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Journal Description

The Journal of Medical Internet Research (JMIR), now in its 20th year, is the pioneer open access eHealth journal and is the flagship journal of JMIR Publications. It is the leading digital health journal globally in terms of quality/visibility (Impact Factor 2017: 4.671, ranked #1 out of 22 journals) and in terms of size (number of papers published). The journal focuses on emerging technologies, medical devices, apps, engineering, and informatics applications for patient education, prevention, population health and clinical care. As leading high-impact journal in its' disciplines (health informatics and health services research), it is selective, but it is now complemented by almost 30 specialty JMIR sister journals, which have a broader scope. Peer-review reports are portable across JMIR journals and papers can be transferred, so authors save time by not having to resubmit a paper to different journals. 

As open access journal, we are read by clinicians, allied health professionals, informal caregivers, and patients alike, and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).

We are also a leader in participatory and open science approaches, and offer the option to publish new submissions immediately as preprints, which receive DOIs for immediate citation (eg, in grant proposals), and for open peer-review purposes. We also invite patients to participate (eg, as peer-reviewers) and have patient representatives on editorial boards.

Be a widely cited leader in the digitial health revolution and submit your paper today!

 

Recent Articles:

  • Source: YouTube / Placeit; Copyright: JMIR Publications; URL: http://www.jmir.org/2019/1/e11935/; License: Creative Commons Attribution (CC-BY).
    Quality/Credibility of eHealth...

    Jan 16, 2019

    The Absence of Evidence is Evidence of Non-Sense: Cross-Sectional Study on the Quality of Psoriasis-Related Videos on YouTube and Their Reception by Health...

    Authors List:

    Abstract:

    Background: Approximately 80% of internet users access health information online and patients with chronic illnesses especially rely on internet-based resources. YouTube ranks second among the most accessed websites worldwide and hosts an increasing number of videos with medical information. However, their quality is sometimes unscientific, misleading, or even harmful. Objective: As little is known about YouTube as a source of information on psoriasis, we aimed to investigate the quality of psoriasis-related videos and, if necessary, point out strategies for their improvement. Methods: The quality of the 100 most viewed psoriasis-related videos was assessed using the DISCERN instrument and the Global Quality Scale (GQS) by categorizing the videos into useful, misleading, and dangerous and by evaluating the reception of the videos by users. Results: Evaluation of the videos exhibited a total of 117,221,391 views and a total duration of 10:28 hour. The majority of clips contained anecdotal personal experiences with complementary and alternative psoriasis treatments, topical treatments, and nutrition and diets being the most frequently addressed topics. While advertisements accounted for 26.0% (26/100) of the videos, evidence-based health information amounted to only 20.0% (20/100); 32.0% (32/100) of the videos were classified as useful, 52.0% (52/100) as misleading, and 11.0% (11/100) as even dangerous. The quality of the videos evaluated by DISCERN and GQS was generally low (1.87 and 1.95, respectively, on a 1 to 5 scale with 5 being the maximum). Moreover, we found that viewers rated poor-quality videos better than higher quality videos. Conclusions: Our in-depth study demonstrates that nearly two-thirds of the psoriasis-related videos we analyzed disseminate misleading or even dangerous content. Subjective anecdotal and unscientific content is disproportionately overrepresented and poor-quality videos are predominantly rated positively by users, while higher quality video clips receive less positive ratings. Strategies by professional dermatological organizations are urgently needed to improve the quality of information on psoriasis on YouTube and other social media.

  • Price-per-unit feature on OpenPrescribing.net, which was one of the features tested in the study. Source: OpenPrescribing.net / Placeit; Copyright: JMIR Publications; URL: http://www.jmir.org/2019/1/e10929; License: Creative Commons Attribution (CC-BY).
    Clinical Informatics

    Jan 16, 2019

    Measuring the Impact of an Open Web-Based Prescribing Data Analysis Service on Clinical Practice: Cohort Study on NHS England Data

    Authors List:

    Abstract:

    Background: OpenPrescribing is a freely accessible service that enables any user to view and analyze the National Health Service (NHS) primary care prescribing data at the level of individual practices. This tool is intended to improve the quality, safety, and cost-effectiveness of prescribing. Objective: We aimed to measure the impact of OpenPrescribing being viewed on subsequent prescribing. Methods: Having preregistered our protocol and code, we measured three different metrics of prescribing quality (mean percentile across 34 existing OpenPrescribing quality measures, available “price-per-unit” savings, and total “low-priority prescribing” spend) to see whether they changed after the viewing of Clinical Commissioning Group (CCG) and practice pages. We also measured whether practices whose data were viewed on OpenPrescribing differed in prescribing, prior to viewing, compared with those who were not. We used fixed-effects and between-effects linear panel regression to isolate change over time and differences between practices, respectively. We adjusted for the month of prescribing in the fixed-effects model to remove underlying trends in outcome measures. Results: We found a reduction in available price-per-unit savings for both practices and CCGs after their pages were viewed. The saving was greater at practice level (−£40.42 per thousand patients per month; 95% CI −54.04 to −26.81) than at CCG level (−£14.70 per thousand patients per month; 95% CI −25.56 to −3.84). We estimate a total saving since launch of £243 thosand at practice level and £1.47 million at CCG level between the feature launch and end of follow-up (August to November 2017) among practices viewed. If the observed savings from practices viewed were extrapolated to all practices, this would generate £26.8 million in annual savings for the NHS, approximately 20% of the total possible savings from this method. The other two measures were not different after CCGs or practices were viewed. Practices that were viewed had worse prescribing quality scores overall prior to viewing. Conclusions: We found a positive impact from the use of OpenPrescribing, specifically for the class of savings opportunities that can only be identified by using this tool. Furthermore, we show that it is possible to conduct a robust analysis of the impact of such a Web-based service on clinical practice.

  • NSFS researchers collect data. Source: Image created by the Authors; Copyright: Meagan Hanbury; URL: http://www.jmir.org/2019/1/e10861/; License: Creative Commons Attribution (CC-BY).
    Electronic/Mobile Data Capture,...

    Jan 16, 2019

    A Web-Based Application to Improve Data Collection in an Interventional Study Targeting Childhood Obesity: Pre-Post Analysis

    Authors List:

    Abstract:

    Background: Although participatory action research (PAR) studies have proliferated in recent years, the development of technological resources to manage these types of projects has not kept pace. Few studies show how Web-based applications can be used to efficiently manage the data collection process. Objective: This study described the development, use, and impact of a Web-based application to facilitate data management in Niños Sanos, Familia Sana (Healthy Children, Healthy Family), an interventional multifaceted PAR field study. Methods: We described the transformation of the data management process and evaluated the impact of the application in terms of time efficiency of data collection and engagement of community-based data collectors. We defined time efficiency as the total number of days it took to collect 3 main surveys, per year of data collection. The engagement of data collectors was assessed based on qualitative reports. Results: The amount of time it took to perform a round of data collection was reduced after implementation of the field team application (between 382 and 383 days and 198 and 233 days). Secondary data were also collected in a tighter time frame around collection of the primary outcome, and communication among data collectors, the field staff, and the research team was streamlined. In focus groups, community-based data collectors reported feeling more empowered and engaged in the data collection process after implementation of the application. Conclusions: A Web-based management application was successful in improving data collection time efficiency and engagement among data collectors.

  • TOC image. Source: Rawpixel; Copyright: Jira; URL: https://www.rawpixel.com/image/380342; License: Licensed by JMIR.
    Personal Health Records,...

    Jan 16, 2019

    Improving Electronic Health Record Note Comprehension With NoteAid: Randomized Trial of Electronic Health Record Note Comprehension Interventions With...

    Authors List:

    Abstract:

    Background: Patient portals are becoming more common, and with them, the ability of patients to access their personal electronic health records (EHRs). EHRs, in particular the free-text EHR notes, often contain medical jargon and terms that are difficult for laypersons to understand. There are many Web-based resources for learning more about particular diseases or conditions, including systems that directly link to lay definitions or educational materials for medical concepts. Objective: Our goal is to determine whether use of one such tool, NoteAid, leads to higher EHR note comprehension ability. We use a new EHR note comprehension assessment tool instead of patient self-reported scores. Methods: In this work, we compare a passive, self-service educational resource (MedlinePlus) with an active resource (NoteAid) where definitions are provided to the user for medical concepts that the system identifies. We use Amazon Mechanical Turk (AMT) to recruit individuals to complete ComprehENotes, a new test of EHR note comprehension. Results: Mean scores for individuals with access to NoteAid are significantly higher than the mean baseline scores, both for raw scores (P=.008) and estimated ability (P=.02). Conclusions: In our experiments, we show that the active intervention leads to significantly higher scores on the comprehension test as compared with a baseline group with no resources provided. In contrast, there is no significant difference between the group that was provided with the passive intervention and the baseline group. Finally, we analyze the demographics of the individuals who participated in our AMT task and show differences between groups that align with the current understanding of health literacy between populations. This is the first work to show improvements in comprehension using tools such as NoteAid as measured by an EHR note comprehension assessment tool as opposed to patient self-reported scores.

  • Telemedicine for patients with sepsis. Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/serious-doctor-using-laptop-in-office_3004187.htm; License: Licensed by JMIR.
    Telehealth and Telemonitoring

    Jan 15, 2019

    Additional Telemedicine Rounds as a Successful Performance-Improvement Strategy for Sepsis Management: Observational Multicenter Study

    Authors List:

    Abstract:

    Background: Sepsis is a major health care problem with high morbidity and mortality rates and affects millions of patients. Telemedicine, defined as the exchange of medical information via electronic communication, improves the outcome of patients with sepsis and decreases the mortality rate and length of stay in the intensive care unit (ICU). Additional telemedicine rounds could be an effective component of performance-improvement programs for sepsis, especially in underserved rural areas and hospitals without ready access to critical care physicians. Objective: Our aim was to evaluate the impact of additional daily telemedicine rounds on adherence to sepsis bundles. We hypothesized that additional telemedicine support may increase adherence to sepsis guidelines and improve the detection rates of sepsis and septic shock. Methods: We conducted a retrospective, observational, multicenter study between January 2014 and July 2015 with one tele-ICU center and three ICUs in Germany. We implemented telemedicine as part of standard care and collected data continuously during the study. During the daily telemedicine rounds, routine screening for sepsis was conducted and adherence to the Surviving Sepsis Campaign’s 3-hour and 6-hour sepsis bundles were evaluated. Results: In total, 1168 patients were included in this study, of which 196 were positive for severe sepsis and septic shock. We found that additional telemedicine rounds improved adherence to the 3-hour (Quarter 1, 35% vs Quarter 6, 76.2%; P=.01) and 6-hour (Quarter 1, 50% vs Quarter 6, 95.2%; P=.001) sepsis bundles. In addition, we noted an increase in adherence to the item “Administration of fluids when hypotension” (Quarter 1, 80% vs Quarter 6, 100%; P=.049) of the 3-hour bundle and the item “Remeasurement of lactate” (Quarter 1, 65% vs Quarter 6, 100%, P=.003) of the 6-hour bundle. The ICU length of stay after diagnosis of severe sepsis and septic shock remained unchanged over the observation period. Due to a higher number of patients with sepsis in Quarter 5 (N=60) than in other quarters, we observed stronger effects of the additional rounds on mortality in this quarter (Quarter 1, 50% vs Quarter 5, 23.33%, P=.046). Conclusions: Additional telemedicine rounds are an effective component of and should be included in performance-improvement programs for sepsis management.

  • Play testing. Source: The Authors; Copyright: The Authors; URL: https://www.jmir.org/2019/1/e11528/; License: Licensed by JMIR.
    Viewpoint

    Jan 14, 2019

    Use of the Principles of Design Thinking to Address Limitations of Digital Mental Health Interventions for Youth: Viewpoint

    Authors List:

    Abstract:

    Numerous reviews and meta-analyses have indicated the enormous potential of technology to improve the appeal, effectiveness, cost, and reach of mental health interventions. However, the promise of digital mental health interventions for youth has not yet been realized. Significant challenges have been repeatedly identified, including engagement, fidelity, and the lack of personalization. We introduce the main tenets of design thinking and explain how they can specifically address these challenges, with an entirely new toolbox of mindsets and practices. In addition, we provide examples of a new wave of digital interventions to demonstrate the applicability of design thinking to a wide range of intervention goals. In the future, it will be critical for scientists and clinicians to implement their scientific standards, methods, and review outlets to evaluate the contribution of design thinking to the next iteration of digital mental health interventions for youth.

  • Source: Flickr; Copyright: kleneway1379; URL: https://www.flickr.com/photos/21060335@N03/8746122580; License: Creative Commons Attribution (CC-BY).
    Participatory Medicine & E-Patients

    Jan 14, 2019

    Evaluating Digital Maturity and Patient Acceptability of Real-Time Patient Experience Feedback Systems: Systematic Review

    Authors List:

    Abstract:

    Background: One of the essential elements of a strategic approach to improving patients’ experience is to measure and report on patients’ experiences in real time. Real-time feedback (RTF) is increasingly being collected using digital technology; however, there are several factors that may influence the success of the digital system. Objective: The aim of this review was to evaluate the digital maturity and patient acceptability of real-time patient experience feedback systems. Methods: We systematically searched the following databases to identify papers that used digital systems to collect RTF: The Cochrane Library, Global Health, Health Management Information Consortium, Medical Literature Analysis and Retrieval System Online, EMBASE, PsycINFO, Web of Science, and CINAHL. In addition, Google Scholar and gray literature were utilized. Studies were assessed on their digital maturity using a Digital Maturity Framework on the basis of the following 4 domains: capacity/resource, usage, interoperability, and impact. A total score of 4 indicated the highest level of digital maturity. Results: RTF was collected primarily using touchscreens, tablets, and Web-based platforms. Implementation of digital systems showed acceptable response rates and generally positive views from patients and staff. Patient demographics according to RTF responses varied. An overrepresentation existed in females with a white predominance and in patients aged ≥65 years. Of 13 eligible studies, none had digital systems that were deemed to be of the highest level of maturity. Three studies received a score of 3, 2, and 1, respectively. Four studies scored 0 points. While 7 studies demonstrated capacity/resource, 8 demonstrated impact. None of the studies demonstrated interoperability in their digital systems. Conclusions: Patients and staff alike are willing to engage in RTF delivered using digital technology, thereby disrupting previous paper-based feedback. However, a lack of emphasis on digital maturity may lead to ineffective RTF, thwarting improvement efforts. Therefore, given the potential benefits of RTF, health care services should ensure that their digital systems deliver across the digital maturity continuum.

  • Searching symptoms (montage). Source: The Authors / Smartmockups; Copyright: The Authors; URL: https://www.jmir.org/2019/1/e10868/; License: Creative Commons Attribution (CC-BY).
    Web-based and Mobile Health...

    Jan 11, 2019

    A Novel Insight Into the Challenges of Diagnosing Degenerative Cervical Myelopathy Using Web-Based Symptom Checkers

    Authors List:

    Abstract:

    Background: Degenerative cervical myelopathy (DCM) is a common debilitating condition resulting from degeneration of the cervical spine. While decompressive surgery can halt disease progression, existing spinal cord damage is often permanent, leaving patients with lifelong disability. Early surgery improves the likelihood of recovery, yet the average time from the onset of symptoms to correct diagnosis is over 2 years. The majority of delays occur initially, before and within primary care, mainly due to a lack of recognition. Symptom checkers are widely used by patients before medical consultation and can be useful for preliminary triage and diagnosis. Lack of recognition of DCM by symptom checkers may contribute to the delay in diagnosis. Objective: The aims of this study were to investigate whether Web-based symptom checkers were able to recognize relevant symptoms of DCM, to characterize the DCM differential they returned , and to evaluate the diagnostic performance of recognized DCM symptoms. Methods: We pooled classical DCM symptoms from leading review articles. These symptoms were entered into the algorithms used by the top 20 symptom checker websites (N=4; Google Search). The most widely cited symptom checker, WebMD, was used to characterize the differential diagnosis for DCM symptoms. Results: A total of 31 classical DCM symptoms were identified, of which 45% (14/31) listed DCM as a differential and 10% (3/31) placed DCM in the top third of the differential. The mean differential rank for motor symptoms was significantly better than that for arthritic symptoms (P=.01) and the average differential rank for all symptoms (P=.048). The symptom checker WebMD performed best at recognizing DCM, placing the condition nearer to the top of the differential list (mean rank of 5.6) than either Healthline (rank of 12.9, P=.02) or Healthtools.AARP (rank of 15.5, P=.001). On WebMD, only one combination of symptoms resulted in DCM as the primary differential: neck, shoulder, and arm pain with hand weakness. Moreover, 151 differential diagnoses for DCM symptoms were recorded on WebMD. Multiple sclerosis and peripheral neuropathy were the most common differentials, shortlisted for 52% (16/31) and 32% (10/31) of the DCM symptoms, respectively. Conclusions: DCM symptoms are poorly identified by Web-based symptom checkers, which leads to a large differential of many other common conditions. While a diagnosis becomes more likely as the number of symptoms increases, this represents more advanced disease and will not support much-needed earlier diagnosis. Symptom checkers remain an attractive concept with potential. Further research is required to support their optimization.

  • Source: Pexels; Copyright: Tristan Le; URL: https://www.pexels.com/photo/smiling-man-and-woman-wearing-jackets-1642883/; License: Licensed by JMIR.
    Medicine 2.0: Social Media, Open,...

    Jan 10, 2019

    Using the Facebook Advertisement Platform to Recruit Chinese, Korean, and Latinx Cancer Survivors for Psychosocial Research: Web-Based Survey Study

    Authors List:

    Abstract:

    Background: Ethnic minority cancer survivors remain an understudied and underrepresented population in cancer research, in part, due to the challenge of low participant recruitment rates. Therefore, identifying effective recruitment strategies is imperative for reducing cancer health disparities among this population. With the widespread use of social media, health researchers have turned to Facebook as a potential source of recruitment. Objective: We aimed to evaluate the feasibility and effectiveness of purchasing ads on Facebook to recruit Chinese, Korean, and Latinx cancer survivors residing in the United States. We assessed their experience with participating in a Web-based survey and their interest for future research. Methods: We showed 5 purchased ads in English, simplified Chinese, traditional Chinese, Korean, and Spanish on Facebook. Participants who clicked on the Facebook ad were directed to the study website and asked to submit their emails to receive the link to the 30-minute Web-based survey. Inclusion criteria included being of Asian or Latinx heritage, age ≥18 years, having a cancer diagnosis, and being within 5 years of cancer treatment. Participants who completed the survey were sent a US $10 Walmart eGiftcard. Results: The Facebook ads were shown for 48 consecutive days for a total spending of US $1200.46 (US $25/day budget). Overall, 11 East Asian and 15 Latinx cancer survivors completed the study, resulting in an average cost per participant of US $46.17. The East Asian and Latinx cancer survivors did not significantly differ in age, years lived in the United States, education level, generation status, and time since diagnosis. However, Latinx cancer survivors were marginally more likely to have limited English proficiency and lower annual income than East Asian cancer survivors. Both Latinx and East Asian cancer survivors reported that they enjoyed participating in this study and indicated an interest in participating in future psychosocial research studies. Conclusions: The use of Facebook ads successfully resulted in the recruitment of East Asian and Latinx cancer survivors with different cancer diagnoses who reside in various geographic regions of the United States. We found that East Asian and Latinx cancer survivors recruited through Facebook were interested in participating in future psychosocial research, thereby providing support for the feasibility and effectiveness of using Facebook as a source of recruitment for ethnic minority cancer survivors.

  • Overcome Social Anxiety intervention (montage). Source: Image created by the Authors; Copyright: The Authors; URL: http://www.jmir.org/2019/1/e11566/; License: Public Domain (CC0).
    Web-based and Mobile Health...

    Jan 10, 2019

    Evaluating a Web-Based Social Anxiety Intervention Among Community Users: Analysis of Real-World Data

    Authors List:

    Abstract:

    Background: Social anxiety is both harmful and prevalent. It also currently remains among the most undertreated major mental disorders, due, in part, to socially anxious individuals’ concerns about the stigma and expense of seeking help. The privacy and affordability of computer-aided psychotherapy interventions may render them particularly helpful in addressing these concerns, and they are also highly scalable, but most tend to be only somewhat effective without therapist support. However, a recent evaluation of a new self-guided, 7-module internet-delivered cognitive behavioral therapy intervention called Overcome Social Anxiety found that it was highly effective. Objective: The initial evaluation of Overcome Social Anxiety revealed that it led to significant reductions in symptom severity among university undergraduates. The aim of this study was to extend the results of the initial study and investigate their generalizability by directly evaluating the intervention’s effectiveness among a general community sample. Methods: While signing up for Overcome Social Anxiety, users consented to the usage of their anonymized outcome data for research purposes. Before and after completing the intervention, users completed the Fear of Negative Evaluation Scale (FNE), which we employed as the primary outcome measure. Secondary outcome measures included the Depression Anxiety Stress Scales (DASS) and 2 bespoke questionnaires measuring socially anxious thoughts (Thoughts Questionnaire) and avoidance behaviors (Avoidance Questionnaire). Results: Participants who completed the intervention (102/369, 27.7%) experienced significant reductions in the severity of their symptoms on all measures employed, including FNE (P<.001; Cohen d=1.76), the depression subscale of DASS (P<.001; Cohen d=0.70), the anxiety subscale of DASS (P<.001; Cohen d=0.74), the stress subscale of DASS (P<.001; Cohen d=0.80), the Thoughts Questionnaire (P<.001; Cohen d=1.46), and the Avoidance Questionnaire (P<.001; Cohen d=1.42). Conclusions: Our results provide further evidence that Overcome Social Anxiety reduces the severity of social anxiety symptoms among those who complete it and suggest that its effectiveness extends to the general community. The completion rate is the highest documented for a fully automated intervention for anxiety, depression, or low mood in a real community sample. In addition, our results indicate that Overcome Social Anxiety reduces the severity of symptoms of depression, physiological symptoms of anxiety, and stress in addition to symptoms of social anxiety.

  • Source: Pexels; Copyright: rawpixel.com; URL: https://www.pexels.com/photo/person-using-laptop-computer-1376863/; License: Licensed by JMIR.
    Demographics of Users, Social &...

    Jan 9, 2019

    Digital Exclusion Among Mental Health Service Users: Qualitative Investigation

    Authors List:

    Abstract:

    Background: Access to internet-enabled technology and Web-based services has grown exponentially in recent decades. This growth potentially excludes some communities and individuals with mental health difficulties, who face a heightened risk of digital exclusion. However, it is unclear what factors may contribute to digital exclusion in this population. Objective: To explore in detail the problems of digital exclusion in mental health service users and potential facilitators to overcome them. Methods: We conducted semistructured interviews with 20 mental health service users who were deemed digitally excluded. We recruited the participants from a large secondary mental health provider in South London, United Kingdom. We employed thematic analysis to identify themes and subthemes relating to historical and extant reasons for digital exclusion and methods of overcoming it. Results: There were three major themes that appeared to maintain digital exclusion: a perceived lack of knowledge, being unable to access the necessary technology and services owing to personal circumstances, and the barriers presented by mental health difficulties. Specific facilitators for overcoming digital exclusion included intrinsic motivation and a personalized learning format that reflects the individual’s unique needs and preferences. Conclusions: Multiple factors contribute to digital exclusion among mental health service users, including material deprivation and mental health difficulties. This means that efforts to overcome digital exclusion must address the multiple deprivations individuals may face in the offline world in addition to their individual mental health needs. Additional facilitators include fostering an intrinsic motivation to overcome digital exclusion and providing a personalized learning format tailored to the individual’s knowledge gaps and preferred learning style.

  • Text messaging for diabetes medication adherence. Source: Freepik; Copyright: Katemangostar; URL: https://www.freepik.com/free-photo/cropped-view-of-man-texting-on-smartphone_1196364.htm#term=text%20messaging&page=1&position=13; License: Licensed by JMIR.
    Web-based and Mobile Health...

    Jan 9, 2019

    Identifying Brief Message Content for Interventions Delivered via Mobile Devices to Improve Medication Adherence in People With Type 2 Diabetes Mellitus: A...

    Authors List:

    Abstract:

    Background: Current interventions to support medication adherence in people with type 2 diabetes are generally resource-intensive and ineffective. Brief messages, such as those delivered via short message service (SMS) systems, are increasingly used in digital health interventions to support adherence because they can be delivered on a wide scale and at low cost. The content of SMS text messages is a crucial intervention feature for promoting behavior change, but it is often unclear what the rationale is for chosen wording or any underlying mechanisms targeted for behavioral change. There is little guidance for developing and optimizing brief message content for use in mobile device–delivered interventions. Objective: This review aimed to (1) identify theoretical constructs (ie, the targets that interventions aim to change) and behavioral strategies (ie, features of intervention content) found to be associated with medication adherence in patients with type 2 diabetes and (2) map these onto a standard taxonomy for behavior change techniques (BCTs, that is, active ingredients of interventions used to promote behavioral change, to produce an evidence-based set of approaches that have shown promise of improving adherence in previous studies and which could be further tested in digital health interventions. Methods: A rapid systematic review of existing relevant systematic reviews was conducted. MEDLINE and PsycINFO databases were searched from inception to April 10, 2017. Inclusion criteria were (1) systematic reviews of quantitative data if the studies reviewed identified predictors of or correlates with medication adherence or evaluated medication adherence–enhancing interventions and included adult participants taking medication to manage a chronic physical health condition, and (2) systematic reviews of qualitative studies of experiences of medication adherence for adult participants with type 2 diabetes. Data were extracted on review characteristics and BCTs, theoretical constructs, or behavioral strategies associated with improved adherence. Constructs and strategies were mapped onto the BCT version 1 taxonomy. Results: A total of 1701 references were identified; 25 systematic reviews (19 quantitative reviews, 3 qualitative reviews, and 3 mixed-method reviews) were included. Moreover, 20 theoretical constructs (eg, self-efficacy) and 19 behavioral strategies (eg, habit analysis) were identified in the included reviews. In total, 46 BCTs were identified as being related to medication adherence in type 2 diabetes (eg, habit formation, prompts or cues, and information about health consequences). Conclusions: We identified 46 promising BCTs related to medication adherence in type 2 diabetes on which the content of brief messages delivered through mobile devices to improve adherence could be based. By using explicit systematic review methods and linking our findings to a standardized taxonomy of BCTs, we have described a novel approach for the development of digital message content. Future brief message interventions that aim to support medication adherence could incorporate the identified BCTs.

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  • Characteristics of Gamblers Using the French National Problem Gambling Helpline and Real-Time Chat Service

    Date Submitted: Jan 13, 2019

    Open Peer Review Period: Jan 16, 2019 - Mar 13, 2019

    Background: Problem gambling is an increasing public health issue characterized by poor help-seeking. Helplines and real-time chat services could reduce treatment gap. Objective: The aim of this study...

    Background: Problem gambling is an increasing public health issue characterized by poor help-seeking. Helplines and real-time chat services could reduce treatment gap. Objective: The aim of this study was to describe the characteristics of gamblers or relatives contacting a governmental help service, to study the evolution of the characteristics over time, to evaluate the differences between the subgroups, and to explore factors influencing referral to care. Methods: From January 2011 to December 2015, the governmental gambling helpline and real-time chat service in France received 9474 contacts from gamblers and 4038 from relatives of gamblers. Counselors filled in a form for each contact including demographics, gambling characteristics and referral. Time-series analyzes were plotted. Univariate logistic models were performed to assess subgroups differences. A multivariate analysis was conducted to determine the variables related to the effective referral. Results: Gamblers were predominantly male (74%), average age was 41 (SD 14). Compared to men, women were older (mean 50.7, SD 14.0 vs mean 37.9, SD 13.0; P<.001), were more often pure offline gamblers (n=1922 or 78.2% vs n=4386 or 62.5%; P<.001) and had a different pattern of gambling. Real-time chat contactors were more often male (n=124 or 82.7% vs n=3643 or 74.6%; P=.039), younger (mean 32.8, SD 12.9 vs mean 41.3, SD 14.3; P<.001), and gambled more often poker (n=41 or 27.3% vs n=592 or 12.1%; P<.001) and online (n=83 or 55.3% vs n=1462 or 30.0%; P<.001) than helpline contactors. The effective referral was positively associated with betting (AOR = 1.46, 95% CI = [1.27,1.67]; P<.001), playing casino games (AOR = 1.38, 95% CI = [1.21,1.57]; P<.001), playing scratch cards (AOR = 1.83, 95% CI = [1.58,2.12]; P<.001), playing poker (AOR = 1.35, 95% CI = [1.14,1.61]; P<.001) and lottery (AOR = 1.27, 95% CI = [1.03,1.56]; P=.029), gambling weekly (AOR = 1.73, 95% CI = [1.40,2.15]; P<.001), referral request (AOR = 17.76, 95% CI = [14.92,21.13]; P<.001) and having a history of suicide attempt (AOR = 2.13, 95% CI = [1.51,3.02]; P<.001) and negatively associated with online gambling (AOR=0.86, 95% CI = [0.75,0.98]; P=.030) and refusal to be referred (AOR=0.35, 95% CI = [0.26,0.49]; P<.001). Conclusions: The governmental help service contactors constituted a broad range of socio-demographics groups. It is important to propose different modalities of contact to help-seeking gamblers, covering the spectrum of preferences, and to actively offer gamblers referral beyond an explicit request. Clinical Trial: Approval: N°2018-031 Comité d’Evaluation de l’Ethique des projets de Recherche Biomédicale (CEERB) Paris Nord (Institutional Review Board -IRB 00006477- of HUPNVS, Paris 7 University, AP-HP) has reviewed and approved the study.

  • Leveraging Technology in Detection of Alzheimer’s Disease: A Systematic Review

    Date Submitted: Jan 13, 2019

    Open Peer Review Period: Jan 16, 2019 - Mar 13, 2019

    Background: Incidence of AD continues to increase, making it the most common cause of dementia and the sixth-leading cause of death in the United States. 2018 numbers are expected to double by 2030. O...

    Background: Incidence of AD continues to increase, making it the most common cause of dementia and the sixth-leading cause of death in the United States. 2018 numbers are expected to double by 2030. Objective: We examined the benefits of utilizing technology to identify and detect Alzheimer’s disease in the diagnostic process. Methods: We searched PubMed and CINAHL using key terms and filters to identify 30 articles for review. We analyzed these articles and reported them in accordance with the PRISMA guidelines. Results: We identified 11 technologies used in the detection of Alzheimer’s disease: 66% of which used some form of MIR. Functional, structural, and 7T magnetic resonance imaging were all used with structural being the most prevalent. Conclusions: MRI is the best form of current technology being used in the detection of Alzheimer’s disease. MRI is a noninvasive approach that provides highly accurate results in the diagnostic process of Alzheimer’s disease.

  • Efficacy of Wearable Devices for Resolution of Metabolic Syndrome: A Clinical Trial in Korean Adults

    Date Submitted: Jan 12, 2019

    Open Peer Review Period: Jan 15, 2019 - Mar 12, 2019

    Background: Few studies have examined the effect of wearable devices on chronic diseases. We hypothesized that a wearable device that can monitor and provide feedback on physical activity may resolve...

    Background: Few studies have examined the effect of wearable devices on chronic diseases. We hypothesized that a wearable device that can monitor and provide feedback on physical activity may resolve metabolic syndrome (MetS). Objective: This study aimed to examine the objective effects of the use of these devices on MetS resolution. Methods: Patients diagnosed with MetS were recruited. Subjects were prescribed regular exercise with a wearable device (Coffee WALKIE +Dv.3, GC Healthcare CI, Korea) on their wrist or waist for 12 weeks. Subjects received self-feedback on the amount of their exercise through an application on their smartphone. The information on physical activities of the subjects was uploaded automatically on a website so that a trained nurse could provide individuals with feedback regarding physical activity via telephone consultation on alternate weeks. Blood pressure (BP), body composition, fasting plasma glucose, and lipid profiles were recorded. The primary outcome was MetS resolution. The secondary outcome was an improvement in the components of metabolic impairment. Results: Of the 53 subjects recruited, 20 subjects with a median age of 46 years (range 36-50 years) completed the trial. There was no significant difference in the amount of calorie expenditure on weeks 4, 8, and 12. The exercise was constantly maintained for 12 weeks. After 12 weeks, MetS was resolved in 9 subjects (45%), and the average number of metabolic impairment components per person decreased from 3.4 to 2.9. Particularly, the mean systolic and diastolic BP decreased from 136.6 ± 18.5 mmHg to 127.4 ± 19.5 mmHg and from 84.0 ± 8.1 mmHg to 77.4 ± 14.4 mmHg, respectively (P=0.015, P=0.022). Conclusions: Wearable devices along with good patient adherence and sustained engagement may be an efficient strategy for treating patients with MetS.

  • The potential for integrating mental health specialist video consultations in office-based routine primary care: A cross-sectional qualitative study among family physicians

    Date Submitted: Jan 12, 2019

    Open Peer Review Period: Jan 15, 2019 - Mar 12, 2019

    Background: Although real-time mental health specialist video consultations (MHSVC) have been proposed as an effective care model for treating patients with mental health conditions in primary care, l...

    Background: Although real-time mental health specialist video consultations (MHSVC) have been proposed as an effective care model for treating patients with mental health conditions in primary care, little is known on the integration into routine practice from the perspective of family physicians (FPs) themselves. Objective: We aimed to determine the degree to which FPs advocate that MHSVC can be integrated in routine primary care, where most patients with mental health conditions receive treatment. Methods: In a cross-sectional qualitative study, we conducted four semi-structured focus groups and three telephone interviews in a sample of 19 FPs from urban and rural districts. We conducted a qualitative content analysis applying the Tailored Implementation in Chronic Diseases framework a combined bottom-up (data-driven) and top-down strategy for deriving key domains. Results: FPs indicated that MHSVC are a promising and practical way to address the most pressing challenges in current practice, i.e. to increase accessibility and coordination of specialized care. To facilitate the implementation of future MHSVC models, we compiled a checklist of recommendations that covers 1) buy-in from practices (e.g., emphasizing logistical and psychological relief for the practice), 2) engaging patients (e.g., establishing a trusted patient-provider-relationship), 3) setup and conduct of consultations (e.g., reliable emergency plans), and 4) fostering collaboration between FPs and MHS (e.g., kick-off meetings to build up trust). Conclusions: Leveraging the primary care practice as a familiar environment for patients, MHSVC provide timely specialist support and potentially lead to benefits for patients and more efficient processes of care. Integration should account for determinants of practice as described by the FPs. Clinical Trial: German Clinical Trials Register (DRKS00012487)

  • Differences among frequently used words in clinical practice: Analysis of their frequency in an online search engine and a community question answering service in Japan.

    Date Submitted: Jan 11, 2019

    Open Peer Review Period: Jan 14, 2019 - Mar 11, 2019

    Background: Despite increasing opportunities for acquiring health information online, discussion of the specific words used in searches has been limited. Objective: This study clarifies health informa...

    Background: Despite increasing opportunities for acquiring health information online, discussion of the specific words used in searches has been limited. Objective: This study clarifies health information sought by Japanese netizens. Methods: This study analyzed the data from one of the most popular domestic search engines (Yahoo! JAPAN Search) and the most popular domestic community question answering (CQA) service (Yahoo! Chiebukuro). We compared the frequency of 100 clinical words appearing in the clinical case reports of medical professionals (“clinical frequency”) with their frequency in Yahoo! JAPAN Search (“search frequency”) search logs and questions posted to Yahoo! Chiebukuro (“question frequency”). Subsequently, the Spearman correlation was used to quantify association patterns between the three search categories. Additionally, user information (sex and age) in search frequency associated with registration were extracted and discussed. Results: The correlation coefficient was r = 0.290 (P=.003) between clinical and search frequencies, r = 0.337(P =.001) between clinical and question frequencies, and r = 0.569 (P <.001) between search and question frequencies. Low-frequency words in clinical frequency, (e.g., “hypothyroidism” and “ulcerative colitis”) were high in search frequency. Similarly, the words “pain,” “slight fever,” and “numbness” had high frequency only in the question frequency. The weighted average of the ages was 34.5 ± 2.7 years, and the weighted average of sex (male: -1, female: 1) was 0.1 ± 0.1 in search frequency. Some words were extracted from the search frequency uniquely based on age groups: “dyspnea,” “abdominal pain,” “subjective symptoms,” and “plasma cells” (10-20 years); “plasma cells,” “inflammatory findings,” “hypoxemia,” “cellular wetness,” and “dyspnea on exertion” (20-30 years); “DM (diabetes mellitus),” “jaundice,” and “high blood pressure” (30-40 years); “abnormal shadow,” “plasma cells,” “inflammatory findings,” “hyponatremia,” “cell wetness,” and “hypercalcemia” (40-50 years); “rheumatoid arthritis,” “hypertension,” “abnormal shadow,” and “inflammatory findings” (50-60 years); and “interstitial pneumonia,” “lung cancer,” “gastric cancer,” “hypertension,” “atrial fibrillation,” and “pneumococcus” (60-70 years). Conclusions: The search and question frequencies were similar, but search and clinical frequencies had a discrepancy. Low-clinical frequency words related to diseases such as hypothyroidism and ulcerative colitis had high search frequencies, whereas those related to symptoms such as pain, slight fever, and numbness had high question frequencies. Moreover, high search frequency words include designated intractable diseases such as “ulcerative colitis”; patients with this condition are less than 0.1% of the national population. Therefore, information needs regarding major diseases are not necessarily high, and minor diseases that users seek more frequently should be valued. Some characteristic words for certain age groups were observed (e.g., 20-40 years: “cancer”; 40-60 years: diagnoses and diseases identified in health examinations; 60-70 years: diseases with late adulthood onset and “death”). In conclusion, information providers should be aware of clinical frequency and users’ medical information gaps should be bridged.

  • Forecasting Implementation, Adoption and Evaluation Challenges For an Electronic Game-Based Antimicrobial Stewardship Intervention: Results of a Codesign Workshop with Experts

    Date Submitted: Jan 10, 2019

    Open Peer Review Period: Jan 14, 2019 - Mar 11, 2019

    Background: Serious games have been proposed to address the lack of engagement and sustainability traditionally affecting interventions aiming to improve optimal antibiotic use among hospital prescrib...

    Background: Serious games have been proposed to address the lack of engagement and sustainability traditionally affecting interventions aiming to improve optimal antibiotic use among hospital prescribers. Objective: To forecast existing gaps in implementation, adoption and evaluation of game-based interventions, and co-design solutions with experts. Methods: A co-development workshop with clinicians and academics in serious games, antimicrobials and behavioural sciences was organised to open an international summit on serious games for health in London (United Kingdom), in March 2018. The workshop was announced on social media and online platforms. On the day, attendees were asked to work in small groups provided with a laptop/tablet with the latest version of ‘On call: Antibiotics. A workshop leader guided open group discussions around implementation, adoption and evaluation threats and potential solutions. Workshop summary notes were collated by an observer. Results: 29 experts attended the workshop. Anticipated challenges to resolve reflected implementation threats such as an inadequate organisational arrangement to scale and sustain the use of the game, requiring sufficient technical and educational support and a streamlined feedback mechanism that made best use of data arriving from the game; adoption threats, particularly collective perceptions that a game would be a ludic rather than professional tool, and demanding efforts to integrate all available educational solutions so none is seen as inferior; and evaluation threats due to the need to combine game metrics with organisational indicators such as antibiotic use, which may be difficult to enable. Conclusions: As with other technology-based interventions, organisations interested in deploying game-based solutions should carefully plan how to engage and support clinicians in their use, and how best integrate the game and game outputs onto existing workflows. The ludic characteristics of the game may foster perceptions of unprofessionalism among gamers, which would need buffering from the organization.

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