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

Twitter-based Journal Clubs: Some Additional Facts and Clarifications

We read the recently published paper on globalization of continuing professional development by Roberts et al with great interest. The authors should be congratulated on their idea as well as their execution of this novel way of evaluating and describing Twitter-based journal clubs. We would like to add to their article by providing some additional advantages and features of a Twitter-based online journal club to provide the reader with a more complete appreciation of their educational potential.


Call for Abstracts is Now Extended. Extended Submission Deadline: May 29 at midnight EST

APRIL 1, 2015, BOSTON, MA -- The Connected Health Symposium, hosted annually by Partners HealthCare, today announced it has established a joint program with JMIR Publications to feature up to 50 poster presentations at this year's Symposium. JMIR Publications is the leading ehealth publisher, with over ten academic journals covering digital health, technology and innovation in health. Its flagship journal, the Journal of Medical Internet Research (JMIR), is the leading publication in the fields of medical informatics, health sciences and services research.

"There is important research being conducted throughout the connected health ecosystem that we can learn from and which deserves recognition. Academics, startups and other innovators will now have a stage to showcase their work at our annual Connected Health Symposium," said Kamal Jethwani, MD, MPH, Senior Director of Connected Health Innovation at Partners HealthCare. "We are very pleased to be working with JMIR Publications, publisher of the largest and most cited journals in ehealth."

As part of this new joint program, JMIR, along with members of the Partners Connected Health Innovation team, will review and select abstracts to be featured in a new poster session at the upcoming Connected Health Symposium. Poster presenters will receive complimentary registration to the Connected Health Symposium. Authors of accepted abstracts will also have an opportunity to submit papers for review and possible publication in JMIR and its sister journals (e.g. JMIR Medical Informatics, JMIR mHealth, JMIR Serious Games, JMIR Rehab, JMIR Mental Health, JMIR Public Health, JMIR Research Protocols and others) at a highly discounted rate.

"The Connected Health Symposium is a destination for discussion, learnings and innovation to advance the adoption and integration of connected health strategies," added Susan Lane, RN, MSN, MBA, Senior Director, Connected Health Operations, Partners HealthCare. "With the addition of this poster session, we are furthering our mission to highlight cutting-edge, novel and scalable programs to over 1,000 attendees at our Symposium, including clinicians, investors, innovators and academicians."

Abstracts must be submitted by May 29, 2015  (midnight EST) at An extended abstract (up to 5 pages) must be also be submitted (template at

For full submission details, please see the call for papers at

“We are thrilled to be involved in selecting the best research submissions for the Connected Health Symposium and to be the official publisher of this conference,” said Gunther Eysenbach, MD, MPH, FACMI, Publisher and Editor-in-Chief of the Journal of Medical Internet Research and its ten sister journals. “The partnership with the Connected Health Symposium is a logical extension of our strategy to partner with the leading knowledge translation initiatives in this field with the ultimate goal to advance ehealth and to expand our unique network of leading researchers in this field.”  

The 12th Annual Connected Health Symposium, being held October 29-30 in Boston, is a change-agent conference that promotes innovative thinking and the application of personal consumer health technologies, with a  focus on trends at the intersection of technology and new models of health care delivery.  Over 1,200 technology leaders, industry execs, Fortune 500 employers, policymakers, clinicians and health plan execs will come together to define the future of care delivery and impact the day-to-day lives of patients.

JMIR Publications
JMIR Publications is the leading ehealth publisher, advancing progress in the health, engineering and social sciences to ultimately help people to live happier and healthier lives using technology. JMIR Publications helps innovators in the health technology space to collaborate and disseminate their innovations, ideas, and research results to the widest possible audience, in a timely manner, adding value to the quality of the work and adhering to the highest ethical and quality standards. We achieve this by using the Internet and the latest available technologies as well as by producing conferences and social media, and other innovative knowledge translation products. We also innovate in the scholarly communication space itself, experimenting with new business models, new models of peer-review and dissemination, and new technologies. Visit

Partners HealthCare Connected Health
Partners is leveraging information technology – cell phones, computers, wearables, sensors and remote health monitoring tools – to deliver quality patient care outside of traditional medical settings. Partners Connected Health programs are also helping providers and patients better manage chronic conditions, maintain health and wellness and improve adherence, engagement and clinical outcomes. The Connected Health team creates and deploys mobile technologies in a number of patient populations and care settings, and is conducting innovative clinical studies to test the effectiveness of mobile health technologies in various clinical applications, including medication adherence, care coordination, chronic disease management, and prevention and wellness.

Partners HealthCare
Partners HealthCare is an integrated health system founded by Brigham and Women’s Hospital and Massachusetts General Hospital.  In addition to its two academic medical centers, the Partners system includes community and specialty hospitals, a managed care organization, community health centers, a physician network, home health and long-term care services, and other health care entities. Partners HealthCare is committed to patient care, research, teaching, and service to the community. Partners is one of the nation’s leading biomedical research organizations and a principal teaching affiliate of Harvard Medical School.  Partners HealthCare is a non-profit organization. Visit


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    The Role of eHealth in Optimizing Preventive Care in the Primary Care Setting


    Modifiable health risk behaviors such as smoking, overweight and obesity, risky alcohol consumption, physical inactivity, and poor nutrition contribute to a substantial proportion of the world’s morbidity and mortality burden. General practitioners (GPs) play a key role in identifying and managing modifiable health risk behaviors. However, these are often underdetected and undermanaged in the primary care setting. We describe the potential of eHealth to help patients and GPs to overcome some of the barriers to managing health risk behaviors. In particular, we discuss (1) the role of eHealth in facilitating routine collection of patient-reported data on lifestyle risk factors, and (2) the role of eHealth in improving clinical management of identified risk factors through provision of tailored feedback, point-of-care reminders, tailored educational materials, and referral to online self-management programs. Strategies to harness the capacity of the eHealth medium, including the use of dynamic features and tailoring to help end users engage with, understand, and apply information need to be considered and maximized. Finally, the potential challenges in implementing eHealth solutions in the primary care setting are discussed. In conclusion, there is significant potential for innovative eHealth solutions to make a contribution to improving preventive care in the primary care setting. However, attention to issues such as data security and designing eHealth interfaces that maximize engagement from end users will be important to moving this field forward.

  • The Image is also used on the projects´ homepage (, so we have the licens to use this picture.

    Personal Electronic Health Records: Understanding User Requirements and Needs in Chronic Cancer Care


    Background: The integration of new information and communication technologies (ICTs) is becoming increasingly important in reorganizing health care. Adapting ICTs as supportive tools to users' needs and daily practices is vital for adoption and use. Objective: In order to develop a Web-based personal electronic health record (PEPA), we explored user requirements and needs with regard to desired information and functions. Methods: A qualitative study across health care sectors and health professions was conducted in a regional health care setting in Germany. Overall, 10 semistructured focus groups were performed, collecting views of 3 prospective user groups: patients with colorectal cancer (n=12) and representatives from patient support groups (n=2), physicians (n=17), and non-medical HCPs (n=16). Data were audio- and videotaped, transcribed verbatim, and thematically analyzed using qualitative content analysis. Results: For both patients and HCPs, it was central to have a tool representing the chronology of illness and its care processes, for example, patients wanted to track their long-term laboratory findings (eg, tumor markers). Designing health information in a patient accessible way was highlighted as important. Users wanted to have general and tumor-specific health information available in a PEPA. Functions such as filtering information and adding information by patients (eg, on their well-being or electronic communication with HCPs via email) were discussed. Conclusions: In order to develop a patient/user centered tool that is tailored to user needs, it is essential to address their perspectives. A challenge for implementation will be how to design PEPA’s health data in a patient accessible way. Adequate patient support and technical advice for users have to be addressed.

  • Photo by Naypong. Published on 28 November 2012 Stock photo - Image ID: 100120940;

    The Acceptability Among Health Researchers and Clinicians of Social Media to Translate Research Evidence to Clinical Practice: Mixed-Methods Survey and...


    Background: Establishing and promoting connections between health researchers and health professional clinicians may help translate research evidence to clinical practice. Social media may have the capacity to enhance these connections. Objective: The aim of this study was to explore health researchers’ and clinicians’ current use of social media and their beliefs and attitudes towards the use of social media for communicating research evidence. Methods: This study used a mixed-methods approach to obtain qualitative and quantitative data. Participation was open to health researchers and clinicians. Data regarding demographic details, current use of social media, and beliefs and attitudes towards the use of social media for professional purposes were obtained through an anonymous Web-based survey. The survey was distributed via email to research centers, educational and clinical institutions, and health professional associations in Australia, India, and Malaysia. Consenting participants were stratified by country and role and selected at random for semistructured telephone interviews to explore themes arising from the survey. Results: A total of 856 participants completed the questionnaire with 125 participants declining to participate, resulting in a response rate of 87.3%. 69 interviews were conducted with participants from Australia, India, and Malaysia. Social media was used for recreation by 89.2% (749/840) of participants and for professional purposes by 80.0% (682/852) of participants. Significant associations were found between frequency of professional social media use and age, gender, country of residence, and graduate status. Over a quarter (26.9%, 229/852) of participants used social media for obtaining research evidence, and 15.0% (128/852) of participants used social media for disseminating research evidence. Most participants (95.9%, 810/845) felt there was a role for social media in disseminating or obtaining research evidence. Over half of the participants (449/842, 53.3%) felt they had a need for training in the use of social media for professional development. A key barrier to the professional use of social media was concerns regarding trustworthiness of information. Conclusions: A large majority of health researchers and clinicians use social media in recreational and professional contexts. Social media is less frequently used for communication of research evidence. Training in the use of social media for professional development and methods to improve the trustworthiness of information obtained via social media may enhance the utility of social media for communicating research evidence. Future studies should investigate the efficacy of social media in translating research evidence to clinical practice.

  • This is a royalty free image by Stuart Miles (

    Seeking Health Information Online: Association With Young Australian Women’s Physical, Mental, and Reproductive Health


    Background: Relatively little is known about the extent to which young adults use the Internet as a health information resource and whether there are factors that distinguish between those who do and do not go online for health information. Objective: The aim was to identify the sociodemographic, physical, mental, and reproductive health factors associated with young women’s use of the Internet for health information. Methods: We used data from 17,069 young women aged 18-23 years who participated in the Australian Longitudinal Study on Women’s Health. Multivariable logistic regression was used to estimate the association between sociodemographic, physical, mental, and reproductive health factors associated with searching the Internet for health information. Results: Overall, 43.54% (7433/17,069) of women used the Internet for health information. Women who used the Internet had higher odds of regular urinary or bowel symptoms (OR 1.44, 95% CI 1.36-1.54), psychological distress (very high distress: OR 1.24, 95% CI 1.13-1.37), self-reported mental health diagnoses (OR 1.16, 95% CI 1.09-1.23), and menstrual symptoms (OR 1.25, 95% CI 1.15-1.36) than women who did not use the Internet for health information. Internet users were less likely to have had blood pressure checks (OR 0.85, 95% CI 0.78-0.93) and skin cancer checks (OR 0.90, 95% CI 0.84-0.97) and to have had a live birth (OR 0.74, 95% CI 0.64-0.86) or pregnancy loss (OR 0.88, 95% CI 0.79-0.98) than non-Internet users. Conclusions: Women experiencing “stigmatized” conditions or symptoms were more likely to search the Internet for health information. The Internet may be an acceptable resource that offers “anonymized” information or support to young women and this has important implications for health service providers and public health policy.

  • Mary James helps Plymouth Senior Net participant. (Photo courtesy of Daily Mail).

    Older People Going Online: Its Value and Before-After Evaluation of Volunteer Support


    Background: Although Internet usage can benefit older people by reducing social isolation, increasing access to services, and improving health and well-being, only a minority are online. Barriers to Internet uptake include attitude and a lack of knowledge and help. We have evaluated volunteer support in helping older people go online. Knowing what value the Internet has been to older people who have just gone online should guide how it is “sold” to those remaining offline. Objective: Objectives of this study are (1) to assess the feasibility of recruiting volunteers aged 50 years and older and supporting them in helping people (ie, beneficiaries) aged 65 years and older go online, (2) to assess the impact of beneficiaries using the Internet on contacts with others, loneliness, and mental health, and (3) to assess the perceived value to beneficiaries of going online. Methods: Beneficiaries received help in using the Internet from 32 volunteers in one of two ways: (1) one-on-one in their own homes, receiving an average of 12 hours of help over eight visits, or (2) in small group sessions, receiving 12 hours of help over six visits. We assessed, at registration and follow-up, the number of contacts with others, using Lubben’s 6-item Lubben Social Network Scale (LBNS-6), loneliness, using De Jong Gierveld’s 6-item De Jong Gierveld loneliness scale (DJG-6), and mental well-being, using Tennant’s Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS). We also assessed how beneficiaries valued going online using a Social Return on Investment (SROI) approach by postal survey. Results: A total of 144 beneficiaries were recruited with the aim of helping them go online via one-on-one (n=58) or small group (n=86) sessions. Data through to follow-up were available on 76.4% (110/144) of participants. From baseline to follow-up, the number of contacts with others was significantly increased—LBNS-6, mean 13.7 to mean 17.6—loneliness scores were reduced—DJG-6, mean 2.38 to mean 1.80—and mental well-being improved—SWEMWBS, mean 24.06 to mean 24.96. Out of six options, beneficiaries valued better communication with family and friends most and better health care least as a benefit of using the Internet. Out of nine options, having the Internet was valued less than having TV, but more than, for example, having a weekly visit from a cleaner. There were no associations between values placed on Internet use or volunteer help and psychological improvements. Conclusions: Volunteer help to go online seemed to result in increased social contacts, reduced loneliness, and improved mental well-being and was valued quite highly by beneficiaries. Although the use of the Internet for health care was the least valued, improved social contact can improve health. Contacting family is likely to be the best “selling point” of the Internet for older people.

  • Gustave Caillebotte [Public domain], via Wikimedia Commons (

    E-Mental Health Care Among Young Adults and Help-Seeking Behaviors: A Transversal Study in a Community Sample


    Background: The Internet is widely used by young people and could serve to improve insufficient access to mental health care. Previous information on this topic comes from selected samples (students or self-selected individuals) and is incomplete. Objective: In a community sample of young adults, we aimed to describe frequency of e-mental health care study-associated factors and to determine if e-mental health care was associated with the use of conventional services for mental health care. Methods: Using data from the 2011 wave of the TEMPO cohort study of French young adults (N=1214, aged 18-37 years), we examined e-mental health care and associated factors following Andersen’s behavioral model: predisposing factors (age, sex, educational attainment, professional activity, living with a partner, children, childhood negative events, chronic somatic disease, parental history of depression), enabling factors (social support, financial difficulties, parents’ income), and needs-related factors (lifetime major depression or anxiety disorders, suicidal ideation, ADHD, cannabis use). We compared traditional service use (seeking help from a general practitioner, a psychiatrist, a psychologist; antidepressant or anxiolytics/hypnotics use) between participants who used e-mental health care versus those who did not. Results: Overall, 8.65% (105/1214) of participants reported seeking e-mental health care in case of psychological difficulties in the preceding 12 months and 15.7% (104/664) reported psychological difficulties. Controlling for all covariates, the likelihood of e-mental health care was positively associated with 2 needs-related factors, lifetime major depression or anxiety disorder (OR 2.36, 95% CI 1.36-4.09) and lifetime suicidal ideation (OR 1.91, 95% CI 1.40-2.60), and negatively associated with a predisposing factor: childhood life events (OR 0.60, 95% CI 0.38-0.93). E-mental health care did not hinder traditional care, but was associated with face-to-face psychotherapy (66.2%, 51/77 vs 52.4%, 186/355, P=.03). Conclusions: E-mental health care represents an important form of help-seeking behavior for young adults. Professionals and policy makers should take note of this and aim to improve the quality of online information on mental health care and to use this fact in clinical care.

  • Photo by Stuart Miles. Published on 26 July 2012; Stock photo - Image ID: 10094197;

    Behavior Change Techniques in Popular Alcohol Reduction Apps: Content Analysis


    Background: Mobile phone apps have the potential to reduce excessive alcohol consumption cost-effectively. Although hundreds of alcohol-related apps are available, there is little information about the behavior change techniques (BCTs) they contain, or the extent to which they are based on evidence or theory and how this relates to their popularity and user ratings. Objective: Our aim was to assess the proportion of popular alcohol-related apps available in the United Kingdom that focus on alcohol reduction, identify the BCTs they contain, and explore whether BCTs or the mention of theory or evidence is associated with app popularity and user ratings. Methods: We searched the iTunes and Google Play stores with the terms “alcohol” and “drink”, and the first 800 results were classified into alcohol reduction, entertainment, or blood alcohol content measurement. Of those classified as alcohol reduction, all free apps and the top 10 paid apps were coded for BCTs and for reference to evidence or theory. Measures of popularity and user ratings were extracted. Results: Of the 800 apps identified, 662 were unique. Of these, 13.7% (91/662) were classified as alcohol reduction (95% CI 11.3-16.6), 53.9% (357/662) entertainment (95% CI 50.1-57.7), 18.9% (125/662) blood alcohol content measurement (95% CI 16.1-22.0) and 13.4% (89/662) other (95% CI 11.1-16.3). The 51 free alcohol reduction apps and the top 10 paid apps contained a mean of 3.6 BCTs (SD 3.4), with approximately 12% (7/61) not including any BCTs. The BCTs used most often were “facilitate self-recording” (54%, 33/61), “provide information on consequences of excessive alcohol use and drinking cessation” (43%, 26/61), “provide feedback on performance” (41%, 25/61), “give options for additional and later support” (25%, 15/61) and “offer/direct towards appropriate written materials” (23%, 14/61). These apps also rarely included any of the 22 BCTs frequently used in other health behavior change interventions (mean 2.46, SD 2.06). Evidence was mentioned by 16.4% of apps, and theory was not mentioned by any app. Multivariable regression showed that apps including advice on environmental restructuring were associated with lower user ratings (Β=-46.61, P=.04, 95% CI -91.77 to -1.45) and that both the techniques of “advise on/facilitate the use of social support” (Β=2549.21, P=.04, 95% CI 96.75-5001.67) and the mention of evidence (Β=1376.74, P=.02, 95%, CI 208.62-2544.86) were associated with the popularity of the app. Conclusions: Only a minority of alcohol-related apps promoted health while the majority implicitly or explicitly promoted the use of alcohol. Alcohol-related apps that promoted health contained few BCTs and none referred to theory. The mention of evidence was associated with more popular apps, but popularity and user ratings were only weakly associated with the BCT content.

  • The basic components of the STM system. The eOPR originates a CPOE that is univocally associated with the patient’s RFID bracelet and the barcodes of the individual chemotherapy and ancillary drug, and washing solution. The RFID/barcode communicates via Bluetooth with the tablet, which communicates via Wi-Fi with the server of the OPR. The RFID/barcode reader checks the patient’s RFID bracelet, the nurse’s RFID, and the barcode on the infusion bag before each drug administration .

    Integrating mHealth in Oncology: Experience in the Province of Trento


    Background: The potential benefits of the introduction of electronic and mobile health (mHealth) information technologies, to support the safe delivery of intravenous chemotherapy or oral anticancer therapies, could be exponential in the context of a highly integrated computerized system. Objective: Here we describe a safe therapy mobile (STM) system for the safe delivery of intravenous chemotherapy, and a home monitoring system for monitoring and managing toxicity and improving adherence in patients receiving oral anticancer therapies at home. Methods: The STM system is fully integrated with the electronic oncological patient record. After the prescription of chemotherapy, specific barcodes are automatically associated with the patient and each drug, and a bedside barcode reader checks the patient, nurse, infusion bag, and drug sequence in order to trace the entire administration process, which is then entered in the patient’s record. The usability and acceptability of the system was investigated by means of a modified questionnaire administered to nurses. The home monitoring system consists of a mobile phone or tablet diary app, which allows patients to record their state of health, the medications taken, their side effects, and a Web dashboard that allows health professionals to check the patient data and monitor toxicity and treatment adherence. A built-in rule-based alarm module notifies health care professionals of critical conditions. Initially developed for chronic patients, the system has been subsequently customized in order to monitor home treatments with capecitabine or sunitinib in cancer patients (Onco-TreC). Results: The STM system never failed to match the patient/nurse/drug sequence association correctly, and proved to be accurate and reliable in tracing and recording the entire administration process. The questionnaires revealed that the users were generally satisfied and had a positive perception of the system’s usefulness and ease of use, and the quality of their working lives. The pilot studies with the home monitoring system with 43 chronic patients have shown that the approach is reliable and useful for clinicians and patients, but it is also necessary to pay attention to the expectations that mHealth solutions may raise in users. The Onco-TreC version has been successfully laboratory tested, and is now ready for validation. Conclusions: The STM and Onco-TreC systems are fully integrated with our complex and composite information system, which guarantees privacy, security, interoperability, and real-time communications between patients and health professionals. They need to be validated in order to confirm their positive contribution to the safer administration of anticancer drugs.

  • Image source: Shutterstock.

    Effectiveness of a Blended Web-Based Intervention on Return to Work for Sick-Listed Employees With Common Mental Disorders: Results of a Cluster Randomized...


    Background: Common mental disorders are strongly associated with long-term sickness absence, which has negative consequences for the individual employee’s quality of life and leads to substantial costs for society. It is important to focus on return to work (RTW) during treatment of sick-listed employees with common mental disorders. Factors such as self-efficacy and the intention to resume work despite having symptoms are important in the RTW process. We developed “E-health module embedded in Collaborative Occupational health care” (ECO) as a blended Web-based intervention with 2 parts: an eHealth module (Return@Work) for the employee aimed at changing cognitions of the employee regarding RTW and a decision aid via email supporting the occupational physician with advice regarding treatment and referral options based on monitoring the employee’s progress during treatment. Objective: This study evaluated the effect of a blended eHealth intervention (ECO) versus care as usual on time to RTW of sick-listed employees with common mental disorders. Methods: The study was a 2-armed cluster randomized controlled trial. Employees sick-listed between 4 and 26 weeks with common mental disorder symptoms were recruited by their occupational health service or employer. The employees were followed up to 12 months. The primary outcome measures were time to first RTW (partial or full) and time to full RTW. Secondary outcomes were response and remission of the common mental disorder symptoms (self-assessed). Results: A total of 220 employees were included: 131 participants were randomized to the ECO intervention and 89 to care as usual (CAU). The duration until first RTW differed significantly between the groups. The median duration was 77.0 (IQR 29.0-152.3) days in the CAU group and 50.0 (IQR 20.8-99.0) days in the ECO group (hazard ratio [HR] 1.390, 95% CI 1.034-1.870, P=.03). No significant difference was found for duration until full RTW. Treatment response of common mental disorder symptoms did not differ significantly between the groups, but at 9 months after baseline significantly more participants in the ECO group achieved remission than in the CAU group (OR 2.228, 95% CI 1.115-4.453, P=.02). Conclusions: The results of this study showed that in a group of sick-listed employees with common mental disorders, applying the blended eHealth ECO intervention led to faster first RTW and more remission of common mental disorder symptoms than CAU. Clinical Trial: Netherlands Trial Register NTR2108; (Archived by WebCite at

  • (cc) Cristancho-Lacroix et al., CC-BY-SA 2.0, please cite as (

    A Web-Based Psychoeducational Program for Informal Caregivers of Patients With Alzheimer’s Disease: A Pilot Randomized Controlled Trial


    Background: Although several face-to-face programs are dedicated to informal caregivers of persons with dementia, they are not always accessible to overburdened or isolated caregivers. Based on a face-to-face intervention program, we adapted and designed a Web-based fully automated psychoeducational program (called Diapason) inspired by a cognitive approach. Objective: This study aimed to evaluate through a pilot unblinded randomized controlled trial the efficacy and acceptability of a Web-based psychoeducational program for informal caregivers of persons with Alzheimer’s disease (PWAD) based on a mixed methods research design. Methods: We recruited and randomized offline 49 informal caregivers of a PWAD in a day care center in Paris, France. They either received the Web-based intervention and usual care for 3 months (experimental group, n=25) or only usual care (control group, n=24). Caregivers’ perceived stress (PSS-14, primary outcome), self-efficacy, burden, perceived health status, and depression (secondary outcomes) were measured during 3 face-to-face on-site visits: at baseline, at the end of the program (month 3), and after follow-up (month 6). Additionally, semistructured interviews were conducted with experimental group caregivers at month 6 and examined with thematic analysis. Results: Intention-to-treat analysis did not show significant differences in self-perceived stress between the experimental and control groups (P=.98). The experimental group significantly improved their knowledge of the illness (d=.79, P=.008) from baseline to month 3. Of the 25 participants allocated to the experimental group, 17 (71%) finished the protocol and entirely viewed at least 10 of 12 online sessions. On average, participants used the website 19.72 times (SD 12.88) and were connected for 262.20 minutes (SD 270.74). The results of the satisfaction questionnaire showed that most participants considered the program to be useful (95%, 19/20), clear (100%, 20/20), and comprehensive (85%, 17/20). Significant correlations were found between relationship and caregivers’ program opinion (P=.01). Thus, positive opinions were provided by husbands and sons (3/3), whereas qualified opinions were primarily reported by daughters (8/11). Female spouses expressed negative (2/3) or neutral opinions (1/3). Caregivers expected more dynamic content and further interaction with staff and peers. Conclusions: In this study, quantitative results were inconclusive owing to small sample size. Qualitative results indicated/showed little acceptance of the program and high expectations from caregivers. Caregivers did not rule out their interest in this kind of intervention provided that it met their needs. More dynamic, personalized, and social interventions are desirable. Our recruitment issues pointed out the necessity of in-depth studies about caregivers’ help-seeking behaviors and readiness factors. Trial Registration: NCT01430286; (Archived by WebCite at http://www.webcitation/6KxHaRspL).

  • © momius #47608318 / Fotolia.

    Who Follows eHealth Interventions as Recommended? A Study of Participants' Personal Characteristics From the Experimental Arm of a Randomized Controlled Trial


    Background: Computer-tailored eHealth interventions to improve health behavior have been demonstrated to be effective and cost-effective if they are used as recommended. However, different subgroups may use the Internet differently, which might also affect intervention use and effectiveness. To date, there is little research available depicting whether adherence to intervention recommendations differs according to personal characteristics. Objective: The aim was to assess which personal characteristics are associated with using an eHealth intervention as recommended. Methods: A randomized controlled trial was conducted among a sample of the adult Dutch population (N=1638) testing an intervention aimed at improving 5 healthy lifestyle behaviors: increasing fruit and vegetable consumption, increasing physical activity, reducing alcohol intake, and promoting smoking cessation. Participants were asked to participate in those specific online modules for which they did not meet the national guideline(s) for the respective behavior(s). Participants who started with fewer than the recommended number of modules of the intervention were defined as users who did not follow the intervention recommendation. Results: The fewer modules recommended to participants, the better participants adhered to the intervention modules. Following the intervention recommendation increased when participants were older (χ21=39.8, P<.001), female (χ21=15.8, P<.001), unemployed (χ21=7.9, P=.003), ill (χ21=4.5, P=.02), or in a relationship (χ21=7.8, P=.003). No significant relevant differences were found between groups with different levels of education, incomes, or quality of life. Conclusion: Our findings indicate that eHealth interventions were used differently by subgroups. The more frequent as-recommended intervention use by unemployed, older, and ill participants may be an indication that these eHealth interventions are attractive to people with a greater need for health care information. Further research is necessary to make intervention use more attractive for people with unhealthy lifestyle patterns.

  • Picture of counselor and patient during telemedicine counseling.  All subjects have provided permission for their image to be used.

    Comparative and Cost Effectiveness of Telemedicine Versus Telephone Counseling for Smoking Cessation


    Background: In rural America, cigarette smoking is prevalent and health care providers lack the time and resources to help smokers quit. Telephone quitlines are important avenues for cessation services in rural areas, but they are poorly integrated with local health care resources. Objective: The intent of the study was to assess the comparative effectiveness and cost effectiveness of two models for delivering expert tobacco treatment at a distance: telemedicine counseling that was integrated into smokers’ primary care clinics (Integrated Telemedicine—ITM) versus telephone counseling, similar to telephone quitline counseling, delivered to smokers in their homes (Phone). Methods: Smokers (n=566) were recruited offline from 20 primary care and safety net clinics across Kansas. They were randomly assigned to receive 4 sessions of ITM or 4 sessions of Phone counseling. Patients in ITM received real-time video counseling, similar to Skype, delivered by computer/webcams in clinic exam rooms. Three full-time equivalent trained counselors delivered the counseling. The counseling duration and content was the same in both groups and was available in Spanish or English. Both groups also received identical materials and assistance in selecting and obtaining cessation medications. The primary outcome was verified 7-day point prevalence smoking abstinence at month 12, using an intent-to-treat analysis. Results: There were no significant baseline differences between groups, and the trial achieved 88% follow-up at 12 months. Verified abstinence at 12 months did not significantly differ between ITM or Phone (9.8%, 27/280 vs 12%, 34/286; P=.406). Phone participants completed somewhat more counseling sessions than ITM (mean 2.6, SD 1.5 vs mean 2.4, SD 1.5; P=.0837); however, participants in ITM were significantly more likely to use cessation medications than participants in Phone (55.9%, 128/280 vs 46.1%, 107/286; P=.03). Compared to Phone participants, ITM participants were significantly more likely to recommend the program to a family member or friend (P=.0075). From the combined provider plus participant (societal) perspective, Phone was significantly less costly than ITM. Participants in ITM had to incur time and mileage costs to travel to clinics for ITM sessions. From the provider perspective, counseling costs were similar between ITM (US $45.46, SD 31.50) and Phone (US $49.58, SD 33.35); however, total provider costs varied widely depending on how the clinic space for delivering ITM was valued. Conclusions: Findings did not support the superiority of ITM over telephone counseling for helping rural patients quit smoking. ITM increased utilization of cessation pharmacotherapy and produced higher participant satisfaction, but Phone counseling was significantly less expensive. Future interventions could combine elements of both approaches to optimize pharmacotherapy utilization, counseling adherence, and satisfaction. Such an approach could commence with a telemedicine-delivered clinic office visit for pharmacotherapy guidance, and continue with telephone or real-time video counseling delivered via mobile phones to flexibly deliver behavioral support to patients where they most need it—in their homes and communities. Trial Registration: NCT00843505; (Archived by WebCite at

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  • Twitter-based Journal Clubs: Some Additional Facts and Clarifications

    Date Submitted: May 8, 2015

    Open Peer Review Period: May 9, 2015 - Jul 4, 2015

    We read the recently published paper on globalization of continuing professional development by Roberts et al with great interest. The authors should be congratulated on their idea as well as their ex...

    We read the recently published paper on globalization of continuing professional development by Roberts et al with great interest. The authors should be congratulated on their idea as well as their execution of this novel way of evaluating and describing Twitter-based journal clubs. We would like to add to their article by providing some additional advantages and features of a Twitter-based online journal club to provide the reader with a more complete appreciation of their educational potential.

  • Serious Games for Healthcare: Online Framework, Applications and Evaluation Case Studies

    Date Submitted: Apr 23, 2015

    Open Peer Review Period: Apr 25, 2015 - Jun 20, 2015

    Background: Integrating serious games for Health has been proposed through a unified framework expanding current Health informatics. Healthcare from this perspective includes care for persons with phy...

    Background: Integrating serious games for Health has been proposed through a unified framework expanding current Health informatics. Healthcare from this perspective includes care for persons with physical, mental or developmental limitations. Objective: The main objective is to suggest an online framework to configure, monitor and analyze the results of health intervention therapy based games using different media. Methods: The technology offers various possibilities to interact with the game through tools such as iPad, Kinect, Wii or robots. All of them communicated through internet and the information stored in the cloud. Results: Having all the data in the cloud allows, not only have the updated tracking of the patient, also to update the treatment based on the combination of appropriate games for every stage of the disease. To do this, biofeedback information is included. Conclusions: The main benefit remains to be that Games can provide an improved lifestyle and a more friendly approach to health diagnostics and therapies when possible.

  • Smoking cessation intervention on Facebook: Which content generates the best engagement?

    Date Submitted: Apr 24, 2015

    Open Peer Review Period: Apr 25, 2015 - Jun 20, 2015

    Background: Social media offer great opportunity to deliver smoking cessation treatment to young adults, but previous online and social media interventions targeting health behavior change have strugg...

    Background: Social media offer great opportunity to deliver smoking cessation treatment to young adults, but previous online and social media interventions targeting health behavior change have struggled with low participant engagement. We examined engagement generated by content based on the Transtheoretical Model of Behavior Change (TTM) in a motivationally tailored smoking cessation intervention on Facebook. Objective: This study aimed to identify which intervention content based on the TTM generated the highest engagement among participants in pre-action stages of change (Precontemplation, Contemplation, Preparation). Methods: Participants (N=79, 20% female, Mean age = 20.8) were assessed for readiness to quit smoking and assigned to one of 7 secret Facebook groups tailored to their stage of change. Daily postings to the groups based on the TTM were made by research staff over 3 months. Engagement was operationalized as the number of participant comments to each post. TTM theory-based predictors of number of comments were analyzed, stratified by baseline stage of change, using zero-inflated negative binomial regression. Results: A total of 512 TTM-based posts generated 630 individual comments. In Precontemplation and Contemplation groups, Decisional Balance posts generated above average engagement (p=.01 and p<.001). In Contemplation groups, Dramatic Relief and Self-Liberation posts resulted in below average engagement (p=.01 and p=.005). In Preparation groups, Consciousness Raising generated above average engagement (p=.009). Participant engagement decreased over time and differed between groups within Precontemplation and Contemplation stages, but was independent of day of the week and time of day the content was posted to the groups. No participant baseline characteristics significantly predicted engagement. Conclusions: Participants not ready to quit in the next 30 days (in Precontemplation or Contemplation) engaged most when prompted to think about the pros and cons of behavior change, while those in the Preparation stage engaged most when posts increased awareness about smoking. Findings support tailoring intervention to readiness to quit and suggest intervention targets that may be most effective through social media.

  • Prevalence of Depression in Medical Students at the Lebanese University and its Correlation with Facebook Relevance:

    Date Submitted: Apr 17, 2015

    Open Peer Review Period: Apr 21, 2015 - Jun 16, 2015

    Background: The prevalence of major depression is particularly high in medical students affecting around one third of this population. Moreover, online social media and in particular Facebook (fb) is...

    Background: The prevalence of major depression is particularly high in medical students affecting around one third of this population. Moreover, online social media and in particular Facebook (fb) is becoming an intrinsic part in the life of a growing proportion of individuals worldwide. Objective: Our primary objective is to identify the prevalence of depression in medical students at the Lebanese University Faculty of Medicine (unique state university in Lebanon) and its correlation with the utilization of the interactive features of fb. Methods: Students of the Lebanese University Faculty of Medicine were assessed for: (1) depression and (2) fb activity. To screen for major depression we used the PHQ-9 scale. As for fb activity we developed the Facebook Resorting Questionnaire (FbRQ), which measures the degree of fb resorting. Results: Three hundred and sixty five (76%) out of 480 students participated in the survey. Twenty four were excluded hence 341 students were finally included. Current depression was reported in 117 students (34.31%) with a (2.25:1) female to male ratio; 81 out of 195 females (41.5%) versus 36 out of 146 males (24.6%). Moreover, 41 depressed students resorted to fb (35%) compared to 73 non-depressed students (32.5%). There was a strong correlation between depression and fb- resorting (P= .001) and depressed users resorted more to fb than the non- depressed. Conclusions: This study showed that depression was highly prevalent among students of the Faculty of Medicine at the Lebanese University. Moreover fb may be a promising helpful psychological tool for optimizing the management of depression. Our study brought to bear further questions that now prompt further observation and scrutiny to know more about the high rates of depression in this student population more so in this part of the world and to the growing role of social media.

  • Developing a mHealth Campaign: Utilizing Principles of Health Communications

    Date Submitted: Apr 16, 2015

    Open Peer Review Period: Apr 17, 2015 - Jun 12, 2015

    Mobile health (mHealth), or the use of mobile devices to improve health, is increasingly used as a powerful campaign tool in health communications. However, there is few peer-reviewed literature outli...

    Mobile health (mHealth), or the use of mobile devices to improve health, is increasingly used as a powerful campaign tool in health communications. However, there is few peer-reviewed literature outlining how a mHealth campaign can be developed according to established principles of health communications. We outline ten steps to guide campaign development, followed by an exemplar detailing how the steps can be used in an example campaign.

  • Twitter Strategies for Online Surveying: Descriptive analysis from the International Concussion Study

    Date Submitted: Apr 16, 2015

    Open Peer Review Period: Apr 17, 2015 - Jun 12, 2015

    Background: Social media is an appealing recruitment strategy for scientific data collection compared to traditional methods. Researchers can conduct surveys studies using Twitter by including a link...

    Background: Social media is an appealing recruitment strategy for scientific data collection compared to traditional methods. Researchers can conduct surveys studies using Twitter by including a link to an online survey. However, a paucity of research currently exists to guide researchers on how to best employ an online survey study using Twitter. Objective: The purpose of this paper is to describe the use of two different Twitter strategies in recruiting participants for an online survey study. Methods: The first strategy targeted high profile twitter accounts (High profile), i.e. those in a prominent position to attract attention or publicity, and the second strategy targeted low profile accounts (Low profile). Potential reach and actual reach for the different strategies were calculated, as well as the time of day, and day of week that received the most retweets. Results: The high profile strategy had a higher potential reach than the low profile strategy (difference 2430802 followers), but the low profile strategy had a higher actual reach (difference 73960 followers). Both stratagies received a large proportion (between 59%-69%) of retweets on Tuesday, Wednesday and Thursday during the average week, with Thursday being the most active day. Mornings, between 06h00-11h59 received the most retweets. Conclusions: Based on this study, Twitter recruitment strategies for scientific data collection through on-line surveys should target both high and low profile accounts.