@Article{info:doi/10.2196/59275,
author="Wang, Yi
and Tyagi, Shilpa
and Ng, Liang David Wei
and Teo, Ying Valerie Hui
and Kok, David
and Foo, Dennis
and Koh, Choon-Huat Gerald",
title="Primary Technology-Enhanced Care for Hypertension Scaling Program: Trial-Based Economic Evaluation Examining Effectiveness and Cost-Effectiveness Using Real-World Data in Singapore",
journal="J Med Internet Res",
year="2025",
month="Apr",
day="15",
volume="27",
pages="e59275",
keywords="telehealth monitoring",
keywords="hypertension",
keywords="cost-effectiveness analysis",
keywords="real-world data",
keywords="Singapore",
keywords="telehealth",
keywords="cost-effectiveness",
keywords="blood pressure monitoring",
keywords="health care",
keywords="teleconsultation",
keywords="chatbot",
keywords="regression analysis",
keywords="medical cost",
abstract="Background: Telehealth interventions are effective in hypertension management. However, the cost-effectiveness of using them for managing patients with hypertension remains inconclusive. Further research is required to understand the effectiveness and cost-effectiveness in the real-world setting. Objective: The Primary Technology-Enhanced Care for Hypertension (PTEC-HT) scaling program, a telehealth intervention for hypertension management, is currently being scaled nationwide in Singapore. The program comprises remote blood pressure (BP) monitoring at home, health care team support through teleconsultations, and in-app support with a digital chatbot. This study aimed to evaluate the program's effectiveness and cost-effectiveness. Methods: For patients under the PTEC-HT scaling program, BP readings over 6 months and 12 months, age, and gender were collected within the program. Health care use, health care cost, and patient ethnicity were extracted from the National Healthcare Group Polyclinics. For patients in the usual care group, demographic information, clinical data, health care use, and health care costs were extracted from the national claims records. Comparing the PTEC-HT scaling program with usual care, a trial-based economic evaluation using patient-level data was conducted to examine the effectiveness and cost-effectiveness over time horizons of 6 months and 12 months. The health care system's perspective was adopted. Regression analysis and exact matching were used to control for the differences between the PTEC-HT group and the usual care group. Results: For the 6-month analysis, 427 patients were included in the PTEC-HT group, and 64,679 patients were included in the usual care group. For the 12-month analysis, 338 patients were included in the PTEC-HT group, and 7324 patients were included in the usual care group. Using exact matching plus regression, in the 6-month analysis, the probability of having controlled BP was 13.5\% (95\% CI 6.3\%-20.7\%) higher for the PTEC-HT group compared to the usual care group. In the 12-month analysis, the probability of having controlled BP was 16\% (95\% CI 10.7\%-21.3\%) higher for the PTEC-HT group. Without considering the cost of the BP machine and program maintenance cost, the direct medical cost was S \$57.7 (95\% CI 54.4-61.0; a currency exchange rate of S \$1=US \$0.74 was applicable;) lower per patient for the PTEC-HT group in the 6-month analysis and S \$170.9 (95\% CI 151.9-189.9) lower per patient for the PTEC-HT group in the 12-month analysis. With the cost of the BP machine and program maintenance considered, compared to usual care, the PTEC-HT program reached breakeven at around the sixth month and saved S \$52.6 (95\% CI 33.6-71.6) per patient at the 12th month. Conclusions: Implemented in a real-world setting in Singapore, our study showed that the PTEC-HT scaling program is more effective in controlling BP status with lower cost compared to the usual care over 12 months. ",
doi="10.2196/59275",
url="https://www.jmir.org/2025/1/e59275"
}


@Article{info:doi/10.2196/70247,
author="Zhang, Xinyue",
title="Authors' Reply: The SCeiP Model for Remote Rehabilitation in Homebound Patients With Coronary Heart Disease",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="28",
volume="27",
pages="e70247",
keywords="exercise rehabilitation",
keywords="coronary heart disease",
keywords="promotion strategy",
keywords="home rehabilitation",
doi="10.2196/70247",
url="https://www.jmir.org/2025/1/e70247"
}


@Article{info:doi/10.2196/69927,
author="Zhang, Siqi
and Chen, Tielong",
title="The SCeiP Model for Remote Rehabilitation in Homebound Patients With Coronary Heart Disease",
journal="J Med Internet Res",
year="2025",
month="Mar",
day="28",
volume="27",
pages="e69927",
keywords="remote exercise rehabilitation",
keywords="SCeiP model",
keywords="coronary heart disease",
keywords="promotion strategy",
keywords="home rehabilitation",
doi="10.2196/69927",
url="https://www.jmir.org/2025/1/e69927"
}


@Article{info:doi/10.2196/67219,
author="Bakas, Tamilyn
and Miller, Elaine
and Sucharew, Heidi
and Kreitzer, Natalie
and Israel, Jahmeel
and Rota, Matthew
and Harnett, Brett
and Dunning, Kari
and Jones, Holly
and McCarthy, Michael
and Brehm, Bonnie
and Austin, K. Joan
and Mitchell, H. Pamela",
title="Examining the Efficacy of the Telehealth Assessment and Skill-Building Kit (TASK III) Intervention for Stroke Caregivers: Protocol for a Randomized Controlled Clinical Trial",
journal="JMIR Res Protoc",
year="2025",
month="Mar",
day="25",
volume="14",
pages="e67219",
keywords="stroke",
keywords="family caregivers",
keywords="depressive symptoms",
keywords="health-related quality of life",
keywords="clinical trial",
keywords="intervention study",
keywords="protocol",
keywords="nursing",
abstract="Background: Stroke is a leading cause of serious, long-term disability and has a sudden onset. Upon discharge to the home setting, families are thrust into providing care, often without sufficient training from health care providers. Aligned with current patient and caregiver guidelines, the Telehealth Assessment and Skill-Building Kit (TASK III) is a nurse-led intervention designed to empower caregivers to address their own needs and those of the survivor using innovative skill-building strategies. Objective: This study aims to test the short-term (immediately after the intervention at 8 wk) and long-term (12, 24, and 52 wk) efficacy of the TASK III intervention, compared with an information, support, and referral (ISR) group, to improve caregiver life changes (ie, changes in physical health, physical functioning, emotional well-being, and general health) as a result of providing care. Methods: A randomized controlled clinical trial design will be used with baseline data collection from 296 family caregivers by telephone after the stroke survivor is discharged home. Caregivers randomly assigned to the ISR group (n=148, 50\%) will receive information from the American Heart Association about stroke family caregiving. Caregivers randomly assigned to the TASK III group (n=148, 50\%) will receive a TASK III resource guide and information from the American Heart Association. Both groups will receive 8 weekly calls from a nurse, with a booster call a month later. Outcomes will be assessed by blinded data collectors at 8, 12, 24, and 52 weeks. The primary outcome (at 8 wk) is caregiver life changes measured by the Bakas Caregiving Outcomes Scale. Secondary outcomes are depressive symptoms; other symptoms (eg, stress, fatigue, sleep, pain, and shortness of breath); unhealthy days; diet; exercise; and self-reported health care use. Mediators are task difficulty, threat appraisal, and self-efficacy. Program evaluation outcomes (satisfaction and technology ratings) will also be analyzed. Results: The trial was registered on March 10, 2022. Enrollment and random assignment of the first participant was on November 30, 2022, with an anticipated completion of recruitment by November 30, 2025. Completion of the primary end point data analysis is anticipated by August 31, 2026, with results expected to be reported on ClinicalTrials.gov by April 1, 2027. As of October 9, 2024, a total of 198 (66.9\% of the proposed total sample of 296) family caregivers have been enrolled and randomly assigned to the TASK III group (n=98, 49.5\%) or the ISR group (n=100, 50.5\%). The last update was performed on January 25, 2024. Conclusions: If the TASK III intervention is shown to be efficacious in the proposed randomized controlled clinical trial, our next goal will be to translate TASK III into ongoing stroke systems of care, providing a tremendous public health impact. Trial Registration: ClinicalTrials.gov NCT05304078; https://clinicaltrials.gov/study/NCT05304078 International Registered Report Identifier (IRRID): DERR1-10.2196/67219 ",
doi="10.2196/67219",
url="https://www.researchprotocols.org/2025/1/e67219",
url="http://www.ncbi.nlm.nih.gov/pubmed/39937971"
}


@Article{info:doi/10.2196/60582,
author="Rivas, Vincent Eric
and Lesley, Ulf
and Davoody, Nadia",
title="Health Care Professionals' Perspectives on Using eHealth Tools in Advanced Home Care: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2025",
month="Mar",
day="24",
volume="12",
pages="e60582",
keywords="eHealth",
keywords="mobile health",
keywords="mHealth",
keywords="advanced home care",
keywords="content analysis",
keywords="nurse",
keywords="staff-patient relationship",
keywords="aging population",
keywords="patient engagement",
keywords="personalized care",
keywords="patient experience",
abstract="Background: The rising demand for advanced home care services, driven by an aging population and the preference for aging in place, presents both challenges and opportunities. While advanced home care can improve cost-effectiveness and patient outcomes, gaps remain in understanding how eHealth technologies can optimize these services. eHealth tools have the potential to offer personalized, coordinated care that increases patient engagement. However, research exploring health care professionals' (HCPs) perspectives on the use of eHealth tools in advanced home care and their impact on the HCP-patient relationship is limited. Objective: This study aims to explore HCPs' perspectives on using eHealth tools in advanced home care and these tools' impact on HCP-patient relationships. Methods: In total, 20 HCPs from 9 clinics specializing in advanced home care were interviewed using semistructured interviews. The discussions focused on their experiences with 2 eHealth tools: a mobile documentation tool and a mobile preconsultation form. The data were analyzed using content analysis to identify recurring themes. Results: The data analysis identified one main theme: optimizing health care with eHealth; that is, enhancing care delivery and overcoming challenges for future health care. Two subthemes emerged: (1) enhancing care delivery, collaboration, and overcoming adoption barriers and (2) streamlining implementation and advancing eHealth tools for future health care delivery. Five categories were also identified: (1) positive experiences and benefits, (2) interactions between HCPs and patients, (3) challenges and difficulties with eHealth tools, (4) integration into the daily workflow, and (5) future directions. Most HCPs expressed positive experiences with the mobile documentation tool, highlighting improved efficiency, documentation quality, and patient safety. While all found the mobile preconsultation form beneficial, patient-related factors limited its utility. Regarding HCP-patient relationships, interactions with patients remained unchanged with the implementation of both tools. HCPs successfully maintained their interpersonal skills and patient-centered approach while integrating eHealth tools into their practice. The tools allowed more focused, in-depth discussions, enhancing patient engagement without affecting relationships. Difficulties with the tools originated from tool-related issues, organizational challenges, or patient-related complexities, occasionally affecting the time available for direct patient interaction. Conclusions: The study underscores the importance of eHealth tools in enhancing advanced home care while maintaining the HCP-patient relationship. While eHealth tools modify care delivery techniques, they do not impact the core dynamics of the relationships between HCPs and patients. While most of the HCPs in the study had a positive attitude toward using the eHealth tools, understanding the challenges they encounter is crucial for improving user acceptance and success in implementation. Future development should focus on features that not only improve efficiency but also actively enhance HCP-patient relationships, such as facilitating more meaningful interactions and supporting personalized care in the advanced home care setting. ",
doi="10.2196/60582",
url="https://humanfactors.jmir.org/2025/1/e60582"
}


@Article{info:doi/10.2196/69107,
author="Donelle, Lorie
and Hiebert, Bradley
and Warner, Grace
and Reid, Michael
and Reid, Jennifer
and Shariff, Salimah
and Richard, Emily
and Regan, Sandra
and Weeks, Lori
and Ledoux, Kathleen",
title="Passive Remote Monitoring Technologies' Influence on Home Care Clients' Ability to Stay Home: Multiprovincial Randomized Controlled Trial",
journal="JMIR Aging",
year="2025",
month="Mar",
day="19",
volume="8",
pages="e69107",
keywords="remote monitoring technology",
keywords="home care",
keywords="health service use",
keywords="aging in place",
abstract="Background: Researchers in Nova Scotia and Ontario, Canada, implemented a passive remote monitoring (PRM) model of home care unique to their health system contexts. Each PRM model integrated tailored PRM devices (eg, motion sensors, cameras, and door alarms) into home care patients' residences with the aim of linking patients, family and friend caregivers, and health care providers to support older adults' aging in place. Objective: The purpose of this study was to examine the use of PRM technologies in the home to support older adults' safe aging in place and avoidance or delay of higher levels of care. Methods: This multiprovincial pragmatic randomized controlled trial examined how PRM technologies support older adults to safely remain in their home and avoid or delay admission to higher levels of care. Pairs of home care patients and their family and friend caregivers were recruited in Ontario and Nova Scotia. Participant pairs were randomly assigned to one of two conditions: (1) standard home care (ie, control) or (2) standard home care plus study-provided PRM (ie, intervention). Participants provided their provincial health insurance numbers to link with provincial health administrative databases and identify if patients were admitted to higher levels of care after 1 year. Cox proportional hazards models were used to evaluate the primary outcome in each province. Results: In total, 313 patient-caregiver pairs were recruited: 174 pairs in Ontario (intervention: n=60; control: n=114) and 139 pairs in Nova Scotia (intervention: n=45; control: n=94). Results indicate PRM was associated with a nonsignificant 30\% reduction in risk of patients being admitted to higher levels of care in Ontario (hazard ratio 0.7, 95\% CI 0.3-1.4) and no reduction in risk in Nova Scotia (hazard ratio 1.1, 95\% CI 0.3-3.7). Adjusting for patient sex had no impact on model estimates for either province. Conclusions: Limitations related, in part, to the impact of the COVID-19 pandemic may have contributed to the effectiveness of the intervention. While our study did not yield statistically significant results (P=.30 and P=.90) regarding the effectiveness of the PRM model in prolonging home stays, the observed trends suggest that technology-assisted aging in place may be a valuable goal for older adults. Further study is required to understand if longer follow-up time allows more effects of PRM on patients' avoidance of higher levels of care to be detected. Trial Registration: ISRCTN ISRCTN79884651; https://www.isrctn.com/ISRCTN79884651 International Registered Report Identifier (IRRID): RR2-10.2196/15027 ",
doi="10.2196/69107",
url="https://aging.jmir.org/2025/1/e69107"
}


@Article{info:doi/10.2196/57768,
author="Kohta, Masushi
and Takahashi, Mayumi
and Koyanagi, Hiroe
and Sugama, Junko",
title="Evaluating the Knowledge Level, Practice, and Behavioral Change Potential of Care Managers in Pressure Injury Prevention Using a Mobile App Prototyping Model in the Home-Care Setting: Single-Arm, Pre-Post Pilot Study",
journal="JMIR Form Res",
year="2025",
month="Feb",
day="7",
volume="9",
pages="e57768",
keywords="behavioral change",
keywords="home care",
keywords="knowledge",
keywords="mobile application",
keywords="pressure injury",
keywords="mHealth",
keywords="mobile health",
keywords="apps",
keywords="practice",
keywords="injury",
keywords="prevention",
keywords="prototype",
keywords="effectiveness",
keywords="care manager",
keywords="Japan",
keywords="Pips-Map",
keywords="questionnaire",
keywords="wound care",
keywords="pilot study",
keywords="women",
abstract="Background: The use of mobile apps to promote knowledge level, practice, and behavioral change potential has become increasingly common. However, studies on apps targeting social welfare employees working in the home-care setting to prevent pressure injury (PI) are lacking. The care manager (CM) plays a key role in connecting the demand and supply of home-care services. PI is more prevalent in the home-care setting, where resources are limited, than in acute settings. Objective: The research hypothesis was that CMs who use a mobile app will have improved general knowledge and heightened practice for PI prevention, compared to that before using the app. This study aimed to assess the effectiveness of a PI prevention support mobile app prototyping model (Pips-Map) in improving the knowledge level, practice, and behavioral change potential of CMs in PI prevention in the home-care setting. Methods: This was conducted between December 2021 and December 2023 as a single-arm, pre-post pilot study including 27 CMs who worked in a Japanese city. Pips-Map was used for 6 months in daily practice, and a self-administered test questionnaire was used to assess participants' knowledge and practice in PI prevention before or after using Pips-Map. At the end of the posttest, a validated App Behavior Change Scale was used to analyze behavioral change potential. This study followed the Consolidated Standards of Reporting Trials (CONSORT) extension to pilot and feasibility trials. Results: In total, 19 participants were analyzed. Out of 55 points, the total mean knowledge score significantly increased from 30.9 (SD 5.9) in the pretest group to 36.1 (SD 5.9) in the posttest group (P=.0003). The number of participants with a total score of >70\% (adequate knowledge level) increased from 2 (11\%) to 7 (36.8\%), but the difference was not statistically significant (P=.07). For the level of practice, out of 21 points, the total score increased from 15.2 (SD 3.1) in the pretest group to 16.2 (SD 3.0) in the posttest group, but no statistically significant differences were observed (P=.16). The behavior change scale revealed that participants positively evaluated the Pips-Map to provide information on PI prevention guidelines but had concerns regarding inadequate usability and financial incentives of Pips-Map. Conclusions: The use of Pips-Map for 6 months in actual practice increased the knowledge level of Japanese CMs in PI prevention, but it did not change the level of practice. Considering the need for updating apps that aim to promote behavioral change, this study identified some limitations of Pips-Map. Thus, revisions must be made to adapt Pips-Map to home-based care needs. Trial Registration: UMIN Clinical Trial Registry UMIN000048904; https://tinyurl.com/5bt6zv7t ",
doi="10.2196/57768",
url="https://formative.jmir.org/2025/1/e57768"
}


@Article{info:doi/10.2196/65840,
author="Alami, Sarah
and Schaller, Manuella
and Blais, Sylvie
and Taupin, Henry
and Hern{\'a}ndez Gonz{\'a}lez, Marta
and Gagnadoux, Fr{\'e}d{\'e}ric
and Pinto, Paula
and Cano-Pumarega, Irene
and Bedert, Lieven
and Braithwaite, Ben
and Servy, Herv{\'e}
and Ouary, St{\'e}phane
and Fabre, C{\'e}line
and Bazin, Fabienne
and Texereau, Jo{\"e}lle",
title="Evaluating the Benefit of Home Support Provider Services for Positive Airway Pressure Therapy in Patients With Obstructive Sleep Apnea: Protocol for an Ambispective International Real-World Study",
journal="JMIR Res Protoc",
year="2025",
month="Jan",
day="31",
volume="14",
pages="e65840",
keywords="obstructive sleep apnea",
keywords="positive airway pressure",
keywords="real-world evidence",
keywords="home support provider",
keywords="adherence",
keywords="electronic patient-reported outcome",
keywords="comparative real-world study",
abstract="Background: Adherence and persistence to positive airway pressure (PAP) therapy are key factors for positive health outcomes. Home support providers participate in the home implementation and follow-up of PAP therapy for patients with obstructive sleep apnea (OSA). In Europe, home support provider service levels are country (or area) specific, resulting in differences in content and frequency of patient interactions. However, no robust evaluation of the impact of these differences on clinical and patient outcomes has been performed. Objective: The AWAIR study aims to evaluate and compare the impact of different home support provider service levels on PAP adherence and persistence in 4 European countries. Methods: This real-world, ambispective, cohort study---conducted in France, Belgium, Spain, and Portugal---will recruit adults with OSA who started PAP therapy between 2019 and 2023 and were followed by an Air Liquide Healthcare home support provider. Given the large number of eligible participants (around 150,000), the study will use a decentralized and digital approach. A patient video will present the study objectives and the participation process. A secure electronic solution will be used to manage patient information and consent, as well as to administer a web-based questionnaire. Retrospective data, collected during routine patient follow-up by home support providers, include the level of service and device data, notably PAP use. Prospective data collected using an electronic patient-reported outcome tool include health status, OSA-related factors, patient-reported outcomes including quality of life and symptoms, OSA and PAP literacy, patient-reported experience, and satisfaction with PAP therapy and service. Hierarchical models, adjusted for preidentified confounding factors, will be used to assess the net effect of home support provider services on PAP adherence and persistence while minimizing real-world study biases and considering the influence of country-level contextual factors. We hypothesize that higher levels of home support provider services will be positively associated with adherence and persistence to PAP therapy. Results: As of December 2024, the study has received approval in France, Portugal, and 2 regions of Spain. The study began enrollment in France in October 2024. Results are expected in the second quarter of 2025. Conclusions: The AWAIR study has a unique design, leveraging an unprecedented number of eligible participants, decentralized technologies, and a real-world comparative methodology across multiple countries. This approach will highlight intercountry differences in terms of patient characteristics, PAP adherence, and persistence, as well as patient-reported outcomes, patient-reported experiences, and satisfaction with the home service provider. By assessing the added value of home support provider services, the results will support best practices for patient management and for decision-making by payers and authorities. International Registered Report Identifier (IRRID): PRR1-10.2196/65840 ",
doi="10.2196/65840",
url="https://www.researchprotocols.org/2025/1/e65840"
}


@Article{info:doi/10.2196/66694,
author="Li, Ming-wei
and Tsai, Yao-Chou
and Yang, Shei-Dei Stephen
and Pong, Yuan-Hung
and Tsai, Yu-Ting
and Tsai, Fang-Sheng Vincent",
title="The Evolution of Uroflowmetry and Bladder Diary and the Emerging Trend of Using Home Devices From Hospital to Home",
journal="Interact J Med Res",
year="2025",
month="Jan",
day="28",
volume="14",
pages="e66694",
keywords="lower urinary tract symptoms",
keywords="uroflowmetry",
keywords="bladder diary",
keywords="home devices",
keywords="bladder",
keywords="noninvasive",
keywords="evaluations",
keywords="viewpoint",
keywords="diagnostic",
keywords="mobile health",
doi="10.2196/66694",
url="https://www.i-jmr.org/2025/1/e66694"
}


@Article{info:doi/10.2196/58301,
author="Ganzevoort, N. Ilse
and van der Veen, L. Adri{\"e}lla
and Alma, A. Manna
and Berger, Y. Marjolein
and Holtman, A. Gea",
title="Children's and Their Parents' Experiences With Home-Based Guided Hypnotherapy: Qualitative Study",
journal="JMIR Pediatr Parent",
year="2025",
month="Jan",
day="27",
volume="8",
pages="e58301",
keywords="qualitative study",
keywords="primary health care",
keywords="children",
keywords="functional abdominal pain",
keywords="irritable bowel syndrome",
keywords="hypnotherapy",
keywords="eHealth",
keywords="abdominal pain",
keywords="child",
keywords="parents",
keywords="accessibility",
keywords="questionnaire",
keywords="interviews",
keywords="thematic analysis",
keywords="home guided",
keywords="primary care",
keywords="mobile phone",
abstract="Background: Management of children with functional abdominal pain (FAP) or irritable bowel syndrome (IBS) is difficult in primary care. When education and reassurance do not alleviate symptoms, primary care physicians lack treatment options for children with FAP or IBS. Home-based guided hypnotherapy is a promising treatment because of its accessibility. To address feasibility, it is of utmost importance to take experiences from children and their parents into account. Objective: We aimed to explore children's and their parents' experiences with home-based guided hypnotherapy for children with FAP or IBS. Methods: This qualitative study used open-ended questions from a questionnaire and in-depth semistructured interviews with children and their parents who had a hypnotherapy intervention prescribed. The interviews were audio-recorded and transcribed verbatim. Data were collected and analyzed iteratively using thematic content analysis. Results: A total of 76 children were eligible, and we collected questionnaire data from 56 children. A total of 23 interviews were conducted with 10 children and 15 parents. Six themes emerged from questionnaire data and interviews: impression of the exercises, not for everyone, influence of perceived effect, integrating exercises in daily life, content and practicalities of the website, and customization to personal preferences. Children with FAP or IBS experienced home-based guided hypnotherapy and the exercises differently, ranging from boring to fun. From interviews with the parents, it emerged that hypnotherapy is not suitable for everyone; for example, when children are very young or have a low developmental level, cannot sit still, cannot surrender to the exercises, or are too energetic or stressed, it might be difficult to comply. Experiences were shaped by the influence of a perceived effect and to which extent children were able to integrate exercises in daily life. The content and practicalities of the website also influenced experiences, and hypnotherapy that is adaptable to personal preferences, including by appearance and content, would be highly appreciated. Conclusions: The children and parents experienced home-based guided hypnotherapy differently, ranging from boring to fun. Hypnotherapy might be difficult or boring for some children. The children enjoyed hypnotherapy when they liked the topic or story, felt positive effects, could easily integrate exercises in daily life, or enjoyed the website in general. The children's experiences and adherence can be further improved by adding short exercises and customizing hypnotherapy to their personal preferences on the website's appearance and content. This could increase effectiveness but must be studied further. Trial Registration: ClinicalTrials.gov NCT05636358; https://clinicaltrials.gov/study/NCT05636358 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-069653 ",
doi="10.2196/58301",
url="https://pediatrics.jmir.org/2025/1/e58301"
}


@Article{info:doi/10.2196/59921,
author="Lu, Wei
and Silvera-Tawil, David
and Yoon, Hwan-Jin
and Higgins, Liesel
and Zhang, Qing
and Karunanithi, Mohanraj
and Bomke, Julia
and Byrnes, Joshua
and Hewitt, Jennifer
and Smallbon, Vanessa
and Freyne, Jill
and Prabhu, Deepa
and Varnfield, Marlien",
title="Impact of the Smarter Safer Homes Solution on Quality of Life and Health Outcomes in Older People Living in Their Own Homes: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="22",
volume="27",
pages="e59921",
keywords="randomized controlled trial",
keywords="digital health",
keywords="eHealth",
keywords="smart home",
keywords="sensor",
keywords="health monitoring",
keywords="home monitoring",
keywords="aged care",
keywords="aging in place",
keywords="older adult",
keywords="quality of life",
abstract="Background: An increasingly aging population, accompanied by a shortage of residential aged care homes and workforce and consumer feedback, has driven a growing interest in enabling older people to age in place through home-based care. In this context, smart home technologies for remote health monitoring have gained popularity for supporting older people to live in their own homes. Objective: This study aims to investigate the impact of smart home monitoring on multiple outcomes, including quality of life, activities of daily living, and depressive symptoms among older people living in their own homes over a 12-month period. Methods: We conducted an open-label, parallel-group randomized controlled trial. The control group continued to receive their existing care from aged care service providers. Meanwhile, the intervention group, in addition to receiving their usual aged care services, had their activities of daily living monitored using a smart home platform. Surveys including the Adult Social Care Outcomes Toolkit (ASCOT), EuroQol-5 Dimensions-5 Levels (EQ-5D-5L), Katz Index of Independence in Activities of Daily Living (Katz ADL), Lawton Instrumental Activities of Daily Living Scale (IADL), and Geriatric Depression Scale (GDS) were conducted at baseline and 6 and 12 months from baseline. Linear mixed-effects models were used to compare the difference between the intervention and control groups, with the ASCOT as the primary outcome measure. Results: Data from 130 participants were used in the analysis, with no significant differences in baseline characteristics between the control group (n=61) and the intervention group (n=69). In comparison to the control group, the intervention group had a higher ASCOT score at the 6-month assessment (mean difference 0.045, 95\% CI 0.001 to 0.089; Cohen d=0.377). However, this difference did not persist at the 12-month assessment (mean difference 0.031, 95\% CI --0.014 to 0.076; Cohen d=0.259). There were no significant differences in EQ-5D-5L, Katz ADL, IADL, and GDS observed between the intervention and control groups at the 6-month and 12-month assessments. Conclusions: The study demonstrates that smart home monitoring can improve social care--related quality of life for older people living in their own homes. However, the improvement was not sustained over the long term. The lack of statistically significant findings and diminished long-term improvements may be attributed to the influence of the COVID-19 pandemic during the later stage of the trial. Further research with a larger sample size is needed to evaluate the effect of smart home monitoring on broader quality-of-life measures. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000829213; https://tinyurl.com/2n6a75em International Registered Report Identifier (IRRID): RR2-10.2196/31970 ",
doi="10.2196/59921",
url="https://www.jmir.org/2025/1/e59921"
}


@Article{info:doi/10.2196/60479,
author="Zvulunov, Alex
and Lenevich, Stepan
and Migacheva, Natalia",
title="Mobile Health App as an Auxiliary Tool in Management of Atopic Dermatitis in Children: Randomized Controlled Trial",
journal="JMIR Dermatol",
year="2025",
month="Jan",
day="22",
volume="8",
pages="e60479",
keywords="atopic dermatitis",
keywords="skin",
keywords="disease management",
keywords="children",
keywords="pediatric",
keywords="feasibility",
keywords="mHealth",
keywords="mobile health",
keywords="app",
keywords="eczema",
keywords="Atopic App",
keywords="dermatology",
abstract="Background: Mobile health apps can boost treatment adherence and support disease management at home. The Atopic App and web-based Atopic School patient education program offer a chance to enhance adherence to atopic dermatitis (AD) management. Objective: We aim to evaluate the feasibility, acceptability, and preliminary efficacy of the Atopic App mobile health intervention in the managing of AD in children. Methods: A randomized controlled study in children with AD divided participants into 3 groups: a control group (no app), an observational group with the app, and an interventional group with investigator supervision. Patients were examined at screening and follow-up visits 1 and 2 at 3-month intervals. Outcome measures included SCORAD (Scoring Atopic Dermatitis) for objective severity and Patient-Oriented Eczema Measure (POEM) for subjective effectiveness. Statistical analysis used paired t tests (2-tailed), the Mann-Whitney U test, and multiple regression. Results: Fifty-eight participants entered this study (38 boys and 20 girls): group 1 (control) comprised 17 patients, while experimental groups 2 and 3 consisted of 20 and 21 patients, respectively. The rates of missed appointments were similar and statistically insignificant across the groups. All groups showed a significant decrease in SCORAD and POEM scores (P<.05). Usage of the app for ?8 days showed a more significant decrease in severity scores compared to those who used it for ?7 days, or did not use it at all. Participants who used the app for ?8 days had a median SCORAD of 6.25 (95\% CI 4.6?14.1; IQR 4-16.3) at visit 1, significantly lower than nonusers (17.9, 95\% CI 13.9?24.0; IQR 13.9-24; P=.03) and those using it ?7 days (13, 95\% CI 9.35?27; IQR 7.2-27; P=.04). Their median POEM of 2 (95\% CI 1.0?4.5; IQR 1-5.3) was also significantly lower than those using the app ?7 days (9, 95\% CI 2?12; IQR 2-12; P=.04) and lower, though not significantly, than nonusers (7, 95\% CI 1?9; IQR 1-9; P=.14). Additionally, using the Atopic App for ?8 days after the screening visit strongly predicted a decrease in both SCORAD and POEM scores (P=.01 and P=.04, respectively). The time since the screening visit significantly predicted increased outcome scores, while prescriptions of topical calcineurin inhibitors, oral antihistamines, and oral antibiotics were weak and insignificant predictors of score changes. Conclusions: Our findings indicate that the Atopic App is helpful tool in managing AD in children, and they underscore the potential of mobile health interventions in the disease management. Trial Registration: ClinicalTrials.gov NCT06412094; https://clinicaltrials.gov/study/NCT06412094 ",
doi="10.2196/60479",
url="https://derma.jmir.org/2025/1/e60479"
}


@Article{info:doi/10.2196/59291,
author="Ko, Eunjung
and Gao, Ye
and Wang, Peng
and Wijayasingha, Lahiru
and Wright, D. Kathy
and Gordon, C. Kristina
and Wang, Hongning
and Stankovic, A. John
and Rose, M. Karen",
title="Recruitment Challenges and Strategies in a Technology-Based Intervention for Dementia Caregivers: Descriptive Study",
journal="JMIR Form Res",
year="2025",
month="Jan",
day="17",
volume="9",
pages="e59291",
keywords="recruitment challenges and strategies",
keywords="technology-based intervention",
keywords="dementia caregivers",
keywords="dementia",
keywords="mobile phone",
keywords="Alzheimer disease",
keywords="smart health",
abstract="Background: Researchers have encountered challenges in recruiting unpaid caregivers of people living with Alzheimer disease and related dementias for intervention studies. However, little is known about the reasons for nonparticipation in in-home smart health interventions in community-based settings. Objective: This study aimed to (1) assess recruitment rates in a smart health technology intervention for caregivers of people living with Alzheimer disease and related dementias and reasons for nonparticipation among them and (2) discuss lessons learned from recruitment challenges and strategies to improve recruitment. Methods: The smart health intervention was a 4-month, single-arm trial designed to evaluate an in-home, technology-based intervention that monitors stressful moments for caregiving dyads through acoustic signals and to provide the caregivers with real-time stress management strategies. The recruitment involved two main methods: on-site engagement by a recruiter from a memory clinic and social media advertising. Caregivers were screened for eligibility by phone between January 2021 and September 2023. The recruitment rates, reasons for nonparticipation, and participant demographics were analyzed using descriptive statistics. Results: Of 201 caregivers contacted, 11 were enrolled in this study. Eighty-two caregivers did not return the screening call, and others did not participate due to privacy concerns (n=30), lack of interest (n=29), and burdensome study procedures (n=26). Our recruitment strategies included addressing privacy concerns, visualizing collected data through a dashboard, boosting social media presence, increasing the recruitment budget, updating advertisements, and preparing and deploying additional study devices. Conclusions: This study highlighted barriers to participation in the smart health intervention. Despite several recruitment strategies, enrollment rates remained below expectations. These findings underscore the need for future research to explore alternative methods for increasing the recruitment of informal dementia caregivers in technology-based intervention studies. Trial Registration: ClinicalTrials.gov NCT04536701; https://clinicaltrials.gov/study/NCT04536701 International Registered Report Identifier (IRRID): RR2-10.1111/jan.14714 ",
doi="10.2196/59291",
url="https://formative.jmir.org/2025/1/e59291"
}


@Article{info:doi/10.2196/55042,
author="Khatib, Sewar
and Palgi, Yuval
and Ashar, K. Yoni
and Polyvyannaya, Natalya
and Goldstein, Pavel",
title="The Combined Effect of Multisensory Stimulation and Therapist Support on Physical and Mental Health of Older Adults Living in Nursing Homes: Pilot Randomized Controlled Trial",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="14",
volume="27",
pages="e55042",
keywords="Snoezelen room",
keywords="mental health",
keywords="sensory stimulation environment",
keywords="social support",
keywords="nursing homes",
keywords="older adults",
abstract="Background: Increasing life expectancy has led to a rise in nursing home admissions, a context in which older adults often experience chronic physical and mental health conditions, chronic pain, and reduced well-being. Nonpharmacological approaches are especially important for managing older adults' chronic pain, mental health conditions (such as anxiety and depression), and overall well-being, including sensory stimulation (SS) and therapist support (TS). However, the combined effects of SS and TS have not been investigated. Objective: This randomized controlled trial examines the specific and combined effects of brief SS and TS interventions on older adults' physical and mental health and pain intensity levels, among individuals living in nursing homes. Methods: A total of 96 patients aged 65-99 years from a nursing home were randomly assigned to 3 groups: SS, TS, and combined SS+TS interventions, each delivered as four 20-minute sessions. SS was implemented using a multisensory Snoezelen room. Pain intensity levels (per a Visual Analog Scale), blood pressure, heart rate, blood oxygen saturation, and hand grip strength (using a Jamar hand dynamometer) were measured before and after each of the 4 weekly therapeutic sessions. In addition, life satisfaction (per the Satisfaction with Life Scale) and anxiety (per the 7-item General Anxiety Disorder Scale) were evaluated before and after the whole intervention. Mixed model analyses tested the relative efficacy of the 3 interventions, applying simple slope analysis with Tukey correction. Study rationale and analytical plans were preregistered. Results: The combined intervention of SS and TS (SS+TS) resulted in reduced pain levels compared with SS (B=0.209, P=.006) and TS alone (B=0.23, P=.002) over 4 sessions (F6,266=2.62; P=.017; R2=0.23). Further, the combined SS+TS intervention resulted in reduced systolic blood pressure versus SS (B=0.09, P=.01) and TS alone (B=0.016, P<.001) groups (F6,272=5.42; P<.001; R2=0.29). In addition, the combined SS+TS intervention resulted in an increased grip strength versus SS (B=--0.35, P=.003) and TS alone  (B=--0.032, P=.008) groups (F6,273=2.25; P=.04; R2=0.19). Moreover, combined SS+TS resulted in an improvement in life satisfaction (B=--4.29, P<.0001) compared with SS (B=--2.38, P=.0042) and TS alone (B=--1.20, P=.13) groups (F2,39=3.47; P=.04). Finally, SS+TS demonstrated greater improvement in symptoms of general anxiety disorder (B=10.64, P<.0001) compared with SS (B=3.30 P=.01) and TS alone (B=1.13, P=.37) (F2,38=13.5; P<.001) groups. No differences between the interventions were shown for blood oxygen saturation (F6,273=2.06; P=.06), diastolic blood pressure (F6,272=1.12; P=.35), and heart rate (F6,273=1.33; P=.23). Conclusions: The combined intervention of SS and TS showed therapeutic benefits for pain management and physical and mental health of older adults living in nursing homes, relative to each therapeutic component in isolation. This brief intervention can be readily implemented to improve well-being and optimize therapeutic resources in nursing home settings. Trial Registration: ClinicalTrials.gov NCT05394389; https://clinicaltrials.gov/ct2/show/NCT05394389 ",
doi="10.2196/55042",
url="https://www.jmir.org/2025/1/e55042",
url="http://www.ncbi.nlm.nih.gov/pubmed/39808474"
}


@Article{info:doi/10.2196/60689,
author="Bertram, Pia
and Oppelaar, C. Martinus
and Bannier, AGE Michiel
and Reijers, HE Monique
and van der Vaart, Hester
and van der Meer, Renske
and Altenburg, Josje
and Conemans, Lennart
and Rottier, L. Bart
and Nuijsink, Marianne
and van den Wijngaart, S. Lara
and Merkus, JFM Peter
and Roukema, Jolt",
title="The Long-Term Uptake of Home Spirometry in Regular Cystic Fibrosis Care: Retrospective Multicenter Observational Study",
journal="J Med Internet Res",
year="2025",
month="Jan",
day="9",
volume="27",
pages="e60689",
keywords="telemonitoring",
keywords="eHealth",
keywords="spirometry",
keywords="adherence",
keywords="pulmonary medicine",
keywords="home spirometers",
keywords="cystic fibrosis",
keywords="autosomal disease",
keywords="treatment",
keywords="remote monitoring",
keywords="survival analyses",
keywords="frequency",
keywords="digital health",
keywords="telehealth",
abstract="Background: Home spirometers have been widely implemented in the treatment of people with cystic fibrosis (CF). Frequent spirometry measurements at home could lead to earlier detection of exacerbations. However, previous research indicates that the long-term use of home spirometry is not well maintained by people with CF. Objective: We aimed to gain insight into the long-term uptake of home spirometry in regular multicenter CF care. Methods: Home spirometers combined with a remote monitoring platform were introduced in the treatment of people with CF in 5 Dutch CF centers starting in April 2020. Usage data from April 2020 to December 2022 were analyzed retrospectively. Survival analyses were conducted to assess use consistency over time, and t tests were used to evaluate the impact of increased pulmonary symptoms on home spirometry frequency. The effect of the initiation of a new treatment, Elexacaftor/Tezacaftor/Ivacaftor, on use frequency over time was assessed in a subgroup of participants with repeated measures ANOVA. Results: During the observation period, a total of 604 people with CF were enrolled in the remote monitoring platform and 9930 home spirometry measurements were performed. After the initiation of home spirometry use, the number of users declined rapidly. One year after the initiation, 232 (54.2\%) people with CF stopped using home spirometry. During the observation period, 67 (11.1\%) users performed more than 20 measurements. Furthermore, the number of consistent home spirometry users decreased over time. After 600 days, only 1\% of users had measured their lung function consistently every 31 days. Use frequency slightly increased during periods with increased pulmonary symptoms ($\Delta$Mean=0.45, t497.278=--4,197; P<.001) and showed an initial rise followed by a decrease after starting treatment with Elexacaftor/Tezacaftor/Ivacaftor ($\Delta$Mean=0.45, t497.278=--4,197; P<.001). Conclusions: Consistent uptake of home spirometry in people with CF is low but increases around periods of changing symptoms. A clear strategy for the organization of remote care seemed to improve the long-term uptake of home spirometry. Nevertheless, home spirometry and its intensity are not a goal on their own but should be used as a tool to reach individual goals within local contexts. ",
doi="10.2196/60689",
url="https://www.jmir.org/2025/1/e60689"
}


@Article{info:doi/10.2196/63946,
author="Nakamura, Kanako
and Hamada, Yuko
and Fujita, Ayaka
and Morokuma, Seiichi",
title="Factors That Affect the Quality of Life of Mothers Caring for Children With Medical Needs at Home: Cross-Sectional Questionnaire Study",
journal="Asian Pac Isl Nurs J",
year="2024",
month="Dec",
day="18",
volume="8",
pages="e63946",
keywords="home care",
keywords="children with special health care needs",
keywords="children with medical complexity",
keywords="mother",
keywords="quality of life",
keywords="caregiver",
keywords="questionnaire",
abstract="Background: The number of children requiring daily medical care is on the rise, with many being cared for at home. This situation places a significant burden on mothers, who often serve as the primary caregivers. Objective: This study aimed to clarify the factors that affect the quality of life of mothers with children who require home health care. Methods: A questionnaire study was conducted among mothers of children needing medical care at home, with 46 participants responding. The questionnaire included items regarding the child's condition, the mother's situation, and the World Health Organization Quality of Life-26scale. Results: Factors influencing the quality of life of mothers included whether the child attended daycare or school ($\beta$=.274; P=.04), the duration of home care ($\beta$=.305; P=.02), and the presence or absence of position changes ($\beta$=--.410; P=.003). The presence or absence of position changes had the most significant impact (adjusted R2=.327). Conclusions: The most significant factor affecting the quality of life of mothers of children requiring home medical care is the presence or absence of positional changes. ",
doi="10.2196/63946",
url="https://apinj.jmir.org/2024/1/e63946"
}


@Article{info:doi/10.2196/63041,
author="Grewal, S. Karl
and Gowda-Sookochoff, Rory
and Peacock, Shelley
and Cammer, Allison
and McWilliams, A. Lachlan
and Spiteri, J. Raymond
and Haase, R. Kristen
and Harrison, Mary
and Holtslander, Lorraine
and MacRae, Rhoda
and Michael, Joanne
and Green, Shoshana
and O'Connell, E. Megan",
title="Perspectives on Technology Use in the Context of Caregiving for Persons With Dementia: Qualitative Interview Study",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="13",
volume="8",
pages="e63041",
keywords="care partner",
keywords="caregiving",
keywords="dementia",
keywords="technology",
keywords="content analysis",
keywords="mobile phone",
keywords="technology adoption",
keywords="assistive technology",
keywords="support",
abstract="Background: Examining ways to support persons with dementia and their caregivers to help minimize the disease's impact on individuals, families, and society is critical. One emerging avenue for support is technology (eg, smartphones and smart homes). Objective: Given the increasing presence of technology in caregiving, it is pertinent to appreciate whether and how technology can be most useful to a care partner's everyday life. This study aims to further understand care partner technology use, attitudes, and the potential role of off-the-shelf technologies (eg, smartphones and smart homes) in supporting caregiving from the perspective of care partners for persons with dementia. Methods: We conducted a telephone cross-sectional survey using random digit dialing with 67 self-identified care partners of persons with dementia across one Canadian province. Participants were asked about attitudes toward technology, barriers to and facilitators for technology use, technology use with caregiving, and demographic information. Eight open-ended questions were analyzed using content analysis; 2 closed-ended questions about comfort with and helpfulness of technology (rated on a scale of 1 to 10) were analyzed with frequencies. From these data, an in-depth semistructured interview was created, and 10 (15\%) randomly sampled care partners from the initial collection of 67 care partners were interviewed approximately 1 year later, with responses analyzed using content analysis. Results: Frequency analysis rated on a scale of 1 to 10 suggested that care partners were comfortable with technology (wearable technology mean 7.94, SD 2.02; smart home technology mean 6.94, SD 2.09), although they rated the helpfulness of technology less strongly (mean 5.02, SD 2.85). Qualitatively, care partners described using technology for functional tasks and some caregiving. Barriers to technology use included cost, lack of knowledge, security or privacy concerns, and undesirable features of technology. Facilitators included access to support and the presence of desirable features. Some care partners described merging technology with caregiving and reported subsequent benefits. Others stated that technology could not be adopted for caregiving due to the degree of impairment, fear of negative consequences for the person living with dementia, or due to incongruity with the caregiving philosophy. Furthermore, care partners noted that their technology use either increased or was unchanged as they moved through the COVID-19 pandemic. Conclusions: The 2 analyses were conducted separately, but there was notable overlap in the data, suggesting temporal stability of identified content. Both analyses suggested care partners' relative comfort with technology and its use, but other care partners noted concerns about integrating technology and caregiving. Care partners' reports of increased technology use throughout the COVID-19 pandemic may also suggest that the pandemic impacted their perceptions of the usefulness of technology, being influenced by the requirements of their reality. Future investigations should examine how to support care partners in adopting relevant technology. ",
doi="10.2196/63041",
url="https://formative.jmir.org/2024/1/e63041"
}


@Article{info:doi/10.2196/56091,
author="Takashi, Naoki
and Fujisawa, Misaki
and Ohtera, Shosuke",
title="Associations Between Successful Home Discharge and Posthospitalization Care Planning: Cross-Sectional Ecological Study",
journal="JMIR Form Res",
year="2024",
month="Dec",
day="12",
volume="8",
pages="e56091",
keywords="health services research",
keywords="health policy",
keywords="quality of care",
keywords="access to care",
keywords="outcome assessment",
keywords="public health",
keywords="health service",
keywords="accessible",
keywords="accessibility",
keywords="care coordination",
keywords="health outcome",
keywords="surveillance",
keywords="regional disparities",
keywords="nonstandardized care",
keywords="nonstandardization",
keywords="hospital discharge",
keywords="hospital care",
keywords="analysis",
keywords="Japan",
keywords="older adults",
abstract="Background: Effective discharge planning is crucial for successful care transitions, reducing hospital length of stay and readmission rates. Japan offers a financial incentive to enhance the coordination of posthospitalization care planning for patients with complex needs. However, the national impact of this incentive remains unclear. Objective: This study aimed to (1) assess the association between the number of claims submitted for discharge planning, as an indicator of the provision of posthospitalization care planning, and key health care outcomes, including discharges to home, 30-day readmissions, length of stay, and medical expenditures at the prefectural level in Japan, and (2) to describe regional differences in the provision of posthospitalization care planning and explore associated factors. Methods: This ecological study used prefectural-level data from fiscal year 2020. Claims submitted for discharge planning were used as indicators that posthospitalization care planning was provided. Supply-adjusted standardized claim ratios (SCRs) were calculated using data from the Seventh National Database of Health Insurance Claims, to evaluate and compare the number of claims across 47 prefectures in Japan, accounting for differences in population structure. Key outcomes included discharges to home, 30-day readmissions, length of stay, and medical expenditures. Multivariate negative binomial regression models assessed associations between SCRs and outcomes, adjusting for socioeconomic covariates. In addition, regional differences in the provision of posthospitalization care planning and associated factors were analyzed using the Mann-Whitney U test. Prefectures were divided into 3 groups (low, medium, and high) based on tertiles of each factor, and supply-adjusted SCRs were compared across these groups. Results: The ratio of the minimum to maximum supply-adjusted SCR was 10.63, highlighting significant regional variation. Higher supply-adjusted SCRs, indicating more frequent provision of posthospitalization care planning, were associated with an increase of 9.68 (95\% CI 0.98-18.47) discharges to home per 1000 patients for each SD increase in supply-adjusted SCR. Several factors contributed to regional differences in the supply-adjusted SCR for posthospitalization care planning. A higher supply-adjusted SCR was significantly associated with a greater number of nurses per 100 hospital beds (median SCR in low, medium, and high groups: 0.055, 0.101, and 0.103, respectively); greater number of care manager offices per 100 km2 of habitable area (0.088, 0.082, and 0.116); higher proportion of hospitals providing electronic medical information to patients (0.083, 0.095, and 0.11); lower proportion of older adults living alone (0.116; 0.092; 0.071); and higher average per capita income (0.078, 0.102, and 0.102). Conclusions: The provision of posthospitalization care planning is associated with an increased likelihood of discharge to home, underscoring its importance in care transitions. However, significant regional disparities in care coordination exist. Addressing these disparities is crucial for equitable health care outcomes. Further research is needed to clarify causal mechanisms. ",
doi="10.2196/56091",
url="https://formative.jmir.org/2024/1/e56091"
}


@Article{info:doi/10.2196/64367,
author="Dermody, Gordana
and Wadsworth, Daniel
and Dunham, Melissa
and Glass, Courtney
and Fritz, Roschelle",
title="Factors Affecting Clinician Readiness to Adopt Smart Home Technology for Remote Health Monitoring: Systematic Review",
journal="JMIR Aging",
year="2024",
month="Dec",
day="5",
volume="7",
pages="e64367",
keywords="clinician",
keywords="provider",
keywords="health professional",
keywords="smart home",
keywords="remote monitoring",
keywords="technology",
keywords="readiness",
keywords="adoption",
keywords="preparedness",
abstract="Background: The population of older adults worldwide continues to increase, placing higher demands on primary health care and long-term care. The costs of housing older people in care facilities have economic and societal impacts that are unsustainable without innovative solutions. Many older people wish to remain independent in their homes and age in place. Assistive technology such as health-assistive smart homes with clinician monitoring could be a widely adopted alternative to aged-care facilities in the future. While studies have found that older persons have demonstrated a readiness to adopt health-assistive smart homes, little is known about clinician readiness to adopt this technology to support older adults to age as independently as possible. Objective: The purpose of this systematic review was to identify the factors that affect clinician readiness to adopt smart home technology for remote health monitoring. Methods: This review was conducted in accordance with the Joanna Briggs Institute methodology for systematic Reviews and followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting. Results: Several factors affected clinicians' perspectives on their readiness to adopt smart home technology for remote health monitoring, including challenges such as patient privacy and dignity, data security, and ethical use of ``invasive'' technologies. Perceived benefits included enhancing the quality of care and outcomes. Conclusions: Clinicians, including nurses, reported both challenges and benefits of adopting smart home technology for remote health monitoring. Clear strategies and frameworks to allay fears and overcome professional concerns and misconceptions form key parts of the Readiness for Adoption Pathway proposed. The use of more rigorous scientific methods and reporting is needed to advance the state of the science. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020195989; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=195989 ",
doi="10.2196/64367",
url="https://aging.jmir.org/2024/1/e64367",
url="http://www.ncbi.nlm.nih.gov/pubmed/39012852"
}


@Article{info:doi/10.2196/57320,
author="Chan, Andrew
and Cai, Joanne
and Qian, Linna
and Coutts, Brendan
and Phan, Steven
and Gregson, Geoff
and Lipsett, Michael
and R{\'i}os Rinc{\'o}n, M. Adriana",
title="In-Home Positioning for Remote Home Health Monitoring in Older Adults: Systematic Review",
journal="JMIR Aging",
year="2024",
month="Dec",
day="2",
volume="7",
pages="e57320",
keywords="gerontology",
keywords="geriatrics",
keywords="older adult",
keywords="elderly",
keywords="aging",
keywords="aging-in-place",
keywords="localization",
keywords="ambient sensor",
keywords="wearable sensor",
keywords="acceptability",
keywords="home monitor",
keywords="health monitor",
keywords="technology",
keywords="digital health",
keywords="e-health",
keywords="telehealth",
keywords="clinical studies",
keywords="cognitive impairment",
keywords="neuro",
keywords="cognition",
abstract="Background: With the growing proportion of Canadians aged >65 years, smart home and health monitoring technologies may help older adults manage chronic disease and support aging in place. Localization technologies have been used to support the management of frailty and dementia by detecting activities in the home. Objective: This systematic review aims to summarize the clinical evidence for in-home localization technologies, review the acceptability of monitoring, and summarize the range of technologies being used for in-home localization. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology was followed. MEDLINE, Embase, CINAHL, and Scopus were searched with 2 reviewers performing screening, extractions, and quality assessments. Results: A total of 1935 articles were found, with 36 technology-focused articles and 10 articles that reported on patient outcomes being included. From moderate- to high-quality studies, 2 studies reported mixed results on identifying mild cognitive dementia or frailty, while 4 studies reported mixed results on the acceptability of localization technology. Technologies included ambient sensors; Bluetooth- or Wi-Fi--received signal strength; localizer tags using radio frequency identification, ultra-wideband, Zigbee, or GPS; and inertial measurement units with localizer tags. Conclusions: The clinical utility of localization remains mixed, with in-home sensors not being able to differentiate between older adults with healthy cognition and older adults with mild cognitive impairment. However, frailty was detectable using in-home sensors. Acceptability is moderately positive, particularly with ambient sensors. Localization technologies can achieve room detection accuracies up to 92\% and linear accuracies of up to 5-20 cm that may be promising for future clinical applications. Trial Registration: PROSPERO CRD42022339845; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=339845 ",
doi="10.2196/57320",
url="https://aging.jmir.org/2024/1/e57320"
}


@Article{info:doi/10.2196/58613,
author="Al-Hamad, Areej
and Yasin, Mohammad Yasin
and Metersky, Kateryna
and Guruge, Sepali
and Jung, Grace
and Mahsud, Khadija",
title="Homestay Hosting Dynamics and Refugee Well-Being: Scoping Review",
journal="Interact J Med Res",
year="2024",
month="Nov",
day="25",
volume="13",
pages="e58613",
keywords="homestay",
keywords="host-guest relationship",
keywords="hospitality",
keywords="hosting",
keywords="well-being",
keywords="homestay accommodation",
keywords="host-refugee relation",
keywords="refugee",
keywords="scoping review",
keywords="review",
abstract="Background: Homestay accommodations aim to support a smoother transition for refugees; yet, the intricate nature of relationships between refugees and their hosting families can make this process complex, which, in turn, can affect their health and well-being. It is crucial to grasp the experiences of both refugees and their host families in order to foster effective settlement, integration, and well-being. Objective: The purpose of this scoping review is to explore the dynamics of homestay or hosting with a focus on understanding the experiences of both refugees and their hosting families to identify gaps in the literature and propose directions for future research. Methods: We used the Joanna Briggs Institute methodology and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist to guide this scoping review. Searches were conducted in MEDLINE via EBSCO, Scopus via OVID, CINAHL, SOCIndex, Web of Science Core Collection, ProQuest Dissertations and Theses, the SciELO Citation Index, and APA PsycInfo. Literature written in English and published from 2011 to 2024 that focused on homestay hosting contexts for refugees was included. Results: The results of this review illuminate the multifaceted and dynamic nature of homestay hosting for refugees. The findings include motivations and barriers for homestay hosting, factors influencing host-refugee relations, and psychological and social outcomes of homestay hosting. Conclusions: The results of this scoping review demonstrated the need for tailored support for refugees to improve homestay programs for the benefit of both refugees and host families and highlighted the need of more inclusive, supportive, and effective strategies for the hosting, resettlement, and integration of refugees. International Registered Report Identifier (IRRID): RR2-10.2196/56242 ",
doi="10.2196/58613",
url="https://www.i-jmr.org/2024/1/e58613"
}


@Article{info:doi/10.2196/59285,
author="Bavngaard, Vinther Martin
and Lund, Anne
and Thordardottir, Bj{\"o}rg
and Rasmussen, B{\o}rve Erik",
title="The Uses and Experiences of Synchronous Communication Technology for Home-Dwelling Older Adults in a Home Care Services Context: Qualitative Systematic Review",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="22",
volume="26",
pages="e59285",
keywords="systematic review",
keywords="qualitative",
keywords="thematic synthesis",
keywords="communication technology",
keywords="relatives",
keywords="home care services",
keywords="aging in place",
keywords="home-dwelling",
keywords="older adult",
keywords="aging",
keywords="gerontology",
keywords="European",
keywords="effectiveness",
keywords="information",
keywords="technology",
keywords="health care provider",
keywords="cross-disciplinary",
keywords="telehealth",
keywords="telemonitoring",
abstract="Background: European health care systems regard information and communication technology as a necessity in supporting future health care provision by community home care services to home-dwelling older adults. Communication technology enabling synchronous communication between 2 or more human actors at a distance constitutes a significant component of this ambition, but few reviews have synthesized research relating to this particular type of technology. As evaluations of information and communication technology in health care services favor measurements of effectiveness over the experiences and dynamics of putting these technologies into use, the nuances involved in technology implementation processes are often omitted. Objective: This review aims to systematically identify and synthesize qualitative findings on the uses and experiences of synchronous communication technology for home-dwelling older adults in a home care services context. Methods: The review follows the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 checklist for reporting. We conducted a cross-disciplinary search in 5 databases for papers published between 2011 and 2023 that yielded 4210 citations. A total of 13 studies were included after 4 screening phases and a subsequent appraisal of methodological quality guided by the Critical Appraisal Skills Programme tool. From these, prespecified data were extracted and incorporated in a 3-stage thematic synthesis producing 4 analytical themes. Results: The first theme presented the multiple trajectories that older users' technology acceptance could take, namely straightforward, gradual, partial, and resistance laden, notwithstanding outright rejection. It also emphasized both instrumental and emotional efforts by the older adults' relatives in facilitating acceptance. Moving beyond acceptance, the second theme foregrounded the different types of work involved in attempts to integrate the technology by older users, their relatives, and health care providers. Theme 3 highlighted how the older users' physical and cognitive conditions formed a contextual backdrop challenging this integration work, together with challenges related to spatial context. Finally, consequences derived from taking the technology into use could be of a both enabling and complicating nature as integration reconfigured the way users related to themselves and each other. Conclusions: The acceptance and integration of synchronous communication technology for older adults involves multiple user groups in work tending to the technology, to the users themselves, and to each other through intergroup negotiations. This review's original contribution consists of its attention to the dynamics across different user groups in deriving consequences from using the technology in question, in addition to its assertion that such consequences may be both intentional and unintentional. We argue that our findings may be used to provide nuance to policies addressing---and practices taking place in---contexts that involve similar user technology constellations to the ones explored in this paper. Trial Registration: PROSPERO CRD42023414243; https://tinyurl.com/wrha6j3f ",
doi="10.2196/59285",
url="https://www.jmir.org/2024/1/e59285"
}


@Article{info:doi/10.2196/64575,
author="Brooks Carthon, Margo J.
and Brom, Heather
and Amenyedor, Eyram Kelvin
and Harhay, O. Michael
and Grantham-Murillo, Marsha
and Nikpour, Jacqueline
and Lasater, B. Karen
and Golinelli, Daniela
and Cacchione, Z. Pamela
and Bettencourt, P. Amanda",
title="Transitional Care Support for Medicaid-Insured Patients With Serious Mental Illness: Protocol for a Type I Hybrid Effectiveness-Implementation Stepped-Wedge Cluster Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="12",
volume="13",
pages="e64575",
keywords="serious mental illness",
keywords="health care disparities",
keywords="Medicaid",
keywords="evidence-based practice",
keywords="implementation science",
keywords="socioeconomic disparities in health",
abstract="Background: People diagnosed with a co-occurring serious mental illness (SMI; ie, major depressive disorder, bipolar disorder, or schizophrenia) but hospitalized for a nonpsychiatric condition experience higher rates of readmissions and other adverse outcomes, in part due to poorly coordinated care transitions. Current hospital-to-home transitional care programs lack a focus on the integrated social, medical, and mental health needs of these patients. The Thrive clinical pathway provides transitional care support for patients insured by Medicaid with multiple chronic conditions by focusing on posthospitalization medical concerns and the social determinants of health. This study seeks to evaluate an adapted version of Thrive that also meets the needs of patients with co-occurring SMI discharged from a nonpsychiatric hospitalization. Objective: This study aimed to (1) engage staff and community advisors in participatory implementation processes to adapt the Thrive clinical pathway for all Medicaid-insured patients, including those with SMI; (2) examine utilization outcomes (ie, Thrive referral, readmission, emergency department [ED], primary, and specialty care visits) for Medicaid-insured individuals with and without SMI who receive Thrive compared with usual care; and (3) evaluate the acceptability, appropriateness, feasibility, and cost-benefit of an adapted Thrive clinical pathway that is tailored for Medicaid-insured patients with co-occurring SMI. Methods: This study will use a prospective, type I hybrid effectiveness-implementation, stepped-wedge, cluster randomized controlled trial design. We will randomize the initiation of Thrive referrals at the unit level. Data collection will occur over 24 months. Inclusion criteria for Thrive referral include individuals who (1) are Medicaid insured, dually enrolled in Medicaid and Medicare, or Medicaid eligible; (2) reside in Philadelphia; (3) are admitted for a medical diagnosis for over 24 hours at the study hospital; (4) are planned for discharge to home; (5) agree to receive home care services; and (6) are aged ?18 years. Primary analyses will use a mixed-effects negative binomial regression model to evaluate readmission and ED utilization, comparing those with and without SMI who receive Thrive to those with and without SMI who receive usual care. Using a convergent parallel mixed methods design, analyses will be conducted simultaneously for the survey and interview data of patients, clinicians, and health care system leaders. The cost of Thrive will be calculated from budget monitoring data for the research budget, the cost of staff time, and average Medicaid facility fee payments. Results: This research project was funded in October 2023. Data collection will occur from April 2024 through December 2025. Results are anticipated to be published in 2025-2027. Conclusions: We anticipate that patients with and without co-occurring SMI will benefit from the adapted Thrive clinical pathway. We also anticipate the adapted version of Thrive to be deemed feasible, acceptable, and appropriate by patients, clinicians, and health system leaders. Trial Registration: ClinicalTrials.gov NCT06203509; https://clinicaltrials.gov/ct2/show/NCT06203509 International Registered Report Identifier (IRRID): DERR1-10.2196/64575 ",
doi="10.2196/64575",
url="https://www.researchprotocols.org/2024/1/e64575"
}


@Article{info:doi/10.2196/57036,
author="Desai, Chaitali
and Dove, Erica
and Nanthakumar, Jarshini
and Main, Emilia
and Colquhoun, Heather
and Astell, Arlene
and Mihailidis, Alex
and Layton, Natasha
and Burhan, M. Amer
and Chan, Brian
and Wang, H. Rosalie",
title="Assistive Technology to Support Dementia Management: Protocol for a Scoping Review of Reviews",
journal="JMIR Res Protoc",
year="2024",
month="Nov",
day="11",
volume="13",
pages="e57036",
keywords="assistive technology",
keywords="assistive products",
keywords="dementia",
keywords="care partners",
keywords="caregivers",
keywords="elderly",
abstract="Background: In Canada, more than 60\% of persons living with dementia reside in their own homes, and over 25\% rely heavily on their care partners (ie, family members or friends) for assistance with daily activities such as personal hygiene, eating, and walking. Assistive technology (AT) is a key dementia management strategy, helping to maintain health and social support in home and community settings. AT comprises assistive products and services required for safe and effective use. Persons living with dementia and their care partners often require multiple types of AT to maintain their needs, dignity, and autonomy. AT for dementia management is rapidly developing with abundant scientific literature, which can present a challenge to efficiently navigate and extract insights?for policy and personal decision-making. Objective: This scoping review aims to synthesize review-level evidence from published scientific literature on AT to support dementia management for persons living with dementia and their care partners in their homes and communities. Research gaps in knowledge and areas for further investigation into the use and access of AT will be identified. This review will provide an overview of AT types and characteristics and chart the outcomes and conclusions in review-level evidence. Methods: This review will follow the Joanna Briggs Institute's framework for conducting scoping reviews and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. In total, 6 electronic databases will be searched. Articles will be screened according to the ``Population-Concept-Context (PCC)'' framework for eligible studies. Population includes persons living with dementia, their care partners, and health care professionals (eg, therapists or others who recommend AT). Concept includes AT and self-help devices of many types. Context includes homes and communities. A data charting template will guide data extraction, charting, and summarization. A descriptive numerical summary and an overview of the findings will be presented. Data, such as (1) article information (eg, author and year), (2) article characteristics (eg, review type), (3) AT types and characteristics, (4) setting and population characteristics, and (5) key review outcomes and conclusions, will be extracted. Results: A total of 10,978 unique citations were identified across the 6 electronic databases. This review is in the full-text screening stage, which is expected to be completed by October 2024. Conclusions: This review will provide a comprehensive understanding and documentation of the published scientific literature on AT to support dementia management. Findings from this review are expected to provide evidence-based insights on the complexities of AT types, uses, availability, and access. The author group's diverse national and international perspectives may contribute to knowledge exchange and influence standards to improve the daily function, safety, and well-being of persons living with dementia. Trial Registration: Open Science Framework DKSM9; https://osf.io/dksm9 International Registered Report Identifier (IRRID): PRR1-10.2196/57036 ",
doi="10.2196/57036",
url="https://www.researchprotocols.org/2024/1/e57036"
}


@Article{info:doi/10.2196/56552,
author="Xu, Dandan
and Xu, Dongmei
and Wei, Lan
and Bao, Zhipeng
and Liao, Shengen
and Zhang, Xinyue",
title="The Effectiveness of Remote Exercise Rehabilitation Based on the ``SCeiP'' Model in Homebound Patients With Coronary Heart Disease: Randomized Controlled Trial",
journal="J Med Internet Res",
year="2024",
month="Nov",
day="5",
volume="26",
pages="e56552",
keywords="coronary heart disease",
keywords="exercise rehabilitation",
keywords="promotion strategy",
keywords="home rehabilitation",
abstract="Background: While exercise rehabilitation is recognized as safe and effective, medium- to long-term compliance among patients with coronary heart disease (CHD) remains low. Therefore, promoting long-term adherence to exercise rehabilitation for these patients warrants significant attention. Objective: This study aims to investigate the impact of remote exercise rehabilitation on time investment and related cognitive levels in homebound patients with CHD. This study utilizes the SCeiP (Self-Evaluation/Condition of Exercise-Effect Perception-Internal Drive-Persistence Behavior) model, alongside WeChat and exercise bracelets. Methods: A total of 147 patients who underwent percutaneous coronary intervention in the cardiovascular department of a grade III hospital in Jiangsu Province from June 2022 to March 2023 were selected as study participants through convenience sampling. The patients were randomly divided into an experimental group and a control group. The experimental group received an exercise rehabilitation promotion strategy based on the ``SCeiP'' model through WeChat and exercise bracelets, while the control group followed rehabilitation training according to a standard exercise rehabilitation guide. The days and duration of exercise, levels of cardiac rehabilitation cognition, exercise planning, and exercise input were analyzed before the intervention and at 1 month and 3 months after the intervention. Results: A total of 81 men (55.1\%) and 66 women (44.9\%) were recruited for the study. The completion rate of exercise days was significantly higher in the experimental group compared with the control group at both 1 month (t145=5.429, P<.001) and 3 months (t145=9.113, P<.001) after the intervention. Similarly, the completion rate of exercise duration was significantly greater in the experimental group (t145=3.471, P=.001) than in the control group (t145=5.574, P<.001). The levels of autonomy, exercise planning, and exercise input in the experimental group were significantly higher than those in the control group at both 1 month and 3 months after the intervention (P<.001). Additionally, the experimental group exhibited a significant reduction in both process anxiety and outcome anxiety scores (P<.001). Repeated measures ANOVA revealed significant differences in the trends of cognitive function related to cardiac rehabilitation between the 2 patient groups over time: autonomy, F1,145(time{\texttimes}group)=9.055 (P<.001); process anxiety, F1,145(time{\texttimes}group)=30.790 (P<.001); and outcome anxiety, F1,145(time{\texttimes}group)=28.186 (P<.001). As expected, the scores for exercise planning (t145=2.490, P=.01 and t145=3.379, P<.001, respectively) and exercise input (t145=2.255, P=.03 and t145=3.817, P<.001, respectively) consistently demonstrated superiority in the experimental group compared with the control group at both 1 and 3 months after the intervention. Interestingly, we observed that the levels of exercise planning and exercise input in both groups initially increased and then slightly decreased over time, although both remained higher than the preintervention levels (P<.001). Conclusions: The remote health intervention based on the ``SCeiP'' model effectively enhances exercise compliance, exercise planning, exercise input, and cognitive levels during cardiac rehabilitation in patients with CHD. Trial Registration: Chinese Clinical Trial Registry ChiCTR2300069463; https://www.chictr.org.cn/showproj.html?proj=192461 ",
doi="10.2196/56552",
url="https://www.jmir.org/2024/1/e56552"
}


@Article{info:doi/10.2196/58048,
author="Lin, Yu-Chih
and Wu, Chen-Ching
and Sung, Wan-Yu
and Yen, Jeng-Hsien
and Lin, Yi-Ching",
title="Home Transcutaneous Electrical Stimulation Rehabilitation Program for Patients With Ankylosing Spondylitis: Crossover Trial",
journal="JMIR Form Res",
year="2024",
month="Oct",
day="28",
volume="8",
pages="e58048",
keywords="ankylosing spondylitis",
keywords="galvanic response",
keywords="home medical device",
keywords="rehabilitation",
keywords="transcutaneous electrical stimulation",
abstract="Background: Maintaining physical function and preserving spinal flexibility have been challenging in managing ankylosing spondylitis (AS). Most rehabilitation programs, including manual therapy, massage, hydrotherapy, and acupuncture, cannot be performed at home. The effect of transcutaneous electrical nerve stimulation (TENS) was validated in treating AS, but no home TENS system has explored its efficacy to date. Objective: This study aims to evaluate the efficacy of a home TENS system with a novel treatment program for patients with AS. Methods: The modified WeHeal TS-200 TENS and galvanic response system provided home-based TENS treatment for patients with AS. Patients were divided into a 2-month course group and a 1-month course group. After the first treatment course, patients went through a washout period for the same duration of their treatment course. Participants could decide whether to accept the second course of treatment. The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Schober test, finger-to-floor flexion test, enthesis score, cytokines, chemokines, inflammatory factors, and immunoglobulins were measured to evaluate its efficacy. The clinical trial protocol (1096607481) received approval from the Ministry of Health and Welfare in Taiwan. Results: A total of 9 patients (5 in a 2-month course group and 4 in a 1-month course group) completed the first treatment course, and 5 patients (4 in a 2-month course group and 1 in a 1-month course group) completed the sequential treatment course. The weighted results showed that patients reported an improving BASFI score (mean difference --0.9, SD 1.7; P=.03) after treatment. Looking into the trajectories, declined BASFI and BASDAI scores were noticed during treatments; this score increased during the washout period. There were improving trends in the Schober test (mean difference 1.9, SD 4.9; P=.11) and finger-to-floor flexion test (mean difference --0.6, SD 9.5; P=.79), but the results were not statistically significant. The response of cytokines, chemokines, inflammatory factors, and immunoglobulins before and after treatment did not show a consistent trend, and all results were not statistically significant (all P>.05). Conclusions: The home TENS device demonstrated a potential role in AS management. It may improve accessibility and adherence for patients with AS and provide remote monitoring for clinicians. Further research can compare the effectiveness of electrotherapy at home or in a medical setting and focus on integrating the home TENS system and exercise program to enhance patients' physical functions and spinal flexibility. ",
doi="10.2196/58048",
url="https://formative.jmir.org/2024/1/e58048"
}


@Article{info:doi/10.2196/59915,
author="Barr{\'i}a, Patricio
and Andrade, Asterio
and Gomez-Vargas, Daniel
and Yelincic, Alejandro
and Roberti, Flavio
and Bahamonde, Eduardo
and Aguilar, Rolando
and Cordova, Bessie",
title="Multidisciplinary Home-Based Rehabilitation Program for Individuals With Disabilities: Longitudinal Observational Study",
journal="JMIR Rehabil Assist Technol",
year="2024",
month="Oct",
day="16",
volume="11",
pages="e59915",
keywords="rehabilitation",
keywords="home-based therapy",
keywords="physical therapy",
keywords="psychological therapy",
keywords="home physiotherapy",
keywords="disabilities",
keywords="occupational therapy",
keywords="personalized care",
keywords="patient care",
keywords="motor disorder",
keywords="mood disorder",
keywords="motor function",
abstract="Background: Disability affects a significant portion of the global population nowadays, necessitating innovative approaches to access rehabilitation processes. Home-based rehabilitation has emerged as a beneficial approach, offering comfort and context-specific therapy. Objective: This study aims to evaluate the impact of a multidisciplinary home-based rehabilitation program for individuals with moderate neuromusculoskeletal disabilities in terms of motor function and mood. Methods: A total of 270 participants with median age of 66 (IQR 20-98) years were recruited from the National Disability Registry of Chile. The intervention involved a multidisciplinary team composed of 49 health care professionals providing personalized treatment plans over 4 months (32 sessions for physical therapy, 8 sessions for occupational therapy, 4 sessions for nutrition, 8 sessions for psychology, and 4 sessions for nursing and podiatry). This program also included 2 medical evaluations (at the beginning and the end) to monitor clinical progress in terms of motor function and mental health, using the Berg Balance Scale and Beck Depression Inventory, respectively. Results: The home-based rehabilitation program showed significant improvements (P<.001) in motor function and balance with a reduction in fall risk. Specifically, the Berg Balance Scale score decreased close to 15\% after the home-based rehabilitation program for all enrolled participants. On the other hand, depression levels showed no significant changes (P=.27), with percentages of variation less than 8\% between the 2 assessed conditions. In this sense, participants remained with the same mild depression level (14 of 63) concerning the Beck Depression Inventory score. Conclusions: This study concludes that personalized home-based rehabilitation programs are effective in enhancing motor function and balance, particularly in individuals with neurological conditions. On the other hand, the findings in terms of mood advocate for further exploration of psychological support within such programs to enhance overall patient well-being. Trial Registration: ClinicalTrials.gov NCT06537791; https://clinicaltrials.gov/study/NCT06537791 ",
doi="10.2196/59915",
url="https://rehab.jmir.org/2024/1/e59915",
url="http://www.ncbi.nlm.nih.gov/pubmed/39412860"
}


@Article{info:doi/10.2196/58888,
author="Wilkes, Matt
and Kramer, Annabel
and Pugmire, Juliana
and Pilkington, Christopher
and Zaniello, Benjamin
and Zahradka, Nicole",
title="Hospital Is Not the Home: Lessons From Implementing Remote Technology to Support Acute Inpatient and Transitional Care in the Home in the United States and United Kingdom",
journal="J Med Internet Res",
year="2024",
month="Oct",
day="11",
volume="26",
pages="e58888",
keywords="telemedicine",
keywords="implementation science",
keywords="hospital-to-home transition",
keywords="remote patient monitoring",
keywords="digital health",
keywords="transition of care",
keywords="accuracy",
keywords="acceptability",
doi="10.2196/58888",
url="https://www.jmir.org/2024/1/e58888",
url="http://www.ncbi.nlm.nih.gov/pubmed/39331537"
}


@Article{info:doi/10.2196/57703,
author="Musheghyan, Lusine
and Harutyunyan, M. Nika
and Sikder, Abu
and Reid, W. Mark
and Zhao, Daniel
and Lulejian, Armine
and Dickhoner, W. James
and Andonian, T. Nicole
and Aslanyan, Lusine
and Petrosyan, Varduhi
and Sargsyan, Zhanna
and Shekherdimian, Shant
and Dorian, Alina
and Espinoza, C. Juan",
title="Managing Patients With COVID-19 in Armenia Using a Remote Monitoring System: Descriptive Study",
journal="JMIR Public Health Surveill",
year="2024",
month="Sep",
day="30",
volume="10",
pages="e57703",
keywords="COVID-19",
keywords="remote patient monitoring",
keywords="Armenia",
keywords="web platform",
keywords="home oxygen therapy",
keywords="pandemic",
keywords="global health care",
keywords="low and middle-income countries",
keywords="health care infrastructure",
keywords="Yerevan",
keywords="home monitoring",
keywords="resource-constrained",
abstract="Background: The COVID-19 pandemic has imposed immense stress on global health care systems, especially in low- and middle-income countries (LMICs). Armenia, a middle-income country in the Caucasus region, contended with the pandemic and a concurrent war, resulting in significant demand on its already strained health care infrastructure. The COVID@home program was a multi-institution, international collaboration to address critical hospital bed shortages by implementing a home-based oxygen therapy and remote monitoring program. Objective: The objective of this study was to describe the program protocol and clinical outcomes of implementing an early discharge program in Armenia through a collaboration of partner institutions, which can inform the future implementation of COVID-19 remote home monitoring programs, particularly in LMICs or low-resource settings. Methods: Seven hospitals in Yerevan participated in the COVID@home program. A web app based on OpenMRS was developed to facilitate data capture and care coordination. Patients meeting eligibility criteria were enrolled during hospitalization and monitored daily while on oxygen at home. Program evaluation relied on data extraction from (1) eligibility and enrollment forms, (2) daily monitoring forms, and (3) discharge forms. Results: Over 11 months, 439 patients were screened, and 221 patients were managed and discharged. Around 94\% (n=208) of participants safely discontinued oxygen therapy at home, with a median home monitoring duration of 26 (IQR 15-45 days; mean 32.33, SD 25.29) days. Women (median 28.5, mean 35.25 days) had similar length of stay to men (median 26, mean 32.21 days; P=.75). Despite challenges in data collection and entry, the program demonstrated feasibility and safety, with a mortality rate below 1\% and low re-admission rate. Opportunities for operational and data quality improvements were identified. Conclusions: This study contributes practical evidence on the implementation and outcomes of a remote monitoring program in Armenia, offering insights into managing patients with COVID-19 in resource-constrained settings. The COVID@home program's success provides a model for remote patient care, potentially alleviating strain on health care resources in LMICs. Policymakers can draw from these findings to inform the development of adaptable health care solutions during public health crises, emphasizing the need for innovative approaches in resource-limited environments. ",
doi="10.2196/57703",
url="https://publichealth.jmir.org/2024/1/e57703",
url="http://www.ncbi.nlm.nih.gov/pubmed/39348686"
}


@Article{info:doi/10.2196/60896,
author="Hoben, Matthias
and Maxwell, J. Colleen
and Ubell, Andrea
and Doupe, B. Malcolm
and Goodarzi, Zahra
and Allana, Saleema
and Beleno, Ron
and Berta, Whitney
and Bethell, Jennifer
and Daly, Tamara
and Ginsburg, Liane
and Rahman, -. Atiqur SM
and Nguyen, Hung
and Tate, Kaitlyn
and McGrail, Kimberlyn",
title="EXploring Patterns of Use and Effects of Adult Day Programs to Improve Trajectories of Continuing Care (EXPEDITE): Protocol for a Retrospective Cohort Study",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="30",
volume="13",
pages="e60896",
keywords="adult day care centers",
keywords="aged",
keywords="program evaluation",
keywords="cohort studies",
keywords="routinely collected health data",
abstract="Background: Adult day programs provide critical supports to older adults and their family or friend caregivers. High-quality care in the community for as long as possible and minimizing facility-based continuing care are key priorities of older adults, their caregivers, and health care systems. While most older adults in need of care live in the community, about 10\% of newly admitted care home residents have relatively low care needs that could be met in the community with the right supports. However, research on the effects of day programs is inconsistent. The methodological quality of studies is poor, and we especially lack robust, longitudinal research. Objective: Our research objectives are to (1) compare patterns of day program use (including nonuse) by province (Alberta, British Columbia, and Manitoba) and time; (2) compare characteristics of older adults by day program use pattern (including nonuse), province, and time; and (3) assess effects of day programs on attendees, compared with a propensity score--matched cohort of older nonattendees in the community. Methods: In this population-based retrospective cohort study, we will use clinical and health administrative data of older adults (65+ years of age) who received publicly funded continuing care in the community in the Canadian provinces of Alberta, British Columbia, and Manitoba between January 1, 2012, and December 31, 2024. We will compare patterns of day program use between provinces and assess changes over time. We will then compare characteristics of older adults (eg, age, sex, physical or cognitive disability, area-based deprivation indices, and caregiver availability or distress) by pattern of day program use or nonuse, province, and time. Finally, we will create a propensity score--matched comparison group of older adults in the community, who have not attended a day program. Using time-to-event models and general estimating equations, we will assess whether day program attendees compared with nonattendees enter care homes later; use emergency, acute, or primary care less frequently; experience less cognitive and physical decline; and have better mental health. Results: This will be a 3-year study (July 1, 2024, to June 30, 2027). We received ethics approvals from the relevant ethics boards. Starting on July 1, 2024, we will work with the 3 provincial health systems on data access and linkage, and we expect data analyses to start in early 2025. Conclusions: This study will generate robust Canadian evidence on the question whether day programs have positive, negative, or no effects on various older adult and caregiver outcomes. This will be a prerequisite to improving the quality of care provided to older adults in day programs, ultimately improving the quality of life of older adults and their caregivers. Trial Registration: ClinicalTrials.gov NCT06440447; https://clinicaltrials.gov/study/NCT06440447 International Registered Report Identifier (IRRID): PRR1-10.2196/60896 ",
doi="10.2196/60896",
url="https://www.researchprotocols.org/2024/1/e60896"
}


@Article{info:doi/10.2196/58296,
author="Knudsen, Anne-Maj
and Dalg{\aa}rd Dunvald, Ann-Cathrine
and Hangaard, Stine
and Hejlesen, Ole
and Kronborg, Thomas",
title="The Effectiveness of Collaborative Care Interventions for the Management of Patients With Multimorbidity: Protocol for a Systematic Review, Meta-Analysis, and Meta-Regression Analysis",
journal="JMIR Res Protoc",
year="2024",
month="Aug",
day="8",
volume="13",
pages="e58296",
keywords="multimorbidity",
keywords="comorbidity",
keywords="multiple chronic conditions",
keywords="patient care team",
keywords="multidisciplinary teams",
keywords="collaborative care",
keywords="quality of life",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Collaborative care interventions have been proposed as a promising strategy to support patients with multimorbidity. Despite this, the effectiveness of collaborative care interventions requires further evaluation. Existing systematic reviews describing the effectiveness of collaborative care interventions in multimorbidity management tend to focus on specific interventions, patient subgroups, and settings. This necessitates a comprehensive review that will provide an overview of the effectiveness of collaborative care interventions for adult patients with multimorbidity. Objective: This systematic review aims to systematically assess the effectiveness of collaborative care interventions in comparison to usual care concerning health-related quality of life (HRQoL), mental health, and mortality among adult patients with multimorbidity. Methods: Randomized controlled trials evaluating collaborative care interventions designed for adult patients (18 years and older) with multimorbidity compared with usual care will be considered for inclusion in this review. HRQoL will be the primary outcome. Mortality and mental health outcomes such as rating scales for anxiety and depression will serve as secondary outcomes. The systematic search will be conducted in the CENTRAL, PubMed, CINAHL, and Embase databases. Additional reference and citation searches will be performed in Google Scholar, Web of Science, and Scopus. Data extraction will be comprehensive and include information about participant characteristics, study design, intervention details, and main outcomes. Included studies will be assessed for limitations according to the Cochrane Risk of Bias tool. Meta-analysis will be conducted to estimate the pooled effect size. Meta-regression or subgroup analysis will be undertaken to explore if certain factors can explain the variation in effect between studies, if feasible. The certainty of evidence will be evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Results: The preliminary literature search was performed on February 16, 2024, and yielded 5255 unique records. A follow-up search will be performed across all databases before submission. The findings will be presented in forest plots, a summary of findings table, and in narrative format. This systematic review is expected to be completed by late 2024. Conclusions: This review will provide an overview of pooled estimates of treatment effects across HRQoL, mental health, and mortality from randomized controlled trials evaluating collaborative care interventions for adults with multimorbidity. Furthermore, the intention is to clarify the participant, intervention, or study characteristics that may influence the effect of the interventions. This review is expected to provide valuable insights for researchers, clinicians, and other decision-makers about the effectiveness of collaborative care interventions targeting adult patients with multimorbidity. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42024512554; https://www.crd.york.ac.uk/PROSPERO/display\_record.php?RecordID=512554 International Registered Report Identifier (IRRID): DERR1-10.2196/58296 ",
doi="10.2196/58296",
url="https://www.researchprotocols.org/2024/1/e58296"
}


@Article{info:doi/10.2196/49403,
author="Wong, Ching Arkers Kwan
and Bayuo, Jonathan
and Su, Jing Jing
and Chow, Sum Karen Kit
and Wong, Man Siu
and Wong, Po Bonnie
and Lee, Lam Athena Yin
and Wong, Yuet Frances Kam",
title="Exploring the Experiences of Community-Dwelling Older Adults on Using Wearable Monitoring Devices With Regular Support From Community Health Workers, Nurses, and Social Workers: Qualitative Descriptive Study",
journal="J Med Internet Res",
year="2024",
month="Aug",
day="7",
volume="26",
pages="e49403",
keywords="community-dwelling older adults",
keywords="focus group",
keywords="wearable monitoring devices",
keywords="mobile phone",
abstract="Background: The use of wearable monitoring devices (WMDs), such as smartwatches, is advancing support and care for community-dwelling older adults across the globe. Despite existing evidence of the importance of WMDs in preventing problems and promoting health, significant concerns remain about the decline in use after a period of time, which warrant an understanding of how older adults experience the devices. Objective: This study aims to explore and describe the experiences of community-dwelling older adults after receiving our interventional program, which included the use of a smartwatch with support from a community health workers, nurses, and social workers, including the challenges that they experienced while using the device, the perceived benefits, and strategies to promote their sustained use of the device. Methods: We used a qualitative descriptive approach in this study. Older adults who had taken part in an interventional study involving the use of smartwatches and who were receiving regular health and social support were invited to participate in focus group discussions at the end of the trial. Purposive sampling was used to recruit potential participants. Older adults who agreed to participate were assigned to focus groups based on their community. The focus group discussions were facilitated and moderated by 2 members of the research team. All discussions were recorded and transcribed verbatim. We used the constant comparison analytical approach to analyze the focus group data. Results: A total of 22 participants assigned to 6 focus groups participated in the study. The experiences of community-dwelling older adults emerged as (1) challenges associated with the use of WMDs, (2) the perceived benefits of using the WMDs, and (3) strategies to promote the use of WMDs. In addition, the findings also demonstrate a hierarchical pattern of health-seeking behaviors by older adults: seeking assistance first from older adult volunteers, then from social workers, and finally from nurses. Conclusions: Ongoing use of the WMDs is potentially possible, but it is important to ensure the availability of technical support, maintain active professional follow-ups by nurses and social workers, and include older adult volunteers to support other older adults in such programs. ",
doi="10.2196/49403",
url="https://www.jmir.org/2024/1/e49403",
url="http://www.ncbi.nlm.nih.gov/pubmed/39110493"
}


@Article{info:doi/10.2196/57618,
author="Anderson, Euan
and Lennon, Marilyn
and Kavanagh, Kimberley
and Weir, Natalie
and Kernaghan, David
and Roper, Marc
and Dunlop, Emma
and Lapp, Linda",
title="Predictive Data Analytics in Telecare and Telehealth: Systematic Scoping Review",
journal="Online J Public Health Inform",
year="2024",
month="Aug",
day="7",
volume="16",
pages="e57618",
keywords="telecare",
keywords="telehealth",
keywords="telemedicine",
keywords="data analytics",
keywords="predictive models",
keywords="scoping review",
keywords="predictive",
keywords="predict",
keywords="prediction",
keywords="predictions",
keywords="synthesis",
keywords="review methods",
keywords="review methodology",
keywords="search",
keywords="searches",
keywords="searching",
keywords="scoping",
keywords="home",
abstract="Background: Telecare and telehealth are important care-at-home services used to support individuals to live more independently at home. Historically, these technologies have reactively responded to issues. However, there has been a recent drive to make better use of the data from these services to facilitate more proactive and predictive care. Objective: This review seeks to explore the ways in which predictive data analytics techniques have been applied in telecare and telehealth in at-home settings. Methods: The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist was adhered to alongside Arksey and O'Malley's methodological framework. English language papers published in MEDLINE, Embase, and Social Science Premium Collection between 2012 and 2022 were considered and results were screened against inclusion or exclusion criteria. Results: In total, 86 papers were included in this review. The types of analytics featuring in this review can be categorized as anomaly detection (n=21), diagnosis (n=32), prediction (n=22), and activity recognition (n=11). The most common health conditions represented were Parkinson disease (n=12) and cardiovascular conditions (n=11). The main findings include: a lack of use of routinely collected data; a dominance of diagnostic tools; and barriers and opportunities that exist, such as including patient-reported outcomes, for future predictive analytics in telecare and telehealth. Conclusions: All papers in this review were small-scale pilots and, as such, future research should seek to apply these predictive techniques into larger trials. Additionally, further integration of routinely collected care data and patient-reported outcomes into predictive models in telecare and telehealth offer significant opportunities to improve the analytics being performed and should be explored further. Data sets used must be of suitable size and diversity, ensuring that models are generalizable to a wider population and can be appropriately trained, validated, and tested. ",
doi="10.2196/57618",
url="https://ojphi.jmir.org/2024/1/e57618",
url="http://www.ncbi.nlm.nih.gov/pubmed/39110501"
}


@Article{info:doi/10.2196/58440,
author="Garcia-Calvente, Mar Mar{\'i}a del
and Mora, Juanita Diana
and Del R{\'i}o-Lozano, Mar{\'i}a",
title="Gender Inequalities of Health and Quality of Life in Informal Caregivers in Spain: Protocol for the Longitudinal and Multicenter CUIDAR-SE Study",
journal="JMIR Res Protoc",
year="2024",
month="Jul",
day="2",
volume="13",
pages="e58440",
keywords="caregivers",
keywords="gender equity",
keywords="sex differences",
keywords="health status",
keywords="quality of life",
keywords="longitudinal studies",
keywords="multicenter studies",
abstract="Background: The aging population and increased disability prevalence in Spain have heightened the demand for long-term care. Informal caregiving, primarily performed by women, plays a crucial role in this scenario. This protocol outlines the CUIDAR-SE study, focusing on the gender-specific impact of informal caregiving on health and quality of life among caregivers in Andalusia and the Basque Country from 2013 to 2024. Objective: This study aims to analyze the gender differences in health and quality of life indicators of informal caregivers residing in 2 Spanish autonomous communities (Granada, Andalusia, and Gipuzkoa; Basque Country) and their evolution over time, in relation to the characteristics of caregivers, the caregiving situation, and support received. Methods: The CUIDAR-SE study uses a longitudinal, multicenter design across 3 phases, tracking health and quality of life indicators among informal caregivers. Using a questionnaire adapted to the Spanish context that uses validated scales and multilevel analysis, the research captures changes in caregivers' experiences amid societal crises, notably the 2008 economic crisis and the COVID-19 pandemic. A multistage randomized cluster sampling technique is used to minimize study design effects. Results: Funding for the CUIDAR-SE study was in 3 phases starting in January 2013, 2017, and 2021, spanning a 10-year period. Data collection commenced in 2013 and continued annually, except for 2016 and 2020 due to financial and pandemic-related challenges. As of March 2024, a total of 1294 participants have been enrolled, with data collection ongoing for 2023. Initial data analysis focused on gender disparities in caregiver health, quality of life, burden, perceived needs, and received support, with results from phase I published. Currently, analysis is ongoing for phases II and III, as well as longitudinal analysis across all phases. Conclusions: This protocol aims to provide comprehensive insights into caregiving dynamics and caregivers' experiences over time, as well as understand the role of caregiving on gender inequality in health, considering regional variations. Despite limitations in participant recruitment, focusing on registered caregivers, the study offers a detailed exploration of the health impacts of caregiving in Spain. The incorporation of a gender perspective and the examination of diverse contextual factors enrich the study's depth, contributing significantly to the discourse on caregiving health complexities in Spain. International Registered Report Identifier (IRRID): DERR1-10.2196/58440 ",
doi="10.2196/58440",
url="https://www.researchprotocols.org/2024/1/e58440"
}


@Article{info:doi/10.2196/54074,
author="Gomes, Cunha Mateus
and Castro, Robert
and Silva Serra, Willian
and Sagica de Vasconcelos, Jhak
and Parente, Andressa
and Botelho, Pinheiro Eli{\~a}
and Ferreira, Glenda
and Sousa, Fabianne",
title="Demographic Profile, Health, and Associated Factors of Family Caregivers and Functionality of Hospitalized Older Adults: Cross-Sectional, Exploratory, and Descriptive Study",
journal="JMIR Form Res",
year="2024",
month="Jun",
day="21",
volume="8",
pages="e54074",
keywords="family caregiver",
keywords="older adult",
keywords="hospitalization",
keywords="functionality",
keywords="caregiver",
keywords="health",
abstract="Background: The longevity of the world population can contribute to an increase in hospitalizations and, consequently, to the emergence of functional limitations, resulting in the need for family caregivers. Hospitalized older adults may become dependent and require more care, increasing the burden on family caregivers. Thus, the nursing team in the hospital environment faces a new situation: an increase in the number of older adults occupying hospital beds and the presence of their family caregivers. Objective: We aimed to analyze the association between the demographic variables of interest and the self-rated health of family caregivers and to describe the functionality of older adults hospitalized in a university hospital in the Amazonian context. Methods: This cross-sectional, quantitative, exploratory, and descriptive study was carried out through individual interviews with 98 interviewees, divided into 49 family caregivers and 49 older adults hospitalized in the surgical clinic sector of a university hospital in Brazil between February and March 2023. Demographic data and health conditions were collected from family caregivers, and to describe the functionality of hospitalized older adults, the Barthel Index was applied. Descriptive (frequency and percentage) and inferential analyses were used, and the student t test was applied. The significance level of 5\% was adopted. Results: Among the 49 family caregivers, the majority were women (n=40, 81.6\%) with an average age of 46.9 (SD 13.3) years. Most were single (n=28, 57.1\%) and had completed an average level of education (n=26, 53.1\%). Additionally, 25 (51\%) caregivers were caring for their parents. Regarding health conditions, respondents self-assessed their health as good (25/49, 51\%; P=.01), and they considered that their health status was not affected by the provision of care (36/49, 73.5\%; P=.01). There was a significant association between demographic variables (ie, gender, age, and education) and self-assessment of family caregivers (P=.01, P=.01, and P=.04, respectively). Of the 49 older adults hospitalized, the majority (n=31, 63.2\%) were men, with a mean age of 69.2 (SD 7.12) years. Regarding the assessment of functionality, most older adults were classified as having mild dependence on care (n=23, 46.9\%), specifically in the age group between 60 and 69 years (21/49, 67.8\%). Conclusions: The data revealed that female gender, age, and education of family caregivers contributed favorably to the provision of care to hospitalized older adults with a lower degree of functional dependence. It is important to emphasize that during the older adult's hospitalization, the family caregiver should not be seen as a delegation of responsibilities or as a complement of human resources to assist in their recovery. Health professionals need to implement assertive interventions so that the family caregiver functions as a therapeutic resource. ",
doi="10.2196/54074",
url="https://formative.jmir.org/2024/1/e54074"
}


@Article{info:doi/10.2196/59294,
author="Pickett, C. Andrew
and Valdez, Danny
and Sinclair, L. Kelsey
and Kochell, J. Wesley
and Fowler, Boone
and Werner, E. Nicole",
title="Social Media Discourse Related to Caregiving for Older Adults Living With Alzheimer Disease and Related Dementias: Computational and Qualitative Study",
journal="JMIR Aging",
year="2024",
month="Jun",
day="19",
volume="7",
pages="e59294",
keywords="caregiving",
keywords="dementia",
keywords="social support",
keywords="social media",
keywords="Reddit",
abstract="Background: In the United States, caregivers of people living with Alzheimer disease and Alzheimer disease--related dementias (AD/ADRD) provide >16 billion hours of unpaid care annually. These caregivers experience high levels of stress and burden related to the challenges associated with providing care. Social media is an emerging space for individuals to seek various forms of support. Objective: We aimed to explore the primary topics of conversation on the social media site Reddit related to AD/ADRD. We then aimed to explore these topics in depth, specifically examining elements of social support and behavioral symptomology discussed by users. Methods: We first generated an unsupervised topic model from 6563 posts made to 2 dementia-specific subreddit forums (r/Alzheimers and r/dementia). Then, we conducted a manual qualitative content analysis of a random subset of these data to further explore salient themes in the corpus. Results: The topic model with the highest overall coherence score (0.38) included 10 topics, including caregiver burden, anxiety, support-seeking, and AD/ADRD behavioral symptomology. Qualitative analyses provided added context, wherein users sought emotional and informational support for many aspects of the care experience, including assistance in making key care-related decisions. Users expressed challenging and complex emotions on Reddit, which may be taboo to express in person. Conclusions: Reddit users seek many different forms of support, including emotional and specific informational support, from others on the internet. Users expressed a variety of concerns, challenges, and behavioral symptoms to manage as part of the care experience. The unique (ie, anonymous and moderated) nature of the forum allowed for a safe space to express emotions free from documented caregiver stigma. Additional support structures are needed to assist caregivers of people living with AD/ADRD. ",
doi="10.2196/59294",
url="https://aging.jmir.org/2024/1/e59294",
url="http://www.ncbi.nlm.nih.gov/pubmed/38896462"
}


@Article{info:doi/10.2196/57341,
author="Tyagi, Pranjal
and Bouldin, D. Erin
and Hathaway, A. Wendy
and D'Arcy, Derek
and Nasr, Zacharia Samer
and Intrator, Orna
and Dang, Stuti",
title="Preimplementation Evaluation of a Self-Directed Care Program in a Veterans Health Administration Regional Network: Protocol for a Mixed Methods Study",
journal="JMIR Res Protoc",
year="2024",
month="Jun",
day="14",
volume="13",
pages="e57341",
keywords="long-term institutional care",
keywords="self-directed care",
keywords="veteran directed care",
keywords="veteran",
keywords="veterans",
keywords="institutional care",
keywords="long term care",
keywords="mixed-methods",
keywords="caregivers",
keywords="caregiver",
keywords="United States",
keywords="nursing home",
keywords="homecare",
keywords="community-based",
keywords="home-based",
keywords="unmet",
keywords="pre-implementation",
keywords="barriers",
keywords="barrier",
keywords="facilitators",
keywords="facilitator",
keywords="quantitative data",
abstract="Background: The Veteran-Directed Care (VDC) program serves to assist veterans at risk of long-term institutional care to remain at home by providing funding to hire veteran-selected caregivers. VDC is operated through partnerships between Department of Veterans Affairs (VA) Medical Centers (VAMCs) and third-party Aging and Disability Network Agency providers. Objective: We aim to identify facilitators, barriers, and adaptations in VDC implementation across 7 VAMCs in 1 region: Veterans Integrated Service Network (VISN) 8, which covers Florida, South Georgia, Puerto Rico, and the US Virgin Islands. We also attempted to understand leadership and stakeholder perspectives on VDC programs' reach and implementation and identify veterans served by VISN 8's VDC programs and describe their home- and community-based service use. Finally, we want to compare veterans served by VDC programs in VISN 8 to the veterans served in VDC programs across the VA. This information is intended to be used to identify strategies and propose recommendations to guide VDC program expansion in VISN 8. Methods: The mixed methods study design encompasses electronically delivered surveys, semistructured interviews, and administrative data. It is guided by the Consolidated Framework for Implementation Research (CFIR version 2.0). Participants included the staff of VAMCs and partnering aging and disability network agencies across VISN 8, leadership at these VAMCs and VISN 8, veterans enrolled in VDC, and veterans who declined VDC enrollment and their caregivers. We interviewed selected VAMC site leaders in social work, Geriatrics and Extended Care, and the Caregiver Support Program. Each interviewee will be asked to complete a preinterview survey that includes information about their personal characteristics, experiences with the VDC program, and perceptions of program aspects according to the CFIR (version 2.0) framework. Participants will complete a semistructured interview that covers constructs relevant to the respondent and facilitators, barriers, and adaptations in VDC implementation at their site. Results: We will calculate descriptive statistics including means, SDs, and percentages for survey responses. Facilitators, barriers, number of patients enrolled, and staffing will also be presented. Interviews will be analyzed using rapid qualitative techniques guided by CFIR domains and constructs. Findings from VISN 8 will be collated to identify strategies for VDC expansion. We will use administrative data to describe veterans served by the programs in VISN 8. Conclusions: The VA has prioritized VDC rollout nationwide and this study will inform these expansion efforts. The findings from this study will provide information about the experiences of the staff, leadership, veterans, and caregivers in the VDC program and identify program facilitators and barriers. These results may be used to improve program delivery, facilitate growth within VISN 8, and inform new program establishment at other sites nationwide as the VDC program expands. International Registered Report Identifier (IRRID): DERR1-10.2196/57341 ",
doi="10.2196/57341",
url="https://www.researchprotocols.org/2024/1/e57341",
url="http://www.ncbi.nlm.nih.gov/pubmed/38875003"
}


@Article{info:doi/10.2196/49482,
author="Pliannuom, Suphawita
and Pinyopornpanish, Kanokporn
and Buawangpong, Nida
and Wiwatkunupakarn, Nutchar
and Mallinson, Carson Poppy Alice
and Jiraporncharoen, Wichuda
and Angkurawaranon, Chaisiri",
title="Characteristics and Effects of Home-Based Digital Health Interventions on Functional Outcomes in Older Patients With Hip Fractures After Surgery: Systematic Review and Meta-Analysis",
journal="J Med Internet Res",
year="2024",
month="Jun",
day="12",
volume="26",
pages="e49482",
keywords="home-based intervention",
keywords="digital health interventions",
keywords="postoperative care",
keywords="older adults",
keywords="hip fracture",
abstract="Background: Digital health interventions (DHIs) have been used to improve postoperative functional ability in older patients with hip fractures. However, there is limited information on the characteristics of home-based DHIs, and controversy exists regarding their impact on functional outcomes in this population. Objective: This study aims to provide an overview of the characteristics and effects of home-based DHIs on functional outcomes in older patients with hip fractures after surgery. Methods: We conducted a systematic review and meta-analysis following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Five electronic medical databases (PubMed, Embase, Cochrane, ProQuest, and CINAHL) were searched up until January 3, 2023. We included clinical trials or randomized controlled trials (RCTs) in English involving home-based DHIs for postoperative care among older patients with hip fractures. Excluded studies involved patients not hospitalized, not discharged to home, not directly using DHIs, or with inaccessible full text. The PROSPERO registration number is CRD42022370550. Two independent reviewers screened and extracted data (SP and NB). Disagreements were resolved through discussion and agreement with the third author (KP). Home-based DHIs were characterized in terms of purpose and content, mode of delivery, and health care provider. Functional outcomes assessed included Timed Up and Go (TUG) test, Short Physical Performance Battery (SPPB), and Functional Independence Measure (FIM). Summary measures were calculated using mean differences with 95\% CIs. Risk of bias was assessed using the Risk-of-Bias 2 assessment tool for RCTs and ROBINS-I for non-RCTs. The quality of evidence was assessed using GRADE (Grading of Recommendations Assessment, Development and Evaluation). Results: Of 2125 identified studies, 16 were included in the systematic review, involving 1467 participants. Six studies were included in the meta-analysis (4 for TUG, 4 for SPPB, and 2 for FIM). Home-based DHIs predominantly involved communication and feedback, education, and telerehabilitation. Telephone calls were the most common mode of delivery, followed by web-based software and mobile apps. Physical therapists were the main health care providers. The meta-analysis showed that home-based DHIs improved functional outcomes compared with usual care, with decreased TUG scores (mean difference=--7.89; 95\% CI --10.34 to --5.45; P<.001), significantly increased SPPB scores (mean difference=1.11; 95\% CI 0.51-1.72; P<.001), and increased FIM scores (mean difference=7.98; 95\% CI 5.73-10.24; P<.001). Conclusions: Home-based DHIs that integrate communication and feedback, education, and telerehabilitation have demonstrated effectiveness in enhancing functional outcomes among older patients recovering from hip fractures after surgery. These interventions are commonly administered by physical therapists, who play a crucial role in facilitating and guiding the rehabilitation process. However, while the existing evidence supports the efficacy of such interventions, further research is needed to enhance our understanding and optimize the implementation of home-based DHIs for this specific population. ",
doi="10.2196/49482",
url="https://www.jmir.org/2024/1/e49482",
url="http://www.ncbi.nlm.nih.gov/pubmed/38865706"
}


@Article{info:doi/10.2196/55169,
author="Yin, Zhijun
and Stratton, Lauren
and Song, Qingyuan
and Ni, Congning
and Song, Lijun
and Commiskey, Patricia
and Chen, Qingxia
and Moreno, Monica
and Fazio, Sam
and Malin, Bradley",
title="Perceptions and Utilization of Online Peer Support Among Informal Dementia Caregivers: Survey Study",
journal="JMIR Aging",
year="2024",
month="May",
day="31",
volume="7",
pages="e55169",
keywords="informal dementia caregiver",
keywords="online health community",
keywords="social support",
keywords="survey",
keywords="online peer support",
keywords="caregiving challenges",
abstract="Background: Informal dementia caregivers are those who care for a person living with dementia and do not receive payment (eg, family members, friends, or other unpaid caregivers). These informal caregivers are subject to substantial mental, physical, and financial burdens. Online communities enable these caregivers to exchange caregiving strategies and communicate experiences with other caregivers whom they generally do not know in real life. Research has demonstrated the benefits of peer support in online communities, but this research is limited, focusing merely on caregivers who are already online community users. Objective: We aimed to investigate the perceptions and utilization of online peer support through a survey. Methods: Following the Andersen and Newman Framework of Health Services Utilization and using REDCap (Research Electronic Data Capture), we designed and administered a survey to investigate the perceptions and utilization of online peer support among informal dementia caregivers. Specifically, we collected types of information that influence whether an informal dementia caregiver accesses online peer support: predisposing factors, which refer to the sociocultural characteristics of caregivers, relationships between caregivers and people living with dementia, and belief in the value of online peer support; enabling factors, which refer to the logistic aspects of accessing online peer support (eg, eHealth literacy and access to high-speed internet); and need factors, which are the most immediate causes of seeking online peer support. We also collected data on caregivers' experiences with accessing online communities. We distributed the survey link on November 14, 2022, within two online locations: the Alzheimer's Association website (as an advertisement) and ALZConnected (an online community organized by the Alzheimer's Association). We collected all responses on February 23, 2023, and conducted a regression analysis to identifyn factors that were associated with accessing online peer support. Results: We collected responses from 172 dementia caregivers. Of these participants, 140 (81.4\%) completed the entire survey. These caregivers were aged 19 to 87 (mean 54, SD 13.5) years, and a majority were female (123/140, 87.9\%) and White (126/140, 90\%). Our findings show that the behavior of accessing any online community was significantly associated with participants' belief in the value of online peer support (P=.006). Moreover, of the 40 non--online community caregivers, 33 (83\%) had a belief score above 24---the score that was assigned when a neutral option was selected for each belief question. The most common reasons for not accessing any online community were having no time to do so (14/140, 10\%) and having insufficient online information--searching skills (9/140, 6.4\%). Conclusions: Our findings suggest that online peer support is valuable, but practical strategies are needed to assist informal dementia caregivers who have limited time or online information--searching skills. ",
doi="10.2196/55169",
url="https://aging.jmir.org/2024/1/e55169"
}


@Article{info:doi/10.2196/56474,
author="Groeneveld, Sjors
and Bin Noon, Gaya
and den Ouden, M. Marjolein E.
and van Os-Medendorp, Harmieke
and van Gemert-Pijnen, C. J. E. W.
and Verdaasdonk, M. Rudolf
and Morita, Pelegrini Plinio",
title="The Cooperation Between Nurses and a New Digital Colleague ``AI-Driven Lifestyle Monitoring'' in Long-Term Care for Older Adults: Viewpoint",
journal="JMIR Nursing",
year="2024",
month="May",
day="23",
volume="7",
pages="e56474",
keywords="artificial intelligence",
keywords="data",
keywords="algorithm",
keywords="nurse",
keywords="nurses",
keywords="health care professional",
keywords="health care professionals",
keywords="health professional",
keywords="health professionals",
keywords="health technology",
keywords="digital health",
keywords="smart home",
keywords="smart homes",
keywords="health monitoring",
keywords="health promotion",
keywords="aging in place",
keywords="assisted living",
keywords="ambient assisted living",
keywords="aging",
keywords="gerontology",
keywords="geriatric",
keywords="geriatrics",
keywords="older adults",
keywords="independent living",
keywords="machine learning",
doi="10.2196/56474",
url="https://nursing.jmir.org/2024/1/e56474",
url="http://www.ncbi.nlm.nih.gov/pubmed/38781012"
}


@Article{info:doi/10.2196/52389,
author="Scheibl, Fiona
and Boots, Lizzy
and Eley, Ruth
and Fox, Christopher
and Gracey, Fergus
and Harrison Dening, Karen
and Oyebode, Jan
and Penhale, Bridget
and Poland, Fiona
and Ridel, Gemma
and West, Juniper
and Cross, L. Jane",
title="Adapting a Dutch Web-Based Intervention to Support Family Caregivers of People With Dementia in the UK Context: Accelerated Experience-Based Co-Design",
journal="JMIR Form Res",
year="2024",
month="May",
day="22",
volume="8",
pages="e52389",
keywords="adaptation",
keywords="caregivers",
keywords="dementia",
keywords="intervention",
keywords="web-based resources",
keywords="United Kingdom",
keywords="co-design",
keywords="web-based intervention",
keywords="support",
keywords="carer",
keywords="caregiver",
keywords="family carer",
keywords="community-based",
keywords="services",
keywords="web-based support",
keywords="staff",
keywords="self-help, web-based",
abstract="Background: Around 700,000 family caregivers provide unpaid care for 900,000 people living with dementia in the United Kingdom. Few family caregivers receive support for their own psychological needs and funding for community respite services has declined. These trends are seen across Europe as demographic and budgetary pressures have intensified due to public spending cuts arising from the 2008 financial crisis and the COVID-19 pandemic. The World Health Organization has prioritized the need to expand the provision of support for caregivers and families of people with dementia by 2025. Web-based interventions have the potential for development as they require modest investment and can be accessed by family caregivers at home. Further cost benefits can be realized by adapting existing interventions with demonstrated effectiveness for new contexts. This paper reports initial findings from the CareCoach study, which is adapting Partner in Balance (PiB), a web-based coaching intervention developed in the Netherlands, for family caregivers in the United Kingdom. Objective: This study aims to work with unpaid family caregivers and staff in adapting the Dutch web-based support tool PiB to improve its acceptability and usability for use in the United Kingdom. Methods: Accelerated Experience-Based Co-Design (AEBCD) was used with caregivers, staff, and core stakeholders. Interviews, workshops, and stakeholder consultations were conducted. Data were analyzed iteratively. Recommendations for the redesign of PiB for use across the United Kingdom were adjudicated by the study Adaptation Working Party. Results: Sixteen caregivers and 17 staff took part in interviews. Thirteen caregivers and 17 staff took part in workshops. Most (n=26) participants were White, female, and retired. All except 4 caregivers (2 male and 2 female) found the PiB's offer of web-based self-help learning acceptable. Caregivers identified complexity and lack of inclusivity in some wording and video resources as problematic. The staff took a stronger perspective on the lack of inclusivity in PiB video resources. Staff and caregivers coproduced new inclusive wording and recommended creating new videos to adapt PiB for the UK context. Conclusions: AEBCD methods facilitated the engagement of caregivers and staff and advanced the adaptation of the PiB complex intervention. An important addition to the AEBCD method in this process was the work of an Adaptation Working Party, which adjudicated and agreed to new wording where this could not be established in consultation with caregivers and staff. Trial Registration: ISRCTN Registry ISRCTN12540555; https://doi.org/10.1186/ISRCTN12540555 ",
doi="10.2196/52389",
url="https://formative.jmir.org/2024/1/e52389",
url="http://www.ncbi.nlm.nih.gov/pubmed/38776139"
}


@Article{info:doi/10.2196/53691,
author="Aspelund, Anna
and Valkonen, Paula
and Viitanen, Johanna
and Rauta, Virpi",
title="Designing for Improved Patient Experiences in Home Dialysis: Usability and User Experience Findings From User-Based Evaluation Study With Patients With Chronic Conditions",
journal="JMIR Hum Factors",
year="2024",
month="May",
day="14",
volume="11",
pages="e53691",
keywords="usability",
keywords="UX",
keywords="user experience",
keywords="PX",
keywords="patient experience",
keywords="user-based evaluation",
keywords="patients",
keywords="eHealth",
keywords="digital health solution",
keywords="kidney disease",
keywords="home dialysis",
abstract="Background: Chronic kidney disease affects 10\% of the population worldwide, and the number of patients receiving treatment for end-stage kidney disease is forecasted to increase. Therefore, there is a pressing need for innovative digital solutions that increase the efficiency of care and improve patients' quality of life. The aim of the eHealth in Home Dialysis project is to create a novel eHealth solution, called eC4Me, to facilitate predialysis and home dialysis care for patients with chronic kidney disease. Objective: Our study aimed to evaluate the usability, user experience (UX), and patient experience (PX) of the first version of the eC4Me solution. Methods: We used a user-based evaluation approach involving usability testing, questionnaire, and interview methods. The test sessions were conducted remotely with 10 patients with chronic kidney disease, 5 of whom had used the solution in their home environment before the tests, while the rest were using it for the first time. Thematic analysis was used to analyze user test and questionnaire data, and descriptive statistics were calculated for the UMUX (Usability Metric for User Experience) scores. Results: Most usability problems were related to navigation, the use of terminology, and the presentation of health-related data. Despite usability challenges, UMUX ratings of the solution were positive overall. The results showed noteworthy variation in the expected benefits and perceived effort of using the solution. From a PX perspective, it is important that the solution supports patients' own health-related goals and fits with the needs of their everyday lives with the disease. Conclusions: A user-based evaluation is a useful and necessary part of the eHealth solution development process. Our study findings can be used to improve the usability and UX of the evaluated eC4Me solution. Patients should be actively involved in the solution development process when specifying what information is relevant for them. Traditional usability tests complemented with questionnaire and interview methods can serve as a meaningful methodological approach for gaining insight not only into usability but also into UX- and PX-related aspects of digital health solutions. ",
doi="10.2196/53691",
url="https://humanfactors.jmir.org/2024/1/e53691",
url="http://www.ncbi.nlm.nih.gov/pubmed/38743476"
}


@Article{info:doi/10.2196/53255,
author="Vick, B. Judith
and Golden, P. Blair
and Cantrell, Sarah
and Harris-Gersten, Louise Melissa
and Selmanoff, R. Mollie
and Hastings, Nicole Susan
and Oyesanya, O. Tolu
and Goldstein, M. Karen
and Van Houtven, Courtney",
title="Family Involvement in the Care of Hospitalized Older Adults: Protocol for a Qualitative Evidence Synthesis",
journal="JMIR Res Protoc",
year="2024",
month="May",
day="10",
volume="13",
pages="e53255",
keywords="systematic review",
keywords="family",
keywords="patient participation",
keywords="hospital medicine",
keywords="aged",
keywords="geriatrics",
keywords="qualitative research",
abstract="Background: Older adults are frequently hospitalized. Family involvement during these hospitalizations is incompletely characterized in the literature. Objective: This study aimed to better understand how families are involved in the care of hospitalized older adults and develop a conceptual model describing the phenomenon of family involvement in the care of hospitalized older adults. Methods: We describe the protocol of a qualitative evidence synthesis (QES), a systematic review of qualitative studies. We chose to focus on qualitative studies given the complexity and multifaceted nature of family involvement in care, a type of topic best understood through qualitative inquiry. The protocol describes our process of developing a research question and eligibility criteria for inclusion in our QES based on the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) tool. It describes the development of our search strategy, which was used to search MEDLINE (via Ovid), Embase (via Elsevier), PsycINFO (via Ovid), and CINAHL Complete (via EBSCO). Title and abstract screening and full-text screening will occur sequentially. Purposive sampling may be used depending on the volume of studies identified as eligible for inclusion during our screening process. Descriptive data regarding included individual studies will be extracted and summarized in tables. The results from included studies will be synthesized using qualitative methods and used to develop a conceptual model. The conceptual model will be presented to community members via engagement panels for further refinement. Results: As of September 2023, we have assembled a multidisciplinary team including physicians, nurses, health services researchers, a librarian, a social worker, and a health economist. We have finalized our search strategy and executed the search, yielding 8862 total citations. We are currently screening titles and abstracts and anticipate that full-text screening, data extraction, quality appraisal, and synthesis will be completed by summer of 2024. Conceptual model development will then take place with community engagement panels. We anticipate submitting our manuscript for publication in the fall of 2024. Conclusions: This paper describes the protocol for a QES of family involvement in the care of hospitalized older adults. We will use identified themes to create a conceptual model to inform further intervention development and policy change. Trial Registration: PROSPERO 465617; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42023465617 International Registered Report Identifier (IRRID): PRR1-10.2196/53255 ",
doi="10.2196/53255",
url="https://www.researchprotocols.org/2024/1/e53255",
url="http://www.ncbi.nlm.nih.gov/pubmed/38457771"
}


@Article{info:doi/10.2196/50507,
author="Boudreau, Hannah Jacqueline
and Moo, R. Lauren
and Kennedy, A. Meaghan
and Conti, Jennifer
and Anwar, Chitra
and Pimentel, B. Camilla
and Nearing, A. Kathryn
and Hung, W. William
and Dryden, M. Eileen",
title="Needs for Successful Engagement in Telemedicine Among Rural Older US Veterans and Their Caregivers: Qualitative Study",
journal="JMIR Form Res",
year="2024",
month="May",
day="7",
volume="8",
pages="e50507",
keywords="caregivers",
keywords="geriatrics",
keywords="older adults",
keywords="rural veterans",
keywords="rural",
keywords="specialty care",
keywords="telehealth",
keywords="telemedicine",
keywords="veterans",
abstract="Background: Telemedicine is an important option for rural older adults who often must travel far distances to clinics or forgo essential care. In 2014, the Geriatric Research, Education, and Clinical Centers (GRECC) of the US Veterans Health Administration (VA) established a national telemedicine network called GRECC Connect. This network increased access to geriatric specialty care for the 1.4 million rural VA-enrolled veterans aged 65 years or older. The use of telemedicine skyrocketed during the COVID-19 pandemic, which disproportionately impacted older adults, exacerbating disparities in specialty care access as overburdened systems shut down in-person services. This surge presented a unique opportunity to study the supports necessary for those who would forgo telemedicine if in-person care were available. Objective: In spring 2021, we interviewed veterans and their informal caregivers to (1) elicit their experiences attempting to prepare for a video visit with a GRECC Connect geriatric specialist and (2) explore facilitators and barriers to successful engagement in a telemedicine visit. Methods: We conducted a cross-sectional qualitative evaluation with patients and their caregivers who agreed to participate in at least 1 GRECC Connect telemedicine visit in the previous 3 months. A total of 30 participants from 6 geographically diverse GRECC Connect hub sites agreed to participate. Semistructured interviews were conducted through telephone or the VA's videoconference platform for home telemedicine visits (VA Video Connect) per participant preference. We observed challenges and, when needed, provided real-time technical support to facilitate VA Video Connect use for interviews. All interviews were recorded with permission and professionally transcribed. A team of 5 researchers experienced in qualitative research analyzed interview transcripts using rapid qualitative analysis. Results: From 30 participant interviews, we identified the following 4 categories of supports participants described regarding successful engagement in telemedicine, as defined by visit completion, satisfaction, and willingness to engage in telemedicine in the future: (1) caregiver presence to facilitate technology setup and communication; (2) flexibility in visit modality (eg, video from home or a clinic or telephone); (3) technology support (eg, determining device compatibility or providing instruction and on-demand assistance); and (4) assurance of comfort with web-based communication, including orientation to features like closed captioning. Supports were needed at multiple points before the visit, and participants stressed the importance of eliciting the varying needs and preferences of each patient-caregiver dyad. Though many initially agreed to a telemedicine visit because of pandemic-related clinic closures, participants were satisfied with telemedicine and willing to use it for other types of health care visits. Conclusions: To close gaps in telemedicine use among rural older adults, supports must be tailored to individuals, accounting for technology availability and comfort, as well as availability of and need for caregiver involvement. Comprehensive scaffolding of support starts well before the first telemedicine visit. ",
doi="10.2196/50507",
url="https://formative.jmir.org/2024/1/e50507",
url="http://www.ncbi.nlm.nih.gov/pubmed/38713503"
}


@Article{info:doi/10.2196/54913,
author="Soares, Suzete
and Hoffmeister, Viecili Lou{\'i}se
and Fernandes, F{\'a}tima Maria de
and Henriques, Adriana
and Costa, Andreia",
title="The Use of Digital Technologies in the Promotion of Health Literacy and Empowerment of Informal Caregivers: Scoping Review",
journal="JMIR Aging",
year="2024",
month="Apr",
day="29",
volume="7",
pages="e54913",
keywords="health literacy",
keywords="empowerment",
keywords="digital technology",
keywords="informal caregiver",
keywords="family caregiver",
abstract="Background: Informal caregivers (IC) play an important role in the community as health care providers for people who are dependent on self-care. Health literacy contributes to empowerment, better care, and self-management of one's own health and can be developed using digital technologies. Objective: This study aims to map scientific evidence about the use of digital technologies to promote health literacy and the empowerment of ICs. Methods: We conducted a scoping review following the Joanna Briggs Institute methodology. The CINAHL, MEDLINE, Scopus, and PubMed databases were searched to find primary studies on the theme. Inclusion criteria were based on the Population, Concept, and Context logic. To be selected for analysis, studies must have involved informal or family caregivers aged ?18 years who provide care to dependent persons and who have access to the internet and digital devices (computer, smartphone, and tablet). A total of 2 independent researchers (SS and LVH) performed the screening process. This study is part of a main project that was approved by the Ethics Committee for Health of the Regional Health Administration of Lisbon and Tagus Valley (reference 058/CES/INV/2022). Results: A total of 9 studies were included in the review. The analysis of the studies showed that ICs use digital tools, such as computers and smartphones, with smartphones being the preferred tool. ICs use the internet to access information; manage home tasks; communicate with relatives, their peers, and health care professionals; and take part in forums. Due to difficulties in leaving their houses, forums are highly valued to preserve human connections. Conclusions: The use of digital technologies to convey clear, objective, reliable, and accessible information is a strategic action for promoting health literacy and for contemplating the variable care needs of ICs. By working with ICs in the development of new technologies, researchers are building a new tool that meets ICs' needs. ",
doi="10.2196/54913",
url="https://aging.jmir.org/2024/1/e54913",
url="http://www.ncbi.nlm.nih.gov/pubmed/38683655"
}


@Article{info:doi/10.2196/53078,
author="Castro, Aimee
and Lalonde-LeBlond, Gabrielle
and Freitas, Zelda
and Arnaert, Antonia
and Bitzas, Vasiliki
and Kildea, John
and Moffatt, Karyn
and Phillips, Devon
and Wiseblatt, Lorne
and Hall, Audrey-Jane
and Despr{\'e}s, V{\'e}ronique
and Tsimicalis, Argerie",
title="In-Home Respite Care Services Available to Families With Palliative Care Needs in Quebec: Novel Digital Environmental Scan",
journal="JMIR Nursing",
year="2024",
month="Apr",
day="16",
volume="7",
pages="e53078",
keywords="respite care",
keywords="palliative care",
keywords="caregiving",
keywords="environmental scan",
keywords="digital methodology",
keywords="accessibility",
abstract="Background: Caregiving dyads in palliative care are confronted with complex care needs. Respite care services can be highly beneficial in alleviating the caregiving burden, supporting survivorship and dying at home. Yet, respite care services are difficult to locate and access in the province of Quebec, Canada, particularly when navigating ubiquitous sources of online health information of varying quality. Objective: This project aimed to (1) compile a list of at-home palliative respite care services in Quebec, Canada; (2) describe key accessibility features for each respite care service; (3) identify accessibility gaps and opportunities; and (4) describe a novel method for conducting environmental scans using internet search engines, internet-based community health databases, and member checking. Methods: A novel environmental scan methodology using 2 internet-based targeted databases and 1 internet search engine was conducted. Results were screened and data were extracted, descriptively analyzed, and geographically schematized. Results: A total of 401 services were screened, and 52 at-home respite care services specific to palliative populations were identified, compiled, and analyzed. These respite care services were characterized by various types of assistance, providers, fees, and serviced geographical regions. Accessibility was explored through the lens of service amenability, availability, eligibility, and compatibility. The data revealed important barriers to accessing respite care services, such as a lack of readily available information on service characteristics, limited availability, and a time-consuming, technical search process for potential respite care users and clinicians to identify appropriate services. Conclusions: Both methodological and contextual knowledge have been gained through this environmental scan. Few methodologies for conducting internet-based environmental scans have been clearly articulated, so we applied several learnings from other scans and devised a methodology for conducting an environmental scan using the mixed methods of internet search engines, internet-based community health databases, and member checking. We have carefully reported our methods, so that others conducting community health environmental scans may replicate our process. Furthermore, through this scan, we identified assorted respite care services and pinpointed needs in the provision of these services. The findings highlighted that more easily accessible and centralized information about respite care services is needed in Quebec. The data will enable the creation of a user-friendly tool to share with community support services across Quebec and ultimately help alleviate the added burden caregivers and clinicians face when looking for respite care services in fragmented and complex digital spaces. ",
doi="10.2196/53078",
url="https://nursing.jmir.org/2024/1/e53078",
url="http://www.ncbi.nlm.nih.gov/pubmed/38625735"
}


@Article{info:doi/10.2196/54168,
author="McLaren, E. Jaye
and Hoang-Gia, Dat
and Dorisca, Eugenia
and Hartz, Stephanie
and Dang, Stuti
and Moo, Lauren",
title="Development and Evaluation of a Clinician-Vetted Dementia Caregiver Resources Website: Mixed Methods Approach",
journal="JMIR Form Res",
year="2024",
month="Apr",
day="4",
volume="8",
pages="e54168",
keywords="Alzheimer disease",
keywords="caregiver education",
keywords="dementia",
keywords="interdisciplinary",
keywords="older adults",
keywords="virtual resources",
keywords="website development",
abstract="Background: About 11 million Americans are caregivers for the 6.7 million Americans currently living with dementia. They provide over 18 billion hours of unpaid care per year, yet most have no formal dementia education or support. It is extremely difficult for clinicians to keep up with the demand for caregiver education, especially as dementia is neurodegenerative in nature, requiring different information at different stages of the disease process. In this digital age, caregivers often seek dementia information on the internet, but clinicians lack a single, reliable compendium of expert-approved digital resources to provide to dementia caregivers. Objective: Our aim was to create a dementia caregiver resources website to serve as a hub for user-friendly, high-quality, and expert-reviewed dementia educational resources that clinicians can easily supply to family caregivers of people with dementia. Methods: An interdisciplinary website development team (representing dementia experts from occupational therapy, nursing, social work, geriatrics, and neurology) went through 6 iterative steps of website development to ensure resource selection quality and eligibility rigor. Steps included (1) resource collection, (2) creation of eligibility criteria, (3) resource organization by topic, (4) additional content identification, (5) finalize resource selection, and (6) website testing and launch. Website visits were tracked, and a 20-item survey about website usability and utility was sent to Veterans Affairs tele-geriatrics interdisciplinary specialty care groups. Results: Following website development, the dementia caregiver resource website was launched in February 2022. Over the first 9 months, the site averaged 1100 visits per month. The 3 subcategories with the highest number of visits were ``general dementia information,'' ``activities of daily living,'' and ``self-care and support.'' Most (44/45, 98\%) respondents agreed or strongly agreed that the website was easy to navigate, and all respondents agreed or strongly agreed that the resources were useful. Conclusions: The iterative process of creating the dementia caregiver resources website included continuous identification, categorization, and prioritization of resources, followed by clinician feedback on website usability, accessibility, and suggestions for improvement. The website received thousands of visits and positive clinician reviews in its first 9 months. Results demonstrate that an expert-vetted, nationally, and remotely available resource website allows for easy access to dementia education for clinicians to provide for their patients and caregivers. This process of website development can serve as a model for other clinical subspecialty groups seeking to create a comprehensive educational resource for populations who lack easy access to specialty care. ",
doi="10.2196/54168",
url="https://formative.jmir.org/2024/1/e54168",
url="http://www.ncbi.nlm.nih.gov/pubmed/38573761"
}


@Article{info:doi/10.2196/53692,
author="Omar, Aminah Siti
and Zulkefly, Sheereen Nor
and Mukhtar, Firdaus",
title="The Effectiveness of Brain Injury Family Intervention in Improving the Psychological Well-Being of Caregivers of Patients With Traumatic Brain Injury: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2024",
month="Mar",
day="14",
volume="13",
pages="e53692",
keywords="traumatic brain injury",
keywords="TBI",
keywords="caregiver",
keywords="randomized controlled trial",
keywords="psychological well-being",
keywords="Malaysia",
abstract="Background: Globally, traumatic brain injury (TBI) is recognized as one of the most significant contributors to mortality and disability. Most of the patients who have experienced TBI will be discharged home and reunited with their families or primary caregivers. The degree of severity of their reliance on caregivers varies. Therefore, the task of delivering essential care to the patients becomes demanding for the caregivers. A significant proportion of caregivers expressed considerable burden, distress, and discontentment with their lives. Therefore, it is critical to comprehend the dynamic of TBI and caregivers to optimize patient care, rehabilitation, and administration. The effectiveness of the Brain Injury Family Intervention (BIFI) program tailored for caregivers of patients with TBI has been widely proven in Western countries. However, the impact is less clear among caregivers of patients with TBI in Malaysia. Objective: This study aims to assess the effectiveness of BIFI in reducing emotional distress and burden of care, fulfilling the needs, and increasing the life satisfaction of caregivers of patients with TBI at government hospitals in Malaysia. Methods: This is a 2-arm, single-blinded, randomized controlled trial. It will be conducted at Hospital Rehabilitasi Cheras and Hospital Sungai Buloh. In total, 100 caregivers of patients with TBI attending the neurorehabilitation unit will be randomized equally to the intervention and control groups. The intervention group will undergo the BIFI program, whereas the control group will receive standard treatment. Caregivers aged ?18 years, caring for patients who have completed >3 months after the injury, are eligible to participate. The BIFI program will be scheduled for 5 sessions as recommended by the developer of the module. Each session will take approximately 90 to 120 minutes. The participants are required to attend all 5 sessions. A total of 5 weeks is needed for each group to complete the program. Self-reported questionnaires (ie, Beck Depression Inventory, Positive and Negative Affect Schedule, Caregiver Strain Index, Satisfaction With Life Scale, and Family Needs Questionnaire) will be collected at baseline, immediately after the intervention program, at 3-month follow-up, and at 6-month follow-up. The primary end point is the caregivers' emotional distress. Results: The participant recruitment process began in January 2019 and was completed in December 2020. In total, 100 participants were enrolled in this study, of whom 70 (70\%) caregivers are women and 30 (30\%) are men. We are currently at the final stage of data analysis. The results of this study are expected to be published in 2024. Ethics approval has been obtained. Conclusions: It is expected that the psychological well-being of the intervention group will be better compared with that of the control group after the intervention at 3-month follow-up and at 6-month follow-up. Trial Registration: Iranian Registry of Clinical Trials IRCT20180809040746N1; https://irct.behdasht.gov.ir/trial/33286 International Registered Report Identifier (IRRID): RR1-10.2196/53692 ",
doi="10.2196/53692",
url="https://www.researchprotocols.org/2024/1/e53692",
url="http://www.ncbi.nlm.nih.gov/pubmed/38483466"
}


@Article{info:doi/10.2196/51150,
author="Chien, Shih-Ying
and Wong, May-Kuen Alice
and Tseng, Winston
and Hu, Han-Chung
and Cho, Hsiu-Ying",
title="Feasibility and Design Factors for Home-Based Pulmonary Rehabilitation of Patients With Chronic Obstructive Pulmonary Disease and Chronic Lung Diseases Based on a People-Object-Environment Framework: Qualitative Interview Study",
journal="JMIR Hum Factors",
year="2024",
month="Mar",
day="7",
volume="11",
pages="e51150",
keywords="chronic lung diseases",
keywords="home-based pulmonary rehabilitation",
keywords="telehealth",
keywords="remote health care",
abstract="Background: The feasibility of implementing home-based pulmonary rehabilitation (PR) can be assessed from the perspectives of patients with chronic lung disease and health care professionals involved in PR. Objective: Through a qualitative inquiry using interviews and the adoption of the people-object-environment framework, this study aims to understand the influences of interpersonal, environmental, and situational factors on the perceptions and considerations of individuals involved in home-based PR for patients with chronic lung disease. Methods: One-on-one interviews were conducted with 20 patients with chronic lung disease and 20 health care professionals for investigating their attitudes and opinions based on their experiences regarding home-based PR as well as for identifying the key factors affecting the benefits and drawbacks of such therapies. This study further evaluates the feasibility of using digital tools for medical diagnosis and treatment by examining the technology usage of both parties. Results: The 4 key issues that all participants were the most concerned about were as follows: distance to outpatient medical care, medical efficiency, internet connectivity and equipment, and physical space for diagnosis and treatment. Interviews with patients and health care professionals revealed that the use of technology and internet was perceived differently depending on age and area of residence. Most participants reported that digital tools and internet connectivity had many benefits but still could not solve all the problems; moreover, these same digital tools and network transmission could lead to problems such as information security and digital divide concerns. This study also emphasizes the significant impact of human behavior and thinking on shaping the design of health care interventions and technologies. Understanding user perspectives and experiences is crucial for developing effective solutions for unmet needs. Conclusions: The results of this study indicate that despite the different perspectives of patients and health care professionals, their considerations of the key issues are very similar. Therefore, the implementation of plans related to telemedicine diagnosis, treatment, or rehabilitation should take the suggestions and considerations of both parties into account as crucial factors for telehealth care design. ",
doi="10.2196/51150",
url="https://humanfactors.jmir.org/2024/1/e51150",
url="http://www.ncbi.nlm.nih.gov/pubmed/38452366"
}


@Article{info:doi/10.2196/48132,
author="Onseng, Pansiree
and Jiraporncharoen, Wichuda
and Moonkayaow, Sasiwimon
and Veerasirikul, Pimchai
and Wiwatkunupakarn, Nutchar
and Angkurawaranon, Chaisiri
and Pinyopornpanish, Kanokporn",
title="Expectation, Attitude, and Barriers to Receiving Telehomecare Among Caregivers of Homebound or Bedridden Older Adults: Qualitative Study",
journal="JMIR Aging",
year="2024",
month="Feb",
day="7",
volume="7",
pages="e48132",
keywords="telehomecare",
keywords="telemedicine",
keywords="telehealth",
keywords="caregivers",
keywords="older adults",
keywords="attitudes",
abstract="Background: In recent years, telehomecare has become an increasingly important option for health care providers to deliver continuous care to their patients. Objective: This study aims to explore the expectations, attitudes, and barriers to telehomecare among caregivers of homebound or bedridden older adults. Methods: This qualitative study used semistructured interviews to explore caregivers' perspectives on telehomecare for homebound or bedridden older adults. The study adhered to the SRQR (Standards for Reporting Qualitative Research) guidelines. Participants were selected using convenience sampling from caregivers of homebound or bedridden older adults with experience in both in-person home visits and telehomecare services provided by the Department of Family Medicine at Chiang Mai University, in an urban area of Chiang Mai Province in Northern Thailand. Semistructured interviews were conducted. The interviews were audio recorded with participant consent and transcribed verbatim. The framework method was used, involving multiple readings of transcripts to facilitate familiarization and accuracy checking. The study used the technology acceptance model and comprehensive geriatric assessment as the analytical framework. Results: The study included 20 caregivers of older adult patients. The patients were predominantly female (15/20, 75\%), with an average age of 86.2 years. Of these patients, 40\% (n=8) of patients were bedridden, and 60\% (n=12) of patients were homebound. Caregivers expressed generally positive attitudes toward telehomecare. They considered it valuable for overall health assessment, despite recognizing certain limitations, particularly in physical assessments. Psychological assessments were perceived as equally effective. While in-person visits offered more extensive environmental assessments, caregivers found ways to make telehomecare effective. Telehomecare facilitated multidisciplinary care, enabling communication with specialists. Caregivers play a key role in care planning and adherence. Challenges included communication issues due to low volume, patient inattention, and faulty devices and internet signals. Some caregivers helped overcome these barriers. The loss of information was mitigated by modifying signaling equipment. Technology use was a challenge for some older adult caregivers. Despite these challenges, telehomecare offered advantages in remote communication and resolving scheduling conflicts. Caregivers varied in their preferences. Some preferred in-person visits for a broader view, while others favored telehomecare for its convenience. Some had no strong preference, appreciating both methods, while others considered the situation and patient conditions when choosing between them. Increased experience with telehomecare led to more confidence in its use. Conclusions: Caregivers have positive attitudes and high expectations for telehomecare services. Although there may be barriers to receiving care through this mode, caregivers have demonstrated the ability to overcome these challenges, which has strengthened their confidence in telehomecare. However, it is important to enhance the skills of caregivers and health care teams to overcome barriers and optimize the use of telehomecare. ",
doi="10.2196/48132",
url="https://aging.jmir.org/2024/1/e48132",
url="http://www.ncbi.nlm.nih.gov/pubmed/38324373"
}


@Article{info:doi/10.2196/44422,
author="Cheng, Weibin
and Cao, Xiaowen
and Lian, Wanmin
and Tian, Junzhang",
title="An Introduction to Smart Home Ward--Based Hospital-at-Home Care in China",
journal="JMIR Mhealth Uhealth",
year="2024",
month="Jan",
day="30",
volume="12",
pages="e44422",
keywords="smart home ward",
keywords="telemonitoring",
keywords="telemedicine",
keywords="home care",
keywords="hospital at home",
keywords="healthcare delivery",
keywords="implementation",
keywords="smart ward",
keywords="medical monitoring",
keywords="medical care",
keywords="rehabilitation",
keywords="health care",
doi="10.2196/44422",
url="https://mhealth.jmir.org/2024/1/e44422"
}


@Article{info:doi/10.2196/49592,
author="Tran, C. Karen
and Mak, Meagan
and Kuyper, M. Laura
and Bittman, Jesse
and Mangat, Birinder
and Lindsay, Heather
and Kim Sing, Chad
and Xu, Liang
and Wong, Hubert
and Dawes, Martin
and Khan, Nadia
and Ho, Kendall",
title="Home Blood Pressure Telemonitoring Technology for Patients With Asymptomatic Elevated Blood Pressure Discharged From the Emergency Department: Pilot Study",
journal="JMIR Form Res",
year="2024",
month="Jan",
day="30",
volume="8",
pages="e49592",
keywords="hypertension",
keywords="remote-home monitoring",
keywords="feasibility study",
keywords="health monitor",
keywords="telehealth",
keywords="pilot study",
keywords="mobile phone",
keywords="monitoring",
keywords="telemonitoring",
keywords="blood pressure",
keywords="emergency department",
keywords="morbidity",
keywords="mortality",
keywords="primary care",
keywords="physician care",
keywords="management",
keywords="hypertension medication",
abstract="Background: Hypertension affects 1 in 5 Canadians and is the leading cause of morbidity and mortality globally. Hypertension control is declining due to multiple factors including lack of access to primary care. Consequently, patients with hypertension frequently visit the emergency department (ED) due to high blood pressure (BP). Telehealth for Emergency-Community Continuity of Care Connectivity via Home-Telemonitoring Blood Pressure is a pilot project that implements and evaluates a comprehensive home blood pressure telemonitoring (HBPT) and physician case management protocol designed as a postdischarge management strategy to support patients with asymptomatic elevated BP as they transition from the ED to home. Objective: Our objective was to conduct a feasibility study of an HBPT program for patients with asymptomatic elevated BP discharged from the ED. Methods: Patients discharged from an urban, tertiary care hospital ED with asymptomatic elevated BP were recruited in Vancouver, British Columbia, Canada, and provided with HBPT technology for 3 months of monitoring post discharge and referred to specialist hypertension clinics. Participants monitored their BP twice in the morning and evenings and tele-transmitted readings via Bluetooth Sensor each day using an app. A monitoring clinician received these data and monitored the patient's condition daily and adjusted antihypertensive medications. Feasibility outcomes included eligibility, recruitment, adherence to monitoring, and retention rates. Secondary outcomes included proportion of those who were defined as having hypertension post-ED visits, changes in mean BP, overall BP control, medication adherence, changes to antihypertensive medications, quality of life, and end user experience at 3 months. Results: A total of 46 multiethnic patients (mean age 63, SD 17 years, 69\%, n=32 women) found to have severe hypertension (mean 191, SD 23/mean 100, SD 14 mm Hg) in the ED were recruited, initiated on HBPT with hypertension specialist physician referral and followed up for 3 months. Eligibility and recruitment rates were 40\% (56/139) and 88\% (49/56), respectively. The proportion of participants that completed ?80\% of home BP measurements at 1 and 3 months were 67\% (31/46) and 41\% (19/46), respectively. The proportion of individuals who achieved home systolic BP and diastolic BP control at 3 months was 71.4\% (30/42) and 85.7\% (36/42) respectively. Mean home systolic and diastolic BP improved by --13/--5 mm Hg after initiation of HBPT to the end of the study. Patients were prescribed 1 additional antihypertensive medication. No differences in medication adherence from enrollment to 3 months were noted. Most patients (76\%, 25/33) were highly satisfied with the HBPT program and 76\% (25/33) found digital health tools easy to use. Conclusions: HBPT intervention is a feasible postdischarge management strategy and can be beneficial in supporting patients with asymptomatic elevated BP from the ED. A randomized trial is underway to evaluate the efficacy of this intervention on BP control. ",
doi="10.2196/49592",
url="https://formative.jmir.org/2024/1/e49592",
url="http://www.ncbi.nlm.nih.gov/pubmed/38111177"
}


@Article{info:doi/10.2196/46941,
author="Messina, Anna
and Amati, Rebecca
and Annoni, Maria Anna
and Bano, Beatrice
and Albanese, Emiliano
and Fiordelli, Maddalena",
title="Culturally Adapting the World Health Organization Digital Intervention for Family Caregivers of People With Dementia (iSupport): Community-Based Participatory Approach",
journal="JMIR Form Res",
year="2024",
month="Jan",
day="24",
volume="8",
pages="e46941",
keywords="informal caregivers",
keywords="iSupport",
keywords="dementia",
keywords="digital interventions",
keywords="mHealth",
keywords="community-based participatory research",
keywords="community",
keywords="caregiver",
keywords="mental distress",
keywords="physical distress",
keywords="support",
keywords="development",
abstract="Background: Informal caregivers of people with dementia are at high risk of developing mental and physical distress because of the intensity of the care provided. iSupport is an evidence-based digital program developed by the World Health Organization to provide education and support for the informal everyday care of people living with dementia. Objective: Our study aims to describe in detail the cultural adaptation process of iSupport in Switzerland. We specifically focused on the participatory strategies we used to design a culturally adapted, Swiss version of iSupport that informed the development of the desktop version, mobile app, and printed manual. Methods: We used a mixed methods design, with a community-based participatory approach. The adaptation of iSupport followed the World Health Organization adaptation guidelines and was developed in 4 phases: content translation, linguistic and cultural revision by the members of the community advisory board, validation with formal and informal caregivers, and refinement and final adaptation. Results: The findings from each phase showed and consolidated the adjustments needed for a culturally adapted, Swiss version of iSupport. We collected feedback and implemented changes related to the following areas: language register and expressions (eg, from ``lesson'' to ``chapter'' and from ``suffering from'' dementia to ``affected by'' dementia), resources (hyperlinks to local resources for dementia), contents (eg, from general nonfamiliar scenarios to local and verisimilar examples), graphics (eg, from generalized illustrations of objects to human illustrations), and extra features (eg, a glossary, a forum session, and a read-aloud option, as well as a navigation survey). Conclusions: Our study provides evidence on how to culturally adapt a digital program for informal caregivers of people living with dementia. Our results suggest that adopting a community-based participatory approach and collecting lived experiences from the final users and stakeholders is crucial to meet local needs and to inform the further development, testing, and implementation of digital interventions in a specific cultural context. ",
doi="10.2196/46941",
url="https://formative.jmir.org/2024/1/e46941",
url="http://www.ncbi.nlm.nih.gov/pubmed/38265857"
}


@Article{info:doi/10.2196/52799,
author="Rochon, A. Elizabeth
and Sy, Maimouna
and Phillips, Mirelle
and Anderson, Erik
and Plys, Evan
and Ritchie, Christine
and Vranceanu, Ana-Maria",
title="Bio-Experiential Technology to Support Persons With Dementia and Care Partners at Home (TEND): Protocol for an Intervention Development Study",
journal="JMIR Res Protoc",
year="2023",
month="Dec",
day="29",
volume="12",
pages="e52799",
keywords="dementia",
keywords="dyadic",
keywords="bio-experiential",
keywords="serious gaming",
keywords="psychosocial",
abstract="Background: Alzheimer disease and related dementias are debilitating and incurable diseases. Persons with dementia and their informal caregivers (ie, dyads) experience high rates of emotional distress and negative health outcomes. Several barriers prevent dyads from engaging in psychosocial care including cost, transportation, and a lack of treatments that target later stages of dementia and target the dyad together. Technologically informed treatment and serious gaming have been shown to be feasible and effective among persons living with dementia and their care partners. To increase access, there is a need for technologically informed psychosocial interventions which target the dyad, together in the home. Objective: This study aims to develop the toolkit for experiential well-being in dementia, a dyadic, ``bio-experiential'' intervention for persons with dementia and their caregivers. Per our conceptual model, the toolkit for experiential well-being in dementia platform aims to target sustained attention, positive emotions, and active engagement among dyads. In this paper, we outline the protocol and conceptual model for intervention development and partnership with design and development experts. Methods: We followed the National Institutes of Health (NIH) stage model (stage 1A) and supplemented the model with principles of user-centered design. The first step includes understanding user needs, goals, and strengths. We met this step by engaging in methodology and definition synthesis and conducting focus groups with dementia care providers (N=10) and persons with dementia and caregivers (N=11). Step 2 includes developing and refining the prototype. We will meet this step by engaging dyads in up to 20 iterations of platform $\beta$ testing workshops. Step 3 includes observing user interactions with the prototype. We will meet this step by releasing the platform for feasibility testing. Results: Key takeaways from the focus groups include balancing individualization and the dyadic relationship and avoiding confusing stimuli. As of September 2023, we have completed focus groups with providers, persons with dementia, and their caregivers. Additionally, we have conducted 4 iterations of $\beta$ testing workshops with dyads. Feedback from focus groups informed the $\beta$ testing workshops; data have not yet been formally analyzed and will be reported in future publications. Conclusions: Technological interventions, particularly ``bio-experiential'' technology, can be used in dementia care to support emotional health among persons with a diagnosis and caregivers. Here, we outline a collaborative intervention development process of bio-experiential technology through a research, design, and development partnership. Next, we are planning to test the platform's feasibility as well as its impact on clinical outcomes and mechanisms of action. International Registered Report Identifier (IRRID): DERR1-10.2196/52799 ",
doi="10.2196/52799",
url="https://www.researchprotocols.org/2023/1/e52799",
url="http://www.ncbi.nlm.nih.gov/pubmed/38157239"
}


@Article{info:doi/10.2196/47997,
author="Fothergill, Lauren
and Holland, Carol
and Latham, Yvonne
and Hayes, Niall",
title="Understanding the Value of a Proactive Telecare System in Supporting Older Adults' Independence at Home: Qualitative Interview Study Among Key Interest Groups",
journal="J Med Internet Res",
year="2023",
month="Dec",
day="14",
volume="25",
pages="e47997",
keywords="older adults",
keywords="telecare",
keywords="independent living",
keywords="health and well-being",
abstract="Background: Telecare is claimed to support people to live in their own homes for longer by providing monitoring services that enable responses to emergencies at home. Although most telecare technologies commissioned in the United Kingdom predominantly supply reactive services, there has been recent interest among policy makers to develop proactive telecare services to provide additional understanding of older adults' health and well-being needs to provide a means for more preventive interventions. Proactive telecare refers to providing regular well-being calls or encouraging users to regularly confirm their well-being to anticipate and prevent crises through an increased understanding of individuals' needs and by building social relationships with older adults. Such technologies have already begun to be introduced, yet little research has explored the potential value of proactive telecare. Objective: This study explores the perceptions of different interest groups to understand the extent to which using a proactive telecare service can support older adults to live independently, what potential health and well-being benefits may be elicited from its use, and what the limitations are. Methods: Semistructured interviews were conducted with older people (those with experience in using proactive telecare and those without), family members of proactive telecare users, and proactive telecare staff regarding their perceptions and opinions about the value of a proactive telecare service. Data were analyzed using inductive thematic analysis. Results: A total of 30 individuals participated in this study. Older adults described the value of proactive telecare in feeling safe and in control and appreciated feeling connected. Family members and staff valued the potential to detect early health deterioration in older adults, and all participants highlighted the benefit of strengthening access to social networks, particularly for socially isolated older people. However, telecare is often viewed as a last resort, and therefore, anticipatory care may not suit all populations, as demonstrated by the mixed acceptance of the technology among older adults who did not have experience using it. Participants also reported limitations, including the requirement for family, friends, or neighbors to assist older adults during an emergency and the need for financial resources to fund the service. Conclusions: This study presents the first known qualitative inquiry about a proactive telecare system, which provides rich and detailed insights from different perspectives into the potential benefits of this intervention. Proactive telecare may promote and facilitate the accumulation of social and technological resources as individuals prepare to cope with age-related challenges, thus helping to avoid negative outcomes prematurely. However, similar to reactive telecare, proactive telecare must be matched to individual preferences and existing financial and social resources. ",
doi="10.2196/47997",
url="https://www.jmir.org/2023/1/e47997",
url="http://www.ncbi.nlm.nih.gov/pubmed/38096023"
}


@Article{info:doi/10.2196/53150,
author="Guay-B{\'e}langer, Sabrina
and Aubin, Emmanuelle
and Cimon, Marie
and Archambault, Patrick
and Blanchette, Virginie
and Giguere, Anik
and Gogovor, Am{\'e}d{\'e}
and Morin, Mich{\`e}le
and Ben Charif, Ali
and Ben Gaied, Nouha
and Bickerstaff, Julie
and Ch{\'e}nard, Nancy
and Emond, Julie
and Gilbert, Julie
and Violet, Isabelle
and L{\'e}gar{\'e}, France",
title="Engagement of Older Adults Receiving Home Care Services and Their Caregivers in Health Decisions in Partnership With Clinical Teams: Protocol for a Multimethod Study to Prioritize and Culturally Adapt Decision Aids for Home Care",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="20",
volume="12",
pages="e53150",
keywords="shared decision making",
keywords="patient-centered care",
keywords="home care",
keywords="older adults",
keywords="caregivers",
keywords="decision aids",
keywords="scalability assessment",
keywords="innovation scalability self-administered questionnaire",
keywords="interprofessional",
keywords="team based",
abstract="Background: Older adults (people aged 65 years and older) face many difficult decisions. Patient decision aids (PtDAs) can help them and their families make informed value-congruent decisions. Some PtDAs have been developed for the home care context, but little is known about scaling them for use with older adults in a different culture. Objective: This study aims to (1) assess the scalability of existing PtDAs for older adults in the home care context; (2) prioritize those that best match the decisional needs of older adults in home care; and (3) culturally adapt the prioritized PtDAs so they can be scaled successfully to the Quebec health care system. Methods: This multimethod study includes 3 phases. All phases will be overseen by a steering committee of older adults, caregivers, health professionals, decision makers, community organization representatives, and researchers with the needed expertise. In phase 1, we will use the Innovation Scalability Self-administered Questionnaire, a validated scalability self-assessment tool, to assess the scalability of 33 PtDAs previously identified in a systematic review. Based on their scalability, their quality (based on the International Patient Decision Aids Standards), and the importance of the decision point, we will retain approximately a third of these. In phase 2, we will conduct a 2-round web-based Delphi to prioritize the PtDAs selected in phase 1. Using a snowball recruitment strategy, we aim to recruit 60 Delphi participants in the province of Quebec, including older adults, caregivers, health professionals, decision makers involved in home care services, and PtDA experts. In the first round, we will ask participants to rate the importance of several PtDA decision points according to various criteria such as prevalence and difficulty on a 5-point Likert scale (1=not important to 5=very important). Approximately 6 of the highest-rated PtDAs will be retained for presentation in the second round, and we will select up to 3 PtDAs judged as having the highest priority for cultural adaptation. In phase 3, using the Chenel framework and user-centered design methods, we will update and adapt the PtDAs to the Quebec health care system and integrate these PtDAs into an interprofessional shared decision-making training program for home care teams. The adapted PtDAs will respect the International Patient Decision Aids Standards criteria. Results: This study was funded in March 2022 by the Canadian Institutes of Health Research. Data collection for the web-based Delphi began in October 2023. Results are expected to be published in May 2024. Conclusions: This project will provide relevant and culturally appropriate decision support tools for older adults making difficult decisions and their home care teams that will be ready for scaling across the province of Quebec. International Registered Report Identifier (IRRID): PRR1-10.2196/53150 ",
doi="10.2196/53150",
url="https://www.researchprotocols.org/2023/1/e53150",
url="http://www.ncbi.nlm.nih.gov/pubmed/37889512"
}


@Article{info:doi/10.2196/52489,
author="Kyl{\'e}n, Maya
and Sturge, Jodi
and Lipson-Smith, Ruby
and Schmidt, M. Steven
and Pessah-Rasmussen, H{\'e}l{\`e}ne
and Svensson, Tony
and de Vries, Laila
and Bernhardt, Julie
and Elf, Marie",
title="Built Environments to Support Rehabilitation for People With Stroke From the Hospital to the Home (B-Sure): Protocol for a Mixed Method Participatory Co-Design Study",
journal="JMIR Res Protoc",
year="2023",
month="Nov",
day="9",
volume="12",
pages="e52489",
keywords="stroke rehabilitation",
keywords="built environment",
keywords="person-centered",
keywords="participation",
keywords="self-efficacy",
keywords="meaningful activities",
keywords="accessibility",
keywords="participatory co-design",
keywords="good quality and local care",
abstract="Background: A global trend is to move rehabilitation closer to people's neighborhoods and homes. Still, little attention has been given to how the built environment outside the hospital setting might impact rehabilitation and recovery for stroke survivors. Objective: The overarching objective of this project is to develop conceptual models of built environments that support stroke rehabilitation and recovery outside the hospital setting. Specifically, the project will explore factors and characteristics of the built environment that support people with stroke and their families and identify innovative built environments that can be designed for local health care. The project will examine facilitators and obstacles for implementing built environmental solutions and evaluate the potential benefits, feasibility, and acceptability. Methods: The project uses a mixed methods design approach with 3 phases. In phase 1, factors and characteristics of the built environment for rehabilitation will be identified. Based on the results from phase 1, phase 2 will involve co-designing prototypes of environments to support the rehabilitation process for people with stroke. Finally, the prototypes will be evaluated in phase 3. Qualitative and quantitative methods will include a literature review, a concept mapping (CM) study, stakeholder interviews, prototype development, and testing. The project will use multidimensional scaling, hierarchical cluster analysis, descriptive statistics for quantitative data, and content analysis for qualitative data. Location analysis will rely on the location-allocation model for network problems, and the rule-based analysis will be based on geographic information systems data. Results: As of the submission of this protocol, ethical approval for the CM study and the interview study has been obtained. Data collection is planned to start in September 2023 and the workshops later in the same year. The scoping review is ongoing from January 2023. The CM study is ongoing and will be finalized in the spring of 2024. We expect to finish the data analysis in the second half of 2024. The project is a 3-year project and will continue until December 2025. Conclusions: We aim to determine how new environments could better support a person's control over their day, environment, goals, and ultimately control over their recovery and rehabilitation activities. This ``taking charge'' approach would have the greatest chance of transferring the care closer to the patient's home. By co-designing with multiple stakeholders, we aim to create solutions with the potential for rapid implementation. The project's outcomes may target other people with frail health after a hospital stay or older persons in Sweden and anywhere else. The impact and social benefits include collaboration between important stakeholders to explore how new environments can support the transition to local health care, co-design, and test of new conceptual models of environments that can promote health and well-being for people post stroke. International Registered Report Identifier (IRRID): DERR1-10.2196/52489 ",
doi="10.2196/52489",
url="https://www.researchprotocols.org/2023/1/e52489",
url="http://www.ncbi.nlm.nih.gov/pubmed/37943590"
}


@Article{info:doi/10.2196/49788,
author="Wang, Bijun
and Asan, Onur
and Mansouri, Mo",
title="Perspectives of Patients With Chronic Diseases on Future Acceptance of AI--Based Home Care Systems: Cross-Sectional Web-Based Survey Study",
journal="JMIR Hum Factors",
year="2023",
month="Nov",
day="6",
volume="10",
pages="e49788",
keywords="consumer informatics",
keywords="artificial intelligence",
keywords="AI",
keywords="technology acceptance model",
keywords="adoption",
keywords="chronic",
keywords="motivation",
keywords="cross-sectional",
keywords="home care",
keywords="perception",
keywords="perceptions",
keywords="attitude",
keywords="attitudes",
keywords="intent",
keywords="intention",
abstract="Background: Artificial intelligence (AI)--based home care systems and devices are being gradually integrated into health care delivery to benefit patients with chronic diseases. However, existing research mainly focuses on the technical and clinical aspects of AI application, with an insufficient investigation of patients' motivation and intention to adopt such systems. Objective: This study aimed to examine the factors that affect the motivation of patients with chronic diseases to adopt AI-based home care systems and provide empirical evidence for the proposed research hypotheses. Methods: We conducted a cross-sectional web-based survey with 222 patients with chronic diseases based on a hypothetical scenario. Results: The results indicated that patients have an overall positive perception of AI-based home care systems. Their attitudes toward the technology, perceived usefulness, and comfortability were found to be significant factors encouraging adoption, with a clear understanding of accountability being a particularly influential factor in shaping patients' attitudes toward their motivation to use these systems. However, privacy concerns persist as an indirect factor, affecting the perceived usefulness and comfortability, hence influencing patients' attitudes. Conclusions: This study is one of the first to examine the motivation of patients with chronic diseases to adopt AI-based home care systems, offering practical insights for policy makers, care or technology providers, and patients. This understanding can facilitate effective policy formulation, product design, and informed patient decision-making, potentially improving the overall health status of patients with chronic diseases. ",
doi="10.2196/49788",
url="https://humanfactors.jmir.org/2023/1/e49788",
url="http://www.ncbi.nlm.nih.gov/pubmed/37930780"
}


@Article{info:doi/10.2196/47586,
author="de Ruiter, Hans-Peter
and Clisbee, David
and Houston, Rebecca
and Sk{\"a}rs{\"a}ter, Ingela",
title="The Ethical, Care, and Client-Caregiver Relationship Impacts Resulting From Introduction of Digital Communication and Surveillance Technologies in the Home Setting: Qualitative Inductive Study",
journal="JMIR Hum Factors",
year="2023",
month="Nov",
day="3",
volume="10",
pages="e47586",
keywords="home care",
keywords="caregivers",
keywords="ethical implications",
keywords="communication technology",
keywords="surveillance technology",
keywords="public health nursing practices",
keywords="digital vulnerability",
keywords="care of the elderly",
abstract="Background: Embedding communication and surveillance technology into the home health care setting has demonstrated the capacity for increased data efficiency, assumptions of convenience, and smart solutions to pressing problems such as caregiver shortages amid a rise in the aging population. The race to develop and implement these technologies within home care and public health nursing often leaves several ethical questions needing to be answered. Objective: The aim of this study was to understand the ethical and care implications of implementing digital communication and surveillance technologies in the home setting as perceived by health caregivers practicing in the region of Halland in Sweden with clients receiving home care services. Methods: A questionnaire was completed by 1260 home health caregivers and the written responses were evaluated by qualitative inductive content analysis. The researchers reviewed data independently and consensus was used to determine themes. Results: This study identified three main themes that illustrate ethical issues and unintended effects as perceived by caregivers of introducing digital communication and surveillance technologies in the home: (1) digital dependence vulnerability, (2) moral distress, and (3) interruptions to caregiving. This study highlights the consequences of technology developers and health systems leaders unintentionally ignoring the perspectives of caregivers who practice the intuitive artistry of providing care to other humans. Conclusions: Beyond the obtrusiveness of devices and impersonal data collection designed to emphasize health care system priorities, this study discovered a multifaceted shadow side of unintended consequences that arise from misalignment between system priorities and caregiver expertise, resulting in ethical issues. To develop communication and surveillance technologies that meet the needs of all stakeholders, it is important to involve caregivers who work with clients in the development process of new health care technology to improve both the quality of life of clients and the services offered by caregivers. ",
doi="10.2196/47586",
url="https://humanfactors.jmir.org/2023/1/e47586",
url="http://www.ncbi.nlm.nih.gov/pubmed/37921843"
}


@Article{info:doi/10.2196/47624,
author="Longacre, L. Margaret
and Chwistek, Marcin
and Keleher, Cynthia
and Siemon, Mark
and Egleston, L. Brian
and Collins, Molly
and Fang, Y. Carolyn",
title="Patient-Caregiver Portal System in Palliative Oncology: Assessment of Usability and Perceived Benefit",
journal="JMIR Hum Factors",
year="2023",
month="Nov",
day="2",
volume="10",
pages="e47624",
keywords="caregiving",
keywords="patient portal, health policy",
keywords="palliative oncology",
keywords="oncology",
keywords="engagement",
keywords="family caregiver",
keywords="caregiver",
keywords="communication",
keywords="usage",
keywords="usability",
keywords="clinical care",
keywords="cancer",
abstract="Background: The engagement of family caregivers in oncology is not universal or systematic. Objective: We implemented a process intervention (ie, patient-caregiver portal system) with an existing patient portal system to (1) allow a patient to specify their caregiver and communication preferences with that caregiver, (2) connect the caregiver to a unique caregiver-specific portal page to indicate their needs, and (3) provide an electronic notification of the dyad's responses to the care team to inform clinicians and connect the caregiver to resources as needed. Methods: We assessed usability and satisfaction with this patient-caregiver portal system among patients with cancer receiving palliative care, their caregivers, and clinicians. Results: Of 31 consented patient-caregiver dyads, 20 patients and 19 caregivers logged in. Further, 60\% (n=12) of patients indicated a preference to communicate equally or together with their caregiver. Caregivers reported high emotional (n=9, 47.3\%), financial (n=6, 31.6\%), and physical (n=6, 31.6\%) caregiving-related strain. The care team received all patient-caregiver responses electronically. Most patients (86.6\%, 13/15 who completed the user experience interview) and caregivers (94\%, 16/17 who completed the user experience interview) were satisfied with the system, while, of the 6 participating clinicians, 66.7\% agreed ``quite a bit'' (n=1, 16.7\%) or ``very much'' (n=3, 50\%) that the system allowed them to provide better care. Conclusions: Our findings demonstrate system usability, including a systematic way to identify caregiver needs and share with the care team in a way that is acceptable to patients and caregivers and perceived by clinicians to benefit clinical care. Integration of a patient-caregiver portal system may be an effective approach for systematically engaging caregivers. These findings highlight the need for additional research among caregivers of patients with less advanced cancer or with different illnesses. ",
doi="10.2196/47624",
url="https://humanfactors.jmir.org/2023/1/e47624",
url="http://www.ncbi.nlm.nih.gov/pubmed/37917129"
}


@Article{info:doi/10.2196/49319,
author="Sharma, Nikita
and Braakman-Jansen, A. Louise M.
and Oinas-Kukkonen, Harri
and Croockewit, Hendrik Jan
and Gemert-Pijnen, van JEWC",
title="Exploring the Needs and Requirements of Informal Caregivers of Older Adults With Cognitive Impairment From Sensor-Based Care Solutions: Multimethod Study",
journal="JMIR Aging",
year="2023",
month="Oct",
day="25",
volume="6",
pages="e49319",
keywords="informal caregiving",
keywords="cognitive impairment",
keywords="unobtrusive sensing solutions",
keywords="in-home care",
keywords="aging in place",
keywords="assistive technologies",
abstract="Background: With the increase in the older adult population, sensor-based care solutions that can monitor the deviations in physical, emotional, and physiological activities in real-time from a distance are demanded for prolonging the stay of community-dwelling older adults with cognitive impairment. To effectively develop and implement these care solutions, it is important to understand the current experiences, future expectations, perceived usefulness (PU), and communication needs of the informal caregivers of older adults with cognitive impairment regarding such solutions. Objective: This comprehensive study with informal caregivers of older adults with cognitive impairment aims to (1) highlight current experiences with (if any) and future expectations from general sensor-based care solutions, (2) explore PU specifically toward unobtrusive sensing solutions (USSs), (3) determine the information communication (IC) needs and requirements for communicating the information obtained through USSs in different care scenarios (fall, nocturnal unrest, agitation, and normal daily life), and (4) elicit the design features for designing the interaction platform in accordance with the persuasive system design (PSD) model. Methods: A multimethod research approach encompassing a survey (N=464) and in-depth interviews (10/464, 2.2\%) with informal caregivers of older adults with cognitive impairment was used. The insights into past experiences with and future expectations from the sensor-based care solutions were obtained through inductive thematic analysis of the interviews. A convergent mixed methods approach was used to explore PU and gather the IC needs from USSs by using scenario-specific questions in both survey and interviews. Finally, the design features were elicited by using the PSD model on the obtained IC needs and requirements. Results: Informal caregivers expect care infrastructure to consider centralized and empathetic care approaches. Specifically, sensor-based care solutions should be adaptable to care needs, demonstrate trust and reliability, and ensure privacy and safety. Most informal caregivers found USSs to be useful for emergencies (mean 4.09, SD 0.04) rather than for monitoring normal daily life activities (mean 3.50, SD 0.04). Moreover, they display variations in information needs including mode, content, time, and stakeholders involved based on the care scenario at hand. Finally, PSD features, namely, reduction, tailoring, personalization, reminders, suggestions, trustworthiness, and social learning, were identified for various care scenarios. Conclusions: From the obtained results, it can be concluded that the care scenario at hand drives PU and IC design needs and requirements toward USSs. Therefore, future technology developers are recommended to develop technology that can be easily adapted to diverse care scenarios, whereas designers of such sensor-driven platforms are encouraged to go beyond tailoring and strive for strong personalization while maintaining the privacy of the users. ",
doi="10.2196/49319",
url="https://aging.jmir.org/2023/1/e49319",
url="http://www.ncbi.nlm.nih.gov/pubmed/37878353"
}


@Article{info:doi/10.2196/46995,
author="Matos Queir{\'o}s, Alcina
and von Gunten, Armin
and Rosselet Amoussou, Jo{\"e}lle
and Martins, Manuela Maria
and Verloo, Henk",
title="Relationship Between Depression and Falls Among Nursing Home Residents: Protocol for an Integrative Review",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="19",
volume="12",
pages="e46995",
keywords="depression",
keywords="falls",
keywords="nursing homes",
keywords="nursing home residents",
keywords="older adults",
keywords="fall risk",
keywords="intervention",
abstract="Background: Aging exposes individuals to new health disorders and debilitating chronic diseases, yet most older adults, even in functional decline, do not want to leave their homes. Nevertheless, for many, institutionalization in a nursing home (NH) may become essential to ensure their continued safety and health. Depression is one of the most common psychiatric disorders among older adults, especially among those who are institutionalized. Depressed NH residents face a high risk of future functional decline and falls, decreasing their quality of life. The relationship between depression and falls is complex and bidirectional. Previous reviews have focused on home-dwelling older adults or explored the relationship between antidepressant drugs and falls. To the best of our knowledge, no integrative literature reviews have explored the relationship between depression and falls among NH residents. Objective: Analyze studies on the relationship between depression and falls among NH residents. Methods: We will conduct an integrative literature review of published articles in relevant scientific journals on the relationship between depression and depressive symptomatology and falls among NH residents. As usually defined, we will consider NH residents to be people aged 65 years and older who can no longer live safely and independently in their homes. We will also consider older adults on short-term stays in an NH for rehabilitation after hospital discharge. Retrieved articles will be screened for eligibility and analyzed following previously reported steps. The most pertinent bibliographical databases will be examined for qualitative, quantitative, and mixed methods studies, from inception until August 31, 2023, thus ensuring that all relevant literature is included. We will also hand-search the bibliographies of all the relevant articles found and search for unpublished studies in any language. If appropriate, we will consider conducting a meta-analysis of the studies retrieved. Results: A first round of data collection was completed in March 2023. We retrieved a total of 2276 references. A supplementary literature search to ensure the most up-to-date evidence is ongoing. We anticipate that the review will be completed in late September 2023, and we expect to publish results at the end of December 2023. Conclusions: This integrative review will increase knowledge and understanding of the complex relationship between depression and falls in NH environments. Its findings will be important for developing integrated, multidisciplinary models and care recommendations, adaptable to each NH resident's situation and health status, and for creating preventive interventions to help them maintain or recover optimal health stability. International Registered Report Identifier (IRRID): DERR1-10.2196/46995 ",
doi="10.2196/46995",
url="https://www.researchprotocols.org/2023/1/e46995",
url="http://www.ncbi.nlm.nih.gov/pubmed/37856175"
}


@Article{info:doi/10.2196/50108,
author="Woodworth, C. Emily
and Briskin, A. Ellie
and Plys, Evan
and Macklin, Eric
and Tatar, G. Raquel
and Huberty, Jennifer
and Vranceanu, Ana-Maria",
title="Mindfulness-Based App to Reduce Stress in Caregivers of Persons With Alzheimer Disease and Related Dementias: Protocol for a Single-Blind Feasibility Proof-of-Concept Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2023",
month="Oct",
day="13",
volume="12",
pages="e50108",
keywords="caregiver",
keywords="dementia",
keywords="mindfulness",
keywords="mobile app",
keywords="protocol",
keywords="randomized controlled trial",
abstract="Background: Informal caregivers (ie, individuals who provide assistance to a known person with health or functional needs, often unpaid) experience high levels of stress. Caregiver stress is associated with negative outcomes for both caregivers and care recipients. Mindfulness-based interventions (MBIs) show promise for improving stress, emotional distress, and sleep disturbance in caregivers of persons with Alzheimer disease and related dementias (ADRD). Commercially available mobile mindfulness apps can deliver MBIs to caregivers of persons with ADRD in a feasible and cost-effective manner. Objective: We are conducting a single-blind feasibility proof-of-concept randomized controlled trial (RCT; National Institutes of Health [NIH] stage 1B) comparing 2 free mobile apps: the active intervention Healthy Minds Program (HMP) with within-app text tailored for addressing stress among caregivers of persons with ADRD, versus Wellness App (WA), a time- and dose-matched educational control also tailored for caregivers of persons with ADRD. Methods: We aim to recruit 80 geographically diverse and stressed caregivers of persons with ADRD. Interested caregivers use a link or QR code on a recruitment flyer to complete a web-based eligibility screener. Research assistants conduct enrollment phone calls, during which participants provide informed consent digitally. After participants complete baseline surveys, we randomize them to the mindfulness-based intervention (HMP) or educational control podcast app (WA) and instruct them to listen to prescribed content for 10 minutes per day (70 minutes per week) for 12 weeks. Caregivers are blinded to intervention versus control. The study team checks adherence weekly and contacts participants to promote adherence as needed. Participants complete web-based self-report measures at baseline, posttest, and follow-up; weekly process measures are also completed. Primary outcomes are a priori set feasibility benchmarks. Secondary outcomes are stress, emotional distress, sleep disturbance, caregiver burden, mindfulness, awareness, connection, insight, and purpose. We will calculate 1-sided 95\% CI to assess feasibility benchmarks. Effect sizes of change in outcomes will be used to examine the proof of concept. Results: Recruitment started on February 20, 2023. We have enrolled 27 caregivers (HMP: n=14; WA: n=13) as of June 2023. Funding began in August 2022, and we plan to finish enrollment by December 2023. Data analysis is expected to begin in May 2024 when all follow-ups are complete; publication of findings will follow. Conclusions: Through this trial, we aim to establish feasibility benchmarks for HMP and WA, as well as establish a proof of concept that HMP improves stress (primary quantitative outcome), emotional distress, sleep, and mindfulness more than WA. Results will inform a future efficacy trial (NIH stage II). HMP has the potential to be a cost-effective solution to reduce stress in caregivers of persons with ADRD, benefiting caregiver health and quality of care as well as patient care. Trial Registration: ClinicalTrials.gov NCT05732038; https://clinicaltrials.gov/study/NCT05732038 International Registered Report Identifier (IRRID): DERR1-10.2196/50108 ",
doi="10.2196/50108",
url="https://www.researchprotocols.org/2023/1/e50108",
url="http://www.ncbi.nlm.nih.gov/pubmed/37831492"
}


@Article{info:doi/10.2196/41035,
author="Stara, Vera
and Soraci, Luca
and Takano, Eiko
and Kondo, Izumi
and M{\"o}ller, Johanna
and Maranesi, Elvira
and Luzi, Riccardo
and Riccardi, Renato Giovanni
and Browne, Ryan
and Dacunha, S{\'e}bastien
and Palmier, Cecilia
and Wieching, Rainer
and Ogawa, Toshimi
and Bevilacqua, Roberta",
title="Intrinsic Capacity and Active and Healthy Aging Domains Supported by Personalized Digital Coaching: Survey Study Among Geriatricians in Europe and Japan on eHealth Opportunities for Older Adults",
journal="J Med Internet Res",
year="2023",
month="Oct",
day="12",
volume="25",
pages="e41035",
keywords="intrinsic capacity",
keywords="functional ability, active and healthy aging",
keywords="digital coaching",
keywords="eHealth interventions",
keywords="older adults",
abstract="Background: The worldwide aging trend requires conceptually new prevention, care, and innovative living solutions to support human-based care using smart technology, and this concerns the whole world. Enabling access to active and healthy aging through personalized digital coaching services like physical activity coaching, cognitive training, emotional well-being, and social connection for older adults in real life could offer valuable advantages to both individuals and societies. A starting point might be the analysis of the perspectives of different professionals (eg, geriatricians) on such technologies. The perspectives of experts in the sector may allow the individualization of areas of improvement of clinical interventions, supporting the positive perspective pointed out by the intrinsic capacity framework. Objective: The overall aim of this study was to explore the cross-national perspectives and experiences of different professionals in the field of intrinsic capacity, and how it can be supported by eHealth interventions. To our knowledge, this is the first study to explore geriatric care providers' perspectives about technology-based interventions to support intrinsic capacity. Methods: A survey involving 20 geriatricians or clinical experts in the fields of intrinsic capacity and active and healthy aging was conducted in Italy, France, Germany, and Japan between August and September 2021. Results: The qualitative findings pointed out relevant domains for eHealth interventions and provided examples for successful practices that support subjective well-being under the intrinsic capacity framework (the benefits offered by personalized interventions, especially by promoting health literacy but avoiding intrusiveness). Moreover, eHealth interventions could be used as a bridge that facilitates and enables social engagement; an instrument that facilitates communication between doctors and patients; and a tool to enrich the monitoring actions of medical staff. Conclusions: There is an unexplored and significant role for such geriatric perspectives to help the development process and evaluate the evidence-based results on the effectiveness of technologies for older people. This is possible only when clinicians collaborate with data scientists, engineers, and developers in order to match the complex daily needs of older adults. ",
doi="10.2196/41035",
url="https://www.jmir.org/2023/1/e41035",
url="http://www.ncbi.nlm.nih.gov/pubmed/37824183"
}


@Article{info:doi/10.2196/47550,
author="Hunsbedt Fjells{\aa}, Marie Hilde
and Huseb{\o}, Lunde Anne Marie
and Braut, Harald
and Mikkelsen, Aslaug
and Storm, Marianne",
title="Older Adults' Experiences With Participation and eHealth in Care Coordination: Qualitative Interview Study in a Primary Care Setting",
journal="J Particip Med",
year="2023",
month="Oct",
day="2",
volume="15",
pages="e47550",
keywords="care coordination",
keywords="older adults",
keywords="participation",
keywords="eHealth",
keywords="primary health care",
abstract="Background: Owing to the demographic changes in the elderly population worldwide, delivering coordinated care at home to multimorbid older adults is of great importance. Older adults living with multiple chronic conditions need information to manage and coordinate their care. eHealth can be effective for gaining sufficient information, communicating, and self-managing chronic conditions. However, incorporating older adults' health preferences and ensuring active involvement remain challenging. More knowledge is needed to ensure successful participation and eHealth use in care coordination. Objective: This study aimed to explore multimorbid older adults' experiences with participation and eHealth in care coordination with general practitioners (GPs) and district nurses (DNs). Methods: The study had a qualitative explorative approach. Data collection included semistructured interviews with 20 older adults with multimorbidity receiving primary care services from their GPs and DNs. The participants were included by their GPs or nurses at a local intermunicipal acute inpatient care unit. The data analysis was guided by systematic text condensation. Results: We identified 2 categories: (1) older adults in charge of and using eHealth in care coordination, and (2) older adults with a loss of control in care coordination. The first category describes how communication with GPs and DNs can facilitate participation, the importance of managing own medication, and how eHealth can support older adults' information needs. The second category focuses on older adults who depend on guidance and help from their GPs and DNs to manage their health, describing how a lack of capacity and system support to be involved makes these adults lose control of their care coordination. Conclusions: Being in charge of care coordination is important for older multimorbid adults. The results show that older adults are willing to use eHealth to be informed and to seek information, which ensures high levels of participation in care coordination. Future research should investigate how older adults can be involved in electronic information sharing with health care providers. ",
doi="10.2196/47550",
url="https://jopm.jmir.org/2023/1/e47550",
url="http://www.ncbi.nlm.nih.gov/pubmed/37782538"
}


@Article{info:doi/10.2196/43099,
author="Wang, Jitao
and Wu, Zhenke
and Choi, Won Sung
and Sen, Srijan
and Yan, Xinghui
and Miner, A. Jennifer
and Sander, M. Angelle
and Lyden, K. Angela
and Troost, P. Jonathan
and Carlozzi, E. Noelle",
title="The Dosing of Mobile-Based Just-in-Time Adaptive Self-Management Prompts for Caregivers: Preliminary Findings From a Pilot Microrandomized Study",
journal="JMIR Form Res",
year="2023",
month="Sep",
day="14",
volume="7",
pages="e43099",
keywords="caregiver",
keywords="just-in-time adaptive intervention",
keywords="JITAI",
keywords="mobile health intervention",
keywords="health-related quality of life",
keywords="HRQOL",
keywords="intervention",
keywords="self-management",
keywords="quality of life",
keywords="psychological",
keywords="effectiveness",
keywords="acceptability",
keywords="feasibility",
keywords="design",
keywords="anxiety",
keywords="depression",
keywords="QOL",
keywords="affect",
keywords="medication",
keywords="pharma",
keywords="rehab",
keywords="wearable",
keywords="ubiquitous",
keywords="accelerometer",
keywords="sleep",
keywords="polysomnography",
keywords="PROMIS Anxiety",
keywords="PROMIS Depression",
keywords="computer adaptive test",
keywords="CAT",
keywords="generalized estimating equations",
keywords="GEE",
keywords="weighted and centered least square",
keywords="WCLS",
abstract="Background: Caregivers of people with chronic illnesses often face negative stress-related health outcomes and are unavailable for traditional face-to-face interventions due to the intensity and constraints of their caregiver role. Just-in-time adaptive interventions (JITAIs) have emerged as a design framework that is particularly suited for interventional mobile health studies that deliver in-the-moment prompts that aim to promote healthy behavioral and psychological changes while minimizing user burden and expense. While JITAIs have the potential to improve caregivers' health-related quality of life (HRQOL), their effectiveness for caregivers remains poorly understood. Objective: The primary objective of this study is to evaluate the dose-response relationship of a fully automated JITAI-based self-management intervention involving personalized mobile app notifications targeted at decreasing the level of caregiver strain, anxiety, and depression. The secondary objective is to investigate whether the effectiveness of this mobile health intervention was moderated by the caregiver group. We also explored whether the effectiveness of this intervention was moderated by (1) previous HRQOL measures, (2) the number of weeks in the study, (3) step count, and (4) minutes of sleep. Methods: We examined 36 caregivers from 3 disease groups (10 from spinal cord injury, 11 from Huntington disease, and 25 from allogeneic hematopoietic cell transplantation) in the intervention arm of a larger randomized controlled trial (subjects in the other arm received no prompts from the mobile app) designed to examine the acceptability and feasibility of this intensive type of trial design. A series of multivariate linear models implementing a weighted and centered least squares estimator were used to assess the JITAI efficacy and effect. Results: We found preliminary support for a positive dose-response relationship between the number of administered JITAI messages and JITAI efficacy in improving caregiver strain, anxiety, and depression; while most of these associations did not meet conventional levels of significance, there was a significant association between high-frequency JITAI and caregiver strain. Specifically, administering 5-6 messages per week as opposed to no messages resulted in a significant decrease in the HRQOL score of caregiver strain with an estimate of --6.31 (95\% CI --11.76 to --0.12; P=.046). In addition, we found that the caregiver groups and the participants' levels of depression in the previous week moderated JITAI efficacy. Conclusions: This study provides preliminary evidence to support the effectiveness of the self-management JITAI and offers practical guidance for designing future personalized JITAI strategies for diverse caregiver groups. Trial Registration: ClinicalTrials.gov NCT04556591; https://clinicaltrials.gov/ct2/show/NCT04556591 ",
doi="10.2196/43099",
url="https://formative.jmir.org/2023/1/e43099",
url="http://www.ncbi.nlm.nih.gov/pubmed/37707948"
}


@Article{info:doi/10.2196/43258,
author="Brown-Johnson, G. Cati
and Lessios, Sophia Anna
and Thomas, Samuel
and Kim, Mirini
and Fukaya, Eri
and Wu, Siqi
and Kling, R. Samantha M.
and Brown, Gretchen
and Winget, Marcy",
title="A Nurse-Led Care Delivery App and Telehealth System for Patients Requiring Wound Care: Mixed Methods Implementation and Evaluation Study",
journal="JMIR Form Res",
year="2023",
month="Aug",
day="23",
volume="7",
pages="e43258",
keywords="nursing",
keywords="telehealth",
keywords="telemedicine",
keywords="follow-up",
keywords="wound care",
keywords="capacity building",
keywords="mobile phone",
abstract="Background: Innovative solutions to nursing care are needed to address nurse, health system, patient, and caregiver concerns related to nursing wellness, work flexibility and control, workforce retention and pipeline, and access to patient care. One innovative approach includes a novel health care delivery model enabling nurse-led, off-hours wound care (PocketRN) to triage emergent concerns and provide additional patient health education via telehealth. Objective: This pilot study aimed to evaluate the implementation of PocketRN from the perspective of nurses and patients. Methods: Patients and part-time or per-diem, wound care--certified and generalist nurses were recruited through the Stanford Medicine Advanced Wound Care Center in 2021 and 2022. Qualitative data included semistructured interviews with nurses and patients and clinical documentation review. Quantitative data included app use and brief end-of-interaction in-app satisfaction surveys. Results: This pilot study suggests that an app-based nursing care delivery model is acceptable, clinically appropriate, and feasible. Low technology literacy had a modest effect on initial patient adoption; this barrier was addressed with built-in outreach and by simplifying the patient experience (eg, via phone instead of video calls). This approach was acceptable for users, despite total patient enrollment and use numbers being lower than anticipated (N=49; 17/49, 35\% of patients used the app at least once beyond the orientation call). We interviewed 10 patients: 7 who had used the app were satisfied with it and reported that real-time advice after hours reduced anxiety, and 3 who had not used the app after enrollment reported having other resources for health care advice and noted their perception that this tool was meant for urgent issues, which did not occur for them. Interviewed nurses (n=10) appreciated working from home, and they reported comfort with the scope of practice and added quality of care facilitated by video capabilities; there was interest in additional wound care--specific training for nonspecialized nurses. Nurses were able to provide direct patient care over the web, including the few participating nurses who were unable to perform in-person care (n=2). Conclusions: This evaluation provides insights into the integration of technology into standard health care services, such as in-clinic wound care. Using in-system nurses with access to electronic medical records and specialized knowledge facilitated app integration and continuity of care. This care delivery model satisfied nurse desires for flexible and remote work and reduced patient anxiety, potentially reducing postoperative wound care complications. Feasibility was negatively impacted by patients' technology literacy and few language options; additional patient training, education, and language support are needed to support equitable access. Adoption was impacted by a lack of perceived need for additional care; lower-touch or higher-acuity settings with a longer wait between visits could be a better fit for this type of nurse-led care. ",
doi="10.2196/43258",
url="https://formative.jmir.org/2023/1/e43258",
url="http://www.ncbi.nlm.nih.gov/pubmed/37610798"
}


@Article{info:doi/10.2196/46480,
author="Krafft, Jelena
and Barisch-Fritz, Bettina
and Krell-Roesch, Janina
and Trautwein, Sandra
and Scharpf, Andrea
and Woll, Alexander",
title="A Tablet-Based App to Support Nursing Home Staff in Delivering an Individualized Cognitive and Physical Exercise Program for Individuals With Dementia: Mixed Methods Usability Study",
journal="JMIR Aging",
year="2023",
month="Aug",
day="22",
volume="6",
pages="e46480",
keywords="dementia",
keywords="individualized physical exercise",
keywords="tailored exercise",
keywords="physical activity",
keywords="older adults",
keywords="app",
keywords="mobile health",
keywords="mHealth",
keywords="usability",
keywords="mobile phone",
abstract="Background: The promotion of physical activity in individuals with dementia living in nursing homes is crucial for preserving physical and cognitive functions and the associated quality of life. Nevertheless, the implementation of physical activity programs in this setting is challenging, as the time and expertise of nursing home staff are limited. This situation was further exacerbated by the COVID-19 pandemic. Mobile health apps may be a sustainable approach to overcome these challenges in the long term. Therefore, the Individualized Cognitive and Physical Exercise-App (the InCoPE-App) was developed to support nursing home staff in delivering and implementing tailored cognitive and physical exercise training for individuals with dementia. Objective: This study aims to assess the usability of the InCoPE-App in terms of user performance and user perception in a laboratory setting using a mixed methods approach. Methods: Nursing home staff were encouraged to perform 5 basic tasks within the InCoPE-App. Their thoughts while using the app were captured by implementing a think aloud protocol. Then, participants completed the System Usability Scale questionnaire. The think aloud transcripts were qualitatively evaluated to unveil usability issues. All identified issues were rated in terms of their necessity to be fixed. Task completion (ie, success rate and time) and perceived usability were evaluated descriptively. Results: A total of 14 nursing home employees (mean age 53.7, SD 10.6 years; n=13, 93\% women) participated in the study. The perceived usability of the InCoPE-App, as assessed by the System Usability Scale questionnaire, can be rated as ``good.'' The main usability issues concerned navigation logic and comprehensibility of app content. Conclusions: The InCoPE-App is a user-friendly app that enables nursing home staff to deliver and implement cognitive and physical exercise training for individuals with dementia in nursing homes. The InCoPE-App can be used with little training, even by people aged ?50 years, who may have low digital literacy. To achieve sustainable use and high user satisfaction of the InCoPE-App in the long term, it should be implemented and evaluated in a field study. ",
doi="10.2196/46480",
url="https://aging.jmir.org/2023/1/e46480",
url="http://www.ncbi.nlm.nih.gov/pubmed/37606974"
}


@Article{info:doi/10.2196/50231,
author="Powell, R. Kimberly
and Popescu, Mihail
and Lee, Suhwon
and Mehr, R. David
and Alexander, L. Gregory",
title="Examining the Use of Text Messages Among Multidisciplinary Care Teams to Reduce Avoidable Hospitalization of Nursing Home Residents with Dementia: Protocol for a Secondary Analysis",
journal="JMIR Res Protoc",
year="2023",
month="Aug",
day="9",
volume="12",
pages="e50231",
keywords="age-friendly health systems",
keywords="Alzheimer disease",
keywords="communication",
keywords="dementia",
keywords="nursing homes",
keywords="older adults",
abstract="Background: Reducing avoidable nursing home (NH)--to-hospital transfers of residents with Alzheimer disease or a related dementia (ADRD) has become a national priority due to the physical and emotional toll it places on residents and the high costs to Medicare and Medicaid. Technologies supporting the use of clinical text messages (TMs) could improve communication among health care team members and have considerable impact on reducing avoidable NH-to-hospital transfers. Although text messaging is a widely accepted mechanism of communication, clinical models of care using TMs are sparsely reported in the literature, especially in NHs. Protocols for assessing technologies that integrate TMs into care delivery models would be beneficial for end users of these systems. Without evidence to support clinical models of care using TMs, users are left to design their own methods and protocols for their use, which can create wide variability and potentially increase disparities in resident outcomes. Objective: Our aim is to describe the protocol of a study designed to understand how members of the multidisciplinary team communicate using TMs and how salient and timely communication can be used to avert poor outcomes for NH residents with ADRD, including hospitalization. Methods: This project is a secondary analysis of data collected from a Centers for Medicare \& Medicaid Services (CMS)--funded demonstration project designed to reduce avoidable hospitalizations for long-stay NH residents. We will use two data sources: (1) TMs exchanged among the multidisciplinary team across the 7-year CMS study period (August 2013-September 2020) and (2) an adapted acute care transfer tool completed by advanced practice registered nurses to document retrospective details about NH-to-hospital transfers. The study is guided by an age-friendly model of care called the 4Ms (What Matters, Medications, Mentation, and Mobility) framework. We will use natural language processing, statistical methods, and social network analysis to generate a new ontology and to compare communication patterns found in TMs occurring around the time NH-to-hospital transfer decisions were made about residents with and without ADRD. Results: After accounting for inclusion and exclusion criteria, we will analyze over 30,000 TMs pertaining to over 3600 NH-to-hospital transfers. Development of the 4M ontology is in progress, and the 3-year project is expected to run until mid-2025. Conclusions: To our knowledge, this project will be the first to explore the content of TMs exchanged among a multidisciplinary team of care providers as they make decisions about NH-to-hospital resident transfers. Understanding how the presence of evidence-based elements of high-quality care relate to avoidable hospitalizations among NH residents with ADRD will generate knowledge regarding the future scalability of behavioral interventions. Without this knowledge, NHs will continue to rely on ineffective and outdated communication methods that fail to account for evidence-based elements of age-friendly care. International Registered Report Identifier (IRRID): DERR1-10.2196/50231 ",
doi="10.2196/50231",
url="https://www.researchprotocols.org/2023/1/e50231",
url="http://www.ncbi.nlm.nih.gov/pubmed/37556199"
}


@Article{info:doi/10.2196/44498,
author="Pol, Margriet
and Qadeer, Amarzish
and van Hartingsveldt, Margo
and Choukou, Mohamed-Amine",
title="Perspectives of Rehabilitation Professionals on Implementing a Validated Home Telerehabilitation Intervention for Older Adults in Geriatric Rehabilitation: Multisite Focus Group Study",
journal="JMIR Rehabil Assist Technol",
year="2023",
month="Jul",
day="18",
volume="10",
pages="e44498",
keywords="aging in place",
keywords="aging well",
keywords="digital technology",
keywords="remote monitoring",
keywords="activity",
keywords="sensor",
keywords="mobile phone",
abstract="Background: Owing to demographic trends and increasing health care costs, quick discharge with geriatric rehabilitation at home is advised and recommended for older adults. Telerehabilitation has been identi?ed as a promising tool to support rehabilitation at home. However, there is insufficient knowledge about how to implement a validated home telerehabilitation system in other contexts. One of the major challenges for rehabilitation professionals is transitioning to a blended work process in which human coaching is supplemented via digital care. Objective: The study aimed to gain an in-depth understanding of the factors that influence the implementation of an evidence-based sensor monitoring intervention (SMI) for older adults by analyzing the perspectives of rehabilitation professionals working in 2 different health ecosystems and mapping SMI barriers and facilitators. Methods: We adopted a qualitative study design to conduct 2 focus groups, 1 in person in the Netherlands during winter of 2017 and 1 on the web via Zoom (Zoom Video Communications; owing to the COVID-19 pandemic) in Canada during winter of 2022, to explore rehabilitation providers' perspectives about implementing SMI. Qualitative data obtained were analyzed using thematic analysis. Participants were a group of rehabilitation professionals in the Netherlands who have previously worked with the SMI and a group of rehabilitation professionals in the province of Manitoba (Canada) who have not previously worked with the SMI but who were introduced to the intervention through a 30-minute web-based presentation before the focus group. Results: The participants expressed different characteristics of the telerehabilitation intervention that contributed to making the intervention successful for at-home rehabilitation: focus on future participation goals, technology support provides the rehabilitation professionals with objective and additional insight into the daily functioning of the older adults at home, SMI can be used as a goal-setting tool, and SMI deepens their contact with older adults. The analysis showed facilitators of and barriers to the implementation of the telerehabilitation intervention. These included personal or client-related, therapist-related, and technology-related aspects. Conclusions: Rehabilitation professionals believed that telerehabilitation could be suitable for monitoring and supporting older adults' rehabilitation at home. To better guide the implementation of telerehabilitation in the daily practice of rehabilitation professionals, the following steps are needed: ensuring that technology is feasible for communities with limited digital health literacy and cognitive impairments, developing instruction tools and guidelines, and training and coaching of rehabilitation professionals. ",
doi="10.2196/44498",
url="https://rehab.jmir.org/2023/1/e44498",
url="http://www.ncbi.nlm.nih.gov/pubmed/37463040"
}


@Article{info:doi/10.2196/47009,
author="Hasan, Mosaad Mohamed
and Rafferty, R. Miriam
and Tawfik, Sara
and Tawfik, Ahmed
and Beestrum, Molly
and Smith, D. Justin
and Hirschhorn, R. Lisa
and Roth, J. Elliot
and Woods, M. Donna",
title="Implementation of Home-Based Telerehabilitation of Patients With Stroke in the United States: Protocol for a Realist Review",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="11",
volume="12",
pages="e47009",
keywords="telerehabilitation",
keywords="telemedicine",
keywords="stroke",
keywords="implementation",
keywords="realist review",
abstract="Background: Stroke is a common cause of mortality and morbidity. Insufficient and untimely rehabilitation has been associated with inadequate recovery. Telerehabilitation provides an opportunity for timely and accessible services for individuals with stroke, especially in remote areas. Telerehabilitation is defined as a health care team's use of a communication mode (eg, videoconferencing) to remotely provide rehabilitation services. Telerehabilitation is as effective as facility-based rehabilitation; however, it is infrequently used due to implementation barriers. Objective: The aim of the study is to explore the interaction between the implementation strategies, context, and outcomes of telerehabilitation of patients with stroke. Methods: This review will follow four steps: (1) defining the review scope, (2) literature search and quality appraisal, (3) data extraction and evidence synthesis, and (4) narrative development. PubMed via MEDLINE, the PEDro database, and CINAHL will be queried till June 2023 and supplemented with citation tracking and a gray literature search. The relevance and rigor of papers will be appraised using the TAPUPAS (Transparency, Accuracy, Purposivity, Utility, Propriety, Accessibility, and Specificity) and Weight of Evidence frameworks. The reviewers will extract and synthesize data iteratively and develop explanatory links between contexts, mechanisms, and outcomes. The results will be reported according to the Realist Synthesis publication standards set by Wong and colleagues in 2013. Results: The literature search and screening will be completed in July 2023. Data extraction and analysis will be completed in August 2023, and findings will be synthesized and reported in October 2023. Conclusions: This will be the first realist synthesis, uncovering the causal mechanisms to explain how, why, and to what extent implementation strategies impact telerehabilitation adoption and implementation. International Registered Report Identifier (IRRID): PRR1-10.2196/47009 ",
doi="10.2196/47009",
url="https://www.researchprotocols.org/2023/1/e47009",
url="http://www.ncbi.nlm.nih.gov/pubmed/37432721"
}


@Article{info:doi/10.2196/47568,
author="Schmidt, M. Steven
and Iwarsson, Susanne
and Hansson, {\AA}sa
and Dahlgren, David
and Kyl{\'e}n, Maya",
title="Homeownership While Aging---How Health and Economic Factors Incentivize or Disincentivize Relocation: Protocol for a Mixed Methods Project",
journal="JMIR Res Protoc",
year="2023",
month="Jul",
day="10",
volume="12",
pages="e47568",
keywords="housing market",
keywords="aging-in-place",
keywords="housing policy",
keywords="healthy aging",
keywords="mobility",
keywords="housing preferences",
abstract="Background: Many factors influence housing choices among older adults, but far from all have been identified. There is little systematic analysis that has included economic factors and virtually no knowledge about the interplay among perceived costs of moving, health status, and the mobility rate of older homeowners. It is currently unclear whether economic factors influence older adults' willingness to move, and the effects of economic policies on their actual behavior in the housing market are largely unknown. Objective: The overarching objective of the AGE-HERE project is to develop knowledge of the relationship between health and economic factors that incentivize or disincentivize relocation during the process of aging. Methods: This project uses a mixed methods convergent design across 4 studies. The initial quantitative register study and subsequent qualitative focus group study will nurture the evidence base and the development of a national survey. The final study will synthesize and integrate the results of the entire project. Results: Ethical approval for the register study (DNR 2022-04626-01) and focus group study (DNR 2023-01887-01) has been obtained. As of July 2023, data analyses (register study) and data collection (focus group study) are currently being conducted. The first paper based on the register data is expected to be submitted after the summer of 2023. Three meetings have been held with the nonacademic reference group. The qualitative data will be analyzed in the autumn. Based on the results of these studies, a survey questionnaire will be developed and distributed nationally during the spring of 2024, followed by data analyses in the autumn. Finally, the results from all studies will be synthesized in 2025. Conclusions: Results from AGE-HERE will add to the knowledge base for research on aging, health, and housing and can play a critical role in guiding future policy decisions aiming to balance the housing market. Such developments may lower related social costs and support older adults to maintain active, independent, and healthy lives. International Registered Report Identifier (IRRID): DERR1-10.2196/47568 ",
doi="10.2196/47568",
url="https://www.researchprotocols.org/2023/1/e47568",
url="http://www.ncbi.nlm.nih.gov/pubmed/37428548"
}


@Article{info:doi/10.2196/42283,
author="Darwich, S. Adam
and Bostr{\"o}m, Anne-Marie
and Guidetti, Susanne
and Raghothama, Jayanth
and Meijer, Sebastiaan",
title="Investigating the Connections Between Delivery of Care, Reablement, Workload, and Organizational Factors in Home Care Services: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2023",
month="Jun",
day="30",
volume="10",
pages="e42283",
keywords="aging",
keywords="intervention",
keywords="health policy",
keywords="health services administration and management",
keywords="health care intervention",
keywords="home care",
keywords="home support",
keywords="in-home assistance",
keywords="personal care",
keywords="policy",
keywords="reablement",
keywords="rehabilitation",
keywords="rehabilitation medicine",
keywords="social support",
keywords="stress",
keywords="support",
keywords="systems thinking",
keywords="user",
abstract="Background: Home care is facing increasing demand due to an aging population. Several challenges have been identified in the provision of home care, such as the need for support and tailoring support to individual needs. Goal-oriented interventions, such as reablement, may provide a solution to some of these challenges. The reablement approach targets adaptation to disease and relearning of everyday life skills and has been found to improve health-related quality of life while reducing service use. Objective: The objective of this study is to characterize home care system variables (elements) and their relationships (connections) relevant to home care staff workload, home care user needs and satisfaction, and the reablement approach. This is to examine the effects of improvement and interventions, such as the person-centered reablement approach, on the delivery of home care services, workload, work-related stress, home care user experience, and other organizational factors. The main focus was on Swedish home care and tax-funded universal welfare systems. Methods: The study used a mixed methods approach where a causal loop diagram was developed grounded in participatory methods with academic health care science research experts in nursing, occupational therapy, aging, and the reablement approach. The approach was supplemented with theoretical models and the scientific literature. The developed model was verified by the same group of experts and empirical evidence. Finally, the model was analyzed qualitatively and through simulation methods. Results: The final causal loop diagram included elements and connections across the categories: stress, home care staff, home care user, organization, social support network of the home care user, and societal level. The model was able to qualitatively describe observed intervention outcomes from the literature. The analysis suggested elements to target for improvement and the potential impact of relevant studied interventions. For example, the elements ``workload'' and ``distress'' were important determinants of home care staff health, provision, and quality of care. Conclusions: The developed model may be of value for informing hypothesis formulation, study design, and discourse within the context of improvement in home care. Further work will include a broader group of stakeholders to reduce the risk of bias. Translation into a quantitative model will be explored. ",
doi="10.2196/42283",
url="https://humanfactors.jmir.org/2023/1/e42283",
url="http://www.ncbi.nlm.nih.gov/pubmed/37389904"
}


@Article{info:doi/10.2196/43980,
author="Jaulmes, Luc
and Yordanov, Youri
and Descamps, Alexandre
and Durand-Zaleski, Isabelle
and Dinh, Aur{\'e}lien
and Jourdain, Patrick
and Dechartres, Agn{\`e}s",
title="Effectiveness and Medicoeconomic Evaluation of Home Monitoring of Patients With Mild COVID-19: Covidom Cohort Study",
journal="J Med Internet Res",
year="2023",
month="Jun",
day="23",
volume="25",
pages="e43980",
keywords="COVID-19",
keywords="Covidom",
keywords="home monitoring",
keywords="telehealth",
keywords="tele-surveillance",
keywords="primary outcome",
keywords="remote monitoring",
keywords="digital health intervention",
keywords="emergency medical service",
keywords="patient care",
keywords="digital care",
keywords="mobile phone",
abstract="Background: Covidom was a telemonitoring solution for home monitoring of patients with mild to moderate COVID-19, deployed in March 2020 in the Greater Paris area in France to alleviate the burden on the health care system. The Covidom solution included a free mobile application with daily monitoring questionnaires and a regional control center to quickly handle patient alerts, including dispatching emergency medical services when necessary. Objective: This study aimed to provide an overall evaluation of the Covidom solution 18 months after its inception in terms of effectiveness, safety, and cost. Methods: Our primary outcome was to measure effectiveness using the number of handled alerts, response escalation, and patient-reported medical contacts outside of Covidom. Then, we analyzed the safety of Covidom by assessing its ability to detect clinical worsening, defined as hospitalization or death, and the number of patients with clinical worsening without any preceding alert. We evaluated the cost of Covidom and compared the cost of hospitalization for Covidom and non-Covidom patients with mild COVID-19 cases seen in the emergency departments of the largest network of hospitals in the Greater Paris area (Assistance Publique-H{\^o}pitaux de Paris). Finally, we reported on user satisfaction. Results: Of the 60,073 patients monitored by Covidom, the regional control center handled 285,496 alerts and dispatched emergency medical services 518 times. Of the 13,204 respondents who responded to either of the follow-up questionnaires, 65.8\% (n=8690) reported having sought medical care outside the Covidom solution during their monitoring period. Of the 947 patients who experienced clinical worsening while adhering to daily monitoring, only 35 (3.7\%) did not previously trigger alerts (35 were hospitalized, including 1 who died). The average cost of Covidom was {\texteuro}54 (US \$1={\texteuro}0.8614) per patient, and the cost of hospitalization for COVID-19 worsening was significantly lower in Covidom than in non-Covidom patients with mild COVID-19 cases seen in the emergency departments of Assistance Publique-H{\^o}pitaux de Paris. The patients who responded to the satisfaction questionnaire had a median rating of 9 (out of 10) for the likelihood of recommending Covidom. Conclusions: Covidom may have contributed to alleviating the pressure on the health care system in the initial months of the pandemic, although its impact was lower than anticipated, with a substantial number of patients having consulted outside of Covidom. Covidom seems to be safe for home monitoring of patients with mild to moderate COVID-19. ",
doi="10.2196/43980",
url="https://www.jmir.org/2023/1/e43980",
url="http://www.ncbi.nlm.nih.gov/pubmed/37134021"
}


@Article{info:doi/10.2196/46156,
author="Garcia-Davis, Sandra
and Palacio, Ana
and Bast, Elizabeth
and Penney, S. Lauren
and Finley, Erin
and Kinosian, Bruce
and Intrator, Orna
and Dang, Stuti",
title="Peer-to--Patient-Aligned Care Team (Peer-to-PACT; P2P), a Peer-Led Home Visit Intervention Program for Targeting and Improving Long-term Care Services and Support for Veterans With High Needs and High Risk: Protocol for a Mixed Methods Feasibility Study",
journal="JMIR Res Protoc",
year="2023",
month="Jun",
day="12",
volume="12",
pages="e46156",
keywords="older veterans with high needs and high risk",
keywords="peer support specialists",
keywords="unmet needs",
keywords="home visit",
keywords="patient engagement",
keywords="home services",
keywords="care coordination",
abstract="Background: Keeping older veterans with high needs and high risk (HNHR) who are at risk of long-term institutional care safely in their homes for as long as possible is a Department of Veterans Affairs priority. Older veterans with HNHR face disproportionate barriers and disparities to engaging in their care, including accessing care and services. Veterans with HNHR often have poor ability to maintain health owing to complicated unmet health and social needs. The use of peer support specialists (peers) is a promising approach to improving patient engagement and addressing unmet needs. The Peer-to--Patient-Aligned Care Team (Peer-to-PACT; P2P) intervention is a multicomponential home visit intervention designed to support older veterans with HNHR to age in place. Participants receive a peer-led home visit to identify unmet needs and home safety risks aligned with the age-friendly health system model; care coordination, health care system navigation, and linking to needed services and resources in collaboration with their PACT; and patient empowerment and coaching using Department of Veterans Affairs whole health principles. Objective: The primary aim of this study is to evaluate the preliminary effect of the P2P intervention on patient health care engagement. The second aim is to identify the number and types of needs and unmet needs as well as needs addressed using the P2P needs identification tool. The third aim is to evaluate the feasibility and acceptability of the P2P intervention delivered over 6 months. Methods: We will use a quantitative-qualitative convergent mixed methods approach to evaluate the P2P intervention outcomes. For our primary outcome, we will conduct an independent, 2-tailed, 2-sample t test to compare the means of the 6-month pre-post differences in the number of outpatient PACT encounters between the intervention and matched comparison groups. Qualitative data analysis will follow a structured rapid approach using deductive coding as well as the Consolidated Framework for Implementation Research. Results: Study enrollment began in July 2020 and was completed in March 2022. Our sample size consists of 114 veterans: 38 (33.3\%) P2P intervention participants and 76 (66.7\%) matched comparison group participants. Study findings are expected to be published in late 2023. Conclusions: Peers may help bridge the gap between PACT providers and veterans with HNHR by evaluating veterans' needs outside of the clinic, summarizing identified unmet needs, and developing team-based solutions in partnership with the PACT. The home visit component of the intervention provides eyes in the home and may be a promising and innovative tool to improve patient engagement. International Registered Report Identifier (IRRID): DERR1-10.2196/46156 ",
doi="10.2196/46156",
url="https://www.researchprotocols.org/2023/1/e46156",
url="http://www.ncbi.nlm.nih.gov/pubmed/37307055"
}


@Article{info:doi/10.2196/44750,
author="Castro, R. Aimee
and Ould Brahim, Lydia
and Chen, Qirong
and Arnaert, Antonia
and Quesnel-Vall{\'e}e, Am{\'e}lie
and Moffatt, Karyn
and Kildea, John
and Bitzas, Vasiliki
and Pang, Carolyn
and Hall, Audrey-Jane
and Pagnotta, Ariana
and Tsimicalis, Argerie",
title="Information and Communication Technologies to Support the Provision of Respite Care Services: Scoping Review",
journal="JMIR Nursing",
year="2023",
month="May",
day="30",
volume="6",
pages="e44750",
keywords="caregivers",
keywords="eHealth",
keywords="health services accessibility",
keywords="home care services",
keywords="mHealth",
keywords="respite care",
keywords="short break care",
abstract="Background: Respite care is one of the most frequently requested support services by family caregivers. Yet, too often, respite care services are inaccessible, due in part to families' lack of knowledge regarding available services and a lack of service flexibility. Information and communication technologies (ICTs) may help to improve the flexibility of services available and families' knowledge of such services. However, an understanding of the use of ICTs and research in this area is lacking. Objective: The objective of this study was to provide a comprehensive overview of the academic literature on ICTs for supporting the provision of respite care services. Methods: A scoping review study was conducted. Six library databases were systematically searched for relevant literature. Key data were extracted into a summary chart. Text and quantitative data were coded using descriptive qualitative content analysis techniques, and the results were collated and summarized into a comprehensive narrative. Results: A total of 23 papers describing 15 unique ICT programs exploring the potential of ICTs to support respite care services met the inclusion criteria. ICTs supported the provision of respite care by facilitating information-sharing with families and providers, recruiting and training respite care providers, and coordinating services. Key design considerations for developing respite care ICTs were trustworthiness and participatory design methods. Implementation considerations included designing for complementarity with existing services, assessing the appropriate timing for introducing the ICT-based services, and ensuring adequate promotion strategies to raise awareness about the services. Conclusions: There is limited but promising research on the potential of ICTs to support the provision of respite care services. Further research should be conducted to advance the results of this review, ultimately aiming to build ICTs that can improve the quality of, and access to, respite care services. ",
doi="10.2196/44750",
url="https://nursing.jmir.org/2023/1/e44750",
url="http://www.ncbi.nlm.nih.gov/pubmed/37252760"
}


@Article{info:doi/10.2196/45045,
author="Liang, Jiaming
and Aranda, P. Maria",
title="The Use of Telehealth Among People Living With Dementia-Caregiver Dyads During the COVID-19 Pandemic: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="May",
day="25",
volume="25",
pages="e45045",
keywords="scoping review",
keywords="COVID-19",
keywords="telehealth",
keywords="people living with dementia",
keywords="family caregiver",
keywords="mobile phone",
abstract="Background: Telehealth has gained substantial attention during the COVID-19 pandemic, and reimbursement policies in health care settings have increased access to remote modes of care delivery. Telehealth has the potential to mitigate care concerns for people living with dementia and their family caregivers. There is a paucity of knowledge on the performance of telehealth services and user experiences, especially among caregiving dyads during the pandemic. Objective: This study aims to describe the implementation, effectiveness, user experience, and barriers to accessing and using telehealth services for people living with dementia and their caregivers during the COVID-19 pandemic. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, we searched 7 databases (PubMed, PsycINFO, AgeLine, CINAHL, Social Services Abstracts, Web of Science, and Scopus) and a web-based search engine (Google Scholar). The inclusion criteria for peer-reviewed English publications from March 2020 to August 2022 consisted of studies related to telehealth services for people living with dementia and their family caregivers and studies conducted during the COVID-19 pandemic. Results: A total of 24 articles (10 quantitative and 14 qualitative studies) from 10 different countries were included. The major findings of the reviewed articles were extracted and organized into the following 4 themes: study design characteristics---strategies were adopted to improve the accessibility and experience of people living with dementia-caregiver dyads; efficacy outcomes of telehealth services---robust evidence is lacking on the comparative effectiveness of in-person services; perceived experiences of people living with dementia and caregivers---most reviewed studies reported positive experiences of using telehealth services and perceived personal and social benefits from their participants; and barriers to accessing and using telehealth services---several barriers related to individuals, infrastructure, and telehealth environments were identified. Conclusions: Although evidence of its effectiveness is still limited, telehealth is widely accepted as a viable alternative to in-person care for high-risk groups, such as people living with dementia and their caregivers. Future research should include expanding digital access for those with limited resources and low technology literacy, adopting randomized controlled trial designs to establish the comparative effectiveness of different modes of service delivery, and increasing the sample diversity. ",
doi="10.2196/45045",
url="https://www.jmir.org/2023/1/e45045",
url="http://www.ncbi.nlm.nih.gov/pubmed/37227755"
}


@Article{info:doi/10.2196/41260,
author="Merch{\'a}n-Baeza, Antonio Jose
and Borralleras Andreu, Cristina
and Minobes-Molina, Eduard
and Grau Carri{\'o}n, Sergi
and Romero-Mas, Montse
and Ramon-Aribau, Anna",
title="Co-created Technological Solutions for Caregivers in Health Care: Systematic Review",
journal="J Med Internet Res",
year="2023",
month="May",
day="1",
volume="25",
pages="e41260",
keywords="co-creation",
keywords="technological solutions",
keywords="caregivers",
keywords="health care",
keywords="systematic review",
keywords="mobile applications",
abstract="Background: Support interventions for caregivers can reduce their stress, possibly improving the quality of patients' care while reducing care costs. Technological solutions have been designed to cover their needs, but there are some challenges in making them truly functional for end users. Co-design approaches present important opportunities for engaging diverse populations to help ensure that technological solutions are inclusive and accessible. Objective: This study aimed to identify co-created technological solutions, as well as the process followed for their co-creation, in the field of health for caregivers. Methods: The literature review was conducted in the Medline, Web of Science, Scopus, Science Direct, Scielo, and IEEE Xplore databases. The inclusion criteria were studies written in English or Spanish and with a publication date until May 2021. The content had to specify that the caregivers actively participated in the co-creation process, which covered until the development phase of the technological solution (prototype). The level of evidence and the methodological quality were analyzed when possible, using the Scottish Intercollegiate Guidelines Network criteria and the Mixed Methods Appraisal Tool, version 2018, respectively. Results: In total, 410 papers were identified, and 11 met the eligibility criteria. The most predominant articles were mixed methods studies and qualitative studies. The technology used in the analyzed articles were mobile or web applications (9 studies) and specific devices such as sensors, cameras, or alarm systems (2 studies) to support the health and social aspects of caregivers and improve their education in care. The most common patient profile was older people (7 studies); 6 studies used co-creation in the requirements phase, 6 studies detailed the design phase. In 9 studies, the prototype was iteratively refined in the development phase, and the validation phase was performed in 5 of the reviewed studies. Conclusions: This systematic review suggests that existing co-created technological solutions in the field of health for caregivers are mostly mobile or web applications to support caregivers' social health and well-being and improve their health knowledge when delivering care to patients, especially older people. As for the co-creation process, caregivers are particularly involved during development and in the design. The scarce literature found indicates that further research with higher methodological quality is needed. ",
doi="10.2196/41260",
url="https://www.jmir.org/2023/1/e41260",
url="http://www.ncbi.nlm.nih.gov/pubmed/37126384"
}


@Article{info:doi/10.2196/42655,
author="G{\'o}mez-Morales, Abigail
and Coon, David
and Joseph, P. Rodney
and Pipe, Teri",
title="Behind the Scenes of a Technologically Enhanced Intervention for Caregivers of People With Dementia: Protocol for a Feasibility and Acceptability Study",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="31",
volume="12",
pages="e42655",
keywords="Alzheimer's disease",
keywords="dementia",
keywords="virtual reality",
keywords="information and communication technology",
keywords="ICT",
keywords="caregivers",
keywords="pilot study",
abstract="Background: Alzheimer's disease affects 55 million people worldwide. As the disease progresses, these individuals require a devoted caregiver, often a family member, who provides evolving complex care. Caregivers can experience a variety of ongoing stressors, resulting in reductions in caregiver emotional well-being (and other quality-of-life indicators). Information and communication technologies provide an excellent opportunity to train caregivers remotely and help them to manage these stressors and related distress. Objective: This protocol describes the theoretical rationale, study design, and methods of a new, technologically enhanced psychoeducational skill-building intervention for caregivers of people with dementia that includes a virtual reality component. Methods: Through Alzheimer's Eyes is a 4-week, single-arm, pre-post test pilot study consisting of 4 sessions of 90 minutes each that are delivered by videoconferencing. These sessions include a weekly virtual reality experience characterizing the journey of an older Latina with Alzheimer's disease from her perspective to help caregivers see through the eyes of a person with dementia. The 4 sessions cover the skill-training topics of communication, managing challenging behaviors and unhelpful thoughts, the importance of self-care, and mindfulness---all of which are key components designed to reduce stress and distress in family caregivers. Individual interviews conducted before and after the intervention gather participant insights into the intervention, evaluate its feasibility and acceptability, and assess its impact on key outcomes. Results: Data collection for the study started in January 2022, and the results are expected to be submitted for publication in the second half of 2023. Twenty caregivers from the United States have completed the workshop to date. Preliminary data gathered from these participants support the intervention's feasibility and acceptability. Conclusions: Through Alzheimer's Eyes leverages existing technology combined with psychoeducational skill building to help caregivers manage their stress, regardless of their location. International Registered Report Identifier (IRRID): DERR1-10.2196/42655 ",
doi="10.2196/42655",
url="https://www.researchprotocols.org/2023/1/e42655",
url="http://www.ncbi.nlm.nih.gov/pubmed/37000480"
}


@Article{info:doi/10.2196/43429,
author="Lundereng, David Elias
and Nes, Gon{\c{c}}alves Andr{\'e}a Aparecida
and Holmen, Heidi
and Winger, Anette
and Thygesen, Hilde
and J{\o}ranson, Nina
and Borge, R{\aa}heim Christine
and Dajani, Olav
and Mariussen, L. Kari
and Steindal, A. Simen",
title="Health Care Professionals' Experiences and Perspectives on Using Telehealth for Home-based Palliative Care: Scoping Review",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="29",
volume="25",
pages="e43429",
keywords="health technology",
keywords="homecare services",
keywords="palliative care",
keywords="review",
keywords="telehealth",
keywords="telemedicine",
keywords="care",
keywords="technology",
keywords="feasibility",
keywords="data",
keywords="decision-making",
keywords="policy makers",
abstract="Background: Telehealth seems feasible for use in home-based palliative care (HBPC). It may improve access to health care professionals (HCPs) at patients' homes, reduce hospital admissions, enhance patients' feelings of security and safety, and increase the time spent at home for patients in HBPC. HBPC requires the involvement of various HCPs such as nurses, physicians, allied health professionals, dietitians, psychologists, religious counselors, and social workers. Acceptance of the use of technology among HCPs is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of HCPs regarding the use of telehealth in HBPC. Objective: The aim of this review was to systematically map published studies on HCPs' experiences and perspectives on the use of telehealth in HBPC. Methods: A scoping review was conducted using the methodology of Arksey and O'Malley. The review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. A systematic search was performed in AMED, CINAHL, Embase, MEDLINE, PsycINFO, and Web of Science for studies published in peer-reviewed journals between January 1, 2000, and August 23, 2022. The reference lists of the included papers were hand searched to identify additional studies. The inclusion criteria were (1) studies using qualitative, quantitative, or mixed methods; (2) studies including HCPs using telehealth with patients in HBPC; (3) studies on HCPs' experiences and perspectives on the use of telehealth in HBPC; (4) studies published between January 1, 2000, and August 23, 2022; and (5) studies published in English, Portuguese, Norwegian, Danish, Swedish, or Spanish. Pairs of authors independently included studies and extracted data. The first 2 stages of thematic synthesis were used to thematically organize the data. Results: This scoping review included 29 papers from 28 studies. Four descriptive themes were identified: (1) easy to use but technological issues undermine confidence, (2) adds value but personal and organizational barriers challenge adoption, (3) potential to provide useful and meaningful patient-reported data, and (4) mutual trust as a prerequisite for interpersonal relationships. Conclusions: Telehealth in HBPC seems to be easy to use and may improve the coordination of care, time efficiency, clinical assessments, and help build and enhance personal and professional relationships. However, the introduction of technology in HBPC is complex, as it may not align well with the overall aim of palliative care from HCPs' point of view. Further, changes in practice and requirements for HCPs may reduce motivation for the use of telehealth in HBPC. HCPs consider themselves to have central roles in implementing telehealth, and a lack of acceptance and motivation is a key barrier to telehealth adoption. Policy makers and telehealth developers should be aware of this potential barrier when developing or implementing new technology for use in HBPC. International Registered Report Identifier (IRRID): RR2-10.2196/33305 ",
doi="10.2196/43429",
url="https://www.jmir.org/2023/1/e43429",
url="http://www.ncbi.nlm.nih.gov/pubmed/36989024"
}


@Article{info:doi/10.2196/44201,
author="Sari, Wulan Dianis
and Aurizki, Ekapuja Gading
and Indarwati, Retno
and Farapti, Farapti
and Rekawati, Etty
and Takaoka, Manami",
title="The Provision of Texture-Modified Foods in Long-term Care Facilities by Health Professionals: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2023",
month="Mar",
day="17",
volume="12",
pages="e44201",
keywords="aged",
keywords="diet",
keywords="dysphagia",
keywords="health professional",
keywords="texture-modified foods",
keywords="residential care",
abstract="Background: Malnutrition among older adults with dysphagia is common. Texture-modified foods (TMFs) are an essential part of dysphagia management. In long-term care (LTC) facilities, health professionals have implemented TMFs, but their application has not been fully elucidated, making them heterogeneous. Objective: We aim to explore the implementation of TMFs in LTC facilities, particularly focusing on the role of health professionals in nutritional care involving TMFs (eg, deciding the type of food, preparing and giving the food, and evaluating the outcomes). Methods: A scoping review using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodological approach will be performed. A comprehensive search for published literature will be systematically performed in PubMed, CINAHL, MEDLINE, ProQuest, PsycINFO, and Science Citation Index (Web of Science). Data screening and extraction will be performed by 2 reviewers independently. The studies included will be synthesized, summarized, and reported, following the preferred reporting items of the Mixed Methods Appraisal Tool. Our review will consider the following study designs: mixed methods, quantitative, and qualitative. Studies with patients who are not older adults will be excluded. Results: Data extraction will be completed by February 2023. Data presentation and analyses will be completed by April 2023, and the final outcomes will be completed by June 2023. The study findings will be published in a peer-reviewed journal. Conclusions: Our scoping review will consider studies related to TMF interventions for older adults in LTC residential facilities, with no exclusion restrictions based on country, gender, or comorbidities. Studies on interventions that address TMF-related issues, such as deciding the type of food, preparing and giving the food, and evaluating the outcomes, are qualified for inclusion. Trial Registration: OSF Registries 79AFZ; https://osf.io/79afz International Registered Report Identifier (IRRID): PRR1-10.2196/44201 ",
doi="10.2196/44201",
url="https://www.researchprotocols.org/2023/1/e44201",
url="http://www.ncbi.nlm.nih.gov/pubmed/36930183"
}


@Article{info:doi/10.2196/43684,
author="Steindal, A. Simen
and Nes, Gon{\c{c}}alves Andr{\'e}a Aparecida
and Godskesen, E. Tove
and Holmen, Heidi
and Winger, Anette
and {\"O}sterlind, Jane
and Dihle, Alfhild
and Klarare, Anna",
title="Advantages and Challenges of Using Telehealth for Home-Based Palliative Care: Systematic Mixed Studies Review",
journal="J Med Internet Res",
year="2023",
month="Mar",
day="13",
volume="25",
pages="e43684",
keywords="digital health",
keywords="eHealth",
keywords="health care technology",
keywords="home-based palliative care",
keywords="review",
keywords="systematic mixed studies review",
keywords="telemedicine",
keywords="mobile phone",
abstract="Background: Owing to the increasing number of people with palliative care needs and the current shortage of health care professionals (HCPs), providing quality palliative care has become challenging. Telehealth could enable patients to spend as much time as possible at home. However, no previous systematic mixed studies reviews have synthesized evidence on patients' experiences of the advantages and challenges of telehealth in home-based palliative care. Objective: In this systematic mixed studies review, we aimed to critically appraise and synthesize the findings from studies that investigated patients' use of telehealth in home-based palliative care, focusing on the advantages and challenges experienced by patients. Methods: This is a systematic mixed studies review with a convergent design. The review is reported according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A systematic search was performed in the following databases: Allied and Complementary Medicine Database, CINAHL, Cochrane Central Register of Controlled Trials, Embase, Latin American and Caribbean Health Sciences Literature, MEDLINE, PsycInfo, and Web of Science. The inclusion criteria were as follows: studies using quantitative, qualitative, or mixed methods; studies that investigated the experience of using telehealth with follow-up from HCPs of home-based patients aged ?18; studies published between January 2010 and June 2022; and studies published in Norwegian, Danish, Swedish, English, Portuguese, or Spanish in peer-reviewed journals. Five pairs of authors independently assessed eligibility of the studies, appraised methodological quality, and extracted data. The data were synthesized using thematic synthesis. Results: This systematic mixed studies review included 41 reports from 40 studies. The following 4 analytical themes were synthesized: potential for a support system and self-governance at home; visibility supports interpersonal relationships and a joint understanding of care needs; optimized information flow facilitates tailoring of remote caring practices; and technology, relationships, and complexity as perpetual obstacles in telehealth. Conclusions: The advantages of telehealth were that patients experience a potential support system that could enable them to remain at home, and the visual features of telehealth enable them to build interpersonal relationships with HCPs over time. Self-reporting provides HCPs with information about symptoms and circumstances that facilitates tailoring care to specific patients. Challenges with the use of telehealth were related to barriers to technology use and inflexible reporting of complex and fluctuating symptoms and circumstances using electronic questionnaires. Few studies have included the self-reporting of existential or spiritual concerns, emotions, and well-being. Some patients perceived telehealth as intrusive and a threat to their privacy at home. To optimize the advantages and minimize the challenges with the use of telehealth in home-based palliative care, future research should include users in the design and development process. ",
doi="10.2196/43684",
url="https://www.jmir.org/2023/1/e43684",
url="http://www.ncbi.nlm.nih.gov/pubmed/36912876"
}


@Article{info:doi/10.2196/36072,
author="Chew, Evelyn
and Teo, Huang Sok
and Tang, Ee Wern
and Ng, Liang David Wei
and Koh, Huat Gerald Choon
and Teo, Ying Valerie Hui",
title="Trust and Uncertainty in the Implementation of a Pilot Remote Blood Pressure Monitoring Program in Primary Care: Qualitative Study of Patient and Health Care Professional Views",
journal="JMIR Hum Factors",
year="2023",
month="Jan",
day="5",
volume="10",
pages="e36072",
keywords="telemedicine",
keywords="hypertension",
keywords="remote blood pressure monitoring",
keywords="health IT",
keywords="primary health care",
keywords="trust",
keywords="health care provider relationship",
keywords="blood pressure",
keywords="primary care",
keywords="qualitative study",
keywords="health care workers",
keywords="patients",
abstract="Background: Trust is of fundamental importance to the adoption of technologies in health care. The increasing use of telemedicine worldwide makes it important to consider user views and experiences. In particular, we ask how the mediation of a technological platform alters the trust relationship between patient and health care provider. Objective: To date, few qualitative studies have focused on trust in the use of remote health care technologies. This study examined the perspectives of patients and clinical staff who participated in a remote blood pressure monitoring program, focusing on their experiences of trust and uncertainty in the use of technology and how this telehealth intervention may have affected the patient-provider relationship. Methods: A secondary qualitative analysis using inductive thematic analysis was conducted on interview data from 13 patients and 8 staff members who participated in a remote blood pressure monitoring program to elicit themes related to trust. Results: In total, 4 themes were elicited that showed increased trust (patients felt reassured, patients trusted the telehealth program, staff felt that the data were trustworthy, and a better patient-provider partnership based on the mutually trusted data), and 4 themes were elicited that reflected decreased trust (patients' distrust of technology, clinicians' concerns about the limitations of technologically mediated interactions, experiences of uncertainty, and institutional risk). Conclusions: Managing trust relationships plays an important role in the successful implementation of telemedicine. Ensuring that trust building is incorporated in the design of telehealth interventions can contribute to improved effectiveness and quality of care. ",
doi="10.2196/36072",
url="https://humanfactors.jmir.org/2023/1/e36072",
url="http://www.ncbi.nlm.nih.gov/pubmed/36602847"
}


@Article{info:doi/10.2196/42493,
author="Cleland, Jenny
and Hutchinson, Claire
and Williams, H. Patricia A.
and Manuel, Kisani
and Laver, Kate",
title="Home Automation for Adults With Disability Following an Injury: Protocol for a Social Return on Investment Study",
journal="JMIR Res Protoc",
year="2022",
month="Dec",
day="21",
volume="11",
number="12",
pages="e42493",
keywords="disability",
keywords="serious injury",
keywords="economic evaluation",
keywords="home automation",
keywords="long-term care",
keywords="social return on investment",
keywords="injury",
keywords="technology",
keywords="community",
keywords="Australia",
keywords="decision-making",
abstract="Background: People with disability following a serious injury require long-term care. The most common injuries resulting in long-term disability are spinal cord and acquired brain injuries. While the long-term effects are difficult to predict and will vary between individuals, the costs of care and recovery span well beyond the initial treatment phase and include long-term care. Long-term care is changing with the availability and advances in cost and function of technologies, such as home automation. ``Home automation'' refers to technology that automates or remotely controls household functions. Home automation costs vastly differ, but home automation has the potential to positively impact the lives of people with disabilities. However, there is a dearth of evidence relating to the impact of home automation for people with a disability and few rigorous evaluations about the costs and return on investment. Objective: The purpose of this study is to describe the impact of home automation for people with long-term disability following a serious injury (such as a motor vehicle accident) using case studies, and by conducting an evaluation of the costs and outcomes for individuals, families, and the wider community using a Social Return on Investment (SROI) approach. Methods: SROI is a form of economic evaluation that develops a theory of change to examine the relationship among inputs, outputs, and outcomes and, in recent years, has gained popularity internationally, including in Australia. SROI has six phases: (1) identify scope and stakeholders, (2) map outcomes, (3) evidence outcomes and give them value, (4) establish impact, (5) calculate the SROI, and (6) report findings. Individuals with a disability who use home automation and key stakeholders will be interviewed. Stakeholders will be individuals involved in home automation for people with disabilities, such as allied health professionals, medical practitioners, equipment suppliers, engineers, and maintenance professionals. Users of home automation will be people who have a disability following a serious injury, have the capacity to provide consent, and have 1 or more elements of home automation. The impact of home automation will be established with financial proxies and appropriate discounts applied to avoid overestimating the social return. The SROI ratio will be calculated, and findings will be reported. Results: The project was funded in November 2021 by the Lifetime Support Authority. Recruitment is underway, and data collection is expected to be completed by October 2022. The final results of the study will be published in March 2023. Conclusions: To our knowledge, this study represents the first study in Australia and internationally to employ SROI to estimate the social, personal, and community outcomes of home automation for people with a disability following a serious injury. This research will provide valuable information for funders, consumers, researchers, and the public to guide and inform future decision-making. International Registered Report Identifier (IRRID): DERR1-10.2196/42493 ",
doi="10.2196/42493",
url="https://www.researchprotocols.org/2022/12/e42493",
url="http://www.ncbi.nlm.nih.gov/pubmed/36542464"
}


@Article{info:doi/10.2196/40360,
author="Seah, L. Cassandra E.
and Zhang, Zheyuan
and Sun, Sijin
and Wiskerke, Esther
and Daniels, Sarah
and Porat, Talya
and Calvo, A. Rafael",
title="Designing Mindfulness Conversational Agents for People With Early-Stage Dementia and Their Caregivers: Thematic Analysis of Expert and User Perspectives",
journal="JMIR Aging",
year="2022",
month="Dec",
day="6",
volume="5",
number="4",
pages="e40360",
keywords="mindfulness",
keywords="dyadic",
keywords="dementia",
keywords="caregivers",
keywords="user needs",
keywords="intervention",
keywords="user",
keywords="feedback",
keywords="design",
keywords="accessibility",
keywords="relationships",
keywords="mindset",
keywords="essential",
abstract="Background: The number of people with dementia is expected to grow worldwide. Among the ways to support both persons with early-stage dementia and their caregivers (dyads), researchers are studying mindfulness interventions. However, few studies have explored technology-enhanced mindfulness interventions for dyads and the needs of persons with dementia and their caregivers. Objective: The main aim of this study was to elicit essential needs from people with dementia, their caregivers, dementia experts, and mindfulness experts to identify themes that can be used in the design of mindfulness conversational agents for dyads. Methods: Semistructured interviews were conducted with 5 dementia experts, 5 mindfulness experts, 5 people with early-stage dementia, and 5 dementia caregivers. Interviews were transcribed and coded on NVivo (QSR International) before themes were identified through a bottom-up inductive approach. Results: The results revealed that dyadic mindfulness is preferred and that implementation formats such as conversational agents have potential. A total of 5 common themes were also identified from expert and user feedback, which should be used to design mindfulness conversational agents for persons with dementia and their caregivers. The 5 themes included enhancing accessibility, cultivating positivity, providing simplified tangible and thought-based activities, encouraging a mindful mindset shift, and enhancing relationships. Conclusions: In essence, this research concluded with 5 themes that mindfulness conversational agents could be designed based on to meet the needs of persons with dementia and their caregivers. ",
doi="10.2196/40360",
url="https://aging.jmir.org/2022/4/e40360",
url="http://www.ncbi.nlm.nih.gov/pubmed/36472897"
}


@Article{info:doi/10.2196/39174,
author="Scott Duncan, Therese
and Engstr{\"o}m, Jon
and Riggare, Sara
and H{\"a}gglund, Maria
and Koch, Sabine",
title="Meeting the Burden of Self-management: Qualitative Study Investigating the Empowering Behaviors of Patients and Informal Caregivers",
journal="J Particip Med",
year="2022",
month="Nov",
day="16",
volume="14",
number="1",
pages="e39174",
keywords="behaviors",
keywords="chronic conditions",
keywords="model of illness-related work",
keywords="empowerment",
keywords="self-management",
abstract="Background: Patient empowerment is an important concept and a movement toward person-centered care of patients with chronic conditions. Nevertheless, to date, most research on empowered patients or informal caregivers has been conducted from a narrow clinical perspective. Such research has mainly focused on how health care professionals can empower patients to increase self-care or compliance with treatment. Research on empowered patient and informal caregiver needs and self-empowering activities is scarce. Objective: We aimed to explore empowering behaviors from a patient and informal caregiver perspective in the context of self-management and to understand how health care can support such behaviors better. Methods: We used an exploratory, qualitative study design. A total of 15 semistructured interviews and 6 focus group interviews were conducted with 48 patients and informal caregivers. We analyzed the interviews using thematic analysis and used a directed content analysis to analyze the focus group interviews. Results: A total of 14 patterns of empowering behaviors were identified that were characterized by several exploratory and influencing activities performed by the participants. The participants expressed a desire to be more active in their care than what is expected and supported by health care professionals. The participants also desired better support for activities imposed on them by health care professionals. Conclusions: To enable a transformation of the health care system to better support self-empowering behaviors, there is a need to develop self-management approaches from a patient and informal caregiver perspective. ",
doi="10.2196/39174",
url="https://jopm.jmir.org/2022/1/e39174",
url="http://www.ncbi.nlm.nih.gov/pubmed/36383418"
}


@Article{info:doi/10.2196/35592,
author="Villalobos, Paola Jennifer
and Bull, Salyers Sheana
and Portz, Dickman Jennifer",
title="Usability and Acceptability of a Palliative Care Mobile Intervention for Older Adults With Heart Failure and Caregivers: Observational Study",
journal="JMIR Aging",
year="2022",
month="Oct",
day="6",
volume="5",
number="4",
pages="e35592",
keywords="mHealth",
keywords="older adult",
keywords="symptom",
keywords="heart failure",
keywords="palliative care",
keywords="app",
keywords="digital health",
keywords="cardiology",
keywords="heart",
keywords="Convoy-Pal",
keywords="mobile",
keywords="tablet",
keywords="smartwatch",
keywords="adult",
keywords="aging",
abstract="Background: Heart failure is a leading cause of death among older adults. Digital health can increase access to and awareness of palliative care for patients with advanced heart failure and their caregivers. However, few palliative care digital interventions target heart failure or patients' caregivers, family, and friends, termed here as the social convoy. To address this need, the Social Convoy Palliative Care (Convoy-Pal) mobile intervention was developed to deliver self-management tools and palliative care resources to older adults with advanced heart failure and their social convoys. Objective: The goal of the research was to test the acceptability and usability of Convoy-Pal among older adults with advanced heart failure and their social convoys. Methods: Convoy-Pal includes tablet-based and smartwatch tools facilitating self-management and access to palliative care resources. Older adults and social convoy caregivers completed an acceptability and usability interview via Zoom, including open-ended questions and the Mobile Application Rating Scale: User Version (uMARS). Descriptive analysis was conducted to summarize the results of open-ended feedback and self-reported acceptability and usability. Results: A total of 26 participants (16 older adults and 10 social convoy caregivers) participated in the interview. Overall, the feedback from users was good (uMARS mean 3.96/5 [SD 0.81]). Both older adults and social convoy caregivers scored information provided by Convoy-Pal the highest (mean 4.22 [SD 0.75] and mean 4.21 [SD 0.64], respectively). Aesthetics, functionality, and engagement were also perceived as acceptable (mean >3.5). Open-ended feedback resulted in 5 themes including improvements to goal setting, monitoring tools, daily check-in call feature, portal and mobile app, and convoy assessment. Conclusions: Convoy-Pal was perceived as acceptable with good usability among older adults with heart failure and their social convoy caregivers. With good acceptability, Convoy-Pal may ultimately lead to increased access to palliative care resources and facilitate self-management among older adults with heart failure and their social convoy caregivers. ",
doi="10.2196/35592",
url="https://aging.jmir.org/2022/4/e35592",
url="http://www.ncbi.nlm.nih.gov/pubmed/36201402"
}


@Article{info:doi/10.2196/39386,
author="Adisso, Lionel {\'E}v{\`e}hou{\'e}nou
and Taljaard, Monica
and Stacey, Dawn
and Bri{\`e}re, Nathalie
and Zomahoun, Vignon Herv{\'e} Tchala
and Durand, Jacob Pierre
and Rivest, Louis-Paul
and L{\'e}gar{\'e}, France",
title="Shared Decision-Making Training for Home Care Teams to Engage Frail Older Adults and Caregivers in Housing Decisions: Stepped-Wedge Cluster Randomized Trial",
journal="JMIR Aging",
year="2022",
month="Sep",
day="20",
volume="5",
number="3",
pages="e39386",
keywords="shared decision-making",
keywords="home care",
keywords="nursing homes",
keywords="patient engagement",
abstract="Background: Frail older adults and caregivers need support from their home care teams in making difficult housing decisions, such as whether to remain at home, with or without assistance, or move into residential care. However, home care teams are often understaffed and busy, and shared decision-making training is costly. Nevertheless, overall awareness of shared decision-making is increasing. We hypothesized that distributing a decision aid could be sufficient for providing decision support without the addition of shared decision-making training for home care teams. Objective: We evaluated the effectiveness of adding web-based training and workshops for care teams in interprofessional shared decision-making to passive dissemination of a decision guide on the proportion of frail older adults or caregivers of cognitively-impaired frail older adults reporting active roles in housing decision-making. Methods: We conducted a stepped-wedge cluster randomized trial with home care teams in 9 health centers in Quebec, Canada. Participants were frail older adults or caregivers of cognitively impaired frail older adults facing housing decisions and receiving care from the home care team at one of the participating health centers. The intervention consisted of a 1.5-hour web-based tutorial for the home care teams plus a 3.5-hour interactive workshop in interprofessional shared decision-making using a decision guide that was designed to support frail older adults and caregivers in making housing decisions. The control was passive dissemination of the decision guide. The primary outcome was an active role in decision-making among frail older adults and caregivers, measured using the Control Preferences Scale. Secondary outcomes included decisional conflict and perceptions of how much care teams involved frail older adults and caregivers in decision-making. We performed an intention-to-treat analysis. Results: A total of 311 frail older adults were included in the analysis, including 208 (66.9\%) women, with a mean age of 81.2 (SD 7.5) years. Among 339 caregivers of cognitively-impaired frail older adults, 239 (70.5\%) were female and their mean age was 66.4 (SD 11.7) years. The intervention increased the proportion of frail older adults reporting an active role in decision-making by 3.3\% (95\% CI --5.8\% to 12.4\%, P=.47) and the proportion of caregivers of cognitively-impaired frail older adults by 6.1\% (95\% CI -11.2\% to 23.4\%, P=.49). There was no significant impact on the secondary outcomes. However, the mean score for the frail older adults' perception of how much health professionals involved them in decision-making increased by 5.4 (95\% CI ?0.6 to 11.4, P=.07) and the proportion of caregivers who reported decisional conflict decreased by 7.5\% (95\% CI ?16.5\% to 1.6\%, P=.10). Conclusions: Although it slightly reduced decisional conflict for caregivers, shared decision-making training did not equip home care teams significantly better than provision of a decision aid for involving frail older adults and their caregivers in decision-making. Trial Registration: ClinicalTrials.gov NCT02592525; https://clinicaltrials.gov/show/NCT02592525 ",
doi="10.2196/39386",
url="https://aging.jmir.org/2022/3/e39386",
url="http://www.ncbi.nlm.nih.gov/pubmed/35759791"
}


@Article{info:doi/10.2196/39005,
author="Kim, Daejin
and Bian, Hongyi
and Chang, K. Carl
and Dong, Liang
and Margrett, Jennifer",
title="In-Home Monitoring Technology for Aging in Place: Scoping Review",
journal="Interact J Med Res",
year="2022",
month="Sep",
day="1",
volume="11",
number="2",
pages="e39005",
keywords="in-home monitoring",
keywords="aging in place",
keywords="ambient assisted living",
keywords="home modification",
keywords="monitoring",
keywords="aging",
keywords="technology",
keywords="intervention",
keywords="older adult",
keywords="wellness",
keywords="independence",
keywords="monitor",
keywords="research",
keywords="sensor",
keywords="activity",
keywords="behavior",
keywords="cognitive",
keywords="sleep",
abstract="Background: For successful aging-in-place strategy development, in-home monitoring technology is necessary as a new home modification strategy. Monitoring an older adult's daily physical activity at home can positively impact their health and well-being by providing valuable information about functional, cognitive, and social health status. However, it is questionable how these in-home monitoring technologies have changed the traditional residential environment. A comprehensive review of existing research findings should be utilized to characterize recent relative technologies and to inform design considerations. Objective: The main purpose of this study was to classify recent smart home technologies that monitor older adults' health and to architecturally describe these technologies as they are used in older adults' homes. Methods: The scoping review method was employed to identify key characteristics of in-home monitoring technologies for older adults. In June 2021, four databases, including Web of Science, IEEE Xplore, ACM Digital Library, and Scopus, were searched for peer-reviewed articles pertaining to smart home technologies used to monitor older adults' health in their homes. We used two search strings to retrieve articles: types of technology and types of users. For the title, abstract, and full-text screening, the inclusion criteria were original and peer-reviewed research written in English, and research on monitoring, detecting, recognizing, analyzing, or tracking human physical, emotional, and social behavior. The exclusion criteria included theoretical, conceptual, or review papers; studies on wearable systems; and qualitative research. Results: This scoping review identified 30 studies published between June 2016 and 2021 providing overviews of in-home monitoring technologies, including (1) features of smart home technologies and (2) sensor locations and sensor data. First, we found six functions of in-home monitoring technology among the reviewed papers: daily activities, abnormal behaviors, cognitive impairment, falls, indoor person positioning, and sleep quality. Most of the research (n=27 articles) focused on functional monitoring and analysis, such as activities of daily living, instrumental activities of daily living, or falls among older adults; a few studies (n=3) covered social interaction monitoring. Second, this scoping review also found 16 types of sensor technologies. The most common data types encountered were passive infrared motion sensors (n=21) and contact sensors (n=19), which were used to monitor human behaviors such as bodily presence and time spent on activities. Specific locations for each sensor were also identified. Conclusions: This wide-ranging synthesis demonstrates that in-home monitoring technologies within older adults' homes play an essential role in aging in place, in that the technology monitors older adults' daily activities and identifies various health-related issues. This research provides a key summarization of in-home monitoring technologies that can be applied in senior housing for successful aging in place. These findings will be significant when developing home modification strategies or new senior housing. ",
doi="10.2196/39005",
url="https://www.i-jmr.org/2022/2/e39005",
url="http://www.ncbi.nlm.nih.gov/pubmed/36048502"
}


@Article{info:doi/10.2196/36879,
author="LeBaron, Virginia
and Alam, Ridwan
and Bennett, Rachel
and Blackhall, Leslie
and Gordon, Kate
and Hayes, James
and Homdee, Nutta
and Jones, Randy
and Lichti, Kathleen
and Martinez, Yudel
and Mohammadi, Sahar
and Ogunjirin, Emmanuel
and Patel, Nyota
and Lach, John",
title="Deploying the Behavioral and Environmental Sensing and Intervention for Cancer Smart Health System to Support Patients and Family Caregivers in Managing Pain: Feasibility and Acceptability Study",
journal="JMIR Cancer",
year="2022",
month="Aug",
day="9",
volume="8",
number="3",
pages="e36879",
keywords="mobile health",
keywords="mHealth",
keywords="smart health",
keywords="cancer",
keywords="pain",
keywords="palliative care",
keywords="family caregiver",
keywords="remote monitoring",
keywords="feasibility and acceptability",
keywords="rural",
abstract="Background: Distressing cancer pain remains a serious symptom management issue for patients and family caregivers, particularly within home settings. Technology can support home-based cancer symptom management but must consider the experience of patients and family caregivers, as well as the broader environmental context. Objective: This study aimed to test the feasibility and acceptability of a smart health sensing system---Behavioral and Environmental Sensing and Intervention for Cancer (BESI-C)---that was designed to support the monitoring and management of cancer pain in the home setting. Methods: Dyads of patients with cancer and their primary family caregivers were recruited from an outpatient palliative care clinic at an academic medical center. BESI-C was deployed in each dyad home for approximately 2 weeks. Data were collected via environmental sensors to assess the home context (eg, light and temperature); Bluetooth beacons to help localize dyad positions; and smart watches worn by both patients and caregivers, equipped with heart rate monitors, accelerometers, and a custom app to deliver ecological momentary assessments (EMAs). EMAs enabled dyads to record and characterize pain events from both their own and their partners' perspectives. Sensor data streams were integrated to describe and explore the context of cancer pain events. Feasibility was assessed both technically and procedurally. Acceptability was assessed using postdeployment surveys and structured interviews with participants. Results: Overall, 5 deployments (n=10 participants; 5 patient and family caregiver dyads) were completed, and 283 unique pain events were recorded. Using our ``BESI-C Performance Scoring Instrument,'' the overall technical feasibility score for deployments was 86.4 out of 100. Procedural feasibility challenges included the rurality of dyads, smart watch battery life and EMA reliability, and the length of time required for deployment installation. Postdeployment acceptability Likert surveys (1=strongly disagree; 5=strongly agree) found that dyads disagreed that BESI-C was a burden (1.7 out of 5) or compromised their privacy (1.9 out of 5) and agreed that the system collected helpful information to better manage cancer pain (4.6 out of 5). Participants also expressed an interest in seeing their own individual data (4.4 out of 5) and strongly agreed that it is important that data collected by BESI-C are shared with their respective partners (4.8 out of 5) and health care providers (4.8 out of 5). Qualitative feedback from participants suggested that BESI-C positively improved patient-caregiver communication regarding pain management. Importantly, we demonstrated proof of concept that seriously ill patients with cancer and their caregivers will mark pain events in real time using a smart watch. Conclusions: It is feasible to deploy BESI-C, and dyads find the system acceptable. By leveraging human-centered design and the integration of heterogenous environmental, physiological, and behavioral data, the BESI-C system offers an innovative approach to monitor cancer pain, mitigate the escalation of pain and distress, and improve symptom management self-efficacy. International Registered Report Identifier (IRRID): RR2-10.2196/16178 ",
doi="10.2196/36879",
url="https://cancer.jmir.org/2022/3/e36879",
url="http://www.ncbi.nlm.nih.gov/pubmed/35943791"
}


@Article{info:doi/10.2196/40181,
author="Milne-Ives, Madison
and Carroll, Camille
and Meinert, Edward",
title="Self-management Interventions for People With Parkinson Disease: Scoping Review",
journal="J Med Internet Res",
year="2022",
month="Aug",
day="5",
volume="24",
number="8",
pages="e40181",
keywords="Parkinson disease",
keywords="self-management",
keywords="self-care",
keywords="home nursing",
keywords="self-efficacy",
keywords="quality of life",
keywords="signs and symptoms",
keywords="health behaviour",
abstract="Background: Parkinson disease can impose substantial distress and costs on patients, their families and caregivers, and health care systems. To address these burdens for families and health care systems, there is a need to better support patient self-management. To achieve this, an overview of the current state of the literature on self-management is needed to identify what is being done, how well it is working, and what might be missing. Objective: The aim of this scoping review was to provide an overview of the current body of research on self-management interventions for people with Parkinson disease and identify any knowledge gaps. Methods: The PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) and Population, Intervention, Comparator, Outcome, and Study type frameworks were used to structure the methodology of the review. Due to time and resource constraints, 1 reviewer systematically searched 4 databases (PubMed, Ovid, Scopus, and Web of Science) for the evaluations of self-management interventions for Parkinson disease published in English. The references were screened using the EndNote X9 citation management software, titles and abstracts were manually reviewed, and studies were selected for inclusion based on the eligibility criteria. Data were extracted into a pre-established form and synthesized in a descriptive analysis. Results: There was variation among the studies on study design, sample size, intervention type, and outcomes measured. The randomized controlled trials had the strongest evidence of effectiveness: 5 out of 8 randomized controlled trials found a significant difference between groups favoring the intervention on their primary outcome, and the remaining 3 had significant effects on at least some of the secondary outcomes. The 2 interventions included in the review that targeted mental health outcomes both found significant changes over time, and the 3 algorithms evaluated performed well. The remaining studies examined patient perceptions, acceptability, and cost-effectiveness and found generally positive results. Conclusions: This scoping review identified a wide variety of interventions designed to support various aspects of self-management for people with Parkinson disease. The studies all generally reported positive results, and although the strength of the evidence varied, it suggests that self-management interventions are promising for improving the care and outcomes of people with Parkinson disease. However, the research tended to focus on the motor aspects of Parkinson disease, with few nonmotor or holistic interventions, and there was a lack of evaluation of cost-effectiveness. This research will be important to providing self-management interventions that meet the varied and diverse needs of people with Parkinson disease and determining which interventions are worth promoting for widespread adoption. ",
doi="10.2196/40181",
url="https://www.jmir.org/2022/8/e40181",
url="http://www.ncbi.nlm.nih.gov/pubmed/35930315"
}


@Article{info:doi/10.2196/36975,
author="Boutilier, J. Justin
and Loganathar, Priya
and Linden, Anna
and Scheer, Eleanore
and Noejovich, Sofia
and Elliott, Christian
and Zuraw, Matthew
and Werner, E. Nicole",
title="A Web-Based Platform (CareVirtue) to Support Caregivers of People Living With Alzheimer Disease and Related Dementias: Mixed Methods Feasibility Study",
journal="JMIR Aging",
year="2022",
month="Aug",
day="4",
volume="5",
number="3",
pages="e36975",
keywords="Alzheimer disease and related dementias",
keywords="mHealth",
keywords="caregivers",
keywords="dementia caregiving",
keywords="eHealth",
keywords="telehealth",
abstract="Background: People living with Alzheimer disease and related dementias (ADRD) require prolonged and complex care that is primarily managed by informal caregivers who face significant unmet needs regarding support for communicating and coordinating across their informal care network. To address this unmet need, we developed CareVirtue, which provides (1) the ability to invite care network members; (2) a care guide detailing the care plan; (3) a journal where care network members can document, communicate, and coordinate; (4) a shared calendar; and (5) vetted geolocated caregiver resources. Objective: This study aims to evaluate CareVirtue's feasibility based on: (1) Who used CareVirtue? (2) How did caregivers use CareVirtue? (3) How did caregivers perceive the acceptability of CareVirtue? (4) What factors were associated with CareVirtue use? Methods: We conducted a feasibility study with 51 care networks over a period of 8 weeks and used a mixed methods approach that included both quantitative CareVirtue usage data and semistructured interviews. Results: Care networks ranged from 1 to 8 members. Primary caregivers were predominantly female (38/51, 75\%), White (44/51, 86\%), married (37/51, 73\%), college educated (36/51, 71\%), and were, on average, 60.3 (SD 9.8) years of age, with 18\% (9/51) living in a rural area. CareVirtue usage varied along 2 axes (total usage and type of usage), with heterogeneity in how the most engaged care networks interacted with CareVirtue. Interviews identified a range of ways CareVirtue was useful, including practically, organizationally, and emotionally. On the Behavioral Intention Scale, 72\% (26/36) of primary caregivers reported an average score of at least 3, indicating an above average intention to use. The average was 81.8 (SD 12.8) for the System Usability Scale score, indicating ``good'' usability, and 3.4 (SD 1.0) for perceived usefulness, suggesting above average usefulness. The average confidence score increased significantly over the study duration from 7.8 in week 2 to 8.9 in week 7 (P=.005; r=0.91, 95\% CI 0.84-0.95). The following sociodemographic characteristics were associated with posting in the journal: retired (mean 59.5 posts for retired caregivers and mean 16.9 for nonretired caregivers), income (mean 13 posts for those reporting >US \$100K and mean 55.4 for those reporting <US \$100K), relationship to care recipient (mean 18.7 posts for child and mean 56.4 for partners/spouses), and living situation (mean 44.7 for those who live with the care recipient and mean 13.1 for those who do not). Older care recipients were associated with fewer posts (r=--0.33, 95\% CI --0.55 to --0.06). Conclusions: This study establishes the acceptability and feasibility of CareVirtue among ADRD care networks and highlights the importance of designing flexible, multicomponent interventions that allow care networks to tailor their engagement according to their needs. The results will be used to improve CareVirtue feasibility and acceptability in preparation for a subsequent randomized trial to test CareVirtue's effectiveness in improving caregiver outcomes. ",
doi="10.2196/36975",
url="https://aging.jmir.org/2022/3/e36975",
url="http://www.ncbi.nlm.nih.gov/pubmed/35925654"
}


@Article{info:doi/10.2196/38100,
author="Miao, Melissa
and Rietdijk, Rachael
and Brunner, Melissa
and Debono, Deborah
and Togher, Leanne
and Power, Emma",
title="Implementation of Web-Based Psychosocial Interventions for Adults With Acquired Brain Injury and Their Caregivers: Systematic Review",
journal="J Med Internet Res",
year="2022",
month="Jul",
day="26",
volume="24",
number="7",
pages="e38100",
keywords="complexity",
keywords="implementation science",
keywords="internet interventions",
keywords="acquired brain injury",
keywords="delivery of health care",
keywords="caregivers",
keywords="digital health",
keywords="psychosocial interventions",
keywords="psychosocial",
keywords="brain injury",
keywords="mobile phone",
abstract="Background: More than 135 million people worldwide live with acquired brain injury (ABI) and its many psychosocial sequelae. This growing global burden necessitates scalable rehabilitation services. Despite demonstrated potential to increase the accessibility and scalability of psychosocial supports, digital health interventions are challenging to implement and sustain. The Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework can offer developers and researchers a comprehensive overview of considerations to implement, scale, and sustain digital health interventions. Objective: This systematic review identified published, peer-reviewed primary evidence of implementation outcomes, strategies, and factors for web-based psychosocial interventions targeting either adults with ABI or their formal or informal caregivers; evaluated and summarized this evidence; synthesized qualitative and quantitative implementation data according to the NASSS framework; and provided recommendations for future implementation. Results were compared with 3 hypotheses which state that complexity (dynamic, unpredictable, and poorly characterized factors) in most or all NASSS domains increases likelihood of implementation failure; success is achievable, but difficult with many complicated domains (containing multiple interacting factors); and simplicity (straightforward, predictable, and few factors) in most or all domains increases the likelihood of success. Methods: From a comprehensive search of MEDLINE, EMBASE, PsycINFO, CINAHL, Scopus, speechBITE, and neuroBITE, we reviewed primary implementation evidence from January 2008 to June 2020. For web-based psychosocial interventions delivered via standard desktop computer, mobile phone, tablet, television, and virtual reality devices to adults with ABI or their formal or informal caregivers, we extracted intervention characteristics, stakeholder involvement, implementation scope and outcomes, study design and quality, and implementation data. Implementation data were both narratively synthesized and descriptively quantified across all 7 domains (condition, technology, value proposition, adopters, organization, wider system, and their interaction over time) and all subdomains of the NASSS framework. Study quality and risk of bias were assessed using the 2018 Mixed Methods Appraisal Tool. Results: We identified 60 peer-reviewed studies from 12 countries, including 5723 adults with ABI, 1920 carers, and 50 health care staff. The findings aligned with all 3 hypotheses. Conclusions: Although studies were of low methodological quality and insufficient number to statistically test relationships, the results appeared consistent with recommendations to reduce complexity as much as possible to facilitate implementation. Although studies excluded individuals with a range of comorbidities and sociocultural challenges, such simplification of NASSS domain 1 may have been necessary to advance intervention value propositions (domain 3). However, to create equitable digital health solutions that can be successfully implemented in real-world settings, it is recommended that developers involve people with ABI, their close others, and health care staff in addressing complexities in domains 2 to 7 from the earliest intervention design stages. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020186387; https://www.crd.york.ac.uk/prospero/display\_record.php?ID=CRD42020186387 International Registered Report Identifier (IRRID): RR2-10.1177/20552076211035988 ",
doi="10.2196/38100",
url="https://www.jmir.org/2022/7/e38100",
url="http://www.ncbi.nlm.nih.gov/pubmed/35881432"
}


@Article{info:doi/10.2196/33085,
author="Garnett, Anna
and Northwood, Melissa
and Ting, Justine
and Sangrar, Ruheena",
title="mHealth Interventions to Support Caregivers of Older Adults: Equity-Focused Systematic Review",
journal="JMIR Aging",
year="2022",
month="Jul",
day="8",
volume="5",
number="3",
pages="e33085",
keywords="caregivers",
keywords="older adults",
keywords="mobile health",
keywords="social determinants of health",
keywords="intervention",
keywords="mobile phone",
abstract="Background: Informal caregivers, hereafter referred to as caregivers, provide support to older adults so that they can age safely at home. The decision to become a caregiver can be influenced by individual factors, such as personal choice, or societal factors such as social determinants of health, including household income, employment status, and culture-specific gender roles. Over time, caregivers' health can be negatively affected by their caregiving roles. Although programs exist to support caregivers, the availability and appropriateness of services do not match caregivers' expressed needs. Research suggests that supportive interventions offered through mobile health (mHealth) technologies have the potential to increase caregivers' access to supportive services. However, a knowledge gap remains regarding the extent to which social determinants of health are considered in the design, implementation, and evaluation of mHealth interventions intended to support the caregivers of older adults. Objective: This study aimed to conduct a systematic review to determine how health equity is considered in the design, implementation, and evaluation of mHealth interventions for caregivers of older adults using Cochrane Equity's PROGRESS-Plus (place of residence, race, ethnicity, culture, language, occupation, gender, religion, education, social capital, socioeconomic status--plus age, disability, and sexual orientation) framework and synthesize evidence of the impacts of the identified caregiver-focused mHealth interventions. Methods: A systematic review was conducted using 5 databases. Articles published between January 2010 and June 2021 were included if they evaluated or explored the impact of mHealth interventions on the health and well-being of informal caregivers of older adults. mHealth interventions were defined as supportive services, for example, education, that caregivers of older adults accessed via mobile or wireless devices. Results: In total, 28 articles met the inclusion criteria and were included in the review. The interventions evaluated sought to connect caregivers with services, facilitate caregiving, and promote caregivers' health and well-being. The PROGRESS-Plus framework factors were mainly considered in the results, discussion, and limitations sections of the included studies. Some PROGRESS-Plus factors such as sexual orientation, religion, and occupation, received little to no consideration across any phase of the intervention design, implementation, or evaluation. Overall, the findings of this review suggest that mHealth interventions were positively received by study participants. Such interventions have the potential to reduce caregiver burden and positively affect caregivers' physical and mental health while supporting them as caregivers. The study findings highlight the importance of making support available to help facilitate caregivers' use of mHealth interventions, as well as in the use of appropriate language and text. Conclusions: The successful uptake and spread of mHealth interventions to support caregivers of older adults will depend on creating opportunities for the inclusive involvement of a broad range of stakeholders at all stages of design, implementation, and evaluation. ",
doi="10.2196/33085",
url="https://aging.jmir.org/2022/3/e33085",
url="http://www.ncbi.nlm.nih.gov/pubmed/35616514"
}


@Article{info:doi/10.2196/36370,
author="Morgan, Catherine
and Tonkin, L. Emma
and Craddock, Ian
and Whone, L. Alan",
title="Acceptability of an In-home Multimodal Sensor Platform for Parkinson Disease: Nonrandomized Qualitative Study",
journal="JMIR Hum Factors",
year="2022",
month="Jul",
day="7",
volume="9",
number="3",
pages="e36370",
keywords="sensor",
keywords="Parkinson disease",
keywords="wearables",
keywords="cameras",
keywords="acceptability",
keywords="smart home",
keywords="behavior change",
keywords="multimodal home-based",
keywords="qualitative",
abstract="Background: Parkinson disease (PD) symptoms are complex, gradually progressive, and fluctuate hour by hour. Home-based technological sensors are being investigated to measure symptoms and track disease progression. A smart home sensor platform, with cameras and wearable devices, could be a useful tool to use to get a fuller picture of what someone's symptoms are like. High-resolution video can capture the ground truth of symptoms and activities. There is a paucity of information about the acceptability of such sensors in PD. Objective: The primary objective of our study was to explore the acceptability of living with a multimodal sensor platform in a naturalistic setting in PD. Two subobjectives are to identify any suggested limitations and to explore the sensors' impact on participant behaviors. Methods: A qualitative study was conducted with an inductive approach using semistructured interviews with a cohort of PD and control participants who lived freely for several days in a home-like environment while continuously being sensed. Results: This study of 24 participants (12 with PD) found that it is broadly acceptable to use multimodal sensors including wrist-worn wearables, cameras, and other ambient sensors passively in free-living in PD. The sensor that was found to be the least acceptable was the wearable device. Suggested limitations on the platform for home deployment included camera-free time and space. Behavior changes were noted by the study participants, which may have related to being passively sensed. Recording high-resolution video in the home setting for limited periods of time was felt to be acceptable to all participants. Conclusions: The results broaden the knowledge of what types of sensors are acceptable for use in research in PD and what potential limitations on these sensors should be considered in future work. The participants' reported behavior change in this study should inform future similar research design to take this factor into account. Collaborative research study design, involving people living with PD at every stage, is important to ensure that the technology is acceptable and that the data outcomes produced are ecologically valid and accurate. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-041303 ",
doi="10.2196/36370",
url="https://humanfactors.jmir.org/2022/3/e36370",
url="http://www.ncbi.nlm.nih.gov/pubmed/35797101"
}


@Article{info:doi/10.2196/24376,
author="Latulippe, Karine
and Giroux, Dominique
and Guay, Manon
and Kairy, Dahlia
and Vincent, Claude
and Boivin, Katia
and Morales, Ernesto
and Obradovic, Natasa
and Provencher, V{\'e}ronique",
title="Mobile Videoconferencing for Occupational Therapists' Assessments of Patients' Home Environments Prior to Hospital Discharge: Mixed Methods Feasibility and Comparative Study",
journal="JMIR Aging",
year="2022",
month="Jul",
day="5",
volume="5",
number="3",
pages="e24376",
keywords="caregivers",
keywords="feasibility",
keywords="mixed methods",
keywords="mobile videoconferencing",
keywords="mobile phone",
keywords="occupational therapy",
keywords="discharge planning",
keywords="home assessment",
abstract="Background: Occupational therapists who work in hospitals need to assess patients' home environment in preparation for hospital discharge in order to provide recommendations (eg, technical aids) to support their independence and safety. Home visits increase performance in everyday activities and decrease the risk of falls; however, in some countries, home visits are rarely made prior to hospital discharge due to the cost and time involved. In most cases, occupational therapists rely on an interview with the patient or a caregiver to assess the home. The use of videoconferencing to assess patients' home environments could be an innovative solution to allow better and more appropriate recommendations. Objective: The aim of this study was (1) to explore the added value of using mobile videoconferencing compared with standard procedure only and (2) to document the clinical feasibility of using mobile videoconferencing to assess patients' home environments. Methods: Occupational therapists assessed home environments using, first, the standard procedure (interview),  and then, videoconferencing (with the help of a family caregiver located in patients' homes, using an electronic tablet). We used a concurrent mixed methods design. The occupational therapist's responsiveness to telehealth, time spent on assessment, patient's occupational performance and satisfaction, and major events influencing the variables were collected as quantitative data. The perceptions of occupational therapists and family caregivers regarding the added value of using this method and the nature of changes made to recommendations as a result of the videoconference (if any) were collected as qualitative data, using questionnaires and semistructured interviews. Results: Eight triads (6 occupational therapists, 8 patients, and 8 caregivers) participated. The use of mobile videoconferencing generally led occupational therapists to modify the initial intervention plan (produced after the standard interview). Occupational therapists and caregivers perceived benefits in using mobile videoconferencing (eg, the ability to provide real-time comments or feedback), and they also perceived disadvantages (eg, videoconferencing requires additional time and greater availability of caregivers). Some occupational therapists believed that mobile videoconferencing added value to assessments, while others did not. Conclusions: The use of mobile videoconferencing in the context of hospital discharge planning has raised questions of clinical feasibility. Although mobile videoconferencing provides multiple benefits to hospital discharge, including more appropriate occupational therapist recommendations, time constraints made it more difficult to perceive the added value. However, with smartphone use, interdisciplinary team involvement, and patient participation in the videoconference visit, mobile videoconferencing can become an asset to hospital discharge planning. International Registered Report Identifier (IRRID): RR2-10.2196/11674 ",
doi="10.2196/24376",
url="https://aging.jmir.org/2022/3/e24376",
url="http://www.ncbi.nlm.nih.gov/pubmed/35787486"
}


@Article{info:doi/10.2196/37688,
author="Tennant, Ryan
and Allana, Sana
and Mercer, Kate
and Burns, M. Catherine",
title="Caregiver Expectations of Interfacing With Voice Assistants to Support Complex Home Care: Mixed Methods Study",
journal="JMIR Hum Factors",
year="2022",
month="Jun",
day="30",
volume="9",
number="2",
pages="e37688",
keywords="caregivers",
keywords="children",
keywords="communication",
keywords="digital",
keywords="home care",
keywords="information management",
keywords="interaction",
keywords="older adult",
keywords="technology acceptance",
keywords="voice assistant",
abstract="Background: Providing care in home environments is complex, and often the pressure is on caregivers to document information and ensure care continuity. Digital information management and communication technologies may support care coordination among caregivers. However, they have yet to be adopted in this context, partly because of issues with supporting long-term disease progression and caregiver anxiety. Voice assistant (VA) technology is a promising method for interfacing with digital health information that may aid in multiple aspects of being a caregiver, thereby influencing adoption. Understanding the expectations for VAs to support caregivers is fundamental to inform the practical development of this technology. Objective: This study explored caregivers' perspectives on using VA technology to support caregiving and inform the design of future digital technologies in complex home care. Methods: This study was part of a larger study of caregivers across North America on the design of digital health technologies to support health communication and information management in complex home care. Caregivers included parents, guardians, and hired caregivers such as personal support workers and home care nurses. Video interviews were conducted with caregivers to capture their mental models on the potential application of VAs in complex home care and were theoretically analyzed using the technology acceptance model. Interviews were followed up with Likert-scale questions exploring perspectives on other VA applications beyond participants' initial perceptions. Results: Data were collected from 22 caregivers, and 3 themes were identified: caregivers' perceived usefulness of VAs in supporting documentation, care coordination, and person-centered care; caregivers' perceived ease of use in navigating information efficiently (they also had usability concerns with this interaction method); and caregivers' concerns, excitement, expected costs, and previous experience with VAs that influenced their attitudes toward use. From the Likert-scale questions, most participants (21/22, 95\%) agreed that VAs should support prompted information recording and retrieval, and all participants (22/22, 100\%) agreed that they should provide reminders. They also agreed that VAs should support them in an emergency (18/22, 82\%)---but only for calling emergency services---and guide caregivers through tasks (21/22, 95\%). However, participants were less agreeable on VAs expressing a personality (14/22, 64\%)---concerned they would manipulate caregivers' perceptions---and listening ambiently to remind caregivers about their documentation (16/22, 73\%). They were much less agreeable about VAs providing unprompted assistance on caregiving tasks (9/22, 41\%). Conclusions: The interviews and Likert-scale results point toward the potential for VAs to support family caregivers and hired caregivers by easing their information management and health communication at home. However, beyond information interaction, the potential impact of VA personality traits on caregivers' perceptions of the care situation and the passive collection of audio data to improve user experience through context-specific interactions are critical design considerations that should be further examined. ",
doi="10.2196/37688",
url="https://humanfactors.jmir.org/2022/2/e37688",
url="http://www.ncbi.nlm.nih.gov/pubmed/35771594"
}


@Article{info:doi/10.2196/35325,
author="Zolnoori, Maryam
and Vergez, Sasha
and Kostic, Zoran
and Jonnalagadda, Reddy Siddhartha
and V McDonald, Margaret
and Bowles, H. Kathryn K.
and Topaz, Maxim",
title="Audio Recording Patient-Nurse Verbal Communications in Home Health Care Settings: Pilot Feasibility and Usability Study",
journal="JMIR Hum Factors",
year="2022",
month="May",
day="11",
volume="9",
number="2",
pages="e35325",
keywords="patients",
keywords="HHC",
keywords="communications",
keywords="nurse",
keywords="audio recording",
keywords="device",
abstract="Background: Patients' spontaneous speech can act as a biomarker for identifying pathological entities, such as mental illness. Despite this potential, audio recording patients' spontaneous speech is not part of clinical workflows, and health care organizations often do not have dedicated policies regarding the audio recording of clinical encounters. No previous studies have investigated the best practical approach for integrating audio recording of patient-clinician encounters into clinical workflows, particularly in the home health care (HHC) setting. Objective: This study aimed to evaluate the functionality and usability of several audio-recording devices for the audio recording of patient-nurse verbal communications in the HHC settings and elicit HHC stakeholder (patients and nurses) perspectives about the facilitators of and barriers to integrating audio recordings into clinical workflows. Methods: This study was conducted at a large urban HHC agency located in New York, United States. We evaluated the usability and functionality of 7 audio-recording devices in a laboratory (controlled) setting. A total of 3 devices---Saramonic Blink500, Sony ICD-TX6, and Black Vox 365---were further evaluated in a clinical setting (patients' homes) by HHC nurses who completed the System Usability Scale questionnaire and participated in a short, structured interview to elicit feedback about each device. We also evaluated the accuracy of the automatic transcription of audio-recorded encounters for the 3 devices using the Amazon Web Service Transcribe. Word error rate was used to measure the accuracy of automated speech transcription. To understand the facilitators of and barriers to integrating audio recording of encounters into clinical workflows, we conducted semistructured interviews with 3 HHC nurses and 10 HHC patients. Thematic analysis was used to analyze the transcribed interviews. Results: Saramonic Blink500 received the best overall evaluation score. The System Usability Scale score and word error rate for Saramonic Blink500 were 65\% and 26\%, respectively, and nurses found it easier to approach patients using this device than with the other 2 devices. Overall, patients found the process of audio recording to be satisfactory and convenient, with minimal impact on their communication with nurses. Although, in general, nurses also found the process easy to learn and satisfactory, they suggested that the audio recording of HHC encounters can affect their communication patterns. In addition, nurses were not aware of the potential to use audio-recorded encounters to improve health care services. Nurses also indicated that they would need to involve their managers to determine how audio recordings could be integrated into their clinical workflows and for any ongoing use of audio recordings during patient care management. Conclusions: This study established the feasibility of audio recording HHC patient-nurse encounters. Training HHC nurses about the importance of the audio-recording process and the support of clinical managers are essential factors for successful implementation. ",
doi="10.2196/35325",
url="https://humanfactors.jmir.org/2022/2/e35325",
url="http://www.ncbi.nlm.nih.gov/pubmed/35544296"
}


@Article{info:doi/10.2196/31486,
author="Read, A. Emily
and Gagnon, A. Danie
and Donelle, Lorie
and Ledoux, Kathleen
and Warner, Grace
and Hiebert, Brad
and Sharma, Ridhi",
title="Stakeholder Perspectives on In-home Passive Remote Monitoring to Support Aging in Place in the Province of New Brunswick, Canada: Rapid Qualitative Investigation",
journal="JMIR Aging",
year="2022",
month="May",
day="11",
volume="5",
number="2",
pages="e31486",
keywords="aging in place",
keywords="home care",
keywords="older adults",
keywords="passive remote monitoring",
abstract="Background: The province of New Brunswick (NB) has one of the oldest populations in Canada, providing an opportunity to develop and test innovative strategies to address the unique health challenges faced by older adults. Passive remote monitoring technology has the potential to support independent living among older adults. Limited research has examined the benefits of and barriers to the adoption of this technology among community-dwelling older adults. Objective: This study aimed to explore perceptions of in-home passive remote monitoring technology designed to support aging in place from the perspective of older adults, their family or friend caregivers, social workers, and government decision-makers in the province of NB, Canada. Methods: Between October 2018 and March 2020, a rapid qualitative investigation of 28 one-on-one interviews was conducted in person or via telephone. Participants included 2 home support services clients and 11 family or friend caregivers who had used passive remote monitoring technology in their homes; 8 social workers who had worked as case managers for home support services clients; and 7 individuals who were key government decision-makers in the adoption, policy development, and use of the technology in the province of NB. The interviews focused on the following topics: decision to adopt the passive remote monitoring system, barriers to adopting the passive remote monitoring system, benefits of the passive remote monitoring system, impact on client health outcomes, and privacy concerns. The interviews were audio recorded, transcribed, and analyzed by a team of 6 researchers. Data analysis was conducted using a rapid assessment process approach that included matrix analysis. Results: Participants reported that the use of the remote monitoring system allowed older adults to live at home longer and provided caregiver relief. Stakeholders were invested in meeting the home support (home care) needs of older adults. However, when it came to the use of remote monitoring, there was a lack of consensus about which clients it was well-suited for and the role that social workers should play in informing clients and caregivers about the service (role ambiguity, gatekeeping, and perceived conflicts of interest). Conclusions: Our findings highlight many benefits and challenges of the adoption of passive remote monitoring for clients, their family or friend caregivers, and public provincial health and social services systems. Passive remote monitoring is a valuable tool that can provide support to older adults and their family or friend caregivers when it is a good fit with client needs. Further work is needed in NB to increase public and social workers' awareness of the service and its benefits. ",
doi="10.2196/31486",
url="https://aging.jmir.org/2022/2/e31486",
url="http://www.ncbi.nlm.nih.gov/pubmed/35544304"
}


@Article{info:doi/10.2196/33714,
author="Camp, Nicola
and Johnston, Julie
and Lewis, C. Martin G.
and Zecca, Massimiliano
and Di Nuovo, Alessandro
and Hunter, Kirsty
and Magistro, Daniele",
title="Perceptions of In-home Monitoring Technology for Activities of Daily Living: Semistructured Interview Study With Community-Dwelling Older Adults",
journal="JMIR Aging",
year="2022",
month="May",
day="5",
volume="5",
number="2",
pages="e33714",
keywords="aging",
keywords="wearable sensors",
keywords="environmental sensors",
keywords="social robots",
keywords="activities of daily living",
keywords="older adults",
keywords="elderly",
keywords="robots",
keywords="wearables",
abstract="Background: Many older adults prefer to remain in their own homes for as long as possible. However, there are still questions surrounding how best to ensure that an individual can cope with autonomous living. Technological monitoring systems are an attractive solution; however, there is disagreement regarding activities of daily living (ADL) and the optimal technologies that should be used to monitor them. Objective: This study aimed to understand older adults' perceptions of important ADL and the types of technologies they would be willing to use within their own homes. Methods: Semistructured interviews were conducted on the web with 32 UK adults, divided equally into a younger group (aged 55-69 years) and an older group (?70 years). Results: Both groups agreed that ADL related to personal hygiene and feeding were the most important and highlighted the value of socializing. The older group considered several activities to be more important than their younger counterparts, including stair use and foot care. The older group had less existing knowledge of monitoring technology but was more willing to accept wearable sensors than the younger group. The younger group preferred sensors placed within the home but highlighted that they would not have them until they felt that daily life was becoming a struggle. Conclusions: Overall, technological monitoring systems were perceived as an acceptable method for monitoring ADL. However, developers and carers must be aware that individuals may express differences in their willingness to engage with certain types of technology depending on their age and circumstances. ",
doi="10.2196/33714",
url="https://aging.jmir.org/2022/2/e33714",
url="http://www.ncbi.nlm.nih.gov/pubmed/35511248"
}


@Article{info:doi/10.2196/35847,
author="Cha, Jinhee
and Peterson, M. Colleen
and Millenbah, N. Ashley
and Louwagie, Katie
and Baker, G. Zachary
and Shah, Ayush
and Jensen, J. Christine
and Gaugler, E. Joseph",
title="Delivering Personalized Recommendations to Support Caregivers of People Living With Dementia: Mixed Methods Study",
journal="JMIR Aging",
year="2022",
month="May",
day="3",
volume="5",
number="2",
pages="e35847",
keywords="caregivers",
keywords="caregiving",
keywords="Alzheimer",
keywords="dementia",
keywords="intervention",
keywords="COVID-19",
abstract="Background: Estimates suggest that 6.2 million Americans aged ?65 years are living with Alzheimer dementia in 2021, and by 2060, this number could more than double to 13.8 million. As a result, public health officials anticipate a greater need for caregivers of persons with Alzheimer disease or related dementia and support resources for both people living with dementia and their caregivers. Despite the growing need for dementia caregiver support services, there is a lack of consensus regarding how to tailor these services to best meet the heterogeneous needs of individual caregivers. To fill this gap, Care to Plan (CtP), a web-based tool for caregivers of people living with dementia, was developed to provide tailored support recommendations to dementia caregivers. Objective: The aim of this study is to formally explore the feasibility, acceptability, and utility of CtP for 20 family members of people living with dementia within a health system over a 1-month time period using a mixed methods parallel convergent design. Methods: A moderately sized health system in the mid-Atlantic region was selected as the site for CtP implementation, where 20 caregivers who were family members of people living with dementia were enrolled. The web-based CtP tool was used by caregivers and facilitated by a health care professional (ie, a senior care navigator [SCN]). Caregivers were given a 21-item review checklist to assess barriers and facilitators associated with reviewing CtP with an SCN. Following the 21-item review checklist, semistructured telephone interviews, which included 18 open-ended questions, focused on the facilitators of and barriers to CtP implementation and recommendations for future implementation. Results: Quantitative results suggested that 85\% (17/20) of caregivers indicated that CtP was helpful and 90\% (18/20) would recommend CtP to someone in a similar situation. The qualitative analysis identified 4 themes regarding facilitators of and barriers to implementation: caregiver factors, SCN factors, CtP tool system factors, and recommendations and resources factors. Conclusions: CtP was found to be not only feasible but also a valuable tool for caregivers seeking resources for themselves and their people living with dementia. Long-term evaluation findings aim to generate results on how CtP can be integrated into care plans for caregivers and how SCNs can provide additional support for caregivers of people living with dementia over an extended period. ",
doi="10.2196/35847",
url="https://aging.jmir.org/2022/2/e35847",
url="http://www.ncbi.nlm.nih.gov/pubmed/35503650"
}


@Article{info:doi/10.2196/32322,
author="Shin, H. Marlena
and McLaren, Jaye
and Ramsey, Alvin
and Sullivan, L. Jennifer
and Moo, Lauren",
title="Improving a Mobile Telepresence Robot for People With Alzheimer Disease and Related Dementias: Semistructured Interviews With Stakeholders",
journal="JMIR Aging",
year="2022",
month="May",
day="3",
volume="5",
number="2",
pages="e32322",
keywords="mild cognitive impairment",
keywords="socially assistive robot",
keywords="robot technology",
keywords="caregiver support",
keywords="gerontology",
keywords="aging in place",
keywords="qualitative research",
keywords="mobile phone",
abstract="Background: By 2050, nearly 13 million Americans will have Alzheimer disease and related dementias (ADRD), with most of those with ADRD or mild cognitive impairment (MCI) receiving home care. Mobile telepresence robots may allow persons with MCI or ADRD to remain living independently at home and ease the burden of caregiving. The goal of this study was to identify how an existing mobile telepresence robot can be enhanced to support at-home care of people with MCI or ADRD through key stakeholder input. Objective: The specific aims were to assess what applications should be integrated into the robot to further support the independence of individuals with MCI or ADRD and understand stakeholders' overall opinions about the robot. Methods: We conducted in-person interviews with 21 stakeholders, including 6 people aged >50 years with MCI or ADRD living in the community, 9 family caregivers of people with MCI or ADRD, and 6 clinicians who work with the ADRD population. Interview questions about the robot focused on technology use, design and functionality, future applications to incorporate, and overall opinions. We conducted a thematic analysis of the data obtained and assessed the patterns within and across stakeholder groups using a matrix analysis technique. Results: Overall, most stakeholders across groups felt positively about the robot's ability to support individuals with MCI or ADRD and decrease caregiver burden. Most ADRD stakeholders felt that the greatest benefits would be receiving help in emergency cases and having fewer in-person visits to the doctor's office. Caregivers and clinicians also noted that remote video communication with their family members using the robot was valuable. Adding voice commands and 1-touch lifesaving or help buttons to the robot were the top suggestions offered by the stakeholders. The 4 types of applications that were suggested included health-related alerts; reminders; smart-home--related applications; and social, entertainment, or well-being applications. Stakeholders across groups liked the robot's mobility, size, interactive connection, and communication abilities. However, stakeholders raised concerns about their physical stability and size for individuals living in smaller, cluttered spaces; screen quality for those with visual impairments; and privacy or data security. Conclusions: Although stakeholders generally expressed positive opinions about the robot, additional adaptations were suggested to strengthen functionality. Adding applications and making improvements to the design may help mitigate concerns and better support individuals with ADRD to live independently in the community. As the number of individuals living with ADRD in the United States increases, mobile telepresence robots are a promising way to support them and their caregivers. Engaging all 3 stakeholder groups in the development of these robots is a critical first step in ensuring that the technology matches their needs. Integrating the feedback obtained from our stakeholders and evaluating their effectiveness will be important next steps in adapting telepresence robots. ",
doi="10.2196/32322",
url="https://aging.jmir.org/2022/2/e32322",
url="http://www.ncbi.nlm.nih.gov/pubmed/35503518"
}


@Article{info:doi/10.2196/35363,
author="Karnehed, Sara
and Erlandsson, Lena-Karin
and Norell Pejner, Margaretha",
title="Nurses' Perspectives on an Electronic Medication Administration Record in Home Health Care: Qualitative Interview Study",
journal="JMIR Nursing",
year="2022",
month="Apr",
day="22",
volume="5",
number="1",
pages="e35363",
keywords="e-health",
keywords="eHealth",
keywords="eMAR",
keywords="electronic medication administration record",
keywords="homecare nurses",
keywords="home health care",
keywords="nursing profession",
keywords="delegation",
keywords="task-shifting",
keywords="medication administration",
abstract="Background: eHealth is considered by policy makers as a prerequisite for meeting the demands of health care from the growing proportion of older people worldwide. The expectation about what the efficiency of eHealth can bring is particularly high in the municipal home health care sector, which is facing pressure regarding resources because of, for example, earlier discharges from hospitals and a growing number of patients receiving medications and treatments at home. Common eHealth services in home health care are electronic medication administration records (eMARs) that aim to communicate delegated tasks between professionals. However, there is an extensive gap in the research on how technology affects and is experienced by home health care professionals. Objective: The objective of this paper is to shed light on how home care nurses experience eMARs in a Swedish municipality. Methods: This qualitative interview study was conducted among home health care nurses using eMARs to facilitate communication and signing of delegated nursing tasks. The analysis of the interviews was performed using constructivist grounded theory, according to Charmaz. Results: Of the 19 day-employed nurses in the municipality where an eMAR was used, 16 (84\%) nurses participated in the study. The following two categories were identified from the focus group interviews: nurses become monitors and slip away from the point of care. The nurses experienced that they became monitors of health care through the increased transparency provided by the eMAR and the measurands they also applied, focusing on the quantitative aspects of the delegated nursing tasks rather than the qualitative aspects. The nurses experienced that their monitoring changed the power relations between the professions, reinforcing the nurses' superior position. The experience of the eMAR was regarded as transitioning the nurses' professional role---away from the point of care and toward more administration---and further strengthened the way of managing work through delegation to health care assistants. Conclusions: Previous analyses of eHealth services in health care showed that implementation is a complex process that changes health care organizations and the work of health care professionals in both intended and unintended ways. This study adds to the literature by examining how users of a specific eHealth service experience its impacts on their daily work. The results indicate that the inscribed functions in an eHealth service may affect the values and priorities where the service is in use. This presents an opportunity for future research and for health care organizations to assess the impacts of specific eHealth services on health care professionals' work and to further examine the effects of inscribed functions in relation to how they may affect actions and priorities at individual and organizational levels. ",
doi="10.2196/35363",
url="https://nursing.jmir.org/2022/1/e35363",
url="http://www.ncbi.nlm.nih.gov/pubmed/35452400"
}


@Article{info:doi/10.2196/33586,
author="Beaus{\'e}jour, Waldo
and Hagens, Simon",
title="Uncovering Important Drivers of the Increase in the Use of Virtual Care Technologies in Nursing Care: Quantitative Analysis From the 2020 National Survey of Canadian Nurses",
journal="JMIR Nursing",
year="2022",
month="Mar",
day="31",
volume="5",
number="1",
pages="e33586",
keywords="adoption of virtual care",
keywords="secure messaging",
keywords="nurses",
keywords="nursing",
keywords="telehealth",
keywords="telehomecare",
keywords="telemonitoring",
keywords="remote patient monitoring",
keywords="virtual videoconferencing",
keywords="uptake of virtual care",
abstract="Background: Canadian nurses are at the forefront of patient care delivery. Although the use of digital health technologies for care delivery is gaining momentum in Canada, nurses are encouraged to integrate virtual care into their practice. In early 2020, more Canadian nurses delivered care virtually compared with 3 years ago. Objective: This study seeks to uncover the professional characteristics of Canadian nurses accessing virtual care in 2020, understand how these characteristics differ across types of technologies, investigate whether the nurses accessing virtual care possess the skills and knowledge needed to use these technologies, and determine the important drivers of the uptake of virtual care observed in 2020. Methods: We used data from the 2017 and 2020 National Survey of Canadian Nurses. This survey collected data on the use of digital health technologies in nursing practice. It concerned regulated nursing professionals working in different health care settings and from different domains of nursing practice. We combined the chi-square independence test and logistic regression analysis to uncover the most relevant drivers of virtual care uptake by nurses in 2020. Results: In early 2020, before the declaration of the COVID-19 pandemic, nurses who delivered care virtually were predominantly nurse practitioners (135/159, 84.9\%) and more likely to work in a primary or community care setting (202/367, 55\%) and in an urban setting (194/313, 61.9\%). Factors such as nursing designation (P<.001), perceived quality of care at the health facility where the nurses practiced (P<.001), and the type of patient record--keeping system they had access to (P=.04) had a statistically significant effect on the probability of nurses to deliver care virtually in early 2020. Furthermore, nurses' perception of the quality of care they delivered through virtual technologies was statistically associated with their perception of the skills ($\chi$24=308.7; P<.001) and knowledge ($\chi$24=283.4; P<.001) to use these technologies. Conclusions: This study emphasizes the critical importance of nursing designation, geographic location, and type of patient record--keeping system in predicting virtual care integration in nursing practice. The findings related to geographic location can be used by decision-makers for better allocation of digital health resources among care settings in rural and urban areas. Similarly, the disparities observed across nursing designations have some implications for the digital training of nurses at all levels of practice. Finally, the association between electronic medical record use and uptake of virtual care could accelerate the implementation of more modernized record-keeping systems in care settings. Hence, this could advance interoperability and improve health care delivery. ",
doi="10.2196/33586",
url="https://nursing.jmir.org/2022/1/e33586",
url="http://www.ncbi.nlm.nih.gov/pubmed/35357326"
}


@Article{info:doi/10.2196/31552,
author="Albers, A. Elizabeth
and Mikal, Jude
and Millenbah, Ashley
and Finlay, Jessica
and Jutkowitz, Eric
and Mitchell, Lauren
and Horn, Brenna
and Gaugler, E. Joseph",
title="The Use of Technology Among Persons With Memory Concerns and Their Caregivers in the United States During the COVID-19 Pandemic: Qualitative Study",
journal="JMIR Aging",
year="2022",
month="Mar",
day="17",
volume="5",
number="1",
pages="e31552",
keywords="social isolation",
keywords="dementia",
keywords="caregiving - informal",
keywords="aging in place",
keywords="caregivers",
keywords="aging",
keywords="elderly",
keywords="pandemic",
keywords="COVID-19",
keywords="mental health",
keywords="technology use",
keywords="health technology",
abstract="Background: Stay-at-home orders and other public health measures designed to mitigate the spread of COVID-19 have increased isolation among persons with memory concerns (PWMCs: individuals diagnosed with cognitive impairment or Alzheimer disease or related dementias). The pandemic has also exacerbated challenges for family members who care for PWMCs. Although technology has demonstrated the potential to improve the social connections and mental health of PWMCs and their family caregivers (CGs), previous research shows that older adults may be reluctant to adopt new technologies. Objective: We aimed to understand why and how some PWMCs and their CGs altered their use of mainstream technology, such as smartphones and fitness trackers, and assistive technology to adapt to lifestyle changes (eg, increased isolation) during the COVID-19 pandemic. Methods: Using data collected in 20 qualitative interviews from June to August 2020 with 20 PWMCs and family CG dyads, we assessed changes in and barriers to everyday technology use following the implementation of COVID-19 mitigation strategies in the United States. Zoom videoconferencing was utilized to conduct the interviews to protect the health of the participants who were primarily older adults. Results: Using qualitative thematic analysis, we identified 3 themes that explained motivations for using technology during a pandemic: (1) maintaining social connections, (2) alleviating boredom, and (3) increasing CG respite. Results further revealed lingering barriers to PWMC and CG adoption of technologies, including: (1) PWMC dependence upon CGs, (2) low technological literacy, and (3) limitations of existing technology. Conclusions: This in-depth investigation suggests that technology can provide PWMCs with more independence and offer CGs relief from CG burden during periods of prolonged isolation. ",
doi="10.2196/31552",
url="https://aging.jmir.org/2022/1/e31552",
url="http://www.ncbi.nlm.nih.gov/pubmed/35134748"
}


@Article{info:doi/10.2196/32516,
author="Gilson, Aaron
and Gassman, Michele
and Dodds, Debby
and Lombardo, Robin
and Ford II, H. James
and Potteiger, Michael",
title="Refining a Digital Therapeutic Platform for Home Care Agencies in Dementia Care to Elicit Stakeholder Feedback: Focus Group Study With Stakeholders",
journal="JMIR Aging",
year="2022",
month="Mar",
day="2",
volume="5",
number="1",
pages="e32516",
keywords="dementia",
keywords="technology",
keywords="mobile app",
keywords="home care",
keywords="focus groups",
keywords="qualitative research",
keywords="digital therapeutics",
keywords="value-based care",
keywords="aging in place",
keywords="caregiving",
abstract="Background: Persons living with dementia require increasing levels of care, and the care model has evolved. The Centers for Medicare and Medicaid Services is transitioning long-term care services from institutional care to home- or community-based services, including reimbursement for nonclinical services. Although home care companies are positioned to handle this transition, they need innovative solutions to address the special challenges posed by caring for persons living with dementia. To live at home longer, these persons require support from formal caregivers (FCGs; ie, paid professionals), who often lack knowledge of their personal histories and have high turnover, or informal caregivers (eg, family or friends), who may have difficulty coping with behavioral and psychological symptoms of dementia. The Generation Connect platform was developed to support these individuals and their formal and informal caregivers. In preliminary studies, the platform improved mood and influenced caregiver satisfaction. To enhance platform effectiveness, Generation Connect received a grant from the National Institutes of Health Small Business Innovation Research to improve clinical outcomes, reduce health care costs, and lower out-of-pocket costs for persons living with dementia who receive care through home care agencies. Objective: This study aims to evaluate information elicited from a series of stakeholder focus groups to understand existing processes, needs, barriers, and goals for the use of the Generation Connect platform by home care agencies and formal and informal caregivers. Methods: A series of focus groups were conducted with home care agency corporate leadership, home care agency franchise owners, home care agency FCGs, and informal caregivers of persons living with dementia. The qualitative approach allowed for unrestricted idea generation that best informed the platform development to enable home care providers to differentiate their dementia care services, involve informal caregivers, improve FCG well-being, and extend the ability of persons living with dementia to age in place. Using the Technology-Enabled Caregiving in the Home framework, an inductive and iterative content analysis was conducted to identify thematic categories from the transcripts. Results: Overall, 39 participants participated across the 6 stakeholder focus groups. The following five overarching themes were identified: technology related; care services; data, documentation, and outcomes; cost, finance, and resources; and resources for caregivers. Within each theme, the most frequent subthemes were identified. Exemplar stakeholder group statements provided support for each of the identified themes. Conclusions: The focus group results will inform the further development of the Generation Connect platform to reduce the burden of caregiving for persons living with dementia, evaluate changes in cognition, preserve functional independence, and promote caregiver engagement between these individuals. The next step is to evaluate the effectiveness of the revised platform in the National Institutes of Health Small Business Innovation Research phase 2 clinical trial to assess the efficacy of its evidence-based interventions and market viability. ",
doi="10.2196/32516",
url="https://aging.jmir.org/2022/1/e32516",
url="http://www.ncbi.nlm.nih.gov/pubmed/35234657"
}


@Article{info:doi/10.2196/19967,
author="Xiong, Chen
and D'Souza, Andrea
and El-Khechen-Richandi, Graziella
and Mihailidis, Alex
and Cameron, I. Jill
and Astell, Arlene
and Nalder, Emily
and Colantonio, Angela",
title="Perceptions of Digital Technology Experiences and Development Among Family Caregivers and Technology Researchers: Qualitative Study",
journal="JMIR Form Res",
year="2022",
month="Jan",
day="28",
volume="6",
number="1",
pages="e19967",
keywords="caregiving",
keywords="digital technologies",
keywords="sex",
keywords="gender",
keywords="diversity",
abstract="Background: Caregiving is highly stressful and is associated with poor mental and physical health. Various technologies, including mobile and eHealth apps, have been developed to address caregiver needs. However, there is still a paucity of research examining the technology perceptions of informal caregivers, especially from the perspectives of sex, gender, and diversity. Objective: To address the research gap and inform the development of future caregiving technologies, this study aims to examine how family caregivers perceive using technology to assist with their caregiving routines; identify the sex, gender, and diversity factors that shape these perceptions; and understand how these perceptions and needs are reflected within the current technology development process. Methods: Semistructured interviews were conducted with 16 informal caregivers of individuals with a range of chronic medical conditions and 8 technology researchers involved in caregiving technology projects. Results: Three main themes with subthemes were developed. The first main theme is that caregivers see a need for technology in their lives, and it comprises the following 3 subthemes: caregiving is a challenging endeavor, technology is multifaceted, and caregiver preferences facilitate technology use. The second main theme is that relationships play a vital role in mediating technology uptake, and it comprises the following 2 subthemes: the caregiver-care recipient dynamic shapes technology perceptions and caregivers rely on external sources for technology information. Finally, the third main theme is that barriers are present in the use and adoption of technology, and it comprises the following 2 subthemes: technology may not be compatible with personal values and abilities and technology that is not tailored toward caregivers lacks adoption. Conclusions: The findings highlight the multifaceted role that technology can play in aiding caregiving while drawing attention to the perceived drawbacks of these technologies among caregivers. The inclusion of technology researchers in this study provides a more holistic understanding of technologies in caregiving from their initial development to their eventual uptake by caregivers. ",
doi="10.2196/19967",
url="https://formative.jmir.org/2022/1/e19967",
url="http://www.ncbi.nlm.nih.gov/pubmed/35089150"
}


@Article{info:doi/10.2196/15413,
author="Egan, J. Kieren
and Clark, Patricia
and Deen, Zahid
and Paputa Dutu, Carmen
and Wilson, Graham
and McCann, Lisa
and Lennon, Marilyn
and Maguire, Roma",
title="Understanding Current Needs and Future Expectations of Informal Caregivers for Technology to Support Health and Well-being: National Survey Study",
journal="JMIR Aging",
year="2022",
month="Jan",
day="27",
volume="5",
number="1",
pages="e15413",
keywords="caregiving",
keywords="technology",
keywords="health",
keywords="well-being",
keywords="digital health",
keywords="co-design",
keywords="mobile phone",
abstract="Background: There are approximately 6.5 million informal (unpaid) caregivers in the United Kingdom. Each caregiver plays a critical role in the society, supporting the health and well-being of those who are ill, disabled, or older and who need frequent support. Digital technologies are becoming a ubiquitous part of everyday life for many, but little is known about the real-world impact of technology for those in a caring role, including the abilities of technologies to address the mental and physical impacts of caregiving. Objective: This study aims to understand the current and future technology use of caregivers, including digital technologies used to care for themselves and the person they look after. Methods: We codeveloped a wide range of questions with caregivers and care professionals and delivered this survey both on the web and in paper format (eg, using social networks such as Twitter alongside in-person events). Questions were focused on providing care and looking after caregiver health and well-being. Analyses focused on both quantitative outcomes (frequency counts and Likert questions) and explored free text entries (thematic analysis). Results: From 356 respondents, we identified that caregivers were receptive to, and largely positive about current and future use of technology both for their own care and their caring role (eg, checking in from distance). There were notable concerns, including the risk that technology could replace human contact. We identified several key areas for future work, including communication with health and social care professionals, and the potential for technology to help caregivers with their own health. We also identified several stakeholders (eg, care workers, pharmacy staff, and general practitioners) who could act as suitable points for technology signposting and support. Conclusions: Caregivers are a transient, often difficult to reach population, and this work has collated a large body of knowledge across a diverse group of individuals. Many caregivers, like the rest of society, are realizing the benefits of using everyday technology to help deliver care. It is clear that there is already a high level of dependency on technologies, where future expectations will grow. However, many barriers to digital technology use remain, including a lack of ongoing technology support. Preventive measures linked to technology that can help look after a caregiver's own health appear acceptable, particularly for communicative tools. This collated caregiver knowledge is a call for all stakeholders---academics, policy makers, and practitioners---to take note of these specific challenges, and to ensure that caregiver voices are both heard and fully integrated within the emerging digital health agenda. ",
doi="10.2196/15413",
url="https://aging.jmir.org/2022/1/e15413",
url="http://www.ncbi.nlm.nih.gov/pubmed/35084339"
}


@Article{info:doi/10.2196/31970,
author="Zhang, Qing
and Varnfield, Marlien
and Higgins, Liesel
and Smallbon, Vanessa
and Bomke, Julia
and O'Dwyer, John
and Byrnes, M. Joshua
and Sum, Melissa
and Hewitt, Jennifer
and Lu, Wei
and Karunanithi, Mohanraj",
title="The Smarter Safer Homes Solution to Support Older People Living in Their Own Homes Through Enhanced Care Models: Protocol for a Stratified Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2022",
month="Jan",
day="24",
volume="11",
number="1",
pages="e31970",
keywords="smart home",
keywords="aged care",
keywords="objective activity of daily living",
keywords="randomized trial",
keywords="wireless sensor network",
keywords="older adults",
keywords="care",
keywords="methodology",
keywords="platform",
keywords="benefit",
keywords="utilization",
keywords="support",
keywords="self-management",
keywords="digital health",
abstract="Background: An aging population, accompanied by the prevalence of age-related diseases, presents a significant burden to health systems. This is exacerbated by an increasing shortage of aged care staff due to the existing workforce entering their retirement and fewer young people being attracted to work in aged care. In line with consumer preferences and potential cost-efficiencies, government and aged care providers are increasingly seeking options to move care and support to the community or home as opposed to residential care facilities. However, compared to residential care, home environments may provide limited opportunity for monitoring patients' progression/decline in functioning and therefore limited opportunity to provide timely intervention. To address this, the Smarter Safer Homes (SSH) platform was designed to enable self-monitoring and/or management, and to provide aged care providers with support to deliver their services. The platform uses open Internet of Things communication protocols to easily incorporate commercially available sensors into the system. Objective: Our research aims to detail the benefits of utilizing the SSH platform as a service in its own right as well as a complementary service to more traditional/historical service offerings in aged care. This work is anticipated to validate the capacity and benefits of the SSH platform to enable older people to self-manage and aged care service providers to support their clients to live functionally and independently in their own homes for as long as possible. Methods: This study was designed as a single-blinded, stratified, 12-month randomized controlled trial with participants recruited from three aged care providers in Queensland, Australia. The study aimed to recruit 200 people, including 145 people from metropolitan areas and 55 from regional areas. Participants were randomized to the intervention group (having the SSH platform installed in their homes to assist age care service providers in monitoring and providing timely support) and the control group (receiving their usual aged care services from providers). Data on community care, health and social-related quality of life, health service utilization, caregiver burden, and user experience of both groups were collected at the start, middle (6 months), and end of the trial (12 months). Results: The trial recruited its first participant in April 2019 and data collection of the last participant was completed in November 2020. The trial eventually recruited 195 participants, with 98 participants allocated to the intervention group and 97 participants allocated to the control group. The study also received participants' health service data from government data resources in June 2021. Conclusions: A crisis is looming to support the aging population. Digital solutions such as the SSH platform have the potential to address this crisis and support aged care in the home and community. The outcomes of this study could improve and support the delivery of aged care services and provide better quality of life to older Australians in various geographical locations. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12618000829213; https://tinyurl.com/2n6a75em International Registered Report Identifier (IRRID): DERR1-10.2196/31970 ",
doi="10.2196/31970",
url="https://www.researchprotocols.org/2022/1/e31970",
url="http://www.ncbi.nlm.nih.gov/pubmed/35072640"
}


@Article{info:doi/10.2196/31038,
author="Zolnoori, Maryam
and Song, Jiyoun
and McDonald, V. Margaret
and Barr{\'o}n, Yolanda
and Cato, Kenrick
and Sockolow, Paulina
and Sridharan, Sridevi
and Onorato, Nicole
and Bowles, H. Kathryn
and Topaz, Maxim",
title="Exploring Reasons for Delayed Start-of-Care Nursing Visits in Home Health Care: Algorithm Development and Data Science Study",
journal="JMIR Nursing",
year="2021",
month="Dec",
day="30",
volume="4",
number="4",
pages="e31038",
keywords="delayed start-of-care nursing visit",
keywords="home healthcare services",
keywords="natural language processing",
keywords="nursing note",
keywords="NLP",
keywords="nursing",
keywords="eHealth",
keywords="home care",
keywords="clinical notes",
keywords="classification",
keywords="clinical informatics",
abstract="Background: Delayed start-of-care nursing visits in home health care (HHC) can result in negative outcomes, such as hospitalization. No previous studies have investigated why start-of-care HHC nursing visits are delayed, in part because most reasons for delayed visits are documented in free-text HHC nursing notes. Objective: The aims of this study were to (1) develop and test a natural language processing (NLP) algorithm that automatically identifies reasons for delayed visits in HHC free-text clinical notes and (2) describe reasons for delayed visits in a large patient sample. Methods: This study was conducted at the Visiting Nurse Service of New York (VNSNY). We examined data available at the VNSNY on all new episodes of care started in 2019 (N=48,497). An NLP algorithm was developed and tested to automatically identify and classify reasons for delayed visits. Results: The performance of the NLP algorithm was 0.8, 0.75, and 0.77 for precision, recall, and F-score, respectively. A total of one-third of HHC episodes (n=16,244) had delayed start-of-care HHC nursing visits. The most prevalent identified category of reasons for delayed start-of-care nursing visits was no answer at the door or phone (3728/8051, 46.3\%), followed by patient/family request to postpone or refuse some HHC services (n=2858, 35.5\%), and administrative or scheduling issues (n=1465, 18.2\%). In 40\% (n=16,244) of HHC episodes, 2 or more reasons were documented. Conclusions: To avoid critical delays in start-of-care nursing visits, HHC organizations might examine and improve ways to effectively address the reasons for delayed visits, using effective interventions, such as educating patients or caregivers on the importance of a timely nursing visit and improving patients' intake procedures. ",
doi="10.2196/31038",
url="https://nursing.jmir.org/2021/4/e31038",
url="http://www.ncbi.nlm.nih.gov/pubmed/34967749"
}


@Article{info:doi/10.2196/34652,
author="Castro, R. Aimee
and Arnaert, Antonia
and Moffatt, Karyn
and Kildea, John
and Bitzas, Vasiliki
and Tsimicalis, Argerie",
title="Developing an mHealth Application to Coordinate Nurse-Provided Respite Care Services for Families Coping With Palliative-Stage Cancer: Protocol for a User-Centered Design Study",
journal="JMIR Res Protoc",
year="2021",
month="Dec",
day="13",
volume="10",
number="12",
pages="e34652",
keywords="respite care",
keywords="caregivers",
keywords="cancer",
keywords="neoplasms",
keywords="user-centered design",
keywords="mobile applications",
keywords="palliative care",
keywords="home care services",
keywords="information systems research framework",
keywords="hospice and palliative care nursing",
abstract="Background: Patients living with palliative-stage cancer frequently require intensive care from their family caregivers. Without adequate community support services, patients are at risk of receiving inadequate care, and family caregivers are at risk for depression and poor health. For such families, in-home respite care can be invaluable, particularly when the services are flexible and staffed by trusted care providers, such as nurses. Other industries are using mobile apps to make services more flexible. However, few apps have been developed to coordinate nurse-provided respite care services, and to our knowledge, none have been designed in conjunction with families affected by cancer. Objective: The aim of this study is to develop a mobile health (mHealth) app prototype for coordinating flexible and trusted in-home respite care services provided by nurses to families coping with palliative-stage cancer in Qu{\'e}bec, Canada. Methods: This user-centered design research comprises the core component of the iRespite Services iR{\'e}pit research program. For this study, we are recruiting 20 nurses, 15 adults with palliative-stage cancer, and 20 of their family caregivers, from two palliative oncology hospital departments and one palliative home-care community partner. Overseen by an Expert Council, remote data collection will occur over three research phases guided by the iterative Information Systems Research Framework: Phase 1, brainstorming potential app solutions to challenging respite care scenarios, for better supporting the respite needs of both family caregivers and care recipients; Phase 2, evaluating low-fidelity proofs of concept for potential app designs; and Phase 3, usability testing of a high-fidelity interactive proof of concept that will then be programmed into an app prototype. Qualitative and quantitative data will be descriptively analyzed within each phase and triangulated to refine the app features. Results: We anticipate that preliminary results will be available by Spring 2022. Conclusions: An app prototype will be developed that has sufficient complimentary evidence to support future pilot testing in the community. Such an app could improve the delivery of community respite care services provided to families with palliative-stage cancer in Qu{\'e}bec, supporting death at home, which is where most patients and their families wish to be. International Registered Report Identifier (IRRID): PRR1-10.2196/34652 ",
doi="10.2196/34652",
url="https://www.researchprotocols.org/2021/12/e34652",
url="http://www.ncbi.nlm.nih.gov/pubmed/34898464"
}


@Article{info:doi/10.2196/29744,
author="Pech, Marion
and Sauzeon, Helene
and Yebda, Thinhinane
and Benois-Pineau, Jenny
and Amieva, Helene",
title="Falls Detection and Prevention Systems in Home Care for Older Adults: Myth or Reality?",
journal="JMIR Aging",
year="2021",
month="Dec",
day="9",
volume="4",
number="4",
pages="e29744",
keywords="elderly people",
keywords="new technologies",
keywords="fall",
keywords="acceptability",
keywords="digital divide",
keywords="aging",
keywords="falls",
keywords="fall prevention",
keywords="detection",
keywords="geriatrics",
keywords="barriers",
keywords="technology acceptance",
keywords="home care",
keywords="seniors",
doi="10.2196/29744",
url="https://aging.jmir.org/2021/4/e29744",
url="http://www.ncbi.nlm.nih.gov/pubmed/34889755"
}


@Article{info:doi/10.2196/23804,
author="Airola, Ella",
title="Learning and Use of eHealth Among Older Adults Living at Home in Rural and Nonrural Settings: Systematic Review",
journal="J Med Internet Res",
year="2021",
month="Dec",
day="2",
volume="23",
number="12",
pages="e23804",
keywords="aged",
keywords="barrier",
keywords="digital competence",
keywords="deinstitutionalization",
keywords="eHealth",
keywords="home care",
keywords="learning",
keywords="older adult",
keywords="rural health",
abstract="Background: Care policies emphasize deinstitutionalization and aging in place in response to demographic changes. Different eHealth technologies are one way to achieve this aim. However, there is a need to better understand older adults' needs for eHealth services, and thus, these health solutions require further exploration. Objective: The purpose of this systematic literature review is to appraise, synthesize, and summarize the literature on older adults' (aged ?60 years) eHealth learning and use in real home settings, particularly in rural and remote areas, with a focus on the social and cultural context. Methods: A systematic search was conducted in January 2020 using 4 academic databases. The studies by means of qualitative thematic analysis to identify the barriers, enablers, and support practices involved in the domestication process were examined. In addition, we identified the various meanings attached to eHealth technologies for older adults living in rural and remote areas. Results: In total, 31 empirical studies published between 2010 and 2020 were included in this review. A total of 17 articles included participants from rural and remote areas. The most regularly reported barriers related to older adults' learning to use and use of eHealth were health-related difficulties, such as cognitive impairment or impaired hearing. The most reported enabler was the support provided for older adults in learning and use of eHealth. Support mainly comprised older adults' own digital competences, which were distributed with their social network. It was found that eHealth technology is needed for rural and remote areas to facilitate access and reduce logistical barriers to health care services. Conclusions: The literature review provided information and practical implications for designers, health care providers, and policy makers. On the basis of these findings, eHealth technologies should be easy to use, and adequate support should be provided to older adults for use. ",
doi="10.2196/23804",
url="https://www.jmir.org/2021/12/e23804",
url="http://www.ncbi.nlm.nih.gov/pubmed/34860664"
}


@Article{info:doi/10.2196/30184,
author="Li, Chong
and Song, Xinyu
and Chen, Shugeng
and Wang, Chuankai
and He, Jieying
and Zhang, Yongli
and Xu, Shuo
and Yan, Zhijie
and Jia, Jie
and Shull, Peter",
title="Long-term Effectiveness and Adoption of a Cellphone Augmented Reality System on Patients with Stroke: Randomized Controlled Trial",
journal="JMIR Serious Games",
year="2021",
month="Nov",
day="23",
volume="9",
number="4",
pages="e30184",
keywords="stroke",
keywords="augmented reality",
keywords="serious game",
keywords="upper limb motor function",
keywords="cognitive function",
keywords="home-based rehabilitation",
abstract="Background: A serious game--based cellphone augmented reality system (CARS) was developed for rehabilitation of stroke survivors, which is portable, convenient, and suitable for self-training. Objective: This study aims to examine the effectiveness of CARS in improving upper limb motor function and cognitive function of stroke survivors via conducting a long-term randomized controlled trial and analyze the patient's acceptance of the proposed system. Methods: A double-blind randomized controlled trial was performed with 30 poststroke, subacute phase patients. All patients in both the experimental group (n=15) and the control group (n=15) performed a 1-hour session of therapy each day, 5 days per week for 2 weeks. Patients in the experimental group received 30 minutes of rehabilitation training with CARS and 30 minutes of conventional occupational therapy (OT) each session, while patients in the control group received conventional OT for the full 1 hour each session. The Fugl-Meyer Assessment of Upper Extremity (FMA-UE) subscale, Action Research Arm Test (ARAT), manual muscle test and Brunnstrom stage were used to assess motor function; the Mini-Mental State Examination, Add VS Sub, and Stroop Game were used to assess cognitive function; and the Barthel index was used to assess activities of daily living before and after the 2-week treatment period. In addition, the User Satisfaction Evaluation Questionnaire was used to reflect the patients' adoption of the system in the experimental group after the final intervention. Results: All the assessment scores of the experimental group and control group were significantly improved after intervention. After the intervention. The experimental group's FMA-UE and ARAT scores increased by 11.47 and 5.86, respectively, and were both significantly higher than the increase of the control group. Similarly, the score of the Add VS Sub and Stroop Game in the experimental group increased by 7.53 and 6.83, respectively, after the intervention, which also represented a higher increase than that in the control group. The evaluation of the adoption of this system had 3 sub-dimensions. In terms of accessibility, the patients reported a mean score of 4.27 (SD 0.704) for the enjoyment of their experience with the system, a mean 4.33 (SD 0.816) for success in using the system, and a mean 4.67 (SD 0.617) for the ability to control the system. In terms of comfort, the patients reported a mean 4.40 (SD 0.737) for the clarity of information provided by the system and a mean 4.40 (SD 0.632) for comfort. In terms of acceptability, the patients reported a mean 4.27 (SD 0.884) for usefulness in their rehabilitation and a mean 4.67 (0.617) in agreeing that CARS is a suitable tool for home-based rehabilitation. Conclusions: The rehabilitation based on combined CARS and conventional OT was more effective in improving both upper limb motor function and cognitive function than was conventional OT. Due to the low cost and ease of use, CARS is also potentially suitable for home-based rehabilitation. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800017568; https://tinyurl.com/xbkkyfyz ",
doi="10.2196/30184",
url="https://games.jmir.org/2021/4/e30184",
url="http://www.ncbi.nlm.nih.gov/pubmed/34817390"
}


@Article{info:doi/10.2196/27630,
author="Xiang, Xiaoling
and Kayser, Jay
and Sun, Yihang
and Himle, Joseph",
title="Internet-Based Psychotherapy Intervention for Depression Among Older Adults Receiving Home Care: Qualitative Study of Participants' Experiences",
journal="JMIR Aging",
year="2021",
month="Nov",
day="22",
volume="4",
number="4",
pages="e27630",
keywords="internet-based cognitive behavioral therapy",
keywords="homebound older adults",
keywords="home care",
keywords="direct care workers",
keywords="depression",
keywords="qualitative study",
abstract="Background: Depression is common among homebound older adults. Internet-based cognitive behavioral therapy (iCBT) is a promising but understudied approach for treating depression among older adults with disabilities. Objective: This study aims to understand the experiences of homebound older adults who participated in a pilot feasibility trial of an iCBT for depression. Methods: The participants included 21 homebound older adults who participated in a generic iCBT program that was not specifically designed for older adults and 8 home care workers who assisted in the iCBT program. Informants completed semistructured individual interviews, which were transcribed verbatim and analyzed using methods informed by grounded theory. A hierarchical code structure of themes and subthemes was developed after an iterative process of constant comparisons and questionings of the initial codes. The data analysis was conducted by using dedoose, a web app for mixed methods research. Results: Three themes and various subthemes emerged related to participants' experience of the iCBT intervention, as follows: intervention impact, which involved subthemes related to participants' perceived impact of the intervention; challenges and difficulties, which involved subthemes on the challenges and difficulties that participants experienced in the intervention; and facilitators, which involved subthemes on the factors that facilitated intervention use and engagement. Conclusions: iCBT is a promising intervention for homebound older adults experiencing depression. Home care workers reported improved relationships with their clients and that the program did not add a burden to their duties. Future programs should involve accessible technical features and age-adapted content to improve user experience, uptake, and adherence. Trial Registration: ClinicalTrials.gov NCT04267289; https://clinicaltrials.gov/ct2/show/NCT04267289 ",
doi="10.2196/27630",
url="https://aging.jmir.org/2021/4/e27630",
url="http://www.ncbi.nlm.nih.gov/pubmed/34813491"
}


@Article{info:doi/10.2196/32708,
author="Wood, M. Sarah
and Pickel, Julia
and Phillips, W. Alexis
and Baber, Kari
and Chuo, John
and Maleki, Pegah
and Faust, L. Haley
and Petsis, Danielle
and Apple, E. Danielle
and Dowshen, Nadia
and Schwartz, A. Lisa",
title="Acceptability, Feasibility, and Quality of Telehealth for Adolescent Health Care Delivery During the COVID-19 Pandemic: Cross-sectional Study of Patient and Family Experiences",
journal="JMIR Pediatr Parent",
year="2021",
month="Nov",
day="15",
volume="4",
number="4",
pages="e32708",
keywords="telehealth",
keywords="telemedicine",
keywords="adolescent",
keywords="COVID-19",
keywords="acceptability",
keywords="feasibility",
keywords="young adult",
keywords="teenager",
keywords="cross-sectional",
keywords="patient experience",
keywords="experience",
keywords="efficiency",
keywords="equity",
keywords="survey",
abstract="Background: Data regarding the acceptability, feasibility, and quality of telehealth among adolescents and young adults (AYA) and their parents and caregivers (caregivers) are lacking. Objective: The aim of this study was to assess the noninferiority of telehealth versus in-person visits by comparing acceptability with respect to efficiency, effectiveness, equity, patient-centeredness, and confidentiality. Methods: Cross-sectional web-based surveys were sent to caregivers and AYA following video visits within an Adolescent Medicine subspecialty clinic in May-July 2020. Proportions of AYA and caregivers who rated telehealth as noninferior were compared using chi-squared tests. Feasibility was assessed via items measuring technical difficulties. Deductive thematic analysis using the Institute of Medicine dimensions of health care quality was used to code open-ended question responses. Results: Survey response rates were 20.5\% (55/268) for AYA and 21.8\% (123/563) for caregivers. The majority of the respondents were White cisgender females. Most AYA and caregivers rated telehealth as noninferior to in-person visits with respect to confidentiality, communication, medication management, and mental health care. A higher proportion of AYA compared to caregivers found telehealth inferior with respect to confidentiality (11/51, 22\% vs 3/118, 2.5\%, P<.001). One-quarter (14/55) of the AYA patients and 31.7\% (39/123) of the caregivers reported technical difficulties. The dominant themes in the qualitative data included advantages of telehealth for efficiency and equity of health care delivery. However, respondents' concerns included reduced safety and effectiveness of care, particularly for patients with eating disorders, owing to lack of hands-on examinations, collection of vital signs, and laboratory testing. Conclusions: Telehealth was highly acceptable among AYA and caregivers. Future optimization should include improving privacy, ameliorating technical difficulties, and standardizing at-home methods of obtaining patient data to assure patient safety. ",
doi="10.2196/32708",
url="https://pediatrics.jmir.org/2021/4/e32708",
url="http://www.ncbi.nlm.nih.gov/pubmed/34779782"
}


@Article{info:doi/10.2196/29788,
author="Kim, Ben
and Ghasemi, Peyman
and Stolee, Paul
and Lee, Joon",
title="Clinicians and Older Adults' Perceptions of the Utility of Patient-Generated Health Data in Caring for Older Adults: Exploratory Mixed Methods Study",
journal="JMIR Aging",
year="2021",
month="Nov",
day="5",
volume="4",
number="4",
pages="e29788",
keywords="mobile health",
keywords="mHealth",
keywords="older adults",
keywords="wearables",
keywords="patient generated health data",
keywords="chronic disease management",
keywords="home care",
keywords="self-care",
keywords="activities of daily living",
keywords="sleep",
abstract="Background: Many people are motivated to self-track their health and optimize their well-being through mobile health apps and wearable devices. The diversity and complexity of these systems have evolved over time, resulting in a large amount of data referred to as patient-generated health data (PGHD), which has recently emerged as a useful set of data elements in health care systems around the world. Despite the increased interest in PGHD, clinicians and older adults' perceptions of PGHD are poorly understood. In particular, although some clinician barriers to using PGHD have been identified, such as concerns about data quality, ease of use, reliability, privacy, and regulatory issues, little is known from the perspectives of older adults. Objective: This study aims to explore the similarities and differences in the perceptions of older adults and clinicians with regard to how various types of PGHD can be used to care for older adults. Methods: A mixed methods study was conducted to explore clinicians and older adults' perceptions of PGHD. Focus groups were conducted with older adults and health care providers from the Greater Toronto area and the Kitchener-Waterloo region. The participants were asked to discuss their perceptions of PGHD, including facilitators and barriers. A questionnaire aimed at exploring the perceived usefulness of a range of different PGHD was also embedded in the study design. Focus group interviews were transcribed for thematic analysis, whereas the questionnaire results were analyzed using descriptive statistics. Results: Of the 9 participants, 4 (44\%) were clinicians (average age 38.3 years, SD 7 years), and 5 (56\%) were older adults (average age 81.0 years, SD 9.1 years). Four main themes were identified from the focus group interviews: influence of PGHD on patient-provider trust, reliability of PGHD, meaningful use of PGHD and PGHD-based decision support systems, and perceived clinical benefits and intrusiveness of PGHD. The questionnaire results were significantly correlated with the frequency of PGHD mentioned in the focus group interviews (r=0.42; P=.03) and demonstrated that older adults and clinicians perceived blood glucose, step count, physical activity, sleep, blood pressure, and stress level as the most useful data for managing health and delivering high-quality care. Conclusions: This embedded mixed methods study generated several important findings about older adults and clinicians' perceptions and perceived usefulness of a range of PGHD. Owing to the exploratory nature of this study, further research is needed to understand the concerns about data privacy, potential negative impact on the trust between older adults and clinicians, data quality and quantity, and usability of PGHD-related technologies for older adults. ",
doi="10.2196/29788",
url="https://aging.jmir.org/2021/4/e29788",
url="http://www.ncbi.nlm.nih.gov/pubmed/34738913"
}


@Article{info:doi/10.2196/28315,
author="Goh, Lina
and Allen, E. Natalie
and Ahmadpour, Naseem
and Ehgoetz Martens, A. Kaylena
and Song, Jooeun
and Clemson, Lindy
and Lewis, G. Simon J.
and MacDougall, G. Hamish
and Canning, G. Colleen",
title="A Video Self-Modeling Intervention Using Virtual Reality Plus Physical Practice for Freezing of Gait in Parkinson Disease: Feasibility and Acceptability Study",
journal="JMIR Form Res",
year="2021",
month="Nov",
day="3",
volume="5",
number="11",
pages="e28315",
keywords="Parkinson disease",
keywords="freezing of gait",
keywords="action observation",
keywords="video self-modelling",
keywords="virtual reality",
abstract="Background: Despite optimal medical and surgical intervention, freezing of gait commonly occurs in people with Parkinson disease. Action observation via video self-modeling, combined with physical practice, has potential as a noninvasive intervention to reduce freezing of gait. Objective: The aim of this study is to determine the feasibility and acceptability of a home-based, personalized video self-modeling intervention delivered via a virtual reality head-mounted display (HMD) to reduce freezing of gait in people with Parkinson disease. The secondary aim is to investigate the potential effect of this intervention on freezing of gait, mobility, and anxiety. Methods: The study was a single-group pre-post mixed methods pilot trial for which 10 participants with Parkinson disease and freezing of gait were recruited. A physiotherapist assessed the participants in their homes to identify person-specific triggers of freezing and developed individualized movement strategies to overcome freezing of gait. 180{\textdegree} videos of the participants successfully performing their movement strategies were created. Participants watched their videos using a virtual reality HMD, followed by physical practice of their strategies in their own homes over a 6-week intervention period. The primary outcome measures included the feasibility and acceptability of the intervention. Secondary outcome measures included freezing of gait physical tests and questionnaires, including the Timed Up and Go Test, 10-meter walk test, Goal Attainment Scale, and Parkinson Anxiety Scale. Results: The recruitment rate was 24\% (10/42), and the retention rate was 90\% (9/10). Adherence to the intervention was high, with participants completing a mean of 84\% (SD 49\%) for the prescribed video viewing and a mean of 100\% (SD 56\%) for the prescribed physical practice. One participant used the virtual reality HMD for 1 week and completed the rest of the intervention using a flat-screen device because of a gradual worsening of his motion sickness. No other adverse events occurred during the intervention or assessment. Most of the participants found using the HMD to view their videos interesting and enjoyable and would choose to use this intervention to manage their freezing of gait in the future. Five themes were constructed from the interview data: reflections when seeing myself, my experience of using the virtual reality system, the role of the virtual reality system in supporting my learning, developing a deeper understanding of how to manage my freezing of gait, and the impact of the intervention on my daily activities. Overall, there were minimal changes to the freezing of gait, mobility, or anxiety measures from baseline to postintervention, although there was substantial variability between participants. The intervention showed potential in reducing anxiety in participants with high levels of anxiety. Conclusions: Video self-modeling using an immersive virtual reality HMD plus physical practice of personalized movement strategies is a feasible and acceptable method of addressing freezing of gait in people with Parkinson disease. ",
doi="10.2196/28315",
url="https://formative.jmir.org/2021/11/e28315",
url="http://www.ncbi.nlm.nih.gov/pubmed/34730537"
}


@Article{info:doi/10.2196/33305,
author="Lundereng, David Elias
and Nes, Goncalves Andrea Aparecida
and Holmen, Heidi
and Winger, Anette
and Thygesen, Hilde
and J{\o}ranson, Nina
and Borge, R{\aa}heim Chrstine
and Chen, Weiqin
and Dajani, Olav
and Mariussen, L. Kari
and Steindal, A. Simen",
title="Health Care Professionals' Experiences and Perspectives on Using Telehealth for Home-Based Palliative Care: Protocol for a Scoping Review",
journal="JMIR Res Protoc",
year="2021",
month="Oct",
day="29",
volume="10",
number="10",
pages="e33305",
keywords="health care technology",
keywords="home care services",
keywords="palliative care",
keywords="review",
keywords="telehealth",
keywords="telemedicine",
abstract="Background: Telehealth seems feasible for use in home-based palliative care. However, acceptance among health care professionals (HCPs) is essential for the successful delivery of telehealth in practice. No scoping review has mapped the experiences and perspectives of HCPs on the use of telehealth for home-based palliative care. Objective: The aim of this review is to systematically map published studies on HCPs' experiences and perspectives on the use of telehealth in home-based palliative care. Methods: The proposed scoping review will employ the methodology of Arksey and O'Malley. This protocol is guided by the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol (PRISMA-P). A systematic search will be performed in MEDLINE, PsycINFO, EMBASE, CINAHL, Allied and Complementary Medicine (AMED), and Web of Science for studies published between January 2000 and July 5, 2021. We will also hand search the reference lists of included papers to identify additional studies of relevance. The search will be updated in 2022. Pairs of authors will independently assess the eligibility of studies and extract data. The first 2 stages of thematic synthesis will be used to thematically organize the data. Because the scoping review methodology consists of reviewing and collecting data from publicly available materials, this study does not require ethics approval. Results: The database searches; testing of eligibility criteria; and screening of titles, abstracts, and full-text papers will be performed by fall 2021. The results from this scoping review will be presented as a descriptive summary of the results from all included papers, and will be inductively organized into descriptive themes. A frequency table illustrating which papers were included in which descriptive themes will be made. Results are anticipated by the fall of 2022. Conclusions: A mapping of studies could identify research gaps regarding HCPs' experiences and perspectives on the use of telehealth in home-based palliative care and may determine the value and feasibility of conducting a full systematic review. International Registered Report Identifier (IRRID): PRR1-10.2196/33305 ",
doi="10.2196/33305",
url="https://www.researchprotocols.org/2021/10/e33305",
url="http://www.ncbi.nlm.nih.gov/pubmed/34714254"
}


@Article{info:doi/10.2196/25460,
author="Li, Po-Hung Lieber
and Han, Ji-Yan
and Zheng, Wei-Zhong
and Huang, Ren-Jie
and Lai, Ying-Hui",
title="Improved Environment-Aware--Based Noise Reduction System for Cochlear Implant Users Based on a Knowledge Transfer Approach: Development and Usability Study",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="28",
volume="23",
number="10",
pages="e25460",
keywords="cochlear implants",
keywords="noise reduction",
keywords="deep learning",
keywords="noise classification",
keywords="hearing",
keywords="deaf",
keywords="sound",
keywords="audio",
keywords="cochlear",
abstract="Background: Cochlear implant technology is a well-known approach to help deaf individuals hear speech again and can improve speech intelligibility in quiet conditions; however, it still has room for improvement in noisy conditions. More recently, it has been proven that deep learning--based noise reduction, such as noise classification and deep denoising autoencoder (NC+DDAE), can benefit the intelligibility performance of patients with cochlear implants compared to classical noise reduction algorithms. Objective: Following the successful implementation of the NC+DDAE model in our previous study, this study aimed to propose an advanced noise reduction system using knowledge transfer technology, called NC+DDAE\_T; examine the proposed NC+DDAE\_T noise reduction system using objective evaluations and subjective listening tests; and investigate which layer substitution of the knowledge transfer technology in the NC+DDAE\_T noise reduction system provides the best outcome. Methods: The knowledge transfer technology was adopted to reduce the number of parameters of the NC+DDAE\_T compared with the NC+DDAE. We investigated which layer should be substituted using short-time objective intelligibility and perceptual evaluation of speech quality scores as well as t-distributed stochastic neighbor embedding to visualize the features in each model layer. Moreover, we enrolled 10 cochlear implant users for listening tests to evaluate the benefits of the newly developed NC+DDAE\_T. Results: The experimental results showed that substituting the middle layer (ie, the second layer in this study) of the noise-independent DDAE (NI-DDAE) model achieved the best performance gain regarding short-time objective intelligibility and perceptual evaluation of speech quality scores. Therefore, the parameters of layer 3 in the NI-DDAE were chosen to be replaced, thereby establishing the NC+DDAE\_T. Both objective and listening test results showed that the proposed NC+DDAE\_T noise reduction system achieved similar performances compared with the previous NC+DDAE in several noisy test conditions. However, the proposed NC+DDAE\_T only required a quarter of the number of parameters compared to the NC+DDAE. Conclusions: This study demonstrated that knowledge transfer technology can help reduce the number of parameters in an NC+DDAE while keeping similar performance rates. This suggests that the proposed NC+DDAE\_T model may reduce the implementation costs of this noise reduction system and provide more benefits for cochlear implant users. ",
doi="10.2196/25460",
url="https://www.jmir.org/2021/10/e25460",
url="http://www.ncbi.nlm.nih.gov/pubmed/34709193"
}


@Article{info:doi/10.2196/30841,
author="Bastoni, Sofia
and Wrede, Christian
and da Silva, Cristina Marcia
and Sanderman, Robbert
and Gaggioli, Andrea
and Braakman-Jansen, Annemarie
and van Gemert-Pijnen, Lisette",
title="Factors Influencing Implementation of eHealth Technologies to Support Informal Dementia Care: Umbrella Review",
journal="JMIR Aging",
year="2021",
month="Oct",
day="8",
volume="4",
number="4",
pages="e30841",
keywords="eHealth",
keywords="assistive technologies",
keywords="dementia",
keywords="informal care",
keywords="home care",
keywords="implementation",
abstract="Background: The worldwide increase in community-dwelling people with dementia underscores the need for innovative eHealth technologies that aim to provide support to both patients and their informal caregivers in the home setting. However, sustainable implementation of eHealth technologies within this target group can be difficult. Objective: The goal of this study was to gain a thorough understanding of why it is often difficult to implement eHealth technologies in practice, even though numerous technologies are designed to support people with dementia and their informal caregivers at home. In particular, our study aimed to (1) provide an overview of technologies that have been used and studied in the context of informal dementia care and (2) explore factors influencing the implementation of these technologies. Methods: Following an umbrella review design, five different databases were searched (PubMed, PsycINFO, Medline, Scopus, and Cochrane) for (systematic) reviews. Among 2205 reviews retrieved, 21 were included in our analysis based on our screening and selection procedure. A combination of deductive and inductive thematic analyses was performed, using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) framework for organizing the findings. Results: We identified technologies designed to be used ``by informal caregivers,'' ``by people with dementia,'' and ``with people with dementia.'' Within those groups, most of the represented technologies included, respectively: (i) devices for in-home monitoring of lifestyle, health, and safety; (ii) technologies for supporting memory, orientation, and day structure; and (iii) technologies to facilitate communication between the informal caregiver and person with dementia. Most of the identified factors influencing implementation related to the condition of dementia, characteristics of the technology, expected/perceived value of users, and characteristics of the informal caregiver. Considerably less information has been reported on factors related to the implementing organization and technology supplier, wider institutional and sociocultural context of policy and regulations, and continued adaptation of technology over time. Conclusions: Our study offers a comprehensive overview of eHealth technologies in the context of informal dementia care and contributes to gaining a better understanding of a broad range of factors influencing their implementation. Our results uncovered a knowledge gap regarding success factors for implementation related to the organizational and broader context and continuous adaptation over the long term. Although future research is needed, the current findings can help researchers and stakeholders in improving the development and implementation of eHealth technologies to support informal dementia care. ",
doi="10.2196/30841",
url="https://aging.jmir.org/2021/4/e30841",
url="http://www.ncbi.nlm.nih.gov/pubmed/34623314"
}


@Article{info:doi/10.2196/29074,
author="Raj, Minakshi
and Iott, Bradley",
title="Evaluation of Family Caregivers' Use of Their Adult Care Recipient's Patient Portal From the 2019 Health Information National Trends Survey: Secondary Analysis",
journal="JMIR Aging",
year="2021",
month="Oct",
day="4",
volume="4",
number="4",
pages="e29074",
keywords="informal caregivers",
keywords="family caregivers",
keywords="patient portal",
keywords="electronic health record",
keywords="telehealth",
keywords="aging in place",
keywords="web-based medical record",
abstract="Background: Patient engagement is critical for realizing the value of telehealth modalities such as the patient portal. Family caregiver engagement may also be critical for facilitating the use of the patient portal among adult patients, including older adults. Objective: This study aims to analyze the 2019 Health Information National Trends Survey to characterize family caregivers' use of their care recipient's patient portal in terms of sociodemographic, health, and caregiving characteristics and caregivers' use of their own portal. Methods: We conducted a secondary analysis of cross-sectional data from the National Cancer Institute's Health Information National Trends Survey 5 Cycle 3. This survey was administered to 5438 US adults between January and May 2019. We analyzed data from 320 respondents who were identified as family caregivers. We created measures to reflect family caregivers' use of their care recipient's and their own portal, caregiver demographic and caregiving characteristics, and care recipient health characteristics. Results: Over half of the caregivers (179/320, 55.9\%) reported using their own portal at least once, whereas only one-third (105/320, 32.8\%) reported using their care recipient's record in the previous 12 months. Caregivers using their own portal were significantly more likely to use their care recipient's portal (odds ratio 11.18; P<.001). Conclusions: Policies should enable patients to designate family caregivers who can access their patient portal. Providers could screen caregivers for challenges in their caregiving responsibilities that may be addressed through the portal so they can better support their adult relatives. Interventions to support family caregivers, especially older caregivers, in using their own portal may facilitate their use of their care recipient's portal. ",
doi="10.2196/29074",
url="https://aging.jmir.org/2021/4/e29074",
url="http://www.ncbi.nlm.nih.gov/pubmed/34605766"
}


@Article{info:doi/10.2196/29210,
author="Saredakis, Dimitrios
and Keage, AD Hannah
and Corlis, Megan
and Ghezzi, S. Erica
and Loffler, Helen
and Loetscher, Tobias",
title="The Effect of Reminiscence Therapy Using Virtual Reality on Apathy in Residential Aged Care: Multisite Nonrandomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="20",
volume="23",
number="9",
pages="e29210",
keywords="reminiscence",
keywords="head-mounted display",
keywords="apathy",
keywords="cognitive aging",
keywords="dementia",
keywords="residential facilities",
keywords="virtual reality",
abstract="Background: Apathy is a frequent and underrecognized neurological disorder symptom. Reduced goal-directed behavior caused by apathy is associated with poor outcomes for older adults in residential aged care. Recommended nonpharmacological treatments include person-centered therapy using information and communication technology. Virtual reality (VR) in the form of head-mounted displays (HMDs) is a fully immersive technology that provides access to a wide range of freely available content. The use of VR as a therapy tool has demonstrated promise in the treatment of posttraumatic stress disorder and anxiety. In addition, VR has been used to improve conditions including depression, anxiety, cognitive function, and balance in older adults with memory deficits, Alzheimer disease, and Parkinson disease. Research using VR for the symptoms of apathy in older adults living in residential aged care facilities is limited. Objective: This study aims to examine whether using HMDs as a tool for reminiscence therapy improves the symptoms of apathy compared with using a laptop computer and physical items with older adults living in residential aged care. Methods: In this multisite trial, 43 participants were allocated to one of three groups: reminiscence therapy intervention using VR in the form of HMDs, reminiscence therapy using a laptop computer supplemented by physical items if required (active control), and a usual care (passive control) group. The primary outcome was apathy, and the secondary outcomes included cognition and depression. The side effects of using HMDs were also measured in the VR group. Results: Mixed model analyses revealed no significant group interaction over time in outcomes between the VR and laptop groups (estimate=?2.24, SE 1.89; t40=?1.18; P=.24). Pooled apathy scores in the two intervention groups compared with the passive control group also revealed no significant group interaction over time (estimate=?0.26, SE 1.66; t40=?0.16; P=.88). There were no significant secondary outcomes. Most participants in the VR group stated that they would prefer to watch content in VR than on a flat screen ($\Chi$22=11.2; P=.004), side effects from HMD use were negligible to minimal according to the Simulator Sickness Questionnaire cutoff scores. Conclusions: Although there were no significant results in outcome measures, this study found that participants engaged in the research and enjoyed the process of reminiscing using both forms of technology. It was found that VR can be implemented in an aged care setting with correct protocols in place. Providing residents in aged care with a choice of technology may assist in increasing participation in activities. We cannot dismiss the importance of immediate effects while the therapy was in progress, and this is an avenue for future research. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001510134; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378564. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2020-046030 ",
doi="10.2196/29210",
url="https://www.jmir.org/2021/9/e29210",
url="http://www.ncbi.nlm.nih.gov/pubmed/34542418"
}


@Article{info:doi/10.2196/26608,
author="Sahandi Far, Mehran
and Eickhoff, B. Simon
and Goni, Maria
and Dukart, Juergen",
title="Exploring Test-Retest Reliability and Longitudinal Stability of Digital Biomarkers for Parkinson Disease in the m-Power Data Set: Cohort Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="13",
volume="23",
number="9",
pages="e26608",
keywords="health sciences",
keywords="medical research",
keywords="biomarkers",
keywords="diagnostic markers",
keywords="neurological disorders",
keywords="Parkinson disease",
keywords="mobile phone",
abstract="Background: Digital biomarkers (DB), as captured using sensors embedded in modern smart devices, are a promising technology for home-based sign and symptom monitoring in Parkinson disease (PD). Objective: Despite extensive application in recent studies, test-retest reliability and longitudinal stability of DB have not been well addressed in this context. We utilized the large-scale m-Power data set to establish the test-retest reliability and longitudinal stability of gait, balance, voice, and tapping tasks in an unsupervised and self-administered daily life setting in patients with PD and healthy controls (HC). Methods: Intraclass correlation coefficients were computed to estimate the test-retest reliability of features that also differentiate between patients with PD and healthy volunteers. In addition, we tested for longitudinal stability of DB measures in PD and HC, as well as for their sensitivity to PD medication effects. Results: Among the features differing between PD and HC, only a few tapping and voice features had good to excellent test-retest reliabilities and medium to large effect sizes. All other features performed poorly in this respect. Only a few features were sensitive to medication effects. The longitudinal analyses revealed significant alterations over time across a variety of features and in particular for the tapping task. Conclusions: These results indicate the need for further development of more standardized, sensitive, and reliable DB for application in self-administered remote studies in patients with PD. Motivational, learning, and other confounders may cause variations in performance that need to be considered in DB longitudinal applications. ",
doi="10.2196/26608",
url="https://www.jmir.org/2021/9/e26608",
url="http://www.ncbi.nlm.nih.gov/pubmed/34515645"
}


@Article{info:doi/10.2196/23539,
author="Miyatake, Hirotomo
and Kosaka, Makoto
and Arita, Satoshi
and Tsunetoshi, Chie
and Masunaga, Hidehisa
and Kotera, Yasuhiro
and Nishikawa, Yoshitaka
and Ozaki, Akihiko
and Beniya, Hiroyuki",
title="Videoconferencing for Home Care Delivery in Japan: Observational Study",
journal="J Med Internet Res",
year="2021",
month="Sep",
day="1",
volume="23",
number="9",
pages="e23539",
keywords="telehome care",
keywords="videoconference",
keywords="home care",
keywords="caregiver",
keywords="telepresenter",
keywords="mobile phone",
abstract="Background: Telemedicine has been increasingly used in many health care fields, including home care, where patients receive medical care at home. Owing to the current COVID-19 crisis, the value of telemedicine via videoconferencing is more recognized, particularly in allowing immobile patients to continue receiving care. However, the efficacy of telemedicine in home care settings in Japan remains to be fully appraised. Objective: This study aims to identify the use and impact of telemedicine in a singular home care delivery setting in Japan. Methods: A retrospective observational study was conducted using patient and other administrative records from a home care clinic. We considered patients who were involved in videoconferencing with home care physicians and telepresenters serving patients during 2018 and 2019. We extracted sociodemographic data of the patients and details of the videoconferencing and descriptively illustrated some specific cases. Results: In a home care clinic in Japan, videoconferencing was conducted in 17 cases (involving 14 patients) over a 2-year period. Of all the cases, 12\% (2/17) required emergency transfers and were hospitalized. A total of 88\% (15/17) of cases remained; 71\% (12/17) of cases were found to need extra medication or to go to a medical facility for consultation, whereas 18\% (3/17) of cases were found not to be in need of urgent attention and were asked to rest. Problematic symptoms subsequently improved in 82\% (14/17) of cases, and only 6\% (1/17) of cases were later hospitalized. Conclusions: Telemedicine was deemed effective for assessing patients' conditions in the home care setting in situations where home visits by a physician cannot be carried out. Our findings indicate that consultations via videoconferencing are safe and effective, suggesting more active use of videoconferencing in other clinical contexts. ",
doi="10.2196/23539",
url="https://www.jmir.org/2021/9/e23539",
url="http://www.ncbi.nlm.nih.gov/pubmed/34468333"
}


@Article{info:doi/10.2196/27347,
author="Yatabe, Junichi
and Yatabe, Sasaki Midori
and Okada, Rika
and Ichihara, Atsuhiro",
title="Efficacy of Telemedicine in Hypertension Care Through Home Blood Pressure Monitoring and Videoconferencing: Randomized Controlled Trial",
journal="JMIR Cardio",
year="2021",
month="Aug",
day="31",
volume="5",
number="2",
pages="e27347",
keywords="blood pressure management",
keywords="digital health",
keywords="web-based medicine",
keywords="prospective study",
keywords="telemonitoring",
keywords="blood pressure",
keywords="monitoring",
keywords="telemedicine",
keywords="telehealth",
keywords="efficacy",
keywords="hypertension",
keywords="video conference",
keywords="safety",
keywords="Japan",
abstract="Background: The burden of time is often the primary reason why patients discontinue their treatment. Telemedicine may help patients adhere to treatment by offering convenience. Objective: This study examined the efficacy and safety of telemedicine for the management of hypertension in Japan. Methods: Patients with uncomplicated hypertension were recruited through web advertising between November 2015 and February 2017. They were then screened, stratified by office systolic blood pressure (SBP), and randomized into two groups: usual care (UC) and telemedicine. The telemedicine group used a 3G network--attached home blood pressure (BP) monitoring device, consulted hypertension specialists from an academic hospital through web-based video visits, and received prescription medication by mail for 1 year. The UC group used the same BP monitoring device but was managed using self-recorded BP readings, which included their diary entries and office BP taken in a community practice setting. Results: Initial screening was completed by 99 patients, 54\% of whom had untreated hypertension. Baseline BP was similar between the groups, but the weekly average SBP at the end of the 1-year study period was significantly lower in the telemedicine group (125, SD 9 mmHg vs 131, SD 12 mmHg, respectively; P=.02). SBP in the telemedicine group was 3.4 mmHg lower in the morning and 5.8 mmHg lower in the evening. The rate of SBP control (135 mmHg) was better in the telemedicine group (85.3\% vs 70.0\%; P=.01), and significant adverse events were not observed. Conclusions: We present evidence suggesting that antihypertensive therapy via home BP telemonitoring and web-based video visits achieve better BP control than conventional care and is a safe treatment alternative that warrants further investigation. Trial Registration: UMIN-CTR UMIN000025372; https://tinyurl.com/47ejkn4b ",
doi="10.2196/27347",
url="https://cardio.jmir.org/2021/2/e27347",
url="http://www.ncbi.nlm.nih.gov/pubmed/34321194"
}


@Article{info:doi/10.2196/27047,
author="Tiersen, Federico
and Batey, Philippa
and Harrison, C. Matthew J.
and Naar, Lenny
and Serban, Alina-Irina
and Daniels, C. Sarah J.
and Calvo, A. Rafael",
title="Smart Home Sensing and Monitoring in Households With Dementia: User-Centered Design Approach",
journal="JMIR Aging",
year="2021",
month="Aug",
day="11",
volume="4",
number="3",
pages="e27047",
keywords="assistive technology",
keywords="independent living",
keywords="internet of things",
keywords="remote monitoring",
keywords="dementia",
keywords="human centered design",
keywords="user-centered design",
keywords="patient-centered care",
keywords="smart home",
keywords="digital health",
abstract="Background: As life expectancy grows, so do the challenges of caring for an aging population. Older adults, including people with dementia, want to live independently and feel in control of their lives for as long as possible. Assistive technologies powered by artificial intelligence and internet of things devices are being proposed to provide living environments that support the users' safety, psychological, and medical needs through remote monitoring and interventions. Objective: This study investigates the functional, psychosocial, and environmental needs of people living with dementia, their caregivers, clinicians, and health and social care service providers toward the design and implementation of smart home systems. Methods: We used an iterative user-centered design approach comprising 9 substudies. First, semistructured interviews (9 people with dementia, 9 caregivers, and 10 academic and clinical staff) and workshops (35 pairs of people with dementia and caregivers, and 12 health and social care clinicians) were conducted to define the needs of people with dementia, home caregivers, and professional stakeholders in both daily activities and technology-specific interactions. Then, the spectrum of needs identified was represented via patient--caregiver personas and discussed with stakeholders in a workshop (14 occupational therapists; 4 National Health Service pathway directors; and 6 researchers in occupational therapy, neuropsychiatry, and engineering) and 2 focus groups with managers of health care services (n=8), eliciting opportunities for innovative care technologies and public health strategies. Finally, these design opportunities were discussed in semistructured interviews with participants of a smart home trial involving environmental sensors, physiological measurement devices, smartwatches, and tablet-based chatbots and cognitive assessment puzzles (10 caregivers and 2 people with dementia). A thematic analysis revealed factors that motivate household members to use these technologies. Results: Outcomes of these activities include a qualitative and quantitative analysis of patient, caregiver, and clinician needs and the identification of challenges and opportunities for the design and implementation of remote monitoring systems in public health pathways. Conclusions: Participatory design methods supported the triangulation of stakeholder perspectives to aid the development of more patient-centered interventions and their translation to clinical practice and public health strategy. We discuss the implications and limitations of our findings, the value and the applicability of our methodology, and directions for future research. ",
doi="10.2196/27047",
url="https://aging.jmir.org/2021/3/e27047",
url="http://www.ncbi.nlm.nih.gov/pubmed/34383672"
}


@Article{info:doi/10.2196/22491,
author="Chen, Rai-Fu
and Cheng, Kuei-Chen
and Lin, Yu-Yin
and Chang, I-Chiu
and Tsai, Cheng-Han",
title="Predicting Unscheduled Emergency Department Return Visits Among Older Adults: Population-Based Retrospective Study",
journal="JMIR Med Inform",
year="2021",
month="Jul",
day="28",
volume="9",
number="7",
pages="e22491",
keywords="classification model",
keywords="decision tree",
keywords="emergency department",
keywords="older adult patients",
keywords="unscheduled return visits",
abstract="Background: Unscheduled emergency department return visits (EDRVs) are key indicators for monitoring the quality of emergency medical care. A high return rate implies that the medical services provided by the emergency department (ED) failed to achieve the expected results of accurate diagnosis and effective treatment. Older adults are more susceptible to diseases and comorbidities than younger adults, and they exhibit unique and complex clinical characteristics that increase the difficulty of clinical diagnosis and treatment. Older adults also use more emergency medical resources than people in other age groups. Many studies have reviewed the causes of EDRVs among general ED patients; however, few have focused on older adults, although this is the age group with the highest rate of EDRVs. Objective: This aim of this study is to establish a model for predicting unscheduled EDRVs within a 72-hour period among patients aged 65 years and older. In addition, we aim to investigate the effects of the influencing factors on their unscheduled EDRVs. Methods: We used stratified and randomized data from Taiwan's National Health Insurance Research Database and applied data mining techniques to construct a prediction model consisting of patient, disease, hospital, and physician characteristics. Records of ED visits by patients aged 65 years and older from 1996 to 2010 in the National Health Insurance Research Database were selected, and the final sample size was 49,252 records. Results: The decision tree of the prediction model achieved an acceptable overall accuracy of 76.80\%. Economic status, chronic illness, and length of stay in the ED were the top three variables influencing unscheduled EDRVs. Those who stayed in the ED overnight or longer on their first visit were less likely to return. This study confirms the results of prior studies, which found that economically underprivileged older adults with chronic illness and comorbidities were more likely to return to the ED. Conclusions: Medical institutions can use our prediction model as a reference to improve medical management and clinical services by understanding the reasons for 72-hour unscheduled EDRVs in older adult patients. A possible solution is to create mechanisms that incorporate our prediction model and develop a support system with customized medical education for older patients and their family members before discharge. Meanwhile, a reasonably longer length of stay in the ED may help evaluate treatments and guide prognosis for older adult patients, and it may further reduce the rate of their unscheduled EDRVs. ",
doi="10.2196/22491",
url="https://medinform.jmir.org/2021/7/e22491",
url="http://www.ncbi.nlm.nih.gov/pubmed/34319244"
}


@Article{info:doi/10.2196/27156,
author="Scheibe, Madlen
and Lang, Caroline
and Druschke, Diana
and Arnold, Katrin
and Luntz, Edwin
and Schmitt, Jochen
and Holthoff-Detto, Vjera",
title="Independent Use of a Home-Based Telemonitoring App by Older Patients With Multimorbidity and Mild Cognitive Impairment: Qualitative Study",
journal="JMIR Hum Factors",
year="2021",
month="Jul",
day="12",
volume="8",
number="3",
pages="e27156",
keywords="telemedicine",
keywords="aged",
keywords="multimorbidity",
keywords="dementia",
keywords="patient acceptance of health care",
keywords="health care quality, access, and evaluation",
keywords="qualitative research",
abstract="Background: The management of multimorbidity is complex and patients have a high burden of disease. When symptoms of dementia also appear, it becomes even more difficult for patients to cope with their everyday lives and manage their diseases. Home-based telemonitoring may support older patients with multimorbidity and mild cognitive impairment (MCI) in their regular monitoring and self-management. However, to date, there has been no investigation into whether patients with MCI are able to operate a telemonitoring app independently to manage their own diseases. This question has become even more important during the current COVID-19 pandemic to maintain high-quality medical care for this patient group. Objective: We examined the following research questions: (1) How do patients with MCI assess the usability of the telemonitoring app? (2) How do patients with MCI assess the range of functions offered by the telemonitoring app? (3) Was there an additional benefit for the patients with MCI in using the telemonitoring app? (4) Were patients with MCI able to use the telemonitoring app independently and without restrictions? (5) To what extent does previous experience with smartphones, tablets, or computers influence the perceived ease of use of the telemonitoring app? Methods: We performed a formative evaluation of a telemonitoring app. Therefore, we carried out a qualitative study and conducted guided interviews. All interviews were audio-recorded, transcribed verbatim, and analyzed using the Mayring method of structured content analysis. Results: Twelve patients (8 women, 4 men) were interviewed; they had an average age of 78.7 years (SD 5.6) and an average Mini-Mental State Examination score of 24.5 (SD 1.6). The interviews lasted between 17 and 75 minutes (mean 41.8 minutes, SD 19.4). Nine patients reported that the telemonitoring app was easy to use. All respondents assessed the range of functions as good or adequate. Desired functionalities mainly included more innovative and varied educational material, better fit of the telemonitoring app for specific needs of patients with MCI, and a more individually tailored content. Ten of the 12 patients stated that the telemonitoring app had an additional benefit for them. Most frequently reported benefits included increased feeling of security, appreciation of regular monitoring of vital parameters, and increased independence due to telemonitoring. Eight patients were able to operate the app independently. Participants found the app easy to use regardless of whether they had prior experience with smartphones, tablets, or computers. Conclusions: The majority of examined patients with MCI were capable of operating the telemonitoring app independently. Crucial components in attaining independent use were comprehensive personal support from the start of use and appropriate design features. This study provides initial evidence that patients with MCI could increasingly be considered as a relevant user group of telemonitoring apps. ",
doi="10.2196/27156",
url="https://humanfactors.jmir.org/2021/3/e27156",
url="http://www.ncbi.nlm.nih.gov/pubmed/34255664"
}


@Article{info:doi/10.2196/27496,
author="Bilger, Marcel
and Koong, Leng Agnes Ying
and Phoon, Yun Ian Kwong
and Tan, Chuan Ngiap
and Bahadin, Juliana
and Bairavi, Joann
and Batcagan-Abueg, M. Ada Portia
and Finkelstein, A. Eric",
title="Wireless Home Blood Pressure Monitoring System With Automatic Outcome-Based Feedback and Financial Incentives to Improve Blood Pressure in People With Hypertension: Protocol for a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="Jun",
day="9",
volume="10",
number="6",
pages="e27496",
keywords="telemedicine",
keywords="home blood pressure monitoring",
keywords="behavior change",
keywords="hypertension",
keywords="financial incentive",
keywords="medication adherence",
keywords="remote titration",
abstract="Background: Hypertension is prevalent in Singapore and is a major risk factor for cardiovascular morbidity and mortality and increased health care costs. Strategies to lower blood pressure include lifestyle modifications and home blood pressure monitoring. Nonetheless, adherence to home blood pressure monitoring remains low. This protocol details an algorithm for remote management of primary care patients with hypertension. Objective: The objective of this study was to determine whether wireless home blood pressure monitoring with or without financial incentives is more effective at reducing systolic blood pressure than nonwireless home blood pressure monitoring (usual care). Methods: This study was designed as a randomized controlled open-label superiority study. A sample size of 224 was required to detect differences of 10 mmHg in average systolic blood pressure. Participants were to be randomized, in the ratio of 2:3:3, into 1 of 3 parallel study arms :(1) usual care, (2) wireless home blood pressure monitoring, and (3) wireless home blood pressure monitoring with financial incentives. The primary outcome was the mean change in systolic blood pressure at month 6. The secondary outcomes were the mean reduction in diastolic blood pressure, cost of financial incentives, time taken for the intervention, adherence to home blood pressure monitoring, effectiveness of the framing of financial incentives in decreasing nonadherence to blood pressure self-monitoring and the adherence to antihypertensive medication at month 6. Results: This study was approved by SingHealth Centralised Institutional Review Board and registered. Between January 24, 2018 and July 10, 2018, 42 participants (18.75\% of the required sample size) were enrolled, and 33 participants completed the month 6 assessment by January 31, 2019. Conclusions: Due to unforeseen events, the study was stopped prematurely; therefore, no results are available. Depending on the blood pressure information received from the patients, the algorithm can trigger immediate blood pressure advice (eg, Accident and Emergency department visit advice for extremely high blood pressure), weekly feedback on blood pressure monitoring, medication titration, or skipping of routine follow-ups. The inclusion of financial incentives framed as health capital provides a novel idea on how to promote adherence to remote monitoring, and ultimately, improve chronic disease management. Trial Registration: ClinicalTrials.gov NCT 03368417; https://clinicaltrials.gov/ct2/show/NCT03368417 International Registered Report Identifier (IRRID): DERR1-10.2196/27496 ",
doi="10.2196/27496",
url="https://www.researchprotocols.org/2021/6/e27496",
url="http://www.ncbi.nlm.nih.gov/pubmed/34106085"
}


@Article{info:doi/10.2196/26605,
author="Huang, Ching-Chang
and Chen, Ying-Hsien
and Hung, Chi-Sheng
and Lee, Jen-Kuang
and Hsu, Tse-Pin
and Wu, Hui-Wen
and Chuang, Pao-Yu
and Chen, Ming-Fong
and Ho, Yi-Lwun",
title="The Association Between Short-term Exposure to Ambient Air Pollution and Patient-Level Home Blood Pressure Among Patients With Chronic Cardiovascular Diseases in a Web-Based Synchronous Telehealth Care Program: Retrospective Study",
journal="JMIR Public Health Surveill",
year="2021",
month="Jun",
day="8",
volume="7",
number="6",
pages="e26605",
keywords="ambient air pollution",
keywords="blood pressure",
keywords="cardiovascular disease",
keywords="chronic disease",
keywords="climate",
keywords="home blood pressure",
keywords="particulate matter",
keywords="pollution",
keywords="remote monitoring",
keywords="telehealth care",
keywords="telemonitoring",
keywords="weather",
abstract="Background: The association between short-term exposure to ambient air pollution and blood pressure has been inconsistent, as reported in the literature. Objective: This study aimed to investigate the relationship between short-term ambient air pollution exposure and patient-level home blood pressure (HBP). Methods: Patients with chronic cardiovascular diseases from a telehealth care program at a university-affiliated hospital were enrolled as the study population. HBP was measured by patients or their caregivers. Hourly meteorological data (including temperature, relative humidity, wind speed, and rainfall) and ambient air pollution monitoring data (including CO, NO2, particulate matter with a diameter of <10 {\textmu}m, particulate matter with a diameter of <2.5 {\textmu}m, and SO2) during the same time period were obtained from the Central Weather Bureau and the Environmental Protection Administration in Taiwan, respectively. A stepwise multivariate repeated generalized estimating equation model was used to assess the significant factors for predicting systolic and diastolic blood pressure (SBP and DBP). Results: A total of 253 patients and 110,715 HBP measurements were evaluated in this study. On multivariate analysis, demographic, clinical, meteorological factors, and air pollutants significantly affected the HBP (both SBP and DBP). All 5 air pollutants evaluated in this study showed a significant, nonlinear association with both home SBP and DBP. Compared with demographic and clinical factors, environmental factors (meteorological factors and air pollutants) played a minor yet significant role in the regulation of HBP. Conclusions: Short-term exposure to ambient air pollution significantly affects HBP in patients with chronic cardiovascular disease. ",
doi="10.2196/26605",
url="https://publichealth.jmir.org/2021/6/e26605",
url="http://www.ncbi.nlm.nih.gov/pubmed/34100764"
}


@Article{info:doi/10.2196/25968,
author="Kim, Gyungha
and Jeon, Hwawoo
and Park, Kee Sung
and Choi, Suk Yong
and Lim, Yoonseob",
title="A Care Knowledge Management System Based on an Ontological Model of Caring for People With Dementia: Knowledge Representation and Development Study",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="8",
volume="23",
number="6",
pages="e25968",
keywords="caregiver",
keywords="caregiver for person with dementia",
keywords="knowledge model",
keywords="ontology",
keywords="knowledge management",
keywords="semantic reasoning",
abstract="Background: Caregivers of people with dementia find it extremely difficult to choose the best care method because of complex environments and the variable symptoms of dementia. To alleviate this care burden, interventions have been proposed that use computer- or web-based applications. For example, an automatic diagnosis of the condition can improve the well-being of both the person with dementia and the caregiver. Other interventions support the individual with dementia in living independently. Objective: The aim of this study was to develop an ontology-based care knowledge management system for people with dementia that will provide caregivers with a care guide suited to the environment and to the individual patient's symptoms. This should also enable knowledge sharing among caregivers. Methods: To build the care knowledge model, we reviewed existing ontologies that contain concepts and knowledge descriptions relating to the care of those with dementia, and we considered dementia care manuals. The basic concepts of the care ontology were confirmed by experts in Korea. To infer the different care methods required for the individual dementia patient, the reasoning rules as defined in Semantic Web Rule Languages and Prolog were utilized. The accuracy of the care knowledge in the ontological model and the usability of the proposed system were evaluated by using the Pellet reasoner and OntOlogy Pitfall Scanner!, and a survey and interviews were conducted with caregivers working in care centers in Korea. Results: The care knowledge model contains six top-level concepts: care knowledge, task, assessment, person, environment, and medical knowledge. Based on this ontological model of dementia care, caregivers at a dementia care facility in Korea were able to access the care knowledge easily through a graphical user interface. The evaluation by the care experts showed that the system contained accurate care knowledge and a level of assessment comparable to normal assessment tools. Conclusions: In this study, we developed a care knowledge system that can provide caregivers with care guides suited to individuals with dementia. We anticipate that the system could reduce the workload of caregivers. ",
doi="10.2196/25968",
url="https://www.jmir.org/2021/6/e25968",
url="http://www.ncbi.nlm.nih.gov/pubmed/34100762"
}


@Article{info:doi/10.2196/25006,
author="Ruggiano, Nicole
and Brown, L. Ellen
and Roberts, Lisa
and Framil Suarez, Victoria C.
and Luo, Yan
and Hao, Zhichao
and Hristidis, Vagelis",
title="Chatbots to Support People With Dementia and Their Caregivers: Systematic Review of Functions and Quality",
journal="J Med Internet Res",
year="2021",
month="Jun",
day="3",
volume="23",
number="6",
pages="e25006",
keywords="dementia",
keywords="caregivers",
keywords="chatbots",
keywords="conversation agents",
keywords="mobile apps",
keywords="mobile phone",
abstract="Background: Over the past decade, there has been an increase in the use of information technologies to educate and support people with dementia and their family caregivers. At the same time, chatbot technologies have become increasingly popular for use by the public and have been identified as having benefits for health care delivery. However, little is known about how chatbot technologies may benefit people with dementia and their caregivers. Objective: This study aims to identify the types of current commercially available chatbots that are designed for use by people with dementia and their caregivers and to assess their quality in terms of features and content. Methods: Chatbots were identified through a systematic search on Google Play Store, Apple App Store, Alexa Skills, and the internet. An evidence-based assessment tool was used to evaluate the features and content of the identified apps. The assessment was conducted through interrater agreement among 4 separate reviewers. Results: Of the 505 initial chatbots identified, 6 were included in the review. The chatbots assessed varied significantly in terms of content and scope. Although the chatbots were generally found to be easy to use, some limitations were noted regarding their performance and programmed content for dialog. Conclusions: Although chatbot technologies are well established and commonly used by the public, their development for people with dementia and their caregivers is in its infancy. Given the successful use of chatbots in other health care settings and for other applications, there are opportunities to integrate this technology into dementia care. However, more evidence-based chatbots that have undergone end user evaluation are needed to evaluate their potential to adequately educate and support these populations. ",
doi="10.2196/25006",
url="https://www.jmir.org/2021/6/e25006",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081019"
}


@Article{info:doi/10.2196/24724,
author="Christie, Liane Hannah
and Boots, Maria Lizzy Mitzy
and Hermans, Ivo
and Govers, Mark
and Tange, Johannes Huibert
and Verhey, Josef Frans Rochus
and de Vugt, Majolein",
title="Business Models of eHealth Interventions to Support Informal Caregivers of People With Dementia in the Netherlands: Analysis of Case Studies",
journal="JMIR Aging",
year="2021",
month="Jun",
day="3",
volume="4",
number="2",
pages="e24724",
keywords="eHealth",
keywords="dementia",
keywords="caregiving",
keywords="implementation",
keywords="business modeling",
abstract="Background: In academic research contexts, eHealth interventions for caregivers of people with dementia have shown ample evidence of effectiveness. However, they are rarely implemented in practice, and much can be learned from their counterparts (commercial, governmental, or other origins) that are already being used in practice. Objective: This study aims to examine a sample of case studies of eHealth interventions to support informal caregivers of people with dementia that are currently used in the Netherlands; to investigate what strategies are used to ensure the desirability, feasibility, viability, and sustainability of the interventions; and to apply the lessons learned from this practical, commercial implementation perspective to academically developed eHealth interventions for caregivers of people with dementia. Methods: In step 1, experts (N=483) in the fields of dementia and eHealth were contacted and asked to recommend interventions that met the following criteria: delivered via the internet; suitable for informal caregivers of people with dementia; accessible in the Netherlands, either in Dutch or in English; and used in practice. The contacted experts were academics working on dementia and psychosocial innovations, industry professionals from eHealth software companies, clinicians, patient organizations, and people with dementia and their caregivers. In step 2, contact persons from the suggested eHealth interventions participated in a semistructured telephone interview. The results were analyzed using a multiple case study methodology. Results: In total, the response rate was 7.5\% (36/483), and 21 eHealth interventions for caregivers of people with dementia were recommended. Furthermore, 43\% (9/21) of the interventions met all 4 criteria and were included in the sample for the case study analysis. Of these 9 interventions, 4 were found to have developed sustainable business models and 5 were implemented in a more exploratory manner and relied on research grants to varying extents, although some had also developed preliminary business models. Conclusions: These findings suggest that the desirability, feasibility, and viability of eHealth interventions for caregivers of people with dementia are linked to their integration into larger structures, their ownership and support of content internally, their development of information and communication technology services externally, and their offer of fixed, low pricing. The origin of the case studies was also important, as eHealth interventions that had originated in an academic research context less reliably found their way to sustainable implementation. In addition, careful selection of digital transformation strategies, more intersectoral cooperation, and more funding for implementation and business modeling research are recommended to help future developers bring eHealth interventions for caregivers of people with dementia into practice. ",
doi="10.2196/24724",
url="https://aging.jmir.org/2021/2/e24724",
url="http://www.ncbi.nlm.nih.gov/pubmed/34081009"
}


@Article{info:doi/10.2196/25679,
author="Lwin, O. May
and Sheldenkar, Anita
and Panchapakesan, Chitra",
title="A Digital Mobile Community App for Caregivers in Singapore: Predevelopment and Usability Study",
journal="JMIR Nursing",
year="2021",
month="May",
day="26",
volume="4",
number="2",
pages="e25679",
keywords="caregiving",
keywords="technological solution",
keywords="mobile application",
keywords="easy communication",
keywords="caregiver",
keywords="mobile app",
keywords="communication",
keywords="elderly",
keywords="aging population",
keywords="internet technology",
keywords="community network",
keywords="network",
abstract="Background: With increasing life expectancy and aging populations, the global prevalence of chronic diseases and the long-term care required for people with comorbidities is rising. This has led to an ever-growing need for caregiving. Previous literature has shown that caregivers face problems of isolation and loneliness. However, many health organizations mainly focus their efforts on in-person community groups that require participants to meet physically. This is not always convenient or accessible for caregivers who are often juggling caring for their care recipient with family and work responsibilities. Objective: With medical advancements such as the proliferation of mobile phones and internet technology, caregivers may have opportunities for easier access to resources and support. Technological innovations could help empower the caregiving community to seek assistance for improving their quality of life at their convenience. A community network app called Caregivers' Circle was conceptualized in response to the needs of the caregivers on a day-to-day caregiving journey. This paper traces the predevelopment inquiry and technical details of this app to provide a clear understanding of its implementation along with a usability study to gauge user opinion of the app within Singapore. Methods: A predevelopment survey was conducted to identify specific needs of caregivers and gaps in the currently available web-based community networks. The survey consisted of questions on demographical data, health-related issues of the care recipient, mental and physical health--related issues of the caregiver, digital media use, information seeking, and support. This pre--app development survey was completed by 103 caregivers. Qualitative enquiries were also conducted with caregivers within Singapore to identify issues related to caregiving, support provided, and what caregivers would want from a caregiving mobile app. Results: From the feedback garnered from the caregivers, the developers were able to identify several caregivers' needs and gaps within the current support networks. This feedback was integrated into the mobile app called Caregivers' Circle upon development. The features of this app include a public forum for community discussions, a marketplace to buy and sell items, care groups to hold private discussions with friends or other users of the app, and a friends feature to search and add new caregiving friends. Conclusions: In general, the caregivers liked the Caregivers' Circle app and were confident that this app could help them have a better quality of life. The Caregivers' Circle app is unique in its integrated approach. The integration of many features that caregivers need on a daily basis into an easy app can save their time as well as help them navigate their life smoothly. ",
doi="10.2196/25679",
url="https://nursing.jmir.org/2021/2/e25679",
url="http://www.ncbi.nlm.nih.gov/pubmed/34345796"
}


@Article{info:doi/10.2196/22626,
author="Steindal, A. Simen
and Nes, Goncalves Andr{\'e}a Aparecida
and Godskesen, E. Tove
and Lind, Susanne
and Dhle, Alfhild
and Winger, Anette
and {\"O}sterlind, Jane
and Pettersen, Solvang Fredrik
and Holmen, Heidi
and Klarare, Anna",
title="Advantages and Challenges in Using Telehealth for Home-Based Palliative Care: Protocol for a Systematic Mixed Studies Review",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="21",
volume="10",
number="5",
pages="e22626",
keywords="eHealth",
keywords="health care technology",
keywords="home-based",
keywords="palliative care",
keywords="review",
keywords="systematic mixed studies review",
keywords="telemedicine",
abstract="Background: Given the increasing number of people in need of palliative care services and the current health care professional workforce strain, providing equitable, quality palliative care has become a challenge. Telehealth could be an innovative approach to palliative care delivery, enabling patients to spend more time or even remain at home, if they wish, throughout the illness trajectory. However, no previous systematic mixed studies reviews have synthesized evidence on patients' experiences of the advantages and challenges of telehealth for home-based palliative care. Objective: The aim of this systematic mixed studies review is to critically appraise and synthesize findings from studies that investigated patients' use of telehealth in home-based palliative care with a focus on the advantages and challenges experienced by the patients. Methods: This article describes the protocol for a systematic mixed studies review with a convergent design. The reporting will be guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. A systematic search was performed in eight databases for studies published from January 2010 to June 2020. The search will be updated in 2021. Pairs of authors will independently assess eligibility, extract data, and assess methodological quality. The data will then be analyzed using thematic synthesis. Results: We describe the rationale and design of a systematic mixed studies review. The database searches were performed on June 25, 2020. Assessment of eligibility and further steps have not yet been performed. Results are anticipated by August 2021. Conclusions: Following the ethos of patient-centered palliative care, this systematic mixed studies review could lead to recommendations for practice and policy, enabling the development and implementation of telehealth applications and services that align with patients' preferences and needs at home. International Registered Report Identifier (IRRID): PRR1-10.2196/22626 ",
doi="10.2196/22626",
url="https://www.researchprotocols.org/2021/5/e22626",
url="http://www.ncbi.nlm.nih.gov/pubmed/34018964"
}


@Article{info:doi/10.2196/18984,
author="Campos, L. Claudia
and Jones, Deanna
and Snively, M. Beverly
and Rocco, Michael
and Pedley, Carolyn
and Atwater, Sara
and Moore, B. Justin",
title="Text Messaging and Home Blood Pressure Monitoring for Patients with Uncontrolled Hypertension: Proposal for a Feasibility Pilot Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2021",
month="May",
day="14",
volume="10",
number="5",
pages="e18984",
keywords="hypertension",
keywords="home blood pressure monitoring",
keywords="telehealth",
keywords="medication adherence",
keywords="SMS",
keywords="health disparities",
abstract="Background: A decrease in blood pressure, even modestly (ie, 2 mmHg), lowers cardiovascular morbidity and mortality. Low patient adherence to antihypertensive medication is the most significant modifiable patient-related barrier to achieving controlled blood pressure. Preliminary studies have shown that SMS text messaging and home blood pressure monitoring (HBPM) can be effective in promoting medication adherence and blood pressure control. The best strategy to engage with older patients of low socioeconomic status who are low adopters of technology and disproportionally affected by uncontrolled hypertension is still unknown. Objective: The objective of this study is to improve blood pressure control in the older, low socioeconomic status population. The study will test two aims: First, we aim to evaluate the feasibility of conducting a randomized controlled trial by using an SMS-based approach among nonadherent, older patients of low socioeconomic status who have uncontrolled hypertension. Feasibility will be assessed in terms of recruitment rates per month (primary outcome); patient acceptability will be evaluated by monitoring retention rates and SMS response rates and using the validated Systems Usability Scale (secondary outcomes). Second, we aim to estimate the effects of the SMS approach on lowering blood pressure and adherence to antihypertensive medications. Methods: We will recruit 24 patients of low socioeconomic status with uncontrolled hypertension (systolic BP>140 mmHg or diastolic BP>90 mmHg) showing low medication adherence and taking at least two antihypertensives, who have presented to two outpatient clinics of Wake Forest Baptist Health (Winston Salem, North Carolina, USA). Participants will be randomly assigned to either SMS and HBPM (n=12) or usual care and HBPM (n=12) intervention. Clinicians adjusting the patients' medications will be blinded to the study assignment. Text messages will be sent from a secure platform to assess medication adherence and HBPM on a weekly basis. The content and delivery frequency of the proposed SMS intervention are based on input from three focus groups conducted in Spring 2019. Participants in both study arms will receive education on HBPM and using an HBPM device. We hypothesize that we will successfully recruit 24 participants and the intervention will be acceptable to the participants. It will also improve medication adherence (assessed by question Medication Adherence Questionnaire scores) and blood pressure control. Results: Our study was funded in July 2020. As of May 2021, we have enrolled 6 participants. Conclusions: Our findings will help design a larger efficacy trial to advance the field of eHealth delivery systems particularly for older adults of low socioeconomic status. This study addresses a highly significant topic and targets a population of high morbidity and mortality that has been traditionally underrepresented in clinical trials. Trial Registration: ClinicalTrials.gov NCT03596242; https://clinicaltrials.gov/ct2/show/NCT03596242 International Registered Report Identifier (IRRID): PRR1-10.2196/18984 ",
doi="10.2196/18984",
url="https://www.researchprotocols.org/2021/5/e18984",
url="http://www.ncbi.nlm.nih.gov/pubmed/33988513"
}


@Article{info:doi/10.2196/26875,
author="Wrede, Christian
and Braakman-Jansen, Annemarie
and van Gemert-Pijnen, Lisette",
title="Requirements for Unobtrusive Monitoring to Support Home-Based Dementia Care: Qualitative Study Among Formal and Informal Caregivers",
journal="JMIR Aging",
year="2021",
month="Apr",
day="12",
volume="4",
number="2",
pages="e26875",
keywords="in-home monitoring",
keywords="ambient assisted living",
keywords="assistive technologies",
keywords="dementia",
keywords="home care",
keywords="informal care",
keywords="aging in place",
abstract="Background: Due to a growing shortage in residential care, people with dementia will increasingly be encouraged to live at home for longer. Although people with dementia prefer extended independent living, this also puts more pressure on both their informal and formal care networks. To support (in)formal caregivers of people with dementia, there is growing interest in unobtrusive contactless in-home monitoring technologies that allow caregivers to remotely monitor the lifestyle, health, and safety of their care recipients. Despite their potential, these solutions will only be viable if they meet the expectations and needs of formal and informal caregivers of people with dementia. Objective: The objective of this study was to explore the expected benefits, barriers, needs, and requirements toward unobtrusive in-home monitoring from the perspective of formal and informal caregivers of community-dwelling people with dementia. Methods: A combination of semistructured interviews and focus groups was used to collect data among informal (n=19) and formal (n=16) caregivers of people with dementia. Both sets of participants were presented with examples of unobtrusive in-home monitoring followed by questions addressing expected benefits, barriers, and needs. Relevant in-home monitoring goals were identified using a previously developed topic list. Interviews and focus groups were transcribed and inductively analyzed. Requirements for unobtrusive in-home monitoring were elicited based on the procedure of van Velsen and Bergvall-K{\aa}reborn. Results: Formal and informal caregivers saw unobtrusive in-home monitoring as a support tool that should particularly be used to monitor (the risk of) falls, day and night rhythm, personal hygiene, nocturnal restlessness, and eating and drinking behavior. Generally, (in)formal caregivers reported cross-checking self-care information, extended independent living, objective communication, prevention and proactive measures, emotional reassurance, and personalized and optimized care as the key benefits of unobtrusive in-home monitoring. Main concerns centered around privacy, information overload, and ethical concerns related to dehumanizing care. Furthermore, 16 requirements for unobtrusive in-home monitoring were generated that specified desired functions, how the technology should communicate with the user, which services surrounding the technology were seen as needed, and how the technology should be integrated into the existing work context. Conclusions: Despite the presence of barriers, formal and informal caregivers of people with dementia generally saw value in unobtrusive in-home monitoring, and felt that these systems could contribute to a shift from reactive to more proactive and less obtrusive care. However, the full potential of unobtrusive in-home monitoring can only unfold if relevant concerns are considered. Our requirements can inform the development of more acceptable and goal-directed in-home monitoring technologies to support home-based dementia care. ",
doi="10.2196/26875",
url="https://aging.jmir.org/2021/2/e26875",
url="http://www.ncbi.nlm.nih.gov/pubmed/33843596"
}


@Article{info:doi/10.2196/20184,
author="Zolnoori, Maryam
and McDonald, V. Margaret
and Barr{\'o}n, Yolanda
and Cato, Kenrick
and Sockolow, Paulina
and Sridharan, Sridevi
and Onorato, Nicole
and Bowles, Kathryn
and Topaz, Maxim",
title="Improving Patient Prioritization During Hospital-Homecare Transition: Protocol for a Mixed Methods Study of a Clinical Decision Support Tool Implementation",
journal="JMIR Res Protoc",
year="2021",
month="Jan",
day="22",
volume="10",
number="1",
pages="e20184",
keywords="clinical decision support system",
keywords="homecare agencies",
keywords="rehospitalization",
keywords="RE-AIM framework",
keywords="PREVENT",
keywords="effective implementation",
abstract="Background: Homecare settings across the United States provide care to more than 5 million patients every year. About one in five homecare patients are rehospitalized during the homecare episode, with up to two-thirds of these rehospitalizations occurring within the first 2 weeks of services. Timely allocation of homecare services might prevent a significant portion of these rehospitalizations. The first homecare nursing visit is one of the most critical steps of the homecare episode. This visit includes an assessment of the patient's capacity for self-care, medication reconciliation, an examination of the home environment, and a discussion regarding whether a caregiver is present. Hence, appropriate timing of the first visit is crucial, especially for patients with urgent health care needs. However, nurses often have limited and inaccurate information about incoming patients, and patient priority decisions vary significantly between nurses. We developed an innovative decision support tool called Priority for the First Nursing Visit Tool (PREVENT) to assist nurses in prioritizing patients in need of immediate first homecare nursing visits. Objective: This study aims to evaluate the effectiveness of the PREVENT tool on process and patient outcomes and to examine the reach, adoption, and implementation of PREVENT. Methods: Employing a pre-post design, survival analysis, and logistic regression with propensity score matching analysis, we will test the following hypotheses: compared with not using the tool in the preintervention phase, when homecare clinicians use the PREVENT tool, high-risk patients in the intervention phase will (1) receive more timely first homecare visits and (2) have decreased incidence of rehospitalization and have decreased emergency department use within 60 days. Reach, adoption, and implementation will be assessed using mixed methods including homecare admission staff interviews, think-aloud observations, and analysis of staffing and other relevant data. Results: The study research protocol was approved by the institutional review board in October 2019. PREVENT is currently being integrated into the electronic health records at the participating study sites. Data collection is planned to start in early 2021. Conclusions: Mixed methods will enable us to gain an in-depth understanding of the complex socio-technological aspects of the hospital to homecare transition. The results have the potential to (1) influence the standardization and individualization of nurse decision making through the use of cutting-edge technology and (2) improve patient outcomes in the understudied homecare setting. Trial Registration: ClinicalTrials.gov NCT04136951; https://clinicaltrials.gov/ct2/show/NCT04136951 International Registered Report Identifier (IRRID): PRR1-10.2196/20184 ",
doi="10.2196/20184",
url="https://www.researchprotocols.org/2021/1/e20184",
url="http://www.ncbi.nlm.nih.gov/pubmed/33480855"
}


@Article{info:doi/10.2196/25307,
author="Palmdorf, Sarah
and Stark, Lea Anna
and Nadolny, Stephan
and Elia{\ss}, Gerrit
and Karlheim, Christoph
and Kreisel, H. Stefan
and Gruschka, Tristan
and Trompetter, Eva
and Dockweiler, Christoph",
title="Technology-Assisted Home Care for People With Dementia and Their Relatives: Scoping Review",
journal="JMIR Aging",
year="2021",
month="Jan",
day="20",
volume="4",
number="1",
pages="e25307",
keywords="dementia",
keywords="home care",
keywords="assistive technologies",
keywords="scoping review",
abstract="Background: Assistive technologies for people with dementia and their relatives have the potential to ensure, improve, and facilitate home care and thereby enhance the health of the people caring or being cared for. The number and diversity of technologies and research have continuously increased over the past few decades. As a result, the research field has become complex. Objective: The goal of this scoping review was to provide an overview of the research on technology-assisted home care for people with dementia and their relatives in order to guide further research and technology development. Methods: A scoping review was conducted following a published framework and by searching 4 databases (MEDLINE, CINAHL, PsycInfo, and CENTRAL) for studies published between 2013 and 2018. We included qualitative and quantitative studies in English or German focusing on technologies that support people with dementia or their informal carers in the home care setting. Studies that targeted exclusively people with mild cognitive impairment, delirium, or health professionals were excluded as well as studies that solely consisted of assessments without implication for the people with dementia or their relatives and prototype developments. We mapped the research field regarding study design, study aim, setting, sample size, technology type, and technology aim, and we report relative and absolute frequencies. Results: From an initial 5328 records, we included 175 studies. We identified a variety of technology types including computers, telephones, smartphones, televisions, gaming consoles, monitoring devices, ambient assisted living, and robots. Assistive technologies were most commonly used by people with dementia (77/175, 44.0\%), followed by relatives (68/175, 38.9\%), and both target groups (30/175, 17.1\%). Their most frequent goals were to enable or improve care, provide therapy, or positively influence symptoms of people with dementia (eg, disorientation). The greatest proportions of studies were case studies and case series (72/175, 41.1\%) and randomized controlled trials (44/175, 25.1\%). The majority of studies reported small sample sizes of between 1 and 50 participants (122/175, 69.7\%). Furthermore, most of the studies analyzed the effectiveness (85/233, 36.5\%) of the technology, while others targeted feasibility or usability or were explorative. Conclusions: This review demonstrated the variety of technologies that support people with dementia and their relatives in the home care setting. Whereas this diversity provides the opportunity for needs-oriented technical solutions that fit individual care arrangements, it complicates the choice of the right technology. Therefore, research on the users' informational needs is required. Moreover, there is a need for larger studies on the technologies' effectiveness that could contribute to a higher acceptance and thus to a transition of technologies from research into the daily lives of people with dementia and their relatives. ",
doi="10.2196/25307",
url="http://aging.jmir.org/2021/1/e25307/",
url="http://www.ncbi.nlm.nih.gov/pubmed/33470935"
}


@Article{info:doi/10.2196/19732,
author="Kim, Ben
and McKay, M. Sandra
and Lee, Joon",
title="Consumer-Grade Wearable Device for Predicting Frailty in Canadian Home Care Service Clients: Prospective Observational Proof-of-Concept Study",
journal="J Med Internet Res",
year="2020",
month="Sep",
day="3",
volume="22",
number="9",
pages="e19732",
keywords="frailty",
keywords="mobile health",
keywords="wearables",
keywords="physical activity",
keywords="home care",
keywords="prediction",
keywords="predictive modeling, older adults",
keywords="activities of daily living, sleep",
abstract="Background: Frailty has detrimental health impacts on older home care clients and is associated with increased hospitalization and long-term care admission. The prevalence of frailty among home care clients is poorly understood and ranges from 4.0\% to 59.1\%. Although frailty screening tools exist, their inconsistent use in practice calls for more innovative and easier-to-use tools. Owing to increases in the capacity of wearable devices, as well as in technology literacy and adoption in Canadian older adults, wearable devices are emerging as a viable tool to assess frailty in this population. Objective: The objective of this study was to prove that using a wearable device for assessing frailty in older home care clients could be possible. Methods: From June 2018 to September 2019, we recruited home care clients aged 55 years and older to be monitored over a minimum of 8 days using a wearable device. Detailed sociodemographic information and patient assessments including degree of comorbidity and activities of daily living were collected. Frailty was measured using the Fried Frailty Index. Data collected from the wearable device were used to derive variables including daily step count, total sleep time, deep sleep time, light sleep time, awake time, sleep quality, heart rate, and heart rate standard deviation. Using both wearable and conventional assessment data, multiple logistic regression models were fitted via a sequential stepwise feature selection to predict frailty. Results: A total of 37 older home care clients completed the study. The mean age was 82.27 (SD 10.84) years, and 76\% (28/37) were female; 13 participants were frail, significantly older (P<.01), utilized more home care service (P=.01), walked less (P=.04), slept longer (P=.01), and had longer deep sleep time (P<.01). Total sleep time (r=0.41, P=.01) and deep sleep time (r=0.53, P<.01) were moderately correlated with frailty. The logistic regression model fitted with deep sleep time, step count, age, and education level yielded the best predictive performance with an area under the receiver operating characteristics curve value of 0.90 (Hosmer-Lemeshow P=.88). Conclusions: We proved that a wearable device could be used to assess frailty for older home care clients. Wearable data complemented the existing assessments and enhanced predictive power. Wearable technology can be used to identify vulnerable older adults who may benefit from additional home care services. ",
doi="10.2196/19732",
url="https://www.jmir.org/2020/9/e19732",
url="http://www.ncbi.nlm.nih.gov/pubmed/32880582"
}


@Article{info:doi/10.2196/17015,
author="Wong, SY Zoie
and Siy, Braylien
and Da Silva Lopes, Katharina
and Georgiou, Andrew",
title="Improving Patients' Medication Adherence and Outcomes in Nonhospital Settings Through eHealth: Systematic Review of Randomized Controlled Trials",
journal="J Med Internet Res",
year="2020",
month="Aug",
day="20",
volume="22",
number="8",
pages="e17015",
keywords="eHealth",
keywords="self-administered drug",
keywords="self-management",
keywords="medication adherence",
keywords="nonhospital settings",
keywords="randomized controlled trial",
abstract="Background: Electronic health (eHealth) refers to the use of information and communication technologies for health. It plays an increasingly important role in patients' medication management. Objective: To assess evidence on (1) whether eHealth for patients' medication management can improve drug adherence and health outcomes in nonhospital settings and (2) which eHealth functions are commonly used and are effective in improving drug adherence. Methods: We searched for randomized controlled trials (RCTs) on PubMed, MEDLINE, CINAHL, EMBASE, EmCare, ProQuest, Scopus, Web of Science, ScienceDirect, and IEEE Xplore, in addition to other published sources between 2000 and 2018. We evaluated the studies against the primary outcome measure of medication adherence and multiple secondary health care outcome measures relating to adverse events, quality of life, patient satisfaction, and health expenditure. The quality of the studies included was assessed using the Cochrane Collaboration's Risk of Bias (RoB) tool. Results: Our initial search yielded 9909 records, and 24 studies met the selection criteria. Of these, 13 indicated improvement in medication adherence at the significance level of P<.1 and 2 indicated an improved quality of life at the significance level of P<.01. The top 3 functions that were employed included mechanisms to communicate with caregivers, monitoring health features, and reminders and alerts. eHealth functions of providing information and education, and dispensing treatment and administration support tended to favor improved medication adherence outcomes (Fisher exact test, P=.02). There were differences in the characteristics of the study population, intervention design, functionality provided, reporting adherence, and outcome measures among the included studies. RoB assessment items, including blinding of outcome assessment and method for allocation concealment, were not explicitly reported in a large number of studies. Conclusions: All the studies included were designed for patient home-based care application and provided a mechanism to communicate with caregivers. A targeted study population such as older patients should be considered to maximize the public health impact on the self-management of diseases. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) CRD42018096627; https://www.crd.york.ac.uk/prospero/display\_record.php?RecordID=96627 ",
doi="10.2196/17015",
url="http://www.jmir.org/2020/8/e17015/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32663145"
}


@Article{info:doi/10.2196/20310,
author="Hassan, Ibrahim Alhassan Yosri",
title="Challenges and Recommendations for the Deployment of Information and Communication Technology Solutions for Informal Caregivers: Scoping Review",
journal="JMIR Aging",
year="2020",
month="Jul",
day="29",
volume="3",
number="2",
pages="e20310",
keywords="informal caregivers",
keywords="ICT",
keywords="digital health",
keywords="eHealth",
keywords="health economics",
keywords="internet",
keywords="health technology",
keywords="ageing",
keywords="home care",
keywords="digital solutions",
abstract="Background: Information and communication technology (ICT)--based solutions have the potential to support informal caregivers in home care delivery. However, there are many challenges to the deployment of these solutions. Objective: The aim of this study was to review literature to explore the challenges of the deployment of ICT-based support solutions for informal caregivers and provide relevant recommendations on how to overcome these challenges. Methods: A scoping review methodology was used following the Arksey and O'Malley methodological framework to map the relevant literature. A search was conducted using PubMed, IEEE library, and Scopus. Publication screening and scrutiny were conducted following inclusion criteria based on inductive thematic analysis to gain insight into patterns of challenges rising from deploying ICT-based support solutions for informal caregivers. The analysis took place through an iterative process of combining, categorizing, summarizing, and comparing information across studies. Through this iterative process, relevant information was identified and coded under emergent broader themes as they pertain to each of the research questions. Results: The analysis identified 18 common challenges using a coding scheme grouping them under four thematic categories: technology-related, organizational, socioeconomic, and ethical challenges. These range from specific challenges related to the technological component of the ICT-based service such as design and usability of technology, to organizational challenges such as fragmentation of support solutions to socioeconomic challenges such as funding of technology and sustainability of solutions to ethical challenges around autonomy and privacy of data. For each identified challenge, recommendations were created on how to overcome it. The recommendations from this study can provide guidance for the deployment of ICT-based support solutions for informal caregivers. Conclusions: Despite a growing interest in the potential offered by ICT solutions for informal caregiving, diverse and overlapping challenges to their deployment still remain. Designers for ICTs for informal caregivers should follow participatory design and involve older informal caregivers in the design process as much as possible. A collaboration between designers and academic researchers is also needed to ensure ICT solutions are designed with the current empirical evidence in mind. Taking actions to build the digital skills of informal caregivers early in the caregiving process is crucial for optimal use of available ICT solutions. Moreover, the lack of awareness of the potential added-value and trust toward ICT-based support solutions requires strategies to raise awareness among all stakeholders---including policy makers, health care professionals, informal caregivers, and care recipients---about support opportunities offered by ICT. On the macro-level, policies to fund ICT solutions that have been shown to be effective at supporting and improving informal caregiver health outcomes via subsidies or other incentives should be considered. ",
doi="10.2196/20310",
url="http://aging.jmir.org/2020/2/e20310/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32723720"
}


@Article{info:doi/10.2196/15472,
author="Chang, Ernest Shuchih
and Chen, YiChian
and Lu, MingFang
and Luo, Louis Hueimin",
title="Development and Evaluation of a Smart Contract--Enabled Blockchain System for Home Care Service Innovation: Mixed Methods Study",
journal="JMIR Med Inform",
year="2020",
month="Jul",
day="28",
volume="8",
number="7",
pages="e15472",
keywords="home care service",
keywords="trust",
keywords="innovation",
keywords="blockchain",
keywords="smart contract",
keywords="automation",
abstract="Background: In the home care industry, the assignment and tracking of care services are controlled by care centers that are centralized in nature and prone to inefficient information transmission. A lack of trust among the involved parties, information opaqueness, and large manual manipulation result in lower process efficiency. Objective: This study aimed to explore and demonstrate the application of blockchain and smart contract technologies to innovate/renovate home care services for harvesting the desired blockchain benefits of process transparency, traceability, and interoperability. Methods: An object-oriented analysis/design combined with a unified modeling language tool was used to construct the architecture of the proposed home care service system. System feasibility was evaluated via an implementation test, and a questionnaire survey was performed to collect opinions from home care service respondents knowledgeable about blockchain and smart contracts. Results: According to the comparative analysis results, the proposed design outperformed the existing system in terms of traceability, system efficiency, and process automation. Moreover, for the questionnaire survey, the quantitative analysis results showed that the proposed blockchain-based system had significantly (P<.001) higher mean scores (when compared with the existing system) in terms of important factors, including timeliness, workflow efficiency, automatic notifications, insurance functionality, and auditable traceability. In summary, blockchain-based home care service participants will be able to enjoy improved efficiency, better transparency, and higher levels of process automation. Conclusions: Blockchain and smart contracts can provide valuable benefits to the home care service industry via distributed data management and process automation. The proposed system enhances user experiences by mitigating human intervention and improving service interoperability, transparency/traceability, and real-time response to home care service events. Efforts in exploring and integrating blockchain-based home care services with emerging technologies, such as the internet of things and artificial intelligence, are expected to provide further benefits and therefore are subject to future research. ",
doi="10.2196/15472",
url="https://medinform.jmir.org/2020/7/e15472",
url="http://www.ncbi.nlm.nih.gov/pubmed/32720903"
}


@Article{info:doi/10.2196/16644,
author="Huang, Rendong
and Xu, Mei
and Li, Xiuting
and Wang, Yinping
and Wang, Bin
and Cui, Naixue",
title="Internet-Based Sharing Nurse Program and Nurses' Perceptions in China: Cross-Sectional Survey",
journal="J Med Internet Res",
year="2020",
month="Jul",
day="22",
volume="22",
number="7",
pages="e16644",
keywords="sharing nurse",
keywords="home visiting",
keywords="internet plus nursing program",
keywords="perception",
keywords="China",
abstract="Background: China is currently piloting a ``Sharing Nurse'' program that aims to increase the accessibility of nursing services to at-home patients by enabling patients to order nursing services using mobile apps or online platforms. Objective: This study aims to assess nurses' perceptions of the Sharing Nurse program, including their acceptance, concerns, needs, and willingness to take part in the program. Methods: A total of 694 nurses participated in the questionnaire survey. The survey collected their sociodemographic and work-related information and their perceptions of the Sharing Nurse program using a self-developed questionnaire. Results: The 694 respondents agreed that?the Sharing Nurse program?could provide patients with better access to nursing care (n=483, 69.6\%). Their main concerns about the program were unclear?liability division when medical disputes occur (n=637, 90.3\%)?and potential personal safety issues (n=604, 87\%). They reported that insurance (n=611, 88\%), permits from their affiliated hospital (n=562, 81.0\%), clear instructions concerning rights and duties (n=580, 83.6\%), real time positioning while delivering the service (n=567, 81.7\%), and one-key alarm equipment (n=590, 85.0\%) were necessary for better implementation of the program. More than half of the respondents (n=416, 60\%) had an optimistic attitude toward the development of the Sharing Nurse program in China. However, only 19.4\% (n=135) of the respondents expressed their willingness to be a ``shared nurse.'' Further analyses found that nurses with a master's degree or above ($\chi$23=28.835, P<.001) or from tertiary hospitals ($\chi$23=18.669, P<.001) were more likely to be aware of the Sharing Nurse program and that male nurses were more willing to be shared nurses (Z=--2.275, P=.02). Conclusions: The Chinese Sharing Nurse program is still in its infancy and many refinements are needed before it can be implemented nationwide. Generally, Chinese nurses are positive about the Sharing Nurse program and are willing to participate if the program is thoroughly regulated and supervised. ",
doi="10.2196/16644",
url="http://www.jmir.org/2020/7/e16644/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32706711"
}


@Article{info:doi/10.2196/17930,
author="Verloo, Henk
and Kampel, Thomas
and Vidal, Nicole
and Pereira, Filipa",
title="Perceptions About Technologies That Help Community-Dwelling Older Adults Remain at Home: Qualitative Study",
journal="J Med Internet Res",
year="2020",
month="Jun",
day="4",
volume="22",
number="6",
pages="e17930",
keywords="technology",
keywords="gerontechnology",
keywords="photo-elicitation",
keywords="informal caregivers",
keywords="cognitive impairment",
keywords="professional caregivers",
keywords="interviews",
keywords="focus groups",
keywords="content analysis",
keywords="physical impairment",
keywords="frailty",
abstract="Background: The population of Europe is aging rapidly. Most community-dwelling older adults (CDOAs) want to remain in their homes, particularly those experiencing functional decline. Politicians and academics repeatedly praise technological instruments for being the preferred solution for helping older adults with deteriorating health to remain at home. Objective: This study aimed to understand the perceptions of CDOAs and their informal caregivers (ICs) and professional caregivers (PCs) about technologies that can help keep older adults at home. Methods: This qualitative study used personal interviews, focus groups, and photo-elicitation interviews to better understand the perceptions of a convenience sample of 68 CDOAs, 21 ICs, and 32 PCs. Results: A fraction of CDOAs did not perceive technological instruments to be a very useful means of helping them remain at home. However, the ICs and PCs were more positive. The CDOAs preferred and were more willing to adopt technologies related to their mobility and safety and those that would help slow down their cognitive decline. The ICs preferred technological aids that assist in the activities of daily living as well as safety-related technologies for detecting falls and helping to locate disoriented older adults. The PCs preferred integrated communication and information systems to improve collaboration between all stakeholders, housing equipped with technologies to manage complex care, high-performance ancillary equipment to transfer people with reduced mobility, and surveillance systems to ensure safety at home. Conclusions: Although our study reports that CDOAs have limited interest in innovative technologies to help them remain at home, their technological skills will undoubtedly improve in the future, as will those of ICs and PCs. Technological tools will play an increasingly important role in home health care. ",
doi="10.2196/17930",
url="http://www.jmir.org/2020/6/e17930/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32496197"
}


@Article{info:doi/10.2196/17863,
author="Talwar, Deepak
and Bendre, Salil",
title="Health-Related Effects of Home Nebulization With Glycopyrronium on Difficult-to-Treat Asthma: Post-Hoc Analyses of an Observational Study",
journal="Interact J Med Res",
year="2020",
month="Apr",
day="29",
volume="9",
number="2",
pages="e17863",
keywords="difficult-to-treat asthma",
keywords="exacerbation",
keywords="glycopyrronium",
keywords="home nebulization",
keywords="uncontrolled asthma",
keywords="vibrating mesh nebulizer",
abstract="Background: Bronchial asthma remains a clinical enigma with poorly controlled symptoms or exacerbations despite regular use of inhaled corticosteroids. Home nebulization offers a simplified solution for the delivery of rescue and maintenance bronchodilators, which is especially true for patients with frequent exacerbations during management of uncontrolled or difficult-to-treat asthma. Objective: We aimed to assess the clinical impact and outcomes associated with home nebulization---delivered long-acting bronchodilators for uncontrolled or difficult-to-treat asthma. Methods: This observational, concurrent study was conducted with 60 patients at 2 centers during November 2018. Statistical analyses for prebronchodilator forced expiratory volume in one second (FEV1) and Global Initiative for Asthma (GINA) asthma control score in patients on long-acting bronchodilators and corticosteroids were conducted, with two-tailed P values <.05 considered statistically significant. Results: Per protocol analyses (53/60) for consecutive cases receiving home nebulization with long-acting bronchodilators and corticosteroids were conducted. The baseline demographics included a male-to-female ratio of 30:23 and mean values of the following: age, 60.3 years (SD 11.8 years); weight, 64 kg (SD 16.8 kg); FEV1, 43\% (SD 16\%); GINA asthma control score, 3.0 points (SD 0.8 points); serum eosinophil level, 4\% (SD 3\%); fractional exhaled nitric oxide (FeNO), 12.1 ppb (SD 6 ppb). Of the patients, 100\% (53/53) had uncontrolled symptoms, 69.8\% (37/53) had prior exacerbations, 100\% (53/53) used formoterol/budesonide, and 75.5\% (40/53) used glycopyrronium. The per protocol group (n=53) had significantly improved mean prebronchodilator FEV1 (23.7\%, SD 29.8\%; 0.46 L, SD 0.58 L; P<.001) and GINA asthma control score (2.1 points, SD 0.8 points, P<.001). At baseline, patients (n=40) receiving glycopyrronium/formoterol/budesonide (25/20/500 mcg) nebulization admixture had the following mean values: prebronchodilator FEV1, 38\% (SD 15\%); GINA asthma control score, 3.0 points (SD 0.8 points); reversibility, 12\% (SD 6\%); peripheral eosinophil level, 4\% (SD 3\%); FeNO, 12 ppb (SD 5.7 ppb). In the post hoc analyses, these patients had significantly improved mean prebronchodilator FEV1 of 27.7\% (SD 26.2\%; 0.54 L, SD 0.51 L; P<.001) at 8 weeks compared with baseline. At baseline, patients (n=13) receiving formoterol/budesonide (20/500 mcg) nebulization had the following mean values: FEV1, 55\% (SD 12\%); GINA asthma control score, 3.0 points (SD 1.2 points); reversibility, 14\% (SD 7\%); serum eosinophil level, 4\% (SD 3\%); FeNO, 13.3 ppb (SD 6.8 ppb). In the post hoc analyses, these patients showed a significant improvement in prebronchodilator FEV1 of 11.2\% (SD 13.1\%; 0.22 L, SD 0.25 L; P<.001) from baseline. Breathlessness of mild to moderate intensity was reported by 10 cases (10/53, 18.9\%), with no other treatment-emergent adverse events or serious adverse events. Conclusions: Home nebulization remains a viable option for symptomatic difficult-to-treat asthma cases with frequent use of rescue medications. Glycopyrronium as add-on therapy offers a synergistic response in patients on corticosteroids with difficult-to-treat asthma. Trial Registration: Clinical Trial Registry of India CTRI/2018/11/016319; https://tinyurl.com/y78cctm3 ",
doi="10.2196/17863",
url="http://www.i-jmr.org/2020/2/e17863/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32347812"
}


@Article{info:doi/10.2196/14139,
author="Wijnen, Annet
and Hoogland, Jildou
and Munsterman, Tjerk
and Gerritsma, LE Carina
and Dijkstra, Baukje
and Zijlstra, P. Wierd
and Dekker, S. Johan
and Annegarn, Janneke
and Ibarra, Francisco
and Slager, EC Geranda
and Zijlstra, Wiebren
and Stevens, Martin",
title="Effectiveness of a Home-Based Rehabilitation Program After Total Hip Arthroplasty Driven by a Tablet App and Remote Coaching: Nonrandomized Controlled Trial Combining a Single-Arm Intervention Cohort With Historical Controls",
journal="JMIR Rehabil Assist Technol",
year="2020",
month="Apr",
day="27",
volume="7",
number="1",
pages="e14139",
keywords="remote coaching",
keywords="internet",
keywords="osteoarthritis",
keywords="total hip arthroplasty",
keywords="home-based rehabilitation program",
keywords="physiotherapy",
keywords="usual care",
keywords="tablet app",
keywords="total hip replacement",
keywords="rehabilitation",
abstract="Background: Recent technological developments such as wearable sensors and tablets with a mobile internet connection hold promise for providing electronic health home-based programs with remote coaching for patients following total hip arthroplasty. It can be hypothesized that such a home-based rehabilitation program can offer an effective alternative to usual care. Objective: The aim of this study was to determine the effectiveness of a home-based rehabilitation program driven by a tablet app and remote coaching for patients following total hip arthroplasty. Methods: Existing data of two studies were combined, in which patients of a single-arm intervention study were matched with historical controls of an observational study. Patients aged 18-65 years who had undergone total hip arthroplasty as a treatment for primary or secondary osteoarthritis were included. The intervention consisted of a 12-week home-based rehabilitation program with video instructions on a tablet and remote coaching (intervention group). Patients were asked to do strengthening and walking exercises at least 5 days a week. Data of the intervention group were compared with those of patients who received usual care (control group). Effectiveness was measured at four moments (preoperatively, and 4 weeks, 12 weeks, and 6 months postoperatively) by means of functional tests (Timed Up \& Go test and the Five Times Sit-to Stand Test) and self-reported questionnaires (Hip disability and Osteoarthritis Outcome Score [HOOS] and Short Form 36 [SF-36]). Each patient of the intervention group was matched with two patients of the control group. Patient characteristics were summarized with descriptive statistics. The 1:2 matching situation was analyzed with a conditional logistic regression. Effect sizes were calculated by Cohen d. Results: Overall, 15 patients of the intervention group were included in this study, and 15 and 12 subjects from the control group were matched to the intervention group, respectively. The intervention group performed functional tests significantly faster at 12 weeks and 6 months postoperatively. The intervention group also scored significantly higher on the subscales ``function in sport and recreational activities'' and ``hip-related quality of life'' of HOOS, and on the subscale ``physical role limitations'' of SF-36 at 12 weeks and 6 months postoperatively. Large effect sizes were found on functional tests at 12 weeks and at 6 months (Cohen d=0.5-1.2),  endorsed by effect sizes on the self-reported outcomes. Conclusions: Our results clearly demonstrate larger effects in the intervention group compared to the historical controls. These results imply that a home-based rehabilitation program delivered by means of internet technology after total hip arthroplasty can be more effective than usual care. Trial Registration: ClinicalTrials.gov NCT03846063; https://clinicaltrials.gov/ct2/show/NCT03846063 and German Registry of Clinical Trials DRKS00011345; https://tinyurl.com/yd32gmdo ",
doi="10.2196/14139",
url="http://rehab.jmir.org/2020/1/e14139/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32338621"
}


@Article{info:doi/10.2196/15678,
author="Kuan, Ya-Ting
and Wang, Tze-Fang
and Guo, Chao-Yu
and Tang, Fu-In
and Hou, I-Ching",
title="Wound Care Knowledge, Attitudes, and Practices and Mobile Health Technology Use in the Home Environment: Cross-Sectional Survey of Social Network Users",
journal="JMIR Mhealth Uhealth",
year="2020",
month="Mar",
day="26",
volume="8",
number="3",
pages="e15678",
keywords="mobile health",
keywords="wound",
keywords="knowledge",
keywords="attitudes",
keywords="practices",
keywords="home environment",
abstract="Background: Injury causing wounds is a frequent event. Inadequate or inappropriate treatment of injuries can threaten individual health. However, little is known about wound care knowledge, attitudes, and practices and mobile health (mHealth) use in the home environment in Taiwan. Objective: This study aimed to evaluate wound care knowledge, attitudes, and practices and mHealth technology use among social network users. Methods: A cross-sectional survey on social media platforms was conducted on adults aged 20 years and older. Data were collected from social network users in the home environment. Results: A total of 361 participants were enrolled. The mHealth technology use of participants was positively correlated with wound care knowledge (r=.132, P=.01), attitudes (r=.239, P<.001), and practices (r=.132, P=.01). Participants did not have adequate knowledge (correct rate 69.1\%) and were unfamiliar with the guidelines of proper wound care (correct rate 74.5\%). Most participants had positive attitudes toward wound care and mHealth technology use. A total of 95.6\% (345/361) of participants perceived that the use of mHealth technology can improve wound care outcomes, and 93.9\% (339/361) perceived that wound care products should be optimized to be used with a mobile device. However, 93.6\% (338/361) of participants had no experience using mHealth technology for wound care. Conclusions: Our study shows the potential of mHealth technology to enhance wound care knowledge among social network users. Thus, government agencies and medical institutions in Taiwan should provide easy-to-use information products that enhance wound care knowledge, promote adequate behavior toward wound care, and prevent unpredictable or undesirable outcomes. ",
doi="10.2196/15678",
url="http://mhealth.jmir.org/2020/3/e15678/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32213478"
}


@Article{info:doi/10.2196/16248,
author="Holmen, Heidi
and Riiser, Kirsti
and Winger, Anette",
title="Home-Based Pediatric Palliative Care and Electronic Health: Systematic Mixed Methods Review",
journal="J Med Internet Res",
year="2020",
month="Feb",
day="28",
volume="22",
number="2",
pages="e16248",
keywords="eHealth",
keywords="home-based",
keywords="pediatric palliative care",
keywords="pediatric",
keywords="children",
keywords="family",
keywords="communication",
keywords="palliative care",
abstract="Background: Children and families in pediatric palliative care depend on close contact with health care personnel, and electronic health (eHealth) is suggested to support care at home by facilitating their remote interactions.  Objective: This study aimed to identify and review the use of eHealth to communicate and support home-based pediatric palliative care and appraise the methodological quality of the published research.  Methods: We conducted a convergent, systematic mixed methods review and searched Medical Literature Analysis and Retrieval System Online (Medline), EMBASE, PsycINFO, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Web of Science, and Scopus for eligible papers. Studies evaluating 2-way communication technology for palliative care for children aged ?18 years and applying quantitative, qualitative, or mixed methods from 2012 to 2018 were eligible for inclusion. Quantitative and qualitative studies were equally valued during the search, screening, extraction, and analysis. Quantitative data were transformed into qualitative data and analyzed using a thematic analysis. Overall, 2 independent researchers methodologically appraised all included studies. Results: We identified 1277 citations. Only 7 papers were eligible for review. Evaluating eHealth interventions in pediatric palliative care poses specific methodological and ethical challenges. eHealth to facilitate remote pediatric palliative care was acknowledged both as an intrusion and as a support at home. Reluctance toward eHealth was mainly identified among professionals.  Conclusions: The strengths of the conclusions are limited by the studies' methodological challenges. Despite the limitless possibilities held by new technologies, research on eHealth in home-based pediatric palliative care is scarce. The affected children and families appeared to hold positive attitudes toward eHealth, although their views were less apparent compared with those of the professionals.  Trial Registration: PROSPERO CRD42018119051; https://tinyurl.com/rtsw5ky ",
doi="10.2196/16248",
url="http://www.jmir.org/2020/2/e16248/",
url="http://www.ncbi.nlm.nih.gov/pubmed/32130127"
}


@Article{info:doi/10.2196/12381,
author="Mowforth, Daniel Oliver
and Davies, Marshall Benjamin
and Kotter, Reinhard Mark",
title="Quality of Life Among Informal Caregivers of Patients With Degenerative Cervical Myelopathy: Cross-Sectional Questionnaire Study",
journal="Interact J Med Res",
year="2019",
month="Nov",
day="7",
volume="8",
number="4",
pages="e12381",
keywords="spinal cord diseases",
keywords="spondylosis",
keywords="spinal osteophytosis",
keywords="surveys and questionnaires",
keywords="quality of life",
keywords="chronic disease",
abstract="Background: Degenerative cervical myelopathy (DCM) is a common, chronic neurological condition that severely affects individuals by causing a range of disabling symptoms, frequently at a time around the peak of their careers. Subsequently, individuals with DCM often become dependent on informal care arrangements. The significant economic contribution of informal care and its burden on care providers are becoming increasingly recognized. Objective: This study aimed to measure the quality of life of DCM informal caregivers and provide preliminary insight into possible contributing factors. Methods: Carers of individuals with DCM completed a Web-based survey hosted by Myelopathy.org, an international DCM charity. Carer quality of life was assessed in the form of caregiver happiness and 7 dimensions of carer burden using the Care-Related Quality of Life (CarerQol) instrument. The relationships between patient disease severity, patient pain, and carer quality of life were investigated. Differences in carer quality of life were assessed across patient and carer demographic groups, including between UK and US carers. Results: DCM caregivers experienced substantial burden as a result of their caregiving (mean CarerQol-7D=64.1; 95\% CI 58.8-69.5) and low happiness (mean CarerQol-VAS [Visual Analog Scale]=6.3; 95\% CI 5.7-6.9). Burden was high and happiness was low in DCM carers when compared with a large, mixed-disease study of adult informal carers where CarerQol-7D was 79.1 and CarerQol-VAS was 7.1. No significant relationship was found between DCM carer quality of life and patient disease severity and pain scores. DCM carer quality of life appeared uniform across all patient and carer demographic groups. Conclusions: Caring for individuals with DCM is associated with reduced quality of life in the form of significant burden and reduced happiness. Reductions appear greater in DCM than in other diseases investigated. However, no simple relationship was identified between individual patient or carer factors and carer quality of life. ",
doi="10.2196/12381",
url="http://www.i-jmr.org/2019/4/e12381/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31697240"
}


@Article{info:doi/10.2196/12781,
author="Tsuda, Kenji
and Higuchi, Asaka
and Yokoyama, Emi
and Kosugi, Kazuhiro
and Komatsu, Tsunehiko
and Kami, Masahiro
and Tanimoto, Tetsuya",
title="Physician Decision-Making Patterns and Family Presence: Cross-Sectional Online Survey Study in Japan",
journal="Interact J Med Res",
year="2019",
month="Sep",
day="06",
volume="8",
number="3",
pages="e12781",
keywords="physician decision making",
keywords="family",
keywords="cross-sectional study",
keywords="cardiopulmonary resuscitation",
keywords="artificial ventilation",
abstract="Background: Due to a low birth rate and an aging population, Japan faces an increase in the number of elderly people without children living in single households. These elderly without a spouse and/or children encounter a lack of caregivers because most sources of care for the elderly in Japan are not provided by private agencies but by family members. However, family caregivers not only help with daily living but are also key participants in treatment decision making. The effect of family absence on treatment decision making has not been elucidated, although more elderly people will not have family members to make surrogate decisions on their behalf. Objective: The aim is to understand the influence of family absence on treatment decision making by physicians through a cross-sectional online survey with three hypothetical vignettes of patients. Methods: We conducted a cross-sectional online survey among Japanese physicians using three hypothetical vignettes. The first vignette was about a 65-year-old man with alcoholic liver cirrhosis and the second was about a 78-year-old woman with dementia, both of whom developed pneumonia with consciousness disturbance. The third vignette was about a 70-year-old woman with necrosis of her lower limb. Participants were randomly assigned to either of the two versions of the questionnaires---with family or without family---but methods were identical otherwise. Participants chose yes or no responses to questions about whether they would perform the presented medical procedures. Results: Among 1112 physicians, 454 (40.8\%) completed the survey; there were no significant differences in the baseline characteristics between groups. Significantly fewer physicians had a willingness to perform dialysis (odds ratio [OR] 0.55, 95\% CI 0.34-0.80; P=.002) and artificial ventilation (OR 0.51, 95\% CI 0.35-0.75; P<.001) for a patient from vignette 1 without family. In vignette 2, fewer physicians were willing to perform artificial ventilation (OR 0.59, 95\% CI 0.39-0.90; P=.02). In vignette 3, significantly fewer physicians showed willingness to perform wound treatment (OR 0.51, 95\% CI 0.31-0.84; P=.007), surgery (OR 0.35, 95\% CI 0.22-0.57; P<.001), blood transfusion (OR 0.45, 95\% CI 0.31-0.66; P<.001), vasopressor (OR 0.49, 95\% CI 0.34-0.72; P<.001), dialysis (OR 0.38, 95\% CI 0.24-0.59; P<.001), artificial ventilation (OR 0.25, 95\% CI 0.15-0.40; P<.001), and chest compression (OR 0.29, 95\% CI 0.18-0.47; P<.001) for a patient without family. Conclusions: Elderly patients may have treatments withheld because of the absence of family, highlighting the potential importance of advance care planning in the era of an aging society with a declining birth rate. ",
doi="10.2196/12781",
url="http://www.i-jmr.org/2019/3/e12781/",
url="http://www.ncbi.nlm.nih.gov/pubmed/31493327"
}


@Article{info:doi/10.2196/10208,
author="Funderskov, Frydenrejn Karen
and Raunki{\ae}r, Mette
and Danbj{\o}rg, Boe Dorthe
and Zwisler, Ann-Dorthe
and Munk, Lene
and Jess, Mia
and Dieperink, Brochstedt Karin",
title="Experiences With Video Consultations in Specialized Palliative Home-Care: Qualitative Study of Patient and Relative Perspectives",
journal="J Med Internet Res",
year="2019",
month="Mar",
day="21",
volume="21",
number="3",
pages="e10208",
keywords="palliative care",
keywords="relatives",
keywords="telemedicine",
keywords="qualitative research",
abstract="Background: The work of specialized palliative care (SPC) teams is often challenged by substantial amounts of time spent driving to and from patients' homes and long distances between the patients and the hospitals. Objective: Video consultations may be a solution for real-time SPC at home. The aim of this study was to explore the use of video consultations, experienced by patients and their relatives, as part of SPC at home. Methods: This explorative and qualitative study included palliative care patients in different stages and relatives to use video consultations as a part of their SPC between October 2016 and March 2017. Data collection took place in the patients' homes and consisted of participant observations followed by semistructured interviews. Inclusion criteria consisted of patients with the need for SPC, aged more than 18 years, who agreed to participate, and relatives wanting to participate in the video consultations. Data were analyzed with Giorgi's descriptive phenomenological methodology. Results: A number of patients (n=11) and relatives (n=3) were included and, in total, 86 video consultations were conducted. Patients participating varied in time from 1 month to 6 months, and the number of video consultations per patient varied from 3 to 18. The use of video consultations led to a situation where patients, despite life-threatening illnesses and technical difficulties, took an active role. In addition, relatives were able to join on equal terms, which increased active involvement. The patients had different opinions on when to initiate the use of video consultations in SPC; it was experienced as optional at the initiating stage as well as the final stage of illness. If the video consultations included multiple participants from the SPC team, the use of video consultations could be difficult to complete without interruptions. Conclusions: Video consultations in SPC for home-based patients are feasible and facilitate a strengthened involvement and communication between patients, relatives, and SPC team members. ",
doi="10.2196/10208",
url="https://www.jmir.org/2019/3/e10208/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30896436"
}


@Article{info:doi/10.2196/10952,
author="van den Kieboom, CP Robin
and Bongers, MB Inge
and Mark, E. Ruth
and Snaphaan, JAE Liselore",
title="User-Driven Living Lab for Assistive Technology to Support People With Dementia Living at Home: Protocol for Developing Co-Creation--Based Innovations",
journal="JMIR Res Protoc",
year="2019",
month="Jan",
day="28",
volume="8",
number="1",
pages="e10952",
keywords="dementia",
keywords="family caregivers",
keywords="longitudinal studies",
keywords="technology",
abstract="Background: Owing to no cure for dementia currently, there is an urgent need to look for alternative ways to support these people and their informal caregivers. Carefully designed interventions can answer the unmet needs of both people with dementia and their informal caregivers in the community. However, existing products, systems, and services are often too complex or unsuitable. Objective: This study aims to identify, longitudinally, the changing needs (as dementia progresses) of people with dementia living at home and their informal caregivers. By developing co-creation-based innovations, these changing needs will hopefully be met. Methods: A user-driven Living Lab design is used to structurally explore the needs over time of people with dementia (and their informal caregivers) living in the community in the North Brabant region of the Netherlands. In addition, co-creation-based innovations will be developed, tested, and evaluated by these people and their caregivers at home. All participants will complete complaints-oriented questionnaires at 3 time-points---at the baseline, 1 year, and 2 years after they start participating. Home interviews are scheduled to explore if and how these complaints translate into participants' specific needs or wishes. Focus groups meet on a monthly basis to further identify the needs of people with dementia and their informal caregivers and provide feedback to the stakeholders. In the context field, participants have an opportunity to actually test the products at home and provide feedback. Quantitative outcome measurements include neuropsychiatric symptoms, cognitive decline, independence in activities of daily living, safety, and caregiver burden. Qualitative outcome measurements include feedback to the stakeholders regarding the needs of people with dementia and their informal caregivers and how these needs change over time, as well as user experiences about the specific innovations. Results: Participant recruitment will start in September 2018 and is ongoing. The first results of data analyses are expected in the spring of 2019. Conclusions: The overall aim of Innovate Dementia 2.0 is to facilitate person-centered innovations developed for people with dementia and their informal caregivers at all stages as dementia progresses. This should lead to newly designed concepts and innovations, which are better able to answer the needs of people with dementia and their caregivers in the community. International Registered Report Identifier (IRRID): DERR1-10.2196/10952 ",
doi="10.2196/10952",
url="http://www.researchprotocols.org/2019/1/e10952/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30688653"
}


@Article{info:doi/10.2196/10424,
author="Offermann-van Heek, Julia
and Ziefle, Martina",
title="They Don't Care About Us! Care Personnel's Perspectives on Ambient Assisted Living Technology Usage: Scenario-Based Survey Study",
journal="JMIR Rehabil Assist Technol",
year="2018",
month="Sep",
day="24",
volume="5",
number="2",
pages="e10424",
keywords="Ambient Assisted Living technologies",
keywords="assistive technologies",
keywords="care professionals",
keywords="diverse care contexts",
keywords="web-based survey",
keywords="quantitative scenario-based approach",
keywords="technology acceptance",
keywords="user diversity",
abstract="Background: Demographic change represents enormous burdens for the care sectors, resulting in high proportions of (older) people in need of care and a lack of care staff. Ambient Assisted Living (AAL) technologies have the potential to support the bottlenecks in care supply but are not yet in widespread use in professional care contexts. Objective: The objective of our study was to investigate professional caregivers' AAL technology acceptance and their perception regarding specific technologies, data handling, perceived benefits, and barriers. In particular, this study focuses on the perspectives on AAL technologies differing between care professionals working in diverse care contexts to examine the extent to which the care context influences the acceptance of assistive technologies. Methods: A Web-based survey (N=170) was carried out focusing on professional caregivers including medical, geriatric, and disabled people's caregivers. Based on a scenario, the participants were asked for their perceptions concerning specific technologies, specific types of gathered data, and potential benefits of and barriers to AAL technology usage. Results: The care context significantly impacted the evaluations of AAL technologies (F14,220=2.514; P=.002). Professional caregivers of disabled people had a significantly more critical attitude toward AAL technologies than medical and geriatric caregivers, indicated (1) by being the only caregiver group that rejected evaluations of AAL technology acceptance (F2,118=4.570; P=.01) and specific technologies (F2,118=11.727; P<.001) applied for gathering data and (2) by the comparatively lowest agreements referring to the evaluations of data types (F2,118=4.073, P=.02) that are allowed to be gathered. Conclusions: AAL technology acceptance is critical because of technology implementation reasons, especially in the care of people with disabilities. AAL technologies in care contexts have to be tailored to care professional's needs and concerns (``care about us''). The results contribute to a broader understanding of professional caregivers' needs referring to specific data and technology configurations and enclose major differences concerning diverse care contexts. Integrating these findings into user group-tailored technology concepts and communication strategies will support a sustainable adoption of AAL systems in professional care contexts. ",
doi="10.2196/10424",
url="http://rehab.jmir.org/2018/2/e10424/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30249592"
}


@Article{info:doi/10.2196/jmir.9895,
author="Vaughan, Christine
and Trail, E. Thomas
and Mahmud, Ammarah
and Dellva, Stephanie
and Tanielian, Terri
and Friedman, Esther",
title="Informal Caregivers' Experiences and Perceptions of a Web-Based Peer Support Network: Mixed-Methods Study",
journal="J Med Internet Res",
year="2018",
month="Aug",
day="28",
volume="20",
number="8",
pages="e257",
keywords="caregivers",
keywords="social support",
keywords="social isolation",
keywords="biomedical technology",
keywords="military family",
abstract="Background: Web-based peer support interventions have shown promise in reducing social isolation and social support deficits among informal caregivers, but little research has examined how caregivers use and perceive these interventions. Objective: In this study, we examined utilization and perceptions of a Web-based social support intervention for informal caregivers of wounded, ill, and injured United States military service members and veterans. Methods: This was a mixed-methods study that used quantitative survey data and qualitative data from focus groups and interviews with informal caregivers enrolled in a Web-based peer support intervention to explore their use and perceptions of the intervention. The intervention was delivered via a website that featured interest groups organized around specific topics, webinars, webchats, and messaging functionality and was moderated by professionally trained peers. This study occurred in the context of a quasi-experimental outcome evaluation of the intervention, where intervention participants were compared with a group of military caregivers who were not enrolled in the intervention. Results: Survey findings indicated that caregivers used the website infrequently, with 60.7\% (128/211) visiting the website once a month or less, and passively, with a minority (32/144, 22.2\%) of users (ie, those who had visited the website at least once during the past 3 months, N=144) posting comments or links to the network. Nonetheless, most users (121/144, 84.0\%) endorsed moderate or greater satisfaction with the website on the survey, and focus group and interview participants reported benefiting sufficiently from passive use of the website (eg, reading posts). Quantitative and qualitative findings suggested that users viewed the website primarily as a source of informational support. Among 63.2\% (91/144) of users who completed the survey, the most commonly reported network-related activity was obtaining information from the network's resource library, and focus group and interview participants viewed the network primarily as an informational resource. Focus group and interview participants expressed an unmet need for emotional support and the desire for a more personal touch in the forms of more active engagement with other caregivers in the network and the creation of local, in-person support groups for caregivers. Conclusions: These findings suggest that Web-based peer support interventions may lend themselves better to the provision of informational (vs emotional) support and may need to be supplemented by in-person peer support groups to better meet caregivers' needs for emotional support. ",
doi="10.2196/jmir.9895",
url="http://www.jmir.org/2018/8/e257/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30154074"
}


@Article{info:doi/10.2196/mhealth.9345,
author="Grossman, R. Molli
and Zak, Kim Deanah
and Zelinski, M. Elizabeth",
title="Mobile Apps for Caregivers of Older Adults: Quantitative Content Analysis",
journal="JMIR Mhealth Uhealth",
year="2018",
month="Jul",
day="30",
volume="6",
number="7",
pages="e162",
keywords="mobile apps",
keywords="aged",
keywords="elderly",
keywords="caregivers",
keywords="family caregivers",
keywords="carers",
keywords="adult children",
keywords="quality of life",
keywords="dementia",
abstract="Background: Informal caregivers of older adults provide critical support for their loved ones but are subject to negative health outcomes because of burden and stress. Interventions to provide information and resources as well as social and emotional support reduce burden. Mobile apps featuring access to information, assistance with scheduling, and other features can automate support functions inexpensively and conveniently and reach a greater proportion of caregivers than otherwise possible. Objective: The aim of this study was to identify mobile apps geared towards caregivers of older adults, catalog features, and suggest best practices for adoption based on empirical findings of beneficial interventions in the caregiving literature. Methods: Search for apps focused on ones catered for caregivers of older adults in Google Play and iTunes, compiling their features, and identifying features reflecting categories of support identified in successful intervention studies to negative caregiver outcomes. Intervention research indicates that provision of information and resources, assistance in practical problem solving, coordinating care among multiple caregivers, and emotional support reduce caregiver burden. Results: Despite approximately over 200,000 mobile health--related apps, the availability of mobile apps for caregivers is relatively sparse (n=44 apps) as of October 2017. Apps generally addressed specific categories of support, including information and resources, family communication, and caregiver-recipient interactions. Few apps were comprehensive. Only 8 out of 44 (18\%) had features that addressed three or more categories. Few apps provided specific stress reduction exercises for caregivers, which is important for reducing burden. Conclusions: Mobile apps have the potential to provide resources, just?-in?-time information for problem-solving, and stress reduction strategies for caregivers. Many apps offer functions that have been shown to reduce burden and improve health outcomes in caregivers, but few provide emotional support. Using an evidence?-based practice approach, mobile apps for caregivers can provide multiple beneficial support functions. Apps can serve a much larger proportion of this highly underserved population in their mobile form than more traditional means, improving their health and quality of life. ",
doi="10.2196/mhealth.9345",
url="http://mhealth.jmir.org/2018/7/e162/",
url="http://www.ncbi.nlm.nih.gov/pubmed/30061093"
}


@Article{info:doi/10.2196/jmir.9812,
author="Marzorati, Chiara
and Renzi, Chiara
and Russell-Edu, William Samuel
and Pravettoni, Gabriella",
title="Telemedicine Use Among Caregivers of Cancer Patients: Systematic Review",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="18",
volume="20",
number="6",
pages="e223",
keywords="telemedicine",
keywords="family",
keywords="caregivers",
keywords="neoplasms",
keywords="systematic review",
abstract="Background: The number of published studies and systematic reviews examining different telehealth interventions targeting patients and their effects on patients' well-being and quality of life have grown in recent decades. However, the use of telemedicine tools aimed at the family members and caregivers of adult cancer patients is less defined. Objective: We aimed to conduct a systematic review to provide a more complete picture regarding telemedicine tools for informal caregivers (usually family members or close friends) implemented in all phases of cancer care. More specifically, the review aimed to better describe the study samples' characteristics, to analyze measured outcomes and the specific questionnaires used to assess them, and to describe in depth the implemented interventions and their formats. Finally, we examined the role of telehealth, and usability and feasibility trends in supporting patients' caregivers. Methods: We systematically searched the literature in the following databases: Web of Science, Cochrane Library, PubMed, Scopus, CINAHL, MEDLINE, EMBASE, Google Scholar, and PsycINFO. Inclusion criteria were being written in English, published in peer-reviewed journals, describing a telehealth-implemented intervention, and focusing on caregivers of adult cancer patients at any stage of the disease. We selected studies published up to November 2017. We critically appraised included articles using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and graded the quality of evidence by outcome using the Centre for Evidence-Based Medicine framework. Results: We included 24 studies in the final selection. In 21 of the 24 studies, the patient-caregiver dyad was analyzed, and the study population dealt with different types of cancer at different stages. Included studies considered the caregiver's condition from both an individual and a relational point of view. Along with psychosocial variables, some studies monitored engagement and user satisfaction regarding Web-based platforms or telehealth interventions. All studies reported significant improvements in some of the investigated areas, but they often showed small effect sizes. Two types of telehealth intervention formats were used: Web-based platforms and telephone calls. Some of the included studies referred to the same project, but on study samples with different cancer diagnoses or with new versions of previously developed interventions. Conclusions: Reported outcomes seem to suggest that we are in an exploratory phase. More detailed and targeted research hypotheses are still needed. Clarifying caregivers' needs related to telehealth tools and better defining outcome measures may yield more significant results. ",
doi="10.2196/jmir.9812",
url="http://www.jmir.org/2018/6/e223/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29914858"
}


@Article{info:doi/10.2196/jmir.9779,
author="Komarzynski, Sandra
and Huang, Qi
and Innominato, F. Pasquale
and Maurice, Monique
and Arbaud, Alexandre
and Beau, Jacques
and Bouchahda, Mohamed
and Ulusakarya, Ayhan
and Beaumatin, Nicolas
and Breda, Gabri{\`e}le
and Finkenst{\"a}dt, B{\"a}rbel
and L{\'e}vi, Francis",
title="Relevance of a Mobile Internet Platform for Capturing Inter- and Intrasubject Variabilities in Circadian Coordination During Daily Routine: Pilot Study",
journal="J Med Internet Res",
year="2018",
month="Jun",
day="11",
volume="20",
number="6",
pages="e204",
keywords="circadian clock",
keywords="eHealth",
keywords="temperature rhythm",
keywords="rest-activity rhythm",
keywords="time series analyses",
keywords="domomedicine",
keywords="biomarkers",
abstract="Background: Experimental and epidemiologic studies have shown that circadian clocks' disruption can play an important role in the development of cancer and metabolic diseases. The cellular clocks outside the brain are effectively coordinated by the body temperature rhythm. We hypothesized that concurrent measurements of body temperature and rest-activity rhythms would assess circadian clocks coordination in individual patients, thus enabling the integration of biological rhythms into precision medicine. Objective: The objective was to evaluate the circadian clocks' coordination in healthy subjects and patients through simultaneous measurements of rest-activity and body temperature rhythms. Methods: Noninvasive real-time measurements of rest-activity and chest temperature rhythms were recorded during the subject's daily life, using a dedicated new mobile electronic health platform (PiCADo). It involved a chest sensor that jointly measured accelerations, 3D orientation, and skin surface temperature every 1-5 min and relayed them out to a mobile gateway via Bluetooth Low Energy. The gateway tele-transmitted all stored data to a server via General Packet Radio Service every 24 hours. The technical capabilities of PiCADo were validated in 55 healthy subjects and 12 cancer patients, whose rhythms were e-monitored during their daily routine for 3-30 days. Spectral analyses enabled to compute rhythm parameters values, with their 90\% confidence limits, and their dynamics in each subject. Results: All the individuals displayed a dominant circadian rhythm in activity with maxima occurring from 12:09 to 20:25. This was not the case for the dominant temperature period, which clustered around 24 hours for 51 out of 67 subjects (76\%), and around 12 hours for 13 others (19\%). Statistically significant sex- and age-related differences in circadian coordination were identified in the noncancerous subjects, based upon the range of variations in temperature rhythm amplitudes, maxima (acrophases), and phase relations with rest-activity. The circadian acrophase of chest temperature was located at night for the majority of people, but it occurred at daytime for 26\% (14/55) of the noncancerous people and 33\% (4/12) of the cancer patients, thus supporting important intersubject differences in circadian coordination. Sex, age, and cancer significantly impacted the circadian coordination of both rhythms, based on their phase relationships. Conclusions: Complementing rest-activity with chest temperature circadian e-monitoring revealed striking intersubject differences regarding human circadian clocks' coordination and timing during daily routine. To further delineate the clinical importance of such finding, the PiCADo platform is currently applied for both the assessment of health effects resulting from atypical work schedules and the identification of the key determinants of circadian disruption in cancer patients. ",
doi="10.2196/jmir.9779",
url="http://www.jmir.org/2018/6/e204/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29704408"
}


@Article{info:doi/10.2196/jmir.9465,
author="Sch{\"a}fer, Meender Axel Georg
and Zalpour, Christoff
and von Piekartz, Harry
and Hall, Maxwell Toby
and Paelke, Volker",
title="The Efficacy of Electronic Health--Supported Home Exercise Interventions for Patients With Osteoarthritis of the Knee: Systematic Review",
journal="J Med Internet Res",
year="2018",
month="Apr",
day="26",
volume="20",
number="4",
pages="e152",
keywords="osteoarthritis, knee",
keywords="telemedicine",
keywords="exercise",
keywords="treatment outcome",
keywords="review",
keywords="meta-analysis",
abstract="Background: Osteoarthritis of the knee is the most common cause for disability and limited mobility in the elderly, with considerable individual suffering and high direct and indirect disease-related costs. Nonsurgical interventions such as exercise, enhanced physical activity, and self-management have shown beneficial effects for pain reduction, physical function, and quality of life (QoL), but access to these treatments may be limited. Therefore, home therapy is strongly recommended. However, adherence to these programs is low. Patients report lack of motivation, feedback, and personal interaction as the main barriers to home therapy adherence. To overcome these barriers, electronic health (eHealth) is seen as a promising opportunity. Although beneficial effects have been shown in the literature for other chronic diseases such as chronic pain, cardiovascular disease, and diabetes, a systematic literature review on the efficacy of eHealth interventions for patients with osteoarthritis of knee is missing so far. Objective: The aim of this study was to compare the efficacy of eHealth-supported home exercise interventions with no or other interventions regarding pain, physical function, and health-related QoL in patients with osteoarthritis of the knee. Methods: MEDLINE, CENTRAL, CINAHL, and PEDro were systematically searched using the keywords osteoarthritis knee, eHealth, and exercise. An inverse variance random-effects meta-analysis was carried out pooling standardized mean differences (SMDs) of individual studies. The Cochrane tool was used to assess risk of bias in individual studies, and the quality of evidence across studies was evaluated following the Grading of Recommendations, Assessment, Development, and Evaluation approach. Results: The literature search yielded a total of 648 results. After screening of titles, abstracts, and full-texts, seven randomized controlled trials were included. Pooling the data of individual studies demonstrated beneficial short-term (pain SMD=?0.31, 95\% CI ?0.58 to ?0.04, low quality; QoL SMD=0.24, 95\% CI 0.05-0.43, moderate quality) and long-term effects (pain ?0.30, 95\% CI ?0.07 to ?0.53, moderate quality; physical function 0.41, 95\% CI 0.17-0.64, high quality; and QoL SMD=0.27, 95\% CI 0.06-0.47, high quality). Conclusions: eHealth-supported exercise interventions resulted in less pain, improved physical function, and health-related QoL compared with no or other interventions; however, these improvements were small (SMD<0.5) and may not make a meaningful difference for individual patients. Low adherence is seen as one limiting factor of eHealth interventions. Future research should focus on participatory development of eHealth technology integrating evidence-based principles of exercise science and ways of increasing patient motivation and adherence. ",
doi="10.2196/jmir.9465",
url="http://www.jmir.org/2018/4/e152/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29699963"
}


@Article{info:doi/10.2196/humanfactors.8319,
author="Dijkstra, Elske Nienke
and Sino, Maria Carolina Geertruida
and Heerdink, Rob Eibert
and Schuurmans, Joanna Marieke",
title="Development of eHOME, a Mobile Instrument for Reporting, Monitoring, and Consulting Drug-Related Problems in Home Care: Human-Centered Design Study",
journal="JMIR Hum Factors",
year="2018",
month="Mar",
day="07",
volume="5",
number="1",
pages="e10",
keywords="primary care",
keywords="home care",
keywords="eHealth",
keywords="mHealth",
abstract="Background: Home care patients often use many medications and are prone to drug-related problems (DRPs). For the management of problems related to drug use, home care could add to the multidisciplinary expertise of general practitioners (GPs) and pharmacists. The home care observation of medication-related problems by home care employees (HOME)-instrument is paper-based and assists home care workers in reporting potential DRPs. To facilitate the multiprofessional consultation, a digital report of DRPs from the HOME-instrument and digital monitoring and consulting of DRPs between home care and general practices and pharmacies is desired. Objective: The objective of this study was to develop an electronic HOME system (eHOME), a mobile version of the HOME-instrument that includes a monitoring and a consulting system for primary care. Methods: The development phase of the Medical Research Council (MRC) framework was followed in which an iterative human-centered design (HCD) approach was applied. The approach involved a Delphi round for the context of use and user requirements analysis of the digital HOME-instrument and the monitoring and consulting system followed by 2 series of pilots for testing the usability and redesign. Results: By using an iterative design approach and by involving home care workers, GPs, and pharmacists throughout the process as informants, design partners, and testers, important aspects that were crucial for system realization and user acceptance were revealed. Through the report webpage interface, which includes the adjusted content of the HOME-instrument and added home care practice--based problems, home care workers can digitally report observed DRPs. Furthermore, it was found that the monitoring and consulting webpage interfaces enable digital consultation between home care and general practices and pharmacies. The webpages were considered convenient, clear, easy, and usable. Conclusions: By employing an HCD approach, the eHOME-instrument was found to be an easy-to-use system. The systematic approach promises a valuable contribution for the future development of digital mobile systems of paper-based tools. ",
doi="10.2196/humanfactors.8319",
url="http://humanfactors.jmir.org/2018/1/e10/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29514771"
}


@Article{info:doi/10.2196/jmir.7666,
author="Boots, MM Lizzy
and de Vugt, E. Marjolein
and Smeets, MJ Claudia
and Kempen, IJM Gertrudis
and Verhey, RJ Frans",
title="Implementation of the Blended Care Self-Management Program for Caregivers of People With Early-Stage Dementia (Partner in Balance): Process Evaluation of a Randomized Controlled Trial",
journal="J Med Internet Res",
year="2017",
month="Dec",
day="19",
volume="19",
number="12",
pages="e423",
keywords="internet",
keywords="caregivers",
keywords="technology",
keywords="therapeutics",
abstract="Background: Caring for a family member with dementia puts caregivers at risk of overburdening. Electronic health (eHealth) support for caregivers offers an opportunity for accessible tailored interventions. The blended care self-management program ``Partner in Balance'' (PiB) for early-stage dementia caregivers was executed in Dutch dementia care organizations. The program combines face-to-face coaching with tailored Web-based modules. Next to an evaluation of program effectiveness, an evaluation of sampling and intervention quality is essential for the generalizability and interpretation of results. Objective: The aim of this study was to describe the process evaluation from the perspective of both family caregivers (participants) and professionals delivering the intervention (coaches) to determine internal and external validity before the effect analysis and aid future implementation. Methods: Implementation, sampling, and intervention quality were evaluated with quantitative and qualitative data from logistical research data, coach questionnaires (n=13), and interviews with coaches (n=10) and participants (n=49). Goal attainment scaling was used to measure treatment-induced change. Analyses were performed with descriptive statistics and deductive content analysis. Results: The participation rate of eligible caregivers was 51.9\% (80/154). Recruitment barriers were lack of computer and lack of need for support. Young age and employment were considered recruitment facilitators. All coaches attended training and supervision in blended care self-management. Deviations from the structured protocol were reported on intervention time, structure, and feedback. Coaches described an intensified relationship with the caregiver post intervention. Caregivers appreciated the tailored content and positive feedback. The blended structure increased their openness. The discussion forum was appreciated less. Overall, personal goals were attained after the program (T>50). Implementation barriers included lack of financing, time, and deviating target population. Conclusions: Participants and coaches were satisfied with the intervention, but adapting the content to specific subgroups, for example, younger caregivers, was recommended. Implementation of the program requires more awareness of the benefits of blended care self-management programs and training in tailored self-management skills. Trial Registration: Dutch Trial Register (NTR): NTR4748; http://www.trialregister.nl (Archived by WebCite at http://www.webcitation.org/6vSb2t9Mg) ",
doi="10.2196/jmir.7666",
url="http://www.jmir.org/2017/12/e423/",
url="http://www.ncbi.nlm.nih.gov/pubmed/29258980"
}


@Article{info:doi/10.2196/jmir.7896,
author="Guay, Cassiopp{\'e}e
and Auger, Claudine
and Demers, Louise
and Mortenson, Ben W.
and Miller, C. William
and G{\'e}linas-Bronsard, Dominique
and Ahmed, Sara",
title="Components and Outcomes of Internet-Based Interventions for Caregivers of Older Adults: Systematic Review",
journal="J Med Internet Res",
year="2017",
month="Sep",
day="19",
volume="19",
number="9",
pages="e313",
keywords="systematic review",
keywords="caregivers",
keywords="aged",
keywords="Internet-based interventions",
keywords="Internet",
keywords="behavior change",
abstract="Background: When trying to access interventions to improve their well-being and quality of life, family caregivers face many challenges. Internet-based interventions provide new and accessible opportunities to remotely support them and can contribute to reducing their burden. However, little is known about the link existing between the components, the use of behavior change techniques, and the outcomes of these Internet-based interventions. Objective: This study aimed to provide an update on the best available evidence about the efficacy of Internet-based interventions for caregivers of older adults. Specifically, the components and the use of behavior change techniques and how they impact on the efficacy of the intervention were sought. Methods: A systematic review searched primary source studies published between 2000 and 2015. Included studies were scored with a high level of evidence by independent raters using the GRADE criteria and reported caregiver-specific outcomes about interventions delivered through the Internet for caregivers of people aged 50 years and older. A narrative synthesis identified intervention components (eg, content, multimedia use, interactive online activities, and provision of support), behavior change techniques, and caregiver outcomes (eg, effects on stressors, mediators, and psychological health). The risk of bias within the included studies was assessed. Results: A total of 2338 articles were screened and 12 studies describing 10 Internet-based interventions were identified. Seven of these interventions led to statistically significant improvements in caregiver outcomes (eg, reducing depression or anxiety, n=4). These efficacious interventions used interactive components, such as online exercises and homework (n=4) or questionnaires on health status (n=2) and five of them incorporated remote human support, either by professionals or peers. The most frequently used behavior change techniques included in efficacious interventions were provision of social support (n=6) and combinations of instructions to guide behavior change and barrier identification (n=5). The design and aim of the included studies did not permit determining exactly which component and/or behavior change technique was more efficacious in producing positive outcomes in caregivers. The risk for selection bias was low for all the studies, and low to high for performance, detection, and attrition biases. Conclusions: In sum, Internet-based interventions that incorporate professional and social support, and provide instructions to change behavior and problem solve in an interactive manner appear to lead to positive outcomes in caregivers. Studies isolating the specific effect of components are needed to improve our understanding of the underlying mechanism of action. ",
doi="10.2196/jmir.7896",
url="http://www.jmir.org/2017/9/e313/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28928109"
}


@Article{info:doi/10.2196/medinform.7308,
author="Celler, Branko
and Varnfield, Marlien
and Nepal, Surya
and Sparks, Ross
and Li, Jane
and Jayasena, Rajiv",
title="Impact of At-Home Telemonitoring on Health Services Expenditure and Hospital Admissions in Patients With Chronic Conditions: Before and After Control Intervention Analysis",
journal="JMIR Med Inform",
year="2017",
month="Sep",
day="08",
volume="5",
number="3",
pages="e29",
keywords="telehealth",
keywords="telemonitoring",
keywords="chronic disease management",
keywords="healthcare outcomes",
keywords="BACI analysis",
abstract="Background: Telemonitoring is becoming increasingly important for the management of patients with chronic conditions, especially in countries with large distances such as Australia. However, despite large national investments in health information technology, little policy work has been undertaken in Australia in deploying telehealth in the home as a solution to the increasing demands and costs of managing chronic disease. Objective: The objective of this trial was to evaluate the impact of introducing at-home telemonitoring to patients living with chronic conditions on health care expenditure, number of admissions to hospital, and length of stay (LOS). Methods: A before and after control intervention analysis model was adopted whereby at each location patients were selected from a list of eligible patients living with a range of chronic conditions. Each test patient was case matched with at least one control patient. Test patients were supplied with a telehealth vital signs monitor and were remotely managed by a trained clinical care coordinator, while control patients continued to receive usual care. A total of 100 test patients and 137 control patients were analyzed. Primary health care benefits provided to Australian patients were investigated for the trial cohort. Time series data were analyzed using linear regression and analysis of covariance for a period of 3 years before the intervention and 1 year after. Results: There were no significant differences between test and control patients at baseline. Test patients were monitored for an average of 276 days with 75\% of patients monitored for more than 6 months. Test patients 1 year after the start of their intervention showed a 46.3\% reduction in rate of predicted medical expenditure, a 25.5\% reduction in the rate of predicted pharmaceutical expenditure, a 53.2\% reduction in the rate of predicted unscheduled admission to hospital, a 67.9\% reduction in the predicted rate of LOS when admitted to hospital, and a reduction in mortality of between 41.3\% and 44.5\% relative to control patients. Control patients did not demonstrate any significant change in their predicted trajectory for any of the above variables. Conclusions: At-home telemonitoring of chronically ill patients showed a statistically robust positive impact increasing over time on health care expenditure, number of admissions to hospital, and LOS as well as a reduction in mortality. Trial Registration: Retrospectively registered with the Australian and New Zealand Clinical Trial Registry ACTRN12613000635763; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364030 (Archived by WebCite at http://www.webcitation.org/6sxqjkJHW) ",
doi="10.2196/medinform.7308",
url="http://medinform.jmir.org/2017/3/e29/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28887294"
}


@Article{info:doi/10.2196/humanfactors.7845,
author="Reblin, Maija
and Wu, P. Yelena
and Pok, Justin
and Kane, Lauren
and Colman, Howard
and Cohen, L. Adam
and Mendivil, Eduardo
and Warner, L. Echo
and Meyer, Miriah
and Agutter, James",
title="Development of the Electronic Social Network Assessment Program Using the Center for eHealth and Wellbeing Research Roadmap",
journal="JMIR Hum Factors",
year="2017",
month="Aug",
day="30",
volume="4",
number="3",
pages="e23",
keywords="intervention development",
keywords="user-centered design",
keywords="oncology",
keywords="caregiver",
abstract="Background: The number of Web-based psychological and behavioral interventions is growing. Beyond their theoretical underpinnings, a key factor to the success of these interventions is how they are designed and developed to ensure usability over a new method of delivery. Our team has adapted ecomapping, a tool for visualizing family caregiver social network resources, for the Web. Here, we describe how we designed and developed the electronic Social Network Assessment Program (eSNAP) Web-based tool using a framework of the Center for eHealth and Wellbeing Research (CeHRes) Roadmap for Web-based intervention development. The CeHRes Roadmap is still new in terms of tool development and we showcase an example of its application. Objective: The aim of our study was to provide an example of the application of the Web-based intervention development process using the CeHRes Roadmap for other research teams to follow. In doing so, we are also sharing our pilot work to enhance eSNAP's acceptance and usability for users and the feasibility of its implementation. Methods: We describe the development of the eSNAP app to support family caregivers of neuro-oncology patients. This development is based on the 5 iterative stages of the CeHRes Roadmap: contextual inquiry, value specification, design, operationalization, and summative evaluation. Research activities to support eSNAP development prior to implementation included literature review, focus groups, and iterative rounds of interviews. Results: Key lessons learned in developing the eSNAP app broadly fell under a theme of translating theoretical needs and ideas to the real world. This included how to prioritize needs to be addressed at one time, how the modality of delivery may change design requirements, and how to develop a tool to fit within the context it will be used. Conclusions: Using the CeHRes Roadmap to develop Web-based interventions such as eSNAP helps to address potential issues by outlining important intervention development milestones. In addition, by encouraging inclusion of users and other stakeholders in the process, Web-based intervention developers using the Roadmap can identify what will work in the real world and increase feasibility and effectiveness. ",
doi="10.2196/humanfactors.7845",
url="http://humanfactors.jmir.org/2017/3/e23/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28855149"
}


@Article{info:doi/10.2196/jmir.7564,
author="Ploeg, Jenny
and Markle-Reid, Maureen
and Valaitis, Ruta
and McAiney, Carrie
and Duggleby, Wendy
and Bartholomew, Amy
and Sherifali, Diana",
title="Web-Based Interventions to Improve Mental Health, General Caregiving Outcomes, and General Health for Informal Caregivers of Adults With Chronic Conditions Living in the Community: Rapid Evidence Review",
journal="J Med Internet Res",
year="2017",
month="Jul",
day="28",
volume="19",
number="7",
pages="e263",
keywords="Internet",
keywords="review",
keywords="chronic disease",
keywords="adult",
keywords="caregivers",
abstract="Background: Most adults with chronic conditions live at home and rely on informal caregivers to provide support. Caregiving can result in negative impacts such as poor mental and physical health. eHealth interventions may offer effective and accessible ways to provide education and support to informal caregivers. However, we know little about the impact of Web-based interventions for informal caregivers of community-dwelling adults with chronic conditions. Objective: The purpose of this rapid evidence review was to assess the impact of Web-based interventions on mental health, general caregiving outcomes, and general health for informal caregivers of persons with chronic conditions living in the community. Methods: A rapid evidence review of the current literature was employed to address the study purpose. EMBASE, MEDLINE, PsychInfo, CINAHL, Cochrane, and Ageline were searched covering all studies published from January 1995 to July 2016. Papers were included if they (1) included a Web-based modality to deliver an intervention; (2) included informal, unpaid adult caregivers of community-living adults with a chronic condition; (3) were either a randomized controlled trial (RCT) or controlled clinical trial (CCT); and (4) reported on any caregiver outcome as a result of use or exposure to the intervention. Results: A total of 20 papers (17 studies) were included in this review. Study findings were mixed with both statistically significant and nonsignificant findings on various caregiver outcomes. Of the 17 included studies, 10 had at least one significant outcome. The most commonly assessed outcome was mental health, which included depressive symptoms, stress or distress, and anxiety. Twelve papers examined the impact of interventions on the outcome of depressive symptoms; 4 found a significant decrease in depressive symptoms. Eight studies examined the outcome of stress or distress; 4 of these found a significant reduction in stress or distress as a result of the intervention. Three studies examined the outcome of anxiety; 2 of these found significant reductions in anxiety. Other significant results of the interventions were seen in the outcomes of caregiver gain (ie, positive aspects of caregiving), knowledge, bonding, reduction of anger-hostility, and negative mood. Based on this review, it is not possible to determine which interventions were most effective since studies differed in their design, sample, and intervention. Study results suggest that Web-based interventions may result in reduced depressive symptoms, anxiety, and stress or distress among informal caregivers of adults with chronic conditions in the community. Conclusions: This is the first review assessing the impact of Web-based technologies on mental health, general caregiving outcomes, and general health for caregivers of adults with chronic conditions living in the community. Further rigorous research is needed that includes adequately powered studies examining the critical components of the intervention and the dosage needed to have an effect. ",
doi="10.2196/jmir.7564",
url="http://www.jmir.org/2017/7/e263/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28754652"
}


@Article{info:doi/10.2196/jmir.6931,
author="Hargreaves, Sarah
and Hawley, S. Mark
and Haywood, Annette
and Enderby, M. Pamela",
title="Informing the Design of ``Lifestyle Monitoring'' Technology for the Detection of Health Deterioration in Long-Term Conditions: A Qualitative Study of People Living With Heart Failure",
journal="J Med Internet Res",
year="2017",
month="Jun",
day="28",
volume="19",
number="6",
pages="e231",
keywords="independent living",
keywords="human activities",
keywords="heart failure",
keywords="biomedical technology",
abstract="Background: Health technologies are being developed to help people living at home manage long-term conditions. One such technology is ``lifestyle monitoring'' (LM), a telecare technology based on the idea that home activities may be monitored unobtrusively via sensors to give an indication of changes in health-state. However, questions remain about LM technology: how home activities change when participants experience differing health-states; and how sensors might capture clinically important changes to inform timely interventions. Objective: The objective of this paper was to report the findings of a study aimed at identifying changes in activity indicative of important changes in health in people with long-term conditions, particularly changes indicative of exacerbation, by exploring the relationship between home activities and health among people with heart failure (HF). We aimed to add to the knowledge base informing the development of home monitoring technologies designed to detect health deterioration in order to facilitate early intervention and avoid hospital admissions. Methods: This qualitative study utilized semistructured interviews to explore everyday activities undertaken during the three health-states of HF: normal days, bad days, and exacerbations. Potential recruits were identified by specialist nurses and attendees at an HF support group. The sample was purposively selected to include a range of experience of living with HF. Results: The sample comprised a total of 20 people with HF aged 50 years and above, and 11 spouses or partners of the individuals with HF. All resided in Northern England. Participant accounts revealed that home activities are in part shaped by the degree of intrusion from HF symptoms. During an exacerbation, participants undertook activities specifically to ease symptoms, and detailed activity changes were identified. Everyday activity was also influenced by a range of factors other than health. Conclusions: The study highlights the importance of careful development of LM technology to identify changes in activities that occur during clinically important changes in health. These detailed activity changes need to be considered by developers of LM sensors, platforms, and algorithms intended to detect early signs of deterioration. Results suggest that for LM to move forward, sensor set-up should be personalized to individual circumstances and targeted at individual health conditions. LM needs to take account of the uncertainties that arise from placing technology within the home, in order to inform sensor set-up and data interpretation. This targeted approach is likely to yield more clinically meaningful data and address some of the ethical issues of remote monitoring. ",
doi="10.2196/jmir.6931",
url="http://www.jmir.org/2017/6/e231/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28659253"
}


@Article{info:doi/10.2196/humanfactors.7161,
author="Hamm, Julian
and Money, Arthur
and Atwal, Anita",
title="Fall Prevention Self-Assessments Via Mobile 3D Visualization Technologies: Community Dwelling Older Adults' Perceptions of Opportunities and Challenges",
journal="JMIR Hum Factors",
year="2017",
month="Jun",
day="19",
volume="4",
number="2",
pages="e15",
keywords="health informatics",
keywords="falls",
keywords="occupational therapy",
keywords="assistive equipment provision process",
keywords="self-assessment",
keywords="measurement guidance",
keywords="extrinsic risk factors",
keywords="3D visualization",
keywords="technology-based systems",
abstract="Background: In the field of occupational therapy, the assistive equipment provision process (AEPP) is a prominent preventive strategy used to promote independent living and to identify and alleviate fall risk factors via the provision of assistive equipment within the home environment. Current practice involves the use of paper-based forms that include 2D measurement guidance diagrams that aim to communicate the precise points and dimensions that must be measured in order to make AEPP assessments. There are, however, issues such as ``poor fit'' of equipment due to inaccurate measurements taken and recorded, resulting in more than 50\% of equipment installed within the home being abandoned by patients. This paper presents a novel 3D measurement aid prototype (3D-MAP) that provides enhanced measurement and assessment guidance to patients via the use of 3D visualization technologies. Objective: The purpose of this study was to explore the perceptions of older adults with regard to the barriers and opportunities of using the 3D-MAP application as a tool that enables patient self-delivery of the AEPP. Methods: Thirty-three community-dwelling older adults participated in interactive sessions with a bespoke 3D-MAP application utilizing the retrospective think-aloud protocol and semistructured focus group discussions. The system usability scale (SUS) questionnaire was used to evaluate the application's usability. Thematic template analysis was carried out on the SUS item discussions, think-aloud, and semistructured focus group data. Results: The quantitative SUS results revealed that the application may be described as having ``marginal-high'' and ``good'' levels of usability, along with strong agreement with items relating to the usability (P=.004) and learnability (P<.001) of the application. Four high-level themes emerged from think-aloud and focus groups discussions: (1) perceived usefulness (PU), (2) perceived ease of use (PEOU), (3) application use (AU) and (4) self-assessment (SA). The application was seen as a useful tool to enhance visualization of measurement guidance and also to promote independent living, ownership of care, and potentially reduce waiting times. Several design and functionality recommendations emerged from the study, such as a need to manipulate the view and position of the 3D furniture models, and a need for clearer visual prompts and alternative keyboard interface for measurement entry. Conclusions: Participants perceived the 3D-MAP application as a useful tool that has the potential to make significant improvements to the AEPP, not only in terms of accuracy of measurement, but also by potentially enabling older adult patients to carry out the data collection element of the AEPP themselves. Further research is needed to further adapt the 3D-MAP application in line with the study outcomes and to establish its clinical utility with regards to effectiveness, efficiency, accuracy, and reliability of measurements that are recorded using the application and to compare it with 2D measurement guidance leaflets. ",
doi="10.2196/humanfactors.7161",
url="http://humanfactors.jmir.org/2017/2/e15/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28630034"
}


@Article{info:doi/10.2196/mhealth.5773,
author="van Kasteren, Yasmin
and Bradford, Dana
and Zhang, Qing
and Karunanithi, Mohan
and Ding, Hang",
title="Understanding Smart Home Sensor Data for Ageing in Place Through Everyday Household Routines: A Mixed Method Case Study",
journal="JMIR Mhealth Uhealth",
year="2017",
month="Jun",
day="13",
volume="5",
number="6",
pages="e52",
keywords="activities of daily living",
keywords="aged",
keywords="remote sensing technology",
abstract="Background: An ongoing challenge for smart homes research for aging-in-place is how to make sense of the large amounts of data from in-home sensors to facilitate real-time monitoring and develop reliable alerts. Objective: The objective of our study was to explore the usefulness of a routine-based approach for making sense of smart home data for the elderly. Methods: Maximum variation sampling was used to select three cases for an in-depth mixed methods exploration of the daily routines of three elderly participants in a smart home trial using 180 days of power use and motion sensor data and longitudinal interview data. Results: Sensor data accurately matched self-reported routines. By comparing daily movement data with personal routines, it was possible to identify changes in routine that signaled illness, recovery from bereavement, and gradual deterioration of sleep quality and daily movement. Interview and sensor data also identified changes in routine with variations in temperature and daylight hours. Conclusions: The findings demonstrated that a routine-based approach makes interpreting sensor data easy, intuitive, and transparent. They highlighted the importance of understanding and accounting for individual differences in preferences for routinization and the influence of the cyclical nature of daily routines, social or cultural rhythms, and seasonal changes in temperature and daylight hours when interpreting information based on sensor data. This research has demonstrated the usefulness of a routine-based approach for making sense of smart home data, which has furthered the understanding of the challenges that need to be addressed in order to make real-time monitoring and effective alerts a reality. ",
doi="10.2196/mhealth.5773",
url="http://mhealth.jmir.org/2017/6/e52/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28611014"
}


@Article{info:doi/10.2196/medinform.7271,
author="Garrett, Bernie
and Taverner, Tarnia
and McDade, Paul",
title="Virtual Reality as an Adjunct Home Therapy in Chronic Pain Management: An Exploratory Study",
journal="JMIR Med Inform",
year="2017",
month="May",
day="11",
volume="5",
number="2",
pages="e11",
keywords="pain management",
keywords="chronic illness",
keywords="therapeutics",
keywords="medical informatics",
abstract="Background: Virtual reality (VR) therapy has been successfully used as an adjunct therapy for the management of acute pain in adults and children, and evidence of potential efficacy in other health applications is growing. However, minimal research exists on the value of VR as an intervention for chronic pain. Objective: This case series examined the value of VR to be used as an adjunctive therapy for chronic pain patients in their own homes. Methods: An exploratory approach using a case series and personal interviews was used. Ten chronic pain patients received VR therapy for 30 min on alternate days for 1 month. Pre- and postexposure (immediately afterwards, 3 h, and at 24 h) pain assessment was recorded using the Numerical Rating Scale (NRS), and weekly using the Brief Pain Inventory (BPI) and Self-completed Leeds Assessment of Neuropathic Symptoms and Signs pain scale (S-LANSS). Terminal semistructured personal interviews with the patients were also undertaken. Results: Of the 8 patients who completed the study, 5 of them reported that pain was reduced during the VR experience but no overall treatment difference in pain scores postexposure was observed. VR was not associated with any serious adverse events, although 60\% of patients reported some cybersickness during some of the experiences. Conclusions: Of note is that the majority of these study participants reported a reduction in pain while using the VR but with highly individualized responses. One patient also reported some short-term improved mobility following VR use. Some evidence was found for the short-term efficacy of VR in chronic pain but no evidence for persistent benefits. ",
doi="10.2196/medinform.7271",
url="http://medinform.jmir.org/2017/2/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28495661"
}


@Article{info:doi/10.2196/jmir.7027,
author="Coffey, T. Nathan
and Cassese, James
and Cai, Xinsheng
and Garfinkel, Steven
and Patel, Drasti
and Jones, Rebecca
and Shaewitz, Dahlia
and Weinstein, A. Ali",
title="Identifying and Understanding the Health Information Experiences and Preferences of Caregivers of Individuals With Either Traumatic Brain Injury, Spinal Cord Injury, or Burn Injury: A Qualitative Investigation",
journal="J Med Internet Res",
year="2017",
month="May",
day="10",
volume="19",
number="5",
pages="e159",
keywords="traumatic brain injury",
keywords="burns",
keywords="spinal cord injuries",
keywords="caregivers",
keywords="health information, consumer",
keywords="qualitative research",
abstract="Background: In order to meet the challenges of caring for an injured person, caregivers need access to health information. However, caregivers often feel that they lack adequate information. Previous studies of caregivers have primarily focused on either their time and emotional burdens or their health outcomes, but the information needs of caregivers have not been thoroughly investigated. Objective: The purpose of this investigation was to identify the preferred sources of health information for caregivers supporting individuals with injuries and to explore how access to this information could be improved. Methods: A total of 32 caregivers participated in semistructured interviews, which were used in order to develop a more in-depth understanding of these caregivers' information needs. Digital audio recordings of the interviews were used for analysis purposes. These audio recordings were analyzed using a thematic analysis or qualitative content analysis. All of participant's interviews were then coded using the qualitative analysis program, Nvivo 10 for Mac (QSR International). Results: The caregivers endorsed similar behaviors and preferences when seeking and accessing health information. Medical professionals were the preferred source of information, while ease of access made the Internet the most common avenue to obtain information. The challenges faced by participants were frequently a result of limited support. In describing an ideal health system, participants expressed interest in a comprehensive care website offering support network resources, instructive services about the injury and caregiving, and injury-specific materials. Conclusions: According to the participants, an ideal health information system would include a comprehensive care website that offered supportive network resources, instructive services about the injury and caregiving, and materials specific to the type of patient injury. ",
doi="10.2196/jmir.7027",
url="http://www.jmir.org/2017/5/e159/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28490418"
}


@Article{info:doi/10.2196/humanfactors.7293,
author="Agnisarman, Sruthy
and Narasimha, Shraddhaa
and Chalil Madathil, Kapil
and Welch, Brandon
and Brinda, FNU
and Ashok, Aparna
and McElligott, James",
title="Toward a More Usable Home-Based Video Telemedicine System: A Heuristic Evaluation of the Clinician User Interfaces of Home-Based Video Telemedicine Systems",
journal="JMIR Hum Factors",
year="2017",
month="Apr",
day="24",
volume="4",
number="2",
pages="e11",
keywords="telemedicine",
keywords="heuristics, Internet, user-computer interface, cognition",
abstract="Background: Telemedicine is the use of technology to provide and support health care when distance separates the clinical service and the patient. Home-based telemedicine systems involve the use of such technology for medical support and care connecting the patient from the comfort of their homes with the clinician. In order for such a system to be used extensively, it is necessary to understand not only the issues faced by the patients in using them but also the clinician. Objectives: The aim of this study was to conduct a heuristic evaluation of 4 telemedicine software platforms---Doxy.me, Polycom, Vidyo, and VSee---to assess possible problems and limitations that could affect the usability of the system from the clinician's perspective. Methods: It was found that 5 experts individually evaluated all four systems using Nielsen's list of heuristics, classifying the issues based on a severity rating scale. Results: A total of 46 unique problems were identified by the experts. The heuristics most frequently violated were visibility of system status and Error prevention amounting to 24\% (11/46 issues) each. Esthetic and minimalist design was second contributing to 13\% (6/46 issues) of the total errors. Conclusions: Heuristic evaluation coupled with a severity rating scale was found to be an effective method for identifying problems with the systems. Prioritization of these problems based on the rating provides a good starting point for resolving the issues affecting these platforms. There is a need for better transparency and a more streamlined approach for how physicians use telemedicine systems. Visibility of the system status and speaking the users' language are keys for achieving this. ",
doi="10.2196/humanfactors.7293",
url="http://humanfactors.jmir.org/2017/2/e11/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28438724"
}


@Article{info:doi/10.2196/resprot.6506,
author="Phanareth, Klaus
and Vingtoft, S{\o}ren
and Christensen, Skovbo Anders
and Nielsen, Sylvest Jakob
and Svenstrup, J{\o}rgen
and Berntsen, Rosvold Gro Karine
and Newman, Peter Stanton
and Kayser, Lars",
title="The Epital Care Model: A New Person-Centered Model of Technology-Enabled Integrated Care for People With Long Term Conditions",
journal="JMIR Res Protoc",
year="2017",
month="Jan",
day="16",
volume="6",
number="1",
pages="e6",
keywords="integrated care",
keywords="technology enabled",
keywords="innovative care",
keywords="chronic obstructive pulmonary disease (COPD)",
keywords="frail",
abstract="Background: There is worldwide recognition that the future provision of health care requires a reorganization of provision of care, with increased empowerment and engagement of patients, along with skilled health professionals delivering services that are coordinated across sectors and organizations that provide health care. Technology may be a way to enable the creation of a coherent, cocreative, person-centered method to provide health care for individuals with one or more long-term conditions (LTCs). It remains to be determined how a new care model can be introduced that supports the intentions of the World Health Organization (WHO) to have integrated people-centered care. Objective: To design, pilot, and test feasibility of a model of health care for people with LTCs based on a cocreative, iterative, and stepwise process in a way that recognizes the need for person-centered care, and embraces the use of digital technology. Methods: The overall research method was inspired by action research and used an agile, iterative approach. In 2012, a living lab was established in a Danish municipality which allowed for the freedom of redesigning health care processes. As the first step, a wide group of stakeholders was gathered to create a layout for the reorganization of services and development of technology, based on established principles for innovative management of people with chronic conditions. The next three steps were (1) a proof of concept in 2012, (2) a pilot study, and (3) a feasibility study from 2013 to 2015, in which a total of 93 chronic obstructive pulmonary disease (COPD) patients were enrolled. Citizens were provided a tablet-based solution for remote follow-up and communication purposes, and access to a 24/7 response and coordination center that coordinated both virtual and face-to-face support for COPD management. In step five the initial model was extended with elements that support continuity of care. Beginning in the autumn of 2013, 1102 frail elderly individuals were included and offered two additional services: an outgoing acute medical team and a local subacute bed function. Results: Based on the findings from the iterative process, and evolving technology and workflow solutions, we propose a robust and feasible model that can provide a framework for developing solutions to support an active life with one or more LTCs. The resulting Epital Care Model (ECM) consists of six stages, and serves as a template for how a digitally-enhanced health service can be provided based on patients' medical needs. The model is designed to be a proactive, preventive, and monitoring health care system that involves individuals in the management of their own health conditions. Conclusions: The ECM is in accordance with WHO's framework for integrated people-centered health services, and may serve as a framework for the development of new technologies and provide a template for future reorganization. ",
doi="10.2196/resprot.6506",
url="http://www.researchprotocols.org/2017/1/e6/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28093379"
}


@Article{info:doi/10.2196/rehab.6376,
author="Meiland, Franka
and Innes, Anthea
and Mountain, Gail
and Robinson, Louise
and van der Roest, Henri{\"e}tte
and Garc{\'i}a-Casal, Antonio J.
and Gove, Dianne
and Thyrian, Ren{\'e} Jochen
and Evans, Shirley
and Dr{\"o}es, Rose-Marie
and Kelly, Fiona
and Kurz, Alexander
and Casey, Dympna
and Szcze?niak, Dorota
and Dening, Tom
and Craven, P. Michael
and Span, Marijke
and Felzmann, Heike
and Tsolaki, Magda
and Franco-Martin, Manuel",
title="Technologies to Support Community-Dwelling Persons With Dementia: A Position Paper on Issues Regarding Development, Usability, Effectiveness and Cost-Effectiveness, Deployment, and Ethics",
journal="JMIR Rehabil Assist Technol",
year="2017",
month="Jan",
day="16",
volume="4",
number="1",
pages="e1",
keywords="dementia",
keywords="technology",
keywords="evaluation studies",
keywords="diffusion of innovation",
keywords="ethics",
abstract="Background: With the expected increase in the numbers of persons with dementia, providing timely, adequate, and affordable care and support is challenging. Assistive and health technologies may be a valuable contribution in dementia care, but new challenges may emerge. Objective: The aim of our study was to review the state of the art of technologies for persons with dementia regarding issues on development, usability, effectiveness and cost-effectiveness, deployment, and ethics in 3 fields of application of technologies: (1) support with managing everyday life, (2) support with participating in pleasurable and meaningful activities, and (3) support with dementia health and social care provision. The study also aimed to identify gaps in the evidence and challenges for future research. Methods: Reviews of literature and expert opinions were used in our study. Literature searches were conducted on usability, effectiveness and cost-effectiveness, and ethics using PubMed, Embase, CINAHL, and PsycINFO databases with no time limit. Selection criteria in our selected technology fields were reviews in English for community-dwelling persons with dementia. Regarding deployment issues, searches were done in Health Technology Assessment databases. Results: According to our results, persons with dementia want to be included in the development of technologies; there is little research on the usability of assistive technologies; various benefits are reported but are mainly based on low-quality studies; barriers to deployment of technologies in dementia care were identified, and ethical issues were raised by researchers but often not studied. Many challenges remain such as including the target group more often in development, performing more high-quality studies on usability and effectiveness and cost-effectiveness, creating and having access to high-quality datasets on existing technologies to enable adequate deployment of technologies in dementia care, and ensuring that ethical issues are considered an important topic for researchers to include in their evaluation of assistive technologies. Conclusions: Based on these findings, various actions are recommended for development, usability, effectiveness and cost-effectiveness, deployment, and ethics of assistive and health technologies across Europe. These include avoiding replication of technology development that is unhelpful or ineffective and focusing on how technologies succeed in addressing individual needs of persons with dementia. Furthermore, it is suggested to include these recommendations in national and international calls for funding and assistive technology research programs. Finally, practitioners, policy makers, care insurers, and care providers should work together with technology enterprises and researchers to prepare strategies for the implementation of assistive technologies in different care settings. This may help future generations of persons with dementia to utilize available and affordable technologies and, ultimately, to benefit from them. ",
doi="10.2196/rehab.6376",
url="http://rehab.jmir.org/2017/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28582262"
}


@Article{info:doi/10.2196/jmir.6722,
author="DeHoff, A. Beth
and Staten, K. Lisa
and Rodgers, Christine Rylin
and Denne, C. Scott",
title="The Role of Online Social Support in Supporting and Educating Parents of Young Children With Special Health Care Needs in the United States: A Scoping Review",
journal="J Med Internet Res",
year="2016",
month="Dec",
day="22",
volume="18",
number="12",
pages="e333",
keywords="health communication",
keywords="child",
keywords="social media",
keywords="health education",
keywords="health resources",
keywords="early childhood",
keywords="disability",
keywords="neonatal intensive care unit",
keywords="family",
keywords="maternal-child health services",
abstract="Background: When parents of young children with special health care needs (CSHCN) receive their child's diagnosis, they encounter information they may not understand, emotions they may not know how to cope with, and questions about their child's immediate and long-term future that frequently lack answers. The challenge of health care providers is how to prepare parents for caring for their CSHCN, for coping with any resulting challenges, and for accessing the systems and services that can assist them. Objective: The purpose of this work was to review evidence of the information and support needs of parents of young CSHCN and to determine whether online social support can serve as an avenue for learning and empowerment for these parents. Methods: A scoping review identified the challenges, coping mechanisms, and support needs among parents of CSHCN, and the reach and effectiveness of digital technologies with these families and health care providers. We also conducted interviews with professionals serving parents of CSHCN. Results: The literature review and interviews suggested that parents best learn the information they need, and cope with the emotional challenges of raising a CSHCN, with support from other parents of CSHCN, and that young parents in recent years have most often been finding this parent-to-parent support through digital media, particularly social media, consistent with the theory of online social support. Evidence also shows that social media, particularly Facebook, is used by nearly all women aged 18-29 years across racial and socioeconomic lines in the United States. Conclusions: Parents of young CSHCN experience significant stress but gain understanding, receive support, and develop the ability to care for and be advocates for their child through parent-to-parent emotional and informational social support. Online social support is most effective with young adults of childbearing age, with social media and apps being the most useful within the theoretical framework of social support. This opens new opportunities to effectively educate and support parents of young CSHCN. Providers seeking to inform, educate, and support families of CSHCN should develop strategies to help parents find and use social support through digital resources to facilitate their emotional adjustment and practical abilities to care for and access services for their child. ",
doi="10.2196/jmir.6722",
url="http://www.jmir.org/2016/12/e333/",
url="http://www.ncbi.nlm.nih.gov/pubmed/28007689"
}


@Article{info:doi/10.2196/jmir.6303,
author="Innominato, F. Pasquale
and Komarzynski, Sandra
and Mohammad-Djafari, Ali
and Arbaud, Alexandre
and Ulusakarya, Ayhan
and Bouchahda, Mohamed
and Haydar, Mazen
and Bossevot-Desmaris, Rachel
and Plessis, Virginie
and Mocquery, Magali
and Bouchoucha, Davina
and Afshar, Mehran
and Beau, Jacques
and Karabou{\'e}, Abdoulaye
and Mor{\`e}re, Jean-Fran{\c{c}}ois
and Fursse, Joanna
and Rovira Simon, Jordi
and Levi, Francis",
title="Clinical Relevance of the First Domomedicine Platform Securing Multidrug Chronotherapy Delivery in Metastatic Cancer Patients at Home: The inCASA European Project",
journal="J Med Internet Res",
year="2016",
month="Nov",
day="25",
volume="18",
number="11",
pages="e305",
keywords="domomedicine",
keywords="chronotherapy",
keywords="actigraphy",
keywords="MDASI",
keywords="telemonitoring",
abstract="Background: Telehealth solutions can improve the safety of ambulatory chemotherapy, contributing to the maintenance of patients at their home, hence improving their well-being, all the while reducing health care costs. There is, however, need for a practicable multilevel monitoring solution, encompassing relevant outputs involved in the pathophysiology of chemotherapy-induced toxicity. Domomedicine embraces the delivery of complex care and medical procedures at the patient's home based on modern technologies, and thus it offers an integrated approach for increasing the safety of cancer patients on chemotherapy. Objective: The objective was to evaluate patient compliance and clinical relevance of a novel integrated multiparametric telemonitoring domomedicine platform in cancer patients receiving multidrug chemotherapy at home. Methods: Self-measured body weight, self-rated symptoms using the 19-item MD Anderson Symptom Inventory (MDASI), and circadian rest-activity rhythm recording with a wrist accelerometer (actigraph) were transmitted daily by patients to a server via the Internet, using a dedicated platform installed at home. Daily body weight changes, individual MDASI scores, and relative percentage of activity in-bed versus out-of-bed (I<O) were computed. Chemotherapy was administered according to the patient medical condition. Compliance was evaluated according to the proportions of (1) patient-days with all data available (full) and (2) patient-days with at least one parameter available (minimal). Acceptability was assessed using the Whole Systems Demonstrator Service User Technology Acceptability Questionnaire. Linear discriminant analysis was used to identify the combination of parameters associated with subsequent unplanned hospitalization. Results: A total of 31 patients (males: 55\% [17/31]; World Health Organization Performance Status=0: 29\% (9/31); age range: 35-91 years) participated for a median of 58 days (38-313). They received a total of 102 chemotherapy courses (64.7\% as outpatients). Overall full compliance was 59.7\% (522/874), with at least one data available for 830/874 patient-days (95.0\%), during the 30-day per-protocol span. Missing data rates were similar for each parameter. Patients were altogether satisfied with the use of the platform. Ten toxicity-related hospitalizations occurred in 6 patients. The combination of weighted circadian function (actigraphy parameter I<O), body weight change, and MDASI scores predicted for ensuing emergency hospitalization within 3 days, with an accuracy of 94\%. Conclusions: Multidimensional daily telemonitoring of body weight, circadian rest-activity rhythm, and patient-reported symptoms was feasible, satisfactory, and clinically relevant in patients on chemotherapy. This domomedicine platform constitutes a unique tool for the further development of safe home-based chemotherapy administration. ",
doi="10.2196/jmir.6303",
url="http://www.jmir.org/2016/11/e305/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27888171"
}


@Article{info:doi/10.2196/jmir.6251,
author="Bacchus, J. Loraine
and Bullock, Linda
and Sharps, Phyllis
and Burnett, Camille
and Schminkey, L. Donna
and Buller, Maria Ana
and Campbell, Jacquelyn",
title="Infusing Technology Into Perinatal Home Visitation in the United States for Women Experiencing Intimate Partner Violence: Exploring the Interpretive Flexibility of an mHealth Intervention",
journal="J Med Internet Res",
year="2016",
month="Nov",
day="17",
volume="18",
number="11",
pages="e302",
keywords="intimate partner violence",
keywords="screening",
keywords="home visitation",
keywords="nurses",
keywords="mhealth",
keywords="intervention",
keywords="technology",
keywords="interpretive flexibility",
abstract="Background: Intimate partner violence (IPV) is common during pregnancy and the postpartum. Perinatal home visitation provides favorable conditions in which to identify and support women affected by IPV. However, the use of mHealth for delivering IPV interventions in perinatal home visiting has not been explored. Objective: Our objective was to conduct a nested qualitative interpretive study to explore perinatal home visitors' and women's perceptions and experiences of the Domestic Violence Enhanced Home Visitation Program (DOVE) using mHealth technology (ie, a computer tablet) or a home visitor-administered, paper-based method. Methods: We used purposive sampling, using maximum variation, to select women enrolled in a US-based randomized controlled trial of the DOVE intervention for semistructured interviews. Selection criteria were discussed with the trial research team and 32 women were invited to participate. We invited 45 home visitors at the 8 study sites to participate in an interview, along with the 2 DOVE program designers. Nonparticipant observations of home visits with trial participants who chose not to participate in semistructured interviews were undertaken. Results: We conducted 51 interviews with 26 women, 23 home visiting staff at rural and urban sites, and the 2 DOVE program designers. We conducted 4 nonparticipant observations. Among 18 IPV-positive women, 7 used the computer tablet and 11 used the home visitor method. Among 8 IPV-negative women, 7 used the home visitor method. The computer tablet was viewed as a safe and confidential way for abused women to disclose their experiences without fear of being judged. The meanings that the DOVE technology held for home visitors and women led to its construction as either an impersonal artifact that was an impediment to discussion of IPV or a conduit through which interpersonal connection could be deepened, thereby facilitating discussion about IPV. Women's and home visitors' comfort with either method of screening was positively influenced by factors such as having established trust and rapport, as well as good interpersonal communication. The technology helped reduce the anticipated stigma associated with disclosing abuse. The didactic intervention video was a limiting feature, as the content could not be tailored to accommodate the fluidity of women's circumstances. Conclusions: Users and developers of technology-based IPV interventions need to consider the context in which they are being embedded and the importance of the patient-provider relationship in promoting behavior change in order to realize the full benefits. An mHealth approach can and should be used as a tool for initiating discussion about IPV, assisting women in enhancing their safety and exploring help-seeking options. However, training for home visitors is required to ensure that a computer tablet is used to complement and enhance the therapeutic relationship. ClinicalTrial: Clinicaltrials.gov NCT01688427; https://clinicaltrials.gov/ct2/show/NCT01688427 (Archived by WebCite at http://www.webcitation.org/6limSWdZP) ",
doi="10.2196/jmir.6251",
url="http://www.jmir.org/2016/11/e302/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27856405"
}


@Article{info:doi/10.2196/medinform.5012,
author="Vannieuwenborg, Frederic
and Van der Auwermeulen, Thomas
and Van Ooteghem, Jan
and Jacobs, An
and Verbrugge, Sofie
and Colle, Didier",
title="Evaluating the Economic Impact of Smart Care Platforms: Qualitative and Quantitative Results of a Case Study",
journal="JMIR Med Inform",
year="2016",
month="Oct",
day="31",
volume="4",
number="4",
pages="e33",
keywords="medical informatics applications",
keywords="home care services",
keywords="ambulatory care information systems",
keywords="evaluation studies as topic",
keywords="cost-benefit analysis",
abstract="Background: In response to the increasing pressure of the societal challenge because of a graying society, a gulf of new Information and Communication Technology (ICT) supported care services (eCare) can now be noticed. Their common goal is to increase the quality of care while decreasing its costs. Smart Care Platforms (SCPs), installed in the homes of care-dependent people, foster the interoperability of these services and offer a set of eCare services that are complementary on one platform. These eCare services could not only result in more quality care for care receivers, but they also offer opportunities to care providers to optimize their processes. Objective: The objective of the study was to identify and describe the expected added values and impacts of integrating SCPs in current home care delivery processes for all actors. In addition, the potential economic impact of SCP deployment is quantified from the perspective of home care organizations. Methods: Semistructured and informal interviews and focus groups and cocreation workshops with service providers, managers of home care organizations, and formal and informal care providers led to the identification of added values of SCP integration. In a second step, process breakdown analyses of home care provisioning allowed defining the operational impact for home care organization. Impacts on 2 different process steps of providing home care were quantified. After modeling the investment, an economic evaluation compared the business as usual (BAU) scenario versus the integrated SCP scenario. Results: The added value of SCP integration for all actors involved in home care was identified. Most impacts were qualitative such as increase in peace of mind, better quality of care, strengthened involvement in care provisioning, and more transparent care communication. For home care organizations, integrating SCPs could lead to a decrease of 38\% of the current annual expenses for two administrative process steps namely, care rescheduling and the billing for care provisioning. Conclusions: Although integrating SCP in home care processes could affect both the quality of life of the care receiver and informal care giver, only scarce and weak evidence was found that supports this assumption. In contrast, there exists evidence that indicates the lack of the impact on quality of life of the care receiver while it increases the cost of care provisioning. However, our cost-benefit quantification model shows that integrating SCPs in home care provisioning could lead to a considerable decrease of costs for care administrative tasks. Because of this cost decreasing impact, we believe that the integration of SCPs will be driven by home care organizations instead of the care receivers themselves. ",
doi="10.2196/medinform.5012",
url="http://medinform.jmir.org/2016/4/e33/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27799137"
}


@Article{info:doi/10.2196/ijmr.5590,
author="Akahane, Manabu
and Maeyashiki, Akie
and Yoshihara, Shingo
and Tanaka, Yasuhito
and Imamura, Tomoaki",
title="Relationship Between Difficulties in Daily Activities and Falling: Loco-Check as a Self-Assessment of Fall Risk",
journal="Interact J Med Res",
year="2016",
month="Jun",
day="20",
volume="5",
number="2",
pages="e20",
keywords="accidental falls",
keywords="disability evaluation",
keywords="self-assessment",
keywords="activity of daily living",
abstract="Background: People aged 65 years or older accounted for 25.1\% of the Japanese population in 2013, and this characterizes the country as a ``super-aging society.'' With increased aging, fall-related injuries are becoming important in Japan, because such injuries underlie the necessity for nursing care services. If people could evaluate their risk of falling using a simple self-check test, they would be able to take preventive measures such as exercise, muscle training, walking with a cane, or renovation of their surroundings to remove impediments. Loco-check is a checklist measure of early locomotive syndrome (circumstances in which elderly people need nursing care service or are at high risk of requiring the service within a short time), prepared by the Japanese Orthopaedic Association (JOA) in 2007, but it is unclear if there is any association between this measure and falls. Objective: To investigate the association between falls during the previous year and the 7 ``loco-check'' daily activity items and the total number of items endorsed, and sleep duration. Methods: We conducted an Internet panel survey. Subjects were 624 persons aged between 30 and 90 years. The general health condition of the participants, including their experience of falling, daily activities, and sleep duration, was investigated. A multivariate analysis was carried out using logistic regression to investigate the relationship between falls in the previous year and difficulties with specific daily activities and total number of difficulties (loco-check) endorsed, and sleep duration, adjusting for sex and age. Results: One-fourth of participants (157 persons) experienced at least one fall during the previous year. Fall rate of females (94/312: 30.1\%) was significantly higher than that of males (63/312: 20.2\%). Fall rate of persons aged more than 65 years (80/242: 33.1\%) was significantly higher than that of younger persons (77/382: 20.2\%). Logistic regression analysis revealed that daily activities such as ``impossibility of getting across the road at a crossing before the traffic light changes'' are significantly related to falling. Logistic regression analysis also demonstrated a relationship between the number of items endorsed on loco-check  and incidence of falling, wherein persons who endorsed 4 or more items appear to be at higher risk for falls. However, logistic regression found no significant relationship between sleep duration and falling. Conclusions: Our study demonstrated a relationship between the number of loco-check items endorsed and the incidence of falling in the previous year. Endorsement of 4 or more items appeared to signal a high risk for falls. The short self-administered checklist can be a valuable tool for assessing the risk of falling and for initiating preventive measures. ",
doi="10.2196/ijmr.5590",
url="http://www.i-jmr.org/2016/2/e20/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27323871"
}


@Article{info:doi/10.2196/jmir.5414,
author="Schoot, S. Tessa
and Weenk, Mariska
and van de Belt, H. Tom
and Engelen, JLPG Lucien
and van Goor, Harry
and Bredie, JH Sebastian",
title="A New Cuffless Device for Measuring Blood Pressure: A Real-Life Validation Study",
journal="J Med Internet Res",
year="2016",
month="May",
day="05",
volume="18",
number="5",
pages="e85",
keywords="hypertension",
keywords="cuffless blood pressure monitor",
keywords="wearable device",
keywords="cardiovascular risk management",
keywords="patient empowerment",
abstract="Background: Cuffless blood pressure (BP) monitoring devices, based on pulse transit time, are being developed as an easy-to-use, more convenient, fast, and relatively cheap alternative to conventional BP measuring devices based on cuff occlusion. Thereby they may provide a great alternative to BP self-measurement. Objective: The objective of our study was to evaluate the performance of the first release of the Checkme Health Monitor (Viatom Technology), a cuffless BP monitor, in a real-life setting. Furthermore, we wanted to investigate whether the posture of the volunteer and the position of the device relative to the heart level would influence its outcomes. Methods: Study volunteers fell into 3 BP ranges: high (>160 mmHg), normal (130--160 mmHg), and low (<130 mmHg). All requirements for test environment, observer qualification, volunteer recruitment, and BP measurements were met according to the European Society of Hypertension International Protocol (ESH-IP) for the validation of BP measurement devices. After calibrating the Checkme device, we measured systolic BP with Checkme and a validated, oscillometric reference BP monitor (RM). Measurements were performed in randomized order both in supine and in sitting position, and with Checkme at and above heart level. Results: We recruited 52 volunteers, of whom we excluded 15 (12 due to calibration failure with Checkme, 3 due to a variety of reasons). The remaining 37 volunteers were divided into low (n=14), medium (n=13), and high (n=10) BP ranges. There were 18 men and 19 women, with a mean age of 54.1 (SD 14.5) years, and mean recruitment systolic BP of 141.7 (SD 24.7) mmHg. BP results obtained by RM and Checkme correlated well. In the supine position, the difference between the RM and Checkme was >5 mmHg in 17 of 37 volunteers (46\%), of whom 9 of 37 (24\%) had a difference >10 mmHg and 5 of 37 (14\%) had a difference >15 mmHg. Conclusions: BP obtained with Checkme correlated well with RM BP, particularly in the position (supine) in which the device was calibrated. These preliminary results are promising for conducting further research on cuffless BP measurement in the clinical and outpatient settings. ",
doi="10.2196/jmir.5414",
url="http://www.jmir.org/2016/5/e85/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27150527"
}


@Article{info:doi/10.2196/ijmr.5015,
author="Valenzuela Espinoza, Alexis
and De Smedt, Ann
and Guldolf, Kaat
and Vandervorst, Fenne
and Van Hooff, Robbert-Jan
and Fernandez Tellez, Helio
and Desmaele, Sara
and Cambron, Melissa
and Hubloue, Ives
and Brouns, Raf",
title="Opinions and Beliefs About Telemedicine for Emergency Treatment During Ambulance Transportation and for Chronic Care at Home",
journal="Interact J Med Res",
year="2016",
month="Mar",
day="30",
volume="5",
number="1",
pages="e9",
keywords="telemedicine",
keywords="stroke",
keywords="adoption",
keywords="diagnostic techniques and procedures",
keywords="emergency care",
keywords="patient-centered care",
abstract="Background: Telemedicine is a valid alternative to face-to-face patient care in many areas. However, the opinion of all stakeholders is decisive for successful adoption of this technique, especially as telemedicine expands into novel domains such as emergency teleconsultations during ambulance transportation and chronic care at home. Objective: We evaluate the viewpoints of the broad public, patients, and professional caregivers in these situations. Methods: A 10-question survey was developed and obtained via face-to-face interviews of visitors at the Universitair Ziekenhuis Brussel (UZB). The online questionnaire was also distributed among professional caregivers via the intranet of the UZB and among the broad public using social media. Results: In total, 607 individuals responded to the questionnaire, expressing a positive opinion regarding telemedicine for in-ambulance emergency treatment and for chronic care at home. Privacy issues were not perceived as relevant, and most respondents were ready to participate in future teleconsultations. Lack of telecommunication knowledge (213/566, 37.6\%) was the only independent factor associated with rejection of telemedicine at home and respondents via social media (250/607, 41.2\%) were less concerned about privacy issues than respondents via face-to-face interviews (visitors, 234/607, 38.6\%). The visitors were more positive towards in-ambulance telemedicine and more likely to agree with future participation in teleconsultations than respondents via social media. Conclusions: The broad public, professional caregivers, and patients reported a positive attitude towards telemedicine for emergency treatment during ambulance transportation and for chronic care at home. These results support further improvement of telemedicine solutions in these domains. ",
doi="10.2196/ijmr.5015",
url="http://www.i-jmr.org/2016/1/e9/",
url="http://www.ncbi.nlm.nih.gov/pubmed/27029999"
}


@Article{info:doi/10.2196/resprot.5142,
author="Boots, MM Lizzy
and de Vugt, E. Marjolein
and Withagen, EJ Hanneke
and Kempen, IJM Gertrudis
and Verhey, RJ Frans",
title="Development and Initial Evaluation of the Web-Based Self-Management Program ``Partner in Balance'' for Family Caregivers of People With Early Stage Dementia: An Exploratory Mixed-Methods Study",
journal="JMIR Res Protoc",
year="2016",
month="Mar",
day="01",
volume="5",
number="1",
pages="e33",
keywords="carers",
keywords="dementia",
keywords="focus groups",
keywords="Internet",
keywords="psychosocial support systems",
abstract="Background: People with dementia increasingly depend on informal caregivers. Internet-based self-management interventions hold considerable promise for meeting the educational and support needs of early stage dementia caregivers (EDCs) at a reduced cost. Objective: This study aimed to (1) develop an online self-management program for EDC to increase self-efficacy and goal attainment, and (2) evaluate the program's feasibility and report preliminary data on effectiveness. Methods: Based on the Medical Research Council (MRC) framework for the development and evaluation of complex interventions, a stepwise approach was adopted to explore potential user needs and develop and validate the content by means of (1) focus group discussions with dementia caregivers (N=28), (2) interviews with dementia care professionals (N=11), and (3) individual think-aloud usability tests with EDC (N=2) and experts (N=2). A pilot evaluation was conducted with EDC (N=17) to test the feasibility and establish preliminary effects. Self-report measures of feasibility were completed after the completion of intervention. Self-efficacy and goal attainment were evaluated before and after the intervention. Results: The different steps provided useful information about the needs of potential users regarding the content and delivery of the program. This resulted in the newly developed ``Partner in Balance'' program. At the start, system failures resulted in a high noncompleter rate (7/17, 41\%), but at the end, an acceptable feasibility score of 209 (range 54-234) was found. The convenience of completing the program at home, the tailored content, and the guidance (face-to-face and online) were appraised positively. Preliminary effects on caregiver self-efficacy (P<.05) and goal attainment (T>50) were promising. Conclusions: Adaptations were made to the program to limit the amount of system failures and prevent high noncompleter rates. As recommended by the MRC framework, confirming the feasibility and preliminary effectiveness is a valuable step toward examining the effectiveness of this newly developed intervention. Trial Registration: Dutch Trial Register (NTR): NTR4217; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=4217 (Archived by WebCite at http://www.webcitation.org/6f6B8lvRP). ",
doi="10.2196/resprot.5142",
url="http://www.researchprotocols.org/2016/1/e33/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26932438"
}


@Article{info:doi/10.2196/ijmr.4270,
author="Dario, Claudio
and Delise, Pietro
and Gubian, Lorenzo
and Saccavini, Claudio
and Brandolino, Glauco
and Mancin, Silvia",
title="Large Controlled Observational Study on Remote Monitoring of Pacemakers and Implantable Cardiac Defibrillators: A Clinical, Economic, and Organizational Evaluation",
journal="Interact J Med Res",
year="2016",
month="Jan",
day="13",
volume="5",
number="1",
pages="e4",
keywords="healthcare economics and organization",
keywords="telehealth and telemonitoring",
keywords="implantable cardiac defibrillator",
keywords="cardiac pacemaker",
abstract="Background: Patients with implantable devices such as pacemakers (PMs) and implantable cardiac defibrillators (ICDs) should be followed up every 3--12 months, which traditionally required in-clinic visits. Innovative devices allow data transmission and technical or medical alerts to be sent from the patient's home to the physician (remote monitoring). A number of studies have shown its effectiveness in timely detection and management of both clinical and technical events, and endorsed its adoption. Unfortunately, in daily practice, remote monitoring has been implemented in uncoordinated and rather fragmented ways, calling for a more strategic approach. Objective: The objective of the study was to analyze the impact of remote monitoring for PM and ICD in a ``real world'' context compared with in-clinic follow-up. The evaluation focuses on how this service is carried out by Local Health Authorities, the impact on the cardiology unit and the health system, and organizational features promoting or hindering its effectiveness and efficiency. Methods: A multi-center, multi-vendor, controlled, observational, prospective study was conducted to analyze the impact of remote monitoring implementation. A total of 2101 patients were enrolled in the study: 1871 patients were followed through remote monitoring of PM/ICD (I-group) and 230 through in-clinic visits (U-group). The follow-up period was 12 months. Results: In-clinic device follow-ups and cardiac visits were significantly lower in the I-group compared with the U-group, respectively: PM, I-group = 0.43, U-group = 1.07, P<.001; ICD, I-group = 0.98, U-group = 2.14, P<.001. PM, I-group = 0.37, U-group = 0.85, P<.001; ICD, I-group = 1.58, U-group = 1.69, P=.01. Hospitalizations for any cause were significantly lower in the I-group for PM patients only (I-group = 0.37, U-group = 0.50, P=.005). There were no significant differences regarding use of the emergency department for both PM and ICD patients. In the I-group, 0.30 (PM) and 0.37 (ICD) real clinical events per patient per year were detected within a mean (SD) time of 1.18 (2.08) days. Mean time spent by physicians to treat a patient was lower in the I-group compared to the U-group  (-4.1 minutes PM; -13.7 minutes ICD). Organizational analysis showed that remote monitoring  implementation was rather haphazard and fragmented. From a health care system perspective, the economic analysis showed statistically significant gains (P<.001) for the I-group using PM. Conclusions: This study contributes to build solid evidence regarding the usefulness of RM in detecting and managing clinical and technical events with limited use of manpower and other health care resources. To fully gain the benefits of RM of PM/ICD, it is vital that organizational processes be streamlined and standardized within an overarching strategy. ",
doi="10.2196/ijmr.4270",
url="http://www.i-jmr.org/2016/1/e4/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26764170"
}


@Article{info:doi/10.2196/mhealth.4666,
author="Taylor, Alan
and Morris, Greg
and Pech, Joanne
and Rechter, Stuart
and Carati, Colin
and Kidd, R. Michael",
title="Home Telehealth Video Conferencing: Perceptions and Performance",
journal="JMIR mHealth uHealth",
year="2015",
month="Sep",
day="17",
volume="3",
number="3",
pages="e90",
keywords="telehealth",
keywords="video conferencing",
keywords="reliability",
keywords="effectiveness, home care",
keywords="mobile data networks",
keywords="broadband",
abstract="Background: The Flinders Telehealth in the Home trial (FTH trial), conducted in South Australia, was an action research initiative to test and evaluate the inclusion of telehealth services and broadband access technologies for palliative care patients living in the community and home-based rehabilitation services for the elderly at home. Telehealth services at home were supported by video conferencing between a therapist, nurse or doctor, and a patient using the iPad tablet. Objective: The aims of this study are to identify which technical factors influence the quality of video conferencing in the home setting and to assess the impact of these factors on the clinical perceptions and acceptance of video conferencing for health care delivery into the home. Finally, we aim to identify any relationships between technical factors and clinical acceptance of this technology. Methods: An action research process developed several quantitative and qualitative procedures during the FTH trial to investigate technology performance and users perceptions of the technology including measurements of signal power, data transmission throughput, objective assessment of user perceptions of videoconference quality, and questionnaires administered to clinical users. Results: The effectiveness of telehealth was judged by clinicians as equivalent to or better than a home visit on 192 (71.6\%, 192/268) occasions, and clinicians rated the experience of conducting a telehealth session compared with a home visit as equivalent or better in 90.3\% (489/540) of the sessions. It was found that the quality of video conferencing when using a third generation mobile data service (3G) in comparison to broadband fiber-based services was concerning as 23.5\% (220/936) of the calls failed during the telehealth sessions. The experimental field tests indicated that video conferencing audio and video quality was worse when using mobile data services compared with fiber to the home services. As well, statistically significant associations were found between audio/video quality and patient comfort with the technology as well as the clinician ratings for effectiveness of telehealth. Conclusions: These results showed that the quality of video conferencing when using 3G-based mobile data services instead of broadband fiber-based services was less due to failed calls, audio/ video jitter, and video pixilation during the telehealth sessions. Nevertheless, clinicians felt able to deliver effective services to patients at home using 3G-based mobile data services. ",
doi="10.2196/mhealth.4666",
url="http://mhealth.jmir.org/2015/3/e90/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26381104"
}


@Article{info:doi/10.2196/ijmr.4257,
author="Agha, Arun
and Liu-Ambrose, L. Teresa Y.
and Backman, L. Catherine
and Leese, Jennifer
and Li, C. Linda",
title="Understanding the Experiences of Rural Community-Dwelling Older Adults in Using a New DVD-Delivered Otago Exercise Program: A Qualitative Study",
journal="Interact J Med Res",
year="2015",
month="Aug",
day="13",
volume="4",
number="3",
pages="e17",
keywords="Otago Exercise Program",
keywords="DVD",
keywords="aging",
keywords="falls",
keywords="physical therapy",
keywords="qualitative research",
abstract="Background: The home-based Otago Exercise Program (OEP) has been shown to reduce the occurrence of falls in community-dwelling seniors. A new OEP DVD was recently developed for people living in rural communities to be used with minimal coaching by a physical therapist. Objective: This study aimed to understand older adults' experiences using the DVD-delivered OEP and explore barriers and facilitators to implementing the DVD-delivered OEP from the participants' perspectives. Methods: Rural community-dwelling older adults (75 years and older) who participated in a six-month DVD-delivered OEP study were invited to participate in this qualitative study. Two small group interviews were initially conducted to explore the breadth of participants' experiences with the program. These were followed by semi-structured individual interviews to gain an in-depth understanding of these experiences. An inductive constant comparison analysis of the transcripts was performed. To ensure methodological rigor, field notes, journaling, and an audit trail were maintained, supplemented by peer-review. Results: Of 32 eligible participants, five participated in group interviews and 16 in individual interviews. Three themes emerged. Theme 1, The OEP DVD---useful training tool but in need of more pep, represented participants' experiences that the DVD provided important guidance at program onset, but was too slow and low-energy for longer-term use. Theme 2, Gaining control over one's exercise regimen, but sometimes life gets in the way of staying active, described participants' appreciation of the program's flexibility, but personal health concerns and everyday lives posed challenges to adhering to the program. Theme 3, Social creatures---wanting greater human connection during exercise, described how some participants desired further social interactions for enhancing motivation and receiving guidance. Conclusions: Individuals should be encouraged to refer to the OEP user manual or DVD as needed and engage friends and family in exercises. The importance of exercise even when living with health problems should be raised at program onset, and participants should be supported in working through challenging issues. Health professionals should work with individuals to integrate the program with their everyday activities. ",
doi="10.2196/ijmr.4257",
url="http://www.i-jmr.org/2015/3/e17/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26272163"
}


@Article{info:doi/10.2196/jmir.4550,
author="Piette, D. John
and Striplin, Dana
and Marinec, Nicolle
and Chen, Jenny
and Trivedi, B. Ranak
and Aron, C. David
and Fisher, Lawrence
and Aikens, E. James",
title="A Mobile Health Intervention Supporting Heart Failure Patients and Their Informal Caregivers: A Randomized Comparative Effectiveness Trial",
journal="J Med Internet Res",
year="2015",
month="Jun",
day="10",
volume="17",
number="6",
pages="e142",
keywords="telehealth",
keywords="mobile health",
keywords="heart failure",
keywords="disease management",
keywords="self-management",
abstract="Background: Mobile health (mHealth) interventions may improve heart failure (HF) self-care, but standard models do not address informal caregivers' needs for information about the patient's status or how the caregiver can help. Objective: We evaluated mHealth support for caregivers of HF patients over and above the impact of a standard mHealth approach. Methods: We identified 331 HF patients from Department of Veterans Affairs outpatient clinics. All patients identified a ``CarePartner'' outside their household. Patients randomized to ``standard mHealth'' (n=165) received 12 months of weekly interactive voice response (IVR) calls including questions about their health and self-management. Based on patients' responses, they received tailored self-management advice, and their clinical team received structured fax alerts regarding serious health concerns. Patients randomized to ``mHealth+CP'' (n=166) received an identical intervention, but with automated emails sent to their CarePartner after each IVR call, including feedback about the patient's status and suggestions for how the CarePartner could support disease care. Self-care and symptoms were measured via 6- and 12-month telephone surveys with a research associate. Self-care and symptom data also were collected through the weekly IVR assessments. Results: Participants were on average 67.8 years of age, 99\% were male (329/331), 77\% where white (255/331), and 59\% were married (195/331). During 15,709 call-weeks of attempted IVR assessments, patients completed 90\% of their calls with no difference in completion rates between arms. At both endpoints, composite quality of life scores were similar across arms. However, more mHealth+CP patients reported taking medications as prescribed at 6 months (8.8\% more, 95\% CI 1.2-16.5, P=.02) and 12 months (13.8\% more, CI 3.7-23.8, P<.01), and 10.2\% more mHealth+CP patients reported talking with their CarePartner at least twice per week at the 6-month follow-up (P=.048). mHealth+CP patients were less likely to report negative emotions during those interactions at both endpoints (both P<.05), were consistently more likely to report taking medications as prescribed during weekly IVR assessments, and also were less likely to report breathing problems or weight gains (all P<.05). Among patients with more depressive symptoms at enrollment, those randomized to mHealth+CP were more likely than standard mHealth patients to report excellent or very good general health during weekly IVR calls. Conclusions: Compared to a relatively intensive model of IVR monitoring, self-management assistance, and clinician alerts, a model including automated feedback to an informal caregiver outside the household improved HF patients' medication adherence and caregiver communication. mHealth+CP may also decrease patients' risk of HF exacerbations related to shortness of breath and sudden weight gains. mHealth+CP may improve quality of life among patients with greater depressive symptoms. Weekly health and self-care monitoring via mHealth tools may identify intervention effects in mHealth trials that go undetected using typical, infrequent retrospective surveys. Trial Registration: ClinicalTrials.gov NCT00555360; https://clinicaltrials.gov/ct2/show/NCT00555360 (Archived by WebCite at http://www.webcitation.org/6Z4Tsk78B). ",
doi="10.2196/jmir.4550",
url="http://www.jmir.org/2015/6/e142/",
url="http://www.ncbi.nlm.nih.gov/pubmed/26063161"
}


@Article{info:doi/10.2196/jmir.3717,
author="Cristancho-Lacroix, Victoria
and Wrobel, J{\'e}r{\'e}my
and Cantegreil-Kallen, Inge
and Dub, Timoth{\'e}e
and Rouquette, Alexandra
and Rigaud, Anne-Sophie",
title="A Web-Based Psychoeducational Program for Informal Caregivers of Patients With Alzheimer's Disease: A Pilot Randomized Controlled Trial",
journal="J Med Internet Res",
year="2015",
month="May",
day="12",
volume="17",
number="5",
pages="e117",
keywords="family caregivers",
keywords="psychological education",
keywords="eHealth",
keywords="Alzheimer disease",
keywords="emotional stress",
keywords="qualitative research",
keywords="Internet",
keywords="randomized controlled trials",
abstract="Background: Although several face-to-face programs are dedicated to informal caregivers of persons with dementia, they are not always accessible to overburdened or isolated caregivers. Based on a face-to-face intervention program, we adapted and designed a Web-based fully automated psychoeducational program (called Diapason) inspired by a cognitive approach. Objective: This study aimed to evaluate through a pilot unblinded randomized controlled trial the efficacy and acceptability of a Web-based psychoeducational program for informal caregivers of persons with Alzheimer's disease (PWAD) based on a mixed methods research design. Methods: We recruited and randomized offline 49 informal caregivers of a PWAD in a day care center in Paris, France. They either received the Web-based intervention and usual care for 3 months (experimental group, n=25) or only usual care (control group, n=24). Caregivers' perceived stress (PSS-14, primary outcome), self-efficacy, burden, perceived health status, and depression (secondary outcomes) were measured during 3 face-to-face on-site visits: at baseline, at the end of the program (month 3), and after follow-up (month 6). Additionally, semistructured interviews were conducted with experimental group caregivers at month 6 and examined with thematic analysis. Results: Intention-to-treat analysis did not show significant differences in self-perceived stress between the experimental and control groups (P=.98). The experimental group significantly improved their knowledge of the illness (d=.79, P=.008) from baseline to month 3. Of the 25 participants allocated to the experimental group, 17 (71\%) finished the protocol and entirely viewed at least 10 of 12 online sessions. On average, participants used the website 19.72 times (SD 12.88) and were connected for 262.20 minutes (SD 270.74). The results of the satisfaction questionnaire showed that most participants considered the program to be useful (95\%, 19/20), clear (100\%, 20/20), and comprehensive (85\%, 17/20). Significant correlations were found between relationship and caregivers' program opinion (P=.01). Thus, positive opinions were provided by husbands and sons (3/3), whereas qualified opinions were primarily reported by daughters (8/11). Female spouses expressed negative (2/3) or neutral opinions (1/3). Caregivers expected more dynamic content and further interaction with staff and peers. Conclusions: In this study, quantitative results were inconclusive owing to small sample size. Qualitative results indicated/showed little acceptance of the program and high expectations from caregivers. Caregivers did not rule out their interest in this kind of intervention provided that it met their needs. More dynamic, personalized, and social interventions are desirable. Our recruitment issues pointed out the necessity of in-depth studies about caregivers' help-seeking behaviors and readiness factors. Trial Registration: Clinicaltrials.gov NCT01430286; http://clinicaltrials.gov/ct2/show/NCT01430286 (Archived by WebCite at http://www.webcitation/6KxHaRspL). ",
doi="10.2196/jmir.3717",
url="http://www.jmir.org/2015/5/e117/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25967983"
}


@Article{info:doi/10.2196/jmir.4174,
author="Kitsiou, Spyros
and Par{\'e}, Guy
and Jaana, Mirou",
title="Effects of Home Telemonitoring Interventions on Patients With Chronic Heart Failure: An Overview of Systematic Reviews",
journal="J Med Internet Res",
year="2015",
month="Mar",
day="12",
volume="17",
number="3",
pages="e63",
keywords="home telemonitoring",
keywords="telemedicine",
keywords="telehealth",
keywords="remote monitoring",
keywords="remote consultation",
keywords="heart failure",
keywords="chronic diseases",
keywords="continuity of patient care",
keywords="physiologic monitoring",
keywords="ambulatory monitoring",
keywords="home care services",
keywords="review",
keywords="umbrella review",
keywords="systematic review",
keywords="meta-analysis",
abstract="Background: Growing interest on the effects of home telemonitoring on patients with chronic heart failure (HF) has led to a rise in the number of systematic reviews addressing the same or very similar research questions with a concomitant increase in discordant findings. Differences in the scope, methods of analysis, and methodological quality of systematic reviews can cause great confusion and make it difficult for policy makers and clinicians to access and interpret the available evidence and for researchers to know where knowledge gaps in the extant literature exist. Objective: This overview aims to collect, appraise, and synthesize existing evidence from multiple systematic reviews on the effectiveness of home telemonitoring interventions for patients with chronic heart failure (HF) to inform policy makers, practitioners, and researchers. Methods: A comprehensive literature search was performed on MEDLINE, EMBASE, CINAHL, and the Cochrane Library to identify all relevant, peer-reviewed systematic reviews published between January 1996 and December 2013. Reviews were searched and screened using explicit keywords and inclusion criteria. Standardized forms were used to extract data and the methodological quality of included reviews was appraised using the AMSTAR (assessing methodological quality of systematic reviews) instrument. Summary of findings tables were constructed for all primary outcomes of interest, and quality of evidence was graded by outcome using the GRADE (Grades of Recommendation, Assessment, Development, and Evaluation) system. Post-hoc analysis and subgroup meta-analyses were conducted to gain further insights into the various types of home telemonitoring technologies included in the systematic reviews and the impact of these technologies on clinical outcomes. Results: A total of 15 reviews published between 2003 and 2013 were selected for meta-level synthesis. Evidence from high-quality reviews with meta-analysis indicated that taken collectively, home telemonitoring interventions reduce the relative risk of all-cause mortality (0.60 to 0.85) and heart failure-related hospitalizations (0.64 to 0.86) compared with usual care. Absolute risk reductions ranged from 1.4\%-6.5\% and 3.7\%-8.2\%, respectively. Improvements in HF-related hospitalizations appeared to be more pronounced in patients with stable HF: hazard ratio (HR) 0.70 (95\% credible interval [Crl] 0.34-1.5]). Risk reductions in mortality and all-cause hospitalizations appeared to be greater in patients who had been recently discharged (?28 days) from an acute care setting after a recent HF exacerbation: HR 0.62 (95\% CrI 0.42-0.89) and HR 0.67 (95\% CrI 0.42-0.97), respectively. However, quality of evidence for these outcomes ranged from moderate to low suggesting that further research is very likely to have an important impact on our confidence in the observed estimates of effect and may change these estimates. The post-hoc analysis identified five main types of non-invasive telemonitoring technologies included in the systematic reviews: (1) video-consultation, with or without transmission of vital signs, (2) mobile telemonitoring, (3) automated device-based telemonitoring, (4) interactive voice response, and (5) Web-based telemonitoring. Of these, only automated device-based telemonitoring and mobile telemonitoring were effective in reducing the risk of all-cause mortality and HF-related hospitalizations. More research data are required for interactive voice response systems, video-consultation, and Web-based telemonitoring to provide robust conclusions about their effectiveness. Conclusions: Future research should focus on understanding the process by which home telemonitoring works in terms of improving outcomes, identify optimal strategies and the duration of follow-up for which it confers benefits, and further investigate whether there is differential effectiveness between chronic HF patient groups and types of home telemonitoring technologies. ",
doi="10.2196/jmir.4174",
url="http://www.jmir.org/2015/3/e63/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25768664"
}


@Article{info:doi/10.2196/medinform.3699,
author="Rocha, Pacheco Nelson
and Queir{\'o}s, Alexandra
and Augusto, Filipe
and Rodr{\'i}guez, Llerena Yosvany
and Cardoso, Carlos
and Grade, Miguel Jos{\'e}
and Quintas, Jo{\~a}o",
title="Information Persistence Services Designed to Support Home Care",
journal="JMIR Med Inform",
year="2015",
month="Mar",
day="10",
volume="3",
number="1",
pages="e15",
keywords="long-term care",
keywords="home help services",
keywords="personal health record",
keywords="electronic health record",
keywords="information management",
keywords="interoperability",
abstract="Background: Due to the challenges faced by health and social care systems, in particular those related to actual demographic trends, home care emerges as a potentially cost-effective solution to answer the needs of citizens, and to allow the reallocation of resources to alternatives to hospitalization or institutionalization. Objective: Home care services require cooperation between different actors, including health and social caregivers, care receivers, and their informal caregivers (eg, relatives or friends), across time, space, and organizational boundaries. Therefore, it is foreseeable that eHealth services can contribute to their improvement. The aim of this study is to evaluate information persistence services based on the Reference Information Model (RIM) of the Health Level Seven (HL7) version 3 to support formal caregivers, both health and social care providers, and informal caregivers in the context of home care services. Methods: A pilot study was set up involving two Portuguese institutions that provide home care services for the elderly. Defining of information requirements was performed according to a comprehensive process. This included a review of the literature, observations of work activities, interviews with caregivers, care receivers and their relatives, analysis of paper documentation related to care receivers' histories, health conditions and care plans, and brainstorming groups involving specialized professionals. Following this, information objects were implemented and validated. Results: The methodological approach, as well as the information persistence services, proved to be robust and adequate to specify, implement, and validate different types of information objects related to home care services for the elderly. This study also reinforces the application of the RIM of the HL7 version 3 beyond the strict scope of health care, allowing the persistence of not only health care information, but also information related to social assistance activities. Conclusions: This study contributes to the ongoing efforts related to the development of eHealth applications to improve the cooperation among formal health care and social caregivers, as well as care receivers and their informal caregivers. ",
doi="10.2196/medinform.3699",
url="http://medinform.jmir.org/2015/1/e15/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25757462"
}


@Article{info:doi/10.2196/resprot.4034,
author="Merch{\'a}n-Baeza, Antonio Jose
and Gonzalez-Sanchez, Manuel
and Cuesta-Vargas, Antonio",
title="Clinical Effect Size of an Educational Intervention in the Home and Compliance With Mobile Phone-Based Reminders for People Who Suffer From Stroke: Protocol of a Randomized Controlled Trial",
journal="JMIR Res Protoc",
year="2015",
month="Mar",
day="10",
volume="4",
number="1",
pages="e33",
keywords="stroke",
keywords="ADL",
keywords="environment",
keywords="patient adherence",
keywords="mobile apps",
keywords="mobile health",
abstract="Background: Stroke is the third-leading cause of death and the leading cause of long-term neurological disability in the world. Cognitive, communication, and physical weakness combined with environmental changes frequently cause changes in the roles, routines, and daily occupations of stroke sufferers. Educational intervention combines didactic and interactive intervention, which combines the best choices for teaching new behaviors since it involves the active participation of the patient in learning. Nowadays, there are many types of interventions or means to increase adherence to treatment. Objective: The aim of this study is to enable patients who have suffered stroke and been discharged to their homes to improve the performance of the activities of daily living (ADL) in their home environment, based on advice given by the therapist. A secondary aim is that these patients continue the treatment through a reminder app installed on their mobile phones. Methods: This study is a clinical randomized controlled trial. The total sample will consist of 80 adults who have suffered a stroke with moderate severity and who have been discharged to their homes in the 3 months prior to recruitment to the study. The following tests and scales will be used to measure the outcome variables: Barthel Index, the Functional Independence Measure, the Mini-Mental State Examination, the Canadian Neurological Scale, the Stroke Impact Scale-16, the Trunk Control Test, the Modified Rankin Scale, the Multidimensional Scale of Perceived Social Support, the Quality of Life Scale for Stroke, the Functional Reach Test, the Romberg Test, the Time Up and Go test, the Timed-Stands Test, a portable dynamometer, and a sociodemographic questionnaire. Descriptive analyses will include mean, standard deviation, and 95\% confidence intervals of the values for each variable. The Kolmogov-Smirnov (KS) test and a 2x2 mixed-model analysis of variance (ANOVA) will be used. Intergroup effect sizes will be calculated (Cohen's d). Results: Currently, the study is in the recruitment phase and implementation of the intervention has begun. The authors anticipate that during 2015 the following processes should be completed: recruitment, intervention, and data collection. It is expected that the analysis of all data and the first results should be available in early-to-mid 2016. Conclusions: An educational intervention based on therapeutic home advice and a reminder app has been developed by the authors with the intention that patients who have suffered stroke perform the ADL more easily and use their affected limbs more actively in the ADL. The use of reminders via mobile phone is proposed as an innovative tool to increase treatment adherence in this population. Trial Registration: ClinicalTrials.gov NCT01980641; https://clinicaltrials.gov/ct2/show/NCT01980641 (Archived by WebCite at http://www.webcitation.org/6WRWFmY6U). ",
doi="10.2196/resprot.4034",
url="http://www.researchprotocols.org/2015/1/e33/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25757808"
}


@Article{info:doi/10.2196/ijmr.3127,
author="Kim, Heejung",
title="Understanding Internet Use Among Dementia Caregivers: Results of Secondary Data Analysis Using the US Caregiver Survey Data",
journal="Interact J Med Res",
year="2015",
month="Feb",
day="23",
volume="4",
number="1",
pages="e1",
keywords="Internet",
keywords="dementia",
keywords="caregiver",
keywords="stress",
keywords="consumer health information",
abstract="Background: Informal caregivers of persons with dementia experience higher levels of chronic stress in the caregiving trajectory. The Internet provides diverse types of caregiver resources that may help ameliorate their stress and relevant negative outcomes. However, there is limited information about the prevalence and factors of using Internet-based resources for health- and caregiving-related purposes in informal caregivers of persons with dementia. Objective: Specific aims of this study were (1) to determine the prevalence and factors of caregiver's health-related Internet use and (2) to compare sociodemographic and caregiving-related characteristics between health-related Internet users and non--health-related Internet users among informal caregivers of persons with dementia. Methods: This quantitative investigation was a descriptive correlational design using a secondary data analysis. Primary data were collected via a survey conducted in 2009 by the National Alliance for Caregiving and the American Association of Retired Persons. Telephone interviews utilizing standardized questionnaires were used to collect self-reported information about sociodemographics and caregiving-related history (N=450). Descriptive statistics and a hierarchical binary logistic regression analysis were completed based on the stress process model. Results: Approximately 59\% (265/450) of dementia caregivers were identified as health-related Internet users. Caregivers' sociodemographics and their subjective responses of caregiving stress were the most significant factors to identify health-related Internet users followed by workload assisting in instrumental activities of daily living of persons with dementia. There were significant differences for caregiver's age, levels of education and income, hours spent caregiving, and the relationship to persons with dementia between health-related Internet users and non--health-related Internet users (P<.05 for all). After controlling for confounding effects, younger age of persons with dementia (OR 0.278, 95\% CI 0.085-0.906), higher education levels of caregivers (OR 3.348, 95\% CI 2.019-5.552), shorter caregiving time spent per week (OR 0.452, 95\% CI 0.243-0.840), higher levels of caregiver's emotional stress (OR 1.249, 95\% CI 1.004-1.555), and financial hardship (OR 4.61, 95\% CI 1.416-14.978) were identified as newly emerging factors of health-related Internet use. Conclusions: Although the Internet provided useful resources for caregivers of persons with dementia, dementia caregivers reported lower levels of health-related Internet use compared to the general public. Our findings confirmed the impact of age, education levels, and/or income on Internet use reported in previous studies. However, the predictive value of subjective responses of caregiving stress for health-related Internet use was a new addition. These findings will assist health care providers, researchers, and policy makers in identifying who is the least likely to access Internet-based resources and how Internet-based strategies can best be designed, implemented, and distributed to meet the needs of this group of users. ",
doi="10.2196/ijmr.3127",
url="http://www.i-jmr.org/2015/1/e1/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25707033"
}


@Article{info:doi/10.2196/jmir.4064,
author="Cattelani, Luca
and Palumbo, Pierpaolo
and Palmerini, Luca
and Bandinelli, Stefania
and Becker, Clemens
and Chesani, Federico
and Chiari, Lorenzo",
title="FRAT-up, a Web-based Fall-Risk Assessment Tool for Elderly People Living in the Community",
journal="J Med Internet Res",
year="2015",
month="Feb",
day="18",
volume="17",
number="2",
pages="e41",
keywords="accidental falls",
keywords="odds ratio",
keywords="risk assessment",
keywords="risk factors",
keywords="ROC curve",
keywords="aged",
abstract="Background: About 30\% of people over 65 are subject to at least one unintentional fall a year. Fall prevention protocols and interventions can decrease the number of falls. To be effective, a prevention strategy requires a prior step to evaluate the fall risk of the subjects. Despite extensive research, existing assessment tools for fall risk have been insufficient for predicting falls. Objective: The goal of this study is to present a novel web-based fall-risk assessment tool (FRAT-up) and to evaluate its accuracy in predicting falls, within a context of community-dwelling persons aged 65 and up. Methods: FRAT-up is based on the assumption that a subject's fall risk is given by the contribution of their exposure to each of the known fall-risk factors. Many scientific studies have investigated the relationship between falls and risk factors. The majority of these studies adopted statistical approaches, usually providing quantitative information such as odds ratios. FRAT-up exploits these numerical results to compute how each single factor contributes to the overall fall risk. FRAT-up is based on a formal ontology that enlists a number of known risk factors, together with quantitative findings in terms of odds ratios. From such information, an automatic algorithm generates a rule-based probabilistic logic program, that is, a set of rules for each risk factor. The rule-based program takes the health profile of the subject (in terms of exposure to the risk factors) and computes the fall risk. A Web-based interface allows users to input health profiles and to visualize the risk assessment for the given subject. FRAT-up has been evaluated on the InCHIANTI Study dataset, a representative population-based study of older persons living in the Chianti area (Tuscany, Italy). We compared reported falls with predicted ones and computed performance indicators. Results: The obtained area under curve of the receiver operating characteristic was 0.642 (95\% CI 0.614-0.669), while the Brier score was 0.174. The Hosmer-Lemeshow test indicated statistical significance of miscalibration. Conclusions: FRAT-up is a web-based tool for evaluating the fall risk of people aged 65 or up living in the community. Validation results of fall risks computed by FRAT-up show that its performance is comparable to externally validated state-of-the-art tools. A prototype is freely available through a web-based interface. Trial Registration: ClinicalTrials.gov NCT01331512 (The InChianti Follow-Up Study); http://clinicaltrials.gov/show/NCT01331512 (Archived by WebCite at http://www.webcitation.org/6UDrrRuaR). ",
doi="10.2196/jmir.4064",
url="http://www.jmir.org/2015/2/e41/",
url="http://www.ncbi.nlm.nih.gov/pubmed/25693419"
}