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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 2018: 4.945, ranked #1 out of 26 journals in the medical informatics category) 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 a 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 an open access journal, we are read by clinicians, allied health professionals, informal caregivers, and patients alike, and have (as with 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:

  • Untitled. Source: freepik; Copyright: freepik; URL:; License: Licensed by JMIR.

    Compliance and Retention With the Experience Sampling Method Over the Continuum of Severe Mental Disorders: Meta-Analysis and Recommendations


    Background: Despite the growing interest in the experience sampling method (ESM) as a data collection tool for mental health research, the absence of methodological guidelines related to its use has resulted in a large heterogeneity of designs. Concomitantly, the potential effects of the design on the response behavior of the participants remain largely unknown. Objective: The objective of this meta-analysis was to investigate the associations between various sample and design characteristics and the compliance and retention rates of studies using ESM in mental health research. Methods: ESM studies investigating major depressive disorder, bipolar disorder, and psychotic disorder were considered for inclusion. Besides the compliance and retention rates, a number of sample and design characteristics of the selected studies were collected to assess their potential relationships with the compliance and retention rates. Multilevel random/mixed effects models were used for the analyses. Results: Compliance and retention rates were lower for studies with a higher proportion of male participants (P<.001) and individuals with a psychotic disorder (P<.001). Compliance was positively associated with the use of a fixed sampling scheme (P=.02), higher incentives (P=.03), higher time intervals between successive evaluations (P=.02), and fewer evaluations per day (P=.008), while no significant associations were observed with regard to the mean age of the sample, the study duration, or other design characteristics. Conclusions: The findings demonstrate that ESM studies can be carried out in mental health research, but the quality of the data collection depends upon a number of factors related to the design of ESM studies and the samples under study that need to be considered when designing such protocols.

  • Source: iStock by Getty Images; Copyright: NanoStockk; URL:; License: Licensed by the authors.

    A Web-Based Self-Titration Program to Control Blood Pressure in Patients With Primary Hypertension: Randomized Controlled Trial


    Background: Hypertension is a major cause of mortality in cardiac, vascular, and renal disease. Effective control of elevated blood pressure has been shown to reduce target organ damage. A Web-based self-titration program may empower patients to control their own disease, share decisions about antihypertensive dose titration, and improve self-management, ultimately improving health-related quality of life. Objective: Our primary aim was to evaluate the effects of a Web-based self-titration program for improving blood pressure control in patients with primary hypertension. Our secondary aim was to evaluate the effects of that program on improving health-related quality of life. Methods: This was a parallel-group, double-blind, randomized controlled trial with assessments at baseline, 3 months, and 6 months. We included patients with primary hypertension (blood pressure>130/80 mm Hg) from a cardiology outpatient department in northern Taiwan and divided them randomly into intervention and control groups. The intervention group received the Web-based self-titration program, while the control group received usual care. The random allocation was concealed from participants and outcome evaluators. Health-related quality of life was measured by the EuroQol five-dimension self-report questionnaire. We used generalized estimating equations to evaluate the effects of the intervention. Results: We included 222 patients and divided them equally into intervention (n=111) and control (n=111) groups. Patients receiving the Web-based self-titration program showed significantly greater improvement in the systolic and diastolic blood pressure control than those who did not receive this program, at 3 months (–21.4 mm Hg and –5.4 mm Hg, respectively; P<.001) and 6 months (–27.8 mm Hg and –9.7 mm Hg, respectively; P<.001). Compared with the control group, the intervention group showed a significant decrease in the overall defined daily dose at both 3 (–0.202, P=.003) and 6 (–0.236, P=.001) months. Finally, health-related quality of life improved significantly in the intervention group compared with the control group at both 3 and 6 months (both, P<.001). Conclusions: A Web-based self-titration program can provide immediate feedback to patients about how to control their blood pressure and manage their disease at home. This program not only decreases mean blood pressure but also increases health-related quality of life in patients with primary hypertension. Clinical Trial: NCT03470974;

  • Source: Image created by the Authors; Copyright: The Authors; URL:; License: Licensed by JMIR.

    Pregnancy-Related Information Seeking and Sharing in the Social Media Era Among Expectant Mothers: Qualitative Study


    Background: Social media has become the most popular communication tool used by Chinese citizens, including expectant mothers. An increasing number of women have adopted various forms of social media channels, such as interactive websites, instant messaging, and mobile apps, to solve problems and obtain answers to queries during pregnancy. Although the use of the internet by pregnant women has been studied extensively worldwide, limited research exists that explores the changing social media usage habits in China, where the 1 child policy ended in 2015. Objective: This study aimed to (1) present the status quo of pregnancy-related information seeking and sharing via social media among Chinese expectant mothers, (2) reveal the impact of social media usage, and (3) shed light on pregnancy-related health services delivered via social media channels. Methods: A qualitative approach was employed to examine social media usage and its consequences on pregnant women. A total of 20 women who had conceived and were at various stages of pregnancy were interviewed from July 20 to August 10, 2017. Thematic analysis was conducted on the collected data to identify patterns in usage. Results: Overall, 80% (16/20) of participants were aged in their 20s (mean 28.5 years [SD 4.3]). All had used social media for pregnancy-related purposes. For the seeking behavior, 18 codes were merged into 4 themes, namely, gravida, fetus, delivery, and the postpartum period; whereas for sharing behaviors, 10 codes were merged into 4 themes, namely, gravida, fetus, delivery, and caretaker. Lurking, small group sharing, bad news avoidance, and cross-checking were identified as the preferred patterns for using social media. Overall, 95% (19/20) of participants reported a positive mental impact from using social media during their pregnancy. Conclusions: It is indisputable that social media has played an increasingly important role in supporting expectant mothers in China. The specific seeking and sharing patterns identified in this study indicate that the general quality of pregnancy-related information on social media, as well as Chinese culture toward pregnancy, is improving. The new themes that merge in pregnancy-related social media use represent a shift toward safe pregnancy and the promotion of a more enjoyable pregnancy. Future prenatal care should provide further information on services related to being comfortable during pregnancy and reducing the inequality of social media–based services caused by the digital divide.

  • Health Care Virtual Communities of Practice. Source: iStock by Getty Images; Copyright: Deagreez; URL:; License: Licensed by the authors.

    Attitudes Toward Health Care Virtual Communities of Practice: Survey Among Health Care Workers


    Background: Virtual communities of practice (VCoPs) have been shown to be an effective means for knowledge and research uptake, but little is known about why health care workers choose to use them. The elaboration likelihood model (ELM) is a theoretical model of persuasion that distinguishes between different routes of information processing that influence attitude formation and change. To date, no research has investigated the antecedents to these processing routes for VCoPs within a health care setting. In understanding these determinants, VCoPs can be appropriately designed to increase their chances of use and value among health care professionals. Objective: Our aim is to explore how motivation and ability affect attitudes toward using VCoPs for those working in health care. Methods: Data were collected from 86 health care workers using an online survey at two Canadian health care conferences. Participants were shown a mock VCoP and asked about their perceptions of the online platform and related technologies. The survey instrument was developed based on previously validated scales to measure participants’ ability and motivation toward using a VCoP. Attitudes were assessed both at the beginning and end of the study; intention to use the platform was assessed at the end. Results: Ability (expertise with CoPs and VCoPs) was found to directly affect intention to use the system (P<.001 and P=.009, respectively) as was motivation (P<.001). Argument quality had the greatest effect on formed attitudes toward VCoPs, regardless of the user’s level of experience (lower expertise: P=.04; higher expertise: P=.003). Those with higher levels of CoPs expertise were also influenced by peripheral cues of source credibility (P=.005 for attitude formation and intention to use the system) and connectedness (P=.04 for attitude formation; P=.008 for intention to use the system), whereas those with lower levels of CoP expertise were not (P>.05). A significant correlation between formed attitude and intention to use the VCoPs system was found for those with higher levels of expertise (P<.001). Conclusions: This research found that both user ability and motivation play an important and positive role in the attitude toward and adoption of health care VCoPs. Unlike previous ELM research, evidence-based arguments were found to be an effective messaging tactic for improving attitudes toward VCoPs for health care professionals with both high and low levels of expertise. Understanding these factors that influence the attitudes of VCoPs can provide insight into how to best design and position such systems to encourage their effective use among health care professionals.

  • Doctor discussing with a patient in a hospital bed and family members. Source: iStock by Getty Images; Copyright: jacoblund; URL:; License: Licensed by the authors.

    Comparative Effectiveness of a Web-Based Patient Decision Aid for Therapeutic Options for Sickle Cell Disease: Randomized Controlled Trial


    Background: Hydroxyurea, chronic blood transfusions, and bone marrow transplantation are efficacious, disease-modifying therapies for sickle cell disease but involve complex risk-benefit trade-offs and decisional dilemma compounded by the lack of comparative studies. A patient decision aid can inform patients about their treatment options, the associated risks and benefits, help them clarify their values, and allow them to participate in medical decision making. Objective: The objective of this study was to develop a literacy-sensitive Web-based patient decision aid based on the Ottawa decision support framework, and through a randomized clinical trial estimate the effectiveness of the patient decision aid in improving patient knowledge and their involvement in decision making. Methods: We conducted population decisional needs assessments in a nationwide sample of patients, caregivers, community advocates, policy makers, and health care providers using qualitative interviews to identify decisional conflict, knowledge and expectations, values, support and resources, decision types, timing, stages and learning, and personal clinical characteristics. Interview transcripts were coded using QSR NVivo 10. Alpha testing of the patient decision aid prototype was done to establish usability and the accuracy of the information it conveyed, and then was followed by iterative cycles of beta testing. We conducted a randomized clinical trial of adults and of caregivers of pediatric patients to evaluate the efficacy of the patient decision aid. Results: In a decisional needs assessment, 223 stakeholders described their preferences, helping to guide the development of the patient decision aid, which then underwent alpha testing by 30 patients and 38 health care providers and iterative cycles of beta testing by 87 stakeholders. In a randomized clinical trial, 120 participants were assigned to either the patient decision aid or standard care (SC) arm. Qualitative interviews revealed high levels of usability, acceptability, and utility of the patient decision aid in education, values clarification, and preparation for decision making. On the acceptability survey, 72% (86/120) of participants rated the patient decision aid as good or excellent. Participants on the patient decision aid arm compared to the SC arm demonstrated a statistically significant improvement in decisional self-efficacy (P=.05) and a reduction in the informed sub-score of decisional conflict (P=.003) at 3 months, with an improvement in preparation for decision making (P<.001) at 6 months. However, there was no improvement in terms of the change in knowledge, the total or other domain scores of decisional conflicts, or decisional self-efficacies at 6 months. The large amount of missing data from survey completion limited our ability to draw conclusions about the effectiveness of the patient decision aid. The patient decision aid met 61 of 62 benchmarks of the international patient decision aid collaboration standards for content, development process, and efficacy. Conclusions: We have developed a patient decision aid for sickle cell disease with extensive input from stakeholders and in a randomized clinical trial demonstrated its acceptability and utility in education and decision making. We were unable to demonstrate its effectiveness in improving patient knowledge and involvement in decision making. Clinical Trial: NCT03224429; and NCT02326597;

  • Source:; Copyright: Suganth; URL:; License: Licensed by JMIR.

    Counting Bites With Bits: Expert Workshop Addressing Calorie and Macronutrient Intake Monitoring


    Background: Conventional diet assessment approaches such as the 24-hour self-reported recall are burdensome, suffer from recall bias, and are inaccurate in estimating energy intake. Wearable sensor technology, coupled with advanced algorithms, is increasingly showing promise in its ability to capture behaviors that provide useful information for estimating calorie and macronutrient intake. Objective: This paper aimed to summarize current technological approaches to monitoring energy intake on the basis of expert opinion from a workshop panel and to make recommendations to advance technology and algorithms to improve estimation of energy expenditure. Methods: A 1-day invitational workshop sponsored by the National Science Foundation was held at Northwestern University. A total of 30 participants, including population health researchers, engineers, and intervention developers, from 6 universities and the National Institutes of Health participated in a panel discussing the state of evidence with regard to monitoring calorie intake and eating behaviors. Results: Calorie monitoring using technological approaches can be characterized into 3 domains: (1) image-based sensing (eg, wearable and smartphone-based cameras combined with machine learning algorithms); (2) eating action unit (EAU) sensors (eg, to measure feeding gesture and chewing rate); and (3) biochemical measures (eg, serum and plasma metabolite concentrations). We discussed how each domain functions, provided examples of promising solutions, and highlighted potential challenges and opportunities in each domain. Image-based sensor research requires improved ground truth (context and known information about the foods), accurate food image segmentation and recognition algorithms, and reliable methods of estimating portion size. EAU-based domain research is limited by the understanding of when their systems (device and inference algorithm) succeed and fail, need for privacy-protecting methods of capturing ground truth, and uncertainty in food categorization. Although an exciting novel technology, the challenges of biochemical sensing range from a lack of adaptability to environmental effects (eg, temperature change) and mechanical impact, instability of wearable sensor performance over time, and single-use design. Conclusions: Conventional approaches to calorie monitoring rely predominantly on self-reports. These approaches can gain contextual information from image-based and EAU-based domains that can map automatically captured food images to a food database and detect proxies that correlate with food volume and caloric intake. Although the continued development of advanced machine learning techniques will advance the accuracy of such wearables, biochemical sensing provides an electrochemical analysis of sweat using soft bioelectronics on human skin, enabling noninvasive measures of chemical compounds that provide insight into the digestive and endocrine systems. Future computing-based researchers should focus on reducing the burden of wearable sensors, aligning data across multiple devices, automating methods of data annotation, increasing rigor in studying system acceptability, increasing battery lifetime, and rigorously testing validity of the measure. Such research requires moving promising technological solutions from the controlled laboratory setting to the field.

  • Source: Shutterstock Inc; Copyright: LeoWolfert; URL:; License: Licensed by the authors.

    Blockchain-Enabled iWellChain Framework Integration With the National Medical Referral System: Development and Usability Study


    Background: Medical referral is the transfer of a patient’s care from one physician to another upon request. This process involves multiple steps that require provider-to-provider and provider-to-patient communication. In Taiwan, the National Health Insurance Administration (NHIA) has implemented a national medical referral (NMR) system, which encourages physicians to refer their patients to different health care facilities to reduce unnecessary hospital visits and the financial stress on the national health insurance. However, the NHIA’s NMR system is a government-based electronic medical referral service, and its referral data access and exchange are limited to authorized clinical professionals using their national health smart cards over the NHIA virtual private network. Therefore, this system lacks scalability and flexibility and cannot establish trusting relationships among patients, family doctors, and specialists. Objective: To eliminate the existing restrictions of the NHIA’s NMR system, this study developed a scalable, flexible, and blockchain-enabled framework that leverages the NHIA’s NMR referral data to build an alliance-based medical referral service connecting health care facilities. Methods: We developed a blockchain-enabled framework that can integrate patient referral data from the NHIA’s NMR system with electronic medical record (EMR) and electronic health record (EHR) data of hospitals and community-based clinics to establish an alliance-based medical referral service serving patients, clinics, and hospitals and improve the trust in relationships and transaction security. We also developed a blockchain-enabled personal health record decentralized app (DApp) based on our blockchain-enabled framework for patients to acquire their EMR and EHR data; DApp access logs were collected to assess patients’ behavior and investigate the acceptance of our personal authorization-controlled framework. Results: The constructed iWellChain Framework was installed in an affiliated teaching hospital and four collaborative clinics. The framework renders all medical referral processes automatic and paperless and facilitates efficient NHIA reimbursements. In addition, the blockchain-enabled iWellChain DApp was distributed for patients to access and control their EMR and EHR data. Analysis of 3 months (September to December 2018) of access logs revealed that patients were highly interested in acquiring health data, especially those of laboratory test reports. Conclusions: This study is a pioneer of blockchain applications for medical referral services, and the constructed framework and DApp have been applied practically in clinical settings. The iWellChain Framework has the scalability to deploy a blockchain environment effectively for health care facilities; the iWellChain DApp has potential for use with more patient-centered applications to collaborate with the industry and facilitate its adoption.

  • All Together Group. Source: Max Pixel; Copyright: Max Pixel; URL:; License: Licensed by the authors.

    Exploring the Characteristics and Preferences for Online Support Groups: Mixed Method Study


    Background: Osteoarthritis (OA) is a chronic, disabling, and prevalent disorder. As there is no cure for OA, long-term self-management is paramount. Support groups (SGs) can facilitate self-management among people living with OA. Understanding preferences in design and features of SGs, including online SGs (OSGs), among people with OA can inform future development of SG interventions for this condition. Objective: The objective of this study was to investigate health care– and health information–seeking behavior, digital literacy, and preferences for the design of SGs in people with OA. The study also explored the perceived barriers and enablers to being involved in OSGs. Methods: An online survey study was conducted with a mixed method design (quantitative and qualitative). Individuals aged ≥45 years with knee, hip, or back pain for ≥3 months were recruited from an extant patient database of the Institute of Bone and Joint Research via email invitations. Quantitative elements of the survey included questions about sociodemographic background; health care– and health information–seeking behavior; digital literacy; and previous participation in, and preferences for, SGs and OSGs. Respondents were classified into 2 groups (Yes-SG and No-SG) based on previous participation or interest in an SG. Group differences were assessed with Chi-square tests (significance level set at 5%). Responses to free-text questions relating to preferences regarding OSG engagement were analyzed qualitatively using an inductive thematic analysis. Results: A total of 415 people with OA completed the survey (300/415, 72.3% females; 252/415, 61.0% lived in a major city). The Yes-SG group included 307 (307/415, 73.9%) participants. Between the Yes-SG and No-SG groups, there were no differences in sociodemographic characteristics, health care– and health information–seeking behavior, and digital literacy. An online format was preferred by 126/259 (48.7%) of the Yes-SG group. Trained peer facilitators were preferred, and trustworthiness of advice and information were highly prioritized by the respondents. Qualitative analysis for OSG participation revealed 5 main themes. Lack of time and motivation were the main barriers identified. The main enablers were related to accessibility, enjoyment of the experience, and the content of the discussed information. Conclusions: These findings highlight the preferences in design features and content of SGs and OSGs and may assist in the further development of such groups.

  • Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Validation of Single Centre Pre-Mobile Atrial Fibrillation Apps for Continuous Monitoring of Atrial Fibrillation in a Real-World Setting: Pilot Cohort Study


    Background: Atrial fibrillation is the most common recurrent arrhythmia in clinical practice, with most clinical events occurring outside the hospital. Low detection and nonadherence to guidelines are the primary obstacles to atrial fibrillation management. Photoplethysmography is a novel technology developed for atrial fibrillation screening. However, there has been limited validation of photoplethysmography-based smart devices for the detection of atrial fibrillation and its underlying clinical factors impacting detection. Objective: This study aimed to explore the feasibility of photoplethysmography-based smart devices for the detection of atrial fibrillation in real-world settings. Methods: Subjects aged ≥18 years (n=361) were recruited from September 14 to October 16, 2018, for screening of atrial fibrillation with active measurement, initiated by the users, using photoplethysmography-based smart wearable devices (ie, a smart band or smart watches). Of these, 200 subjects were also automatically and periodically monitored for 14 days with a smart band. The baseline diagnosis of “suspected” atrial fibrillation was confirmed by electrocardiogram and physical examination. The sensitivity and accuracy of photoplethysmography-based smart devices for monitoring atrial fibrillation were evaluated. Results: A total of 2353 active measurement signals and 23,864 periodic measurement signals were recorded. Eleven subjects were confirmed to have persistent atrial fibrillation, and 20 were confirmed to have paroxysmal atrial fibrillation. Smart devices demonstrated >91% predictive ability for atrial fibrillation. The sensitivity and specificity of devices in detecting atrial fibrillation among active recording of the 361 subjects were 100% and about 99%, respectively. For subjects with persistent atrial fibrillation, 127 (97.0%) active measurements and 2240 (99.2%) periodic measurements were identified as atrial fibrillation by the algorithm. For subjects with paroxysmal atrial fibrillation, 36 (17%) active measurements and 717 (19.8%) periodic measurements were identified as atrial fibrillation by the algorithm. All persistent atrial fibrillation cases could be detected as “atrial fibrillation episodes” by the photoplethysmography algorithm on the first monitoring day, while 14 (70%) patients with paroxysmal atrial fibrillation demonstrated “atrial fibrillation episodes” within the first 6 days. The average time to detect paroxysmal atrial fibrillation was 2 days (interquartile range: 1.25-5.75) by active measurement and 1 day (interquartile range: 1.00-2.00) by periodic measurement (P=.10). The first detection time of atrial fibrillation burden of <50% per 24 hours was 4 days by active measurement and 2 days by periodic measurementThe first detection time of atrial fibrillation burden of >50% per 24 hours was 1 day for both active and periodic measurements (active measurement: P=.02, periodic measurement: P=.03). Conclusions: Photoplethysmography-based smart devices demonstrated good atrial fibrillation predictive ability in both active and periodic measurements. However, atrial fibrillation type could impact detection, resulting in increased monitoring time. Clinical Trial: Chinese Clinical Trial Registry of the International Clinical Trials Registry Platform of the World Health Organization ChiCTR-OOC-17014138;

  • Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Comparison of YouthCHAT, an Electronic Composite Psychosocial Screener, With a Clinician Interview Assessment for Young People: Randomized Controlled Trial


    Background: Psychosocial problems such as depression, anxiety, and substance abuse are common and burdensome in young people. In New Zealand, screening for such problems is undertaken routinely only with year 9 students in low-decile schools and opportunistically in pediatric settings using a nonvalidated and time-consuming clinician-administered Home, Education, Eating, Activities, Drugs and Alcohol, Sexuality, Suicide and Depression, Safety (HEEADSSS) interview. The Youth version, Case-finding and Help Assessment Tool (YouthCHAT) is a relatively new, locally developed, electronic tablet–based composite screener for identifying similar psychosocial issues to HEEADSSS Objective: This study aimed to compare the performance and acceptability of YouthCHAT with face-to-face HEEADSSS assessment among 13-year-old high school students. Methods: A counterbalanced randomized trial of YouthCHAT screening either before or after face-to-face HEEADSSS assessment was undertaken with 129 13-year-old New Zealand high school students of predominantly Māori and Pacific Island ethnicity. Main outcome measures were comparability of YouthCHAT and HEEADSSS completion times, detection rates, and acceptability to students and school nurses. Results: YouthCHAT screening was more than twice as fast as HEEADSSS assessment (mean 8.57 min vs mean 17.22 min; mean difference 8 min 25 seconds [range 6 min 20 seconds to 11 min 10 seconds]; P<.01) and detected more issues overall on comparable domains. For substance misuse and problems at home, both instruments were roughly comparable. YouthCHAT detected significantly more problems with eating or body image perception (70/110, 63.6% vs 25/110, 22.7%; P<.01), sexual health (24/110, 21.8% vs 10/110, 9.1%; P=.01), safety (65/110, 59.1% vs 17/110, 15.5%; P<.01), and physical inactivity (43/110, 39.1% vs 21/110, 19.1%; P<.01). HEEADSSS had a greater rate of detection for a broader set of mental health issues (30/110, 27%) than YouthCHAT (11/110, 10%; P=.001), which only assessed clinically relevant anxiety and depression. Assessment order made no significant difference to the duration of assessment or to the rates of YouthCHAT-detected positive screens for anxiety and depression. There were no significant differences in student acceptability survey results between the two assessments. Nurses identified that students found YouthCHAT easy to answer and that it helped students answer face-to-face questions, especially those of a sensitive nature. Difficulties encountered with YouthCHAT included occasional Wi-Fi connectivity and student literacy issues. Conclusions: This study provides preliminary evidence regarding the shorter administration time, detection rates, and acceptability of YouthCHAT as a school-based psychosocial screener for young people. Although further research is needed to confirm its effectiveness in other age and ethnic groups, YouthCHAT shows promise for aiding earlier identification and treatment of common psychosocial problems in young people, including possible use as part of an annual, school-based, holistic health check. Clinical Trial: Australian New Zealand Clinical Trials Network Registry (ACTRN) ACTRN12616001243404p;

  • Source:; Copyright: Ake; URL:; License: Licensed by JMIR.

    QardioArm Upper Arm Blood Pressure Monitor Against Omron M3 Upper Arm Blood Pressure Monitor in Patients With Chronic Kidney Disease: A Validation Study...


    Background: Hypertension is considered as a main risk factor for chronic kidney disease development and progression. Thus, the control and evaluation of this disease with new software and devices are especially important in patients who suffer from chronic kidney disease. Objective: This study aimed to validate the QardioArm mobile device, which is used for blood pressure (BP) self-measurement in patients who suffer from chronic kidney disease, by following the European Society of Hypertension International Protocol 2 (ESH-IP2) guidelines. Methods: A validation study was carried out by following the ESH-IP2 guidelines. A sample of 33 patients with chronic kidney disease self-measured their BP by using the QardioArm and Omron M3 Intellisense devices. Heart rate (HR), diastolic BP, and systolic BP were measured. Results: The QardioArm fulfilled the ESH-IP2 validation criteria in patients who suffered from chronic kidney disease. Conclusions: Thus, this study is considered as the first validation using a wireless upper arm oscillometric device connected to an app to measure BP and HR meeting the ESH-IP2 requirements in patients who suffer from chronic kidney disease. New validation studies following the ESH-IP2 guidelines should be carried out using different BP devices in patients with specific diseases.

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    Cost and Effectiveness of Using Facebook Advertising to Recruit Young Women for Research: PREFER (Contraceptive Preferences Study) Experience


    Background: Social media is a popular and convenient method for communicating on the Web. The most commonly used social networking website, Facebook, is increasingly being used as a tool for recruiting research participants because of its large user base and its ability to target advertisements on the basis of Facebook users’ information. Objective: We evaluated the cost and effectiveness of using Facebook to recruit young women into a Web-based intervention study (PREFER). The PREFER study aimed to determine whether an educational video could increase preference for and uptake of long-acting reversible contraception (LARC). Methods: We placed an advertisement on Facebook over a 19-day period from December 2017 to January 2018, inviting 16- to 25-year-old women from Australia to participate in a Web-based study about contraception. Those who clicked on the advertisement were directed to project information, and their eligibility was determined by using a screening survey. Results: Our Facebook advertisement delivered 130,129 impressions, resulting in over 2000 clicks at an overall cost of Aus $918 (Aus $0.44 per click). Web-based project information was accessed by 493 women. Of these, 462 women completed the screening survey, and 437 (437/463, 95%) women were eligible. A total of 322 young women participated in Surveys 1 and 2 (74% response rate), and 284 women participated in Survey 3 (88% retention rate), with an advertising cost of Aus $2.85 per consenting participant. Conclusions: Facebook proved to be a quick, effective, and cost-efficient tool for recruiting young Australian women into a study that was investigating contraceptive preferences. However, Web-based recruitment may result in sociodemographic biases. Further research is required to evaluate whether Facebook is suitable for recruiting older study populations.

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    Date Submitted: Dec 4, 2019

    Open Peer Review Period: Dec 4, 2019 - Jan 29, 2020

    Background: The incidence and global burden of inflammatory bowel disease (IBD) have steadily increased in the past few decades. Improved methods to stratify risk and predict disease-related outcomes...

    Background: The incidence and global burden of inflammatory bowel disease (IBD) have steadily increased in the past few decades. Improved methods to stratify risk and predict disease-related outcomes are required for IBD. Objective: The aim of this study was to develop and validate a machine learning (ML) model to predict the 5-year risk of starting biologic agents in IBD patients. Methods: We applied an ML method to the database of the Korean common data model (K-CDM) network, a data sharing consortium of tertiary centers in Korea, to develop a model to predict the 5-year risk of starting biologic agents in IBD patients. The records analyzed were those of patients diagnosed with IBD between January 2006 and June 2017 at Gil Medical Center (GMC; n = 1,299) or present in the K-CDM network (n = 3,286). The ML algorithm was developed using data from GMC and externally validated with the K-CDM network database. Results: The ML model for prediction of IBD-related outcomes at 5 years after diagnosis yielded an area under the curve (AUC) of 0.86 (95% CI: 0.82–0.92), in an internal validation study carried out at GMC. The model performed consistently across a range of other datasets, including that of the K-CDM network (AUC = 0.81; 95% CI: 0.80–0.85), in an external validation study. Conclusions: The ML-based prediction model can be used to identify IBD-related outcomes in patients at risk, enabling physicians to perform close follow-up based on the patient’s risk level, estimated through the ML algorithm.

  • Non-professional peer support to improve mental health: Randomized trial of a scalable web-based peer counseling course

    Date Submitted: Nov 27, 2019

    Open Peer Review Period: Nov 27, 2019 - Jan 27, 2020

    Background: Millions are underserved by the mental health care system. Most mental health problems go untreated because people lack access or are not interested in professional help. Innovative and sc...

    Background: Millions are underserved by the mental health care system. Most mental health problems go untreated because people lack access or are not interested in professional help. Innovative and scalable treatment delivery methods are needed to supplement traditional treatments in order to make mental health support more accessible and more appealing. Objective: This study investigated whether a self-guided web-based course can teach pairs of non-professional peers to deliver psychological support to each other. Methods: Thirty dyads (60 participants; mostly friends), many of whom presented with mild to moderate psychological distress, were randomized to immediate or delayed access to a web-based counseling skills course. Dyads were recorded taking turns discussing stressors before and after training. Participants’ skills in the helper role were assessed before and after taking the course by coding recordings for the presence of specific counseling skills and overall competence. When in the client role, participants rated how helpful they found the session. Results: The course had large effects on most helper-role speech behaviors: helpers decreased total speaking time, used more restatements, made fewer efforts to influence the speaker, and decreased self-focused and off-topic utterances (ds = 0.8-1.6). On average, helpers met 5 out of 6 competence criteria after completing the course. As clients, participants perceived more progress in addressing their stressors during post-training counseling sessions than during pre-training sessions (d = 1.1). Conclusions: Results provide proof-of-concept that non-professionals can learn basic counseling skills from a scalable web-based course. The course serves as a promising model for the development of highly scalable, web-based counseling skills training. Such scalable, web-based courses could potentially be used for professional training purposes as well as for reciprocal peer counseling programs that can provide accessible mental health support to those underserved by traditional psychotherapy.

  • The influence of scanner precision and analysis software on quantifying 3D intraoral changes: Two-factor factorial experimental design

    Date Submitted: Nov 27, 2019

    Open Peer Review Period: Nov 27, 2019 - Jan 22, 2020

    Background: Digital scanners are being increasingly used to quantify biological topographical changes and clinical health outcomes in primary care settings. However, measurements obtained using these...

    Background: Digital scanners are being increasingly used to quantify biological topographical changes and clinical health outcomes in primary care settings. However, measurements obtained using these rapidly developing systems are rarely compared with previous precision measurements in tertiary laboratory-based settings. Objective: This investigation used dental intraoral scans to compare a primary care method of measurement (intraoral scanners with an open-source measurement software) with a precision hospital-based method of measurement (laser profilometer and engineering software). Methods: Longitudinal dental wear data from 30 patients were analysed using a two-factor factorial experimental design. At the same appointment, bimaxillary intraoral digital scans (TrueDefinition, 3M, UK) and silicone impressions, poured in type 4 dental stone, were made at baseline and follow up appointments (36 months±10.9). Stone models were scanned using precision laser profilometry (Taicaan, Southampton UK). 3D changes in the digital scans of the first molars (n=76) were quantitatively analysed in both engineering software Geomagic Control (3DSystems, Germany) and free ware WearCompare (Leeds, UK). Volume change(mm3) was the primary measurement outcome in addition to, maximum point loss (microns) and the average profile loss (microns) were recorded. Data, analysed in SPSSv25 (IBM, USA), were paired and skewed. Wilcoxon signed rank tests with Bonferroni correction were used. Results: The median volume change(IQR) for Geomagic using profilometry was -0.37mm3(IQR-3.75,2.30) and for the intraoral scan +0.51mm3(IQR -2.17,4.26), p<0.001. In WearCompare, the median volume change for profilometry was -1.21mm3(IQR -3.48,0.56) and -0.39 mm3(IQR -3.96,2.76) for intraoral scanning (p=0.039). WearCompare detected significantly greater volume loss than Geomagic regardless of scanner type. No differences were observed between groups when maximum point loss or average profile loss was analysed. Conclusions: The method of data capture, software used, and measurement metric significantly affected the measurement outcome. The combination of analysing profilometry data in WearCompare reported statistically more volume loss over the study period.

  • Patients' Perceptions of Barriers and Facilitators to the Adoption of e-Hospitals: Cross-sectional Analysis in China

    Date Submitted: Nov 26, 2019

    Open Peer Review Period: Nov 26, 2019 - Jan 21, 2020

    Background: As an innovative approach to distributing online healthcare services from physical hospitals to patients at a distance, e-hospitals, i.e., internet hospitals, have been extensively develop...

    Background: As an innovative approach to distributing online healthcare services from physical hospitals to patients at a distance, e-hospitals, i.e., internet hospitals, have been extensively developed in China. This closed healthcare delivery chain was developed through combining e-hospitals with physical hospitals; treatments begin with an online consultation and registration, then patients are diagnosed and treated in a physical hospital, followed by post-treatment care and monitoring via e-hospital. This approach is promising in its ability to improve accessibility, efficiency, and quality of healthcare. Though, to achieve its potential, it is essential that patients adopt the new technology. However, there is limited research on end-users’ acceptance of e-hospitals, nor the effectivity of strategies aimed to prompt the adoption of e-hospitals in China. Objective: To provide insight regarding the adoption of e-hospitals, this study investigated patients’ willingness to use e-hospitals, and analyzed barriers and facilitators to the adoption of the e-hospital technology. Methods: We administered a pretested self-administered questionnaire and performed a cross-sectional analysis including 1032 patients across three hierarchical hospitals in West China from June to August 2019. Patients’ sociodemographic characteristics, medical history and current disease information, proficiency of electronic devices, previous experience of online health services, willingness to use e-hospitals, and perceived facilitators as well as barriers were surveyed. Multiple significance tests were employed to examine disparities across four age groups as well as those between patients who were willing to use e-hospitals and those who were not. Multivariate logistic regression was also performed to identify potential predictors of willingness to use e-hospitals. Results: Overall, it was found that 65.6% of patients were willing to use e-hospitals. Employment status (P <.05), living with children (P <.001), IT skills (P <.001), and previous experience in online healthcare (P <.001) were statistically significant predictors of willingness to use e-hospitals; while age, education level, income, medical insurance, and familiarity with e-hospitals were not. Also, the prominent facilitators of e-hospitals were convenience (94.68%) and accessibility to skilled medical experts (72.23%). The most frequently perceived barrier varied between age groups: seniors most often reported their inability to operate technological devices as a barrier (86.75%), while young respondents most often reported that their avoidance of e-hospital services was due to their accustomization to face-to-face consultation (75.00%). Conclusions: We identified variables, facilitators, and barriers that play an essential role in the adoption of e-hospitals. Efforts to increase the adoption of e-hospitals should utilize these findings and be tailored towards the needs and characteristics of different subpopulations in China. Clinical Trial: N/A

  • Adherence to Smoking Cessation Treatment and predictors of adherence: Comparing Blended Treatment with Face-To-Face Treatment

    Date Submitted: Dec 3, 2019

    Open Peer Review Period: Nov 26, 2019 - Jan 21, 2020

    Background: Blended face-to-face and web-based treatment is a promising way to deliver smoking cessation treatment. Since adherence has been shown to be an indicator for treatment acceptability and a...

    Background: Blended face-to-face and web-based treatment is a promising way to deliver smoking cessation treatment. Since adherence has been shown to be an indicator for treatment acceptability and a determinant for effectiveness, we explored and compared adherence and predictors of adherence to a blended and a face-to-face smoking cessation treatment, both similar in content and intensity. Objective: The objectives of this study were (1) to compare adherence to a blended smoking cessation treatment (BSCT) with adherence to a face-to-face treatment (F2F); (2) to compare adherence within the blended treatment to its F2F-mode and Web-mode; and (3) to determine baseline predictors of adherence to both treatments as well as (4) the predictors to both modes of the blended treatment. Methods: We calculated the total duration of treatment exposure for patients (N=292) of a Dutch outpatient smoking cessation clinic, who were randomly assigned either to the blended smoking cessation treatment (BSCT, N=162) or to a face-to-face treatment with identical ingredients (F2F, N=130). For both treatments (BSCT vs. F2F) and for the two modes of delivery within the blended treatment (BSCTs F2F mode vs. BSCTs Web mode), adherence levels (i.e. treatment time) were compared and the predictors of adherence were identified within 33 demographic, smoking-related, and health-related patient characteristics. Results: We found no significant difference in adherence between the blended and the face-to-face treatment. BSCT patients spent an average of 246 minutes in treatment (IQR 150-355; 106.7% of intended treatment time); F2F patients spent 238 minutes (IQR 150-330; 103.3%). Within BSCT, adherence to the face-to-face mode was twice as high as to the web-mode. BSCT-patients spent an average of 198 minutes in F2F-mode (SD 120; 152% of the intended treatment time) and 75 minutes in Web-mode (SD 53, 75%). Higher age was the only characteristic consistently found to uniquely predict higher adherence in both BSCT and F2F. For F2F, more social support for smoking cessation was also predictive of higher adherence. The variability in adherence explained by these predictors was rather low (BSCT: R2=.049; F2F: R2=.076). Within BSCT, to be living without children predicted higher adherence to BSCTs F2F-mode (R2=.034), independent of age. Higher adherence to BSCTs Web-mode was predicted by a combination of an extrinsic motivation to quit, a less negative attitude toward quitting and less health complaints (R2=1.64). Conclusions: This study has been one of the first attempts to thoroughly compare adherence and predictors of adherence of a blended smoking cessation treatment to an equivalent face-to-face treatment. Interestingly, although the overall adherence to both treatments appeared to be high, adherence within the blended treatment was much higher to the face-to-face mode than the web mode. This supports the idea that in blended treatment one mode of delivery can compensate for the weaknesses of the other. Higher age was found to be a common predictor of adherence to the treatments. The low variance in adherence predicted by the characteristics examined in this study, suggests that other variables, such as provider-related health system factors and time-varying patient characteristics should be explored in future research. Clinical Trial: NTR5113

  • Using Geosocial Networking Apps and HIV Risk Behavior among Men Who Have Sex with Men: Case-Crossover Analysis of Respondents to an Online Survey Delivered via Blued in China

    Date Submitted: Nov 26, 2019

    Open Peer Review Period: Nov 26, 2019 - Jan 21, 2020

    Background: HIV disproportionately affects the estimated 21 million men who have sex with men (MSM) who live in China. The HIV epidemic is largely driven by unprotected anal sex (sex not protected by...

    Background: HIV disproportionately affects the estimated 21 million men who have sex with men (MSM) who live in China. The HIV epidemic is largely driven by unprotected anal sex (sex not protected by condoms or HIV pre-expsoure prophylaxis). The possible association between unprotected anal sex and the use of a geospatial networking apps has been a subject of scientific debate. Objective: This study assesses whether users of a gay geospatial networking app in China were more likely to use condoms when they met their partners online versus offline. A case-crossover analysis, with each person serving as his own control, was employed to address the potential bias that men looking for sex partners through an online dating medium might have inherently different (and riskier) patterns of sexual behavior compared to men not using the online dating medium. Methods: A cross-sectional survey was administered in 2018 to adult, male users of Blued (a gay geospatial networking app) in Beijing, Tianjin, Sichuan, and Yunnan China. A case-crossover analysis was conducted among 1,311 MSM not taking pre-exposure prophylaxis (PrEP) who reported both unprotected and protected anal sex in the past 6 months. Multivariable conditional logistic regression was used to quantify the association of where the partnership was initiated (offline or online) and unprotected anal sex, controlling for other interval-level covariates. Four sensitivity analyses were conducted to assess other potential sources of bias. Results: We identified 1311 matched instances where a person reported both an unprotected anal sex act and a protected anal sex acts in the last 6 months. Of the most recent unprotected anal sex acts, 22% (n=292), were initiated offline. Of the most recent protected anal sex acts, 16% (n=214), were initiated offline. In multivariable analyses, initiating a partnership offline was positively associated with unprotected anal sex (OR 2.66, 95% CI 1.84 – 3.85, p<.001), compared to initiating a partnership online. These results were robust to each of the different sensitivity analyses we conducted. Conclusions: Among Blued users in these four Chinese cities, men were less likely to have unprotected anal sex in partnerships that they initiated online compared to partnerships that they initiated offline. The relationship was strong, with over 2.5 times the likelihood of engaging in unprotected anal sex in partnerships initiated offline compared to those initiated online. These findings suggest that geospatial networking apps are a proxy for, and not a cause of, high risk behaviors for HIV infection, and that these platforms should be viewed as a useful venue to identify individuals at risk for HIV transmission to allow for targeted service provision.