TY - JOUR AU - Parry, Monica AU - Huang, Tony AU - Clarke, Hance AU - Bjørnnes, Kristin Ann AU - Harvey, Paula AU - Parente, Laura AU - Norris, Colleen AU - Pilote, Louise AU - Price, Jennifer AU - Stinson, N. Jennifer AU - O?Hara, Arland AU - Fernando, Madusha AU - Watt-Watson, Judy AU - Nickerson, Nicole AU - Spiteri DeBonis, Vincenza AU - Hart, Donna AU - Faubert, Christine PY - 2025/4/17 TI - Development and Systematic Evaluation of a Progressive Web Application for Women With Cardiac Pain: Usability Study JO - JMIR Hum Factors SP - e57583 VL - 12 KW - digital health KW - chatbot KW - women KW - cardiac pain KW - usability testing KW - self-management KW - artificial intelligence KW - AI N2 - Background: Cardiac pain has been widely considered to be the primary indicator of coronary artery disease. The presentation of cardiac pain and associated symptoms vary in women, making it challenging to interpret as cardiac, possibly cardiac, or noncardiac. Women prefer to consult with family and friends instead of seeking immediate medical care. Objective: This study aimed to assess the user performance (ie, ease of use, efficiency, and errors) and user satisfaction (System Usability Scale; SUS) of a progressive web application for women with cardiac pain. Methods: Following ethics approval, a purposive sample of women aged >18 years with cardiac pain or associated symptoms lasting >3 months and able to speak and read English was recruited to participate in 2 iterative usability testing cycles. The first cycle assessed the performance of and satisfaction with at heart using a web application, and the second cycle assessed the performance of and satisfaction with at heart across various Android and iOS devices. In total, 2 investigators recorded user comments and documented problems. At the end of the testing session, the participants completed the SUS and 4 semistructured interview questions. Results: In total, 10 eligible women participated in usability testing from March 31, 2020, to April 17, 2020 (cycle 1), and from November 17, 2020, to November 30, 2020 (cycle 2). Women across usability testing cycles had a mean age of 55.6 (SD 7.3) years, and most (9/10, 90%) were well educated. In total, 50% (5/10) were employed full or part time, and 60% (6/10) earned >CAD $70,000 (US $48,881.80) annually. Participants across 2 testing cycles reported the overall usability of the at heart progressive web application as highly acceptable (mean SUS score 81.75, SD 10.41). In total, 90% (9/10) of participants rated the user-friendliness of at heart as good or excellent. All participants (10/10, 100%) thought at heart was easy to use and efficient. Only 2 testing errors were noted as high priority; these were low contrast or small font and clarification that the chatbot was not a real person. User satisfaction was assessed using themes that emerged from the debrief and 4 semistructured interview questions; at heart was engaging, comprehensive, understandable, credible, relevant, affirming, personalized, and innovative. Conclusions: This study provides initial support for the at heart progressive web application for women living with cardiac pain and symptoms. Ongoing evaluations in phases 3 and 4 should aim to examine the feasibility and acceptability of and the extent of engagement with the at heart core feature set: Heart Check, Wellness Check, and the library. In addition to assessing effectiveness in the phase-4 effectiveness-implementation hybrid trial (type I), describing and better understanding the context for implementation (eg, race and ethnicity and geography) will be necessary. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2019-033092 UR - https://humanfactors.jmir.org/2025/1/e57583 UR - http://dx.doi.org/10.2196/57583 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57583 ER - TY - JOUR AU - de França, Galvão Caroline Villela AU - Segalla, Boaro Paola AU - Reis, Assis Felipe Sebastião de AU - Pereira, Silveira José Ricardo AU - de Mattos, Oliveira Alexandre AU - Ferron, Moura Roberta de AU - de Oliveira, Zanardo Cleyton AU - Borges, Bassani Jéssica AU - Hoffmann, Quintal Lilian AU - Caboclo, Giaimo Edmundo Di PY - 2025/4/16 TI - Patients' and Physicians' Experience With and Acceptability of a Telemedicine Cabin: Mixed Methods Study JO - JMIR Hum Factors SP - e55430 VL - 12 KW - telemedicine cabin KW - telehealth KW - teleservice KW - e-health KW - connected offices N2 - Background: Telemedicine represents an essential tool with the potential to reduce health costs, thus avoiding patient displacement and improving patient care outcomes, positioning it as a significant social technology. Objective: This study aims to analyze the implementation of a telehealth cabin at BP Hospital (A Beneficência Portuguesa de São Paulo), focusing on the evaluation of the experiences of both patients and health care professionals, as well as the acceptability of this tool. Methods: A mixed methods study was conducted with 229 participants, divided into 2 phases. The first phase involved 40 apparently healthy individuals to assess the usability, experience, and satisfaction of this group for the later safe application in the group with clinical complaints. The second phase included 189 participants, with complaints to assess the usability, experience, and satisfaction of patients and doctors. In both phases, participants completed screening questionnaires (to assess the eligibility criteria), a socioeconomic demographic questionnaire before using the cabin, and a questionnaire including the System Usability Scale and the Net Promoter Score (NPS) after using the cabin. Results: The data analysis of the first phase showed high acceptance of the telehealth cabin, which supported the progression to the second phase. In the second phase, a high usability score was observed among participants with clinical complaints (mean System Usability Scale score of 85.97, SD 15.50) and a high favorability rating (NPS score of 9.4). Health care professionals also reported favorable results, with a usability score of 67.8 and an NPS of 8.0. Conclusions: The results of this study reinforce the potential for scaling up this practice based on usability outcomes, and highlight its relevance for the development of public policies aimed at expanding access to quality health care in Brazil. This approach improves the interaction of patients with the health care system, while providing professionals with an extended view of clinical conditions through integrated devices, particularly in areas with limited access to medical care. UR - https://humanfactors.jmir.org/2025/1/e55430 UR - http://dx.doi.org/10.2196/55430 ID - info:doi/10.2196/55430 ER - TY - JOUR AU - Munir, Mamoon Malik AU - Ahmed, Nabil PY - 2025/4/7 TI - Using Social Media Platforms to Raise Health Awareness and Increase Health Education in Pakistan: Structural Equation Modeling Analysis and Questionnaire Study JO - JMIR Hum Factors SP - e65745 VL - 12 KW - social media KW - health awareness KW - health education KW - innovation diffusion theory KW - structural equation modeling KW - disease burden KW - healthcare facilities KW - health professionals KW - misinformation KW - cost effective N2 - Background: Current health care education methods in Pakistan use traditional media (eg, television and radio), community health workers, and printed materials, which often fall short of reach and engagement among most of the population. The health care sector in Pakistan has not yet used social media effectively to raise awareness and provide education about diseases. Research on the impact social media can have on health care education in Pakistan may expand current efforts, engage a wider audience, and reduce the disease burden on health care facilities. Objective: This study aims to evaluate the perceptions of health care professionals and paramedic staff regarding social media use to raise awareness and educate people about diseases as a potential means of reducing the disease burden in Pakistan. Methods: The study used two-stage structural equation modeling (SEM). Data analysis used AMOS 26.0 software, adopting scales from previous literature. Four-item scales for each social media usefulness and health awareness construct and 8-item scales for health care education constructs were adopted on the basis of their higher loading in alignment with psychometric literature. A 7-point Likert scale was used to measure each item. Data collection used convenience sampling, with questionnaires distributed to more than 450 health care professionals and paramedic staff from 2 private hospitals in Lahore, Pakistan. There were 389 useful responses received. However, 340 completed questionnaires were included in the data analysis. Results: The study found that all the squared multiple correlation (SMC) values were greater than 0.30. Furthermore, convergent validity was measured using (1) standardized factor loading (found greater than 0.5), (2) average variance explained (found greater than 0.5), and (3) composite reliability (found greater than 0.7). The confirmatory factor analysis (CFA) of the measurement model indicated the fitness of the constructs (Chi-square minimum [CMIN]=357.62; CMIN/degrees of freedom [DF]=1.80; Goodness of Fit [GFI]=0.90; Adjusted Goodness of Fit Index [AGFI]=0.89; Buntler-Bonett Normed Fit Index [NFI]=0:915; Comparative Fit Index [CFI]=0:93; Root Mean Square Residual [RMR]=0:075; Root Mean Square Error of Approximation [RMSEA]=0:055). Moreover, the structural model fitness was also confirmed (CMIN=488.6; CMIN/DF=1.85; GFI=0.861; AGFI=0.893; NFI=0.987; CFI=0.945; RMR=0:079; RMSEA=0.053). Hence, the results indicated that social media usefulness has a positive and significant effect on health awareness (hypothesis 1: ?=.669, P<.001), and health awareness has a positive and significant effect on health care education in Pakistan (hypothesis 2: ?=.557, P<.001). Conclusions: This study concludes that health care professionals and paramedic staff in private hospitals support the use of social media to raise awareness and provide health care education. It is considered an effective tool for reducing the disease burden in Pakistan. The study results also revealed that young health care professionals are more inclined toward social media usage and express the need for legislation to support it and establish a monitoring process to avoid misinformation. UR - https://humanfactors.jmir.org/2025/1/e65745 UR - http://dx.doi.org/10.2196/65745 ID - info:doi/10.2196/65745 ER - TY - JOUR AU - Wadman, Ruth AU - Walker, Lauren AU - Taylor, Olivia AU - Heron, Paul AU - Newbronner, Elizabeth AU - Spanakis, Panagiotis AU - Crosland, Suzanne AU - Peckham, Jane Emily PY - 2025/3/28 TI - Patterns of Internet Use in People Diagnosed With Severe Mental Illness: Qualitative Interview Study JO - J Med Internet Res SP - e55072 VL - 27 KW - severe mental illness KW - internet use KW - qualitative KW - typology KW - protective strategies KW - digital divide N2 - Background: People with severe mental illness (SMI) face profound health inequalities, which may be exacerbated by increased rates of digital exclusion, especially as health services move to online provision. The activities that people carry out online can affect how they feel about the internet and may determine whether a person has a positive or negative experience when using the internet. This, in turn, could affect their mental health. To support people with SMI in using digital technology and the internet safely, it is important to understand the internet and digital technology use of those with SMI and their perceived positive or negative impact on their mental health. Objective: This study aimed to explore the internet and digital technology use of those with SMI, with particular focus on any association between greater use of the internet and poorer self-reported mental health. Methods: We carried out a qualitative interview study with 16 people with SMI. The sample was drawn from a wider investigation of the impact of the pandemic and its restrictions on the health and well-being of 367 people with SMI. We purposively sampled from the wider study based on age, gender, frequency of internet use, and self-reported mental health. The data were analyzed by 2 researchers using framework analysis. Results: Participant experiences fell into 3 broad categories: those who had a positive or neutral internet-based experience, those who had negative or difficult experiences, and low users or those with poor digital literacy. Those who had positive or neutral experiences could be broken down into 2 subcategories: first, those with positive or neutral experiences of the internet who were similar in terms of the activities participated in, feelings reported, and their concerns about the internet, and second, conscious users who were mindful of their interaction with the internet world. Participants with difficult experiences fell into 2 categories: those with worries and fears related to using the internet and those who had difficulty limiting their internet use. Conclusions: People with SMI, similarly the general population, are expected to conduct more of their activities of daily living online in the postpandemic world. This research shows that most internet users with SMI have positive or neutral experiences. However, our typology reveals subgroups of the population with SMI for whom there is a relationship between internet use and difficult feelings. These subgroups can be identified by asking questions about online activities; time spent online; feelings, difficulties, or issues experienced; and use of gambling, dating, adult content, and conspiracy theory websites. Our findings point to further work in collaboration with people with lived experience to modify and test this typology. UR - https://www.jmir.org/2025/1/e55072 UR - http://dx.doi.org/10.2196/55072 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55072 ER - TY - JOUR AU - Mishina, Kaisa AU - Baumel, Amit AU - Kinnunen, Malin AU - Ristkari, Terja AU - Heinonen, Emmi AU - Hinkka-Yli-Salomäki, Susanna AU - Sourander, Andre PY - 2025/3/13 TI - BePresent Universal Internet-Based Parenting Intervention: Single-Arm Pre-Post Intervention Study JO - J Med Internet Res SP - e65391 VL - 27 KW - parent training KW - universal intervention KW - online intervention KW - irritability KW - conduct problems KW - hyperactivity KW - preschool KW - mental health KW - strongest families KW - positive parenting KW - parenting skills KW - parent-child relationships KW - parent satisfaction KW - BePresent KW - feasibility study KW - single-arm pre-post intervention study N2 - Background: Internet-based parenting programs have great potential to promote positive parent-child relationships as well as to reach and engage parents. Objective: This study aimed to assess the universal internet-based BePresent parenting intervention for families with 3-year-old children and how it influences the child?s behavior and daily-life situations assessed by parents. The first aim of the study was to assess the change from baseline to follow-up in child hyperactivity and conduct problems, affective reactivity, and daily activities. The second aim was to assess intervention completion rates. The third aim was to evaluate parent satisfaction with the intervention. The fourth aim was to assess all outcomes by comparing those who completed the intervention and those who did not. Methods: We conducted a single-arm pre- and postintervention study. Parents attending their child?s 3-year health check-up were recruited from children?s health clinics. The intervention was an unguided internet-based parenting program consisting of 5 modules. Self-reported measures were collected at baseline and at an 8-week follow-up. Linear mixed-effects models were used to analyze the changes from baseline to follow-up. Results: Altogether, 752 parents registered, and 515 started the intervention. Of those, 36% (n=183) completed the intervention. Parents reported high satisfaction with the intervention: the majority (68.8%?84.9%) were satisfied with various aspects of the program, and 89.9% said the intervention provided information about positive parenting skills. The findings show significant decreases with small effect sizes in parents? ratings of child hyperactivity (P=.03; d=0.12) and conduct problems (P=.001; d=0.20) between baseline and the 8-week follow-up. A similar finding was observed in the parent ratings of child irritability (P?.001; d=0.27) using the Affective Reactivity Index. Parents reported improvement in the daily functioning of their child when it was measured with a questionnaire adapted from the Barkley Home Situations Questionnaire (P=.01; d=0.14). Conclusions: Universal digital interventions have the potential to be implemented widely in community settings to improve knowledge and positive parenting skills. However, there is a need to assess the efficacy of digital universal interventions using randomized controlled designs and to examine additional ways to increase adherence to universal programs. UR - https://www.jmir.org/2025/1/e65391 UR - http://dx.doi.org/10.2196/65391 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65391 ER - TY - JOUR AU - Moody, Louise AU - Clarke, Samantha AU - Compton, Matt AU - Hughson-Gill, Rachael AU - Boardman, Felicity AU - Clark, Corinna AU - Holder, Pru AU - Bonham, R. James AU - Chudleigh, Jane PY - 2025/3/6 TI - Development of an Online Scenario-Based Tool to Enable Research Participation and Public Engagement in Cystic Fibrosis Newborn Screening: Mixed Methods Study JO - J Particip Med SP - e59686 VL - 17 KW - extended genetic testing KW - next-generation sequencing KW - cystic fibrosis KW - decision-making KW - engagement N2 - Background: Newborn screening aims to identify babies affected by rare but serious genetic conditions. As technology advances, there is the potential to expand the newborn screening program following evaluation of the likely benefits and drawbacks. To inform these decisions, it is important to consider the family experience of screening and the views of the public. Engaging in public dialogue can be difficult. The conditions, screening processes, and associated moral and ethical considerations are complex. Objective: This study aims to develop a stand-alone online resource to enable a range of stakeholders to understand whether and how next-generation sequencing should be incorporated into the CF screening algorithm. Methods: Around 4 development workshops with policymakers, parents, and other stakeholders informed the design of an interactive activity, including the structure, content, and questions posed. Stakeholders were recruited to take part in the development workshops via purposeful and snowball sampling methods to achieve a diversity of views across roles and organizations, with email invitations sent to representative individuals with lived, clinical, and academic experience related to CF and screening. Ten stakeholders informed the development process including those with lived experience of CF (2/10, 20%), clinicians (2/10, 20%), and representatives from relevant government, charity, and research organizations (6/10, 60%). Vignettes constructed using interview data and translated into scripts were recorded to provide short films to represent and provoke consideration of families? experiences. Participants were recruited (n=6, adults older than 18 years) to test the resulting resource. Study advertisements were circulated via physical posters and digital newsletters to recruit participants who self-identified as having a reading difficulty or having English as a second language. Results: An open access online resource, ?Cystic Fibrosis Newborn Screening: You Decide,? was developed and usability and acceptability tested to provide the ?user? (eg, a parent, the general public, or a health care professional) with an interactive scenario-based presentation of the potential outcomes of extended genetic testing, allowing them to visualize the impact on families. This included a learning workbook that explains key concepts and processes. The resulting tool facilitates public engagement with and understanding of complex genetic and screening concepts. Conclusions: Online resources such as the one developed during this work have the potential to help people form considered views and facilitate access to the perspectives of parents and the wider public on genetic testing. These may be otherwise difficult to obtain but are of importance to health care professionals and policymakers. Trial Registration: ClinicalTrials.gov NCT06299566; https://clinicaltrials.gov/study/NCT06299566 UR - https://jopm.jmir.org/2025/1/e59686 UR - http://dx.doi.org/10.2196/59686 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053726 ID - info:doi/10.2196/59686 ER - TY - JOUR AU - van der Smissen, Doris AU - Schreijer, A. Maud AU - van Gemert-Pijnen, C. Lisette J. E. W. AU - Verdaasdonk, M. Rudolf AU - van der Heide, Agnes AU - Korfage, J. Ida AU - Rietjens, C. Judith A. PY - 2025/3/4 TI - Implementation of a Web-Based Program for Advance Care Planning and Evaluation of its Complexity With the Nonadoption, Abandonment, Scale-Up, Spread, And Sustainability (NASSS) Framework: Qualitative Evaluation Study JO - JMIR Aging SP - e49507 VL - 8 KW - eHealth KW - web-based intervention KW - implementation KW - sustainability KW - advance care planning KW - NASSS framework KW - nonadoption, abandonment, scale-up, spread, and sustainability framework KW - health communication KW - patient education KW - patient-centered care N2 - Background: The implementation of eHealth applications often fails. The NASSS (nonadoption, abandonment, scale-up, spread, and sustainability) framework aims to identify complexities in eHealth applications; the more complex, the more risk of implementation failure. Objective: This study aimed to analyze the implementation of the web-based advance care planning (ACP) program ?Explore Your Preferences for Treatment and Care? using the NASSS framework. Methods: The NASSS framework enables a systematic approach to improve the implementation of eHealth tools. It is aimed at generating a rich and situated analysis of complexities in multiple domains, based on thematic analysis of existing and newly collected data. It also aims at supporting individuals and organizations to handle these complexities. We used 6 of 7 domains of the NASSS framework (ie, condition, technology, value proposition, adopters, external context, and embedding and adaptation over time) leaving out ?organization,? and analyzed the multimodal dataset of a web-based ACP program, its development and evaluation, including peer-reviewed publications, notes of stakeholder group meetings, and interviews with stakeholders. Results: This study showed that the web-based ACP program uses straightforward technology, is embedded in a well-established web-based health platform, and in general appears to generate a positive value for stakeholders. A complexity is the rather broad target population of the program. A potential complexity considers the limited insight into the extent to which health care professionals adopt the program. Awareness of the relevance of the web-based ACP program may still be improved among target populations of ACP and among health care professionals. Furthermore, the program may especially appeal to those who value individual autonomy, self-management, and an explicit and direct communicative approach. Conclusions: Relatively few complexities were identified considering the implementation of the web-based ACP program ?Explore Your Preferences for Treatment and Care.? The program is evidence-based, freestanding, and well-maintained, with straightforward, well-understood technology. The program is expected to generate a positive value for different stakeholders. Complexities include the broad target population of the program and sociocultural factors. People with limited digital literacy may need support to use the program. Its uptake might be improved by increasing awareness of ACP and the program among a wider population of potential users and among health care professionals. Addressing these issues may guide future use and sustainability of the program. UR - https://aging.jmir.org/2025/1/e49507 UR - http://dx.doi.org/10.2196/49507 UR - http://www.ncbi.nlm.nih.gov/pubmed/40053753 ID - info:doi/10.2196/49507 ER - TY - JOUR AU - Francis, Karlee AU - Francis, Julie AU - Latimer, Margot AU - Gould, Hayley AU - Blackmore, Shante AU - MacLeod, Emily PY - 2025/3/3 TI - Development and Testing of the Kids Hurt App, a Web-Based, Pain Self-Report App for First Nations Youths: Mixed Methods Study JO - JMIR Hum Factors SP - e48370 VL - 12 KW - app KW - eHealth KW - pain KW - Indigenous KW - First Nations KW - children KW - youths KW - mobile phone N2 - Background: First Nations children and youths may have unique ways to convey their health needs that have not been recognized by health providers. This may contribute to the disparity between high rates of mental health and physical pain and low rates of treatment for the conditions they experience. Evidence suggests that a colonial history has resulted in poor experiences with the health care system, lack of trust with health providers, and miscommunication between clinicians and patients. Contemporary ways, using both Indigenous and Western knowledge, are needed to bridge the gap in communicating pain. Objective: The aim of this qualitative study was to test the usability and clinical feasibility of the Kids Hurt App with First Nations youths and clinicians working with youths. Methods: Using a Two-Eyed Seeing approach, the Kids Hurt App was developed using concepts from validated mood and pain assessment apps combined with community-based research that gathered First Nations youths and clinicians perspectives on quality, intensity, and location of pain and hurt. The Kids Hurt App contains 16 screens accessible on any web-based device. Results: In total, 3 rounds of low-fidelity testing (n=19), 2 rounds of high-fidelity testing (n=20), and 2 rounds of clinical feasibility testing (n=10) were conducted with First Nations youths (10?19 years) to determine the relevance, validity, and usability of the Kids Hurt App. High-fidelity testing was also conducted with 15 clinicians after completing the high-fidelity youth sessions. Youths had constructive suggestions that were used to improve the app in subsequent rounds of version testing. There was one main discrepancy between youths and clinicians related to preference for how best to visually convey pain. The youth?s preference was maintained in the app. Conclusions: All youths in all rounds of testing indicated that they would use the Kids Hurt App if it was available to them in a health care setting, with most clinicians noting that the app would be useful in practice. UR - https://humanfactors.jmir.org/2025/1/e48370 UR - http://dx.doi.org/10.2196/48370 ID - info:doi/10.2196/48370 ER - TY - JOUR AU - Reifegerste, Doreen AU - Wagner, M. Anna J. AU - Huber, Lisa AU - Fastuca, Manuel PY - 2025/2/26 TI - Formative Evaluation of Suicide Prevention Websites for Men: Qualitative Study with Men at Risk of Suicide and with Potential Gatekeepers JO - JMIR Form Res SP - e59829 VL - 9 KW - mental health KW - suicide prevention KW - men?s health KW - evaluation KW - website KW - gatekeeper KW - suicide KW - male KW - suicide risk KW - digital communication KW - intervention KW - suicidal behavior KW - digital intervention KW - digital media N2 - Background: The suicide rate among men exceeds that of women worldwide. One important measure in suicide prevention for men is digital communication interventions, as they enable easy and anonymous access to information resources. This is especially important for men who might not be reached by traditional, in-person prevention methods. Thus, as part of an interdisciplinary project on suicide prevention for men, two specific digital communication prevention measures were developed: (1) a website to inform men at risk about suicide prevention, and (2) a website to educate potential gatekeepers who are in contact with men at risk of suicide about appropriate life-saving measures. Both websites needed evaluation to explore how they are perceived by (1) men and by (2) potential gatekeepers of men at risk of suicide. This is crucial, as existing research lacks formative evaluation that informs the development of intervention communication materials. Objective: This study aimed to analyze whether these websites were perceived as (1) comprehensible and engaging, (2) authentic and trustworthy, as well as (3) useful by (potential) users. Furthermore, we examined (4) additional ideas for effective communication about suicide prevention. Methods: We conducted (1) individual videoconference interviews with 24 men to evaluate the website and (2) four focus groups with 8 gatekeepers in each group (32 participants) to evaluate the online education program. The focus group sample was equally distributed regarding gender and age. Recruitment was conducted together with a field research partner who posted adverts on Facebook and Instagram (Meta) to reach as many potential participants as possible in an efficient way. All participants were asked to evaluate the intervention materials using a fictitious scenario of a man experiencing a mental health crisis before the interviews or focus groups took place. Results: The videos were perceived as (1) catchy, comprehensible, and empathetic, but too long for a short introduction. A balanced mix of emotional and informative content was considered appropriate and helpful. The health information provided was perceived as (2) serious and trustworthy due to citing scientific institutions and video material of men who had experienced suicidal ideation. (3) The intervention?s applicability for men experiencing acute crisis was critiqued, but it was regarded as very useful for comprehensive information. (4) Further communication channels and addressing other male subgroups or gender identities were presented as possible extensions of the program. Conclusions: Effective suicide prevention research should address both the groups at risk and their support network. Digital communication interventions can provide low-threshold access. Videos with personalized examples are important to give men someone to identify with, which validates their emotional responses and supports their self-esteem, while videos with experts provide relevant and credible information. UR - https://formative.jmir.org/2025/1/e59829 UR - http://dx.doi.org/10.2196/59829 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59829 ER - TY - JOUR AU - Junkins, Zachary AU - Zahan, Nusrath AU - Neyens, David PY - 2025/2/26 TI - Examining Individuals? Use of the Internet for Health Care Activities Over Time: Results from the US National Health Interview Survey JO - JMIR Hum Factors SP - e58362 VL - 12 KW - internet KW - web search KW - internet search KW - internet use KW - searching behavior KW - access to health information KW - telemedicine KW - telehealth KW - virtual care KW - virtual health KW - virtual medicine KW - logistic regression model KW - regression model KW - National Health Interview Survey KW - NHIS N2 - Background: Telehealth is an increasingly important component of health care services. Telehealth services may present an opportunity to increase the equity, accessibility, and effectiveness of health care. As such, it is critical that telehealth design focuses on reducing the barriers to access and usability that may impair some telehealth users. Objective: Our goal was to identify different demographic characteristics, behaviors, or opinions that may predict groups who are likely to face a barrier to using telehealth services. Methods: We used data from the National Health Interview Survey and multiple logit regression models focused on different aspects of telehealth to examine three different avenues of telehealth service: looking up health information using the internet, scheduling an appointment using the internet, and communicating with a care provider through email using the internet in order to consider the ways in which different telehealth services may face different barriers. Results: Our results suggest that middle-aged (36-55 years old) and older adult (56-85 years old) respondents were significantly less likely to look up health information using the internet or schedule an appointment using the internet versus younger individuals (18-35 years old). Specifically, our analysis found that middle-aged adults were found to have a higher odds ratio than older adults (0.83 vs 0.65) for looking up health information using the internet. We also found that there were differences in age groups for using technology to perform health care?related tasks. In terms of searching for health information using the internet and scheduling appointments using the internet, we found differences between men and women, with women being significantly more likely than men to look up health information using the internet, schedule an appointment using the internet, and communicate with a care provider through email using the internet. Across all the investigated variables, we found that the rates of using the internet for looking up health information, scheduling an appointment, and communicating with a care provider over email increased substantially across the study period. The impact of costs was inconsistent across the different models in our analysis. We also found that there is a strong correlation between respondents? collaboration in their personal health and the likelihood that they would use telehealth services to meet these needs. Conclusions: This analysis provides an exploratory look at the data to highlight barriers that may impact a user?s ability to access telehealth services in the context of other potential predictor variables to account for the real-world variability that these may present. Future work should examine the complex relationships of those variables and understand how these interactions are correlated with the respondents? use of telehealth. UR - https://humanfactors.jmir.org/2025/1/e58362 UR - http://dx.doi.org/10.2196/58362 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58362 ER - TY - JOUR AU - Evans, Kerrie AU - Ko, Jonathan AU - Ceprnja, Dragana AU - Maka, Katherine AU - Beales, Darren AU - Sterling, Michele AU - Bennell, L. Kim AU - Jull, Gwendolen AU - Hodges, W. Paul AU - McKay, J. Marnee AU - Rebbeck, J. Trudy PY - 2025/2/24 TI - Development and Implementation of MyPainHub, a Web-Based Resource for People With Musculoskeletal Conditions and Their Health Care Professionals: Mixed Methods Study JO - JMIR Form Res SP - e63780 VL - 9 KW - clinical pathways KW - allied health KW - self-management KW - health information KW - ehealth KW - co-design N2 - Background: Musculoskeletal conditions, including low back pain (LBP), neck pain, and knee osteoarthritis, are the greatest contributors to years lived with disability worldwide. Resources aiming to aid both patients and health care professionals (HCPs) exist but are poorly implemented and adopted. Objective: We aimed to develop and implement MyPainHub, an evidence-based web-based resource designed to provide comprehensive, credible and accessible information for people with, and HCPs who manage, common musculoskeletal conditions. Methods: This mixed methods study adhered to the New South Wales Translational Research Framework and was evaluated against the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Consultation with key stakeholders (patients, HCPs, researchers, industry, consumer groups, and website developers) informed content, design, features, and functionality. Development then aimed to meet the identified need for a ?one-stop shop??a central location for information about common musculoskeletal conditions tailored to a person?s condition and risk of poor outcomes. MyPainHub was then developed through an iterative process and implementation strategies were tailored to different health care settings. Quantitative and qualitative evaluation occurred with patients and HCPs. Results: In total, 127 stakeholders participated in the development phase; initial consultation with them led to embedding 2 validated screening tools (the Short Form Örebro Musculoskeletal Pain Screening Questionnaire and the Keele STarT MSK tool) in MyPainHub to guide information tailoring for patients based on risk of poor outcomes. Development occurred in parallel and feedback from stakeholders informed design and content including structure, functionality, and phrasing and images to use to emphasize key points. Consultation resulted in information for patients being categorized using key guideline-based messages (general information, your pathway, exercise, and imaging) while information for clinicians was categorized into assessment, management, and prognosis. Implementation occurred in different health care settings with the most effective strategies being interactive education via webinars and workshops. The evaluation phase involved web-based questionnaires (patients: n=44; HCPs: n=29) and focus groups (patients: n=6; HCPs: n=6). Patients and HCPs found MyPainHub user-friendly, acceptable, credible, and potentially able to support self-management. Patient participants identified areas for improvement such as including more specific information on preventative measures and pain relief options. Despite positive feedback, only 35% (10/29) of HCPs used MyPainHub with their patients. HCP participants identified challenges including insufficient training and lack of familiarity with using web-based resources in existing clinical workflows. Following implementation, the information contained on MyPainHub changed knowledge and practice for some patients and HCPs. Conclusions: Following extensive and iterative stakeholder engagement, MyPainHub was developed as an evidence-based web-based resource and perceived by patients and HCPs as user-friendly, credible, and acceptable. Active implementation strategies are required for adoption and implementation and greater training focusing on strategies to implement MyPainHub into clinical practice may be necessary. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619000871145; https://tinyurl.com/438kkyt3 UR - https://formative.jmir.org/2025/1/e63780 UR - http://dx.doi.org/10.2196/63780 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63780 ER - TY - JOUR AU - Midgett, Aida AU - Doumas, M. Diana AU - Peralta, Claudia AU - Peck, Matt AU - Reilly, Blaine AU - Buller, K. Mary PY - 2025/2/21 TI - Usability Testing of a Bystander Bullying Intervention for Rural Middle Schools: Mixed Methods Study JO - JMIR Hum Factors SP - e67962 VL - 12 KW - technology-based bullying intervention KW - STAC-T KW - usability testing KW - middle school KW - rural N2 - Background: Targets of bullying are at high risk of negative socioemotional outcomes. Bullying programming in rural schools is important as bullying is more prevalent in those schools compared to urban schools. Comprehensive, school-wide bullying programs require resources that create significant barriers to implementation for rural schools. Because technology-based programs can reduce implementation barriers, the development of a technology-based program increases access to bullying prevention in rural settings. Objective: We aimed to conduct usability testing of a bystander bullying intervention (STAC-T). We assessed usability and acceptability of the STAC-T application and differences in usability between school personnel and students. We were also interested in qualitative feedback about usability, program features, and feasibility. Methods: A sample of 21 participants (n=10, 48% school personnel; n=11, 52% students) recruited from 2 rural middle schools in 2 states completed usability testing and a qualitative interview. We used descriptive statistics and 2-tailed independent-sample t tests to assess usability and program satisfaction. We used consensual qualitative research as a framework to extract themes about usefulness, relevance, needs, barriers, and feedback for intervention development. Results: Usability testing indicated that the application was easy to use, acceptable, and feasible. School personnel (mean score 96.0, SD 3.9) and students (mean score 88.6, SD 9.5) rated the application well above the standard cutoff score for above-average usability (68.0). School personnel (mean score 6.10, SD 0.32) and students (mean score 6.09, SD 0.30) gave the application high user-friendliness ratings (0-7 scale; 7 indicates highest user-friendliness). All 10 school personnel stated they would recommend the program to others, and 90% (9/10) rated the program with 4 or 5 stars. Among students, 91% (10/11) stated they would recommend the program to others, and 100% (11/11) rated the program with 4 or 5 stars. There were no statistically significant differences in ratings between school personnel and students. Qualitative data revealed school personnel and students found the application useful, relevant, and appropriate while providing feedback about the importance of text narration and the need for teacher and parent training to accompany the student program. The data showed that school personnel and students found a tracker to report different types of bullying witnessed and strategies used to intervene by students a useful addition to STAC-T. School personnel reported perceiving the program to be practical and very likely to be adopted by schools, with time, cost, and accessibility being potential barriers. Overall, findings suggest that the STAC-T application has the potential to increase access to bullying prevention for students in rural communities. Conclusions: The results demonstrate high usability and acceptability of STAC-T and provide support for implementing a full-scale randomized controlled trial to test the efficacy of the application. UR - https://humanfactors.jmir.org/2025/1/e67962 UR - http://dx.doi.org/10.2196/67962 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67962 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 - Knowles, Kayla AU - Lee, Susan AU - Yapalater, Sophia AU - Taylor, Maria AU - Akers, Y. Aletha AU - Wood, Sarah AU - Dowshen, Nadia PY - 2025/2/19 TI - Simulation of Contraceptive Access for Adolescents and Young Adults Using a Pharmacist-Staffed e-Platform: Development, Usability, and Pilot Testing Study JO - JMIR Pediatr Parent SP - e60315 VL - 8 KW - adolescent KW - contraception KW - telemedicine KW - user-centered design KW - young adult KW - reproductive KW - design KW - usability KW - experience KW - mHealth KW - mobile health KW - app KW - youth KW - teenager KW - drug KW - pharmacology KW - pharmacotherapy KW - pharmaceutics KW - medication KW - pharmacy KW - digital health KW - platform KW - access N2 - Background: Offering contraceptive methods at pharmacies without a prescription is an innovative solution to reduce the incidence of unintended pregnancies among adolescents and young adults (AYA). Pharmacy-prescribed contraception may increase the convenience, simplicity, and affordability of contraceptives. Objective: The aim of this study was to develop, pilot test, and evaluate the acceptability and feasibility of a telemedicine electronic platform app simulating pharmacist prescribing of contraceptives to AYA as well as assess agreement between pharmacist-simulated contraceptive approvals and contraception as prescribed in routine clinic visits. Methods: This study was conducted in two phases: (1) development and usability testing of a prototype app to simulate pharmacists prescribing contraceptives to AYA and (2) pilot testing the app in a simulation for AYA requesting contraception from a pharmacist with pharmacist review and request approval or rejection. Eligibility criteria in both phases included the following: assigned female sex at birth, age 15-21 years, seeking contraceptive services at an academic adolescent medicine clinic, prior history of or intention to have penile-vaginal intercourse in the next 12 months, smartphone ownership, and English language proficiency. Phase 1 (usability) involved a video-recorded ?think aloud? interview to share feedback and technical issues while using the app prototype on a smartphone and the completion of sociodemographic, sexual history, and perception of the prototype surveys to further develop the app. Phase 2 (pilot) participants completed phase 1 surveys, tested the updated app in a simulation, and shared their experiences in an audio-recorded interview. Descriptive analyses were conducted for quantitative survey data, and thematic analyses were used for interview transcripts. Results: Of the 22 participants, 10 completed usability testing, with a mean age of 16.9 (SD 1.97) years, and 12 completed pilot testing, with a mean age of 18.25 (SD 1.48) years. Three issues with the prototype were identified during ?think aloud? interviews: challenges in comprehension of medical language, prototype glitches, and graphic design suggestions for engagement. Usability testing guided the frontend and backend creation of the platform. Overall, participants agreed or strongly agreed that using an app to receive contraceptives would make it easier for teens to access (n=19, 86%) and make contraceptive use less stigmatizing (n=19, 86%). In addition, participants agreed that receiving contraception prescriptions from a pharmacist without a clinic visit would be safe (n=18, 82%), convenient (n=19, 86%), acceptable (n=18, 82%), and easy (n=18, 82%). Pharmacists and medical providers had 100% agreement on the prescribed contraceptive method for pilot participants. Conclusions: AYA found contraceptive prescription by a pharmacist via an app to be highly acceptable and provided critical feedback to improve the design and delivery of the app. Additionally, pharmacist contraceptive approvals and contraception as prescribed in routine clinic visits were identical. UR - https://pediatrics.jmir.org/2025/1/e60315 UR - http://dx.doi.org/10.2196/60315 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60315 ER - TY - JOUR AU - Li, Xiancheng AU - Vaghi, Emanuela AU - Pasi, Gabriella AU - Coulson, S. Neil AU - De Simoni, Anna AU - Viviani, Marco AU - PY - 2025/2/13 TI - Understanding the Engagement and Interaction of Superusers and Regular Users in UK Respiratory Online Health Communities: Deep Learning?Based Sentiment Analysis JO - J Med Internet Res SP - e56038 VL - 27 KW - social media KW - online health communities KW - social network analysis KW - sentiment analysis KW - bio-bidirectional encoder representations from transformers KW - asthma KW - chronic obstructive pulmonary disease N2 - Background: Online health communities (OHCs) enable people with long-term conditions (LTCs) to exchange peer self-management experiential information, advice, and support. Engagement of ?superusers,? that is, highly active users, plays a key role in holding together the community and ensuring an effective exchange of support and information. Further studies are needed to explore regular users? interactions with superusers, their sentiments during interactions, and their ultimate impact on the self-management of LTCs. Objective: This study aims to gain a better understanding of sentiment distribution and the dynamic of sentiment of posts from 2 respiratory OHCs, focusing on regular users? interaction with superusers. Methods: We conducted sentiment analysis on anonymized data from 2 UK respiratory OHCs hosted by Asthma UK (AUK), and the British Lung Foundation (BLF) charities between 2006-2016 and 2012-2016, respectively, using the Bio-Bidirectional Encoder Representation from Transformers (BioBERT), a pretrained language representation model. Given the scarcity of health-related labeled datasets, BioBERT was fine-tuned on the COVID-19 Twitter Dataset. Positive, neutral, and negative sentiments were categorized as 1, 0, and ?1, respectively. The average sentiment of aggregated posts by regular users and superusers was then calculated. Superusers were identified based on a definition already used in our previous work (ie, ?the 1% users with the largest number of posts over the observation period?) and VoteRank, (ie, users with the best spreading ability). Sentiment analyses of posts by superusers defined with both approaches were conducted for correlation. Results: The fine-tuned BioBERT model achieved an accuracy of 0.96. The sentiment of posts was predominantly positive (60% and 65% of overall posts in AUK and BLF, respectively), remaining stable over the years. Furthermore, there was a tendency for sentiment to become more positive over time. Overall, superusers tended to write shorter posts characterized by positive sentiment (63% and 67% of all posts in AUK and BLF, respectively). Superusers defined by posting activity or VoteRank largely overlapped (61% in AUK and 79% in BLF), showing that users who posted the most were also spreaders. Threads initiated by superusers typically encouraged regular users to reply with positive sentiments. Superusers tended to write positive replies in threads started by regular users whatever the type of sentiment of the starting post (ie, positive, neutral, or negative), compared to the replies by other regular users (62%, 51%, 61% versus 55%, 45%, 50% in AUK; 71%, 62%, 64% versus 65%, 56%, 57% in BLF, respectively; P<.001, except for neutral sentiment in AUK, where P=.36). Conclusions: Network and sentiment analyses provide insight into the key sustaining role of superusers in respiratory OHCs, showing they tend to write and trigger regular users? posts characterized by positive sentiment. UR - https://www.jmir.org/2025/1/e56038 UR - http://dx.doi.org/10.2196/56038 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56038 ER - TY - JOUR AU - McMullan, Christel AU - Turner, Grace AU - Retzer, Ameeta AU - Belli, Antonio AU - Davies, Haf Elin AU - Nice, Laura AU - Flavell, Luke AU - Flavell, Jackie AU - Calvert, Melanie PY - 2025/1/23 TI - Testing an Electronic Patient-Reported Outcome Platform in the Context of Traumatic Brain Injury: PRiORiTy Usability Study JO - JMIR Form Res SP - e58128 VL - 9 KW - usability study KW - usability KW - patient reported outcome KW - PRO KW - electronic patient reported outcome KW - ePRO KW - traumatic brain injury KW - TBI KW - think aloud KW - cognitive interviews KW - early warning KW - early detection KW - mobile phone N2 - Background: Traumatic brain injury (TBI) is a significant public health issue and a leading cause of death and disability globally. Advances in clinical care have improved survival rates, leading to a growing population living with long-term effects of TBI, which can impact physical, cognitive, and emotional health. These effects often require continuous management and individualized care. Traditional paper-based assessments can be cumbersome, potentially impeding regular monitoring of patient-reported outcomes (PROs). Electronic PROs (ePROs) offer a promising alternative by enabling real-time symptom tracking, which can facilitate early identification of issues, support shared decision-making, and improve outcomes for patients with TBI. Objective: This study evaluates the usability of an ePRO platform?Atom5?for individuals with TBI. By analyzing how patients use the system to report their symptoms, the study aims to identify usability issues, assess user satisfaction, and determine the potential of Atom5 to support ongoing patient-centered care. Methods: Atom5 was customized to enable individuals with TBI to report their symptoms. Usability testing was conducted through one-on-one sessions with participants recruited from Headway UK?an organization supporting brain injury survivors. Each participant took part in cognitive interviews using with the ?Think Aloud? method, encouraging them to verbalize their thoughts and experiences while using the platform. This approach provided qualitative insights into areas of difficulty, usability strengths, and accessibility barriers. User satisfaction was quantitatively assessed with a brief 4-item questionnaire based on the System Usability Scale. Usability outcomes were analyzed for critical and noncritical errors, focusing on user experience and overall satisfaction. Results: In total, 9 participants completed a single usability testing session using Atom5, including 4 men, 4 women, and 1 nonbinary individual; 4 participants were under 55 years old, and 6 had their TBI <10 years ago. Finally, 8 participants used an Android device. The platform included measures for anxiety (Generalized Anxiety Disorder-2 item), depression (Patient Health Questionnaire-2), posttraumatic stress disorder (Posttraumatic Stress Disorder checklist 2), and TBI-specific quality of life (Traumatic Brain Injury ? Quality of Life Short form) and a total of 26 questions. Overall, all participants were satisfied with the system, noting that it was easy to navigate and accessible despite difficulties in understanding some questions. Further, 6 participants encountered no errors, while 1 participant reported one critical error and 2 others reported one noncritical error each. The participants rated their overall satisfaction with the platform at an average score of 3.9 (SD 0.49) out of 5. Conclusions: This usability study suggests that individuals living with TBI can effectively report symptoms using the Atom5 ePRO platform, with generally high satisfaction and few usability issues, thereby enabling continuous monitoring and proactive symptom management. Future ePRO development should focus on inclusivity and adaptability to address the diverse needs of patients with TBI, ensuring these tools can effectively support a wide range of users. UR - https://formative.jmir.org/2025/1/e58128 UR - http://dx.doi.org/10.2196/58128 ID - info:doi/10.2196/58128 ER - @Article{info:doi/10.2196/60868, author="Alichniewicz, Katarzyna Karolina and Hampton, Sarah and Romaniuk, Madeline and Bennett, Darcy and Guindalini, Camila", title="Use of Go-Beyond as a Self-Directed Internet-Based Program Supporting Veterans' Transition to Civilian Life: Preliminary Usability Study", journal="JMIR Form Res", year="2025", month="Jan", day="23", volume="9", pages="e60868", keywords="military transition", keywords="web-based interventions", keywords="military-civilian adjustment", keywords="Go-Beyond", keywords="internet-based program", keywords="civilian", keywords="military service", keywords="veteran", keywords="premilitary life", keywords="mental health issues", keywords="physical injuries", keywords="adoption", keywords="quantitative analysis", keywords="survey", keywords="family", keywords="support", keywords="digital technology", keywords="user engagement", keywords="effectiveness", keywords="assessment", abstract="Background: The transition from military service to civilian life presents a variety of challenges for veterans, influenced by individual factors such as premilitary life, length of service, and deployment history. Mental health issues, physical injuries, difficulties in relationships, and identity loss compound the reintegration process. To address these challenges, various face-to-face and internet-based programs are available yet underused. This paper presents the preliminary evaluation of ``Go-Beyond, Navigating Life Beyond Service,'' an internet-based psychoeducational program for veterans. Objective: The study aims to identify the reach, adoption, and engagement with the program and to generate future recommendations to enhance its overall impact. Methods: This study exclusively used data that were automatically and routinely collected from the start of the Go-Beyond program's launch on May 24, 2021, until May 7, 2023. When accessing the Go-Beyond website, veterans were asked to complete the Military-Civilian Adjustment and Reintegration Measure (M-CARM) questionnaire, which produces a unique M-CARM profile of results specifying potential areas of need on the 5 domains of the measure. Users were then automatically allocated to Go-Beyond modules that aligned with their M-CARM profile. Additionally, quantitative and qualitative data were collected from a survey on aesthetics, interactivity, user journey, and user experience, which was optional for users to complete at the end of each module. Results: Results show a conversion rate of 28.5\% (273/959) from the M-CARM survey to the Go-Beyond program. This rate is notably higher compared with similar internet-based self-help programs, such as VetChange (1033/22,087, 4.7\%) and resources for gambling behavior (5652/8083, 14\%), but lower than the MoodGYM program (82,159/194,840, 42.2\%). However, these comparisons should be interpreted with caution due to the limited availability of published conversion rates and varying definitions of uptake and adoption across studies. Additionally, individuals were 1.64 (95\% CI 1.17-2.28) more likely to enroll when they express a need in Purpose and Connection, and they were 1.50 (95\% CI 1.06-2.18) times more likely to enroll when they express the need Beliefs About Civilians, compared with those without these needs. The overall completion rate for the program was 31\% (85/273) and modules' individual completion rates varied from 8.4\% (17/203) to 20\% (41/206). Feedback survey revealed high overall user satisfaction with Go-Beyond, emphasizing its engaging content and user-friendly modules. Notably, 94\% (88/94) of survey respondents indicated they would recommend the program to other veterans, family, or friends. Conclusions: The Go-Beyond program may offer promising support for veterans transitioning to civilian life through digital technology. Our study reveals insights on user engagement and adoption, emphasizing the need for ongoing evaluation to further address the diverse needs of military personnel. Future research should explore predictors of engagement, the addition of peer or facilitator support, and the use of outcome measures for effectiveness assessment. ", doi="10.2196/60868", url="https://formative.jmir.org/2025/1/e60868", url="http://www.ncbi.nlm.nih.gov/pubmed/39847427" } TY - JOUR AU - Butt, L. Michelle AU - Willett, Jayne Ysabella AU - Miller, Vicky AU - Jacobs, Brenda AU - Ferron, Mae Era AU - Wright, L. Amy PY - 2024/11/22 TI - Indigenous Parents? Perspectives of Factors That Facilitate or Impede Engagement in Internet-Based Parenting Support Programs: Interpretive Description Study JO - JMIR Pediatr Parent SP - e64994 VL - 7 KW - child KW - parenting KW - qualitative KW - Indigenous health KW - support programs N2 - Background: Parenting support programs enhance parents? health and their child?s development. The COVID-19 pandemic necessitated the delivery of these programs over the internet. After the pandemic, internet-based programs are still preferred by some. Objective: We aimed to understand Indigenous parents? experiences engaging in internet-based parenting support programs; thus, an interpretive description study was conducted. Methods: A total of 20 Indigenous (female, male, and Two-Spirit) parents of children aged <5 years participated in semistructured interviews; data underwent collaborative thematic analysis with Indigenous community partners informed by the Two-Eyed Seeing framework and ethical space. Results: Parents? experiences were classified into five themes: (1) Purpose: Program Delivery and Content, (2) Belonging: Building Relationships and Connections, (3) Hope: Cultural Connection, (4) Meaning: New or Improved Parenting Skills and Mental Wellness, and (5) Recommendations for Organizations. Conclusions: The study findings can inform internet-based parenting program delivery to enhance engagement for Indigenous families. UR - https://pediatrics.jmir.org/2024/1/e64994 UR - http://dx.doi.org/10.2196/64994 UR - http://www.ncbi.nlm.nih.gov/pubmed/39576680 ID - info:doi/10.2196/64994 ER - TY - JOUR AU - Reynaud, Danielle AU - Bouscaren, Nicolas AU - Cartron, Emmanuelle AU - Marimoutou, Catherine PY - 2024/11/1 TI - Feasibility of Sexual Health and Contraceptive Web Services for Adolescents and Young Adults: Retrospective Study of a Pilot Program on Reunion Island JO - JMIR Pediatr Parent SP - e52557 VL - 7 KW - sexual health KW - adolescent KW - young adults KW - web application KW - contraception prescription KW - contraception KW - teleconsultation KW - telemedicine KW - youth KW - usage KW - e-consultation KW - web based N2 - Background: Sexual health indicators for adolescents and young adults (AYAs) aged between 13 and 25 years are particularly poor on Reunion Island. Access to accurate information as well as sexual health and contraceptive services are vital to maintaining sexual well-being. Teleconsultations offer a promising approach to addressing the sexual health and contraceptive needs of AYAs who are more susceptible to engaging in unprotected sexual intercourse. However, the literature on digital sexual health services for this demographic group is limited. Objective: This study aims to describe the feasibility of a pilot sexual health and contraceptive teleconsultation web service used by AYAs on Reunion Island. Methods: A descriptive, retrospective study was conducted at the Reunion Island University Hospital Center using a convenient sample. Eligible participants were informed about the program through various communication channels, including seminars for health care professionals, radio broadcasts, posters, flyers, press articles, videos, and social media posts. AYAs accessed a web-based platform named SEXTUOZE from December 15, 2021, to September 30, 2022, that offered sexual health information and teleconsultations. Data collected included participant and teleconsultation characteristics, patient satisfaction, and the quality of completeness of medical records. Results: A total of 22 teleconsultations were scheduled and 7 were completed, all via synchronous video communication (duration: median 35 min). Overall, 4731 sessions were generated on the SEXTUOZE website. Reasons cited for accessing the web services were to seek sexual health advice (8/22, 36%), receive an initial birth control prescription (12/22, 55%), and inquire about condom prescriptions (2/22, 9%). Conclusions: While teleconsultation use for sexual health was initially low, it rose toward the end of the study period. Considering all elements of the implementation theory, future research should design interventions that not only are more operative and tailored but also ensure their adoption and sustainability in various health contexts. UR - https://pediatrics.jmir.org/2024/1/e52557 UR - http://dx.doi.org/10.2196/52557 ID - info:doi/10.2196/52557 ER - TY - JOUR AU - Pearson, Rahel AU - Beevers, G. Christopher AU - Mignogna, Joseph AU - Benzer, Justin AU - Pfeiffer, N. Paul AU - Post, Edward AU - Creech, K. Suzannah PY - 2024/10/24 TI - The Evaluation of a Web-Based Intervention (Deprexis) to Decrease Depression and Restore Functioning in Veterans: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e59119 VL - 13 KW - depression KW - eHealth KW - mental health KW - randomized controlled trial KW - RCT KW - mobile phone N2 - Background: Depressive symptoms are common in veterans, and the presence of these symptoms increases disability as well as suicidal thoughts and behaviors. However, there is evidence that these symptoms often go untreated. Intervening before symptoms become severe and entrenched is related to better long-term outcomes, including improved functioning and less disease chronicity. Computer-delivered interventions may be especially appropriate for those veterans with mild to moderate depressive symptoms, because these interventions can require fewer resources and have lower barriers to access and thus have potential for wider reach. Despite this potential, there is a dearth of research examining computerized interventions for depressive symptoms in veteran samples. Objective: The aim of this study is to evaluate the efficacy of Deprexis (GAIA AG), a computerized intervention for depressive symptoms and related functional impairment. Methods: Veterans will be recruited through the US Department of Veterans Affairs electronic medical record and through primary care and specialty clinics. First, qualitative interviews will be completed with a small subset of veterans (n=16-20) to assess the acceptability of treatment procedures. Next, veterans (n=132) with mild to moderate depressive symptoms will be randomly assigned to the fully automated Deprexis intervention or a treatment-as-usual control group. The primary outcomes will be self-reported depressive symptoms and various dimensions of psychosocial functioning. Results: This project was funded in May 2024, and data collection will be conducted between October 2024 and April 2029. Overall, 4 participants have been recruited as of the submission of the manuscript, and data analysis is expected in June 2029, with initial results expected in November 2029. Conclusions: This study will provide initial evidence for the efficacy of self-guided, computerized interventions for depressive symptoms and functional impairment in veterans. If effective, these types of interventions could improve veteran access to low-resource psychosocial treatments. Trial Registration: ClinicalTrials.gov NCT06217198; https://www.clinicaltrials.gov/study/NCT06217198 International Registered Report Identifier (IRRID): PRR1-10.2196/59119 UR - https://www.researchprotocols.org/2024/1/e59119 UR - http://dx.doi.org/10.2196/59119 UR - http://www.ncbi.nlm.nih.gov/pubmed/39446432 ID - info:doi/10.2196/59119 ER - TY - JOUR AU - Zhu, Julia Shiyi AU - Bennell, L. Kim AU - Hinman, S. Rana AU - Harrison, Jenny AU - Kimp, J. Alexander AU - Nelligan, K. Rachel PY - 2024/9/30 TI - Development of a 12-Week Unsupervised Online Tai Chi Program for People With Hip and Knee Osteoarthritis: Mixed Methods Study JO - JMIR Aging SP - e55322 VL - 7 KW - intervention development KW - osteoarthritis KW - Tai Chi KW - web-based intervention KW - online KW - telehealth KW - unsupervised exercise KW - exercise KW - physical activity KW - arthritis KW - development KW - web based KW - hip KW - knee KW - gerontology KW - geriatric KW - older adult KW - aging KW - bone KW - workout KW - digital health KW - eHealth KW - literature review KW - telemedicine N2 - Background: Osteoarthritis is a leading contributor to global disability. While evidence supports the effectiveness of Tai Chi in improving symptoms for people with hip/knee osteoarthritis, access to in-person Tai Chi classes may be difficult for many people. An unsupervised online Tai Chi intervention for people with osteoarthritis can help overcome accessibility barriers. The Approach to Human-Centered, Evidence-Driven Adaptive Design (AHEAD) framework provides a practical guide for co-designing such an intervention. Objective: This study aims to develop an unsupervised online Tai Chi program for people with hip/knee osteoarthritis. Methods: An iterative process was conducted using the AHEAD framework. Initially, a panel of Tai Chi instructors and people with osteoarthritis was assembled. A literature review was conducted to inform the content of a survey (survey 1), which was completed by the panel and additional Australian Tai Chi instructors to identify Tai Chi movements for potential inclusion. Selection of Tai Chi movements was based on 3 criteria: those that were appropriate (for people with hip/knee osteoarthritis aged 45+ years), safe (to be performed at home unsupervised), and practical (to be delivered online using prerecorded videos). Movements that met these criteria were then ranked in a second survey (survey 2; using conjoint analysis methodology). Survey findings were discussed in a focus group, and the Tai Chi movements for program use were identified. A draft of the online Tai Chi program was developed, and a final survey (survey 3) was conducted with the panel to rate the appropriateness and safety of the proposed program. The final program was developed, and usability testing (think-aloud protocol) was conducted with people with knee osteoarthritis. Results: The panel consisted of 10 Tai Chi instructors and 3 people with osteoarthritis. The literature review identified Yang Style 24 as a common and effective Tai Chi style used in hip/knee osteoarthritis studies. Surveys 1 (n=35) and 2 (n=27) produced a ranked list of 24 Tai Chi movements for potential inclusion. This list was refined and informed by a focus group, with 10 Tai Chi movements being selected for inclusion (known as the Yang Style 10 form). Survey 3 (n=13) found that 92% (n=12) of the panel members believed that the proposed draft Tai Chi program was appropriate and safe, resulting in its adoption. The final program was produced and hosted on a customized website, ?My Joint Tai Chi,? which was further refined based on user feedback (n=5). ?My Joint Tai Chi? is currently being evaluated in a randomized controlled trial. Conclusions: This study demonstrates the use of the AHEAD framework to develop an unsupervised online Tai Chi intervention (?My Joint Tai Chi?) for people with hip/knee osteoarthritis. This intervention is now being tested for effectiveness and safety in a randomized controlled trial. UR - https://aging.jmir.org/2024/1/e55322 UR - http://dx.doi.org/10.2196/55322 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55322 ER - TY - JOUR AU - Eaton, Cyd AU - Vallejo, Natalie AU - McDonald, Xiomara AU - Wu, Jasmine AU - Rodríguez, Rosa AU - Muthusamy, Nishanth AU - Mathioudakis, Nestoras AU - Riekert, A. Kristin PY - 2024/9/24 TI - User Engagement With mHealth Interventions to Promote Treatment Adherence and Self-Management in People With Chronic Health Conditions: Systematic Review JO - J Med Internet Res SP - e50508 VL - 26 KW - mobile health KW - mHealth KW - digital health KW - treatment adherence KW - self-management KW - user engagement KW - chronic health conditions KW - mobile phone N2 - Background: There are numerous mobile health (mHealth) interventions for treatment adherence and self-management; yet, little is known about user engagement or interaction with these technologies. Objective: This systematic review aimed to answer the following questions: (1) How is user engagement defined and measured in studies of mHealth interventions to promote adherence to prescribed medical or health regimens or self-management among people living with a health condition? (2) To what degree are patients engaging with these mHealth interventions? (3) What is the association between user engagement with mHealth interventions and adherence or self-management outcomes? (4) How often is user engagement a research end point? Methods: Scientific database (Ovid MEDLINE, Embase, Web of Science, PsycINFO, and CINAHL) search results (2016-2021) were screened for inclusion and exclusion criteria. Data were extracted in a standardized electronic form. No risk-of-bias assessment was conducted because this review aimed to characterize user engagement measurement rather than certainty in primary study results. The results were synthesized descriptively and thematically. Results: A total of 292 studies were included for data extraction. The median number of participants per study was 77 (IQR 34-164). Most of the mHealth interventions were evaluated in nonrandomized studies (157/292, 53.8%), involved people with diabetes (51/292, 17.5%), targeted medication adherence (98/292, 33.6%), and comprised apps (220/292, 75.3%). The principal findings were as follows: (1) >60 unique terms were used to define user engagement; ?use? (102/292, 34.9%) and ?engagement? (94/292, 32.2%) were the most common; (2) a total of 11 distinct user engagement measurement approaches were identified; the use of objective user log-in data from an app or web portal (160/292, 54.8%) was the most common; (3) although engagement was inconsistently evaluated, most of the studies (99/195, 50.8%) reported >1 level of engagement due to the use of multiple measurement methods or analyses, decreased engagement across time (76/99, 77%), and results and conclusions suggesting that higher engagement was associated with positive adherence or self-management (60/103, 58.3%); and (4) user engagement was a research end point in only 19.2% (56/292) of the studies. Conclusions: The results revealed major limitations in the literature reviewed, including significant variability in how user engagement is defined, a tendency to rely on user log-in data over other measurements, and critical gaps in how user engagement is evaluated (infrequently evaluated over time or in relation to adherence or self-management outcomes and rarely considered a research end point). Recommendations are outlined in response to our findings with the goal of improving research rigor in this area. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42022289693; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022289693 UR - https://www.jmir.org/2024/1/e50508 UR - http://dx.doi.org/10.2196/50508 UR - http://www.ncbi.nlm.nih.gov/pubmed/39316431 ID - info:doi/10.2196/50508 ER - TY - JOUR AU - Delaney, Tessa AU - Jackson, K. Jacklyn AU - Brown, L. Alison AU - Lecathelinais, Christophe AU - Wolfenden, Luke AU - Hudson, Nayerra AU - Young, Sarah AU - Groombridge, Daniel AU - Pinfold, Jessica AU - Craven, David Paul AU - Redman, Sinead AU - Wiggers, John AU - Kingsland, Melanie AU - Hayes, Margaret AU - Sutherland, Rachel PY - 2024/9/24 TI - Perceived Acceptability of Technology Modalities for the Provision of Universal Child and Family Health Nursing Support in the First 6-8 Months After Birth: Cross-Sectional Study JO - JMIR Pediatr Parent SP - e59191 VL - 7 KW - maternal KW - postnatal KW - postpartum KW - acceptability KW - technology KW - digital health KW - first 2000 days KW - child health KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - cross sectional KW - survey KW - surveys KW - questionnaire KW - questionnaires KW - pediatric KW - pediatrics KW - infant KW - infants KW - infancy KW - baby KW - babies KW - neonate KW - neonates KW - neonatal KW - newborn KW - newborns KW - nurse KW - nurses KW - nursing N2 - Background: Child and Family Health Nursing (CFHN) services provide universal care to families during the first 2000 days (conception: 5 years) to support optimal health and developmental outcomes of children in New South Wales, Australia. The use of technology represents a promising means to encourage family engagement with CFHN services and enable universal access to evidenced-based age and stage information. Currently, there is little evidence exploring the acceptability of various models of technology-based support provided during the first 2000 days, as well as the maternal characteristics that may influence this. Objective: This study aims to describe (1) the acceptability of technology-based models of CFHN support to families in the first 6 months, and (2) the association between the acceptability of technology-based support and maternal characteristics. Methods: A cross-sectional survey was undertaken between September and November 2021 with women who were 6-8 months post partum within the Hunter New England Local Health District of New South Wales, Australia. Survey questions collected information on maternal demographics and pregnancy characteristics, perceived stress, access to CFHN services, as well as preferences and acceptability of technology-based support. Descriptive statistics were used to describe the characteristics of the sample, the proportion of women accessing CFHN services, maternal acceptability of technology-based support from CFHN services, and the appropriateness of timing of support. Multivariable logistic regression models were conducted to assess the association between maternal characteristics and the acceptability of technology-based CFHN support. Results: A total of 365 women participated in the study, most were 25 to 34 years old (n=242, 68%), had completed tertiary level education or higher (n=250, 71%), and were employed or on maternity leave (n=280, 78%). Almost all (n=305, 89%) women reported accessing CFHN services in the first 6 months following their child?s birth. The majority of women (n=282-315, 82%-92%) ?strongly agreed or agreed? that receiving information from CFHN via technology would be acceptable, and most (n=308) women ?strongly agreed or agreed? with being provided information on a variety of relevant health topics. Acceptability of receiving information via websites was significantly associated with maternal employment status (P=.01). The acceptability of receiving support via telephone and email was significantly associated with maternal education level (adjusted odds ratio 2.64, 95% CI 1.07-6.51; P=.03 and adjusted odds ratio 2.90, 95% CI 1.20-7.00; P=.02, respectively). Maternal age was also associated with the acceptability of email support (P=.04). Conclusions: Technology-based CFHN support is generally acceptable to mothers. Maternal characteristics, including employment status, education level, and age, were found to modify the acceptability of specific technology modalities. The findings of this research should be considered when designing technology-based solutions to providing universal age and stage child health and developmental support for families during the first 2000 days. UR - https://pediatrics.jmir.org/2024/1/e59191 UR - http://dx.doi.org/10.2196/59191 UR - http://www.ncbi.nlm.nih.gov/pubmed/39316424 ID - info:doi/10.2196/59191 ER - TY - JOUR AU - Staras, S. Stephanie A. AU - Tauscher, Justin AU - Vinson, Michelle AU - Thompson, A. Lindsay AU - Gerend, A. Mary AU - Shenkman, A. Elizabeth PY - 2024/9/19 TI - Usability of a Web-Based App for Increasing Adolescent Vaccination in Primary Care Settings: Think-Aloud and Survey Assessment JO - JMIR Form Res SP - e56559 VL - 8 KW - participatory design KW - think-aloud KW - implementation science KW - adolescent vaccination KW - human papillomavirus vaccine KW - usability KW - eHealth N2 - Background: In the United States, only 58% of teens receive the recommended 2 doses of the human papillomavirus vaccine by 15 years of age. Overcoming vaccine hesitancy often requires effective communication between clinicians and parents to address specific concerns. To support this, we developed ProtectMe4, a multilevel, theory-informed web-based intervention designed to address parents? vaccine-related questions and assist clinicians in discussing vaccine concerns for 4 adolescent vaccines. Objective: This study aims to evaluate the usability of ProtectMe4 in routine care settings across 3 pediatric primary care clinics. Specifically, the study aims to (1) observe the proposed workflow in practice, (2) identify usability issues experienced by parents and clinicians, and (3) assess the perceptions of both parents and clinicians regarding the app?s usability. Methods: On designated days in 2020 and 2021, the study team recruited parents of 11- to 12-year-old patients attending appointments with participating clinicians. We conducted think-aloud assessments during routine care visits and administered a usability survey after participants used the app. For parents, we simultaneously video-recorded the app screens and audio-recorded their commentary. For clinicians, observational notes were taken regarding their actions and comments. Timings recorded within the app provided data on the length of use. We reviewed the recordings and notes to compile a list of identified issues and calculated the frequencies of survey responses. Results: Out of 12 parents invited to use the app, 9 (75%) participated. Two parents who were invited outside of the planned workflow, after seeing the clinician, refused to participate. For the parents whose child?s vaccination record was identified by the app, the median time spent using the app was 9 (range 6-28) minutes. Think-aloud assessment results for parents were categorized into 2 themes: (1) troubleshooting vaccine record identification and (2) clarifying the app content and purpose. Among the 8 parents who completed the survey, at least 75% (6/8) agreed with each acceptability measure related to user satisfaction, perceived usefulness, and acceptance. These parents? children were patients of 4 of the 7 participating clinicians. Consistent with the planned workflow, clinicians viewed the app before seeing the patient in 4 of 9 (44%) instances. The median time spent on the app per patient was 95 (range 5-240) seconds. Think-aloud assessment results for clinicians were grouped into 2 themes: (1) trust of app vaccine results and (2) clarifying the app content. On the survey, clinicians were unanimously positive about the app, with an average System Usability Scale score of 87.5 (SE 2.5). Conclusions: This mixed methods evaluation demonstrated that ProtectMe4 was usable and acceptable to both parents and clinicians in real-world pediatric primary care. Improved coordination among clinic staff is needed to ensure the app is consistently offered to patients and reviewed by clinicians before seeing the patient. UR - https://formative.jmir.org/2024/1/e56559 UR - http://dx.doi.org/10.2196/56559 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56559 ER - TY - JOUR AU - Fareed, Naleef AU - Olvera, G. Ramona AU - Wang, Yiting AU - Hayes, Michael AU - Larimore, Liz Elizabeth AU - Balvanz, Peter AU - Langley, Ronald AU - Noel, A. Corinna AU - Rock, Peter AU - Redmond, Daniel AU - Neufeld, Jessica AU - Kosakowski, Sarah AU - Harris, Daniel AU - LaRochelle, Marc AU - Huerta, R. Timothy AU - Glasgow, LaShawn AU - Oga, Emmanuel AU - Villani, Jennifer AU - Wu, Elwin PY - 2024/9/9 TI - Lessons Learned From Developing Dashboards to Support Decision-Making for Community Opioid Response by Community Stakeholders: Mixed Methods and Multisite Study JO - JMIR Hum Factors SP - e51525 VL - 11 KW - data visualizations KW - dashboards KW - public health KW - overdose epidemic KW - human-centered design N2 - Background: Data dashboards are published tools that present visualizations; they are increasingly used to display data about behavioral health, social determinants of health, and chronic and infectious disease risks to inform or support public health endeavors. Dashboards can be an evidence-based approach used by communities to influence decision-making in health care for specific populations. Despite widespread use, evidence on how to best design and use dashboards in the public health realm is limited. There is also a notable dearth of studies that examine and document the complexity and heterogeneity of dashboards in community settings. Objective: Community stakeholders engaged in the community response to the opioid overdose crisis could benefit from the use of data dashboards for decision-making. As part of the Communities That HEAL (CTH) intervention, community data dashboards were created for stakeholders to support decision-making. We assessed stakeholders? perceptions of the usability and use of the CTH dashboards for decision-making. Methods: We conducted a mixed methods assessment between June and July 2021 on the use of CTH dashboards. We administered the System Usability Scale (SUS) and conducted semistructured group interviews with users in 33 communities across 4 states of the United States. The SUS comprises 10 five-point Likert-scale questions measuring usability, each scored from 0 to 4. The interview guides were informed by the technology adoption model (TAM) and focused on perceived usefulness, perceived ease of use, intention to use, and contextual factors. Results: Overall, 62 users of the CTH dashboards completed the SUS and interviews. SUS scores (grand mean 73, SD 4.6) indicated that CTH dashboards were within the acceptable range for usability. From the qualitative interview data, we inductively created subthemes within the 4 dimensions of the TAM to contextualize stakeholders? perceptions of the dashboard?s usefulness and ease of use, their intention to use, and contextual factors. These data also highlighted gaps in knowledge, design, and use, which could help focus efforts to improve the use and comprehension of dashboards by stakeholders. Conclusions: We present a set of prioritized gaps identified by our national group and list a set of lessons learned for improved data dashboard design and use for community stakeholders. Findings from our novel application of both the SUS and TAM provide insights and highlight important gaps and lessons learned to inform the design of data dashboards for use by decision-making community stakeholders. Trial Registration: ClinicalTrials.gov NCT04111939; https://clinicaltrials.gov/study/NCT04111939 UR - https://humanfactors.jmir.org/2024/1/e51525 UR - http://dx.doi.org/10.2196/51525 UR - http://www.ncbi.nlm.nih.gov/pubmed/39250216 ID - info:doi/10.2196/51525 ER - TY - JOUR AU - Hodson, Nathan AU - Woods, Peter AU - Solano, Luque Juan AU - Talbot, Charlotte AU - Giacco, Domenico PY - 2024/9/5 TI - Evaluating a Mobile App Supporting Evidence-Based Parenting Skills: Thematic Analysis of Parent Experience JO - JMIR Pediatr Parent SP - e53907 VL - 7 KW - digital microintervention KW - parenting app KW - product management KW - parent KW - parents KW - parenting KW - app KW - apps KW - usability KW - acceptability KW - family KW - families KW - interview KW - interviews KW - pediatric KW - pediatrics KW - child KW - children KW - youths KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - behavior KW - behaviors KW - disruptive behavior KW - thematic analysis N2 - Background: Disruptive behavior disorders are among the most common disorders of childhood, and evidence-based parenting programs are the first-line treatment. Digital microinterventions have been proposed as one possible means of supporting parenting style change by giving parents in-the-moment advice about how to respond to challenging behavior. Until now, no digital microintervention supporting evidence-based parenting skills programs has been evaluated. Objective: The aim of this study is to evaluate the subjective experience of parents using a digital microintervention to support evidence-based parenting skills, with particular attention to acceptability, usability, family relationships, and parents? values. Methods: We conducted serial interviews with 11 parents of 33 children before and after spending 3 weeks using an app including 3 digital microinterventions. Parents were recruited via local authorities in the Midlands region of the United Kingdom. Previous participation in a parenting program was an inclusion criterion. Interviews explored family composition; child behavior problems; and experience of using the mobile app, including barriers to use. Thematic analysis was conducted from a user-centered design perspective, and illustrative case vignettes were produced. Results: Many parents used the app in ways that helped them rather than strictly following the instructions they were given. Parents described a range of barriers to using the app including practical problems and failure to change child behavior. Parents and children responded in a variety of ways to the use of the phone, with many wholeheartedly embracing the convenience of technology. Case vignettes illustrate the uniqueness of each family?s experience. Conclusions: Parents? use of a mobile app supporting evidence-based parenting skills is difficult to predict due to the unique challenges each family encounters. Many parents found it an acceptable and helpful addition to family life, but increased personalization is likely to be key to supporting parents. Future digital microintervention developers should keep in mind that parents are likely to use the app pragmatically rather than following instructions, may struggle to use a complex app under pressure, and are likely to hold complex feelings about parenting with an app. UR - https://pediatrics.jmir.org/2024/1/e53907 UR - http://dx.doi.org/10.2196/53907 ID - info:doi/10.2196/53907 ER - TY - JOUR AU - Landman, Benjamin AU - Khoury, Elie AU - Cohen, Alicia AU - Trebossen, Vincent AU - Michel, Alexandre AU - Lefebvre, Aline AU - Delorme, Richard PY - 2024/8/15 TI - Acceptance of a French e?Mental Health Information Website (CléPsy) for Families: A Web-Based Survey JO - JMIR Pediatr Parent SP - e50978 VL - 7 KW - mental health education KW - children KW - family KW - child KW - pediatrics KW - pediatric KW - mental health KW - parent KW - parents KW - parenting KW - psychiatry KW - website KW - acceptance KW - patient education KW - online information KW - health information KW - ease of use KW - usefulness KW - survey KW - surveys KW - user KW - experience KW - questionnaire KW - questionnaires KW - families N2 - Background: Childhood mental health issues concern a large amount of children worldwide and represent a major public health challenge. The lack of knowledge among parents and caregivers in this area hinders effective management. Empowering families enhances their ability to address their children?s difficulties, boosts health literacy, and promotes positive changes. However, seeking reliable mental health information remains challenging due to fear, stigma, and mistrust of the sources of information. Objective: This study evaluates the acceptance of a website, CléPsy, designed to provide reliable information and practical tools for families concerned about child mental health and parenting. Methods: This study examines user characteristics and assesses ease of use, usefulness, trustworthiness, and attitude toward using the website. Platform users were given access to a self-administered questionnaire by means of mailing lists, social networks, and posters between May and July 2022. Results: Findings indicate that the wide majority of the 317 responders agreed or somewhat agreed that the website made discussions about mental health easier with professionals (n=264, 83.3%) or with their relatives (n=260, 82.1%). According to the ANOVA, there was a significant effect between educational level and perceived trust (F6=3.03; P=.007) and between frequency of use and perceived usefulness (F2=4.85; P=.008). Conclusions: The study underlines the importance of user experience and design in web-based health information dissemination and emphasizes the need for accessible and evidence-based information. Although the study has limitations, it provides preliminary support for the acceptability and usefulness of the website. Future efforts should focus on inclusive co-construction with users and addressing the information needs of families from diverse cultural and educational backgrounds. UR - https://pediatrics.jmir.org/2024/1/e50978 UR - http://dx.doi.org/10.2196/50978 ID - info:doi/10.2196/50978 ER - TY - JOUR AU - Erbas, Ege Mert AU - Ziehfreund, Stefanie AU - Wecker, Hannah AU - Biedermann, Tilo AU - Zink, Alexander PY - 2024/8/7 TI - Digital Media Usage Behavior and Its Impact on the Physician-Patient Relationship: Cross-Sectional Study Among Individuals Affected by Psoriasis in Germany JO - J Med Internet Res SP - e57823 VL - 26 KW - psoriasis KW - dermatology KW - digital health KW - digital media KW - internet use KW - questionnaire KW - physician-patient relationship N2 - Background: Psoriasis is a chronic skin disorder with a high burden of disease. People affected with psoriasis increasingly use the internet for health-related reasons, especially those with younger age, higher education, and higher disease severity. Despite advantages such as enhancing the individuals? knowledge with the use of digital media for health-related issues, disadvantages were also present such as quality control, and variability in the individuals? health information literacy. While patients with psoriasis within medical settings generally trust physicians over digital media, they commonly withhold their web-based research findings from health care providers. Objective: The study aims to (1) identify further factors associated with regular psoriasis-related internet use, (2) rank specific digital media platforms used, and (3) examine digital media within the physician-patient relationship among individuals with and without dermatological treatment. Methods: A cross-sectional, questionnaire-based study was conducted among individuals with self-reported psoriasis in Germany between September 2021 and February 2022. Participants were recruited via digital media platforms and in person at a University Hospital Department of Dermatology in southern Germany. The questionnaire asked about demographic and medical information, individual psoriasis-related digital media use, and the impact of digital media on the physician-patient relationship. Data were analyzed descriptively, and logistic regression models were performed to assess the factors associated with regular psoriasis-related internet use. Results: Among 321 individuals with a median age of 53 (IQR 41-61) years (nonnormally distributed; females: 195/321), female sex, shorter disease duration, moderate mental burden of disease, and good self-assessed psoriasis-related knowledge were associated with regular psoriasis-related internet use. Of the 188 participants with a mean age of 51.2 (SD 13.9) years (normally distributed) who used digital media 106 (56.4%) usually searched for information on psoriasis-based websites and 98 (52.1%) on search engines, primarily for obtaining information about the disease and therapy options, while social media were less frequently used (49/188, 26.1%). Nearly two-thirds of internet users (125/188) claimed that their physicians did not recommend digital media platforms. About 44% (82/188) of the individuals reported to seek for additional information due to the insufficient information provided by their physician. Conclusions: This study revealed the importance of digital media in the context of psoriasis, especially among women, individuals with shorter disease duration, and moderate mental disease severity. The lack of physicians? digital media recommendations despite their patients? desire to receive such and being more involved in health-related decisions seems to be a shortcoming within the physician-patient relationships. Physicians should guide their patients on digital media by recommending platforms with evidence-based information, thereby potentially creating an adequate framework for shared decision-making. Future research should focus on strategies to prevent the spread of false information on digital media and address the needs of patients and physicians to enhance health-related digital media offerings. UR - https://www.jmir.org/2024/1/e57823 UR - http://dx.doi.org/10.2196/57823 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57823 ER - TY - JOUR AU - Kapp, M. Julie AU - Dicke, Rachel AU - Quinn, Kathleen PY - 2024/8/7 TI - Online Delivery of Interprofessional Adverse Childhood Experiences Training to Rural Providers: Usability Study JO - JMIR Pediatr Parent SP - e56722 VL - 7 KW - adverse childhood experiences KW - ACE KW - training KW - trauma-informed care KW - provider KW - rural KW - adverse KW - trauma KW - traumatic KW - providers KW - teaching KW - curriculum KW - curricula KW - education KW - educational KW - social work KW - social worker KW - social workers KW - psychologist KW - psychologists KW - counselor KW - counselors KW - interprofessional KW - pediatric KW - pediatrics KW - paediatric KW - paediatrics KW - child KW - children KW - experience KW - experiences KW - continuing education N2 - Background: The population health burden of adverse childhood experiences (ACEs) reflects a critical need for evidence-based provider training. Rural children are also more likely than urban children to have any ACEs. A large proportion of providers are unaware of the detrimental effects of ACEs. There is a significant documented need for training providers about ACEs and trauma-informed care, in addition to a demand for that training. Objective: The objective was to develop, implement, and evaluate an online ACEs training curriculum tailored to Missouri providers, particularly those in rural areas given the higher prevalence of ACEs. Methods: From July 2021 to June 2022, we conducted literature reviews and environmental scans of training videos, partner organizations, clinical practice guidelines, and community-based resources to curate appropriate and tailored content for the course. We developed the ACEs training course in the Canvas learning platform (Instructure) with the assistance of an instructional designer and media designer. The course was certified for continuing medical education, as well as continuing education for licensed professional counselors, psychologists, and social workers. Recruitment occurred via key stakeholder email invitations and snowball recruitment. Results: Overall, 135 providers across Missouri requested enrollment, with 72.6% (n=98) enrolling and accessing the training. Of the latter, 49% (n=48) completed course requirements, with 100% of respondents agreeing that the content was relevant to their work, life, or practice; they intend to apply the content to their work, life, or practice; they feel confident to do so; and they would recommend the course to others. Qualitative responses supported active intent to translate knowledge into practice. Conclusions: This study demonstrated the feasibility, acceptability, and effectiveness of interprofessional workforce ACEs training. Robust interest statewide reflects recognition of the topic?s importance and intention to translate knowledge into practice. UR - https://pediatrics.jmir.org/2024/1/e56722 UR - http://dx.doi.org/10.2196/56722 ID - info:doi/10.2196/56722 ER - TY - JOUR AU - Rouvere, Julien AU - Blanchard, E. Brittany AU - Johnson, Morgan AU - Griffith Fillipo, Isabell AU - Mosser, Brittany AU - Romanelli, Meghan AU - Nguyen, Theresa AU - Rushton, Kevin AU - Marion, John AU - Althoff, Tim AU - Areán, A. Patricia AU - Pullmann, D. Michael PY - 2024/8/7 TI - Application of an Adapted Health Action Process Approach Model to Predict Engagement With a Digital Mental Health Website: Cross-Sectional Study JO - JMIR Hum Factors SP - e57082 VL - 11 KW - Health Action Process Approach (HAPA) KW - digital health KW - health behavior KW - Mental Health America (MHA) KW - digital mental health engagement KW - mental health website N2 - Background: Digital Mental Health (DMH) tools are an effective, readily accessible, and affordable form of mental health support. However, sustained engagement with DMH is suboptimal, with limited research on DMH engagement. The Health Action Process Approach (HAPA) is an empirically supported theory of health behavior adoption and maintenance. Whether this model also explains DMH tool engagement remains unknown. Objective: This study examined whether an adapted HAPA model predicted engagement with DMH via a self-guided website. Methods: Visitors to the Mental Health America (MHA) website were invited to complete a brief survey measuring HAPA constructs. This cross-sectional study tested the adapted HAPA model with data collected using voluntary response sampling from 16,078 sessions (15,619 unique IP addresses from United States residents) on the MHA website from October 2021 through February 2022. Model fit was examined via structural equation modeling in predicting two engagement outcomes: (1) choice to engage with DMH (ie, spending 3 or more seconds on an MHA page, excluding screening pages) and (2) level of engagement (ie, time spent on MHA pages and number of pages visited, both excluding screening pages). Results: Participants chose to engage with the MHA website in 94.3% (15,161/16,078) of the sessions. Perceived need (?=.66; P<.001), outcome expectancies (?=.49; P<.001), self-efficacy (?=.44; P<.001), and perceived risk (?=.17-.18; P<.001) significantly predicted intention, and intention (?=.77; P<.001) significantly predicted planning. Planning was not significantly associated with choice to engage (?=.03; P=.18). Within participants who chose to engage, the association between planning with level of engagement was statistically significant (?=.12; P<.001). Model fit indices for both engagement outcomes were poor, with the adapted HAPA model accounting for only 0.1% and 1.4% of the variance in choice to engage and level of engagement, respectively. Conclusions: Our data suggest that the HAPA model did not predict engagement with DMH via a self-guided website. More research is needed to identify appropriate theoretical frameworks and practical strategies (eg, digital design) to optimize DMH tool engagement. UR - https://humanfactors.jmir.org/2024/1/e57082 UR - http://dx.doi.org/10.2196/57082 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57082 ER - TY - JOUR AU - Engelsma, Thomas AU - Heijmink, Simone AU - Hendriksen, A. Heleen M. AU - Visser, C. Leonie N. AU - Lemstra, W. Afina AU - Jaspers, M. Monique W. AU - Peute, P. Linda W. PY - 2024/7/31 TI - Capturing Usability Problems for People Living With Dementia by Applying the DEMIGNED Principles in Usability Evaluation Methods: Mixed Methods Study JO - JMIR Hum Factors SP - e54032 VL - 11 KW - dementia KW - design principles KW - digital health KW - memory clinic KW - usability evaluation KW - mobile phone N2 - Background: Dementia-related impairments can cause complex barriers to access, use, and adopt digital health technologies (DHTs). These barriers can contribute to digital health inequities. Therefore, literature-based design principles called DEMIGNED have been developed to support the design and evaluation of DHTs for this rapidly increasing population. Objective: This study aims to apply the DEMIGNED principles in usability evaluation methods to (1) capture usability problems on a mobile website providing information resources for people visiting a memory clinic, including those living with subjective cognitive decline (SCD), mild cognitive impairment (MCI), or dementia, and (2) investigate the realness of usability problems captured by the DEMIGNED principles in expert testing, specifically for mobile websites that act as a means of providing DHTs. Methods: First, a heuristic evaluation was conducted, with the DEMIGNED principles serving as domain-specific guidelines, with 3 double experts (experienced in both usability and dementia) and 2 usability engineering experts. Second, think-aloud sessions were conducted with patients visiting a memory clinic who were living with SCD, MCI, or dementia. Results: The heuristic evaluation resulted in 36 unique usability problems. A representative sample of 7 people visiting a memory clinic participated in a think-aloud session, including 4 (57%) with SCD, 1 (14%) with MCI, and 2 (29%) with dementia. The analysis of the think-aloud sessions revealed 181 encounters with usability problems. Of these encounters, 144 (79.6%) could be mapped to 18 usability problems identified in the heuristic evaluation. The remaining 37 (20.4%) encounters from the user testing revealed another 10 unique usability problems. Usability problems frequently described in the think-aloud sessions encompassed difficulties with using the search function, discrepancies between the user?s expectations and the content organization, the need for scrolling, information overload, and unclear system feedback. Conclusions: By applying the DEMIGNED principles in expert testing, evaluators were able to capture 79.6% (144/181) of all usability problem encounters in the user testing of a mobile website for people visiting a memory clinic, including people living with dementia. Regarding unique usability problems, 50% (18/36) of the unique usability problems identified during the heuristic evaluation were captured by the user-testing sessions. Future research should look into the applicability of the DEMIGNED principles to other digital health functionalities to increase the accessibility of digital health and decrease digital health inequity for this complex and rapidly increasing population. UR - https://humanfactors.jmir.org/2024/1/e54032 UR - http://dx.doi.org/10.2196/54032 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54032 ER - TY - JOUR AU - Galvin, Emer AU - Desselle, Shane AU - Gavin, Blánaid AU - McNicholas, Fiona AU - Cullinan, Shane AU - Hayden, John PY - 2024/7/31 TI - Training Service Users in the Use of Telehealth: Scoping Review JO - J Med Internet Res SP - e57586 VL - 26 KW - telehealth KW - video consultations KW - training KW - education KW - older adults KW - digital divide KW - digital literacy KW - review KW - scoping review KW - modality of care KW - training service KW - user KW - users KW - older adult KW - gerontology KW - geriatric KW - geriatrics KW - caregiver KW - caregivers KW - consultation KW - consultations KW - health care professional KW - health care professionals KW - PRISMA-ScR KW - Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews KW - data extraction KW - phone KW - phones KW - telemonitoring N2 - Background: The use of telehealth has rapidly increased, yet some populations may be disproportionally excluded from accessing and using this modality of care. Training service users in telehealth may increase accessibility for certain groups. The extent and nature of these training activities have not been explored. Objective: The objective of this scoping review is to identify and describe activities for training service users in the use of telehealth. Methods: Five databases (MEDLINE [via PubMed], Embase, CINAHL, PsycINFO, and Web of Science) were searched in June 2023. Studies that described activities to train service users in the use of synchronous telehealth consultations were eligible for inclusion. Studies that focused on health care professional education were excluded. Papers were limited to those published in the English language. The review followed the Joanna Briggs Institute guidelines for scoping reviews and was reported in line with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. Titles and abstracts were screened by 1 reviewer (EG). Full texts were screened by 2 reviewers (EG and JH or SC). Data extraction was guided by the research question. Results: The search identified 8087 unique publications. In total, 13 studies met the inclusion criteria. Telehealth training was commonly described as once-off preparatory phone calls to service users before a telehealth visit, facilitated primarily by student volunteers, and accompanied by written instructions. The training content included guidance on how to download and install software, troubleshoot technical issues, and adjust device settings. Older adults were the most common target population for the training. All but 1 of the studies were conducted during the COVID-19 pandemic. Overall, training was feasible and well-received by service users, and studies mostly reported increased rates of video visits following training. There was limited and mixed evidence that training improved participants? competency with telehealth. Conclusions: The review mapped the literature on training activities for service users in telehealth. The common features of telehealth training for service users included once-off preparatory phone calls on the technical elements of telehealth, targeted at older adults. Key issues for consideration include the need for co-designed training and improving the broader digital skills of service users. There is a need for further studies to evaluate the outcomes of telehealth training activities in geographically diverse areas. UR - https://www.jmir.org/2024/1/e57586 UR - http://dx.doi.org/10.2196/57586 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57586 ER - TY - JOUR AU - Sehgal, R. Neil K. AU - Rader, Benjamin AU - Brownstein, S. John PY - 2024/7/29 TI - Examining the Role of Physician Characteristics in Web-Based Verified Primary Care Physician Reviews: Observational Study JO - J Med Internet Res SP - e51672 VL - 26 KW - patient review websites KW - patient online review KW - telemedicine KW - internet KW - online review KW - online reviews KW - rating KW - physician review KW - physician reviews KW - doctor review KW - doctor reviews N2 - Background: Doctor review websites have become increasingly popular as a source of information for patients looking to select a primary care provider. Zocdoc is one such platform that allows patients to not only rate and review their experiences with doctors but also directly schedule appointments. This study examines how several physician characteristics including gender, age, race, languages spoken in a physician?s office, education, and facial attractiveness impact the average numerical rating of primary care doctors on Zocdoc. Objective: The aim of this study was to investigate the association between physician characteristics and patient satisfaction ratings on Zocdoc. Methods: A data set of 1455 primary care doctor profiles across 30 cities was scraped from Zocdoc. The profiles contained information on the physician?s gender, education, and languages spoken in their office. Age, facial attractiveness, and race were imputed from profile pictures using commercial facial analysis software. Each doctor profile listed an average overall satisfaction rating, bedside manner rating, and wait time rating from verified patients. Descriptive statistics, the Wilcoxon rank sum test, and multivariate logistic regression were used to analyze the data. Results: The average overall rating on Zocdoc was highly positive, with older age, lower facial attractiveness, foreign degrees, allopathic degrees, and speaking more languages negatively associated with the average rating. However, the effect sizes of these factors were relatively small. For example, graduates of Latin American medical schools had a mean overall rating of 4.63 compared to a 4.77 rating for US graduates (P<.001), a difference roughly equivalent to a 2.8% decrease in appointments. On multivariate analysis, being Asian and having a doctor of osteopathic medicine degree were positively associated with higher overall ratings, while attending a South Asian medical school and speaking more European and Middle Eastern languages in the office were negatively associated with higher overall ratings. Conclusions: Overall, the findings suggest that age, facial attractiveness, education, and multilingualism do have some impact on web-based doctor reviews, but the numerical effect is small. Notably, bias may play out in many forms. For example, a physician's appearance or accent may impact a patient's trust, confidence, or satisfaction with their physician, which could in turn influence their take-up of preventative services and lead to either better or worse health outcomes. The study highlights the need for further research in how physician characteristics influence patient ratings of care. UR - https://www.jmir.org/2024/1/e51672 UR - http://dx.doi.org/10.2196/51672 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51672 ER - TY - JOUR AU - Leung, Lam Chung AU - Alacapa, Jason AU - Tasca, Gonçalves Bianca AU - Villanueva, Daniel Andre AU - Masulit, Saniata AU - Ignacio, Louie Marvin AU - Uy, Nicole Kathleen AU - Pell, Christopher AU - van Kalmthout, Kristian AU - Powers, Rachel AU - Fielding, Katherine AU - Jerene, Degu PY - 2024/7/23 TI - Digital Adherence Technologies and Differentiated Care for Tuberculosis Treatment and Their Acceptability Among Persons With Tuberculosis, Health Care Workers, and Key Informants in the Philippines: Qualitative Interview Study JO - JMIR Hum Factors SP - e54117 VL - 11 KW - tuberculosis KW - digital adherence technologies KW - implementation KW - acceptability KW - qualitative research KW - Philippines KW - digital health KW - tuberculosis treatment KW - support strategy KW - support KW - medication adherence KW - health care workers KW - interview KW - interviews KW - user KW - user privacy KW - privacy KW - digital adherence N2 - Background: Digital adherence technologies (DATs) are being studied to determine their potential to support tuberculosis (TB) treatment and address the shortcomings of directly observed therapy. Previous research has shown inconclusive results on whether DATs can enhance medication adherence among persons with TB. Objective: This study aims to understand the acceptability of DATs, namely, medication labels and smart pillboxes, among persons with TB, health care workers (HCWs), and key informants (KIs) in the Philippines. The objective is to gain valuable insights that can inform the design and implementation of DATs in the Southeast Asian region, which meet the needs and preferences of end users. Methods: Persons with TB, HCWs, and KIs were recruited from intervention facilities to participate in in-depth interviews conducted between March 2022 and January 2023. These interviews were transcribed and translated into English. A thematic analysis was carried out using NVivo software (Lumivero) to identify and analyze themes. Themes were then structured within a modified social-ecological model. Results: A total of 25 persons with drug-sensitive TB and 20 HCWs or KIs were interviewed. Both groups emphasized that users? technology literacy level, financial conditions, and motivation to be cured determined how they interacted with the DAT. They also acknowledged that DATs helped foster their relationship with HCWs and enabled efficient treatment support. Concerning technology, persons with TB found DATs easy to use and able to reduce clinic visits. HCWs mentioned that DATs added to their workload but also allowed them to support users who missed doses. However, both groups experienced technical challenges with DATs. Regarding program implementation, users appreciated the clear explanations and demonstrations provided by HCWs. Yet, some users reported inconsistencies between DAT settings and the information provided. HCWs stressed the importance of comprehensive training and sufficient resources for effective program implementation in the future. At the community level, both groups noted that DATs and program design protected users? privacy and reduced the risk of stigma. Finally, users and HCWs shared various contextual factors that influenced their experience with DAT, including infrastructure challenges and the impact of the COVID-19 pandemic. Conclusions: In the Philippines, persons with TB and HCWs showed a high level of acceptance and satisfaction with the impact of DAT and program design. They expressed a desire for the continuation of DATs. The challenges encountered underscore the need for ongoing technological development to minimize malfunctions, enhance the capacity of health facilities, and improve infrastructure. DATs have demonstrated their ability to strengthen user-HCW relationships and protect users from stigmatization. Additional efforts are required to scale up the DAT program in the Philippines. UR - https://humanfactors.jmir.org/2024/1/e54117 UR - http://dx.doi.org/10.2196/54117 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54117 ER - TY - JOUR AU - Hasson, E. Rebecca AU - Xie, Michelle AU - Tadikamalla, Dhiraj AU - Beemer, R. Lexie PY - 2024/7/15 TI - Using a Human-Centered Design Process to Evaluate and Optimize User Experience of a Website (InPACT at Home) to Promote Youth Physical Activity: Case Study JO - JMIR Hum Factors SP - e52496 VL - 11 KW - web-based interventions KW - children KW - adolescents KW - child KW - adolescent KW - youth KW - user experience KW - website KW - websites KW - implementation science KW - human-centered design KW - human-centred design KW - HCD KW - web based KW - home based KW - interview KW - heuristics KW - interviews KW - heuristic KW - competitive analysis KW - video KW - videos KW - YouTube KW - physical activity KW - exercise KW - fitness N2 - Background: Web-based physical activity interventions often fail to reach the anticipated public health impact due to insufficient use by the intended audiences. Objective: The purpose of this study was to use a human-centered design process to optimize the user experience of the Interrupting Prolonged sitting with ACTivity (InPACT) at Home website to promote youth physical activity participation. Methods: Qualitative interviews were conducted to assess engagement and pain points with the InPACT at Home website. Interview data were used to create affinity maps to identify themes of user responses, conduct a heuristic evaluation according to Nielsen?s usability heuristics framework, and complete a competitive analysis to identify the strengths and weaknesses of competitors who offered similar products. Results: Key themes from end user interviews included liking the website design, finding the website difficult to navigate, and wanting additional features (eg, library of watched videos). The website usability issues identified were lack of labeling and categorization of exercise videos, hidden necessary actions and options hindering users from decision-making, error-prone conditions, and high cognitive load of the website. Competitive analysis results revealed that YouTube received the highest usability ratings followed by the Just Dance and Presidential Youth Fitness Program websites. Conclusions: Human-centered design approaches are useful for bringing end users and developers together to optimize user experience and impact public health. Future research is needed to examine the effectiveness of the InPACT at Home website redesign to attract new users and retain current users, with the end goal of increasing youth physical activity engagement. UR - https://humanfactors.jmir.org/2024/1/e52496 UR - http://dx.doi.org/10.2196/52496 ID - info:doi/10.2196/52496 ER - TY - JOUR AU - Ortiz, Fernanda AU - Grasberger, Juulia AU - Ekstrand, Agneta AU - Helanterä, Ilkka AU - Giunti, Guido PY - 2024/7/9 TI - Interactive Health Technology Tool for Kidney Living Donor Assessment to Standardize the Informed Consent Process: Usability and Qualitative Content Analysis JO - JMIR Form Res SP - e47785 VL - 8 KW - eHealth KW - kidney living donor KW - informed consent KW - telemedicine KW - process standardization KW - kidney KW - donor KW - tool KW - usability KW - psychological impact KW - utility KW - smartphone KW - coping KW - surgery N2 - Background: Kidney living donation carries risks, yet standardized information provision regarding nephrectomy risks and psychological impacts for candidates remains lacking. Objective: This study assesses the benefit of interactive health technology in improving the informed consent process for kidney living donation. Methods: The Kidney Hub institutional open portal offers comprehensive information on kidney disease and donation. Individuals willing to start the kidney living donation process at Helsinki University Hospital (January 2019-January 2022) were invited to use the patient-tailored digital care path (Living Donor Digital Care Path) included in the Kidney Hub. This platform provides detailed donation process information and facilitates communication between health care professionals and patients. eHealth literacy was evaluated via the eHealth Literacy Scale (eHEALS), usability with the System Usability Scale (SUS), and system utility through Likert-scale surveys with scores of 1-5. Qualitative content analysis addressed an open-ended question. Results: The Kidney Hub portal received over 8000 monthly visits, including to its sections on donation benefits (n=1629 views) and impact on donors? lives (n=4850 views). Of 127 living kidney donation candidates, 7 did not use Living Donor Digital Care Path. Users? ages ranged from 20 to 79 years, and they exchanged over 3500 messages. A total of 74 living donor candidates participated in the survey. Female candidates more commonly searched the internet about kidney donation (n=79 female candidates vs n=48 male candidates; P=.04). The mean eHEALS score correlated with internet use for health decisions (r=0.45; P<.001) and its importance (r=0.40; P=.01). Participants found that the Living Donor Digital Care Path was technically satisfactory (mean SUS score 4.4, SD 0.54) and useful but not pivotal in donation decision-making. Concerns focused on postsurgery coping for donors and recipients. Conclusions: Telemedicine effectively educates living kidney donor candidates on the donation process. The Living Donor Digital Care Path serves as a valuable eHealth tool, aiding clinicians in standardizing steps toward informed consent. Trial Registration: ClinicalTrials.gov NCT04791670; https://clinicaltrials.gov/study/NCT04791670 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2021-051166 UR - https://formative.jmir.org/2024/1/e47785 UR - http://dx.doi.org/10.2196/47785 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47785 ER - TY - JOUR AU - Naderbagi, Aila AU - Loblay, Victoria AU - Zahed, Md Iqthyer Uddin AU - Ekambareshwar, Mahalakshmi AU - Poulsen, Adam AU - Song, C. Yun J. AU - Ospina-Pinillos, Laura AU - Krausz, Michael AU - Mamdouh Kamel, Mostafa AU - Hickie, B. Ian AU - LaMonica, M. Haley PY - 2024/7/9 TI - Cultural and Contextual Adaptation of Digital Health Interventions: Narrative Review JO - J Med Internet Res SP - e55130 VL - 26 KW - cultural adaptation KW - digital health KW - context KW - translation KW - participatory research KW - mobile phone N2 - Background: Emerging evidence suggests that positive impacts can be generated when digital health interventions are designed to be responsive to the cultural and socioeconomic context of their intended audiences. Objective: This narrative review aims to synthesize the literature about the cultural adaptation of digital health interventions. It examines how concepts of culture and context feature in design and development processes, including the methods, models, and content of these interventions, with the aim of helping researchers to make informed decisions about how to approach cultural adaptation in digital health. Methods: Literature searches for this narrative review were conducted across 4 databases. Following full-text article screening by 2 authors, 16 studies of interventions predominantly focused on the self-management of health were selected based on their detailed focus on the process of cultural adaptation. Key considerations for cultural adaptation were identified and synthesized through a qualitative narrative approach, enabling an integrative and in-depth understanding of cultural adaptation. Results: The literature demonstrates varying approaches and levels of cultural adaptation across stages of intervention development, involving considerations such as the research ethos orienting researchers, the methodologies and models used, and the resultant content adaptations. In relation to the latter, culturally appropriate and accessible user interface design and translation can be seen as particularly important in shaping the level of adaptation. Conclusions: Optimizing cultural adaptation involves linking culture with other contextual factors such as economic conditions and social systems to ensure accessibility and the sustained use of digital health interventions. Culturally humble approaches that use the involvement of a broad range of participants, experts, and other stakeholders are demonstrated to spark vital insights for content development, implementation, and evaluation. UR - https://www.jmir.org/2024/1/e55130 UR - http://dx.doi.org/10.2196/55130 UR - http://www.ncbi.nlm.nih.gov/pubmed/38980719 ID - info:doi/10.2196/55130 ER - TY - JOUR AU - Belanger, Christopher AU - Peixoto, Cayden AU - Francoeur, Sara AU - Bjerre, M. Lise PY - 2024/7/9 TI - Patient and Provider Satisfaction With a Geomapping Tool for Finding Community Family Physicians in Ontario, Canada: Cross-Sectional Online Survey Study JO - JMIR Form Res SP - e56716 VL - 8 KW - primary care KW - language-concordant care KW - web-based maps KW - maps KW - physicians KW - experience KW - language KW - access KW - accessibility N2 - Background: Language-concordant health care, or health care in a patient?s language of choice, is an important element of health accessibility that improves patient safety and comfort and facilitates an increased quality of care. However, prior research has found that linguistic minorities often face higher travel burdens to access language-concordant care compared to the general population. Objective: This study intended to assess patient experiences and satisfaction with an online interactive physician map that allows patients to find family physicians who speak their preferred language in and around Ottawa, Ontario, Canada, as a means of identifying areas of improvement. Methods: This study used an online survey with questions related to user satisfaction. Responses to Likert-scale questions were compiled as summary statistics and short-answer responses underwent thematic analysis. The study setting was Ottawa and Renfrew County, Ontario, and the surrounding region, including the province of Quebec. Results: A total of 93 respondents completed the survey and self-identified as living in Ontario or Quebec. Overall, 57 (61%) respondents were ?very satisfied? or ?somewhat satisfied? with the map, 16 (17%) were ?neither satisfied nor dissatisfied,? and 20 (22%) were ?very dissatisfied? or ?somewhat dissatisfied.? We found no significant differences in satisfaction by preferred language, age group, physician attachment, or intended beneficiary. A total of 56 respondents provided short-answer responses to an open-ended question about map improvements. The most common specific suggestion was to show which physicians are accepting new patients (n=20). Other suggestions included data refreshes (n=6), user interface adjustments (n=23), and additional languages (n=2). Some participants also provided positive feedback (n=5) or expressed concern with their inability to find a family physician (n=5). Several comments included multiple suggestions. Conclusions: While most patients were satisfied with the online map, a significant minority expressed dissatisfaction that the map did not show which family physicians were accepting new patients. This suggests that there may be public interest in an accessible database of which family physicians in Ontario are currently accepting new patients. UR - https://formative.jmir.org/2024/1/e56716 UR - http://dx.doi.org/10.2196/56716 UR - http://www.ncbi.nlm.nih.gov/pubmed/38980717 ID - info:doi/10.2196/56716 ER - TY - JOUR AU - Syed, Ahmed Toufeeq AU - Thompson, L. Erika AU - Johnson, Jason AU - Latif, Zainab AU - Kennedy, Nan AU - Javier, Damaris AU - Stinson, Katie AU - Vishwanatha, K. Jamboor PY - 2024/7/2 TI - A/B Testing of User Enrollment Forms to Enhance Diversity in the Biomedical Workforce via the National Research Mentoring Network: User-Centered Design Case Study JO - JMIR Hum Factors SP - e54532 VL - 11 KW - diversity KW - mentoring KW - health workforce KW - underrepresented groups KW - online platform KW - user-computer interface KW - A/B testing KW - split testing KW - recommendation algorithm KW - network of mentors KW - groups KW - enrollment N2 - Background: The National Research Mentoring Network (NRMN) is a National Institutes of Health?funded program for diversifying the science, technology, engineering, math, and medicine research workforce through the provision of mentoring, networking, and professional development resources. The NRMN provides mentoring resources to members through its online platform?MyNRMN. Objective: MyNRMN helps members build a network of mentors. Our goal was to expand enrollment and mentoring connections, especially among those who have been historically underrepresented in biomedical training and the biomedical workforce. Methods: To improve the ease of enrollment, we implemented the split testing of iterations of our user interface for platform registration. To increase mentoring connections, we developed multiple features that facilitate connecting via different pathways. Results: Our improved user interface yielded significantly higher rates of completed registrations (P<.001). Our analysis showed improvement in completed enrollments that used the version 1 form when compared to those that used the legacy form (odds ratio 1.52, 95% CI 1.30-1.78). The version 2 form, with its simplified, 1-step process and fewer required fields, outperformed the legacy form (odds ratio 2.18, 95% CI 1.90-2.50). By improving the enrollment form, the rate of MyNRMN enrollment completion increased from 57.3% (784/1368) with the legacy form to 74.5% (2016/2706) with the version 2 form. Our newly developed features delivered an increase in connections between members. Conclusions: Our technical efforts expanded MyNRMN?s membership base and increased connections between members. Other platform development teams can learn from these efforts to increase enrollment among underrepresented groups and foster continuing, successful engagement. UR - https://humanfactors.jmir.org/2024/1/e54532 UR - http://dx.doi.org/10.2196/54532 ID - info:doi/10.2196/54532 ER - TY - JOUR AU - Singla, Ashwani AU - Khanna, Ritvik AU - Kaur, Manpreet AU - Kelm, Karen AU - Zaiane, Osmar AU - Rosenfelt, Scott Cory AU - Bui, An Truong AU - Rezaei, Navid AU - Nicholas, David AU - Reformat, Z. Marek AU - Majnemer, Annette AU - Ogourtsova, Tatiana AU - Bolduc, Francois PY - 2024/6/18 TI - Developing a Chatbot to Support Individuals With Neurodevelopmental Disorders: Tutorial JO - J Med Internet Res SP - e50182 VL - 26 KW - chatbot KW - user interface KW - knowledge graph KW - neurodevelopmental disability KW - autism KW - intellectual disability KW - attention-deficit/hyperactivity disorder UR - https://www.jmir.org/2024/1/e50182 UR - http://dx.doi.org/10.2196/50182 UR - http://www.ncbi.nlm.nih.gov/pubmed/38888947 ID - info:doi/10.2196/50182 ER - TY - JOUR AU - Porta, Xènia AU - Nieto, Rubén AU - Serrat, Mayte AU - Bourdin Kreitz, Pierre PY - 2024/6/18 TI - Perception of People Diagnosed With Fibromyalgia About Information and Communication Technologies for Chronic Pain Management: Cross-Sectional Survey Study JO - JMIR Form Res SP - e55751 VL - 8 KW - fibromyalgia KW - chronic pain KW - pain management KW - information and communication technologies KW - use KW - satisfaction N2 - Background: Chronic pain is prevalent in our society, with conditions such as fibromyalgia being notably widespread. The gold standard for aiding individuals dealing with chronic pain involves interdisciplinary approaches rooted in a biopsychosocial perspective. Regrettably, access to such care is difficult for most of the people in need. Information and communication technologies (ICTs) have been used as a way of overcoming access barriers (among other advantages). Objective: This study addressed the little explored area of how individuals with fibromyalgia use and perceive different types of ICTs for pain management. Methods: A cross-sectional study was conducted using an online survey. This survey was created to assess the use of different ICT tools for pain management, satisfaction with the tools used, and perceived advantages and disadvantages. In addition, data collection encompassed sociodemographic variables and pain-related variables, pain intensity, the impact of pain on daily life activities, and fear of movement/injury beliefs. In total, 265 individuals diagnosed with fibromyalgia completed the survey. Results: Only 2 (0.75%) participants reported not having used any ICT tool for pain management. Among those who used ICT tools, an average of 10.94 (SD 4.48) of 14 different tools were used, with the most used options being instant messaging apps, websites dedicated to managing fibromyalgia, phone calls with health professionals, and online multimedia resources. Satisfaction rates were relatively modest (mean 2.09, SD 0.38) on a scale from 0 to 5, with instant messaging apps, phone calls with health professionals, fibromyalgia management websites, and online multimedia resources being the ones with higher satisfaction. Participants appreciated the ability to receive treatment from home, access to specialized treatment, and using ICTs as a supplement to in-person interventions. However, they also highlighted drawbacks, such as a lack of close contact with health professionals, difficulty expressing emotions, and a lack of knowledge or resources to use ICTs. The use of ICTs was influenced by age and educational background. Additionally, there was a negative correlation between satisfaction with ICT tools and fear of movement/injury. Conclusions: People with fibromyalgia are prone to using ICTs for pain management, especially those tools that allow them to be in contact with health professionals and have access to online resources. However, there is still a need to improve ICT tools since satisfaction ratings are modest. Moreover, strategies aimed at older people, those with lower levels of education, and those with higher levels of fear of movement/injury can be useful to potentiate the use of ICTs among them. UR - https://formative.jmir.org/2024/1/e55751 UR - http://dx.doi.org/10.2196/55751 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55751 ER - TY - JOUR AU - Siste, Kristiana AU - Ophinni, Youdiil AU - Hanafi, Enjeline AU - Yamada, Chika AU - Novalino, Reza AU - Limawan, P. Albert AU - Beatrice, Evania AU - Rafelia, Vania AU - Alison, Peter AU - Matsumoto, Toshihiko AU - Sakamoto, Ryota PY - 2024/6/18 TI - Relapse Prevention Group Therapy in Indonesia Involving Peers via Videoconferencing for Substance Use Disorder: Development and Feasibility Study JO - JMIR Form Res SP - e50452 VL - 8 KW - substance use disorder KW - cognitive behavioral therapy KW - telemedicine KW - peer involvement KW - Indonesia KW - substance use disorders KW - digital intervention KW - COVID-19 KW - psychotherapy KW - drug KW - mobile phone N2 - Background: Substance use disorder (SUD) is a major health issue in Indonesia, where several barriers to treatment exist, including inaccessibility to treatment services, stigma, and criminalization of drug issues. Peer involvement and the use of telemedicine to deliver psychotherapy are promising approaches to overcome these barriers. Objective: This study aims (1) to describe the development of a new group psychotherapy coprovided by a health care worker and a peer and (2) to evaluate the acceptability, practicality, and preliminary outcomes of the program delivered via videoconferencing in Indonesia. Methods: Building upon an established relapse prevention therapy in Japan, we developed a 3-month weekly group therapy module in the Indonesian language. Adjustments were made via focus group discussions with local stakeholders in terms of substance types, understandability, inclusive language, and cultural relevance. A pilot study was conducted to test the new module provided by a peer and a psychiatrist via videoconferencing, termed tele-Indonesia Drug Addiction Relapse Prevention Program (tele-Indo-DARPP), with a pre- and postcontrolled design. We analyzed data from semistructured feedback interviews and outcome measurements, including the number of days using substances and quality of life, and compared the intervention (tele-Indo-DARPP added to treatment as usual [TAU]) and control (TAU only) arms. Results: In total, 8 people diagnosed with SUD participated in the pilot study with a mean age of 37 (SD 12.8) years. All were men, and 7 (88%) used sedatives as the primary substance. Collectively, they attended 44 of the 48 tele-Indo-DARPP sessions. A total of 3 out of 4 (75%) preferred telemedicine rather than in-person therapy. Positive acceptability and practicality were shown from qualitative feedback, in which the participants who joined the tele-Indo-DARPP reported that they liked the convenience of joining from home and that they were able to open up about personal matters, received helpful advice from peers, and received support from other participants. Providers reported that they feel the module was provider-friendly, and the session was convenient to join without diminishing rapport-building. Meanwhile, troubles with the internet connection and difficulty in comprehending some terminology in the workbook were reported. The intervention arm showed better improvements in psychological health and anxiety symptoms. Conclusions: Group psychotherapy via videoconferencing coprovided by health care workers and peers was acceptable and practical for participants with SUD and service providers in this study. A large-scale study is warranted to examine the effectiveness of the newly developed module in Indonesia. UR - https://formative.jmir.org/2024/1/e50452 UR - http://dx.doi.org/10.2196/50452 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50452 ER - TY - JOUR AU - Burn, Anne-Marie AU - Hall, Poppy AU - Anderson, Joanna PY - 2024/6/4 TI - A Web-Based Training Program for School Staff to Respond to Self-Harm: Design and Development of the Supportive Response to Self-Harm Program JO - JMIR Form Res SP - e50024 VL - 8 KW - self-harm KW - schools KW - young people KW - youth KW - school staff KW - training KW - coproduction KW - qualitative N2 - Background: Self-harm is common among adolescents and is a major public health concern. School staff may be the first adults to notice a young person?s self-harm and are well placed to provide support or signpost students to help. However, school staff often report that they do not feel equipped or confident to support students. Despite the need, there is a lack of evidence-based training about self-harm for school staff. A web-based training program would provide schools with a flexible and cost-effective method of increasing staff knowledge, skills, and confidence in how to respond to students who self-harm. Objective: The main objective of this study was to coproduce an evidence-based training program for school staff to improve their skills and confidence in responding to students who self-harm (Supportive Response to Self-Harm [SORTS]). This paper describes the design and development process of an initial prototype coproduced with stakeholders to ensure that the intervention meets their requirements. Methods: Using a user-centered design and person-based approach, the SORTS prototype was informed by (1) a review of research literature, existing guidelines, and policies; (2) coproduction discussions with the technical provider and subject matter experts (mental health, education, and self-harm); (3) findings from focus groups with young people; and (4) coproduction workshops with school staff. Thematic analysis using the framework method was applied. Results: Coproduction sessions with experts and the technical provider enabled us to produce a draft of the training content, a wireframe, and example high-fidelity user interface designs. Analysis of focus groups and workshops generated four key themes: (1) need for a training program; (2) acceptability, practicality, and implementation; (3) design, content, and navigation; and (4) adaptations and improvements. The findings showed that there is a clear need for a web-based training program about self-harm in schools, and the proposed program content and design were useful, practical, and acceptable. Consultations with stakeholders informed the iterative development of the prototype. Conclusions: SORTS is a web-based training program for school staff to appropriately respond to students who self-harm that is based on research evidence and developed in collaboration with stakeholders. The SORTS program will equip school staff with the skills and strategies to respond in a supportive way to students who self-harm and encourage schools to adopt a whole-school approach to self-harm. Further research is needed to complete the intervention development based on the feedback from this study and evaluate the program?s effectiveness. If found to be effective, the SORTS program could be implemented in schools and other youth organizations. UR - https://formative.jmir.org/2024/1/e50024 UR - http://dx.doi.org/10.2196/50024 UR - http://www.ncbi.nlm.nih.gov/pubmed/38833286 ID - info:doi/10.2196/50024 ER - TY - JOUR AU - Li, Wenhao AU - O'Hara, Rebecca AU - Hull, Louise M. AU - Slater, Helen AU - Sirohi, Diksha AU - Parker, A. Melissa AU - Bidargaddi, Niranjan PY - 2024/5/29 TI - Enabling Health Information Recommendation Using Crowdsourced Refinement in Web-Based Health Information Applications: User-Centered Design Approach and EndoZone Informatics Case Study JO - JMIR Hum Factors SP - e52027 VL - 11 KW - information recommendation KW - crowdsourcing KW - health informatics KW - digital health KW - endometriosis N2 - Background: In the digital age, search engines and social media platforms are primary sources for health information, yet their commercial interests?focused algorithms often prioritize irrelevant content. Web-based health applications by reputable sources offer a solution to circumvent these biased algorithms. Despite this advantage, there remains a significant gap in research on the effective integration of content-ranking algorithms within these specialized health applications to ensure the delivery of personalized and relevant health information. Objective: This study introduces a generic methodology designed to facilitate the development and implementation of health information recommendation features within web-based health applications. Methods: We detail our proposed methodology, covering conceptual foundation and practical considerations through the stages of design, development, operation, review, and optimization in the software development life cycle. Using a case study, we demonstrate the practical application of the proposed methodology through the implementation of recommendation functionalities in the EndoZone platform, a platform dedicated to providing targeted health information on endometriosis. Results: Application of the proposed methodology in the EndoZone platform led to the creation of a tailored health information recommendation system known as EndoZone Informatics. Feedback from EndoZone stakeholders as well as insights from the implementation process validate the methodology?s utility in enabling advanced recommendation features in health information applications. Preliminary assessments indicate that the system successfully delivers personalized content, adeptly incorporates user feedback, and exhibits considerable flexibility in adjusting its recommendation logic. While certain project-specific design flaws were not caught in the initial stages, these issues were subsequently identified and rectified in the review and optimization stages. Conclusions: We propose a generic methodology to guide the design and implementation of health information recommendation functionality within web-based health information applications. By harnessing user characteristics and feedback for content ranking, this methodology enables the creation of personalized recommendations that align with individual user needs within trusted health applications. The successful application of our methodology in the development of EndoZone Informatics marks a significant progress toward personalized health information delivery at scale, tailored to the specific needs of users. UR - https://humanfactors.jmir.org/2024/1/e52027 UR - http://dx.doi.org/10.2196/52027 UR - http://www.ncbi.nlm.nih.gov/pubmed/38809588 ID - info:doi/10.2196/52027 ER - TY - JOUR AU - Tremoulet, D. Patrice AU - Lobo, F. Andrea AU - Simmons, A. Christina AU - Baliga, Ganesh AU - Brady, Matthew PY - 2024/4/25 TI - Assessing the Usability and Feasibility of Digital Assistant Tools for Direct Support Professionals: Participatory Design and Pilot-Testing JO - JMIR Hum Factors SP - e51612 VL - 11 KW - technology prototype KW - data collection KW - documentation KW - direct support professionals KW - intellectual and developmental disabilities KW - pilot test KW - mobile phone N2 - Background: The United States is experiencing a direct support professional (DSP) crisis, with demand far exceeding supply. Although generating documentation is a critical responsibility, it is one of the most wearisome aspects of DSPs? jobs. Technology that enables DSPs to log informal time-stamped notes throughout their shift could help reduce the burden of end-of-shift documentation and increase job satisfaction, which in turn could improve the quality of life of the individuals with intellectual and developmental disabilities (IDDs) whom DSPs support. However, DSPs, with varied ages, levels of education, and comfort using technology, are not likely to adopt tools that detract from caregiving responsibilities or increase workload; therefore, technological tools for them must be relatively simple, extremely intuitive, and provide highly valued capabilities. Objective: This paper describes the development and pilot-testing of a digital assistant tool (DAT) that enables DSPs to create informal notes throughout their shifts and use these notes to facilitate end-of-shift documentation. The purpose of the pilot study was to assess the usability and feasibility of the DAT. Methods: The research team applied an established user-centered participatory design process to design, develop, and test the DAT prototypes between May 2020 and April 2023. Pilot-testing entailed having 14 DSPs who support adults with IDDs use the first full implementation of the DAT prototypes during 2 or 3 successive work shifts and fill out demographic and usability questionnaires. Results: Participants used the DAT prototypes to create notes and help generate end-of-shift reports. The System Usability Scale score of 81.79 indicates that they found the prototypes easy to use. Survey responses imply that using the DAT made it easier for participants to produce required documentation and suggest that they would adopt the DAT if this tool were available for daily use. Conclusions: Simple technologies such as the DAT prototypes, which enable DSPs to use mobile devices to log time-stamped notes throughout their shift with minimal effort and use the notes to help write reports, have the potential to both reduce the burden associated with producing documentation and enhance the quality (level of detail and accuracy) of this documentation. This could help to increase job satisfaction and reduce turnover in DSPs, both of which would help improve the quality of life of the individuals with IDDs whom they support. The pilot test results indicate that DSPs found the DAT easy to use. Next steps include (1) producing more robust versions of the DAT with additional capabilities, such as storing data locally on mobile devices when Wi-Fi is not available; and (2) eliciting input from agency directors, families, and others who use data about adults with IDDs to help care for them to ensure that data produced by DSPs are relevant and useful. UR - https://humanfactors.jmir.org/2024/1/e51612 UR - http://dx.doi.org/10.2196/51612 UR - http://www.ncbi.nlm.nih.gov/pubmed/38662420 ID - info:doi/10.2196/51612 ER - TY - JOUR AU - Han, Yunmin AU - Sung, Hoyong AU - Kim, Geonhui AU - Ryu, Yeun AU - Yoon, Jiyeon AU - Kim, Soo Yeon PY - 2024/4/18 TI - Effects of a Web-based Weight Management Education Program on Various Factors for Overweight and Obese Women: Randomized Controlled Trial JO - JMIR Cardio SP - e42402 VL - 8 KW - weight loss KW - obesity KW - health education KW - self-management KW - health promotion KW - tailored feedback KW - web-based intervention KW - behavior change N2 - Background: Mediated diet and exercise methods yield effective short-term weight loss but are costly and hard to manage. However, web-based programs can serve many participants, offering ease of access and cost-efficiency. Objective: This study aimed to compare the effectiveness of a web-based weight management program through web-based education alone (MINE) or combined with tailored video feedback (MINE Plus) with a control (CO) group. Methods: This intervention included 60 Korean women with overweight and obesity (BMI?23 kg/m2) aged 19 years to 39 years old. We randomly allocated 60 participants to each of 3 groups: (1) MINE group (web-based education video and self-monitoring app), (2) MINE Plus group (web-based education video, self-monitoring app, and 1:1 tailored video feedback), and (3) CO group (only self-monitoring app). Web-based education included nutrition, physical activity, psychological factors, medical knowledge for weight loss, goal setting, and cognitive and behavioral strategies. Tailored feedback aimed to motivate and provide solutions via weekly 10-minute real-time video sessions. The intervention lasted 6 weeks, followed by a 6-week observation period to assess the education's lasting effects, with evaluations at baseline, 6 weeks, and 12 weeks. A generalized linear mixed model was used to evaluate time and group interactions. Results: In the intention-to-treat analysis including all 60 participants, there were significant differences in weight change at 6 weeks in the MINE and MINE Plus groups, with mean weight changes of ?0.74 (SD 1.96) kg (P=.03) and ?1.87 (SD 1.8) kg (P<.001), respectively, while no significant change was observed in the CO group, who had a mean weight increase of 0.03 (SD 1.68) kg (P=.91). After 12 weeks, changes in body weight were ?1.65 (SD 2.64) kg in the MINE group, ?1.59 (SD 2.79) kg in the MINE Plus group, and 0.43 (SD 1.42) kg in the CO group. There was a significant difference between the MINE and MINE Plus groups (P<.001). Significant group × time effects were found for body weight in the MINE and CO groups (P<.001) and in the MINE Plus and CO groups (P<.001), comparing baseline and 12 weeks. Regarding physical activity and psychological factors, only body shape satisfaction and health self-efficacy were associated with improvements in the MINE and MINE Plus groups (P<.001). Conclusions: This study found that the group receiving education and tailored feedback showed significant weight loss and improvements in several psychological factors, though there were differences in the sustainability of the effects. Trial Registration: Korea Disease Control and Prevention Agency (KDCA) KCT0007780: https://cris.nih.go.kr/cris/search/detailSearch.do/22861 UR - https://cardio.jmir.org/2024/1/e42402 UR - http://dx.doi.org/10.2196/42402 UR - http://www.ncbi.nlm.nih.gov/pubmed/38635975 ID - info:doi/10.2196/42402 ER - TY - JOUR AU - Bilder, A. Deborah AU - Mthembu, Mariah AU - Worsham, Whitney AU - Aguayo, Patricia AU - Knight, R. Jacob AU - Deng, W. Steven AU - Singh, P. Tejinder AU - Davis, John PY - 2024/3/29 TI - Developing and Implementing a Web-Based Branching Logic Survey to Support Psychiatric Crisis Evaluations of Individuals With Developmental Disabilities: Qualitative Study and Evaluation of Validity JO - JMIR Ment Health SP - e50907 VL - 11 KW - developmental disabilities KW - disruptive behavior KW - psychiatric comorbidity KW - web-based KW - psychiatric crisis KW - disability KW - mental health KW - behavioral crises KW - intervention KW - general population KW - screening KW - accuracy KW - mood disorder KW - sources of distress KW - autism KW - intellectual disability N2 - Background: Individuals with developmental disabilities (DD) experience increased rates of emotional and behavioral crises that necessitate assessment and intervention. Psychiatric disorders can contribute to crises; however, screening measures developed for the general population are inadequate for those with DD. Medical conditions can exacerbate crises and merit evaluation. Screening tools using checklist formats, even when designed for DD, are too limited in depth and scope for crisis assessments. The Sources of Distress survey implements a web-based branching logic format to screen for common psychiatric and medical conditions experienced by individuals with DD by querying caregiver knowledge and observations. Objective: This paper aims to (1) describe the initial survey development, (2) report on focus group and expert review processes and findings, and (3) present results from the survey?s clinical implementation and evaluation of validity. Methods: Sources of Distress was reviewed by focus groups and clinical experts; this feedback informed survey revisions. The survey was subsequently implemented in clinical settings to augment providers? psychiatric and medical history taking. Informal and formal consults followed the completion of Sources of Distress for a subset of individuals. A records review was performed to identify working diagnoses established during these consults. Results: Focus group members (n=17) expressed positive feedback overall about the survey?s content and provided specific recommendations to add categories and items. The survey was completed for 231 individuals with DD in the clinical setting (n=161, 69.7% men and boys; mean age 17.7, SD 10.3; range 2-65 years). Consults were performed for 149 individuals (n=102, 68.5% men and boys; mean age 18.9, SD 10.9 years), generating working diagnoses to compare survey screening results. Sources of Distress accuracy rates were 91% (95% CI 85%-95%) for posttraumatic stress disorder, 87% (95% CI 81%-92%) for anxiety, 87% (95% CI 81%-92%) for episodic expansive mood and bipolar disorder, 82% (95% CI 75%-87%) for psychotic disorder, 79% (95% CI 71%-85%) for unipolar depression, and 76% (95% CI 69%-82%) for attention-deficit/hyperactivity disorder. While no specific survey items or screening algorithm existed for unspecified mood disorder and disruptive mood dysregulation disorder, these conditions were caregiver-reported and working diagnoses for 11.7% (27/231) and 16.8% (25/149) of individuals, respectively. Conclusions: Caregivers described Sources of Distress as an acceptable tool for sharing their knowledge and insights about individuals with DD who present in crisis. As a screening tool, this survey demonstrates good accuracy. However, better differentiation among mood disorders is needed, including the addition of items and screening algorithm for unspecified mood disorder and disruptive mood dysregulation disorder. Additional validation efforts are necessary to include a more geographically diverse population and reevaluate mood disorder differentiation. Future study is merited to investigate the survey?s impact on the psychiatric and medical management of distress in individuals with DD. UR - https://mental.jmir.org/2024/1/e50907 UR - http://dx.doi.org/10.2196/50907 UR - http://www.ncbi.nlm.nih.gov/pubmed/38551644 ID - info:doi/10.2196/50907 ER - TY - JOUR AU - Heilemann, V. MarySue AU - Lai, Jianchao AU - Cadiz, P. Madonna AU - Meza, I. Jocelyn AU - Flores Romero, Daniela AU - Wells, B. Kenneth PY - 2024/3/25 TI - Community Members? Perceptions of a Resource-Rich Well-Being Website in California During the COVID-19 Pandemic: Qualitative Thematic Analysis JO - JMIR Form Res SP - e55517 VL - 8 KW - adaptation KW - humans KW - pandemics KW - mental health KW - COVID-19 KW - health resources KW - California KW - psychological KW - stigma KW - digital KW - prevention KW - public health KW - emotions KW - website KW - qualitative research N2 - Background: To address needs for emotional well-being resources for Californians during the COVID-19 pandemic, the Together for Wellness/Juntos por Nuestro Bienestar (T4W/Juntos) website was developed in collaboration with multiple community partners across California, funded by the California Department of Health Care Services Behavioral Health Division federal emergency response. Objective: This qualitative study was designed to explore and describe the perspectives of participants affiliated with California organizations on the T4W/Juntos website, understand their needs for web-based emotional health resources, and inform iterative website development. Methods: After providing informed consent and reviewing the website, telephone interviews were conducted with 29 participants (n=21, 72% in English and n=8, 28% in Spanish) recruited by partnering community agencies (October 2021-February 2022). A 6-phase thematic analysis was conducted, enhanced using grounded theory techniques. The investigators wrote reflexive memos and performed line-by-line coding of 12 transcripts. Comparative analyses led to the identification of 15 overarching codes. The ATLAS.ti Web software (ATLAS.ti Scientific Software Development GmbH) was used to mark all 29 transcripts using these codes. After examining the data grouped by codes, comparative analyses led to the identification of main themes, each with a central organizing concept. Results: Four main themes were identified: (1) having to change my coping due to the pandemic, (2) confronting a context of shifting perceptions of mental health stigma among diverse groups, (3) ?Feels like home??experiencing a sense of inclusivity and belonging in T4W/Juntos, and (4) ?It?s a one-stop-shop??judging T4W/Juntos to be a desirable and useful website. Overall, the T4W/Juntos website communicated support and community to this sample during the pandemic. Participants shared suggestions for website improvement, including adding a back button and a drop-down menu to improve functionality as well as resources tailored to the needs of groups such as older adults; adolescents; the lesbian, gay, bisexual, transgender, and queer community; police officers; and veterans. Conclusions: The qualitative findings from telephone interviews with this sample of community members and service providers in California suggest that, during the COVID-19 pandemic, the T4W/Juntos website was well received as a useful, accessible tool, with some concerns noted such as language sometimes being too ?professional? or ?clinical.? The look, feel, and content of the website were described as welcoming due to pictures, animations, and videos that showcased resources in a personal, colorful, and inviting way. Furthermore, the content was perceived as lacking the stigma typically attached to mental health, reflecting the commitment of the T4W/Juntos team. Unique features and diverse resources, including multiple languages, made the T4W/Juntos website a valuable resource, potentially informing dissemination. Future efforts to develop mental health websites should consider engaging a diverse sample of potential users to understand how to tailor messages to specific communities and help reduce stigma. UR - https://formative.jmir.org/2024/1/e55517 UR - http://dx.doi.org/10.2196/55517 UR - http://www.ncbi.nlm.nih.gov/pubmed/38526558 ID - info:doi/10.2196/55517 ER - TY - JOUR AU - Onie, Sandersan AU - Armstrong, Oliver Susanne AU - Josifovski, Natasha AU - Berlinquette, Patrick AU - Livingstone, Nicola AU - Holland, Sarah AU - Finemore, Coco AU - Gale, Nyree AU - Elder, Emma AU - Laggis, George AU - Heffernan, Cassandra AU - Theobald, Adam AU - Torok, Michelle AU - Shand, Fiona AU - Larsen, Mark PY - 2024/3/19 TI - The Effect of Explicit Suicide Language in Engagement With a Suicide Prevention Search Page Help-Seeking Prompt: Nonrandomized Trial JO - JMIR Ment Health SP - e50283 VL - 11 KW - suicide KW - suicide prevention KW - Google KW - Google Ads KW - internet search KW - explicit wording KW - mental health KW - suicidal KW - advertisement KW - advertisements KW - messaging KW - prevention signage KW - campaign KW - campaigns KW - distress KW - engagement KW - prompt KW - prompts KW - information seeking KW - help seeking KW - searching KW - search N2 - Background: Given that signage, messaging, and advertisements (ads) are the gateway to many interventions in suicide prevention, it is important that we understand what type of messaging works best for whom. Objective: We investigated whether explicitly mentioning suicide increases engagement using internet ads by investigating engagement with campaigns with different categories of keywords searched, which may reflect different cognitive states. Methods: We ran a 2-arm study Australia-wide, with or without ads featuring explicit suicide wording. We analyzed whether there were differences in engagement for campaigns with explicit and nonexplicit ads for low-risk (distressed but not explicitly suicidal), high-risk (explicitly suicidal), and help-seeking for suicide keywords. Results: Our analyses revealed that having explicit wording has opposite effects, depending on the search terms used: explicit wording reduced the engagement rate for individuals searching for low-risk keywords but increased engagement for those using high-risk keywords. Conclusions: The findings suggest that individuals who are aware of their suicidality respond better to campaigns that explicitly use the word ?suicide.? We found that individuals who search for low-risk keywords also respond to explicit ads, suggesting that some individuals who are experiencing suicidality search for low-risk keywords. UR - https://mental.jmir.org/2024/1/e50283 UR - http://dx.doi.org/10.2196/50283 UR - http://www.ncbi.nlm.nih.gov/pubmed/38502162 ID - info:doi/10.2196/50283 ER - TY - JOUR AU - Abdulai, Abdul-Fatawu AU - Naghdali, Hasti AU - Noga, Heather AU - Yong, J. Paul PY - 2024/3/15 TI - Patient-Centered Approaches for Designing Destigmatizing Sexual Pain-Related Web-Based Platforms: Qualitative Study JO - JMIR Form Res SP - e53742 VL - 8 KW - stigma KW - digital health KW - sexual pain KW - destigmatizing KW - end user patients N2 - Background: Sexual pain is a common but neglected disorder that affects approximately 3% to 18% of women and an unmeasured number of gender-diverse people worldwide. Despite its wide prevalence, many people feel reluctant to visit conventional health care services or disclose their symptoms due to the fear of stigmatization. To alleviate this stigma, various web-based interventions have been developed to complement and, in some cases, replace conventional sexual health interventions. However, the way these web-based interventions are developed could inadvertently reproduce, perpetuate, or exacerbate stigma among end user patients. Objective: The purpose of this study was to understand patients? perspectives on how sexual pain?related web platforms can be designed to alleviate stigma or prevent the unintended effects of stigma among patients who use web-based interventions. Methods: Individual semistructured interviews were conducted among 16 participants with lived experiences of painful sex in a large urban city in Western Canada. Participants were recruited via social media platforms, newsletters, and a provincial health volunteer website. Using a sample sexual pain website to provide context, participants were interviewed about their experiences of stigma and how they think web platforms could be designed to address stigma. The interviews were conducted via Zoom (Zoom Technologies Inc) and analyzed using thematic analysis. Results: The findings revealed 4 overarching themes that represented participants? perspectives on designing web platforms that may alleviate or prevent the unintended effects of stigma. These findings suggested the design of inclusive web platforms, having a nonprovocative and calming user interface, having features that facilitate connections among users and between users and providers, and displaying personal testimonials and experiences of sexual pain. Conclusions: This study highlighted patient-centered design approaches that could serve as a reference guide in developing web platforms that alleviate or prevent the unintended effects of stigma, particularly among nonheterosexual and gender-diverse people. While this study was conducted in the context of sexual pain, the results might also apply to web platforms on other potentially stigmatizing health-related disorders or conditions. UR - https://formative.jmir.org/2024/1/e53742 UR - http://dx.doi.org/10.2196/53742 UR - http://www.ncbi.nlm.nih.gov/pubmed/38488844 ID - info:doi/10.2196/53742 ER - TY - JOUR AU - Eager, Sharon AU - Killaspy, Helen AU - C, Joanna AU - Mezey, Gillian AU - McPherson, Peter AU - Downey, Megan AU - Thompson, Georgina AU - Lloyd-Evans, Brynmor PY - 2024/3/13 TI - A Web-Based Tool to Assess Social Inclusion and Support Care Planning in Mental Health Supported Accommodation: Development and Preliminary Test Study JO - Interact J Med Res SP - e45987 VL - 13 KW - social inclusion KW - supported accommodation KW - mental health KW - digital health KW - care planning N2 - Background: Individuals with severe mental illness living in supported accommodation are often socially excluded. Social inclusion is an important aspect of recovery-based practice and quality of life. The Social Inclusion Questionnaire User Experience (SInQUE) is a measure of social inclusion that has been validated for use with people with mental health problems. Previous research has suggested that the SInQUE could also help support care planning focused on enabling social inclusion in routine mental health practice. Objective: This study aims to develop a web-based version of the SInQUE for use in mental health supported accommodation services, examine its acceptability and perceived usefulness as a tool to support care planning with service users, determine the extent of uptake of the tool in supported accommodation settings, and develop a program theory and logic model for the online SInQUE. Methods: This study involved a laboratory-testing stage to assess the acceptability of the SInQUE tool through ?think-aloud? testing with 6 supported accommodation staff members and a field-testing stage to assess the acceptability, utility, and use of the SInQUE tool over a 5-month period. An implementation strategy was used in 1 London borough to encourage the use of the SInQUE. Qualitative interviews with 12 service users and 12 staff members who used the tool were conducted and analyzed using thematic analysis. The use of the SInQUE was compared with that in 2 other local authority areas, 1 urban and 1 rural, where the tool was made available for use but no implementation strategy was used. Results: Overall, 17 staff members used the SInQUE with 28 different service users during the implementation period (approximately 10% of all service users living in supported accommodation in the study area). The staff and service users interviewed felt that the SInQUE was collaborative, comprehensive, user-friendly, and relevant. Although some staff were concerned that particular questions might be too personal, service users did not echo this view. Participants generally felt that the SInQUE could help identify individuals? priorities regarding different aspects of social inclusion by prompting in-depth conversations and tailoring specific support to address service users? inclusion goals. Some interviewees also suggested that the tool could highlight areas of unmet or unmeetable needs across the borough that could feed into service planning. The SInQUE was not used in the comparison areas that had no implementation strategy. Conclusions: The online SInQUE is an acceptable and potentially useful tool that can be recommended to assess and support care planning to enable social inclusion of people living in mental health supported accommodation services. Despite this, uptake rates were modest during the study period. A concerted implementation strategy is key to embedding its use in usual care, including proactive endorsement by senior leaders and service managers. UR - https://www.i-jmr.org/2024/1/e45987 UR - http://dx.doi.org/10.2196/45987 UR - http://www.ncbi.nlm.nih.gov/pubmed/38477978 ID - info:doi/10.2196/45987 ER - TY - JOUR AU - Kazemi, Alireza AU - Boyd, Marisha AU - Choi, Fiona AU - Tai, Yeung Andy Man AU - Tsang, WL Vivian AU - To, Tam AU - Kim, Jane AU - Jang, Kerry AU - Shams, Farhud AU - Schreiter, Stefanie AU - Cabanis, Maurice AU - Krausz, Michael Reinhard PY - 2024/3/11 TI - Architecture and Development Framework for a Web-Based Risk Assessment and Management Platform Developed on WordPress to Address Opioid Overdose JO - JMIR Form Res SP - e49759 VL - 8 KW - software designs KW - risks management KW - risk assessments KW - opioid overdose KW - crisis intervention KW - substance related disorders UR - https://formative.jmir.org/2024/1/e49759 UR - http://dx.doi.org/10.2196/49759 UR - http://www.ncbi.nlm.nih.gov/pubmed/38466977 ID - info:doi/10.2196/49759 ER - TY - JOUR AU - Sisk, Bryan AU - Antes, L. Alison AU - Bereitschaft, Christine AU - Enloe, Madi AU - Bourgeois, Fabienne AU - DuBois, James PY - 2024/3/11 TI - Guiding Principles for Adolescent Web-Based Portal Access Policies: Interviews With Informatics Administrators JO - JMIR Pediatr Parent SP - e49177 VL - 7 KW - adolescent KW - patient portal KW - electronic health records KW - policy KW - ethics KW - portal KW - portals KW - adolescents KW - youth KW - health record KW - health records KW - EHR KW - EHRs KW - perspective KW - perspectives KW - policies KW - administrator KW - administration KW - informatics KW - information system KW - information systems KW - guidelines N2 - Background: Web-based patient portals are tools that could support adolescents in managing their health and developing autonomy. However, informatics administrators must navigate competing interests when developing portal access policies for adolescents and their parents. Objective: We aimed to assess the perspectives of informatics administrators on guiding principles for the development of web-based health care portal access policies in adolescent health care. Methods: We interviewed informatics administrators from US hospitals with ?50 dedicated pediatric beds. We performed a thematic analysis of guiding principles for developing and implementing adolescent portal access policies. Results: We interviewed 65 informatics leaders who represented 63 pediatric hospitals, 58 health care systems, 29 states, and 14,379 pediatric hospital beds. Participants described 9 guiding principles related to three overarching themes: (1) balancing confidentiality and other care needs, (2) balancing simplicity and granularity, and (3) collaborating and advocating. Participants described the central importance of prioritizing the health and safety of the adolescent while also complying with state and federal laws. However, there were differing beliefs about how to prioritize health and safety and what role parents should play in supporting the adolescent?s health care. Participants also identified areas where clinicians and institutions can advocate for adolescents, especially with electronic health record vendors and legislators. Conclusions: Informatics administrators provided guiding principles for adolescent portal access policies that aimed to balance the competing needs of adolescent confidentiality and the usefulness of the portal. Portal access policies must prioritize the adolescent?s health and safety while complying with state and federal laws. However, institutions must determine how to best enact these principles. Institutions and clinicians should strive for consensus on principles to strengthen advocacy efforts with institutional leadership, electronic health record vendors, and lawmakers. UR - https://pediatrics.jmir.org/2024/1/e49177 UR - http://dx.doi.org/10.2196/49177 UR - http://www.ncbi.nlm.nih.gov/pubmed/38466976 ID - info:doi/10.2196/49177 ER - TY - JOUR AU - Sinha, Jayati AU - Serin, Nuket PY - 2024/3/11 TI - Online Health Information Seeking and Preventative Health Actions: Cross-Generational Online Survey Study JO - J Med Internet Res SP - e48977 VL - 26 KW - digital natives KW - digital immigrants KW - online health information seeking KW - preventative health actions KW - mobile phone N2 - Background: The popularity of online health information seeking (OHIS) has increased significantly owing to its accessibility and affordability. To facilitate better health management, it is essential to comprehend the generational differences in OHIS behavior and preventative health actions after seeking online health information (OHI). Objective: This study investigates the variations in OHIS and engagement in preventative health actions between 2 generations based on their technology use (digital natives [aged 18-42 years] and digital immigrants [aged ?43 years]). Additionally, this research explores the mediating role of OHIS types on the generational effect on preventative health actions and the moderating role of OHI search frequency, gender, and the presence of chronic diseases on the generational effect on OHIS types and preventative health actions. Methods: A preregistered online survey was conducted on the Prolific online data collection platform using stratified sampling of 2 generations (digital natives and digital immigrants) from the United States in November 2023. Overall, 3 types of OHIS were collected: health wellness information search, health guidance information search, and health management information search. A 1-way analysis of covariance tested the generational differences in types of OHIS and preventative health actions, and a 2-way analysis of covariance tested the moderating role of OHIS search frequency, gender, and the presence of chronic diseases using 7 control variables. The PROCESS Macro Model 4 was used to conduct mediation analyses, testing OHI search types as mediators. Linear regression analyses tested age as a predictor of OHIS and preventative health actions. Results: The analysis of 1137 responses revealed generational differences in OHIS. Digital natives searched for health wellness information more frequently (P<.001), whereas digital immigrants searched for health guidance (P<.001) and health management information (P=.001) more frequently. There were no significant differences between the 2 generations regarding preventative health actions (P=.85). Moreover, all 3 types of OHIS mediated the relationship between generational differences and preventative health actions. Furthermore, as people aged, they searched for significantly less health wellness information (P<.001) and more health guidance (P<.001), and health management information (P=.003). Age was not a significant predictor of preventative health actions (P=.48). The frequency of OHI searches did not moderate the effect of generations on OHIS types and preventative health actions. Gender only moderated the relationship between generation and health guidance information search (P=.02), and chronic diseases only moderated the relationship between generation and health wellness information search (P=.03). Conclusions: To the best of our knowledge, this study is the first to explore how 2 digital generations vary in terms of searching for OHI and preventative health behaviors. As the older adult population grows, it is crucial to understand their OHIS behavior and how they engage in preventative health actions to enhance their quality of life. UR - https://www.jmir.org/2024/1/e48977 UR - http://dx.doi.org/10.2196/48977 UR - http://www.ncbi.nlm.nih.gov/pubmed/38466985 ID - info:doi/10.2196/48977 ER - TY - JOUR AU - Costanza, Marco AU - Sobieraj, Jeffrey AU - Wang, Frank PY - 2024/2/12 TI - Evaluating Participation in Gender-Affirming Care: Cross-Sectional Analysis of Dermatology Program Websites in the United States JO - JMIR Dermatol SP - e54480 VL - 7 KW - dermatology KW - gender-affirming care KW - transgender KW - dermatology residency KW - medical education KW - website KW - digital platform KW - media KW - gender KW - websites KW - school KW - resident KW - residencies KW - residency KW - schools KW - universities KW - cross-sectional UR - https://derma.jmir.org/2024/1/e54480 UR - http://dx.doi.org/10.2196/54480 UR - http://www.ncbi.nlm.nih.gov/pubmed/38345853 ID - info:doi/10.2196/54480 ER - TY - JOUR AU - Breitenstein, M. Susan AU - Berteletti, Julia AU - Smoske, Shea AU - Barger, Charles AU - Tipps, Kyrie AU - Helsabeck, P. Nathan PY - 2024/1/30 TI - Administrative Dashboard for Monitoring Use of a Web-Based Parent Training Intervention: Usability Study JO - JMIR Form Res SP - e53439 VL - 8 KW - usability KW - development KW - dashboard KW - portal KW - implementation KW - design KW - System Usability Scale KW - internet-based intervention KW - parents KW - parent KW - child KW - children KW - web-based KW - web-based parent training KW - PT KW - descriptive survey KW - single group KW - survey KW - system usability KW - ezParent KW - videoconference KW - information KW - reviews on usage KW - improvement KW - qualitative N2 - Background: Web-based parent training (PT) programs can strengthen parent-child relationships by equipping caregivers with knowledge and evidence-based strategies to manage behavior. Hybrid facilitation of PT includes facilitator interaction paired with self-administered and web-based PT. Web-based administrative dashboards provide users (eg, administrators, facilitators, and researchers) with an integrated platform to monitor parent progress and activities within a PT program or website. Despite the utility and prevalence of administrative dashboards for web-based behavioral interventions, to our knowledge, no research studies have explored the perspectives and insights of dashboard users to enhance user experience and program delivery. Objective: The purpose of this study is to evaluate the usability of the administrative dashboard (ezDashboard) for the ezParent program, a 6-module web-based PT program for parents of children aged 2-5 years. Methods: This study used a descriptive, single-group design with administrators who were overseeing the implementation of the ezParent program and trained facilitators for hybrid ezParent delivery. Participants spent at least 30 minutes reviewing and evaluating the ezDashboard and then completed a survey of their experience with the dashboard. The survey included the validated 10-item System Usability Scale and open-ended questions focusing on user performance, navigation ease, and overall usefulness of the ezDashboard. Results: Participants (N=15) indicated high usability of the ezDashboard with System Usability Scale scoring a total mean score of 83.5 (SD 16.3). Most participants (n=13, 87%) rated the overall user-friendliness of the ezDashboard as good (n=3, 20%), excellent (n=9, 60%), or best imaginable (n=1, 7%). Open-ended questions revealed the ezDashboard is or would be useful to monitor parent progress and trends in engagement (n=8, 53%) and for reviewing topics for discussion and communicating with parents (n=5, 33%). ezParent administrators (n=4) identified that real-time data for ezParent use helps overall management of program uptake. Suggestions for features to add to the ezDashboard included the ability to track partial progress of program modules (4/14, 29%), total time spent per module (2/14, 14%), and exportable reports (4/14, 29%). Other ideas for improvement included direct messaging capabilities, videoconferencing platform integration, and being able to modify participant account and contact information. Conclusions: Results indicate that the ezDashboard is easy to use and provides functional information to facilitators and administrators in delivering ezParent. Qualitative results indicate that integrating suggested features into the ezDashboard may help provide a smoother experience for facilitators, administrators, and ultimately the parents using the program. Providing resources for facilitators and administrators in real time to monitor intervention participants? progress in a program can be helpful in tracking progress and providing facilitated support in tailoring program content and program completion. UR - https://formative.jmir.org/2024/1/e53439 UR - http://dx.doi.org/10.2196/53439 UR - http://www.ncbi.nlm.nih.gov/pubmed/38289675 ID - info:doi/10.2196/53439 ER - TY - JOUR AU - Ha, Sandeul AU - Ho, Hee Seung AU - Bae, Young-Hyeon AU - Lee, Minyoung AU - Kim, Hee Ju AU - Kim, Han Ju AU - Lee, Jisan PY - 2023/11/28 TI - Digital Health Equity and Tailored Health Care Service for People With Disability: User-Centered Design and Usability Study JO - J Med Internet Res SP - e50029 VL - 25 KW - digital health equity KW - digital health care service KW - COVID-19 KW - mobile health KW - mHealth KW - mobile apps KW - needs assessments KW - heuristic KW - people with disability KW - caregivers KW - health personnel KW - mobile phone N2 - Background: As digital health services advance, digital health equity has become a significant concern. However, people with disability and older adults still face health management limitations, particularly in the COVID-19 pandemic. An essential area of investigation is proposing a patient-centered design strategy that uses patient-generated health data (PGHD) to facilitate optimal communication with caregivers and health care service providers. Objective: This study aims to conceptualize, develop, and validate a digitally integrated health care service platform for people with disability, caregivers, and health care professionals, using Internet of Things devices and PGHD to contribute to improving digital health equity. Methods: The methodology consists of 5 stages. First, a collaborative review of the previous app, Daily Healthcare 1.0, was conducted with individuals with disabilities, caregivers, and health care professionals. Secondly, user needs were identified via personas, scenarios, and user interface sketches to shape a user-centered service design. The third stage created an enhanced app that integrated these specifications. In the fourth stage, heuristic evaluations by clinical and app experts paved the way for Daily Healthcare 2.0, now featuring Internet of Things device integration. Conclusively, in the fifth stage, an extensive 2-month usability evaluation was executed with user groups comprising individuals with disabilities using the app and their caregivers. Results: Among the participants, ?disability welfare information and related institutional linkage? was the highest priority. Three of the 14 user interface sketches the participants created were related to ?providing educational content.? The 11 heuristic evaluation experts identified ?focusing on a single task? as a crucial issue and advocated redesigning the home menu to simplify it and integrate detailed menus. Subsequently, the app Daily Healthcare 2.0 was developed, incorporating wearable devices for collecting PGHD and connecting individuals with disabilities, caregivers, and health care professionals. After the 2-month usability evaluation with 27 participants, all participants showed an increase in eHealth literacy, particularly those who used the caregiver app. Relatively older users demonstrated improved scores in health IT usability and smartphone self-efficacy. All users? satisfaction and willingness to recommend increased, although their willingness to pay decreased. Conclusions: In this study, we underscore the significance of incorporating the distinct needs of individuals with disabilities, caregivers, and health care professionals from the design phase of a digital health care service, highlighting its potential to advance digital health equity. Our findings also elucidate the potential benefits of fostering partnerships between health consumers and providers, thereby attenuating the vulnerability of marginalized groups, even amid crises such as the COVID-19 pandemic. Emphasizing this imperative, we advocate for sustained endeavors to bolster the digital literacy of individuals with disabilities and champion collaborative cocreation, aiming to uphold the collective ethos of health and digital health equity. UR - https://www.jmir.org/2023/1/e50029 UR - http://dx.doi.org/10.2196/50029 UR - http://www.ncbi.nlm.nih.gov/pubmed/38015589 ID - info:doi/10.2196/50029 ER - TY - JOUR AU - Zimbile, Filippo AU - Beek, Titia AU - David, Silke AU - Crutzen, Rik PY - 2023/10/26 TI - An Implementation Pilot of Web-Based Self-Training Programs on Sexual Dysfunctions in the Dutch Public Sexual Health Setting: Mixed Methods Study JO - JMIR Form Res SP - e49009 VL - 7 KW - implementation pilot digital health KW - e-sexual health KW - sexual dysfunctions KW - self-care KW - public health KW - sexual issue KW - barrier KW - sexual health KW - intervention KW - young adult KW - young KW - sexual problem N2 - Background: Web-based sexual health interventions may be more acceptable to people compared with face-to-face support, given the stigma and embarrassment often associated with sexual problems. The Dutch public sexual health clinics (SHCs) conducted an implementation pilot with 4 web-based self-training programs on sexual dysfunctions (WSTPs) for young people. In addition to a basic sexuality program, the WSTPs focused on the following complaints: pain during intercourse, premature ejaculation, and no sex drive. Objective: This study aims to gain insight into the potential reach of the freely offered WSTPs; use, acceptance, evaluation, and perceived impact of the WSTPs by young people; and evaluation and acceptance of the WSTPs by nurses of the SHCs. Methods: A quantitative baseline measurement (BM) and a follow-up measurement (FM) were conducted among the users. In addition, qualitative data were gathered through video interviews with a sample of respondents of the FM and nurses of the SHCs to gain more in-depth insights into their assessment of the WSTPs. Participants were recruited via social media, posters, and referrals by nurses of the SHCs. Quantitative data were analyzed using descriptive statistics. Independent 2-tailed t tests and one-way independent ANOVAs were used to compare the scores between subgroups based on background characteristics. Dependent 2-tailed t tests were used to assess the possible changes between BM and FM. The interviews were analyzed using a thematic analysis. Results: A total of 1028 young people (aged 16-24 y) completed the BM, 666 started with 1 of the WSTPs, and 104 participants completed the FM. In addition, 8 users and 8 nurses were interviewed. Of the participants who completed the BM, 87.74% (902/1028) experienced moderate (411/1028, 39.98%) to high (491/1028, 47.76%) severity of complaints, of which 20.43% (210/1028) had had them for >1 year and 27.82% (286/1028) even for ?2 years, and 38.91% (400/1028) were dissatisfied with their sex lives. Only 8.75% (90/1028) had sought professional help in the past 2 years. At FM, users rated satisfaction with their sex life more positively than they did at BM, and they experienced less discomfort from their complaints. The overall rating was positive, with a mean report grade of 7.3 (SD 1.45; on a 10-point scale). Anonymity, clear information and explanation, and practical exercises are indicated as strengths of the WSTPs, leading to more understanding and normalization. Nurses appreciate the high quality of information and accessibility of the WSTPs. They consider them as a valuable addition to the consultation hours. Conclusions: WSTPs can reach a large number of young people with sexual problems who are less likely to seek professional help. This can result in an improved understanding of their issues, a decrease in complaints, and reduced barriers to communicating with a partner or professional. UR - https://formative.jmir.org/2023/1/e49009 UR - http://dx.doi.org/10.2196/49009 UR - http://www.ncbi.nlm.nih.gov/pubmed/37883172 ID - info:doi/10.2196/49009 ER - TY - JOUR AU - Goueth, Rose AU - Darney, Blair AU - Hoffman, Aubri AU - Eden, B. Karen PY - 2023/10/3 TI - Evaluating the Acceptability and Feasibility of a Sexual Health?Focused Contraceptive Decision Aid for Diverse Young Adults: User-Centered Usability Study JO - JMIR Form Res SP - e44170 VL - 7 KW - decision aid KW - contraception KW - decision-making KW - user-centered design KW - young adults KW - pilot study KW - feasibility KW - acceptability KW - development KW - support KW - tool KW - survey KW - sexual health N2 - Background: Young adults with low sexual health literacy levels may find it difficult to make informed decisions about contraceptive methods. We developed and pilot-tested a web-based decision aid?Healthy Sex Choices?designed to support diverse young adults with their contraceptive decision-making. Objective: This pilot study aimed to evaluate whether the Healthy Sex Choices decision aid is acceptable and feasible to patients and clinicians. Methods: We used the Ottawa Decision Support Framework and the International Patient Decision Aid Standards to develop and pilot the decision tool. We first conducted a needs assessment with our advisory panel (5 clinicians and 2 patients) that informed decision aid development. All panelists participated in semistructured interviews about their experience with contraceptive counseling. Clinicians also completed a focus group session centered around the development of sex education content for the tool. Before commencing the pilot study, 5 participants from ResearchMatch (Vanderbilt University Medical Center) assessed the tool and suggested improvements. Results: Participants were satisfied with the tool, rating the acceptability as ?good.? Interviewees revealed that the tool made contraceptive decision-making easier and would recommend the tool to a family member or friend. Participants had a nonsignificant change in knowledge scores (53% before vs 45% after; P=.99). Overall, decisional conflict scores significantly decreased (16.1 before vs 2.8 after; P<.001) with the informed subscale (patients feeling more informed) having the greatest decline (23.1 vs 4.7; mean difference 19.0, SD 27.1). Subanalyses of contraceptive knowledge and decisional conflict illustrated that participants of color had lower knowledge scores (48% vs 55%) and higher decisional conflict (20.0 vs 14.5) at baseline than their white counterparts. Conclusions: Participants found Healthy Sex Choices to be acceptable and reported reduced decisional conflict after using the tool. The development and pilot phases of this study provided a foundation for creating reproductive health decision aids that acknowledge and provide guidance for diverse patient populations. UR - https://formative.jmir.org/2023/1/e44170 UR - http://dx.doi.org/10.2196/44170 UR - http://www.ncbi.nlm.nih.gov/pubmed/37788070 ID - info:doi/10.2196/44170 ER - TY - JOUR AU - Bul, Kim AU - Holliday, Nikki AU - Bhuiyan, Alam Mohammad Rashed AU - Clark, T. Cain C. AU - Allen, John AU - Wark, A. Petra PY - 2023/8/9 TI - Usability and Preliminary Efficacy of an Artificial Intelligence?Driven Platform Supporting Dietary Management in Diabetes: Mixed Methods Study JO - JMIR Hum Factors SP - e43959 VL - 10 KW - nutrition and dietetics KW - general diabetes KW - qualitative research KW - preventive medicine KW - web technology KW - self-management KW - diabetes KW - nutrition KW - deep learning KW - artificial KW - mobile phone N2 - Background: Nutrition plays an important role in diabetes self-management. Web-based diabetes care, driven by artificial intelligence (AI), enables more personalized care. Objective: This study aimed to examine the usability and preliminary efficacy of a web-based AI-driven nutrition platform to support people with diabetes and their carers in identifying healthy recipes, meal planning, and web-based shopping. Methods: Diabetes UK signposted people with diabetes and their carers to the platform?s study-specific portal through its website, social media, and newsletters. A total of 73 adult participants with prediabetes or diabetes or their carers completed the baseline web-based survey. Of these 73 participants, 23 (32%) completed a web-based survey after 8 weeks of platform use. Web-based semistructured interviews were conducted with platform users (7/23, 30%) who agreed to be followed up and diabetes experts (n=3) who had nutrition and platform knowledge. The intervention consists of a web-based platform that incorporates AI to personalize recipes, meal planning, and shopping list experiences and was made available for 8 weeks. Baseline characteristics, satisfaction, system usability, and diabetes-related and general health indicators were assessed before and after using the platform for 8 weeks. Results: Reductions in weight (mean difference 4.5 kg/m2, 95% CI 1.0-12.0; P=.009; Cliff ?=0.33) and waist size (mean difference 3.9 cm, 95% CI 2.0-6.5; P=.008; Cliff ?=0.48) were found. Most of the participants (151/217, 69.6%) did not regularly use the platform and had low or very low engagement scores. However, the platform was perceived as accessible with no need for additional assistance (11/21, 52%), user-friendly (8/21, 38%), and easy to use (8/21, 38%), regardless of some usability issues. Saving recipes was the most popular feature, with 663 saved recipes. Conclusions: This study indicated that the usability of the nutrition platform was well perceived by users and their carers. As participants managed their diabetes well, adding an education component would be specifically relevant for people less familiar with the role of diet in diabetes management. To assess the platform?s effectiveness in improving diabetes-related health indicators, controlled studies with a larger and more diverse participant sample are recommended. UR - https://humanfactors.jmir.org/2023/1/e43959 UR - http://dx.doi.org/10.2196/43959 UR - http://www.ncbi.nlm.nih.gov/pubmed/37556198 ID - info:doi/10.2196/43959 ER - TY - JOUR AU - Wrightson-Hester, Aimee-Rose AU - Anderson, Georgia AU - Dunstan, Joel AU - McEvoy, M. Peter AU - Sutton, J. Christopher AU - Myers, Bronwyn AU - Egan, Sarah AU - Tai, Sara AU - Johnston-Hollitt, Melanie AU - Chen, Wai AU - Gedeon, Tom AU - Mansell, Warren PY - 2023/7/21 TI - An Artificial Therapist (Manage Your Life Online) to Support the Mental Health of Youth: Co-Design and Case Series JO - JMIR Hum Factors SP - e46849 VL - 10 KW - mental health KW - conversational agents KW - chatbots KW - young people KW - acceptability KW - feasibility KW - co-design KW - artificial therapist KW - artificial intelligence KW - youth KW - child KW - adolescent KW - chatbot KW - Manage Your Life Online KW - MYLO KW - support KW - mobile phone N2 - Background: The prevalence of child and adolescent mental health issues is increasing faster than the number of services available, leading to a shortfall. Mental health chatbots are a highly scalable method to address this gap. Manage Your Life Online (MYLO) is an artificially intelligent chatbot that emulates the method of levels therapy. Method of levels is a therapy that uses curious questioning to support the sustained awareness and exploration of current problems. Objective: This study aimed to assess the feasibility and acceptability of a co-designed interface for MYLO in young people aged 16 to 24 years with mental health problems. Methods: An iterative co-design phase occurred over 4 months, in which feedback was elicited from a group of young people (n=7) with lived experiences of mental health issues. This resulted in the development of a progressive web application version of MYLO that could be used on mobile phones. We conducted a case series to assess the feasibility and acceptability of MYLO in 13 young people over 2 weeks. During this time, the participants tested MYLO and completed surveys including clinical outcomes and acceptability measures. We then conducted focus groups and interviews and used thematic analysis to obtain feedback on MYLO and identify recommendations for further improvements. Results: Most participants were positive about their experience of using MYLO and would recommend MYLO to others. The participants enjoyed the simplicity of the interface, found it easy to use, and rated it as acceptable using the System Usability Scale. Inspection of the use data found evidence that MYLO can learn and adapt its questioning in response to user input. We found a large effect size for the decrease in participants? problem-related distress and a medium effect size for the increase in their self-reported tendency to resolve goal conflicts (the proposed mechanism of change) in the testing phase. Some patients also experienced a reliable change in their clinical outcome measures over the 2 weeks. Conclusions: We established the feasibility and acceptability of MYLO. The initial outcomes suggest that MYLO has the potential to support the mental health of young people and help them resolve their own problems. We aim to establish whether the use of MYLO leads to a meaningful reduction in participants? symptoms of depression and anxiety and whether these are maintained over time by conducting a randomized controlled evaluation trial. UR - https://humanfactors.jmir.org/2023/1/e46849 UR - http://dx.doi.org/10.2196/46849 UR - http://www.ncbi.nlm.nih.gov/pubmed/37477969 ID - info:doi/10.2196/46849 ER - TY - JOUR AU - Stapinski, Ann Lexine AU - Nepal, Smriti AU - Guckel, Tara AU - Grummitt, Rachel Lucinda AU - Chapman, Cath AU - Lynch, Jane Samantha AU - Lawler, Maree Siobhan AU - Teesson, Maree AU - Newton, Clare Nicola PY - 2022/8/26 TI - Evaluation of Positive Choices, a National Initiative to Disseminate Evidence-Based Alcohol and Other Drug Prevention Strategies: Web-Based Survey Study JO - JMIR Pediatr Parent SP - e34721 VL - 5 IS - 3 KW - alcohol and other drugs KW - prevention KW - adolescence KW - schools KW - drug prevention KW - drug prevention website N2 - Background: To prevent adolescents from initiating alcohol and other drug use and reduce the associated harms, effective strategies need to be implemented. Despite their availability, effective school-based programs and evidence-informed parental guidelines are not consistently implemented. The Positive Choices alcohol and other drug prevention initiative and website was launched to address this research and practice gap. The intended end users were school staff, parents, and school students. An 8-month postlaunch evaluation of the website showed that end users generally had positive feedback on the website?s usability, and following its use, most of them would consider the evidence base and effectiveness of drug education resources. This study extends this initial evaluation by examining the effectiveness and impact of the Positive Choices initiative over a 3-year period. Objective: Guided by the five dimensions of the RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework, the study assessed the impact of the Positive Choices initiative in increasing awareness and implementation of evidence-based drug prevention. Methods: Data were collected between 2017 and 2019, using web-based evaluation and community awareness surveys. Data from the surveys were merged to examine reach, effectiveness, adoption, implementation, and maintenance using descriptive statistics. Google Analytics was used to further understand the reach of the website. The System Usability Scale was used to measure website usability. In addition, inductive analysis was used to assess the participants? feedback about Positive Choices. Results: A total of 5 years after launching, the Positive Choices website has reached 1.7 million users. A national Australian campaign increased awareness from 8% to 14% among school staff and from 15% to 22% among parents after the campaign. Following a brief interaction with the website, most participants, who were not already following the recommended strategies, reported an intention to shift toward evidence-based practices. The System Usability Scale score for the website was good for both user groups. The participants intended to maintain their use of the Positive Choices website in the future. Both user groups reported high level of confidence in communicating about topics related to alcohol and other drugs. Participants? suggestions for improvement informed a recent website update. Conclusions: The Positive Choices website has the capacity to be an effective strategy for disseminating evidence-based drug prevention information and resources widely. The findings highlight the importance of investing in ongoing maintenance and promotion to enhance awareness of health websites. With the increased use and acceptability of health education websites, teams should ensure that websites are easy to navigate, are engaging, use simple language, contain evidence-informed resources, and are supported by ongoing promotional activities. UR - https://pediatrics.jmir.org/2022/3/e34721 UR - http://dx.doi.org/10.2196/34721 UR - http://www.ncbi.nlm.nih.gov/pubmed/36018617 ID - info:doi/10.2196/34721 ER - TY - JOUR AU - Egan, A. Luke AU - Mulcahy, Mary AU - Tuqiri, Karen AU - Gatt, M. Justine PY - 2022/4/21 TI - A Web-Based Well-being Program for Health Care Workers (Thrive): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e34005 VL - 11 IS - 4 KW - well-being KW - Composure, Own-worth, Mastery, Positivity, Achievement, and Satisfaction for Wellbeing KW - COMPAS-W KW - mental health KW - resilience KW - health care KW - hospital KW - brain KW - neuroscience KW - online KW - randomized controlled trial KW - RCT N2 - Background: Mental health has come to be understood as not merely the absence of mental illness but also the presence of mental well-being, and recent interventions have sought to increase well-being in various populations. A population that deserves particular attention is that of health care workers, whose occupations entail high levels of stress, especially given the ongoing COVID-19 pandemic. A neuroscience-based web-based well-being program for health care workers?the Thrive program?has been newly developed to promote habits and activities that contribute to brain health and overall mental well-being. Objective: This paper describes the protocol for a randomized controlled trial whose objective is to evaluate the Thrive program in comparison with an active control condition to measure whether the program is effective at increasing well-being and decreasing symptoms of psychological distress in health care workers at a designated Australian hospital. Methods: The trial will comprise two groups (intervention vs active control) and 4 measurement occasions over a 12-week period. A survey will be administered in each of weeks 0, 4, 8, and 12, and the well-being program will be delivered in weeks 1-7 (via web-based video presentations or digital pamphlets). Each of the 4 surveys will comprise a range of questionnaires to measure well-being, psychological distress, and other key variables. The planned analyses will estimate group-by-time interaction effects to test the hypothesis that mental health will increase over time in the intervention condition relative to the active control condition. Results: The Thrive program was delivered to a small number of wards at the hospital between February 2021 and July 2021, and it will be delivered to the remaining wards from October 2021 to December 2021. A power calculation has recommended a sample size of at least 200 participants in total. A linear mixed model will be used to estimate the interaction effects. Conclusions: This trial seeks to evaluate a new web-based well-being program for health care workers at a major public hospital. It will contribute to the growing body of research on mental well-being and ways to promote it. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12621000027819; https://tinyurl.com/58wwjut9 International Registered Report Identifier (IRRID): DERR1-10.2196/34005 UR - https://www.researchprotocols.org/2022/4/e34005 UR - http://dx.doi.org/10.2196/34005 UR - http://www.ncbi.nlm.nih.gov/pubmed/35451973 ID - info:doi/10.2196/34005 ER - TY - JOUR AU - Agachi, Elena AU - Bijmolt, A. Tammo H. AU - Mierau, O. Jochen AU - van Ittersum, Koert PY - 2022/2/2 TI - Adoption of the Website and Mobile App of a Preventive Health Program Across Neighborhoods With Different Socioeconomic Conditions in the Netherlands: Longitudinal Study JO - JMIR Hum Factors SP - e32112 VL - 9 IS - 1 KW - eHealth KW - mHealth KW - mobile health KW - mobile app KW - internet KW - preventive health program KW - health disparities KW - NSES KW - program adoption KW - survival analysis N2 - Background: Socioeconomic disparities in the adoption of preventive health programs represent a well-known challenge, with programs delivered via the web serving as a potential solution. The preventive health program examined in this study is a large-scale, open-access web-based platform operating in the Netherlands, which aims to improve the health behaviors and wellness of its participants. Objective: This study aims to examine the differences in the adoption of the website and mobile app of a web-based preventive health program across socioeconomic groups. Methods: The 83,466 participants in this longitudinal, nonexperimental study were individuals who had signed up for the health program between July 2012 and September 2019. The rate of program adoption per delivery means was estimated using the Prentice, Williams, and Peterson Gap?Time model, with the measure of neighborhood socioeconomic status (NSES) used to distinguish between population segments with different socioeconomic characteristics. Registration to the health program was voluntary and free, and not within a controlled study setting, allowing the observation of the true rate of adoption. Results: The estimation results indicate that program adoption across socioeconomic groups varies depending on the program?s delivery means. For the website, higher NSES groups have a higher likelihood of program adoption compared with the lowest NSES group (hazard ratio 1.03, 95% CI 1.01-1.05). For the mobile app, the opposite holds: higher NSES groups have a lower likelihood of program adoption compared with the lowest NSES group (hazard ratio 0.94, 95% CI 0.91-0.97). Conclusions: Promoting preventive health programs using mobile apps can help to increase program adoption among the lowest socioeconomic segments. Given the increasing use of mobile phones among disadvantaged population groups, structuring future health interventions to include mobile apps as means of delivery can support the stride toward diminishing health disparities. UR - https://humanfactors.jmir.org/2022/1/e32112 UR - http://dx.doi.org/10.2196/32112 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107433 ID - info:doi/10.2196/32112 ER - TY - JOUR AU - Gunn, M. Kate AU - Skaczkowski, Gemma AU - Dollman, James AU - Vincent, D. Andrew AU - Short, E. Camille AU - Brumby, Susan AU - Barrett, Alison AU - Harrison, Nathan AU - Turnbull, Deborah PY - 2022/1/11 TI - Combining Farmers? Preferences With Evidence-Based Strategies to Prevent and Lower Farmers? Distress: Co-design and Acceptability Testing of ifarmwell JO - JMIR Hum Factors SP - e27631 VL - 9 IS - 1 KW - farm KW - agriculture KW - rural KW - drought KW - mental health KW - stress KW - coping KW - online intervention KW - acceptance and commitment therapy N2 - Background: Farming is physically and psychologically hazardous. Farmers face many barriers to help seeking from traditional physical and mental health services; however, improved internet access now provides promising avenues for offering support. Objective: This study aims to co-design with farmers the content and functionality of a website that helps them adopt transferable coping strategies and test its acceptability in the broader farming population. Methods: Research evidence and expert opinions were synthesized to inform key design principles. A total of 18 farmers detailed what they would like from this type of website. Intervention logic and relevant evidence-based strategies were mapped. Website content was drafted and reviewed by 2 independent mental health professionals. A total of 9 farmers provided detailed qualitative feedback on the face validity of the draft content. Subsequently, 9 farmers provided feedback on the website prototype. Following amendments and internal prototype testing and optimization, prototype usability (ie, completion rate) was examined with 157 registered website users who were (105/157, 66.9%) female, aged 21-73 years; 95.5% (149/156) residing in inner regional to very remote Australia, and 68.2% (107/157) ?sheep, cattle and/or grain farmers.? Acceptability was examined with a subset of 114 users who rated at least module 1. Interviews with 108 farmers who did not complete all 5 modules helped determine why, and detailed interviews were conducted with 18 purposively sampled users. Updates were then made according to adaptive trial design methodology. Results: This systematic co-design process resulted in a web-based resource based on acceptance and commitment therapy and designed to overcome barriers to engagement with traditional mental health and well-being strategies?ifarmwell. It was considered an accessible and confidential source of practical and relevant farmer-focused self-help strategies. These strategies were delivered via 5 interactive modules that include written, drawn, and audio- and video-based psychoeducation and exercises, as well as farming-related jokes, metaphors, examples, and imagery. Module 1 included distress screening and information on how to speak to general practitioners about mental health?related concerns (including a personalized conversation script). Modules were completed fortnightly. SMS text messages offered personalized support and reminders. Qualitative interviews and star ratings demonstrated high module acceptability (average 4.06/5 rating) and suggested that additional reminders, higher quality audio recordings, and shorter modules would be useful. Approximately 37.1% (52/140) of users who started module 1 completed all modules, with too busy or not got to it yet being the main reason for non-completion, and previous module acceptability not predicting subsequent module completion. Conclusions: Sequential integration of research evidence, expert knowledge, and farmers? preferences in the co-design process allowed for the development of a self-help intervention that focused on important intervention targets and was acceptable to this difficult-to-engage group. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12617000506392; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372526 UR - https://humanfactors.jmir.org/2022/1/e27631 UR - http://dx.doi.org/10.2196/27631 UR - http://www.ncbi.nlm.nih.gov/pubmed/35014963 ID - info:doi/10.2196/27631 ER - TY - JOUR AU - Gale, James Jonathan AU - Black, Collin Kameron AU - Calvano, David Joshua AU - Fundingsland Jr, Lauritz Edwin AU - Lai, Deborah AU - Silacci, Sara AU - He, Shuhan PY - 2021/12/21 TI - An Analysis of US Academic Medical Center Websites: Usability Study JO - J Med Internet Res SP - e27750 VL - 23 IS - 12 KW - website usability KW - digital health KW - health care website KW - academic medical center KW - usability testing KW - web crawler N2 - Background: Health care organizations are tasked with providing web-based health resources and information. Usability refers to the ease of user experience on a website. In this study, we conducted a usability analysis of academic medical centers in the United States, which, to the best of our knowledge, has not been previously carried out. Objective: The primary aims of the study were to the following: (1) adapt a preexisting usability scoring methodology to academic medical centers; (2) apply and test this methodology on a sample set of academic medical center websites; and (3) make recommendations from these results on potential areas of improvements for our sample of academic medical center websites. Methods: All website usability testing took place from June 1, 2020, to December 15, 2020. We replicated a methodology developed in previous literature and applied it to academic medical centers. Our sample included 73 US academic medical centers. Usability was split into four broad categories: accessibility (the ability of those with low levels of computer literacy to access and navigate the hospital?s website); marketing (the ability of websites to be found through search engines and the relevance of descriptions to the links provided); content quality (grammar, frequency of information updates, material relevancy, and readability); and technology (download speed, quality of the programming code, and website infrastructure). Using these tools, we scored each website in each category. The composite of key factors in each category contributed to an overall ?general usability? score for each website. An overall score was then calculated by applying a weighted percentage across all factors and was used for the final ?overall usability? ranking. Results: The category with the highest average score was technology, with a 0.82 (SD 0.068, SE 0.008). The lowest-performing category was content quality, with an average of 0.22 (SD 0.069, SE 0.008). As these numbers reflect weighted percentages as an integer, the higher the score, the greater the overall usability in that category. Conclusions: Our data suggest that technology, on average, was the highest-scored variable among academic medical center websites. Because website functionality is essential to a user?s experience, it is justified that academic medical centers invest in optimal website performance. The overall lowest-scored variable was content quality. A potential reason for this may be that academic medical center websites are usually larger in size, making it difficult to monitor the increased quantity of content. An easy way to improve this variable is to conduct more frequent website audits to assess readability, grammar, and relevance. Marketing is another area in which these organizations have potential for improvement. Our recommendation is that organizations utilize search engine optimization techniques to improve their online visibility and discoverability. UR - https://www.jmir.org/2021/12/e27750 UR - http://dx.doi.org/10.2196/27750 UR - http://www.ncbi.nlm.nih.gov/pubmed/34932015 ID - info:doi/10.2196/27750 ER - TY - JOUR AU - Massanelli, Jackson AU - Sexton, W. Kevin AU - Lesher, T. Chris AU - Jensen, K. Hanna AU - Kimbrough, K. Mary AU - Privratsky, Anna AU - Taylor, R. John AU - Bhavaraju, Avi PY - 2021/12/13 TI - Integration of Web Analytics Into Graduate Medical Education: Usability Study JO - JMIR Form Res SP - e29748 VL - 5 IS - 12 KW - graduate medical education KW - website analysis KW - residency recruitment KW - medical education KW - website KW - analytics KW - usage KW - usability KW - user engagement KW - user-centered design KW - website design N2 - Background: Web analytics is the measurement, collection, analysis, and reporting of website and web application usage data. While common in the e-commerce arena, web analytics is underutilized in graduate medical education (GME). Objective: The University of Arkansas for Medical Sciences Department of Surgery website was revamped with input from in-house surgeons in August 2017. This study investigated the use of web analytics to gauge the impact of our department?s website redesign project. Methods: Google Analytics software was used to measure website performance before and after implementation of the new website. Eight-month matched periods were compared. Factors tracked included total users, new users, total sessions, sessions per user, pages per session, average session duration, total page views, and bounce rate (the percentage of visitors who visit a site and then leave [ie, bounce] without continuing to another page on the same site). Results: Analysis using a nonpaired Student t test demonstrated a statistically significant increase for total page views (before vs after: 33,065 vs 81,852; P<.001) and decrease for bounce rate (before vs after: 50.70% vs 0.23%; P<.001). Total users, new users, total sessions, sessions per user, and pages per session showed improvement. The average session duration was unchanged. Subgroup analysis showed that after the main page, the next 3 most frequently visited pages were related to GME programs in our department. Conclusions: Web analytics is a practical measure of a website?s efficacy. Our data suggest that a modern website significantly improves user engagement. An up-to-date website is essential for contemporary GME recruitment, will likely enhance engagement of residency applicants with GME programs, and warrants further investigation. UR - https://formative.jmir.org/2021/12/e29748 UR - http://dx.doi.org/10.2196/29748 UR - http://www.ncbi.nlm.nih.gov/pubmed/34898459 ID - info:doi/10.2196/29748 ER - TY - JOUR AU - Wray, B. Tyler AU - Chan, A. Philip AU - Kahler, W. Christopher PY - 2021/11/16 TI - Game Plan, a Web-Based Intervention to Improve Adherence and Persistence to HIV Pre-exposure Prophylaxis and Reduce Heavy Drinking in Gay, Bisexual, and Other Men Who Have Sex With Men: Usability and User Experience Testing JO - JMIR Form Res SP - e31843 VL - 5 IS - 11 KW - pre-exposure prophylaxis KW - HIV KW - HIV prevention KW - mHealth KW - mobile health KW - eHealth KW - mobile phone N2 - Background: Encouraging consistent use of pre-exposure prophylaxis (PrEP) is essential for reducing HIV incidence, particularly among gay, bisexual, and other men who have sex with men (GBM), and especially those who engage in heavy drinking. Although practice guidelines recommend providing adherence counseling to PrEP patients, clinics and providers may not have the resources or expertise to provide it. Internet-facilitated interventions have been shown to improve HIV prevention outcomes, including medication and care adherence. Game Plan is a website we created to help users make a tangible plan for reducing their HIV risk. We designed additional components of Game Plan to address key individual level barriers to PrEP use. Objective: The aim of this mixed methods research is to test the usability and user experience of these components with intended users: GBM who drink heavily and are on PrEP. Methods: In study 1 (usability), we completed a detailed individual interview in which participants (n=10) walked through a prototype of the website, thinking aloud as they did, and completed a follow-up interview and web-based survey afterward. Study 2 (user experience) involved providing participants (n=40) with a link to the prototype website to explore on their own and asking them to complete the same follow-up survey afterward. Qualitative data were analyzed using thematic analysis, and descriptive statistics were used to analyze quantitative data. Results: Users in both studies gave the website excellent ratings for usability, overall satisfaction, and quality, and most often described the site as informative, helpful, and supportive. Users also rated the site?s content and feel as respectful of them and their autonomy, empathetic, and they stated that it conveyed confidence in their ability to change. The study 1 interviews highlighted the importance of the website?s esthetics to the participants? engagement with it and its credibility in prompting genuine reflection. Conclusions: GBM who reported heavy drinking and used PrEP generally found a website focused on helping them to create a plan to use PrEP consistently to be helpful. Adopting user-centered design methods and attending to the esthetics of mobile health interventions are important steps toward encouraging engagement and reducing at-risk behaviors. UR - https://formative.jmir.org/2021/11/e31843 UR - http://dx.doi.org/10.2196/31843 UR - http://www.ncbi.nlm.nih.gov/pubmed/34783662 ID - info:doi/10.2196/31843 ER - TY - JOUR AU - Ziemssen, Tjalf AU - Giovannoni, Gavin AU - Alvarez, Enrique AU - Bhan, Virender AU - Hersh, Carrie AU - Hoffmann, Olaf AU - Oreja-Guevara, Celia AU - Robles-Cedeño, R. Rene AU - Trojano, Maria AU - Vermersch, Patrick AU - Dobay, Pamela AU - Khwaja, Mudeer AU - Stadler, Bianca AU - Rauser, Benedict AU - Hach, Thomas AU - Piani-Meier, Daniela AU - Burton, Jason PY - 2021/10/6 TI - Multiple Sclerosis Progression Discussion Tool Usability and Usefulness in Clinical Practice: Cross-sectional, Web-Based Survey JO - J Med Internet Res SP - e29558 VL - 23 IS - 10 KW - multiple sclerosis KW - relapsing remitting multiple sclerosis KW - secondary progressive multiple sclerosis KW - transition KW - progression KW - digital KW - usability N2 - Background: A digital tool, Multiple Sclerosis Progression Discussion Tool (MSProDiscuss), was developed to facilitate discussions between health care professionals (HCPs) and patients in evaluating early, subtle signs of multiple sclerosis (MS) disease progression. Objective: The aim of this study is to report the findings on the usability and usefulness of MSProDiscuss in a real-world clinical setting. Methods: In this cross-sectional, web-based survey, HCPs across 34 countries completed an initial individual questionnaire (comprising 7 questions on comprehensibility, usability, and usefulness after using MSProDiscuss during each patient consultation) and a final questionnaire (comprising 13 questions on comprehensibility, usability, usefulness, and integration and adoption into clinical practice to capture the HCPs? overall experience of using the tool). The responses were provided on a 5-point Likert scale. All analyses were descriptive, and no statistical comparisons were made. Results: In total, 301 HCPs tested the tool in 6974 people with MS, of whom 77% (5370/6974) had relapsing-remitting MS, including those suspected to be transitioning to secondary progressive MS. The time taken to complete MSProDiscuss was reported to be in the range of 1 to 4 minutes in 97.3% (6786/6974; initial) to 98.2% (269/274; final) of the cases. In 93.54% (6524/6974; initial) to 97.1% (266/274; final) of the cases, the HCPs agreed (4 or 5 on the Likert scale) that patients were able to comprehend the questions in the tool. The HCPs were willing to use the tool again in the same patient, 90.47% (6310/6974; initial) of the cases. The HCPs reported MSProDiscuss to be useful in discussing MS symptoms and their impact on daily activities (6121/6974, 87.76% initial and 252/274, 92% final) and cognitive function (5482/6974, 78.61% initial and 271/274, 79.2% final), as well as in discussing progression in general (6102/6974, 87.49% initial and 246/274, 89.8% final). While completing the final questionnaire, 94.9% (260/274) of the HCPs agreed that the questions were similar to those asked in regular consultation, and the tool helped to better understand the impact of MS symptoms on daily activities (249/274, 90.9%) and cognitive function (220/274, 80.3%). Overall, 92% (252/274) of the HCPs reported that they would recommend MSProDiscuss to a colleague, and 85.8% (235/274) were willing to integrate it into their clinical practice. Conclusions: MSProDiscuss is a usable and useful tool to facilitate a physician-patient discussion on MS disease progression in daily clinical practice. Most of the HCPs agreed that the tool is easy to use and were willing to integrate MSProDiscuss into their daily clinical practice. UR - https://www.jmir.org/2021/10/e29558 UR - http://dx.doi.org/10.2196/29558 UR - http://www.ncbi.nlm.nih.gov/pubmed/34612826 ID - info:doi/10.2196/29558 ER - TY - JOUR AU - Myhre, Leren Enid AU - Garnweidner-Holme, Lisa AU - Dahl, Bente AU - Reigstad, Myhre Marte AU - Lukasse, Mirjam PY - 2021/9/27 TI - Development of and Experiences With an Informational Website on Early Labor: Qualitative User Involvement Study JO - JMIR Form Res SP - e28698 VL - 5 IS - 9 KW - early labor KW - latent phase KW - think aloud KW - usability KW - website KW - labor KW - pregnancy KW - user-friendliness KW - eHealth KW - user satisfaction N2 - Background: The period of regular contractions before 4 cm of cervical dilatation is often referred to as the latent phase or early labor. Women find it challenging to prepare for and cope with this phase of labor, and easily accessed web-based information from reliable sources may be useful in this preparation. Objective: The aim of this study is to describe the development of a Norwegian website, Latens.no, for people seeking information on early labor and to explore users? experiences with the website to increase its user-friendliness. Methods: We developed a website using an iterative process involving a multidisciplinary research team, health personnel, users, a graphic designer, and an expert in software development. We explored the website?s user-friendliness using semistructured individual interviews and the think-aloud method. All interviews were audio recorded and transcribed. We then analyzed the participants? feedback on the website. Results: Participants included women who had recently given birth to their first baby (n=2), women who were pregnant with their first baby (n=4), and their partners (n=2). Results from participants? experiences completing tasks included positive feedback related to the content of Latens.no, positive feedback related to the website?s design, and suggestions for improvement. Participants wanted to find information on early labor on the internet. Moreover, they found the information on the website relevant, trustworthy, and easy to read, and the design was attractive and easy to use. Overall, the participants performed the tasks easily, with few clicks and minimal effort. Conclusions: The think-aloud method, while performing tasks, allowed for detailed feedback. The participants confirmed the user-friendliness of the website but at the same time provided information enabling improvement. We expect that changes made based on this user-centered design study will further increase the usability and acceptability of Latens.no. UR - https://formative.jmir.org/2021/9/e28698 UR - http://dx.doi.org/10.2196/28698 UR - http://www.ncbi.nlm.nih.gov/pubmed/34569940 ID - info:doi/10.2196/28698 ER - TY - JOUR AU - Nowaskie, Z. Dustin PY - 2021/9/22 TI - Development, Implementation, and Effectiveness of a Self-sustaining, Web-Based LGBTQ+ National Platform: A Framework for Centralizing Local Health Care Resources and Culturally Competent Providers JO - JMIR Form Res SP - e17913 VL - 5 IS - 9 KW - cultural competency KW - disparities KW - e-health KW - healthcare KW - internet KW - LGBTQ+ KW - online platform KW - providers KW - resources KW - eHealth KW - health care N2 - Background: The lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) population has long faced substantial marginalization, discrimination, and health care disparities compared to the cisgender, heterosexual population. As the etiology of such disparities is multifaceted, finding concrete solutions for LGBTQ+ health care equity is challenging. However, the internet may offer the space to initiate an effective model. Objective: In an effort to make LGBTQ+ public resources and culturally competent providers transparent, modernize medical education, and promote cultural competency, OutCare Health?a nonprofit 501(c)(3) multidisciplinary, multicenter web-based platform?was created. Methods: The organization employs a cyclic, multidimensional framework to conduct needs assessments, identify resources and providers, promote these efforts on the website, and educate the next generation of providers. LGBTQ+ public health services are identified via the internet, email, and word of mouth and added to the Public Resource Database; culturally competent providers are recruited to the OutList directory via listservs, medical institutions, local organizations, and word of mouth; and mentors are invited to the Mentorship Program by emailing OutList providers. These efforts are replicated across nearly 30 states in the United States. Results: The organization has identified over 500 public health organizations across all states, recognized more than 2000 OutList providers across all states and 50 specialties, distributed hundreds of thousands of educational materials, received over 10,000 monthly website visits (with 83% unique viewership), and formed nearly 30 state-specific teams. The total number of OutList providers and monthly website views has doubled every 12-18 months. The majority of OutList providers are trained in primary, first point-of-care specialties such as family medicine, infectious disease, internal medicine, mental health, obstetrics and gynecology, and pediatrics. Conclusions: A web-based LGBTQ+ platform is a feasible, effective model to identify public health resources, culturally competent providers, and mentors as well as provide cultural competency educational materials and education across the country. Such a platform also has the opportunity to reach self-perpetuating sustainability. The cyclic, multidisciplinary, multidimensional, multicenter framework presented here appears to be pivotal in achieving such growth and stability. Other organizations and medical institutions should heavily consider using this framework to reach their own communities with high-quality, culturally competent care for the LGBTQ+ population. UR - https://formative.jmir.org/2021/9/e17913 UR - http://dx.doi.org/10.2196/17913 UR - http://www.ncbi.nlm.nih.gov/pubmed/34550083 ID - info:doi/10.2196/17913 ER - TY - JOUR AU - Hulbert-Williams, J. Nicholas AU - Leslie, Monica AU - Hulbert-Williams, Lee AU - Koczwara, Bogda AU - Watson, K. Eila AU - Hall, S. Peter AU - Ashley, Laura AU - Coulson, S. Neil AU - Jackson, Richard AU - Millington, Sue AU - AU - Beatty, Lisa PY - 2021/9/20 TI - The Finding My Way UK Clinical Trial: Adaptation Report and Protocol for a Replication Randomized Controlled Efficacy Trial of a Web-Based Psychological Program to Support Cancer Survivors JO - JMIR Res Protoc SP - e31976 VL - 10 IS - 9 KW - cancer KW - survivorship KW - psychosocial intervention KW - digital health KW - quality of life KW - protocol KW - mobile phone N2 - Background: Cancer survivors frequently report a range of unmet psychological and supportive care needs; these often continue after treatment has finished and are predictive of psychological distress and poor health-related quality of life. Web-based interventions demonstrate good efficacy in addressing these concerns and are more accessible than face-to-face interventions. Finding My Way (FMW) is a web-based, psycho-educational, and cognitive behavioral therapy intervention for cancer survivors developed in Australia. Previous trials have demonstrated that FMW is acceptable, highly adhered to, and effective in reducing the impact of distress on quality of life while leading to cost savings through health resource use reduction. Objective: This study aims to adapt the Australian FMW website for a UK cancer care context and then undertake a single-blinded, randomized controlled trial of FMW UK against a treatment-as-usual waitlist control. Methods: To an extent, our trial design replicates the existing Australian randomized controlled trial of FMW. Following a comprehensive adaptation of the web resource, we will recruit 294 participants (147 per study arm) from across clinical sites in North West England and North Wales. Participants will have been diagnosed with cancer of any type in the last 6 months, have received anticancer treatment with curative intent, be aged ?16 years, be proficient in English, and have access to the internet and an active email address. Participants will be identified and recruited through the National Institute for Health Research clinical research network. Measures of distress, quality of life, and health economic outcomes will be collected using a self-report web-based questionnaire at baseline, midtreatment, posttreatment, and both 3- and 6-month follow-up. Quantitative data will be analyzed using intention-to-treat mixed model repeated measures analysis. Embedded semistructured qualitative interviews will probe engagement with, and experiences of using, FMW UK and suggestions for future improvements. Results: The website adaptation work was completed in January 2021. A panel of cancer survivors and health care professionals provided feedback on the test version of FMW UK. Feedback was positive overall, although minor updates were made to website navigation, inclusivity, terminology, and the wording of the Improving Communication and Sexuality and Intimacy content. Recruitment for the clinical trial commenced in April 2021. We aim to report on findings from mid-2023. Conclusions: Replication studies are an important aspect of the scientific process, particularly in psychological and clinical trial literature, especially in different geographical settings. Before replicating the FMW trial in the UK setting, content updating was required. If FMW UK now replicates Australian findings, we will have identified a novel and cost-effective method of psychosocial care delivery for cancer survivors in the United Kingdom. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 14317248; https://www.isrctn.com/ISRCTN14317248 International Registered Report Identifier (IRRID): DERR1-10.2196/31976 UR - https://www.researchprotocols.org/2021/9/e31976 UR - http://dx.doi.org/10.2196/31976 UR - http://www.ncbi.nlm.nih.gov/pubmed/34542420 ID - info:doi/10.2196/31976 ER - TY - JOUR AU - Keyworth, Chris AU - O'Connor, Rory AU - Quinlivan, Leah AU - Armitage, J. Christopher PY - 2021/9/14 TI - Acceptability of a Brief Web-Based Theory-Based Intervention to Prevent and Reduce Self-harm: Mixed Methods Evaluation JO - J Med Internet Res SP - e28349 VL - 23 IS - 9 KW - self-harm KW - implementation intentions KW - acceptability KW - online KW - volitional help sheet KW - digital health KW - mental health N2 - Background: The volitional help sheet (VHS) for self-harm equips people with a means of responding automatically to triggers for self-harm with coping strategies. Although there is some evidence of its efficacy, improving acceptability and making the intervention available in a web-based format may be crucial to increasing effectiveness and reach. Objective: This study aims to use the Theoretical Framework of Acceptability (TFA) to explore the acceptability of the VHS, examine for whom and under what circumstances this intervention is more or less acceptable, and develop a series of recommendations for how the VHS can be used to support people in reducing repeat self-harm. Methods: We explored acceptability in two phases. First, our patient and public involvement partners evaluated the original VHS from a lived experience perspective, which was subsequently translated into a web-based format. Second, a representative sample of adults in the United Kingdom who had previously self-harmed were recruited via a YouGov survey (N=514) and were asked to rate the acceptability of the VHS based on the seven constructs of the TFA, namely, affective attitude, burden, perceived effectiveness, ethicality, intervention coherence, opportunity costs, and self-efficacy. Data were analyzed using descriptive statistics, one-tailed t tests, and binary logistic regression. A directed content analysis approach was used to analyze qualitative data. Results: Participants in the web-based survey rated the VHS as positive (affective attitude; t457=4.72; P<.001); were confident using it (self-efficacy; t457=9.54; P<.001); felt they did not have to give up any benefits, profits, or values when using it (opportunity costs; t439=?15.51; P<.001); understood it and how it worked (intervention coherence; t464=11.90; P<.001); and were confident that it would achieve its purpose (perceived effectiveness; t466=2.04; P=.04). The TFA domain burden appeared to be an important indicator of acceptability. Lower levels of perceived burden when using the VHS tool were more prevalent among younger adults aged 18-24 years (OR 3.63, 95% CI 1.50-8.78), people of White ethnic background (OR 3.02, 95% CI 1.06-8.613), and people without a long-term health condition (OR 1.53, 95% CI 1.01-2.30). Perceived modifications to further improve acceptability included improved formatting (burden), the feature to add new situations and responses or amend existing ones (ethicality), and clearer instructions and further detail about the purpose of the VHS (intervention coherence). Conclusions: Our findings show high levels of acceptability among some people who have previously self-harmed, particularly among younger adults, people of White ethnic backgrounds, and people without long-term health conditions. Future research should aim to improve acceptability among older adults, people from minority ethnic groups, and people with long-term health conditions. UR - https://www.jmir.org/2021/9/e28349 UR - http://dx.doi.org/10.2196/28349 UR - http://www.ncbi.nlm.nih.gov/pubmed/34518153 ID - info:doi/10.2196/28349 ER - TY - JOUR AU - Crawford, D. Natalie AU - Josma, Dorie AU - Harrington, V. Kristin R. AU - Morris, Joseph AU - Quamina, Alvan AU - Birkett, Michelle AU - Phillips II, Gregory PY - 2021/9/9 TI - Using the Think-Aloud Method to Assess the Feasibility and Acceptability of Network Canvas Among Black Men Who Have Sex With Men and Transgender Persons: Qualitative Analysis JO - JMIR Form Res SP - e30237 VL - 5 IS - 9 KW - think-aloud KW - egocentric networks KW - sociogram KW - social networks KW - MSM KW - transgender KW - network canvas KW - black MSM KW - infectious disease transmission KW - stigma N2 - Background: Characteristics of an individual?s social network have been important factors in understanding infectious disease transmission patterns. Social network data collection is generally time and resource intensive, yet it is crucial to our understanding of the complex epidemiologic landscape of human behaviors among stigmatized social groups. Objective: We sought to evaluate the feasibility and acceptability of a self-administered social network data collection tool, Network Canvas, among Black men who have sex with men (BMSM) and transgender persons using the think-aloud method, which is a robust and flexible research technique used to perform usability testing. Methods: We piloted a self-administered network interview within the Network Canvas Software Suite. Participants aged 18 years and older were recruited through a community-based organization in Atlanta, GA, and were included based upon their willingness to share information on sexual behaviors and drug use for themselves and their social networks. A semistructured interview guide was used to document cognitive decision-making processes while using the tool. Recorded interviews were transcribed verbatim, and thematic analyses were performed. Results: Among 7 BMSM and transgender participants, three main themes were identified from cognitive processes: (1) the utility, (2) navigation, and (3) intuitive design of Network Canvas. Overall, Network Canvas was described as ?easy to use,? with suggestions mainly directed toward improving navigation tools and implementing an initial tutorial on the program prior to use. Participants were willing to use Network Canvas to document their social networks and characteristics. In general, observed verbal responses from participants matched their behavior, although there were some discrepancies between verbal affirmations of use and understanding versus external observation. Conclusions: We found Network Canvas to be a useful new tool to capture social network data. Self-administration allowed participants the opportunity to provide sensitive information about themselves and their social networks. Furthermore, automated name generation and visualization of an individuals? social network in the app has the potential to reduce cognitive burden during data collection. More efficient methods of social network data collection have the potential to provide epidemiologic information to guide prevention efforts for populations with stigmatized health conditions or behaviors. UR - https://formative.jmir.org/2021/9/e30237 UR - http://dx.doi.org/10.2196/30237 UR - http://www.ncbi.nlm.nih.gov/pubmed/34499040 ID - info:doi/10.2196/30237 ER - TY - JOUR AU - Karpathakis, Kassandra AU - Libow, Gene AU - Potts, W. Henry W. AU - Dixon, Simon AU - Greaves, Felix AU - Murray, Elizabeth PY - 2021/9/8 TI - An Evaluation Service for Digital Public Health Interventions: User-Centered Design Approach JO - J Med Internet Res SP - e28356 VL - 23 IS - 9 KW - digital health KW - internet-based interventions KW - mHealth KW - evaluation studies KW - public health KW - human-centered design KW - service design KW - mobile phone N2 - Background: Digital health interventions (DHIs) have the potential to improve public health by combining effective interventions and population reach. However, what biomedical researchers and digital developers consider an effective intervention differs, thereby creating an ongoing challenge to integrating their respective approaches when evaluating DHIs. Objective: This study aims to report on the Public Health England (PHE) initiative set out to operationalize an evaluation framework that combines biomedical and digital approaches and demonstrates the impact, cost-effectiveness, and benefit of DHIs on public health. Methods: We comprised a multidisciplinary project team including service designers, academics, and public health professionals and used user-centered design methods, such as qualitative research, engagement with end users and stakeholders, and iterative learning. The iterative approach enabled the team to sequentially define the problem, understand user needs, identify opportunity areas, develop concepts, test prototypes, and plan service implementation. Stakeholders, senior leaders from PHE, and a working group critiqued the outputs. Results: We identified 26 themes and 82 user needs from semistructured interviews (N=15), expressed as 46 Jobs To Be Done, which were then validated across the journey of evaluation design for a DHI. We identified seven essential concepts for evaluating DHIs: evaluation thinking, evaluation canvas, contract assistant, testing toolkit, development history, data hub, and publish health outcomes. Of these, three concepts were prioritized for further testing and development, and subsequently refined into the proposed PHE Evaluation Service for public health DHIs. Testing with PHE?s Couch-to-5K app digital team confirmed the viability, desirability, and feasibility of both the evaluation approach and the Evaluation Service. Conclusions: An iterative, user-centered design approach enabled PHE to combine the strengths of academic and biomedical disciplines with the expertise of nonacademic and digital developers for evaluating DHIs. Design-led methodologies can add value to public health settings. The subsequent service, now known as Evaluating Digital Health Products, is currently in use by health bodies in the United Kingdom and is available to others for tackling the problem of evaluating DHIs pragmatically and responsively. UR - https://www.jmir.org/2021/9/e28356 UR - http://dx.doi.org/10.2196/28356 UR - http://www.ncbi.nlm.nih.gov/pubmed/34494965 ID - info:doi/10.2196/28356 ER - TY - JOUR AU - Hatzioannou, Anna AU - Chatzittofis, Andreas AU - Koutroubas, Sunday Virginia AU - Papastavrou, Evridiki AU - Karanikola, Maria PY - 2021/9/8 TI - Combined Use of Web-Based and In-Person Education on Ill Health Self-management Skills in Adults With Bipolar Disorder: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e25168 VL - 10 IS - 9 KW - education KW - empowerment KW - bipolar disorders KW - self-management KW - bipolar KW - mental health N2 - Background: Addressing the enhancement of ill health self-management skills in adults diagnosed with bipolar disorder may be considered an important intervention for health care systems worldwide. Objective: This protocol describes the study ?Management of my Bipolarity? (MoB), which aims to develop an educational intervention for adults with bipolar disorder and assess its effectiveness. The objectives include (a) a literature review on bipolar disorder educational interventions; (b) a qualitative exploration of the educational needs of people with bipolar disorder; (c) development of an educational intervention based on objectives (a) and (b) (ie, the MoB educational intervention); and (d) exploration of the effectiveness of the intervention regarding participants? knowledge of their mental health condition and enhancement of their ill health self-management skills. The MoB educational intervention will consist of an in-person and a web-based intervention in the form of a digital platform. Methods: The proposed interventional study is a combination of a qualitative and a quantitative design (mixed methods study). A focus group and content analysis will be implemented for the qualitative assessment of the educational needs of adults with bipolar disorder. The intervention will be developed based on the qualitative data of the study and relevant literature. The effectiveness of the acquired knowledge and self-management skills will be assessed according to (a) substance use behavior, (b) health locus of control, (c) impulse control, (d) adherence to pharmacotherapy, (e) relapse prevention, (f) improvement of quality of life, and (g) bipolar disorder knowledge level via structured instruments in the quantitative part of the study using descriptive and inferential statistics (SPSS version 24.0). Results: A total of 13 patients with bipolar disorder have been interviewed (8 women, 5 men) to identify educational needs to be covered through the intervention. Moreover, a literature review on bipolar disorder educational interventions has been completed. These data have been incorporated in the design of the MoB in-person intervention and the digital platform. The digital platform is live, and the development of the MoB in-person intervention was completed at the end of 2020. The recruitment of the participants for the intervention (40 patients) and the control group (40 patients) began during the first semester of 2021. Moreover, by tracking the platform for 1.5 years, we have recorded that 2180 users have visited the platform with an average session duration of almost 2 minutes. Mobile and tablet devices are being used by 70% of the visitors. Conclusions: Since new parameters regarding educational interventions will be explored, these findings are expected to provide evidence that participation in structured educational interventions offers patients the opportunity to improve adherence to pharmacotherapy and increase their quality of life. Trial Registration: ClinicalTrials.gov NCT04643210; https://clinicaltrials.gov/ct2/show/NCT04643210 International Registered Report Identifier (IRRID): DERR1-10.2196/25168 UR - https://www.researchprotocols.org/2021/9/e25168 UR - http://dx.doi.org/10.2196/25168 UR - http://www.ncbi.nlm.nih.gov/pubmed/34494969 ID - info:doi/10.2196/25168 ER - TY - JOUR AU - Katiri, Roulla AU - Hall, A. Deborah AU - Hoare, J. Derek AU - Fackrell, Kathryn AU - Horobin, Adele AU - Buggy, Nóra AU - Hogan, Nicholas AU - Kitterick, T. Pádraig AU - PY - 2021/8/19 TI - Redesigning a Web-Based Stakeholder Consensus Meeting About Core Outcomes for Clinical Trials: Formative Feedback Study JO - JMIR Form Res SP - e28878 VL - 5 IS - 8 KW - COVID-19 KW - nominal group technique KW - formative research KW - patient participation KW - persons with hearing impairments KW - mobile phone N2 - Background: Clinical trials that assess the benefits and harms of an intervention do so by measuring and reporting outcomes. Inconsistent selection and diversity in the choice of outcomes make it challenging to directly compare interventions. To achieve an agreed core set of outcomes, a consensus methodology is recommended, comprising a web-based Delphi survey and a face-to-face consensus meeting. However, UK government regulations to control the pandemic prohibited plans for a face-to-face consensus meeting as part of the Core Rehabilitation Outcome Set for Single-Sided Deafness (CROSSSD) study. Objective: This study aims to evaluate the modifications made by the CROSSSD study team to achieve consensus using web-based methods, but with minimal deviation from the original study protocol. Methods: The study team worked with health care users and professionals to translate the planned face-to-face consensus meeting in a web-based format, preserving the key elements of the nominal group technique. A follow-up survey gathered evaluation feedback on the experiences of the 22 participating members. Feedback covered premeeting preparation, the process of facilitated discussions and voting, ability to contribute, and perceived fairness of the outcome. Results: Overall, 98% (53/54) of feedback responses agreed or strongly agreed with the statements given, indicating that the web-based meeting achieved its original goals of open discussion, debate, and voting to agree with a core outcome set for single-sided deafness. Hearing-impaired participants were fully engaged, but there were some methodological challenges. For the participants, challenges included building rapport, understanding, and delivering the tasks in hand. For the study team, challenges included the need for thorough preparation and management of the unpredictability of tasks on the day. Conclusions: Sharing our experiences and lessons learned can benefit future core outcome set developers. Overcoming the challenges of delivering a web-based consensus exercise in the face of the pandemic can be applied more generally to maximize inclusiveness, enhance geographical access, and reduce research costs. UR - https://formative.jmir.org/2021/8/e28878 UR - http://dx.doi.org/10.2196/28878 UR - http://www.ncbi.nlm.nih.gov/pubmed/34420915 ID - info:doi/10.2196/28878 ER - TY - JOUR AU - Tremblay, Melanie AU - Latulippe, Karine AU - Guay, Manon AU - Provencher, Véronique AU - Giguère, Anick AU - Poulin, Valérie AU - Dubé, Véronique AU - Giroux, Dominique PY - 2021/8/18 TI - Usability of a Co-designed eHealth Prototype for Caregivers: Combination Study of Three Frameworks JO - JMIR Hum Factors SP - e26532 VL - 8 IS - 3 KW - usability evaluation KW - co-design KW - research methods KW - caregivers KW - service providers KW - product objectives N2 - Background: Co-design (or the participation of users) has shown great potential in the eHealth domain, demonstrating positive results. Nevertheless, the co-design approach cannot guarantee the usability of the system designed, and usability assessment is a complex analysis to perform, as evaluation criteria will differ depending on the usability framework (or set of criteria) used. ISO (International Organization for Standardization) on usability (ISO 9241-210), Nielsen heuristic, and Garrett element of user experience inform different yet complementary aspects of usability. Objective: This study aims to assess the usability and user experience of a co-design prototype by combining 3 complementary frameworks. Methods: To help caregivers provide care for functionally impaired older people, an eHealth tool was co-designed with caregivers, health and social service professionals, and community workers assisting caregivers. The prototype was a website that aims to support the help-seeking process for caregivers (finding resources) and allow service providers to advertise their services (offering resources). We chose an exploratory study method to assess usability in terms of each objective. The first step was to assess users? first impressions of the website. The second was a task scenario with a think-aloud protocol. The final step was a semistructured interview. All steps were performed individually (with a moderator) in a single session. The data were analyzed using 3 frameworks. Results: A total of 10 participants were recruited, 5 for each objective of the website. We were able to identify several usability problems, most of which were located in the information design and interface design dimensions (Garrett framework). Problems in both dimensions were mainly coded as effectiveness and efficiency (ISO framework) and error prevention and match between the systemand the real world (Nielsen heuristic). Conclusions: Our study provided a novel contribution about usability analysis by combining the 3 different models to classify the problems found. This combination provided a holistic understanding of the usability improvements needed. It can also be used to analyze other eHealth products. International Registered Report Identifier (IRRID): RR2-10.2196/11634 UR - https://humanfactors.jmir.org/2021/3/e26532 UR - http://dx.doi.org/10.2196/26532 UR - http://www.ncbi.nlm.nih.gov/pubmed/34406123 ID - info:doi/10.2196/26532 ER - TY - JOUR AU - Ashrafi, Agaah AU - Tabatabaee, Maryam AU - Sharifi, Vandad PY - 2021/8/17 TI - Development and Evaluation of Acceptability and Feasibility of a Web-Based Intervention for Patients With Bipolar Disorder in Iran: Implementation Study JO - JMIR Form Res SP - e23360 VL - 5 IS - 8 KW - bipolar disorder KW - psychoeducation KW - web-based intervention KW - feasibility KW - acceptability N2 - Background: Psychoeducation for bipolar disorder has a significant impact on symptoms and treatment adherence. In Iran, as a low-resource setting, infrastructural barriers, such as inadequate mental health professionals, difficulties in transportation, and costs of care, may hinder optimum delivery of this evidence-based intervention to patients. Objective: This study sought to explore the acceptability and feasibility of a web-based intervention for bipolar patients in Iran. Methods: A website has been developed as a platform for providing psychoeducational content about bipolar disorder. Patients were chosen via a convenient sampling method in 2018-2019. The main component of the intervention included streaming 7 weekly video clips after attending a single in-person meeting, as well as a medication self-monitoring application. Information was collected about the feasibility and acceptability of the intervention. Results: We invited 45 patients from the day center and the outpatient clinic of Roozbeh psychiatric hospital and some private clinics in Tehran. Of the 23 patients (51%) who attended the first in-person session and provided informed consent, 14 patients dropped out during the study. While 9 patients completed the course (attended 4 or more online sessions), only 5 watched all the video sessions. The rate of adherence to the intervention and frequency of exposure to the website were much higher for those recruited from the private and outpatient clinics. Conclusions: This web-based intervention can be feasible and acceptable only for a subgroup of patients with specific educational status and socioeconomic level. UR - https://formative.jmir.org/2021/8/e23360 UR - http://dx.doi.org/10.2196/23360 UR - http://www.ncbi.nlm.nih.gov/pubmed/34402794 ID - info:doi/10.2196/23360 ER - TY - JOUR AU - Lester, Gabriel Ethan AU - Hopkins, Whitall Sarah AU - Popok, Jean Paula AU - Vranceanu, Ana-Maria PY - 2021/6/10 TI - Adaptation of a Live Video Mind?Body Program to a Web-Based Platform for English-Speaking Adults With Neurofibromatosis: Protocol for the NF-Web Study JO - JMIR Res Protoc SP - e27526 VL - 10 IS - 6 KW - neurofibromatosis KW - quality of life KW - stress management KW - mind?body KW - asynchronous delivery KW - resiliency KW - mobile phone N2 - Background: Neurofibromatosis (NF) is a rare genetic condition associated with lower but modifiable quality of life (QoL). Although a virtual live video program (Relaxation Response Resiliency Program for Neurofibromatosis [3RP-NF]; efficacy randomized controlled trial underway) that we created has been made available, ongoing barriers impede some patients from engaging in this intervention. A necessary next step is to develop a stand-alone web-based intervention that reduces barriers to accessing NF-specific psychosocial care. Objective: First, we aim to develop a web-based platform (Neurofibromatosis-Web [NF-Web]) of our mind?body resiliency program (3RP-NF) through qualitative interviews with participants from an adult efficacy randomized controlled trial. Second, we aim to iteratively optimize the feasibility, acceptability, credibility, and satisfaction of the NF-Web platform through open pilot trials with participant exit interviews and explore quantitative outcomes within this sample. Here, we describe the protocol and study design, intervention, and analysis plan. Methods: For aim 1, we will invite completers from our efficacy trial to participate in qualitative interviews. We will use data from these interviews to adapt the content of the live video program for asynchronous delivery and understand how to create a user-friendly format for an engaging web platform. For aim 2, we will enroll eligible participants recruited for the efficacy trial who could not enroll because of treatment barriers. Eligible participants will complete QoL, depression, anxiety, pain, treatment satisfaction, and program credibility measures at baseline and posttest. Inclusion criteria are identical to those for the efficacy trial, including stress and coping difficulties (self-report), no change in antidepressant medication in the past 3 months, no psychotherapy in the past 3 months, no major upcoming surgeries in the next 12 months, English speaking, ability to complete questionnaires on the web and participate in live video interventions, and consent before participation. The primary outcomes are feasibility, treatment satisfaction, and credibility. The secondary outcomes include physical, psychological, social, and environmental QoL; depression; anxiety; pain intensity; and pain interference. We will enroll at least two group cohorts and iteratively refine the program based on participant feedback after each cohort completes the open pilot trial. Results: This trial is ongoing. We have completed the interviews (n=23) and analyzed the data to construct the website. Afterward, we will recruit our cohorts for the trial (approximately n=15/cohort; total=30). Recruitment will end by May 2021, with plans to analyze the data by October 2021. Conclusions: We will develop the first web platform for people with NF with difficulties managing stress and NF symptoms and report on feasibility and preliminary effects in improving QoL and psychosocial functioning. NF-Web has potential to extend the reach of our 3RP-NF intervention by removing barriers to care, including lack of trained providers, scheduling difficulties, and appearance concerns. International Registered Report Identifier (IRRID): DERR1-10.2196/27526 UR - https://www.researchprotocols.org/2021/6/e27526 UR - http://dx.doi.org/10.2196/27526 UR - http://www.ncbi.nlm.nih.gov/pubmed/34110294 ID - info:doi/10.2196/27526 ER - TY - JOUR AU - Zhang, Xing AU - Hu, Wenli AU - Xiao, Quan PY - 2021/5/4 TI - Influences of Medical Crowdfunding Website Design Features on Trust and Intention to Donate: Controlled Laboratory Experiment JO - J Med Internet Res SP - e25554 VL - 23 IS - 5 KW - medical crowdfunding KW - website design KW - cognition-based trust KW - affect-based trust KW - intention to donate N2 - Background: As a type of donation-based crowdfunding, medical crowdfunding has gradually become an important way for patients who have difficulty paying medical bills to seek help from the public. However, many people still have limited confidence in donating money to medical crowdfunding projects. Objective: Given that the features of a medical crowdfunding website may be important to gain users? trust, this study draws upon two-factor and trust theories to explore how different design features of medical crowdfunding websites affect potential donors? cognition-based trust and affect-based trust, and how these types of trust affect the intention to donate. Methods: A 2 (informativeness: high vs low) × 2 (visual cues: cool color vs warm color) × 2 (social cues: with vs without) between-subject laboratory experiment was performed to validate our research model. A total of 320 undergraduate students recruited from a university in China participated in the controlled laboratory experiment. Results: Cognition-based trust (?=.528, P<.001) and affect-based trust (?=.344, P<.001) exerted significant effects on the intention to donate of potential donors of medical crowdfunding. Informativeness as a hygiene factor positively influenced potential donors? cognition-based trust (F1,311=49.764, P<.001) and affect-based trust (F1,311=16.093, P<.001), whereas social cues as a motivating factor significantly influenced potential donors? cognition-based trust (F1,311=38.160, P<.001) and affect-based trust (F1,311=23.265, P<.001). However, the color of the webpages affected the two dimensions of trust differently. Specifically, medical crowdfunding webpages with warm colors were more likely to induce affect-based trust than those with cool colors (F1,311=17.120, P<.001), whereas no significant difference was found between the effects of cool and warm colors on cognition-based trust (F1,311=1.707, P=.19). Conclusions: This study deepens our understanding of the relationships among the design features of medical crowdfunding websites, trust, and intention to donate, and provides guidelines for managers of medical crowdfunding platforms to enhance potential donors? trust-building by improving the website design features. UR - https://www.jmir.org/2021/5/e25554 UR - http://dx.doi.org/10.2196/25554 UR - http://www.ncbi.nlm.nih.gov/pubmed/33944787 ID - info:doi/10.2196/25554 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 - LaMonica, M. Haley AU - Roberts, E. Anna AU - Davenport, A. Tracey AU - Hickie, B. Ian PY - 2021/4/21 TI - Evaluation of the Usability and Acceptability of the InnoWell Platform as Rated by Older Adults: Survey Study JO - JMIR Aging SP - e25928 VL - 4 IS - 2 KW - older adults KW - mental health KW - technology KW - community-based participatory research KW - stakeholder participation KW - smartphone KW - mobile phone N2 - Background: As the global population ages, there is increased interest in developing strategies to promote health and well-being in later life, thus enabling continued productivity, social engagement, and independence. As older adults use technologies with greater frequency, proficiency, and confidence, health information technologies (HITs) now hold considerable potential as a means to enable broader access to tools and services for the purposes of screening, treatment, monitoring, and ongoing maintenance of health for this group. The InnoWell Platform is a digital tool co-designed with lived experience to facilitate better outcomes by enabling access to a comprehensive multidimensional assessment, the results of which are provided in real time to enable consumers to make informed decisions about clinical and nonclinical care options independently or in collaboration with a health professional. Objective: This study aims to evaluate the usability and acceptability of a prototype of the InnoWell Platform, co-designed and configured with and for older adults, using self-report surveys. Methods: Participants were adults 50 years and older who were invited to engage with the InnoWell Platform naturalistically (ie, at their own discretion) for a period of 90 days. In addition, they completed short web-based surveys at baseline regarding their background, health, and mental well-being. After 90 days, participants were asked to complete the System Usability Scale to evaluate the usability and acceptability of the prototyped InnoWell Platform, with the aim of informing the iterative redesign and development of this digital tool before implementation within a health service setting. Results: A total of 19 participants consented to participate in the study; however, only the data from the 16 participants (mean age 62.8 years, SD 7.5; range 50-72) who completed at least part of the survey at 90 days were included in the analyses. Participants generally reported low levels of psychological distress and good mental well-being. In relation to the InnoWell Platform, the usability scores were suboptimal. Although the InnoWell Platform was noted to be easy to use, participants had difficulty identifying the relevance of the tool for their personal circumstances. Ease of use, the comprehensive nature of the assessment tools, and the ability to track progress over time were favored features of the InnoWell Platform, whereas the need for greater personalization and improved mobile functionality were cited as areas for improvement. Conclusions: HITs such as the InnoWell Platform have tremendous potential to improve access to cost-effective and low-intensity interventions at scale to improve and maintain mental health and well-being in later life. However, to promote adoption of and continued engagement with such tools, it is essential that these HITs are personalized and relevant for older adult end users, accounting for differences in background, clinical profiles, and levels of need. UR - https://aging.jmir.org/2021/2/e25928 UR - http://dx.doi.org/10.2196/25928 UR - http://www.ncbi.nlm.nih.gov/pubmed/33881410 ID - info:doi/10.2196/25928 ER - TY - JOUR AU - Boyle, C. Sarah AU - LaBrie, W. Joseph PY - 2021/4/16 TI - A Gamified, Social Media?Inspired, Web-Based Personalized Normative Feedback Alcohol Intervention for Lesbian, Bisexual, and Queer-Identified Women: Protocol for a Hybrid Trial JO - JMIR Res Protoc SP - e24647 VL - 10 IS - 4 KW - sexual minority women KW - alcohol KW - intervention KW - social norms KW - gamification KW - protocol KW - mobile phone N2 - Background: Sexual minority women are more likely to drink alcohol, engage in heavy drinking, and experience alcohol-related problems than heterosexual women. However, culturally tailored interventions for this population have been slow to emerge. Objective: This type 1 effectiveness-implementation trial examines the feasibility and efficacy of a gamified, culturally tailored, personalized normative feedback (PNF) alcohol intervention for sexual minority women who psychologically identify as lesbian, bisexual, or queer (LBQ). Methods: The core components of a PNF intervention were delivered within LezParlay, a fun, social media?inspired, digital competition designed to challenge negative stereotypes about LBQ women and increase visibility. The competition was advertised on the web through social media platforms and collaboration with LBQ community organizations. After 2 rounds of play by a large cohort of LBQ women, a subsample of 500 drinkers already taking part in the competition were invited to participate in the evaluation study. Study participants were randomized to receive 1 of 3 unique sequences of PNF (ie, alcohol and stigma coping, alcohol and control, or control topics only) over 2 intervention rounds. Randomization was fully automated by the web app, and both researchers and participants were blinded. Results: Analyses will evaluate whether PNF on alcohol use reduces participants? drinking and negative consequences at 2 and 4 months postintervention; examine whether providing PNF on stigma-coping behaviors, in addition to alcohol use, further reduces alcohol use and consequences beyond PNF on alcohol alone; identify mediators and moderators of intervention efficacy; and examine broader LezParlay app engagement, acceptability, and perceived benefits. Conclusions: This incognito intervention approach is uniquely oriented toward engaging and preventing alcohol-related risks among community populations of LBQ women who may view their heavy drinking as normative and not in need of change because of the visibility of alcohol use in sexual minority community spaces. Thus, this intervention strategy diverges from, and is intended to complement, more intensive programs being developed to meet the needs of LBQ women already motivated to reduce their consumption. Trial Registration: ClinicalTrials.gov NCT03884478; https://clinicaltrials.gov/ct2/show/NCT03884478 International Registered Report Identifier (IRRID): DERR1-10.2196/24647 UR - https://www.researchprotocols.org/2021/4/e24647 UR - http://dx.doi.org/10.2196/24647 UR - http://www.ncbi.nlm.nih.gov/pubmed/33861212 ID - info:doi/10.2196/24647 ER - TY - JOUR AU - Dauber-Decker, L. Katherine AU - Basile, Melissa AU - King, D'Arcy AU - Polo, Jennifer AU - Calise, Karina AU - Khan, Sundas AU - Solomon, Jeffrey AU - Dunne, Daniel AU - Hajizadeh, Negin PY - 2021/4/14 TI - Developing a Decision Aid to Facilitate Informed Decision Making About Invasive Mechanical Ventilation and Lung Transplantation Among Adults With Cystic Fibrosis: Usability Testing JO - JMIR Hum Factors SP - e21270 VL - 8 IS - 2 KW - usability KW - medical informatics KW - clinical decision support KW - cystic fibrosis KW - advance care planning N2 - Background: Cystic fibrosis (CF) is a life-limiting genetic disease that causes chronic lung infections. We developed an internet-based decision aid (DA) to help patients with CF make better informed decisions regarding treatments and advance care planning. We built the DA around two major treatment decisions: whether to have a lung transplant and whether to agree to invasive mechanical ventilation (intubation). Objective: This study aims to conduct usability testing of the InformedChoices CF DA among key stakeholder groups. Methods: We performed a patient needs assessment using think-aloud usability testing with patients with CF, their surrogates, and CF clinicians. Think-aloud participants provided feedback while navigating the DA, and after viewing, they answered surveys. Transcripts from the think-aloud sessions and survey results were categorized into common, generalizable themes and optimizations for improving content, comprehension, and navigation. We assessed the ease of use of the DA (System Usability Scale) and also assessed the participants? perceptions regarding the overall tone, with an emphasis on emotional reactions to the DA content, level of detail, and usefulness of the information for making decisions about either intubation or lung transplantation, including how well they understood the information and were able to apply it to their own decision-making process. We also assessed the DA?s ease of navigation, esthetics, and whether participants were able to complete a series of usability tasks (eg, locating specific information in the DA or using the interactive survival estimates calculator) to ensure that the website was easy to navigate during the clinic-based advance care planning discussions. Results: A total of 12 participants from 3 sites were enrolled from March 9 to August 30, 2018, for the usability testing: 5 CF clinicians (mean age 48.2, SD 12.0 years), 5 adults with CF, and 2 family and surrogate caregivers of people with CF (mean age of CF adults and family and surrogate caregivers 38.8, SD 10.8 years). Among the 12 participants, the average System Usability Scale score for the DA was 88.33 (excellent). Think-aloud analysis identified 3 themes: functionality, visibility and navigation, and content and usefulness. Areas for improvement included reducing repetition, enhancing comprehension, and changing the flow. Several changes to improve the content and usefulness of the DA were recommended, including adding information about alternatives to childbearing, such as adoption and surrogacy. On the basis of survey responses, we found that the navigation of the site was easy for clinicians, patients, and surrogates who participated in usability testing. Conclusions: Usability testing revealed areas of potential improvement. Testing also yielded positive feedback, suggesting the DA?s future success. Integrating changes before implementation should improve the DA?s comprehension, navigation, and usefulness and lead to greater adoption. UR - https://humanfactors.jmir.org/2021/2/e21270 UR - http://dx.doi.org/10.2196/21270 UR - http://www.ncbi.nlm.nih.gov/pubmed/33851921 ID - info:doi/10.2196/21270 ER - TY - JOUR AU - Coulter, S. Robert W. AU - Mitchell, Shannon AU - Prangley, Kelly AU - Smallwood, Seth AU - Bonanno, Leyna AU - Foster, N. Elizabeth AU - Wilson, Abby AU - Miller, Elizabeth AU - Chugani, D. Carla PY - 2021/4/12 TI - Generating Intervention Concepts for Reducing Adolescent Relationship Abuse Inequities Among Sexual and Gender Minority Youth: Protocol for a Web-Based, Longitudinal, Human-Centered Design Study JO - JMIR Res Protoc SP - e26554 VL - 10 IS - 4 KW - sexual and gender minorities KW - adolescent KW - psychosocial intervention KW - internet-based intervention KW - intimate partner violence N2 - Background: Sexual and gender minority youth (SGMY; eg, lesbian, gay, bisexual, and transgender youth) are at greater risk than their cisgender heterosexual peers for adolescent relationship abuse (ARA; physical, sexual, or psychological abuse in a romantic relationship). However, there is a dearth of efficacious interventions for reducing ARA among SGMY. To address this intervention gap, we designed a novel web-based methodology leveraging the field of human-centered design to generate multiple ARA intervention concepts with SGMY. Objective: This paper aims to describe study procedures for a pilot study to rigorously test the feasibility, acceptability, and appropriateness of using web-based human-centered design methods with SGMY to create novel, stakeholder-driven ARA intervention concepts. Methods: We are conducting a longitudinal, web-based human-centered design study with 45-60 SGMY (aged between 14 and 18 years) recruited via social media from across the United States. Using MURAL (a collaborative, visual web-based workspace) and Zoom (a videoconferencing platform), the SGMY will participate in four group-based sessions (1.5 hours each). In session 1, the SGMY will use rose-thorn-bud to individually document their ideas about healthy and unhealthy relationship characteristics and then use affinity clustering as a group to categorize their self-reported ideas based on similarities and differences. In session 2, the SGMY will use rose-thorn-bud to individually critique a universal evidence-based intervention to reduce ARA and affinity clustering to aggregate their ideas as a group. In session 3, the SGMY will use a creative matrix to generate intervention ideas for reducing ARA among them and force-rank the intervention ideas based on their potential ease of implementation and potential impact using an importance-difficulty matrix. In session 4, the SGMY will generate and refine intervention concepts (from session 3 ideations) to reduce ARA using round robin (for rapid iteration) and concept poster (for fleshing out ideas more fully). We will use content analyses to document the intervention concepts. In a follow-up survey, the SGMY will complete validated measures about the feasibility, acceptability, and appropriateness of the web-based human-centered design methods (a priori benchmarks for success: means >3.75 on each 5-point scale). Results: This study was funded in February 2020. Data collection began in August 2020 and will be completed by April 2021. Conclusions: Through rigorous testing of the feasibility of our web-based human-centered design methodology, our study may help demonstrate the use of human-centered design methods to engage harder-to-reach stakeholders and actively involve them in the co-creation of relevant interventions. Successful completion of this project also has the potential to catalyze intervention research to address ARA inequities for SGMY. Finally, our approach may be transferable to other populations and health topics, thereby advancing prevention science and health equity. International Registered Report Identifier (IRRID): DERR1-10.2196/26554 UR - https://www.researchprotocols.org/2021/4/e26554 UR - http://dx.doi.org/10.2196/26554 UR - http://www.ncbi.nlm.nih.gov/pubmed/33843601 ID - info:doi/10.2196/26554 ER - TY - JOUR AU - Calvano, David Joshua AU - Fundingsland Jr, Lauritz Edwin AU - Lai, Deborah AU - Silacci, Sara AU - Raja, S. Ali AU - He, Shuhan PY - 2021/3/29 TI - Applying Website Rankings to Digital Health Centers in the United States to Assess Public Engagement: Website Usability Study JO - JMIR Hum Factors SP - e20721 VL - 8 IS - 1 KW - website usability KW - digital health KW - health care website KW - usability testing KW - web interventions KW - digital health care KW - web crawler N2 - Background: As the public increasingly uses the internet to search for resources and information regarding health and medicine, it is important that health care organizations provide adequate web resources. Website usability refers to the ease of user experience on a website. In this study, we conducted usability analyses on digital health center websites. Objective: The primary aims of this study were to (1) replicate a preexisting usability scoring methodology for digital health centers; (2) apply and test this replicated usability scoring methodology on a sample set of digital health center websites; and (3) derive recommendations from the results on potential areas of improvements for our sample of digital health center websites. Methods: Website usability testing was conducted from March 1, 2020, to March 15, 2020. We replicated a methodology and scoring system from previous literature and applied them to digital health center websites. Our sample included 67 digital health centers that were affiliated with US universities or hospital systems. Usability was split into the following four broad categories: accessibility, marketing, content quality, and technology. Usability tools were used to score websites in each of the four categories. The composite of the key factors of each category was used to generate a general usability and overall usability score for each website. Results: The category with the highest average score (6.3) was content quality. The content quality score also had the highest SD (2.18) and an SE of 0.27. The lowest performing category was technology, which had an average score of 0.9. The technology score also had the smallest SD (0.07) and an SE of 0.01. Conclusions: Our data suggest that content quality, on average, was the highest scoring variable among digital health center websites. As content is crucial to digital health knowledge, it is justified that digital health centers invest more resources into creating quality content. The overall lowest scoring variable was technology. Potential reasons for this finding include designated funding for servers, a lack of regulatory frameworks for social media presence and liability, and infrequent website audits. An easy approach for improving this variable is increasing website speed. Accessibility is another area that organizations can potentially improve. We recommend that these organizations perform periodic audits of their web presence with usability tools. UR - https://humanfactors.jmir.org/2021/1/e20721 UR - http://dx.doi.org/10.2196/20721 UR - http://www.ncbi.nlm.nih.gov/pubmed/33779564 ID - info:doi/10.2196/20721 ER - TY - JOUR AU - Rotondi, J. Armando AU - Grady, Jonathan AU - Hanusa, H. Barbara AU - Haas, L. Gretchen AU - Spring, R. Michael AU - Abebe, Z. Kaleab AU - Luther, James AU - Gurklis, John PY - 2021/3/24 TI - Key Variables for Effective eHealth Designs for Individuals With and Without Mental Health Disorders: 2^12-4 Fractional Factorial Experiment JO - J Med Internet Res SP - e23137 VL - 23 IS - 3 KW - schizophrenia KW - severe mental illness KW - eHealth KW - eHealth design KW - website KW - usability KW - website design KW - website usability KW - fractional factorial design N2 - Background: eHealth applications not only offer the potential to increase service convenience and responsiveness but also expand the ability to tailor services to improve relevance, engagement, and use. To achieve these goals, it is critical that the designs are intuitive. Limited research exists on designs that work for those with a severe mental illness (SMI), many of whom have difficulty traveling for treatments, reject or infrequently seek treatment, and tend to discontinue treatments for significant periods. Objective: This study aims to evaluate the influence of 12 design variables (eg, navigational depth, reading level, and use of navigational lists) on the usability of eHealth application websites for those with and without SMI. Methods: A 212-4 fractional factorial experiment was used to specify the designs of 256 eHealth websites. This approach systematically varied the 12 design variables. The final destination contents of all websites were identical, and only the designs of the navigational pages varied. The 12 design elements were manipulated systematically to allow the assessment of combinations of design elements rather than only one element at a time. Of the 256 websites, participants (n=222) sought the same information on 8 randomly selected websites. Mixed effect regressions, which accounted for the dependency of the 8 observations within participants, were used to test for main effects and interactions on the ability and time to find information. Classification and regression tree analyses were used to identify effects among the 12 variables on participants? abilities to locate information, for the sample overall and each of the 3 diagnostic groups of participants (schizophrenia spectrum disorder [SSD], other mental illnesses, and no mental illness). Results: The best and worst designs were identified for each of these 4 groups. The depth of a website?s navigation, that is, the number of screens users needed to navigate to find the desired content, had the greatest influence on usability (ability to find information) and efficiency (time to find information). The worst performing designs for those with SSD had a 9% success rate, and the best had a 51% success rate: the navigational designs made a 42% difference in usability. For the group with other mental illnesses, the design made a 50% difference, and for those with no mental illness, a 55% difference was observed. The designs with the highest usability had several key design similarities, as did those with the poorest usability. Conclusions: It is possible to identify evidence-based strategies for designing eHealth applications that result in significantly better performance. These improvements in design benefit all users. For those with SSD or other SMIs, there are designs that are highly effective. Both the best and worst designs have key similarities but vary in some characteristics. UR - https://www.jmir.org/2021/3/e23137 UR - http://dx.doi.org/10.2196/23137 UR - http://www.ncbi.nlm.nih.gov/pubmed/33759796 ID - info:doi/10.2196/23137 ER - TY - JOUR AU - Yeong, Lee Jian AU - Thomas, Peter AU - Buller, James AU - Moosajee, Mariya PY - 2021/1/20 TI - A Newly Developed Web-Based Resource on Genetic Eye Disorders for Users With Visual Impairment (Gene.Vision): Usability Study JO - J Med Internet Res SP - e19151 VL - 23 IS - 1 KW - internet access KW - blindness KW - eye disease KW - genetic diseases KW - usability testing KW - qualitative research KW - internet-based intervention KW - consumer health information KW - mobile phone N2 - Background: Despite the introduction of the Web Content Accessibility Guidelines and legislations, many websites remain poorly accessible to users with disability, especially those with visual impairment, as the internet has become a more visually complex environment. With increasing reliance on the internet and almost 2 million people in the United Kingdom being affected by vision loss, it is important that they are not overlooked when developing web-based materials. A significant proportion of those affected have irreversible vision loss due to rare genetic eye disorders, and many of them use the internet as a primary source of information for their conditions. However, access to high-quality web-based health information with an inclusive design remains a challenge for many. We have developed a new web-based resource for genetic eye disorders called Gene.Vision that aims to provide a holistic guide for patients, relatives, and health care professionals. Objective: Through a usability testing session of our website prototype, this study aims to identify key web-based accessibility features for internet users with vision impairment and to explore whether the contents provided in Gene.Vision are relevant and comprehensible. Methods: A face-to-face testing session with 8 participants (5 patients, 2 family members, and 1 member of the public) and 8 facilitators was conducted on a prototype website. Remote testing was performed with another patient due to COVID-19 restrictions. Home page design, navigation, content layout and quality, language, and readability were explored through direct observation and task completion using the think-aloud method. A patient focus group was organized to elicit further feedback. Qualitative data were gathered and analyzed to identify core themes through open and axial coding. Results: All participants had good computer literacy; 6 patients with visual impairment used visual aid software including iOS VoiceOver and Speak Screen, iOS Classic Invert, ZoomText 2020, Job Access With Speech, and Nonvisual Desktop Access. The features identified by the participants that will enhance accessibility and usability for users with visual impairment were a consistent website layout, a structured information hierarchy with a clear description of links, good chromatic and luminance contrast, a simple home page with predictable and easy navigation, adaptability to various assistive software, and readable and relevant content. They reported that dynamic content (such as carousels) and large empty spaces reduced accessibility. Information on research, support available, practical advice, and links to charities were incentives for repeated website visits. Conclusions: We demonstrated the importance of developing a website with a user-based approach. Through end user testing, we identified several key web-based accessibility features for people with visual impairment. Target end users should always be involved early and throughout the design process to ensure their needs are met. Many of these steps can be implemented easily and will aid in search engine optimization. UR - http://www.jmir.org/2021/1/e19151/ UR - http://dx.doi.org/10.2196/19151 UR - http://www.ncbi.nlm.nih.gov/pubmed/33470932 ID - info:doi/10.2196/19151 ER - TY - JOUR AU - Silva, G. Anabela AU - Caravau, Hilma AU - Martins, Ana AU - Almeida, Pisco Ana Margarida AU - Silva, Telmo AU - Ribeiro, Óscar AU - Santinha, Gonçalo AU - Rocha, P. Nelson PY - 2021/1/13 TI - Procedures of User-Centered Usability Assessment for Digital Solutions: Scoping Review of Reviews Reporting on Digital Solutions Relevant for Older Adults JO - JMIR Hum Factors SP - e22774 VL - 8 IS - 1 KW - mobile phone KW - user-centered design KW - aged KW - review KW - telemedicine N2 - Background: The assessment of usability is a complex process that involves several steps and procedures. It is important to standardize the evaluation and reporting of usability procedures across studies to guide researchers, facilitate comparisons across studies, and promote high-quality usability studies. The first step to standardizing is to have an overview of how usability study procedures are reported across the literature. Objective: This scoping review of reviews aims to synthesize the procedures reported for the different steps of the process of conducting a user-centered usability assessment of digital solutions relevant for older adults and to identify potential gaps in the present reporting of procedures. The secondary aim is to identify any principles or frameworks guiding this assessment in view of a standardized approach. Methods: This is a scoping review of reviews. A 5-stage scoping review methodology was used to identify and describe relevant literature published between 2009 and 2020 as follows: identify the research question, identify relevant studies, select studies for review, chart data from selected literature, and summarize and report results. The research was conducted on 5 electronic databases: PubMed, ACM Digital Library, IEEE, Scopus, and Web of Science. Reviews that met the inclusion criteria (reporting on user-centered usability evaluation procedures for any digital solution that could be relevant for older adults and were published in English) were identified, and data were extracted for further analysis regarding study evaluators, study participants, methods and techniques, tasks, and test environment. Results: A total of 3958 articles were identified. After a detailed screening, 20 reviews matched the eligibility criteria. The characteristics of the study evaluators and participants and task procedures were only briefly and differently reported. The methods and techniques used for the assessment of usability are the topics that were most commonly and comprehensively reported in the reviews, whereas the test environment was seldom and poorly characterized. Conclusions: A lack of a detailed description of several steps of the process of assessing usability and no evidence on good practices of performing it suggests that there is a need for a consensus framework on the assessment of user-centered usability evaluation. Such a consensus would inform researchers and allow standardization of procedures, which are likely to result in improved study quality and reporting, increased sensitivity of the usability assessment, and improved comparability across studies and digital solutions. Our findings also highlight the need to investigate whether different ways of assessing usability are more sensitive than others. These findings need to be considered in light of review limitations. UR - http://humanfactors.jmir.org/2021/1/e22774/ UR - http://dx.doi.org/10.2196/22774 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439128 ID - info:doi/10.2196/22774 ER - TY - JOUR AU - Ferrucci, Francesca AU - Jorio, Manuele AU - Marci, Stefano AU - Bezenchek, Antonia AU - Diella, Giulia AU - Nulli, Cinzia AU - Miranda, Ferdinando AU - Castelli-Gattinara, Guido PY - 2021/1/13 TI - A Web-Based Application for Complex Health Care Populations: User-Centered Design Approach JO - JMIR Hum Factors SP - e18587 VL - 8 IS - 1 KW - patient KW - community participation KW - eHealth KW - patient-centered care KW - user-centered design, comorbidity N2 - Background: Although eHealth technology makes it possible to improve the management of complex health care systems and follow up on chronic patients, it is not without challenges, thus requiring the development of efficient programs and graphic user interface (GUI) features. Similar information technology tools are crucial, as health care populations are going to have to endure social distancing measures in the forthcoming months and years. Objective: This study aims to provide adequate and personalized support to complex health care populations by developing a specific web-based mobile app. The app is designed around the patient and adapted to specific groups, for example, people with complex or rare diseases, autism, or disabilities (especially among children) as well as Alzheimer or senile dementia. The app?s core features include the collection, labeling, analysis, and sorting of clinical data. Furthermore, it authorizes a network of people around the patient to securely access the data contained in his or her electronic health record. Methods: The application was designed according to the paradigms of patient-centered care and user-centered design (UCD). It considers the patient as the main empowered and motivating factor in the management of his or her well-being. Implementation was informed through a family needs and technology perception assessment. We used 3 interdisciplinary focus groups and 2 assessment surveys to study the contexts of app use, subpopulation management, and preferred functions. Finally, we developed an observational study involving 116 enrolled patients and 253 system users, followed by 2 feedback surveys to evaluate the performance and impact of the app. Results: In the validated general GUI, we developed 10 user profiles with different privacy settings. We tested 81 functions and studied a modular structure based on disease or medical area. This allowed us to identify replicable methods to be applied to module design. The observational study not only showed good family and community engagement but also revealed some limitations that need to be addressed. In total, 42 of 51 (82%) patients described themselves as satisfied or very satisfied. Health care providers reported facilitated communication with colleagues and the need to support data quality. Conclusions: The experimented solution addressed some of the health system challenges mentioned by the World Health Organization: usability appears to be significantly improved when the GUI is designed according to patients? UCD mental models and when new media and medical literacy are promoted. This makes it possible to maximize the impact of eHealth products, thereby overcoming some crucial gaps reported in the literature. Two main features seemed to have potential benefit compared with other eHealth products: the modeling, within the app, of both the formal and informal health care support networks and the modular structure allowing for comorbidity management, both of which require further implementation. UR - http://humanfactors.jmir.org/2021/1/e18587/ UR - http://dx.doi.org/10.2196/18587 UR - http://www.ncbi.nlm.nih.gov/pubmed/33439146 ID - info:doi/10.2196/18587 ER - TY - JOUR AU - Levinson, J. Anthony AU - Bousfield, John AU - Douglas, William AU - Ayers, Stephanie AU - Sztramko, Richard PY - 2020/12/4 TI - A Novel Educational Prescription Web-Based Application to Support Education for Caregivers of People Living With Dementia: Development and Usability Study With Clinicians JO - JMIR Hum Factors SP - e23904 VL - 7 IS - 4 KW - dementia KW - caregiver KW - education prescription KW - online education KW - internet KW - eHealth KW - knowledge translation KW - implementation science KW - scale and spread N2 - Background: It is estimated that 564,000 Canadians are currently living with dementia and there are approximately 486,000 to 1.1 million informal family/friend caregivers. Family/friend caregivers often receive little to no education or training about dementia but are expected to provide ongoing support for a complex condition. Web-based family/friend caregiver interventions may be helpful, but little is known about how best to implement them. Objective: The objectives of this study were to 1) design and develop a novel education prescription application to help scale and spread web-based dementia education to family/friend caregivers, 2) conduct user testing, and 3) conduct a larger-scale field trial. Methods: A novel education prescription web-based application was designed and developed. Initial user testing used task completion and the ?think aloud? technique with a small sample of representative clinicians who work with people living with dementia and family/friend caregivers. Following iterative incorporation of feedback, a larger field trial was conducted with a convenience sample of clinicians. Account invitations were sent to 55 clinicians and, following a 2-month trial period, surveys were administered to participants including the System Usability Scale and the Net Promoter Score. Results: During the initial user testing phase, participants (N=7) from representative disciplines easily completed associated tasks, and had very positive feedback with respect to the usability of the application. The System Usability Scale score during this phase was 91.4. Suggestions from feedback were incorporated into the application. During the larger field trial phase, participants (total N=55; activated account n=17; did not activate account n=38) were given access to the iGeriCare education prescription application. During this period, 2 participants created educational prescriptions; a total of 3 educational prescriptions were sent. Survey completers who did not activate their account (n=5) identified that their lack of use was due to time constraints, competing priorities, or forgetting to use the application. Survey completers who activated their account (n=5) identified their lower use was due to lack of time, lack of eligible family/friend caregivers during trial period, and competing priorities due to the COVID-19 pandemic. The System Usability Scale score during this phase was 78.75, and the Net Promoter Score was 50. Conclusions: Study findings indicate a generally positive response for the usability of a web-based application for clinicians to prescribe dementia education to family/friend caregivers. The dissonance between the promising data and widespread enthusiasm for the design and purpose of the education prescription application found in the initial user testing phase and subsequent lack of significant adoption in the field trial represents both an important lesson for other novel health technologies and a potential area for further investigation. Further research is required to better understand factors associated with implementation of this type of intervention and impact on dissemination of education to family/friend caregivers. UR - http://humanfactors.jmir.org/2020/4/e23904/ UR - http://dx.doi.org/10.2196/23904 UR - http://www.ncbi.nlm.nih.gov/pubmed/33275103 ID - info:doi/10.2196/23904 ER - TY - JOUR AU - Michel, Toni AU - Tachtler, Franziska AU - Slovak, Petr AU - Fitzpatrick, Geraldine PY - 2020/11/9 TI - Young People?s Attitude Toward Positive Psychology Interventions: Thematic Analysis JO - JMIR Hum Factors SP - e21145 VL - 7 IS - 4 KW - adolescent KW - mental health KW - health resources N2 - Background: Digital instantiations of positive psychology intervention (PPI) principles have been proposed to combat the current global youth mental health crisis; however, young people are largely not engaging with available resources. Objective: The aim of this study is to explore young people?s attitudes toward various PPI principles to find ways of making digital instantiations of them more engaging. Methods: We conducted an explorative workshop with 30 young people (aged 16-21 years). They rated and reviewed 29 common PPIs. Ratings and recorded discussions were analyzed using thematic analysis. Results: Some interventions were conflicting with young people?s values or perceived as too difficult. Participants responded positively to interventions that fit them personally and allowed them to use their strengths. Conclusions: Values, context, strengths, and other personal factors are entangled with young people?s attitudes toward digital instantiations of PPI principles. UR - http://humanfactors.jmir.org/2020/4/e21145/ UR - http://dx.doi.org/10.2196/21145 UR - http://www.ncbi.nlm.nih.gov/pubmed/33164908 ID - info:doi/10.2196/21145 ER - TY - JOUR AU - Lattie, G. Emily AU - Bass, Michael AU - Garcia, F. Sofia AU - Phillips, M. Siobhan AU - Moreno, I. Patricia AU - Flores, Marie Ann AU - Smith, JD AU - Scholtens, Denise AU - Barnard, Cynthia AU - Penedo, J. Frank AU - Cella, David AU - Yanez, Betina PY - 2020/9/21 TI - Optimizing Health Information Technologies for Symptom Management in Cancer Patients and Survivors: Usability Evaluation JO - JMIR Form Res SP - e18412 VL - 4 IS - 9 KW - cancer survivorship KW - eHealth KW - patient-reported outcomes KW - digital health KW - symptom management KW - supportive care N2 - Background: Unmanaged cancer symptoms and treatment-related side effects can compromise long-term clinical outcomes and health-related quality of life. Health information technologies such as web-based platforms offer the possibility to supplement existing care and optimize symptom management. Objective: This paper describes the development and usability of a web-based symptom management platform for cancer patients and survivors that will be implemented within a large health system. Methods: A web-based symptom management platform was designed and evaluated via one-on-one usability testing sessions. The System Usability Scale (SUS), After Scenario Questionnaire (ASQ), and qualitative analysis of semistructured interviews were used to assess program usability. Results: Ten cancer survivors and five cancer center staff members participated in usability testing sessions. The mean score on the SUS was 86.6 (SD 14.0), indicating above average usability. The mean score on the ASQ was 2.5 (SD 2.1), indicating relatively high satisfaction with the usability of the program. Qualitative analyses identified valued features of the program and recommendations for further improvements. Conclusions: Cancer survivors and oncology care providers reported high levels of acceptability and usability in the initial development of a web-based symptom management platform for cancer survivors. Future work will test the effectiveness of this web-based platform. UR - http://formative.jmir.org/2020/9/e18412/ UR - http://dx.doi.org/10.2196/18412 UR - http://www.ncbi.nlm.nih.gov/pubmed/32955450 ID - info:doi/10.2196/18412 ER - TY - JOUR AU - Reen, Kaur Gurpreet AU - Muirhead, Linden AU - Langdon, Wendy Dawn PY - 2019/04/23 TI - Usability of Health Information Websites Designed for Adolescents: Systematic Review, Neurodevelopmental Model, and Design Brief JO - J Med Internet Res SP - e11584 VL - 21 IS - 4 KW - adolescents KW - health communication KW - internet KW - information seeking behavior KW - usability KW - systematic review N2 - Background: Adolescence is a unique developmental period characterized by biological, social, and cognitive changes, as well as an interest in managing one?s own health care. Many adolescents use the internet to seek health care information. However, young people face barriers before they can understand and apply the health information that they access on the web. It is essential that usability of adolescent health websites on the internet is improved to help adolescents overcome these barriers and allow them to engage successfully with web-based health care content. Objective: The aim of this review was to synthesize the usability of specific health information websites. These findings were mapped onto the adolescent neurodevelopmental profile, and a design brief based on the findings was developed to tailor future websites for specific adolescent requirements. Methods: A systematic search conducted using PubMed, PsycINFO, and Education Resources Information Center (ERIC) identified 25 studies that assessed the usability of health information websites. Adolescent feedback was collected by a mixture of surveys, focus groups, interviews, and think-aloud procedures. Results: A majority of the information websites were developed for specific health issues that may be relevant to adolescents. The most preferred website features were interactive content such as games and quizzes, as well as videos, images, audio clips, and animations. Participants also preferred communicating with other adolescents with similar conditions or learning about their experience through real stories and testimonials. Adolescents found it difficult to use health information websites if they contained too much text, were too cluttered, or had features that made it difficult to access. The findings are considered in the context of adolescent social processes, low tolerance of delayed gratification, and attraction to novelty and mapped onto a neurodevelopmental model of adolescence. Conclusions: Young people?s feedback can determine usability and content that make a health information website easy or informative to use. Neurodevelopmental profiles and the users? specific preferences and skills should be addressed in future development of health information websites for adolescents. UR - http://www.jmir.org/2019/4/e11584/ UR - http://dx.doi.org/10.2196/11584 UR - http://www.ncbi.nlm.nih.gov/pubmed/31012856 ID - info:doi/10.2196/11584 ER - TY - JOUR AU - Radomski, D. Ashley AU - Wozney, Lori AU - McGrath, Patrick AU - Huguet, Anna AU - Hartling, Lisa AU - Dyson, P. Michele AU - Bennett, Kathryn AU - Newton, S. Amanda PY - 2019/02/05 TI - Design and Delivery Features That May Improve the Use of Internet-Based Cognitive Behavioral Therapy for Children and Adolescents With Anxiety: A Realist Literature Synthesis With a Persuasive Systems Design Perspective JO - J Med Internet Res SP - e11128 VL - 21 IS - 2 KW - internet KW - cognitive behavioral therapy KW - computer-assisted therapy KW - persuasive communication KW - anxiety KW - children KW - adolescents KW - review KW - adherence N2 - Background: Internet-based cognitive behavioral therapy (iCBT) is a persuasive system as its design combines therapeutic content, technological features, and interactions between the user and the program to reduce anxiety for children and adolescents. How iCBT is designed and delivered differs across programs. Although iCBT is considered an effective approach for treating child and adolescent anxiety, rates of program use (eg, module completion) are highly variable for reasons that are not clear. As the extent to which users complete a program can impact anxiety outcomes, understanding what iCBT design and delivery features improve program use is critical for optimizing treatment effects. Objective: The objectives of this study were to use a realist synthesis approach to explore the design and delivery features of iCBT for children and adolescents with anxiety as described in the literature and to examine their relationship to program use outcomes. Methods: A search of published and gray literature was conducted up to November 2017. Prespecified inclusion criteria identified research studies, study protocols, and program websites on iCBT for child and adolescent anxiety. Literature was critically appraised for relevance and methodological rigor. The persuasive systems design (PSD) model, a comprehensive framework for designing and evaluating persuasive systems, was used to guide data extraction. iCBT program features were grouped under 4 PSD categories?Primary task support, Dialogue support, System credibility support, and Social support. iCBT design (PSD Mechanisms) and delivery features (Context of use) were linked to program use (Outcomes) using meta-ethnographic methods; these relationships were described as Context-Mechanism-Outcome configurations. For our configurations, we identified key PSD features and delivery contexts that generated moderate-to-high program use based on moderate-to-high quality evidence found across multiple iCBT programs. Results: A total of 44 documents detailing 10 iCBT programs were included. Seven iCBT programs had at least one document that scored high for relevance; most studies were of moderate-to-high methodological rigor. We developed 5 configurations that highlighted 8 PSD features (Tailoring, Personalization [Primary task supports]; Rewards, Reminders, Social role [Dialogue supports]; and Trustworthiness, Expertise, Authority [System credibility supports]) associated with moderate-to-high program use. Important features of delivery Context were adjunct support (a face-to-face, Web- or email-based communications component) and whether programs targeted the prevention or treatment of anxiety. Incorporating multiple PSD features may have additive or synergistic effects on program use. Conclusions: The Context-Mechanism-Outcome configurations we developed suggest that, when delivered with adjunct support, certain PSD features contribute to moderate-to-high use of iCBT prevention and treatment programs for children and adolescents with anxiety. Standardization of the definition and measurement of program use, formal testing of individual and combined PSD features, and use of real-world design and testing methods are important next steps to improving how we develop and deliver increasingly useful treatments to target users. UR - https://www.jmir.org/2019/2/e11128/ UR - http://dx.doi.org/10.2196/11128 UR - http://www.ncbi.nlm.nih.gov/pubmed/30720436 ID - info:doi/10.2196/11128 ER - TY - JOUR AU - Eggeling, Marie AU - Bientzle, Martina AU - Shiozawa, Thomas AU - Cress, Ulrike AU - Kimmerle, Joachim PY - 2018/11/22 TI - The Impact of Visualization Format and Navigational Options on Laypeople?s Perception and Preference of Surgery Information Videos: Randomized Controlled Trial and Online Survey JO - J Participat Med SP - e12338 VL - 10 IS - 4 KW - attitude KW - decision aids KW - emotions KW - informed decision making KW - knowledge acquisition KW - medical decision making KW - surgery KW - video N2 - Background: Patients need to be educated about possible treatment choices in order to make informed medical decisions. As most patients are medical laypeople, they find it difficult to understand complex medical information sufficiently to feel confident about a decision. Multimedia interventions such as videos are increasingly used to supplement personal consultations with medical professionals. Former research has shown that such interventions may have a positive effect on understanding, decision making, and emotional reactions. However, it is thus far unclear how different features of videos influence these outcomes. Objective: We aimed to examine the impact of visualization formats and basic navigational options in medical information videos about cruciate ligament surgery on recipients? knowledge gain, emotions, attitude, and hypothetical decision-making ability. Methods: In a between-group randomized experiment (Study 1), 151 participants watched 1 of 4 videos (schematic vs realistic visualization; available vs unavailable navigational options). In a separate online survey (Study 2), 110 participants indicated their preference for a video design. All participants were medical laypeople without personal experience with a cruciate ligament rupture and were presented with a fictional decision situation. Results: In Study 1, participants who used navigational options (n=36) gained significantly more factual knowledge (P=.005) and procedural knowledge (P<.001) than participants who did not have or use navigational options (n=115). A realistic visualization induced more fear (P=.001) and disgust (P<.001) than a schematic video. Attitude toward the surgery (P=.02) and certainty regarding the decision for or against surgery (P<.001) were significantly more positive after watching the video than before watching the video. Participants who watched a schematic video rated the video significantly higher than that by participants who watched a realistic video (P<.001). There were no significant group differences with regard to hypothetical decision making and attitude toward the intervention. In addition, we did not identify any influence of the visualization format on knowledge acquisition. In Study 2, 58 of 110 participants (52.7%) indicated that they would prefer a schematic visualization, 26 (23.6%) preferred a realistic visualization, 17 (15.5%) wanted either visualization, and 9 (8.2%) did not want to watch a video at all. Of the participants who wanted to watch a video, 91 (90.1%) preferred to have navigational options, 3 (3.0%) preferred not to have navigational options, and 7 (6.9%) did not mind the options. Conclusion: Our study indicates that the perception of medical information videos is influenced by their design. Schematic videos with navigational options are the most helpful among all videos to avoid negative emotions and support knowledge acquisition when informing patients about an intervention. The visualization format and navigational options are important features that should be considered when designing medical videos for patient education. Trial Registration: Deutsches Register Klinischer Studien DRKS00016003; https://www.drks.de/drks_web/ navigate.do?navigationId= trial.HTML&TRIAL_ID=DRKS00016003 (Archived by WebCite at http://www.webcitation.org/746ASSAhN) UR - http://jopm.jmir.org/2018/4/e12338/ UR - http://dx.doi.org/10.2196/12338 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/12338 ER - TY - JOUR AU - Tistad, Malin AU - Lundell, Sara AU - Wiklund, Maria AU - Nyberg, André AU - Holmner, Åsa AU - Wadell, Karin PY - 2018/10/26 TI - Usefulness and Relevance of an eHealth Tool in Supporting the Self-Management of Chronic Obstructive Pulmonary Disease: Explorative Qualitative Study of a Cocreative Process JO - JMIR Hum Factors SP - e10801 VL - 5 IS - 4 KW - COPD KW - eHealth KW - cocreation KW - self-management KW - primary care, chronic disease N2 - Background: New strategies are urgently needed to support self-management for people with chronic obstructive pulmonary disease (COPD) in primary care. The use of electronic health (eHealth) solutions is promising. However, there is a lack of knowledge about how such eHealth tools should be designed in order to be perceived as relevant and useful and meet the needs and expectations of the health professionals as well as people with COPD and their relatives. Objective: The objective of this study was to explore the aspects of an eHealth tool design and content that make it relevant and useful for supporting COPD-related self-management strategies from the perspective of health care professionals, people with COPD and their relatives, and external researchers. Methods: Data were collected during the development of an eHealth tool. A cocreation process was carried out with participants from two primary care units in northern Sweden and external researchers. Individual interviews were performed with health care professionals (n=13) as well as people with COPD (n=6) and their relatives (n=2), and focus group discussions (n=9) were held with all groups of participants. Data were analyzed using qualitative content analysis. Results: The overarching theme, reinforcing existing support structures, reflects participant views that the eHealth tool needs to be directly applicable and create a sense of commitment in users. Moreover, participants felt that the tool needs to fit with existing routines and contexts and preferably should not challenge existing hierarchies between health care professionals and people with COPD. Important content for health care professionals and people with COPD included knowledge about self-management strategies. Videos were regarded as the most effective method for communicating such knowledge. Conclusions: The cocreation in the development process enables participant perspectives and priorities to be built into the eHealth tool. This is assumed to contribute to a tool that is useful and relevant and, therefore, adopted into clinical practice and everyday life. Findings from this study can inform the development of eHealth tools for people with COPD in other contexts, as well as the development of eHealth tools for self-management support of other chronic diseases. UR - http://humanfactors.jmir.org/2018/4/e10801/ UR - http://dx.doi.org/10.2196/10801 UR - http://www.ncbi.nlm.nih.gov/pubmed/30368440 ID - info:doi/10.2196/10801 ER - TY - JOUR AU - Bromley, Sally AU - Drew, Michael AU - Talpey, Scott AU - McIntosh, Andrew AU - Finch, Caroline PY - 2018/10/09 TI - Collecting Health and Exposure Data in Australian Olympic Combat Sports: Feasibility Study Utilizing an Electronic System JO - JMIR Hum Factors SP - e27 VL - 5 IS - 4 KW - online KW - health KW - injury & prevention KW - athletic performance KW - internet KW - mobile phone N2 - Background: Electronic methods are increasingly being used to manage health-related data among sporting populations. Collection of such data permits the analysis of injury and illness trends, improves early detection of injuries and illnesses, collectively referred to as health problems, and provides evidence to inform prevention strategies. The Athlete Management System (AMS) has been employed across a range of sports to monitor health. Australian combat athletes train across the country without dedicated national medical or sports science teams to monitor and advocate for their health. Employing a Web-based system, such as the AMS, may provide an avenue to increase the visibility of health problems experienced by combat athletes and deliver key information to stakeholders detailing where prevention programs may be targeted. Objective: The objectives of this paper are to (1) report on the feasibility of utilizing the AMS to collect longitudinal injury and illness data of combat sports athletes and (2) describe the type, location, severity, and recurrence of injuries and illnesses that the cohort of athletes experience across a 12-week period. Methods: We invited 26 elite and developing athletes from 4 Olympic combat sports (boxing, judo, taekwondo, and wrestling) to participate in this study. Engagement with the AMS was measured, and collected health problems (injuries or illnesses) were coded using the Orchard Sports Injury Classification System (version 10.1) and International Classification of Primary Care (version 2). Results: Despite >160 contacts, athlete engagement with online tools was poor, with only 13% compliance across the 12-week period. No taekwondo or wrestling athletes were compliant. Despite low overall engagement, a large number of injuries or illness were recorded across 11 athletes who entered data?22 unique injuries, 8 unique illnesses, 30 recurrent injuries, and 2 recurrent illnesses. The most frequent injuries were to the knee in boxing (n=41) and thigh in judo (n=9). In this cohort, judo players experienced more severe, but less frequent, injuries than boxers, yet judo players sustained more illnesses than boxers. In 97.0% (126/130) of cases, athletes in this cohort continued to train irrespective of their health problems. Conclusions: Among athletes who reported injuries, many reported multiple conditions, indicating a need for health monitoring in Australian combat sports. A number of factors may have influenced engagement with the AMS, including access to the internet, the design of the system, coach views on the system, previous experiences with the system, and the existing culture within Australian combat sports. To increase engagement, there may be a requirement for sports staff to provide relevant feedback on data entered into the system. Until the barriers are addressed, it is not feasible to implement the system in its current form across a larger cohort of combat athletes. UR - http://humanfactors.jmir.org/2018/4/e27/ UR - http://dx.doi.org/10.2196/humanfactors.9541 UR - http://www.ncbi.nlm.nih.gov/pubmed/30305257 ID - info:doi/10.2196/humanfactors.9541 ER - TY - JOUR AU - Schoen, W. Martin AU - Basch, Ethan AU - Hudson, L. Lori AU - Chung, E. Arlene AU - Mendoza, R. Tito AU - Mitchell, A. Sandra AU - St. Germain, Diane AU - Baumgartner, Paul AU - Sit, Laura AU - Rogak, J. Lauren AU - Shouery, Marwan AU - Shalley, Eve AU - Reeve, B. Bryce AU - Fawzy, R. Maria AU - Bhavsar, A. Nrupen AU - Cleeland, Charles AU - Schrag, Deborah AU - Dueck, C. Amylou AU - Abernethy, P. Amy PY - 2018/07/16 TI - Software for Administering the National Cancer Institute?s Patient-Reported Outcomes Version of the Common Terminology Criteria for Adverse Events: Usability Study JO - JMIR Hum Factors SP - e10070 VL - 5 IS - 3 KW - usability KW - patient-reported outcomes KW - symptoms KW - adverse events KW - PRO-CTCAE KW - cancer clinical trials N2 - Background: The US National Cancer Institute (NCI) developed software to gather symptomatic adverse events directly from patients participating in clinical trials. The software administers surveys to patients using items from the Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE) through Web-based or automated telephone interfaces and facilitates the management of survey administration and the resultant data by professionals (clinicians and research associates). Objective: The purpose of this study was to iteratively evaluate and improve the usability of the PRO-CTCAE software. Methods: Heuristic evaluation of the software functionality was followed by semiscripted, think-aloud protocols in two consecutive rounds of usability testing among patients with cancer, clinicians, and research associates at 3 cancer centers. We conducted testing with patients both in clinics and at home (remotely) for both Web-based and telephone interfaces. Furthermore, we refined the software between rounds and retested. Results: Heuristic evaluation identified deviations from the best practices across 10 standardized categories, which informed initial software improvement. Subsequently, we conducted user-based testing among 169 patients and 47 professionals. Software modifications between rounds addressed identified issues, including difficulty using radio buttons, absence of survey progress indicators, and login problems (for patients) as well as scheduling of patient surveys (for professionals). The initial System Usability Scale (SUS) score for the patient Web-based interface was 86 and 82 (P=.22) before and after modifications, respectively, whereas the task completion score was 4.47, which improved to 4.58 (P=.39) after modifications. Following modifications for professional users, the SUS scores improved from 71 to 75 (P=.47), and the mean task performance improved significantly (4.40 vs 4.02; P=.001). Conclusions: Software modifications, informed by rigorous assessment, rendered a usable system, which is currently used in multiple NCI-sponsored multicenter cancer clinical trials. Trial Registration: ClinicalTrials.gov NCT01031641; https://clinicaltrials.gov/ct2/show/NCT01031641 (Archived by WebCite at http://www.webcitation.org/708hTjlTl) UR - http://humanfactors.jmir.org/2018/3/e10070/ UR - http://dx.doi.org/10.2196/10070 UR - http://www.ncbi.nlm.nih.gov/pubmed/30012546 ID - info:doi/10.2196/10070 ER - TY - JOUR AU - Shepherd, Matthew AU - Merry, Sally AU - Lambie, Ian AU - Thompson, Andrew PY - 2018/07/05 TI - Indigenous Adolescents? Perception of an eMental Health Program (SPARX): Exploratory Qualitative Assessment JO - JMIR Serious Games SP - e13 VL - 6 IS - 3 KW - M?ori youth KW - indigenous KW - depression KW - computerized CBT KW - consumer views KW - serious games KW - virtual worlds N2 - Background: Depression is a major health issue for indigenous adolescents, yet there is little research conducted about the efficacy and development of psychological interventions for these populations. In New Zealand there is little known about taitamariki (M?ori adolescent) opinions regarding the development and effectiveness of psychological interventions, let alone computerized cognitive behavioral therapy. SPARX (Smart, Positive, Active, Realistic, X-factor thoughts) is a computerized intervention developed in New Zealand to treat mild-to-moderate depression in young people. Users are engaged in a virtual 3D environment where they must complete missions to progress to the next level. In each level there are challenges and puzzles to completeIt was designed to appeal to all young people in New Zealand and incorporates several images and concepts that are specifically M?ori. Objective: The aim was to conduct an exploratory qualitative study of M?ori adolescents? opinions about the SPARX program. This is a follow-up to an earlier study where taitamariki opinions were gathered to inform the design of a computerized cognitive behavior therapy program. Methods: Taitamariki were interviewed using a semistructured interview once they had completed work with the SPARX resource. Six participants agreed to complete the interview; the interviews ranged from 10 to 30 minutes. Results: Taitamariki participating in the interviews found SPARX to be helpful. The M?ori designs from the SPARX game were appropriate and useful, and the ability to customize the SPARX characters with M?ori designs was beneficial and appeared to enhance cultural identity. These helped young people to feel engaged with SPARX which, in turn, assisted with the acquisition of relaxation and cognitive restructuring skills. Overall, using SPARX led to improved mood and increased levels of hope for the participants. In some instances, SPARX was used by wider wh?nau (M?ori word for family) members with reported beneficial effect. Conclusions: Overall, this small group of M?ori adolescents reported that cultural designs made it easier for them to engage with SPARX, which, in turn, led to an improvement in their mood and gave them hope. Further research is needed about how SPARX could be best used to support the families of these young people. UR - http://games.jmir.org/2018/3/e13/ UR - http://dx.doi.org/10.2196/games.8752 UR - http://www.ncbi.nlm.nih.gov/pubmed/29980495 ID - info:doi/10.2196/games.8752 ER - TY - JOUR AU - Nieroda, Ewa Marzena AU - Lophatananon, Artitaya AU - McMillan, Brian AU - Chen, Li-Chia AU - Hughes, John AU - Daniels, Rona AU - Clark, James AU - Rogers, Simon AU - Muir, Ross Kenneth PY - 2018/07/04 TI - Online Decision Support Tool for Personalized Cancer Symptom Checking in the Community (REACT): Acceptability, Feasibility, and Usability Study JO - JMIR Cancer SP - e10073 VL - 4 IS - 2 KW - early detection of cancer KW - cancer education KW - cancer symptoms KW - cancer risk KW - personalized risk KW - website development KW - REACT N2 - Background: Improving cancer survival in the UK, despite recent significant gains, remains a huge challenge. This can be attributed to, at least in part, patient and diagnostic delays, when patients are unaware they are suffering from a cancerous symptom and therefore do not visit a general practitioner promptly and/or when general practitioners fail to investigate the symptom or refer promptly. To raise awareness of symptoms that may potentially be indicative of underlying cancer among members of the public a symptom-based risk assessment model (developed for medical practitioner use and currently only used by some UK general practitioners) was utilized to develop a risk assessment tool to be offered to the public in community settings. Such a tool could help individuals recognize a symptom, which may potentially indicate cancer, faster and reduce the time taken to visit to their general practitioner. In this paper we report results about the design and development of the REACT (Risk Estimation for Additional Cancer Testing) website, a tool to be used in a community setting allowing users to complete an online questionnaire and obtain personalized cancer symptom-based risk estimation. Objective: The objectives of this study are to evaluate (1) the acceptability of REACT among the public and health care practitioners, (2) the usability of the REACT website, (3) the presentation of personalized cancer risk on the website, and (4) potential approaches to adopt REACT into community health care services in the UK. Methods: Our research consisted of multiple stages involving members of the public (n=39) and health care practitioners (n=20) in the UK. Data were collected between June 2017 and January 2018. User views were collected by (1) the ?think-aloud? approach when participants using the website were asked to talk about their perceptions and feelings in relation to the website, and (2) self-reporting of website experiences through open-ended questionnaires. Data collection and data analysis continued simultaneously, allowing for website iterations between different points of data collection. Results: The results demonstrate the need for such a tool. Participants suggest the best way to offer REACT is through a guided approach, with a health care practitioner (eg, pharmacist or National Health Service Health Check nurse) present during the process of risk evaluation. User feedback, which was generally consistent across members of public and health care practitioners, has been used to inform the development of the website. The most important aspects were: simplicity, ability to evaluate multiple cancers, content emphasizing an inviting community ?feel,? use (when possible) of layperson language in the symptom screening questionnaire, and a robust and positive approach to cancer communication relying on visual risk representation both with affected individuals and the entire population at risk. Conclusions: This study illustrates the benefits of involving public and stakeholders in developing and implementing a simple cancer symptom check tool within community. It also offers insights and design suggestions for user-friendly interfaces of similar health care Web-based services, especially those involving personalized risk estimation. UR - http://cancer.jmir.org/2018/2/e10073/ UR - http://dx.doi.org/10.2196/10073 UR - http://www.ncbi.nlm.nih.gov/pubmed/29973334 ID - info:doi/10.2196/10073 ER - TY - JOUR AU - Himes, Park Katherine AU - Donovan, Heidi AU - Wang, Stephanie AU - Weaver, Carrie AU - Grove, Rae Jillian AU - Facco, Lucia Francesca PY - 2017/10/10 TI - Healthy Beyond Pregnancy, a Web-Based Intervention to Improve Adherence to Postpartum Care: Randomized Controlled Feasibility Trial JO - JMIR Hum Factors SP - e26 VL - 4 IS - 4 KW - postpartum visit KW - behavioral economics KW - Medicaid KW - intervention KW - usability N2 - Background: During the postpartum visit, health care providers address issues with short- and long-term implications for maternal and child health. Women with Medicaid insurance are less likely to return for a postpartum visit compared with women with private insurance. Behavioral economics acknowledges that people do not make exclusively rational choices, rather immediate gratification, cognitive and psychological biases, and social norms influence decision making. Drawing on insights from decision science, behavioral economists have examined how these biases can be modulated through carefully designed interventions. We have developed a Web-based tool, Healthy Beyond Pregnancy, that incorporates empirically derived concepts of behavioral economics to improve adherence rates to the postpartum visit. Objectives: The primary objectives of this pilot study were to (1) refine and assess the usability of Healthy Beyond Pregnancy and (2) assess the feasibility of a randomized controlled trial (RCT) of the intervention. Methods: We used a multistep process and multidisciplinary team of maternal-fetal medicine physicians, a behavioral economist, and researchers with expertise in behavioral interventions to design Healthy Beyond Pregnancy. We assessed the usability of the program with the Post-Study System Usability Questionnaire (PSSUQ), a validated 7-point scale, and semistructured interviews with postpartum women. We then conducted a feasibility trial to determine the proportion of eligible women who were willing to participate in an RCT of Healthy Beyond Pregnancy and the proportion of women willing to complete the Web-based program. Exploratory outcomes of the pilot trial included attendance at the postpartum visit, uptake of long-acting reversible contraception, and uptake of any contraception. Results: The median PSSUQ score for Healthy Beyond Pregnancy was 6.5 (interquartile range: 6.1-7) demonstrating high usability. Semistructured interviews (n=10) provided in-depth comments about users? experience and further improved the program. A total of 34 postpartum women with Medicaid insurance were approached for the pilot trial, and 30 (88%) were consented and randomized. All women randomized to Healthy Beyond Pregnancy completed the Web-based program, had text-enabled cell phones, and were willing to receive text messages from the study team. Women in the Healthy Beyond Pregnancy arm were more likely to return for a postpartum visit compared with women in the control arm with 85% of women in Healthy Beyond Pregnancy returning versus 53% in the control arm (odds ratio in the Healthy Beyond Pregnancy group: 5.3; 95% CI 0.9-32.0; P=.06). Conclusions: We have developed a highly usable and acceptable Web-based program designed to increase attendance at the postpartum visit. Our pilot trial demonstrates that women are willing and able to participate in a randomized trial of a Web-based program and text messaging system. Trial Registration: Clinicaltrials.gov NCT03296774; https://clinicaltrials.gov/ct2/show/NCT03296774 (Archived by WebCite at http://www.webcitation.org/6tpgXFzyk) UR - http://humanfactors.jmir.org/2017/4/e26/ UR - http://dx.doi.org/10.2196/humanfactors.7964 UR - http://www.ncbi.nlm.nih.gov/pubmed/29017990 ID - info:doi/10.2196/humanfactors.7964 ER - TY - JOUR AU - Cranen, Karlijn AU - Groothuis-Oudshoorn, GM Catharina AU - Vollenbroek-Hutten, MR Miriam AU - IJzerman, J. Maarten PY - 2017/01/20 TI - Toward Patient-Centered Telerehabilitation Design: Understanding Chronic Pain Patients? Preferences for Web-Based Exercise Telerehabilitation Using a Discrete Choice Experiment JO - J Med Internet Res SP - e26 VL - 19 IS - 1 KW - patient preference KW - patient acceptance of health care KW - telerehabilitation KW - choice behavior KW - decision making KW - decision support techniques KW - patient compliance KW - chronic disease KW - exercise therapy KW - chronic pain N2 - Background: Patient-centered design that addresses patients? preferences and needs is considered an important aim for improving health care systems. At present, within the field of pain rehabilitation, patients? preferences regarding telerehabilitation remain scarcely explored and little is known about the optimal combination between human and electronic contact from the patients? perspective. In addition, limited evidence is available about the best way to explore patients? preferences. Therefore, the assessment of patients? preferences regarding telemedicine is an important step toward the design of effective patient-centered care. Objective: To identify which telerehabilitation treatment options patients with chronic pain are most likely to accept as alternatives to conventional rehabilitation and assess which treatment attributes are most important to them. Methods: A discrete choice experiment with 15 choice tasks, combining 6 telerehabilitation treatment characteristics, was designed. Each choice task consisted of 2 hypothetical treatment scenarios and 1 opt-out scenario. Relative attribute importance was estimated using a bivariate probit regression analysis. One hundred and thirty surveys were received, of which 104 were usable questionnaires; thus, resulting in a total of 1547 observations. Results: Physician communication mode, the use of feedback and monitoring technology (FMT), and exercise location were key drivers of patients? treatment preferences (P<.001). Patients were willing to accept less frequent physician consultation offered mainly through video communication, provided that they were offered FMT and some face-to-face consultation and could exercise outside their home environment at flexible exercise hours. Home-based telerehabilitation scenarios with minimal physician supervision were the least preferred. A reduction in health care premiums would make these telerehabilitation scenarios as attractive as conventional clinic-based rehabilitation. Conclusions: ?Intermediate? telerehabilitation treatments offering FMT, some face-to-face consulting, and a gym-based exercise location should be pursued as promising alternatives to conventional chronic pain rehabilitation. Further research is necessary to explore whether strategies other than health care premium reductions could also increase the value of home telerehabilitation treatment. UR - http://www.jmir.org/2017/1/e26/ UR - http://dx.doi.org/10.2196/jmir.5951 UR - http://www.ncbi.nlm.nih.gov/pubmed/28108429 ID - info:doi/10.2196/jmir.5951 ER - TY - JOUR AU - Rotondi, J. Armando AU - Spring, R. Michael AU - Hanusa, H. Barbara AU - Eack, M. Shaun AU - Haas, L. Gretchen PY - 2017/01/05 TI - Designing eHealth Applications to Reduce Cognitive Effort for Persons With Severe Mental Illness: Page Complexity, Navigation Simplicity, and Comprehensibility JO - JMIR Hum Factors SP - e1 VL - 4 IS - 1 KW - Internet technology KW - mobile application KW - cognitive impairment KW - eHealth KW - eHealth design KW - e-mental health KW - schizophrenia KW - severe mental illness KW - usability KW - website design N2 - Background: eHealth technologies offer great potential for improving the use and effectiveness of treatments for those with severe mental illness (SMI), including schizophrenia and schizoaffective disorder. This potential can be muted by poor design. There is limited research on designing eHealth technologies for those with SMI, others with cognitive impairments, and those who are not technology savvy. We previously tested a design model, the Flat Explicit Design Model (FEDM), to create eHealth interventions for individuals with SMI. Subsequently, we developed the design concept page complexity, defined via the design variables we created of distinct topic areas, distinct navigation areas, and number of columns used to organize contents and the variables of text reading level, text reading ease (a newly added variable to the FEDM), and the number of hyperlinks and number of words on a page. Objective: The objective of our study was to report the influence that the 19 variables of the FEDM have on the ability of individuals with SMI to use a website, ratings of a website?s ease of use, and performance on a novel usability task we created termed as content disclosure (a measure of the influence of a homepage?s design on the understanding user?s gain of a website). Finally, we assessed the performance of 3 groups or dimensions we developed that organize the 19 variables of the FEDM, termed as page complexity, navigational simplicity, and comprehensibility. Methods: We measured 4 website usability outcomes: ability to find information, time to find information, ease of use, and a user?s ability to accurately judge a website?s contents. A total of 38 persons with SMI (chart diagnosis of schizophrenia or schizoaffective disorder) and 5 mental health websites were used to evaluate the importance of the new design concepts, as well as the other variables in the FEDM. Results: We found that 11 of the FEDM?s 19 variables were significantly associated with all 4 usability outcomes. Most other variables were significantly related to 2 or 3 of these usability outcomes. With the 5 tested websites, 7 of the 19 variables of the FEDM overlapped with other variables, resulting in 12 distinct variable groups. The 3 design dimensions had acceptable coefficient alphas. Both navigational simplicity and comprehensibility were significantly related to correctly identifying whether information was available on a website. Page complexity and navigational simplicity were significantly associated with the ability and time to find information and ease-of-use ratings. Conclusions: The 19 variables and 3 dimensions (page complexity, navigational simplicity, and comprehensibility) of the FEDM offer evidence-based design guidance intended to reduce the cognitive effort required to effectively use eHealth applications, particularly for persons with SMI, and potentially others, including those with cognitive impairments and limited skills or experience with technology. The new variables we examined (topic areas, navigational areas, columns) offer additional and very simple ways to improve simplicity. UR - http://humanfactors.jmir.org/2017/1/e1/ UR - http://dx.doi.org/10.2196/humanfactors.6221 UR - http://www.ncbi.nlm.nih.gov/pubmed/28057610 ID - info:doi/10.2196/humanfactors.6221 ER -