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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  • eHealth_Project_IPD. Image sourced and copyright owned by authors.

    An eHealth Project on Invasive Pneumococcal Disease: Comprehensive Evaluation of a Promotional Campaign


    Background: The recently launched Pneumo Rischio eHealth project, which consists of an app, a website, and social networking activity, is aimed at increasing public awareness of invasive pneumococcal disease (IPD). The launch of this project was prompted by the inadequate awareness of IPD among both laypeople and health care workers, the heavy socioeconomic burden of IPD, and the far from optimal vaccination coverage in Italy, despite the availability of safe and effective vaccines. Objective: The objectives of our study were to analyze trends in Pneumo Rischio usage before and after a promotional campaign, to characterize its end users, and to assess its user-rated quality. Methods: At 7 months after launching Pneumo Rischio, we established a 4-month marketing campaign to promote the project. This intervention used various approaches and channels, including both traditional and digital marketing strategies. To highlight usage trends, we used different techniques of time series analysis and modeling, including a modified Mann-Kendall test, change-point detection, and segmented negative binomial regression of interrupted time series. Users were characterized in terms of demographics and IPD risk categories. Customer-rated quality was evaluated by means of a standardized tool in a sample of app users. Results: Over 1 year, the app was accessed by 9295 users and the website was accessed by 143,993 users, while the project’s Facebook page had 1216 fans. The promotional intervention was highly effective in increasing the daily number of users. In particular, the Mann-Kendall trend test revealed a significant (P ≤.01) increasing trend in both app and website users, while change-point detection analysis showed that the first significant change corresponded to the start of the promotional campaign. Regression analysis showed a significant immediate effect of the intervention, with a mean increase in daily numbers of users of 1562% (95% CI 456%-4870%) for the app and 620% (95% CI 176%-1777%) for the website. Similarly, the postintervention daily trend in the number of users was positive, with a relative increase of 0.9% (95% CI 0.0%-1.8%) for the app and 1.4% (95% CI 0.7%-2.1%) for the website. Demographics differed between app and website users and Facebook fans. A total of 69.15% (10,793/15,608) of users could be defined as being at risk of IPD, while 4729 users expressed intentions to ask their doctor for further information on IPD. The mean app quality score assigned by end users was approximately 79.5% (397/500). Conclusions: Despite its specific topic, Pneumo Rischio was accessed by a considerable number of users, who ranked it as a high-quality project. In order to reach their target populations, however, such projects should be promoted.

  • Tele-EMS-physician center. Image sourced and copyright owned by author Frederik Hirsch.

    Treatment of Acute Coronary Syndrome by Telemedically Supported Paramedics Compared With Physician-Based Treatment: A Prospective, Interventional,...


    Background: Prehospital treatment of acute coronary syndrome (ACS) in German emergency medical services (EMSs) is reserved for EMS physicians due to legal issues. Objective: The objective of this prospective, interventional, multicenter trial was to evaluate the quality of telemedically-delegated therapy and the possible complications in patients with ACS. Methods: After approval by the ethics committee and trial registration, a one-year study phase was started in August 2012 with 5 ambulances, telemedically equipped and staffed with paramedics, in 4 German EMS districts. The paramedics could contact an EMS-physician–staffed telemedicine center. After initiation of an audio connection, real-time data transmission was automatically established. If required, 12-lead electrocardiogram (ECG) and still pictures could be sent. Video was streamed from inside each ambulance. All drugs, including opioids, were delegated to the paramedics based on standardized, predefined algorithms. To compare telemedically-delegated medication and treatment in ACS cases with regular EMS missions, a matched pair analysis with historical controls was performed. Results: Teleconsultation was performed on 150 patients having a cardiovascular emergency. In 39 cases, teleconsultation was started due to suspected ACS. No case had a medical complication. Correct handling of 12-lead ECG was performed equally between the groups (study group, n=38 vs control group, n=39, P>.99). There were no differences in correct handling of intravenous administration of acetylsalicylic acid, heparin, or morphine between both the groups (study group vs control group): acetylsalicylic acid, n=31 vs n=33, P=.73; unfractionated heparin, n=34 vs n=33, P>.99; morphine, n=29 vs n=27, P=.50. The correct handling of oxygen administration was significantly higher in the study group (n=29 vs n=18, P=.007). Conclusions: Telemedical delegation of guideline conform medication and therapy by paramedics in patients with ACS and was found to be feasible and safe. The quality of guideline-adherent therapy was not significantly different in both the groups except for the correct administration of oxygen, which was significantly higher in the study group. Trial Registration: NCT01644006; (Archived by WebCite at

  • Asthma inhaler use. Image Source: Author: United States National Institute of Health: Heart, Llung and Blood Institute. Copyright: Public Domain.

    The Effectiveness of Web-Based Asthma Self-Management System, My Asthma Portal (MAP): A Pilot Randomized Controlled Trial


    Background: Whether Web-based technologies can improve disease self-management is uncertain. My Asthma Portal (MAP) is a Web-based self-management support system that couples evidence-based behavioral change components (self-monitoring of symptoms, physical activity, and medication adherence) with real-time monitoring, feedback, and support from a nurse case manager. Objective: The aim of this study was to compare the impact of access to a Web-based asthma self-management patient portal linked to a case-management system (MAP) over 6 months compared with usual care on asthma control and quality of life. Methods: A multicenter, parallel, 2-arm, pilot, randomized controlled trial was conducted with 100 adults with confirmed diagnosis of asthma from 2 specialty clinics. Asthma control was measured using an algorithm based on overuse of fast-acting bronchodilators and emergency department visits, and asthma-related quality of life was assessed using the Mini-Asthma Quality of Life Questionnaire (MAQLQ). Secondary mediating outcomes included asthma symptoms, depressive symptoms, self-efficacy, and beliefs about medication. Process evaluations were also included. Results: A total of 49 individuals were randomized to MAP and 51 to usual care. Compared with usual care, participants in the intervention group reported significantly higher asthma quality of life (mean change 0.61, 95% CI 0.03 to 1.19), and the change in asthma quality of life for the intervention group between baseline and 3 months (mean change 0.66, 95% CI 0.35 to 0.98) was not seen in the control group. No significant differences in asthma quality of life were found between the intervention and control groups at 6 (mean change 0.46, 95% CI –0.12 to 1.05) and 9 months (mean change 0.39, 95% CI –0.2 to 0.98). For poor control status, there was no significant effect of group, time, or group by time. For all self-reported measures, the intervention group had a significantly higher proportion of individuals, demonstrating a minimal clinically meaningful improvement compared with the usual care group. Conclusions: This study supported the use of MAP to enhance asthma quality of life but not asthma control as measured by an administrative database. Implementation of MAP beyond 6 months with tailored protocols for monitoring symptoms and health behaviors as individuals’ knowledge and self-management skills improve may result in long-term gains in asthma control. ClinicalTrial: International Standard Randomized Controlled Trial Number (ISRCTN): 34326236; (Archived by Webcite at

  • Crossroads For Ideas. Image sourced and copyright owned by authors.

    Patients’ Need for Tailored Comparative Health Care Information: A Qualitative Study on Choosing a Hospital


    Background: The Internet is increasingly being used to provide patients with information about the quality of care of different health care providers. Although online comparative health care information is widely available internationally, and patients have been shown to be interested in this information, its effect on patients’ decision making is still limited. Objective: This study aimed to explore patients’ preferences regarding information presentation and their values concerning tailored comparative health care information. Meeting patients’ information presentation needs might increase the perceived relevance and use of the information. Methods: A total of 38 people participated in 4 focus groups. Comparative health care information about hip and knee replacement surgery was used as a case example. One part of the interview focused on patients’ information presentation preferences, whereas the other part focused on patients’ values of tailored information (ie, showing reviews of patients with comparable demographics). The qualitative data were transcribed verbatim and analyzed using the constant comparative method. Results: The following themes were deduced from the transcripts: number of health care providers to be presented, order in which providers are presented, relevancy of tailoring patient reviews, and concerns about tailoring. Participants’ preferences differed concerning how many and in which order health care providers must be presented. Most participants had no interest in patient reviews that were shown for specific subgroups based on age, gender, or ethnicity. Concerns of tailoring were related to the representativeness of results and the complexity of information. A need for information about the medical specialist when choosing a hospital was stressed by several participants. Conclusions: The preferences for how comparative health care information should be presented differ between people. “Information on demand” and information about the medical specialist might be promising ways to increase the relevancy and use of online comparative health care information. Future research should focus on how different groups of people use comparative health care information for different health care choices in real life.

  • Glucometer. Image Source: Author:Tuned_In; Stock photo ID:483874008. Image purchased by authors.

    Impact of Information Technology–Based Interventions for Type 2 Diabetes Mellitus on Glycemic Control: A Systematic Review and Meta-Analysis


    Background: Information technology–based interventions are increasingly being used to manage health care. However, there is conflicting evidence regarding whether these interventions improve outcomes in people with type 2 diabetes. Objective: The objective of this study was to conduct a systematic review and meta-analysis of clinical trials, assessing the impact of information technology on changes in the levels of hemoglobin A1c (HbA1c) and mapping the interventions with chronic care model (CCM) elements. Methods: Electronic databases PubMed and EMBASE were searched to identify relevant studies that were published up until July 2016, a method that was supplemented by identifying articles from the references of the articles already selected using the electronic search tools. The study search and selection were performed by independent reviewers. Of the 1082 articles retrieved, 32 trials (focusing on a total of 40,454 patients) were included. A random-effects model was applied to estimate the pooled results. Results: Information technology–based interventions were associated with a statistically significant reduction in HbA1c levels (mean difference −0.33%, 95% CI −0.40 to −0.26, P<.001). Studies focusing on electronic self-management systems demonstrated the largest reduction in HbA1c (0.50%), followed by those with electronic medical records (0.17%), an electronic decision support system (0.15%), and a diabetes registry (0.05%). In addition, the more CCM-incorporated the information technology–based interventions were, the more improvements there were in HbA1c levels. Conclusions: Information technology strategies combined with the other elements of chronic care models are associated with improved glycemic control in people with diabetes. No clinically relevant impact was observed on low-density lipoprotein levels and blood pressure, but there was evidence that the cost of care was lower.

  • Multidimensional telemonitoring at patient's home. Image sourced and copyright owned by authors.

    Clinical Relevance of the First Domomedicine Platform Securing Multidrug Chronotherapy Delivery in Metastatic Cancer Patients at Home: The inCASA European...


    Background: Telehealth solutions can improve the safety of ambulatory chemotherapy, contributing to the maintenance of patients at their home, hence improving their well-being, all the while reducing health care costs. There is, however, need for a practicable multilevel monitoring solution, encompassing relevant outputs involved in the pathophysiology of chemotherapy-induced toxicity. Domomedicine embraces the delivery of complex care and medical procedures at the patient’s home based on modern technologies, and thus it offers an integrated approach for increasing the safety of cancer patients on chemotherapy. Objective: The objective was to evaluate patient compliance and clinical relevance of a novel integrated multiparametric telemonitoring domomedicine platform in cancer patients receiving multidrug chemotherapy at home. Methods: Self-measured body weight, self-rated symptoms using the 19-item MD Anderson Symptom Inventory (MDASI), and circadian rest-activity rhythm recording with a wrist accelerometer (actigraph) were transmitted daily by patients to a server via the Internet, using a dedicated platform installed at home. Daily body weight changes, individual MDASI scores, and relative percentage of activity in-bed versus out-of-bed (I

  • Patients App Word Cloud. Image sourced and copyright owned by authors.

    Mobile Apps in Oncology: A Survey on Health Care Professionals’ Attitude Toward Telemedicine, mHealth, and Oncological Apps


    Background: Mobile apps are an evolving trend in the medical field. To date, few apps in an oncological context exist. Objective: The aim was to analyze the attitude of health care professionals (HCPs) toward telemedicine, mHealth, and mobile apps in the field of oncology. Methods: We developed and conducted an online survey with 24 questions evaluating HCPs’ general attitude toward telemedicine and patients using medical mobile apps. Specific questions on the possible functionality for patients and the resulting advantages and disadvantages for both the patients’ and HCPs’ daily clinical routine were evaluated. Results: A total of 108 HCPs completed the survey. In all, 88.9% (96/108) considered telemedicine useful and 84.3% (91/108) supported the idea of an oncological app complementing classical treatment. Automatic reminders, timetables, and assessment of side effects and quality of life during therapy were rated as the most important functions. In contrast, uncertainty regarding medical responsibility and data privacy were reasons mostly named by critics. Most (64.8%, 70/108) were in favor of an alert function due to data input needing further clarification, and 94% (66/70) were willing to contact the patient after a critical alert. In all, 93.5% (101/108) supported the idea of using the collected data for scientific research. Moreover, 75.0% (81/108) believed establishing a mobile app could be beneficial for the providing hospital. Conclusions: A majority of HCPs are in favor of telemedicine and the use of oncological apps by patients. Assessing side effects can lead to quicker response and thus lower inconvenience for patients. Clinical data, such as life quality and treatment satisfaction, could be used to evaluate and improve the therapy workflow. Eventually, a mobile app would enhance the patients’ relationship to their treating department because they are in permanent contact.

  • Collaboration using e-communication tool Congredi. Image sourced by authors and copyright owned by Waldemar Hogerwaard. Permission has been granted to use this image.

    How Professionals Share an E-Care Plan for the Elderly in Primary Care: Evaluating the Use of an E-Communication Tool by Different Combinations of Professionals


    Background: Home-dwelling elderly patients with multimorbidity are at risk of fragmentation of care because of the many different professionals involved and a potentially unclear level of communication. Multidisciplinary communication seems to occur incidentally. Mutual feedback is needed for a professional team to provide consistent care and adequate support to the patient system. eHealth technology can improve outcomes. Objective: The aim of this study was to evaluate the use of a tool, Congredi, for electronic communication by professionals for the care of home-dwelling elderly patients. Methods: The research group was recruited through general practices and home care organizations. Congredi, a tool designed for multidisciplinary communication, was made available for professionals in primary care. It consists of a care plan and a communication channel (secure emailing). Professionals opened Congredi records for elderly patients who had 2 or more professionals involved. The records were the unit of analysis. Data were gathered from the Congredi system over a period of 42 weeks. Results: An inclusion rate of 21.4% (203/950) was achieved; nearly half of the participants were nurses. During the study, professionals were active in 448 patient records; female professionals were prevalent. In the patient records, 3 types of actions (care activities, emailing, and process activities) were registered. Most activities occurred in the multidisciplinary records (mean 12.2), which had twice the number of activities of monodisciplinary records (6.35), and solo records had a mean of 3.43 activities. Most activities were care activities (mean 9.14), emailing had a mean of 0.89 activities, and process activities had a mean of 0.29. Conclusions: An e-communication tool (Congredi) was usable for improving multidisciplinary communication among professionals. It even seemed to yield results for 40% of the professionals who used the e-care plan on their own. The content of the tool provided an active communication practice, with significant increases observed in the actions that must be shared for the effective coordination of care.

  • Older Veterans. Image Source: Author: U.S. Navy photo by Mass Communication Specialist 2nd Class John Benson/Released. Copyright: Public Domain.

    Older Veteran Digital Disparities: Examining the Potential for Solutions Within Social Networks


    Background: Older adults typically have less access to the Internet than other age groups, and older Veterans may use the Internet even less due to economic and geographic reasons. Objective: To explore solutions to this problem, our study examined older Veterans’ reported ability to access technology through their close social ties. Methods: Data were collected via mail survey from a sample of Veterans aged 65 years and older (N=266). Results: Nearly half (44.0%, 117/266) of the sample reported having no Internet access. Yet, among those without current access, older Veterans reported having a median of 5 (IQR 7) close social ties with home Internet access. These older Veterans also reported that they would feel comfortable asking a median of 2 (IQR 4) social ties for help to access the Internet, and that a median of 2 (IQR 4) social ties would directly access the Internet for the older Veteran to help with health management. Conclusions: Findings suggest that even older Veterans without current Internet access have at least two social ties with home Internet who could be called upon for technology support. Thus, older Veterans may be willing to call upon these “surrogate seekers” for technology assistance and support in health management. This has implications for the digital divide, technology design, and health care policy.

  • Hand Holding an iPhone 4. Image source: Author: Image Catalog. Copyright:

    Do We Still Have a Digital Divide in Mental Health? A Five-Year Survey Follow-up


    Background: Nearly everyone in society uses the Internet in one form or another. The Internet is heralded as an efficient way of providing mental health treatments and services. However, some people are still excluded from using Internet-enabled technology through lack of resources, skills, and confidence. Objective: Five years ago, we showed that people with severe mental illness were at risk of digital exclusion, especially middle-aged patients with psychosis and/or people from black or minority ethnic groups with psychosis. An understanding of the breadth of potential digital exclusion is vital for the implementation of digital health services. The aim of this study is to understand the context of digital exclusion for people who experience mental illness. Methods: We conducted a survey involving people with a primary diagnosis of psychosis or depression in London, United Kingdom. A total of 241 participants were recruited: 121 with psychosis and 120 with depression. The majority of surveys were collected face-to-face (psychosis: n=109; depression: n=71). Participants answered questions regarding familiarity, access, use, motivation, and confidence with Internet-enabled technologies (ie, computers and mobile phones). Variables predicting digital exclusion were identified in regression analyses. The results were compared with the survey conducted in 2011. Results: Digital exclusion has declined since 2011. Online survey collection introduced biases into the sample, masking those who were likely to be excluded. Only 18.3% (20/109) of people with psychosis in our sample were digitally excluded, compared with 30% (28/93) in 2011 (χ21=3.8, P=.04). People with psychosis had less confidence in using the Internet than people with depression (χ21=7.4, P=.004). Only 9.9% (24/241) of participants in the total sample were digitally excluded, but the majority of these people had psychosis (n=20). Those with psychosis who were digitally excluded were significantly older than their included peers (t30=3.3, P=.002) and had used services for longer (t97=2.5, P=.02). Younger people were more likely to use mobile phones. Digitally excluded participants cited a lack of knowledge as a barrier to digital inclusion, and most wanted to use the Internet via computers (rather than mobile phones). Conclusions: Digital exclusion is lower, but some remain excluded. Facilitating inclusion among this population means helping them develop skills and confidence in using technology, and providing them with access. Providing mobile phones without basic information technology training may be counterproductive because excluded people may be excluded from mobile technology too. An evidence-based digital inclusion strategy is needed within the National Health Service to help digitally excluded populations access Internet-enabled services.

  • Sign on door to My HealtheVet enrollment office. Image sourced and copyright owned by authors.

    Encouraging Patient Portal Use in the Patient-Centered Medical Home: Three Stakeholder Perspectives


    Background: Health care organizations are increasingly offering patients access to their electronic medical record and the ability to communicate with their providers through Web-based patient portals, thus playing a prominent role within the patient-centered medical home (PCMH). However, despite enthusiasm, adoption remains low. Objective: We examined factors in the PCMH context that may affect efforts to improve enrollment in a patient portal. Methods: Using a sociotechnical approach, we conducted qualitative, semistructured interviews with patients and providers from 3 primary care clinics and with national leaders from across a large integrated health care system. Results: We gathered perspectives and analyzed data from 4 patient focus groups and one-on-one interviews with 1 provider from each of 3 primary care clinics and 10 program leaders. We found that leaders were focused on marketing in primary care, whereas patients and providers were often already aware of the portal. In contrast, both patients and providers cited administrative and logistical barriers impeding enrollment. Further, although leadership saw the PCMH as the logical place to focus enrollment efforts, providers and patients were more circumspect and expressed concern about how the patient portal would affect their practice and experience of care. Further, some providers expressed ambivalence about patients using the portal. Despite absence of consensus on how and where to encourage portal adoption, there was wide agreement that promoting enrollment was a worthwhile goal. Conclusions: Patients, clinicians, and national leaders agreed that efforts were needed to increase enrollment in the patient portal. Opinions diverged regarding the suitability of the PCMH and, specifically, the primary care clinic for promoting patient portal enrollment. Policymakers should consider diverse stakeholder perspectives in advance of interventions to increase technology adoption.

  • DSC01714. Image source: Author: The Man-Machine. Copyright:

    Methods for Evaluating Respondent Attrition in Web-Based Surveys


    Background: Electronic surveys are convenient, cost effective, and increasingly popular tools for collecting information. While the online platform allows researchers to recruit and enroll more participants, there is an increased risk of participant dropout in Web-based research. Often, these dropout trends are simply reported, adjusted for, or ignored altogether. Objective: To propose a conceptual framework that analyzes respondent attrition and demonstrates the utility of these methods with existing survey data. Methods: First, we suggest visualization of attrition trends using bar charts and survival curves. Next, we propose a generalized linear mixed model (GLMM) to detect or confirm significant attrition points. Finally, we suggest applications of existing statistical methods to investigate the effect of internal survey characteristics and patient characteristics on dropout. In order to apply this framework, we conducted a case study; a seventeen-item Informed Decision-Making (IDM) module addressing how and why patients make decisions about cancer screening. Results: Using the framework, we were able to find significant attrition points at Questions 4, 6, 7, and 9, and were also able to identify participant responses and characteristics associated with dropout at these points and overall. Conclusions: When these methods were applied to survey data, significant attrition trends were revealed, both visually and empirically, that can inspire researchers to investigate the factors associated with survey dropout, address whether survey completion is associated with health outcomes, and compare attrition patterns between groups. The framework can be used to extract information beyond simple responses, can be useful during survey development, and can help determine the external validity of survey results.

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  • Whiplash syndrome reloaded: digital echoes of whiplash syndrome inside the Europeans internet´s search-engine context

    Date Submitted: Nov 27, 2016

    Open Peer Review Period: Dec 2, 2016 - Jan 27, 2017

    Background: In many Western countries, after a motor vehicle collision, those involved seek health care for the assessment of injuries and for insurance documentation purposes. In contrast, in many le...

    Background: In many Western countries, after a motor vehicle collision, those involved seek health care for the assessment of injuries and for insurance documentation purposes. In contrast, in many less wealthy countries, there may be limited access to care, and no insurance or compensation system. Objective: The purpose of this study was to investigate the global pattern of evolving internet usage in countries with and without insurance and the corresponding compensation systems for whiplash injury. Methods: We used internet search engine analytics via Google Trends to study the health information-seeking behavior concerning whiplash injury at national population levels in Europe. Results: We found that the search for “whiplash” is strikingly and consistently often associated with the search for “compensation” in countries or cultures with a tort system. Frequent or traumatic painful injuries, diseases or disorders such as arthritis, headache, radius and hip fracture, depressive disorders, and fibromyalgia were not associated similarly with searches on "compensation". Conclusions: In this study, we present evidence from the evolving viewpoint of naturalistic internet search engine analytics that the expectations for receiving compensation may influence internet search behavior in relation to whiplash injury.

  • ‘Am I normal?’ Patients with lymphoma wish to compare their own quality of life and symptom scores with those of others of same age and sex

    Date Submitted: Dec 1, 2016

    Open Peer Review Period: Dec 2, 2016 - Jan 27, 2017

    Background: Providing feedback to patients on their health-related quality of life (HRQoL) and symptoms can help patients in monitoring their functioning and symptoms and may help empower them. Object...

    Background: Providing feedback to patients on their health-related quality of life (HRQoL) and symptoms can help patients in monitoring their functioning and symptoms and may help empower them. Objective: This study investigates whether patients with lymphoma wish to receive feedback, including the option to compare their scores to the scores of others, and how this feedback is evaluated. Methods: Sixty-four patients participating in a lymphoma cohort who were eligible for a follow-up questionnaire were invited and given an option to receive patient-reported outcomes (PRO) feedback. Patients completed questions about HRQoL and symptoms. PRO feedback was provided via bar-charts. Results: Forty-five of 64 invited patients participated (response=70%) and 36 patients (80%) wished to receive PRO feedback. The vast majority (34/36=94%) compared their scores to a lymphoma reference cohort, and 64% (23/36) to a normative population without cancer. All patients wished to receive feedback on their HRQoL and 81-92% on their functioning, fatigue, neuropathy, anxiety and depressive feelings. Ninety-seven percent reviewed the PRO feedback as useful, with reassurance and knowledge about own functioning in relation to what is ‘normal’ as most frequently mentioned arguments. Conclusions: Patients reported the comparison of their scores to a lymphoma reference cohort as most valuable. Research should demonstrate if PRO feedback could increase empowerment and possibly improve HRQoL.

  • Methods for Coding Tobacco-Related Twitter Data: A Systematic Review

    Date Submitted: Nov 30, 2016

    Open Peer Review Period: Nov 30, 2016 - Jan 25, 2017

    Background: As Twitter has grown in popularity to 313 million monthly active users, researchers have increasingly been using it as a data source for tobacco-related research. Objective: The objective...

    Background: As Twitter has grown in popularity to 313 million monthly active users, researchers have increasingly been using it as a data source for tobacco-related research. Objective: The objective of this systematic review was to assess the methodological approaches of categorically coded tobacco Twitter data and make recommendations for future studies. Methods: Data sources included PsychInfo, Web of Science, PubMed, ABI/INFORM, Communication Source, and Tobacco Regulatory Science. Searches were limited to peer reviewed journals in English from January 2006 to July 2016. The initial search identified 274 articles using a Twitter keyword and a tobacco keyword. One coder reviewed all abstracts and identified 27 articles that met the following inclusion criteria: 1) original research; 2) focused on tobacco or a tobacco product; 3) analyzed Twitter data; and 4) coded Twitter data categorically. One coder extracted data collection and coding methods. Results: The most common type of Twitter data analyzed was e-cigarettes, followed by specific tobacco campaigns. The most prevalent data sources were Gnip and Twitter’s Streaming Application Programming Interface (API). The primary methods of coding were hand-coding and machine-learning. The articles predominantly coded for relevance, sentiment, theme, user/account, and location of user. Conclusions: Standards for data collection and coding should be developed to be able to more easily compare and replicate tobacco-related Twitter results. Additional recommendations include: sample Twitter’s databases multiple times, make a distinction between message attitude and emotional tone for sentiment, code images and URLs, and analyze user profiles. Being relatively novel and widely used among adolescents and Black and Hispanic individuals, Twitter could provide a rich source of tobacco surveillance data among vulnerable populations.

  • Description of the Emergence of a Health Care Online Community of Practice: Using a Netnographic Framework for Twitter Hashtag Analytics

    Date Submitted: Nov 29, 2016

    Open Peer Review Period: Nov 30, 2016 - Jan 25, 2017

    Background: The advent of social media as an educational tool is based on the assumption that online communities of practice (CoP) emerge from these interactions. These communities offer an open digit...

    Background: The advent of social media as an educational tool is based on the assumption that online communities of practice (CoP) emerge from these interactions. These communities offer an open digital space and flat role hierarchy for information sharing and provide a strong group identity, rapid flow of information, content curation, and knowledge translation. To date, no evidence verifies the existence of online CoP. Objective: We aimed to demonstrate the emergence of a online CoP through the study of social media interactions of the Free Open Access Medical education movement. Methods: We examined the social media activity in Twitter by analyzing the network centrality metrics of tweets with the #FOAMed hashtag and compared them with previously validated criteria to determine whether it was a true community of practice. Results: The centrality analytics of the FOAMed community showed marked concordance with all aspects of a general community of practice (in terms of community, domain, and practice), as well as with the specific traits of a health care community, including interdependence, community-based interactions, social control common purpose, flat hierarchy, and network-based and concrete achievement. Conclusions: This study showed the emergence of online CoP focused on education and based on social media interactions. These communities result in significant knowledge translation and practice change for their participants. Clinical Trial: N/A

  • Sexual Health and the Internet: A Cross-Sectional Study on Online Preferences amongst Adolescents

    Date Submitted: Nov 29, 2016

    Open Peer Review Period: Nov 30, 2016 - Jan 25, 2017

    Background: The internet is widely used by adolescents for sexual health information and bears the potential to increase knowledge and positively affect behavior. Objective: The objective of this stud...

    Background: The internet is widely used by adolescents for sexual health information and bears the potential to increase knowledge and positively affect behavior. Objective: The objective of this study is to assess students’ preferences when looking for sexual health information online. Methods: We conducted a cross-sectional survey amongst 9th-grade students in a convenience sample of 13 secondary schools in Berlin, Germany. During a regular school period, participants were requested to rate the importance they attribute to nine aspects of sexual health websites in a paper-based questionnaire. Bivariate and multivariable analyses were used to assess awareness and preferences by gender, age, migrant background and school type. Results: Out of 1,190 eligible students, 1,177 (98.9%) students with a mean age of 14.6 years participated (SD = .67), 52.5% were male and 52.9% had at least one parent born abroad. Participant numbers were spread equally across the three types of secondary schools in Berlin. Website aspects most frequently cited as important were easily comprehensible wording (88.3%), clear information layout (80.6%) and reliability of the website’s publisher (79.2%), whilst the visual style of a website was deemed important by the lowest number of students (35.1%). Demographic differences were particularly visible in how important respondents found publisher reliability: the odds ratio from multivariable regression for male students to select this item was .50 (reference=female, Confidence Interval (CI) .37; .69). The odds ratio for students with migrant background was .64 (reference=no migrant background, CI .50;.81) and .49 for students of the most academic set of schools (reference=least academic, CI .25;.97). Conclusions: Students prefer easily understandable online resources. Setting up sexual health websites according to the explicit preferences of the target audience might encourage usage, especially by those subpopulations less likely to critically assess information validity: Male adolescents, children of immigrants and the academically disadvantaged.

  • COPD self-management with web-based platforms: high level of integration in integrated disease management leads to higher usage in the e-Vita COPD study

    Date Submitted: Nov 24, 2016

    Open Peer Review Period: Nov 28, 2016 - Jan 23, 2017

    Background: Worldwide nearly 3 million people die from chronic obstructive pulmonary disease (COPD) every year. Integrated disease management (IDM) improves disease-specific quality of life and exerci...

    Background: Worldwide nearly 3 million people die from chronic obstructive pulmonary disease (COPD) every year. Integrated disease management (IDM) improves disease-specific quality of life and exercise capacity for people with COPD, but can also reduce hospital admissions and hospital days. Self-management of COPD through eHealth interventions has shown to be an effective method to improve the quality and efficiency of IDM. Objective: Our study, e-Vita COPD, compares different levels of integration of web-based self-management platforms in IDM in 3 primary care settings. The main aim of this study is to analyze the factors that successfully promote the use of a self-management platform for COPD patients. Methods: We investigated different implementation methods of two platforms using a parallel cohort design. The design included three different levels of integration in IDM (group 1, 2 and 3) and randomization of two levels of personal assistance for patients (group A high assistance and B no assistance). Every visit to the platforms e-Vita and Zorgdraad was tracked objectively by collecting log data (sessions and services). The amount of use and user's patterns were analyzed. Baseline characteristics were extracted from the log files, i.e. age, gender, education level, scores on the Clinical COPD Questionnaire (CCQ) and on 3 questionnaires. Multiple regression analyses were used to evaluate the care group, integration in IDM (high, medium, non) and personal assistance for the participants (high vs. low assistance) as determinants for the usage. We analyzed the educational level and self-efficacy level (GSES) as independent variables to predict the usage of the platform. A correction was made for age and gender. Results: Of the 702 invited COPD patients, 215 (31%) registered to a platform. 82 patients participated in group 1 (high integration IDM); 36 patients in group 1A (personal assistance), 46 in group 1B (low assistance). 96 patients participated in group 2 (medium integration IDM); 44 in group 2A (telephone assistance) and 52 in group 2B (low assistance). 37 patients participated in group 3 (no integration IDM). 107 users visited the platform at least once in the 15-month period. The mean (SD) number of sessions differed between the three groups 1, 2 and 3 (10.5 (SD 1.3); 8.8 (SD 1.4) and 3.7 (SD 1.8) respectively, p=0.011). The mean (SD) number of sessions differed between high assistance group 1A & 2A and low assistance group 1B & 2B; (11.8 (SD 1.3); 6.7 (SD 1.4) respectively, p=0.012). No association was found between the educational level and the usage and between the GSES and the usage. Conclusions: Use of a self-management platform is higher when the platform is an integrated part of IDM, with adequate personal assistance about how to use the platform. An implementation setup with blended care, will likely lead to increased use of the online program. Future research should provide additional insights into the preferences of different patient groups. Clinical Trial: NTR4098 (31072013)