JMIR Publications

Journal of Medical Internet Research

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

JMIR's Thomson Reuter Impact Factor of 4.5 for 2015

Recent Articles:

  • Image Source: Upper Back Stretch, copyright Rhona-Mae Arca,, Licensed under Creative Commons Attribution cc-by 2.0

    Web-Based Interventions for Chronic Back Pain: A Systematic Review


    Background: Chronic low back pain is one of the most common presenting complaints to a physician’s office. Treatment is often challenging and recovery depends on various factors, often resulting in significant investments of time and resources. Objective: The aim of this review is to determine which Web-based interventions aimed at chronic low back pain are of benefit to patients. Methods: Randomized controlled trials (RCTs) studying Web-based interventions directed at adults with chronic low back pain were included. Retrospective studies, narrative reviews, nonrandomized trials, and observational studies were excluded. Electronic databases and bibliographies were searched. Results: In total, nine unique RCTs were identified (total participants=1796). The number of patients randomized in each trial ranged from 51 to 580. Four trials studied online cognitive behavioral therapy (CBT) and five trials studied other Web-based interventions with interactive features. Empowerment/control was improved in six studies. Use of CBT was associated with reduced catastrophization among patients. Mixed results were reported with regards to reduction in pain levels and disability, although some studies showed promise in reducing disability in the short term. One study that measured health care utilization reported reduced utilization with the use of moderated email discussion. Conclusions: Limited data are available regarding effective Web-based interventions to improve outcomes for patients with chronic low back pain. Nine RCTs with small sample sizes were identified in this review. Online CBT appears to show some promise in terms of reducing catastrophization and improving patient attitudes. Further research in this area with larger-scale studies focusing on appropriate outcomes appears to be a priority.

  • Image Source: 01_2014_64, copyright, We have moved! Please visit /highwaysengland,, Licensed under Creative Commons Attribution cc-by 2.0

    Older Cancer Patients’ User Experiences With Web-Based Health Information Tools: A Think-Aloud Study


    Background: Health information is increasingly presented on the Internet. Several Web design guidelines for older Web users have been proposed; however, these guidelines are often not applied in website development. Furthermore, although we know that older individuals use the Internet to search for health information, we lack knowledge on how they use and evaluate Web-based health information. Objective: This study evaluates user experiences with existing Web-based health information tools among older (≥ 65 years) cancer patients and survivors and their partners. The aim was to gain insight into usability issues and the perceived usefulness of cancer-related Web-based health information tools. Methods: We conducted video-recorded think-aloud observations for 7 Web-based health information tools, specifically 3 websites providing cancer-related information, 3 Web-based question prompt lists (QPLs), and 1 values clarification tool, with colorectal cancer patients or survivors (n=15) and their partners (n=8) (median age: 73; interquartile range 70-79). Participants were asked to think aloud while performing search, evaluation, and application tasks using the Web-based health information tools. Results: Overall, participants perceived Web-based health information tools as highly useful and indicated a willingness to use such tools. However, they experienced problems in terms of usability and perceived usefulness due to difficulties in using navigational elements, shortcomings in the layout, a lack of instructions on how to use the tools, difficulties with comprehensibility, and a large amount of variety in terms of the preferred amount of information. Although participants frequently commented that it was easy for them to find requested information, we observed that the large majority of the participants were not able to find it. Conclusions: Overall, older cancer patients appreciate and are able to use cancer information websites. However, this study shows the importance of maintaining awareness of age-related problems such as cognitive and functional decline and navigation difficulties with this target group in mind. The results of this study can be used to design usable and useful Web-based health information tools for older (cancer) patients.

  • Image Source: Senior WordPress User - WordCamp Montreal 2015, copyright Michael Cannon,,
Licensed under Creative Commons Attribution cc-by 2.0

    Behavioral Analysis of Visitors to a Medical Institution’s Website Using Markov Chain Monte Carlo Methods


    Background: Consistent with the “attention, interest, desire, memory, action” (AIDMA) model of consumer behavior, patients collect information about available medical institutions using the Internet to select information for their particular needs. Studies of consumer behavior may be found in areas other than medical institution websites. Such research uses Web access logs for visitor search behavior. At this time, research applying the patient searching behavior model to medical institution website visitors is lacking. Objective: We have developed a hospital website search behavior model using a Bayesian approach to clarify the behavior of medical institution website visitors and determine the probability of their visits, classified by search keyword. Methods: We used the website data access log of a clinic of internal medicine and gastroenterology in the Sapporo suburbs, collecting data from January 1 through June 31, 2011. The contents of the 6 website pages included the following: home, news, content introduction for medical examinations, mammography screening, holiday person-on-duty information, and other. The search keywords we identified as best expressing website visitor needs were listed as the top 4 headings from the access log: clinic name, clinic name + regional name, clinic name + medical examination, and mammography screening. Using the search keywords as the explaining variable, we built a binomial probit model that allows inspection of the contents of each purpose variable. Using this model, we determined a beta value and generated a posterior distribution. We performed the simulation using Markov Chain Monte Carlo methods with a noninformation prior distribution for this model and determined the visit probability classified by keyword for each category. Results: In the case of the keyword “clinic name,” the visit probability to the website, repeated visit to the website, and contents page for medical examination was positive. In the case of the keyword “clinic name and regional name,” the probability for a repeated visit to the website and the mammography screening page was negative. In the case of the keyword “clinic name + medical examination,” the visit probability to the website was positive, and the visit probability to the information page was negative. When visitors referred to the keywords “mammography screening,” the visit probability to the mammography screening page was positive (95% highest posterior density interval = 3.38-26.66). Conclusions: Further analysis for not only the clinic website but also various other medical institution websites is necessary to build a general inspection model for medical institution websites; we want to consider this in future research. Additionally, we hope to use the results obtained in this study as a prior distribution for future work to conduct higher-precision analysis.

  • Mother looking for health information on the Internet with her daughter

Source: CC0 Public Domain.

    Modelling and Predicting eHealth Usage in Europe: A Multidimensional Approach From an Online Survey of 13,000 European Union Internet Users


    Background: More advanced methods and models are needed to evaluate the participation of patients and citizens in the shared health care model that eHealth proposes. Objective: The goal of our study was to design and evaluate a predictive multidimensional model of eHealth usage. Methods: We used 2011 survey data from a sample of 13,000 European citizens aged 16–74 years who had used the Internet in the previous 3 months. We proposed and tested an eHealth usage composite indicator through 2-stage structural equation modelling with latent variables and measurement errors. Logistic regression (odds ratios, ORs) to model the predictors of eHealth usage was calculated using health status and sociodemographic independent variables. Results: The dimensions with more explanatory power of eHealth usage were health Internet attitudes, information health Internet usage, empowerment of health Internet users, and the usefulness of health Internet usage. Some 52.39% (6811/13,000) of European Internet users’ eHealth usage was more intensive (greater than the mean). Users with long-term health problems or illnesses (OR 1.20, 95% CI 1.12–1.29) or receiving long-term treatment (OR 1.11, 95% CI 1.03–1.20), having family members with long-term health problems or illnesses (OR 1.44, 95% CI 1.34–1.55), or undertaking care activities for other people (OR 1.58, 95% CI 1.40–1.77) had a high propensity toward intensive eHealth usage. Sociodemographic predictors showed that Internet users who were female (OR 1.23, 95% CI 1.14–1.31), aged 25–54 years (OR 1.12, 95% CI 1.05–1.21), living in larger households (3 members: OR 1.25, 95% CI 1.15–1.36; 5 members: OR 1.13, 95% CI 0.97–1.28; ≥6 members: OR 1.31, 95% CI 1.10–1.57), had more children <16 years of age (1 child: OR 1.29, 95% CI 1.18–1.14; 2 children: OR 1.05, 95% CI 0.94–1.17; 4 children: OR 1.35, 95% CI 0.88–2.08), and had more family members >65 years of age (1 member: OR 1.33, 95% CI 1.18–1.50; ≥4 members: OR 1.82, 95% CI 0.54–6.03) had a greater propensity toward intensive eHealth usage. Likewise, users residing in densely populated areas, such as cities and large towns (OR 1.17, 95% CI 1.09–1.25), also had a greater propensity toward intensive eHealth usage. Educational levels presented an inverted U shape in relation to intensive eHealth usage, with greater propensities among those with a secondary education (OR 1.08, 95% CI 1.01–1.16). Finally, occupational categories and net monthly income data suggest a higher propensity among the employed or self-employed (OR 1.07, 95% CI 0.99–1.15) and among the minimum wage stratum, earning ≤€1000 per month (OR 1.66, 95% CI 1.48–1.87). Conclusions: We provide new evidence of inequalities that explain intensive eHealth usage. The results highlight the need to develop more specific eHealth practices to address different realities.

  • Image Source: Halfway, copyright Rory MacLeod,, Licensed under Creative Commons Attribution cc-by 2.0

    Health Care Applicability of a Patient-Centric Web Portal for Patients’ Medication Experience


    Background: With the advent of the patient-centered care paradigm, it is important to examine what patients’ reports of medication experience (PROME) mean to patient care. PROME available through a Web portal provide information on medication treatment options and outcomes from the patient’s perspective. Patients who find certain PROME compelling are likely to mention them at their physician visit, triggering a discussion between the patient and the physician. However, no studies have examined PROME’s potential applicability to patient care. Objective: This study aimed to examine older (≥50 years) adults’ perceptions of the health care applicability of a hypothetical PROME Web portal. Specifically, this study investigated whether PROME would facilitate patient-physician communication, and identified the preferred reporting items and the trusted sponsors of such a PROME Web portal. Methods: We used a cross-sectional, self-administered, 5-point Likert scale survey to examine participants’ perceptions of a hypothetical PROME Web portal that compared PROME for 5 common antihypertensive medications. Between August and December 2013, we recruited 300 members of 7 seniors’ centers in a metropolitan area of a southeastern state of the United States to participate in the survey. Results: An overwhelming majority of study participants (243/300, 81.0%) had a favorable perception of PROME’s health care applicability. They were mostly positive that PROME would facilitate patient-physician communication, except for the perception that physicians would be upset by the mention of PROME (n=133, 44.3%). Further, 85.7% (n=257) of participants considered the PROME information trustworthy, and 72.0% (n=216) were willing to participate by reporting their own medication experiences. Study participants wanted the PROME Web portal to report the number of reviews, star ratings, and individual comments concerning different medication attributes such as side effects (224/809, 27.7%), cost (168/809, 20.8%), and effectiveness (153/809, 18.9%). Finally, the PROME Web portal sponsorship was important to participants, with the most trusted sponsor being academic institutions (120/400, 30.0%). Conclusions: PROME, if well compiled through Web portals, have the potential to facilitate patient-physician communication.

  • Image Source: AGC Photo Girls Enjoy Lunch, copyright U.S. Department of Agriculture,, Licensed under Creative Commons Attribution cc-by 2.0

    Parent-Focused Childhood and Adolescent Overweight and Obesity eHealth Interventions: A Systematic Review and Meta-Analysis


    Background: Effective broad-reach interventions to reduce childhood obesity are needed, but there is currently little consensus on the most effective approach. Parental involvement in interventions appears to be important. The use of eHealth modalities in interventions also seems to be promising. To our knowledge, there have been no previous reviews that have specifically investigated the effectiveness of parent-focused eHealth obesity interventions, a gap that this systematic review and meta-analysis intends to address. Objective: The objective of this study was to review the evidence for body mass index (BMI)/BMI z-score improvements in eHealth overweight and obesity randomized controlled trials for children and adolescents, where parents or carers were an agent of change. Methods: A systematic review and meta-analysis was conducted, which conforms to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. Seven databases were searched for the period January 1995 to April 2015. Primary outcome measures were BMI and/or BMI z-score at baseline and post-intervention. Secondary outcomes included diet, physical activity, and screen time. Interventions were included if they targeted parents of children and adolescents aged 0-18 years of age and used an eHealth medium such as the Internet, interactive voice response (IVR), email, social media, telemedicine, or e-learning. Results: Eight studies were included, involving 1487 parent and child or adolescent dyads. A total of 3 studies were obesity prevention trials, and 5 were obesity treatment trials. None of the studies found a statistically significant difference in BMI or BMI z-score between the intervention and control groups at post-intervention, and a meta-analysis demonstrated no significant difference in the effects of parent-focused eHealth obesity interventions compared with a control on BMI/BMI z-score (Standardized Mean Difference −0.15, 95% CI −0.45 to 0.16, Z=0.94, P=.35). Four of seven studies that reported on dietary outcomes demonstrated significant improvements in at least 1 dietary measurement, and 1 of 6 studies that reported on physical activity outcomes demonstrated significant improvements compared with the control. The quality of the interventions was generally not high; therefore, these results should be interpreted with caution. Conclusion: It is recommended that larger, longer duration, high-quality parent-focused eHealth studies are conducted, which transform successful components from face-to-face interventions into an eHealth format and target younger age groups in particular. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews: CRD42015019837; (Archived by WebCite at

  • Source and copyright: the authors;, license to use under creative commons.

    Investigating the Potential Contribution of Patient Rating Sites to Hospital Supervision: Exploratory Results From an Interview Study in the Netherlands


    Background: Over the last decades, the patient perspective on health care quality has been unconditionally integrated into quality management. For several years now, patient rating sites have been rapidly gaining attention. These offer a new approach toward hearing the patient’s perspective on the quality of health care. Objective: The aim of our study was to explore whether and how patient reviews of hospitals, as reported on rating sites, have the potential to contribute to health care inspector’s daily supervision of hospital care. Methods: Given the unexplored nature of the topic, an interview study among hospital inspectors was designed in the Netherlands. We performed 2 rounds of interviews with 10 senior inspectors, addressing their use and their judgment on the relevance of review data from a rating site. Results: All 10 Dutch senior hospital inspectors participated in this research. The inspectors initially showed some reluctance to use the major patient rating site in their daily supervision. This was mainly because of objections such as worries about how representative they are, subjectivity, and doubts about the relevance of patient reviews for supervision. However, confrontation with, and assessment of, negative reviews by the inspectors resulted in 23% of the reviews being deemed relevant for risk identification. Most inspectors were cautiously positive about the contribution of the reviews to their risk identification. Conclusions: Patient rating sites may be of value to the risk-based supervision of hospital care carried out by the Health Care Inspectorate. Health care inspectors do have several objections against the use of patient rating sites for daily supervision. However, when they are presented with texts of negative reviews from a hospital under their supervision, it appears that most inspectors consider it as an additional source of information to detect poor quality of care. Still, it should always be accompanied and verified by other quality and safety indicators. More research on the value and usability of patient rating sites in daily hospital supervision and other health settings is needed.

  • Source:; Attribution: Dooder -; Creative commons licensed; modified.

    Social Annotation Valence: The Impact on Online Informed Consent Beliefs and Behavior


    Background: Social media, mobile and wearable technology, and connected devices have significantly expanded the opportunities for conducting biomedical research online. Electronic consent to collecting such data, however, poses new challenges when contrasted to traditional consent processes. It reduces the participant-researcher dialogue but provides an opportunity for the consent deliberation process to move from solitary to social settings. In this research, we propose that social annotations, embedded in the consent form, can help prospective participants deliberate on the research and the organization behind it in ways that traditional consent forms cannot. Furthermore, we examine the role of the comments’ valence on prospective participants’ beliefs and behavior. Objective: This study focuses specifically on the influence of annotations’ valence on participants’ perceptions and behaviors surrounding online consent for biomedical research. We hope to shed light on how social annotation can be incorporated into digitally mediated consent forms responsibly and effectively. Methods: In this controlled between-subjects experiment, participants were presented with an online consent form for a personal genomics study that contained social annotations embedded in its margins. Individuals were randomly assigned to view the consent form with positive-, negative-, or mixed-valence comments beside the text of the consent form. We compared participants’ perceptions of being informed and having understood the material, their trust in the organization seeking the consent, and their actual consent across conditions. Results: We find that comment valence has a marginally significant main effect on participants’ perception of being informed (F2=2.40, P=.07); specifically, participants in the positive condition (mean 4.17, SD 0.94) felt less informed than those in the mixed condition (mean 4.50, SD 0.69, P=.09). Comment valence also had a marginal main effect on the extent to which participants reported trusting the organization (F2=2.566, P=.08). Participants in the negative condition (mean 3.59, SD 1.14) were marginally less trusting than participants exposed to the positive condition (mean 4.02, SD 0.90, P=.06). Finally, we found that consent rate did not differ across comment valence conditions; however, participants who spent less time studying the consent form were more likely to consent when they were exposed to positive-valence comments. Conclusions: This work explores the effects of adding a computer-mediated social dimension, which inherently contains human emotions and opinions, to the consent deliberation process. We proposed that augmenting the consent deliberation process to incorporate multiple voices can enable individuals to capitalize on the knowledge of others, which brings to light questions, problems, and concerns they may not have considered on their own. We found that consent forms containing positive valence annotations are likely to lead participants to feel less informed and simultaneously more trusting of the organization seeking consent. In certain cases where participants spent little time considering the content of the consent form, participants exposed to positive valence annotations were even more likely to consent to the study. We suggest that these findings represent important considerations for the design of future electronic informed consent mechanisms.

  •; CCBY2.0, Attribution: Joe The Goat Farmer; modified.

    How Affiliation Disclosure and Control Over User-Generated Comments Affects Consumer Health Knowledge and Behavior: A Randomized Controlled Experiment of...


    Background: More people are seeking health information online than ever before and pharmaceutical companies are increasingly marketing their drugs through social media. Objective: The aim was to examine two major concerns related to online direct-to-consumer pharmaceutical advertising: (1) how disclosing an affiliation with a pharmaceutical company affects how people respond to drug information produced by both health organizations and online commenters, and (2) how knowledge that health organizations control the display of user-generated comments affects consumer health knowledge and behavior. Methods: We conducted a 2×2×2 between-subjects experiment (N=674). All participants viewed an infographic posted to Facebook by a health organization about a prescription allergy drug. Across conditions, the infographic varied in the degree to which the health organization and commenters appeared to be affiliated with a drug manufacturer, and the display of user-generated comments appeared to be controlled. Results: Affiliation disclosure statements on a health organization’s Facebook post increased perceptions of an organization-drug manufacturer connection, which reduced trust in the organization (point estimate –0.45, 95% CI –0.69 to –0.24) and other users who posted comments about the drug (point estimate –0.44, 95% CI –0.68 to –0.22). Furthermore, increased perceptions of an organization-manufacturer connection reduced the likelihood that people would recommend the drug to important others (point estimate –0.35, 95% CI –0.59 to –0.15), and share the drug post with others on Facebook (point estimate –0.37, 95% CI –0.64 to –0.16). An affiliation cue next to the commenters' names increased perceptions that the commenters were affiliated with the drug manufacturer, which reduced trust in the comments (point estimate –0.81, 95% CI –1.04 to –0.59), the organization that made the post (point estimate –0.68, 95% CI –0.90 to –0.49), the likelihood of participants recommending the drug (point estimate –0.61, 95% CI –0.82 to –0.43), and sharing the post with others on Facebook (point estimate –0.63, 95% CI –0.87 to –0.43). Cues indicating that a health organization removed user-generated comments from a post increased perceptions that the drug manufacturer influenced the display of the comments, which negatively affected trust in the comments (point estimate –0.35, 95% CI –0.53 to –0.20), the organization (point estimate –0.31, 95% CI –0.47 to –0.17), the likelihood of recommending the drug (point estimate –0.26, 95% CI –0.41 to –0.14), and the likelihood of sharing the post with others on Facebook (point estimate –0.28, 95% CI –0.45 to –0.15). (All estimates are unstandardized indirect effects and 95% bias-corrected bootstrap confidence intervals.) Conclusions: Concern over pharmaceutical companies hiding their affiliations and strategically controlling user-generated comments is well founded; these practices can greatly affect not only how viewers evaluate drug information online, but also how likely they are to propagate the information throughout their online and offline social networks.

  • Source: media&page=1&position=1, Creative Commons Licensed, Attribution: Freepik.

    Follow #eHealth2011: Measuring the Role and Effectiveness of Online and Social Media in Increasing the Outreach of a Scientific Conference


    Background: Social media promotion is increasingly adopted by organizers of industry and academic events; however, the success of social media strategies is rarely questioned or the real impact scientifically analyzed. Objective: We propose a framework that defines and analyses the impact, outreach, and effectiveness of social media for event promotion and research dissemination to participants of a scientific event as well as to the virtual audience through the Web. Methods: Online communication channels Twitter, Facebook, Flickr, and a Liveblog were trialed and their impact measured on outreach during five phases of an eHealth conference: the setup, active and last-minute promotion phases before the conference, the actual event, and after the conference. Results: Planned outreach through online channels and social media before and during the event reached an audience several magnitudes larger in size than would have been possible using traditional means. In the particular case of eHealth 2011, the outreach using traditional means would have been 74 attendees plus 23 extra as sold proceedings and the number of downloaded articles from the online proceedings (4107 until October 2013). The audience for the conference reached via online channels and social media was estimated at more than 5300 in total during the event. The role of Twitter for promotion before the event was complemented by an increased usage of the website and Facebook during the event followed by a sharp increase of views of posters on Flickr after the event. Conclusions: Although our case study is focused on a particular audience around eHealth 2011, our framework provides a template for redefining “audience” and outreach of events, merging traditional physical and virtual communities and providing an outline on how these could be successfully reached in clearly defined event phases.

  • TOC image.
The image is free for commercial use, and no attribution required.

    Possible Biases of Researchers’ Attitudes Toward Video Games: Publication Trends Analysis of the Medical Literature (1980–2013)


    Background: The study of video games is expanding, and so is the debate regarding their possible positive and deleterious effects. 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 the professional and in the lay literature. However, no study has tried to examine this issue quantitatively. Objective: The objective of our study was to examine possible systematic biases in the literature, by analyzing the publication trends of the medical and life sciences literature regarding video games. Methods: We performed a complete and systematic PubMed search up to December 31, 2013. We assessed all 1927 articles deemed relevant for their attitude toward video games according to the focus, hypothesis, and authors’ interpretation of the study results, using a 3-category outcome (positive, negative, and neutral). We assessed the prevalence of different attitudes for possible association with year of publication, location of researchers, academic discipline, methodological research, and centrality of the publishing journals. Results: The attitude toward video games presented in publications varied by year of publication, location, academic discipline, and methodological research applied (P<.001 for all). Moreover, representation of different attitudes differed according to centrality of the journals, as measured by their impact factor (P<.001). Conclusions: The results suggest that context, whether scientific or social, is related to researchers’ attitudes toward video games. Readers, both lay and professional, should weigh these contextual variables when interpreting studies’ results, in light of the possible bias they carry. The results also support a need for a more balanced, open-minded approach toward video games, as it is likely that this complex phenomenon carries novel opportunities as well as new hazards.

  • Source:; CC0 Public Domain.

    Associations of eHealth Literacy With Health Behavior Among Adult Internet Users


    Background: In the rapidly developing use of the Internet in society, eHealth literacy—having the skills to utilize health information on the Internet—has become an important prerequisite for promoting healthy behavior. However, little is known about whether eHealth literacy is associated with health behavior in a representative sample of adult Internet users. Objective: The aim of this study was to examine the association between eHealth literacy and general health behavior (cigarette smoking, physical exercise, alcohol consumption, sleeping hours, eating breakfast, eating between meals, and balanced nutrition) among adult Internet users in Japan. Methods: The participants were recruited among registrants of a Japanese Internet research service company and asked to answer a cross-sectional Internet-based survey in 2012. The potential respondents (N=10,178) were randomly and blindly invited via email from the registrants in accordance with the set sample size and other attributes. eHealth literacy was assessed using the Japanese version of the eHealth Literacy Scale. The self-reported health behaviors investigated included never smoking cigarettes, physical exercise, alcohol consumption, sleeping hours, eating breakfast, not eating between meals, and balanced nutrition. We obtained details of sociodemographic attributes (sex, age, marital status, educational attainment, and household income level) and frequency of conducting Internet searches. To determine the association of each health behavior with eHealth literacy, we performed a logistic regression analysis; we adjusted for sociodemographic attributes and frequency of Internet searching as well as for other health behaviors that were statistically significant with respect to eHealth literacy in univariate analyses. Results: We analyzed the data of 2115 adults (response rate: 24.04%, 2142/10,178; male: 49.74%, 1052/2115; age: mean 39.7, SD 10.9 years) who responded to the survey. Logistic regression analysis showed that individuals with high eHealth literacy were significantly more likely to exhibit the good health behaviors of physical exercise (adjusted odds ratio [AOR] 1.377, 95% CI 1.131-1.678) and eating a balanced diet (AOR 1.572, 95% CI 1.274-1.940) than individuals with low eHealth literacy. Conclusions: We found that some health behaviors, including exercise and balanced nutrition, were independently associated with eHealth literacy among Japanese adult Internet users.

Citing this Article

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

Latest Submissions Open for Peer-Review:

View All Open Peer Review Articles
  • Assessment of stress in healthy individuals using smartphones: a systematic review

    Date Submitted: Jul 26, 2016

    Open Peer Review Period: Jul 26, 2016 - Sep 20, 2016

    Background: Stress is a common experience in today’s society. Smartphone ownership is widespread and smartphones can be used to monitor health and wellbeing. Smartphone-based subjective self-assessm...

    Background: Stress is a common experience in today’s society. Smartphone ownership is widespread and smartphones can be used to monitor health and wellbeing. Smartphone-based subjective self-assessment of stress can be done in naturalistic settings. Smartphone data may potentially reflect a person’s real-time stress level. Objective: The objectives of this systematic review were 1) to evaluate how smartphones have been used to measure self-assessed stress in healthy adult individuals, 2) to evaluate the validity of self-assessed stress on smartphones compared with validated stress scales and 3) to evaluate the association between self-assessed stress and smartphone generated objective data. Methods: A systematic review of the scientific literature was reported and conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The scientific databases PubMed, PsycINFO, Embase, IEEE and ACM were searched and supplemented by a hand search of reference lists. The databases were searched for original studies involving healthy individuals over the age of 18 years, measuring self-assessed stress on a smartphone. Results: A total of 31 published articles comprising a total of 1259 individuals were included for review. According to the objectives 1) The study designs were heterogeneous and self-assessed stress was measured using various methods, including a) a dichotomised question on stress (yes/no), b) a Likert-scale on stress and c) a questionnaire on stress; 2) The validity of self-assessed stress compared with validated stress scales was investigated in three studies, and of these only one study found a moderate statistically significant positive correlation (r=0.4; P < 0.05); 3) Some of the reported smartphone generated objective data, including voice, activity and usage data, were found to correlate with self-assessed stress in exploratory analyses. Conclusions: Smartphones are being used to measure self-assessed stress in different contexts. The evidence of the validity of self-assessed stress is limited and should be investigated further. Smartphone generated objective data can potentially be used to monitor, predict and reduce stress-levels.

  • Can Facebook be used for Research? Experiences using Facebook to Recruit Pregnant Women for a Randomized Control Trial in Edmonton, Alberta

    Date Submitted: Jul 25, 2016

    Open Peer Review Period: Jul 25, 2016 - Sep 19, 2016

    Background: Recruitment is often a difficult and costly part of any human research study. Social media and other emerging means of mass communication hold promise as means to complement traditional st...

    Background: Recruitment is often a difficult and costly part of any human research study. Social media and other emerging means of mass communication hold promise as means to complement traditional strategies used for recruiting participants because they can reach a large number of people, in short amount of time. With the ability to target a specified audience, paid Facebook advertisements have potential to reach future research participants of a specific demographic. A randomized control trial in trial in Edmonton, Alberta trialed various traditional recruitment approaches in addition to paid Facebook advertisements to find healthy pregnant women between 8-20 weeks gestation, to participate in a prenatal study. Objective: To evaluate the effectiveness of paid advertisements on Facebook as a platform for recruiting pregnant women to a randomized control trial, in comparison to Traditional recruitment approaches. Methods: Recruitment using Traditional approaches occurred for 7 months, while Facebook advertisements were trialed for a total of 26 days. Interested women were prompted to contact the study staff for a screening call to determine study eligibility. Costs associated with each recruitment approach were recorded and used to calculate the cost to recruit eligible participants. Performance of Facebook advertisements was monitored using Facebook Ads Manager. Results: Of the 115 women included, 39% (n=45) of the women who contacted study staff heard about the study through Facebook, while 61% (n=70) of them had heard about it through Traditional recruitment approaches. During the 215 days (~ 7 months) that the Traditional approaches were used, the average rate of interest was 0.3±0.2 women/day, while the 26 days of Facebook advertisements resulted in an average interest rate of 2.8±2.1 women/day. Facebook advertisements cost $506.91, with a cost per eligible participant of $20.28. In comparison, the Traditional approaches cost $1087, with an approximate of $24.15 per eligible participant. Demographic characteristics of women were similar between the two recruitment methods, except that women recruited using Facebook were significantly earlier in their pregnancy than those recruited using Traditional approaches (p<.03). Conclusions: Paid Facebook advertisements hold promise as a platform for reaching pregnant women. The relative ease of placing an ad, the comparable cost per participant recruited, and the dramatically improved recruitment rates in comparison to Traditional approaches highlights the importance of combining novel and traditional recruitment approaches to recruit women for pregnancy related studies. Clinical Trial: ID: NCT02711644

  • A Five-Step Framework on Biomedical Signal Analysis for Tackling Noncommunicable Diseases: Current and Future Perspectives

    Date Submitted: Jul 25, 2016

    Open Peer Review Period: Jul 25, 2016 - Sep 19, 2016

    Low- and middle-income countries (LMICs) continue to face major challenges in providing high-quality and universally accessible healthcare. Researchers, policy-makers, donors, and program implementers...

    Low- and middle-income countries (LMICs) continue to face major challenges in providing high-quality and universally accessible healthcare. Researchers, policy-makers, donors, and program implementers consistently strive to develop and provide innovative approaches to eliminate geographical and financial barriers to healthcare access. Recently, interest has increased in using mobile health (mHealth) as a potential solution to overcome barriers to improving healthcare in LMICs. Moreover, with use increasing and cost decreasing for cellphones and internet, mHealth solutions are becoming considerably more promising and efficient. As part of mHealth solutions, biomedical signals collection and processing could play a major role in improving global healthcare. Information extracted from biomedical signals might increase diagnostic precision while augmenting the robustness of healthcare workers’ clinical decision making. This paper presents a high-level framework using biomedical signal processing (BSP) to tackle noncommunicable diseases (NCDs), especially in LMICs. Researchers can consider each of these elements during the research and design of BSP-based devices, enabling them to elevate their work to a level that extends beyond the scope of local application and use. This paper includes technical examples to emphasize the applicability of the proposed framework, which is relevant to a wide variety of stakeholders, including researchers, policy makers, clinicians, computer scientists, and engineers.

  • Mobile Applications in Oncology: A Survey on the Attitude of Healthcare Professionals about Telemedicine, mHealth and an Oncological App

    Date Submitted: Jul 25, 2016

    Open Peer Review Period: Jul 25, 2016 - Sep 19, 2016

    Background: Mobile applications (apps) are an evolving trend in the medical field. To date, few apps in an oncological context exist. Objective: We analyzed health care professionals’ (HCP) attitude...

    Background: Mobile applications (apps) are an evolving trend in the medical field. To date, few apps in an oncological context exist. Objective: We analyzed health care professionals’ (HCP) attitude about telemedicine, mHealth, and mobile apps. Methods: We developed and conducted an online survey with 24 questions evaluating HCPs’ attitude towards telemedicine and patients using medical mobile apps in general, as well as specified questions on functionality and possible disadvantages of an app. Results: A total of 108 HCPs completed the survey. Of all, 88.9% consider telemedicine as useful, 84.3% versus 15.7% support the idea of an oncological app complementing classical treatment. Automatic reminders, timetables, and assessing side effects as well as quality of life during therapy were rated as the most important functions. In contrast, uncertainty regarding medical responsibility and data security were reasons mostly named by critics. Favorable of an alert function due to data input by patients with the need for further clarification are 64.8% (versus 35.2%), 94.3% are willing to contact the patient after notification. Of all, 93.5% support the idea to use collected data for scientific research and 75.0% believe it could beneficial for the providing hospital. Conclusions: A majority of HCPs are in favor of telemedicine and the use of an oncological app by patients. Not least because the fields of application are limitless. Assessing side effects can lead to quicker response and thus lower inconvenience of patients. Clinical data as life quality and treatment satisfaction could be used to evaluate and improve the therapy workflow. Eventually, a mobile app would enhance the patient relation to his treating department as he is continually linked to it by the mobile app. Clinical Trial: no registration needed

  • Barriers to Remote Health Interventions for Type 2 Diabetes: A Systematic Review and Proposed Classification Scheme

    Date Submitted: Jul 22, 2016

    Open Peer Review Period: Jul 22, 2016 - Sep 16, 2016

    Background: Diabetes self-management involves adherence to good daily habits typically involving blood glucose monitoring, medication, exercise, and diet. To support self-management, some providers ha...

    Background: Diabetes self-management involves adherence to good daily habits typically involving blood glucose monitoring, medication, exercise, and diet. To support self-management, some providers have begun testing remote interventions for monitoring and assisting patients between clinic visits. Although some studies have shown success, there are barriers to widespread adoption. Objective: This systematic review seeks to identify and classify barriers to adoption of remote systems for management of type 2 diabetes. Methods: Six electronic databases, MEDLINE (Ovid), Embase (Ovid), CINAHL, Cochrane Central, Northern Light Life Sciences Conference Abstracts, and Scopus (Elsevier), were searched for articles published from 2010 to 2015. The search identified studies involving remote technologies for type 2 diabetes self-management. Reviewers worked in teams of two to review and extract data from identified papers. Information collected included study characteristics, outcomes, drop-out rates, technologies used, and barriers identified. Results: Fifty-three publications on 42 studies met the specified criteria. Lack of data accuracy due to input bias (n=13/42, 31%), limitations on scalability (n=10/42, 24%), and technology illiteracy (n=10/42, 24%) were the most commonly cited barriers. Technology illiteracy was most prominent in low-income populations while limitations on scalability was more prominent in mid-income populations. Barriers identified were applied to a conceptual model of successful remote health, which includes patient engagement, patient technology accessibility, quality of care, system technology cost, and provider productivity. Forty-one percent of identified barrier instances impeded patient engagement, which is manifest in the large drop-out rates cited (up to 57%). Conclusions: The barriers identified represent major challenges in the design of remote health systems for diabetes. Breakthrough technologies and systems are needed to alleviate the barriers identified so far, particularly those associated with patient engagement. Monitoring devices that provide objective and reliable data streams on medication, exercise, diet, and glucose monitoring will be essential for widespread effectiveness. Additional work is needed to understand root causes of high drop-out rates, and new interventions are needed to identify and assist those at greatest risk of dropout. Finally, future studies must quantify costs and benefits to determine financially sustainability.

  • Technologies to support community-dwelling persons with dementia: an INTERDEM position paper on issues regarding development, usability, (cost)effectiveness, implementation and ethics

    Date Submitted: Jul 20, 2016

    Open Peer Review Period: Jul 21, 2016 - Sep 15, 2016

    Background: With the expected growing number of people with dementia, providing timely, adequate and affordable care and support is challenging. Assistive and health technologies may be a valuable con...

    Background: With the expected growing number of people with dementia, providing timely, adequate and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. Objective: To review the state of the art of technologies for people with dementia in three fields of technologies: 1) managing everyday life, 2) pleasurable and meaningful activities, and 3) health care technologies to support dementia care provision. And to identify challenges and calls for action. Methods: Reviews of literature in the three fields of technologies regarding issues on development, usability, (cost)effectiveness, implementation and ethics. Results: Results showed that: persons with dementia want to be included in development of technologies, little research is performed on usability of assistive technologies, various benefits are reported but mainly based on low quality studies, various barriers are found to implementation of technologies in dementia care and ethical issues were addressed by researchers but often not studied. Many challenges remain. These are: including the target group more often in development, performing more high quality studies on usability and (cost)effectiveness, having access to high quality data on existing technologies to enable adequate implementation of technologies in dementia care and to ensure that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions: Based on the results of the state of the art, various actions are recommended for development, usability, evaluation, implementation and ethics of assistive and health technologies across Europe. Examples are to ensure that unnecessary replication of technology development that is provenly unhelpful or ineffective does not occur and to better focus on how technological services succeed in addressing individual needs of persons with dementia, as the population is heterogeneous and many face co-morbid conditions. Furthermore, it is suggested to have these recommendations implemented in national and international calls for funding and assistive technology research programmes in the coming decade. In practice, policy makers, care insurers and care providers together with technology enterprises and researchers should prepare strategies for the implementation of assistive technologies in different care settings, to ensure that next generations of people with dementia are enabled to actually utilize the developed technologies in an affordable way and that they can all benefit from it Clinical Trial: NO clinical trial