TY - JOUR AU - ?uto Pavi?i?, Jelena AU - Maru?i?, Ana AU - Buljan, Ivan PY - 2025/3/19 TI - Using ChatGPT to Improve the Presentation of Plain Language Summaries of Cochrane Systematic Reviews About Oncology Interventions: Cross-Sectional Study JO - JMIR Cancer SP - e63347 VL - 11 KW - health literacy KW - patient education KW - health communication KW - ChatGPT KW - neoplasms KW - Cochrane KW - oncology KW - plain language KW - medical information KW - decision-making KW - large language model KW - artificial intelligence KW - AI N2 - Background: Plain language summaries (PLSs) of Cochrane systematic reviews are a simple format for presenting medical information to the lay public. This is particularly important in oncology, where patients have a more active role in decision-making. However, current PLS formats often exceed the readability requirements for the general population. There is still a lack of cost-effective and more automated solutions to this problem. Objective: This study assessed whether a large language model (eg, ChatGPT) can improve the readability and linguistic characteristics of Cochrane PLSs about oncology interventions, without changing evidence synthesis conclusions. Methods: The dataset included 275 scientific abstracts and corresponding PLSs of Cochrane systematic reviews about oncology interventions. ChatGPT-4 was tasked to make each scientific abstract into a PLS using 3 prompts as follows: (1) rewrite this scientific abstract into a PLS to achieve a Simple Measure of Gobbledygook (SMOG) index of 6, (2) rewrite the PLS from prompt 1 so it is more emotional, and (3) rewrite this scientific abstract so it is easier to read and more appropriate for the lay audience. ChatGPT-generated PLSs were analyzed for word count, level of readability (SMOG index), and linguistic characteristics using Linguistic Inquiry and Word Count (LIWC) software and compared with the original PLSs. Two independent assessors reviewed the conclusiveness categories of ChatGPT-generated PLSs and compared them with original abstracts to evaluate consistency. The conclusion of each abstract about the efficacy and safety of the intervention was categorized as conclusive (positive/negative/equal), inconclusive, or unclear. Group comparisons were conducted using the Friedman nonparametric test. Results: ChatGPT-generated PLSs using the first prompt (SMOG index 6) were the shortest and easiest to read, with a median SMOG score of 8.2 (95% CI 8?8.4), compared with the original PLSs (median SMOG score 13.1, 95% CI 12.9?13.4). These PLSs had a median word count of 240 (95% CI 232?248) compared with the original PLSs? median word count of 364 (95% CI 339?388). The second prompt (emotional tone) generated PLSs with a median SMOG score of 11.4 (95% CI 11.1?12), again lower than the original PLSs. PLSs produced with the third prompt (write simpler and easier) had a median SMOG score of 8.7 (95% CI 8.4?8.8). ChatGPT-generated PLSs across all prompts demonstrated reduced analytical tone and increased authenticity, clout, and emotional tone compared with the original PLSs. Importantly, the conclusiveness categorization of the original abstracts was unchanged in the ChatGPT-generated PLSs. Conclusions: ChatGPT can be a valuable tool in simplifying PLSs as medically related formats for lay audiences. More research is needed, including oversight mechanisms to ensure that the information is accurate, reliable, and culturally relevant for different audiences. UR - https://cancer.jmir.org/2025/1/e63347 UR - http://dx.doi.org/10.2196/63347 ID - info:doi/10.2196/63347 ER - TY - JOUR AU - Haegens, L. Lex AU - Huiskes, B. Victor J. AU - van den Bemt, F. Bart J. AU - Bekker, L. Charlotte PY - 2025/3/13 TI - Factors Influencing the Intentions of Patients With Inflammatory Rheumatic Diseases to Use a Digital Human for Medication Information: Qualitative Study JO - J Med Internet Res SP - e57697 VL - 27 KW - digital human KW - information provision KW - intention to use KW - qualitative study KW - focus groups KW - drug-related problems KW - medication safety KW - safety information KW - information seeking KW - Netherlands KW - Pharmacotherapy KW - medication KW - telehealth KW - communication technologies KW - medication information KW - rheumatic diseases KW - rheumatology N2 - Background: Introduction: Patients with inflammatory rheumatic diseases (IRDs) frequently experience drug-related problems (DRPs). DRPs can have negative health consequences and should be addressed promptly to prevent complications. A digital human, which is an embodied conversational agent, could provide medication-related information in a time- and place-independent manner to support patients in preventing and decreasing DRPs. Objective: This study aims to identify factors that influence the intention of patients with IRDs to use a digital human to retrieve medication-related information. Methods: A qualitative study with 3 in-person focus groups was conducted among adult patients diagnosed with an IRD in the Netherlands. The prototype of a digital human is an innovative tool that provides spoken answers to medication-related questions and provides information linked to the topic, such as (instructional) videos, drug leaflets, and other relevant sources. Before the focus group, participants completed a preparatory exercise at home to become familiar with the digital human. A semistructured interview guide based on the Proctor framework for implementation determinants was used to interview participants about the acceptability, adoption, appropriateness, costs, feasibility, fidelity, penetration, and sustainability of the digital human. Focus groups were recorded, transcribed, and analyzed thematically. Results: The participants included 22 patients, with a median age of 68 (IQR 52-75) years, of whom 64% (n=22) were female. In total, 6 themes describing factors influencing patients? intention to use a digital human were identified: (1) the degree to which individual needs for medication-related information are met; (2) confidence in one?s ability to use the digital human; (3) the degree to which using the digital human resembles interacting with a human; (4) technical functioning of the digital human; (5) privacy and security; and (6) expected benefit of using the digital human. Conclusions: The intention of patients with IRDs to use a novel digital human to retrieve medication-related information was influenced by factors related to each patient?s information needs and confidence in their ability to use the digital human, features of the digital human, and the expected benefits of using the digital human. These identified themes should be considered during the further development of the digital human and during implementation to increase intention to use and future adoption. Thereafter, the effect of applying a digital human as an instrument to improve patients? self-management regarding DRPs could be researched. UR - https://www.jmir.org/2025/1/e57697 UR - http://dx.doi.org/10.2196/57697 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57697 ER - TY - JOUR AU - Varela, Kimahri Luna AU - Horton, Stephanie AU - Abdelmoity, Ahmed AU - Le Pichon, Jean-Baptiste AU - Hoffman, A. Mark PY - 2025/3/13 TI - YouTube User Traffic to Paired Epilepsy Education Videos in English and Spanish: Comparative Study JO - JMIR Form Res SP - e56720 VL - 9 KW - epilepsy KW - patient education KW - informatics KW - social media KW - biomedical research KW - social determinants of health KW - accessibility KW - engagement KW - comparative analysis KW - clinical videos KW - English KW - Spanish KW - neurological disorder KW - YouTube KW - bilingual KW - audience engagement KW - clinical knowledge N2 - Background: Effectively managing epilepsy in children necessitates the active engagement of parents, a factor that is reliant on their understanding of this neurological disorder. Widely available, high-quality, patient-focused, bilingual videos describing topics important for managing epilepsy are limited. YouTube Analytics is a helpful resource for gaining insights into how users of differing backgrounds consume video content. Objective: This study analyzes traffic to paired educational videos of English and Spanish versions of the same content. By examining the use patterns and preferences of individuals seeking information in different languages, we gained valuable insights into how language influences the use of clinical content. Methods: Physician experts created epilepsy management videos for the REACT (Reaching Out for Epilepsy in Adolescents and Children Through Telemedicine) YouTube channel about 17 subjects, with an English and Spanish version of each. The Children?s Mercy Kansas City neurology clinic incorporated these into the department?s educational process. YouTube Analytics enabled analysis of traffic patterns and video characteristics between September 2, 2021, and August 31, 2023. Results: The Spanish group had higher engagement and click-through rates. The English versions of all videos had 141,605 total impressions, while impressions for the Spanish versions totaled 156,027. The Spanish videos had 11,339 total views, while the English videos had 3366. The views per month were higher for the Spanish videos (mean 472, SD 292) compared to the English set (mean 140, SD 91; P<.001). The two groups also differed in search behavior and external traffic sources, with WhatsApp driving more traffic to the Spanish videos than the English versions (94 views compared to 1). The frequency of search terms used varied by language. For example, ?tonic clonic? was the most frequent term (n=372) resulting in views for English videos, while ?tipos de convulsiones? (types of convulsions) was the most common expression (n=798) resulting in views for Spanish videos. We noted increased monthly views for all videos after adding tags on YouTube. Before tagging, the mean number of views per month for the English-language group was 61 (SD 28), which increased to 220 (SD 53) post tagging. A similar trend can be observed in the Spanish-language group as well. Before tagging, the mean number of monthly views was 201 (SD 71), which increased to 743 (SD 144) after tagging. Conclusions: This study showed high traffic for Spanish video content related to epilepsy in a set of paired English/Spanish videos. This highlights the importance of bilingual health content and optimizing video content based on viewer preferences and search behavior. Understanding audience engagement patterns through YouTube Analytics can further enhance the dissemination of clinical video content to users seeking content in their primary language, and tagging videos can have a substantial impact on views. UR - https://formative.jmir.org/2025/1/e56720 UR - http://dx.doi.org/10.2196/56720 ID - info:doi/10.2196/56720 ER - TY - JOUR AU - Shi, Xiaoyu AU - Wang, Yijun AU - Wang, Yuhong AU - Wang, Jun AU - Peng, Chen AU - Cheng, Siyi AU - Song, Lingpeng AU - Li, Rui AU - Guo, Fuding AU - Li, Zeyan AU - Duan, Shoupeng AU - Yang, Xiaomeng AU - Zhou, Liping AU - Jiang, Hong AU - Yu, Lilei PY - 2025/3/11 TI - The Effectiveness of Digital Animation?Based Multistage Education for Patients With Atrial Fibrillation Catheter Ablation: Randomized Clinical Trial JO - J Med Internet Res SP - e65685 VL - 27 KW - animation education KW - digital health care KW - atrial fibrillation KW - catheter ablation KW - video KW - mHealth KW - digital care KW - digital health KW - digital animation KW - randomized clinical trial KW - RCT KW - digital education KW - outpatient KW - AFCA KW - atrial fibrillation catheter ablation KW - therapeutic KW - cardiac arrhythmia KW - Asian KW - animations KW - comics N2 - Background: Digital education for outpatient patients with atrial fibrillation (AF) has gradually increased. However, research on digital education for patients undergoing atrial fibrillation catheter ablation (AFCA) is limited. Objective: This study aimed to develop a novel digital animation-based multistage education system and evaluate its quality-of-life benefits for patients with AFCA. Methods: This randomized controlled clinical trial included 208 patients with AF who underwent catheter ablation in the Department of Cardiology at Renmin Hospital of Wuhan University between January 2022 and August 2023. The patients were randomly assigned to the digital animation intervention (n=104) and standard treatment (n=104) groups. The primary outcome was the difference in the quality of life of patients with atrial fibrillation (AF-QoL-18) scores at 3 months. Secondary outcomes included differences in scores on the 5-item Medication Adherence Report Scale (MARS-5), Self-rating Anxiety Scale (SAS), and Self-Rating Depression Scale (SDS) at 3 months. Results: In the digital animation intervention group, the AF-QoL-18 score increased from 38.02 (SD 6.52) to 47.77 (SD 5.74), the MARS-5 score increased from 17.04 (SD 3.03) to 20.13 (SD 2.12), the SAS score decreased from 52.82 (SD 8.08) to 45.39 (SD 6.13), and the SDS score decreased from 54.12 (SD 6.13) to 45.47 (SD 5.94), 3 months post discharge from the hospital. In the conventional treatment group, the AF-QoL-18 score increased from 36.97 (SD 7.00) to 45.31 (SD 5.71), the MARS-5 score increased from 17.14 (SD 3.01) to 18.47 (SD 2.79), the SAS score decreased from 51.83 (SD 7.74) to 47.31 (SD 5.87), and the SDS score decreased from 52.78 (SD 5.21) to 45.37 (SD 6.18). The mean difference in AF-QoL-18 score change between the 2 groups was 1.41 (95% CI 2.42-0.40, P=.006) at 3 months. The mean difference in MARS-5 score change was 1.76 (95% CI 2.42-1.10, P<.001). The mean difference in SAS score was ?2.91 (95% CI ?3.88 to ?1.95, P<.001). Additionally, the mean difference in SDS score was ?1.23 (95% CI ?0.02 to ?2.44, P=.047). Conclusions: Our study introduces a novel digital animation educational approach that provides multidimensional, easily understandable, and multistage education for patients with AF undergoing catheter ablation. This educational model effectively improves postoperative anxiety, depression, medication adherence, and quality of life in patients at 3 months post discharge. Trial Registration: Chinese Clinical Trial Registry ChiCTR2400081673; https://www.chictr.org.cn/showproj.html?proj=201059 UR - https://www.jmir.org/2025/1/e65685 UR - http://dx.doi.org/10.2196/65685 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65685 ER - TY - JOUR AU - Haughey, Marketa AU - Neyens, M. David AU - Hopkins, S. Casey AU - Gonzaga, Christofer AU - Harman, Melinda PY - 2025/3/6 TI - Identifying Strategies for Home Management of Ostomy Care: Content Analysis of YouTube JO - JMIR Hum Factors SP - e66634 VL - 12 KW - medical device usability KW - digital health KW - online support groups KW - living with chronic medical conditions KW - ostomy self-care KW - YouTube KW - patient education KW - user needs assessment KW - users experience KW - social media KW - ostomates KW - colostomy KW - ileostomy KW - usability KW - usefulness KW - utility KW - wearable device KW - medical device KW - support group KW - socials KW - social network KW - ostomy KW - digital KW - digital technology KW - digital intervention N2 - Background: The social media platform YouTube is a recognized educational resource for health information, but few studies have explored its value for conveying the lived experience of individuals managing chronic health conditions and end users? interactions with medical device technology. Our study explores self-care strategies and end user needs of people living with a stoma because patient education and engagement in ostomy self-care are essential for avoiding ostomy-related complications. Ostomy surgery creates a stoma (an opening) in the abdomen to alter the route of excreta from digestive and urinary organs into a detachable external pouching system. After hospital discharge, people who have undergone ostomies perform critical self-care tasks including frequent ostomy appliance changes and stomal and peristomal skin maintenance. Objective: The purpose of this study was to systematically assess YouTube videos narrated by people who have undergone ostomies about their ostomy self-care in home (nonhospital) settings with a focus on identifying end user needs and different strategies used by people who have undergone ostomies during critical self-care tasks. Methods: Using predefined search terms and clear inclusion and exclusion criteria, we identified YouTube videos depicting narrators who have undergone ostomies and their ostomy self-care in home settings. Using a consensus coding approach among 3 independent reviewers, all videos were analyzed to collect metadata, data of narrators who have undergone ostomies, and specific content data. Results: There were 65 user-generated YouTube videos that met the inclusion and exclusion criteria. These videos were posted by 28 unique content creators representing a broad range of ages who used a variety of supplies. The common challenges discussed were peristomal skin complications, inadequate appliance adhesion and subsequent leakage, and supplies-related challenges. Narrators who have undergone ostomies discussed various expert tricks and tips to successfully combat these challenges. Conclusions: This study used a novel approach to gain insights about end user interactions with medical devices while performing ostomy self-care, which are difficult to gain using traditional behavioral techniques. The analysis revealed that people who have undergone ostomies are willing to share their personal experience with ostomy self-care on the web and that these videos are viewed by the public. User-generated videos demonstrated a variety of supplies used, end user needs, and different strategies for performing ostomy self-care. Future research should examine how these findings connect to YouTube ostomy self-care content generated by health care professionals and organizations and to guidelines for ostomy self-care. UR - https://humanfactors.jmir.org/2025/1/e66634 UR - http://dx.doi.org/10.2196/66634 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053741 ID - info:doi/10.2196/66634 ER - TY - JOUR AU - Choo, Seungheon AU - Yoo, Suyoung AU - Endo, Kumiko AU - Truong, Bao AU - Son, Hi Meong PY - 2025/2/27 TI - Advancing Clinical Chatbot Validation Using AI-Powered Evaluation With a New 3-Bot Evaluation System: Instrument Validation Study JO - JMIR Nursing SP - e63058 VL - 8 KW - artificial intelligence KW - patient education KW - therapy KW - computer-assisted KW - computer KW - understandable KW - accurate KW - understandability KW - automation KW - chatbots KW - bots KW - conversational agents KW - emotions KW - emotional KW - depression KW - depressive KW - anxiety KW - anxious KW - nervous KW - nervousness KW - empathy KW - empathetic KW - communication KW - interactions KW - frustrated KW - frustration KW - relationships N2 - Background: The health care sector faces a projected shortfall of 10 million workers by 2030. Artificial intelligence (AI) automation in areas such as patient education and initial therapy screening presents a strategic response to mitigate this shortage and reallocate medical staff to higher-priority tasks. However, current methods of evaluating early-stage health care AI chatbots are highly limited due to safety concerns and the amount of time and effort that goes into evaluating them. Objective: This study introduces a novel 3-bot method for efficiently testing and validating early-stage AI health care provider chatbots. To extensively test AI provider chatbots without involving real patients or researchers, various AI patient bots and an evaluator bot were developed. Methods: Provider bots interacted with AI patient bots embodying frustrated, anxious, or depressed personas. An evaluator bot reviewed interaction transcripts based on specific criteria. Human experts then reviewed each interaction transcript, and the evaluator bot?s results were compared to human evaluation results to ensure accuracy. Results: The patient-education bot?s evaluations by the AI evaluator and the human evaluator were nearly identical, with minimal variance, limiting the opportunity for further analysis. The screening bot?s evaluations also yielded similar results between the AI evaluator and human evaluator. Statistical analysis confirmed the reliability and accuracy of the AI evaluations. Conclusions: The innovative evaluation method ensures a safe, adaptable, and effective means to test and refine early versions of health care provider chatbots without risking patient safety or investing excessive researcher time and effort. Our patient-education evaluator bots could have benefitted from larger evaluation criteria, as we had extremely similar results from the AI and human evaluators, which could have arisen because of the small number of evaluation criteria. We were limited in the amount of prompting we could input into each bot due to the practical consideration that response time increases with larger and larger prompts. In the future, using techniques such as retrieval augmented generation will allow the system to receive more information and become more specific and accurate in evaluating the chatbots. This evaluation method will allow for rapid testing and validation of health care chatbots to automate basic medical tasks, freeing providers to address more complex tasks. UR - https://nursing.jmir.org/2025/1/e63058 UR - http://dx.doi.org/10.2196/63058 ID - info:doi/10.2196/63058 ER - TY - JOUR AU - Krewulak, Karla AU - Strayer, Kathryn AU - Jaworska, Natalia AU - Spence, Krista AU - Foster, Nadine AU - Kupsch, Scotty AU - Sauro, Khara AU - Fiest, M. Kirsten PY - 2025/2/20 TI - Evaluation of the Quality of Delirium Website Content for Patient and Family Education: Cross-Sectional Study JO - J Med Internet Res SP - e53087 VL - 27 KW - education KW - health information KW - internet KW - delirium KW - patient KW - caregiver KW - brain lesions KW - confusion KW - inattentiveness KW - disorientation KW - family education KW - information seeking KW - readability KW - high-quality websites KW - accessibility N2 - 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. UR - https://www.jmir.org/2025/1/e53087 UR - http://dx.doi.org/10.2196/53087 UR - http://www.ncbi.nlm.nih.gov/pubmed/39977019 ID - info:doi/10.2196/53087 ER - TY - JOUR AU - Dinesen, Birthe AU - Albertsen, Eie Andi AU - Joensen, Ragnvaldsdóttir Elisabet Dortea AU - Spindler, Helle AU - Jensen, Møller Katja AU - Kidholm, Kristian AU - Frost, Lars AU - Dittman, Lars AU - Gunasegaram, Mathushan AU - Johnsen, Paaske Søren AU - Jochumsen, Rovsing Mads AU - Svenstrup, Dorthe PY - 2025/2/18 TI - Future Patient?Telerehabilitation of Patients With Atrial Fibrillation: Protocol for a Multicenter, Mixed Methods, Randomized Controlled Trial JO - JMIR Res Protoc SP - e64259 VL - 14 KW - atrial fibrillation KW - telerehabilitation KW - quality of life KW - research design KW - patient education KW - co-creation KW - randomized controlled trial KW - chronic KW - cardiovascular disease KW - adult KW - aging KW - prevalence KW - comorbidity KW - Future Patient KW - patient engagement KW - primary outcome KW - cost-effectiveness KW - monitoring KW - health care professional KW - digital health KW - remote therapy KW - telehealth N2 - Background: Atrial fibrillation (AF) is a chronic cardiovascular condition with a lifetime risk of 1 in 3 and a prevalence of 3% among adults. AF?s prevalence is predicted to more than double during the next 20 years due to better detection, increasing comorbidities, and an aging population. Due to increased AF prevalence, telerehabilitation has been developed to enhance patient engagement, health care accessibility, and compliance through digital technologies. A telerehabilitation program called ?Future Patient?telerehabilitation of patients with AF (FP-AF)? has been developed to enhance rehabilitation for AF. The FP-AF program comprises two modules: (1) an education and monitoring module using telerehabilitation technologies (4 months) and (2) a follow-up module, where patients can measure steps and access a data and knowledge-sharing portal, HeartPortal, using their digital devices. Those patients in the FP-AF program measure their heart rhythm, pulse, blood pressure, weight, steps, and sleep. Patients also complete web-based questionnaires regarding their well-being and coping with AF. All recorded data are transmitted to the HeartPortal, accessible to patients, relatives, and health care professionals. Objective: This paper aims to describe the research design, outcome measures, and data collection techniques in a clinical trial of the FP-AF program for patients with AF. Methods: This is a multicenter, mixed methods, randomized controlled trial. Patients are recruited from AF clinics serving the North Jutland region of Denmark. The telerehabilitation group will participate in the FP-AF program, while the control group will follow the conventional care regime based on physical visits to the AF clinic. The primary outcome measure is AF-specific health-related quality of life, to be assessed using the Atrial Fibrillation Effect on Quality-of-Life Questionnaire. Secondary outcomes are knowledge of AF; measurement of vital parameters; level of anxiety and depression; degree of motivation; burden of AF; use of the HeartPortal; qualitative exploration of patients?, relatives?, and health care professionals? experiences of participating in the FP-AF program; cost-effectiveness evaluation of the program; and analysis of multiparametric monitoring data. Outcomes are assessed through data from digital technologies, interviews, and questionnaires. Results: Patient enrollment began in January 2023 and will be completed by December 2024, with a total of 208 patients enrolled. Qualitative interviews conducted in spring 2024 will be analyzed and published in peer-reviewed journals in 2025. Data from questionnaires and digital technologies will be analyzed upon study completion and presented at international conferences and published in peer-reviewed journals by the fall of 2025. Conclusions: Results from the FP-AF study will determine whether the FP-AF program can increase quality of life for patients with AF and increase their knowledge of symptoms and living with AF in everyday life compared to conventional AF care. The cost-effectiveness evaluation will determine whether telerehabilitation can be a viable alternative for rehabilitation of patients with AF. Trial Registration: ClinicalTrials.gov NCT06101485; https://clinicaltrials.gov/study/NCT06101485 International Registered Report Identifier (IRRID): DERR1-10.2196/64259 UR - https://www.researchprotocols.org/2025/1/e64259 UR - http://dx.doi.org/10.2196/64259 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64259 ER - TY - JOUR AU - Dunleavy, Kim AU - Radunovich, Liss Heidi AU - Beneciuk, M. Jason AU - Hu, Boyi AU - Yang, Yang AU - Blythe, McCormick Janeen AU - Gurka, K. Kelly PY - 2025/1/28 TI - Self-Management Strategies for Low Back Pain Among Horticulture Workers: Protocol for a Type II Hybrid Effectiveness-Implementation Study JO - JMIR Res Protoc SP - e64817 VL - 14 KW - low back pain KW - self-management KW - implementation KW - horticulture workers KW - video training KW - video feedback KW - text message reminders KW - agriculture KW - ergonomic KW - nonpharmacological N2 - Background: Low back pain (LBP) is highly prevalent and disabling, especially in agriculture sectors. However, there is a gap in LBP prevention and intervention studies in these physically demanding occupations, and to date, no studies have focused on horticulture workers. Given the challenges of implementing interventions for those working in small businesses, self-management offers an attractive and feasible option to address work-related risk factors and manage LBP. Objective: This study will (1) investigate the effectiveness of self-management strategies for nursery and landscape workers by comparing within-subject control and intervention periods and (2) determine if adoption and effectiveness differs between participants randomly assigned to review self-management videos only and those who also receive multimodal implementation support. We will also identify contextual factors impacting effectiveness and implementation. Methods: A pragmatic, mixed methods, hybrid effectiveness and implementation design will be used to compare back pain with work tasks, disability, medication and substance use, and psychological factors between a baseline control and intervention periods. We aim to recruit 122 English- and Spanish-speaking horticulture workers with back pain, 30 supervisors, and 12 focus group participants. Participants will review short video modules designed to increase awareness of opioid risk and introduce self-management and ergonomic choices and use 1 self-management and 1 ergonomic strategy for 10 weeks. They will be randomly assigned to 2 implementation groups: video modules only or video + multimodal personalized support (checklist guidance, review of video feedback for ergonomic problem-solving, and text message reminders). Questionnaires will be administered at 3-month time points: baseline, pre- and postintervention, and at 3 and 6 months. Qualitative analysis of field notes, open-ended comments, and focus groups will expand understanding of results with comprehensive documentation of the context, barriers and facilitators, and reasons for adoption. Results: The project was funded on September 29, 2023 (Centers for Disease Control and Prevention National Institute of Occupational Health and Safety, CDC NIOSH; U54OH011230-07S1), as a core research grant for the Southeast Coastal Center for Agricultural Health and Safety. The design, creation, and editing of English and Spanish videos was completed in June 2024 after comprehensive formative evaluation. Enrollment began in June 2024 with anticipated completion in 2027. Conclusions: We hypothesize that both self-management interventions will result in reductions in work task pain and disability and that the video enhanced with multimodal personalized support will result in greater reductions than the video alone. If self-management is effective, mitigating pain positively impacts quality of life, productivity, and retention, while increasing the use of nonpharmacological alternatives to opioids addresses an important public health issue. Implementation aims will help inform reasons for results, barriers and facilitators, and potential for similar interventions in these and similar industries with physically challenging outdoor work. Trial Registration: ClinicalTrials.gov NCT06153199; http://clinicaltrials.gov/study/NCT06153199 International Registered Report Identifier (IRRID): DERR1-10.2196/64817 UR - https://www.researchprotocols.org/2025/1/e64817 UR - http://dx.doi.org/10.2196/64817 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64817 ER - TY - JOUR AU - Barbazi, Neda AU - Shin, Youn Ji AU - Hiremath, Gurumurthy AU - Lauff, Anne Carlye PY - 2025/1/27 TI - Developing Assessments for Key Stakeholders in Pediatric Congenital Heart Disease: Qualitative Pilot Study to Inform Designing of a Medical Education Toy JO - JMIR Form Res SP - e63818 VL - 9 KW - assessment KW - congenital heart disease KW - children health literacy KW - health education KW - caregiving KW - patient-centered care KW - design KW - qualitative pilot KW - children health KW - educational interventions N2 - Background: Congenital heart disease (CHD) is a birth defect of the heart that requires long-term care and often leads to additional health complications. Effective educational strategies are essential for improving health literacy and care outcomes. Despite affecting around 40,000 children annually in the United States, there is a gap in understanding children?s health literacy, parental educational burdens, and the efficiency of health care providers in delivering education. Objective: This qualitative pilot study aims to develop tailored assessment tools to evaluate educational needs and burdens among children with CHD, their parents, and health care providers. These assessments will inform the design of medical education toys to enhance health management and outcomes for pediatric patients with CHD and key stakeholders. Methods: Through stakeholder feedback from pediatric patients with CHD, parents, and health care providers, we developed three tailored assessments in two phases: (1) iterative development of the assessment tools and (2) pilot testing. In the first phase, we defined key concepts, conducted a literature review, and created initial drafts of the assessments. During the pilot-testing phase, 12 participants were recruited at the M Health Fairview Pediatric Specialty Clinic for Cardiology?Explorer in Minneapolis, Minnesota, United States. We gathered feedback using qualitative methods, including cognitive interviews such as think-aloud techniques, verbal probing, and observations of nonverbal cues. The data were analyzed to identify the strengths and weaknesses of each assessment item and areas for improvement. Results: The 12 participants included children with CHD (n=5), parents (n=4), and health care providers (n=3). The results showed the feasibility and effectiveness of the tailored assessments. Participants showed high levels of engagement and found the assessment items relevant to their education needs. Iterative revisions based on participant feedback improved the assessments? clarity, relevance, and engagement for all stakeholders, including children with CHD. Conclusions: This pilot study emphasizes the importance of iterative assessment development, focusing on multistakeholder engagement. The insights gained from the development process will guide the creation of tailored assessments and inform the development of child-led educational interventions for pediatric populations with CHD. UR - https://formative.jmir.org/2025/1/e63818 UR - http://dx.doi.org/10.2196/63818 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63818 ER - TY - JOUR AU - Specht, Lisa AU - Scheible, Raphael AU - Boeker, Martin AU - Farin-Glattacker, Erik AU - Kampel, Nikolas AU - Schmölz, Marina AU - Schöpf-Lazzarino, Andrea AU - Schulz, Stefan AU - Schlett, Christian AU - Thomczyk, Fabian AU - Voigt-Radloff, Sebastian AU - Wegner, Constanze AU - Wollmann, Katharina AU - Maun, Andy PY - 2025/1/23 TI - Evaluating the Acceptance and Usability of an Independent, Noncommercial Search Engine for Medical Information: Cross-Sectional Questionnaire Study and User Behavior Tracking Analysis JO - JMIR Hum Factors SP - e56941 VL - 12 KW - medical information KW - health information KW - search engine KW - user behavior KW - health literacy KW - digital health literacy KW - navigational needs KW - information-seeking behavior KW - evidence-based content KW - Germany N2 - 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. UR - https://humanfactors.jmir.org/2025/1/e56941 UR - http://dx.doi.org/10.2196/56941 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56941 ER - TY - JOUR AU - Eisinger, Felix AU - Holderried, Friederike AU - Mahling, Moritz AU - Stegemann?Philipps, Christian AU - Herrmann?Werner, Anne AU - Nazarenus, Eric AU - Sonanini, Alessandra AU - Guthoff, Martina AU - Eickhoff, Carsten AU - Holderried, Martin PY - 2025/1/21 TI - What?s Going On With Me and How Can I Better Manage My Health? The Potential of GPT-4 to Transform Discharge Letters Into Patient-Centered Letters to Enhance Patient Safety: Prospective, Exploratory Study JO - J Med Internet Res SP - e67143 VL - 27 KW - GPT-4 KW - patient letters KW - health care communication KW - artificial intelligence KW - patient safety KW - patient education N2 - Background: For hospitalized patients, the discharge letter serves as a crucial source of medical information, outlining important discharge instructions and health management tasks. However, these letters are often written in professional jargon, making them difficult for patients with limited medical knowledge to understand. Large language models, such as GPT, have the potential to transform these discharge summaries into patient-friendly letters, improving accessibility and understanding. Objective: This study aims to use GPT-4 to convert discharge letters into more readable patient-centered letters. We evaluated how effectively and comprehensively GPT-4 identified and transferred patient safety?relevant information from the discharge letters to the transformed patient letters. Methods: Three discharge letters were created based on common medical conditions, containing 72 patient safety?relevant pieces of information, referred to as ?learning objectives.? GPT-4 was prompted to transform these discharge letters into patient-centered letters. The resulting patient letters were analyzed for medical accuracy, patient centricity, and the ability to identify and translate the learning objectives. Bloom?s taxonomy was applied to analyze and categorize the learning objectives. Results: GPT-4 addressed the majority (56/72, 78%) of the learning objectives from the discharge letters. However, 11 of the 72 (15%) learning objectives were not included in the majority of the patient-centered letters. A qualitative analysis based on Bloom?s taxonomy revealed that learning objectives in the ?Understand? category (9/11) were more frequently omitted than those in the ?Remember? category (2/11). Most of the missing learning objectives were related to the content field of ?prevention of complications.? By contrast, learning objectives regarding ?lifestyle? and ?organizational? aspects were addressed more frequently. Medical errors were found in a small proportion of sentences (31/787, 3.9%). In terms of patient centricity, the patient-centered letters demonstrated better readability than the discharge letters. Compared with discharge letters, they included fewer medical terms (132/860, 15.3%, vs 165/273, 60/4%), fewer abbreviations (43/860, 5%, vs 49/273, 17.9%), and more explanations of medical terms (121/131, 92.4%, vs 0/165, 0%). Conclusions: Our study demonstrates that GPT-4 has the potential to transform discharge letters into more patient-centered communication. While the readability and patient centricity of the transformed letters are well-established, they do not fully address all patient safety?relevant information, resulting in the omission of key aspects. Further optimization of prompt engineering may help address this issue and improve the completeness of the transformation. UR - https://www.jmir.org/2025/1/e67143 UR - http://dx.doi.org/10.2196/67143 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67143 ER - TY - JOUR AU - Liao, Jiaman AU - Huang, Xueliang AU - Huang, Hao AU - Shen, Cuina AU - Li, Lixia AU - Li, Yushao AU - Zhan, Yiqiang PY - 2025/1/20 TI - Analysis of ?Dr Ding Xiang? on WeChat in China to Determine Factors Influencing Readership on Medical Social Media: Observational Study JO - J Med Internet Res SP - e65372 VL - 27 KW - WeChat Official Accounts KW - Dr Ding Xiang KW - health communication KW - information dissemination KW - readership analysis N2 - Background: With the rapid expansion of social media platforms, the demand for health information has increased substantially, leading to innovative approaches and new opportunities in health education. Objective: This study aims to analyze the characteristics of articles published on the ?Dr Ding Xiang? WeChat official account (WOA), one of the most popular institutional accounts on the WeChat platform, to identify factors influencing readership engagement and to propose strategies for enhancing the effectiveness of health information dissemination. Methods: A total of 5286 articles published on the ?Dr Ding Xiang? WOA from January 2021 to December 2021 were collected and analyzed. Additionally, a random sample of 324 articles was selected for detailed text analysis. Univariate analysis was conducted using the chi-square test, and multivariate analysis was performed using multivariable logistic regression. Results: In 2021, the total number of reads for ?Dr Ding Xiang? articles reached 323,479,841, with an average of 61,196 reads per article. Articles exceeding 100,000 reads accounted for 33.90% of the total. Most articles were published during the time slots of 8:00-10:00 AM, 11:30 AM to 1:30 PM, and 8:30-10:30 PM. Analysis indicated that the order of publication, style of the title sentence, number of likes, number of in-views, total likes on comments, and number of replies to comments were significantly associated with an article?s number of reads. Text analysis further revealed that the article?s reasoning approaches and concluding methods also had a significant impact on readership. Conclusions: To enhance readership and the effectiveness of health communication, health-focused WOAs should consider key factors such as optimal publication timing, engaging title design, and effective content structuring. Attention to these elements can improve user engagement and support the broader dissemination of health information. UR - https://www.jmir.org/2025/1/e65372 UR - http://dx.doi.org/10.2196/65372 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65372 ER - TY - JOUR AU - Rivera Rivera, N. Jessica AU - Snir, Moran AU - Simmons, Emilie AU - Schmidlen, Tara AU - Sholeh, Misha AU - Maconi, Leigh Melinda AU - Geiss, Carley AU - Fulton, Hayden AU - Barton, Laura AU - Gonzalez, D. Brian AU - Permuth, Jennifer AU - Vadaparampil, Susan PY - 2025/1/17 TI - Developing and Assessing a Scalable Digital Health Tool for Pretest Genetic Education in Patients With Early-Onset Colorectal Cancer: Mixed Methods Design JO - JMIR Cancer SP - e59464 VL - 11 KW - genetic education KW - genetic testing KW - genetic counseling KW - digital health KW - early-onset colorectal cancer N2 - Background: National guidelines recommend germline genetic testing (GT) for all patients with early-onset colorectal cancer. With recent advances in targeted therapies and GT, these guidelines are expected to expand to include broader groups of patients with colorectal cancer. However, there is a shortage of genetic professionals to provide the necessary education and support for informed consent. As such, there is a pressing need to identify alternative approaches to facilitate and expedite access to GT. Objective: This study describes the development of a pretest education intervention, Nest-CRC, to facilitate the uptake of germline GT among patients with early-onset colorectal cancer. Patients with early-onset colorectal cancer and health care providers reviewed Nest-CRC, and their reactions and recommendations were captured using a nested mixed methods approach. Methods: Using the learner verification approach, we conducted 2 sequential phases of surveys and interviews with English- and Spanish-speaking patients with early-onset colorectal cancer and health care providers. The surveys assessed participants? experiences with genetic services and provided immediate feedback on the Nest-CRC genetic education modules. Semistructured interviews evaluated participants? perceptions of self-efficacy, attraction, comprehension, cultural acceptability, and usability of Nest-CRC. Survey data were analyzed using descriptive statistics (mean, median, and proportions), while interview data were analyzed through line-by-line coding of the transcribed interviews. After each phase, Nest-CRC was refined based on participants? recommendations. Results: A total of 52 participants, including 39 patients with early-onset colorectal cancer and 13 providers, participated in the study. Of these, 19 patients and 6 providers participated in phase 1 (N=25), and 20 patients and 7 providers participated in phase 2 (N=27). Most participants (phase 1: 23/25, 92%, to 25/25, 100%; phase 2: 24/27, 89%, to 27/27, 100%) agreed that each of the 5 education modules was easy to understand and helpful; 13 patients reported no history of GT, with 11 (85%) expressing interest in GT and 2 (15%) remaining unsure after completing Nest-CRC. Participants reported that Nest-CRC provided sufficient information to help them decide about GT. The tool was deemed acceptable by individuals from diverse backgrounds, and participants found it visually attractive, easy to comprehend, and user-friendly. Conclusions: The findings revealed that Nest-CRC is a promising strategy for facilitating pretest education and promoting GT. Nest-CRC has been refined based on participant recommendations and will be re-evaluated. UR - https://cancer.jmir.org/2025/1/e59464 UR - http://dx.doi.org/10.2196/59464 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59464 ER - TY - JOUR AU - Furukawa, Emi AU - Okuhara, Tsuyoshi AU - Liu, Mingxin AU - Okada, Hiroko AU - Kiuchi, Takahiro PY - 2025/1/15 TI - Evaluating Online and Offline Health Information With the Patient Education Materials Assessment Tool: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e63489 VL - 14 KW - patient education KW - health communication KW - health information KW - behavior change KW - understandability KW - actionability Patient Education Materials Assessment Tool KW - PEMAT KW - medical information KW - health literacy KW - patient education materials N2 - Background: The Patient Education Materials Assessment Tool (PEMAT) is a reliable and validated instrument for assessing the understandability and actionability of patient education materials. It has been applied across diverse cultural and linguistic contexts, enabling cross-field and cross-national material quality comparisons. Accumulated evidence from studies using the PEMAT over the past decade underscores its potential impact on patient and public action. Objective: This systematic review aims to investigate how the quality of patient education materials has been assessed using the PEMAT. Methods: This review protocol follows PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols) guidelines. PubMed, MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), APA PsycInfo, and Web of Science Core Collection will be searched systematically for articles published since September 2014. Two independent reviewers will conduct the search to yield a list of relevant studies based on the inclusion and exclusion criteria. Rayyan QCRI software will be used for screening and data extraction. Results: The results will be included in the full systematic review, which is expected to start in September 2024 and be completed to be submitted for publication by early 2025. Conclusions: The findings are expected to identify the quality of materials evaluated by the PEMAT and the areas under evaluation. This review can also highlight gaps that exist in research and practice for improving the understandability and actionability of the materials, offering deeper insights into how existing materials can facilitate patient and public action. International Registered Report Identifier (IRRID): PRR1-10.2196/63489 UR - https://www.researchprotocols.org/2025/1/e63489 UR - http://dx.doi.org/10.2196/63489 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63489 ER - TY - JOUR AU - Fan, Lok Heidi Sze AU - Leung, Yan Emily Tsz AU - Lau, Wing Ka AU - Wong, Ha Janet Yuen AU - Choi, Hang Edmond Pui AU - Lam, Christine AU - Tarrant, Marie AU - Ngan, Sheung Hextan Yuen AU - Ip, Patrick AU - Lin, Chin Chia AU - Lok, Wan Kris Yuet PY - 2025/1/10 TI - A Mobile App for Promoting Breastfeeding-Friendly Communities in Hong Kong: Design and Development Study JO - JMIR Form Res SP - e64191 VL - 9 KW - Baby-Friendly Community Initiative KW - Baby-Friendly Hospital Initiative KW - breastfeeding KW - community KW - stakeholders KW - mobile app KW - friendly communities KW - baby-friendly KW - well-being KW - mother KW - infant KW - application KW - mHealth KW - qualitative KW - user-friendly KW - self-management N2 - Background: Breastfeeding is vital for the health and well-being of both mothers and infants, and it is crucial to create supportive environments that promote and maintain breastfeeding practices. Objective: The objective of this paper was to describe the development of a breastfeeding-friendly app called ?bfGPS? (HKU TALIC), which provides comprehensive territory-wide information on breastfeeding facilities in Hong Kong, with the goal of fostering a breastfeeding-friendly community. Methods: The development of bfGPS can be categorized into three phases, which are (1) planning, prototype development, and preimplementation evaluation; (2) implementation and updates; and (3) usability evaluation. In phase 1, a meeting was held with experts, including maternal and child health researchers, app developers, breastfeeding individuals, and health professionals, to discuss the focus and functionality of the breastfeeding app. A prototype was developed, and breastfeeding facilities in various public venues in Hong Kong were assessed using a structured checklist. For the preimplementation evaluation, 10 focus groups and 19 one-on-one interviews were conducted between May 2019 and October 2020 with staff working in public premises (n=29) and breastfeeding individuals (n=29). For phase 2, bfGPS was published on iOS (Apple Inc) and Android (Google) platforms in September 2020. App updates were launched in September 2021 and May 2022 based on the suggestions provided by the participants in the preimplementation evaluation. For the usability evaluation, semistructured, in-depth, one-to-one interviews were conducted with breastfeeding individuals (n=30) to understand their experiences of using bfGPS. Content analysis was used to analyze the data. Results: bfGPS is a mobile app that was developed to assist breastfeeding individuals in locating breastfeeding facilities in public venues in Hong Kong. In the preimplementation evaluation, the participants gave comments on the layout and interface of bfGPS, and suggestions were given on incorporating new functions into the app. Based on the suggestions of the participants in the preimplementation evaluation, a few additional functions were added into bfGPS, including allowing the users to rate and upload recent information about breastfeeding facilities and an infant tracker function that encourages users to record infant development. In the usability evaluation, 3 main themes emerged?bfGPS improves the community experience for breastfeeding individuals, facilitates tracking the infant?s growth, and provides suggestions for further development. Conclusions: The bfGPS app is the first user-friendly tool designed to assist users in locating breastfeeding facilities within the community. It stands as a guide for similar health care app developments, emphasizing the importance of accurate, current data to ensure user adoption and long-term use. The app?s potential lies in the support and reinforcement of breastfeeding practices coupled with self-management strategies. UR - https://formative.jmir.org/2025/1/e64191 UR - http://dx.doi.org/10.2196/64191 ID - info:doi/10.2196/64191 ER - TY - JOUR AU - Varghese, Johny Kevin AU - Singh, Som AU - Kamali, Emily AU - Qureshi, Fahad AU - Jamal, Aleena AU - Qureshi, Fawad PY - 2025/1/6 TI - Modern Digital Query Analytics of Patient Education Materials on Acanthosis Nigricans: Systematic Search and Content Analysis JO - JMIR Dermatol SP - e60210 VL - 8 KW - acanthosis nigricans KW - dermatology KW - patient education KW - public health KW - skin KW - readability KW - information resource KW - DISCERN KW - general public KW - reading level KW - information seeking KW - information behavior N2 - Background: Online digital materials are integral to patient education and health care outcomes in dermatology. Acanthosis nigricans (AN) is a common condition, often associated with underlying diseases such as insulin resistance. Patients frequently search the internet for information related to this cutaneous finding. To our knowledge, the quality of online educational materials for AN has not been systematically examined. Objective: The primary objective of this study was to profile the readability and quality of the content of publicly available digital educational materials on AN and identify questions frequently asked by patients. Methods: This study analyzed publicly available internet sources to identify the most frequent questions searched by patients regarding AN using the Google Rankbrain algorithm. Furthermore, available articles on AN were evaluated for quality and reading level using metrics such as the Brief DISCERN score, and readability was determined using three specific scales including the Flesch-Kincaid score, Gunning Fog index, and the Coleman-Liau index, based on literature. Results: Patients most frequently accessed facts on AN from government sources, which comprised 30% (n=15) of the analyzed sources. The available articles did not meet quality standards and were at a reading level not appropriate for the general public. The majority of articles (n=29/50, 58%) had substandard Brief DISCERN scores, failing to meet the criteria for good quality. Conclusions: Clinicians should be aware of the paucity of valuable online educational material on AN and educate their patients accordingly. UR - https://derma.jmir.org/2025/1/e60210 UR - http://dx.doi.org/10.2196/60210 ID - info:doi/10.2196/60210 ER - TY - JOUR AU - Zhang, Jinbao AU - Prunty, E. Jonathan AU - Charles, C. Alison AU - Forder, Julien PY - 2025/1/2 TI - Association Between Digital Front Doors and Social Care Use for Community-Dwelling Adults in England: Cross-Sectional Study JO - J Med Internet Res SP - e53205 VL - 27 KW - social care support KW - long term care KW - access KW - front door KW - easy-read KW - self-assessment KW - system navigation KW - digital system KW - digital technology KW - internet N2 - Background: Requests for public social care support can be made through an online portal. These digital ?front doors? can help people navigate complex social care systems and access services. These systems can be set up in different ways, but there is little evidence about the impact of alternative arrangements. Digital front-door systems should help people better access services, particularly low-intensity services (high-intensity care is likely to require a full in-person assessment). Objective: This study aimed to investigate the association between 2 primary digital front door arrangements, easy-read information, and self-assessment tools provided on official websites, and the type of social care support that is offered: ongoing low-level support (OLLS), short-term care (STC) and long-term care (LTC). Methods: Information on front door arrangements was collected from the official websites of 152 English local authorities in 2021. We conducted a cross-sectional analysis using aggregated service use data from official government returns at the local authority level. The independent variables were derived from the policy information collected, specifically focusing on the availability of online digital easy-read information and self-assessment tools for adults and caregivers through official websites. The dependent variables were the rates of using social care support, including OLLS, STC, and LTC, across different age groups: the adult population (aged 18 and older), younger population (aged between 18 and 64 years), and older population (aged 65 and older). Multivariate regression analysis was used to examine the association between digital front door arrangements and access to social care support, controlling for population size, dependency level, and financial need factors. Results: Less than 20% (27/147) of local authorities provided an integrated digital easy-read format as part of their digital front door system with about 25% (37/147) adopting digital self-assessment within their system. We found that local authorities that offered an integrated digital easy-read information format showed higher rates of using OLLS (? coefficient=0.54; P=.03; but no statistically significant association with LTC and STC). The provision of an online self-assessment system was not associated with service use in the 1-year (2021) cross-sectional estimate, but when 2 years (2020 and 2021) of service-use data were analyzed, a significant positive association was found on OLLS rates (? coefficient=0.41; P=.21). Notably, these findings were consistent across different age groups. Conclusions: These findings are consistent with our hypothesis that digital systems with built-in easy-read and self-assessment may make access to (low-intensity) services easier for people. Adoption of these arrangements could potentially help increase the uptake of support among those who are eligible, with expected benefits for their care-related well-being. Given the limited adoption of the digital front door by local authorities in England, expanding their use could improve care-related outcomes and save social care costs. UR - https://www.jmir.org/2025/1/e53205 UR - http://dx.doi.org/10.2196/53205 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53205 ER - TY - JOUR AU - Hansen, Steffen AU - Jensen, Secher Tue AU - Schmidt, Mette Anne AU - Strøm, Janni AU - Vistisen, Peter AU - Høybye, Terp Mette PY - 2024/12/30 TI - The Effectiveness of Video Animations as a Tool to Improve Health Information Recall for Patients: Systematic Review JO - J Med Internet Res SP - e58306 VL - 26 KW - public health KW - health information KW - patient information KW - animation video KW - digital health KW - visualization KW - memory KW - recall KW - education KW - synthesis KW - review methods KW - review methodology KW - systematic KW - PRISMA N2 - Background: Access to clear and comprehensible health information is crucial for patient empowerment, leading to improved self-care, adherence to treatment plans, and overall health outcomes. Traditional methods of information delivery, such as written documents and oral communication, often result in poor memorization and comprehension. Recent innovations, such as animation videos, have shown promise in enhancing patient understanding, but comprehensive investigations into their effectiveness across various health care settings are lacking. Objective: This systematic review aims to investigate the effectiveness of animation videos on health information recall in adult patients across diverse health care sectors, comparing their impact to usual information delivery methods on short-term and long-term recall of health information. Methods: We conducted systematic searches in PubMed, CINAHL, and Embase databases, supplemented by manual searches of reference lists. Included studies were randomized controlled trials involving adult participants (?18 years) that focused on the use of animation videos to provide health information measured against usual information delivery practice. There were no language restrictions. Out of 2 independent reviewers screened studies, extracted data, and assessed the risk of bias using the Revised Cochrane risk-of-bias tool for randomized trials (RoB2), Covidence was used to handle screening and risk of bias process. A narrative synthesis approach was applied to present results. Results: A total of 15 randomized controlled trials?3 in the United States, 2 in France, 2 in Australia, 2 in Canada, and 1 in the United Kingdom, Japan, Singapore, Brazil, Austria, and Türkiye, respectively?met the inclusion criteria, encompassing 2,454 patients across various health care settings. The majority of studies (11/15, 73%) reported statistically significant improvements in health information recall when animation videos were used, compared with usual care. Animation videos ranged from 1 to 15 minutes in duration with the most common length ranging from 1 to 8 minutes (10/15) and used various styles including 2D cartoons, 3D computers, and whiteboard animations. Most studies (12/15) assessed information recall immediately after intervention, with only 3 studies including longer follow-up periods. Most studies exhibited some concerns related to the risk of bias, particularly in domains related to deviations from intended interventions and selection of reported results. Conclusions: Animation videos appear to significantly improve short-term recall of health information among adult patients across various health care settings compared with usual care. This suggests that animation videos could be a valuable tool for informing patients in different health care settings. However, further research is needed to explore the long-term efficacy of these interventions, their impact on diverse populations, and how different animation styles might affect information recall. Future studies should also address methodological limitations identified in current research, including the use of validated outcome measures and longer follow-up periods. Trial Registration: PROSPERO CRD42022380016; http://crd.york.ac.uk/prospero/display_record.php?RecordID=380016 UR - https://www.jmir.org/2024/1/e58306 UR - http://dx.doi.org/10.2196/58306 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58306 ER - TY - JOUR AU - Peerawong, Thanarpan AU - Phenwan, Tharin AU - Makita, Meiko AU - Supanichwatana, Sojirat AU - Puttarak, Panupong AU - Siammai, Naowanit AU - Sunthorn, Prakaidao PY - 2024/12/24 TI - Evaluating Online Cannabis Health Information for Thai Breast Cancer Survivors Using the Quality Evaluation Scoring Tool (QUEST): Mixed Method Study JO - JMIR Cancer SP - e55300 VL - 10 KW - cannabis KW - medical cannabis KW - Thailand KW - critical discourse analysis KW - mixed method study KW - breast cancer KW - digital literacy KW - legislation KW - health literacy N2 - Background: Following medical cannabis legalization in Thailand in 2019, more people are seeking medical cannabis?related information, including women living with breast cancer. The extent to which they access cannabis-related information from internet sources and social media platforms and the quality of such content are relatively unknown and need further evaluation. Objective: This study aims to analyze the factors determining cannabis-related content quality for breast cancer care from internet sources and on social media platforms and examine the characteristics of such content accessed and consumed by Thai breast cancer survivors. Methods: A mixed methods study was conducted between January 2021 and May 2022, involving a breast cancer survivor support group. The group identified medical cannabis?related content from frequently accessed internet sources and social media platforms. The contents were categorized based on content creators, platforms, content category, and upload dates. Four researchers used the Quality Evaluation Scoring Tool (QUEST) to assess content quality, with scores ranging from 0 to 28. Contents were expert-rated as either high or poor. The QUEST interobserver reliability was analyzed. Receiver-operating characteristic curve analysis with the Youden index was used to determine the QUEST score cut-off point. Statistical significance was set at P<.05. Fairclough Critical Discourse Analysis was undertaken to examine the underlying discourses around poor-quality content. Results: Sixty-two Thai-language cannabis-related items were evaluated. The content sources were categorized as follows: news channels (21/62, 34%), government sources (16/62, 26%), health care providers (12/62, 19%), and alternative medicine providers (12/62, 19%). Most of the contents (30/62, 48%) were uploaded to YouTube, whereas 31% (19/62) appeared on websites and Facebook. Forty of 62 content items (64%) were news-related and generic cannabis advertisements while 8 of 62 (13%) content items had no identifiable date. The interobserver QUEST score correlation was 0.86 (P<.001). The mean QUEST score was 12.1 (SD 7.6). Contents were considered ?high? when the expert rating was >3. With a QUEST score of 15 as the threshold, the sensitivity and specificity for differentiating between high and poor content quality were 81% and 98%, respectively. Content creation was the only significant factor between high- and poor-quality content. Poor-quality contents were primarily created by alternative medicine providers and news channels. Two discourses were identified: advocacy for cannabis use normalization and cannabis romanticization as a panacea. These discourses overly normalize and romanticize the use of cannabis, focusing on indications and instructions for cannabis use, and medical cannabis promotion, while neglecting discussions on cannabis contraindications and potential side effects. Conclusions: The varying quality of medical cannabis?related information on internet sources and social media platforms accessed and shared by Thai breast cancer survivors is an issue of concern. Given that content creators are the sole predictive factors of high content quality, future studies should examine a wider range of cannabis-related sources accessible to both the public and patients to gain a more comprehensive understanding of the issue. UR - https://cancer.jmir.org/2024/1/e55300 UR - http://dx.doi.org/10.2196/55300 ID - info:doi/10.2196/55300 ER - TY - JOUR AU - Dorney, Edwina AU - Hammarberg, Karin AU - Rodgers, Raymond AU - Black, I. Kirsten PY - 2024/12/24 TI - 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 JO - JMIR Hum Factors SP - e63334 VL - 11 KW - technology KW - internet KW - eHealth KW - user experience KW - patient engagement KW - self-assessment tool KW - preconception KW - health communication N2 - 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. UR - https://humanfactors.jmir.org/2024/1/e63334 UR - http://dx.doi.org/10.2196/63334 ID - info:doi/10.2196/63334 ER - TY - JOUR AU - Almenara, A. Carlos AU - Gulec, Hayriye PY - 2024/12/11 TI - Uncovering the Top Nonadvertising Weight Loss Websites on Google: A Data-Mining Approach JO - JMIR Infodemiology SP - e51701 VL - 4 KW - consumer health informatics KW - cyberattack risk KW - data mining KW - Google KW - information seeking KW - weight loss KW - online health information KW - website analysis KW - digital health KW - internet search N2 - Background: Online weight loss information is commonly sought by internet users, and it may impact their health decisions and behaviors. Previous studies examined a limited number of Google search queries and relied on manual approaches to retrieve online weight loss websites. Objective: This study aimed to identify and describe the characteristics of the top weight loss websites on Google. Methods: This study gathered 432 Google search queries collected from Google autocomplete suggestions, ?People Also Ask? featured questions, and Google Trends data. A data-mining software tool was developed to retrieve the search results automatically, setting English and the United States as the default criteria for language and location, respectively. Domain classification and evaluation technologies were used to categorize the websites according to their content and determine their risk of cyberattack. In addition, the top 5 most frequent websites in nonadvertising (ie, nonsponsored) search results were inspected for quality. Results: The results revealed that the top 5 nonadvertising websites were healthline.com, webmd.com, verywellfit.com, mayoclinic.org, and womenshealthmag.com. All provided accuracy statements and author credentials. The domain categorization taxonomy yielded a total of 101 unique categories. After grouping the websites that appeared less than 5 times, the most frequent categories involved ?Health? (104/623, 16.69%), ?Personal Pages and Blogs? (91/623, 14.61%), ?Nutrition and Diet? (48/623, 7.7%), and ?Exercise? (34/623, 5.46%). The risk of being a victim of a cyberattack was low. Conclusions: The findings suggested that while quality information is accessible, users may still encounter less reliable content among various online resources. Therefore, better tools and methods are needed to guide users toward trustworthy weight loss information. UR - https://infodemiology.jmir.org/2024/1/e51701 UR - http://dx.doi.org/10.2196/51701 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51701 ER - TY - JOUR AU - Wetzel, Anna-Jasmin AU - Preiser, Christine AU - Müller, Regina AU - Joos, Stefanie AU - Koch, Roland AU - Henking, Tanja AU - Haumann, Hannah PY - 2024/12/9 TI - Unveiling Usage Patterns and Explaining Usage of Symptom Checker Apps: Explorative Longitudinal Mixed Methods Study JO - J Med Internet Res SP - e55161 VL - 26 KW - self-triage KW - eHealth KW - self-diagnosis KW - mHealth KW - mobile health KW - usage KW - patterns KW - predicts KW - prediction KW - symptoms checker KW - apps KW - applications KW - explorative longitudinal study KW - self care KW - self management KW - self-rated KW - mixed method KW - circumstances KW - General Linear Mixed Models KW - GLMM KW - qualitative data KW - content analysis KW - Kuckartz KW - survey KW - participants KW - users N2 - Background: Symptom checker apps (SCA) aim to enable individuals without medical training to classify perceived symptoms and receive guidance on appropriate actions, such as self-care or seeking professional medical attention. However, there is a lack of detailed understanding regarding the contexts in which individuals use SCA and their opinions on these tools. Objective: This mixed methods study aims to explore the circumstances under which medical laypeople use SCA and to identify which aspects users find noteworthy after using SCA. Methods: A total of 48 SCA users documented their medical symptoms, provided open-ended responses, and recorded their SCA use along with other variables over 6 weeks in a longitudinal study. Generalized linear mixed models with and those without regularization were applied to consider the hierarchical structure of the data, and the models? outcomes were evaluated for comparison. Qualitative data were analyzed through Kuckartz qualitative content analysis. Results: Significant predictors of SCA use included the initial occurrence of symptoms, day of measurement (odds ratio [OR] 0.97), self-rated health (OR 0.80, P<.001), and the following International Classification in Primary Care-2?classified symptoms, that are general and unspecified (OR 3.33, P<.001), eye (OR 5.56, P=.001), cardiovascular (OR 8.33, P<.001), musculoskeletal (OR 5.26, P<.001), and skin (OR 4.76, P<.001). The day of measurement and self-rated health showed minor importance due to their small effect sizes. Qualitative analysis highlighted four main themes: (1) reasons for using SCA, (2) diverse affective responses, (3) a broad spectrum of behavioral reactions, and (4) unmet needs including a lack of personalization. Conclusions: The emergence of new and unfamiliar symptoms was a strong determinant for SCA use. Specific International Classification in Primary Care?rated symptom clusters, particularly those related to cardiovascular, eye, skin, general, and unspecified symptoms, were also highly predictive of SCA use. The varied applications of SCA fit into the concept of health literacy as bricolage, where SCA is leveraged as flexible tools by patients based on individual and situational requirements, functioning alongside other health care resources. UR - https://www.jmir.org/2024/1/e55161 UR - http://dx.doi.org/10.2196/55161 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55161 ER - TY - JOUR AU - Chang, Annie AU - Young, Jade AU - Para, Andrew AU - Lamb, Angela AU - Gulati, Nicholas PY - 2024/11/20 TI - Efficacy of ChatGPT in Educating Patients and Clinicians About Skin Toxicities Associated With Cancer Treatment JO - JMIR Dermatol SP - e54919 VL - 7 KW - artificial intelligence KW - ChatGPT KW - oncodermatology KW - cancer therapy KW - language learning model UR - https://derma.jmir.org/2024/1/e54919 UR - http://dx.doi.org/10.2196/54919 ID - info:doi/10.2196/54919 ER - TY - JOUR AU - Cauley, Elaine Christy AU - Rubio, Atziri AU - Brindle, Mary AU - Cooper, Zara AU - Vranceanu, Ana-Maria AU - Ritchie, S. Christine PY - 2024/11/15 TI - A Video-Based Communication Intervention for Fecal Ostomy Surgery (CI-oSurg): Protocol for Open Pilot Testing to Improve Intervention Acceptability and Feasibility JO - JMIR Res Protoc SP - e60575 VL - 13 KW - fecal ostomy KW - distress KW - open pilot KW - fecal ostomy surgeryl CI-oSurg KW - intervention acceptability KW - biopsychosocial outcomes KW - psychosocial support KW - ostomy care N2 - Background: Approximately 100,000 patients undergo fecal ostomy operations annually across the United States. This patient population experiences high surgical complication rates and poor biopsychosocial outcomes. Surgical teams are not trained to address the psychosocial needs that often arise during recovery after fecal ostomy surgery. Objective: This study aims to refine and establish the acceptability and usability of the Communication Intervention for fecal ostomy Surgery (CI-oSurg), a web-based communication intervention aimed at reducing distress among patients recovering from ostomy surgery. Methods: We describe the proposed study design, methodology, and training protocol. We will conduct an open pilot (n=24 patients and n=8 clinicians) of video-based training to first identify the level and types of distress patients are experiencing. Next, patients will view web videos that address frequent challenges faced by ostomy patients, considering practical management and emotional and adaptation concerns. Qualitative one-to-one semistructured interviews will be conducted with participants to explore the acceptability and feasibility of the program and refine the intervention and study procedures. Results: This study has been approved by the Mass General Brigham Institutional Review Board. Study funding has been obtained, and recruitment is planned for the fall of 2024. Conclusions: Through this study, we will refine CI-oSurg, a web-based communication intervention focused on reducing distress after ostomy surgery, to improve intervention acceptability and usability. These improvements will allow us to establish the usability and acceptability of the intervention before efficacy testing to determine the ability of this intervention to reduce distress after fecal ostomy surgery. Trial Registration: ClinicalTrials.gov NCT06320002; https://clinicaltrials.gov/study/NCT06320002 International Registered Report Identifier (IRRID): PRR1-10.2196/60575 UR - https://www.researchprotocols.org/2024/1/e60575 UR - http://dx.doi.org/10.2196/60575 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60575 ER - TY - JOUR AU - Shojaei, Fereshtehossadat AU - Shojaei, Fatemehalsadat AU - Desai, P. Archita AU - Long, Emily AU - Mehta, Jade AU - Fowler, R. Nicole AU - Holden, J. Richard AU - Orman, S. Eric AU - Boustani, Malaz PY - 2024/11/13 TI - The Feasibility of AgileNudge+ Software to Facilitate Positive Behavioral Change: Mixed Methods Design JO - JMIR Form Res SP - e57390 VL - 8 KW - AgileNudge+ KW - agile KW - nudge strategy KW - nudging interventions KW - agile implementation KW - human behavior KW - software design KW - human-computer interaction KW - user experience design KW - usability testing N2 - Background: In today?s digital age, web-based apps have become integral to daily life, driving transformative shifts in human behavior. ?AgileNudge+? (Indiana University Center for Health Innovation and Implementation Science) is a web-based solution to simplify the process of positive behavior change using nudging as an intervention. By integrating knowledge from behavioral economics with technology, AgileNudge+ organizes multiple steps, simplifies complex tasks, minimizes errors by enhancing user engagement, and provides resources for creating and testing nudge interventions. Objective: This paper aimed to outline the design process, methodologies, and usefulness of ?AgileNudge+? for the development of evidence-based nudges. It used a mixed methods approach to evaluate the software?s interface usability and usefulness for creating and testing nudge interventions. Methods: AgileNudge+ was developed through iterative processes integrating principles from behavioral economics and user-centered design. The content of AgileNudge+ operationalizes an Agile science?based process to efficiently design, embed, and disseminate evidence-based nudges that encourage positive behavior change without limiting choice. Using a mixed methods approach, we tested AgileNudge+ software?s ability to organize and simplify the nudge intervention process, allowing a diverse range of scholars with limited knowledge of Agile science to use nudges. Usability testing assessed the tool?s usefulness and interface with a sample of 18 health care professionals, each asked to interact with the software and create a nudge intervention to solve a problem within their professional project?s sphere. Results: The study was funded in August 2022, with data collection occurring from June 2023 to July 2024. As of July 2024, we have enrolled 18 participants. Quantitative results found a mean usefulness rating of AgileNudge+ of 3.83 (95% CI 3.00-4.66). Qualitative results highlighted ways to modify the language used in AgileNudge+ to be more comprehensible to a diverse user base and promoted modifications to the software that facilitate real-time assistance and prioritize time efficiency in user interactions. Feedback further supported the positive impact of gamification on participant motivation when using the software. Conclusions: AgileNudge+ is an effective assistive tool for simplifying the positive behavior change process using nudge interventions, with tailored content and interactions to meet users? needs and demands. Building onto the current design, future iterations of AgileNudge+ will use artificial intelligence to process large volumes of data while reducing the time and mental energy required to scan for existing cognitive biases and nudge prototypes. The software is also being upgraded to build on current gamification efforts, encouraging more sustained motivation by increasing the temporal resolution of the digital interface. These modifications stay true to the agility and user-centered aspects of AgileNudge+, emphasizing the novelty of the constantly evolving software design process. UR - https://formative.jmir.org/2024/1/e57390 UR - http://dx.doi.org/10.2196/57390 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57390 ER - TY - JOUR AU - Deinboll, Anne AU - Moe, Fredriksen Cathrine AU - Ludvigsen, Spliid Mette PY - 2024/11/11 TI - Participation in eHealth Communication Interventions Among Patients Undergoing Hemodialysis: Scoping Review JO - J Med Internet Res SP - e51900 VL - 26 KW - eHealth KW - electronic health records KW - hemodialysis KW - patient participation KW - renal dialysis KW - renal insufficiency KW - chronic KW - mobile phone N2 - Background: eHealth communication interventions have been shown to offer individuals with chronic kidney disease the opportunity to embrace dialysis therapies with greater confidence, the potential to obtain better clinical outcomes, and an increased quality of life. eHealth is an emerging field that offers diverse, flexible designs and delivery options. However, existing evidence on eHealth communication among patients undergoing hemodialysis is sparse and scattered and lacks systematization. Objective: This scoping review aims to identify and map the current evidence on patient participation in eHealth communication interventions. We aimed to map the associations between interventions and electronic health records, the participative role of individuals living with chronic kidney disease and undergoing hemodialysis, and the barriers to and facilitators of patient involvement in eHealth communication with health care professionals. Methods: This study used the Joanna Briggs Institute methodology for conducting a scoping review. Studies eligible for inclusion were those that included adult patients (aged >18 y) undergoing all types of hemodialysis, including prescheduled in-center hemodialysis and conventional home-based hemodialysis. Systematic searches were completed in Ovid MEDLINE, Ovid Embase, EBSCOhost CINAHL with Full Text, Scopus, and ProQuest Dissertations and Theses. Extracted data from the included studies were presented in figures and tables along with descriptions that responded to the research questions. This review was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Results: In total, 9 peer-reviewed studies were included. The main result was a low participative patient role and a vaguely described link to electronic health records. The key participative facilitators were availability of and access to the intervention; security, trust, and confidence; patient knowledge of their health situation and use of self-care; and patient preparedness for an uncertain future health situation and the ability to relate to family and friends about it. The key participative barriers were lack of availability of and access to information, mistrust and lack of safety, lack of knowledge of health situation and self-care, and relational issues. All barriers and facilitators were related to health literacy. Conclusions: This scoping review summarizes 4 specific and 3 nonspecific eHealth communication interventions developed and evaluated in various studies involving patients receiving hemodialysis. A knowledge gap exists between low levels of patient participation in eHealth communication and patients? limited access to electronic health records. eHealth communication interventions should implement patient participation and focus on the fact that different modalities of eHealth communication can complement face-to-face communication. International Registered Report Identifier (IRRID): RR2-10.2196/38615 UR - https://www.jmir.org/2024/1/e51900 UR - http://dx.doi.org/10.2196/51900 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51900 ER - TY - JOUR AU - Perme, Natalie AU - Reid, Endia AU - Eluagu, Chinwenwa Macdonald AU - Thompson, John AU - Hebert, Courtney AU - Gabbe, Steven AU - Swoboda, Marie Christine PY - 2024/11/8 TI - Development and Usability of the OHiFamily Mobile App to Enhance Accessibility to Maternal and Infant Information for Expectant Families in Ohio: Qualitative Study JO - JMIR Form Res SP - e53299 VL - 8 KW - health resources KW - pregnancy KW - patient engagement KW - mHealth KW - maternal KW - mobile health KW - app KW - focus group KW - landscape analysis KW - birth KW - preterm KW - premature KW - mortality KW - death KW - pediatric KW - infant KW - neonatal KW - design KW - development KW - obstetric KW - mobile phone N2 - Background: The Infant Mortality Research Partnership in Ohio is working to help pregnant individuals and families on Medicaid who are at risk for infant mortality and preterm birth. As part of this initiative, researchers at The Ohio State University worked to develop a patient-facing mobile app, OHiFamily, targeted toward, and created for, this population. To address the social determinants of health that can affect maternal and infant health, the app provides curated information on community resources, health care services, and educational materials in a format that is easily accessible and intended to facilitate contact between families and resources. The OHiFamily app includes 3 distinct features, that is, infant care logging (eg, feeding and diaper changes), curated educational resources, and a link to the curated Ohio resource database (CORD). This paper describes the development and assessment of the OHiFamily app as well as CORD. Objective: This study aimed to describe the development of the OHiFamily mobile app and CORD and the qualitative feedback received by the app?s intended audience. Methods: The researchers performed a landscape analysis and held focus groups to determine the resources and app features of interest to Ohio families on Medicaid. Results: Participants from several focus groups were interested in an app that could offer community resources with contact information, information about medical providers and information and ways to contact them, health tips, and information about pregnancy and infant development. Feedback was provided by 9 participants through 3 focus group sessions. Using this feedback, the team created a curated resource database and mobile app to help users locate and access resources, as well as access education materials and infant tracking features. Conclusions: OHiFamily offers a unique combination of features and access to local resources for families on Medicaid in Ohio not seen in other smartphone apps. UR - https://formative.jmir.org/2024/1/e53299 UR - http://dx.doi.org/10.2196/53299 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53299 ER - TY - JOUR AU - Nkabane-Nkholongo, Elizabeth AU - Mpata-Mokgatle, Mathildah AU - Jack, W. Brian AU - Julce, Clevanne AU - Bickmore, Timothy PY - 2024/3/12 TI - Usability and Acceptability of a Conversational Agent Health Education App (Nthabi) for Young Women in Lesotho: Quantitative Study JO - JMIR Hum Factors SP - e52048 VL - 11 KW - preconception care KW - conversational agent technology KW - women?s health education KW - mHealth adaptation KW - health information technology KW - health education in Africa KW - education KW - women's health KW - women KW - woman KW - health information KW - young women KW - survey KW - usability KW - acceptability KW - application KW - applications KW - app KW - health promotion N2 - Background: Young women in Lesotho face myriad sexual and reproductive health problems. There is little time to provide health education to women in low-resource settings with critical shortages of human resources for health. Objective: This study aims to determine the acceptability and usability of a conversational agent system, the Nthabi health promotion app, which was culturally adapted for use in Lesotho. Methods: We conducted a descriptive quantitative study, using a 22-item Likert scale survey to assess the perceptions of the usability and acceptability of 172 young women aged 18-28 years in rural districts of Lesotho, who used the system on either smartphones or tablets for up to 6 weeks. Descriptive statistics were used to calculate the averages and frequencies of the variables. ?2 tests were used to determine any associations among variables. Results: A total of 138 participants were enrolled and completed the survey. The mean age was 22 years, most were unmarried, 56 (40.6%) participants had completed high school, 39 (28.3%) participants were unemployed, and 88 (63.8%) participants were students. Respondents believed the app was helpful, with 134 (97.1%) participants strongly agreeing or agreeing that the app was ?effective in helping them make decisions? and ?could quickly improve health education and counselling.? In addition, 136 (98.5%) participants strongly agreed or agreed that the app was ?simple to use,? 130 (94.2 %) participants reported that Nthabi could ?easily repeat words that were not well understood,? and 128 (92.7%) participants reported that the app ?could quickly load the information on the screen.? Respondents were generally satisfied with the app, with 132 (95.6%) participants strongly agreeing or agreeing that the health education content delivered by the app was ?well organised and delivered in a timely way,? while 133 (96.4%) participants ?enjoyed using the interface.? They were satisfied with the cultural adaptation, with 133 (96.4%) participants strongly agreeing or agreeing that the app was ?culturally appropriate and that it could be easily shared with a family or community members.? They also reported that Nthabi was worthwhile, with 127 (92%) participants reporting that they strongly agreed or agreed that they were ?satisfied with the application and intended to continue using it,? while 135 (97.8%) participants would ?encourage others to use it.? Participants aged 18-24 years (vs those aged 25-28 years) agreed that the ?Nthabi app was simple to use? (106/106, 100% vs 30/32, 98.8%; P=.01), and agreed that ?the educational content was well organised and delivered in a timely way? (104/106, 98.1% vs 28/32, 87.5%; P=.01). Conclusions: These results support further study of conversational agent systems as alternatives to traditional face-to-face provision of health education services in Lesotho, where there are critical shortages of human resources for health. Trial Registration: ClinicalTrials.gov NCT04354168; https://www.clinicaltrials.gov/study/NCT04354168 UR - https://humanfactors.jmir.org/2024/1/e52048 UR - http://dx.doi.org/10.2196/52048 UR - http://www.ncbi.nlm.nih.gov/pubmed/38470460 ID - info:doi/10.2196/52048 ER - TY - JOUR AU - Zhang, Xiaojuan AU - Wen, Justin Yingkun AU - Han, Ning AU - Jiang, Yawen PY - 2024/1/29 TI - The Effect of a Video-Assisted Health Education Program Followed by Peer Education on the Health Literacy of COVID-19 and Other Infectious Diseases Among School Children: Quasi-Randomized Controlled Trial JO - JMIR Hum Factors SP - e43943 VL - 11 KW - infectious diseases KW - primary school students KW - quasi-randomized controlled trial KW - video-assisted health education KW - peer education KW - item response theory KW - IRT N2 - Background: To improve the engagement and effectiveness of traditional health programs, it is necessary to explore alternative models of health education including video-assisted lectures and peer education. Objective: This study aimed to evaluate the effects of a combination of video-assisted lectures and peer education on health literacy related to infectious diseases among students. Methods: Third-grade classes from 11 pilot schools in Longgang District of Shenzhen, China, were randomized to the intervention and control groups. In the intervention group, a video-assisted interactive health education program was conducted twice over a time span of 5 months. Each of the 2 sessions included a 40-minute lecture on COVID-19 and other common infectious diseases in schools and a 5-minute science video. In addition, 5 ?little health supervisors? at the end of the first session were elected in each class, who were responsible for helping class members to learn health knowledge and develop good hygiene habits. Students answered the same quiz before the first and after the second session. Models based on item response theory (IRT) were constructed to score the students? knowledge of infectious diseases based on the quiz. Results: In total, 52 classes and 2526 students (intervention group: n=1311; control group: n=1215) were enrolled. Responses of the baseline survey were available for 2177 (86.2%; intervention group: n=1306; control group: n=871) students and those of the postintervention survey were available for 1862 (73.7%; intervention group: n=1187; control group: n=675). There were significant cross-group differences in the rates of correctly answering questions about influenza symptoms, transmission, and preventive measures; chicken pox symptoms; norovirus diarrhea symptoms; mumps symptoms; and COVID-19 symptoms. Average IRT scores of questions related to infectious diseases in the intervention and control groups were, respectively, ?0.0375 (SD 0.7784) and 0.0477 (SD 0.7481) before the intervention (P=.01), suggesting better baseline knowledge in the control group. After the intervention, the average scores of the intervention and control groups were 0.0543 (SD 0.7569) and ?0.1115 (SD 0.7307), respectively (P<.001), suggesting not only significantly better scores but also greater improvement in the intervention group. Conclusions: After the health education project, the correct answer rate of infectious disease questions in the intervention group was higher than that of the control group, which indicates significant effects of the combination of video-assisted lectures and peer education for the promotion of health literacy. In addition, the intervention effect of the first session persisted for at least 4 months up to the second session. As such, the proposed program was effective in improving the health literacy of school children in relation to infectious diseases and should be considered for massive health promotion campaigns during pandemics. Trial Registration: ISRCTN ISRCTN49297995; https://www.isrctn.com/ISRCTN49297995 UR - https://humanfactors.jmir.org/2024/1/e43943 UR - http://dx.doi.org/10.2196/43943 UR - http://www.ncbi.nlm.nih.gov/pubmed/38285496 ID - info:doi/10.2196/43943 ER - TY - JOUR AU - Seinsche, Julia AU - de Bruin, D. Eling AU - Saibene, Enrico AU - Rizzo, Francesco AU - Carpinella, Ilaria AU - Ferrarin, Maurizio AU - Moza, Sotiria AU - Ritter, Tanja AU - Giannouli, Eleftheria PY - 2023/12/7 TI - A Newly Developed Exergame-Based Telerehabilitation System for Older Adults: Usability and Technology Acceptance Study JO - JMIR Hum Factors SP - e48845 VL - 10 KW - older adults KW - motor-cognitive intervention KW - exergame KW - telerehabilitation KW - information and communications technologies KW - user-centered design KW - usability KW - technology acceptance N2 - Background: Telerehabilitation has gained significance as a tool to deliver and supervise therapy and training as effective as traditional rehabilitation methods yet more accessible and affordable. An exergame-based telerehabilitation system has recently been developed within the scope of the international Continuum-of-Care (COCARE) project. The system comprises training devices for use in clinics (Dividat Senso) and at home (Dividat Senso Flex), an assessment system, and a rehabilitation cockpit, and its focus lies on home-based motor-cognitive training, which is remotely managed by health care professionals (HPs). Objective: This study aims to analyze the usability, acceptance, and enjoyment of the COCARE system from the perspective of primary (older adults [OAs]) and secondary (HPs) end users. Methods: At 3 trial sites (located in Switzerland, Italy, and Cyprus), participants engaged in a single-session trial of the COCARE system, including testing of exergames and assessments. Mixed methods encompassing qualitative approaches (eg, think aloud) and quantitative measures (eg, Exergame Enjoyment Questionnaire [EEQ], System Usability Scale [SUS], and Unified Theory of Acceptance and Use of Technology [UTAUT] questionnaire) were used to analyze participants? perceptions of the system and identify potential barriers to its implementation in a home setting. In addition, the associations of performance during gameplay and assessments, demographics, and training motivation (Behavioral Regulation in Exercise Questionnaire?3 [BREQ-3]) with usability, acceptance, and enjoyment were explored. Results: A total of 45 OAs and 15 HPs participated in this study. The COCARE system achieved good acceptance ratings (OAs: 83%, range 36%-100% and HPs: 81%, range 63.8%-93.3% of the maximum score), and OAs indicated high enjoyment (mean 73.3, SD 12.7 out of 100 points in the EEQ) during the exergame session. The system?s usability, assessed with the SUS, received scores of 68.1 (SD 18.8; OAs) and 70.7 (SD 12.3; HPs) out of 100 points, with substantial differences observed between the trial sites. Several requirements for improvement were identified. Commonly mentioned barriers to adoption included the movement-recognition sensitivity of the Senso Flex, its limited markings, and difficulties in understanding certain instructions for assessments and games. Performance in games and assessments showed the highest significant correlations with the SUS (Spearman ?=0.35, P=.02 to ?=0.52, P<.001). The BREQ-3 had significant correlations with all usability measures, thereby even large significant correlations with enjoyment (Spearman ?=0.58; P<.001). Age had moderately significant correlations with the SUS (Spearman ?=?0.35; P=.02) and the UTAUT total score (?=?0.35; P=.02) but no significant correlation with the EEQ. Concerning sex and years of education, no significant correlations were found. Conclusions: The study?s findings will inform the further development of the COCARE system toward a user-friendly and widely accepted version, enhancing cognitive and physical functions in OAs. Future randomized controlled trials should evaluate the system?s feasibility and effectiveness. UR - https://humanfactors.jmir.org/2023/1/e48845 UR - http://dx.doi.org/10.2196/48845 UR - http://www.ncbi.nlm.nih.gov/pubmed/38060283 ID - info:doi/10.2196/48845 ER - TY - JOUR AU - Bertholet, Nicolas AU - Schmutz, Elodie AU - Cunningham, A. John AU - McNeely, Jennifer AU - Gmel, Gerhard AU - Daeppen, Jean-Bernard AU - Grazioli, S. Véronique PY - 2023/3/7 TI - Development of a Secondary Prevention Smartphone App for Students With Unhealthy Alcohol Use: Results From a Qualitative Assessment JO - JMIR Hum Factors SP - e41088 VL - 10 KW - app KW - alcohol-related secondary prevention KW - university students KW - tertiary students KW - qualitative KW - alcohol KW - mHealth KW - mobile app KW - smartphone KW - mobile phone N2 - Background: Despite considerable efforts devoted to the development of prevention interventions aiming at reducing unhealthy alcohol use in tertiary students, their delivery remains often challenging. Interventions including information technology are promising given their potential to reach large parts of the population. Objective: This study aims to develop a secondary prevention smartphone app with an iterative qualitative design involving the target population. Methods: The app development process included testing a first prototype and a second prototype, developed based on the results of 2 consecutive qualitative assessments. Participants (aged ?18 years, screened positive for unhealthy alcohol use) were students from 4 tertiary education institutions in the French-speaking part of Switzerland. Participants tested prototype 1 or prototype 2 or both and provided feedback in 1-to-1 semistructured interviews after 2-3 weeks of testing. Results: The mean age of the participants was 23.3 years. A total of 9 students (4/9 female) tested prototype 1 and participated in qualitative interviews. A total of 11 students (6/11 female) tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. Content analysis identified 6 main themes: ?General Acceptance of the App,? ?Importance of the Targeted and Relevant App Content,? ?Importance of Credibility,? ?Importance of the App Usability,? ?Importance of a Simple and Attractive Design,? ?Importance of Notifications to Ensure App Use over Time.? Besides a general acceptance of the app, these themes reflected participants? recommendations toward increased usability; to improve the design; to include useful and rewarding contents; to make the app look serious and credible; and to add notifications to ensure its use over time. A total of 11 students tested prototype 2 (6 who tested prototype 1 and 5 new) and participated in semistructured interviews. The 6 same themes emerged from the analysis. Participants from phase 1 generally found the design and content of the app improved. Conclusions: Students recommend prevention smartphone apps to be easy to use, useful, rewarding, serious, and credible. These findings may be important to consider when developing prevention smartphone apps to increase the likelihood of app use over time. Trial Registration: ISRCTN registry 10007691; https://www.isrctn.com/ISRCTN10007691 International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-4145-2 UR - https://humanfactors.jmir.org/2023/1/e41088 UR - http://dx.doi.org/10.2196/41088 UR - http://www.ncbi.nlm.nih.gov/pubmed/36881448 ID - info:doi/10.2196/41088 ER - TY - JOUR AU - Biro, Joshua AU - Linder, Courtney AU - Neyens, David PY - 2023/2/1 TI - The Effects of a Health Care Chatbot?s Complexity and Persona on User Trust, Perceived Usability, and Effectiveness: Mixed Methods Study JO - JMIR Hum Factors SP - e41017 VL - 10 KW - electronic health record KW - EHR KW - health information KW - health education KW - patient education KW - chatbot KW - virtual agent KW - virtual assistant KW - usability KW - trust KW - adoption KW - artificial intelligence KW - effectiveness N2 - Background: The rising adoption of telehealth provides new opportunities for more effective and equitable health care information mediums. The ability of chatbots to provide a conversational, personal, and comprehendible avenue for learning about health care information make them a promising tool for addressing health care inequity as health care trends continue toward web-based and remote processes. Although chatbots have been studied in the health care domain for their efficacy for smoking cessation, diet recommendation, and other assistive applications, few studies have examined how specific design characteristics influence the effectiveness of chatbots in providing health information. Objective: Our objective was to investigate the influence of different design considerations on the effectiveness of an educational health care chatbot. Methods: A 2×3 between-subjects study was performed with 2 independent variables: a chatbot?s complexity of responses (eg, technical or nontechnical language) and the presented qualifications of the chatbot?s persona (eg, doctor, nurse, or nursing student). Regression models were used to evaluate the impact of these variables on 3 outcome measures: effectiveness, usability, and trust. A qualitative transcript review was also done to review how participants engaged with the chatbot. Results: Analysis of 71 participants found that participants who received technical language responses were significantly more likely to be in the high effectiveness group, which had higher improvements in test scores (odds ratio [OR] 2.73, 95% CI 1.05-7.41; P=.04). Participants with higher health literacy (OR 2.04, 95% CI 1.11-4.00, P=.03) were significantly more likely to trust the chatbot. The participants engaged with the chatbot in a variety of ways, with some taking a conversational approach and others treating the chatbot more like a search engine. Conclusions: Given their increasing popularity, it is vital that we consider how chatbots are designed and implemented. This study showed that factors such as chatbots? persona and language complexity are two design considerations that influence the ability of chatbots to successfully provide health care information. UR - https://humanfactors.jmir.org/2023/1/e41017 UR - http://dx.doi.org/10.2196/41017 UR - http://www.ncbi.nlm.nih.gov/pubmed/36724004 ID - info:doi/10.2196/41017 ER - TY - JOUR AU - Wang, Darrel AU - Balapal, Neha AU - Ankem, Amala AU - Shyamsundar, Saishravan AU - Balaji, Adarsh AU - Kannikal, Jasmine AU - Bruno, Marlie AU - He, Shuhan AU - Chong, Paul PY - 2023/1/27 TI - Primary Perspectives in Meme Utilization as a Digital Driver for Medical Community Engagement and Education Mobilization: Pre-Post Study JO - JMIR Hum Factors SP - e40244 VL - 10 KW - buprenorphine KW - DEA X-waiver KW - opioid use disorder KW - OUD KW - MAT KW - opioid KW - waiver KW - medical education KW - continuing education KW - e-training KW - e-learning KW - awareness KW - social media KW - engagement KW - marketing KW - promotion KW - meme KW - campaign KW - advertisement KW - advertising KW - outreach KW - Facebook KW - Twitter KW - Instagram N2 - Background: Memes have gone ?viral,? gaining increasing prominence as an effective communications strategy based on their unique ability to engage, educate, and mobilize target audiences in a call to action through a cost-efficient and culturally relevant approach. Within the medical community in particular, visual media has evolved as a means to influence clinical knowledge transfer. To this end, the GetWaivered (GW) project has leveraged memes as part of a behavioral economics toolkit to address one of the most critical public health emergencies of our time?the 20-year opioid epidemic. As part of a multidimensional digital awareness campaign to increase Drug Enforcement Administration (DEA)-X waiver course registration, GW investigated the results of meme usage in terms of impressions, website traffic, and ultimately user acquisition, as determined by web-based training enrollment and attendance outcomes. Objective: The objective of this study was to determine the efficacy of implementing humor-based promotional content versus the traditional educational model, and how the translation of the increase in engagement would increase the participant count and website traffic for GW?s remote DEA-X waiver training. Methods: The approach to this study was based on 2 time frames (pre- and postcampaign). During April-July 2021, we developed a campaign via advertisements on Facebook, Twitter, Instagram, and the GW website to expand outreach. These memes targeted medical professionals with the ability to prescribe buprenorphine. The time frame of this campaign measured engagement metrics and compared values to preceding months (January-March 2021) for our GetWaivered website and social media pages, which translated to registrants for our remote DEA-X waiver training. Results: By the end of July 2021, a total of 9598 individuals had visited the GW website. There was an average of 79.3 visitors per day, with the lowest number of daily visitors being 0 and the highest being 575. Conclusions: The use of memes may provide a medium for social media engagement (likes, comments, and shares) while influencing viewers to pursue a proposed action, such as e-training registration. UR - https://humanfactors.jmir.org/2023/1/e40244 UR - http://dx.doi.org/10.2196/40244 UR - http://www.ncbi.nlm.nih.gov/pubmed/36705964 ID - info:doi/10.2196/40244 ER - TY - JOUR AU - Morse, Brad AU - Soares, Andrey AU - Ytell, Kate AU - DeSanto, Kristen AU - Allen, Marvyn AU - Holliman, Dorsey Brooke AU - Lee, S. Rita AU - Kwan, M. Bethany AU - Schilling, M. Lisa PY - 2023/1/10 TI - Co-design of the Transgender Health Information Resource: Web-Based Participatory Design JO - J Particip Med SP - e38078 VL - 15 KW - transgender KW - gender diverse KW - participatory design KW - web-based design KW - co-design KW - health information resource KW - smartphone KW - app KW - mobile phone N2 - Background: There is an urgent and unmet need for accessible and credible health information within the transgender and gender-diverse (TGD) community. Currently, TGD individuals often seek and must find relevant resources by vetting social media posts. A resource that provides accessible and credible health-related resources and content via a mobile phone app may have a positive impact on and support the TGD population. Objective: COVID-19 stay-at-home orders forced a shift in the methods used in participatory design. In this paper, we aimed to describe the web-based participatory methods used to develop the Transgender Health Information Resource. We also described and characterized the web-based engagement that occurred during a single session of the overall design process. Methods: We planned and conducted web-based design sessions to replace the proposed in-person sessions. We used web-based collaborative tools, including Zoom (Zoom Video Communications), Mural (Mural), REDCap (Research Electronic Data Capture; Vanderbilt University), and Justinmind (Justinmind), to engage the participants in the design process. Zoom was used as an integrated platform for design activities. Mural was used to perform exercises, such as free listing, brainstorming, and grouping. REDCap allowed us to collect survey responses. Justinmind was used to create prototypes that were shared and discussed via Zoom. Recruitment was led by one of our community partners, One Colorado, who used private Facebook groups in which web-based flyers were dispersed. The design process took place in several workshops over a period of 10 months. We described and characterized engagement during a single design session by tracking the number of influential interactions among participants. We defined an influential interaction as communication, either verbal or web-based content manipulation, that advanced the design process. Results: We presented data from a single design session that lasted 1 hour and 48 minutes and included 4 participants. During the session, there were 301 influential interactions, consisting of 79 verbal comments and 222 web-based content manipulations. Conclusions: Web-based participatory design can elicit input and decisions from participants to develop a health information resource, such as a mobile app user interface. Overall, participants were highly engaged. This approach maintained the benefits and fidelity of traditional in-person design sessions, mitigated deficits, and exploited the previously unconsidered benefits of web-based methods, such as enhancing the ability to participate for those who live far from academic institutions. The web-based approach to participatory design was an efficient and feasible methodological design approach. UR - https://jopm.jmir.org/2023/1/e38078 UR - http://dx.doi.org/10.2196/38078 UR - http://www.ncbi.nlm.nih.gov/pubmed/36626222 ID - info:doi/10.2196/38078 ER - TY - JOUR AU - Herrijgers, Corinne AU - Platteau, Tom AU - Vandebosch, Heidi AU - Poels, Karolien AU - Florence, Eric PY - 2022/12/21 TI - Using Intervention Mapping to Develop an mHealth Intervention to Support Men Who Have Sex With Men Engaging in Chemsex (Budd): Development and Usability Study JO - JMIR Res Protoc SP - e39678 VL - 11 IS - 12 KW - mobile health KW - chemsex KW - intervention mapping KW - harm reduction KW - men who have sex with men KW - intervention KW - mobile phone N2 - Background: Chemsex refers to the intentional use of drugs before or during sex among men who have sex with men (MSM). Engaging in chemsex has been linked to significant negative impacts on physical, psychological, and social well-being. However, no evidence-based support tools have addressed either these harms or the care needs of MSM who engage in chemsex. Objective: The purpose of this paper was to describe the development of a mobile health intervention (named Budd) using the intervention mapping protocol (IMP). Budd aims to support and inform MSM who participate in chemsex, reduce the negative impacts associated with chemsex, and encourage more reasoned participation. Methods: The IMP consists of 6 steps to develop, implement, and evaluate evidence-based health interventions. A needs assessment was carried out between September 2, 2019, and March 31, 2020, by conducting a literature study and in-depth interviews. Change objectives were selected based on these findings, after which theory-based intervention methods were selected. The first version of the intervention was developed in December 2020 and pilot-tested between February 1, 2021, and April 30, 2021. Adjustments were made based on the findings from this study. A separate article will be dedicated to the effectiveness study, conducted between October 15, 2021, and February 24, 2022, and implementation of the intervention. The Budd app went live in April 2022. Results: Budd aims to address individual factors and support chemsex participants in applying harm reduction measures when taking drugs (drug information, drug combination tool, and notebook), preparing for participation in a chemsex session (articles on chemsex, preparation tool, and event-specific checklist), planning sufficient time after a chemsex session to recover (planning tool), seeking support for their chemsex participation (overview of existing local health care and peer support services, reflection, personal statistics, and user testimonials), taking HIV medication or pre-exposure prophylaxis in a timely manner during a chemsex session (preparation tool), and contacting emergency services in case of an emergency and giving first aid to others (emergency information and personal buddy). Conclusions: The IMP proved to be a valuable tool in the planning and development of the Budd app. This study provides researchers and practitioners with valuable information that may help them to set up their own health interventions. International Registered Report Identifier (IRRID): RR1-10.2196/39678 UR - https://www.researchprotocols.org/2022/12/e39678 UR - http://dx.doi.org/10.2196/39678 UR - http://www.ncbi.nlm.nih.gov/pubmed/36542451 ID - info:doi/10.2196/39678 ER - TY - JOUR AU - Fischer-Suárez, Natalia AU - Lozano-Paniagua, David AU - García-Duarte, Sonia AU - Castro-Luna, Gracia AU - Parrón-Carreño, Tesifón AU - Nievas-Soriano, José Bruno PY - 2022/11/8 TI - Using QR Codes as a Form of eHealth to Promote Health Among Women in a Pandemic: Cross-sectional Study JO - JMIR Hum Factors SP - e41143 VL - 9 IS - 4 KW - eHealth KW - QR code KW - women KW - health promotion KW - public health KW - healthcare sector KW - women's health KW - gynecology KW - gynecologist KW - gynecological KW - obstetrician KW - obstetric KW - healthcare KW - health care KW - pandemic KW - questionnaire KW - validation KW - validate KW - development KW - cross sectional KW - factorial analysis N2 - Background: QR codes have played an integral role during the pandemic in many sectors, but their use has been limited in the health care sector, especially by patients. Although some authors have stated that developing specific content for women on how to cope with health problems could be an effective way to prevent problems, especially during pandemics, there is little research regarding the use of QR codes to promote health during a pandemic, and even fewer studies are focused on women. Moreover, although the importance of assessing these interventions from the users? perspective has been stated, research carried out from this point of view is still scarce. Objective: This study aimed to assess the usefulness of using QR codes with information to promote women?s health in the context of a pandemic. We also sought to design and validate a questionnaire to assess this. Methods: A cross-sectional study was conducted among women in the gynecology waiting rooms of a reference hospital. Exploratory factorial analysis with the split-half method and Cronbach ? values was performed for questionnaire validation. Univariant and bivariant analyses were performed to analyze the data obtained. Results: In total, 186 women took part in the study. Exploratory factor analysis identified 2 domains: usability and applicability in medical practice. The Cronbach ? value was .81. Overall, 83.7% of the answers to the first domain and 56.4% of those to the second were favorable. Women with university education or those who had used QR codes before scored better in the usability domain, while no differences were observed in the applicability scores. Conclusions: Using QR codes in the gynecology clinics? waiting rooms can help promote women?s health during a pandemic, regardless of their education level or whether they have used QR codes before. The questionnaire developed herein is a helpful tool to assess this. These findings are important for clinical practice. This research can be performed in other ambits, specialties, or countries. UR - https://humanfactors.jmir.org/2022/4/e41143 UR - http://dx.doi.org/10.2196/41143 UR - http://www.ncbi.nlm.nih.gov/pubmed/36346657 ID - info:doi/10.2196/41143 ER - TY - JOUR AU - Wang, Tingting AU - Giunti, Guido AU - Melles, Marijke AU - Goossens, Richard PY - 2022/8/4 TI - Digital Patient Experience: Umbrella Systematic Review JO - J Med Internet Res SP - e37952 VL - 24 IS - 8 KW - digital health KW - eHealth KW - telemedicine KW - telehealth KW - mobile health KW - mHealth KW - patient experience KW - user experience KW - influencing factors KW - user-centered design KW - human-computer interaction N2 - Background: The adoption and use of technology have significantly changed health care delivery. Patient experience has become a significant factor in the entire spectrum of patient-centered health care delivery. Digital health facilitates further improvement and empowerment of patient experiences. Therefore, the design of digital health is served by insights into the barriers to and facilitators of digital patient experience (PEx). Objective: This study aimed to systematically review the influencing factors and design considerations of PEx in digital health from the literature and generate design guidelines for further improvement of PEx in digital health. Methods: We performed an umbrella systematic review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. We searched Scopus, PubMed, and Web of Science databases. Two rounds of small random sampling (20%) were independently reviewed by 2 reviewers who evaluated the eligibility of the articles against the selection criteria. Two-round interrater reliability was assessed using the Fleiss-Cohen coefficient (k1=0.88 and k2=0.80). Thematic analysis was applied to analyze the extracted data based on a small set of a priori categories. Results: The search yielded 173 records, of which 45 (26%) were selected for data analysis. Findings and conclusions showed a great diversity; most studies presented a set of themes (19/45, 42%) or descriptive information only (16/45, 36%). The digital PEx?related influencing factors were classified into 9 categories: patient capability, patient opportunity, patient motivation, intervention technology, intervention functionality, intervention interaction design, organizational environment, physical environment, and social environment. These can have three types of impacts: positive, negative, or double edged. We captured 4 design constructs (personalization, information, navigation, and visualization) and 3 design methods (human-centered or user-centered design, co-design or participatory design, and inclusive design) as design considerations. Conclusions: We propose the following definition for digital PEx: ?Digital patient experience is the sum of all interactions affected by a patient?s behavioral determinants, framed by digital technologies, and shaped by organizational culture, that influence patient perceptions across the continuum of care channeling digital health.? In this study, we constructed a design and evaluation framework that contains 4 phases?define design, define evaluation, design ideation, and design evaluation?and 9 design guidelines to help digital health designers and developers address digital PEx throughout the entire design process. Finally, our review suggests 6 directions for future digital PEx?related research. UR - https://www.jmir.org/2022/8/e37952 UR - http://dx.doi.org/10.2196/37952 UR - http://www.ncbi.nlm.nih.gov/pubmed/35925651 ID - info:doi/10.2196/37952 ER - TY - JOUR AU - Waddington, Claire AU - Harding, Emma AU - Brotherhood, V. Emilie AU - Davies Abbott, Ian AU - Barker, Suzanne AU - Camic, M. Paul AU - Ezeofor, Victory AU - Gardner, Hannah AU - Grillo, Adetola AU - Hardy, Chris AU - Hoare, Zoe AU - McKee-Jackson, Roberta AU - Moore, Kirsten AU - O?Hara, Trish AU - Roberts, Jennifer AU - Rossi-Harries, Samuel AU - Suarez-Gonzalez, Aida AU - Sullivan, Pat Mary AU - Edwards, Tudor Rhiannon AU - Van Der Byl Williams, Millie AU - Walton, Jill AU - Willoughby, Alicia AU - Windle, Gill AU - Winrow, Eira AU - Wood, Olivia AU - Zimmermann, Nikki AU - Crutch, J. Sebastian AU - Stott, Joshua PY - 2022/7/20 TI - The Development of Videoconference-Based Support for People Living With Rare Dementias and Their Carers: Protocol for a 3-Phase Support Group Evaluation JO - JMIR Res Protoc SP - e35376 VL - 11 IS - 7 KW - dementia KW - Alzheimer disease KW - frontotemporal dementia KW - posterior cortical atrophy KW - Lewy body dementia KW - Lewy body disease KW - primary progressive aphasia KW - young-onset dementia KW - early-onset dementia KW - atypical dementia KW - virtual KW - web-based KW - videoconference KW - videophone KW - support group N2 - Background: People living with rarer dementias face considerable difficulty accessing tailored information, advice, and peer and professional support. Web-based meeting platforms offer a critical opportunity to connect with others through shared lived experiences, even if they are geographically dispersed, particularly during the COVID-19 pandemic. Objective: We aim to develop facilitated videoconferencing support groups (VSGs) tailored to people living with or caring for someone with familial or sporadic frontotemporal dementia or young-onset Alzheimer disease, primary progressive aphasia, posterior cortical atrophy, or Lewy body dementia. This paper describes the development, coproduction, field testing, and evaluation plan for these groups. Methods: We describe a 3-phase approach to development. First, information and knowledge were gathered as part of a coproduction process with members of the Rare Dementia Support service. This information, together with literature searches and consultation with experts by experience, clinicians, and academics, shaped the design of the VSGs and session themes. Second, field testing involved 154 Rare Dementia Support members (people living with dementia and carers) participating in 2 rounds of facilitated sessions across 7 themes (health and social care professionals, advance care planning, independence and identity, grief and loss, empowering your identity, couples, and hope and dementia). Third, a detailed evaluation plan for future rounds of VSGs was developed. Results: The development of the small groups program yielded content and structure for 9 themed VSGs (the 7 piloted themes plus a later stages program and creativity club for implementation in rounds 3 and beyond) to be delivered over 4 to 8 sessions. The evaluation plan incorporated a range of quantitative (attendance, demographics, and geography; pre-post well-being ratings and surveys; psycholinguistic analysis of conversation; facial emotion recognition; facilitator ratings; and economic analysis of program delivery) and qualitative (content and thematic analysis) approaches. Pilot data from round 2 groups on the pre-post 3-word surveys indicated an increase in the emotional valence of words selected after the sessions. Conclusions: The involvement of people with lived experience of a rare dementia was critical to the design, development, and delivery of the small virtual support group program, and evaluation of this program will yield convergent data about the impact of tailored support delivered to geographically dispersed communities. This is the first study to design and plan an evaluation of VSGs specifically for people affected by rare dementias, including both people living with a rare dementia and their carers, and the outcome of the evaluation will be hugely beneficial in shaping specific and targeted support, which is often lacking in this population. International Registered Report Identifier (IRRID): DERR1-10.2196/35376 UR - https://www.researchprotocols.org/2022/7/e35376 UR - http://dx.doi.org/10.2196/35376 UR - http://www.ncbi.nlm.nih.gov/pubmed/35857375 ID - info:doi/10.2196/35376 ER - TY - JOUR AU - Buss, Helen Vera AU - Varnfield, Marlien AU - Harris, Mark AU - Barr, Margo PY - 2022/7/1 TI - Remotely Conducted App-Based Intervention for Cardiovascular Disease and Diabetes Risk Awareness and Prevention: Single-Group Feasibility Trial JO - JMIR Hum Factors SP - e38469 VL - 9 IS - 3 KW - mobile health KW - feasibility studies KW - primary prevention KW - cardiovascular disease KW - diabetes mellitus, type 2 KW - mHealth KW - cardiology KW - heart disease KW - diabetes KW - smartphone KW - participate engagement KW - app-based intervention N2 - Background: Cardiovascular disease and type 2 diabetes mellitus are two of the most prevalent chronic conditions worldwide. An unhealthy lifestyle greatly contributes to someone?s risk of developing these conditions. Mobile health is an emerging technology that can help deliver health promotion interventions to the population, for example, in the form of health apps. Objective: The aim of this study was to test the feasibility of an app-based intervention for cardiovascular and diabetes risk awareness and prevention by measuring nonusage, dropout, adherence to app use, and usability of the app over 3 months. Methods: Participants were eligible if they were aged 45 years or older, resided in Australia, were free of cardiovascular disease and diabetes, were fluent in English, and owned a smartphone. In the beginning, participants received an email with instructions on how to install the app and a user guide. After 3 months, they received an email with an invitation to an end-of-study survey. The survey included questions about general smartphone use and the user version of the Mobile Application Rating Scale. We analyzed app-generated and survey data by using descriptive and inferential statistics as well as thematic analysis for open-text comments. Results: Recruitment took place between September and October 2021. Of the 46 participants who consented to the study, 20 (44%) never used the app and 15 (33%) dropped out. The median age of the app users at baseline was 62 (IQR 56-67) years. Adherence to app use, that is, using the app at least once a week over 3 months, was 17% (8/46) of the total sample and 31% (8/26) of all app users. The mean app quality rating on the user version of the Mobile Application Rating Scale was 3.5 (SD 0.6) of 5 points. The app scored the highest for the information section and the lowest for the engagement section of the scale. Conclusions: Nonusage and dropouts were too high, and the adherence was too low to consider the intervention in its current form feasible. Potential barriers that we identified include the research team not actively engaging with participants early in the study to verify that all participants could install the app, the intervention did not involve direct contact with health care professionals, and the app did not have enough interactive features. UR - https://humanfactors.jmir.org/2022/3/e38469 UR - http://dx.doi.org/10.2196/38469 UR - http://www.ncbi.nlm.nih.gov/pubmed/35776504 ID - info:doi/10.2196/38469 ER - TY - JOUR AU - Kopka, Marvin AU - Schmieding, L. Malte AU - Rieger, Tobias AU - Roesler, Eileen AU - Balzer, Felix AU - Feufel, A. Markus PY - 2022/5/3 TI - Determinants of Laypersons? Trust in Medical Decision Aids: Randomized Controlled Trial JO - JMIR Hum Factors SP - e35219 VL - 9 IS - 2 KW - symptom checkers KW - disposition advice KW - anthropomorphism KW - artificial intelligence KW - urgency assessment KW - patient-centered care KW - human-computer interaction KW - consumer health KW - information technology KW - IT KW - mobile phone N2 - Background: Symptom checker apps are patient-facing decision support systems aimed at providing advice to laypersons on whether, where, and how to seek health care (disposition advice). Such advice can improve laypersons? self-assessment and ultimately improve medical outcomes. Past research has mainly focused on the accuracy of symptom checker apps? suggestions. To support decision-making, such apps need to provide not only accurate but also trustworthy advice. To date, only few studies have addressed the question of the extent to which laypersons trust symptom checker app advice or the factors that moderate their trust. Studies on general decision support systems have shown that framing automated systems (anthropomorphic or emphasizing expertise), for example, by using icons symbolizing artificial intelligence (AI), affects users? trust. Objective: This study aims to identify the factors influencing laypersons? trust in the advice provided by symptom checker apps. Primarily, we investigated whether designs using anthropomorphic framing or framing the app as an AI increases users? trust compared with no such framing. Methods: Through a web-based survey, we recruited 494 US residents with no professional medical training. The participants had to first appraise the urgency of a fictitious patient description (case vignette). Subsequently, a decision aid (mock symptom checker app) provided disposition advice contradicting the participants? appraisal, and they had to subsequently reappraise the vignette. Participants were randomized into 3 groups: 2 experimental groups using visual framing (anthropomorphic, 160/494, 32.4%, vs AI, 161/494, 32.6%) and a neutral group without such framing (173/494, 35%). Results: Most participants (384/494, 77.7%) followed the decision aid?s advice, regardless of its urgency level. Neither anthropomorphic framing (odds ratio 1.120, 95% CI 0.664-1.897) nor framing as AI (odds ratio 0.942, 95% CI 0.565-1.570) increased behavioral or subjective trust (P=.99) compared with the no-frame condition. Even participants who were extremely certain in their own decisions (ie, 100% certain) commonly changed it in favor of the symptom checker?s advice (19/34, 56%). Propensity to trust and eHealth literacy were associated with increased subjective trust in the symptom checker (propensity to trust b=0.25; eHealth literacy b=0.2), whereas sociodemographic variables showed no such link with either subjective or behavioral trust. Conclusions: Contrary to our expectation, neither the anthropomorphic framing nor the emphasis on AI increased trust in symptom checker advice compared with that of a neutral control condition. However, independent of the interface, most participants trusted the mock app?s advice, even when they were very certain of their own assessment. Thus, the question arises as to whether laypersons use such symptom checkers as substitutes rather than as aids in their own decision-making. With trust in symptom checkers already high at baseline, the benefit of symptom checkers depends on interface designs that enable users to adequately calibrate their trust levels during usage. Trial Registration: Deutsches Register Klinischer Studien DRKS00028561; https://tinyurl.com/rv4utcfb (retrospectively registered). UR - https://humanfactors.jmir.org/2022/2/e35219 UR - http://dx.doi.org/10.2196/35219 UR - http://www.ncbi.nlm.nih.gov/pubmed/35503248 ID - info:doi/10.2196/35219 ER - TY - JOUR AU - Nißen, Marcia AU - Rüegger, Dominik AU - Stieger, Mirjam AU - Flückiger, Christoph AU - Allemand, Mathias AU - v Wangenheim, Florian AU - Kowatsch, Tobias PY - 2022/4/27 TI - The Effects of Health Care Chatbot Personas With Different Social Roles on the Client-Chatbot Bond and Usage Intentions: Development of a Design Codebook and Web-Based Study JO - J Med Internet Res SP - e32630 VL - 24 IS - 4 KW - chatbot KW - conversational agent KW - social roles KW - interpersonal closeness KW - social role theory KW - working alliance KW - design KW - persona KW - digital health intervention KW - web-based experiment N2 - Background: The working alliance refers to an important relationship quality between health professionals and clients that robustly links to treatment success. Recent research shows that clients can develop an affective bond with chatbots. However, few research studies have investigated whether this perceived relationship is affected by the social roles of differing closeness a chatbot can impersonate and by allowing users to choose the social role of a chatbot. Objective: This study aimed at understanding how the social role of a chatbot can be expressed using a set of interpersonal closeness cues and examining how these social roles affect clients? experiences and the development of an affective bond with the chatbot, depending on clients? characteristics (ie, age and gender) and whether they can freely choose a chatbot?s social role. Methods: Informed by the social role theory and the social response theory, we developed a design codebook for chatbots with different social roles along an interpersonal closeness continuum. Based on this codebook, we manipulated a fictitious health care chatbot to impersonate one of four distinct social roles common in health care settings?institution, expert, peer, and dialogical self?and examined effects on perceived affective bond and usage intentions in a web-based lab study. The study included a total of 251 participants, whose mean age was 41.15 (SD 13.87) years; 57.0% (143/251) of the participants were female. Participants were either randomly assigned to one of the chatbot conditions (no choice: n=202, 80.5%) or could freely choose to interact with one of these chatbot personas (free choice: n=49, 19.5%). Separate multivariate analyses of variance were performed to analyze differences (1) between the chatbot personas within the no-choice group and (2) between the no-choice and the free-choice groups. Results: While the main effect of the chatbot persona on affective bond and usage intentions was insignificant (P=.87), we found differences based on participants? demographic profiles: main effects for gender (P=.04, ?p2=0.115) and age (P<.001, ?p2=0.192) and a significant interaction effect of persona and age (P=.01, ?p2=0.102). Participants younger than 40 years reported higher scores for affective bond and usage intentions for the interpersonally more distant expert and institution chatbots; participants 40 years or older reported higher outcomes for the closer peer and dialogical-self chatbots. The option to freely choose a persona significantly benefited perceptions of the peer chatbot further (eg, free-choice group affective bond: mean 5.28, SD 0.89; no-choice group affective bond: mean 4.54, SD 1.10; P=.003, ?p2=0.117). Conclusions: Manipulating a chatbot?s social role is a possible avenue for health care chatbot designers to tailor clients? chatbot experiences using user-specific demographic factors and to improve clients? perceptions and behavioral intentions toward the chatbot. Our results also emphasize the benefits of letting clients freely choose between chatbots. UR - https://www.jmir.org/2022/4/e32630 UR - http://dx.doi.org/10.2196/32630 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475761 ID - info:doi/10.2196/32630 ER - TY - JOUR AU - Dupont, Charlèss AU - Smets, Tinne AU - Monnet, Fanny AU - Pivodic, Lara AU - De Vleminck, Aline AU - Van Audenhove, Chantal AU - Van den Block, Lieve PY - 2022/4/20 TI - Publicly Available, Interactive Web-Based Tools to Support Advance Care Planning: Systematic Review JO - J Med Internet Res SP - e33320 VL - 24 IS - 4 KW - advance care planning KW - systematic review KW - web-based tools KW - health communication KW - quality of online content N2 - Background: There is an increasing number of interactive web-based advance care planning (ACP) support tools, which are web-based aids in any format encouraging reflection, communication, and processing of publicly available information, most of which cannot be found in the peer-reviewed literature. Objective: This study aims to conduct a systematic review of web-based ACP support tools to describe the characteristics, readability, and quality of content and investigate whether and how they are evaluated. Methods: We systematically searched the web-based gray literature databases OpenGrey, ClinicalTrials.gov, ProQuest, British Library, Grey Literature in the Netherlands, and Health Services Research Projects in Progress, as well as Google and app stores, and consulted experts using the following eligibility criteria: web-based, designed for the general population, accessible to everyone, interactive (encouraging reflection, communication, and processing of information), and in English or Dutch. The quality of content was evaluated using the Quality Evaluation Scoring Tool (score 0-28?a higher score indicates better quality). To synthesize the characteristics of the ACP tools, readability and quality of content, and whether and how they were evaluated, we used 4 data extraction tables. Results: A total of 30 tools met the eligibility criteria, including 15 (50%) websites, 10 (33%) web-based portals, 3 (10%) apps, and 2 (7%) with a combination of formats. Of the 30 tools, 24 (80%) mentioned a clear aim, including 7 (23%) that supported reflection or communication, 8 (27%) that supported people in making decisions, 7 (23%) that provided support to document decisions, and 2 (7%) that aimed to achieve all these aims. Of the 30 tools, 7 (23%) provided information on the development, all of which were developed in collaboration with health care professionals, and 3 (10%) with end users. Quality scores ranged between 11 and 28, with most of the lower-scoring tools not referring to information sources. Conclusions: A variety of ACP support tools are available on the web, varying in the quality of content. In the future, users should be involved in the development process of ACP support tools, and the content should be substantiated by scientific evidence. Trial Registration: PROSPERO CRD42020184112; https://tinyurl.com/mruf8b43 UR - https://www.jmir.org/2022/4/e33320 UR - http://dx.doi.org/10.2196/33320 UR - http://www.ncbi.nlm.nih.gov/pubmed/35442207 ID - info:doi/10.2196/33320 ER - TY - JOUR AU - Öeren, Mariliis AU - Jordan, Iain AU - Coughlin, Deborah AU - Turnbull, Sophie PY - 2022/3/23 TI - Improving Access to Behavioral Strategies to Improve Mental Well-being With an Entertaining Breakfast Show App: Feasibility Evaluation Study JO - JMIR Form Res SP - e25715 VL - 6 IS - 3 KW - mental well-being KW - mental health KW - smartphone KW - mobile app KW - education KW - entertainment KW - psychotherapy KW - feasibility KW - mobile phone N2 - Background: Although mental ill-health is more prevalent among people from lower socioeconomic groups, digital mental well-being innovations are often developed for people from higher socioeconomic groups, who already have resources to maintain good mental and physical health. To decrease health inequalities and ensure that available solutions are appealing and accessible to people with fewer resources, new approaches should be explored. We developed the app Wakey!, which focused on creating engaging mental health content that is accessible, particularly among lower socioeconomic groups in the United Kingdom. Objective: The aim of this study is to assess engagement with the app, investigate initial effectiveness data for 6 well-being outcomes, and explore participants? subjective experiences of using Wakey! Methods: The app Wakey! was publicly launched on January 20, 2020, and was free to download from Apple Store and Google Play. The app provided its users with entertaining and educational content related to mental well-being. Concurrently, a single-arm mixed methods feasibility trial was carried out from January to April 2020 among people who had downloaded the app and created an account. The primary outcome was engagement, which was collected passively from data logs. Secondary outcome measures were 6 well-being outcomes collected from self-report questionnaires. Individual interviews with 19 app users were carried out in April 2020. Results: In total, 5413 people fit the inclusion criteria and were included in the final sample?65.62% (3520/5364) women, 61.07% (3286/5381) aged between 25 and 44 years, 61.61% (2902/4710) in employment, 8.92% (420/4710) belonging to the lower socioeconomic group, and 8.09% (438/5413) were engaged users. There was no evidence of a difference in engagement regarding sociodemographic and socioeconomic characteristics. There was evidence that users with a higher average daily sleep score, who joined the study more recently, who had higher baseline self-report of sleep quality, and who found episodes more entertaining were more likely to be engaged users. Among 230 users who provided follow-up data, there was evidence of improvements on four of the six well-being outcomes: life satisfaction (P<.001), feeling that life is worthwhile (P=.01), ease of getting up in the morning (P<.001), and self-efficacy (P=.04). The app and its content were well received by those who were interviewed, and several people perceived a positive change in their mental well-being. Conclusions: This study shows that the app Wakey! could potentially be engaging across different socioeconomic groups, and there is an indication that it could positively impact the mental well-being of those engaged with the app. However, this study was a pragmatic trial with a limited sample, and the selection bias was present in the qualitative and quantitative study. Further work is needed to make any generalizable conclusions. Trial Registration: ClinicalTrials.gov NCT04287296; https://clinicaltrials.gov/ct2/show/NCT04287296 UR - https://formative.jmir.org/2022/3/e25715 UR - http://dx.doi.org/10.2196/25715 UR - http://www.ncbi.nlm.nih.gov/pubmed/35319468 ID - info:doi/10.2196/25715 ER - TY - JOUR AU - Marziliano, Allison AU - Diefenbach, A. Michael AU - Hudson, V. Shawna AU - Tagai, K. Erin AU - Handorf, A. Elizabeth AU - Bator, Alicja AU - Miller, M. Suzanne PY - 2022/3/21 TI - Demographic and Psychosocial Characteristics Associated With Use of a Prostate Cancer Survivorship Website: Implications From a Multisite Randomized Controlled Trial JO - J Med Internet Res SP - e27890 VL - 24 IS - 3 KW - prostate cancer KW - cancer survivorship KW - web-based resource KW - monitoring style of coping KW - cancer KW - survivorship KW - eHealth KW - emotions KW - interpersonal N2 - Background: Many prostate cancer (PC) survivors experience disease and treatment-related symptomatology in both the physical and psychosocial domains. Although the benefits and barriers to using web-based resources for cancer patients are well-documented, less research has focused on the personal characteristics important for efficient tailoring and targeting of information that are associated with usage. Objective: We used the Cognitive-Social Health Information Processing (C-SHIP) framework to guide our exploration of personal characteristics associated with use of PROGRESS, an informational PC survivorship website that addresses physical, emotional, interpersonal, and practical concerns relevant for PC survivors. Methods: PC survivors (N=217) were randomized to the intervention arm (PROGRESS) of a randomized controlled trial. Of those randomized to the intervention arm, 84 used PROGRESS, and 133 did not use PROGRESS. Multivariable analyses evaluated demographic and psychosocial characteristics (eg, style of coping, health literacy, self-efficacy, affective states of depression, anxiety, and fatigue) associated with website use. Results: A larger proportion of non-Hispanic White (68/160, 42.5%), compared with non-Hispanic Black (9/40, 23%), participants used PROGRESS (P<.001). Further, PROGRESS users were older in age (P<.001), had a monitoring style of coping (P=.01), and were less depressed (P=.004), anxious (P=.02), and fatigued (P<.001) than nonusers. Education, income, health literacy, blunting style of coping, self-efficacy, and treatment type (radiation therapy or surgery) were not significantly related to use. On multivariable analyses, race (OR 0.28, P<.001), age (OR 1.05, P<.001), monitoring style of coping (OR 1.27, P=.02), and overall mood (OR 0.98, P<.001) remained significant. Conclusions: A combination of monitoring and low levels of negative affect were associated with website use. Additionally, users were older, non-Hispanic White survivors. To ensure that important survivorship-relevant information reaches users, future efforts need to focus on enhancing patient engagement. Trial Registration: ClinicalTrials.gov NCT02224482; https://clinicaltrials.gov/ct2/show/NCT02224482 UR - https://www.jmir.org/2022/3/e27890 UR - http://dx.doi.org/10.2196/27890 UR - http://www.ncbi.nlm.nih.gov/pubmed/35311678 ID - info:doi/10.2196/27890 ER - TY - JOUR AU - Happe, Lisa AU - Sgraja, Marie AU - Hein, Andreas AU - Diekmann, Rebecca PY - 2022/3/16 TI - Iterative Development and Applicability of a Tablet-Based e-Coach for Older Adults in Rehabilitation Units to Improve Nutrition and Physical Activity: Usability Study JO - JMIR Hum Factors SP - e31823 VL - 9 IS - 1 KW - older adults KW - rehabilitation KW - physical activity KW - nutrition KW - e-coach KW - usability testing KW - tablet computers KW - health behavior KW - mobile phone N2 - Background: Maintaining nutrition and exercise strategies after rehabilitation can be difficult for older people with malnutrition or limited mobility. A technical assistance system such as an e-coach could help to positively influence changes in dietary and exercise behavior and contribute to a sustainable improvement in one?s nutrition and mobility status. Most apps do not provide a combination of nutrition and exercise content. In most cases, these apps were evaluated with healthy individuals aged <70 years, making transferability to vulnerable patients, with functional limitations and an assumed lower affinity for technology, in geriatric rehabilitation unlikely. Objective: This study aims to identify the potential for optimization and enhance usability through iterative test phases to develop a nutrition and mobility e-coach suitable for older adults (?65 years) based on individual health behavior change stages in a rehabilitation setting. Methods: Iterative testing was performed with patients aged ?65 years in a rehabilitation center. During testing, participants used an e-coach prototype with educational elements and active input options on nutrition and mobility as a 1-time application test. The participants performed navigation and comprehension tasks and subsequently provided feedback on the design aspects. Hints were provided by the study team when required, documented, and used for improvements. After testing, the participants were asked to rate the usability of the prototype using the System Usability Scale (SUS). Results: In all, 3 iterative test phases (T1-T3) were conducted with 49 participants (24/49, 49% female; mean 77.8, SD 6.2 years). Improvements were made after each test phase, such as adding explanatory notes on overview screens or using consistent chart types. The use of the user-centered design in this specific target group facilitated an increase in the average SUS score from 69.3 (SD 16.3; median 65) at T1 to 78.1 (SD 11.8; median 82.5) at T3. Fewer hints were required for navigation tasks (T1: 14.1%; T2: 26.5%; T3: 17.2%) than for comprehension questions (T1: 30.5%; T2: 21.6%; T3: 20%). However, the proportion of unsolved tasks, calculated across all participants in all tasks, was higher for navigation tasks (T1: 0%, T2: 15.2%, T3: 4.3%) than for comprehension tasks (T1: 1.9%, T2: 0%, T3: 2.5%). Conclusions: The extensive addition of explanatory sentences and terms, instead of shorter keywords, to make it easier for users to navigate and comprehend the content was a major adjustment. Thus, good usability (SUS: 80th-84th percentile) was achieved using iterative optimizations within the user-centered design. Long-term usability and any possible effects on nutritional and physical activity behavior need to be evaluated in an additional study in which patients should be able to use the e-coach with increasing independence, thereby helping them to gain access to content that could support their long-term behavior change. UR - https://humanfactors.jmir.org/2022/1/e31823 UR - http://dx.doi.org/10.2196/31823 UR - http://www.ncbi.nlm.nih.gov/pubmed/35293874 ID - info:doi/10.2196/31823 ER - TY - JOUR AU - Bangash, Hana AU - Makkawy, Ahmed AU - Gundelach, H. Justin AU - Miller, A. Alexandra AU - Jacobson, A. Kimberly AU - Kullo, J. Iftikhar PY - 2022/2/15 TI - Web-Based Tool (FH Family Share) to Increase Uptake of Cascade Testing for Familial Hypercholesterolemia: Development and Evaluation JO - JMIR Hum Factors SP - e32568 VL - 9 IS - 1 KW - familial hypercholesterolemia KW - cascade testing KW - communication KW - genetic counselors KW - digital tools KW - website KW - usability KW - user experience KW - public health N2 - Background: Familial hypercholesterolemia, a prevalent genetic disorder, remains significantly underdiagnosed in the United States. Cascade testing, wherein individuals diagnosed with familial hypercholesterolemia? probands?contact their family members to inform them of their risk for familial hypercholesterolemia, has low uptake in the United States. Digital tools are needed to facilitate communication between familial hypercholesterolemia probands and their family members and to promote sharing of familial hypercholesterolemia?related risk information. Objective: We aimed to create and evaluate a web-based tool designed to enhance familial communication and promote cascade testing for familial hypercholesterolemia. Methods: A hybrid type 1 implementation science framework and a user-centered design process were used to develop an interactive web-based tool?FH Family Share?that enables familial hypercholesterolemia probands to communicate information about their familial hypercholesterolemia diagnosis with at-risk relatives. Probands can also use the tool to draw a family pedigree and learn more about familial hypercholesterolemia through education modules and curated knowledge resources. Usability guidelines and standards were taken into account during the design and development of the tool. The initial prototype underwent a cognitive walkthrough, which was followed by usability testing with key stakeholders including genetic counselors and patients with familial hypercholesterolemia. Participants navigated the prototype using the think-aloud technique, and their feedback was used to refine features of the tool. Results: Key themes that emerged from the cognitive walkthrough were design, format, navigation, terminology, instructions, and learnability. Expert feedback from the cognitive walkthrough resulted in a rebuild of the web-based tool to align it with institutional standards. Usability testing with genetic counselors and patients with familial hypercholesterolemia provided insights on user experience, satisfaction and interface design and highlighted specific modifications that were made to refine the features of FH Family Share. Genetic counselors and patients with familial hypercholesterolemia suggested inclusion of the following features in the web-based tool: (1) a letter-to-family-member email template, (2) education modules, and (3) knowledge resources. Surveys revealed that 6 of 9 (67%) genetic counselors found information within FH Family Share very easy to find, and 5 of 9 (56%) genetic counselors found information very easy to understand; 5 of 9 (56%) patients found information very easy to find within the website, and 7 of 9 (78%) patients found information very easy to understand. All genetic counselors and patients indicated that FH Family Share was a resource worth returning to. Conclusions: FH Family Share facilitates communication between probands and their relatives. Once informed, at-risk family members have the option to seek testing and treatment for familial hypercholesterolemia. UR - https://humanfactors.jmir.org/2022/1/e32568 UR - http://dx.doi.org/10.2196/32568 UR - http://www.ncbi.nlm.nih.gov/pubmed/35166678 ID - info:doi/10.2196/32568 ER - TY - JOUR AU - Bassi, Giulia AU - Giuliano, Claudio AU - Perinelli, Alessio AU - Forti, Stefano AU - Gabrielli, Silvia AU - Salcuni, Silvia PY - 2022/1/21 TI - A Virtual Coach (Motibot) for Supporting Healthy Coping Strategies Among Adults With Diabetes: Proof-of-Concept Study JO - JMIR Hum Factors SP - e32211 VL - 9 IS - 1 KW - virtual coach KW - diabetes mellitus KW - adults KW - psychosocial factors KW - mindfulness KW - proof-of-concept study KW - mobile phone N2 - Background: Motivation is a core component of diabetes self-management because it allows adults with diabetes mellitus (DM) to adhere to clinical recommendations. In this context, virtual coaches (VCs) have assumed a central role in supporting and treating common barriers related to adherence. However, most of them are mainly focused on medical and physical purposes, such as the monitoring of blood glucose levels or following a healthy diet. Objective: This proof-of-concept study aims to evaluate the preliminary efficacy of a VC intervention for psychosocial support before and after the intervention and at follow-up. The intent of this VC is to motivate adults with type 1 DM and type 2 DM to adopt and cultivate healthy coping strategies to reduce symptoms of depression, anxiety, perceived stress, and diabetes-related emotional distress, while also improving their well-being. Methods: A total of 13 Italian adults with DM (18-51 years) interacted with a VC, called Motibot (motivational bot) using the Telegram messaging app. The interaction covered 12 sessions, each lasting 10 to 20 minutes, during which the user could dialogue with the VC by inputting text or tapping an option on their smartphone screen. Motibot is developed within the transtheoretical model of change to deliver the most appropriate psychoeducational intervention based on the user?s motivation to change. Results: Results showed that over the 12 sessions, there were no significant changes before and after the intervention and at follow-up regarding psychosocial factors. However, most users showed a downward trend over the 3 time periods in depression and anxiety symptoms, thereby presenting good psychological well-being and no diabetes-related emotional distress. In addition, users felt motivated, involved, encouraged, emotionally understood, and stimulated by Motibot during the interaction. Indeed, the analyses of semistructured interviews, using a text mining approach, showed that most users reported a perceived reduction in anxiety, depression, and/or stress symptoms. Moreover, users indicated the usefulness of Motibot in supporting and motivating them to find a mindful moment for themselves and to reflect on their own emotions. Conclusions: Motibot was well accepted by users, particularly because of the inclusion of mindfulness practices, which motivated them to adopt healthy coping skills. To this extent, Motibot provided psychosocial support for adults with DM, particularly for those with mild and moderate symptoms, whereas those with severe symptoms may benefit more from face-to-face psychotherapy. UR - https://humanfactors.jmir.org/2022/1/e32211 UR - http://dx.doi.org/10.2196/32211 UR - http://www.ncbi.nlm.nih.gov/pubmed/35060918 ID - info:doi/10.2196/32211 ER - TY - JOUR AU - Braakhuis, Andrea AU - Gillies, Nicola AU - Worthington, Anna AU - Knowles, Scott AU - Conner, Tamlin AU - Roy, Rajshri AU - Pham, Toan AU - Bermingham, Emma AU - Cameron-Smith, David PY - 2021/12/21 TI - A Modern Flexitarian Dietary Intervention Incorporating Web-Based Nutrition Education in Healthy Young Adults: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e30909 VL - 10 IS - 12 KW - protein KW - meat KW - vegetarian KW - eating patterns KW - diet KW - nutrition KW - dietary restrictions KW - biomarkers KW - health KW - well-being KW - macronutrients KW - micronutrients N2 - Background: The trend of flexitarian eating patterns is on the rise, with young adults among the biggest adopters claiming health and environmental reasons to reduce red meat intake. Nutrient-dense meat and animal products are often the lynchpin of these diets, even when consumed only occasionally and in moderate amounts. Red meat provides forms and concentrations of essential proteins, lipids, and micronutrients that are scarce in exclusively vegetarian regimens. Objective: The aim of this study is to consider the effects of moderate consumption of lean red meat as part of an otherwise vegetarian balanced diet and its impact on biomarkers of sustained health and well-being. Methods: A cohort of healthy, young (20-34 years old, n=80) male and female participants will take part in a 2-arm, parallel randomized controlled trial (RCT) for a duration of 12 weeks, with a 3-month posttrial follow-up. The trial will commence with a 2-week assessment period followed by allocation to the intervention arms. The intervention will include the consumption of red meat or meat alternatives 3 times per week for 10 weeks. Blood samples of the participants will be collected to measure changes in erythrocyte fatty acid distribution, circulating amino acids, neurotransmitters, markers of mineral status, and inflammatory markers. Questionnaires to assess well-being and mental health will be undertaken every 2 weeks. Body composition, physical function, and blood parameters will be assessed at allocation (t0), week 5 into the intervention (t5), and post intervention (t10). Results: The protocol has been developed using the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) checklist and the outcomes will be reported in accordance with the CONSORT (Consolidated Standards of Reporting Trials) guidelines. The trial was approved by the New Zealand Ministry of Health?s Health and Disability Ethics Committees (protocol 20/STH/157). The results of this study will be communicated via publication. Conclusions: To our knowledge, this is the first RCT investigating the overarching health consequences of consuming pasture-fed red meat or no meat as part of a healthy diet. Trial Registration: ClinicalTrials.gov NCT04869163; https://clinicaltrials.gov/ct2/show/NCT04869163 International Registered Report Identifier (IRRID): PRR1-10.2196/30909 UR - https://www.researchprotocols.org/2021/12/e30909 UR - http://dx.doi.org/10.2196/30909 UR - http://www.ncbi.nlm.nih.gov/pubmed/34931994 ID - info:doi/10.2196/30909 ER - TY - JOUR AU - Pant, Ichhya AU - Rimal, Rajiv AU - Yilma, Hagere AU - Bingenheimer, Jeffrey AU - Sedlander, Erica AU - Behera, Sibabrata PY - 2021/11/22 TI - mHealth for Anemia Reduction: Protocol for an Entertainment Education?Based Dual Intervention JO - JMIR Res Protoc SP - e26252 VL - 10 IS - 11 KW - mHealth KW - interactive KW - voice response KW - entertainment KW - education KW - rural KW - anemia KW - bystander KW - violence against women N2 - Background: More than half of the women of reproductive age (aged 15-49 years) are anemic in India. The uptake of and adherence to iron folic acid (IFA) supplements remain low despite sustained efforts to increase their use. With India?s burgeoning digital environment, mobile phones offer a potential medium for increasing their uptake, especially when combined with interactive voice messages that deliver entertaining stories infused with norms-based educational messages. Objective: This study aims to investigate whether a norms-based entertainment education mobile health intervention can increase self-efficacy for IFA adherence among women of reproductive age in Odisha, India. Methods: Mobile reduction in anemia through normative innovations (mRANI) is a randomized 2-arm study that includes assessments before and after the intervention. All study participants will be recruited from the intervention arm of the parent reduction in anemia through normative innovations trial only. Although the usual practice is to randomize participants either to a treatment arm or a usual care control arm, we will assign the mRANI control group to another entertainment education?based treatment group that is designed to improve bystander intervention to reduce violence against women. Data collection for the mRANI study is embedded in the parent trial and will include baseline and end line assessments. The primary outcomes are self-efficacy for IFA adherence and violence against women?related bystander intervention. The inclusion criteria for the mRANI study are participation in the parent trial and phone ownership. Women (approximately n=400) who meet the mRANI inclusion criteria will be randomly assigned to the IFA arm or the bystander arm. Ordinary least squares regression with robust SEs will be conducted to assess between-group comparisons at the end line. A mediation analysis will be conducted to examine whether social norms and interactivity mediate the relationship between intervention exposure and primary outcomes in both arms. Real-time monitoring data will offer insights into intervention receptivity and audience engagement. Results: Data collection for the mRANI study is integrated within the parent trial. Household surveys were conducted between February and March of 2021. Responses on the mRANI study?s primary and secondary outcomes were collected from 381 participants. The data analysis is expected to be completed by October 2021. Conclusions: This study will provide evidence on whether a mobile health norms?based entertainment education intervention can increase self-efficacy for IFA adherence and violence against women?related bystander intervention. International Registered Report Identifier (IRRID): PRR1-10.2196/26252 UR - https://www.researchprotocols.org/2021/11/e26252 UR - http://dx.doi.org/10.2196/26252 UR - http://www.ncbi.nlm.nih.gov/pubmed/34812735 ID - info:doi/10.2196/26252 ER - TY - JOUR AU - Tian, Xu AU - Yi, Li-Juan AU - Han, Yang AU - Chen, Hui AU - Liu, Xiao-Ling AU - Chen, Wei-Qing AU - Jiménez-Herrera, F. Maria PY - 2021/10/25 TI - Comparative Effectiveness of Enhanced Patient Instructions for Bowel Preparation Before Colonoscopy: Network Meta-analysis of 23 Randomized Controlled Trials JO - J Med Internet Res SP - e19915 VL - 23 IS - 10 KW - colonoscopy KW - bowel preparation KW - patient instruction KW - systematic review KW - network meta-analysis N2 - Background: Various enhanced patient instructions (EPIs) have been used for bowel preparation (BP) and our previous meta-analysis also demonstrated the efficacy of EPIs in increasing the colonic polyp and adenoma detection rates; however, the optimal method for adequate BP has not yet been developed. Objective: We performed a network meta-analysis to determine the optimal instructions. Methods: We searched for randomized controlled trials (RCTs) comparing the effectiveness of EPIs with each other or standard patient instructions (SPIs) for BP. We performed direct and Bayesian network meta-analyses for all instructions and used the GRADE (Grading of Recommendations Assessment, Development and Evaluation) criteria to appraise the quality of evidence. Results: We included 23 RCTs (7969 patients) comparing 10 different instructions. In direct meta-analyses, most of the EPIs, except visual aids and mobile apps, increased the adequate preparation rate (APR). Network meta-analyses showed that additional explanations were superior to visual aids (odds ratio [OR] 0.35, 95% CI 0.19-0.59), telephone calls (OR 0.62, 95% CI 0.37-0.99), educational videos (OR 0.79, 95% CI 0.5-0.77), and mobile apps (OR 0.33, 95% CI 0.14-0.68) with low-to-high-quality evidence; newly designed booklets (OR 3.28, 95% CI 1.59-6.16), SMS text messaging (OR 2.33, 95% CI 1.28-3.91), telephone calls (OR 1.86, 95% CI 1.03-1.78), educational videos (OR 2.33, 95% CI 1.40-3.65), and social media applications (OR 2.42, 95% CI 1.4-3.93) were superior to visual aids and mobile apps with low-to-high-quality evidence. SMS text messaging, telephone calls, and social media applications increase adherence to and satisfaction with the BP regime. Social media applications reduce the risk of adverse events (AEs). Telephone calls and social media applications increase the polyp detection rate (PDR). Conclusions: Newly designed booklets, telephone calls, educational videos, and social media applications can improve the quality of BP. Telephone calls and social media applications improve adherence to and satisfaction with the BP regime, reduce the risk of AEs, and increase the PDR. Trial Registration: INPLASY (International Platform of Registered Systematic Review and Meta-analysis Protocols) INPLASY2020120103; https://inplasy.com/inplasy-2020-12-0103/ UR - https://www.jmir.org/2021/10/e19915 UR - http://dx.doi.org/10.2196/19915 UR - http://www.ncbi.nlm.nih.gov/pubmed/34694227 ID - info:doi/10.2196/19915 ER - TY - JOUR AU - Xiao, Jin AU - Luo, Jiebo AU - Ly-Mapes, Oriana AU - Wu, Tong Tong AU - Dye, Timothy AU - Al Jallad, Nisreen AU - Hao, Peirong AU - Ruan, Jinlong AU - Bullock, Sherita AU - Fiscella, Kevin PY - 2021/10/22 TI - Assessing a Smartphone App (AICaries) That Uses Artificial Intelligence to Detect Dental Caries in Children and Provides Interactive Oral Health Education: Protocol for a Design and Usability Testing Study JO - JMIR Res Protoc SP - e32921 VL - 10 IS - 10 KW - artificial intelligence KW - smartphone app KW - mDentistry KW - dental caries KW - underserved population KW - mobile dentistry N2 - Background: Early childhood caries (ECC) is the most common chronic childhood disease, with nearly 1.8 billion new cases per year worldwide. ECC afflicts approximately 55% of low-income and minority US preschool children, resulting in harmful short- and long-term effects on health and quality of life. Clinical evidence shows that caries is reversible if detected and addressed in its early stages. However, many low-income US children often have poor access to pediatric dental services. In this underserved group, dental caries is often diagnosed at a late stage when extensive restorative treatment is needed. With more than 85% of lower-income Americans owning a smartphone, mobile health tools such as smartphone apps hold promise in achieving patient-driven early detection and risk control of ECC. Objective: This study aims to use a community-based participatory research strategy to refine and test the usability of an artificial intelligence?powered smartphone app, AICaries, to be used by children?s parents/caregivers for dental caries detection in their children. Methods: Our previous work has led to the prototype of AICaries, which offers artificial intelligence?powered caries detection using photos of children?s teeth taken by the parents? smartphones, interactive caries risk assessment, and personalized education on reducing children?s ECC risk. This AICaries study will use a two-step qualitative study design to assess the feedback and usability of the app component and app flow, and whether parents can take photos of children?s teeth on their own. Specifically, in step 1, we will conduct individual usability tests among 10 pairs of end users (parents with young children) to facilitate app module modification and fine-tuning using think aloud and instant data analysis strategies. In step 2, we will conduct unmoderated field testing for app feasibility and acceptability among 32 pairs of parents with their young children to assess the usability and acceptability of AICaries, including assessing the number/quality of teeth images taken by the parents for their children and parents? satisfaction. Results: The study is funded by the National Institute of Dental and Craniofacial Research, United States. This study received institutional review board approval and launched in August 2021. Data collection and analysis are expected to conclude by March 2022 and June 2022, respectively. Conclusions: Using AICaries, parents can use their regular smartphones to take photos of their children?s teeth and detect ECC aided by AICaries so that they can actively seek treatment for their children at an early and reversible stage of ECC. Using AICaries, parents can also obtain essential knowledge on reducing their children?s caries risk. Data from this study will support a future clinical trial that evaluates the real-world impact of using this smartphone app on early detection and prevention of ECC among low-income children. International Registered Report Identifier (IRRID): PRR1-10.2196/32921 UR - https://www.researchprotocols.org/2021/10/e32921 UR - http://dx.doi.org/10.2196/32921 UR - http://www.ncbi.nlm.nih.gov/pubmed/34529582 ID - info:doi/10.2196/32921 ER - TY - JOUR AU - Kruglova, Katya AU - O'Connell, Laura Siobhan Bernadette AU - Dawadi, Shrinkhala AU - Gelgoot, Noah Eden AU - Miner, A. Skye AU - Robins, Stephanie AU - Schinazi, Joy AU - Zelkowitz, Phyllis PY - 2021/10/12 TI - An mHealth App to Support Fertility Patients Navigating the World of Infertility (Infotility): Development and Usability Study JO - JMIR Form Res SP - e28136 VL - 5 IS - 10 KW - mHealth app KW - mHealth development process KW - infertility KW - intervention design KW - mobile phone N2 - Background: The experience of infertility and its treatment engenders considerable stress and is often described as an emotional rollercoaster. A mobile health (mHealth) app may be a novel solution to address the psychoeducational and psychosocial support needs of fertility patients because of its potential to reduce stress and increase patient empowerment. There are a few fertility-related apps that provide information and support to both men and women undergoing fertility treatment; however, none have documented their development and evaluation process. Objective: This study aims to describe the development and evaluation process of a bilingual mHealth app, Infotility, designed to meet the psychoeducational and psychosocial support needs of men and women undergoing fertility treatment. Methods: To develop the Infotility app, we adhered to the Medical Research Council guidelines for the development and evaluation of complex interventions. First, we conducted literature reviews and needs assessment surveys of fertility patients and health care providers who informed the content and design of the app. Second, we tested the intervention with a small group of end users who provided feedback on the design and appropriateness of the app?s content. Third, we evaluated the uptake and usability of the app using a pre-post study design. Finally, we updated the app?s content based on participants? feedback and searched for partners to disseminate the app to the broader public. Results: This study is the first to describe the development and evaluation process of an mHealth app for men and women undergoing fertility treatment. The app met its goal in providing fertility patients with a clinician-approved, portable resource for reliable information about medical and psychosocial aspects of infertility and its treatments and a confidential peer support forum monitored by trained peer supporters. Participants rated the engagement, functionality, information, and esthetics of the app positively, with an overall app quality mean score of 3.75 (SD 0.53) and a star rating of 3.43 (SD 0.75), with a total possible score and star rating of 5.00. Conclusions: By documenting the systematic development and evaluation of the mHealth app for men and women undergoing fertility treatment, this paper can facilitate the replication of the study intervention and the development of similar mHealth apps. UR - https://formative.jmir.org/2021/10/e28136 UR - http://dx.doi.org/10.2196/28136 UR - http://www.ncbi.nlm.nih.gov/pubmed/34636741 ID - info:doi/10.2196/28136 ER - TY - JOUR AU - Kovoor, G. Joshua AU - McIntyre, Daniel AU - Chik, B. William W. AU - Chow, K. Clara AU - Thiagalingam, Aravinda PY - 2021/10/11 TI - Clinician-Created Educational Video Resources for Shared Decision-making in the Outpatient Management of Chronic Disease: Development and Evaluation Study JO - J Med Internet Res SP - e26732 VL - 23 IS - 10 KW - Shared decision-making KW - chronic disease KW - outpatients KW - audiovisual aids KW - atrial fibrillation KW - educational technology KW - teaching materials KW - referral and consultation KW - physician-patient relations KW - physicians N2 - Background: The provision of reliable patient education is essential for shared decision-making. However, many clinicians are reluctant to use commonly available resources, as they are generic and may contain information of insufficient quality. Clinician-created educational materials, accessed during the waiting time prior to consultation, can potentially benefit clinical practice if developed in a time- and resource-efficient manner. Objective: The aim of this study is to evaluate the utility of educational videos in improving patient decision-making, as well as consultation satisfaction and anxiety, within the outpatient management of chronic disease (represented by atrial fibrillation). The approach involves clinicians creating audiovisual patient education in a time- and resource-efficient manner for opportunistic delivery, using mobile smart devices with internet access, during waiting time before consultation. Methods: We implemented this educational approach in outpatient clinics and collected patient responses through an electronic survey. The educational module was a web-based combination of 4 short videos viewed sequentially, followed by a patient experience survey using 5-point Likert scales and 0-100 visual analogue scales. The clinician developed the audiovisual module over a 2-day span while performing usual clinical tasks, using existing hardware and software resources (laptop and tablet). Patients presenting for the outpatient management of atrial fibrillation accessed the module during waiting time before their consultation using either a URL or Quick Response (QR) code on a provided tablet or their own mobile smart devices. The primary outcome of the study was the module?s utility in improving patient decision-making ability, as measured on a 0-100 visual analogue scale. Secondary outcomes were the level of patient satisfaction with the videos, measured with 5-point Likert scales, in addition to the patient?s value for clinician narration and the module?s utility in improving anxiety and long-term treatment adherence, as represented on 0-100 visual analogue scales. Results: This study enrolled 116 patients presenting for the outpatient management of atrial fibrillation. The proportion of responses that were ?very satisfied? with the educational video content across the 4 videos ranged from 93% (86/92) to 96.3% (104/108) and this was between 98% (90/92) and 99.1% (107/108) for ?satisfied? or ?very satisfied.? There were no reports of dissatisfaction for the first 3 videos, and only 1% (1/92) of responders reported dissatisfaction for the fourth video. The median reported scores (on 0-100 visual analogue scales) were 90 (IQR 82.5-97) for improving patient decision-making, 89 (IQR 81-95) for reducing consultation anxiety, 90 (IQR 81-97) for improving treatment adherence, and 82 (IQR 70-90) for the clinician?s narration adding benefit to the patient experience. Conclusions: Clinician-created educational videos for chronic disease management resulted in improvements in patient-reported informed decision-making ability and expected long-term treatment adherence, as well as anxiety reduction. This form of patient education was also time efficient as it used the sunk time cost of waiting time to provide education without requiring additional clinician input. UR - https://www.jmir.org/2021/10/e26732 UR - http://dx.doi.org/10.2196/26732 UR - http://www.ncbi.nlm.nih.gov/pubmed/34633292 ID - info:doi/10.2196/26732 ER - TY - JOUR AU - MacPherson, Megan AU - Cranston, Kaela AU - Johnston, Cara AU - Locke, Sean AU - Jung, E. Mary PY - 2021/8/27 TI - Evaluation and Refinement of a Bank of SMS Text Messages to Promote Behavior Change Adherence Following a Diabetes Prevention Program: Survey Study JO - JMIR Form Res SP - e28163 VL - 5 IS - 8 KW - text messaging KW - prediabetic state KW - telemedicine KW - telecommunications KW - exercise KW - diet KW - preventive medicine KW - mHealth KW - intervention development KW - behavior change KW - mobile phone N2 - Background: SMS text messaging is a low-cost and far-reaching modality that can be used to augment existing diabetes prevention programs and improve long-term diet and exercise behavior change adherence. To date, little research has been published regarding the process of SMS text message content development. Understanding how interventions are developed is necessary to evaluate their evidence base and to guide the implementation of effective and scalable mobile health interventions in public health initiatives and in future research. Objective: This study aims to describe the development and refinement of a bank of SMS text messages targeting diet and exercise behavior change to be implemented following a diabetes prevention program. Methods: A bank of 124 theory-based SMS text messages was developed using the Behaviour Change Wheel and linked to active intervention components (behavior change techniques [BCTs]). The Behaviour Change Wheel is a theory-based framework that provides structure to intervention development and can guide the use of evidence-based practices in behavior change interventions. Once the messages were written, 18 individuals who either participated in a diabetes prevention program or were a diabetes prevention coach evaluated the messages on their clarity, utility, and relevance via survey using a 5-point Likert scale. Messages were refined according to participant feedback and recoded to obtain an accurate representation of BCTs in the final bank. Results: 76/124 (61.3%) messages were edited, 4/124 (3.2%) were added, and 8/124 (6.5%) were removed based on participant scores and feedback. Of the edited messages, 43/76 (57%) received minor word choice and grammar alterations while retaining their original BCT code; the remaining 43% (33/76, plus the 4 newly written messages) were recoded by a reviewer trained in BCT identification. Conclusions: This study outlines the process used to develop and refine a bank of SMS text messages to be implemented following a diabetes prevention program. This resulted in a bank of 120 theory-based, user-informed SMS text messages that were overall deemed clear, useful, and relevant by both individuals who will be receiving and delivering them. This formative development process can be used as a blueprint in future SMS text messaging development to ensure that message content is representative of the evidence base and is also grounded in theory and evaluated by key knowledge users. UR - https://formative.jmir.org/2021/8/e28163 UR - http://dx.doi.org/10.2196/28163 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448713 ID - info:doi/10.2196/28163 ER - TY - JOUR AU - Artieta-Pinedo, Isabel AU - Paz-Pascual, Carmen AU - Bully, Paola AU - Espinosa, Maite AU - PY - 2021/8/9 TI - Design of the Maternal Website EMAeHealth That Supports Decision-Making During Pregnancy and in the Postpartum Period: Collaborative Action Research Study JO - JMIR Form Res SP - e28855 VL - 5 IS - 8 KW - prenatal education KW - women KW - patient decision aid KW - decision-making KW - clinical decision support systems KW - action research and pregnancy KW - implementation science KW - health service needs and demands N2 - 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. UR - https://formative.jmir.org/2021/8/e28855 UR - http://dx.doi.org/10.2196/28855 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383670 ID - info:doi/10.2196/28855 ER - TY - JOUR AU - Miller, C. William AU - Mohammadi, Somayyeh AU - Watson, Wendy AU - Crocker, Morag AU - Westby, Marie PY - 2021/7/6 TI - The Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER) as an eHealth Approach to Presurgical Hip Replacement Education: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e29322 VL - 10 IS - 7 KW - total hip replacement KW - osteoarthritis KW - eHealth KW - prehabiliatation KW - preoperative education KW - randomized controlled trial KW - evaluation KW - feasibility KW - rehabilitation KW - recovery KW - hip KW - bone KW - surgery KW - education N2 - Background: Osteoarthritis (OA), leading to hip replacement (THR), is a primary contributor to global mobility impairment. In 2018, more than 59,000 THR surgeries were performed in Canada. Health promotion education, such as prehabilitation, is vital to optimizing surgical outcomes. Objective: This study aims to evaluate the feasibility of the Hip Instructional Prehabilitation Program for Enhanced Recovery (HIPPER), an eHealth approach to prehabilitation education. Methods: A single-blind (assessor-blind), 2-arm, feasibility randomized controlled trial will be conducted. We will recruit 40 (HIPPER group, n=20; control group, n=20) older adults with hip OA and on a waitlist for a THR. The HIPPER intervention consists of 12 online, interactive modules. The control group will receive the current standard practice consisting of 2 online educational sessions lasting 2 hours each (webinars). Feasibility outcomes (eg, recruitment and retention rates) will be evaluated. Results: Recruitment started in March 2021. As of April 20, 2021, 18 participants were recruited. All 18 completed T1 measures. Only 1 participant has been scheduled to have a surgery and therefore has been scheduled to complete T2 measures. The remainder of the participants are waiting to be notified of their surgery date. This project was funded by a Canadian Institutes of Health Research Project Grant. Our institute?s research ethics board approved this study in November 2016. Conclusions: Results will lead to refinement of the HIPPER protocol in order to evaluate a standardized and geographically accessible prehabilitation program. Trial Registration: ClinicalTrials.gov NCT02969512; https://clinicaltrials.gov/ct2/show/NCT02969512 International Registered Report Identifier (IRRID): DERR1-10.2196/29322 UR - https://www.researchprotocols.org/2021/7/e29322 UR - http://dx.doi.org/10.2196/29322 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255722 ID - info:doi/10.2196/29322 ER - TY - JOUR AU - Vandormael, Alain AU - Adam, Maya AU - Hachaturyan, Violetta AU - Greuel, Merlin AU - Favaretti, Caterina AU - Gates, Jennifer AU - Baernighausen, Till PY - 2021/5/28 TI - Reactance to Social Authority in Entertainment-Education Media: Protocol for a Web-Based Randomized Controlled Trial JO - JMIR Res Protoc SP - e25343 VL - 10 IS - 5 KW - entertainment-education KW - sugar reduction KW - reactance KW - animated video KW - list experiment N2 - Background: Entertainment-education media can be an effective strategy for influencing health behaviors. To improve entertainment-education effectiveness, we seek to investigate whether the social authority of a person delivering a health message arouses the motivation to reject that message?a phenomenon known as reactance. Objective: In this study, using a short animated video, we aim to measure reactance to a sugar reduction message narrated by a child (low social authority), the child?s mother (equivalent social authority to the target audience), and a family physician (high social authority). The aims of the study are to determine the effect of the narrator?s perceived social authority on reactance to the sugar reduction message, establish the effectiveness of the video in improving behavioral intent to reduce the intake of added sugars, and quantify participants? interest in watching the entertainment-education intervention video. Methods: This is a parallel group, randomized controlled trial comparing an intervention video narrated by a low, equivalent, or high social authority against a content placebo video and a placebo video. Using a web-based recruitment platform, we plan to enroll 4000 participants aged between 18 and 59 years who speak English and reside in the United Kingdom. The primary end points will include measures of the antecedents to reactance (proneness to reactance and threat level of the message), its components (anger and negative cognition), and attitudinal and behavioral intent toward sugar intake. We will measure behavioral intent using list experiments. Participants randomized to the placebo videos will be given a choice to watch one of the sugar-intervention videos at the end of the study to assess participant engagement with the entertainment-education video. Results: The study was approved by the ethics committee of Heidelberg University on March 18, 2020 (S-088/2020). Participant recruitment and data collection were completed in December 2020. The data analysis was completed in April 2021, and the final results are planned to be published by August 2021. Conclusions: In this trial, we will use several randomization procedures, list experimentation methods, and new web-based technologies to investigate the effect of perceived social authority on reactance to a message about reducing sugar intake. Our results will inform the design of future entertainment-education videos for public health promotion needs. Trial Registration: German Clinical Trials Registry DRKS00022340: https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022340. International Registered Report Identifier (IRRID): DERR1-10.2196/25343 UR - https://www.researchprotocols.org/2021/5/e25343 UR - http://dx.doi.org/10.2196/25343 UR - http://www.ncbi.nlm.nih.gov/pubmed/34047702 ID - info:doi/10.2196/25343 ER - TY - JOUR AU - Elling, Mathis Jan AU - Crutzen, Rik AU - Talhout, Reinskje AU - de Vries, Hein PY - 2021/5/14 TI - Effects of Providing Tailored Information About e-Cigarettes in a Web-Based Smoking Cessation Intervention: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e27088 VL - 10 IS - 5 KW - digital health KW - eHealth KW - mHealth KW - electronic cigarette KW - e-cigarette KW - electronic nicotine delivery system KW - ENDS KW - smoking KW - smoking cessation KW - computer tailoring N2 - Background: There is an ongoing debate whether electronic cigarettes (e-cigarettes) should be advocated for smoking cessation. Because of this uncertainty, information about the use of e-cigarettes for smoking cessation is usually not provided in governmental smoking cessation communications. However, there is an information need among smokers because despite this uncertainty, e-cigarettes are used by many smokers to reduce and quit tobacco smoking. Objective: The aim of this study is to describe the protocol of a randomized controlled trial that assesses the effect of providing tailored information about e-cigarettes compared to not providing this information on determinants of decision making and smoking reduction and abstinence. This information is provided in the context of a digital smoking cessation intervention. Methods: A randomized controlled trial with a 6-month follow-up period will be conducted among adult smokers motivated to quit smoking within 5 years. Participants will be 1:1 randomized into either the intervention condition or control condition. In this trial, which is grounded on the I-Change model, participants in both conditions will receive tailored feedback on attitude, social influence, preparatory plans, self-efficacy, and coping plans. Information on 6 clusters of smoking cessation methods (face-to-face counselling, eHealth interventions, telephone counselling, group-based programs, nicotine replacement therapy, and prescription medication) will be provided in both conditions. Smokers in the intervention condition will also receive detailed tailored information on e-cigarettes, while smokers in the control condition will not receive this information. The primary outcome measure will be the number of tobacco cigarettes smoked in the past 7 days. Secondary outcome measures will include 7-day point prevalence tobacco abstinence, 7-day point prevalence e-cigarette abstinence, and determinants of decision making (ie, knowledge and attitude regarding e-cigarettes). All outcomes will be self-assessed through web-based questionnaires. Results: This project is supported by a research grant of the National Institute for Public Health and the Environment (Rijksinstituut voor Volksgezondheid en Milieu). Ethical approval was granted by the Ethics Review Committee Health, Medicine and Life Sciences at Maastricht University (FHML-REC/2019/072). Recruitment began in March 2020 and was completed by July 2020. We enrolled 492 smokers in this study. The results are expected to be published in June 2021. Conclusions: The experimental design of this study allows conclusions to be formed regarding the effects of tailored information about e-cigarettes on decision making and smoking behavior. Our findings can inform the development of future smoking cessation interventions. Trial Registration: Dutch Trial Register Trial NL8330; https://www.trialregister.nl/trial/8330 International Registered Report Identifier (IRRID): DERR1-10.2196/27088 UR - https://www.researchprotocols.org/2021/5/e27088 UR - http://dx.doi.org/10.2196/27088 UR - http://www.ncbi.nlm.nih.gov/pubmed/33988520 ID - info:doi/10.2196/27088 ER - TY - JOUR AU - Leitch, Sharon AU - Smith, Alesha AU - Zeng, Jiaxu AU - Stokes, Tim PY - 2021/4/30 TI - Using an Information Package to Reduce Patients? Risk of Renal Damage: Protocol for a Randomized Feasibility Trial JO - JMIR Res Protoc SP - e29161 VL - 10 IS - 4 KW - triple whammy KW - medication safety KW - patient education KW - general practice KW - NSAID KW - digital intervention KW - primary care KW - safety KW - protocol KW - feasibility KW - randomized controlled trial KW - risk KW - kidney KW - renal KW - information KW - acceptability N2 - Background: Non-steroidal anti-inflammatory drugs (NSAIDs) are a common cause of renal damage, especially when taken together with angiotensin-converting enzyme inhibitors (ACE-i) or angiotensin II receptor blockers (ARBs) plus a diuretic ? a combination known as the ?triple whammy.? New Zealand patients are at high risk of the ?triple whammy? because they can easily purchase NSAIDs without a prescription and in nonpharmacy retail settings (eg, the supermarket), there is no legal requirement to include patient information sheets with medication, and direct-to-consumer drug advertising is permitted. A patient information package has been developed for those at greatest risk of the ?triple whammy,? consisting of a printable PDF and an interactive online learning activity. This information package aims to inform patients about their elevated risk of harm from NSAIDS and discourage use of NSAIDs. A randomized control trial was planned to assess the effect of the information package. Objective: This study aims to pilot the trial procedures for recruiting patients and providing patient information online and to assess the acceptability of the patient information package. Methods: A two-armed randomized feasibility trial will be undertaken in Northland, New Zealand. We will recruit 50 patients who are at least 18 years old from those who have signed up to receive email alerts through their general practice. Patients eligible for this study have been prescribed an ACE-i or ARB plus a diuretic in the past 3 months. They will be randomly allocated to 2 study arms. The intervention arm will receive access to an information package plus usual care; the control arm will receive usual care alone. Online surveys will be used to assess NSAID knowledge and NSAID use at baseline and after 2 weeks for both arms. The intervention arm will also evaluate the information package in an additional survey based on Normalization Process Theory (NPT) concepts. We will report the number and proportion of participants who are eligible and consent to participate in the trial. Response and drop-out rates will be reported for each trial arm. The numbers of patients who interact with the education package will be reported together with the patient evaluation of it. Results: Funding has been obtained from the Health Research Council of New Zealand (HRC 18-031). The University of Otago Human Research Ethics Committee (H21/016) has approved this trial. Consultation has been undertaken with The Ngai Tahu research consultation committee. The trial commenced on April 12, 2021. Conclusions: This feasibility trial will test the study processes prior to commencing a randomized controlled trial and will determine the acceptability of the patient information package. We anticipate this work will provide useful information for other researchers attempting similar work. International Registered Report Identifier (IRRID): PRR1-10.2196/29161 UR - https://www.researchprotocols.org/2021/4/e29161 UR - http://dx.doi.org/10.2196/29161 UR - http://www.ncbi.nlm.nih.gov/pubmed/33929338 ID - info:doi/10.2196/29161 ER - TY - JOUR AU - McCall, C. Hugh AU - Hadjistavropoulos, D. Heather AU - Sundström, Francis Christopher Richard PY - 2021/4/29 TI - 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 JO - J Med Internet Res SP - e26939 VL - 23 IS - 4 KW - ICBT KW - internet KW - depression KW - anxiety KW - persuasive design KW - eHealth N2 - 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. UR - https://www.jmir.org/2021/4/e26939 UR - http://dx.doi.org/10.2196/26939 UR - http://www.ncbi.nlm.nih.gov/pubmed/33913811 ID - info:doi/10.2196/26939 ER - TY - JOUR AU - Lindsay, Sally AU - Kolne, Kendall AU - Barker, J. Donna AU - Colantonio, Angela AU - Stinson, Jennifer AU - Moll, Sandra AU - Thomson, Nicole PY - 2021/3/15 TI - Exploration of Gender-Sensitive Care in Vocational Rehabilitation Providers Working With Youth With Disabilities: Codevelopment of an Educational Simulation JO - JMIR Form Res SP - e23568 VL - 5 IS - 3 KW - continuing education KW - gender-identity KW - gender-sensitive care KW - rehabilitation N2 - Background: Although research shows that there is a need for gender-specific vocational support to help youth with disabilities find employment, health care providers often report needing more training in this area. Currently, there are no existing educational simulations of gender-sensitive care within vocational rehabilitation for clinicians who provide care to youth with disabilities. Therefore, developing further educational tools that address gender-sensitive care could help them enhance the care they provide while optimizing patient outcomes. Objective: This study aims to codevelop an educational simulation and identify issues relevant to providing gender-sensitive care within the context of vocational rehabilitation for youth with disabilities. Methods: We used a qualitative co-design approach with a purposive sampling strategy that involved focus group discussions and journal reflections to understand and address issues relevant to gender-sensitive care within vocational rehabilitation for those working with youth with disabilities. A total of 10 rehabilitation providers participated in two sessions (5 participants per session) to design the web-based simulation tool. The sessions (2.5 hours each) were audio recorded, transcribed, and analyzed thematically. Results: Two main themes arose from our analysis of codeveloping a simulation focusing on gender-sensitive care. The first theme involved the relevance of gender within clinical practice; responses varied from hesitance to acknowledging but not talking about it to those who incorporated gender into their practice. The second theme focused on creating a comfortable and safe space to enable gender-sensitive care (ie, included patient-centered care, effective communication and rapport building, appropriate language and pronoun use, respecting gender identity, awareness of stereotypes, and responding to therapeutic ruptures). Conclusions: Our web-based gender-sensitive care simulation that addressed vocational rehabilitation among youth with disabilities was cocreated with clinicians. The simulation highlights many issues relevant to clinical practice and has potential as an educational tool for those working with young people with disabilities. UR - https://formative.jmir.org/2021/3/e23568 UR - http://dx.doi.org/10.2196/23568 UR - http://www.ncbi.nlm.nih.gov/pubmed/33720023 ID - info:doi/10.2196/23568 ER - TY - JOUR AU - Moreno, Georgina AU - van Mierlo, Trevor PY - 2021/3/2 TI - A Digital Health Tool to Understand and Prevent Cannabis-Impaired Driving Among Youth: A Cross-sectional Study of Responses to a Brief Intervention for Cannabis Use JO - JMIR Form Res SP - e25583 VL - 5 IS - 3 KW - cannabis use KW - driving after cannabis use KW - internet KW - intervention KW - online intervention KW - digital health KW - cannabis KW - drug KW - online tool KW - youth KW - adolescent KW - Canada N2 - Background: Cannabis legalization has raised concern about an increased risk of cannabis-impaired driving, particularly among youth. Youth advocates and policy makers require cost-effective tools to target educational resources to promote responsible cannabis use. Objective: The objective of this paper is threefold. First, it describes how a youth advocacy organization disseminated a low-cost digital brief intervention to educate and inform young people about responsible cannabis use. Second, it illustrates how digital tools can help promote understanding about attitudes and behaviors toward cannabis while simultaneously offering tailored education. Finally, this paper contributes to examining behavioral factors associated with youth cannabis-impaired driving by quantifying relationships between cannabis users' willingness to drive impaired and self-reported demographic and behavioral factors. Methods: This paper analyzed data from 1110 completed Check Your Cannabis (CYC) brief interventions between March 2019 and October 2020. The CYC asks respondents a brief set of questions about their cannabis use and their personal beliefs and behaviors. Respondents receive comprehensive feedback about their cannabis use and how it compares with others. They also receive a summary of reported behaviors with brief advice. An ordered probit model was used to test relationships between cannabis use, demographics, and driving behaviors to gain further insights. Results: The vast majority (817/1110, 73.6%) of respondents reported using cannabis. However, a much smaller share of respondents reported problems associated with their cannabis use (257/1110, 23.2%) or driving after cannabis use (342/1110, 30.8%). We found statistically significant relationships between driving after cannabis use and age; Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) risk score; and polysubstance use. However, we did not find gender to be a significant determinant of driving after cannabis use. We estimated that every 10-point increase in the ASSIST score increased the probability of sometimes driving after cannabis use by 7.3% (P<.001). Relative to respondents who reported never drinking alcohol or using other substances with cannabis, those who sometimes drink or use other substances with cannabis were 13% (P<.001) more likely to sometimes or always drive after using cannabis. Conclusions: The digital health tool cost the youth advocacy organization approximately Can $0.90 (US $0.71) per use. Due to the tool's unlimited use structure, the per-use cost would further decrease with increased use by the organization?s target population. Based on our results, public health campaigns and other interventions may consider tailoring resources to frequent cannabis users, youth with high ASSIST scores, and those with polysubstance abuse. The cost-effectiveness of delivering digital brief interventions with unlimited use is attractive, as increased use decreases the per-user cost. Further research examining the efficacy of digital health interventions targeting problematic cannabis use is required. UR - https://formative.jmir.org/2021/3/e25583 UR - http://dx.doi.org/10.2196/25583 UR - http://www.ncbi.nlm.nih.gov/pubmed/33650982 ID - info:doi/10.2196/25583 ER - TY - JOUR AU - Willems, J. Stijn AU - Coppieters, W. Michel AU - Pronk, Yvette AU - Diks, F. Miranda J. AU - van der Heijden, P. Klaas W. A. AU - Rooker, Servan AU - Scholten-Peeters, M. Gwendolyne G. PY - 2021/2/8 TI - A Clinical Journey Mobile Health App for Perioperative Patients: Cross-sectional Study JO - JMIR Hum Factors SP - e20694 VL - 8 IS - 1 KW - eHealth KW - mHealth KW - applications KW - musculoskeletal KW - user-friendliness KW - rehabilitation KW - usability KW - patient education KW - technology KW - disability KW - feasibility KW - adherence N2 - Background: Mobile eHealth apps are important tools in personal health care management. The Patient Journey app was developed to inform patients with musculoskeletal disorders during their perioperative period. The app contains timely information, video exercises, and functional tasks. Although the Patient Journey app and other health apps are widely used, little research is available on how patients appreciate these apps. Objective: The primary aim of this study was to evaluate the user-friendliness of the Patient Journey app in terms of its usability and the attitudes of users toward the app. The secondary aim was to evaluate positive and negative user experiences. Methods: A web-based questionnaire was sent to 2114 patients scheduled for surgery for a musculoskeletal disorder. Primary outcomes were usability (measured with the System Usability Scale) and user attitudes regarding the Patient Journey app (assessed with the second part of the eHealth Impact Questionnaire). The secondary outcomes were evaluated with multiple choice questions and open-ended questions, which were analyzed via inductive thematic content analyses. Results: Of the 940 patients who responded, 526 used the Patient Journey app. The usability of the app was high (System Usability Scale: median 85.0, IQR 72.5-92.5), and users had a positive attitude toward the Information and Presentation provided via the app (eHealth Impact Questionnaire: median 78.0, IQR 68.8-84.4). The app did not adequately improve the users? confidence in discussing health with others (eHealth Impact Questionnaire: median 63.9, IQR 50.0-75.0) or motivation to manage health (eHealth Impact Questionnaire: median 61.1, IQR 55.6-72.2). Three core themes emerged regarding positive and negative user experiences: (1) content and information, (2) expectations and experiences, and (3) technical performance. Users experienced timely information and instructions positively and found that the app prepared and guided them optimally through the perioperative period. Negative user experiences were overly optimistic information, scarcely presented information about pain (medication), lack of reference data, insufficient information regarding clinical course deviations and complications, and lack of interaction with clinicians. Conclusions: The Patient Journey app is a usable, informative, and presentable tool to inform patients with musculoskeletal disorders during their perioperative period. The qualitative analyses identified aspects that can further improve the user experiences of the app. UR - http://humanfactors.jmir.org/2021/1/e20694/ UR - http://dx.doi.org/10.2196/20694 UR - http://www.ncbi.nlm.nih.gov/pubmed/33555262 ID - info:doi/10.2196/20694 ER - TY - JOUR AU - Jackowich, A. Robyn AU - Mooney, M. Kayla AU - Hecht, Evelyn AU - Pukall, F. Caroline PY - 2021/1/11 TI - Online Pelvic Floor Group Education Program for Women With Persistent Genital Arousal Disorder/Genito-Pelvic Dysesthesia: Descriptive Feasibility Study JO - JMIR Form Res SP - e22450 VL - 5 IS - 1 KW - persistent genital arousal disorder KW - genitopelvic dysesthesia KW - online program KW - pelvic floor KW - pilot N2 - Background: Persistent genital arousal disorder/genito-pelvic dysesthesia (PGAD/GPD) is a highly distressing yet poorly understood condition characterized by persistent genito-pelvic sensations, often described as ?genital arousal,? which occur in the absence of sexual desire. PGAD/GPD is associated with significant impairment in psychosocial and daily functioning; however, there are currently no empirically validated treatment algorithms for PGAD/GPD. Pelvic floor physical therapy exercises have been found to be effective at reducing other forms of genito-pelvic discomfort, such as vulvodynia, and may also be beneficial to those experiencing PGAD/GPD. Many individuals with PGAD/GPD report difficulty finding a health care provider who is knowledgeable about PGAD/GPD; therefore, pelvic floor education and exercises in an online format may have the potential to reach more individuals in need. Objective: This study examined the feasibility of an online pelvic floor group education program; descriptively assessed outcomes related to distress, discomfort, catastrophizing, and mood; and obtained feedback from participants in order to inform the development of improved online group programs. Methods: Fourteen women with current symptoms of PGAD/GPD attended an online, 8-session pelvic floor group education program. Participants completed questionnaires of symptoms (ie, symptom distress, discomfort) and psychosocial well-being (ie, depression, anxiety, symptom catastrophizing) prior to the group sessions (Time 1), immediately after the final group session (Time 2), and 6 months following the final group session (Time 3). Participants also completed an anonymous feedback questionnaire immediately following the group program. Results: Overall, participants who attended a larger number of the group sessions (>5 sessions, n=7) appeared to report lower baseline (Time 1) symptoms and psychosocial impairment than those who attended fewer sessions (<5 sessions, n=7). A pattern of small improvements was seen following the group sessions on symptom and psychosocial outcomes. In the feedback questionnaire, breathing and relaxation exercises were described to be the most helpful home practice exercises, and participants rated sessions on (1) the relationship between emotions and PGAD/GPD symptoms and (2) relaxation exercises to be the most helpful. A number of barriers to participation in the group program were also identified, including comorbid health concerns and lack of personal time to complete the program/exercises. Conclusions: Online interventions provide an opportunity to reach international participants who may otherwise struggle to access a knowledgeable provider for their PGAD/GPD symptoms. Addressing barriers may help to increase participants? abilities to engage in the program. Future programs may seek to integrate a greater focus on relaxation strategies and cognitive-affective strategies for managing PGAD/GPD symptoms. UR - http://formative.jmir.org/2021/1/e22450/ UR - http://dx.doi.org/10.2196/22450 UR - http://www.ncbi.nlm.nih.gov/pubmed/33427673 ID - info:doi/10.2196/22450 ER - TY - JOUR AU - Monkman, Helen AU - Kushniruk, W. Andre AU - Borycki, M. Elizabeth AU - Sheets, J. Debra AU - Barnett, Jeffrey PY - 2020/12/1 TI - Differences in Memory, Perceptions, and Preferences of Multimedia Consumer Medication Information: Experimental Performance and Self-Report Study JO - JMIR Hum Factors SP - e15913 VL - 7 IS - 4 KW - consumer medication information KW - medication guides KW - patient medication information KW - prescription drug information leaflet KW - patient information leaflets KW - multimedia learning KW - health literacy KW - eHealth literacy KW - consumer health informatics KW - cognitive theory of multimedia learning N2 - Background: Electronic health resources are becoming prevalent. However, consumer medication information (CMI) is still predominantly text based. Incorporating multimedia into CMI (eg, images, narration) may improve consumers? memory of the information as well as their perceptions and preferences of these materials. Objective: This study examined whether adding images and narration to CMI impacted patients? (1) memory, (2) perceptions of comprehensibility, utility, or design quality, and (3) overall preferences. Methods: We presented 36 participants with CMI in 3 formats: (1) text, (2) text + images, and (3) narration + images, and subsequently asked them to recall information. After seeing all 3 CMI formats, participants rated the formats in terms of comprehensibility, utility, and design quality, and ranked them from most to least favorite. Results: Interestingly, no significant differences in memory were observed (F2,70=0.1, P=0.901). Thus, this study did not find evidence to support multimedia or modality principles in the context of CMI. Despite the absence of effects on memory, the CMI format significantly impacted perceptions of the materials. Specifically, participants rated the text + images format highest in terms of comprehensibility (?22=26.5, P<.001) and design quality (?22=35.69, P<.001). Although the omnibus test suggested a difference in utility ratings as well (?22=8.21, P=.016), no significant differences were found after correcting for multiple comparisons. Consistent with perception findings, the preference ranks yielded a significant difference (?22=26.00, P<.001), whereby participants preferred the text + images format overall. Indeed, 75% (27/36) of participants chose the text + images format as their most favorite. Thus, although there were no objective memory differences between the formats, we observed subjective differences in comprehensibility, design quality, and overall preferences. Conclusions: This study revealed that although multimedia did not appear to influence memory of CMI, it did impact participants? opinions about the materials. The lack of observed differences in memory may have been due to ceiling effects, memory rather than understanding as an index of learning, the fragmented nature of the information in CMI itself, or the size or characteristics of the sample (ie, young, educated subjects with adequate health literacy skills). The differences in the subjective (ie, perceptions and preferences) and objective (ie, memory) results highlight the value of using both types of measures. Moreover, findings from this study could be used to inform future research on how CMI could be designed to better suit the preferences of consumers and potentially increase the likelihood that CMI is used. Additional research is warranted to explore whether multimedia impacts memory of CMI under different conditions (eg, older participants, subjects with lower levels of health literacy, more difficult stimuli, or extended time for decay). UR - http://humanfactors.jmir.org/2020/4/e15913/ UR - http://dx.doi.org/10.2196/15913 UR - http://www.ncbi.nlm.nih.gov/pubmed/33258780 ID - info:doi/10.2196/15913 ER - TY - JOUR AU - Bernstein, T. Matthew AU - Garber, Jesse AU - Faucher, Patrick AU - Reynolds, A. Kristin AU - Restall, Gayle AU - Walker, R. John AU - Singh, Harminder PY - 2020/10/21 TI - New Patient Education Video on Colonoscopy Preparation: Development and Evaluation Study JO - JMIR Hum Factors SP - e15353 VL - 7 IS - 4 KW - bowel preparation KW - evaluation study KW - medical informatics KW - information dissemination KW - information literacy KW - patient preference KW - implementation science KW - translational medical research KW - patient education N2 - Background: Although several patient education materials on colonoscopy preparation exist, few studies have evaluated or compared them; hence, there is no professional consensus on recommended content or media to use. Objective: This study aims to address this need by developing and evaluating a new video on colonoscopy preparation. Methods: We developed a new video explaining split-dose bowel preparation for colonoscopy. Of similar content videos on the internet (n=20), the most favorably reviewed video among patient and physician advisers was used as the comparator for the study. A total of 232 individuals attending gastroenterology or urology clinics reviewed the new and comparator videos. The order of administration of the new and comparator videos was randomly counterbalanced to assess the impact of presentation order. Respondents rated each video on the following dimensions: information amount, clarity, trustworthiness, understandability, new or familiar information, reassurance, information learned, understanding from the patient?s point of view, appeal, and the likelihood of recommending the video to others. Results: Overall, 71.6% (166/232) of the participants preferred the new video, 25.0% (58/232) preferred the comparator video, and 3.4% (8/232) were not sure. Furthermore, 64.0% (71/111) of those who viewed the new video first preferred it, whereas 77.7% (94/121) of the participants who viewed the new video second preferred it. Multivariable logistic regression analysis also demonstrated that participants were more likely to prefer the new video if they had viewed it second. Participants who preferred the new video rated it as clearer and more trustworthy than those who preferred the comparator video. Conclusions: This study developed and assessed the strengths of a newly developed colonoscopy educational video. UR - http://humanfactors.jmir.org/2020/4/e15353/ UR - http://dx.doi.org/10.2196/15353 UR - http://www.ncbi.nlm.nih.gov/pubmed/33084594 ID - info:doi/10.2196/15353 ER -