Journal of Medical Internet Research
The leading peer-reviewed journal for health and healthcare in the Internet age.
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OCD Treatment Online: Preliminary results of the OCD? Not Me! self-guided iCBT program for young people with OCD
Date Submitted: Nov 22, 2015
Open Peer Review Period: Nov 24, 2015 - Jan 19, 2016
Background: The development and evaluation of e-mental health interventions provides a potential solution for current limitations in the acceptability, availability and accessibility of mental health...
Background: The development and evaluation of e-mental health interventions provides a potential solution for current limitations in the acceptability, availability and accessibility of mental health care for young people with obsessive-compulsive disorder (OCD). This study is the first of its kind to report on the effectiveness of fully-automated online treatment for young people (12-18 years) with OCD. Objective: We aimed to conduct a preliminary evaluation of the effectiveness of the OCD? Not Me! program for reducing OCD-related psychopathology in young people (12-18 years). This program is an eight-stage, fully-automated online cognitive behavioural treatment for OCD. Methods: The current data were taken from a parent study in which an open trial design is being used to evaluate the effectiveness of the OCD? Not Me! program. Participants were required to have at least subclinical levels of OCD to be offered the online program. Participants with moderate-high suicide/self-harm risk, or symptoms of eating disorder or psychosis were not offered the program. OCD symptoms and severity were measured at pre- and post-test, and at the beginning of each stage of the program. Data were analysed with generalized linear mixed models (GLMM). Results: A total of 334 people were screened for inclusion in the study, with 132 participants aged 12-18 years providing data for the final analysis. Participants showed significant reductions in OCD symptoms (P < .001) and severity (P < .001) between pre- and post-test. Conclusions: These preliminary results suggest that fully-automated iCBT holds promise as way of increasing access to treatment for young people with OCD, however further research needs to be conducted to replicate the results and to determine the feasibility of the program. Clinical Trial: The trial was registered on 8 February 2013 with the Australian New Zealand Clinical Trials Registry (ACTRN12613000152729).
Devices for self-monitoring sedentary time and/or physical activity: A systematic review
Date Submitted: Nov 24, 2015
Open Peer Review Period: Nov 24, 2015 - Dec 2, 2015
Background: It is well documented that guideline fulfilling (150 minutes per week) levels of moderate-to-vigorous physical activity (PA) are protective against chronic disease. Conversely, emerging ev...
Background: It is well documented that guideline fulfilling (150 minutes per week) levels of moderate-to-vigorous physical activity (PA) are protective against chronic disease. Conversely, emerging evidence indicates the deleterious effects of prolonged sitting. Therefore, there is a need to change both behaviours. Self-monitoring of behaviour has been established as one of the most robust behaviour change techniques available. The growing number of technologies in the consumer electronics (CE) sector provides a unique opportunity for individuals to self-monitor their behaviour. Objective: Therefore, it seems timely to review the characteristics and measurement properties of currently available self-monitoring devices for sedentary time (ST) and/or PA. Methods: To identify technologies, four scientific databases were systematically searched using key terms related to behaviour, measurement and population. Articles published through October 2014 were identified. To identify technologies from the CE sector, systematic searches of three internet search engines were also performed through to October 2015. Results: Initial database searches identified 46 devices and internet search engines identified 100 device yielding a total of 146 technologies. Of these, 64 were further removed because there was no evidence that they were designed for, have been used in, or could readily be modified for self-monitoring purposes or that they are currently unavailable for purchase. The remaining 82 technologies were included in this review (73 devices self-monitor PA, 9 devices self-monitor SB). Conclusions: Of the 83 devices included, this review identified no published articles in which these devices have been used for the purpose of self-monitoring physical activity and/or sedentary behaviour, however a number of technologies have been found via internet searches which match the criteria to self-monitor and provide immediate feedback on PA; (ActiGraph Link, Microsoft Band, and Garmin Vivofit ) and SB; (activPAL VT, the Lumo Back, and Darma,). There are a large number that self-monitor PA however, there is a greater need for the development of tools to self-monitor SB. The novelty of these devices means they have yet to be used in behaviour change interventions however with the growing field of wearable technology may facilitate this to change.
Electronic Adherence Monitoring in a High Utilizing Pediatric Asthma Cohort: A Feasibility Study
Date Submitted: Nov 21, 2015
Open Peer Review Period: Nov 21, 2015 - Jan 16, 2016
Background: Inner-city, minority children with asthma have highest rates of morbidity and death from asthma and the lowest rates of asthma controller medication adherence. A number of recent electroni...
Background: Inner-city, minority children with asthma have highest rates of morbidity and death from asthma and the lowest rates of asthma controller medication adherence. A number of recent electronic medication monitoring interventions demonstrated dramatic improvements in adherence in lower risk populations. The feasibility and acceptability of such an intervention in the highest risk children with asthma has not been studied. Objective: Our objective was to assess feasibility and acceptability of a community health worker delivered, electronic adherence monitoring intervention among the highest utilizers of acute asthma care in an inner city practice. Methods: This was a prospective cohort pilot study of targeting the 50 children with the highest frequency of asthma-related emergency department and hospital care within a local managed care Medicaid plan. The 3-month intervention included motivational interviewing, electronic monitoring of controller and rescue inhaler use, and outreach by a community health worker for predefined medication alerts. Acceptability was measured using a modified Technology Acceptability Model and changes in asthma control using the Asthma Control Test (ACT). A classification framework was developed to describe different patterns of medication use. Results: We enrolled fourteen non-Hispanic Black children with a mean age of 3.5. Subjects averaged 7.8 emergency or hospital visits in the year preceding enrollment. All subjects initiated use of the electronic devices, however, no modem signal was transmitted for 5/14 subjects after a mean of 45 days. All (100%) of the caregivers who completed the final study visit viewed the electronic monitoring device favorably and would recommend it to friends and 56% believed the device helped to improve asthma control. ACT scores improved by a mean of 2.7 points (P=0.05) over the 3-month intervention. We observed three distinct patterns of controller use; four patients demonstrated sustained use, 5 patients had periodic use, and 5 patients lapsed within two weeks. Conclusions: High utilizer, minority families with asthma found a community health worker delivered, electronic adherence intervention acceptable. Feasibility concerns, such as recruitment, data transmission failure and lost devices, should be carefully considered when designing interventions in this setting. High asthma care utilizers demonstrated three qualitatively different patterns of controller use.
Frugal innovation and personalized health technology
Date Submitted: Nov 19, 2015
Open Peer Review Period: Nov 19, 2015 - Jan 14, 2016
Personalised health technologies – devices like wearables, smartwatches, and mobile health applications – enable users to quantify their health behaviors. Despite their potential to advance health...
Personalised health technologies – devices like wearables, smartwatches, and mobile health applications – enable users to quantify their health behaviors. Despite their potential to advance health for all populations, personalised health technologies are used largely by the healthy and wealthy. They remain unaffordable, inaccessible, and largely unusable for marginalized populations who often have the greatest health needs. The creation of personalised health technologies using a frugal innovation mindset combined with stakeholder collaboration among the public and private sectors are proposed as strategies to ensure the disruptive technology advantages all populations.
A Data-Driven Approach to Characterizing the (Perceived) Newsworthiness of Health Science Articles
Date Submitted: Nov 18, 2015
Open Peer Review Period: Nov 19, 2015 - Jan 14, 2016
Background: Health science findings are primarily disseminated through manuscript publications, and are then communicated to the public by the news media. Journalists and communication staff members s...
Background: Health science findings are primarily disseminated through manuscript publications, and are then communicated to the public by the news media. Journalists and communication staff members select which articles receive coverage and thus public attention. Objective: This study aims to identify attributes of published health science articles that correlate with (1) journal editor issuance of press releases and (2) mainstream media coverage. Methods: We constructed four novel datasets to identify factors that correlate with press release issuance and media coverage. These corpora include thousands of published articles, subsets of which received a press release or mainstream media coverage. We used statistical machine learning methods to identify correlations between words in the science abstracts and press release issuance and media coverage. Further, we used topic modeling-based machine learning approach to uncover latent topics predictive of perceived newsworthiness in each of the datasets. Results: Both press release issuance for and media coverage of health science articles are predictable from corresponding journal article content. For the former task, we achieved average AUCs of 0.666 and 0.822 on two separate datasets, with size 3024 and 10760. For the latter task, models realized mean AUCs of 0.591 and 0.783 on two datasets, with size 422 and 28910. We reported most predictive words and topics for press release or news coverage. Conclusions: We have presented a novel data-driven characterization of content that renders health science "news-worthy". The analysis provides new insights into the news coverage selection process.
Acceptability of mental health apps for Aboriginal and Torres Strait Islander Australians: A qualitative study.
Date Submitted: Nov 15, 2015
Open Peer Review Period: Nov 16, 2015 - Jan 11, 2016
Background: Aboriginal and Torres Strait Islander Australians experience high rates of mental illness and psychological distress compared to their non-Indigenous counterparts. Electronic mental health...
Background: Aboriginal and Torres Strait Islander Australians experience high rates of mental illness and psychological distress compared to their non-Indigenous counterparts. Electronic mental health (e-mental health) tools offer an opportunity for accessible, effective and acceptable treatment. The AIMhi Stay Strong App and the ibobbly suicide prevention App are treatment tools designed to combat the disproportionately high levels of mental illness and stress experienced within the Aboriginal and Torres Strait Islander community. Objective: This study aimed to explore Aboriginal and Torres Strait Islander community members’ experiences of using two culturally responsive e-mental health apps and identify factors which influence the acceptability of these approaches. Methods: Using a phenomenological approach we explored the acceptability of two culturally responsive e-mental health apps through a series of three, three-hour focus groups with nine Aboriginal and Torres Strait Islander community members. Thematic analysis was conducted and co-researcher and member checking were used to verify findings. Results: Findings suggest strong support for the concept of e-mental health apps and optimism for their potential. Factors that influence acceptability related to three key themes: personal factors, such as motivation, severity and awareness of illness, technological competence and literacy levels; environmental factors, such as community awareness, stigma and availability of support; and app characteristics, such as ease of use, content, graphics, access and security and information sharing. Specific adaptions, such as local production, culturally relevant content and graphics, a purposeful journey, clear navigation, meaningful language, options to assist people with poor literacy, offline use and password protection may aid uptake. Conclusions: When designed to meet the needs of Aboriginal and Torres Strait Islander Australians, e-mental health tools add an important element to public health approaches to improving the wellbeing of Aboriginal and Torres Strait Islander people.