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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: Freepik; Copyright: Freepik; URL: https://www.freepik.com/free-photo/close-up-woman-pinching-her-arm_3480504.htm#page=1&query=skin%20rash&position=1; License: Licensed by JMIR.
    Web-based and Mobile Health...

    Sep 20, 2019

    An Internet-Based Self-Help Intervention for Skin Picking (SaveMySkin): Pilot Randomized Controlled Trial

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    Abstract:

    Background: In spite of the psychosocial burden and medical risks associated with skin picking disorder, the health care system does not provide sufficient treatment for affected individuals to date. Therefore, an internet-based self-help program for skin picking was developed to offer easily accessible support for this population. Objective: This pilot study evaluated the internet-based self-help program SaveMySkin. The 12-week program is based on cognitive-behavioral therapy and contains comprehensive information and exercises, a daily supportive monitoring system, and dermatological and psychological counseling via internet chat. Primary objectives were the investigation of attitudes and expectations toward the program, intervention effects on skin picking severity, user satisfaction, adherence, and willingness to participate. Secondary outcomes included the feasibility of study procedures, adequacy of assessment instruments, effects on skin picking–related impairment, dimensions of skin picking, and general psychological impairment. Methods: A 2-arm randomized controlled trial was conducted in a sample of 133 participants (female: 124/133, 93.2%; mean age 26.67 [SD 6.42]) recruited via the internet. Inclusion required a minimum age of 17 years and at least mild skin picking severity. Participants were randomly allocated to the intervention (64/133) or waitlist control group (69/133). All assessments were conducted online and based on self-report. Results: The willingness to participate was very high in the study, so the initially planned sample size of 100 was exceeded after only 18 days. Participant expectations indicate that they believed the program to be beneficial for them (131/133, 98.5%) and provide a feeling of support (119/133, 89.5%). Reasons for study participation were insufficient outpatient health care (83/133, 62.4%) and flexibility regarding time (106/133, 79.7%) and location (109/133, 82.0%). The post-assessment was completed by 65.4% (87/133) of the sample. The majority of the intervention group who completed the entire post-assessment were satisfied with SaveMySkin (28/38, 74%) and agreed that the program is an appropriate support service (35/38, 92%). On average, participants viewed 29.31 (SD 42.02) pages in the program, and 47% (30/64) of the intervention group used the monitoring at least once a week. In comparison with the control group, the intervention group displayed substantial improvements in the skin picking severity total score (Cohen d=0.67) and especially on the subscale Symptom Severity (Cohen d=0.79). No effects on secondary outcomes were found. Conclusions: This study confirms the need for easily accessible interventions for skin picking disorder and the high interest in internet-based self-help within the target population. It provides important insights into the attitudes toward online support and actual user experiences. Participant feedback will be used to further enhance the intervention. Our results point to the preliminary efficacy of SaveMySkin and may lay the foundation for future research into the efficacy and cost-effectiveness of the program in a multicenter clinical trial. Clinical Trial: German Clinical Trial Register DRKS00015236; https://www.ncbi.nlm.nih.gov/pubmed/31011654 International Registered Report Identifier (IRRID): RR2-10.1016/j.conctc.2018.100315

  • Source: freepik; Copyright: freepik; URL: https://www.freepik.com/free-photo/middle-aged-woman-with-fitness-tracker_4785890.htm#page=1&query=wearable%20device&position=36; License: Licensed by JMIR.
    Mobile Health (mhealth)

    Sep 19, 2019

    Predicting Inpatient Aggression in Forensic Services Using Remote Monitoring Technology: Qualitative Study of Staff Perspectives

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    Abstract:

    Background: Monitoring risk of imminent aggression in inpatient forensic mental health services could be supported by passive remote monitoring technology, but staff attitudes toward the relevance and likelihood of engagement with this technology are unknown. Objective: This study aimed to explore staff views, specifically potential benefits and implementation barriers, on using this technology for monitoring risk of inpatient aggression. Methods: We conducted semistructured focus groups with nurses in an inpatient forensic mental health service. We used thematic analysis with two independent raters to identify themes and subthemes related to staff attitudes toward passive remote monitoring. We subsequently checked with members to ensure the validity of the themes identified by the raters. Results: From January to March 2019, a total of 25 nurses took part in five focus groups. We identified five main themes, one of which concerned the potential benefits that passive remote monitoring could provide for monitoring risk of aggression. Staff suggested it could provide an early warning of impending aggression and enable support to be provided earlier. The remaining themes concerned implementation barriers, including risks to the users’ physical and mental well-being; data security concerns and potential access by third parties; the negative impact of a constant stream of real-time data on staff workload; and design characteristics and user awareness of the benefits of passive remote monitoring. Conclusions: Passive remote monitoring technology could support existing methods of monitoring inpatient aggression risk, but multiple barriers to implementation exist. Empirical research is required to investigate whether these potential benefits can be realized, and to identify ways of addressing these barriers to ensure acceptability and user engagement.

  • 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.
    Virtual Reality and Virtual Worlds

    Sep 16, 2019

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

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    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.
    Research Instruments, Questionnaires,...

    Sep 16, 2019

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

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  • 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).
    Cost-Effectiveness and Economics

    Sep 13, 2019

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

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    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.
    Web-based and Mobile Health...

    Sep 13, 2019

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

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    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 and Economics

    Sep 13, 2019

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

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    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.
    Medicine 2.0: Social Media, Open,...

    Sep 12, 2019

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

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    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).
    Theme issue 2018: Health professions...

    Sep 12, 2019

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

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

    Sep 12, 2019

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

    Authors List:

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    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.
    Theme Issue 2019: Blockchain in...

    Sep 10, 2019

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

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    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).
    Medicine 2.0: Social Media, Open,...

    Sep 9, 2019

    Underage JUUL Use Patterns: Content Analysis of Reddit Messages

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  • Preliminary Efficacy of a Multilevel mHealth Application for Substance Use, Sexual Risk Behaviors, and STI/HIV Testing among Youth: A Randomized Controlled Trial

    Date Submitted: Sep 19, 2019

    Open Peer Review Period: Sep 19, 2019 - Sep 26, 2019

    Background: Preventing and reducing substance use disorders, sexually transmitted infections/human immunodeficiency virus (STI/HIV) and teen pregnancy, and the associated risk behaviors (i.e., substan...

    Background: Preventing and reducing substance use disorders, sexually transmitted infections/human immunodeficiency virus (STI/HIV) and teen pregnancy, and the associated risk behaviors (i.e., substance use and sexual risk behaviors) among youth remain public health priorities in the United States. Equally important is improving the uptake of STI/HIV testing among youth. Mobile-health (mHealth) applications (apps) may be a solution to ameliorate these public health concerns; however, few mHealth preventive interventions have demonstrated preliminary efficacy in reducing substance use or sexual risk behaviors, or improving uptake of STI/HIV testing among youth, particularly in clinic settings. Objective: This study examined the preliminary efficacy of Storytelling 4 Empowerment (S4E), relative to enhanced usual practice, in reducing past 30-day substance use (i.e., alcohol, tobacco, and other drug use), condomless sex, and alcohol or drug use prior to sex, as well as improving uptake of STI/HIV testing. Additionally, this study examined changes in the potential mechanisms by which behavior change occurs, namely clinician–youth risk communication, prevention knowledge, and substance use and sexual risk refusal self-efficacy. Methods: Employing community-based participatory principles, 50 youth aged 13–21 years were recruited from a youth-centered community health clinic in Southeast Michigan; randomized sequentially to either S4E or enhanced usual practice; and assessed at baseline, immediately post-intervention, and 30 days post-intervention. Results: Relative to youth in the enhanced usual practice group, S4E participants demonstrated reductions in the proportions of past 30-day overall substance use, as well as past 30-day alcohol, tobacco, and drug use. The results also showed a reduction in the proportion of youth who reported past 30-day condomless sex, and alcohol use prior to sex. Findings also demonstrated an increase in the proportion of youth who reported STI/HIV testing over time. Finally, the results showed increases in youth–clinician risk communication, prevention knowledge, and self-efficacy. Conclusions: S4E demonstrated preliminary efficacy in reducing substance use and sexual risk behaviors and improving uptake of STI/HIV testing among youth in a clinic setting, which suggests that a larger randomized controlled trial may be warranted. Clinical Trial: Identifiers: NCT03368456 Unique Protocol ID: HUM00158089 Secondary IDs: Previous HUM00118704 Brief Title: Preventing HIV/STI in Urban Adolescents Via an mHealth Primary Care Intervention

  • Improving Theoretical Understanding towards Patient-driven Healthcare Innovation: Online Value Co-Creation Perspective: A Systematic Review

    Date Submitted: Sep 18, 2019

    Open Peer Review Period: Sep 18, 2019 - Nov 13, 2019

    Background: Patient participation in the healthcare domain has surged dramatically through the availability of digital health platforms and online health communities (OHCs). Such patient-driven servic...

    Background: Patient participation in the healthcare domain has surged dramatically through the availability of digital health platforms and online health communities (OHCs). Such patient-driven service innovation has both challenges and potentials for healthcare organizations. On one hand, they are worry about broadcasting misinformation and its negative influence on patients’ health decisions. On the other hand, patient participation offers the potential to enhance service value. Over the last five years, articles have surfaced that focus on value co-creation in the healthcare services and the importance of engaging patients and other actors in service delivery. However, a theoretical understanding of how to use OHCs for this purpose is still underdeveloped within the healthcare service ecosystem. Objective: This paper aims to introduce a theoretical discussion for better understanding the potential of OHCs for healthcare organisations, in particular for patients’ empowerment. Methods: The literature review study conducted a comprehensive search using 12 electronic databases (EMBASE, PsychINFO, Web of Science, Scopus, ScienceDirect, Medline, PubMed, EBSCO (academic), CINAHL, AISeL, ACM, and Google Scholar) from 2013 to 2019. A total of 1388 studies were identified from the database search. After removing duplicates and applying inclusion criteria, we thematically analysed 56 articles. We then follow the six-step thematic analysis process defined by Braun and Clarke [1]. Coding consensus was achieved after conducting the percent agreement method with two scholars. Results: Following the thematic analysis steps, we identified a list of 5 salient themes including “communication extension”, “improved health literacy for patients and healthcare organisations”, “communication transparency with patients”, “informational and social support for patients”, and “patient empowerment in self-management”. The most frequent theme was the communication extension which covers 42% of the literature. This theme reported that an extension of communication between patients, caregivers, and physicians with organizations leading to new opportunities to create value with minimal time and cost restrictions. Improved health literacy and communication transparency with patients were the second and third most frequent themes, respectively with 26% (n=15) and 25% (n=14) of the literature. The frequency of these themes indicated that the use of OHCs to generate new knowledge from patients’ interactions, help healthcare organisations to customise treatment plans and establish transparent and effective communication between healthcare organizations and patients. Furthermore, thirteen (23%) and ten (17%) of the 56 studies contend the opportunity of using OHCs in terms of informational and emotional support and empowering patients in their self-management of diseases. Conclusions: This review enables better understanding of the current state-of-the-art into the online value co-creation and its potential for healthcare organisations. This study found that the opportunities for healthcare organizations through enhancing the engagement of patients and their co-creation of value have been rapidly increasing focusing on various digital health platforms. Our findings revealed an overall increase in research on value co-creation and the identified gaps and opportunities would release avenues for future directions in developing modernised and more effective value-oriented healthcare informatics research.

  • Using a web scraper to assess the level of privacy of diabetes mobile applications

    Date Submitted: Sep 18, 2019

    Open Peer Review Period: Sep 18, 2019 - Nov 13, 2019

    Background: Mobile health has become a major channel for the support of people living with diabetes. Accordingly, the availability of diabetes mobile apps has been steadily increasing. Most of the pr...

    Background: Mobile health has become a major channel for the support of people living with diabetes. Accordingly, the availability of diabetes mobile apps has been steadily increasing. Most of the previous reviews of diabetes apps have focused on the apps’ features and their alignment with clinical guidelines. However, there is a lack of knowledge on the actual compliance of diabetes apps with privacy and data security aspects. Objective: The aim of this study was to assess the level of privacy of diabetes mobile applications to contribute to raising the awareness of final users, developers and data-protection governmental regulators towards privacy issues. Methods: A web scraper capable of retrieving Android apps’ privacy-related information, particularly the dangerous permissions required by the apps, was developed with the aim of analyzing privacy aspects related to diabetes apps. Following the research selection criteria, the original 882 apps were narrowed down to 497 apps, which were finally included in the analysis. Results: 60% of diabetes apps may request dangerous permissions, which poses a significant risk for the users’ data privacy. In addition, 30% of the apps do not return their privacy policy website. Moreover, it was found that 40% of apps contain advertising, and that some apps that declared not to contain it actually had ads. 95.4% of the apps were free of cost, and those belonging to the Medical and Health and Fitness categories were the most popular. However, final users do not always realize that the free-apps’ business model is largely based on advertising, and consequently, on sharing or selling their private data, either directly or indirectly, to unknown third-parties. Conclusions: The aforementioned findings unquestionably confirm the necessity to educate users and raise their awareness regarding diabetes apps privacy aspects. For this purpose, this research recommends properly and comprehensively training users, ensuring that governments and regulatory bodies enforce strict data protection laws, devising much tougher security policies and protocols in Android and in the Google Play Store, and the implication and supervision of all stakeholders in the apps’ development process.

  • The ethical and responsible development and application of advanced brain machine interfaces

    Date Submitted: Sep 18, 2019

    Open Peer Review Period: Sep 18, 2019 - Nov 13, 2019

    Advanced Brain Machine Interfaces (BMIs) provide potentially transformative approaches to treating neurological conditions, and enhancing the performance of users. Yet as technological capabilities co...

    Advanced Brain Machine Interfaces (BMIs) provide potentially transformative approaches to treating neurological conditions, and enhancing the performance of users. Yet as technological capabilities continue to progress in leaps and bounds, there is a danger that these capabilities outstrip our collective understanding of how to ensure BMIs are developed and used ethically and responsibility. In this case, there is an overt danger of rapid technological developments leading to unanticipated harm through lack of foresight—including threats to privacy, autonomy, self-identity, and other areas of personal and social value which, while hard to quantify, nevertheless represent substantial risks. There is also a very real likelihood of such risks undermining value creation around the technologies and the associated enterprises, as key stakeholders push back against perceived and actual threats to what they in turn hold to be of value. In order to successfully traverse the resulting risk landscape, researchers and developers will need to become increasingly adept at integrating a sophisticated understanding of ethical and socially responsible innovation into their enterprises. Here, we illustrate how a “risk innovation” approach may provide novel insights into mapping ou this landscape and revealing potentially blindsiding risks. We show how this approach can be used to illuminate challenges and opportunities to the successful, ethical, and responsible development of advanced BMIs. And we emphasize how success will ultimately depend on the willingness of innovators and others to take ethical and responsible innovation seriously, and to draw on the interdisciplinary and transdisciplinary expertise that is necessary to translate good intentions into positive outcomes.

  • Accuracy of wristband Fitbit models in assessing sleep: A systematic review and meta-analysis

    Date Submitted: Sep 16, 2019

    Open Peer Review Period: Sep 16, 2019 - Sep 24, 2019

    Background: Wearable sleep monitors are of high interest to consumers and researchers because of their ability to provide estimation of sleep patterns in free-living condition in a cost-efficient way....

    Background: Wearable sleep monitors are of high interest to consumers and researchers because of their ability to provide estimation of sleep patterns in free-living condition in a cost-efficient way. Objective: We conducted a systematic review of publications reporting performance of wristband Fitbit models in assessing sleep parameters and stages. Methods: In adherence with the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) statement, we comprehensively searched PubMed, CINAHL, Cochran, Medline, PsycInfo, and Web of Science databases using keyword ‘Fitbit’ to identify relevant publications meeting predefined inclusion/exclusion criteria. Results: The search yielded 1649 candidate articles, with 11 others identified through citations. After eliminating duplicates and in compliance with inclusion/exclusion criteria, 20 qualified for systematic review and with 8 providing quantitative data for meta-analysis. In reference to polysomnography (PSG), non-sleep-staging Fitbit wristband models tended to overestimate Total Sleep Time and Sleep Efficiency and underestimate Wake After Sleep Onset, with accuracy between 0.81 and 0.91, sensitivity between 0.87 and 0.99, and specificity between 0.10 and 0.52 in correctly identifying sleep epochs. In comparison to PSG, Fitbit models that collectively utilized heart rate variability and body movement to assess sleep-stages performed better, and with higher sensitivity (0.95-0.96) and specificity (0.58-0.69), than early-generation non-sleep-staging Fitbit models that utilized only body movement. Moreover, relative to standard PSG, performance of sleep-staging Fitbit models was better than that reported for actigraphy. Conclusions: Sleep-staging Fitbit models show promising performance, especially in differentiating wake from sleep. However, although a convenient and economical means for consumers to obtain gross estimates of sleep parameters and time spent in sleep stages, they are of limited specificity and not a substitute for PSG.

  • Cost-effectiveness of a mobile phone-based support intervention to increase uptake of post-abortion family planning in Cambodia

    Date Submitted: Sep 16, 2019

    Open Peer Review Period: Sep 16, 2019 - Sep 23, 2019

    Background: Despite progress over the last decade, there is a continuing unmet need for contraception in Cambodia. Interventions delivered by mobile phone could help increase uptake and continuation o...

    Background: Despite progress over the last decade, there is a continuing unmet need for contraception in Cambodia. Interventions delivered by mobile phone could help increase uptake and continuation of contraception, particularly amongst hard-to-reach populations, by providing interactive, personalised support inexpensively wherever the person is located and whenever needed. Objective: The objective of this study was to evaluate the cost-effectiveness of mobile phone-based support added to standard post-abortion family planning care in Cambodia, based on results of the MObile Technology for Improved Family Planning (MOTIF) trial. Methods: A model was created to estimate the costs and effects of the intervention versus standard care. We adopted a societal perspective when estimating costs, including direct and indirect costs for users. The incremental cost-effectiveness ratio was calculated for the base case, as well as a deterministic and probabilistic sensitivity analysis, which we compared against a range of likely cost-effectiveness thresholds. Results: The incremental cost of mobile phone-based support was estimated to be an additional $8,160.49 per 1000 clients, leading to an estimated 518 couple-years of protection gained per 1,000 clients and 99 disability adjusted life years averted. The Incremental Cost-Effectiveness Ratio (ICER) was $15.75 per additional Couple Year of Protection (CYP) and $82.57 per Disability Adjusted Life Year (DALY) averted. The model was most sensitive to personnel and mobile service costs. Assuming a range of cost-effectiveness thresholds of $58 to $176 for Cambodia, the probability of the intervention being cost-effective ranged from 11% to 95%. Conclusions: This study demonstrates that the cost-effectiveness of the intervention delivered by mobile phone studied in the MOTIF trial lies within the estimated range of cost-effectiveness thresholds for Cambodia. When assessing value in interventions to improve the uptake and adherence to family planning services, the use of interactive mobile phone messaging and counselling for women who have had an abortion should be considered as an option to policy makers. Clinical Trial: This study is a cost-effectiveness analysis of the intervention evaluated in the Mobile Technology for Improved Family Planning (MOTIF) trial: ClinicalTrials.gov NCT01823861.

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