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 4.7 for 2013

Recent Articles:

  • This is the feature image for my paper (Image from: http://www.shutterstock.com/).

    The Association Between Online Health Information–Seeking Behaviors and Health Behaviors Among Hispanics in New York City: A Community-Based...


    Background: Hispanics are the fastest-growing minority group in the United States and they suffer from a disproportionate burden of chronic diseases. Studies have shown that online health information has the potential to affect health behaviors and influence management of chronic disease for a significant proportion of the population, but little research has focused on Hispanics. Objective: The specific aim of this descriptive, cross-sectional study was to examine the association between online health information–seeking behaviors and health behaviors (physical activity, fruit and vegetable consumption, alcohol use, and hypertension medication adherence) among Hispanics. Methods: Data were collected from a convenience sample (N=2680) of Hispanics living in northern Manhattan by bilingual community health workers in a face-to-face interview and analyzed using linear and ordinal logistic regression. Variable selection and statistical analyses were guided by the Integrative Model of eHealth Use. Results: Only 7.38% (198/2680) of the sample reported online health information–seeking behaviors. Levels of moderate physical activity and fruit, vegetable, and alcohol consumption were low. Among individuals taking hypertension medication (n=825), adherence was reported as high by approximately one-third (30.9%, 255/825) of the sample. Controlling for demographic, situational, and literacy variables, online health information–seeking behaviors were significantly associated with fruit (β=0.35, 95% CI 0.08-0.62, P=.01) and vegetable (β=0.36, 95% CI 0.06-0.65, P=.02) consumption and physical activity (β=3.73, 95% CI 1.99-5.46, P<.001), but not alcohol consumption or hypertension medication adherence. In the regression models, literacy factors, which were used as control variables, were associated with 3 health behaviors: social networking site membership (used to measure one dimension of computer literacy) was associated with fruit consumption (β=0.23, 95% CI 0.05-0.42, P=.02), health literacy was associated with alcohol consumption (β=0.44, 95% CI 0.24-0.63, P<.001), and hypertension medication adherence (β=–0.32, 95% CI –0.62 to –0.03, P=.03). Models explained only a small amount of the variance in health behaviors. Conclusions: Given the promising, although modest, associations between online health information–seeking behaviors and some health behaviors, efforts are needed to improve Hispanics’ ability to access and understand health information and to enhance the availability of online health information that is suitable in terms of language, readability level, and cultural relevance.

  • Doctor-patient communication in an online forum. Image created by authors who hold the copyright.

    Impact of Scientific Versus Emotional Wording of Patient Questions on Doctor-Patient Communication in an Internet Forum: A Randomized Controlled Experiment...


    Background: Medical expert forums on the Internet play an increasing role in patient counseling. Therefore, it is important to understand how doctor-patient communication is influenced in such forums both by features of the patients or advice seekers, as expressed in their forum queries, and by characteristics of the medical experts involved. Objective: In this experimental study, we aimed to examine in what way (1) the particular wording of patient queries and (2) medical experts’ therapeutic health concepts (for example, beliefs around adhering to a distinctly scientific understanding of diagnosis and treatment and a clear focus on evidence-based medicine) impact communication behavior of the medical experts in an Internet forum. Methods: Advanced medical students (in their ninth semester of medical training) were recruited as participants. Participation in the online forum was part of a communication training embedded in a gynecology course. We first measured their biomedical therapeutic health concept (hereinafter called “biomedical concept”). Then they participated in an online forum where they answered fictitious patient queries about mammography screening that either included scientific or emotional wording in a between-group design. We analyzed participants’ replies with regard to the following dimensions: their use of scientific or emotional wording, the amount of communicated information, and their attempt to build a positive doctor-patient relationship. Results: This study was carried out with 117 medical students (73 women, 41 men, 3 did not indicate their sex). We found evidence that both the wording of patient queries and the participants’ biomedical concept influenced participants’ response behavior. They answered emotional patient queries in a more emotional way (mean 0.92, SD 1.02) than scientific patient queries (mean 0.26, SD 0.55; t74=3.48, P<.001, d=0.81). We also found a significant interaction effect between participants’ use of scientific or emotional wording and type of patient query (F2,74=10.29, P<.01, partial η2=0.12) indicating that participants used scientific wording independently of the type of patient query, whereas they used emotional wording particularly when replying to emotional patient queries. In addition, the more pronounced the medical experts’ biomedical concept was, the more scientifically (adjusted β=.20; F1,75=2.95, P=.045) and the less emotionally (adjusted β=–.22; F1,74=3.66, P=.03) they replied to patient queries. Finally, we found that participants’ biomedical concept predicted their engagement in relationship building (adjusted β=–.26): The more pronounced their biomedical concept was, the less they attempted to build a positive doctor-patient relationship (F1,74=5.39, P=.02). Conclusions: Communication training for medical experts could aim to address this issue of recognizing patients’ communication styles and needs in certain situations in order to teach medical experts how to take those aspects adequately into account. In addition, communication training should also make medical experts aware of their individual therapeutic health concepts and the consequential implications in communication situations.

  • The eHealth portal in use. Photo by Kai T.Dragland/NTNU.

    The Impact of an eHealth Portal on Health Care Professionals’ Interaction with Patients: Qualitative Study


    Background: People who undergo weight loss surgery require a comprehensive treatment program to achieve successful outcomes. eHealth solutions, such as secure online portals, create new opportunities for improved health care delivery and care, but depend on the organizational delivery systems and on the health care professionals providing it. So far, these have received limited attention and the overall adoption of eHealth solutions remains low. In this study, a secure eHealth portal was implemented in a bariatric surgery clinic and offered to their patients. During the study period of 6 months, 60 patients and 5 health care professionals had access. The portal included patient information, self-management tools, and communication features for online dialog with peers and health care providers at the bariatric surgery clinic. Objective: The aim of this study was to characterize and assess the impact of an eHealth portal on health care professionals’ interaction with patients in bariatric surgery. Methods: This qualitative case study involved a field study consisting of contextual interviews at the clinic involving observing and speaking with personnel in their actual work environment. Semi-structured in-depth interviews were conducted with health care professionals who interacted with patients through the portal. Analysis of the collected material was done inductively using thematic analysis. Results: The analysis revealed two main dimensions of using an eHealth portal in bariatric surgery: the transparency it represents and the responsibility that follows by providing it. The professionals reported the eHealth portal as (1) a source of information, (2) a gateway to approach and facilitate the patients, (3) a medium for irrevocable postings, (4) a channel that exposes responsibility and competence, and (5) a tool in the clinic. Conclusions: By providing an eHealth portal to patients in a bariatric surgery program, health care professionals can observe patients’ writings and revelations thereby capturing patient challenges and acting and implementing measures. Interacting with patients through the portal can prevent dropouts and deterioration of patients’ health. However, professionals report on organizational challenges and personal constraints related to communicating with patients in writing online. Further development of guidelines and education of health care professionals about how to handle, prioritize, communicate, and facilitate patients online is required in addition to increased attention to the organizational infrastructures and incentives for enabling such solutions in health care.

  • Screenshot of NPS MedicineWise Facebook advertising the Pharmacist Hour service.

    Provision of a Medicines Information Service to Consumers on Facebook: An Australian Case Study


    Background: Social networking sites (SNSs) have changed the way people communicate. They may also change the way people seek health advice. Objective: This study describes the provision of a medicines information service on Facebook to individual consumers. It aimed to discuss the pros and cons, and inform health and pharmacy stakeholders and researchers about the opportunities and challenges of providing such a service. Methods: We adopted an exploratory approach using a case study method. Results: NPS MedicineWise, an independent, not-for-profit Australian organization, runs a public question-and-answer service on Facebook, dubbed Pharmacist Hour. Consumers following the organization’s Facebook page are invited to post medication-related questions often with a suggested health topic. A wide range of questions and comments are posted related to medication usage. The pharmacist answers the queries, providing evidence-based medicines information and using consumer-friendly language, during the specific 1-hour period. The most popular questions in the past 12 months were related to adverse effects, treatment options for conditions, and drug interactions. The service had a mean number of engagements (defined as a like or share of the Pharmacy Hour post) of 38 (SD 19) people and a mean 5 (SD 3) questions per session. Conclusions: The Pharmacist Hour Facebook service addresses the medicines information needs of consumers and indirectly promotes other appropriate and relevant NPS MedicineWise products and services to further assist consumers. The service offers a new medium for a quality use of medicines organization committed to promoting awareness about the correct and safe use of medicines in Australia.

  • Feature image for homepage.
Created by author.

    Measuring Use of Health-Related Support on the Internet: Development of the Health Online Support Questionnaire (HOSQ)


    Background: Social support plays an important role for the perceived health in people with health problems and chronic diseases. Provision of different kinds of support during the disease trajectory is crucial for many people. Online support is ubiquitous and represents a promising modality for people with chronic diseases. There are no existing instruments that measure various aspects of online support. Objective: The objective of this study was to create a generic questionnaire regarding health-related support online that can be applied to people with various health problems and illnesses. Additionally, we wanted to test the questionnaire in a cancer population to assess its adequacy in the context of severe disease. Methods: Initial items for the Health Online Support Questionnaire (HOSQ) were inspired by sociologist James House regarding social support. An exploratory factor analysis was conducted in healthy persons or with minor health problems (n=243) on 31 initial items. The scale was reduced to 18 items and the internal consistency and reliability of the scale was examined along with content validity. Further validation was conducted by a confirmatory analysis on the 18-item scale in a cancer population (n=215). In addition, data on demographics, health problems experienced, and Internet use were collected. Results: The exploratory factor analysis on the final 18-item scale resulted in 2 factors. After scrutinizing the content, these factors were labeled “reading” and “interacting” and they demonstrated good internal consistency (Cronbach alphas .88 and .77, respectively). The factors were confirmed in the cancer population. The response pattern revealed expected differences both between the interaction and reading scales and according to age, gender, education, and health problems thereby supporting the validity of the HOSQ. Conclusions: The HOSQ may be a reliable and valid instrument for measuring the use of online support for people with health problems, but the results ought to be replicated in more studies to confirm the results for different diagnoses. If the results of this study are corroborated by future studies, the HOSQ may be used as a basis for the development of different forms of support on the Internet.

  • Google Trends and Dementia (image created by authors who hold the copyright).

    Forecasting the Incidence of Dementia and Dementia-Related Outpatient Visits With Google Trends: Evidence From Taiwan


    Background: Google Trends has demonstrated the capability to both monitor and predict epidemic outbreaks. The connection between Internet searches for dementia information and dementia incidence and dementia-related outpatient visits remains unknown. Objective: This study aimed to determine whether Google Trends could provide insight into trends in dementia incidence and related outpatient visits in Taiwan. We investigated and validated the local search terms that would be the best predictors of new dementia cases and outpatient visits. We further evaluated the nowcasting (ie, forecasting the present) and forecasting effects of Google Trends search trends for new dementia cases and outpatient visits. The long-term goal is to develop a surveillance system to help early detection and interventions for dementia in Taiwan. Methods: This study collected (1) dementia data from Taiwan’s National Health Insurance Research Database and (2) local Internet search data from Google Trends, both from January 2009 to December 2011. We investigated and validated search terms that would be the best predictors of new dementia cases and outpatient visits. We then evaluated both the nowcasting and the forecasting effects of Google Trends search trends through cross-correlation analysis of the dementia incidence and outpatient visit data with the Google Trends data. Results: The search term “dementia + Alzheimer’s disease” demonstrated a 3-month lead effect for new dementia cases and a 6-month lead effect for outpatient visits (r=.503, P=.002; r=.431, P=.009, respectively). When gender was included in the analysis, the search term “dementia” showed 6-month predictive power for new female dementia cases (r=.520, P=.001), but only a nowcasting effect for male cases (r=.430, P=.009). The search term “neurology” demonstrated a 3-month leading effect for new dementia cases (r=.433, P=.008), for new male dementia cases (r=.434, P=.008), and for outpatient visits (r=.613, P<.001). Conclusions: Google Trends established a plausible relationship between search terms and new dementia cases and dementia-related outpatient visits in Taiwan. This data may allow the health care system in Taiwan to prepare for upcoming outpatient and dementia screening visits. In addition, the validated search term results can be used to provide caregivers with caregiving-related health, skills, and social welfare information by embedding dementia-related search keywords in relevant online articles.

  • Screenshots from the myFitnessCompanion app.

    Bringing Health and Fitness Data Together for Connected Health Care: Mobile Apps as Enablers of Interoperability


    Background: A transformation is underway regarding how we deal with our health. Mobile devices make it possible to have continuous access to personal health information. Wearable devices, such as Fitbit and Apple’s smartwatch, can collect data continuously and provide insights into our health and fitness. However, lack of interoperability and the presence of data silos prevent users and health professionals from getting an integrated view of health and fitness data. To provide better health outcomes, a complete picture is needed which combines informal health and fitness data collected by the user together with official health records collected by health professionals. Mobile apps are well positioned to play an important role in the aggregation since they can tap into these official and informal health and data silos. Objective: The objective of this paper is to demonstrate that a mobile app can be used to aggregate health and fitness data and can enable interoperability. It discusses various technical interoperability challenges encountered while integrating data into one place. Methods: For 8 years, we have worked with third-party partners, including wearable device manufacturers, electronic health record providers, and app developers, to connect an Android app to their (wearable) devices, back-end servers, and systems. Results: The result of this research is a health and fitness app called myFitnessCompanion, which enables users to aggregate their data in one place. Over 6000 users use the app worldwide to aggregate their health and fitness data. It demonstrates that mobile apps can be used to enable interoperability. Challenges encountered in the research process included the different wireless protocols and standards used to communicate with wireless devices, the diversity of security and authorization protocols used to be able to exchange data with servers, and lack of standards usage, such as Health Level Seven, for medical information exchange. Conclusions: By limiting the negative effects of health data silos, mobile apps can offer a better holistic view of health and fitness data. Data can then be analyzed to offer better and more personalized advice and care.

  • http://www.freedigitalphotos.net/images/Internet_g170-Hand_Pressing_On_Email_Icon_p104792.html; By watcharakun, published on 03 October 2012 Stock Photo - image ID: 100104792.

    Using the Consolidated Framework for Implementation Research to Identify Barriers and Facilitators for the Implementation of an Internet-Based...


    Background: Although there is growing evidence of the positive effects of Internet-based patient-provider communication (IPPC) services for both patients and health care providers, their implementation into clinical practice continues to be a challenge. Objective: The 3 aims of this study were to (1) identify and compare barriers and facilitators influencing the implementation of an IPPC service in 5 hospital units using the Consolidated Framework for Implementation Research (CFIR), (2) assess the ability of the different constructs of CFIR to distinguish between high and low implementation success, and (3) compare our findings with those from other studies that used the CFIR to discriminate between high and low implementation success. Methods: This study was based on individual interviews with 10 nurses, 6 physicians, and 1 nutritionist who had used the IPPC to answer messages from patients. Results: Of the 36 CFIR constructs, 28 were addressed in the interviews, of which 12 distinguished between high and low implementation units. Most of the distinguishing constructs were related to the inner setting domain of CFIR, indicating that institutional factors were particularly important for successful implementation. Health care providers’ beliefs in the intervention as useful for themselves and their patients as well as the implementation process itself were also important. A comparison of constructs across ours and 2 other studies that also used the CFIR to discriminate between high and low implementation success showed that 24 CFIR constructs distinguished between high and low implementation units in at least 1 study; 11 constructs distinguished in 2 studies. However, only 2 constructs (patient need and resources and available resources) distinguished consistently between high and low implementation units in all 3 studies. Conclusions: The CFIR is a helpful framework for illuminating barriers and facilitators influencing IPPC implementation. However, CFIR’s strength of being broad and comprehensive also limits its usefulness as an implementation framework because it does not discriminate between the relative importance of its many constructs for implementation success. This is the first study to identify which CFIR constructs are the most promising to distinguish between high and low implementation success across settings and interventions. Findings from this study can contribute to the refinement of CFIR toward a more succinct and parsimonious framework for planning and evaluation of the implementation of clinical interventions. ClinicalTrial: Clinicaltrials.gov NCT00971139; http://clinicaltrial.gov/ct2/show/NCT00971139 (Archived by WebCite at http://www.webcitation.org/6cWeqN1uY)

  • ALICE screenshot.

    Web-Based Immersive Virtual Patient Simulators: Positive Effect on Clinical Reasoning in Medical Education


    Background: Clinical reasoning is based on the declarative and procedural knowledge of workflows in clinical medicine. Educational approaches such as problem-based learning or mannequin simulators support learning of procedural knowledge. Immersive patient simulators (IPSs) go one step further as they allow an illusionary immersion into a synthetic world. Students can freely navigate an avatar through a three-dimensional environment, interact with the virtual surroundings, and treat virtual patients. By playful learning with IPS, medical workflows can be repetitively trained and internalized. As there are only a few university-driven IPS with a profound amount of medical knowledge available, we developed a university-based IPS framework. Our simulator is free to use and combines a high degree of immersion with in-depth medical content. By adding disease-specific content modules, the simulator framework can be expanded depending on the curricular demands. However, these new educational tools compete with the traditional teaching Objective: It was our aim to develop an educational content module that teaches clinical and therapeutic workflows in surgical oncology. Furthermore, we wanted to examine how the use of this module affects student performance. Methods: The new module was based on the declarative and procedural learning targets of the official German medical examination regulations. The module was added to our custom-made IPS named ALICE (Artificial Learning Interface for Clinical Education). ALICE was evaluated on 62 third-year students. Results: Students showed a high degree of motivation when using the simulator as most of them had fun using it. ALICE showed positive impact on clinical reasoning as there was a significant improvement in determining the correct therapy after using the simulator. ALICE positively impacted the rise in declarative knowledge as there was improvement in answering multiple-choice questions before and after simulator use. Conclusions: ALICE has a positive effect on knowledge gain and raises students’ motivation. It is a suitable tool for supporting clinical education in the blended learning context.

  • Finger touch hand structure by geralt (Creative Commons: https://pixabay.com/en/finger-touch-hand-structure-769300).

    Mobile Phone and Web 2.0 Technologies for Weight Management: A Systematic Scoping Review


    Background: Widespread diffusion of mobile phone and Web 2.0 technologies make them potentially useful tools for promoting health and tackling public health issues, such as the increasing prevalence of overweight and obesity. Research in this domain is growing rapidly but, to date, no review has comprehensively and systematically documented how mobile and Web 2.0 technologies are being deployed and evaluated in relation to weight management. Objective: To provide an up-to-date, comprehensive map of the literature discussing the use of mobile phone and Web 2.0 apps for influencing behaviors related to weight management (ie, diet, physical activity [PA], weight control, etc). Methods: A systematic scoping review of the literature was conducted based on a published protocol (registered at PROSPERO: CRD42014010323). Using a comprehensive search strategy, we searched 16 multidisciplinary electronic databases for original research documents published in English between 2004 and 2014. We used duplicate study selection and data extraction. Using an inductively developed charting tool, selected articles were thematically categorized. Results: We identified 457 articles, mostly published between 2013 and 2014 in 157 different journals and 89 conference proceedings. Articles were categorized around two overarching themes, which described the use of technologies for either (1) promoting behavior change (309/457, 67.6%) or (2) measuring behavior (103/457, 22.5%). The remaining articles were overviews of apps and social media content (33/457, 7.2%) or covered a combination of these three themes (12/457, 2.6%). Within the two main overarching themes, we categorized articles as representing three phases of research development: (1) design and development, (2) feasibility studies, and (3) evaluations. Overall, articles mostly reported on evaluations of technologies for behavior change (211/457, 46.2%). Conclusions: There is an extensive body of research on mobile phone and Web 2.0 technologies for weight management. Research has reported on (1) the development, feasibility, and efficacy of persuasive mobile technologies used in interventions for behavior change (PA and diet) and (2) the design, feasibility, and accuracy of mobile phone apps for behavioral assessment. Further research has focused exclusively on analyses of the content and quality of available apps. Limited evidence exists on the use of social media for behavior change, but a segment of studies deal with content analyses of social media. Future research should analyze mobile phone and Web 2.0 technologies together by combining the evaluation of content and design aspects with usability, feasibility, and efficacy/effectiveness for behavior change, or accuracy/validity for behavior assessment, in order to understand which technological components and features are likely to result in effective interventions.

  • Heart failure telemonitoring.

This image was created by the authors.

    Heart Failure Telemonitoring in Japan and Sweden: A Cross-Sectional Survey


    Background: Telemonitoring of heart failure (HF) patients is increasingly discussed at conferences and addressed in research. However, little is known about actual use in specific countries. Objective: We aimed to (1) describe the use of non-invasive HF telemonitoring, (2) clarify expectations of telemonitoring among cardiologists and nurses, and (3) describe barriers to the implementation of telemonitoring in Japan and Sweden. Methods: This study used a cross-sectional survey of non-invasive HF telemonitoring. A total of 378 Japanese (120 cardiologists, 258 nurses) and 120 Swedish (39 cardiologists, 81 nurses) health care professionals from 165 Japanese and 61 Swedish hospitals/clinics nationwide participated in the study (210 in Japan and 98 in Sweden were approached). Data were collected between November 2013 and May 2014 with a questionnaire that was adapted from a previous Dutch study on telemonitoring. Results: The mean age of the cardiologists and nurses was 47 years and 41 years, respectively. Experience at the current position caring for HF patients was 19 years among the physicians and 15 years among the nurses. In total, 7 Japanese (4.2%) and none of the Swedish health care institutions used telemonitoring. One fourth (24.0%, 118/498) of the health care professionals were familiar with the technology (in Japan: 21.6%, 82/378; in Sweden: 30.0%, 36/120). The highest expectations of telemonitoring (rated on a scale from 0-10) were reduced hospitalizations (8.3 in Japan and 7.5 in Sweden), increased patient self-care (7.8 and 7.4), and offering high-quality care (7.8 and 7.0). The major goal for introducing telemonitoring was to monitor physical condition and recognize signs of worsening HF in Japan (94.1%, 352/374) and Sweden (88.7%, 102/115). The following reasons were also high in Sweden: to monitor effects of treatment and adjust it remotely (86.9%, 100/115) and to do remote drug titration (79.1%, 91/115). Just under a quarter of Japanese (22.4%, 85/378) and over a third of Swedish (38.1%, 45/118) health care professionals thought that telemonitoring was a good way to follow up stable HF patients. Three domains of barriers were identified by content analysis: organizational barriers “how are we going to do it?” (categories include structure and resource), health care professionals themselves “what do we need to know and do” (reservation), and barriers related to patients “not everybody would benefit” (internal and external shortcomings). Conclusions: Telemonitoring for HF patients has not been implemented in Japan or Sweden. However, health care professionals have expectations of telemonitoring to reduce patients’ hospitalizations and increase patient self-care. There are still a wide range of barriers to the implementation of HF telemonitoring.

  • How to deal with weight gain when recovering from an ED [This screenshot image is from the public domain (url: https://www.youtube.com/watch?v=s20gIUzZXDk)].

    Pro-Anorexia and Anti-Pro-Anorexia Videos on YouTube: Sentiment Analysis of User Responses


    Background: Pro-anorexia communities exist online and encourage harmful weight loss and weight control practices, often through emotional content that enforces social ties within these communities. User-generated responses to videos that directly oppose pro-anorexia communities have not yet been researched in depth. Objective: The aim was to study emotional reactions to pro-anorexia and anti-pro-anorexia online content on YouTube using sentiment analysis. Methods: Using the 50 most popular YouTube pro-anorexia and anti-pro-anorexia user channels as a starting point, we gathered data on users, their videos, and their commentators. A total of 395 anorexia videos and 12,161 comments were analyzed using positive and negative sentiments and ratings submitted by the viewers of the videos. The emotional information was automatically extracted with an automatic sentiment detection tool whose reliability was tested with human coders. Ordinary least squares regression models were used to estimate the strength of sentiments. The models controlled for the number of video views and comments, number of months the video had been on YouTube, duration of the video, uploader’s activity as a video commentator, and uploader’s physical location by country. Results: The 395 videos had more than 6 million views and comments by almost 8000 users. Anti-pro-anorexia video comments expressed more positive sentiments on a scale of 1 to 5 (adjusted prediction [AP] 2.15, 95% CI 2.11-2.19) than did those of pro-anorexia videos (AP 2.02, 95% CI 1.98-2.06). Anti-pro-anorexia videos also received more likes (AP 181.02, 95% CI 155.19-206.85) than pro-anorexia videos (AP 31.22, 95% CI 31.22-37.81). Negative sentiments and video dislikes were equally distributed in responses to both pro-anorexia and anti-pro-anorexia videos. Conclusions: Despite pro-anorexia content being widespread on YouTube, videos promoting help for anorexia and opposing the pro-anorexia community were more popular, gaining more positive feedback and comments than pro-anorexia videos. Thus, the anti-pro-anorexia content provided a user-generated counterforce against pro-anorexia content on YouTube. Professionals working with young people should be aware of the social media dynamics and versatility of user-generated eating disorder content online.

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  • OCD Treatment Online: Preliminary results of the OCD? Not Me! self-guided iCBT program for young people with OCD

    Date Submitted: Nov 22, 2015

    Open Peer Review Period: Nov 24, 2015 - Jan 19, 2016

    Background: The development and evaluation of e-mental health interventions provides a potential solution for current limitations in the acceptability, availability and accessibility of mental health...

    Background: The development and evaluation of e-mental health interventions provides a potential solution for current limitations in the acceptability, availability and accessibility of mental health care for young people with obsessive-compulsive disorder (OCD). This study is the first of its kind to report on the effectiveness of fully-automated online treatment for young people (12-18 years) with OCD. Objective: We aimed to conduct a preliminary evaluation of the effectiveness of the OCD? Not Me! program for reducing OCD-related psychopathology in young people (12-18 years). This program is an eight-stage, fully-automated online cognitive behavioural treatment for OCD. Methods: The current data were taken from a parent study in which an open trial design is being used to evaluate the effectiveness of the OCD? Not Me! program. Participants were required to have at least subclinical levels of OCD to be offered the online program. Participants with moderate-high suicide/self-harm risk, or symptoms of eating disorder or psychosis were not offered the program. OCD symptoms and severity were measured at pre- and post-test, and at the beginning of each stage of the program. Data were analysed with generalized linear mixed models (GLMM). Results: A total of 334 people were screened for inclusion in the study, with 132 participants aged 12-18 years providing data for the final analysis. Participants showed significant reductions in OCD symptoms (P < .001) and severity (P < .001) between pre- and post-test. Conclusions: These preliminary results suggest that fully-automated iCBT holds promise as way of increasing access to treatment for young people with OCD, however further research needs to be conducted to replicate the results and to determine the feasibility of the program. Clinical Trial: The trial was registered on 8 February 2013 with the Australian New Zealand Clinical Trials Registry (ACTRN12613000152729).

  • Devices for self-monitoring sedentary time and/or physical activity: A systematic review

    Date Submitted: Nov 24, 2015

    Open Peer Review Period: Nov 24, 2015 - Dec 2, 2015

    Background: It is well documented that guideline fulfilling (150 minutes per week) levels of moderate-to-vigorous physical activity (PA) are protective against chronic disease. Conversely, emerging ev...

    Background: It is well documented that guideline fulfilling (150 minutes per week) levels of moderate-to-vigorous physical activity (PA) are protective against chronic disease. Conversely, emerging evidence indicates the deleterious effects of prolonged sitting. Therefore, there is a need to change both behaviours. Self-monitoring of behaviour has been established as one of the most robust behaviour change techniques available. The growing number of technologies in the consumer electronics (CE) sector provides a unique opportunity for individuals to self-monitor their behaviour. Objective: Therefore, it seems timely to review the characteristics and measurement properties of currently available self-monitoring devices for sedentary time (ST) and/or PA. Methods: To identify technologies, four scientific databases were systematically searched using key terms related to behaviour, measurement and population. Articles published through October 2014 were identified. To identify technologies from the CE sector, systematic searches of three internet search engines were also performed through to October 2015. Results: Initial database searches identified 46 devices and internet search engines identified 100 device yielding a total of 146 technologies. Of these, 64 were further removed because there was no evidence that they were designed for, have been used in, or could readily be modified for self-monitoring purposes or that they are currently unavailable for purchase. The remaining 82 technologies were included in this review (73 devices self-monitor PA, 9 devices self-monitor SB). Conclusions: Of the 83 devices included, this review identified no published articles in which these devices have been used for the purpose of self-monitoring physical activity and/or sedentary behaviour, however a number of technologies have been found via internet searches which match the criteria to self-monitor and provide immediate feedback on PA; (ActiGraph Link, Microsoft Band, and Garmin Vivofit ) and SB; (activPAL VT, the Lumo Back, and Darma,). There are a large number that self-monitor PA however, there is a greater need for the development of tools to self-monitor SB. The novelty of these devices means they have yet to be used in behaviour change interventions however with the growing field of wearable technology may facilitate this to change.

  • Electronic Adherence Monitoring in a High Utilizing Pediatric Asthma Cohort: A Feasibility Study

    Date Submitted: Nov 21, 2015

    Open Peer Review Period: Nov 21, 2015 - Jan 16, 2016

    Background: Inner-city, minority children with asthma have highest rates of morbidity and death from asthma and the lowest rates of asthma controller medication adherence. A number of recent electroni...

    Background: Inner-city, minority children with asthma have highest rates of morbidity and death from asthma and the lowest rates of asthma controller medication adherence. A number of recent electronic medication monitoring interventions demonstrated dramatic improvements in adherence in lower risk populations. The feasibility and acceptability of such an intervention in the highest risk children with asthma has not been studied. Objective: Our objective was to assess feasibility and acceptability of a community health worker delivered, electronic adherence monitoring intervention among the highest utilizers of acute asthma care in an inner city practice. Methods: This was a prospective cohort pilot study of targeting the 50 children with the highest frequency of asthma-related emergency department and hospital care within a local managed care Medicaid plan. The 3-month intervention included motivational interviewing, electronic monitoring of controller and rescue inhaler use, and outreach by a community health worker for predefined medication alerts. Acceptability was measured using a modified Technology Acceptability Model and changes in asthma control using the Asthma Control Test (ACT). A classification framework was developed to describe different patterns of medication use. Results: We enrolled fourteen non-Hispanic Black children with a mean age of 3.5. Subjects averaged 7.8 emergency or hospital visits in the year preceding enrollment. All subjects initiated use of the electronic devices, however, no modem signal was transmitted for 5/14 subjects after a mean of 45 days. All (100%) of the caregivers who completed the final study visit viewed the electronic monitoring device favorably and would recommend it to friends and 56% believed the device helped to improve asthma control. ACT scores improved by a mean of 2.7 points (P=0.05) over the 3-month intervention. We observed three distinct patterns of controller use; four patients demonstrated sustained use, 5 patients had periodic use, and 5 patients lapsed within two weeks. Conclusions: High utilizer, minority families with asthma found a community health worker delivered, electronic adherence intervention acceptable. Feasibility concerns, such as recruitment, data transmission failure and lost devices, should be carefully considered when designing interventions in this setting. High asthma care utilizers demonstrated three qualitatively different patterns of controller use.

  • Frugal innovation and personalized health technology

    Date Submitted: Nov 19, 2015

    Open Peer Review Period: Nov 19, 2015 - Jan 14, 2016

    Personalised health technologies – devices like wearables, smartwatches, and mobile health applications – enable users to quantify their health behaviors. Despite their potential to advance health...

    Personalised health technologies – devices like wearables, smartwatches, and mobile health applications – enable users to quantify their health behaviors. Despite their potential to advance health for all populations, personalised health technologies are used largely by the healthy and wealthy. They remain unaffordable, inaccessible, and largely unusable for marginalized populations who often have the greatest health needs. The creation of personalised health technologies using a frugal innovation mindset combined with stakeholder collaboration among the public and private sectors are proposed as strategies to ensure the disruptive technology advantages all populations.

  • A Data-Driven Approach to Characterizing the (Perceived) Newsworthiness of Health Science Articles

    Date Submitted: Nov 18, 2015

    Open Peer Review Period: Nov 19, 2015 - Jan 14, 2016

    Background: Health science findings are primarily disseminated through manuscript publications, and are then communicated to the public by the news media. Journalists and communication staff members s...

    Background: Health science findings are primarily disseminated through manuscript publications, and are then communicated to the public by the news media. Journalists and communication staff members select which articles receive coverage and thus public attention. Objective: This study aims to identify attributes of published health science articles that correlate with (1) journal editor issuance of press releases and (2) mainstream media coverage. Methods: We constructed four novel datasets to identify factors that correlate with press release issuance and media coverage. These corpora include thousands of published articles, subsets of which received a press release or mainstream media coverage. We used statistical machine learning methods to identify correlations between words in the science abstracts and press release issuance and media coverage. Further, we used topic modeling-based machine learning approach to uncover latent topics predictive of perceived newsworthiness in each of the datasets. Results: Both press release issuance for and media coverage of health science articles are predictable from corresponding journal article content. For the former task, we achieved average AUCs of 0.666 and 0.822 on two separate datasets, with size 3024 and 10760. For the latter task, models realized mean AUCs of 0.591 and 0.783 on two datasets, with size 422 and 28910. We reported most predictive words and topics for press release or news coverage. Conclusions: We have presented a novel data-driven characterization of content that renders health science "news-worthy". The analysis provides new insights into the news coverage selection process.

  • Acceptability of mental health apps for Aboriginal and Torres Strait Islander Australians: A qualitative study.

    Date Submitted: Nov 15, 2015

    Open Peer Review Period: Nov 16, 2015 - Jan 11, 2016

    Background: Aboriginal and Torres Strait Islander Australians experience high rates of mental illness and psychological distress compared to their non-Indigenous counterparts. Electronic mental health...

    Background: Aboriginal and Torres Strait Islander Australians experience high rates of mental illness and psychological distress compared to their non-Indigenous counterparts. Electronic mental health (e-mental health) tools offer an opportunity for accessible, effective and acceptable treatment. The AIMhi Stay Strong App and the ibobbly suicide prevention App are treatment tools designed to combat the disproportionately high levels of mental illness and stress experienced within the Aboriginal and Torres Strait Islander community. Objective: This study aimed to explore Aboriginal and Torres Strait Islander community members’ experiences of using two culturally responsive e-mental health apps and identify factors which influence the acceptability of these approaches. Methods: Using a phenomenological approach we explored the acceptability of two culturally responsive e-mental health apps through a series of three, three-hour focus groups with nine Aboriginal and Torres Strait Islander community members. Thematic analysis was conducted and co-researcher and member checking were used to verify findings. Results: Findings suggest strong support for the concept of e-mental health apps and optimism for their potential. Factors that influence acceptability related to three key themes: personal factors, such as motivation, severity and awareness of illness, technological competence and literacy levels; environmental factors, such as community awareness, stigma and availability of support; and app characteristics, such as ease of use, content, graphics, access and security and information sharing. Specific adaptions, such as local production, culturally relevant content and graphics, a purposeful journey, clear navigation, meaningful language, options to assist people with poor literacy, offline use and password protection may aid uptake. Conclusions: When designed to meet the needs of Aboriginal and Torres Strait Islander Australians, e-mental health tools add an important element to public health approaches to improving the wellbeing of Aboriginal and Torres Strait Islander people.