JMIR Publications

Journal of Medical Internet Research

The leading peer-reviewed journal for health and healthcare in the Internet age.

JMIR's Thomson Reuter Impact Factor of 4.5 for 2015
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  • Screenshot of the community under study (https://www.reddit.com/r/loseit/).

    Factors Associated With Weight Change in Online Weight Management Communities: A Case Study in the LoseIt Reddit Community

    Abstract:

    Background: Recent research has shown that of the 72% of American Internet users who have looked for health information online, 22% have searched for help to lose or control weight. This demand for information has given rise to many online weight management communities, where users support one another throughout their weight loss process. Whether and how user engagement in online communities relates to weight change is not totally understood. Objective: We investigated the activity behavior and analyze the semantic content of the messages of active users in LoseIt (r/loseit), a weight management community of the online social network Reddit. We then explored whether these features are associated with weight loss in this online social network. Methods: A data collection tool was used to collect English posts, comments, and other public metadata of active users (ie, users with at least one post or comment) on LoseIt from August 2010 to November 2014. Analyses of frequency and intensity of user interaction in the community were performed together with a semantic analysis of the messages, done by a latent Dirichlet allocation method. The association between weight loss and online user activity patterns, the semantics of the messages, and real-world variables was found by a linear regression model using 30-day weight change as the dependent variable. Results: We collected posts and comments of 107,886 unique users. Among these, 101,003 (93.62%) wrote at least one comment and 38,981 (36.13%) wrote at least one post. Median percentage of days online was 3.81 (IQR 9.51). The 10 most-discussed semantic topics on posts were related to healthy food, clothing, calorie counting, workouts, looks, habits, support, and unhealthy food. In the subset of 754 users who had gender, age, and 30-day weight change data available, women were predominant and 92.9% (701/754) lost weight. Female gender, body mass index (BMI) at baseline, high levels of online activity, the number of upvotes received per post, and topics discussed within the community were independently associated with weight change. Conclusions: Our findings suggest that among active users of a weight management community, self-declaration of higher BMI levels (which may represent greater dissatisfaction with excess weight), high online activity, and engagement in discussions that might provide social support are associated with greater weight loss. These findings have the potential to aid health professionals to assist patients in online interventions by focusing efforts on increasing engagement and/or starting discussions on topics of higher impact on weight change.

  • A digital pill. Image sourced and copyright owned by Peter R Chai.

    Digital Pills to Measure Opioid Ingestion Patterns in Emergency Department Patients With Acute Fracture Pain: A Pilot Study

    Abstract:

    Background: Nonadherence to prescribed regimens for opioid analgesic agents contributes to increasing opioid abuse and overdose death. Opioids are frequently prescribed on an as-needed basis, placing the responsibility to determine opioid dose and frequency with the patient. There is wide variability in physician prescribing patterns because of the lack of data describing how patients actually use as-needed opioid analgesics. Digital pill systems have a radiofrequency emitter that directly measures medication ingestion events, and they provide an opportunity to discover the dose, timing, and duration of opioid therapy. Objective: The purpose of this study was to determine the feasibility of a novel digital pill system to measure as-needed opioid ingestion patterns in patients discharged from the emergency department (ED) after an acute bony fracture. Methods: We used a digital pill with individuals who presented to a teaching hospital ED with an acute extremity fracture. The digital pill consisted of a digital radiofrequency emitter within a standard gelatin capsule that encapsulated an oxycodone tablet. When ingested, the gastric chloride ion gradient activated the digital pill, transmitting a radiofrequency signal that was received by a hip-worn receiver, which then transmitted the ingestion data to a cloud-based server. After a brief, hands-on training session in the ED, study participants were discharged home and used the digital pill system to ingest oxycodone prescribed as needed for pain for one week. We conducted pill counts to verify digital pill data and open-ended interviews with participants at their follow-up appointment with orthopedics or at one week after enrollment in the study to determine the knowledge, attitudes, beliefs, and practices regarding digital pills. We analyzed open-ended interviews using applied thematic analysis. Results: We recruited 10 study participants and recorded 96 ingestion events (87.3%, 96/110 accuracy). Study participants reported being able to operate all aspects of the digital pill system after their training. Two participants stopped using the digital pill, reporting they were in too much pain to focus on the novel technology. The digital pill system detected multiple simultaneous ingestion events by the digital pill system. Participants ingested a mean 8 (SD 5) digital pills during the study period and four participants continued on opioids at the end of the study period. After interacting with the digital pill system in the real world, participants found the system highly acceptable (80%, 8/10) and reported a willingness to continue to use a digital pill to improve medication adherence monitoring (90%, 9/10). Conclusions: The digital pill is a feasible method to measure real-time opioid ingestion patterns in individuals with acute pain and to develop real-time interventions if opioid abuse is detected. Deploying digital pills is possible through the ED with a short instructional course. Patients who used the digital pill accepted the technology.

  • A Practice Approach to Developing Nutrition Label Reading Skills. Image sourced and copyright owned by authors.

    Developing Nutrition Label Reading Skills: A Web-Based Practice Approach

    Abstract:

    Background: Nutrition labels offer the information needed to follow Dietary Guidelines for Americans, yet many individuals use labels infrequently or ineffectively due to limited comprehension and the effort required to use them. Objective: The objective of our study was to develop and test a Web-based label-reading training tool to improve individuals’ ability to use labels to select more healthful foods. We were particularly interested in determining whether practice can lead to increased accuracy using labels as well as decreased effort, together reflecting greater efficiency. We compared a basic and an enhanced, prior-knowledge version of the tool that contained an additional component, a brief nutrition tutorial. Methods: Participants were 140 college students with an average age of 20.7 (SD 2.1) years and education 14.6 (SD 1.2) years, who completed 3 sets of practice that were designed to teach them, through repetition and feedback, how to use nutrition labels to select more healthful products. Prior to training, participants in the prior-knowledge group viewed a multimedia nutrition presentation, which those in the basic group did not receive. Mixed-effects models tested for improvement in accuracy and speed with practice, and whether improvements varied by group. Results: The training led to significant increases in average accuracy across the 3 practice sets (averaging 79% [19/24 questions], 92% [22/24], 96% [23/24] respectively, P<.001), as well as decreases in time to complete with mean (SD) values of 8.7 (2.8), 4.6 (1.8), and 4.1 (1.7) seconds, respectively. In block 3, the odds of a correct answer for the prior-knowledge group were 79% higher (odds ratio, OR=1.79, 95% CI 1.1-2.9) than those for the basic group (P=.02). There was no significant difference between the groups in block 2 (P=.89). Conclusions: Practice led to improvements in nutrition label reading skills that are indicative of early stages of automatic processing. To the extent that automatic processes are at the core of healthy habit change, this may be an efficient way to improve dietary decision-making.

  • Xbox Kinect interaction. Image sourced and copyright owned by authors.

    The Use of Motion-Based Technology for People Living With Dementia or Mild Cognitive Impairment: A Literature Review

    Abstract:

    Background: The number of people living with dementia and mild cognitive impairment (MCI) is increasing substantially. Although there are many research efforts directed toward the prevention and treatment of dementia and MCI, it is also important to learn more about supporting people to live well with dementia or MCI through cognitive, physical, and leisure means. While past research suggests that technology can be used to support positive aging for people with dementia or MCI, the use of motion-based technology has not been thoroughly explored with this population. Objective: The aim of this study was to identify and synthesize the current literature involving the use of motion-based technology for people living with dementia or MCI by identifying themes while noting areas requiring further research. Methods: A systematic review of studies involving the use of motion-based technology for human participants living with dementia or MCI was conducted. Results: A total of 31 articles met the inclusion criteria. Five questions are addressed concerning (1) context of use; (2) population included (ie, dementia, MCI, or both); (3) hardware and software selection; (4) use of motion-based technology in a group or individual setting; and (5) details about the introduction, teaching, and support methods applied when using the motion-based technology with people living with dementia or MCI. Conclusions: The findings of this review confirm the potential of motion-based technology to improve the lives of people living with dementia or MCI. The use of this technology also spans across several contexts including cognitive, physical, and leisure; all of which support multidimensional well-being. The literature provides evidence that people living with dementia or MCI can learn how to use this technology and that they enjoy doing so. However, there is a lack of information provided in the literature regarding the introduction, training, and support methods applied when using this form of technology with this population. Future research should address the appropriate introduction, teaching, and support required for people living with dementia or MCI to use the motion-based technology. In addition, it is recommended that the diverse needs of these specific end-users be considered in the design and development of this technology.

  • Aboriginal health provider training. Image sourced and copyright owned by authors.

    Translating E-Mental Health Into Practice: What Are the Barriers and Enablers to E-Mental Health Implementation by Aboriginal and Torres Strait Islander...

    Abstract:

    Background: With increasing evidence for the effectiveness of e-mental health interventions for enhancing mental health and well-being, a growing challenge is how to translate promising research findings into service delivery contexts. A 2012 e-mental health initiative by the Australian Federal Government (eMHPrac) has sought to address the issue through several strategies, one of which has been to train different health professional workforces in e-mental health (e-MH). Objective: The aim of the study was to report on the barriers and enablers of e-MH uptake in a cohort of predominantly Aboriginal and Torres Strait Islander health professionals (21 Indigenous, 5 non-Indigenous) who occupied mainly support or case management roles within their organizations. Methods: A 3- or 2-day e-MH training program was followed by up to 5 consultation sessions (mean 2.4 sessions) provided by the 2 trainers. The trainer-consultants provided written reports on each of the 30 consultation sessions for 7 consultation groups. They were also interviewed as part of the study. The written reports and interview data were thematically analyzed by 2 members of the research team. Results: Uptake of e-MH among the consultation group was moderate (22%-30% of participants). There were significant organizational barriers to uptake resulting from procedural and administrative problems, demanding workloads, prohibitive policies, and a lack of fit between the organizational culture and the introduction of new technologies. Personal barriers included participant beliefs about the applicability of e-MH to certain populations, and workers’ lack of confidence and skills. However, enthusiastic managers and tech-savvy champions could provide a counter-balance as organizational enablers of e-MH; and the consultation sessions themselves appear to have enhanced skills and confidence, shifted attitudes to new technologies, and seeded a perception that e-MH could be a valuable health education resource. Conclusions: A conclusion from the program was that it was important to match e-MH training and resources to work roles. In the latter stages of the consultation sessions, the Aboriginal and Torres Strait Islander health professionals responded very positively to YouTube video clips and apps with a health education dimension. Therapy-oriented apps and programs may fit less well within the scope of practice of some workforces, including this one. We suggest that researchers broaden their focus and definitions of e-MH and give rather more weight to e-MH’s health education possibilities. Developing criteria for evaluating apps and YouTube videos may empower a rather greater section of health workforce to use e-MH with their clients.

  • Pregnancy test. Image source: https://www.flickr.com/photos/isnow/5700736622. . Author: Johannes Jander. Copyright: https://creativecommons.org/licenses/by-nd/2.0/.

    Patient Information Websites About Medically Induced Second-Trimester Abortions: A Descriptive Study of Quality, Suitability, and Issues

    Abstract:

    Background: Patients undergoing medically induced second-trimester abortions feel insufficiently informed and use the Web for supplemental information. However, it is still unclear how people who have experience with pregnancy termination appraise the quality of patient information websites about medically induced second-trimester abortions, whether they consider the websites suitable for patients, and what issues they experience with the websites. Objective: Our objective was to investigate the quality of, suitability of, and issues with patient information websites about medically induced second-trimester abortions and potential differences between websites affiliated with the health care system and private organizations. Methods: We set out to answer the objective by using 4 laypeople who had experience with pregnancy termination as quality assessors. The first 50 hits of 26 systematic searches were screened (N=1300 hits) using search terms reported by the assessors. Of these hits, 48% (628/1300) were irrelevant and 51% (667/1300) led to websites about medically induced second-trimester abortions. After correcting for duplicate hits, 42 patient information websites were included, 18 of which were affiliated with the health care system and 24 with private organizations. The 4 assessors systematically assessed the websites with the DISCERN instrument (total score range 16-80), the Ensuring Quality Information for Patients (EQIP) tool (total score range 0-100), as well as questions concerning website suitability and perceived issues. Results: The interrater reliability was 0.8 for DISCERN and EQIP, indicating substantial agreement between the assessors. The total mean score was 36 for DISCERN and 40 for EQIP, indicating poor overall quality. Websites from the health care system had greater total EQIP (45 vs 37, P>.05) and reliability scores (22 vs 20, P>.05). Only 1 website was recommended by all assessors and 57% (24/42) were rated as very unsuitable by at least one assessor. The most reported issues with the websites involved lack of information (76%, 32/42), and poor design (36%, 15/42). Conclusions: The high number of irrelevant hits and poor quality of patient information websites are considerable issues that must be addressed and considered when consulting patients awaiting medically induced second-trimester abortions. In clinical encounters, health professionals should initiate discussions concerning websites about medically induced second-trimester abortions and inform patients about the issues and quality deficits associated with these websites.

  • Laptop. Image source: https://www.flickr.com/photos/johnloo/8709720022. Author: John Loo. Copyright: https://creativecommons.org/licenses/by/2.0/.

    The Associations Among Individual Factors, eHealth Literacy, and Health-Promoting Lifestyles Among College Students

    Abstract:

    Background: eHealth literacy is gaining importance for maintaining and promoting health. Studies have found that individuals with high eHealth literacy are more likely to adopt healthy eating, exercise, and sleep behaviors. In addition, previous studies have shown that various individual factors (eg, frequency of seeking information on health issues, degree of health concern, frequency of eating organic food, and students’ college major) are associated with eHealth literacy and health-promoting lifestyles. Nevertheless, few studies have explored the associations among individual factors, eHealth literacy, and health-promoting lifestyles among college students. Moreover, there is a lack of studies that focus on eHealth literacy as a predictor of psychological health behaviors. Objective: To examine the associations among various individual factors, eHealth literacy, and health-promoting lifestyles. Methods: The eHealth Literacy Scale is a 12-item instrument designed to measure college students’ functional, interactive, and critical eHealth literacy. The Health-promoting Lifestyle Scale is a 23-item instrument developed to measure college students’ self-actualization, health responsibility, interpersonal support, exercise, nutrition, and stress management. A nationally representative sample of 556 valid college students in Taiwan was surveyed. A questionnaire was administered to gather the respondents’ background information, including the frequency of seeking information on health issues, the frequency of eating organic food, the degree of health concern, and the students’ major. We then conducted a multiple regression analysis to examine the associations among individual factors, eHealth literacy, and health-promoting lifestyles. Results: The study found that factors such as medical majors (t550=2.47-7.55, P<.05) and greater concern with health (t550=2.15-9.01, P<.05) predicted college students’ 4-6 health-promoting lifestyle dimensions and the 3 dimensions of eHealth literacy. Moreover, critical eHealth literacy positively predicted all 6 health-promoting lifestyle dimensions (t547=2.66-7.28, P<.01), functional literacy positively predicted 2 dimensions (t547=2.32-2.98, P<.05), and interactive literacy predicted only the self-actualization dimension (t547=2.81, P<.01). Conclusions: This study found that participants who majored in medical fields had greater concern with their health and frequently sought health information, exhibited better eHealth literacy, and had a positive health-promoting lifestyle. Moreover, this study showed that college students with a higher critical eHealth literacy engaged better in health-promoting activities than those with functional and interactive literacy.

  • Screenshot of the intervention arm website dashboard. Image sourced and copyright owned by authors.

    Does Usage of an eHealth Intervention Reduce the Risk of Excessive Gestational Weight Gain? Secondary Analysis From a Randomized Controlled Trial

    Abstract:

    Background: Excessive gestational weight gain (GWG) contributes to the development of obesity in mother and child. Internet-based interventions have the potential for delivering innovative and interactive options for prevention of excessive GWG to large numbers of people. Objective: The objective of this study was to create a novel measure of Internet-based intervention usage patterns and examine whether usage of an Internet-based intervention is associated with reduced risk of excessive GWG. Methods: The website featured blogs, local resources, articles, frequently asked questions (FAQs), and events that were available to women in both the intervention and control arm. Weekly reminders to use the website and to highlight new content were emailed to participants in both arms. Only intervention arm participants had access to the weight gain tracker and diet and physical activity goal-setting tools. A total of 1335 (898 intervention and 437 control) relatively diverse and healthy pregnant women were randomly assigned to the intervention arm or control arm. Usage patterns were examined for both intervention and control arm participants using latent class analysis. Regression analyses were used to estimate the association between usage patterns and three GWG outcomes: excessive total GWG, excessive GWG rate, and GWG. Results: Five usage patterns best characterized the usage of the intervention by intervention arm participants. Three usage patterns best characterized control arm participants’ usage. Control arm usage patterns were not associated with excessive GWG, whereas intervention arm usage patterns were associated with excessive GWG. Conclusions: The control and intervention arm usage pattern characterization is a unique methodological contribution to process evaluations for self-directed Internet-based interventions. In the intervention arm some usage patterns were associated with GWG outcomes. ClinicalTrial: ClinicalTrials.gov; Clinical Trials Number: NCT01331564; https://clinicaltrials.gov/ct2/show/NCT01331564 (Archived by WebCite at http://www.webcitation/6nI9LuX9w)

  • Chemotherapy IV administration. Image Source: https://commons.wikimedia.org/wiki/File:Chemotherapy_iv.jpg. Author: Linda Bartlett. Copyright: Public Domain.

    Cancer Survivors’ Experience With Telehealth: A Systematic Review and Thematic Synthesis

    Abstract:

    Background: Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors—individuals living with and beyond cancer—to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are “complex,” and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized. Objective: To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group. Methods: Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes. Analytical themes were developed through an iterative process of reflection on, and interpretation of, the descriptive themes within and across studies. Results: Across the 22 included papers, 3 analytical themes emerged, each with 3 descriptive subthemes: (1) influence of telehealth on the disrupted lives of cancer survivors (convenience, independence, and burden); (2) personalized care across physical distance (time, space, and the human factor); and (3) remote reassurance—a safety net of health care professional connection (active connection, passive connection, and slipping through the net). Telehealth interventions represent a convenient approach, which can potentially minimize treatment burden and disruption to cancer survivors’ lives. Telehealth interventions can facilitate an experience of personalized care and reassurance for those living with and beyond cancer; however, it is important to consider individual factors when tailoring interventions to ensure engagement promotes benefit rather than burden. Conclusions: Telehealth interventions can provide cancer survivors with independence and reassurance. Future telehealth interventions need to be developed iteratively in collaboration with a broad range of cancer survivors to maximize engagement and benefit.

  • The Facebook app featured on a smartphone. Image Source: https://pixabay.com/en/facebook-login-phone-smartphone-390860/. Author: PDPics. Copyright: Public Domain.

    Variations in Facebook Posting Patterns Across Validated Patient Health Conditions: A Prospective Cohort Study

    Abstract:

    Background: Social media is emerging as an insightful platform for studying health. To develop targeted health interventions involving social media, we sought to identify the patient demographic and disease predictors of frequency of posting on Facebook. Objective: The aims were to explore the language topics correlated with frequency of social media use across a cohort of social media users within a health care setting, evaluate the differences in the quantity of social media postings across individuals with different disease diagnoses, and determine if patients could accurately predict their own levels of social media engagement. Methods: Patients seeking care at a single, academic, urban, tertiary care emergency department from March to October 2014 were queried on their willingness to share data from their Facebook accounts and electronic medical records (EMRs). For each participant, the total content of Facebook posts was extracted. Using the latent Dirichlet allocation natural language processing technique, Facebook language topics were correlated with frequency of Facebook use. The mean number of Facebook posts over 6 months prior to enrollment was then compared across validated health outcomes in the sample. Results: A total of 695 patients consented to provide access to their EMR and social media data. Significantly correlated language topics among participants with the highest quartile of posts contained health terms, such as “cough,” “headaches,” and “insomnia.” When adjusted for demographics, individuals with a history of depression had significantly higher posts (mean 38, 95% CI 28-50) than individuals without a history of depression (mean 22, 95% CI 19-26, P=.001). Except for depression, across prevalent health outcomes in the sample (hypertension, diabetes, asthma), there were no significant posting differences between individuals with or without each condition. Conclusions: High-frequency posters in our sample were more likely to post about health and to have a diagnosis of depression. The direction of causality between depression and social media use requires further evaluation. Our findings suggest that patients with depression may be appropriate targets for health-related interventions on social media.

  • Doctor with tablet in hands. Image Source: http://www.freepik.com/free-photo/doctor-with-tablet-in-hands_978248.htm#term=health%20tablet&page=1&position=27. Author: jannoon028. Copyright: CCO License.

    Personal Health Records: A Systematic Literature Review

    Abstract:

    Background: Information and communication technology (ICT) has transformed the health care field worldwide. One of the main drivers of this change is the electronic health record (EHR). However, there are still open issues and challenges because the EHR usually reflects the partial view of a health care provider without the ability for patients to control or interact with their data. Furthermore, with the growth of mobile and ubiquitous computing, the number of records regarding personal health is increasing exponentially. This movement has been characterized as the Internet of Things (IoT), including the widespread development of wearable computing technology and assorted types of health-related sensors. This leads to the need for an integrated method of storing health-related data, defined as the personal health record (PHR), which could be used by health care providers and patients. This approach could combine EHRs with data gathered from sensors or other wearable computing devices. This unified view of patients’ health could be shared with providers, who may not only use previous health-related records but also expand them with data resulting from their interactions. Another PHR advantage is that patients can interact with their health data, making decisions that may positively affect their health. Objective: This work aimed to explore the recent literature related to PHRs by defining the taxonomy and identifying challenges and open questions. In addition, this study specifically sought to identify data types, standards, profiles, goals, methods, functions, and architecture with regard to PHRs. Methods: The method to achieve these objectives consists of using the systematic literature review approach, which is guided by research questions using the population, intervention, comparison, outcome, and context (PICOC) criteria. Results: As a result, we reviewed more than 5000 scientific studies published in the last 10 years, selected the most significant approaches, and thoroughly surveyed the health care field related to PHRs. We developed an updated taxonomy and identified challenges, open questions, and current data types, related standards, main profiles, input strategies, goals, functions, and architectures of the PHR. Conclusions: All of these results contribute to the achievement of a significant degree of coverage regarding the technology related to PHRs.

  • Thought Challenger Screen. Image sourced and copyright owned by authors.

    IntelliCare: An Eclectic, Skills-Based App Suite for the Treatment of Depression and Anxiety

    Abstract:

    Background: Digital mental health tools have tended to use psychoeducational strategies based on treatment orientations developed and validated outside of digital health. These features do not map well to the brief but frequent ways that people use mobile phones and mobile phone apps today. To address these challenges, we developed a suite of apps for depression and anxiety called IntelliCare, each developed with a focused goal and interactional style. IntelliCare apps prioritize interactive skills training over education and are designed for frequent but short interactions. Objective: The overall objective of this study was to pilot a coach-assisted version of IntelliCare and evaluate its use and efficacy at reducing symptoms of depression and anxiety. Methods: Participants, recruited through a health care system, Web-based and community advertising, and clinical research registries, were included in this single-arm trial if they had elevated symptoms of depression or anxiety. Participants had access to the 14 IntelliCare apps from Google Play and received 8 weeks of coaching on the use of IntelliCare. Coaching included an initial phone call plus 2 or more texts per week over the 8 weeks, with some participants receiving an additional brief phone call. Primary outcomes included the Patient Health Questionnaire-9 (PHQ-9) for depression and the Generalized Anxiety Disorder-7 (GAD-7) for anxiety. Participants were compensated up to US $90 for completing all assessments; compensation was not for app use or treatment engagement. Results: Of the 99 participants who initiated treatment, 90.1% (90/99) completed 8 weeks. Participants showed substantial reductions in the PHQ-9 and GAD-7 (P<.001). Participants used the apps an average of 195.4 (SD 141) times over the 8 weeks. The average length of use was 1.1 (SD 2.1) minutes, and 95% of participants downloaded 5 or more of the IntelliCare apps. Conclusions: This study supports the IntelliCare framework of providing a suite of skills-focused apps that can be used frequently and briefly to reduce symptoms of depression and anxiety. The IntelliCare system is elemental, allowing individual apps to be used or not used based on their effectiveness and utility, and it is eclectic, viewing treatment strategies as elements that can be applied as needed rather than adhering to a singular, overarching, theoretical model. Trial Registration: Clinicaltrials.gov NCT02176226; http://clinicaltrials.gov/ct2/show/NCT02176226 (Archived by WebCite at http://www.webcitation/6mQZuBGk1)

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  • User testing of mobile apps and wearables to monitor rare disease in India

    Date Submitted: Jan 13, 2017

    Open Peer Review Period: Jan 14, 2017 - Mar 11, 2017

    Background: Remote monitoring may offer solutions for patients with limited access to clinicians, chronic disease sufferers who lives rurally or a great distance from specialist Doctors, and could off...

    Background: Remote monitoring may offer solutions for patients with limited access to clinicians, chronic disease sufferers who lives rurally or a great distance from specialist Doctors, and could offer a resolution to the data problem suffered in rare disease groups, where small populations and limited disease progression data exists. Objective: This was a user testing exercise coordinated with the Gauchers Association [UK] and the Lysosomal Storage Disorder Support Society [LSDSS] to explore the reception of remote monitoring using a wearable and mobile app with Type I Gauchers patients in India. Methods: Participants were provided with a wearable wristband that counts steps and a mobile app that collects additional health data. They had the opportunity to use these for a month before answering an online questionnaire about their experience of using the tech. Results: Six volunteers participated, with four becoming active users and responding to the questionnaires Conclusions: The mobile app and band collected information for all users. While the band was able to collect objective step data, some subjective measures in the app were identified as being more useful than others, and additional measurements were identified for future trials. The experience demonstrated that the tech could be successfully deployed in India and resulted in good engagement and adherence with patients. Clinical Trial: Not applicable

  • Assess suicide risk and emotional distress in Chinese social media by natural language use

    Date Submitted: Jan 9, 2017

    Open Peer Review Period: Jan 13, 2017 - Mar 10, 2017

    Background: The mainstream assessment of individuals’ suicide risk or emotional distress relies on self-report scales or clinical assessments. Such assessment relies on individuals’ willingness an...

    Background: The mainstream assessment of individuals’ suicide risk or emotional distress relies on self-report scales or clinical assessments. Such assessment relies on individuals’ willingness and ability to seek help/treatment, which is often challenging for distressed or suicidal people. Objective: The present study explores how natural language can be utilized to proactively assess one’s suicide risk and emotional distress in Chinese social media. Methods: An online survey was conducted on Sina Weibo to assess the respondents’ suicide risk and emotional distress. With the respondents’ consent, we also downloaded all of their Weibo posts which were posted in the public domain during the 12 months prior to the survey by calling the Weibo API. Weibo posts were tokenized and language features were extracted by applying Simplified Chinese Linguistic Inquiry and Word Count (SC-LIWC). Logistic regression analysis were operated to examine the relationship between use of SC-LIWC categories and the respondents’ suicide risk with emotional distress. Support Vector Machines were trained to automatically classify whether a respondent was showing suicide risk or emotional distress. ROC curve analysis was operated for examining the diagnostic accuracy of the machine classifiers. Results: Weibo users with high suicide risk were marked by a higher usage of pronoun, prepend words, and multifunction words, a lower usage of verb, and a greater total word count. Severe depression was marked by more use of second-person plural and achievement-related words, but less use of work-related words. Anxiety was also marked by less use of work-related words. Stress was marked by more use of third-person and second-person plural, health-related words, and death-related word. and stress were marked by more use of second-person plural, and less use of work-related words. The machine classification on suicide risk and depression achieved satisfying results after adding a filter of Weibo suicide communication. However, the classification results for severe depression and stress were still not significant. Conclusions: The study demonstrates the utility of natural language as alternative assessment tool of suicide risk and emotional distress in Chinese social media. The current development can improve assessment coverage and efficiency but still requires experts’ inputs to increase accuracy. Clinical Trial: N/A

  • Key Components in eHealth Interventions Combining Self-Tracking and Persuasive eCoaching to Promote a Healthier Lifestyle: a Scoping Review

    Date Submitted: Jan 9, 2017

    Open Peer Review Period: Jan 13, 2017 - Mar 10, 2017

    Background: The combination of self-tracking and persuasive eCoaching in automated interventions is a new and promising approach for healthy lifestyle management. Objective: This scoping review aims t...

    Background: The combination of self-tracking and persuasive eCoaching in automated interventions is a new and promising approach for healthy lifestyle management. Objective: This scoping review aims to identify key components of self-tracking and persuasive eCoaching in automated healthy lifestyle interventions that contribute to the effectiveness on health outcomes, usability, and adherence. A secondary aim was to identify the way in which the key components should be designed to contribute to improved health outcomes, usability, and adherence. Knowledge about these key components can be used during development of such healthy lifestyle interventions. Methods: The scoping review methodology proposed by Arskey and O’Malley was applied. Scopus, EMBASE, PsycINFO and PubMed were searched for publications between January 1st, 2013 – January 31st, 2016 that included (1) self-tracking, (2) persuasive eCoaching, and (3) healthy lifestyle intervention. Results: The search resulted in 32 publications of which 17 publications provided results on the effect on health outcomes, 27 studies provided results on usability and 13 studies provided results on adherence. Among the 32 publications, 27 described an intervention. The most commonly applied persuasive eCoaching components in the described interventions were personalization (n=24), suggestion (n=19), goal-setting (n=17), simulation (n=17), and reminders (n=15). Concerning self-tracking components, most interventions utilized an accelerometer to measure steps (n=11). In addition, the intervention was most often delivered via a smartphone (n=10). The following key components and their specific design both seem to influence health outcomes and usability in a positive way: reduction by setting short term goals to eventually reach long-term goals, personalization of goals, praise messages, reminders to input self-tracking data into the technology, use of validity tested devices, integration of self-tracking and persuasive eCoaching, and provision of face-to-face instructions during implementation. In addition, it did not seem to negatively affect health outcomes or usability when more effort was requested from participants to input data into the technology. Data extracted from the included publications limited the ability to provide key components on adherence. However, one key component identified for both usability and adherence was the provision of personalized content. Conclusions: This scoping review provides a first overview of the key components in automated healthy lifestyle interventions combining self-tracking and persuasive eCoaching that can be utilized during the development of such interventions. Future studies should focus on the identification of key components for effect on adherence as adherence is a prerequisite for an intervention to be effective.

  • Critical Appraisal of E-Health Intervention for Anxiety Management in Youths

    Date Submitted: Jan 3, 2017

    Open Peer Review Period: Jan 11, 2017 - Mar 8, 2017

    Background: Advances in technology are progressively more relevant to the clinical practice of psychology and mental health services generally. Studies indicate that technology facilitates the deliver...

    Background: Advances in technology are progressively more relevant to the clinical practice of psychology and mental health services generally. Studies indicate that technology facilitates the delivery of interventions, such as Cognitive Behavioral Therapy (CBT), in the treatment of a number of psychological disorders in adults, including depression, anxiety, obsessive–compulsive disorder, panic symptoms, and eating disorders. Fewer data exist for computer-based (stand-alone; self-help) and computer-assisted (in combination with face-to-face therapy; therapist guided) programs in youths. Objective: This article summarizes and critically reviews the literature evaluating the acceptability and efficacy of using technology with treatment and prevention programs for anxiety in young children and adolescents. The aim is to improve the understanding of what would be critical for future development of effective technology-based interventions. Methods: A systematic literature search was conducted in three scientific electronic databases (including PsycINFO, Science Direct and PubMed). Keywords with various combinations were used: child/children, adolescent, pre-school children, anxiety, intervention or treatment or program, smartphone applications or apps, online or web-based tool, computer-based tool, serious games, cognitive behavioral therapy (CBT), biofeedback. Results: Available studies demonstrate promising results in reducing anxiety, especially relative to the application of CBT with technology. For those programs demonstrating efficacy, no difference was noted when compared with traditional intervention. Other approaches have been applied to technology-based interventions with inconclusive results. The majority of existing programs are developed to be used concurrently with traditional treatments and lack long term evaluation. Very little has been done in terms of prevention interventions. Conclusions: Future development of e-Health programs for the management of anxiety in children will have to address several unmet needs and overcome key challenges: although developmental stages may limit the applicability to preschool children, prevention should start in early ages; self-help format and personalization are highly relevant for large-scale dissemination; automated data collection should be built in for program evaluation and effectiveness assessment; a strategy to stimulate motivation to play and maintain high adherence should be carefully considered.

  • Towards understanding pain-monitoring electronic technologies for adults: a Systematic Literature Review

    Date Submitted: Jan 6, 2017

    Open Peer Review Period: Jan 9, 2017 - Mar 6, 2017

    Background: Remote monitoring of patients may decrease treatment costs and improve quality of care. Pain is the most common health problem that people seek help for in hospitals. Therefore, remote mon...

    Background: Remote monitoring of patients may decrease treatment costs and improve quality of care. Pain is the most common health problem that people seek help for in hospitals. Therefore, remote monitoring of patients with pain may have significant impact in improving treatment. Several studies have studied factors affecting pain, however, no previous study has characterized a patient’s situation through all the relevant contextual information that a monitoring system may capture. Objective: The objective of this study was to conduct a systematic review to (1) determine what types of technologies have been used to monitor adult patients with pain, and (2) construct a model of the context information relevant to pain monitoring that may be used to implement applications and devices aimed at monitoring patients with pain. Methods: A literature search (2005-2015) was conducted in electronic databases pertaining to medical and computer science literature (PubMed, Science Direct, ACM Digital Library, and IEEE Xplore), using a defined search string. Article selection was done through a process of removing duplicates, analyzing title and abstract, and then reviewing the full text of the article. Results: 87 articles were included in the final analysis and 53 of them (61%) used technologies to collect contextual information. 49 types of context information were found and a five-dimension model of context information to monitor patients was proposed, expanding a previous model. Most technological interfaces for pain monitoring are wearable, possibly because they can be used in more realistic contexts. Few studies focus on older adults, creating a relevant avenue of research on how to create devices for users that may have impaired cognitive skills or low digital literacy. Conclusions: The design of remote monitoring devices and interfaces for patients with pain must deal with the challenge of selecting relevant contextual information to understand the user’s situation, and not overburdening or inconveniencing users with information requests. A complete model of contextual information that a device can capture may be used by designers to review possible contextual information and choose which is relevant for a particular device.

  • User and website characteristics related to attrition in a self-regulation-based eHealth intervention to promote a healthy lifestyle

    Date Submitted: Jan 6, 2017

    Open Peer Review Period: Jan 8, 2017 - Mar 5, 2017

    Background: EHealth interventions can reach large populations and are effective in increasing physical activity (PA) and fruit and vegetable intake. Nevertheless, the effects of eHealth interventions...

    Background: EHealth interventions can reach large populations and are effective in increasing physical activity (PA) and fruit and vegetable intake. Nevertheless, the effects of eHealth interventions are overshadowed by high attrition rates. Examining more closely when users decide to leave the intervention can help eHealth developers to make informed decisions about which intervention components should be reshaped or simply removed. Investigating which users are more likely to quit an intervention can inform developers about whether and how their intervention should be adapted to specific subgroups of users. Objective: This study investigates the pattern of attrition in a web-based intervention to increase PA, fruit and vegetable intake. The first aim is to describe attrition rates according to different self-regulation components. A second aim is to investigate if certain user characteristics are predictors for start session completion, returning to a follow-up session and intervention completion. Methods: The sample consisted of 549 adults who participated in an online intervention, based on self-regulation theory, to promote PA and fruit and vegetable intake, called ‘MyPlan 1.0’. Using descriptive analysis, attrition was explored per self-regulation component (e.g. action planning, coping planning, …). To identify which user characteristics predict completion, logistic regression analyses were conducted. Results: At the end of the intervention programme, there was an attrition rate of 78.2%. Attrition rates were very similar for the different self-regulation components. However, attrition levels were higher for the fulfilment of questionnaires (e.g. to generate tailored feedback) than for the more interactive components. The highest amount of attrition could be observed when people were asked to make their own action plan. There were no significant predictors for first session completion. Yet, two subgroups had a lower chance to complete the intervention, namely male users (OR: 2.24, 95% CI= 1.23-4.08) and younger adults (OR: 1.02, 95% CI= 1.00-1.04). Furthermore, younger adults were less likely to return to the website for the first follow-up after one week (OR= 1.03, 95% CI= 1.01-1.04). Conclusions: This study informs us that eHealth interventions should avoid the use of extensive questionnaires and that users should be provided with a rationale for several components (e.g. making an action plan, completing questions, …). Furthermore, future interventions should focus first on motivating users for the behaviour change, before guiding them through action planning. Though, this study provides no evidence for removal of one of the self-regulation techniques based on attrition rates. Lastly, strong efforts are needed to motivate male users and younger adults to complete eHealth interventions.

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