Latest Submissions Open for Peer Review

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JMIR Submissions under Open Peer Review

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Titles/Abstracts of Articles Currently Open for Review:

  • Effect of caffeine on attention and alertness measured in a home-setting, using web-based cognition tests

    Date Submitted: Sep 30, 2016
    Open Peer Review Period: Sep 30, 2016 - Nov 25, 2016

    Background: Background: There is an increasing interest among nutritional researchers to perform life style and nutritional intervention studies in a home setting instead of testing subjects in a clinical unit. The term used in other disciplines is ‘ecological validity’ stressing a realistic situation. This becomes more and more feasible since devices and self-tests that enable such studies are more commonly available. Here we present such a study, in which we reproduced the effect of caffeine on attention and alertness in an at-home setting. Objective: Objective: The study is aimed to reproduce the effect of caffeine on attention and alertness using a web-based study environment of subjects at home performing different online cognition tests. Methods: Study design: The study is designed as a randomized, placebo-controlled, double blind, cross-over study. Methods: Subjects were provided with coffee sachets (two with and two without caffeine). They were also provided with a written instruction of the test days. Healthy volunteers consumed a cup of coffee after an overnight fast. Coffee was prepared from a sachet containing either regular coffee or decaf coffee. Each intervention was repeated once. Before and one hour after coffee consumption subjects performed online cognitive performance tests at home which measured alertness and attention, established by three computerized tests provided by Quantified Mind. Each test was performed for five minutes. Results: The recruitment via internet was fast and efficient. Within two weeks about 100 subjects applied of whom 70 were eligible. Of these, 53 completed all four test sessions, indicating that they were able to perform the do it yourself tests at home correctly. The Go-NoGo cognition test performed at home showed the same significant improvement in performance with caffeine as found in controlled studies in a metabolic ward. Conclusions: The study showed that the effects of caffeine consumption on a cognition test in an at-home setting revealed similar results as in a controlled setting. The Go-NoGo test applied showed improved results after caffeine intake, similar as seen in clinical trials. This type of study thus is a fast, reliable, economical and easy way to demonstrate effectiveness of a supplement and is rapidly becoming a viable alternative for the classical RCT to evaluate life style and nutritional interventions. Clinical Trial: Registration of the study was done at ClinicalTrials.gov (NCT 02061982).

  • The Impact of Internet Health Information on the Physiotherapist-Patient Relationship: the Case of the Lebanese Community.

    Date Submitted: Sep 30, 2016
    Open Peer Review Period: Sep 30, 2016 - Nov 25, 2016

    Background: With the evolution of the internet and communication media, endless information are made available for all individuals, most of the time free of charge. The health care field seems to be of high interest for patients who surf the net for pathology definitions, symptoms, treatments and medications mostly before visiting a health practitioner. No matter the quantity of information found on the internet, the quality and credibility of this information is sometimes questionable, leading to undesirable health outcomes or resulting in inappropriate requests for clinical interventions. Few researches on physiotherapy were generally conducted and almost none in Lebanon and none targeted specifically the impact of internet use for medical information research. Objective: This research attempts to examine the effect of searching for health related information by patients over the internet on the physiotherapist-patient relationship, exploring particularly how the online medical information can affect the physiotherapist-patient relationship and the patients’ acceptance of the physiotherapist’s medical approach. Methods: This research adopts a positivist and deductive approach, based on similar studies conducted in the context of other health care specialties. A questionnaire-based survey was sent using communication media to a representative sample population and data was computerized and analyzed using SPSS program to be able to analyze the results and accept or reject H1 and H2. Results: According to the order of physiotherapist in Lebanon2, 1935 physiotherapists are currently registered at the order and working within the Lebanon territory. Our sample is 92 physiotherapists, chosen from those registered at the OPTL, distributed in Lebanon, using an acceptable error of 10% and a confidence level of 95%. Eighty six percent of the physiotherapists valued the recent increase of health information on the internet. Eighty percent found the time to discuss that information with their patients. Seventy three percent believed that the latter positively affects the physiotherapist-patient relationship and eighty one percent said that it positively engages patients in the treatment plan. For H1, 32% of the variation in the physiotherapist-patient relationship was caused by seeking health information on the internet, and in H2: 27.2% of the variation in the acceptance of the physiotherapist’s medical plan was caused by seeking health information on the internet. Conclusions: This study is the first of its kind in the physiotherapy field in general and in Lebanon specifically, aiming to explore the impact of the medical information research on the internet and how it affects the physiotherapist-patient relationship. This study can help raising PTs awareness on how to use appropriate skills to assist their patients in facing information overflow and achieving good health outcomes.

  • Internet-based cognitive behaviour therapy for stress, anxiety and depressive symptoms among perinatal women: A systematic review and meta-analysis

    Date Submitted: Sep 30, 2016
    Open Peer Review Period: Sep 30, 2016 - Nov 25, 2016

    Background: A growing number of meta-analyses have supported the application of Internet-based cognitive behaviour therapy (iCBT) for psychological disorders across different populations, but relatively few meta-analyses have concentrated on perinatal women. Objective: This meta-analysis evaluated the efficacy of iCBT in improving stress, anxiety and depressive symptoms among perinatal women. Methods: Ten electronic databases were used to search for published and unpublished trials. Cochrane Collaboration’s tool for assessing risk of bias was utilised to measure methodological quality. Meta-analysis was performed using RevMan software. Among the 789 studies identified, nine randomised controlled trials were selected, involving 1,626 participants across seven countries. Results: More than half (63%) of the selected studies had a low risk of bias with no to moderate heterogeneity. Results revealed that iCBT significantly improved stress (d = 0.70, n = 6), anxiety (d = 0.32, n = 7) and depressive symptoms (d = 0.63, n = 8,) of the intervention group compared to those of the control group at post-intervention. Significant subgroup differences according to different control conditions and supportive types were found on stress symptoms. Conclusions: This review revealed that iCBT significantly improve stress, anxiety, and depressive symptoms among perinatal women with small to medium effects. Future effectiveness studies should establish the essential components, format and approach of iCBT with optimal levels of human support to maximize a long-term effect.

  • Non-participation in Videoconferencing-based Treatment for Alcohol Use Disorder

    Date Submitted: Sep 30, 2016
    Open Peer Review Period: Sep 30, 2016 - Nov 25, 2016

    Background: We recently conducted an effectiveness study randomized controlled pilot trial concerning videoconferencing-based treatment for alcohol use disorder (AUD). In short, the aim was to test if optional videoconferencing increases adherence and effect in treatment for AUD. Due to a lower patient- and participation rate than anticipated arose the opportunity and need to examine why the patients declined to participate in the effectiveness study. Objective: To examine non-participants’ barriers against participating in an effectiveness study randomized controlled pilot trial and to examine differences between participants and non-participants. Objective: To examine non-participants’ barriers against participating in an effectiveness study randomized controlled pilot trial and to examine differences between participants and non-participants. Methods: The design of this study was mixed methods; an analysis of barriers against participating using an anonymous questionnaire filled out by non-participants, and a comparative analysis of participants and non-participants using data from a clinical database. Results: 43 non-participants filled out the questionnaire. Two categories were derived: scientific barriers, which were barriers against the scientific study in general, and technical barriers, which were barriers against using a laptop and/or videoconferencing in specific. 6 patients stated scientific barriers: of these, 6 patients declined to participate in a research project, and 1 patient also declined to participate in a randomization. 27 patients stated technical barriers: of these, 22 patients declined to use videoconferencing, 12 declined to learn how to use a laptop, and 13 declined to spend time learning it. Non-participants who had technical barriers to participating in the study were older, more often female and part of the work force than those who did not have technical barriers. 13 patients elaborated on technical barriers. 9 patients found it impersonal, preferred personal contact, and would rather attend face-to-face treatment at the clinic. There were no significant differences between participants and non-participants according to socio-demographics, alcohol measures, and composite scores. Conclusions: Patients’ barriers against participating in the effectiveness study were mainly concerned with the technology. They declined to participate because they refused to receive treatment via videoconferencing. Clinical Trial: The regional health research ethics committee system in Southern Denmark, S-20110052

  • Techniques for Improving Communication of Emotional Content in Text-only Online Therapeutic Communications – A Systematic Review

    Date Submitted: Sep 30, 2016
    Open Peer Review Period: Sep 30, 2016 - Nov 25, 2016

    Background: Online typed exchanges are increasingly used by professionals to provide emotional support to patients. Although some empirical evidence exists to suggest that various strategies may be used to convey emotion during online typed exchanges, there has been no critical review of these data. Objective: The objective of this review was to identify the techniques used to convey emotion in written or typed online communication and assess the empirical evidence regarding impact on communication and psychological outcomes. Methods: An electronic search of databases including Medline, CINAHL, PsycINFO, Embase and the Cochrane Library was conducted to identify literature published between 1990 and 2015. Searches were also conducted using Google Scholar, manual searching of reference lists of identified articles and manual searching of tables of contents for selected relevant journals. Data extraction and coding were completed by two reviewers. Publications were assessed against the eligibility criteria and excluded if they: were duplicates; were not published in English; were published before 1990; referenced animal/non-human subjects; did not describe original research; were not journal articles; or did not empirically test the effect of one or more non-verbal communication techniques (for instance smilies, emoticons, emotional bracketing, voice accentuation, trailers (ellipsis) and pseudowords) as part of online, web-based or typed communication on communication-related variables including: message interpretation, social presence, the nature of the interaction (e.g. therapeutic alliance), consumer perceptions of the interaction (e.g. participant satisfaction), or psychological outcomes including depression, anxiety and distress. Results: A total of 4617 unique publications were identified. Of these, four publications met the eligibility criteria and were included in a narrative synthesis. All four studies addressed the effect of smilies or emoticons on participant responses, message interpretation or social presence of the writer. It was found that smilies and emoticons were able to convey a limited amount of emotion. No studies addressed other techniques for conveying emotion in written communication. No studies addressed the effects of any techniques on the nature of the interaction (e.g. therapeutic alliance), consumer perceptions of the interaction (e.g. participant satisfaction) or psychological outcomes (depression, anxiety or distress). Conclusions: There is a need for greater empirical attention to the effects of the various proposed techniques for conveying emotion in online or typed communications in order to inform health service providers regarding best-practice online communication skills.

  • Telehealth interventions to support self-management of long-term conditions: a systematic meta-review of diabetes, heart failure, asthma, chronic obstructive pulmonary disease and cancer.

    Date Submitted: Sep 26, 2016
    Open Peer Review Period: Sep 26, 2016 - Nov 21, 2016

    Background: Self-management support is one mechanism by which telehealth interventions have been proposed to facilitate management of long-term conditions. This meta-review synthesises evidence for telehealth-supported self-management of diabetes (types 1 and 2), heart failure, asthma, chronic obstructive pulmonary disease (COPD) and cancer to identify components of effective self-management support. Objective: The objectives of this review were a) to assess the impact of telehealth interventions to support self-management on disease control and healthcare utilisation, and b) to identify components of telehealth support and their impact on disease control and the process of self-management. Methods: We performed a meta-review (a systematic review of systematic reviews) of randomised controlled trials (RCTs) of telehealth interventions to support self-management in six exemplar long-term conditions. Seven databases were searched from January 2000 to May 2016 and studies screened against eligibility criteria. Reviews were weighted by quality (R-AMSTAR), size and relevance). Results were combined in a narrative synthesis and using Harvest Plots. Results: Fifty-three systematic reviews, comprising 232 unique RCTs, were included. Reviews concerned diabetes (type 1 (n=6), type 2 (n=11), mixed (n=19)), heart failure (n=9), asthma (n=7), COPD (n=7) and cancer (n=3). Findings varied between and within disease areas. The highest weighted reviews showed blood glucose telemonitoring with feedback and some educational and lifestyle interventions improved glycaemic control in type-2, but not type-1, diabetes; telemonitoring and telephone interventions reduced mortality and hospital admissions in heart failure; but these findings were not consistent in all reviews. Results for the other conditions were mixed, although no reviews showed evidence of harm. Analysis of the mediating role of self-management, and of components of successful interventions, was limited and inconclusive. More intensive and multi-faceted interventions were associated with greater improvements in diabetes, heart failure and asthma. Conclusions: While not consistently superior to usual care, none of the reviews reported any negative effects, suggesting that telehealth represents a safe option for delivery for self-management support, particularly in conditions such as heart failure and type 2 diabetes where the evidence base is more developed. Larger scale trials of telehealth-supported self-management, based on explicit self-management theory, are needed before the extent to which telehealth technologies may be harnessed to support self-management can be established.

  • Student Evaluation of a Distance Learning Module Using The Sigu Questionnaire

    Date Submitted: Sep 26, 2016
    Open Peer Review Period: Sep 26, 2016 - Nov 21, 2016

    Background: Infectious diseases remain a public health concern in Brazil. To achieve success in this process and to implement surveillance and public policy action, it is necessary to have health professionals that are highly trained and updated with the latest skills. The Brazilian government, through the Open University of SUS (UNA-SUS), in partnership with public universities in several states, offers specialization courses, further training and extension courses with free access, in the distance learning (DE) modality. In order to assess the DE courses offered by the institution, UNA-SUS/UFMA created the SIGU questionnaire, a subsystem that facilitates the processing and interpretation of data that is collected when students assess course’s modules. Objective: This study aimed to analyze students’ perceptions regarding didactic and pedagogical aspects related to the content and activities, educational resources, and tutoring in the Communicable Disease module in two distance learning (DE) postgraduate courses at UNA-SUS/UFMA. Methods: The authors analyzed a sample of 319 students, enrolled in two Postgraduate in Family Health classes (class of 2013 and 2014), and two Postgraduate Classes in Primary Care (two classes of 2014), who had completed the Communicable Diseases module and responded to evaluation questions through the SIGU questionnaire, an auxiliary system for processing and interpreting assessments of distance education modules offered by UNA-SUS/UFMA. By way of a statistical analysis, evaluation variables were dichotomized into either a positive outcome (“great” and “good”) or a negative outcome (“bad” and “insufficient”). Data were analyzed using SPSS (Version 18); the significance level was set at 5% (P < .05). Results: After analyzing the data, the authors observed that 99% of the students evaluated the module positively. With regard to the evaluation of the content and activities developed in the module, 53% (169), 43.6% (139), and 3.4% (11) of students evaluated the item workload of the course educational units as great, good, and bad, respectively. The highest rated item was tutor performance, with a rating of “great” from 229 (71.8%) of the students. Conclusions: Overall, the results contributed to the improvement of DE courses offered by UNA-SUS/UFMA from the perspectives of controlling dropout rates and the development of public health services offered in Brazil.

  • Attachment style and Internet addiction

    Date Submitted: Sep 25, 2016
    Open Peer Review Period: Sep 25, 2016 - Nov 20, 2016

    Background: One of the clinically relevant problems of Internet use is the phenomenon of Internet addiction. Overall, the estimated prevalence of computer game and Internet addiction is between 3 and 5%. Considering the fact that there is ample evidence for the relationship between attachment style and substance abuse, it stands to reason that attachment theory can also make an important contribution to the understanding of the pathogenesis of Internet addiction. Accordingly, the aim of this study was to examine people’s tendency toward pathological Internet usage in relation to their attachment style. Method: An online survey was conducted. Sociodemographic data, attachment style (Bielefeld questionnaire partnership expectations), symptoms of Internet addiction (scale for online addiction for adults), used Internet services and online relationship motives (Cyper relationship motive Scale) were assessed. In order to confirm the findings, a study using the Rorschach test was also conducted. Results: In total N = 245 subjects were recruited. Participants with insecure attachment style showed a higher tendency to pathological Internet usage compared to securely-attached participants. An ambivalent attachment style was particularly associated with pathological Internet usage. Escapist and social-compensatory motives played an important role for insecurely attached subjects. However, there were no significant effects with respect to online services and applications used. Results of the analysis of the Rorschach protocol with N = 16 subjects corroborated these results. Users with pathological Internet use frequently showed signs of infantile relationship structures in the context of social groups. This refers to the results of the online survey, in which interpersonal relationships were the result of an insecure attachment style. Conclusions: In summary, pathological Internet use was a function of insecure attachment and limited interpersonal relationships.

  • Designing patient-centered text messaging interventions for increasing physical activity among participants with Type II Diabetes: Qualitative results from the Text to Move intervention

    Date Submitted: Sep 21, 2016
    Open Peer Review Period: Sep 22, 2016 - Nov 17, 2016

    Background: The Text to Move (TTM) study was a six-month 2-parallel group randomized controlled trial of individuals with type II diabetes (T2DM) to increase physical activity, measured by a pedometer. The intervention arm received twice daily text messages for 6 months that were tailored to the participant’s stage of behavior change as defined by the Transtheoretical Model of Behavior Change. Objective: The purpose of this follow-up study was to collect feedback from participants in the TTM program and explore their views on text messaging as a health promotion tool. Categorizing the perceived barriers and facilitators to the TTM program will help inform the design of future technology-based studies to maximize participant engagement. Methods: We assessed participants’ attitudes regarding their experience with text messaging, focusing on perceived barriers and facilitators, through two focus groups and telephone interviews. All interviews were audio-recorded, transcribed verbatim, coded and analyzed using a grounded theory approach. Results: The response rate was 67.4% (31/46 participants). The average age was 51 and 61% were male. The majority of individuals were English speakers and married, had completed at least 12th grade and approximately half of all participants were employed full-time. Overall, participants were satisfied with the TTM program and recalled the text messages as educational, informational, and motivational. Program involvement increased the sense of connection with their healthcare center. The wearing of pedometers and daily step count information served as motivational reminders and created a sense of accountability through the sentinel effect. However, there was frustration concerning the automation of the text message program, including the repetitiveness, predictability of text time delivery, and lack of customization and interactivity of text message content. Participants recommended personalization of texting content and frequency as well as more contact time with personnel for a stronger sense of support, including greater surveillance and feedback based on their own results and comparison to other participants. Conclusions: Participants in a theory-based text messaging intervention identified key facilitators and barriers to program efficacy that should be incorporated into future texting interventions to optimize participant satisfaction and outcomes. Clinical Trial: clinicaltrials.gov/ct2/show/NCT01569243

  • Does usage of an e-health intervention reduce the risk of excessive gestational weight gain?

    Date Submitted: Sep 13, 2016
    Open Peer Review Period: Sep 13, 2016 - Nov 8, 2016

    Background: Excessive gestational weight gain (GWG) contributes to the development of obesity in mother and child. Online interventions have the potential for delivering innovative, interactive excessive GWG prevention to large numbers of people. Objective: This study creates a novel measure of online intervention usage patterns and examines whether online intervention usage is associated with reduced risk of excessive GWG. Methods: The online intervention was theory based and emphasized the active ingredients of weight gain tracking and behavioral goal-setting and self-monitoring. One-thousand three hundred and thirty-five (898 intervention and 437 control) relatively diverse and healthy pregnant women were randomly assigned to the intervention arms or control arm. Usage patterns were examined for both intervention and control arm participants using Latent Class Analysis. A modified Poisson regression approach was used to estimate the relative risk of excessive total or weekly GWG for women with different usage patterns. Results: Five usage patterns best characterized the usage of the intervention arm participants. Three usage patterns best characterized control arm participants’ usage. Control arm usage patterns were not associated with excessive GWG, whereas intervention arm usage patterns were associated with excessive GWG. Conclusions: The control and intervention arm usage pattern characterization is a unique methodological contribution to process evaluations for self-directed, online interventions. Clinical Trial: NCT01331564, ClinicalTrials.gov, www.clinicaltrials.gov

  • The Sugarsquare study: a multicenter randomized controlled feasibility trial concerning a web-based patient portal for parents of a child with type 1 diabetes

    Date Submitted: Sep 10, 2016
    Open Peer Review Period: Sep 11, 2016 - Nov 6, 2016

    Background: Raising a child with type 1 diabetes (T1D) faces parents with the task of combining the demands of the disease-management with everyday parenting, which is associated with increased levels of distress. To support parents, a web-based patient portal Sugarsquare was developed, delivering online parent-professional communication, peer support and disease information. Objective: The first aim of this study was to assess the feasibility of conducting a multicenter, randomized controlled trial concerning Sugarsquare in a population of parents of a child with T1D. The second aim was to assess the feasibility of implementing Sugarsquare in clinical practice. Methods: Hundred and five parents of 105 children with T1D under the age of 13 participated in a 6-month multicenter randomized controlled feasibility trial and were randomly assigned to an experimental (usual care + Sugarsquare) or a control group (usual care). Attrition rates and user statistics were gathered throughout the study-period for feasibility of the trial and the implementation. To determine potential efficacy of Sugarsquare, parenting stress (PSI-SF) was assessed at baseline (T0) and after six months (T1). Results: Enrollment refusal rate (58%), baseline attrition rate (25%) and post-randomization attrition rate during follow-up (26%) were all average. User statistics in the experimental group showed high practicability, integration in all users, moderate acceptability and demand in parents and high acceptability and demand in healthcare professionals. Reporting higher levels of parenting stress at baseline was related to higher frequency of logging in by parents (ρ=.282, p=.030) on Sugarsquare and higher parents’ number of page views (ρ=.304, p=.019). No significant differences in change in parenting stress between experimental and control group were found (F=.49, p=.49). Conclusions: Conducting a trial concerning an Internet intervention in a population of parents of a child with T1D can be considered feasible. Implementing Sugarsquare in clinical practice was found to be partly feasible, given the moderate demand and acceptability in parent users and lack of potential efficacy. Parents who reported higher levels of parenting stress used Sugarsquare more often. Although usage did not lead to a decrease in parenting stress, results indicate that online provision of care is suitable for parents of a child with T1D, who are in need for additional support. Future research should clarify whether incorporating targeted interventions in Sugarsquare will lead to less psychosocial problems. Factors potentially contributing to successful implementation are suggested. Clinical Trial: The study described in this paper is registered under NTR3643 (Dutch Trial Register).

  • Remote monitoring of patients with heart failure: An overview of Systematic Reviews

    Date Submitted: Sep 8, 2016
    Open Peer Review Period: Sep 9, 2016 - Nov 4, 2016

    Background: Many systematic reviews exist on Remote Patient Monitoring (RPM) interventions to improve clinical outcomes and psychological wellbeing of patients with heart failure (HF). However, research is broadly distributed from simple telephone based to highly technology based interventions. The scope and focus of such evidence also vary widely, creating challenges for clinicians who seek information on the effect of RPM interventions. Objective: The aim of this article is to investigate the effects of RPM interventions on the health outcomes of HF patients by synthesising review-level evidence. Methods: We searched CINAHL, PubMed, EMBASE and the Cochrane Electronic Library from 2005 to 2015.We screened reviews based on relevance to RPM interventions using criteria developed for this overview. Using the standardised forms, we extracted information from systematic reviews. Independent authors screened, selected and assessed reviews for methodological quality. We used standardised language to summarise results across reviews and provide final statements about intervention effectiveness. Results: 19 systematic reviews met our inclusion criteria. Reviews consisted of RPM with diverse interventions such as tele-monitoring, home telehealth, mobile phone based monitoring and video conferencing. All cause and HF mortality were the most frequently-reported outcomes, but others such as quality of life, rehospitalisation, emergency visits and length of stay were also reported. Self-care and knowledge were less commonly identified. Conclusions: Tele-monitoring and home telehealth appear generally effective to improve HF rehospitalisation and to reduce mortality. Other interventions including the use of mobile phone and videoconferencing require further investigation.

  • Opportunities and Challenges of Behavior Change Support Systems for Enhancing Habit Formation: Qualitative Study

    Date Submitted: Sep 9, 2016
    Open Peer Review Period: Sep 9, 2016 - Nov 4, 2016

    Background: Calls for action to break down the global burden of obesity have arisen, where already 5% weight loss can reduce the significantly prevalence of metabolic syndrome. Studies of health Behavior Change Support Systems (hBCSS) have been made, where individuals use the system to influence their own attitude or behavior to achieve their personal goals. However hardly any research have been made to study how users perceive habit formation with the help of eHealth intervention, not to mention how to design information systems aimed to particularly enhance habit formation. Habits are considered to play a fundamental role in behavior change, and the formation of healthy habits may be the key to aid maintenance beyond the intervention period. Objective: The objective of this article is to study hBCSS users’ experiences regarding habit formation of system use and healthier lifestyle. In addition this study aims to compare elements of PSD model with stages of habit formation suggested by Lally and Gardner. Methods: This study employs a web based hBCSS named Onnikka, a lifestyle intervention designed for prevention of metabolic syndrome for participants who are at risk of developing a metabolic syndrome or already suffering from it. A total of 43 Onnikka users were interviewed for this study during and after a 52-week eHealth-intervention period. The system was designed according to the principles of the Persuasive System Design (PSD) model and Behavior Change Support System framework. The research approach here is hermeneutics, which leans ontologically to social construction of reality, gained through language, consciousness, and shared meaning. Lally and Gardner’s research on stages of habit formation is used as a lens to explain data. In addition, the system’s login data and subjects’ weight measurements were utilized to build an interpretation of the results. Results: Habit formation stages provide possible explanation for why self-monitoring, reminders and tunneling were perceived as valuable features in this research case. The findings of this study suggest that IT habits appear to have a strong linkage with use adherence, whereas lifestyle habits did not seem to resonate with the 5% weight loss among subjects. Conclusions: Complete lifestyle change is highly complex activity where behavior change in one area might not be sufficient for sustainable weight management. Holistic eHealth interventions are needed to support weight loss, and stages of habit formation provide valuable guidance for hBCSS design. PSD model can offer practical design tools for developing a eHealth intervention system development that enhances also habit formation.

  • Filtering entities to optimize ADR identification from social media: how can the number of words between entities in the messages help?

    Date Submitted: Sep 1, 2016
    Open Peer Review Period: Sep 1, 2016 - Oct 27, 2016

    Background: With the increasing popularity of web 2.0 applications, social media has made it possible for individuals to post messages on adverse drug reactions. In such online conversations, patients discuss their symptoms, medical history, and diseases. These disorders may correspond to adverse drug reactions (ADRs) or any other medical condition. Therefore, methods must be developed to distinguish between false positives and true ADR declarations. Objective: We investigated a method for filtering out disorder terms that did not correspond to adverse events by using the distance between the drug term and the disorder/symptom term in the post. Methods: We analyzed a corpus of 648 messages corresponding to a total of 1 654 (drug, disorder) pairs from five French forums using Gaussian mixture models and an expectation-maximization (EM) algorithm. Results: The distribution of the distances between the drug term and the disorder term enabled the filtering of 50 % of the disorders that were not ADRs. Conclusions: This study suggests that such distance between terms can be used for identifying false positives, thereby improving ADR detection in social media.

  • Online Physician Rating Sites in Germany: Developments in the Frequency of Ratings and Evaluation Tendencies Compared with 2010 Baseline

    Date Submitted: Sep 1, 2016
    Open Peer Review Period: Sep 1, 2016 - Oct 27, 2016

    Background: At the beginning of 2010, the frequency of ratings and evaluation tendency on six German-language physician rating sites (PRSs) were investigated. This forms the basis for the present re-examination of PRSs, five years later. Objective: To examine the frequency of ratings and evaluation tendency of selected German-language PRSs and to compare these data with 2010 results. Methods: A total of 298 randomly selected physicians from the physician associations in Hamburg and Thuringia were searched for in 7 German-language PRSs regarding the quantity and quality of ratings. Results: Overall, between 64% and 95% of the physicians from the random sample could be identified on the selected PRSs. The average rating remains very positive and has improved even further towards “very good” since 2010. The average number of ratings per physician ranged from 1.2 to 8.9 across PRSs. While this represented an increase (range in 2010 was from 1.1 and 3.9), this increase reflects one more rating per physician per year. Conclusions: Further research is needed to identify barriers for patients to rate their physicians, to assist efforts to increase the number of ratings on PRSs, and therefore, improve the fairness and practical importance of PRSs. Clinical Trial: N/A

  • Developing a curriculum for ICT use in global health research and training: A qualitative study among Chinese health science graduate students

    Date Submitted: Aug 31, 2016
    Open Peer Review Period: Aug 31, 2016 - Oct 26, 2016

    Background: Rapid development of Information and communication technology (ICT) during the last decade have transformed biomedical and population based research and have become an essential part of many types of research and educational programs. However, access to these ICT resources and the capacity to use them in global health research are often lacking in low and middle income country (LMIC) institutions. Objective: This study assesses the needs, barriers, and opportunities for developing an ICT training curriculum for use by researchers in China to build their capacity in using ICT for global health research and training. Methods: Nine Focus groups discussions (FGDs) were conducted during December 2015- March 2016, involving 74 graduate students studying in areas of health sciences from six medical universities in southern China. All FGDs were audio recorded and analyzed thematically. Results: Researchers had different views and arguments about the use of ICT which are summarized under five themes: 1) ICT use in routine research, 2) ICT related training and training experience; 3) 3) understanding about the pros and cons of online training, 4) suggestions about the design of ICT training curriculum, and 5) potential challenges to promoting ICT courses and related marketing strategies for ICT training curriculum. Many graduate students used ICT on a daily basis in their research, to stay up-to-date on current development in their area of research or study or practice. The participants were very willing to participate in ICT courses that were relevant to their academic majors and would count credits. They found the affordability and flexibility of on line training very important, and said it would also save them time. Suggestion for an ICT curriculum included: i) both organized training course or short lecture series, depending on the background and specialty of the students; ii) a mixture of lecture and on-line activities, and iii) inclusion of topics that are career focused. Conclusions: The findings of the current study suggest that a need exists for a specialized curriculum related to ICT use in health research for health sciences graduate students in China. The results have important implications for the design and implementation of ICT-related educational program in China or other developing countries.

  • Preventing depression in adults with subthreshold depression: health-economic evaluation alongside a pragmatic randomised controlled trial of a web-based intervention

    Date Submitted: Aug 31, 2016
    Open Peer Review Period: Aug 31, 2016 - Oct 26, 2016

    Background: Psychological interventions for the prevention of depression might be a cost-effective way to reduce the burden associated with depressive disorders. Objective: To evaluate the cost-effectiveness of a web-based guided self-help intervention to prevent major depressive disorder (MDD) in people with subthreshold depression. Methods: A pragmatic randomised controlled trial was conducted with follow-up at 12 months. Participants were recruited from the general population via a large statutory health insurance company and an open access website. Participants were randomised to a web-based guided self-help intervention (i.e. cognitive-behavioural therapy and problem-solving therapy assisted by supervised graduate students or health care professionals) in addition to usual care or to usual care supplemented with web-based psycho-education (enhanced usual care). Depression-free years (DFYs) were assessed by blinded diagnostic raters using the telephone-administered Structured Clinical Interview for DSM-IV Axis Disorders at 6- and 12-month follow-up, covering the period to the previous assessment. Costs were self-assessed through a questionnaire. Costs measured from a societal and health care perspective were related to DFYs and quality-adjusted life years (QALYs). Results: In total, 406 participants were enrolled in the trial. The mean treatment duration was 5.84 (SD 4.37) weeks. On average, participants completed 4.93 of 6 sessions. Significantly more DFYs were gained in the intervention group (0∙82 vs 0∙70). Likewise, QALY health gains were in favour of the intervention, but only statistically significant when measured with the more sensitive SF-6D. The incremental per-participant costs were €136 (£116). Taking the health care perspective and assuming a willingness-to-pay of €20,000 (£17,000), the intervention’s likelihood of being cost-effective was 99% for gaining a DFY, 64% or 99% for gaining an EQ-5D or a SF-6D QALY. Conclusions: Our study supports guidelines recommending web-based treatment for subthreshold depression and adds that this may not only restore health in people with subthreshold depression, but in addition reduces the risk of developing a MDD. Offering the intervention has an acceptable likelihood of being more cost-effective than enhanced usual care and could therefore reach community members on a wider scale. Clinical Trial: German Clinical Trials Register DRKS00004709, http://www.drks.de/DRKS00004709 (Archived at: http://www.webcitation.org/6kAZVUxy9)

  • Seeking Web-Based Information about Attention Deficit Hyperactive Disorder (ADHD): Where, What and When

    Date Submitted: Aug 30, 2016
    Open Peer Review Period: Aug 30, 2016 - Oct 25, 2016

    Background: Attention Deficit Hyperactive Disorder (ADHD) is a common neuro-developmental disorder, prevalent among 3-10% of the population. Objective: The objective of the current study was to describe where, what and when people search the web for topics related to ADHD. Methods: Data was collected from Microsoft’s Bing search engine and from the community question and answer site, Yahoo Answers. The questions were analyzed based on keywords and using further statistical methods. Results: Our results revealed that the internet indeed constitutes a source of information for people searching the topic of ADHD, and that they search for information mostly about ADHD symptoms. Furthermore, individuals personally affected by the disorder made 2.0 more questions about ADHD compared to others. Questions begin when children reach 2 years of age, with an average age of 5.1 years. Most of the websites searched were not specifically related to ADHD and the timing of searches as well as the query content were different among those pre-diagnosis compared to post-diagnosis. Conclusions: The study results shed light on the features of ADHD-related searches. Thus, they may help improve the web as a source of information, and promote improved awareness and knowledge of ADHD as well as quality of life for populations dealing with the complex phenomena of ADHD.

  • Lessons from recruitment to an internet based survey for Degenerative Cervical Myelopathy: merits of free and fee based methods

    Date Submitted: Aug 28, 2016
    Open Peer Review Period: Aug 30, 2016 - Oct 25, 2016

    Background: Degenerative Cervical Myelopathy [DCM] is a syndrome of subacute cervical spinal cord compression due to spinal degeneration. Although DCM is common, patient pathways are underdeveloped and a unified treatment approach is lacking. Moreover, fundamental questions, such as the natural history of DCM remain to be answered. The internet has become an attractive tool for medical research, including internet health surveys, with its unrivalled, efficient reach. The most effective recruitment strategy is unknown. Objective: To compare the efficacy of fee based advertisement with alternative free recruitment strategies to a DCM internet health survey. Methods: An internet health survey (Survey Monkey ®), accessed by a new DCM internet platform (myelopathy.org) was created. Using multiple survey collectors and the website Google Analytics ®, the efficacy of fee based recruitment strategies (Google Adwords ®) and free alternatives (including Facebook ®, Twitter ® and Myelopathy.org) were compared. Results: Overall, 772 surveys (513, 66% fully complete) were completed, 305 (40%) from fee based strategies and 455 (59%) from free alternatives. Accounting for researcher time, fee based strategies were more expensive ($7.8/response vs $3.8/response) and identified a less motivated audience (Click-Through-Rate 5% vs 57%) but were more time efficient for the researcher (2mins/response vs 16mins/response). Facebook ® was the most effective free strategy, providing 239 (31%) responses; a single message to 4 existing communities yielded 133 (17%) responses within 7 days. Conclusions: The internet can efficiently reach large numbers of patients. Free and fee based recruitment strategies both have merits. Facebook communities are a rich resource for internet researchers. Clinical Trial: N/A

  • Internet Use, eHealth Literacy and Attitudes Toward Computer/Internet Among People with Schizophrenia-Spectrum Disorders: A Cross-Sectional Study in Two Distant European Regions

    Date Submitted: Aug 26, 2016
    Open Peer Review Period: Aug 30, 2016 - Oct 25, 2016

    Background: Individuals with schizophrenia-spectrum disorders use the Internet for general and health-related purposes, such as searching for health information. However, their ability to find, understand, and apply the health information they acquire online in order to make appropriate health decisions – known as eHealth literacy – has never been investigated. The European agenda strives to limit health inequalities and enhance mental health literacy. Nevertheless, each European member state varies in levels of Internet use and online health information-seeking. Various studies have described Internet use of adults with mental illness; however, few have focused on their eHealth literacy and on their attitudes toward computer/Internet. Objective: To examine computer/Internet use for general and health-related purposes, eHealth literacy, and attitudes toward computer/Internet among adults with schizophrenia-spectrum disorders from two distant European regions. Methods: Data were collected from mental health services of psychiatric clinics in Finland (FI) and Greece (GR). A total of 229 patients (FI=128, GR=101) participated in the questionnaire survey. The data analysis included evaluation of frequencies and group comparisons with multiple linear and logistic regression models. Results: The majority of Finnish participants were current Internet users (FI=111, 87%, vs. GR=33, 33%, P<0.0001), while the majority of Greek participants had never used computers/Internet (GR=60, 59%, vs. FI=14, 11%, P<0.0001), mostly due to their perception that they do not need it. In both countries, more than half of Internet users used the Internet for health-related purposes (FI=61, 55%, vs. GR=20, 61%). The eHealth literacy of Internet users (previous and current Internet users) was found significantly higher in the Finnish group (FI: Mean=27.05, SD 5.36; GR: Mean=23.15, SD=7.23, P<0.0001) upon comparison with their Greek counterparts. Attitudes toward Computer/Internet of never Internet users was found to be higher in the Greek group (GR: Efficacy Mean=3.06, SD=.86, P=.58; Interest Mean=3.16, SD=.50) when compared to the Finnish group (FI: Efficacy Mean=2.93, SD=.81; Interest Mean=2.60, SD=.67, P<0.0001). For current Internet users, Internet use patterns were significantly different between country groups regarding: location and frequency of Internet access, ease of locating website, and reasons for Internet use. When adjusting for gender, age, education and disease duration, country was a significant predictor of frequency of Internet use, eHealth literacy and Interest (ATC/IQ component). The Finnish group of Internet users scored higher in eHealth literacy, while the Greek group of never Internet users had a higher Interest in computer/Internet. Conclusions: eHealth literacy is either moderate (Finnish group) or low (Greek group). Thus, exposure to ICT and eHealth skills training are needed for this population. Recommendations to improve the eHealth literacy and access to health information among these individuals are provided.

  • MONItoring and TELetransmission of medical data in Heart Failure. Rationale and design of the MONITEL-HF project

    Date Submitted: Aug 26, 2016
    Open Peer Review Period: Aug 28, 2016 - Oct 23, 2016

    Background: Frequent hospitalisation of patients with heart failure (HF) is a key clinical problem worldwide. Remote patient monitoring (RPM) has emerged as promising tool for early identification of pending decompensation and prevention of further deterioration. The use of data from implanted ICD/CRT-D may be useful, but differences in RPM systems provided by different manufacturers impede standardized data analysis. Large proportion of patients with HF do not have indication for implantation; in such individuals RPM needs a non-invasive approach. The advent of miniaturized sensors enabling registration of numerous physiological parameters along with new teletransmission techniques open new era in multiparametric monitoring and intervention aimed at preservation of stability instead of treatment of established pathology. Objective: Our project run by Consortium MONITEL-HF consisting of 8 institutions has 3 objectives: - To design and develop biosensor device enabling non-invasive, individually customizable monitoring of patients with different HF phenotypes (EXTRABIOTEL-HF study), - To create an integrated information platform which will enable RPM either using any kind of implanted ICD/CRT-D, or by dint of individually customised non-invasive, biosensor network, provided to patients without implanted ICD/CRT-D, - To investigate whether teletransmission, telemonitoring and appropriate management of data collected from ICD/CRT-D of different manufacturers will reduce the number of hospitalisations, improve the quality of life and reduce treatment costs (RESULT study). Methods: The project contains three components, two developmental and one clinical. The first component is the development of information platform. This telematic infrastructure will give the technical base for recording, collection and standardized analysis of data from all kinds of implanted ICD/CRT-D, as well as from non-invasive device. This non-invasive device will be designed in second developmental component of the project. This study will start with survey of the market for miniaturised biosensors and its components suitable for integration with textile. The measurements of various biological signals provided by sensors will be tested against gold standard. In the next step, reproducibility of measurements in healthy persons and in HF population will be carried out. Finally, we will test the reliability of sensor`s network to transmit signals into the information platform. The clinical component of the project is the prospective, randomised, open-label study of 600 HF participants to show whether RPM from ICD/CRT-D delivered by different companies, recorded and analysed in a standardized fashion using information platform will reduce hospitalisations, improve quality of life and diminish costs of therapy in this population. Results: We expect that design and creation of proper information infrastructure for both invasive and non-invasive RPM and provision of proof to lower cost, will give rise to inclusion of procedures of RPM into the catalogue of treatment methods reimbursed by the State. This is in our opinion necessary step towards better and more economically efficient treatment of patients with HF in Poland. Conclusions: The project MONITEL-HF will give as a technological toll indispensable to initiate and expand RPM of heart failure in Poland. Clinical Trial: ClinicalTrials.gov - NCT02409225

  • An Online Group-based Self-tracking Program to Increase Fruit and Vegetable Consumption: The Effects of Demographic Similarity, Social Modeling and Performance Discrepancy

    Date Submitted: Aug 23, 2016
    Open Peer Review Period: Aug 24, 2016 - Oct 19, 2016

    Background: Self-tracking allows people to reflect on their health behaviors and make improvements accordingly to achieve a health goal. Web-based interventions with a self-tracking component have been found to be effective in promoting adults’ fruit and vegetable consumptions (FVC). However, these interventions primarily focus on individual- rather than group-based self-tracking. The rise of social media technologies enables sharing and comparing self-tracking records in a group context. Therefore, we develop an online group-based self-tracking program to promote FVC in early young adults, who are at an important stage of developing food patterns that will affect their future. Objective: This study aims to examine (1) the effectiveness of online group-based self-tracking on FVC, and (2) composition characteristics of online self-tracking groups that make the group more effective in promoting FVC in early young adults. Methods: During a 4-week web-based experiment, 113 college students self-tracked their FVC either individually (i.e., the control group) or in an online group characterized by a 2 (demographic similarity: demographically similar vs. demographically diverse) × 2 (social modeling: incremental-change vs. ideal-change) experimental design. Each online group consisted of one focal participant and three confederates as group members whose demographics and FVC were manipulated to create the four treatment groups. Self-reported FVC were assessed using the food frequency questionnaire at baseline and after the 4-week experiment, and were recorded using participants’ self-tracking messages during the 4-week experiment. Results: Participants who self-tracked their FVC collectively with other group members consumed more FV than participants who self-tracked their FVC individually, P = .02, η2 = .08, controlling for demographics, BMI, baseline FVC and meal plan enrollment. The results did not show significant main effects of demographic similarity (P = .47) or types of social modeling (P = .54) in making self-tracking groups more effective in promoting FVC. However, additional analyses revealed the main effect of performance discrepancy (i.e., difference in FVC between a focal participant and his/her group members during the 4-week experiment), such that participants who had a low performance discrepancy from other group members consumed greater FVC than participants who had a high performance discrepancy from other group members, P = .003, η2 = .16. A mediation test showed that low performance discrepancy led to greater downward contrast (b = -0.78, CI = [-2.44, -0.15]), which in turn, led to greater FVC. Conclusions: Online self-tracking groups with models consistently increasing their FVC were more effective than self-tracking alone in promoting FVC for early young adults. Low performance discrepancy from models would lead to downward contrast, which in turn, increased participants’ FVC over time. The study highlighted social comparison processes in online groups that allow for sharing personal health information.

  • Redirecting behavioural cues using technology: Is there a role for the use of social media in conjunction with activity trackers?

    Date Submitted: Aug 18, 2016
    Open Peer Review Period: Aug 23, 2016 - Oct 18, 2016

    Recent work by Cole-Lewis and colleagues explored the use of health promotion tools within social media to better understand complex network analyses. However, there is a lack of evidence on the use of social media and activity trackers in conjunction to augment health behaviours. This is a novel strategy and we propose its use in combating the growing obesity epidemic.

  • A smarter pathway for delivering cue exposure therapy? The design and development of a smartphone application targeting alcohol use disorder.

    Date Submitted: Aug 19, 2016
    Open Peer Review Period: Aug 19, 2016 - Oct 14, 2016

    Background: While the number of alcohol-related treatments in app stores is proliferating, none of them are based on a psychological framework and supported by empirical evidence. Cue exposure treatment (CET) with urge-specific coping skills (USCS) is often used in Danish treatment settings. It is an evidence-based psychological approach that focuses on promoting `confrontation with alcohol cues’ as a means of reducing urges and the likelihood of relapse. Objective: This paper describes the design and development of a CET-based smartphone application; an innovative delivery pathway for treating alcohol use disorder (AUD). Methods: The treatment is based on Monty and co-workers’ manual for CET with USCS (2002). It was created by a multidisciplinary team of psychiatrists, psychologists, engineers and graphic designers as well as patients with AUD. A database was developed for the purpose of registering and monitoring training activities. A final version of the CET app and database was developed after several user tests. Results: The final version of the CET app includes: an introduction, 4 sessions featuring USCS, 8 alcohol exposure videos promoting the use of one of the USCS, and a results component providing an overview of training activities and potential progress. Real-time urges are measured before, during and after exposure to alcohol cues and are registered in the app together with other training activity variables. Data packages are continuously sent in encrypted form to an external database, and will be merged with other data (in an internal database) in the future. Conclusions: The CET smartphone app is currently being tested in a large-scale, randomized controlled trial with the aim of clarifying whether it can be classified as an evidence-based treatment solution. The app has the potential to augment the reach of psychological treatment for AUD. Clinical Trial: ClinicalTrials.gov ID: NCT02298751 Registration date: 6 November 2014

  • Comparison of ecological momentary assessment versus direct measurement of e-cigarette use with a Bluetooth-enabled e-cigarette: a pilot study

    Date Submitted: Aug 15, 2016
    Open Peer Review Period: Aug 16, 2016 - Oct 11, 2016

    Background: Background: Assessing the frequency and intensity of e-cigarette use presents special challenges beyond those posed by cigarette use. Accurate measurement of puff counts, the duration of an e-cigarette puff, and the stability of these measures is the basis for estimating the behavioral and health effects of e-cigarette use. Objective: Objective: The purpose of this pilot study was to: 1) examine the feasibility of capturing e-cigarette puff behavior via ecological momentary assessment (EMA) by comparing daily EMA self-reported e-cigarette puff counts to objective puff data from a Bluetooth-enabled e-cigarette device; and, 2) to examine the feasibility and acceptability of using a second-generation e-cigarette among adult smokers. A secondary objective was to demonstrate the utility of e-cigarette EMA data for understanding the e-cigarette trial period, including examining the interaction between e-cigarette and cigarette consumption. Methods: Methods: Five adult smokers were enrolled in a 3-week longitudinal parent study assessing how e-cigarette use affects cigarette use among e-cigarette naïve smokers. Using a text message-based EMA system, participants reported cigarette smoking for one week, followed by cigarette smoking and e-cigarette puffs for two weeks. Participants were also given a Bluetooth-enabled e-cigarette (“Smokio”) that passively collected puff counts and puff duration. Comparisons between mean reports of Smokio (device report) and EMA (self-report) use were evaluated using paired t-tests. Correlation and agreement between device- and self-reports were evaluated using Pearson correlation and the concordance correlation coefficient (CCC), respectively. Results: Results: Five African American participants, 4 men and 1 woman, with a mean age of 38.8 years (SD=13.8) completed the study, resulting in 5,180 observations (device report) of e-cigarette use. At baseline, participants reported smoking for an average of 14.4 years (SD=8.5) and consumed a mean of 9 cigarettes per day (CPD; SD=3.5); 4 smoked within 30 minutes of waking. At the 30-day follow-up, CPD decreased to 1.8 (SD=2.3), 4 participants reported past 7-day e-cigarette use, and 1 participant reported no cigarette smoking in the past 7 days. Over 2 weeks of e-cigarette use, participants took an average of 1,074 e-cigarette puffs (SD=779.0) per person as captured by the device reports. Each participant took a mean of 75.0 puffs (SD=58.8) per day, with each puff lasting an average of 3.6 seconds (SD=2.4). Device reports captured an average of 33.3 more puffs per person per day (SD=47.8) than the self-reported e-cigarette puffs. In 87% of days, participants underestimated the number of puffs they had taken on the Smokio. There was significant moderate correlation (r = 0.47, p=0.0001) but poor agreement (pc=0.31, 95% CI: 0.15, 0.46) between the device- and self-reported data. Conclusions: Conclusions: EMA is a feasible method for collecting e-cigarette puff data; however, a Bluetooth-enabled device captured significantly more e-cigarette use and allowed for examination of puff duration in addition to puff counts.

  • What drives young Vietnamese to use M-health innovations? An insight into the patterns of smartphone usage and user preferences of mobile applications

    Date Submitted: Aug 12, 2016
    Open Peer Review Period: Aug 12, 2016 - Oct 7, 2016

    Background: Low and Middle - income countries, such as Vietnam, are becoming more connected to the Internet. In addition, aside to the increased penetration and proliferation of Internet services, there has also been an eight times increment in the absolute number of mobile subscriptions in this period. There has been prior research looking at the attitudes of the general population towards smartphone and smartphone applications, as well as how smartphone have helped in terms of self-management of medical disorders Objective: With the increased penetration of Internet and smartphone devices in countries like Vietnam, it is the aim and objective of this current research article to look into the patterns of usage of smartphone applications as well as the preferences with regards to the functionalities of smartphone based applications. Methods: In order to achieve the study objectives, an online cross-sectional study was conducted from August 2015 to October 2015 in Vietnam. The Vietnam Authority of HIV/AIDS Control provided the ethical approval for the current research project. Response-driven sampling technique (RDS) was utilized in the recruitment of participants. The online questionnaire was programmed and implemented using Google Form. The web-based questionnaire that was conceptualized included the following parts: a) Baseline demographics; b) Smartphone usage pattern; c) Attitudes towards existing Smartphone applications and d) Preferences for a smartphone application. Chi-squared, t-test and ANOVA were used to explore the differences of satisfaction among characteristics. A p-value of less than 0.05 was set as the level of statistical significance. Results: A cumulative total of 380 individuals completed the web-based questionnaires, out of which 35.0% (n=133) were males. The vast majority of the participants were between the age groups of 18 to 22 years old, amounting to 77.6% of the entire sample. The vast majority of the participants (54.2%) rated themselves as being intermediate in terms of their proficiency with regards to their knowledge of utilization of a smartphone device. A similar percentage of the participants preferred to download applications for disease prevention (11.1%), as compared to applications for beauty counseling, nutrition counseling and disease treatment, with65.8% of the participants perceiving these applications to be very useful and 52.7% of the participants reported that they were very satisfied with the existing mobile health applications that were available. The vast majority of the participants would prefer applications that they could download and run directly from their smartphone. With regards to the contents of the applications, they would prefer there to be a balance between visuals as well as text-based information and participants also indicated that it is crucial for smartphone applications to have sharing functionalities, for them to share information onto their own personal social networks. Conclusions: An understanding of the attitudes and user preferences with regards to smartphone applications is essential in the conceptualization and development of appropriate smartphone interventions targeting youths and young adults.

  • Opening the black box of eHealth: Collecting, analysing, and interpreting log data

    Date Submitted: Aug 5, 2016
    Open Peer Review Period: Aug 6, 2016 - Oct 1, 2016

    Background: In most eHealth research, limited insights have been obtained regarding why a particular outcome occurred or how the use of a technology has contributed to the users’ ability to have a healthier life, improved wellbeing, or activate new attitudes in their daily tasks. As a result, eHealth is often perceived as a black box. One promising approach to explain why a statistical hypothesis was accepted or not and to identify the unexpected effects of a technology is the analysis of log data. Such analyses of anonymous records of real-time actions performed by each user can provide continuous and objective insights into the actual usage of the technology, and hence open the black box of eHealth. However, until now the possibilities of log data in eHealth research has not been exploited to its fullest extent. Objective: This article describes how log data can be of added value in eHealth research and how to fully exploit its possibilities. This paper serves as a starting point for using log data analysis in eHealth research. Outline: First, an overview of research questions to answer with log data is provided. Secondly, methods for data collection and data preparation are explained, as well as the requirements for the data. In the third part, some methods for data analysis are described. Finally, a conclusion is drawn regarding the importance of the results for both scientific and practical applications. Conclusion: The analysis of log data can be of great value for opening the black box of eHealth. A deliberate log data analysis can give new insights into the usage of the technology and help to improve the persuasiveness and effectiveness of the eHealth technology.