JMIR Publications

Journal of Medical Internet Research

The leading peer-reviewed journal for health and healthcare in the Internet age.

JMIR's Thomson Reuter Impact Factor of 4.5 for 2015

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  • Two Illness Indicates Adult Onset Diabetes And Advertisement Stock Photo. Image source: Author: Stuart Miles. License: Free photo with attribution.

    Do Web-Based Interventions Improve Well-Being in Type 2 Diabetes? A Systematic Review and Meta-Analysis


    Background: Poor diabetes self-care can have a negative impact on psychological well-being and quality of life. Given the scarcity of traditional psychological support and the barriers to uptake of and attendance at face-to-face education programs, Web-based interventions are becoming a popular approach to provide an additional platform for psychological support in long-term conditions. However, there is limited evidence to assess the effect of Web-based psychological support in people with type 2 diabetes. Objective: This systematic review is the first review to critically appraise and quantify the evidence on the effect of Web-based interventions that aim to improve well-being in people with type 2 diabetes. Methods: Searches were carried out in the following electronic databases: MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Library. Reference lists were hand-searched. A meta-analysis was conducted for depression and distress outcomes. Results: A total of 16 randomized controlled studies met the inclusion criteria for the systematic review and 9 were included in the meta-analyses. Theories were applied to the majority of the interventions. The most common behavior change techniques were “General information” and “Tracking/monitoring.” Interventions with a duration of 2-6 months providing professional-led support with asynchronous and synchronous communication appeared to be associated with significant well-being outcomes. The pooled mean (95% confidence interval) difference between the intervention and control arms at follow-up on depression score was -0.31 (-0.73 to 0.11). The pooled mean difference on distress scores at follow-up was -0.11 (-0.38 to 0.16). No significant improvements in depression (P=.15) or distress (P=.43) were found following meta-analyses. Conclusions: While the meta-analyses demonstrated nonsignificant results for depression and distress scores, this review has shown that there is a potential for Web-based interventions to improve well-being outcomes in type 2 diabetes. Further research is required to confirm the findings of this review.

  • Prevail Splash Screen. Image created and copyright owned by authors.

    Using Intensive Longitudinal Data Collected via Mobile Phone to Detect Imminent Lapse in Smokers Undergoing a Scheduled Quit Attempt


    Background: Mobile phone‒based real-time ecological momentary assessments (EMAs) have been used to record health risk behaviors, and antecedents to those behaviors, as they occur in near real time. Objective: The objective of this study was to determine if intensive longitudinal data, collected via mobile phone, could be used to identify imminent risk for smoking lapse among socioeconomically disadvantaged smokers seeking smoking cessation treatment. Methods: Participants were recruited into a randomized controlled smoking cessation trial at an urban safety-net hospital tobacco cessation clinic. All participants completed in-person EMAs on mobile phones provided by the study. The presence of six commonly cited lapse risk variables (ie, urge to smoke, stress, recent alcohol consumption, interaction with someone smoking, cessation motivation, and cigarette availability) collected during 2152 prompted or self-initiated postcessation EMAs was examined to determine whether the number of lapse risk factors was greater when lapse was imminent (ie, within 4 hours) than when lapse was not imminent. Various strategies were used to weight variables in efforts to improve the predictive utility of the lapse risk estimator. Results: Participants (N=92) were mostly female (52/92, 57%), minority (65/92, 71%), 51.9 (SD 7.4) years old, and smoked 18.0 (SD 8.5) cigarettes per day. EMA data indicated significantly higher urges (P=.01), stress (P=.002), alcohol consumption (P<.001), interaction with someone smoking (P<.001), and lower cessation motivation (P=.03) within 4 hours of the first lapse compared with EMAs collected when lapse was not imminent. Further, the total number of lapse risk factors present within 4 hours of lapse (mean 2.43, SD 1.37) was significantly higher than the number of lapse risk factors present during periods when lapse was not imminent (mean 1.35, SD 1.04), P<.001. Overall, 62% (32/52) of all participants who lapsed completed at least one EMA wherein they reported ≥3 lapse risk factors within 4 hours of their first lapse. Differentially weighting lapse risk variables resulted in an improved risk estimator (weighted area=0.76 vs unweighted area=0.72, P<.004). Specifically, 80% (42/52) of all participants who lapsed had at least one EMA with a lapse risk score above the cut-off within 4 hours of their first lapse. Conclusions: Real-time estimation of smoking lapse risk is feasible and may pave the way for development of mobile phone‒based smoking cessation treatments that automatically tailor treatment content in real time based on presence of specific lapse triggers. Interventions that identify risk for lapse and automatically deliver tailored messages or other treatment components in real time could offer effective, low cost, and highly disseminable treatments to individuals who do not have access to other more standard cessation treatments.

  • Swordplay. Image source: Author: Xotatoman. License:CC0 Public Domain.

    The Narrative Impact of Active Video Games on Physical Activity Among Children: A Feasibility Study


    Background: Active video games (AVGs) capable of inducing physical activity offer an innovative approach to combating childhood obesity. Unfortunately, children’s AVG game play decreases quickly, underscoring the need to identify novel methods for player engagement. Narratives have been demonstrated to influence behaviors. Objective: The objective of this study was to test the hypothesis that a narrative would motivate increased AVG play, though a feasibility study that investigated the motivational effect of adding a previously developed narrative cutscene to an originally nonnarrative AVG, Nintendo Wii Sports Resort: Swordplay Showdown. Methods: A total of 40 overweight and obese 8- to 11-year-olds equally divided by sex played the AVG. Half (n=20) were randomly assigned to a narrative group that watched the narrative cutscene before game play. The other half played the game without watching it. Results: Children in the narrative group had significantly (P<.05) more steps per 10-second period (mean 3.2, SD 0.7) and overall (mean 523, SD 203) during game play compared with the nonnarrative group (10-second period: mean 2.7, SD 0.7; overall: mean 366, SD 172). Conclusions: The AVG with narrative induced increased physical activity. Additional research is needed to understand the mechanisms through which narrative increases physical activity during AVG game play.

  • Internet Security. Image Source: Author:TBIT. License:CC0 Public Domain.

    “I Always Vet Things”: Navigating Privacy and the Presentation of Self on Health Discussion Boards Among Individuals with Long-Term Conditions


    Background: The ethics of research into online communities is a long-debated issue, with many researchers arguing that open-access discussion groups are publically accessible data and do not require informed consent from participants for their use for research purposes. However, it has been suggested that there is a discrepancy between the perceived and actual privacy of user-generated online content by community members. Objective: There has been very little research regarding how privacy is experienced and enacted online. The objective of this study is to address this gap by qualitatively exploring the expectations of privacy on Internet forums among individuals with long-term conditions. Methods: Semistructured interviews were conducted with 20 participants with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and 21 participants with type 1 and 2 diabetes mellitus, and were analyzed using thematic analysis. Participants were recruited via online and offline routes, namely forums, email lists, newsletters, and face-to-face support groups. Results: The findings indicate that privacy online is a nebulous concept. Rather than individuals drawing a clear-cut distinction between what they would and would not be comfortable sharing online, it was evident that these situations were contextually dependent and related to a number of unique and individual factors. Conclusions: Interviewees were seen to carefully manage how they presented themselves on forums, filtering and selecting the information that they shared about themselves in order to develop and maintain a particular online persona, while maintaining and preserving an acceptable level of privacy.

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    Education-Based Gaps in eHealth: A Weighted Logistic Regression Approach

    Authors List:


    Background: Persons with a college degree are more likely to engage in eHealth behaviors than persons without a college degree, compounding the health disadvantages of undereducated groups in the United States. However, the extent to which quality of recent eHealth experience reduces the education-based eHealth gap is unexplored. Objective: The goal of this study was to examine how eHealth information search experience moderates the relationship between college education and eHealth behaviors. Methods: Based on a nationally representative sample of adults who reported using the Internet to conduct the most recent health information search (n=1458), I evaluated eHealth search experience in relation to the likelihood of engaging in different eHealth behaviors. I examined whether Internet health information search experience reduces the eHealth behavior gaps among college-educated and noncollege-educated adults. Weighted logistic regression models were used to estimate the probability of different eHealth behaviors. Results: College education was significantly positively related to the likelihood of 4 eHealth behaviors. In general, eHealth search experience was negatively associated with health care behaviors, health information-seeking behaviors, and user-generated or content sharing behaviors after accounting for other covariates. Whereas Internet health information search experience has narrowed the education gap in terms of likelihood of using email or Internet to communicate with a doctor or health care provider and likelihood of using a website to manage diet, weight, or health, it has widened the education gap in the instances of searching for health information for oneself, searching for health information for someone else, and downloading health information on a mobile device. Conclusion: The relationship between college education and eHealth behaviors is moderated by Internet health information search experience in different ways depending on the type of eHealth behavior. After controlling for college education, it was found that persons who experienced more fruitful Internet health information searches are generally less likely to engage in eHealth behaviors.

  • Patient Disability. Image Source: Copyright: Falco. License: CC Public Domain.

    The Effectiveness of Lower-Limb Wearable Technology for Improving Activity and Participation in Adult Stroke Survivors: A Systematic Review


    Background: With advances in technology, the adoption of wearable devices has become a viable adjunct in poststroke rehabilitation. Regaining ambulation is a top priority for an increasing number of stroke survivors. However, despite an increase in research exploring these devices for lower limb rehabilitation, little is known of the effectiveness. Objective: This review aims to assess the effectiveness of lower limb wearable technology for improving activity and participation in adult stroke survivors. Methods: Randomized controlled trials (RCTs) of lower limb wearable technology for poststroke rehabilitation were included. Primary outcome measures were validated measures of activity and participation as defined by the International Classification of Functioning, Disability and Health. Databases searched were MEDLINE, Web of Science (Core collection), CINAHL, and the Cochrane Library. The Cochrane Risk of Bias Tool was used to assess the methodological quality of the RCTs. Results: In the review, we included 11 RCTs with collectively 550 participants at baseline and 474 participants at final follow-up including control groups and participants post stroke. Participants' stroke type and severity varied. Only one study found significant between-group differences for systems functioning and activity. Across the included RCTs, the lowest number of participants was 12 and the highest was 151 with a mean of 49 participants. The lowest number of participants to drop out of an RCT was zero in two of the studies and 19 in one study. Significant between-group differences were found across three of the 11 included trials. Out of the activity and participation measures alone, P values ranged from P=.87 to P ≤.001. Conclusions: This review has highlighted a number of reasons for insignificant findings in this area including low sample sizes, appropriateness of the RCT methodology for complex interventions, a lack of appropriate analysis of outcome data, and participant stroke severity.

  • Image Source: A. Haddon / Alamy Stock Photo.

    Influence of Pedometer Position on Pedometer Accuracy at Various Walking Speeds: A Comparative Study


    Background: Demographic growth in conjunction with the rise of chronic diseases is increasing the pressure on health care systems in most OECD countries. Physical activity is known to be an essential factor in improving or maintaining good health. Walking is especially recommended, as it is an activity that can easily be performed by most people without constraints. Pedometers have been extensively used as an incentive to motivate people to become more active. However, a recognized problem with these devices is their diminishing accuracy associated with decreased walking speed. The arrival on the consumer market of new devices, worn indifferently either at the waist, wrist, or as a necklace, gives rise to new questions regarding their accuracy at these different positions. Objective: Our objective was to assess the performance of 4 pedometers (iHealth activity monitor, Withings Pulse O2, Misfit Shine, and Garmin vívofit) and compare their accuracy according to their position worn, and at various walking speeds. Methods: We conducted this study in a controlled environment with 21 healthy adults required to walk 100 m at 3 different paces (0.4 m/s, 0.6 m/s, and 0.8 m/s) regulated by means of a string attached between their legs at the level of their ankles and a metronome ticking the cadence. To obtain baseline values, we asked the participants to walk 200 m at their own pace. Results: A decrease of accuracy was positively correlated with reduced speed for all pedometers (12% mean error at self-selected pace, 27% mean error at 0.8 m/s, 52% mean error at 0.6 m/s, and 76% mean error at 0.4 m/s). Although the position of the pedometer on the person did not significantly influence its accuracy, some interesting tendencies can be highlighted in 2 settings: (1) positioning the pedometer at the waist at a speed greater than 0.8 m/s or as a necklace at preferred speed tended to produce lower mean errors than at the wrist position; and (2) at a slow speed (0.4 m/s), pedometers worn at the wrist tended to produce a lower mean error than in the other positions. Conclusions: At all positions, all tested pedometers generated significant errors at slow speeds and therefore cannot be used reliably to evaluate the amount of physical activity for people walking slower than 0.6 m/s (2.16 km/h, or 1.24 mph). At slow speeds, the better accuracy observed with pedometers worn at the wrist could constitute a valuable line of inquiry for the future development of devices adapted to elderly people.

  • Deutsch: Seniorin macht erste Erfahrung mit Tablet-PC. Image Source: Deutsch: Seniorin macht erste Erfahrung mit Tablet-PC. Author: Sigismund von Dobschütz. License: Creative Commons Attribution-Share Alike 3.0 Unported license.

    Developing a Health Information Technology Systems Matrix: A Qualitative Participatory Approach


    Background: The US Department of Veterans Affairs (VA) has developed various health information technology (HIT) resources to provide accessible veteran-centered health care. Currently, the VA is undergoing a major reorganization of VA HIT to develop a fully integrated system to meet consumer needs. Although extensive system documentation exists for various VA HIT systems, a more centralized and integrated perspective with clear documentation is needed in order to support effective analysis, strategy, planning, and use. Such a tool would enable a novel view of what is currently available and support identifying and effectively capturing the consumer’s vision for the future. Objective: The objective of this study was to develop the VA HIT Systems Matrix, a novel tool designed to describe the existing VA HIT system and identify consumers’ vision for the future of an integrated VA HIT system. Methods: This study utilized an expert panel and veteran informant focus groups with self-administered surveys. The study employed participatory research methods to define the current system and understand how stakeholders and veterans envision the future of VA HIT and interface design (eg, look, feel, and function). Directed content analysis was used to analyze focus group data. Results: The HIT Systems Matrix was developed with input from 47 veterans, an informal caregiver, and an expert panel to provide a descriptive inventory of existing and emerging VA HIT in four worksheets: (1) access and function, (2) benefits and barriers, (3) system preferences, and (4) tasks. Within each worksheet is a two-axis inventory. The VA’s existing and emerging HIT platforms (eg, My HealtheVet, Mobile Health, VetLink Kiosks, Telehealth), My HealtheVet features (eg, Blue Button, secure messaging, appointment reminders, prescription refill, vet library, spotlight, vitals tracker), and non-VA platforms (eg, phone/mobile phone, texting, non-VA mobile apps, non-VA mobile electronic devices, non-VA websites) are organized by row. Columns are titled with thematic and functional domains (eg, access, function, benefits, barriers, authentication, delegation, user tasks). Cells for each sheet include descriptions and details that reflect factors relevant to domains and the topic of each worksheet. Conclusions: This study provides documentation of the current VA HIT system and efforts for consumers’ vision of an integrated system redesign. The HIT Systems Matrix provides a consumer preference blueprint to inform the current VA HIT system and the vision for future development to integrate electronic resources within VA and beyond with non-VA resources. The data presented in the HIT Systems Matrix are relevant for VA administrators and developers as well as other large health care organizations seeking to document and organize their consumer-facing HIT resources.

  • Woman working. Image Source: Author: Moleshko. License: CC0 Public Domain.

    Effects of the Web Behavior Change Program for Activity and Multimodal Pain Rehabilitation: Randomized Controlled Trial


    Background: Web-based interventions with a focus on behavior change have been used for pain management, but studies of Web-based interventions integrated in clinical practice are lacking. To emphasize the development of cognitive skills and behavior, and to increase activity and self-care in rehabilitation, the Web Behavior Change Program for Activity (Web-BCPA) was developed and added to multimodal pain rehabilitation (MMR). Objective: The objective of our study was to evaluate the effects of MMR in combination with the Web-BCPA compared with MMR among persons with persistent musculoskeletal pain in primary health care on pain intensity, self-efficacy, and copying, as part of a larger collection of data. Web-BCPA adherence and feasibility, as well as treatment satisfaction, were also investigated. Methods: A total of 109 participants, mean age 43 (SD 11) years, with persistent pain in the back, neck, shoulder, and/or generalized pain were recruited to a randomized controlled trial with two intervention arms: (1) MMR+WEB (n=60) and (2) MMR (n=49). Participants in the MMR+WEB group self-guided through the eight modules of the Web-BCPA: pain, activity, behavior, stress and thoughts, sleep and negative thoughts, communication and self-esteem, solutions, and maintenance and progress. Data were collected with a questionnaire at baseline and at 4 and 12 months. Outcome measures were pain intensity (Visual Analog Scale), self-efficacy to control pain and to control other symptoms (Arthritis Self-Efficacy Scale), general self-efficacy (General Self-Efficacy Scale), and coping (two-item Coping Strategies Questionnaire; CSQ). Web-BCPA adherence was measured as minutes spent in the program. Satisfaction and Web-BCPA feasibility were assessed by a set of items. Results: Of 109 participants, 99 received the allocated intervention (MMR+WEB: n=55; MMR: n=44); 88 of 99 (82%) completed the baseline and follow-up questionnaires. Intention-to-treat analyses were performed with a sample size of 99. The MMR+WEB intervention was effective over time (time*group) compared to MMR for the two-item CSQ catastrophizing subscale (P=.003), with an effect size of 0.61 (Cohen d) at 12 months. There were no significant between-group differences over time (time*group) regarding pain intensity, self-efficacy (pain, other symptoms, and general), or regarding six subscales of the two-item CSQ. Improvements over time (time) for the whole study group were found regarding mean (P<.001) and maximum (P=.002) pain intensity. The mean time spent in the Web-based program was 304 minutes (range 0-1142). Participants rated the items of Web-BCPA feasibility between 68/100 and 90/100. Participants in the MMR+WEB group were more satisfied with their MMR at 4 months (P<.001) and at 12 months (P=.003). Conclusions: Adding a self-guided Web-based intervention with a focus on behavioral change for activity to MMR can reduce catastrophizing and increase satisfaction with MMR. Patients in MMR may need more supportive coaching to increase adherence in the Web-BCPA to find it valuable. ClinicalTrial: NCT01475591; (Archived by WebCite at

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    Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide


    Background: Approximately one-half of American adults exhibit low health literacy and thus struggle to find and use health information. Low health literacy is associated with negative outcomes including overall poorer health. Health information technology (HIT) makes health information available directly to patients through electronic tools including patient portals, wearable technology, and mobile apps. The direct availability of this information to patients, however, may be complicated by misunderstanding of HIT privacy and information sharing. Objective: The purpose of this study was to determine whether health literacy is associated with patients’ use of four types of HIT tools: fitness and nutrition apps, activity trackers, and patient portals. Additionally, we sought to explore whether health literacy is associated with patients’ perceived ease of use and usefulness of these HIT tools, as well as patients’ perceptions of privacy offered by HIT tools and trust in government, media, technology companies, and health care. This study is the first wide-scale investigation of these interrelated concepts. Methods: Participants were 4974 American adults (n=2102, 42.26% male, n=3146, 63.25% white, average age 43.5, SD 16.7 years). Participants completed the Newest Vital Sign measure of health literacy and indicated their actual use of HIT tools, as well as the perceived ease of use and usefulness of these applications. Participants also answered questions regarding information privacy and institutional trust, as well as demographic items. Results: Cross-tabulation analysis indicated that adequate versus less than adequate health literacy was significantly associated with use of fitness apps (P=.02), nutrition apps (P<.001), activity trackers (P<.001), and patient portals (P<.001). Additionally, greater health literacy was significantly associated with greater perceived ease of use and perceived usefulness across all HIT tools after controlling for demographics. Regarding privacy perceptions of HIT and institutional trust, patients with greater health literacy often demonstrated decreased privacy perceptions for HIT tools including fitness apps (P<.001) and nutrition apps (P<.001). Health literacy was negatively associated with trust in government (P<.001), media (P<.001), and technology companies (P<.001). Interestingly, health literacy score was positively associated with trust in health care (P=.03). Conclusions: Patients with low health literacy were less likely to use HIT tools or perceive them as easy or useful, but they perceived information on HIT as private. Given the fast-paced evolution of technology, there is a pressing need to further the understanding of how health literacy is related to HIT app adoption and usage. This will ensure that all users receive the full health benefits from these technological advances, in a manner that protects health information privacy, and that users engage with organizations and providers they trust.

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    Overcoming Addictions, a Web-Based Application, and SMART Recovery, an Online and In-Person Mutual Help Group for Problem Drinkers, Part 2: Six-Month...


    Background: Despite empirical evidence supporting the use of Web-based interventions for problem drinking, much remains unknown about factors that influence their effectiveness. Objective: We evaluated the performance of 2 resources for people who want to achieve and maintain abstinence: SMART Recovery (SR) and Overcoming Addictions (OA). OA is a Web application based on SR. We also examined participant and intervention-related factors hypothesized to impact clinical outcomes of Web-based interventions. Methods: We recruited 189 heavy drinkers through SR’s website and in-person meetings throughout the United States. We began by randomly assigning participants to (1) SR meetings alone, (2) OA alone, and (3) OA and SR (OA+SR). Recruitment challenges compelled us to assign participants only to SR (n=86) or OA+SR (n=102). The experimental hypotheses were as follows: (1) Both groups will reduce their drinking and alcohol-related consequences at follow-up compared with their baseline levels, and (2) The OA+SR condition will reduce their drinking and alcohol or drug-related consequences more than the SR only condition. Additionally, we derived 3 groups empirically (SR, OA, and OA+SR) based on the participants’ actual use of each intervention and conducted analyses by comparing them. Primary outcome measures included percent days abstinent (PDA), mean drinks per drinking day (DDD), and alcohol or drug-related consequences. Postbaseline assessments were conducted by phone at 3 and 6 months. Secondary analyses explored whether clinical issues (eg, severity of alcohol problems, level of distress, readiness to change) or intervention-related factors (eg, Internet fluency, satisfaction with site) affected outcomes. Results: Both intent-to-treat analyses and the actual-use analyses showed highly significant improvement from baseline to follow-ups for all 3 groups. Mean within-subject effect sizes were large (d>0.8) overall. There was no significant difference between groups in the amount of improvement from baseline to the average of the follow-ups. We found that participants who stopped drinking before joining the clinical trial had significantly better outcomes than participants who were still drinking when they joined the study. Neither Internet fluency nor participants’ reported ease of navigating the site had an impact on outcomes. Conclusions: These results support our first experimental hypothesis but not the second. On average, participants improved on all dependent measures. Both SR and OA helped participants recover from their problem drinking. Web-based interventions can help even those individuals with lengthy histories of heavy drinking to make clinically significant reductions in their consumption and related problems. These interventions work well for individuals in the action stage of change. Trial Registration: NCT01389297; (Archived by WebCite at

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    “I Want to Keep the Personal Relationship With My Doctor”: Understanding Barriers to Portal Use among African Americans and Latinos


    Background: Despite the widespread implementation of electronic health records (EHRs), there is growing evidence that racial/ethnic minority patients do not use portals as frequently as non-Hispanic whites to access their EHR information online. This differential portal use could be problematic for health care disparities since early evidence links portal use to better outcomes. Objective: We sought to understand specific barriers to portal use among African American and Latino patients at Kaiser Permanente, which has had a portal in place for over a decade, and broad uptake among the patient population at large. Methods: We conducted 10 focus groups with 87 participants in 2012 and 2013 among African American and Latino Kaiser Permanente members in the mid-Atlantic, Georgia, and Southern California regions. Members were eligible to participate if they were not registered for portal access. Focus groups were conducted within each racial/ethnic group, and each included individuals who were older, had a chronic disease, or were parents (as these are the three biggest users of the portal at Kaiser Permanente overall). We videotaped each focus group and transcribed the discussion for analysis. We used general inductive coding to develop themes for major barriers to portal use, overall and separately by racial/ethnic group. Results: We found that lack of support was a key barrier to initiating portal use in our sample—both in terms of technical assistance as well as the fear of the portal eroding existing personal relationships with health care providers. This held true across a range of focus groups representing a mix of age, income, health conditions, and geographic regions. Conclusions: Our study was among the first qualitative explorations of barriers to portal use among racial/ethnic subgroups. Our findings suggest that uniform adoption of portal use across diverse patient groups requires more usable and personalized websites, which may be particularly important for reducing health care disparities. This work is particularly important as all health care systems continue to offer and promote more health care features online via portals.

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  • The feasibility and acceptability of a web-based alcohol management intervention in community sports clubs: a cross sectional study

    Date Submitted: Oct 20, 2016

    Open Peer Review Period: Oct 21, 2016 - Dec 16, 2016

    Background: The implementation of comprehensive alcohol management strategies can reduce excessive alcohol use and reduce the risk of alcohol related harm at sporting venues. Supporting sports venues...

    Background: The implementation of comprehensive alcohol management strategies can reduce excessive alcohol use and reduce the risk of alcohol related harm at sporting venues. Supporting sports venues to implement alcohol management strategies via the web may represent an effective and efficient means of reducing harm caused by alcohol in this setting. However, the feasibility and acceptability of such an approach is unknown. Objective: This study aimed to identify: (1) current access to and use of the web and electronic devices by sports clubs; (2) perceived usefulness, ease of use, and intention to use a web-based program to support implementation of alcohol management practices in sports clubs; (3) factors associated with intention to use such a web-based support program; and (4) the specific features of such a program that sports clubs would find useful. Methods: A cross-sectional survey was conducted with club administrators of community football clubs in the state of New South Wales, Australia. Perceived usefulness, ease of use and behavioural intention to use a hypothetical web-based alcohol management support program was assessed using the validated Technology Acceptance Model (TAM) instrument. Associations between intention to use a web-based program and club characteristics as well as perceived ease of use and usefulness was tested using Fisher’s exact test and represented using relative risk for high intention to use the program. Results: Of the 73 football clubs that were approached to participate in the study, 63 consented to participate, 46 were eligible and completed the survey. All participants reported having access to the web and 98% reported current use of electronic devices (e.g. computers, iPads/tablets, smartphones, laptops, televisions and smartboards). Mean scores (out of a possible 7) for the TAM constructs were high for: intention to use (Mean: 6.25, SD: 0.87), perceived ease of use (Mean: 6.00, SD: 0.99), and perceived usefulness (mean: 6.17, SD: 0.85). Intention to use the web-based alcohol management program was significantly associated with perceived ease of use (P=.02, RR: 1.4, CI: 1.0-2.9), perceived usefulness (P=.03, RR: 1.5, CI: 1.0-6.8) and club size (P=.02, RR: 0.8 CI: 0.5-0.9). The most useful features of such a program included the perceived ability to complete program requirements within users own time, complete program accreditation assessment and monitoring online, develop tailored action plans and receive email reminders and prompts to complete action. Conclusions: A web-based alcohol management approach to support sports clubs in the implementation of recommended alcohol management practices appears both feasible and acceptable. Future research should aim to determine if such intended use leads to actual use and club implementation of alcohol management practices. Clinical Trial: NA

  • An Inter-hospital 12-Lead Electrocardiography Teleconsultation System and Mobile Application Based on Users’ Experiences

    Date Submitted: Oct 20, 2016

    Open Peer Review Period: Oct 21, 2016 - Dec 16, 2016

    Background: More and more hospitals have formed hospital alliance to share medical resources with one another in Taiwan. Consequently, the need for developing a safe and convenient inter-hospital 12-l...

    Background: More and more hospitals have formed hospital alliance to share medical resources with one another in Taiwan. Consequently, the need for developing a safe and convenient inter-hospital 12-lead electrocardiography (ECG) and tele-consultation system arises. Objective: The major goal of this study is to develop a safe and effective mobile application (App) and ECG system to deliver inter-hospital 12-lead ECG tele-consultation. Methods: The design of this APP and system was based on the experiences of cardiologists as users and human factor consideration so to minimize misuse, misdiagnosis, and violation of patients’ privacy. In addition, this technology facilitated the interoperability of 12-lead ECG across hospitals, which integrates heterogeneous 12-lead ECG from different hospitals and various mobile phones of consulting cardiologists. Notably, the use of role-based certificates enhanced the safety of ECG delivery on internet. This App was evaluated by two senior cardiologists as with credible usability. Results: This technology allowed the practice of 12-lead ECG tele-consultation easier and more convenient. It also helped clinicians give proper diagnosis and disposition more efficiently based on more comprehensive ECG reports and consultation. Conclusions: In summary, this App can be applied easily in clinical settings and greatly improves the efficiency and quality of medical services.

  • What predicts online health information seeking behaviour among Egyptian adults? A cross-sectional study.

    Date Submitted: Oct 21, 2016

    Open Peer Review Period: Oct 21, 2016 - Dec 16, 2016

    Background: Over the last decade, the Internet has become an important source of health-related information for a wide range of people worldwide. However, little is known about who accesses this sourc...

    Background: Over the last decade, the Internet has become an important source of health-related information for a wide range of people worldwide. However, little is known about who accesses this source of information among Egyptian users. Objective: To identify personal characteristics of Egyptian online health information (OHI) seekers and their association with health information seeking behaviour. Methods: This cross-sectional study was conducted from June to October 2015. An online questionnaire was sent to Egyptian users of a popular health information website aged ≥ 18 years or older (N = 1400). The study questionnaire included: (1) demographic characteristics, (2) general health status, and (3) health information seeking behaviour which included: frequency of use, different topics sought, and self reported impact of obtained OHI on health behaviours. Data were analysed using descriptive statistics and multiple regression analysis. Results: A total of 490 respondents completed the electronic questionnaire with response rate equivalent to 35.0 % . Of the participants; 57.1% were females, 63.4% had a university level qualification, and 37.1 % had a chronic health problem. The results of the multiple regression analysis showed that 31.0% (F= 9.94, P < 0.05) of variance in frequency of using OHI can be predicted by personal characteristics. Participants who sought for OHI were more likely to be female, younger age, higher education levels, and good self-reported general health. Conclusions: Our results provide insights into Internet use and health information–seeking behaviours of the Egyptian internet users. This will contribute to better recognize their needs, highlight improvements of internet health information availability and provide tools to navigate to the highest-quality health information to Egyptian OHI users.

  • Beyond use versus non-use: identifying subgroups based on older adults’ activities on the Internet

    Date Submitted: Oct 20, 2016

    Open Peer Review Period: Oct 20, 2016 - Dec 15, 2016

    Background: As for all individuals, the Internet is essential in everyday life of older adults. Research on older adults’ use of the Internet has merely focused on users versus non-users, and conseq...

    Background: As for all individuals, the Internet is essential in everyday life of older adults. Research on older adults’ use of the Internet has merely focused on users versus non-users, and consequences of Internet use and non-use. Older adults are a heterogeneous group, which may implicate that their use of the Internet is diverse as well. Older adults can use the Internet for different activities, and this usage can be of influence on benefits the Internet can have for older adults. Objective: The aim of this paper is to describe the diversity or heterogeneity in the activities for which older adults use the Internet, and to determine whether diversity is related to social or health related variables. Methods: We used data of a national representative Internet panel in the Netherlands. Panel members aged 65 years and older and who have access and make use of the Internet were selected (n=1418, 88.18% of the total sample were Internet users). We conducted a latent class analysis based upon the Internet activities that panel members reported to spend time on. Second, we described the identified clusters with descriptive statistics, and compared the clusters using ANOVA and chi-square tests. Results: Four clusters were distinguished. Cluster 1 was labelled as the ‘practical users’ (36.88%, n=523). These respondents mainly used the Internet for practical and financial purposes such as searching for information, comparing products, and banking. Respondents in cluster 2 ‘the minimizers’ (32.23%, n=457), reported the lowest frequency on most Internet activities, are older and spent the smallest time on the Internet. Cluster 3 was labelled as ‘the maximizers’ (17.77%, n=252): these respondents used the Internet for various activities, spent the most time on the Internet and were younger. Respondents in cluster 4 ‘the social users’ mainly used the Internet for social and leisure related activities, such as gaming and social network sites. The identified clusters were significantly different in age (P<.001, ω2=.07), time spent on the Internet (P<.001, ω2=.12), frequency of downloading apps (P<.001, ω2=.14) with medium to large effect sizes. Social and health related variables were significantly different between the clusters, except social and emotional loneliness. However, effect sizes were small. The minimizers scored significantly lower on psychological well-being, iADL and experienced health compared with the practical users and maximizers. Conclusions: Older adults are a diverse group concerning their activities on the Internet. This underlines the importance to look beyond use versus non-use when studying older adults Internet use. The clusters we have identified in this study can help tailor the development and deployment of eHealth intervention to specific segments of the older population.

  • Nurse-moderated Internet-based Support for New Mothers: A Non-inferiority, Randomised Controlled Trial

    Date Submitted: Oct 19, 2016

    Open Peer Review Period: Oct 19, 2016 - Dec 14, 2016

    Background: Internet-based interventions moderated by community nurses have the potential to improve support offered to new mothers, many of whom now make extensive use of the internet to obtain infor...

    Background: Internet-based interventions moderated by community nurses have the potential to improve support offered to new mothers, many of whom now make extensive use of the internet to obtain information about infant care. However, evidence from population-based randomised controlled trials is lacking. Objective: The aim of this study was to test the non-inferiority of outcomes for mothers and infants who received a clinic-based postnatal health check plus nurse-moderated, internet-based-group support when infants were aged 1-7 months as compared to outcomes for those who received standard care consisting of postnatal home-based support provided by a community nurse. Methods: The design of the study was a pragmatic, preference, non-inferiority randomised control trial. Participants were recruited from mothers contacted for their postnatal health check, which is offered to all mothers in South Australia. Mothers were assigned either: 1) on the basis of their preference to clinic+internet or home-based support groups (n=328), or 2) randomly assigned to clinic+internet or home-based groups if they declared no strong preference (n=491). The overall response rate was 45%. Primary outcomes were Parenting Stress Index (PSI) Confidence and Karitane Parenting Confidence Scale scores. Secondary outcomes were PSI Isolation, Interpersonal Support Evaluation List – Short Form, Maternal Support Scale, Ages and Stages Questionnaire – Social-Emotional and MacArthur Communicative Development Inventory (MCDI) scores. Assessments were completed offline via self-assessment questionnaires at enrolment, (mean child age = 4.1 weeks, SD = 1.3) and again when infants were aged 9, 15 and 21 months. Results: Generalised estimating equations adjusting for post-randomisation baseline imbalances showed that differences in outcomes between mothers in the clinic+internet and home-based support groups did not exceed the pre-specified margin of inferiority (0.25 SD) on any outcome measure at any follow-up assessment, with the exception of MCDI scores assessing children’s language development at 21 months for randomised mothers, and PSI Isolation scores at 9 months for preference mothers. Conclusions: Maternal and child outcomes from a clinic-based postnatal health check plus nurse-moderated internet-based support were not inferior to those achieved by a universal home-based postnatal support program. Postnatal maternal and infant support using the internet is a promising alternative to home-based universal support programs. Clinical Trial: Australian New Zealand Clinical Trials Registry ACTRN12613000204741

  • Motivational determinants of exergame participation for older people in Assisted Living facilities: a mixed methods study.

    Date Submitted: Oct 18, 2016

    Open Peer Review Period: Oct 18, 2016 - Dec 13, 2016

    Background: Exergames (exercise based videogames) as a mode of delivering strength and balance exercise for older people are growing in popularity with the emergence of new Kinect based technologies,...

    Background: Exergames (exercise based videogames) as a mode of delivering strength and balance exercise for older people are growing in popularity with the emergence of new Kinect based technologies, however little is known about the factors affecting their uptake and use with older people. Objective: The aim of this study is to determine the factors that may influence the motivation of older people to use exergames to improve their physical function and reduce fall risk. Methods: Mixed methods were employed in which fourteen semi-structured interviews were conducted with older people (n=12, aged 59-91 years) from two supportive housing facilities in the North West of the UK who participated in a 6 week trial of the exergames, one manager and one physiotherapist; 81 hours of observation and Technology Acceptance Model questionnaires were conducted. Results: The findings suggest that the participants were intrinsically motivated to participate in the exergames due to the enjoyment experienced when playing the exergames and perceived improvements of their physical and mental health and/or social confidence. The social interaction provided in this study was an important extrinsic motivator which increased the intrinsic motivation to adhere to the exergame programme. Conclusions: The findings of this study suggest that exergames may be a promising tool for delivering falls prevention exercises and increasing adherence to exercise in older people. Understanding the motivation of older people to use exergames may assist in the process of implementation.