Latest Submissions Open for Peer Review

JMIR has been a leader in applying openness, participation, collaboration and other "2.0" ideas to scholarly publishing, and since December 2009 offers open peer review articles, allowing JMIR users to sign themselves up as peer reviewers for specific articles currently considered by the Journal (in addition to author- and editor-selected reviewers).

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JMIR Submissions under Open Peer Review

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Titles/Abstracts of Articles Currently Open for Review:

  • 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.

  • Developing a Veterans’ Health Information Technology Systems Matrix Using Participatory Methods

    Date Submitted: Aug 24, 2016
    Open Peer Review Period: Aug 24, 2016 - Sep 2, 2016

    Background: The Department of Veterans Affairs (VA) has developed various health information technology (HIT) resources to provide accessible veteran-centered health care. Currently, the VA is undergoing a major re-organization of VA HIT to develop a fully integrated system to meet consumer needs. While extensive system documentation exists for various VA HIT systems, a more centralized and integrated view across systems, with clear documentation, is needed in order to support effective analysis, strategy, planning, and use. Such a tool would enable a novel view of what is currently available and support identifying and effectively capturing the consumer’s vision for the future. Objective: The objective of this article is to present the VA HIT systems matrix (HITSM); a novel tool designed to describe the existing VA HIT system and identify consumers’ vision for the future of an integrated VA HIT system. Methods: This study utilized an expert panel and veteran focus groups with self-administered surveys. The study employed participatory research methods to define the current system and understand how stakeholders and veterans envision the future of VA HIT and interface design (e.g. look, feel, and function). Results: The HITSM was developed with input from 47 Veterans, an informal caregiver, and an expert panel to provide a descriptive inventory of existing and emerging VA HIT. There are four worksheets that present data, titled: (1) Access and Function; (2) Benefits and Barriers; (3) System Preferences; and (4) Tasks. Within each worksheet there is a two-axis inventory. The VA’s existing and emerging HIT platforms (e.g. My HealtheVet, Mobile Health, VetLink Kiosks, Telehealth); My HealtheVet features (e.g. Blue Button, Secure Messaging, Appointment Reminders, Prescription Refill, Vet Library, Spotlight, Vitals Tracker); and non-VA platforms (e.g. Phone/Smartphone, Texting, non-VA Mobile Applications, non-VA Mobile Electronic Devices, non-VA Websites) are organized by row. Columns are titled with thematic and functional domains (e.g. access, function, benefits, barriers, authentication, delegation, user tasks). Cells for each sheet include descriptions and details that reflect factors relevant to domains and the topic of each worksheet. Conclusions: The current work provides documentation of the current VA HIT system and efforts for consumers’ vision of an integrated system redesign. The HITSM provides a consumer preference blueprint to inform the current VA HIT system and the vision for future development.

  • 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.

  • Supervised machine learning algorithms can classify open-text feedback of doctor performance with human-level accuracy

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

    Background: Machine learning techniques may be an efficient and effective way to classify open text reports on doctor’s activity for the purposes of quality assurance, safety, and continuing professional development. Objective: To evaluate the accuracy of machine learning algorithms trained to classify open-text reports of doctor performance and to assess the potential for classifications to signal differences in doctors’ professional performance in the UK. Methods: We used 1636 open-text comments (34,283 words) relating to the performance of 548 doctors collected from a survey of clinician’s colleagues using the GMC Colleague Questionnaire. We coded comments into five global themes (innovation, interpersonal skills, popularity, professionalism, and respect) using a qualitative framework. We trained machine learning algorithms to classify doctors and assessed their performance using several training samples. We evaluated doctor performance using the GMC Colleague Questionnaire (GMC-CQ) and compared scores between doctors with different classifications using t-tests. Results: Individual algorithm performance was high (range F=0.80 to 0.85). Inter-rater agreement between the algorithms and the human coder was highest for codes relating to ‘popular’ (recall =.97), ‘innovator’ (recall =.98), and ‘respected’ (recall =.87) codes and was lower for the ‘interpersonal’ (recall =.80) and ‘professional’ (recall =.82) codes. Four-fold cross-validation demonstrated similar performance in each analysis. When combined into an ensemble of multiple algorithms, mean human-computer inter-rater agreement was .87. Doctors who were classified as ‘respected’, ‘professional’, and ‘interpersonal’ had higher scores on the GMC Colleague Questionnaire compared to doctors who were not classified (P<.05). Scores did not vary between doctors who were rated as popular or innovative and those who were not rated at all (P>.05). Conclusions: Machine learning algorithms can classify open-text feedback of doctor performance into multiple themes derived by human raters with high performance. Colleague open-text comments that signal respect, professionalism, and being interpersonal may be key indicators of doctor’s performance.

  • 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

  • Disease monitoring and health campaign evaluation using Internet search activities for HIV/AIDS, stroke, colorectal cancer and marijuana use in Canada: A Retrospective Observational Study

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

    Background: Infodemiology can offer practical and feasible health research applications through the practice of studying information available on the Internet. Google Trends provides publically accessible information regarding search behaviours in a population, which may be studied and used for health campaign evaluation and disease monitoring. Additional studies examining the use and effectiveness of Google Trends for these purposes remain warranted. Objective: The study explored the use of infodemiology in the context of health campaign evaluation and chronic disease monitoring. It was hypothesized that following a launch of the campaign, there would be an increase in information seeking behaviour on the Internet. Secondly, increasing and decreasing disease patterns in a population would be associated with the Internet search activity trends. This study examined four different diseases: HIV, stroke, colorectal cancer and marijuana use. Methods: Using Google Trends, relative search volume data were collected throughout the period of February 2004 to January 2015. Campaign information and disease statistics were obtained from governmental publications. Search activity trends were graphed and assessed with disease trends and the campaign interval. Pearson product correlation statistics and joinpoint methodology analyses were used to determine significance. Results: Disease patterns and online activity across all four diseases were significantly correlated: HIV (r=0.36, p<0.001), stroke (r=0.40, p<0.001), colorectal cancer (r= -0.41, p<0.001) and substance use (r=0.64, p<0.001). Visual inspection and the joinpoint analysis showed significant correlations for the campaigns on colorectal cancer and substance use in stimulating online search activity. No significant correlations were observed for the campaigns on stroke and HIV regarding Internet search activity. Conclusions: The use of infoveillance shows promises as an alternative and inexpensive solution to disease surveillance and health campaign evaluation. Further research is needed to understand Google Trends as a valid and reliable tool for health research.

  • 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.

  • A web-based patient portal for mental health care: Benefits evaluation

    Date Submitted: Aug 11, 2016
    Open Peer Review Period: Aug 11, 2016 - Oct 6, 2016

    Background: Treatment for mental illness has shifted from a pure symptom focus to one of personal recovery, which is facilitated by patient activation. Patient portals have shown promise to increase activation in primary and acute care settings, but the benefits to tertiary level mental health care remain unknown. Objective: To conduct a benefits evaluation of a web-based portal for patients undergoing treatment for serious or persistent mental illness in order to examine the effects on: 1) patient activation; 2) recovery; 3) productivity; and 4) administrative efficiencies. Methods: All registered inpatients and outpatients at a tertiary level mental health care facility were offered the opportunity to enroll and utilize the patient portal. Those who chose to use the portal or not were designated as “users” and “non-users”, respectively. All patients received usual treatment. Users had web-based access to view parts of their electronic medical record, view upcoming appointments and communicate with their health care provider. Users could attend portal training/support sessions led by either the Engagement Coordinator or Peer Support Specialists. A subset of patients who created and utilized their portal account completed two web-based surveys at baseline (just after enrollment) and at follow-up (6 and 10 months). The total score of the Mental Health Recovery Measure (MHRM©) was a proxy for patient activation and the individual domains measured recovery. The System Use Survey (SUS) examined use of functions and general feedback about the portal. Organizational efficiencies were evaluated by examining the odds of portal users and non-users missing appointments (productivity) or requesting information from health information management (administrative efficiencies) in the year before (2014) and the year after (2015) portal implementation. Results: 461 patients (44% male) registered for the portal, which was used 4761 times over the one-year follow-up period. The majority of uses (95%) were for e-views. The overall MHRM© score increased from 70.4 (SD, 23.6) at baseline to 81.7 (SD, 25.1) at combined follow-up (P=0.01). Seven of eight recovery domains were increased at follow-up (all P <0.05). The odds of a portal user attending an appointment was 67% (CI, 56% to 79%) greater than non-users over the follow-up period. Compared to 2014, over 2015, there was an 86% and 57% decrease in requests for information in users and non-users, respectively. The SUS revealed that users felt increased autonomy, found the portal to be user-friendly, helpful and efficient, but felt that more information should be accessible. Conclusions: The benefits evaluation showed that access to personal health records via patient portal increased patient activation and recovery scores and improved organizational efficiencies in a tertiary level mental health care facility.

  • Correlating Health Insurance Plans' Ratings to Their Providers' Attributes

    Date Submitted: Aug 10, 2016
    Open Peer Review Period: Aug 10, 2016 - Oct 5, 2016

    Background: There is a push towards quality measures in healthcare. Towards that, the National Committee for Quality Assurance (NCQA) has been publishing insurance plan quality measures. Objective: The focus of this paper is to study the relationship between insurance plan quality measures and the participating providers (doctors). Methods: We collected and analyzed provider and insurance plan data from several online sources, including provider directories, provider referrals and awards, patient reviewing sites and hospital rankings. The relationships between the provider attributes and the insurance plan quality measures were studied. Results: Our analysis yielded several findings: (1) there is a moderate Pearson correlation (0.376) between consumer satisfaction insurance plan score and the review ratings of the member providers; (2) referral frequency and provider awards are negligibly correlated to consumer satisfaction plan score (correlations of 0.031 and 0.183, respectively); (3) there is weak positive correlation (0.266) between the cost charged for the same procedures and the consumer satisfaction plan score; (4) there is no significant correlation between member specialists’ review ratings and specialty-specific insurance plan treatment score for most specialties, except a surprising weak negative correlation for diabetes treatment (-0.259). Conclusions: Our findings may be employed by consumers to make informed choices about their insurance plans or by insurances to understand the relationship between patients’ satisfaction and their network of providers.

  • A Culturally Tailored Physical Activity Promotion Program for Chinese and Korean American Midlife Women: Practical Issues

    Date Submitted: Aug 9, 2016
    Open Peer Review Period: Aug 9, 2016 - Oct 4, 2016

    With advances in computer technologies, Web-based interventions are widely accepted and welcomed by health care providers and researchers. Although the benefits of Web-based interventions on physical activity promotion have been documented, the programs have rarely targeted Asian Americans including Asian American midlife women. Subsequently, the necessity of culturally competent Web-based physical activity programs for Asian Americans has been claimed. The purpose of this paper is to explore practical issues in developing and implementing a culturally competent Web-based physical activity promotion program for two groups of Asian American midlife women—Chinese American and Korean American midlife women—and to propose future directions for culturally competent Web-based physical activity promotionprograms for Asian Americans. While conducting the study, the research team members wroteindividual memos on issues and their inferences on plausible reasons for the issues. The team had group discussions each week, and kept the minutes of the discussions. Then, the memos and minutes were analyzed using a content analysis method. The results indicated practical issues in four major idea categories, which included: (a) bilingual translators’ language proficiency in both languages; (b) cultural sensitivity required; (c) low responses, interests, and retention; and (d) issues in implementation logistics. Based on the issues, we made several suggestions for the use of bilingual translators, motivational strategies, and implementation logistics.

  • Framework to guide the collection and use of patient-reported outcomes in the learning healthcare system

    Date Submitted: Aug 8, 2016
    Open Peer Review Period: Aug 8, 2016 - Oct 3, 2016

    Background: Web-based collection of patient-reported outcomes is expanding rapidly as electronic health records include web portals for patients to report standardized assessments of their symptoms. Objective: As the value of patient reported outcomes (PROs) to the delivery of patient care expands, we need to define a framework to guide the implementation planning, collection, and use of PROs to serve multiple goals and stakeholders. Methods: To define this framework, we identified diverse clinical, quality, and research settings where PROs have been successfully integrated into care and routinely collected and analyzed drivers of successful implementation. Unifying themes emerged from successful examples in behavioral health, primary care, oncology, orthopedics, pediatric gastroenterology, and neurology. Key informant interviews, followed by webinars and an in-person workshop allowed broad stakeholder review and refinement of the PRO implementation model. Stakeholders identified four differing PRO uses including to support individual patient care decisions, quality improvement initiatives, payer mandates, and population health and research. Results: This paper describes the implementation framework and steps that are consistently identified across best practices of PRO capture and use. Of note, while web-based informatics tools are necessary for PRO use, successful implementation requires integration into clinic operations and careful planning for user analytic needs. Implementation modifications are required at each step to serve the four stakeholder groups and their primary goals. Conclusions: The proposed framework will guide future PRO implementation efforts across learning healthcare systems to assure that complete PROs are captured at the correct time, and with associated risk factors, to generate meaningful information to serve diverse stakeholders.

  • 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.

  • A standardised, validated measure of mobile application quality: The User Version of the Mobile Application Rating Scale (uMARS).

    Date Submitted: Jul 27, 2016
    Open Peer Review Period: Jul 29, 2016 - Sep 23, 2016

    Background: Letter to the Editor

  • Bridging the health data divide

    Date Submitted: Jul 28, 2016
    Open Peer Review Period: Jul 28, 2016 - Sep 22, 2016

    Fundamental quality, safety, and cost problems have not been resolved by the increasing digitization of healthcare. This digitization has progressed alongside the presence of a persistent divide between clinicians, the domain experts, and the technical experts, such as data scientists. The disconnect between clinicians and data scientists translates into a waste of research and healthcare resources, slow uptake of innovations, and poorer outcomes than desirable and achievable. The divide can be narrowed by creating a culture of collaboration between these two disciplines, exemplified by events such as datathons. However, in order to more fully and meaningfully bridge the divide, the infrastructure of medical education, publication and funding processes must evolve to support and enhance a learning healthcare system.

  • Can Gaming Increase Antibiotic Awareness in Children? A Mixed Methods Approach

    Date Submitted: Jul 28, 2016
    Open Peer Review Period: Jul 28, 2016 - Sep 22, 2016

    Background: e-Bug is a pan-European educational resource for junior and senior school children that contains activities covering prudent antibiotic use and the spread, treatment, and prevention of infection. Teaching resources for children aged 7-15 years are complemented by a student website that hosts games and interactive activities for the children to continue their learning at home. Objective: The aim of this study was to appraise young people’s opinions of three antibiotic games on the e-Bug student website by exploring children’s views and suggestions for improvements, and analysing change in awareness about the learning outcomes. The three games selected for evaluation all contained elements and learning outcomes relating to antibiotics, the correct use of antibiotics, and bacteria and viruses. Methods: A mixed methodological approach was undertaken. 153 pupils aged 9-11 in primary schools and summer schools in the Bristol and Gloucestershire area completed a questionnaire with antibiotic and microbe awareness questions, before and after playing three e-Bug games for a total of 15 minutes each. The after questionnaire also contained open-ended and Likert scale questions. In addition, six focus groups with 48 students and think-aloud sessions with four students who had all played the games were performed. Results: The questionnaire data showed a significant increase in awareness for 2 out of 7 questions, while all questions showed a small level of increase. The two areas of significant knowledge improvement focused around the use of antibiotics for bacterial versus viral infections, and ensuring the course of antibiotics is completed. Qualitative data showed that the e-Bug game 'Body Busters' was the most popular game, closely followed by ‘Doctor Doctor’, with 'Microbe Mania' being the least popular. Conclusions: The conclusions of this study show that two of the e-Bug antibiotic educational games are valuable. The ‘Body Busters’ game effectively increased antibiotic awareness in children and had the greatest flow and enjoyment for children. The ‘Doctor Doctor’ game also resulted in increased knowledge, but was less enjoyable. The ‘Microbe Mania’ game had neither flow nor knowledge gain and therefore needs much modification and review. These games, especially the ‘Body Busters’ and ‘Doctor Doctor’ games should be promoted to schools and families. The results from the qualitative part of this study will be very important to inform future modifications and improvements to the e-Bug games.

  • The Internet as a Source of Health Information – the Results of a Polish Survey Study

    Date Submitted: Jul 28, 2016
    Open Peer Review Period: Jul 28, 2016 - Sep 22, 2016

    Background: The popularisation of Internet access has made it one of the basic sources of information (in this article, the term “Internet” is understood as different kinds of: websites, blogs, social networking sites, such as: Facebook, Twitter, etc.; text messages, including: email, skype, other instant messengers; discussion forums). This relates also to health and its correlates. Objective: The main objective of the study was to evaluate the scale of the phenomenon of using the Internet to look for health information in Poland. The aim of the study was also to evaluate the influence of information about health published in the network on the behaviour of internet users. Methods: A questionnaire-based survey (face-to-face interview) was carried out among a representative group of 1000 inhabitants of Poland aged 15 years and older. Results: Among the 1000 respondents surveyed in this study, 670 (67%) declared using the Internet, more than half of which (53.7%) reported seeking, among others, health information. The most commonly sought information included: diet and healthy eating (33.3%), a particular medication or dietary supplement (its effect, dosage, side effects) (28.9%), reviews of doctors (26.7%), and how other people coped with similar health problems (25.3%). More than 53% of Internet health information seekers were driven by curiosity, 46.4% by the ease and speed of finding information, 32.5% by the opportunity of finding a lot of independent reviews in one place, and 29.7% by no extra costs. Conclusions: The importance of the Internet as a source of information about health is constantly increasing. Our study presents that in Poland, women, younger, well-educated, living in big cities, especially often look for health information on the web. However most people have limited trust in the data derived from that source. The influence of information about health published in the network on people's behaviour could be less than is commonly believed.

  • The development and user evaluation of Foodbook24; a web-based 24 hour recall dietary assessment tool.

    Date Submitted: Jul 26, 2016
    Open Peer Review Period: Jul 27, 2016 - Sep 21, 2016

    Background: The application of technology in the area of dietary assessment has resulted in the development of an array of tools which are often specifically designed for a particular country/region. Objective: The aim of this study is to describe the development and user evaluation of a web-based dietary assessment tool Foodbook24 which was developed to provide a user-friendly and cost effective approach to nutrition surveillance in Ireland. Methods: The development of Foodbook24 was informed by various stakeholder engagement activities, ESFA guidelines issued on the collection of dietary information and an extensive literature review. To assess the user acceptability of the tool, participants involved in both a comparison and validation study using Foodbook24 against a distinct reference method were asked to complete a 16 item, online evaluation questionnaire. Results: The final design of Foodbook24 resulted in a web based dietary assessment tool with several different components such as demographic and consent questionnaires, a 24 hour recall component and a Food Frequency Questionnaire. All components of the tool are independent of each other and can be activated or deactivated depending on study design. Completeness of collection mechanisms and portion size photographs were incorporated into the 24 hour dietary recall component of the tool to enhance the usability of the tool. A total of 118 adult participants evaluated the acceptability of Foodbook24. The tool was well received with the majority of respondents: having no issues with reporting all food and drinks (95.8%); willing to use Foodbook24 for a week (82.2%); satisfied with ease of use (69%) and the time required to complete recalls as OK (63.6%) or short (22.9%). Importantly, the majority opted for Foodbook24 as the preferred method for future dietary intake assessment when compared against a traditional interviewer led recall and semi weighed food diary (67.8%). Conclusions: The results of this study demonstrate the potential for Foodbook24 as a web based dietary assessment method and presents a viable alternative to nutritional surveillance in Ireland.

  • Assessment of stress in healthy individuals using smartphones: a systematic review

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

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

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

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

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

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

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

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

  • The Physical Activity Tracker Testing in Youth (P.A.T.T.Y) Study: Content analysis and Children’s Perceptions

    Date Submitted: Jul 15, 2016
    Open Peer Review Period: Jul 15, 2016 - Sep 9, 2016

    Background: Activity trackers are widely used by adults and several models are now marketed for childre Objective: The purposes of this study were to: 1) perform a content analysis of behavioral change techniques (BCTs) used by three commercially available youth-oriented activity trackers; 2) obtain feedback describing children’s perception of these devices and the associated websites. Methods: A content analysis recorded the presence of 36 possible BCTs for the MovBand™, Sqord™ and Zamzee™ activity trackers (MB, SQ, and ZZ, respectively). In addition, 16 participants (age: 8.6±1.6 y, 50% female) received all three trackers and oriented to the devices and websites. Participants were instructed to wear the trackers on 4 consecutive days and spend ≥10 min/d on each website. A cognitive interview and survey were administered when the participant returned the devices. Qualitative data analysis was used to analyze the content of the cognitive interviews. Chi square analyses were used to determine differences in behavioral monitoring and social interaction features between websites. Results: The MB, SQ, and ZZ devices/websites included 8, 15 and 14 of the possible 36 BCTs, respectively. All of the websites had a behavioral monitoring feature (charts for tracking activity) but the percentage of participants indicating that they “liked” those features varied by website (MB: 50%, SQ: 38%, ZZ: 69%). Two websites (SQ and ZZ) included an “avatar” the user could create to represent themselves on the website. Participants reported that they “liked” creating and changing their avatar (SQ: 75%, ZZ: 94%), which was supported by the qualitative analyses of the cognitive interviews. Most participants (75%) indicated that they would want to wear the devices more if their friends were wearing a tracker. No significant differences were observed between SQ and ZZ devices in regards to liking or use of social support interaction features (P=0.21-0.37) Conclusions: The websites contained several BCTs consistent with previously identified strategies. Children “liked” the social aspects of the websites more than the activity tracking features. Developers of commercial activity trackers for youth may benefit from considering a theoretical perspective during the website design process.

  • Comprehensive laboratory- and field-based validation of youth-oriented activity trackers

    Date Submitted: Jul 15, 2016
    Open Peer Review Period: Jul 15, 2016 - Sep 9, 2016

    Background: Commercial activity trackers are growing in popularity among adults and some are beginning to be marketed to children. There is, however, a paucity of independent research examining the validity of these devices to detect physical activity of different intensity levels. Objective: The purpose of this study was to determine the validity of the output from three commercial youth-oriented activity trackers in three phases; 1) orbital shaker, 2) structured indoor activities, and 3) four days of free-living activity. Methods: Four units of each activity tracker (Movband™, Sqord™, and Zamzee™; MB, SQ, and ZZ, respectively) were tested in an orbital shaker for 5-minutes at three frequencies (1.3, 1.9, and 2.5 Hz). Participants for Phase 2 (N=14) and Phase 3 (N=16) were 6-12 year old children (50% male). For Phase 2, participants completed nine structured activities while wearing each tracker, the ActiGraph GT3X+ (AG) research accelerometer, and a portable indirect calorimetry system to assess energy expenditure (EE). For Phase 3, participants wore all four devices for four consecutive days. Correlation coefficients, linear models and non-parametric statistics evaluated the criterion and construct validity of the activity tracker output. Results: Output from all devices was significantly associated with oscillation frequency (r = .92 to .99). During Phase 2 the MB and ZZ only differentiated sedentary from light intensity (P < .01) while the SQ significantly differentiated among all intensity categories (all comparisons P < .01), similar to AG and EE. During Phase 3, AG counts were significantly associated with activity tracker output (r = .76, .86, and .59 for the MB, SQ, and ZZ, respectively). Conclusions: Across study phases, the SQ demonstrated stronger validity than the MB and ZZ. The validity of youth-oriented activity trackers may directly impact their effectiveness as behavior modification tools, demonstrating a need for more research on such devices.

  • Development of a mobile, avatar-based application for improving body perceptions among adolescents

    Date Submitted: Jul 14, 2016
    Open Peer Review Period: Jul 14, 2016 - Sep 8, 2016

    Background: One barrier to effectively treating weight issues among adolescents is that most adolescents do not perceive they are overweight or that being overweight is a problem. When adolescents correctly perceive themselves as overweight, they are more likely to adopt healthy lifestyle behaviors. Objective: The purpose of this pilot test was to develop and assess acceptability and feasibility of an avatar-based, theoretically derived, mobile application entitled, Having A Positive Perception of You Application (HAPPY App). Methods: The HAPPY App was engineered for high school students to identify what they thought they looked like, what they wanted to look like, and what they actually looked like based on body measurements using avatars. Results: The HAPPY App was pilot tested with male and female adolescents ages 15 to 18 to assess for acceptability and feasibility. A total of 42 students created and viewed their avatars. A majority of the students were female (67%), age 16 (38.1%), white (74%), non-Hispanic (86%), and in Grade 10 (47.5%). The students had positive reactions to the avatar application. Almost half thought it was good to be able to see their actual selves. Most of the students were comfortable creating and viewing the avatars (95.2%) and would use the application in the future to see how their bodies change (95.2%) over time. Conclusions: Avatar-based mobile applications, such as the HAPPY App, provide immediate feedback and allow users to engage with images that are personalized to represent their perceptions and actual body images. This pilot study adds to the increasing but limited research of using games to improve health outcomes among high school students. There is a need to further adapt the HAPPY App and implore feedback from a larger number of high school students including those from diverse backgrounds.

  • Twitter content analysis for investigating subjective experience and the influence of weather among fibromyalgia sufferers

    Date Submitted: Jul 13, 2016
    Open Peer Review Period: Jul 13, 2016 - Sep 7, 2016

    Background: Little is understood about the determinants of symptom expression in individuals with fibromyalgia syndrome (FMS). While FMS sufferers often report environmental influences, including weather events, on their symptom severity, a consistent effect of specific weather conditions on FMS symptoms has yet to be demonstrated. Content analysis of a large number of messages by FMS sufferers on Twitter can provide valuable insights into variation in the fibromyalgia experience from a first-person perspective. Objective: To use content analysis of tweets to investigate the association between weather conditions and fibromyalgia symptoms among individuals who tweet about fibromyalgia. Secondly, to gain insight into how Twitter is used as a form of communication and expression by fibromyalgia sufferers, and to explore and uncover thematic clusters and communities related to weather. Methods: Computerised sentiment analysis was performed to measure the association between negative sentiment scores (indicative of severe symptoms such as pain) and coincident environmental variables. Date, time and location data for each individual tweet were used to identify corresponding climate data (such as temperature). We used graph analysis to investigate the frequency and distribution of domain-related terms exchanged in Twitter and their association strengths. A community detection algorithm was applied to partition the graph and detect different communities. Results: We analysed 140,432 tweets related to fibromyalgia from 2008 to 2014. There was a very weak positive correlation between humidity and negative sentiment scores (r=.009, P=.001). There was no significant correlation between other environmental variables and negative sentiment scores. The graph analysis showed that ‘pain’ and ‘chronicpain’ were the most frequently used terms. The Louvain method identified 6 communities. Community 1 was related to feelings and symptoms at the time (subjective experience). It also included a list of weather related terms such as ‘weather’, ‘cold’ and ’rain’. Conclusions: According to our results, a uniform causal effect of weather variation on fibromyalgia symptoms at the group level remains unlikely. Any impact of weather on fibromyalgia symptoms may vary geographically or at an individual level. Future work will further explore geographical variation and interactions focusing on individual pain trajectories over time. Clinical Trial: N/A

  • The role of Web-based health information in help-seeking behaviour prior to a diagnosis of lung cancer: A mixed-methods study

    Date Submitted: Jul 11, 2016
    Open Peer Review Period: Jul 12, 2016 - Sep 6, 2016

    Background: Early diagnosis of lung cancer depends largely on timely presentation of symptoms to health services. The Web has become an important lay information source and is often used to appraise symptoms. Objective: A questionnaire and interview study was conducted to understand the role of the Web in symptom appraisal prior to lung cancer diagnosis. Methods: Patients diagnosed with lung cancer in the 6 months before study entry completed a survey about Web use to appraise their symptoms prior to diagnosis. Based on survey responses, sociodemographic variables and smoking status, we purposively sampled patients and their family/friends for semi-structured interviews (24 interviews with 33 participants). Survey data were analysed descriptively. Interview data were analysed qualitatively using Framework Analysis. Results: 113 patients completed the survey (mean age=67, SD=8.8). 20.5% (23/112) reported they or a family member/friend had researched symptoms online. Only seven patients (7/112, 6.3%) had researched their own symptoms, four of these with the help of family/friends. The remainder of searches were conducted by family members/friends. Interview results suggest that patients and family/friends perceived an impact of Web use on decisions to seek help and on communication with health professionals. Some reported Web-based information triggered help-seeking while others reported it delayed help-seeking. Some participants used information found online to support their requests for further investigations of symptoms. Online health information also reportedly impacted on understanding of medical jargon during the diagnostic process. Conclusions: Although its role is at present still limited, the Web appears to have an impact on the diagnostic process, and seems to play a role not only in the time before seeking medical help, but also following first consultation with a health professional. Improving online resources to meet specific needs may help to encourage early help-seeking and facilitate communication with health professionals. Clinical Trial: n/a

  • Are demographic and indication-specific variables associated with social network engagement?

    Date Submitted: Jul 7, 2016
    Open Peer Review Period: Jul 7, 2016 - Sep 1, 2016

    Background: Digital Health Social Networks (DHSNs) are widespread, and the general consensus is that they contribute to wellness through offering social support and knowledge sharing. The success of a DHSN is based on number of participants, and their consistent creation of externalities though the generation of new content. To promote network growth and individual agency, it would be helpful to identify actors who create value by generating positive network externalities. Objective: The objective of this study is to examine the association between posting behavior, demographic characteristics, and indication severity from actors and non-actors from four large DHSNs. Methods: Data were extracted from the custom SQL databases of four digital health behavior change interventions. To investigate associations between user characteristics and social network engagement, ten models were analyzed with standard multiple regression and F-tests. Results: The DHSNs varied in number of days active (36,580 vs. 5,210), number of registrants (5,049 vs. 78,903), number of actors (1,085 vs. 8,452), and number of posts (16,231 vs. 620,487). Eight of the ten models had low R2 results (.004-.064), with limited statistically significant demographic and indication specific independent variables. The exception was the panic disorder social network, where the R2 results were 0.363 for all registrants, and 0.343 for all actors. F-tests indicated that independent variables were preferable to reduced models in six of the ten models. In regards to categorical variables, level of education had limited association with engagement. Conclusions: Some of the demographic variables were statistically associated with social network engagement as evidenced by t-tests and F-tests for ungrouped variables, and F-tests for categorical variables. Although some of these individual variables are statistically significant, they do not appear to be significant from a practical perspective due to the low R2 results. Based on the large number of study participants, variation in DHSN theme, and extensive time-period, we did not find strong evidence that demographic characteristics or indication severity sufficiently explain the variability in number of posts per actor. Researchers should investigate alternative models that identify individuals who promote social network growth.

  • Analysis of Requirements for developing an mHealth based Health Management Platform

    Date Submitted: Jul 7, 2016
    Open Peer Review Period: Jul 7, 2016 - Sep 1, 2016

    Background: Studies have consistently shown that mobile and web-based applications have positive impacts on people’s daily lifestyles, health management and disease treatment. As the development of medical and health informationization in China has evolved, different kinds of mobile based applications for individuals and hospitals have been developed by software vendors. However, doubts and challenges posed by the media have prevented these applications from having a stable and substantial user base. We think the key problem is that the software does not satisfy the main needs of general users, which means an analysis of user requirements has not been performed prior to design of the application. The health information government authority in Liaoning Province, China, was planning to set up a mHealth based health management platform, aiming to alleviate the difficulties citizens have in seeking hospital services. Objective: The goal of this study was to determine the actual health and medical needs of citizens that may be addressed by medical information technologies. The results may contribute to the functional design and development of health management and appointed treatment-oriented mobile applications. Methods: In this study, an unstructured questionnaire on mHealth requirements was designed and tested, and 240 questionnaires were given to the outpatients of the First Hospital of the China Medical University in Shenyang, Liaoning Province, China; of these, 228 valid responses were collected, for a response rate of 95%. We discussed the current development of mHealth with 50 related experts and engineers from health authorities and a medical information company. SPSS 13.0 was used for statistical and analysis. Results: After detailed analysis of the questionnaire data and interview results, several findings were made: firstly, most citizens were unclear about their health conditions (64.5%) and would like to receive a mobile application (app) as a tool to manage their health and medical needs (71.1%); on the other hand, the main problems for outpatients were long waiting times (66.4%) and difficulties in making appointments (46.5%), and they also worried about payments and internet problems when using a mobile application for appointment reservations. Furthermore, as the main service target of mHealth is innovated health management of the general population, first we need to solve the associated interoperability and data security problems. Conclusions: This study provides insight into the health and medical requirements of Smartphone apps and draws attention to some of the challenges and opportunities of mHealth. We suggest several value-added features and characteristics that app developers should take into consideration when developing health and medical related apps. The findings also highlight some major challenges that require further consideration and research to ensure these apps meet the core needs of patients and aid the development of the health information system in Liaoning Province, China. Clinical Trial: This study had been confirmed by ethics committee of Shengjing Hospital of China Medical University before started that the study has no relationship with any clinical actions with patients or animals , the need for ethics approval is not necessary.

  • Stepping into the Era of Personal Big Data: a Roadmap to the Design of a Personal Digital Life Coach

    Date Submitted: Jul 5, 2016
    Open Peer Review Period: Jul 5, 2016 - Aug 30, 2016

    The increased availability of devices that can record every aspect of a person’s life will allow the recording of a large amount of data that will be primarily useful for that particular user. These devices and their data will place each and every one of us at the doorstep of the era of personal big data. Using this data, in a not so distant future, we will be able to set a personal digital life coach, a digital platform that will act at an individual level, but also considering a global interaction, not only as a social networking tool, but as a platform that will profit from the individual experiences of its users. This position paper focuses on the identification of the milestones that will mark the creation of such a software and hardware platform, by exploring the opportunities and challenges that it poses to the computer science researchers, and how such a solution can be designed to be a user-adoptable lifestyles monitoring and training tool.

  • You sort of go down a rabbit hole ……You’re just going to keep on searching’. A qualitative study of searching online for pregnancy related information during pregnancy

    Date Submitted: Jul 1, 2016
    Open Peer Review Period: Jul 1, 2016 - Aug 26, 2016

    Background: The internet is becoming increasing popular for gaining information on medical/health issues; with women in particular likely to search online for this type of information and support. Despite the increased use of the internet for health-related information, we need to question if the internet and the ease of seeking health information that it provides, leads to more [patient] empowerment. Pregnancy is a particularly worrying time for women, especially first time mums-to-be, with unfamiliar experiences and symptoms and concerns for the baby as well as the self. Objective: Our aim was to explore how and why pregnant women with different levels of health anxiety (HA) use the internet to gain information and support during pregnancy and what they consider a reliable source. The aim was also to explore any notable differences between women with differing levels of HA. Methods: To meet the objectives of the study, a qualitative approach was required to gather information on the experiences of currently pregnant women who use the internet to gain information and support during their pregnancy. Sixteen pregnant women took part in a semi-structured interview, either face-to-face or via telephone. Qualitative analytical procedures were employed, supported by NVivo software. Results: Pregnant women found reassurance from the experiences of others. This reassurance resulted in them feeling less alone, as well as enabling them to normalize any symptoms or experiences they were undergoing. The women understood that caution was needed at times whilst reading the stories of others, acknowledging the potential for extreme cases or worst case scenarios. This is particularly pertinent to the internet, as this wide range of stories may not be as easily accessible if stories where confined to those in a woman’s offline social circle. The interviews combined with the HA levels of the participants provide insights into how and why pregnant women search online for information and perhaps more so, support whilst pregnant. The project had the novel aspect of HA level as well as the interview data, this made for a more interesting discussion in relation to anxiety level and disparities between those with low, moderate and high health anxiety in terms of what was said. Conclusions: Searching for health information and advice online during pregnancy is viewed as quick, easy and accessible. The affordances of the internet provided women the opportunity to go online as a first port of call, irrespective of health anxiety levels. Knowing they were not alone and reading the experiences and/or symptoms of other pregnant women enabled women to normalize their experience and was ultimately reassuring for pregnant women. Clinical Trial: n/a