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Vol 13, No 3 (2011) - Jul-Sep


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Viewpoint

Opportunities and Challenges of Cloud Computing to Improve Health Care Services

Mu-Hsing Kuo

J Med Internet Res 2011 (Sep 21); 13(3):e67

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Cloud computing is a new way of delivering computing resources and services. Many managers and experts believe that it can improve health care services, benefit health care research, and change the face of health information technology. However, as with any innovation, cloud computing should be rigorously evaluated before its widespread adoption. This paper discusses the concept and its current place in health care, and uses 4 aspects (management, technology, security, and legal) to evaluate...

Institutionalizing Telemedicine Applications: The Challenge of Legitimizing Decision-Making

Paolo Zanaboni, Emanuele Lettieri

J Med Internet Res 2011 (Sep 28); 13(3):e72

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During the last decades a variety of telemedicine applications have been trialed worldwide. However, telemedicine is still an example of major potential benefits that have not been fully attained. Health care regulators are still debating why institutionalizing telemedicine applications on a large scale has been so difficult and why health care professionals are often averse or indifferent to telemedicine applications, thus preventing them from becoming part of everyday clinical routines. We...

Web-based and Mobile Health Interventions

Using the Internet to Understand Smokers’ Treatment Preferences: Informing Strategies to Increase Demand

J Lee Westmaas, Lorien Abroms, Jeuneviette Bontemps-Jones, Joseph E Bauer, Jeanine Bade

J Med Internet Res 2011 (Aug 26); 13(3):e58

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Background: Most smokers attempt to quit on their own even though cessation aids can substantially increase their chances of success. Millions of smokers seek cessation advice on the Internet, so using it to promote cessation products and services is one strategy for increasing demand for treatments. Little is known, however, about what cessation aids these smokers would find most appealing or what predicts their preferences (eg, age, level of dependence, or timing of quit date). Objective:...

A Systematic Review of Information and Communication Technology–Based Interventions for Promoting Physical Activity Behavior Change in Children and Adolescents

Patrick WC Lau, Erica Y Lau, Del P Wong, Lynda Ransdell

J Med Internet Res 2011 (Jul 13); 13(3):e48

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Background: A growing body of research has employed information and communication technologies (ICTs) such as the Internet and mobile phones for disseminating physical activity (PA) interventions with young populations. Although several systematic reviews have documented the effects of ICT-based interventions on PA behavior, very few have focused on children and adolescents specifically. Objectives: The present review aimed to systematically evaluate the efficacy and methodological quality of...

Persuasive Features in Web-Based Alcohol and Smoking Interventions: A Systematic Review of the Literature

Tuomas Lehto, Harri Oinas-Kukkonen

J Med Internet Res 2011 (Jul 22); 13(3):e46

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Background: In the past decade, the use of technologies to persuade, motivate, and activate individuals’ health behavior change has been a quickly expanding field of research. The use of the Web for delivering interventions has been especially relevant. Current research tends to reveal little about the persuasive features and mechanisms embedded in Web-based interventions targeting health behavior change. Objectives: The purpose of this systematic review was to extract and analyze...

A Systematic Review of the Impact of Adherence on the Effectiveness of e-Therapies

Liesje Donkin, Helen Christensen, Sharon L Naismith, Bruce Neal, Ian B Hickie, Nick Glozier

J Med Internet Res 2011 (Aug 05); 13(3):e52

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Background: As the popularity of e-therapies grows, so too has the body of literature supporting their effectiveness. However, these interventions are often plagued by high attrition rates and varying levels of user adherence. Understanding the role of adherence may be crucial to understanding how program usage influences the effectiveness of e-therapy interventions. Objective: The aim of this study was to systematically review the e-therapy literature to (1) describe the methods used to...

Modeling the Cost-Effectiveness of Health Care Systems for Alcohol Use Disorders: How Implementation of eHealth Interventions Improves Cost-Effectiveness

Filip Smit, Joran Lokkerbol, Heleen Riper, Cristina Majo, Brigitte Boon, Matthijs Blankers

J Med Internet Res 2011 (Aug 11); 13(3):e56

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Background: Informing policy decisions about the cost-effectiveness of health care systems (ie, packages of clinical interventions) is probably best done using a modeling approach. To this end, an alcohol model (ALCMOD) was developed. Objective: The aim of ALCMOD is to estimate the cost-effectiveness of competing health care systems in curbing alcohol use at the national level. This is illustrated for scenarios where new eHealth technologies for alcohol use disorders are introduced in the...

Bringing Loyalty to E-health: Theory Validation Using Three Internet-Delivered Interventions

Rik Crutzen, Dianne Cyr, Nanne K de Vries

J Med Internet Res 2011 (Sep 24); 13(3):e73

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Background: Internet-delivered interventions can effectively change health risk behaviors, but the actual use of these interventions by the target group once they access the website is often very low (high attrition, low adherence). Therefore, it is relevant and necessary to focus on factors related to use of an intervention once people arrive at the intervention website. We focused on user perceptions resulting in e-loyalty (ie, intention to visit an intervention again and to recommend it to...

Factors Influencing the Use of a Web-Based Application for Supporting the Self-Care of Patients with Type 2 Diabetes: A Longitudinal Study

Nicol Nijland, Julia EWC van Gemert-Pijnen, Saskia M Kelders, Bart J Brandenburg, Erwin R Seydel

J Med Internet Res 2011 (Sep 30); 13(3):e71

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Background: The take-up of eHealth applications in general is still rather low and user attrition is often high. Only limited information is available about the use of eHealth technologies among specific patient groups. Objective: The aim of this study was to explore the factors that influence the initial and long-term use of a Web-based application (DiabetesCoach) for supporting the self-care of patients with type 2 diabetes. Methods: A mixed-methods research design was used for a process...

Mobile Health (mhealth)

Real-Time Social Support Through a Mobile Virtual Community to Improve Healthy Behavior in Overweight and Sedentary Adults: A Focus Group Analysis

Yoshimi Fukuoka, Emiko Kamitani, Kemberlee Bonnet, Teri Lindgren

J Med Internet Res 2011 (Jul 14); 13(3):e49

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Background: The onset of type 2 diabetes mellitus can be prevented or delayed by lifestyle changes. Communication technologies such as a mobile phone can be used as a means of delivering these lifestyle changes. Objectives: The purposes of this analysis were to explore applicability of potential components of a mobile phone-based healthy lifestyle program and to understand motivators and barriers to continued engagement in a mobile phone healthy lifestyle program. Methods: We conducted 6...

An Evaluation of the Use of Smartphones to Communicate Between Clinicians: A Mixed-Methods Study

Robert Wu, Peter Rossos, Sherman Quan, Scott Reeves, Vivian Lo, Brian Wong, Mark Cheung, Dante Morra

J Med Internet Res 2011 (Aug 29); 13(3):e59

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Background: Communication between clinicians is critical to providing quality patient care but is often hampered by limitations of current systems. Smartphones such as BlackBerrys may improve communication, but studies of these technologies have been limited to date. Objective: Our objectives were to describe how smartphones were adopted for clinical communication within general internal medical wards and determine their impact on team effectiveness and communication. Methods: This was a...

Harnessing Context Sensing to Develop a Mobile Intervention for Depression

Michelle Nicole Burns, Mark Begale, Jennifer Duffecy, Darren Gergle, Chris J Karr, Emily Giangrande, David C Mohr

J Med Internet Res 2011 (Aug 12); 13(3):e55

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Background: Mobile phone sensors can be used to develop context-aware systems that automatically detect when patients require assistance. Mobile phones can also provide ecological momentary interventions that deliver tailored assistance during problematic situations. However, such approaches have not yet been used to treat major depressive disorder. Objective: The purpose of this study was to investigate the technical feasibility, functional reliability, and patient satisfaction with...

Features of Mobile Diabetes Applications: Review of the Literature and Analysis of Current Applications Compared Against Evidence-Based Guidelines

Taridzo Chomutare, Luis Fernandez-Luque, Eirik Årsand, Gunnar Hartvigsen

J Med Internet Res 2011 (Sep 22); 13(3):e65

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Background: Interest in mobile health (mHealth) applications for self-management of diabetes is growing. In July 2009, we found 60 diabetes applications on iTunes for iPhone; by February 2011 the number had increased by more than 400% to 260. Other mobile platforms reflect a similar trend. Despite the growth, research on both the design and the use of diabetes mHealth applications is scarce. Furthermore, the potential influence of social media on diabetes mHealth applications is largely...

Estimation of Physical Activity Levels Using Cell Phone Questionnaires: A Comparison With Accelerometry for Evaluation of Between-Subject and Within-Subject Variations

Christin Bexelius, Sven Sandin, Ylva Trolle Lagerros, Jan-Eric Litton, Marie Löf

J Med Internet Res 2011 (Sep 25); 13(3):e70

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Background: Physical activity promotes health and longevity. Further elaboration of the role of physical activity for human health in epidemiological studies on large samples requires accurate methods that are easy to use, cheap, and possible to repeat. The use of telecommunication technologies such as cell phones is highly interesting in this respect. In an earlier report, we showed that physical activity level (PAL) assessed using a cell phone procedure agreed well with corresponding...

Internet-based Survey & Research Methodology

Predictors of Retention in an Online Follow-up Study of Men Who Have Sex With Men

Christine M Khosropour, Patrick S Sullivan

J Med Internet Res 2011 (Jul 11); 13(3):e47

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Background: In the past 10 years, the Internet has emerged as a venue for men who have sex with men (MSM) to meet sex partners. Because online sex seeking has increased among MSM, Internet-based human immunodeficiency virus (HIV) prevention interventions are of interest. However, few online studies to date have demonstrated an ability to retain study participants, specifically MSM of color, in longitudinal online studies. Objective: The current analysis examines data from a 3-month online...

A Web-Based Computerized Adaptive Testing (CAT) to Assess Patient Perception in Hospitalization

Tsair-Wei Chien, Wen-Chung Wang, Sheng-Yun Huang, Wen-Pin Lai, Julie Chi Chow

J Med Internet Res 2011 (Aug 15); 13(3):e61

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Background: Many hospitals have adopted mobile nursing carts that can be easily rolled up to a patient’s bedside to access charts and help nurses perform their rounds. However, few papers have reported data regarding the use of wireless computers on wheels (COW) at patients’ bedsides to collect questionnaire-based information of their perception of hospitalization on discharge from the hospital. Objective: The purpose of this study was to evaluate the relative efficiency of...

Development of a Web-Based Survey for Monitoring Daily Health and its Application in an Epidemiological Survey

Hiroaki Sugiura, Yasushi Ohkusa, Manabu Akahane, Tomomi Sano, Nobuhiko Okabe, Tomoaki Imamura

J Med Internet Res 2011 (Sep 23); 13(3):e66

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Background: Early detection of symptoms arising from exposure to pathogens, harmful substances, or environmental changes is required for timely intervention. The administration of Web-based questionnaires is a potential method for collecting information from a sample population. Objective: The objective of our study was to develop a Web-based daily questionnaire for health (WDQH) for symptomatic surveillance. Methods: We adopted two different survey methods to develop the WDQH: an Internet...

A Comparison of a Postal Survey and Mixed-Mode Survey Using a Questionnaire on Patients’ Experiences With Breast Care

Marloes Zuidgeest, Michelle Hendriks, Laura Koopman, Peter Spreeuwenberg, Jany Rademakers

J Med Internet Res 2011 (Sep 27); 13(3):e68

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Background: The Internet is increasingly considered to be an efficient medium for assessing the quality of health care seen from the patients’ perspective. Potential benefits of Internet surveys such as time efficiency, reduced effort, and lower costs should be balanced against potential weaknesses such as low response rates and accessibility for only a subset of potential participants. Combining an Internet questionnaire with a traditional paper follow-up questionnaire (mixed-mode...

Using Web-Based and Paper-Based Questionnaires for Collecting Data on Fertility Issues Among Female Childhood Cancer Survivors: Differences in Response Characteristics

Marleen H. van den Berg, Annelies Overbeek, Helena J. van der Pal, A. Birgitta Versluys, Dorine Bresters, Flora E. van Leeuwen, Cornelis B. Lambalk, Gertjan J.L. Kaspers, Eline van Dulmen-den Broeder

J Med Internet Res 2011 (Sep 29); 13(3):e76

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Background: Web-based questionnaires have become increasingly popular in health research. However, reported response rates vary and response bias may be introduced. Objective: The aim of this study was to evaluate whether sending a mixed invitation (paper-based together with Web-based questionnaire) rather than a Web-only invitation (Web-based questionnaire only) results in higher response and participation rates for female childhood cancer survivors filling out a questionnaire on fertility...

Virtual Worlds

A Pilot Study of Motivational Interviewing Training in a Virtual World

Suzanne Mitchell, Neil Heyden, Paul Schroy, Stephen Andrew, Ekaterina Sadikova, John Wiecha

J Med Internet Res 2011 (Sep 26); 13(3):e77

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Background: Motivational interviewing (MI) is an evidence-based, patient-centered counseling strategy proven to support patients seeking health behavior change. Yet the time and travel commitment for MI training is often a barrier to the adoption of MI by health care professionals. Virtual worlds such as Second Life (SL) are rapidly becoming part of the educational technology landscape and offer not only the potential to improve access to MI training but also to deepen the MI training...

Medicine 2.0: Social Media, Open, Participatory, Collaborative Medicine

Can Online Consumers Contribute to Drug Knowledge? A Mixed-Methods Comparison of Consumer-Generated and Professionally Controlled Psychotropic Medication Information on the Internet

Shannon Hughes, David Cohen

J Med Internet Res 2011 (Jul 29); 13(3):e53

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Background: Ongoing initiatives to filter online health searches exclude consumer-generated content from search returns, though its inferiority compared with professionally controlled content is not demonstrated. The antidepressant escitalopram and the antipsychotic quetiapine have ranked over the last 5 years as top-selling agents in their respective drug classes. Both drugs have various off-label mental health and non–mental health uses, ranging from the relief of insomnia and...

Prevalence and Global Health Implications of Social Media in Direct-to-Consumer Drug Advertising

Bryan A Liang, Timothy K Mackey

J Med Internet Res 2011 (Aug 31); 13(3):e64

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Background: Direct-to-consumer advertising (DTCA), linked to inappropriate medication use and higher health care expenditures, is the fastest growing form of pharmaceutical marketing. DTCA is legal only in the United States and New Zealand. However, the advent of online interactive social media “Web 2.0” technologies—that is, eDTCA 2.0—may circumvent DTCA legal proscriptions. Objective: The purpose of this study was to assess the prevalence of DTCA of leading...

Clinical Informatics

A Comparison of Physician Pre-Adoption and Adoption Views on Electronic Health Records in Canadian Medical Practices

Norm Archer, Mihail Cocosila

J Med Internet Res 2011 (Aug 12); 13(3):e57

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Background: There is a major campaign involving large expenditures of public money to increase the adoption rate of electronic health record (EHR) systems in Canada. To maximize the chances of success in this effort, physician views on EHRs must be addressed, since user perceptions are key to successful implementation of technology innovations. Objective: We propose a theoretical model comprising behavioral factors either favoring or against EHR adoption and use in Canadian medical...

Consumer & Patient Education and Shared-Decision Making

3D Visualization as a Communicative Aid in Pharmaceutical Advice-Giving over Distance

Martin Östlund, Nils Dahlbäck, Göran Ingemar Petersson

J Med Internet Res 2011 (Jul 18); 13(3):e50

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Background: Medication misuse results in considerable problems for both patient and society. It is a complex problem with many contributing factors, including timely access to product information. Objective: To investigate the value of 3-dimensional (3D) visualization paired with video conferencing as a tool for pharmaceutical advice over distance in terms of accessibility and ease of use for the advice seeker. Methods: We created a Web-based communication service called AssistancePlus that...

Cool but Counterproductive: Interactive, Web-Based Risk Communications Can Backfire

Brian J Zikmund-Fisher, Mark Dickson, Holly O Witteman

J Med Internet Res 2011 (Aug 25); 13(3):e60

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Background: Paper-based patient decision aids generally present risk information using numbers and/or static images. However, limited psychological research has suggested that when people interactively graph risk information, they process the statistics more actively, making the information more available for decision making. Such interactive tools could potentially be incorporated in a new generation of Web-based decision aids. Objective: The objective of our study was to investigate...

Managing the Personal Side of Health: How Patient Expertise Differs from the Expertise of Clinicians

Andrea Hartzler, Wanda Pratt

J Med Internet Res 2011 (Aug 16); 13(3):e62

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Background: When patients need health information to manage their personal health, they turn to both health professionals and other patients. Yet, we know little about how the information exchanged among patients (ie, patient expertise) contrasts with the information offered by health professionals (ie, clinician expertise). Understanding how patients’ experiential expertise contrasts with the medical expertise of health professionals is necessary to inform the design of peer-support...

Risk Estimates From an Online Risk Calculator Are More Believable and Recalled Better When Expressed as Integers

Holly O Witteman, Brian J Zikmund-Fisher, Erika A Waters, Teresa Gavaruzzi, Angela Fagerlin

J Med Internet Res 2011 (Sep 07); 13(3):e54

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Background: Online risk calculators offer different levels of precision in their risk estimates. People interpret numbers in varying ways depending on how they are presented, and we do not know how the number of decimal places displayed might influence perceptions of risk estimates. Objective: The objective of our study was to determine whether precision (ie, number of decimals) in risk estimates offered by an online risk calculator influences users’ ratings of (1) how believable the...

An Online Resource of Digital Stories About Cancer Genetics: Qualitative Study of Patient Preferences and Information Needs

Rachel Iredale, Lisa Mundy, Jennifer Hilgart

J Med Internet Res 2011 (Sep 30); 13(3):e78

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Background: The Cancer Genetics Service for Wales (CGSW) was established in 1998 as an all-Wales service for individuals with concerns about their family history of cancer. CGSW offers a range of services such as risk assessment, genetic counseling, and genetic testing. Individuals referred to cancer genetics services often have unmet information and support needs, and they value access to practical and experiential information from other patients and health professionals. As a result of the...

Personal Health Records and Patient Portals

Two Complementary Personal Medication Management Applications Developed on a Common Platform: Case Report

Stephen E Ross, Kevin B Johnson, Katie A Siek, Jeffry S Gordon, Danish U Khan, Leah M Haverhals

J Med Internet Res 2011 (Jul 12); 13(3):e45

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Background: Adverse drug events are a major safety issue in ambulatory care. Improving medication self-management could reduce these adverse events. Researchers have developed medication applications for tethered personal health records (PHRs), but little has been reported about medication applications for interoperable PHRs. Objective: Our objective was to develop two complementary personal health applications on a common PHR platform: one to assist children with complex health needs...

Cyberpharmacies

Quality of Online Pharmacies and Websites Selling Prescription Drugs: A Systematic Review

Grazia Orizio, Anna Merla, Peter J Schulz, Umberto Gelatti

J Med Internet Res 2011 (Sep 30); 13(3):e74

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Background: Online pharmacies are companies that sell pharmaceutical preparations, including prescription-only drugs, on the Internet. Very little is known about this phenomenon because many online pharmacies operate from remote countries, where legal bases and business practices are largely inaccessible to international research. Objective: The aim of the study was to perform an up-to-date and comprehensive review of the scientific literature focusing on the broader picture of online...

eHealth Literacy

Internet Use and eHealth Literacy of Low-Income Parents Whose Children Have Special Health Care Needs

Caprice Knapp, Vanessa Madden, Hua Wang, Phyllis Sloyer, Elizabeth Shenkman

J Med Internet Res 2011 (Sep 29); 13(3):e75

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Background: The Internet has revolutionized the way in which many Americans search for health care information. Unfortunately, being able to use the Internet for this purpose is predicated on having access to the Internet and being able to understand and comprehend online health information. This is especially important for parents of children with special health care needs who are forced to make many medical decisions throughout the lives of their children. Yet, no information is available...

Quality/Credibility of eHealth Information and Trust Issues

Perceived Threat and Corroboration: Key Factors That Improve a Predictive Model of Trust in Internet-based Health Information and Advice

Peter R Harris, Elizabeth Sillence, Pam Briggs

J Med Internet Res 2011 (Jul 27); 13(3):e51

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Background: How do people decide which sites to use when seeking health advice online? We can assume, from related work in e-commerce, that general design factors known to affect trust in the site are important, but in this paper we also address the impact of factors specific to the health domain. Objective: The current study aimed to (1) assess the factorial structure of a general measure of Web trust, (2) model how the resultant factors predicted trust in, and readiness to act on, the...

Research Instruments, Questionnaires, and Tools

Development and Validation of the Online Social Support for Smokers Scale

Amanda L. Graham, George D. Papandonatos, Hakmook Kang, Jose L. Moreno, David B. Abrams

J Med Internet Res 2011 (Sep 28); 13(3):e69

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Background: Social networks play an important role in smoking. Provision of social support during cessation is a cornerstone of treatment. Online social networks for cessation are ubiquitous and represent a promising modality for smokers to receive and provide the support necessary for cessation. There are no existing measures specific to online social support for smoking cessation. Objective: The objective was to develop a measure of social support to be used in online smoking cessation...