Journal of Medical Internet Research
The leading peer-reviewed journal for health and healthcare in the Internet age.
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Potential reach of eHealth/mHealth vs. traditional mass media for prevention of chronic diseases: Evidence from a nationally representative survey in a middle-income country in Africa
Date Submitted: Feb 8, 2016
Open Peer Review Period: Feb 9, 2016 - Feb 17, 2016
Background: Data is based on a population survey of 1,240 participants aged 24-64 years conducted in 2013-2014 in the Seychelles, a rapidly developing island state in the African region. A structured...
Background: Data is based on a population survey of 1,240 participants aged 24-64 years conducted in 2013-2014 in the Seychelles, a rapidly developing island state in the African region. A structured questionnaire was administered and NCD risk factors were measured. SES was determined based on income, education and occupation. Univariate and multivariate analyses explored the relationships between outcomes and socio-demographic variables. Objective: To examine i) self-reported exposure to programs related to noncommunicable diseases (NCD) on national public TV and radio during the past 12 months; ii) current ownership of computers, smart phone, computers, tablets, and use of Internet and iii) willingness of individuals to receive SMS with information on health, with a focus on the distribution of these variables according to demographic, socioeconomic status (SES) and NCD risk groups. Methods: Based on a population survey of 1,240 participants aged 24-64 years conducted in 2013-2014 in the Seychelles, a rapidly developing island state in the African region. A structured questionnaire was administered and NCD risk factors were measured. SES was determined based on income, education and occupation. Univariate and multivariate analyses explored the relationships between outcomes and socio-demographic variables. Results: Exposure to NCD-related programs was higher on public TV (83.6%) than on public radio (59.7%). Exposure to NCD-related programs on public TV was associated with older age and female gender, but not with SES, while exposure to NCD-related programs on public radio was associated with older age and lower SES. Overall, there was a high mobile phone ownership (93.2%) and was found to be associated with female gender, younger age and higher SES. Only 31.9% of adults owned a smart phone and 19.7% used their smart phone to access the Internet. The willingness to receive health-related SMS was reported by 84.5% of adults and was associated with female gender, younger age and higher SES. Controlling for SES, exposure to NCD related programs on public TV or radio and willingness to receive health-related SMS were not independently associated with a person’s NCD risk. Conclusions: Broadcasting health programs through traditional mass media (national public radio and TV) reach majority of population, including older adults or those in lower SES groups. With a high penetration of mobile phones and willingness to receive health-related SMS, mHealth presents an opportunity for health programs especially when targeted SMS messages are used for younger adults and those in higher SES groups. By contrast, due to reduced internet access eHealth programs have limited reach for health promotion programs. These findings emphasize the heterogeneous scope of reach of mHealth, eHealth and traditional mass media for health promotion programs in diverse demographic and socioeconomic groups in developing countries.
Can We Foster a Culture of Peer Support and Promote Mental Health in Adolescence Using a Web-Based Application? A Control Group Study
Date Submitted: Feb 3, 2016
Open Peer Review Period: Feb 6, 2016 - Apr 2, 2016
Background: Adolescence with its many transitions is a vulnerable period for the development of mental illnesses. Establishing effective mental health promotion programs for this age group is a challe...
Background: Adolescence with its many transitions is a vulnerable period for the development of mental illnesses. Establishing effective mental health promotion programs for this age group is a challenge but crucial to societal health. Programs need to take into account the specific developmental tasks that adolescents face. Considering peer influence and fostering adolescent autonomy strivings is essential. Moreover, program participation needs to be compelling to young people. Their affinity to new technologies offers unprecedented opportunities in this respect. Objective: This companion project built on these premises and developed an application (the companion app) to foster a positive peer culture among adolescents and thereby strengthen social support and reduce stress. Methods: In a control group study design, a group of employed (n = 546) and unemployed (n = 76) adolescents had access to the companion app during 10 months. The companion app was developed as a web-based app giving adolescents access to a peer mentoring system and interactive, health-relevant content. The intervention was evaluated using a combined quantitative and qualitative approach. Linear mixed effect models were used to analyze changes in chronic stress levels and users’ perception of social support. Monthly feedback on the app and qualitative interviews at the end of the study allowed for an in-depth exploration of the adolescents’ perception of the intervention. Results: Adolescents in the intervention group did not use the companion app consistently. The intervention had no effects on chronic stress levels and perception of social support. Adolescents reported endorsing the concept of the app and in particular the implementation of a mentoring system. However, the immediate benefit of using the app did not seem obvious to the majority of them. Also, some participants reported that there had not been enough activity by other users on the app and that this had made the app less attractive to them. Conclusions: The companion project implemented a theory-driven and innovative approach to mental health promotion in adolescence, taking into account the specificities of this developmental phase. Among other things, insufficient external encouragement and the short duration of the study may have contributed to the lacking commitment of the adolescents to this intervention. Further research is needed on how to best take advantage of new technologies to promote mental health in adolescence.
Feasibility and Limitations of Vaccine 2d Barcoding Using Mobile Devices
Date Submitted: Feb 2, 2016
Open Peer Review Period: Feb 6, 2016 - Apr 2, 2016
Background: 2d barcoding has the potential to enhance documentation of vaccine encounters at the point of care. However, this is currently limited to environments equipped with dedicated barcode scann...
Background: 2d barcoding has the potential to enhance documentation of vaccine encounters at the point of care. However, this is currently limited to environments equipped with dedicated barcode scanners and compatible record systems. Mobile devices may present a cost effective alternative to leverage 2d vaccine vial barcodes and improve vaccine product specific information residing in digital health records. Objective: Mobile devices have the potential to capture product specific information from 2d vaccine vial barcodes. We sought to examine the feasibility, performance, and potential limitations of scanning 2d barcodes on vaccine vials using four different smartphones. Methods: A unique barcode scanning application was developed for Android and iOS operating systems. The impact of four variables on the scan success rate, data accuracy, and time to scan were examined: barcode size, curvature, fading and ambient lighting conditions. Two experimenters performed four trials ten times each amounting to a total of 2160 barcode scan attempts. Results: 1832(84.8%) attempts scanned successfully. Of those, zero produced incorrect data. 5mm barcodes were the slowest to scan, although only by 0.5 seconds on average. Barcodes up to 50% fading had a 100% success rate, but success rate deteriorated beyond 60% fading. Curved barcodes took longer to scan compared to flat but success rate deterioration was only observed at a vial diameter of 10mm. Light conditions did not impact success rate or scan time between 500 and 20 lux. Conditions below 20 lux impeded the device’s ability to scan successfully. Variability in scan time was observed across devices in all trials performed. Conclusions: 2d vaccine barcoding is possible using mobile devices and is successful under the majority of conditions examined. Manufacturers utilizing 2d barcodes should take into consideration the impact of factors which limit scan success rates. Future studies should evaluate the impact of mobile barcoding on workflow and vaccine administrator acceptance.
Google Flu Trends Spatial Variability Validated against Emergency Department Influenza-related Visits
Date Submitted: Jan 30, 2016
Open Peer Review Period: Jan 31, 2016 - Mar 27, 2016
Background: Influenza is a deadly and costly public health problem. Variations in its seasonal patterns cause dangerous surges in Emergency Department (ED) patient volume. Google Flu Trends (GFT) can...
Background: Influenza is a deadly and costly public health problem. Variations in its seasonal patterns cause dangerous surges in Emergency Department (ED) patient volume. Google Flu Trends (GFT) can provide faster influenza surveillance information than traditional CDC methods, potentially leading to improved public health preparedness. GFT has been found to correlate well with reported influenza and to improve influenza prediction models. However, previous validation studies have focused on isolated clinical locations. Objective: To measure GFT surveillance effectiveness by correlating GFT with influenza-related ED visits in 19 United States (US) cities across seven influenza seasons. To explore which city characteristics lead to better or worse GFT effectiveness. Methods: Using Healthcare Cost and Utilization Project data, we collected weekly counts of ED visits for all patients with diagnosis (ICD-9) codes for influenza-related visits from 2005 to 2011 in 19 different US cities. We measured the correlation between weekly volume of GFT searches and influenza-related ED visits (i.e., GFT ED surveillance effectiveness) per city. We evaluated the relationship between 15 publically-available city indicators (11 sociodemographic, 2 healthcare utilization, and 2 climate) and GFT surveillance effectiveness using univariate linear regression. Results: Correlation between city-level GFT and influenza-related ED visits had a median of 0.84, ranging from 0.67 to 0.93 across 19 cities. Temporal variability was observed, with median correlation ranging from 0.78 in 2009 to 0.94 in 2005. City indicators significantly associated (P <0.10) with improved GFT surveillance include higher proportion of population female, higher proportion with Medicare coverage, higher ED visits per capita, and lower socio-economic status. Conclusions: GFT is strongly correlated with ED influenza-related visits at the city level, but unexplained variation over geographic location and time limits its utility as standalone surveillance. GFT is likely most useful as an early signal used in conjunction with other more comprehensive surveillance techniques. City indicators associated with improved GFT surveillance provide some insight into the variability of GFT effectiveness. For example, populations with lower socio-economic status may have a greater tendency to initially turn to the internet for health questions, thus leading to increased GFT effectiveness. GFT has the potential to provide valuable information to ED providers for patient care and to administrators for ED surge preparedness.
Decreased BMI z-score in school children after year-long information sessions with parents reinforced with web and mobile phone resources
Date Submitted: Jan 29, 2016
Open Peer Review Period: Jan 30, 2016 - Mar 26, 2016
Background: The obesity pandemic has now reached children and households should change their lifestyles to prevent it. Objective: The objective was to assess the effect of a comprehensive intervention...
Background: The obesity pandemic has now reached children and households should change their lifestyles to prevent it. Objective: The objective was to assess the effect of a comprehensive intervention on body mass index z-score (BMIZ) in school children. Methods: Four elementary schools in Mexico City, two governmental and two private, were engaged. The intervention was implemented in two schools, one governmental and one private (intervention group, IG); the others two schools were controls (CG). The intervention lasted for a school year. Three educational parent/child sessions were held at two-month intervals to promote healthy eating habits and exercise. To reinforce the information, a website provided extensive discussion on a new topic every 15 days, menus about school snacks, and tool for assessing BMI in children and adults. Text messages were sent to parents’ mobile phones. IG contained 226 children and CG 181 children. We measured their weight and height and BMIZ at 0, 6, and 12 months. Results: The CG children showed a change of +0.06 (95% CI 0.01 to 0.11) and +0.05 (95% CI 0.01 to 0.10) in their BMIZ at 6 and 12 months, respectively. The IG children decreased their BMIZ by -0.13 (95% CI -0.19 to -0.06) and -0.10 (95% CI -0.16 to -0.03), respectively, and the effect was greater in children with obesity. Conclusions: The comprehensive intervention tested had beneficial effects, preserved the BMIZ of eutrophic children and reduced the BMIZ of children with obesity.
Supporting knowledge and medical decisions in the digital age: a psychological point of view
Date Submitted: Jan 26, 2016
Open Peer Review Period: Jan 28, 2016 - Mar 24, 2016
The process of web information searching is a crucial point in our digital age. We would like to suggest a critical thinking about the role and the use of internet and web search engines. Doctors and...
The process of web information searching is a crucial point in our digital age. We would like to suggest a critical thinking about the role and the use of internet and web search engines. Doctors and Health operators should consider seriously how to support their patients into web navigation and they should consider which skills are required to assist them in an appropriate way.