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The leading peer-reviewed journal for digital medicine, and health & healthcare in the Internet age
The Journal of Medical Internet Research (JMIR), now in its 20th year, is the pioneer open access eHealth journal and is the flagship journal of JMIR Publications. It is the leading digital health journal globally in terms of quality/visibility (Impact Factor 2017: 4.671, ranked #1 out of 22 journals) and in terms of size (number of papers published). The journal focuses on emerging technologies, medical devices, apps, engineering, and informatics applications for patient education, prevention, population health and clinical care. As leading high-impact journal in its' disciplines (health informatics and health services research), it is selective, but it is now complemented by almost 30 specialty JMIR sister journals, which have a broader scope. Peer-review reports are portable across JMIR journals and papers can be transferred, so authors save time by not having to resubmit a paper to different journals.
As open access journal, we are read by clinicians, allied health professionals, informal caregivers, and patients alike, and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews).
We are also a leader in participatory and open science approaches, and offer the option to publish new submissions immediately as preprints, which receive DOIs for immediate citation (eg, in grant proposals), and for open peer-review purposes. We also invite patients to participate (eg, as peer-reviewers) and have patient representatives on editorial boards.
Be a widely cited leader in the digitial health revolution and submit your paper today!
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Background: Anxiety conditions are debilitating and prevalent throughout the world. Acceptance and Commitment Therapy (ACT) is an effective, mindfulness-based psychological treatment for anxiety. Ho...
Background: Anxiety conditions are debilitating and prevalent throughout the world. Acceptance and Commitment Therapy (ACT) is an effective, mindfulness-based psychological treatment for anxiety. However, there are treatment barriers (e.g. financial, geographical, and attitudinal) which prevent people from accessing it. To overcome these barriers, internet-delivered Acceptance and Commitment Therapy (iACT) interventions have been developed in recent years. These interventions use websites to deliver ACT information and skill training exercises online, either as pure self-help or with therapist guidance. Objective: The present systematic review aimed to examine the therapeutic impact of iACT on all anxiety conditions. Empirical studies of all designs, population types, and comparator groups were included if they appraised the impact of iACT treatment on any standardised measure of anxiety. Data on participant characteristics, intervention delivery, anxiety outcomes, user attrition rates, and treatment satisfaction were extracted to help identify efficacious and acceptable interventions, elucidate research gaps, and guide the design, development and administration of new iACT programs. Methods: The Embase, Medline, ProQuest Central, PsycINFO, Scopus, and Web of Science databases were searched up to September 2018. The titles and abstracts of remaining records after deduplication were screened by two authors with a total of 36 full-text articles being retained for closer inspection next to eligibility criteria. Included studies were appraised on methodological quality and had their data extracted into a standardised coding sheet. Findings were then tabulated and a narrative synthesis was performed due to the heterogeneity found between studies. Results: Twenty studies met inclusion criteria. There were 11 randomised controlled trials and 9 uncontrolled pilot studies. Participants across all studies were adults. Treated anxiety conditions included: generalised anxiety disorder, social anxiety disorder, illness anxiety disorder, and general anxiety symptoms with or without comorbid physical and/or mental health problems. Eighteen studies reported significant anxiety reduction after iACT treatment with effect sizes ranging from small to large. This was observed in studies that delivered iACT with (n = 13) or without (n = 5) therapist guidance. The average attrition rate across all included studies during the active iACT treatment phase was 24.21%. In the 13 studies that assessed treatment satisfaction, participants on average rated their iACT experience with above average to high treatment satisfaction. Conclusions: These findings indicate that iACT can be an efficacious and acceptable treatment for adults with generalised anxiety disorder and general anxiety symptoms. More randomised controlled trial studies are needed to corroborate these early iACT findings using empirical treatments in active control groups (e.g. internet-delivered cognitive behavioural therapy). This would potentially validate the promising results found for social anxiety disorder and illness anxiety disorder as well as address the full spectrum of anxiety disorders.
Background: Adolescents living with HIV (ALHIV) enrolled in HIV treatment services experience greater loss to follow-up and suboptimal adherence compared to other age groups. HIV-related stigma, issue...
Background: Adolescents living with HIV (ALHIV) enrolled in HIV treatment services experience greater loss to follow-up and suboptimal adherence compared to other age groups. HIV-related stigma, issues related to disclosure, lack of social support, and limited HIV knowledge thwart ALHIV from adhering to antiretroviral therapy (ART) and being retained in HIV services. The 90-90-90 goals for ALHIV will only be met through strategies targeted to meet their specific needs. Objective: We tested the feasibility of implementing a social media-based intervention to improve HIV knowledge, social support, ART adherence and retention among ALHIV ages 15-19 years on ART in Nigeria. Methods: We conducted a single-group pre/post-test study from June 2017 to January 2018. We adapted an existing support group curriculum and delivered it through trained facilitators in five support groups using Facebook groups. This pilot intervention included five week-long sessions. We conducted structured interviews with participants pre- and post-intervention, extracted clinical data, and documented intervention implementation and participation. In-depth interviews were conducted with a subset of participants at endline. Quantitative data from structured interviews and group participation data were summarized descriptively and qualitative data were coded and summarized. Results: Forty-one ALHIV enrolled in the study. At baseline, 93% of participants reported existing phone access; 65% used the internet and 64% were Facebook users. Thirty-seven participants completed the 5-session intervention; 32 actively posted comments in at least one session online and at least half commented in each of the five sessions. Facilitators delivered most sessions as intended and on-time. Participants were enthusiastic about the intervention. Most liked aspects included: interacting with other ALHIV; learning about HIV; sharing questions, experiences and fears. Key recommendations included having larger groups and encouraging more group interaction. Specific recommendations on various intervention components were also made to improve the intervention. Conclusions: This novel intervention proved feasible to implement in a predominantly suburban/rural Nigerian setting. Social media may be leveraged to provide much needed information and social support on platforms accessible and familiar to many, even in resource constrained communities. Findings have been incorporated into the intervention and an outcome study is underway. Clinical Trial: NCT03076996
Background: Text message interventions hold promise for adolescents and young adults (AYA) with chronic health conditions, including childhood cancer survivors. However, engagement is often suboptimal...
Background: Text message interventions hold promise for adolescents and young adults (AYA) with chronic health conditions, including childhood cancer survivors. However, engagement is often suboptimal. Limited research has studied mHealth intervention outcomes beyond efficacy. Understanding responsivity to different types of text messages (i.e., when a participant texts back) can provide practical, actionable information to optimize engagement in future projects. Objective: Within a two-way text messaging study in AYA who recently completed treatment for cancer, we sought to evaluate text message responsivity across different types of text messages. Methods: AYA who recently completed treatment for cancer (n = 26, M age = 16, 62% female) received two-way text messages about survivorship health topics over a 16-week period. Using participants’ text message log data, we coded responsivity to text messages and evaluated trends in responsivity to unprompted text messages and prompted text messages of varying content (e.g., medication reminders, appointment reminders, texts about personal experiences as a cancer survivor). Results: Across prompted and unprompted text messages, responsivity rapidly decreased and plateaued by the third week of the intervention. However, participants were more responsive to prompted text messages than unprompted messages. They also demonstrated stable responsivity to certain prompted content: medication reminders, appointment reminders, goal motivation, goal progress, and patient experience texts. Conclusions: Our methodology of evaluating text message responsivity revealed important patterns of engagement in a two-way text message intervention for AYA cancer survivors.
This manuscript needs more reviewersPeer-Review Me
Background: Receiving insufficient sleep has wide-ranging consequences for health and well-being. Although educational programs have been developed to promote sleep, these have had limited success in...
Background: Receiving insufficient sleep has wide-ranging consequences for health and well-being. Although educational programs have been developed to promote sleep, these have had limited success in extending sleep duration. To address this gap, we developed a web-based program emphasizing how physical appearances change with varying amounts of sleep. Objective: The aims of this study were to evaluate: (1) whether participants can detect changes in appearances as a function of sleep, and (2) whether this intervention can alter habitual sleep patterns. Methods: We conducted a 5-week, parallel-group, randomized controlled trial amongst 70 habitual short sleepers (healthy adults who reported having <7 hours of sleep routinely). Upon study enrolment, participants were randomly assigned (1:1) to receive either standard information or an appearance-based intervention. Both groups received educational materials about sleep, but those in the appearance group also viewed a website containing digitally-edited photographs that showed how they would look with varying amounts of sleep. As outcome variables, sleep duration was monitored objectively via actigraphy (at baseline, and at post-intervention weeks 1 and 4), and participants completed a measure of sleep hygiene (at baseline, and at post-intervention weeks 2, 4, and 5). For each outcome, we ran intention-to-treat analyses using linear mixed-effects models. Results: In total, 35 participants were assigned to each group. Validating the intervention, participants in the appearance group: (i) were able to identify what they looked like at baseline, and (ii) judged that they would look more attractive with a longer sleep duration (P < .001). In turn, this translated to changes in sleep hygiene: whereas participants in the appearance group showed improvements following the intervention (P = .003), those in the information group did not (P = .66). Finally, there was no significant effect of group nor interaction of group and time on actigraphy-measured sleep duration (smallest P = .26). Conclusions: Our findings suggest that an appearance-based intervention – while not sufficient as a standalone – could have an adjunctive role in sleep promotion. Clinical Trial: ClinicalTrials.gov NCT02491138
Background: Being 21st century healthcare workers is extremely demanding. The growing number of chronic diseases, lack of medical workforce, increasing amount of administrative tasks and cost of medic...
Background: Being 21st century healthcare workers is extremely demanding. The growing number of chronic diseases, lack of medical workforce, increasing amount of administrative tasks and cost of medical treatment and the rising of life expectancy mean immense challenge on medical professionals. This transformation is triggered by the appearance of digital health. Digital health doesn’t only mean technological transformation but it fundamentally reshapes physician-patient relationship and treatment circumstances. We argue that patient empowerment, the spread of digital health, the bio-psycho-social-digital approach and the disappearance of the ivory tower of medicine lead to a new role for physicians. Main text: Digital health offers the opportunity to make the job of being a medical professional rewarding and creative. The general idol of a physician could shift from self-confident to curious; from rule-follower to creative; and from the lone hero to a team worker. E-physicians are “electronic” they use digital technologies in their practice with ease. They are “enabled" by regulations and guidelines and "empowered" by technologies that support their job and e-patients. They are "experts" of using technologies in their practice or know the best and most reliable and trustworthy sources and technologies. And also “engaged” to understand the feelings and point of view of the patients, giving relevant feedback and involving them throughout the whole healing process. Conclusion: There are major factors that facilitate this transition from demigods to guides who enjoy their job. Examples include meaningful incentives proposed by providers; a well-designed medical curriculum, post-graduate education teaching relevant skills; the wider availability of technologies; useful recommendations from peers; a rising number of evidence-based papers and guidelines; technologies that help save time and effort; and generally, a good experience with e-patients.
Background: Online self-management enhancing programmes has the potential to support patients with Rheumatoid Arthritis in their self-management, for example improve their health status and self-effic...
Background: Online self-management enhancing programmes has the potential to support patients with Rheumatoid Arthritis in their self-management, for example improve their health status and self-efficacy or decrease overuse of medication. We developed an online self-management enhancing program in collaboration with RA patients and professionals as co-designers, based on the Intervention Mapping Framework. While self-management programs are complex interventions, it is informative to perform an explorative Randomized Controlled Trial before embarking on a larger trial. Objective: This study aimed to evaluate the efficacy of an online self-management enhancing programme for patients with rheumatoid arthritis and to identify outcome measures most likely to capture potential benefits. Methods: A multicentre exploratory randomised controlled trial was performed with an intervention and a control group. Both groups received care as usual. In addition, the intervention group received 12 months of access to an online self-management programme. Assessment occurred at baseline, 6 and 12 months. Outcome measures included self-management behaviour (PAM-13, SMAS-S), self-efficacy (RASE, PEPPI-5), general health status (RAND-36), focus on fatigue (MPCI-F), perceived pain and fatigue (NRS scales). A linear mixed model for repeated measures, using the intention-to-treat principle, was applied to study differences between the patients in the intervention (n=78) and control (n=79) groups. A sensitivity analysis was performed in the intervention group to study the influence of patients with high (N=30) and low (N=40) use of the intervention. Results: The intervention group scored statistically significantly better on the subscale RAND-36 vitality. The group with high use scored statistically significantly better on the subscale RAND-36 perception, although the effect sizes were small. No other statistically significant or clinically relevant effects were found. Conclusions: Based on these results, it is not possible to conclude on the positive effects of the intervention or to select outcome measures to be regarded as the primary/main or secondary outcomes for a future trial. A process evaluation should be performed to provide more insight into the low compliance with and effectiveness of the intervention. Clinical Trial: The trial is registered in the Dutch Trial Register (ID: NTR4871). URL: http://www.trialregister.nl/trialreg/admin/rctsearch.asp?Term=4871