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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:

  • Source: Pxhere; Copyright: Pxhere; URL: https://pxhere.com/en/photo/714530; License: Public Domain (CC0).

    Searching the Internet for Infertility Information: A Survey of Patient Needs and Preferences

    Abstract:

    Background: Given the complexity of infertility diagnoses and treatments and the convenience of the internet for finding health-related information, people undergoing infertility treatments often use Web-based resources to obtain infertility information and support. However, little is known about the types of information and support resources infertility patients search for on the internet and whether these resources meet their needs. Objective: The aims of this study were to (1) examine what individual factors, namely, demographic characteristics and distress, are associated with searching the internet for different types of infertility-related information and support resources and (2) determine whether Web-based resources meet the needs of patients. Methods: Men and women seeking infertility care responded to a survey assessing use of Web-based resources for accessing infertility-related information and support. The survey further assessed satisfaction with Web-based resources as well as perceived stress and depressive symptomatology. Results: A total of 567 participants, including 254 men and 313 women, completed the survey. Most participants (490/558, 87.8%) had searched the internet for infertility information and support. Searchers were more likely to be women (P<.001), highly educated (P=.04), long-term patients (P=.03), and more distressed (P=.04). Causes of infertility, treatment options, and scientific literature about infertility were the three most frequently searched topics, whereas ways to discuss treatment with family and friends as well as surrogacy and ways to find peer support were the three least searched topics. Of those who searched the internet, 70.9% (346/488) indicated that their needs were met by Web-based information, whereas 29.1% (142/488) said that their needs were not met. Having unmet needs was related to greater levels of perceived stress (P=.005) and depressive symptomatology (P=.03). Conclusions: This study provides evidence for the important role of the internet in accessing infertility information and support and for the ability of Web-based resources to meet patients’ needs. However, although distressed patients reported particularly high rates of searching, their needs were not always met, suggesting that they may benefit from alternative sources of information and support or guidance from health care providers when searching the internet.

  • Martin Luther nails his 95 theses to the cathedral door, declaring that the people should have direct access to knowledge (the Bible). Source: Wikimedia Commons; Copyright: Ferdinand Pauwels; URL: https://commons.wikimedia.org/wiki/File:Ferdinand_Pauwels_-_Luther_hammers_his_95_theses_to_the_door.jpg; License: Public Domain (CC0).

    Open Access as a Revolution: Knowledge Alters Power

    Authors List:

    Abstract:

    The slogan “Gimme My Damn Data” has become a hallmark of a patient movement whose goal is to gain access to data in their medical records. Its first conference appearance was ten years ago, in September 2009. In the decade since there have been enormous changes in both the technology and sociology of medicine as well as in their synthesis. As the patient movement has made strides, it has been met with opposition and obstacles. It has also become clear that the availability of Open Access information is just as empowering (or disabling) as access to electronic medical records and device data. Knowledge truly is power, and to withhold knowledge is to disempower patients. This essay lays out many examples of how this shows up as we strive for the best future of care.

  • Lifestyle modifications for patients with chronic kidney disease. Source: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/happy-woman-doing-exercise-with-dumbbells_4321494.htm#page=1&query=exercise,%20elderly&position=33; License: Licensed by JMIR.

    Detecting Lifestyle Risk Factors for Chronic Kidney Disease With Comorbidities: Association Rule Mining Analysis of Web-Based Survey Data

    Abstract:

    Background: The rise in the number of patients with chronic kidney disease (CKD) and consequent end-stage renal disease necessitating renal replacement therapy has placed a significant strain on health care. The rate of progression of CKD is influenced by both modifiable and unmodifiable risk factors. Identification of modifiable risk factors, such as lifestyle choices, is vital in informing strategies toward renoprotection. Modification of unhealthy lifestyle choices lessens the risk of CKD progression and associated comorbidities, although the lifestyle risk factors and modification strategies may vary with different comorbidities (eg, diabetes, hypertension). However, there are limited studies on suitable lifestyle interventions for CKD patients with comorbidities. Objective: The objectives of our study are to (1) identify the lifestyle risk factors for CKD with common comorbid chronic conditions using a US nationwide survey in combination with literature mining, and (2) demonstrate the potential effectiveness of association rule mining (ARM) analysis for the aforementioned task, which can be generalized for similar tasks associated with noncommunicable diseases (NCDs). Methods: We applied ARM to identify lifestyle risk factors for CKD progression with comorbidities (cardiovascular disease, chronic pulmonary disease, rheumatoid arthritis, diabetes, and cancer) using questionnaire data for 450,000 participants collected from the Behavioral Risk Factor Surveillance System (BRFSS) 2017. The BRFSS is a Web-based resource, which includes demographic information, chronic health conditions, fruit and vegetable consumption, and sugar- or salt-related behavior. To enrich the BRFSS questionnaire, the Semantic MEDLINE Database was also mined to identify lifestyle risk factors. Results: The results suggest that lifestyle modification for CKD varies among different comorbidities. For example, the lifestyle modification of CKD with cardiovascular disease needs to focus on increasing aerobic capacity by improving muscle strength or functional ability. For CKD patients with chronic pulmonary disease or rheumatoid arthritis, lifestyle modification should be high dietary fiber intake and participation in moderate-intensity exercise. Meanwhile, the management of CKD patients with diabetes focuses on exercise and weight loss predominantly. Conclusions: We have demonstrated the use of ARM to identify lifestyle risk factors for CKD with common comorbid chronic conditions using data from BRFSS 2017. Our methods can be generalized to advance chronic disease management with more focused and optimized lifestyle modification of NCDs.

  • Source: Image created by the Authors; Copyright: Damian Hacking; URL: http://www.jmir.org/2019/11/e14012/; License: Creative Commons Attribution (CC-BY).

    Peer Mentorship via Mobile Phones for Newly Diagnosed HIV-Positive Youths in Clinic Care in Khayelitsha, South Africa: Mixed Methods Study

    Abstract:

    Background: Youths in South Africa are poor utilizers of HIV health services. Medecins Sans Frontieres has been piloting youth-adapted services at a youth clinic in Khayelitsha, including a peer virtual mentorship program over mobile phones, piloted from March 2015 to May 2016. Objective: The objective of this study was to evaluate the effect of the peer mentorship program on youth engagement with HIV services and explore the acceptability of the program to both mentors and mentees. Methods: Antiretroviral initiation, retention in care (RIC), and viral load suppression were compared between youths engaged in the virtual mentorship program and two matched controls. In-depth interviews were also conducted for 5 mentors and 5 mentees to explore acceptability and impact of the program. Results: A total of 40 youths were recruited into the virtual mentorship program over the study period. Of these, data were obtained for 35 and 2 matched controls were randomly sampled for each. There was no difference in baseline demographics (eg, age, gender, and CD4 count). Mentees had increased antiretroviral initiation (28/35, 80% vs 30/70, 42% in matched controls) and viral load completion (28/35, 80% vs 32/70, 45%); however, no differences were found in viral load suppression or RIC at 6 or 12 months. Mentors reported being motivated to participate in the program because of previous personal struggles with HIV and a desire to help their peers. Mentees reported fears of disclosure and lack of acceptance of their status as barrier to accessing services, but they felt free to talk to their mentors, valued the mentorship program, and indicated a preference for phone calls. Conclusions: Peer mentorship in youths is acceptable to both mentors and mentees and appears to increase linkage to care and viral load completion rates.

  • Source: Unsplash.com; Copyright: Crew; URL: https://unsplash.com/photos/4Hg8LH9Hoxc; License: Licensed by JMIR.

    Attitudes Toward Blockchain Technology in Managing Medical Information: Survey Study

    Abstract:

    Background: The recently developed blockchain technology uses a peer-to-peer network to distribute data to all participants for storage. This method enhances data safety, reliability, integrity, and transparency. To successfully introduce blockchain technology to medical data management, it is essential to obtain consent from medical doctors and patients. Objective: The aim of this study was to examine medical doctors’ and patients’ attitudes toward the use of blockchain technology and interpret the findings within the framework of expectancy theory. Methods: In this questionnaire survey, we examined medical doctors’ (n=90) and patients’ (n=90) attitudes toward the use of blockchain technology in the management and distribution of medical information. The questionnaire comprised 8 questions that assessed attitudes toward new means of managing and distributing medical information using blockchain technology. Responses were rated on a scale that ranged from 1 (very negative) to 7 (very positive). Results: Medical doctors (mean 3.7-5.0) reported significantly more negative attitudes than patients (mean 6.3-6.8). Furthermore, self-employed doctors reported more negative attitudes than employed doctors and university professors. Conclusions: To successfully introduce blockchain technology to medical data management, it is necessary to promote positive attitudes toward this technology among medical doctors, especially self-employed doctors.

  • Source: Unsplash.com; Copyright: Anastasia Mihalkova; URL: https://unsplash.com/photos/WpcT8nqyPRM; License: Licensed by JMIR.

    Effectiveness of Smartphone App–Based Interactive Management on Glycemic Control in Chinese Patients With Poorly Controlled Diabetes: Randomized Controlled...

    Abstract:

    Background: In recent years, the rapid development of mobile medical technology has provided multiple ways for the long-term management of chronic diseases, especially diabetes. As a new type of management model, smartphone apps are global, convenient, cheap, and interactive. Although apps were proved to be more effective at glycemic control, compared with traditional computer- and Web-based telemedicine technologies, how to gain a further and sustained improvement is still being explored. Objective: The objective of this study was to investigate the effectiveness of an app-based interactive management model by a professional health care team on glycemic control in Chinese patients with poorly controlled diabetes. Methods: This study was a 6-month long, single-center, prospective randomized controlled trial. A total of 276 type 1 or type 2 diabetes patients were enrolled and randomized to the control group (group A), app self-management group (group B), and app interactive management group (group C) in a 1:1:1 ratio. The primary outcome was the change in glycated hemoglobin (HbA1c) level. Missing data were handled by multiple imputation. Results: At months 3 and 6, all 3 groups showed significant decreases in HbA1c levels (all P<.05). Patients in the app interactive management group had a significantly lower HbA1clevel than those in the app self-management group at 6 months (P=.04). The average HbA1c reduction in the app interactive management group was larger than that in the app self-management and control groups at both months 3 and 6 (all P<.05). However, no differences in HbA1c reduction were observed between the app self-management and control groups at both months 3 and 6 (both P>.05). Multivariate line regression analyses also showed that the app interactive management group was associated with the larger reduction of HbA1c compared with groups A and B at both months 3 and 6 (all P>.05). In addition, the app interactive management group had better control of triglyceride and high-density lipoprotein cholesterol levels at both months 3 and 6 compared with baseline (both P<.05). Conclusions: In Chinese patients with poorly controlled diabetes, it was difficult to achieve long-term effective glucose improvement by using app self-management alone, but combining it with interactive management can help achieve rapid and sustained glycemic control. Clinical Trial: ClinicalTrials.gov NCT02589730; https://clinicaltrials.gov/ct2/show/NCT02589730.

  • Source: http://news.gog.cn/system/2015/04/21/014259073.shtml; Copyright: Colorful Guizhou Network - Guizhou business daily; URL: http://news.gog.cn/system/2015/04/21/014259073.shtml; License: Creative Commons Attribution (CC-BY).

    Understanding the Function Constitution and Influence Factors on Communication for the WeChat Official Account of Top Tertiary Hospitals in China:...

    Abstract:

    Background: Widespread adoption and continued developments in mobile health care technologies have led to the improved accessibility and quality of medical services. In China, WeChat, an instant messaging and social networking app released by the company Tencent, has developed a specific type of user account called WeChat official account (WOA), which is now widely adopted by hospitals in China. It enables health care providers to connect with local citizens, allowing them to, among other actions, send regular updates through mass circulation. However, with the diversity in function provided by WOA, little is known about its major constitution as well as the influence factors on the WeChat communication index (WCI). The WCI has been widely used in social media impact ranking with various types of WeChat content to fully reflect the dissemination and coverage of tweets as well as the maturity and impact of WOA. Objective: There are two typical WOAs available to users, namely, WeChat subscription account (WSSA) and WeChat service account (WSVA). The biggest difference between them is the frequency of messages transmitted. This study aimed to explore the function constitution of WSVA adopted by top tertiary hospitals in China and the major contributors of the WCI score. Methods: A total of 681 top tertiary hospitals were selected from the Hospital Quality Monitoring System; the WOA of every top tertiary hospital was retrieved in the WeChat app. We divided core functional items of WSVAs using categorical principal component analysis. To elicit the factors that influenced the use of WSVA, quantile regression was employed to analyze the WCI score. Results: From the 668 WOAs identified, adoption of WSVAs (543/668, 81.3%) was more than that of WSSAs (125/668, 18.7%). Functional items of WSVAs were categorized into four clusters: (1) hospital introduction, (2) medical services, (3) visiting assistants, and (4) others. With regard to the influence factors on the WCI, the impact of the activity index of WSVA and the total visiting number of outpatients and emergencies on WCI were statistically significant and positive in all quantiles. However, the year of certification, the type of hospital, the year of public hospital reform, and the number of beds merely affected the WCI at some quantiles. Conclusions: Our findings are considered helpful to tertiary hospitals in developing in-depth functional items that improve patient experience. The tertiary hospitals should take full advantage of times of posting and provide high-quality tweets to meet the various needs of patients.

  • Untitled. Source: freepik; Copyright: freepik; URL: https://www.freepik.com/free-photo/doctor-doing-research-his-laptop_5480774.htm#page=1&query=doctor%20research&position=36; License: Licensed by JMIR.

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

    Abstract:

    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: https://www.istockphoto.com/ca/photo/doctor-with-health-insurance-healthcare-graphic-gm1126636198-296684969; License: Licensed by the authors.

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

    Abstract:

    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: ClinicalTrials.gov NCT03470974; https://clinicaltrials.gov/ct2/show/NCT03470974

  • Source: Image created by the Authors; Copyright: The Authors; URL: http://www.jmir.org/2019/12/e13694/; License: Licensed by JMIR.

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

    Abstract:

    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: https://www.istockphoto.com/ca/photo/concept-of-using-modern-technology-at-hospitals-portrait-of-smiling-charming-female-gm926649932-254252846; License: Licensed by the authors.

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

    Abstract:

    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: https://www.istockphoto.com/ca/photo/female-physician-visiting-patient-in-hospital-room-gm852501710-140081373?clarity=false; License: Licensed by the authors.

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

    Abstract:

    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: ClinicalTrials.gov NCT03224429; https://clinicaltrials.gov/ct2/show/NCT03224429 and ClinicalTrials.gov NCT02326597; https://clinicaltrials.gov/ct2/show/NCT02326597

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  • The Personal Health Network Mobile Application for Chemotherapy Care Coordination: A qualitative evaluation of a randomized clinical trial

    Date Submitted: Dec 7, 2019

    Open Peer Review Period: Dec 7, 2019 - Feb 1, 2020

    Background: Cancer care coordination addresses the fragmented and inefficient care of individuals with complex care needs. The complexity of care coordination can be aided with innovative technology....

    Background: Cancer care coordination addresses the fragmented and inefficient care of individuals with complex care needs. The complexity of care coordination can be aided with innovative technology. Few examples of information technology (IT)-enabled care coordination exist beyond the conventional telephone follow-up. For this study, we implemented a custom-designed application, the “personal health network” (PHN)—a HIPAA-compliant social network built around a patient to enable patient-centered health and healthcare activities in collaboration with clinicians, care team members, caregivers and others designated by the patient—to facilitate a care coordination intervention for patients undergoing chemotherapy. Objective: The objective of this study was to understand patient experiences with the PHN technology and assess their perspectives on usability and usefulness of the PHN with care coordination during chemotherapy. Methods: A two-arm randomized clinical trial was conducted comparing the PHN and care coordination with care coordination alone over a six-month period beginning with the initiation of chemotherapy. A semi-structured interview guide was constructed based on a theoretical framework of technology acceptance addressing usefulness, usability, and the context of use of the technology within the participant’s life and healthcare setting. All participants in the intervention arm were offered interviews on completion of the study. Interviews were recorded and transcribed verbatim. Summative thematic analysis was completed for the transcribed interviews. Features of the applications were also evaluated. Results: 27 interviews were completed. The resulting themes included the care coordinator as a partner in care; learning while sick; comparison of other technology to make sense of the PHN; communication; learning, usability; and usefulness. Users expressed that the nurse care coordinators were beneficial to them because they helped them stay connected to the care team and answered their questions. They shared that the mobile application gave them access to health information they were seeking. Users expressed that the mobile application would be more useful if it was fully integrated with the electronic health record. Conclusions: The findings highlight the value of care coordination from the perspectives of cancer patients undergoing chemotherapy and the important role of technology, such as the PHN, in enhancing this process by facilitating better communication and access to information regarding their illness. Clinical Trial: NCT02238951

  • The patients’ perspective on mental health specialist video consultations in primary care: A qualitative pre-implementation study of anticipated benefits, barriers, and therapeutic relationship

    Date Submitted: Dec 6, 2019

    Open Peer Review Period: Dec 6, 2019 - Jan 31, 2020

    Background: Due to limited access to specialist services, most patients with mental health conditions usually receive treatment in primary care. More recently, innovative technology-based care models...

    Background: Due to limited access to specialist services, most patients with mental health conditions usually receive treatment in primary care. More recently, innovative technology-based care models (e.g., video consultations) have been proposed to facilitate access to specialist services. Objective: From the patients’ perspective, this qualitative pre-implementation study explores (a) anticipated benefits from and (b) barriers to implementing mental health specialist video consultations embedded in primary care services and (c) prerequisites for interacting with therapists via video consultations. Methods: Using a convenience sampling strategy, we recruited 13 patients from primary care services and a tertiary care hospital for one-off semi-structured interviews. In a computer-assisted thematic analysis, we inductively (bottom-up) derived key themes concerning the practicability of mental health specialist video consultations. To validate our results, we discussed our findings with the interviewees as part of a systematic member checking. Results: Overall, we derived three key themes and ten subthemes. Participants identified specific benefits in two areas, namely the accessibility to mental health specialist care (shorter waiting times (11/13, 85%), overcoming stigma for seeking specialist mental health care (6/13, 46%), shorter travel distances (3/13, 23%)) and the environment in primary care (familiar travel modalities, premises, and employees (5/13, 38%)). The main barriers to the implementation of mental health video consultations from the patients’ perspective were the lack of face-to-face contact (13/13, 100%) and technical challenges (12/13, 92%). Notably, participants’ prerequisites for interacting with therapists (12/13, 92%) did not seem to differ much from those concerning face-to-face contacts. Conclusions: Mental health service users mostly welcome mental health specialist video consultations in primary care. Taking a pragmatic stance, service users, who are often frustrated about uncoordinated care, particularly value the embedment of the consultations in the familiar environment of the primary care practice. With respect to interventional studies and implementation, our findings underscore the need to minimize technical disruptions during video consultations as well as ensure optimal resemblance to face-to-face settings (e.g., by training therapists in consistently reacting to verbal cues). Clinical Trial: German Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012487

  • Doctor image on People's Daily Weibo and its impact on the doctor-patient relationship:content analysis

    Date Submitted: Dec 6, 2019

    Open Peer Review Period: Dec 6, 2019 - Jan 31, 2020

    Background: Since the 2009 medical reform in China, the doctor-patient relationship seems to be an increasingly serious issue. And with the new media era, Weibo is one of the most important platforms...

    Background: Since the 2009 medical reform in China, the doctor-patient relationship seems to be an increasingly serious issue. And with the new media era, Weibo is one of the most important platforms for building the doctor image. However, no studies have focused on how China official media Weibo reports on doctor-patient issues. Objective: The aim of this study was to study the presentation of doctor image on People's Daily Weibo and how it affects the direction of the doctor-patient relationship. Methods: This study used a content analysis method and collected data from 01 January 2016 to 31 December 2018 on People's Daily Weibo. Through the characteristics, these postings were categorized into four-doctor images. Results: A total of 216 postings about the doctor image were collected on People's Daily Weibo. It was reported 122 postings on positive doctor image, up to 56%, while the number of negative doctor image postings is 15, accounting for only 7%. 44 postings about victim doctor image, accounting for 21%. There are about 25 medical disturbances. People’s Daily Weibo has reported 35 postings that have a neutral image of doctors, accounting for 16%. Conclusions: People’s Daily Weibo has shaped four-doctor media images in the past three years. Moreover, it has mostly reported postings with a rigorous attitude, but some also exaggerate the facts leading to unreal. People’s Daily, the official Chinese media, actively embraces new media by using Weibo to shape doctor media images to influence the harmony of doctor-patient relationships.

  • Needs assessment survey for a food safety education through We-media: A cross-sectional survey among junior students of a normal and a medical university in Chongqing, China

    Date Submitted: Dec 4, 2019

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

    Background: Many studies on food safety cognition and practice intervention among university students exist, but only few conduct needs assessment surveys. In recent years, We-media has been applied i...

    Background: Many studies on food safety cognition and practice intervention among university students exist, but only few conduct needs assessment surveys. In recent years, We-media has been applied in the field of health education and promotion, but its application in food safety intervention is limited at home and abroad. Objective: This study aimed to explore the current situation of We-media use and assess the needs for food safety information through We-media among junior students of a normal and a medical university. Methods: A cross-sectional survey was conducted among junior students of a normal and a medical university in Chongqing, China in 2016. A total of 1,250 normal university students and 1,434 medical students participated in the questionnaire survey. Results: Findings reveal that 71.4% and 64.8% of normal university and medical students were willing to accept food safety educational information by We-media, respectively. In addition, 47.6% and 48.8% of normal university and medical students were willing to accept food safety information through WeChat official accounts, respectively. Among normal university students, 83.8%, 63.9%, 59.6%, and 13.0% wanted to acquire food safety knowledge by picture, text, video, and voice, respectively. Of the medical students, 84.7%, 67.7%, 62.3%, and 11.9% wanted to acquire food safety knowledge by picture, text, video, and voice, respectively. Gender, school category, and whether food safety information is given attention were the influencing factors of participants’ willingness to accept such information through We-media (p < 0.05). Conclusions: This study indicated that We-media could be an appropriate intervention approach for the junior students of a normal and a medical university to accept food safety intervention. WeChat was also revealed as the best platform. Pictures, text messages, and videos were observed the most popular means for students to acquire food safety knowledge.

  • Development of machine learning model to predict the risk of 5- year disease related outcomes in patients with inflammatory bowel disease

    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.

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