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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: eMental Health interventions can address the mental health needs of different populations. Cultural adaptation of these interventions is crucial to establish better fit with the cultural g...
Background: eMental Health interventions can address the mental health needs of different populations. Cultural adaptation of these interventions is crucial to establish better fit with the cultural group and to achieve better treatment outcomes. Objective: The aim of this study is to describe the cultural adaptation of the World Health Organization’s eMental Health program, Step-by-Step, for overseas Filipino workers (OFWs). We used a framework which posits that cultural adaptation should enhance: (a) relevance, in that the cultural group can relate with the content; (b) acceptability, where the cultural group will not find any element offensive; (c) comprehensibility, in that the program is understandable, and; (d) completeness, wherein the adapted version covers the same concepts and constructs as the original program. We aimed to have English and Filipino, and male and female versions. Methods: Three experienced Filipino psychologists provided their perspectives on the program and how it might be adapted for OFWs. We then adapted the program and obtained further feedback and suggestions from 28 OFWs working in diverse industries through focus group discussions (FGDs). We conducted seven FGDs with all-male participants and nine FGDs with all-female participants. In each FGD, cognitive interviewing was used to probe for relevance, acceptability, comprehensibility, and completeness of illustrations and text. Participant feedback guided a further round of iterative program adaptations, which were again shown to participants to seek additional feedback for validation and improvement. Results: We made a number of key adaptations to the Step-by-Step program. To enhance relevance, we adapted the program narrative to match OFW experiences, incorporated Filipino values, and illustrated familiar problems and activities. To increase acceptability, our main characters were changed to wise elders rather than health professionals (reducing mental health and help-seeking stigma), potentially political or unacceptable content was removed, and the program was made suitable for OFWs working in a variety of sectors. To increase comprehension, we used English and Filipino languages, simplified the text to ease interpretation of abstract terms or ideas, and ensured that text and illustrations matched. We also used Taglish (i.e., merged English and Filipino) when participants deemed pure Filipino translations sounded odd or were difficult to understand. Lastly, we retained the core elements and concepts included in the original Step-by-Step program to maintain completeness. Conclusions: This study showed the utility of using the four-point framework that focuses on acceptance, relevance, comprehensibility, and completeness in cultural adaptation. In the end, we achieved a culturally-appropriate adapted version of the Step-by-Step program for OFWs. We discuss lessons we learned in the process to guide future cultural adaptation projects of eMental Health interventions.
Background: E-learning in medical education can contribute to alleviating the severe shortages of health workers in many low- and middle-income countries. In the past few decades, the rapid developmen...
Background: E-learning in medical education can contribute to alleviating the severe shortages of health workers in many low- and middle-income countries. In the past few decades, the rapid development of technologies resulted in an abundance of new resources, including personal computers, smartphones, handheld devices, software and the Internet – at constantly decreasing costs. Consequently, educational interventions increasingly integrate e-learning to tackle the challenges of health workforce development and training. However, evaluations of e-learning interventions still lack clear methodology to assess the effectiveness and the success of e-learning for medical education, especially in those countries where they are most needed. Objective: Our specific research aim was to systematically describe currently used evaluation methods and definitions for the success of medical e-learning interventions for medical doctors and medical students in low- and middle-income countries. Our long-term objective is to contribute to generating effective and robust e-learning interventions to address critical health worker shortages in low- and middle-income countries. Methods: Seven databases were searched for e-learning interventions for medical education in low- and middle-income countries, covering publications ranging from January 2007 to June 2017. We derived search terms following a preliminary review of relevant literature and included studies published in English which implemented e-learning asynchronously for medical doctors and/or medical students in a low- or middle-income country. Three reviewers screened the references, assessed their study quality, and synthesized extracted information from the literature. Results: We included 52 studies representing a total of 12294 participants. Most of the e-learning evaluations were assessed summatively (83%) and within pilot studies (73%), relying mainly on quantitative evaluation methods using questionnaire (45%) and/or knowledge testing (36%). We identified a lack of evaluation standards for medical e-learning interventions, as methods varied considerably in the evaluation of their medical e-learning interventions with a high variation in study quality (general low study quality, based on study quality scales MERSQI, NOS and NOS-E), study period (ranging from 5 days up to 6 years), assessment methods (6 different main methods) and outcome measures (a total of 52 different outcomes), as well as in the interpretation of intervention success. The majority of studies relied on subjective measures and self-made evaluation frameworks, resulting in low comparability and validity of evidence. Most of the included studies reported success in their e-learning intervention. Conclusions: The evaluation of e-learning interventions needs to produce meaningful and comparable results. Currently, a majority of evaluations of e-learning approaches to educate medical doctors and medical students is based on self-reported measures that lack adherence to a standard evaluation framework. While the majority of studies report success of e-learning interventions – suggesting the potential benefits of the e-learning – the overall low quality of the evidence makes it difficult to draw firm conclusions. Methods development, study design guidance, and standardization of evaluation outcomes and approaches for e-learning interventions will be important for this field of education research to prosper. Methodological strength and standardization are particularly important, because the majority of the existing studies evaluate pilot interventions. Rigorous evidence on pilot success can improve the chances of scaling and sustaining e-learning approaches for health workers.
Over the past 40 years, the healthcare community has been repeatedly excited by the hope of providing better care through the effective adoption of the technology. In the hope that digital health is g...
Over the past 40 years, the healthcare community has been repeatedly excited by the hope of providing better care through the effective adoption of the technology. In the hope that digital health is going to be the game changer, an aura of hype has been created amongst the stakeholders of healthcare industry. However, digital health is yet to witness a large-scale adoption that could match the hope created about its utility. There does not exist an example where digital health has successfully transformed the health system of a geography and has demonstrated a net positive return on the initial investment. Owing to the lack of a positive business case, the initiatives pertaining to digital health are losing steam. Corporates are shutting down digital health labs, staunching investments in digital health, digital health conferences are consolidating, and governments are re-evaluating the funding regimes for such initiatives. For the technology to be able to create desired impact in this sector, the principle stakeholders namely governments, hospitals, insurers, tech developers, medical professionals, and patients need to participate equitably. The resources need to be focused on high impact areas like epidemiology surveys, legal and regulatory frameworks, geriatric care, and human resources training. For a new technology to thrive, the industry competitors and governments must work in unison to develop solutions that are pragmatic, solves the problems, reduce the cost of care delivery, and are sustainable in the long-term. Digital health is not dead, but it is in a stage where its revival will be an up-hill task.
Background: Type 2 Diabetes Mellitus (T2DM) is a major health problem worldwide. Proper self-management can improve health outcomes and reduces risk of diabetic complications. Recently, smartphone-bas...
Background: Type 2 Diabetes Mellitus (T2DM) is a major health problem worldwide. Proper self-management can improve health outcomes and reduces risk of diabetic complications. Recently, smartphone-based technology has been used for self-management programs but their effectiveness in improving self-efficacy, self-care activities, health-related quality of life (HRQoL) and clinical outcomes for patients with T2DM is not well understood. Objective: To review the evidence and determine the effectiveness of smartphone-based self-management interventions on self-efficacy, self-care activities, HRQoL, glycated haemoglobin (HbA1c), body mass index (BMI), blood pressure (BP) levels of adults with T2DM. Methods: A systematic search of five databases (PubMed, Embase, Cochrane, CINAHL and Scopus) was conducted. Study published in English, from January 2007 to January 2018, were considered. Only randomised controlled trials (RCTs) of smartphone-based self-management interventions for patients with T2DM that reported any of the study outcomes were included. Two reviewers independently screened the studies, extracted data and assessed the quality of the studies. Meta-analyses were conducted for the different study outcomes. Results: A total of 26 articles, consisting of 22 studies with 2645 participants were included in the review. A meta-analysis conducted on self-efficacy revealed a large improvement of 0.98 (95% confidence interval [CI] 0.42 to 1.55; P < 0.001) with smartphone-based self-management interventions. The effect size on self-care activities was also large (d = 0.90; 95% CI 0.24 to 1.57; P < 0.001). Significant heterogeneity was present among studies pooled for both outcomes and subgroup analyses were conducted for self-efficacy. Smartphone-based self-management interventions also gave a small improvement on HRQoL (d = 0.26; 95% CI 0.06 to 0.47; P = .01) and a significant reduction in HbA1c (pooled MD = -0.55; 95% CI -0.60 to -0.40; P < 0.001). The effects on BMI and BP were not statistically significant. Conclusions: Smartphone-based self-management interventions appear to have beneficial effects on self-efficacy, self-care activities and health-relevant outcomes for patients with T2DM. However, more research with good study designs is needed to evaluate the effectiveness of smartphone-based self-care interventions for T2DM. Clinical Trial: NA
Background: Relapse of schizophrenia is common, has profound, adverse consequences for patients and is costly to health services. Early signs interventions aim to use warning signs of deterioration to...
Background: Relapse of schizophrenia is common, has profound, adverse consequences for patients and is costly to health services. Early signs interventions aim to use warning signs of deterioration to prevent full relapse. Such interventions show promise but could be further developed. The current paper addresses two developments: adding basic symptoms to checklists of conventional early signs; using a smartphone app (ExPRESS) to aid early signs monitoring. Objective: 1. Design a pool of self-report items assessing basic symptoms (Basic Symptoms Checklist, BSC); 2. Develop and beta test a smartphone app (ExPRESS) monitoring early signs, basic symptoms and psychotic symptoms; 3. Test the long-term usability of ExPRESS by gathering qualitative feedback from participants asked to use it weekly for six months. Methods: The BSC items and ExPRESS app were developed by a multidisciplinary team and adjusted following feedback from beta testers (n=5) with a schizophrenia diagnosis. Individuals (n=18) who had experienced a relapse of schizophrenia within the past year were then asked to use ExPRESS once a week for 6 months to answer questions on their experience of early signs, basic symptoms and psychotic symptoms. Face-to-face qualitative interviews (n=16) were conducted at the end of follow-up to explore participants’ experiences of using the phone app. The topic guide sought participants’ views on the following a priori themes: item content, layout and wording; the way the app looked; length and frequency of assessments; worries about using the app; how app use fitted with participants’ routines; the app’s extra features. Interview transcripts were analyzed using the framework method which allows both a priori and a posteriori themes to be identified and examined. Results: Participants had a mean age of 38 (range 22-57). Participants’ responses to a priori topics indicated that long-term use of the ExPRESS app was acceptable; they suggested small changes that could be made for future versions of ExPRESS. A posteriori themes gave further insight into individuals’ experiences of using ExPRESS. Some participants reported finding it more accessible than visits from a clinician, since assessments were more frequent, more anonymous and did not require the individual to explain their feelings in their own words. Nevertheless, barriers to app use were also reported. Despite the app containing no overtly therapeutic components, some participants found that answering weekly questions on the app prompted self-reflection which had therapeutic value for them. Conclusions: This study suggests that apps are an acceptable means of long-term symptom monitoring for service users with schizophrenia diagnosis across a wide age range. As long as the potential benefits are understood, patients are generally willing and motivated to use a weekly symptom-monitoring app; virtually all participants in the current study were prepared to do so for more than six months. Clinical Trial: ClinicalTrials.gov NCT03558529
The Industrial Revolution brought new economics and new epidemic patterns to the people, which formed the healthcare 1.0 that focused on public health solutions. The emergence of large production conc...
The Industrial Revolution brought new economics and new epidemic patterns to the people, which formed the healthcare 1.0 that focused on public health solutions. The emergence of large production concept and technology brought healthcare to 2.0. Bigger hospitals and better medical education were established, and doctors were trained for specialty for better treatment quality. The size of computer shrunk. This allowed fast development of computer-based devices and information technology, leading the healthcare to 3.0. The initiation of smart medicine nowadays announces the arrival of healthcare 4.0 with new brain and new hands. It is an era of big revision of previous technologies, one of which is artificial intelligence which will lead humans to a new world that emphasizes more on advanced and continuous learnings.