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

Towards a mobile-based platform for traceability control and hazard analysis in the context of Parenteral Nutrition

Background: Management control and traceability of medications improves patient care, ensuring treatment adherence. Objective: To develop a mobile-based platform to allow in an efficient and non-intrusive manner the implementation of control procedures and traceability services in the domain of parenteral nutrient mixtures (PN). Methods: A comprehensive approach combining techniques of software engineering and knowledge engineering was used for the characterization of the framework. Local try-outs for evaluation were performed in a number of application areas, carrying out a test/retest monitoring to detect possible errors or conflicts in different contexts and control processes throughout the entire cycle of PN. From these data, the absolute and relative frequencies (percentages) were calculated. Results: A mobile application for the Android operating system was developed. This application allows reading different types of tags and interacts with the local server according to a proposed model. Also, through a internal caching mechanism, the availability of the system is preserved even in the event of problems with the network connection. A set of 1040 test traces were generated for the assessment of the system under various environments tested. Among them, 102 traces (9.81%) involved conflictive situations that were properly taken care of in this paper by suggesting solutions to overcome them. Conclusions: A mobile oriented system was generated and tested in order to allow enhanced control and quality management of parenteral nutrient (PN) mixtures that it is easy to integrate into the daily praxis of healthcare processes.

2015-07-04

Thomson Reuters has published the Journal Citation Reports (JCR) with its Journal Impact Factors for 2015. The Journal Impact Factor 2015 is defined as the number of citations in 2014 to the citations to articles published in the previous 2 years (2012-2013), divided by the number of articles published during that time. The Journal Impact Factor is a metric of excellence for a journal, it is not an article-level metric.

The Impact Factor is an increasingly controversial metric due its frequent misuse, e.g. administrators comparing the "raw" impact factor score across disciplines. This disadvantages journals in smaller disciplines such as medical informatics, which traditionally have less citations than for example multidisciplinary or general medicine journals. As one innovation, Thomson Reuters is now ranking journals by quartile (Q1, Q2, Q3, Q4), within their discipline.

While we at JMIR discourage obsession over the journal impact factor (in particular if abused as proxy to assess the quality of individual articles), our ranking in the JCR is an important validation that even as small open access publisher we can compete with journals published by publishing giants.

JMIR continues to be ranked in the first quartile (Q1) in both of it's disciplines, medical informatics (Q1) and health services research (Q1).

However, even these category-specific rankings are sometimes questionable, in particular for multidisciplinary journals such as JMIR which fit into more than the categories selected by the JCR editors. Moreover, the current JCR categories sometimes lump together journals which do not belong together, for example statistics journals are part of the medical informatics category, and oddly enough, the journal Statistical Methods in Medical Research is now suddenly the top-ranked journal in the medical informatics category.

It may therefore make more sense to compare JMIR against other leading multidisciplinary open access journals, as shown below. However, once again, the impact factor should not be the only determining factor when submitting an article. The journal scope and audience (who reads the journal) are equally important if one wants to maximize impact and influence of an article on key stakeholders and researchers, which is not measurable by citations (perhaps better measured with social media uptake and altmetrics).

We continue to encourage our authors to consider the full range of JMIR journals when submitting an article and consider the scope of the journal and the topic of the article.

Quiz: Which of the following #openaccess journals has the highest impact factor:

1) PloS One,

2) PeerJ,

3) BMC MDM,

4) BMJ Open,

5) JMIR 

(scroll down for the answer)

Journal Quartile (in their category)   Impact Factor 2015
1. JMIR Q1, Q1 3.428
2. PloS One Q1 3.234
3. BMJ Open Q2 2.271
4. PeerJ Q1 2.112
5. BMC Med Inform Med Dec Mk Q2 1.830

Beyond the Journal Impact Factor

Authors care (and should care) about other metrics/ratings such as author satisfaction with reviews and turnaround times, as for example evaluated by SciRevJMIR is ranked highly here as well (compare for example against PlosOne ratings).

scirev ranking of JMIR vs PlosOne

Other metrics to look at are the twimpact factor (social media impact) as well as post-publication dissemination activies by the publisher (JMIR is using TrendMD to promote published articles across other publishers such as BMJ and the JAMA network).

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Recent Articles:

  • Screenshot of MyJointPain.

    The Web-Based Osteoarthritis Management Resource My Joint Pain Improves Quality of Care: A Quasi-Experimental Study

    Abstract:

    Background: Despite the availability of evidence-based guidelines for conservative treatment of osteoarthritis (OA), management is often confined to the use of analgesics and waiting for eventual total joint replacement. This suggests a gap in knowledge for persons with OA regarding the many different treatments available to them. Objective: Our objective was to evaluate outcomes after usage of a Web-based resource called My Joint Pain that contains tailored, evidence-based information and tools aimed to improve self-management of OA on self-management and change in knowledge. Methods: A quasi-experimental design was used to evaluate the My Joint Pain website intervention over a 12-month period. The intervention provided participants with general and user-specific information, monthly assessments with validated instruments, and progress-tracking tools. A nationwide convenience sample of 195 participants with self-assessed hip and/or knee OA completed both baseline and 12-month questionnaires (users: n=104; nonusers: n=91). The primary outcome measure was the Health Evaluation Impact Questionnaire (heiQ) to evaluate 8 different domains (health-directed activity, positive and active engagement in life, emotional distress, self-monitoring and insight, constructive attitudes and approaches, skill and technique acquisition, social integration and support, health service navigation) and the secondary outcome measure was the 17-item Osteoarthritis Quality Indicator (OAQI) questionnaire to evaluate the change in appropriateness of care received by participants. Independent t tests were used to compare changes between groups for the heiQ and chi-square tests to identify changes within and between groups from baseline to 12 months for each OAQI item. Results: Baseline demographics between groups were similar for gender (152/195, 77.9% female), age (mean 60, SD 9 years) and body mass index (mean 31.1, SD 6.8 kg/m2). With the exception of health service navigation, mean effect sizes from all other heiQ domains showed a positive trend for My Joint Pain users compared to the nonusers, although the differences between groups did not reach statistical significance. Within-group changes also showed improvements among the users of the My Joint Pain website for self-management (absolute change score=15%, P=.03), lifestyle (absolute change score=16%, P=.02), and physical activity (absolute change score=11%, P=.04), with no significant improvements for the nonusers. Following 12 months of exposure to the website, there were significant improvements for users compared to nonusers in self-management (absolute change score 15% vs 2%, P=.001) and weight reduction (absolute change scores 3% vs –6%, P=.03) measured on the OAQI. Conclusions: The My Joint Pain Web resource does not significantly improve overall heiQ, but does improve other important aspects of quality of care in people with hip and/or knee OA. Further work is required to improve engagement with the website and the quality of information delivered in order to provide a greater impact.

  • This image is from the public domain (http://www.publicdomainpictures.net/view-image.php?image=17783&picture=mozzicone-di-sigaretta).

    Prevalence and Frequency of mHealth and eHealth Use Among US and UK Smokers and Differences by Motivation to Quit

    Abstract:

    Background: Both mHealth and eHealth interventions for smoking cessation are rapidly being developed and tested. There are no data on use of mHealth and eHealth technologies by smokers in general or by smokers who are not motivated to quit smoking. Objective: The aims of our study were to (1) assess technology use (eg, texting, social media, Internet) among smokers in the United States and United Kingdom, (2) examine whether technology use differs between smokers who are motivated to quit and smokers who are not motivated to quit, (3) examine previous use of technology to assist with smoking cessation, and (4) examine future intentions to use technology to assist with smoking cessation. Methods: Participants were 1000 adult smokers (54.90%, 549/1000 female; mean age 43.9, SD 15.5 years; US: n=500, UK: n=500) who were recruited via online representative sampling strategies. Data were collected online and included demographics, smoking history, and frequency and patterns of technology use. Results: Among smokers in general, there was a high prevalence of mobile and smartphone ownership, sending and receiving texts, downloading and using apps, using Facebook, and visiting health-related websites. Smokers who were unmotivated to quit were significantly less likely to own a smartphone or handheld device that connects to the Internet than smokers motivated to quit. There was a significantly lower prevalence of sending text messages among US smokers unmotivated to quit (78.2%, 179/229) versus smokers motivated to quit (95.0%, 229/241), but no significant differences between the UK groups (motivated: 96.4%, 239/248; unmotivated: 94.9%, 223/235). Smokers unmotivated to quit in both countries were significantly less likely to use a handheld device to read email, play games, browse the Web, or visit health-related websites versus smokers motivated to quit. US smokers had a high prevalence of app downloads regardless of motivation to quit, but UK smokers who were motivated to quit had greater prevalence of app downloads than smokers unmotivated to quit. US smokers were significantly more likely to have a Facebook account (87.0%, 435/500) than UK smokers (76.4%, 382/500), but smokers unmotivated to quit in both countries used Facebook less frequently than smokers motivated to quit. Smokers who were unmotivated to quit were less likely to have used eHealth or mHealth platforms to help them quit smoking in the past and less likely to say that they would use them for smoking cessation in the future. Conclusions: Although smokers unmotivated to quit make less use of technology than smokers motivated to quit, there is sufficient prevalence to make it worthwhile to develop eHealth and mHealth interventions to encourage cessation. Short and low-effort communications, such as text messaging, might be better for smokers who are less motivated to quit. Multiple channels may be required to reach unmotivated smokers.

  • This is a royalty free image by patrisyu (http://www.freedigitalphotos.net/images/pregnant-woman-and-smart-phone-photo-p286456).

    Information and Communication Technology Use Among Low-Income Pregnant and Postpartum Women by Race and Ethnicity: A Cross-Sectional Study

    Abstract:

    Background: Pregnancy and the postpartum period provide windows of opportunity to impact perinatal and lifelong preventive health behavior for women and their families, but these opportunities are often missed. Understanding racial/ethnic differences in information and communication technology (ICT) use could inform technology-based interventions in diverse populations. Objective: The objective of the study was to evaluate differences in the use of ICT between racial and ethnic groups as well as by English language proficiency. Methods: We conducted a cross-sectional study of 246 women who were aged 18 years or older and pregnant or within 1 year of delivery. They were recruited from 4 hospital-based outpatient clinics and completed a self-administered survey. We used multivariate regression analysis to evaluate the association between race/ethnicity and ICT (mobile phone/short message service [SMS] text message, Internet, and social network) usage by race/ethnicity and perceived English language proficiency after adjusting for age, income, marital status, and insurance status. Results: In all, 28% (69/246) of participants were Latina, 40% (98/246) were African American, 23% (56/246) were white, and 9% (23/246) from other racial/ethnic groups. Of the Latinas, 84% (58/69) reported limited English language proficiency and 59% (41/69) were uninsured. More than 90% of all participants reported mobile phone use, but more than 25% (65/246) had changed phone numbers 2 or more times in the past year. Compared to white women, African American women were less likely to SMS text message (OR 0.07, 95% CI 0.01-0.63) and Latinas were less likely to use the Internet to find others with similar concerns (OR 0.23, 95% CI 0.08-0.73). Women with limited English language proficiency were less likely to use the Internet overall (OR 0.30, 95% CI 0.09-0.99) or use email (OR 0.22, 95% CI 0.08-0.63) compared to women with adequate English language proficiency. Conclusions: Mobile phones are widely available for the delivery of health interventions to low-income, racially diverse pregnant and postpartum women, but disparities in Internet use and SMS text messaging exist. Interventions or programs requiring Web-based apps may have lower uptake unless alternatives are available, such as those adapted for limited English proficiency populations.

  • Pediatric basic life support training.

    Improving Pediatric Basic Life Support Performance Through Blended Learning With Web-Based Virtual Patients: Randomized Controlled Trial

    Abstract:

    Background: E-learning and blended learning approaches gain more and more popularity in emergency medicine curricula. So far, little data is available on the impact of such approaches on procedural learning and skill acquisition and their comparison with traditional approaches. Objective: This study investigated the impact of a blended learning approach, including Web-based virtual patients (VPs) and standard pediatric basic life support (PBLS) training, on procedural knowledge, objective performance, and self-assessment. Methods: A total of 57 medical students were randomly assigned to an intervention group (n=30) and a control group (n=27). Both groups received paper handouts in preparation of simulation-based PBLS training. The intervention group additionally completed two Web-based VPs with embedded video clips. Measurements were taken at randomization (t0), after the preparation period (t1), and after hands-on training (t2). Clinical decision-making skills and procedural knowledge were assessed at t0 and t1. PBLS performance was scored regarding adherence to the correct algorithm, conformance to temporal demands, and the quality of procedural steps at t1 and t2. Participants’ self-assessments were recorded in all three measurements. Results: Procedural knowledge of the intervention group was significantly superior to that of the control group at t1. At t2, the intervention group showed significantly better adherence to the algorithm and temporal demands, and better procedural quality of PBLS in objective measures than did the control group. These aspects differed between the groups even at t1 (after VPs, prior to practical training). Self-assessments differed significantly only at t1 in favor of the intervention group. Conclusions: Training with VPs combined with hands-on training improves PBLS performance as judged by objective measures.

  • Collage from https://www.youtube.com/watch?v=JPuQIt_w8l4 and title cover of the October 2013 issue of the Multiple Sclerosis Journal (which contained results from the CoSMo study, showing that prevalence of chronic cerebrospinal venous insufficiency (CCSVI) in multiple sclerosis (MS) did not differ from that in other neurological diseases or healthy controls). Collage (cc-by) Eysenbach, JMIR Publications.

    Scientific Versus Experiential Evidence: Discourse Analysis of the Chronic Cerebrospinal Venous Insufficiency Debate in a Multiple Sclerosis Forum

    Abstract:

    Background: The vascular hypothesis of multiple sclerosis (MS), called chronic cerebrospinal venous insufficiency (CCSVI), and its treatment (known as liberation therapy) was immediately rejected by experts but enthusiastically gripped by patients who shared their experiences with other patients worldwide by use of social media, such as patient online forums. Contradictions between scientific information and lay experiences may be a source of distress for MS patients, but we do not know how patients perceive and deal with these contradictions. Objective: We aimed to understand whether scientific and experiential knowledge were experienced as contradictory in MS patient online forums and, if so, how these contradictions were resolved and how patients tried to reconcile the CCSVI debate with their own illness history and experience. Methods: By using critical discourse analysis, we studied CCSVI-related posts in the patient online forum of the German MS Society in a chronological order from the first post mentioning CCSVI to the time point when saturation was reached. For that time period, a total of 117 CCSVI-related threads containing 1907 posts were identified. We analyzed the interaction and communication practices of and between individuals, looked for the relation between concrete subtopics to identify more abstract discourse strands, and tried to reveal discourse positions explaining how users took part in the CCSVI discussion. Results: There was an emotionally charged debate about CCSVI which could be generalized to 2 discourse strands: (1) the “downfall of the professional knowledge providers” and (2) the “rise of the nonprofessional treasure trove of experience.” The discourse strands indicated that the discussion moved away from the question whether scientific or experiential knowledge had more evidentiary value. Rather, the question whom to trust (ie, scientists, fellow sufferers, or no one at all) was of fundamental significance. Four discourse positions could be identified by arranging them into the dimensions “trust in evidence-based knowledge,” “trust in experience-based knowledge,” and “subjectivity” (ie, the emotional character of contributions manifested by the use of popular rhetoric that seemed to mask a deep personal involvement). Conclusions: By critical discourse analysis of the CCSVI discussion in a patient online forum, we reconstruct a lay discourse about the evidentiary value of knowledge. We detected evidence criteria in this lay discourse that are different from those in the expert discourse. But we should be cautious to interpret this dissociation as a sign of an intellectual incapability to understand scientific evidence or a naïve trust in experiential knowledge. Instead, it might be an indication of cognitive dissonance reduction to protect oneself against contradictory information.

  • public-domain-images-free-high-resolution-quality-photos-unsplash-0190_v222.

    “Nothing About Me Without Me”: An Interpretative Review of Patient Accessible Electronic Health Records

    Abstract:

    Background: Patient accessible electronic health records (PAEHRs) enable patients to access and manage personal clinical information that is made available to them by their health care providers (HCPs). It is thought that the shared management nature of medical record access improves patient outcomes and improves patient satisfaction. However, recent reviews have found that this is not the case. Furthermore, little research has focused on PAEHRs from the HCP viewpoint. HCPs include physicians, nurses, and service providers. Objective: We provide a systematic review of reviews of the impact of giving patients record access from both a patient and HCP point of view. The review covers a broad range of outcome measures, including patient safety, patient satisfaction, privacy and security, self-efficacy, and health outcome. Methods: A systematic search was conducted using Web of Science to identify review articles on the impact of PAEHRs. Our search was limited to English-language reviews published between January 2002 and November 2014. A total of 73 citations were retrieved from a series of Boolean search terms including “review*” with “patient access to records”. These reviews went through a novel scoring system analysis whereby we calculated how many positive outcomes were reported per every outcome measure investigated. This provided a way to quantify the impact of PAEHRs. Results: Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well as HCPs were found but eight were included for the analysis of outcome measures. We found mixed outcomes across both patient and HCP groups, with approximately half of the reviews showing positive changes with record access. Patients believe that record access increases their perception of control; however, outcome measures thought to create psychological concerns (such as patient anxiety as a result of seeing their medical record) are still unanswered. Nurses are more likely than physicians to gain time efficiencies by using a PAEHR system with the main concern from physicians being the security of the PAEHRs. Conclusions: This review implements a novel scoring system, which shows there is a lack of rigorous empirical testing that separates the effect of record access from other existing disease management programs. Current research is too targeted within certain clinical groups’ needs, and although there are positive signs for the adoption of PAEHRs, there is currently insufficient evidence about the effect of PAEHRs on health outcomes for patients or HCPs.

  • Screenshot of AlcoholHelpCenter home page.

    Mapping Power Law Distributions in Digital Health Social Networks: Methods, Interpretations, and Practical Implications

    Abstract:

    Background: Social networks are common in digital health. A new stream of research is beginning to investigate the mechanisms of digital health social networks (DHSNs), how they are structured, how they function, and how their growth can be nurtured and managed. DHSNs increase in value when additional content is added, and the structure of networks may resemble the characteristics of power laws. Power laws are contrary to traditional Gaussian averages in that they demonstrate correlated phenomena. Objectives: The objective of this study is to investigate whether the distribution frequency in four DHSNs can be characterized as following a power law. A second objective is to describe the method used to determine the comparison. Methods: Data from four DHSNs—Alcohol Help Center (AHC), Depression Center (DC), Panic Center (PC), and Stop Smoking Center (SSC)—were compared to power law distributions. To assist future researchers and managers, the 5-step methodology used to analyze and compare datasets is described. Results: All four DHSNs were found to have right-skewed distributions, indicating the data were not normally distributed. When power trend lines were added to each frequency distribution, R2 values indicated that, to a very high degree, the variance in post frequencies can be explained by actor rank (AHC .962, DC .975, PC .969, SSC .95). Spearman correlations provided further indication of the strength and statistical significance of the relationship (AHC .987. DC .967, PC .983, SSC .993, P<.001). Conclusions: This is the first study to investigate power distributions across multiple DHSNs, each addressing a unique condition. Results indicate that despite vast differences in theme, content, and length of existence, DHSNs follow properties of power laws. The structure of DHSNs is important as it gives insight to researchers and managers into the nature and mechanisms of network functionality. The 5-step process undertaken to compare actor contribution patterns can be replicated in networks that are managed by other organizations, and we conjecture that patterns observed in this study could be found in other DHSNs. Future research should analyze network growth over time and examine the characteristics and survival rates of superusers.

  • (cc) Couturier et al, CC-BY-SA-2.0, please cite as (http://www.jmir.org/article/viewFile/4379/1/61224).

    Comparing Patients’ Opinions on the Hospital Discharge Process Collected With a Self-Reported Questionnaire Completed Via the Internet or Through a...

    Abstract:

    Background: Hospital discharge, a critical stage in the hospital-to-home transition of patient care, is a complex process with potential dysfunctions having an impact on patients’ health on their return home. No study has yet reported the feasibility and usefulness of an information system that would directly collect and transmit, via the Internet, volunteer patients’ opinions on their satisfaction concerning the organization of hospital discharge. Objective: Our primary objective was to compare patients’ opinions on the discharge process collected with 2 different methods: self-questionnaire completed on a dedicated website versus a telephone interview. The secondary goal was to estimate patient satisfaction. Methods: We created a questionnaire to examine hospital discharge according to 3 dimensions: discharge logistics organization, preplanned posthospital continuity-of-care organization, and patients’ impressions at the time of discharge. A satisfaction score (between 0 and 1) for each of those dimensions and an associated total score were calculated. Taking advantage of the randomized SENTIPAT trial that questioned patients recruited at hospital discharge about the evolution of their health after returning home and randomly assigned them to complete a self-questionnaire directly online or during a telephone interview, we conducted an ancillary study comparing satisfaction with the organization of hospital discharge for these 2 patient groups. The questionnaire was proposed to 1141 patients included in the trial who were hospitalized for ≥2 days, among whom 867 eligible patients had access to the Internet at home and were randomized to the Internet or telephone group. Results: Of the 1141 patients included, 755 (66.17%) completed the questionnaire. The response rates for the Internet (39.1%, 168/430) and telephone groups (87.2%, 381/437) differed significantly (P<.001), but their total satisfaction scores did not (P=.08) nor did the satisfaction subscores (P=.58 for discharge logistics organization, P=.12 for preplanned posthospital continuity-of-care organization, and P=.35 for patients’ impressions at the time of discharge). The total satisfaction score (median 0.83, IQR 0.72-0.92) indicated the patients’ high satisfaction. Conclusions: The direct transmission of personal health data via the Internet requires patients’ active participation and those planning surveys in the domain explored in this study should anticipate a lower response rate than that issued from a similar survey conducted by telephone interviews. Nevertheless, collecting patients’ opinions on their hospital discharge via the Internet proved operational; study results indicate that conducting such surveys via the Internet yields similar estimates to those obtained via a telephone survey. The results support the establishment of a permanent dedicated website that could also be used to obtain users’ opinions on other aspects of their hospital stay and follow-up. Trial Registration: Clinicaltrials.gov NCT01769261; http://clinicaltrials.gov/ct2/show/NCT01769261 (Archived by WebCite at http://www.webcitation.org/6ZDF5bdQb).

  • Screenshot from https://mycw3.eclinicalweb.com/empi/jsp/100mp/login.jsp. Copyright ©2015 eClinicalWeb. Licensed under the fair use/fair dealings clause for educational/scientific use.

    Patient Portals and Patient Engagement: A State of the Science Review

    Abstract:

    Background: Patient portals (ie, electronic personal health records tethered to institutional electronic health records) are recognized as a promising mechanism to support greater patient engagement, yet questions remain about how health care leaders, policy makers, and designers can encourage adoption of patient portals and what factors might contribute to sustained utilization. Objective: The purposes of this state of the science review are to (1) present the definition, background, and how current literature addresses the encouragement and support of patient engagement through the patient portal, and (2) provide a summary of future directions for patient portal research and development to meaningfully impact patient engagement. Methods: We reviewed literature from 2006 through 2014 in PubMed, Ovid Medline, and PsycInfo using the search terms “patient portal” OR “personal health record” OR “electronic personal health record”. Final inclusion criterion dictated that studies report on the patient experience and/or ways that patients may be supported to make competent health care decisions and act on those decisions using patient portal functionality. Results: We found 120 studies that met the inclusion criteria. Based on the research questions, explicit and implicit aims of the studies, and related measures addressed, the studies were grouped into five major topics (patient adoption, provider endorsement, health literacy, usability, and utility). We discuss the findings and conclusions of studies that address the five topical areas. Conclusions: Current research has demonstrated that patients’ interest and ability to use patient portals is strongly influenced by personal factors such age, ethnicity, education level, health literacy, health status, and role as a caregiver. Health care delivery factors, mainly provider endorsement and patient portal usability also contribute to patient’s ability to engage through and with the patient portal. Future directions of research should focus on identifying specific populations and contextual considerations that would benefit most from a greater degree of patient engagement through a patient portal. Ultimately, adoption by patients and endorsement by providers will come when existing patient portal features align with patients’ and providers’ information needs and functionality.

  • This is a royalty free image by imagerymajestic (http://www.freedigitalphotos.net/images/Computing_g368-Businessman_In_Tension_p89760.html).

    Association Between Acute Medical Exacerbations and Consuming or Producing Web-Based Health Information: Analysis From Pew Survey Data

    Abstract:

    Background: The Internet is an increasingly important resource for individuals who seek information from both health professionals and peers. While the demographic and health characteristics of persons who use health information technology has been well described, less is known about the relationship between these health characteristics and level of engagement with health information technology. Even less is known about whether persons who produce Web-based health information differ in health status from persons who consume such content. Objective: We explored the health characteristics of persons who engage with the Internet for the purposes of consuming or producing Web-based health information, and specifically, whether healthier versus sicker persons engage with health information technology in different ways. Methods: We analyzed data from the 2012 Pew Health survey, a landline and cell phone survey of 3104 adults in the United States. Using multiple logistic regression with sampling weights, we examined the association between sociodemographic and health characteristics and the consumption or production of Web-based health information. Sociodemographic variables included age, sex, race, and education. Health characteristics included self-reported health status, presence of chronic condition(s), and having an acute medical exacerbation. Acute medical exacerbations were defined as an emergency department visit, hospitalization, or other serious medical emergency in the last 12 months. Results: The majority of the sample reported good or excellent health (79.7%), although 50.3% reported having at least one chronic condition. About a fifth (20.2%) of the sample experienced an acute medical exacerbation in the past year. Education was the sociodemographic characteristic most strongly associated with consuming Web-based health information. The strongest health-related predictors of consuming Web-based health information were an acute medical exacerbation (OR 2.39, P<.001) and having a chronic condition (OR 1.54, P=.007). Having an acute medical exacerbation was the only predictor of producing Web-based health information (OR 1.97, P=.003). All participants, regardless of health status, were most interested in Web-based health information regarding diseases or medical problems. However, persons with acute medical exacerbations were more likely to seek Web-based health information regarding medical tests, procedures, and drugs compared to persons without acute medical exacerbations. Conclusions: Producers of Web-based health information differ from consumers of this information in important health characteristics that could skew the content of peer-generated Web-based health information and overrepresent the experiences of persons with acute medical exacerbations. Providers may have a role to play in directing patients towards high-quality, easy-to-understand online information, especially information regarding treatments and procedures.

  • © kebox_fotolia. Image purchased by authors.

    Gender Differences in Searching for Health Information on the Internet and the Virtual Patient-Physician Relationship in Germany: Exploratory Results on How...

    Abstract:

    Background: Many studies have shown that women use the Internet more often for health-related information searches than men, but we have limited knowledge about the underlying reasons. We also do not know whether and how women and men differ in their current use of the Internet for communicating with their general practitioner (GP) and in their future intention to do so (virtual patient-physician relationship). Objective: This study investigates (1) gender differences in health-related information search behavior by exploring underlying emotional, motivational, attitudinal as well as cognitive variables, situational involvement, and normative influences, and different personal involvement regarding health-related information searching and (2) gender differences in the virtual patient-physician relationship. Methods: Gender differences were analyzed based on an empirical online survey of 1006 randomly selected German patients. The sample was drawn from an e-panel maintained by GfK HealthCare. A total of 958 usable questionnaires were analyzed. Principal component analyses were carried out for some variables. Differences between men (517/958) and women (441/958) were analyzed using t tests and Kendall’s tau-b tests. The survey instrument was guided by several research questions and was based on existing literature. Results: Women were more engaged in using the Internet for health-related information searching. Gender differences were found for the frequency of usage of various Internet channels for health-related information searches. Women used the Internet for health-related information searches to a higher degree for social motives and enjoyment and they judged the usability of the Internet medium and of the information gained by health information searches higher than men did. Women had a more positive attitude toward Web 2.0 than men did, but perceived themselves as less digitally competent. Women had a higher health and nutrition awareness and a greater reluctance to make use of medical support, as well as a higher personal disposition of being well-informed as a patient. Men may be more open toward the virtual patient-physician relationship. Conclusions: Women have a stronger social motive for and experience greater enjoyment in health-related information searches, explained by social role interpretations, suggesting these needs should be met when offering health-related information on the Internet. This may be interesting for governmental bodies as well as for the insurance and the pharmaceutical industries. Furthermore, women may be more easily convinced by health awareness campaigns and are, therefore, the primary target group for them. Men are more open to engaging in a virtual relationship with the GP; therefore, they could be the primary target group for additional online services offered by GPs. There were several areas for GPs to reinforce the virtual patient-physician relationship: the fixing of personal appointments, referral to other doctors, writing prescriptions, and discussions of normal test results and doctor’s notes/certificates of health.

  • Online recruitment document.

    eHealth, Participatory Medicine, and Ethical Care: A Focus Group Study of Patients’ and Health Care Providers’ Use of Health-Related Internet Information

    Abstract:

    Background: The rapid explosion in online digital health resources is seen as transformational, accelerating the shift from traditionally passive patients to patients as partners and altering the patient–health care professional (HCP) relationship. Patients with chronic conditions are increasingly engaged, enabled, and empowered to be partners in their care and encouraged to take responsibility for managing their conditions with HCP support. Objective: In this paper, we focus on patients’ and HCPs’ use of health-related Internet information and how it influences the patient-HCP relationship. In particular, we examine the challenges emerging in medical encounters as roles and relationships shift and apply a conceptual framework of relational ethics to examine explicit and nuanced ethical dimensions emerging in patient-HCP interactions as both parties make increased use of health-related Internet information. Methods: We purposively sampled patients and HCPs in British Columbia, Canada, to participate in focus groups. To be eligible, patients self-reported a diagnosis of arthritis and at least one other chronic health condition; HCPs reported a caseload with >25% of patients with arthritis and multimorbidity. We used a semistructured, but flexible, discussion guide. All discussions were audiotaped and transcribed verbatim. Elements of grounded theory guided our constant comparison thematic analytic approach. Analysis was iterative. A relational ethics conceptual lens was applied to the data. Results: We recruited 32 participants (18 patients, 14 HCPs). They attended seven focus groups: four with patients and three with rehabilitation professionals and physicians. Predominant themes to emerge were how use of health-related Internet information fostered (1) changing roles, (2) patient-HCP partnerships, and (3) tensions and burdens for patients and HCPs. Conclusions: Relational aspects such as mutual trust, uncertainty, and vulnerability are illuminated in patient-HCP interactions around health-related Internet information and the negotiated space of clinical encounters. New roles and associated responsibilities have key ethical dimensions that make clear the changes are fundamental and important to understand in ethical care. When faced with tensions and burdens around incorporating health-related Internet information as a resource in clinical encounters, participants described a particular ambivalence illustrating the fundamental changes being negotiated by both patients and HCPs.

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  • Towards a mobile-based platform for traceability control and hazard analysis in the context of Parenteral Nutrition

    Date Submitted: Jul 6, 2015

    Open Peer Review Period: Jul 6, 2015 - Aug 31, 2015

    Background: Management control and traceability of medications improves patient care, ensuring treatment adherence. Objective: To develop a mobile-based platform to allow in an efficient and non-intru...

    Background: Management control and traceability of medications improves patient care, ensuring treatment adherence. Objective: To develop a mobile-based platform to allow in an efficient and non-intrusive manner the implementation of control procedures and traceability services in the domain of parenteral nutrient mixtures (PN). Methods: A comprehensive approach combining techniques of software engineering and knowledge engineering was used for the characterization of the framework. Local try-outs for evaluation were performed in a number of application areas, carrying out a test/retest monitoring to detect possible errors or conflicts in different contexts and control processes throughout the entire cycle of PN. From these data, the absolute and relative frequencies (percentages) were calculated. Results: A mobile application for the Android operating system was developed. This application allows reading different types of tags and interacts with the local server according to a proposed model. Also, through a internal caching mechanism, the availability of the system is preserved even in the event of problems with the network connection. A set of 1040 test traces were generated for the assessment of the system under various environments tested. Among them, 102 traces (9.81%) involved conflictive situations that were properly taken care of in this paper by suggesting solutions to overcome them. Conclusions: A mobile oriented system was generated and tested in order to allow enhanced control and quality management of parenteral nutrient (PN) mixtures that it is easy to integrate into the daily praxis of healthcare processes.

  • Efficacy of a web-based self-help intervention with and without chat counseling to reduce cannabis use in problematic cannabis users: results of a three-arm randomized controlled trial

    Date Submitted: Jul 6, 2015

    Open Peer Review Period: Jul 6, 2015 - Aug 31, 2015

    Background: Background: After alcohol and tobacco, cannabis is the most widely used psychoactive substance in many countries worldwide. Although approximately one in ten users develops serious problem...

    Background: Background: After alcohol and tobacco, cannabis is the most widely used psychoactive substance in many countries worldwide. Although approximately one in ten users develops serious problems of dependency, only a minority attend outpatient addiction counseling centers. A web-based intervention could potentially reach those users who hesitate to approach such treatment centers and help them to reduce their cannabis use. It is unclear whether brief chat counseling in addition to web-based self-help provides added value. Objective: Objective: To test the efficacy of a web-based self-help intervention with and without chat counseling in reducing the cannabis use of problematic cannabis users as an alternative to outpatient treatment services. Methods: Methods: 436 participants for the web-based trial were recruited by various online and offline media. 308 of these were eligible for study participation and were randomly allocated in an unblinded manner to either self-help with chat (n=114), self-help without chat (n=101) or a waiting list control group (n=93). The fully automated self-help intervention consisted of 8 modules designed to reduce cannabis use, and was based on the principles of motivational interviewing, self-control practices, and methods of cognitive behavioral therapy. Additional individual chat-counseling sessions were based on the same therapeutic principles. They were conducted by trained counselors and considered participants´ self-help information data as well as personal problems. The main outcome criteria were the number of cannabis use days per week and the weekly quantity of cannabis use, as entered into the consumption diary at baseline and at the 3 months follow-up. Secondary outcomes included cannabis use disorder symptoms, severity of cannabis dependence, alcohol and risky alcohol use, and changes in mental health symptoms and were self-assessed. Intervention participation and retention were extracted from the user progress data and the consumption diary, respectively. Results: Results: Can Reduce participants were older (U = 2.296, P = .02) and reported a greater number of cannabis use days at baseline than patients who entered treatment in the Swiss treatment demand monitoring system with cannabis as their main problem substance (Chi-Square = 4.000, P = .046). Participants in the self-help with chat study arm completed a mean of 3.2 modules and 27 (23.7%) of the participants received at least one chat session. Participants in the self-help without chat study arm completed similar numbers of self-help modules. 117 (39%) of the participants completed the 3-month follow-up assessment. The change in the mean number of cannabis use days per week at 3 months differed between self-help without chat (Mean (M) = 5.3, Standard Deviation (SD) = 1.8) and self-help with chat (M = 4.5, SD = 2.1; β = -2.23, se = .36, P = .03, d = .37, 95% confidence interval (CI) (0.10-0.65)), as well as between self-help with chat and waiting list (M = 5.4, SD = 1.8; β = -2.39, se = .39, P = .02, d = .40, 95% CI (0.12-0.69)). However, there were no differences between self-help without chat and waiting list (β = .36, se = .38, P = 0.72, d = .03, 95% CI (-0.26-0.32)). Moreover, the differences between self-help with chat (M = 12.9, SD = 11.7) and waiting list (M = 25.2, SD = 31.6) were also significant for the change in the number of weekly number of cannabis joints used (β = 2.15, se = 5.33, P = .03, d = .20, 95% CI (-0.09-0.48)); there were also trends to differences between self-help with and without chat (M = 15.3, SD = 14.1) and with chat and waiting list (β = 1.72, se = 5.46, P = .09, d = .17, 95% CI (-0.11-0.46)). There were no significant differences between the study arms with respect to the secondary outcomes. However, in each study arm there were improvements between baseline and follow-up with respect to cannabis use disorders symptoms, the severity of cannabis dependence, and in mental health symptoms. Self-reported abstinence tended to be significantly higher in self-help with chat (8.4%) than in self-help without chat study arm (2.0%) (β = -1.88, se = .79, P = .06, d = .28, 95% CI (0.01-0.56)). Conclusions: Conclusions: Web-based interventions can potentially reach a group of heavy cannabis users who differ from those who enter addiction treatment services. Brief chat counseling in addition to web-based self-help can significantly enhance the reduction in cannabis use. Clinical Trial: This trial is registered at Current Controlled Trials and is traceable as ISRCTN59948178.

  • A Group-based Mobile Application to Increase Adherence in Exercise and Nutrition Programs

    Date Submitted: Jul 3, 2015

    Open Peer Review Period: Jul 4, 2015 - Aug 29, 2015

    Background: Novel methods of promoting self-monitoring and social support are needed to ensure long-term maintenance of behavior change. In this paper, we directly investigate the effects of group sup...

    Background: Novel methods of promoting self-monitoring and social support are needed to ensure long-term maintenance of behavior change. In this paper, we directly investigate the effects of group support in an exercise and nutrition program delivered by an mHealth application called Fittle. Objective: Our first specific study aim was to explore whether social support improved adherence in wellness programs. Our second specific study aim was to assess whether media types (ePaper vs. mobile) were associated with different levels of compliance and adherence to wellness programs. The third aim was to assess whether the use of an mHealth application led to positive changes to participants’ eating behavior, physical activity and stress level, compared to traditional paper-based programs. Methods: A 2 (Media: Mobile vs ePaper) x 2 (Group Type: Team vs Solo) factorial design feasibility study was conducted. A sample of 124 volunteers who were interested in improving eating behavior, increasing physical activity, or reducing stress was recruited. The study duration was 8 weeks. All groups were self-directed with no ongoing human input from the research team. Results: Participants in ePaper conditions had higher attrition rates compared to participants in Mobile conditions (Χ2(3, N = 124) = 9.96, P = .02). Participants in Mobile conditions reported their compliance with a much higher frequency closer to the time of challenge activity completion (2-sample Kolmogorov-Smirnov test comparing distributions was highly significant; (KS (N = 63) = 0.33, P < .001). Participants in ePaper conditions had a much higher frequency of guessing while reporting as compared to those in Mobile conditions (Χ2 (1, N = 63) = 25.25 P < .001). Together, these findings suggest that the mobile app allows a more accurate method to report and track health behaviors over a longer period of time than traditional ePaper-based diaries or log books. There was a significant difference in the overall compliance score for Mobile-Solo (M= 0.30, SD=0.39) and Mobile-Team (M=0.49, SD=0.35) conditions (t (50.82)=1.94, P = .05). This suggests that working in a team increases participants’ overall compliance within Fittle. Survival analysis showed that participants assigned to Team conditions are 66%, more likely to engage longer with mHealth app-based intervention than those assigned to the solo condition. Overall, participants across all groups reported some positive changes in eating behavior, physical activity and stress level; however, participants in the Mobile-Solo condition reported higher perceived stress levels at the end of the study. Conclusions: The team-based Fittle app is an acceptable and feasible wellness behavior change intervention and a full RCT to investigate the efficacy of such an intervention is warranted.

  • Are health-related posts on twitter evidence based?

    Date Submitted: Jul 3, 2015

    Open Peer Review Period: Jul 4, 2015 - Aug 29, 2015

    Background: Twitter is a free social networking website with over 500 million users, thus a great resource for real-time knowledge. Healthcare professionals have utilized social media to communicate a...

    Background: Twitter is a free social networking website with over 500 million users, thus a great resource for real-time knowledge. Healthcare professionals have utilized social media to communicate and share information between patients and health care decision makers, develop disease surveillance systems and mine health-related information. The immediate direct users of this health information is the general public including patients who communicate and gain health-related information online. This necessitates the validation of health-related tweets by healthcare professionals, to ensure access to evidence-based content and avoid the spread of non-credible health information which may be the basis for critical decisions. Objective: To evaluate health-related tweets on twitter in terms of validity according to the available evidences, and to create awareness in the community. Methods: All tweets containing health-related information Arabic language, from 01 April 2015 to 05 April 2015, were mined from Twitter. The tweets were classified by types of users, including physicians, non-official health institute accounts (unverifiable accounts), dietitian accounts, and government institute accounts. These tweets were evaluated by 3 American Board certified medical consultants and a score was generated depending on the validity of the content (T=true, F=False). Statistical analysis was performed to assess the significance of the results. Kappa statistics was used to evaluate inter-observer agreement. Results: A total of 625 health-related Arabic language tweets identified from 8 physician accounts, 10 non-official health institute accounts, 4 dietician accounts and 3 government institute accounts. The reviewers labeled 320 (51.2%) tweets as ‘false’ and 305 (48.8%) tweets as “true”. Comparative analysis of the tweets by account type showed that the highest number of valid tweets were by government institutes (80%) followed by physicians (61.7%) and dieticians (41.6%). The inter-observer agreement was moderate (ranging from 0.78 to 0.22). More than half of the health related tweets (68.1%) from non-official health institutes were false or invalid. Tweets by the physicians were valid compared to other groups (P<0.001). Conclusions: About half of the medical conversations on twitter were false. Furthermore, most of its evidence-based health-related conversations are from physicians and government institute accounts.

  • Effects of an eHealth intervention combined with person-centered care throughout the continuum of care for patients diagnosed with acute coronary syndrome

    Date Submitted: Jul 3, 2015

    Open Peer Review Period: Jul 4, 2015 - Aug 29, 2015

    Background: There is increasing evidence that patients with chronic heart disease who receive person-centered care (PCC) have better outcomes and satisfaction with their care compared to traditional c...

    Background: There is increasing evidence that patients with chronic heart disease who receive person-centered care (PCC) have better outcomes and satisfaction with their care compared to traditional care. The concept of eHealth, which encompasses a variety of actions referring to health services and information delivered or enhanced through digital technology, could have a positive effect on management of optimizing self-care. While the use of mobile eHealth is increasing, there is a lack of knowledge regarding the effects of mobile-based self-management tools in combination with PCC for patients with chronic heart diseases. Objective: To investigate the effect of a smartphone-based eHealth application in combination with PCC for patients with acute coronary syndrome (ACS). Methods: This study was a sub-study, which was part of a randomized, controlled trial investigating the effects of PCC in patients who were hospitalized with ACS. A total of 199 patients with ACS who were aged <75 years were randomly assigned to a PCC intervention (n=94) or standard treatment (control group, n=105) and followed for 6 months. Patients who were included in the intervention arm were provided the option to use a smartphone-based or internet-based eHealth tool for at least 2 months post-hospital discharge. The primary end-point was a composite score of changes in general self- efficacy ≥5 units, return to work or prior activity level, and re-hospitalization or death at 6 months post-discharge. Results: Of the 94 patients included into the intervention arm, 37 (39%) used the eHealth diary at least once during the study. Patients who used the eHealth tool in combination with the PCC intervention had a 4 times higher chance of improvement in the primary endpoint compared with the control group (odds ratio: 4.0; 95% confidence interval: 1.6-11.0; P = .005). Conclusions: Our findings indicate a significant beneficial effect on self-efficacy for patients using eHealth as a self-management tool to improve PCC outcomes.

  • Differences in utilization of a smoking cessation website between young and older adults: Results of an observational study

    Date Submitted: Jul 2, 2015

    Open Peer Review Period: Jul 4, 2015 - Aug 29, 2015

    Background: Few studies have explored variations in usage patterns of web-based smoking cessation interventions. Several studies have suggested that young adults may be less likely to use cessation we...

    Background: Few studies have explored variations in usage patterns of web-based smoking cessation interventions. Several studies have suggested that young adults may be less likely to use cessation websites; however, it is unknown how use patterns among young adults compare to those of older adults, and whether utilization differs by gender and race/ethnicity within age groups. Addressing this knowledge gap is important to identify opportunities to optimize the effectiveness of online cessation programs across all subgroups of users. Objective: The present study examines utilization of the BecomeAnEX.org smoking cessation website to identify patterns of use by age, and by gender and race/ethnicity within age strata. Methods: Study participants were N=5,983 new registered users on a free smoking cessation website who were between the ages of 18-70. Website utilization was tracked for six months; metrics of use included website visits, pages per visit, and length of visit, as well as interaction with specific website features. Differences in website use by age were examined via bivariate analyses and multivariate logistic regression adjusted for age, gender and race/ethnicity. Interactions were examined to determine differences by gender and race/ethnicity within young (18-30 years old) and older (31+ years old) adult segments. Results: A greater percentage of younger adults visited the site only once compared to older adults (72.22% vs. 59.67% respectively, P<.001). Younger adults also spent less time on the site (mean 2.26 minutes [SE: 0.13] vs. 6.70 minutes [1.12], respectively; P<.001) and viewed fewer pages (mean 45.22 [SE: 7.11] pages vs. 96.48 [SE: 10.76] pages, respectively; P<.001) than older adults. While young adults were significantly less likely to visit more than once (AOR 0.63, 95% CI 0.56, 0.71; P<.001), spend 3 minutes or more on the site (AOR 0.73, 95% 0.64, 0.82), view 12 or more pages (AOR 0.76, 95% CI 0.68, 0.85), utilize the EX community (AOR 0.79, 95% CI 0.66, 0.94), and utilize Separation Exercises (AOR 0.76, 95% CI 0.63, 0.92) in adjusted analyses. Gender differences in utilization were more pronounced among young adults, with lower levels of utilization among young men than young women. For both age groups, utilization was higher among whites and African Americans than among Hispanics and other racial minorities, with the exception of the EX Community. Community utilization was significantly higher among Hispanic young adults compared with white and African American young adults. Conclusions: Although interpretation of findings is constrained by the limited available information about participants, results point to important areas of inquiry for future research and development efforts. Research should focus on enhancing demand and increasing engagement among younger adults and men, and increasing utilization of effective site features among all users.