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

Swab2know: Results of an HIV-testing strategy using oral fluid samples and online communication of test results for MSM in Belgium.

Background: As HIV remains a public health concern, increased testing among those at risk for HIV-acquisition is important. Men who have sex with men (MSM) are the most important group for targeted HIV-testing in Europe. Several new strategies are developed and implemented to increase HIV-testing uptake in this group, among them the “Swab2know” project. Objective: In this project, we aim to facilitate testing uptake by offering free oral fluid test during outreach activities in MSM settings or online ordering sampling kits, and communicating test results via a secured website. Methods: Sample collection happened via outreach and online sampling among MSM. Test results were communicated through a secured website. HIV-test was executed in the laboratory. Each reactive sample needed to be confirmed using state-of-the-art confirmation procedures on a blood sample. Close follow-up of participants who didn’t pick up their result, or those with a reactive result, was included in the protocol. Participants were asked to provide feedback on the methodology using a short survey. Results: During 17 months, 1071 tests were executed on samples collected among 898 men. Over half of the samples (n=553; 51.6%) was collected during 23 outreach sessions. During an 8 months period, 430 samples (40.2%) were collected from online sampling. Additionally, 88 samples (8.2%) were collected by 2 partner organizations using the methodology during face-to-face consultations with MSM, and male sex workers. Results of 983 (91.8%) tests have been collected from the website. The pickup rate was higher among participants who ordered their kit online (421; 98.6%), compared to those participating during outreach activities (559; 87.2%; P<.001). MSM participating during outreach activities were more likely to have never been tested before (17.3% vs. 10.0%; P=.001), and reported more sexual partners in the 6 months prior to the participation in the project (7.18 vs. 3.23; P<.001). Ninety-two percent of the test results were checked. Twenty participants (2.2%) were confirmed HIV-positive, and linked to care. Twenty-eight participants (2.6%) with a weak reactive result could not be confirmed, and are thereby classified as ‘false reactive’ results. Most of the 388 (39.5%) obtained post-test surveys were very positive. The vast majority (371; 95.6%) was very satisfied, while 17 (4.4%) reported mixed feelings. Conclusions: Despite a high yield, and a considerable number of false reactive results, satisfaction was high among participants. The project helped us to reach the target population, both in numbers of tests executed, as in newly diagnosed HIV infections. Further operationalization should be considered in the accuracy of the test, the functionalities of the website, including an online counseling tool, and study the cost-effectiveness of the methodology.

2015-02-10

We are pleased to announce our forthcoming new journals, all of which have currently no submission or publication fees, and all of which focus on emerging technologies and patient-centered innovations in specific areas, going beyond Internet/webbased interventions: * JMIR Cancer (http://cancer.jmir.org) * JMIR Medical Education (http://mededu.jmir.org) * JMIR Public Health and Surveillance (http://publichealth.jmir.org) We welcome submissions for the inaugural issues of these journals. The following journals have already published articles and are still free of charge to publish in (no submission or publication fees): * JMIR Human Factors (http://humanfactors.jmir.org) * JMIR Rehabilitation and Assistive Technologies (http://rehab.jmir.org) * JMIR Mental Health (http://mental.jmir.org) To submit to these journals, simply append /author to the URLs above (e.g. http://cancer.jmir.org/author), or submit to the main JMIR journal and use the dropdown-box in step 1 to change the journal name. All journals offer careful copyediting and typesetting of manuscripts, and submission to PubMed and PubMed Central (being new journals it may however take a few month until they appear in PubMed). We are also happy to announce that JMIR Medical Informatics and JMIR Serious Games are now indexed in PubMed.

Read Post

Recent Articles:

  • Screenshot of the eBalance Web-based app.

    The Impact of a Web-Based App (eBalance) in Promoting Healthy Lifestyles: Randomized Controlled Trial

    Abstract:

    Background: The use of Web-based apps to promote a healthy lifestyle is increasing, although most of these programs were not assessed using suitable epidemiological methods. We evaluated the effectiveness of a newly developed Web-based app in promoting a healthy lifestyle and educating adults on such lifestyles. We also analyzed predictors for success in acquiring and maintaining a healthy lifestyle. Objective: Our aim was to compare people receiving a new Web-based app with people who got an introductory lecture alone on healthy lifestyle, weight change, nutritional knowledge, and physical activity, and to identify predictors of success for maintaining a healthy lifestyle. Methods: Subjects were recruited from the community and were randomized into intervention and control groups. The intervention subjects received access to the app without any face-to-face support; the control subjects continued their standard lifestyle. Measurements were taken by the researcher at baseline and after 14 weeks and included weight and waist circumference. Nutritional knowledge, diet quality, and physical activity duration were obtained using online questionnaires. The new Web-based app was developed based on current US Department of Agriculture and Israel Ministry of Health recommendations for healthy lifestyle. The app provides tools for monitoring diet and physical activity while instructing and encouraging healthy diet and physical activity. Results: Out of 99 subjects who were randomized into app and control groups, 85 participants (86%) completed the study, 56 in the intervention and 29 in the control group. The mean age was 47.9 (SD 12.3) years, and mean Body Mass Index was 26.2 (SD 3.9). Among the intervention group only, frequency of app use was 2.7 (SD 1.9) days/week. The mean change in physical activity was 63 (SD 20.8) minutes in the app group and -30 (SD 27.5) minutes in the control group (P=.02). The mean weight change was -1.44 (SD 0.4) kg in the app group and -0.128 (SD 0.36) kg in the control group (P=.03). Knowledge score increased significantly in the app group, 76 (SD 7.5) to 79 (SD 8.7) at the end of the study (P=.04) compared with the control group. Diet quality score also increased significantly at the end of the study, from 67 (SD 9.8) to 71 (SD 7.6; P<.001) in contrast to the control group. Success score (represents the success in maintaining healthy lifestyle) was higher among the app group (68%) compared with 36% in the control group (P<.001). The app frequency of use was significantly related to a higher success score (P<.001). Conclusions: We showed a positive impact of a newly developed Web-based app on lifestyle indicators during an intervention of 14 weeks. These results are promising in the app’s potential to promote a healthy lifestyle, although larger and longer duration studies are needed to achieve more definitive conclusions. Trial Registration: Clinicaltrial.gov number: NCT01913496; http://www.clinicaltrials.gov/ct2/show/NCT01913496 (Archived by WebCite at http://www.webcitation.org/6WSTUEPuJ).

  • Image courtesy of [imagerymajestic] at FreeDigitalPhotos.net.

    Advantages and Disadvantages of Educational Email Alerts for Family Physicians: Viewpoint

    Abstract:

    Background: Electronic knowledge resources constitute an important channel for accredited Continuing Medical Education (CME) activities. However, email usage for educational purposes is controversial. On the one hand, family physicians become aware of new information, confirm what they already know, and obtain reassurance by reading educational email alerts. Email alerts can also encourage physicians to search Web-based resources. On the other hand, technical difficulties and privacy issues are common obstacles. Objective: The purpose of this discussion paper, informed by a literature review and a small qualitative study, was to understand family physicians’ knowledge, attitudes, and behavior in regard to email in general and educational emails in particular, and to explore the advantages and disadvantages of educational email alerts. In addition, we documented participants’ suggestions to improve email alert services for CME. Methods: We conducted a qualitative descriptive study using the “Knowledge, Attitude, Behavior” model. We conducted semi-structured face-to-face interviews with 15 family physicians. We analyzed the collected data using inductive-deductive thematic qualitative data analysis. Results: All 15 participants scanned and prioritized their email, and 13 of them checked their email daily. Participants mentioned (1) advantages of educational email alerts such as saving time, convenience and valid information, and (2) disadvantages such as an overwhelming number of emails and irrelevance. They offered suggestions to improve educational email. Conclusions: The advantages of email alerts seem to compensate for their disadvantages. Suggestions proposed by family physicians can help to improve educational email alerts.

  • Anxiety online screenshot.

    Multiple Comorbidities of 21 Psychological Disorders and Relationships With Psychosocial Variables: A Study of the Online Assessment and Diagnostic System...

    Abstract:

    Background: While research in the area of e-mental health has received considerable attention over the last decade, there are still many areas that have not been addressed. One such area is the comorbidity of psychological disorders in a Web-based sample using online assessment and diagnostic tools, and the relationships between comorbidities and psychosocial variables. Objective: We aimed to identify comorbidities of psychological disorders of an online sample using an online diagnostic tool. Based on diagnoses made by an automated online assessment and diagnostic system administered to a large group of online participants, multiple comorbidities (co-occurrences) of 21 psychological disorders for males and females were identified. We examined the relationships between dyadic comorbidities of anxiety and depressive disorders and the psychosocial variables sex, age, suicidal ideation, social support, and quality of life. Methods: An online complex algorithm based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision, was used to assign primary and secondary diagnoses of 21 psychological disorders to 12,665 online participants. The frequency of co-occurrences of psychological disorders for males and females were calculated for all disorders. A series of hierarchical loglinear analyses were performed to examine the relationships between the dyadic comorbidities of depression and various anxiety disorders and the variables suicidal ideation, social support, quality of life, sex, and age. Results: A 21-by-21 frequency of co-occurrences of psychological disorders matrix revealed the presence of multiple significant dyadic comorbidities for males and females. Also, for those with some of the dyadic depression and the anxiety disorders, the odds for having suicidal ideation, reporting inadequate social support, and poorer quality of life increased for those with two-disorder comorbidity than for those with only one of the same two disorders. Conclusions: Comorbidities of several psychological disorders using an online assessment tool within a Web-based population were similar to those found in face-to-face clinics using traditional assessment tools. Results provided support for the transdiagnostic approaches and confirmed the positive relationship between comorbidity and suicidal ideation, the negative relationship between comorbidity and social support, and the negative relationship comorbidity and quality of life. Trial Registration: Australian and New Zealand Clinical Trials Registry ACTRN121611000704998; http://www.anzctr.org.au/trial_view.aspx?ID=336143 (Archived by WebCite at http://www.webcitation.org/618r3wvOG)

  • This image is from the public domain (http://www.publicdomainpictures.net/view-image.php?image=5587&picture=teenager-typing).

    The Contribution of Online Peer-to-Peer Communication Among Patients With Adrenal Disease to Patient-Centered Care

    Abstract:

    Background: Addison’s disease and Cushing’s syndrome are rare. The Dutch Adrenal Society offers an online forum for Dutch adrenal patients to meet and communicate. However, little is known about the added value such a forum has for the delivery of patient-centered care. Objective: Our aim was to analyze the purposes of online patient-to-patient forum conversations, within the context of patient-centered care. Methods: For this study a consecutive sample of 300 questions (“threads”) from the past 3.5 years was selected from the forum. The content of these patient-driven questions was analyzed based on the dimensions of patient-centeredness of the Picker Institute. This analysis was performed using ATLAS.ti. Results: From the 390 questions analyzed, 80.8% (N=315) were intended to gain more information about the disease, the treatment, and to verify if other patients had similar complaints. To a much lesser extent (38/390, 9.7%), questions expressed a call for emotional support. Patients answered primarily by giving practical tips to fellow patients and to share their own experiences. Conclusions: On an online patient forum for Cushing’s syndrome and Addison’s disease, patients appear to primarily gain knowledge and, to a lesser extent, emotional support from their peers. This experience-based knowledge has become a very important information source. As such, patients can make a substantial contribution to the creation of patient-centered care if this knowledge is integrated into the care provided by health care professionals.

  • Thumbnail photo. (C) PATH, 2014.

    Impact of mHealth Chronic Disease Management on Treatment Adherence and Patient Outcomes: A Systematic Review

    Abstract:

    Background: Adherence to chronic disease management is critical to achieving improved health outcomes, quality of life, and cost-effective health care. As the burden of chronic diseases continues to grow globally, so does the impact of non-adherence. Mobile technologies are increasingly being used in health care and public health practice (mHealth) for patient communication, monitoring, and education, and to facilitate adherence to chronic diseases management. Objective: We conducted a systematic review of the literature to evaluate the effectiveness of mHealth in supporting the adherence of patients to chronic diseases management (“mAdherence”), and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among patients and health care providers. Methods: We searched PubMed, Embase, and EBSCO databases for studies that assessed the role of mAdherence in chronic disease management of diabetes mellitus, cardiovascular disease, and chronic lung diseases from 1980 through May 2014. Outcomes of interest included effect of mHealth on patient adherence to chronic diseases management, disease-specific clinical outcomes after intervention, and the usability, feasibility, and acceptability of mAdherence tools and platforms in chronic disease management among target end-users. Results: In all, 107 articles met all inclusion criteria. Short message service was the most commonly used mAdherence tool in 40.2% (43/107) of studies. Usability, feasibility, and acceptability or patient preferences for mAdherence interventions were assessed in 57.9% (62/107) of studies and found to be generally high. A total of 27 studies employed randomized controlled trial (RCT) methods to assess impact on adherence behaviors, and significant improvements were observed in 15 of those studies (56%). Of the 41 RCTs that measured effects on disease-specific clinical outcomes, significant improvements between groups were reported in 16 studies (39%). Conclusions: There is potential for mHealth tools to better facilitate adherence to chronic disease management, but the evidence supporting its current effectiveness is mixed. Further research should focus on understanding and improving how mHealth tools can overcome specific barriers to adherence.

  • Twitter search results for

    Twitter Sentiment Predicts Affordable Care Act Marketplace Enrollment

    Abstract:

    Background: Traditional metrics of the impact of the Affordable Care Act (ACA) and health insurance marketplaces in the United States include public opinion polls and marketplace enrollment, which are published with a lag of weeks to months. In this rapidly changing environment, a real-time barometer of public opinion with a mechanism to identify emerging issues would be valuable. Objective: We sought to evaluate Twitter’s role as a real-time barometer of public sentiment on the ACA and to determine if Twitter sentiment (the positivity or negativity of tweets) could be predictive of state-level marketplace enrollment. Methods: We retrospectively collected 977,303 ACA-related tweets in March 2014 and then tested a correlation of Twitter sentiment with marketplace enrollment by state. Results: A 0.10 increase in the sentiment score was associated with an 8.7% increase in enrollment at the state level (95% CI 1.32-16.13; P=.02), a correlation that remained significant when adjusting for state Medicaid expansion (P=.02) or use of a state-based marketplace (P=.03). Conclusions: This correlation indicates Twitter’s potential as a real-time monitoring strategy for future marketplace enrollment periods; marketplaces could systematically track Twitter sentiment to more rapidly identify enrollment changes and potentially emerging issues. As a repository of free and accessible consumer-generated opinions, this study reveals a novel role for Twitter in the health policy landscape.

  • Tweet2Quit Project, Source: http://tweet2quit.merage.uci.edu/. Accessed: 2015-02-19. (Archived by WebCite® at http://www.webcitation.org/6WSPlIAGi).

    Development of a Twitter-Based Intervention for Smoking Cessation that Encourages High-Quality Social Media Interactions via Automessages

    Abstract:

    Background: The medical field seeks to use social media to deliver health interventions, for example, to provide low-cost, self-directed, online self-help groups. However, engagement in online groups is often low and the informational content may be poor. Objective: The specific study aims were to explore if sending automessages to online self-help groups encouraged engagement and to see if overall or specific types of engagement related to abstinence. Methods: We conducted a Stage I Early Therapy Development Trial of a novel social media intervention for smoking cessation called Tweet2Quit that was delivered online over closed, 20-person quit-smoking groups on Twitter in 100 days. Social media such as Twitter traditionally involves non-directed peer-to-peer exchanges, but our hybrid social media intervention sought to increase and direct such exchanges by sending out two types of autocommunications daily: (1) an “automessage” that encouraged group discussion on an evidence-based cessation-related or community-building topic, and (2) individualized “autofeedback” to each participant on their past 24-hour tweeting. The intervention was purposefully designed without an expert group facilitator and with full automation to ensure low cost, easy implementation, and broad scalability. This purely Web-based trial examined two online quit-smoking groups with 20 members each. Participants were adult smokers who were interested in quitting and were recruited using Google AdWords. Participants’ tweets were counted and content coded, distinguishing between responses to the intervention’s automessages and spontaneous tweets. In addition, smoking abstinence was assessed at 7 days, 30 days, and 60 days post quit date. Statistical models assessed how tweeting related to abstinence. Results: Combining the two groups, 78% (31/40) of the members sent at least one tweet; and on average, each member sent 72 tweets during the 100-day period. The automessage-suggested discussion topics and participants’ responses to those daily automessages were related in terms of their content (r=.75, P=.012). Responses to automessages contributed 22.78% (653/2867) of the total tweets; 77.22% (2214/2867) were spontaneous. Overall tweeting related only marginally to abstinence (OR 1.03, P=.086). However, specific tweet content related to abstinence including tweets about setting of a quit date or use of nicotine patches (OR 1.52, P=.024), countering of roadblocks to quitting (OR 1.76, P=.008) and expressions of confidence about quitting (OR 1.71, SE 0.42, P=.032). Questionable, that is, non-evidence-based, information about quitting did not relate to abstinence (OR 1.12, P=.278). Conclusions: A hybrid social media intervention that combines traditional online social support with daily automessages appears to hold promise for smoking cessation. This hybrid approach capitalizes on social media’s spontaneous real-time peer-to-peer exchanges but supplements this with daily automessages that group members respond to, bolstering and sustaining the social network and directing the information content. Highly engaging, this approach should be studied further. Trial Registration: Clinicaltrials.gov NCT01602536; https://clinicaltrials.gov/ct2/show/NCT01602536 (Archived by WebCite at http://www.webcitation.org/6WGbt0o1K)

  • Screenshot of MyGeisinger.

    The Wired Patient: Patterns of Electronic Patient Portal Use Among Patients With Cardiac Disease or Diabetes

    Abstract:

    Background: As providers develop an electronic health record–based infrastructure, patients are increasingly using Web portals to access their health information and participate electronically in the health care process. Little is known about how such portals are actually used. Objective: In this paper, our goal was to describe the types and patterns of portal users in an integrated delivery system. Methods: We analyzed 12 months of data from Web server log files on 2282 patients using a Web-based portal to their electronic health record (EHR). We obtained data for patients with cardiovascular disease and/or diabetes who had a Geisinger Clinic primary care provider and were registered “MyGeisinger” Web portal users. Hierarchical cluster analysis was applied to longitudinal data to profile users based on their frequency, intensity, and consistency of use. User types were characterized by basic demographic data from the EHR. Results: We identified eight distinct portal user groups. The two largest groups (41.98%, 948/2258 and 24.84%, 561/2258) logged into the portal infrequently but had markedly different levels of engagement with their medical record. Other distinct groups were characterized by tracking biometric measures (10.54%, 238/2258), sending electronic messages to their provider (9.25%, 209/2258), preparing for an office visit (5.98%, 135/2258), and tracking laboratory results (4.16%, 94/2258). Conclusions: There are naturally occurring groups of EHR Web portal users within a population of adult primary care patients with chronic conditions. More than half of the patient cohort exhibited distinct patterns of portal use linked to key features. These patterns of portal access and interaction provide insight into opportunities for electronic patient engagement strategies.

  • Photo credit: Fuse/Gettyimages, http://www.gettyimages.ca/detail/photo/senior-man-using-laptop-royalty-free-image/78717266?Language=en-GB.

    Patient and Provider Attitudes Toward the Use of Patient Portals for the Management of Chronic Disease: A Systematic Review

    Abstract:

    Background: Patient portals provide patients with the tools to better manage and understand their health status. However, widespread adoption of patient portals faces resistance from patients and providers for a number of reasons, and there is limited evidence evaluating the characteristics of patient portals that received positive remarks from patients and providers. Objective: The objectives of this systematic review are to identify the shared characteristics of portals that receive favorable responses from patients and providers and to identify the elements that patients and providers believe need improvement. Methods: The authors conducted a systematic search of the CINAHL and PubMed databases to gather data about the use of patient portals in the management of chronic disease. Two reviewers analyzed the articles collected in the search process in order remove irrelevant articles. The authors selected 27 articles to use in the literature review. Results: Results of this systematic review conclude that patient portals show significant improvements in patient self-management of chronic disease and improve the quality of care provided by providers. The most prevalent positive attribute was patient-provider communication, which appeared in 10 of 27 articles (37%). This was noted by both patients and providers. The most prevalent negative perceptions are security (concerns) and user-friendliness, both of which occurred in 11 of 27 articles (41%). The user-friendliness quality was a concern for patients and providers who are not familiar with advanced technology and therefore find it difficult to navigate the patient portal. The high cost of installation and maintenance of a portal system, not surprisingly, deters some providers from implementing such technology into their practice, but this was only mentioned in 3 of the 27 articles (11%). It is possible that the incentives for meaningful use assuage the barrier of cost. Conclusions: This systematic review revealed mixed attitudes from patients and their providers regarding the use of patient portals to manage their chronic disease. The authors suggest that a standard patient portal design providing patients with the resources to understand and manage their chronic conditions will promote the adoption of patient portals in health care organizations.

  • Nargile (waterpipe) smoking. Photo Credit: Fedor Shmidt, http://hdscreen.me/walls/art-design/fedor-shmidt-nargile-smoke-2941126-1280x1024.jpg.

    A Web-Based Program to Increase Knowledge and Reduce Cigarette and Nargila Smoking Among Arab University Students in Israel: Mixed-Methods Study to Test...

    Abstract:

    Background: Among Arab citizens in Israel, cigarette and nargila (hookah, waterpipe) smoking is a serious public health problem, particularly among the young adult population. With the dramatic increase of Internet and computer use among Arab college and university students, a Web-based program may provide an easy, accessible tool to reduce smoking rates without heavy resource demands required by traditional methods. Objective: The purpose of this research was to examine the acceptability and feasibility of a pilot Web-based program that provides tailored feedback to increase smoking knowledge and reduce cigarette and nargila smoking behaviors among Arab college/university students in Israel. Methods: A pilot Web-based program was developed, consisting of a self-administered questionnaire and feedback system on cigarette and nargila smoking. Arab university students were recruited to participate in a mixed-methods study, using both quantitative (pre-/posttest study design) and qualitative tools. A posttest was implemented at 1 month following participation in the intervention to assess any changes in smoking knowledge and behaviors. Focus group sessions were implemented to assess acceptability and preferences related to the Web-based program. Results: A total of 225 participants—response rate of 63.2% (225/356)—completed the intervention at baseline and at 1-month poststudy, and were used for the comparative analysis. Statistically significant reductions in nargila smoking among participants (P=.001) were found. The intervention did not result in reductions in cigarette smoking. However, the tailored Web intervention resulted in statistically significant increases in the intention to quit smoking (P=.021). No statistically significant increases in knowledge were seen at 1-month poststudy. Participants expressed high satisfaction with the intervention and 93.8% (211/225) of those who completed the intervention at both time intervals reported that they would recommend the program to their friends, indicating excellent acceptability and feasibility of the intervention. This was further emphasized in the focus group sessions. Conclusions: A tailored Web-based program may be a promising tool to reduce nargila smoking among Arab university students in Israel. The tailored Web intervention was not successful at significantly reducing cigarette smoking or increasing knowledge. However, the intervention did increase participants’ intention to quit smoking. Participants considered the Web-based tool to be an interesting, feasible, and highly acceptable strategy. Trial Registration: Trial Registration: ISRCTN registry ISRCTN59207794; http://www.isrctn.com/ISRCTN59207794 (Archived by WebCite at http://www.webcitation.org/6VkYOBNOJ).

  • Feature image for homepage.

    Integrating Health Belief Model and Technology Acceptance Model: An Investigation of Health-Related Internet Use

    Abstract:

    Background: Today, people use the Internet to satisfy health-related information and communication needs. In Malaysia, Internet use for health management has become increasingly significant due to the increase in the incidence of chronic diseases, in particular among urban women and their desire to stay healthy. Past studies adopted the Technology Acceptance Model (TAM) and Health Belief Model (HBM) independently to explain Internet use for health-related purposes. Although both the TAM and HBM have their own merits, independently they lack the ability to explain the cognition and the related mechanism in which individuals use the Internet for health purposes. Objective: This study aimed to examine the influence of perceived health risk and health consciousness on health-related Internet use based on the HBM. Drawing on the TAM, it also tested the mediating effects of perceived usefulness of the Internet for health information and attitude toward Internet use for health purposes for the relationship between health-related factors, namely perceived health risk and health consciousness on health-related Internet use. Methods: Data obtained for the current study were collected using purposive sampling; the sample consisted of women in Malaysia who had Internet access. The partial least squares structural equation modeling method was used to test the research hypotheses developed. Results: Perceived health risk (β=.135, t1999=2.676) and health consciousness (β=.447, t1999=9.168) had a positive influence on health-related Internet use. Moreover, perceived usefulness of the Internet and attitude toward Internet use for health-related purposes partially mediated the influence of health consciousness on health-related Internet use (β=.025, t1999=3.234), whereas the effect of perceived health risk on health-related Internet use was fully mediated by perceived usefulness of the Internet and attitude (β=.029, t1999=3.609). These results suggest the central role of perceived usefulness of the Internet and attitude toward Internet use for health purposes for women who were health conscious and who perceived their health to be at risk. Conclusions: The integrated model proposed and tested in this study shows that the HBM, when combined with the TAM, is able to predict Internet use for health purposes. For women who subjectively evaluate their health as vulnerable to diseases and are concerned about their health, cognition beliefs in and positive affective feelings about the Internet come into play in determining the use of health-related Internet use. Furthermore, this study shows that engaging in health-related Internet use is a proactive behavior rather than a reactive behavior, suggesting that TAM dimensions have a significant mediating role in Internet health management.

  • Wiki-based Medpedia (now discontinued).

    Medical Wikis Dedicated to Clinical Practice: A Systematic Review

    Abstract:

    Background: Wikis may give clinician communities the opportunity to build knowledge relevant to their practice. The only previous study reviewing a set of health-related wikis, without specification of purpose or audience, globally showed a poor reliability. Objective: Our aim was to review medical wiki websites dedicated to clinical practices. Methods: We used Google in ten languages, PubMed, Embase, Lilacs, and Web of Science to identify websites. The review included wiki sites, accessible and operating, having a topic relevant for clinical medicine, targeting physicians or medical students. Wikis were described according to their purposes, platform, management, information framework, contributions, content, and activity. Purposes were classified as “encyclopedic” or “non-encyclopedic”. The information framework quality was assessed based on the Health On the Net (HONcode) principles for collaborative websites, with additional criteria related to users’ transparency and editorial policy. From a sample of five articles per wikis, we assessed the readability using the Flesch test and compared articles according to the wikis’ main purpose. Annual editorial activities were estimated using the Google engine. Results: Among 25 wikis included, 11 aimed at building an encyclopedia, five a textbook, three lessons, two oncology protocols, one a single article, and three at reporting clinical cases. Sixteen wikis were specialized with specific themes or disciplines. Fifteen wikis were using MediaWiki software as-is, three were hosted by online wiki farms, and seven were purpose-built. Except for one MediaWiki-based site, only purpose-built platforms managed detailed user disclosures. The owners were ten organizations, six individuals, four private companies, two universities, two scientific societies, and one unknown. Among 21 open communities, 10 required users’ credentials to give editing rights. The median information framework quality score was 6 out of 16 (range 0-15). Beyond this score, only one wiki had standardized peer-reviews. Physicians contributed to 22 wikis, medical learners to nine, and lay persons to four. Among 116 sampled articles, those from encyclopedic wikis had more videos, pictures, and external resources, whereas others had more posology details and better readability. The median creation year was 2007 (1997-2011), the median number of content pages was 620.5 (3-98,039), the median of revisions per article was 17.7 (3.6-180.5) and 0.015 of talk pages per article (0-0.42). Five wikis were particularly active, whereas six were declining. Two wikis have been discontinued after the completion of the study. Conclusions: The 25 medical wikis we studied present various limitations in their format, management, and collaborative features. Professional medical wikis may be improved by using clinical cases, developing more detailed transparency and editorial policies, and involving postgraduate and continuing medical education learners.

Citing this Article

Right click to copy or hit: ctrl+c (cmd+c on mac)

Latest Submissions Open for Peer-Review:

View All Open Peer Review Articles
  • Swab2know: Results of an HIV-testing strategy using oral fluid samples and online communication of test results for MSM in Belgium.

    Date Submitted: Feb 27, 2015

    Open Peer Review Period: Feb 27, 2015 - Apr 24, 2015

    Background: As HIV remains a public health concern, increased testing among those at risk for HIV-acquisition is important. Men who have sex with men (MSM) are the most important group for targeted HI...

    Background: As HIV remains a public health concern, increased testing among those at risk for HIV-acquisition is important. Men who have sex with men (MSM) are the most important group for targeted HIV-testing in Europe. Several new strategies are developed and implemented to increase HIV-testing uptake in this group, among them the “Swab2know” project. Objective: In this project, we aim to facilitate testing uptake by offering free oral fluid test during outreach activities in MSM settings or online ordering sampling kits, and communicating test results via a secured website. Methods: Sample collection happened via outreach and online sampling among MSM. Test results were communicated through a secured website. HIV-test was executed in the laboratory. Each reactive sample needed to be confirmed using state-of-the-art confirmation procedures on a blood sample. Close follow-up of participants who didn’t pick up their result, or those with a reactive result, was included in the protocol. Participants were asked to provide feedback on the methodology using a short survey. Results: During 17 months, 1071 tests were executed on samples collected among 898 men. Over half of the samples (n=553; 51.6%) was collected during 23 outreach sessions. During an 8 months period, 430 samples (40.2%) were collected from online sampling. Additionally, 88 samples (8.2%) were collected by 2 partner organizations using the methodology during face-to-face consultations with MSM, and male sex workers. Results of 983 (91.8%) tests have been collected from the website. The pickup rate was higher among participants who ordered their kit online (421; 98.6%), compared to those participating during outreach activities (559; 87.2%; P<.001). MSM participating during outreach activities were more likely to have never been tested before (17.3% vs. 10.0%; P=.001), and reported more sexual partners in the 6 months prior to the participation in the project (7.18 vs. 3.23; P<.001). Ninety-two percent of the test results were checked. Twenty participants (2.2%) were confirmed HIV-positive, and linked to care. Twenty-eight participants (2.6%) with a weak reactive result could not be confirmed, and are thereby classified as ‘false reactive’ results. Most of the 388 (39.5%) obtained post-test surveys were very positive. The vast majority (371; 95.6%) was very satisfied, while 17 (4.4%) reported mixed feelings. Conclusions: Despite a high yield, and a considerable number of false reactive results, satisfaction was high among participants. The project helped us to reach the target population, both in numbers of tests executed, as in newly diagnosed HIV infections. Further operationalization should be considered in the accuracy of the test, the functionalities of the website, including an online counseling tool, and study the cost-effectiveness of the methodology.

  • How do young adults rate behavior change techniques applied in smartphone apps that promote physical activity? A cross-sectional survey

    Date Submitted: Feb 27, 2015

    Open Peer Review Period: Feb 27, 2015 - Apr 24, 2015

    Background: Interventions delivered through new technology devices, including smartphone apps, seem an effective method to reach young adults. Previous research indicates that self-efficacy and social...

    Background: Interventions delivered through new technology devices, including smartphone apps, seem an effective method to reach young adults. Previous research indicates that self-efficacy and social support for physical activity and self-regulation behavior change techniques (BCT), such as goal setting, feedback, and self-monitoring, are important for promoting physical activity; however, how the target population rates such BCTs applied to physical activity is unknown. Objective: This study aims to explore young adults’ opinions regarding BCTs applied in smartphone physical activity apps by rating these BCTs that include self-regulation techniques, and to examine the associations between personality characteristics and ratings of BCTs applied in physical activity apps. Methods: We conducted a cross-sectional online survey among healthy 18-30 year old adults (N=179). Data on participants’ gender, age, height, weight, current education level, living situation, smartphone use, personality traits, exercise self-efficacy, exercise self-identity, total physical activity level, and whether participants met the Dutch physical activity guidelines were collected. Items for rating BCTs applied in physical activity apps were selected from a hierarchical taxonomy for BCTs and were clustered into three BCT categories, according to factor analysis: “goal setting and goal reviewing,” “feedback and self-monitoring,” and “social support and social comparison.” Results: Most participants were female (N=146) and highly educated (N=169). In general, we observed high ratings of BCTs aimed to increase “goal setting and goal reviewing” and “feedback and self-monitoring,” but not for BCTs addressing “social support and social comparison.” Significant associations were observed between the personality characteristic “agreeableness” and more positive ratings of BCTs addressing “goal setting and goal reviewing” (OR = 1.6, 95%CI 1.06 – 2.41), the personality characteristic “neuroticism” and BCTs addressing “feedback and self-monitoring” (OR = 0.76, 95%CI 0.58 – 1.00), and exercise self-efficacy and a high rating of BCTs addressing “feedback and self-monitoring” (OR = 1.06, 95%CI 1.02 – 1.11). No associations were observed between personality characteristics (i.e. personality, exercise self-efficacy, exercise self-identity) and participants’ ratings of BCTs addressing “social support and social comparison.” Conclusions: Young Dutch adults rate self-regulation techniques as most positive and techniques addressing social support as less positive in smartphone apps that aim to promote physical activity. Such ratings of BCTs differ according to personality traits and exercise self-efficacy. Future research should focus on what behavior change techniques are effective in app-based interventions to increase physical activity behavior.

  • How Internet users perceive and address the tentativeness of medical research findings in online news articles

    Date Submitted: Feb 27, 2015

    Open Peer Review Period: Feb 27, 2015 - Apr 24, 2015

    Background: Laypeople frequently discuss medical research findings on web-based platforms, but little is known about whether they grasp the tentativeness that is inherent in these findings. Potential...

    Background: Laypeople frequently discuss medical research findings on web-based platforms, but little is known about whether they grasp the tentativeness that is inherent in these findings. Potential influential factors involved in understanding medical tentativeness have to date also not been assessed. Objective: The research presented here aimed to examine the effects of personality factors and of topics discussed in a web-based forum on laypeople’s understanding of the tentativeness of medical research findings. Methods: Seventy participants (aged 18 to 35) were presented with an online news article that reported findings on a novel therapeutic method for depression. In a randomized controlled experiment, we manipulated the forum such that depending on the experimental condition, the article was accompanied by user comments that addressed the issue of tentativeness of the findings, by user comments that did not address this issue, or the article was accompanied by no comments at all. Participants were instructed to write their own individual user comments. Their scientific literacy, epistemological beliefs, and academic self-efficacy were measured; the outcomes measured were perceived tentativeness (measured by a questionnaire) and tentativeness addressed in the participants’ own comments (coded by raters). All analyses controlled for the respective remaining predictors and, in the case of addressed tentativeness, for word count. Results: More sophisticated epistemological beliefs enhanced the perception of tentativeness (stand. β = .26, P = .034). Greater scientific literacy (stand. β = .25, P = .025) and greater academic self-efficacy (stand. β = .31, P = .007) were both predictors of a more extensive discussion of tentativeness in participants’ comments. When forum posts presented in the experiment addressed the issue of tentativeness, participants’ subsequent behavior tended to be consistent with what they had read in the forum, F(2, 63) = 3.66; P = .049. Conclusions: Laypeople’s understanding of the tentativeness of medical research findings in an online forum is not universal but is influenced by the topics that are discussed in the forum and by a number of character traits. The potential that targeted modification of traits such as scientific literacy, epistemological beliefs, and academic self-efficacy might foster critical thinking in laypeople who take part in online discussions of medical research findings is discussed.

  • The invisible work of personal health information management among people with multiple chronic conditions

    Date Submitted: Feb 26, 2015

    Open Peer Review Period: Feb 26, 2015 - Apr 23, 2015

    Background: A critical problem for patients with chronic conditions who see multiple healthcare providers is incomplete or inaccurate information, which can contribute to lack of care coordination, lo...

    Background: A critical problem for patients with chronic conditions who see multiple healthcare providers is incomplete or inaccurate information, which can contribute to lack of care coordination, low quality of care, and medical errors. Objective: As part of a larger project on applications of consumer HIT and barriers to its use, we conducted a semistructured interview study with patients with multiple chronic conditions (MCC) with the objective of exploring the role in managing their personal health information. Methods: Semistructured interviews were conducted with patients and providers. Patients were eligible if they had multiple chronic conditions and were in regular care with one of 2 medical organizations in New York City; healthcare providers were eligible if they had experience caring for patients with multiple chronic conditions. Analysis was conducted from a grounded theory perspective, and recruitment was concluded when saturation was achieved. Results: Twenty-two patients and 7 providers were interviewed; patients had an average of 2.7 chronic conditions and reported having regular relationships with an average of 5 providers. Four major themes arose. (1) Responsibility for managing medical information: Some patients perceived information management and sharing as the responsibility of healthcare providers. Others – particularly those who had had bad experiences in the past – took primary responsibility for information sharing. (2) What information should be shared: Although privacy concerns did influence some patients’ perceptions of sharing of medical data, decisions about what to share were also heavily influenced by their understanding of health and disease and by the degree to which they understood the healthcare system. (3) Methods and tools varied: Those patients who did take an active role in managing their records used a variety of electronic tools, paper tools, and memory. (4) Information management as invisible work: Managing transfers of medical information to solve problems was a tremendous amount of work that was largely unrecognized by the medical establishment. Conclusions: We conclude that personal health information management should be recognized as an additional burden that MCC places upon patients. Effective structural solutions for information sharing, whether institutional ones such as care management or technological ones such as electronic health information exchange, are likely not only to improve the quality of information shared but reduce the burden on patients already weighed down by MCC.

  • Using videogame applications to assess gains in health-related knowledge in adolescents: New opportunities for evaluating intervention exposure and content mastery

    Date Submitted: Feb 24, 2015

    Open Peer Review Period: Feb 25, 2015 - Apr 22, 2015

    Background: Videogame interventions are becoming increasingly popular as a means to engage people in behavioral interventions; however, strategies for examining data from such interventions have not b...

    Background: Videogame interventions are becoming increasingly popular as a means to engage people in behavioral interventions; however, strategies for examining data from such interventions have not been developed. Objective: The objective of the study was to describe how a technology-based intervention can yield meaningful, objective evidence of intervention exposure within a behavioral intervention. This study demonstrates the analysis of automatic log files, created by software from a videogame intervention, that catalog game play and the association of these data with changes in health knowledge, as documented with standardized assessments. Methods: We analyzed 3- and 6-month follow-up data from 173 participants enrolled in a randomized controlled trial evaluating a videogame intervention, PlayForward: Elm City Stories (PlayForward). PlayForward is a videogame developed as a risk reduction and prevention program targeting HIV risk behaviors (sex and substance use) in young minority adolescents. Log files were analyzed to extract the total amount of time spent playing the videogame intervention and the total number of game levels completed and beaten by each player. Results: Completing and beating more of the game levels, and not total game play time, was related to higher substance use knowledge scores at the 3- (p = .001) and 6-month (p = .001) follow ups. Conclusions: Our findings highlight the potential contributions a videogame intervention can make to the study of health behavior change. Specifically, the use of objective data collected during game play can address challenges in traditional human-delivered behavioral interventions. Clinical Trial: NCT01666496

  • My Joint Pain: web-based osteoarthritis management resource improves quality of care

    Date Submitted: Feb 24, 2015

    Open Peer Review Period: Feb 24, 2015 - Apr 21, 2015

    Background: Despite the availability of evidence-based guidelines for conservative treatment of osteoarthritis (OA), management is often confined to the use of analgesics and waiting for eventual tota...

    Background: Despite the availability of evidence-based guidelines for conservative treatment of osteoarthritis (OA), management is often confined to the use of analgesics and waiting for eventual total joint replacement. This suggests a gap in knowledge of persons with OA regarding the many different treatments available to them. Objective: Our objective was to test the effects of a web-based resource MyJointPain.org.au (“My Joint Pain”) that contains tailored, evidence-based information and tools aimed to improve self-management of OA on quality of care and health evaluation impact. Methods: A quasi experimental design was utilised to evaluate the intervention, “My Joint Pain”, over a 12-month period. The intervention provided participants with general and user-specific information, monthly assessments with validated instruments and progress tracking tools. A nationwide convenience sample of 195 participants with self-assessed hip and/or knee OA completed baseline and 12-month questionnaires (My Joint Pain Users n=104, Control n=91). The primary outcome measure was the Health Evaluation Impact Questionnaire (heiQ) to evaluate 8 different domains (health-directed activity; positive and active engagement in life; emotional distress; self-monitoring and insight; constructive attitudes and approaches; skill and technique acquisition; social integration and support; health service navigation) and the secondary outcome measure was the 17-item Osteoarthritis Quality Indicator (OAQI) questionnaire to evaluate the change in appropriateness of care received by participants. Independent t-tests were used to compare changes between groups for the heiQ and chi-square tests to identify change within and between groups from baseline to 12-months for each OAQI item. Results: Baseline demographics between groups were similar for gender (78% female), age (mean +SD 60 (±9) years) and body mass index (31.1 (±6.8) kg/m2). With the exception of ‘Health service navigation’, mean effect sizes from all other heiQ domains showed a positive trend for My Joint Pain users compared to the controls although the differences between groups did not reach statistical significance. Within group changes also showed improvements among the users of “My Joint Pain” for self-management (15.2%, p=.03), lifestyle (16.2%, p=.02) and physical activity (10.8%, p=.04), with no significant improvements in the control group. Following 12-month exposure to the website, compared to the control group, there were significant improvements between groups in self-management (change score=15.2% vs 1.7%, p=.001) and weight reduction (change score=2.5% vs -6.3%, p=.026) measured on the OAQI. Conclusions: A web resource “My Joint Pain” does not significantly improve overall heiQ but does improve other important aspects of quality of care in people with hip and/or knee OA. Further work is required to improve engagement with the website and the quality of information delivered in order to provide a greater impact.