Open Peer-Review: eHealth for Patient Engagement: a systematic review., and other submissions


 

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JMIR Submissions under Open Peer Review

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Titles/Abstracts of Articles Currently Open for Review


eHealth for Patient Engagement: a systematic review.

Background: New forms of health care interventions featuring the use of technologies for health (e-Health) are recognized to have tremendous potential for fostering patient engagement in their health management. To date, the majority of studies were designed to examine the efficacy of eHealth in enhancing clinical outcomes both physical and psychological. However, less attention has been devoted to the understanding of the impact of eHealth on the engagement of patients in their healthcare. Objective: To review findings from the literature about the application of eHealth in engaging people in their own care process. The best practices, potential challenges and opportunities for the ability of eHealth interventions to foster patient engagement in existing healthcare systems are also discussed. Methods: We undertook comprehensive literature searches in PubMed, PsycINFO, Scopus and ISI Web of Science. The publication selection was independently conducted by two researchers. All papers that met the eligibility criteria were thoroughly analyzed and coded accordingly. Results: A total of 8 studies met the inclusion criteria. The eHealth interventions reviewed were mainly devoted to foster only a single experiential dimension of patient engagement (i.e. alternatively cognitive, emotional or behavioral experiential domains related to the healthcare management), thus failing to consider the complexity of such an experience. This also led to a great heterogeneity of technological tools, assessed variables and of the achieved results. Conclusions: Although scholars agree on the importance of tailoring eHealth interventions on the basis of a deep understanding of the patients’ experience, this goal was often not achieved in the papers analyzed. This systematic review underlines the need for a more holistic view of patient needs and priorities, in order to directly engage in the management of their care and to better address the intervention. The review concludes by proposing a unifying framework of eHealth action priorities to support patient engagement in the light of a more holistic understanding of the patient care experience.
 
Date Submitted: Apr 11, 2014
Open Peer Review Period: Apr 11, 2014 - Jun 6, 2014
 
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A Web-based Non-intrusive Ambient System to Measure and Classify Activities of Daily Living

Background: The number of older adults in the global population is increasing. This demographic shift leads to an increasing prevalence of age-associated disorders, such as Alzheimer Disease (AD) and other types of dementia. With the progression of the disease, the risk for institutional care increases, which contrasts with the desire of most patients who would like to live in their known home-environment as long as possible. In this regard, the occurrence, performance and duration of different Activities of Daily Living (ADL) is an important indicator of functional ability. The patient’s ability to cope with ADL is traditionally assessed with questionnaires, which has disadvantages (e.g. lack of reliability and sensitivity). Several groups have proposed sensor-based systems to recognize and quantify ADL in the patient’s home. Combined with web technology, these systems can also inform caregivers in real-time, e.g. via smartphone, about current ADL of their patients. Objective: In contrast to other commercial products available on the market, we hypothesize that a non-intrusive system, which does not use body-mounted sensors, video-based imaging and microphone recordings would be better suited for use in dementia patients. Since it does not require patient’s attention and compliance, such a system might be very well accepted by patients. In this manuscript, we present a novel passive, web-based, non-intrusive, assistive technology system that recognizes and classifies ADL. Methods: The components of the novel assistive technology system are a number of wireless sensors that are distributed in every room of the participant’s home and a central computer unit (CCU). The environmental data was acquired for 20 days (per participant) and was stored and processed on the CCU. In cooperation with medical experts, eight ADL were allotted for the classifier to determine. Results: Ten healthy participants (6 women, 4 men; mean age = 48.8 years; SD = 20.0 years; age range 28-79 years) were included in the study. In total, 1’317 ADL were performed by the participants. 1’211 ADL were classified correctly and 106 ADL were missed. This leads to an overall sensitivity of 91.27% and a specificity of 92.52%. Each subject performed 134.8 ADL on average (SD = 75). Conclusions: The non-intrusive wireless sensor system can acquire environmental data essential for ADL classification. By analyzing the retrieved data, it is possible to distinguish and assign data pattern to subject specific activities and to identify eight different ADL. Owing to the web based technology, the system has a high potential to improve care and provides valuable information about the patient in real-time.
 
Date Submitted: Apr 11, 2014
Open Peer Review Period: Apr 11, 2014 - Apr 23, 2014
 
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Clinical Decision Support System to Enhance Quality Control of Forced Spirometry using Information and Communication Technologies

Background. We recently demonstrated that quality of forced spirometry (FS) in primary care can markedly improve with remote off-line support from specialized professionals (Burgos et al. Eur Respir J 2012; 39: 1313-1318). It is hypothesized that implementation of automatic on-line assessment of quality of FS using information and communication technologies (ICT) may significantly enhance the potential for extensive deployment of a high quality FS program in integrated care settings. Aims. To elaborate and validate a Clinical Decision Support System (CDSS) for automatic on-line quality assessment of FS. Method. The CDSS was done through a three-step process including: i) identification of optimal sampling frequency; ii) iterations to build-up an initial version using the 24 standard FS curves recommended by the American Thoracic Society; and, iii) iterations to refine the CDSS using 270 curves from 90 patients. In each of these steps the results were checked against one expert. Finally, 778 FS curves from 291 patients were analyzed for validation purposes. Results. The CDSS generated appropriate on-line classification and certification in 88% of FS testing with 96% sensitivity and 95% specificity. Conclusions. Consequently, only 12% of FS testing required off-line remote classification by an expert indicating a potential positive role of the CDSS in the deployment a high quality FS program in an integrated care setting.
 
Date Submitted: Apr 6, 2014
Open Peer Review Period: Apr 7, 2014 - Jun 2, 2014
 
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Impact of an online medical internet site, the Spinal Cord Injury Rehabilitation Evidence Project, on knowledge and practice of health-care providers: A mixed methods study

Background: It is not known whether ongoing access to a broad-based internet knowledge resource can influence the practice of health-care providers. We undertook a study to evaluate the impact of a web-based knowledge resource on increasing access to evidence and facilitating best practice of health-care providers. Objective: The objective of this study was to evaluate the impact of the Spinal Cord Injury Rehabilitation Evidence (SCIRE) project (www.scireproject.com) on 1) access to information for health-care providers and researchers and 2) influence on the practice of these health-care providers in the management of their clients. Methods: A four part mixed methods evaluation was undertaken: 1. Monitoring of website traffic and utilization using Google Analytics; 2. Online survey to users who accessed the SCIRE website; 3. Online survey to targeted end-users (rehabilitation health-care providers known to work with spinal cord injury (SCI) clients, as well as researchers) and 4. Focus groups with health care providers who had previously accessed SCIRE. Results: The online format allowed the content for a relatively specialized field to have far reach (e.g., 26 countries and over 6500 users per month). The website survey and targeted-end user survey confirmed that health-care providers, as well as researchers perceived that the website increased their access to SCI evidence. Access to SCIRE not only improved knowledge of SCI evidence, but helped inform changes to the health providers’ clinical practice and improved their confidence in treating SCI clients. The SCIRE information directly influenced the health providers’ clinical decision-making, in terms of choice of intervention, equipment needs or assessment tool. Conclusions: A web-based knowledge resource can be a relatively inexpensive method to increase access to evidence-based information, increase knowledge of the evidence, inform changes to the health-providers’ practice, and influence their clinical decision-making.
 
Date Submitted: Apr 4, 2014
Open Peer Review Period: Apr 7, 2014 - Jun 2, 2014
 
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Analysis of primary care physician workflow and interactions with electronic health record systems

Background: Although health information technology (health IT) has the potential to improve the quality and efficiency of patient care, it may also negatively impact physician workflow and patient-centered care. In particular, the switch from paper to electronic record keeping requires new work practices that may disrupt physicians’ common tasks and direct their attention away from patients. Understanding the impact of technology on primary care physician workflow is vital to designing and implementing health IT that best supports physicians’ work and contributes to patient-centered care. Objective: This study explores the relationship between primary care physicians’ interactions with health information technology (technology centered, human centered, or mixed interaction) and primary care workflow. Methods: Clinical encounters were recorded with high-resolution video cameras to capture physicians’ workflow and interactions with two objects of interest: the electronic health record (EHR) system and their patient. To analyze the data, a coding scheme was developed based on a validated list of primary care tasks to define the presence or absence of a task, the time spent on each task, and the sequence of tasks. To investigate the relationship between each task and interaction style, regression analysis was conducted. Finally, a t-test with the ( = .05) level of significance was used to determine if the amount of time spent on a task was significantly different between the different interaction-style groups. Results: Results revealed divergent workflows and significant differences between physicians’ EHR use surrounding common workflow tasks: gathering information, documenting information, and recommending/discussing treatment options. Time spent gathering information varied significantly across interaction style groups (technology-centered= 48.80%, mixed = 23.14%, human-centered= 35.41%). Significant differences were found between the technology-centered and human-centered groups (P= .049), as well as technology-centered and mixed interaction groups (P= .006). For time spent documenting information, a significant difference was found between the technology-centered group and human-centered group (P= .015), and the technology-centered group and mixed interaction group (P= .008). Conclusions: These findings suggest that EHR use significantly impacts primary care workflow. The study identifies types of workflows that can inform future studies with larger sample sizes, which may lead to more effective primary care EHR design. Future research on this topic and design strategies for effective health information technology in primary care are discussed. Clinical Trial: N/A
 
Date Submitted: Apr 4, 2014
Open Peer Review Period: Apr 7, 2014 - Jun 2, 2014
 
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Finding Collaborators: Towards Interactive Discovery Tools for Research Network Systems

Background: Research networking systems hold great promise for helping biomedical scientists identify collaborators with the expertise needed to build interdisciplinary teams. Although efforts to date have been focused primarily on collecting and aggregating information, less attention has been paid to the design of end-user tools for using these collections to identify collaborators. To be effective, collaborator search tools must provide researchers with easy access to information relevant to their collaboration needs Objective: To study user requirements and preferences for research networking system collaborator search tools, and to design and evaluate a functional prototype. Methods: Paper prototypes exploring possible interface designs were presented to 18 participants in semi-structured interviews aimed at eliciting collaborator search needs. Interview data were coded and analyzed to identify recurrent themes and related software requirements. Analysis results and elements from paper prototypes were used to design a web-based prototype, using the D3 Javascript library and on VIVO data. Preliminary usability studies asked 20 participants to use the tool and to provide feedback through semi-structured interviews and completion of the System Usability Scale (SUS). Results: Initial interviews identified consensus regarding several novel requirements for collaborator search tools, including chronological display of publication and research funding information, the need for conjunctive keyword searches, and tools for tracking candidate collaborators. Participant responses were positive (average SUS score: 76.4%). Opportunities for improving the interface design were identified. Conclusions: Interactive, timeline-based displays that support comparison of researcher productivity in funding and publication have the potential to effectively support searching for collaborators. Further refinement and longitudinal studies may be needed to better understand the implications of collaborator search tools for researcher workflows.
 
Date Submitted: Apr 2, 2014
Open Peer Review Period: Apr 3, 2014 - May 29, 2014
 
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VDR rs2228570 Polymorphism May Contribute to the Pathogenesis of Asthma: a Meta-Analysis

Background: Additionally, several studies have linked vitamin D receptor (VDR) and its intronic SNPs with asthma on the genetic basis, suggesting that genetic polymorphisms in VDR gene may alter the function of vitamin D in immune system and influence individual susceptibility to asthma Objective: We performed the present meta-analysis to determine whether VDR rs2228570 polymorphism contribute to the pathogenesis of asthma. Methods: The Web of Science (1945~2013), the Cochrane Library Database (Issue 12, 2013), PubMed (1966~2013), EMBASE (1980~2013), CINAHL (1982~2013) and the Chinese Biomedical Database (CBM) (1982~2013) were searched without language restrictions. Meta-analysis was performed with the use of the STATA statistical software. Odds ratio (OR) and its 95% confidence interval (95%CI) were calculated. Seven studies with a total of 1,997 asthma patients and 1,868 healthy subjects met the inclusion criteria. Results: The Web of Science (1945~2013), the Cochrane Library Database (Issue 12, 2013), PubMed (1966~2013), EMBASE (1980~2013), CINAHL (1982~2013) and the Chinese Biomedical Database (CBM) (1982~2013) were searched without language restrictions. Meta-analysis was performed with the use of the STATA statistical software. Odds ratio (OR) and its 95% confidence interval (95%CI) were calculated. Seven studies with a total of 1,997 asthma patients and 1,868 healthy subjects met the inclusion criteria. Conclusions: The Web of Science (1945~2013), the Cochrane Library Database (Issue 12, 2013), PubMed (1966~2013), EMBASE (1980~2013), CINAHL (1982~2013) and the Chinese Biomedical Database (CBM) (1982~2013) were searched without language restrictions. Meta-analysis was performed with the use of the STATA statistical software. Odds ratio (OR) and its 95% confidence interval (95%CI) were calculated. Seven studies with a total of 1,997 asthma patients and 1,868 healthy subjects met the inclusion criteria.
 
Date Submitted: Apr 2, 2014
Open Peer Review Period: Apr 3, 2014 - May 29, 2014
 
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Uptake and acceptability of information and communication technology in a community-based cohort of people who inject drugs: Implications for mobile health interventions

Background: Mobile phone and internet-based technologies are increasingly used to disseminate health information and facilitate delivery of medical care. While these strategies hold promise for reducing barriers to care for medically-underserved populations, their acceptability among marginalized populations such as people who inject drugs is not well-understood. Objective: To understand patterns of mobile phone ownership, internet use and willingness to receive health information via mobile devices among people who inject drugs. Methods: We surveyed current and former drug injectors participating in a longitudinal cohort study in Baltimore, Maryland, USA. Respondents completed a 12-item, interviewer-administered questionnaire during a regular semi-annual study visit that assessed their use of mobile technology and preferred modalities of receiving health information. Using data from the parent study, we used logistic regression to evaluate associations among participants’ demographic and clinical characteristics and their mobile phone and internet use. Results: The survey was completed by 845 individuals, who had a median age of 51 years. The sample was 89% African-American, 65% male, and 33% HIV-positive. Participants were generally of low education and income levels. Fewer than half of respondents (40%) indicated they had ever used the internet. Mobile phones were used by 86% of respondents. Among mobile phone owners, 46% had used their phone for text messaging and 25% had accessed the internet on their phone. A minority of respondents (42%) indicated they would be interested in receiving health information via phone or internet. Of those receptive to receiving health information, a mobile phone call was the most favored modality (66%) followed by text messaging (58%) and internet (51%). Conclusions: Utilization of information and communication technology among this cohort of people who inject drugs was reported at a lower level than what has been estimated for the general U.S. population. Our findings identify a potential barrier to successful implementation of mobile health and internet-based interventions for people who inject drugs, particularly those who are older and have lower levels of income and educational attainment. As mobile communication technology continues to expand, future studies should re-examine whether mHealth applications become more accessible and accepted by socioeconomically disadvantaged groups.
 
Date Submitted: Mar 31, 2014
Open Peer Review Period: Apr 3, 2014 - May 29, 2014
 
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Collecting and Analyzing Patient Experience of Healthcare from Social Media

Background: Social Media, such as Yelp, provides rich information of consumer experience. Previous studies suggest that Yelp can serve as a new source to study patient experience. However, the lack of a corpus of patient reviews causes a major bottleneck for applying computational techniques. Objective: We took the initiative to create a Corpus of Patient Experience (COPE) and reported descriptive statistics to characterize COPE. Methods: We extracted Yelp reviews about healthcare related businesses from the Yelp Academic Dataset. We used available natural language processing tools to split reviews into sentences, extract noun phrases, and adjectives from each sentence, and generated parse trees and dependency trees for each sentence. We used sentiment analysis techniques to calculate sentiment score of each sentence, and we used Hadoop for parallel processing. Results: COPE contains 79,173 sentences from 6,914 patient reviews of 985 healthcare facilities near 30 universities in the United States. We found that patients wrote longer reviews when they rated the facility poorly (1 or 2 stars). We demonstrated that the computed sentiment scores correlated well with consumer generated ratings. A consumer vocabulary to describe their healthcare experience was constructed by a statistical analysis of word counts and co-occurrences in COPE. Conclusions: We built a corpus called COPE as an initial step to utilize social media to understand patient experiences at healthcare facilities. The corpus is available to download at https://cope.codeplex.com/. COPE can be used in future studies to extract knowledge of patients’ experiences from their perspective. Such information can subsequently inform and provide opportunity to improve the quality of healthcare. Clinical Trial: Not applicable
 
Date Submitted: Mar 31, 2014
Open Peer Review Period: Apr 3, 2014 - May 29, 2014
 
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Focus Groups Move Online: Feasibility of Tumblr Use for e-Health Curriculum Development

Background: Constructing successful online programs requires engaging potential users in development. However, assembling focus groups can be costly and time consuming. Objective: We asked whether Tumblr could be used to prioritize activities for an online young worker risk reduction and health promotion program. Methods: A new potentially useful activity for assessment was posted on Tumblr with linked survey questions. Young summer parks and recreation employees were encouraged to visit the site with weekly announcements and competitions. Responses were downloaded and analyzed. Results: An average of 36 young workers rated each activity on its likeability and perceived educational value. The method was feasible, efficient and sustainable across the summer weeks. Ratings indicated significant differences in likeability among activities (P<0.005). Conclusions: Tumblr is means to obtain formative feedback on potential curricular components when assembling an online intervention. Its initial use is described along with suggestions for future refinements.
 
Date Submitted: Mar 28, 2014
Open Peer Review Period: Mar 28, 2014 - May 23, 2014
 
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Influence of DPYD Genetic Polymorphisms on 5-fluorouracil Toxicities in Patients with Colorectal Cancer: A Meta-Analysis

Background: Recently, extensive studies have suggested that single nucleotide polymorphism (SNP) may be associated with toxicity of 5-FU adjuvant chemotherapy in CRC. Objective: Our meta-analysis aggregated existing results from relevant studies to comprehensively investigate the correlations between genetic polymorphisms in dihydropyrimidine dehydrogenase (DPYD) gene and 5-fluorouracil (5-FU) toxicities in patients with colorectal cancer (CRC). Methods: The MEDLINE (1966~2013), the Cochrane Library Database (Issue 12, 2013), EMBASE (1980~2013), CINAHL (1982~2013), Web of Science (1945~2013) and the Chinese Biomedical Database (CBM) (1982~2013) were searched without language restrictions. Meta-analyses were conducted with the use of STATA software (Version 12.0, Stata Corporation, College Station, Texas USA). Results: Seven clinical cohort studies with a total of 946 CRC patients met our inclusion criteria. Our findings showed that DPYD genetic polymorphisms were significantly correlated with high incidences of marrow suppression, gastrointestinal reaction and hand-foot syndrome in CRC patients. SNP-stratified analysis indicated that there were remarkable connections of IVS14+1, 464T>A, and 2194G>A polymorphisms with the incidence of marrow suppression in CRC patients receiving 5-FU chemotherapy. Furthermore, we found that IVS14+1, 496A>G and 2194G>A polymorphisms were correlated with the incidence of gastrointestinal reaction. Ethnicity-stratified analysis also revealed that DPYD genetic polymorphisms might contribute to the development of marrow suppression and gastrointestinal reaction among Asians, but not among Caucasians. Conclusions: Seven clinical cohort studies with a total of 946 CRC patients met our inclusion criteria. Our findings showed that DPYD genetic polymorphisms were significantly correlated with high incidences of marrow suppression, gastrointestinal reaction and hand-foot syndrome in CRC patients. SNP-stratified analysis indicated that there were remarkable connections of IVS14+1, 464T>A, and 2194G>A polymorphisms with the incidence of marrow suppression in CRC patients receiving 5-FU chemotherapy. Furthermore, we found that IVS14+1, 496A>G and 2194G>A polymorphisms were correlated with the incidence of gastrointestinal reaction. Ethnicity-stratified analysis also revealed that DPYD genetic polymorphisms might contribute to the development of marrow suppression and gastrointestinal reaction among Asians, but not among Caucasians.
 
Date Submitted: Mar 26, 2014
Open Peer Review Period: Mar 28, 2014 - May 23, 2014
 
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Mobile Application Rating Scale (MARS): A new tool for assessing the quality of health mobile applications.

Background: The use of mobile applications for health and wellbeing promotion has grown exponentially in recent years. Yet, there is currently no app-quality assessment tool beyond ‘star’-ratings. Objective: This study aimed to develop a reliable measure for classifying and rating the quality of mobile applications. A critical review of existing literature on app and web quality was used to develop the new measure, the Mobile Application Rating Scale (MARS) The MARS was piloted on apps for wellbeing. Methods: A search of journal articles on the assessment of app or web quality since 1999 was conducted using six databases and three key websites. Existing criteria for assessment of app quality were categorised by an expert panel and used to develop items. Wellbeing apps were identified using an iTunes search: 60 of these were randomly selected for rating on the MARS. Ten were used to pilot the rating procedure, and the remaining 50 provided data on inter-rater reliability. Results: 372 explicit criteria for assessing app or web quality was extracted from 25 published papers, conference proceedings, and online resources. Five broad categories of criteria were identified: engagement, functionality, aesthetics, information quality, and overall satisfaction, which were refined into the 23-item MARS. A systematic iTunes search for apps on wellbeing or common psychological problems revealed 405 meeting inclusion criteria. After piloting, the MARS demonstrated excellent internal consistency (α = 0.92) and inter-rater reliability (ICC = 0.85). Conclusions: The MARS is a simple, objective and reliable tool developed to classify and assess mobile app quality, and provides a checklist for design and development of new high quality health apps.
 
Date Submitted: Mar 25, 2014
Open Peer Review Period: Mar 25, 2014 - May 20, 2014
 
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A Case Study of the New York City 2012-2013 Influenza Season with Daily, Geocoded Twitter Data from Temporal, Spatial, and Spatiotemporal Perspectives

Background: Twitter has shown usefulness in predicting influenza cases on a weekly basis in multiple countries and on different geographic scales. Recently, Broniatowski and colleagues suggested Twitter's relevance at the city-level for New York City. Here we look to dive deeper into the case of the New York City by analyzing daily Twitter data from temporal, spatial, and spatiotemporal perspectives. Also, through manual coding of tweets, we look to gain qualitative insights that can help direct future automated searches. Objective: First, to validate the temporal predictive strength of daily Twitter data for influenza-like illness emergency department (ILI-ED) visits during the New York City 2012-2013 influenza season against other available and established data sets (Google search query, GSQ), and second, to examine the spatial distribution and the spread of geocoded tweets as proxies for potential cases. Methods: From the Twitter Streaming API, 2972 tweets were collected in the NYC region matching the keywords “flu”, “influenza”, “gripe”, and “high fever”. The tweets were categorized according to the scheme developed by Lamb et al. A fourth category was added as an evaluator guess for the probability of the subject(s) being sick to account for strength of confidence in the validity of the statement. Temporal correlations were made for tweets against daily ILI-ED visits and daily GSQ volume. The best models were used for linear regression for forecasting ILI visits. A weighted, exponential Kringing was used to examine the spatial distribution of high-sickness tweets (n = 1185). A weighted, retrospective, Poisson model with SaTScan (n = 1484), and vector map were used for spatiotemporal analysis. Results: Infection related tweets (R = 0.763) correlated better than GSQ time series (R = 0.683) for the same keywords and had a lower mean average percent error (8.4 vs. 11.8) for ILI-ED visit prediction in January, the most volatile month of flu. The spatial probability distribution of sick tweets showed a discrepancy with nearby vaccination sites. SaTScan identified primary outbreak cluster of high-probability infection tweets with a 2.74 relative risk ratio compared to medium-probability infection tweets at P = 0.001 in Northern Brooklyn, in a radius that includes Barclay’s Center and the Atlantic Avenue Terminal. Conclusions: While others have looked at weekly, regional tweets, this study is the first to examine Twitter for city level, daily data for New York City. Extraction of personal testimonies of infection-related tweets suggests Twitter’s strength both qualitatively and quantitatively for ILI-ED prediction compared to alternative daily data sets mixed with awareness-based data such as GSQ. Additionally, Twitter provides important spatial insights. A tweet vector-map is useful for spatiotemporal visualization of spread when local gold standard data are otherwise unavailable.
 
Date Submitted: Mar 22, 2014
Open Peer Review Period: Mar 24, 2014 - May 19, 2014
 
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Virtual communities of practice: overcoming barriers of time and technology

None
 
Date Submitted: Mar 14, 2014
Open Peer Review Period: Mar 24, 2014 - May 19, 2014
 
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Design and usage of the HeartCycle education and coaching programme for patients with heart failure

Background: Heart failure (HF) is common and associated with high rates of readmission and mortality. It is generally assumed that appropriate self-care can improve outcomes in patients with HF but patient adherence to many self-care behaviours is poor. Objective: To develop and test an intervention to increase self-care in patients with HF using a novel on-line automated education and coaching programme. Methods: The on-line automated programme was developed from a well-established, face-to-face, home-based cardiac rehabilitation approach. Education is tailored to the behaviour and knowledge of the individual patient and the system supports patients in adopting self-care behaviours. Patients are guided through a goal setting process that they conduct at their own pace through the support of the system, and record their progress in an electronic diary such that the system can provide appropriate feedback. Only in challenging situations do HF nurses intervene to offer help. The programme was evaluated in the HeartCycle study, a multi-centre, observational trial with randomised components investigating the ability of a third generation HTM system to enhance the management of patients with HF who had a recent (<60 days) admission to the hospital for symptoms or signs of heart failure (either new onset or recurrent) or were outpatients with persistent NYHA III/IV symptoms despite treatment with diuretics. Patients were enrolled from January 2012 through February 2013 from three hospital sites within the United Kingdom, Germany, and Spain. Results: Of 123 patients enrolled (mean age 66 +/- 12 years, 29% NYHA II, 66% NYHA III, 79% men), 50 patients (41%) reported that they were not physically active, 56 patients (46%) did not follow a low salt diet, six patients (5%) did not restrict their fluid intake, and six patients (5%) did not take their medication as prescribed. About 80% of the patients who started the coaching programme for physical activity and low salt diet became adherent by achieving their personal goals for two consecutive weeks. After becoming adherent, 61% continued physical activity coaching, but only 36% continued low salt diet coaching. Conclusions: The HeartCycle education and coaching programme helped most non-adherents patients with HF to adopt recommended self-care behaviours. Automated coaching worked well for most patients who started the coaching programme, and many patients who achieved their goals continued to use the programme. For many patients that did not engage in the automated coaching programme, this was an appropriate choice rather than a failure of the programme.
 
Date Submitted: Mar 20, 2014
Open Peer Review Period: Mar 21, 2014 - May 16, 2014
 
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Evaluation of online narrative information by breast cancer patients in Japan

Background: The DIPEx (Database of individual patient experiences) website which originated in Oxford, England in 2001, was launched in Japan in 2009. DIPEx narratives have different characteristics from general online narratives in that they are visually presented, supervised by medical professionals, edited and compiled as a narrative database. The impact of such narratives upon patients has not been evaluated yet. Objective: The present study aims to describe how breast cancer patients in Japan evaluate the DIPEx narratives from both quantitative and qualitative aspects. Methods: 110 Japanese breast cancer patients participated in the exploratory, descriptive, cross-sectional, Web-based survey via online communities. We asked them to evaluate the credibility, usefulness, and negative aspect of the DIPEx narratives. We also asked the participants to write free comments about the DIPEx website. Results: Most of the participants had positive opinions for the DIPEx website. They considered usefulboth the topics which they had already experienced (e.g. about hormone therapy), and the topics which they had not experienced yet (e.g. about recurrence or metastasis). Thirty-seven percent of the participants answered that they “became anxious by watching other patients’ stories.” Conclusions: We found that the DIPEx websites gained mostly positive evaluation about usefulness and credibility. While previous studies showed that people tend to identify themselves with the storytellers in personal video narratives, present study showed that those who accessed the visual narrative information felt less anxiety that those who accessed the narrative mostly through written texts. Further investigation is needed to clarify the reasons why people feel less anxious when they view the DIPEx video narratives.
 
Date Submitted: Mar 18, 2014
Open Peer Review Period: Mar 20, 2014 - May 15, 2014
 
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Effectiveness of a web-based, computer-tailored, pedometer-based physical activity intervention for adults: a cluster-randomized controlled trial

Background: Computer-tailored physical activity (PA) interventions delivered through the Internet represent a promising and appealing method to promote PA at a population level. However, personalized advice is mostly provided based on subjectively measured PA, which is not very accurate and might result in the delivery of advice that is not credible or effective. Therefore, an innovative computer-tailored PA advice was developed, based on objectively pedometer-measured PA. Objective: To evaluate the effectiveness of a computer-tailored, pedometer-based PA intervention in working adults. Methods: Participants (≥18 years) were recruited between May 2012 and December 2012 from eight Flemish workplaces. These workplaces were allocated randomly to an intervention or control group. Intervention group participants (n=137) received (1) a booklet with information on how to increase their steps, (2) a non-blinded pedometer and (3) an Internet link to request computer-tailored step advice. Control group participants (n=137) did not receive any of the above mentioned intervention components. Self-reported (IPAQ) and pedometer-based PA were assessed at baseline (T0), and one (T1) and three (T2) months post baseline. Repeated measures analyses of covariance were used to examine intervention effects for both the total sample and the sample at risk (i.e. adults not reaching 10,000 steps a day at baseline). Results: The recruitment process resulted in 274 respondents (response rate of 15.1%) who agreed to participate. Between T0 and T1 (one-month post baseline), significant intervention effects were found for participants’ daily step counts in both the total sample (P = .004), and the at-risk sample (P = .001). In the sample at risk, the intervention effects showed a daily step count increase of 1056 steps in the intervention group, compared to a decrease of 258 steps in the control group. Comparison of participants’ self-reported PA revealed a significant intervention effect for time spent walking in the at-risk sample (P = .02). Intervention effects were still significant three-months post baseline for participants’ daily step counts in both the total sample (P = .03) and the at-risk sample (P = .02); however, self-reported PA differences were no longer significant. Conclusions: A computer-tailored, pedometer-based PA intervention was effective in increasing both pedometer-based, and self-reported PA levels. However, more efforts should be devoted to recruit and retain participants in order to improve the public health impact of the intervention. Clinical Trial: ClinicalTrials.gov: NCT02080585
 
Date Submitted: Mar 16, 2014
Open Peer Review Period: Mar 20, 2014 - May 15, 2014
 
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Knowledge, attitudes and practices regarding to influenza A (H7N9) among mobile phone users: a rapid survey in Zhejiang province, Eastern China

Background: Knowledge, attitudes and practices (KAP) towards a particular disease is very crucial in new infectious disease prevention and control. However, they were often investigated at the cost of more human and material resources in traditional studies. Objective: The goal of this study was to more rapidly identify them regarding to A (H7N9) among mobile phone users in Zhejiang province. Methods: An anonymous questionnaire was designed by Zhejiang Provincial Center for Disease Control and Prevention (CDC). A cross-sectional survey was executed through a mobile Internet application platform of China Unicom in five regions in Zhejiang province. Results: A total of 9105 valid questionnaires were achieved for analysis. 8379(92.03%) respondents were familiar with A (H7N9) symptoms, while 2585 (25.14%) did not know that the virus could be transmitted by contacting with infected poultry. There were 5569(61.17%)respondents considered themselves to be influenced by A (H7N9) in daily life. About 4795 (52.66%) and 4291 (47.13%) respondents had taken preventive practices by avoiding crowding areas and increasing the frequency of hand-washing, respectively. At the occurrence of fever or cough, 1957 (21.49%) respondents did not choose to visit a hospital. Our results indicated 1147 (54.78%) and 1355 (64.71%) female respondents were likely to worry about being infected and to report being influenced by A (H7N9), respectively. Females were likely to take precautionary measures. Our findings also indicated that people with occupations related to the poultry industry and those received lower education, were more likely to worry about being infected, to report being influenced by A (H7N9),and to take precautionary measures. Young people were more likely to worry about being infected, but few of them would take preventive measures. Conclusions: Our study provides valuable insights into KAP related to A (H7N9) as well as public health in Zhejiang province. The public of five regions had gotten high level knowledge no matter there was an A(H7N9) outbreak or not. However, attitudes and practices levels were higher in areas with epidemic. Our government needs to enhance the public health education for some special groups, such males, young people, people with occupations related to the poultry industry, and those received lower education. The use of mobile internet devices presents a rapid method to survey KAP and quickly recruit a large number of participants to assess future public health events.
 
Date Submitted: Mar 13, 2014
Open Peer Review Period: Mar 14, 2014 - May 9, 2014
 
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The Effect of Online Chronic Disease Personas on Activation for Self-Management Original Paper

Background: Coronary artery disease (CAD), diabetes, asthma, and depression require patient self-care for effective disease management. Personas are composite summaries of detailed user research based on interviews with specific consumer groups. Personas offer a manageable way to visualize the end user while designing health intervention materials or programs. Personas have the potential to communicate empathically about the knowledge and skills necessary for self-care and guide selection of the right health information and tools for a particular audience. Personas can also be meaningful in creating content groupings so that multiple pieces of tailored content (learning paths) can be offered to patients. Online tailored communication using chronic disease health personas have not been tested for potential effectiveness in increasing patient activation with their health. Objective: Pre-post changes in self-reported levels of activation for self-management were analyzed for 11 chronic health personas developed for 4 prevalent chronic diseases. Methods: Creation of each persona began with completion of 20 to 25 hour-long non-directed interviews with consumers with a chronic disease. The interviews were transcribed and subsequently coded for behaviors, feelings, and beliefs using the principles of grounded theory. Participants for the online assessment were determined to be eligible through self-report of their personal health history through a commercial online recruitment service. Participants completed at least 1 module from any learning path or persona for their chronic disease. Participants were asked at pre-post to assess their standing on elements of activation on a 5-point Likert scale. The activation elements taken from an integrated theory of health behavior are knowledge of a given health issue, perceived skills in making personal health better, confidence in making personal health better, and intention to act to make personal health better. Data were analyzed with a mixed design with one within-subjects factor (pre-post) and one between-group factor (persona) and with the SPSS Statistics 21 General Linear Model with Repeated Measures. Results: A total of 398 participants were recruited (249 women and 149 men). Eighty-seven percent (345) of the participants were Caucasian/not Hispanic, and 79.9 % (318) were middle age and older. All but two of the within-subjects effects were significant at the .05 level or less on all pre-post measures of activation. All changes were in the direction of increased activation scores at post-test. Fifty percent or more of low activation participants shifted to high activation across the four measures with 8% (21) and less in the reverse direction. Conclusions: The majority of participants using a persona-tailored learning path reported high levels of satisfaction with their online user experience and increased levels of activation with regards to their own health. This communication approach may be of interest for engaging specific groups in self-management.
 
Date Submitted: Mar 13, 2014
Open Peer Review Period: Mar 14, 2014 - May 9, 2014
 
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A mixed methods study on using e-health to increase HIV testing and linkage to care among men who have sex with men in South China

Background: Worldwide, most HIV-positive men who have sex with men (MSM) do not know their HIV status. Mobile phones and web interventions (eHealth) show promise for supporting HIV testing and linkage to care. Objective: This mixed methods study among MSM in China assessed technology utilization and eHealth acceptability for sexual health care. Methods: We conducted in-depth interviews and an online survey. Qualitative analyses informed the development of the internet survey which was administered through two popular MSM websites. Bivariate and multivariate analysis assessed characteristics of MSM interested in eHealth for sexual health care. Results: The qualitative sample included MSM across a range of ages, education, marital status, sexuality, and HIV testing experience. Qualitative findings included the importance of the internet as the primary source of information about sexual health and HIV/STDs, use of the internet to enable HIV testing opportunities by facilitating connections with both the gay community and healthcare providers, and mixed perceptions regarding the confidentiality of eHealth tools for sexual health. Among the internet sample (n=1342), average age was 30.6 years old, 82.81% were single, and 53.42% had completed college. In the past 3 months, 38.66% had unprotected anal intercourse and 60.53% self-reported having ever tested for HIV. The majority of men owned computers (94.14%) and mobile phones (92.32%) which many had used to search online for HIV/STD information and testing sites. In multivariate analysis, interest in eHealth for sexual health care was associated with accessing the internet daily by phone, past HIV testing, and confidentiality concerns. Conclusions: MSM in this sample had high utilization of technology and interest in eHealth in spite of confidentiality concerns. Future eHealth interventions can thoughtfully and creatively address these concerns as a priority for successful implementation.
 
Date Submitted: Mar 12, 2014
Open Peer Review Period: Mar 12, 2014 - May 7, 2014
 
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Digital inequalities of family life information seeking and family well-being among Chinese adults in Hong Kong

Background: Inequalities in internet use and health information seeking are well-documented, but less is known on information for family life activities. Objective: We investigated the social determinants of online family life information seeking (FLIS) behaviours and its associations with family well-being among Chinese adults. Methods: A probability-based telephone survey was conducted in 2012 to record FLIS behaviours including frequency of seeking and paying attention to family life information, levels of trust and perceived usefulness of family life information. Family well-being was assessed using three single items on perceived family harmony, happiness and health with higher scores indicating greater well-being. Adjusted odds ratios for FLIS behaviours by socioeconomic characteristics and lifestyle behaviours, and adjusted β-coefficients for family well-being by FLIS behaviours were calculated. Results: Of 1537 respondents, 57.6% had ever and 26.5% sought monthly for family life information through internet. Lower educational attainment and household income, smoking and physical inactivity were associated with less frequent seeking and paying attention (all p<0.05). Greater perceived family health was associated with more frequent attention (adjusted β=0.32, 95% CI: 0.11 to 0.52), greater levels of trust (0.28, 0.07 to 0.48) and perceived usefulness (0.23, 0.01 to 0.45). Frequent attention and higher level of trust were also associated with greater family harmony (0.22, 0.002 to 0.41) and happiness (0.23, 0.003 to 0.42), respectively. Conclusions: This is the first study investigating family life information seeking behaviours and suggested inequalities of online FLIS behaviours. The association between FLIS behaviours and family well-being needs to be confirmed in prospective studies.
 
Date Submitted: Mar 7, 2014
Open Peer Review Period: Mar 7, 2014 - May 2, 2014
 
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Effects of Performance Feedback on CHW Motivation and Performance, a randomized control study of CHWs in Madhya Pradesh, India

Background: CHWs working with an m-health platform to reduce malnutrition in 5 districts of Madhya Pradesh, India,received weekly calls relaying their performance feedback on specific indicators identified by their program. Objective: To evaluate the immediate and retention effects of providing performance feedback and supportive supervision on CHW motivation and performance.Hypothesis: We expect positive impact of performance feedback on CHW’s performance on the indicator on which they receive feedback. Performance on indicators on which the CHW does not receive feedback is not expected to change. Methods: Design: Randomized control trial; 60 CHW’s were randomized into three treatment groups based on overall baseline performance ranks to achieve balanced treatment groups. Data for each treatment indicator is analyzed with the remaining two treatments acting as the control. 10 CNEs were lost to follow up. Main Outcome Variables: Three performance indicators, case activity, form submissions, and duration of counseling. Intervention: Each group received weekly calls to provide performance targets and discuss their performance on the specific indicator they were allocated to, as well as any challenges or technical issued faced during the week, for a six week period. Data was collected for a further four weeks to assess inter-temporal sustained effects of the intervention. Results: We find positive and significant impacts on duration of counseling, while case activity and number of form submissions do not show significant improvements as a result of the intervention. We find moderate to large effect (effect size=.974, P=.004) of providing performance feedback on counseling times in the initial six weeks. These effects were sustained the post-intervention period (effect size=1.69, P=.000). The counseling times decreased slightly from the intervention to post intervention period by 2.14 minutes (P =.015). Case activity improved for all CNEs after the intervention. We also performed the analysis by replacing the CNEs lost to follow up with those in their treatment groups with the closest ranks in baseline performance with similar results. Conclusions: Conclusion: Calls providing performance feedback are effective in improving CHW motivation and performance. Providing feedback had positive effect on performance in the case of duration of counseling. The results suggest that difficulty of achieving the performance target can affect results of performance feedback. Regardless of the performance information disclosed, calls can improve performance due to elements of supportive supervision included in the calls encouraging CHW motivation Clinical Trial: No trial registration since the intervention does not look at patients, drugs, or any health outcomes.
 
Date Submitted: Mar 6, 2014
Open Peer Review Period: Mar 7, 2014 - May 2, 2014
 
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CohortExplorer: A generic application programming interface (API) for entity attribute value database schemas

Background: Most electronic data capture tools developed to collect and store clinical data from participants recruited into studies are based on generic Entity-Attribute-Value (EAV) database schemas which enable rapid and flexible deployment in a range of study designs. The drawback to such schemas is that they are cumbersome to query with structured query language (SQL). The problem increases when researchers involved in multiple studies use multiple electronic data capture tools each with variation on the EAV schema. Objective: Develop a generic tool which allows easy and rapid exploration of data and metadata stored under any EAV schema. Methods: CohortExplorer is written in Perl programming language and uses the concept of SQL abstract which allows the SQL query to be treated like a hash (key-value pairs). Results: We have developed a tool, CohortExplorer, which will ‘plug-n-play’ with EAV schemas, enabling the easy construction of complex queries through an abstracted interface. To demonstrate the utility of the CohortExplorer tool, we show how it can be used with the popular EAV based frameworks; Opal (OBiBa) and REDCap. Conclusions: The tool is available under a GPL-3+ license at the following URL: https://metacpan.org/pod/CohortExplorer.
 
Date Submitted: Mar 3, 2014
Open Peer Review Period: Mar 5, 2014 - Apr 30, 2014
 
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Understanding and Predicting Social Media Use for Health Information and Support among Community Health Center Patients

Background: The use of social media by health care organizations is growing and provides web-based tools to connect patients, caregivers and providers. Objective: To determine the use and factors predicting the use of social media for health care related purposes among medically underserved primary care patients. Methods: A cross-sectional survey was administered to 444 patients of a federally qualified community health center. Results: Community health center patients prefer that their providers use email, cell phone for texting, and Facebook and cell phone apps for sharing health information. Significantly more Hispanic than Caucasian patients believed their providers should use Facebook, YouTube and Twitter for sharing health information. Use and intentions to use social media for health related purposes were significantly higher for those patients with higher subjective norm scores. Conclusions: Understanding use and factors predicting use can increase adoption and utilization of social media for health care related purposes among underserved patients in community health centers.
 
Date Submitted: Mar 3, 2014
Open Peer Review Period: Mar 4, 2014 - Apr 29, 2014
 
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Seeking health information and support online – does it differ as a function of engagement in risky health behaviours? Evidence from the Health Information National Trends Survey

Background: The Internet is an important tool to deliver health behaviour interventions; yet, little is known about Internet access and use for health-related or medical information/topics and support (HMIS) by the intended intervention targets. Objective: To evaluate whether health-related Internet use differed as a function of common health behaviours (excessive alcohol consumption, smoking, poor diet, inactive/sedentary lifestyle, unprotected sun exposure or overeating/obesity). Methods: Socio-demographic, health behaviour characteristics and information on Internet access and use were assessed in the nationally representative US Health Information National Trends Survey (HINTS) 4. Data from 3,911 participants collated in 2011/12 were included. Results: Over three-quartOver three-quarters of participants (78.2%, 95%CI 76.1-80.1) had ever accessed the Internet, of whom a similar proportion (78.2%, 95%CI 75.4-80.7) had obtained HMIS online last year. Adjusting for socio-demographic determinants associated with going online (being younger, white, female, with at least college education) revealed few differences in Internet access and use between health-risk behaviours. Participants with inadequate sun protection were less likely to access the Internet (OR 0.59, 95%CI 0.04-0.88), those with a poor diet were less likely to have gone online to obtain HMIS last year (OR 0.60, 95%CI 0.45-0.80) or to pay attention to the Internet for HMIS (OR 0.57, 95%CI 0.35-0.95) as were participants with a sedentary lifestyle (OR 0.45, 95%CI 0.20-1.00). Conclusions: Internet access and use to obtain HMIS is mostly independent of engagement in health-risk behaviours. However, when developing online health promotions, relevant socio-demographic determinants need to be targeted to maximise impact; those with a poor diet, sedentary lifestyle or inadequate sun-protective behaviours may be more difficult to reach with Internet interventions.
 
Date Submitted: Mar 2, 2014
Open Peer Review Period: Mar 4, 2014 - Apr 29, 2014
 
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Usability Evaluation of a Mobile Application to Support Cancer Patients in Illness Management

Background: Smartphones and tablet PCs have currently achieved a significant presence in people’s everyday lives. They enable access to different information and services independent of current place and time. Such widespread connectivity offers a lot of potential in different application areas including healthcare. Objective: In this paper we present the results of the usability evaluation study of the Connect Mobile application. The mobile application enables mobile access to the Connect system, an online system that supports cancer patients in managing health-related issues. Along with symptoms management, this system promotes better patient-provider communication, collaboration, and shared decision-making. The Connect Mobile application enables access to the Connect system over both smartphones and tablet PCs. Methods: The study consisted of usability tests of a high fidelity prototype where the objectives were to identify existing design and functionality issues and to provide patients with a real look-and-feel of the mobile system. In addition, we conducted semi-structured interviews to gain participants’ feedback about application usefulness, identify the need for new system features and design requirements, and measure the acceptance of the mobile application and its features within everyday health management. Results: The study revealed a total of 27 design issues (13 for mobile application and 14 for tablet application) which were mapped to source events (errors, requests for help, participant’s concurrent feedback, and moderator observation). We also applied usability heuristics to identify violations of usability principles. The majority of violations were related to enabling ease of input, screen readability, and glanceability (15 issues) and supporting appropriate match between systems and real world (7 issues) and consistent mapping of system’s functions and interactions (4 issues). The feedback from the participants additionally showed us the cancer patients’ requirements for support systems and how these needs are influenced by different context related factors, such as type of access terminal (e.g. desktop PC, tablet, smartphone) and phases of illness. Based on the observed results, we proposed design and functionality guidelines that can be used for the development of mobile applications for cancer patients to support their health management process. Conclusions: Understanding and addressing users’ requirements is one of the main prerequisites for developing useful and effective technologically based health interventions. The results of this study outline different user requirements that are related to the design of the mobile patient support application for cancer patients. The results will be employed in the iterative development of Connect Mobile application, and can be also used by other developers and researchers in development, integration and evaluation of mobile health applications and services that support cancer patients in managing their health related issues and problems.
 
Date Submitted: Feb 28, 2014
Open Peer Review Period: Feb 28, 2014 - Apr 25, 2014
 
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Reproducibility and Validity of the online Food4Me Food Frequency Questionnaire against a 4-day Weighed Food Record

Background: Advances in nutritional assessment are continuing to embrace developments in computer technology. The online Food4Me FFQ was created as an electronic system for the collection of nutrient intake data. To ensure its accuracy in assessing both nutrient and food group intake, further validation against data obtained using a reliable, but independent, instrument and assessment of its reproducibility are required. Objective: To assess the reproducibility and validity of the Food4Me FFQ against a 4-day weighed food record (WFR). Methods: Reproducibility of the Food4Me FFQ was assessed using test-retest methodology by asking participants to complete the FFQ on two occasions four weeks apart. To assess the validity of the Food4Me FFQ against the 4-day WFR, half the participants were also asked to complete a 4-day WFR one week after the first administration of the Food4Me-FFQ. Level of agreement between nutrient and food group intakes estimated by the repeated Food4Me FFQ and the Food4Me FFQ and 4-day WFR were evaluated using Bland and Altman methodology and classification into quartiles of daily intake. Crude unadjusted correlation coefficients were also calculated for nutrient and food group intakes. Results: In total, 100 subjects participated in the assessment of reproducibility (mean age 32 ± 12 y), and 49 of these (mean age 27 ± 8 y) also took part in the assessment of validity. Crude unadjusted correlations for repeated Food4Me FFQ ranged from 0.65 (vitamin D) to 0.90 (alcohol). The mean cross-classification into exact plus adjacent quartiles was 92% for both nutrient and food group intakes, and Bland and Altman plots showed good agreement for energy adjusted macronutrient intakes. Agreement between the Food4Me FFQ and 4-day WFR varied, with crude unadjusted correlations ranging from 0.23 (Vitamin D) to 0.65 (Protein, %TE) for nutrient intakes and 0.11 (soups, sauces & miscellaneous foods) to 0.73 (yoghurts) for food group intake. The mean cross-classification into exact plus adjacent quartiles was 80% and 78% for nutrient and food group intake respectively. There were no significant differences between energy intakes estimated using the Food4Me FFQ and 4-day WFR, and Bland and Altman plots showed good agreement for both energy and energy controlled nutrient intakes. Conclusions: The results demonstrate that the online Food4Me FFQ is reproducible for assessing nutrient and food group intake, and has good agreement with the 4-day WFR for assessing energy and energy-adjusted nutrient intakes. The Food4Me FFQ is a suitable online tool for assessing dietary intake in healthy adults.
 
Date Submitted: Feb 27, 2014
Open Peer Review Period: Feb 28, 2014 - Apr 25, 2014
 
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Diet App Use in Sports Nutrition: A Survey in Five Countries

Background: While there are hundreds of diet apps available for use on smartphones, there have been no studies that have examined the use of diet applications (diet apps) for the purpose of dietary assessment in sports nutrition. Objective: To assess sports dietitians’ prevalence of using smartphone diet apps for dietary assessment, and sports dietitians’ perception of the effectiveness of diet app use for recording and assessing dietary intake. Methods: A cross-sectional online survey to assess smartphone diet app use in sports dietetics was developed and distributed between 22 June and 11 November 2012 to sports dietitians in Australia, Canada, New Zealand, the United Kingdom, and the United States of America (USA). Results: The overall response rate from the 1709 sports dietitians invited to participate was 10.3% (n=180). Smartphone diet apps were used by 32.4% (57/176) of sports dietitians to help them assess the dietary intake of athletes. Sports dietitians from the USA were more likely to use diet apps than sports dietitians from other countries (OR = 5.61, 95% CI 1.84–17.08, P = .002). Sports dietitians used twenty-eight different diet apps, with 56% (32/57) choosing MyFitnessPal. Sports dietitians held a positive perception of diet apps, with the majority of respondents viewing diet apps as “better” (25/53, 47%) or “equivalent” (22/53, 41%) when compared with traditional dietary assessment methods. Conclusions: Nearly one-third of sports dietitians used smartphone diet apps in sports nutrition, and viewed them as useful in helping to record and assess the dietary intake of athletes.
 
Date Submitted: Feb 25, 2014
Open Peer Review Period: Feb 26, 2014 - Apr 23, 2014
 
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Effectiveness of a video- and text-based computer-tailored smoking cessation intervention among LSES and HSES smokers

Background: In western countries smoking prevalence rates are high among unmotivated people and people with a lower socioeconomic status (LSES). Multiple computer tailoring and the use of visual aids may improve such interventions and increase cessation in LSES smokers. Objective: This study assessed the 12-month effectiveness of a video- and text-based computer-tailored intervention, and potential differential effects for subgroups varying in socioeconomic status (SES) and motivation to quit. Methods: A randomized controlled trial was used in which smokers were allocated to the video-based condition (N=670), the text-based condition (N=708) or the control condition (brief generic text advice) (N=721). After 12 months, self-reported prolonged abstinence was investigated and biochemically verified in respondents who indicated they had quit smoking. Multiple imputation analyses were used as primary analyses, whereas complete case and a negative scenario (respondents lost to follow-up considered as smokers) were conducted as secondary analyses. Results: Primary analyses revealed that the video-based computer-tailored intervention was more effective on prolonged abstinence compared to the control condition (OR=1.90, p=.005) and the text-based condition (OR=1.71, p=.01). No differential effects were found for people with different SES levels and different motivational levels. Results were confirmed in the complete cases and negative scenario analyses. Conclusions: The video-based computer-tailored intervention is effective to help smokers in achieving long-term smoking abstinence. Clinical Trial: Trial Registration: Netherlands Trial Register (NTR3102).
 
Date Submitted: Feb 25, 2014
Open Peer Review Period: Feb 26, 2014 - Apr 23, 2014
 
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An AIDS-denialist Online Community in a Russian Social Networking Service: Patterns of Interactions with the Newcomers and Rhetorical Strategies of Persuasion

Background: The rise of social media proved to be a fertile ground for the expansion of AIDS-denialist movement (in form of online communities). While there is substantial literature devoted to disproving AIDS-denialist views there is dearth of studies exploring AIDS-denialists as online communities that interact with external environment. Objective: We explored three research questions: why newcomers come to an AIDS-denialist community; what are patterns of interactions of the community with the newcomers; what are rhetorical strategies that denialists employ for persuasion in the veracity of their views. Methods: We studied the largest AIDS-denialist community in one of the most popular social networking services in Russia. We used netnography as a method for collecting data for qualitative analysis. We observed the community during 9 months (at least 2-3 times a week). While doing netnography we periodically downloaded the community discussions. In total we have downloaded 4821 posts and comments for analysis. Grounded theory approach was used for data analysis. Results: Most people come to the community for the following reasons: their stories do not fit the unitary picture of AIDS disease progression translated by popular and popular medical discourses; health problems; concern about HIV-positive tests; desire to dissuade the community members from false AIDS-beliefs. On the basis of strength in AIDS-denialist beliefs we constructed a typology of the newcomers that consists of the three idealtypical groups: ‘convinced’ (who already had become dissidents before coming to the group); ‘doubters’ – who are undecided as to the truth of either HIV science theory or AIDS-denialist theory; ‘orthodox’ – who openly hold HIV science views. Reception of a newcomer mainly depends on the newcomer’s belief status – it is very warm for ‘convinced’, cold or slightly hostile for ‘doubters’ and extremely hostile or derisive for ‘orthodox’. We identified sixth main rhetorical strategies of persuasion of the undecideds on the issue used by denialists. Conclusions: Contrary to the widespread public health depictions of AIDS-denialists as totally irrational, our study suggests that some of those who become AIDS-denialist have sufficiently reasonable grounds to suspect that 'something is wrong' with the scientific theory because their personal experience contradicts the unitary picture of AIDS disease progression they have in mind. Odd and inexplicable practices of some AIDS-centers only fuel these people's suspicions. We can conclude that public health practitioners’ practices may play a role in generating AIDS-denialists sentiments. In interactions with the newcomers the experienced community members highlighted the importance of personal autonomy and freedom of choice in decision-making consistent with the consumerist ideology of healthcare. The study findings suggest that healthcare workers should change a one-size-fits-all mode of counseling for a more complex and patient-tailored approach, allowing for diversity of disease progression scenarios and scientific uncertainty.
 
Date Submitted: Feb 19, 2014
Open Peer Review Period: Feb 24, 2014 - Apr 21, 2014
 
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