi.nlm.nih.gov/pubmed/32459628 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e18391 %T Designing for the Co-Use of Consumer Health Technology in Self-Management of Adolescent Overweight and Obesity: Mixed Methods Qualitative Study %A LeRouge,Cynthia M %A Hah,Hyeyoung %A Deckard,Gloria J %A Jiang,Haoqiang %+ Department of Information Systems and Business Analytics, Florida International University, 11200 SW 8th Street, Miami, FL, 33199, United States, 1 3147090624, clerouge@fiu.edu %K consumer health technologies %K obesity care model %K chronic care model %K UTAUT %K qualitative research %K overweight %K mobile phone %K adolescent %K couse %K social support %K obesity %K social influence %K consumer health informatics %D 2020 %7 29.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Overweight and obesity in adolescents has reached epidemic proportions in the United States. Consumer health technology (CHT) can serve as a behavioral and social support tool for the management of overweight in adolescence. Recognizing CHT as a social support tool during design enables input from multiple stakeholders who engage in shared co-use to reinforce and empower adolescents in their self-management efforts. Objective: This study aimed to explore design requirements and enabling factors for the use of CHT as a social support tool for patients (as primary users) and parents and health care providers (as co-users). Our model incorporates key components of the unified theory of acceptance and use of technology (UTAUT) within the framework of the obesity care model (OCM) by recognizing patient self-management as the central process with the influence of their care support network on CHT use and outcomes. Methods: This study was part of a larger two-staged usability study combining focus group, semistructured interviews, and usability walkthroughs of CHT mockups from adolescents (BMI in the 85th-99th percentile range), parents, and physicians. In phase 1, 48 adolescents between the ages of 12 and 17 years, 10 of their parents, and 6 health care providers participated in identifying design requirements and enabling factors for the use of a potential CHT. In phase 2, 70 adolescents and 10 health care providers evaluated the CHT mockups and indicated enabling factors and willingness to use the proposed CHT. Results: Our qualitative analysis identified adolescents’ intention for the use of CHT in alignment with UTAUT elements of performance expectancy, effort expectancy, and facilitating conditions. Our reconceptualization of social influence identified the expectations and envisioned roles of parents and health care providers as co-users and influencing factors on the co-use of CHT in managing overweight in adolescence. Parents were expected to monitor, to provide guidance and motivation, and to suggest modifications in daily habits, for example, recipes and meals, whereas health care providers were expected to encourage and monitor progress in a clinical setting. These expected roles and co-use patterns were congruent among all 3 stakeholders; the co-use of CHT was desired to be minimally invasive for parents and health care providers and controlled by the adolescents. Conclusions: Our study integrates and extends the perspectives of 2 seminal models to explore design features and social influence roles for the successful user-centered design of CHT for weight self-management in adolescents. Although the co-users (ie, adolescents, parents, health care providers) suggested differing features consistent with their roles, role definitions were congruent. All users recognized the adolescent as the primary user with differential, supportive use from parents and health care providers. This multistakeholder approach can guide successful CHT design that reinforces the collective perspective of self-management. %M 32597788 %R 10.2196/18391 %U http://mhealth.jmir.org/2020/6/e18391/ %U https://doi.org/10.2196/18391 %U http://www.ncbi.nlm.nih.gov/pubmed/32597788 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e17337 %T Perceptions About Mindfulness and Text Messaging for Smoking Cessation in Vietnam: Results From a Qualitative Study %A Do,Vuong Van %A Spears,Claire Adams %A Van Minh,Hoang %A Huang,Jidong %A Redmon,Pamela Buffington %A Xuan Long,Nguyen %A Eriksen,Michael Paul %+ Center for Population Health Sciences, Hanoi University of Public Health, 1A Duc Thang, Bac Tu Liem, Hanoi, 100000, Vietnam, 1 7702352346, dvv@huph.edu.vn %K mHealth %K mobile health %K text messages %K smoking %K smoking cessation %K mobile phone %D 2020 %7 24.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With 15.6 million smokers, Vietnam is one of the top 10 largest cigarette-consuming countries in the world. Unfortunately, smoking cessation programs are still scarce in Vietnam. Mindfulness-based and text messaging–based interventions have been increasingly used in smoking cessation studies in developed countries, with promising results. Given the exponential growth of mobile phone usage in Vietnam in recent years, mobile health interventions could be a potential strategy to increase smoking cessation in Vietnam. However, substantial cultural adaptations are needed to optimize the effectiveness of these interventions among Vietnamese smokers. Objective: This study aims to involve qualitative research to inform the development of a mindfulness-based text messaging smoking cessation intervention for Vietnamese smokers. Methods: A total of 10 focus groups were conducted with 71 Vietnamese male smokers aged between 18 and 65 years (5-9 participants per focus group). Overall, 5 focus groups were conducted with smokers who had the intention to quit (ie, preparation stage of change in the transtheoretical model), and 5 focus groups were conducted with smokers who did not have the intention to quit (contemplation or precontemplation stage). The focus groups were audio recorded, transcribed verbatim, and analyzed using NVivo 12 software (QSR International). Results: The major themes included smoking triggers, barriers and facilitators for quitting, the perceptions of text messaging and mindfulness approaches for smoking cessation, and suggestions for the development of a text messaging–based smoking cessation program. Common smoking triggers included stress, difficulties concentrating, and fatigue. Frequently encountering other people who were smoking was a common barrier to quitting. However, participants indicated that concerns about the harmful effects of smoking on themselves and their wives and children, and encouragement from family members could motivate them to quit. The participants preferred diverse message content, including information about the consequences of smoking, encouragement to quit, and tips to cope with cravings. They suggested that text messages be clear and concise and use familiar language. Most smokers perceived that mindfulness training could be useful for smoking cessation. However, some suggested that videos or in-person training may also be needed to supplement teaching mindfulness through text messages. Conclusions: This study provides important insights to inform the development of a text messaging–based smoking cessation program that incorporates mindfulness for Vietnamese male smokers. The results could also be useful for informing similar programs in other low- and middle-income countries. %M 32442140 %R 10.2196/17337 %U http://mhealth.jmir.org/2020/6/e17337/ %U https://doi.org/10.2196/17337 %U http://www.ncbi.nlm.nih.gov/pubmed/32442140 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e17323 %T Intersectoral Cooperation in 12 European Case Studies Aiming for Better Health, Environmental Sustainability, and Health Equity: Protocol for a Qualitative Evaluation %A van der Vliet,Nina %A Den Broeder,Lea %A Romeo-Velilla,María %A Kruize,Hanneke %A Staatsen,Brigit %A Schuit,Jantine %+ National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3721 MA, Netherlands, 31 302743816, nina.van.der.vliet@rivm.nl %K intersectoral cooperation %K health %K environmental sustainability %K equity %K focus groups %K protocol %D 2020 %7 24.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The INHERIT (INtersectoral Health and Environment Research for InnovaTion) project has evaluated intersectoral cooperation (IC) in 12 European case studies attempting to promote health, environmental sustainability, and equity through behavior and lifestyle changes. These factors are the concerns of multiple sectors of government and society. Cooperation of health and environmental sectors with other sectors is needed to enable effective action. IC is thus essential to promote a triple win of health, sustainability, and equity. Objective: This paper describes the design of a qualitative study to gain insights into successful organization of IC, facilitators and barriers, and how future steps can be taken to improve IC in the evaluated case studies. Methods: Each case study was assessed qualitatively through a focus group. A total of 12 focus groups in 10 different European countries with stakeholders, implementers, policymakers, and/or citizens were held between October 2018 and March 2019. Five to eight participants attended each focus group. The focus group method was based on appreciative inquiry, which is an asset-based approach focusing on what works well, why it is working well, and how to strengthen assets in the future. A stepped approach was used, with central coordination and analysis, and local implementation and reporting. Local teams were trained to apply a common protocol using a webinar and handbook on organizing, conducting, and reporting focus groups. Data were gathered in each country in the local language. Translated data were analyzed centrally using deductive thematic analysis, with consideration of further emerging themes. Analyses involved the capability, opportunity, motivation-behavior (COM-b) system to categorize facilitators and barriers into capability, motivation, or opportunity-related themes, as these factors influence the behaviors of individuals and groups. Web-based review sessions with representatives from all local research teams were held to check data analysis results and evaluate the stepped approach. Results: Data collection has been completed. A total of 76 individuals participated in 12 focus groups. In December 2019, data analysis was nearly complete, and the results are expected to be published in fall 2020. Conclusions: This study proposes a stepped approach that allows cross-country focus group research using a strict protocol while dealing with language and cultural differences. The study generates insights into IC processes and facilitators in different countries and case studies to filter out which facilitators are essential to include. Simultaneously, the approach can strengthen cooperation among stakeholders by looking at future cooperation possibilities. By providing knowledge on how to plan for, improve, and sustain IC successfully to deal with today’s multisectoral challenges, this study can contribute to better intersectoral action for the triple win of better health, sustainability, and equity. This protocol can serve as a tool for other researchers who plan to conduct cross-country qualitative research. International Registered Report Identifier (IRRID): RR1-10.2196/17323 %M 32579122 %R 10.2196/17323 %U http://www.researchprotocols.org/2020/6/e17323/ %U https://doi.org/10.2196/17323 %U http://www.ncbi.nlm.nih.gov/pubmed/32579122 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e20712 %T Using Social Media and Technology to Communicate in Pediatric HIV Research: Qualitative Study With Young Adults Living With or Exposed to Perinatal HIV %A Berman,Claire A %A Kacanek,Deborah %A Nichamin,Mindy %A Wilson,Dominique %A Davtyan,Mariam %A Salomon,Liz %A Patel,Kunjal %A Reznick,Megan %A Tassiopoulos,Katherine %A Lee,Sonia %A Bauermeister,Jose %A Paul,Mary %A Aldape,Theresa %A Seage III,George R %+ Department of Epidemiology, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, United States, 1 6174321853, cberman@hsph.harvard.edu %K pediatric HIV %K perinatal HIV %K youth %K young adults %K social media %K study retention %K COVID-19 %D 2020 %7 23.6.2020 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: As young adults living with perinatal HIV (PHIV) or perinatal HIV exposure but uninfected (PHEU) grow older and manage the challenges and competing demands of young adulthood, new approaches are needed to facilitate their retention in longitudinal research and clinical care beyond in-person clinic visits. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the novel virus that causes coronavirus disease (COVID-19), emerged in the United States in January 2020 and has underscored this need; studies are adapting to remote communication with and data collection from participants. However, there are limited data on communication preferences among young adults who are living with PHIV or PHEU. Objective: The objectives of this qualitative study were to describe participants’ perceptions and use of social media and technology in their personal lives and in the context of participating in longitudinal pediatric HIV research and to describe the implications of the use of technology and social media for communication and retention purposes within a longitudinal pediatric study about HIV. Methods: We conducted 6 focus group discussions with 31 young adults living with PHIV and 13 in-depth interviews with 6 young adults living with PHIV and 7 living with PHEU. We asked about their preferences for the use of social media and digital technology in the Adolescent Master Protocol, a US-based longitudinal cohort study of youth affected by HIV. Results: Participants’ willingness to use social media platforms, telephone calls, SMS text messages, and video calls within the context of HIV research varied due to fears of HIV stigma and inadvertent disclosure. However, trusting relationships with clinical staff positively impacted their willingness to use these platforms. Conclusions: Our findings offer insight into how pediatric studies and clinics can communicate with participants as they age, even as new technologies and social media platforms emerge and replace old ones. For optimal retention, pediatric clinical staff should consider communication approaches offering flexible and tailored options for young adults participating in HIV research. %M 32540839 %R 10.2196/20712 %U http://pediatrics.jmir.org/2020/1/e20712/ %U https://doi.org/10.2196/20712 %U http://www.ncbi.nlm.nih.gov/pubmed/32540839 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 3 %N 1 %P e17299 %T Clinician Perspectives on the Design and Application of Wearable Cardiac Technologies for Older Adults: Qualitative Study %A Ferguson,Caleb %A Inglis,Sally C %A Breen,Paul P %A Gargiulo,Gaetano D %A Byiers,Victoria %A Macdonald,Peter S %A Hickman,Louise D %+ Western Sydney Nursing & Midwifery Research Centre, Western Sydney Local Health District and Western Sydney University, Blacktown Hospital, Marcel Crescent, Blacktown, 2148, Australia, 61 410207543, c.ferguson@westernsydney.edu.au %K technology %K arrhythmia %K monitoring %K older people %K cardiology %K qualitative %K wearable %D 2020 %7 18.6.2020 %9 Original Paper %J JMIR Aging %G English %X Background: New wearable devices (for example, AliveCor or Zio patch) offer promise in detecting arrhythmia and monitoring cardiac health status, among other clinically useful parameters in older adults. However, the clinical utility and usability from the perspectives of clinicians is largely unexplored. Objective: This study aimed to explore clinician perspectives on the use of wearable cardiac monitoring technology for older adults. Methods: A descriptive qualitative study was conducted using semistructured focus group interviews. Clinicians were recruited through purposive sampling of physicians, nurses, and allied health staff working in 3 tertiary-level hospitals. Verbatim transcripts were analyzed using thematic content analysis to identify themes. Results: Clinicians representing physicians, nurses, and allied health staff working in 3 tertiary-level hospitals completed 4 focus group interviews between May 2019 and July 2019. There were 50 participants (28 men and 22 women), including cardiologists, geriatricians, nurses, and allied health staff. The focus groups generated the following 3 overarching, interrelated themes: (1) the current state of play, understanding the perceived challenges of patient cardiac monitoring in hospitals, (2) priorities in cardiac monitoring, what parameters new technologies should measure, and (3) cardiac monitoring of the future, “the ideal device.” Conclusions: There remain pitfalls related to the design of wearable cardiac technology for older adults that present clinical challenges. These pitfalls and challenges likely negatively impact the uptake of wearable cardiac monitoring in routine clinical care. Partnering with clinicians and patients in the co-design of new wearable cardiac monitoring technologies is critical to optimize the use of these devices and their uptake in clinical care. %M 32554377 %R 10.2196/17299 %U http://aging.jmir.org/2020/1/e17299/ %U https://doi.org/10.2196/17299 %U http://www.ncbi.nlm.nih.gov/pubmed/32554377 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17708 %T Usability of a Consumer Health Informatics Tool Following Completion of a Clinical Trial: Focus Group Study %A Cho,Hwayoung %A Porras,Tiffany %A Flynn,Gabriella %A Schnall,Rebecca %+ School of Nursing, Columbia University, 560 West 168th Street, New York, NY, 10032, United States, 1 2123426886, rb897@columbia.edu %K consumer health informatics tool %K mobile Health %K mobile apps %K clinical trial %K symptom care %K self-management %K HIV-associated nonAIDS (HANA) %K HANA conditions %K HIV/AIDS %D 2020 %7 15.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health (mHealth) apps have the potential to be effective tools for encouraging patients with chronic diseases to self-manage their health. The success of mHealth apps is related to technology acceptance and its subsequent use by intended consumers. Therefore, it is essential to gain insights from consumers’ perspectives about their use of mHealth apps in daily life. Objective: The purpose of this work was to understand consumers’ perspectives on use of a self-management app following completion of a clinical trial that tested the efficacy of the app for improving health outcomes. Methods: We conducted five focus groups with paricipants of a clinical trial (NCT03182738) who were randomized to use the video information provider (VIP) for HIV-associated nonAIDS (HANA) conditions app (VIP-HANA) or an attention control app. Thematic analysis was conducted, and the themes were organized according to the two key constructs of the technology acceptance model framework: perceived usefulness and perceived ease of use. Results: Thirty-nine people living with HIV (20 from the intervention group and 19 from the control group) participated in the focus group sessions. Of the eight themes identified from focus group data, the five themes related to perceived usefulness were: (1) self-monitoring HIV-related symptoms of HANA conditions, (2) enhanced relationship with clinical providers, (3) improvement in physical and emotional health, (4) long-term impact of self-care strategies on improvement in symptoms of HANA conditions, and (5) inspired lifestyle changes to manage symptoms. The three themes related to perceived ease of use were: (1) easy to navigate, (2) avatar personalization, and (3) privacy/confidentiality maintained even when changing the location of app use. Conclusions: Perceived ease of use was similar in both study groups but perceived usefulness differed between study groups. Participants in both study groups found the VIP-HANA app to be useful in monitoring their symptoms and enhancing communication with their clinical care providers. However, only intervention group participants perceived the app to be useful in improving overall health and long-term symptom management. Findings from this study highlight factors that are essential to ensure the usefulness of self-management apps and facilitate sustained use of mHealth apps for people living with chronic illnesses. %M 32538796 %R 10.2196/17708 %U http://www.jmir.org/2020/6/e17708/ %U https://doi.org/10.2196/17708 %U http://www.ncbi.nlm.nih.gov/pubmed/32538796 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e17876 %T An Evidence-Based, Nursing Handover Standard for a Multisite Public Hospital in Switzerland: Web-Based, Modified Delphi Study %A Tacchini-Jacquier,Nadine %A Hertzog,Hélène %A Ambord,Kilian %A Urben,Peter %A Turini,Pierre %A Verloo,Henk %+ Valais Hospital, Avenue du Grand-Champsec, 86, Sion, 1951, Switzerland, 1 27 603 67 52, nadine.tacchini-jacquier@hopitalvs.ch %K Delphi survey %K consensus %K nursing %K shift %K nursing handover %K standard %K patient transfers %K peripheral hospital %D 2020 %7 15.6.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: Ineffective communication procedures create openings for errors when health care professionals fail to transfer complete, consistent information. Deficient or absent clinical handovers, or failures to transfer information, responsibility, and accountability, can have severe consequences for hospitalized patients. Clinical handovers are practiced every day, in many ways, in all institutional health care settings. Objective: This study aimed to design an evidence-based, nursing handover standard for inpatients for use at shift changes or internal transfers between hospital wards. Methods: We carried out a modified, multiround, web-based, Delphi data collection survey of an anonymized panel sample of 264 nurse experts working at a multisite public hospital in Switzerland. Each survey round was built on responses from the previous one. The surveys ended with a focus group discussion consisting of a randomly selected panel of participants to explain why items for the evidence-based clinical nursing handover standard were selected or not selected. Items had to achieve a consensus of ≥70% for selection and inclusion. Results: The study presents the items selected by consensus for an evidence-based nursing handover standard for inpatients for use at shift changes or internal transfers. It also presents the reasons why survey items were or were not included. Conclusions: This modified Delphi survey method enabled us to develop a consensus- and evidence-based nursing handover standard now being trialed at shift changes and the internal transfers of inpatients at our multisite public hospital in Switzerland. %R 10.2196/17876 %U https://nursing.jmir.org/2020/1/e17876/ %U https://doi.org/10.2196/17876 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e17114 %T User Experiences and Preferences Regarding an App for the Treatment of Urinary Incontinence in Adult Women: Qualitative Study %A Wessels,Nienke J %A Hulshof,Lisa %A Loohuis,Anne M M %A van Gemert-Pijnen,Lisette %A Jellema,Petra %A van der Worp,Henk %A Blanker,Marco H %+ Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Postbus 196, Huispostcode FA21, Groningen, 9700 AD, Netherlands, 31 503616746, n.j.wessels@umcg.nl %K ehealth %K mobile applications %K self-management %K qualitative research %D 2020 %7 12.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Although several apps are available to support the treatment of urinary incontinence (UI), little has been reported about the experiences and preferences of their users. Objective: The objective of this study was to explore the experiences and preferences of women using a mobile app for the treatment of UI and to identify potential improvements to the app. We developed this app for three types of UI: stress UI, urgency UI, and mixed UI. Methods: The participants in this qualitative study were women with self-reported stress UI, urgency UI, or mixed UI who used an app-based treatment to manage their condition for at least six weeks. Following the intervention, semistructured interviews were conducted to explore the participants’ experiences and preferences regarding the app. All interviews were audio-recorded, transcribed verbatim, and analyzed separately by two researchers. Results: Data saturation was reached after interviewing 9 women (aged 32-68 years) with stress UI (n=1, 11%), urgency UI (n=3, 33%), or mixed UI (n=5, 56%). Accessibility, awareness, usability, and adherence emerged as the main themes. On the one hand, participants appreciated that the app increased their accessibility to care, preserved their privacy, increased their awareness of therapeutic options, was easy to use and useful, and supported treatment adherence. On the other hand, some participants reported that they wanted more contact with a care provider, and others reported that using the app increased their awareness of symptoms. Conclusions: This qualitative study indicates that women appreciate app-based treatment for UI because it can lower barriers to treatment and increase both awareness and adherence to treatment. However, the app does not offer the ability of face-to-face contact and can lead to a greater focus on symptoms. %M 32530431 %R 10.2196/17114 %U http://mhealth.jmir.org/2020/6/e17114/ %U https://doi.org/10.2196/17114 %U http://www.ncbi.nlm.nih.gov/pubmed/32530431 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 6 %P e15086 %T Patients’ Measurement Priorities for Remote Measurement Technologies to Aid Chronic Health Conditions: Qualitative Analysis %A Simblett,Sara %A Matcham,Faith %A Curtis,Hannah %A Greer,Ben %A Polhemus,Ashley %A Novák,Jan %A Ferrao,Jose %A Gamble,Peter %A Hotopf,Matthew %A Narayan,Vaibhav %A Wykes,Til %A , %+ Institute of Psychiatry, Psychology and Neuroscience, King's College London, Henry Wellcome Building, Psychology Department, 2nd Floor, London, United Kingdom, 44 2078480762, sara.simblett@kcl.ac.uk %K qualitative analysis %K patient involvement %K remote measurement technology %K mHealth %D 2020 %7 10.6.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Remote measurement technology (RMT), including the use of mobile phone apps and wearable devices, may provide the opportunity for real-world assessment and intervention that will streamline clinical input for years to come. In order to establish the benefits of this approach, we need to operationalize what is expected in terms of a successful measurement. We focused on three clinical long-term conditions where a novel case has been made for the benefits of RMT: major depressive disorder (MDD), multiple sclerosis (MS), and epilepsy. Objective: The aim of this study was to conduct a consultation exercise on the clinical end point or outcome measurement priorities for RMT studies, drawing on the experiences of people with chronic health conditions. Methods: A total of 24 participants (16/24 women, 67%), ranging from 28 to 65 years of age, with a diagnosis of one of three chronic health conditions―MDD, MS, or epilepsy―took part in six focus groups. A systematic thematic analysis was used to extract themes and subthemes of clinical end point or measurement priorities. Results: The views of people with MDD, epilepsy, and MS differed. Each group highlighted unique measurements of importance, relevant to their specific needs. Although there was agreement that remote measurement could be useful for tracking symptoms of illness, some symptoms were specific to the individual groups. Measuring signs of wellness was discussed more by people with MDD than by people with MS and epilepsy. However, overlap did emerge when considering contextual factors, such as life events and availability of support (MDD and epilepsy) as well as ways of coping (epilepsy and MS). Conclusions: This is a unique study that puts patients’ views at the forefront of the design of a clinical study employing novel digital resources. In all cases, measuring symptom severity is key; people want to know when their health is getting worse. Second, symptom severity needs to be placed into context. A holistic approach that, in some cases, considers signs of wellness as well as illness, should be the aim of studies employing RMT to understand the health of people with chronic conditions. %M 32519975 %R 10.2196/15086 %U https://mhealth.jmir.org/2020/6/e15086 %U https://doi.org/10.2196/15086 %U http://www.ncbi.nlm.nih.gov/pubmed/32519975 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e17930 %T Perceptions About Technologies That Help Community-Dwelling Older Adults Remain at Home: Qualitative Study %A Verloo,Henk %A Kampel,Thomas %A Vidal,Nicole %A Pereira,Filipa %+ School of Health Sciences, HES-SO Valais/Wallis, 5, Chemin de l’Agasse, Sion, 1950, Switzerland, 41 276036752, henk.verloo@netplus.ch %K technology %K gerontechnology %K photo-elicitation %K informal caregivers %K cognitive impairment %K professional caregivers %K interviews %K focus groups %K content analysis %K physical impairment %K frailty %D 2020 %7 4.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The population of Europe is aging rapidly. Most community-dwelling older adults (CDOAs) want to remain in their homes, particularly those experiencing functional decline. Politicians and academics repeatedly praise technological instruments for being the preferred solution for helping older adults with deteriorating health to remain at home. Objective: This study aimed to understand the perceptions of CDOAs and their informal caregivers (ICs) and professional caregivers (PCs) about technologies that can help keep older adults at home. Methods: This qualitative study used personal interviews, focus groups, and photo-elicitation interviews to better understand the perceptions of a convenience sample of 68 CDOAs, 21 ICs, and 32 PCs. Results: A fraction of CDOAs did not perceive technological instruments to be a very useful means of helping them remain at home. However, the ICs and PCs were more positive. The CDOAs preferred and were more willing to adopt technologies related to their mobility and safety and those that would help slow down their cognitive decline. The ICs preferred technological aids that assist in the activities of daily living as well as safety-related technologies for detecting falls and helping to locate disoriented older adults. The PCs preferred integrated communication and information systems to improve collaboration between all stakeholders, housing equipped with technologies to manage complex care, high-performance ancillary equipment to transfer people with reduced mobility, and surveillance systems to ensure safety at home. Conclusions: Although our study reports that CDOAs have limited interest in innovative technologies to help them remain at home, their technological skills will undoubtedly improve in the future, as will those of ICs and PCs. Technological tools will play an increasingly important role in home health care. %M 32496197 %R 10.2196/17930 %U http://www.jmir.org/2020/6/e17930/ %U https://doi.org/10.2196/17930 %U http://www.ncbi.nlm.nih.gov/pubmed/32496197 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 2 %P e16310 %T Usability of a Mobile App for Improving Literacy in Children With Hearing Impairment: Focus Group Study %A DeForte,Shelly %A Sezgin,Emre %A Huefner,Janelle %A Lucius,Shana %A Luna,John %A Satyapriya,Anand A %A Malhotra,Prashant %+ Research Information Solutions and Innovation, The Abigail Wexner Research Institute, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, United States, 1 6143556814, emre.sezgin@nationwidechildrens.org %K hearing aids %K focus groups %K cochlear implants %K literacy %K reading %K hearing loss %K hearing impairment %K mobile applications %K qualitative study %K usability %K aural rehabilitation %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Children with hearing loss, even those identified early and who use hearing aids or cochlear implants, may face challenges in developing spoken language and literacy. This can lead to academic, behavioral, and social difficulties. There are apps for healthy children to improve their spoken language and literacy and apps that focus on sign language proficiency for children with hearing loss, but these apps are limited for children with hearing loss. Therefore, we have developed an app called Hear Me Read, which uses enhanced digital stories as therapy tools for speech, language, and literacy for children with hearing loss. The platform has therapist and parent/child modes that allow (1) the selection of high-quality, illustrated digital stories by a speech-language pathologist, parent, or child; (2) the modification of digital stories for a multitude of speech and language targets; and (3) the assignment of stories by a therapist to facilitate individualized speech and language goals. In addition, Hear Me Read makes the caregiver a core partner in engagement through functionality, whereby the caregiver can record video and audio of themselves to be played back by the child. Objective: This study aimed to evaluate the user experience of the Hear Me Read app through a focus group study with caregivers and their children. Methods: We recruited 16 participants (8 children with and without hearing loss and 8 caregivers) to participate in 1-hour focus groups. Caregivers and children interacted with the app and discussed their experiences through a semistructured group interview. We employed thematic analysis methods and analyzed the data. We used feedback from the focus group to improve the elements of the app for a larger clinical trial assessing the impact of the app on outcomes. Results: We identified three themes: default needs, specific needs, and family needs. Participants found the app to be esthetically pleasing and easy to use. The findings of this study helped us to identify usability attributes and to amend app functionalities to best fit user needs. Caregivers and children appreciated the enhancements, such as highlighting of parts of speech and caregiver reading of video playback, which were made possible by the digital format. Participants expressed that the app could be used to enhance family reading sessions and family interaction. Conclusions: The findings from this focus group study are promising for the use of educational apps designed specifically for those with hearing loss who are pursuing listening and spoken language as a communication outcome. Further investigation is needed with larger sample sizes to understand the clinical impact on relevant language and literacy outcomes in this population. %M 32205305 %R 10.2196/16310 %U http://humanfactors.jmir.org/2020/2/e16310/ %U https://doi.org/10.2196/16310 %U http://www.ncbi.nlm.nih.gov/pubmed/32205305 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e15976 %T How Geographical Isolation and Aging in Place Can Be Accommodated Through Connected Health Stakeholder Management: Qualitative Study With Focus Groups %A Chen,Sonia Chien-I %A Liu,Chenglian %A Wang,Zhenyuan %A McAdam,Rodney %A Brennan,Michael %A Davey,Shirley %A Cheng,Teng Yuan %+ Faculty of Economics and Management, East China Normal University, Room 307, S Fashang Building, No 500, Dongchuan Rd, Minhang District, Shanghai, 201108, China, 86 15800705298, wangzhenyuan@dbm.ecnu.edu.cn %K connected health care %K remote areas %K business strategy %K Taiwan %K population aging %K knowledge sharing %D 2020 %7 27.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In remote areas, connected health (CH) is needed, but as local resources are often scarce and the purchasing power of residents is usually poor, it is a challenge to apply CH in these settings. In this study, CH is defended as a technological solution for reshaping the direction of health care to be more proactive, preventive, and precisely targeted—and thus, more effective. Objective: The objective of this study was to explore the identity of CH stakeholders in remote areas of Taiwan and their interests and power in order to determine ideal strategies for applying CH. We aimed to explore the respective unknowns and discover insights for those facing similar issues. Methods: Qualitative research was conducted to investigate and interpret the phenomena of the aging population in a remote setting. An exploratory approach was employed involving semistructured interviews with 22 participants from 8 remote allied case studies. The interviews explored perspectives on stakeholder arrangements, including the power and interests of stakeholders and the needs of all the parties in the ecosystem. Results: Results were obtained from in-depth interviews and focus groups that included identifying the stakeholders of remote health and determining how they influence its practice, as well as how associated agreements bring competitive advantages. Stakeholders included people in government sectors, industrial players, academic researchers, end users, and their associates who described their perspectives on their power and interests in remote health service delivery. Specific facilitators of and barriers to effective delivery were identified. A number of themes, such as government interests and power of decision making, were corroborated across rural and remote services. These themes were broadly grouped into the disclosure of conflicts of interest, asymmetry in decision making, and data development for risk assessment. Conclusions: This study contributes to current knowledge by exploring the features of CH in remote areas and investigating its implementation from the perspectives of stakeholder management. It offers insights into managing remote health through a CH platform, which can be used for preliminary quantitative research. Consequently, these findings could help to more effectively facilitate diverse stakeholder engagement for health information sharing and social interaction. %M 32459181 %R 10.2196/15976 %U http://www.jmir.org/2020/5/e15976/ %U https://doi.org/10.2196/15976 %U http://www.ncbi.nlm.nih.gov/pubmed/32459181 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e16202 %T Identifying the Needs for a Web-Based Postpartum Platform Among Parents of Newborns and Health Care Professionals: Qualitative Focus Group Study %A Laureij,Lyzette T %A Breunis,Leonieke J %A Steegers-Theunissen,Regine P M %A Rosman,Ageeth N %+ Department of Health Care Studies, Rotterdam University of Applied Sciences, IVG, RS.06.121, PO Box 25035 Rotterdam, 3001 HR, Rotterdam, 3000 CA, Netherlands, 31 6 425 27 919, a.n.rosman@hr.nl %K newborn %K focus groups %K postpartum period %K postnatal care %K eHealth %K pregnancy %K obstetrics %K qualitative research %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: During the turbulent postpartum period, there is an urgent need by parents for support and information regarding the care for their infant. In the Netherlands, professional support is provided during the first 8 days postpartum and for a maximum of 8 hours a day. This care is delivered by maternity care assistants (MCAs). Despite the availability of this extensive care, a majority of women prefer to make use of a lesser amount of postpartum care. After this period, access to care is less obvious. Where parents are automatically offered care in the first 8 days after birth, they must request care in the period thereafter. To compensate for a possible gap in information transfer, electronic health (eHealth) can be a valuable, easily accessible addition to regular care. Objective: We explored the needs and preferred content by new parents and health care professionals of a web-based platform dedicated to the postpartum period and identified barriers and facilitators for using such a platform. Methods: We conducted 3 semistructured focus groups among (1) parents of newborns, (2) MCAs, and (3) clinicians and administrators in maternity care. A topic list based on a framework designed for innovation processes was used. Thematic content analysis was applied. Results: In the focus group for parents, 5 mothers and 1 male partner participated. A total of 6 MCAs participated in the second focus group. A total of 5 clinicians and 2 administrators—a member of a stakeholder party and a manager of a maternity care organization—participated in the third focus group. All user groups underlined that a platform focusing on the postpartum period was missing in current care, especially by parents experiencing a gap following the intensive care ending after the first week of childbirth. Parents indicated that they would perceive a postpartum platform as a proper source of reliable information on topics regarding breastfeeding, growth, and developmental milestones, but also as a tool to support them in seeking care with appropriate professionals. They also emphasized the need to receive personalized information and the opportunity to ask questions via the platform. MCAs acknowledged added value of providing additional information on topics that they address during the early postpartum period. MCAs as well as clinicians and administrators would guide parents to such a platform for additional support. All user groups experienced disadvantages of using an authentication procedure and filling out extra questionnaires to receive tailored information. Conclusions: Our research shows that parents of newborns, MCAs, and clinicians and administrators foresee the additional value of a web-based postpartum platform for at least the whole postpartum period. The platform should be easily accessible and personalized. Content on the platform should contain information regarding breastfeeding, growth, and developmental milestones. A chat function with professionals could be considered as an option. %M 32452805 %R 10.2196/16202 %U http://formative.jmir.org/2020/5/e16202/ %U https://doi.org/10.2196/16202 %U http://www.ncbi.nlm.nih.gov/pubmed/32452805 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 1 %P e15859 %T Assessing Breast Cancer Survivors’ Perceptions of Using Voice-Activated Technology to Address Insomnia: Feasibility Study Featuring Focus Groups and In-Depth Interviews %A Arem,Hannah %A Scott,Remle %A Greenberg,Daniel %A Kaltman,Rebecca %A Lieberman,Daniel %A Lewin,Daniel %+ Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Rm 514, Washington, DC, 20052, United States, 1 2029944676, hannaharem@gwu.edu %K artificial intelligence %K breast neoplasms %K survivors %K insomnia %K cognitive behavioral therapy %K mobile phones %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: Breast cancer survivors (BCSs) are a growing population with a higher prevalence of insomnia than women of the same age without a history of cancer. Cognitive behavioral therapy for insomnia (CBT-I) has been shown to be effective in this population, but it is not widely available to those who need it. Objective: This study aimed to better understand BCSs’ experiences with insomnia and to explore the feasibility and acceptability of delivering CBT-I using a virtual assistant (Amazon Alexa). Methods: We first conducted a formative phase with 2 focus groups and 3 in-depth interviews to understand BCSs’ perceptions of insomnia as well as their interest in and comfort with using a virtual assistant to learn about CBT-I. We then developed a prototype incorporating participant preferences and CBT-I components and demonstrated it in group and individual settings to BCSs to evaluate acceptability, interest, perceived feasibility, educational potential, and usability of the prototype. We also collected open-ended feedback on the content and used frequencies to describe the quantitative data. Results: We recruited 11 BCSs with insomnia in the formative phase and 14 BCSs in the prototype demonstration. In formative work, anxiety, fear, and hot flashes were identified as causes of insomnia. After prototype demonstration, nearly 79% (11/14) of participants reported an interest in and perceived feasibility of using the virtual assistant to record sleep patterns. Approximately two-thirds of the participants thought lifestyle modification (9/14, 64%) and sleep restriction (9/14, 64%) would be feasible and were interested in this feature of the program (10/14, 71% and 9/14, 64%, respectively). Relaxation exercises were rated as interesting and feasible using the virtual assistant by 71% (10/14) of the participants. Usability was rated as better than average, and all women reported that they would recommend the program to friends and family. Conclusions: This virtual assistant prototype delivering CBT-I components by using a smart speaker was rated as feasible and acceptable, suggesting that this prototype should be fully developed and tested for efficacy in the BCS population. If efficacy is shown in this population, the prototype should also be adapted for other high-risk populations. %M 32348274 %R 10.2196/15859 %U http://cancer.jmir.org/2020/1/e15859/ %U https://doi.org/10.2196/15859 %U http://www.ncbi.nlm.nih.gov/pubmed/32348274 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 5 %P e15568 %T Mental Health Therapy Protocols and eHealth Design: Focus Group Study %A van Dooren,Marierose M M %A Visch,Valentijn %A Spijkerman,Renske %A Goossens,Richard H M %A Hendriks,Vincent M %+ Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 15 27 87660, m.m.m.vandooren@tudelft.nl %K eHealth design %K mental health care %K personalization %K protocol %K youth addiction care %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic health (eHealth) programs are often based on protocols developed for the original face-to-face therapies. However, in practice, therapists and patients may not always follow the original therapy protocols. This form of personalization may also interfere with the intended implementation and effects of eHealth interventions if designers do not take these practices into account. Objective: The aim of this explorative study was to gain insights into the personalization practices of therapists and patients using cognitive behavioral therapy, one of the most commonly applied types of psychotherapy, in a youth addiction care center as a case context. Methods: Focus group discussions were conducted asking therapists and patients to estimate the extent to which a therapy protocol was followed and about the type and reasons for personalization of a given therapy protocol. A total of 7 focus group sessions were organized involving therapists and patients. We used a commonly applied protocol for cognitive behavioral therapy as a therapy protocol example in youth mental health care. The first focus group discussions aimed at assessing the extent to which patients (N=5) or therapists (N=6) adapted the protocol. The second focus group discussions aimed at estimating the extent to which the therapy protocol is applied and personalized based on findings from the first focus groups to gain further qualitative insight into the reasons for personalization with groups of therapists and patients together (N=7). Qualitative data were analyzed using thematic analysis. Results: Therapists used the protocol as a “toolbox” comprising different therapy tools, and personalized the protocol to enhance the therapeutic alliance and based on their therapy-provision experiences. Therapists estimated that they strictly follow 48% of the protocol, adapt 30%, and replace 22% by other nonprotocol therapeutic components. Patients personalized their own therapy to conform the assignments to their daily lives and routines, and to reduce their levels of stress and worry. Patients estimated that 29% of the provided therapy had been strictly followed by the therapist, 48% had been adjusted, and 23% had been replaced by other nonprotocol therapeutic components. Conclusions: A standard cognitive behavioral therapy protocol is not strictly and fully applied but is mainly personalized. Based on these results, the following recommendations for eHealth designers are proposed to enhance alignment of eHealth to therapeutic practice and implementation: (1) study and copy at least the applied parts of a protocol, (2) co-design eHealth with therapists and patients so they can allocate the components that should be open for user customization, and (3) investigate if components of the therapy protocol that are not applied should remain part of the eHealth applied. To best generate this information, we suggest that eHealth designers should collaborate with therapists, patients, protocol developers, and mental health care managers during the development process. %M 32374271 %R 10.2196/15568 %U https://formative.jmir.org/2020/5/e15568 %U https://doi.org/10.2196/15568 %U http://www.ncbi.nlm.nih.gov/pubmed/32374271 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e14201 %T Smart, Remote, and Targeted Health Care Facilitation Through Connected Health: Qualitative Study %A Chen,Sonia Chien-I %A Hu,Ridong %A McAdam,Rodney %+ Institute of Quantitative Economics, Huaqiao University, No. 668, Jimei Avenue, Jimei dist, Xiamen, 361021, China, 86 17750619886, j_rdhu@hqu.edu.cn %K connected health care %K smart health care %K health care quality %K access %K remote monitoring %K precision medicine %K self-management %D 2020 %7 28.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Societies around the world are aging. Widespread aging creates problems for social services and health care practices. In this light, research on connected health (CH) is becoming essential. CH refers to a variety of technological measures that allow health care to be provided remotely with the aim of increasing efficiency, cost-effectiveness, and satisfaction on the part of health care recipients. CH is reshaping health care’s direction to be more proactive, more preventive, and more precisely targeted and, thus, more effective. CH has been demonstrated to have great value in managing and preventing chronic diseases, which create huge burdens on health care and social services. In short, CH provides promising solutions to diseases and social challenges associated with aging populations. However, there are many barriers that need to be overcome before CH can be successfully and widely implemented. Objective: The research question of this study is as follows: How can CH facilitate smart, remote, and targeted health care? The objective is to identify how health care can be managed in more comprehensive ways, such as by providing timely, flexible, accessible, and personalized services to preserve continuity and offer high-quality seamless health care. Methods: A qualitative approach was used based on 60 multistage, semistructured stakeholder interviews. Results: The results can be divided into two functions of CH: ecosystem and platform. On the one hand, the interviews enabled the authors to develop a stakeholder classification and interaction diagram. These stakeholders interacted sequentially to provide technology-based content to end users. On the other hand, interviewees reflected on how CH serves as a platform to address remote monitoring and patient self-management. In the Discussion section, three innovation strategies are discussed to reflect the manner in which CH promotes smart, timely, and precise health care. Conclusions: This study indicates that it is essential to continually revise CH business models, given the ongoing and rapid changes in technology across groups of CH stakeholders. We also found that global trends toward smart, timely, and precise health care shape what individuals expect from products and services, providing firms with unique opportunities for growth. %M 32343254 %R 10.2196/14201 %U http://www.jmir.org/2020/4/e14201/ %U https://doi.org/10.2196/14201 %U http://www.ncbi.nlm.nih.gov/pubmed/32343254 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14376 %T Proposal for the User-Centered Design Approach for Health Apps Based on Successful Experiences: Integrative Review %A Molina-Recio,Guillermo %A Molina-Luque,Rafael %A Jiménez-García,Ana M. %A Ventura-Puertos,Pedro E %A Hernández-Reyes,Alberto %A Romero-Saldaña,Manuel %+ Department of Nursing, University of Córdoba, Av. Menéndez Pidal 7, Córdoba, Spain, 34 957 218 101, rafael.moluq@gmail.com %K mHealth %K user-centered development %K focus groups %K discussion groups %K interdisciplinarity %D 2020 %7 22.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Different strategies encompassed within mHealth have shown themselves to be effective for maintaining good health or controlling certain diseases. However, there is usually a very high rate of abandonment of health apps. Therefore, it would seem obvious that there is a need for involving the end users (whether they are health professionals, patients, or both) in the design process from the early stages in order to enable their needs and characteristics to be identified. In this sense, it is common knowledge that focusing on the user permits the consideration of valuable details aimed at making the correct adjustment between the patient, the technology, and the organization of attention. Objective: The goal of the research was to propose a methodology based on the review of previous successful user experiences in setting up health apps by using qualitative techniques (focus groups and discussion groups) that includes the participation of information technology and health professionals and the patients themselves. Methods: An integrative review was made of studies in which a qualitative methodology was employed mainly through focus and/or discussion groups for the design and development of health apps, consulting diverse databases (PubMed, Scopus, and Proquest) with the following search strategy: “mHealth AND apps AND focus group OR discussion group.” A total of 69 papers were included in the review. Results: A proposal structured in 4 sessions of variable duration was made in which information technology and health professionals and patients take part: composing, preparing, and organizing contents (session 1); testing structure and usability (session 2); does the app fit the needs of end users? (session 3); and last testing—keep on improving (session 4). Throughout the sessions, we propose studying aspects like previous user experiences in mHealth, barriers to the adoption of mHealth, interface contents, management and browsability, usability, perceived quality, security and privacy, capacity to self-manage disease with the app, ergonomics, and glanceability, etc. Specific tools that have proved useful in previous research for measuring these aspects are presented. Conclusions: These work sessions would be based on predominantly qualitative methodologies although, as they evolve, validated questionnaires permitting the assessment of the objectivity of certain technical aspects could be incorporated. With this proposal, a project centered on end users could be effected, responding to their needs. However, this requires validation that will be made via implementation in the development of health apps, with the subsequent measurement of results in terms of adherence and improvement in the clinical variables of the end users. %M 32319965 %R 10.2196/14376 %U http://mhealth.jmir.org/2020/4/e14376/ %U https://doi.org/10.2196/14376 %U http://www.ncbi.nlm.nih.gov/pubmed/32319965 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e14351 %T Needs, Experiences, and Views of People With Rheumatic and Musculoskeletal Diseases on Self-Management Mobile Health Apps: Mixed Methods Study %A Najm,Aurelie %A Lempp,Heidi %A Gossec,Laure %A Berenbaum,Francis %A Nikiphorou,Elena %+ Department of Rheumatology, Nantes University Hospital, 1, Place Alexis Ricordeau, Nantes, France, 33 633444793, aurelie.najm@gmail.com %K mHealth %K mixed methods %K mobile health apps %K rheumatic and musculoskeletal disease %K smartphone %K apps %K rheumatoid arthritis, digital health, mobile health %D 2020 %7 20.4.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Despite the growing interest and exponential popularity of mobile health (mHealth) apps for long-term conditions such as rheumatic and musculoskeletal diseases (RMDs) and their self-management, patients are rarely directly consulted and involved in the app development process. Objective: This study aims to explore the needs, experiences, and views of people diagnosed with RMDs on mHealth apps. Methods: The study used a mixed methods approach: (1) an initial qualitative phase via a patient focus group in the UK and (2) a survey disseminated through national organizations for patients with RMDs across European countries, the United States, Canada, and Australia. Results: The focus group included six patients with life-long musculoskeletal conditions. Half had used a self-management app at least once. The use of existing apps was reported as time-consuming due to a lack of functionality. The need for bespoke apps was voiced by all participants. Among 424 patients across European countries, the United States, Canada, and Australia, the main age group was 45 to 54 years (122/424, 28.7%), and 86.8% (368/424) were women. Half of the respondents were aware of the existence of apps to support self-management of their RMDs (188/355, 53%), with 42% (79/188) of them currently using such devices. Patients were mostly interested in an app to self-monitor their health parameters (259/346, 74.9%) and disease activity (221/346, 63.9%) or communicate directly with their health care provider (200/346, 57.8%). Conclusions: Patients considered that using an app could help them to self-manage their RMD condition if it was tailored to their needs and co-developed with health professionals. The development of such apps will require standardization and regular quality control. %M 32310151 %R 10.2196/14351 %U https://mhealth.jmir.org/2020/4/e14351 %U https://doi.org/10.2196/14351 %U http://www.ncbi.nlm.nih.gov/pubmed/32310151 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 1 %P e14599 %T Factors Influencing Motivation and Engagement in Mobile Health Among Patients With Sickle Cell Disease in Low-Prevalence, High-Income Countries: Qualitative Exploration of Patient Requirements %A Issom,David-Zacharie %A Henriksen,André %A Woldaregay,Ashenafi Zebene %A Rochat,Jessica %A Lovis,Christian %A Hartvigsen,Gunnar %+ Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, Geneva, 1206, Switzerland, 41 223722601, david.issom@unige.ch %K mHealth %K wearable devices %K self-management %K sickle cell disease %K patient engagement %K adoption %K motivation %K user computer interfaces %K health behavior %K persuasion %D 2020 %7 24.3.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Sickle cell disease (SCD) is a hematological genetic disease affecting over 25 million people worldwide. The main clinical manifestations of SCD, hemolytic anemia and vaso-occlusion, lead to chronic pain and organ damages. With recent advances in childhood care, high-income countries have seen SCD drift from a disease of early childhood mortality to a neglected chronic disease of adulthood. In particular, coordinated, preventive, and comprehensive care for adults with SCD is largely underresourced. Consequently, patients are left to self-manage. Mobile health (mHealth) apps for chronic disease self-management are now flooding app stores. However, evidence remains unclear about their effectiveness, and the literature indicates low user engagement and poor adoption rates. Finally, few apps have been developed for people with SCD and none encompasses their numerous and complex self-care management needs. Objective: This study aimed to identify factors that may influence the long-term engagement and user adoption of mHealth among the particularly isolated community of adult patients with SCD living in low-prevalence, high-income countries. Methods: Semistructured interviews were conducted. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Analysis was informed by the Braun and Clarke framework and mapped to the COM-B model (capability, opportunity, motivation, and behavior). Results were classified into high-level functional requirements (FRs) and nonfunctional requirements (NFRs) to guide the development of future mHealth interventions. Results: Overall, 6 males and 4 females were interviewed (aged between 21 and 55 years). Thirty FRs and 31 NFRs were extracted from the analysis. Most participants (8/10) were concerned about increasing their physical capabilities being able to stop pain symptoms quickly. Regarding the psychological capability aspects, all interviewees desired to receive trustworthy feedback on their self-care management practices. About their physical opportunities, most (7/10) expressed a strong desire to receive alerts when they would reach their own physiological limitations (ie, during physical activity). Concerning social opportunity, most (9/10) reported wanting to learn about the self-care practices of other patients. Relating to motivational aspects, many interviewees (6/10) stressed their need to learn how to avoid the symptoms and live as normal a life as possible. Finally, NFRs included inconspicuousness and customizability of user experience, automatic data collection, data shareability, and data privacy. Conclusions: Our findings suggest that motivation and engagement with mHealth technologies among the studied population could be increased by providing features that clearly benefit them. Self-management support and self-care decision aid are patients’ major demands. As the complexity of SCD self-management requires a high cognitive load, pervasive health technologies such as wearable sensors, implantable devices, or inconspicuous conversational user interfaces should be explored to ease it. Some of the required technologies already exist but must be integrated, bundled, adapted, or improved to meet the specific needs of people with SCD. %M 32207692 %R 10.2196/14599 %U http://humanfactors.jmir.org/2020/1/e14599/ %U https://doi.org/10.2196/14599 %U http://www.ncbi.nlm.nih.gov/pubmed/32207692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 3 %P e14652 %T Developing SMS Content to Promote Papanicolaou Triage Among Women Who Performed HPV Self-collection Test: Qualitative Study %A Sanchez Antelo,Victoria %A Kohler,Racquel E %A Curotto,Mariana %A Viswanath,Kasisomayajula "Vish" %A Paolino,Melisa %A Arrossi,Silvina %+ Centro de Estudios de Estado y Sociedad, Sánchez de Bustamante, 27, C1173AAA, Buenos Aires, Argentina, 54 1148651707, silviarrossi2020@gmail.com %K text messaging %K cell phone use %K telemedicine %K human papillomavirus DNA tests %K triage %K health behavior %K Argentina %D 2020 %7 6.3.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: SMS interventions are effective in promoting a variety of health behaviors; however, there is limited information regarding the use of SMS for cervical cancer screening and follow-up care. The Application of Communication and Information Technologies to Self-Collection study aims to evaluate a multicomponent mobile health intervention to increase triage adherence among women with human papillomavirus (HPV)–positive self-collected tests in Jujuy, Argentina. Here, we describe the formative results used to design the content of the SMS to be tested in the trial. Objective: This study aimed to understand the cultural and contextual elements, women’s beliefs, and perceptions regarding the use of SMS by the health care system and women’s preferences about the message content. Methods: We conducted five focus groups (FGs), stratified by rural or urban residence and age. All participants were aged 30 years or older and had performed HPV self-collection. Participatory techniques, including brainstorming, card-based classification, and discussions were used to debate the advantages and disadvantages of messages. We openly coded the discussions for agreements and preferences regarding the SMS content. Messages for both HPV-negative and HPV-positive women were validated through interviews with health authorities and 14 HPV-tested women. The final versions of the messages were pilot-tested. Results: A total of 48 women participated in the FGs. Participants rejected receiving both negative and positive HPV results by SMS because, for them, the delivery of results should be done in a face-to-face interaction with health professionals. They stressed the importance of the SMS content informing them that results were available for pick up and reflecting the kind of relationship that they have with the community health workers and the nearest health center. Women considered that a personalized SMS was important, as was the use of a formal yet warm tone. Owing to confidentiality issues, not using the word “HPV” was also a key component of the desired SMS content; therefore, the final message included the term “self-collection” without the mention of HPV infection. Results from the validation stage and pilot test showed high acceptability of the final version of the message. Conclusions: The results suggest that SMS is accepted when notifying women about the availability of the HPV test result, but it should not replace the delivery of results in face-to-face, doctor-patient encounters. In addition, messages must be tailored and must have a persuasive tone to motivate women to adhere to the triage. %M 32032940 %R 10.2196/14652 %U https://formative.jmir.org/2020/3/e14652 %U https://doi.org/10.2196/14652 %U http://www.ncbi.nlm.nih.gov/pubmed/32032940 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e15691 %T Exploring an Innovative Care Model and Telemonitoring for the Management of Patients With Complex Chronic Needs: Qualitative Description Study %A Gordon,Kayleigh %A Steele Gray,Carolyn %A Dainty,Katie N %A DeLacy,Jane %A Ware,Patrick %A Seto,Emily %+ University of Toronto, 155 College St 4th Floor, Toronto, ON, M5T 3M6, Canada, 1 (416) 978 4326, kayleigh.gordon@mail.utoronto.ca %K models of care %K complex patients %K multimorbidity %K telemonitoring %D 2020 %7 6.3.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: The growing number of patients with complex chronic conditions presents an urgent challenge across the Canadian health care system. Current care delivery models are overburdened, struggling to monitor and stabilize the complex needs of this growing patient population. Objective: This qualitative study aimed to explore the needs and perspectives of patients and members of the care team to inform the development of an innovative integrated model of care and the needs of telemonitoring (TM) for patients with complex chronic conditions. Furthermore, we explored how these needs could be successfully embedded to support this novel model of complex chronic care. Methods: A qualitative description design was utilized to conduct and analyze 29 semistructured interviews with patients (n=16) and care team members (CTM) (n=13) involved in developing the model of care in an ambulatory care facility in Southern Ontario. Participants were identified through purposive sampling. Two researchers performed an iterative thematic analysis using NVivo 12 (QSR International; Melbourne, Australia) to gain insights from examining multiple perspectives of different participants on complex chronic care needs. Results: The analysis revealed 3 themes and 13 subthemes, including the following: (1) adequate health care delivery remains challenging for patients with complex care needs, (2) insights into how to structure an integrated care model, and (3) opportunities for TM in an integrated model of care. Participants not only identified continued challenges in accessing and navigating care in a fragmented and disconnected delivery system but also identified the need for more self-management support. Patients and CTM described the structure of an integrated model of care, including the need for a clear referral and triage processes and composing a tight-knit circle of collaborating interdisciplinary providers led by a nurse practitioner (NP). Finally, opportunities for TM in an integrated model of care were identified, including increasing access and communication, the ability to monitor specific signs and symptoms, and building a clinical workflow around TM-enabled care. Conclusions: Despite entrenched health care service delivery models, a new model of care is acutely needed to care for patients with complex chronic needs (CCN). NPs are in a unique position to lead TM-enabled integrated models of care. TM can facilitate frequent and necessary monitoring of patients with CCN with more than one condition in integrated models of care. %R 10.2196/15691 %U https://nursing.jmir.org/2020/1/e15691/ %U https://doi.org/10.2196/15691 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 2 %P e16090 %T Development and Field Evaluation of the INTER-ACT App, a Pregnancy and Interpregnancy Coaching App to Reduce Maternal Overweight and Obesity: Mixed Methods Design %A Bogaerts,Annick %A Bijlholt,Margriet %A Mertens,Lotte %A Braeken,Marijke %A Jacobs,Bart %A Vandenberghe,Bert %A Ameye,Lieveke %A Devlieger,Roland %+ Department of Development and Regeneration, University of Leuven, O&N IV Herestraat 49 - bus 805, Leuven, 3000, Belgium, 32 16 19 31 27, annick.bogaerts@kuleuven.be %K pregnancy %K postpartum %K coaching %K lifestyle %K mobile app %D 2020 %7 14.2.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: The interpregnancy and pregnancy periods are important windows of opportunity to prevent excessive gestational weight retention. Despite an overwhelming number of existing health apps, validated apps to support a healthy lifestyle between and during pregnancies are lacking. Objective: To describe the development and evaluation of the INTER-ACT app, which is part of an interpregnancy and pregnancy lifestyle coaching module, to prevent excessive weight gain in pregnancy and enhance optimal weight and a healthy lifestyle in the interpregnancy period. Methods: A mixed methods design was used to identify the needs of health care providers and end users, according to 15 semistructured interviews, two focus groups, and two surveys. The user interface was evaluated in a pilot study (N=9). Results: Health care providers indicated that a mobile app can enhance a healthy lifestyle in pregnant and postpartum women. Pregnant women preferred graphic displays in the app, weekly notifications, and support messages according to their own goals. Both mothers and health care providers reported increased awareness and valued the combination of the app with face-to-face coaching. Conclusions: The INTER-ACT app was valued by its end users because it was offered in combination with face-to-face contact with a caregiver. %M 32130109 %R 10.2196/16090 %U http://formative.jmir.org/2020/2/e16090/ %U https://doi.org/10.2196/16090 %U http://www.ncbi.nlm.nih.gov/pubmed/32130109 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 1 %P e14424 %T Exploring How Professionals Within Agile Health Care Informatics Perceive Visualizations of Log File Analyses: Observational Study Followed by a Focus Group Interview %A ten Klooster,Iris %A Noordzij,Matthijs Leendert %A Kelders,Saskia Marion %+ University of Twente, Faculty of Behavioral, Management, and Social Sciences, Department of Psychology, Health, and Technology, De Zul 10, Enschede, 7522 NJ, Netherlands, 31 620730557, i.tenklooster@utwente.nl %K log file analyses %K user-centered design %K agile %K Markov Chains %K health care systems %D 2020 %7 21.1.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: An increasing number of software companies work according to the agile software development method, which is difficult to integrate with user-centered design (UCD) practices. Log file analysis may provide opportunities for integrating UCD practices in the agile process. However, research within health care information technology mostly has a theoretical approach and is often focused on the researcher’s interpretation of log file analyses. Objective: We aimed to propose a systematic approach to log file analysis in this study and present this to developers to explore how they react and interpret this approach in the context of a real-world health care information system, in an attempt to answer the following question: How may log file analyses contribute to increasing the match between the health care system and its users, within the agile development method, according to agile team members? Methods: This study comprised 2 phases to answer the research question. In the first phase, log files were collected from a health care information system and subsequently analyzed (summarizing sequential patterns, heat mapping, and clustering). In the second phase, the results of these analyses are presented to agile professionals during a focus group interview. The interpretations of the agile professionals are analyzed by open axial coding. Results: Log file data of 17,924 user sessions and, in total, 176,678 activities were collected. We found that the Patient Timeline is mainly visited, with 23,707 (23,707/176,678; 13.42%) visits in total. The main unique user session occurred in 5.99% (1074/17,924) of all user sessions, and this comprised Insert Measurement Values for Patient and Patient Timeline, followed by the page Patient Settings and, finally, Patient Treatment Plan. In the heat map, we found that users often navigated to the pages Insert Measurement Values and Load Messages Collaborate. Finally, in the cluster analysis, we found 5 clusters, namely, the Information-seeking cluster, the Collaborative cluster, the Mixed cluster, the Administrative cluster, and the Patient-oriented cluster. We found that the interpretations of these results by agile professionals are related to stating hypotheses (n=34), comparing paths (n=31), benchmarking (n=22), and prioritizing (n=17). Conclusions: We found that analyzing log files provides agile professionals valuable insights into users’ behavior. Therefore, we argue that log file analyses should be used within agile development to inform professionals about users’ behavior. In this way, further UCD research can be informed by these results, making the methods less labor intensive. Moreover, we argue that these translations to an approach for further UCD research will be carried out by UCD specialists, as they are able to infer which goals the user had when going through these paths when looking at the log data. %M 31961325 %R 10.2196/14424 %U https://humanfactors.jmir.org/2020/1/e14424 %U https://doi.org/10.2196/14424 %U http://www.ncbi.nlm.nih.gov/pubmed/31961325 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 1 %P e14588 %T Using Mobile Devices to Deliver Lifestyle Interventions Targeting At-Risk High School Students: Protocol for a Participatory Design Study %A Müssener,Ulrika %A Löf,Marie %A Bendtsen,Preben %A Bendtsen,Marcus %+ Department of Medical and Health Sciences, Linköping University, Sandbäcksgatan, Linköping, 58183, Sweden, 46 073 2702426, ulrika.mussener@liu.se %K mHealth intervention %K lifestyle behavior %K high school students %K qualitative methods %K participatory design %D 2020 %7 6.1.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Unhealthy lifestyle behaviors such as insufficient physical activity, unhealthy diet, smoking, and harmful use of alcohol tend to cluster (ie, individuals may be at risk from more than one lifestyle behavior that can be established in early childhood and adolescence and track into adulthood). Previous research has underlined the potential of lifestyle interventions delivered via mobile phones. However, there is a need for deepened knowledge on how to design mobile health (mHealth) interventions taking end user views into consideration in order to optimize the overall usability of such interventions. Adolescents are early adopters of technology and frequent users of mobile phones, yet research on interventions that use mobile devices to deliver multiple lifestyle behavior changes targeting at-risk high school students is lacking. Objective: This protocol describes a participatory design study with the aim of developing an mHealth lifestyle behavior intervention to promote healthy lifestyles among high school students. Methods: Through an iterative process using participatory design, user requirements are investigated in terms of technical features and content. The procedures around the design and development of the intervention, including heuristic evaluations, focus group interviews, and usability tests, are described. Results: Recruitment started in May 2019. Data collection, analysis, and scientific reporting from heuristic evaluations and usability tests are expected to be completed in November 2019. Focus group interviews were being undertaken with high school students from October through December, and full results are expected to be published in Spring 2020. A planned clinical trial will commence in Summer 2020. The study was funded by a grant from the Swedish Research Council for Health, Working Life, and Welfare. Conclusions: The study is expected to add knowledge on how to design an mHealth intervention taking end users’ views into consideration in order to develop a novel, evidence-based, low-cost, and scalable intervention that high school students want to use in order to achieve a healthier lifestyle. International Registered Report Identifier (IRRID): DERR1-10.2196/14588 %M 31904576 %R 10.2196/14588 %U https://www.researchprotocols.org/2020/1/e14588 %U https://doi.org/10.2196/14588 %U http://www.ncbi.nlm.nih.gov/pubmed/31904576 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 1 %P e12797 %T Health Care Personnel’s Perspective on Potential Electronic Health Interventions to Prevent Hospitalizations for Older Persons Receiving Community Care: Qualitative Study %A Gjestsen,Martha Therese %A Wiig,Siri %A Testad,Ingelin %+ Centre for Age-related Medicine, Stavanger University Hospital, Jan Johnsensgate 12, Stavanger, 4011, Norway, 47 92805525, gjemja@sus.no %K health services research %K community health services %K hospitalization %K health services for the aged %K qualitative research %K focus groups %K eHealth %K technology %D 2020 %7 2.1.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of electronic health (eHealth) interventions is suggested to help monitor and treat degenerative and chronic diseases through the use of sensors, alarms, and reminders and can potentially prevent hospitalizations for home-dwelling older persons receiving community care. It is increasingly recognized that the health care personnel’s acceptance of a technological application remains a key challenge in adopting an intervention, thus interventions must be perceived to be useful and fit for purpose by the actual users. Objective: The aim of this study was to identify and explore the perspectives of managers and health care personnel in community care regarding the use of eHealth interventions in terms of prevention of hospitalizations for home-dwelling older persons receiving community care. Methods: A case study with a qualitative approach was carried out in community care in a Norwegian municipality, comprising individual interviews and focus group interviews. A total of 5 individual interviews and 2 focus group interviews (n=12) were undertaken to provide the health care personnel’s and managers’ perspective regarding the use of eHealth interventions, which could potentially prevent hospitalizations for home-dwelling older persons receiving community care. Data were analyzed by way of systematic text condensation, as described by Malterud. Results: The data analysis of focus group interviews and individual interviews resulted in 2 categories: potential technological applications and potential patient groups. Discussions in the focus groups generated several suggestions and wishes related to technical applications that they could make use of in their day-to-day practice. The health care personnel warranted tools and measures to enhance and document their clinical observations in contact with patients. They also identified patient groups, such as patients with chronic obstructive pulmonary disease or dehydration or urinary tract infections, for whom hospitalizations could potentially have been prevented. Conclusions: We have shown that the health care personnel in community care warrant various technological applications that have the potential to improve quality of care and resource utilization in the studied municipality. We have identified needs and important matters in practice, which are paramount for acceptance and adoption of an intervention in community care. %M 31895045 %R 10.2196/12797 %U https://www.jmir.org/2020/1/e12797 %U https://doi.org/10.2196/12797 %U http://www.ncbi.nlm.nih.gov/pubmed/31895045 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 12 %P e15924 %T Exploring the Views of Osteogenesis Imperfecta Caregivers on Internet-Based Technologies: Qualitative Descriptive Study %A Castro,Aimee R %A Chougui,Khadidja %A Bilodeau,Claudette %A Tsimicalis,Argerie %+ Shriners Hospitals for Children-Canada, 1003 Decarie Blvd, Montreal, QC, H4A 0A9, Canada, 1 (514) 3988142, argerie.tsimicalis@mcgill.ca %K smartphone %K caregivers %K pediatrics %K rare diseases %K telemedicine %K quality improvement %K social media %K chronic disease %K osteogenesis imperfecta %D 2019 %7 18.12.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Osteogenesis imperfecta (OI) is a rare genetic condition that can lead to frequent debilitating bone fractures. Family caregivers of children with OI face unique challenges in providing care, which may include limited access to information about the condition, feelings of distress, and experiences of social isolation. Internet-based technologies (IBTs) have been useful for supporting other types of caregivers. However, the views of OI caregivers on IBTs have not been explored. Objective: This study aimed to explore the views of OI caregivers on the uses of IBTs to support them in caring for their children with OI. Methods: A qualitative descriptive study was conducted. Caregivers of children with OI were recruited at a pediatric hospital in Montreal, Canada. Interviews were used to explore each caregiver’s views on the applicability of IBTs in supporting their caregiving needs. The interviews were transcribed verbatim and thematically analyzed. Results: A total of 18 caregivers participated. The caregivers shared that IBTs were useful for facilitating the following activities: daily activities of caregiving (such as providing physical care, supporting relationships, supporting self-care and hope, and managing the logistics of caregiving), OI medical information seeking, and OI social networking. However, they also revealed concerns about the health consequences of IBT use and the quality of IBT content. Concerns regarding IBTs varied somewhat with caregivers’ geographies. Caregivers offered suggestions and strategies for how IBTs can be optimized for caregiving. Conclusions: Family caregivers of children with OI face unique challenges in providing care, which may include lacking access to information about the rare condition and feeling socially isolated. OI caregivers use IBTs to overcome some of these challenges and to support their specific caregiving needs. These findings contribute to the paucity of knowledge by offering varied IBT strategies to support caregiving activities, which may be beneficial for other caregivers. Participants’ suggestions for IBT services can inform the development of new resources for OI caregivers and potentially for other caregivers of children living with rare conditions. %M 31850851 %R 10.2196/15924 %U http://www.jmir.org/2019/12/e15924/ %U https://doi.org/10.2196/15924 %U http://www.ncbi.nlm.nih.gov/pubmed/31850851 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 4 %P e13854 %T Beliefs Related to Participation in a Large Web-Based Prospective Survey on Diet and Health Among Individuals With a Low Socioeconomic Status: Qualitative Study %A Côté,Mélina %A Lapointe,Annie %A Laramée,Catherine %A Lemieux,Simone %A Desroches,Sophie %A Belanger-Gravel,Ariane %A Lamarche,Benoît %+ Centre Nutrition, Santé, et Société, Institute of Nutrition and Functional Foods, Université Laval, 2440 Hochelaga Boulevard, Québec, QC, G1V 0A6, Canada, 1 418 656 2131 ext 404355, benoit.lamarche@fsaa.ulaval.ca %K focus groups %K qualitative research %K social class %K research subject %K retention %D 2019 %7 10.12.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: NutriQuébec is a Web-based prospective study on the relationship between diet and health as well as the impact of food-related health policies in the adult population of Québec, Canada. Recruitment and retention of individuals with a low socioeconomic status (SES) in such a study are known to be challenging, yet critical for achieving representativeness of the entire population. Objective: This study aimed to identify the behavioral, normative, and control beliefs of individuals with a low SES regarding participation in the NutriQuébec project and to identify their preferences regarding recruitment methods. Methods: A total of four focus groups were conducted in community centers located in low-income areas of Québec City, Canada. On the basis of the theory of planned behavior, participants’ beliefs associated with attitude, subjective norm, and perceived behavioral control regarding hypothetical participation in the NutriQuébec project were identified. Focus groups were recorded, transcribed, and coded by two analysts. Results: Participants (16 men and 12 women) were aged between 28 and 72 years, and a majority of the participants had an annual household income of Can $19,999 or less. The main perceived advantages of participating in the NutriQuébec project were contributing to improved collective health and supporting research. The only disadvantage identified was the risk of having to fill out too many questionnaires. Participants could not, in general, identify persons from their entourage who would approve or disapprove their participation in the study. The main facilitators identified were obtaining a brief health assessment and the ability to complete questionnaires in a way that is not Web-based. The main barrier was the lack of internet access. The preferred means of recruitment were through social media, television, and community centers. Conclusions: These results provide insightful information regarding the best methods and messages to use in order to recruit and retain individuals with a low SES in a population-based prospective study on lifestyle and health on the internet. %M 31821149 %R 10.2196/13854 %U http://formative.jmir.org/2019/4/e13854/ %U https://doi.org/10.2196/13854 %U http://www.ncbi.nlm.nih.gov/pubmed/31821149 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e15441 %T Assessing the Appeal of Instagram Electronic Cigarette Refill Liquid Promotions and Warnings Among Young Adults: Mixed Methods Focus Group Study %A Laestadius,Linnea I %A Penndorf,Kendall E %A Seidl,Melissa %A Cho,Young I %+ Zilber School of Public Health, University of Wisconsin-Milwaukee, PO Box 413, Milwaukee, WI, 53201-0413, United States, 1 414 227 4512, llaestad@uwm.edu %K social media %K vaping %K tobacco %K marketing %D 2019 %7 25.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: While marketing for electronic cigarette refill liquids (e-liquids) is widespread on Instagram, little is known about the post elements that create appeal among young adult Instagram users. Further information is needed to help shape regulatory strategies appropriate for social media. Objective: This study examined young adult Instagram user perceptions of actual e-liquid marketing posts and US Food and Drug Administration (FDA)–mandated nicotine addiction warning statements on Instagram. Methods: A series of 12 focus groups (n=69) were held with non–tobacco users, vapers, smokers, and dual users in Wisconsin between September and December 2018. Participants discussed the elements of posts that they found appealing or unappealing, in addition to completing a survey about each post and e-liquid. Focus group transcripts were analyzed by smoking status using a framework analysis approach. Results: Although willingness to try e-liquids was highest among nicotine users, focus group discussions indicated that Instagram posts promoting e-liquids held appeal for individuals across smoking statuses. The primary elements that created appeal were the perceived trustworthiness of the Instagram account, attractive design and flavor visuals, and promotion of flavors and nicotine levels that met personal preferences. Post appeal was reduced by references to vaping subcultures, indicators that the post creator did not take nicotine addiction seriously, and FDA-mandated nicotine warning statements. Non–tobacco users were particularly drawn to posts featuring nicotine-free e-liquids with attractive visual designs and flavors known from foods. Conclusions: Young adults consider a broad range of elements in assessing the appeal of e-liquid marketing on Instagram, with minor but notable distinctions by smoking status. Non–tobacco users are uniquely drawn to nicotine-free e-liquids and are more deterred by the FDA’s mandated nicotine addiction warning statements than those from other smoking statuses. This suggests that it may be possible to tailor policy interventions in a manner that helps to reduce novel uptake of vaping without significantly diminishing its potential harm-reduction benefits. %M 31763987 %R 10.2196/15441 %U http://www.jmir.org/2019/11/e15441/ %U https://doi.org/10.2196/15441 %U http://www.ncbi.nlm.nih.gov/pubmed/31763987 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 11 %P e15664 %T Development of MyTeen Text Messaging Program to Support Parents of Adolescents: Qualitative Study %A Chu,Joanna Ting Wai %A Wadham,Angela %A Jiang,Yannan %A Whittaker,Robyn %A Stasiak,Karolina %A Shepherd,Matthew %A Bullen,Christopher %+ National Institute for Health Innovation, University of Auckland, 261 Morrin Road, Glen Innes, Auckland, 1072, New Zealand, 64 3737599, jt.chu@auckland.ac.nz %K programs %K mHealth %K adolescents %K parents %K text messaging %D 2019 %7 20.11.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Parents play an important role in the lives of adolescents, and supporting and addressing the needs of families continue to be the focus of many researchers and policy makers. Mobile health interventions have great potential for supporting parents at a population level because of their broad reach and convenience. However, limited evidence exists for such interventions for parents of adolescents. This study reports on the formative work conducted with parents and/or primary caregivers to identify their needs and preferences for the development of MyTeen—an SMS text messaging program on promoting parental competence and mental health literacy for parents of adolescents (aged 10-15 years). Objective: The aim of this qualitative study was to explore parents and/or primary caregivers’ perspectives around youth well-being, parenting, and parenting support and their input on the development of MyTeen SMS text messaging parenting intervention. Methods: A total of 5 focus groups (n=45) were conducted with parents or primary caregivers of adolescents aged 10 to 15 years between October and December 2017 in New Zealand. A semistructured interview guideline and prompts were used. Data were audiotaped, transcribed, and analyzed using inductive thematic analysis. Results: Participants were concerned about youth mental health (ie, stigma and increasing demand on adolescents), and a number of parenting challenges (ie, social expectations, time, impact of technology, changes in family communication pattern, and recognizing and talking about mental health issues) were noted. Importantly, participants reported the lack of services and support available for families, and many were not aware of services for parents themselves. A number of recommendations were given on the style, content, and frequency of developing the text messaging program. Conclusions: Findings from this qualitative work informed the development of MyTeen, an SMS text messaging program designed to increase parental competence and improve mental health literacy for parents of adolescents. %M 31746767 %R 10.2196/15664 %U http://mhealth.jmir.org/2019/11/e15664/ %U https://doi.org/10.2196/15664 %U http://www.ncbi.nlm.nih.gov/pubmed/31746767 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 11 %P e15681 %T Exploring People’s Candidacy for Mobile Health–Supported HIV Testing and Care Services in Rural KwaZulu-Natal, South Africa: Qualitative Study %A Adeagbo,Oluwafemi %A Herbst,Carina %A Blandford,Ann %A McKendry,Rachel %A Estcourt,Claudia %A Seeley,Janet %A Shahmanesh,Maryam %+ Africa Health Research Institute, KwaZulu-Natal, R168 Hlabisa Road Somkhele, PO Box 198, Mtubatuba, 3935, South Africa, 27 355507695, Oluwafemi.Adeagbo@ahri.org %K mHealth %K antiretroviral therapy %K HIV testing %K South Africa %K candidacy framework %D 2019 %7 18.11.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of mobile communication technologies (mHealth: mobile health) in chronic disease management has grown significantly over the years. mHealth interventions have the potential to decentralize access to health care and make it convenient, particularly in resource-constrained settings. It is against this backdrop that we aimed to codevelop (with potential users) a new generation of mobile phone–connected HIV diagnostic tests and Web-based clinical care pathways needed for optimal delivery of decentralized HIV testing, prevention, and care in low- and middle-income countries. Objective: The aim of this study was to understand ways in which an mHealth intervention could be developed to overcome barriers to existing HIV testing and care services and promote HIV self-testing and linkage to prevention and care in a poor, HIV hyperendemic community in rural KwaZulu-Natal, South Africa. Methods: A total of 54 in-depth interviews and 9 focus group discussions were conducted with potential users (including health care providers) in 2 different communities. Theoretically informed by the candidacy framework, themes were identified from the interview transcripts, manually coded, and thematically analyzed. Results: Participants reported barriers, such as fear of HIV identity, stigma, long waiting hours, clinic space, and health care workers’ attitudes, as major impediments to effective uptake of HIV testing and care services. People continued to reassess their candidacy for HIV testing and care services on the basis of their experiences and how they or others were treated within the health systems. Despite the few concerns raised about new technology, mobile phone–linked HIV testing was broadly acceptable to potential users (particularly men and young people) and providers because of its privacy (individual control of HIV testing over health provider–initiated testing), convenience (individual time and place of choice for HIV testing versus clinic-based testing), and time saving. Conclusions: Mobile phone–connected HIV testing and Web-based clinical care and prevention pathways have the potential to support access to HIV prevention and care, particularly for young people and men. Although mHealth provides a way for individuals to test their candidacy for HIV services, the barriers that can make the service unattractive at the clinic level will also need to be addressed if potential demand is to turn into actual demand. %M 31738174 %R 10.2196/15681 %U https://www.jmir.org/2019/11/e15681 %U https://doi.org/10.2196/15681 %U http://www.ncbi.nlm.nih.gov/pubmed/31738174 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e15019 %T Content and Feature Preferences for a Physical Activity App for Adults With Physical Disabilities: Focus Group Study %A Olsen,Sara H %A Saperstein,Sandra L %A Gold,Robert S %+ Department of Behavioral and Community Health, School of Public Health, University of Maryland, 4200 Valley Dr #1234, College Park, MD, 20742, United States, 1 301 405 2463, sara.olsen@gmail.com %K adapted sport %K disability %K physical activity %K focus group %K apps %K fitness %K user-centered design %K mHealth %D 2019 %7 11.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Hundreds of thousands of mobile phone apps intended to improve health and fitness are available for download across platforms and operating systems; however, few have been designed with people with physical disabilities in mind, ignoring a large population that may benefit from an effective tool to increase physical activity. Objective: This study represents the first phase in the development process of a fitness tracking app for people with physical disabilities interested in nontraditional sport. The aim of this research was to explore user preferences for content, appearance, and operational features of a proposed physical activity app for people with physical disabilities to inform the design of a mobile phone app for increasing physical activity. Methods: Four focus groups were conducted with 15 adults with physical disabilities who currently participate in nontraditional, non-Paralympic sport. Data collected from the focus group sessions centered on content, functionality, and appearance of apps currently used by participants as well as preferences for a future app. Results: Participants (mean age 35.7, SD 9.2 years) were mostly white (13/15, 87%), and all were currently participating in CrossFit and at least one other sport. Five main themes were identified. Themes included preferences for (1) workout-specific features that were tailored or searchable by disability, (2) user experience that was intuitive and accessible, (3) profile personalization options, (4) gamification features that allowed for competition with self and other users, and (5) social features that allowed increased interaction among users. Participants expressed a primary interest in having a fitness app that was designed for people with physical disabilities such that the features present in other fitness tracking apps were relevant to them and their community of adaptive athletes. Conclusions: The results showed that features related to user experience, social engagement, and gamification are considered important to people with physical disabilities. Features highlighted by participants as most desired, from a consumer perspective, were in line with research identifying attributes of quality apps that use behavior change techniques to influence positive physical activity behavior change. Such insights should inform the development of any fitness app designed to integrate users with disabilities as a primary user base. %M 31605518 %R 10.2196/15019 %U %U https://doi.org/10.2196/15019 %U http://www.ncbi.nlm.nih.gov/pubmed/31605518 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 4 %P e13295 %T Identification of Factors That Motivate People With Multiple Sclerosis to Participate in Digital Data Collection in Research: Sequential Mixed Methods Study %A Karnoe,Astrid %A Kayser,Lars %A Skovgaard,Lasse %+ Danish Multiple Sclerosis Patient Society, Poul Bungaardsvej 1, Valby, 2500, Denmark, 45 30436701, askn@sund.ku.dk %K health literacy %K computer literacy %K mobile apps %K patient participation %K research design %K multiple sclerosis %D 2019 %7 9.10.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital data collection has the potential to reduce participant burden in research projects that require extensive registrations from participants. To achieve this, a digital data collection tool needs to address potential barriers and motivations for participation. Objective: This study aimed to identify factors that may affect motivation for participation and adoption of a digital data collection tool in a research project on nutrition and multiple sclerosis (MS). Methods: The study was designed as a sequential mixed methods study with 3 phases. In phase 1, 15 semistructured interviews were conducted in a Danish population of individuals with MS. Interview guide frameworks were based on dimensions from the electronic health literacy framework and the Health Education Impact Questionnaire. Data from phase 1 were analyzed in a content analysis, and findings were used to inform the survey design in phase 2 that validates the results from the content analysis in a larger population. The survey consisted of 14 items, and it was sent to 1000 individuals with MS (response rate 42.5%). In phase 3, participants in 3 focus group interviews discussed how findings from phases 1 and 2 might affect motivation for participation and adoption of the digital tool. Results: The following 3 categories related to barriers and incentives for participation were identified in the content analysis of the 15 individual interviews: (1) life with MS, (2) use of technology, and (3) participation and incentives. Phase 1 findings were tested in phase 2’s survey in a larger population (n=1000). The majority of participants were comfortable using smartphone technologies and participated actively on social media platforms. MS symptoms did cause limitations in the use of Web pages and apps when the given pages had screen clutter, too many colors, or too small buttons. Life with MS meant that most participants had to ration their energy levels. Support from family and friends was important to participants, but support could also come in the form of physical aids (walking aids and similar) and digital aids (reminders, calendar functions, and medication management). Factors that could discourage participation were particularly related to the time it would take every day. The biggest motivations for participation were to contribute to research in MS, to learn more about one’s own MS and what affects it, and to be able to exchange experiences with other people with MS. Conclusions: MS causes limitations that put demands on tools developed for digital data collection. A digital data collection tool can increase chances of high adoption rates, but it needs to be supplemented with a clear and simple project design and continuous communication with participants. Motivational factors should be considered in both study design and the development of a digital data collection tool for research. %M 31599738 %R 10.2196/13295 %U https://humanfactors.jmir.org/2019/4/e13295 %U https://doi.org/10.2196/13295 %U http://www.ncbi.nlm.nih.gov/pubmed/31599738 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 10 %P e11665 %T Analysis of the Recomposition of Norms and Representations in the Field of Psychiatry and Mental Health in the Age of Electronic Mental Health: Qualitative Study %A Morgiève,Margot %A Sebbane,Déborah %A De Rosario,Bianca %A Demassiet,Vincent %A Kabbaj,Soraya %A Briffault,Xavier %A Roelandt,Jean-Luc %+ World Health Organization Collaborating Centre for Research and Training in Mental Health, Établissement Public de Santé Mentale Lille Metropole, 211 rue Roger Salengro, 59260, Lille-Hellemmes, France, 33 620578776, deborah.sebbane6@gmail.com %K ehealth %K mental health %K psychiatry %K social representations %K focus group %K users %K caregivers %K qualitative analysis %K digital tools. %D 2019 %7 9.10.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: For the World Health Organization, electronic health (eHealth) is seen as an effective way to improve therapeutic practices and disease prevention in health. Digital tools lead to major changes in the field of mental medicine, but specific analyses are required to understand and accompany these changes. Objective: Our objective was to highlight the positions of the different stakeholders of the mental health care system on eHealth services and tools, as well as to establish professional and user group profiles of these positions and the uses of these services. Methods: In order to acquire the opinions and expectations of different categories of people, we carried out a qualitative study based on 10 focus groups (n=70, from 3-12 people per group) composed of: general practitioners, psychiatrists, psychologists, social workers, occupational therapists, nurses, caregivers, mental health services users, user representatives, and the general public. The analyses of focus group discussions were performed independently by four investigators through a common analysis grid. The constant comparative method was adopted within this framework. Results: The interviewees expressed different problems that new technologies engender in the field of mental health. What was previously strictly under the jurisdiction of physicians now tends to be fragmented and distributed over different groups and locations. New technologies reposition care in the field of domestic, rather than therapeutic, activities, and thus the conception of care as an autonomous activity in the subject’s life is questioned. The ideal of social autonomy through technology is part of the new logic of health democracy and empowerment, which is linked to a strong, contemporary aspiration to perform. Participants emphasized that there was the potential risk of a decrease in autonomy for the digitally engaged patient, while personal empowerment could become a set of obligations. Conclusions: This qualitative research highlights the heterogeneity of opinions among the groups and within each group. It suggests that opinions on electronic mental health devices are still far from being stabilized, and that a change management process should be set up to both regulate the development and facilitate the use of these tools. %M 31356151 %R 10.2196/11665 %U https://mental.jmir.org/2019/10/e11665 %U https://doi.org/10.2196/11665 %U http://www.ncbi.nlm.nih.gov/pubmed/31356151 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e13022 %T From Information Seekers to Innovators: Qualitative Analysis Describing Experiences of the Second Generation of E-Patients %A Scott Duncan,Therese %A Riggare,Sara %A Koch,Sabine %A Sharp,Lena %A Hägglund,Maria %+ Health Informatics Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Tomtebodavägen 18 A, Stockholm, 17177, Sweden, 46 73 512 40 63, therese.scott.duncan@ki.se %K consumer health informatics %K eHealth %K qualitative research %K self-care %K motivation %D 2019 %7 15.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Current health care systems are rarely designed to meet the needs of people living with chronic conditions. However, some patients and informal caregivers are not waiting for the health care system to redesign itself. These individuals are sometimes referred to as e-patients. The first generation of e-patients used the internet for finding information and for communicating with peers. Compared with the first generation, the second generation of e-patients collects their own health data and appears to be more innovative. Objective: The aim of this study was to describe the second generation of e-patients through exploration of their active engagement in their self-care and health care. Methods: Semistructured interviews were conducted with 10 patients with chronic conditions and 5 informal caregivers. They were all recruited through a Web-based advertisement. Data were analyzed according to the framework analysis approach, using the 3 concepts of the self-determination theory—autonomy, relatedness, and competence—at the outset. Results: Study participants were actively engaged in influencing their self-care and the health care system to improve their own health, as well as the health of others. This occurred at different levels, such as using their own experience when giving presentations and lectures to health care professionals and medical students, working as professional peers in clinical settings, performing self-tracking, contributing with innovations, and being active on social media. When interaction with health care providers was perceived as being insufficient, the participants sought support through their peers, which showed strong relatedness. Competence increased through the use of technology and learning experiences with peers. Their autonomy was important but was sometimes described as involuntary and to give up was not an option for them. Conclusions: Like the first generation of e-patients, the participants frequently searched for Web-based information. However, the second generation of e-patients also produce their own health data, which they learn from and share. They also engage in the innovation of digital tools to meet health-related needs. Utilizing technological developments comes naturally to the second generation of e-patients, even if the health care system is not prepared to support them under these new circumstances. %M 31418421 %R 10.2196/13022 %U http://www.jmir.org/2019/8/e13022/ %U https://doi.org/10.2196/13022 %U http://www.ncbi.nlm.nih.gov/pubmed/31418421 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12824 %T A Health Education Website Developed to Meet Young People’s Information Needs About Web-Based Pornography and Sharing of Sexually Explicit Imagery (SCOPE): Usability Study %A Davis,Angela C %A Wright,Cassandra J C %A Temple-Smith,Meredith J %A Hellard,Margaret E %A Lim,Megan S C %+ Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia, 61 385062403, megan.lim@burnet.edu.au %K adolescent %K pornography %K health promotion %K internet %K sex education %D 2019 %7 13.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Although we know that many young people watch online pornography and engage in sexting, there is limited literature examining their needs in relation to information on these highly sensitive and complex issues. Online resources exist; however, we can find no evidence of any of them having been formally tested for usability within the target population. Objective: This study aimed to test the usability of a resource about online pornography and sexting among young people. Methods: Semistructured interviews were conducted with 17 participants aged 15 to 29 years. Results: We found that the SCOPE resource was perceived as trustworthy and credible because of its evidence-based content, nonjudgmental tone, and balanced perspectives. Multimedia and video content enhanced the layout and usability of the resource; however, content relevance could be improved by targeting age and developmental stages. Participants identified resource sections such as Real Stories from young people as relevant and engaging. However, they raised issues with the translation of formative research findings relating to these stories into their final presentation. Conclusions: Our findings suggest that young people prefer online resources about complex issues, such as online pornography and sexting, if they are balanced in content and tone. Most importantly, in the context of responding to complex and sensitive issues such as these, co-design methods can ensure that young people are central to the development of resources and avoid gaps in translating research into practice. In the context of limited literature focusing on the usability of online resources about these topics, this paper provides important insights for public health practitioners working in this emerging space. %M 31411140 %R 10.2196/12824 %U http://formative.jmir.org/2019/3/e12824/ %U https://doi.org/10.2196/12824 %U http://www.ncbi.nlm.nih.gov/pubmed/31411140 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e13228 %T How Prefrail Older People Living Alone Perceive Information and Communications Technology and What They Would Ask a Robot for: Qualitative Study %A Daniele,Katia %A Marcucci,Maura %A Cattaneo,Cesarina %A Borghese,Nunzio Alberto %A Zannini,Lucia %+ Department of Biomedical Sciences for Health, University of Milan, Via Carlo Pascal, 36, Milan, 20133, Italy, 39 02503 15101, lucia.zannini@unimi.it %K frail elders %K independent living %K attitude %K technology %K information technology %K robotics %K qualitative research %K interview %D 2019 %7 06.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: In the last decade, the family system has changed significantly. Although in the past, older people used to live with their children, nowadays, they cannot always depend on assistance of their relatives. Many older people wish to remain as independent as possible while remaining in their homes, even when living alone. To do so, there are many tasks that they must perform to maintain their independence in everyday life, and above all, their well-being. Information and communications technology (ICT), particularly robotics and domotics, could play a pivotal role in aging, especially in contemporary society, where relatives are not always able to accurately and constantly assist the older person. Objective: The aim of this study was to understand the needs, preferences, and views on ICT of some prefrail older people who live alone. In particular, we wanted to explore their attitude toward a hypothetical caregiver robot and the functions they would ask for. Methods: We designed a qualitative study based on an interpretative phenomenological approach. A total of 50 potential participants were purposively recruited in a big town in Northern Italy and were administered the Fried scale (to assess the participants’ frailty) and the Mini-Mental State Examination (to evaluate the older person’s capacity to comprehend the interview questions). In total, 25 prefrail older people who lived alone participated in an individual semistructured interview, lasting approximately 45 min each. Overall, 3 researchers independently analyzed the interviews transcripts, identifying meaning units, which were later grouped in clustering of themes, and finally in emergent themes. Constant triangulation among researchers and their reflective attitude assured trustiness. Results: From this study, it emerged that a number of interviewees who were currently using ICT (ie, smartphones) did not own a computer in the past, or did not receive higher education, or were not all young older people (aged 65-74 years). Furthermore, we found that among the older people who described their relationship with ICT as negative, many used it in everyday life. Referring to robotics, the interviewees appeared quite open-minded. In particular, robots were considered suitable for housekeeping, for monitoring older people’s health and accidental falls, and for entertainment. Conclusions: Older people’s use and attitudes toward ICT does not always seem to be related to previous experiences with technological devices, higher education, or lower age. Furthermore, many participants in this study were able to use ICT, even if they did not always acknowledge it. Moreover, many interviewees appeared to be open-minded toward technological devices, even toward robots. Therefore, proposing new advanced technology to a group of prefrail people, who are self-sufficient and can live alone at home, seems to be feasible. %M 31389341 %R 10.2196/13228 %U https://www.jmir.org/2019/8/e13228/ %U https://doi.org/10.2196/13228 %U http://www.ncbi.nlm.nih.gov/pubmed/31389341 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 8 %P e12483 %T Patient Commitment to Health (PACT-Health) in the Heart Failure Population: A Focus Group Study of an Active Communication Framework for Patient-Centered Health Behavior Change %A Meeker,Daniella %A Goldberg,Jordan %A Kim,Katherine K %A Peneva,Desi %A Campos,Hugo De Oliveira %A Maclean,Ross %A Selby,Van %A Doctor,Jason N %+ Schaeffer Center for Health Policy and Economics, University of Southern California, 635 Downey Way, Los Angeles, CA, 90089, United States, 1 213 821 8142, jdoctor@usc.edu %K heart failure %K behavioral economics %K motivational interviewing %D 2019 %7 06.08.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Over 6 million Americans have heart failure, and 1 in 8 deaths included heart failure as a contributing cause in 2016. Lifestyle changes and adherence to diet and exercise regimens are important in limiting disease progression. Health coaching and public commitment are two interactive communication strategies that may improve self-management of heart failure. Objective: This study aimed to conduct patient focus groups to gain insight into how best to implement health coaching and public commitment strategies within the heart failure population. Methods: Focus groups were conducted in two locations. We studied 2 patients in Oakland, California, and 5 patients in Los Angeles, California. Patients were referred by local cardiologists and had to have a diagnosis of chronic heart failure. We used a semistructured interview tool to explore several patient-centered themes including medication adherence, exercise habits, dietary habits, goals, accountability, and rewards. We coded focus group data using the a priori coding criteria for these domains. Results: Medication adherence barriers included regimen complexity, forgetfulness, and difficulty coping with side effects. Participants reported that they receive little instruction from care providers on appropriate exercise and dietary habits. They also reported personal and social obstacles to achieving these objectives. Participants were in favor of structured goal setting, use of online social networks, and financial rewards as a means of promoting health lifestyles. Peers were viewed as better motivating agents than family members. Conclusions: An active communication framework involving dissemination of diet- and exercise-related health information, structured goal setting, peer accountability, and financial rewards appears promising in the management of heart failure. %M 31389339 %R 10.2196/12483 %U http://www.jmir.org/2019/8/e12483/ %U https://doi.org/10.2196/12483 %U http://www.ncbi.nlm.nih.gov/pubmed/31389339 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e13143 %T Implementation of a Digitally Enabled Care Pathway (Part 2): Qualitative Analysis of Experiences of Health Care Professionals %A Connell,Alistair %A Black,Georgia %A Montgomery,Hugh %A Martin,Peter %A Nightingale,Claire %A King,Dominic %A Karthikesalingam,Alan %A Hughes,Cían %A Back,Trevor %A Ayoub,Kareem %A Suleyman,Mustafa %A Jones,Gareth %A Cross,Jennifer %A Stanley,Sarah %A Emerson,Mary %A Merrick,Charles %A Rees,Geraint %A Laing,Christopher %A Raine,Rosalind %+ Department of Applied Health Research, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 (0) 20 7679 1713, r.raine@ucl.ac.uk %K nephrology %K acute kidney injury %D 2019 %7 15.7.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: One reason for the introduction of digital technologies into health care has been to try to improve safety and patient outcomes by providing real-time access to patient data and enhancing communication among health care professionals. However, the adoption of such technologies into clinical pathways has been less examined, and the impacts on users and the broader health system are poorly understood. We sought to address this by studying the impacts of introducing a digitally enabled care pathway for patients with acute kidney injury (AKI) at a tertiary referral hospital in the United Kingdom. A dedicated clinical response team—comprising existing nephrology and patient-at-risk and resuscitation teams—received AKI alerts in real time via Streams, a mobile app. Here, we present a qualitative evaluation of the experiences of users and other health care professionals whose work was affected by the implementation of the care pathway. Objective: The aim of this study was to qualitatively evaluate the impact of mobile results viewing and automated alerting as part of a digitally enabled care pathway on the working practices of users and their interprofessional relationships. Methods: A total of 19 semistructured interviews were conducted with members of the AKI response team and clinicians with whom they interacted across the hospital. Interviews were analyzed using inductive and deductive thematic analysis. Results: The digitally enabled care pathway improved access to patient information and expedited early specialist care. Opportunities were identified for more constructive planning of end-of-life care due to the earlier detection and alerting of deterioration. However, the shift toward early detection also highlighted resource constraints and some clinical uncertainty about the value of intervening at this stage. The real-time availability of information altered communication flows within and between clinical teams and across professional groups. Conclusions: Digital technologies allow early detection of adverse events and of patients at risk of deterioration, with the potential to improve outcomes. They may also increase the efficiency of health care professionals’ working practices. However, when planning and implementing digital information innovations in health care, the following factors should also be considered: the provision of clinical training to effectively manage early detection, resources to cope with additional workload, support to manage perceived information overload, and the optimization of algorithms to minimize unnecessary alerts. %M 31368443 %R 10.2196/13143 %U http://www.jmir.org/2019/7/e13143/ %U https://doi.org/10.2196/13143 %U http://www.ncbi.nlm.nih.gov/pubmed/31368443 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e14187 %T The Preferences of Patients With Cancer Regarding Apps to Help Meet Their Illness-Related Information Needs: Qualitative Interview Study %A Richards,Rebecca %A Kinnersley,Paul %A Brain,Kate %A Staffurth,John %A Wood,Fiona %+ Division of Population Medicine, Cardiff University, 503 Neuadd Meirionnydd, University Hospital of Wales, Heath Park, Cardiff, CF14 4YS, United Kingdom, 44 29206 87185, wood@cf.ac.uk %K education, medical %K medical information exchange %K smartphone %K mobile apps %D 2019 %7 31.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The shift from inpatient to outpatient and community cancer care means that more patients with cancer need to manage their condition at home, without the direct supervision of their clinician. Subsequently, research has reported that many patients with cancer have unmet information needs during their illness. Mobile devices, such as mobile phones and tablet computers, provide an opportunity to deliver information to patients remotely. Before designing an app intervention to help patients with cancer to meet their information needs, in-depth qualitative research is required to gain an understanding of the views of the target users. Objective: We aimed to develop an app intervention to help patients meet their illness-related information needs in noninpatient settings. This study explored the information needs of patients with cancer and their preferences for an app and desired app features. Specifically, the perceived acceptability of an app, desired app features, and the potential benefits and disadvantages of, and barriers to, an app were explored. Methods: Qualitative, one-on-one semistructured interviews were conducted with patients with urological, colorectal, breast, or gynecological cancers (N=23) across two hospitals in South Wales. Interviews were audio-taped, transcribed, and analyzed using a thematic analysis. Results: Findings indicated that barriers to information exchange and understanding in consultations, and identification of reliable information sources between consultations, appeared to contribute to patients’ unmet information needs. Consequently, app feature suggestions included a question prompt list, a glossary of cancer terms, a resources feature, and a contacts feature. Anticipated benefits of this type of app included a more informed patient, improved quality of life, decreased anxiety, and increased confidence to participate in their care. The anticipated barriers to app use are likely to be temporary or can be minimized with regard to these findings during app development and implementation. Conclusions: This study highlights the desire of patients with cancer for an app intervention to help them meet their information needs during and between consultations with their clinicians. This study also highlights the anticipated acceptability and benefits of this type of intervention; however, further research is warranted. %M 31368446 %R 10.2196/14187 %U http://mhealth.jmir.org/2019/7/e14187/ %U https://doi.org/10.2196/14187 %U http://www.ncbi.nlm.nih.gov/pubmed/31368446 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e13906 %T Barriers and Facilitators to the Implementation of a Mobile Insulin Titration Intervention for Patients With Uncontrolled Diabetes: A Qualitative Analysis %A Rogers,Erin %A Aidasani,Sneha R %A Friedes,Rebecca %A Hu,Lu %A Langford,Aisha T %A Moloney,Dana N %A Orzeck-Byrnes,Natasha %A Sevick,Mary Ann %A Levy,Natalie %+ Department of Population Health, New York University School of Medicine, 180 Madison Avenue, New York, NY, 10016, United States, 1 646 501 3556, erin.rogers@nyulangone.org %K type 2 diabetes %K telemedicine %K implementation science %D 2019 %7 31.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In 2016, a short message service text messaging intervention to titrate insulin in patients with uncontrolled type 2 diabetes was implemented at two health care facilities in New York City. Objective: This study aimed to conduct a qualitative evaluation assessing barriers to and the facilitators of the implementation of the Mobile Insulin Titration Intervention (MITI) program into usual care. Methods: We conducted in-depth interviews with 36 patients enrolled in the MITI program and the staff involved in MITI (n=19) in the two health care systems. Interviews were transcribed and iteratively coded by two study investigators, both inductively and deductively using a codebook guided by the Consolidated Framework for Implementation Research. Results: Multiple facilitator themes emerged: (1) MITI had strong relative advantages to in-person titration, including its convenience and time-saving design, (2) the free cost of MITI was important to the patients, (3) MITI was easy to use and the patients were confident in their ability to use it, (4) MITI was compatible with the patients’ home routines and clinic workflow, (5) the patients and staff perceived MITI to have value beyond insulin titration by reminding and motivating the patients to engage in healthy behaviors and providing a source of patient support, and (6) implementation in clinics was made easy by having a strong implementation climate, communication networks to spread information about MITI, and a strong program champion. The barriers identified included the following: (1) language limitations, (2) initial nurse concerns about the scope of practice changes required to deliver MITI, (3) initial provider knowledge gaps about the program, and (4) provider perceptions that MITI might not be appropriate for some patients (eg, older or not tech-savvy). There was also a theme that emerged during the patient and staff interviews of an unmet need for long-term additional diabetes management support among this population, specifically diet, nutrition, and exercise support. Conclusions: The patients and staff were overwhelmingly supportive of MITI and believed that it had many benefits and that it was compatible with the clinic workflow and patients’ lives. Initial implementation efforts should address staff training and nurse concerns. Future research should explore options for integrating additional diabetes support for patients. %M 31368439 %R 10.2196/13906 %U http://mhealth.jmir.org/2019/7/e13906/ %U https://doi.org/10.2196/13906 %U http://www.ncbi.nlm.nih.gov/pubmed/31368439 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 2 %N 1 %P e13862 %T Advancing the Science of Recruitment for Family Caregivers: Focus Group and Delphi Methods %A Hansen,Dana %A Petrinec,Amy %A Hebeshy,Mona %A Sheehan,Denice %A Drew,Barbara L %+ College of Nursing, Kent State University, PO Box 5190, Kent, OH, 44236, United States, 1 330 672 8779, dhansen1@kent.edu %K family caregivers %K recruitment %K social media %K illness stories %D 2019 %7 22.07.2019 %9 Original Paper %J JMIR Nursing %G English %X Background: Successful recruitment of participants is imperative to a rigorous study, and recruitment challenges are not new to researchers. Many researchers have used social media successfully to recruit study participants. However, challenges remain for effective online social media recruitment for some populations. Objective: Using a multistep approach that included a focus group and Delphi method, researchers performed this study to gain expert advice regarding material development for social media recruitment and to test the recruitment material with the target population. Methods: In the first phase, we conducted a focus group with 5 social media experts to identify critical elements for effective social media recruitment material. Utilizing the Delphi method with 5 family caregivers, we conducted the second phase to reach consensus regarding effective recruitment videos. Results: Phase I utilized a focus group that resulted in identification of three barriers related to social media recruitment, including lack of staff and resources, issues with restrictive algorithms, and not standing out in the crowd. Phase II used the Delphi method. At the completion of Delphi Round 1, 5 Delphi participants received a summary of the analysis for feedback and agreement with our summary. Using data and recommendations from Round 1, researchers created two new recruitment videos with additions to improve trustworthiness and transparency, such as the university’s logo. In Round 2 of the Delphi method, consensus regarding the quality and trustworthiness of the recruitment videos reached 100%. Conclusions: One of the primary challenges for family caregiver research is recruitment. Despite the broad adoption of social media marketing approaches, the effectiveness of online recruitment strategies needs further investigation. %R 10.2196/13862 %U https://nursing.jmir.org/2019/1/e13862/ %U https://doi.org/10.2196/13862 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e14289 %T Mothers’ Perceptions of the Internet and Social Media as Sources of Parenting and Health Information: Qualitative Study %A Moon,Rachel Y %A Mathews,Anita %A Oden,Rosalind %A Carlin,Rebecca %+ University of Virginia, PO Box 800386, Charlottesville, VA, 22908, United States, 1 4349245521, rym4z@virginia.edu %K internet %K parenting %K social media %K focus groups %D 2019 %7 09.07.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Traditionally, guidance and support to new parents have come from family, friends, and health care providers. However, the internet and social media are growing sources of guidance and support for parents. Little is known about how the internet and social media are used by parents of young infants and specifically about parental perceptions of the internet and social media as sources of parenting and infant health information. Objective: The aim of this study was to explore, using qualitative methods, parental perceptions of the advantages and disadvantages of the internet and social media as sources of parenting and health information regarding their infant. Methods: A total of 28 mothers participated in focus groups or individual interviews. Probing questions concerning parenting and health information sources were asked. Themes were developed in an iterative manner from coded data. Results: The central themes were (1) reasons that mothers turn to the internet for parenting and health information, (2) cautionary advice about the internet, and (3) reasons that mothers turn to social media for parenting and health information. Mothers appreciated the ability to gather unlimited information and multiple opinions quickly and anonymously, but recognized the need to use reputable sources of information. Mothers also appreciated the immediacy of affirmation, support, and tailored information available through social media. Conclusions: The internet and social media are rapidly becoming important and trusted sources of parenting and health information that mothers turn to when making infant care decisions. %M 31290403 %R 10.2196/14289 %U https://www.jmir.org/2019/7/e14289/ %U https://doi.org/10.2196/14289 %U http://www.ncbi.nlm.nih.gov/pubmed/31290403 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 4 %N 3 %P e14032 %T Experiences of Adults With Type 1 Diabetes Using Glucose Sensor–Based Mobile Technology for Glycemic Variability: Qualitative Study %A Ritholz,Marilyn D %A Henn,Owen %A Atakov Castillo,Astrid %A Wolpert,Howard %A Edwards,Stephanie %A Fisher,Lawrence %A Toschi,Elena %+ Joslin Diabetes Center, 1 Joslin Place, Boston, MA, 02215, United States, 1 6173094196, marilyn.ritholz@joslin.harvard.edu %K diabetes mellitus, type 1 %K educational technology %K blood glucose self-monitoring %K qualitative research %D 2019 %7 08.07.2019 %9 Original Paper %J JMIR Diabetes %G English %X Background: Adults with type 1 diabetes (PWDs) face challenging self-management regimens including monitoring their glucose values multiple times a day to assist with achieving glycemic targets and reduce the risk of long-term diabetes complications. Recent advances in diabetes technology have reportedly improved glycemia, but little is known about how PWDs utilize mobile technology to make positive changes in their diabetes self-management. Objective: The aim of this qualitative study was to explore PWDs’ experiences using Sugar Sleuth, a glucose sensor–based mobile app and Web-based reporting system, integrated with the FreeStyle Libre glucose monitor that provides feedback about glycemic variability. Methods: We used a qualitative descriptive research design and conducted semistructured interviews with 10 PWDs (baseline mean glycated hemoglobin, HbA1c) 8.0%, (SD 0.45); 6 males and 4 females, aged 52 years (SD 15), type 1 diabetes (T1D) duration 31 years (SD 13), 40% (4/10, insulin pump) following a 14-week intervention during which they received clinical support and used Sugar Sleuth to evaluate and understand their glucose data. Audio-recorded interviews were transcribed, coded, and analyzed using thematic analysis and NVivo 11 (QSR International Pty Ltd). Results: A total of 4 main themes emerged from the data. Participants perceived Sugar Sleuth as an Empowering Tool that served to inform lifestyle choices and diabetes self-management tasks, promoted preemptive self-care actions, and improved discussions with clinicians. They also described Sugar Sleuth as providing a Source of Psychosocial Support and offering relief from worry, reducing glycemic uncertainty, and supporting positive feelings about everyday life with diabetes. Participants varied in their Approaches to Glycemic Data: 40% (4/10) described using Sugar Sleuth to review data, understand glycemic cause and effect, and plan for future self-care. On the contrary, 60% (6/10) were reluctant to review past data; they described receiving benefits from the immediate numbers and trend arrows, but the app still prompted them to enter in the suspected causes of glucose excursions within hours of their occurrence. Finally, only 2 participants voiced Concerns About Use of Sugar Sleuth; they perceived the app as sometimes too demanding of information or as not attuned to the socioeconomic backgrounds of PWDs from diverse populations. Conclusions: Results suggest that Sugar Sleuth can be an effective educational tool to enhance both patient-clinician collaboration and diabetes self-management. Findings also highlight the importance of exploring psychosocial and socioeconomic factors that may advance the understanding of PWDs’ individual differences when using glycemic technology and may promote the development of customized mobile tools to improve diabetes self-management. %M 31287065 %R 10.2196/14032 %U http://diabetes.jmir.org/2019/3/e14032/ %U https://doi.org/10.2196/14032 %U http://www.ncbi.nlm.nih.gov/pubmed/31287065 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e12952 %T “Seeing Pain Differently”: A Qualitative Investigation Into the Differences and Similarities of Pain and Rheumatology Specialists’ Interpretation of Multidimensional Mobile Health Pain Data From Children and Young People With Juvenile Idiopathic Arthritis %A Lee,Rebecca Rachael %A Rashid,Amir %A Ghio,Daniela %A Thomson,Wendy %A Cordingley,Lis %+ NIHR Manchester Musculoskeletal Biomedical Research Centre, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Room 2.908, Stopford Building, Oxford Road, Manchester, M13 9PT, United Kingdom, 44 1612757757, rebecca.lee-4@manchester.ac.uk %K mHeath %K pain assessment %K juvenile idiopathic arthritis %K focus group %K qualitative research %D 2019 %7 02.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In contrast to the use of traditional unidimensional paper-based scales, a mobile health (mHealth) assessment of pain in children and young people (CYP) with juvenile idiopathic arthritis (JIA) enables comprehensive and complex multidimensional pain data to be captured remotely by individuals. However, how professionals use multidimensional pain data to interpret and synthesize pain reports gathered using mHealth tools is not yet known. Objective: The aim of this study was to explore the salience and prioritization of different mHealth pain features as interpreted by key stakeholders involved in research and management of pain in CYP with JIA. Methods: Pain and rheumatology specialists were purposively recruited via professional organizations. Face-to-face focus groups were conducted for each specialist group. Participants were asked to rank order 9 static vignette scenarios created from real patient mHealth multidimensional pain data. These data had been collected by a researcher in a separate study using My Pain Tracker, a valid and acceptable mHealth iPad pain communication tool that collects information about intensity, severity, location, emotion, and pictorial pain qualities. In the focus groups, specialists discussed their decision-making processes behind each rank order in the focus groups. The total group rank ordering of vignette scenarios was calculated. Qualitative data from discussions were analyzed using latent thematic analysis. Results: A total of 9 pain specialists took part in 1 focus group and 10 rheumatology specialists in another. In pain specialists, the consensus for the highest pain experience (44%) was poorer than their ranking of the lowest pain experiences (55%). Conversely, in rheumatology specialists, the consensus for the highest pain experience (70%) was stronger than their ranking of the lowest pain experience (50%). Pain intensity was a high priority for pain specialists, but rheumatology specialists gave high priority to intensity and severity taken together. Pain spread was highly prioritized, with the number of pain locations (particular areas or joints) being a high priority for both groups; radiating pain was a high priority for pain specialists only. Pain emotion was challenging for both groups and was only perceived to be a high priority when specialists had additional confirmatory evidence (such as information about pain interference or clinical observations) to validate the pain emotion report. Pain qualities such as particular word descriptors, use of the color red, and fire symbols were seen to be high priority by both groups in interpretation of CYP pain reports. Conclusions: Pain interpretation is complex. Findings from this study of specialists’ decision-making processes indicate which aspects of pain are prioritized and weighted more heavily than others by those interpreting mHealth data. Findings are useful for developing electronic graphical summaries which assist specialists in interpreting patient-reported mHealth pain data more efficiently in clinical and research settings. %M 31267979 %R 10.2196/12952 %U https://mhealth.jmir.org/2019/7/e12952/ %U https://doi.org/10.2196/12952 %U http://www.ncbi.nlm.nih.gov/pubmed/31267979 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 7 %P e12242 %T What Patients Want in a Smartphone App That Supports Colonoscopy Preparation: Qualitative Study to Inform a User-Centered Smartphone App %A Sewitch,Maida J %A Fallone,Carlo A %A Ghali,Peter %A Lee,Ga Eun %+ Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, 5252 de Maisonneuve West, Montreal, QC, H4A 3S5, Canada, 1 514 934 1934 ext 44736, maida.sewitch@mcgill.ca %K colonoscopy %K early detection of cancer %K mobile health technology %K qualitative research %K smartphone %K user-centered %D 2019 %7 02.07.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The preparation for colonoscopy is elaborate and complex. In the context of colorectal cancer screening, up to 11% of patients do not keep their colonoscopy appointments and up to 33% of those attending their appointments have inadequately cleansed bowels that can delay cancer diagnosis and treatment. A smartphone app may be an acceptable and wide-reaching tool to improve patient adherence to colonoscopy. Objective: The aim of this qualitative study was to employ a user-centered approach to design the content and features of a smartphone app called colonAPPscopy to support individuals preparing for their colonoscopy appointments. Methods: We conducted 2 focus group discussions (FGDs) with gastroenterology patients treated at the McGill University Health Centre in Montreal, Canada. Patients were aged 50 to 75 years, were English- or French-speaking, and had undergone outpatient colonoscopy in the previous 3 months; they did not have inflammatory bowel disease or colorectal cancer. FGDs were 75 to 90 min, conducted by a trained facilitator, and audiotaped. Participants discussed the electronic health support tools they might use to help them prepare for the colonoscopy, the content needed for colonoscopy preparation, and the features that would make the smartphone app useful. Recordings of FGDs were transcribed and analyzed using thematic analysis to identify key user-defined content and features to inform the design of colonAPPscopy. Results: A total of 9 patients (7 male and 2 female) participated in one of 2 FGDs. Main content areas focused on bowel preparation instructions, medication restrictions, appointment logistics, communication, and postcolonoscopy expectations. Design features to make the app useful and engaging included minimization of data input, reminders and alerts for up to 7 days precolonoscopy, and visual aids. Participants wanted a smartphone app that comes from a trusted source, sends timely and tailored messages, provides reassurance, provides clear instructions, and is simple to use. Conclusions: Participants identified the need for postcolonoscopy information as well as reminders and alerts in the week before colonoscopy, novel content, and features that had not been included in previous smartphone-based strategies for colonoscopy preparation. The ability to tailor instructions made the smartphone app preferable to other modes of delivery. Study findings recognize the importance of including potential users in the development phase of building a smartphone app. %M 31125310 %R 10.2196/12242 %U https://mhealth.jmir.org/2019/7/e12242/ %U https://doi.org/10.2196/12242 %U http://www.ncbi.nlm.nih.gov/pubmed/31125310 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 6 %P e11310 %T Evaluation of the Effectiveness of a Musical Cognitive Restructuring App for Black Inner-City Girls: Survey, Usage, and Focus Group Evaluation %A Neal-Barnett,Angela %A Stadulis,Robert %A Ellzey,Delilah %A Jean,Elizabeth %A Rowell,Tiffany %A Somerville,Keaton %A Petitti,Kallie %A Siglow,Benjamin %A Ruttan,Arden %A Hogue,Mary %+ Kent State University, Department of Psychological Sciences, Program for Research on Anxiety Disorders among African Americans, 600 Hilltop Dr, Kent, OH, 44242-0001, United States, 1 330 672 2166, aneal@kent.edu %K black girls %K musical cognitive restructuring %K mHealth %K negative thinking %D 2019 %7 27.06.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Research on mobile health (mHealth) app use during adolescence is growing; however, little attention has been paid to black adolescents, particularly black girls, who are generally underresearched and underserved in psychological intervention research. Cognitive restructuring is an important tool in anxiety and fear management and involves two parts: (1) recognizing and deconstructing erroneous thoughts and (2) replacing negative anxiety and stress-provoking thoughts with positive thoughts. In our work with black adolescent females, we found that cognitive restructuring is a difficult skill to practice on one’s own. Thus, drawing upon the importance of music in the black community, we developed the Build Your Own Theme Song (BYOTS) app to deliver a musical form of the technique to middle-school black girls. Objective: Our aim in this mixed methods study is to evaluate the effectiveness of the BYOTS app. We hypothesize that participants will expect the app to be effective in reducing negative thoughts and that the app will meet their expectations and data generated from the app will demonstrate a reduction in negative thinking and anxiety. Methods: A total of 72 black or biracial seventh- and eighth-grade adolescent females were enrolled in Sisters United Now (SUN), an eight-session culturally infused and app-augmented stress and anxiety sister circle intervention. Before using the BYOTS app, girls completed the Multidimensional Anxiety Scale for Children 2 and the App Expectations Survey. Usage data collected from the app included an assessment of negative thinking before and after listening to their song. After completion of the intervention, focus groups were held to gather qualitative data on participants’ app experience. Results: Results using paired sample t tests indicated negative thinking was significantly lower at day 7 than day 1 (t31=1.69, P=.05). Anxiety from preuse to postuse of the app was also reduced (t38=2.82, P=.004). Four effectiveness themes emerged from the focus groups: difference in behavior and temperament, promoted calmness, helpfulness in stressful home situations, and focused thinking via the SUN theme song. Conclusions: The BYOTS app is a useful tool for delivering musical cognitive restructuring to reduce negative thinking and anxiety in an underserved urban population. Changes were supported both quantitatively and qualitatively. Participants, their peers, and their family noted the difference. Findings support expanding the research to black girls of various socioeconomic statuses and geographic diversity. Currently, the app augments SUN, a culturally relevant intervention. Future research will explore BYOTS as a stand-alone app. %M 31188130 %R 10.2196/11310 %U http://mhealth.jmir.org/2019/6/e11310/ %U https://doi.org/10.2196/11310 %U http://www.ncbi.nlm.nih.gov/pubmed/31188130 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 6 %P e12848 %T Preferences of Information Dissemination on Treatment for Bipolar Disorder: Patient-Centered Focus Group Study %A Kerner,Berit %A Crisanti,Annette S %A DeShaw,Jason L %A Ho,Janika-Marie G %A Jordan,Kimmie %A Krall,Ronald L %A Kuntz,Matt J %A Mazurie,Aurélien J %A Nestsiarovich,Anastasiya %A Perkins,Douglas J %A Schroeter,Quentin L %A Smith,Alicia N %A Tohen,Mauricio %A Volesky,Emma %A Zhu,Yiliang %A Lambert,Christophe G %+ Division of Translational Informatics, Center for Global Health, Department of Internal Medicine, University of New Mexico Health Sciences Center, MSC10-5550, Albuquerque, NM, 87131, United States, 1 505 272 9709, CGLambert@unm.edu %K internet %K information seeking %K psychiatry %K bipolar disorder %K patient-physician relationship %K decision-making %K patient education %K therapeutics %D 2019 %7 25.06.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Patient education has taken center stage in successfully shared decision making between patients and health care providers. However, little is known about how patients with bipolar disorder typically obtain information on their illness and the treatment options available to them. Objective: This study aimed to obtain the perspectives of patients with bipolar disorder and their family members on the preferred and most effectively used information channels on bipolar disorder and the available treatment options. Methods: We conducted nine focus groups in Montana, New Mexico, and California, in which we surveyed 84 individuals including patients with bipolar disorder and family members of patients with bipolar disorder. The participants were recruited using National Alliance on Mental Illness mailing lists and websites. Written verbatim responses to semistructured questionnaires were analyzed using summative content analysis based on grounded theory. Two annotators coded and analyzed the data on the sentence or phrase level to create themes. Relationships between demographics and information channel were also examined using the Chi-square and Fisher exact tests. Results: The focus group participants mentioned a broad range of information channels that were successfully used in the past and could be recommended for future information dissemination. The majority of participants used providers (74%) and internet-based resources (75%) as their main information sources. There was no association between internet use and basic demographics such as age or geographical region of the focus groups. Patients considered time constraints and the fast pace in which an overwhelming amount of information is often presented by the provider as major barriers to successful provider-patient interactions. If Web-based channels were used, the participants perceived information obtained through Web-based channels as more helpful than information received in the provider’s office (P<.05). Conclusions: Web-based resources are increasingly used by patients with bipolar disorder and their family members to educate themselves about the disease and its treatment. Although provider-patient interactions are frequently perceived to be burdened with time constraints, Web-based information sources are considered reliable and helpful. Future research should explore how high-quality websites could be used to empower patients and improve provider-patient interactions with the goal of enhancing shared decision making between patients and providers. %M 31237566 %R 10.2196/12848 %U http://mental.jmir.org/2019/6/e12848/ %U https://doi.org/10.2196/12848 %U http://www.ncbi.nlm.nih.gov/pubmed/31237566 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e9481 %T Complementing a Clinical Trial With Human-Computer Interaction: Patients’ User Experience With Telehealth %A Jalil,Sakib %A Myers,Trina %A Atkinson,Ian %A Soden,Muriel %+ Betty Irene Moore School of Nursing, UCDavis Health, University of California - Davis, 2450 48th Street, Sacramento, CA, 95817, United States, 1 2139158762, dr.sakib.jalil@gmail.com %K clinical user-experience evaluation %K telehealth %K type 2 diabetes %K user experience %K human-computer interaction %K patient-centered %K patient-technology interaction %K eHealth %D 2019 %7 06.06.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The use of telehealth to monitor patients from home is on the rise. Telehealth technology is evaluated in a clinical trial with measures of health outcomes and cost-effectiveness. However, what happens between a technology and the patients is not investigated during a clinical trial—the telehealth technology remains as a “black box.” Meanwhile, three decades of research in the discipline of human-computer interaction (HCI) presents design, implementation, and evaluation of technologies with a primary emphasis on users. HCI research has exposed the importance of user experience (UX) as an essential part of technology development and evaluation. Objective: This research investigates the UX of patients with type 2 diabetes mellitus (T2D) with a telehealth in-home monitoring device to manage T2D from home. We investigate how the UX during a clinical trial can be researched and what a clinical trial can learn from HCI research. Methods: We adopted an ethnographic philosophy and conducted a contextual inquiry due to time limitations followed by semistructured interviews of 9 T2D patients. We defined the method as Clinical User-experience Evaluation (CUE). The patients were enrolled in a telehealth clinical trial of T2D; however, this research was an independent study conducted by information technologists and health researchers for a user-centered evaluation of telehealth. Results: Key analytical findings were that patients valued the benefits of in-home monitoring, but the current device did not possess all functionalities that patients wanted. The results include patients’ experiences and emotions while using the device, patients’ perceived benefits of the device, and how patients domesticated the device. Further analysis showed the influence of the device on patients’ awareness, family involvement, and design implications for telehealth for T2D. Conclusions: HCI could complement telehealth clinical trials and uncover knowledge about T2D patients’ UX and future design implications. Through HCI we can look into the “black box” phenomenon of clinical trials and create patient-centered telehealth solutions. %M 31172958 %R 10.2196/humanfactors.9481 %U http://humanfactors.jmir.org/2019/2/e9481/ %U https://doi.org/10.2196/humanfactors.9481 %U http://www.ncbi.nlm.nih.gov/pubmed/31172958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e10388 %T Connecting Home-Based Self-Monitoring of Blood Pressure Data Into Electronic Health Records for Hypertension Care: A Qualitative Inquiry With Primary Care Providers %A Rodriguez,Sarah %A Hwang,Kevin %A Wang,Jing %+ School of Nursing, The University of Texas Health Science Center at San Antonio, MSC 7851, 7703 Floyd Curl Drive, San Antonio, TX, 78229, United States, 1 210 450 8561, wangj1@uthscsa.edu %K patient-generated health data %K connected health %K remote monitoring %K electronic health record %K hypertension %K patient reported outcome %K self-measured blood pressure %K self-monitoring of blood pressure %D 2019 %7 23.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: There is a lack of research on how to best incorporate home-based self-measured blood pressure (SMBP) measurements, combined with other patient-generated health data (PGHD), into electronic health record (EHR) systems in a way that promotes primary care workflow without burdening the primary care team with irrelevant or superfluous data. Objective: The purpose of this study was to explore the perspectives of primary care providers in utilizing SMBP measurements and integrating SMBP data into the clinical workflow for the management of hypertension in the primary care setting. Methods: A total of 13 primary care physicians were interviewed in total; 5 in individual interviews and 8 in a focus group. The interview questions were centered on (1) the value of SMBP in hypertension care, (2) needs of viewing SMBP and desired visual display, (3) desired alert algorithm and critical values, (4) needs for other PGHD, and (5) workflow of primary care team in utilizing SMBP. The interviews were audiotaped and transcribed verbatim, and a thematic analysis was performed to extract overarching themes. Results: The primary care experience of the 13 providers ranged from 5 to 35 years. The following themes emerged from the individual and focus group interviews: (1) ways to utilize SMBP measurements in primary care, (2) preferred visual display of SMBP, (3) patient condition determines preferred scheduling of patient SMBP measurements and provider’s preferred frequency of viewing SMBP data, (4) effect of patient condition on alert parameters, (5) location to receive critical value alerts, (6) primary recipient of critical value alerts, and (7) the need of additional PGHD (eg, emotional stressors, food diary, and medication adherence) to provide context of SMBP values. Conclusions: The perspectives of primary care providers need to be incorporated into the design of a built-in interface in the EHR to incorporate SMBP and other PGHD. Future usability evaluation should be conducted with mock-up interfaces to solicit opinions on the optimal alert frequency and mechanism to best fit the workflow in the primary care setting. Future studies should examine how the utilization of a built-in interface that fully integrates SMBP measurements and PGHD into EHR systems can support patient self-management and thus, improve patient outcomes. %M 31124468 %R 10.2196/10388 %U http://formative.jmir.org/2019/2/e10388/ %U https://doi.org/10.2196/10388 %U http://www.ncbi.nlm.nih.gov/pubmed/31124468 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 2 %P e8885 %T Communicating Bad News: Insights for the Design of Consumer Health Technologies %A Choe,Eun Kyoung %A Duarte,Marisa E %A Suh,Hyewon %A Pratt,Wanda %A Kientz,Julie A %+ Human Centered Design and Engineering, University of Washington, 423C Sieg Hall, Box 352315, Seattle, WA, 98195, United States, 1 2062210614, jkientz@uw.edu %K mobile health %K eHealth %K mHealth %K patient-centered care %K health communication %K empathy %D 2019 %7 17.05.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: As people increasingly receive personal health information through technology, there is increased importance for this information to be communicated with empathy and consideration for the patient’s experience of consuming it. Although technology enables people to have more frequent and faster access to their health information, it could also cause unnecessary anxiety, distress, or confusion because of the sensitive and complex nature of the information and its potential to provide information that could be considered bad news. Objective: The aim of this study was to uncover insights for the design of health information technologies that potentially communicate bad news about health such as the result of a diagnosis, increased risk for a chronic or terminal disease, or overall declining health. Methods: On the basis of a review of established guidelines for clinicians on communicating bad news, we developed an interview guide and conducted interviews with patients, patients’ family members, and clinicians on their experience of delivering and receiving the diagnosis of a serious disease. We then analyzed the data using a thematic analysis to identify overall themes from a perspective of identifying ways to translate these strategies to technology design. Results: We describe qualitative results combining an analysis of the clinical guidelines for sharing bad health news with patients and interviews on clinicians’ specific strategies to communicate bad news and the emotional and informational support that patients and their family members seek. Specific strategies clinicians use included preparing for the patients’ visit, anticipating patients’ feelings, building a partnership of trust with patients, acknowledging patients’ physical and emotional discomfort, setting up a scene where patients can process the information, helping patients build resilience and giving hope, matching the level of information to the patients’ level of understanding, communicating face-to-face, if possible, and using nonverbal means. Patient and family member experiences included internal turmoil and emotional distress when receiving bad news and emotional and informational support that patients and family members seek. Conclusions: The results from this study identify specific strategies for health information technologies to better promote empathic communication when they communicate concerning health news. We distill the findings from our study into design hypotheses for ways technologies may be able to help people better cope with the possibility of receiving bad health news, including tailoring the delivery of information to the patients’ individual preferences, supporting interfaces for sharing patients’ context, mitigating emotional stress from self-monitoring data, and identifying clear, actionable steps patients can take next. %M 31102374 %R 10.2196/humanfactors.8885 %U http://humanfactors.jmir.org/2019/2/e8885/ %U https://doi.org/10.2196/humanfactors.8885 %U http://www.ncbi.nlm.nih.gov/pubmed/31102374 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 5 %P e12656 %T The Importance of User Segmentation for Designing Digital Therapy for Adolescent Mental Health: Findings From Scoping Processes %A Fleming,Theresa %A Merry,Sally %A Stasiak,Karolina %A Hopkins,Sarah %A Patolo,Tony %A Ruru,Stacey %A Latu,Manusiu %A Shepherd,Matthew %A Christie,Grant %A Goodyear-Smith,Felicity %+ Department of Psychological Medicine, University of Auckland, Private Bag 92019, Auckland, 1142, New Zealand, 64 9 923 5025, t.fleming@auckland.ac.nz %K gamification %K computerized therapy %K mental health %K adolescent %K mobile apps %K internet %D 2019 %7 08.05.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: New Zealand youth, especially those of Māori and Pacific descent, have high rates of depression, anxiety, and self-harm, but have low rates of help-seeking from mental health professionals. Apps, computerized therapy, and other digital tools can be effective, highly scalable treatments for anxiety and depression. Co-design processes are often used to foster engagement with end users, but this does not always lead to high levels of engagement. Objective: We aimed to carry out preliminary scoping to understand adolescents’ current internet use and diversity of preferences to inform a planned co-design process for creating digital mental health tools for teenagers. Methods: Interactive workshops and focus groups were held with young people. Data were analyzed using a general inductive approach. Results: Participants (N=58) engaged in 2 whānau (extended family) focus groups (n=4 and n=5), 2 school- or community-based focus groups (n=9 each), and 2 workshops (n=11 and n=20). The authors identified 3 overarching themes: (1) Digital mental health tools are unlikely to be successful if they rely solely on youth help-seeking. (2) A single approach is unlikely to appeal to all. Participants had diverse, noncompatible preferences in terms of look or feel of an app or digital tool. The authors identified 4 user groups players or gamers, engagers, sceptics, and straight-talkers. These groups differed by age and degree of current mental health need and preferred gamified or fun approaches, were open to a range of approaches, were generally disinterested, or preferred direct-to-the-point, serious approaches, respectively. (3) Digital mental health tools should provide an immediate response to a range of different issues and challenges that a young person may face. Conclusions: Defining the preferences of different groups of users may be important for increasing engagement with digital therapies even within specific population and mental health–need groups. This study demonstrates the importance of scoping possible user needs to inform design processes. %M 31066705 %R 10.2196/12656 %U https://mental.jmir.org/2019/5/e12656/ %U https://doi.org/10.2196/12656 %U http://www.ncbi.nlm.nih.gov/pubmed/31066705 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12406 %T Considerations of Privacy and Confidentiality in Developing a Clinical Support Tool for Adolescent Tobacco Prevention: Qualitative Study %A Theis,Ryan P %A Malik,Ali M %A Thompson,Lindsay A %A Shenkman,Elizabeth A %A Pbert,Lori %A Salloum,Ramzi G %+ Institute for Child Health Policy, Department of Health Outcomes and Biomedical Informatics, University of Florida, 2004 Mowry Road, Suite 2252, Gainesville, FL, 32610, United States, 1 352 294 5973, rtheis@ufl.edu %K clinical decision support %K adolescent %K primary care %K tobacco use %K confidentiality %K implementation science %K qualitative research %D 2019 %7 28.4.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic clinical support tools show promise for facilitating tobacco screening and counseling in adolescent well-care. However, the application of support tools in pediatric settings has not been thoroughly studied. Successfully implementing support tools in local settings requires an understanding of barriers and facilitators from the perspective of both patients and providers. Objective: This paper aimed to present the findings of a qualitative study conducted to inform the development and implementation of a support tool for adolescent tobacco screening and counseling in 3 pediatric clinics in North Florida. The primary objective of the study was to test and collect information needed to refine a tablet-based support tool with input from patients and providers in the study clinics. Methods: A tablet prototype was designed to collect information from adolescents on tobacco susceptibility and use before their well-care visit and to present tobacco prevention videos based on their responses. Information collected from adolescents by the support tool would be available to providers during the visit to facilitate and streamline tobacco use assessment and counseling components of well-care. Focus groups with providers and staff from 3 pediatric clinics (n=24) identified barriers and facilitators to implementation of the support tool. In-depth interviews with racially and ethnically diverse adolescent patients who screened as susceptible to tobacco use (n=16) focused on acceptability and usability of the tool. All focus groups and interviews were audio-recorded and transcribed for team-based coding using thematic analysis. Results: Privacy and confidentiality of information was a salient theme. Both groups expressed concerns that the tool’s audio and visual components would impede privacy and that parents may read their child’s responses or exert control over the process. Nearly all adolescents stated they would be comfortable with the option to complete the tool at home via a Web portal. Most adolescents stated they would feel comfortable discussing tobacco with their doctor. Adolescent interviews elicited 3 emergent themes that added context to perspectives on confidentiality and had practical implications for implementation: (1) purity: an expressed lack of concern for confidentiality among adolescents with no reported history of tobacco use; (2) steadfast honesty: a commitment to being honest with parents and providers about tobacco use, regardless of the situation; and (3) indifference: a perceived lack of relevance of confidentiality, based on the premise that others will “find out anyway” if adolescents are using tobacco. Conclusions: This study informed several modifications to the intervention to address confidentiality and introduce efficiency to well-care visits. The support tool was integrated into the electronic health record system used by the study clinics and modified to offer videos to all adolescents regardless of their tobacco use or susceptibility. Future studies will further test the acceptability of the intervention in practice. %M 31066687 %R 10.2196/12406 %U http://formative.jmir.org/2019/2/e12406/ %U https://doi.org/10.2196/12406 %U http://www.ncbi.nlm.nih.gov/pubmed/31066687 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 4 %P e12203 %T Identifying Treatment Modalities for a Multidisciplinary and Blended Care Intervention for Patients With Moderate Medically Unexplained Physical Symptoms: Qualitative Study Among Professionals %A van Westrienen,Paula Elisabeth %A Pisters,Martijn F %A Gerrits,Marloes %A Veenhof,Cindy %A de Wit,Niek J %+ Department of Health Innovation and Technology, Fontys University of Applied Sciences, Ds Th Fliednerstraat 2, Eindhoven,, Netherlands, 31 641621942, e.vanwestrienen@fontys.nl %K medically unexplained physical symptoms %K intervention development %K primary care %K qualitative study %K nominal group technique %D 2019 %7 12.04.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: Medically unexplained physical symptoms (MUPS) are a substantial health problem in primary care with a high burden for patients, general practitioners, and the health care system. Most studies focus on chronic MUPS patients. Little research is conducted in patients with moderate MUPS, and an effective primary care intervention for prevention of chronic MUPS is lacking. Objective: The objective of our study was to identify treatment modalities based on expert opinions for the development of a multidisciplinary and blended intervention for patients with moderate MUPS to prevent chronicity. Methods: Two focus groups with 8 and 6 experts (general practitioners, physical therapists, psychologists, and mental health nurses) were carried out. The focus groups were structured using the nominal group technique. Results: A total of 70 ideas were generated from two nominal group meetings, and 37 of these got votes, were included in the rank order, and were sorted into 8 separate themes. According to the participants, the most important treatment modalities for a multidisciplinary and blended intervention in patients with moderate MUPS were (1) coaching to a healthier lifestyle, (2) education regarding psychosocial factors, (3) therapeutic neuroscience education, (4) multidisciplinary intake, (5) multidisciplinary cooperation and coordination, (6) relaxation or body awareness exercises, (7) clear communication by professionals to the patient, and (8) graded activity. Five independent researchers checked the ideas and linked them to themes to confirm the content analysis and check the validity of the themes. Conclusions: From professional expert perspectives, 8 themes should be included in a multidisciplinary and blended intervention to prevent chronicity. These themes provide a first step in developing an intervention for patients with moderate MUPS. Future research should focus on further development steps in which patients with moderate MUPS should be involved to determine if the intervention matches their needs. %M 30977737 %R 10.2196/12203 %U http://mental.jmir.org/2019/4/e12203/ %U https://doi.org/10.2196/12203 %U http://www.ncbi.nlm.nih.gov/pubmed/30977737 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e10904 %T Text Messaging to Enhance Behavioral Health Treatment Engagement Among Justice-Involved Youth: Qualitative and User Testing Study %A Tolou-Shams,Marina %A Yonek,Juliet %A Galbraith,Katharine %A Bath,Eraka %+ Department of Psychiatry, Weill Institute of Neurosciences, University of California, San Francisco, 401 Parnassus Ave, San Francisco, CA,, United States, 1 415 206 2212, marina.tolou-shams@ucsf.edu %K juvenile delinquency %K treatment adherence and compliance %K mental health %K short message service text messaging %D 2019 %7 05.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mental health and substance use disorders are highly prevalent in justice-involved youth, yet only 8% of court-involved, nonincarcerated (CINI) youth in need of treatment receive it. Dual diagnosis (co-occurring psychiatric and substance use disorders) in justice-involved youth is highly predictive of recidivism. Identifying novel approaches, such as the use of mobile health (mHealth) technologies, to close this gap between need and receipt of behavioral health treatment for the CINI population could potentially offset rates of reoffending into adulthood. Text-messaging (short message service, SMS) interventions have demonstrated efficacy in improving treatment adherence and other associated outcomes in other vulnerable youth populations, but development and testing of mHealth interventions to improve behavioral health treatment rates and outcomes for CINI youth are lacking. Objective: This study aimed to collect qualitative data from key stakeholders to inform the development of a theoretically grounded, family-based text-messaging (SMS) intervention targeting CINI youth’s behavioral health treatment engagement; additionally, the aim was to conduct end-user testing over 6 months with CINI youth and caregivers to determine intervention feasibility and acceptability. Methods: CINI youth and caregivers were referred from a California-based Juvenile Probation Department and community-based provider organizations providing services for justice-involved youth. Eligibility criteria included the following: being a justice-involved youth or a caregiver of a justice-involved youth, English speaking, youth aged 13 to 17 years old and either referred to or currently attending mental health or substance use treatment, and youth and caregiver have access to a cell phone with text-messaging capability. Results: Overall, 28 individuals participated in focus groups and interviews—8 youth, 5 caregivers, and 15 juvenile justice (JJ) personnel. Three major themes emerged: (1) texting among JJ personnel and CINI youth and caregivers in their caseload is common but not systematic, (2) stigma and privacy are perceived as barriers to texting youth about behavioral health treatment appointments, and (3) messages should be short, simple, relatable, positive, and personalized. In total, 9 participants (7 youth and 2 caregivers) participated in end-user testing and rated the intervention as useful, helpful, and supportive. Conclusions: Text messaging (SMS) is an acceptable and feasible means of reminding CINI youth to attend behavioral health treatment appointments. Future implementation challenges include making text messaging (SMS) personalized and tailored but not resource intensive (eg, requiring one-to-one, 24/7 human contact) and identifying which systems will deliver and sustain the intervention. Text messaging (SMS) among justice personnel, youth, and their caregivers is already widespread, but lack of clear guidelines about privacy, confidentiality, and information sharing poses ethical conundrums. Future hybrid-type research designs that explore the efficacy of the intervention while also studying ethical, system, and policy-level factors associated with using digital health interventions to improve CINI youth outcomes is a key next step. %M 30950808 %R 10.2196/10904 %U https://mhealth.jmir.org/2019/4/e10904/ %U https://doi.org/10.2196/10904 %U http://www.ncbi.nlm.nih.gov/pubmed/30950808 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e9832 %T The Use of Wearable Activity Trackers Among Older Adults: Focus Group Study of Tracker Perceptions, Motivators, and Barriers in the Maintenance Stage of Behavior Change %A Kononova,Anastasia %A Li,Lin %A Kamp,Kendra %A Bowen,Marie %A Rikard,RV %A Cotten,Shelia %A Peng,Wei %+ Department of Advertising and Public Relations, Michigan State University, Room 319, 404 Wilson Road, East Lansing, MI, 48824, United States, 1 5174325129, kononova@msu.edu %K aging %K wearable electronic devices %K biobehavioral sciences %K transtheoretical model of behavior change %K exercise %K physical activity %D 2019 %7 05.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Wearable activity trackers offer the opportunity to increase physical activity through continuous monitoring. Viewing tracker use as a beneficial health behavior, we explored the factors that facilitate and hinder long-term activity tracker use, applying the transtheoretical model of behavior change with the focus on the maintenance stage and relapse. Objective: The aim of this study was to investigate older adults’ perceptions and uses of activity trackers at different points of use: from nonuse and short-term use to long-term use and abandoned use to determine the factors to maintain tracker use and prevent users from discontinuing tracker usage. Methods: Data for the research come from 10 focus groups. Of them, 4 focus groups included participants who had never used activity trackers (n=17). These focus groups included an activity tracker trial. The other 6 focus groups (without the activity tracker trial) were conducted with short-term (n=9), long-term (n=11), and former tracker users (n=11; 2 focus groups per user type). Results: The results revealed that older adults in different tracker use stages liked and wished for different tracker features, with long-term users (users in the maintenance stage) being the most diverse and sophisticated users of the technology. Long-term users had developed a habit of tracker use whereas other participants made an effort to employ various encouragement strategies to ensure behavior maintenance. Social support through collaboration was the primary motivator for long-term users to maintain activity tracker use. Short-term and former users focused on competition, and nonusers engaged in vicarious tracker use experiences. Former users, or those who relapsed by abandoning their trackers, indicated that activity tracker use was fueled by curiosity in quantifying daily physical activity rather than the desire to increase physical activity. Long-term users saw a greater range of pros in activity tracker use whereas others focused on the cons of this behavior. Conclusions: The results suggest that activity trackers may be an effective technology to encourage physical activity among older adults, especially those who have never tried it. However, initial positive response to tracker use does not guarantee tracker use maintenance. Maintenance depends on recognizing the long-term benefits of tracker use, social support, and internal motivation. Nonadoption and relapse may occur because of technology’s limitations and gaining awareness of one’s physical activity without changing the physical activity level itself. %M 30950807 %R 10.2196/mhealth.9832 %U https://mhealth.jmir.org/2019/4/e9832/ %U https://doi.org/10.2196/mhealth.9832 %U http://www.ncbi.nlm.nih.gov/pubmed/30950807 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e12569 %T Computer-Mediated Communication to Facilitate Synchronous Online Focus Group Discussions: Feasibility Study for Qualitative HIV Research Among Transgender Women Across the United States %A Wirtz,Andrea L %A Cooney,Erin E %A Chaudhry,Aeysha %A Reisner,Sari L %A , %+ Department of Epidemiology, Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, E7644, Baltimore, MD, 21205, United States, 1 4105020800, awirtz1@jhu.edu %K transgender %K qualitative research %K formative research %K technology %D 2019 %7 29.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Novel, technology-based methods are rapidly increasing in popularity across multiple facets of quantitative research. Qualitative research, however, has been slower to integrate technology into research methodology. One method, computer-mediated communication (CMC), has been utilized to a limited extent for focus group discussions. Objective: This study aimed to assess feasibility of an online video conferencing system to further adapt CMC to facilitate synchronous focus group discussions among transgender women living in six cities in eastern and southern United States. Methods: Between August 2017 and January 2018, focus group discussions with adult transgender women were conducted in English and Spanish by research teams based in Boston, MA, and Baltimore, MD. Participants were sampled from six cities: Baltimore, MD; Boston, MA; New York, NY; Washington, DC; Atlanta, GA; and Miami, FL. This was formative research to inform a technology-enhanced cohort study to assess HIV acquisition among transgender women. This analysis focused on the methodologic use of CMC focus groups conducted synchronously using online software that enabled video or phone discussion. Findings were based on qualitative observations of attendance and study team debriefing on topics of individual, social, technical, and logistical challenges encountered. Results: A total of 41 transgender women from all six cities participated in seven online focus group discussions—five English and two Spanish. There was equal racial distribution of black/African American (14/41, 34%) and white (14/41, 34%) attendees, with 29% (12/41) identifying as Hispanic/Latina ethnicity. Overall, 29 of 70 (41%) eligible and scheduled transgender women failed to attend the focus group discussions. The most common reason for nonattendance was forgetting or having a scheduling conflict (16/29, 55%). A total of 14% (4/29) reported technical challenges associated with accessing the CMC focus group discussion. CMC focus group discussions were found to facilitate geographic diversity; allow participants to control anonymity and privacy (eg, use of pseudonyms and option to use video); ease scheduling by eliminating challenges related to travel to a data collection site; and offer flexibility to join via a variety of devices. Challenges encountered were related to overlapping conversations; variable audio quality in cases where Internet or cellular connection was poor; and distribution of incentives (eg, cash versus gift cards). As with all focus group discussions, establishment of ground rules and employing both a skilled facilitator and a notetaker who could troubleshoot technology issues were critical to the success of CMC focus group discussions. Conclusions: Synchronous CMC focus group discussions provide a secure opportunity to convene participants across geographic space with minimal time burden and without losing the standardized approach that is expected of focus group discussions. This method may provide an optimal alternative to engaging hard-to-reach participants in focus group discussions. Participants with limited technological literacy or inconsistent access to a phone and/or cellular data or service, as well as circumstances necessitating immediate cash incentives may, however, require additional support and accommodation when participating in CMC focus group discussions. %M 30924782 %R 10.2196/12569 %U http://www.jmir.org/2019/3/e12569/ %U https://doi.org/10.2196/12569 %U http://www.ncbi.nlm.nih.gov/pubmed/30924782 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e9958 %T User-Centered Design of a Web-Based Tool to Support Management of Chemotherapy-Related Toxicities in Cancer Patients %A Prince,Rebecca M %A Soung Yee,Anthony %A Parente,Laura %A Enright,Katherine A %A Grunfeld,Eva %A Powis,Melanie %A Husain,Amna %A Gandhi,Sonal %A Krzyzanowska,Monika K %+ University Health Network, 610 University Ave., Toronto, ON,, Canada, 1 416 946 6542, monika.krzyzanowska@uhn.ca %K prototype %K Web-based tool %K toxicity management %K chemotherapy %K self-management %D 2019 %7 28.03.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Cancer patients receiving chemotherapy have high symptom needs that can negatively impact quality of life and result in high rates of unplanned acute care visits. Remote monitoring tools may improve symptom management in this patient population. Objective: This study aimed to design a prototype tool to facilitate remote management of chemotherapy-related toxicities. Methods: User needs were assessed using a participatory, user-centered design methodology that included field observation, interviews, and focus groups, and then analyzed using affinity diagramming. Participants included oncology patients, caregivers, and health care providers (HCPs) including medical oncologists, oncology nurses, primary care physicians, and pharmacists in Ontario, Canada. Overarching themes informed development of a Web-based prototype, which was further refined over 2 rounds of usability testing with end users. Results: Overarching themes were derived from needs assessments, which included 14 patients, 1 caregiver, and 12 HCPs. Themes common to both patients and HCPs included gaps and barriers in current systems, need for decision aids, improved communication and options in care delivery, secure access to credible and timely information, and integration into existing systems. In addition, patients identified missed opportunities, care not meeting their needs, feeling overwhelmed and anxious, and wanting to be more empowered. HCPs identified accountability for patient management as an issue. These themes informed development of a Web-based prototype (bridges), which included toxicity tracking, self-management advice, and HCP communication functionalities. Usability testing with 11 patients and 11 HCPs was generally positive; however, identified challenges included tool integration into existing workflows, need for standardized toxicity self-management advice, issues of privacy and consent, and patient-tailored information. Conclusions: Web-based tools integrating just-in-time self-management advice and HCP support into routine care may address gaps in systems for managing chemotherapy-related toxicities. Attention to the integration of new electronic tools into self-care by patients and practice was a strong theme for both patients and HCP participants and is a key issue that needs to be addressed for wide-scale adoption. %M 30920373 %R 10.2196/jmir.9958 %U http://www.jmir.org/2019/3/e9958/ %U https://doi.org/10.2196/jmir.9958 %U http://www.ncbi.nlm.nih.gov/pubmed/30920373 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11694 %T Older Adults’ Perspectives on Using Digital Technology to Maintain Good Mental Health: Interactive Group Study %A Andrews,Jacob A %A Brown,Laura JE %A Hawley,Mark S %A Astell,Arlene J %+ Centre for Assistive Technology and Connected Healthcare, School of Health and Related Research, University of Sheffield, 30 Regent Street, Sheffield, S1 4DA, United Kingdom, 44 1142220682, mark.hawley@sheffield.ac.uk %K mental health %K older adults %K technology %K digital technology %K Internet %K apps %D 2019 %7 13.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: A growing number of apps to support good mental health and well-being are available on digital platforms. However, very few studies have examined older adults’ attitudes toward the use of these apps, despite increasing uptake of digital technologies by this demographic. Objective: This study sought to explore older adults’ perspectives on technology to support good mental health. Methods: A total of 15 older adults aged 50 years or older, in two groups, participated in sessions to explore the use of digital technologies to support mental health. Interactive activities were designed to capture participants’ immediate reactions to apps and websites designed to support mental health and to explore their experiences of using technology for these purposes in their own lives. Template analysis was used to analyze transcripts of the group discussions. Results: Older adults were motivated to turn to technology to improve mood through mechanisms of distraction, normalization, and facilitated expression of mental states, while aiming to reduce burden on others. Perceived barriers to use included fear of consequences and the impact of low mood on readiness to engage with technology, as well as a lack of prior knowledge applicable to digital technologies. Participants were aware of websites available to support mental health, but awareness alone did not motivate use. Conclusions: Older adults are motivated to use digital technologies to improve their mental health, but barriers remain that developers need to address for this population to access them. %M 30758292 %R 10.2196/11694 %U http://www.jmir.org/2019/2/e11694/ %U https://doi.org/10.2196/11694 %U http://www.ncbi.nlm.nih.gov/pubmed/30758292 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e10985 %T Cardiac Rehabilitees’ Technology Experiences Before Remote Rehabilitation: Qualitative Study Using a Grounded Theory Approach %A Anttila,Marjo-Riitta %A Kivistö,Heikki %A Piirainen,Arja %A Kokko,Katja %A Malinen,Anita %A Pekkonen,Mika %A Sjögren,Tuulikki %+ Faculty of Sport and Health Sciences, University of Jyväskylä, PO Box 35, Jyväskylä,, Finland, 358 40 805 4648, marjo-riitta.m-r.anttila@jyu.fi %K coronary disease %K rehabilitees’ experience %K focus group %K qualitative study %K grounded theory %K remote rehabilitation %K e-health %K e-rehabilitation %K telerehabilitation %K secondary prevention %D 2019 %7 07.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Even though technology is becoming increasingly common in rehabilitation programs, insufficient data are as yet available on rehabilitees’ perceptions and experiences. It is important to understand their abilities when using technology for remote rehabilitation. Objective: This is a qualitative study on technology experiences of persons affected by cardiovascular disease assessed before remote rehabilitation. The aim of the study was to explore rehabilitees’ experiences and attitudes toward technology before 12 months of remote rehabilitation. Methods: Qualitative interviews were conducted with 39 rehabilitees in four focus groups. The subjects were aged 34 to 77 years (average age 54.8 years) and 74% (29/39) of them were male. They had been diagnosed with coronary artery disease and were undergoing treatment in a rehabilitation center. The interviews were conducted between September 2015 and November 2016. Data were analyzed using Glaser’s mode of the grounded theory approach. Results: The result of the study was an “identifying e-usage” experience category, which refers to the rehabilitees’ notions of the use of information and communication technologies (e-usage) in the process of behavior change. The main category comprises four subcategories that define the rehabilitees’ technology experience. These subcategories are “feeling outsider,” “being uninterested,” “reflecting benefit,” and “enthusiastic using.” All rehabilitees expected that technology should be simple, flexible, and easy to use and learn. The results reflecting their technology experience can be used in e-rehabilitation programs. Rehabilitees who feel like outsiders and are not interested in technology need face-to-face communication for the major part of rehabilitation, while rehabilitees who reflect benefit and are enthusiastic about the use of technology need incrementally less face-to-face interaction and feel that Web-based coaching could offer sufficient support for rehabilitation. Conclusions: The findings show that persons affected by heart disease had different experiences with technology and expectations toward counseling, while all rehabilitees expected technology to be easy to use and their experiences to be smooth and problem-free. The results can be used more widely in different contexts of social and health care for the planning of and training in remote rehabilitation counseling and education. Trial Registration: ISRCTN Registry ISRCTN61225589; http://www.isrctn.com/ISRCTN61225589 (Archived by WebCite at http://www.webcitation.org/74jmrTXFD) %M 30730298 %R 10.2196/10985 %U http://www.jmir.org/2019/2/e10985/ %U https://doi.org/10.2196/10985 %U http://www.ncbi.nlm.nih.gov/pubmed/30730298 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 1 %P e11714 %T A Qualitative Study of the Theory Behind the Chairs: Balancing Lean-Accelerated Patient Flow With the Need for Privacy and Confidentiality in an Emergency Medicine Setting %A Zibrowski,Elaine %A Shepherd,Lisa %A Booth,Richard %A Sedig,Kamran %A Gibson,Candace %+ Health Information Science, Faculty of Information & Media Studies, University of Western Ontario, Room 4092 FNB, University of Western Ontario,, London, ON, N6A 5B9, Canada, 1 519 641 7196, emzibrow@alumni.uwo.ca %K Lean health care %K emergency medicine %K privacy and confidentiality %K work intensification %K qualitative research %D 2019 %7 06.02.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Many emergency departments (EDs) have used the Lean methodology to guide the restructuring of their practice environments and patient care processes. Despite research cautioning that the layout and design of treatment areas can increase patients’ vulnerability to privacy breaches, evaluations of Lean interventions have ignored the potential impact of these on patients’ informational and physical privacy. If professional regulatory organizations are going to require that nurses and physicians interact with their patients privately and confidentially, we need to examine the degrees to which their practice environment supports them to do so. Objective: This study explored how a Lean intervention impacted the ability of emergency medicine physicians and nurses to optimize conditions of privacy and confidentiality for patients under their care. Methods: From July to December 2017, semistructured interviews were iteratively conducted with health care professionals practicing emergency medicine at a single teaching hospital in Ontario, Canada. The hospital has 1000 beds, and approximately 128,000 patients visit its 2 EDs annually. In response to poor wait times, in 2013, the hospital’s 2 EDs underwent a Lean redesign. As the interviews proceeded, information from their transcripts was first coded into topics and then organized into themes. Data collection continued to theoretical sufficiency. Results: Overall, 15 nurses and 5 physicians were interviewed. A major component of the Lean intervention was the construction of a three-zone front cell at both sites. Each zone was outfitted with a set of chairs in an open concept configuration. Although, in theory, professionals perceived value in having the chairs, in practice, these served multiple, and often, competing uses by patients, family members, and visitors. In an attempt to work around limitations they encountered and keep patients flowing, professionals often needed to move a patient out from a front chair and actively search for another location that better protected individuals’ informational and physical privacy. Conclusions: To our knowledge, this is the first qualitative study of the impact of a Lean intervention on patient privacy and confidentiality. The physical configuration of the front cell often intensified the clinical work of professionals because they needed to actively search for spaces better affording privacy and confidentiality for patient encounters. These searches likely increased clinical time and added to these patients’ length of stay. We advocate that the physical structure and configuration of the front cell should be re-examined under the lens of Lean’s principle of value-added activities. Future exploration of the perspectives of patients, family members, and visitors regarding the relative importance of privacy and confidentiality during emergency care is warranted. %M 30724743 %R 10.2196/11714 %U http://humanfactors.jmir.org/2019/1/e11714/ %U https://doi.org/10.2196/11714 %U http://www.ncbi.nlm.nih.gov/pubmed/30724743 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11954 %T Exploring Community Smokers’ Perspectives for Developing a Chat-Based Smoking Cessation Intervention Delivered Through Mobile Instant Messaging: Qualitative Study %A Luk,Tzu Tsun %A Wong,Sze Wing %A Lee,Jung Jae %A Chan,Sophia Siu-Chee %A Lam,Tai Hing %A Wang,Man Ping %+ School of Nursing, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong,, China (Hong Kong), 852 39176636, mpwang@hku.hk %K chat intervention %K instant messaging %K mHealth %K mobile phone %K social media %K smoking cessation %K tobacco dependence %K WhatsApp %D 2019 %7 31.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Advances in mobile communication technologies provide a promising avenue for the delivery of tobacco dependence treatment. Although mobile instant messaging (IM) apps (eg, WhatsApp, Facebook messenger, and WeChat) are an inexpensive and widely used communication tool, evidence on its use for promoting health behavior, including smoking cessation, is scarce. Objective: This study aims to explore the perception of using mobile IM as a modality to deliver a proposed chat intervention for smoking cessation in community smokers in Hong Kong, where the proportion of smartphone use is among the highest in the world. Methods: We conducted 5 focus group, semistructured qualitative interviews on a purposive sample of 15 male and 6 female current cigarette smokers (age 23-68 years) recruited from the community in Hong Kong. All interviews were audiotaped and transcribed. Two investigators independently analyzed the transcripts using thematic analyses. Results: Participants considered mobile IM as a feasible and acceptable platform for the delivery of a supportive smoking cessation intervention. The ability to provide more personalized and adaptive behavioral support was regarded as the most valued utility of the IM–based intervention. Other perceived utilities included improved perceived psychosocial support and identification of motivator to quit. In addition, participants provided suggestions on the content and design of the intervention, which may improve the acceptability and usability of the IM–based intervention. These include avoiding health warning information, positive messaging, using former smokers as counselors, and adjusting the language style (spoken vs written) according to the recipients’ preference. Conclusions: This qualitative study provides the first evidence that mobile IM may be an alternative mobile health platform for the delivery of a smoking cessation intervention. Furthermore, the findings inform the development of a chat-based, IM smoking cessation program being evaluated in a community trial. %M 30702431 %R 10.2196/11954 %U https://mhealth.jmir.org/2019/1/e11954/ %U https://doi.org/10.2196/11954 %U http://www.ncbi.nlm.nih.gov/pubmed/30702431 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 6 %N 1 %P e10106 %T Designing Online Interventions in Consideration of Young People’s Concepts of Well-Being: Exploratory Qualitative Study %A Winsall,Megan %A Orlowski,Simone %A Vogl,Gillian %A Blake,Victoria %A Nicholas,Mariesa %A Antezana,Gaston %A Schrader,Geoffrey %A Bidargaddi,Niranjan %+ Personal Health Informatics, Flinders University, 1284 South Road, Clovelly Park, SA 5024, Australia, 61 872218842, niranjan.bidargaddi@flinders.edu.au %K well-being %K youth %K online intervention %K participatory design %K technology %D 2019 %7 30.01.2019 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A key challenge in developing online well-being interventions for young people is to ensure that they are based on theory and reflect adolescent concepts of well-being. Objective: This exploratory qualitative study aimed to understand young people’s concepts of well-being in Australia. Methods: Data were collected via workshops at five sites across rural and metropolitan sites with 37 young people from 15 to 21 years of age, inclusive. Inductive, data-driven coding was then used to analyze transcripts and artifacts (ie, written or image data). Results: Young adults’ conceptions of well-being were diverse, personally contextualized, and shaped by ongoing individual experiences related to physical and mental health, along with ecological accounts acknowledging the role of family, community, and social factors. Key emerging themes were (1) positive emotions and enjoyable activities, (2) physical wellness, (3) relationships and social connectedness, (4) autonomy and control, (5) goals and purpose, (6) being engaged and challenged, and (7) self-esteem and confidence. Participants had no difficulty describing actions that led to positive well-being; however, they only considered their own well-being at times of stress. Conclusions: In this study, young people appeared to think mostly about their well-being at times of stress. The challenge for online interventions is to encourage young people to monitor well-being prior to it becoming compromised. A more proactive focus that links the overall concept of well-being to everyday, concrete actions and activities young people engage in, and that encourages the creation of routine good habits, may lead to better outcomes from online well-being interventions. %M 30698537 %R 10.2196/10106 %U http://humanfactors.jmir.org/2019/1/e10106/ %U https://doi.org/10.2196/10106 %U http://www.ncbi.nlm.nih.gov/pubmed/30698537 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e9711 %T Farm Owners and Workers as Key Informants in User-Centered Occupational Health Prototype Development: A Stakeholder-Engaged Project %A Weichelt,Bryan %A Bendixsen,Casper %A Keifer,Matthew %+ Marshfield Clinic Research Institute, National Farm Medicine Center, 701 W Kalsched Ave, Marshfield, WI, 54449, United States, 1 715 221 7276, weichelt.bryan@mcrf.mfldclin.edu %K agriculture %K farmworkers %K injuries %K occupational medicine %K return to work %K software application %D 2019 %7 29.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The cost of workplace injuries and illnesses significantly impacts the overall cost of health care and is a significant annual economic burden in the United States. Many dairy and pork farm owners in the Upper Midwest have expanded operations and taken on the role of manager and employer yet receive little training in injury prevention, farm safety, or workers’ compensation programs and processes. Clinicians play a key role in the return to work of injured and ill farmers and farmworkers to their jobs, though little to no formal training is offered by medical schools. Objective: This stakeholder-engaged project aimed to develop a prototype application designed to assist clinicians in returning injured farmworkers to light-duty job assignments with their current employers and to assess farm owners’ and managers’ attitudes toward and barriers to adopting mobile health tools for themselves or their employees. Methods: We conducted 12 semistructured interviews with English-speaking farm owners and farmworkers from the Upper Midwest: 5 English-speaking and Spanish-speaking farmworker focus groups and 8 postproject interviews with farm owners that focused on attitudes and barriers to adoption of the developed software. Interviews and focus groups were audio recorded, and data were analyzed and thematically coded using audio coding. Results: Interviews and worker focus groups guided an iterative design and development cycle, which informed workflow design, button placement, and output sheets that offer specific light-duty farm work recommendations for the injured worker to discuss with his or her employer. Conclusions: The development of a complex prototype intended to impact patient care is a significant undertaking. Reinventing a paper-based process that can eventually integrate with an electronic health record or a private company’s human resources system requires substantial stakeholder input from each facet including patients, employers, and clinical care teams. The prototype is available for testing, but further research is needed in the form of clinical trials to assess the effectiveness of the process and the software’s impact on patients and employers. %M 30694202 %R 10.2196/jmir.9711 %U https://www.jmir.org/2019/1/e9711/ %U https://doi.org/10.2196/jmir.9711 %U http://www.ncbi.nlm.nih.gov/pubmed/30694202 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 1 %P e11481 %T How Women Use Digital Technologies for Health: Qualitative Interview and Focus Group Study %A Lupton,Deborah %A Maslen,Sarah %+ News and Media Research Centre, Faculty of Arts & Design, University of Canberra, Building 9, Bruce,, Australia, 61 04 0307 6791, deborah.lupton@canberra.edu.au %K digital health %K websites %K online forums %K social media %K apps %K wearable devices %K women %K Australia %K feminist new materialism %K qualitative research %D 2019 %7 25.01.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: A range of digital technologies are available to lay people to find, share, and generate health-related information. Few studies have directed attention specifically to how women are using these technologies from the diverse array available to them. Even fewer have focused on Australian women’s use of digital health. Objective: The Australian Women and Digital Health Project aimed to investigate which types of digital technologies women used regularly for health-related purposes and which they found most helpful and useful. Qualitative methods—semistructured interviews and focus groups—were employed to shed light on the situated complexities of the participants’ enactments of digital health technologies. The project adopted a feminist new materialism theoretical perspective, focusing on the affordances, relational connections, and affective forces that came together to open up or close off the agential capacities generated with and through these enactments. Methods: The project comprised two separate studies including a total of 66 women. In study 1, 36 women living in the city of Canberra took part in face-to-face interviews and focus groups, while study 2 involved telephone interviews with 30 women from other areas of Australia. Results: The affordances of search engines to locate health information and websites and social media platforms for providing information and peer support were highly used and valued. Affective forces such as the desire for trust, motivation, empowerment, reassurance, control, care, and connection emerged in the participants’ accounts. Agential capacities generated with and through digital health technologies included the capacity to seek and generate information and create a better sense of knowledge and expertise about bodies, illness, and health care, including the women’s own bodies and health, that of their families and friends, and that of their often anonymous online social networks. The participants referred time and again to appreciating the feelings of agency and control that using digital health technologies afforded them. When the technologies failed to work as expected, these agential capacities were not realized. Women responded with feelings of frustration, disappointment, and annoyance, leading them to become disenchanted with the possibilities of the digital technologies they had tried. Conclusions: The findings demonstrate the nuanced and complex ways in which the participants were engaging with and contributing to online sources of information and using these sources together with face-to-face encounters with doctors and other health care professionals and friends and family members. They highlight the lay forms of expertise that the women had developed in finding, assessing, and creating health knowledges. The study also emphasized the key role that many women play in providing advice and health care for family members not only as digitally engaged patients but also as digitally engaged carers. %M 30681963 %R 10.2196/11481 %U http://www.jmir.org/2019/1/e11481/ %U https://doi.org/10.2196/11481 %U http://www.ncbi.nlm.nih.gov/pubmed/30681963 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 5 %N 1 %P e10447 %T Self-Care Behaviors of Ovarian Cancer Patients Before Their Diagnosis: Proof-of-Concept Study %A Flanagan,James M %A Skrobanski,Hanna %A Shi,Xin %A Hirst,Yasemin %+ Division of Cancer, Department of Surgery and Cancer, Imperial College London, Hammersmith Campus, Du Cane Road, London, W12 0NN, United Kingdom, 44 20 75942127, j.flanagan@imperial.ac.uk %K cancer %K early diagnosis %K proof of concept %K focus group %K acceptability %K data linkage %K cancer surveillance %D 2019 %7 17.01.2019 %9 Original Paper %J JMIR Cancer %G English %X Background: Longer patient intervals can lead to more late-stage cancer diagnoses and higher mortality rates. Individuals may delay presenting to primary care with red flag symptoms and instead turn to the internet to seek information, purchase over-the-counter medication, and change their diet or exercise habits. With advancements in machine learning, there is the potential to explore this complex relationship between a patient’s symptom appraisal and their first consultation at primary care through linkage of existing datasets (eg, health, commercial, and online). Objective: Here, we aimed to explore feasibility and acceptability of symptom appraisal using commercial- and health-data linkages for cancer symptom surveillance. Methods: A proof-of-concept study was developed to assess the general public’s acceptability of commercial- and health-data linkages for cancer symptom surveillance using a qualitative focus group study. We also investigated self-care behaviors of ovarian cancer patients using high-street retailer data, pre- and postdiagnosis. Results: Using a high-street retailer’s data, 1118 purchases—from April 2013 to July 2017—by 11 ovarian cancer patients and one healthy individual were analyzed. There was a unique presence of purchases for pain and indigestion medication prior to cancer diagnosis, which could signal disease in a larger sample. Qualitative findings suggest that the public are willing to consent to commercial- and health-data linkages as long as their data are safeguarded and users of this data are transparent about their purposes. Conclusions: Cancer symptom surveillance using commercial data is feasible and was found to be acceptable. To test efficacy of cancer surveillance using commercial data, larger studies are needed with links to individual electronic health records. %M 30664464 %R 10.2196/10447 %U https://cancer.jmir.org/2019/1/e10447/ %U https://doi.org/10.2196/10447 %U http://www.ncbi.nlm.nih.gov/pubmed/30664464 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 1 %P e11246 %T Text Messaging to Enhance Mindfulness-Based Smoking Cessation Treatment: Program Development Through Qualitative Research %A Spears,Claire A %A Bell,Sharrill A %A Scarlett,Charlayne A %A Anderson,Natalie K %A Cottrell-Daniels,Cherell %A Lotfalian,Sadaf %A Bandlamudi,Maitreyi %A Grant,Amanda %A Sigurdardottir,Anna %A Carter,Brittani P %A Abroms,Lorien C %A Wetter,David W %+ Division of Health Promotion and Behavior, Georgia State University School of Public Health, 140 Decatur Street SE, Suite 612, Atlanta, GA, United States, 1 404 413 9335, cspears@gsu.edu %K mobile phone %K low socioeconomic status %K qualitative %K short message service text messaging %K smoking cessation %D 2019 %7 07.01.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mindfulness-based programs show promise for promoting smoking cessation in diverse populations. Mobile health strategies could increase treatment engagement and in-the-moment support, thus enhancing the effects of mindfulness-based smoking cessation interventions. However, most mobile health programs have been developed without sufficient input from the target population. Objective: By eliciting input from the target population, predominantly low socioeconomic status (SES) African American adult smokers, throughout the development of an SMS (short message service) text messaging program that teaches mindfulness for smoking cessation, we aimed for the resulting program to be optimally effective and consistent with participants’ needs and preferences. Methods: Two qualitative studies (N=25) were conducted with predominantly low SES, African American adult smokers. In Study 1 (initial qualitative input; n=15), participants engaged in focus groups to provide suggestions for program development. In Study 2 (abbreviated trial; n=10), participants received a 1-week version of the SMS text messaging program and provided feedback through in-depth interviews. Results: In Study 1, participants suggested that the SMS text messaging program should be personalized and interactive (ie, involve two-way messaging); provide strategies for coping with cravings and recovering from smoking lapses; involve relatively short, to-the-point messages; and include pictures. In Study 2, participants were highly engaged with the texts, indicated that the program was useful, and provided additional suggestions for improvement. Conclusions: Eliciting feedback from the target population throughout the intervention development process allowed for iterative revisions to increase feasibility, acceptability, and effectiveness. Overall, SMS text messaging appears to be a feasible, appealing way to provide in-the-moment personalized support and encourage mindfulness among low-income African American smokers. %M 30617043 %R 10.2196/11246 %U https://mhealth.jmir.org/2019/1/e11246/ %U https://doi.org/10.2196/11246 %U http://www.ncbi.nlm.nih.gov/pubmed/30617043 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 1 %P e10944 %T Community Engagement in the Development of an mHealth-Enabled Physical Activity and Cardiovascular Health Intervention (Step It Up): Pilot Focus Group Study %A Ceasar,Joniqua Nashae %A Claudel,Sophie Elizabeth %A Andrews,Marcus R %A Tamura,Kosuke %A Mitchell,Valerie %A Brooks,Alyssa T %A Dodge,Tonya %A El-Toukhy,Sherine %A Farmer,Nicole %A Middleton,Kimberly %A Sabado-Liwag,Melanie %A Troncoso,Melissa %A Wallen,Gwenyth R %A Powell-Wiley,Tiffany M %+ National Heart, Lung, and Blood Institute, National Institutes of Health, Building 10-CRC, Room 5-5332, MSC 1454, 10 Center Drive, Bethesda, MD, 20892, United States, 1 301 594 3735, tiffany.powell-wiley@nih.gov %K cardiovascular health %K community-based participatory research %K health behaviors %K mHealth %K mobile phone %K physical activity %K qualitative data %D 2019 %7 04.01.2019 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Community-based participatory research is an effective tool for improving health outcomes in minority communities. Few community-based participatory research studies have evaluated methods of optimizing smartphone apps for health technology-enabled interventions in African Americans. Objective: This study aimed to utilize focus groups (FGs) for gathering qualitative data to inform the development of an app that promotes physical activity (PA) among African American women in Washington, DC. Methods: We recruited a convenience sample of African American women (N=16, age range 51-74 years) from regions of Washington, DC metropolitan area with the highest burden of cardiovascular disease. Participants used an app created by the research team, which provided motivational messages through app push notifications and educational content to promote PA. Subsequently, participants engaged in semistructured FG interviews led by moderators who asked open-ended questions about participants’ experiences of using the app. FGs were audiorecorded and transcribed verbatim, with subsequent behavioral theory-driven thematic analysis. Key themes based on the Health Belief Model and emerging themes were identified from the transcripts. Three independent reviewers iteratively coded the transcripts until consensus was reached. Then, the final codebook was approved by a qualitative research expert. Results: In this study, 10 main themes emerged. Participants emphasized the need to improve the app by optimizing automation, increasing relatability (eg, photos that reflect target demographic), increasing educational material (eg, health information), and connecting with community resources (eg, cooking classes and exercise groups). Conclusions: Involving target users in the development of a culturally sensitive PA app is an essential step for creating an app that has a higher likelihood of acceptance and use in a technology-enabled intervention. This may decrease health disparities in cardiovascular diseases by more effectively increasing PA in a minority population. %M 30684422 %R 10.2196/10944 %U https://formative.jmir.org/2019/1/e10944/ %U https://doi.org/10.2196/10944 %U http://www.ncbi.nlm.nih.gov/pubmed/30684422 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 12 %P e11872 %T Development of an Internet-Based Cognitive Behavioral Therapy Self-Help Program for Arabic-Speaking Immigrants: Mixed-Methods Study %A Nygren,Tomas %A Berg,Matilda %A Sarkohi,Ali %A Andersson,Gerhard %+ Department of Behavioural Sciences and Learning, Linköping University, I:Building, Campus Valla, Linköping,, Sweden, 46 760733837, tomas.nygren@liu.se %K internet %K cognitive behavioral therapy %K Arabs %K focus groups %D 2018 %7 18.12.2018 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Recent years have seen an increase in Arabic-speaking immigrants in Sweden and other European countries, with research showing this group to suffer from elevated levels of various forms of psychological disorders. There is a lack of treatment options for immigrants with mild to moderate mental health problems, with barriers including lack of accessible services and concerns that problems will not be understood by health care providers. Objective: This study aims to describe the process of developing a transdiagnostic internet-based cognitive behavioral therapy self-help program in Arabic for mild to moderate symptoms of common psychological problems such as anxiety, depression, and insomnia. Methods: The iterative development process, including feedback from 105 pilot users as well as 2 focus groups, is described. Results: Overall, the modules were rated as acceptable by the pilot users, with overall ratings ranging from 3 to 4 points on average for the respective modules on a 5-point Likert scale. Feedback from the 2 focus groups was overall positive with regard to the content and structure of the program but also included suggestions for improving the Arabic translation as well as the usability of the material. Conclusions: An internet-based self-help program that is deemed acceptable by an Arabic-speaking audience can be successfully developed, thus providing increased access to psychological help for an at-risk population. However, further research regarding the efficacy of this type of intervention is warranted. %M 30563819 %R 10.2196/11872 %U http://www.researchprotocols.org/2018/12/e11872/ %U https://doi.org/10.2196/11872 %U http://www.ncbi.nlm.nih.gov/pubmed/30563819 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e22 %T Assessing the Needs and Perspectives of Patients With Asthma and Chronic Obstructive Pulmonary Disease on Patient Web Portals: Focus Group Study %A Metting,Esther %A Schrage,Aaltje Jantine %A Kocks,Janwillem WH %A Sanderman,Robbert %A van der Molen,Thys %+ Groningen Research Institute for Asthma and COPD, Department of General Practice and Elderly Care Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 4, Groningen, 9713 AW, Netherlands, 31 6 2564 7087, e.i.metting@umcg.nl %K asthma %K chronic obstructive pulmonary disease %K health care %K health literacy %K internet %K electronic medical record %K self-management %D 2018 %7 22.11.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: As accessibility to the internet has increased in society, many health care organizations have developed patient Web portals (PWPs), which can provide a range of self-management options to improve patient access. However, the available evidence suggests that they are used inefficiently and do not benefit patients with low health literacy. Asthma and chronic obstructive pulmonary disease (COPD) are common chronic diseases that require ongoing self-management. Moreover, patients with COPD are typically older and have lower health literacy. Objective: This study aimed to obtain and present an overview of patients’ perspectives of PWPs to facilitate the development of a portal that better meets the needs of patients with asthma and COPD. Methods: We performed a focus group study using semistructured interviews in 3 patient groups from the north of the Netherlands who were recruited through the Dutch Lung Foundation. Each group met 3 times for 2 hours each at a 1-week interval. Data were analyzed with coding software, and patient descriptors were analyzed with nonparametric tests. The consolidated criteria for reporting qualitative research were followed when conducting the study. Results: We included 29 patients (16/29, 55% male; mean age 65 [SD 10] years) with COPD (n=14), asthma-COPD overlap (n=4), asthma (n=10), or other respiratory disease (n=1). There was a large variation in the internet experience; some patients hardly used the internet (4/29, 14%), whereas others used internet >3 times a week (23/29, 79%). In general, patients were positive about having access to a PWP, considering access to personal medical records as the most important option, though only after discussion with their physician. A medication overview was considered a useful option. We found that communication between health care professionals could be improved if patients could use the PWP to share information with their health care professionals. However, as participants were worried about the language and usability of portals, it was recommended that language should be adapted to the patient level. Another concern was that disease monitoring through Web-based questionnaire use would only be useful if the results were discussed with health care professionals. Conclusions: Participants were positive about PWPs and considered them a logical step. Today, most patients tend to be better educated and have internet access, while also being more assertive and better informed about their disease. A PWP could support these patients. Our participants also provided practical suggestions for implementation in current and future PWP developments. The next step will be to develop a portal based on these recommendations and assess whether it meets the needs of patients and health care providers. %M 30684436 %R 10.2196/formative.8822 %U http://formative.jmir.org/2018/2/e22/ %U https://doi.org/10.2196/formative.8822 %U http://www.ncbi.nlm.nih.gov/pubmed/30684436 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 11 %P e288 %T Clinicians’ Selection Criteria for Video Visits in Outpatient Care: Qualitative Study %A Sturesson,Linda %A Groth,Kristina %+ Centre for Innovation, Karolinska University Hospital, C1:77 Huddinge, Stockholm,, Sweden, 46 700856664, kristina.groth@sll.se %K outpatient care %K selection criteria %K telemedicine %K telehealth %K ethnography %D 2018 %7 05.11.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Video visits with patients were introduced into outpatient care at a hospital in Sweden. New behaviors and tasks emerged due to changes in roles, work processes, and responsibilities. This study investigates the effects of the digital transformation—in this case, how video visits in outpatient care change work processes and introduce new tasks—to further improve the concept of video visits. The overarching goal was to increase the value of these visits, with a focus on the value of conducting the treatment for the patient. Objective: Through the real-time, social interactional features of preparing for and conducting video visits with patients with obesity, this study examines which patients the clinicians considered suitable for video visits and why. The aim was to identify the criteria used by clinicians when selecting patients for video visits to understand what criteria the clinicians used as the grounds for their selection. Methods: Qualitative methods were used, including 13 observations of video visits at 2 different clinics and 14 follow-up interviews with clinicians. Transcripts of interviews and field notes were thematically analyzed, discussed, and synthesized into themes. Results: From the interviews, 20 different arguments for selecting a specific patient for video visits were identified. Analyzing interviews and field notes also revealed unexpressed arguments that played a part in the selection process. The unexpressed arguments, as well as the implicit reasons, for why a patient was given the option of video visits can be understood as the selection criteria for helping clinicians in their decision about whether to offer video visits or not. The criteria identified in the collected data were divided into 3 themes: practicalities, patient ability, and meeting content. Conclusions: Not all patients with obesity undergoing treatment programs should be offered video visits. Patients’ new responsibilities could influence the content of the meeting and the progress of the treatment program. The selection criteria developed and used by the clinicians could be a tool for finding a balance between what the patient wants and what the clinician thinks the patient can manage and achieving good results in the treatment program. The criteria could also reduce the number and severity of disturbances and limitations during the meeting and could be used to communicate the requirements they represent to the patient. Some of the criteria are based on facts, whereas others are subjective. A method for how and when to involve the patient in the selection process is recommended as it may strengthen the patient’s sense of responsibility and the relationship with the clinician. %M 30401661 %R 10.2196/jmir.9851 %U https://www.jmir.org/2018/11/e288/ %U https://doi.org/10.2196/jmir.9851 %U http://www.ncbi.nlm.nih.gov/pubmed/30401661 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e10158 %T Web-Based Health Intervention for Young People Who Have a Parent with a Mental Illness: Delphi Study Among Potential Future Users %A Matar,Jodie L %A Maybery,Darryl J %A McLean,Louise A %A Reupert,Andrea %+ Education, Psychology Programs, Monash University, 19 Ancora Imparo Way, Clayton, 3800, Australia, 61 399024587, andrea.reupert@monash.edu %K Delphi studies %K early medical intervention %K internet %K preventative health %K Web-based intervention %K youth %D 2018 %7 31.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Young people who have a parent with a mental illness face elevated risks to their mental health and well-being. However, they may not have access to appropriate interventions. Web-based interventions may reach and meet the needs of this at-risk group, yet their preferences regarding the features of this medium are unknown. Objective: This study sought to determine the utility of a Web-based intervention to meet the needs of young people who have a parent with a mental illness and their perspectives regarding the types of features of such a website. Methods: A systematic, 2-round Delphi study was employed to solicit the views of 282 young people aged 16 to 21 years (Round 1, n=14; Round 2, n=268) from urban and regional settings in Australia who self-reported that their parent has a mental illness. “Regional” was used to refer to nonurban participants in the study. After ascertaining whether a Web-based intervention was warranted, Web-based intervention features were identified, including how the site might be facilitated, topics, duration and frequency, and the nature of the professional contact. The extent to which young people agreed on the importance of these factors was assessed. Differences and similarities across gender and location were investigated. A mixed method analytic framework was employed using thematic analysis as well as 2-way between-groups analysis of covariance (ANCOVA) controlling for age and chi-square test of independence analysis. Results: Both rounds highlighted a strong preference for a Web-based intervention. Consensus was reached for a professionally monitored site, young people and professionals having equal input into the weekly facilitated sessions (eg, sharing the lead role in discussions or deciding on relevant session content), unlimited time access, 1-hour, open discussion, weekly sessions over 6 weeks, psychoeducation about mental illness, and considerations for the management of safety violations. There were significant main effects of location type and several of the preferred features for a Web-based intervention for young people who have a parent with a mental illness. However, effect sizes were small to moderate, limiting practical application. Conclusions: Young people aged 16 to 21 years indicated a need for a professionally monitored, psychoeducational, Web-based intervention, with input from professional facilitators and other young people who have a parent with a mental illness, in addition to recommendations to external resources. These findings may inform the development of future Web-based interventions for this highly vulnerable group. %M 30381281 %R 10.2196/10158 %U http://www.jmir.org/2018/10/e10158/ %U https://doi.org/10.2196/10158 %U http://www.ncbi.nlm.nih.gov/pubmed/30381281 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 4 %P e10091 %T Early Psychosis Service User Views on Digital Technology: Qualitative Analysis %A Bucci,Sandra %A Morris,Rohan %A Berry,Katherine %A Berry,Natalie %A Haddock,Gillian %A Barrowclough,Christine %A Lewis,Shôn %A Edge,Dawn %+ Manchester Academic Health Science Centre, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Zochonis Building, 2nd Floor, Brunswick Street, Manchester, M139PL, United Kingdom, 44 1613060422, sandra.bucci@manchester.ac.uk %K qualitative %K psychosis %K framework analysis %K digital health %K mHealth %K mobile phone %D 2018 %7 31.10.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Digital technology has the potential to improve outcomes for people with psychosis. However, to date, research has largely ignored service user views on digital health interventions (DHIs). Objective: The objective of our study was to explore early psychosis service users’ subjective views on DHIs. Methods: Framework analysis was undertaken with data obtained from 21 semistructured interviews with people registered with early intervention for psychosis services. Robust measures were used to develop a stable framework, including member checking, triangulation, independent verification of themes, and consensus meetings. Results: The following 4 themes were established a priori: acceptability of technology in psychosis and mental health; technology increasing access to and augmenting mental health support; barriers to adopting DHIs; and concerns about management of data protection, privacy, risk, and security of information. The following 2 themes were generated a posteriori: blending DHIs with face-to-face treatment and empowerment, control, and choice. DHIs were also viewed as potentially destigmatizing, overcoming barriers faced in traditional service settings, facilitating communication, and empowering service users to take active control of their health care. Conclusions: In the first study of its kind, early psychosis service users’ were largely positive about the potential use of DHIs supporting and managing mental health. Overall, service users felt that DHIs were a progressive, modern, and relevant platform for health care delivery. Concerns were expressed around privacy and data security and practical barriers inherent within DHIs, all of which require further attention. Future research should explore whether findings transfer to other service user groups, other technology delivery formats, and across a range of treatment modalities. %M 30381280 %R 10.2196/10091 %U http://mental.jmir.org/2018/4/e10091/ %U https://doi.org/10.2196/10091 %U http://www.ncbi.nlm.nih.gov/pubmed/30381280 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 2 %N 2 %P e10183 %T Multidisciplinary Smartphone-Based Interventions to Empower Patients With Acute Coronary Syndromes: Qualitative Study on Health Care Providers’ Perspectives %A Bashi,Nazli %A Hassanzadeh,Hamed %A Varnfield,Marlien %A Wee,Yong %A Walters,Darren %A Karunanithi,Mohanraj %+ Australian e-Health Research Centre, Level 5 - UQ Health Sciences Building 901/16, Royal Brisbane and Women's Hospital, Herston, 4029, Australia, 61 7 3253 3611, nazli.bashi@csiro.au %K acute coronary syndrome %K focus group %K health care professionals %K mobile phone %K multidisciplinary %K thematic analysis %D 2018 %7 31.10.2018 %9 Original Paper %J JMIR Cardio %G English %X Background: Postdischarge interventions are limited in patients with acute coronary syndrome (ACS) due to few scheduled visits to outpatient clinics and travel from remote areas. Smartphones have become a viable lifestyle technology to deliver educational and health interventions following discharge from hospital. Objective: The purpose of this study was to identify the requirements for the delivery of a mobile health intervention for the postdischarge management of patients with ACS via a multidisciplinary focus group. Methods: We conducted a focus group among health care professionals (n=10) from a large metropolitan hospital in May 2017. These participants from a multidisciplinary team contributed to a 1-hour discussion by responding to 8 questions relating to the applicability of smartphone-based educational and health interventions. Descriptive statistics of the focus group data were analyzed using SPSS. The qualitative data were analyzed according to relevant themes extracted from the focus group transcription, using a qualitative description software program (NVivo 11) and an ontology-based concept mapping approach. Results: The mean age of the participants was 47 (SD 8) years: 3 cardiologists; 2 nurse practitioners; 2 clinical nurses; 2 research scientists; and 1 physiotherapist. Of these participants, 70% (7/10) had experience using electronic health intervention during their professional practice. A total of 7 major themes and their subthemes emerged from the qualitative analysis. Health care providers indicated that comprehensive education on diet, particularly providing daily meal plans, is critical for patients with ACS. In terms of ACS symptoms, a strong recommendation was to focus on educating patients instead of daily monitoring of chest pain and shortness of breathing due to subjectivity and insufficient information for clinicians. Participants pointed that monitoring health measures such as blood pressure and body weight may result in increased awareness of patient physical health, yet may not be sufficient to support patients with ACS via the smartphone-based intervention. Therefore, monitoring pain and emotional status along with other health measures was recommended. Real-time support via FaceTime or video conferencing was indicated as motivational and supportive for patient engagement and self-monitoring. The general demographics of patients with ACS being older, having a low educational level, and a lack of computer skills were identified as potential barriers for engagement with the smartphone-based intervention. Conclusions: A smartphone-based program that incorporates the identified educational materials and health interventions would motivate patients with ACS to engage in the multidisciplinary intervention and improve their health outcomes following discharge from hospital. %M 31758781 %R 10.2196/10183 %U http://cardio.jmir.org/2018/2/e10183/ %U https://doi.org/10.2196/10183 %U http://www.ncbi.nlm.nih.gov/pubmed/31758781 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 1 %N 2 %P e10973 %T Feasibility and Conceptualization of an e-Mental Health Treatment for Depression in Older Adults: Mixed-Methods Study %A Eichenberg,Christiane %A Schott,Markus %A Sawyer,Adam %A Aumayr,Georg %A Plößnig,Manuela %+ Sigmund Freud Privat Universität Wien, Freudpl. 1, Vienna, 1020, Austria, 43 15124049991, markus.s.c.schott@gmail.com %K depression %K online therapy %K e-mental health %D 2018 %7 23.10.2018 %9 Original Paper %J JMIR Aging %G English %X Background: Depression is one of the most common mental disorders in older adults. Unfortunately, it often goes unrecognized in the older population. Objective: The aim of this study was to identify how Web-based apps can recognize and help treat depression in older adults. Methods: Focus groups were conducted with mental health care experts. A Web-based survey of 56 older adults suffering from depression was conducted. Qualitative interviews were conducted with 2 individuals. Results: Results of the focus groups highlighted that there is a need for a collaborative care platform for depression in old age. Findings from the Web-based study showed that younger participants (aged 50 to 64 years) used electronic media more often than older participants (aged 65 years and older). The interviews pointed in a comparable direction. Conclusions: Overall, an e-mental (electronic mental) health treatment for depression in older adults would be well accepted. Web-based care platforms should be developed, evaluated, and in case of evidence for their effectiveness, integrated into the everyday clinic. %M 31518235 %R 10.2196/10973 %U http://aging.jmir.org/2018/2/e10973/ %U https://doi.org/10.2196/10973 %U http://www.ncbi.nlm.nih.gov/pubmed/31518235 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 10 %P e182 %T mHealth App Patient Testing and Review of Educational Materials Designed for Self-Management of Gout Patients: Descriptive Qualitative Studies %A Nguyen,Amy D %A Frensham,Lauren J %A Wong,Michael XC %A Meslin,Sylvain MM %A Martin,Paige %A Lau,Annie YS %A Baysari,Melissa T %A Day,Richard O %+ Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Sydney, 2109, Australia, 61 2 9850 2412, amy.nguyen@mq.edu.au %K mobile apps %K gout %K self-management %K chronic disease %K uric acid %D 2018 %7 15.10.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Gout is a form of chronic arthritis caused by elevated serum uric acid (SUA) and culminates in painful gout attacks. Although effective uric acid-lowering therapies exist, adherence is low. This is partly due to the lack of support for patients to self-manage their disease. Mobile health apps have been used in the self-management of chronic conditions. However, not all are developed with patients, limiting their effectiveness. Objective: The objective of our study was to collect feedback from gout patients to design an effective gout self-management app. Methods: Two descriptive qualitative studies were conducted. In Study 1, researchers developed a short educational video and written materials about gout management, designed to be embedded into an app; 6 interviews and 1 focus group were held with gout patients to gather feedback on these materials. Usability testing in Study 2 involved additional gout patients using a pilot version of Healthy.me Gout, a gout self-management app, for 2 weeks. Following the trial, patients participated in an interview about their experiences using the app. Results: Patients viewed the gout educational material positively, appreciating the combined use of video, text, and images. Patients were receptive to using a mobile app to self-manage their gout. Feedback about Healthy.me Gout was generally positive with patients reporting that the tracking and diary features were most useful. Patients also provided suggestions for improving the app and educational materials. Conclusions: These studies involved patients in the development of a gout self-management app. Patients provided insight to improve the app’s presentation and usability and general lessons on useful features for chronic disease apps. Gout patients enjoyed tracking their SUA concentrations and gout attack triggers. These capabilities can be translated into self-management apps for chronic diseases that require monitoring of pathological values, medication adherence, or symptoms. Future health app design should integrate patient input and be developed iteratively to address concerns identified by patients. %M 30322835 %R 10.2196/mhealth.9811 %U http://mhealth.jmir.org/2018/10/e182/ %U https://doi.org/10.2196/mhealth.9811 %U http://www.ncbi.nlm.nih.gov/pubmed/30322835 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 4 %P e10213 %T Digital Gaming to Improve Adherence Among Adolescents and Young Adults Living With HIV: Mixed-Methods Study to Test Feasibility and Acceptability %A Castel,Amanda D %A Qasmieh,Saba %A Greenberg,Daniel %A Ellenberger,Nicole %A Howell,Tyriesa Howard %A Griffith,Caleb %A Wilbourn,Brittany C %A Ganesan,Kavitha %A Hussein,Nadia %A Ralte,Gabriel %A Rakhmanina,Natella %+ Department of Epidemiology and Biostatistics, Milken Institute School of Public Health, George Washington University, 5th Floor, 950 New Hampshire Avenue Northwest, Washington, DC,, United States, 1 202 994 8325, acastel@gwu.edu %K youth %K HIV %K adherence %K video games %K Wisepill %K adolescents %K digital technology %K serious games %D 2018 %7 15.10.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: An estimated 50% of adolescents and young adults (AYA) living with HIV are failing to adhere to prescribed antiretroviral treatment (ART). Digital games are effective in chronic disease management; however, research on gaming to improve ART adherence among AYA is limited. Objective: We assessed the feasibility and acceptability of video gaming to improve AYA ART adherence. Methods: Focus group discussions and surveys were administered to health care providers and AYA aged 13 to 24 years living with HIV at a pediatric HIV program in Washington, DC. During focus group discussions, AYA viewed demonstrations of 3 game prototypes linked to portable Wisepill medication dispensers. Content analysis strategies and thematic coding were used to identify adherence themes and gaming acceptance and feasibility. Likert scale and descriptive statistics were used to summarize response frequencies. Results: Providers (n=10) identified common adherence barriers and strategies, including use of gaming analogies to improve AYA ART adherence. Providers supported exploration of digital gaming as an adherence intervention. In 6 focus group discussions, 12 AYA participants identified disclosure of HIV status and irregular daily schedules as major barriers to ART and use of alarms and pillboxes as reminders. Most AYA were very or somewhat likely to use the demonstrated game prototypes to help with ART adherence and desired challenging, individually tailored, user-friendly games with in-game incentives. Game prototypes were modified accordingly. Conclusions: AYA and their providers supported the use of digital games for ART adherence support. Individualization and in-game incentives were preferable and informed the design of an interactive technology-based adherence intervention among AYA living with HIV. %M 30322838 %R 10.2196/10213 %U http://games.jmir.org/2018/4/e10213/ %U https://doi.org/10.2196/10213 %U http://www.ncbi.nlm.nih.gov/pubmed/30322838 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 4 %P e29 %T Developing Culturally Sensitive mHealth Apps for Caribbean Immigrant Women to Use During Pregnancy: Focus Group Study %A AlJaberi,Hana %+ Department of Computer Graphics Technology, Purdue Polytechnic Institute, Purdue University, Knoy Hall, 401 N Grant St, West Lafayette, IN, 47907, United States, 1 765 494 7505, aljaberi.hana@gmail.com %K mHealth %K human computer interaction %K prenatal health %K Caribbean %K immigrant women %K mobile phone %D 2018 %7 10.10.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A valuable addition to the mobile health (mHealth) space is an exploration of the context of minorities in developed countries. The transition period postmigration, culture, and socioeconomic uniqueness of migratory groups can shed light on the problems with existing prenatal mHealth apps. Objective: The objectives of this study were to (1) use the theoretical concept of pregnancy ecology to understand the emotional, physical, information, and social challenges affecting low-income Caribbean immigrant women’s prenatal well-being practices and (2) develop a deep understanding of challenges worthy of consideration in mHealth design for these women. Methods: This qualitative interpretive approach using analytical induction presents the findings of 3 focus group sessions with 12 Caribbean immigrant women living in South Florida in the United States. The study took place from April to September 2015. Results: The participants revealed problematic tiers and support needs within the pregnancy ecology including emotional stressors caused by family separation, physical challenges, information gaps, and longing for social support. Conclusions: mHealth interventions for low-income Caribbean immigrant women must be designed beyond the conventional way of focusing on the events surrounding the unborn child. It can be tailored to the needs of the expecting mother. Pregnancy information should be customized on the basis of the variability of lifestyle, cultural practices, socioeconomic status, and social ties while still being able to deliver appropriate guidelines and clear cultural misconceptions. %M 30305256 %R 10.2196/humanfactors.9787 %U http://humanfactors.jmir.org/2018/4/e29/ %U https://doi.org/10.2196/humanfactors.9787 %U http://www.ncbi.nlm.nih.gov/pubmed/30305256 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 8 %P e173 %T Assessing the Cross-Cultural Adaptation and Translation of a Text-Based Mobile Smoking Cessation Program in Samoa (TXTTaofiTapaa): Pilot Study %A McCool,Judith %A Tanielu,Helen %A Umali,Elaine %A Whittaker,Robyn %+ Department of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Private Bag 92019, Auckland, 1141, New Zealand, 64 09 373 7599 ext 82372, j.mccool@auckland.ac.nz %K mHealth %K mobile phone %K Pacific %K Samoa %K tobacco cessation %K text messages %D 2018 %7 31.08.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Samoa faces a persistently high prevalence of adult tobacco use and few existing cessation support services. Mobile phones are ubiquitous and generally affordable. Objective: This study aimed to adopt a text message (short message service, SMS) smoking cessation program designed in New Zealand (stop smoking with mobile phones, STOMP) for use in Samoa to assist national objectives in reducing the tobacco use. Methods: Using focus groups with smokers and ex-smokers, we explored the context for tobacco use and preferences for SMS text messages. Postintervention focus groups were held after participants received SMS text messages for 1 week. Frequent face-to-face meetings with the primary partner (Ministry of Health Samoa) and key stakeholders contributed to the adaptation process. Participatory feedback and collaboration from stakeholders became an integral part of the cultural adaptation and translation of the program. Furthermore, detailed document analyses were included as part of the formal evaluation of the initiative to explore the core determinants of success in adapting the program to the Samoan cultural context. Results: The SMS text messages evolved remarkably following an iterative process of consultation, in situ testing, revision, and retesting to arrive at an acceptable country-specific version of the mobile smoking cessation program. The SMS text messages retained in the final set were consistent with the theory of behavioral change but reflected both linguistic and cultural nuances appropriate for Samoa. Adapting messages required simultaneous multilevel processes, including complex high-level engagement, between the team and the stakeholders, along with crafting the precise content for (character limited) messages. Conclusions: Receiving cessation support messages through a mobile phone is promising and appears to be an acceptable and accessible mode of delivery for tobacco cessation, particularly in the absence of alternative support. Adapting a text-based program in Samoa requires fastidious attention to the nuances of culture, language, and sociopolitical structures in the country. %M 30170994 %R 10.2196/mhealth.9033 %U http://mhealth.jmir.org/2018/8/e173/ %U https://doi.org/10.2196/mhealth.9033 %U http://www.ncbi.nlm.nih.gov/pubmed/30170994 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 2 %P e10411 %T Utilizing a Prototype Patient-Controlled Electronic Health Record in Germany: Qualitative Analysis of User-Reported Perceptions and Perspectives %A Poss-Doering,Regina %A Kunz,Aline %A Pohlmann,Sabrina %A Hofmann,Helene %A Kiel,Marion %A Winkler,Eva C %A Ose,Dominik %A Szecsenyi,Joachim %+ Department of General Practice and Health Services Research, University Hospital Heidelberg, Marsilius Arkaden, Tower West, 4th Floor, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 56 ext 38643, regina.poss-doering@med.uni-heidelberg.de %K personal patient-controlled electronic health record %K eHealth %K nationwide implementation %K continuity of care %D 2018 %7 03.08.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: Personal electronic health records (PHR) are considered instrumental in improving health care quality and efficiency, enhancing communication between all parties involved and strengthening the patient’s role. Technical architectures, data privacy, and applicability issues have been discussed for many years. Nevertheless, nationwide implementation of a PHR is still pending in Germany despite legal regulations provided by the eHealth Act passed in 2015. Within the information technology for patient-oriented care project funded by the Federal Ministry of Education and Research (2012-2017), a Web-based personal electronic health record prototype (PEPA) was developed enabling patient-controlled information exchange across different care settings. Gastrointestinal cancer patients and general practitioners utilized PEPA during a 3-month trial period. Both patients and physicians authorized by them could view PEPA content online and upload or download files. Objective: This paper aims to outline findings of the posttrial qualitative study carried out to evaluate user-reported experiences, perceptions, and perspectives, focusing on their interpretation of PEPA beyond technical usability and views on a future nationwide implementation. Methods: Data were collected through semistructured guide-based interviews with 11 patients and 3 physicians (N=14). Participants were asked to share experiences, views of perceived implications, and perspectives towards nationwide implementation. Further data were generated through free-text fields in a subsequent study-specific patient questionnaire and researcher’s notes. Data were pseudonymized, audiotaped, and transcribed verbatim. Content analysis was performed through the Framework Analysis approach. All qualitative data were systemized by using MAXQDA Analytics PRO 12 (Rel.12.3.1). Additionally, participant characteristics were analyzed descriptively using IBM SPSS Statistics Version 24. Results: Users interpreted PEPA as a central medium containing digital chronological health-related documentation that simplifies information sharing across care settings. While patients consider the implementation of PEPA in Germany in the near future, physicians are more hesitant. Both groups believe in PEPA’s concept, but share awareness of concerns about data privacy and older or impaired people’s abilities to manage online records. Patients perceive benefits for involvement in treatment processes and continuity of care but worry about financing and the implementation of functionally reduced versions. Physicians consider integration into primary systems critical for interoperability but anticipate technical challenges, as well as resistance from older patients and colleagues. They omit clear positioning regarding PEPA’s potential incremental value for health care organizations or the provider-patient relationship. Conclusions: Digitalization in German health care will continue to bring change, both organizational and in the physician-patient relationship. Patients endorse and expect a nationwide PEPA implementation, anticipating various benefits. Decision makers and providers need to contribute to closing modernization gaps by committing to new concepts and by invigorating transformed roles. %M 30684411 %R 10.2196/10411 %U http://formative.jmir.org/2018/2/e10411/ %U https://doi.org/10.2196/10411 %U http://www.ncbi.nlm.nih.gov/pubmed/30684411 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e10211 %T A Realistic Talking Human Embodied Agent Mobile Phone Intervention to Promote HIV Medication Adherence and Retention in Care in Young HIV-Positive African American Men Who Have Sex With Men: Qualitative Study %A Dworkin,Mark %A Chakraborty,Apurba %A Lee,Sangyoon %A Monahan,Colleen %A Hightow-Weidman,Lisa %A Garofalo,Robert %A Qato,Dima %A Jimenez,Antonio %+ Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 W Taylor Street, Chicago, IL, 60612, United States, 1 312 413 0348, mdworkin@uic.edu %K adherence %K mHealth %K HIV %K African American %K men who have sex with men %K avatar, embodied agent %D 2018 %7 31.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Avatars and embodied agents are a promising innovation for human health intervention because they may serve as a relational agent that might augment user engagement in a behavioral change intervention and motivate behavioral change such as antiretroviral adherence and retention in care. Objective: This study aimed to develop a theory-driven talking avatar-like embodied agent mobile phone intervention guided by the information-motivation-behavioral skills model to promote HIV medication adherence and retention in care in young African American men who have sex with men (MSM). Methods: We performed 5 iterative focus groups in Chicago with HIV-positive African American MSM aged 18-34 years to inform the ongoing development of a mobile phone app. Participants for the focus groups were recruited from 4 University of Illinois at Chicago Community Outreach Intervention Project sites located in different high HIV incidence areas of the city and the University of Illinois at Chicago HIV clinic using fliers and word of mouth. The focus group data analysis included developing an ongoing list of priorities for app changes and discussion between two of the investigators based on the project timeline, resources, and to what extent they served the app’s objectives. Results: In this study, 16 men participated, including 3 who participated in two groups. The acceptability for an embodied agent app was universal in all 5 focus groups. The app included the embodied agent response to questions and antiretroviral regimen information, adherence tracking, CD4 count and viral load tracking, motivational spoken messages, and customizability. Concerns that were identified and responded to in the development process included privacy, stigma, avoiding the harsh or commanding tone of voice, avoiding negative motivational statements, and making reminder functions for a variety of health care interactions. Conclusions: An avatar-like embodied agent mHealth approach was acceptable to young HIV-positive African American MSM. Its relational nature may make it an effective method of informing, motivating, and promoting health behavioral skills. Furthermore, the app’s ease of access, stigma-free environment, and audiovisual format may help overcome some adherence barriers reported in this population. %M 30064971 %R 10.2196/10211 %U http://mhealth.jmir.org/2018/7/e10211/ %U https://doi.org/10.2196/10211 %U http://www.ncbi.nlm.nih.gov/pubmed/30064971 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 7 %P e10671 %T You Will Know That Despite Being HIV Positive You Are Not Alone: Qualitative Study to Inform Content of a Text Messaging Intervention to Improve Prevention of Mother-to-Child HIV Transmission %A Fairbanks,Jade %A Beima-Sofie,Kristin %A Akinyi,Pamela %A Matemo,Daniel %A Unger,Jennifer A %A Kinuthia,John %A O'Malley,Gabrielle %A Drake,Alison L %A John-Stewart,Grace %A Ronen,Keshet %+ Department of Global Health, University of Washington, 325 9th Avenue, Seattle, WA, 98104, United States, 1 206 685 4363, keshet@uw.edu %K HIV %K ART %K PMTCT %K SMS text messaging %K adherence %K retention %D 2018 %7 19.07.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Prevention of mother-to-child HIV transmission (PMTCT) relies on long-term adherence to antiretroviral therapy (ART). Mobile health approaches, such as text messaging (short message service, SMS), may improve adherence in some clinical contexts, but it is unclear what SMS content is desired to improve PMTCT-ART adherence. Objective: We aimed to explore the SMS content preferences related to engagement in PMTCT care among women, male partners, and health care workers. The message content was used to inform an ongoing randomized trial to enhance the PMTCT-ART adherence. Methods: We conducted 10 focus group discussions with 87 HIV-infected pregnant or postpartum women and semistructured individual interviews with 15 male partners of HIV-infected women and 30 health care workers from HIV and maternal child health clinics in Kenya. All interviews were recorded, translated, and transcribed. We analyzed transcripts using deductive and inductive approaches to characterize women’s, partners’, and health care workers’ perceptions of text message content. Results: All women and male partners, and most health care workers viewed text messages as a useful strategy to improve engagement in PMTCT care. Women desired messages spanning 3 distinct content domains: (1) educational messages on PMTCT and maternal child health, (2) reminder messages regarding clinic visits and adherence, and (3) encouraging messages that provide emotional support. While all groups valued reminder and educational messages, women highlighted emotional support more than the other groups (partners or health care workers). In addition, women felt that encouraging messages would assist with acceptance of their HIV status, support disclosure, improve patient-provider relationship, and provide support for HIV-related challenges. All 3 groups valued not only messages to support PMTCT or HIV care but also messages that addressed general maternal child health topics, stressing that both HIV- and maternal child health–related messages should be part of an SMS system for PMTCT. Conclusions: Women, male partners, and health care workers endorsed SMS text messaging as a strategy to improve PMTCT and maternal child health outcomes. Our results highlight the specific ways in which text messaging can encourage and support HIV-infected women in PMTCT to remain in care, adhere to treatment, and care for themselves and their children. Trial Registration: ClinicalTrials.gov NCT02400671; https://clinicaltrials.gov/ct2/show/NCT02400671 (Archived by WebCite at http://www.webcitation.org/70W7SVIVJ) %M 30026177 %R 10.2196/10671 %U http://mhealth.jmir.org/2018/7/e10671/ %U https://doi.org/10.2196/10671 %U http://www.ncbi.nlm.nih.gov/pubmed/30026177 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 3 %P e23 %T A Text Message–Based Intervention Targeting Alcohol Consumption Among University Students: User Satisfaction and Acceptability Study %A Müssener,Ulrika %A Thomas,Kristin %A Linderoth,Catharina %A Leijon,Matti %A Bendtsen,Marcus %+ Department of Medical and Health Sciences, Linköping University, Linköping, Sweden, S-58183, Sweden, 46 732702426, ulrika.mussener@liu.se %K students %K text messages %K mobile phones %K SMS %K alcohol consumption intervention %D 2018 %7 10.07.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Heavy consumption of alcohol among university students is a global problem, with excessive drinking being the social norm. Students can be a difficult target group to reach, and only a minority seek alcohol-related support. It is important to develop interventions that can reach university students in a way that does not further stretch the resources of the health services. Text messaging (short message service, SMS)–based interventions can enable continuous, real-time, cost-effective, brief support in a real-world setting, but there is a limited amount of evidence for effective interventions on alcohol consumption among young people based on text messaging. To address this, a text messaging–based alcohol consumption intervention, the Amadeus 3 intervention, was developed. Objective: This study explored self-reported changes in drinking habits in an intervention group and a control group. Additionally, user satisfaction among the intervention group and the experience of being allocated to a control group were explored. Methods: Students allocated to the intervention group (n=460) were asked about their drinking habits and offered the opportunity to give their opinion on the structure and content of the intervention. Students in the control group (n=436) were asked about their drinking habits and their experience in being allocated to the control group. Participants received an email containing an electronic link to a short questionnaire. Descriptive analyses of the distribution of the responses to the 12 questions for the intervention group and 5 questions for the control group were performed. Results: The response rate for the user feedback questionnaire of the intervention group was 38% (176/460) and of the control group was 30% (129/436). The variation in the content of the text messages from facts to motivational and practical advice was appreciated by 77% (135/176) participants, and 55% (97/176) found the number of messages per week to be adequate. Overall, 81% (142/176) participants stated that they had read all or nearly all the messages, and 52% (91/176) participants stated that they were drinking less, and increased awareness regarding negative consequences was expressed as the main reason for reduced alcohol consumption. Among the participants in the control group, 40% (52/129) stated that it did not matter that they had to wait for access to the intervention. Regarding actions taken while waiting for access, 48% (62/129) participants claimed that they continued to drink as before, whereas 35% (45/129) tried to reduce their consumption without any support. Conclusions: Although the main randomized controlled trial was not able to detect a statistically significant effect of the intervention, most participants in this qualitative follow-up study stated that participation in the study helped them reflect upon their consumption, leading to altered drinking habits and reduced alcohol consumption. Trial Registration: International Standard Randomized Controlled Trial Number ISRCTN95054707; http://www.isrctn.com/ISRCTN95054707 (Archived by WebCite at http://www.webcitation.org/705putNZT) %M 29991469 %R 10.2196/humanfactors.9641 %U http://humanfactors.jmir.org/2018/3/e23/ %U https://doi.org/10.2196/humanfactors.9641 %U http://www.ncbi.nlm.nih.gov/pubmed/29991469 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 2 %P e10958 %T Online Peer-to-Peer Mentoring Support for Youth with Hemophilia: Qualitative Needs Assessment %A Breakey,Vicky R %A Bouskill,Vanessa %A Nguyen,Cynthia %A Luca,Stephanie %A Stinson,Jennifer N %A Ahola Kohut,Sara %+ Division of Pediatric Hematology/Oncology, Department of Pediatrics, McMaster Children’s Hospital, HSC 3N27a, 1280 Main Street W, Hamilton, ON, L8S 4K1, Canada, 1 905 521 2100 ext 73080, breakev@mcmaster.ca %K hemophilia %K adolescents %K transition %K self-management %K education %K internet %K mentoring %D 2018 %7 10.07.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: To support adolescents through transition from pediatrics to adult care, health care providers and families help teens gain knowledge and develop self-management skills. Peer mentoring can provide meaningful support and has been associated with improved health outcomes in patients with other chronic conditions. Peer mentoring is an appealing way to provide support, but it is imperative to consider the unique needs of adolescents to ensure its success. Objective: The objective of our study was to identify the peer mentoring wants and needs of youth with hemophilia in order to guide the development of a new program. Methods: In this qualitative study, we interviewed a convenience sample of youth with hemophilia from 2 Canadian hemophilia treatment centers. Two iterative cycles of audiorecorded, semistructured individual interviews were conducted. Descriptive statistics and content analyses were used to organize data into categories that reflected emerging themes. Results: In total, we recruited 23 participants aged 12-20 years, with a mean age of 14.91 (2.57) years. When asked about program design, participants weighed the importance of flexibility in delivery (eg, Web-based, in person, text messaging [short message service]), content (eg, structured vs unstructured), frequency of sessions, and length of the program. Participants identified some potential challenges such as scheduling issues, comfort level for disease discussion, and discordant mentor-mentee personality types. The program was viewed as a positive medium for connecting peers with hemophilia. Conclusions: Adolescents with hemophilia expressed interest in a peer mentoring program and provided valuable insight that will be applied in the development of a peer mentoring program for youth with hemophilia. %M 31518296 %R 10.2196/10958 %U http://pediatrics.jmir.org/2018/2/e10958/ %U https://doi.org/10.2196/10958 %U http://www.ncbi.nlm.nih.gov/pubmed/31518296 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 3 %P e13 %T Indigenous Adolescents’ Perception of an eMental Health Program (SPARX): Exploratory Qualitative Assessment %A Shepherd,Matthew %A Merry,Sally %A Lambie,Ian %A Thompson,Andrew %+ School of Counselling, Human Services and Social Work, Faculty of Education, The University of Auckland, Gate 4, 60 Epsom Ave, Epsom, Auckland,, New Zealand, 64 9 623 8899 ext 46368, m.shepherd@auckland.ac.nz %K Māori youth %K indigenous %K depression %K computerized CBT %K consumer views %K serious games %K virtual worlds %D 2018 %7 05.07.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: Depression is a major health issue for indigenous adolescents, yet there is little research conducted about the efficacy and development of psychological interventions for these populations. In New Zealand there is little known about taitamariki (Māori adolescent) opinions regarding the development and effectiveness of psychological interventions, let alone computerized cognitive behavioral therapy. SPARX (Smart, Positive, Active, Realistic, X-factor thoughts) is a computerized intervention developed in New Zealand to treat mild-to-moderate depression in young people. Users are engaged in a virtual 3D environment where they must complete missions to progress to the next level. In each level there are challenges and puzzles to completeIt was designed to appeal to all young people in New Zealand and incorporates several images and concepts that are specifically Māori. Objective: The aim was to conduct an exploratory qualitative study of Māori adolescents’ opinions about the SPARX program. This is a follow-up to an earlier study where taitamariki opinions were gathered to inform the design of a computerized cognitive behavior therapy program. Methods: Taitamariki were interviewed using a semistructured interview once they had completed work with the SPARX resource. Six participants agreed to complete the interview; the interviews ranged from 10 to 30 minutes. Results: Taitamariki participating in the interviews found SPARX to be helpful. The Māori designs from the SPARX game were appropriate and useful, and the ability to customize the SPARX characters with Māori designs was beneficial and appeared to enhance cultural identity. These helped young people to feel engaged with SPARX which, in turn, assisted with the acquisition of relaxation and cognitive restructuring skills. Overall, using SPARX led to improved mood and increased levels of hope for the participants. In some instances, SPARX was used by wider whānau (Māori word for family) members with reported beneficial effect. Conclusions: Overall, this small group of Māori adolescents reported that cultural designs made it easier for them to engage with SPARX, which, in turn, led to an improvement in their mood and gave them hope. Further research is needed about how SPARX could be best used to support the families of these young people. %M 29980495 %R 10.2196/games.8752 %U http://games.jmir.org/2018/3/e13/ %U https://doi.org/10.2196/games.8752 %U http://www.ncbi.nlm.nih.gov/pubmed/29980495 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 2 %P e10073 %T Online Decision Support Tool for Personalized Cancer Symptom Checking in the Community (REACT): Acceptability, Feasibility, and Usability Study %A Nieroda,Marzena Ewa %A Lophatananon,Artitaya %A McMillan,Brian %A Chen,Li-Chia %A Hughes,John %A Daniels,Rona %A Clark,James %A Rogers,Simon %A Muir,Kenneth Ross %+ Division of Management Sciences and Marketing, Alliance Manchester Business School, The University of Manchester, Booth Street West, Manchester, M13 9PL, United Kingdom, 44 161 275 6739, marzena.nieroda@manchester.ac.uk %K early detection of cancer %K cancer education %K cancer symptoms %K cancer risk %K personalized risk %K website development %K REACT %D 2018 %7 04.07.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Improving cancer survival in the UK, despite recent significant gains, remains a huge challenge. This can be attributed to, at least in part, patient and diagnostic delays, when patients are unaware they are suffering from a cancerous symptom and therefore do not visit a general practitioner promptly and/or when general practitioners fail to investigate the symptom or refer promptly. To raise awareness of symptoms that may potentially be indicative of underlying cancer among members of the public a symptom-based risk assessment model (developed for medical practitioner use and currently only used by some UK general practitioners) was utilized to develop a risk assessment tool to be offered to the public in community settings. Such a tool could help individuals recognize a symptom, which may potentially indicate cancer, faster and reduce the time taken to visit to their general practitioner. In this paper we report results about the design and development of the REACT (Risk Estimation for Additional Cancer Testing) website, a tool to be used in a community setting allowing users to complete an online questionnaire and obtain personalized cancer symptom-based risk estimation. Objective: The objectives of this study are to evaluate (1) the acceptability of REACT among the public and health care practitioners, (2) the usability of the REACT website, (3) the presentation of personalized cancer risk on the website, and (4) potential approaches to adopt REACT into community health care services in the UK. Methods: Our research consisted of multiple stages involving members of the public (n=39) and health care practitioners (n=20) in the UK. Data were collected between June 2017 and January 2018. User views were collected by (1) the “think-aloud” approach when participants using the website were asked to talk about their perceptions and feelings in relation to the website, and (2) self-reporting of website experiences through open-ended questionnaires. Data collection and data analysis continued simultaneously, allowing for website iterations between different points of data collection. Results: The results demonstrate the need for such a tool. Participants suggest the best way to offer REACT is through a guided approach, with a health care practitioner (eg, pharmacist or National Health Service Health Check nurse) present during the process of risk evaluation. User feedback, which was generally consistent across members of public and health care practitioners, has been used to inform the development of the website. The most important aspects were: simplicity, ability to evaluate multiple cancers, content emphasizing an inviting community “feel,” use (when possible) of layperson language in the symptom screening questionnaire, and a robust and positive approach to cancer communication relying on visual risk representation both with affected individuals and the entire population at risk. Conclusions: This study illustrates the benefits of involving public and stakeholders in developing and implementing a simple cancer symptom check tool within community. It also offers insights and design suggestions for user-friendly interfaces of similar health care Web-based services, especially those involving personalized risk estimation. %M 29973334 %R 10.2196/10073 %U http://cancer.jmir.org/2018/2/e10073/ %U https://doi.org/10.2196/10073 %U http://www.ncbi.nlm.nih.gov/pubmed/29973334 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 1 %N 1 %P e6 %T Maternal and Child Acceptability of a Proposed Guided Imagery Therapy Mobile App Designed to Treat Functional Abdominal Pain Disorders in Children: Mixed-Methods Predevelopment Formative Research %A Hollier,John M %A Vaughan,Adetola O %A Liu,Yan %A van Tilburg,Miranda AL %A Shulman,Robert J %A Thompson,Debbe I %+ Section of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Baylor College of Medicine, 6621 Fannin Street, Suite 1010, Houston, TX, 77030, United States, 1 8328243814, jmhollie@bcm.edu %K functional abdominal pain disorders %K guided imagery therapy %K mixed methods %K mobile applications %K pediatrics %K parents %K Technology Acceptance Model %K imagery (psychotherapy) %D 2018 %7 29.06.2018 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Functional abdominal pain disorders are chronic abdominal pain conditions, which affect up to 20% of children worldwide. Of the various functional abdominal pain disorder treatment modalities, psychological therapies such as guided imagery therapy appear most effective. However, there are significant barriers to receiving psychological therapies, including access to trained therapists. Alternatively, remotely delivered psychological therapies for functional abdominal pain disorders have been efficacious. Objective: The objective of our study was to assess acceptability of a proposed guided imagery therapy app designed to treat functional abdominal pain disorders through remote delivery of prerecorded audio sessions and to evaluate user preferences for using such an app. Methods: Using a mixed-methods approach, we conducted a predevelopment formative study among children aged 7 to 12 years with a functional abdominal pain disorder and their parents. The parents completed our modified Technology Acceptance Model (TAM) questionnaire, which quantified behavioral intention and related factors for using a guided imagery therapy app. Dyads participated in separate in-person semistructured interviews to assess their attitudes toward and preferences for a guided imagery therapy app. Questionnaire and interview findings were collected concurrently, analyzed separately, and then integrated through methods triangulation. Results: Among the 15 participating parent-child dyads, 5 (33%) children were Hispanic and 11 (73%) had irritable bowel syndrome. They had diverse socioeconomic status. All parent participants were mothers. The TAM questionnaire indicated that mothers scored favorably on behavioral intention to use a guided imagery therapy app (mean score 12.0, SD 2.6, possible range 3-15). Scores for the TAM factors perceived usefulness, perceived ease of use, hedonic motivation, compatibility, and habit also were favorable. Maternal interviews confirmed positive attitudes toward the proposed app. They advocated a visual component to hold their child’s attention during the guided imagery therapy sessions; recommended incorporating background sounds into the sessions; favored session reminder notifications from the app; and thought the best time for their child to listen to the sessions would be in the evening or before bed. The child interviews also confirmed positive attitudes toward the proposed app. They suggested guided imagery therapy session topics such as sports and adventures; listening to sessions in their bedroom; and the need for parental supervision to install the app on their mobile device. Integration of the quantitative and qualitative methods findings complimented one another on acceptability. The favorable behavioral intention TAM score aligned well with expressed positive maternal and child attitudes toward the app and can be explained by the desire to avoid medications. The questionnaire and interviews also confirmed therapeutic benefit as an intrinsic motivator to promote routine use. Conclusions: A guided imagery therapy app designed to treat pediatric patients with functional abdominal pain disorders appears to be acceptable to both mothers and children. Incorporating parent and child preferences into a guided imagery therapy app could promote therapeutic compliance and increase access to optimal care. %M 31518303 %R 10.2196/pediatrics.8535 %U http://pediatrics.jmir.org/2018/1/e6/ %U https://doi.org/10.2196/pediatrics.8535 %U http://www.ncbi.nlm.nih.gov/pubmed/31518303 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 3 %N 2 %P e9 %T Experiences of Using Web-Based and Mobile Technologies to Support Self-Management of Type 2 Diabetes: Qualitative Study %A Kelly,Laura %A Jenkinson,Crispin %A Morley,David %+ Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Headington, Oxford, OX3 7LF, United Kingdom, 44 1865 289425, laura.kelly@dph.ox.ac.uk %K mobile health %K qualitative research %K self-care %K type 2 diabetes %D 2018 %7 11.05.2018 %9 Original Paper %J JMIR Diabetes %G English %X Background: The prevalence of type 2 diabetes is rising, placing increasing strain on health care services. Web-based and mobile technologies can be an important source of information and support for people with type 2 diabetes and may prove beneficial with respect to reducing complications due to mismanagement. To date, little research has been performed to gain an insight into people’s perspectives of using such technologies in their daily management. Objective: The purpose of this study was to understand the impact of using Web-based and mobile technologies to support the management of type 2 diabetes. Methods: In-depth interviews were conducted with 15 people with type 2 diabetes to explore experiences of using Web-based and mobile technologies to manage their diabetes. Transcripts were analyzed using the framework method. Results: Technology supported the users to maintain individualized and tailored goals when managing their health. A total of 7 themes were identified as important to participants when using technology to support self-management: (1) information, (2) understanding individual health and personal data, (3) reaching and sustaining goals, (4) minimizing disruption to daily life, (5) reassurance, (6) communicating with health care professionals, and (7) coordinated care. Conclusions: Patients need to be supported to manage their condition to improve well-being and prevent diabetes-related complications from arising. Technologies enabled the users to get an in-depth sense of how their body reacted to both lifestyle and medication factors—something that was much more difficult with the use of traditional standardized information alone. It is intended that the results of this study will inform a new questionnaire designed to assess self-management in people using Web-based and mobile technology to manage their health. %M 30291098 %R 10.2196/diabetes.9743 %U http://diabetes.jmir.org/2018/2/e9/ %U https://doi.org/10.2196/diabetes.9743 %U http://www.ncbi.nlm.nih.gov/pubmed/30291098 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 5 %P e163 %T Electronic Health Physical Activity Behavior Change Intervention to Self-Manage Cardiovascular Disease: Qualitative Exploration of Patient and Health Professional Requirements %A Walsh,Deirdre MJ %A Moran,Kieran %A Cornelissen,Véronique %A Buys,Roselien %A Cornelis,Nils %A Woods,Catherine %+ MedEx Wellness, School of Health and Human Performance, Dublin City Unviersity, Room A246, Albert College, Dublin, Dublin 9, Ireland, 353 1 7008011, kieran.moran@dcu.ie %K telemedicine %K exercise %K cardiovascular diseases %K rehabilitation %D 2018 %7 08.05.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Cardiovascular diseases are a leading cause of premature death worldwide. International guidelines recommend routine delivery of all phases of cardiac rehabilitation. Uptake of traditional cardiac rehabilitation remains suboptimal, as attendance at formal hospital-based cardiac rehabilitation programs is low, with community-based cardiac rehabilitation rates and individual long-term exercise maintenance even lower. Home-based cardiac rehabilitation programs have been shown to be equally effective in clinical and health-related quality of life outcomes and yet are not readily available. Objective: Given the potential that home-based cardiac rehabilitation programs have, it is important to explore how to appropriately design any such intervention in conjunction with key stakeholders. The aim of this study was to engage with individuals with cardiovascular disease and other professionals within the health ecosystem to (1) understand the personal, social, and physical factors that inhibit or promote their capacity to engage with physical activity and (2) explore their technology competencies, needs, and wants in relation to an eHealth intervention. Methods: Fifty-four semistructured interviews were conducted across two countries. Interviews were audiotaped, transcribed verbatim, and analyzed using thematic analysis. Barriers to the implementation of PATHway were also explored specifically in relation to physical capability and safety as well as technology readiness and further mapped onto the COM-B model for future intervention design. Results: Key recommendations included collection of patient data and use of measurements, harnessing hospital based social connections, and advice to utilize a patient-centered approach with personalization and tailoring to facilitate optimal engagement. Conclusions: In summary, a multifaceted, personalizable intervention with an inclusively designed interface was deemed desirable for use among cardiovascular disease patients both by end users and key stakeholders. In-depth understanding of core needs of the population can aid intervention development and acceptability. %M 29739740 %R 10.2196/jmir.9181 %U http://www.jmir.org/2018/5/e163/ %U https://doi.org/10.2196/jmir.9181 %U http://www.ncbi.nlm.nih.gov/pubmed/29739740 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e113 %T User Needs in the Development of a Health App Ecosystem for Self-Management of Cystic Fibrosis: User-Centered Development Approach %A Floch,Jacqueline %A Zettl,Annabel %A Fricke,Lena %A Weisser,Tina %A Grut,Lisbet %A Vilarinho,Thomas %A Stav,Erlend %A Ascolese,Antonio %A Schauber,Cornelia %+ SINTEF, Strindveien 4, Trondheim, 7465, Norway, 47 93008536, jacqueline.floch@sintef.no %K self-management %K cystic fibrosis %K mobile health %K user centered design %D 2018 %7 08.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital self-management in cystic fibrosis (CF) is foreseen as a means toward better understanding of the disease and its treatment and better adherence to the treatment. Mobile apps hold the potential to provide access to information, motivate, and strengthen compliance. However, to deliver high-quality apps, the development should be based on thorough knowledge about user needs. Empirical research on the user-centered development of mobile apps for health care is, however, still limited. Objective: The aim of this research is to develop and evaluate an app ecosystem for self-management in CF. It targets not only those directly affected by CF but also parents and health care professionals involved in the treatment. This paper covers the first step of the design process that aims to analyze the context and the user requirements. The primary research question is as follows: what digital support has the potential to usefully support persons with CF and their caregivers in the CF care? To answer this question, we address two preliminary questions: what important factors in everyday life affect the care of persons with CF? and how is the CF care delivered today and what are the limitations of CF care services? Methods: The overall research adopts a user-centered design approach in which future users are involved in the development process from the very beginning to ensure that the apps developed best suit the potential users. The research presented in the paper follows an interpretative case study research strategy seeking to understand the concerns and needs of persons with CF and their caregivers. Data were collected through semistructured qualitative interviews involving 74 participants in seven European countries and from internet forums. Results: The results of the analysis phase show a strong need for individuality of the digital support, as well as for its adaptability to different contexts. The paper presents the concerns and needs of the participants in the study and extracts a set of relevant features for a self-management app ecosystem. Education, enzyme dosage calculation, nutrition management, treatment organization, health diary, treatment follow-up, practical guidelines for treatment, communication with doctors, and communication with peers are foreseen as useful features. Conclusions: The results indicate the readiness for self-management in the CF care even in countries that provide well-functioning health care services for CF care. The large diversity of user requirements identified reflects the crucial role user integration plays in developing apps for a chronic condition such as CF. The need for personalization stemming from the individuality of the patients and the need for communication with health care professionals support the idea of an app ecosystem for the self-management of CF. %M 29739742 %R 10.2196/mhealth.8236 %U http://mhealth.jmir.org/2018/5/e113/ %U https://doi.org/10.2196/mhealth.8236 %U http://www.ncbi.nlm.nih.gov/pubmed/29739742 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 5 %P e108 %T Users’ Perspectives on mHealth Self-Management of Bipolar Disorder: Qualitative Focus Group Study %A Switsers,Lise %A Dauwe,Arthur %A Vanhoudt,Anneleen %A Van Dyck,Hilde %A Lombaerts,Koen %A Oldenburg,JFE %+ Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, Brussels, 1050, Belgium, 32 02 629 26 74, lise.switsers@vub.be %K bipolar disorder %K self-management %K mHealth %K focus groups %D 2018 %7 02.05.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Recent research indicates that current mHealth apps for bipolar disorders (BDs) show crucial shortcomings. They lack important functionality, are of inconsistent quality, and are insufficiently evidence-based. mHealth apps need to be better adapted to the needs of users. The perspectives of adult service users with BD regarding mHealth apps have not been well investigated. Objective: The objective of this study was to examine the needs and expectations of adults with BD regarding mHealth apps. Methods: Two focus group sessions were organized in which patients’ views on self-management and design and functionality of an mHealth app for BD were assessed. During session 1, four focus groups were organized to identify users’ needs regarding support for self-management. Session 2 contained three cocreation focus groups. Through this method, the desired functionality and design were explored. Results: Participants indicated that they were in need of support in various ways. Not only support in psychoeducation, including daily routine, sleep pattern, maintaining social contacts, maintaining a healthy lifestyle, and avoidance of stimuli, was considered important for them but also gaining insight into their illness was found to be crucial. Conclusions: According to the participants, their illness-related information is a key factor in gaining insight into their mood pattern. Participants wanted a functional design that would increase daily use and prevent overstimulation. The results of this study should be taken into account when developing new mHealth apps. %M 29720363 %R 10.2196/mhealth.9529 %U http://mhealth.jmir.org/2018/5/e108/ %U https://doi.org/10.2196/mhealth.9529 %U http://www.ncbi.nlm.nih.gov/pubmed/29720363 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 5 %P e10062 %T Community Consultation for Planned Emergent Use Research: Experiences From an Academic Medical Center %A Smischney,Nathan J %A Pannu,Jasleen %A Hinds,Richard F %A McCormick,Jennifer B %+ Department of Anesthesiology and Perioperative Medicine, Division of Critical Care Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, United States, 1 507 255 6051, smischney.nathan@mayo.edu %K qualitative research %K research design %K research ethics %D 2018 %7 02.05.2018 %9 Viewpoint %J JMIR Res Protoc %G English %X Background: Emergent use research—research involving human subjects that have a life-threatening medical condition and who are unlikely to provide informed consent—in critical illness is fraught with challenges related to obtaining informed consent. Per federal regulations, to meet criteria to conduct such trials, the investigators have to seek community consultations. Effective ways of obtaining this consultation remains ill-defined. Objective: We sought to describe methods, interpretations, and our experiences of conducting community consultation in a planned emergent use randomized controlled trial. Methods: As part of a planned emergent use clinical trial in our study, community consultation consisted of four focus groups sessions with members from the community in which the clinical trial was conducted. Three focus group sessions were conducted with members who had an affiliation to Mayo Clinic, and the other focus group session was conducted with non-Mayo affiliation members. The feedback from the focus group sessions led to the creation of the public notification plan. The public was notified of the trial through community meetings as well as social media. Results: As compared to community meetings, focus group sessions resulted in greater attendance with more interactive discussions. Moreover, focus group sessions resulted in greater in-depth conversations leading to institutional acceptance of the clinical trial under study. Conclusions: Exception from informed consent can be acceptable to the community. Focus groups provided better participation and valuable interactive insight as compared to community meetings in our study. This could serve as a valuable guide for investigators pursuing exception from informed consent in their research studies. %M 29720360 %R 10.2196/10062 %U http://www.researchprotocols.org/2018/5/e10062/ %U https://doi.org/10.2196/10062 %U http://www.ncbi.nlm.nih.gov/pubmed/29720360 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 2 %P e19 %T Designing for Clinical Change: Creating an Intervention to Implement New Statin Guidelines in a Primary Care Clinic %A DeJonckheere,Melissa %A Robinson,Claire H %A Evans,Lindsey %A Lowery,Julie %A Youles,Bradley %A Tremblay,Adam %A Kelley,Caitlin %A Sussman,Jeremy B %+ Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, United States, 1 734 845 3502, jeremysu@med.umich.edu %K cardiovascular disease %K preventative medicine %K clinical decision support %K user-centered design %K qualitative research %K implementation %D 2018 %7 24.04.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Recent clinical practice guidelines from major national organizations, including a joint United States Department of Veterans Affairs (VA) and Department of Defense (DoD) committee, have substantially changed recommendations for the use of the cholesterol-lowering statin medications after years of relative stability. Because statin medications are among the most commonly prescribed treatments in the United States, any change in their use may have significant implications for patients and providers alike. Prior research has shown that effective implementation interventions should be both user centered and specifically chosen to address identified barriers. Objective: The objectives of this study were to identify potential determinants of provider uptake of the new statin guidelines and to use that information to tailor a coordinated and streamlined local quality improvement intervention focused on prescribing appropriate statins. Methods: We employed user-centered design principles to guide the development and testing of a multicomponent guideline implementation intervention to improve statin prescribing. This paper describes the intervention development process whereby semistructured qualitative interviews with providers were conducted to (1) illuminate the knowledge, attitudes, and behaviors of providers and (2) elicit feedback on intervention prototypes developed to align with and support the use of the VA/DoD guidelines. Our aim was to use this information to design a local quality improvement intervention focused on statin prescribing that was tailored to the needs of primary care providers at our facility. Cabana’s Clinical Practice Guidelines Framework for Improvement and Nielsen’s Usability Heuristics were used to guide the analysis of data obtained in the intervention development process. Results: Semistructured qualitative interviews were conducted with 15 primary care Patient Aligned Care Team professionals (13 physicians and 2 clinical pharmacists) at a single VA medical center. Findings highlight that providers were generally comfortable with the paradigm shift to risk-based guidelines but less clear on the need for the VA/DoD guidelines in specific. Providers preferred a clinical decision support tool that helped them calculate patient risk and guide their care without limiting autonomy. They were less comfortable with risk communication and performance measurement systems that do not account for shared decision making. When possible, we incorporated their recommendations into the intervention. Conclusions: By combining qualitative methods and user-centered design principles, we could inform the design of a multicomponent guideline implementation intervention to better address the needs and preferences of providers, including clear and direct language, logical decision prompts with an option to dismiss a clinical decision support tool, and logical ordering of feedback information. Additionally, this process allowed us to identify future design considerations for quality improvement interventions. %M 29691206 %R 10.2196/humanfactors.9030 %U http://humanfactors.jmir.org/2018/2/e19/ %U https://doi.org/10.2196/humanfactors.9030 %U http://www.ncbi.nlm.nih.gov/pubmed/29691206 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 4 %P e105 %T Experiences of General Practitioners and Practice Support Staff Using a Health and Lifestyle Screening App in Primary Health Care: Implementation Case Study %A Webb,Marianne Julie %A Wadley,Greg %A Sanci,Lena Amanda %+ Department of General Practice, Melbourne Medical School, University of Melbourne, Ground Floor, 200 Berkeley Street, Parkville, 3053, Australia, 61 90355011, webbm@unimelb.edu.au %K adolescent %K primary health care %K primary prevention %K health behavior %K quality improvement %K telemedicine %D 2018 %7 24.04.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technology-based screening of young people for mental health disorders and health compromising behaviors in general practice increases the disclosure of sensitive health issues and improves patient-centered care. However, few studies investigate how general practitioners (GPs) and practice support staff (receptionists and practice managers) integrate screening technology into their routine work, including the problems that arise and how the staff surmount them. Objective: The aim of this study was to investigate the implementation of a health and lifestyle screening app, Check Up GP, for young people aged 14 to 25 years attending an Australian general practice. Methods: We conducted an in-depth implementation case study of Check Up GP in one general practice clinic, with methodology informed by action research. Semistructured interviews and focus groups were conducted with GPs and support staff at the end of the implementation period. Data were thematically analyzed and mapped to normalization process theory constructs. We also analyzed the number of times we supported staff, the location where young people completed Check Up GP, and whether they felt they had sufficient privacy and received a text messaging (short message service, SMS) link at the time of taking their appointment. Results: A total of 4 GPs and 10 support staff at the clinic participated in the study, with all except 3 receptionists participating in the final interviews and focus groups. During the 2-month implementation period, the technology and administration of Check Up GP was iterated through 4 major quality improvement cycles in response to the needs of the staff. This resulted in a reduction in the average time taken to complete Check Up GP from 14 min to 10 min, improved SMS text messaging for young people, and a more consistent description of the app by receptionists to young people. In the first weeks of implementation, researchers needed to regularly support staff with the app’s administration; however, this support decreased over time, even as usage rose slightly. The majority of young people (73/87, 84%) completed Check Up GP in the waiting room, with less than half (35/80, 44%) having received an SMS from the clinic with a link to the tool. Participating staff valued Check Up GP, particularly its facilitation of youth-friendly practice. However, there was at first a lack of organizational systems and capacity to implement the app and also initially a reliance on researchers to facilitate the process. Conclusions: The implementation of a screening app in the dynamic and time-restricted general practice setting presents a range of technical and administrative challenges. Successful implementation of a screening app is possible but requires adequate time and intensive facilitation. More resources, external to staff, are needed to drive and support sustainable technology innovation and implementation in general practice settings. %M 29691209 %R 10.2196/mhealth.8778 %U http://mhealth.jmir.org/2018/4/e105/ %U https://doi.org/10.2196/mhealth.8778 %U http://www.ncbi.nlm.nih.gov/pubmed/29691209 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e7 %T Development of a Web-based Family Intervention for BRCA Carriers and Their Biological Relatives: Acceptability, Feasibility, and Usability Study %A Katapodi,Maria C %A Jung,Miyeon %A Schafenacker,Ann M %A Milliron,Kara J %A Mendelsohn-Victor,Kari E %A Merajver,Sofia D %A Northouse,Laurel L %+ Department of Public Health, Faculty of Medicine, University of Basel, Bernoullistrasse 28, Room 113, Basel, 4056, Switzerland, 41 79 109 5163, maria.katapodi@unibas.ch %K BRCA families %K family-based intervention study %K Web-based intervention study %K psycho-educational and skills-building intervention study %K communication and coping %K patient decision-aid %K genetic testing %D 2018 %7 13.04.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: Carriers of breast cancer gene (BRCA) mutations are asked to communicate genetic test results to their biological relatives to increase awareness of cancer risk and promote use of genetic services. This process is highly variable from family to family. Interventions that support communication of genetic test results, coping, and offer decision support in families harboring a pathogenic variant may contribute to effective management of hereditary cancer. Objective: The aim of this paper was to describe the development of the Family Gene Toolkit, a Web-based intervention targeting BRCA carriers and untested blood relatives, designed to enhance coping, family communication, and decision making. Methods: We present findings from focus groups regarding intervention acceptability and participant satisfaction and from a pre-post pilot study with random allocation to a wait-listed control group regarding intervention feasibility and usability. Results: The Family Gene Toolkit was developed by a multidisciplinary team as a psycho-educational and skills-building intervention. It includes two live webinar sessions and a follow-up phone call guided by a certified genetic counselor and a master’s prepared oncology nurse. Each live webinar includes two modules (total four modules) presenting information about BRCA mutations, a decision aid for genetic testing, and two skill-building modules for effective coping and family communication. Participants in focus groups (n=11) were highly satisfied with the intervention, reporting it to be useful and describing clearly the important issues. From the 12 dyads recruited in the pre-post pilot study (response rate 12/52, 23%), completion rate was 71% (10/14) for intervention and 40% (4/10) for wait-listed control groups. Conclusions: Acceptability and satisfaction with the Family Gene Toolkit is high. On the basis of the findings from usability and feasibility testing, modifications on timing, delivery mode, and recruitment methods have been implemented. Trial Registration: ClinicalTrials.gov NCT02154633; https://clinicaltrials.gov/ct2/show/NCT02154633 (Archived by WebCite at http://www.webcitation.org/6yYNvLPjv) %M 29653920 %R 10.2196/cancer.9210 %U http://cancer.jmir.org/2018/1/e7/ %U https://doi.org/10.2196/cancer.9210 %U http://www.ncbi.nlm.nih.gov/pubmed/29653920 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 6 %N 2 %P e6 %T Gamified Cognitive Control Training for Remitted Depressed Individuals: User Requirements Analysis %A Vervaeke,Jasmien %A Van Looy,Jan %A Hoorelbeke,Kristof %A Baeken,Chris %A Koster,Ernst HW %+ Psychopathology and Affective Neuroscience Lab, Department of Experimental Clinical and Health Psychology, Ghent University, Henri Dunantlaan 2, Ghent, 9000, Belgium, 32 92649446, jasmien.vervaeke@ugent.be %K depression %K cognitive dysfunction %K cognitive remediation %K relapse prevention %K qualitative research %K secondary prevention %D 2018 %7 05.04.2018 %9 Original Paper %J JMIR Serious Games %G English %X Background: The high incidence and relapse rates of major depressive disorder demand novel treatment options. Standard treatments (psychotherapy, medication) usually do not target cognitive control impairments, although these seem to play a crucial role in achieving stable remission. The urgent need for treatment combined with poor availability of adequate psychological interventions has instigated a shift toward internet interventions. Numerous computerized programs have been developed that can be presented online and offline. However, their uptake and adherence are oftentimes low. Objective: The aim of this study was to perform a user requirements analysis for an internet-based training targeting cognitive control. This training focuses on ameliorating cognitive control impairments, as these are still present during remission and can be a risk factor for relapse. To facilitate uptake of and adherence to this intervention, a qualitative user requirements analysis was conducted to map mandatory and desirable requirements. Methods: We conducted a user requirements analysis through a focus group with 5 remitted depressed individuals and individual interviews with 6 mental health care professionals. All qualitative data were transcribed and examined using a thematic analytic approach. Results: Results showed mandatory requirements for the remitted sample in terms of training configuration, technological and personal factors, and desirable requirements regarding knowledge and enjoyment. Furthermore, knowledge and therapeutic benefits were key requirements for therapists. Conclusions: The identified requirements provide useful information to be integrated in interventions targeting cognitive control in depression. %M 29622525 %R 10.2196/games.8609 %U http://games.jmir.org/2018/2/e6/ %U https://doi.org/10.2196/games.8609 %U http://www.ncbi.nlm.nih.gov/pubmed/29622525 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 4 %P e31 %T Challenges During Implementation of a Patient-Facing Mobile App for Surgical Rehabilitation: Feasibility Study %A Lau,Annie YS %A Piper,Kalman %A Bokor,Desmond %A Martin,Paige %A Lau,Victor SL %A Coiera,Enrico %+ Centre for Health Informatics, Australian Institute of Health Innovation, Macquarie University, Level 6/75 Talavera Rd Macquarie Park, Sydney, 2109, Australia, 61 431599890, annie.lau@mq.edu.au %K mobile application %K mobile health %K personal health record %K patients %K health services %K medical informatics %K surgery %K orthopedics %K shoulder %K rotator cuff %K rehabilitation %D 2017 %7 07.12.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Translating research into practice, especially the implementation of digital health technologies in routine care, is increasingly important. Yet, there are few studies examining the challenges of implementing patient-facing digital technologies in health care settings. Objective: The aim of this study was to report challenges experienced when implementing mobile apps for patients to support their postsurgical rehabilitation in an orthopedic setting. Methods: A mobile app was tailored to the needs of patients undergoing rotator cuff repair. A 30-min usability session and a 12-week feasibility study were conducted with patients to evaluate the app in routine care. Implementation records (observation reports, issues log, and email correspondence) explored factors that hindered or facilitated patient acceptance. Interviews with clinicians explored factors that influenced app integration in routine care. Results: Participant completion was low (47%, 9/19). Factors that affected patient acceptance included digital literacy, health status, information technology (IT) infrastructure at home, privacy concerns, time limitations, the role of a caregiver, inconsistencies in instruction received from clinicians and the app, and app advice not reflective of patient progress over time. Factors that negatively influenced app integration in routine care included competing demands among clinicians, IT infrastructure in health care settings, identifying the right time to introduce the app to patients, user interface complexity for older patients, lack of coordination among multidisciplinary clinicians, and technical issues with app installation. Conclusions: Three insights were identified for mobile app implementation in routine care: (1) apps for patients need to reflect their journey over time and in particular, postoperative apps ought to be introduced as part of preoperative care with opportunities for patients to learn and adopt the app during their postoperative journey; (2) strategies to address digital literacy issues among patients and clinicians are essential; and (3) impact of the app on patient outcomes and clinician workflow needs to be communicated, monitored, and reviewed. Lastly, digital health interventions should supplement but not replace patient interaction with clinicians. %M 29217504 %R 10.2196/humanfactors.8096 %U http://humanfactors.jmir.org/2017/4/e31/ %U https://doi.org/10.2196/humanfactors.8096 %U http://www.ncbi.nlm.nih.gov/pubmed/29217504 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e359 %T Veterans’ Preferences for Exchanging Information Using Veterans Affairs Health Information Technologies: Focus Group Results and Modeling Simulations %A Haun,Jolie N %A Chavez,Margeaux %A Nazi,Kim %A Antinori,Nicole %A Melillo,Christine %A Cotner,Bridget A %A Hathaway,Wendy %A Cook,Ashley %A Wilck,Nancy %A Noonan,Abigail %+ HSR&D Center of Innovation on Disability and Rehabilitation Research, James A. Haley VA Medical Center, 8900 Grand Oak Circle, Tampa, FL, 33637, United States, 1 813 558 7622, joliehaun@gmail.com %K communication %K patient participation %K quality improvement %K health information technology %K medical informatics %K patient portal %K personal health record %K telehealth %K kiosk %K mhealth %D 2017 %7 23.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The Department of Veterans Affairs (VA) has multiple health information technology (HIT) resources for veterans to support their health care management. These include a patient portal, VetLink Kiosks, mobile apps, and telehealth services. The veteran patient population has a variety of needs and preferences that can inform current VA HIT redesign efforts to meet consumer needs. Objective: This study aimed to describe veterans’ experiences using the current VA HIT and identify their vision for the future of an integrated VA HIT system. Methods: Two rounds of focus group interviews were conducted with a single cohort of 47 veterans and one female caregiver recruited from Bedford, Massachusetts, and Tampa, Florida. Focus group interviews included simulation modeling activities and a self-administered survey. This study also used an expert panel group to provide data and input throughout the study process. High-fidelity, interactive simulations were created and used to facilitate collection of qualitative data. The simulations were developed based on system requirements, data collected through operational efforts, and participants' reported preferences for using VA HIT. Pairwise comparison activities of HIT resources were conducted with both focus groups and the expert panel. Rapid iterative content analysis was used to analyze qualitative data. Descriptive statistics summarized quantitative data. Results: Data themes included (1) current use of VA HIT, (2) non-VA HIT use, and (3) preferences for future use of VA HIT. Data indicated that, although the Secure Messaging feature was often preferred, a full range of HIT options are needed. These data were then used to develop veteran-driven simulations that illustrate user needs and expectations when using a HIT system and services to access VA health care services. Conclusions: Patient participant redesign processes present critical opportunities for creating a human-centered design. Veterans value virtual health care options and prefer standardized, integrated, and synchronized user-friendly interface designs. %M 29061553 %R 10.2196/jmir.8614 %U http://www.jmir.org/2017/10/e359/ %U https://doi.org/10.2196/jmir.8614 %U http://www.ncbi.nlm.nih.gov/pubmed/29061553 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 4 %P e28 %T Formative Assessment: Design of a Web-Connected Sedentary Behavior Intervention for Females %A Kinsey,Amber W %A Whipple,Matthew %A Reid,Lauren %A Affuso,Olivia %+ Department of Epidemiology, University of Alabama at Birmingham, 1665 University Boulevard, Birmingham, AL,, United States, 1 (205) 9757662, oaffuso@uab.edu %K health promotion %K qualitative research %K sedentary lifestyle %K motivation %D 2017 %7 20.10.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Sedentary behavior (SB) is a significant risk factor for heart disease, diabetes, obesity, and early mortality, particularly among women, and the health consequences associated with SB are independent of physical activity status. Interventions utilizing wearable technologies can improve SB, but their effectiveness is influenced by individual preferences, device engagement strategies, and technological features, which may affect user compliance. Gathering a priori insight from target populations on their preferences for program tools and strategies may assist researchers in identifying effective methods to improve the efficacy of SB interventions. Objective: The objective of this study was to (1) explore the likeability (likes and dislikes) and usability (engagement intentions and navigation) of a wearable device (Movband) and its accompanying website (dashboard), (2) examine social incentive preferences (teammates), and (3) assess the feasibility (participants’ experiences during an activity-monitoring period) of these tools for use in an intervention to reduce SB in girls and women. Methods: A total of 9 girls (mean age: 8.9 years, standard deviation [SD] 1.1 years) and 11 college-aged women (mean age: 22.6 years, SD 3.2 years) participated in this study. Separate focus groups were held for girls and women, and all participants attended one before and the other following a 7-day activity-monitoring period. During the focus groups, participants were prompted with questions to address the study aims, and the nominal group technique was used to compile lists of group-specific preferences for the activity-monitoring system. The top three ranking likes and dislikes were reverse coded to determine likeability. Results: The top-ranking responses for the girls and women were the following: visual display of movements and ease of navigation (dashboard like), boring to look at and no calorie-tracking function (dashboard dislike), backlight and long battery life (Movband like), and color and not waterproof (tied for girls) and vertical time display (Movband dislike). Additionally, participants identified several aesthetic preferences and functional limitations. At the second focus group visit, the majority of the participants self-reported less SB during the previous week. Objective data from the activity-monitoring period revealed that the average steps per day for girls and women were 12,373.4 (SD 2617.6) and 8515.8 (SD 3076.7), respectively. Conclusions: These results suggest that the girls and women liked many features of the Movband and dashboard. However, several dislikes were mentioned, which may negatively influence compliance and the effectiveness of the activity-monitoring system and require improvements before using in an SB intervention. %M 29054836 %R 10.2196/humanfactors.7670 %U http://humanfactors.jmir.org/2017/4/e28/ %U https://doi.org/10.2196/humanfactors.7670 %U http://www.ncbi.nlm.nih.gov/pubmed/29054836 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 10 %P e352 %T Consumer Health-Related Activities on Social Media: Exploratory Study %A Benetoli,Arcelio %A Chen,Timothy F %A Aslani,Parisa %+ Faculty of Pharmacy, The University of Sydney, Pharmacy & Bank Building (A15), Science Road, The University of Sydney, Sydney,, Australia, 61 2 9351 7110, arceliobenetoli@hotmail.com %K social media %K social networking sites %K Facebook %K YouTube %K Wikipedia %K Twitter %K health %K consumers %K patients %K focus groups %D 2017 %7 13.10.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Although a number of studies have investigated how consumers use social media for health-related purposes, there is a paucity of studies in the Australian context. Objective: This study aimed to explore how Australian consumers used social media for health-related purposes, specifically how they identified social media platforms, which were used, and which health-related activities commonly took place. Methods: A total of 5 focus groups (n=36 participants), each lasting 60 to 90 minutes, were conducted in the Sydney metropolitan area. The group discussions were audiorecorded and transcribed verbatim. The transcripts were coded line-by-line and thematically analyzed. Results: Participants used general search engines to locate health-related social media platforms. They accessed a wide range of social media on a daily basis, using several electronic devices (in particular, mobile phones). Although privacy was a concern, it did not prevent consumers from fully engaging in social media for health-related purposes. Blogs were used to learn from other people’s experiences with the same condition. Facebook allowed consumers to follow health-related pages and to participate in disease-specific group discussions. Wikipedia was used for factual information about diseases and treatments. YouTube was accessed to learn about medical procedures such as surgery. No participant reported editing or contributing to Wikipedia or posting YouTube videos related to health topics. Twitter was rarely used for health-related purposes. Social media allowed consumers to obtain and provide disease and treatment-related information and social and emotional support for those living with the same condition. Most considered their participation as observational, but some also contributed (eg, responded to people’s questions). Conclusions: Participants used a wide range of social media for health-related purposes. Medical information exchange (eg, disease and treatment) and social and emotional support were the cornerstones of their online activities. Social media appears to be used as a key tool to support disease self-management. %M 29030326 %R 10.2196/jmir.7656 %U http://www.jmir.org/2017/10/e352/ %U https://doi.org/10.2196/jmir.7656 %U http://www.ncbi.nlm.nih.gov/pubmed/29030326 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 4 %P e25 %T Defining Information Quality Into Health Websites: A Conceptual Framework of Health Website Information Quality for Educated Young Adults %A Tao,Donghua %A LeRouge,Cynthia %A Smith,K Jody %A De Leo,Gianluca %+ Medical Center Library, Saint Louis Univesity, 1402 S. Grand Blvd., St. Louis, MO, 63104, United States, 1 3149778812, donghua.tao@slu.edu %K consumer health information %K World Wide Web %K Internet %K information services %K quality control %K young adults %K evaluation studies as topic %K medical informatics %D 2017 %7 06.10.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Today’s health care environment encourages health care consumers to take an active role in managing their health. As digital natives, young educated adults do much of their health information management through the Internet and consider it a valid source of health advice. However, the quality of information on health websites is highly variable and dynamic. Little is known about the understandings and perceptions that young educated adults have garnered on the quality of information on health websites used for health care–related purposes. Objective: To fill this gap, the aim of this study was to develop a conceptual framework of health website information quality with quality dimensions (ie, criteria) and associated quality drivers (ie, attributes) specified in the context of young educated adults’ use of health websites for health care–related purposes. This aim was achieved by (1) identifying information quality dimensions of health websites from the perspective of young educated adults; (2) identifying the importance ratings of these quality dimensions; and (3) constructing a framework of health website information quality with quality dimensions and associated drivers specified in the context of young educated adults’ use of health websites for health care–related purposes. Methods: The study employed both qualitative and quantitative methods. Methods included semistructured group interviews and an individual quality assessment exercise grounded in visiting various websites and responding to Likert scale questions regarding the importance ratings of information quality dimensions and open-ended questions with specifying website quality drivers. Study participants included junior and senior undergraduate and graduate students in business, allied health, and public health majors. Qualitative, open-coding procedures were used to develop the conceptual framework reflecting the participants’ means of assessing information quality on health websites. Results: Five dimensions of information quality for health websites were identified: Completeness of information, Understandability of information, Relevance of information, Depth of information, and Accuracy of information. Completeness of information and Understandability of information were rated as the two most important quality dimensions by the study participants. Results indicated that these five information quality dimensions for health websites were supported by the following main driver themes: Content, Design, Links, Consumer resources, Search functionality, Supporting references, User focus, Content FAQ, Open access, Policy statements, and Site performance. Conclusions: This study contributes to the literature by developing a health website information quality conceptual framework with quality dimensions and associated drivers specified for a young educated adult population. The detailed quality drivers supporting the corresponding quality dimensions provide a rich picture of young educated adults’ perceptions on health website information quality. This framework can be used to guide the development of health websites, as well as the foundation for a means to evaluate health information from existing health websites with young educated adults as the target audience. %M 28986336 %R 10.2196/humanfactors.6455 %U http://humanfactors.jmir.org/2017/4/e25/ %U https://doi.org/10.2196/humanfactors.6455 %U http://www.ncbi.nlm.nih.gov/pubmed/28986336 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e300 %T Barriers and Facilitators to eHealth Use in Daily Practice: Perspectives of Patients and Professionals in Dermatology %A Ariens,Lieneke FM %A Schussler-Raymakers,Florine ML %A Frima,Cynthia %A Flinterman,Annebeth %A Hamminga,Eefje %A Arents,Bernd WM %A Bruijnzeel-Koomen,Carla AFM %A de Bruin-Weller,Marjolein S %A van Os-Medendorp,Harmieke %+ Department of Dermatology and Allergology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Utrecht, 3584 CX, Netherlands, 31 887563687, l.f.m.ariens@umcutrecht.nl %K dermatology %K eHealth %K implementation %K barriers %K facilitators %D 2017 %7 05.09.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of eHealth interventions in the management of chronic diseases such as atopic dermatitis (AD) is growing. Despite promising results, the implementation and use of these interventions is limited. Objectives: This study aimed to assess opinions of the most important stakeholders influencing the implementation and use of eHealth services in daily dermatology practice. Methods: The perspectives of health care professionals and patients towards the implementation and use of eHealth services in daily practice were assessed by using a mixed method design. A cross-sectional survey based on the eHealth implementation toolkit (eHit) was conducted to explore factors influencing the adoption of eHealth interventions offering the possibility of e-consultations, Web-based monitoring, and Web-based self-management training among dermatologists and dermatology nurses. The perspectives of patients with atopic dermatitis (AD) regarding the use of eHealth services were discussed in an online focus group. Results: Health care professionals (n=99) and patients (n=9) acknowledged the value of eHealth services and were willing to use these digital tools in daily dermatology practice. Key identified barriers (statements with <50% of the participants scoring totally agree or agree) in the implementation and adoption of eHealth interventions included concerns about the availability (12/99, 12%) and allocation (14/99, 14%) of resources, financial aspects (26/99, 26%), reliability, security, and confidentially of the intervention itself (29/99, 29%), and the lack of education and training (6/99, 6%). Conclusions: Health care professionals and patients acknowledge the benefits arising from the implementation and use of eHealth services in daily dermatology practice. However, some important barriers were identified that might be useful in addressing the implementation strategy in order to enhance the implementation success of eHealth interventions in dermatology. %M 28874336 %R 10.2196/jmir.7512 %U http://www.jmir.org/2017/9/e300/ %U https://doi.org/10.2196/jmir.7512 %U http://www.ncbi.nlm.nih.gov/pubmed/28874336 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 8 %P e163 %T Barriers and Facilitators for the Use of a Medical Mobile App to Prevent Work-Related Risks in Pregnancy: A Qualitative Analysis %A Velu,Adeline V %A van Beukering,Monique DM %A Schaafsma,Frederieke G %A Frings-Dresen,Monique HW %A Mol,Ben WJ %A van der Post,Joris AM %A Kok,Marjolein %+ Academic Medical Center, Department of Obstetrics and Gynecology, University of Amsterdam, Room H4-232, Meibergdreef 9, Amsterdam,, Netherlands, 31 20 5663453, a.v.velu@amc.uva.nl %K qualitative research %K mobile app %K smartphone %K pregnancy %K work %K occupation %K exposure %K eHealth %K mHealth %D 2017 %7 22.08.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The number of women participating in the labor market in Europe has increased over the last several decades. At the same time, there is growing evidence that certain conditions of employment during pregnancy may have a negative influence on pregnancy outcomes. In order to better inform pregnant women, we aim to develop an app to help assess the health risk as a result of personal and work-related factors and provide personal advice for these women and their health care providers. Objective: The aim of this study was to compose a thematic overview of the perceived facilitators and barriers according to pregnant women, medical professionals, and employers for the use of a mobile app in obstetrical care to prevent occupational-related pregnancy complications. Methods: Two multidisciplinary focus group meetings with in total 14 participants were conducted with pregnant women, occupational physicians, general practitioners, midwives, obstetricians, and representatives of trade unions and employer organizations. Transcripts were analyzed by qualitatively coding procedures and constant comparative methods. Results: We identified 24 potential facilitators and 12 potential barriers for the use of the app in 4 categories: content of the app, the app as a mean to provide information, ease of use, and external factors. The 3 main facilitators identified were the need for a good interaction between the app and the user, apps were viewed as a more practical source of information, and the information should be understandable, according to the existing guidelines, and well-dosed. The 2 main barriers for use were extensive battery and memory use of the smartphone and sending frequent push notifications. Conclusions: The results of this study are important considerations in the developing process of a medical app implementing a guideline or evidence-based information in practice. %M 28830851 %R 10.2196/resprot.7224 %U http://www.researchprotocols.org/2017/8/e163/ %U https://doi.org/10.2196/resprot.7224 %U http://www.ncbi.nlm.nih.gov/pubmed/28830851 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e123 %T Opportunities of mHealth in Preconception Care: Preferences and Experiences of Patients and Health Care Providers and Other Involved Professionals %A Van Dijk,Matthijs R %A Koster,Maria PH %A Rosman,Ageeth N %A Steegers-Theunissen,Regine PM %+ Erasmus MC, Obstetrics and Gynecology, Dr Molewaterplein 50, Rotterdam, PO Box 2040, Netherlands, 31 107038254, r.steegers@erasmusmc.nl %K Focus group %K Lifestyle %K mHealth %K Nutrition %K Personalized medicine %K Preconception care %D 2017 %7 17.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The importance of the preconception period and preconception care (PCC) are broadly acknowledged and the potential benefits regarding health promotion have been studied extensively. PCC provides the opportunity to identify, prevent, and treat modifiable and nonmodifiable risk factors to optimize the health of couples trying to become pregnant. The prevalence of modifiable and nonmodifiable risk factors in these couples is high, but the uptake of PCC remains low. Objective: The aim of this study is to identify the preferences and experiences of women and men (patients) trying to become pregnant and of health care providers and other involved professionals regarding mobile health (mHealth), in particular the coaching platform Smarter Pregnancy, and its potential role in PCC. Methods: Patients who participated in the Smarter Pregnancy randomized controlled trial (RCT) and health care providers and professionals also involved in PCC were invited to participate in a qualitative study. The barriers, benefits, and opportunities of big data collection by mHealth were discussed in focus group sessions, prompted with statements regarding PCC. Results: We composed five focus groups, consisting of 27 patients in total (23 women and 4 men), who participated in the RCT, and nine health care providers and other professionals. Of the patients, 67% (18/27) were familiar with the concept of PCC, but only 15% (4/27) received any form of PCC. A majority of 56% (combined percentages of statements 1 [n=18], 2 [n=11], and 3 [n=16]) of the patients believed in the benefit of receiving PCC, and all agreed that men should be involved in PCC as well. Patients did not have a problem using anonymized data obtained from mHealth tools for scientific purposes. Patients and health care providers and other professionals both acknowledged the lack of awareness regarding the importance of PCC and stated that mHealth provides several opportunities to support clinical PCC. Conclusions: Our findings substantiate previous studies addressing the low uptake of PCC due to unawareness or lack of perception of its relevance by couples who are trying to become pregnant. The positive judgment and experiences with mHealth, in particular Smarter Pregnancy, will stimulate future research and further development of effective and cost-effective personalized mHealth apps for patients, health care providers, and other professionals as an add-on to clinical PCC. %M 28818820 %R 10.2196/mhealth.7834 %U http://mhealth.jmir.org/2017/8/e123/ %U https://doi.org/10.2196/mhealth.7834 %U http://www.ncbi.nlm.nih.gov/pubmed/28818820 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 8 %P e109 %T Usability Testing of the BRANCH Smartphone App Designed to Reduce Harmful Drinking in Young Adults %A Milward,Joanna %A Deluca,Paolo %A Drummond,Colin %A Watson,Rod %A Dunne,Jacklyn %A Kimergård,Andreas %+ Addictions Department, King's College London, 4 Windsor Walk, Denmark Hill, London, SE58BB, United Kingdom, 44 7590829898, joanna.milward@kcl.ac.uk %K alcohol %K drinking %K young adults %K mHealth %K brief intervention %K apps %K usability testing %K user experience %K focus group %D 2017 %7 08.08.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Electronic screening and brief intervention (eSBI) apps demonstrate potential to reduce harmful drinking. However, low user engagement rates with eSBI reduce overall effectiveness of interventions. As “Digital Natives,” young adults have high expectations of app quality. Ensuring that the design, content, and functionality of an eSBI app are acceptable to young adults is an integral stage to the development process. Objective: The objective of this study was to identify usability barriers and enablers for an app, BRANCH, targeting harmful drinking in young adults. Methods: The BRANCH app contains a drinking diary, alcohol reduction goal setting functions, normative drinking feedback, and information on risks and advice for cutting down. The app includes a social feature personalized to motivate cutting down and to promote engagement with a point-based system for usage. Three focus groups were conducted with 20 users who had tested the app for 1 week. A detailed thematic analysis was undertaken. Results: The first theme, “Functionality” referred to how users wanted an easy-to-use interface, with minimum required user-input. Poor functionality was considered a major usability barrier. The second theme, “Design” described how an aesthetic with minimum text, clearly distinguishable tabs and buttons and appealing infographics was integral to the level of usability. The final theme, “Content” described how participants wanted all aspects of the app to be automatically personalized to them, as well as providing them with opportunities to personalize the app themselves, with increased options for social connectivity. Conclusions: There are high demands for apps such as BRANCH that target skilled technology users including young adults. Key areas to optimize eSBI app development that emerged from testing BRANCH with representative users include high-quality functionality, appealing aesthetics, and improved personalization. %M 28790022 %R 10.2196/mhealth.7836 %U http://mhealth.jmir.org/2017/8/e109/ %U https://doi.org/10.2196/mhealth.7836 %U http://www.ncbi.nlm.nih.gov/pubmed/28790022 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 4 %N 3 %P e28 %T A Smartphone App for Adolescents With Sleep Disturbance: Development of the Sleep Ninja %A Werner-Seidler,Aliza %A O'Dea,Bridianne %A Shand,Fiona %A Johnston,Lara %A Frayne,Anna %A Fogarty,Andrea S %A Christensen,Helen %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, 2031, Australia, 61 293823769, a.werner-seidler@blackdog.org.au %K insomnia %K sleep %K adolescence %K depression %K cognitive behavioral therapy %K smartphone %D 2017 %7 28.07.2017 %9 Original Paper %J JMIR Ment Health %G English %X Background: Sleep disturbances are common in young people and have consequences for academic, social, emotional, and behavioral development. The most effective treatment is cognitive behavioral therapy for insomnia (CBT-I), with evidence suggesting that it is efficacious even when delivered digitally. Objective: There are no commercially available digitally delivered CBT-I programs for use by young people. The aim of this project was to develop a smartphone app that delivers CBT-I to young people to improve sleep. Methods: To inform the development of the app, young people (N=21) aged between 12 and 16 years attended one of the 3 focus groups (each with 4-10 participants). These focus groups were conducted at different stages of the development process such that the process could be iterative. Participants were asked the reasons why they might use an app to help them sleep, the kinds of features or functions that they would like to see in such an app, and any concerns they may have in using the app. Data were analyzed using a thematic analysis approach. Of the issues discussed by the participants, the researchers selected themes associated with content, functionality, and accessibility and user experience to examine, as these were most informative for the app design process. Results: In terms of content, young people were interested in receiving information about recommended sleep guidelines and personalized information for their age group. They reported that keeping a sleep diary was acceptable, but they should be able to complete it flexibly, in their own time. They reported mixed views about the use of the phone’s accelerometer. Young people felt that the functionality of the app should include elements of game playing if they were to remain engaged with the app. Flexibility of use and personalized features were also desirable, and there were mixed views about the schedule of notifications and reminders. Participants reported that for the app to be accessible and usable, it should be from a trusted developer, have engaging aesthetics, have a layout that is easy to navigate, not rely on Internet coverage, and preferably be free. Participants felt that being able to conceal the purpose of the app from peers was an advantage and were willing to provide personal information to use the app if the purpose and use of that information was made clear. Overall, participants endorsed the use of the app for sleep problems among their age group and reported motivation to use it. Conclusions: The Sleep Ninja is a fully-automated app that delivers CBT-I to young people, incorporating the features and information that young people reported they would expect from this app. A pilot study testing the feasibility, acceptability, and efficacy of the Sleep Ninja is now underway. %M 28754651 %R 10.2196/mental.7614 %U http://mental.jmir.org/2017/3/e28/ %U https://doi.org/10.2196/mental.7614 %U http://www.ncbi.nlm.nih.gov/pubmed/28754651 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e261 %T Adolescents’ Perspectives on Personalized E-Feedback in the Context of Health Risk Behavior Screening for Primary Care: Qualitative Study %A Zieve,Garret G %A Richardson,Laura P %A Katzman,Katherine %A Spielvogle,Heather %A Whitehouse,Sandy %A McCarty,Carolyn A %+ Center for Child Health, Behavior and Development, Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, 98121, United States, 1 206 884 7800, cari.mccarty@seattlechildrens.org %K adolescent %K screening %K health behavior %K motivation %K primary health care %K software %K technology %K qualitative research %D 2017 %7 20.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Electronic health screening tools for primary care present an opportunity to go beyond data collection to provide education and feedback to adolescents in order to motivate behavior change. However, there is limited research to guide feedback message development. Objective: The aim of this study was to explore youth perceptions of and preferences for receiving personalized feedback for multiple health risk behaviors and reinforcement for health promoting behaviors from an electronic health screening tool for primary care settings, using qualitative methodology. Methods: In total, 31 adolescents aged 13-18 years completed the screening tool, received the electronic feedback, and subsequently participated in individual, semistructured, qualitative interviews lasting approximately 60 min. Participants were queried about their overall impressions of the tool, perceptions regarding various types of feedback messages, and additional features that would help motivate health behavior change. Using thematic analysis, interview transcripts were coded to identify common themes expressed across participants. Results: Overall, the tool was well-received by participants who perceived it as a way to enhance—but not replace—their interactions with providers. They appreciated receiving nonjudgmental feedback from the tool and responded positively to information regarding the consequences of behaviors, comparisons with peer norms and health guidelines, tips for behavior change, and reinforcement of healthy choices. A small but noteworthy minority of participants dismissed the peer norms as not real or relevant and national guidelines as not valid or reasonable. When prompted for possible adaptations to the tool, adolescents expressed interest in receiving follow-up information, setting health-related goals, tracking their behaviors over time, and communicating with providers electronically between appointments. Conclusions: Adolescents in this qualitative study desired feedback that validates their healthy behavior choices and supports them as independent decision makers by neutrally presenting health information, facilitating goal setting, and offering ongoing technological supports. %M 28729236 %R 10.2196/jmir.7474 %U http://www.jmir.org/2017/7/e261/ %U https://doi.org/10.2196/jmir.7474 %U http://www.ncbi.nlm.nih.gov/pubmed/28729236 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 2 %N 2 %P e17 %T The Value of Children's Voices for a Video Game Development in the Context of Type 1 Diabetes: Focus Group Study %A Sparapani,Valéria de Cássia %A Fels,Sidney %A Nascimento,Lucila Castanheira %+ Ribeirao Preto College of Nursing, World Health Organization Collaborating Centre for Nursing Research Development, Department of Maternal-Infant and Public Health Nursing, University of São Paulo, Avenida Bandeirantes, 3900, Ribeirão Preto,, Brazil, 55 16 3315 3435, valsparapani@hotmail.com %K type 1 diabetes mellitus %K video games %K qualitative research %K pediatric nursing %K serious games %K self-management %D 2017 %7 19.07.2017 %9 Original Paper %J JMIR Diabetes %G English %X Background: Children with type 1 diabetes mellitus (T1DM) face daily challenges performing self-care tasks, controlling symptoms, and dealing with psychosocial issues. The use of video games to improve health is a successful support for persons with chronic diseases, promoting adequate self-management through simulations of real life. Involving future users in the development of games is essential to generating innovative, creative, and effective programs. Objective: Our goal is to identify what children with T1DM need to know about their disease and their self-care tasks as well as their preferences in video games. Methods: Children with T1DM provided input about their learning needs, self-care tasks, and preferences in video games. Three categories were identified through qualitative content analysis: dealing with emotions and knowledge, practical skills and awareness, and game preferences. Results: Children expressed concerns about the difficulties of self-care, lack of knowledge about diabetes, and lack of awareness about the consequences of behaviors related to self-care, which contribute to inappropriate behaviors and significantly impact self-management of their disease. They expressed enthusiasm for a video game for children with diabetes that considered their needs and preferences. Conclusions: Findings support the potential benefits when children’s input is considered in game design. Consideration of customer needs and preferences is a powerful resource in the development of video games with enhanced learning experience. %M 30291061 %R 10.2196/diabetes.7652 %U http://diabetes.jmir.org/2017/2/e17/ %U https://doi.org/10.2196/diabetes.7652 %U http://www.ncbi.nlm.nih.gov/pubmed/30291061 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 7 %P e235 %T Desirable Components for a Customized, Home-Based, Digital Care-Management App for Children and Young People With Long-Term, Chronic Conditions: A Qualitative Exploration %A Nightingale,Ruth %A Hall,Andrew %A Gelder,Carole %A Friedl,Simone %A Brennan,Eileen %A Swallow,Veronica %+ Great Ormond Street Hospital for Children, NHS Foundation Trust, Great Ormond Street, London,, United Kingdom, 44 7825 098844, ruth.nightingale@gosh.nhs.uk %K child %K adolescent %K long-term condition %K chronic condition %K self-management %K self-care %K mobile apps %K apps %K qualitative %D 2017 %7 04.07.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile apps for mobile phones and tablet devices are widely used by children and young people aged 0-18 years with long-term health conditions, such as chronic kidney disease (CKD), and their healthy peers for social networking or gaming. They are also poised to become a major source of health guidance. However, app development processes that are coproduced, rigorously developed, and evaluated to provide tailored, condition-specific, practical advice on day-to-day care management are seldom systematic or sufficiently described to enable replication. Furthermore, attempts to extrapolate to the real world are hampered by a poor understanding of the effects of key elements of app components. Therefore, effective and cost-effective novel, digital apps that will effectively and safely support care management are critical and timely. To inform development of such an app for children with CKD, a user requirements-gathering exercise was first needed. Objective: To explore the views of children with CKD, their parents, and health care professionals to inform future development of a child-focused, care-management app. Methods: Using age- and developmentally appropriate methods, we interviewed 36 participants: 5-10-year-olds (n=6), 11-14-year-olds (n=6), 15-18-year-olds (n=5), mothers (n=10), fathers (n=2), and health care professionals (n=7). Data were analyzed using Framework Analysis and behavior change theories. Results: Of the 27 interviews, 19 (70%) interviews were individual and 8 (30%) were joint—5 out of 8 (63%) joint interviews were with a child or young person and their parent, 1 out of 8 (13%) were with a child and both parents, and 2 out of 8 (25%) were with 2 professionals. Three key themes emerged to inform development of a software requirement specification for a future home-based, digital care-management app intervention: (1) Gaps in current online information and support, (2) Difficulties experienced by children with a long-term condition, and (3) Suggestions for a digital care-management app. Reported gaps included the fact that current online information is not usually appropriate for children as it is “dry” and “boring,” could be “scary,” and was either hard to understand or not relevant to individuals’ circumstances. For children, searching online was much less accessible than using a professional-endorsed mobile app. Children also reported difficulty explaining their condition to others, maintaining treatment adherence, coping with feeling isolated, and with trying to live a “normal” life. There was recognition that a developmentally appropriate, CKD-specific app could support the process of explaining the condition to healthy peers, reducing isolation, adhering to care-management plans, and living a “normal” life. Participants recommended a range of media and content to include in a tailored, interactive, age- and developmentally appropriate app. For example, the user would be able to enter their age and diagnosis so that only age-appropriate and condition-specific content is displayed. Conclusions: Future development of a digital app that meets the identified information and support needs and preferences of children with CKD will maximize its utility, thereby augmenting CKD caregiving and optimizing outcomes. %M 28676470 %R 10.2196/jmir.7760 %U http://www.jmir.org/2017/7/e235/ %U https://doi.org/10.2196/jmir.7760 %U http://www.ncbi.nlm.nih.gov/pubmed/28676470 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 6 %P e120 %T Development of a Web-Based Intervention for Addressing Distress in Caregivers of Patients Receiving Stem Cell Transplants: Formative Evaluation With Qualitative Interviews and Focus Groups %A Pensak,Nicole Amoyal %A Joshi,Tanisha %A Simoneau,Teresa %A Kilbourn,Kristin %A Carr,Alaina %A Kutner,Jean %A Laudenslager,Mark L %+ Hackensack University Medical Center, Department of Research, Cancer Prevention and Control, John Theurer Cancer Center, 40 Prospect Avenue, Hackensack, NJ, 07601, United States, 1 5519964267, Nicole.Pensak@HackensackMeridian.org %K cancer %K caregivers %K distress %K anxiety %K depression %K stem cell transplant %D 2017 %7 22.06.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Caregivers of cancer patients experience significant burden and distress including depression and anxiety. We previously demonstrated the efficacy of an eight session, in-person, one-on-one stress management intervention to reduce distress in caregivers of patients receiving allogeneic hematopoietic stem cell transplants (allo-HSCT). Objective: The objective of this study was to adapt and enhance the in-person caregiver stress management intervention to a mobilized website (eg, tablet, smartphone, or computer-based) for self-delivery in order to enhance dissemination to caregiver populations most in need. Methods: We used an established approach for development of a mhealth intervention, completing the first two research and evaluation steps: Step One: Formative Research (eg, expert and stakeholder review from patients, caregivers, and palliative care experts) and Step Two: Pretesting (eg, Focus Groups and Individual Interviews with caregivers of patients with autologous HSCT (auto-HSCT). Step one included feedback elicited for a mock-up version of Pep-Pal session one from caregiver, patients and clinician stakeholders from a multidisciplinary palliative care team (N=9 caregivers and patient stakeholders and N=20 palliative care experts). Step two included two focus groups (N=6 caregivers) and individual interviews (N=9 caregivers) regarding Pep-Pal’s look and feel, content, acceptability, and potential usability/feasibility. Focus groups and individual interviews were audio-recorded. In addition, individual interviews were transcribed, and applied thematic analysis was conducted in order to gain an in-depth understanding to inform the development and refinement of the mobilized caregiver stress management intervention, Pep-Pal (PsychoEducation and skills for Patient caregivers). Results: Overall, results were favorable. Pep-Pal was deemed acceptable for caregivers of patients receiving an auto-HSCT. The refined Pep-Pal program consisted of 9 sessions (Introduction to Stress, Stress and the Mind Body Connection, How Thoughts Can Lead to Stress, Coping with Stress, Strategies for Maintaining Energy and Stamina, Coping with Uncertainty, Managing Changing Relationships and Communicating Needs, Getting the Support You Need, and Improving Intimacy) delivered via video instruction through a mobilized website. Conclusions: Feedback from stakeholder groups, focus groups, and individual interviews provided valuable feedback in key areas that was integrated into the development of Pep-Pal with the goal of enhancing dissemination, engagement, acceptability, and usability. %M 28642213 %R 10.2196/resprot.7075 %U http://www.researchprotocols.org/2017/6/e120/ %U https://doi.org/10.2196/resprot.7075 %U http://www.ncbi.nlm.nih.gov/pubmed/28642213 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 6 %P e79 %T Beyond Basic Feedback in Mobile Brief Interventions: Designing SMS Message Content for Delivery to Young Adults During Risky Drinking Events %A Wright,Cassandra J C %A Dietze,Paul M %A Lim,Megan S C %+ Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Rd, Melbourne,, Australia, 61 392822173, cassandra.wright@burnet.edu.au %K alcohol drinking %K young adult %K mHealth %K text messaging %K motivational interviewing %K community-based participatory research %D 2017 %7 20.06.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Brief interventions can reduce alcohol consumption in young people through screening and delivery of personally relevant feedback. Recently, Web and mobile platforms have been harnessed to increase the reach of brief interventions. Existing literature on mobile-based alcohol brief interventions indicates mixed use of theory in developing interventions. There is no research available to guide the development of SMS text messaging (short message service, SMS) interventions delivered during risky drinking events. Objective: The aim of this study was to develop and pilot an alcohol-related risk-reduction brief intervention delivered by SMS to Australian young adults during drinking events. This paper describes the development of intervention message content, with specific focus on the context of delivery during drinking events. Methods: A sample of 42 young adults attended 4 workshops; these comprised focus-group style discussion on drinking habits and motivations, discussion of intervention design, analysis of existing alcohol media campaigns, and participant development of message content. Data were analyzed thematically. Results: Participants described a focus on having fun and blocking out any incongruent negative influences during drinking episodes. For content to be acceptable, nonjudgmental and non-authoritative language was deemed essential. A preference for short, actionable messages was observed, including suggestions for reminders around drinking water, organizing transport home, checking on friends, and plans the next day. Participants were excited about the potential for messages to be tailored to individuals, as previous alcohol-related campaigns were deemed too generic and often irrelevant. Normative-based messages were also perceived as largely irrelevant as participants felt that they understood the drinking-related norms of their immediate peers already. Conclusions: Findings from this study offer insights into young adults’ drinking events and practical advice for designing alcohol-related brief interventions. During our formative development process, we demonstrated a neat correspondence between young people’s preferences for alcohol harm reduction interventions and the theoretical principles of brief interventions, including acceptable topics and message style. %M 28634153 %R 10.2196/mhealth.6497 %U http://mhealth.jmir.org/2017/6/e79/ %U https://doi.org/10.2196/mhealth.6497 %U http://www.ncbi.nlm.nih.gov/pubmed/28634153 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 2 %P e15 %T Fall Prevention Self-Assessments Via Mobile 3D Visualization Technologies: Community Dwelling Older Adults’ Perceptions of Opportunities and Challenges %A Hamm,Julian %A Money,Arthur %A Atwal,Anita %+ Department of Computer Science, Brunel University, Department of Computer Science, St Johns, Kingston Lane, UB8 3PH, London,, United Kingdom, 44 01895 266758, arthur.money@brunel.ac.uk %K health informatics %K falls %K occupational therapy %K assistive equipment provision process %K self-assessment %K measurement guidance %K extrinsic risk factors %K 3D visualization %K technology-based systems %D 2017 %7 19.06.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In the field of occupational therapy, the assistive equipment provision process (AEPP) is a prominent preventive strategy used to promote independent living and to identify and alleviate fall risk factors via the provision of assistive equipment within the home environment. Current practice involves the use of paper-based forms that include 2D measurement guidance diagrams that aim to communicate the precise points and dimensions that must be measured in order to make AEPP assessments. There are, however, issues such as “poor fit” of equipment due to inaccurate measurements taken and recorded, resulting in more than 50% of equipment installed within the home being abandoned by patients. This paper presents a novel 3D measurement aid prototype (3D-MAP) that provides enhanced measurement and assessment guidance to patients via the use of 3D visualization technologies. Objective: The purpose of this study was to explore the perceptions of older adults with regard to the barriers and opportunities of using the 3D-MAP application as a tool that enables patient self-delivery of the AEPP. Methods: Thirty-three community-dwelling older adults participated in interactive sessions with a bespoke 3D-MAP application utilizing the retrospective think-aloud protocol and semistructured focus group discussions. The system usability scale (SUS) questionnaire was used to evaluate the application’s usability. Thematic template analysis was carried out on the SUS item discussions, think-aloud, and semistructured focus group data. Results: The quantitative SUS results revealed that the application may be described as having “marginal-high” and “good” levels of usability, along with strong agreement with items relating to the usability (P=.004) and learnability (P<.001) of the application. Four high-level themes emerged from think-aloud and focus groups discussions: (1) perceived usefulness (PU), (2) perceived ease of use (PEOU), (3) application use (AU) and (4) self-assessment (SA). The application was seen as a useful tool to enhance visualization of measurement guidance and also to promote independent living, ownership of care, and potentially reduce waiting times. Several design and functionality recommendations emerged from the study, such as a need to manipulate the view and position of the 3D furniture models, and a need for clearer visual prompts and alternative keyboard interface for measurement entry. Conclusions: Participants perceived the 3D-MAP application as a useful tool that has the potential to make significant improvements to the AEPP, not only in terms of accuracy of measurement, but also by potentially enabling older adult patients to carry out the data collection element of the AEPP themselves. Further research is needed to further adapt the 3D-MAP application in line with the study outcomes and to establish its clinical utility with regards to effectiveness, efficiency, accuracy, and reliability of measurements that are recorded using the application and to compare it with 2D measurement guidance leaflets. %M 28630034 %R 10.2196/humanfactors.7161 %U http://humanfactors.jmir.org/2017/2/e15/ %U https://doi.org/10.2196/humanfactors.7161 %U http://www.ncbi.nlm.nih.gov/pubmed/28630034 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e79 %T Recruitment of Community College Students Into a Web-Assisted Tobacco Intervention Study %A McIntosh,Scott %A Johnson,Tye %A Wall,Andrew F %A Prokhorov,Alexander V %A Calabro,Karen Sue %A Ververs,Duncan %A Assibey-Mensah,Vanessa %A Ossip,Deborah J %+ Department of Public Health Sciences, University of Rochester School of Medicine & Dentistry, 265 Crittenden Blvd, CU 420644, Rochester, NY, 14642, United States, 1 5858029944, scott_mcintosh@urmc.rochester.edu %K community colleges %K tobacco control %K study recruitment %K qualitative research %K baseline %D 2017 %7 08.05.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: United States college students, particularly those attending community colleges, have higher smoking rates than the national average. Recruitment of such smokers into research studies has not been studied in depth, despite a moderate amount information on study recruitment success with smokers from traditional four-year colleges. Recruitment channels and success are evolving as technology evolves, so it is important to understand how to best target, implement, and evaluate recruitment strategies. Objective: The aim of this paper is to both qualitatively and quantitatively explore recruitment channels (eg, mass email, in-person referral, posted materials) and their success with enrollment into a Web-Assisted Tobacco Intervention study in this priority population of underserved and understudied smokers. Methods: Qualitative research methods included key informant interviews (n=18) and four focus groups (n=37). Quantitative research methods included observed online responsiveness to any channel (n=10,914), responses from those completing online screening and study consent (n=2696), and responses to a baseline questionnaire from the fully enrolled study participants (n=1452). Results: Qualitative results prior to recruitment provided insights regarding the selection of a variety of recruitment channels proposed to be successful, and provided context for the unique attributes of the study sample. Quantitative analysis of self-reported channels used to engage with students, and to enroll participants into the study, revealed the relative utilization of channels at several recruitment points. The use of mass emails to the student body was reported by the final sample as the most influential channel, accounting for 60.54% (879/1452) of the total enrolled sample. Conclusions: Relative channel efficiency was analyzed across a wide variety of channels. One primary channel (mass emails) and a small number of secondary channels (including college websites and learning management systems) accounted for most of the recruitment success. Trial Registration: ClinicalTrials.gov NCT01692730; https://clinicaltrials.gov/ct2/show/NCT01692730 (Archived by WebCite at http://www.webcitation.org/6qEcFQN9Q) %M 28483741 %R 10.2196/resprot.6485 %U http://www.researchprotocols.org/2017/5/e79/ %U https://doi.org/10.2196/resprot.6485 %U http://www.ncbi.nlm.nih.gov/pubmed/28483741 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 6 %N 5 %P e76 %T Meeting the Needs of Mothers During the Postpartum Period: Using Co-Creation Workshops to Find Technological Solutions %A Slomian,Justine %A Emonts,Patrick %A Vigneron,Lara %A Acconcia,Alessandro %A Reginster,Jean-Yves %A Oumourgh,Mina %A Bruyère,Olivier %+ Epidemiology and Health Economics and Support Unit in Epidemiology and Biostatistics, Department of Public Health, University of Liège, CHU - Sart Tilman, Quartier Hôpital, Avenue Hippocrate 13, Bât. B23, Liège, 4000, Belgium, 32 43 66 49 33, jslomian@ulg.ac.be %K mothers’ needs %K technological solutions %K co-creating workshop %K co-creation %K postpartum needs %D 2017 %7 03.05.2017 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The postnatal period is associated with many new needs for mothers. Objective: The aim of this study was to find technological solutions that meet the needs of mothers during the year following childbirth. Methods: Two co-creation workshops were undertaken with parents and professionals. The aim of the first workshop was to create a list of all the criteria the proposed solution would have to address to meet the needs of mothers after childbirth. The aim of the second workshop was to create solutions in response to the criteria selected during the first workshop. Results: Parents and health professionals want solutions that include empathy (ie, to help fight against the feelings of abnormality and loneliness), that help mothers in daily life, that are personalized and adapted to different situations, that are educational, and that assures some continuity in their contact with health professionals. In practice, we found that parents and professionals think the solution should be accessible to everyone and available at all times. To address these criteria, technology experts proposed different solutions, such as a forum dedicated to the postpartum period that is supervised by professionals, a centralized website, a system of videoconferencing, an online exchange group, a “gift voucher” system, a virtual reality app, or a companion robot. Conclusions: The human component seems to be very important during the postnatal period. Nevertheless, technology could be a great ally in helping mothers during the postpartum period. Technology can help reliably inform parents and may also give them the right tools to find supportive people. However, these technologies should be tested in clinical trials. %M 28468746 %R 10.2196/resprot.6831 %U http://www.researchprotocols.org/2017/5/e76/ %U https://doi.org/10.2196/resprot.6831 %U http://www.ncbi.nlm.nih.gov/pubmed/28468746 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e47 %T A Framework for the Study of Complex mHealth Interventions in Diverse Cultural Settings %A Maar,Marion A %A Yeates,Karen %A Perkins,Nancy %A Boesch,Lisa %A Hua-Stewart,Diane %A Liu,Peter %A Sleeth,Jessica %A Tobe,Sheldon W %+ Faculty of Medicine, Northern Ontario School of Medicine, Laurentian University, 935 Ramsey Lake Rd, Sudbury, ON, P3E 2C6, Canada, 1 705 662 7233, mmaar@nosm.ca %K mobile health %K health care texting %K SMS %K protocol %K process evaluation %K process assessment (health care) %K health services, Indigenous %K Tanzania %K community-based participatory research %K DREAM-GLOBAL %D 2017 %7 20.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: To facilitate decision-making capacity between options of care under real-life service conditions, clinical trials must be pragmatic to evaluate mobile health (mHealth) interventions under the variable conditions of health care settings with a wide range of participants. The mHealth interventions require changes in the behavior of patients and providers, creating considerable complexity and ambiguity related to causal chains. Process evaluations of the implementation are necessary to shed light on the range of unanticipated effects an intervention may have, what the active ingredients in everyday practice are, how they exert their effect, and how these may vary among recipients or between sites. Objective: Building on the CONSORT-EHEALTH (Consolidated Standards of Reporting Trials of Electronic and Mobile HEalth Applications and onLine TeleHealth) statement and participatory evaluation theory, we present a framework for the process evaluations for mHealth interventions in multiple cultural settings. We also describe the application of this evaluation framework to the implementation of DREAM-GLOBAL (Diagnosing hypertension—Engaging Action and Management in Getting Lower BP in Indigenous and LMIC [low- and middle-income countries]), a pragmatic randomized controlled trial (RCT), and mHealth intervention designed to improve hypertension management in low-resource environments. We describe the evaluation questions and the data collection processes developed by us. Methods: Our literature review revealed that there is a significant knowledge gap related to the development of a process evaluation framework for mHealth interventions. We used community-based participatory research (CBPR) methods and formative research data to develop a process evaluation framework nested within a pragmatic RCT. Results: Four human organizational levels of participants impacted by the mHealth intervention were identified that included patients, providers, community and organizations actors, and health systems and settings. These four levels represent evaluation domains and became the core focus of the evaluation. In addition, primary implementation themes to explore in each of the domains were identified as follows: (1) the major active components of the intervention, (2) technology of the intervention, (3) cultural congruence, (4) task shifting, and (5) unintended consequences. Using the four organizational domains and their interaction with primary implementation themes, we developed detailed evaluation research questions and identified the data or information sources to best answer our questions. Conclusions: Using DREAM-GLOBAL to illustrate our approach, we succeeded in developing an uncomplicated process evaluation framework for mHealth interventions that provide key information to stakeholders, which can optimize implementation of a pragmatic trial as well as inform scale up. The human organizational level domains used to focus the primary implementation themes in the DREAM-GLOBAL process evaluation framework are sufficiently supported in our research, and the literature and can serve as a valuable tool for other mHealth process evaluations. Trial Registration: ClinicalTrials.gov NCT02111226; https://clinicaltrials.gov/ct2/show/NCT02111226 (Archived by WebCite at http://www.webcitation.org/6oxfHXege) %M 28428165 %R 10.2196/mhealth.7044 %U http://mhealth.jmir.org/2017/4/e47/ %U https://doi.org/10.2196/mhealth.7044 %U http://www.ncbi.nlm.nih.gov/pubmed/28428165 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e124 %T Using Persuasive Technology to Increase Physical Activity in People With Chronic Obstructive Pulmonary Disease by Encouraging Regular Walking: A Mixed-Methods Study Exploring Opinions and Preferences %A Bartlett,Yvonne Kiera %A Webb,Thomas L %A Hawley,Mark S %+ Manchester Centre for Health Psychology, Manchester Academic Health Science Centre, The School of Health Sciences, University of Manchester, Coupland 1 Building, Oxford Road, Manchester, M139PL, United Kingdom, 44 161306436 ext 65436, kiera.bartlett@manchester.ac.uk %K persuasive technology %K chronic obstructive pulmonary disease %K physical activity %K walking %K mHealth %K mobile apps %D 2017 %7 20.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: People with chronic obstructive pulmonary disease (PwCOPD) often experience breathlessness and fatigue, making physical activity challenging. Although many persuasive technologies (such as mobile phone apps) have been designed to support physical activity among members of the general population, current technologies aimed at PwCOPD are underdeveloped and only use a limited range of persuasive technology design principles. Objective: The aim of this study was to explore how acceptable different persuasive technology design principles were considered to be in supporting and encouraging physical activity among PwCOPD. Methods: Three prototypes for mobile apps using different persuasive technology design principles as defined by the persuasive systems design (PSD) model—namely, dialogue support, primary task support, and social support—were developed. Opinions of these prototypes were explored through 28 interviews with PwCOPD, carers, and the health care professionals (HCPs) involved in their care and questionnaires completed by 87 PwCOPD. Participants also ranked how likely individual techniques (eg, competition) would be to convince them to use a technology designed to support physical activity. Data were analyzed using framework analysis, Friedman tests, and Wilcoxon signed rank tests and a convergent mixed methods design was used to integrate findings. Results: The prototypes for mobile apps were received positively by participants. The prototype that used a dialogue support approach was identified as the most likely to be used or recommended by those interviewed, and was perceived as more persuasive than both of the other prototypes (Z=−3.06, P=.002; Z=−5.50, P<.001) by those who completed the questionnaire. PwCOPD identified dialogue support and primary task support techniques as more likely to convince them to use a technology than social support techniques (Z=−5.00, P<.001; Z=−4.92, P<.001, respectively). Opinions of social support techniques such as competition and collaboration were divided. Conclusions: Dialogue support and primary task support approaches are considered to be both acceptable and likely to be persuasive by PwCOPD, carers, and HCPs. In the future, these approaches should be considered when designing apps to encourage physical activity by PwCOPD. %M 28428155 %R 10.2196/jmir.6616 %U http://www.jmir.org/2017/4/e124/ %U https://doi.org/10.2196/jmir.6616 %U http://www.ncbi.nlm.nih.gov/pubmed/28428155 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 5 %N 4 %P e53 %T Developing a Patient-Centered mHealth App: A Tool for Adolescents With Type 1 Diabetes and Their Parents %A Holtz,Bree E %A Murray,Katharine M %A Hershey,Denise D %A Dunneback,Julie K %A Cotten,Shelia R %A Holmstrom,Amanda J %A Vyas,Arpita %A Kaiser,Molly K %A Wood,Michael A %+ Department of Advertising and Public Relations, Michigan State University, 404 Wilson Road, Room 309, East Lansing, MI, 48824, United States, 1 5178844537, bholtz@msu.edu %K mHealth %K qualitative research %K type 1 diabetes %K family %D 2017 %7 19.04.2017 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Type 1 diabetes (T1D) afflicts approximately 154,000 people under 20 years of age. Three-quarters of adolescents are not achieving glycosylated hemoglobin (HbA1c) targets, which leads to negative health outcomes. Mobile health (mHealth), the use of technology in health, has been used successfully to improve health in many chronic conditions, including diabetes. Objective: The purpose of this study was to use patient-centered research methods to inform and improve the design and functionality of our T1D app, MyT1DHero, and to provide insight for others who are designing a health app for adolescents and parents. Methods: This study included data from focus groups with participants recruited from the Juvenile Diabetes Research Foundation (JDRF) southeast Michigan’s family network. All data collected during the sessions were audio-recorded, transcribed, and coded. Results: Four key themes were identified: (1) diabetes is unpredictable, (2) negative and frustrated communication, (3) motivations to use an app, and (4) feedback specific to our app. Conclusions: A patient-centered approach was used to assist in the development of an app for adolescents with T1D. Participants were satisfied with overall app design; customization, interactivity, and tangible rewards were identified as being necessary for continued use. Participants believed the app would help improve the communication between parents and adolescents. Many apps developed in the health context have not used a patient-centered design method or have seen vast improvements in health. This paper offers suggestions to others seeking to develop apps for adolescents and their parents. %M 28428167 %R 10.2196/mhealth.6654 %U http://mhealth.jmir.org/2017/4/e53/ %U https://doi.org/10.2196/mhealth.6654 %U http://www.ncbi.nlm.nih.gov/pubmed/28428167 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e9 %T Design and Usability of a Heart Failure mHealth System: A Pilot Study %A Alnosayan,Nagla %A Chatterjee,Samir %A Alluhaidan,Ala %A Lee,Edward %A Houston Feenstra,Linda %+ IDEA Laboratory, Center for Information Systems and Technology, Claremont Graduate University, 130 East 9th Street, Claremont, CA, 91711, United States, 1 (909) 541 1559, nagla.alnosayan@alumni.cgu.edu %K mHealth %K telehealth %K heart failure %K human factors engineering %K self-management %D 2017 %7 24.03.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Despite the advances in mobile health (mHealth) systems, little is known about patients’ and providers’ experiences using a new mHealth system design. Objective: This study aimed to understand challenges and provide design considerations for a personalized mHealth system that could effectively support heart failure (HF) patients after they transition into the home environment. Methods: Following exploratory interviews with nurses and preventive care physicians, an mHealth system was developed. Patients were asked to measure their weight, blood pressure, and blood glucose (if they had diabetes). They were also instructed to enter symptoms, view notifications, and read messages on a mobile app that we developed. A Bluetooth-enabled weight scale, blood pressure monitor, glucometer, and mobile phone was provided after an introductory orientation and training session. HF nurses used a dashboard to view daily measurements for each patient and received text and email alerts when risk was indicated. Observations of usage, cases of deterioration, readmissions, and metrics related to system usability and quality of life outcomes were used to determine overall effectiveness of the system, whereas focus group sessions with patients were conducted to elicit participants’ feedback on the system’s design. Results: A total of 8 patients with HF participated over a 6-month period. Overall, the mean users’ satisfaction with the system ranked 73%, which was above average. Quality of life improvement was 3.6. Patients and nurses used the system on a regular basis and were able to successfully identify and manage 8 health deteriorations, of which 5 were completely managed remotely. Focus groups revealed that, on one hand, the system was beneficial and helped patients with: recording and tracking readings; receiving encouragement and reassurance from nurses; spotting and solving problems; learning from past experiences; and communication. On the other hand, findings also highlighted design issues and recommendations for future systems such as the need to communicate via other media, personalize symptom questions and messages, integrate other health tracking technologies, and provide additional methods to analyze and visualize their data. Conclusions: Understanding users’ experiences provides important design considerations that could complement existing design recommendations from the literature, and, when combined with physician and nurse requirements, have the potential to yield a feasible telehealth system that is effective in supporting HF self-care. Future studies will include these guidelines and use a larger sample size to validate the outcomes. %M 28341615 %R 10.2196/humanfactors.6481 %U http://humanfactors.jmir.org/2017/1/e9/ %U https://doi.org/10.2196/humanfactors.6481 %U http://www.ncbi.nlm.nih.gov/pubmed/28341615 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 3 %N 1 %P e2 %T Parent and Health Care Provider Perceptions for Development of a Web-Based Weight Management Program for Survivors of Pediatric Acute Lymphoblastic Leukemia: A Mixed Methods Study %A Folta,Sara %A Chang,Winnie %A Hill,Rachel %A Kelly,Michael %A Meagher,Susan %A Bowman,W Paul %A Zhang,Fang Fang %+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA,, United States, 1 617 636 3423, sara.folta@tufts.edu %K weight management %K childhood cancer survivors %K mixed methods %D 2017 %7 09.02.2017 %9 Original Paper %J JMIR Cancer %G English %X Background: Survivors of pediatric acute lymphoblastic leukemia (ALL) may experience unhealthy weight gain during treatment, which has been associated with higher risk for chronic health issues. Objective: The purpose of this study was to obtain feedback on weight management in pediatric ALL survivors and on the content and implementation of a Web-based weight management program. Methods: Study participants included 54 parent survey respondents and 19 pediatric oncology professionals in 4 focus groups. Survey questions included report of child weight status and interest in participating in weight management programming at various time points. Pediatric oncology professionals were asked about the preferred topics and timing, as well as their role. Focus group data were analyzed by a multidisciplinary research team for common themes. Results: The mean age of survivors was 6.5 years. By parent report, 19% of children were overweight and 25% were obese. Preferred timing for weight management program participation was within 3 months of starting maintenance chemotherapy (23/53, 43%) or within 12 months after completion of all cancer treatments (18/53, 34%). Pediatric oncology professionals likewise considered the maintenance phase appropriate. They considered parenting to be an important topic to include and indicated that their most appropriate roles would be promotion and support. Conclusions: Parents and pediatric oncology professionals are interested in and supportive of early weight management in pediatric ALL survivors. Future research needs to identify strategies to integrate this into pediatric cancer care and to evaluate the feasibility and efficacy of these strategies. %M 28410182 %R 10.2196/cancer.6680 %U http://cancer.jmir.org/2017/1/e2/ %U https://doi.org/10.2196/cancer.6680 %U http://www.ncbi.nlm.nih.gov/pubmed/28410182 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 1 %P e7 %T SmartMom Text Messaging for Prenatal Education: A Qualitative Focus Group Study to Explore Canadian Women’s Perceptions %A Munro,Sarah %A Hui,Amber %A Salmons,Vanessa %A Solomon,Carolyn %A Gemmell,Emily %A Torabi,Nahal %A Janssen,Patricia A %+ School of Population and Public Health, Faculty of Medicine, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T 1Z3, Canada, 1 604 827 4026, patti.janssen@ubc.ca %K pregnancy %K text messaging %K prenatal education %K health behavior %D 2017 %7 07.02.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: We engaged Canadian women in the development of a prenatal education program delivered via one-way text messaging called SmartMom. SmartMom is the first peer-reviewed, evidence-based mHealth program for prenatal education in Canada and the first to be endorsed by the Society of Obstetricians and Gynaecologists of Canada. Objective: To explore women’s preferences for a prenatal education program by text messaging. Methods: We conducted a qualitative focus group study in three Canadian communities in the Northern Health Authority. Women completed a demographic questionnaire, participated in a guided discussion about their pregnancy information-seeking behavior, reviewed a printed copy of the SmartMom text messages, and then engaged in a moderated discussion about their perceptions of the usability of the SmartMom program. Open-ended questions explored women’s perceptions regarding the message content, acceptability of receiving information by text message, positive health behaviors they might engage in after receiving a message, modifiable program factors, and intention to use the program. Thematic analysis of transcribed audio recordings was undertaken and modifications were made to the SmartMom program based on these findings. Results: A total of 40 women participated in seven focus groups in three rural northern communities. The vast majority had a mobile phone (39/40, 98%), used text messages “all the time” (28/40, 70%), and surfed the Internet on their phone (37/40, 93%). Participants perceived SmartMom to be highly acceptable and relevant. The text message modality reflected how participants currently sought pregnancy-related information and provided them with local information tailored to their gestational age, which they had not received through other pregnancy resources. Women recommended adding the opportunity to receive supplemental streams of messages tailored to their individual needs, for example, depression, pregnancy after previous cesarean, >35 years of age, new immigrants, and harm reduction for smoking and alcohol. Conclusions: This formative qualitative evaluation provides evidence that a prenatal education program by text messaging, SmartMom, is acceptable to the end users. These findings support the usability of the SmartMom program at a population level and the development of an evaluation program exploring the effects of the text messages on adoption of health-promoting behaviors and maternal-child health outcomes. %M 28174149 %R 10.2196/publichealth.6949 %U http://publichealth.jmir.org/2017/1/e7/ %U https://doi.org/10.2196/publichealth.6949 %U http://www.ncbi.nlm.nih.gov/pubmed/28174149 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e5 %T A Self-Regulation Theory–Based Asthma Management Mobile App for Adolescents: A Usability Assessment %A Sage,Adam %A Roberts,Courtney %A Geryk,Lorie %A Sleath,Betsy %A Tate,Deborah %A Carpenter,Delesha %+ Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, 2213 Kerr Hall, Chapel Hill, NC,, United States, 1 330 388 3025, asage@email.unc.edu %K mHealth %K asthma %K mobile %K usability %D 2017 %7 01.02.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Self-regulation theory suggests people learn to influence their own behavior through self-monitoring, goal-setting, feedback, self-reward, and self-instruction, all of which smartphones are now capable of facilitating. Several mobile apps exist to manage asthma; however, little evidence exists about whether these apps employ user-centered design processes that adhere to government usability guidelines for mobile apps. Objective: Building upon a previous study that documented adolescent preferences for an asthma self-management app, we employed a user-centered approach to assess the usability of a high-fidelity wireframe for an asthma self-management app intended for use by adolescents with persistent asthma. Methods: Individual interviews were conducted with adolescents (ages 11-18 years) with persistent asthma who owned a smartphone (N=8). Adolescents were asked to evaluate a PDF app wireframe consisting of 76 screen shots displaying app features, including log in and home screen, profile setup, settings and info, self-management features, and graphical displays for charting asthma control and medication. Preferences, comments, and suggestions for each set of screen shots were assessed using the audio-recorded interviews. Two coders reached consensus on adolescent evaluations of the following aspects of app features: (1) usability, (2) behavioral intentions to use, (3) confusing aspects, and (4) suggestions for improvement. Results: The app wireframe was generally well received, and several suggestions for improvement were recorded. Suggestions included increased customization of charts and notifications, reminders, and alerts. Participants preferred longitudinal data about asthma control and medication use to be displayed using line graphs. All participants reported that they would find an asthma management app like the one depicted in the wireframe useful for managing their asthma. Conclusions: Early stage usability tests guided by government usability guidelines (usability.gov) revealed areas for improvement for an asthma self-management app for adolescents. Addressing these areas will be critical to developing an engaging and effective asthma self-management app that is capable of improving adolescent asthma outcomes. %M 28148471 %R 10.2196/humanfactors.7133 %U http://humanfactors.jmir.org/2017/1/e5/ %U https://doi.org/10.2196/humanfactors.7133 %U http://www.ncbi.nlm.nih.gov/pubmed/28148471 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e229 %T Parent and Clinician Preferences for an Asthma App to Promote Adolescent Self-Management: A Formative Study %A Geryk,Lorie L %A Roberts,Courtney A %A Sage,Adam J %A Coyne-Beasley,Tamera %A Sleath,Betsy L %A Carpenter,Delesha M %+ Division of Pharmaceutical Outcomes and Policy, Eshelman School of Pharmacy, University of North Carolina, 301 Pharmacy Lane, Chapel Hill, NC, 27599, United States, 1 9198432278, llgeryk@email.unc.edu %K asthma %K self-management %K social support %K mHealth %K mobile apps %K adolescents %K parents %K clinicians %D 2016 %7 06.12.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Most youth asthma apps are not designed with parent and clinician use in mind, and rarely is the app development process informed by parent or clinician input. Objective: This study was conducted to generate formative data on the use, attitudes, and preferences for asthma mHealth app features among parents and clinicians, the important stakeholders who support adolescents with asthma and promote adolescent self-management skills. Methods: We conducted a mixed-methods study from 2013 to 2014 employing a user-centered design philosophy to acquire feedback from a convenience sample of 20 parents and 6 clinicians. Participants were given an iPod Touch and asked to evaluate 10 features on 2 existing asthma apps. Participant experiences using the apps were collected from questionnaires and a thematic analysis of audio-recorded and transcribed (verbatim) interviews using MAXQDA. Descriptive statistics were calculated to characterize the study sample and app feature feedback. Independent samples t tests were performed to compare parent and clinician ratings of app feature usefulness (ratings: 1=not at all useful to 5=very useful). Results: All parents were female (n=20), 45% were black, 20% had an income ≥US $50,000, and 45% had a bachelor’s degree or higher education. The clinician sample included 2 nurses and 4 physicians with a mean practice time of 13 years. Three main themes provided an understanding of how participants perceived their roles and use of asthma app features to support adolescent asthma self-management: monitoring and supervision, education, and communication/information sharing. Parents rated the doctor report feature highest, and clinicians rated the doctor appointment reminder highest of all evaluated app features on usefulness. The peak flow monitoring feature was the lowest ranked feature by both parents and clinicians. Parents reported higher usefulness for the doctor report (t(10)=2.7, P<.02), diary (t(10)=2.7, P<.03), and self-check quiz (t(14)=2.5, P<.02) features than clinicians. Specific participant suggestions for app enhancements (eg, a tutorial showing correct inhaler use, refill reminders, pop-up messages tied to a medication log, evidence-based management steps) were also provided. Conclusions: Parent and clinician evaluations and recommendations can play an important role in the development of an asthma app designed to help support youth asthma management. Two-way asthma care communication between families and clinicians and components involving families and clinicians that support adolescent self-management should be incorporated into adolescent asthma apps. %M 27923777 %R 10.2196/resprot.5932 %U http://www.researchprotocols.org/2016/4/e229/ %U https://doi.org/10.2196/resprot.5932 %U http://www.ncbi.nlm.nih.gov/pubmed/27923777 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 3 %N 2 %P e26 %T Integrating Patient-Generated Health Data Into Clinical Care Settings or Clinical Decision-Making: Lessons Learned From Project HealthDesign %A Cohen,Deborah J %A Keller,Sara R %A Hayes,Gillian R %A Dorr,David A %A Ash,Joan S %A Sittig,Dean F %+ Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, FM, Portland, OR, 97239, United States, 1 503 494 7840, cohendj@ohsu.edu %K mobile applications %K chronic disease, self-management %K doctor-patient relations %D 2016 %7 19.10.2016 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Patient-generated health data (PGHD) are health-related data created or recorded by patients to inform their self-care and understanding about their own health. PGHD is different from other patient-reported outcome data because the collection of data is patient-driven, not practice- or research-driven. Technical applications for assisting patients to collect PGHD supports self-management activities such as healthy eating and exercise and can be important for preventing and managing disease. Technological innovations (eg, activity trackers) are making it more common for people to collect PGHD, but little is known about how PGHD might be used in outpatient clinics. Objective: The objective of our study was to examine the experiences of health care professionals who use PGHD in outpatient clinics. Methods: We conducted an evaluation of Project HealthDesign Round 2 to synthesize findings from 5 studies funded to test tools designed to help patients collect PGHD and share these data with members of their health care team. We conducted semistructured interviews with 13 Project HealthDesign study team members and 12 health care professionals that participated in these studies. We used an immersion-crystallization approach to analyze data. Our findings provide important information related to health care professionals’ attitudes toward and experiences with using PGHD in a clinical setting. Results: Health care professionals identified 3 main benefits of PGHD accessibility in clinical settings: (1) deeper insight into a patient’s condition; (2) more accurate patient information, particularly when of clinical relevance; and (3) insight into a patient’s health between clinic visits, enabling revision of care plans for improved health goal achievement, while avoiding unnecessary clinic visits. Study participants also identified 3 areas of consideration when implementing collection and use of PGHD data in clinics: (1) developing practice workflows and protocols related to PGHD collection and use; (2) data storage, accessibility at the point of care, and privacy concerns; and (3) ease of using PGHD data. Conclusions: PGHD provides value to both patients and health care professionals. However, more research is needed to understand the benefit of using PGHD in clinical care and to identify the strategies and clinic workflow needs for optimizing these tools. %M 27760726 %R 10.2196/humanfactors.5919 %U http://humanfactors.jmir.org/2016/2/e26/ %U https://doi.org/10.2196/humanfactors.5919 %U http://www.ncbi.nlm.nih.gov/pubmed/27760726 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 4 %P e196 %T A Web-Based Psychosocial Intervention for Family Caregivers of Older People: Results from a Mixed-Methods Study in Three European Countries %A Barbabella,Francesco %A Poli,Arianna %A Andréasson,Frida %A Salzmann,Benjamin %A Papa,Roberta %A Hanson,Elizabeth %A Efthymiou,Areti %A Döhner,Hanneli %A Lancioni,Cristina %A Civerchia,Patrizia %A Lamura,Giovanni %+ Centre for Socio-Economic Research on Ageing, National Institute of Health and Science on Ageing (INRCA), Via S. Margherita 5, Ancona, 60126, Italy, 39 0718004799, f.barbabella@inrca.it %K caregivers %K frail elderly %K Internet %K social support %K social networking %K health education %D 2016 %7 06.10.2016 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Informal caregiving is the main source of care for older people in Europe. An enormous amount of responsibility and care activity is on the shoulders of family caregivers, who might experience problems in their psychological well-being and in reconciling caregiving and their personal sphere. In order to alleviate such burden, there is increasing interest and growing research in Europe on Web-based support addressing family caregivers and their needs. However, the level of development and penetration of innovative Web-based services for caregivers is still quite low and the access to traditional face-to-face services can be problematic for logistic, availability, and quality reasons. Objective: As part of the European project INNOVAGE, a pilot study was conducted for developing and testing a Web-based psychosocial intervention aimed at empowering family caregivers of older people in Italy, Sweden, and Germany. The program offered information resources and interactive services to enable both professional and peer support. Methods: A mixed-methods, sequential explanatory design was adopted. Caregivers’ psychological well-being, perceived negative and positive aspects of caregiving, and social support received were assessed before and after the 3-month intervention. Poststudy, a subsample of users participated in focus groups to assist in the interpretation of the quantitative results. Results: A total of 94 out of 118 family caregivers (79.7%) from the three countries used the Web platform at least once. The information resources were used to different extents in each country, with Italian users having the lowest median number of visits (5, interquartile range [IQR] 2-8), whereas German users had the highest number (17, IQR 7-66) (P<.001). The interactive services most frequently accessed (more than 12 times) in all countries were the social network (29/73, 40%) and private messages (27/73, 37%). The pretest-posttest analysis revealed some changes, particularly the slight worsening of perceived positive values of caregiving (Carers of Older People in Europe [COPE] positive value subscale: P=.02) and social support received (COPE quality-of-support subscale: P=.02; Multidimensional Scale of Perceived Social Support subscale: P=.04), in all cases with small effect size (r range -.15 to -.18). Focus groups were conducted with 20 family caregivers and the content analysis of discussions identified five main themes: online social support, role awareness, caregiving activities, psychological well-being, and technical concerns. The analysis suggested the intervention was useful and appropriate, also stimulating a better self-efficacy and reappraisal of the caregivers’ role. Conclusions: The intervention seemed to contribute to the improvement of family caregivers’ awareness, efficacy, and empowerment, which in turn may lead to a better self-recognition of their own needs and improved efforts for developing and accessing coping resources. A major implication of the study was the finalization and implementation of the InformCare Web platform in 27 European countries, now publicly accessible (www.eurocarers.org/informcare). %M 27713113 %R 10.2196/resprot.5847 %U http://www.researchprotocols.org/2016/4/e196/ %U https://doi.org/10.2196/resprot.5847 %U http://www.ncbi.nlm.nih.gov/pubmed/27713113 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 3 %N 2 %P e22 %T User Experiences of the McMaster Optimal Aging Portal’s Evidence Summaries and Blog Posts: Usability Study %A M Barbara,Angela %A Dobbins,Maureen %A Haynes,R Brian %A Iorio,Alfonso %A Lavis,John N %A Levinson,Anthony J %+ Division of e-Learning Innovation, Faculty of Health Sciences, McMaster University, MDCL 3117, 1280 Main Street West, Hamilton, L8S 4K1, ON, Canada, 65 66011603, nurly@nus.edu.sg %K Web-based health information %K consumer health information %K usability testing %K knowledge translation %K aging %D 2016 %7 19.08.2016 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Evidence summaries and blogs can support evidence-informed healthy aging, by presenting high-quality health research evidence in plain language for a nonprofessional (citizen) audience. Objective: Our objective was to explore citizens’ perceptions about the usability of evidence summaries and blog posts on the Web-based McMaster Optimal Aging Portal. Methods: Twenty-two citizens (aged 50 years and older) and informal caregivers participated in a qualitative study using a think-aloud method and semistructured interviews. Eleven interviews were conducted in person, 7 over the telephone, and 4 by Skype. Results: We identified themes that fell under 4 user-experience categories: (1) desirability: personal relevance, (2) understandability: language comprehension, grasping the message, dealing with uncertainty, (3) usability: volume of information, use of numbers, and (4) usefulness: intention to use, facility for sharing. Conclusions: Participants recognized that high-quality evidence on aging was valuable. Their intended use of the information was influenced by how much it applied to their own health circumstances or those of a loved one. Some specific formatting features that were preferred included consistent layout, content organized by subheadings, catchy titles, numerical information summarized in a table, and inclusion of a glossary. %M 27542995 %R 10.2196/humanfactors.6208 %U http://humanfactors.jmir.org/2016/2/e22/ %U https://doi.org/10.2196/humanfactors.6208 %U http://www.ncbi.nlm.nih.gov/pubmed/27542995 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 4 %N 3 %P e95 %T Prioritizing the mHealth Design Space: A Mixed-Methods Analysis of Smokers’ Perspectives %A Hartzler,Andrea Lisabeth %A BlueSpruce,June %A Catz,Sheryl L %A McClure,Jennifer B %+ Group Health Research Institute, 1730 Minor Ave Suite 1600, Seattle, WA, 98101, United States, 1 206 287 2030, hartzler.a@ghc.org %K mobile health %K human-centered design %K human-computer interaction %K smartphone %K smoking cessation %K telemedicine %K software design %D 2016 %7 05.08.2016 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smoking remains the leading cause of preventable disease and death in the United States. Therefore, researchers are constantly exploring new ways to promote smoking cessation. Mobile health (mHealth) technologies could be effective cessation tools. Despite the availability of commercial quit-smoking apps, little research to date has examined smokers’ preferred treatment intervention components (ie, design features). Honoring these preferences is important for designing programs that are appealing to smokers and may be more likely to be adopted and used. Objective: The aim of this study was to understand smokers’ preferred design features of mHealth quit-smoking tools. Methods: We used a mixed-methods approach consisting of focus groups and written surveys to understand the design preferences of adult smokers who were interested in quitting smoking (N=40). Focus groups were stratified by age to allow differing perspectives to emerge between older (>40 years) and younger (<40 years) participants. Focus group discussion included a “blue-sky” brainstorming exercise followed by participant reactions to contrasting design options for communicating with smokers, providing social support, and incentivizing program use. Participants rated the importance of preselected design features on an exit survey. Qualitative analyses examined emergent discussion themes and quantitative analyses compared feature ratings to determine which were perceived as most important. Results: Participants preferred a highly personalized and adaptive mHealth experience. Their ideal mHealth quit-smoking tool would allow personalized tracking of their progress, adaptively tailored feedback, and real-time peer support to help manage smoking cravings. Based on qualitative analysis of focus group discussion, participants preferred pull messages (ie, delivered upon request) over push messages (ie, sent automatically) and preferred interaction with other smokers through closed social networks. Preferences for entertaining games or other rewarding incentives to encourage program use differed by age group. Based on quantitative analysis of surveys, participants rated the importance of select design features significantly differently (P<.001). Design features rated as most important included personalized content, the ability to track one’s progress, and features designed to help manage nicotine withdrawal and medication side effects. Design features rated least important were quit-smoking videos and posting on social media. Communicating with stop-smoking experts was rated more important than communicating with family and friends about quitting (P=.03). Perceived importance of various design features varied by age, experience with technology, and frequency of smoking. Conclusions: Future mHealth cessation aids should be designed with an understanding of smokers’ needs and preferences for these tools. Doing so does not guarantee treatment effectiveness, but balancing user preferences with best-practice treatment considerations could enhance program adoption and improve treatment outcomes. Grounded in the perspectives of smokers, we identify several design considerations, which should be prioritized when designing future mHealth cessation tools and which warrant additional empirical validation. %M 27496593 %R 10.2196/mhealth.5742 %U http://mhealth.jmir.org/2016/3/e95/ %U https://doi.org/10.2196/mhealth.5742 %U http://www.ncbi.nlm.nih.gov/pubmed/27496593 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e210 %T Integrating Evidence From Systematic Reviews, Qualitative Research, and Expert Knowledge Using Co-Design Techniques to Develop a Web-Based Intervention for People in the Retirement Transition %A O'Brien,Nicola %A Heaven,Ben %A Teal,Gemma %A Evans,Elizabeth H %A Cleland,Claire %A Moffatt,Suzanne %A Sniehotta,Falko F %A White,Martin %A Mathers,John C %A Moynihan,Paula %+ Institute of Health and Society, Centre for Oral Health Research, Newcastle University, Framlington Place, Newcastle upon Tyne, NE24BW, United Kingdom, 44 1912088241, paula.moynihan@ncl.ac.uk %K intervention studies %K health behavior %K retirement %K Internet %D 2016 %7 03.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Integrating stakeholder involvement in complex health intervention design maximizes acceptability and potential effectiveness. However, there is little methodological guidance about how to integrate evidence systematically from various sources in this process. Scientific evidence derived from different approaches can be difficult to integrate and the problem is compounded when attempting to include diverse, subjective input from stakeholders. Objective: The intent of the study was to describe and appraise a systematic, sequential approach to integrate scientific evidence, expert knowledge and experience, and stakeholder involvement in the co-design and development of a complex health intervention. The development of a Web-based lifestyle intervention for people in retirement is used as an example. Methods: Evidence from three systematic reviews, qualitative research findings, and expert knowledge was compiled to produce evidence statements (stage 1). Face validity of these statements was assessed by key stakeholders in a co-design workshop resulting in a set of intervention principles (stage 2). These principles were assessed for face validity in a second workshop, resulting in core intervention concepts and hand-drawn prototypes (stage 3). The outputs from stages 1-3 were translated into a design brief and specification (stage 4), which guided the building of a functioning prototype, Web-based intervention (stage 5). This prototype was de-risked resulting in an optimized functioning prototype (stage 6), which was subject to iterative testing and optimization (stage 7), prior to formal pilot evaluation. Results: The evidence statements (stage 1) highlighted the effectiveness of physical activity, dietary and social role interventions in retirement; the idiosyncratic nature of retirement and well-being; the value of using specific behavior change techniques including those derived from the Health Action Process Approach; and the need for signposting to local resources. The intervention principles (stage 2) included the need to facilitate self-reflection on available resources, personalization, and promotion of links between key lifestyle behaviors. The core concepts and hand-drawn prototypes (stage 3) had embedded in them the importance of time use and work exit planning, personalized goal setting, and acceptance of a Web-based intervention. The design brief detailed the features and modules required (stage 4), guiding the development of wireframes, module content and functionality, virtual mentors, and intervention branding (stage 5). Following an iterative process of intervention testing and optimization (stage 6), the final Web-based intervention prototype of LEAP (Living, Eating, Activity, and Planning in retirement) was produced (stage 7). The approach was resource intensive and required a multidisciplinary team. The design expert made an invaluable contribution throughout the process. Conclusions: Our sequential approach fills an important methodological gap in the literature, describing the stages and techniques useful in developing an evidence-based complex health intervention. The systematic and rigorous integration of scientific evidence, expert knowledge and experience, and stakeholder input has resulted in an intervention likely to be acceptable and feasible. %M 27489143 %R 10.2196/jmir.5790 %U http://www.jmir.org/2016/8/e210/ %U https://doi.org/10.2196/jmir.5790 %U http://www.ncbi.nlm.nih.gov/pubmed/27489143 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 5 %N 2 %P e99 %T Why We Belong - Exploring Membership of Healthcare Professionals in an Intensive Care Virtual Community Via Online Focus Groups: Rationale and Protocol %A Rolls,Kaye %A Hansen,Margaret %A Jackson,Debra %A Elliott,Doug %+ Agency for Clinical Innovation, Intensive Care Coordination and Monitoring Unit, Sage Building, Albert Avenue, Chatswood, 2067, Australia, 61 +61294644666, kaye.d.rolls@student.uts.edu.au %K focus groups %K virtual communities %K social media %K qualitative methods %K clinicians %K intensive care %D 2016 %7 13.06.2016 %9 Proposal %J JMIR Res Protoc %G English %X Background: Many current challenges of evidence-based practice are related to ineffective social networks among health care professionals. Opportunities exist for multidisciplinary virtual communities to transcend professional and organizational boundaries and facilitate important knowledge transfer. Although health care professionals have been using the Internet to form virtual communities for many years, little is known regarding “why” they join, as most research has focused on the perspective of “posters,” who form a minority of members. Objective: Our aim was to develop a comprehensive understanding of why health care professionals belong to a virtual community (VC). Methods: A qualitative approach will be used to explore why health care professionals belong to an intensive care practice-based VC, established since 2003. Three asynchronous online focus groups will be convened using a closed secure discussion forum. Participants will be recruited directly by sending emails to the VC and a Google form used to collect consent and participant demographics. Participants will be stratified by their online posting behaviors between September 1, 2012, and August 31, 2014: (1) more than 5 posts, (2) 1-5 posts, or (3) no posts. A question guide will be used to guide participant discussion. A moderation approach based on the principles of focus group method and e-moderation has been developed. The main source of data will be discussion threads, supported by a research diary and field notes. Data analysis will be undertaken using a thematic approach and framed by the Diffusion of Innovation theory. NVivo software will be used to support analyses. Results: At the time of writing, 29 participants agreed to participate (Focus Group 1: n=4; Focus Group 2: n=16; Focus Group 3: n=9) and data collection was complete. Conclusions: This study will contribute to a growing body of research on the use of social media in professional health care settings. Specifically, we hope results will demonstrate an enhancement of health care professionals’ social networks and how VCs may improve knowledge distribution and patient care outcomes. Additionally, the study will contribute to research methods development in this area by detailing approaches to understand the effectiveness of online focus groups as a data collection method for qualitative research methods. %M 27296929 %R 10.2196/resprot.5323 %U http://www.researchprotocols.org/2016/2/e99/ %U https://doi.org/10.2196/resprot.5323 %U http://www.ncbi.nlm.nih.gov/pubmed/27296929 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 2 %P e33 %T Diet and Physical Activity Apps: Perceived Effectiveness by App Users %A Wang,Qing %A Egelandsdal,Bjørg %A Amdam,Gro V %A Almli,Valerie L %A Oostindjer,Marije %+ Department of Chemistry, Biotechnology, and Food Science, Norwegian University of Life Sciences, 1430 Aas, Norway, 47 67 23 25 74, qing.wang@nmbu.no %K diet app %K physical activity app %K perceived effectiveness %K behavioral changes %D 2016 %7 07.04.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Diet and physical activity apps are two types of health apps that aim to promote healthy eating and energy expenditure through monitoring of dietary intake and physical activity. No clear evidence showing the effectiveness of using these apps to promote healthy eating and physical activity has been previously reported. Objective: This study aimed to identify how diet and physical activity (PA) apps affected their users. It also investigated if using apps was associated with changes in diet and PA. Methods: First, 3 semi-structured focus group discussions concerning app usability were conducted (15 app users and 8 nonusers; mean age 24.2 years, SD 6.4), including outcome measures such as motivations, experiences, opinions, and adherence. Results from the discussions were used to develop a questionnaire. The questionnaire, which contained questions about behavior changes, app usage, perceived effectiveness, and opinions of app usability, was answered by 500 Norwegians, with a mean age of 25.8 years (SD 5.1). Results: App users found diet and PA apps effective in promoting healthy eating and exercising. These apps affected their actions, health consciousness, and self-education about nutrition and PA; and were also a part of their social lives. Over half of the users perceived that apps were effective in assisting them to eat healthily and to exercise more. Diet apps were more effective when they were frequently used and over a long period of time, compared to infrequent or short-term use (P=.01 and P=.02, respectively). Users who used diet and PA apps, perceived apps as more effective than users who only used one type of app (all P<.05). App users were better at maintaining diet and PA behaviors than nonusers (all P<.05). Young adults found apps fun to use, but sometimes time consuming. They wanted apps to be designed to meet their personal expectations. Conclusions: App usage influenced action, consciousness, self-education about nutrition and PA, and social life. It facilitated maintaining a healthy diet and exercising more. Diet and PA apps of the future can be further strengthened by being tailored to meet personal needs. %M 27056639 %R 10.2196/mhealth.5114 %U http://mhealth.jmir.org/2016/2/e33/ %U https://doi.org/10.2196/mhealth.5114 %U http://www.ncbi.nlm.nih.gov/pubmed/27056639 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 3 %N 1 %P e8 %T A Mixed-Methods Approach to the Development, Refinement, and Pilot Testing of Social Networks for Improving Healthy Behaviors %A Hales,Sarah %A Turner-McGrievy,Gabrielle %A Fahim,Arjang %A Freix,Andrew %A Wilcox,Sara %A Davis,Rachel E %A Huhns,Michael %A Valafar,Homayoun %+ Arnold School of Public Health, Department of Health Promotion, Education, and Behavior, University of South Carolina, Discovery I Building, 915 Greene St., Columbia, SC, , United States, 1 843 670 5317, bridges5@mailbox.sc.edu %K mHealth %K obesity %K weight loss %K social support %K social cognitive theory %D 2016 %7 12.02.2016 %9 Original Paper %J JMIR Human Factors %G English %X Background: Mobile health (mHealth) has shown promise as a way to deliver weight loss interventions, including connecting users for social support. Objective: To develop, refine, and pilot test the Social Pounds Off Digitally (POD) Android app for personalized health monitoring and interaction. Methods: Adults who were overweight and obese with Android smartphones (BMI 25-49.9 kg/m2; N=9) were recruited for a 2-month weight loss pilot intervention and iterative usability testing of the Social POD app. The app prompted participants via notification to track daily weight, diet, and physical activity behaviors. Participants received the content of the behavioral weight loss intervention via podcast. In order to re-engage infrequent users (did not use the app within the previous 48 hours), the app prompted frequent users to select 1 of 3 messages to send to infrequent users targeting the behavioral theory constructs social support, self-efficacy, or negative outcome expectations. Body weight, dietary intake (2 24-hr recalls), and reported calories expended during physical activity were assessed at baseline and 2 months. All participants attended 1 of 2 focus groups to provide feedback on use of the app. Results: Participants lost a mean of 0.94 kg (SD 2.22, P=.24) and consumed significantly fewer kcals postintervention (1570 kcal/day, SD 508) as compared to baseline (2384 kcal/day, SD 993, P=.01). Participants reported expending a mean of 171 kcal/day (SD 153) during intentional physical activity following the intervention as compared to 138 kcal/day (SD 139) at baseline, yet this was not a statistically significant difference (P=.57). There was not a statistically significant correlation found between total app entries and percent weight loss over the course of the intervention (r=.49, P=.19). Mean number of app entries was 77.2 (SD 73.8) per person with a range of 0 to 219. Messages targeting social support were selected most often (32/68, 47%), followed by self-efficacy (28/68, 41%), and negative outcome expectations (8/68, 12%). Themes from the focus groups included functionality issues, revisions to the messaging system, and the addition of a point system with rewards for achieving goals. Conclusions: The Social POD app provides an innovative way to re-engage infrequent users by encouraging frequent users to provide social support. Although more time is needed for development, this mHealth intervention can be disseminated broadly for many years and to many individuals without the need for additional intensive in-person hours. %M 27026535 %R 10.2196/humanfactors.4512 %U http://humanfactors.jmir.org/2016/1/e8/ %U https://doi.org/10.2196/humanfactors.4512 %U http://www.ncbi.nlm.nih.gov/pubmed/27026535 %0 Journal Article %@ 2292-9495 %I Gunther Eysenbach %V 3 %N 1 %P e3 %T University Students’ Views on the Perceived Benefits and Drawbacks of Seeking Help for Mental Health Problems on the Internet: A Qualitative Study %A Chan,Jade KY %A Farrer,Louise M %A Gulliver,Amelia %A Bennett,Kylie %A Griffiths,Kathleen M %+ School of Psychology, Faculty of Science, University of New South Wales, Mathews Building, 11 Botany Street, Sydney, NSW 2052, Australia, 61 2 6125 8859, chan.jadeky@gmail.com %K online %K mental health %K help seeking %K university %K students %K qualitative %D 2016 %7 19.01.2016 %9 Original Paper %J JMIR Human Factors %G English %X Background: University students experience high levels of mental health problems yet very few seek professional help. Web-based mental health interventions may be useful for the university student population. However, there are few published qualitative studies that have examined the perceived benefits and drawbacks of seeking help for mental health problems on the Internet from the perspective of university students. Objective: To investigate the attitudes of university students on mental health help-seeking on the Internet. Methods: A total of 19 university students aged 19-24 years participated in 1 of 4 focus groups to examine their views toward help-seeking for mental health problems on the Internet. Results: Perceived concerns about Web-based help-seeking included privacy and confidentiality, difficulty communicating on the Internet, and the quality of Web-based resources. Potential benefits included anonymity/avoidance of stigma, and accessibility. Participants reported mixed views regarding the ability of people with similar mental health issues to interact on the Internet. Conclusions: These factors should be considered in the development of Web-based mental health resources to increase acceptability and engagement from university students. %M 27026140 %R 10.2196/humanfactors.4765 %U http://humanfactors.jmir.org/2016/1/e3/ %U https://doi.org/10.2196/humanfactors.4765 %U http://www.ncbi.nlm.nih.gov/pubmed/27026140 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 4 %N 1 %P e1 %T Preferred Tone of Nutrition Text Messages for Young Adults: Focus Group Testing %A Pollard,Christina Mary %A Howat,Peter A %A Pratt,Iain S %A Boushey,Carol J %A Delp,Edward J %A Kerr,Deborah Anne %+ School of Public Health, Curtin University, Kent Street, Bentley, 6012, Australia, 61 892661142, C.Pollard@curtin.edu.au %K text messages %K tone of voice %K nutrition messages %K fruit %K vegetable %K junk food %K alcohol %K communication %D 2016 %7 19.01.2016 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Young adults are a particularly hard to reach group using conventional health promotion practices as they do not see nutrition messages as personally relevant to them. Text messaging (short message service, SMS) offers an innovative approach to reaching young adults to support and promote dietary behavior change. Objective: The aim of this study was to develop and test tonal preferences for nutrition text messages among young adults using focus groups. Methods: A total of 39 young adults aged 18-30 years residing in Perth, Western Australia participated in four focus groups. Participants briefly discussed their perception of healthy eating and their responses to messages about increasing fruit and vegetables, and reducing “junk food” and alcohol intake. They ranked their preference for 15 nutrition messages across 3 dietary behaviors (fruit and vegetables, junk food, and alcohol) with 5 different message tones (authoritative, empathetic, generation Y, solutions, and substitutions) and identified the messages most likely to persuade young adults to change their diet. A 5-point ranking of the nutrition messages was from the most likely to least likely to persuade (1-5). The focus groups were conducted by a trained facilitator and observer and were recorded. Data driven content analysis was used to explore themes. Tonal preferences and potential motivators were collated and frequencies presented. Results: Participants ranked offering substitutes (29%, 11/39) and using empathy (22%, 9/39) as the most persuasive message techniques in improving diets of young adults, with low responses for Generation Y (17%, 7/39), solutions (17%, 7/39), and authoritative (15%, 6/39) tones. Females were more likely to consider substitution messages persuasive (35%, 7/20) compared with males (22%, 4/19). A greater proportion of males compared with females considered authoritative messages persuasive: (22%, 4/19) compared with (7%, 1/20). There is a strong preference for a substitution tone for fruit and vegetable messages (52%, 20/39), and no overall message tone preference for junk food and alcohol messages. Substitutions were viewed as helpful and practical. Empathy was liked as it acknowledged previous efforts. Responses to authoritative tone were mixed with some feeling guilt while others found them informative. Acceptability of the solutions depended on the behavioral change and acceptability of the solution proposed. Generation Y tone had some support for junk food and alcohol messages, and if favored, was considered casual, humorous, catchy, and motivational. Conclusions: Substitutions and tone of empathy were favored as the most likely execution styles to motivate nutrition behavior change across all participants. There is no “one size fits all” with different tones preferred by individuals for different dietary behaviors. Although text messaging provides instant message delivery direct to the individual, these results demonstrate the complexity of developing motivational nutrition message for young adults. These findings reveal the importance of considering the tone and content and pretesting messages for health promotion text message interventions. %M 26787115 %R 10.2196/mhealth.4764 %U http://mhealth.jmir.org/2016/1/e1/ %U https://doi.org/10.2196/mhealth.4764 %U http://www.ncbi.nlm.nih.gov/pubmed/26787115 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e106 %T A Community-Engaged Approach to Developing an mHealth HIV/STI and Drug Abuse Preventive Intervention for Primary Care: A Qualitative Study %A Cordova,David %A Bauermeister,Jose A %A Fessler,Kathryn %A Delva,Jorge %A Nelson,Annabelle %A Nurenberg,Rachel %A Mendoza Lua,Frania %A Alers-Rojas,Francheska %A Salas-Wright,Christopher P %A , %+ School of Social Work, University of Michigan, 1080 S University Ave, Ann Arbor, MI, 48109, United States, 1 (734) 763 6201, cordovad@umich.edu %K adolescent %K primary prevention %K HIV %K STI %K mHealth %K telemedicine %K primary health care %K drug users %K sexually transmitted infections %D 2015 %7 18.12.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Despite ongoing prevention efforts, HIV and other sexually transmitted infections (HIV/STIs) and drug use remain public health concerns. Urban adolescents, many of whom are underserved and racial minorities, are disproportionately affected. Recent changes in policy, including the Affordable Care Act, and advances in technology provide HIV/STI and drug abuse prevention scientists with unique opportunities to deliver mobile health (mHealth) preventive interventions in primary care. Objectives: The purpose of this community-engaged study was to develop an mHealth version of the Storytelling for Empowerment preventive intervention for primary care (hereinafter referred to as “S4E”). Methods: A total of 29 adolescents were recruited from a youth-centered primary care clinic in Southeast, Michigan, to participate in qualitative interviews. Participants were predominantly African American (n=19, 65.5%) and female (n=21, 72.4%) with a mean age of 16.23 (SD 2.09). The principles of community-based participatory research (CBPR), in conjunction with agile software development and the recommended core prevention principles of the National Institute on Drug Abuse (NIDA) were employed during S4E development. CBPR principles are aimed at improving the effectiveness of research by addressing locally relevant health problems, working with community strengths, and translating basic science into applied research. Complementing this approach, the NIDA prevention principles are derived from decades of drug abuse prevention research aimed at increasing the effectiveness and uptake of programs, through the development of culturally specific interventions and ensuring the structure, content, and delivery of the intervention fit the needs of the community. Data were analyzed using thematic analysis. Results: A total of 5 themes emerged from the data: (1) acceptability of the mHealth app to adolescents in primary care, (2) inclusion of a risk assessment to improve clinician-adolescent HIV/STI and drug use communication, (3) incorporation of culturally specific HIV/STI and drug use content, (4) incorporation of interactive aspects in the app to engage youth, and (5) perspectives on the appearance of the app. Conclusions: There is a dearth of mHealth HIV/STI and drug abuse preventive interventions for primary care. Incorporating the principles of CBPR in conjunction with agile software development and NIDA-recommended core prevention principles may be helpful in developing culturally specific mHealth interventions. An important next step in this program of research is to examine the feasibility, acceptability, and efficacy of S4E on adolescent sexual risk and drug use behaviors, and HIV/STI testing. Implications for prevention research and primary care practice are discussed in the context of the Affordable Care Act and technological advances. %M 26685288 %R 10.2196/mhealth.4620 %U http://mhealth.jmir.org/2015/4/e106/ %U https://doi.org/10.2196/mhealth.4620 %U http://www.ncbi.nlm.nih.gov/pubmed/26685288 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 4 %P e105 %T A Text-Messaging and Pedometer Program to Promote Physical Activity in People at High Risk of Type 2 Diabetes: The Development of the PROPELS Follow-On Support Program %A Morton,Katie %A Sutton,Stephen %A Hardeman,Wendy %A Troughton,Jacqui %A Yates,Tom %A Griffin,Simon %A Davies,Melanie %A Khunti,Kamlesh %A Eborall,Helen %+ Social Science Applied to Healthcare Improvement Research Group, Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester, , United Kingdom, 44 116 252 5400, hce3@le.ac.uk %K physical activity %K mHealth %K text messaging %K pedometer %K tailoring %K type 2 diabetes %K intervention development %D 2015 %7 15.12.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Mobile technologies for health (mHealth) represent a promising strategy for reducing type 2 diabetes (T2DM) risk. The PROPELS trial investigates whether structured group-based education alone or supplemented with a follow-on support program combining self-monitoring with pedometers and tailored text-messaging is effective in promoting and maintaining physical activity among people at high risk of T2DM. Objective: This paper describes the iterative development of the PROPELS follow-on support program and presents evidence on its acceptability and feasibility. Methods: We used a modified mHealth development framework with four phases: (1) conceptualization of the follow-on support program using theory and evidence, (2) formative research including focus groups (n=15, ages 39-79 years), (3) pre-testing focus groups using a think aloud protocol (n=20, ages 52-78 years), and (4) piloting (n=11). Analysis was informed by the constant comparative approach, with findings from each phase informing subsequent phases. Results: The first three phases informed the structure, nature, and content of the follow-on support program, including the frequency of text messages, the need for tailored content and two-way interaction, the importance of motivational messages based on encouragement and reinforcement of affective benefits (eg, enjoyment) with minimal messages about weight and T2DM risk, and the need for appropriate language. The refined program is personalized and tailored to the individual’s perceived confidence, previous activity levels, and physical activity goals. The pilot phase indicated that the program appeared to fit well with everyday routines and was easy to use by older adults. Conclusions: We developed a feasible and innovative text messaging and pedometer program based on evidence and behavior change theory and grounded in the experiences, views, and needs of people at high diabetes risk. A large scale trial is testing the effectiveness of this 4-year program over and above structured group education alone. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 83465245; http://www.controlled-trials.com/ISRCTN83465245/83465245 (Archived by WebCite at http://www.webcitation.org/6dfSmrVAe) %M 26678750 %R 10.2196/mhealth.5026 %U http://mhealth.jmir.org/2015/4/e105/ %U https://doi.org/10.2196/mhealth.5026 %U http://www.ncbi.nlm.nih.gov/pubmed/26678750 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 2 %P e18 %T Building a Mobile HIV Prevention App for Men Who Have Sex With Men: An Iterative and Community-Driven Process %A Goldenberg,Tamar %A McDougal,Sarah J %A Sullivan,Patrick S %A Stekler,Joanne D %A Stephenson,Rob %+ School of Nursing, Department of Health Behavior and Biological Sciences and the Center for Sexuality and Health Disparities, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI, , United States, 1 734 647 8826, tamargol@umich.edu %K HIV %K AIDS %K MSM %K mobile app %K prevention %K community %D 2015 %7 16.11.2015 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Gay, bisexual, and other men who have sex with men (MSM) account for a disproportionate burden of new HIV infections in the United States. Mobile technology presents an opportunity for innovative interventions for HIV prevention. Some HIV prevention apps currently exist; however, it is challenging to encourage users to download these apps and use them regularly. An iterative research process that centers on the community’s needs and preferences may increase the uptake, adherence, and ultimate effectiveness of mobile apps for HIV prevention. Objective: The aim of this paper is to provide a case study to illustrate how an iterative community approach to a mobile HIV prevention app can lead to changes in app content to appropriately address the needs and the desires of the target community. Methods: In this three-phase study, we conducted focus group discussions (FGDs) with MSM and HIV testing counselors in Atlanta, Seattle, and US rural regions to learn preferences for building a mobile HIV prevention app. We used data from these groups to build a beta version of the app and theater tested it in additional FGDs. A thematic data analysis examined how this approach addressed preferences and concerns expressed by the participants. Results: There was an increased willingness to use the app during theater testing than during the first phase of FGDs. Many concerns that were identified in phase one (eg, disagreements about reminders for HIV testing, concerns about app privacy) were considered in building the beta version. Participants perceived these features as strengths during theater testing. However, some disagreements were still present, especially regarding the tone and language of the app. Conclusions: These findings highlight the benefits of using an interactive and community-driven process to collect data on app preferences when building a mobile HIV prevention app. Through this process, we learned how to be inclusive of the larger MSM population without marginalizing some app users. Though some issues in phase one were able to be addressed, disagreements still occurred in theater testing. If the app is going to address a large and diverse risk group, we cannot include niche functionality that may offend some of the target population. %M 27227136 %R 10.2196/publichealth.4449 %U http://publichealth.jmir.org/2015/2/e18/ %U https://doi.org/10.2196/publichealth.4449 %U http://www.ncbi.nlm.nih.gov/pubmed/27227136 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 10 %P e235 %T An eHealth Application in Head and Neck Cancer Survivorship Care: Health Care Professionals' Perspectives %A Duman-Lubberding,Sanne %A van Uden-Kraan,Cornelia F %A Peek,Niels %A Cuijpers,Pim %A Leemans,C René %A Verdonck-de Leeuw,Irma M %+ Department of Otolaryngology / Head and Neck Surgery, VU University Medical Center, PO Box 7057, Amsterdam, 1007 MB, Netherlands, 31 20 444 0931, s.lubberding@vumc.nl %K cancer %K tertiary prevention %K participatory design approach %K follow-up care %K supportive care %D 2015 %7 21.10.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Although many cancer survivors could benefit from supportive care, they often do not utilize such services. Previous studies have shown that patient-reported outcomes (PROs) could be a solution to meet cancer survivors’ needs, for example through an eHealth application that monitors quality of life and provides personalized advice and supportive care options. In order to develop an effective application that can successfully be implemented in current health care, it is important to include health care professionals in the development process. Objective: The aim of this study was to investigate health care professionals’ perspectives toward follow-up care and an eHealth application, OncoKompas, in follow-up cancer care that monitors quality of life via PROs, followed by automatically generated tailored feedback and personalized advice on supportive care. Methods: Health care professionals involved in head and neck cancer care (N=11) were interviewed on current follow-up care and the anticipated value of the proposed eHealth application (Step 1). A prototype of the eHealth application, OncoKompas, was developed (Step 2). Cognitive walkthroughs were conducted among health care professionals (N=21) to investigate perceived usability (Step 3). Interviews were recorded, transcribed verbatim, and analyzed by 2 coders. Results: Health care professionals indicated several barriers in current follow-up care including difficulties in detecting symptoms, patients’ perceived need for supportive care, and a lack of time to encourage survivors to obtain supportive care. Health care professionals expected the eHealth application to be of added value. The cognitive walkthroughs demonstrated that health care professionals emphasized the importance of tailoring care. They considered the navigation structure of OncoKompas to be complex. Health care professionals differed in their opinion toward the best strategy to implement the application in clinical practice but indicated that it should be incorporated in the HNC cancer care pathway to ensure all survivors would benefit. Conclusions: Health care professionals experienced several barriers in directing patients to supportive care. They were positive toward the development and implementation of an eHealth application and expected it could support survivors in obtaining supportive care tailored to their needs. The cognitive walkthroughs revealed several points for optimizing the application prototype and developing an efficient implementation strategy. Including health care professionals in an early phase of a participatory design approach is valuable in developing an eHealth application and an implementation strategy meeting stakeholders’ needs. %M 26489918 %R 10.2196/jmir.4870 %U http://www.jmir.org/2015/10/e235/ %U https://doi.org/10.2196/jmir.4870 %U http://www.ncbi.nlm.nih.gov/pubmed/26489918 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 10 %P e230 %T Views of People With High and Low Levels of Health Literacy About a Digital Intervention to Promote Physical Activity for Diabetes: A Qualitative Study in Five Countries %A Rowsell,Alison %A Muller,Ingrid %A Murray,Elizabeth %A Little,Paul %A Byrne,Christopher D %A Ganahl,Kristin %A Müller,Gabriele %A Gibney,Sarah %A Lyles,Courtney R %A Lucas,Antonia %A Nutbeam,Don %A Yardley,Lucy %+ Department of Psychology, Faculty of Social and Human Sciences, University of Southampton, Highfield Campus, Highfield, Southampton, SO17 1BJ, United Kingdom, 44 02380 592581, I.Muller@soton.ac.uk %K health literacy, digital intervention, diabetes, qualitative, physical activity %D 2015 %7 12.10.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Low health literacy is associated with poor health-related knowledge, illness self-management, health service use, health, and survival, and thus addressing issues related to low health literacy has been highlighted as a pressing international priority. Objective: To explore views of a digital health promotion intervention designed to be accessible to people with lower levels of health literacy, in particular examining reactions to the interactive and audiovisual elements of the intervention. Methods: Qualitative think-aloud interviews were carried out with 65 adults with type 2 diabetes in the UK, Ireland, USA, Germany, and Austria, with purposive sampling to ensure representation of people with lower levels of health literacy. Inductive thematic analysis was used to identify common themes. We then systematically compared views in subgroups based on country, health literacy level, age, gender, and time since diagnosis. Results: Most participants from the chosen countries expressed positive views of most elements and features of the intervention. Some interactive and audiovisual elements required modification to increase their usability and perceived credibility and relevance. There were some differences in views based on age and gender, but very few differences relating to health literacy level or time since diagnosis. Conclusions: In general, participants found the intervention content and format accessible, appropriate, engaging, and motivating. Digital interventions can and should be designed to be accessible and engaging for people with a wide range of health literacy levels. %M 26459743 %R 10.2196/jmir.4999 %U http://www.jmir.org/2015/10/e230/ %U https://doi.org/10.2196/jmir.4999 %U http://www.ncbi.nlm.nih.gov/pubmed/26459743 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 3 %P e92 %T Mobile Phone App Aimed at Improving Iron Intake and Bioavailability in Premenopausal Women: A Qualitative Evaluation %A Mann,Davina %A Riddell,Lynn %A Lim,Karen %A Byrne,Linda K %A Nowson,Caryl %A Rigo,Manuela %A Szymlek-Gay,Ewa A %A Booth,Alison O %+ Centre for Physical Activity and Nutrition Research, School of Exercise and Nutrition, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia, 61 0392517211, davinam@deakin.edu.au %K cell phones %K telemedicine %K mobile apps %K iron %K behavior therapy %K focus groups %K goals %D 2015 %7 28.09.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Low iron intake can lead to iron deficiency, which can result in impaired health and iron-deficiency anemia. A mobile phone app, combining successful dietary strategies to increase bioavailable iron with strategies for behavior change, such as goal setting, monitoring, feedback, and resources for knowledge acquisition, was developed with the aim to increase bioavailable iron intake in premenopausal women. Objective: To evaluate the content, usability, and acceptability of a mobile phone app designed to improve intake of bioavailable dietary iron. Methods: Women aged 18-50 years with an Android mobile phone were invited to participate. Over a 2-week period women were asked to interact with the app. Following this period, semistructured focus groups with participants were conducted. Focus groups were audio recorded and analyzed via an inductive open-coding method using the qualitative analysis software NVivo 10. Themes were identified and frequency of code occurrence was calculated. Results: Four focus groups (n=26) were conducted (age range 19-36 years, mean 24.7, SD 5.2). Two themes about the app’s functionality were identified (frequency of occurrence in brackets): interface and design (134) and usability (86). Four themes about the app’s components were identified: goal tracker (121), facts (78), photo diary (40), and games (46). A number of suggestions to improve the interface and design of the app were provided and will inform the ongoing development of the app. Conclusions: This research indicates that participants are interested in iron and their health and are willing to use an app utilizing behavior change strategies to increase intake of bioavailable iron. The inclusion of information about the link between diet and health, monitoring and tracking of the achievement of dietary goals, and weekly reviews of goals were also seen as valuable components of the app and should be considered in mobile health apps aimed at adult women. %M 26416479 %R 10.2196/mhealth.4300 %U http://mhealth.jmir.org/2015/3/e92/ %U https://doi.org/10.2196/mhealth.4300 %U http://www.ncbi.nlm.nih.gov/pubmed/26416479 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 17 %N 8 %P e202 %T “You Get Reminded You’re a Sick Person”: Personal Data Tracking and Patients With Multiple Chronic Conditions %A Ancker,Jessica S %A Witteman,Holly O %A Hafeez,Baria %A Provencher,Thierry %A Van de Graaf,Mary %A Wei,Esther %+ Weill Cornell Medical College, Department of Healthcare Policy and Research, Division of Health Informatics, 425 E. 61st St., Suite 301, New York, NY, 10065, United States, 1 646 962 9404, jsa7002@med.cornell.edu %K medical informatics %K consumer health information %K health knowledge, attitudes, practices %K self-care %K chronic disease %D 2015 %7 19.08.2015 %9 Original Paper %J J Med Internet Res %G English %X Background: Consumer health information technologies (HIT) that encourage self-tracking, such as diet and fitness tracking apps and disease journals, are attracting widespread interest among technology-oriented consumers (such as “quantified self” advocates), entrepreneurs, and the health care industry. Such electronic technologies could potentially benefit the growing population of patients with multiple chronic conditions (MCC). However, MCC is predominantly a condition of the elderly and disproportionately affects the less affluent, so it also seems possible that the barriers to use of consumer HIT would be particularly severe for this patient population. Objective: Our aim was to explore the perspectives of individuals with MCC using a semistructured interview study. Our research questions were (1) How do individuals with MCC track their own health and medical data? and (2) How do patients and providers perceive and use patient-tracked data? Methods: We used semistructured interviews with patients with multiple chronic diseases and providers with experience caring for such patients, as well as participation in a diabetes education group to triangulate emerging themes. Data were analyzed using grounded theory and thematic analysis. Recruitment and analysis took place iteratively until thematic saturation was reached. Results: Interviews were conducted with 22 patients and 7 health care providers. The patients had an average of 3.5 chronic conditions, including type 2 diabetes, heart disease, chronic pain, and depression, and had regular relationships with an average of 5 providers. Four major themes arose from the interviews: (1) tracking this data feels like work for many patients, (2) personal medical data for individuals with chronic conditions are not simply objective facts, but instead provoke strong positive and negative emotions, value judgments, and diverse interpretations, (3) patients track for different purposes, ranging from sense-making to self-management to reporting to the doctor, and (4) patients often notice that physicians trust technologically measured data such as lab reports over patients’ self-tracked data. Conclusions: Developers of consumer health information technologies for data tracking (such as diet and exercise apps or blood glucose logs) often assume patients have unlimited enthusiasm for tracking their own health data via technology. However, our findings potentially explain relatively low adoption of consumer HIT, as they suggest that patients with multiple chronic illnesses consider it work to track their own data, that the data can be emotionally charged, and that they may perceive that providers do not welcome it. Similar themes have been found in some individual chronic diseases but appeared more complex because patients often encountered “illness work” connected to multiple diseases simultaneously and frequently faced additional challenges from aging or difficult comorbidities such as chronic pain, depression, and anxiety. We suggest that to make a public health impact, consumer HIT developers should engage creatively with these pragmatic and emotional issues to reach an audience that is broader than technologically sophisticated early adopters. Novel technologies are likely to be successful only if they clearly reduce patient inconvenience and burden, helping them to accomplish their “illness work” more efficiently and effectively. %M 26290186 %R 10.2196/jmir.4209 %U http://www.jmir.org/2015/8/e202/ %U https://doi.org/10.2196/jmir.4209 %U http://www.ncbi.nlm.nih.gov/pubmed/26290186 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e84 %T Patient-Centered mHealth Living Donor Transplant Education Program for African Americans: Development and Analysis %A Sieverdes,John Christopher %A Nemeth,Lynne S %A Magwood,Gayenell S %A Baliga,Prabhakar K %A Chavin,Kenneth D %A Brunner-Jackson,Brenda %A Patel,Sachin K %A Ruggiero,Kenneth J %A Treiber,Frank A %+ Technology Applications Center for Healthful Lifestyles, College of Nursing, Medical University of South Carolina, 99 Jonathan Lucas St, MSC 160, Charleston, SC, 29425-1600, United States, 1 843 792 8852, treiberf@musc.edu %K kidney transplantation %K living donors %K mobile apps %K qualitative research %K telemedicine %D 2015 %7 10.08.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: There is a critical need to expand the pool of available kidneys for African Americans who are on the transplant wait-list due to the disproportionally lower availability of deceased donor kidneys compared with other races/ethnic groups. Encouraging living donation is one method to fill this need. Incorporating mHealth strategies may be a way to deliver educational and supportive services to African American transplant-eligible patients and improve reach to those living in remote areas or unable to attend traditional group-session-based programs. Before program development, it is essential to perform formative research with target populations to determine acceptability and cultivate a patient-centered and culturally relevant approach to be used for program development. Objective: The objectives of this study were to investigate African American kidney transplant recipients’ and kidney donors’/potential donors’ attitudes and perceptions toward mobile technology and its viability in an mHealth program aimed at educating patients about the process of living kidney donation. Methods: Using frameworks from the technology acceptance model and self-determination theory, 9 focus groups (n=57) were administered to African Americans at a southeastern medical center, which included deceased/living donor kidney recipients and living donors/potential donors. After a demonstration of a tablet-based video education session and explanation of a group-based videoconferencing session, focus groups examined members’ perceptions about how educational messages should be presented on topics pertaining to the process of living kidney donation and the transplantation. Questionnaires were administered on technology use and perceptions of the potential program communication platform. Transcripts were coded and themes were examined using NVivo 10 software. Results: Qualitative findings found 5 major themes common among all participants. These included the following: (1) strong support for mobile technology use; (2) different media formats were preferred; (3) willingness to engage in video chats, but face-to-face interaction sometimes preferred; (4) media needs to be user friendly; (5) high prevalence of technology access. Our results show that recipients were willing to spend more time on education than the donors group, they wanted to build conversation skills to approach others, and preferred getting information from many sources, whereas the donor group wanted to hear from other living donors. The questionnaires revealed 85% or more of the sample scored 4+ on a 5-point Likert scale, which indicates high degree of interest to use the proposed program, belief that other mHealth technologies would help with adherence to medical regimens, and doctors would make regimen adjustments quicker. In addition, high utilization of mobile technology was reported; 71.9% of the participants had a mobile phone and 43.9% had a tablet. Conclusions: Our study supports the use of an mHealth education platform for African Americans to learn about living donation. However, potential recipients and potential donors have differing needs, and therefore, programs should be tailored to each target audience. %M 26265532 %R 10.2196/resprot.3715 %U http://www.researchprotocols.org/2015/3/e84/ %U https://doi.org/10.2196/resprot.3715 %U http://www.ncbi.nlm.nih.gov/pubmed/26265532 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 3 %P e95 %T Lessons Learned From Using Focus Groups to Refine Digital Interventions %A Avis,Jillian LS %A van Mierlo,Trevor %A Fournier,Rachel %A Ball,Geoff DC %+ Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, 4-515 Edmonton Clinic Health Academy, 11405 - 87 Avenue NW, Edmonton, AB, T6G1C9, Canada, 1 780 492 8727, gdball@ualberta.ca %K data collection %K digital interventions %K focus groups %K health care %K Internet %K qualitative research %D 2015 %7 31.07.2015 %9 Viewpoint %J JMIR Res Protoc %G English %X There is growing interest in applying novel eHealth approaches for the prevention and management of various health conditions, with the ultimate goal of increasing positive patient outcomes and improving the effectiveness and efficiency of health services delivery. Coupled with the use of innovative approaches is the possibility for adverse outcomes, highlighting the need to strategically refine digital practices prior to implementation with patients. One appropriate method for modification purposes includes focus groups. Although it is a well-established method in qualitative research, there is a lack of guidance regarding the use of focus groups for digital intervention refinement. To address this gap, the purpose of our paper is to highlight several lessons our research team has learned in using focus groups to help refine digital interventions prior to use with patients. %M 26232313 %R 10.2196/resprot.4404 %U http://www.researchprotocols.org/2015/3/e95/ %U https://doi.org/10.2196/resprot.4404 %U http://www.ncbi.nlm.nih.gov/pubmed/26232313 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 1 %P e22 %T Development of a Web-Based and Mobile App to Support Physical Activity in Individuals With Rheumatoid Arthritis: Results From the Second Step of a Co-Design Process %A Revenäs,Åsa %A Opava,Christina H %A Martin,Cathrin %A Demmelmaier,Ingrid %A Keller,Christina %A Åsenlöf,Pernilla %+ Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Zanderska huset, Alfred Nobels Allé 23 /23100, Huddinge, 141 83, Sweden, 46 722 304853, asa.revenas@ki.se %K eHealth %K Internet intervention %K physical activity %K rheumatoid arthritis %K behavior change techniques %K participatory design %D 2015 %7 09.02.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Long-term adherence to physical activity recommendations remains challenging for most individuals with rheumatoid arthritis (RA) despite evidence for its health benefits. Objective: The aim of this study was to provide basic data on system requirement specifications for a Web-based and mobile app to self-manage physical activity. More specifically, we explored the target user group, features of the future app, and correlations between the system requirements and the established behavior change techniques (BCTs). Methods: We used a participatory action research design. Qualitative data were collected using multiple methods in four workshops. Participants were 5 individuals with RA, a clinical physiotherapist, an officer from the Swedish Rheumatism Association, a Web designer, and 2 physiotherapy researchers. A taxonomy was used to determine the degree of correlation between the system requirements and established BCTs. Results: Participants agreed that the future Web-based and mobile app should be based on two major components important for maintaining physical activity: (1) a calendar feature for goal setting, planning, and recording of physical activity performance and progress, and (2) a small community feature for positive feedback and support from peers. All system requirements correlated with established BCTs, which were coded as 24 different BCTs. Conclusions: To our knowledge, this study is the first to involve individuals with RA as co-designers, in collaboration with clinicians, researchers, and Web designers, to produce basic data to generate system requirement specifications for an eHealth service. The system requirements correlated to the BCTs, making specifications of content and future evaluation of effectiveness possible. %M 25665589 %R 10.2196/resprot.3795 %U http://www.researchprotocols.org/2015/1/e22/ %U https://doi.org/10.2196/resprot.3795 %U http://www.ncbi.nlm.nih.gov/pubmed/25665589