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 4.7 for 2013
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  • Image Source: Tai chi at Queen Elizabeth Park, copyright Ruth Hartnup,
https://www.flickr.com/photos/ruthanddave/14999447716/,
Licensed under Creative Commons Attribution cc-by 2.0 https://creativecommons.org/licenses/by/2.0/.

    Testing the Efficacy of OurSpace, a Brief, Group Dynamics-Based Physical Activity Intervention: A Randomized Controlled Trial

    Abstract:

    Background: Emerging technologies (ie, mobile phones, Internet) may be effective tools for promoting physical activity (PA). However, few interventions have provided effective means to enhance social support through these platforms. Face-to-face programs that use group dynamics-based principles of behavior change have been shown to be highly effective in enhancing social support through promoting group cohesion and PA, but to date, no studies have examined their effects in Web-based programs. Objective: The aim was to explore proof of concept and test the efficacy of a brief, online group dynamics-based intervention on PA in a controlled experiment. We expected that the impact of the intervention on PA would be moderated by perceptions of cohesion and the partner’s degree of presence in the online media. Methods: Participants (n=135) were randomized into same-sex dyads and randomly assigned to one of four experimental conditions: standard social support (standard), group dynamics-based–high presence, group dynamics-based–low presence, or individual control. Participants performed two sets of planking exercises (pre-post). Between sets, participants in partnered conditions interacted with a virtual partner using either a standard social support app or a group dynamics-based app (group dynamics-based–low presence and group dynamics-based–high presence), the latter of which they participated in a series of online team-building exercises. Individual participants were given an equivalent rest period between sets. To increase presence during the second set, participants in the group dynamics-based–high presence group saw a live video stream of their partner exercising. Perceptions of cohesion were measured using a modified PA Group Environment Questionnaire. Physical activity was calculated as the time persisted during set 2 after controlling for persistence in set 1. Results: Perceptions of cohesion were higher in the group dynamics-based–low presence (overall mean 5.81, SD 1.04) condition compared to the standard (overall mean 5.04, SD 0.81) conditions (P=.006), but did not differ between group dynamics-based–low presence and group dynamics-based–high presence (overall mean 5.42, SD 1.07) conditions (P=.25). Physical activity was higher in the high presence condition (mean 64.48, SD 20.19, P=.01) than all other conditions (mean 53.3, SD 17.35). Conclusions: A brief, online group dynamics-based intervention may be an effective method of improving group cohesion in virtual PA groups. However, it may be insufficient on its own to improve PA.

  • Image Source: MedSentry medication monitoring system, Image Copyright 2016 MedSentry, Inc. Source: MedSentry, Inc. Licensed under Creative Commons Attribution cc-by 2.0 https://creativecommons.org/licenses/by/2.0/.

    A Remote Medication Monitoring System for Chronic Heart Failure Patients to Reduce Readmissions: A Two-Arm Randomized Pilot Study

    Abstract:

    Background: Heart failure (HF) is a chronic condition affecting nearly 5.7 million Americans and is a leading cause of morbidity and mortality. With an aging population, the cost associated with managing HF is expected to more than double from US $31 billion in 2012 to US $70 billion by 2030. Readmission rates for HF patients are high—25% are readmitted at 30 days and nearly 50% at 6 months. Low medication adherence contributes to poor HF management and higher readmission rates. Remote telehealth monitoring programs aimed at improved medication management and adherence may improve HF management and reduce readmissions. Objective: The primary goal of this randomized controlled pilot study is to compare the MedSentry remote medication monitoring system versus usual care in older HF adult patients who recently completed a HF telemonitoring program. We hypothesized that remote medication monitoring would be associated with fewer unplanned hospitalizations and emergency department (ED) visits, increased medication adherence, and improved health-related quality of life (HRQoL) compared to usual care. Methods: Participants were randomized to usual care or use of the remote medication monitoring system for 90 days. Twenty-nine participants were enrolled and the final analytic sample consisted of 25 participants. Participants completed questionnaires at enrollment and closeout to gather data on medication adherence, health status, and HRQoL. Electronic medical records were reviewed for data on baseline classification of heart function and the number of unplanned hospitalizations and ED visits during the study period. Results: Use of the medication monitoring system was associated with an 80% reduction in the risk of all-cause hospitalization and a significant decrease in the number of all-cause hospitalization length of stay in the intervention arm compared to usual care. Objective device data indicated high adherence rates (95%-99%) among intervention group participants despite finding no significant difference in self-reported adherence between study arms. The intervention group had poorer heart function and HRQoL at baseline, and HRQoL declined significantly in the intervention group compared to controls. Conclusions: The MedSentry medication monitoring system is a promising technology that merits continued development and evaluation. The MedSentry medication monitoring system may be useful both as a standalone system for patients with complex medication regimens or used to complement existing HF telemonitoring interventions. We found significant reductions in risk of all-cause hospitalization and the number of all-cause length of stay in the intervention group compared to controls. Although HRQoL deteriorated significantly in the intervention group, this may have been due to the poorer HF-functioning at baseline in the intervention group compared to controls. Telehealth medication adherence technologies, such as the MedSentry medication monitoring system, are a promising method to improve patient self-management,the quality of patient care, and reduce health care utilization and expenditure for patients with HF and other chronic diseases that require complex medication regimens. Trial Registration: ClinicalTrials.gov NCT01814696; https://clinicaltrials.gov/ct2/show/study/NCT01814696 (Archived by WebCite® at http://www.webcitation.org/6giqAVhno)

  • Checkme position during measurement (front).

    A New Cuffless Device for Measuring Blood Pressure: A Real-Life Validation Study

    Abstract:

    Background: Cuffless blood pressure (BP) monitoring devices, based on pulse transit time, are being developed as an easy-to-use, more convenient, fast, and relatively cheap alternative to conventional BP measuring devices based on cuff occlusion. Thereby they may provide a great alternative to BP self-measurement. Objective: The objective of our study was to evaluate the performance of the first release of the Checkme Health Monitor (Viatom Technology), a cuffless BP monitor, in a real-life setting. Furthermore, we wanted to investigate whether the posture of the volunteer and the position of the device relative to the heart level would influence its outcomes. Methods: Study volunteers fell into 3 BP ranges: high (>160 mmHg), normal (130–160 mmHg), and low (<130 mmHg). All requirements for test environment, observer qualification, volunteer recruitment, and BP measurements were met according to the European Society of Hypertension International Protocol (ESH-IP) for the validation of BP measurement devices. After calibrating the Checkme device, we measured systolic BP with Checkme and a validated, oscillometric reference BP monitor (RM). Measurements were performed in randomized order both in supine and in sitting position, and with Checkme at and above heart level. Results: We recruited 52 volunteers, of whom we excluded 15 (12 due to calibration failure with Checkme, 3 due to a variety of reasons). The remaining 37 volunteers were divided into low (n=14), medium (n=13), and high (n=10) BP ranges. There were 18 men and 19 women, with a mean age of 54.1 (SD 14.5) years, and mean recruitment systolic BP of 141.7 (SD 24.7) mmHg. BP results obtained by RM and Checkme correlated well. In the supine position, the difference between the RM and Checkme was >5 mmHg in 17 of 37 volunteers (46%), of whom 9 of 37 (24%) had a difference >10 mmHg and 5 of 37 (14%) had a difference >15 mmHg. Conclusions: BP obtained with Checkme correlated well with RM BP, particularly in the position (supine) in which the device was calibrated. These preliminary results are promising for conducting further research on cuffless BP measurement in the clinical and outpatient settings.

  • Devices for Self-Monitoring Sedentary Time and/or Physical Activity. Source and copyright: the authors.

    Devices for Self-Monitoring Sedentary Time or Physical Activity: A Scoping Review

    Abstract:

    Background: It is well documented that meeting the guideline levels (150 minutes per week) of moderate-to-vigorous physical activity (PA) is protective against chronic disease. Conversely, emerging evidence indicates the deleterious effects of prolonged sitting. Therefore, there is a need to change both behaviors. Self-monitoring of behavior is one of the most robust behavior-change techniques available. The growing number of technologies in the consumer electronics sector provides a unique opportunity for individuals to self-monitor their behavior. Objective: The aim of this study is to review the characteristics and measurement properties of currently available self-monitoring devices for sedentary time and/or PA. Methods: To identify technologies, four scientific databases were systematically searched using key terms related to behavior, measurement, and population. Articles published through October 2015 were identified. To identify technologies from the consumer electronic sector, systematic searches of three Internet search engines were also performed through to October 1, 2015. Results: The initial database searches identified 46 devices and the Internet search engines identified 100 devices yielding a total of 146 technologies. Of these, 64 were further removed because they were currently unavailable for purchase or there was no evidence that they were designed for, had been used in, or could readily be modified for self-monitoring purposes. The remaining 82 technologies were included in this review (73 devices self-monitored PA, 9 devices self-monitored sedentary time). Of the 82 devices included, this review identified no published articles in which these devices were used for the purpose of self-monitoring PA and/or sedentary behavior; however, a number of technologies were found via Internet searches that matched the criteria for self-monitoring and provided immediate feedback on PA (ActiGraph Link, Microsoft Band, and Garmin Vivofit) and sedentary time (activPAL VT, the Lumo Back, and Darma). Conclusions: There are a large number of devices that self-monitor PA; however, there is a greater need for the development of tools to self-monitor sedentary time. The novelty of these devices means they have yet to be used in behavior change interventions, although the growing field of wearable technology may facilitate this to change.

  • Stakeholders share their perspectives on what it takes to successfully implement technology for aging in place. Copyright (c) 2016 Institute of Allied Health Professions, Fontys University of Applied Sciences.

    What it Takes to Successfully Implement Technology for Aging in Place: Focus Groups With Stakeholders

    Abstract:

    Background: There is a growing interest in empowering older adults to age in place by deploying various types of technology (ie, eHealth, ambient assisted living technology, smart home technology, and gerontechnology). However, initiatives aimed at implementing these technologies are complicated by the fact that multiple stakeholder groups are involved. Goals and motives of stakeholders may not always be transparent or aligned, yet research on convergent and divergent positions of stakeholders is scarce. Objective: To provide insight into the positions of stakeholder groups involved in the implementation of technology for aging in place by answering the following questions: What kind of technology do stakeholders see as relevant? What do stakeholders aim to achieve by implementing technology? What is needed to achieve successful implementations? Methods: Mono-disciplinary focus groups were conducted with participants (n=29) representing five groups of stakeholders: older adults (6/29, 21%), care professionals (7/29, 24%), managers within home care or social work organizations (5/29, 17%), technology designers and suppliers (6/29, 21%), and policy makers (5/29, 17%). Transcripts were analyzed using thematic analysis. Results: Stakeholders considered 26 different types of technologies to be relevant for enabling independent living. Only 6 out of 26 (23%) types of technology were mentioned by all stakeholder groups. Care professionals mentioned fewer different types of technology than other groups. All stakeholder groups felt that the implementation of technology for aging in place can be considered a success when (1) older adults’ needs and wishes are prioritized during development and deployment of the technology, (2) the technology is accepted by older adults, (3) the technology provides benefits to older adults, and (4) favorable prerequisites for the use of technology by older adults exist. While stakeholders seemed to have identical aims, several underlying differences emerged, for example, with regard to who should pay for the technology. Additionally, each stakeholder group mentioned specific steps that need to be taken to achieve successful implementation. Collectively, stakeholders felt that they need to take the leap (ie, change attitudes, change policies, and collaborate with other organizations); bridge the gap (ie, match technology with individuals and stimulate interdisciplinary education); facilitate technology for the masses (ie, work on products and research that support large-scale rollouts and train target groups on how to use technology); and take time to reflect (ie, evaluate use and outcomes). Conclusions: Stakeholders largely agree on the direction in which they should be heading; however, they have different perspectives with regard to the technologies that can be employed and the work that is needed to implement them. Central to these issues seems to be the tailoring of technology or technologies to the specific needs of each community-dwelling older adult and the work that is needed by stakeholders to support this type of service delivery on a large scale.

  • Participatory Design in Serious Games
https://www.flickr.com/photos/thehub/3743752312
Copyright Filippo Podestà.

    Is Participatory Design Associated with the Effectiveness of Serious Digital Games for Healthy Lifestyle Promotion? A Meta-Analysis

    Abstract:

    Background: Serious digital games can be effective at changing healthy lifestyles, but large differences in their effectiveness exist. The extent of user involvement in game design may contribute to game effectiveness by creating a better fit with user preferences. Participatory design (PD), which represents active user involvement as informant (ie, users are asked for input and feedback) or codesigner (ie, users as equal partners in the design) early on and throughout the game development, may be associated with higher game effectiveness, as opposed to no user involvement or limited user involvement. Objective: This paper reports the results of a meta-analysis examining the moderating role of PD in the effectiveness of serious digital games for healthy lifestyle promotion. Methods: Four databases were searched for peer-reviewed papers in English that were published or in press before October 2014, using a (group-) randomized controlled trial design. Effectiveness data were derived from another meta-analysis assessing the role of behavior change techniques and game features in serious game effectiveness. Results: A total of 58 games evaluated in 61 studies were included. As previously reported, serious digital games had positive effects on healthy lifestyles and their determinants. Unexpectedly, PD (g=0.075, 95% CI 0.017 to 0.133) throughout game development was related to lower game effectiveness on behavior (Q=6.74, P<.05) than when users were only involved as testers (g=0.520, 95% CI 0.150 to 0.890, P<.01). Games developed with PD (g=0.171, 95% CI 0.061 to 0.281, P<.01) were also related to lower game effectiveness on self-efficacy (Q=7.83, P<.05) than when users were not involved in game design (g=0.384, 95% CI 0.283 to 0.485, P<.001). Some differences were noted depending on age group, publication year of the study, and on the specific role in PD (ie, informant or codesigner), and depending on the game design element. Games developed with PD were more effective in changing behavioral determinants when they included users in design elements on game dynamics (beta=.215, 95% CI .075 to .356, P<.01) and, more specifically, as an informant (beta=.235, 95% CI .079 to .329, P<.01). Involving users as informants in PD to create game levels was also related to higher game effectiveness (Q=7.02, P<.01). Codesign was related to higher effectiveness when used to create the game challenge (Q=11.23, P<.01), but to lower game effectiveness when used to create characters (Q=4.36, P<.05) and the game world (Q=3.99, P<.05). Conclusions: The findings do not support higher effectiveness of games developed with PD. However, significant differences existed among PD games. More support was found for informant roles than for codesign roles. When PD was applied to game dynamics, levels, and game challenge, this was associated with higher effectiveness than when it was applied to game aesthetics. Since user involvement may have an important influence on reach, adoption, and implementation of the intervention, further research and design efforts are needed to enhance effectiveness of serious games developed with PD.

  • Source: https://pixabay.com/en/laptop-woman-coffee-breakfast-943558, CC0 Public Domain.

    Answers to Health Questions: Internet Search Results Versus Online Health Community Responses

    Abstract:

    Background: About 6 million people search for health information on the Internet each day in the United States. Both patients and caregivers search for information about prescribed courses of treatments, unanswered questions after a visit to their providers, or diet and exercise regimens. Past literature has indicated potential challenges around quality in health information available on the Internet. However, diverse information exists on the Internet—ranging from government-initiated webpages to personal blog pages. Yet we do not fully understand the strengths and weaknesses of different types of information available on the Internet. Objective: The objective of this research was to investigate the strengths and challenges of various types of health information available online and to suggest what information sources best fit various question types. Methods: We collected questions posted to and the responses they received from an online diabetes community and classified them according to Rothwell’s classification of question types (fact, policy, or value questions). We selected 60 questions (20 each of fact, policy, and value) and the replies the questions received from the community. We then searched for responses to the same questions using a search engine and recorded the Results: Community responses answered more questions than did search results overall. Search results were most effective in answering value questions and least effective in answering policy questions. Community responses answered questions across question types at an equivalent rate, but most answered policy questions and the least answered fact questions. Value questions were most answered by community responses, but some of these answers provided by the community were incorrect. Fact question search results were the most clinically valid. Conclusions: The Internet is a prevalent source of health information for people. The information quality people encounter online can have a large impact on them. We present what kinds of questions people ask online and the advantages and disadvantages of various information sources in getting answers to those questions. This study contributes to addressing people’s online health information needs.

  • Older adult using digital technology. Source: https://pixabay.com/en/hands-old-typing-laptop-internet-545394/ CC0 Public Domain.

    An Internet-Based Physical Activity Intervention to Improve Quality of Life of Inactive Older Adults: A Randomized Controlled Trial

    Abstract:

    Background: Increasing physical activity is a viable strategy for improving both the health and quality of life of older adults. Objective: The aim of this study was to assess if an Internet-based intervention aimed to increase physical activity was effective in improving quality of life of inactive older adults. In addition, we analyzed the effect of the intervention on quality of life among those participants who successfully reached their individually targeted increase in daily physical activity as indicated by the intervention program, as well as the dose-response effect of increasing physical activity on quality of life. Methods: The intervention was tested in a randomized controlled trial and was comprised of an Internet program—DirectLife (Philips)—aimed at increasing physical activity using monitoring and feedback by accelerometry and feedback by digital coaching (n=119). The control group received no intervention (n=116). Participants were inactive 60-70-year-olds and were recruited from the general population. Quality of life and physical activity were measured at baseline and after 3 months using the Research ANd Development 36-item health survey (RAND-36) and wrist-worn triaxial accelerometer, respectively. Results: After 3 months, a significant improvement in quality of life was seen in the intervention group compared to the control group for RAND-36 subscales on emotional and mental health (2.52 vs -0.72, respectively; P=.03) and health change (8.99 vs 2.03, respectively; P=.01). A total of 50 of the 119 participants (42.0%) in the intervention group successfully reached their physical activity target and showed a significant improvement in quality of life compared to the control group for subscales on emotional and mental health (4.31 vs -0.72, respectively; P=.009) and health change (11.06 vs 2.03, respectively; P=.004). The dose-response analysis showed that there was a significant association between increase in minutes spent in moderate-to-vigorous physical activity (MVPA) and increase in quality of life. Conclusions: Our study shows that an Internet-based physical activity program was effective in improving quality of life in 60-70-year-olds after 3 months, particularly in participants that reached their individually targeted increase in daily physical activity. Trial Registration: Nederlands Trial Register: NTR 3045; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3045 (Archived by WebCite at http://www.webcitation.org/6fobg2sjJ)

  • Image Source: Sad man holding pillow and the clock, copyright Vic,
https://www.flickr.com/photos/59632563@N04/6480297645,
Licensed under Creative Commons Attribution cc-by 2.0 https://creativecommons.org/licenses/by/2.0/.

    The Pros and Cons of Getting Engaged in an Online Social Community Embedded Within Digital Cognitive Behavioral Therapy for Insomnia: Survey Among Users

    Abstract:

    Background: Sleepio is a proven digital sleep improvement program based on cognitive behavioral therapy techniques. Users have the option to join an online community that includes weekly expert discussions, peer-to-peer discussion forums, and personal message walls. Objective: The aim of this study was to conduct an online survey to (1) explore the reasons for deciding to engage with the Sleepio online community, (2) explore the potential benefits arising from engagement with the online community, and (3) identify and describe any problematic issues related to use of the online community. Methods: We developed an online survey and posted an invitation to the community discussion forum inviting users to participate. In addition, we sent an email invitation to 970 individuals who had previously or were currently working through the Sleepio program to participate in this study. Results: In total, 100 respondents (70/100, 70% female; mean age 51 years, range 26–82 years) completed the online survey. Most respondents had started Sleepio with chronic sleep problems (59/100, 59% up to 10 years; 35/100, 35% >10 years) and had actively engaged with the online community (85/100, 85%) had made a discussion or wall post). At the time of the survey, respondents had used Sleepio for a median of 12 weeks (range from 3 weeks to 2 years). We analyzed responses to the open-ended questions using thematic analysis. This analysis revealed 5 initial drivers for engagement: (1) the desire to connect with people facing similar issues, (2) seeking personalized advice, (3) curiosity, (4) being invited by other members, and (5) wanting to use all available sleep improvement tools. Advantages of engagement included access to continuous support, a reduced sense of isolation, being part of a nonjudgmental community, personalized advice, positive comparisons with others, encouragement to keep going, and altruism. We found 5 potential disadvantages: design and navigation issues, uncertain quality of user-generated content, negative comparisons with others, excessive time commitments, and data privacy concerns. Participants related their community experiences to engagement with the Sleepio program, with many stating it had supported their efforts to improve their sleep, as well as helping with adherence and commitment to the program. Despite some concerns, members regarded the Sleepio community as a valuable resource. Conclusions: Online communities may be a useful means through which to support long-term engagement with Web-based therapy for insomnia.

  • Image source and copyright: Anna Mäkinen, Department of Nursing Science, University of Turku, Finland.

    Effectiveness of Social Media Interventions for People With Schizophrenia: A Systematic Review and Meta-Analysis

    Abstract:

    Background: Recent studies have shown that people with serious mental disorders spend time online for the purposes of disclosure, information gathering, or gaming. However, coherent information on the effects of social media on treatment for people with schizophrenia is still lacking. Objective: Our aim was to determine the effects of social media interventions for supporting mental health and well-being among people with schizophrenia. Methods: A systematic review and meta-analysis were undertaken to determine the effects of social media interventions for supporting mental health and well-being among people with schizophrenia. Ten databases were searched, while search parameters included English-only manuscripts published prior to June 25, 2015. Study appraisals were made independently by 2 reviewers, and qualitative and quantitative syntheses of data were conducted. Results: Out of 1043 identified records, only two randomized studies of moderate quality (three records, total N=331, duration 12 months) met the inclusion criteria. Participants were people with schizophrenia spectrum or an affective disorder. Social media was used as part of Web-based psychoeducation, or as online peer support (listserv and bulletin board). Outcome measures included perceived stress, social support, and disease-related distress. At 3 months, participants with schizophrenia in the intervention group reported lower perceived stress levels (P=.04) and showed a trend for a higher perceived level of social support (P=.06). However, those who reported more positive experiences with the peer support group also reported higher levels of psychological distress (P=.01). Conclusions: Despite using comprehensive searches from 10 databases, we found only two studies, whereas numerous reports have been published citing the benefits of social media in mental health. Findings suggest the effects of social media interventions are largely unknown. More research is needed to understand the effects of social media, for users with and without mental illness, in order to determine the impact on mental well-being ofsocial media use as well as its risks.

  • Source: https://www.pexels.com/photo/apple-desk-laptop-macbook-6568, CC0 Licensed; modified to include image from authors.

    A Web-Based Computer-Tailored Alcohol Prevention Program for Adolescents: Cost-Effectiveness and Intersectoral Costs and Benefits

    Abstract:

    Background: Preventing excessive alcohol use among adolescents is important not only to foster individual and public health, but also to reduce alcohol-related costs inside and outside the health care sector. Computer tailoring can be both effective and cost-effective for working with many lifestyle behaviors, yet the available information on the cost-effectiveness of computer tailoring for reducing alcohol use by adolescents is limited as is information on the costs and benefits pertaining to sectors outside the health care sector, also known as intersectoral costs and benefits (ICBs). Objective: The aim was to assess the cost-effectiveness of a Web-based computer-tailored intervention for reducing alcohol use and binge drinking by adolescents from a health care perspective (excluding ICBs) and from a societal perspective (including ICBs). Methods: Data used were from the Alcoholic Alert study, a cluster randomized controlled trial with randomization at the level of schools into two conditions. Participants either played a game with tailored feedback on alcohol awareness after the baseline assessment (intervention condition) or received care as usual (CAU), meaning that they had the opportunity to play the game subsequent to the final measurement (waiting list control condition). Data were recorded at baseline (T0=January/February 2014) and after 4 months (T1=May/June 2014) and were used to calculate incremental cost-effectiveness ratios (ICERs), both from a health care perspective and a societal perspective. Stochastic uncertainty in the data was dealt with by using nonparametric bootstraps (5000 simulated replications). Additional sensitivity analyses were conducted based on excluding cost outliers. Subgroup cost-effectiveness analyses were conducted based on several background variables, including gender, age, educational level, religion, and ethnicity. Results: From both the health care perspective and the societal perspective for both outcome measures, the intervention was more costly and more effective in comparison with CAU. ICERs differed for both perspectives, namely €40 and €79 from the health care perspective to €62 and €144 for the societal perspective per incremental reduction of one glass of alcohol per week and one binge drinking occasion per 30 days, respectively. Subgroup analyses showed, from both perspectives and for both outcome measures, that the intervention was cost-effective for older adolescents (aged 17-19 years) and those at a lower educational level and, from a health care perspective, the male and nonreligious adolescent subgroups. Conclusions: Computer-tailored feedback could be a cost-effective way to target alcohol use and binge drinking among adolescents. Including ICBs in the economic evaluation had an impact on the cost-effectiveness results of the analysis. It could be worthwhile to aim the intervention specifically at specific subgroups. Trial Registration: Nederlands Trial Register: NTR4048; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4048 (Archived by Webcite at http://www.webcitation.org/6c7omN8wG)

  • Image Source: QuitNow Men image on laptop; Image Copyright Joan L. Bottorff et al. Source: Joan L. Bottorff et al. Licensed under Creative Commons Attribution cc-by 2.0 https://creativecommons.org/licenses/by/2.0/.

    Evaluation of QuitNow Men: An Online, Men-Centered Smoking Cessation Intervention

    Abstract:

    Background: Men continue to smoke cigarettes in greater numbers than women. There is growing evidence for the value of developing targeted, men-centered health promotion programs. However, few smoking cessation interventions have been designed for men. A gender-specific website, QuitNow Men, was developed based on focus group interview findings, stakeholder feedback, and evidence-based cessation strategies. The website was designed to incorporate a masculine look and feel through the use of images, direct language, and interactive content. Usability experts and end-users provided feedback on navigation and functionality of the website prior to pilot testing. Objectives: The objectives of the pilot study were to describe (1) men’s use and evaluations of the interactive resources and information on the QuitNow Men website, and (2) the potential of QuitNow Men to engage men in reducing and quitting smoking. Methods: A one-group, pretest-posttest study design was used. Men who were interested in quitting were recruited and invited to use the website over a 6-month period. Data were collected via online questionnaires at baseline, 3-month, and 6-month follow-up. A total of 117 men completed the baseline survey. Over half of those (67/117, 57.3%) completed both follow-up surveys. Results: At baseline, participants (N=117) had been smoking for an average of 24 years (SD 12.1) and smoked on average 15 cigarettes a day (SD 7.4). The majority had not previously used a quit smoking website (103/117, 88.0%) or websites focused on men’s health (105/117, 89.7%). At the 6-month follow-up, the majority of men used the QuitNow Men website at least once (64/67, 96%). Among the 64 users, 29 (43%) reported using the website more than 6 times. The men using QuitNow Men agreed or strongly agreed that the website was easy to use (51/64, 80%), the design and images were appealing (42/64, 66%), they intended to continue to use the website (42/64, 66%), and that they would recommend QuitNow Men to others who wanted to quit (46/64, 72%). Participants reported using an average of 8.76 (SD 4.08) of the 15 resources available on the website. At 6-month follow-up, 16 of the 67 participants (24%) had quit, 27 (40%) had reduced their smoking and 24 (36%) had not changed their smoking habits. Repeated measures general linear model showed a significant decrease in the number of cigarettes smoked between the 3-month and 6-month follow-up (F1,63=6.41, P=.01, eta squared=0.09). Number of resources used on the website, quit confidence, nicotine dependence and age significantly predicted number of quit attempts by those still smoking at 6 months (F4,45=2.73, P=.04), with number of resources used being the strongest predictor (P=.02). Conclusions: The results of this research support efforts to integrate gender-sensitive approaches in smoking cessation interventions and indicate that this novel Web-based resource has potential in supporting men’s smoking cessation efforts.

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  • How do people suffering from psychosis use the Internet for getting information on their mental health? Literature review and recommendations

    Date Submitted: May 6, 2016

    Open Peer Review Period: May 6, 2016 - Jul 1, 2016

    Background: Studies show that the Internet has become an influential source of information for psychotic people, among which the rate of Internet users is growing, with rates ranging from 33,3% to 79,...

    Background: Studies show that the Internet has become an influential source of information for psychotic people, among which the rate of Internet users is growing, with rates ranging from 33,3% to 79,5% given the countries. Among people suffering from mental illness using the Internet on a regular basis, between 20,5% and 56,4% seek mental health information. Objective: Focusing on people suffering from psychosis’ navigation about their mental health, this paper examines what content they look for and what could be the benefits and disadvantages. Methods: We conducted a literature review through medical and psychological databases between 2000 and 2015, using the keywords “Internet”, “Web”, “Virtual”, “Health information”, “Psychosis”, “Schizophrenia”, “eMental health”, “eSupport”, “Telepsychiatry”. Results: People suffering from mental illness wish to find on the Internet trustful, non-stigmatizing information about their disease, flexibility, security standards, and positive peer-to-peer exchanges. E-mental health also appears to be desired by a substantial proportion of them. In this field, cost effectiveness and clinical efficiency have been demonstrated, and the existing developments for intervention and early prevention in the areas of depression, bipolar and anxiety disorders become also operational for schizophrenia. The many benefits of the Internet as a source of information and support, such as empowerment, enhancement of self-esteem, relief from peer information, better social interactions and more available care, seem to overcome the difficulties. Conclusions: In our paper, after having discussed the challenges related to the various aspects of the emergence of the Internet into the life of people suffering from psychosis, we propose areas of future research and practical recommendations for this major transition.

  • Possible Biases of Researchers' Attitudes towards Video Games: Publication Trends Analysis of the Medical Literature (1980-2013)

    Date Submitted: May 4, 2016

    Open Peer Review Period: May 5, 2016 - Jun 30, 2016

    Background: The study of video-games is expanding, and so is the debate regarding their possible positive and deleterious effect. As controversies continue, several researchers have expressed their co...

    Background: The study of video-games is expanding, and so is the debate regarding their possible positive and deleterious effect. As controversies continue, several researchers have expressed their concerns about substantial biases existing in the field, which might lead to the creation of a skewed picture, both in professional and in lay literature. However, no study has tried to examine this issue quantitatively. Objective: The current study is set to examine possible systematic biases in the literature, by analyzing the publication trends of the medical and life-sciences literature regarding video-games. Methods: A complete and systematic PubMed search till December 2013 was performed. All 1927 articles deemed relevant were assessed for their attitude towards video-games according to the focus, hypothesis and authors' interpretation of the study results, using a three-category outcome (Positive, Negative, Neutral). Prevalence of different attitudes was assessed for possible association with year of publication, location of researchers, academic discipline, methodological research and centrality of publishing journals. Results: The attitude towards video-games presented in publications varies by year of publication, location, academic discipline and methodological research applied (P<.001 for all). Moreover, representation of different attitudes differs according to centrality of journals, as measured by Impact Factor (P<.001). Conclusions: The results suggest that context, whether scientific or social, is related to researchers' attitudes toward video-games. Weighing in these contextual variables may contribute to the debate and to the interpretation of studies' results, both in the professional community, as well as the public domain. Funding: No funding was received for the current study. Clinical Trial: As this was a publication trends analysis, no patients were involved and no intervention was performed, thus trial was not registered.

  • How do you #relax when you're #stressed? A content analysis and infodemiology study of stress-related tweets

    Date Submitted: May 5, 2016

    Open Peer Review Period: May 5, 2016 - Jun 30, 2016

    Background: Stress is a contributing factor to many major health problems in the United States, such as heart disease, depression and autoimmune diseases. Relaxation is often recommended in mental hea...

    Background: Stress is a contributing factor to many major health problems in the United States, such as heart disease, depression and autoimmune diseases. Relaxation is often recommended in mental health treatment as a frontline strategy to reduce stress, thereby improving health conditions. Twitter is a micro-blog platform that allows users to post their own personal messages (tweets), including their expressions about feelings and actions related to stress and stress management (e.g., relaxing). While Twitter is increasingly used as a source of data for understanding mental health from a population perspective, the specific issue of stress – as manifested on Twitter – has not yet been the focus of any systematic study. Objective: To understand how and in what way people express their feelings of stress and relaxation through Twitter messages. In addition, we investigate automated natural language processing (NLP) methods to (1) classify stress vs. non-stress and relaxation vs. non-relaxation tweets and (2) identify first-hand experience – i.e., who is the experiencer – in stress and relaxation tweets. Furthermore, we apply the automated classification methods we have developed to rank stress and relaxation levels at the city level, and compare the results to United States national stress surveys. Methods: We first performed a qualitative content analysis of 814 first-person tweets containing stress and relaxation related keywords, resulting in a manually annotated (coded) data set of 479 first-person stress-related tweets and 335 first-person relaxation-related tweets. We then investigated the use of machine learning algorithms – in particular naïve Bayes and Support Vector Machines (SVMs) – to automatically classify tweets as stress vs. non-stress and relaxation vs. non-relaxation. Finally, we applied these classifiers to sample data sets drawn from four cities (Los Angeles, New York, San Diego, and San Francisco) obtained from Twitter’s Streaming Application Programming Interface (API), with the goal of evaluating the extent of any correlation between our automatic classification of tweets and results from public stress surveys. Results: Content analysis showed that the most frequent topic of stress tweets was education (15%), followed by work (9%) and social relationships (8%). The most frequent topic of relaxation tweets was rest and vacation (36%), followed by nature (22%) and water (20%). Evaluations using 10-fold cross-validation showed that SVM outperformed naïve Bayes in classifying stress vs. non-stress and relaxation vs. non-relaxation tweets. However, naïve Bayes is better in identifying first-hand experience in both stress and relaxation tweets. When applied to the city dataset, we found that the proportion of stress tweets in New York and San Diego is substantially higher than in Los Angeles and San Francisco. In addition, we found that characteristic expressions of stress and relaxation vary for each city based on its geo-location. Conclusions: This content analysis and infodemiology study revealed that Twitter, when used in conjunction with NLP techniques, is a useful data source for understanding stress and stress management strategies, and can potentially serve as a supplement to infrequently collected survey-based stress data.

  • Information-seeking behavior and information needs in patients with amyotrophic lateral sclerosis: Analyzing an online patient community

    Date Submitted: May 4, 2016

    Open Peer Review Period: May 4, 2016 - May 14, 2016

    Background: Many patients with amyotrophic lateral sclerosis (ALS) and their family members need information about the disease’s course and specific caring skills. A few studies have examined the sp...

    Background: Many patients with amyotrophic lateral sclerosis (ALS) and their family members need information about the disease’s course and specific caring skills. A few studies have examined the specific informational needs of the ALS population. Objective: The aims of this study were to describe the information-seeking behavior and information needs in patients with ALS and their families in Korea by analyzing messages from an online patient community. Methods: A total of 1047 messages from the Q&A board of the “Lou Gehrig's Disease Network” (http://cafe.daum.net/alsfree) from January 2000 to September 2015 were collected. The word frequency, main questions, and asker of the messages were analyzed and coded using NVivo 11. Results: Terms such as “hospital,” “mother,” “father,” “gastrostomy” and “ALS” were most frequently identified. The most commonly mentioned main topic was about disease-specific information, while the most frequent subcategory was symptoms/management of symptoms. Other prominent categories concerned information about treatment, rehabilitation, and the medical system. The people who wrote the questions were mostly adult children of ALS patients. It was found that patients with ALS and their family members commonly obtain information by posting their inquiries online and have a variety of questions regarding ALS. Conclusions: The findings of this study can be used as basic information for developing education programs and resources for ALS patients and their families.

  • Evaluating the Accuracy of Google Translate Website for Diabetes Education Material

    Date Submitted: May 3, 2016

    Open Peer Review Period: May 4, 2016 - Jun 29, 2016

    Background: Approximately 21% of the US population speaks a language other than English at home, of which a large number cannot effectively communicate in English. Hispanics and Chinese Americans, in...

    Background: Approximately 21% of the US population speaks a language other than English at home, of which a large number cannot effectively communicate in English. Hispanics and Chinese Americans, in particular, are the two largest minority groups having low health literacy in the United States. Fortunately, machine-generated translations represent a novel tool non-English speakers can utilize to receive and relay health education information when human interpreters are not available. Objective: The purpose of this study is to evaluate the accuracy of the Google Translate website when translating health information from English to Spanish and English to Chinese. Methods: The pamphlet, “You are the heart of your family…take care of it”, is a health education sheet for diabetes patients which outlines six tips for behavior change. Two professional translators translated the original English sentences into Spanish and Chinese. We recruited six certified translators (three Spanish and three Chinese) to conduct blinded evaluations of the following versions: (1) sentences translated by Google Translate; and (2) sentences translated by a professional human translator. Evaluators rated the provided sentences on four scales: fluency, adequacy, meaning, and severity. We performed descriptive analysis to examine differences between these two versions. Results: The Cronbach’s alpha values were exhibiting high degrees of agreement on the rating outcome of both evaluator groups: 0.919 for the Spanish evaluators and 0.972 for the Chinese evaluators. The readability of the sentences in this study ranged from 2.8 to 9.0 (M=5.4, SD=2.7). The correlation coefficients between the Grade Level and translation accuracy for all the sentences translated by Google were negative (e.g., rMeaning=-.660), which indicates Google provided accurate translation for simple sentences; however, the likelihood of incorrect translation increased when the original English sentences required higher grade levels to comprehend. The Chinese human translator provided more accurate translation compared to Google. The Spanish human translator, on the other hand, did not provide a significantly better translation compared to Google. Conclusions: Google produced a more accurate translation from English to Spanish than English to Chinese. Some sentences translated by Google from English to Chinese exhibit the potential to result in delayed patient care. We recommend continuous training and credential practice standards for professional medical translators to enhance patient safety as well as providing health education information in multiple languages.

  • Consumers' perceived attitudes to wearable devices in health monitoring in China: a survey study

    Date Submitted: Apr 29, 2016

    Open Peer Review Period: May 2, 2016 - May 7, 2016

    Background: Capital market and consumer market interest in wearable devices has surged in recent years, and wearable products swamp the market, however their actual acceptance in the field of health m...

    Background: Capital market and consumer market interest in wearable devices has surged in recent years, and wearable products swamp the market, however their actual acceptance in the field of health monitoring has not reached such expectation. Objective: This study aims to understand the perceptions of wearable devices of general consumers, analyze the review of the devices by users, and find existing problems associated with current wearable devices. Methods: Sojump.com, an on-line questionnaire tool, was used to generate the questionnaire, which focused on four aspects, i.e., the basic information of the respondents, the general perceptions of wearable devices, the tendencies of expected functions and potential problems. The snowball sampling method was employed to collect questionnaires by making use of the author’s social network. Results: (1) A total of 2058 valid questionnaires were received from the respondents from every province in China; of the respondents, 52.4% have used a wearable device. (2) The respondents had a low level of knowledge about wearable devices (2.79/5) but were optimistic with regard to the devices’ future (3.86/5), anticipating that it takes four years for the devices to become fashionable, and 84% recognized an acceptable price of less than 2000 RMB. Nearly half of the respondents were unwilling to continuously wear the device (47.1%) and share their health data (44.7%). (3) The respondents placed more emphasis on the health management functions than on the mobile phone auxiliary functions. Regarding the health monitoring functions, the respondents were most interested in heart health monitoring. The functions of wearable devices that the respondents expected were mainly health management (63.5%), mobile phone accessories (61.9%), and location tracking (61.2%), and the promising hot future functions were mainly data monitoring and analysis (74.2%), exercise coaching (60.5%), and child tracking (58.8%). (4) The respondents had different levels of emphasis regarding the existing problems of wearable devices at different use stages. Being easily damaged or lost (49.7%), being incapable of providing credible, valuable, and easily executable health recommendations based on an analysis of the monitoring data (46.7%), and being uncomfortable to wear (45.8%) likely lead consumers to abandon the use of wearable devices. Conclusions: Consumers are optimistic about the prospects of wearable devices; however, there is a large gap between the accuracy and reliability of the measurement data, the ease of use of the product design, and the interpretation of the measurement data of current wearable products and consumer expectations. Consumer demand for health management functions, especially heart health monitoring functions, is higher than that for daily auxiliary-type functions, which is an issue that should be properly addressed and resolved by manufacturers.

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