%0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e57583 %T Development and Systematic Evaluation of a Progressive Web Application for Women With Cardiac Pain: Usability Study %A Parry,Monica %A Huang,Tony %A Clarke,Hance %A Bjørnnes,Ann Kristin %A Harvey,Paula %A Parente,Laura %A Norris,Colleen %A Pilote,Louise %A Price,Jennifer %A Stinson,Jennifer N %A O’Hara,Arland %A Fernando,Madusha %A Watt-Watson,Judy %A Nickerson,Nicole %A Spiteri DeBonis,Vincenza %A Hart,Donna %A Faubert,Christine %+ Lawrence Bloomberg Faculty of Nursing, University of Toronto, Office 276, 155 College Street, Toronto, ON, M5T 1P8, Canada, 1 416 946 3561, monica.parry@utoronto.ca %K digital health %K chatbot %K women %K cardiac pain %K usability testing %K self-management %K artificial intelligence %K AI %D 2025 %7 17.4.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cardiac pain has been widely considered to be the primary indicator of coronary artery disease. The presentation of cardiac pain and associated symptoms vary in women, making it challenging to interpret as cardiac, possibly cardiac, or noncardiac. Women prefer to consult with family and friends instead of seeking immediate medical care. Objective: This study aimed to assess the user performance (ie, ease of use, efficiency, and errors) and user satisfaction (System Usability Scale; SUS) of a progressive web application for women with cardiac pain. Methods: Following ethics approval, a purposive sample of women aged >18 years with cardiac pain or associated symptoms lasting >3 months and able to speak and read English was recruited to participate in 2 iterative usability testing cycles. The first cycle assessed the performance of and satisfaction with at heart using a web application, and the second cycle assessed the performance of and satisfaction with at heart across various Android and iOS devices. In total, 2 investigators recorded user comments and documented problems. At the end of the testing session, the participants completed the SUS and 4 semistructured interview questions. Results: In total, 10 eligible women participated in usability testing from March 31, 2020, to April 17, 2020 (cycle 1), and from November 17, 2020, to November 30, 2020 (cycle 2). Women across usability testing cycles had a mean age of 55.6 (SD 7.3) years, and most (9/10, 90%) were well educated. In total, 50% (5/10) were employed full or part time, and 60% (6/10) earned >CAD $70,000 (US $48,881.80) annually. Participants across 2 testing cycles reported the overall usability of the at heart progressive web application as highly acceptable (mean SUS score 81.75, SD 10.41). In total, 90% (9/10) of participants rated the user-friendliness of at heart as good or excellent. All participants (10/10, 100%) thought at heart was easy to use and efficient. Only 2 testing errors were noted as high priority; these were low contrast or small font and clarification that the chatbot was not a real person. User satisfaction was assessed using themes that emerged from the debrief and 4 semistructured interview questions; at heart was engaging, comprehensive, understandable, credible, relevant, affirming, personalized, and innovative. Conclusions: This study provides initial support for the at heart progressive web application for women living with cardiac pain and symptoms. Ongoing evaluations in phases 3 and 4 should aim to examine the feasibility and acceptability of and the extent of engagement with the at heart core feature set: Heart Check, Wellness Check, and the library. In addition to assessing effectiveness in the phase-4 effectiveness-implementation hybrid trial (type I), describing and better understanding the context for implementation (eg, race and ethnicity and geography) will be necessary. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-033092 %M 40245401 %R 10.2196/57583 %U https://humanfactors.jmir.org/2025/1/e57583 %U https://doi.org/10.2196/57583 %U http://www.ncbi.nlm.nih.gov/pubmed/40245401 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e55430 %T Patients' and Physicians' Experience With and Acceptability of a Telemedicine Cabin: Mixed Methods Study %A de França,Caroline Villela Galvão %A Segalla,Paola Boaro %A Reis,Felipe Sebastião de Assis %A Pereira,José Ricardo Silveira %A de Mattos,Alexandre Oliveira %A Ferron,Roberta de Moura %A de Oliveira,Cleyton Zanardo %A Borges,Jéssica Bassani %A Hoffmann,Lilian Quintal %A Caboclo,Edmundo Di Giaimo %K telemedicine cabin %K telehealth %K teleservice %K e-health %K connected offices %D 2025 %7 16.4.2025 %9 %J JMIR Hum Factors %G English %X Background: Telemedicine represents an essential tool with the potential to reduce health costs, thus avoiding patient displacement and improving patient care outcomes, positioning it as a significant social technology. Objective: This study aims to analyze the implementation of a telehealth cabin at BP Hospital (A Beneficência Portuguesa de São Paulo), focusing on the evaluation of the experiences of both patients and health care professionals, as well as the acceptability of this tool. Methods: A mixed methods study was conducted with 229 participants, divided into 2 phases. The first phase involved 40 apparently healthy individuals to assess the usability, experience, and satisfaction of this group for the later safe application in the group with clinical complaints. The second phase included 189 participants, with complaints to assess the usability, experience, and satisfaction of patients and doctors. In both phases, participants completed screening questionnaires (to assess the eligibility criteria), a socioeconomic demographic questionnaire before using the cabin, and a questionnaire including the System Usability Scale and the Net Promoter Score (NPS) after using the cabin. Results: The data analysis of the first phase showed high acceptance of the telehealth cabin, which supported the progression to the second phase. In the second phase, a high usability score was observed among participants with clinical complaints (mean System Usability Scale score of 85.97, SD 15.50) and a high favorability rating (NPS score of 9.4). Health care professionals also reported favorable results, with a usability score of 67.8 and an NPS of 8.0. Conclusions: The results of this study reinforce the potential for scaling up this practice based on usability outcomes, and highlight its relevance for the development of public policies aimed at expanding access to quality health care in Brazil. This approach improves the interaction of patients with the health care system, while providing professionals with an extended view of clinical conditions through integrated devices, particularly in areas with limited access to medical care. %R 10.2196/55430 %U https://humanfactors.jmir.org/2025/1/e55430 %U https://doi.org/10.2196/55430 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e65745 %T Using Social Media Platforms to Raise Health Awareness and Increase Health Education in Pakistan: Structural Equation Modeling Analysis and Questionnaire Study %A Munir,Malik Mamoon %A Ahmed,Nabil %K social media %K health awareness %K health education %K innovation diffusion theory %K structural equation modeling %K disease burden %K healthcare facilities %K health professionals %K misinformation %K cost effective %D 2025 %7 7.4.2025 %9 %J JMIR Hum Factors %G English %X Background: Current health care education methods in Pakistan use traditional media (eg, television and radio), community health workers, and printed materials, which often fall short of reach and engagement among most of the population. The health care sector in Pakistan has not yet used social media effectively to raise awareness and provide education about diseases. Research on the impact social media can have on health care education in Pakistan may expand current efforts, engage a wider audience, and reduce the disease burden on health care facilities. Objective: This study aims to evaluate the perceptions of health care professionals and paramedic staff regarding social media use to raise awareness and educate people about diseases as a potential means of reducing the disease burden in Pakistan. Methods: The study used two-stage structural equation modeling (SEM). Data analysis used AMOS 26.0 software, adopting scales from previous literature. Four-item scales for each social media usefulness and health awareness construct and 8-item scales for health care education constructs were adopted on the basis of their higher loading in alignment with psychometric literature. A 7-point Likert scale was used to measure each item. Data collection used convenience sampling, with questionnaires distributed to more than 450 health care professionals and paramedic staff from 2 private hospitals in Lahore, Pakistan. There were 389 useful responses received. However, 340 completed questionnaires were included in the data analysis. Results: The study found that all the squared multiple correlation (SMC) values were greater than 0.30. Furthermore, convergent validity was measured using (1) standardized factor loading (found greater than 0.5), (2) average variance explained (found greater than 0.5), and (3) composite reliability (found greater than 0.7). The confirmatory factor analysis (CFA) of the measurement model indicated the fitness of the constructs (Chi-square minimum [CMIN]=357.62; CMIN/degrees of freedom [DF]=1.80; Goodness of Fit [GFI]=0.90; Adjusted Goodness of Fit Index [AGFI]=0.89; Buntler-Bonett Normed Fit Index [NFI]=0:915; Comparative Fit Index [CFI]=0:93; Root Mean Square Residual [RMR]=0:075; Root Mean Square Error of Approximation [RMSEA]=0:055). Moreover, the structural model fitness was also confirmed (CMIN=488.6; CMIN/DF=1.85; GFI=0.861; AGFI=0.893; NFI=0.987; CFI=0.945; RMR=0:079; RMSEA=0.053). Hence, the results indicated that social media usefulness has a positive and significant effect on health awareness (hypothesis 1: β=.669, P<.001), and health awareness has a positive and significant effect on health care education in Pakistan (hypothesis 2: β=.557, P<.001). Conclusions: This study concludes that health care professionals and paramedic staff in private hospitals support the use of social media to raise awareness and provide health care education. It is considered an effective tool for reducing the disease burden in Pakistan. The study results also revealed that young health care professionals are more inclined toward social media usage and express the need for legislation to support it and establish a monitoring process to avoid misinformation. %R 10.2196/65745 %U https://humanfactors.jmir.org/2025/1/e65745 %U https://doi.org/10.2196/65745 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e55072 %T Patterns of Internet Use in People Diagnosed With Severe Mental Illness: Qualitative Interview Study %A Wadman,Ruth %A Walker,Lauren %A Taylor,Olivia %A Heron,Paul %A Newbronner,Elizabeth %A Spanakis,Panagiotis %A Crosland,Suzanne %A Peckham,Emily Jane %+ School of Medical and Health Sciences, Bangor University, Wrexham Technology Park,, Croesnewydd Road, Wrexham, LL13 7YP, United Kingdom, 44 7934877022, lrw24ltt@bangor.ac.uk %K severe mental illness %K internet use %K qualitative %K typology %K protective strategies %K digital divide %D 2025 %7 28.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: People with severe mental illness (SMI) face profound health inequalities, which may be exacerbated by increased rates of digital exclusion, especially as health services move to online provision. The activities that people carry out online can affect how they feel about the internet and may determine whether a person has a positive or negative experience when using the internet. This, in turn, could affect their mental health. To support people with SMI in using digital technology and the internet safely, it is important to understand the internet and digital technology use of those with SMI and their perceived positive or negative impact on their mental health. Objective: This study aimed to explore the internet and digital technology use of those with SMI, with particular focus on any association between greater use of the internet and poorer self-reported mental health. Methods: We carried out a qualitative interview study with 16 people with SMI. The sample was drawn from a wider investigation of the impact of the pandemic and its restrictions on the health and well-being of 367 people with SMI. We purposively sampled from the wider study based on age, gender, frequency of internet use, and self-reported mental health. The data were analyzed by 2 researchers using framework analysis. Results: Participant experiences fell into 3 broad categories: those who had a positive or neutral internet-based experience, those who had negative or difficult experiences, and low users or those with poor digital literacy. Those who had positive or neutral experiences could be broken down into 2 subcategories: first, those with positive or neutral experiences of the internet who were similar in terms of the activities participated in, feelings reported, and their concerns about the internet, and second, conscious users who were mindful of their interaction with the internet world. Participants with difficult experiences fell into 2 categories: those with worries and fears related to using the internet and those who had difficulty limiting their internet use. Conclusions: People with SMI, similarly the general population, are expected to conduct more of their activities of daily living online in the postpandemic world. This research shows that most internet users with SMI have positive or neutral experiences. However, our typology reveals subgroups of the population with SMI for whom there is a relationship between internet use and difficult feelings. These subgroups can be identified by asking questions about online activities; time spent online; feelings, difficulties, or issues experienced; and use of gambling, dating, adult content, and conspiracy theory websites. Our findings point to further work in collaboration with people with lived experience to modify and test this typology. %M 40153777 %R 10.2196/55072 %U https://www.jmir.org/2025/1/e55072 %U https://doi.org/10.2196/55072 %U http://www.ncbi.nlm.nih.gov/pubmed/40153777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65391 %T BePresent Universal Internet-Based Parenting Intervention: Single-Arm Pre-Post Intervention Study %A Mishina,Kaisa %A Baumel,Amit %A Kinnunen,Malin %A Ristkari,Terja %A Heinonen,Emmi %A Hinkka-Yli-Salomäki,Susanna %A Sourander,Andre %+ Research Centre for Child Psychiatry, Faculty of Medicine, University of Turku, Lemminkäisenkatu 3, Turku, 20014, Finland, 358 50 310 135, kaemka@utu.fi %K parent training %K universal intervention %K online intervention %K irritability %K conduct problems %K hyperactivity %K preschool %K mental health %K strongest families %K positive parenting %K parenting skills %K parent-child relationships %K parent satisfaction %K BePresent %K feasibility study %K single-arm pre-post intervention study %D 2025 %7 13.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet-based parenting programs have great potential to promote positive parent-child relationships as well as to reach and engage parents. Objective: This study aimed to assess the universal internet-based BePresent parenting intervention for families with 3-year-old children and how it influences the child’s behavior and daily-life situations assessed by parents. The first aim of the study was to assess the change from baseline to follow-up in child hyperactivity and conduct problems, affective reactivity, and daily activities. The second aim was to assess intervention completion rates. The third aim was to evaluate parent satisfaction with the intervention. The fourth aim was to assess all outcomes by comparing those who completed the intervention and those who did not. Methods: We conducted a single-arm pre- and postintervention study. Parents attending their child’s 3-year health check-up were recruited from children’s health clinics. The intervention was an unguided internet-based parenting program consisting of 5 modules. Self-reported measures were collected at baseline and at an 8-week follow-up. Linear mixed-effects models were used to analyze the changes from baseline to follow-up. Results: Altogether, 752 parents registered, and 515 started the intervention. Of those, 36% (n=183) completed the intervention. Parents reported high satisfaction with the intervention: the majority (68.8%–84.9%) were satisfied with various aspects of the program, and 89.9% said the intervention provided information about positive parenting skills. The findings show significant decreases with small effect sizes in parents’ ratings of child hyperactivity (P=.03; d=0.12) and conduct problems (P=.001; d=0.20) between baseline and the 8-week follow-up. A similar finding was observed in the parent ratings of child irritability (P≤.001; d=0.27) using the Affective Reactivity Index. Parents reported improvement in the daily functioning of their child when it was measured with a questionnaire adapted from the Barkley Home Situations Questionnaire (P=.01; d=0.14). Conclusions: Universal digital interventions have the potential to be implemented widely in community settings to improve knowledge and positive parenting skills. However, there is a need to assess the efficacy of digital universal interventions using randomized controlled designs and to examine additional ways to increase adherence to universal programs. %M 40080811 %R 10.2196/65391 %U https://www.jmir.org/2025/1/e65391 %U https://doi.org/10.2196/65391 %U http://www.ncbi.nlm.nih.gov/pubmed/40080811 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 17 %N %P e59686 %T Development of an Online Scenario-Based Tool to Enable Research Participation and Public Engagement in Cystic Fibrosis Newborn Screening: Mixed Methods Study %A Moody,Louise %A Clarke,Samantha %A Compton,Matt %A Hughson-Gill,Rachael %A Boardman,Felicity %A Clark,Corinna %A Holder,Pru %A Bonham,James R %A Chudleigh,Jane %+ Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College London, Cicely Saunders Institute, Bessemer Road, London, SE5 9PJ, United Kingdom, 44 02078485590, jane.2.chudleigh@kcl.ac.uk %K extended genetic testing %K next-generation sequencing %K cystic fibrosis %K decision-making %K engagement %D 2025 %7 6.3.2025 %9 Original Paper %J J Particip Med %G English %X Background: Newborn screening aims to identify babies affected by rare but serious genetic conditions. As technology advances, there is the potential to expand the newborn screening program following evaluation of the likely benefits and drawbacks. To inform these decisions, it is important to consider the family experience of screening and the views of the public. Engaging in public dialogue can be difficult. The conditions, screening processes, and associated moral and ethical considerations are complex. Objective: This study aims to develop a stand-alone online resource to enable a range of stakeholders to understand whether and how next-generation sequencing should be incorporated into the CF screening algorithm. Methods: Around 4 development workshops with policymakers, parents, and other stakeholders informed the design of an interactive activity, including the structure, content, and questions posed. Stakeholders were recruited to take part in the development workshops via purposeful and snowball sampling methods to achieve a diversity of views across roles and organizations, with email invitations sent to representative individuals with lived, clinical, and academic experience related to CF and screening. Ten stakeholders informed the development process including those with lived experience of CF (2/10, 20%), clinicians (2/10, 20%), and representatives from relevant government, charity, and research organizations (6/10, 60%). Vignettes constructed using interview data and translated into scripts were recorded to provide short films to represent and provoke consideration of families’ experiences. Participants were recruited (n=6, adults older than 18 years) to test the resulting resource. Study advertisements were circulated via physical posters and digital newsletters to recruit participants who self-identified as having a reading difficulty or having English as a second language. Results: An open access online resource, “Cystic Fibrosis Newborn Screening: You Decide,” was developed and usability and acceptability tested to provide the “user” (eg, a parent, the general public, or a health care professional) with an interactive scenario-based presentation of the potential outcomes of extended genetic testing, allowing them to visualize the impact on families. This included a learning workbook that explains key concepts and processes. The resulting tool facilitates public engagement with and understanding of complex genetic and screening concepts. Conclusions: Online resources such as the one developed during this work have the potential to help people form considered views and facilitate access to the perspectives of parents and the wider public on genetic testing. These may be otherwise difficult to obtain but are of importance to health care professionals and policymakers. Trial Registration: ClinicalTrials.gov NCT06299566; https://clinicaltrials.gov/study/NCT06299566 %M 40053726 %R 10.2196/59686 %U https://jopm.jmir.org/2025/1/e59686 %U https://doi.org/10.2196/59686 %U http://www.ncbi.nlm.nih.gov/pubmed/40053726 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e49507 %T Implementation of a Web-Based Program for Advance Care Planning and Evaluation of its Complexity With the Nonadoption, Abandonment, Scale-Up, Spread, And Sustainability (NASSS) Framework: Qualitative Evaluation Study %A van der Smissen,Doris %A Schreijer,Maud A %A van Gemert-Pijnen,Lisette J E W C %A Verdaasdonk,Rudolf M %A van der Heide,Agnes %A Korfage,Ida J %A Rietjens,Judith A C %+ Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands, 31 107038460, i.korfage@erasmusmc.nl %K eHealth %K web-based intervention %K implementation %K sustainability %K advance care planning %K NASSS framework %K nonadoption, abandonment, scale-up, spread, and sustainability framework %K health communication %K patient education %K patient-centered care %D 2025 %7 4.3.2025 %9 Original Paper %J JMIR Aging %G English %X Background: The implementation of eHealth applications often fails. The NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework aims to identify complexities in eHealth applications; the more complex, the more risk of implementation failure. Objective: This study aimed to analyze the implementation of the web-based advance care planning (ACP) program “Explore Your Preferences for Treatment and Care” using the NASSS framework. Methods: The NASSS framework enables a systematic approach to improve the implementation of eHealth tools. It is aimed at generating a rich and situated analysis of complexities in multiple domains, based on thematic analysis of existing and newly collected data. It also aims at supporting individuals and organizations to handle these complexities. We used 6 of 7 domains of the NASSS framework (ie, condition, technology, value proposition, adopters, external context, and embedding and adaptation over time) leaving out “organization,” and analyzed the multimodal dataset of a web-based ACP program, its development and evaluation, including peer-reviewed publications, notes of stakeholder group meetings, and interviews with stakeholders. Results: This study showed that the web-based ACP program uses straightforward technology, is embedded in a well-established web-based health platform, and in general appears to generate a positive value for stakeholders. A complexity is the rather broad target population of the program. A potential complexity considers the limited insight into the extent to which health care professionals adopt the program. Awareness of the relevance of the web-based ACP program may still be improved among target populations of ACP and among health care professionals. Furthermore, the program may especially appeal to those who value individual autonomy, self-management, and an explicit and direct communicative approach. Conclusions: Relatively few complexities were identified considering the implementation of the web-based ACP program “Explore Your Preferences for Treatment and Care.” The program is evidence-based, freestanding, and well-maintained, with straightforward, well-understood technology. The program is expected to generate a positive value for different stakeholders. Complexities include the broad target population of the program and sociocultural factors. People with limited digital literacy may need support to use the program. Its uptake might be improved by increasing awareness of ACP and the program among a wider population of potential users and among health care professionals. Addressing these issues may guide future use and sustainability of the program. %M 40053753 %R 10.2196/49507 %U https://aging.jmir.org/2025/1/e49507 %U https://doi.org/10.2196/49507 %U http://www.ncbi.nlm.nih.gov/pubmed/40053753 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e48370 %T Development and Testing of the Kids Hurt App, a Web-Based, Pain Self-Report App for First Nations Youths: Mixed Methods Study %A Francis,Karlee %A Francis,Julie %A Latimer,Margot %A Gould,Hayley %A Blackmore,Shante %A MacLeod,Emily %K app %K eHealth %K pain %K Indigenous %K First Nations %K children %K youths %K mobile phone %D 2025 %7 3.3.2025 %9 %J JMIR Hum Factors %G English %X Background: First Nations children and youths may have unique ways to convey their health needs that have not been recognized by health providers. This may contribute to the disparity between high rates of mental health and physical pain and low rates of treatment for the conditions they experience. Evidence suggests that a colonial history has resulted in poor experiences with the health care system, lack of trust with health providers, and miscommunication between clinicians and patients. Contemporary ways, using both Indigenous and Western knowledge, are needed to bridge the gap in communicating pain. Objective: The aim of this qualitative study was to test the usability and clinical feasibility of the Kids Hurt App with First Nations youths and clinicians working with youths. Methods: Using a Two-Eyed Seeing approach, the Kids Hurt App was developed using concepts from validated mood and pain assessment apps combined with community-based research that gathered First Nations youths and clinicians perspectives on quality, intensity, and location of pain and hurt. The Kids Hurt App contains 16 screens accessible on any web-based device. Results: In total, 3 rounds of low-fidelity testing (n=19), 2 rounds of high-fidelity testing (n=20), and 2 rounds of clinical feasibility testing (n=10) were conducted with First Nations youths (10‐19 years) to determine the relevance, validity, and usability of the Kids Hurt App. High-fidelity testing was also conducted with 15 clinicians after completing the high-fidelity youth sessions. Youths had constructive suggestions that were used to improve the app in subsequent rounds of version testing. There was one main discrepancy between youths and clinicians related to preference for how best to visually convey pain. The youth’s preference was maintained in the app. Conclusions: All youths in all rounds of testing indicated that they would use the Kids Hurt App if it was available to them in a health care setting, with most clinicians noting that the app would be useful in practice. %R 10.2196/48370 %U https://humanfactors.jmir.org/2025/1/e48370 %U https://doi.org/10.2196/48370 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59829 %T Formative Evaluation of Suicide Prevention Websites for Men: Qualitative Study with Men at Risk of Suicide and with Potential Gatekeepers %A Reifegerste,Doreen %A Wagner,Anna J M %A Huber,Lisa %A Fastuca,Manuel %+ School of Public Health, Bielefeld University, Universitaetsstrasse 25, Bielefeld, 33615, Germany, 49 521 10667 ext 807, doreen.reifegerste@uni-bielefeld.de %K mental health %K suicide prevention %K men’s health %K evaluation %K website %K gatekeeper %K suicide %K male %K suicide risk %K digital communication %K intervention %K suicidal behavior %K digital intervention %K digital media %D 2025 %7 26.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The suicide rate among men exceeds that of women worldwide. One important measure in suicide prevention for men is digital communication interventions, as they enable easy and anonymous access to information resources. This is especially important for men who might not be reached by traditional, in-person prevention methods. Thus, as part of an interdisciplinary project on suicide prevention for men, two specific digital communication prevention measures were developed: (1) a website to inform men at risk about suicide prevention, and (2) a website to educate potential gatekeepers who are in contact with men at risk of suicide about appropriate life-saving measures. Both websites needed evaluation to explore how they are perceived by (1) men and by (2) potential gatekeepers of men at risk of suicide. This is crucial, as existing research lacks formative evaluation that informs the development of intervention communication materials. Objective: This study aimed to analyze whether these websites were perceived as (1) comprehensible and engaging, (2) authentic and trustworthy, as well as (3) useful by (potential) users. Furthermore, we examined (4) additional ideas for effective communication about suicide prevention. Methods: We conducted (1) individual videoconference interviews with 24 men to evaluate the website and (2) four focus groups with 8 gatekeepers in each group (32 participants) to evaluate the online education program. The focus group sample was equally distributed regarding gender and age. Recruitment was conducted together with a field research partner who posted adverts on Facebook and Instagram (Meta) to reach as many potential participants as possible in an efficient way. All participants were asked to evaluate the intervention materials using a fictitious scenario of a man experiencing a mental health crisis before the interviews or focus groups took place. Results: The videos were perceived as (1) catchy, comprehensible, and empathetic, but too long for a short introduction. A balanced mix of emotional and informative content was considered appropriate and helpful. The health information provided was perceived as (2) serious and trustworthy due to citing scientific institutions and video material of men who had experienced suicidal ideation. (3) The intervention’s applicability for men experiencing acute crisis was critiqued, but it was regarded as very useful for comprehensive information. (4) Further communication channels and addressing other male subgroups or gender identities were presented as possible extensions of the program. Conclusions: Effective suicide prevention research should address both the groups at risk and their support network. Digital communication interventions can provide low-threshold access. Videos with personalized examples are important to give men someone to identify with, which validates their emotional responses and supports their self-esteem, while videos with experts provide relevant and credible information. %M 40009838 %R 10.2196/59829 %U https://formative.jmir.org/2025/1/e59829 %U https://doi.org/10.2196/59829 %U http://www.ncbi.nlm.nih.gov/pubmed/40009838 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e58362 %T Examining Individuals’ Use of the Internet for Health Care Activities Over Time: Results from the US National Health Interview Survey %A Junkins,Zachary %A Zahan,Nusrath %A Neyens,David %+ Department of Industrial Engineering, Clemson University, 100 Freeman Hall, Clemson, SC, 29634, United States, 1 8646564719, dneyens@clemson.edu %K internet %K web search %K internet search %K internet use %K searching behavior %K access to health information %K telemedicine %K telehealth %K virtual care %K virtual health %K virtual medicine %K logistic regression model %K regression model %K National Health Interview Survey %K NHIS %D 2025 %7 26.2.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Telehealth is an increasingly important component of health care services. Telehealth services may present an opportunity to increase the equity, accessibility, and effectiveness of health care. As such, it is critical that telehealth design focuses on reducing the barriers to access and usability that may impair some telehealth users. Objective: Our goal was to identify different demographic characteristics, behaviors, or opinions that may predict groups who are likely to face a barrier to using telehealth services. Methods: We used data from the National Health Interview Survey and multiple logit regression models focused on different aspects of telehealth to examine three different avenues of telehealth service: looking up health information using the internet, scheduling an appointment using the internet, and communicating with a care provider through email using the internet in order to consider the ways in which different telehealth services may face different barriers. Results: Our results suggest that middle-aged (36-55 years old) and older adult (56-85 years old) respondents were significantly less likely to look up health information using the internet or schedule an appointment using the internet versus younger individuals (18-35 years old). Specifically, our analysis found that middle-aged adults were found to have a higher odds ratio than older adults (0.83 vs 0.65) for looking up health information using the internet. We also found that there were differences in age groups for using technology to perform health care–related tasks. In terms of searching for health information using the internet and scheduling appointments using the internet, we found differences between men and women, with women being significantly more likely than men to look up health information using the internet, schedule an appointment using the internet, and communicate with a care provider through email using the internet. Across all the investigated variables, we found that the rates of using the internet for looking up health information, scheduling an appointment, and communicating with a care provider over email increased substantially across the study period. The impact of costs was inconsistent across the different models in our analysis. We also found that there is a strong correlation between respondents’ collaboration in their personal health and the likelihood that they would use telehealth services to meet these needs. Conclusions: This analysis provides an exploratory look at the data to highlight barriers that may impact a user’s ability to access telehealth services in the context of other potential predictor variables to account for the real-world variability that these may present. Future work should examine the complex relationships of those variables and understand how these interactions are correlated with the respondents’ use of telehealth. %M 40009837 %R 10.2196/58362 %U https://humanfactors.jmir.org/2025/1/e58362 %U https://doi.org/10.2196/58362 %U http://www.ncbi.nlm.nih.gov/pubmed/40009837 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e63780 %T Development and Implementation of MyPainHub, a Web-Based Resource for People With Musculoskeletal Conditions and Their Health Care Professionals: Mixed Methods Study %A Evans,Kerrie %A Ko,Jonathan %A Ceprnja,Dragana %A Maka,Katherine %A Beales,Darren %A Sterling,Michele %A Bennell,Kim L %A Jull,Gwendolen %A Hodges,Paul W %A McKay,Marnee J %A Rebbeck,Trudy J %+ The University of Sydney, City Road, Camperdown, Sydney, 2050, Australia, 61 0731804900, kerrie.evans@healthia.com.au %K clinical pathways %K allied health %K self-management %K health information %K ehealth %K co-design %D 2025 %7 24.2.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Musculoskeletal conditions, including low back pain (LBP), neck pain, and knee osteoarthritis, are the greatest contributors to years lived with disability worldwide. Resources aiming to aid both patients and health care professionals (HCPs) exist but are poorly implemented and adopted. Objective: We aimed to develop and implement MyPainHub, an evidence-based web-based resource designed to provide comprehensive, credible and accessible information for people with, and HCPs who manage, common musculoskeletal conditions. Methods: This mixed methods study adhered to the New South Wales Translational Research Framework and was evaluated against the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Consultation with key stakeholders (patients, HCPs, researchers, industry, consumer groups, and website developers) informed content, design, features, and functionality. Development then aimed to meet the identified need for a “one-stop shop”—a central location for information about common musculoskeletal conditions tailored to a person’s condition and risk of poor outcomes. MyPainHub was then developed through an iterative process and implementation strategies were tailored to different health care settings. Quantitative and qualitative evaluation occurred with patients and HCPs. Results: In total, 127 stakeholders participated in the development phase; initial consultation with them led to embedding 2 validated screening tools (the Short Form Örebro Musculoskeletal Pain Screening Questionnaire and the Keele STarT MSK tool) in MyPainHub to guide information tailoring for patients based on risk of poor outcomes. Development occurred in parallel and feedback from stakeholders informed design and content including structure, functionality, and phrasing and images to use to emphasize key points. Consultation resulted in information for patients being categorized using key guideline-based messages (general information, your pathway, exercise, and imaging) while information for clinicians was categorized into assessment, management, and prognosis. Implementation occurred in different health care settings with the most effective strategies being interactive education via webinars and workshops. The evaluation phase involved web-based questionnaires (patients: n=44; HCPs: n=29) and focus groups (patients: n=6; HCPs: n=6). Patients and HCPs found MyPainHub user-friendly, acceptable, credible, and potentially able to support self-management. Patient participants identified areas for improvement such as including more specific information on preventative measures and pain relief options. Despite positive feedback, only 35% (10/29) of HCPs used MyPainHub with their patients. HCP participants identified challenges including insufficient training and lack of familiarity with using web-based resources in existing clinical workflows. Following implementation, the information contained on MyPainHub changed knowledge and practice for some patients and HCPs. Conclusions: Following extensive and iterative stakeholder engagement, MyPainHub was developed as an evidence-based web-based resource and perceived by patients and HCPs as user-friendly, credible, and acceptable. Active implementation strategies are required for adoption and implementation and greater training focusing on strategies to implement MyPainHub into clinical practice may be necessary. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000871145; https://tinyurl.com/438kkyt3 %M 39993289 %R 10.2196/63780 %U https://formative.jmir.org/2025/1/e63780 %U https://doi.org/10.2196/63780 %U http://www.ncbi.nlm.nih.gov/pubmed/39993289 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e67962 %T Usability Testing of a Bystander Bullying Intervention for Rural Middle Schools: Mixed Methods Study %A Midgett,Aida %A Doumas,Diana M %A Peralta,Claudia %A Peck,Matt %A Reilly,Blaine %A Buller,Mary K %+ Boise State University, 301 University Drive, Boise, ID, 83706, United States, 1 426 1214, AidaMidgett@boisestate.edu %K technology-based bullying intervention %K STAC-T %K usability testing %K middle school %K rural %D 2025 %7 21.2.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Targets of bullying are at high risk of negative socioemotional outcomes. Bullying programming in rural schools is important as bullying is more prevalent in those schools compared to urban schools. Comprehensive, school-wide bullying programs require resources that create significant barriers to implementation for rural schools. Because technology-based programs can reduce implementation barriers, the development of a technology-based program increases access to bullying prevention in rural settings. Objective: We aimed to conduct usability testing of a bystander bullying intervention (STAC-T). We assessed usability and acceptability of the STAC-T application and differences in usability between school personnel and students. We were also interested in qualitative feedback about usability, program features, and feasibility. Methods: A sample of 21 participants (n=10, 48% school personnel; n=11, 52% students) recruited from 2 rural middle schools in 2 states completed usability testing and a qualitative interview. We used descriptive statistics and 2-tailed independent-sample t tests to assess usability and program satisfaction. We used consensual qualitative research as a framework to extract themes about usefulness, relevance, needs, barriers, and feedback for intervention development. Results: Usability testing indicated that the application was easy to use, acceptable, and feasible. School personnel (mean score 96.0, SD 3.9) and students (mean score 88.6, SD 9.5) rated the application well above the standard cutoff score for above-average usability (68.0). School personnel (mean score 6.10, SD 0.32) and students (mean score 6.09, SD 0.30) gave the application high user-friendliness ratings (0-7 scale; 7 indicates highest user-friendliness). All 10 school personnel stated they would recommend the program to others, and 90% (9/10) rated the program with 4 or 5 stars. Among students, 91% (10/11) stated they would recommend the program to others, and 100% (11/11) rated the program with 4 or 5 stars. There were no statistically significant differences in ratings between school personnel and students. Qualitative data revealed school personnel and students found the application useful, relevant, and appropriate while providing feedback about the importance of text narration and the need for teacher and parent training to accompany the student program. The data showed that school personnel and students found a tracker to report different types of bullying witnessed and strategies used to intervene by students a useful addition to STAC-T. School personnel reported perceiving the program to be practical and very likely to be adopted by schools, with time, cost, and accessibility being potential barriers. Overall, findings suggest that the STAC-T application has the potential to increase access to bullying prevention for students in rural communities. Conclusions: The results demonstrate high usability and acceptability of STAC-T and provide support for implementing a full-scale randomized controlled trial to test the efficacy of the application. %M 39984169 %R 10.2196/67962 %U https://humanfactors.jmir.org/2025/1/e67962 %U https://doi.org/10.2196/67962 %U http://www.ncbi.nlm.nih.gov/pubmed/39984169 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53087 %T Evaluation of the Quality of Delirium Website Content for Patient and Family Education: Cross-Sectional Study %A Krewulak,Karla %A Strayer,Kathryn %A Jaworska,Natalia %A Spence,Krista %A Foster,Nadine %A Kupsch,Scotty %A Sauro,Khara %A Fiest,Kirsten M %+ , Department of Critical Care Medicine, University of Calgary, MT 04111, 3260 Hospital Drive NW, Calgary, AB, , Canada, 1 9448768, kmfiest@ucalgary.ca %K education %K health information %K internet %K delirium %K patient %K caregiver %K brain lesions %K confusion %K inattentiveness %K disorientation %K family education %K information seeking %K readability %K high-quality websites %K accessibility %D 2025 %7 20.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients and families who have experienced delirium may seek information about delirium online, but the quality and reliability of online delirium-related websites are unknown. Objective: This study aimed to identify and evaluate online delirium-related websites that could be used for patient and family education. Methods: We searched Microsoft Bing, Google, and Yahoo using the keywords “delirium” and the misspelled “delerium” to identify delirium-related websites created to inform patients, families, and members of the public about delirium. The quality of identified delirium-related website content was evaluated by 2 authors using the validated DISCERN tool and the JAMA (Journal of the American Medical Association) benchmark criteria. Readability was assessed with the Simple Measure of Gobbledygook, the Flesch Reading Ease score, and the Flesch Kincaid grade level. Each piece of website content was assessed for its delirium-related information using a checklist of items co-designed by a working group, which included patients, families, researchers, and clinicians. Results: We identified 106 websites targeted toward patients and families, with most hospital-affiliated (21/106, 20%) from commercial websites (20/106, 19%), government-affiliated organizations (19/106, 18%), or from a foundation or advocacy group (16/106, 15%). The median time since the last content update was 3 (IQR 2-5) years. Most websites’ content (101/106, 95%) was written at a reading level higher than the recommended grade 6 level. The median DISCERN total score was 42 (IQR 33-50), with scores ranging from 20 (very poor quality) to 78 (excellent quality). The median delirium-related content score was 8 (IQR 6-9), with scores ranging from 1 to 12. Many websites lacked information on the short- and long-term outcomes of delirium as well as how common it is. The median JAMA benchmark score was 1 (IQR 1-3), indicating the quality of the websites’ content had poor transparency. Conclusions: We identified high-quality websites that could be used to educate patients, families, or the public about delirium. While most delirium-related website content generally meets quality standards based on DISCERN and JAMA benchmark criteria, high scores do not always ensure patient and family-friendliness. Many of the top-rated delirium content were text-heavy and complex in layout, which could be overwhelming for users seeking clear, concise information. Future efforts should prioritize the development of websites with patients and families, considering usability, accessibility, and cultural relevance to ensure they are truly effective for delirium education. %M 39977019 %R 10.2196/53087 %U https://www.jmir.org/2025/1/e53087 %U https://doi.org/10.2196/53087 %U http://www.ncbi.nlm.nih.gov/pubmed/39977019 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e60315 %T Simulation of Contraceptive Access for Adolescents and Young Adults Using a Pharmacist-Staffed e-Platform: Development, Usability, and Pilot Testing Study %A Knowles,Kayla %A Lee,Susan %A Yapalater,Sophia %A Taylor,Maria %A Akers,Aletha Y %A Wood,Sarah %A Dowshen,Nadia %+ PolicyLab, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, United States, 1 267 425 1449, knowlesk1@chop.edu %K adolescent %K contraception %K telemedicine %K user-centered design %K young adult %K reproductive %K design %K usability %K experience %K mHealth %K mobile health %K app %K youth %K teenager %K drug %K pharmacology %K pharmacotherapy %K pharmaceutics %K medication %K pharmacy %K digital health %K platform %K access %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Offering contraceptive methods at pharmacies without a prescription is an innovative solution to reduce the incidence of unintended pregnancies among adolescents and young adults (AYA). Pharmacy-prescribed contraception may increase the convenience, simplicity, and affordability of contraceptives. Objective: The aim of this study was to develop, pilot test, and evaluate the acceptability and feasibility of a telemedicine electronic platform app simulating pharmacist prescribing of contraceptives to AYA as well as assess agreement between pharmacist-simulated contraceptive approvals and contraception as prescribed in routine clinic visits. Methods: This study was conducted in two phases: (1) development and usability testing of a prototype app to simulate pharmacists prescribing contraceptives to AYA and (2) pilot testing the app in a simulation for AYA requesting contraception from a pharmacist with pharmacist review and request approval or rejection. Eligibility criteria in both phases included the following: assigned female sex at birth, age 15-21 years, seeking contraceptive services at an academic adolescent medicine clinic, prior history of or intention to have penile-vaginal intercourse in the next 12 months, smartphone ownership, and English language proficiency. Phase 1 (usability) involved a video-recorded “think aloud” interview to share feedback and technical issues while using the app prototype on a smartphone and the completion of sociodemographic, sexual history, and perception of the prototype surveys to further develop the app. Phase 2 (pilot) participants completed phase 1 surveys, tested the updated app in a simulation, and shared their experiences in an audio-recorded interview. Descriptive analyses were conducted for quantitative survey data, and thematic analyses were used for interview transcripts. Results: Of the 22 participants, 10 completed usability testing, with a mean age of 16.9 (SD 1.97) years, and 12 completed pilot testing, with a mean age of 18.25 (SD 1.48) years. Three issues with the prototype were identified during “think aloud” interviews: challenges in comprehension of medical language, prototype glitches, and graphic design suggestions for engagement. Usability testing guided the frontend and backend creation of the platform. Overall, participants agreed or strongly agreed that using an app to receive contraceptives would make it easier for teens to access (n=19, 86%) and make contraceptive use less stigmatizing (n=19, 86%). In addition, participants agreed that receiving contraception prescriptions from a pharmacist without a clinic visit would be safe (n=18, 82%), convenient (n=19, 86%), acceptable (n=18, 82%), and easy (n=18, 82%). Pharmacists and medical providers had 100% agreement on the prescribed contraceptive method for pilot participants. Conclusions: AYA found contraceptive prescription by a pharmacist via an app to be highly acceptable and provided critical feedback to improve the design and delivery of the app. Additionally, pharmacist contraceptive approvals and contraception as prescribed in routine clinic visits were identical. %M 39970429 %R 10.2196/60315 %U https://pediatrics.jmir.org/2025/1/e60315 %U https://doi.org/10.2196/60315 %U http://www.ncbi.nlm.nih.gov/pubmed/39970429 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e56038 %T Understanding the Engagement and Interaction of Superusers and Regular Users in UK Respiratory Online Health Communities: Deep Learning–Based Sentiment Analysis %A Li,Xiancheng %A Vaghi,Emanuela %A Pasi,Gabriella %A Coulson,Neil S %A De Simoni,Anna %A Viviani,Marco %A , %+ School of Business and Management, Queen Mary University of London, Mile End Road, Bethnal Green, London, E14NS, United Kingdom, 44 2078825555, x.l.li@qmul.ac.uk %K social media %K online health communities %K social network analysis %K sentiment analysis %K bio-bidirectional encoder representations from transformers %K asthma %K chronic obstructive pulmonary disease %D 2025 %7 13.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Online health communities (OHCs) enable people with long-term conditions (LTCs) to exchange peer self-management experiential information, advice, and support. Engagement of “superusers,” that is, highly active users, plays a key role in holding together the community and ensuring an effective exchange of support and information. Further studies are needed to explore regular users’ interactions with superusers, their sentiments during interactions, and their ultimate impact on the self-management of LTCs. Objective: This study aims to gain a better understanding of sentiment distribution and the dynamic of sentiment of posts from 2 respiratory OHCs, focusing on regular users’ interaction with superusers. Methods: We conducted sentiment analysis on anonymized data from 2 UK respiratory OHCs hosted by Asthma UK (AUK), and the British Lung Foundation (BLF) charities between 2006-2016 and 2012-2016, respectively, using the Bio-Bidirectional Encoder Representation from Transformers (BioBERT), a pretrained language representation model. Given the scarcity of health-related labeled datasets, BioBERT was fine-tuned on the COVID-19 Twitter Dataset. Positive, neutral, and negative sentiments were categorized as 1, 0, and –1, respectively. The average sentiment of aggregated posts by regular users and superusers was then calculated. Superusers were identified based on a definition already used in our previous work (ie, “the 1% users with the largest number of posts over the observation period”) and VoteRank, (ie, users with the best spreading ability). Sentiment analyses of posts by superusers defined with both approaches were conducted for correlation. Results: The fine-tuned BioBERT model achieved an accuracy of 0.96. The sentiment of posts was predominantly positive (60% and 65% of overall posts in AUK and BLF, respectively), remaining stable over the years. Furthermore, there was a tendency for sentiment to become more positive over time. Overall, superusers tended to write shorter posts characterized by positive sentiment (63% and 67% of all posts in AUK and BLF, respectively). Superusers defined by posting activity or VoteRank largely overlapped (61% in AUK and 79% in BLF), showing that users who posted the most were also spreaders. Threads initiated by superusers typically encouraged regular users to reply with positive sentiments. Superusers tended to write positive replies in threads started by regular users whatever the type of sentiment of the starting post (ie, positive, neutral, or negative), compared to the replies by other regular users (62%, 51%, 61% versus 55%, 45%, 50% in AUK; 71%, 62%, 64% versus 65%, 56%, 57% in BLF, respectively; P<.001, except for neutral sentiment in AUK, where P=.36). Conclusions: Network and sentiment analyses provide insight into the key sustaining role of superusers in respiratory OHCs, showing they tend to write and trigger regular users’ posts characterized by positive sentiment. %M 39946690 %R 10.2196/56038 %U https://www.jmir.org/2025/1/e56038 %U https://doi.org/10.2196/56038 %U http://www.ncbi.nlm.nih.gov/pubmed/39946690 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 8 %N %P e60652 %T Uncovering Specific Navigation Patterns by Assessing User Engagement of People With Dementia and Family Caregivers With an Advance Care Planning Website: Quantitative Analysis of Web Log Data %A Dupont,Charlèss %A Smets,Tinne %A Potts,Courtney %A Monnet,Fanny %A Pivodic,Lara %A De Vleminck,Aline %A Van Audenhove,Chantal %A Mulvenna,Maurice %A Van den Block,Lieve %K dementia %K advance care planning %K user engagement %K web-based tool %K care %K website %K caregiver %K communication %K tool %K online %D 2025 %7 11.2.2025 %9 %J JMIR Aging %G English %X Background: Web-based tools have gained popularity to inform and empower individuals in advance care planning. We have developed an interactive website tailored to the unique needs of people with dementia and their families to support advance care planning. This website aims to break away from the rigid pathways shown in other tools that support advance care planning, in which advance care planning is shown as a linear process from information to reflection, communication, and documentation. Objective: This study aimed to assess the website’s usage by people with dementia and their family caregivers, identify distinct user engagement patterns, and visualize how users navigated the website. Methods: We analyzed the website’s log data obtained from an 8-week evaluation study of the site. Interactions with the website were collected in log data files and included visited web pages or clicked-on hyperlinks. Distinct user engagement patterns were identified using K-means clustering process mining, a technique that extracts insights from log data to model and visualize workflows, was applied to visualize user pathways through the website. Results: A total of 52 participants, 21 individuals with dementia and their family caregivers as dyads and 10 family caregivers were included in the study. Throughout the 8-week study, users spent an average of 35.3 (SD 82.9) minutes over 5.5 (SD 3.4) unique days on the website. Family caregivers mostly used the website (alone or with a person with dementia) throughout the 8-week study. Only 3 people with dementia used it on their own. In total, 3 distinct engagement patterns emerged: low, moderate, and high. Low-engagement participants spent less time on the website during the 8 weeks, following a linear path from information to communication to documentation. Moderate- and high-engagement users showed more dynamic patterns, frequently navigating between information pages and communication tools to facilitate exploration of aspects related to advance care planning. Conclusions: The diverse engagement patterns underscore the need for personalized support in advance care planning and challenge the conventional linear advance care planning representations found in other web-based tools. %R 10.2196/60652 %U https://aging.jmir.org/2025/1/e60652 %U https://doi.org/10.2196/60652 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e67263 %T Development of a Web-Based Intervention for Middle Managers to Enhance Resilience at the Individual, Team, and Organizational Levels in Health Care Systems: Multiphase Study %A Gil-Hernández,Eva %A Carrillo,Irene %A Martin-Delgado,Jimmy %A García-Torres,Daniel %A Mira,José Joaquín %+ Health Psychology Department, Universidad Miguel Hernández, Avinguda de la Universitat d'Elx, Elche, 03202, Spain, 34 966658984, jose.mira@umh.es %K resilience %K health care professionals %K web-based intervention %K middle management %K well-being %K patient safety %D 2025 %7 5.2.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Health care institutions face high systemic risk due to the inherent uncertainty and complexity of their operations. This often leads to stressful incidents impacting the well-being of health care professionals, which can compromise the effectiveness of health care systems. Enhancing resilience among health care professionals is essential for maintaining high-quality care and ensuring patient safety. The role of middle managers is essential to ensure the response capacity of individuals and teams. Objective: This study aims to develop a web-based intervention aimed at middle management to enhance individual, team, and organizational resilience. Methods: An observational study was conducted in 3 phases: design, validation, and pilot study. The study was initiated in February 2022 and concluded in June 2023. Phase 1 involved designing the content for the web-based tool based on a comprehensive review of critical elements around resilience. Phase 2 included validation by an international panel of experts who reviewed the tool and rated it according to a structured grid. They were also encouraged to highlight strengths and areas for improvement. Phase 3 involved piloting the tool with health care professionals in Ecuador to refine the platform and assess its effectiveness. A total of 458 people were invited to participate through the Institutional Course on Continuous Improvement in Health Care Quality and Safety offered by the Ministry of Public Health of Ecuador. Results: The tool, eResiliencia, was structured into 2 main blocks: individual and team resilience and organizational resilience. It included videos, images, PDFs, and links to dynamic graphics and additional texts. Furthermore, 13 (65%) of the 20 experts validated the tool, rating content clarity at an average of 4.5 (SD 0.7) and utility at an average of 4.7 (SD 0.5) out of 5. The average overall satisfaction was 9.3 (SD 0.6) out of 10 points, and feedback on improvements was implemented. A total of 362 health care professionals began the intervention, of which 218 (60.2%) completed preintervention and postintervention questionnaires, with significant knowledge increases (P<.001). Of the 362 health care professionals, 146 (40.3%) completed the satisfaction questionnaire, where overall satisfaction was rated at an average of 9.4 (SD 1.1) out of 10 points. Conclusions: The eResiliencia web-based platform provides middle managers with resources to enhance resilience among their teams and their components, promoting better well-being and performance, even under highly stressful events. Future research should focus on long-term impacts and practical applications in diverse clinical settings. %M 39908547 %R 10.2196/67263 %U https://humanfactors.jmir.org/2025/1/e67263 %U https://doi.org/10.2196/67263 %U http://www.ncbi.nlm.nih.gov/pubmed/39908547 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e53188 %T Latinx and White Adolescents’ Preferences for Latinx-Targeted Celebrity and Noncelebrity Food Advertisements: Experimental Survey Study %A Bragg,Marie A %A Lutfeali,Samina %A Gabler,Daniela Godoy %A Quintana Licona,Diego A %A Harris,Jennifer L %+ Department of Population Health, NYU Grossman School of Medicine, 180 Madison Avenue, New York, NY, 10016, United States, 1 6465012717, marie.bragg@nyulangone.org %K Latinx %K Hispanic %K adolescents %K marketing %K celebrities %K Spanish %K advertisements %K products %K brands %K food %K unhealthy %K beverages %K diet %K nutrition %K consumers %K intention %K purchasing %K attitudes %K perceptions %K preferences %K youth %D 2025 %7 31.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Exposure to food advertisements is a major driver of childhood obesity, and food companies disproportionately target Latinx youth with their least healthy products. This study assessed the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents. Objective: This web-based within-subjects study aims to assess the effects of food and beverage advertisements featuring Latinx celebrities versus Latinx noncelebrities on Latinx and White adolescents’ preferences for the advertisements and featured products. Methods: Participants (N=903) were selected from a volunteer sample of adolescents, aged 13-17 years, who self-identified as Latinx or White, had daily internet access, and could read and write in English. They participated in a web-based Qualtrics study where each participant viewed 8 advertisements for novel foods and beverages, including 4 advertisements that featured Latinx celebrities and the same 4 advertisements that featured Latinx noncelebrities (matched on all other attributes), in addition to 2 neutral advertisements (featuring bland, nontargeted products and did not feature people). Primary outcomes were participants’ ratings of 4 advertisements for food and beverage brands featuring a Latinx celebrity and the same 4 advertisements featuring a Latinx noncelebrity. Multilevel linear regression models compared the effects of celebrities and differences between Latinx and White participants on attitudes (advertisement likeability; positive affect; and brand perceptions) and behavioral intentions (consumption; social media engagement—“liking;” following; commenting; tagging a friend). Results: Latinx (n=436; 48.3%) and White (n=467; 51.7%) participants rated advertisements featuring Latinx celebrities more positively than advertisements featuring noncelebrities on attitude measures except negative affect (Ps≤.002), whereas only negative affect differed between Latinx and White participants. Two of the 5 behavioral intention measures differed by celebrity advertisement status (P=.02; P<.001). Additionally, the interaction between celebrity and participant ethnicity was significant for 4 behavioral intentions; Latinx, but not White, participants reported higher willingness to consume the product (P<.001), follow brands (P<.001), and tag friends (P<.001). While White and Latinx adolescents both reported higher likelihoods of “liking” advertisements on social media endorsed by Latinx celebrities versus noncelebrities, the effect was significantly larger among Latinx adolescents (P<.01). Conclusions: This study demonstrates the power of Latinx celebrities in appealing to both Latinx and White adolescents but may be particularly persuasive in shaping behavioral intentions among Latinx adolescents. These findings suggest an urgent need to reduce celebrity endorsements in ethnically targeted advertisements that promote unhealthy food products to communities disproportionately affected by obesity and diabetes. The food industry limits food advertising to children ages 12 years and younger, but industry self-regulatory efforts and policies should expand to include adolescents and address disproportionate marketing of unhealthy food to Latinx youth and celebrity endorsements of unhealthy products. %M 39889276 %R 10.2196/53188 %U https://www.jmir.org/2025/1/e53188 %U https://doi.org/10.2196/53188 %U http://www.ncbi.nlm.nih.gov/pubmed/39889276 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e56941 %T Evaluating the Acceptance and Usability of an Independent, Noncommercial Search Engine for Medical Information: Cross-Sectional Questionnaire Study and User Behavior Tracking Analysis %A Specht,Lisa %A Scheible,Raphael %A Boeker,Martin %A Farin-Glattacker,Erik %A Kampel,Nikolas %A Schmölz,Marina %A Schöpf-Lazzarino,Andrea %A Schulz,Stefan %A Schlett,Christian %A Thomczyk,Fabian %A Voigt-Radloff,Sebastian %A Wegner,Constanze %A Wollmann,Katharina %A Maun,Andy %+ Institute of General Practice, Faculty of Medicine and Medical Center, University of Freiburg, Elsässer Straße 2m, Freiburg, 79110, Germany, 49 761 270 72490, lisa.specht@uniklinik-freiburg.de %K medical information %K health information %K search engine %K user behavior %K health literacy %K digital health literacy %K navigational needs %K information-seeking behavior %K evidence-based content %K Germany %D 2025 %7 23.1.2025 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The internet is a key source of health information, but the quality of content from popular search engines varies, posing challenges for users—especially those with low health or digital health literacy. To address this, the “tala-med” search engine was developed in 2020 to provide access to high-quality, evidence-based content. It prioritizes German health websites based on trustworthiness, recency, user-friendliness, and comprehensibility, offering category-based filters while ensuring privacy by avoiding data collection and advertisements. Objective: This study aims to evaluate the acceptance and usability of this independent, noncommercial search engine from the users’ perspectives and their actual use of the search engine. Methods: For the questionnaire study, a cross-sectional study design was used. In total, 802 participants were recruited through a web-based panel and were asked to interact with the new search engine before completing a web-based questionnaire. Descriptive statistics and multiple regression analyses were used to assess participants’ acceptance and usability ratings, as well as predictors of acceptance. Furthermore, from October 2020 to June 2021, we used the open-source web analytics platform Matomo to collect behavior-tracking data from consenting users of the search engine. Results: The study indicated positive findings on the acceptance and usability of the search engine, with more than half of the participants willing to reuse (465/802, 58%) and recommend it (507/802, 63.2%). Of the 802 users, 747 (93.1%) valued the absence of advertising. Furthermore, 92.3% (518/561), 93.9% (553/589), 94.7% (567/599), and 96.5% (600/622) of those users who used the filters agreed at least partially that the filter functions were helpful in finding trustworthy, recent, user-friendly, or comprehensible results. Participants criticized some of the search results regarding the selection of domains and shared ideas for potential improvements (eg, for a clearer design). Regression analyses showed that the search engine was especially well accepted among older users, frequent internet users, and those with lower educational levels, indicating an effective targeting of segments of the population with lower health literacy and digital health literacy. Tracking data analysis revealed 1631 sessions, comprising 3090 searches across 1984 unique terms. Users performed 1.64 (SD 1.31) searches per visit on average. They prioritized the search terms “corona,” “back pain,” and “cough.” Filter changes were common, especially for recency and trustworthiness, reflecting the importance that users placed on these criteria. Conclusions: User questionnaires and behavior tracking showed the platform was well received, particularly by older and less educated users, especially for its advertisement-free design and filtering system. While feedback highlighted areas for improvement in design and filter functionality, the search engine’s focus on transparency, evidence-based content, and user privacy shows promise in addressing health literacy and navigational needs. Future updates and research will further refine its effectiveness and impact on promoting access to quality health information. %M 39847765 %R 10.2196/56941 %U https://humanfactors.jmir.org/2025/1/e56941 %U https://doi.org/10.2196/56941 %U http://www.ncbi.nlm.nih.gov/pubmed/39847765 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58128 %T Testing an Electronic Patient-Reported Outcome Platform in the Context of Traumatic Brain Injury: PRiORiTy Usability Study %A McMullan,Christel %A Turner,Grace %A Retzer,Ameeta %A Belli,Antonio %A Davies,Elin Haf %A Nice,Laura %A Flavell,Luke %A Flavell,Jackie %A Calvert,Melanie %K usability study %K usability %K patient reported outcome %K PRO %K electronic patient reported outcome %K ePRO %K traumatic brain injury %K TBI %K think aloud %K cognitive interviews %K early warning %K early detection %K mobile phone %D 2025 %7 23.1.2025 %9 %J JMIR Form Res %G English %X Background: Traumatic brain injury (TBI) is a significant public health issue and a leading cause of death and disability globally. Advances in clinical care have improved survival rates, leading to a growing population living with long-term effects of TBI, which can impact physical, cognitive, and emotional health. These effects often require continuous management and individualized care. Traditional paper-based assessments can be cumbersome, potentially impeding regular monitoring of patient-reported outcomes (PROs). Electronic PROs (ePROs) offer a promising alternative by enabling real-time symptom tracking, which can facilitate early identification of issues, support shared decision-making, and improve outcomes for patients with TBI. Objective: This study evaluates the usability of an ePRO platform—Atom5—for individuals with TBI. By analyzing how patients use the system to report their symptoms, the study aims to identify usability issues, assess user satisfaction, and determine the potential of Atom5 to support ongoing patient-centered care. Methods: Atom5 was customized to enable individuals with TBI to report their symptoms. Usability testing was conducted through one-on-one sessions with participants recruited from Headway UK—an organization supporting brain injury survivors. Each participant took part in cognitive interviews using with the “Think Aloud” method, encouraging them to verbalize their thoughts and experiences while using the platform. This approach provided qualitative insights into areas of difficulty, usability strengths, and accessibility barriers. User satisfaction was quantitatively assessed with a brief 4-item questionnaire based on the System Usability Scale. Usability outcomes were analyzed for critical and noncritical errors, focusing on user experience and overall satisfaction. Results: In total, 9 participants completed a single usability testing session using Atom5, including 4 men, 4 women, and 1 nonbinary individual; 4 participants were under 55 years old, and 6 had their TBI <10 years ago. Finally, 8 participants used an Android device. The platform included measures for anxiety (Generalized Anxiety Disorder-2 item), depression (Patient Health Questionnaire-2), posttraumatic stress disorder (Posttraumatic Stress Disorder checklist 2), and TBI-specific quality of life (Traumatic Brain Injury – Quality of Life Short form) and a total of 26 questions. Overall, all participants were satisfied with the system, noting that it was easy to navigate and accessible despite difficulties in understanding some questions. Further, 6 participants encountered no errors, while 1 participant reported one critical error and 2 others reported one noncritical error each. The participants rated their overall satisfaction with the platform at an average score of 3.9 (SD 0.49) out of 5. Conclusions: This usability study suggests that individuals living with TBI can effectively report symptoms using the Atom5 ePRO platform, with generally high satisfaction and few usability issues, thereby enabling continuous monitoring and proactive symptom management. Future ePRO development should focus on inclusivity and adaptability to address the diverse needs of patients with TBI, ensuring these tools can effectively support a wide range of users. %R 10.2196/58128 %U https://formative.jmir.org/2025/1/e58128 %U https://doi.org/10.2196/58128 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60868 %T Use of Go-Beyond as a Self-Directed Internet-Based Program Supporting Veterans’ Transition to Civilian Life: Preliminary Usability Study %A Alichniewicz,Karolina Katarzyna %A Hampton,Sarah %A Romaniuk,Madeline %A Bennett,Darcy %A Guindalini,Camila %+ Greenslopes Private Hospital, Gallipoli Medical Research, Newdegate Street, Greenslopes, Brisbane, QLD 4120, Australia, 61 7 33947613, alichniewiczkarolina@gallipoliresearch.org.au %K military transition %K web-based interventions %K military-civilian adjustment %K Go-Beyond %K internet-based program %K civilian %K military service %K veteran %K premilitary life %K mental health issues %K physical injuries %K adoption %K quantitative analysis %K survey %K family %K support %K digital technology %K user engagement %K effectiveness %K assessment %D 2025 %7 23.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: The transition from military service to civilian life presents a variety of challenges for veterans, influenced by individual factors such as premilitary life, length of service, and deployment history. Mental health issues, physical injuries, difficulties in relationships, and identity loss compound the reintegration process. To address these challenges, various face-to-face and internet-based programs are available yet underused. This paper presents the preliminary evaluation of “Go-Beyond, Navigating Life Beyond Service,” an internet-based psychoeducational program for veterans. Objective: The study aims to identify the reach, adoption, and engagement with the program and to generate future recommendations to enhance its overall impact. Methods: This study exclusively used data that were automatically and routinely collected from the start of the Go-Beyond program’s launch on May 24, 2021, until May 7, 2023. When accessing the Go-Beyond website, veterans were asked to complete the Military-Civilian Adjustment and Reintegration Measure (M-CARM) questionnaire, which produces a unique M-CARM profile of results specifying potential areas of need on the 5 domains of the measure. Users were then automatically allocated to Go-Beyond modules that aligned with their M-CARM profile. Additionally, quantitative and qualitative data were collected from a survey on aesthetics, interactivity, user journey, and user experience, which was optional for users to complete at the end of each module. Results: Results show a conversion rate of 28.5% (273/959) from the M-CARM survey to the Go-Beyond program. This rate is notably higher compared with similar internet-based self-help programs, such as VetChange (1033/22,087, 4.7%) and resources for gambling behavior (5652/8083, 14%), but lower than the MoodGYM program (82,159/194,840, 42.2%). However, these comparisons should be interpreted with caution due to the limited availability of published conversion rates and varying definitions of uptake and adoption across studies. Additionally, individuals were 1.64 (95% CI 1.17-2.28) more likely to enroll when they express a need in Purpose and Connection, and they were 1.50 (95% CI 1.06-2.18) times more likely to enroll when they express the need Beliefs About Civilians, compared with those without these needs. The overall completion rate for the program was 31% (85/273) and modules’ individual completion rates varied from 8.4% (17/203) to 20% (41/206). Feedback survey revealed high overall user satisfaction with Go-Beyond, emphasizing its engaging content and user-friendly modules. Notably, 94% (88/94) of survey respondents indicated they would recommend the program to other veterans, family, or friends. Conclusions: The Go-Beyond program may offer promising support for veterans transitioning to civilian life through digital technology. Our study reveals insights on user engagement and adoption, emphasizing the need for ongoing evaluation to further address the diverse needs of military personnel. Future research should explore predictors of engagement, the addition of peer or facilitator support, and the use of outcome measures for effectiveness assessment. %M 39847427 %R 10.2196/60868 %U https://formative.jmir.org/2025/1/e60868 %U https://doi.org/10.2196/60868 %U http://www.ncbi.nlm.nih.gov/pubmed/39847427 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e53456 %T Leveraging Smart Telemedicine Technology to Enhance Nursing Care Satisfaction and Revolutionize COVID-19 Care: Prospective Cohort Study %A Chang,You-Lung %A Lin,Chi-Ying %A Hsu,Jiun %A Liao,Sui-Ling %A Yu,Chun-Ti %A Peng,Hung-Chueh %A Chen,Chung-Yu %A Ma,Matthew Huei-Ming %A Hwang,Juey-Jen %K COVID-19 %K telemedicine %K smart home care %K intelligent medical care %K nursing care %K medical care %K remote monitoring %K vital signs %K quarantine %K home-care %K hospital-care %K screening %K treatment %K mHealth %K mobile health %K digital health %K health education %K remote equipment %K smartphone %K video consultation %K remote care %K caregiver %K patient %K quality of care %K medical staff %D 2025 %7 21.1.2025 %9 %J JMIR Hum Factors %G English %X Background: Telemedicine has been utilized in the care of patients with COVID-19, allowing real-time remote monitoring of vital signs. This technology reduces the risk of transmission while providing high-quality care to both self-quarantined patients with mild symptoms and critically ill patients in hospitals. Objective: This study aims to investigate the application of telemedicine technology in the care of patients with COVID-19, specifically focusing on usability, effectiveness, and patient outcomes in both home isolation and hospital ward settings. Methods: The study was conducted between January 2022 and December 2022. More than 800 cases were monitored using the QOCA remote home care system, a telemedicine platform that enables remote monitoring of physiological data—including heart rate, blood pressure, temperature, and oxygen levels—through Internet of Things devices and a 4G-connected tablet. Of these, 27 patients participated in thie study: the QOCA remote home care system was deployed 36 times in the isolation ward and 21 times to those in home isolation. The QOCA remote care system monitored isolated cases through remote care packages and a 4G tablet. Case managers and physicians provided telemedicine appointments and medications. Innovative methods were developed to enhance usage, including online health education, remote care equipment instructions via QR core links, and video consultations for patients without smartphones. Results: A clinical nurse satisfaction survey revealed that most respondents found the content of the remote care package comprehensive and the interface easy to learn. They expressed a desire to continue using the system. The majority also agreed that using the remote care system and package would reduce their workload and that patients and caregivers could easily learn to use the package. While some respondents expressed concerns about network and Bluetooth connectivity, the majority (24/27, 89%) agreed to include the remote device as part of their routine equipment, with an average score of 84.8 points. Conclusions: The integration of telemedicine technology improves the quality of care while reducing the workload and exposure of health care workers to viruses. %R 10.2196/53456 %U https://humanfactors.jmir.org/2025/1/e53456 %U https://doi.org/10.2196/53456 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58265 %T A Mindfulness-Based App Intervention for Pregnant Women: Qualitative Evaluation of a Prototype Using Multiple Case Studies %A Rizzi,Silvia %A Pavesi,Maria Chiara %A Moser,Alessia %A Paolazzi,Francesca %A Marchesoni,Michele %A Poggianella,Stefania %A Gadotti,Erik %A Forti,Stefano %+ Digital Health Research, Centre for Digital Health & Wellbeing, Fondazione Bruno Kessler, Via Sommarive 18, Trento, 38123, Italy, 39 0461312415, srizzi@fbk.eu %K mindfulness %K promoting well-being %K pregnancy %K eHealth %K mHealth %K mobile apps %K development %K usability %K user-centered design %K well-being %K maternal health %K digital health %K intervention %K design %K preliminary testing %K technology-based %K interview %K multidisciplinary approach %K mother %K women %K WhatsApp %K email %K midwife %D 2025 %7 17.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Pregnancy is a complex period characterized by significant transformations. How a woman adapts to these changes can affect her quality of life and psychological well-being. Recently developed digital solutions have assumed a crucial role in supporting the psychological well-being of pregnant women. However, these tools have mainly been developed for women who already present clinically relevant psychological symptoms or mental disorders. Objective: This study aimed to develop a mindfulness-based well-being intervention for all pregnant women that can be delivered electronically and guided by an online assistant with wide reach and dissemination. This paper aimed to describe a prototype technology-based mindfulness intervention’s design and development process for pregnant women, including the exploration phase, intervention content development, and iterative software development (including design, development, and formative evaluation of paper and low-fidelity prototypes). Methods: Design and development processes were iterative and performed in close collaboration with key stakeholders (N=15), domain experts including mindfulness experts (n=2), communication experts (n=2), and psychologists (n=3), and target users including pregnant women (n=2), mothers with young children (n=2), and midwives (n=4). User-centered and service design methods, such as interviews and usability testing, were included to ensure user involvement in each phase. Domain experts evaluated a paper prototype, while target users evaluated a low-fidelity prototype. Intervention content was developed by psychologists and mindfulness experts based on the Mindfulness-Based Childbirth and Parenting program and adjusted to an electronic format through multiple iterations with stakeholders. Results: An 8-session intervention in a prototype electronic format using text, audio, video, and images was designed. In general, the prototypes were evaluated positively by the users involved. The questionnaires showed that domain experts, for instance, positively evaluated chatbot-related aspects such as empathy and comprehensibility of the terms used and rated the mindfulness traces present as supportive and functional. The target users found the content interesting and clear. However, both parties regarded the listening as not fully active. In addition, the interviews made it possible to pick up useful suggestions in order to refine the intervention. Domain experts suggested incorporating auditory components alongside textual content or substituting text entirely with auditory or audiovisual formats. Debate surrounded the inclusion of background music in mindfulness exercises, with opinions divided on its potential to either distract or aid in engagement. The target users proposed to supplement the app with some face-to-face meetings at crucial moments of the course, such as the beginning and the end. Conclusions: This study illustrates how user-centered and service designs can be applied to identify and incorporate essential stakeholder aspects in the design and development process. Combined with evidence-based concepts, this process facilitated the development of a mindfulness intervention designed for the end users, in this case, pregnant women. %M 39625414 %R 10.2196/58265 %U https://formative.jmir.org/2025/1/e58265 %U https://doi.org/10.2196/58265 %U http://www.ncbi.nlm.nih.gov/pubmed/39625414 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 12 %N %P e59181 %T The MyGuide Web-Based Self-Management Tool for Concussion Rehabilitation: Mixed Methods Cross-Sectional Study %A Turcott,Alyssa %A Kang,Ruthine %A Yao,Christopher %A O'Melinn,Colleen %A Mahoney,Patricia %A Barlow,Susan %A Schmidt,Julia %+ Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health, G.F. Strong Rehabilitation Centre, 4255 Laurel St., Vancouver, BC, V5Z2G9, Canada, 1 604 737 6311, julia.schmidt@ubc.ca %K concussion %K self-management %K health information technology %K perceptions %K concussion recovery %K concussion management %K concussion rehabilitation %K rehabilitation %K self-management tool %K perception %K digital health %K e-health %K mobile app %K mhealth %K web-based tool %D 2025 %7 7.1.2025 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Web-based concussion self-management education programs for adolescents can improve functional outcomes, reduce concussion symptoms, and increase self-efficacy. However, there are a limited number of studies examining the perceptions and acceptance of these programs and the use of these tools in the adult concussion population. Objective: This study aimed to investigate the perceptions and acceptance of clinicians and adults with concussions using MyGuide Concussion (Vancouver Coastal Health), a web-based concussion self-management tool. Methods: Using a mixed methods sequential explanatory design, a convenience sample of 8 adults with concussions and 8 clinicians who used MyGuide Concussion over a 2-year period were interviewed, and their responses were analyzed. Results: Participants reported two key benefits of using the web-based self-management tool: (1) the tool’s emphasis on the interconnectedness of physical and psychological symptoms, and (2) the ability to provide reassurance that symptom being experienced were a normal part of the concussion experience. Clinicians described the tool as being useful as a supplementary source of information for clients in addition to clinical sessions and believed the content was useful for increasing clients’ independence in managing their own recovery. Conclusions: Overall, the evaluation of the MyGuide tool is an acceptable and well-perceived tool for adults with concussions who require a basic understanding of concussion recovery, particularly in the early stages of recovery. Future research may include optimizing MyGuide by targeting promotional strategies and addressing other barriers to use. %M 39773679 %R 10.2196/59181 %U https://rehab.jmir.org/2025/1/e59181 %U https://doi.org/10.2196/59181 %U http://www.ncbi.nlm.nih.gov/pubmed/39773679 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e53057 %T Gender-Inclusive Language in Public-Facing Labor and Delivery Web Pages in the New York Tristate Area: Cross-Sectional Study %A Isaac,Sarah Mohsen %A Dawes,Mark %A Howell,Emily Ruth %A Oladipo,Antonia Francis %K OBGYN %K transgender %K nonbinary %K pregnancy %K maternity %K transmasculine %K observational study %K gestational %K perinatal care %K communication %K labor %K USA %K United States %K New York City %K sexual orientation %K inclusion %K parents %K obstetrician gynecologist %K delivery %D 2025 %7 6.1.2025 %9 %J JMIR Hum Factors %G English %X Background: Transgender and nonbinary (TGNB) individuals are increasingly intentionally becoming pregnant to raise children, and hospital websites should reflect these trends. For prospective TGNB parents, a hospital website is the only way they can assess their safety from discrimination while receiving perinatal care. Cisnormativity enforced by communication gaps between medical institutions and TGNB patients can and has caused delays in receiving urgent care during their pregnancy. Objective: The aim of this study was to evaluate the current prevalence of gender-inclusive terminology among labor and delivery services in the New York tristate area. Methods: The labor and delivery web pages of 189 hospitals from New York, New Jersey, and Connecticut were examined for gender-inclusive language. “Fully inclusive” websites explicitly acknowledged lesbian, gay, bisexual, transgender, queer, intersex, and asexual plus other gender- and sexual-oriented (LGBTQIA+) parents, “inclusive” websites did not use gendered terminology for parents, and “noninclusive” websites used gendered terms at least once in the text reviewed. The hospitals’ web pages were further stratified by Healthcare Equality Index scores and population classifications defined by the 2013 National Center for Health Statistics Urban-Rural classification given to the county that each hospital was located in. Results: Of the 300 hospital websites reviewed, only 189 websites met the criteria for inclusion. Overall, only 6.3% (n=12) of labor and delivery web pages were “inclusive” or “fully inclusive.” No geographic areas (P=.61) or Healthcare Equality Index scores (P=.81) were associated with inclusive or fully inclusive language. Conclusions: Hospitals need to use inclusive language to help TGNB people identify hospitals where their existence and needs are acknowledged and thus feel more comfortable in their transition to parenthood. %R 10.2196/53057 %U https://humanfactors.jmir.org/2025/1/e53057 %U https://doi.org/10.2196/53057 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60042 %T Factors Affecting Usability and Acceptability of an Online Platform Used by Caregivers in Child and Adolescent Mental Health Services: Mixed Methods Study %A Radley,Jessica %A Penhallow,Jessica %A Wickersham,Alice %A Morris,Anna %A Colling,Craig %A Downs,Johnny %K child mental health %K caregivers %K digital technology %K digital health %K technology use %K digital skill %K digital literacy %K digital divides %K online systems %K online survey %K pediatric %K mental health %K usability %K platform %K survey %K questionnaire %K children %K youth %K adolescent %K informal care %K family care %K acceptability %K System Usability Scale %K SUS %K mobile phone %D 2024 %7 26.12.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Young people and families endure protracted waits for specialist mental health support in the United Kingdom. Staff shortages and limited resources have led many organizations to develop digital platforms to improve access to support. myHealthE is a digital platform used by families referred to Child and Adolescent Mental Health Services in South London. It was initially designed to improve the collection of routine outcome measures and subsequently the “virtual waiting room” module was added, which includes information about child and adolescent mental health as well as signposting to supportive services. However, little is known about the acceptability or use of digital resources, such as myHealthE, or about sociodemographic inequalities affecting access to these resources. Objective: This study aimed to assess the usability and acceptability of myHealthE as well as investigating whether any digital divides existed among its userbase in terms of sociodemographic characteristics. Methods: A survey was sent to all myHealthE users (N=7337) in May 2023. Caregivers were asked about their usage of myHealthE, their levels of comfort with technology and the internet. They completed the System Usability Scale and gave open-ended feedback on their experiences of using myHealthE. Results: A total of 680 caregivers responded, of whom 45% (n=306) were from a Black, Asian, or a minority ethnic background. Most (n=666, 98%) used a mobile phone to access myHealthE, and many had not accessed the platform’s full functionality, including the new “virtual waiting room” module. Household income was a significant predictor of caregivers’ levels of comfort using technology; caregivers were 13% more likely to be comfortable using technology with each increasing income bracket (adjusted odds ratio 1.13, 95% CI 1.00‐1.29). Themes generated from caregivers’ feedback highlight strengths of digital innovation as well as ideas for improvement, such as making digital platforms more personalized and tailored toward an individual’s needs. Conclusions: Technology can bring many benefits to health care; however, sole reliance on technology may result in many individuals being excluded. To enhance engagement, clinical services must ensure that digital platforms are mobile friendly, personalized, that users are alerted and directed to their full functionality, and that efforts are made to bridge digital divides. Enhancing dissemination practices and improving accessibility to informative resources on the internet is critical to provide fair access to all using Child and Adolescent Mental Health Services. %R 10.2196/60042 %U https://pediatrics.jmir.org/2024/1/e60042 %U https://doi.org/10.2196/60042 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e63334 %T Optimization of a Web-Based Self-Assessment Tool for Preconception Health in People of Reproductive Age in Australia: User Feedback and User-Experience Testing Study %A Dorney,Edwina %A Hammarberg,Karin %A Rodgers,Raymond %A Black,Kirsten I %K technology %K internet %K eHealth %K user experience %K patient engagement %K self-assessment tool %K preconception %K health communication %D 2024 %7 24.12.2024 %9 %J JMIR Hum Factors %G English %X Background: Good preconception health reduces the incidence of preventable morbidity and mortality for women, their babies, and future generations. In Australia, there is a need to increase health literacy and awareness about the importance of good preconception health. Digital health tools are a possible enabler to increase this awareness at a population level. The Healthy Conception Tool (HCT) is an existing web-based, preconception health self-assessment tool, that has been developed by academics and clinicians. Objective: This study aims to optimize the HCT and to seek user feedback to increase the engagement and impact of the tool. Methods: In-depth interviews were held with women and men aged 18‐41 years, who spoke and read English and were residing in Australia. Interview transcripts were analyzed, and findings were used to inform an enhanced HCT prototype. This prototype underwent user-experience testing and feedback from users to inform a final round of design changes to the tool. Results: A total of 20 women and 5 men were interviewed; all wanted a tool that was quick and easy to use with personalized results. Almost all participants were unfamiliar with the term “preconception care” and stated they would not have found this tool on the internet with its current title. User-experience testing with 6 women and 5 men identified 11 usability issues. These informed further changes to the tool’s title, the information on how to use the tool, and the presentation of results. Conclusions: Web-based self-assessment tools need to be easy to find and should communicate health messages effectively. End users’ feedback informed changes to improve the tool’s acceptability, engagement, and impact. We expect that the revised tool will have greater reach and prompt more people to prepare well for pregnancy. %R 10.2196/63334 %U https://humanfactors.jmir.org/2024/1/e63334 %U https://doi.org/10.2196/63334 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e58757 %T Parental Information-Use Strategies in a Digital Parenting Environment and Their Associations With Parental Social Support and Self-Efficacy: Cross-Sectional Study %A Onishi,Ryuta %+ Faculty of Nursing, Toyama Prefectural University, 2-2-78, Nishinagae, Toyama-shi, Toyama-ken, Japan, 81 76 464 5410, onishi.r1121@pu-toyama.ac.jp %K parenting %K information use %K digital society %K online information %K social support %K self-efficacy %K parents %K surveys %K information seeking %K information behaviors %K resources %K children %K youth %K pediatric %D 2024 %7 19.12.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: In today’s digital society, the acquisition of parenting information through online platforms such as social networking sites (SNSs) has become widespread. Amid the mix of online and offline information sources, there is a need to discover effective information-seeking methods for solving parenting problems. Objective: This study aimed to identify patterns of information use among parents of young children in the digital age and elucidate the characteristics of these patterns through a comparative analysis of parental social support and self-efficacy. Methods: An internet-based survey was administered to fathers and mothers of children aged 0-3 years. Convenience sampling, facilitated by an internet-based survey company, was adopted, and data from 227 fathers and 206 mothers were analyzed. The survey included questions on personal characteristics, frequency of use of different sources of parenting information (websites, SNSs, parenting apps, family, friends, and professionals), availability of parental social support, and parental self-efficacy. The Partitioning Around Medoids (PAM) clustering algorithm was used to identify patterns in parenting information use. Results: A total of 4 clusters were identified: multisource gatherers (n=161), offline-centric gatherers (n=105), online-centric gatherers (n=86), and minimal information gatherers (n=68). The availability of parental social support was perceived to be relatively higher among multisource and offline-centric gatherers compared with online-centric and minimal information gatherers. Parental self-efficacy was highest among multisource gatherers, followed by offline-centric and online-centric gatherers, and lowest among minimal information gatherers. Conclusions: This study contributes to the evidence that online information can effectively complement offline information in addressing parenting challenges, although its ability to fully replace offline sources remains limited. Parenting support professionals are encouraged to understand parents’ current information use strategies and actively foster their social relationships, helping them to adopt more diverse and comprehensive approaches to information use. %M 39700496 %R 10.2196/58757 %U https://pediatrics.jmir.org/2024/1/e58757 %U https://doi.org/10.2196/58757 %U http://www.ncbi.nlm.nih.gov/pubmed/39700496 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e64343 %T “Crying in the Wilderness”—The Use of Web-Based Support in Telomere Biology Disorders: Thematic Analysis %A Pearce,Emily Eidenier %A Majid,Alina %A Brown,Toniya %A Shepherd,Rowan Forbes %A Rising,Camella %A Wilsnack,Catherine %A Thompson,Ashley S %A Gilkey,Melissa B %A Ribisl,Kurt M %A Lazard,Allison J %A Han,Paul KJ %A Werner-Lin,Allison %A Hutson,Sadie P %A Savage,Sharon A %+ Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, 9609 Medical Center Drive, 6E578, Rockville, MD, 20850, United States, 1 919 699 2547, emily.pearce@nih.gov %K social media %K dyskeratosis congenita %K telomere biology disorder %K health communication %K qualitative %K thematic analysis %K web-based information %K web-based support %K telomere %K biology disorder %K social support %K emotional support %K genetic %K internet-based %K information-seeking %K descriptive study %K semistructured interview %K adult %K illness experience %K psychosocial %K digital health %K health intervention %K health informatics %D 2024 %7 16.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based information and social support are commonly used in rare disease communities where geographic dispersion and limited provider expertise complicate in-person support. We examined web-based resource use among caregivers of individuals with telomere biology disorders (TBDs), which are rare genetic conditions with long diagnostic odysseys and uncertain prognoses including multiorgan system cancer risk. Objective: This study explored internet-based information-seeking and social support practices and perspectives of patients with TBDs and their caregivers. Methods: Our qualitative descriptive study used semistructured interviews of patients with TBDs and caregivers. Data were transcribed verbatim and thematically analyzed by an interdisciplinary team. Results: A total of 32 adults completed interviews. Participant ages ranged from 27 to 74 years. The majority (n=28, 88%) were female, occupied multiple TBD roles (eg, patient and parent), and had undergone genetic testing. Most engaged in web-based information-seeking (n=29, 91%) and TBD-specific social media (n=26, 81%). Participants found web-based resources useful for information-seeking but reported privacy concerns and frustration with forming supportive relationships. Most participants described ambivalence toward web-based resource use, citing tensions between hunger for information versus distrust, empowerment versus overwhelm, disclosure versus privacy, and accessibility versus connection. Fluctuations in web-based support use arose from perceived harms, information saturation, or decreased relevance over the course of TBD illness experience. Conclusions: Individuals with TBDs and their caregivers reported frequent use of web-based informational and emotional support. However, ambivalence about the benefits and liabilities of web-based resources and persistent medical uncertainty may impact the adoption of and adherence to web-based support among patients with TBD and caregivers. Our findings suggest web-based psychosocial support should target long-term and multifaceted informational and emotional needs, be user-initiated, be offered alongside in-person formats, provide expert-informed information, and be attentive to personal privacy and evolving support needs of the TBD community. This study suggests web-based resources will be most effective in the TBD context when they achieve the following features: (1) offer a variety of ways to engage (eg, active and passive), (2) provide privacy protections in moderated “safe spaces” designed for personal disclosure, (3) offer separate venues for informational versus emotional support, (4) combine web-based relationship formation with opportunities for in-person gathering, (5) provide information that is reliable, easy to access, and informed by medical professionals, (6) remain mindful of user distress, and (7) are responsive to variations in levels and types of engagement. Additionally, advocacy organizations may wish to avoid traditional social media platforms when designing safe spaces for web-based emotional support, instead pivoting to internet-based tools that minimize privacy threats and limit the perpetual public availability of shared information. %M 39680438 %R 10.2196/64343 %U https://formative.jmir.org/2024/1/e64343 %U https://doi.org/10.2196/64343 %U http://www.ncbi.nlm.nih.gov/pubmed/39680438 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56567 %T Expanding a Health Technology Solution to Address Therapist Challenges in Implementing Homework With Adult Clients: Mixed Methods Study %A Bunnell,Brian E %A Schuler,Kaitlyn R %A Ivanova,Julia %A Flynn,Lea %A Barrera,Janelle F %A Niazi,Jasmine %A Turner,Dylan %A Welch,Brandon M %+ Department of Psychiatry and Behavioral Neurosciences, Morsani College of Medicine, University of South Florida, 3515 E Fletcher Ave, Tampa, FL, 33613-4706, United States, 1 8139748607, bbunnell@usf.edu %K mental health %K mental illness %K mental disease %K mental disorder %K homework %K homework challenge %K therapy %K therapist %K barriers %K adult client %K adult %K technology-based solution %K health technology %K digital health %K digital technology %K digital intervention %K mobile phone %D 2024 %7 12.12.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Homework is implemented with variable effectiveness in real-world therapy settings, indicating a need for innovative solutions to homework challenges. We developed Adhere.ly, a user-friendly, Health Insurance Portability and Accountability Act–compliant web-based platform to help therapists implement homework with youth clients and their caregivers. The initial version had limited functionality, was designed for youth clients and their caregivers, and required expanding available features and exercises to suit adult clients. Objective: The purpose of this study was to better understand barriers and potential solutions to homework implementation experienced by therapists seeing adult clients and obtain their input on new features and exercises that would enable Adhere.ly to better meet their needs when working with this population. Methods: This study used an exploratory, sequential mixed methods design that included 13 semistructured focus groups with mental health therapists and clinic leaders and a survey administered to 100 therapists. Analyses were performed using the NVivo qualitative analysis software and SPSS. Results: The findings revealed common barriers, such as clients and therapists being busy, forgetting to complete homework, managing multiple platforms and homework materials, and clients lacking motivation. Adhere.ly was perceived as a potential solution, particularly its user-friendly interface and SMS text-message based reminders. Therapists suggested integrating Adhere.ly with telemedicine and electronic health record platforms and adding more exercises to support manualized therapy protocols and therapy guides. Conclusions: This study highlights the importance of technology-based solutions in addressing barriers to homework implementation in mental health treatment with adult clients. Adhere.ly shows promise in addressing these challenges and has the potential to improve therapy efficiency and homework completion rates. The input from therapists informed the development of Adhere.ly, guiding the expansion of features and exercises to better meet the needs of therapists working with adult clients. %M 39665475 %R 10.2196/56567 %U https://humanfactors.jmir.org/2024/1/e56567 %U https://doi.org/10.2196/56567 %U http://www.ncbi.nlm.nih.gov/pubmed/39665475 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e58014 %T Delivering a Group-Based Quality of Life Intervention to Young Adult Cancer Survivors via a Web Platform: Feasibility Trial %A Fox,Rina S %A Torres,Tara K %A Badger,Terry A %A Katsanis,Emmanuel %A Yang,DerShung %A Sanford,Stacy D %A Victorson,David E %A Yanez,Betina %A Penedo,Frank J %A Antoni,Michael H %A Oswald,Laura B %K cancer survivors %K survivorship %K clinical trials %K psychosocial intervention %K usability testing %K digital therapeutics %K young adults %K nonrandomized %D 2024 %7 4.12.2024 %9 %J JMIR Cancer %G English %X Background: Young adult (YA) cancer survivors frequently report unmet health information and peer support needs, as well as poor health-related quality of life (HRQOL). YAs also have expressed a desire that behavioral interventions be convenient. In response to this, our team has developed a 10-week, group-based, supportive care intervention titled TOGETHER to improve YA cancer survivors’ HRQOL. TOGETHER is delivered via videoconference and has shown initial feasibility, acceptability, and promise for improving HRQOL among YA survivors. Objective: In an effort to increase convenience, the goal of this 2-part study was to design and test a website to host the TOGETHER intervention for YA cancer survivors aged 18‐39 years at the time of participation and aged 15‐39 years at the time of initial cancer diagnosis. Methods: In part 1, we leveraged an existing web-based platform and adapted it to meet the needs of TOGETHER. We conducted 3 iterative waves of usability testing with 3 YAs per wave to refine the website. In part 2, we conducted a single-group feasibility trial of TOGETHER using the website. Primary outcomes were feasibility (ie, recruitment, retention, and attendance) and acceptability (ie, satisfaction). Results: Usability testing participants (n=9) indicated that the TOGETHER website was easy to use (mean 5.9, SD 1.3) and easy to learn (mean 6.5, SD 0.9; possible ranges 1‐7). Qualitative feedback identified needed revisions to the aesthetics (eg, images), content (eg, session titles), function (eg, clarity of functionality), and structure (eg, expandable sections), which were implemented. In the feasibility trial, participants (n=7) were an average of 25 (SD 4.7) years old and mostly non-Hispanic White (n=4, 57%). Recruitment (58%) and retention (71%) rates and average session attendance (mean 7.1 , SD 4.2) supported feasibility. Participant agreement with positive statements about TOGETHER and average satisfaction ratings (mean 5.06, SD 1.64; possible range: 1‐7) demonstrated acceptability. Conclusions: Results supported the usability, feasibility, and acceptability of the TOGETHER program and website. By providing the content digitally, the program effectively addresses YAs’ expressed preference for convenience. Future studies are needed to increase TOGETHER’s efficiency and explore its efficacy for improving targeted outcomes. Trial Registration: NCT05597228, October 24, 2022; https://clinicaltrials.gov/study/NCT05597228 %R 10.2196/58014 %U https://cancer.jmir.org/2024/1/e58014 %U https://doi.org/10.2196/58014 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50664 %T Effectiveness of an Internet-Based Self-Help Acceptance and Commitment Therapy Program on Medical Students’ Mental Well-Being: Follow-Up Randomized Controlled Trial %A Wang,Difan %A Lin,Bingyan %A Zhang,Shuangxi %A Xu,Wei %A Liu,Xinying %+ Faculty of Psychology, Beijing Normal University, 19 Xinjiekouwai Street Haidian District, Beijing, 100875, China, 86 010 66939114, livingxw@163.com %K internet-delivered self-help acceptance and commitment therapy %K depression %K anxiety %K stress %K psychological inflexibility %K obsessive-compulsive symptoms %K medical students %K iACT 2.0 program %D 2024 %7 4.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Psychological distress is a growing problem among medical students worldwide. This highlights the need for psychological interventions to focus on mental health and improve well-being in this population. Objective: This study developed an internet-based, self-help, acceptance and commitment therapy program (iACT 2.0), aiming to examine its effectiveness in reducing depression, anxiety, stress, psychological inflexibility (PI), and obsessive-compulsive symptoms (OCSs) among medical students. Methods: A total of 520 Chinese postgraduate medical students were randomly assigned to either an iACT 2.0 intervention group (n=260; six online lessons, once every 5 days) or a control condition (n=260; without intervention). Participants completed questionnaires including the 21-item Depression Anxiety Stress Scale, the revised Obsessive-Compulsive Inventory, and the Multidimensional Psychological Flexibility Inventory at the preintervention (T1), postintervention (T2), and 1-month follow-up time points (T3). No therapist support was provided during the 1-month iACT 2.0 intervention period. Data were collected via an online platform and analyzed using repeated-measures ANOVA. Results: Participants in the intervention group demonstrated a significant decrease in depression, anxiety, stress, PI, and OCSs compared to the control group after the intervention (F=22.9-672.04, all P<.001). Specifically, the intervention group showed significant reductions in all measured outcomes from the preintervention to postintervention time point and at the 1-month follow-up (all P<.001). In contrast, no significant changes were observed in the control group over the same period (all P>.05). The groups did not differ significantly at baseline (all P>.05). Significant differences were noted at both the postintervention and follow-up time points (all P<.001). Conclusions: This study demonstrated that the newly developed iACT 2.0 was effective in reducing depression, anxiety, stress, PI, and OCSs. Notably, the positive effects of the intervention persisted at the 1-month follow-up. This program can offer a useful addition to existing mental illness treatment and lead to improvements in clinical and psychotherapy planning while simultaneously reducing the burden on traditional counseling and services. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300070725; https://tinyurl.com/2h75wx8n %M 39631061 %R 10.2196/50664 %U https://www.jmir.org/2024/1/e50664 %U https://doi.org/10.2196/50664 %U http://www.ncbi.nlm.nih.gov/pubmed/39631061 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e60050 %T Sentiment Dynamics Among Informal Caregivers in Web-Based Alzheimer Communities: Systematic Analysis of Emotional Support and Interaction Patterns %A Ni,Congning %A Song,Qingyuan %A Chen,Qingxia %A Song,Lijun %A Commiskey,Patricia %A Stratton,Lauren %A Malin,Bradley %A Yin,Zhijun %+ Department of Computer Science, Vanderbilt University, 2525 West End Avenue, Nashville, TN, 37203, United States, 1 6156381164, congning.ni@vanderbilt.edu %K informal caregivers %K Alzheimer disease %K dementias %K web-based community %K sentiment analysis %K topic modeling %K caregiving %K carers %K family care %K support group %K peer support %K gerontology %K geriatrics %K aging %K attitudes %K opinion %K perceptions %K perspectives %K sentiment %K cognitive %K web-based communities %K Linguistic Inquiry and Word Count %K machine learning %K Valence Aware Dictionary for Sentiment Reasoning %D 2024 %7 4.12.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Alzheimer disease and related dementias (ADRD) are a growing global health challenge. ADRD place significant physical, emotional, and financial burdens on informal caregivers and negatively affects their well-being. Web-based social media platforms have emerged as valuable sources of peer support for these caregivers. However, there has been limited investigation into how web-based peer support might influence their mental well-being. Objective: This study aims to examine the dynamics of sentiment scores, a major indicator of mental well-being, among informal ADRD caregivers, specifically how their sentiment changes as they participate in caregiving experience discussions within 2 ADRD web-based communities. Methods: We collected data from 2 large web-based ADRD caregiving communities, ALZConnected (from November 2011 to August 2022) and TalkingPoint (from March 2003 to November 2022). Using the Valence Aware Dictionary for Sentiment Reasoning and Linguistic Inquiry and Word Count, we calculated sentiment scores for each post and evaluated how the initial sentiment score of a topic initiator evolves within a discussion thread. Structured topic modeling and regression analysis were used to identify the primary topics consistently associated with sentiment changes within these threads. We investigated longitudinal sentiment trends to identify patterns of sentimental stability or enhancement due to prolonged engagement in web-based communities by plotting linear interpolation lines of the sentiment values of each individual user. Results: The ALZConnected dataset comprised 532,992 posts, consisting of 57,641 topic threads and 475,351 comments. The TalkingPoint dataset was composed of 846,344 posts, consisting of 81,068 topic threads and 765,276 comments. Our research revealed that topic initiators experienced a notable increase in sentiment as they engaged in subsequent discussions within their threads, with a significant uptick in positivity in the short term. This phenomenon is part of a broader trend of steadily rising positive sentiment among ADRD caregivers. Using structured topic modeling, we cataloged a diverse range of topics that included both emotional aspects, such as family emotions, and practical concerns, such as diagnosis and treatment and everyday care practices. We observed that sentiment scores were positively aligned with discussions about family and daily routines life (coefficient=3.53; P<.001), while topics related to illness (coefficient=–1.37; P<.001) and caregiving facilities (coefficient=–1.98; P<.001) tended to correlate with lower sentiment scores. This evidence highlights the significant impact that both the time of participation and the posting content have on the sentiment changes of caregivers. Conclusions: This study identifies sentiment changes among informal ADRD caregivers through their interactions in 2 extensive web-based communities. These findings emphasize the importance of early emotional support within a topic thread and demonstrate a predominantly positive sentiment in these communities over time. These further highlight the value of web-based peer support and its potential to enhance the emotional well-being of informal ADRD caregivers. %M 39630495 %R 10.2196/60050 %U https://aging.jmir.org/2024/1/e60050 %U https://doi.org/10.2196/60050 %U http://www.ncbi.nlm.nih.gov/pubmed/39630495 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e53440 %T Scope, Findability, and Quality of Information About Music-Based Interventions in Oncology: Quantitative Content Analysis of Public-Facing Websites at National Cancer Institute–Designated Cancer Centers %A Blank,Carol Ann %A Biedka,Sarah %A Montalmant,Abigail %A Saft,Katelyn %A Lape,Miranda %A Mao,Kate %A Bradt,Joke %A Liou,Kevin T %K music-based interventions %K cancer %K oncology %K symptom management %K music therapy %K music services %K National Cancer Institute %D 2024 %7 22.11.2024 %9 %J JMIR Cancer %G English %X Background: Music-based interventions (MBIs) are evidence-based, nonpharmacological treatments that include music therapy (MT) delivered by board-certified music therapists, as well as music services (MS) delivered by other health professionals and volunteers. Despite MBI’s growing evidence base in cancer symptom management, it remains unclear how MBI-related information is presented to the public. Over 80% of people with cancer use the internet to find health-related information. In the United States, the National Cancer Institute (NCI) identifies certain Cancer Centers (CCs) as NCI-designated CCs or Comprehensive Cancer Centers (CCCs) based on their excellence in research. As NCI-designated CCs and CCCs are considered the gold standard in cancer care, their websites are viewed by the public as important sources of information. Objective: We aimed to determine scope, findability, and quality of MBI-related information on public-facing websites of NCI-designated CCs/CCCs. Methods: We reviewed 64 NCI-designated CC/CCC websites (excluding basic laboratories) between November 2022 and January 2023. We extracted data on the scope of information: (1) type of MBI offered (MT or MS), (2) format (individual, group), (3) method of delivery (in person or remotely delivered), (4) setting (inpatient or outpatient), (5) target population (pediatric or adult), (6) MBI practitioner qualifications, (7) clinical indications or benefits, (8) presence of testimonials, (9) cost, and (10) scheduling or referral information. We also extracted data on findability (ie, presence of direct link or drop-down menu and the number of clicks to locate MBI-related information). Based on the scope and findability data, we rated the information quality as high, moderate, or low using an adapted scale informed by prior research. Results: Thirty-one (48%) of the 64 CC/CCCs described MBIs on their websites. Of these, 6 (19%) mentioned both MT and MS, 16 (52%) mentioned MT only, and 9 (29%) mentioned MS only. The most common format was hybrid, involving individuals and groups (n=20, 65%). The most common delivery method was in person (n=16, 52%). The most common target population was adults (n=12, 39%). The most common MBI practitioners were board-certified music therapists (n=21, 68%). The most described indications or benefits were psychological. Twenty-eight (90%) websites lacked testimonials, and 26 (84%) lacked cost information. Twenty-six (84%) websites provided scheduling or referral information. MBI-related information was found with an average of 4 (SD 1) clicks. Nine (29%) websites were of high quality, 18 (58%) were moderate, and 4 (13%) were low. Conclusions: Based on public websites, MBIs were most commonly delivered in person by board-certified music therapists to outpatient and inpatient adults, using individual and group formats to provide psychological benefits. The findability and quality of this information should be improved to promote the dissemination of MBIs for cancer symptom management. %R 10.2196/53440 %U https://cancer.jmir.org/2024/1/e53440 %U https://doi.org/10.2196/53440 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e64994 %T Indigenous Parents’ Perspectives of Factors That Facilitate or Impede Engagement in Internet-Based Parenting Support Programs: Interpretive Description Study %A Butt,Michelle L %A Willett,Ysabella Jayne %A Miller,Vicky %A Jacobs,Brenda %A Ferron,Era Mae %A Wright,Amy L %+ Lawrence Bloomberg Faculty of Nursing, University of Toronto, 155 College St, Toronto, ON, M5T 1P8, Canada, 1 416 978 0695, amyl.wright@utoronto.ca %K child %K parenting %K qualitative %K Indigenous health %K support programs %D 2024 %7 22.11.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Parenting support programs enhance parents’ health and their child’s development. The COVID-19 pandemic necessitated the delivery of these programs over the internet. After the pandemic, internet-based programs are still preferred by some. Objective: We aimed to understand Indigenous parents’ experiences engaging in internet-based parenting support programs; thus, an interpretive description study was conducted. Methods: A total of 20 Indigenous (female, male, and Two-Spirit) parents of children aged <5 years participated in semistructured interviews; data underwent collaborative thematic analysis with Indigenous community partners informed by the Two-Eyed Seeing framework and ethical space. Results: Parents’ experiences were classified into five themes: (1) Purpose: Program Delivery and Content, (2) Belonging: Building Relationships and Connections, (3) Hope: Cultural Connection, (4) Meaning: New or Improved Parenting Skills and Mental Wellness, and (5) Recommendations for Organizations. Conclusions: The study findings can inform internet-based parenting program delivery to enhance engagement for Indigenous families. %M 39576680 %R 10.2196/64994 %U https://pediatrics.jmir.org/2024/1/e64994 %U https://doi.org/10.2196/64994 %U http://www.ncbi.nlm.nih.gov/pubmed/39576680 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52883 %T Web-Based Intervention Using Self-Compassionate Writing to Induce Positive Mood in Family Caregivers of Older Adults: Quantitative Study %A Wiita,Farah %A Ho,Aileen K %A Weinstein,Netta %+ School of Psychology and Clinical Language Sciences, University of Reading, Earley Gate, Berkshire, RG6 6AL, United Kingdom, 44 7951506136, f.l.wiita@pgr.reading.ac.uk %K self-compassion %K caregivers %K mindfulness %K intervention %K writing %K experimental %D 2024 %7 21.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Caregiver burden can impact the mental health of family caregivers, but self-compassion may help reduce this impact. Brief self-compassion interventions have been shown to be useful but have not been tested in family caregivers of older adults. Objective: This study aimed to test the effects of a brief self-compassion intervention and its components (self-kindness, common humanity, and mindfulness) on mental well-being and mood when reflecting on difficult family caregiving experiences. Methods: British caregivers were recruited through a web-based panel. Three experimental studies manipulated the self-compassion intervention. In study 1 (n=206) and study 2 (n=224), participants wrote about a difficult caregiving experience while focusing on 1 self-compassion component (self-kindness, common humanity, or mindfulness). In study 3 (n=222) participants focused on all components. Self-compassion, serenity, guilt, and sadness were measured. Results: In studies 1 and 2, condition effects showed mindfulness unexpectedly lowered mood. Inconsistent and modest benefits to affect were achieved by engagement in self-kindness and common humanity in study 1 (guilt [lowered]: P=.02 and sadness [lowered]: P=.04; serenity [nonsignificantly raised]: P=.20) and also in study 2 (sadness [nonsignificantly lowered]: P=.23 and guilt [nonsignificantly lowered]: P=.26; serenity [raised]: P=.33); significant benefits for self-compassion and mood were found in study 3 (serenity [raised]: P=.01, kindness [raised]: P=.003, and common humanity [raised]: P≤.001; guilt [lowered]: P<.001 and sadness [lowered]: P≤.001). More intensive efforts should be made to promote self-compassion in caregivers of older adults, with caution advised when relying primarily on mindfulness approaches. Conclusions: Self-compassionate writing may be beneficial for family caregivers, but more intensive interventions are needed. Further research is needed to determine the optimal dosage and content for achieving the greatest effects. %M 39571153 %R 10.2196/52883 %U https://formative.jmir.org/2024/1/e52883 %U https://doi.org/10.2196/52883 %U http://www.ncbi.nlm.nih.gov/pubmed/39571153 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54679 %T Development and Implementation of an Online Patient Education Program for Children and Adolescents With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Their Parents, Siblings, and School Personnel: Protocol for the Prospective BAYNET FOR ME/CFS Study %A Keicher,Franca %A Thomann,Julia %A Erlenwein,Jana %A Schottdorf,Mara %A Reiter,Nils Lennart %A Scholz-Schwärzler,Nadine Patricia %A Vogel,Barbara %A Warlitz,Cordula %A Stojanov,Silvia %A Augustin,Silvia %A Goldbrunner,Lola %A Schanz,Linda %A Dodel,Veronika %A Zipper,Charlotte %A Schiweck,Nicole %A Jaeschke,Robert %A Saramandic,Milica %A Wiejaczka,Karolina %A Eberhartinger,Maria %A Dettmer,Kristina %A Hattesohl,Daniel Bruno Ricardo %A Englbrecht,Stephanie %A Behrends,Uta %A Spiegler,Juliane %+ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Wuerzburg, Margarete-Höppel-Platz 1, Würzburg, 97080, Germany, 49 93120127769, Keicher_F1@ukw.de %K patient education %K ME/CFS %K children %K adolescents %K ModuS %K parents %K teachers %K siblings %K training %D 2024 %7 21.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) presents significant challenges for affected children and adolescents, their social environment, and treating physicians, due to its profound impact on quality of life and the lack of causal therapeutic approaches. One crucial aspect of care that has been missing for these patients is comprehensive education for both them and their social circles. Objective: This study protocol aims to outline the goals, study design, execution, and evaluation of the subproject within the BAYNET FOR ME/CFS project. The focus is on developing online education programs for children and adolescents with ME/CFS, as well as for their parents, siblings, and school staff. These programs are designed to improve independent disease management, increase knowledge, and promote interaction with other affected individuals. Methods: In phase I, the group-based online education programs were developed by a multidisciplinary team based on the ModuS concept created by the Competence Network for Patient Education (KomPaS). These programs were then piloted and finalized. Phase II involved recruiting participants and implementing the finalized programs. Given the restricted physical and cognitive capacities of the affected individuals, the patient education programs were exclusively designed in a digital format to facilitate participation. In phase III, the programs will be evaluated for acceptance, completeness, and participant satisfaction. The qualitative assessment will focus on individual expectations and benefits derived from the training. Phase IV will further assess the programs in terms of improvements in disease knowledge, health-related quality of life, life satisfaction, and family burden. Results: The programs were developed, piloted, and finalized during phase I, which ran from December 2022 to May 2023. The pilot phase, from March to May 2023, led to adaptations in the program concept. In total, 8 patients and their parents, 5 siblings, and 59 school staff participated in the piloting. Adjustments were made to the format, content, duration, and schedule to better meet the needs of the affected individuals and their social circles. In phase II, participant recruitment for the patient education program took place from January to July 2023. The study successfully recruited 24 young patients with ME/CFS and their parents, along with 8 siblings and 51 school staff. Two program blocks for patients and parents and 2-3 blocks for siblings and school staff commenced in May 2023 and were completed within the same year. Phase III began after phase II and involves the evaluation of the programs, with the process expected to conclude by the end of 2024. Phase IV, planned for 2025-2026, will involve the rollout of the program to 150 children and their caretakers. This phase will focus on evaluating disease knowledge, health-related quality of life, life satisfaction, and family burden, as well as include longitudinal assessments. Conclusions: The data aim to support the development of a comprehensive, interprofessional care model for children and adolescents with ME/CFS. International Registered Report Identifier (IRRID): DERR1-10.2196/54679 %M 39570662 %R 10.2196/54679 %U https://www.researchprotocols.org/2024/1/e54679 %U https://doi.org/10.2196/54679 %U http://www.ncbi.nlm.nih.gov/pubmed/39570662 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e59283 %T An Online Resource for Monitoring 24-Hour Activity in Children and Adolescents: Observational Analysis %A Loo,Benny Kai Guo %A Toh,Siao Hui %A Fadzully,Fadzlynn %A Zainuddin,Mohammad Ashik %A Abu Bakar,Muhammad Alif %A Gao,Joanne Shumin %A Teo,Jing Chun %A Lim,Ethel Jie Kai %A Tan,Beron Wei Zhong %A Chia,Michael Yong Hwa %A Chua,Terence Buan Kiong %A Tan,Kok Hian %K online %K physical activity %K sedentary behaviour %K sleep %K diet %K 24-hour activity %K child %K adolescent %D 2024 %7 18.11.2024 %9 %J JMIR Pediatr Parent %G English %X Background: The Singapore integrated 24-hour activity guide for children and adolescents was introduced to promote healthy lifestyle behaviors, including physical activity, sedentary behavior, sleep, and diet, to enhance metabolic health and prevent noncommunicable diseases. To support the dissemination and implementation of these recommendations, a user-friendly online resource was created to help children and adolescents adopt these behaviors in Singapore. Objective: This study aimed to assess the acceptability of the online resource in the adoption of healthier lifestyle behaviors, and the change in the users’ behaviors with the use of this online resource. Methods: Participants aged 7-17 years were required to log their activity levels of the past 7 days at the beginning and at the end of a 3-month period using the browser-based online resource, including information on the duration and frequency of moderate- to vigorous-intensity physical activity (MVPA), length of sedentary behavior, duration and regularity of sleep, and food portions. User satisfaction, on the length, ease of use, and relevance of the online resource, was also recorded using a 10-point Likert scale. Descriptive statistics and statistical analyses, including the Wilcoxon signed rank test and McNemar test, were carried out at baseline and at the end of 3 months. Results: A total of 46 participants were included for analysis. For physical activity, the number of days of MVPA increased from a median of 3 (IQR 2‐5) days to 4 (IQR 2‐5) days (P=.01). For sedentary behavior, the median daily average screen time decreased from 106 (IQR 60‐142.5) minutes to 90 (IQR 60‐185) minutes. For sleep, 10% (5/46) more participants met the recommended duration, and the number of days with regular sleep increased from a median of 6 (IQR 5‐7) days to 7 (IQR 5‐7) days (P=.03). For diet, there was a decrease in the portion of carbohydrates consumed from a median of 42% (IQR 30‐50) to 40% (IQR 30‐48.5; P=.03), and the number of days of water and unsweetened beverage consumption remained stable at a median of 5 days but with a higher IQR of 4‐7 days (P=.04). About 90% (39-41/46) of the participants reported that the online resource was relevant and easy to use, and the rating for user satisfaction remained favorable at a median of 8 with a higher IQR of 7‐9 (P=.005). Conclusions: The findings support the development of a dedicated online resource to assist the implementation of healthy lifestyle behaviors based on the Singapore integrated 24-hour activity guide for children and adolescents. This resource received favorable ratings and its use showed the adoption of healthier behaviors, including increased physical activity and sleep, as well as decreased sedentary time and carbohydrate consumption, at the end of a 3-month period. %R 10.2196/59283 %U https://pediatrics.jmir.org/2024/1/e59283 %U https://doi.org/10.2196/59283 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59158 %T A Web-Based Intervention to Support a Growth Mindset and Well-Being in Unemployed Young Adults: Development Study %A Straand,Ingjerd J %A Følstad,Asbjørn %A Wünsche,Burkhard C %+ Department of Social Work, University of Stavanger, Kjell Arholms hus, Kjell Arholms gate 41, Stavanger, 4021, Norway, 47 93222289, ingjerd.j.straand@uis.no %K web-based intervention %K positive psychology %K mental health %K user experience %K persuasive design %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Engaging young adults in the labor market is vital for economic growth and well-being. However, the path to employment often presents setbacks that impact motivation and psychological functioning. Research suggests exploring positive psychology interventions in job-seeking and scaling the delivery of these using technology. However, dropout rates are high for self-administered psychological interventions on digital platforms. This challenge needs to be addressed for such platforms to be effective conveyors of psychological interventions. This study addresses this challenge by exploring user-oriented methods and proposes persuasive features for the design and development of a new web-based intervention targeting young unemployed adults. Objective: This study aims to provide an overview of a new positive psychology wise intervention, including its theoretical underpinnings and human-centered design methodology, targeting young, unemployed adults. Methods: Researchers collaborated with designers, developers, and stakeholders to design a web-based positive psychology intervention that leverages evidence-based wise interventions. Key improvements and adaptations were explored through formative usability testing with 13 unemployed young adults aged between 18 and 25 years (the target population). Qualitative usability testing data were collected, analyzed, and integrated into the ongoing design process as iterative improvements. Results: The result of this study is a modular intervention web application named RØST, designed to align with the user needs and the preferences of the specific end-user group of unemployed young adults. During the project, this application evolved from early concept sketches and prototypes into a developed solution ready for further testing and use. Insights from both end-user feedback and rich user observation gained in the study were used to refine the content and the design. To increase targeted end users’ motivation, persuasive design features including praise, rewards, and reminders were added. The web application was designed primarily to be used on mobile phones using text messaging for reminders. The development process included technical and data protection considerations. Conclusions: This study offers valuable insights into developing psychological or behavioral interventions to support unemployed young adults by documenting the design process and the adaptation and combination of diverse theoretical and empirical foundations. Involving stakeholders and end users in the development enabled relatable content development and resolved potential usability problems. An essential implication is the finding that end-user feedback and insights are crucial in shaping interventions. However, we experienced tensions between the evidence-based interventions and the human-centered design approaches. These tensions were not resolved and highlighted a need for ongoing user motivation support through monetary rewards, which were incorporated into the final web app design. %M 39514255 %R 10.2196/59158 %U https://formative.jmir.org/2024/1/e59158 %U https://doi.org/10.2196/59158 %U http://www.ncbi.nlm.nih.gov/pubmed/39514255 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e58684 %T Exploring the Feasibility and Acceptability of Technological Interventions to Prevent Adolescents’ Exposure to Online Pornography: Qualitative Research %A Turvey,Jake %A McKay,Dana %A Kaur,Sarah T %A Castree,Natasha %A Chang,Shanton %A Lim,Megan S C %+ Burnet Institute, 85 Commercial Road, Melbourne, 3004, Australia, 61 0385062403, megan.lim@burnet.edu.au %K pornography %K sexual health %K young people %K co-design %K online safety %K age verification %K adolescents %K attitudes %K acceptability %K usability %K feasibility %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Amid growing concern over children’s access to online pornography, policy makers are looking toward new and emerging technological concepts for unexplored solutions including artificial intelligence and facial recognition. Objective: This study sought to explore and ideate emerging technological interventions that are feasible, acceptable, and effective in preventing and controlling the exposure of young people to online pornographic material. Methods: We conducted a series of qualitative co-design workshops with both adult (n=8; aged 32-53 years) and adolescent participants (n=4; aged 15-17 years) to ideate potential technological interventions that are feasible, acceptable, and effective at preventing and controlling the exposure of young people to online pornographic material. A story stem methodology was used to explore participants’ attitudes toward two unique technological prototypes. Results: Participants expressed a generally favorable view of the proposed technological concepts but remained unconvinced of their overall utility and effectiveness in preventing the intentional viewing of pornography by young people. Age-appropriate parent-child conversations remained participants’ preferred approach to mitigating potential harms from pornographic material, with parents also expressing a desire for more educational resources to help them better navigate these discussions. User privacy and data security were a primary concern for participants, particularly surrounding the use and collection of biometric data. Conclusions: Internationally, policy makers are taking action to use age assurance technologies to prevent children’s access to online pornography. It is important to consider the needs and opinions of parents and young people in the use and implementation of these technologies. Participants in this study were generally supportive of new and emerging technologies as useful tools in preventing the accidental exposure of young people to online pornographic material. However, participants remained less convinced of their ability to avert intentional viewing, with substantial concerns regarding technological efficacy, adaptability, and user privacy. Further, co-design and prototype refinement are needed to better understand user acceptability and comfortability of these new technological interventions, alongside additional research exploring sociocultural differences in information needs and user experiences. %M 39499925 %R 10.2196/58684 %U https://pediatrics.jmir.org/2024/1/e58684 %U https://doi.org/10.2196/58684 %U http://www.ncbi.nlm.nih.gov/pubmed/39499925 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e60165 %T Effectiveness of Computer-Based Psychoeducational Self-Help Platforms for Eating Disorders (With or Without an Associated App): Protocol for a Systematic Review %A Gentile,Alessandra %A Kristian,Yosua Yan %A Cini,Erica %+ Division of Medicine, University College London, Gower St, London, WC1E 6BT, United Kingdom, 44 020 7679 2000, yosua.kristian.23@ucl.ac.uk %K self-help %K online self-help %K eating disorders %K anorexia nervosa %K psychoeducational intervention %K psychoeducation %K binge eating %K anorexia %K bulimia %K access to care %K patient education %K patient self-help %D 2024 %7 4.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Access to psychological health care is extremely difficult, especially for individuals with severely stigmatized disorders such as eating disorders (EDs). There has been an increase in children, adolescents, and adults with ED symptoms and ED, especially following the COVID-19 pandemic. Computer-based self-help platforms (± associated apps) allow people to bridge the treatment gap and receive support when in-person treatment is unavailable or not preferred. Objective: The aim of this systematic review is to evaluate the effectiveness of computer-based self-help platforms for EDs, some of which may have associated apps. Methods: The proposed systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. This review will report and evaluate the literature concerning the efficacy of self-help platforms for EDs. Articles were obtained from the Ovid MEDLINE, Embase, Global Health, and APA PsycInfo. The inclusion criteria included research with original data and gray literature; research evaluating the efficacy of web-based psychoeducational self-help platforms for EDs; people with an ED diagnosis, ED symptoms, at risk of developing EDs, or from the general population without ED-related behaviors; pre– and post–computer-based ± associated apps intervention clinical outcome of ED symptoms; pre– and post–computer-based ± associated apps intervention associated mental health difficulties; and literature in English. The exclusion criteria were solely guided self-help platforms, only in-person interventions with no computer-based ± associated apps comparison group, only in-person–delivered CBT, self-help platforms for conditions other than eating disorders, systematic reviews, meta-analyses, posters, leaflets, books, reviews, and research that only reported physical outcomes. Two independent authors used the search terms to conduct the initial search. The collated articles then were screened by their titles and abstracts, and finally, full-text screenings were conducted. The Cochrane Risk of Bias 2 tool will be used to assess the risks of bias in the included studies. Data extraction will be conducted, included studies will undergo narrative synthesis, and results will be presented in tables. The systematic review will be submitted to a peer-reviewed journal. Results: The authors conducted a database search for articles published by May 31, 2024. In total, 14 studies were included in the systematic review. Data charting, synthesis, and analysis were completed in Microsoft Excel by the end of July 2024. Results will be grouped based on the intervention stages. The results are expected to be published by the end of 2024. Overall, the systematic review found that computer-based self-help platforms are effective in reducing global ED psychopathology and ED-related behaviors. Conclusions: Self-help platforms are helpful first-stage resource in a tiered health care system. Trial Registration: PROSPERO CRD42024520866; https://tinyurl.com/5ys2unsw International Registered Report Identifier (IRRID): DERR1-10.2196/60165 %M 39495557 %R 10.2196/60165 %U https://www.researchprotocols.org/2024/1/e60165 %U https://doi.org/10.2196/60165 %U http://www.ncbi.nlm.nih.gov/pubmed/39495557 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e52557 %T Feasibility of Sexual Health and Contraceptive Web Services for Adolescents and Young Adults: Retrospective Study of a Pilot Program on Reunion Island %A Reynaud,Danielle %A Bouscaren,Nicolas %A Cartron,Emmanuelle %A Marimoutou,Catherine %K sexual health %K adolescent %K young adults %K web application %K contraception prescription %K contraception %K teleconsultation %K telemedicine %K youth %K usage %K e-consultation %K web based %D 2024 %7 1.11.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Sexual health indicators for adolescents and young adults (AYAs) aged between 13 and 25 years are particularly poor on Reunion Island. Access to accurate information as well as sexual health and contraceptive services are vital to maintaining sexual well-being. Teleconsultations offer a promising approach to addressing the sexual health and contraceptive needs of AYAs who are more susceptible to engaging in unprotected sexual intercourse. However, the literature on digital sexual health services for this demographic group is limited. Objective: This study aims to describe the feasibility of a pilot sexual health and contraceptive teleconsultation web service used by AYAs on Reunion Island. Methods: A descriptive, retrospective study was conducted at the Reunion Island University Hospital Center using a convenient sample. Eligible participants were informed about the program through various communication channels, including seminars for health care professionals, radio broadcasts, posters, flyers, press articles, videos, and social media posts. AYAs accessed a web-based platform named SEXTUOZE from December 15, 2021, to September 30, 2022, that offered sexual health information and teleconsultations. Data collected included participant and teleconsultation characteristics, patient satisfaction, and the quality of completeness of medical records. Results: A total of 22 teleconsultations were scheduled and 7 were completed, all via synchronous video communication (duration: median 35 min). Overall, 4731 sessions were generated on the SEXTUOZE website. Reasons cited for accessing the web services were to seek sexual health advice (8/22, 36%), receive an initial birth control prescription (12/22, 55%), and inquire about condom prescriptions (2/22, 9%). Conclusions: While teleconsultation use for sexual health was initially low, it rose toward the end of the study period. Considering all elements of the implementation theory, future research should design interventions that not only are more operative and tailored but also ensure their adoption and sustainability in various health contexts. %R 10.2196/52557 %U https://pediatrics.jmir.org/2024/1/e52557 %U https://doi.org/10.2196/52557 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e53443 %T Development of an Educational Website for Patients With Cancer and Preexisting Autoimmune Diseases Considering Immune Checkpoint Blockers: Usability and Acceptability Study %A Lopez-Olivo,Maria A %A Suarez-Almazor,Maria E %A Duhon,Gabrielle F %A Cherry,McKenna %A Lu,Huifang %A Calabrese,Cassandra %A Altan,Mehmet %A Tawbi,Hussain %A Meara,Alexa %A Bingham,Clifton O %A Diab,Adi %A Leal,Viola B %A Volk,Robert J %+ Department of Health Services Research, MD Anderson Cancer Center, The University of Texas, 1515 Holcombe Boulevard, Houston, TX, TX 77030, United States, 1 7135630020, amlopezo@mdanderson.org %K immune checkpoint inhibitors %K patient education %K usability testing %K cancer %K autoimmune diseases %K mobile phones %K user testing %K usability %K user experience %K immunotherapy %K websites %K development %K acceptability %K autoimmune %K immunology %K oncology %K architecture %K iterative %K vasculitis %K Crohn disease %K Sjogren syndrome %K educational %K web-based resource %K health information %K rheumatology %K arthritis %K web design %K eHealth %K adverse events %K patient care %K treatment %D 2024 %7 25.10.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients with cancer and an underlying autoimmune disease who are considering immune checkpoint blockers (ICBs) need to know about the benefits and risks of severe immune-related adverse events and flares of the autoimmune condition. Objective: This study aims to develop and alpha test an educational website for patients with cancer. Methods: Learning topics, images, and website architecture (including flow and requirements) were developed and iteratively reviewed by members of a community scientist program, a patient advisory group, and content experts. Alpha testing was performed, measuring the site’s usability using the Suitability Assessment of Materials and its acceptability using the Ottawa Acceptability Measure. Results: The website included a home page; general information about ICBs; comprehensive modules on the benefits and risks of ICBs for patients with cancer and preexisting autoimmune diseases; general wellness information; and features such as a quiz, additional resources, and a glossary. For the alpha testing, 9 users assessed the newly developed website. Patient reviewers (n=5) had rheumatoid arthritis, Crohn disease, Sjogren syndrome, or vasculitis. Health care provider reviewers (n=4) were medical oncologists or rheumatologists. The median Suitability Assessment of Materials rating was 75 (IQR 70-79; range 0-100) for patients versus 66 (IQR 57-72; range 0-100) for providers (scores ≥70 indicate no substantial changes needed). Recommendations for improvement, mostly involving navigation and accessibility, were addressed. All participants expressed that the website was acceptable and balanced in terms of discussion of benefits and harms. Because half (2/4, 50%) of the providers suggested we increase the amount of information, we extended the content on the impact of having an autoimmune disease when considering ICB treatment, the probability of flares, and the management of flares in this context. Conclusions: The feedback led to minor revisions to enhance readability, navigation, and accessibility, ensuring the website’s suitability as a decision-making aid. The newly developed website could become a supporting tool to facilitate patient-physician discussion regarding ICBs. %M 39454185 %R 10.2196/53443 %U https://cancer.jmir.org/2024/1/e53443 %U https://doi.org/10.2196/53443 %U http://www.ncbi.nlm.nih.gov/pubmed/39454185 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e59119 %T The Evaluation of a Web-Based Intervention (Deprexis) to Decrease Depression and Restore Functioning in Veterans: Protocol for a Randomized Controlled Trial %A Pearson,Rahel %A Beevers,Christopher G %A Mignogna,Joseph %A Benzer,Justin %A Pfeiffer,Paul N %A Post,Edward %A Creech,Suzannah K %+ Veterans Integrated Service Network 17 Center of Excellence for Research on Returning War Veterans, Central Texas Veterans Affairs Healthcare System, 4800 Memorial Drive (151C), Waco, TX, 76711, United States, 1 254 297 5155, rahel.pearson@va.gov %K depression %K eHealth %K mental health %K randomized controlled trial %K RCT %K mobile phone %D 2024 %7 24.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Depressive symptoms are common in veterans, and the presence of these symptoms increases disability as well as suicidal thoughts and behaviors. However, there is evidence that these symptoms often go untreated. Intervening before symptoms become severe and entrenched is related to better long-term outcomes, including improved functioning and less disease chronicity. Computer-delivered interventions may be especially appropriate for those veterans with mild to moderate depressive symptoms, because these interventions can require fewer resources and have lower barriers to access and thus have potential for wider reach. Despite this potential, there is a dearth of research examining computerized interventions for depressive symptoms in veteran samples. Objective: The aim of this study is to evaluate the efficacy of Deprexis (GAIA AG), a computerized intervention for depressive symptoms and related functional impairment. Methods: Veterans will be recruited through the US Department of Veterans Affairs electronic medical record and through primary care and specialty clinics. First, qualitative interviews will be completed with a small subset of veterans (n=16-20) to assess the acceptability of treatment procedures. Next, veterans (n=132) with mild to moderate depressive symptoms will be randomly assigned to the fully automated Deprexis intervention or a treatment-as-usual control group. The primary outcomes will be self-reported depressive symptoms and various dimensions of psychosocial functioning. Results: This project was funded in May 2024, and data collection will be conducted between October 2024 and April 2029. Overall, 4 participants have been recruited as of the submission of the manuscript, and data analysis is expected in June 2029, with initial results expected in November 2029. Conclusions: This study will provide initial evidence for the efficacy of self-guided, computerized interventions for depressive symptoms and functional impairment in veterans. If effective, these types of interventions could improve veteran access to low-resource psychosocial treatments. Trial Registration: ClinicalTrials.gov NCT06217198; https://www.clinicaltrials.gov/study/NCT06217198 International Registered Report Identifier (IRRID): PRR1-10.2196/59119 %M 39446432 %R 10.2196/59119 %U https://www.researchprotocols.org/2024/1/e59119 %U https://doi.org/10.2196/59119 %U http://www.ncbi.nlm.nih.gov/pubmed/39446432 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e64614 %T A Chatbot-Based Version of the World Health Organization–Validated Self-Help Plus Intervention for Stress Management: Co-Design and Usability Testing %A Fietta,Valentina %A Rizzi,Silvia %A De Luca,Chiara %A Gios,Lorenzo %A Pavesi,Maria Chiara %A Gabrielli,Silvia %A Monaro,Merylin %A Forti,Stefano %+ Fondazione Bruno Kessler, Via Sommarive, 18, Povo TN, Trento, 38123, Italy, 39 049 827 6628, valentina.fietta.1@phd.unipd.it %K acceptance and commitment therapy %K ACT %K well-being %K pregnancy %K breast cancer %K eHealth %K mobile health %K mHealth %K development %K usability %K user-centered design %D 2024 %7 18.10.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Advancements in technology offer new opportunities to support vulnerable populations, such as pregnant women and women diagnosed with breast cancer, during physiologically and psychologically stressful periods. Objective: This study aims to adapt and co-design the World Health Organization’s Self-Help Plus intervention into a mobile health intervention for these target groups. Methods: On the basis of the Obesity-Related Behavioral Intervention Trials and Center for eHealth Research and Disease Management models, low-fidelity and high-fidelity prototypes were developed. Prototypes were evaluated by 13 domain experts from diverse sectors and 15 participants from the target groups to assess usability, attractiveness, and functionality through semantic differential scales, the User Version of the Mobile Application Rating Scale questionnaire, and semistructured interviews. Results: Feedback from participants indicated positive perceptions of the mobile health intervention, highlighting its ease of use, appropriate language, and attractive multimedia content. Areas identified for improvement included enhancing user engagement through reminders, monitoring features, and increased personalization. The quality of the content and adherence to initial protocols were positively evaluated. Conclusions: This research provides valuable insights for future studies aiming to enhance the usability, efficacy, and effectiveness of the app, suggesting the potential role of a chatbot-delivered Self-Help Plus intervention as a supportive tool for pregnant women and women with a breast cancer diagnosis. %M 39355954 %R 10.2196/64614 %U https://humanfactors.jmir.org/2024/1/e64614 %U https://doi.org/10.2196/64614 %U http://www.ncbi.nlm.nih.gov/pubmed/39355954 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53557 %T User-Centered Design for Designing and Evaluating a Prototype of a Data Collection Tool to Submit Information About Incidents of Violence Against Sex Workers: Multiple Methods Approach %A Ditmore,Melissa H %A Florez-Arango,Jose Fernando %K mobile health %K sex worker %K user-centered design methods %K usability %K heuristic analysis %K cognitive walkthrough %K aggression %K abuse %K occupational health %K reporting %K prototype %K heuristics %K human-centered design %K implementation %K barriers %K enablers %K data collection %K digital health %K underreporting %D 2024 %7 9.10.2024 %9 %J JMIR Hum Factors %G English %X Background: Sex workers face an epidemic of violence in the United States. However, violence against sex workers in the United States is underreported. Sex workers hesitate to report it to the police because they are frequently punished themselves; therefore, an alternative for reporting is needed. Objective: We aim to apply human-centered design methods to create and evaluate the usability of the prototype interface for ReportVASW (violence against sex worker, VASW) and identify opportunities for improvement. Methods: This study explores ways to improve the prototype of ReportVASW, with particular attention to ways to improve the data collection tool. Evaluation methods included cognitive walkthrough, system usability scale, and heuristic evaluation. Results: End users were enthusiastic about the idea of a website to document violence against sex workers. ReportVASW scored 90 on the system usability scale. The tool scored neutral on consistency, and all other responses were positive toward the app, with most being strong. Conclusions: Many opportunities to improve the interface were identified. Multiple methods identified multiple issues to address. Most changes are not overly complex, and the majority were aesthetic or minor. Further development of the ReportVASW data collection tool is worth pursuing. %R 10.2196/53557 %U https://humanfactors.jmir.org/2024/1/e53557 %U https://doi.org/10.2196/53557 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55322 %T Development of a 12-Week Unsupervised Online Tai Chi Program for People With Hip and Knee Osteoarthritis: Mixed Methods Study %A Zhu,Shiyi Julia %A Bennell,Kim L %A Hinman,Rana S %A Harrison,Jenny %A Kimp,Alexander J %A Nelligan,Rachel K %+ Department of Physiotherapy, School of Health Sciences, Centre for Health, Exercise and Sports Medicine, University of Melbourne, 161 Barry Street, Parkville, Melbourne, 3010, Australia, 61 3 8344 0556, k.bennell@unimelb.edu.au %K intervention development %K osteoarthritis %K Tai Chi %K web-based intervention %K online %K telehealth %K unsupervised exercise %K exercise %K physical activity %K arthritis %K development %K web based %K hip %K knee %K gerontology %K geriatric %K older adult %K aging %K bone %K workout %K digital health %K eHealth %K literature review %K telemedicine %D 2024 %7 30.9.2024 %9 Original Paper %J JMIR Aging %G English %X Background: Osteoarthritis is a leading contributor to global disability. While evidence supports the effectiveness of Tai Chi in improving symptoms for people with hip/knee osteoarthritis, access to in-person Tai Chi classes may be difficult for many people. An unsupervised online Tai Chi intervention for people with osteoarthritis can help overcome accessibility barriers. The Approach to Human-Centered, Evidence-Driven Adaptive Design (AHEAD) framework provides a practical guide for co-designing such an intervention. Objective: This study aims to develop an unsupervised online Tai Chi program for people with hip/knee osteoarthritis. Methods: An iterative process was conducted using the AHEAD framework. Initially, a panel of Tai Chi instructors and people with osteoarthritis was assembled. A literature review was conducted to inform the content of a survey (survey 1), which was completed by the panel and additional Australian Tai Chi instructors to identify Tai Chi movements for potential inclusion. Selection of Tai Chi movements was based on 3 criteria: those that were appropriate (for people with hip/knee osteoarthritis aged 45+ years), safe (to be performed at home unsupervised), and practical (to be delivered online using prerecorded videos). Movements that met these criteria were then ranked in a second survey (survey 2; using conjoint analysis methodology). Survey findings were discussed in a focus group, and the Tai Chi movements for program use were identified. A draft of the online Tai Chi program was developed, and a final survey (survey 3) was conducted with the panel to rate the appropriateness and safety of the proposed program. The final program was developed, and usability testing (think-aloud protocol) was conducted with people with knee osteoarthritis. Results: The panel consisted of 10 Tai Chi instructors and 3 people with osteoarthritis. The literature review identified Yang Style 24 as a common and effective Tai Chi style used in hip/knee osteoarthritis studies. Surveys 1 (n=35) and 2 (n=27) produced a ranked list of 24 Tai Chi movements for potential inclusion. This list was refined and informed by a focus group, with 10 Tai Chi movements being selected for inclusion (known as the Yang Style 10 form). Survey 3 (n=13) found that 92% (n=12) of the panel members believed that the proposed draft Tai Chi program was appropriate and safe, resulting in its adoption. The final program was produced and hosted on a customized website, “My Joint Tai Chi,” which was further refined based on user feedback (n=5). “My Joint Tai Chi” is currently being evaluated in a randomized controlled trial. Conclusions: This study demonstrates the use of the AHEAD framework to develop an unsupervised online Tai Chi intervention (“My Joint Tai Chi”) for people with hip/knee osteoarthritis. This intervention is now being tested for effectiveness and safety in a randomized controlled trial. %M 39348676 %R 10.2196/55322 %U https://aging.jmir.org/2024/1/e55322 %U https://doi.org/10.2196/55322 %U http://www.ncbi.nlm.nih.gov/pubmed/39348676 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53224 %T The Development of a Digital Patient Navigation Tool to Increase Colorectal Cancer Screening Among Federally Qualified Health Center Patients: Acceptability and Usability Testing %A Savage,Leah C %A Soto-Cossio,Luz Estefhany %A Minardi,Francesca %A Beyrouty,Matthew %A Schoonover,Julie %A Musella,Jay %A Frazier,Michaela %A Villagra,Cristina N %A Sly,Jamilia R %A Erblich,Joel %A Itzkowitz,Steven H %A Jandorf,Lina H %A Calman,Neil S %A Atreja,Ashish %A Miller,Sarah J %+ Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, Box 1077, 1 Gustave L Levy Place, New York, NY, 10029, United States, 1 2128247783, sarah.miller@mssm.edu %K digital navigation %K digital health %K Federally Qualified Health Center %K colorectal cancer %K cancer screening %K mobile phone %D 2024 %7 25.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Federally Qualified Health Centers (FQHCs) are an essential place for historically underserved patients to access health care, including screening for colorectal cancer (CRC), one of the leading causes of cancer death in the United States. Novel interventions aimed at increasing CRC screening completion rates at FQHCs are crucial. Objective: This study conducts user testing of a digital patient navigation tool, called eNav, designed to support FQHC patients in preparing for, requesting, and completing CRC screening tests. Methods: We recruited English- and Spanish-speaking patients (N=20) at an FQHC in New York City to user-test the eNav website (2 user tests; n=10 participants per user test). In each user test, participants engaged in a “think aloud” exercise and a qualitative interview to summarize and review their feedback. They also completed a baseline questionnaire gathering data about demographics, technology and internet use, medical history, and health literacy, and completed surveys to assess the website’s acceptability and usability. Based on participant feedback from the first user test, we modified the eNav website for a second round of testing. Then, feedback from the second user test was used to modify and finalize the eNav website. Results: Survey results supported the overall usability and acceptability of the website. The average System Usability Scale score for our first user test was 75.25; for the second, it was 75.28. The average Acceptability E-scale score for our first user test was 28.3; for the second, it was 29.2. These scores meet suggested benchmarks for usability and acceptability. During qualitative think-aloud exercises, in both user tests, many participants favorably perceived the website as motivating, interesting, informative, and user-friendly. Respondents also gave suggestions on how to improve the website’s content, usability, accessibility, and appeal. We found that some participants did not have the digital devices or internet access needed to interact with the eNav website at home. Conclusions: Based on participant feedback on the eNav website and reported limitations to digital access across both user tests, we made modifications to the content and design of the website. We also designed alternative methods of engagement with eNav to increase the tool’s usability, accessibility, and impact for patients with diverse needs, including those with limited access to devices or the internet at home. Next, we will test the eNav intervention in a randomized controlled trial to evaluate the efficacy of the eNav website for improving CRC screening uptake among patients treated at FQHCs. %M 39321451 %R 10.2196/53224 %U https://formative.jmir.org/2024/1/e53224 %U https://doi.org/10.2196/53224 %U http://www.ncbi.nlm.nih.gov/pubmed/39321451 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50508 %T User Engagement With mHealth Interventions to Promote Treatment Adherence and Self-Management in People With Chronic Health Conditions: Systematic Review %A Eaton,Cyd %A Vallejo,Natalie %A McDonald,Xiomara %A Wu,Jasmine %A Rodríguez,Rosa %A Muthusamy,Nishanth %A Mathioudakis,Nestoras %A Riekert,Kristin A %+ Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD, 21224, United States, 1 6673066201, ceaton4@jhmi.edu %K mobile health %K mHealth %K digital health %K treatment adherence %K self-management %K user engagement %K chronic health conditions %K mobile phone %D 2024 %7 24.9.2024 %9 Review %J J Med Internet Res %G English %X Background: There are numerous mobile health (mHealth) interventions for treatment adherence and self-management; yet, little is known about user engagement or interaction with these technologies. Objective: This systematic review aimed to answer the following questions: (1) How is user engagement defined and measured in studies of mHealth interventions to promote adherence to prescribed medical or health regimens or self-management among people living with a health condition? (2) To what degree are patients engaging with these mHealth interventions? (3) What is the association between user engagement with mHealth interventions and adherence or self-management outcomes? (4) How often is user engagement a research end point? Methods: Scientific database (Ovid MEDLINE, Embase, Web of Science, PsycINFO, and CINAHL) search results (2016-2021) were screened for inclusion and exclusion criteria. Data were extracted in a standardized electronic form. No risk-of-bias assessment was conducted because this review aimed to characterize user engagement measurement rather than certainty in primary study results. The results were synthesized descriptively and thematically. Results: A total of 292 studies were included for data extraction. The median number of participants per study was 77 (IQR 34-164). Most of the mHealth interventions were evaluated in nonrandomized studies (157/292, 53.8%), involved people with diabetes (51/292, 17.5%), targeted medication adherence (98/292, 33.6%), and comprised apps (220/292, 75.3%). The principal findings were as follows: (1) >60 unique terms were used to define user engagement; “use” (102/292, 34.9%) and “engagement” (94/292, 32.2%) were the most common; (2) a total of 11 distinct user engagement measurement approaches were identified; the use of objective user log-in data from an app or web portal (160/292, 54.8%) was the most common; (3) although engagement was inconsistently evaluated, most of the studies (99/195, 50.8%) reported >1 level of engagement due to the use of multiple measurement methods or analyses, decreased engagement across time (76/99, 77%), and results and conclusions suggesting that higher engagement was associated with positive adherence or self-management (60/103, 58.3%); and (4) user engagement was a research end point in only 19.2% (56/292) of the studies. Conclusions: The results revealed major limitations in the literature reviewed, including significant variability in how user engagement is defined, a tendency to rely on user log-in data over other measurements, and critical gaps in how user engagement is evaluated (infrequently evaluated over time or in relation to adherence or self-management outcomes and rarely considered a research end point). Recommendations are outlined in response to our findings with the goal of improving research rigor in this area. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022289693; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022289693 %M 39316431 %R 10.2196/50508 %U https://www.jmir.org/2024/1/e50508 %U https://doi.org/10.2196/50508 %U http://www.ncbi.nlm.nih.gov/pubmed/39316431 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e59191 %T Perceived Acceptability of Technology Modalities for the Provision of Universal Child and Family Health Nursing Support in the First 6-8 Months After Birth: Cross-Sectional Study %A Delaney,Tessa %A Jackson,Jacklyn K %A Brown,Alison L %A Lecathelinais,Christophe %A Wolfenden,Luke %A Hudson,Nayerra %A Young,Sarah %A Groombridge,Daniel %A Pinfold,Jessica %A Craven,Paul David %A Redman,Sinead %A Wiggers,John %A Kingsland,Melanie %A Hayes,Margaret %A Sutherland,Rachel %+ Hunter New England Local Health District, Lookout Road, New Lambton, 2306, Australia, 61 249246499, Rachel.Sutherland@health.nsw.gov.au %K maternal %K postnatal %K postpartum %K acceptability %K technology %K digital health %K first 2000 days %K child health %K experience %K experiences %K attitude %K attitudes %K opinion %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %K cross sectional %K survey %K surveys %K questionnaire %K questionnaires %K pediatric %K pediatrics %K infant %K infants %K infancy %K baby %K babies %K neonate %K neonates %K neonatal %K newborn %K newborns %K nurse %K nurses %K nursing %D 2024 %7 24.9.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Child and Family Health Nursing (CFHN) services provide universal care to families during the first 2000 days (conception: 5 years) to support optimal health and developmental outcomes of children in New South Wales, Australia. The use of technology represents a promising means to encourage family engagement with CFHN services and enable universal access to evidenced-based age and stage information. Currently, there is little evidence exploring the acceptability of various models of technology-based support provided during the first 2000 days, as well as the maternal characteristics that may influence this. Objective: This study aims to describe (1) the acceptability of technology-based models of CFHN support to families in the first 6 months, and (2) the association between the acceptability of technology-based support and maternal characteristics. Methods: A cross-sectional survey was undertaken between September and November 2021 with women who were 6-8 months post partum within the Hunter New England Local Health District of New South Wales, Australia. Survey questions collected information on maternal demographics and pregnancy characteristics, perceived stress, access to CFHN services, as well as preferences and acceptability of technology-based support. Descriptive statistics were used to describe the characteristics of the sample, the proportion of women accessing CFHN services, maternal acceptability of technology-based support from CFHN services, and the appropriateness of timing of support. Multivariable logistic regression models were conducted to assess the association between maternal characteristics and the acceptability of technology-based CFHN support. Results: A total of 365 women participated in the study, most were 25 to 34 years old (n=242, 68%), had completed tertiary level education or higher (n=250, 71%), and were employed or on maternity leave (n=280, 78%). Almost all (n=305, 89%) women reported accessing CFHN services in the first 6 months following their child’s birth. The majority of women (n=282-315, 82%-92%) “strongly agreed or agreed” that receiving information from CFHN via technology would be acceptable, and most (n=308) women “strongly agreed or agreed” with being provided information on a variety of relevant health topics. Acceptability of receiving information via websites was significantly associated with maternal employment status (P=.01). The acceptability of receiving support via telephone and email was significantly associated with maternal education level (adjusted odds ratio 2.64, 95% CI 1.07-6.51; P=.03 and adjusted odds ratio 2.90, 95% CI 1.20-7.00; P=.02, respectively). Maternal age was also associated with the acceptability of email support (P=.04). Conclusions: Technology-based CFHN support is generally acceptable to mothers. Maternal characteristics, including employment status, education level, and age, were found to modify the acceptability of specific technology modalities. The findings of this research should be considered when designing technology-based solutions to providing universal age and stage child health and developmental support for families during the first 2000 days. %M 39316424 %R 10.2196/59191 %U https://pediatrics.jmir.org/2024/1/e59191 %U https://doi.org/10.2196/59191 %U http://www.ncbi.nlm.nih.gov/pubmed/39316424 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56559 %T Usability of a Web-Based App for Increasing Adolescent Vaccination in Primary Care Settings: Think-Aloud and Survey Assessment %A Staras,Stephanie A S %A Tauscher,Justin %A Vinson,Michelle %A Thompson,Lindsay A %A Gerend,Mary A %A Shenkman,Elizabeth A %+ Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, 1889 Museum Road, Room 7005, Gainesville, FL, 32611, United States, 1 (352)294 8299, sstaras@ufl.edu %K participatory design %K think-aloud %K implementation science %K adolescent vaccination %K human papillomavirus vaccine %K usability %K eHealth %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In the United States, only 58% of teens receive the recommended 2 doses of the human papillomavirus vaccine by 15 years of age. Overcoming vaccine hesitancy often requires effective communication between clinicians and parents to address specific concerns. To support this, we developed ProtectMe4, a multilevel, theory-informed web-based intervention designed to address parents’ vaccine-related questions and assist clinicians in discussing vaccine concerns for 4 adolescent vaccines. Objective: This study aims to evaluate the usability of ProtectMe4 in routine care settings across 3 pediatric primary care clinics. Specifically, the study aims to (1) observe the proposed workflow in practice, (2) identify usability issues experienced by parents and clinicians, and (3) assess the perceptions of both parents and clinicians regarding the app’s usability. Methods: On designated days in 2020 and 2021, the study team recruited parents of 11- to 12-year-old patients attending appointments with participating clinicians. We conducted think-aloud assessments during routine care visits and administered a usability survey after participants used the app. For parents, we simultaneously video-recorded the app screens and audio-recorded their commentary. For clinicians, observational notes were taken regarding their actions and comments. Timings recorded within the app provided data on the length of use. We reviewed the recordings and notes to compile a list of identified issues and calculated the frequencies of survey responses. Results: Out of 12 parents invited to use the app, 9 (75%) participated. Two parents who were invited outside of the planned workflow, after seeing the clinician, refused to participate. For the parents whose child’s vaccination record was identified by the app, the median time spent using the app was 9 (range 6-28) minutes. Think-aloud assessment results for parents were categorized into 2 themes: (1) troubleshooting vaccine record identification and (2) clarifying the app content and purpose. Among the 8 parents who completed the survey, at least 75% (6/8) agreed with each acceptability measure related to user satisfaction, perceived usefulness, and acceptance. These parents’ children were patients of 4 of the 7 participating clinicians. Consistent with the planned workflow, clinicians viewed the app before seeing the patient in 4 of 9 (44%) instances. The median time spent on the app per patient was 95 (range 5-240) seconds. Think-aloud assessment results for clinicians were grouped into 2 themes: (1) trust of app vaccine results and (2) clarifying the app content. On the survey, clinicians were unanimously positive about the app, with an average System Usability Scale score of 87.5 (SE 2.5). Conclusions: This mixed methods evaluation demonstrated that ProtectMe4 was usable and acceptable to both parents and clinicians in real-world pediatric primary care. Improved coordination among clinic staff is needed to ensure the app is consistently offered to patients and reviewed by clinicians before seeing the patient. %M 39298761 %R 10.2196/56559 %U https://formative.jmir.org/2024/1/e56559 %U https://doi.org/10.2196/56559 %U http://www.ncbi.nlm.nih.gov/pubmed/39298761 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e56486 %T Nutrition Management Miniprograms in WeChat: Evaluation of Functionality and Quality %A Sun,Hui %A Wu,Yanping %A Sun,Jia %A Zhou,Wu %A Xu,Qian %A Hu,Dandan %K nutrition management %K WeChat mini-program %K User Version of the Mobile Application Rating Scale %K uMARS %K function and quality evaluation %D 2024 %7 12.9.2024 %9 %J JMIR Hum Factors %G English %X Background: With the rise in people’s living standards and aging populations, a heightened emphasis has been placed in the field of medical and health care. In recent years, there has been a drastic increase in nutrition management in domestic research circles. The mobile nutritional health management platform based on WeChat miniprograms has been widely used to promote health and self-management and to monitor individual nutritional health status in China. Nevertheless, there has been a lack of comprehensive scientific evaluation regarding the functionality and quality of the diverse range of nutritional miniprograms that have surfaced in the market. Objective: This study aimed to evaluate the functionality and quality of China’s WeChat nutrition management miniprogram by using the User Version of the Mobile Application Rating Scale (uMARS). Methods: This observational study involves quantitative methods. A keyword search for “nutrition,” “diet,” “food,” and “meal” in Chinese or English was conducted on WeChat, and all miniprograms pertaining to these keywords were thoroughly analyzed. Then, basic information including name, registration date, update date, service type, user scores, and functional scores was extracted from January 2017 to November 2023. Rating scores were provided by users based on their experience and satisfaction with the use of the WeChat miniprogram, and functional scores were integrated and summarized for the primary functions of each miniprogram. Moreover, the quality of nutrition management applets was evaluated by 3 researchers independently using the uMARS. Results: Initially, 27 of 891 miniprograms identified were relevant to nutrition management. Among them, 85.2% (23/27) of them offered features for diet management, facilitating recording of daily dietary intake to evaluate nutritional status; 70.4% (19/27) provided resources for nutrition education and classroom instruction; 59.3% (16/27) included functionalities for exercise management, allowing users to record daily physical activity; and only 44.4% (12/27) featured components for weight management. The total quality score on the uMARS ranged 2.85-3.88 (median 3.38, IQR 3.14-3.57). Engagement scores on the uMARS varied from 2.00 to 4.33 (median 3.00, IQR 2.67-3.67). Functional dimension scores ranged from 3.00 to 4.00 (median 3.33, IQR 3.33-3.67), with a lower score of 2.67 and a higher score of 4.33 outside the reference range. Aesthetic dimension scores ranged from 2.33 to 4.67 (median 3.67, IQR 3.33-4.00). Informational dimension scores ranged from 2.33 to 4.67 (median 3.33, IQR 2.67-3.67). Conclusions: Our findings from the uMARS highlight a predominant emphasis on health aspects over nutritional specifications in the app supporting WeChat miniprograms related to nutrition management. The quality of these miniprograms is currently at an average level, with considerable room for functional improvements in the future. %R 10.2196/56486 %U https://humanfactors.jmir.org/2024/1/e56486 %U https://doi.org/10.2196/56486 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e51525 %T Lessons Learned From Developing Dashboards to Support Decision-Making for Community Opioid Response by Community Stakeholders: Mixed Methods and Multisite Study %A Fareed,Naleef %A Olvera,Ramona G %A Wang,Yiting %A Hayes,Michael %A Larimore,Elizabeth Liz %A Balvanz,Peter %A Langley,Ronald %A Noel,Corinna A %A Rock,Peter %A Redmond,Daniel %A Neufeld,Jessica %A Kosakowski,Sarah %A Harris,Daniel %A LaRochelle,Marc %A Huerta,Timothy R %A Glasgow,LaShawn %A Oga,Emmanuel %A Villani,Jennifer %A Wu,Elwin %+ Department of Biomedical Informatics, College of Medicine, The Ohio State University, 370 W. 9th Avenue, Columbus, OH, 43210, United States, 1 614 685 3251, naleef.fareed@osumc.edu %K data visualizations %K dashboards %K public health %K overdose epidemic %K human-centered design %D 2024 %7 9.9.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Data dashboards are published tools that present visualizations; they are increasingly used to display data about behavioral health, social determinants of health, and chronic and infectious disease risks to inform or support public health endeavors. Dashboards can be an evidence-based approach used by communities to influence decision-making in health care for specific populations. Despite widespread use, evidence on how to best design and use dashboards in the public health realm is limited. There is also a notable dearth of studies that examine and document the complexity and heterogeneity of dashboards in community settings. Objective: Community stakeholders engaged in the community response to the opioid overdose crisis could benefit from the use of data dashboards for decision-making. As part of the Communities That HEAL (CTH) intervention, community data dashboards were created for stakeholders to support decision-making. We assessed stakeholders’ perceptions of the usability and use of the CTH dashboards for decision-making. Methods: We conducted a mixed methods assessment between June and July 2021 on the use of CTH dashboards. We administered the System Usability Scale (SUS) and conducted semistructured group interviews with users in 33 communities across 4 states of the United States. The SUS comprises 10 five-point Likert-scale questions measuring usability, each scored from 0 to 4. The interview guides were informed by the technology adoption model (TAM) and focused on perceived usefulness, perceived ease of use, intention to use, and contextual factors. Results: Overall, 62 users of the CTH dashboards completed the SUS and interviews. SUS scores (grand mean 73, SD 4.6) indicated that CTH dashboards were within the acceptable range for usability. From the qualitative interview data, we inductively created subthemes within the 4 dimensions of the TAM to contextualize stakeholders’ perceptions of the dashboard’s usefulness and ease of use, their intention to use, and contextual factors. These data also highlighted gaps in knowledge, design, and use, which could help focus efforts to improve the use and comprehension of dashboards by stakeholders. Conclusions: We present a set of prioritized gaps identified by our national group and list a set of lessons learned for improved data dashboard design and use for community stakeholders. Findings from our novel application of both the SUS and TAM provide insights and highlight important gaps and lessons learned to inform the design of data dashboards for use by decision-making community stakeholders. Trial Registration: ClinicalTrials.gov NCT04111939; https://clinicaltrials.gov/study/NCT04111939 %M 39250216 %R 10.2196/51525 %U https://humanfactors.jmir.org/2024/1/e51525 %U https://doi.org/10.2196/51525 %U http://www.ncbi.nlm.nih.gov/pubmed/39250216 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e53907 %T Evaluating a Mobile App Supporting Evidence-Based Parenting Skills: Thematic Analysis of Parent Experience %A Hodson,Nathan %A Woods,Peter %A Solano,Juan Luque %A Talbot,Charlotte %A Giacco,Domenico %K digital microintervention %K parenting app %K product management %K parent %K parents %K parenting %K app %K apps %K usability %K acceptability %K family %K families %K interview %K interviews %K pediatric %K pediatrics %K child %K children %K youths %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K acceptance %K behavior %K behaviors %K disruptive behavior %K thematic analysis %D 2024 %7 5.9.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Disruptive behavior disorders are among the most common disorders of childhood, and evidence-based parenting programs are the first-line treatment. Digital microinterventions have been proposed as one possible means of supporting parenting style change by giving parents in-the-moment advice about how to respond to challenging behavior. Until now, no digital microintervention supporting evidence-based parenting skills programs has been evaluated. Objective: The aim of this study is to evaluate the subjective experience of parents using a digital microintervention to support evidence-based parenting skills, with particular attention to acceptability, usability, family relationships, and parents’ values. Methods: We conducted serial interviews with 11 parents of 33 children before and after spending 3 weeks using an app including 3 digital microinterventions. Parents were recruited via local authorities in the Midlands region of the United Kingdom. Previous participation in a parenting program was an inclusion criterion. Interviews explored family composition; child behavior problems; and experience of using the mobile app, including barriers to use. Thematic analysis was conducted from a user-centered design perspective, and illustrative case vignettes were produced. Results: Many parents used the app in ways that helped them rather than strictly following the instructions they were given. Parents described a range of barriers to using the app including practical problems and failure to change child behavior. Parents and children responded in a variety of ways to the use of the phone, with many wholeheartedly embracing the convenience of technology. Case vignettes illustrate the uniqueness of each family’s experience. Conclusions: Parents’ use of a mobile app supporting evidence-based parenting skills is difficult to predict due to the unique challenges each family encounters. Many parents found it an acceptable and helpful addition to family life, but increased personalization is likely to be key to supporting parents. Future digital microintervention developers should keep in mind that parents are likely to use the app pragmatically rather than following instructions, may struggle to use a complex app under pressure, and are likely to hold complex feelings about parenting with an app. %R 10.2196/53907 %U https://pediatrics.jmir.org/2024/1/e53907 %U https://doi.org/10.2196/53907 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e57172 %T Exploring Acceptability, Barriers, and Facilitators for Digital Health in Dermatology: Qualitative Focus Groups With Dermatologists, Nurses, and Patients %A Reinders,Patrick %A Augustin,Matthias %A Fleyder,Anastasia %A Otten,Marina %+ Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Martinistraße 52, Hamburg, 20246, Germany, 49 40 7410 ext 24723, m.otten@uke.de %K digitalization %K digital health interventions %K UTAUT %K unified theory of acceptance and use of technology %K barriers and facilitators %K dermatology %K qualitative research %K focus groups %K mobile phone %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Dermatol %G English %X Background: Although several digital health interventions (DHIs) have shown promise in the care of skin diseases their uptake in Germany has been limited. To fully understand the reasons for the low uptake, an in-depth analysis of patients’ and health care providers’ barriers and facilitators in dermatology is needed. Objective: The objective of this study was to explore and compare attitudes, acceptability, barriers, and facilitators of patients, dermatologists, and nurses toward DHIs in dermatology. Methods: We conducted 6 web-based focus groups each with patients (n=34), dermatologists (n=30), and nurses (n=30) using a semistructured interview guide with short descriptions of DHIs described in the literature. A content analysis was performed using deductive constructs, following the unified theory of acceptance and use of technology framework, and inductive categories. Results: Patients identified many positive performance expectancies, such as reduced travel times and improvement in follow-up appointments. Dermatologists also stated positive effects (eg, promotion of standardized care), but also negative implications of health care digitalization (eg, increased workload). All stakeholders reported that a DHI should bring additional value to all stakeholders. A lack of digital competence among patients was identified as the major barrier to adoption by all 3 groups. Nurses and dermatologists want apps that are easy to use and easy to implement into their daily routines. Trust in selected institutions, colleagues, and physicians was identified as a facilitator. Patients reported their dependence on the dermatologists’ acceptance. All groups expressed concerns about data privacy risks and dermatologists stated insecurities toward data privacy laws. Conclusions: To ensure successful digitalization in dermatology, apps should be user-friendly, adapted to users’ skill levels, and beneficial for all stakeholders. The incorporation of dermatologists’ perspectives is especially important as their acceptance may impact use among patients and nurses. DHIs should ensure and be transparent about data privacy. The found barriers and facilitators can be used for implementation strategies. %M 39226097 %R 10.2196/57172 %U https://derma.jmir.org/2024/1/e57172 %U https://doi.org/10.2196/57172 %U http://www.ncbi.nlm.nih.gov/pubmed/39226097 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56319 %T Developing a Guided Web App for Postpartum Depression Symptoms: User-Centered Design Approach %A Franco,Pamela %A Olhaberry,Marcia %A Muzard,Antonia %A Harismendy,Ángeles %A Kelders,Saskia %+ Centre for eHealth & Well-being Research, Department of Psychology, Health & Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 0 534899180, s.m.kelders@utwente.nl %K internet-based intervention %K postpartum depression %K user-centered development %K perinatal mental health %K user-centered design %K mobile phone %D 2024 %7 19.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychological internet-based interventions have shown promise in preventing and treating perinatal depression, but their effectiveness can be hindered by low user engagement. This challenge often arises from a misalignment between technology attributes, user needs, and context. A user-centered, iterative approach involving all stakeholders is recommended. Objective: In this paper, we aimed to develop a user-friendly psychological internet-based intervention aimed at addressing the symptoms of perinatal depression through an iterative, user-centered approach. Methods: The development process followed the Center for eHealth Research and Disease Management Roadmap phases of contextual inquiry, value specification, and design. It involved a comprehensive literature review, 2 surveys, 10 focus groups, 5 usability interviews, and 1 technical pilot. Results: The contextual inquiry revealed a demand for accessible interventions for perinatal mental health, with internet-based solutions seen as viable options. Insights from the literature influenced intervention content and features. Stakeholders’ openness to the intervention became evident during this phase, along with the integration of the first set of values. Initially, we assessed the broader perinatal context to identify the optimal period for the intervention. On the basis of the findings and practical considerations, we decided to specifically target postpartum depression symptoms. The value specification phase further defined the central values and translated them into requirements. In the design phase, feedback was obtained on the user experience of an early digital prototype and on the prototype’s final version. The resulting intervention, named Mamá, te entiendo (“Mom, I get you”), is a guided web app based on cognitive behavioral therapy principles, integrating elements from attachment and mentalization theories. It aims to reduce depressive symptoms in women during the first months postpartum and consists of 6 core sequential modules, along with 3 additional modules, including 5 case examples illustrating depressive symptoms and therapeutic techniques. The intervention provides homework exercises and offers users the opportunity to receive feedback from an e-coach through the web app. Conclusions: This study emphasizes the importance of a user-centered and iterative development process for psychological internet-based interventions. This process helps clarify user needs and provides valuable feedback on service design and quality, ultimately having the potential to enhance the utility and, presumably, the effectiveness of the intervention. The Discussion section shares valuable insights from the project, such as the value of the requirement sessions. %M 39159447 %R 10.2196/56319 %U https://formative.jmir.org/2024/1/e56319 %U https://doi.org/10.2196/56319 %U http://www.ncbi.nlm.nih.gov/pubmed/39159447 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47733 %T Identification of Motivational Determinants for Telemedicine Use Among Patients With Rheumatoid Arthritis in Germany: Secondary Analysis of Data From a Nationwide Cross-Sectional Survey Study %A Muehlensiepen,Felix %A Petit,Pascal %A Knitza,Johannes %A Welcker,Martin %A Vuillerme,Nicolas %+ Center for Health Services Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Seebad 82/83, Rüdersdorf bei Berlin, 16816, Germany, 49 15119126024, Felix.Muehlensiepen@mhb-fontane.de %K telemedicine %K rheumatoid arthritis %K rheumatology %K primary care %K health services research %K eHealth %K data analysis %K survey %K Germany %K tool %K care %K willingness %K sociodemographic %K age %K telehealth %K digital transition %D 2024 %7 19.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Previous studies have demonstrated telemedicine to be an effective tool to complement rheumatology care and address workforce shortage. With the COVID-19 outbreak, telemedicine experienced a massive upswing. An earlier analysis revealed that the motivation of patients with rheumatic and musculoskeletal diseases to use telemedicine is closely connected to their disease. It remains unclear which factors are associated with patients’ motivation to use telemedicine in certain rheumatic and musculoskeletal diseases groups, such as rheumatoid arthritis (RA). Objective: This study aims to identify factors that determine the willingness to try telemedicine among patients diagnosed with RA. Methods: We conducted a secondary analysis of data from a German nationwide cross-sectional survey among patients with RA. Bayesian univariate logistic regression analysis was applied to the data to determine which factors were associated with willingness to try telemedicine. Predictor variables (covariates) studied individually included sociodemographic factors (eg, age, sex) and health characteristics (eg, health status). All the variables positively and negatively associated with willingness to try telemedicine in the univariate analyses were then considered for Bayesian model averaging analysis after a selection based on the variance inflation factor (≤ 2.5) to identify determinants of willingness to try telemedicine. Results: Among 438 surveyed patients in the initial study, 210 were diagnosed with RA (47.9%). Among them, 146 (69.5%) answered either yes or no regarding willingness to try telemedicine and were included in the analysis. A total of 22 variables (22/55, 40%) were associated with willingness to try telemedicine (region of practical equivalence %≤5). A total of 9 determinant factors were identified using Bayesian model averaging analysis. Positive determinants included desiring telemedicine services provided by a rheumatologist (odds ratio [OR] 13.7, 95% CI 5.55-38.3), having prior knowledge of telemedicine (OR 2.91, 95% CI 1.46-6.28), residing in a town (OR 2.91, 95% CI 1.21-7.79) or city (OR 0.56, 95% CI 0.23-1.27), and perceiving one’s health status as moderate (OR 1.87, 95% CI 0.94-3.63). Negative determinants included the lack of an electronic device (OR 0.1, 95% CI 0.01-0.62), absence of home internet access (OR 0.1, 95% CI 0.02-0.39), self-assessment of health status as bad (OR 0.44, 95% CI 0.21-0.89) or very bad (OR 0.47, 95% CI 0.06-2.06), and being aged between 60 and 69 years (OR 0.48, 95% CI 0.22-1.04) or older than 70 years (OR 0.38, 95% CI 0.16-0.85). Conclusions: The results suggest that some patients with RA will not have access to telemedicine without further support. Older patients, those not living in towns, those without adequate internet access, reporting a bad health status, and those not owning electronic devices might be excluded from the digital transformation in rheumatology and might not have access to adequate RA care. These patient groups certainly require support for the use of digital rheumatology care. %M 39159448 %R 10.2196/47733 %U https://www.jmir.org/2024/1/e47733 %U https://doi.org/10.2196/47733 %U http://www.ncbi.nlm.nih.gov/pubmed/39159448 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e50978 %T Acceptance of a French e–Mental Health Information Website (CléPsy) for Families: A Web-Based Survey %A Landman,Benjamin %A Khoury,Elie %A Cohen,Alicia %A Trebossen,Vincent %A Michel,Alexandre %A Lefebvre,Aline %A Delorme,Richard %K mental health education %K children %K family %K child %K pediatrics %K pediatric %K mental health %K parent %K parents %K parenting %K psychiatry %K website %K acceptance %K patient education %K online information %K health information %K ease of use %K usefulness %K survey %K surveys %K user %K experience %K questionnaire %K questionnaires %K families %D 2024 %7 15.8.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Childhood mental health issues concern a large amount of children worldwide and represent a major public health challenge. The lack of knowledge among parents and caregivers in this area hinders effective management. Empowering families enhances their ability to address their children’s difficulties, boosts health literacy, and promotes positive changes. However, seeking reliable mental health information remains challenging due to fear, stigma, and mistrust of the sources of information. Objective: This study evaluates the acceptance of a website, CléPsy, designed to provide reliable information and practical tools for families concerned about child mental health and parenting. Methods: This study examines user characteristics and assesses ease of use, usefulness, trustworthiness, and attitude toward using the website. Platform users were given access to a self-administered questionnaire by means of mailing lists, social networks, and posters between May and July 2022. Results: Findings indicate that the wide majority of the 317 responders agreed or somewhat agreed that the website made discussions about mental health easier with professionals (n=264, 83.3%) or with their relatives (n=260, 82.1%). According to the ANOVA, there was a significant effect between educational level and perceived trust (F6=3.03; P=.007) and between frequency of use and perceived usefulness (F2=4.85; P=.008). Conclusions: The study underlines the importance of user experience and design in web-based health information dissemination and emphasizes the need for accessible and evidence-based information. Although the study has limitations, it provides preliminary support for the acceptability and usefulness of the website. Future efforts should focus on inclusive co-construction with users and addressing the information needs of families from diverse cultural and educational backgrounds. %R 10.2196/50978 %U https://pediatrics.jmir.org/2024/1/e50978 %U https://doi.org/10.2196/50978 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55535 %T Evaluation of the Quality and Readability of Web-Based Information Regarding Foreign Bodies of the Ear, Nose, and Throat: Qualitative Content Analysis %A Ko,Tsz Ki %A Tan,Denise Jia Yun %A Fan,Ka Siu %+ Department of Surgery, Royal Stoke Hospital, Newcastle Road, Stoke, United Kingdom, 44 7378977812, tszkiko95@gmail.com %K foreign body %K quality of internet information %K readability of internet information %K EQIP %K Ensuring Quality Information for Patients %K medical informatics %K readability %K readable %K health information %K online information %K information resource %K information resources %K website %K websites %K quality %K evaluation %K evaluations %K reading level %K grade level %D 2024 %7 15.8.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Foreign body (FB) inhalation, ingestion, and insertion account for 11% of emergency admissions for ear, nose, and throat conditions. Children are disproportionately affected, and urgent intervention may be needed to maintain airway patency and prevent blood vessel occlusion. High-quality, readable online information could help reduce poor outcomes from FBs. Objective: We aim to evaluate the quality and readability of available online health information relating to FBs. Methods: In total, 6 search phrases were queried using the Google search engine. For each search term, the first 30 results were captured. Websites in the English language and displaying health information were included. The provider and country of origin were recorded. The modified 36-item Ensuring Quality Information for Patients tool was used to assess information quality. Readability was assessed using a combination of tools: Flesch Reading Ease score, Flesch-Kincaid Grade Level, Gunning-Fog Index, and Simple Measure of Gobbledygook. Results: After the removal of duplicates, 73 websites were assessed, with the majority originating from the United States (n=46, 63%). Overall, the quality of the content was of moderate quality, with a median Ensuring Quality Information for Patients score of 21 (IQR 18-25, maximum 29) out of a maximum possible score of 36. Precautionary measures were not mentioned on 41% (n=30) of websites and 30% (n=22) did not identify disk batteries as a risky FB. Red flags necessitating urgent care were identified on 95% (n=69) of websites, with 89% (n=65) advising patients to seek medical attention and 38% (n=28) advising on safe FB removal. Readability scores (Flesch Reading Ease score=12.4, Flesch-Kincaid Grade Level=6.2, Gunning-Fog Index=6.5, and Simple Measure of Gobbledygook=5.9 years) showed most websites (56%) were below the recommended sixth-grade level. Conclusions: The current quality and readability of information regarding FBs is inadequate. More than half of the websites were above the recommended sixth-grade reading level, and important information regarding high-risk FBs such as disk batteries and magnets was frequently excluded. Strategies should be developed to improve access to high-quality information that informs patients and parents about risks and when to seek medical help. Strategies to promote high-quality websites in search results also have the potential to improve outcomes. %M 39145998 %R 10.2196/55535 %U https://formative.jmir.org/2024/1/e55535 %U https://doi.org/10.2196/55535 %U http://www.ncbi.nlm.nih.gov/pubmed/39145998 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57823 %T Digital Media Usage Behavior and Its Impact on the Physician-Patient Relationship: Cross-Sectional Study Among Individuals Affected by Psoriasis in Germany %A Erbas,Mert Ege %A Ziehfreund,Stefanie %A Wecker,Hannah %A Biedermann,Tilo %A Zink,Alexander %+ Department of Dermatology and Allergy, School of Medicine, Technical University of Munich, Biedersteiner Str 29, Munich, 80802, Germany, 49 8941403176, alexander.zink@tum.de %K psoriasis %K dermatology %K digital health %K digital media %K internet use %K questionnaire %K physician-patient relationship %D 2024 %7 7.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Psoriasis is a chronic skin disorder with a high burden of disease. People affected with psoriasis increasingly use the internet for health-related reasons, especially those with younger age, higher education, and higher disease severity. Despite advantages such as enhancing the individuals’ knowledge with the use of digital media for health-related issues, disadvantages were also present such as quality control, and variability in the individuals’ health information literacy. While patients with psoriasis within medical settings generally trust physicians over digital media, they commonly withhold their web-based research findings from health care providers. Objective: The study aims to (1) identify further factors associated with regular psoriasis-related internet use, (2) rank specific digital media platforms used, and (3) examine digital media within the physician-patient relationship among individuals with and without dermatological treatment. Methods: A cross-sectional, questionnaire-based study was conducted among individuals with self-reported psoriasis in Germany between September 2021 and February 2022. Participants were recruited via digital media platforms and in person at a University Hospital Department of Dermatology in southern Germany. The questionnaire asked about demographic and medical information, individual psoriasis-related digital media use, and the impact of digital media on the physician-patient relationship. Data were analyzed descriptively, and logistic regression models were performed to assess the factors associated with regular psoriasis-related internet use. Results: Among 321 individuals with a median age of 53 (IQR 41-61) years (nonnormally distributed; females: 195/321), female sex, shorter disease duration, moderate mental burden of disease, and good self-assessed psoriasis-related knowledge were associated with regular psoriasis-related internet use. Of the 188 participants with a mean age of 51.2 (SD 13.9) years (normally distributed) who used digital media 106 (56.4%) usually searched for information on psoriasis-based websites and 98 (52.1%) on search engines, primarily for obtaining information about the disease and therapy options, while social media were less frequently used (49/188, 26.1%). Nearly two-thirds of internet users (125/188) claimed that their physicians did not recommend digital media platforms. About 44% (82/188) of the individuals reported to seek for additional information due to the insufficient information provided by their physician. Conclusions: This study revealed the importance of digital media in the context of psoriasis, especially among women, individuals with shorter disease duration, and moderate mental disease severity. The lack of physicians’ digital media recommendations despite their patients’ desire to receive such and being more involved in health-related decisions seems to be a shortcoming within the physician-patient relationships. Physicians should guide their patients on digital media by recommending platforms with evidence-based information, thereby potentially creating an adequate framework for shared decision-making. Future research should focus on strategies to prevent the spread of false information on digital media and address the needs of patients and physicians to enhance health-related digital media offerings. %M 39110972 %R 10.2196/57823 %U https://www.jmir.org/2024/1/e57823 %U https://doi.org/10.2196/57823 %U http://www.ncbi.nlm.nih.gov/pubmed/39110972 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e56722 %T Online Delivery of Interprofessional Adverse Childhood Experiences Training to Rural Providers: Usability Study %A Kapp,Julie M %A Dicke,Rachel %A Quinn,Kathleen %K adverse childhood experiences %K ACE %K training %K trauma-informed care %K provider %K rural %K adverse %K trauma %K traumatic %K provider %K providers %K teaching %K curriculum %K curricula %K education %K educational %K social work %K social worker %K social workers %K psychologist %K psychologists %K counselor %K counselors %K interprofessional %K pediatric %K pediatrics %K paediatric %K paediatrics %K child %K children %K experience %K experiences %K continuing education %D 2024 %7 7.8.2024 %9 %J JMIR Pediatr Parent %G English %X Background: The population health burden of adverse childhood experiences (ACEs) reflects a critical need for evidence-based provider training. Rural children are also more likely than urban children to have any ACEs. A large proportion of providers are unaware of the detrimental effects of ACEs. There is a significant documented need for training providers about ACEs and trauma-informed care, in addition to a demand for that training. Objective: The objective was to develop, implement, and evaluate an online ACEs training curriculum tailored to Missouri providers, particularly those in rural areas given the higher prevalence of ACEs. Methods: From July 2021 to June 2022, we conducted literature reviews and environmental scans of training videos, partner organizations, clinical practice guidelines, and community-based resources to curate appropriate and tailored content for the course. We developed the ACEs training course in the Canvas learning platform (Instructure) with the assistance of an instructional designer and media designer. The course was certified for continuing medical education, as well as continuing education for licensed professional counselors, psychologists, and social workers. Recruitment occurred via key stakeholder email invitations and snowball recruitment. Results: Overall, 135 providers across Missouri requested enrollment, with 72.6% (n=98) enrolling and accessing the training. Of the latter, 49% (n=48) completed course requirements, with 100% of respondents agreeing that the content was relevant to their work, life, or practice; they intend to apply the content to their work, life, or practice; they feel confident to do so; and they would recommend the course to others. Qualitative responses supported active intent to translate knowledge into practice. Conclusions: This study demonstrated the feasibility, acceptability, and effectiveness of interprofessional workforce ACEs training. Robust interest statewide reflects recognition of the topic’s importance and intention to translate knowledge into practice. %R 10.2196/56722 %U https://pediatrics.jmir.org/2024/1/e56722 %U https://doi.org/10.2196/56722 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e57082 %T Application of an Adapted Health Action Process Approach Model to Predict Engagement With a Digital Mental Health Website: Cross-Sectional Study %A Rouvere,Julien %A Blanchard,Brittany E %A Johnson,Morgan %A Griffith Fillipo,Isabell %A Mosser,Brittany %A Romanelli,Meghan %A Nguyen,Theresa %A Rushton,Kevin %A Marion,John %A Althoff,Tim %A Areán,Patricia A %A Pullmann,Michael D %+ Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356560, Seattle, WA, 98195-6560, United States, 1 206 221 5498, rouvere@uw.edu %K Health Action Process Approach (HAPA) %K digital health %K health behavior %K Mental Health America (MHA) %K digital mental health engagement %K mental health website %D 2024 %7 7.8.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital Mental Health (DMH) tools are an effective, readily accessible, and affordable form of mental health support. However, sustained engagement with DMH is suboptimal, with limited research on DMH engagement. The Health Action Process Approach (HAPA) is an empirically supported theory of health behavior adoption and maintenance. Whether this model also explains DMH tool engagement remains unknown. Objective: This study examined whether an adapted HAPA model predicted engagement with DMH via a self-guided website. Methods: Visitors to the Mental Health America (MHA) website were invited to complete a brief survey measuring HAPA constructs. This cross-sectional study tested the adapted HAPA model with data collected using voluntary response sampling from 16,078 sessions (15,619 unique IP addresses from United States residents) on the MHA website from October 2021 through February 2022. Model fit was examined via structural equation modeling in predicting two engagement outcomes: (1) choice to engage with DMH (ie, spending 3 or more seconds on an MHA page, excluding screening pages) and (2) level of engagement (ie, time spent on MHA pages and number of pages visited, both excluding screening pages). Results: Participants chose to engage with the MHA website in 94.3% (15,161/16,078) of the sessions. Perceived need (β=.66; P<.001), outcome expectancies (β=.49; P<.001), self-efficacy (β=.44; P<.001), and perceived risk (β=.17-.18; P<.001) significantly predicted intention, and intention (β=.77; P<.001) significantly predicted planning. Planning was not significantly associated with choice to engage (β=.03; P=.18). Within participants who chose to engage, the association between planning with level of engagement was statistically significant (β=.12; P<.001). Model fit indices for both engagement outcomes were poor, with the adapted HAPA model accounting for only 0.1% and 1.4% of the variance in choice to engage and level of engagement, respectively. Conclusions: Our data suggest that the HAPA model did not predict engagement with DMH via a self-guided website. More research is needed to identify appropriate theoretical frameworks and practical strategies (eg, digital design) to optimize DMH tool engagement. %M 39110965 %R 10.2196/57082 %U https://humanfactors.jmir.org/2024/1/e57082 %U https://doi.org/10.2196/57082 %U http://www.ncbi.nlm.nih.gov/pubmed/39110965 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54032 %T Capturing Usability Problems for People Living With Dementia by Applying the DEMIGNED Principles in Usability Evaluation Methods: Mixed Methods Study %A Engelsma,Thomas %A Heijmink,Simone %A Hendriksen,Heleen M A %A Visser,Leonie N C %A Lemstra,Afina W %A Jaspers,Monique W M %A Peute,Linda W P %+ eHealth Living & Learning Lab Amsterdam, Department of Medical Informatics, Amsterdam UMC, location University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, Netherlands, 31 657570009, t.engelsma@amsterdamumc.nl %K dementia %K design principles %K digital health %K memory clinic %K usability evaluation %K mobile phone %D 2024 %7 31.7.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Dementia-related impairments can cause complex barriers to access, use, and adopt digital health technologies (DHTs). These barriers can contribute to digital health inequities. Therefore, literature-based design principles called DEMIGNED have been developed to support the design and evaluation of DHTs for this rapidly increasing population. Objective: This study aims to apply the DEMIGNED principles in usability evaluation methods to (1) capture usability problems on a mobile website providing information resources for people visiting a memory clinic, including those living with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia, and (2) investigate the realness of usability problems captured by the DEMIGNED principles in expert testing, specifically for mobile websites that act as a means of providing DHTs. Methods: First, a heuristic evaluation was conducted, with the DEMIGNED principles serving as domain-specific guidelines, with 3 double experts (experienced in both usability and dementia) and 2 usability engineering experts. Second, think-aloud sessions were conducted with patients visiting a memory clinic who were living with SCD, MCI, or dementia. Results: The heuristic evaluation resulted in 36 unique usability problems. A representative sample of 7 people visiting a memory clinic participated in a think-aloud session, including 4 (57%) with SCD, 1 (14%) with MCI, and 2 (29%) with dementia. The analysis of the think-aloud sessions revealed 181 encounters with usability problems. Of these encounters, 144 (79.6%) could be mapped to 18 usability problems identified in the heuristic evaluation. The remaining 37 (20.4%) encounters from the user testing revealed another 10 unique usability problems. Usability problems frequently described in the think-aloud sessions encompassed difficulties with using the search function, discrepancies between the user’s expectations and the content organization, the need for scrolling, information overload, and unclear system feedback. Conclusions: By applying the DEMIGNED principles in expert testing, evaluators were able to capture 79.6% (144/181) of all usability problem encounters in the user testing of a mobile website for people visiting a memory clinic, including people living with dementia. Regarding unique usability problems, 50% (18/36) of the unique usability problems identified during the heuristic evaluation were captured by the user-testing sessions. Future research should look into the applicability of the DEMIGNED principles to other digital health functionalities to increase the accessibility of digital health and decrease digital health inequity for this complex and rapidly increasing population. %M 39083790 %R 10.2196/54032 %U https://humanfactors.jmir.org/2024/1/e54032 %U https://doi.org/10.2196/54032 %U http://www.ncbi.nlm.nih.gov/pubmed/39083790 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57586 %T Training Service Users in the Use of Telehealth: Scoping Review %A Galvin,Emer %A Desselle,Shane %A Gavin,Blánaid %A McNicholas,Fiona %A Cullinan,Shane %A Hayden,John %+ School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, 111 St Stephen's Green, Dublin, D02 YN77, Ireland, 353 1 402 2100, emergalvin20@rcsi.ie %K telehealth %K video consultations %K training %K education %K older adults %K digital divide %K digital literacy %K review %K scoping review %K modality of care %K training service %K user %K users %K older adult %K gerontology %K geriatric %K geriatrics %K caregiver %K caregivers %K consultation %K consultations %K health care professional %K health care professionals %K PRISMA-ScR %K Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews %K data extraction %K phone %K phones %K telemonitoring %D 2024 %7 31.7.2024 %9 Review %J J Med Internet Res %G English %X Background: The use of telehealth has rapidly increased, yet some populations may be disproportionally excluded from accessing and using this modality of care. Training service users in telehealth may increase accessibility for certain groups. The extent and nature of these training activities have not been explored. Objective: The objective of this scoping review is to identify and describe activities for training service users in the use of telehealth. Methods: Five databases (MEDLINE [via PubMed], Embase, CINAHL, PsycINFO, and Web of Science) were searched in June 2023. Studies that described activities to train service users in the use of synchronous telehealth consultations were eligible for inclusion. Studies that focused on health care professional education were excluded. Papers were limited to those published in the English language. The review followed the Joanna Briggs Institute guidelines for scoping reviews and was reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Titles and abstracts were screened by 1 reviewer (EG). Full texts were screened by 2 reviewers (EG and JH or SC). Data extraction was guided by the research question. Results: The search identified 8087 unique publications. In total, 13 studies met the inclusion criteria. Telehealth training was commonly described as once-off preparatory phone calls to service users before a telehealth visit, facilitated primarily by student volunteers, and accompanied by written instructions. The training content included guidance on how to download and install software, troubleshoot technical issues, and adjust device settings. Older adults were the most common target population for the training. All but 1 of the studies were conducted during the COVID-19 pandemic. Overall, training was feasible and well-received by service users, and studies mostly reported increased rates of video visits following training. There was limited and mixed evidence that training improved participants’ competency with telehealth. Conclusions: The review mapped the literature on training activities for service users in telehealth. The common features of telehealth training for service users included once-off preparatory phone calls on the technical elements of telehealth, targeted at older adults. Key issues for consideration include the need for co-designed training and improving the broader digital skills of service users. There is a need for further studies to evaluate the outcomes of telehealth training activities in geographically diverse areas. %M 39083789 %R 10.2196/57586 %U https://www.jmir.org/2024/1/e57586 %U https://doi.org/10.2196/57586 %U http://www.ncbi.nlm.nih.gov/pubmed/39083789 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51672 %T Examining the Role of Physician Characteristics in Web-Based Verified Primary Care Physician Reviews: Observational Study %A Sehgal,Neil K R %A Rader,Benjamin %A Brownstein,John S %+ Department of Computer and Information Science, University of Pennsylvania, 3330 Walnut St, Philadelphia, PA, 19104, United States, 1 215 898 9672, neilsehgal99@gmail.com %K patient review websites %K patient online review %K telemedicine %K internet %K online review %K online reviews %K rating %K physician review %K physician reviews %K doctor review %K doctor reviews %D 2024 %7 29.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Doctor review websites have become increasingly popular as a source of information for patients looking to select a primary care provider. Zocdoc is one such platform that allows patients to not only rate and review their experiences with doctors but also directly schedule appointments. This study examines how several physician characteristics including gender, age, race, languages spoken in a physician’s office, education, and facial attractiveness impact the average numerical rating of primary care doctors on Zocdoc. Objective: The aim of this study was to investigate the association between physician characteristics and patient satisfaction ratings on Zocdoc. Methods: A data set of 1455 primary care doctor profiles across 30 cities was scraped from Zocdoc. The profiles contained information on the physician’s gender, education, and languages spoken in their office. Age, facial attractiveness, and race were imputed from profile pictures using commercial facial analysis software. Each doctor profile listed an average overall satisfaction rating, bedside manner rating, and wait time rating from verified patients. Descriptive statistics, the Wilcoxon rank sum test, and multivariate logistic regression were used to analyze the data. Results: The average overall rating on Zocdoc was highly positive, with older age, lower facial attractiveness, foreign degrees, allopathic degrees, and speaking more languages negatively associated with the average rating. However, the effect sizes of these factors were relatively small. For example, graduates of Latin American medical schools had a mean overall rating of 4.63 compared to a 4.77 rating for US graduates (P<.001), a difference roughly equivalent to a 2.8% decrease in appointments. On multivariate analysis, being Asian and having a doctor of osteopathic medicine degree were positively associated with higher overall ratings, while attending a South Asian medical school and speaking more European and Middle Eastern languages in the office were negatively associated with higher overall ratings. Conclusions: Overall, the findings suggest that age, facial attractiveness, education, and multilingualism do have some impact on web-based doctor reviews, but the numerical effect is small. Notably, bias may play out in many forms. For example, a physician's appearance or accent may impact a patient's trust, confidence, or satisfaction with their physician, which could in turn influence their take-up of preventative services and lead to either better or worse health outcomes. The study highlights the need for further research in how physician characteristics influence patient ratings of care. %M 39074363 %R 10.2196/51672 %U https://www.jmir.org/2024/1/e51672 %U https://doi.org/10.2196/51672 %U http://www.ncbi.nlm.nih.gov/pubmed/39074363 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e54117 %T Digital Adherence Technologies and Differentiated Care for Tuberculosis Treatment and Their Acceptability Among Persons With Tuberculosis, Health Care Workers, and Key Informants in the Philippines: Qualitative Interview Study %A Leung,Chung Lam %A Alacapa,Jason %A Tasca,Bianca Gonçalves %A Villanueva,Andre Daniel %A Masulit,Saniata %A Ignacio,Marvin Louie %A Uy,Kathleen Nicole %A Pell,Christopher %A van Kalmthout,Kristian %A Powers,Rachel %A Fielding,Katherine %A Jerene,Degu %+ KNCV Tuberculosis Foundation, Maanweg 174, Den Haag, 2516AB, Netherlands, 31 070 416 7222, adrian.leung@kncvtbc.org %K tuberculosis %K digital adherence technologies %K implementation %K acceptability %K qualitative research %K Philippines %K digital health %K tuberculosis treatment %K support strategy %K support %K medication adherence %K health care workers %K interview %K interviews %K user %K user privacy %K privacy %K digital adherence %D 2024 %7 23.7.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital adherence technologies (DATs) are being studied to determine their potential to support tuberculosis (TB) treatment and address the shortcomings of directly observed therapy. Previous research has shown inconclusive results on whether DATs can enhance medication adherence among persons with TB. Objective: This study aims to understand the acceptability of DATs, namely, medication labels and smart pillboxes, among persons with TB, health care workers (HCWs), and key informants (KIs) in the Philippines. The objective is to gain valuable insights that can inform the design and implementation of DATs in the Southeast Asian region, which meet the needs and preferences of end users. Methods: Persons with TB, HCWs, and KIs were recruited from intervention facilities to participate in in-depth interviews conducted between March 2022 and January 2023. These interviews were transcribed and translated into English. A thematic analysis was carried out using NVivo software (Lumivero) to identify and analyze themes. Themes were then structured within a modified social-ecological model. Results: A total of 25 persons with drug-sensitive TB and 20 HCWs or KIs were interviewed. Both groups emphasized that users’ technology literacy level, financial conditions, and motivation to be cured determined how they interacted with the DAT. They also acknowledged that DATs helped foster their relationship with HCWs and enabled efficient treatment support. Concerning technology, persons with TB found DATs easy to use and able to reduce clinic visits. HCWs mentioned that DATs added to their workload but also allowed them to support users who missed doses. However, both groups experienced technical challenges with DATs. Regarding program implementation, users appreciated the clear explanations and demonstrations provided by HCWs. Yet, some users reported inconsistencies between DAT settings and the information provided. HCWs stressed the importance of comprehensive training and sufficient resources for effective program implementation in the future. At the community level, both groups noted that DATs and program design protected users’ privacy and reduced the risk of stigma. Finally, users and HCWs shared various contextual factors that influenced their experience with DAT, including infrastructure challenges and the impact of the COVID-19 pandemic. Conclusions: In the Philippines, persons with TB and HCWs showed a high level of acceptance and satisfaction with the impact of DAT and program design. They expressed a desire for the continuation of DATs. The challenges encountered underscore the need for ongoing technological development to minimize malfunctions, enhance the capacity of health facilities, and improve infrastructure. DATs have demonstrated their ability to strengthen user-HCW relationships and protect users from stigmatization. Additional efforts are required to scale up the DAT program in the Philippines. %M 39042889 %R 10.2196/54117 %U https://humanfactors.jmir.org/2024/1/e54117 %U https://doi.org/10.2196/54117 %U http://www.ncbi.nlm.nih.gov/pubmed/39042889 %0 Journal Article %@ 2292-9495 %I %V 11 %N %P e52496 %T Using a Human-Centered Design Process to Evaluate and Optimize User Experience of a Website (InPACT at Home) to Promote Youth Physical Activity: Case Study %A Hasson,Rebecca E %A Xie,Michelle %A Tadikamalla,Dhiraj %A Beemer,Lexie R %K web-based interventions %K children %K adolescents %K child %K adolescent %K youth %K user experience %K website %K websites %K implementation science %K human-centered design %K human-centred design %K HCD %K web based %K home based %K interview %K heuristics %K interviews %K heuristic %K competitive analysis %K video %K videos %K YouTube %K physical activity %K exercise %K fitness %D 2024 %7 15.7.2024 %9 %J JMIR Hum Factors %G English %X Background: Web-based physical activity interventions often fail to reach the anticipated public health impact due to insufficient use by the intended audiences. Objective: The purpose of this study was to use a human-centered design process to optimize the user experience of the Interrupting Prolonged sitting with ACTivity (InPACT) at Home website to promote youth physical activity participation. Methods: Qualitative interviews were conducted to assess engagement and pain points with the InPACT at Home website. Interview data were used to create affinity maps to identify themes of user responses, conduct a heuristic evaluation according to Nielsen’s usability heuristics framework, and complete a competitive analysis to identify the strengths and weaknesses of competitors who offered similar products. Results: Key themes from end user interviews included liking the website design, finding the website difficult to navigate, and wanting additional features (eg, library of watched videos). The website usability issues identified were lack of labeling and categorization of exercise videos, hidden necessary actions and options hindering users from decision-making, error-prone conditions, and high cognitive load of the website. Competitive analysis results revealed that YouTube received the highest usability ratings followed by the Just Dance and Presidential Youth Fitness Program websites. Conclusions: Human-centered design approaches are useful for bringing end users and developers together to optimize user experience and impact public health. Future research is needed to examine the effectiveness of the InPACT at Home website redesign to attract new users and retain current users, with the end goal of increasing youth physical activity engagement. %R 10.2196/52496 %U https://humanfactors.jmir.org/2024/1/e52496 %U https://doi.org/10.2196/52496 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56608 %T Web-Based Group Conversational Intervention on Cognitive Function and Comprehensive Functional Status Among Japanese Older Adults: Protocol for a 6-Month Randomized Controlled Trial %A Miura,Kumi Watanabe %A Kudo,Takashi %A Otake-Matsuura,Mihoko %+ Center for Advanced Intelligence Project, RIKEN, Nihonbashi 1-chome Mitsui Building, 15th floor 1-4-1 Nihonbashi, Tokyo, 103-0027, Japan, 81 3 6225 2482, mihoko.otake@riken.jp %K randomized controlled trial %K web-based intervention %K communication technology %K cognitive health %K neural blood markers %K social isolation %K well-being %D 2024 %7 11.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social communication is a key factor in maintaining cognitive function and contributes to well-being in later life. Objective: This study will examine the effects of “Photo-Integrated Conversation Moderated by Application version 2” (PICMOA-2), which is a web-based conversational intervention, on cognitive performance, frailty, and social and psychological indicators among community-dwelling older adults. Methods: This study is a randomized controlled trial with an open-label, 2-parallel group trial and 1:1 allocation design. Community dwellers aged 65 years and older were enrolled in the trial and divided into the intervention and control groups. The intervention group receives the PICMOA-2 program, a web-based group conversation, once every 2 weeks for 6 months. The primary outcome is verbal fluency, including phonemic and semantic fluency. The secondary outcomes are other neuropsychiatric batteries, including the Mini-Mental State Examination, Logical Memory (immediate and delay), verbal paired associates, and comprehensive functional status evaluated by questionnaires, including frailty, social status, and well-being. The effect of the intervention will be examined using a mixed linear model. As a secondary aim, we will test whether the intervention effects vary with the covariates at baseline to examine the effective target attributes. Results: Recruitment was completed in July 2023. A total of 66 participants were randomly allocated to intervention or control groups. As of January 1, 2024, the intervention is ongoing. Participants are expected to complete the intervention at the end of February 2024, and the postintervention evaluation will be conducted in March 2024. Conclusions: This protocol outlines the randomized controlled trial study design evaluating the effect of a 6-month intervention with PICMOA-2. This study will provide evidence on the effectiveness of social interventions on cognitive function and identify effective target images for remote social intervention. Trial Registration: UMIN Clinical Trials UMIN000050877; https://tinyurl.com/5eahsy66 International Registered Report Identifier (IRRID): DERR1-10.2196/56608 %M 38990615 %R 10.2196/56608 %U https://www.researchprotocols.org/2024/1/e56608 %U https://doi.org/10.2196/56608 %U http://www.ncbi.nlm.nih.gov/pubmed/38990615 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e47785 %T Interactive Health Technology Tool for Kidney Living Donor Assessment to Standardize the Informed Consent Process: Usability and Qualitative Content Analysis %A Ortiz,Fernanda %A Grasberger,Juulia %A Ekstrand,Agneta %A Helanterä,Ilkka %A Giunti,Guido %+ Abdominal Center–Nephrology, Helsinki University Hospital, Haartmaninkatu 4, Helsinki, 00130, Finland, 358 504270795, fernanda.ortiz@hus.fi %K eHealth %K kidney living donor %K informed consent %K telemedicine %K process standardization %K kidney %K donor %K tool %K usability %K psychological impact %K utility %K smartphone %K coping %K surgery %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Kidney living donation carries risks, yet standardized information provision regarding nephrectomy risks and psychological impacts for candidates remains lacking. Objective: This study assesses the benefit of interactive health technology in improving the informed consent process for kidney living donation. Methods: The Kidney Hub institutional open portal offers comprehensive information on kidney disease and donation. Individuals willing to start the kidney living donation process at Helsinki University Hospital (January 2019-January 2022) were invited to use the patient-tailored digital care path (Living Donor Digital Care Path) included in the Kidney Hub. This platform provides detailed donation process information and facilitates communication between health care professionals and patients. eHealth literacy was evaluated via the eHealth Literacy Scale (eHEALS), usability with the System Usability Scale (SUS), and system utility through Likert-scale surveys with scores of 1-5. Qualitative content analysis addressed an open-ended question. Results: The Kidney Hub portal received over 8000 monthly visits, including to its sections on donation benefits (n=1629 views) and impact on donors’ lives (n=4850 views). Of 127 living kidney donation candidates, 7 did not use Living Donor Digital Care Path. Users’ ages ranged from 20 to 79 years, and they exchanged over 3500 messages. A total of 74 living donor candidates participated in the survey. Female candidates more commonly searched the internet about kidney donation (n=79 female candidates vs n=48 male candidates; P=.04). The mean eHEALS score correlated with internet use for health decisions (r=0.45; P<.001) and its importance (r=0.40; P=.01). Participants found that the Living Donor Digital Care Path was technically satisfactory (mean SUS score 4.4, SD 0.54) and useful but not pivotal in donation decision-making. Concerns focused on postsurgery coping for donors and recipients. Conclusions: Telemedicine effectively educates living kidney donor candidates on the donation process. The Living Donor Digital Care Path serves as a valuable eHealth tool, aiding clinicians in standardizing steps toward informed consent. Trial Registration: ClinicalTrials.gov NCT04791670; https://clinicaltrials.gov/study/NCT04791670 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-051166 %M 38981119 %R 10.2196/47785 %U https://formative.jmir.org/2024/1/e47785 %U https://doi.org/10.2196/47785 %U http://www.ncbi.nlm.nih.gov/pubmed/38981119 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55130 %T Cultural and Contextual Adaptation of Digital Health Interventions: Narrative Review %A Naderbagi,Aila %A Loblay,Victoria %A Zahed,Iqthyer Uddin Md %A Ekambareshwar,Mahalakshmi %A Poulsen,Adam %A Song,Yun J C %A Ospina-Pinillos,Laura %A Krausz,Michael %A Mamdouh Kamel,Mostafa %A Hickie,Ian B %A LaMonica,Haley M %+ Brain and Mind Centre, The University of Sydney, 94 Mallett Street, Sydney NSW, 2050, Australia, 61 0426955658, haley.lamonica@sydney.edu.au %K cultural adaptation %K digital health %K context %K translation %K participatory research %K mobile phone %D 2024 %7 9.7.2024 %9 Review %J J Med Internet Res %G English %X Background: Emerging evidence suggests that positive impacts can be generated when digital health interventions are designed to be responsive to the cultural and socioeconomic context of their intended audiences. Objective: This narrative review aims to synthesize the literature about the cultural adaptation of digital health interventions. It examines how concepts of culture and context feature in design and development processes, including the methods, models, and content of these interventions, with the aim of helping researchers to make informed decisions about how to approach cultural adaptation in digital health. Methods: Literature searches for this narrative review were conducted across 4 databases. Following full-text article screening by 2 authors, 16 studies of interventions predominantly focused on the self-management of health were selected based on their detailed focus on the process of cultural adaptation. Key considerations for cultural adaptation were identified and synthesized through a qualitative narrative approach, enabling an integrative and in-depth understanding of cultural adaptation. Results: The literature demonstrates varying approaches and levels of cultural adaptation across stages of intervention development, involving considerations such as the research ethos orienting researchers, the methodologies and models used, and the resultant content adaptations. In relation to the latter, culturally appropriate and accessible user interface design and translation can be seen as particularly important in shaping the level of adaptation. Conclusions: Optimizing cultural adaptation involves linking culture with other contextual factors such as economic conditions and social systems to ensure accessibility and the sustained use of digital health interventions. Culturally humble approaches that use the involvement of a broad range of participants, experts, and other stakeholders are demonstrated to spark vital insights for content development, implementation, and evaluation. %M 38980719 %R 10.2196/55130 %U https://www.jmir.org/2024/1/e55130 %U https://doi.org/10.2196/55130 %U http://www.ncbi.nlm.nih.gov/pubmed/38980719 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56716 %T Patient and Provider Satisfaction With a Geomapping Tool for Finding Community Family Physicians in Ontario, Canada: Cross-Sectional Online Survey Study %A Belanger,Christopher %A Peixoto,Cayden %A Francoeur,Sara %A Bjerre,Lise M %+ Institut du Savoir Montfort, 713 Montréal Rd, Ottawa, ON, K1K 0T2, Canada, 1 613 746 4621, lbjerre@uottawa.ca %K primary care %K language-concordant care %K web-based maps %K maps %K physicians %K experience %K language %K access %K accessibility %D 2024 %7 9.7.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Language-concordant health care, or health care in a patient’s language of choice, is an important element of health accessibility that improves patient safety and comfort and facilitates an increased quality of care. However, prior research has found that linguistic minorities often face higher travel burdens to access language-concordant care compared to the general population. Objective: This study intended to assess patient experiences and satisfaction with an online interactive physician map that allows patients to find family physicians who speak their preferred language in and around Ottawa, Ontario, Canada, as a means of identifying areas of improvement. Methods: This study used an online survey with questions related to user satisfaction. Responses to Likert-scale questions were compiled as summary statistics and short-answer responses underwent thematic analysis. The study setting was Ottawa and Renfrew County, Ontario, and the surrounding region, including the province of Quebec. Results: A total of 93 respondents completed the survey and self-identified as living in Ontario or Quebec. Overall, 57 (61%) respondents were “very satisfied” or “somewhat satisfied” with the map, 16 (17%) were “neither satisfied nor dissatisfied,” and 20 (22%) were “very dissatisfied” or “somewhat dissatisfied.” We found no significant differences in satisfaction by preferred language, age group, physician attachment, or intended beneficiary. A total of 56 respondents provided short-answer responses to an open-ended question about map improvements. The most common specific suggestion was to show which physicians are accepting new patients (n=20). Other suggestions included data refreshes (n=6), user interface adjustments (n=23), and additional languages (n=2). Some participants also provided positive feedback (n=5) or expressed concern with their inability to find a family physician (n=5). Several comments included multiple suggestions. Conclusions: While most patients were satisfied with the online map, a significant minority expressed dissatisfaction that the map did not show which family physicians were accepting new patients. This suggests that there may be public interest in an accessible database of which family physicians in Ontario are currently accepting new patients. %M 38980717 %R 10.2196/56716 %U https://formative.jmir.org/2024/1/e56716 %U https://doi.org/10.2196/56716 %U http://www.ncbi.nlm.nih.gov/pubmed/38980717 %0 Journal Article %@ 2292-9495 %I %V 11 %N %P e54532 %T A/B Testing of User Enrollment Forms to Enhance Diversity in the Biomedical Workforce via the National Research Mentoring Network: User-Centered Design Case Study %A Syed,Toufeeq Ahmed %A Thompson,Erika L %A Johnson,Jason %A Latif,Zainab %A Kennedy,Nan %A Javier,Damaris %A Stinson,Katie %A Vishwanatha,Jamboor K %K diversity %K mentoring %K health workforce %K underrepresented groups %K online platform %K user-computer interface %K A/B testing %K split testing %K recommendation algorithm %K network of mentors %K groups %K enrollment %D 2024 %7 2.7.2024 %9 %J JMIR Hum Factors %G English %X Background: The National Research Mentoring Network (NRMN) is a National Institutes of Health–funded program for diversifying the science, technology, engineering, math, and medicine research workforce through the provision of mentoring, networking, and professional development resources. The NRMN provides mentoring resources to members through its online platform—MyNRMN. Objective: MyNRMN helps members build a network of mentors. Our goal was to expand enrollment and mentoring connections, especially among those who have been historically underrepresented in biomedical training and the biomedical workforce. Methods: To improve the ease of enrollment, we implemented the split testing of iterations of our user interface for platform registration. To increase mentoring connections, we developed multiple features that facilitate connecting via different pathways. Results: Our improved user interface yielded significantly higher rates of completed registrations (P<.001). Our analysis showed improvement in completed enrollments that used the version 1 form when compared to those that used the legacy form (odds ratio 1.52, 95% CI 1.30-1.78). The version 2 form, with its simplified, 1-step process and fewer required fields, outperformed the legacy form (odds ratio 2.18, 95% CI 1.90-2.50). By improving the enrollment form, the rate of MyNRMN enrollment completion increased from 57.3% (784/1368) with the legacy form to 74.5% (2016/2706) with the version 2 form. Our newly developed features delivered an increase in connections between members. Conclusions: Our technical efforts expanded MyNRMN’s membership base and increased connections between members. Other platform development teams can learn from these efforts to increase enrollment among underrepresented groups and foster continuing, successful engagement. %R 10.2196/54532 %U https://humanfactors.jmir.org/2024/1/e54532 %U https://doi.org/10.2196/54532 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53334 %T Issues Related to the Use of Visual Social Networks and Perceived Usefulness of Social Media Literacy During the Recovery Phase: Qualitative Research Among Girls With Eating Disorders %A Faccio,Elena %A Reggiani,Margherita %A Rocelli,Michele %A Cipolletta,Sabrina %+ Department of Philosophy, Sociology, Education and Applied Psychology, University of Padova, Via Venezia 14, 35131, Padua, 35131, Italy, 39 3479607182, elena.faccio@unipd.it %K visual social networks %K body image %K eating disorders %K risks %K potentials %K social networks %K social network %K social media %K literacy %K food intake %K appetite disorders %K appetite disorder %K eating disorder %K patient safety %K patient-centered approach %K recovery %K body comparison %K users %K semistructured interviews %K semistructured interview %K girls %K adolescent %K adolescents %K content analysis %K online %D 2024 %7 2.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The patient-centered approach is essential for quality health care and patient safety. Understanding the service user’s perspective on the factors maintaining the health problem is crucial for successful treatment, especially for patients who do not recognize their condition as clinically relevant or concerning. Despite the association between intensive use of visual social media and body dissatisfaction and eating disorders, little is known about the meanings users assign to posting or searching for edited photos and the strategies they use to protect themselves from digital risks. Objective: This study aims to examine how young women recovering from eating disorders in Northern Italy perceive the health risks and potential benefits associated with visual social networks (ie, Instagram and Snapchat). The literature has found these platforms to be detrimental to online body comparisons. It also explores the perceived usefulness, willingness, and personal interest in coconstructing social media literacy programs with girls recovering from eating disorders. Methods: A total of 30 semistructured interviews were conducted with adolescent girls aged 14-17 years at the end of their treatment for eating disorders. The following areas of research were addressed: (1) the meanings associated with the use of Instagram and Snapchat; (2) the investment in the photographic dimension and feedback; (3) the impact of visual social networks on body experiences; (4) the potential and risks perceived in their use; (5) the importance of supporting girls undergoing treatment for eating disorders in using social networks; and (6) the usefulness and willingness to co-design social network literacy programs. Content analysis was applied. Results: A total of 7 main contents emerged: active or passive role in using social networks, the impact of online interactions on body image, investment in the photographic dimension, effects on self-representation, perceived risks, self-protective strategies, and potential benefits. The findings highlight a strong awareness of the processes that trigger body comparisons in the virtual context, creating insecurity and worsening the relationship with oneself. The self-protective behaviors identified are the development of critical thinking, the avoidance of sensitive content, increased control over social networking site use, and a certain skepticism toward developing antagonistic ideologies. All these topics were considered fundamental. Conclusions: The findings provide important insights for health professionals working with youth in preparing media literacy programs. These programs aim to reduce potential risks and amplify the positive effects of online resources. They underscore the importance of addressing this issue during hospitalization to develop skills and critical thinking aimed at changing small habits that perpetuate the problem in everyday life. The inherent limitations in current service practices, which may not adequately address individual needs or impact posttreatment life, must also be considered. %M 38954459 %R 10.2196/53334 %U https://www.jmir.org/2024/1/e53334 %U https://doi.org/10.2196/53334 %U http://www.ncbi.nlm.nih.gov/pubmed/38954459 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58551 %T Real-World Evidence From a Digital Health Treatment Program for Female Urinary Incontinence: Observational Study of Outcomes Following User-Centered Product Design %A Hall,Evelyn %A Keyser,Laura %A McKinney,Jessica %A Pulliam,Samantha %A Weinstein,Milena %+ Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, 1500 Owens Street, Ste 400, San Francisco, CA, 94158, United States, 1 866 657 5382, laura.keyser@ucsf.edu %K urinary incontinence %K digital health %K pelvic floor muscle training %K real-world %K evidence %K user-centered design %K mobile phone %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Urinary incontinence (UI) affects millions of women with substantial health and quality-of-life impacts. Supervised pelvic floor muscle training (PFMT) is the recommended first-line treatment. However, multiple individual and institutional barriers impede women’s access to skilled care. Evidence suggests that digital health solutions are acceptable and may be effective in delivering first-line incontinence treatment, although these technologies have not yet been leveraged at scale. Objective: The primary objective is to describe the effectiveness and safety of a prescribed digital health treatment program to guide PFMT for UI treatment among real-world users. The secondary objectives are to evaluate patient engagement following an updated user platform and identify the factors predictive of success. Methods: This retrospective cohort study of women who initiated device use between January 1, 2022, and June 30, 2023, included users aged ≥18 years old with a diagnosis of stress, urgency, or mixed incontinence or a score of >33.3 points on the Urogenital Distress Inventory Short Form (UDI-6). Users are prescribed a 2.5-minute, twice-daily, training program guided by an intravaginal, motion-based device that pairs with a smartphone app. Data collected by the device or app include patient-reported demographics and outcomes, adherence to the twice-daily regimen, and pelvic floor muscle performance parameters, including angle change and hold time. Symptom improvement was assessed by the UDI-6 score change from baseline to the most recent score using paired 2-tailed t tests. Factors associated with meeting the UDI-6 minimum clinically important difference were evaluated by regression analysis. Results: Of 1419 users, 947 met inclusion criteria and provided data for analysis. The mean baseline UDI-6 score was 46.8 (SD 19.3), and the mean UDI-6 score change was 11.3 (SD 19.9; P<.001). Improvement was reported by 74% (697/947) and was similar across age, BMI, and incontinence subtype. Mean adherence was 89% (mean 12.5, SD 2.1 of 14 possible weekly uses) over 12 weeks. Those who used the device ≥10 times per week were more likely to achieve symptom improvement. In multivariate logistic regression analysis, baseline incontinence symptom severity and maximum angle change during pelvic floor muscle contraction were significantly associated with meeting the UDI-6 minimum clinically important difference. Age, BMI, and UI subtype were not associated. Conclusions: This study provides real-world evidence to support the effectiveness and safety of a prescribed digital health treatment program for female UI. A digital PFMT program completed with visual guidance from a motion-based device yields significant results when executed ≥10 times per week over a period of 12 weeks. The program demonstrates high user engagement, with 92.9% (880/947) of users adhering to the prescribed training regimen. First-line incontinence treatment, when implemented using this digital program, leads to statistically and clinically substantial symptom improvements across age and BMI categories and incontinence subtypes. %R 10.2196/58551 %U https://formative.jmir.org/2024/1/e58551 %U https://doi.org/10.2196/58551 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50182 %T Developing a Chatbot to Support Individuals With Neurodevelopmental Disorders: Tutorial %A Singla,Ashwani %A Khanna,Ritvik %A Kaur,Manpreet %A Kelm,Karen %A Zaiane,Osmar %A Rosenfelt,Cory Scott %A Bui,Truong An %A Rezaei,Navid %A Nicholas,David %A Reformat,Marek Z %A Majnemer,Annette %A Ogourtsova,Tatiana %A Bolduc,Francois %+ Department of Pediatrics, University of Alberta, 11315 87th Avenue, Edmonton, AB, T6G 2E1, Canada, 1 780 492 9713, fbolduc@ualberta.ca %K chatbot %K user interface %K knowledge graph %K neurodevelopmental disability %K autism %K intellectual disability %K attention-deficit/hyperactivity disorder %D 2024 %7 18.6.2024 %9 Tutorial %J J Med Internet Res %G English %X Families of individuals with neurodevelopmental disabilities or differences (NDDs) often struggle to find reliable health information on the web. NDDs encompass various conditions affecting up to 14% of children in high-income countries, and most individuals present with complex phenotypes and related conditions. It is challenging for their families to develop literacy solely by searching information on the internet. While in-person coaching can enhance care, it is only available to a minority of those with NDDs. Chatbots, or computer programs that simulate conversation, have emerged in the commercial sector as useful tools for answering questions, but their use in health care remains limited. To address this challenge, the researchers developed a chatbot named CAMI (Coaching Assistant for Medical/Health Information) that can provide information about trusted resources covering core knowledge and services relevant to families of individuals with NDDs. The chatbot was developed, in collaboration with individuals with lived experience, to provide information about trusted resources covering core knowledge and services that may be of interest. The developers used the Django framework (Django Software Foundation) for the development and used a knowledge graph to depict the key entities in NDDs and their relationships to allow the chatbot to suggest web resources that may be related to the user queries. To identify NDD domain–specific entities from user input, a combination of standard sources (the Unified Medical Language System) and other entities were used which were identified by health professionals as well as collaborators. Although most entities were identified in the text, some were not captured in the system and therefore went undetected. Nonetheless, the chatbot was able to provide resources addressing most user queries related to NDDs. The researchers found that enriching the vocabulary with synonyms and lay language terms for specific subdomains enhanced entity detection. By using a data set of numerous individuals with NDDs, the researchers developed a knowledge graph that established meaningful connections between entities, allowing the chatbot to present related symptoms, diagnoses, and resources. To the researchers’ knowledge, CAMI is the first chatbot to provide resources related to NDDs. Our work highlighted the importance of engaging end users to supplement standard generic ontologies to named entities for language recognition. It also demonstrates that complex medical and health-related information can be integrated using knowledge graphs and leveraging existing large datasets. This has multiple implications: generalizability to other health domains as well as reducing the need for experts and optimizing their input while keeping health care professionals in the loop. The researchers' work also shows how health and computer science domains need to collaborate to achieve the granularity needed to make chatbots truly useful and impactful. %M 38888947 %R 10.2196/50182 %U https://www.jmir.org/2024/1/e50182 %U https://doi.org/10.2196/50182 %U http://www.ncbi.nlm.nih.gov/pubmed/38888947 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55751 %T Perception of People Diagnosed With Fibromyalgia About Information and Communication Technologies for Chronic Pain Management: Cross-Sectional Survey Study %A Porta,Xènia %A Nieto,Rubén %A Serrat,Mayte %A Bourdin Kreitz,Pierre %+ eHealthLab, Faculty of Psychology and Education, Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 933263538, xeniaporta@uoc.edu %K fibromyalgia %K chronic pain %K pain management %K information and communication technologies %K use %K satisfaction %D 2024 %7 18.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Chronic pain is prevalent in our society, with conditions such as fibromyalgia being notably widespread. The gold standard for aiding individuals dealing with chronic pain involves interdisciplinary approaches rooted in a biopsychosocial perspective. Regrettably, access to such care is difficult for most of the people in need. Information and communication technologies (ICTs) have been used as a way of overcoming access barriers (among other advantages). Objective: This study addressed the little explored area of how individuals with fibromyalgia use and perceive different types of ICTs for pain management. Methods: A cross-sectional study was conducted using an online survey. This survey was created to assess the use of different ICT tools for pain management, satisfaction with the tools used, and perceived advantages and disadvantages. In addition, data collection encompassed sociodemographic variables and pain-related variables, pain intensity, the impact of pain on daily life activities, and fear of movement/injury beliefs. In total, 265 individuals diagnosed with fibromyalgia completed the survey. Results: Only 2 (0.75%) participants reported not having used any ICT tool for pain management. Among those who used ICT tools, an average of 10.94 (SD 4.48) of 14 different tools were used, with the most used options being instant messaging apps, websites dedicated to managing fibromyalgia, phone calls with health professionals, and online multimedia resources. Satisfaction rates were relatively modest (mean 2.09, SD 0.38) on a scale from 0 to 5, with instant messaging apps, phone calls with health professionals, fibromyalgia management websites, and online multimedia resources being the ones with higher satisfaction. Participants appreciated the ability to receive treatment from home, access to specialized treatment, and using ICTs as a supplement to in-person interventions. However, they also highlighted drawbacks, such as a lack of close contact with health professionals, difficulty expressing emotions, and a lack of knowledge or resources to use ICTs. The use of ICTs was influenced by age and educational background. Additionally, there was a negative correlation between satisfaction with ICT tools and fear of movement/injury. Conclusions: People with fibromyalgia are prone to using ICTs for pain management, especially those tools that allow them to be in contact with health professionals and have access to online resources. However, there is still a need to improve ICT tools since satisfaction ratings are modest. Moreover, strategies aimed at older people, those with lower levels of education, and those with higher levels of fear of movement/injury can be useful to potentiate the use of ICTs among them. %M 38888943 %R 10.2196/55751 %U https://formative.jmir.org/2024/1/e55751 %U https://doi.org/10.2196/55751 %U http://www.ncbi.nlm.nih.gov/pubmed/38888943 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50452 %T Relapse Prevention Group Therapy in Indonesia Involving Peers via Videoconferencing for Substance Use Disorder: Development and Feasibility Study %A Siste,Kristiana %A Ophinni,Youdiil %A Hanafi,Enjeline %A Yamada,Chika %A Novalino,Reza %A Limawan,Albert P %A Beatrice,Evania %A Rafelia,Vania %A Alison,Peter %A Matsumoto,Toshihiko %A Sakamoto,Ryota %+ Department of Environmental Coexistence, Center for Southeast Asian Studies, Kyoto University, 46 Yoshidashimoadachicho, Sakyo Ward, Kyoto, 606-8304, Japan, 81 757537351, chika128@cseas.kyoto-u.ac.jp %K substance use disorder %K cognitive behavioral therapy %K telemedicine %K peer involvement %K Indonesia %K substance use disorders %K digital intervention %K COVID-19 %K psychotherapy %K drug %K mobile phone %D 2024 %7 18.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Substance use disorder (SUD) is a major health issue in Indonesia, where several barriers to treatment exist, including inaccessibility to treatment services, stigma, and criminalization of drug issues. Peer involvement and the use of telemedicine to deliver psychotherapy are promising approaches to overcome these barriers. Objective: This study aims (1) to describe the development of a new group psychotherapy coprovided by a health care worker and a peer and (2) to evaluate the acceptability, practicality, and preliminary outcomes of the program delivered via videoconferencing in Indonesia. Methods: Building upon an established relapse prevention therapy in Japan, we developed a 3-month weekly group therapy module in the Indonesian language. Adjustments were made via focus group discussions with local stakeholders in terms of substance types, understandability, inclusive language, and cultural relevance. A pilot study was conducted to test the new module provided by a peer and a psychiatrist via videoconferencing, termed tele-Indonesia Drug Addiction Relapse Prevention Program (tele-Indo-DARPP), with a pre- and postcontrolled design. We analyzed data from semistructured feedback interviews and outcome measurements, including the number of days using substances and quality of life, and compared the intervention (tele-Indo-DARPP added to treatment as usual [TAU]) and control (TAU only) arms. Results: In total, 8 people diagnosed with SUD participated in the pilot study with a mean age of 37 (SD 12.8) years. All were men, and 7 (88%) used sedatives as the primary substance. Collectively, they attended 44 of the 48 tele-Indo-DARPP sessions. A total of 3 out of 4 (75%) preferred telemedicine rather than in-person therapy. Positive acceptability and practicality were shown from qualitative feedback, in which the participants who joined the tele-Indo-DARPP reported that they liked the convenience of joining from home and that they were able to open up about personal matters, received helpful advice from peers, and received support from other participants. Providers reported that they feel the module was provider-friendly, and the session was convenient to join without diminishing rapport-building. Meanwhile, troubles with the internet connection and difficulty in comprehending some terminology in the workbook were reported. The intervention arm showed better improvements in psychological health and anxiety symptoms. Conclusions: Group psychotherapy via videoconferencing coprovided by health care workers and peers was acceptable and practical for participants with SUD and service providers in this study. A large-scale study is warranted to examine the effectiveness of the newly developed module in Indonesia. %M 38888959 %R 10.2196/50452 %U https://formative.jmir.org/2024/1/e50452 %U https://doi.org/10.2196/50452 %U http://www.ncbi.nlm.nih.gov/pubmed/38888959 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50086 %T Gamification Approach to Provide Support About the Deferral Experience in Blood Donation: Design and Feasibility Study %A Espinoza Chamorro,Roberto %A Santos,Luciano H O %A Mori,Yukiko %A Liu,Chang %A Yamamoto,Goshiro %A Kuroda,Tomohiro %+ Graduate School of Informatics, Kyoto University, 36-1 Yoshida-Honmachi, Sakyo-ku, Kyoto, 606-8501, Japan, 81 075 753 7531, rech91@outlook.com %K blood donation %K deferral experience %K Theory of Planned Behavior %K Self-Determination Theory %K gamification %K ICT design %K motivation %K patient education %K prototype %K feasibility %D 2024 %7 14.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Multiple studies have examined the impact of deferral on the motivation of prospective blood donors, proposing various policies and strategies to support individuals who undergo this experience. However, existing information and communications technology systems focused on blood donation have not yet integrated these ideas or provided options to assist with the deferral experience. Objective: This study aims to propose an initial gamified design aimed at mitigating the impact of the deferral experience by addressing the drivers of awareness and knowledge, interaction and validation, and motivation. Additionally, the study explores the feasibility of implementing such a system for potential users. Methods: We conducted a literature review focusing on the dynamics of motivation and intention related to blood donation, as well as the deferral situation and its impact on citizens. Through this review, we identified weak donor identity, lack of knowledge, and reduced motivation as key factors requiring support from appropriate interventions. These factors were then defined as our key drivers. Taking these into account, we proposed a gamification approach that incorporates concepts from the MDA framework. The aim is to stimulate the aforementioned drivers and expand the concept of contribution and identity in blood donation. For a preliminary evaluation, we designed a prototype to collect feedback on usability, usefulness, and interest regarding a potential implementation of our proposed gamification approach. Results: Among the participants, a total of 11 citizens interacted with the app and provided feedback through our survey. They indicated that interacting with the app was relatively easy, with an average score of 4.13 out of 5 when considering the 11 tasks of interaction. The SUS results yielded a final average score of 70.91 from the participants’ answers. Positive responses were received when participants were asked about liking the concept of the app (3.82), being likely to download it (3.55), and being likely to recommend it to others (3.64). Participants expressed positivity about the implementation of the design but also highlighted current shortcomings and suggested possible improvements in both functionality and usability. Conclusions: Although deferral is a common issue in blood donation, there is a missed opportunity in existing ICT services regarding how to effectively handle such experiences. Our proposed design and implementation seem to have captured the interest of prospective users due to its perceived positive usefulness and potential. However, further confirmation is needed. Improving the design of activities that currently rely heavily on extrinsic motivation elements and integrating more social components to create an enhanced activity loop for intrinsic motivation could further increase the value of the proposed project. Future research could involve conducting a more specialized and longitudinal design evaluation with a larger sample size. %M 38875005 %R 10.2196/50086 %U https://humanfactors.jmir.org/2024/1/e50086 %U https://doi.org/10.2196/50086 %U http://www.ncbi.nlm.nih.gov/pubmed/38875005 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50557 %T Web-Based Tool Designed to Encourage Supplemental Nutrition Assistance Program Use in Urban College Students: Usability Testing Study %A Li,Catherine Yan Hei %A Platkin,Charles %A Chin,Jonathan %A Khan,Asia %A Bennett,Jaleel %A Speck,Anna %A Nielsen,Annette %A Leung,May May %+ Friedman School of Nutrition Science and Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, United States, 1 617 636 3676, maymay.leung@tufts.edu %K SNAP %K SNAP eligibility screening %K food insecurity %K college students %K web-based tool %K think-aloud %K system usability %K user experience %K student %K college %K chronic health %K stress %K anxiety %K barrier %K technology %K tool %K Supplemental Nutrition Assistance Program %K usability %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Food insecurity continues to be a risk for college students in the United States. It is associated with numerous problems, such as chronic health conditions, increased stress and anxiety, and a lower grade point average. After COVID-19, the Supplemental Nutrition Assistance Program (SNAP) benefits were extended to college-aged students; however, there were some barriers to participation, which persisted such as lack of perceived food insecurity risk, lack of knowledge regarding the SNAP application process, the complexity of determining eligibility, and stigma associated with needing social assistance. A technology-enhanced tool was developed to address these barriers to SNAP enrollment and encourage at-risk college students to apply for SNAP. Objective: The purpose of this study was to test the usability and acceptability of a web-based SNAP screening tool designed for college-aged students. Methods: College students aged 18-25 years were recruited to participate in 2 rounds of usability testing during fall 2022. Participants tested the prototype of a web-based SNAP screener tool using a standardized think-aloud method. The usability and acceptability of the tool were assessed using a semistructured interview and a 10-item validated System Usability Scale questionnaire. Audio recordings and field notes were systematically reviewed by extracting and sorting feedback as positive or negative comments. System Usability Scale questionnaire data were analyzed using the Wilcoxon signed rank test and sign test. Results: A total of 12 students (mean age 21.8, SD 2.8 years; n=6, 50% undergraduate; n=11, 92% female; n=7, 58% Hispanic or Black or African American; n=9, 78% low or very low food security) participated in both rounds of user testing. Round 1 testing highlighted overall positive experiences with the tool, with most participants (10/12) stating that the website fulfills its primary objective as a support tool to encourage college students to apply for SNAP. However, issues related to user interface design, navigation, and wording of some questions in the screening tool were noted. Key changes after round 1 reflected these concerns, including improved design of response buttons and tool logo and improved clarity of screening questions. The overall system usability showed slight, but not statistically significant, improvement between round 1 and round 2 (91.25 vs 92.50; P=.10, respectively). Conclusions: Overall usability findings suggest that this web-based tool was highly usable and acceptable to urban college students and could be an effective and appealing approach as a support tool to introduce college students to the SNAP application process. The findings from this study will inform further development of the tool, which could eventually be disseminated publicly among various college campuses. %M 38869926 %R 10.2196/50557 %U https://formative.jmir.org/2024/1/e50557 %U https://doi.org/10.2196/50557 %U http://www.ncbi.nlm.nih.gov/pubmed/38869926 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53976 %T Implementing a Hospital Call Center Service for Mental Health in Uganda: User-Centered Design Approach %A Kabukye,Johnblack K %A Namagembe,Rosemary %A Nakku,Juliet %A Kiberu,Vincent %A Sjölinder,Marie %A Nilsson,Susanne %A Wamala-Larsson,Caroline %+ SPIDER - The Swedish Program for ICT in Developing Regions, Department of Computer and Systems Sciences, Stockholm University, Borgarfjordsgatan 12 (NOD Building), PO Box 7003 Kista, Stockholm, SE-164 07, Sweden, 46 8162000, kabukye@dsv.su.se %K mHealth %K mobile health %K digital health %K digital solution %K digital solutions %K digital intervention %K digital interventions %K mental health %K awareness %K Uganda %K Africa %K African %K user centred %K user centered %K design %K qualitative %K focus group %K focus groups %K call centre %K call centres %K call center %K call centers %K mental %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K cocreated %K cocreation %K service %K services %K mobile phone %D 2024 %7 6.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Mental health conditions are a significant public health problem globally, responsible for >8 million deaths per year. In addition, they lead to lost productivity, exacerbate physical illness, and are associated with stigma and human rights violations. Uganda, like many low- and middle-income countries, faces a massive treatment gap for mental health conditions, and numerous sociocultural challenges exacerbate the burden of mental health conditions. Objective: This study aims to describe the development and formative evaluation of a digital health intervention for improving access to mental health care in Uganda. Methods: This qualitative study used user-centered design and design science research principles. Stakeholders, including patients, caregivers, mental health care providers, and implementation experts (N=65), participated in focus group discussions in which we explored participants’ experience of mental illness and mental health care, experience with digital interventions, and opinions about a proposed digital mental health service. Data were analyzed using the Consolidated Framework for Implementation Research to derive requirements for the digital solution, which was iteratively cocreated with users and piloted. Results: Several challenges were identified, including a severe shortage of mental health facilities, unmet mental health information needs, heavy burden of caregiving, financial challenges, stigma, and negative beliefs related to mental health. Participants’ enthusiasm about digital solutions as a feasible, acceptable, and convenient method for accessing mental health services was also revealed, along with recommendations to make the service user-friendly, affordable, and available 24×7 and to ensure anonymity. A hospital call center service was developed to provide mental health information and advice in 2 languages through interactive voice response and live calls with health care professionals and peer support workers (recovering patients). In the 4 months after launch, 456 calls, from 236 unique numbers, were made to the system, of which 99 (21.7%) calls went to voicemails (out-of-office hours). Of the remaining 357 calls, 80 (22.4%) calls stopped at the interactive voice response, 231 (64.7%) calls were answered by call agents, and 22 (6.2%) calls were not answered. User feedback was positive, with callers appreciating the inclusion of peer support workers who share their recovery journeys. However, some participant recommendations (eg, adding video call options) or individualized needs (eg, prescriptions) could not be accommodated due to resource limitations or technical feasibility. Conclusions: This study demonstrates a systematic and theory-driven approach to developing contextually appropriate digital solutions for improving mental health care in Uganda and similar contexts. The positive reception of the implemented service underscores its potential impact. Future research should address the identified limitations and evaluate clinical outcomes of long-term adoption. %M 38843515 %R 10.2196/53976 %U https://humanfactors.jmir.org/2024/1/e53976 %U https://doi.org/10.2196/53976 %U http://www.ncbi.nlm.nih.gov/pubmed/38843515 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50024 %T A Web-Based Training Program for School Staff to Respond to Self-Harm: Design and Development of the Supportive Response to Self-Harm Program %A Burn,Anne-Marie %A Hall,Poppy %A Anderson,Joanna %+ Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Forvie Site, Robinson Way, Cambridge, CB2 0SZ, United Kingdom, 44 1223336961, amb278@cam.ac.uk %K self-harm %K schools %K young people %K youth %K school staff %K training %K coproduction %K qualitative %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Self-harm is common among adolescents and is a major public health concern. School staff may be the first adults to notice a young person’s self-harm and are well placed to provide support or signpost students to help. However, school staff often report that they do not feel equipped or confident to support students. Despite the need, there is a lack of evidence-based training about self-harm for school staff. A web-based training program would provide schools with a flexible and cost-effective method of increasing staff knowledge, skills, and confidence in how to respond to students who self-harm. Objective: The main objective of this study was to coproduce an evidence-based training program for school staff to improve their skills and confidence in responding to students who self-harm (Supportive Response to Self-Harm [SORTS]). This paper describes the design and development process of an initial prototype coproduced with stakeholders to ensure that the intervention meets their requirements. Methods: Using a user-centered design and person-based approach, the SORTS prototype was informed by (1) a review of research literature, existing guidelines, and policies; (2) coproduction discussions with the technical provider and subject matter experts (mental health, education, and self-harm); (3) findings from focus groups with young people; and (4) coproduction workshops with school staff. Thematic analysis using the framework method was applied. Results: Coproduction sessions with experts and the technical provider enabled us to produce a draft of the training content, a wireframe, and example high-fidelity user interface designs. Analysis of focus groups and workshops generated four key themes: (1) need for a training program; (2) acceptability, practicality, and implementation; (3) design, content, and navigation; and (4) adaptations and improvements. The findings showed that there is a clear need for a web-based training program about self-harm in schools, and the proposed program content and design were useful, practical, and acceptable. Consultations with stakeholders informed the iterative development of the prototype. Conclusions: SORTS is a web-based training program for school staff to appropriately respond to students who self-harm that is based on research evidence and developed in collaboration with stakeholders. The SORTS program will equip school staff with the skills and strategies to respond in a supportive way to students who self-harm and encourage schools to adopt a whole-school approach to self-harm. Further research is needed to complete the intervention development based on the feedback from this study and evaluate the program’s effectiveness. If found to be effective, the SORTS program could be implemented in schools and other youth organizations. %M 38833286 %R 10.2196/50024 %U https://formative.jmir.org/2024/1/e50024 %U https://doi.org/10.2196/50024 %U http://www.ncbi.nlm.nih.gov/pubmed/38833286 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e52027 %T Enabling Health Information Recommendation Using Crowdsourced Refinement in Web-Based Health Information Applications: User-Centered Design Approach and EndoZone Informatics Case Study %A Li,Wenhao %A O'Hara,Rebecca %A Hull,M Louise %A Slater,Helen %A Sirohi,Diksha %A Parker,Melissa A %A Bidargaddi,Niranjan %+ College of Medicine and Public Health, Flinders University, 1284 South Road, Clovelly Park, 5042, Australia, 61 423416543, niranjan.bidargaddi@flinders.edu.au %K information recommendation %K crowdsourcing %K health informatics %K digital health %K endometriosis %D 2024 %7 29.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In the digital age, search engines and social media platforms are primary sources for health information, yet their commercial interests–focused algorithms often prioritize irrelevant content. Web-based health applications by reputable sources offer a solution to circumvent these biased algorithms. Despite this advantage, there remains a significant gap in research on the effective integration of content-ranking algorithms within these specialized health applications to ensure the delivery of personalized and relevant health information. Objective: This study introduces a generic methodology designed to facilitate the development and implementation of health information recommendation features within web-based health applications. Methods: We detail our proposed methodology, covering conceptual foundation and practical considerations through the stages of design, development, operation, review, and optimization in the software development life cycle. Using a case study, we demonstrate the practical application of the proposed methodology through the implementation of recommendation functionalities in the EndoZone platform, a platform dedicated to providing targeted health information on endometriosis. Results: Application of the proposed methodology in the EndoZone platform led to the creation of a tailored health information recommendation system known as EndoZone Informatics. Feedback from EndoZone stakeholders as well as insights from the implementation process validate the methodology’s utility in enabling advanced recommendation features in health information applications. Preliminary assessments indicate that the system successfully delivers personalized content, adeptly incorporates user feedback, and exhibits considerable flexibility in adjusting its recommendation logic. While certain project-specific design flaws were not caught in the initial stages, these issues were subsequently identified and rectified in the review and optimization stages. Conclusions: We propose a generic methodology to guide the design and implementation of health information recommendation functionality within web-based health information applications. By harnessing user characteristics and feedback for content ranking, this methodology enables the creation of personalized recommendations that align with individual user needs within trusted health applications. The successful application of our methodology in the development of EndoZone Informatics marks a significant progress toward personalized health information delivery at scale, tailored to the specific needs of users. %M 38809588 %R 10.2196/52027 %U https://humanfactors.jmir.org/2024/1/e52027 %U https://doi.org/10.2196/52027 %U http://www.ncbi.nlm.nih.gov/pubmed/38809588 %0 Journal Article %@ 2561-7605 %I %V 7 %N %P e53098 %T Combating Barriers to the Development of a Patient-Oriented Frailty Website %A Greeley,Brian %A Chung,Sally Seohyeon %A Graves,Lorraine %A Song,Xiaowei %K frailty %K frailty website %K patient-oriented assessment %K community-dwelling older adults %K internet security %K privacy %K barrier %K barriers %K development %K implementation %K patient-oriented %K internet %K virtual health resource %K community dwelling %K older adult %K older adults %K health care professional %K caregiver %K caregivers %K technology %K real-time %K monitoring %K aging %K ageing %D 2024 %7 28.5.2024 %9 %J JMIR Aging %G English %X This viewpoint article, which represents the opinions of the authors, discusses the barriers to developing a patient-oriented frailty website and potential solutions. A patient-oriented frailty website is a health resource where community-dwelling older adults can navigate to and answer a series of health-related questions to receive a frailty score and health summary. This information could then be shared with health care professionals to help with the understanding of health status prior to acute illness, as well as to screen and identify older adult individuals for frailty. Our viewpoints were drawn from 2 discussion sessions that included caregivers and care providers, as well as community-dwelling older adults. We found that barriers to a patient-oriented frailty website include, but are not limited to, its inherent restrictiveness to frail persons, concerns over data privacy, time commitment worries, and the need for health and lifestyle resources in addition to an assessment summary. For each barrier, we discuss potential solutions and caveats to those solutions, including assistance from caregivers, hosting the website on a trusted source, reducing the number of health questions that need to be answered, and providing resources tailored to each users’ responses, respectively. In addition to screening and identifying frail older adults, a patient-oriented frailty website will help promote healthy aging in nonfrail adults, encourage aging in place, support real-time monitoring, and enable personalized and preventative care. %R 10.2196/53098 %U https://aging.jmir.org/2024/1/e53098 %U https://doi.org/10.2196/53098 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54586 %T A Web-Based Intervention to Support the Mental Well-Being of Sexual and Gender Minority Young People: Mixed Methods Co-Design of Oneself %A Brown,Katherine %A Lucassen,Mathijs F G %A Núñez-García,Alicia %A Rimes,Katharine A %A Wallace,Louise M %A Samra,Rajvinder %+ Centre for Research in Psychology and Sports Science, School of Life and Medical Sciences, University of Hertfordshire, College Lane, Hatfield, AL109AB, United Kingdom, 44 1707 284 615, k.brown25@herts.ac.uk %K sexual minority %K gender minority %K lesbian, gay, bisexual, transgender, queer %K LGBTQ+ %K mental well-being %K support %K intervention %K resilience %K digital %K co-design %K sexual and gender minority youth %K SGMY %K mobile phone %D 2024 %7 21.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual and gender minority youth are at greater risk of compromised mental health than their heterosexual and cisgender peers. This is considered to be due to an increased burden of stigma, discrimination, or bullying resulting in a heightened experience of daily stress. Given the increasing digital accessibility and a strong preference for web-based support among sexual and gender minority youth, digital interventions are a key means to provide support to maintain their well-being. Objective: This paper aims to explicate the co-design processes and underpinning logic of Oneself, a bespoke web-based intervention for sexual and gender minority youth. Methods: This study followed a 6-stage process set out by Hagen et al (identify, define, position, concept, create, and use), incorporating a systematic scoping review of existing evidence, focus groups with 4 stakeholder groups (ie, sexual and gender minority youth, professionals who directly support them, parents, and UK public health service commissioners), a series of co-design workshops and web-based consultations with sexual and gender minority youth, the appointment of a digital development company, and young adult sexual and gender minority contributors to create content grounded in authentic experiences. Results: Oneself features a welcome and home page, including a free accessible to all animation explaining the importance of using appropriate pronouns and the opportunity to create a user account and log-in to access further free content. Creating an account provides an opportunity (for the user and the research team) to record engagement, assess users’ well-being, and track progress through the available content. There are three sections of content in Oneself focused on the priority topics identified through co-design: (1) coming out and doing so safely; (2) managing school, including homophobic, biphobic, or transphobic bullying or similar; and (3) dealing with parents and families, especially unsupportive family members, including parents or caregivers. Oneself’s content focuses on identifying these as topic areas and providing potential resources to assist sexual and gender minority youth in coping with these areas. For instance, Oneself drew on therapeutic concepts such as cognitive reframing, stress reduction, and problem-solving techniques. There is also a section containing relaxation exercises, a section with links to other recommended support and resources, and a downloads section with more detailed techniques and strategies for improving well-being. Conclusions: This study contributes to research by opening up the black box of intervention development. It shows how Oneself is underpinned by a logic that can support future development and evaluation and includes diverse co-designers. More interactive techniques to support well-being would be beneficial for further development. Additional content specific to a wider range of intersecting identities (such as care-experienced Asian sexual and gender minority youth from a minority faith background) would also be beneficial in future Oneself developments. International Registered Report Identifier (IRRID): RR2-10.2196/31036 %M 38772025 %R 10.2196/54586 %U https://formative.jmir.org/2024/1/e54586 %U https://doi.org/10.2196/54586 %U http://www.ncbi.nlm.nih.gov/pubmed/38772025 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e54007 %T Veteran Experiences With an mHealth App to Support Measurement-Based Mental Health Care: Results From a Mixed Methods Evaluation %A Higashi,Robin T %A Etingen,Bella %A Richardson,Eric %A Palmer,Jennifer %A Zocchi,Mark S %A Bixler,Felicia R %A Smith,Bridget %A McMahon,Nicholas %A Frisbee,Kathleen L %A Fortney,John C %A Turvey,Carolyn %A Evans,Jennifer %A Hogan,Timothy P %+ Peter O’Donnell Jr School of Public Health, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, United States, 1 (214) 648 3645, Robin.Higashi@UTSouthwestern.edu %K measurement-based care %K mobile health app %K mental health %K veteran %K mHealth %K support %K mixed-methods evaluation %K digital health %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Mental health conditions are highly prevalent among US veterans. The Veterans Health Administration (VHA) is committed to enhancing mental health care through the integration of measurement-based care (MBC) practices, guided by its Collect-Share-Act model. Incorporating the use of remote mobile apps may further support the implementation of MBC for mental health care. Objective: This study aims to evaluate veteran experiences with Mental Health Checkup (MHC), a VHA mobile app to support remote MBC for mental health. Methods: Our mixed methods sequential explanatory evaluation encompassed mailed surveys with veterans who used MHC and follow-up semistructured interviews with a subset of survey respondents. We analyzed survey data using descriptive statistics. We then compared responses between veterans who indicated having used MHC for ≥3 versus <3 months using χ2 tests. We analyzed interview data using thematic analysis. Results: We received 533 surveys (533/2631, for a 20% response rate) and completed 20 interviews. Findings from these data supported one another and highlighted 4 key themes. (1) The MHC app had positive impacts on care processes for veterans: a majority of MHC users overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed or strongly agreed that using MHC helped them be more engaged in their health and health care (169/262, 65%), make decisions about their treatment (157/262, 60%), and set goals related to their health and health care (156/262, 60%). Similarly, interviewees described that visualizing progress through graphs of their assessment data over time motivated them to continue therapy and increased self-awareness. (2) A majority of respondents overall, and a greater proportion who had used MHC for ≥3 months (versus <3 months), agreed/strongly agreed that using MHC enhanced their communication (112/164, 68% versus 51/98, 52%; P=.009) and rapport (95/164, 58% versus 42/98, 43%; P=.02) with their VHA providers. Likewise, interviewees described how MHC helped focus therapy time and facilitated trust. (3) However, veterans also endorsed some challenges using MHC. Among respondents overall, these included difficulty understanding graphs of their assessment data (102/245, 42%), not receiving enough training on the app (73/259, 28%), and not being able to change responses to assessment questions (72/256, 28%). (4) Interviewees offered suggestions for improving the app (eg, facilitating ease of log-in, offering additional reminder features) and for increasing adoption (eg, marketing the app and its potential advantages for veterans receiving mental health care). Conclusions: Although experiences with the MHC app varied, veterans were positive overall about its use. Veterans described associations between the use of MHC and engagement in their own care, self-management, and interactions with their VHA mental health providers. Findings support the potential of MHC as a technology capable of supporting the VHA’s Collect-Share-Act model of MBC. %M 38728684 %R 10.2196/54007 %U https://mental.jmir.org/2024/1/e54007 %U https://doi.org/10.2196/54007 %U http://www.ncbi.nlm.nih.gov/pubmed/38728684 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53194 %T A Web-Based Peer Support Network to Help Care Partners of People With Serious Illness: Co-Design Study %A O’Donnell,Elizabeth A %A Van Citters,Aricca D %A Khayal,Inas S %A Wilson,Matthew M %A Gustafson,David %A Barnato,Amber E %A Buccellato,Andrea C %A Young,Colleen %A Holthoff,Megan M %A Korsunskiy,Eugene %A Tomlin,Stephanie C %A Cullinan,Amelia M %A Steinbaugh,Alexandra C %A Hinson,Jennifer J %A Johnson,Kristen R %A Williams,Andrew %A Thomson,Ruth M %A Haines,Janet M %A Holmes,Anne B %A Bradley,Ann D %A Nelson,Eugene C %A Kirkland,Kathryn B %+ The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine at Dartmouth, One Medical Center Drive, WTRB Level 5, Lebanon, NH, 03756, United States, 1 603 646 5668, aricca.d.van.citters@dartmouth.edu %K human-centered design %K caregivers %K care partners %K serious illness %K peer support %K online support network %K virtual network %K online network %K caregiver %K unmet need %K unmet needs %K active care %K bereaved care %K bereavement %K clinician %K clinicians %K function %K functions %K specification %K information %K emotional support %K technical support %K privacy protection %K rural %K viability %K impact %K engineering design %K care provider %K care providers %K mortality %K quality of life %K tertiary care %K caregiving %D 2024 %7 8.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Care partners of people with serious illness experience significant challenges and unmet needs during the patient’s treatment period and after their death. Learning from others with shared experiences can be valuable, but opportunities are not consistently available. Objective: This study aims to design and prototype a regional, facilitated, and web-based peer support network to help active and bereaved care partners of persons with serious illness be better prepared to cope with the surprises that arise during serious illness and in bereavement. Methods: An 18-member co-design team included active care partners and those in bereavement, people who had experienced serious illness, regional health care and support partners, and clinicians. It was guided by facilitators and peer network subject-matter experts. We conducted design exercises to identify the functions and specifications of a peer support network. Co-design members independently prioritized network specifications, which were incorporated into an early iteration of the web-based network. Results: The team prioritized two functions: (1) connecting care partners to information and (2) facilitating emotional support. The design process generated 24 potential network specifications to support these functions. The highest priorities included providing a supportive and respectful community; connecting people to trusted resources; reducing barriers to asking for help; and providing frequently asked questions and responses. The network platform had to be simple and intuitive, provide technical support for users, protect member privacy, provide publicly available information and a private discussion forum, and be easily accessible. It was feasible to enroll members in the ConnectShareCare web-based network over a 3-month period. Conclusions: A co-design process supported the identification of critical features of a peer support network for care partners of people with serious illnesses in a rural setting, as well as initial testing and use. Further testing is underway to assess the long-term viability and impact of the network. %M 38717809 %R 10.2196/53194 %U https://humanfactors.jmir.org/2024/1/e53194 %U https://doi.org/10.2196/53194 %U http://www.ncbi.nlm.nih.gov/pubmed/38717809 %0 Journal Article %@ 2818-3045 %I JMIR Publications %V 1 %N %P e54230 %T Perspectives of Medical Students and Developers Regarding Virtual Reality, Augmented Reality, Mixed Reality, and 3D Printing Technologies: Survey Study %A Yun,Young Hyun %A Shin,Dong Hoon %A Choi,Hyung Jin %+ Department of Anatomy and Cell Biology, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 27408204, hjchoi@snu.ac.kr %K medical student %K developer %K virtual reality %K augmented reality %K mixed reality %K 3D printing %K perspective %K survey %D 2024 %7 7.5.2024 %9 Original Paper %J JMIR XR Spatial Comput %G English %X Background: Emerging technologies, such as virtual reality (VR), augmented reality (AR), mixed reality (MR), and 3D printing (3DP), have transformative potential in education and health care. However, complete integration has not yet been achieved, and routine use is limited. There may exist gaps in the perspectives of these technologies between users and developers, and improvement may be necessary in developing such technologies. Objective: The purpose of this study was to investigate the gaps in perspectives between medical students and developers in medical education regarding satisfaction and anticipated future use of VR, AR, MR, and 3DP technologies, as well as developers’ perspectives on their advantages and current challenges. Methods: This retrospective survey study was conducted during a 4-hour elective course over a period of 4 weeks. In this course, computed tomography scans of congenital heart disease patients, medical image processing software, head-mounted displays, and a virtual table were used. Student pre- and postsurveys and the developer survey included demographic and other characteristics, satisfaction, and anticipated future use of VR, AR, MR, and 3DP technologies. The advantages and current challenges of these technologies were only assessed in the developer survey. Results: The study enrolled 41 participants, including 15 first-year medical students and 26 software and content developers. Students were more satisfied than developers across AR, VR, and 3DP in terms of overall satisfaction (VR and AR: P<.001; 3DP: P=.002), esthetics (VR: all P<.001; AR: vividness, P=.006 and design, P<.001; 3DP: vividness, P=.001 and design, P=.002), and continuous use intention (VR: repetition, P=.04 and continuous use, P=.02). Particularly in VR, satisfaction with reality was higher among students than among developers (real world, P=.006). Developers anticipated future use of MR for educating medical students and residents, individual and collaborative surgical planning, and performing surgery on patients. In contrast, students anticipated future use of VR primarily for student education, 3DP for resident education and individual surgical planning, and AR for collaborative surgical planning and performing surgery on patients. Developers perceived the inherent capabilities of VR, AR, and MR technologies as strengths, with hardware performance identified as a drawback. For 3DP, the possibility of customized product manufacturing was seen as an advantage, while cost was seen as a disadvantage. Conclusions: This study elucidated the different perspectives between medical students and developers regarding 3D technologies, highlighting the discrepancy in potential applications and challenges within the medical field. These findings will guide the integration of 3D technologies in education and health care to fulfill the needs and goals of both medical students and developers. %R 10.2196/54230 %U https://xr.jmir.org/2024/1/e54230 %U https://doi.org/10.2196/54230 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50747 %T Assessing the Feasibility and Preliminary Effects of a Web-Based Self-Management Program for Chronic Noncancer Pain: Mixed Methods Study %A Marier-Deschenes,Pascale %A Pinard,Anne Marie %A Jalbert,Laura %A LeBlanc,Annie %+ CIRRIS, Centre interdisciplinaire de recherche en réadaptation et intégration sociale, 525, boul. Wilfrid-Hamel Québec, Québec, QC, G1M 2S8, Canada, 1 418 649 3735, pascale.marier-deschenes.1@ulaval.ca %K persistent pain %K eHealth %K self-paced intervention %K web-based program %K evidence based %K web based %K self-management %K pain %K chronic pain %K mixed methods study %K pain treatment %K pain education %D 2024 %7 3.5.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In Canada, adults with chronic noncancer pain face a persistent insufficiency of publicly funded resources, with the gold standard multidisciplinary pain treatment facilities unable to meet the high clinical demand. Web-based self-management programs cost-effectively increase access to pain management and can improve several aspects of physical and emotional functioning. Aiming to meet the demand for accessible, fully automated resources for individuals with chronic noncancer pain, we developed a French web- and evidence-based self-management program, Agir pour moi (APM). This program includes pain education and strategies to reduce stress, practice mindfulness, apply pacing, engage in physical activity, identify and manage thinking traps, sleep better, adapt diet, and sustain behavior change. Objective: This study aims to assess the APM self-management program’s feasibility, acceptability, and preliminary effects in adults awaiting specialized services from a center of expertise in chronic pain management. Methods: We conducted a mixed methods study with an explanatory sequential design, including a web-based 1-arm trial and qualitative semistructured interviews. We present the results from both phases through integrative tables called joint displays. Results: Response rates were 70% (44/63) at postintervention and 56% (35/63) at 3-month follow-up among the 63 consenting participants who provided self-assessed information at baseline. In total, 46% (29/63) of the participants completed the program. We interviewed 24% (15/63) of the participants. The interview’s first theme revolved around the overall acceptance, user-friendliness, and engaging nature of the program. The second theme emphasized the differentiation between microlevel and macrolevel engagements. The third theme delved into the diverse effects observed, potentially influenced by the macrolevel engagements. Participants highlighted the features that impacted their self-efficacy and the adoption of self-management strategies. We observed indications of improvement in self-efficacy, pain intensity, pain interference, depression, and catastrophizing. Interviewees described these and various other effects as potentially influenced by macrolevel engagement through behavioral change. Conclusions: These findings provided preliminary evidence that the APM self-management program and research methods are feasible. However, some participants expressed the need for at least phone reminders and minimal support from a professional available to answer questions over the first few weeks of the program to engage. Recruitment strategies of a future randomized controlled trial should focus on attracting a broader representation of individuals with chronic pain in terms of gender and ethnicity. Trial Registration: ClinicalTrials.gov NCT05319652; https://clinicaltrials.gov/study/NCT05319652 %M 38701440 %R 10.2196/50747 %U https://humanfactors.jmir.org/2024/1/e50747 %U https://doi.org/10.2196/50747 %U http://www.ncbi.nlm.nih.gov/pubmed/38701440 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50385 %T An Exploration of the Goodness of Fit of Web-Based Tools for Māori: Qualitative Study Using Interviews and Focus Groups %A Donkin,Liesje %A Bidois-Putt,Marie-Claire %A Wilson,Holly %A Hayward,Penelope %A Chan,Amy Hai Yan %+ Department of Psychology and Neuroscience, Auckland University of Technology, Akoranga Drive, Northcote, Auckland, 0627, New Zealand, 64 21847886, liesje.donkin@aut.ac.nz %K Indigenous people %K Māori %K eHealth %K mental health %K web-based intervention %K digital intervention %D 2024 %7 2.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Indigenous communities often have poorer health outcomes and services under traditional models of care. In New Zealand, this holds true for Māori people who are tāngata whenua (the indigenous people). Several barriers exist that decrease the likelihood of indigenous communities often have poorer health outcomes and poor service fit under traditional models of care, including access issues, systemic and provider racism, and a lack of culturally safe and responsive services. Web-based interventions (WBIs) have been shown to be effective in supporting mental health and well-being and can overcome some of these barriers. Despite the large number of WBIs developed, more investigation is needed to know how well WBIs fit with an indigenous worldview and how they meet the needs of indigenous communities so that a digitally based future does not drive social and health inequities. Objective: This study aims to explore the goodness-of-fit of WBIs of Māori individuals, the indigenous people of Aotearoa/New Zealand. Methods: We used interviews (n=3) and focus groups (n=5) with 30 Māori participants to explore their views about WBIs. Interviews were analyzed using reflexive thematic analysis by members of the research team. Results: Overall, there was a perception that the design of WBIs did not align with the Māori worldview, which centers around people, relationships, spirituality, and holistic views of well-being. A total of 4 key themes and several subthemes emerged, indicating that WBIs were generally considered a poor fit for Māori. Specifically, the themes were as follows: (1) WBIs are disconnected from the core values of te ao Māori (the Māori worldview), (2) WBIs could be helpful in the right context, (3) there are significant barriers that may make it harder for Māori to use WBIs than other groups, and (4) ways to improve WBIs to help engagement with Māori. Conclusions: While WBIs are often considered a way to reduce barriers to care, they may not meet the needs of Māori when used as a stand-alone intervention. If WBIs are continued to be offered, developers and researchers need to consider how to develop WBIs that are responsive and engaging to the needs of indigenous communities rather than driving inequities. Ideally, WBIs should be developed by the people they are intended for to fit with those populations’ world views. %M 38696236 %R 10.2196/50385 %U https://formative.jmir.org/2024/1/e50385 %U https://doi.org/10.2196/50385 %U http://www.ncbi.nlm.nih.gov/pubmed/38696236 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e51612 %T Assessing the Usability and Feasibility of Digital Assistant Tools for Direct Support Professionals: Participatory Design and Pilot-Testing %A Tremoulet,Patrice D %A Lobo,Andrea F %A Simmons,Christina A %A Baliga,Ganesh %A Brady,Matthew %+ Department of Psychology, Rowan University, 201 Mullica Hill Rd, Robinson Hall Room 115K, Glassboro, NJ, 08028, United States, 1 8562564500 ext 53777, tremoulet@rowan.edu %K technology prototype %K data collection %K documentation %K direct support professionals %K intellectual and developmental disabilities %K pilot test %K mobile phone %D 2024 %7 25.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The United States is experiencing a direct support professional (DSP) crisis, with demand far exceeding supply. Although generating documentation is a critical responsibility, it is one of the most wearisome aspects of DSPs’ jobs. Technology that enables DSPs to log informal time-stamped notes throughout their shift could help reduce the burden of end-of-shift documentation and increase job satisfaction, which in turn could improve the quality of life of the individuals with intellectual and developmental disabilities (IDDs) whom DSPs support. However, DSPs, with varied ages, levels of education, and comfort using technology, are not likely to adopt tools that detract from caregiving responsibilities or increase workload; therefore, technological tools for them must be relatively simple, extremely intuitive, and provide highly valued capabilities. Objective: This paper describes the development and pilot-testing of a digital assistant tool (DAT) that enables DSPs to create informal notes throughout their shifts and use these notes to facilitate end-of-shift documentation. The purpose of the pilot study was to assess the usability and feasibility of the DAT. Methods: The research team applied an established user-centered participatory design process to design, develop, and test the DAT prototypes between May 2020 and April 2023. Pilot-testing entailed having 14 DSPs who support adults with IDDs use the first full implementation of the DAT prototypes during 2 or 3 successive work shifts and fill out demographic and usability questionnaires. Results: Participants used the DAT prototypes to create notes and help generate end-of-shift reports. The System Usability Scale score of 81.79 indicates that they found the prototypes easy to use. Survey responses imply that using the DAT made it easier for participants to produce required documentation and suggest that they would adopt the DAT if this tool were available for daily use. Conclusions: Simple technologies such as the DAT prototypes, which enable DSPs to use mobile devices to log time-stamped notes throughout their shift with minimal effort and use the notes to help write reports, have the potential to both reduce the burden associated with producing documentation and enhance the quality (level of detail and accuracy) of this documentation. This could help to increase job satisfaction and reduce turnover in DSPs, both of which would help improve the quality of life of the individuals with IDDs whom they support. The pilot test results indicate that DSPs found the DAT easy to use. Next steps include (1) producing more robust versions of the DAT with additional capabilities, such as storing data locally on mobile devices when Wi-Fi is not available; and (2) eliciting input from agency directors, families, and others who use data about adults with IDDs to help care for them to ensure that data produced by DSPs are relevant and useful. %M 38662420 %R 10.2196/51612 %U https://humanfactors.jmir.org/2024/1/e51612 %U https://doi.org/10.2196/51612 %U http://www.ncbi.nlm.nih.gov/pubmed/38662420 %0 Journal Article %@ 2561-1011 %I JMIR Publications %V 8 %N %P e42402 %T Effects of a Web-based Weight Management Education Program on Various Factors for Overweight and Obese Women: Randomized Controlled Trial %A Han,Yunmin %A Sung,Hoyong %A Kim,Geonhui %A Ryu,Yeun %A Yoon,Jiyeon %A Kim,Yeon Soo %+ Department of Physical Education, Seoul National University, Seoul, Gawnak Gu, Gawankro 1, 71-1, 408, Seoul, 08826, Republic of Korea, 82 2 880 7894, kys0101@snu.ac.kr %K weight loss %K obesity %K health education %K self-management %K health promotion %K tailored feedback %K web-based intervention %K behavior change %D 2024 %7 18.4.2024 %9 Original Paper %J JMIR Cardio %G English %X Background: Mediated diet and exercise methods yield effective short-term weight loss but are costly and hard to manage. However, web-based programs can serve many participants, offering ease of access and cost-efficiency. Objective: This study aimed to compare the effectiveness of a web-based weight management program through web-based education alone (MINE) or combined with tailored video feedback (MINE Plus) with a control (CO) group. Methods: This intervention included 60 Korean women with overweight and obesity (BMI≥23 kg/m2) aged 19 years to 39 years old. We randomly allocated 60 participants to each of 3 groups: (1) MINE group (web-based education video and self-monitoring app), (2) MINE Plus group (web-based education video, self-monitoring app, and 1:1 tailored video feedback), and (3) CO group (only self-monitoring app). Web-based education included nutrition, physical activity, psychological factors, medical knowledge for weight loss, goal setting, and cognitive and behavioral strategies. Tailored feedback aimed to motivate and provide solutions via weekly 10-minute real-time video sessions. The intervention lasted 6 weeks, followed by a 6-week observation period to assess the education's lasting effects, with evaluations at baseline, 6 weeks, and 12 weeks. A generalized linear mixed model was used to evaluate time and group interactions. Results: In the intention-to-treat analysis including all 60 participants, there were significant differences in weight change at 6 weeks in the MINE and MINE Plus groups, with mean weight changes of –0.74 (SD 1.96) kg (P=.03) and –1.87 (SD 1.8) kg (P<.001), respectively, while no significant change was observed in the CO group, who had a mean weight increase of 0.03 (SD 1.68) kg (P=.91). After 12 weeks, changes in body weight were –1.65 (SD 2.64) kg in the MINE group, –1.59 (SD 2.79) kg in the MINE Plus group, and 0.43 (SD 1.42) kg in the CO group. There was a significant difference between the MINE and MINE Plus groups (P<.001). Significant group × time effects were found for body weight in the MINE and CO groups (P<.001) and in the MINE Plus and CO groups (P<.001), comparing baseline and 12 weeks. Regarding physical activity and psychological factors, only body shape satisfaction and health self-efficacy were associated with improvements in the MINE and MINE Plus groups (P<.001). Conclusions: This study found that the group receiving education and tailored feedback showed significant weight loss and improvements in several psychological factors, though there were differences in the sustainability of the effects. Trial Registration: Korea Disease Control and Prevention Agency (KDCA) KCT0007780: https://cris.nih.go.kr/cris/search/detailSearch.do/22861 %M 38635975 %R 10.2196/42402 %U https://cardio.jmir.org/2024/1/e42402 %U https://doi.org/10.2196/42402 %U http://www.ncbi.nlm.nih.gov/pubmed/38635975 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50907 %T Developing and Implementing a Web-Based Branching Logic Survey to Support Psychiatric Crisis Evaluations of Individuals With Developmental Disabilities: Qualitative Study and Evaluation of Validity %A Bilder,Deborah A %A Mthembu,Mariah %A Worsham,Whitney %A Aguayo,Patricia %A Knight,Jacob R %A Deng,Steven W %A Singh,Tejinder P %A Davis,John %+ University of Utah Huntsman Mental Health Institute, 383 Colorow Drive, Room 360, Salt Lake City, UT, 84108, United States, 1 801 410 0852, deborah.bilder@hsc.utah.edu %K developmental disabilities %K disruptive behavior %K psychiatric comorbidity %K web-based %K psychiatric crisis %K disability %K mental health %K behavioral crises %K intervention %K general population %K screening %K accuracy %K mood disorder %K sources of distress %K autism %K intellectual disability %D 2024 %7 29.3.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Individuals with developmental disabilities (DD) experience increased rates of emotional and behavioral crises that necessitate assessment and intervention. Psychiatric disorders can contribute to crises; however, screening measures developed for the general population are inadequate for those with DD. Medical conditions can exacerbate crises and merit evaluation. Screening tools using checklist formats, even when designed for DD, are too limited in depth and scope for crisis assessments. The Sources of Distress survey implements a web-based branching logic format to screen for common psychiatric and medical conditions experienced by individuals with DD by querying caregiver knowledge and observations. Objective: This paper aims to (1) describe the initial survey development, (2) report on focus group and expert review processes and findings, and (3) present results from the survey’s clinical implementation and evaluation of validity. Methods: Sources of Distress was reviewed by focus groups and clinical experts; this feedback informed survey revisions. The survey was subsequently implemented in clinical settings to augment providers’ psychiatric and medical history taking. Informal and formal consults followed the completion of Sources of Distress for a subset of individuals. A records review was performed to identify working diagnoses established during these consults. Results: Focus group members (n=17) expressed positive feedback overall about the survey’s content and provided specific recommendations to add categories and items. The survey was completed for 231 individuals with DD in the clinical setting (n=161, 69.7% men and boys; mean age 17.7, SD 10.3; range 2-65 years). Consults were performed for 149 individuals (n=102, 68.5% men and boys; mean age 18.9, SD 10.9 years), generating working diagnoses to compare survey screening results. Sources of Distress accuracy rates were 91% (95% CI 85%-95%) for posttraumatic stress disorder, 87% (95% CI 81%-92%) for anxiety, 87% (95% CI 81%-92%) for episodic expansive mood and bipolar disorder, 82% (95% CI 75%-87%) for psychotic disorder, 79% (95% CI 71%-85%) for unipolar depression, and 76% (95% CI 69%-82%) for attention-deficit/hyperactivity disorder. While no specific survey items or screening algorithm existed for unspecified mood disorder and disruptive mood dysregulation disorder, these conditions were caregiver-reported and working diagnoses for 11.7% (27/231) and 16.8% (25/149) of individuals, respectively. Conclusions: Caregivers described Sources of Distress as an acceptable tool for sharing their knowledge and insights about individuals with DD who present in crisis. As a screening tool, this survey demonstrates good accuracy. However, better differentiation among mood disorders is needed, including the addition of items and screening algorithm for unspecified mood disorder and disruptive mood dysregulation disorder. Additional validation efforts are necessary to include a more geographically diverse population and reevaluate mood disorder differentiation. Future study is merited to investigate the survey’s impact on the psychiatric and medical management of distress in individuals with DD. %M 38551644 %R 10.2196/50907 %U https://mental.jmir.org/2024/1/e50907 %U https://doi.org/10.2196/50907 %U http://www.ncbi.nlm.nih.gov/pubmed/38551644 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55517 %T Community Members’ Perceptions of a Resource-Rich Well-Being Website in California During the COVID-19 Pandemic: Qualitative Thematic Analysis %A Heilemann,MarySue V %A Lai,Jianchao %A Cadiz,Madonna P %A Meza,Jocelyn I %A Flores Romero,Daniela %A Wells,Kenneth B %+ School of Nursing, University of California, Los Angeles, 700 Tiverton Avenue, Box 956919, Los Angeles, CA, 90095-6919, United States, 1 310 206 4735, mheilema@sonnet.ucla.edu %K adaptation %K humans %K pandemics %K mental health %K COVID-19 %K health resources %K California %K psychological %K stigma %K digital %K prevention %K public health %K emotions %K website %K qualitative research %D 2024 %7 25.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To address needs for emotional well-being resources for Californians during the COVID-19 pandemic, the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website was developed in collaboration with multiple community partners across California, funded by the California Department of Health Care Services Behavioral Health Division federal emergency response. Objective: This qualitative study was designed to explore and describe the perspectives of participants affiliated with California organizations on the T4W/Juntos website, understand their needs for web-based emotional health resources, and inform iterative website development. Methods: After providing informed consent and reviewing the website, telephone interviews were conducted with 29 participants (n=21, 72% in English and n=8, 28% in Spanish) recruited by partnering community agencies (October 2021-February 2022). A 6-phase thematic analysis was conducted, enhanced using grounded theory techniques. The investigators wrote reflexive memos and performed line-by-line coding of 12 transcripts. Comparative analyses led to the identification of 15 overarching codes. The ATLAS.ti Web software (ATLAS.ti Scientific Software Development GmbH) was used to mark all 29 transcripts using these codes. After examining the data grouped by codes, comparative analyses led to the identification of main themes, each with a central organizing concept. Results: Four main themes were identified: (1) having to change my coping due to the pandemic, (2) confronting a context of shifting perceptions of mental health stigma among diverse groups, (3) “Feels like home”—experiencing a sense of inclusivity and belonging in T4W/Juntos, and (4) “It’s a one-stop-shop”—judging T4W/Juntos to be a desirable and useful website. Overall, the T4W/Juntos website communicated support and community to this sample during the pandemic. Participants shared suggestions for website improvement, including adding a back button and a drop-down menu to improve functionality as well as resources tailored to the needs of groups such as older adults; adolescents; the lesbian, gay, bisexual, transgender, and queer community; police officers; and veterans. Conclusions: The qualitative findings from telephone interviews with this sample of community members and service providers in California suggest that, during the COVID-19 pandemic, the T4W/Juntos website was well received as a useful, accessible tool, with some concerns noted such as language sometimes being too “professional” or “clinical.” The look, feel, and content of the website were described as welcoming due to pictures, animations, and videos that showcased resources in a personal, colorful, and inviting way. Furthermore, the content was perceived as lacking the stigma typically attached to mental health, reflecting the commitment of the T4W/Juntos team. Unique features and diverse resources, including multiple languages, made the T4W/Juntos website a valuable resource, potentially informing dissemination. Future efforts to develop mental health websites should consider engaging a diverse sample of potential users to understand how to tailor messages to specific communities and help reduce stigma. %M 38526558 %R 10.2196/55517 %U https://formative.jmir.org/2024/1/e55517 %U https://doi.org/10.2196/55517 %U http://www.ncbi.nlm.nih.gov/pubmed/38526558 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e50283 %T The Effect of Explicit Suicide Language in Engagement With a Suicide Prevention Search Page Help-Seeking Prompt: Nonrandomized Trial %A Onie,Sandersan %A Armstrong,Susanne Oliver %A Josifovski,Natasha %A Berlinquette,Patrick %A Livingstone,Nicola %A Holland,Sarah %A Finemore,Coco %A Gale,Nyree %A Elder,Emma %A Laggis,George %A Heffernan,Cassandra %A Theobald,Adam %A Torok,Michelle %A Shand,Fiona %A Larsen,Mark %+ Black Dog Institute, University of New South Wales, Hospital Road, Sydney, 2031, Australia, 61 432359134, s.onie@blackdog.org.au %K suicide %K suicide prevention %K Google %K Google Ads %K internet search %K explicit wording %K mental health %K suicidal %K advertisement %K advertisements %K messaging %K prevention signage %K campaign %K campaigns %K distress %K engagement %K prompt %K prompts %K information seeking %K help seeking %K searching %K search %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Ment Health %G English %X Background: Given that signage, messaging, and advertisements (ads) are the gateway to many interventions in suicide prevention, it is important that we understand what type of messaging works best for whom. Objective: We investigated whether explicitly mentioning suicide increases engagement using internet ads by investigating engagement with campaigns with different categories of keywords searched, which may reflect different cognitive states. Methods: We ran a 2-arm study Australia-wide, with or without ads featuring explicit suicide wording. We analyzed whether there were differences in engagement for campaigns with explicit and nonexplicit ads for low-risk (distressed but not explicitly suicidal), high-risk (explicitly suicidal), and help-seeking for suicide keywords. Results: Our analyses revealed that having explicit wording has opposite effects, depending on the search terms used: explicit wording reduced the engagement rate for individuals searching for low-risk keywords but increased engagement for those using high-risk keywords. Conclusions: The findings suggest that individuals who are aware of their suicidality respond better to campaigns that explicitly use the word “suicide.” We found that individuals who search for low-risk keywords also respond to explicit ads, suggesting that some individuals who are experiencing suicidality search for low-risk keywords. %M 38502162 %R 10.2196/50283 %U https://mental.jmir.org/2024/1/e50283 %U https://doi.org/10.2196/50283 %U http://www.ncbi.nlm.nih.gov/pubmed/38502162 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53742 %T Patient-Centered Approaches for Designing Destigmatizing Sexual Pain-Related Web-Based Platforms: Qualitative Study %A Abdulai,Abdul-Fatawu %A Naghdali,Hasti %A Noga,Heather %A Yong,Paul J %+ School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada, 1 604 822 7214, fatawu.abdulai@ubc.ca %K stigma %K digital health %K sexual pain %K destigmatizing %K end user patients %D 2024 %7 15.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual pain is a common but neglected disorder that affects approximately 3% to 18% of women and an unmeasured number of gender-diverse people worldwide. Despite its wide prevalence, many people feel reluctant to visit conventional health care services or disclose their symptoms due to the fear of stigmatization. To alleviate this stigma, various web-based interventions have been developed to complement and, in some cases, replace conventional sexual health interventions. However, the way these web-based interventions are developed could inadvertently reproduce, perpetuate, or exacerbate stigma among end user patients. Objective: The purpose of this study was to understand patients’ perspectives on how sexual pain–related web platforms can be designed to alleviate stigma or prevent the unintended effects of stigma among patients who use web-based interventions. Methods: Individual semistructured interviews were conducted among 16 participants with lived experiences of painful sex in a large urban city in Western Canada. Participants were recruited via social media platforms, newsletters, and a provincial health volunteer website. Using a sample sexual pain website to provide context, participants were interviewed about their experiences of stigma and how they think web platforms could be designed to address stigma. The interviews were conducted via Zoom (Zoom Technologies Inc) and analyzed using thematic analysis. Results: The findings revealed 4 overarching themes that represented participants’ perspectives on designing web platforms that may alleviate or prevent the unintended effects of stigma. These findings suggested the design of inclusive web platforms, having a nonprovocative and calming user interface, having features that facilitate connections among users and between users and providers, and displaying personal testimonials and experiences of sexual pain. Conclusions: This study highlighted patient-centered design approaches that could serve as a reference guide in developing web platforms that alleviate or prevent the unintended effects of stigma, particularly among nonheterosexual and gender-diverse people. While this study was conducted in the context of sexual pain, the results might also apply to web platforms on other potentially stigmatizing health-related disorders or conditions. %M 38488844 %R 10.2196/53742 %U https://formative.jmir.org/2024/1/e53742 %U https://doi.org/10.2196/53742 %U http://www.ncbi.nlm.nih.gov/pubmed/38488844 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e45987 %T A Web-Based Tool to Assess Social Inclusion and Support Care Planning in Mental Health Supported Accommodation: Development and Preliminary Test Study %A Eager,Sharon %A Killaspy,Helen %A C,Joanna %A Mezey,Gillian %A McPherson,Peter %A Downey,Megan %A Thompson,Georgina %A Lloyd-Evans,Brynmor %+ Division of Psychiatry, University College London, Maple House, 149 Tottenham Court Road, London, W1T 7NF, United Kingdom, 44 (0)20 7679 9428, b.lloyd-evans@ucl.ac.uk %K social inclusion %K supported accommodation %K mental health %K digital health %K care planning %D 2024 %7 13.3.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice. Objective: This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE. Methods: This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through “think-aloud” testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used. Results: Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals’ priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users’ inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy. Conclusions: The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers. %M 38477978 %R 10.2196/45987 %U https://www.i-jmr.org/2024/1/e45987 %U https://doi.org/10.2196/45987 %U http://www.ncbi.nlm.nih.gov/pubmed/38477978 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49759 %T Architecture and Development Framework for a Web-Based Risk Assessment and Management Platform Developed on WordPress to Address Opioid Overdose %A Kazemi,Alireza %A Boyd,Marisha %A Choi,Fiona %A Tai,Andy Man Yeung %A Tsang,Vivian WL %A To,Tam %A Kim,Jane %A Jang,Kerry %A Shams,Farhud %A Schreiter,Stefanie %A Cabanis,Maurice %A Krausz,Reinhard Michael %+ Institute of Mental Health, Department of Psychiatry, University of British Columbia, 4th Floor, Room 430, David Strangway Building, 5950 University Blvd, Vancouver, BC, V6T 1Z3, Canada, 1 236 888 8330, alireza.kazemi@ubc.ca %K software designs %K risks management %K risk assessments %K opioid overdose %K crisis intervention %K substance related disorders %D 2024 %7 11.3.2024 %9 Viewpoint %J JMIR Form Res %G English %X The number of overdose-related fatalities continues to reach historic levels across Canada, despite ongoing efforts by authorities. To reduce mortality, a clinical trajectory ranging from preventative measures to crisis intervention, skill training to treatment, and risk assessment to risk management needs to be supported. The web-based Risk Assessment and Management Platform (RAMP) was developed to realize this concept and to empower people who use drugs through an integrated tool that allows them to better understand and manage their risk of overdose. This paper outlines the architecture and development of RAMP, which is built on the WordPress platform. WordPress components are mapped onto a 3-tier architecture that consists of presentation, application, and database layers. The architecture facilitates the development of a modular software that includes several features that are independent in functionality but interact with each other in an integrated platform. The relatively low coupling and high coherence of the features may reduce the cost of maintenance and increase flexibility of future developments. RAMP’s architecture comprises a user interface, conceptual framework, and backend layers. The RAMP front end effectively uses some of the WordPress’ features such as HTML5, CSS, and JavaScript to create a mobile, friendly, and scalable user interface. The RAMP backend uses several standard and custom WordPress plug-ins to support risk assessment and monitoring, with the goal of mitigating the impacts and eliminating risks together. A rule-based decision support system has been hard-coded to suggest relevant modules and goals to complement each user’s lifestyle and goals based on their risk assessment. Finally, the backend uses the MySQL database management system and communicates with the RAMP framework layer via the data access layer to facilitate a timely and secure handling of information. Overall, RAMP is a modular system developed to identify and manage the risk of opioid overdose in the population of people who use drugs. Its modular design uses the WordPress architecture to efficiently communicate between layers and provide a base for external plug-ins. There is potential for the current system to adopt and address other related fields such as suicide, anxiety, and trauma. Broader implementation will support this concept and lead to the next level of functionality. %M 38466977 %R 10.2196/49759 %U https://formative.jmir.org/2024/1/e49759 %U https://doi.org/10.2196/49759 %U http://www.ncbi.nlm.nih.gov/pubmed/38466977 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e49177 %T Guiding Principles for Adolescent Web-Based Portal Access Policies: Interviews With Informatics Administrators %A Sisk,Bryan %A Antes,Alison L %A Bereitschaft,Christine %A Enloe,Madi %A Bourgeois,Fabienne %A DuBois,James %+ Bioethics Research Center, Department of Medicine, Washington University School of Medicine, MSC 8116-43-10, 660 S Euclid, St Louis, MO, 63110, United States, 1 3142739084, siskb@wustl.edu %K adolescent %K patient portal %K electronic health records %K policy %K ethics %K portal %K portals %K adolescents %K youth %K health record %K health records %K EHR %K EHRs %K perspective %K perspectives %K policies %K administrator %K administration %K informatics %K information system %K information systems %K guidelines %D 2024 %7 11.3.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Web-based patient portals are tools that could support adolescents in managing their health and developing autonomy. However, informatics administrators must navigate competing interests when developing portal access policies for adolescents and their parents. Objective: We aimed to assess the perspectives of informatics administrators on guiding principles for the development of web-based health care portal access policies in adolescent health care. Methods: We interviewed informatics administrators from US hospitals with ≥50 dedicated pediatric beds. We performed a thematic analysis of guiding principles for developing and implementing adolescent portal access policies. Results: We interviewed 65 informatics leaders who represented 63 pediatric hospitals, 58 health care systems, 29 states, and 14,379 pediatric hospital beds. Participants described 9 guiding principles related to three overarching themes: (1) balancing confidentiality and other care needs, (2) balancing simplicity and granularity, and (3) collaborating and advocating. Participants described the central importance of prioritizing the health and safety of the adolescent while also complying with state and federal laws. However, there were differing beliefs about how to prioritize health and safety and what role parents should play in supporting the adolescent’s health care. Participants also identified areas where clinicians and institutions can advocate for adolescents, especially with electronic health record vendors and legislators. Conclusions: Informatics administrators provided guiding principles for adolescent portal access policies that aimed to balance the competing needs of adolescent confidentiality and the usefulness of the portal. Portal access policies must prioritize the adolescent’s health and safety while complying with state and federal laws. However, institutions must determine how to best enact these principles. Institutions and clinicians should strive for consensus on principles to strengthen advocacy efforts with institutional leadership, electronic health record vendors, and lawmakers. %M 38466976 %R 10.2196/49177 %U https://pediatrics.jmir.org/2024/1/e49177 %U https://doi.org/10.2196/49177 %U http://www.ncbi.nlm.nih.gov/pubmed/38466976 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48977 %T Online Health Information Seeking and Preventative Health Actions: Cross-Generational Online Survey Study %A Sinha,Jayati %A Serin,Nuket %+ Department of Marketing & Logistics, College of Business, Florida International University, 11200 SW 8th Street, Miami, FL, 33146, United States, 1 3053487573, jsinha@fiu.edu %K digital natives %K digital immigrants %K online health information seeking %K preventative health actions %K mobile phone %D 2024 %7 11.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The popularity of online health information seeking (OHIS) has increased significantly owing to its accessibility and affordability. To facilitate better health management, it is essential to comprehend the generational differences in OHIS behavior and preventative health actions after seeking online health information (OHI). Objective: This study investigates the variations in OHIS and engagement in preventative health actions between 2 generations based on their technology use (digital natives [aged 18-42 years] and digital immigrants [aged ≥43 years]). Additionally, this research explores the mediating role of OHIS types on the generational effect on preventative health actions and the moderating role of OHI search frequency, gender, and the presence of chronic diseases on the generational effect on OHIS types and preventative health actions. Methods: A preregistered online survey was conducted on the Prolific online data collection platform using stratified sampling of 2 generations (digital natives and digital immigrants) from the United States in November 2023. Overall, 3 types of OHIS were collected: health wellness information search, health guidance information search, and health management information search. A 1-way analysis of covariance tested the generational differences in types of OHIS and preventative health actions, and a 2-way analysis of covariance tested the moderating role of OHIS search frequency, gender, and the presence of chronic diseases using 7 control variables. The PROCESS Macro Model 4 was used to conduct mediation analyses, testing OHI search types as mediators. Linear regression analyses tested age as a predictor of OHIS and preventative health actions. Results: The analysis of 1137 responses revealed generational differences in OHIS. Digital natives searched for health wellness information more frequently (P<.001), whereas digital immigrants searched for health guidance (P<.001) and health management information (P=.001) more frequently. There were no significant differences between the 2 generations regarding preventative health actions (P=.85). Moreover, all 3 types of OHIS mediated the relationship between generational differences and preventative health actions. Furthermore, as people aged, they searched for significantly less health wellness information (P<.001) and more health guidance (P<.001), and health management information (P=.003). Age was not a significant predictor of preventative health actions (P=.48). The frequency of OHI searches did not moderate the effect of generations on OHIS types and preventative health actions. Gender only moderated the relationship between generation and health guidance information search (P=.02), and chronic diseases only moderated the relationship between generation and health wellness information search (P=.03). Conclusions: To the best of our knowledge, this study is the first to explore how 2 digital generations vary in terms of searching for OHI and preventative health behaviors. As the older adult population grows, it is crucial to understand their OHIS behavior and how they engage in preventative health actions to enhance their quality of life. %M 38466985 %R 10.2196/48977 %U https://www.jmir.org/2024/1/e48977 %U https://doi.org/10.2196/48977 %U http://www.ncbi.nlm.nih.gov/pubmed/38466985 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 7 %N %P e54480 %T Evaluating Participation in Gender-Affirming Care: Cross-Sectional Analysis of Dermatology Program Websites in the United States %A Costanza,Marco %A Sobieraj,Jeffrey %A Wang,Frank %+ Department of Dermatology, Michigan Medicine, University of Michigan, 1500 E Medical Center Drive, Ann Arbor, MI, 48109, United States, 1 734 936 4054, frawang@med.umich.edu %K dermatology %K gender-affirming care %K transgender %K dermatology residency %K medical education %K website %K digital platform %K media %K gender %K websites %K school %K resident %K residencies %K residency %K schools %K universities %K universities %K cross-sectional %D 2024 %7 12.2.2024 %9 Research Letter %J JMIR Dermatol %G English %X %M 38345853 %R 10.2196/54480 %U https://derma.jmir.org/2024/1/e54480 %U https://doi.org/10.2196/54480 %U http://www.ncbi.nlm.nih.gov/pubmed/38345853 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53439 %T Administrative Dashboard for Monitoring Use of a Web-Based Parent Training Intervention: Usability Study %A Breitenstein,Susan M %A Berteletti,Julia %A Smoske,Shea %A Barger,Charles %A Tipps,Kyrie %A Helsabeck,Nathan P %+ College of Nursing, The Ohio State University, 1577 Neil Avenue, Columbus, OH, 43210, United States, 1 6146884614, breitenstein.5@osu.edu %K usability %K development %K dashboard %K portal %K implementation %K design %K System Usability Scale %K internet-based intervention %K parents %K parent %K child %K children %K web-based %K web-based parent training %K PT %K descriptive survey %K single group %K survey %K system usability %K ezParent %K videoconference %K information %K reviews on usage %K improvement %K qualitative %D 2024 %7 30.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based parent training (PT) programs can strengthen parent-child relationships by equipping caregivers with knowledge and evidence-based strategies to manage behavior. Hybrid facilitation of PT includes facilitator interaction paired with self-administered and web-based PT. Web-based administrative dashboards provide users (eg, administrators, facilitators, and researchers) with an integrated platform to monitor parent progress and activities within a PT program or website. Despite the utility and prevalence of administrative dashboards for web-based behavioral interventions, to our knowledge, no research studies have explored the perspectives and insights of dashboard users to enhance user experience and program delivery. Objective: The purpose of this study is to evaluate the usability of the administrative dashboard (ezDashboard) for the ezParent program, a 6-module web-based PT program for parents of children aged 2-5 years. Methods: This study used a descriptive, single-group design with administrators who were overseeing the implementation of the ezParent program and trained facilitators for hybrid ezParent delivery. Participants spent at least 30 minutes reviewing and evaluating the ezDashboard and then completed a survey of their experience with the dashboard. The survey included the validated 10-item System Usability Scale and open-ended questions focusing on user performance, navigation ease, and overall usefulness of the ezDashboard. Results: Participants (N=15) indicated high usability of the ezDashboard with System Usability Scale scoring a total mean score of 83.5 (SD 16.3). Most participants (n=13, 87%) rated the overall user-friendliness of the ezDashboard as good (n=3, 20%), excellent (n=9, 60%), or best imaginable (n=1, 7%). Open-ended questions revealed the ezDashboard is or would be useful to monitor parent progress and trends in engagement (n=8, 53%) and for reviewing topics for discussion and communicating with parents (n=5, 33%). ezParent administrators (n=4) identified that real-time data for ezParent use helps overall management of program uptake. Suggestions for features to add to the ezDashboard included the ability to track partial progress of program modules (4/14, 29%), total time spent per module (2/14, 14%), and exportable reports (4/14, 29%). Other ideas for improvement included direct messaging capabilities, videoconferencing platform integration, and being able to modify participant account and contact information. Conclusions: Results indicate that the ezDashboard is easy to use and provides functional information to facilitators and administrators in delivering ezParent. Qualitative results indicate that integrating suggested features into the ezDashboard may help provide a smoother experience for facilitators, administrators, and ultimately the parents using the program. Providing resources for facilitators and administrators in real time to monitor intervention participants’ progress in a program can be helpful in tracking progress and providing facilitated support in tailoring program content and program completion. %M 38289675 %R 10.2196/53439 %U https://formative.jmir.org/2024/1/e53439 %U https://doi.org/10.2196/53439 %U http://www.ncbi.nlm.nih.gov/pubmed/38289675 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48880 %T Acceptance of a Web-Based Intervention in Individuals Who Committed Sexual Offenses Against Children: Cross-Sectional Study %A Schröder,Sonja %A Buntrock,Claudia %A Neumann,Louisa %A Müller,Jürgen L %A Fromberger,Peter %+ Clinic for Psychiatry and Psychotherapy – Forensic Psychiatry, University Medical Center Göttingen, Rosdorfer Weg 70, Göttingen, 37081, Germany, 49 5514022114, sonja.schroeder@med.uni-goettingen.de %K mHealth %K web-based intervention %K acceptance %K Unified Theory of Acceptance and Use of Technology %K UTAUT %K sexual offenses against children %K child abuse %K child pornography %K children %K sexual offense %K cross-sectional study %K community %K anxiety %K psychiatry %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Individuals who have committed sexual offenses against children often have difficulties finding treatment, despite its potential effectiveness. Although the development of web-based interventions could enhance therapeutic supply, up to now the acceptance thereof among this target group is unknown. Objective: For the first time, this study assesses the acceptance of a web-based intervention among individuals who committed sexual offenses against children and analyzes variables that predict acceptance. Following the Unified Theory of Acceptance and Use of Technology (UTAUT), it is assumed that acceptance of web-based interventions in individuals who have committed sexual offenses against children follows the same mechanisms as for individuals in general psychiatry. Methods: This cross-sectional study is based on the data from an ongoing clinical trial (@myTabu) evaluating the effectiveness of a web-based intervention in individuals who committed sexual offenses against children (N=113). Acceptance level was measured using a questionnaire based on the UTAUT and modified for the target group. Furthermore, predictors of acceptance from the UTAUT (performance expectancy, effort expectancy, and social influence [SI]), attitudes toward web-based interventions, and internet anxiety were assessed at baseline. Results: Most participants (61.1%, 69/113), reported high acceptance, while 36.3% (41/113) of them indicated moderate acceptance, and 2.7% (3/113) of them expressed low acceptance. In a linear regression model, the predictors explained 41.2% of the variance (F11,101=9.055; P=.01). Attitudes toward web-based interventions (B=0.398, 95% CI 0.16-0.64; P=.001) and SI (B=0.183, 95% CI 0.03-0.38; P=.04) significantly predicted acceptance. Post hoc explorative analysis showed that the participants’ belief that people close to them would recommend the use of a web-based intervention is a predictor of acceptance. In contrast, the belief that their community supervisor would recommend the use thereof was not predictive in this respect. Conclusions: For the participants of this study, we identified high acceptance of web-based interventions for the majority of participants. SI and the participants’ attitudes toward web-based interventions were important in predicting acceptance. Trial Registration: German Clinical Trial Registration (DRKS, Deutsches Register Klinischer Studien) DRKS 00021256; https://drks.de/search/de/trial/DRKS00021256 %M 38277200 %R 10.2196/48880 %U https://formative.jmir.org/2024/1/e48880 %U https://doi.org/10.2196/48880 %U http://www.ncbi.nlm.nih.gov/pubmed/38277200 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48945 %T Designing a Web-Based Navigation Tool to Support Access to Youth Mental Health Services: Qualitative Study %A Calear,Alison L %A Batterham,Philip J %A McCallum,Sonia M %A Banfield,Michelle %A Moore,Elizabeth %A Johnson,Natalie %A Morse,Alyssa R %+ Centre for Mental Health Research, The Australian National University, 63 Eggleston Road, Canberra, 2601, Australia, 61 261258406, Alison.Calear@anu.edu.au %K mental health services %K youth %K navigation tool %K mental health %K website %K user experience %K design %K service %K services %K access %K accessibility %K health care system %D 2024 %7 18.1.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Many young people with mental health problems do not readily seek help or receive treatment and support. One way to address low help-seeking behavior is to improve access to information on mental health services and how to navigate the mental health system via a web-based tool. Seeking input from the end users (young people and parents or caregivers) on key features of the tool is imperative to ensure that it is relevant, engaging, and likely to meet their needs and expectations. Objective: This study aims to investigate young person and parent or caregiver views on the design, content, functioning, and user experience of a web-based mental health navigation tool to support connection to mental health services for children and young people aged up to 25 years. Methods: A total of 4 online focus groups were conducted: 2 with young people aged 16 years and older (total n=15) and 2 with parents or caregivers (total n=13). Focus groups were structured around a series of guiding questions to explore participants’ views on content, features, user experience, and design of a mental health navigation website. Focus groups were audio recorded with detailed notes taken. In addition, 53 young people aged 16-25 years and 97 parents or caregivers completed an online survey, comprising closed- and open-ended questions; open-ended responses were included with the focus group data in the qualitative analysis. All qualitative data were analyzed using thematic analysis. Results: A total of 2 topic areas and 7 themes were developed. The first topic area covered the types of information needs of young people and parents. Identified themes concerned the scope of the navigation website, as well as the provision of up-to-date and practical information on how to navigate the whole help-seeking process. The second topic area covered website features that would be beneficial and included the consideration of the website design; search engines; supported navigation; and forums, reviews, and user accounts. Conclusions: This study provides important insights into the navigation needs of young people and parents or caregivers in seeking mental health services. Key findings identified through this research have directly informed the development of MindMap, a web-based youth navigation tool providing a searchable database of local services, including a clear description, their location, and potential wait times. The website can be navigated independently or with support. %M 38236625 %R 10.2196/48945 %U https://formative.jmir.org/2024/1/e48945 %U https://doi.org/10.2196/48945 %U http://www.ncbi.nlm.nih.gov/pubmed/38236625 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e48677 %T An Online Psychological Program for Adolescents and Young Adults With Headaches: Iterative Design and Rapid Usability Testing %A Huguet,Anna %A Rozario,Sharlene %A Wozney,Lori %A McGrath,Patrick J %+ Department of Psychology, Universitat Rovira i Virgili, Carretera de Valls, s/n, Tarragona, 43007, Spain, 34 977 55 80 96, anna.huguet@urv.cat %K adolescents %K cognitive-behavioral intervention %K design process %K end users %K headaches %K internet %K usability %K young adult %D 2023 %7 12.12.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Headache disorders are common, debilitating health problems. Cognitive-behavioral therapy (CBT) is recommended but rarely easily available. With the use of the internet and communication technologies among youth and young adults, these individuals could be self-trained in CBT skills. There is an increasing number of internet-based interventions for headaches, but there has been little research into the usability of these interventions because evaluating usability across the intervention development life cycle is costly. We developed an internet-based CBT program, the Specialized Program for Headache Reduction (SPHERE). While developing it, we aimed to improve SPHERE through rapid usability testing cycles. Objective: This study aims to presents a rapid and affordable usability testing approach that can be performed throughout the intervention development life cycle. This paper also provides evidence of the usability of SPHERE. Methods: We used the “think aloud” usability testing method based on Krug’s approach to test user interaction within a lab setting. This was followed by a short posttest interview. We planned to test SPHERE with 3-5 participants testing the same part of the program each cycle. Both the design and development team and the research team actively participated in the usability testing process. Observers independently identified the top 3 usability issues, rated their severity, and conducted debriefing sessions to come to consensus on major issues and generate potential solutions. Results: The testing process allowed major usability issues to be identified and rectified rapidly before piloting SPHERE in a real-world context. A total of 2 cycles of testing were conducted. Of the usability issues encountered in cycles 1 and 2, a total of 68% (17/25) and 32% (12/38), respectively, were rated as major, discussed, and fixed. Conclusions: This study shows that rapid usability testing is an essential part of the design process that improves program functionality and can be easy and inexpensive to undertake. %M 38085567 %R 10.2196/48677 %U https://humanfactors.jmir.org/2023/1/e48677 %U https://doi.org/10.2196/48677 %U http://www.ncbi.nlm.nih.gov/pubmed/38085567 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e39791 %T Internet Tool to Support Self-Assessment and Self-Swabbing of Sore Throat: Development and Feasibility Study %A Lown,Mark %A Smith,Kirsten A %A Muller,Ingrid %A Woods,Catherine %A Maund,Emma %A Rogers,Kirsty %A Becque,Taeko %A Hayward,Gail %A Moore,Michael %A Little,Paul %A Glogowska,Margaret %A Hay,Alastair %A Stuart,Beth %A Mantzourani,Efi %A Wilcox,Christopher R %A Thompson,Natalie %A Francis,Nick A %+ Nuffield Department of Primary Health Care Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 01865617872, margaret.glogowska@phc.ox.ac.uk %K sore throat %K ear, neck, throat %K pharyngitis %K self-assessment %K self-swabbing %K primary care %K throat %K development %K feasibility %K web-based tool %K tool %K antibiotics %K develop %K self-assess %K symptoms %K diagnostic testing %K acceptability %K adult %K children %K social media %K saliva %K swab %K inflammation %K samples %K support %K clinical %K antibiotic %K web-based support tool %K think-aloud %K neck %K tonsil %K tongue %K teeth %K dental %K dentist %K tooth %K laboratory %K lab %K oral %K oral health %K mouth %K mobile phone %D 2023 %7 8.12.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Sore throat is a common problem and a common reason for the overuse of antibiotics. A web-based tool that helps people assess their sore throat, through the use of clinical prediction rules, taking throat swabs or saliva samples, and taking throat photographs, has the potential to improve self-management and help identify those who are the most and least likely to benefit from antibiotics. Objective: We aimed to develop a web-based tool to help patients and parents or carers self-assess sore throat symptoms and take throat photographs, swabs, and saliva samples for diagnostic testing. We then explored the acceptability and feasibility of using the tool in adults and children with sore throats. Methods: We used the Person-Based Approach to develop a web-based tool and then recruited adults and children with sore throats who participated in this study by attending general practices or through social media advertising. Participants self-assessed the presence of FeverPAIN and Centor score criteria and attempted to photograph their throat and take throat swabs and saliva tests. Study processes were observed via video call, and participants were interviewed about their views on using the web-based tool. Self-assessed throat inflammation and pus were compared to clinician evaluation of patients’ throat photographs. Results: A total of 45 participants (33 adults and 12 children) were recruited. Of these, 35 (78%) and 32 (71%) participants completed all scoring elements for FeverPAIN and Centor scores, respectively, and most (30/45, 67%) of them reported finding self-assessment relatively easy. No valid response was provided for swollen lymph nodes, throat inflammation, and pus on the throat by 11 (24%), 9 (20%), and 13 (29%) participants respectively. A total of 18 (40%) participants provided a throat photograph of adequate quality for clinical assessment. Patient assessment of inflammation had a sensitivity of 100% (3/3) and specificity of 47% (7/15) compared with the clinician-assessed photographs. For pus on the throat, the sensitivity was 100% (3/3) and the specificity was 71% (10/14). A total of 89% (40/45), 93% (42/45), 89% (40/45), and 80% (30/45) of participants provided analyzable bacterial swabs, viral swabs, saliva sponges, and saliva drool samples, respectively. Participants were generally happy and confident in providing samples, with saliva samples rated as slightly more acceptable than swab samples. Conclusions: Most adult and parent participants were able to use a web-based intervention to assess the clinical features of throat infections and generate scores using clinical prediction rules. However, some had difficulties assessing clinical signs, such as lymph nodes, throat pus, and inflammation, and scores were assessed as sensitive but not specific. Many participants had problems taking photographs of adequate quality, but most were able to take throat swabs and saliva samples. %M 38064265 %R 10.2196/39791 %U https://www.jmir.org/2023/1/e39791 %U https://doi.org/10.2196/39791 %U http://www.ncbi.nlm.nih.gov/pubmed/38064265 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49718 %T Web-Based Delivery of a Family-Based Dating Abuse Prevention Program for Adolescents Exposed to Interparental Violence: Feasibility and Acceptability Study %A McNaughton Reyes,H Luz %A Armora Langoni,Eliana G %A Sharpless,Laurel %A Moracco,Kathryn E %A Benavides,Quetzabel %A Foshee,Vangie A %+ Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27599, United States, 1 9199663215, mcnaught@email.unc.edu %K dating violence %K adolescents %K family-based prevention %K web-based delivery %K feasibility and acceptability %K mobile phone %D 2023 %7 1.12.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Numerous studies have demonstrated that exposure to caregiver intimate partner violence (IPV) can have cascading negative impacts on children that elevate the risk of involvement in dating abuse. This cascade may be prevented by programs that support the development of healthy relationships in children exposed to IPV. This paper describes the results of a study of the web-based adaptation of an evidence-based dating abuse prevention program for IPV-exposed youth and their maternal caregivers. Core information and activities from an evidence-based program, Moms and Teens for Safe Dates, were adapted to create the web-based program (e-MTSD), which comprises 1 module for mothers only and 5 modules for mother-adolescent dyads to complete together. Objective: The primary objective of this study was to evaluate the feasibility and acceptability of the e-MTSD program and the associated research processes. We also examined the practicability of randomizing mothers to receive SMS text message reminders and an action planning worksheet, which were intended to support engagement in the program. Methods: Mothers were recruited through community organizations and social media advertising and were eligible to participate if they had at least one adolescent aged 12 to 16 years of any gender identity who was willing to participate in the program with them, had experienced IPV after their adolescent was born, and were not currently living with an abusive partner. All mothers were asked to complete the program with their adolescent over a 6- to 8-week period. Participants were randomized to receive SMS text message reminders, action planning, or both using a 2×2 factorial design. Research feasibility was assessed by tracking recruitment, randomization, enrollment, and attrition rates. Program feasibility was assessed by tracking program uptake, completion, duration, and technical problems, and acceptability was assessed using web-based surveys. Results: Over a 6-month recruitment period, 101 eligible mother-adolescent dyads were enrolled in the study and were eligible for follow-up. The median age of the adolescent participants was 14 years; 57.4% (58/101) identified as female, 32.7% (33/101) identified as male, and 9.9% (10/101) identified as gender diverse. All but one mother accessed the program website at least once; 87.1% (88/101) completed at least one mother-adolescent program module, and 74.3% (75/101) completed all 6 program modules. Both mothers and adolescents found the program to be highly acceptable; across all program modules, over 90% of mothers and over 80% of adolescents reported that the modules kept their attention, were enjoyable, were easy to do, and provided useful information. Conclusions: Findings suggest the feasibility of web-based delivery and evaluation of the e-MTSD program. Furthermore, average ratings of program acceptability were high. Future research is needed to assess program efficacy and identify the predictors and outcomes of program engagement. %M 38039070 %R 10.2196/49718 %U https://formative.jmir.org/2023/1/e49718 %U https://doi.org/10.2196/49718 %U http://www.ncbi.nlm.nih.gov/pubmed/38039070 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e50029 %T Digital Health Equity and Tailored Health Care Service for People With Disability: User-Centered Design and Usability Study %A Ha,Sandeul %A Ho,Seung Hee %A Bae,Young-Hyeon %A Lee,Minyoung %A Kim,Ju Hee %A Kim,Ju Han %A Lee,Jisan %+ Department of Nursing, Gangneung-Wonju National University, 402 W5 Department of Nursing, Gangneung-Wonju National University,, 150 Namwon-ro, Heungeop-myeon, Wonju, Gangwon State, 26403, Republic of Korea, 82 33 760 8646, saan2mari@gmail.com %K digital health equity %K digital health care service %K COVID-19 %K mobile health %K mHealth %K mobile apps %K needs assessments %K heuristic %K people with disability %K caregivers %K health personnel %K mobile phone %D 2023 %7 28.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: As digital health services advance, digital health equity has become a significant concern. However, people with disability and older adults still face health management limitations, particularly in the COVID-19 pandemic. An essential area of investigation is proposing a patient-centered design strategy that uses patient-generated health data (PGHD) to facilitate optimal communication with caregivers and health care service providers. Objective: This study aims to conceptualize, develop, and validate a digitally integrated health care service platform for people with disability, caregivers, and health care professionals, using Internet of Things devices and PGHD to contribute to improving digital health equity. Methods: The methodology consists of 5 stages. First, a collaborative review of the previous app, Daily Healthcare 1.0, was conducted with individuals with disabilities, caregivers, and health care professionals. Secondly, user needs were identified via personas, scenarios, and user interface sketches to shape a user-centered service design. The third stage created an enhanced app that integrated these specifications. In the fourth stage, heuristic evaluations by clinical and app experts paved the way for Daily Healthcare 2.0, now featuring Internet of Things device integration. Conclusively, in the fifth stage, an extensive 2-month usability evaluation was executed with user groups comprising individuals with disabilities using the app and their caregivers. Results: Among the participants, “disability welfare information and related institutional linkage” was the highest priority. Three of the 14 user interface sketches the participants created were related to “providing educational content.” The 11 heuristic evaluation experts identified “focusing on a single task” as a crucial issue and advocated redesigning the home menu to simplify it and integrate detailed menus. Subsequently, the app Daily Healthcare 2.0 was developed, incorporating wearable devices for collecting PGHD and connecting individuals with disabilities, caregivers, and health care professionals. After the 2-month usability evaluation with 27 participants, all participants showed an increase in eHealth literacy, particularly those who used the caregiver app. Relatively older users demonstrated improved scores in health IT usability and smartphone self-efficacy. All users’ satisfaction and willingness to recommend increased, although their willingness to pay decreased. Conclusions: In this study, we underscore the significance of incorporating the distinct needs of individuals with disabilities, caregivers, and health care professionals from the design phase of a digital health care service, highlighting its potential to advance digital health equity. Our findings also elucidate the potential benefits of fostering partnerships between health consumers and providers, thereby attenuating the vulnerability of marginalized groups, even amid crises such as the COVID-19 pandemic. Emphasizing this imperative, we advocate for sustained endeavors to bolster the digital literacy of individuals with disabilities and champion collaborative cocreation, aiming to uphold the collective ethos of health and digital health equity. %M 38015589 %R 10.2196/50029 %U https://www.jmir.org/2023/1/e50029 %U https://doi.org/10.2196/50029 %U http://www.ncbi.nlm.nih.gov/pubmed/38015589 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36324 %T Use of the Smart Excretion Care System Linked to Electronic Medical Records to Alleviate Nursing Burden and Enhance Patient Convenience: Mixed Methods Study %A Moon,Hui-Woun %A Park,Da Som Me %A Jung,Se Young %+ Office of eHealth Research and Business, Seoul National University Bundang Hospital, 172 Dolma-ro, Bundang-gu, Seongnam-si, 13620, Republic of Korea, 82 31 787 0114, imsyjung@gmail.com %K care %K caregiving %K instrument development %K elderly %K quality of life %K ergonomics %K focus groups %K musculoskeletal %K usability %K feasibility %K digital health intervention %K digital health %K health intervention %K nursing %K electronic medical record %D 2023 %7 30.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The surge in older demographics has inevitably resulted in a heightened demand for health care, and a shortage of nursing staff is impending. Consequently, there is a growing demand for the development of nursing robots to assist patients with urinary and bowel elimination. However, no study has examined nurses’ opinions of smart devices that provide integrated nursing for patients’ urinary and bowel elimination needs. Objective: This study aimed to evaluate the feasibility of the Smart Excretion Care System tethered to electronic medical records in a tertiary hospital and community care setting and discuss the anticipated reductions in the burden of nursing care. Methods: Focus group interviews were conducted using the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines. The interviews were conducted in March 2021 and involved 67 nurses who had worked at Seoul National University Bundang Hospital for more than 1 year and had experience in assisting patients with excretion care. Data were collected using purposive and snowball sampling methods. Results: A total of four themes relevant to the Smart Excretion Care System were found: (1) expected reductions in the burden of nursing care, (2) applicable indications (by departments and diseases), (3) preferred features/functions, and (4) expected benefits of using the Smart Excretion Care System in clinical facilities. Nurses from comprehensive nursing care wards had the highest burden when it came to excretion care. It was a common opinion that the Smart Excretion Care System would be very useful in intensive care units and should be applied first to patients with stroke or dementia. Conclusions: Excretion care is one of the most burdensome tasks for nurses, increasing their workload. The development of the Smart Excretion Care System as a digital health intervention could help improve nurses’ work efficiency, reduce their burden, and extend to caregivers and guardians. %M 37902820 %R 10.2196/36324 %U https://formative.jmir.org/2023/1/e36324 %U https://doi.org/10.2196/36324 %U http://www.ncbi.nlm.nih.gov/pubmed/37902820 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49962 %T Adolescents and Young Adults Evaluating a Website for Affective-Sexual Information and Education: Multicenter Cross-Sectional Study %A Montero-Pons,Laura %A Rodríguez-Martín,Dolors %A Esquinas,Cristina %A García-Sierra,Rosa %A Manresa-Domínguez,Josep Maria %A Reyes-Lacalle,Azahara %A Cabedo-Ferreiro,Rosa %A Vicente-Hernández,MªMercedes %A Gómez Masvidal,Míriam %A Toran-Monserrat,Pere %A Falguera-Puig,Gemma %+ Sexual and Reproductive Healthcare Santa Coloma de Gramenet, Primary Care Management Metropolitana Nord, Catalan Institute of Health, 49, 53 Major St, Santa Coloma de Gramenet, 08921, Spain, 34 936 932 736, lmontero.ics@gencat.cat %K sex education %K adolescent %K young adult %K internet %K cross-sectional studies %K program evaluation %K gender mainstreaming %D 2023 %7 26.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Today’s young people have long been demanding a paradigm shift in the emotional and sexual education they receive. While for them, affective-sexual and gender diversity is already a reality, the sexual and reproductive health professionals they encounter lack sufficient training. The digital devices and affective-sexual education websites aimed at today’s young people must also be thoroughly evaluated. The website Sexe Joves is a website on sexuality by the Department of Health of the Government of Catalonia (Spain). It is designed for people aged 14 to 25 years. It currently needs to undergo a process of evaluation. Affective-sexual education aimed at young people must stem from their participation and the whole range of sexual and gender diversity in order to reach the entire population equally. Objective: The aim of this study was to evaluate the website Sexe Joves as a source of affective-sexual health information, education, and communication for young people. It takes into account sex, gender identity, sexual orientation, socioeconomic status, and location within Catalonia (urban, semiurban, and rural areas). Methods: This was an observational, descriptive, and cross-sectional study that forms part of a larger mixed methods study. An ad hoc questionnaire was used to collect data. In total, 1830 participants were included. The study was carried out simultaneously in all the territorial administrations of Catalonia. Results: Almost 30% of the sample obtained were young people who experience affective-sexual and gender diversity. Of those surveyed, only 14.2% (n=260) said they were familiar with the website and of these, 6.5% said they used it (n=114). The website content rated most indispensable was on sexual abuse, harassment, and violence, followed by sexually transmitted infections; 70.5% (n=1200) reported that they visit pornographic websites. Conclusions: The results of this study will contribute to the design of new strategies for the website Sexe Joves, a public health resource, in order to improve affective sexual education for young people. International Registered Report Identifier (IRRID): RR2-10.3390/ijerph192416586 %M 37883153 %R 10.2196/49962 %U https://www.jmir.org/2023/1/e49962 %U https://doi.org/10.2196/49962 %U http://www.ncbi.nlm.nih.gov/pubmed/37883153 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e49009 %T An Implementation Pilot of Web-Based Self-Training Programs on Sexual Dysfunctions in the Dutch Public Sexual Health Setting: Mixed Methods Study %A Zimbile,Filippo %A Beek,Titia %A David,Silke %A Crutzen,Rik %+ National Institute for Public Health and the Environment, Antonie van Leeuwenhoeklaan 9, Bilthoven, 3720BA, Netherlands, 31 0651953096, filippo.zimbile@rivm.nl %K implementation pilot digital health %K e-sexual health %K sexual dysfunctions %K self-care %K public health %K sexual issue %K barrier %K sexual health %K intervention %K young adult %K young %K sexual problem %D 2023 %7 26.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Web-based sexual health interventions may be more acceptable to people compared with face-to-face support, given the stigma and embarrassment often associated with sexual problems. The Dutch public sexual health clinics (SHCs) conducted an implementation pilot with 4 web-based self-training programs on sexual dysfunctions (WSTPs) for young people. In addition to a basic sexuality program, the WSTPs focused on the following complaints: pain during intercourse, premature ejaculation, and no sex drive. Objective: This study aims to gain insight into the potential reach of the freely offered WSTPs; use, acceptance, evaluation, and perceived impact of the WSTPs by young people; and evaluation and acceptance of the WSTPs by nurses of the SHCs. Methods: A quantitative baseline measurement (BM) and a follow-up measurement (FM) were conducted among the users. In addition, qualitative data were gathered through video interviews with a sample of respondents of the FM and nurses of the SHCs to gain more in-depth insights into their assessment of the WSTPs. Participants were recruited via social media, posters, and referrals by nurses of the SHCs. Quantitative data were analyzed using descriptive statistics. Independent 2-tailed t tests and one-way independent ANOVAs were used to compare the scores between subgroups based on background characteristics. Dependent 2-tailed t tests were used to assess the possible changes between BM and FM. The interviews were analyzed using a thematic analysis. Results: A total of 1028 young people (aged 16-24 y) completed the BM, 666 started with 1 of the WSTPs, and 104 participants completed the FM. In addition, 8 users and 8 nurses were interviewed. Of the participants who completed the BM, 87.74% (902/1028) experienced moderate (411/1028, 39.98%) to high (491/1028, 47.76%) severity of complaints, of which 20.43% (210/1028) had had them for >1 year and 27.82% (286/1028) even for ≥2 years, and 38.91% (400/1028) were dissatisfied with their sex lives. Only 8.75% (90/1028) had sought professional help in the past 2 years. At FM, users rated satisfaction with their sex life more positively than they did at BM, and they experienced less discomfort from their complaints. The overall rating was positive, with a mean report grade of 7.3 (SD 1.45; on a 10-point scale). Anonymity, clear information and explanation, and practical exercises are indicated as strengths of the WSTPs, leading to more understanding and normalization. Nurses appreciate the high quality of information and accessibility of the WSTPs. They consider them as a valuable addition to the consultation hours. Conclusions: WSTPs can reach a large number of young people with sexual problems who are less likely to seek professional help. This can result in an improved understanding of their issues, a decrease in complaints, and reduced barriers to communicating with a partner or professional. %M 37883172 %R 10.2196/49009 %U https://formative.jmir.org/2023/1/e49009 %U https://doi.org/10.2196/49009 %U http://www.ncbi.nlm.nih.gov/pubmed/37883172 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e44170 %T Evaluating the Acceptability and Feasibility of a Sexual Health–Focused Contraceptive Decision Aid for Diverse Young Adults: User-Centered Usability Study %A Goueth,Rose %A Darney,Blair %A Hoffman,Aubri %A Eden,Karen B %+ Department of Medical Informatics and Clinical Epidemiology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, United States, 1 5034944502, gouethr@ochin.org %K decision aid %K contraception %K decision-making %K user-centered design %K young adults %K pilot study %K feasibility %K acceptability %K development %K support %K tool %K survey %K sexual health %D 2023 %7 3.10.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Young adults with low sexual health literacy levels may find it difficult to make informed decisions about contraceptive methods. We developed and pilot-tested a web-based decision aid—Healthy Sex Choices—designed to support diverse young adults with their contraceptive decision-making. Objective: This pilot study aimed to evaluate whether the Healthy Sex Choices decision aid is acceptable and feasible to patients and clinicians. Methods: We used the Ottawa Decision Support Framework and the International Patient Decision Aid Standards to develop and pilot the decision tool. We first conducted a needs assessment with our advisory panel (5 clinicians and 2 patients) that informed decision aid development. All panelists participated in semistructured interviews about their experience with contraceptive counseling. Clinicians also completed a focus group session centered around the development of sex education content for the tool. Before commencing the pilot study, 5 participants from ResearchMatch (Vanderbilt University Medical Center) assessed the tool and suggested improvements. Results: Participants were satisfied with the tool, rating the acceptability as “good.” Interviewees revealed that the tool made contraceptive decision-making easier and would recommend the tool to a family member or friend. Participants had a nonsignificant change in knowledge scores (53% before vs 45% after; P=.99). Overall, decisional conflict scores significantly decreased (16.1 before vs 2.8 after; P<.001) with the informed subscale (patients feeling more informed) having the greatest decline (23.1 vs 4.7; mean difference 19.0, SD 27.1). Subanalyses of contraceptive knowledge and decisional conflict illustrated that participants of color had lower knowledge scores (48% vs 55%) and higher decisional conflict (20.0 vs 14.5) at baseline than their white counterparts. Conclusions: Participants found Healthy Sex Choices to be acceptable and reported reduced decisional conflict after using the tool. The development and pilot phases of this study provided a foundation for creating reproductive health decision aids that acknowledge and provide guidance for diverse patient populations. %M 37788070 %R 10.2196/44170 %U https://formative.jmir.org/2023/1/e44170 %U https://doi.org/10.2196/44170 %U http://www.ncbi.nlm.nih.gov/pubmed/37788070 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e42647 %T Key Factors in Helpfulness and Use of the SAFE Intervention for Women Experiencing Intimate Partner Violence and Abuse: Qualitative Outcomes From a Randomized Controlled Trial and Process Evaluation %A van Gelder,Nicole E %A Ligthart,Suzanne A %A van Rosmalen-Nooijens,Karin A W L %A Prins,Judith B %A Oertelt-Prigione,Sabine %+ Department of Primary and Community Care, Research Institute for Medical Innovation, Radboud University Medical Center, Geert Grooteplein Noord 21, Nijmegen, 6525 EZ, Netherlands, 31 243618181, nicole.vangelder@radboudumc.nl %K intimate partner violence and abuse %K domestic violence and abuse %K eHealth %K web based %K web-based intervention %K help seeking %K interview %K qualitative %K randomized controlled trial %K process evaluation %D 2023 %7 21.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Many women experience at least one type of intimate partner violence and abuse (IPVA), and although various support options are available, we still know relatively little about web-based interventions for IPVA survivors. We conducted a qualitative evaluation of the SAFE eHealth intervention for women experiencing IPVA in the Netherlands, complementing the quantitative evaluation of self-efficacy, depression, anxiety, and multiple feasibility aspects. Objective: This study assessed users’ experiences and what, according to them, were useful and helpful aspects of the intervention. Methods: The intervention consisted of modules with information on relationships and IPVA, help options, physical and mental health, and social support. It also contained interactive elements such as exercises, stories from survivors, a chat, and a forum. A randomized controlled trial was conducted with an intervention arm receiving the complete version of the intervention and a control arm receiving only a static version with the modules on relationships and IPVA and help options. We gathered data through open questions from surveys (for both study arms; n=65) and semistructured interviews (for the intervention study arm; n=10), all conducted on the web, during the randomized controlled trial and process evaluation. Interview data were coded following the principles of open thematic coding, and all qualitative data were analyzed using qualitative content analysis. Results: Overall, most users positively rated the intervention regarding safety, content, and suiting their needs, especially participants from the intervention study arm. The intervention was helpful in the domains of acknowledgment, awareness, and support. However, participants also identified points for improvement: the availability of a simplified version for acute situations; more attention for survivors in the aftermath of ending an abusive relationship; and more information on certain topics, such as technological IPVA, support for children, and legal affairs. Furthermore, although participants expressed a prominent need for interactive contact options such as a chat or forum, the intervention study arm (the only group that had these features at their disposal) mainly used them in a passive way—reading instead of actively joining the conversation. The participants provided various reasons for this passive use. Conclusions: The positive outcomes of this study are similar to those of other web-based interventions for IPVA survivors, and specific points for improvement were identified. The availability of interactive elements seems to be of added value even when they are used passively. This study provides in-depth insight into the experiences of female IPVA survivors with the SAFE eHealth intervention and makes suggestions for improvements to SAFE and comparable web-based interventions for IPVA as well as inspiring future research. Furthermore, this study shows the importance of a varied assessment of an intervention’s effectiveness to understand the real-world impact on its users. Trial Registration: Netherlands Trial Register NTR7313; https://tinyurl.com/3t7vwswz %M 37603391 %R 10.2196/42647 %U https://www.jmir.org/2023/1/e42647 %U https://doi.org/10.2196/42647 %U http://www.ncbi.nlm.nih.gov/pubmed/37603391 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e42506 %T A Beta-Prototype Chatbot for Increasing Health Literacy of Patients With Decompensated Cirrhosis: Usability Study %A Au,Jessica %A Falloon,Caitlin %A Ravi,Ayngaran %A Ha,Phil %A Le,Suong %+ School of Clinical Sciences, Monash University, 30 Wellington Road, Clayton, 3800, Australia, 61 431201056, jessicaau7@gmail.com %K chronic liver disease %K chatbot %K artificial intelligence %K health literacy %K acceptability %D 2023 %7 15.8.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Health literacy is low among patients with chronic liver disease (CLD) and associated with poor health outcomes and increased health care use. Lucy LiverBot, an artificial intelligence chatbot was created by a multidisciplinary team at Monash Health, Australia, to improve health literacy and self-efficacy in patients with decompensated CLD. Objective: The aim of this study was to explore users’ experience with Lucy LiverBot using an unmoderated, in-person, qualitative test. Methods: Lucy LiverBot is a simple, low cost, and scalable digital intervention, which was at the beta prototype development phase at the time of usability testing. The concept and prototype development was realized in 2 phases: concept development and usability testing. We conducted a mixed methods study to assess usability of Lucy LiverBot as a tool for health literacy education among ambulatory and hospitalized patients with decompensated CLD at Monash Health. Patients were provided with free reign to interact with Lucy LiverBot on an iPad device under moderator observation. A 3-part survey (preuser, user, and postuser) was developed using the Unified Acceptance Theory Framework to capture the user experience. Results: There were 20 participants with a median age of 55.5 (IQR 46.0-60.5) years, 55% (n=11) of them were female, and 85% (n=17) of them were White. In total, 35% (n=7) of them reported having difficulty reading and understanding written medical information. Alcohol was the predominant etiology in 70% (n=14) of users. Participants actively engaged with Lucy LiverBot and identified it as a potential educational tool and device that could act as a social companion to improve well-being. In total, 25% (n=5) of them reported finding it difficult to learn about their health problems and 20% (n=4) of them found it difficult to find medical information they could trust. Qualitative interviews revealed the conversational nature of Lucy LiverBot was considered highly appealing with improvement in mental health and well-being reported as an unintended benefit of Lucy LiverBot. Patients who had been managing their liver cirrhosis for several years identified that they would be less likely to use Lucy LiverBot, but that it would have been more useful at the time of their diagnosis. Overall, Lucy LiverBot was perceived as a reliable and trustworthy source of information. Conclusions: Lucy LiverBot was well received and may be used to improve health literacy and address barriers to health care provision in patients with decompensated CLD. The study revealed important feedback that has been used to further optimize Lucy LiverBot. Further acceptability and validation studies are being undertaken to investigate whether Lucy LiverBot can improve clinical outcomes and health related quality of life in patients with decompensated CLD. %M 37581920 %R 10.2196/42506 %U https://humanfactors.jmir.org/2023/1/e42506 %U https://doi.org/10.2196/42506 %U http://www.ncbi.nlm.nih.gov/pubmed/37581920 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e43959 %T Usability and Preliminary Efficacy of an Artificial Intelligence–Driven Platform Supporting Dietary Management in Diabetes: Mixed Methods Study %A Bul,Kim %A Holliday,Nikki %A Bhuiyan,Mohammad Rashed Alam %A Clark,Cain C T %A Allen,John %A Wark,Petra A %+ Research Institute for Health and Wellbeing, Coventry University, Priory Street, Coventry, CV1 5FB, United Kingdom, 44 07392096816, ac2658@coventry.ac.uk %K nutrition and dietetics %K general diabetes %K qualitative research %K preventive medicine %K web technology %K self-management %K diabetes %K nutrition %K deep learning %K artificial %K mobile phone %D 2023 %7 9.8.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Nutrition plays an important role in diabetes self-management. Web-based diabetes care, driven by artificial intelligence (AI), enables more personalized care. Objective: This study aimed to examine the usability and preliminary efficacy of a web-based AI-driven nutrition platform to support people with diabetes and their carers in identifying healthy recipes, meal planning, and web-based shopping. Methods: Diabetes UK signposted people with diabetes and their carers to the platform’s study-specific portal through its website, social media, and newsletters. A total of 73 adult participants with prediabetes or diabetes or their carers completed the baseline web-based survey. Of these 73 participants, 23 (32%) completed a web-based survey after 8 weeks of platform use. Web-based semistructured interviews were conducted with platform users (7/23, 30%) who agreed to be followed up and diabetes experts (n=3) who had nutrition and platform knowledge. The intervention consists of a web-based platform that incorporates AI to personalize recipes, meal planning, and shopping list experiences and was made available for 8 weeks. Baseline characteristics, satisfaction, system usability, and diabetes-related and general health indicators were assessed before and after using the platform for 8 weeks. Results: Reductions in weight (mean difference 4.5 kg/m2, 95% CI 1.0-12.0; P=.009; Cliff δ=0.33) and waist size (mean difference 3.9 cm, 95% CI 2.0-6.5; P=.008; Cliff δ=0.48) were found. Most of the participants (151/217, 69.6%) did not regularly use the platform and had low or very low engagement scores. However, the platform was perceived as accessible with no need for additional assistance (11/21, 52%), user-friendly (8/21, 38%), and easy to use (8/21, 38%), regardless of some usability issues. Saving recipes was the most popular feature, with 663 saved recipes. Conclusions: This study indicated that the usability of the nutrition platform was well perceived by users and their carers. As participants managed their diabetes well, adding an education component would be specifically relevant for people less familiar with the role of diet in diabetes management. To assess the platform’s effectiveness in improving diabetes-related health indicators, controlled studies with a larger and more diverse participant sample are recommended. %M 37556198 %R 10.2196/43959 %U https://humanfactors.jmir.org/2023/1/e43959 %U https://doi.org/10.2196/43959 %U http://www.ncbi.nlm.nih.gov/pubmed/37556198 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e46849 %T An Artificial Therapist (Manage Your Life Online) to Support the Mental Health of Youth: Co-Design and Case Series %A Wrightson-Hester,Aimee-Rose %A Anderson,Georgia %A Dunstan,Joel %A McEvoy,Peter M %A Sutton,Christopher J %A Myers,Bronwyn %A Egan,Sarah %A Tai,Sara %A Johnston-Hollitt,Melanie %A Chen,Wai %A Gedeon,Tom %A Mansell,Warren %+ Curtin enAble Institute, Faculty of Health Sciences, Curtin University, Kent St, Perth, WA 6102, Australia, 61 452491337, aimee.wrightson-hester@curtin.edu.au %K mental health %K conversational agents %K chatbots %K young people %K acceptability %K feasibility %K co-design %K artificial therapist %K artificial intelligence %K youth %K child %K adolescent %K chatbot %K Manage Your Life Online %K MYLO %K support %K mobile phone %D 2023 %7 21.7.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The prevalence of child and adolescent mental health issues is increasing faster than the number of services available, leading to a shortfall. Mental health chatbots are a highly scalable method to address this gap. Manage Your Life Online (MYLO) is an artificially intelligent chatbot that emulates the method of levels therapy. Method of levels is a therapy that uses curious questioning to support the sustained awareness and exploration of current problems. Objective: This study aimed to assess the feasibility and acceptability of a co-designed interface for MYLO in young people aged 16 to 24 years with mental health problems. Methods: An iterative co-design phase occurred over 4 months, in which feedback was elicited from a group of young people (n=7) with lived experiences of mental health issues. This resulted in the development of a progressive web application version of MYLO that could be used on mobile phones. We conducted a case series to assess the feasibility and acceptability of MYLO in 13 young people over 2 weeks. During this time, the participants tested MYLO and completed surveys including clinical outcomes and acceptability measures. We then conducted focus groups and interviews and used thematic analysis to obtain feedback on MYLO and identify recommendations for further improvements. Results: Most participants were positive about their experience of using MYLO and would recommend MYLO to others. The participants enjoyed the simplicity of the interface, found it easy to use, and rated it as acceptable using the System Usability Scale. Inspection of the use data found evidence that MYLO can learn and adapt its questioning in response to user input. We found a large effect size for the decrease in participants’ problem-related distress and a medium effect size for the increase in their self-reported tendency to resolve goal conflicts (the proposed mechanism of change) in the testing phase. Some patients also experienced a reliable change in their clinical outcome measures over the 2 weeks. Conclusions: We established the feasibility and acceptability of MYLO. The initial outcomes suggest that MYLO has the potential to support the mental health of young people and help them resolve their own problems. We aim to establish whether the use of MYLO leads to a meaningful reduction in participants’ symptoms of depression and anxiety and whether these are maintained over time by conducting a randomized controlled evaluation trial. %M 37477969 %R 10.2196/46849 %U https://humanfactors.jmir.org/2023/1/e46849 %U https://doi.org/10.2196/46849 %U http://www.ncbi.nlm.nih.gov/pubmed/37477969 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47524 %T The Design, Development, and Usability Testing of an eHealth Program for Youths With Osteogenesis Imperfecta: Protocol for a 2-Phase User-Centered Mixed Methods Study %A Tsimicalis,Argerie %A Stinson,Jennifer %A Thorstad,Kelly %A Rauch,Frank %A Hamdy,Reggie %A Chougui,Khadidja %A Addab,Sofia %A Palomo,Telma %A Bernstein,Mitchell %A Dahan-Oliel,Noemi %A Veilleux,Louis-Nicolas %A Massochin Nunes Pinto,Laura %A Passos dos Santos,Raissa %+ Shriners Hospitals for Children-Canada, 1003 Decarie Blvd, Montreal, QC, H4A 0A9, Canada, 1 514 842 4464, argerie.tsimicalis@mcgill.ca %K eHealth program %K osteogenesis imperfecta %K self-management %K youth %K transition of care %D 2023 %7 23.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Innovative approaches are needed to address the self-management needs of youths with osteogenesis imperfecta (OI) transitioning into adult-oriented health care systems. Using a sequentially phased research approach, the goal is to design, develop, and test the usability of an innovative eHealth program called “Teens Taking Charge: Managing OI Online,” hereafter named “Teens OI.” This program seeks to optimize self-management, facilitate a successful transition to adult care, and address a critical gap in the quality of care for youths with OI. Objective: The study objectives are to (1) design and develop an English and French version of the Teens OI and (2) test the usability of the Teens OI in terms of efficiency, effectiveness, and satisfaction from the perspectives of youths with OI and their parents. Methods: A user-centered design is presently in progress to design and develop Teens OI. A “Website Design and Development Council” (ie, Council) has been convened, with 20 youths and parent dyads recruited and global experts surveyed at an international meeting. With unanimous support from the Council, usability testing of the Teens OI will ensue in 4 iterative cycles with 32 youth-parent dyads. All sociodemographic and usability metrics will be descriptively analyzed. All recorded interview and focus group data are analyzed using content analysis techniques involving an iterative process of data reduction, data display, conclusion drawing, and verification. Results: As of December 2022, an 8-person, interdisciplinary Teens OI council, comprising 4 health care professionals, 3 youths and young adults with OI, and 1 parent, has been convened to oversee the design and development of Teens OI. Two cycles of interviews have been conducted with 10 youths with OI with or without their parents (n=6) from December 2021 to September 2022. Data analysis has been in progress since April 2022. Aim 2 is ethically approved and will commence following the completion of content development, expected by late July 2023. Preliminary analysis indicates that the following topics need to be prioritized for the youths: mental health, pain, accessibility, medical care, education, community, and parental care. Conclusions: The proposed study will design and develop a self-management and transitional care program for youths with OI in partnership with patients, caregivers, and health care professionals. This study leverages youths’ openness to adopt eHealth technologies to meet their needs and has the potential to actively engage them to autonomously manage their lifelong conditions, and facilitate a successful transition to adult health care. Finally, the proposed study will also address a critical gap in the quality of care and the growing concern that the OI population transitioning from pediatric to adult care is at risk of various adverse events associated with the transition. International Registered Report Identifier (IRRID): DERR1-10.2196/47524 %M 37351933 %R 10.2196/47524 %U https://www.researchprotocols.org/2023/1/e47524 %U https://doi.org/10.2196/47524 %U http://www.ncbi.nlm.nih.gov/pubmed/37351933 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e44535 %T Acceptability and Potential Impact of the #chatsafe Suicide Postvention Response Among Young People Who Have Been Exposed to Suicide: Pilot Study %A La Sala,Louise %A Pirkis,Jane %A Cooper,Charlie %A Hill,Nicole T M %A Lamblin,Michelle %A Rajaram,Gowri %A Rice,Simon %A Teh,Zoe %A Thorn,Pinar %A Zahan,Rifat %A Robinson,Jo %+ Orygen, Centre for Youth Mental Health, The University of Melbourne, 35 Poplar Road, Parkville, 3052, Australia, 61 3 9966 9512, louise.lasala@orygen.org.au %K youth %K suicide %K social media %K suicide postvention %K suicide prevention %K contagion %K postvention %D 2023 %7 19.5.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Young people are more likely to be affected by suicide contagion, and there are concerns about the role social media plays in the development and maintenance of suicide clusters or in facilitating imitative suicidal behavior. However, social media also presents an opportunity to provide real-time and age-appropriate suicide prevention information, which could be an important component of suicide postvention activities. Objective: This study aimed to test an intervention designed to equip young people to communicate safely online about suicide (#chatsafe) with a sample of young people who had recently been exposed to a suicide or suicide attempt, with a view to determining the role social media can play as part of a postvention response. Methods: A sample of 266 young people from Australia, aged 16 to 25 years, were recruited to participate in the study. They were eligible if they had been exposed to a suicide or knew of a suicide attempt in the past 2 years. All participants received the #chatsafe intervention, which comprised 6 pieces of social media content that were sent to them weekly via direct message through Instagram, Facebook, or Snapchat. Participants were assessed on a range of outcome measures (social media use, willingness to intervene against suicide, internet self-efficacy, confidence, and safety when communicating about suicide on social media platforms) at baseline, immediately after the intervention, and at 4-week follow-up. Results: After the 6-week #chatsafe intervention, participants reported substantial improvements in their willingness to intervene against suicide online, their internet self-efficacy, and their perceived confidence and safety when communicating about suicide online. Overall, the participants reported that it was appropriate to receive the #chatsafe intervention via social media, and no iatrogenic effects were recorded. Conclusions: The findings suggest that it is safe and acceptable to disseminate suicide prevention information entirely via social media among young people who have recently been exposed to a suicide or suicide attempt. Interventions such as #chatsafe could potentially mitigate the risk of distress and future suicidal behavior in young people by improving the quality and safety of online communication about suicide and, as such, can be an important component of delivering a postvention response to young people. %M 37204854 %R 10.2196/44535 %U https://humanfactors.jmir.org/2023/1/e44535 %U https://doi.org/10.2196/44535 %U http://www.ncbi.nlm.nih.gov/pubmed/37204854 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e43129 %T The Teach-ABI Professional Development Module for Educators About Pediatric Acquired Brain Injury: Mixed Method Usability Study %A Saly,Lauren %A Provvidenza,Christine %A Al-Hakeem,Hiba %A Hickling,Andrea %A Stevens,Sara %A Kakonge,Lisa %A Hunt,Anne W %A Bennett,Sheila %A Martinussen,Rhonda %A Scratch,Shannon E %+ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, 150 Kilgour Road, Toronto, ON, M4G 1R8, Canada, 1 416 425 6220 ext 3261, sscratch@hollandbloorview.ca %K acquired brain injury %K educators %K professional development %K usability testing %K satisfaction testing %K knowledge translation %K usability %K death %K disability %K children %K development %K Ontario %K research %K online %K school %D 2023 %7 15.5.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Acquired brain injury (ABI) is a leading cause of death and disability in children and can lead to lasting cognitive, physical, and psychosocial outcomes that affect school performance. Students with an ABI experience challenges returning to school due in part to lack of educator support and ABI awareness. A lack of knowledge and training contribute to educators feeling unprepared to support students with ABI. Teach-ABI, an online professional development module, was created to enhance educators’ ABI knowledge and awareness to best support students. Using a case-based approach, Teach-ABI explains what an ABI is, identifies challenges for students with ABI in the classroom, discusses the importance of an individualized approach to supporting students with ABI, and describes how to support a student with an ABI in the classroom. Objective: This study aims to assess the usability of and satisfaction with Teach-ABI by elementary school educators. The following questions were explored: (1) Can elementary school teachers use and navigate Teach-ABI?, (2) Are the content and features of Teach-ABI satisfactory?, and (3) What modifications are needed to improve Teach-ABI? Methods: Elementary school educators currently employed or in training to be employed in Ontario elementary schools were recruited. Using Zoom, individual online meetings with a research team member were held, where educators actively reviewed Teach-ABI. Module usability was evaluated through qualitative analysis of think-aloud data and semistructured interviews, direct observation, user success rate during task completion, and the System Usability Scale (SUS) scores. The usability benchmark selected was 70% of participants performing more than half of module tasks independently. Results: A total of 8 female educators participated in the study. Educators were classroom (n=7) and preservice (n=1) teachers from public (n=7) and private (n=1) school boards. In terms of task performance, more than 85% of participants (ie, 7/8) independently completed 10 out of 11 tasks and 100% of participants independently completed 7 out of 11 tasks, demonstrating achievement of the module usability goal. The average overall SUS score was 86.25, suggesting a high satisfaction level with the perceived usability of Teach-ABI. Overall, participants found Teach-ABI content valuable, useful, and aligned with the realities of their profession. Participants appreciated the visual design, organization, and varying use of education strategies within Teach-ABI. Opportunities for enhancement included broadening content case examples of students with ABI and enhancing the accessibility of the content. Conclusions: Validated usability measures combined with qualitative methodology revealed educators’ high level of satisfaction with the design, content, and navigation of Teach-ABI. Educators engaged with the module as active participants in knowledge construction, as they reflected, questioned, and connected content to their experiences and knowledge. This study established strong usability and satisfaction with Teach-ABI and demonstrated the importance of usability testing in building online professional development modules. %M 37184920 %R 10.2196/43129 %U https://humanfactors.jmir.org/2023/1/e43129 %U https://doi.org/10.2196/43129 %U http://www.ncbi.nlm.nih.gov/pubmed/37184920 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e43819 %T Web-Based COVID-19 Dashboards and Trackers in the United States: Survey Study %A Clarkson,Melissa D %+ Division of Biomedical Informatics, University of Kentucky, 725 Rose Street, Lexington, KY, 40536, United States, 1 859 323 7232, mclarkson@uky.edu %K COVID-19 %K data visualization %K data dashboard %K public health reporting %K human information interaction %K transparency %K trust %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The SARS-CoV-2 pandemic provided an opportunity to use public-facing web data visualization tools to help citizens understand the evolving status of the outbreak. Given the heterogeneity of data sources, developers, tools, and designs used in this effort, it raised questions about how visualizations were constructed during a time when daily batches of data were available, but issues of data quality and standardization were unresolved. Objective: This paper surveyed web-based COVID-19 dashboards and trackers that are likely to be used by the residents of the United States to monitor the spread of infection on a local, national, and global scale. This study is intended to provide insights that will help application developers increase the usefulness, transparency, and trustworthiness of dashboards and trackers for public health data in the future. Methods: Websites of coronavirus dashboards and trackers were identified in August 2020 using the Google search engine. They were examined to determine the data sources used, types of data presented, types of data visualizations, characteristics of the visualizations, and issues with messy data. The websites were surveyed 3 more times for changes in design and data sources with the final survey conducted in June 2022. Themes were developed to highlight the issues concerning challenges in presenting COVID-19 data and techniques of effective visualization. Results: In total, 111 websites were identified and examined (84 state focused, 11 nationwide, and 16 with global data), and this study found an additional 17 websites providing access to the state vaccination data. This study documents how data aggregators have played a central role in making data accessible to visualization developers. The designs of dashboards and tracker visualizations vary in type and quality, with some well-designed displays supporting the interpretation of the data and others obscuring the meaning of the data and potentially misleading the viewers. Five themes were identified to describe challenges in presenting COVID-19 data and techniques of effective visualization. Conclusions: This analysis reveals the extent to which dashboards and trackers informing the American public about the COVID-19 pandemic relied on an ad hoc pipeline of data sources and data aggregators. The dashboards and trackers identified in this survey offer an opportunity to compare different approaches for the display of similar data. %M 36696270 %R 10.2196/43819 %U https://humanfactors.jmir.org/2023/1/e43819 %U https://doi.org/10.2196/43819 %U http://www.ncbi.nlm.nih.gov/pubmed/36696270 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e40785 %T A Web-Based Self-management App for Living Well With Dementia: User-Centered Development Study %A Lee,Abigail Rebecca %A Csipke,Emese %A Yates,Lauren %A Moniz-Cook,Esme %A McDermott,Orii %A Taylor,Steven %A Stephens,Michael %A Kelleher,Daniel %A Orrell,Martin %+ Institute of Mental Health, School of Medicine, University of Nottingham, Jubilee Campus, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 07563254838, abigail.lee19@nhs.net %K dementia %K self-management %K independence %K quality of life %K web-based %K website %K psychosocial %D 2023 %7 24.2.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Self-management, autonomy, and quality of life are key constructs in enabling people to live well with dementia. This population often becomes isolated following diagnosis, but it is important for them to feel encouraged to maintain their daily activities and stay socially active. Promoting Independence in Dementia (PRIDE) fosters social inclusion and greater dementia self-management through an interactive handbook. Objective: This study aimed to develop a paper-based PRIDE manual on a web-based platform. Methods: Two overarching stages were used to create the web-based version of PRIDE. The first was Preliminary Development, which encompassed tendering, preliminary development work, consultations, beta version of the website, user testing and consultation on beta version, and production of the final web-based prototype. The second stage was Development of the Final PRIDE App, which included 2 sprints and further user testing. Results: Through a lengthy development process, modifications were made to app areas such as the log-in process, content layout, and aesthetic appearance. Feedback from the target population was incorporated into the process to achieve a dementia-friendly product. The finished PRIDE app has defined areas for reading dementia-related topics, creating activity plans, and logging these completed activities. Conclusions: The PRIDE app has evolved from its initial prototype into a more dementia-friendly and usable program that is suitable for further testing. The finished version will be tested in a reach, effectiveness, adoption, implementation, and maintenance study, with its potential reach, effectiveness, and adoption explored. Feedback gathered during the reach, effectiveness, adoption, implementation, and maintenance study will lead to any further developments in the app to increase its applicability to the target audience and usability. %M 36826978 %R 10.2196/40785 %U https://humanfactors.jmir.org/2023/1/e40785 %U https://doi.org/10.2196/40785 %U http://www.ncbi.nlm.nih.gov/pubmed/36826978 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 3 %P e34721 %T Evaluation of Positive Choices, a National Initiative to Disseminate Evidence-Based Alcohol and Other Drug Prevention Strategies: Web-Based Survey Study %A Stapinski,Lexine Ann %A Nepal,Smriti %A Guckel,Tara %A Grummitt,Lucinda Rachel %A Chapman,Cath %A Lynch,Samantha Jane %A Lawler,Siobhan Maree %A Teesson,Maree %A Newton,Nicola Clare %+ The Matilda Centre for Research in Mental Health and Substance Use, The University of Sydney, Level 6 Jane Foss Russell Building, G02, Camperdown, 2006, Australia, 61 0426200221, tara.guckel@sydney.edu.au %K alcohol and other drugs %K prevention %K adolescence %K schools %K drug prevention %K drug prevention website %D 2022 %7 26.8.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: To prevent adolescents from initiating alcohol and other drug use and reduce the associated harms, effective strategies need to be implemented. Despite their availability, effective school-based programs and evidence-informed parental guidelines are not consistently implemented. The Positive Choices alcohol and other drug prevention initiative and website was launched to address this research and practice gap. The intended end users were school staff, parents, and school students. An 8-month postlaunch evaluation of the website showed that end users generally had positive feedback on the website’s usability, and following its use, most of them would consider the evidence base and effectiveness of drug education resources. This study extends this initial evaluation by examining the effectiveness and impact of the Positive Choices initiative over a 3-year period. Objective: Guided by the five dimensions of the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, the study assessed the impact of the Positive Choices initiative in increasing awareness and implementation of evidence-based drug prevention. Methods: Data were collected between 2017 and 2019, using web-based evaluation and community awareness surveys. Data from the surveys were merged to examine reach, effectiveness, adoption, implementation, and maintenance using descriptive statistics. Google Analytics was used to further understand the reach of the website. The System Usability Scale was used to measure website usability. In addition, inductive analysis was used to assess the participants’ feedback about Positive Choices. Results: A total of 5 years after launching, the Positive Choices website has reached 1.7 million users. A national Australian campaign increased awareness from 8% to 14% among school staff and from 15% to 22% among parents after the campaign. Following a brief interaction with the website, most participants, who were not already following the recommended strategies, reported an intention to shift toward evidence-based practices. The System Usability Scale score for the website was good for both user groups. The participants intended to maintain their use of the Positive Choices website in the future. Both user groups reported high level of confidence in communicating about topics related to alcohol and other drugs. Participants’ suggestions for improvement informed a recent website update. Conclusions: The Positive Choices website has the capacity to be an effective strategy for disseminating evidence-based drug prevention information and resources widely. The findings highlight the importance of investing in ongoing maintenance and promotion to enhance awareness of health websites. With the increased use and acceptability of health education websites, teams should ensure that websites are easy to navigate, are engaging, use simple language, contain evidence-informed resources, and are supported by ongoing promotional activities. %M 36018617 %R 10.2196/34721 %U https://pediatrics.jmir.org/2022/3/e34721 %U https://doi.org/10.2196/34721 %U http://www.ncbi.nlm.nih.gov/pubmed/36018617 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e34005 %T A Web-Based Well-being Program for Health Care Workers (Thrive): Protocol for a Randomized Controlled Trial %A Egan,Luke A %A Mulcahy,Mary %A Tuqiri,Karen %A Gatt,Justine M %+ Neuroscience Research Australia, Margarete Ainsworth Building, Barker St, Randwick, 2031, Australia, 61 2 9399 1812, j.gatt@neura.edu.au %K well-being %K Composure, Own-worth, Mastery, Positivity, Achievement, and Satisfaction for Wellbeing %K COMPAS-W %K mental health %K resilience %K health care %K hospital %K brain %K neuroscience %K online %K randomized controlled trial %K RCT %D 2022 %7 21.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Mental health has come to be understood as not merely the absence of mental illness but also the presence of mental well-being, and recent interventions have sought to increase well-being in various populations. A population that deserves particular attention is that of health care workers, whose occupations entail high levels of stress, especially given the ongoing COVID-19 pandemic. A neuroscience-based web-based well-being program for health care workers—the Thrive program—has been newly developed to promote habits and activities that contribute to brain health and overall mental well-being. Objective: This paper describes the protocol for a randomized controlled trial whose objective is to evaluate the Thrive program in comparison with an active control condition to measure whether the program is effective at increasing well-being and decreasing symptoms of psychological distress in health care workers at a designated Australian hospital. Methods: The trial will comprise two groups (intervention vs active control) and 4 measurement occasions over a 12-week period. A survey will be administered in each of weeks 0, 4, 8, and 12, and the well-being program will be delivered in weeks 1-7 (via web-based video presentations or digital pamphlets). Each of the 4 surveys will comprise a range of questionnaires to measure well-being, psychological distress, and other key variables. The planned analyses will estimate group-by-time interaction effects to test the hypothesis that mental health will increase over time in the intervention condition relative to the active control condition. Results: The Thrive program was delivered to a small number of wards at the hospital between February 2021 and July 2021, and it will be delivered to the remaining wards from October 2021 to December 2021. A power calculation has recommended a sample size of at least 200 participants in total. A linear mixed model will be used to estimate the interaction effects. Conclusions: This trial seeks to evaluate a new web-based well-being program for health care workers at a major public hospital. It will contribute to the growing body of research on mental well-being and ways to promote it. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000027819; https://tinyurl.com/58wwjut9 International Registered Report Identifier (IRRID): DERR1-10.2196/34005 %M 35451973 %R 10.2196/34005 %U https://www.researchprotocols.org/2022/4/e34005 %U https://doi.org/10.2196/34005 %U http://www.ncbi.nlm.nih.gov/pubmed/35451973 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e30258 %T Designing Formulae for Ranking Search Results: Mixed Methods Evaluation Study %A Douze,Laura %A Pelayo,Sylvia %A Messaadi,Nassir %A Grosjean,Julien %A Kerdelhué,Gaétan %A Marcilly,Romaric %+ Inserm, Centre d'Investigation Clinique pour les Innovations Technologiques 1403, Institut Coeur-Poumon, 3ème étage Aile Est, CS 70001, Bd du Professeur Jules Leclercq, Lille, 59037, France, 33 0362943939, laura.douze@univ-lille.fr %K information retrieval %K search engine %K topical relevance %K search result ranking %K user testing %K human factors %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: A major factor in the success of any search engine is the relevance of the search results; a tool should sort the search results to present the most relevant documents first. Assessing the performance of the ranking formula is an important part of search engine evaluation. However, the methods currently used to evaluate ranking formulae mainly collect quantitative data and do not gather qualitative data, which help to understand what needs to be improved to tailor the formulae to their end users. Objective: This study aims to evaluate 2 different parameter settings of the ranking formula of LiSSa (the French acronym for scientific literature in health care; Department of Medical Informatics and Information), a tool that provides access to health scientific literature in French, to adapt the formula to the needs of the end users. Methods: To collect quantitative and qualitative data, user tests were carried out with representative end users of LiSSa: 10 general practitioners and 10 registrars. Participants first assessed the relevance of the search results and then rated the ranking criteria used in the 2 formulae. Verbalizations were analyzed to characterize each criterion. Results: A formula that prioritized articles representing a consensus in the field was preferred. When users assess an article’s relevance, they judge its topic, methods, and value in clinical practice. Conclusions: Following the evaluation, several improvements were implemented to give more weight to articles that match the search topic and to downgrade articles that have less informative or scientific value for the reader. Applying a qualitative methodology generates valuable user inputs to improve the ranking formula and move toward a highly usable search engine. %M 35333180 %R 10.2196/30258 %U https://humanfactors.jmir.org/2022/1/e30258 %U https://doi.org/10.2196/30258 %U http://www.ncbi.nlm.nih.gov/pubmed/35333180 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e31820 %T Assessment of the Readability of Web-Based Patient Education Material From Major Canadian Pediatric Associations: Cross-sectional Study %A Man,Alice %A van Ballegooie,Courtney %+ Department of Experimental Therapeutics, British Columbia Cancer Research Institute, 675 West 10th Avenue, Vancouver, BC, V5Z 1L3, Canada, 1 604 675 8000 ext 7024, cballegooie@bccrc.ca %K health literacy %K accessibility %K online health information %K pediatrics %K patient education %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Web-based patient education materials (PEMs) are frequently written above the recommended reading level in North America. Poor PEM readability limits the accessibility of medical information for individuals with average literacy levels or lower. Pediatric hospital and association websites have not only been shown to be a preferred source of information among caregivers but have also become a necessity during the COVID-19 pandemic. The readability of Canadian pediatric association websites has not yet been assessed. Objective: The aim of this study is to determine if the content of PEMs from Canadian pediatric associations is written at a reading level that the majority of Canadians can understand. Methods: A total of 258 PEMs were extracted from 10 Canadian pediatric associations and evaluated for their reading level using 10 validated readability scales. The PEMs underwent a difficult word analysis and comparisons between PEMs from different associations were conducted. Results: Web-based PEMs were identified from 3 pediatric association websites, where the reading level (calculated as a grade level) was found to be an average of 8.8 (SD 1.8) for the Caring for Kids website, 9.5 (SD 2.2) for the Pediatric Endocrine Group website, and 13.1 (SD 2.1) for the Atlantic Pediatric Society website. The difficult word analysis identified that 19.9% (SD 6.6%) of words were unfamiliar, with 13.3% (SD 5.3%) and 31.9% (SD 6.1%) of words being considered complex (≥3 syllables) and long (≥6 letters), respectively. Conclusions: The web-based PEMs were found to be written above the recommended seventh-grade reading level for Canadians. Consideration should be made to create PEMs at an appropriate reading level for both patients and their caregivers to encourage health literacy and ultimately promote preventative health behaviors and improve child health outcomes. %M 35293875 %R 10.2196/31820 %U https://pediatrics.jmir.org/2022/1/e31820 %U https://doi.org/10.2196/31820 %U http://www.ncbi.nlm.nih.gov/pubmed/35293875 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e31317 %T Developing an Educational Website for Women With Endometriosis-Associated Dyspareunia: Usability and Stigma Analysis %A Abdulai,Abdul-Fatawu %A Howard,A Fuchsia %A Yong,Paul J %A Noga,Heather %A Parmar,Gurkiran %A Currie,Leanne M %+ The School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B5, Canada, 1 7782230137, Fatawu@student.ubc.ca %K endometriosis %K sexual pain %K dyspareunia %K usability testing %K think-aloud %K stigma %K web sites %K digital health %K informatics %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Endometriosis is a chronic condition that affects approximately 10% of women worldwide. Despite its wide prevalence, knowledge of endometriosis symptoms, such as pelvic pain, and treatments remains relatively low. This not only leads to a trivialization of symptoms and delayed diagnosis but also fuels myths and misconceptions about pain symptoms. At the same time, the use of web-based platforms for information seeking is particularly common among people with conditions that are perceived as stigmatizing and difficult to discuss. The Sex, Pain, and Endometriosis website is an educational resource designed to provide evidence-based information on endometriosis and sexual pain to help people understand the condition, feel empowered, dispel myths, and destigmatize endometriosis-associated sexual pain. Objective: The study objective is to evaluate the usability of the website and assess for destigmatizing properties of sexual health–related web-based resources. Methods: We conducted a usability analysis by using a think-aloud observation, a postsystem usability questionnaire, and follow-up interviews with 12 women with endometriosis. The think-aloud data were analyzed using the framework by Kushniruk and Patel for analyzing usability video data, the questionnaire data were analyzed using descriptive statistics, and the follow-up interviews were analyzed using simple content analysis. We conducted a usability assessment by deductively analyzing the interview data via a trauma-informed care framework and a content analysis approach. Results: Through usability analysis, we found the website to be simple, uncluttered, satisfying, and easy to use. However, 30 minor usability problems related to navigation; website response; the comprehension of graphics, icons, and tabs; the understanding of content; and mismatch between the website and users’ expectations were reported. In our stigma analysis, we found the web content to be nonstigmatizing. The participants suggested ways in which websites could be designed to address stigma, including ensuring privacy, anonymity, inclusiveness, and factual and nonjudgmental content, as well as providing opportunities for web-based engagement. Conclusions: Overall, the participants found the website to be useful, easy to use, and satisfying. The usability problems identified were largely minor and informed the website redesign process. In the context of the limited literature on stigma and website design, this paper offers useful strategies on how sexual health–related websites can be designed to be acceptable and less stigmatizing to individuals with sensitive health issues. %M 35238789 %R 10.2196/31317 %U https://humanfactors.jmir.org/2022/1/e31317 %U https://doi.org/10.2196/31317 %U http://www.ncbi.nlm.nih.gov/pubmed/35238789 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e33451 %T Evaluation of an Experimental Web-based Educational Module on Opioid-related Occupational Safety Among Police Officers: Protocol for a Randomized Pragmatic Trial to Minimize Barriers to Overdose Response %A Simmons,Janie %A Elliott,Luther %A Bennett,Alex S %A Beletsky,Leo %A Rajan,Sonali %A Anders,Brad %A Dastparvardeh,Nicole %+ Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, 4th floor, Rm. 459, New York, NY, 10003, United States, 1 2129923807, js8822@nyu.edu %K occupational health %K law enforcement %K police/education %K naloxone %K opioid overdose prevention and response training %K online education %K opioids %K occupational risk %D 2022 %7 25.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: As drug-related morbidity and mortality continue to surge, police officers are on the front lines of the North American overdose (OD) crisis. Drug law enforcement shapes health risks among people who use drugs (PWUD), while also impacting the occupational health and wellness of officers. Effective interventions to align law enforcement practices with public health and occupational safety goals remain underresearched. Objective: The Opioids and Police Safety Study (OPS) aims to shift police practices relating to PWUD. It adapts and evaluates the relative effectiveness of a curriculum that bundles content on public health promotion with occupational risk reduction (ORR) to supplement a web-based OD response and naloxone training platform (GetNaloxoneNow.org, or GNN). This novel approach has the potential to improve public health and occupational safety practices, including using naloxone to reverse ODs, referring PWUD to treatment and other supportive services, and avoiding syringe confiscation. Methods: This longitudinal study uses a randomized pragmatic trial design. A sample of 300 active-duty police officers from select counties in Pennsylvania, Vermont, and New Hampshire with high OD fatality rates will be randomized (n=150 each) to either the experimental arm (GNN + OPS) or the control arm (GNN + COVID-19 ORR). A pre- and posttraining survey will be administered to all 300 officers, after which they will be administered quarterly surveys for 12 months. A subsample of police officers will also be qualitatively followed in a simultaneous embedded mixed-methods approach. Research ethics approval was obtained from the New York University Institutional Review Board. Results: Results will provide an understanding of the experiences, knowledge, and perceptions of this sample of law enforcement personnel. Generalized linear models will be used to analyze differences in key behavioral outcomes between the participants in each of the 2 study arms and across multiple time points (anticipated minimum effect size to be detected, d=0.50). Findings will be disseminated widely, and the training products will be available nationally once the study is completed. Conclusions: The OPS is the first study to longitudinally assess the impact of a web-based opioid-related ORR intervention for law enforcement in the U.S. Our randomized pragmatic clinical trial aims to remove barriers to life-saving police engagement with PWUD/people who inject drugs by focusing both on the safety of law enforcement and evidence-based and best practices for working with persons at risk of an opioid OD. Our simultaneous embedded mixed-methods approach will provide empirical evaluation of the diffusion of the naloxone-based response among law enforcement. Trial Registration: ClinicalTrail.gov NCT05008523; https://clinicaltrials.gov/show/NCT05008523 International Registered Report Identifier (IRRID): DERR1-10.2196/33451 %M 35212639 %R 10.2196/33451 %U https://www.researchprotocols.org/2022/2/e33451 %U https://doi.org/10.2196/33451 %U http://www.ncbi.nlm.nih.gov/pubmed/35212639 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e32112 %T Adoption of the Website and Mobile App of a Preventive Health Program Across Neighborhoods With Different Socioeconomic Conditions in the Netherlands: Longitudinal Study %A Agachi,Elena %A Bijmolt,Tammo H A %A Mierau,Jochen O %A van Ittersum,Koert %+ Department of Marketing, Faculty of Economics and Business, University of Groningen, PO Box 800, Groningen, 9700 AV, Netherlands, 31 50 363 3686, e.agachi@rug.nl %K eHealth %K mHealth %K mobile health %K mobile app %K internet %K preventive health program %K health disparities %K NSES %K program adoption %K survival analysis %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Socioeconomic disparities in the adoption of preventive health programs represent a well-known challenge, with programs delivered via the web serving as a potential solution. The preventive health program examined in this study is a large-scale, open-access web-based platform operating in the Netherlands, which aims to improve the health behaviors and wellness of its participants. Objective: This study aims to examine the differences in the adoption of the website and mobile app of a web-based preventive health program across socioeconomic groups. Methods: The 83,466 participants in this longitudinal, nonexperimental study were individuals who had signed up for the health program between July 2012 and September 2019. The rate of program adoption per delivery means was estimated using the Prentice, Williams, and Peterson Gap–Time model, with the measure of neighborhood socioeconomic status (NSES) used to distinguish between population segments with different socioeconomic characteristics. Registration to the health program was voluntary and free, and not within a controlled study setting, allowing the observation of the true rate of adoption. Results: The estimation results indicate that program adoption across socioeconomic groups varies depending on the program’s delivery means. For the website, higher NSES groups have a higher likelihood of program adoption compared with the lowest NSES group (hazard ratio 1.03, 95% CI 1.01-1.05). For the mobile app, the opposite holds: higher NSES groups have a lower likelihood of program adoption compared with the lowest NSES group (hazard ratio 0.94, 95% CI 0.91-0.97). Conclusions: Promoting preventive health programs using mobile apps can help to increase program adoption among the lowest socioeconomic segments. Given the increasing use of mobile phones among disadvantaged population groups, structuring future health interventions to include mobile apps as means of delivery can support the stride toward diminishing health disparities. %M 35107433 %R 10.2196/32112 %U https://humanfactors.jmir.org/2022/1/e32112 %U https://doi.org/10.2196/32112 %U http://www.ncbi.nlm.nih.gov/pubmed/35107433 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e31381 %T Educators' Perspectives on Integrating Technology Into Sexual Health Education: Implementation Study %A Decker,Martha J %A Harrison,Salish %A Price,Melisa %A Gutmann-Gonzalez,Abigail %A Yarger,Jennifer %A Tenney,Rachel %+ Department of Epidemiology and Biostatistics, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 550 16th Street, Second Floor, San Francisco, CA, 94158, United States, 1 (415) 476 3095, Mara.Decker@ucsf.edu %K adolescent %K sex education %K technology %K mobile app %K implementation %K California %K health educator %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In the last decade, the use of technology-based sexual health education has increased. Multiple studies have shown the feasibility of technology-based interventions, while a subset has also shown efficacy in improving youths’ sexual health outcomes such as increased condom use and knowledge. However, little is known about health educators’ experiences in integrating technology to augment sexual health curricula. Objective: The purpose of this study was to assess the perceptions and experiences of health educators regarding the incorporation of technology into a sexual health education program designed for underserved youth in Fresno County, California, and to identify facilitators and challenges to incorporating technology into the in-person curriculum. Methods: This implementation study used data collected as part of a cluster randomized controlled trial to evaluate In the Know (ITK), an in-person sexual health education curriculum that includes technology-based content, such as a resource locator, videos, and games, which can be accessed through a mobile app or website. Data from implementation logs from each cohort (n=51) and annual interviews (n=8) with health educators were analyzed to assess the health educators’ experiences using the technology and adaptations made during the implementation. Results: The health educators reported that technological issues affected implementation to some degree: 87% of the time in the first year, which decreased to 47% in the third year as health educators’ familiarity with the app increased and functionality improved. Technology issues were also more common in non–school settings. Successes and challenges in 3 domains emerged: managing technology, usability of the ITK app, and youth engagement. The health educators generally had positive comments about the app and youth engagement with the technology-based content and activities; however, they also noted certain barriers to adolescents’ use of the mobile app including limited data storage and battery life on mobile phones. Conclusions: Health educators require training and support to optimize technology as a resource for engaging with youth and providing sensitive information. Although technology is often presented as a solution to reach underserved populations, educational programs should consider the technological needs and limitations of the participants, educators, and settings. International Registered Report Identifier (IRRID): RR2-10.2196/18060 %M 35019842 %R 10.2196/31381 %U https://humanfactors.jmir.org/2022/1/e31381 %U https://doi.org/10.2196/31381 %U http://www.ncbi.nlm.nih.gov/pubmed/35019842 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e27631 %T Combining Farmers’ Preferences With Evidence-Based Strategies to Prevent and Lower Farmers’ Distress: Co-design and Acceptability Testing of ifarmwell %A Gunn,Kate M %A Skaczkowski,Gemma %A Dollman,James %A Vincent,Andrew D %A Short,Camille E %A Brumby,Susan %A Barrett,Alison %A Harrison,Nathan %A Turnbull,Deborah %+ Department of Rural Health, Allied Health and Human Performance, University of South Australia, City East Campus BJ2-03, North Terrace, Adelaide, 5001, Australia, 61 417852537, kate.gunn@unisa.edu.au %K farm %K agriculture %K rural %K drought %K mental health %K stress %K coping %K online intervention %K acceptance and commitment therapy %D 2022 %7 11.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Farming is physically and psychologically hazardous. Farmers face many barriers to help seeking from traditional physical and mental health services; however, improved internet access now provides promising avenues for offering support. Objective: This study aims to co-design with farmers the content and functionality of a website that helps them adopt transferable coping strategies and test its acceptability in the broader farming population. Methods: Research evidence and expert opinions were synthesized to inform key design principles. A total of 18 farmers detailed what they would like from this type of website. Intervention logic and relevant evidence-based strategies were mapped. Website content was drafted and reviewed by 2 independent mental health professionals. A total of 9 farmers provided detailed qualitative feedback on the face validity of the draft content. Subsequently, 9 farmers provided feedback on the website prototype. Following amendments and internal prototype testing and optimization, prototype usability (ie, completion rate) was examined with 157 registered website users who were (105/157, 66.9%) female, aged 21-73 years; 95.5% (149/156) residing in inner regional to very remote Australia, and 68.2% (107/157) “sheep, cattle and/or grain farmers.” Acceptability was examined with a subset of 114 users who rated at least module 1. Interviews with 108 farmers who did not complete all 5 modules helped determine why, and detailed interviews were conducted with 18 purposively sampled users. Updates were then made according to adaptive trial design methodology. Results: This systematic co-design process resulted in a web-based resource based on acceptance and commitment therapy and designed to overcome barriers to engagement with traditional mental health and well-being strategies—ifarmwell. It was considered an accessible and confidential source of practical and relevant farmer-focused self-help strategies. These strategies were delivered via 5 interactive modules that include written, drawn, and audio- and video-based psychoeducation and exercises, as well as farming-related jokes, metaphors, examples, and imagery. Module 1 included distress screening and information on how to speak to general practitioners about mental health–related concerns (including a personalized conversation script). Modules were completed fortnightly. SMS text messages offered personalized support and reminders. Qualitative interviews and star ratings demonstrated high module acceptability (average 4.06/5 rating) and suggested that additional reminders, higher quality audio recordings, and shorter modules would be useful. Approximately 37.1% (52/140) of users who started module 1 completed all modules, with too busy or not got to it yet being the main reason for non-completion, and previous module acceptability not predicting subsequent module completion. Conclusions: Sequential integration of research evidence, expert knowledge, and farmers’ preferences in the co-design process allowed for the development of a self-help intervention that focused on important intervention targets and was acceptable to this difficult-to-engage group. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000506392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372526 %M 35014963 %R 10.2196/27631 %U https://humanfactors.jmir.org/2022/1/e27631 %U https://doi.org/10.2196/27631 %U http://www.ncbi.nlm.nih.gov/pubmed/35014963 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27750 %T An Analysis of US Academic Medical Center Websites: Usability Study %A Gale,Jonathan James %A Black,Kameron Collin %A Calvano,Joshua David %A Fundingsland Jr,Edwin Lauritz %A Lai,Deborah %A Silacci,Sara %A He,Shuhan %+ Rocky Vista University College of Osteopathic Medicine, 8401 S Chambers Rd, Parker, CO, 80134, United States, 1 303 373 2008, jonathan.gale@rvu.edu %K website usability %K digital health %K health care website %K academic medical center %K usability testing %K web crawler %D 2021 %7 21.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health care organizations are tasked with providing web-based health resources and information. Usability refers to the ease of user experience on a website. In this study, we conducted a usability analysis of academic medical centers in the United States, which, to the best of our knowledge, has not been previously carried out. Objective: The primary aims of the study were to the following: (1) adapt a preexisting usability scoring methodology to academic medical centers; (2) apply and test this methodology on a sample set of academic medical center websites; and (3) make recommendations from these results on potential areas of improvements for our sample of academic medical center websites. Methods: All website usability testing took place from June 1, 2020, to December 15, 2020. We replicated a methodology developed in previous literature and applied it to academic medical centers. Our sample included 73 US academic medical centers. Usability was split into four broad categories: accessibility (the ability of those with low levels of computer literacy to access and navigate the hospital’s website); marketing (the ability of websites to be found through search engines and the relevance of descriptions to the links provided); content quality (grammar, frequency of information updates, material relevancy, and readability); and technology (download speed, quality of the programming code, and website infrastructure). Using these tools, we scored each website in each category. The composite of key factors in each category contributed to an overall “general usability” score for each website. An overall score was then calculated by applying a weighted percentage across all factors and was used for the final “overall usability” ranking. Results: The category with the highest average score was technology, with a 0.82 (SD 0.068, SE 0.008). The lowest-performing category was content quality, with an average of 0.22 (SD 0.069, SE 0.008). As these numbers reflect weighted percentages as an integer, the higher the score, the greater the overall usability in that category. Conclusions: Our data suggest that technology, on average, was the highest-scored variable among academic medical center websites. Because website functionality is essential to a user’s experience, it is justified that academic medical centers invest in optimal website performance. The overall lowest-scored variable was content quality. A potential reason for this may be that academic medical center websites are usually larger in size, making it difficult to monitor the increased quantity of content. An easy way to improve this variable is to conduct more frequent website audits to assess readability, grammar, and relevance. Marketing is another area in which these organizations have potential for improvement. Our recommendation is that organizations utilize search engine optimization techniques to improve their online visibility and discoverability. %M 34932015 %R 10.2196/27750 %U https://www.jmir.org/2021/12/e27750 %U https://doi.org/10.2196/27750 %U http://www.ncbi.nlm.nih.gov/pubmed/34932015 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e29748 %T Integration of Web Analytics Into Graduate Medical Education: Usability Study %A Massanelli,Jackson %A Sexton,Kevin W %A Lesher,Chris T %A Jensen,Hanna K %A Kimbrough,Mary K %A Privratsky,Anna %A Taylor,John R %A Bhavaraju,Avi %+ Division of Trauma and Acute Care Surgery, Department of Surgery, University of Arkansas for Medical Sciences, 4301 W Markham St, Little Rock, AR, 72205, United States, 1 501 320 7233, avi99@uams.edu %K graduate medical education %K website analysis %K residency recruitment %K medical education %K website %K analytics %K usage %K usability %K user engagement %K user-centered design %K website design %D 2021 %7 13.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Web analytics is the measurement, collection, analysis, and reporting of website and web application usage data. While common in the e-commerce arena, web analytics is underutilized in graduate medical education (GME). Objective: The University of Arkansas for Medical Sciences Department of Surgery website was revamped with input from in-house surgeons in August 2017. This study investigated the use of web analytics to gauge the impact of our department’s website redesign project. Methods: Google Analytics software was used to measure website performance before and after implementation of the new website. Eight-month matched periods were compared. Factors tracked included total users, new users, total sessions, sessions per user, pages per session, average session duration, total page views, and bounce rate (the percentage of visitors who visit a site and then leave [ie, bounce] without continuing to another page on the same site). Results: Analysis using a nonpaired Student t test demonstrated a statistically significant increase for total page views (before vs after: 33,065 vs 81,852; P<.001) and decrease for bounce rate (before vs after: 50.70% vs 0.23%; P<.001). Total users, new users, total sessions, sessions per user, and pages per session showed improvement. The average session duration was unchanged. Subgroup analysis showed that after the main page, the next 3 most frequently visited pages were related to GME programs in our department. Conclusions: Web analytics is a practical measure of a website’s efficacy. Our data suggest that a modern website significantly improves user engagement. An up-to-date website is essential for contemporary GME recruitment, will likely enhance engagement of residency applicants with GME programs, and warrants further investigation. %M 34898459 %R 10.2196/29748 %U https://formative.jmir.org/2021/12/e29748 %U https://doi.org/10.2196/29748 %U http://www.ncbi.nlm.nih.gov/pubmed/34898459 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e31843 %T Game Plan, a Web-Based Intervention to Improve Adherence and Persistence to HIV Pre-exposure Prophylaxis and Reduce Heavy Drinking in Gay, Bisexual, and Other Men Who Have Sex With Men: Usability and User Experience Testing %A Wray,Tyler B %A Chan,Philip A %A Kahler,Christopher W %+ Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 S Main Street, Box G-S121-5, Providence, RI, 02903, United States, 1 4018636659, tyler_wray@brown.edu %K pre-exposure prophylaxis %K HIV %K HIV prevention %K mHealth %K mobile health %K eHealth %K mobile phone %D 2021 %7 16.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Encouraging consistent use of pre-exposure prophylaxis (PrEP) is essential for reducing HIV incidence, particularly among gay, bisexual, and other men who have sex with men (GBM), and especially those who engage in heavy drinking. Although practice guidelines recommend providing adherence counseling to PrEP patients, clinics and providers may not have the resources or expertise to provide it. Internet-facilitated interventions have been shown to improve HIV prevention outcomes, including medication and care adherence. Game Plan is a website we created to help users make a tangible plan for reducing their HIV risk. We designed additional components of Game Plan to address key individual level barriers to PrEP use. Objective: The aim of this mixed methods research is to test the usability and user experience of these components with intended users: GBM who drink heavily and are on PrEP. Methods: In study 1 (usability), we completed a detailed individual interview in which participants (n=10) walked through a prototype of the website, thinking aloud as they did, and completed a follow-up interview and web-based survey afterward. Study 2 (user experience) involved providing participants (n=40) with a link to the prototype website to explore on their own and asking them to complete the same follow-up survey afterward. Qualitative data were analyzed using thematic analysis, and descriptive statistics were used to analyze quantitative data. Results: Users in both studies gave the website excellent ratings for usability, overall satisfaction, and quality, and most often described the site as informative, helpful, and supportive. Users also rated the site’s content and feel as respectful of them and their autonomy, empathetic, and they stated that it conveyed confidence in their ability to change. The study 1 interviews highlighted the importance of the website’s esthetics to the participants’ engagement with it and its credibility in prompting genuine reflection. Conclusions: GBM who reported heavy drinking and used PrEP generally found a website focused on helping them to create a plan to use PrEP consistently to be helpful. Adopting user-centered design methods and attending to the esthetics of mobile health interventions are important steps toward encouraging engagement and reducing at-risk behaviors. %M 34783662 %R 10.2196/31843 %U https://formative.jmir.org/2021/11/e31843 %U https://doi.org/10.2196/31843 %U http://www.ncbi.nlm.nih.gov/pubmed/34783662 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29558 %T Multiple Sclerosis Progression Discussion Tool Usability and Usefulness in Clinical Practice: Cross-sectional, Web-Based Survey %A Ziemssen,Tjalf %A Giovannoni,Gavin %A Alvarez,Enrique %A Bhan,Virender %A Hersh,Carrie %A Hoffmann,Olaf %A Oreja-Guevara,Celia %A Robles-Cedeño,Rene R %A Trojano,Maria %A Vermersch,Patrick %A Dobay,Pamela %A Khwaja,Mudeer %A Stadler,Bianca %A Rauser,Benedict %A Hach,Thomas %A Piani-Meier,Daniela %A Burton,Jason %+ Center of Clinical Neuroscience, Neurological University Clinic Carl-Gustav Carus, Dresden University of Technology, Helmholtzstr. 10, Dresden, 01069, Germany, 49 3514584465, Ziemssen@web.de %K multiple sclerosis %K relapsing remitting multiple sclerosis %K secondary progressive multiple sclerosis %K transition %K progression %K digital %K usability %D 2021 %7 6.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: A digital tool, Multiple Sclerosis Progression Discussion Tool (MSProDiscuss), was developed to facilitate discussions between health care professionals (HCPs) and patients in evaluating early, subtle signs of multiple sclerosis (MS) disease progression. Objective: The aim of this study is to report the findings on the usability and usefulness of MSProDiscuss in a real-world clinical setting. Methods: In this cross-sectional, web-based survey, HCPs across 34 countries completed an initial individual questionnaire (comprising 7 questions on comprehensibility, usability, and usefulness after using MSProDiscuss during each patient consultation) and a final questionnaire (comprising 13 questions on comprehensibility, usability, usefulness, and integration and adoption into clinical practice to capture the HCPs’ overall experience of using the tool). The responses were provided on a 5-point Likert scale. All analyses were descriptive, and no statistical comparisons were made. Results: In total, 301 HCPs tested the tool in 6974 people with MS, of whom 77% (5370/6974) had relapsing-remitting MS, including those suspected to be transitioning to secondary progressive MS. The time taken to complete MSProDiscuss was reported to be in the range of 1 to 4 minutes in 97.3% (6786/6974; initial) to 98.2% (269/274; final) of the cases. In 93.54% (6524/6974; initial) to 97.1% (266/274; final) of the cases, the HCPs agreed (4 or 5 on the Likert scale) that patients were able to comprehend the questions in the tool. The HCPs were willing to use the tool again in the same patient, 90.47% (6310/6974; initial) of the cases. The HCPs reported MSProDiscuss to be useful in discussing MS symptoms and their impact on daily activities (6121/6974, 87.76% initial and 252/274, 92% final) and cognitive function (5482/6974, 78.61% initial and 271/274, 79.2% final), as well as in discussing progression in general (6102/6974, 87.49% initial and 246/274, 89.8% final). While completing the final questionnaire, 94.9% (260/274) of the HCPs agreed that the questions were similar to those asked in regular consultation, and the tool helped to better understand the impact of MS symptoms on daily activities (249/274, 90.9%) and cognitive function (220/274, 80.3%). Overall, 92% (252/274) of the HCPs reported that they would recommend MSProDiscuss to a colleague, and 85.8% (235/274) were willing to integrate it into their clinical practice. Conclusions: MSProDiscuss is a usable and useful tool to facilitate a physician-patient discussion on MS disease progression in daily clinical practice. Most of the HCPs agreed that the tool is easy to use and were willing to integrate MSProDiscuss into their daily clinical practice. %M 34612826 %R 10.2196/29558 %U https://www.jmir.org/2021/10/e29558 %U https://doi.org/10.2196/29558 %U http://www.ncbi.nlm.nih.gov/pubmed/34612826 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28698 %T Development of and Experiences With an Informational Website on Early Labor: Qualitative User Involvement Study %A Myhre,Enid Leren %A Garnweidner-Holme,Lisa %A Dahl,Bente %A Reigstad,Marte Myhre %A Lukasse,Mirjam %+ Centre for Women’s, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, P O Box 235, Kongsberg, N-3603, Norway, 47 91698469, enid.myhre@usn.no %K early labor %K latent phase %K think aloud %K usability %K website %K labor %K pregnancy %K user-friendliness %K eHealth %K user satisfaction %D 2021 %7 27.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The period of regular contractions before 4 cm of cervical dilatation is often referred to as the latent phase or early labor. Women find it challenging to prepare for and cope with this phase of labor, and easily accessed web-based information from reliable sources may be useful in this preparation. Objective: The aim of this study is to describe the development of a Norwegian website, Latens.no, for people seeking information on early labor and to explore users’ experiences with the website to increase its user-friendliness. Methods: We developed a website using an iterative process involving a multidisciplinary research team, health personnel, users, a graphic designer, and an expert in software development. We explored the website’s user-friendliness using semistructured individual interviews and the think-aloud method. All interviews were audio recorded and transcribed. We then analyzed the participants’ feedback on the website. Results: Participants included women who had recently given birth to their first baby (n=2), women who were pregnant with their first baby (n=4), and their partners (n=2). Results from participants’ experiences completing tasks included positive feedback related to the content of Latens.no, positive feedback related to the website’s design, and suggestions for improvement. Participants wanted to find information on early labor on the internet. Moreover, they found the information on the website relevant, trustworthy, and easy to read, and the design was attractive and easy to use. Overall, the participants performed the tasks easily, with few clicks and minimal effort. Conclusions: The think-aloud method, while performing tasks, allowed for detailed feedback. The participants confirmed the user-friendliness of the website but at the same time provided information enabling improvement. We expect that changes made based on this user-centered design study will further increase the usability and acceptability of Latens.no. %M 34569940 %R 10.2196/28698 %U https://formative.jmir.org/2021/9/e28698 %U https://doi.org/10.2196/28698 %U http://www.ncbi.nlm.nih.gov/pubmed/34569940 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e17913 %T Development, Implementation, and Effectiveness of a Self-sustaining, Web-Based LGBTQ+ National Platform: A Framework for Centralizing Local Health Care Resources and Culturally Competent Providers %A Nowaskie,Dustin Z %+ Department of Psychiatry, Indiana University School of Medicine, 355 W 16th Street, #2364, Indianapolis, IN, 46202, United States, 1 317 963 7307, dznowaskie@gmail.com %K cultural competency %K disparities %K e-health %K healthcare %K internet %K LGBTQ+ %K online platform %K providers %K resources %K eHealth %K health care %D 2021 %7 22.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) population has long faced substantial marginalization, discrimination, and health care disparities compared to the cisgender, heterosexual population. As the etiology of such disparities is multifaceted, finding concrete solutions for LGBTQ+ health care equity is challenging. However, the internet may offer the space to initiate an effective model. Objective: In an effort to make LGBTQ+ public resources and culturally competent providers transparent, modernize medical education, and promote cultural competency, OutCare Health—a nonprofit 501(c)(3) multidisciplinary, multicenter web-based platform—was created. Methods: The organization employs a cyclic, multidimensional framework to conduct needs assessments, identify resources and providers, promote these efforts on the website, and educate the next generation of providers. LGBTQ+ public health services are identified via the internet, email, and word of mouth and added to the Public Resource Database; culturally competent providers are recruited to the OutList directory via listservs, medical institutions, local organizations, and word of mouth; and mentors are invited to the Mentorship Program by emailing OutList providers. These efforts are replicated across nearly 30 states in the United States. Results: The organization has identified over 500 public health organizations across all states, recognized more than 2000 OutList providers across all states and 50 specialties, distributed hundreds of thousands of educational materials, received over 10,000 monthly website visits (with 83% unique viewership), and formed nearly 30 state-specific teams. The total number of OutList providers and monthly website views has doubled every 12-18 months. The majority of OutList providers are trained in primary, first point-of-care specialties such as family medicine, infectious disease, internal medicine, mental health, obstetrics and gynecology, and pediatrics. Conclusions: A web-based LGBTQ+ platform is a feasible, effective model to identify public health resources, culturally competent providers, and mentors as well as provide cultural competency educational materials and education across the country. Such a platform also has the opportunity to reach self-perpetuating sustainability. The cyclic, multidisciplinary, multidimensional, multicenter framework presented here appears to be pivotal in achieving such growth and stability. Other organizations and medical institutions should heavily consider using this framework to reach their own communities with high-quality, culturally competent care for the LGBTQ+ population. %M 34550083 %R 10.2196/17913 %U https://formative.jmir.org/2021/9/e17913 %U https://doi.org/10.2196/17913 %U http://www.ncbi.nlm.nih.gov/pubmed/34550083 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e31976 %T The Finding My Way UK Clinical Trial: Adaptation Report and Protocol for a Replication Randomized Controlled Efficacy Trial of a Web-Based Psychological Program to Support Cancer Survivors %A Hulbert-Williams,Nicholas J %A Leslie,Monica %A Hulbert-Williams,Lee %A Koczwara,Bogda %A Watson,Eila K %A Hall,Peter S %A Ashley,Laura %A Coulson,Neil S %A Jackson,Richard %A Millington,Sue %A , %A Beatty,Lisa %+ Centre for Contextual Behavioural Science, School of Psychology, University of Chester, Parkgate Road, Chester, CH1 4BJ, United Kingdom, 44 1244511950, n.hulbertwilliams@chester.ac.uk %K cancer %K survivorship %K psychosocial intervention %K digital health %K quality of life %K protocol %K mobile phone %D 2021 %7 20.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Cancer survivors frequently report a range of unmet psychological and supportive care needs; these often continue after treatment has finished and are predictive of psychological distress and poor health-related quality of life. Web-based interventions demonstrate good efficacy in addressing these concerns and are more accessible than face-to-face interventions. Finding My Way (FMW) is a web-based, psycho-educational, and cognitive behavioral therapy intervention for cancer survivors developed in Australia. Previous trials have demonstrated that FMW is acceptable, highly adhered to, and effective in reducing the impact of distress on quality of life while leading to cost savings through health resource use reduction. Objective: This study aims to adapt the Australian FMW website for a UK cancer care context and then undertake a single-blinded, randomized controlled trial of FMW UK against a treatment-as-usual waitlist control. Methods: To an extent, our trial design replicates the existing Australian randomized controlled trial of FMW. Following a comprehensive adaptation of the web resource, we will recruit 294 participants (147 per study arm) from across clinical sites in North West England and North Wales. Participants will have been diagnosed with cancer of any type in the last 6 months, have received anticancer treatment with curative intent, be aged ≥16 years, be proficient in English, and have access to the internet and an active email address. Participants will be identified and recruited through the National Institute for Health Research clinical research network. Measures of distress, quality of life, and health economic outcomes will be collected using a self-report web-based questionnaire at baseline, midtreatment, posttreatment, and both 3- and 6-month follow-up. Quantitative data will be analyzed using intention-to-treat mixed model repeated measures analysis. Embedded semistructured qualitative interviews will probe engagement with, and experiences of using, FMW UK and suggestions for future improvements. Results: The website adaptation work was completed in January 2021. A panel of cancer survivors and health care professionals provided feedback on the test version of FMW UK. Feedback was positive overall, although minor updates were made to website navigation, inclusivity, terminology, and the wording of the Improving Communication and Sexuality and Intimacy content. Recruitment for the clinical trial commenced in April 2021. We aim to report on findings from mid-2023. Conclusions: Replication studies are an important aspect of the scientific process, particularly in psychological and clinical trial literature, especially in different geographical settings. Before replicating the FMW trial in the UK setting, content updating was required. If FMW UK now replicates Australian findings, we will have identified a novel and cost-effective method of psychosocial care delivery for cancer survivors in the United Kingdom. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 14317248; https://www.isrctn.com/ISRCTN14317248 International Registered Report Identifier (IRRID): DERR1-10.2196/31976 %M 34542420 %R 10.2196/31976 %U https://www.researchprotocols.org/2021/9/e31976 %U https://doi.org/10.2196/31976 %U http://www.ncbi.nlm.nih.gov/pubmed/34542420 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28349 %T Acceptability of a Brief Web-Based Theory-Based Intervention to Prevent and Reduce Self-harm: Mixed Methods Evaluation %A Keyworth,Chris %A O'Connor,Rory %A Quinlivan,Leah %A Armitage,Christopher J %+ School of Psychology, University of Leeds, Woodhouse, Leeds, LS2 9JT, United Kingdom, 44 01133433738, c.keyworth@leeds.ac.uk %K self-harm %K implementation intentions %K acceptability %K online %K volitional help sheet %K digital health %K mental health %D 2021 %7 14.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The volitional help sheet (VHS) for self-harm equips people with a means of responding automatically to triggers for self-harm with coping strategies. Although there is some evidence of its efficacy, improving acceptability and making the intervention available in a web-based format may be crucial to increasing effectiveness and reach. Objective: This study aims to use the Theoretical Framework of Acceptability (TFA) to explore the acceptability of the VHS, examine for whom and under what circumstances this intervention is more or less acceptable, and develop a series of recommendations for how the VHS can be used to support people in reducing repeat self-harm. Methods: We explored acceptability in two phases. First, our patient and public involvement partners evaluated the original VHS from a lived experience perspective, which was subsequently translated into a web-based format. Second, a representative sample of adults in the United Kingdom who had previously self-harmed were recruited via a YouGov survey (N=514) and were asked to rate the acceptability of the VHS based on the seven constructs of the TFA, namely, affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Data were analyzed using descriptive statistics, one-tailed t tests, and binary logistic regression. A directed content analysis approach was used to analyze qualitative data. Results: Participants in the web-based survey rated the VHS as positive (affective attitude; t457=4.72; P<.001); were confident using it (self-efficacy; t457=9.54; P<.001); felt they did not have to give up any benefits, profits, or values when using it (opportunity costs; t439=−15.51; P<.001); understood it and how it worked (intervention coherence; t464=11.90; P<.001); and were confident that it would achieve its purpose (perceived effectiveness; t466=2.04; P=.04). The TFA domain burden appeared to be an important indicator of acceptability. Lower levels of perceived burden when using the VHS tool were more prevalent among younger adults aged 18-24 years (OR 3.63, 95% CI 1.50-8.78), people of White ethnic background (OR 3.02, 95% CI 1.06-8.613), and people without a long-term health condition (OR 1.53, 95% CI 1.01-2.30). Perceived modifications to further improve acceptability included improved formatting (burden), the feature to add new situations and responses or amend existing ones (ethicality), and clearer instructions and further detail about the purpose of the VHS (intervention coherence). Conclusions: Our findings show high levels of acceptability among some people who have previously self-harmed, particularly among younger adults, people of White ethnic backgrounds, and people without long-term health conditions. Future research should aim to improve acceptability among older adults, people from minority ethnic groups, and people with long-term health conditions. %M 34518153 %R 10.2196/28349 %U https://www.jmir.org/2021/9/e28349 %U https://doi.org/10.2196/28349 %U http://www.ncbi.nlm.nih.gov/pubmed/34518153 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30237 %T Using the Think-Aloud Method to Assess the Feasibility and Acceptability of Network Canvas Among Black Men Who Have Sex With Men and Transgender Persons: Qualitative Analysis %A Crawford,Natalie D %A Josma,Dorie %A Harrington,Kristin R V %A Morris,Joseph %A Quamina,Alvan %A Birkett,Michelle %A Phillips II,Gregory %+ Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Grace Crum Rollins Building, 1518 Clifton Rd, Atlanta, GA, 30322, United States, 1 404 712 9445, ndcrawford@emory.edu %K think-aloud %K egocentric networks %K sociogram %K social networks %K MSM %K transgender %K network canvas %K black MSM %K infectious disease transmission %K stigma %D 2021 %7 9.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Characteristics of an individual’s social network have been important factors in understanding infectious disease transmission patterns. Social network data collection is generally time and resource intensive, yet it is crucial to our understanding of the complex epidemiologic landscape of human behaviors among stigmatized social groups. Objective: We sought to evaluate the feasibility and acceptability of a self-administered social network data collection tool, Network Canvas, among Black men who have sex with men (BMSM) and transgender persons using the think-aloud method, which is a robust and flexible research technique used to perform usability testing. Methods: We piloted a self-administered network interview within the Network Canvas Software Suite. Participants aged 18 years and older were recruited through a community-based organization in Atlanta, GA, and were included based upon their willingness to share information on sexual behaviors and drug use for themselves and their social networks. A semistructured interview guide was used to document cognitive decision-making processes while using the tool. Recorded interviews were transcribed verbatim, and thematic analyses were performed. Results: Among 7 BMSM and transgender participants, three main themes were identified from cognitive processes: (1) the utility, (2) navigation, and (3) intuitive design of Network Canvas. Overall, Network Canvas was described as “easy to use,” with suggestions mainly directed toward improving navigation tools and implementing an initial tutorial on the program prior to use. Participants were willing to use Network Canvas to document their social networks and characteristics. In general, observed verbal responses from participants matched their behavior, although there were some discrepancies between verbal affirmations of use and understanding versus external observation. Conclusions: We found Network Canvas to be a useful new tool to capture social network data. Self-administration allowed participants the opportunity to provide sensitive information about themselves and their social networks. Furthermore, automated name generation and visualization of an individuals’ social network in the app has the potential to reduce cognitive burden during data collection. More efficient methods of social network data collection have the potential to provide epidemiologic information to guide prevention efforts for populations with stigmatized health conditions or behaviors. %M 34499040 %R 10.2196/30237 %U https://formative.jmir.org/2021/9/e30237 %U https://doi.org/10.2196/30237 %U http://www.ncbi.nlm.nih.gov/pubmed/34499040 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28356 %T An Evaluation Service for Digital Public Health Interventions: User-Centered Design Approach %A Karpathakis,Kassandra %A Libow,Gene %A Potts,Henry W W %A Dixon,Simon %A Greaves,Felix %A Murray,Elizabeth %+ Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 20 3549 5303, h.potts@ucl.ac.uk %K digital health %K internet-based interventions %K mHealth %K evaluation studies %K public health %K human-centered design %K service design %K mobile phone %D 2021 %7 8.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health interventions (DHIs) have the potential to improve public health by combining effective interventions and population reach. However, what biomedical researchers and digital developers consider an effective intervention differs, thereby creating an ongoing challenge to integrating their respective approaches when evaluating DHIs. Objective: This study aims to report on the Public Health England (PHE) initiative set out to operationalize an evaluation framework that combines biomedical and digital approaches and demonstrates the impact, cost-effectiveness, and benefit of DHIs on public health. Methods: We comprised a multidisciplinary project team including service designers, academics, and public health professionals and used user-centered design methods, such as qualitative research, engagement with end users and stakeholders, and iterative learning. The iterative approach enabled the team to sequentially define the problem, understand user needs, identify opportunity areas, develop concepts, test prototypes, and plan service implementation. Stakeholders, senior leaders from PHE, and a working group critiqued the outputs. Results: We identified 26 themes and 82 user needs from semistructured interviews (N=15), expressed as 46 Jobs To Be Done, which were then validated across the journey of evaluation design for a DHI. We identified seven essential concepts for evaluating DHIs: evaluation thinking, evaluation canvas, contract assistant, testing toolkit, development history, data hub, and publish health outcomes. Of these, three concepts were prioritized for further testing and development, and subsequently refined into the proposed PHE Evaluation Service for public health DHIs. Testing with PHE’s Couch-to-5K app digital team confirmed the viability, desirability, and feasibility of both the evaluation approach and the Evaluation Service. Conclusions: An iterative, user-centered design approach enabled PHE to combine the strengths of academic and biomedical disciplines with the expertise of nonacademic and digital developers for evaluating DHIs. Design-led methodologies can add value to public health settings. The subsequent service, now known as Evaluating Digital Health Products, is currently in use by health bodies in the United Kingdom and is available to others for tackling the problem of evaluating DHIs pragmatically and responsively. %M 34494965 %R 10.2196/28356 %U https://www.jmir.org/2021/9/e28356 %U https://doi.org/10.2196/28356 %U http://www.ncbi.nlm.nih.gov/pubmed/34494965 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e25168 %T Combined Use of Web-Based and In-Person Education on Ill Health Self-management Skills in Adults With Bipolar Disorder: Protocol for a Mixed Methods Study %A Hatzioannou,Anna %A Chatzittofis,Andreas %A Koutroubas,Virginia Sunday %A Papastavrou,Evridiki %A Karanikola,Maria %+ Nursing Department, School of Health Sciences, Cyprus University of Technology, 15 Vragadinou Street, Limassol, 3041, Cyprus, 357 99786069, maria.karanikola@cut.ac.cy %K education %K empowerment %K bipolar disorders %K self-management %K bipolar %K mental health %D 2021 %7 8.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Addressing the enhancement of ill health self-management skills in adults diagnosed with bipolar disorder may be considered an important intervention for health care systems worldwide. Objective: This protocol describes the study “Management of my Bipolarity” (MoB), which aims to develop an educational intervention for adults with bipolar disorder and assess its effectiveness. The objectives include (a) a literature review on bipolar disorder educational interventions; (b) a qualitative exploration of the educational needs of people with bipolar disorder; (c) development of an educational intervention based on objectives (a) and (b) (ie, the MoB educational intervention); and (d) exploration of the effectiveness of the intervention regarding participants’ knowledge of their mental health condition and enhancement of their ill health self-management skills. The MoB educational intervention will consist of an in-person and a web-based intervention in the form of a digital platform. Methods: The proposed interventional study is a combination of a qualitative and a quantitative design (mixed methods study). A focus group and content analysis will be implemented for the qualitative assessment of the educational needs of adults with bipolar disorder. The intervention will be developed based on the qualitative data of the study and relevant literature. The effectiveness of the acquired knowledge and self-management skills will be assessed according to (a) substance use behavior, (b) health locus of control, (c) impulse control, (d) adherence to pharmacotherapy, (e) relapse prevention, (f) improvement of quality of life, and (g) bipolar disorder knowledge level via structured instruments in the quantitative part of the study using descriptive and inferential statistics (SPSS version 24.0). Results: A total of 13 patients with bipolar disorder have been interviewed (8 women, 5 men) to identify educational needs to be covered through the intervention. Moreover, a literature review on bipolar disorder educational interventions has been completed. These data have been incorporated in the design of the MoB in-person intervention and the digital platform. The digital platform is live, and the development of the MoB in-person intervention was completed at the end of 2020. The recruitment of the participants for the intervention (40 patients) and the control group (40 patients) began during the first semester of 2021. Moreover, by tracking the platform for 1.5 years, we have recorded that 2180 users have visited the platform with an average session duration of almost 2 minutes. Mobile and tablet devices are being used by 70% of the visitors. Conclusions: Since new parameters regarding educational interventions will be explored, these findings are expected to provide evidence that participation in structured educational interventions offers patients the opportunity to improve adherence to pharmacotherapy and increase their quality of life. Trial Registration: ClinicalTrials.gov NCT04643210; https://clinicaltrials.gov/ct2/show/NCT04643210 International Registered Report Identifier (IRRID): DERR1-10.2196/25168 %M 34494969 %R 10.2196/25168 %U https://www.researchprotocols.org/2021/9/e25168 %U https://doi.org/10.2196/25168 %U http://www.ncbi.nlm.nih.gov/pubmed/34494969 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28878 %T Redesigning a Web-Based Stakeholder Consensus Meeting About Core Outcomes for Clinical Trials: Formative Feedback Study %A Katiri,Roulla %A Hall,Deborah A %A Hoare,Derek J %A Fackrell,Kathryn %A Horobin,Adele %A Buggy,Nóra %A Hogan,Nicholas %A Kitterick,Pádraig T %A , %+ National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre (BRC), Ropewalk House, 113 The Ropewalk, Nottingham, NG1 5DU, United Kingdom, 44 1158232626, padraig.kitterick@nottingham.ac.uk %K COVID-19 %K nominal group technique %K formative research %K patient participation %K persons with hearing impairments %K mobile phone %D 2021 %7 19.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Clinical trials that assess the benefits and harms of an intervention do so by measuring and reporting outcomes. Inconsistent selection and diversity in the choice of outcomes make it challenging to directly compare interventions. To achieve an agreed core set of outcomes, a consensus methodology is recommended, comprising a web-based Delphi survey and a face-to-face consensus meeting. However, UK government regulations to control the pandemic prohibited plans for a face-to-face consensus meeting as part of the Core Rehabilitation Outcome Set for Single-Sided Deafness (CROSSSD) study. Objective: This study aims to evaluate the modifications made by the CROSSSD study team to achieve consensus using web-based methods, but with minimal deviation from the original study protocol. Methods: The study team worked with health care users and professionals to translate the planned face-to-face consensus meeting in a web-based format, preserving the key elements of the nominal group technique. A follow-up survey gathered evaluation feedback on the experiences of the 22 participating members. Feedback covered premeeting preparation, the process of facilitated discussions and voting, ability to contribute, and perceived fairness of the outcome. Results: Overall, 98% (53/54) of feedback responses agreed or strongly agreed with the statements given, indicating that the web-based meeting achieved its original goals of open discussion, debate, and voting to agree with a core outcome set for single-sided deafness. Hearing-impaired participants were fully engaged, but there were some methodological challenges. For the participants, challenges included building rapport, understanding, and delivering the tasks in hand. For the study team, challenges included the need for thorough preparation and management of the unpredictability of tasks on the day. Conclusions: Sharing our experiences and lessons learned can benefit future core outcome set developers. Overcoming the challenges of delivering a web-based consensus exercise in the face of the pandemic can be applied more generally to maximize inclusiveness, enhance geographical access, and reduce research costs. %M 34420915 %R 10.2196/28878 %U https://formative.jmir.org/2021/8/e28878 %U https://doi.org/10.2196/28878 %U http://www.ncbi.nlm.nih.gov/pubmed/34420915 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 3 %P e26532 %T Usability of a Co-designed eHealth Prototype for Caregivers: Combination Study of Three Frameworks %A Tremblay,Melanie %A Latulippe,Karine %A Guay,Manon %A Provencher,Véronique %A Giguère,Anick %A Poulin,Valérie %A Dubé,Véronique %A Giroux,Dominique %+ Department of Teaching and Learning Studies, Université Laval, 2325 Rue de l'Université, Québec, QC, G1V 0A6, Canada, 1 (418) 656 2131, melanie.tremblay.50@ulaval.ca %K usability evaluation %K co-design %K research methods %K caregivers %K service providers %K product objectives %D 2021 %7 18.8.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Co-design (or the participation of users) has shown great potential in the eHealth domain, demonstrating positive results. Nevertheless, the co-design approach cannot guarantee the usability of the system designed, and usability assessment is a complex analysis to perform, as evaluation criteria will differ depending on the usability framework (or set of criteria) used. ISO (International Organization for Standardization) on usability (ISO 9241-210), Nielsen heuristic, and Garrett element of user experience inform different yet complementary aspects of usability. Objective: This study aims to assess the usability and user experience of a co-design prototype by combining 3 complementary frameworks. Methods: To help caregivers provide care for functionally impaired older people, an eHealth tool was co-designed with caregivers, health and social service professionals, and community workers assisting caregivers. The prototype was a website that aims to support the help-seeking process for caregivers (finding resources) and allow service providers to advertise their services (offering resources). We chose an exploratory study method to assess usability in terms of each objective. The first step was to assess users’ first impressions of the website. The second was a task scenario with a think-aloud protocol. The final step was a semistructured interview. All steps were performed individually (with a moderator) in a single session. The data were analyzed using 3 frameworks. Results: A total of 10 participants were recruited, 5 for each objective of the website. We were able to identify several usability problems, most of which were located in the information design and interface design dimensions (Garrett framework). Problems in both dimensions were mainly coded as effectiveness and efficiency (ISO framework) and error prevention and match between the systemand the real world (Nielsen heuristic). Conclusions: Our study provided a novel contribution about usability analysis by combining the 3 different models to classify the problems found. This combination provided a holistic understanding of the usability improvements needed. It can also be used to analyze other eHealth products. International Registered Report Identifier (IRRID): RR2-10.2196/11634 %M 34406123 %R 10.2196/26532 %U https://humanfactors.jmir.org/2021/3/e26532 %U https://doi.org/10.2196/26532 %U http://www.ncbi.nlm.nih.gov/pubmed/34406123 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e23360 %T Development and Evaluation of Acceptability and Feasibility of a Web-Based Intervention for Patients With Bipolar Disorder in Iran: Implementation Study %A Ashrafi,Agaah %A Tabatabaee,Maryam %A Sharifi,Vandad %+ Department of Psychiatry, Roozbeh Hospital, Tehran University of Medical Sciences, South Kargar Avenue, Roozbeh Hospital, Tehran, Iran, 98 9123875869, vsharifi@tums.ac.ir %K bipolar disorder %K psychoeducation %K web-based intervention %K feasibility %K acceptability %D 2021 %7 17.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Psychoeducation for bipolar disorder has a significant impact on symptoms and treatment adherence. In Iran, as a low-resource setting, infrastructural barriers, such as inadequate mental health professionals, difficulties in transportation, and costs of care, may hinder optimum delivery of this evidence-based intervention to patients. Objective: This study sought to explore the acceptability and feasibility of a web-based intervention for bipolar patients in Iran. Methods: A website has been developed as a platform for providing psychoeducational content about bipolar disorder. Patients were chosen via a convenient sampling method in 2018-2019. The main component of the intervention included streaming 7 weekly video clips after attending a single in-person meeting, as well as a medication self-monitoring application. Information was collected about the feasibility and acceptability of the intervention. Results: We invited 45 patients from the day center and the outpatient clinic of Roozbeh psychiatric hospital and some private clinics in Tehran. Of the 23 patients (51%) who attended the first in-person session and provided informed consent, 14 patients dropped out during the study. While 9 patients completed the course (attended 4 or more online sessions), only 5 watched all the video sessions. The rate of adherence to the intervention and frequency of exposure to the website were much higher for those recruited from the private and outpatient clinics. Conclusions: This web-based intervention can be feasible and acceptable only for a subgroup of patients with specific educational status and socioeconomic level. %M 34402794 %R 10.2196/23360 %U https://formative.jmir.org/2021/8/e23360 %U https://doi.org/10.2196/23360 %U http://www.ncbi.nlm.nih.gov/pubmed/34402794 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e23834 %T Efficiency, Usability, and Outcomes of Proctored Next-Level Exams for Proficiency Testing in Primary Care Education: Observational Study %A Schoenmakers,Birgitte %A Wens,Johan %+ Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 33/7001, Leuven, 3000, Belgium, 32 495235639, birgitte.schoenmakers@kuleuven.be %K primary care %K education %K graduate %K medical education %K testing %K assessment %K app %K COVID-19 %K efficiency %K accuracy %D 2021 %7 16.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has affected education and assessment programs and has resulted in complex planning. Therefore, we organized the proficiency test for admission to the Family Medicine program as a proctored exam. To prevent fraud, we developed a web-based supervisor app for tracking and tracing candidates’ behaviors. Objective: We aimed to assess the efficiency and usability of the proctored exam procedure and to analyze the procedure’s impact on exam scores. Methods: The application operated on the following three levels to register events: the recording of actions, analyses of behavior, and live supervision. Each suspicious event was given a score. To assess efficiency, we logged the technical issues and the interventions. To test usability, we counted the number of suspicious students and behaviors. To analyze the impact that the supervisor app had on students’ exam outcomes, we compared the scores of the proctored group and those of the on-campus group. Candidates were free to register for off-campus participation or on-campus participation. Results: Of the 593 candidates who subscribed to the exam, 472 (79.6%) used the supervisor app and 121 (20.4%) were on campus. The test results of both groups were comparable. We registered 15 technical issues that occurred off campus. Further, 2 candidates experienced a negative impact on their exams due to technical issues. The application detected 22 candidates with a suspicion rating of >1. Suspicion ratings mainly increased due to background noise. All events occurred without fraudulent intent. Conclusions: This pilot observational study demonstrated that a supervisor app that records and registers behavior was able to detect suspicious events without having an impact on exams. Background noise was the most critical event. There was no fraud detected. A supervisor app that registers and records behavior to prevent fraud during exams was efficient and did not affect exam outcomes. In future research, a controlled study design should be used to compare the cost-benefit balance between the complex interventions of the supervisor app and candidates’ awareness of being monitored via a safe browser plug-in for exams. %M 34398786 %R 10.2196/23834 %U https://formative.jmir.org/2021/8/e23834 %U https://doi.org/10.2196/23834 %U http://www.ncbi.nlm.nih.gov/pubmed/34398786 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28855 %T Design of the Maternal Website EMAeHealth That Supports Decision-Making During Pregnancy and in the Postpartum Period: Collaborative Action Research Study %A Artieta-Pinedo,Isabel %A Paz-Pascual,Carmen %A Bully,Paola %A Espinosa,Maite %A , %+ Osakidetza-Basque Health Service, Biocruces-Bizkaia Health Research Institute, Osi Barakaldo-Sestao, Lurkizaga S/N, Barakaldo, 48901, Spain, 34 946006667, misabel.artieta@ehu.eus %K prenatal education %K women %K patient decision aid %K decision-making %K clinical decision support systems %K action research and pregnancy %K implementation science %K health service needs and demands %D 2021 %7 9.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the benefit maternal education has for women, it needs new tools to increase its effectiveness and scope, in tune with the needs of current users. Objective: We attempted to develop a multifunctional personalized eHealth platform aimed at the self-management of health in relation to maternity, which can be considered a flexible and adaptable maternal education tool. Methods: The International Patient Decision Aid Standards (IPDAS) were applied. A website prototype was developed for implementation in the public health system using a collaborative action research process, in which experts and patients participate, with qualitative research techniques, as well as focus groups, prioritization, and consensus techniques. Results: We have proposed a website that includes (1) systematically updated information related to clinical practice guidelines, (2) interaction between peers and users/professionals, (3) instruments for self-assessment of health needs as a basis for working on counseling, agreement on actions, help in the search for resources, support in decision-making, and monitoring and evaluation of results, and (4) access for women to their clinical data and the option of sharing the data with other health agents. These components, with different access requirements, would be reviewed through iterative cycles depending on the frequency and effectiveness resulting from their use and would be accessible from any digital device. Conclusions: A website that supports maternal education should contain not only information, but also resources for individual attention and social support. Its usefulness for the health and satisfaction of women should be evaluated in various different environments. %M 34383670 %R 10.2196/28855 %U https://formative.jmir.org/2021/8/e28855 %U https://doi.org/10.2196/28855 %U http://www.ncbi.nlm.nih.gov/pubmed/34383670 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e27526 %T Adaptation of a Live Video Mind–Body Program to a Web-Based Platform for English-Speaking Adults With Neurofibromatosis: Protocol for the NF-Web Study %A Lester,Ethan Gabriel %A Hopkins,Sarah Whitall %A Popok,Paula Jean %A Vranceanu,Ana-Maria %+ Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square,, 1st Floor, Suite 100, Boston, MA, 02114, United States, 1 617 724 4977, avranceanu@mgh.harvard.edu %K neurofibromatosis %K quality of life %K stress management %K mind–body %K asynchronous delivery %K resiliency %K mobile phone %D 2021 %7 10.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Neurofibromatosis (NF) is a rare genetic condition associated with lower but modifiable quality of life (QoL). Although a virtual live video program (Relaxation Response Resiliency Program for Neurofibromatosis [3RP-NF]; efficacy randomized controlled trial underway) that we created has been made available, ongoing barriers impede some patients from engaging in this intervention. A necessary next step is to develop a stand-alone web-based intervention that reduces barriers to accessing NF-specific psychosocial care. Objective: First, we aim to develop a web-based platform (Neurofibromatosis-Web [NF-Web]) of our mind–body resiliency program (3RP-NF) through qualitative interviews with participants from an adult efficacy randomized controlled trial. Second, we aim to iteratively optimize the feasibility, acceptability, credibility, and satisfaction of the NF-Web platform through open pilot trials with participant exit interviews and explore quantitative outcomes within this sample. Here, we describe the protocol and study design, intervention, and analysis plan. Methods: For aim 1, we will invite completers from our efficacy trial to participate in qualitative interviews. We will use data from these interviews to adapt the content of the live video program for asynchronous delivery and understand how to create a user-friendly format for an engaging web platform. For aim 2, we will enroll eligible participants recruited for the efficacy trial who could not enroll because of treatment barriers. Eligible participants will complete QoL, depression, anxiety, pain, treatment satisfaction, and program credibility measures at baseline and posttest. Inclusion criteria are identical to those for the efficacy trial, including stress and coping difficulties (self-report), no change in antidepressant medication in the past 3 months, no psychotherapy in the past 3 months, no major upcoming surgeries in the next 12 months, English speaking, ability to complete questionnaires on the web and participate in live video interventions, and consent before participation. The primary outcomes are feasibility, treatment satisfaction, and credibility. The secondary outcomes include physical, psychological, social, and environmental QoL; depression; anxiety; pain intensity; and pain interference. We will enroll at least two group cohorts and iteratively refine the program based on participant feedback after each cohort completes the open pilot trial. Results: This trial is ongoing. We have completed the interviews (n=23) and analyzed the data to construct the website. Afterward, we will recruit our cohorts for the trial (approximately n=15/cohort; total=30). Recruitment will end by May 2021, with plans to analyze the data by October 2021. Conclusions: We will develop the first web platform for people with NF with difficulties managing stress and NF symptoms and report on feasibility and preliminary effects in improving QoL and psychosocial functioning. NF-Web has potential to extend the reach of our 3RP-NF intervention by removing barriers to care, including lack of trained providers, scheduling difficulties, and appearance concerns. International Registered Report Identifier (IRRID): DERR1-10.2196/27526 %M 34110294 %R 10.2196/27526 %U https://www.researchprotocols.org/2021/6/e27526 %U https://doi.org/10.2196/27526 %U http://www.ncbi.nlm.nih.gov/pubmed/34110294 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e25787 %T Comparing Single-Page, Multipage, and Conversational Digital Forms in Health Care: Usability Study %A Iftikhar,Aleeha %A Bond,Raymond R %A McGilligan,Victoria %A Leslie,Stephen J %A Rjoob,Khaled %A Knoery,Charles %A Quigg,Ciara %A Campbell,Ryan %A Boyd,Kyle %A McShane,Anne %A Peace,Aaron %+ Computing Engineering and Build Environment, Ulster University, Shore Rd, Newtownabbey, Jordanstown, BT37 0QB, United Kingdom, 44 07496635353, iftikhar-a1@ulster.ac.uk %K digital forms %K health care %K usability evaluation %K single-page form %K multipage form %K conversational forms %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Even in the era of digital technology, several hospitals still rely on paper-based forms for data entry for patient admission, triage, drug prescriptions, and procedures. Paper-based forms can be quick and convenient to complete but often at the expense of data quality, completeness, sustainability, and automated data analytics. Digital forms can improve data quality by assisting the user when deciding on the appropriate response to certain data inputs (eg, classifying symptoms). Greater data quality via digital form completion not only helps with auditing, service improvement, and patient record keeping but also helps with novel data science and machine learning research. Although digital forms are becoming more prevalent in health care, there is a lack of empirical best practices and guidelines for their design. The study-based hospital had a definite plan to abolish the paper form; hence, it was not necessary to compare the digital forms with the paper form. Objective: This study aims to assess the usability of three different interactive forms: a single-page digital form (in which all data input is required on one web page), a multipage digital form, and a conversational digital form (a chatbot). Methods: The three digital forms were developed as candidates to replace the current paper-based form used to record patient referrals to an interventional cardiology department (Cath-Lab) at Altnagelvin Hospital. We recorded usability data in a counterbalanced usability test (60 usability tests: 20 subjects×3 form usability tests). The usability data included task completion times, System Usability Scale (SUS) scores, User Experience Questionnaire data, and data from a postexperiment questionnaire. Results: We found that the single-page form outperformed the other two digital forms in almost all usability metrics. The mean SUS score for the single-page form was 76 (SD 15.8; P=.01) when compared with the multipage form, which had a mean score of 67 (SD 17), and the conversational form attained the lowest scores in usability testing and was the least preferred choice of users, with a mean score of 57 (SD 24). An SUS score of >68 was considered above average. The single-page form achieved the least task completion time compared with the other two digital form styles. Conclusions: In conclusion, the digital single-page form outperformed the other two forms in almost all usability metrics; it had the least task completion time compared with those of the other two digital forms. Moreover, on answering the open-ended question from the final customized postexperiment questionnaire, the single-page form was the preferred choice. %M 34037531 %R 10.2196/25787 %U https://humanfactors.jmir.org/2021/2/e25787 %U https://doi.org/10.2196/25787 %U http://www.ncbi.nlm.nih.gov/pubmed/34037531 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25554 %T Influences of Medical Crowdfunding Website Design Features on Trust and Intention to Donate: Controlled Laboratory Experiment %A Zhang,Xing %A Hu,Wenli %A Xiao,Quan %+ School of Information Management, Jiangxi University of Finance and Economics, Yuping Avenue, Changbei Economic and Technological Development Zone, Nanchang, 330032, China, 86 13970840123, xiaoquan@foxmail.com %K medical crowdfunding %K website design %K cognition-based trust %K affect-based trust %K intention to donate %D 2021 %7 4.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As a type of donation-based crowdfunding, medical crowdfunding has gradually become an important way for patients who have difficulty paying medical bills to seek help from the public. However, many people still have limited confidence in donating money to medical crowdfunding projects. Objective: Given that the features of a medical crowdfunding website may be important to gain users’ trust, this study draws upon two-factor and trust theories to explore how different design features of medical crowdfunding websites affect potential donors’ cognition-based trust and affect-based trust, and how these types of trust affect the intention to donate. Methods: A 2 (informativeness: high vs low) × 2 (visual cues: cool color vs warm color) × 2 (social cues: with vs without) between-subject laboratory experiment was performed to validate our research model. A total of 320 undergraduate students recruited from a university in China participated in the controlled laboratory experiment. Results: Cognition-based trust (β=.528, P<.001) and affect-based trust (β=.344, P<.001) exerted significant effects on the intention to donate of potential donors of medical crowdfunding. Informativeness as a hygiene factor positively influenced potential donors’ cognition-based trust (F1,311=49.764, P<.001) and affect-based trust (F1,311=16.093, P<.001), whereas social cues as a motivating factor significantly influenced potential donors’ cognition-based trust (F1,311=38.160, P<.001) and affect-based trust (F1,311=23.265, P<.001). However, the color of the webpages affected the two dimensions of trust differently. Specifically, medical crowdfunding webpages with warm colors were more likely to induce affect-based trust than those with cool colors (F1,311=17.120, P<.001), whereas no significant difference was found between the effects of cool and warm colors on cognition-based trust (F1,311=1.707, P=.19). Conclusions: This study deepens our understanding of the relationships among the design features of medical crowdfunding websites, trust, and intention to donate, and provides guidelines for managers of medical crowdfunding platforms to enhance potential donors’ trust-building by improving the website design features. %M 33944787 %R 10.2196/25554 %U https://www.jmir.org/2021/5/e25554 %U https://doi.org/10.2196/25554 %U http://www.ncbi.nlm.nih.gov/pubmed/33944787 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26939 %T Exploring the Role of Persuasive Design in Unguided Internet-Delivered Cognitive Behavioral Therapy for Depression and Anxiety Among Adults: Systematic Review, Meta-analysis, and Meta-regression %A McCall,Hugh C %A Hadjistavropoulos,Heather D %A Sundström,Christopher Richard Francis %+ Department of Psychology, University of Regina, 3737 Wascana Pkwy, Regina, SK, S4S 0A2, Canada, 1 306 585 4111, hugh.c.mccall@gmail.com %K ICBT %K internet %K depression %K anxiety %K persuasive design %K eHealth %D 2021 %7 29.4.2021 %9 Review %J J Med Internet Res %G English %X Background: Internet-delivered cognitive behavioral therapy (ICBT) is an effective treatment that can overcome barriers to mental health care. Various research groups have suggested that unguided ICBT (ie, ICBT without therapist support) and other eHealth interventions can be designed to enhance user engagement and thus outcomes. The persuasive systems design framework captures most design recommendations for eHealth interventions, but there is little empirical evidence that persuasive design is related to clinical outcomes in unguided ICBT. Objective: This study aims to provide an updated meta-analysis of randomized controlled trials of unguided ICBT for depression and anxiety, describe the frequency with which various persuasive design principles are used in such interventions, and use meta-regression to explore whether a greater number of persuasive design elements predicts efficacy in unguided ICBT for depression and anxiety. Methods: We conducted a systematic review of 5 databases to identify randomized controlled trials of unguided ICBT for depression and anxiety. We conducted separate random effects meta-analyses and separate meta-regressions for depression and anxiety interventions. Each meta-regression included 2 steps. The first step included, as a predictor, whether each intervention was transdiagnostic. For the meta-regression of ICBT for depression, the first step also included the type of control condition. The number of persuasive design principles identified for each intervention was added as a predictor in the second step to reveal the additional variance in effect sizes explained by persuasive design. Results: Of the 4471 articles we identified in our search, 46 (1.03%) were eligible for inclusion in our analyses. Our meta-analyses showed effect sizes (Hedges g) ranging from 0.22 to 0.31 for depression interventions, depending on the measures taken to account for bias in the results. We found a mean effect size of 0.45 (95% CI 0.33-0.56) for anxiety interventions, with no evidence that the results were inflated by bias. Included interventions were identified as using between 1 and 13 persuasive design principles, with an average of 4.95 (SD 2.85). The meta-regressions showed that a greater number of persuasive design principles predicted greater efficacy in ICBT for depression (R2 change=0.27; B=0.04; P=.02) but not anxiety (R2 change=0.05; B=0.03; P=.17). Conclusions: These findings show wide variability in the use of persuasive design in unguided ICBT for depression and anxiety and provide preliminary support for the proposition that more persuasively designed interventions are more efficacious, at least in the treatment of depression. Further research is needed to clarify the role of persuasive design in ICBT. %M 33913811 %R 10.2196/26939 %U https://www.jmir.org/2021/4/e26939 %U https://doi.org/10.2196/26939 %U http://www.ncbi.nlm.nih.gov/pubmed/33913811 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e25928 %T Evaluation of the Usability and Acceptability of the InnoWell Platform as Rated by Older Adults: Survey Study %A LaMonica,Haley M %A Roberts,Anna E %A Davenport,Tracey A %A Hickie,Ian B %+ Brain and Mind Centre, The University of Sydney, 88 Mallett Street, Camperdown, 2050, Australia, 61 426955658, haley.lamonica@sydney.edu.au %K older adults %K mental health %K technology %K community-based participatory research %K stakeholder participation %K smartphone %K mobile phone %D 2021 %7 21.4.2021 %9 Original Paper %J JMIR Aging %G English %X Background: As the global population ages, there is increased interest in developing strategies to promote health and well-being in later life, thus enabling continued productivity, social engagement, and independence. As older adults use technologies with greater frequency, proficiency, and confidence, health information technologies (HITs) now hold considerable potential as a means to enable broader access to tools and services for the purposes of screening, treatment, monitoring, and ongoing maintenance of health for this group. The InnoWell Platform is a digital tool co-designed with lived experience to facilitate better outcomes by enabling access to a comprehensive multidimensional assessment, the results of which are provided in real time to enable consumers to make informed decisions about clinical and nonclinical care options independently or in collaboration with a health professional. Objective: This study aims to evaluate the usability and acceptability of a prototype of the InnoWell Platform, co-designed and configured with and for older adults, using self-report surveys. Methods: Participants were adults 50 years and older who were invited to engage with the InnoWell Platform naturalistically (ie, at their own discretion) for a period of 90 days. In addition, they completed short web-based surveys at baseline regarding their background, health, and mental well-being. After 90 days, participants were asked to complete the System Usability Scale to evaluate the usability and acceptability of the prototyped InnoWell Platform, with the aim of informing the iterative redesign and development of this digital tool before implementation within a health service setting. Results: A total of 19 participants consented to participate in the study; however, only the data from the 16 participants (mean age 62.8 years, SD 7.5; range 50-72) who completed at least part of the survey at 90 days were included in the analyses. Participants generally reported low levels of psychological distress and good mental well-being. In relation to the InnoWell Platform, the usability scores were suboptimal. Although the InnoWell Platform was noted to be easy to use, participants had difficulty identifying the relevance of the tool for their personal circumstances. Ease of use, the comprehensive nature of the assessment tools, and the ability to track progress over time were favored features of the InnoWell Platform, whereas the need for greater personalization and improved mobile functionality were cited as areas for improvement. Conclusions: HITs such as the InnoWell Platform have tremendous potential to improve access to cost-effective and low-intensity interventions at scale to improve and maintain mental health and well-being in later life. However, to promote adoption of and continued engagement with such tools, it is essential that these HITs are personalized and relevant for older adult end users, accounting for differences in background, clinical profiles, and levels of need. %M 33881410 %R 10.2196/25928 %U https://aging.jmir.org/2021/2/e25928 %U https://doi.org/10.2196/25928 %U http://www.ncbi.nlm.nih.gov/pubmed/33881410 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24647 %T A Gamified, Social Media–Inspired, Web-Based Personalized Normative Feedback Alcohol Intervention for Lesbian, Bisexual, and Queer-Identified Women: Protocol for a Hybrid Trial %A Boyle,Sarah C %A LaBrie,Joseph W %+ HeadsUp Labs, Department of Psychology, Loyola Marymount University, 1 LMU Drive, Suite 3787, Los Angeles, CA, 90045, United States, 1 8182909940, sarah.boyle@lmu.edu %K sexual minority women %K alcohol %K intervention %K social norms %K gamification %K protocol %K mobile phone %D 2021 %7 16.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual minority women are more likely to drink alcohol, engage in heavy drinking, and experience alcohol-related problems than heterosexual women. However, culturally tailored interventions for this population have been slow to emerge. Objective: This type 1 effectiveness-implementation trial examines the feasibility and efficacy of a gamified, culturally tailored, personalized normative feedback (PNF) alcohol intervention for sexual minority women who psychologically identify as lesbian, bisexual, or queer (LBQ). Methods: The core components of a PNF intervention were delivered within LezParlay, a fun, social media–inspired, digital competition designed to challenge negative stereotypes about LBQ women and increase visibility. The competition was advertised on the web through social media platforms and collaboration with LBQ community organizations. After 2 rounds of play by a large cohort of LBQ women, a subsample of 500 drinkers already taking part in the competition were invited to participate in the evaluation study. Study participants were randomized to receive 1 of 3 unique sequences of PNF (ie, alcohol and stigma coping, alcohol and control, or control topics only) over 2 intervention rounds. Randomization was fully automated by the web app, and both researchers and participants were blinded. Results: Analyses will evaluate whether PNF on alcohol use reduces participants’ drinking and negative consequences at 2 and 4 months postintervention; examine whether providing PNF on stigma-coping behaviors, in addition to alcohol use, further reduces alcohol use and consequences beyond PNF on alcohol alone; identify mediators and moderators of intervention efficacy; and examine broader LezParlay app engagement, acceptability, and perceived benefits. Conclusions: This incognito intervention approach is uniquely oriented toward engaging and preventing alcohol-related risks among community populations of LBQ women who may view their heavy drinking as normative and not in need of change because of the visibility of alcohol use in sexual minority community spaces. Thus, this intervention strategy diverges from, and is intended to complement, more intensive programs being developed to meet the needs of LBQ women already motivated to reduce their consumption. Trial Registration: ClinicalTrials.gov NCT03884478; https://clinicaltrials.gov/ct2/show/NCT03884478 International Registered Report Identifier (IRRID): DERR1-10.2196/24647 %M 33861212 %R 10.2196/24647 %U https://www.researchprotocols.org/2021/4/e24647 %U https://doi.org/10.2196/24647 %U http://www.ncbi.nlm.nih.gov/pubmed/33861212 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e21270 %T Developing a Decision Aid to Facilitate Informed Decision Making About Invasive Mechanical Ventilation and Lung Transplantation Among Adults With Cystic Fibrosis: Usability Testing %A Dauber-Decker,Katherine L %A Basile,Melissa %A King,D'Arcy %A Polo,Jennifer %A Calise,Karina %A Khan,Sundas %A Solomon,Jeffrey %A Dunne,Daniel %A Hajizadeh,Negin %+ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Feinstein Institutes for Medical Research, Center for Health Innovations and Outcomes Research, 600 Community Drive, Manhasset, NY, 11030, United States, 1 3474004684, jpolo1@northwell.edu %K usability %K medical informatics %K clinical decision support %K cystic fibrosis %K advance care planning %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Cystic fibrosis (CF) is a life-limiting genetic disease that causes chronic lung infections. We developed an internet-based decision aid (DA) to help patients with CF make better informed decisions regarding treatments and advance care planning. We built the DA around two major treatment decisions: whether to have a lung transplant and whether to agree to invasive mechanical ventilation (intubation). Objective: This study aims to conduct usability testing of the InformedChoices CF DA among key stakeholder groups. Methods: We performed a patient needs assessment using think-aloud usability testing with patients with CF, their surrogates, and CF clinicians. Think-aloud participants provided feedback while navigating the DA, and after viewing, they answered surveys. Transcripts from the think-aloud sessions and survey results were categorized into common, generalizable themes and optimizations for improving content, comprehension, and navigation. We assessed the ease of use of the DA (System Usability Scale) and also assessed the participants’ perceptions regarding the overall tone, with an emphasis on emotional reactions to the DA content, level of detail, and usefulness of the information for making decisions about either intubation or lung transplantation, including how well they understood the information and were able to apply it to their own decision-making process. We also assessed the DA’s ease of navigation, esthetics, and whether participants were able to complete a series of usability tasks (eg, locating specific information in the DA or using the interactive survival estimates calculator) to ensure that the website was easy to navigate during the clinic-based advance care planning discussions. Results: A total of 12 participants from 3 sites were enrolled from March 9 to August 30, 2018, for the usability testing: 5 CF clinicians (mean age 48.2, SD 12.0 years), 5 adults with CF, and 2 family and surrogate caregivers of people with CF (mean age of CF adults and family and surrogate caregivers 38.8, SD 10.8 years). Among the 12 participants, the average System Usability Scale score for the DA was 88.33 (excellent). Think-aloud analysis identified 3 themes: functionality, visibility and navigation, and content and usefulness. Areas for improvement included reducing repetition, enhancing comprehension, and changing the flow. Several changes to improve the content and usefulness of the DA were recommended, including adding information about alternatives to childbearing, such as adoption and surrogacy. On the basis of survey responses, we found that the navigation of the site was easy for clinicians, patients, and surrogates who participated in usability testing. Conclusions: Usability testing revealed areas of potential improvement. Testing also yielded positive feedback, suggesting the DA’s future success. Integrating changes before implementation should improve the DA’s comprehension, navigation, and usefulness and lead to greater adoption. %M 33851921 %R 10.2196/21270 %U https://humanfactors.jmir.org/2021/2/e21270 %U https://doi.org/10.2196/21270 %U http://www.ncbi.nlm.nih.gov/pubmed/33851921 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e26554 %T Generating Intervention Concepts for Reducing Adolescent Relationship Abuse Inequities Among Sexual and Gender Minority Youth: Protocol for a Web-Based, Longitudinal, Human-Centered Design Study %A Coulter,Robert W S %A Mitchell,Shannon %A Prangley,Kelly %A Smallwood,Seth %A Bonanno,Leyna %A Foster,Elizabeth N %A Wilson,Abby %A Miller,Elizabeth %A Chugani,Carla D %+ Department of Behavioral and Community Health Sciences, Graduate School of Public Health, University of Pittsburgh, 130 DeSoto St, Pittsburgh, PA, 15261, United States, 1 4126240647, robert.ws.coulter@pitt.edu %K sexual and gender minorities %K adolescent %K psychosocial intervention %K internet-based intervention %K intimate partner violence %D 2021 %7 12.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual and gender minority youth (SGMY; eg, lesbian, gay, bisexual, and transgender youth) are at greater risk than their cisgender heterosexual peers for adolescent relationship abuse (ARA; physical, sexual, or psychological abuse in a romantic relationship). However, there is a dearth of efficacious interventions for reducing ARA among SGMY. To address this intervention gap, we designed a novel web-based methodology leveraging the field of human-centered design to generate multiple ARA intervention concepts with SGMY. Objective: This paper aims to describe study procedures for a pilot study to rigorously test the feasibility, acceptability, and appropriateness of using web-based human-centered design methods with SGMY to create novel, stakeholder-driven ARA intervention concepts. Methods: We are conducting a longitudinal, web-based human-centered design study with 45-60 SGMY (aged between 14 and 18 years) recruited via social media from across the United States. Using MURAL (a collaborative, visual web-based workspace) and Zoom (a videoconferencing platform), the SGMY will participate in four group-based sessions (1.5 hours each). In session 1, the SGMY will use rose-thorn-bud to individually document their ideas about healthy and unhealthy relationship characteristics and then use affinity clustering as a group to categorize their self-reported ideas based on similarities and differences. In session 2, the SGMY will use rose-thorn-bud to individually critique a universal evidence-based intervention to reduce ARA and affinity clustering to aggregate their ideas as a group. In session 3, the SGMY will use a creative matrix to generate intervention ideas for reducing ARA among them and force-rank the intervention ideas based on their potential ease of implementation and potential impact using an importance-difficulty matrix. In session 4, the SGMY will generate and refine intervention concepts (from session 3 ideations) to reduce ARA using round robin (for rapid iteration) and concept poster (for fleshing out ideas more fully). We will use content analyses to document the intervention concepts. In a follow-up survey, the SGMY will complete validated measures about the feasibility, acceptability, and appropriateness of the web-based human-centered design methods (a priori benchmarks for success: means >3.75 on each 5-point scale). Results: This study was funded in February 2020. Data collection began in August 2020 and will be completed by April 2021. Conclusions: Through rigorous testing of the feasibility of our web-based human-centered design methodology, our study may help demonstrate the use of human-centered design methods to engage harder-to-reach stakeholders and actively involve them in the co-creation of relevant interventions. Successful completion of this project also has the potential to catalyze intervention research to address ARA inequities for SGMY. Finally, our approach may be transferable to other populations and health topics, thereby advancing prevention science and health equity. International Registered Report Identifier (IRRID): DERR1-10.2196/26554 %M 33843601 %R 10.2196/26554 %U https://www.researchprotocols.org/2021/4/e26554 %U https://doi.org/10.2196/26554 %U http://www.ncbi.nlm.nih.gov/pubmed/33843601 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e20721 %T Applying Website Rankings to Digital Health Centers in the United States to Assess Public Engagement: Website Usability Study %A Calvano,Joshua David %A Fundingsland Jr,Edwin Lauritz %A Lai,Deborah %A Silacci,Sara %A Raja,Ali S %A He,Shuhan %+ Department of Research, Rocky Vista University College of Osteopathic Medicine, 8401 S Chambers Rd, Parker, CO, 80134, United States, 1 3033732008, joshua.calvano@rvu.edu %K website usability %K digital health %K health care website %K usability testing %K web interventions %K digital health care %K web crawler %D 2021 %7 29.3.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: As the public increasingly uses the internet to search for resources and information regarding health and medicine, it is important that health care organizations provide adequate web resources. Website usability refers to the ease of user experience on a website. In this study, we conducted usability analyses on digital health center websites. Objective: The primary aims of this study were to (1) replicate a preexisting usability scoring methodology for digital health centers; (2) apply and test this replicated usability scoring methodology on a sample set of digital health center websites; and (3) derive recommendations from the results on potential areas of improvements for our sample of digital health center websites. Methods: Website usability testing was conducted from March 1, 2020, to March 15, 2020. We replicated a methodology and scoring system from previous literature and applied them to digital health center websites. Our sample included 67 digital health centers that were affiliated with US universities or hospital systems. Usability was split into the following four broad categories: accessibility, marketing, content quality, and technology. Usability tools were used to score websites in each of the four categories. The composite of the key factors of each category was used to generate a general usability and overall usability score for each website. Results: The category with the highest average score (6.3) was content quality. The content quality score also had the highest SD (2.18) and an SE of 0.27. The lowest performing category was technology, which had an average score of 0.9. The technology score also had the smallest SD (0.07) and an SE of 0.01. Conclusions: Our data suggest that content quality, on average, was the highest scoring variable among digital health center websites. As content is crucial to digital health knowledge, it is justified that digital health centers invest more resources into creating quality content. The overall lowest scoring variable was technology. Potential reasons for this finding include designated funding for servers, a lack of regulatory frameworks for social media presence and liability, and infrequent website audits. An easy approach for improving this variable is increasing website speed. Accessibility is another area that organizations can potentially improve. We recommend that these organizations perform periodic audits of their web presence with usability tools. %M 33779564 %R 10.2196/20721 %U https://humanfactors.jmir.org/2021/1/e20721 %U https://doi.org/10.2196/20721 %U http://www.ncbi.nlm.nih.gov/pubmed/33779564 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23137 %T Key Variables for Effective eHealth Designs for Individuals With and Without Mental Health Disorders: 2^12-4 Fractional Factorial Experiment %A Rotondi,Armando J %A Grady,Jonathan %A Hanusa,Barbara H %A Haas,Gretchen L %A Spring,Michael R %A Abebe,Kaleab Z %A Luther,James %A Gurklis,John %+ Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Health Care System, Department of Veterans Affairs, Research Office Bld, (151R-U), University Drive C, Pittsburgh, PA, 15240, United States, 1 412 360 2369, armandorotondi1@gmail.com %K schizophrenia %K severe mental illness %K eHealth %K eHealth design %K website %K usability %K website design %K website usability %K fractional factorial design %D 2021 %7 24.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth applications not only offer the potential to increase service convenience and responsiveness but also expand the ability to tailor services to improve relevance, engagement, and use. To achieve these goals, it is critical that the designs are intuitive. Limited research exists on designs that work for those with a severe mental illness (SMI), many of whom have difficulty traveling for treatments, reject or infrequently seek treatment, and tend to discontinue treatments for significant periods. Objective: This study aims to evaluate the influence of 12 design variables (eg, navigational depth, reading level, and use of navigational lists) on the usability of eHealth application websites for those with and without SMI. Methods: A 212-4 fractional factorial experiment was used to specify the designs of 256 eHealth websites. This approach systematically varied the 12 design variables. The final destination contents of all websites were identical, and only the designs of the navigational pages varied. The 12 design elements were manipulated systematically to allow the assessment of combinations of design elements rather than only one element at a time. Of the 256 websites, participants (n=222) sought the same information on 8 randomly selected websites. Mixed effect regressions, which accounted for the dependency of the 8 observations within participants, were used to test for main effects and interactions on the ability and time to find information. Classification and regression tree analyses were used to identify effects among the 12 variables on participants’ abilities to locate information, for the sample overall and each of the 3 diagnostic groups of participants (schizophrenia spectrum disorder [SSD], other mental illnesses, and no mental illness). Results: The best and worst designs were identified for each of these 4 groups. The depth of a website’s navigation, that is, the number of screens users needed to navigate to find the desired content, had the greatest influence on usability (ability to find information) and efficiency (time to find information). The worst performing designs for those with SSD had a 9% success rate, and the best had a 51% success rate: the navigational designs made a 42% difference in usability. For the group with other mental illnesses, the design made a 50% difference, and for those with no mental illness, a 55% difference was observed. The designs with the highest usability had several key design similarities, as did those with the poorest usability. Conclusions: It is possible to identify evidence-based strategies for designing eHealth applications that result in significantly better performance. These improvements in design benefit all users. For those with SSD or other SMIs, there are designs that are highly effective. Both the best and worst designs have key similarities but vary in some characteristics. %M 33759796 %R 10.2196/23137 %U https://www.jmir.org/2021/3/e23137 %U https://doi.org/10.2196/23137 %U http://www.ncbi.nlm.nih.gov/pubmed/33759796 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e19151 %T A Newly Developed Web-Based Resource on Genetic Eye Disorders for Users With Visual Impairment (Gene.Vision): Usability Study %A Yeong,Jian Lee %A Thomas,Peter %A Buller,James %A Moosajee,Mariya %+ Institute of Ophthalmology, University College London, 11-43 Bath Street, London, EC1V 9EL, United Kingdom, 44 2076086800, m.moosajee@ucl.ac.uk %K internet access %K blindness %K eye disease %K genetic diseases %K usability testing %K qualitative research %K internet-based intervention %K consumer health information %K mobile phone %D 2021 %7 20.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the introduction of the Web Content Accessibility Guidelines and legislations, many websites remain poorly accessible to users with disability, especially those with visual impairment, as the internet has become a more visually complex environment. With increasing reliance on the internet and almost 2 million people in the United Kingdom being affected by vision loss, it is important that they are not overlooked when developing web-based materials. A significant proportion of those affected have irreversible vision loss due to rare genetic eye disorders, and many of them use the internet as a primary source of information for their conditions. However, access to high-quality web-based health information with an inclusive design remains a challenge for many. We have developed a new web-based resource for genetic eye disorders called Gene.Vision that aims to provide a holistic guide for patients, relatives, and health care professionals. Objective: Through a usability testing session of our website prototype, this study aims to identify key web-based accessibility features for internet users with vision impairment and to explore whether the contents provided in Gene.Vision are relevant and comprehensible. Methods: A face-to-face testing session with 8 participants (5 patients, 2 family members, and 1 member of the public) and 8 facilitators was conducted on a prototype website. Remote testing was performed with another patient due to COVID-19 restrictions. Home page design, navigation, content layout and quality, language, and readability were explored through direct observation and task completion using the think-aloud method. A patient focus group was organized to elicit further feedback. Qualitative data were gathered and analyzed to identify core themes through open and axial coding. Results: All participants had good computer literacy; 6 patients with visual impairment used visual aid software including iOS VoiceOver and Speak Screen, iOS Classic Invert, ZoomText 2020, Job Access With Speech, and Nonvisual Desktop Access. The features identified by the participants that will enhance accessibility and usability for users with visual impairment were a consistent website layout, a structured information hierarchy with a clear description of links, good chromatic and luminance contrast, a simple home page with predictable and easy navigation, adaptability to various assistive software, and readable and relevant content. They reported that dynamic content (such as carousels) and large empty spaces reduced accessibility. Information on research, support available, practical advice, and links to charities were incentives for repeated website visits. Conclusions: We demonstrated the importance of developing a website with a user-based approach. Through end user testing, we identified several key web-based accessibility features for people with visual impairment. Target end users should always be involved early and throughout the design process to ensure their needs are met. Many of these steps can be implemented easily and will aid in search engine optimization. %M 33470932 %R 10.2196/19151 %U http://www.jmir.org/2021/1/e19151/ %U https://doi.org/10.2196/19151 %U http://www.ncbi.nlm.nih.gov/pubmed/33470932 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e22774 %T Procedures of User-Centered Usability Assessment for Digital Solutions: Scoping Review of Reviews Reporting on Digital Solutions Relevant for Older Adults %A Silva,Anabela G %A Caravau,Hilma %A Martins,Ana %A Almeida,Ana Margarida Pisco %A Silva,Telmo %A Ribeiro,Óscar %A Santinha,Gonçalo %A Rocha,Nelson P %+ School of Health Sciences, Center for Health Technology and Services Research, University of Aveiro, Campus Universitário de Santiago, Aveiro, 3810-193, Portugal, 351 234401558, asilva@ua.pt %K mobile phone %K user-centered design %K aged %K review %K telemedicine %D 2021 %7 13.1.2021 %9 Review %J JMIR Hum Factors %G English %X Background: The assessment of usability is a complex process that involves several steps and procedures. It is important to standardize the evaluation and reporting of usability procedures across studies to guide researchers, facilitate comparisons across studies, and promote high-quality usability studies. The first step to standardizing is to have an overview of how usability study procedures are reported across the literature. Objective: This scoping review of reviews aims to synthesize the procedures reported for the different steps of the process of conducting a user-centered usability assessment of digital solutions relevant for older adults and to identify potential gaps in the present reporting of procedures. The secondary aim is to identify any principles or frameworks guiding this assessment in view of a standardized approach. Methods: This is a scoping review of reviews. A 5-stage scoping review methodology was used to identify and describe relevant literature published between 2009 and 2020 as follows: identify the research question, identify relevant studies, select studies for review, chart data from selected literature, and summarize and report results. The research was conducted on 5 electronic databases: PubMed, ACM Digital Library, IEEE, Scopus, and Web of Science. Reviews that met the inclusion criteria (reporting on user-centered usability evaluation procedures for any digital solution that could be relevant for older adults and were published in English) were identified, and data were extracted for further analysis regarding study evaluators, study participants, methods and techniques, tasks, and test environment. Results: A total of 3958 articles were identified. After a detailed screening, 20 reviews matched the eligibility criteria. The characteristics of the study evaluators and participants and task procedures were only briefly and differently reported. The methods and techniques used for the assessment of usability are the topics that were most commonly and comprehensively reported in the reviews, whereas the test environment was seldom and poorly characterized. Conclusions: A lack of a detailed description of several steps of the process of assessing usability and no evidence on good practices of performing it suggests that there is a need for a consensus framework on the assessment of user-centered usability evaluation. Such a consensus would inform researchers and allow standardization of procedures, which are likely to result in improved study quality and reporting, increased sensitivity of the usability assessment, and improved comparability across studies and digital solutions. Our findings also highlight the need to investigate whether different ways of assessing usability are more sensitive than others. These findings need to be considered in light of review limitations. %M 33439128 %R 10.2196/22774 %U http://humanfactors.jmir.org/2021/1/e22774/ %U https://doi.org/10.2196/22774 %U http://www.ncbi.nlm.nih.gov/pubmed/33439128 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e18587 %T A Web-Based Application for Complex Health Care Populations: User-Centered Design Approach %A Ferrucci,Francesca %A Jorio,Manuele %A Marci,Stefano %A Bezenchek,Antonia %A Diella,Giulia %A Nulli,Cinzia %A Miranda,Ferdinando %A Castelli-Gattinara,Guido %+ Informapro Srl, via Guido Guinizelli, 98/100, Rome, 00152, Italy, 39 06 5502218, fferrucci@unitus.it %K patient %K community participation %K eHealth %K patient-centered care %K user-centered design, comorbidity %D 2021 %7 13.1.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Although eHealth technology makes it possible to improve the management of complex health care systems and follow up on chronic patients, it is not without challenges, thus requiring the development of efficient programs and graphic user interface (GUI) features. Similar information technology tools are crucial, as health care populations are going to have to endure social distancing measures in the forthcoming months and years. Objective: This study aims to provide adequate and personalized support to complex health care populations by developing a specific web-based mobile app. The app is designed around the patient and adapted to specific groups, for example, people with complex or rare diseases, autism, or disabilities (especially among children) as well as Alzheimer or senile dementia. The app’s core features include the collection, labeling, analysis, and sorting of clinical data. Furthermore, it authorizes a network of people around the patient to securely access the data contained in his or her electronic health record. Methods: The application was designed according to the paradigms of patient-centered care and user-centered design (UCD). It considers the patient as the main empowered and motivating factor in the management of his or her well-being. Implementation was informed through a family needs and technology perception assessment. We used 3 interdisciplinary focus groups and 2 assessment surveys to study the contexts of app use, subpopulation management, and preferred functions. Finally, we developed an observational study involving 116 enrolled patients and 253 system users, followed by 2 feedback surveys to evaluate the performance and impact of the app. Results: In the validated general GUI, we developed 10 user profiles with different privacy settings. We tested 81 functions and studied a modular structure based on disease or medical area. This allowed us to identify replicable methods to be applied to module design. The observational study not only showed good family and community engagement but also revealed some limitations that need to be addressed. In total, 42 of 51 (82%) patients described themselves as satisfied or very satisfied. Health care providers reported facilitated communication with colleagues and the need to support data quality. Conclusions: The experimented solution addressed some of the health system challenges mentioned by the World Health Organization: usability appears to be significantly improved when the GUI is designed according to patients’ UCD mental models and when new media and medical literacy are promoted. This makes it possible to maximize the impact of eHealth products, thereby overcoming some crucial gaps reported in the literature. Two main features seemed to have potential benefit compared with other eHealth products: the modeling, within the app, of both the formal and informal health care support networks and the modular structure allowing for comorbidity management, both of which require further implementation. %M 33439146 %R 10.2196/18587 %U http://humanfactors.jmir.org/2021/1/e18587/ %U https://doi.org/10.2196/18587 %U http://www.ncbi.nlm.nih.gov/pubmed/33439146 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 4 %P e23904 %T A Novel Educational Prescription Web-Based Application to Support Education for Caregivers of People Living With Dementia: Development and Usability Study With Clinicians %A Levinson,Anthony J %A Bousfield,John %A Douglas,William %A Ayers,Stephanie %A Sztramko,Richard %+ Division of e-Learning Innovation, McMaster University, Michael G. DeGroote Centre for Learning and Discovery, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 22210, levinsa@mcmaster.ca %K dementia %K caregiver %K education prescription %K online education %K internet %K eHealth %K knowledge translation %K implementation science %K scale and spread %D 2020 %7 4.12.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: It is estimated that 564,000 Canadians are currently living with dementia and there are approximately 486,000 to 1.1 million informal family/friend caregivers. Family/friend caregivers often receive little to no education or training about dementia but are expected to provide ongoing support for a complex condition. Web-based family/friend caregiver interventions may be helpful, but little is known about how best to implement them. Objective: The objectives of this study were to 1) design and develop a novel education prescription application to help scale and spread web-based dementia education to family/friend caregivers, 2) conduct user testing, and 3) conduct a larger-scale field trial. Methods: A novel education prescription web-based application was designed and developed. Initial user testing used task completion and the “think aloud” technique with a small sample of representative clinicians who work with people living with dementia and family/friend caregivers. Following iterative incorporation of feedback, a larger field trial was conducted with a convenience sample of clinicians. Account invitations were sent to 55 clinicians and, following a 2-month trial period, surveys were administered to participants including the System Usability Scale and the Net Promoter Score. Results: During the initial user testing phase, participants (N=7) from representative disciplines easily completed associated tasks, and had very positive feedback with respect to the usability of the application. The System Usability Scale score during this phase was 91.4. Suggestions from feedback were incorporated into the application. During the larger field trial phase, participants (total N=55; activated account n=17; did not activate account n=38) were given access to the iGeriCare education prescription application. During this period, 2 participants created educational prescriptions; a total of 3 educational prescriptions were sent. Survey completers who did not activate their account (n=5) identified that their lack of use was due to time constraints, competing priorities, or forgetting to use the application. Survey completers who activated their account (n=5) identified their lower use was due to lack of time, lack of eligible family/friend caregivers during trial period, and competing priorities due to the COVID-19 pandemic. The System Usability Scale score during this phase was 78.75, and the Net Promoter Score was 50. Conclusions: Study findings indicate a generally positive response for the usability of a web-based application for clinicians to prescribe dementia education to family/friend caregivers. The dissonance between the promising data and widespread enthusiasm for the design and purpose of the education prescription application found in the initial user testing phase and subsequent lack of significant adoption in the field trial represents both an important lesson for other novel health technologies and a potential area for further investigation. Further research is required to better understand factors associated with implementation of this type of intervention and impact on dissemination of education to family/friend caregivers. %M 33275103 %R 10.2196/23904 %U http://humanfactors.jmir.org/2020/4/e23904/ %U https://doi.org/10.2196/23904 %U http://www.ncbi.nlm.nih.gov/pubmed/33275103 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e15833 %T Usability of eHealth and Mobile Health Interventions by Young People Living With Juvenile Idiopathic Arthritis: Systematic Review %A Butler,Sonia %A Sculley,Dean %A Santos,Derek Santos %A Fellas,Antoni %A Gironès,Xavier %A Singh-Grewal,Davinder %A Coda,Andrea %+ School of Bioscience and Pharmacy, University of Newcastle, 10 Chittaway Rd, Ourimbah, New South Wales, 2258, Australia, 61 421945914, sonia.butler@newcastle.edu.au %K juvenile idiopathic arthritis %K child %K adolescence %K eHealth %K mHealth %K systematic review %K mobile phone %K pain %K physical activity %K self-management %K quality of life %D 2020 %7 1.12.2020 %9 Review %J JMIR Pediatr Parent %G English %X Background: Considering the changing landscape of internet use and rising ownership of digital technology by young people, new methods could be considered to improve the current model of juvenile idiopathic arthritis (JIA) management. Objective: This systematic review aims to evaluate the usability of eHealth and mobile health (mHealth) interventions currently available for young people living with JIA. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to oversee this review. We systematically searched 15 databases for 252 potential studies; 2 authors independently screened all quantitative studies reporting the use of eHealth and mHealth interventions for young people (aged 1-18 years) diagnosed with JIA. Studies were excluded if they did not report outcome measures or were reviews, commentaries, or qualitative studies. Study methodological quality was scored using the Down and Black (modified) checklist. A narrative descriptive methodology was used to quantify the data because of heterogeneity across the studies. Results: A total of 11 studies were included in this review, reporting 7 eHealth and mHealth interventions for young people (aged 4-18 years) living with JIA, targeting health issues such as pain, health-related quality of life, physical activity, and chronic disease self-management. The usability of the interventions was facilitated through training and ongoing support. The engagement was promoted by a combination of persuasive influences, and barriers preventing adherence were removed through personal reminders and flexible program schedules to cater to JIA and non-JIA illnesses or other commonly seen activities in childhood. The feedback obtained was that most young people and their parents liked the interventions. Conclusions: The results of this review need to be considered cautiously because of the lack of rigorous testing and heterogeneity, which limits the detailed descriptions of data synthesis. Further research is needed to consider gender differences, associated costs, and the effectiveness of the interventions on health outcomes to better support young people living with JIA. %M 33258786 %R 10.2196/15833 %U http://pediatrics.jmir.org/2020/2/e15833/ %U https://doi.org/10.2196/15833 %U http://www.ncbi.nlm.nih.gov/pubmed/33258786 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 4 %P e21145 %T Young People’s Attitude Toward Positive Psychology Interventions: Thematic Analysis %A Michel,Toni %A Tachtler,Franziska %A Slovak,Petr %A Fitzpatrick,Geraldine %+ Technical University Vienna, Wien, Argentinierstraße 8, Vienna, , Austria, 49 1773075023, toni.michel@tuwien.ac.at %K adolescent %K mental health %K health resources %D 2020 %7 9.11.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Digital instantiations of positive psychology intervention (PPI) principles have been proposed to combat the current global youth mental health crisis; however, young people are largely not engaging with available resources. Objective: The aim of this study is to explore young people’s attitudes toward various PPI principles to find ways of making digital instantiations of them more engaging. Methods: We conducted an explorative workshop with 30 young people (aged 16-21 years). They rated and reviewed 29 common PPIs. Ratings and recorded discussions were analyzed using thematic analysis. Results: Some interventions were conflicting with young people’s values or perceived as too difficult. Participants responded positively to interventions that fit them personally and allowed them to use their strengths. Conclusions: Values, context, strengths, and other personal factors are entangled with young people’s attitudes toward digital instantiations of PPI principles. %M 33164908 %R 10.2196/21145 %U http://humanfactors.jmir.org/2020/4/e21145/ %U https://doi.org/10.2196/21145 %U http://www.ncbi.nlm.nih.gov/pubmed/33164908 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e18412 %T Optimizing Health Information Technologies for Symptom Management in Cancer Patients and Survivors: Usability Evaluation %A Lattie,Emily G %A Bass,Michael %A Garcia,Sofia F %A Phillips,Siobhan M %A Moreno,Patricia I %A Flores,Ann Marie %A Smith,JD %A Scholtens,Denise %A Barnard,Cynthia %A Penedo,Frank J %A Cella,David %A Yanez,Betina %+ Department of Medical Social Sciences, Northwestern University, 750 N Lake Shore Drive, 10th Floor, Chicago, IL, 60611, United States, 1 312 503 3741, emily.lattie@northwestern.edu %K cancer survivorship %K eHealth %K patient-reported outcomes %K digital health %K symptom management %K supportive care %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Unmanaged cancer symptoms and treatment-related side effects can compromise long-term clinical outcomes and health-related quality of life. Health information technologies such as web-based platforms offer the possibility to supplement existing care and optimize symptom management. Objective: This paper describes the development and usability of a web-based symptom management platform for cancer patients and survivors that will be implemented within a large health system. Methods: A web-based symptom management platform was designed and evaluated via one-on-one usability testing sessions. The System Usability Scale (SUS), After Scenario Questionnaire (ASQ), and qualitative analysis of semistructured interviews were used to assess program usability. Results: Ten cancer survivors and five cancer center staff members participated in usability testing sessions. The mean score on the SUS was 86.6 (SD 14.0), indicating above average usability. The mean score on the ASQ was 2.5 (SD 2.1), indicating relatively high satisfaction with the usability of the program. Qualitative analyses identified valued features of the program and recommendations for further improvements. Conclusions: Cancer survivors and oncology care providers reported high levels of acceptability and usability in the initial development of a web-based symptom management platform for cancer survivors. Future work will test the effectiveness of this web-based platform. %M 32955450 %R 10.2196/18412 %U http://formative.jmir.org/2020/9/e18412/ %U https://doi.org/10.2196/18412 %U http://www.ncbi.nlm.nih.gov/pubmed/32955450 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 7 %P e14951 %T Sedentary Work in Desk-Dominated Environments: A Data-Driven Intervention Using Intervention Mapping %A Berninger,Nathalie M %A ten Hoor,Gill A %A Plasqui,Guy %A Kok,Gerjo %A Peters,Gjalt-Jorn Ygram %A Ruiter,Robert A C %+ Department of Work and Social Psychology, Maastricht University, PO Box 616, WSP, Universiteitssingel 40, Maastricht, Netherlands, 31 433881908, nathalie.berninger@maastrichtuniversity.nl %K intervention mapping %K sedentary behavior %K sedentary work %K computer-based %K occupational health %K eHealth %K mHealth %K data-driven programs %D 2020 %7 20.7.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Since desk-dominated work environments facilitate sedentary behavior, office workers sit for 66% of their working days and only 8% succeed in interrupting their prolonged periods of sitting within the first 55 minutes. Yet stretches of long and uninterrupted sitting increase the likelihood of several chronic metabolic and cardiovascular diseases. Objective: We therefore developed a computer-based app designed to interrupt periods of prolonged sitting among office employees. Methods: When developing the intervention, we applied the intervention mapping protocol. This approach for the systematic design of theory and evidence-based behavior change programs consists of 6 steps: creation of a logic model of the problem, creation of a logic model of change, program design, program production, design of an implementation plan, and development of an evaluation plan. Results: Working through all 6 steps has resulted in an individually adaptable intervention to reduce sedentary behavior at work. The intervention, UPcomplish, consists of tailored, half-automatized motivational components delivered by a coach. To register sedentary behavior, the VitaBit (VitaBit Software International BV) toolkit, a wearable accelerometry-based monitoring device, is used. Among others, UPcomplish includes personalized goal setting, tailored suggestions to overcome hurdles, and weekly challenges. The VitaBit toolkit supports the participants to monitor their behavior in relation to self-set goals. Conclusions: Intervention mapping is a useful protocol not only for the systematic development of a comprehensive intervention to reduce sedentary behavior but also for planning program adherence, program implementation, and program maintenance. It facilitates obtaining the participation of relevant stakeholders at different ecological levels in the development process of the intervention and anticipating facilitators to and barriers of program implementation and maintenance. Trial Registration: Netherlands Trial Register NL7503; https://www.trialregister.nl/trial/7503 %M 32706695 %R 10.2196/14951 %U http://formative.jmir.org/2020/7/e14951/ %U https://doi.org/10.2196/14951 %U http://www.ncbi.nlm.nih.gov/pubmed/32706695 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 7 %N 3 %P e18171 %T Process Evaluation of an eHealth Intervention (Food4toddlers) to Improve Toddlers' Diet: Randomized Controlled Trial %A Røed,Margrethe %A Vik,Frøydis Nordgård %A Hillesund,Elisabet Rudjord %A Van Lippevelde,Wendy %A Medin,Anine Christine %A Øverby,Nina Cecilie %+ Department of Nutrition and Public Health, Faculty of Health and Sports Sciences, University of Agder, PO Box 422, Kristiansand, 4604, Norway, 47 38141324, nina.c.overby@uia.no %K toddler %K mHealth %K usability %K eHealth %K diet intervention %K digital intervention %K education difference %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Parents seek trustworthy information online to promote healthy eating for their toddlers. Such information must be perceived as relevant and easy to implement and use. Objective: The objectives of this study were to conduct a process evaluation of the electronic health (eHealth) intervention (Food4toddlers) targeting food environment, parental feeding practices, and toddlers’ diet and to examine possible differences in these areas according to education and family composition. Methods: A 2-armed randomized controlled trial, including 298 parent–toddler dyads from Norway, was conducted in 2017. In total, 148 parents in the intervention group received access to an intervention website for 6 months. Data on website usage were retrieved from the learning management platform used (NEO). Participants’ satisfaction with the intervention was asked for in a postintervention questionnaire. Chi-square and t tests were used to examine differences in usage and satisfaction between education and family composition groups. Results: Most participants were mothers (144/148, 97.2%), lived in two-adult households (148/148, 100%), and were born in Norway (132/148, 89.1%). Mean parental age was 31.5 years (SD 4.2). More than 87.8% (129/147) had a university education degree and 56.5% (83/147) had over 4 years of university education. Most (128/148, 86.5%) intervention participants entered the website at least once (mean days of access 7.4 [SD 7.1]). Most parents reported the website as appropriate to the child’s age (71/83, 86%) and self-explanatory (79/83, 95%) and appreciated the interface (52/83, 63%) and layout (46/83, 55%). In total, 61% (51/83) stated that they learned something new from the intervention. Parents with over 4 years of university education and in 1-child households used the intervention website more than those with 4 years or less of university education (8.4 vs 5.9 days in total, P=.04) and households with more than 1 child (8.3 vs 5.8 days in total, P=.04), respectively. Conclusions: The Food4toddlers intervention website was found to be relevant by most participants in the intervention group, although usage of the website differed according to educational level and family composition. For eHealth interventions to be effective, intervention materials such as websites must be used by the target group. Our results highlight the need to include users from different groups when developing interventions. Trial Registration: ISRCTN Registry ISRCTN92980420; http://www.isrctn.com/ISRCTN92980420 %M 32628612 %R 10.2196/18171 %U https://humanfactors.jmir.org/2020/3/e18171 %U https://doi.org/10.2196/18171 %U http://www.ncbi.nlm.nih.gov/pubmed/32628612 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 1 %P e15008 %T Usability of a Mobile Phone App Aimed at Adolescents and Young Adults During and After Cancer Treatment: Qualitative Study %A Hanghøj,Signe %A Boisen,Kirsten A %A Hjerming,Maiken %A Elsbernd,Abbey %A Pappot,Helle %+ Center of Adolescent Medicine, Department of Paediatrics and Adolescent Medicine, The Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, Copenhagen, 2100, Denmark, 45 27318806, signe.hanghoej@gmail.com %K AYA %K adolescent and young adult %K app %K cancer %K co-creation %K mHealth %K mobile phone %K think-aloud test %K usability %D 2020 %7 2.1.2020 %9 Original Paper %J JMIR Cancer %G English %X Background: Adolescent and young adult (AYA) cancer patients are seldom involved in the process of testing cancer-related apps. As such, knowledge about youth-specific content, functionalities, and design is sparse. As a part of a co-creation process of developing the mobile phone app Kræftværket, AYAs in treatment for cancer and in follow-up participated in a usability think-aloud test of a prototype of the app. Thus, the app was initiated, created, and evaluated by AYAs with cancer experience. Objective: The aim of this study was to explore the results of a think-aloud test administered to see how the prototype of the app Kræftværket was used by AYAs in treatment for cancer and in follow-up, and to investigate the strengths and weaknesses of the app. Methods: A total of 20 AYA cancer patients aged 16 to 29 years (n=10 on treatment, n=10 in follow-up) were provided with the first version of the co-created mobile phone app Kræftværket during a 6-week test period (April-May 2018). After the test period, 15 participated in individual usability think-aloud tests. The tests were video-recorded, transcribed verbatim, and analyzed using a thematic analysis approach. Results: The thematic analysis led to the following themes and subthemes: navigation (subthemes: intuition, features, buttons, home page, profile), visual and graphic design (subthemes: overview, text and colors, photos, videos, YouTube), and usefulness (subthemes: notifications, posts, adding). The analysis identified gender differences in app utilization—female participants seemed to be more familiar with parts of the app. The app seemed to be more relevant to AYAs receiving treatment due to app functions such as tracking symptoms and searching for relevant information. Lack of notifications and incorrect counting of posts were perceived as barriers to using the app. Conclusions: Usability testing is crucial to meet the needs of the AYA target audience. AYA cancer apps should preferably be relevant, targeted, and unique, and include a tracking function and AYA-produced videos. Notifications and correct marking and ordering of posts are critical to make apps engaging and dynamic. Further research is recommended to evaluate the Kræftværket app with the input of more AYAs. %M 31895046 %R 10.2196/15008 %U https://cancer.jmir.org/2020/1/e15008 %U https://doi.org/10.2196/15008 %U http://www.ncbi.nlm.nih.gov/pubmed/31895046 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 12 %P e14866 %T Moderated Online Social Therapy: Viewpoint on the Ethics and Design Principles of a Web-Based Therapy System %A D'Alfonso,Simon %A Phillips,Jessica %A Valentine,Lee %A Gleeson,John %A Alvarez-Jimenez,Mario %+ School of Computing and Information Systems, University of Melbourne, Grattan Street, Parkville, 3010, Australia, 61 399669387, dalfonso@unimelb.edu.au %K Web-based intervention %K social network %K well-being %K eudaimonia %K persuasive technology %K ethical design %D 2019 %7 4.12.2019 %9 Viewpoint %J JMIR Ment Health %G English %X The modern omnipresence of social media and social networking sites (SNSs) brings with it a range of important research questions. One of these concerns the impact of SNS use on mental health and well-being, a question that has been pursued in depth by scholars in the psychological sciences and the field of human-computer interaction. Despite this attention, the design choices made in the development of SNSs and the notion of well-being employed to evaluate such systems require further scrutiny. In this viewpoint paper, we examine the strategic design choices made in our development of an enclosed SNS for young people experiencing mental ill-health in terms of ethical and persuasive design and in terms of how it fosters well-being. In doing so, we critique the understanding of well-being that is used in much of the existing literature to make claims about the impact of a given technology on well-being. We also demonstrate how the holistic concept of eudaimonic well-being and ethical design of SNSs can complement one another. %M 31799937 %R 10.2196/14866 %U https://mental.jmir.org/2019/12/e14866 %U https://doi.org/10.2196/14866 %U http://www.ncbi.nlm.nih.gov/pubmed/31799937 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 10 %P e12514 %T Difficulties Encountered by People With Depression and Anxiety on the Web: Qualitative Study and Web-Based Expert Survey %A Bernard,Renaldo %A Sabariego,Carla %A Cieza,Alarcos %+ Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, Department of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Marchioninistraße 17, Munich, 81377, Germany, 49 49 89 2180 7822, renaldo.bernard@med.lmu.de %K World Wide Web %K depression %K anxiety %K accessibility %K interview %K persona %K expert study %K eHealth %K usability %K user experience %K facilitators %K barriers %K mental disorders %D 2019 %7 31.10.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Depression and anxiety are the most common mental health conditions, and they were identified as leading contributors to global disability in 2016. People with these conditions rely on Web-based resources as a source of accurate health information, convenient and effective treatment, and essential social support. However, a recent systematic review revealed several potentially limiting difficulties that this group experiences online and also suggested that there is a partial understanding of these difficulties as only difficulties associated with neurocognitive, but not sociocognitive, deficits were identified. Therefore, this study fills this knowledge gap and contributes to a more robust and fuller understanding of the difficulties this group experiences online. Objective: The objective of this study was to identify the difficulties people with depression and anxiety experience when using the Web and the Web activities that are most associated with the experience of difficulties. Methods: The study employed data triangulation using face-to-face semistructured interviews with 21 participants affected by depression and anxiety and a comparison group (7 participants) without mental disorders (study 1) as well as a persona-based expert online survey with 21 mental health practitioners (MHPs) who treated people with depression and anxiety (study 2). Framework analysis for both studies proceeded through 5 stages: (1) familiarization, (2) identifying a thematic framework, (3) indexing, (4) charting, and (5) mapping and interpretation. Results: In study 1, 167 difficulties were identified from the experiences of participants in the depression and anxiety group were discussed within the context of 81 Web activities, services, and features. From these, 4 themes and 12 subthemes describing the difficulties people with depression and anxiety experienced online were identified. Difficulties relating to the subtheme lack of control over access and usage were the most common difficulties experienced by participants in the depression and anxiety group (19/21). Sixteen difficulties identified from the experiences of participants in the comparison group were discussed within the context of 11 Web activities, services, and features. Most participants in the comparison group (6/7) contributed to the subtheme describing difficulties with unexpected and irrelevant content. In study 2, researchers identified 3 themes and 10 subthemes that described the perceived difficulties people with depression and anxiety might experience online as reported by MHPs. Practitioners linked these difficulties with 22 common impairments, limitations in activities of daily life, and diagnostic criteria associated with depression and anxiety. Conclusions: People with depression and anxiety also experience difficulties when using the Web that are related to the sociocognitive deficits associated with their conditions. MHPs have a good awareness of the difficulties that people with depression and anxiety are likely to experience when using the Web. This investigation has contributed to a fuller understanding of these difficulties and provides innovative guidance on how to remove and reduce them for people with depression and anxiety when using the Web. International Registered Report Identifier (IRRID): RR2-10.1007/978-3-319-21006-3_3 %M 31674915 %R 10.2196/12514 %U http://www.jmir.org/2019/10/e12514/ %U https://doi.org/10.2196/12514 %U http://www.ncbi.nlm.nih.gov/pubmed/31674915 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 4 %P e12225 %T How Do Publicly Available Allergy-Specific Web-Based Training Programs Conform to the Established Criteria for the Reporting, Methods, and Content of Evidence-Based (Digital) Health Information and Education: Thematic Content Evaluation %A Lander,Jonas %A Drixler,Karin %A Dierks,Marie-Luise %A Bitzer,Eva Maria %+ Freiburg University of Education, Department of Public Health and Health Education, Kartäuserstraße 47, Freiburg, 79117, Germany, 49 761 682 142, evamaria.bitzer@ph-freiburg.de %K allergy %K asthma %K health communication %K health education %K health information systems %K evidence-based practice %D 2019 %7 24.10.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Allergic diseases, such as allergic asthma, rhinitis, and atopic eczema, are widespread, and they are a considerable burden on the health care system. For patients and health care professionals, Web-based training programs may be helpful to foster self-management and provide allergy-specific information, given, for instance, their good accessibility. Objective: This study aimed to assess an exploratory sample of publicly available allergy-specific Web-based training programs—that is, interactive, feedback-oriented Web-based training platforms promoting health behavior change and improvement of personal skills—with regard to (1) general characteristics, aims, and target groups and (2) the extent to which these tools meet established criteria for the reporting, methods, and content of evidence-based (digital) health information and education. Methods: Web-based training programs were identified via an initial Google search and a search of English and German language websites of medical and public health services, such as the European Centre for Allergy Research Foundation (German), Asthma UK, and Anaphylaxis Canada. We developed a checklist from (1) established guidelines for Web-based health information (eg, the Journal of the American Medical Association benchmarks, DISCERN criteria, and Health On the Net code) and (2) a database search of related studies. The checklist contained 44 items covering 11 domains in 3 areas: (1) content (completeness, transparency, and evidence), (2) structure (data safety and qualification of trainers and authors), and (3) impact (effectiveness, user perspective, and integration into health care). We rated the Web-based training programs as completely, partly, or not satisfying each checklist item and calculated overall and domain-specific scores for each Web-based training program using SPSS 23.0 (SPSS Inc). Results: The 15 identified Web-based training programs covered an average of 37% of the items (score 33 out of 88). A total of 7 Web-based training programs covered more than 40% (35/88; maximum: 49%; 43/88). A total of 5 covered 30% (26/88) to 40% (35/88) of all rated items and the rest covered fewer (n=3; lowest score 24%; 21/88). Items relating to intervention (58%; 10/18), content (49%; 9/18), and data safety (60%; 1/2) were more often considered, as opposed to user safety (10%; 0.4/4), qualification of staff (10%; 0.8/8), effectiveness (16%; 0.4/2), and user perspective (45%; 5/12). In addition, in 13 of 15 Web-based training programs, a minimum of 3 domains were not covered at all. Regarding evidence-based content, 46% of all Web-based training programs (7/15) scored on use of scientific research, 53% on regular information update (8/15), and 33% on provision of references (5/15). None of 15 provided details on the quality of references or the strength of evidence. Conclusions: English and German language allergy-specific Web-based training programs, addressing lay audiences and health care professionals, conform only partly to established criteria for the reporting, methods, and content of evidence-based (digital) health information and education. Particularly, well-conducted studies on their effectiveness are missing. %M 31651401 %R 10.2196/12225 %U http://www.i-jmr.org/2019/4/e12225/ %U https://doi.org/10.2196/12225 %U http://www.ncbi.nlm.nih.gov/pubmed/31651401 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 2 %P e13875 %T Exploring the Perceived Usefulness and Ease of Use of a Personalized Web-Based Resource (Care Companion) to Support Informal Caring: Qualitative Descriptive Study %A Turk,Amadea %A Fairclough,Emma %A Grason Smith,Gillian %A Lond,Benjamin %A Nanton,Veronica %A Dale,Jeremy %+ Unit of Academic Primary Care, Warwick Medical School, University of Warwick, Coventry, CV4 7AL, United Kingdom, 44 02476522891, jeremy.dale@warwick.ac.uk %K caregivers %K information technology %K internet %D 2019 %7 20.8.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Informal carers play an increasingly vital role in supporting the older population and the sustainability of health care systems. Care Companion is a theory-based and coproduced Web-based intervention to help support informal carers’ resilience. It aims to provide personalized access to information and resources that are responsive to individuals’ caring needs and responsibilities and thereby reduce the burdens associated with caregiving roles. Following the development of a prototype, it was necessary to undertake user acceptability testing to assess its suitability for wider implementation. Objective: This study aimed to undertake user acceptance testing to investigate the perceived usefulness and ease of use of Care Companion. The key objectives were to (1) explore how potential and actual users perceived its usefulness, (2) explore the barriers and facilitators to its uptake and use and (3) gather suggestions to inform plans for an area-wide implementation. Methods: We conducted user acceptance testing underpinned by principles of rapid appraisal using a qualitative descriptive approach. Focus groups, observations, and semistructured interviews were used in two phases of data collection. Participants were adult carers who were recruited through local support groups. Within the first phase, think-aloud interviews and observations were undertaken while the carers familiarized themselves with and navigated through the platform. In the second phase, focus group discussions were undertaken. Interested participants were then invited to trial Care Companion for up to 4 weeks and were followed up through semistructured telephone interviews exploring their experiences of using the platform. Thematic analysis was applied to the data, and a coding framework was developed iteratively with each phase of the study, informing subsequent phases of data collection and analysis. Results: Overall, Care Companion was perceived to be a useful tool to support caregiving activities. The key themes were related to its appearance and ease of use, the profile setup and log-in process, concerns related to the safety and confidentiality of personal information, potential barriers to use and uptake and suggestions for overcoming them, and suggestions for improving Care Companion. More specifically, these related to the need for personalized resources aimed specifically at the carers (instead of care recipients), the benefits of incorporating a Web-based journal, the importance of providing transparency about security and data usage, minimizing barriers to initial registration, offering demonstrations to support uptake by people with low technological literacy, and the need to develop a culturally sensitive approach. Conclusions: The findings identified ways of improving the ease of use and usefulness of Care Companion and demonstrated the importance of undertaking detailed user acceptance testing when developing an intervention for a diverse population, such as informal carers of older people. These findings have informed the further refinement of Care Companion and the strategy for its full implementation. %M 31518272 %R 10.2196/13875 %U https://aging.jmir.org/2019/2/e13875 %U https://doi.org/10.2196/13875 %U http://www.ncbi.nlm.nih.gov/pubmed/31518272 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e13898 %T The Internet-Based Cognitive Assessment Tool: System Design and Feasibility Study %A Hafiz,Pegah %A Miskowiak,Kamilla Woznica %A Kessing,Lars Vedel %A Elleby Jespersen,Andreas %A Obenhausen,Kia %A Gulyas,Lorant %A Zukowska,Katarzyna %A Bardram,Jakob Eyvind %+ Digital Health Section, Department of Health Technology, Technical University of Denmark, Richard Petersens Plads, Building 324, 2nd Floor, Room 270, Kongens Lyngby, 2800, Denmark, 45 91858371, pegh@dtu.dk %K screening %K memory %K executive function %K bipolar disorder %K depression %K cognitive impairments %K neuropsychological tests %K computer software %K speech recognition software %D 2019 %7 26.07.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Persistent cognitive impairment is prevalent in unipolar and bipolar disorders and is associated with decreased quality of life and psychosocial dysfunction. The screen for cognitive impairment in psychiatry (SCIP) test is a validated paper-and-pencil instrument for the assessment of cognition in affective disorders. However, there is no digital cognitive screening tool for the brief and accurate assessment of cognitive impairments in this patient group. Objective: In this paper, we present the design process and feasibility study of the internet-based cognitive assessment tool (ICAT) that is designed based on the cognitive tasks of the SCIP. The aims of this feasibility study were to perform the following tasks among healthy individuals: (1) evaluate the usability of the ICAT, (2) investigate the feasibility of the ICAT as a patient-administered cognitive assessment tool, and (3) examine the performance of automatic speech recognition (ASR) for the assessment of verbal recall. Methods: The ICAT was developed in a user-centered design process. The cognitive measures of the ICAT were immediate and delayed recall, working memory, and psychomotor speed. Usability and feasibility studies were conducted separately with 2 groups of healthy individuals (N=21 and N=19, respectively). ICAT tests were available in the English and Danish languages. The participants were asked to fill in the post study system usability questionnaire (PSSUQ) upon completing the ICAT test. Verbal recall in the ICAT was assessed using ASR, and the performance evaluation criterion was word error rate (WER). A Pearson 2-tailed correlation analysis significant at the .05 level was applied to investigate the association between the SCIP and ICAT scores. Results: The overall psychometric factors of PSSUQ for both studies gave scores above 4 (out of 5). The analysis of the feasibility study revealed a moderate to strong correlation between the total scores of the SCIP and ICAT (r=0.63; P=.009). There were also moderate to strong correlations between the SCIP and ICAT subtests for immediate verbal recall (r=0.67; P=.002) and psychomotor speed (r=0.71; P=.001). The associations between the respective subtests for working memory, executive function, and delayed recall, however, were not statistically significant. The corresponding WER for English and Danish responses were 17.8% and 6.3%, respectively. Conclusions: The ICAT is the first digital screening instrument modified from the SCIP using Web-based technology and ASR. There was good accuracy of the ASR for verbal memory assessment. The moderate correlation between the ICAT and SCIP scores suggests that the ICAT is a valid tool for assessing cognition, although this should be confirmed in a larger study with greater statistical power. Taken together, the ICAT seems to be a valid Web-based cognitive assessment tool that, after some minor modifications and further validation, may be used to screen for cognitive impairment in clinical settings. %M 31350840 %R 10.2196/13898 %U http://formative.jmir.org/2019/3/e13898/ %U https://doi.org/10.2196/13898 %U http://www.ncbi.nlm.nih.gov/pubmed/31350840 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 4 %P e11584 %T Usability of Health Information Websites Designed for Adolescents: Systematic Review, Neurodevelopmental Model, and Design Brief %A Reen,Gurpreet Kaur %A Muirhead,Linden %A Langdon,Dawn Wendy %+ University of Oxford, Department of Experimental Psychology, Oxford, OX2 6AE, United Kingdom, 44 7878451844, Gurpreet.reen.2014@live.rhul.ac.uk %K adolescents %K health communication %K internet %K information seeking behavior %K usability %K systematic review %D 2019 %7 23.04.2019 %9 Review %J J Med Internet Res %G English %X Background: Adolescence is a unique developmental period characterized by biological, social, and cognitive changes, as well as an interest in managing one’s own health care. Many adolescents use the internet to seek health care information. However, young people face barriers before they can understand and apply the health information that they access on the web. It is essential that usability of adolescent health websites on the internet is improved to help adolescents overcome these barriers and allow them to engage successfully with web-based health care content. Objective: The aim of this review was to synthesize the usability of specific health information websites. These findings were mapped onto the adolescent neurodevelopmental profile, and a design brief based on the findings was developed to tailor future websites for specific adolescent requirements. Methods: A systematic search conducted using PubMed, PsycINFO, and Education Resources Information Center (ERIC) identified 25 studies that assessed the usability of health information websites. Adolescent feedback was collected by a mixture of surveys, focus groups, interviews, and think-aloud procedures. Results: A majority of the information websites were developed for specific health issues that may be relevant to adolescents. The most preferred website features were interactive content such as games and quizzes, as well as videos, images, audio clips, and animations. Participants also preferred communicating with other adolescents with similar conditions or learning about their experience through real stories and testimonials. Adolescents found it difficult to use health information websites if they contained too much text, were too cluttered, or had features that made it difficult to access. The findings are considered in the context of adolescent social processes, low tolerance of delayed gratification, and attraction to novelty and mapped onto a neurodevelopmental model of adolescence. Conclusions: Young people’s feedback can determine usability and content that make a health information website easy or informative to use. Neurodevelopmental profiles and the users’ specific preferences and skills should be addressed in future development of health information websites for adolescents. %M 31012856 %R 10.2196/11584 %U http://www.jmir.org/2019/4/e11584/ %U https://doi.org/10.2196/11584 %U http://www.ncbi.nlm.nih.gov/pubmed/31012856 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e11014 %T Social Media Intervention Design: Applying an Affordances Framework %A Moreno,Megan A %A D'Angelo,Jonathan %+ Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, 2870 University Ave, Suite 200, Madison, WI, 53705, United States, 1 6082632846, mamoreno@pediatrics.wisc.edu %K social media %K health %K adolescent %K research %D 2019 %7 26.03.2019 %9 Viewpoint %J J Med Internet Res %G English %X Social media interventions are a growing area of internet research, particularly for adolescent health. Researchers developing social media intervention approaches face the task of selecting a social media platform for their intervention. In this paper, we present the theoretical framework of affordances to help guide social media platform selection for intervention research. Affordances are a concept often used in fields associated with design and by those systematically studying the impact of a design of an object. Thus, the affordances approach is often used by those considering the impact of information technology and the design of social media platforms. Affordances are often described as properties of artifacts that can be recognized by users and contribute to their function or items that present an action possibility. We describe common affordances that can be applied to intervention design as well as current evidence and an intervention case example for each affordance. A scientific approach for the selection of the appropriate social media platform for a given intervention is an important research priority to advance the field of internet research. %M 30912754 %R 10.2196/11014 %U http://www.jmir.org/2019/3/e11014/ %U https://doi.org/10.2196/11014 %U http://www.ncbi.nlm.nih.gov/pubmed/30912754 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 2 %N 1 %P e12393 %T Engaging Aging Individuals in the Design of Technologies and Services to Support Health and Well-Being: Constructivist Grounded Theory Study %A Du Preez,Vikki %A De La Harpe,Retha %+ Department of Design, Faculty of Informatics and Design, Cape Peninsula University of Technology, District Six Campus, Keizergracht Street, Cape Town, 8001, South Africa, 27 21 460 3280, dupreezv@cput.ac.za %K technology %K healthy aging %K grounded theory %K qualitative research %D 2019 %7 20.03.2019 %9 Original Paper %J JMIR Aging %G English %X Background: Changes noted within the aging population are physical, cognitive, as well as emotional. Social isolation and loneliness are also serious problems that the aging population may encounter. As technology and apps become more accessible, many basic services, such as those offered by social services, well-being organizations, and health care institutions, have invested in the development of supportive devices, services, and Web-based interactions. Despite the perceived benefits that these devices and services offer, many aging individuals choose not to engage, or engage in a limited manner. To explore this phenomenon, we developed a theory to describe the condition for engagement. Objective: The main objective of this study was to understand the perceptions of an aging South African population regarding Web-based services and technologies that could support aging in place (AiP). Although the concept of AiP speaks to a great number of everyday activities, this paper explores aspects of health and well-being as being central to AiP. Methods: The study used a grounded theory (GT) methodology, relying on an iterative and simultaneous process of data collection, coding, category development, and data comparisons. Data were collected through qualitative methods, including interviews (13 participants aged between 64 and 85 years), 2 participatory workshops (15 participants), and observations. The study focused on Charmaz’s approach to constructivist GT, which puts forward the premise that theory or knowledge cannot take shape in a purely objective manner. Instead, theory is constructed through the interaction of the researcher and research participant. Coding and data analysis were supported with ATLAS.ti (ATLAS.ti Scientific Software Development GmbH). Results: The study resulted in a substantive theory exploring the process of interaction and engaging factors through user insights and experiences. The emerging design theory, Ageing User Decision-Driven Engagement (AUDDE), explored the elements that support engagement with technology and supportive apps, which could offer access to required health and wellness services. Conclusions: In AUDDE, the perceived value of the interaction is a crucial catalyst for engagement. Aging users continuously make meaning of their experiences, which affects their current and future actions. %M 31518258 %R 10.2196/12393 %U http://aging.jmir.org/2019/1/e12393/ %U https://doi.org/10.2196/12393 %U http://www.ncbi.nlm.nih.gov/pubmed/31518258 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 6 %N 1 %P e10449 %T Design Requirements for a Digital Aid to Support Adults With Mild Learning Disabilities During Clinical Consultations: Qualitative Study With Experts %A Gibson,Ryan Colin %A Bouamrane,Matt-Mouley %A Dunlop,Mark %+ Digital Health and Well-Being Group, Department of Computer & Information Sciences, University of Strathclyde, Computer & Information Sciences, Livingstone Tower, 26 Richmond Street, Glasgow, G11XH, United Kingdom, 44 (0)0141548318, ryan.gibson@strath.ac.uk %K learning disabilities %K intellectual disability %K communicative disorder %K augmentative and alternative communications systems %K primary care %D 2019 %7 04.03.2019 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Adults with mild learning disabilities (MLDs) face a plethora of obstacles when accessing effective health care. Central to many of these barriers is communication, with medical practitioners often remaining untrained on how to interact with patients who have learning disabilities (LDs). To date, research on how to promote this communication has largely centered on the development of low-tech aids. Objective: The objective of this study was to assess the feasibility of utilizing tablet technologies to promote communication between general practitioners and patients with MLDs. We achieved this by identifying a set of design requirements from experts in LDs. Methods: A set of design guidelines was formed during a 2-phase process. Phase 1 involved conducting a series of requirements-gathering interviews with 10 experts in LDs—the protocol of which emerged from the results of a separate scoping review. The interviews were subjected to a framework analysis to discern the key requirements discussed by the experts, and these were embedded within a technology probe. In phase 2, this probe was presented to a subset (n=4) of the experts during a round of usability studies, and the feedback received was used to update the requirements identified in phase 1. Results: An initial set of design requirements has been produced that may assist in the development of clinical Alternative and Augmentative Communication technologies for adults with MLDs. Factors that must be considered range from the health, physical and cognitive needs of stakeholders, to the more individual needs of users. Conclusions: The experts involved in the study were optimistic about the proposed app. They believe that such technologies can help to alleviate time constraints and promote communication by presenting information in a form understood by both practitioners and patients. %M 30829575 %R 10.2196/10449 %U http://rehab.jmir.org/2019/1/e10449/ %U https://doi.org/10.2196/10449 %U http://www.ncbi.nlm.nih.gov/pubmed/30829575 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e11128 %T Design and Delivery Features That May Improve the Use of Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Anxiety: A Realist Literature Synthesis With a Persuasive Systems Design Perspective %A Radomski,Ashley D %A Wozney,Lori %A McGrath,Patrick %A Huguet,Anna %A Hartling,Lisa %A Dyson,Michele P %A Bennett,Kathryn %A Newton,Amanda S %+ Department of Pediatrics, University of Alberta, 3-526 Edmonton Clinic Health Academy, 11405 - 87 Avenue, Edmonton, AB, T6G 1C9, Canada, 1 780 248 5581, mandi.newton@ualberta.ca %K internet %K cognitive behavioral therapy %K computer-assisted therapy %K persuasive communication %K anxiety %K children %K adolescents %K review %K adherence %D 2019 %7 05.02.2019 %9 Review %J J Med Internet Res %G English %X Background: Internet-based cognitive behavioral therapy (iCBT) is a persuasive system as its design combines therapeutic content, technological features, and interactions between the user and the program to reduce anxiety for children and adolescents. How iCBT is designed and delivered differs across programs. Although iCBT is considered an effective approach for treating child and adolescent anxiety, rates of program use (eg, module completion) are highly variable for reasons that are not clear. As the extent to which users complete a program can impact anxiety outcomes, understanding what iCBT design and delivery features improve program use is critical for optimizing treatment effects. Objective: The objectives of this study were to use a realist synthesis approach to explore the design and delivery features of iCBT for children and adolescents with anxiety as described in the literature and to examine their relationship to program use outcomes. Methods: A search of published and gray literature was conducted up to November 2017. Prespecified inclusion criteria identified research studies, study protocols, and program websites on iCBT for child and adolescent anxiety. Literature was critically appraised for relevance and methodological rigor. The persuasive systems design (PSD) model, a comprehensive framework for designing and evaluating persuasive systems, was used to guide data extraction. iCBT program features were grouped under 4 PSD categories—Primary task support, Dialogue support, System credibility support, and Social support. iCBT design (PSD Mechanisms) and delivery features (Context of use) were linked to program use (Outcomes) using meta-ethnographic methods; these relationships were described as Context-Mechanism-Outcome configurations. For our configurations, we identified key PSD features and delivery contexts that generated moderate-to-high program use based on moderate-to-high quality evidence found across multiple iCBT programs. Results: A total of 44 documents detailing 10 iCBT programs were included. Seven iCBT programs had at least one document that scored high for relevance; most studies were of moderate-to-high methodological rigor. We developed 5 configurations that highlighted 8 PSD features (Tailoring, Personalization [Primary task supports]; Rewards, Reminders, Social role [Dialogue supports]; and Trustworthiness, Expertise, Authority [System credibility supports]) associated with moderate-to-high program use. Important features of delivery Context were adjunct support (a face-to-face, Web- or email-based communications component) and whether programs targeted the prevention or treatment of anxiety. Incorporating multiple PSD features may have additive or synergistic effects on program use. Conclusions: The Context-Mechanism-Outcome configurations we developed suggest that, when delivered with adjunct support, certain PSD features contribute to moderate-to-high use of iCBT prevention and treatment programs for children and adolescents with anxiety. Standardization of the definition and measurement of program use, formal testing of individual and combined PSD features, and use of real-world design and testing methods are important next steps to improving how we develop and deliver increasingly useful treatments to target users. %M 30720436 %R 10.2196/11128 %U https://www.jmir.org/2019/2/e11128/ %U https://doi.org/10.2196/11128 %U http://www.ncbi.nlm.nih.gov/pubmed/30720436 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 10 %N 4 %P e12338 %T The Impact of Visualization Format and Navigational Options on Laypeople’s Perception and Preference of Surgery Information Videos: Randomized Controlled Trial and Online Survey %A Eggeling,Marie %A Bientzle,Martina %A Shiozawa,Thomas %A Cress,Ulrike %A Kimmerle,Joachim %+ Knowledge Construction Lab, Leibniz-Institut fuer Wissensmedien, Schleichstr 6, Tuebingen, 72076, Germany, 49 7071979 ext 363, j.kimmerle@iwm-tuebingen.de %K attitude %K decision aids %K emotions %K informed decision making %K knowledge acquisition %K medical decision making %K surgery %K video %D 2018 %7 22.11.2018 %9 Original Paper %J J Participat Med %G English %X Background: Patients need to be educated about possible treatment choices in order to make informed medical decisions. As most patients are medical laypeople, they find it difficult to understand complex medical information sufficiently to feel confident about a decision. Multimedia interventions such as videos are increasingly used to supplement personal consultations with medical professionals. Former research has shown that such interventions may have a positive effect on understanding, decision making, and emotional reactions. However, it is thus far unclear how different features of videos influence these outcomes. Objective: We aimed to examine the impact of visualization formats and basic navigational options in medical information videos about cruciate ligament surgery on recipients’ knowledge gain, emotions, attitude, and hypothetical decision-making ability. Methods: In a between-group randomized experiment (Study 1), 151 participants watched 1 of 4 videos (schematic vs realistic visualization; available vs unavailable navigational options). In a separate online survey (Study 2), 110 participants indicated their preference for a video design. All participants were medical laypeople without personal experience with a cruciate ligament rupture and were presented with a fictional decision situation. Results: In Study 1, participants who used navigational options (n=36) gained significantly more factual knowledge (P=.005) and procedural knowledge (P<.001) than participants who did not have or use navigational options (n=115). A realistic visualization induced more fear (P=.001) and disgust (P<.001) than a schematic video. Attitude toward the surgery (P=.02) and certainty regarding the decision for or against surgery (P<.001) were significantly more positive after watching the video than before watching the video. Participants who watched a schematic video rated the video significantly higher than that by participants who watched a realistic video (P<.001). There were no significant group differences with regard to hypothetical decision making and attitude toward the intervention. In addition, we did not identify any influence of the visualization format on knowledge acquisition. In Study 2, 58 of 110 participants (52.7%) indicated that they would prefer a schematic visualization, 26 (23.6%) preferred a realistic visualization, 17 (15.5%) wanted either visualization, and 9 (8.2%) did not want to watch a video at all. Of the participants who wanted to watch a video, 91 (90.1%) preferred to have navigational options, 3 (3.0%) preferred not to have navigational options, and 7 (6.9%) did not mind the options. Conclusion: Our study indicates that the perception of medical information videos is influenced by their design. Schematic videos with navigational options are the most helpful among all videos to avoid negative emotions and support knowledge acquisition when informing patients about an intervention. The visualization format and navigational options are important features that should be considered when designing medical videos for patient education. Trial Registration: Deutsches Register Klinischer Studien DRKS00016003; https://www.drks.de/drks_web/ navigate.do?navigationId= trial.HTML&TRIAL_ID=DRKS00016003 (Archived by WebCite at http://www.webcitation.org/746ASSAhN) %R 10.2196/12338 %U http://jopm.jmir.org/2018/4/e12338/ %U https://doi.org/10.2196/12338 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 4 %P e10801 %T Usefulness and Relevance of an eHealth Tool in Supporting the Self-Management of Chronic Obstructive Pulmonary Disease: Explorative Qualitative Study of a Cocreative Process %A Tistad,Malin %A Lundell,Sara %A Wiklund,Maria %A Nyberg,André %A Holmner,Åsa %A Wadell,Karin %+ Unit of Physiotherapy, Department of Community Medicine and Rehabilitation, Umeå University, 901 87, Umeå,, Sweden, 46 90 786 50 00, mti@du.se %K COPD %K eHealth %K cocreation %K self-management %K primary care, chronic disease %D 2018 %7 26.10.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: New strategies are urgently needed to support self-management for people with chronic obstructive pulmonary disease (COPD) in primary care. The use of electronic health (eHealth) solutions is promising. However, there is a lack of knowledge about how such eHealth tools should be designed in order to be perceived as relevant and useful and meet the needs and expectations of the health professionals as well as people with COPD and their relatives. Objective: The objective of this study was to explore the aspects of an eHealth tool design and content that make it relevant and useful for supporting COPD-related self-management strategies from the perspective of health care professionals, people with COPD and their relatives, and external researchers. Methods: Data were collected during the development of an eHealth tool. A cocreation process was carried out with participants from two primary care units in northern Sweden and external researchers. Individual interviews were performed with health care professionals (n=13) as well as people with COPD (n=6) and their relatives (n=2), and focus group discussions (n=9) were held with all groups of participants. Data were analyzed using qualitative content analysis. Results: The overarching theme, reinforcing existing support structures, reflects participant views that the eHealth tool needs to be directly applicable and create a sense of commitment in users. Moreover, participants felt that the tool needs to fit with existing routines and contexts and preferably should not challenge existing hierarchies between health care professionals and people with COPD. Important content for health care professionals and people with COPD included knowledge about self-management strategies. Videos were regarded as the most effective method for communicating such knowledge. Conclusions: The cocreation in the development process enables participant perspectives and priorities to be built into the eHealth tool. This is assumed to contribute to a tool that is useful and relevant and, therefore, adopted into clinical practice and everyday life. Findings from this study can inform the development of eHealth tools for people with COPD in other contexts, as well as the development of eHealth tools for self-management support of other chronic diseases. %M 30368440 %R 10.2196/10801 %U http://humanfactors.jmir.org/2018/4/e10801/ %U https://doi.org/10.2196/10801 %U http://www.ncbi.nlm.nih.gov/pubmed/30368440 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 4 %P e27 %T Collecting Health and Exposure Data in Australian Olympic Combat Sports: Feasibility Study Utilizing an Electronic System %A Bromley,Sally %A Drew,Michael %A Talpey,Scott %A McIntosh,Andrew %A Finch,Caroline %+ Physical Therapies Department, Australian Institute of Sport, , Canberra,, Australia, 61 411802057, sally.bromley@live.com.au %K online %K health %K injury & prevention %K athletic performance %K internet %K mobile phone %D 2018 %7 09.10.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Electronic methods are increasingly being used to manage health-related data among sporting populations. Collection of such data permits the analysis of injury and illness trends, improves early detection of injuries and illnesses, collectively referred to as health problems, and provides evidence to inform prevention strategies. The Athlete Management System (AMS) has been employed across a range of sports to monitor health. Australian combat athletes train across the country without dedicated national medical or sports science teams to monitor and advocate for their health. Employing a Web-based system, such as the AMS, may provide an avenue to increase the visibility of health problems experienced by combat athletes and deliver key information to stakeholders detailing where prevention programs may be targeted. Objective: The objectives of this paper are to (1) report on the feasibility of utilizing the AMS to collect longitudinal injury and illness data of combat sports athletes and (2) describe the type, location, severity, and recurrence of injuries and illnesses that the cohort of athletes experience across a 12-week period. Methods: We invited 26 elite and developing athletes from 4 Olympic combat sports (boxing, judo, taekwondo, and wrestling) to participate in this study. Engagement with the AMS was measured, and collected health problems (injuries or illnesses) were coded using the Orchard Sports Injury Classification System (version 10.1) and International Classification of Primary Care (version 2). Results: Despite >160 contacts, athlete engagement with online tools was poor, with only 13% compliance across the 12-week period. No taekwondo or wrestling athletes were compliant. Despite low overall engagement, a large number of injuries or illness were recorded across 11 athletes who entered data—22 unique injuries, 8 unique illnesses, 30 recurrent injuries, and 2 recurrent illnesses. The most frequent injuries were to the knee in boxing (n=41) and thigh in judo (n=9). In this cohort, judo players experienced more severe, but less frequent, injuries than boxers, yet judo players sustained more illnesses than boxers. In 97.0% (126/130) of cases, athletes in this cohort continued to train irrespective of their health problems. Conclusions: Among athletes who reported injuries, many reported multiple conditions, indicating a need for health monitoring in Australian combat sports. A number of factors may have influenced engagement with the AMS, including access to the internet, the design of the system, coach views on the system, previous experiences with the system, and the existing culture within Australian combat sports. To increase engagement, there may be a requirement for sports staff to provide relevant feedback on data entered into the system. Until the barriers are addressed, it is not feasible to implement the system in its current form across a larger cohort of combat athletes. %M 30305257 %R 10.2196/humanfactors.9541 %U http://humanfactors.jmir.org/2018/4/e27/ %U https://doi.org/10.2196/humanfactors.9541 %U http://www.ncbi.nlm.nih.gov/pubmed/30305257 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 3 %P e10070 %T Software for Administering the National Cancer Institute’s Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events: Usability Study %A Schoen,Martin W %A Basch,Ethan %A Hudson,Lori L %A Chung,Arlene E %A Mendoza,Tito R %A Mitchell,Sandra A %A St. Germain,Diane %A Baumgartner,Paul %A Sit,Laura %A Rogak,Lauren J %A Shouery,Marwan %A Shalley,Eve %A Reeve,Bryce B %A Fawzy,Maria R %A Bhavsar,Nrupen A %A Cleeland,Charles %A Schrag,Deborah %A Dueck,Amylou C %A Abernethy,Amy P %+ Division of Hematology/Oncology, Department of Medicine, University of North Carolina School of Medicine, 170 Manning Drive, Chapel Hill, NC,, United States, 1 919 843 3055, ebasch@med.unc.edu %K usability %K patient-reported outcomes %K symptoms %K adverse events %K PRO-CTCAE %K cancer clinical trials %D 2018 %7 16.07.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The US National Cancer Institute (NCI) developed software to gather symptomatic adverse events directly from patients participating in clinical trials. The software administers surveys to patients using items from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) through Web-based or automated telephone interfaces and facilitates the management of survey administration and the resultant data by professionals (clinicians and research associates). Objective: The purpose of this study was to iteratively evaluate and improve the usability of the PRO-CTCAE software. Methods: Heuristic evaluation of the software functionality was followed by semiscripted, think-aloud protocols in two consecutive rounds of usability testing among patients with cancer, clinicians, and research associates at 3 cancer centers. We conducted testing with patients both in clinics and at home (remotely) for both Web-based and telephone interfaces. Furthermore, we refined the software between rounds and retested. Results: Heuristic evaluation identified deviations from the best practices across 10 standardized categories, which informed initial software improvement. Subsequently, we conducted user-based testing among 169 patients and 47 professionals. Software modifications between rounds addressed identified issues, including difficulty using radio buttons, absence of survey progress indicators, and login problems (for patients) as well as scheduling of patient surveys (for professionals). The initial System Usability Scale (SUS) score for the patient Web-based interface was 86 and 82 (P=.22) before and after modifications, respectively, whereas the task completion score was 4.47, which improved to 4.58 (P=.39) after modifications. Following modifications for professional users, the SUS scores improved from 71 to 75 (P=.47), and the mean task performance improved significantly (4.40 vs 4.02; P=.001). Conclusions: Software modifications, informed by rigorous assessment, rendered a usable system, which is currently used in multiple NCI-sponsored multicenter cancer clinical trials. Trial Registration: ClinicalTrials.gov NCT01031641; https://clinicaltrials.gov/ct2/show/NCT01031641 (Archived by WebCite at http://www.webcitation.org/708hTjlTl) %M 30012546 %R 10.2196/10070 %U http://humanfactors.jmir.org/2018/3/e10070/ %U https://doi.org/10.2196/10070 %U http://www.ncbi.nlm.nih.gov/pubmed/30012546 %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 %@ 2292-9495 %I JMIR Publications %V 5 %N 2 %P e20 %T A Moderated e-Forum for Adults With Cardiovascular Disease: Usability Study %A Tanaka,Rika %A Banerjee,Anita %A Surikova,Jelena %A Tracey,Jacqueline %A Payne,Ada %A Ross,Heather %A Nolan,Robert %+ Cardiac eHealth and Behavioural Cardiology Research Unit, Peter Munk Cardiac Centre, University Health Network, 585 University Avenue, 6NU-618, Toronto, ON, M5G 2N2, Canada, 1 416 340 4800 ext 6400, rika.tanaka@uhnresearch.ca %K support groups %K cardiovascular disease %K qualitative research %D 2018 %7 18.05.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Self-care behaviors are commonly prescribed to manage both cardiovascular disease and hypertension to reduce modifiable risk factors and improve quality of life. Nevertheless, long-term adherence to self-care recommendations for cardiac patients has been problematic. In cardiac patients, moderated online forums have been found to be particularly useful in supporting maintenance of heart-healthy diet and fewer hospital visits. As such, we developed the e-Forum, a Web-based moderated forum designed to promote continued user engagement and long-term self-care adherence. Objective: The objective of this study was to assess the usability of the user interface for the newly designed e-Forum. In addition to overall user satisfaction, we obtained feedback from our target users on the key features of this newly developed interface. Methods: An iterative design tested the usability of the e-Forum. On the basis of the user feedback, adjustments were made to the design of our e-Forum, and these changes were then tested in the succeeding group. Participants were recruited from the Heart Function Clinic at the Peter Munk Cardiac Center, University Health Network. After consenting to participate in our study, patients were asked to complete a set of goal-oriented tasks and a feedback interview for the e-Forum. A content analysis of the transcripts from the set of goal-oriented tasks and feedback interviews identified several themes, including general feedback and comments regarding 3 key areas of the e-Forum: layout, navigation, and content. Results: Overall, 13 cardiac patients (aged 32-81 years) participated in 3 rounds of testing. Participants across all 3 rounds were highly satisfied with our e-Forum and indicated that they would find such a forum useful in managing their health. Expressions of overall satisfaction with the e-Forum and positive comments regarding layout increased between the initial and the final round. As improvements were made to the e-Forum based on participant feedback, potential barriers, negative comments related to the content, and the number of navigation errors decreased between rounds 1 and 3. Conclusions: We found evidence to support the usability of the user interface for our e-Forum. These results indicate that the e-Forum will likely be a successful tool to support an online community of cardiac patients in their efforts to sustain long-term lifestyle behavior change. %M 29776901 %R 10.2196/humanfactors.8820 %U http://humanfactors.jmir.org/2018/2/e20/ %U https://doi.org/10.2196/humanfactors.8820 %U http://www.ncbi.nlm.nih.gov/pubmed/29776901 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 2 %P e17 %T A Web-Based Treatment Decision Support Tool for Patients With Advanced Knee Arthritis: Evaluation of User Interface and Content Design %A Zheng,Hua %A Rosal,Milagros C %A Li,Wenjun %A Borg,Amy %A Yang,Wenyun %A Ayers,David C %A Franklin,Patricia D %+ Department of Orthopedics and Physical Rehabilitation, University of Massachusetts Medical School, 55 Lake Ave North, Worcester, MA, 01655, United States, 1 (508) 856 5748, patricia.franklin@umassmed.edu %K usability evaluation %K patient decision support %K knee osteoarthritis %K total knee replacement %K outcome prediction %D 2018 %7 30.04.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Data-driven surgical decisions will ensure proper use and timing of surgical care. We developed a Web-based patient-centered treatment decision and assessment tool to guide treatment decisions among patients with advanced knee osteoarthritis who are considering total knee replacement surgery. Objective: The aim of this study was to examine user experience and acceptance of the Web-based treatment decision support tool among older adults. Methods: User-centered formative and summative evaluations were conducted for the tool. A sample of 28 patients who were considering total knee replacement participated in the study. Participants’ responses to the user interface design, the clarity of information, as well as usefulness, satisfaction, and acceptance of the tool were collected through qualitative (ie, individual patient interviews) and quantitative (ie, standardized Computer System Usability Questionnaire) methods. Results: Participants were older adults with a mean age of 63 (SD 11) years. Three-quarters of them had no technical questions using the tool. User interface design recommendations included larger fonts, bigger buttons, less colors, simpler navigation without extra “next page” click, less mouse movement, and clearer illustrations with simple graphs. Color-coded bar charts and outcome-specific graphs with positive action were easiest for them to understand the outcomes data. Questionnaire data revealed high satisfaction with the tool usefulness and interface quality, and also showed ease of use of the tool, regardless of age or educational status. Conclusions: We evaluated the usability of a patient-centered decision support tool designed for advanced knee arthritis patients to facilitate their knee osteoarthritis treatment decision making. The lessons learned can inform other decision support tools to improve interface and content design for older patients’ use. %M 29712620 %R 10.2196/humanfactors.8568 %U http://humanfactors.jmir.org/2018/2/e17/ %U https://doi.org/10.2196/humanfactors.8568 %U http://www.ncbi.nlm.nih.gov/pubmed/29712620 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e97 %T Information Architecture of Web-Based Interventions to Improve Health Outcomes: Systematic Review %A Pugatch,Jillian %A Grenen,Emily %A Surla,Stacy %A Schwarz,Mary %A Cole-Lewis,Heather %+ ICF, 530 Gaither Road, Suite 500, Rockville, MD, 28770, United States, 1 301 572 0856, jillian.pugatch@icf.com %K information architecture %K systematic review %K health outcomes %K behavior change %K health behavior %D 2018 %7 21.03.2018 %9 Review %J J Med Internet Res %G English %X Background: The rise in usage of and access to new technologies in recent years has led to a growth in digital health behavior change interventions. As the shift to digital platforms continues to grow, it is increasingly important to consider how the field of information architecture (IA) can inform the development of digital health interventions. IA is the way in which digital content is organized and displayed, which strongly impacts users’ ability to find and use content. While many information architecture best practices exist, there is a lack of empirical evidence on the role it plays in influencing behavior change and health outcomes. Objective: Our aim was to conduct a systematic review synthesizing the existing literature on website information architecture and its effect on health outcomes, behavioral outcomes, and website engagement. Methods: To identify all existing information architecture and health behavior literature, we searched articles published in English in the following databases (no date restrictions imposed): ACM Digital Library, CINAHL, Cochrane Library, Google Scholar, Ebsco, and PubMed. The search terms used included information terms (eg, information architecture, interaction design, persuasive design), behavior terms (eg, health behavior, behavioral intervention, ehealth), and health terms (eg, smoking, physical activity, diabetes). The search results were reviewed to determine if they met the inclusion and exclusion criteria created to identify empirical research that studied the effect of IA on health outcomes, behavioral outcomes, or website engagement. Articles that met inclusion criteria were assessed for study quality. Then, data from the articles were extracted using a priori categories established by 3 reviewers. However, the limited health outcome data gathered from the studies precluded a meta-analysis. Results: The initial literature search yielded 685 results, which was narrowed down to three publications that examined the effect of information architecture on health outcomes, behavioral outcomes, or website engagement. One publication studied the isolated impact of information architecture on outcomes of interest (ie, website use and engagement; health-related knowledge, attitudes, and beliefs; and health behaviors), while the other two publications studied the impact of information architecture, website features (eg, interactivity, email prompts, and forums), and tailored content on these outcomes. The paper that investigated IA exclusively found that a tunnel IA improved site engagement and behavior knowledge, but it decreased users’ perceived efficiency. The first study that did not isolate IA found that the enhanced site condition improved site usage but not the amount of content viewed. The second study that did not isolate IA found that a tailored site condition improved site usage, behavior knowledge, and some behavior outcomes. Conclusions: No clear conclusion can be made about the relationship between IA and health outcomes, given limited evidence in the peer-reviewed literature connecting IA to behavioral outcomes and website engagement. Only one study reviewed solely manipulated IA, and we therefore recommend improving the scientific evidence base such that additional empirical studies investigate the impact of IA in isolation. Moreover, information from the gray literature and expert opinion might be identified and added to the evidence base, in order to lay the groundwork for hypothesis generation to improve empirical evidence on information architecture and health and behavior outcomes. %M 29563076 %R 10.2196/jmir.7867 %U http://www.jmir.org/2018/3/e97/ %U https://doi.org/10.2196/jmir.7867 %U http://www.ncbi.nlm.nih.gov/pubmed/29563076 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 2 %N 1 %P e4 %T A Web-Based Platform for People With Memory Problems and Their Caregivers (CAREGIVERSPRO-MMD): Mixed-Methods Evaluation of Usability %A Zafeiridi,Paraskevi %A Paulson,Kevin %A Dunn,Rosie %A Wolverson,Emma %A White,Caroline %A Thorpe,Jonathan Adrian %A Antomarini,Marco %A Cesaroni,Francesca %A Scocchera,Francesca %A Landrin-Dutot,Isabelle %A Malherbe,Laëtitia %A Lingiah,Hendi %A Bérard,Marie %A Gironès,Xavier %A Quintana,Maria %A Cortés,Ulises %A Barrué,Cristian %A Cortés,Atia %A Paliokas,Ioannis %A Votis,Konstantinos %A Tzovaras,Dimitrios %+ School of Engineering and Computer Science, University of Hull, Aire Building, Cottingham Road, Hull, HU67RX, United Kingdom, 44 01482464571 ext 4571, P.Zafeiridi@hull.ac.uk %K dementia %K technology %K social support %K caregivers %D 2018 %7 12.03.2018 %9 Original Paper %J JMIR Formativ Res %G English %X Background: The increasing number of people with dementia (PwD) drives research exploring Web-based support interventions to provide effective care for larger populations. In this concept, a Web-based platform (CAREGIVERSPRO-MMD, 620911) was designed to (1) improve the quality of life for PwD, (2) reduce caregiver burden, (3) reduce the financial costs for care, and (4) reduce administration time for health and social care professionals. Objective: The objective of this study was to evaluate the usability and usefulness of CAREGIVERSPRO-MMD platform for PwD or mild cognitive impairment (MCI), informal caregivers, and health and social care professionals with respect to a wider strategy followed by the project to enhance the user-centered approach. A secondary aim of the study was to collect recommendations to improve the platform before the future pilot study. Methods: A mixed methods design was employed for recruiting PwD or MCI (N=24), informal caregivers (N=24), and professionals (N=10). Participants were asked to rate their satisfaction, the perceived usefulness, and ease of use of each function of the platform. Qualitative questions about the improvement of the platform were asked when participants provided low scores for a function. Testing occurred at baseline and 1 week after participants used the platform. The dropout rate from baseline to the follow-up was approximately 10% (6/58). Results: After 1 week of platform use, the system was useful for 90% (20.75/23) of the caregivers and for 89% (5.36/6) of the professionals. When users responded to more than 1 question per platform function, the mean of satisfied users per function was calculated. These user groups also provided positive evaluations for the ease of use (caregivers: 82%, 18.75/23; professionals: 97%, 5.82/6) and their satisfaction with the platform (caregivers: 79%, 18.08/23; professionals: 73%, 4.36/6). Ratings from PwD were lower than the other groups for usefulness (57%, 13/23), ease of use (41%, 9.4/23), and overall satisfaction (47%, 11/23) with the platform (P<.05). Qualitative comments related to both improvements for functionality and the platform interface. Conclusions: Although caregivers and professionals were overall satisfied with the platform, further adaptations were recommended by PwD. This reiterates the importance of the involvement of end users in the development of Web-based interventions. Recommendations from users in this paper apply for the interface and functionality of a wider range of Web-based support interventions. %M 30684403 %R 10.2196/formative.9083 %U http://formative.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/formative.9083 %U http://www.ncbi.nlm.nih.gov/pubmed/30684403 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 1 %P e10 %T Development of eHOME, a Mobile Instrument for Reporting, Monitoring, and Consulting Drug-Related Problems in Home Care: Human-Centered Design Study %A Dijkstra,Nienke Elske %A Sino,Carolina Geertruida Maria %A Heerdink,Eibert Rob %A Schuurmans,Marieke Joanna %+ Research Group Care for the Chronically Ill, University of Applied Sciences Utrecht, Heidelberglaan 7, Utrecht, 3584CS, Netherlands, 31 641620681, nienke.dijkstra@hu.nl %K primary care %K home care %K eHealth %K mHealth %D 2018 %7 07.03.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Home care patients often use many medications and are prone to drug-related problems (DRPs). For the management of problems related to drug use, home care could add to the multidisciplinary expertise of general practitioners (GPs) and pharmacists. The home care observation of medication-related problems by home care employees (HOME)-instrument is paper-based and assists home care workers in reporting potential DRPs. To facilitate the multiprofessional consultation, a digital report of DRPs from the HOME-instrument and digital monitoring and consulting of DRPs between home care and general practices and pharmacies is desired. Objective: The objective of this study was to develop an electronic HOME system (eHOME), a mobile version of the HOME-instrument that includes a monitoring and a consulting system for primary care. Methods: The development phase of the Medical Research Council (MRC) framework was followed in which an iterative human-centered design (HCD) approach was applied. The approach involved a Delphi round for the context of use and user requirements analysis of the digital HOME-instrument and the monitoring and consulting system followed by 2 series of pilots for testing the usability and redesign. Results: By using an iterative design approach and by involving home care workers, GPs, and pharmacists throughout the process as informants, design partners, and testers, important aspects that were crucial for system realization and user acceptance were revealed. Through the report webpage interface, which includes the adjusted content of the HOME-instrument and added home care practice–based problems, home care workers can digitally report observed DRPs. Furthermore, it was found that the monitoring and consulting webpage interfaces enable digital consultation between home care and general practices and pharmacies. The webpages were considered convenient, clear, easy, and usable. Conclusions: By employing an HCD approach, the eHOME-instrument was found to be an easy-to-use system. The systematic approach promises a valuable contribution for the future development of digital mobile systems of paper-based tools. %M 29514771 %R 10.2196/humanfactors.8319 %U http://humanfactors.jmir.org/2018/1/e10/ %U https://doi.org/10.2196/humanfactors.8319 %U http://www.ncbi.nlm.nih.gov/pubmed/29514771 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 5 %N 1 %P e17 %T Supporting Our Valued Adolescents (SOVA), a Social Media Website for Adolescents with Depression and/or Anxiety: Technological Feasibility, Usability, and Acceptability Study %A Radovic,Ana %A Gmelin,Theresa %A Hua,Jing %A Long,Cassandra %A Stein,Bradley D %A Miller,Elizabeth %+ Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, 3420 Fifth Avenue, Pittsburgh, PA, 15213, United States, 1 412 692 7227, ana.radovic@chp.edu %K adolescent %K adolescent health services %K technology %K depression %K anxiety %D 2018 %7 26.02.2018 %9 Original Paper %J JMIR Ment Health %G English %X Background: Supporting Our Valued Adolescents (SOVA), a social media website for adolescents, was designed to increase mental health literacy and address negative health beliefs toward depression and/or anxiety diagnosis and treatment. This stakeholder-informed site underwent iterative user testing to evolve into its current version with daily blog posts, round-the-clock site moderation, and Web-based peer interaction to create an online support community. Objective: The aim of this study was to evaluate the technological feasibility (at least 100 users on the site, logging in 12 to 18 times in the first 6 weeks) and acceptability of the SOVA site determined by the System Usability Scale (SUS). Methods: Adolescents and young adults (aged 14-26 years) with a self-reported history of depressive and/or anxiety symptoms were recruited to access the research website (sova.pitt.edu). Participants were screened out if they reported active suicidality or a prior suicide attempt. Baseline survey measures included demographics, symptomatology using the Patient Health Questionnaire-9 modified for adolescents (PHQ-9A) and Screen for Child Anxiety Related Disorders (SCARED-C), and mental health treatment history. The 6-week follow-up measures taken in addition to the symptomatology, included feasibility (total number of log-ins), usability, and acceptability of SOVA using SUS. Results: Most of the 96 participants identified as female (75% [72/96]) and white (67% [64/96]). Most participants (73% [70/96]) reported having taken prior professional psychological help. The average PHQ-9A score was 11.8 (SD 5.5), and for SCARED-C, 85% (80/94) of the participants reported a score consistent with being susceptible to a diagnosed anxiety disorder. There were 46% (41/90) of eligible users who ever logged in. Out of the total users who ever logged in, the mean of total log-ins over the entire study was 4.1 (SD 6.9). Median number of users rated the user-friendliness of the site as “good.” The average SUS score was 71.2% (SD 18.7), or a “C-grade,” which correlated to an acceptable range. The participants reported to have liked the “easy-to-understand format” and “positive, helpful atmosphere,” but they also reported a desire for greater social interaction. Iterative recruitment resulted in incremental improvements to the site. Conclusions: The SOVA site met feasibility goals of recruiting almost 100 users and establishing acceptable usability. Subsequent interventions are planned to increase site engagement and to evaluate efficacy in increasing uptake of primary care–recommended depression and/or anxiety treatment. %M 29483067 %R 10.2196/mental.9441 %U http://mental.jmir.org/2018/1/e17/ %U https://doi.org/10.2196/mental.9441 %U http://www.ncbi.nlm.nih.gov/pubmed/29483067 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 4 %N 1 %P e2 %T Web-Based Communication Strategies Designed to Improve Intention to Minimize Risk for Colorectal Cancer: Randomized Controlled Trial %A Wilson,Carlene %A Flight,Ingrid %A Zajac,Ian T %A Turnbull,Deborah %A Young,Graeme P %A Olver,Ian %+ Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Sturt Road, Bedford Park, SA, 5042, Australia, 61 3 9496 9967, carlene.wilson@flinders.edu.au %K internet %K randomized controlled trial %K information seeking behavior %K consumer health information %K health communication %D 2018 %7 12.02.2018 %9 Original Paper %J JMIR Cancer %G English %X Background: People seek information on the Web for managing their colorectal cancer (CRC) risk but retrieve much personally irrelevant material. Targeting information pertinent to this cohort via a frequently asked question (FAQ) format could improve outcomes. Objective: We identified and prioritized colorectal cancer information for men and women aged 35 to 74 years (study 1) and built a website containing FAQs ordered by age and gender. In study 2, we conducted a randomized controlled trial (RCT) to test whether targeted FAQs were more influential on intention to act on CRC risk than the same information accessed via a generic topic list. Secondary analyses compared preference for information delivery, usability, relevance, and likelihood of recommendation of FAQ and LIST websites. Methods: Study 1 determined the colorectal cancer information needs of Australians (N=600) by sex and age group (35-49, 50-59, 60-74) through a Web-based survey. Free-text responses were categorized as FAQs: the top 5 issues within each of the 6 cohorts were identified. Study 2 (N=240) compared the impact of presentation as targeted FAQ links to information with links presented as a generic list (LIST) and a CONTROL (no information) condition. We also tested preference for presentation of access to information as FAQ or LIST by adding a CHOICE condition (a self-selected choice of FAQs or a list of information topics). Results: Study 1 showed considerable consistency in information priorities among all 6 cohorts with 2 main concerns: treatment of CRC and risk factors. Some differences included a focus on general risk factors, excluding diet and lifestyle, in the younger cohort, and on the existence of a test for CRC in the older cohorts. Study 2 demonstrated that, although respondents preferred information access ordered by FAQs over a list, presentation in this format had limited impact on readiness to act on colorectal cancer risk compared with the list or a no-information control (P=.06). Both FAQ and LIST were evaluated as equally usable. Those aged 35 to 49 years rated the information less relevant to them and others in their age group, and information ordered by FAQs was rated, across all age groups and both sexes, as less relevant to people outside the age group targeted within the FAQs. Conclusions: FAQs are preferred over a list as a strategy for presenting access to information about CRC. They may improve intention to act on risk, although further research is required. Future research should aim to identify better the characteristics of information content and presentation that optimize perceived relevance and fully engage the target audience. Trial Registration: Australian New Zealand Clinical Trials Registry: ACTRN12618000137291; https://www.anzctr.org. au/Trial/Registration/TrialReview.aspx?id=374129 (Archived by WebCite at http://www.webcitation.org/6x2Mr6rPC) %M 29434013 %R 10.2196/cancer.8250 %U http://cancer.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/cancer.8250 %U http://www.ncbi.nlm.nih.gov/pubmed/29434013 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 5 %N 1 %P e2 %T The Perceived Ease of Use and Usefulness of Loop: Evaluation and Content Analysis of a Web-Based Clinical Collaboration System %A Kurahashi,Allison M %A Stinson,Jennifer N %A van Wyk,Margaret %A Luca,Stephanie %A Jamieson,Trevor %A Weinstein,Peter %A Cafazzo,Joseph A %A Lokuge,Bhadra %A Cohen,Eyal %A Rapoport,Adam %A Husain,Amna %+ The Temmy Latner Centre for Palliative Care, Sinai Health System, 60 Murray Street, 4th Floor, Box 13, Toronto, ON, M5T 3L9, Canada, 1 416 586 4800 ext 7886, amna.husain@sinaihealthsystem.ca %K patient-centered care %K patient participation %K chronic disease %K communication %K internet communication tools %K usability testing %K interdisciplinary communication %K health communication %K continuity of patient care %K patient care team %K inventions %D 2018 %7 09.01.2018 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Patients with complex health care needs require the expertise of many health care providers. Communication, collaboration, and patient-centered care positively impact care quality and patient outcomes. Few technologies exist that facilitate collaboration between providers across settings of care and also engage the patient. We developed a Web-based clinical collaboration system, Loop, to address this gap. The likelihood of a technological system’s uptake is associated with its perceived ease of use and perceived usefulness. We engaged stakeholders in the conceptualization and development of Loop in an effort to maximize its intuitiveness and utility. Objective: This study aimed to report end users’ perceptions about the ease of use and usefulness of Loop captured during usability tests of Loop. Methods: Participants represented three user types (patients, caregivers, and health care providers) recruited from three populations (adults with cancer, adolescents and young adults with cancer, and children with medical complexity). We conducted usability testing over three iterative cycles of testing and development in both laboratory-based and off-site environments. We performed a content analysis of usability testing transcripts to summarize and describe participant perceptions about the ease of use and usefulness of Loop. Results: Participants enjoyed testing Loop and were able to use the core functions—composing, posting, and reading messages—with little difficulty. They had difficulty interpreting certain visual cues and design elements or the purpose of some features. This difficulty negatively impacted perceived ease of use but was primarily limited to auxiliary features. Participants predicted that Loop could improve the efficiency and effectiveness of communication between care team members; however, this perceived usefulness could be compromised by disruptions to personal workflow such as additional time or task requirements. Conclusions: Loop was perceived to have value as a collaboration system; however, usability testing findings indicate that some design and functional elements need to be addressed to improve ease of use. Additionally, participant concerns highlight the need to consider how a system can be implemented so as to minimize impact on workflow and optimize usefulness. %M 29317386 %R 10.2196/humanfactors.7882 %U http://humanfactors.jmir.org/2018/1/e2/ %U https://doi.org/10.2196/humanfactors.7882 %U http://www.ncbi.nlm.nih.gov/pubmed/29317386 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 4 %P e32 %T Deciding How to Stay Independent at Home in Later Years: Development and Acceptability Testing of an Informative Web-Based Module %A Garvelink,Mirjam Marjolein %A Jones,C Allyson %A Archambault,Patrick M %A Roy,Noémie %A Blair,Louisa %A Légaré,France %+ Centre de recherche sur les soins et les services de première ligne de l'Université Laval, Centre intégré universitaire de santé et services sociaux de la Capitale-Nationale, Pavillon Landry-Poulin, Bureau A-4574 Entrée A. 1-2, 2525 Chemin de la Canardière, Québec City, QC, G1J 0A4, Canada, 1 418 663 5919, france.legare@fmed.ulaval.ca %K decision making %K shared %K housing for the elderly %K decision support techniques %K instruction films and videos %D 2017 %7 14.12.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Seniors with loss of autonomy may face decisions about whether they should stay at home or move elsewhere. Most seniors would prefer to stay home and be independent for as long as possible, but most are unaware of options that would make this possible. Objective: The study aimed to develop and test the acceptability of an interactive website for seniors, their caregivers, and health professionals with short interlinked videos presenting information about options for staying independent at home. Methods: The approach for design and data collection varied, involving a multipronged, user-centered design of the development process, qualitative interviews, and end-user feedback to determine content (ie, needs assessment) in phase I; module development (in English and French) in phase II; and survey to test usability and acceptability with end users in phase III. Phase I participants were a convenience sample of end users, that is, seniors, caregivers, and professionals with expertise in modifiable factors (eg, day centers, home redesign, equipment, community activities, and finances), enabling seniors to stay independent at home for longer in Quebec and Alberta, Canada. Phase II participants were bilingual actors; phase III participants included phase I participants and new participants recruited through snowballing. Qualitative interviews were thematically analyzed in phase II to determine relevant topics for the video-scripts, which were user-checked by interview participants. In phase III, the results of a usability questionnaire were analyzed using descriptive statistics. Results: In phase I, interviews with 29 stakeholders, including 4 seniors, 3 caregivers, and 22 professionals, showed a need for a one-stop information resource about options for staying independent at home. They raised issues relating to 6 categories: cognitive autonomy, psychological or mental well-being, functional autonomy, social autonomy, financial autonomy, and people involved. A script was developed and evaluated by participants. In phase II, after 4 days in a studio with 15 bilingual actors, 30 videos were made of various experts (eg, family doctor, home care nurse, and social worker) presenting options and guidance for the decision-making process. These were integrated into an interactive website, which included a comments tool for visitors to add information. In phase III (n=21), 8 seniors (7 women, mean age 75 years), 7 caregivers, and 6 professionals evaluated the acceptability of the module and suggested improvements. Clarity of the videos scored 3.6 out of 4, length was considered right by 17 (separate videos) and 13 participants (all videos together), and 18 participants considered the module acceptable. They suggested that information should be tailored more, and that seniors may need someone to help navigate it. Conclusions: Our interactive website with interlinked videos presenting information about options for staying independent at home was deemed acceptable and potentially helpful by a diverse group of stakeholders. %M 29242178 %R 10.2196/humanfactors.8387 %U http://humanfactors.jmir.org/2017/4/e32/ %U https://doi.org/10.2196/humanfactors.8387 %U http://www.ncbi.nlm.nih.gov/pubmed/29242178 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e411 %T A Web-Based Training Resource for Therapists to Deliver an Evidence-Based Exercise Program for Rheumatoid Arthritis of the Hand (iSARAH): Design, Development, and Usability Testing %A Srikesavan,Cynthia Swarnalatha %A Williamson,Esther %A Eldridge,Lucy %A Heine,Peter %A Adams,Jo %A Cranston,Tim %A Lamb,Sarah E %+ Centre for Rehabilitation Research in Oxford, Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, United Kingdom, 44 01865 737907, cynthia.srikesavan@ndorms.ox.ac.uk %K hand function %K hand exercises %K rheumatoid arthritis %K online training %K implementation %D 2017 %7 13.12.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The Strengthening and Stretching for Rheumatoid Arthritis of the Hand (SARAH) is a tailored, progressive exercise program for people having difficulties with wrist and hand function due to rheumatoid arthritis (RA). The program was evaluated in a large-scale clinical trial and was found to improve hand function, was safe to deliver, and was cost-effective. These findings led to the SARAH program being recommended in the UK National Institute for Health and Care Excellence guidelines for the management of adults with RA. To facilitate the uptake of this evidence-based program by clinicians, we proposed a Web-based training program for SARAH (iSARAH) to educate and train physiotherapists and occupational therapists on delivering the SARAH program in their practice. The overall iSARAH implementation project was guided by the 5 phases of the analysis, design, development, implementation, and evaluation (ADDIE) system design model. Objective: The objective of our study was to conduct the first 3 phases of the model in the development of the iSARAH project. Methods: Following publication of the trial, the SARAH program materials were made available to therapists to download from the trial website for use in clinical practice. A total of 35 therapists who downloaded these materials completed an online survey to provide feedback on practice trends in prescribing hand exercises for people with RA, perceived barriers and facilitators to using the SARAH program in clinical practice, and their preferences for the content and Web features of iSARAH. The development and design of iSARAH were further guided by a team of multidisciplinary health professionals (n=17) who took part in a half-day development meeting. We developed the preliminary version of iSARAH and tested it among therapists (n=10) to identify and rectify usability issues and to produce the final version. Results: The major recommendations made by therapists and the multidisciplinary team were having a simple Web design and layout, clear exercise pictures and videos, and compatibility of iSARAH on various browsers and devices. We rectified all usability issues in the preliminary version to develop the final version of iSARAH, which included 4 short modules and additional sections on self-assessment, frequently asked questions, and a resource library. Conclusions: The use of the ADDIE design model and engagement of end users in the development and evaluation phases have rendered iSARAH a convenient, easy-to-use, and effective Web-based learning resource for therapists on how to deliver the SARAH program. There is also huge potential for adapting iSARAH across different cultures and languages, thus opening more opportunities for wider uptake and application of the SARAH program into practice. %M 29237581 %R 10.2196/jmir.8424 %U http://www.jmir.org/2017/12/e411/ %U https://doi.org/10.2196/jmir.8424 %U http://www.ncbi.nlm.nih.gov/pubmed/29237581 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 4 %P e30 %T An eHealth Application of Self-Reported Sports-Related Injuries and Illnesses in Paralympic Sport: Pilot Feasibility and Usability Study %A Fagher,Kristina %A Jacobsson,Jenny %A Dahlström,Örjan %A Timpka,Toomas %A Lexell,Jan %+ Rehabilitation Medicine Research Group, Department of Health Sciences, Lund University, PO Box 157, Lund,, Sweden, 46 46 222 1991, kristina.fagher@med.lu.se %K epidemiology %K feasibility studies %K sports medicine %K sports for persons with disabilities %K telemedicine %D 2017 %7 29.11.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Sport participation is associated with a risk of sports-related injuries and illnesses, and Paralympic athletes’ additional medical issues can be a challenge to health care providers and medical staff. However, few prospective studies have assessed sports-related injuries and illnesses in Paralympic sport (SRIIPS) over time. Advances in mobile phone technology and networking systems offer novel opportunities to develop innovative eHealth applications for collection of athletes’ self-reports. Using eHealth applications for collection of self-reported SRIIPS is an unexplored area, and before initiation of full-scale research of SRIIPS, the feasibility and usability of such an approach needs to be ascertained. Objective: The aim of this study was to perform a 4-week pilot study and (1) evaluate the monitoring feasibility and system usability of a novel eHealth application for self-reported SRIIPS and (2) report preliminary data on SRIIPS. Methods: An eHealth application for routine collection of data from athletes was developed and adapted to Paralympic athletes. A 4-week pilot study was performed where Paralympic athletes (n=28) were asked to weekly self-report sport exposure, training load, general well-being, pain, sleep, anxiety, and possible SRIIPS. The data collection was followed by a poststudy use assessment survey. Quantitative data related to the system use (eg, completed self-reports, missing responses, and errors) were analyzed using descriptive statistics. The qualitative feasibility and usability data provided by the athletes were condensed and categorized using thematic analysis methods. Results: The weekly response rate was 95%. The athletes were of the opinion that the eHealth application was usable and feasible but stated that it was not fully adapted to Paralympic athletes and their impairments. For example, it was difficult to understand how a new injury or illness should be identified when the impairment was involved. More survey items related to the impairments were requested, as the athletes perceived that injuries and illnesses often occurred because of the impairment. Options for description of multifactorial incidents including an injury, an illness, and the impairment were also insufficient. Few technical issues were encountered, but athletes with visual impairment reported usability difficulties with the speech synthesizer. An incidence rate of 1.8 injuries and 1.7 illnesses per 100 hours of athlete exposure were recorded. The weekly pain prevalence was 56% and the impairment contributed to 20% of the reported incidents. Conclusions: The novel eHealth-based application for self-reported SRIIPS developed and tested in this pilot study was generally feasible and usable. With some adaptation to accommodate Paralympic athletes’ prerequisites and improved technical support for athletes with visual impairment, this application can be recommended for use in prospective studies of SRIIPS. Trial Registration: ClinicalTrials.gov NCT02788500; https://clinicaltrials.gov/ct2/show/NCT02788500 (Archived by WebCite at http://www.webcitation.org/6v56OqTeP) %M 29187343 %R 10.2196/humanfactors.8117 %U http://humanfactors.jmir.org/2017/4/e30/ %U https://doi.org/10.2196/humanfactors.8117 %U http://www.ncbi.nlm.nih.gov/pubmed/29187343 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 4 %P e26 %T Healthy Beyond Pregnancy, a Web-Based Intervention to Improve Adherence to Postpartum Care: Randomized Controlled Feasibility Trial %A Himes,Katherine Park %A Donovan,Heidi %A Wang,Stephanie %A Weaver,Carrie %A Grove,Jillian Rae %A Facco,Francesca Lucia %+ Magee-Womens Research Institute, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15228, United States, 1 4126411805, himekp@upmc.edu %K postpartum visit %K behavioral economics %K Medicaid %K intervention %K usability %D 2017 %7 10.10.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: During the postpartum visit, health care providers address issues with short- and long-term implications for maternal and child health. Women with Medicaid insurance are less likely to return for a postpartum visit compared with women with private insurance. Behavioral economics acknowledges that people do not make exclusively rational choices, rather immediate gratification, cognitive and psychological biases, and social norms influence decision making. Drawing on insights from decision science, behavioral economists have examined how these biases can be modulated through carefully designed interventions. We have developed a Web-based tool, Healthy Beyond Pregnancy, that incorporates empirically derived concepts of behavioral economics to improve adherence rates to the postpartum visit. Objectives: The primary objectives of this pilot study were to (1) refine and assess the usability of Healthy Beyond Pregnancy and (2) assess the feasibility of a randomized controlled trial (RCT) of the intervention. Methods: We used a multistep process and multidisciplinary team of maternal-fetal medicine physicians, a behavioral economist, and researchers with expertise in behavioral interventions to design Healthy Beyond Pregnancy. We assessed the usability of the program with the Post-Study System Usability Questionnaire (PSSUQ), a validated 7-point scale, and semistructured interviews with postpartum women. We then conducted a feasibility trial to determine the proportion of eligible women who were willing to participate in an RCT of Healthy Beyond Pregnancy and the proportion of women willing to complete the Web-based program. Exploratory outcomes of the pilot trial included attendance at the postpartum visit, uptake of long-acting reversible contraception, and uptake of any contraception. Results: The median PSSUQ score for Healthy Beyond Pregnancy was 6.5 (interquartile range: 6.1-7) demonstrating high usability. Semistructured interviews (n=10) provided in-depth comments about users’ experience and further improved the program. A total of 34 postpartum women with Medicaid insurance were approached for the pilot trial, and 30 (88%) were consented and randomized. All women randomized to Healthy Beyond Pregnancy completed the Web-based program, had text-enabled cell phones, and were willing to receive text messages from the study team. Women in the Healthy Beyond Pregnancy arm were more likely to return for a postpartum visit compared with women in the control arm with 85% of women in Healthy Beyond Pregnancy returning versus 53% in the control arm (odds ratio in the Healthy Beyond Pregnancy group: 5.3; 95% CI 0.9-32.0; P=.06). Conclusions: We have developed a highly usable and acceptable Web-based program designed to increase attendance at the postpartum visit. Our pilot trial demonstrates that women are willing and able to participate in a randomized trial of a Web-based program and text messaging system. Trial Registration: Clinicaltrials.gov NCT03296774; https://clinicaltrials.gov/ct2/show/NCT03296774 (Archived by WebCite at http://www.webcitation.org/6tpgXFzyk) %M 29017990 %R 10.2196/humanfactors.7964 %U http://humanfactors.jmir.org/2017/4/e26/ %U https://doi.org/10.2196/humanfactors.7964 %U http://www.ncbi.nlm.nih.gov/pubmed/29017990 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 4 %P e123 %T Usability, Acceptability, and Adherence to an Electronic Self-Monitoring System in Patients With Major Depression Discharged From Inpatient Wards %A Lauritsen,Lise %A Andersen,Louise %A Olsson,Emilia %A Søndergaard,Stine Rauff %A Nørregaard,Lasse Benn %A Løventoft,Philip Kaare %A Svendsen,Signe Dunker %A Frøkjær,Erik %A Jensen,Hans Mørch %A Hageman,Ida %A Kessing,Lars Vedel %A Martiny,Klaus %+ Psychiatric Center Copenhagen, Rigshospitalet, University of Copenhagen, Edel Sauntes Alle 10, Copenhagen, 2100 Ø, Denmark, 45 38647100, klaus.martiny@regionh.dk %K depressive disorder, major %K electronic monitoring %K graph drawing %K sleep %K self-assessment %K observational study %K inpatients %K patient participation %K chronotherapeutics %D 2017 %7 21.04.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients suffering from depression have a high risk of relapse and readmission in the weeks following discharge from inpatient wards. Electronic self-monitoring systems that offer patient-communication features are now available to offer daily support to patients, but the usability, acceptability, and adherence to these systems has only been sparsely investigated. Objective: We aim to test the usability, acceptability, adherence, and clinical outcome of a newly developed computer-based electronic self-assessment system (the Daybuilder system) in patients suffering from depression, in the period from discharge until commencing outpatient treatment in the Intensive Outpatient Unit for Affective Disorders. Methods: Patients suffering from unipolar major depression that were referred from inpatient wards to an intensive outpatient unit were included in this study before their discharge, and were followed for four weeks. User satisfaction was assessed using semiqualitative questionnaires and the System Usability Scale (SUS). Patients were interviewed at baseline and at endpoint with the Hamilton depression rating scale (HAM-D17), the Major Depression Inventory (MDI), and the 5-item World Health Organization Well-Being Index (WHO-5). In this four-week period patients used the Daybuilder system to self-monitor mood, sleep, activity, and medication adherence on a daily basis. The system displayed a graphical representation of the data that was simultaneously displayed to patients and clinicians. Patients were phoned weekly to discuss their data entries. The primary outcomes were usability, acceptability, and adherence to the system. The secondary outcomes were changes in: the electronically self-assessed mood, sleep, and activity scores; and scores from the HAM-D17, MDI, and WHO-5 scales. Results: In total, 76% of enrolled patients (34/45) completed the four-week study. Five patients were readmitted due to relapse. The 34 patients that completed the study entered data for mood on 93.8% of the days (872/930), sleep on 89.8% of the days (835/930), activity on 85.6% of the days (796/930), and medication on 88.0 % of the days (818/930). SUS scores were 86.2 (standard deviation [SD] 9.7) and 79% of the patients (27/34) found that the system lived up to their expectations. A significant improvement in depression severity was found on the HAM-D17 from 18.0 (SD 6.5) to 13.3 (SD 7.3; P<.01), on the MDI from 27.1 (SD 13.1) to 22.1 (SD 12.7; P=.006), and in quality of life on the WHO-5 from 31.3 (SD 22.9) to 43.4 (SD 22.1; P<.001) scales, but not on self-assessed mood (P=.08). Mood and sleep parameters were highly variable from day-to-day. Sleep-offset was significantly delayed from baseline, averaging 48 minutes (standard error 12 minutes; P<.001). Furthermore, when estimating delay of sleep-onset (with sleep quality included in the model) during the study period, this showed a significant negative effect on mood (P=.03) Conclusions: The Daybuilder systems performed well technically, and patients were satisfied with the system and had high adherence to self-assessments. The dropout rate and the gradual delay in sleep emphasize the need for continued clinical support for these patients, especially when considering sleep guidance. %M 28432040 %R 10.2196/jmir.6673 %U http://www.jmir.org/2017/4/e123/ %U https://doi.org/10.2196/jmir.6673 %U http://www.ncbi.nlm.nih.gov/pubmed/28432040 %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 %@ 1438-8871 %I JMIR Publications %V 19 %N 1 %P e26 %T Toward Patient-Centered Telerehabilitation Design: Understanding Chronic Pain Patients’ Preferences for Web-Based Exercise Telerehabilitation Using a Discrete Choice Experiment %A Cranen,Karlijn %A Groothuis-Oudshoorn,Catharina GM %A Vollenbroek-Hutten,Miriam MR %A IJzerman,Maarten J %+ Roessingh Research and Development, Telemedicine group, PO Box 310, Enschede, 7500 AH, Netherlands, 31 0 53 4875777, k.cranen@rrd.nl %K patient preference %K patient acceptance of health care %K telerehabilitation %K choice behavior %K decision making %K decision support techniques %K patient compliance %K chronic disease %K exercise therapy %K chronic pain %D 2017 %7 20.01.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Patient-centered design that addresses patients’ preferences and needs is considered an important aim for improving health care systems. At present, within the field of pain rehabilitation, patients’ preferences regarding telerehabilitation remain scarcely explored and little is known about the optimal combination between human and electronic contact from the patients’ perspective. In addition, limited evidence is available about the best way to explore patients’ preferences. Therefore, the assessment of patients’ preferences regarding telemedicine is an important step toward the design of effective patient-centered care. Objective: To identify which telerehabilitation treatment options patients with chronic pain are most likely to accept as alternatives to conventional rehabilitation and assess which treatment attributes are most important to them. Methods: A discrete choice experiment with 15 choice tasks, combining 6 telerehabilitation treatment characteristics, was designed. Each choice task consisted of 2 hypothetical treatment scenarios and 1 opt-out scenario. Relative attribute importance was estimated using a bivariate probit regression analysis. One hundred and thirty surveys were received, of which 104 were usable questionnaires; thus, resulting in a total of 1547 observations. Results: Physician communication mode, the use of feedback and monitoring technology (FMT), and exercise location were key drivers of patients’ treatment preferences (P<.001). Patients were willing to accept less frequent physician consultation offered mainly through video communication, provided that they were offered FMT and some face-to-face consultation and could exercise outside their home environment at flexible exercise hours. Home-based telerehabilitation scenarios with minimal physician supervision were the least preferred. A reduction in health care premiums would make these telerehabilitation scenarios as attractive as conventional clinic-based rehabilitation. Conclusions: “Intermediate” telerehabilitation treatments offering FMT, some face-to-face consulting, and a gym-based exercise location should be pursued as promising alternatives to conventional chronic pain rehabilitation. Further research is necessary to explore whether strategies other than health care premium reductions could also increase the value of home telerehabilitation treatment. %M 28108429 %R 10.2196/jmir.5951 %U http://www.jmir.org/2017/1/e26/ %U https://doi.org/10.2196/jmir.5951 %U http://www.ncbi.nlm.nih.gov/pubmed/28108429 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 4 %N 1 %P e1 %T Designing eHealth Applications to Reduce Cognitive Effort for Persons With Severe Mental Illness: Page Complexity, Navigation Simplicity, and Comprehensibility %A Rotondi,Armando J %A Spring,Michael R %A Hanusa,Barbara H %A Eack,Shaun M %A Haas,Gretchen L %+ Mental Illness Research, Education and Clinical Center (MIRECC), VA Pittsburgh Health Care System, Department of Veterans Affairs, Research Office Bld. (151R), University Drive C, Pittsburgh, PA, 15240, United States, 1 412 360 2494, rotondi@pitt.edu %K Internet technology %K mobile application %K cognitive impairment %K eHealth %K eHealth design %K e-mental health %K schizophrenia %K severe mental illness %K usability %K website design %D 2017 %7 05.01.2017 %9 Original Paper %J JMIR Hum Factors %G English %X Background: eHealth technologies offer great potential for improving the use and effectiveness of treatments for those with severe mental illness (SMI), including schizophrenia and schizoaffective disorder. This potential can be muted by poor design. There is limited research on designing eHealth technologies for those with SMI, others with cognitive impairments, and those who are not technology savvy. We previously tested a design model, the Flat Explicit Design Model (FEDM), to create eHealth interventions for individuals with SMI. Subsequently, we developed the design concept page complexity, defined via the design variables we created of distinct topic areas, distinct navigation areas, and number of columns used to organize contents and the variables of text reading level, text reading ease (a newly added variable to the FEDM), and the number of hyperlinks and number of words on a page. Objective: The objective of our study was to report the influence that the 19 variables of the FEDM have on the ability of individuals with SMI to use a website, ratings of a website’s ease of use, and performance on a novel usability task we created termed as content disclosure (a measure of the influence of a homepage’s design on the understanding user’s gain of a website). Finally, we assessed the performance of 3 groups or dimensions we developed that organize the 19 variables of the FEDM, termed as page complexity, navigational simplicity, and comprehensibility. Methods: We measured 4 website usability outcomes: ability to find information, time to find information, ease of use, and a user’s ability to accurately judge a website’s contents. A total of 38 persons with SMI (chart diagnosis of schizophrenia or schizoaffective disorder) and 5 mental health websites were used to evaluate the importance of the new design concepts, as well as the other variables in the FEDM. Results: We found that 11 of the FEDM’s 19 variables were significantly associated with all 4 usability outcomes. Most other variables were significantly related to 2 or 3 of these usability outcomes. With the 5 tested websites, 7 of the 19 variables of the FEDM overlapped with other variables, resulting in 12 distinct variable groups. The 3 design dimensions had acceptable coefficient alphas. Both navigational simplicity and comprehensibility were significantly related to correctly identifying whether information was available on a website. Page complexity and navigational simplicity were significantly associated with the ability and time to find information and ease-of-use ratings. Conclusions: The 19 variables and 3 dimensions (page complexity, navigational simplicity, and comprehensibility) of the FEDM offer evidence-based design guidance intended to reduce the cognitive effort required to effectively use eHealth applications, particularly for persons with SMI, and potentially others, including those with cognitive impairments and limited skills or experience with technology. The new variables we examined (topic areas, navigational areas, columns) offer additional and very simple ways to improve simplicity. %M 28057610 %R 10.2196/humanfactors.6221 %U http://humanfactors.jmir.org/2017/1/e1/ %U https://doi.org/10.2196/humanfactors.6221 %U http://www.ncbi.nlm.nih.gov/pubmed/28057610