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

The Effect of Age on Use and Perceptions about e-Health by Men with Prostate Cancer: Results from an Online Survey

Background: Men with prostate cancer require ample information and support along the continuum of care, and e-health is one way to meet such critical information and support needs. Currently, evidence about how age influences use and perceptions about prostate cancer e-health information is lacking. Objective: The aim of this paper is to explore use and perceptions about e-health among men living with prostate cancer. Specifically, we analyze men with prostate cancer by age-specific cohorts to identify potential age-related differences in use and perceptions about prostate cancer e-health information. Methods: We used survey methodology to examine how men under 65 years old with prostate cancer differ from those aged 65 years old or older in use and perceptions about prostate cancer e-health information (n = 297). Results: We found that men in the younger cohort used the Internet more often to be informed about treatment options (P = .04) and to learn more about staging/grading (P = .01) than men in the older cohort. Results also showed comparatively greater use of online prostate cancer information for emotional support and encouragement by the younger as compared to the older cohort (P < .001). Furthermore, the older cohort experienced more negative psychosocial effects of e-health (e.g., more anxious, depressed) than younger men (P = .003). We also found that as a result of more frequent Internet use younger men experienced more positive psychosocial effects (e.g., more informed, in control) from accessing information about prostate cancer through e-health channels (b = -0.10, 95% CI [-.26, -.01]). Conclusions: Men with prostate cancer have different information and support needs; our findings suggest that these needs may vary by age. Since using the Internet for e-health information resulted in more positive psychosocial effects, men under 65 years old may benefit from having access to non-static Web technologies, while men 65 years old and older may benefit from assistance with using the Internet in more advanced ways.

Recent Articles:

  • Spinal Cord Injury Rehabilitation Evidence (SCIRE) Logo.

    Impact of an Online Medical Internet Site on Knowledge and Practice of Health Care Providers: A Mixed Methods Study of the Spinal Cord Injury Rehabilitation...

    Abstract:

    Background: It is not known whether ongoing access to a broad-based Internet knowledge resource can influence the practice of health care providers. We undertook a study to evaluate the impact of a Web-based knowledge resource on increasing access to evidence and facilitating best practice of health care providers. Objective: The objective of this study was to evaluate (1) the impact of the Spinal Cord Injury Rehabilitation Evidence (SCIRE) project on access to information for health care providers and researchers and (2) how SCIRE influenced health care providers' management of clients. Methods: A 4-part mixed methods evaluation was undertaken: (1) monitoring website traffic and utilization using Google Analytics, (2) online survey of users who accessed the SCIRE website, (3) online survey of targeted end-users, that is, rehabilitation health care providers known to work with spinal cord injury (SCI) clients, as well as researchers, and (4) focus groups with health care providers who had previously accessed SCIRE. Results: The online format allowed the content for a relatively specialized field to have far reach (eg, 26 countries and over 6500 users per month). The website survey and targeted end-user survey confirmed that health care providers, as well as researchers perceived that the website increased their access to SCI evidence. Access to SCIRE not only improved knowledge of SCI evidence but helped inform changes to the health providers’ clinical practice and improved their confidence in treating SCI clients. The SCIRE information directly influenced the health providers’ clinical decision making, in terms of choice of intervention, equipment needs, or assessment tool. Conclusions: A Web-based knowledge resource may be a relatively inexpensive method to increase access to evidence-based information, increase knowledge of the evidence, inform changes to the health providers’ practice, and influence their clinical decision making.

  • https://www.youtube.com/watch?v=RBTkpsQiDcM.

    Therapeutic Affordances of Social Media: Emergent Themes From a Global Online Survey of People With Chronic Pain

    Abstract:

    Background: Research continues to present tenuous suggestions that social media is well suited to enhance management of chronic disease and improve health outcomes. Various studies have presented qualitative reports of health outcomes from social media use and have examined discourse and communication themes occurring through different social media. However, there is an absence of published studies examining and unpacking the underlying therapeutic mechanisms driving social media’s effects. Objective: This paper presents a qualitative analysis thoroughly describing what social media therapeutically affords people living with chronic pain who are self-managing their condition. From this therapeutic affordance perspective, we aim to formulate a preliminary conceptual model aimed at better understanding "how" social media can influence patient outcomes. Methods: In total, 218 people with chronic pain (PWCP) completed an online survey, investigating patient-reported outcomes (PROs) from social media use. Supplementary to quantitative data collected, participants were also given the opportunity to provide further open commentary regarding their use of social media as part of chronic pain management; 68/218 unique users (31.2%) chose to provide these free-text responses. Through thematic content analysis, 117 free-text responses regarding 10 types of social media were coded. Quotes were extracted and tabulated based on therapeutic affordances that we had previously identified. Inductive analysis was then performed to code defining language and emergent themes central to describing each affordance. Three investigators examined the responses, developed the coding scheme, and applied the coding to the data. Results: We extracted 155 quotes from 117 free-text responses. The largest source of quotes came from social network site users (78/155, 50.3%). Analysis of component language used to describe the aforementioned affordances and emergent themes resulted in a final revision and renaming of therapeutic affordances: "exploration" (52/155, 33.5% of quotes), "connection" (50/155, 32.3% of quotes), "narration" (33/155, 21.3% of quotes), "adaptation" (13/155, 8.4% of quotes), and "self-presentation" (7/155, 4.5% of quotes). Of the most described affordances, "exploration" was based on a propensity for participants to explain their social media use for information seeking purposes. "Connection" placed greater emphasis on interaction, highlighting themes of "exchanging information" and "mitigating isolation". Responses regarding "narration" highlighted the value of shared experiences and the emotionally cathartic role this plays. Conclusions: Much of the efficacy of social media may be explicable via a closer examination of therapeutic affordances. Particular areas that warrant attention include social media’s ability to filter and guide people to useful information, connect individuals, and share experiences. Further research into a variety of chronic conditions is warranted. Coupled with the results of the present study, a greater theoretical basis detailing how social media may foster health outcomes may lead to an improved evidence base for conducting research and may inform recommendations for social media use in chronic disease management.

  • Image Source: Gettyimages.

    Ethical Issues in Using Twitter for Public Health Surveillance and Research: Developing a Taxonomy of Ethical Concepts From the Research Literature

    Authors List:

    Abstract:

    Background: The rise of social media and microblogging platforms in recent years, in conjunction with the development of techniques for the processing and analysis of “big data”, has provided significant opportunities for public health surveillance using user-generated content. However, relatively little attention has been focused on developing ethically appropriate approaches to working with these new data sources. Objective: Based on a review of the literature, this study seeks to develop a taxonomy of public health surveillance-related ethical concepts that emerge when using Twitter data, with a view to: (1) explicitly identifying a set of potential ethical issues and concerns that may arise when researchers work with Twitter data, and (2) providing a starting point for the formation of a set of best practices for public health surveillance through the development of an empirically derived taxonomy of ethical concepts. Methods: We searched Medline, Compendex, PsycINFO, and the Philosopher’s Index using a set of keywords selected to identify Twitter-related research papers that reference ethical concepts. Our initial set of queries identified 342 references across the four bibliographic databases. We screened titles and abstracts of these references using our inclusion/exclusion criteria, eliminating duplicates and unavailable papers, until 49 references remained. We then read the full text of these 49 articles and discarded 36, resulting in a final inclusion set of 13 articles. Ethical concepts were then identified in each of these 13 articles. Finally, based on a close reading of the text, a taxonomy of ethical concepts was constructed based on ethical concepts discovered in the papers. Results: From these 13 articles, we iteratively generated a taxonomy of ethical concepts consisting of 10 top level categories: privacy, informed consent, ethical theory, institutional review board (IRB)/regulation, traditional research vs Twitter research, geographical information, researcher lurking, economic value of personal information, medical exceptionalism, and benefit of identifying socially harmful medical conditions. Conclusions: In summary, based on a review of the literature, we present a provisional taxonomy of public health surveillance-related ethical concepts that emerge when using Twitter data.

  • (cc) Fradgley et al. CC-BY-SA-2.0, please cite as http://www.jmir.org/article/viewFile/3545/1/49404. This image is of a participant navigating the Web-based survey using a touchscreen tablet device.

    Consumer Participation in Quality Improvements for Chronic Disease Care: Development and Evaluation of an Interactive Patient-Centered Survey to Identify...

    Abstract:

    Background: With increasing attention given to the quality of chronic disease care, a measurement approach that empowers consumers to participate in improving quality of care and enables health services to systematically introduce patient-centered initiatives is needed. A Web-based survey with complex adaptive questioning and interactive survey items would allow consumers to easily identify and prioritize detailed service initiatives. Objective: The aim was to develop and test a Web-based survey capable of identifying and prioritizing patient-centered initiatives in chronic disease outpatient services. Testing included (1) test-retest reliability, (2) patient-perceived acceptability of the survey content and delivery mode, and (3) average completion time, completion rates, and Flesch-Kincaid reading score. Methods: In Phase I, the Web-based Consumer Preferences Survey was developed based on a structured literature review and iterative feedback from expert groups of service providers and consumers. The touchscreen survey contained 23 general initiatives, 110 specific initiatives available through adaptive questioning, and a relative prioritization exercise. In Phase II, a pilot study was conducted within 4 outpatient clinics to evaluate the reliability properties, patient-perceived acceptability, and feasibility of the survey. Eligible participants were approached to complete the survey while waiting for an appointment or receiving intravenous therapy. The age and gender of nonconsenters was estimated to ascertain consent bias. Participants with a subsequent appointment within 14 days were asked to complete the survey for a second time. Results: A total of 741 of 1042 individuals consented to participate (71.11% consent), 529 of 741 completed all survey content (78.9% completion), and 39 of 68 completed the test-retest component. Substantial or moderate reliability (Cohen’s kappa>0.4) was reported for 16 of 20 general initiatives with observed percentage agreement ranging from 82.1%-100.0%. The majority of participants indicated the Web-based survey was easy to complete (97.9%, 531/543) and comprehensive (93.1%, 505/543). Participants also reported the interactive relative prioritization exercise was easy to complete (97.0%, 189/195) and helped them to decide which initiatives were of most importance (84.6%, 165/195). Average completion time was 8.54 minutes (SD 3.91) and the Flesch-Kincaid reading level was 6.8. Overall, 84.6% (447/529) of participants indicated a willingness to complete a similar survey again. Conclusions: The Web-based Consumer Preferences Survey is sufficiently reliable and highly acceptable to patients. Based on completion times and reading level, this tool could be integrated in routine clinical practice and allows consumers to easily participate in quality evaluation. Results provide a comprehensive list of patient-prioritized initiatives for patients with major chronic conditions and delivers practice-ready evidence to guide improvements in patient-centered care.

  • PainCoach screenshot.

    Retaining Critical Therapeutic Elements of Behavioral Interventions Translated For Delivery via the Internet: Recommendations and an Example Using Pain...

    Abstract:

    Evidence supporting the efficacy of behavioral interventions based on principles of cognitive behavioral therapies has spurred interest in translating these interventions for delivery via the Internet. However, the benefits of this dissemination method cannot be realized unless the translated interventions are as effective as possible. We describe a challenge that must be overcome to ensure this occurs—Internet interventions must retain therapeutic components and processes underlying the success of face-to-face interventions on which they are based. These components and processes vary in the ease with which they can be translated to the online environment. Moreover, some are subtle and may be overlooked, despite being recognized as essential to the success of face-to-face interventions. We provide preliminary guidance for retaining critical therapeutic components and processes in the translation process, using Pain Coping Skills Training for osteoarthritis pain to illustrate methods. Directions for future research are also discussed.

  • Virtual Reality Interior Design Application for Occupational Therapy.

    Occupational Therapists’ Views on Using a Virtual Reality Interior Design Application Within the Pre-Discharge Home Visit Process

    Abstract:

    Background: A key role of Occupational Therapists (OTs) is to carry out pre-discharge home visits (PHV) and propose appropriate adaptations to the home environment in order to enable patients to function independently after hospital discharge. However, research shows that more than 50% of specialist equipment installed as part of home adaptations is not used by patients. A key reason for this is that decisions about home adaptations are often made without adequate collaboration and consultation with the patient. Consequently, there is an urgent need to seek out new and innovative uses of technology to facilitate patient/practitioner collaboration, engagement, and shared decision making in the PHV process. Virtual reality interior design applications (VRIDAs) primarily allow users to simulate the home environment and visualize changes prior to implementing them. Customized VRIDAs, which also model specialist occupational therapy equipment, could become a valuable tool to facilitate improved patient/practitioner collaboration, if developed effectively and integrated into the PHV process. Objective: The intent of the study was to explore the perceptions of OTs with regard to using VRIDAs as an assistive tool within the PHV process. Methods: Task-oriented interactive usability sessions, utilizing the think-aloud protocol and subsequent semi-structured interviews were carried out with seven OTs who possessed significant experience across a range of clinical settings. Template analysis was carried out on the think-aloud and interview data. Analysis was both inductive and driven by theory, centering around the parameters that impact upon the acceptance, adoption, and use of this technology in practice as indicated by the Technology Acceptance Model (TAM). Results: OTs’ perceptions were identified relating to three core themes: (1) perceived usefulness (PU), (2) perceived ease of use (PEoU), and (3) actual use (AU). Regarding PU, OTs believed VRIDAs had promising potential to increase understanding, enrich communication and patient involvement, and improve patient/practitioner shared understanding. However, it was unlikely that VRIDAs would be suitable for use with cognitively impaired patients. For PEoU, all OTs were able to use the software and complete the tasks successfully; however, participants noted numerous specialist equipment items that could be added to the furniture library. AU perceptions were positive regarding use of the application across a range of clinical settings including children/young adults, long-term conditions, neurology, older adults, and social services. However, some “fine tuning” may be necessary if the application is to be optimally used in practice. Conclusions: Participants perceived the use of VRIDAs in practice would enhance levels of patient/practitioner collaboration and provide a much needed mechanism via which patients are empowered to become more equal partners in decisions made about their care. Further research is needed to explore patient perceptions of VRIDAs, to make necessary customizations accordingly, and to explore deployment of the application in a collaborative patient/practitioner-based context.

  • Illustrative photo of the intervention. Picture taken by the developers of WebChoice at Centre for Shared Decision Making and Collaborative Care Research. Licensed under Creative Commons Attribution (please cite the JMIR article).

    Comparing Effects in Regular Practice of E-Communication and Web-Based Self-Management Support Among Breast Cancer Patients: Preliminary Results From a...

    Abstract:

    Background: While Web-based interventions have been shown to assist a wide range of patients successfully in managing their illness, few studies have examined the relative contribution of different Web-based components to improve outcomes. Further efficacy trials are needed to test the effects of Web support when offered as a part of routine care. Objective: Our aim was to compare in regular care the effects of (1) an Internet-based patient provider communication service (IPPC), (2) WebChoice, a Web-based illness management system for breast cancer patients (IPPC included), and (3) usual care on symptom distress, anxiety, depression, (primary outcomes), and self-efficacy (secondary outcome). This study reports preliminary findings from 6 months’ follow-up data in a 12-month trial. Methods: We recruited 167 patients recently diagnosed with breast cancer and undergoing treatment from three Norwegian hospitals. The nurse-administered IPPC allowed patients to send secure e-messages to and receive e-messages from health care personnel at the hospital where they were treated. In addition to the IPPC, WebChoice contains components for symptom monitoring, tailored information and self-management support, a diary, and communication with other patients. A total of 20 care providers (11 nurses, 6 physicians, and 3 social workers) were trained to answer questions from patients. Outcomes were measured with questionnaires at study entry and at study months 2, 4, and 6. Linear mixed models for repeated measures were fitted to compare effects on outcomes over time. Results: Patients were randomly assigned to the WebChoice group (n=64), the IPPC group (n=45), or the usual care group (n=58). Response rates to questionnaires were 73.7% (123/167) at 2 months, 65.9 (110/167) at 4 months, and 62.3% (104/167) at 6 months. Attrition was similar in all study groups. Among those with access to WebChoice, 64% (41/64) logged on more than once and 39% (25/64) sent e-messages to care providers. In the IPPC group, 40% (18/45) sent e-messages. Linear mixed models analyses revealed that the WebChoice group reported significantly lower symptom distress (mean difference 0.16, 95% CI 0.06-0.25, P=.001), anxiety (mean difference 0.79, 95% CI 0.09-1.49, P=.03), and depression (mean difference 0.79, 95% CI 0.09-1.49, P=.03) compared with the usual care group. The IPPC group reported significant lower depression scores compared with the usual care group (mean difference 0.69, 95% CI 0.05-1.32, P=.03), but no differences were observed for symptom distress or anxiety. No significant differences in self-efficacy were found among the study groups. Conclusions: In spite of practice variations and moderate use of the interventions, our results suggest that offering Web support as part of regular care can be a powerful tool to help patients manage their illness. Our finding that a nurse-administered IPPC alone can significantly reduce depression is particularly promising. However, the multicomponent intervention WebChoice had additional positive effects. Trial Registration: Clinicaltrials.gov:NCT00971009; http://clinicaltrials.gov/show/NCT00971009 (Archived by WebCite at http://www.webcitation.org/6USKezP0Y).

  • This is a royalty free image by Ambro (http://www.freedigitalphotos.net/images/CouplesPartners_g216-Elderly_Couple_With_Laptop_p41091.html).

    Which Frail Older Patients Use Online Health Communities and Why? A Mixed Methods Process Evaluation of Use of the Health and Welfare Portal

    Abstract:

    Background: Frail older people often receive fragmented care from multiple providers. According to the literature, there is an urgent need for coordination of care. Online and eHealth tools are increasingly used to improve coordination. However, there are significant barriers to their implementation in frail older people. Objective: Our aim was to (1) evaluate differences in use of a personal online health community (POHC) for frail older people in relation to personal characteristics, and (2) explore barriers and facilitators for use as experienced by older people and their informal caregivers, using the case of the Health and Welfare Information Portal (ZWIP). Methods: This is a mixed methods study. For the quantitative analysis, we used POHC usage information (2 years follow-up) and baseline characteristics of frail older people. For the qualitative analysis, we used semistructured interviews with older people and their informal caregivers. Participants were recruited from 11 family practices in the east of the Netherlands and frail older people over 70 years. The ZWIP intervention is a personal online health community for frail older people, their informal caregivers, and their providers. ZWIP was developed at the Geriatrics Department of Radboud University Medical Center. We collected data on POHC use for 2 years as well as relevant patient characteristics. Interview topics were description of use, reasons for use and non-use, and user profiles. Results: Of 622 frail patients in the intervention group, 290 were connected to ZWIP; 79 used ZWIP regularly (at least monthly). Main predictors for use were having an informal caregiver, having problems with activities of daily living, and having a large number of providers. Family practice level predictors were being located in a village, and whether the family practitioners had previously used electronic consultation and cared for a large percentage of frail older people. From 23 interviews, main reasons for use were perceiving ZWIP to be a good, quick, and easy way of communicating with providers and the presence of active health problems. Important reasons for non-use were lack of computer skills and preferring traditional means of consultation. Conclusions: Only 27.2% (79/290) of frail older enrolled in the POHC intervention used the POHC frequently. For implementation of personal online health communities, older people with active health problems and a sizable number of health care providers should be targeted, and the informal caregiver, if present, should be involved in the implementation process. Clinical Trial: International Standard Randomized Controlled Trial Number (ISRCTN): 11165483; http://www.controlled-trials.com/isrctn/pf/11165483 (Archived by WebCite at http://www.webcitation.org/6U3fZovoU).

  • Youth use online resources for seeking information about mental health. © 2014 Felicia Wetterlin, Institute of Mental Health. All Rights Reserved.

    eMental Health Experiences and Expectations: A Survey of Youths' Web-Based Resource Preferences in Canada

    Abstract:

    Background: Due to the high prevalence of psychological disorders and the lack of access to care among Canadian youth, the development of accessible services is increasingly important. eMental Health is an expanding field that may help to meet this need through the provision of mental health care using technology. Objective: The primary goals of the study are to explore youth experiences with traditional and online mental health resources, and to investigate youth expectations for mental health websites. Methods: A Web-based survey containing quantitative and qualitative questions was delivered to youth aged 17-24 years. Participants were surveyed to evaluate their use of mental health resources as well as their preferences for various components of a potential mental health website. Results: A total of 521 surveys were completed. Most participants (61.6%, 321/521) indicated that they had used the Internet to seek information or help for feelings they were experiencing. If they were going through a difficult time, 82.9% (432/521) of participants were either “somewhat likely” or “very likely” to use an information-based website and 76.8% (400/521) reported that they were either “somewhat unlikely” or “very unlikely” to visit social media websites for information or help-seeking purposes during this time. Most (87.7%, 458/521) participants rated their online privacy as very important. Descriptions of interventions and treatments was the most highly rated feature to have in a mental health-related website, with 91.9% (479/521) of participants regarding it as “important” or “very important”. When presented a select list of existing Canadian mental health-related websites, most participants had not accessed any of the sites. Of the few who had, the Canadian Mental Health Association website was the most accessed website (5.8%, 30/521). Other mental health-related websites were accessed by only 10.9% of the participants (57/521). Conclusions: The findings suggest that despite interest in these tools, current eMental Health resources either do not meet the needs of or are not widely accessed by youth with mental health problems. In order to improve access to these resources for Canadian youth, Web-based platforms should provide information about mental health problems, support for these problems (peer and professional), and information about resources (self-help as well as ability to locate nearby resources), while protecting the privacy of the user. These findings will not only assist in the development of new mental health platforms but may also help improve existing ones.

  • H1N1 Virus. Photo Credit: C. S. Goldsmith and A. Balish, CDC [Public domain], via Wikimedia Commons.

    Cumulative Query Method for Influenza Surveillance Using Search Engine Data

    Abstract:

    Background: Internet search queries have become an important data source in syndromic surveillance system. However, there is currently no syndromic surveillance system using Internet search query data in South Korea. Objectives: The objective of this study was to examine correlations between our cumulative query method and national influenza surveillance data. Methods: Our study was based on the local search engine, Daum (approximately 25% market share), and influenza-like illness (ILI) data from the Korea Centers for Disease Control and Prevention. A quota sampling survey was conducted with 200 participants to obtain popular queries. We divided the study period into two sets: Set 1 (the 2009/10 epidemiological year for development set 1 and 2010/11 for validation set 1) and Set 2 (2010/11 for development Set 2 and 2011/12 for validation Set 2). Pearson’s correlation coefficients were calculated between the Daum data and the ILI data for the development set. We selected the combined queries for which the correlation coefficients were .7 or higher and listed them in descending order. Then, we created a cumulative query method n representing the number of cumulative combined queries in descending order of the correlation coefficient. Results: In validation set 1, 13 cumulative query methods were applied, and 8 had higher correlation coefficients (min=.916, max=.943) than that of the highest single combined query. Further, 11 of 13 cumulative query methods had an r value of ≥.7, but 4 of 13 combined queries had an r value of ≥.7. In validation set 2, 8 of 15 cumulative query methods showed higher correlation coefficients (min=.975, max=.987) than that of the highest single combined query. All 15 cumulative query methods had an r value of ≥.7, but 6 of 15 combined queries had an r value of ≥.7. Conclusions: Cumulative query method showed relatively higher correlation with national influenza surveillance data than combined queries in the development and validation set.

  • (cc) Mishra et al. CC-BY-SA-2.0, please cite as (http://www.jmir.org/article/viewFile/3788/1/48423).

    Recruitment via the Internet and Social Networking Sites: The 1989-1995 Cohort of the Australian Longitudinal Study on Women’s Health

    Abstract:

    Background: Faced with the challenge of recruiting young adults for health studies, researchers have increasingly turned to the Internet and social networking sites, such as Facebook, as part of their recruitment strategy. As yet, few large-scale studies are available that report on the characteristics and representativeness of the sample obtained from such recruitment methods. Objective: The intent of the study was to describe the sociodemographic and health characteristics of a national sample of young Australian women recruited mainly through the Internet and social networking sites and to discuss the representativeness of their sociodemographic, health, and lifestyle characteristics relative to the population. Methods: A cohort of 17,069 women (born between 1989 and 1995) was recruited in 2012-13 for the Australian Longitudinal Study on Women’s Health. Sociodemographic characteristics (percentages, means, and 95% confidence intervals) from the online survey data were compared with women aged 18-23 years from the 2011 Australian Census. Sample data were compared by age and education level with data from the 2011-13 Australian Health Survey (AHS). Results: Compared to the Australian Census data, study participants were broadly representative in terms of geographical distribution across Australia, marital status (95.62%, 16,321/17,069) were never married), and age distribution. A higher percentage had attained university (22.52%, 3844/17,069) and trade/certificate/diploma qualifications (25.94%, 4428/17,069) compared with this age group of women in the national population (9.4% and 21.7% respectively). Among study participants, 22.05% (3721/16,877) were not in paid employment with 35.18% (5931/16,857) studying 16 or more hours a week. A higher percentage of study participants rated their health in the online survey as fair or poor (rather than good, very good, or excellent) compared with those participating in face-to-face interviews in the AHS (18.77%, 3203/17,069 vs 10.1%). A higher percentage of study participants were current smokers (21.78%, 3718/17,069 vs 16.4%) and physically active (59.30%, 10,089/17,014 were classified as sufficiently active vs 48.3%) but alcohol consumption was lower (59.58%, 9865/16,558 reported drinking alcohol at least once per month vs 65.9% in the AHS). Using self-reported height and weight to determine body mass index (BMI, kg/m2), 34.80% (5901/16,956) of the cohort were classified as overweight or obese (BMI of 25 or more), compared with 33.6% respectively using measured height and weight in the AHS. Conclusions: Findings indicated that using the Internet and social networking sites for an online survey represent a feasible recruitment strategy for a national cohort of young women and result in a broadly representative sample of the Australian population.

  • Image courtesy of Witthaya Phonsawat at FreeDigitalPhotos.net.

    Exploring the Relationship Between Changes in Weight and Utterances in an Online Weight Loss Forum: A Content and Correlational Analysis Study

    Abstract:

    Background: There is increasing interest in the use of online forums as a component of eHealth weight loss interventions. Although the research is mixed on the utility of online forums in general, results suggest that there is promise to this, particularly if the systems can be designed well to support healthful interactions that foster weight loss and continued engagement. Objective: The purpose of this study was to examine the relationship between the styles of utterances individuals make on an online weight loss forum and week-to-week fluctuations in weight. This analysis was conducted to generate hypotheses on possible strategies that could be used to improve the overall design of online support groups to facilitate more healthful interactions. Methods: A convenience sample of individuals using an online weight loss forum (N=4132) included data both on online forum use and weight check-in data. All interactions were coded utilizing the Linguistic Inquiry and Word Count (LIWC) system. Mixed model analyses were conducted to examine the relationship between these LIWC variables and weight over time. Results: Results suggested that increased use of past-tense verbs (P=.05) and motion (P=.02) were associated with lower weekly weights whereas increased use of conjunctions (eg, and, but, whereas; P=.001) and exclusion words (eg, but, without, exclude; P=.07) were both associated with higher weight during the weeks when these utterances were used more. Conclusions: These results provide some insights on the styles of interactions that appear to be associated with weight fluctuations. Future work should explore the stability of these findings and also explore possibilities for fostering these types of interactions more explicitly within online weight loss forums.

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  • The Effect of Age on Use and Perceptions about e-Health by Men with Prostate Cancer: Results from an Online Survey

    Date Submitted: Dec 23, 2014

    Open Peer Review Period: Dec 24, 2014 - Feb 18, 2015

    Background: Men with prostate cancer require ample information and support along the continuum of care, and e-health is one way to meet such critical information and support needs. Currently, evidence...

    Background: Men with prostate cancer require ample information and support along the continuum of care, and e-health is one way to meet such critical information and support needs. Currently, evidence about how age influences use and perceptions about prostate cancer e-health information is lacking. Objective: The aim of this paper is to explore use and perceptions about e-health among men living with prostate cancer. Specifically, we analyze men with prostate cancer by age-specific cohorts to identify potential age-related differences in use and perceptions about prostate cancer e-health information. Methods: We used survey methodology to examine how men under 65 years old with prostate cancer differ from those aged 65 years old or older in use and perceptions about prostate cancer e-health information (n = 297). Results: We found that men in the younger cohort used the Internet more often to be informed about treatment options (P = .04) and to learn more about staging/grading (P = .01) than men in the older cohort. Results also showed comparatively greater use of online prostate cancer information for emotional support and encouragement by the younger as compared to the older cohort (P < .001). Furthermore, the older cohort experienced more negative psychosocial effects of e-health (e.g., more anxious, depressed) than younger men (P = .003). We also found that as a result of more frequent Internet use younger men experienced more positive psychosocial effects (e.g., more informed, in control) from accessing information about prostate cancer through e-health channels (b = -0.10, 95% CI [-.26, -.01]). Conclusions: Men with prostate cancer have different information and support needs; our findings suggest that these needs may vary by age. Since using the Internet for e-health information resulted in more positive psychosocial effects, men under 65 years old may benefit from having access to non-static Web technologies, while men 65 years old and older may benefit from assistance with using the Internet in more advanced ways.

  • A Content Analysis of the Most Popular Calorie Counting Apps for the Presence of Health Behavior Change Theory

    Date Submitted: Dec 23, 2014

    Open Peer Review Period: Dec 24, 2014 - Feb 18, 2015

    Background: The emergence of smartphones has provided designers with a new platform to develop third party apps, which increase the functionality and utility of these devices for public health. Object...

    Background: The emergence of smartphones has provided designers with a new platform to develop third party apps, which increase the functionality and utility of these devices for public health. Objective: The study evaluates the presence of health behavior change theories in calorie counting apps. Methods: Data for this study came from an extensive content analysis of the 10 most popular calorie counting apps in the Health & Fitness category of the Apple App Store. Results: Each app was given a theory score to reflect the extent to which health behavior change theory was integrated into the app. The highest possible score was 60. Out of the 10 apps evaluated, Diet Coach obtained the highest theory score of 15. Map My Fitness and Yumget both received the lowest scores of 0. The average theory score among the apps was 5.6. Conclusions: Most of the selected calorie counting apps contained minimal health behavior theory.

  • Evaluation of Major Online Diabetes Risk Calculators and Computerized Predictive Models

    Date Submitted: Dec 22, 2014

    Open Peer Review Period: Dec 24, 2014 - Feb 18, 2015

    Background: Classical paper-and-pencil based risk assessment questionnaires for different medical conditions are often accompanied by the online versions of the questionnaire to reach wider population...

    Background: Classical paper-and-pencil based risk assessment questionnaires for different medical conditions are often accompanied by the online versions of the questionnaire to reach wider population and make the process of entering the data and calculation of risk scores easier for the end-user. This study focuses on the loss, especially in risk estimation performance, that can be inflicted by direct transformation from the paper to online versions of risk estimation calculators by ignoring the possibilities of more complex and accurate calculations that can be performed using the online calculators. Objective: This study focuses on empirical comparison of risk estimation performance in four major diabetes risk calculators used and distributed by national associations and government institutions in the US, Canada, UK and Australia. Additionally, results from four major risk calculators were compared to statistical methods that are simple to implement in online version, but cannot be used in the paper versions of the calculators. Methods: National Health and Nutrition Examination Survey (NHANES) data from 1999-2012 was used to evaluate the performance of detecting diabetes, defined as fasting plasma glucose levels ≥ 126 mg/dL without known diabetes, and pre-diabetes condition (≥ 100 mg/dL). Classification performance of four major screening instruments was compared to logistic regression and generalized boosted regression models. Results: When comparing four classical screening instruments, we obtained the best results for a questionnaire that is used by American Diabetes Association with Area Under the ROC Curve (AUC) and standard deviation of 0.699±0.008 for undiagnosed diabetes (0.662±0.004 for pre-diabetes) with 47% (47%) persons selected for screening. Our results demonstrate a significant difference in performance with additional benefits in lower number of persons selected for screening when statistical methods are used. The best AUC overall was obtained in diabetes risk prediction using logistic regression with AUC of 0.775±0.009 (0.734±0.004) and 34% (48%) persons selected for screening on average. On the other hand, generalized boosted regression models might be a better option from the economical point of view as the number of selected persons for screening of 30% (47%) lies significantly lower for diabetes risk assessment in comparison to logistic regression (p < 0.001), with a significantly higher AUC (p < 0.001) of 0.774±0.009 (0.74+-0.004) for pre-diabetes group. Number of questions does not significantly influence the difference between questionnaire and computerized version of screening instruments. Conclusions: Our results demonstrate serious lack of performance in four major online diabetes risk calculators when compared to basic classification algorithms that are easy to integrate in online settings. Therefore, one should take great care and consider optimizing the online versions of questionnaires that were primarily developed as classical paper questionnaires.

  • Intervention adjunctive to conventional care: The experience of persons living with HIV

    Date Submitted: Dec 19, 2014

    Open Peer Review Period: Dec 22, 2014 - Feb 16, 2015

    Background: Persons living with HIV (PLHIV) must adhere to antiretroviral therapy (ART) optimally on a daily basis and for life in order to maintain an undetectable viral load, thus allowing them to p...

    Background: Persons living with HIV (PLHIV) must adhere to antiretroviral therapy (ART) optimally on a daily basis and for life in order to maintain an undetectable viral load, thus allowing them to preserve their health. Taking advantage of the opportunity that information and communication technologies provide to broaden intervention modalities and intensify clinical follow-up, a virtual nursing intervention consisting of four interactive computer sessions was developed to empower PLHIV to manage their ART and symptoms optimally. a virtual nursing intervention consisting of four interactive computer sessions was developed to empower PLHIV to manage their ART and symptoms optimally. Compared with other type of ICT-assisted intervention such as text message, VIH-TAVIE™ requires a certain degree of active engagement on the part of the user to develop and strengthen the self-management skills to optimize adherence. After the intervention’s impact on ART adherence was measured quantitatively, a qualitative study was undertaken to describe how users experience the intervention. Understanding how PLHIV perceive being assisted asynchronously by a virtual nurse was of particular interest. Objective: To explore and describe how PLHIV experience VIH-TAVIE™, that is, receiving customized asynchronous accompaniment via a virtual nurse. Methods: A qualitative study was conducted with 26 PLHIV (20 men, 6 women) who received all four VIH-TAVIE™ sessions. Participants had been diagnosed with HIV 14 years earlier on average and had been on ART for a mean period of 10 years. The sessions lasted 20-30 minutes each and were received two weeks apart. They are hosted by a virtual nurse who engages the user in a self-management skills-learning process for the purpose of treatment adherence. Semi-structured interviews were conducted lasting 30-40 minutes to get participants to share their experience of the intervention through personal stories and what they thought and felt during their participation. Results: Content analysis yielded five themes regarding how PLHIV experience VIH-TAVIE™: 1) Exposure to the virtual nursing intervention; 2) Virtual nurse humanizes experience of the computer-delivered intervention; 3) Learner’s experience of the virtual nursing intervention; 4) Perceived benefits following participation in the virtual nursing intervention; and 5) Relevance of the virtual nursing intervention in relation to the medication management trajectory. Conclusions: Analyzing the participants’ experience revealed that they found the intervention’s content and format appropriate. To their eyes, the virtual nurse humanized the experience and helped them acquire new skills for achieving optimal ART adherence. Results seem to underscore the importance of offering the intervention to persons who have more problems with drug intake or who are just beginning ART.

  • Overcoming Clinical Inertia: A Randomized Clinical Trial of a Telehealth Remote Monitoring Intervention using Paired Glucose Testing in Adults with Type 2 Diabetes

    Date Submitted: Dec 22, 2014

    Open Peer Review Period: Dec 22, 2014 - Feb 16, 2015

    Background: Type 2 diabetes is a worldwide challenge. Research indicates people with diabetes remain at suboptimal glucose control for 2.9 years from patient and provider clinical inertia limiting tr...

    Background: Type 2 diabetes is a worldwide challenge. Research indicates people with diabetes remain at suboptimal glucose control for 2.9 years from patient and provider clinical inertia limiting treatment intensification. Practice guidelines promote structured self-monitoring of blood glucose (SMBG) for informing healthcare providers about glycemic control and providing patient feedback to increase knowledge, self-efficacy, and behavior change. Paired glucose testing—pairs of glucose results obtained before and after a meal, physical activity, or other event— is one method of structured SMBG. However, frequent access to glucose data to interpret values and recommend actions is challenging. A complete feedback loop (CFL)—data collection and interpretation combined with feedback to modify treatment—has been associated with improved outcomes, yet there remains limited integration of SMBG feedback in diabetes management. Incorporating telehealth remote monitoring (RM) and asynchronous electronic health record (EHR) feedback from certified diabetes educators (CDE)—specialists in glucose pattern management—employ the CFL to improve outcomes. Objective: The purpose of this study was to evaluate a telehealth RM intervention using paired glucose testing and asynchronous data analysis in adults with type 2 diabetes. Primary aim was change in A1C—a measure of overall glucose management— between groups after six months. Secondary aims were change in self-reported Summary of Diabetes Self-Care Activities (SDSCA), Diabetes Empowerment Scale (DES), and Diabetes Knowledge Test (DKT). Methods: Methods: A two-group randomized clinical trial was conducted comparing usual care to telehealth RM with paired glucose testing and asynchronous virtual visits. Participants were 30–70 years old, not using insulin with A1C between 7.5%–10.9%. The telehealth RM tablet computer transmitted glucose data and facilitated a CFL to educate participants, analyze actionable glucose data, and provide feedback. Data from paired glucose testing were analyzed asynchronously using computer-assisted pattern analysis and were shared with patients via the EHR weekly. CDEs called participants monthly to discuss paired glucose testing trends and treatment changes. Separate mixed-effects models were used to analyze data. Results: Participants (n=90) were White (64%), mean age of 58 years, body mass index of 34.1 with diabetes for 8.2 years and mean A1C of 8.3%. Both groups lowered A1C with an estimated average decrease of 0.70 percentage points in control and 1.11 percentage points in intervention with a significant group difference of 0.41 percentage points at six months (se = 0.08, t = -2.87, P = .005). Change in medication (se =0.21, t = -3.37, P = .009) was significant on A1C. The treatment group significantly improved SDSCA subscales carbohydrate spacing (P = .04), monitoring glucose (P = .001), and foot care (P = .02). Conclusions: An e-Health model incorporating a CFL with telehealth RM and paired glucose testing with asynchronous data analysis significantly improved A1C compared to control. Clinical Trial: Clinicaltrials.gov identifier NCT01715649