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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: mali maeder / Pexels.com; Copyright: mali maeder; URL: https://www.pexels.com/photo/person-wearing-black-henley-shirt-and-white-vr-goggles-756439/; License: Licensed by JMIR.

    What Players of Virtual Reality Exercise Games Want: Thematic Analysis of Web-Based Reviews

    Abstract:

    Background: Physical activity (PA) is associated with a variety of physical and psychosocial health benefits, but levels of moderate-to-vigorous intensity PA remain low worldwide. Virtual reality (VR) gaming systems involving movement (VR exergames) could be used to engage people in more PA. Methods: We conducted a thematic analysis of 498 reviews of the 29 most popular exergames sold in the top 3 VR marketplaces: Steam (Valve Corporation), Viveport (Valve Corporation), and Oculus (Oculus VR). We categorized reviews as positive and negative as they appeared in the marketplaces and identified the most common themes using an inductive thematic analysis. Results: The reviews were often mixed, reporting a wide variety of expectations, preferences, and gaming experiences. Players preferred highly realistic games (eg, closely simulated real-world sport), games that were intuitive (in terms of body movement and controls), and games that provided gradual increases in skill acquisition. Players reported feeling that they reached a high level of exertion when playing and that the immersion distracted them from the intensity of the exercise. Some preferred features included music and social aspects of the games, with multiplayer options to include friends or receive help from experienced players. There were 3 main themes in negative reviews. The first concerned bugs that rendered games frustrating. Second, the quality of graphics had a particularly strong impact on perceived enjoyment. Finally, reviewers disliked when games had overly complex controls and display functions that evoked motion sickness. Conclusions: Exergames prove to be a stimulating avenue for players to engage in PA and distract themselves from the negative perceptions of performing exercise. The common negative aspects of VR exergames should be addressed for increased uptake and continued engagement.

  • Source: Unsplash; Copyright: Alexander Dummer; URL: https://unsplash.com/photos/UH-xs-FizTk; License: Licensed by JMIR.

    Accuracy of Parent-Reported Child Height and Weight and Calculated Body Mass Index Compared With Objectively Measured Anthropometrics: Secondary Analysis of...

    Abstract:

  • Cost-effectiveness of telemonitoring inflammatory bowel disease. Source: Image created by the Authors; Copyright: The Authors; URL: https://www.jmir.org/2019/9/e15505; License: Creative Commons Attribution (CC-BY).

    Telemonitoring of Crohn’s Disease and Ulcerative Colitis (TECCU): Cost-Effectiveness Analysis

    Abstract:

    Background: Although electronic health interventions are considered safe and efficient, evidence regarding the cost-effectiveness of telemonitoring in inflammatory bowel disease is lacking. Methods: We analyzed cost-effectiveness from a societal perspective by comparing the 3 follow-up methods used in a previous 24-week randomized controlled trial, conducted at a tertiary university hospital in Spain. Patients with inflammatory bowel disease who initiated immunosuppressants or biologic agents, or both, to control inflammatory activity were recruited consecutively. Data on the effects on disease activity (using clinical indexes) and quality-adjusted life-years (using the EuroQol 5 dimensions questionnaire) were collected. We calculated the costs of health care, equipment, and patients’ productivity and social activity impairment. We compared the mean costs per patient, utilities, and bootstrapped differences. Results: We included 63 patients (21 patients per group). TECCU saved €1005 (US $1100) per additional patient in remission compared with G_control (95% CI €–13,518 to 3137; US $–14,798 to 3434), with a 79.96% probability of being more effective at lower costs. Compared with G_NT, TECCU saved €2250 (US $2463) per additional patient in remission (95% CI €–15,363 to 11,086; US $–16,817 to 12,135), and G_NT saved €538 (US $589) compared with G_control (95% CI €–6475 to 5303; US $–7088 to 5805). G_TECCU and G_NT showed an 84% and 67% probability, respectively, of producing a cost saving per additional quality-adjusted life-year (QALY) compared with G_control, considering those simulations that involved negative incremental QALYs as well. Conclusions: There is a high probability that the TECCU Web platform is more cost-effective than standard and telephone care in the short term. Further research considering larger cohorts and longer time horizons is required.

  • Source: The Authors / Bouncing Pixel; Copyright: The Authors; URL: https://www.jmir.org/2019/9/e15318/; License: Licensed by JMIR.

    Using Relational Agents to Promote Family Communication Around Type 1 Diabetes Self-Management in the Diabetes Family Teamwork Online Intervention:...

    Abstract:

    Background: Family conflict can reduce adolescent adherence to type 1 diabetes management tasks. The Family Teamwork in-person intervention was shown to be efficacious in reducing conflict and low adherence to diabetes-related tasks. Its reach and potential impact, however, were limited by the need to deliver the intervention sessions in person. Relational agents (ie, computerized versions of humans) have been shown to appeal to diverse audiences and may be an acceptable replacement for a human in technology-based behavior change interventions. Objective: The purpose of this paper is to present the results of a pilot study assessing feasibility and acceptability of Diabetes Family Teamwork Online, an adapted version of the Family Teamwork intervention, delivered over the internet and guided by a relational agent. Methods: Parent-adolescent dyads were recruited through a diabetes care clinic at a large tertiary care hospital in the southwestern United States. A one-group design, with assessments at baseline, immediate postintervention, and 3 months later, was used to assess feasibility. A priori feasibility criteria included an assessment of recruitment, completion, attrition, program satisfaction, therapeutic alliance, attitudes toward the relational agent, and data collection. The institutional review board at Baylor College of Medicine approved the protocol (H-37245). Results: Twenty-seven adolescents aged 10 to 15 years with type 1 diabetes and their parents were enrolled. Criteria used to assess feasibility were (1) recruitment goals were met (n=20), (2) families completed ≥75% of the modules, (3) attrition rate was ≤10%, (4) program satisfaction was high (≥80% of families), (5) therapeutic alliance was high (average score of ≥60/84), (6) families expressed positive attitudes toward the relational agent (average item score of ≥5 on ≥4 items), (7) ≥80% of data were collected at post 1 and post 2, and (8) few technical issues (≤10%) occurred during intervention delivery. All feasibility criteria were met. Qualitative data confirmed that adolescents and parents had positive reactions to both the content and approach. Conclusions: The Diabetes Family Teamwork Online intervention proved to be a feasible and acceptable method for enhancing communication around diabetes management tasks in families with an adolescent who has type 1 diabetes. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.5817

  • Cost-effectiveness of therapist-guided internet-based cognitive behavioral therapy for stress-related disorders. Source: Pexels; Copyright: rawpixels.com; URL: https://www.pexels.com/photo/person-holding-pink-piggy-coin-bank-1246954/; License: Licensed by the authors.

    Cost-Effectiveness of Therapist-Guided Internet-Based Cognitive Behavioral Therapy for Stress-Related Disorders: Secondary Analysis of a Randomized...

    Abstract:

    Background: Stress-related disorders are associated with significant suffering, functional impairment, and high societal costs. Internet-based cognitive behavioral therapy (ICBT) is a promising treatment for stress-related disorders but has so far not been subjected to health economic evaluation. Objective: The objective of this study was to evaluate the cost-effectiveness and cost-utility of ICBT for patients with stress-related disorders in the form of adjustment disorder (AD) or exhaustion disorder (ED). We hypothesized that ICBT, compared with a waitlist control (WLC) group, would generate improvements at low net costs, thereby making it cost-effective. Methods: Health economic data were obtained in tandem with a randomized controlled trial of a 12-week ICBT in which patients (N=100) were randomized to an ICBT (n=50) or a WLC (n=50) group. Health outcomes and costs were surveyed pre- and posttreatment. We calculated incremental cost-effectiveness ratios (ICERs) based on remission rates and incremental cost-utility ratios (ICURs) based on health-related quality of life. Bootstrap sampling was used to assess the uncertainty of our results. Results: The ICER indicated that the most likely scenario was that ICBT led to higher remission rates compared with the WLC and was associated with slightly larger reductions in costs from pre- to posttreatment. ICBT had a 60% probability of being cost-effective at a willingness to pay (WTP) of US $0 and a 96% probability of being cost-effective at a WTP of US $1000. The ICUR indicated that ICBT also led to improvements in quality of life at no net societal cost. Sensitivity analyses supported the robustness of our results. Conclusions: The results suggest that ICBT is a cost-effective treatment for patients suffering from AD or ED. Compared with no treatment, ICBT for these patients yields large effects at no or minimal societal net costs. Trial Registration: ClinicalTrials.gov NCT02540317; https://clinicaltrials.gov/ct2/show/NCT02540317

  • Source: freestocks.org / Pexels; Copyright: freestocks.org; URL: https://www.pexels.com/photo/silver-iphone-6-987585/; License: Licensed by JMIR.

    Social Media Outrage in Response to a School-Based Substance Use Survey: Qualitative Analysis

    Abstract:

    Background: School-based alcohol, tobacco, and other drug use (ATOD) surveys are a common epidemiological means of understanding youth risk behaviors. They can be used to monitor national trends and provide data, in aggregate, to schools, communities, and states for the purposes of funding allocation, prevention programming, and other supportive infrastructure. However, such surveys sometimes are targeted by public criticism, and even legal action, often in response to a lack of perceived appropriateness. The ubiquity of social media has added the risk of potential online firestorms, or digital outrage events, to the hazards to be considered when administering such a survey. Little research has investigated the influence of online firestorms on public health survey administration, and no research has analyzed the content of such an occurrence. Analyzing this content will facilitate insights as to how practitioners can minimize the risk of generating outrage when conducting such surveys. Methods: Data were collected by archiving all public comments made in response to a news study about a school-based ATOD survey that was featured on a common social networking platform. Using the general inductive approach and elements of thematic analysis, two researchers followed a multi-step protocol to clean, categorize, and consolidate data, generating codes for all 207 responses. Results: In total, 133 comments were coded as oppositional to the survey and 74 were coded as supportive. Among the former, comments tended to reflect government-related concerns, conspiratorial or irrational thinking, issues of parental autonomy and privacy, fear of child protective services or police, issues with survey mechanisms, and reasoned disagreement. Among the latter, responses showed that posters perceived the ability to prevent abuse and neglect and support holistic health, surmised that opponents were hiding something, expressed reasoned support, or made factual statements about the survey. Consistent with research on moral outrage and digital firestorms, few comments (<10%) contained factual information about the survey; nearly half of the comments, both supportive and oppositional, were coded in categories that presupposed misinformation. Conclusions: The components of even a small online firestorm targeting a school-based ATOD survey are nuanced and complex. It is likely impossible to be fully insulated against the risk of outrage in response to this type of public health work; however, careful articulation of procedures, anticipating specific concerns, and two-way community-based interaction may reduce risk.

  • Source: Flickr; Copyright: Jeri Koegel; URL: https://www.flickr.com/photos/jerikoegel/495501849/in/photolist-KMzrk-S81fC1-i6eQF-4s9WFR-347rav-24fB3og-QWAkCV-S81feL-rnbHC7-2aJe5pZ-5QVF9i-Y49n-S7ZKXf-7NQtCx-QWAk9Z-RX17hj-8Lbd2T-dXGpzs-QWAkuP-x3nfB-9puFvz-8kPt3p-k4p74v-23LQa8H-9xWQjF-4NVQEb-6YzbVN-6Yva; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Health Professions Digital Education on Antibiotic Management: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration

    Abstract:

  • Source: Pexels; Copyright: Matthew T Rader; URL: https://www.pexels.com/photo/man-holding-smartphone-2310695/; License: Licensed by JMIR.

    Interaction Patterns of Men Who Have Sex With Men on a Geosocial Networking Mobile App in Seven United States Metropolitan Areas: Observational Study

    Abstract:

    Background: The structure of the sexual networks and partnership characteristics of young black men who have sex with men (MSM) may be contributing to their high risk of contracting HIV in the United States. Assortative mixing, which refers to the tendency of individuals to have partners from one’s own group, has been proposed as a potential explanation for disparities. Objective: The objective of this study was to identify the age- and race-related search patterns of users of a diverse geosocial networking mobile app in seven metropolitan areas in the United States to understand the disparities in sexually transmitted infection and HIV risk in MSM communities. Methods: Data were collected on user behavior between November 2015 and May 2016. Data pertaining to behavior on the app were collected for men who had searched for partners with at least one search parameter narrowed from defaults or used the app to send at least one private chat message and used the app at least once during the study period. Newman assortativity coefficient (R) was calculated from the study data to understand assortativity patterns of men by race. Pearson correlation coefficient was used to assess assortativity patterns by age. Heat maps were used to visualize the relationship between searcher’s and candidate’s characteristics by age band, race, or age band and race. Results: From November 2015 through May 2016, there were 2,989,737 searches in all seven metropolitan areas among 122,417 searchers. Assortativity by age was important for looking at the profiles of candidates with correlation coefficients ranging from 0.284 (Birmingham) to 0.523 (San Francisco). Men tended to look at the profiles of candidates that matched their race in a highly assortative manner with R ranging from 0.310 (Birmingham) to 0.566 (Los Angeles). For the initiation of chats, race appeared to be slightly assortative for some groups with R ranging from 0.023 (Birmingham) to 0.305 (Los Angeles). Asian searchers were most assortative in initiating chats with Asian candidates in Boston, Los Angeles, New York, and San Francisco. In Birmingham and Tampa, searchers from all races tended to initiate chats with black candidates. Conclusions: Our results indicate that the age preferences of MSM are relatively consistent across cities, that is, younger MSM are more likely to be chatted with and have their profiles viewed compared with older MSM, but the patterns of racial mixing are more variable. Although some generalizations can be made regarding Web-based behaviors across all cities, city-specific usage patterns and trends should be analyzed to create targeted and localized interventions that may make the most difference in the lives of MSM in these areas.

  • The first page of the DApp Laiyin Health. Source: Image created by the Authors; Copyright: The Authors; URL: http://www.jmir.org/2019/9/e13587/; License: Licensed by JMIR.

    Application of a Blockchain Platform to Manage and Secure Personal Genomic Data: A Case Study of LifeCODE.ai in China

    Abstract:

    Background: The rapid development of genetic and genomic technologies, such as next-generation sequencing and genome editing, has made disease treatment much more precise and effective. The technologies’ value can only be realized by the aggregation and analysis of people’s genomic and health data. However, the collection and sharing of genomic data has many obstacles, including low data quality, information islands, tampering distortions, missing records, leaking of private data, and gray data transactions. Objective: This study aimed to prove that emerging blockchain technology provides a solution for the protection and management of sensitive personal genomic data because of its decentralization, traceability, encryption algorithms, and antitampering features. Methods: This paper describes the case of a blockchain-based genomic big data platform, LifeCODE.ai, to illustrate the means by which blockchain enables the storage and management of genomic data from the perspectives of data ownership, data sharing, and data security. Results: Blockchain opens up new avenues for dealing with data ownership, data sharing, and data security issues in genomic big data platforms and realizes the psychological empowerment of individuals in the platform. Conclusions: The blockchain platform provides new possibilities for the management and security of genetic data and can help realize the psychological empowerment of individuals in the process, and consequently, the effects of data self-governance, incentive-sharing, and security improvement can be achieved. However, there are still some problems in the blockchain that have not been solved, and which require continuous in-depth research and innovation in the future.

  • Source: Flickr; Copyright: Ecig Click; URL: https://www.flickr.com/photos/ecigclick/15308450119/in/photolist-pjKNTa-CwNiuo-pv94Lo-rj2RwQ-ptaWTe-S9vB8g-dASNdR-jaDpde-2bxPBjZ-pZLz5F-2fTucwF-oLcK6p-raLHD5-GadLBr-qfjb7m-23FTg3H-p3qxk2-2cQHxXr-pBjdmA-ny4BhB-FM4QSj-2fTuaK4-Wgfw6n-24No5i3-XrLE9k-mFD7Te-w2; License: Creative Commons Attribution + ShareAlike (CC-BY-SA).

    Underage JUUL Use Patterns: Content Analysis of Reddit Messages

    Abstract:

  • Source: The Authors / Freepik; Copyright: The Authors; URL: https://www.freepik.com/free-photo/sporty-woman-presenting-smartphone-template_4507661.htm; License: Creative Commons Attribution (CC-BY).

    An Assessment of Physical Activity Data Collected via a Smartphone App and a Smart Band in Breast Cancer Survivors: Observational Study

    Abstract:

    Background: Although distress screening is crucial for cancer survivors, it is not easy for clinicians to recognize distress. Physical activity (PA) data collected by mobile devices such as smart bands and smartphone apps have the potential to be used to screen distress in breast cancer survivors. Methods: In this prospective observational study, patients who underwent surgery for breast cancer at Asan Medical Center, Seoul, Republic of Korea, between June 2017 and March 2018 were enrolled and asked to use both a smartphone app and smart band for 6 months. The overall compliance rates of the daily PA data collection via the smartphone walking apps and wearable smart bands were analyzed in a within-subject manner. The longitudinal daily collection rates were calculated to examine the dropout pattern. We also performed multivariate linear regression analysis to examine factors associated with compliance with daily collection. Finally, we tested the correlation between the count of daily average steps and distress level using Pearson correlation analysis. Results: A total of 160 female patients who underwent breast cancer surgeries were enrolled. The overall compliance rates for using a smartphone app and smart bands were 88.0% (24,224/27,513) and 52.5% (14,431/27,513), respectively. The longitudinal compliance rate for smartphone apps was 77.8% at day 180, while the longitudinal compliance rate for smart bands rapidly decreased over time, reaching 17.5% at day 180. Subjects who were young, with other comorbidities, or receiving antihormonal therapy or targeted therapy showed significantly higher compliance rates to the smartphone app. However, no factor was associated with the compliance rate to the smart band. In terms of the correlation between the count of daily steps and distress level, step counts collected via smart band showed a significant correlation with distress level. Conclusions: Smartphone apps or smart bands are feasible tools to collect data on the physical activity of breast cancer survivors. PA data from mobile devices are correlated with participants’ distress data, which suggests the potential role of mobile devices in the management of distress in breast cancer survivors.

  • Source: Pexels.com; Copyright: freestocks.org; URL: https://www.pexels.com/photo/coffee-smartphone-twitter-application-58639/; License: Licensed by JMIR.

    Association Between Institutional Social Media Involvement and Gastroenterology Divisional Rankings: Cohort Study

    Abstract:

    Background: Patients often look to social media as an important tool to gather information about institutions and professionals. Since 1990, United States News and World Report (USNWR) has published annual rankings of hospitals and subspecialty divisions. It remains unknown if social media presence is associated with the USNWR gastroenterology and gastrointestinal (GI) surgery divisional rankings, or how changes in online presence over time affects division ranking. Objective: The objective of this study was to determine if social media presence is associated with USNWR gastroenterology and GI surgery divisional rankings and to ascertain how changes in online presence over time affect division rankings. Methods: Social media presence among the top 30 institutions listed in the 2014 USNWR gastroenterology and GI surgery divisional rankings were assessed using Pearson’s correlation coefficients and multivariate analysis, controlling for covariates. Linear and logistic regression using data from 2014 and 2016 USNWR rankings were then used to assess the association between institutional ranking or reputation score with any potential changes in numbers of followers over time. Sensitivity analysis was performed by assessing the area under the receiver operating characteristic curve to determine the follower threshold associated with improved or maintained ranking, which was done by dichotomizing changes in followers at values between the 7000 and 12,000 follower mark. Results: Twitter follower count was an independent predictor of divisional ranking (β=.00004; P<.001) and reputation score (β=–.00002; P=.03) in 2014. Academic affiliation also independently predicted USNWR division ranking (β=5.3; P=.04) and reputation score (β=–7.3; P=.03). Between 2014 and 2016, Twitter followers remained significantly associated with improved or maintained rankings (OR 14.63; 95% CI 1.08-197.81; P=.04). On sensitivity analysis, an 8000 person increase in Twitter followers significantly predicted improved or maintained rankings compared to other cutoffs. Conclusions: Institutional social media presence is independently associated with USNWR divisional ranking and reputation score. Improvement in social media following was also independently associated with improved or maintained divisional ranking and reputation score, with a threshold of 8000 additional followers as the best predictor of improved or stable ranking.

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  • Radiation oncologists perceptions and utilization of digital patient assessment platforms

    Date Submitted: Sep 13, 2019

    Open Peer Review Period: Sep 13, 2019 - Nov 8, 2019

    Background: There is increasing patient engagement in the presence of digital patient assessment platforms, or physician rating websites. Despite this rapid growth, there remains insufficient data on...

    Background: There is increasing patient engagement in the presence of digital patient assessment platforms, or physician rating websites. Despite this rapid growth, there remains insufficient data on how these evaluations are collected and impact radiation oncologists. Objective: The purpose of this study was to assess radiation oncologists worldwide on their awareness and noted effects of digital patient assessment platforms. Methods: An electronic survey was delivered to 6,199 members of the American Society of Radiation Oncology. Survey subjects were radiation oncologists currently practicing in the world. The survey consisted of 14 questions focused on on demographics, practice details, patient volume, institutional utilization of patient reviews, and perceptions of radiation oncologists on health care reviews provided by patients. Results: There were 447 responses from practicing radiation oncologists in total, 321 (72%) of which were practicing in the US. Most respondents (228; 51%) either agreed or strongly agreed that patients consider online reviews when deciding which physician to visit. Of all respondents, 188 (42%) reported their institution checks their online feedback, whereas 157 (36%) and 99 (22%) reported not knowing, or to their knowledge, their institution did not, check their online feedback. Respondents who saw more than the average number of consults per week, were significantly more likely to receive negative feedback (p-value = 0.005). Forty-five percent of respondents agreed or strongly agreed that online virtual assessment tools contribute to physician burn-out. Respondents (100; 22%) who received inappropriate or misdirected feedback were significantly more likely to report virtual reviews contribute to burnout (p-value = 0.001). Conclusions: Radiation oncologists need to be aware that self-reported patient assessments are a data point in quality of a physician and healthcare establishment. To best ensure appropriate feedback of a physician’s capabilities as a doctor, leadership and employee alignment for patient experience are now more important than ever.

  • Does tailoring reduce attrition in web-based smoking cessation interventions? A systematic review and meta-analysis

    Date Submitted: Sep 14, 2019

    Open Peer Review Period: Sep 13, 2019 - Nov 8, 2019

    Background: The growing number of internet users presents an opportunity to deliver health interventions to large populations. Despite their potential, many web-based interventions, including those fo...

    Background: The growing number of internet users presents an opportunity to deliver health interventions to large populations. Despite their potential, many web-based interventions, including those for smoking cessation, face high rates of attrition. Further consideration of how intervention features impact attrition is needed. Objective: The objective of this systematic review is to identify whether tailored web-based smoking cessation interventions for smokers is associated with reduced attrition when compared to active or passive untailored web-based interventions. The outcomes of interest were loss to follow-up attrition at 1-, 3-, 6- and 12-months follow-up. Methods: Literature searches were conducted in May 2018 on MEDLINE, PsycINFO, CINAHL, PubMed and the Cochrane Tobacco Addiction Group Specialized Register with the following search terms: smoking cessation, tailored, web or internet-based. Included studies were published in English before or in 2018 using a randomized control trial (RCT) design. Studies were restricted to those with web-based delivery, a tailored intervention group, an untailored control group and a reported outcome of smoking cessation. Studies were assessed for methodological quality using the Cochrane Risk of Bias tool. Two reviewers independently extracted study characteristics and the number of participants lost to follow-up for each treatment group. Results: 14 studies were included in the systematic review, 12 of which were included in the meta-analysis. Tailoring had no statistically significant effect on loss to follow-up attrition at 1-month (RR= 1.02, 95% CI 0.95–1.09, P=.58), 3-months (RR=0.99, 95% CI 0.95-1.04, P=.80), 6-months (RR=1.00, 95% CI 0.95-1.05, P=.92) or 12-months (RR=0.97, 95% CI 0.92-1.02, P=.26) follow-up. Subgroup analyses suggested that there is a statistically significant effect of tailoring between the active and passive subgroups at 1-month (P=.03), 3-months (P<.001), 6-months (P=.02) follow-up, but not at 12-months follow-up (P=.25). Conclusions: Results suggest that tailoring of web-based smoking cessation interventions may not be associated with reduced loss to follow-up attrition at 1-,3-,6- or 12-months; however, the role of tailoring may be more prominent for studies including a passive control group. These findings may be due to variability in the presence of additional features, the definition of smokers used, and duration of smoking abstinence measured. Future systematic reviews should seek to compare studies with similar operational definitions of smokers and smoking abstinence to facilitate more meaningful comparisons.

  • A Marketplace for Health: Opportunities and Challenges for Biomedical Blockchains

    Date Submitted: Sep 12, 2019

    Open Peer Review Period: Sep 12, 2019 - Nov 7, 2019

    Incentive alignment is a fundamental challenge to improving the financial and operational efficiency of the healthcare system in the United States. The current system incentivizes payers to reduce uti...

    Incentive alignment is a fundamental challenge to improving the financial and operational efficiency of the healthcare system in the United States. The current system incentivizes payers to reduce utilization and providers to perform procedures, while patients are caught between cost savings and utilization. Blockchain is an emerging technology that enables the construction of large-scale open digital networks with characteristics that can incentivize participants towards a common goal. There is an opportunity to use blockchain technology to reimagine how we cooperate to promote health and potentially improve efficiency of the healthcare system. In this perspective, we discuss the strengths and limitations of this new technology through the lens of healthcare. We explore how challenges in healthcare (e.g. costs, accessibility, and data ownership) can be addressed by blockchain technology and, equally important, how they cannot. Through the evaluation of existing projects, we find clear advantages and disadvantages of the technology and identify open areas of innovation for healthcare executives, academics, and entrepreneurs.

  • Developing Kids Helpline Circles: Evaluating a customised social network platform for delivering group counselling to young people experiencing family discord that impacts their wellbeing.

    Date Submitted: Sep 12, 2019

    Open Peer Review Period: Sep 7, 2019 - Sep 19, 2019

    Background: It is well reported that young people are at high risk of mental health concerns, more so than at any other time in lifespan development. What is less addressed is situational factors that...

    Background: It is well reported that young people are at high risk of mental health concerns, more so than at any other time in lifespan development. What is less addressed is situational factors that young people report as impacting their wellbeing. Specifically, family discord. Kids Helpline, a national service in Australia that provides free counselling online and by telephone to young people in distress, report that family discord and wellbeing issues are one of the majority of concerns reported by clients. In order to meet the preferences that young people seek to access counselling support, Kids Helpline have designed and trialled a custom built social network platform for group counselling young people experiencing family discord that impacts their wellbeing. Objective: This exploratory study is communicating findings of phase 1 of an innovation study in user and online counsellor experience, leading to an iterative design for a world-first, purpose built, social network to: 1) increase reach and quality of service by utilising a digital tool of preference for youth to engage peer-to-peer and peer-to-counsellor support in a safe online environment and; 2) provide the evidence-base to document the best-practice for online group counselling in a social network environment. Methods: The study utilised a Participatory Action Research design. Young people aged 13-25 (N=105), evaluated to be mild to moderate in depression or anxiety (not high risk) who contacted Kids Helpline were asked if they would like to trial the Social Network System (SNS) for peer-to-peer and counsellor-to-peer group support. Subjects were grouped into age cohorts of no more than 1 year above or below their reported age, and assigned to groups of no more than 36 in order to create a community of familiarity around age and problems experienced. Each group entered into a 8 week group counselling support program guided by counsellors making regular posts and providing topic specific content for psycho-education and discussion. Counsellors provided a weekly log of events to researchers, and at 2 weekly intervals, subjects provided qualitative and quantitative feedback through open ended questions and specific psychometric measures. Results: Qualitative results provided evidence of user support and benefits of the online group counselling environment. Counsellors also reported benefits of the modality of therapy delivery. Psychometric scales did not report significance in changes mood or affect. Counsellor and users reported improvements to the platform to increase user engagement. Conclusions: Phase 1 provided ‘proof of concept’ for this mode of online counselling delivery. Users and counsellors saw value in the model and innovation of the service. Phase 2 will address platform issues with changes to a new social network platform. Phase 2 will focus more broadly on mental health concerns raised by users and permit inclusion of a clinical population of young people experiencing depression and anxiety. Clinical Trial: Australian New Zealand Clinical Trial Registry ACTRN12616000518460 www.anzctr.org.au

  • Supporting Self-Management of Cardiovascular Diseases Through Remote Monitoring Technologies: Metaethnography Review of Frameworks, Models, and Theories Used in Research and Development

    Date Submitted: Sep 6, 2019

    Open Peer Review Period: Sep 6, 2019 - Nov 1, 2019

    Background: Electronic health (eHealth) is a rapidly evolving field informed by multiple scientific disciplines. Because of this, the usage of different terms and concepts to explain the same phenomen...

    Background: Electronic health (eHealth) is a rapidly evolving field informed by multiple scientific disciplines. Because of this, the usage of different terms and concepts to explain the same phenomena and the lack of standardization in reporting interventions often leaves a gap that hinders knowledge accumulation. Interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies are a cross-disciplinary area potentially affected by this gap. A holistic view of the underlying frameworks, models, and theories that have informed projects at this crossroad could advance future research and development efforts. Objective: This research aimed to identify and compare underlying approaches that have informed interventions focused on self-management support of cardiovascular diseases through the use of remote monitoring technologies. The objective was to create a holistic understanding of the distinct approaches by highlighting common or conflicting principles, guidelines, and methods. Methods: The metaethnography approach was used to review and synthesize researchers’ reports on how they applied frameworks, models, and theories in their projects. Literature was systematically searched in 7 databases: Scopus, Web of Science, EMBASE, CINAHL, PsycINFO, ACM Digital Library, and the Cochrane Library. Included studies were thoroughly read and coded to extract data for the synthesis. Studies were mainly related by the key ingredients of the underlying approaches they applied. The key ingredients were finally translated across studies and synthesized into thematic clusters. Results: Out of 1224 initial results, 17 articles were included. The articles described research and development of 10 different projects. Frameworks, models, and theories (n=43) were identified to have informed these projects. Key ingredients (n=293) were mapped to the following themes of eHealth development: (1) it is a participatory process; (2) it creates new infrastructures for improving health care, health, and well-being; (3) it is intertwined with implementation; (4) it integrates theory, evidence, and participatory approaches for persuasive design; (5) it requires continuous evaluation cycles; (6) key ingredients for behavior change; (7) key ingredients for technology adoption; (8) key health-related outcomes of an intervention. Conclusions: The findings of this review support and exemplify the numerous possibilities in the use of frameworks, models, and theories to guide research and development of eHealth. Participatory, user-centered design, and integration with empirical evidence and theoretical modelling were widely identified principles in the literature. On the contrary, less attention has been given to the integration of implementation in the development process and to supporting novel eHealth-based health care infrastructures. To better integrate theory and evidence, holistic approaches can combine patient-centered studies with consolidated knowledge from expert-based approaches.

  • Effectiveness of a web-based medication adherence tool with patient centered communication: Results of a clustered randomized controlled trial

    Date Submitted: Sep 9, 2019

    Open Peer Review Period: Sep 5, 2019 - Oct 31, 2019

    Background: Growing numbers of people use medication for chronic conditions; non-adherence is common, leading to poor disease control. A newly developed web-based tool to identify an increased risk fo...

    Background: Growing numbers of people use medication for chronic conditions; non-adherence is common, leading to poor disease control. A newly developed web-based tool to identify an increased risk for non-adherence with related potential individual barriers might facilitate tailored interventions and improve adherence. Objective: To assess the effectiveness of the newly developed tool to improve medication adherence. Methods: A cluster randomized controlled trial assessed the effectiveness of this adherence tool in patients initiating cardiovascular or oral blood glucose lowering medication. Participants were included in community pharmacies. They completed an online questionnaire comprising an assessments of their risk for medication non-adherence and subsequently of barriers to adherence. In pharmacies belonging to the intervention group, individual barriers displayed in a graphical profile on a tablet were discussed by pharmacists and patients at high non-adherence risk in face to face meetings and shared with their general practitioners and practice nurses. Tailored interventions were initiated by the healthcare providers. Barriers of control patients were not presented or discussed and these patients received usual care. The primary outcome was the difference in medication adherence at 8 months follow-up between patients with an increased non-adherence risk from intervention and control group, calculated from dispensing data. Results: Data from 492 participants in 15 community pharmacies were available for analyses (intervention 253, 7 pharmacies; control 239, 8 pharmacies). The intervention had no effect on medication adherence (-0.01; 95%CI -0.59 – 0.57; P= .96), neither in the post hoc per protocol analysis (0.19; 95%CI -0.50 – 0.89; P=.58). Conclusions: This study showed no effectiveness of a risk stratification and tailored intervention addressing personal barriers for medication adherence. Various potential explanations for lack of effect were identified. These explanations relate for instance to high medication adherence in the control group, study power and fidelity. Process evaluation should elicit possible improvements and inform the redesign of intervention and implementation. Clinical Trial: The Netherlands National Trial Register: NTR5186. Date: May 18, 2015 (http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=5186)

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