Infodemiology can be defined as the science of distribution and determinants of information in an electronic medium, specifically the Internet, or in a population, with the ultimate aim to inform public health and public policy. Infodemiology data can be collected and analyzed in near real time. Examples for infodemiology applications include: the analysis of queries from Internet search engines to predict disease outbreaks (eg. influenza); monitoring peoples' status updates on microblogs...

Background: To our knowledge, no studies have evaluated whether weight loss can be promoted in overweight adults through the use of an intervention that is largely based on daily SMS (Short Message Service: text) and MMS (Multimedia Message Service: small picture) messages transmitted via mobile phones. Objective: This paper describes the development and evaluation of a text message-based intervention designed to help individuals lose or maintain weight over 4 months. Methods: The study was...

Background: The use of the Internet to administer questionnaires has many potential advantages over the use of pen-and-paper administration. Yet it is important to validate Internet administration, as most questionnaires were initially developed and validated for pen-and-paper delivery. While some have been validated for use over the Internet, these questionnaires have predominately been used amongst the healthy general population. To date, information is lacking on the validity of...

Background: eHealth tools on the Internet have the potential to help people manage their health and health care. However, little is known about the distribution and use of different kinds of eHealth tools across the population or within population subgroups. Objective: The purpose of this study was to examine the prevalence and predictors of participation in specific online health-related activities. Methods: A secondary data analysis of the National Cancer Institute’s Health Information...

Background: There have been no previous studies of the variables that predict adherence to online depression and anxiety intervention programs among adolescents. However, research of traditionally delivered intervention programs for a variety of health conditions in adolescence suggests that health knowledge, type and level of symptomatology, race, socioeconomic status, treatment setting, and support may predict adherence. Objective: The aim was to compare adherence rates and identify the...

Background: Inpatient discharge instructions are a mandatory requirement of the Centers for Medicare and Medicaid Services and Joint Commission on Accreditation of Healthcare Organizations. The instructions include all the information relevant to post-discharge patient care. Prior studies show that patients often cannot fully understand or remember all the instructions. To address this issue, we have previously conducted a pilot study in which pictographs were created through a participatory...

Background: Health messages may have the highest impact if they are given early in life. Therefore, the Dutch Ministry of Health identified pregnant women as a target population and initiated an innovative eHealth program to serve as a communication channel of health messages to pregnant women. Objective: The aim was to study the feasibility of implementing this eHealth program into standard midwifery care and to investigate use and user perceptions of the online program among pregnant...

Background: Electronic data capture (EDC) tools provide automated support for data collection, reporting, query resolution, randomization, and validation, among other features, for clinical trials. There is a trend toward greater adoption of EDC tools in clinical trials, but there is also uncertainty about how many trials are actually using this technology in practice. A systematic review of EDC adoption surveys conducted up to 2007 concluded that only 20% of trials are using EDC systems,...

Background: Internet-based interventions to assist in diabetes management have the potential to provide patients with the information and support they need to become effective self-managers. Objective: To assess the feasibility, acceptability, and effectiveness of an Internet-based virtual clinic designed to facilitate self-management in patients who used insulin pumps to manage their diabetes. Methods: For a period of 6 months, 17 patients joined the virtual clinic. The system allowed...

A number of errors regarding the cited references occurred in the article by Amanda Graham et al. (J Med Internet Res 2008;10(5):e50). The corrected version was republished on the JMIR website on 14.01.2009 at http://www.jmir.org/2008/5/e50 and resubmitted to PubMed Central; however, we have no control over other websites and aggregators which may mirror content from JMIR and may not update the original version. The corrected version can be identified by citing 60 references, while the...

Background: The Internet, created and maintained in part by third-party apomediation, has become a dynamic resource for living with a chronic disease. Modern management of type 1 diabetes requires continuous support and problem-based learning, but few pediatric clinics offer Web 2.0 resources to patients as part of routine diabetes care. Objectives: To explore pediatric practitioners’ attitudes towards the introduction of a local Web portal for providing young type 1 diabetes patients...

Background: Consumer-centered health information systems that address problems related to fragmented health records and disengaged and disempowered patients are needed, as are information systems that support public health monitoring and research. Personally controlled health records (PCHRs) represent one response to these needs. PCHRs are a special class of personal health records (PHRs) distinguished by the extent to which users control record access and contents. Recently launched PCHR...

Background: Depression is associated with immense suffering and costs, and many patients receive inadequate care, often because of the limited availability of treatment. Web-based treatments may play an increasingly important role in closing this gap between demand and supply. We developed the integrative, Web-based program Deprexis, which covers therapeutic approaches such as behavioral activation, cognitive restructuring, mindfulness/acceptance exercises, and social skills training....

Background: Recent evidence indicates increased access to and use of Internet and non-healthcare-related email by older patients. Because email adoption could potentially reduce some of the disparities faced by this age group, there is a need to understand factors determining older patients’ enthusiasm to use email to communicate with their physicians. Electronic mail (email) represents a means of communication that, coupled with face-to-face communication, could enhance quality of...

Background: Adult women living in rural areas have high rates of obesity. Although rural populations have been deemed hard to reach, Internet-based programming is becoming a viable strategy as rural Internet access increases. However, when people are able to get online, they may not find information designed for them and their needs, especially harder to reach populations. This results in a “content gap” for many users. Objective: User-centered design is a methodology that can...

Background: Diabetes-related disparities are well documented among racial minority groups in the United States. Online programs hold great potential for reducing these disparities. However, little is known about how people of different races utilize and communicate in such groups. This type of research is necessary to ensure that online programs respond to the needs of diverse populations. Objective: This exploratory study investigated message frequency and content on bulletin boards by...

Background: Concurrent with their enrollment in Web-based Randomized Controlled Trials (RCTs), participants can easily choose to use treatment programs that are not assigned in the study. The prevalence of using non-assigned treatments is largely unknown although it is likely to be related to the extent to which non-assigned treatments are: (a) easy to find and use, (b) low in cost, (c) well publicized, and (d) available from trusted sources. The impact of using other programs—both...

Background: Open access websites which deliver cognitive and behavioral interventions for anxiety and depression are characterised by poor adherence. We need to understand more about adherence in order to maximize the impact of Internet-based interventions on the disease burden associated with common mental disorders. Objective: The aims of this paper are to review briefly the adherence literature with respect to Internet interventions and to investigate the rates of dropout and compliance...

Background: Increasingly, governments, health care agencies, companies, and private groups have chosen Second Life as part of their Web 2.0 communication strategies. Second Life offers unique design features for disseminating health information, training health professionals, and enabling patient education for both academic and commercial health behavior research. Objectives: This study aimed to survey and categorize the range of health-related activities on Second Life; to examine the...

Background: Website evaluation is a key issue for researchers, organizations, and others responsible for designing, maintaining, endorsing, approving, and/or assessing the use and impact of interventions designed to influence health and health services. Traditionally, these evaluations have included elements such as content credibility, interface usability, and overall design aesthetics. With the emergence of collaborative, adaptive, and interactive ("Web 2.0") technologies such as...

Background: Health behavior interventions using periodic prompts have utilized technology, such as the Internet, that allows messages to be sent to participants in cost-effective ways. To our knowledge, no comprehensive evidence review has been performed specifically to evaluate the effectiveness of communicating regular messages and to examine how characteristics of the prompts change the effectiveness of programs aimed at reminding people to adopt healthy behaviors, maintain those they...

: Health care and health care services are increasingly being delivered over the Internet. There is a strong argument that interventions delivered online should also be evaluated online to maximize the trial’s external validity. Conducting a trial online can help reduce research costs and improve some aspects of internal validity. To date, there are relatively few trials of health interventions that have been conducted entirely online. In this paper we describe the major methodological...

Background: Both healthy and sick people increasingly use electronic media to obtain medical information and advice. For example, Internet users may send requests to Web-based expert forums, or so-called “ask the doctor” services. Objective: To automatically classify lay requests to an Internet medical expert forum using a combination of different text-mining strategies. Methods: We first manually classified a sample of 988 requests directed to a involuntary childlessness forum on...

Background: The quality of physician-patient communication is a critical factor influencing treatment outcomes and patient satisfaction with care. To date, there is little research to document the effect of telemedicine (TM) on physician-patient communication. Objective: The objectives of this study are to measure and describe verbal and nonverbal communication during clinical TM consultations and to compare TM with in-person (IP) consultations in terms of the quality of physician-patient...

Background: Internet peer support groups for depression are becoming popular and could be affected by an increasing number of social network services (SNSs). However, little is known about participant characteristics, social relationships in SNSs, and the reasons for usage. In addition, the effects of SNS participation on people with depression are rather unknown. Objective: The aim was to explore the potential benefits and harms of an SNS for depression based on a concurrent triangulation...

Background: The advent of Internet-based self-help systems for common mental disorders has generated a need for quick ways to triage would-be users to systems appropriate for their disorders. This need can be met by using brief online screening questionnaires, which can also be quickly used to screen patients prior to consultation with a GP. Objective: To test and enhance the validity of the Web Screening Questionnaire (WSQ) to screen for: depressive disorder, alcohol abuse/dependence, GAD,...

Background: Internet and computer use are increasingly common leisure-time sedentary behaviors, which have the potential to impact negatively on health outcomes. However, little is known about the extent to which adults’ Internet and computer use is associated with weight status and time spent in leisure-time physical activity. Objective: The objective is to examine associations of leisure-time Internet and computer use with overweight and obesity, leisure-time physical activity, and...

Background: Effective interventions are needed to reduce the chronic disease epidemic. The Internet has the potential to provide large populations with individual advice at relatively low cost. Objective: The focus of the study was the Web-based tailored physical activity intervention Active-online. The main research questions were (1) How effective is Active-online, compared to a nontailored website, in increasing self-reported and objectively measured physical activity levels in the general...

Background: Inactive people are often not aware of the fact that they are insufficiently active. Providing insight into their actual physical activity (PA) levels may raise awareness and could, in combination with tailored PA advice, stimulate a physically active lifestyle. Objective: This study evaluated the feasibility and effectiveness of a 3-month intervention in which Dutch office workers were provided with a personal activity monitor (PAM) coupled to simple and concise Web-based...

Background: In November 2006, an email-based health promotion program for pregnant women was implemented nationally in the Netherlands. The program consisted of emails containing quizzes with pregnancy-related questions tailored to the number of weeks of pregnancy. Emails were sent out once every 4 weeks, up to a maximum of nine emails. Objectives: The aims of the study were (1) to assess the recruitment of participants and their representativeness of the Dutch population and (2) to study...

Background: Internet-based cancer risk assessment tools have the potential to inform the public about cancer risk and promote risk-reducing behaviors. However, poorly communicated information on these websites may result in unintended adverse health outcomes. Objective: This study examined whether: (1) Internet-based cancer risk assessment tools use risk communication formats that facilitate comprehension and reduce bias (as identified by the empirical literature); (2) the use of these...

Background: Selecting the right mix of stationary and mobile computing devices is a significant challenge for system planners and implementers. There is very limited research evidence upon which to base such decisions. Objective: We aimed to investigate the relationships between clinician role, clinical task, and selection of a computer hardware device in hospital wards. Methods: Twenty-seven nurses and eight doctors were observed for a total of 80 hours as they used a range of computing...

Background: In many countries, there has been substantial progress in establishing the electronic transmission of patients’ health information between health care providers, but little is known about how best to engage patients in the process. Objective: We explored patients’ views about sharing of electronic health information and their preferences for learning about and participating in this process. Methods: Patients in one Massachusetts community in the northeastern United...

Background: The ability to generate registries of patients with particular clinical attributes, such as diagnoses or medications taken, is central to measuring and improving the quality of health care. However, it is not known how many providers have the ability to generate such registries. Objectives: To assess the proportion of physician practices that can construct registries of patients with specific diagnoses, laboratory results, or medications, and to determine the relationship...

Background: Retrospectively collected data about the development and maintenance of behaviors that impact health are a valuable source of information. Establishing the reliability of retrospective measures is a necessary step in determining the utility of that methodology and in studying behaviors in the context of risk and protective factors. Objective: The goal of this study was to examine the reliability of self-report of a specific health-affecting behavior, tobacco use, and its...

Background: Telemonitoring of patients with chronic heart failure (CHF) is an emerging concept to detect early warning signs of impending acute decompensation in order to prevent hospitalization. Objective: The goal of the MOBIle TELemonitoring in Heart Failure Patients Study (MOBITEL) was to evaluate the impact of home-based telemonitoring using Internet and mobile phone technology on the outcome of heart failure patients after an episode of acute decompensation. Methods: Patients were...

Background: Internet sites typically contain visual design elements that are unrelated to the quality of the health information presented but that could influence credibility judgments and responses to health advice. To assess the effects of such design elements, or credibility cues, experimentally, we exposed women with different levels of weekly alcohol consumption to a website containing high quality but unpalatable information about a related health risk (breast cancer). The information...

Background: Web-based behavioral programs efficiently disseminate health information to a broad population, and online tailoring may increase their effectiveness. While the number of Internet-based behavioral interventions has grown in the last several years, additional information is needed to understand the characteristics of subjects who enroll in these interventions, relative to those subjects who are invited to enroll. Objective: The aim of the study was to compare the characteristics...

Background: Survivorship care plans have been recommended by the Institute of Medicine for all cancer survivors. We implemented an Internet-based tool for creation of individualized survivorship care plans. To our knowledge, this is the first tool of this type to be designed and made publicly accessible. Objective: To investigate patterns of use and satisfaction with an Internet-based tool for creation of survivorship care plans. Methods: OncoLife, an Internet-based...

Background: Internet support groups (ISGs) enable individuals with specific health problems to readily communicate online. Peer support has been postulated to improve mental health, including depression, through the provision of social support. Given the growing role of ISGs for both users with depression and those with a physical disorder, there is a need to evaluate the evidence concerning the efficacy of ISGs in reducing depressive symptoms. Objective: The objective was to systematically...

Background: Internet support groups (ISGs) are a popular means by which consumers with depression communicate online. A number of studies have evaluated the nature and impact of depression-specific ISGs. However, to date there have been no published systematic reviews of this evidence. Objective: The aim was to systematically identify and summarize the available evidence concerning the scope and findings of studies of depression ISGs. Methods: Three databases (PubMed, PsycINFO, Cochrane)...

Background: There is a need to identify interventions that increase help seeking for depression among young adults. Objective: The aim was to evaluate a brief depression information intervention employing health e-cards (personalized emails containing links to health information presented on a Web page). Methods: A randomized controlled trial was carried out with 348 19- to 24-year-olds drawn from the community. Participants were randomized to receive one of three conditions, all of which...

Background: Producing “traditional” e-learning can be time consuming, and in a topic such as eHealth, it may have a short shelf-life. Students sometimes report feeling isolated and lacking in motivation. Synchronous methods can play an important part in any blended approach to learning. Objective: The aim was to develop, deliver, and evaluate an international postgraduate module in eHealth using live interactive webcasting. Methods: We developed a hybrid solution for live...

Background: Rising health insurance premiums represent a rapidly increasing burden on employer-sponsors of health insurance and their employees. Some employers have become proactive in managing health care costs by providing tools to encourage employees to directly manage their health and prevent disease. One example of such a tool is DASH for Health, an Internet-based nutrition and exercise behavior modification program. This program was offered as a free, opt-in benefit to US-based...

Background: Electronic personal health records (PHRs) are increasingly recognized and used as a tool to address various challenges stemming from scattered and incompatible personal health information (PHI) in the contemporary U.S. healthcare system. Although activities on PHR development and deployment have increased in recent years, little has been reported regarding the use and utility of PHRs among low-income and/or elderly populations. Objective: To assess the use and utility of PHRs in a...

Background: Older people are among the segments of the population for which the digital divide is most persistent and are considered to be at risk of losing out on the potential benefits that the information society can provide to their quality of life. Little attention has been paid, however, to relationships between Internet use and actual indicators of health among older people. Objective: The aim of this study was to examine the association between Internet use and self-rated health...

Background: Older adults’ health maintenance may be enhanced by having access to online health information. However, usability issues may prevent older adults from easily accessing such information. Prior research has shown that aging is associated with a unique pattern of cognitive changes, and knowledge of these changes may be used in the design of health websites for older adults. Objective: The goal of the current study was to examine whether older adults use of a health information...

Background: The rapid growth of eHealth could have the unintended effect of deepening health disparities between population subgroups. Most concerns to date have focused on population differences in access to technology, but differences may also exist in the appropriateness of online health content for diverse populations. Objective: This paper reports findings from the first descriptive study of online cancer survivor stories by race and ethnicity of the survivor. Methods: Using the five...

Background: Challenges remain in translating the well-established evidence for management of cardiovascular disease (CVD) risk into clinical practice. Although electronic clinical decision support (CDS) systems are known to improve practitioner performance, their development in Australian primary health care settings is limited. Objective: Study aims were to (1) develop a valid CDS tool that assists Australian general practitioners (GPs) in global CVD risk management, and (2) preliminarily...

Background: Given the rapid changes in the communication landscape brought about by participative Internet use and social media, it is important to develop a better understanding of these technologies and their impact on health communication. The first step in this effort is to identify the characteristics of current social media users. Up-to-date reporting of current social media use will help monitor the growth of social media and inform health promotion/communication efforts aiming to...

Background: The Internet is increasingly utilized by researchers, health care providers, and the public to seek medical information. The Internet also provides a powerful tool for public health messaging. Understanding the needs of the intended audience and how they use websites is critical for website developers to provide better services to the intended users. Objective: The aim of the study was to examine the utilization of the chronic fatigue syndrome (CFS) website at the Centers for...

Background: Computer-mediated educational applications can provide a self-paced, interactive environment to deliver educational content to individuals about their health condition. These programs have been used to deliver health-related information about a variety of topics, including breast cancer screening, asthma management, and injury prevention. We have designed the Patient Education and Motivation Tool (PEMT), an interactive computer-based educational program based on behavioral,...