TY - JOUR AU - Wang, Longyun AU - Wang, Zeyu AU - Zhao, Bowei AU - Wang, Kai AU - Zheng, Jingying AU - Zhao, Lijing PY - 2025/4/18 TI - Diagnosis Test Accuracy of Artificial Intelligence for Endometrial Cancer: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e66530 VL - 27 KW - artificial intelligence KW - endometrial cancer KW - diagnostic test accuracy KW - systematic review KW - meta-analysis KW - machine learning KW - deep learning N2 - Background: Endometrial cancer is one of the most common gynecological tumors, and early screening and diagnosis are crucial for its treatment. Research on the application of artificial intelligence (AI) in the diagnosis of endometrial cancer is increasing, but there is currently no comprehensive meta-analysis to evaluate the diagnostic accuracy of AI in screening for endometrial cancer. Objective: This paper presents a systematic review of AI-based endometrial cancer screening, which is needed to clarify its diagnostic accuracy and provide evidence for the application of AI technology in screening for endometrial cancer. Methods: A search was conducted across PubMed, Embase, Cochrane Library, Web of Science, and Scopus databases to include studies published in English, which evaluated the performance of AI in endometrial cancer screening. A total of 2 independent reviewers screened the titles and abstracts, and the quality of the selected studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies?2 (QUADAS-2) tool. The certainty of the diagnostic test evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. Results: A total of 13 studies were included, and the hierarchical summary receiver operating characteristic model used for the meta-analysis showed that the overall sensitivity of AI-based endometrial cancer screening was 86% (95% CI 79%-90%) and specificity was 92% (95% CI 87%-95%). Subgroup analysis revealed similar results across AI type, study region, publication year, and study type, but the overall quality of evidence was low. Conclusions: AI-based endometrial cancer screening can effectively detect patients with endometrial cancer, but large-scale population studies are needed in the future to further clarify the diagnostic accuracy of AI in screening for endometrial cancer. Trial Registration: PROSPERO CRD42024519835; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024519835 UR - https://www.jmir.org/2025/1/e66530 UR - http://dx.doi.org/10.2196/66530 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/66530 ER - TY - JOUR AU - Churchill, Alexandra AU - Georgiou, Ektoras AU - Abruzzo, Veronica AU - Polyakov, Alex AU - Teh, Tinn Wan PY - 2025/4/11 TI - Feasibility of a Progesterone-Modified Natural Protocol for Frozen Embryo Transfer: Protocol for a Pilot Cohort Study JO - JMIR Res Protoc SP - e66579 VL - 14 KW - frozen embryo transfer KW - fertility care KW - reproductive health KW - infertility KW - progesterone-modified natural cycle protocol KW - in vitro fertilization N2 - Background: With the existence of various frozen embryo transfer (FET) methods currently used in the field of assisted reproductive technologies, the debate surrounding which of these is superior remains. All FET protocols aim to prime the endometrium and time embryo transfer during the window of implantation. Current methods include the true natural cycle FET (tNFET), modified natural cycle FET, artificial cycle FET, and ovulation induction. Each of these harbors, distinct advantages and disadvantages, namely, surrounding the timing of transfer and flexibility conferred through this process. More recently, a newer approach has been used whereby the need to monitor or trigger ovulation is circumvented, with luteal phase support commenced once a certain follicle diameter and endometrial thickness criteria are met but before ovulation. However, the research into this protocol has certain important limitations that our study seeks to address. Objective: This study aims to assess the feasibility of a progesterone-modified natural cycle protocol for FET. The primary outcome will be the presence of a corpus luteum on ultrasound scans on the day of embryo transfer. The secondary outcomes will include the number of clinic visits required per patient undergoing the protocol, biochemical pregnancy rate, and clinical pregnancy rate. Methods: We will conduct a prospective cohort study, recruiting 20 women undertaking FET at the Public Fertility Care of The Royal Women?s Hospital in Melbourne, Australia. These women will be matched to a control group who have undergone the tNFET protocol within the preceding 12 months of the study start date. Results: This project received ethics approval on July 17, 2024, with commencement of the study in September 2024, aiming for a duration of completion of 9 months. The completion of the follow-up and submission of the study for publication are anticipated for September 2025. Conclusions: After this preliminary study, the aim would be to progress to a noninferiority randomized controlled trial to compare the progesterone-modified natural cycle protocol for FET to the tNFET. International Registered Report Identifier (IRRID): PRR1-10.2196/66579 UR - https://www.researchprotocols.org/2025/1/e66579 UR - http://dx.doi.org/10.2196/66579 UR - http://www.ncbi.nlm.nih.gov/pubmed/40215104 ID - info:doi/10.2196/66579 ER - TY - JOUR AU - Price, L. Sarah A. AU - Koye, N. Digsu AU - Lewin, Alice AU - Nankervis, Alison AU - Kane, C. Stefan PY - 2025/4/11 TI - Maternal Metabolic Health and Mother and Baby Health Outcomes (MAMBO): Protocol of a Prospective Observational Study JO - JMIR Res Protoc SP - e72542 VL - 14 KW - preconception KW - large for gestational age KW - small for gestational age KW - pregnancy outcomes KW - metabolic disease KW - diabetes KW - obesity KW - hypertension N2 - Background: Metabolic disease is increasingly impacting women of reproductive age. In pregnancy, uncontrolled metabolic disease can result in offspring with major congenital anomalies, preterm birth, and abnormal fetal growth. Pregnancy also accelerates the complications of metabolic diseases in mothers resulting in an increased risk of premature cardiovascular events. Despite the convincing evidence that preconception care can largely mitigate the risks of metabolic disease in pregnancy, there are few data about how to identify the highest-risk women so that they can be connected with appropriate preconception care services. Objective: The aim of the study is to determine the maternal phenotype that represents the highest risk of having adverse neonatal and maternal pregnancy outcomes. Methods: This will be a prospective cohort study of 500 women recruited in early pregnancy. The primary outcome is a composite of offspring born small for gestational age (SGA) or large for gestational age (LGA) (customized birthweight ?10th and ?90th centile for gestational age). Secondary outcomes are (1) composite of adverse neonatal birth outcomes (SGA, LGA, major congenital abnormalities, preterm birth [<37 weeks? gestation]) and (2) composite of new maternal metabolic outcomes (gestational diabetes, diabetes in pregnancy, type 2 diabetes [T2D] or prediabetes; gestational hypertension, preeclampsia, eclampsia or new essential hypertension after pregnancy; and gestational weight gain ?20kg or new overweight/obesity at the 12-18 months postpartum visit). A multivariable logistic regression analysis will be conducted to identify candidate predictors of poor pregnancy outcomes due to metabolic disease. From this model, model coefficients and the associated 95% CIs will be extracted to derive the risk score for predicting the delivery of LGA/SGA offspring (primary outcome) and composites of adverse neonatal outcomes and maternal outcomes (secondary outcomes). Results: Seed funding for the project was acquired in November 2022 and subsequent funding was acquired in May 2024. The first participant was recruited on March 23, 2023. At the time of manuscript submission, 402 participants have been recruited. Data analysis has not yet been performed. Results are expected to be published in the first half of 2027. Conclusions: This is a prospective observational cohort study that intends to identify the metabolic disease risk factors, or combination of factors, that are most likely to cause adverse maternal and fetal health outcomes. These characteristics will be used to develop a risk calculator which will assist in identifying the highest risk women and in triaging them to appropriate services. The study has been approved by the institutional Human Research Ethics Committee (HREC/90080/MH-2022). Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12623000037606; https://tinyurl.com/yeytsxtp International Registered Report Identifier (IRRID): DERR1-10.2196/72542 UR - https://www.researchprotocols.org/2025/1/e72542 UR - http://dx.doi.org/10.2196/72542 UR - http://www.ncbi.nlm.nih.gov/pubmed/40215105 ID - info:doi/10.2196/72542 ER - TY - JOUR AU - Juqu, Z. Final AU - Baloyi, B. Olivia AU - Mbobnda Kapche, L. Esther AU - ten Ham-Baloyi, Wilma AU - Chironda, Geldine AU - Xulu-Kasaba, Nokuthula Zamadonda PY - 2025/4/10 TI - Experiences of Birth Attendants on Upward Obstetric Emergency Referrals in Low- and Middle-Income Countries: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e64886 VL - 14 KW - referral systems KW - upward referral KW - obstetric emergencies KW - traditional birth attendants KW - skilled birth attendants KW - low- and middle-income countries KW - birth attendants KW - obstetric KW - middle-income countries KW - scoping review protocol KW - pregnancy KW - neonatal deaths KW - deaths KW - obstetric care KW - health care KW - medical education KW - mortality KW - Africa KW - pregnant KW - women?s health N2 - Background: Every day, approximately 800 women die from pregnancy-related causes, alongside 2.6 million stillbirths and 2.8 million neonatal deaths annually. Inadequate referral by skilled birth attendants hinders timely access to necessary emergency obstetric care, challenging progress toward the maternal health Sustainable Development Goal (SDG) 3. The COVID-19 pandemic further disrupted care in low- and middle-income countries, forcing women to rely on traditional birth attendants, thereby affecting the referral system. It is crucial to understand the experiences of both skilled and traditional birth attendants regarding upward referrals in emergency obstetric care to identify barriers and facilitators within these systems in low- and middle-income countries. Objective: This study aims to map existing evidence on the experiences of skilled and traditional birth attendants regarding upward referral systems in emergency obstetric care within low- and middle-income countries. Methods: We will conduct a scoping review guided by the Joanna Briggs Institute?s methodological framework. Studies will be included if they report on experiences with upward referral in obstetrical emergencies. We will consider studies published in English and French from 2016 to July 2024. The literature search will be conducted in databases including PubMed, EBSCOhost (Academic Search Complete and CINAHL with full text), Scopus, Web of Science, and Google Scholar. Identified citations will be managed using EndNote version 21 (Clarivate Analytics) and Rayyan. Two independent reviewers will screen eligible studies and resolve disagreements through discussion with a third reviewer. Data will be extracted using a validated form and analyzed through content analysis, with findings presented narratively. This protocol aligns with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The review will offer a comprehensive narrative of upward referral systems in obstetrical emergencies, focusing on transitions from traditional birth attendants to health care facilities and from lower to higher levels of health care. Results: The preliminary search was completed in August 2024, and the database search will be conducted within the next 6 months. Findings will be disseminated through medical education conferences and publications. Conclusions: This review contributes a comprehensive narrative of upward referral systems in obstetrical emergencies, aiming to enhance understanding and improve transitions from traditional birth attendants to health care facilities and between different health care levels. It could significantly impact maternal and neonatal care by identifying the referral experiences of both skilled and traditional birth attendants. The insights may inform interventions that integrate traditional birth attendants into health care systems, potentially reducing maternal and neonatal mortality. The results will guide future research aimed at developing a model to improve upward referrals for obstetric emergencies in sub-Saharan Africa. Trial Registration: Open Science Framework 4HAVZ; https://osf.io/4havz International Registered Report Identifier (IRRID): PRR1-10.2196/64886 UR - https://www.researchprotocols.org/2025/1/e64886 UR - http://dx.doi.org/10.2196/64886 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64886 ER - TY - JOUR AU - Dougherty, Kylie AU - Tesfaye, Yihenew AU - Biza, Heran AU - Belew, Mulusew AU - Benda, Natalie AU - Gebremariam Gobezayehu, Abebe AU - Cranmer, John AU - Bakken, Suzanne PY - 2025/4/3 TI - User-Centered Design of an Electronic Dashboard for Monitoring Facility-Level Basic Emergency Obstetric Care Readiness in Amhara, Ethiopia: Mixed Methods Study JO - JMIR Hum Factors SP - e64131 VL - 12 KW - health information technology KW - design and evaluation KW - Ethiopia KW - usability KW - nursing informatics KW - user-centered design KW - basic emergency obstetric care KW - obstetric KW - nurse KW - user-centered KW - design KW - maternal mortality KW - maternal KW - develop KW - sub-Saharan Africa KW - Africa KW - dashboard KW - tracking KW - emergency care N2 - Background: Maternal mortality remains a persistent public health concern in sub-Saharan African countries such as Ethiopia. Health information technology solutions are a flexible and low-cost method for improving health outcomes with proven benefits in low- to middle-income countries? health systems. Objective: This study aimed to develop and assess the usability of an electronic dashboard to monitor facility-level readiness to manage basic emergency obstetric care (BEmOC) in Amhara, Ethiopia. Methods: The study used three methods to iteratively refine the dashboard: (1) user-centered design sessions with individuals who interact with the BEmOC supply chain, (2) review and feedback from domain and information visualization subject matter experts (SMEs) to refine the dashboard, and (3) usability heuristic evaluation with human-computer interaction (HCI) SMEs. Results: User-centered design sessions resulted in a preliminary version of the dashboard informed by end-user preferences and perceptions, with recommendations focusing on aesthetic design, filtering and sorting, and matching with the real world. An example of an end-user recommendation included increasing font sizes on the dashboard and using a red, yellow, and green color-coding scheme. Next, domain and visualization SMEs continued the dashboard?s iterative refinement, focusing on aesthetic design and navigation, by confirming design choices incorporated from the user-centered design sessions and recommending changes to enhance user experience moving through the dashboard, such as adding more filtering options. HCI SMEs rated the dashboard as highly usable (0.82 on a scale of 0-4, with 0 being no usability concern and 4 being a catastrophic usability concern). The principle with the highest usability severity scores was a match between the system and the real world with a score of 1.4. The HCI SMEs also rated the information visualization aspects of the dashboard favorably with 2 usability principles, spatial organization and information coding, scoring 0. Conclusions: Dashboards are a novel method for promoting and tracking facility capacity to manage BEmOC. By including targeted end users and SMEs in the design process, the team was able to tailor the dashboard to meet user needs, fit it into the existing government health systems, and ensure that the dashboard follows design best practices. Collectively, the novel, customized BEmOC dashboard can be used to track and improve facility-level readiness in Amhara, Ethiopia, and similar global BEmOC facilities. UR - https://humanfactors.jmir.org/2025/1/e64131 UR - http://dx.doi.org/10.2196/64131 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64131 ER - TY - JOUR AU - Groene, Nicole AU - Nickel, Audrey AU - Rohn, E. Amanda PY - 2025/4/3 TI - Insights on the Side Effects of Female Contraceptive Products From Online Drug Reviews: Natural Language Processing?Based Content Analysis JO - JMIR AI SP - e68809 VL - 4 KW - contraception KW - side effects KW - natural language processing KW - NLP KW - informed choices KW - online reviews KW - women KW - well-being N2 - Background: Most online and social media discussions about birth control methods for women center on side effects, highlighting a demand for shared experiences with these products. Online user reviews and ratings of birth control products offer a largely untapped supplementary resource that could assist women and their partners in making informed contraception choices. Objective: This study sought to analyze women?s online ratings and reviews of various birth control methods, focusing on side effects linked to low product ratings. Methods: Using natural language processing (NLP) for topic modeling and descriptive statistics, this study analyzes 19,506 unique reviews of female contraceptive products posted on the website Drugs.com. Results: Ratings vary widely across contraception types. Hormonal contraceptives with high systemic absorption, such as progestin-only pills and extended-cycle pills, received more unfavorable reviews than other methods and women frequently described menstrual irregularities, continuous bleeding, and weight gain associated with their administration. Intrauterine devices were generally rated more positively, although about 1 in 10 users reported severe cramps and pain, which were linked to very poor ratings. Conclusions: While exploratory, this study highlights the potential of NLP in analyzing extensive online reviews to reveal insights into women?s experiences with contraceptives and the impact of side effects on their overall well-being. In addition to results from clinical studies, NLP-derived insights from online reviews can provide complementary information for women and health care providers, despite possible biases in online reviews. The findings suggest a need for further research to validate links between specific side effects, contraceptive methods, and women?s overall well-being. UR - https://ai.jmir.org/2025/1/e68809 UR - http://dx.doi.org/10.2196/68809 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68809 ER - TY - JOUR AU - Pereira, P. Ana AU - Janela, Dora AU - Areias, C. Anabela AU - Molinos, Maria AU - Tong, Xin AU - Bento, Virgílio AU - Yanamadala, Vijay AU - Atherton, Jennesa AU - Dias Correia, Fernando AU - Costa, Fabíola PY - 2025/4/2 TI - Innovating Care for Postmenopausal Women Using a Digital Approach for Pelvic Floor Dysfunctions: Prospective Longitudinal Cohort Study JO - JMIR Mhealth Uhealth SP - e68242 VL - 13 KW - women's health KW - pelvic floor muscle training KW - physical therapy KW - menopause KW - digital therapeutics KW - biofeedback KW - mobile phone N2 - Background: The menopause transition is a significant life milestone that impacts quality of life and work performance. Among menopause-related conditions, pelvic floor dysfunctions (PFDs) affect ?40%?50% of postmenopausal women, including urinary or fecal incontinence, genito-pelvic pain, and pelvic organ prolapse. While pelvic floor muscle training (PFMT) is the primary treatment, access barriers leave many untreated, advocating for new care delivery models. Objective: This study aims to assess the outcomes of a digital pelvic program, combining PFMT and education, in postmenopausal women with PFDs. Methods: This prospective, longitudinal study evaluated engagement, safety, and clinical outcomes of a remote digital pelvic program among postmenopausal women (n=3051) with PFDs. Education and real-time biofeedback PFMT sessions were delivered through a mobile app. The intervention was asynchronously monitored and tailored by a physical therapist specializing in pelvic health. Clinical measures assessed pelvic floor symptoms and their impact on daily life (Pelvic Floor Impact Questionnaire?short form 7, Urinary Impact Questionnaire?short form 7, Colorectal-Anal Impact Questionnaire?short form 7, and Pelvic Organ Prolapse Impact Questionnaire?short form 7), mental health, and work productivity and activity impairment. Structural equation modeling and minimal clinically important change response rates were used for analysis. Results: The digital pelvic program had a high completion rate of 77.6% (2367/3051), as well as a high engagement and satisfaction level (8.6 out of 10). The safety of the intervention was supported by the low number of adverse events reported (21/3051, 0.69%). The overall impact of pelvic floor symptoms in participants? daily lives decreased significantly (?19.55 points, 95% CI ?22.22 to ?16.88; P<.001; response rate of 59.5%, 95% CI 54.9%-63.9%), regardless of condition. Notably, nonwork-related activities and productivity impairment were reduced by around half at the intervention-end (?18.09, 95% CI ?19.99 to ?16.20 and ?15.08, 95% CI ?17.52 to ?12.64, respectively; P<.001). Mental health also improved, with 76.1% (95% CI 60.7%-84.9%; unadjusted: 97/149, 65.1%) and 54.1% (95% CI 39%-68.5%; unadjusted: 70/155, 45.2%) of participants with moderate to severe symptomatology achieving the minimal clinically important change for anxiety and depression, respectively. Recovery was generally not influenced by the higher baseline symptoms? burden in individuals with younger age, high BMI, social deprivation, and residence in urban areas, except for pelvic health symptoms where lower BMI levels (P=.02) and higher social deprivation (P=.04) were associated with a steeper recovery. Conclusions: This study demonstrates the feasibility, safety, and positive clinical outcomes of a fully remote digital pelvic program to significantly improve PFD symptoms, mental health, and work productivity in postmenopausal women while enhancing equitable access to personalized interventions that empower women to manage their condition and improve their quality of life. Trial Registration: ClinicalTrials.gov NCT05513417; https://clinicaltrials.gov/study/NCT05513417 UR - https://mhealth.jmir.org/2025/1/e68242 UR - http://dx.doi.org/10.2196/68242 ID - info:doi/10.2196/68242 ER - TY - JOUR AU - Abou Malham, Sabina AU - Traoré, Doufain AU - Dicko, Fatoumata AU - Blouin Genest, Gabriel AU - Boudreau, Jennyfer AU - Sidibé, Mansa Drissa AU - Sidibé, Souleymane AU - Goïta, Souleymane Issa AU - Sangaré, Aminata AU - Togo, Mohamed AU - Diarra, Delphine AU - Rietmann, Michèle AU - Maïga, Mahamoudou Mahamane AU - Boulanger, Suzie AU - Grégoire, Isabelle Ann AU - Milot, David-Martin AU - Berbiche, Djamal AU - Stecko, Sarah PY - 2025/4/1 TI - Assessment of Community Stakeholders? and Health Educators and Professionals? Needs for the Continuous Enhancement of Sexual and Reproductive Health and Rights in Mali (Project CLEFS): Protocol for a Convergent Mixed Methods Study JO - JMIR Res Protoc SP - e64796 VL - 14 KW - mixed methods study KW - protocol KW - sexual and reproductive health and rights KW - Mali KW - primary health care providers KW - women and girls? health needs N2 - Background: In Mali, a lack of qualified human resources in primary health care and sexual and reproductive health and rights (SRHR) is one of the greatest barriers to the population?s access to standard health services. Frontline professional training must be strengthened to respond to the needs of the population, particularly those of women and girls. Training must be conducted using an interdisciplinary and adapted approach to promote gender equality. Objective: This study aims to identify the SRHR training needs among the community, educational actors, and primary health care providers. Methods: A concurrent mixed methods design was adopted, using 2 methods. A quantitative method, through a cross-sectional analytical survey, will be conducted at the community level with university community health centers (CSCom-U) users and adolescents in CSCom-U health areas, as well as at the health education institution and community health centers levels with teachers, students, and interdisciplinary professional groups within the CSCom-U and district hospital maternity. Descriptive and inferential analyses will be conducted to process quantitative data. This research is at the stage of data analysis and interpretation. A qualitative method, based on 3 sources of data (focus groups, individual semistructured interviews, and document analysis), which involved the same targets as the quantitative component, with additional community actors such as Community Health Associations (Associations de santé communautaire) and Women?s Service User Communities. A thematic analysis of the qualitative data using a mixed deductive and inductive method will be performed. Results: : Field data collection took place from March to April 2022. Quantitative data from 3153 participants are being analyzed using SPSS. Qualitative data from 11 interviews and 27 focus groups were processed with Qualitative Data Analysis Miner. Data analysis is still ongoing. Conclusions: This study will provide a better understanding of adolescents and SRHR user?s service needs in terms of health services availability and quality and SRHR knowledge, issues related to student training quality, the level of adequacy between the training offered and the actual needs of the service recipients, and the level of preparation and ability of teachers to provide quality teaching taking gender equity into account. The recommendations drawn from this assessment will propose concrete actions to improve women and girls? health services provided by professionals, and to better adapt the future health professionals? profiles to the needs of communities, particularly those of women and girls. International Registered Report Identifier (IRRID): DERR1-10.2196/64796 UR - https://www.researchprotocols.org/2025/1/e64796 UR - http://dx.doi.org/10.2196/64796 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64796 ER - TY - JOUR AU - Cagnacci, Angelo AU - Grandi, Giovanni AU - Capobianco, Giampiero AU - Fulghesu, Maria Anna AU - Morgante, Giuseppe AU - Biondelli, Vincenzo AU - Piccolo, Elena AU - Casolati, Elena AU - Mangrella, Mario PY - 2025/3/31 TI - Effects of a Monophasic Hormonal Contraceptive With Norgestimate+Ethinyl Estradiol on Menstrual Bleeding: Protocol and Design of a Multicenter, Prospective, Open-Label, Noncomparative Study in Italy JO - JMIR Res Protoc SP - e63683 VL - 14 KW - combined oral contraceptive KW - ethinyl estradiol KW - menstrual cycle KW - monophasic KW - norgestimate KW - hormonal contraceptive KW - menstrual health KW - Italy KW - women?s health KW - patient-reported outcomes KW - methodology KW - observational study KW - reproductive health KW - data analysis KW - assessment N2 - Background: Norgestimate (NGM) is a progestin with negligible androgenic activity that is available in combination with ethinyl estradiol (EE) as a monophasic combined oral contraceptive (COC). It has been more than 30 years since a clinical study evaluated the effects of monophasic NGM/EE on menstrual cycle characteristics in healthy women, and in the interim, there has been growing recognition that clinical trials of contraceptives should evaluate a wide range of potential positive and negative impacts for users. Objective: The aim of this study is to investigate menstrual cycle control during the use of a monophasic COC formulation containing NGM 0.25 mg and EE 0.035 mg (Effimia; Italfarmaco SpA), using established methodologies as well as patient-reported outcomes. Methods: This is a prospective observational study being undertaken in a target population of 228 healthy Italian women aged 18-35 years who are starting oral contraception for the first time or switching from another COC. The participants are asked to complete a diary for 6 cycles recording information about their menstrual cycles (frequency, duration, regularity, estimated flow volume, and breakthrough bleeding), any unscheduled bleeding, and an evaluation of dysmenorrhea, using a 100-mm visual analog scale from 0=no pain to 100=very severe pain, and any adverse events. Compliance is assessed after 3 and 6 months via returned medication. The primary end point is the change from baseline in the rate of intermenstrual bleeding during the sixth cycle. At baseline, 3 months, and 6 months, acne will also be assessed using the Global Acne Grading Scale, and participants will complete a Profile of Mood State to assess premenstrual syndrome and the Female Sexual Function Index to evaluate the quality of their sex life. A subgroup of 28 participants at 1 site (Genoa) is also providing a blood sample for the assessment of metabolic, endocrine, and coagulation parameters. Results: Study enrollment began in July 2023 and is expected to be complete by December 2024. Data analysis is expected to be complete by October 2025. Conclusions: This study into the effects of monophasic NGM/EE 0.25/0.035 mg on menstrual characteristics in healthy Italian women will provide up-to-date data on these effects and includes assessments of a range of other parameters, such as acne severity and patient-reported outcomes, in line with recent international consensus recommendations. Trial Registration: ClinicalTrials.gov NCT06067256; https://clinicaltrials.gov/study/NCT06067256 and EudraCT 2021-003027-15; https://www.clinicaltrialsregister.eu/ctr-search/trial/2021-003027-15/IT International Registered Report Identifier (IRRID): DERR1-10.2196/63683 UR - https://www.researchprotocols.org/2025/1/e63683 UR - http://dx.doi.org/10.2196/63683 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63683 ER - TY - JOUR AU - Bologna, Federica AU - Thalken, Rosamond AU - Pepin, Kristen AU - Wilkens, Matthew PY - 2025/3/31 TI - Endometriosis Communities on Reddit: Quantitative Analysis JO - J Med Internet Res SP - e57987 VL - 27 KW - online health communities KW - patient-centered care KW - chronic disease KW - internet KW - consumer health information KW - self-help groups KW - community networks KW - information science KW - social support N2 - Background: Endometriosis is a chronic condition that affects 10% of the people with a uterus. Due to the complex social and psychological impacts caused by this condition, people with endometriosis often turn to online health communities (OHCs) for support. Objective: Prior work identifies a lack of large-scale analyses of the experiences of patients with endometriosis and of OHCs. This study aims to fill this gap by investigating aspects of the condition and aggregate user needs that emerge from 2 endometriosis OHCs, r/Endo and r/endometriosis. Methods: We used latent Dirichlet allocation topic modeling, an unsupervised machine learning method, to extract the subject matter (?topic?) of >30,000 posts and >300,000 comments. In addition to latent Dirichlet allocation, we leveraged supervised classification. Specifically, we fine-tuned a series of the DistilBERT models to identify the people and relationships (personas) a post mentions as well as the type of support that the post seeks (intent). Combining the results of these 2 methods, we identified associations between a post?s topic, the personas mentioned, and the post?s intent. Results: The most discussed topics in posts were medical stories, medical appointments, sharing symptoms, menstruation, and empathy. Through the combination of the results from topic modeling and supervised classification, we found that when discussing medical appointments, users were more likely to mention the endometriosis OHCs than medical professionals. Medical professional was the least likely of any persona to be associated with empathy. Posts that mentioned partner or family were likely to discuss topics from the life issues category, particularly fertility. Users sought experiential knowledge regarding treatments and health care processes, and they also wished to vent and establish emotional connections about the life-altering aspects of the condition. Conclusions: We conclude that members of the OHCs need greater empathy within clinical settings, easier access to appointments, more information on care pathways, and more support for their loved ones. Endometriosis OHCs currently fulfill some of these needs as they provide members with a space where they can receive validation, discuss care pathways, and learn to manage symptoms. This study demonstrates the value of quantitative analyses of OHCs. Computational analyses can support and extend findings from small-scale studies about patient experiences and provide insights into hard-to-reach groups. Finally, we provide recommendations for clinical practice and medical training programs. UR - https://www.jmir.org/2025/1/e57987 UR - http://dx.doi.org/10.2196/57987 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57987 ER - TY - JOUR AU - Rajput, Shivshankar AU - Mata, Shweta AU - Saxena, Upma AU - Ota, Sarada AU - Gupta, Bharti PY - 2025/3/31 TI - Ayurveda Management of Menorrhagia (Raktapradara): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e60801 VL - 14 KW - Ashokarishta KW - Trinakantamani pishti KW - tranexamic acid KW - menorrhagia KW - Raktapradara N2 - Background: In India, heavy menstrual bleeding or menorrhagia (Raktapradara) constitutes about 15% to 20% of all gynecological admissions in an institution. Of these, 43% of patients are aged 20-40 years. This condition is worsening because of the high prevalence of anemia among Indian women. Menorrhagia can have a significant impact on women?s lives. Medical treatment is usually the first choice in excessive bleeding, but it reduces menstrual blood loss by only 50%, and up to 50% of women undergo surgical treatment within 5 years. However, none of these treatments proved their definite efficacy in spite of the high price and side effects. This condition presents a major financial burden on health care services. In Ayurveda, encouraging work has been done on the compound drug Ashokarishta, and the drug Trinakantamani pishti is indicated in Ayurvedic classics and the Ayurvedic Formulary of India. Also, these medicines have been used in Ayurvedic practice for a long time. However, no clinical trial has been carried out on these formulations. Objective: The primary objective is to evaluate the efficacy of Ayurvedic intervention in the management of menorrhagia, and the secondary objective is to assess the efficacy of Ayurvedic intervention on the quality of life of the women with menorrhagia. Methods: This ongoing study is an open-label, interventional, randomized controlled trial, with a sample size of 140 in the treatment and control groups combined (including 20% dropouts), and will be carried out within the duration of 36 months. Participants in the treatment group will receive Ayurvedic treatment, that is, 20 mL of Ashokarishta, 250 mg of Trinakantamani pishti, and 1 iron and folic acid tablet (100 mg of elemental iron and 1.5 mg of folic acid) twice a day orally for 3 months. Participants in the control group will receive a 500-mg tranexamic acid tablet thrice a day for 7 days from the first day of menses for 3 cycles and 1 iron and folic acid tablet twice a day orally for 3 months. The primary outcomes are changes in the amount of uterine bleeding evaluated by the Pictorial Blood Loss Assessment Chart, changes in the duration of bleeding, and attainment of a normal quantity of blood loss during the interval of cycles. The secondary outcome is changes in the Menorrhagia Impact Questionnaire. Results: As of December 2024, a total of 79 patients have been enrolled. Data analysis should be completed by February 2026. The study will be reported following standard guidelines for reporting randomized controlled trials. Clinical results will be disseminated through conferences and peer-reviewed publications in a relevant journal. Conclusions: The Ayurvedic approach may provide an evidence-based therapeutic tactic for the management of menorrhagia. Trial Registration: Clinical Trial Registry India CTRI/2023/05/052929; https://tinyurl.com/3cd6mxrn International Registered Report Identifier (IRRID): DERR1-10.2196/60801 UR - https://www.researchprotocols.org/2025/1/e60801 UR - http://dx.doi.org/10.2196/60801 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60801 ER - TY - JOUR AU - Wu, Tong AU - Wang, Yuting AU - Cui, Xiaoli AU - Xue, Peng AU - Qiao, Youlin PY - 2025/3/31 TI - AI-Based Identification Method for Cervical Transformation Zone Within Digital Colposcopy: Development and Multicenter Validation Study JO - JMIR Cancer SP - e69672 VL - 11 KW - artificial intelligence KW - AI KW - cervical cancer screening KW - transformation zone KW - diagnosis and early treatment KW - lightweight neural network N2 - Background: In low- and middle-income countries, cervical cancer remains a leading cause of death and morbidity for women. Early detection and treatment of precancerous lesions are critical in cervical cancer prevention, and colposcopy is a primary diagnostic tool for identifying cervical lesions and guiding biopsies. The transformation zone (TZ) is where a stratified squamous epithelium develops from the metaplasia of simple columnar epithelium and is the most common site of precancerous lesions. However, inexperienced colposcopists may find it challenging to accurately identify the type and location of the TZ during a colposcopy examination. Objective: This study aims to present an artificial intelligence (AI) method for identifying the TZ to enhance colposcopy examination and evaluate its potential clinical application. Methods: The study retrospectively collected data from 3616 women who underwent colposcopy at 6 tertiary hospitals in China between 2019 and 2021. A dataset from 4 hospitals was collected for model conduction. An independent dataset was collected from the other 2 geographic hospitals to validate model performance. There is no overlap between the training and validation datasets. Anonymized digital records, including each colposcopy image, baseline clinical characteristics, colposcopic findings, and pathological outcomes, were collected. The classification model was proposed as a lightweight neural network with multiscale feature enhancement capabilities and designed to classify the 3 types of TZ. The pretrained FastSAM model was first implemented to identify the location of the new squamocolumnar junction for segmenting the TZ. Overall accuracy, average precision, and recall were evaluated for the classification and segmentation models. The classification performance on the external validation was assessed by sensitivity and specificity. Results: The optimal TZ classification model performed with 83.97% classification accuracy on the test set, which achieved average precision of 91.84%, 89.06%, and 95.62% for types 1, 2, and 3, respectively. The recall and mean average precision of the TZ segmentation model were 0.78 and 0.75, respectively. The proposed model demonstrated outstanding performance in predicting 3 types of the TZ, achieving the sensitivity with 95% CIs for TZ1, TZ2, and TZ3 of 0.78 (0.74-0.81), 0.81 (0.78-0.82), and 0.8 (0.74-0.87), respectively, with specificity with 95% CIs of 0.94 (0.92-0.96), 0.83 (0.81-0.86), and 0.91 (0.89-0.92), based on a comprehensive external dataset of 1335 cases from 2 of the 6 hospitals. Conclusions: Our proposed AI-based identification system classified the type of cervical TZs and delineated their location on multicenter, colposcopic, high-resolution images. The findings of this study have shown its potential to predict TZ types and specific regions accurately. It was developed as a valuable assistant to encourage precise colposcopic examination in clinical practice. UR - https://cancer.jmir.org/2025/1/e69672 UR - http://dx.doi.org/10.2196/69672 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69672 ER - TY - JOUR AU - Ng, Y. Madelena AU - Halpern, Jodi AU - Shane, Olivia AU - Teng, Tina AU - Nguy?n, Michael AU - Alt, Ryan Casey AU - Leite, Barthe Anaïs AU - Moss-Pultz, Sean AU - Lyles, R. Courtney AU - Cheshire, Coye PY - 2025/3/25 TI - Participant Evaluation of Blockchain-Enhanced Women?s Health Research Apps: Mixed Methods Experimental Study JO - JMIR Mhealth Uhealth SP - e65747 VL - 13 KW - blockchain technology KW - privacy KW - trust KW - data control KW - data ownership KW - digital health study KW - user-centered design KW - user experience KW - mHealth KW - mobile health KW - women?s health KW - reproductive health KW - data sharing KW - research participation KW - bioethics N2 - Background: Blockchain technology has capabilities that can transform how sensitive personal health data are safeguarded, shared, and accessed in digital health research. Women?s health data are considered especially sensitive, given the privacy and safety risks associated with their unauthorized disclosure. These risks may affect research participation. Using a privacy-by-design approach, we developed 2 app-based women?s health research study prototypes for user evaluation and assessed how blockchain may impact participation. Objective: This study aims to seek the perspectives of women to understand whether applications of blockchain technology in app-based digital research would affect their decision to participate and contribute sensitive personal health data. Methods: A convergent, mixed methods, experimental design was used to evaluate participant perceptions and attitudes toward using 2 app-based women?s health research study prototypes with blockchain features. Prototype A was based on the status quo ResearchKit framework and had extensive electronic informed consent, while prototype B minimized study onboarding requirements and had no informed consent; the mechanisms of how the contributed data flowed and were made pseudonymous were the same. User evaluations were carried out in February and March 2021 and consisted of a think-aloud protocol, a perception survey, and a semistructured interview. Findings were mapped to the technology acceptance model to guide interpretation. Results: We recruited 16 representative female participants from 175 respondents. User evaluations revealed that while participants considered prototype B easier to use on intuitive navigation (theme 1) of specified tasks and comprehension (theme 2) of research procedures, prototype A trended toward being perceived more favorably than prototype B across most perception survey constructs, with an overall lower level of privacy concern (mean [SD]: 2.22 [1.10] vs 2.95 [1.29]) and perceived privacy risk (2.92 [1.46] vs 3.64 [1.73]) and higher level of perceived privacy (5.21 [1.26] vs 4.79 [1.47]), trust (5.46 [1.19] vs 4.76 [1.27]), and usability (67.81 [21.77] vs 64.84 [23.69]). Prototype B was perceived more favorably than prototype A with perceived control (4.92 [1.32] vs 4.89 [1.29]) and perceived ownership (5.18 [0.59] vs 5.01 [0.96]). These constructs, except for perceived ownership, were significantly correlated with behavioral intention to use the app (P<.05). Participants perceived the usefulness of these prototypes in relation to the value of research study to women?s health field (theme 3), the value of research study to self (theme 4), and the value of blockchain features for participation (theme 5). Conclusions: This study provides nuanced insights into how blockchain applications in app-based research remain secondary in value to participants? expectations of health research, and hence their intention to participate and contribute data. However, with impending data privacy and security concerns, it remains prudent to understand how to best integrate blockchain technology in digital health research infrastructure. UR - https://mhealth.jmir.org/2025/1/e65747 UR - http://dx.doi.org/10.2196/65747 UR - http://www.ncbi.nlm.nih.gov/pubmed/40131317 ID - info:doi/10.2196/65747 ER - TY - JOUR AU - Vey, Trinity AU - Kinnicutt, Eleonora AU - Day, G. Andrew AU - West, Nicola AU - Sleeth, Jessica AU - Nchimbi, Bernard Kenneth AU - Yeates, Karen PY - 2025/3/19 TI - Targeted Behavior Change Communication Using a Mobile Health Platform to Increase Uptake of Long-Lasting Insecticidal Nets Among Pregnant Women in Tanzania: Hati Salama ?Secure Voucher? Study Cluster Randomized Controlled Trial JO - J Med Internet Res SP - e51524 VL - 27 KW - malaria prevention KW - pregnant KW - mHealth KW - mobile health KW - short message service KW - behaviour change communication KW - long-lasting insecticidal nets KW - protozoan infections KW - parasitic diseases KW - vector borne diseases KW - randomized controlled trial KW - morbidity KW - mortality KW - intervention N2 - Background: Malaria remains a significant cause of maternal and neonate morbidity and mortality in sub-Saharan Africa. Long-lasting insecticidal nets (LLINs) represent an important component of malaria prevention and can decrease the adverse health outcomes associated with malaria infection during pregnancy. Voucher programs have been successfully implemented for a variety of initiatives across sub-Saharan Africa, including the distribution of subsidized LLINs in Tanzania. However, mobile messaging for behavior change communication (BCC), in combination with an e-voucher program, has not been explored for malaria prevention. Objective: This study aimed to assess the efficacy of mobile messaging in increasing the redemption of e-vouchers for LLINs for pregnant women and adolescents in Tanzania. Methods: This study was a blinded, 2-arm, cluster randomized controlled trial implemented in 100 antenatal health facilities in Tanzania (both urban and rural settings), with 50 clusters in both intervention and control groups. Clusters were antenatal clinics with e-voucher capabilities, with randomization stratified such that 25 urban and 25 rural clinics were randomized to each arm. Participants were pregnant females aged 13 years or older. Participants in both intervention and control groups were issued e-vouchers on their mobile phones that could be redeemed for LLINs at registered retailers within a 14-day redemption period. Participants in the intervention group received targeted BCC messages about the importance of malaria prevention and LLIN use during pregnancy, while participants in the control group did not receive BCC messages. Analyses were by intention to treat. The primary outcome was the redemption rate of e-vouchers for LLINs from retailers. Outcome measures pertain to clinic sites and individual participant-level data. Results: The study enrolled 5449 participants; the analysis included 2708 participants in the intervention arm and 2740 participants in the control arm (49 clusters in each group analyzed). There was no significant difference in the raw redemption rate of e-vouchers between pregnant participants in the intervention group (70%) and the control group (67%). Younger participants were less likely to redeem e-vouchers. Conclusions: The use of a BCC mobile messaging intervention did not result in a significant increase in LLIN uptake for pregnant individuals. However, the study shows that e-voucher distribution through nurses in antenatal clinics in partnership with local retailers is feasible on a large scale. Consideration of women and adolescents who are low-income and live in rural areas is needed for future interventions leveraging e-vouchers or mHealth technology in low-resource settings. Trial Registration: ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624 UR - https://www.jmir.org/2025/1/e51524 UR - http://dx.doi.org/10.2196/51524 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/51524 ER - TY - JOUR AU - Sohail, Maira AU - Matthews, Lynn AU - Williams, Audra AU - Kempf, Mirjam-Colette AU - Phillips, Desiree AU - Goymer, Hannah AU - Johnson,, Bernadette AU - Mugavero, Michael AU - Elopre, Latesha PY - 2025/3/14 TI - Improving Pre-Exposure Prophylaxis Provision as Part of Routine Gynecologic Care Among Black Cisgender Women (Project PrEP4Her): Protocol for the Implementation of an Intervention JO - JMIR Res Protoc SP - e58976 VL - 14 KW - Black KW - cis-Gender women KW - PrEP KW - pre-exposure prophylaxis KW - South KW - HIV KW - gynecology N2 - Background: Although HIV pre-exposure prophylaxis (PrEP) has been proven to be an effective prevention tool in decreasing HIV transmission, achieving adequate PrEP uptake has remained a challenge among Black cisgender women living in the Southern United States. Gynecology clinics, which provide primary health care services for many cisgender women, have the potential to be an ideal setting for the integration of PrEP services. Objective: We designed an intervention, PrEP4Her, which aims to implement PrEP service delivery at gynecology clinics in Alabama, the United States, as part of routine reproductive and sexual health care visits to improve PrEP engagement rates among Black cisgender women. Methods: Guided by the information gathered on (1) factors impacting PrEP implementation at gynecology clinics, including key barriers and facilitators to PrEP implementation and potential strategies to address the identified barriers (in-depth interviews with the gynecology care team), (2) structural barriers and provider-level barriers to PrEP implementation (cross-sectional study among gynecologists), and (3) implementation strategies on how to integrate PrEP services into routine gynecology care (in-depth interviews and focus groups with Black cisgender women), a multicomponent implementation strategy, tailored for Black cisgender women, was developed to integrate PrEP in routine women?s health visits (ie, PrEP4Her). To determine the efficacy of the program, we will measure implementation outcomes, reach (increase in the absolute number of Black cisgender women receiving PrEP prescriptions), effectiveness (increase in the proportion of PrEP prescriptions over time), and adoption (proportion of team members willing to implement PrEP4Her) using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. In addition, acceptability (the extent to which providers and Black cisgender women feel PrEP4Her to be acceptable?in-depth interviews); Feasibility (appropriateness of PrEP4Her for a larger, full-scale trial?the Feasibility of Intervention Measure scale); and fidelity (the degree to which PrEP4Her program was implemented as designed?electronic survey with patients) will also be assessed. Results: The qualitative and quantitative data from the gynecology care team and the qualitative data from Black cisgender women were collected from August 9, 2022, to April 19, 2023, and were integrated through joint displays to identify major themes. The combined findings provided a comprehensive understanding of factors that were fundamental in the development and refinement of PrEP4Her implementation. The PrEP4Her was implemented from January 29, 2024, to August 16, 2024. The information gathered is being used to assess PrEP4Her efficacy (based on reach, effectiveness, adoption, acceptability, feasibility, and fidelity). Conclusions: Upon completion of our research, our interdisciplinary team, which includes experts in infectious diseases, implementation science, community-engaged research, and psychology, will be primed to lead a multisite type III implementation trial for PrEP service delivery at gynecology clinics across the Southern United States. International Registered Report Identifier (IRRID): DERR1-10.2196/58976 UR - https://www.researchprotocols.org/2025/1/e58976 UR - http://dx.doi.org/10.2196/58976 UR - http://www.ncbi.nlm.nih.gov/pubmed/40085134 ID - info:doi/10.2196/58976 ER - TY - JOUR AU - Song, Gao AU - Zhang, Cai-qiong AU - Bai, Zhong-ping AU - Li, Rong AU - Cheng, Meng-qun PY - 2025/3/12 TI - Assisted Reproductive Technology and Risk of Childhood Cancer Among the Offspring of Parents With Infertility: Systematic Review and Meta-Analysis JO - JMIR Cancer SP - e65820 VL - 11 KW - assisted reproductive technology KW - childhood cancer KW - infertility KW - subfertile KW - risks KW - systematic review N2 - Background: The relationship between assisted reproductive technology (ART) and childhood cancer risk has been widely debated. Previous meta-analyses did not adequately account for the impact of infertility, and this study addresses this gap. Objective: Our primary objective was to assess the relative risk (RR) of childhood cancer in infertile populations using ART versus non-ART offspring, with a secondary focus on comparing frozen embryo transfer (FET) and fresh embryo transfer (fresh-ET). Methods: A literature review was conducted through PubMed, Embase, Cochrane, and Web of Science, with a cutoff date of July 10, 2024. The study was registered with the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY 202470119). Inclusion criteria were based on the PICOS (Population, Intervention, Comparison, Outcomes, and Study Design) framework: infertile or subfertile couples (population), ART interventions (in vitro fertilization [IVF], intracytoplasmic sperm injection [ICSI], FET, and fresh-ET), non-ART comparison, and childhood cancer risk outcomes. Data abstraction focused on the primary exposures (ART vs non-ART and FET vs fresh-ET) and outcomes (childhood cancer risk). The risk of bias was assessed using the Newcastle-Ottawa Quality Assessment Scale, and the evidence quality was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Pooled estimates and 95% CIs were calculated using random effects models. Results: A total of 18 studies were included, published between 2000 and 2024, consisting of 14 (78%) cohort studies and 4 (22%) case-control studies, all of which were of moderate to high quality. The cohort studies had follow-up periods ranging from 3 to 18 years. Compared with non-ART conception, ART conception was not significantly associated with an increased risk of childhood overall cancer (RR 0.95, 95% CI 0.71?1.27; GRADE quality: low to moderate). Subgroup analyses of IVF (RR 0.86, 95% CI 0.59?1.25), ICSI (RR 0.76, 95% CI 0.26?2.2), FET (RR 0.98, 95% CI 0.54?1.76), and fresh-ET (RR 0.75, 95% CI 0.49?1.15) showed similar findings. No significant differences were found for specific childhood cancers, including leukemia (RR 0.99, 95% CI 0.79?1.24), lymphoma (RR 1.22, 95% CI 0.64?2.34), brain cancer (RR 1.22, 95% CI 0.73?2.05), embryonal tumors (RR 1, 95% CI 0.63?1.58), retinoblastoma (RR 1.3, 95% CI 0.73?2.31), and neuroblastoma (RR 1.02, 95% CI 0.48?2.16). Additionally, no significant difference was observed in a head-to-head comparison of FET versus fresh-ET (RR 0.99, 95% CI 0.86?1.14; GRADE quality: moderate). Conclusions: In conclusion, this study found no significant difference in the risk of childhood cancer between offspring conceived through ART and those conceived through non-ART treatments (such as fertility drugs or intrauterine insemination) in infertile populations. While infertility treatments may elevate baseline risks, our findings suggest that whether individuals with infertility conceive using ART or non-ART methods, their offspring do not face a significantly higher risk of childhood cancer. Further research, especially comparing infertile populations who conceive naturally, is needed to better understand potential long-term health outcomes. Trial Registration: INPLASY 202470119; https://inplasy.com/?s=202470119 UR - https://cancer.jmir.org/2025/1/e65820 UR - http://dx.doi.org/10.2196/65820 ID - info:doi/10.2196/65820 ER - TY - JOUR AU - Gao, Jing AU - Jie, Xu AU - Yao, Yujun AU - Xue, Jingdong AU - Chen, Lei AU - Chen, Ruiyao AU - Chen, Jiayuan AU - Cheng, Weiwei PY - 2025/3/10 TI - Fetal Birth Weight Prediction in the Third Trimester: Retrospective Cohort Study and Development of an Ensemble Model JO - JMIR Pediatr Parent SP - e59377 VL - 8 KW - fetal birthweight KW - ensemble learning model KW - machine learning KW - prediction model KW - ultrasonography KW - macrosomia KW - low birth weight KW - birth weight KW - fetal KW - AI KW - artificial intelligence KW - prenatal KW - prenatal care KW - Shanghai KW - neonatal KW - maternal KW - parental N2 - Background: Accurate third-trimester birth weight prediction is vital for reducing adverse outcomes, and machine learning (ML) offers superior precision over traditional ultrasound methods. Objective: This study aims to develop an ML model on the basis of clinical big data for accurate prediction of birth weight in the third trimester of pregnancy, which can help reduce adverse maternal and fetal outcomes. Methods: From January 1, 2018 to December 31, 2019, a retrospective cohort study involving 16,655 singleton live births without congenital anomalies (>28 weeks of gestation) was conducted in a tertiary first-class hospital in Shanghai. The initial set of data was divided into a train set for algorithm development and a test set on which the algorithm was divided in a ratio of 4:1. We extracted maternal and neonatal delivery outcomes, as well as parental demographics, obstetric clinical data, and sonographic fetal biometry, from electronic medical records. A total of 5 basic ML algorithms, including Ridge, SVM, Random Forest, extreme gradient boosting (XGBoost), and Multi-Layer Perceptron, were used to develop the prediction model, which was then averaged into an ensemble learning model. The models were compared using accuracy, mean squared error, root mean squared error, and mean absolute error. International Peace Maternity and Child Health Hospital's Research Ethics Committee granted ethical approval for the usage of patient information (GKLW2021-20). Results: Train and test sets contained a total of 13,324 and 3331 cases, respectively. From a total of 59 variables, we selected 17 variables that were readily available for the ?few feature model,? which achieved high predictive power with an accuracy of 81% and significantly exceeded ultrasound formula methods. In addition, our model maintained superior performance for low birth weight and macrosomic fetal populations. Conclusions: Our research investigated an innovative artificial intelligence model for predicting fetal birth weight and maximizing health care resource use. In the era of big data, our model improves maternal and fetal outcomes and promotes precision medicine. UR - https://pediatrics.jmir.org/2025/1/e59377 UR - http://dx.doi.org/10.2196/59377 ID - info:doi/10.2196/59377 ER - TY - JOUR AU - Pozzar, A. Rachel AU - Tulsky, A. James AU - Berry, L. Donna AU - Batista, Jeidy AU - Barwick, Paige AU - Lindvall, J. Charlotta AU - Dykes, C. Patricia AU - Manni, Michael AU - Matulonis, A. Ursula AU - McCleary, J. Nadine AU - Wright, A. Alexi PY - 2025/3/10 TI - Usability, Acceptability, and Barriers to Implementation of a Collaborative Agenda-Setting Intervention (CASI) to Promote Person-Centered Ovarian Cancer Care: Development Study JO - JMIR Cancer SP - e66801 VL - 11 KW - ovarian neoplasm KW - ovarian cancer KW - cancer KW - oncology KW - oncologist KW - metastases KW - communication KW - physician-patient relations KW - electronic health record KW - EHR KW - electronic medical record KW - EMR KW - implementation science KW - digital KW - digital health KW - digital technology KW - digital intervention KW - mobile phone N2 - Background: People with advanced ovarian cancer and their caregivers report unmet supportive care needs. We developed a Collaborative Agenda-Setting Intervention (CASI) to elicit patients? and caregivers? needs through the patient portal before a clinic visit and to communicate these needs to clinicians using the electronic health record. Objective: We aimed to assess the usability and acceptability of the CASI and identify barriers to and facilitators of its implementation. Methods: We recruited English- and Spanish-speaking patients, caregivers, and clinicians from the gynecologic oncology program at a comprehensive cancer center. Participants used the CASI prototype and then completed individual cognitive interviews and surveys. We assessed usability with the System Usability Scale (scores range 0?100, scores ?70 indicate acceptable usability) and acceptability with the Acceptability of Intervention Measure and Intervention Appropriateness Measure (scores for both measures range from 1 to 5, higher scores indicate greater acceptability). Interviews were audio recorded, transcribed, and analyzed using directed content analysis. Domains and constructs from the Consolidated Framework for Implementation Research comprised the initial codebook. We analyzed survey data using descriptive statistics and compared usability and acceptability scores across patients, caregivers, and clinicians using analyses of variance. Results: We enrolled 15 participants (5 patients, 5 caregivers, and 5 clinicians). The mean System Usability Scale score was 72 (SD 16). The mean Acceptability of Intervention Measure and Intervention Appropriateness Measure scores were 3.9 (SD 1.0) and 4.1 (SD 0.8), respectively. Participants viewed the CASI content and format positively overall. Several participants appreciated the CASI?s integration into the clinical workflow and its potential to increase attention to psychosocial concerns. Suggestions to refine the CASI included removing redundant items, simplifying item language, and adding options to request a conversation or opt out of supportive care referrals. Key barriers to implementing the CASI include its complexity and limited resources available to address patients? and caregivers? needs. Conclusions: The CASI is usable and acceptable to patients with advanced ovarian cancer, caregivers, and clinicians. We identified several barriers to and facilitators of implementing the CASI. In future research, we will apply these insights to a pilot randomized controlled trial to assess the feasibility of comparing the CASI to usual care in a parallel group-randomized efficacy trial. UR - https://cancer.jmir.org/2025/1/e66801 UR - http://dx.doi.org/10.2196/66801 ID - info:doi/10.2196/66801 ER - TY - JOUR AU - Smeenk, Jesper AU - Smit, Ellen AU - Jacobs, Marc AU - van Rooij, Ilse PY - 2025/3/10 TI - Evaluation of the MyFertiCoach Lifestyle App for Subfertile Couples: Single-Center Evaluation of Augmented Standard Care JO - JMIR Form Res SP - e64239 VL - 9 KW - fertility KW - mHealth KW - pregnancy KW - lifestyle KW - app KW - smartphone N2 - Background: Many couples undergoing fertility treatment face multiple lifestyle risk factors that lower their chances of achieving pregnancy. The MyFertiCoach (MFC) app was designed as an integrated lifestyle program featuring modules on healthy weight management, nutrition, exercise, quitting smoking, reducing alcohol and drug use, and managing stress. We hypothesized that supplementing standard care with the MFC app would improve lifestyle outcomes. Objective: This study aims to assess the impact of the MFC app on changing multiple lifestyle habits in women seeking fertility treatment. The primary outcome is the change in the total risk score (TRS) at 3- and six-month follow-ups. The TRS is calculated for each individual as the sum of all risk scores per behavior (eg, vegetable/fruit/folic acid intake, smoking, and alcohol use) at 3 and 6 months. A higher TRS indicates unhealthier nutrition and lifestyle habits and a lower likelihood of achieving pregnancy. The secondary endpoints include changes in BMI, activity score, preconception dietary risk score, distress score (eg, perceived burden), smoking habits, alcohol intake, and program adherence. Methods: This retrospective, observational, single-center evaluation included patients between January 1, 2022, and December 31, 2023. Subfertile female patients aged 18-43 years and their partners, who were referred to a gynecologist, were invited to participate in online lifestyle coaching via the MFC app. The gynecologist selected relevant lifestyle modules based on the results of integrated screening questionnaires. We used (hierarchical) linear mixed models (LMMs) to estimate changes in outcomes. For missing data patterns deemed missing not at random, joint modeling was applied. Statistical significance was set at P?.05, with methods in place to maintain the same false-positive rate. Results: A total of 1805 patients were invited to participate in the evaluation, with an average of 737 (40.83%) completing the screening questionnaire at baseline. For the TRS, 798 (44.21%) patients were included at baseline, of whom 517 (64.8%) involved their partner. On average, 282 of 744 (37.9%) patients submitted at least one follow-up questionnaire. Patients rated the app above average (n=137, median score of 7 on a 1-10 scale) on days 7 and 14. The TRS decreased by an average of 1.5 points (P<.001) at T3 and T6 compared with baseline, a clinically meaningful improvement. All secondary outcomes showed statistically significant positive changes for patients who used a relevant lifestyle module (P<.001). Most improvements were achieved by 3 months and remained significant at 6 months (P<.001), except for alcohol intake (P<.53). These findings were consistent across both LMMs and joint models. Conclusions: Our evaluation of a mobile health app integrated into standard care demonstrates immediate and clinically meaningful improvements in key lifestyle parameters among women seeking to become pregnant. Additional scientific research is needed to identify the causal pathways leading to sustained effectiveness. To maintain and enhance these outcomes, further tailoring of patient-specific programs is essential. UR - https://formative.jmir.org/2025/1/e64239 UR - http://dx.doi.org/10.2196/64239 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64239 ER - TY - JOUR AU - Grutman, J. Aurora AU - Perelmuter, Sara AU - Perez, Abigail AU - Meurer, Janine AU - Contractor, Monica AU - Mathews, Eva AU - Shearer, Katie AU - Burnett, A. Lindsey AU - Uloko, Maria PY - 2025/3/6 TI - Understanding Patient Experiences of Vulvodynia Through Reddit: Qualitative Analysis JO - JMIR Infodemiology SP - e63072 VL - 5 KW - sexual health KW - health literacy KW - vulvodynia KW - vestibulodynia KW - pelvic pain KW - Reddit N2 - Background: Vulvodynia is a chronic vulvar pain condition affecting up to 25% of the US population. However, diagnosis and effective treatment remain elusive. Many individuals with vulvodynia face stigma and medical uncertainty, leading them to seek information and web-based support. Reddit is a popular social media platform where patients share health concerns and experiences. The anonymity and accessibility of this platform make it a valuable source of real-world patient perspectives that are often overlooked in clinical settings. Objective: This study evaluated Reddit content related to vulvodynia to explore how individuals with vulvodynia describe their symptoms, treatments, and personal experiences. Methods: The subreddits ?r/vulvodynia? and ?r/vestibulodynia? were selected for analysis in May 2023. Threads were sorted from the most popular to least popular, with ?popularity? measured by upvotes. Opening threads from the top 70 posts in each subreddit were extracted and analyzed using inductive qualitative analysis to identify themes and sentiment analysis to evaluate attitudes. Results: In May 2023, the ?r/vulvodynia? and ?r/vestibulodynia? subreddits had a total of 7930 members (7245 and 685 members, respectively). Out of 140 analyzed threads, 77 (55%) contained negative attitudes. A total of 50 (35.7%) threads were seeking information or advice and 90 (64.3%) included some form of peer support. Inductive thematic analysis identified 6 core themes: symptoms (n=86, 61.4%), treatments (n=83, 59.3%), sexuality (n=47, 33.6%), erasure or disbelief (n=38, 27.1%), representation or media (n=17, 12.1%), and humor (n=15, 10.7%). Threads that discussed treatments (48/83, 57.8%), sexual experiences (25/47, 53.2%), and representation (14/17, 82.4%) had the highest proportions of positive attitudes, while threads that touched on erasure (21/38, 55.3%), symptoms (51/86, 59.3%), and humor (12/15, 80%), had the highest proportion of negative attitudes. A multivariable logistic regression of valence on the themes revealed that posts referring to treatments (odds ratio 12.5, 95% CI 3.7-42.2; P<.001) or representation (odds ratio 21.2, 95% CI 4.2-106.0; P<.001) were associated with significantly increased odds of positive valence. Furthermore, it was noted that 3 of the 5 most frequently discussed treatments aligned with clinical guidelines from the American College of Obstetricians and Gynecologists, American Urological Association, and International Society for the Study of Vulvovaginal Disease. Despite this alignment, threads frequently mentioned alternative remedies and frustration with medical professionals related to diagnostic delays and perceived lack of understanding. Conclusions: This is the first study of Reddit discussions about vulvodynia. Findings suggest a gap between patient experiences and provider understanding, underscoring the need for improved patient education and greater clinician awareness of psychosocial factors in vulvodynia care. While limited by its sample size and lack of demographic data, this study highlights how web-based communities can help identify ways health care providers can better meet patient needs and how patients mutually support each other. UR - https://infodemiology.jmir.org/2025/1/e63072 UR - http://dx.doi.org/10.2196/63072 ID - info:doi/10.2196/63072 ER - TY - JOUR AU - Breton, Zélia AU - Stern, Emilie AU - Pinault, Mathilde AU - Lhuillery, Delphine AU - Petit, Erick AU - Panel, Pierre AU - Alexaline, Maïa PY - 2025/2/28 TI - A Digital Program for Daily Life Management With Endometriosis: Pilot Cohort Study on Symptoms and Quality of Life Among Participants JO - JMIR Form Res SP - e58262 VL - 9 KW - digital program KW - endometriosis KW - integrative therapies KW - quality of life KW - nonpharmacological intervention KW - daily life KW - adenomyosis KW - lesions KW - women KW - digital KW - France KW - case control KW - digital health KW - pilot study KW - control group KW - global symptom KW - burden KW - depression KW - neuropathic pain KW - chronic KW - multidisciplinary KW - web based KW - mobile health KW - mHealth KW - intervention N2 - Background: After experiencing symptoms for an average of 7 years before diagnosis, patients with endometriosis are usually left with more questions than answers about managing their symptoms in the absence of a cure. To help women with endometriosis after their diagnosis, we developed a digital program combining user research, evidence-based medicine, and clinical expertise. Structured around cognitive behavioral therapy and the quality of life metrics from the Endometriosis Health Profile score, the program was designed to guide participants for 3 months. Objective: This cohort study was designed to measure the impact of a digital health program on the symptoms and quality of life levels of women with endometriosis. Methods: In total, 63% (92/146) of the participants were included in the pilot study, recruited either free of charge through employer health insurance or via individual direct access. A control group of 404 women with endometriosis who did not follow the program, recruited through social media and mailing campaigns, was sampled (n=149, 36.9%) according to initial pain levels to ensure a similar pain profile to participants. Questionnaires assessing quality of life and symptom levels were emailed to both groups at baseline and 3 months. Descriptive statistics and statistical tests were used to analyze intragroup and intergroup differences, with Cohen d measuring effect sizes for significant results. Results: Over 3 months, participants showed substantial improvements in global symptom burden, general pain level, anxiety, depression, dysmenorrhea, dysuria, chronic fatigue, neuropathic pain, and endo belly. These improvements were significantly different from the control group for global symptom burden (participants: mean ?0.7, SD 1.6; controls: mean ?0.3, SD 1.3; P=.048; small effect size), anxiety (participants: mean ?1.1, SD 2.8; controls: mean 0.2, SD 2.5; P<.001; medium effect size), depression (participants: mean ?0.9, SD 2.5; controls: mean 0.0, SD 3.1; P=.04; small effect size), neuropathic pain (participants: mean ?1.0, SD 2.7; controls: mean ?0.1, SD 2.6; P=.004; small effect size), and endo belly (participants: mean ?0.9, SD 2.5; controls: mean ?0.3, SD 2.4; P=.03; small effect size). Participants? quality of life improved between baseline and 3 months and significantly differed from that of the control group for the core part of the Endometriosis Health Profile-5 (participants: mean ?5.9, SD 21.0; controls: mean 1.0, SD 14.8; P=.03; small effect size) and the EQ-5D (participants: mean 0.1, SD 0.1; controls: mean ?0.0, SD 0.1; P=.001; medium effect size). Perceived knowledge of endometriosis was significantly greater at 3 months among participants compared to the control group (P<.001). Conclusions: This study?s results suggest that a digital health program providing medical and scientific information about endometriosis and multidisciplinary self-management tools may be useful to reduce global symptom burden, anxiety, depression, neuropathic pain, and endo belly while improving knowledge on endometriosis and quality of life among participants. UR - https://formative.jmir.org/2025/1/e58262 UR - http://dx.doi.org/10.2196/58262 UR - http://www.ncbi.nlm.nih.gov/pubmed/39791286 ID - info:doi/10.2196/58262 ER - TY - JOUR AU - Ryu, Hyeyoung AU - Pratt, Wanda PY - 2025/2/26 TI - Women?s Educating and Coping Strategies for Cultivating Supportive Web-Based Spaces for Discussing Sexual and Reproductive Health: Co-Design Study JO - J Med Internet Res SP - e62716 VL - 27 KW - sexual and reproductive health KW - women?s health KW - stigma KW - microaggression KW - coping KW - counternarrative KW - social media KW - web-based communities KW - support KW - co-design N2 - Background: Stigma surrounding women?s sexual and reproductive health (SRH) often prevents them from seeking essential care. In South Korea, unmarried women face strong cultural taboos, increasing their risk for conditions such as pelvic inflammatory disease, infertility, and cervical cancer. While many unmarried women turn to web-based communities for support, these spaces frequently expose them to microaggressions, further discouraging their access to health care and worsening their health risks. Objective: We aimed to encourage a safe space for seeking support on the culturally taboo topic of SRH by counteracting and reducing web-based microaggressions. We sought to make these last-resort safe spaces supportive by reducing and preventing microaggressions, fostering coping strategies, and educating rather than solely punishing perpetrators. Methods: We conducted co-design sessions with 14 unmarried Korean women. In the first co-design session, we introduced the term microaggression and collaborated with participants to create base design components aimed at countering and preventing microaggressions. In the second co-design session, participants initially viewed examples of microaggression comments, then designed using the provided base design templates inspired by their suggestions from the first session and finally designed for a scenario where they would be seeking support. We analyzed co-design session transcripts using inductive and deductive methods. Results: Our analysis revealed 6 goals addressing coping strategies, educational approaches, and cultural characteristics shaping participants? designs. Reflective coping strategies were supported through designs that numerically indicate positive support and provide holistic views of diverse perspectives, helping participants reassess provocative situations with cognitive clarity. Suppressive coping strategies were fostered by encouraging less-emotional responses, empowering participants to address microaggressions logically without self-blame. Educational approaches emphasized fostering shared awareness of microaggressions and providing respectful education for perpetrators about the harm their words can cause. Participants suggested counterspeech mechanisms, including rephrasing suggestions and public educational resources, to balance education with freedom of expression. They also proposed that forum-approved experts guide discussions to ensure accurate, empathetic responses and support users in addressing nuanced situations effectively. Cultural characteristics heavily influenced these goals. Participants noted the nebulous nature of microaggressions, their reluctance to burden their social support network, and societal perceptions of women as overly emotional?all of which shaped their desire for designs that enhance logical justification. For example, participants preferred tools such as expert-led discussions and comprehensive perspectives to rationalize their experiences while reducing stigma. Conclusions: Our work advocates for prioritizing educational and explanatory approaches over punitive detection and deletion measures to create supportive web-based spaces for individuals discussing stigmatized SRH. By integrating culturally informed coping strategies, counter speech mechanisms, and educational designs, these tools empower microaggression targets and allies while fostering reflection and behavior change among perpetrators. Our work provides a first step toward counteracting microaggressions and ultimately encouraging women to seek the needed SRH care. UR - https://www.jmir.org/2025/1/e62716 UR - http://dx.doi.org/10.2196/62716 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/62716 ER - TY - JOUR AU - Plouvier, Pauline AU - Marcilly, Romaric AU - Robin, Geoffroy AU - Benamar, Chaymae AU - Robin, Camille AU - Simon, Virginie AU - Piau, Sophie Anne AU - Cambay, Isabelle AU - Schiro, Jessica AU - Decanter, Christine PY - 2025/2/24 TI - Evaluation of Satisfaction With a Secure, Connected Mobile App for Women in Assisted Reproductive Technology Programs: Prospective Observational Study JO - JMIR Hum Factors SP - e63570 VL - 12 KW - mobile apps KW - mHealth KW - mobile health KW - assisted reproductive technologies KW - evaluation KW - satisfaction KW - reproduction KW - fertility KW - ovarian stimulation KW - ease of use KW - usability KW - midwives KW - obstetrics KW - gynecology N2 - Background: Telemedicine has emerged rapidly as a novel and secure tool to deliver medical information and prescriptions. A secure, connected health care app (WiStim) has been developed in order to facilitate dialogue between patients and the medical team during an ovarian stimulation cycle for medically assisted reproduction (MAR). Objective: This study aimed to evaluate the patients? and midwives? levels of satisfaction with the connected mobile app. Methods: We conducted a prospective, observational, single-center study at Lille University Hospital, France. From May 1 to July 31, 2021, all women undergoing ovarian stimulation started to receive their treatment advice through the mobile app. A total of 184 women were included and they filled out the 30-item Usefulness Satisfaction and Ease-of-Use (USE) questionnaire, which examines the users? opinions in 4 dimensions: usefulness, ease of use, ease of learning, and satisfaction. The women also answered a series of closed and open questions. The 5 midwives in our assisted reproductive technology center filled out the French version of the 10-item System Usability Scale (SUS) when the app was implemented and then after 3 and 6 months of use. We also performed semistructured interviews with the midwives. Results: Overall, 183 women using the app completed the questionnaire. None refused to use the app, and 1 withdrew from the study. The mean scores for the four USE dimensions were all significantly greater than 4, that is, the middle of the response scale. The women liked the app?s ease of use, the access to tutorial videos, and the reminders about appointments and treatments. In particular, the women liked to be able to (re)read the information; this reassured them, might have reduced the number of missed appointments and treatments, and made them more independent during the day, especially when they were working. Some of the women regretted the loss of direct contact with the midwife. The mean SUS score was 76 (SD 13.54) at the start of the study, 75 (SD 17.16) after 3 months, and 84 (11.21) after 6 months. According to the adjective rating scale, these scores corresponded to good usability for the app. After the requisite training and a familiarization period, the midwives reported that using the app saved them 2 hours a day. The mobile app enabled better transmission of information and thus probably helped to decrease treatment errors. Conclusions: The WiStim connected mobile app is one of the first reliable, secure apps in the field of MAR. The app reassured the patients during the ovarian stimulation. Women and the medical team considered that the app was easy and intuitive to use. Given the growth in demand for MAR programs and the medical team?s workload, the time savings provided by the app constitute a nonnegligible advantage. UR - https://humanfactors.jmir.org/2025/1/e63570 UR - http://dx.doi.org/10.2196/63570 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63570 ER - TY - JOUR AU - Knowles, Kayla AU - Lee, Susan AU - Yapalater, Sophia AU - Taylor, Maria AU - Akers, Y. Aletha AU - Wood, Sarah AU - Dowshen, Nadia PY - 2025/2/19 TI - Simulation of Contraceptive Access for Adolescents and Young Adults Using a Pharmacist-Staffed e-Platform: Development, Usability, and Pilot Testing Study JO - JMIR Pediatr Parent SP - e60315 VL - 8 KW - adolescent KW - contraception KW - telemedicine KW - user-centered design KW - young adult KW - reproductive KW - design KW - usability KW - experience KW - mHealth KW - mobile health KW - app KW - youth KW - teenager KW - drug KW - pharmacology KW - pharmacotherapy KW - pharmaceutics KW - medication KW - pharmacy KW - digital health KW - platform KW - access N2 - Background: Offering contraceptive methods at pharmacies without a prescription is an innovative solution to reduce the incidence of unintended pregnancies among adolescents and young adults (AYA). Pharmacy-prescribed contraception may increase the convenience, simplicity, and affordability of contraceptives. Objective: The aim of this study was to develop, pilot test, and evaluate the acceptability and feasibility of a telemedicine electronic platform app simulating pharmacist prescribing of contraceptives to AYA as well as assess agreement between pharmacist-simulated contraceptive approvals and contraception as prescribed in routine clinic visits. Methods: This study was conducted in two phases: (1) development and usability testing of a prototype app to simulate pharmacists prescribing contraceptives to AYA and (2) pilot testing the app in a simulation for AYA requesting contraception from a pharmacist with pharmacist review and request approval or rejection. Eligibility criteria in both phases included the following: assigned female sex at birth, age 15-21 years, seeking contraceptive services at an academic adolescent medicine clinic, prior history of or intention to have penile-vaginal intercourse in the next 12 months, smartphone ownership, and English language proficiency. Phase 1 (usability) involved a video-recorded ?think aloud? interview to share feedback and technical issues while using the app prototype on a smartphone and the completion of sociodemographic, sexual history, and perception of the prototype surveys to further develop the app. Phase 2 (pilot) participants completed phase 1 surveys, tested the updated app in a simulation, and shared their experiences in an audio-recorded interview. Descriptive analyses were conducted for quantitative survey data, and thematic analyses were used for interview transcripts. Results: Of the 22 participants, 10 completed usability testing, with a mean age of 16.9 (SD 1.97) years, and 12 completed pilot testing, with a mean age of 18.25 (SD 1.48) years. Three issues with the prototype were identified during ?think aloud? interviews: challenges in comprehension of medical language, prototype glitches, and graphic design suggestions for engagement. Usability testing guided the frontend and backend creation of the platform. Overall, participants agreed or strongly agreed that using an app to receive contraceptives would make it easier for teens to access (n=19, 86%) and make contraceptive use less stigmatizing (n=19, 86%). In addition, participants agreed that receiving contraception prescriptions from a pharmacist without a clinic visit would be safe (n=18, 82%), convenient (n=19, 86%), acceptable (n=18, 82%), and easy (n=18, 82%). Pharmacists and medical providers had 100% agreement on the prescribed contraceptive method for pilot participants. Conclusions: AYA found contraceptive prescription by a pharmacist via an app to be highly acceptable and provided critical feedback to improve the design and delivery of the app. Additionally, pharmacist contraceptive approvals and contraception as prescribed in routine clinic visits were identical. UR - https://pediatrics.jmir.org/2025/1/e60315 UR - http://dx.doi.org/10.2196/60315 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60315 ER - TY - JOUR AU - Abdulai, Abdul-Fatawu AU - Duong, Cam AU - Stroulia, Eleni AU - Czerniak, Efrat AU - Chiu, Rachel AU - Mehta, Aashay AU - Koike, Ken AU - Norman, V. Wendy PY - 2025/2/19 TI - A Health Professional Mentorship Platform to Improve Equitable Access to Abortion: Development, Usability, and Content Evaluation JO - JMIR Hum Factors SP - e63364 VL - 12 KW - medication abortion KW - mifepristone KW - web-based platform KW - user-centered design KW - underserved populations KW - abortion KW - equitable KW - accessibility KW - open-access website KW - gender-affirming KW - user-centered KW - Canada KW - unwanted pregnancy KW - framework N2 - Background: Access to safe abortion care is a reproductive right for all individuals across Canada. Underserved populations are overrepresented among those with unintended pregnancies and particularly those seeking abortion. Yet, few resources exist to help health care and allied helping professionals provide culturally competent and gender-affirming abortion care to such a population group. Objective: This project aimed to redesign and adapt an existing subscription-based medication abortion mentorship platform into a culturally appropriate and gender-affirming open-access website of curated health professional resources to promote equitable, accessible, high-quality abortion care, particularly for underserved populations. Methods: We drew on a user-centered design framework to redesign the web platform in 5 iterative phases. Health care and allied helping professionals were engaged in each stage of the development process including the initial design of the platform, curation of the resources, review of the content, and evaluation of the wireframes and the end product. Results: This project resulted in an open-access bilingual (English and French) web-based platform containing comprehensive information and resources on abortion care for health care providers (physicians, nurse practitioners, and pharmacists) and allied helping professionals (midwives, medical officers, community workers, and social workers). The website incorporated information on clinical, logistical, and administrative guidance, including culturally competent and gender-affirming toolkits that could equip health care professionals with the requisite knowledge to provide abortion care for underserved populations. Conclusions: This platform contains resources that can increase the competencies of health care professionals to initiate and sustain culturally and contextually appropriate abortion care for underserved groups while clarifying myths and misconceptions that often militate against initiating abortion. Our resource also has the potential to support equitable access to high-quality abortion care, particularly for those among underserved populations who may have the greatest unmet need for abortion services yet face the greatest barriers to accessing care. UR - https://humanfactors.jmir.org/2025/1/e63364 UR - http://dx.doi.org/10.2196/63364 ID - info:doi/10.2196/63364 ER - TY - JOUR AU - Muliokela, K. Rosemary AU - Banda, Kuwani AU - Hussen, Mohammed Abdulaziz AU - Malumo, Bvulani Sarai AU - Kashoka, Andrew AU - Mwiche, Angel AU - Chiboma, Innocent AU - Barreix, Maria AU - Nyirenda, Muyereka AU - Sithole, Zvanaka AU - Ratanaprayul, Natschja AU - Endehabtu, Fikadie Berhanu AU - Telake, Abayneh Hanna AU - Weldeab, Adane AU - Probert, M. William J. AU - Tunçalp, ?zge AU - Maya, Ernest AU - Woldetsadik, Mulatu AU - Tilahun, Binyam AU - Guure, Chris AU - Senya, Kafui AU - Say, Lale AU - Tamrat, Tigest PY - 2025/2/7 TI - Implementation of WHO SMART Guidelines-Digital Adaptation Kits in Pathfinder Countries in Africa: Processes and Early Lessons Learned JO - JMIR Med Inform SP - e58858 VL - 13 KW - guidelines KW - reproductive health KW - maternal health KW - antenatal care KW - clinical decision support KW - clinical decision support systems KW - digital health KW - HIV/AIDS KW - family planning KW - electronic medical records KW - electronic health record KW - standards KW - interoperability KW - system uptake KW - digital health governance N2 - Background: The adoption of digital systems requires processes for quality assurance and uptake of standards to achieve universal health coverage. The World Health Organization developed the Digital Adaptation Kits (DAKs) within the SMART (Standards-based, Machine-readable, Adaptive, Requirements-based, and Testable) guidelines framework to support the uptake of standards and recommendations through digital systems. DAKs are a software-neutral mechanism for translating narrative guidelines to support the design of digital systems. However, a systematic process is needed to implement and ensure the impact of DAKs in country contexts. Objective: This paper details the structured process and stepwise approach to customize the DAKs to the national program and digital context in 5 countries in Africa with diverse program guideline uptake and significant digital health investments: Ethiopia, Ghana, Malawi, Zambia, and Zimbabwe. All these countries have existing digital systems, which have the potential to be updated with the DAKs. Methods: A DAK assessment tool was developed and used to assess guideline digitization readiness and opportunities for system uptake in each country. Multistakeholder teams were established to conduct the content review and alignment of the generic DAK to national guidelines and protocols through a series of stakeholder consultations, including stakeholder orientation, content review and alignment, content validation, and software update meetings. Implementation (Results): Country adaptation processes identified requirements for national-level contextualization and highlighted opportunities for refinement of DAKs. Quality assurance of the content during the content review and validation processes ensured alignment with national protocols. Adaptation processes also facilitated the adoption of the DAKs approach into national guidelines and strategic documents for sexual and reproductive health. Conclusions: Country experiences offered early insights into the opportunities and benefits of a structured approach to digitalizing primary health care services. They also highlighted how this process can be continuously refined and sustained to enhance country-level impact. UR - https://medinform.jmir.org/2025/1/e58858 UR - http://dx.doi.org/10.2196/58858 ID - info:doi/10.2196/58858 ER - TY - JOUR AU - Sirohi, Diksha AU - Ng, HM Cecilia AU - Bidargaddi, Niranjan AU - Slater, Helen AU - Parker, Melissa AU - Hull, Louise M. AU - O'Hara, Rebecca PY - 2025/2/7 TI - Good-Quality mHealth Apps for Endometriosis Care: Systematic Search JO - J Med Internet Res SP - e49654 VL - 27 KW - adenomyosis KW - endometriosis KW - m-health apps KW - mobile apps KW - digital health KW - pelvic pain KW - self-learning KW - clinicians KW - mHealth KW - application KW - endometriomas KW - chocolate cysts KW - uterus KW - womb KW - pain management KW - women's health KW - mobile phone N2 - Background: Mobile health (mHealth) apps are increasingly being used by community members to track symptoms and manage endometriosis. In addition, clinicians use mHealth apps for continued medical education and clinical decision-making and recommend good-quality apps to patients. However, poor-quality apps can spread misinformation or provide recommendations that are not evidence-based. Therefore, a critical evaluation is needed to assess and recommend good-quality endometriosis mHealth apps. Objective: This study aimed to evaluate the quality and provide recommendations for good quality endometriosis mHealth apps for the community and clinicians. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines informed the search of mHealth apps on the Google Play Store and Apple App Store. The search terms included ?endometriosis,? ?adenomyosis,? and ?pelvic pain.? mHealth apps were eligible if they were (1) related to the search terms, (2) were in the English language, and (3) were available free of cost. Only the free content of the eligible mHealth apps was assessed. ENLIGHT, a validated evaluation tool for mobile and web-based interventions, was used to assess the quality across 7 domains such as usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. mHealth apps with a total score of ?3.5 were classified as ?good? according to the ENLIGHT scoring system and are recommended as good-quality mHealth apps for endometriosis care. Results: In total, 42 mHealth apps were screened, and 19 were included in the quality assessment. A total of 6 good-quality mHealth apps were identified (QENDO, Bearable, Luna for Health, Matilda Health, Branch Health: Pain Management, and CHARLI Health). These apps provided symptom-tracking functions and self-management support. A total of 17 apps were designed for community use, while 2 apps provided a digital endometriosis classification tool to clinicians. Most mHealth apps scored well (?3.5) in the domains of usability (16/19, 84.2%), visual design (14/19, 73.7%), user engagement (11/19, 57.9%), and content (15/19, 78.9%). Few eHealth websites scored well on therapeutic persuasiveness (6/19, 31.6%), therapeutic alliance (9/19, 47.4%), and general subjective evaluation (6/19, 31.6%). Conclusions: Although time and geographical location can influence the search results, we identified 6 ?good-quality? endometriosis mHealth apps that can be recommended to the endometriosis community. mHealth apps designed for community use should evaluate their effectiveness on user?s endometriosis knowledge, self-recommended management strategies, pain self-efficacy, user satisfaction, and user quality of life. Digital technology should be leveraged to develop mHealth apps for clinicians that contribute to continued medical education and assist clinical decision-making in endometriosis management. Factors that enhance usability, visual design, therapeutic persuasiveness, and therapeutic alliance should be incorporated to ensure successful and long-term uptake of mHealth apps. Trial Registration: PROSPERO CRD42020185475; https://tinyurl.com/384dkkmj UR - https://www.jmir.org/2025/1/e49654 UR - http://dx.doi.org/10.2196/49654 UR - http://www.ncbi.nlm.nih.gov/pubmed/39918848 ID - info:doi/10.2196/49654 ER - TY - JOUR AU - Thigpen, Nina AU - Patel, Shyamal AU - Zhang, Xi PY - 2025/1/31 TI - Oura Ring as a Tool for Ovulation Detection: Validation Analysis JO - J Med Internet Res SP - e60667 VL - 27 KW - ovulation KW - digital medicine KW - physiology KW - body temperature KW - menstrual cycles KW - wearable KW - fertility KW - nonhormonal contraception KW - reproductive health KW - women?s health KW - calendar method KW - mHealth KW - mobile health KW - detection N2 - Background: Oura Ring is a wearable device that estimates ovulation dates using physiology data recorded from the finger. Estimating the ovulation date can aid fertility management for conception or nonhormonal contraception and provides insights into follicular and luteal phase lengths. Across the reproductive lifespan, changes in these phase lengths can serve as a biomarker for reproductive health. Objective: We assessed the strengths, weaknesses, and limitations of using physiology from the Oura Ring to estimate the ovulation date. We compared performance across cycle length, cycle variability, and participant age. In each subgroup, we compared the algorithm?s performance with the traditional calendar method, which estimates the ovulation date based on an individual?s last period start date and average menstrual cycle length. Methods: The study sample contained 1155 ovulatory menstrual cycles from 964 participants recruited from the Oura Ring commercial database. Ovulation prediction kits served as a benchmark to evaluate the performance. The Fisher test was used to determine an odds ratio to assess if ovulation detection rate significantly differed between methods or subgroups. The Mann-Whitney U test was used to determine if the accuracy of the estimated ovulation date differed between the estimated and reference ovulation dates. Results: The physiology method detected 1113 (96.4%) of 1155 ovulations with an average error of 1.26 days, which was significantly lower (U=904942.0, P<.001) than the calendar method?s average error of 3.44 days. The physiology method had significantly better accuracy across all cycle lengths, cycle variability groups, and age groups compared with the calendar method (P<.001). The physiology method detected fewer ovulations in short cycles (odds ratio 3.56, 95% CI 1.65-8.06; P=.008) but did not differ between typical and long or abnormally long cycles. Abnormally long cycle lengths were associated with decreased accuracy (U=22,383, P=.03), with a mean absolute error of 1.7 (SEM .09) days compared with 1.18 (SEM .02) days. The physiology method was not associated with differences in accuracy across age or typical cycle variability, while the calendar method performed significantly worse in participants with irregular cycles (U=21,643, P<.001). Conclusions: The physiology method demonstrated superior accuracy over the calendar method, with approximately 3-fold improvement. Calendar-based fertility tracking could be used as a backup in cases of insufficient physiology data but should be used with caution, particularly for individuals with irregular menstrual cycles. Our analyses suggest the physiology method can reliably estimate ovulation dates for adults aged 18-52 years, across a variety of cycle lengths, and in users with regular or irregular cycles. This method may be used as a tool to improve fertile window estimation, which can aid in conceiving or preventing pregnancies. This method also offers a low-effort solution for follicular and luteal phase length tracking, which are key biomarkers for reproductive health. UR - https://www.jmir.org/2025/1/e60667 UR - http://dx.doi.org/10.2196/60667 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60667 ER - TY - JOUR AU - Cantarutti, Anna AU - Boracchini, Riccardo AU - Bellù, Roberto AU - Ronco, Raffaella AU - Rea, Federico AU - Locatelli, Anna AU - Zanini, Rinaldo AU - Corrao, Giovanni PY - 2025/1/21 TI - Assessing the Impact of Distance Traveled and Birth Volumes of Hospital Maternity Units on Newborn Outcomes: Population-Based Cohort Study JO - JMIR Public Health Surveill SP - e58944 VL - 11 KW - maternity level KW - road travel distance KW - delivery KW - regionalization KW - neonatal outcome KW - childbirth KW - newborn KW - cohort KW - birth KW - population-based KW - maternal KW - maternal outcomes KW - neonatal KW - European KW - health system KW - health care system KW - perinatal care KW - antenatal KW - mortality KW - neonatal mortality KW - perinatal N2 - Background: The centralization of childbirth and newborn care in large maternity units has become increasingly prevalent in Europe. While this trend offers potential benefits such as specialized care and improved outcomes, it can also lead to longer travel and waiting times, especially for women in rural areas. Objective: This study aimed to evaluate the association between hospital maternity unit (HMU) volumes, road travel distance (RTD) to the hospital, and other neonatal outcomes. Methods: We conducted a population-based cohort study including all live births in hospitals without intensive care units between 2016 and 2019 in the Lombardy region, Italy. Given the hierarchical structure of our data (births nested within hospitals), we employed log-binomial regression models with random intercepts to estimate relative risks and 95% CIs for evaluating the association between HMU volumes (?1500 births/year) and RTD (<5 km) with the risk of being transferred and/or death after birth (primary outcome). Secondary outcomes included a low Apgar score at 5 minutes and low adherence to antenatal care (ANC). We controlled for several potential confounders including adherence to the ANC pathway for the primary and low Apgar outcomes. To explore the influence of HMU volumes on the primary outcome, we identified the fractional polynomial model that best described this relationship. Results: Of 65,083 live births, 71% (n=45,955) occurred in low-volume hospitals (<1000 births/year), 21% (n=13,560) involved long-distance travel (>15 km), 1% (n=735) were transferred and/or died after birth, 0.5% (n=305) had a low Apgar score at 5 minutes, and 64% (n=41,317) completely adhered to ANC. The risk of transfer and/or death increased as HMU volume decreased, ranging from 1% for hospitals with 1000?1500 births/year to a 3.6-fold high risk for hospitals with <500 births/year (compared to high-volume hospitals). Travel distance did not affect the primary outcome. Neither HMU volume nor RTD were associated with low Apgar scores. Conversely, the risk of complete adherence to ANC decreased with lower HMU volumes but increased with shorter RTD. Additionally, high-volume hospitals demonstrated a decreasing trend in the frequency of the primary outcome, with transfer and/or death rates ranging from 2% to 0.5% and flattening to 0.5% in hospitals, with activity volume ?1000 mean births/year. Conclusions: Our findings showed an excess risk of neonatal transfer and/or death for live births in HMUs with low activity volumes without an intensive care unit. In contrast, RTD primarily affected adherence to ANC. Moreover, data suggest that 1000 births/year could be an optimal cutoff for maternity hospitals to ensure an appropriate standard of care at delivery. UR - https://publichealth.jmir.org/2025/1/e58944 UR - http://dx.doi.org/10.2196/58944 ID - info:doi/10.2196/58944 ER - TY - JOUR AU - Namatovu, Kasujja Hasifah AU - Magumba, Abraham Mark AU - Akena, Dickens PY - 2025/1/14 TI - E-Screening for Prenatal Depression in Kampala, Uganda Using the Edinburgh Postnatal Depression Scale: Survey Results JO - Online J Public Health Inform SP - e51602 VL - 17 KW - perinatal KW - prenatal KW - antenatal KW - antepartum KW - depression KW - Edinburgh Postnatal Depression Scale N2 - Background: Perinatal depression remains a substantial public health challenge, often overlooked or incorrectly diagnosed in numerous low-income nations. Objective: The goal of this study was to establish statistical baselines for the prevalence of perinatal depression in Kampala and understand its relationship with key demographic variables. Methods: We employed an Android-based implementation of the Edinburgh Postnatal Depression Scale (EPDS) to survey 12,913 women recruited from 7 government health facilities located in Kampala, Uganda. We used the standard EPDS cutoff, which classifies women with total scores above 13 as possibly depressed and those below 13 as not depressed. The ?2 test of independence was used to determine the most influential categorical variables. We further analyzed the most influential categorical variable using odds ratios. For continuous variables such as age and the weeks of gestation, we performed a simple correlation analysis. Results: We found that 21.5% (2783/12,913, 95% CI 20.8%?22.3%) were possibly depressed. Respondents? relationship category was found to be the most influential variable (?21=806.9, P<.001; Cramer?s V=0.25), indicating a small effect size. Among quantitative variables, we found a weak negative correlation between respondents? age and the total EPDS score (r=?0.11, P<.001). Similarly, a weak negative correlation was also observed between the total EPDS score and the number of previous children of the respondent (r=?0.07, P<.001). Moreover, a weak positive correlation was noted between weeks of gestation and the total EPDS score (r=0.02, P=.05) Conclusions: This study shows that demographic factors such as spousal employment category, age, and relationship status have an influence on the respondents? EPDS scores. These variables may serve as proxies for latent factors such as financial stability and emotional support. UR - https://ojphi.jmir.org/2025/1/e51602 UR - http://dx.doi.org/10.2196/51602 ID - info:doi/10.2196/51602 ER - TY - JOUR AU - Hemler, R. Jennifer AU - Wagner, B. Rachel AU - Sullivan, Brittany AU - Macenat, Myneka AU - Tagai, K. Erin AU - Vega, L. Jazmarie AU - Hernandez, Enrique AU - Miller, M. Suzanne AU - Wen, Kuang-Yi AU - Ayers, A. Charletta AU - Einstein, H. Mark AU - Hudson, V. Shawna AU - Kohler, E. Racquel PY - 2025/1/14 TI - A Proposed mHealth Intervention to Address Patient Barriers to Colposcopy Attendance: Qualitative Interview Study of Clinic Staff and Patient Perspectives JO - JMIR Form Res SP - e55043 VL - 9 KW - cervical cancer screening KW - colposcopy KW - HPV KW - human papillomavirus KW - mHealth KW - health communication KW - qualitative research KW - cancer screening KW - cancer KW - cervical cancer KW - screening KW - women KW - clinic staff KW - barrier KW - messaging KW - privacy KW - text message KW - qualitative KW - colposcopic KW - mhealth intervention KW - mobile phone N2 - Background: Cervical cancer disparities persist among minoritized women due to infrequent screening and poor follow-up. Structural and psychosocial barriers to following up with colposcopy are problematic for minoritized women. Evidence-based interventions using patient navigation and tailored telephone counseling, including the Tailored Communication for Cervical Cancer Risk (TC3), have modestly improved colposcopy attendance. However, the efficacious TC3 intervention is human resource-intense and could have greater reach if adapted for mobile health, which increases convenience and access to health information. Objective: This study aimed to describe feedback from clinic staff members involved in colposcopy processes and patients referred for colposcopy regarding adaptions to the TC3 phone-based intervention to text messaging, which addresses barriers among those referred for colposcopy after abnormal screening results. Methods: Semistructured depth qualitative interviews were conducted over Zoom [Zoom Communications, Inc] or telephone with a purposive sample of 22 clinic staff members (including clinicians and support staff members) and 34 patients referred for colposcopy from 3 academic obstetrics and gynecology (OB-GYN) clinics that serve predominantly low-income, minoritized patients in different urban locations in New Jersey and Pennsylvania. Participants were asked about colposcopy attendance barriers and perspectives on a proposed text message intervention to provide tailored education and support in the time between abnormal cervical screening and colposcopy. The analytic team discussed interviews, wrote summaries, and consensus-coded transcripts, analyzing output for emergent findings and crystallizing themes. Results: Clinic staff members and patients had mixed feelings about a text-only intervention. They overwhelmingly perceived a need to provide patients with appointment reminders and information about abnormal cervical screening results and colposcopy purpose and procedure. Both groups also thought messages emphasizing that human papillomavirus is common and cervical cancer can be prevented with follow-up could enhance attendance. However, some had concerns about the privacy of text messages and text fatigue. Both groups thought that talking to clinic staff members was needed in certain instances; they proposed connecting patients experiencing complex psychosocial or structural barriers to staff members for additional information, psychological support, and help with scheduling around work and finding childcare and transportation solutions. They also identified inadequate scheduling and reminder systems as barriers. From this feedback, we revised our text message content and intervention design, adding a health coaching component to support patients with complex barriers and concerns. Conclusions: Clinic staff members and patient perspectives are critical for designing appropriate and relevant interventions. These groups conveyed that text message-only interventions may be useful for patients with lesser barriers who may benefit from reminders, basic educational information, and scheduling support. However, multimodal interventions may be necessary for patients with complex barriers to colposcopy attendance, which we intend to evaluate in a subsequent trial. UR - https://formative.jmir.org/2025/1/e55043 UR - http://dx.doi.org/10.2196/55043 UR - http://www.ncbi.nlm.nih.gov/pubmed/39808485 ID - info:doi/10.2196/55043 ER - TY - JOUR AU - Kaufman, Jaycee AU - Jeon, Jouhyun AU - Oreskovic, Jessica AU - Thommandram, Anirudh AU - Fossat, Yan PY - 2025/1/9 TI - Longitudinal Changes in Pitch-Related Acoustic Characteristics of the Voice Throughout the Menstrual Cycle: Observational Study JO - JMIR Form Res SP - e65448 VL - 9 KW - menstrual cycle KW - women's health KW - voice KW - acoustic analysis KW - longitudinal observational study KW - fertility tracking KW - fertility KW - reproductive health KW - feasibility KW - voice recording KW - vocal pitch KW - follicular KW - luteal phase KW - fertility status KW - mobile phone N2 - Background: Identifying subtle changes in the menstrual cycle is crucial for effective fertility tracking and understanding reproductive health. Objective: The aim of the study is to explore how fundamental frequency features vary between menstrual phases using daily voice recordings. Methods: This study analyzed smartphone-collected voice recordings from 16 naturally cycling female participants, collected every day for 1 full menstrual cycle. Fundamental frequency features (mean, SD, 5th percentile, and 95th percentile) were extracted from each voice recording. Ovulation was estimated using luteinizing hormone urine tests taken every morning. The analysis included comparisons of these features between the follicular and luteal phases and the application of changepoint detection algorithms to assess changes and pinpoint the day in which the shifts in vocal pitch occur. Results: The fundamental frequency SD was 9.0% (SD 2.9%) lower in the luteal phase compared to the follicular phase (95% CI 3.4%?14.7%; P=.002), and the 5th percentile of the fundamental frequency was 8.8% (SD 3.6%) higher (95% CI 1.7%?16.0%; P=.01). No significant differences were found between phases in mean fundamental frequency or the 95th percentile of the fundamental frequency (P=.65 and P=.07). Changepoint detection, applied separately to each feature, identified the point in time when vocal frequency behaviors shifted. For the fundamental frequency SD and 5th percentile, 81% (n=13) of participants exhibited shifts within the fertile window (P=.03). In comparison, only 63% (n=10; P=.24) and 50% (n=8; P=.50) of participants had shifts in the fertile window for the mean and 95th percentile of the fundamental frequency, respectively. Conclusions: These findings indicate that subtle variations in vocal pitch may reflect changes associated with the menstrual cycle, suggesting the potential for developing a noninvasive and convenient method for monitoring reproductive health. Changepoint detection may provide a promising avenue for future work in longitudinal fertility analysis. UR - https://formative.jmir.org/2025/1/e65448 UR - http://dx.doi.org/10.2196/65448 ID - info:doi/10.2196/65448 ER - TY - JOUR AU - Scheffrahn, Katherine AU - Hall, Claire AU - Muñiz, Vanessa AU - Elkins, Gary PY - 2025/1/9 TI - User Outcomes for an App-Delivered Hypnosis Intervention for Menopausal Hot Flashes: Retrospective Analysis JO - JMIR Form Res SP - e63948 VL - 9 KW - hypnosis KW - hypnotherapy KW - hot flash KW - menopause KW - women?s health KW - gynecology KW - smartphone app KW - applications KW - mobile health KW - mHealth KW - user KW - outcome KW - intervention KW - alternative KW - complementary KW - mind-body KW - mobile phone N2 - Background: Hypnotherapy has been shown to be a safe, nonhormonal intervention effective for treating menopausal hot flashes. However, women experiencing hot flashes may face accessibility barriers to in-person hypnotherapy. To solve this issue, a smartphone app has been created to deliver hypnotherapy. The Evia app delivers audio-recorded hypnotherapy and has the potential to help individuals experiencing hot flashes. Objective: This study aims to determine user outcomes in hot flash frequency and severity for users of the Evia app. Methods: This study is a retrospective analysis of a dataset of Evia app users. Participants were divided into 2 groups for analysis. The first group reported daytime hot flashes and night sweats, while the second group was asked to report only daytime hot flashes. The participants in the first group (daytime hot flashes and night sweats) were 139 women with ?3 daily hot flashes who downloaded the Evia app between November 6, 2021, and June 9, 2022, with a baseline mean of 8.330 (SD 3.977) daily hot flashes. The participants in the second group (daytime hot flashes) were 271 women with ?3 daily hot flashes who downloaded the Evia app between June 10, 2022, and February 5, 2024, with a baseline mean of 6.040 (SD 3.282) daily hot flashes. The Evia program included a 5-week program for all participants with daily tasks such as educational readings, hypnotic inductions, and daily hot-flash tracking. The app uses audio-recorded hypnosis and mental imagery for coolness, such as imagery for a cool breeze, snow, or calmness. Results: A clinically significant reduction, defined as a 50% reduction, in daily hot flashes was experienced by 76.3% (106/139) of the women with hot flashes and night sweats and 56.8% (154/271) of the women with daily hot flashes from baseline to their last logged Evia app survey. On average, the women with hot flashes and night sweats experienced a reduction of 61.4% (SD 33.185%) in their hot flashes experienced at day and night while using the Evia app, and the women with daily hot flashes experienced a reduction of 45.2% (SD 42.567%) in their daytime hot flashes. In both groups, there was a large, statistically significant difference in the average number of daily hot flashes from baseline to end point (women with hot flashes and night sweats: Cohen d=1.28; t138=15.055; P<.001; women with daily hot flashes: Cohen d=0.82; t270=13.555; P<.001). Conclusions: Hypnotherapy is an efficacious intervention for hot flashes, with the potential to improve women?s lives by reducing hot flashes without hormonal or pharmacological intervention. This study takes the first step in evaluating the efficacy of an app-delivered hypnosis intervention for menopausal hot flashes, demonstrating the Evia app provides a promising app delivery of hypnotherapy with potential to increase accessibility to hypnotherapy. UR - https://formative.jmir.org/2025/1/e63948 UR - http://dx.doi.org/10.2196/63948 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63948 ER - TY - JOUR AU - Borrowman, D. Jaclyn AU - Carr, J. Lucas AU - Pierce, L. Gary AU - Story, T. William AU - Gibbs, Barone Bethany AU - Whitaker, M. Kara PY - 2025/1/8 TI - Postpartum Remote Health Coaching Intervention for Individuals With a Hypertensive Disorder of Pregnancy: Proof-of-Concept Study JO - JMIR Form Res SP - e65611 VL - 9 KW - cardiovascular disease KW - postpartum KW - hypertensive disorders of pregnancy KW - intervention KW - physical activity intervention KW - proof-of-concept KW - cardiovascular health KW - CVD risk KW - cardiovascular disease risk KW - feasibility KW - acceptability KW - health coaching KW - women's health KW - postnatal N2 - Background: Cardiovascular disease (CVD) is the leading cause of death among women in America. Hypertensive disorders of pregnancy (HDP) negatively impact acute and long-term cardiovascular health, with approximately 16% of all pregnancies affected. With CVD 2?4 times more likely after HDP compared to normotensive pregnancies, effective interventions to promote cardiovascular health are imperative. Objective: With postpartum physical activity (PA) interventions after HDP as an underexplored preventative strategy, we aimed in this study to assess (1) the feasibility and acceptability of a remotely delivered PA intervention for individuals with HDP 3?6 months postpartum and (2) changes in average steps per day, skills related to PA behavior, and postpartum blood pressure (BP). Methods: A remotely delivered 14-week health coaching intervention was designed based on prior formative work. The health coaching intervention called the Hypertensive Disorders of Pregnancy Postpartum Exercise (HyPE) intervention was tested for feasibility and acceptability with a single-arm proof-of-concept study design. A total of 19 women who were 3?6 months postpartum HDP; currently inactive; 18 years of age or older; resided in Iowa; and without diabetes, kidney disease, and CVD were enrolled. Feasibility was assessed by the number of sessions attended and acceptability by self-reported satisfaction with the program. Changes in steps achieved per day were measured with an activPAL4 micro, PA behavior skills via validated surveys online, and BP was assessed remotely with a research-grade Omron Series 5 (Omron Corporation) BP monitor. Results: Participants at enrollment were on average 30.3 years of age, 4.1 months postpartum, self-identified as non-Hispanic White (14/17, 82%), in a committed relationship (16/17, 94%), and had a bachelor?s degree (9/17, 53%). A total of 140 of 152 possible health coaching sessions were attended by those who started the intervention (n=19, 92%). Intervention completers (n=17) indicated they were satisfied with the program (n=17, 100%) and would recommend it to others (n=17, 100%). No significant changes in activPAL measured steps were observed from pre- to posttesting (mean 138.40, SD 129.40 steps/day; P=.75). Significant improvements were observed in PA behavior skills including planning (mean 5.35, SD 4.97 vs mean 15.06, SD 3.09; P<.001) and monitoring of PA levels (mean 7.29, SD 3.44 vs mean 13.00, SD 2.45; P<.001). No significant decreases were observed for systolic (mean ?1.28, SD 3.59 mm Hg; Hedges g=?0.26; P=.16) and diastolic BP (mean ?1.80, SD 5.03 mm Hg; Hedges g=?0.44; P=.12). Conclusions: While PA behaviors did not change, the intervention was found to be feasible and acceptable among this sample of at-risk women. After additional refinement, the intervention should be retested among a larger, more diverse, and less physically active sample. Trial Registration: ClinicalTrials.gov NCT06019715; https://clinicaltrials.gov/study/NCT06019715 UR - https://formative.jmir.org/2025/1/e65611 UR - http://dx.doi.org/10.2196/65611 ID - info:doi/10.2196/65611 ER - TY - JOUR AU - Levy, S. Morgan AU - Bernstein, A. Simone AU - McNeilly, M. Sarah AU - Liberty, Abigail AU - Fishbach, Shira AU - Jain, Shikha AU - Gold, A. Jessica AU - Arora, M. Vineet PY - 2025/1/7 TI - Student and Physician Views of How the Dobbs Decision Affects Training and Practice Location Preferences: Cross-Sectional Questionnaire Study JO - Interact J Med Res SP - e55035 VL - 14 KW - abortion KW - physician workforce KW - social media KW - reproductive health KW - medical education KW - abortion access KW - education KW - survey study KW - students KW - training KW - patient care KW - care KW - medical students KW - human rights KW - autonomy N2 - Background: By allowing for abortion bans and restrictions to take effect in the majority of US states, the 2022 Dobbs v Jackson Women?s Health Organization decision portends to have lasting impacts on patient care and the physician workforce. Notably, it is already beginning to impact practice location preferences of US health care workers, evidenced by declining application rates to residency programs in abortion-restrictive states since 2022. Yet, there remains a gap in the literature regarding why this trend exists. Objective: This study aims to describe what factors are driving the practice location preferences of medical students and physicians after the Dobbs decision. Methods: This study analyzes qualitative data from a web-based, cross-sectional study. In August 2022, a nonprobabilistic sample of physicians and medical students were surveyed on social media about the impact of overturning Roe v Wade on practice location preferences, which included the free-text question ?Please share your thoughts about the overturning of Roe v Wade and how it will affect your decision about your (residency/job or fellowship) programs.? A total of 3 independent team members completed an inductive thematic analysis of 524 free responses, resolving differences by discussion. Results: Approximately 1 in 4 survey respondents also completed the free-response item (524/2063, 25.4%); a total of 219 were medical students, 129 were residents and fellows, and 176 were practicing physicians. Of them, approximately half (261/524, 50.5%) resided in states where abortion bans were in place or anticipated. Those who answered the free-response item were relatively more likely to hail from states with restrictive abortion bans (P<.001) compared to those who did not, with other demographic characteristics being largely similar between the groups. Inductive thematic analysis yielded 2 broad thematic categories: patient-related and workforce-related factors influencing practice decision preferences. The 3 most common themes overall were respondent concerns regarding their patient?s access to care (249/524, 47.5%), their desire not to practice or train in a state with abortion restrictions regardless of current residence (249/524, 47.5%), and their personal belief that abortion bans are human rights and/or body autonomy violation (197/524, 37.6%). Some respondents stated that the Dobbs decision would not impact their choice of practice location (41/524, 7.8%), and some supported it (35/594, 6.7%). Conclusions: This study shows that abortion restrictions are having an impact on the practice location preferences of the physician workforce due to both patient care and personal factors. It is important that state policy makers and others who are considering abortion restrictions also consider how to address these concerns of physicians and medical students, to avoid worsening geographic maldistribution of physicians and worsening access to care from physicians for their citizens. UR - https://www.i-jmr.org/2025/1/e55035 UR - http://dx.doi.org/10.2196/55035 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55035 ER - TY - JOUR AU - Isaac, Mohsen Sarah AU - Dawes, Mark AU - Howell, Ruth Emily AU - Oladipo, Francis Antonia PY - 2025/1/6 TI - Gender-Inclusive Language in Public-Facing Labor and Delivery Web Pages in the New York Tristate Area: Cross-Sectional Study JO - JMIR Hum Factors SP - e53057 VL - 12 KW - OBGYN KW - transgender KW - nonbinary KW - pregnancy KW - maternity KW - transmasculine KW - observational study KW - gestational KW - perinatal care KW - communication KW - labor KW - USA KW - United States KW - New York City KW - sexual orientation KW - inclusion KW - parents KW - obstetrician gynecologist KW - delivery N2 - Background: Transgender and nonbinary (TGNB) individuals are increasingly intentionally becoming pregnant to raise children, and hospital websites should reflect these trends. For prospective TGNB parents, a hospital website is the only way they can assess their safety from discrimination while receiving perinatal care. Cisnormativity enforced by communication gaps between medical institutions and TGNB patients can and has caused delays in receiving urgent care during their pregnancy. Objective: The aim of this study was to evaluate the current prevalence of gender-inclusive terminology among labor and delivery services in the New York tristate area. Methods: The labor and delivery web pages of 189 hospitals from New York, New Jersey, and Connecticut were examined for gender-inclusive language. ?Fully inclusive? websites explicitly acknowledged lesbian, gay, bisexual, transgender, queer, intersex, and asexual plus other gender- and sexual-oriented (LGBTQIA+) parents, ?inclusive? websites did not use gendered terminology for parents, and ?noninclusive? websites used gendered terms at least once in the text reviewed. The hospitals? web pages were further stratified by Healthcare Equality Index scores and population classifications defined by the 2013 National Center for Health Statistics Urban-Rural classification given to the county that each hospital was located in. Results: Of the 300 hospital websites reviewed, only 189 websites met the criteria for inclusion. Overall, only 6.3% (n=12) of labor and delivery web pages were ?inclusive? or ?fully inclusive.? No geographic areas (P=.61) or Healthcare Equality Index scores (P=.81) were associated with inclusive or fully inclusive language. Conclusions: Hospitals need to use inclusive language to help TGNB people identify hospitals where their existence and needs are acknowledged and thus feel more comfortable in their transition to parenthood. UR - https://humanfactors.jmir.org/2025/1/e53057 UR - http://dx.doi.org/10.2196/53057 ID - info:doi/10.2196/53057 ER - TY - JOUR AU - Apsey, Chloe AU - Di Florio, Arianna AU - Stawarz, Katarzyna PY - 2024/12/24 TI - Developing a Mood and Menstrual Tracking App for People With Premenstrual Dysphoric Disorder: User-Centered Design Study JO - JMIR Form Res SP - e59333 VL - 8 KW - premenstrual dysphoric disorder KW - menstrual tracking KW - mood tracking KW - mobile health KW - mHealth KW - user-centered design KW - menstrual KW - tracking app KW - hormonal fluctuations KW - mood monitoring KW - menstruation N2 - Background: People with premenstrual dysphoric disorder (PMDD) experience a range of symptoms that increase and decline as a result of the natural hormonal fluctuations of the menstrual cycle. For the diagnosis of PMDD, symptom severity needs to be recorded daily for at least two symptomatic cycles. In recent years, the rise in interest in Femtech (tools and technology developed to address women?s health issues) has resulted in a large quantity of ?period-tracking apps? being developed and downloaded. However, there is not currently a menstrual and mood tracking app that has the full capabilities to accurately capture the symptoms of PMDD to aid with diagnosis. Objective: This study aimed to collect feedback and insights from potential users (ie, people with lived experience of PMDD or severe premenstrual syndrome) to inform the development of a prototype app that could support prospective mood monitoring of PMDD symptoms for research, and to support diagnosis. Methods: We conducted two user-centered design studies. Study 1 consisted of 4 interviews with individual participants who had taken part in our previous web-based mood tracking study for PMDD. During the interviews, participants were encouraged to identify the strengths and weaknesses of the existing web-based mood tracking system. Study 2 consisted of 2 workshops with a total of 8 participants, in which participants were asked to discuss the needs and desirable features they would like in a PMDD-specific tracking app. Interviews and workshops were recorded, and the transcripts were analyzed inductively following a thematic approach. Results: A total of four themes were identified from the interviews and workshops with potential users: (1) ease of use as a key consideration for users with PMDD; (2) avoiding a reductionist approach for a broad range of symptoms; (3) recognizing the importance of correct language; and (4) integrating features for the users? benefits. These suggestions align with the current understanding of the implications of PMDD symptoms on daily activities and with findings from previous research on encouraging long-term engagement with apps. Conclusions: To meet the needs of potential users with PMDD or suspected PMDD, there needs to be a special consideration to how their symptoms impact the way they might interact with the app. In order for users to want to interact with the app daily, particularly during the days where they may not have symptoms to track, the app needs to be simple yet engaging. In addition, if the app provides insights and feedback that can benefit the well-being of the users, it is suggested that this could ensure prolonged use. UR - https://formative.jmir.org/2024/1/e59333 UR - http://dx.doi.org/10.2196/59333 ID - info:doi/10.2196/59333 ER - TY - JOUR AU - Dorney, Edwina AU - Hammarberg, Karin AU - Rodgers, Raymond AU - Black, I. Kirsten PY - 2024/12/24 TI - Optimization of a Web-Based Self-Assessment Tool for Preconception Health in People of Reproductive Age in Australia: User Feedback and User-Experience Testing Study JO - JMIR Hum Factors SP - e63334 VL - 11 KW - technology KW - internet KW - eHealth KW - user experience KW - patient engagement KW - self-assessment tool KW - preconception KW - health communication N2 - Background: Good preconception health reduces the incidence of preventable morbidity and mortality for women, their babies, and future generations. In Australia, there is a need to increase health literacy and awareness about the importance of good preconception health. Digital health tools are a possible enabler to increase this awareness at a population level. The Healthy Conception Tool (HCT) is an existing web-based, preconception health self-assessment tool, that has been developed by academics and clinicians. Objective: This study aims to optimize the HCT and to seek user feedback to increase the engagement and impact of the tool. Methods: In-depth interviews were held with women and men aged 18?41 years, who spoke and read English and were residing in Australia. Interview transcripts were analyzed, and findings were used to inform an enhanced HCT prototype. This prototype underwent user-experience testing and feedback from users to inform a final round of design changes to the tool. Results: A total of 20 women and 5 men were interviewed; all wanted a tool that was quick and easy to use with personalized results. Almost all participants were unfamiliar with the term ?preconception care? and stated they would not have found this tool on the internet with its current title. User-experience testing with 6 women and 5 men identified 11 usability issues. These informed further changes to the tool?s title, the information on how to use the tool, and the presentation of results. Conclusions: Web-based self-assessment tools need to be easy to find and should communicate health messages effectively. End users? feedback informed changes to improve the tool?s acceptability, engagement, and impact. We expect that the revised tool will have greater reach and prompt more people to prepare well for pregnancy. UR - https://humanfactors.jmir.org/2024/1/e63334 UR - http://dx.doi.org/10.2196/63334 ID - info:doi/10.2196/63334 ER - TY - JOUR AU - Smit, JP Ashley AU - Al-Dhahir, Isra AU - Schiphof-Godart, Lieke AU - Breeman, D. Linda AU - Evers, WM Andrea AU - Joosten, FM Koen PY - 2024/12/20 TI - Investigating eHealth Lifestyle Interventions for Vulnerable Pregnant Women: Scoping Review of Facilitators and Barriers JO - J Med Internet Res SP - e54366 VL - 26 KW - eHealth KW - pregnancy KW - vulnerability KW - socioeconomic status KW - lifestyle intervention KW - intervention development KW - barriers KW - facilitators KW - mobile phone KW - PRISMA N2 - Background: The maintenance of a healthy lifestyle significantly influences pregnancy outcomes. Certain pregnant women are more at risk of engaging in unhealthy behaviors due to factors such as having a low socioeconomic position and low social capital. eHealth interventions tailored to pregnant women affected by these vulnerability factors can provide support and motivation for healthier choices. However, there is still a lack of insight into how interventions for this target group are best designed, used, and implemented and how vulnerable pregnant women are best reached. Objective: This review aimed to identify the strategies used in the design, reach, use, and implementation phases of eHealth lifestyle interventions for vulnerable pregnant women; assess whether these strategies acted as facilitators; and identify barriers that were encountered. Methods: We conducted a search on MEDLINE, Embase, Web of Science, CINAHL, and Google Scholar for studies that described an eHealth intervention for vulnerable pregnant women focusing on at least one lifestyle component (diet, physical activity, alcohol consumption, smoking, stress, or sleep) and provided information on the design, reach, use, or implementation of the intervention. Results: The literature search identified 3904 records, of which 29 (0.74%) met our inclusion criteria. These 29 articles described 20 eHealth lifestyle interventions, which were primarily delivered through apps and frequently targeted multiple lifestyle components simultaneously. Barriers identified in the design and use phases included financial aspects (eg, budgetary constraints) and technological challenges for the target group (eg, limited internet connectivity). In addition, barriers were encountered in reaching vulnerable pregnant women, including a lack of interest and time constraints among eligible participants and limited support from health care providers. Facilitators identified in the design and use phases included collaborating with the target group and other stakeholders (eg, health care providers), leveraging existing eHealth platforms for modifications or extensions, and adhering to clinical and best practice guidelines and behavior change frameworks. Furthermore, tailoring (eg, matching the content of the intervention to the target groups? norms and values) and the use of incentives (eg, payments for abstaining from unhealthy behavior) were identified as potential facilitators to eHealth use. Facilitators in the interventions? reach and implementation phases included stakeholder collaboration and a low workload for the intervention deliverers involved in these phases. Conclusions: This scoping review offers a comprehensive overview of strategies used in different phases of eHealth lifestyle interventions for vulnerable pregnant women, highlighting specific barriers and facilitators. Limited reporting on the impact of the strategies used and barriers encountered hinders a complete identification of facilitators and barriers. Nevertheless, this review sheds light on how to optimize the development of eHealth lifestyle interventions for vulnerable pregnant women, ultimately enhancing the health of both future mothers and their offspring. UR - https://www.jmir.org/2024/1/e54366 UR - http://dx.doi.org/10.2196/54366 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54366 ER - TY - JOUR AU - Lemieux, Mackenzie AU - Zhou, Cyrus AU - Cary, Caroline AU - Kelly, Jeannie PY - 2024/12/16 TI - Changes in Reproductive Health Information-Seeking Behaviors After the Dobbs Decision: Systematic Search of the Wikimedia Database JO - JMIR Infodemiology SP - e64577 VL - 4 KW - abortion KW - Dobbs KW - internet KW - viewer trends KW - Wikipedia KW - women?s health KW - contraception KW - contraceptive KW - trend KW - information seeking KW - page view KW - reproductive KW - reproduction N2 - Background: After the US Supreme Court overturned Roe v. Wade, confusion followed regarding the legality of abortion in different states across the country. Recent studies found increased Google searches for abortion-related terms in restricted states after the Dobbsv. Jackson Women?s Health Organization decision was leaked. As patients and providers use Wikipedia (Wikimedia Foundation) as a predominant medical information source, we hypothesized that changes in reproductive health information-seeking behavior could be better understood by examining Wikipedia article traffic. Objective: This study aimed to examine trends in Wikipedia usage for abortion and contraception information before and after the Dobbs decision. Methods: Page views of abortion- and contraception-related Wikipedia pages were scraped. Temporal changes in page views before and after the Dobbs decision were then analyzed to explore changes in baseline views, differences in views for abortion-related information in states with restrictive abortion laws versus nonrestrictive states, and viewer trends on contraception-related pages. Results: Wikipedia articles related to abortion topics had significantly increased page views following the leaked and final Dobbs decision. There was a 103-fold increase in the page views for the Wikipedia article Roe v. Wade following the Dobbs decision leak (mean 372,654, SD 135,478 vs mean 3614, SD 248; P<.001) and a 67-fold increase in page views following the release of the final Dobbs decision (mean 8942, SD 402 vs mean 595,871, SD 178,649; P<.001). Articles about abortion in the most restrictive states had a greater increase in page views (mean 40.6, SD 12.7; 18/51, 35% states) than articles about abortion in states with some restrictions or protections (mean 26.8, SD 7.3; 24/51, 47% states; P<.001) and in the most protective states (mean 20.6, SD 5.7; 8/51, 16% states; P<.001). Finally, views to pages about common contraceptive methods significantly increased after the Dobbs decision. ?Vasectomy? page views increased by 183% (P<.001), ?IUD? (intrauterine device) page views increased by 80% (P<.001), ?Combined oral contraceptive pill? page views increased by 24% (P<.001), ?Emergency Contraception? page views increased by 224% (P<.001), and ?Tubal ligation? page views increased by 92% (P<.001). Conclusions: People sought information on Wikipedia about abortion and contraception at increased rates after the Dobbs decision. Increased traffic to abortion-related Wikipedia articles correlated to the restrictiveness of state abortion policies. Increased interest in contraception-related pages reflects the increased demand for contraceptives observed after the Dobbs decision. Our work positions Wikipedia as an important source of reproductive health information and demands increased attention to maintain and improve Wikipedia as a reliable source of health information after the Dobbs decision. UR - https://infodemiology.jmir.org/2024/1/e64577 UR - http://dx.doi.org/10.2196/64577 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64577 ER - TY - JOUR AU - Hanach, Nivine AU - Saqan, Roba AU - Radwan, Hadia AU - Baniissa, Wegdan AU - de Vries, Nanne PY - 2024/12/16 TI - Perceived Experiences and Needs of Digital Resources Among Postpartum Women in the United Arab Emirates: Qualitative Focus Group Study JO - J Med Internet Res SP - e53720 VL - 26 KW - digital health KW - social support KW - telemedicine KW - postpartum women KW - focus group KW - maternal health KW - postpartum mental health KW - postpartum depression KW - emotional support KW - health information N2 - Background: The postpartum period is a critical phase in a woman's life, marked by various physical, psychological, and social challenges. In light of the rapid proliferation and uptake of digital technologies, particularly in the United Arab Emirates (UAE), mothers increasingly seek informational and emotional support from digital resources. No previous study has thoroughly explored the usage of various digital resources beyond telehealth services in the UAE. This literature gap is particularly relevant for the postpartum period, which remains largely understudied in the UAE. Objective: This study aims to delve into the digital experiences of postpartum women in the UAE by exploring the types of resources they navigate and the purposes those resources serve. In addition, it seeks to identify their perspectives and needs regarding digital resources that support their postpartum journey. Methods: Four focus groups were conducted synchronously on the web, involving a total of 27 multicultural mothers (mean age 32.47, SD 4.56 years), between 2 and 12 months post partum and living in the UAE. Descriptive interpretive thematic analysis was used to analyze the data. Results: Sixteen out of 27 women exhibited severe depressive symptoms at the time of the discussions (Edinburgh Postnatal Depression Scale score of >12). Two main themes were generated from the analysis: (1) Mothers? Experiences with Digital Resources: Participants valued digital resources for providing immediate information, convenience, and support. They primarily used these resources to seek information on infant health, parenting advice, and emotional support through web-based communities. However, the abundance of conflicting information and the pressure to conform to health recommendations often created stress and anxiety. (2) The Perceived Need for Digital Resources: Despite their extensive use of digital resources, mothers articulated the need for a reliable UAE government digital platform tailored specifically to postpartum care, offering trusted information on infant health and postpartum mental well-being. They also emphasized the need for tailored postpartum telemedicine services and moderated web-based discussion forums to foster peer support among mothers. Conclusions: This study reveals the multifaceted role of digital resources in supporting mothers during the postpartum period, highlighting unmet needs that present opportunities for advancing postpartum care in the UAE. It demonstrates the importance of developing reliable digital solutions for postpartum women, especially regarding mental health and to enhance access to care through tailored telemedicine services. Collaborative efforts are required to ensure the implementation of user-centered digital platforms. Future research should focus on the diverse needs of postpartum women, including cultural sensitivity, the feasibility of telemedicine services, and the integration of partner support in digital interventions to improve maternal health outcomes. UR - https://www.jmir.org/2024/1/e53720 UR - http://dx.doi.org/10.2196/53720 UR - http://www.ncbi.nlm.nih.gov/pubmed/39680428 ID - info:doi/10.2196/53720 ER - TY - JOUR AU - Wickham, P. Aidan AU - Hewings-Martin, Yella AU - Goddard, GB Frederick AU - Rodgers, K. Allison AU - Cunningham, C. Adam AU - Prentice, Carley AU - Wilks, Octavia AU - Kaplan, C. Yusuf AU - Marhol, Andrei AU - Meczner, András AU - Stsefanovich, Heorhi AU - Klepchukova, Anna AU - Zhaunova, Liudmila PY - 2024/12/12 TI - Exploring Self-Reported Symptoms for Developing and Evaluating Digital Symptom Checkers for Polycystic Ovarian Syndrome, Endometriosis, and Uterine Fibroids: Exploratory Survey Study JO - JMIR Form Res SP - e65469 VL - 8 KW - polycystic ovary syndrome KW - PCOS KW - self-assessment KW - self-reported KW - endometriosis KW - uterine fibroids KW - symptoms KW - digital symptom checker KW - women's health KW - gynecological conditions KW - reproductive health N2 - Background: Reproductive health conditions such as polycystic ovary syndrome (PCOS), endometriosis, and uterine fibroids pose a significant burden to people who menstruate, health care systems, and economies. Despite clinical guidelines for each condition, prolonged delays in diagnosis are commonplace, resulting in an increase to health care costs and risk of health complications. Symptom checker apps have the potential to significantly reduce time to diagnosis by providing users with health information and tools to better understand their symptoms. Objective: This study aims to study the prevalence and predictive importance of self-reported symptoms of PCOS, endometriosis, and uterine fibroids, and to explore the efficacy of 3 symptom checkers (developed by Flo Health UK Limited) that use self-reported symptoms when screening for each condition. Methods: Flo?s symptom checkers were transcribed into separate web-based surveys for PCOS, endometriosis, and uterine fibroids, asking respondents their diagnostic history for each condition. Participants were aged 18 years or older, female, and living in the United States. Participants either had a confirmed diagnosis (condition-positive) and reported symptoms retrospectively as experienced at the time of diagnosis, or they had not been examined for the condition (condition-negative) and reported their current symptoms as experienced at the time of surveying. Symptom prevalence was calculated for each condition based on the surveys. Least absolute shrinkage and selection operator regression was used to identify key symptoms for predicting each condition. Participants? symptoms were processed by Flo?s 3 single-condition symptom checkers, and accuracy was assessed by comparing the symptom checker output with the participant?s condition designation. Results: A total of 1317 participants were included with 418, 476, and 423 in the PCOS, endometriosis, and uterine fibroids groups, respectively. The most prevalent symptoms for PCOS were fatigue (92%), feeling anxious (87%), BMI over 25 (84%); for endometriosis: very regular lower abdominal pain (89%), fatigue (85%), and referred lower back pain (80%); for uterine fibroids: fatigue (76%), bloating (69%), and changing sanitary protection often (68%). Symptoms of anovulation and amenorrhea (long periods, irregular cycles, and absent periods), and hyperandrogenism (excess hair on chin and abdomen, scalp hair loss, and BMI over 25) were identified as the most predictive symptoms for PCOS, while symptoms related to abdominal pain and the effect pain has on life, bleeding, and fertility complications were among the most predictive symptoms for both endometriosis and uterine fibroids. Symptom checker accuracy was 78%, 73%, and 75% for PCOS, endometriosis, and uterine fibroids, respectively. Conclusions: This exploratory study characterizes self-reported symptomatology and identifies the key predictive symptoms for 3 reproductive conditions. The Flo symptom checkers were evaluated using real, self-reported symptoms and demonstrated high levels of accuracy. UR - https://formative.jmir.org/2024/1/e65469 UR - http://dx.doi.org/10.2196/65469 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/65469 ER - TY - JOUR AU - Dubbelman, Julia AU - Ooms, Jonelle AU - Havgry, Laura AU - Simonse, Lianne PY - 2024/12/10 TI - Communal Load Sharing of Miscarriage Experiences: Thematic Analysis of Social Media Community Support JO - J Med Internet Res SP - e56680 VL - 26 KW - miscarriage KW - miscarriage grief KW - online health communities KW - thematic analysis KW - social support KW - communal load sharing KW - peer-to-peer support N2 - Background: Miscarriage is a common experience, affecting 15% of recognized pregnancies, but societal ignorance and taboos often downplay the mental distress and personal impact following a miscarriage. Emerging stories on social media in which women express their miscarriage grief are breaking such taboos. Research in the area of online health communities is increasingly focused on studying how people share their health experiences on social media. However, a clear understanding on the social support involved in this type of sharing of health experiences is lacking. Objective: This study explored the use of Instagram in sharing miscarriage experiences, guided by the following research question: How is social community support given to women who share their miscarriage experiences on social media? Considering that social media is increasingly used as a source of social support, in this study, we chose Instagram as the social media platform. The purpose of this research was to create a better understanding of how social media provides support in expressing personal miscarriage experiences and how people engage with such posts. Methods: This study used a qualitative inductive research method in which a phenomenological strategy and thematic analysis were followed to create a comprehensive understanding of the social community support phenomenon. The dataset was established from a sample of 258 Instagram posts and 736 comments collected over a period of 6 months after initial posts and from 6 different women. These data were categorized and clustered through a thematic analysis. Results: Three themes were identified: (1) storytelling of emotional turmoil and grief after miscarriage, (2) sharing positivity amidst miscarriage grief, and (3) mentioning personal medical information about miscarriage. Theme 1 represents the emotional experience of women who have had a miscarriage. It encompasses the initial posts that included miscarriage storytelling that express deep grief and mental distress and the emotional impact on both the posters and the commenters. Theme 2 highlights the importance of finding moments of joy and positivity in the midst of mental distress and pain. The posts shared with the online community convey a sense of moving forward and a refusal to let grief become the defining aspect of one?s life. Theme 3 focuses on sharing medical and practical advice. This theme includes posts and comments about medications, in vitro fertilization procedures, hospital experiences, and personal physical symptoms. Conclusions: As an overarching theme for this social support phenomenon, we introduce the term communal load sharing to describe the therapeutic role of social media in helping women cope with miscarriage by providing a platform for sharing similar experiences, breaking social taboos, and fostering load sharing. UR - https://www.jmir.org/2024/1/e56680 UR - http://dx.doi.org/10.2196/56680 UR - http://www.ncbi.nlm.nih.gov/pubmed/39656509 ID - info:doi/10.2196/56680 ER - TY - JOUR AU - Lewkowitz, K. Adam AU - Guillen, Melissa AU - Ursino, Katrina AU - Baker, Rackeem AU - Lum, Liana AU - Battle, L. Cynthia AU - Ware, Crystal AU - Ayala, K. Nina AU - Clark, Melissa AU - Ranney, L. Megan AU - Miller, S. Emily AU - Guthrie, M. Kate PY - 2024/12/9 TI - Optimizing a Novel Smartphone App to Prevent Postpartum Depression Adapted From an Evidence-Based Cognitive Behavioral Therapy Program: Qualitative Study JO - JMIR Hum Factors SP - e63143 VL - 11 KW - cognitive behavioral therapy KW - mothers and babies program KW - digital health KW - postpartum depression KW - smartphone application KW - FRAME for intervention adaptation KW - Framework for Modification and Adaptation KW - behavioral therapy KW - mental health apps N2 - Background: Low-income pregnant patients are at high risk of postpartum depression (PPD). Mothers and Babies (MB) is a cognitive behavioral therapy?based program that prevents up to 50% of de novo PPD when provided in person to low-income Spanish- and English-speaking people who are pregnant without depression. MB is limited by the need for trained personnel to support it. Transforming MB into a smartphone app may mitigate this key barrier. Objective: We aimed to use qualitative data from target end users to create and optimize MBapp, a novel app centered on the MB program. Methods: Draft wireframes of MBapp were created in English and Spanish with cognitive behavioral therapy?based modules adapted from MB. These wireframes included several features shown previously to sustain app engagement: (1) push notifications delivered at participant-preferred times; (2) text-, graphic-, and video-based content; and (3) gamification with digital rewards for app engagement. English- or Spanish-speaking individuals with public health insurance who were between 32 weeks gestation and 6 months post partum and owned smartphones were eligible to consent for individual in-depth interviews. Individuals with prior or current depression were excluded. Interviews were recorded, transcribed, and analyzed using deductive and inductive codes to characterize opinions about MBapp and perceptions of challenges and facilitators of use of MBapp or other perinatal or mental health apps. End user feedback led to major modifications to the wireframes. Each of these changes was categorized according to the FRAME (Framework for Modification and Adaptation), an established method of systematically reporting adaptations and modifications to evidence-based interventions via end user feedback. Recruitment ceased with content saturation, defined as 3 successive participants providing only positive feedback on MBapp?s wireframe, without further suggestions for improvement. Results: A total of 25 interviews were completed. Participants were racially and ethnically diverse, generally representing our target end user population, and 48% (n=12) of interviews were conducted in Spanish. Participants? suggestions to improve MBapp were categorized within the FRAME as adaptations that improved either content or context to optimize reach, retention, engagement, and fit for end users. Specifically, the following features were added to MBapp secondary to end user feedback: (1) audio narration; (2) ?ask a clinician? nonurgent questions; (3) on-demand module summaries accessible upon module completion; and (4) choice to defer assessments and start the next module. Participants also provided insights into features of perinatal or mental health apps they found appealing or unappealing to understand preferences, challenges, and negotiables or nonnegotiables for MBapp. Conclusions: Adapting MBapp to incorporate end users? perspectives optimized our digital PPD prevention intervention, ideally increasing its appeal to future users. Our team?s next steps will confirm that MBapp is a feasible, acceptable intervention among English- and Spanish-speaking perinatal people at risk of PPD. UR - https://humanfactors.jmir.org/2024/1/e63143 UR - http://dx.doi.org/10.2196/63143 ID - info:doi/10.2196/63143 ER - TY - JOUR AU - Klimiuk, Bartosz Krzysztof AU - Kot, Amelia AU - Majcherek, Ewa AU - Kubiak, B. Katarzyna AU - Balwicki, ?ukasz PY - 2024/12/9 TI - Themes in Abortion Forum Discussions in a Restrictive Access Context: Qualitative and Quantitative Analyses JO - J Med Internet Res SP - e59544 VL - 26 KW - abortion KW - content analysis KW - reproductive health KW - online forum KW - Poland KW - women KW - support N2 - Background: Abortion is one of the most common medical procedures worldwide. Despite this, access to abortion on demand remains restricted in many countries, including Poland. As a result, many women resort to undergoing the procedure without medical supervision, putting themselves at risk of serious health consequences such as drug poisoning, excessive bleeding, and hypovolemia. Unfortunately, some abortions also lead to severe infections. Objective: This study aims to qualitatively identify key themes in abortion forums to analyze the issues faced by individuals. The forums were then quantitatively analyzed to determine which problems were most prevalent. Methods: The most popular abortion forums were identified. A preliminary thematic analysis was conducted for the qualitative phase, followed by a manual quantitative analysis. Two independent researchers reviewed forum posts, categorizing them into specific themes. Results: An analysis of 13,397 responses from 370 threads across 4 forums revealed ?Abortion Process Progression? as the most discussed theme, highlighting a strong demand for information, emotional support, and medical guidance. The highest percentage of threads (162/886, 18.3%) focused on the need for mental support and the desire to have someone in contact during the abortion process. Concerns about the effectiveness of the termination also emerged as a significant topic, accounting for 83 of the 886 (9.4%) discussions. ?Emotional and Psychological Aspects? and ?Medical and Pharmacological Aspects? were also significant, highlighting the need for holistic care. Anxiety and fear related to the process were frequently discussed, accounting for 60 of the 886 (6.8%) responses. The issue of isolation and lack of support was also a common topic, appearing in 30 of the 886 (3.4%) threads. Notably, ?Social and Ethical Perception? accounted for only 13 of the 886 (1.5%) responses and appeared in just 13 threads. Conclusions: This study highlights the critical need for information and support for women navigating abortion, particularly in regions where access is restricted. It emphasizes the importance of addressing the multifaceted challenges women face and calls for policy changes and strengthened support networks to improve the health and rights of women, as well as all those seeking gynecological care in abortion contexts. Further research is encouraged to refine and expand support strategies. UR - https://www.jmir.org/2024/1/e59544 UR - http://dx.doi.org/10.2196/59544 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59544 ER - TY - JOUR AU - Baer, J. Rebecca AU - Bandoli, Gretchen AU - Jelliffe-Pawlowski, Laura AU - Chambers, D. Christina PY - 2024/12/3 TI - The University of California Study of Outcomes in Mothers and Infants (a Population-Based Research Resource): Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e59844 VL - 10 KW - birth certificate KW - vital statistics KW - hospital discharge KW - administrative data KW - linkage KW - pregnancy outcome KW - birth outcome KW - infant outcome KW - adverse outcome KW - preterm birth KW - birth defects KW - pregnancy KW - prenatal KW - California KW - policy KW - disparities KW - children KW - data collection N2 - Background: Population-based databases are valuable for perinatal research. The California Department of Health Care Access and Information (HCAI) created a linked birth file covering the years 1991 through 2012. This file includes birth and fetal death certificate records linked to the hospital discharge records of the birthing person and infant. In 2019, the University of California Study of Outcomes in Mothers and Infants received approval to create similar linked birth files for births from 2011 onward, with 2 years of overlapping birth files to allow for linkage comparison. Objective: This paper aims to describe the University of California Study of Outcomes in Mothers and Infants linkage methodology, examine the linkage quality, and discuss the benefits and limitations of the approach. Methods: Live birth and fetal death certificates were linked to hospital discharge records for California infants between 2005 and 2020. The linkage algorithm includes variables such as birth hospital and date of birth, and linked record selection is made based on a ?link score.? The complete file includes California Vital Statistics and HCAI hospital discharge records for the birthing person (1 y before delivery and 1 y after delivery) and infant (1 y after delivery). Linkage quality was assessed through a comparison of linked files and California Vital Statistics only. Comparisons were made to previous linked birth files created by the HCAI for 2011 and 2012. Results: Of the 8,040,000 live births, 7,427,738 (92.38%) California Vital Statistics live birth records were linked to HCAI records for birthing people, 7,680,597 (95.53%) birth records were linked to HCAI records for the infant, and 7,285,346 (90.61%) California Vital Statistics birth records were linked to HCAI records for both the birthing person and the infant. The linkage rates were 92.44% (976,526/1,056,358) for Asian and 86.27% (28,601/33,151) for Hawaiian or Pacific Islander birthing people. Of the 44,212 fetal deaths, 33,355 (75.44%) had HCAI records linked to the birthing person. When assessing variables in both California Vital Statistics and hospital records, the percentage was greatest when using both sources: the rates of gestational diabetes were 4.52% (329,128/7,285,345) in the California Vital Statistics records, 8.2% (597,534/7,285,345) in the HCAI records, and 9.34% (680,757/7,285,345) when using both data sources. Conclusions: We demonstrate that the linkage strategy used for this data platform is similar in linkage rate and linkage quality to the previous linked birth files created by the HCAI. The linkage provides higher rates of crucial variables, such as diabetes, compared to birth certificate records alone, although selection bias from the linkage must be considered. This platform has been used independently to examine health outcomes, has been linked to environmental datasets and residential data, and has been used to obtain and examine maternal serum and newborn blood spots. UR - https://publichealth.jmir.org/2024/1/e59844 UR - http://dx.doi.org/10.2196/59844 UR - http://www.ncbi.nlm.nih.gov/pubmed/39625748 ID - info:doi/10.2196/59844 ER - TY - JOUR AU - Hammarberg, Karin AU - Bandyopadhyay, Mridula AU - Nguyen, Hau AU - Cicuttini, Flavia AU - Stanzel, Andrea Karin AU - Brown, Helen AU - Hickey, Martha AU - Fisher, Jane PY - 2024/12/2 TI - Development and Evaluation of 4 Short, Animated Videos for Women in Midlife Promoting Positive Health Behaviors: Survey Study JO - Interact J Med Res SP - e60949 VL - 13 KW - health promotion KW - healthy aging KW - self-management KW - midlife KW - menopause KW - internet KW - video KW - animation KW - survey KW - questionnaire KW - education KW - women KW - gynecology N2 - Background: Health and health behaviors in midlife are important determinants of healthy aging. There is evidence of unmet needs for health-promoting information for women from culturally and linguistically diverse backgrounds and women with low literacy. Objective: This study aimed to (1) develop accessible short, animated videos viewable and downloadable from YouTube aimed at promoting positive health behaviors in women in midlife and (2) evaluate their accessibility, acceptability, understanding, and usability and whether this was influenced by the level of education or socioeconomic disadvantage. Methods: In collaboration with a video production company, a multidisciplinary team of academics and health professionals developed 2 short, animated videos on self-management of menopause health and 2 promoting joint health. Their accessibility, acceptability, understanding, and usability to women were evaluated in an anonymous web-based survey. Results: A total of 490 women viewed the videos and responded to the survey. Of these, 353 (72%) completed all questions. Almost all (from 321/353, 91% to 334/363, 92%) agreed that the information in the videos was ?very easy to understand.? The proportions reporting that all or some of the information in the video was new to them varied between videos from 36% (137/386) to 66% (233/353), the reported likelihood of using the practical tips offered in the videos varied from 70% (271/386) to 89% (331/373), and between 61% (235/386) and 70% (263/373) of respondents stated that they would recommend the videos to others. Education-level group comparisons revealed few differences in opinions about the videos, except that women with lower education were more likely than those with higher education to state that they would recommend the 2 joint health videos to others (36/45, 80% vs 208/318, 65%; P=.051 for video 3; and 36/44, 80% vs 197/309, 64%; P=.04 for video 4). There were no differences between women living in the least advantaged areas (Socioeconomic Indexes for Areas quintile areas 1 and 2) and those living in the most advantaged areas (Socioeconomic Indexes for Areas quintile areas 3, 4, and 5) in their responses to any of the questions about the 4 videos. Conclusions: Most women found the videos easy to understand, learned something new from watching them, planned to use the practical tips they offered, and were likely to recommend them to other women. This suggests that short, animated videos about health self-management strategies in midlife to improve the chance of healthy aging are perceived as accessible, acceptable, easy to understand, and useful by women. UR - https://www.i-jmr.org/2024/1/e60949 UR - http://dx.doi.org/10.2196/60949 UR - http://www.ncbi.nlm.nih.gov/pubmed/39621404 ID - info:doi/10.2196/60949 ER - TY - JOUR AU - Meng, Jian AU - Niu, Xiaoyu AU - Luo, Can AU - Chen, Yueyue AU - Li, Qiao AU - Wei, Dongmei PY - 2024/11/22 TI - Development and Validation of a Machine Learning?Based Early Warning Model for Lichenoid Vulvar Disease: Prediction Model Development Study JO - J Med Internet Res SP - e55734 VL - 26 KW - female KW - lichenoid vulvar disease KW - risk factors KW - evidence-based medicine KW - early warning model N2 - Background: Given the complexity and diversity of lichenoid vulvar disease (LVD) risk factors, it is crucial to actively explore these factors and construct personalized warning models using relevant clinical variables to assess disease risk in patients. Yet, to date, there has been insufficient research, both nationwide and internationally, on risk factors and warning models for LVD. In light of these gaps, this study represents the first systematic exploration of the risk factors associated with LVD. Objective: The risk factors of LVD in women were explored and a medically evidence-based warning model was constructed to provide an early alert tool for the high-risk target population. The model can be applied in the clinic to identify high-risk patients and evaluate its accuracy and practicality in predicting LVD in women. Simultaneously, it can also enhance the diagnostic and treatment proficiency of medical personnel in primary community health service centers, which is of great significance in reducing overall health care spending and disease burden. Methods: A total of 2990 patients who attended West China Second Hospital of Sichuan University from January 2013 to December 2017 were selected as the study candidates and were divided into 1218 cases in the normal vulvovagina group (group 0) and 1772 cases in the lichenoid vulvar disease group (group 1) according to the results of the case examination. We investigated and collected routine examination data from patients for intergroup comparisons, included factors with significant differences in multifactorial analysis, and constructed logistic regression, random forests, gradient boosting machine (GBM), adaboost, eXtreme Gradient Boosting, and Categorical Boosting analysis models. The predictive efficacy of these six models was evaluated using receiver operating characteristic curve and area under the curve. Results: Univariate analysis revealed that vaginitis, urinary incontinence, humidity of the long-term residential environment, spicy dietary habits, regular intake of coffee or caffeinated beverages, daily sleep duration, diabetes mellitus, smoking history, presence of autoimmune diseases, menopausal status, and hypertension were all significant risk factors affecting female LVD. Furthermore, the area under the receiver operating characteristic curve, accuracy, sensitivity, and F1-score of the GBM warning model were notably higher than the other 5 predictive analysis models. The GBM analysis model indicated that menopausal status had the strongest impact on female LVD, showing a positive correlation, followed by the presence of autoimmune diseases, which also displayed a positive dependency. Conclusions: In accordance with evidence-based medicine, the construction of a predictive warning model for female LVD can be used to identify high-risk populations at an early stage, aiding in the formulation of effective preventive measures, which is of paramount importance for reducing the incidence of LVD in women. UR - https://www.jmir.org/2024/1/e55734 UR - http://dx.doi.org/10.2196/55734 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55734 ER - TY - JOUR AU - Essop, Hafsa AU - Kekana, Mable Ramadimetja AU - Brosens, Jacques AU - Smuts, Hanlie PY - 2024/11/15 TI - A Reflective Thematic Analysis Into the Perceptions of Pregnant Radiographers Regarding the Usefulness of the PregiDose Mobile App to Enhance Fetal Dosimetry and Well-Being: Qualitative Exploration JO - JMIR Form Res SP - e58608 VL - 8 KW - mobile app KW - design science research KW - usefulness KW - pregnant radiographers KW - fetal dosimetry KW - occupational health and safety KW - mobile phone KW - maternal and child health KW - PregiDose N2 - Background: Pregnancy apps are widely used by pregnant women, who benefit from self-tracking features to support their health goals. Pregnant radiographers are considered a high-risk group of health workers practicing in ionizing radiation environments. Radiation exposure above threshold limits can cause harmful genetic effects on a fetus. Accordingly, pregnant radiographers are required to wear special fetal dosimeters, which provide real-time readings of radiation dose exposure to the fetus. Pregnant radiographers have the responsibility to self-track their fetal doses to ensure that the threshold limit of 1 mGy is not exceeded. The traditional method used to track doses includes a written log of doses in a notebook. Thus, PregiDose, a unique offering in the context of pregnancy apps, was developed to enhance fetal dose tracking and monitoring using technological methods. Objective: This study aims to describe the users? perceptions of the app?s usefulness using PregiDose in a natural setting. Methods: The overarching framework adopted for the study was a design science research (DSR) methodology encompassing five steps, namely (1) problem awareness, (2) suggestion, (3) development, (4) evaluation, and (5) conclusion. This paper presents the evaluation step of DSR. DSR step 4 included a qualitative approach to explore users? perceptions regarding the app. Data were collected using a semistructured interview guide. Open-ended questions were guided by the app?s core features, namely dose tracking, education, and wellness. In total, 17 pregnant radiographers in South Africa enrolled to use the app, 9 (53%) engaged with the app, and 4 (24%) agreed to participate in the feedback interviews. The data were collected from October 2023 to March 2024 and analyzed using a reflective thematic data analysis method. Results: Three overarching themes emerged from the data, namely (1) usefulness of PregiDose, (2) barriers to PregiDose adoption and use, and (3) recommendations for the advancement of PregiDose. Users labeled the app?s usefulness as positive and perceived it as a modern approach to traditional dose-tracking methods. They perceived the graph output of the dose-tracking feature to be useful for viewing their accumulative doses. They did not fully engage with the journaling feature, indicating that it was a personal preference and not a practice they would usually engage in. Physiological barriers, such as fatigue and ?pregnancy brain,? were contributors to decreased engagement. Finally, because of the demanding workload and fast-paced nature of the radiography department, users recommended the automation of fetal dosimetry through the Internet of Things. Conclusions: PregiDose is an occupational health and safety mobile app developed for pregnant radiographers through a DSR approach. The app offers a modern method of dose tracking consistent with technological advancements in the context of self-tracking. However, future implementation would require using Internet of Things to make fetal dose tracking more effective. UR - https://formative.jmir.org/2024/1/e58608 UR - http://dx.doi.org/10.2196/58608 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58608 ER - TY - JOUR AU - Reynolds, W. Christopher AU - Lee, HaEun AU - Sieka, Joseph AU - Perosky, Joseph AU - Lori, R. Jody PY - 2024/11/13 TI - Implementation of a Technology-Based Mobile Obstetric Referral Emergency System (MORES): Qualitative Assessment of Health Workers in Rural Liberia JO - JMIR Mhealth Uhealth SP - e58624 VL - 12 KW - mHealth KW - mobile triage KW - referral pathways KW - Liberia KW - LMIC KW - low- income country KW - obstetric triage KW - third delay KW - mobile health KW - mobile application KW - digital health KW - digital intervention KW - smartphone KW - middle-income country N2 - Background: Maternal mortality remains a persistent challenge in low- and middle-income countries, where evidence-based interventions of obstetric triage and prehospital communication remain sparse. There is limited implementation evidence for technology-based approaches to improve obstetric care in such contexts. Liberia struggles with maternal mortality, particularly in rural areas where deaths are attributable to delays from absent triage and interfacility communication. We implemented a Mobile Obstetric Referral Emergency System (MORES) in rural Bong County to improve prehospital transfer, health worker attentiveness, and patient care for critical obstetric patients. MORES consisted of triage training and a 2-way, templated WhatsApp communication system to reduce delays among patients transferred from rural health facilities (RHF) to hospitals. Objective: This study aimed to examine MORES implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, as well as additional impacts on the wider health system. Methods: A structured case study design interview was developed by Liberian and US experts in obstetric triage. Participants included 62 frontline obstetric health providers including midwives (38/62, 61%), nurses (20/62, 32%), physicians assistants (3/62, 5%), and physicians (1/62, 2%) from 19 RHFs and 2 district hospitals who had used MORES for 1 year. Individual interviews were conducted on MORES implementation outcomes, transcribed, and analyzed in NVivo (version 12; Lumivero) with a team-based coding methodology. Content analysis with a deductive approach examined implementation outcomes of usability, fidelity, effectiveness, sustainability, and scalability, while an inductive approach categorized the unanticipated impacts of MORES on the wider health system. Results: Four domains were identified regarding MORES implementation: Usability and Fidelity, Effectiveness, Sustainability and Scalability, and Health System Impact. All participants perceived MORES to have high usability and fidelity, as the triage and messaging system was implemented as intended for critical obstetric patients (62/62, 100%). For effectiveness, MORES accomplished its intended aims by improving prehospital transfer (57/62, 92%), increasing health worker attentiveness (39/62, 63%), and contributing to improved patient care (34/62, 55%). MORES was perceived as sustainable and scalable (62/62, 100%), particularly if technological barriers (21/62, 34%) and staff training (19/62, 31%) were addressed. MORES impacted the wider health system in unanticipated ways including improved coordination and accountability (55/62, 89%), feedback mechanisms for hospitals and RHFs (48/62, 77%), interprofessional teamwork (21/62, 34%), longitudinal follow-up care (20/62, 32%), creating a record of care delays (17/62, 27%), and electronic health record infrastructure (13/62, 21%). Conclusions: MORES was perceived to have high usability, fidelity, effectiveness, sustainability, and scalability by frontline obstetric providers in rural Liberia. MORES accomplished the intended aims of improving prehospital transfer, increasing health worker attentiveness, and contributing to improved patient care. Additionally, MORES strengthened the health system through 6 domains which impacted individual and system levels. Future studies should quantitatively evaluate delay and morbidity reductions and strategies for scaling MORES. UR - https://mhealth.jmir.org/2024/1/e58624 UR - http://dx.doi.org/10.2196/58624 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58624 ER - TY - JOUR AU - Liu, Xiaoxia AU - Ning, Lianzhen AU - Fan, Wenqi AU - Jia, Chanyi AU - Ge, Lina PY - 2024/10/31 TI - Electronic Health Interventions and Cervical Cancer Screening: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e58066 VL - 26 KW - cervical cancer KW - electronic health record KW - cancer screening KW - HPV KW - women's health KW - electronic health interventions N2 - Background: Cervical cancer is a significant cause of mortality in women. Although screening has reduced cervical cancer mortality, screening rates remain suboptimal. Electronic health interventions emerge as promising strategies to effectively tackle this issue. Objective: This systematic review and meta-analysis aimed to determine the effectiveness of electronic health interventions in cervical cancer screening. Methods: On December 29, 2023, we performed an extensive search for randomized controlled trials evaluating electronic health interventions to promote cervical cancer screening in adults. The search covered multiple databases, including MEDLINE, the Cochrane Central Registry of Controlled Trials, Embase, PsycINFO, PubMed, Scopus, Web of Science, and the Cumulative Index to Nursing and Allied Health Literature. These studies examined the effectiveness of electronic health interventions on cervical cancer screening. Studies published between 2013 and 2022 were included. Two independent reviewers evaluated the titles, abstracts, and full-text publications, also assessing the risk of bias using the Cochrane Risk of Bias 2 tool. Subgroup analysis was conducted based on subjects, intervention type, and economic level. The Mantel-Haenszel method was used within a random-effects model to pool the relative risk of participation in cervical cancer screening. Results: A screening of 713 records identified 14 articles (15 studies) with 23,102 participants, which were included in the final analysis. The intervention strategies used in these studies included short messaging services (4/14), multimode interventions (4/14), phone calls (2/14), web videos (3/14), and internet-based booking (1/14). The results indicated that electronic health interventions were more effective than control interventions for improving cervical cancer screening rates (relative risk [RR] 1.464, 95% CI 1.285-1.667; P<.001; I2=84%), cervical cancer screening (intention-to-treat) (RR 1.382, 95% CI 1.214-1.574; P<.001; I2=82%), and cervical cancer screening (per-protocol; RR 1.565, 95% CI 1.381-1.772; P<.001; I2=74%). Subgroup analysis revealed that phone calls (RR 1.82, 95% CI 1.40-2.38), multimode (RR 1.62, 95% CI 1.26-2.08), SMS (RR 1.41, 95% CI 1.14-1.73), and video- and internet-based booking (RR 1.25, 95% CI 1.03-1.51) interventions were superior to usual care. In addition, electronic health interventions did not show a statistically significant improvement in cervical cancer screening rates among women with HPV (RR 1.17, 95% CI 0.95-1.45). Electronic health interventions had a greater impact on improving cervical cancer screening rates among women in low- and middle-income areas (RR 1.51, 95% CI 1.27-1.79). There were no indications of small study effects or publication bias. Conclusions: Electronic health interventions are recommended in cervical cancer screening programs due to their potential to increase participation rates. However, significant heterogeneity remained in this meta-analysis. Researchers should conduct large-scale studies focusing on the cost-effectiveness of these interventions. Trial Registration: CRD42024502884; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=502884 UR - https://www.jmir.org/2024/1/e58066 UR - http://dx.doi.org/10.2196/58066 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58066 ER - TY - JOUR AU - Oliveira, Almeida Juliana AU - Eskandar, Karine AU - Kar, Emre AU - de Oliveira, Ribeiro Flávia AU - Filho, Silva Agnaldo Lopes da PY - 2024/10/30 TI - Understanding AI?s Role in Endometriosis Patient Education and Evaluating Its Information and Accuracy: Systematic Review JO - JMIR AI SP - e64593 VL - 3 KW - endometriosis KW - gynecology KW - machine learning KW - artificial intelligence KW - large language models KW - natural language processing KW - patient-generated health data KW - health knowledge KW - information seeking KW - patient education N2 - Background: Endometriosis is a chronic gynecological condition that affects a significant portion of women of reproductive age, leading to debilitating symptoms such as chronic pelvic pain and infertility. Despite advancements in diagnosis and management, patient education remains a critical challenge. With the rapid growth of digital platforms, artificial intelligence (AI) has emerged as a potential tool to enhance patient education and access to information. Objective: This systematic review aims to explore the role of AI in facilitating education and improving information accessibility for individuals with endometriosis. Methods: This review followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to ensure rigorous and transparent reporting. We conducted a comprehensive search of PubMed; Embase; the Regional Online Information System for Scientific Journals of Latin America, the Caribbean, Spain and Portugal (LATINDEX); Latin American and Caribbean Literature in Health Sciences (LILACS); Institute of Electrical and Electronics Engineers (IEEE) Xplore, and the Cochrane Central Register of Controlled Trials using the terms ?endometriosis? and ?artificial intelligence.? Studies were selected based on their focus on AI applications in patient education or information dissemination regarding endometriosis. We included studies that evaluated AI-driven tools for assessing patient knowledge and addressed frequently asked questions related to endometriosis. Data extraction and quality assessment were conducted independently by 2 authors, with discrepancies resolved through consensus. Results: Out of 400 initial search results, 11 studies met the inclusion criteria and were fully reviewed. We ultimately included 3 studies, 1 of which was an abstract. The studies examined the use of AI models, such as ChatGPT (OpenAI), machine learning, and natural language processing, in providing educational resources and answering common questions about endometriosis. The findings indicated that AI tools, particularly large language models, offer accurate responses to frequently asked questions with varying degrees of sufficiency across different categories. AI?s integration with social media platforms also highlights its potential to identify patients? needs and enhance information dissemination. Conclusions: AI holds promise in advancing patient education and information access for endometriosis, providing accurate and comprehensive answers to common queries, and facilitating a better understanding of the condition. However, challenges remain in ensuring ethical use, equitable access, and maintaining accuracy across diverse patient populations. Future research should focus on developing standardized approaches for evaluating AI?s impact on patient education and exploring its integration into clinical practice to enhance support for individuals with endometriosis. UR - https://ai.jmir.org/2024/1/e64593 UR - http://dx.doi.org/10.2196/64593 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64593 ER - TY - JOUR AU - Acero, Nicole AU - Herrero, Emma AU - Foncham, Juanita AU - McIlvaine, Jamie AU - Kayaalp, Emre AU - Figueora, Melissa AU - Oladipo, Francis Antonia PY - 2024/10/22 TI - Accuracy, Quality, and Misinformation of YouTube Abortion Procedural Videos: Cross-Sectional Study JO - J Med Internet Res SP - e50099 VL - 26 KW - abortion KW - YouTube KW - social media KW - accuracy KW - quality KW - misinformation KW - reliability KW - obstetrics KW - women's health KW - reproductive KW - patient education KW - health information KW - prochoice N2 - Background: The internet is often the first source patients turn to for medical information. YouTube is a commonly used internet-based resource for patients seeking to learn about medical procedures, including their risks, benefits, and safety profile. Abortion is a common yet polarizing medical procedure. People interested in obtaining an abortion are likely to use the internet to learn more about abortion procedures and may encounter misinformed and biased information. This is troubling as information found on the internet can significantly alter perceptions and understanding of these procedures. There is no current research that evaluates the accuracy, quality, and misinformation of instructional abortion videos available to patients. Objective: The purpose of this study was to assess if any given video can deliver accurate and quality information about this topic in an unbiased manner and to assess the level of factually incorrect, distorted, or medically irrelevant information in any given video. Methods: Procedural methods of abortion were queried on YouTube on August 22, 2022. The videos were screened with strict exclusion criteria. Videos were categorized into ?video slants? based on the language and attitudes expressed in each video. Video accuracy was calculated using the Surgical Curriculum in Obstetrics and Gynecology (SCOG) checklist for each corresponding procedure. Video quality was calculated using the Laparoscopic Surgery Video Educational Guidelines (LAP-VEGaS) criteria. The level of misinformation was assessed with the evidence-based Anti-Choice Rubric, which scores the amount of factually incorrect, distorted, or medically irrelevant information in each video. Results: A total of 32 videos were analyzed and categorized into 3 ?video slant? groups: neutral (n=23, 72%), antichoice (n=4, 12%), and prochoice (n=5, 16%). Using the SCOG checklist, neutral videos had the highest median accuracy (45.9%), followed by antichoice videos (24.6%) and prochoice videos (18.5%). None of the videos met the LAP-VEGaS quality control criteria, (score>11, indicating adequate quality). Neutral videos had a median score of 8.8 out of 18, with antichoice videos scoring 10.75 and prochoice videos scoring 6.2. Using the Anti-Choice Rubric, neutral videos mentioned only 1 factually incorrect piece of information. Antichoice videos mentioned 12 factually incorrect pieces of information, 8 distortions, and 3 medically irrelevant pieces of information. Prochoice videos did not mention any of the 3 themes. Conclusions: Using the SCOG checklist, the accuracy of instructional videos were inconsistent across the 3 identified ?video slants.? Using LAP-VEGaS criteria, the quality of educational videos were also inconsistent across the 3 ?video slants.? Prochoice videos had the lowest level of misinformation, with no mentions of any of the 3 themes. Antichoice videos had the highest levels of misinformation, with mentions in all 3 themes. Health care professionals should consider this when counseling patients who may watch YouTube videos for information regarding abortion procedures. UR - https://www.jmir.org/2024/1/e50099 UR - http://dx.doi.org/10.2196/50099 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50099 ER - TY - JOUR AU - Devlin, M. Paulina AU - Akingbola, Oluwabukola AU - Stonehocker, Jody AU - Fitzgerald, T. James AU - Winkel, Ford Abigail AU - Hammoud, M. Maya AU - Morgan, K. Helen PY - 2024/10/21 TI - Opportunities to Improve Communication With Residency Applicants: Cross-Sectional Study of Obstetrics and Gynecology Residency Program Websites JO - JMIR Med Educ SP - e48518 VL - 10 KW - obstetrics and gynecology KW - residency program KW - residency application KW - website KW - program signals KW - communication best practices N2 - Background: As part of the residency application process in the United States, many medical specialties now offer applicants the opportunity to send program signals that indicate high interest to a limited number of residency programs. To determine which residency programs to apply to, and which programs to send signals to, applicants need accurate information to determine which programs align with their future training goals. Most applicants use a program?s website to review program characteristics and criteria, so describing the current state of residency program websites can inform programs of best practices. Objective: This study aims to characterize information available on obstetrics and gynecology residency program websites and to determine whether there are differences in information available between different types of residency programs. Methods: This was a cross-sectional observational study of all US obstetrics and gynecology residency program website content. The authorship group identified factors that would be useful for residency applicants around program demographics and learner trajectories; application criteria including standardized testing metrics, residency statistics, and benefits; and diversity, equity, and inclusion mission statements and values. Two authors examined all available websites from November 2011 through March 2022. Data analysis consisted of descriptive statistics and one-way ANOVA, with P<.05 considered significant. Results: Among 290 programs, 283 (97.6%) had websites; 238 (82.1%) listed medical schools of current residents; 158 (54.5%) described residency alumni trajectories; 107 (36.9%) included guidance related to the preferred United States Medical Licensing Examination Step 1 scores; 53 (18.3%) included guidance related to the Comprehensive Osteopathic Medical Licensing Examination Level 1 scores; 185 (63.8%) included international applicant guidance; 132 (45.5%) included a program-specific mission statement; 84 (29%) included a diversity, equity, and inclusion statement; and 167 (57.6%) included program-specific media or links to program social media on their websites. University-based programs were more likely to include a variety of information compared to community-based university-affiliated and community-based programs, including medical schools of current residents (113/123, 91.9%, university-based; 85/111, 76.6%, community-based university-affiliated; 40/56, 71.4%, community-based; P<.001); alumni trajectories (90/123, 73.2%, university-based; 51/111, 45.9%, community-based university-affiliated; 17/56, 30.4%, community-based; P<.001); the United States Medical Licensing Examination Step 1 score guidance (58/123, 47.2%, university-based; 36/111, 32.4%, community-based university-affiliated; 13/56, 23.2%, community-based; P=.004); and diversity, equity, and inclusion statements (57/123, 46.3%, university-based; 19/111, 17.1%, community-based university-affiliated; 8/56, 14.3%, community-based; P<.001). Conclusions: There are opportunities to improve the quantity and quality of data on residency websites. From this work, we propose best practices for what information should be included on residency websites that will enable applicants to make informed decisions. UR - https://mededu.jmir.org/2024/1/e48518 UR - http://dx.doi.org/10.2196/48518 ID - info:doi/10.2196/48518 ER - TY - JOUR AU - Brinson, K. Alison AU - Jahnke, R. Hannah AU - Henrich, Natalie AU - Moss, Christa AU - Shah, Neel PY - 2024/10/16 TI - Digital Health as a Mechanism to Reduce Neonatal Intensive Care Unit Admissions: Retrospective Cohort Study JO - JMIR Pediatr Parent SP - e56247 VL - 7 KW - digital health KW - education KW - gestational conditions KW - Maven Clinic KW - mental health management KW - neonatal KW - NICU admissions KW - neonatal intensive care unit KW - mobile phone N2 - Background: Admission to the neonatal intensive care unit (NICU) is costly and has been associated with financial and emotional stress among families. Digital health may be well equipped to impact modifiable health factors that contribute to NICU admission rates. Objective: The aim of the study is to investigate how the use of a comprehensive prenatal digital health platform is associated with gestational age at birth and mechanisms to reduce the risk of admission to the NICU. Methods: Data were extracted from 3326 users who enrolled in a comprehensive digital health platform between January 2020 and May 2022. Multivariable linear and logistic regression models were used to estimate the associations between hours of digital health use and (1) gestational age at birth and (2) mechanisms to reduce the risk of a NICU admission. Multivariable logistic regression models estimated the associations between (1) gestational age at birth and (2) mechanisms to reduce the risk of a NICU admission and the likelihood of a NICU admission. All analyses were stratified by the presence of any gestational conditions during pregnancy. Results: For users both with and without gestational conditions, hours of digital health use were positively associated with gestational age at birth (in weeks; with gestational conditions: ?=.01; 95% CI 0.0006-0.02; P=.04 and without gestational conditions: ?=.01; 95% CI 0.0006-0.02; P=.04) and mechanisms that have the potential to reduce risk of a NICU admission, including learning medically accurate information (with gestational conditions: adjusted odds ratio [AOR] 1.05, 95% CI 1.03-1.07; P<.001 and without gestational conditions: AOR 1.04, 95% CI 1.02-1.06; P<.001), mental health management (with gestational conditions: AOR 1.06, 95% CI 1.04-1.08; P<.001 and without gestational conditions: AOR 1.03, 95% CI 1.02-1.05; P<.001), and understanding warning signs during pregnancy (with gestational conditions: AOR 1.08, 95% CI 1.06-1.11; P<.001 and without gestational conditions: AOR 1.09, 95% CI 1.07-1.11; P<.001). For users with and without gestational conditions, an increase in gestational age at birth was associated with a decreased likelihood of NICU admission (with gestational conditions: AOR 0.62, 95% CI 0.55-0.69; P<.001 and without gestational conditions: AOR 0.59, 95% CI 0.53-0.65; P<.001). Among users who developed gestational conditions, those who reported that the platform helped them understand warning signs during pregnancy had lower odds of a NICU admission (AOR 0.63, 95% CI 0.45-0.89; P=.01). Conclusions: Digital health use may aid in extending gestational age at birth and reduce the risk of NICU admission. UR - https://pediatrics.jmir.org/2024/1/e56247 UR - http://dx.doi.org/10.2196/56247 ID - info:doi/10.2196/56247 ER - TY - JOUR AU - Kennedy, Blair Ann AU - Harb, Tarasidis Anna AU - Schockling, Chloe AU - Ray, Jackson Lauren AU - Palomo, Jennifer AU - Russ-Sellers, Rebecca PY - 2024/10/16 TI - Understanding the Values, Qualities, and Preferences of Patients in Their Relationships With Obstetrics and Gynecology Providers: Cross-Sectional Survey With a Mixed Methods Approach JO - J Particip Med SP - e58096 VL - 16 KW - communication KW - obstetrics KW - gynecology KW - trust KW - barriers to care KW - patient-provider relationships N2 - Background: The patient-provider relationship in obstetrics and gynecology (OBGYN) is uniquely complex due to the sensitive nature of examinations and topics. Patients often prefer health care providers who share similar racial, ethnic, gender, or linguistic backgrounds, particularly in sensitive health care situations, to improve communication and comfort, though historically, specific gender preferences for OBGYNs have not been evident. Objective: This study aims to describe the values, qualities, and preferences of patients in their relationships with OBGYN providers. Methods: This cross-sectional survey, conducted from October 2019 to December 2019, involved 1039 US OBGYN patients and used a mixed methods approach, integrating quantitative responses and qualitative insights from open-ended questions. Recruitment was facilitated through targeted social media campaigns, and the survey aimed to capture detailed patient preferences and barriers to care by assessing responses on provider traits, patient experiences, and demographic factors. The study?s rigorous data collection and analysis were designed to fill gaps identified in previous research on patient-provider relationships in OBGYN care. Results: The findings underscore the paramount importance of trust and comfort, with listening skills identified as crucial. A notable finding is the marked preference for same-gender providers, observed in 80.7% (545/675) of participants. Primary barriers to seeking care reported included daily commitments, highlighting the need for accessible and flexible care options. Conclusions: The study highlights a significant shift from previous scientific findings in patient preferences toward gender concordance and trust in OBGYN settings, diverging from previous research. These results emphasize the need for patient-centered care and tailored communication strategies to enhance patient experiences and outcomes. Future research should focus on diverse populations to broaden the findings? applicability and explore the impact of recent shifts in health care policies. UR - https://jopm.jmir.org/2024/1/e58096 UR - http://dx.doi.org/10.2196/58096 UR - http://www.ncbi.nlm.nih.gov/pubmed/39412870 ID - info:doi/10.2196/58096 ER - TY - JOUR AU - Oyovwi, Sr Mega Obukohwo AU - Ohwin, Peggy Ejiro AU - Rotu, Arientare Rume AU - Olowe, Gideon Temitope PY - 2024/10/16 TI - Internet-Based Abnormal Chromosomal Diagnosis During Pregnancy Using a Noninvasive Innovative Approach to Detecting Chromosomal Abnormalities in the Fetus: Scoping Review JO - JMIR Bioinform Biotech SP - e58439 VL - 5 KW - internet-based KW - abnormal chromosomal diagnosis KW - pregnancy KW - noninvasive KW - innovative approach KW - detecting KW - preventing KW - chromosomal abnormalities KW - fetus N2 - Background: Chromosomal abnormalities are genetic disorders caused by chromosome errors, leading to developmental delays, birth defects, and miscarriages. Currently, invasive procedures such as amniocentesis or chorionic villus sampling are mostly used, which carry a risk of miscarriage. This has led to the need for a noninvasive and innovative approach to detect and prevent chromosomal abnormalities during pregnancy. Objective: This review aims to describe and appraise the potential of internet-based abnormal chromosomal preventive measures as a noninvasive approach to detecting and preventing chromosomal abnormalities during pregnancy. Methods: A thorough review of existing literature and research on chromosomal abnormalities and noninvasive approaches to prenatal diagnosis and therapy was conducted. Electronic databases such as PubMed, Google Scholar, ScienceDirect, CENTRAL, CINAHL, Embase, OVID MEDLINE, OVID PsycINFO, Scopus, ACM, and IEEE Xplore were searched for relevant studies and articles published in the last 5 years. The keywords used included chromosomal abnormalities, prenatal diagnosis, noninvasive, and internet-based, and diagnosis. Results: The review of literature revealed that internet-based abnormal chromosomal diagnosis is a potential noninvasive approach to detecting and preventing chromosomal abnormalities during pregnancy. This innovative approach involves the use of advanced technology, including high-resolution ultrasound, cell-free DNA testing, and bioinformatics, to analyze fetal DNA from maternal blood samples. It allows early detection of chromosomal abnormalities, enabling timely interventions and treatment to prevent adverse outcomes. Furthermore, with the advancement of technology, internet-based abnormal chromosomal diagnosis has emerged as a safe alternative with benefits including its cost-effectiveness, increased accessibility and convenience, potential for earlier detection and intervention, and ethical considerations. Conclusions: Internet-based abnormal chromosomal diagnosis has the potential to revolutionize prenatal care by offering a safe and noninvasive alternative to invasive procedures. It has the potential to improve the detection of chromosomal abnormalities, leading to better pregnancy outcomes and reduced risk of miscarriage. Further research and development in this field is needed to make this approach more accessible and affordable for pregnant women. UR - https://bioinform.jmir.org/2024/1/e58439 UR - http://dx.doi.org/10.2196/58439 UR - http://www.ncbi.nlm.nih.gov/pubmed/39412876 ID - info:doi/10.2196/58439 ER - TY - JOUR AU - Martin-Key, A. Nayra AU - Funnell, L. Erin AU - Benacek, Jiri AU - Spadaro, Benedetta AU - Bahn, Sabine PY - 2024/10/16 TI - Intention to Use a Mental Health App for Menopause: Health Belief Model Approach JO - JMIR Form Res SP - e60434 VL - 8 KW - menopause KW - menopause transition KW - mental health KW - perimenopause KW - women?s health KW - psychological framework KW - symptom tracking KW - app usage KW - app KW - Health Belief Model N2 - Background: Menopause presents a period of heightened vulnerability for mental health issues. Despite this, mental health screening is not consistently integrated into menopausal health care, and access to psychological interventions is limited. Digital technologies, such as web and smartphone apps, may offer a way to facilitate and improve mental health care provision throughout menopause. However, little is known about potential users? intention to use such technologies during this critical phase of life. Objective: To examine the factors that impact the intention of potential users to use a mental health app during menopause, we used the Health Belief Model (HBM), a psychological framework widely used to understand and predict individuals? health-related behaviors. Methods: An online survey was generated. Convenience sampling was used, with participants recruited via social media and email, through relevant foundations and support groups, and by word of mouth. Structural equation modeling with maximum likelihood estimation was conducted to explore whether the factor structure of the HBM is a good fit for predicting the intention to use a mental health app for menopause. A Cronbach ? value of .05 was used for determining statistical significance. Results: A total of 1154 participants commenced the survey, of which 82.49% (n=952) completed at least 97% of the survey. Of these, 86.76% (n=826) expressed that their menopausal symptoms had negatively affected their mental health, and went on to answer questions regarding their experiences and interest in using a web or smartphone app for mental health symptoms related to menopause. Data from this subgroup (N=826) were analyzed. In total, 74.09% (n=612) of respondents sought online help for mental health symptoms related to menopause. The most common topics searched for were symptom characteristics (n=435, 52.66%) and treatment or therapy options (n=210, 25.42%). Psychoeducation (n=514, 62.23%) was the most desired mental health app feature, followed by symptom tracking (n=499, 60.41%) and self-help tips (n=469, 56.78%). In terms of the intention to use a mental health app, the Satorra-Bentler?scaled fit statistics indicated a good fit for the model (?2278=790.44, P<.001; comparative fit index=0.933, root mean square error of approximation=0.047, standardized root mean square residual=0.056), with cues to action emerging as the most significant predictor of intention (?=.48, P<.001). This was followed by perceived barriers (?=?.25, P<.001), perceived susceptibility (?=.15, P<.001), and perceived benefits (?=.13, P<.001). Perceived severity (?=.01, P=.869) and self-efficacy (?=.03, P=.286) were not significantly associated with behavioral intention. Conclusions: This study reveals important factors that influence the intention to use a mental health app during menopause. It emphasizes the need to address barriers to app usage, while highlighting the impact of credible endorsements and psychoeducation. Furthermore, the study underscores the significance of improving accessibility for users with lower digital literacy or limited resources. UR - https://formative.jmir.org/2024/1/e60434 UR - http://dx.doi.org/10.2196/60434 UR - http://www.ncbi.nlm.nih.gov/pubmed/39412868 ID - info:doi/10.2196/60434 ER - TY - JOUR AU - Hong, Minji AU - Rajaguru, Vasuki AU - Kim, KyungYi AU - Jang, Suk-Yong AU - Lee, Gyu Sang PY - 2024/10/10 TI - Menstrual Cycle Management and Period Tracker App Use in Millennial and Generation Z Individuals: Mixed Methods Study JO - J Med Internet Res SP - e53146 VL - 26 KW - menstruation KW - dysmenorrhea KW - period tracker app, menstrual cycle management, health care application, millennial KW - Gen Z KW - mobile phone N2 - Background: Menstruation is a physical symptom that occurs in women of reproductive age. It has a significant impact on the daily life and health of women when their academic and social activities are most active. Since many women experience difficulties in daily life because of premenstrual syndrome and dysmenorrhea, it is important to identify, prepare for, and manage the menstrual cycle in advance. Objective: This study aimed to investigate the relationship between menstruation-related experiences and the use of mobile-based period tracker apps by millennial and generation Z (gen Z) individuals. The objectives of this study are to investigate (1) menstrual cycle management, (2) factors affecting app usage (3) factors affecting cycle management, and (4) motivators and barriers to using period tracker apps, in millennial and gen Z women. Methods: A mixed methods design was used for this study. The participants were young women aged 20-39 years and recruited via the Ovey application. Data were collected through surveys and focus group interviews. The survey was conducted among 700 women, and 8 of them participated in the focus group interviews. Results: In total, 431 (62.3%) participants used period tracker apps primarily to predict their next menstrual cycle. Factors affecting app usage included childbirth experience (odds ratio [OR] 0.475, P<.05), number of dysmenorrhea symptoms (OR 1.136, P<.05), and cycle management level (OR 2.279, P<.001). Additionally, education level (OR 1.122, P<.05 [university level compared high school level]) and the number of dysmenorrhea symptoms (OR 1.024, P<.05) showed a positive association with the cycle management level. However, childbirth experience (OR 0.902, P<.05) and period irregularity (OR 0.929, P<.001) were negatively associated with the cycle management level. Conclusions: Period tracker apps are becoming the new normal among millennials and gen Z individuals for managing their menstrual cycles. The use of a period tracker app empowers women by helping them gain a better understanding of their bodies, ultimately enhancing their social, academic, and health-related lives. Improving the accuracy and literacy of the app is an ongoing task for period-tracking apps, and it is important to provide added value tailored to users? needs. Therefore, the findings of this study should be considered when designing or upgrading period tracker apps to facilitate the adoption of digital technology among young women, thereby promoting their overall well-being and reproductive health. UR - https://www.jmir.org/2024/1/e53146 UR - http://dx.doi.org/10.2196/53146 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53146 ER - TY - JOUR AU - Durkin, M. Amanda AU - Zou, Runyu AU - Boucher, M. Justin AU - Boyles, SP Matthew AU - van Boxel, Jeske AU - Bustamante, Mariona AU - Christopher, A. Emily AU - Dadvand, Payam AU - Dusza, M. Hanna AU - van Duursen, Majorie AU - Forsberg, M. Markus AU - Galea, S. Karen AU - Legler, Juliette AU - Mandemaker, DB Laurens AU - Meirer, Florian AU - Muncke, Jane AU - Nawrot, S. Tim AU - P?ibylová, Petra AU - Robuck, R. Anna AU - Saenen, D. Nelly AU - Scholz-Böttcher, M. Barbara AU - Shao, Kuanliang AU - Vrijheid, Martine AU - Walker, I. Douglas AU - Zimmermann, Lisa AU - Zoutendijk, M. Laura AU - Lenters, Virissa AU - Vermeulen, Roel PY - 2024/10/8 TI - Investigating Exposure and Hazards of Micro- and Nanoplastics During Pregnancy and Early Life (AURORA Project): Protocol for an Interdisciplinary Study JO - JMIR Res Protoc SP - e63176 VL - 13 KW - epidemiology KW - pregnancy KW - toxicology KW - microplastics KW - placenta KW - risk assessment N2 - Background: Micro- and nanoplastics (MNPs) are emerging pollutants of concern with ubiquitous presence in global ecosystems. MNPs pose potential implications for human health; however, the health impacts of MNP exposures are not yet understood. Recent evidence suggests that MNPs can cross the placental barrier, underlying the urgent need to understand their impact on reproductive health and development. Objective: The Actionable eUropean ROadmap for early-life health Risk Assessment of micro- and nanoplastics (AURORA) project will investigate MNP exposures and their biological and health effects during pregnancy and early life, which are critical periods due to heightened vulnerability to environmental stressors. The AURORA project will enhance exposure assessment capabilities for measuring MNPs, MNP-associated chemicals, and plastic additives in human tissues, including placenta and blood. Methods: In this interdisciplinary project, we will advance methods for in-depth characterization and scalable chemical analytical strategies, enabling high-resolution and large-scale toxicological, exposure assessment, and epidemiological studies. The AURORA project performs observational studies to investigate determinants and health impacts of MNPs by including 800 mother-child pairs from 2 existing birth cohorts and 110 women of reproductive age from a newly established cohort. This will be complemented by toxicological studies using a tiered-testing approach and epidemiological investigations to evaluate associations between maternal and prenatal MNP exposures and health perturbations, such as placental function, immune-inflammatory responses, oxidative stress, accelerated aging, endocrine disruption, and child growth and development. The ultimate goal of the AURORA project is to create an MNP risk assessment framework and identify the remaining knowledge gaps and priorities needed to comprehensively assess the impact of MNPs on early-life health. Results: In the first 3 years of this 5-year project (2021-2026), progress was made toward all objectives. This includes completion of recruitment and data collection for new and existing cohorts, development of analytical methodological protocols, and initiation of the toxicological tiered assessments. As of September 2024, data analysis is ongoing and results are expected to be published starting in 2025. Conclusions: As plastic pollution increases globally, it is imperative to understand the impact of MNPs on human health, particularly during vulnerable developmental stages such as early life. The contributions of the AURORA project will inform future risk assessment. International Registered Report Identifier (IRRID): DERR1-10.2196/63176 UR - https://www.researchprotocols.org/2024/1/e63176 UR - http://dx.doi.org/10.2196/63176 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63176 ER - TY - JOUR AU - Campbell, B. Grace AU - Kim, Hansol AU - Klinedinst, C. Tara AU - Klinger, Julie AU - Lee, Ji Young AU - Donovan, S. Heidi PY - 2024/10/3 TI - Needs of Patients With Gynecologic Cancer and Their Caregivers for Obtaining mHealth-Supported Self-Management: Focus Group Study JO - JMIR Cancer SP - e48465 VL - 10 KW - gynecologic oncology KW - gynecologic cancer KW - self-management support KW - user-centered design KW - cancer distress KW - self-management KW - caregiver support KW - cancer information KW - women's health KW - family support KW - informal caregivers KW - informal care KW - mhealth N2 - Background: Family caregivers of individuals with gynecologic cancer experience high levels of distress. Web-based caregiver support interventions have demonstrated efficacy in improving caregiver outcomes. However, the lack of portability could be a limitation. Mobile health (mHealth) apps could fill this gap and facilitate communication between patient-caregiver dyads. Objective: We sought to obtain information on desired usage and features to be used to design an mHealth self-management support app targeting both patients with gynecologic cancer and their caregivers. Methods: We conducted Zoom focus groups with women who had been treated for gynecologic cancers (ovarian, fallopian, primary peritoneal, uterine, endometrial, cervical, and vulvar); patients were also asked to invite a self-identified ?closest support person? (caregiver). A semistructured focus group guide was used to elicit information on patients? and caregivers? perceived gaps in information and support, desired features of an mHealth app, and interest in and preferences for app usage. After transcription, rapid qualitative analysis using a thematic matrix was used to identify common themes across groups. Results: A total of 8 groups were held. The final sample included 41 individuals with gynecologic cancer and 22 support persons or caregivers (total n=63). Patients were aged between 32 and 84 years, and most (38/41, 93%) were White and married. For caregivers (n=22), 15 (68%) identified as male and 7 (32%) as female, with ages ranging between 19 and 81 years. Overall, 59% (n=13) of caregivers were spouses. Questions geared at eliciting 3 a priori topics yielded the following themes: topic 1?gaps in information and support: finding relevant information is time-consuming; patients and caregivers lack confidence in deciding the urgency of problems that arise and from whom to seek information and guidance; topic 2?desired features of the mHealth app: patients and caregivers desire centralized, curated, trustworthy information; they desire timely recommendations tailored to specific personal and cancer-related needs; they desire opportunities to interact with clinical and peer experts through the app; and topic 3?interest and preferences for app usage: need for private space in the app for patients and caregivers to get information and support without the others? knowledge; patients and caregivers desire having control over sharing of information with other family members. Conclusions: Designing a single mHealth app to be used by patients and caregivers presents unique challenges for intervention designers and app developers. Implications of the study suggest that app developers need to prioritize flexibility in app functionality and provide individuals the ability to control information sharing between patients and caregivers. UR - https://cancer.jmir.org/2024/1/e48465 UR - http://dx.doi.org/10.2196/48465 UR - http://www.ncbi.nlm.nih.gov/pubmed/39361371 ID - info:doi/10.2196/48465 ER - TY - JOUR AU - MacNeil, Nora AU - Price, Victoria AU - Pike, Meghan PY - 2024/10/3 TI - The WeThrive App and Its Impact on Adolescents Who Menstruate: Qualitative Study JO - JMIR Form Res SP - e57936 VL - 8 KW - heavy menstrual bleeding KW - adolescents KW - menorrhagia KW - quality of life KW - mobile applications KW - mobile health application KW - mobile phone N2 - Background: Heavy menstrual bleeding (HMB) affects up to 37% of adolescents. Without recognition, HMB can lead to other medical conditions resulting in diminished health-related quality of life. WeThrive, a new mobile health (mHealth) app, implements the pictorial bleeding assessment chart to identify HMB, and the adolescent Menstrual Bleeding Questionnaire to measure the effects of HMB on adolescents? health-related quality of life. If HMB is identified, WeThrive will connect users to local clinics for further assessment of their menstrual bleeding with a health care provider. Objective: This study aimed to describe adolescents? experiences using WeThrive app. Methods: This qualitative study was approved by the local Research Ethics Board in Halifax, Nova Scotia, and informed consent was provided by all participants. Individual semistructured interviews were held via videoconference with adolescents younger than 18 years, who had at least 1 menstrual period and had used WeThrive at least once. Interview transcripts were thematically analyzed by 2 investigators (MP and NMN) independently, and the ? statistic was calculated to determine the strength of correlation in themes. Results: Five adolescents (mean age 15.5, range 13-18 years), participated in the interviews. All participants stated that WeThrive helps them better understand their menstrual periods by predicting period onset, recognizing menstrual symptoms, and identifying HMB. Four themes were identified: (1) the importance of visual features and usability, (2) newly obtained knowledge using WeThrive, (3) feature use depends on menstrual health, and (4) trustworthiness. There was substantial agreement on the identified themes (?=0.73). Conclusions: WeThrive is visually appealing, and trustworthy, and helps users better understand their menstrual periods, including identifying HMB. By identifying HMB early, WeThrive has the potential to improve the recognition of bleeding disorders and iron deficiency in adolescents. WeThrive is a useful tool to help adolescents better understand their menstrual periods. UR - https://formative.jmir.org/2024/1/e57936 UR - http://dx.doi.org/10.2196/57936 UR - http://www.ncbi.nlm.nih.gov/pubmed/39361373 ID - info:doi/10.2196/57936 ER - TY - JOUR AU - Dilimulati, Diliqingna AU - Shao, Xiaowen AU - Wang, Lihua AU - Cai, Meili AU - Zhang, Yuqin AU - Lu, Jiayi AU - Wang, Yao AU - Liu, Hongying AU - Kuang, Ming AU - Chen, Haibing AU - Zhang, Manna AU - Qu, Shen PY - 2024/10/2 TI - Efficacy of WeChat-Based Digital Intervention Versus Metformin in Women With Polycystic Ovary Syndrome: Randomized Controlled Trial JO - J Med Internet Res SP - e55883 VL - 26 KW - polycystic ovary syndrome KW - insulin resistance KW - digital intervention KW - metformin KW - women?s health N2 - Background: The first-line treatment for polycystic ovary syndrome (PCOS) is lifestyle modification. However, it is currently unknown whether digital medicine can assist patients with PCOS in maintaining a healthy lifestyle while alleviating PCOS symptoms. Objective: This study aims to evaluate the efficacy of WeChat-based digital intervention versus metformin treatment in women with PCOS and insulin resistance. Methods: A total of 80 women with PCOS and insulin resistance were recruited from an endocrinology clinic and randomly assigned to receive either a WeChat-based digital intervention (n=40, 50%) or metformin (n=40, 50%) for 12 weeks. The WeChat-based digital intervention consisted of 3 modules; a coach assisted the patients in using the intervention. The primary outcome was the change in a homeostatic model assessment for insulin resistance. At baseline and after the 12-week intervention, anthropometric parameters, menstruation frequency, sex hormone levels, metabolic factors, and body fat distribution were measured in the clinic. Furthermore, self-assessed web-based questionnaires on diet, exercise, sleep, anxiety, and depression were obtained. Results: A total of 72 participants completed the follow-up (for a 90% follow-up rate), including 35 of 40 (88%) participants from the digital intervention group and 37 of 40 (93%) participants from the metformin group. The homeostatic model assessment for insulin resistance in the digital intervention group was significantly improved after 12 weeks of treatment with a mean change of ?0.93 (95% CI ?1.64 to ?0.23), but no statistical difference was observed between the groups (least squares mean difference ?0.20; 95% CI ?0.98 to 0.58; P=.62). Both digital intervention and metformin treatment significantly improved menstruation frequency (digital intervention: P<.001; metformin: P<.001) and reduced body weight (digital intervention: P<.001; metformin: P<.001) and total fat mass (digital intervention: P<.001; metformin: P<.001). Furthermore, the digital intervention had a significant advantage over metformin in improving waist circumference (least squares mean difference ?1.84; 95% CI ?3.44 to ?0.24; P=.03), waist-to-hip ratio (least squares mean difference ?0.02; 95% CI ?0.03 to 0.00; P=.03), total fat mass (least squares mean difference ?1.59; 95% CI ?2.88 to ?0.30; P=.02), and dehydroepiandrosterone sulfate (least squares mean difference ?69.73; 95% CI ?129.70 to ?9.75; P=.02). In terms of safety, the main adverse events were sensations of hunger in the digital intervention group (2/40, 5%) and gastrointestinal adverse events in the metformin group (12/40, 30%). Conclusions: Our data suggest that digital intervention is an effective treatment option for patients with PCOS, with an efficacy comparable to that of metformin, and that it can also alleviate the negative effects of medications and make it easier and more efficient to adhere to lifestyle treatments. WeChat-based digital interventions have the potential to provide a new path for the improvement and health of women with PCOS in China. Trial Registration: ClinicalTrials.gov NCT05386706; https://clinicaltrials.gov/study/NCT05386706 UR - https://www.jmir.org/2024/1/e55883 UR - http://dx.doi.org/10.2196/55883 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/55883 ER - TY - JOUR AU - Ng, Ying Wei AU - Lau, Yin Ni AU - Lee, Vien V. AU - Vijayakumar, Smrithi AU - Leong, Ying Qiao AU - Ooi, Delicia Shu Qin AU - Su, Lin Lin AU - Lee, Seng Yung AU - Chan, Shiao-Yng AU - Blasiak, Agata AU - Ho, Dean PY - 2024/10/1 TI - Shaping Adoption and Sustained Use Across the Maternal Journey: Qualitative Study on Perceived Usability and Credibility in Digital Health Tools JO - JMIR Hum Factors SP - e59269 VL - 11 KW - maternal and child health KW - conception KW - pregnancy KW - perinatal care KW - postpartum KW - maternal care KW - obstetric care KW - user engagement KW - Unified Theory of Acceptance and Use of Technology KW - femtech N2 - Background: Maternal and child health outcomes are positively influenced by early intervention, and digital health (DH) tools provide the potential for a low-cost and scalable solution such as informational platforms or digital tracking tools. Despite the wide availability of DH tools out there for women from before to after pregnancy, user engagement remains low. Objective: This study aims to explore the factors that shape women?s DH adoption and sustained use across the maternal journey from preconception to postbirth, to improve user engagement with DH tools. Methods: One-hour semistructured qualitative interviews were conducted with 44 women from before to after pregnancy (age range 21-40 years) about their experiences with DH. This study is part of a larger study on women?s maternal experiences with health care and DH and focuses on the factors that affected women?s DH adoption and sustained use. Interviews were audio recorded, transcribed verbatim, and analyzed using inductive thematic analysis. Results: Five main themes and 10 subthemes were identified that affected women?s adoption and sustained use of DH tools. These included themes on their preexisting attitudes to DH, perceived ease of use, perceived usefulness, perceived credibility, and perceived value of the tool. Conclusions: The themes that emerged were fully or partially mapped according to the Unified Theory of Acceptance and Use of Technology 2 model. The applicability of the model and the need to consider specific cultural nuances in the Asian context (such as the importance of trust and social influence) are discussed. The interaction of the 5 themes with DH adoption and sustained use are explored with different themes being relevant at various points of the DH adoption journey. The insights gained serve to inform future DH design and implementation of tools for women to optimize their DH engagement and the benefits they derive from it. Trial Registration: ClinicalTrials.gov NCT05099900; https://clinicaltrials.gov/study/NCT05099900 UR - https://humanfactors.jmir.org/2024/1/e59269 UR - http://dx.doi.org/10.2196/59269 UR - http://www.ncbi.nlm.nih.gov/pubmed/39352732 ID - info:doi/10.2196/59269 ER - TY - JOUR AU - Sharma, Divya AU - Yadav, Jyoti AU - Gupta, Madhu AU - Halder, Pritam AU - Rajan, K. Abin AU - Kiran, Tanvi PY - 2024/9/24 TI - Socioeconomic Moderators of the Association Between Delayed Breastfeeding Initiation and Place of Delivery: Cross-Sectional Study JO - JMIR Public Health Surveill SP - e57254 VL - 10 KW - breastfeeding KW - institutional deliveries KW - delayed initiation KW - moderation analysis KW - Indian mothers KW - socio-economic KW - cross-sectional study KW - infant KW - infancy KW - infant feeding KW - human milk KW - breastfeeding initiation KW - mother KW - women KW - India KW - healthcare services KW - awareness KW - pregnancy KW - public health N2 - Background: Breastfeeding is a crucial and irreplaceable method of feeding infants. Despite the well-established advantages of early breastfeeding initiation, its progress remains constrained. Over half of Indian mothers witness delayed breastfeeding initiation. Various factors have been implicated to influence breastfeeding initiation, with institutional deliveries emerging as a crucial factor among them. Objective: We tested the hypothesized association between institutional delivery and initiation delays and identified how various socioeconomic variables moderate (weaken, strengthen, or reverse) the association between breastfeeding initiation delays and place of delivery. Methods: This cross-sectional study analyses data of 106,569 breastfeeding mothers from the NFHS-5 (National Family Health Survey, 2019-21). Missing data were managed by using a complete case analysis approach. The outcome variable was the timing of breastfeeding initiation for the most recent child, with the place of delivery being the explanatory variable. Socioeconomic factors including age, education level, marital status, place of residence, and wealth index were considered moderating variables. Logistic regression?based moderation analysis explored how these variables influence the relationship between breastfeeding initiation delays and place of delivery. Separate binary logistic regression models analyzed the effect of each moderating variable. Statistical analysis was conducted using IBM SPSS Statistics 26. Results: The highest occurrence of delayed breastfeeding initiation was observed among mothers aged ?36 years (58.3%), lacking formal education (60.9%), belonging to lower wealth groups (58.1%), residing in rural areas (57.4%), and having home births (64.1%). Results confirmed the primary hypothesis that institutional delivery significantly and negatively affects delayed breastfeeding initiation (odds ratio [OR] 0.705, 95% CI 0.676-0.735, P<.001). Age as a moderating variable significantly affected this association (adjusted OR [aOR] 0.757, 95% CI 0.696-1.307, P=.02 for the 15-25 age group). Notably, education level (aOR 0.616, 95% CI 0.429-1.930, P=.005 for no education and aOR 0.510, 95% CI 0.429-1.772, P=.04 for primary education) and poor wealth index (aOR 0.672, 95% CI 0.528-1.432, P=.004) as moderating factors significantly strengthened the negative effect of institutional delivery on delayed initiation. Poor mothers and those without education or a lower level of education (primary) when delivering the child at the health institution further reduced the chances of witnessing delayed initiation. Conclusions: Institutional delivery significantly lowers the likelihood of delayed breastfeeding initiation, and this negative effect is significantly strengthened when uneducated women or lesser-educated women and those with lower wealth deliver their children at the institutional facilities, underscoring the significance of these moderating factors. Developing strategies targeting these socioeconomic moderating factors is crucial. Tailored awareness programs crafted to address the needs of uneducated mothers from economically disadvantaged backgrounds can enhance coverage. Outreach initiatives aimed at promoting health care service use during pregnancy and delivery, as well as raising awareness about breastfeeding practices, are warranted for the adoption and implementation of early breastfeeding initiation. UR - https://publichealth.jmir.org/2024/1/e57254 UR - http://dx.doi.org/10.2196/57254 UR - http://www.ncbi.nlm.nih.gov/pubmed/39316434 ID - info:doi/10.2196/57254 ER - TY - JOUR AU - Lin, Xinnian AU - Liang, Chen AU - Liu, Jihong AU - Lyu, Tianchu AU - Ghumman, Nadia AU - Campbell, Berry PY - 2024/9/16 TI - Artificial Intelligence?Augmented Clinical Decision Support Systems for Pregnancy Care: Systematic Review JO - J Med Internet Res SP - e54737 VL - 26 KW - artificial intelligence KW - biomedical ontologies KW - clinical decision support systems KW - implementation science KW - obstetrics KW - pregnancy KW - AI KW - systematic review KW - CDSS KW - functionality KW - methodology KW - implementation KW - database query KW - database queries KW - bibliography KW - record KW - records KW - eligibility KW - literature review KW - prenatal KW - early pregnancy KW - obstetric care KW - postpartum care KW - pregnancy care KW - diagnostic support KW - clinical prediction KW - knowledge base KW - therapeutic KW - therapeutics KW - recommendation KW - recommendations KW - diagnosis KW - abnormality KW - abnormalities KW - cost-effective KW - surveillance KW - ultrasound KW - ontology N2 - Background: Despite the emerging application of clinical decision support systems (CDSS) in pregnancy care and the proliferation of artificial intelligence (AI) over the last decade, it remains understudied regarding the role of AI in CDSS specialized for pregnancy care. Objective: To identify and synthesize AI-augmented CDSS in pregnancy care, CDSS functionality, AI methodologies, and clinical implementation, we reported a systematic review based on empirical studies that examined AI-augmented CDSS in pregnancy care. Methods: We retrieved studies that examined AI-augmented CDSS in pregnancy care using database queries involved with titles, abstracts, keywords, and MeSH (Medical Subject Headings) terms. Bibliographic records from their inception to 2022 were retrieved from PubMed/MEDLINE (n=206), Embase (n=101), and ACM Digital Library (n=377), followed by eligibility screening and literature review. The eligibility criteria include empirical studies that (1) developed or tested AI methods, (2) developed or tested CDSS or CDSS components, and (3) focused on pregnancy care. Data of studies used for review and appraisal include title, abstract, keywords, MeSH terms, full text, and supplements. Publications with ancillary information or overlapping outcomes were synthesized as one single study. Reviewers independently reviewed and assessed the quality of selected studies. Results: We identified 30 distinct studies of 684 studies from their inception to 2022. Topics of clinical applications covered AI-augmented CDSS from prenatal, early pregnancy, obstetric care, and postpartum care. Topics of CDSS functions include diagnostic support, clinical prediction, therapeutics recommendation, and knowledge base. Conclusions: Our review acknowledged recent advances in CDSS studies including early diagnosis of prenatal abnormalities, cost-effective surveillance, prenatal ultrasound support, and ontology development. To recommend future directions, we also noted key gaps from existing studies, including (1) decision support in current childbirth deliveries without using observational data from consequential fetal or maternal outcomes in future pregnancies; (2) scarcity of studies in identifying several high-profile biases from CDSS, including social determinants of health highlighted by the American College of Obstetricians and Gynecologists; and (3) chasm between internally validated CDSS models, external validity, and clinical implementation. UR - https://www.jmir.org/2024/1/e54737 UR - http://dx.doi.org/10.2196/54737 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54737 ER - TY - JOUR AU - Tortal, Danna AU - Shabanova, Veronika AU - Taylor, Sarah AU - Xu, Xiao AU - McAdow, Molly AU - Stetson, Bethany AU - McCollum, Sarah AU - Sanchez, Ester AU - Adjakple, Amie AU - Leventhal, Jessica AU - Son, Moeun PY - 2024/8/29 TI - Stimulation Therapy to Induce Mothers: Protocol for a Multicenter Randomized Controlled Trial JO - JMIR Res Protoc SP - e63463 VL - 13 KW - nipple stimulation KW - nipple stimulation therapy KW - breast pump KW - labor induction KW - oxytocin KW - lactation N2 - Background: More than 1 million women have their labor induced in the United States each year, and synthetic oxytocin infusion is the most common method used. However, compared to spontaneous labor, medical induction is resource intensive, has increased obstetric risks, and is associated with less successful breastfeeding. In contrast to the endogenous oxytocin hormone, which is released in a pulsatile fashion in the brain, synthetic oxytocin is continuously infused intravenously, resulting in important limitations related to efficacy, safety, and cost. Akin to spontaneous labor contractions, infant suckling of the breast nipple is known to stimulate the pulsatile release of endogenous oxytocin from the posterior pituitary gland. Nipple stimulation therapy via an electric breast pump similarly stimulates endogenous oxytocin release and may be a favorable inpatient method for patients undergoing labor induction. Objective: This study aims to examine whether inpatient nipple stimulation therapy is an efficacious labor induction method that increases the likelihood of spontaneous vaginal delivery and sustained breastfeeding and determine whether it is a cost-effective approach. Methods: This is a multicenter, pragmatic, open-label, parallel-group randomized controlled trial of nulliparous patients with singleton gestations ?36 weeks undergoing labor induction. This trial compares inpatient nipple stimulation therapy via an electric breast pump versus immediate synthetic oxytocin infusion without nipple stimulation. This trial including 988 nulliparas will provide adequate statistical power to detect clinically meaningful differences in delivery mode and breast milk as the sole source of nutrition for newborns at hospital discharge or 72 hours after birth. Results: The project received pilot funding in 2021 and full funding in 2023. Enrollment for this study began in November 2021 at a single site, and as of May 2024, recruitment is underway at 3 study sites. It is anticipated that enrollment will be completed by late 2026. Conclusions: Successful completion of this trial will provide rigorous data to determine whether inpatient nipple stimulation therapy with an electric breast pump can improve the way we induce labor and positively impact breastfeeding success and early infant nutrition through lactation. Trial Registration: ClinicalTrials.gov NCT05079841; https://clinicaltrials.gov/study/NCT05079841 International Registered Report Identifier (IRRID): DERR1-10.2196/63463 UR - https://www.researchprotocols.org/2024/1/e63463 UR - http://dx.doi.org/10.2196/63463 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/63463 ER - TY - JOUR AU - Tsai, Feng-Fang AU - Chang, Yung-Chun AU - Chiu, Yu-Wen AU - Sheu, Bor-Ching AU - Hsu, Min-Huei AU - Yeh, Huei-Ming PY - 2024/8/21 TI - Machine Learning Model for Anesthetic Risk Stratification for Gynecologic and Obstetric Patients: Cross-Sectional Study Outlining a Novel Approach for Early Detection JO - JMIR Form Res SP - e54097 VL - 8 KW - gradient boosting machine KW - comorbidity KW - gynecological and obstetric procedure KW - ASA classification KW - American Society of Anesthesiologists KW - preoperative evaluation KW - machine learning KW - machine learning model KW - gynecology KW - obstetrics KW - early detection KW - artificial intelligence KW - physiological KW - gestational KW - anesthetic risk KW - clinical laboratory data KW - laboratory data KW - risk KW - risk classification N2 - Background: Preoperative evaluation is important, and this study explored the application of machine learning methods for anesthetic risk classification and the evaluation of the contributions of various factors. To minimize the effects of confounding variables during model training, we used a homogenous group with similar physiological states and ages undergoing similar pelvic organ?related procedures not involving malignancies. Objective: Data on women of reproductive age (age 20-50 years) who underwent gestational or gynecological surgery between January 1, 2017, and December 31, 2021, were obtained from the National Taiwan University Hospital Integrated Medical Database. Methods: We first performed an exploratory analysis and selected key features. We then performed data preprocessing to acquire relevant features related to preoperative examination. To further enhance predictive performance, we used the log-likelihood ratio algorithm to generate comorbidity patterns. Finally, we input the processed features into the light gradient boosting machine (LightGBM) model for training and subsequent prediction. Results: A total of 10,892 patients were included. Within this data set, 9893 patients were classified as having low anesthetic risk (American Society of Anesthesiologists physical status score of 1-2), and 999 patients were classified as having high anesthetic risk (American Society of Anesthesiologists physical status score of >2). The area under the receiver operating characteristic curve of the proposed model was 0.6831. Conclusions: By combining comorbidity information and clinical laboratory data, our methodology based on the LightGBM model provides more accurate predictions for anesthetic risk classification. Trial Registration: Research Ethics Committee of the National Taiwan University Hospital 202204010RINB; https://www.ntuh.gov.tw/RECO/Index.action UR - https://formative.jmir.org/2024/1/e54097 UR - http://dx.doi.org/10.2196/54097 UR - http://www.ncbi.nlm.nih.gov/pubmed/38991090 ID - info:doi/10.2196/54097 ER - TY - JOUR AU - Liu, Chao AU - Jiao, Yuanshi AU - Su, Licong AU - Liu, Wenna AU - Zhang, Haiping AU - Nie, Sheng AU - Gong, Mengchun PY - 2024/8/20 TI - Effective Privacy Protection Strategies for Pregnancy and Gestation Information From Electronic Medical Records: Retrospective Study in a National Health Care Data Network in China JO - J Med Internet Res SP - e46455 VL - 26 KW - pregnancy KW - electronic medical record KW - privacy protection KW - risk stratification KW - rule-based N2 - Background: Pregnancy and gestation information is routinely recorded in electronic medical record (EMR) systems across China in various data sets. The combination of data on the number of pregnancies and gestations can imply occurrences of abortions and other pregnancy-related issues, which is important for clinical decision-making and personal privacy protection. However, the distribution of this information inside EMR is variable due to inconsistent IT structures across different EMR systems. A large-scale quantitative evaluation of the potential exposure of this sensitive information has not been previously performed, ensuring the protection of personal information is a priority, as emphasized in Chinese laws and regulations. Objective: This study aims to perform the first nationwide quantitative analysis of the identification sites and exposure frequency of sensitive pregnancy and gestation information. The goal is to propose strategies for effective information extraction and privacy protection related to women?s health. Methods: This study was conducted in a national health care data network. Rule-based protocols for extracting pregnancy and gestation information were developed by a committee of experts. A total of 6 different sub?data sets of EMRs were used as schemas for data analysis and strategy proposal. The identification sites and frequencies of identification in different sub?data sets were calculated. Manual quality inspections of the extraction process were performed by 2 independent groups of reviewers on 1000 randomly selected records. Based on these statistics, strategies for effective information extraction and privacy protection were proposed. Results: The data network covered hospitalized patients from 19 hospitals in 10 provinces of China, encompassing 15,245,055 patients over an 11-year period (January 1, 2010-December 12, 2020). Among women aged 14-50 years, 70% were randomly selected from each hospital, resulting in a total of 1,110,053 patients. Of these, 688,268 female patients with sensitive reproductive information were identified. The frequencies of identification were variable, with the marriage history in admission medical records being the most frequent at 63.24%. Notably, more than 50% of female patients were identified with pregnancy and gestation history in nursing records, which is not generally considered a sub?data set rich in reproductive information. During the manual curation and review process, 1000 cases were randomly selected, and the precision and recall rates of the information extraction method both exceeded 99.5%. The privacy-protection strategies were designed with clear technical directions. Conclusions: Significant amounts of critical information related to women?s health are recorded in Chinese routine EMR systems and are distributed in various parts of the records with different frequencies. This requires a comprehensive protocol for extracting and protecting the information, which has been demonstrated to be technically feasible. Implementing a data-based strategy will enhance the protection of women?s privacy and improve the accessibility of health care services. UR - https://www.jmir.org/2024/1/e46455 UR - http://dx.doi.org/10.2196/46455 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/46455 ER - TY - JOUR AU - Gomez, Manchikanti Anu AU - Reed, Diane Reiley AU - Bennett, H. Ariana AU - Kavanaugh, Megan PY - 2024/8/20 TI - Integrating Sexual and Reproductive Health Equity Into Public Health Goals and Metrics: Comparative Analysis of Healthy People 2030?s Approach and a Person-Centered Approach to Contraceptive Access Using Population-Based Data JO - JMIR Public Health Surveill SP - e58009 VL - 10 KW - contraception KW - public health objectives KW - public health metrics KW - person-centeredness KW - sexual and reproductive health equity N2 - Background: The Healthy People initiative is a national effort to lay out public health goals in the United States every decade. In its latest iteration, Healthy People 2030, key goals related to contraception focus on increasing the use of effective birth control (contraceptive methods classified as most or moderately effective for pregnancy prevention) among women at risk of unintended pregnancy. This narrow focus is misaligned with sexual and reproductive health equity, which recognizes that individuals? self-defined contraceptive needs are critical for monitoring contraceptive access and designing policy and programmatic strategies to increase access. Objective: We aimed to compare 2 population-level metrics of contraceptive access: a conventional metric, use of contraceptive methods considered most or moderately effective for pregnancy prevention among those considered at risk of unintended pregnancy (approximating the Healthy People 2030 approach), and a person-centered metric, use of preferred contraceptive method among current and prospective contraceptive users. Methods: We used nationally representative data collected in 2022 to construct the 2 metrics of contraceptive access; the overall sample included individuals assigned female at birth not using female sterilization or otherwise infecund and who were not pregnant or trying to become pregnant (unweighted N=2760; population estimate: 43.9 million). We conducted a comparative analysis to examine the convergence and divergence of the metrics by examining whether individuals met the inclusion criteria for the denominators of both metrics, neither metric, only the conventional metric, or only the person-centered metric. Results: Comparing the 2 approaches to measuring contraceptive access, we found that 79% of respondents were either included in or excluded from both metrics (reflecting that the metrics converged when individuals were treated the same by both). The remaining 21% represented divergence in the metrics, with an estimated 5.7 million individuals who did not want to use contraception included only in the conventional metric denominator and an estimated 3.5 million individuals who were using or wanted to use contraception but had never had penile-vaginal sex included only in the person-centered metric denominator. Among those included only in the conventional metric, 100% were content nonusers?individuals who were not using contraception, nor did they want to. Among those included only in the person-centered metric, 68% were currently using contraception. Despite their current or desired contraceptive use, these individuals were excluded from the conventional metric because they had never had penile-vaginal sex. Conclusions: Our analysis highlights that a frequently used metric of contraceptive access misses the needs of millions of people by simultaneously including content nonusers and excluding those who are using or want to use contraception who have never had sex. Documenting and quantifying the gap between current approaches to assessing contraceptive access and more person-centered ones helps clearly identify where programmatic and policy efforts should focus going forward. UR - https://publichealth.jmir.org/2024/1/e58009 UR - http://dx.doi.org/10.2196/58009 UR - http://www.ncbi.nlm.nih.gov/pubmed/39163117 ID - info:doi/10.2196/58009 ER - TY - JOUR AU - Shaffer, M. Kelly AU - Reese, Barsky Jennifer AU - Dressler, V. Emily AU - Glazer, V. Jillian AU - Cohn, Wendy AU - Showalter, L. Shayna AU - Clayton, H. Anita AU - Danhauer, C. Suzanne AU - Loch, Michelle AU - Kadi, Mai AU - Smith, Caleigh AU - Weaver, E. Kathryn AU - Lesser, J. Glenn AU - Ritterband, M. Lee PY - 2024/8/19 TI - Factorial Trial to Optimize an Internet-Delivered Intervention for Sexual Health After Breast Cancer: Protocol for the WF-2202 Sexual Health and Intimacy Enhancement (SHINE) Trial JO - JMIR Res Protoc SP - e57781 VL - 13 KW - breast neoplasms KW - cancer survivorship KW - clinical trial KW - communication skills KW - factorial trial KW - internet interventions KW - intimacy KW - mobile phone KW - multiphase optimization strategy KW - sexual distress KW - sexual functioning KW - sexual health N2 - Background: Although most survivors of breast cancer report substantial sexual concerns following treatment, few receive support for these concerns. Delivering sexual health care to survivors of breast cancer via the internet could overcome many of the barriers to in-person treatment. Even when delivered remotely, survivor time constraints remain a leading barrier to sexual health intervention uptake. Objective: Guided by the multiphase optimization strategy methodological framework, the primary objective of this study is to identify the most efficient internet-delivered sexual health intervention package that is expected to provide survivors of breast cancer the greatest benefit with the fewest (and least-intensive) intervention components. This study aims to determine how intervention components work (mediators) and for whom they work best (moderators). Methods: Partnered, posttreatment adult female survivors of breast cancer (N=320) experiencing at least 1 bothersome sexual symptom (ie, pain with sex, vaginal dryness, low sexual desire, and difficulty with orgasm) related to their breast cancer treatment will be enrolled. Clinic-based recruitment will be conducted via the Wake Forest National Cancer Institute Community Oncology Research Program (NCORP) Research Base. Participants will be randomly assigned to 1 of 16 combinations of four intervention components with two levels each in this factorial trial: (1) psychoeducation about cancer-related sexual morbidity (receive either enhanced vs standard versions); (2) communication skills training for discussing concerns with health care providers (received vs not received); (3) communication skills training for discussing concerns with a partner (received vs not received); and (4) intimacy promotion skills training (received vs not received). Cores will be fully automated and implemented using a robust internet intervention platform with highly engaging elements such as animation, video, and automated email prompts. Survivors will complete web-based assessments at baseline (prerandomization time point) and again at 12 and 24 weeks later. The primary study aim will be achieved through a decision-making process based on systematically evaluating the main and interaction effects of components on sexual distress (Female Sexual Distress Scale?Desire, Arousal, Orgasm) and sexual functioning (Female Sexual Function Index) using a generalized linear model approach to ANOVA with effect coding. Mediation analyses will be conducted through a structural equation modeling approach, and moderation analyses will be conducted by extending the generalized linear model to include interaction effects. Results: This protocol has been reviewed and approved by the National Cancer Institute Central Institutional Review Board. Data collection is planned to begin in March 2024 and conclude in 2027. Conclusions: By identifying the combination of the fewest and least-intensive intervention components likely to provide survivors of breast cancer the greatest sexual health benefit, this study will result in the first internet intervention that is optimized for maximum impact on the undertreated, prevalent, and distressing problem of breast cancer?related sexual morbidity. Trial Registration: ClinicalTrials.gov NCT06216574; https://clinicaltrials.gov/study/NCT06216574 International Registered Report Identifier (IRRID): PRR1-10.2196/57781 UR - https://www.researchprotocols.org/2024/1/e57781 UR - http://dx.doi.org/10.2196/57781 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57781 ER - TY - JOUR AU - Bhandoria, Geetu AU - Bilir, Esra AU - Uwins, Christina AU - Vidal-Alaball, Josep AU - Fuster-Casanovas, Aïna AU - Ahmed, Wasim PY - 2024/8/14 TI - Impact of a New Gynecologic Oncology Hashtag During Virtual-Only ASCO Annual Meetings: An X (Twitter) Social Network Analysis JO - JMIR Med Educ SP - e45291 VL - 10 KW - social media KW - academic tweeting KW - hashtag KW - gynecologic oncology KW - Twitter KW - ASCO KW - gynecology KW - oncology KW - virtual KW - engagement KW - software application KW - users KW - cancer KW - social network KW - health promotion N2 - Background: Official conference hashtags are commonly used to promote tweeting and social media engagement. The reach and impact of introducing a new hashtag during an oncology conference have yet to be studied. The American Society of Clinical Oncology (ASCO) conducts an annual global meeting, which was entirely virtual due to the COVID-19 pandemic in 2020 and 2021. Objective: This study aimed to assess the reach and impact (in the form of vertices and edges generated) and X (formerly Twitter) activity of the new hashtags #goASCO20 and #goASCO21 in the ASCO 2020 and 2021 virtual conferences. Methods: New hashtags (#goASCO20 and #goASCO21) were created for the ASCO virtual conferences in 2020 and 2021 to help focus gynecologic oncology discussion at the ASCO meetings. Data were retrieved using these hashtags (#goASCO20 for 2020 and #goASCO21 for 2021). A social network analysis was performed using the NodeXL software application. Results: The hashtags #goASCO20 and #goASCO21 had similar impacts on the social network. Analysis of the reach and impact of the individual hashtags found #goASCO20 to have 150 vertices and 2519 total edges and #goASCO20 to have 174 vertices and 2062 total edges. Mentions and tweets between 2020 and 2021 were also similar. The circles representing different users were spatially arranged in a more balanced way in 2021. Tweets using the #goASCO21 hashtag received significantly more responses than tweets using #goASCO20 (75 times in 2020 vs 360 times in 2021; z value=16.63 and P<.001). This indicates increased engagement in the subsequent year. Conclusions: Introducing a gynecologic oncology specialty?specific hashtag (#goASCO20 and #goASCO21) that is related but different from the official conference hashtag (#ASCO20 and #ASCO21) helped facilitate discussion on topics of interest to gynecologic oncologists during a virtual pan-oncology meeting. This impact was visible in the social network analysis. UR - https://mededu.jmir.org/2024/1/e45291 UR - http://dx.doi.org/10.2196/45291 ID - info:doi/10.2196/45291 ER - TY - JOUR AU - Ballard, K. Hailey AU - Yang, Xiaotong AU - Mahadevan, D. Aditya AU - Lemas, J. Dominick AU - Garmire, X. Lana PY - 2024/8/14 TI - Five-Feature Models to Predict Preeclampsia Onset Time From Electronic Health Record Data: Development and Validation Study JO - J Med Internet Res SP - e48997 VL - 26 KW - preeclampsia KW - survival analysis KW - risk prediction KW - pregnancy KW - prognosis KW - survival KW - risk KW - mortality KW - EHR KW - health records KW - maternal KW - machine learning KW - electronic health records N2 - Background:  Preeclampsia is a potentially fatal complication during pregnancy, characterized by high blood pressure and the presence of excessive proteins in the urine. Due to its complexity, the prediction of preeclampsia onset is often difficult and inaccurate. Objective:  This study aimed to create quantitative models to predict the onset gestational age of preeclampsia using electronic health records. Methods:  We retrospectively collected 1178 preeclamptic pregnancy records from the University of Michigan Health System as the discovery cohort, and 881 records from the University of Florida Health System as the validation cohort. We constructed 2 Cox-proportional hazards models: 1 baseline model using maternal and pregnancy characteristics, and the other full model with additional laboratory findings, vitals, and medications. We built the models using 80% of the discovery data, tested the remaining 20% of the discovery data, and validated with the University of Florida data. We further stratified the patients into high- and low-risk groups for preeclampsia onset risk assessment. Results:  The baseline model reached Concordance indices of 0.64 and 0.61 in the 20% testing data and the validation data, respectively, while the full model increased these Concordance indices to 0.69 and 0.61, respectively. For preeclampsia diagnosed at 34 weeks, the baseline and full models had area under the curve (AUC) values of 0.65 and 0.70, and AUC values of 0.69 and 0.70 for preeclampsia diagnosed at 37 weeks, respectively. Both models contain 5 selective features, among which the number of fetuses in the pregnancy, hypertension, and parity are shared between the 2 models with similar hazard ratios and significant P values. In the full model, maximum diastolic blood pressure in early pregnancy was the predominant feature. Conclusions:  Electronic health records data provide useful information to predict the gestational age of preeclampsia onset. Stratification of the cohorts using 5-predictor Cox-proportional hazards models provides clinicians with convenient tools to assess the onset time of preeclampsia in patients. UR - https://www.jmir.org/2024/1/e48997 UR - http://dx.doi.org/10.2196/48997 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48997 ER - TY - JOUR AU - Burns, Christina AU - Bakaj, Angela AU - Berishaj, Amonda AU - Hristidis, Vagelis AU - Deak, Pamela AU - Equils, Ozlem PY - 2024/8/6 TI - Use of Generative AI for Improving Health Literacy in Reproductive Health: Case Study JO - JMIR Form Res SP - e59434 VL - 8 KW - ChatGPT KW - chat-GPT KW - chatbots KW - chat-bot KW - chat-bots KW - artificial intelligence KW - AI KW - machine learning KW - ML KW - large language model KW - large language models KW - LLM KW - LLMs KW - natural language processing KW - NLP KW - deep learning KW - chatbot KW - Google Search KW - internet KW - communication KW - English proficiency KW - readability KW - health literacy KW - health information KW - health education KW - health related questions KW - health information seeking KW - health access KW - reproductive health KW - oral contraceptive KW - birth control KW - emergency contraceptive KW - comparison KW - clinical KW - patients N2 - Background: Patients find technology tools to be more approachable for seeking sensitive health-related information, such as reproductive health information. The inventive conversational ability of artificial intelligence (AI) chatbots, such as ChatGPT (OpenAI Inc), offers a potential means for patients to effectively locate answers to their health-related questions digitally. Objective: A pilot study was conducted to compare the novel ChatGPT with the existing Google Search technology for their ability to offer accurate, effective, and current information regarding proceeding action after missing a dose of oral contraceptive pill. Methods: A sequence of 11 questions, mimicking a patient inquiring about the action to take after missing a dose of an oral contraceptive pill, were input into ChatGPT as a cascade, given the conversational ability of ChatGPT. The questions were input into 4 different ChatGPT accounts, with the account holders being of various demographics, to evaluate potential differences and biases in the responses given to different account holders. The leading question, ?what should I do if I missed a day of my oral contraception birth control?? alone was then input into Google Search, given its nonconversational nature. The results from the ChatGPT questions and the Google Search results for the leading question were evaluated on their readability, accuracy, and effective delivery of information. Results: The ChatGPT results were determined to be at an overall higher-grade reading level, with a longer reading duration, less accurate, less current, and with a less effective delivery of information. In contrast, the Google Search resulting answer box and snippets were at a lower-grade reading level, shorter reading duration, more current, able to reference the origin of the information (transparent), and provided the information in various formats in addition to text. Conclusions: ChatGPT has room for improvement in accuracy, transparency, recency, and reliability before it can equitably be implemented into health care information delivery and provide the potential benefits it poses. However, AI may be used as a tool for providers to educate their patients in preferred, creative, and efficient ways, such as using AI to generate accessible short educational videos from health care provider-vetted information. Larger studies representing a diverse group of users are needed. UR - https://formative.jmir.org/2024/1/e59434 UR - http://dx.doi.org/10.2196/59434 UR - http://www.ncbi.nlm.nih.gov/pubmed/38986153 ID - info:doi/10.2196/59434 ER - TY - JOUR AU - Koenig, R. Leah AU - Ko, Jennifer AU - Upadhyay, D. Ushma PY - 2024/8/5 TI - Virtual Clinic Telehealth Abortion Services in the United States One Year After Dobbs: Landscape Review JO - J Med Internet Res SP - e50749 VL - 26 KW - medication abortion KW - telehealth KW - virtual clinics KW - abortion KW - access KW - policy KW - health equity N2 - Background: Telehealth abortion has taken on a vital role in maintaining abortion access since the Dobbs v. Jackson Women?s Health Organization Supreme Court decision. However, little remains known about the landscape of new telehealth-only virtual clinic abortion providers that have expanded since telehealth abortion first became widely available in the United States in 2021. Objective: This study aimed to (1) document the landscape of telehealth-only virtual clinic abortion care in the United States, (2) describe changes in the presence of virtual clinic abortion services between September 2022, following the Dobbs decision, and June 2023, and (3) identify structural factors that may perpetuate inequities in access to virtual clinic abortion care. Methods: We conducted a repeated cross-sectional study by reviewing web search results and abortion directories to identify virtual abortion clinics in September 2022 and June 2023 and described changes in the presence of virtual clinics between these 2 periods. In June 2023, we also described each virtual clinic?s policies, including states served, costs, patient age limits, insurance acceptance, financial assistance available, and gestational limits. Results: We documented 11 virtual clinics providing telehealth abortion care in 26 states and Washington DC in September 2022. By June 2023, 20 virtual clinics were providing services in 27 states and Washington DC. Most (n=16) offered care to minors, 8 provided care until 10 weeks of pregnancy, and median costs were US $259. In addition, 2 accepted private insurance and 1 accepted Medicaid, within a limited number of states. Most (n=16) had some form of financial assistance available. Conclusions: Virtual clinic abortion providers have proliferated since the Dobbs decision. We documented inequities in the availability of telehealth abortion care from virtual clinics, including age restrictions that exclude minors, gestational limits for care, and limited insurance and Medicaid acceptance. Notably, virtual clinic abortion care was not permitted in 11 states where in-person abortion is available. UR - https://www.jmir.org/2024/1/e50749 UR - http://dx.doi.org/10.2196/50749 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/50749 ER - TY - JOUR AU - Congy, Juliette AU - Rahib, Delphine AU - Leroy, Céline AU - Bouyer, Jean AU - de La Rochebrochard, Elise PY - 2024/7/22 TI - Contraceptive Use Measured in a National Population?Based Approach: Cross-Sectional Study of Administrative Versus Survey Data JO - JMIR Public Health Surveill SP - e45030 VL - 10 KW - contraception KW - administrative data KW - health data KW - implant KW - oral contraceptives KW - intrauterine device KW - IUD KW - contraceptive prevalence KW - contraceptive KW - birth control KW - monitoring KW - public health issue KW - population-based survey KW - prevalence N2 - Background: Prescribed contraception is used worldwide by over 400 million women of reproductive age. Monitoring contraceptive use is a major public health issue that usually relies on population-based surveys. However, these surveys are conducted on average every 6 years and do not allow close follow-up of contraceptive use. Moreover, their sample size is often too limited for the study of specific population subgroups such as people with low income. Health administrative data could be an innovative and less costly source to study contraceptive use. Objective: We aimed to explore the potential of health administrative data to study prescribed contraceptive use and compare these data with observations based on survey data. Methods: We selected all women aged 15-49 years, covered by French health insurance and living in France, in the health administrative database, which covers 98% of the resident population (n=14,788,124), and in the last French population?based representative survey, the Health Barometer Survey, conducted in 2016 (n=4285). In health administrative data, contraceptive use was recorded with detailed information on the product delivered, whereas in the survey, it was self-declared by the women. In both sources, the prevalence of contraceptive use was estimated globally for all prescribed contraceptives and by type of contraceptive: oral contraceptives, intrauterine devices (IUDs), and implants. Prevalences were analyzed by age. Results: There were more low-income women in health administrative data than in the population-based survey (1,576,066/14,770,256, 11% vs 188/4285, 7%, respectively; P<.001). In health administrative data, 47.6% (7034,710/14,770,256; 95% CI 47.6%-47.7%) of women aged 15-49 years used a prescribed contraceptive versus 50.5% (2297/4285; 95% CI 49.1%-52.0%) in the population-based survey. Considering prevalences by the type of contraceptive in health administrative data versus survey data, they were 26.9% (95% CI 26.9%-26.9%) versus 27.7% (95% CI 26.4%-29.0%) for oral contraceptives, 17.7% (95% CI 17.7%-17.8%) versus 19.6% (95% CI 18.5%-20.8%) for IUDs, and 3% (95% CI 3.0%-3.0%) versus 3.2% (95% CI 2.7%-3.7%) for implants. In both sources, the same overall tendency in prevalence was observed for these 3 contraceptives. Implants remained little used at all ages, oral contraceptives were highly used among young women, whereas IUD use was low among young women. Conclusions: Compared with survey data, health administrative data exhibited the same overall tendencies for oral contraceptives, IUDs, and implants. One of the main strengths of health administrative data is the high quality of information on contraceptive use and the large number of observations, allowing studies of subgroups of population. Health administrative data therefore appear as a promising new source to monitor contraception in a population-based approach. They could open new perspectives for research and be a valuable new asset to guide public policies on reproductive and sexual health. UR - https://publichealth.jmir.org/2024/1/e45030 UR - http://dx.doi.org/10.2196/45030 UR - http://www.ncbi.nlm.nih.gov/pubmed/39037774 ID - info:doi/10.2196/45030 ER - TY - JOUR AU - Myers, J. Sarah AU - Knight, L. Rebecca AU - Wardle, L. Sophie AU - Waldock, AM Kirsty AU - O'Leary, J. Thomas AU - Jones, K. Richard AU - Muckelt, E. Paul AU - Eisenhauer, Anton AU - Tang, CY Jonathan AU - Fraser, D. William AU - Greeves, P. Julie PY - 2024/7/11 TI - Effect of Menstrual Cycle and Hormonal Contraception on Musculoskeletal Health and Performance: Protocol for a Prospective Cohort Design and Cross-Sectional Comparison JO - JMIR Res Protoc SP - e50542 VL - 13 KW - estrogens KW - oestradiol KW - progesterone KW - calcium KW - musculoskeletal health KW - hormonal contraceptive N2 - Background: Women of reproductive age experience cyclical variation in the female sex steroid hormones 17?-estradiol and progesterone during the menstrual cycle that is attenuated by some hormonal contraceptives. Estrogens perform a primary function in sexual development and reproduction but have nonreproductive effects on bone, muscle, and sinew tissues (ie, ligaments and tendons), which may influence injury risk and physical performance. Objective: The purpose of the study is to understand the effect of the menstrual cycle and hormonal contraceptive use on bone and calcium metabolism, and musculoskeletal health and performance. Methods: A total of 5 cohorts of physically active women (aged 18-40 years) will be recruited to participate: eumenorrheic, nonhormonal contraceptive users (n=20); combined oral contraceptive pill (COCP) users (n=20); hormonal implant users (n=20); hormonal intrauterine system users (n=20); and hormonal injection users (n=20). Participants must have been using the COCP and implant for at least 1 year and the intrauterine system and injection for at least 2 years. First-void urine samples and fasted blood samples will be collected for biochemical analysis of calcium and bone metabolism, hormones, and metabolic markers. Knee extensor and flexor strength will be measured using an isometric dynamometer, and lower limb tendon and stiffness, tone, and elasticity will be measured using a Myoton device. Functional movement will be assessed using a single-leg drop to assess the frontal plane projection angle and the qualitative assessment of single leg loading. Bone density and macro- and microstructure will be measured using ultrasound, dual-energy x-ray absorptiometry, and high-resolution peripheral quantitative computed tomography. Skeletal material properties will be estimated from reference point indentation, performed on the flat surface of the medial tibia diaphysis. Body composition will be assessed by dual-energy x-ray absorptiometry. The differences in outcome measures between the hormonal contraceptive groups will be analyzed in a one-way between-group analysis of covariance. Within the eumenorrheic group, the influence of the menstrual cycle on outcome measures will be assessed using a linear mixed effects model. Within the COCP group, differences across 2 time points will be analyzed using the paired-samples 2-tailed t test. Results: The research was funded in January 2020, and data collection started in January 2022, with a projected data collection completion date of August 2024. The number of participants who have consented at the point of manuscript submission is 66. It is expected that all data analysis will be completed and results published by the end of 2024. Conclusions: Understanding the effects of the menstrual cycle and hormonal contraception on musculoskeletal health and performance will inform contraceptive choices for physically active women to manage injury risk. Trial Registration: ClinicalTrials.gov NCT05587920; https://classic.clinicaltrials.gov/ct2/show/NCT05587920 International Registered Report Identifier (IRRID): DERR1-10.2196/50542 UR - https://www.researchprotocols.org/2024/1/e50542 UR - http://dx.doi.org/10.2196/50542 UR - http://www.ncbi.nlm.nih.gov/pubmed/38990638 ID - info:doi/10.2196/50542 ER - TY - JOUR AU - AlSaad, Rawan AU - Abd-alrazaq, Alaa AU - Choucair, Fadi AU - Ahmed, Arfan AU - Aziz, Sarah AU - Sheikh, Javaid PY - 2024/7/5 TI - Harnessing Artificial Intelligence to Predict Ovarian Stimulation Outcomes in In Vitro Fertilization: Scoping Review JO - J Med Internet Res SP - e53396 VL - 26 KW - artificial intelligence KW - AI KW - AI models KW - AI model KW - in vitro fertilization KW - IVF KW - ovarian stimulation KW - infertility KW - fertility KW - ovary KW - ovaries KW - reproductive KW - reproduction KW - gynecology KW - prediction KW - predictions KW - predictive KW - prediction model KW - ovarian KW - adverse outcome KW - fertilization KW - pregnancy N2 - Background: In the realm of in vitro fertilization (IVF), artificial intelligence (AI) models serve as invaluable tools for clinicians, offering predictive insights into ovarian stimulation outcomes. Predicting and understanding a patient?s response to ovarian stimulation can help in personalizing doses of drugs, preventing adverse outcomes (eg, hyperstimulation), and improving the likelihood of successful fertilization and pregnancy. Given the pivotal role of accurate predictions in IVF procedures, it becomes important to investigate the landscape of AI models that are being used to predict the outcomes of ovarian stimulation. Objective: The objective of this review is to comprehensively examine the literature to explore the characteristics of AI models used for predicting ovarian stimulation outcomes in the context of IVF. Methods: A total of 6 electronic databases were searched for peer-reviewed literature published before August 2023, using the concepts of IVF and AI, along with their related terms. Records were independently screened by 2 reviewers against the eligibility criteria. The extracted data were then consolidated and presented through narrative synthesis. Results: Upon reviewing 1348 articles, 30 met the predetermined inclusion criteria. The literature primarily focused on the number of oocytes retrieved as the main predicted outcome. Microscopy images stood out as the primary ground truth reference. The reviewed studies also highlighted that the most frequently adopted stimulation protocol was the gonadotropin-releasing hormone (GnRH) antagonist. In terms of using trigger medication, human chorionic gonadotropin (hCG) was the most commonly selected option. Among the machine learning techniques, the favored choice was the support vector machine. As for the validation of AI algorithms, the hold-out cross-validation method was the most prevalent. The area under the curve was highlighted as the primary evaluation metric. The literature exhibited a wide variation in the number of features used for AI algorithm development, ranging from 2 to 28,054 features. Data were mostly sourced from patient demographics, followed by laboratory data, specifically hormonal levels. Notably, the vast majority of studies were restricted to a single infertility clinic and exclusively relied on nonpublic data sets. Conclusions: These insights highlight an urgent need to diversify data sources and explore varied AI techniques for improved prediction accuracy and generalizability of AI models for the prediction of ovarian stimulation outcomes. Future research should prioritize multiclinic collaborations and consider leveraging public data sets, aiming for more precise AI-driven predictions that ultimately boost patient care and IVF success rates. UR - https://www.jmir.org/2024/1/e53396 UR - http://dx.doi.org/10.2196/53396 UR - http://www.ncbi.nlm.nih.gov/pubmed/38967964 ID - info:doi/10.2196/53396 ER - TY - JOUR AU - Sato, Daisuke AU - Ikarashi, Koyuki AU - Nakajima, Fumiko AU - Fujimoto, Tomomi PY - 2024/7/5 TI - Novel Methodology for Identifying the Occurrence of Ovulation by Estimating Core Body Temperature During Sleeping: Validity and Effectiveness Study JO - JMIR Form Res SP - e55834 VL - 8 KW - menstrual cycle KW - ovulation KW - biphasic temperature shift KW - estimation method KW - women N2 - Background: Body temperature is the most-used noninvasive biomarker to determine menstrual cycle and ovulation. However, issues related to its low accuracy are still under discussion. Objective: This study aimed to improve the accuracy of identifying the presence or absence of ovulation within a menstrual cycle. We investigated whether core body temperature (CBT) estimation can improve the accuracy of temperature biphasic shift discrimination in the menstrual cycle. The study consisted of 2 parts: experiment 1 assessed the validity of the CBT estimation method, while experiment 2 focused on the effectiveness of the method in discriminating biphasic temperature shifts. Methods: In experiment 1, healthy women aged between 18 and 40 years had their true CBT measured using an ingestible thermometer and their CBT estimated from skin temperature and ambient temperature measured during sleep in both the follicular and luteal phases of their menstrual cycles. This study analyzed the differences between these 2 measurements, the variations in temperature between the 2 phases, and the repeated measures correlation between the true and estimated CBT. Experiment 2 followed a similar methodology, but focused on evaluating the diagnostic accuracy of these 2 temperature measurement approaches (estimated CBT and traditional oral basal body temperature [BBT]) for identifying ovulatory cycles. This was performed using urine luteinizing hormone (LH) as the reference standard. Menstrual cycles were categorized based on the results of the LH tests, and a temperature shift was identified using a specific criterion called the ?three-over-six rule.? This rule and the nested design of the study facilitated the assessment of diagnostic measures, such as sensitivity and specificity. Results: The main findings showed that CBT estimated from skin temperature and ambient temperature during sleep was consistently lower than directly measured CBT in both the follicular and luteal phases of the menstrual cycle. Despite this, the pattern of temperature variation between these phases was comparable for both the estimated and true CBT measurements, suggesting that the estimated CBT accurately reflected the cyclical variations in the true CBT. Significantly, the CBT estimation method showed higher sensitivity and specificity for detecting the occurrence of ovulation than traditional oral BBT measurements, highlighting its potential as an effective tool for reproductive health monitoring. The current method for estimating the CBT provides a practical and noninvasive method for monitoring CBT, which is essential for identifying biphasic shifts in the BBT throughout the menstrual cycle. Conclusions: This study demonstrated that the estimated CBT derived from skin temperature and ambient temperature during sleep accurately captures variations in true CBT and is more accurate in determining the presence or absence of ovulation than traditional oral BBT measurements. This method holds promise for improving reproductive health monitoring and understanding of menstrual cycle dynamics. UR - https://formative.jmir.org/2024/1/e55834 UR - http://dx.doi.org/10.2196/55834 UR - http://www.ncbi.nlm.nih.gov/pubmed/38967967 ID - info:doi/10.2196/55834 ER - TY - JOUR AU - Furusho, Miku AU - Noda, Minami AU - Sato, Yoko AU - Suetsugu, Yoshiko AU - Morokuma, Seiichi PY - 2024/6/26 TI - Association Between Gestational Weeks, Initial Maternal Perception of Fetal Movement, and Individual Interoceptive Differences in Pregnant Women: Cross-Sectional Study JO - Asian Pac Isl Nurs J SP - e57128 VL - 8 KW - fetal movement KW - gestational weeks KW - gestation KW - gestational KW - heartbeat counting task KW - interoception KW - pregnancy KW - pregnant KW - maternal KW - fetus KW - fetal KW - association KW - associations KW - correlation KW - correlations KW - obstetric KW - obstetrics KW - interoceptive KW - perception KW - perceptions KW - awareness KW - sense KW - sensing KW - senses KW - internal stimulus KW - internal stimuli N2 - Background: Interoception encompasses the conscious awareness of homeostasis in the body. Given that fetal movement awareness is a component of interoception in pregnant women, the timing of initial detection of fetal movement may indicate individual differences in interoceptive sensitivity. Objective: The aim of this study is to determine whether the association between the gestational week of initial movement awareness and interoception can be a convenient evaluation index for interoception in pregnant women. Methods: A cross-sectional study was conducted among 32 pregnant women aged 20 years or older at 22-29 weeks of gestation with stable hemodynamics in the Obstetric Outpatient Department. Interoception was assessed using the heartbeat-counting task, with gestational weeks at the first awareness of fetal movement recorded via a questionnaire. Spearman rank correlation was used to compare the gestational weeks at the first awareness of fetal movement and heartbeat-counting task scores. Results: A significant negative correlation was found between the gestational weeks at the first fetal movement awareness and heartbeat-counting task performance among all participants (r=?0.43, P=.01) and among primiparous women (r=?0.53, P=.03) but not among multiparous women. Conclusions: Individual differences in interoception appear to correlate with the differences observed in the timing of the first awareness of fetal movement. UR - https://apinj.jmir.org/2024/1/e57128 UR - http://dx.doi.org/10.2196/57128 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57128 ER - TY - JOUR AU - van Dijk, R. Merle AU - van der Marel, Anne-Fleur AU - van Rheenen-Flach, E. Leonie AU - Ganzevoort, Wessel AU - Moll, Etelka AU - Scheele, Fedde AU - Velzel, Joost PY - 2024/6/6 TI - YouTube as a Source of Patient Information on External Cephalic Version: Cross-Sectional Study JO - JMIR Form Res SP - e50087 VL - 8 KW - YouTube KW - ECV KW - external cephalic version KW - breech KW - education KW - video KW - cesarean KW - health education KW - childbirth KW - patient information KW - cross-sectional study KW - cesarean delivery KW - implementation KW - usefulness KW - medical information KW - pregnancy KW - pregnant women KW - engagement N2 - Background: With the global increase of cesarean deliveries, breech presentation is the third indication for elective cesarean delivery. Implementation of external cephalic version (ECV), in which the position of the baby is manipulated externally to prevent breech presentation at term, remains suboptimal. Increasing knowledge for caretakers and patients is beneficial in the uptake of ECV implementation. In recent decades, the internet has become the most important source of information for both patients and health care professionals. However, the use and availability of the internet also bring about concerns since the information is often not regulated or reviewed. Information needs to be understandable, correct, and easily obtainable for the patient. Owing to its global reach, YouTube has great potential to both hinder and support spreading medical information and can therefore be used as a tool for shared decision-making. Objective: The objective of this study was to investigate the available information on YouTube about ECV and assess the quality and usefulness of the information in the videos. Methods: A YouTube search was performed with five search terms and the first 35 results were selected for analysis. A quality assessment scale was developed to quantify the accuracy of medical information of each video. The main outcome measure was the usefulness score, dividing the videos into useful, slightly useful, and not useful categories. The source of upload was divided into five subcategories and two broad categories of medical or nonmedical. Secondary outcomes included audience engagement, misinformation, and encouraging or discouraging ECV. Results: Among the 70 videos, only 14% (n=10) were defined as useful. Every useful video was uploaded by educational channels or health care professionals and 80% (8/10) were derived from a medical source. Over half of the not useful videos were uploaded by birth attendants and vloggers. Videos uploaded by birth attendants scored the highest on audience engagement. The presence of misinformation was low across all groups. Two-thirds of the vloggers encouraged ECV to their viewers. Conclusions: A minor percentage of videos about ECV on YouTube are considered useful. Vloggers often encourage their audience to opt for ECV. Videos with higher audience engagement had a lower usefulness score compared to videos with lower audience engagement. Sources from medically accurate videos should cooperate with sources with high audience engagement to contribute to the uptake of ECV by creating more awareness and a positive attitude of the procedure, thereby lowering the chance for a cesarean delivery due to breech presentation at term. UR - https://formative.jmir.org/2024/1/e50087 UR - http://dx.doi.org/10.2196/50087 UR - http://www.ncbi.nlm.nih.gov/pubmed/38843520 ID - info:doi/10.2196/50087 ER - TY - JOUR AU - Kim, Min Hyung AU - Kang, Hyoeun AU - Lee, Chaeyoon AU - Park, Hyuk Jong AU - Chung, Kyung Mi AU - Kim, Miran AU - Kim, Young Na AU - Lee, Jun Hye PY - 2024/6/3 TI - Evaluation of the Clinical Efficacy and Trust in AI-Assisted Embryo Ranking: Survey-Based Prospective Study JO - J Med Internet Res SP - e52637 VL - 26 KW - assisted reproductive technology KW - in vitro fertilization KW - artificial intelligence KW - intraobserver and interobserver agreements KW - embryos KW - embryologists N2 - Background: Current embryo assessment methods for in vitro fertilization depend on subjective morphological assessments. Recently, artificial intelligence (AI) has emerged as a promising tool for embryo assessment; however, its clinical efficacy and trustworthiness remain unproven. Simulation studies may provide additional evidence, provided that they are meticulously designed to mitigate bias and variance. Objective: The primary objective of this study was to evaluate the benefits of an AI model for predicting clinical pregnancy through well-designed simulations. The secondary objective was to identify the characteristics of and potential bias in the subgroups of embryologists with varying degrees of experience. Methods: This simulation study involved a questionnaire-based survey conducted on 61 embryologists with varying levels of experience from 12 in vitro fertilization clinics. The survey was conducted via Google Forms (Google Inc) in three phases: (1) phase 1, an initial assessment (December 23, 2022, to January 22, 2023); (2) phase 2, a validation assessment (March 6, 2023, to April 5, 2023); and (3) phase 3 an AI-guided assessment (March 6, 2023, to April 5, 2023). Inter- and intraobserver assessments and the accuracy of embryo selection from 360 day-5 embryos before and after AI guidance were analyzed for all embryologists and subgroups of senior and junior embryologists. Results: With AI guidance, the interobserver agreement increased from 0.355 to 0.527 and from 0.440 to 0.524 for junior and senior embryologists, respectively, thus reaching similar levels of agreement. In a test of accurate embryo selection with 90 questions, the numbers of correct responses by the embryologists only, embryologists with AI guidance, and AI only were 34 (38%), 45 (50%), and 59 (66%), respectively. Without AI, the average score (accuracy) of the junior group was 33.516 (37%), while that of the senior group was 35.967 (40%), with P<.001 in the t test. With AI guidance, the average score (accuracy) of the junior group increased to 46.581 (52%), reaching a level similar to that of the senior embryologists of 44.833 (50%), with P=.34. Junior embryologists had a higher level of trust in the AI score. Conclusions: This study demonstrates the potential benefits of AI in selecting embryos with high chances of pregnancy, particularly for embryologists with 5 years or less of experience, possibly due to their trust in AI. Thus, using AI as an auxiliary tool in clinical practice has the potential to improve embryo assessment and increase the probability of a successful pregnancy. UR - https://www.jmir.org/2024/1/e52637 UR - http://dx.doi.org/10.2196/52637 UR - http://www.ncbi.nlm.nih.gov/pubmed/38830209 ID - info:doi/10.2196/52637 ER - TY - JOUR AU - Tilahun, Naniye Kefyalew AU - Adem, Bashir Jibril AU - Atinafu, Temesgen Wabi AU - Walle, Damtew Agmasie AU - Mengestie, Demeke Nebyu AU - Birhanu, Yeneneh Abraham PY - 2024/5/10 TI - Intention to Use Mobile-Based Partograph and Its Predictors Among Obstetric Health Care Providers Working at Public Referral Hospitals in the Oromia Region of Ethiopia in 2022: Cross-Sectional Questionnaire Study JO - Online J Public Health Inform SP - e51601 VL - 16 KW - mobile-based partograph KW - mHealth KW - mobile health KW - cross-sectional KW - questionnaire KW - questionnaires KW - survey KW - surveys KW - modified TAM KW - technology acceptance model KW - intention to use KW - obstetric health care providers KW - Ethiopia KW - intent KW - intention KW - TAM KW - experience KW - experiences KW - attitude KW - attitudes KW - opinion KW - opinions KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance KW - adoption KW - partograph KW - digital health KW - health technology KW - birth KW - women's health KW - obstetrics KW - obstetric KW - obstetric health care KW - labor monitoring N2 - Background: A partograph is a pictorial representation of the relationship between cervical dilatation and the time used to diagnose prolonged and obstructed labor. However, the utilization of paper-based partograph is low and it is prone to documentation errors, which can be avoided with the use of electronic partographs. There is only limited information on the proportion of intention to use mobile-based partographs and its predictors. Objective: The objective of this study was to determine the proportion of obstetric health care providers at public referral hospitals in Oromia, Ethiopia, in 2022 who had the intention to use mobile-based partographs and to determine the predictors of their intention to use mobile-based partographs. Methods: We performed an institution-based cross-sectional study from June 1 to July 1, 2022. Census was conducted on 649 participants. A self-administered structured English questionnaire was used, and a 5% pretest was performed. Data were entered into EpiData version 4.6 and exported to SPSS version 25 for descriptive analysis and AMOS (analysis of moment structure; version 23) for structural and measurement model assessment. Descriptive and structural equation modeling analyses were performed. The hypotheses developed based on a modified Technology Acceptance Model were tested using path coefficients and P values <.05. Results: About 65.7% (414/630; 95% CI 61.9%-69.4%) of the participants intended to use mobile-based electronic partographs, with a 97% (630/649) response rate. Perceived usefulness had a positive influence on intention to use (?=.184; P=.02) and attitude (?=.521; P=.002). Perceived ease of use had a positive influence on attitude (?=.382; P=.003), perceived usefulness (?=.503; P=.002), and intention to use (?=.369; P=.001). Job relevance had a positive influence on perceived usefulness (?=.408; P=.001) and intention to use (?=.185; P=.008). Attitude positively influenced intention to use (?=.309; P=.002). Subjective norms did not have a significant influence on perceived usefulness (?=.020; P=.61) and intention to use (?=?.066; P=.07). Conclusions: Two-thirds of the obstetric health care providers in our study intended to use mobile-based partographs. Perceived usefulness, perceived ease of use, job relevance, and attitude positively and significantly influenced their intention to use mobile-based electronic partographs. The development of a user-friendly mobile-based partograph that meets job and user expectations can enhance the intention to use. UR - https://ojphi.jmir.org/2024/1/e51601 UR - http://dx.doi.org/10.2196/51601 UR - http://www.ncbi.nlm.nih.gov/pubmed/38728079 ID - info:doi/10.2196/51601 ER - TY - JOUR AU - MacEwan, R. Sarah AU - Olvera, G. Ramona AU - Jonnalagadda, Pallavi AU - Fareed, Naleef AU - McAlearney, Scheck Ann PY - 2024/5/8 TI - Patient and Provider Perspectives About the Use of Patient-Generated Health Data During Pregnancy: Qualitative Exploratory Study JO - JMIR Form Res SP - e52397 VL - 8 KW - patient-generated health data KW - patient-centered care KW - obstetrics KW - postpartum period KW - qualitative methods N2 - Background: There is increasing interest in using patient-generated health data (PGHD) to improve patient-centered care during pregnancy. However, little research has examined the perspectives of patients and providers as they report, collect, and use PGHD to inform obstetric care. Objective: This study aims to explore the perspectives of patients and providers about the use of PGHD during pregnancy, including the benefits and challenges of reporting, collecting, and using these data, as well as considerations for expanding the use of PGHD to improve obstetric care. Methods: We conducted one-on-one interviews with 30 pregnant or postpartum patients and 14 health care providers from 2 obstetrics clinics associated with an academic medical center. Semistructured interview guides included questions for patients about their experience and preferences for sharing PGHD and questions for providers about current processes for collecting PGHD, opportunities to improve or expand the collection of PGHD, and challenges faced when collecting and using this information. Interviews were conducted by phone or videoconference and were audio recorded, transcribed verbatim, and deidentified. Interview transcripts were analyzed deductively and inductively to characterize and explore themes in the data. Results: Patients and providers described how PGHD, including physiologic measurements and experience of symptoms, were currently collected during and between in-person clinic visits for obstetric care. Both patients and providers reported positive perceptions about the collection and use of PGHD during pregnancy. Reported benefits of collecting PGHD included the potential to use data to directly inform patient care (eg, identify issues and adjust medication) and to encourage ongoing patient involvement in their care (eg, increase patient attention to their health). Patients and providers had suggestions for expanding the collection and use of PGHD during pregnancy, and providers also shared considerations about strategies that could be used to expand PGHD collection and use. These strategies included considering the roles of both patients and providers in reporting and interpreting PGHD. Providers also noted the need to consider the unintended consequences of using PGHD that should be anticipated and addressed. Conclusions: Acknowledging the challenges, suggestions, and considerations voiced by patients and providers can inform the development and implementation of strategies to effectively collect and use PGHD to support patient-centered care during pregnancy. UR - https://formative.jmir.org/2024/1/e52397 UR - http://dx.doi.org/10.2196/52397 UR - http://www.ncbi.nlm.nih.gov/pubmed/38718395 ID - info:doi/10.2196/52397 ER - TY - JOUR AU - Cunningham, C. Adam AU - Prentice, Carley AU - Peven, Kimberly AU - Wickham, Aidan AU - Bamford, Ryan AU - Radovic, Tara AU - Klepchukova, Anna AU - Fomina, Maria AU - Cunningham, Katja AU - Hill, Sarah AU - Hantsoo, Liisa AU - Payne, Jennifer AU - Zhaunova, Liudmila AU - Ponzo, Sonia PY - 2024/5/2 TI - Efficacy of the Flo App in Improving Health Literacy, Menstrual and General Health, and Well-Being in Women: Pilot Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e54124 VL - 12 KW - digital health KW - health literacy KW - menstrual cycle KW - period tracking app KW - women?s health KW - PMS KW - PMDD KW - tracking KW - app KW - application KW - tracking app KW - tracking application KW - menstrual KW - women KW - efficacy KW - general health KW - wellbeing KW - randomized controlled trial KW - awareness KW - symptoms KW - manage KW - management KW - premenstrual KW - premenstrual syndrome KW - premenstrual dysphoric disorder KW - reproductive KW - reproductive health KW - health management KW - communication KW - pregnancy KW - quality of life KW - productivity KW - education KW - functionality N2 - Background: Reproductive health literacy and menstrual health awareness play a crucial role in ensuring the health and well-being of women and people who menstruate. Further, awareness of one?s own menstrual cycle patterns and associated symptoms can help individuals identify and manage conditions of the menstrual cycle such as premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD). Digital health products, and specifically menstrual health apps, have the potential to effect positive change due to their scalability and ease of access. Objective: The primary aim of this study was to measure the efficacy of a menstrual and reproductive health app, Flo, in improving health literacy and health and well-being outcomes in menstruating individuals with and without PMS and PMDD. Further, we explored the possibility that the use of the Flo app could positively influence feelings around reproductive health management and communication about health, menstrual cycle stigma, unplanned pregnancies, quality of life, work productivity, absenteeism, and body image. Methods: We conducted 2 pilot, 3-month, unblinded, 2-armed, remote randomized controlled trials on the effects of using the Flo app in a sample of US-based (1) individuals who track their cycles (n=321) or (2) individuals who track their cycles and are affected by PMS or PMDD (n=117). Results: The findings revealed significant improvements at the end of the study period compared to baseline for our primary outcomes of health literacy (cycle tracking: D?=1.11; t311=5.73, P<.001; PMS or PMDD: D?=1.20; t115=3.76, P<.001) and menstrual health awareness (D?=3.97; t311=7.71, P<.001), health and well-being (D?=3.44; t311=5.94, P<.001), and PMS or PMDD symptoms burden (D?=?7.08; t115=?5.44, P<.001). Improvements were also observed for our secondary outcomes of feelings of control and management over health (D?=1.01; t311=5.08, P<.001), communication about health (D?=0.93; t311=2.41, P=.002), menstrual cycle stigma (D?=?0.61; t311=?2.73, P=.007), and fear of unplanned pregnancies (D?=?0.22; t311=?2.11, P=.04) for those who track their cycles, as well as absenteeism from work and education due to PMS or PMDD (D?=?1.67; t144=?2.49, P=.01). Conclusions: These pilot randomized controlled trials demonstrate that the use of the Flo app improves menstrual health literacy and awareness, general health and well-being, and PMS or PMDD symptom burden. Considering the widespread use and affordability of the Flo app, these findings show promise for filling important gaps in current health care provisioning such as improving menstrual knowledge and health. Trial Registration: OSF Registries osf.io/pcgw7; https://osf.io/pcgw7 ; OSF Registries osf.io/ry8vq; https://osf.io/ry8vq UR - https://mhealth.jmir.org/2024/1/e54124 UR - http://dx.doi.org/10.2196/54124 UR - http://www.ncbi.nlm.nih.gov/pubmed/38696773 ID - info:doi/10.2196/54124 ER - TY - JOUR AU - Gouy, Giulia AU - Attali, Luisa AU - Voillot, Paméla AU - Fournet, Patrick AU - Agostini, Aubert PY - 2024/5/2 TI - Experiences of Women With Medical Abortion Care Reflected in Social Media (VEILLE Study): Noninterventional Retrospective Exploratory Infodemiology Study JO - JMIR Infodemiology SP - e49335 VL - 4 KW - infodemiology KW - medical abortion KW - patient experience KW - real-world evidence KW - social media KW - abortion KW - women's health KW - reproduction KW - reproductive KW - obstetric KW - obstetrics KW - gynecology KW - gynecological KW - text mining KW - topic model KW - topic modeling KW - natural language processing KW - NLP N2 - Background: Abortion (also known as termination of pregnancy) is an essential element of women?s reproductive health care. Feedback from women who underwent medical termination of pregnancy about their experience is crucial to help practitioners identify women?s needs and develop necessary tools to improve the abortion care process. However, the collection of this feedback is quite challenging. Social media offer anonymity for women who share their abortion experience. Objective: This exploratory infodemiology study aimed to analyze, through French social media posts, personal medical symptoms and the different experiences and information dynamics associated with the medical abortion process. Methods: A retrospective study was performed by analyzing posts geolocated in France and published from January 1, 2017, to November 30, 2021. Posts were extracted from all French-language general and specialized publicly available web forums using specific keywords. Extracted messages were cleaned and pseudonymized. Automatic natural language processing methods were used to identify posts from women having experienced medical abortion. Biterm topic modeling was used to identify the main discussion themes and the Medical Dictionary for Regulatory Activities was used to identify medical terms. Encountered difficulties were explored using qualitative research methods until the saturation of concepts was reached. Results: Analysis of 5398 identified posts (3409 users) led to the identification of 9 major topics: personal experience (n=2413 posts, 44.7%), community support (n=1058, 19.6%), pain and bleeding (n=797, 14.8%), psychological experience (n=760, 14.1%), questioned efficacy (n=410, 7.6%), social pressure (n=373, 6.9%), positive experiences (n=257, 4.8%), menstrual cycle disorders (n=107, 2%), and reported inefficacy (n=104, 1.9%). Pain, which was mentioned in 1627 (30.1%) of the 5398 posts by 1024 (30.0%) of the 3409 users, was the most frequently reported medical term. Pain was considered severe to unbearable in 24.5% of the cases (399 of the 1627 posts). Lack of information was the most frequently reported difficulty during and after the process. Conclusions: Our findings suggest that French women used social media to share their experiences, offer and find support, and provide and receive information regarding medical abortion. Infodemiology appears to be a useful tool to obtain women?s feedback, therefore offering the opportunity to enhance care in women undergoing medical abortion. UR - https://infodemiology.jmir.org/2024/1/e49335 UR - http://dx.doi.org/10.2196/49335 UR - http://www.ncbi.nlm.nih.gov/pubmed/38696232 ID - info:doi/10.2196/49335 ER - TY - JOUR AU - Kötting, Lukas AU - Anand-Kumar, Vinayak AU - Keller, Maria Franziska AU - Henschel, Tobias Nils AU - Lippke, Sonia PY - 2024/4/26 TI - Effective Communication Supported by an App for Pregnant Women: Quantitative Longitudinal Study JO - JMIR Hum Factors SP - e48218 VL - 11 KW - clinical care KW - health action process approach KW - HAPA KW - intention KW - communication behavior KW - patient safety KW - patient education KW - internet intervention KW - dropout KW - digital health KW - behavior change KW - prediction KW - obstetric KW - pregnant women KW - pregnancy KW - safe communication KW - health behaviors KW - obstetric care N2 - Background: In the medical field of obstetrics, communication plays a crucial role, and pregnant women, in particular, can benefit from interventions improving their self-reported communication behavior. Effective communication behavior can be understood as the correct transmission of information without misunderstanding, confusion, or losses. Although effective communication can be trained by patient education, there is limited research testing this systematically with an app-based digital intervention. Thus, little is known about the success of such a digital intervention in the form of a web-app, potential behavioral barriers for engagement, as well as the processes by which such a web-app might improve self-reported communication behavior. Objective: This study fills this research gap by applying a web-app aiming at improving pregnant women?s communication behavior in clinical care. The goals of this study were to (1) uncover the potential risk factors for early dropout from the web-app and (2) investigate the social-cognitive factors that predict self-reported communication behavior after having used the web-app. Methods: In this study, 1187 pregnant women were recruited. They all started to use a theory-based web-app focusing on intention, planning, self-efficacy, and outcome expectancy to improve communication behavior. Mechanisms of behavior change as a result of exposure to the web-app were explored using stepwise regression and path analysis. Moreover, determinants of dropout were tested using logistic regression. Results: We found that dropout was associated with younger age (P=.014). Mechanisms of behavior change were consistent with the predictions of the health action process approach. The stepwise regression analysis revealed that action planning was the best predictor for successful behavioral change over the course of the app-based digital intervention (?=.331; P<.001). The path analyses proved that self-efficacy beliefs affected the intention to communicate effectively, which in turn, elicited action planning and thereby improved communication behavior (?=.017; comparative fit index=0.994; Tucker?Lewis index=0.971; root mean square error of approximation=0.055). Conclusions: Our findings can guide the development and improvement of apps addressing communication behavior in the following ways in obstetric care. First, such tools would enable action planning to improve communication behavior, as action planning is the key predictor of behavior change. Second, younger women need more attention to keep them from dropping out. However, future research should build upon the gained insights by conducting similar internet interventions in related fields of clinical care. The focus should be on processes of behavior change and strategies to minimize dropout rates, as well as replicating the findings with patient safety measures. Trial Registration: ClinicalTrials.gov identifier: NCT03855735; https://classic.clinicaltrials.gov/ct2/show/NCT03855735 UR - https://humanfactors.jmir.org/2024/1/e48218 UR - http://dx.doi.org/10.2196/48218 UR - http://www.ncbi.nlm.nih.gov/pubmed/38669073 ID - info:doi/10.2196/48218 ER - TY - JOUR AU - Smith, M. Sharissa AU - Bais, Babette AU - Ismaili M'hamdi, Hafez AU - Schermer, HN Maartje AU - Steegers-Theunissen, PM Régine PY - 2024/4/22 TI - Stimulating Preconception Care Uptake by Women With a Vulnerable Health Status Through a Mobile Health App (Pregnant Faster): Pilot Feasibility Study JO - JMIR Hum Factors SP - e53614 VL - 11 KW - preconception care KW - mHealth KW - mobile health KW - pregnancy preparation KW - nudge KW - health inequality KW - socioeconomic status KW - lifestyle KW - women KW - pregnancy KW - pregnant women KW - pregnant KW - socioeconomic KW - pilot feasibility study KW - mHealth app KW - mHealth application KW - app KW - application KW - risk factor KW - nutrition KW - stress KW - chronic stress KW - health literacy KW - usability KW - user satisfaction KW - user KW - users N2 - Background: A low socioeconomic status is associated with a vulnerable health status (VHS) through the accumulation of health-related risk factors, such as poor lifestyle behaviors (eg, inadequate nutrition, chronic stress, and impaired health literacy). For pregnant women, a VHS translates into a high incidence of adverse pregnancy outcomes and therefore pregnancy-related inequity. We hypothesize that stimulating adequate pregnancy preparation, targeting lifestyle behaviors and preconception care (PCC) uptake, can reduce these inequities and improve the pregnancy outcomes of women with a VHS. A nudge is a behavioral intervention aimed at making healthy choices easier and more attractive and may therefore be a feasible way to stimulate engagement in pregnancy preparation and PCC uptake, especially in women with a VHS. To support adequate pregnancy preparation, we designed a mobile health (mHealth) app, Pregnant Faster, that fits the preferences of women with a VHS and uses nudging to encourage PCC consultation visits and engagement in education on healthy lifestyle behaviors. Objective: This study aimed to test the feasibility of Pregnant Faster by determining usability and user satisfaction, the number of visited PCC consultations, and the course of practical study conduction. Methods: Women aged 18-45 years, with low-to-intermediate educational attainment, who were trying to become pregnant within 12 months were included in this open cohort. Recruitment took place through social media, health care professionals, and distribution of flyers and posters from September 2021 until June 2022. Participants used Pregnant Faster daily for 4 weeks, earning coins by reading blogs on pregnancy preparation, filling out a daily questionnaire on healthy lifestyle choices, and registering for a PCC consultation with a midwife. Earned coins could be spent on rewards, such as fruit, mascara, and baby products. Evaluation took place through the mHealth App Usability Questionnaire (MAUQ), an additional interview or questionnaire, and assessment of overall study conduction. Results: Due to limited inclusions, the inclusion criterion ?living in a deprived neighborhood? was dropped. This resulted in the inclusion of 47 women, of whom 39 (83%) completed the intervention. In total, 16 (41%) of 39 participants visited a PCC consultation, with their main motivation being obtaining personalized information. The majority of participants agreed with 16 (88.9%) of 18 statements of the MAUQ, indicating high user satisfaction. The mean rating was 7.7 (SD 1.0) out of 10. Points of improvement included recruitment of the target group, simplification of the log-in system, and automation of manual tasks. Conclusions: Nudging women through Pregnant Faster to stimulate pregnancy preparation and PCC uptake has proven feasible, but the inclusion criteria must be revised. A substantial number of PCC consultations were conducted, and this study will therefore be continued with an open cohort of 400 women, aiming to establish the (cost-)effectiveness of an updated version, named Pregnant Faster 2. International Registered Report Identifier (IRRID): RR2-10.2196/45293 UR - https://humanfactors.jmir.org/2024/1/e53614 UR - http://dx.doi.org/10.2196/53614 UR - http://www.ncbi.nlm.nih.gov/pubmed/38648092 ID - info:doi/10.2196/53614 ER - TY - JOUR AU - Chen, Yi-Chu AU - Chen, Yun-Yuan AU - Su, Shih-Yung AU - Jhuang, Jing-Rong AU - Chiang, Chun-Ju AU - Yang, Ya-Wen AU - Lin, Li-Ju AU - Wu, Chao-Chun AU - Lee, Wen-Chung PY - 2024/4/18 TI - Projected Time for the Elimination of Cervical Cancer Under Various Intervention Scenarios: Age-Period-Cohort Macrosimulation Study JO - JMIR Public Health Surveill SP - e46360 VL - 10 KW - age-period-cohort model KW - population attributable fraction KW - macrosimulation KW - cancer screening KW - human papillomavirus KW - HPV KW - cervical cancer KW - intervention KW - women KW - cervical screening KW - public health intervention N2 - Background: The World Health Organization aims for the global elimination of cervical cancer, necessitating modeling studies to forecast long-term outcomes. Objective: This paper introduces a macrosimulation framework using age-period-cohort modeling and population attributable fractions to predict the timeline for eliminating cervical cancer in Taiwan. Methods: Data for cervical cancer cases from 1997 to 2016 were obtained from the Taiwan Cancer Registry. Future incidence rates under the current approach and various intervention strategies, such as scaled-up screening (cytology based or human papillomavirus [HPV] based) and HPV vaccination, were projected. Results: Our projections indicate that Taiwan could eliminate cervical cancer by 2050 with either 70% compliance in cytology-based or HPV-based screening or 90% HPV vaccination coverage. The years projected for elimination are 2047 and 2035 for cytology-based and HPV-based screening, respectively; 2050 for vaccination alone; and 2038 and 2033 for combined screening and vaccination approaches. Conclusions: The age-period-cohort macrosimulation framework offers a valuable policy analysis tool for cervical cancer control. Our findings can inform strategies in other high-incidence countries, serving as a benchmark for global efforts to eliminate the disease. UR - https://publichealth.jmir.org/2024/1/e46360 UR - http://dx.doi.org/10.2196/46360 UR - http://www.ncbi.nlm.nih.gov/pubmed/38635315 ID - info:doi/10.2196/46360 ER - TY - JOUR AU - Carter, Sarah AU - Lin, C. Jane AU - Chow, Ting AU - Martinez, P. Mayra AU - Qiu, Chunyuan AU - Feldman, Klara R. AU - McConnell, Rob AU - Xiang, H. Anny PY - 2024/4/17 TI - Preeclampsia Onset, Days to Delivery, and Autism Spectrum Disorders in Offspring: Clinical Birth Cohort Study JO - JMIR Public Health Surveill SP - e47396 VL - 10 KW - autism spectrum disorders KW - autism KW - clinical management KW - diagnosis KW - expectant management KW - fetal exposure KW - fetal KW - management KW - preeclampsia KW - pregnancy KW - pregnant women KW - risk N2 - Background: Maternal preeclampsia is associated with a risk of autism spectrum disorders (ASD) in offspring. However, it is unknown whether the increased ASD risk associated with preeclampsia is due to preeclampsia onset or clinical management of preeclampsia after onset, as clinical expectant management of preeclampsia allows pregnant women with this complication to remain pregnant for potentially weeks depending on the onset and severity. Identifying the risk associated with preeclampsia onset and exposure provides evidence to support the care of high-risk pregnancies and reduce adverse effects on offspring. Objective: This study aimed to fill the knowledge gap by assessing the ASD risk in children associated with the gestational age of preeclampsia onset and the number of days from preeclampsia onset to delivery. Methods: This retrospective population-based clinical cohort study included 364,588 mother-child pairs of singleton births between 2001 and 2014 in a large integrated health care system in Southern California. Maternal social demographic and pregnancy health data, as well as ASD diagnosis in children by the age of 5 years, were extracted from electronic medical records. Cox regression models were used to assess hazard ratios (HRs) of ASD risk in children associated with gestational age of the first occurrence of preeclampsia and the number of days from first occurrence to delivery. Results: Preeclampsia occurred in 16,205 (4.4%) out of 364,588 pregnancies; among the 16,205 pregnancies, 2727 (16.8%) first occurred at <34 weeks gestation, 4466 (27.6%) first occurred between 34 and 37 weeks, and 9012 (55.6%) first occurred at ?37 weeks. Median days from preeclampsia onset to delivery were 4 (IQR 2,16) days, 1 (IQR 1,3) day, and 1 (IQR 0,1) day for those first occurring at <34, 34-37, and ?37 weeks, respectively. Early preeclampsia onset was associated with greater ASD risk (P=.003); HRs were 1.62 (95% CI 1.33-1.98), 1.43 (95% CI 1.20-1.69), and 1.23 (95% CI 1.08-1.41), respectively, for onset at <34, 34-37, and ?37 weeks, relative to the unexposed group. Within the preeclampsia group, the number of days from preeclampsia onset to delivery was not associated with ASD risk in children; the HR was 0.995 (95% CI 0.986-1.004) after adjusting for gestational age of preeclampsia onset. Conclusions: Preeclampsia during pregnancy was associated with ASD risk in children, and the risk was greater with earlier onset. However, the number of days from first preeclampsia onset to delivery was not associated with ASD risk in children. Our study suggests that ASD risk in children associated with preeclampsia is not increased by expectant management of preeclampsia in standard clinical practice. Our results emphasize the need to identify effective approaches to preventing the onset of preeclampsia, especially during early pregnancy. Further research is needed to confirm if this finding applies across different populations and clinical settings. UR - https://publichealth.jmir.org/2024/1/e47396 UR - http://dx.doi.org/10.2196/47396 UR - http://www.ncbi.nlm.nih.gov/pubmed/38630528 ID - info:doi/10.2196/47396 ER - TY - JOUR AU - Wahl, J. Kate AU - Brooks, Melissa AU - Trenaman, Logan AU - Desjardins-Lorimer, Kirsten AU - Bell, M. Carolyn AU - Chokmorova, Nazgul AU - Segall, Romy AU - Syring, Janelle AU - Williams, Aleyah AU - Li, C. Linda AU - Norman, V. Wendy AU - Munro, Sarah PY - 2024/4/16 TI - User-Centered Development of a Patient Decision Aid for Choice of Early Abortion Method: Multi-Cycle Mixed Methods Study JO - J Med Internet Res SP - e48793 VL - 26 KW - family planning KW - abortion KW - shared decision-making KW - patient decision aid KW - qualitative KW - evaluation KW - Canada KW - health equity N2 - Background: People seeking abortion in early pregnancy have the choice between medication and procedural options for care. The choice is preference-sensitive?there is no clinically superior option and the choice depends on what matters most to the individual patient. Patient decision aids (PtDAs) are shared decision-making tools that support people in making informed, values-aligned health care choices. Objective: We aimed to develop and evaluate the usability of a web-based PtDA for the Canadian context, where abortion care is publicly funded and available without legal restriction. Methods: We used a systematic, user-centered design approach guided by principles of integrated knowledge translation. We first developed a prototype using available evidence for abortion seekers? decisional needs and the risks, benefits, and consequences of each option. We then refined the prototype through think-aloud interviews with participants at risk of unintended pregnancy (?patient? participants). Interviews were audio-recorded and documented through field notes. Finally, we conducted a web-based survey of patients and health care professionals involved with abortion care, which included the System Usability Scale. We used content analysis to identify usability issues described in the field notes and open-ended survey questions, and descriptive statistics to summarize participant characteristics and close-ended survey responses. Results: A total of 61 individuals participated in this study. Further, 11 patients participated in think-aloud interviews. Overall, the response to the PtDA was positive; however, the content analysis identified issues related to the design, language, and information about the process and experience of obtaining abortion care. In response, we adapted the PtDA into an interactive website and revised it to include consistent and plain language, additional information (eg, pain experience narratives), and links to additional resources on how to find an abortion health care professional. In total, 25 patients and 25 health care professionals completed the survey. The mean System Usability Scale score met the threshold for good usability among both patient and health care professional participants. Most participants felt that the PtDA was user-friendly (patients: n=25, 100%; health care professionals: n=22, 88%), was not missing information (patients: n=21, 84%; health care professionals: n=18, 72%), and that it was appropriate for patients to complete the PtDA before a consultation (patients: n=23, 92%; health care professionals: n=23, 92%). Open-ended responses focused on improving usability by reducing the length of the PtDA and making the website more mobile-friendly. Conclusions: We systematically designed the PtDA to address an unmet need to support informed, values-aligned decision-making about the method of abortion. The design process responded to a need identified by potential users and addressed unique sensitivities related to reproductive health decision-making. UR - https://www.jmir.org/2024/1/e48793 UR - http://dx.doi.org/10.2196/48793 UR - http://www.ncbi.nlm.nih.gov/pubmed/38625731 ID - info:doi/10.2196/48793 ER - TY - JOUR AU - Tamrat, Tigest AU - Zhao, Yu AU - Schalet, Denise AU - AlSalamah, Shada AU - Pujari, Sameer AU - Say, Lale PY - 2024/4/9 TI - Exploring the Use and Implications of AI in Sexual and Reproductive Health and Rights: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e53888 VL - 13 KW - artificial intelligence KW - AI KW - sexual health KW - reproductive health KW - maternal health KW - gender KW - machine learning KW - natural language processing KW - review KW - systematic documentation KW - protocol KW - scoping review KW - electronic database KW - technical consultation KW - intervention KW - methodology KW - qualitative KW - World Health Organization KW - WHO KW - decision-making N2 - Background: Artificial intelligence (AI) has emerged as a transformative force across the health sector and has garnered significant attention within sexual and reproductive health and rights (SRHR) due to polarizing views on its opportunities to advance care and the heightened risks and implications it brings to people?s well-being and bodily autonomy. As the fields of AI and SRHR evolve, clarity is needed to bridge our understanding of how AI is being used within this historically politicized health area and raise visibility on the critical issues that can facilitate its responsible and meaningful use. Objective: This paper presents the protocol for a scoping review to synthesize empirical studies that focus on the intersection of AI and SRHR. The review aims to identify the characteristics of AI systems and tools applied within SRHR, regarding health domains, intended purpose, target users, AI data life cycle, and evidence on benefits and harms. Methods: The scoping review follows the standard methodology developed by Arksey and O?Malley. We will search the following electronic databases: MEDLINE (PubMed), Scopus, Web of Science, and CINAHL. Inclusion criteria comprise the use of AI systems and tools in sexual and reproductive health and clear methodology describing either quantitative or qualitative approaches, including program descriptions. Studies will be excluded if they focus entirely on digital interventions that do not explicitly use AI systems and tools, are about robotics or nonhuman subjects, or are commentaries. We will not exclude articles based on geographic location, language, or publication date. The study will present the uses of AI across sexual and reproductive health domains, the intended purpose of the AI system and tools, and maturity within the AI life cycle. Outcome measures will be reported on the effect, accuracy, acceptability, resource use, and feasibility of studies that have deployed and evaluated AI systems and tools. Ethical and legal considerations, as well as findings from qualitative studies, will be synthesized through a narrative thematic analysis. We will use the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) format for the publication of the findings. Results: The database searches resulted in 12,793 records when the searches were conducted in October 2023. Screening is underway, and the analysis is expected to be completed by July 2024. Conclusions: The findings will provide key insights on usage patterns and evidence on the use of AI in SRHR, as well as convey key ethical, safety, and legal considerations. The outcomes of this scoping review are contributing to a technical brief developed by the World Health Organization and will guide future research and practice in this highly charged area of work. Trial Registration: OSF Registries osf.io/ma4d9; https://osf.io/ma4d9 International Registered Report Identifier (IRRID): PRR1-10.2196/53888 UR - https://www.researchprotocols.org/2024/1/e53888 UR - http://dx.doi.org/10.2196/53888 UR - http://www.ncbi.nlm.nih.gov/pubmed/38593433 ID - info:doi/10.2196/53888 ER - TY - JOUR AU - Gagnon, M. Michelle AU - Brilz, R. Alexandra AU - Alberts, M. Nicole AU - Gordon, L. Jennifer AU - Risling, L. Tracie AU - Stinson, N. Jennifer PY - 2024/4/8 TI - Understanding Adolescents? Experiences With Menstrual Pain to Inform the User-Centered Design of a Mindfulness-Based App: Mixed Methods Investigation Study JO - JMIR Pediatr Parent SP - e54658 VL - 7 KW - adolescent health KW - endometriosis KW - pain management, biopsychosocial KW - women?s health KW - dysmenorrhea KW - thematic analysis KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - attitude KW - attitudes KW - opinion KW - perception KW - perceptions KW - perspective KW - perspectives KW - interest KW - intent KW - intention KW - survey KW - surveys KW - focus group KW - focus groups KW - content analysis KW - mindfulness KW - meditation KW - menstrual KW - menstruation KW - experience KW - experiences KW - pain KW - youth KW - adolescent KW - adolescents KW - teen KW - teens KW - teenager KW - teenagers N2 - Background: Digital interventions are increasingly popular for the provision of nonpharmacological pain interventions, but few exist for adolescents with menstrual pain. User-centered design involves incorporating users across phases of digital health intervention design, development, and implementation and leads to improved user engagement and outcomes. A needs assessment is the first step of this approach. Objective: The goal of this study was to conduct a needs assessment to understand menstrual pain management needs and preferences and mindfulness experiences, preferences, and knowledge of adolescents with menstrual pain to inform the future development of an app for managing menstrual pain. Methods: We used an explanatory sequential mixed method design that included a survey followed by focus groups. Adolescents aged 13-17 years completed a survey (n=111) and participated in focus groups (n=16). Data were analyzed using descriptive statistics and thematic content analysis and synthesized to provide specific recommendations based on adolescent responses. Results: Adolescents (n=111) who completed the survey reported a moderate understanding of mindfulness and menstrual pain. Over three-quarters (n=87, 78%) of participants practiced some form of mindfulness and 87% (n=97) of survey participants used nonpharmacological pain management strategies. Teens had a moderate perception that mindfulness could help their menstrual pain (mean 4.51/10, SD 2.45, with higher scores suggesting more interest). Themes were generated related to mindfulness experiences, menstrual pain knowledge and experiences, and app functionality. These themes underscored adolescents? need for continued support and flexible access to mindfulness activities; their awareness of multiple influences to pain, with potential for further education in this area; and the need for menstrual pain?specific content, along with content relevant to typical day-to-day experiences of adolescents. Conclusions: Adolescents with menstrual pain have an interest in using a mindfulness app for pain but have unique needs that need to be addressed to ensure app engagement and relevance for this population. Concrete recommendations for future app development are provided. UR - https://pediatrics.jmir.org/2024/1/e54658 UR - http://dx.doi.org/10.2196/54658 UR - http://www.ncbi.nlm.nih.gov/pubmed/38587886 ID - info:doi/10.2196/54658 ER - TY - JOUR AU - Coutinho-Almeida, João AU - Cardoso, Alexandrina AU - Cruz-Correia, Ricardo AU - Pereira-Rodrigues, Pedro PY - 2024/4/8 TI - Fast Healthcare Interoperability Resources?Based Support System for Predicting Delivery Type: Model Development and Evaluation Study JO - JMIR Form Res SP - e54109 VL - 8 KW - obstetrics KW - machine-learning KW - clinical decision support KW - interoperability KW - interoperable KW - obstetric KW - cesarean delivery KW - cesarean KW - cesarean deliveries KW - decision support KW - pregnant KW - pregnancy KW - maternal KW - algorithm KW - algorithms KW - simulation KW - simulations N2 - Background: The escalating prevalence of cesarean delivery globally poses significant health impacts on mothers and newborns. Despite this trend, the underlying reasons for increased cesarean delivery rates, which have risen to 36.3% in Portugal as of 2020, remain unclear. This study delves into these issues within the Portuguese health care context, where national efforts are underway to reduce cesarean delivery occurrences. Objective: This paper aims to introduce a machine learning, algorithm-based support system designed to assist clinical teams in identifying potentially unnecessary cesarean deliveries. Key objectives include developing clinical decision support systems for cesarean deliveries using interoperability standards, identifying predictive factors influencing delivery type, assessing the economic impact of implementing this tool, and comparing system outputs with clinicians? decisions. Methods: This study used retrospective data collected from 9 public Portuguese hospitals, encompassing maternal and fetal data and delivery methods from 2019 to 2020. We used various machine learning algorithms for model development, with light gradient-boosting machine (LightGBM) selected for deployment due to its efficiency. The model?s performance was compared with clinician assessments through questionnaires. Additionally, an economic simulation was conducted to evaluate the financial impact on Portuguese public hospitals. Results: The deployed model, based on LightGBM, achieved an area under the receiver operating characteristic curve of 88%. In the trial deployment phase at a single hospital, 3.8% (123/3231) of cases triggered alarms for potentially unnecessary cesarean deliveries. Financial simulation results indicated potential benefits for 30% (15/48) of Portuguese public hospitals with the implementation of our tool. However, this study acknowledges biases in the model, such as combining different vaginal delivery types and focusing on potentially unwarranted cesarean deliveries. Conclusions: This study presents a promising system capable of identifying potentially incorrect cesarean delivery decisions, with potentially positive implications for medical practice and health care economics. However, it also highlights the challenges and considerations necessary for real-world application, including further evaluation of clinical decision-making impacts and understanding the diverse reasons behind delivery type choices. This study underscores the need for careful implementation and further robust analysis to realize the full potential and real-world applicability of such clinical support systems. UR - https://formative.jmir.org/2024/1/e54109 UR - http://dx.doi.org/10.2196/54109 UR - http://www.ncbi.nlm.nih.gov/pubmed/38587885 ID - info:doi/10.2196/54109 ER - TY - JOUR AU - Yao, Jiasi AU - Roth, Heike AU - Anderson, Debra AU - Lu, Hong AU - Rong, Huijuan AU - Baird, Kathleen PY - 2024/3/26 TI - Comparison of Spontaneous Pushing and Directed Pushing During the Second Stage of Labor Among Chinese Women Without Epidural Analgesia: Protocol for a Noninferior Feasibility Study JO - JMIR Res Protoc SP - e55701 VL - 13 KW - spontaneous pushing KW - directed pushing KW - labour stage, labour KW - labor KW - obstetric KW - obstetrics KW - child KW - birth KW - delivery KW - second KW - feasibility study KW - China KW - Chinese KW - women KW - protocol KW - maternal-neonatal outcomes KW - maternal KW - healthcare KW - labouring women KW - cohort KW - effectiveness KW - Midwives KW - midwife KW - midwifery KW - childbirth N2 - Background: Maternal pushing during the second stage of labor could influence labor progress and maternal-neonatal outcomes. Although the image of health care providers directing the laboring women to push during the second stage of labor could be commonly observed globally, this practice is not sufficiently researched and is questioned regarding its effectiveness and outcomes on the mother and baby. Meanwhile, a strategy referred to as ?spontaneous pushing,? which supports women to push by following their bodily urges, has been evaluated in several trials. However, in China, spontaneous pushing is not common practice. Notwithstanding the evaluation of spontaneous pushing, there is a lack of high-quality evidence to support either strategies of directed pushing or spontaneous pushing. Objective: This study aims to test the feasibility of a future randomized controlled trial to compare the effects of spontaneous pushing and directed pushing during the second stage of labor for maternal and neonatal outcomes in China. Methods: A nonrandomized, single-group, noninferiority feasibility study will be conducted in a public hospital in Hebei Province, China. In total, 105 women meeting the selection criteria will be recruited to receive the intervention (spontaneous pushing), while 105 sets of medical notes from women who received routine care (directed pushing) will be identified and reviewed to compare outcomes for both cohorts. A mixed methods approach will be used to assess primary outcomes (feasibility and acceptability) and secondary outcomes (effectiveness). Results: Data collection took place between May and October 2023. A total of 110 women were invited to participate in the intervention of spontaneous pushing. Midwives? interviews were conducted and will be transcribed for analysis in March 2024. The data analysis is planned to be completed by May 2024. Conclusions: This feasibility study will provide important information by conducting a full-scale clinical trial in the future as well as the potential facilitators and barriers of it. A future randomized controlled trial is likely to have considerable policy and funding impacts regarding pushing management during the second stage of labor and improvement in women?s childbirth experience. Trial Registration: Chinese Clinical Trial Register ChiCTR2300071178; https://tinyurl.com/mudtnbft International Registered Report Identifier (IRRID): DERR1-10.2196/55701 UR - https://www.researchprotocols.org/2024/1/e55701 UR - http://dx.doi.org/10.2196/55701 UR - http://www.ncbi.nlm.nih.gov/pubmed/38530330 ID - info:doi/10.2196/55701 ER - TY - JOUR AU - Snyder, Morgan AU - Elkins, R. Gary PY - 2024/3/14 TI - Characteristics of Users of a Digital Hypnotherapy Intervention for Hot Flashes: Retrospective Study JO - JMIR Form Res SP - e53555 VL - 8 KW - hypnotherapy KW - hot flashes KW - smartphone app KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - hypnosis KW - menopause KW - menopausal KW - gynecology KW - usage KW - women's health KW - user KW - users KW - demographics KW - demographic KW - characteristic KW - characteristics KW - mental health KW - alternative KW - complementary KW - mind body KW - hypnotism N2 - Background: Hot flashes are associated with a lower quality of life and sleep disturbances. Given the many consequences of hot flashes, it is important to find treatments to reduce them. Hypnotherapy, the use of hypnosis for a medical disorder or concern, has been shown in clinical trials to be effective in reducing hot flashes, but it is not routinely used in clinical practice. One solution to close this implementation gap is to administer hypnotherapy for hot flashes via a smartphone app. Evia is a smartphone app that delivers hypnotherapy for hot flashes. Evia has made hypnotherapy more widely accessible for women who are experiencing hot flashes; however, the app has yet to undergo empirical testing. Additionally, research on user characteristics is lacking. Objective: This study aims to (1) determine the average age, stage of menopause, and length of menopause symptoms for users of the Evia app; (2) determine the characteristics of hot flashes and night sweats for users of the Evia app; (3) determine the self-reported sleep quality of users of the Evia app; (4) determine the self-reported mental health of users of the Evia app; and (5) determine the relationship between hot flash frequency and anxiety and depression for users of the Evia app. Methods: This study analyzed data collected from participants who have downloaded the Evia app. Data were collected at 1 time point from a self-report questionnaire that assessed the demographic and clinical characteristics of users. The questionnaire was given to users when they downloaded the Evia app. Users of the Evia app fill out a questionnaire upon enrolling in the program and prior to beginning the intervention. This included 9764 users. Results: Results showed that the mean age of users was 49.31 years. A total of 41.6% (1942/4665) of users reported experiencing 5 or more hot flashes per day, while 51.2% (1473/2877) of users reported having difficulty falling asleep each night and 47.7% (1253/2626) of users reported their sleep quality to be terrible. In addition, 38.4% (1104/2877) of users reported that they often feel anxious or depressed. There was a small, significant, and negative correlation between hot flash frequency and self-report frequency of anxiety and depression (r=?0.09). Conclusions: This study showed that the average age of app users is in line with the median age of natural menopause. A large percentage of users reported experiencing 5 or more hot flashes per day, reported difficulties with sleep, and reported experiencing depression and anxiety. These findings are in line with previous studies that assessed hot flash frequency and the consequences of hot flashes. This was the first study to report on the characteristics of users of the Evia app. Results will be used to optimize the hypnotherapy program delivered via the Evia app. UR - https://formative.jmir.org/2024/1/e53555 UR - http://dx.doi.org/10.2196/53555 UR - http://www.ncbi.nlm.nih.gov/pubmed/38483465 ID - info:doi/10.2196/53555 ER - TY - JOUR AU - Percy, Carol AU - Turner, Andrew AU - Orr, Charys PY - 2024/3/7 TI - Developing a Novel Web-Based Self-Management Support Intervention for Polycystic Ovary Syndrome: Mixed Methods Study With Patients and Health Care Professionals JO - JMIR Form Res SP - e52427 VL - 8 KW - anxiety KW - depression KW - PCOS KW - peer support KW - polycystic ovary syndrome KW - positive well-being KW - psychoeducation KW - self-management KW - web-based health intervention KW - women?s health N2 - Background: Polycystic ovary syndrome (PCOS) represents a significant global health burden requiring urgent attention. This common chronic endocrine and cardiometabolic condition affects around 1 in 10 women and individuals assigned female at birth, with significant adverse effects on well-being, quality of life, and mental health, as well as serious and complex long-term health consequences. International guidelines for best health care practice recommend the provision of comprehensive cognitive behavioral interventions to support self-management and improve health outcomes for those living with PCOS. Web-based health interventions have the potential to meet this need in an accessible and scalable way. Objective: We aim to identify barriers to self-management and psychological well-being in women with PCOS and adapt a web-based self-management program to provide a prototype digital support intervention for them. Methods: We adapted an existing support program (HOPE) for PCOS using the antecedent target measure approach. We conducted qualitative interviews with 13 adult women living with PCOS, 3 trustees of a patients with PCOS advocacy charity, and 4 endocrinologists to identify ?antecedents? (barriers) to self-management and psychological well-being. Framework analysis was used to identify potentially modifiable antecedents to be targeted by the novel intervention. At a national conference, 58 key stakeholders (patients and health professionals) voted for the antecedents they felt were most important to address. We used research evidence and relevant theory to design a prototype for the PCOS intervention. Results: Voting identified 32 potentially modifiable antecedents, relating to knowledge, understanding, emotions, motivation, and behaviors, as priorities to be targeted in the new intervention. A modular, web-based prototype HOPE PCOS intervention was developed to address these, covering six broad topic areas (instilling HOPE for PCOS; managing the stress of PCOS; feeding your mind and body well; body image, intimacy, and close relationships; staying healthy with PCOS; and keeping PCOS in its place). Conclusions: We identified barriers to self-management and psychological well-being in women with PCOS and used these to adapt a web-based self-management program, tailoring it for PCOS, which is a comprehensive group intervention combining education, empowerment, lifestyle management, peer support with cognitive behavioral tools, and goal-setting (to be delivered by peers or codelivered with health care professionals). The modular structure offers flexibility to adapt the program further as new clinical recommendations emerge. The intervention has the potential to be delivered, evaluated for feasibility, and, if effective, integrated into health care services. Self-management interventions are not designed to replace clinical care; rather, they serve as an additional source of support. The HOPE PCOS program conveys this message in its content and activities. Future research should evaluate the prototype intervention using primary outcomes such as measures of psychological well-being, self-management self-efficacy, depression, anxiety, and PCOS-related quality of life. They should also assess the intervention?s acceptability, scalability, and cost-effectiveness. UR - https://formative.jmir.org/2024/1/e52427 UR - http://dx.doi.org/10.2196/52427 UR - http://www.ncbi.nlm.nih.gov/pubmed/38451567 ID - info:doi/10.2196/52427 ER - TY - JOUR AU - Mills, Rhiana AU - Mangone, Rose Emily AU - Lesh, Neal AU - Jayal, Gayatri AU - Mohan, Diwakar AU - Baraitser, Paula PY - 2024/2/27 TI - Chatbots That Deliver Contraceptive Support: Systematic Review JO - J Med Internet Res SP - e46758 VL - 26 KW - chatbot KW - contraceptives KW - digital health KW - AI KW - systematic review KW - conversational agent KW - development best practices KW - development KW - counseling KW - communication KW - user feedback KW - users KW - feedback KW - attitudes KW - behavior N2 - Background: A chatbot is a computer program that is designed to simulate conversation with humans. Chatbots may offer rapid, responsive, and private contraceptive information; counseling; and linkages to products and services, which could improve contraceptive knowledge, attitudes, and behaviors. Objective: This review aimed to systematically collate and interpret evidence to determine whether and how chatbots improve contraceptive knowledge, attitudes, and behaviors. Contraceptive knowledge, attitudes, and behaviors include access to contraceptive information, understanding of contraceptive information, access to contraceptive services, contraceptive uptake, contraceptive continuation, and contraceptive communication or negotiation skills. A secondary aim of the review is to identify and summarize best practice recommendations for chatbot development to improve contraceptive outcomes, including the cost-effectiveness of chatbots where evidence is available. Methods: We systematically searched peer-reviewed and gray literature (2010-2022) for papers that evaluated chatbots offering contraceptive information and services. Sources were included if they featured a chatbot and addressed an element of contraception, for example, uptake of hormonal contraceptives. Literature was assessed for methodological quality using appropriate quality assessment tools. Data were extracted from the included sources using a data extraction framework. A narrative synthesis approach was used to collate qualitative evidence as quantitative evidence was too sparse for a quantitative synthesis to be carried out. Results: We identified 15 sources, including 8 original research papers and 7 gray literature papers. These sources included 16 unique chatbots. This review found the following evidence on the impact and efficacy of chatbots: a large, robust randomized controlled trial suggests that chatbots have no effect on intention to use contraception; a small, uncontrolled cohort study suggests increased uptake of contraception among adolescent girls; and a development report, using poor-quality methods, suggests no impact on improved access to services. There is also poor-quality evidence to suggest increased contraceptive knowledge from interacting with chatbot content. User engagement was mixed, with some chatbots reaching wide audiences and others reaching very small audiences. User feedback suggests that chatbots may be experienced as acceptable, convenient, anonymous, and private, but also as incompetent, inconvenient, and unsympathetic. The best practice guidance on the development of chatbots to improve contraceptive knowledge, attitudes, and behaviors is consistent with that in the literature on chatbots in other health care fields. Conclusions: We found limited and conflicting evidence on chatbots to improve contraceptive knowledge, attitudes, and behaviors. Further research that examines the impact of chatbot interventions in comparison with alternative technologies, acknowledges the varied and changing nature of chatbot interventions, and seeks to identify key features associated with improved contraceptive outcomes is needed. The limitations of this review include the limited evidence available on this topic, the lack of formal evaluation of chatbots in this field, and the lack of standardized definition of what a chatbot is. UR - https://www.jmir.org/2024/1/e46758 UR - http://dx.doi.org/10.2196/46758 UR - http://www.ncbi.nlm.nih.gov/pubmed/38412028 ID - info:doi/10.2196/46758 ER - TY - JOUR AU - Lyzwinski, Lynnette AU - Elgendi, Mohamed AU - Menon, Carlo PY - 2024/2/15 TI - Innovative Approaches to Menstruation and Fertility Tracking Using Wearable Reproductive Health Technology: Systematic Review JO - J Med Internet Res SP - e45139 VL - 26 KW - fertility cycle KW - fertility monitoring KW - ovulation KW - menstruation KW - wearable devices KW - mHealth KW - reproductive health KW - wearable KW - fertility KW - menstrual KW - women?s health KW - ovulate KW - sexual health KW - scoping KW - review method N2 - Background: Emerging digital health technology has moved into the reproductive health market for female individuals. In the past, mobile health apps have been used to monitor the menstrual cycle using manual entry. New technological trends involve the use of wearable devices to track fertility by assessing physiological changes such as temperature, heart rate, and respiratory rate. Objective: The primary aims of this study are to review the types of wearables that have been developed and evaluated for menstrual cycle tracking and to examine whether they may detect changes in the menstrual cycle in female individuals. Another aim is to review whether these devices are effective for tracking various stages in the menstrual cycle including ovulation and menstruation. Finally, the secondary aim is to assess whether the studies have validated their findings by reporting accuracy and sensitivity. Methods: A review of PubMed or MEDLINE was undertaken to evaluate wearable devices for their effectiveness in predicting fertility and differentiating between the different stages of the menstrual cycle. Results: Fertility cycle?tracking wearables include devices that can be worn on the wrists, on the fingers, intravaginally, and inside the ear. Wearable devices hold promise for predicting different stages of the menstrual cycle including the fertile window and may be used by female individuals as part of their reproductive health. Most devices had high accuracy for detecting fertility and were able to differentiate between the luteal phase (early and late), fertile window, and menstruation by assessing changes in heart rate, heart rate variability, temperature, and respiratory rate. Conclusions: More research is needed to evaluate consumer perspectives on reproductive technology for monitoring fertility, and ethical issues around the privacy of digital data need to be addressed. Additionally, there is also a need for more studies to validate and confirm this research, given its scarcity, especially in relation to changes in respiratory rate as a proxy for reproductive cycle staging. UR - https://www.jmir.org/2024/1/e45139 UR - http://dx.doi.org/10.2196/45139 UR - http://www.ncbi.nlm.nih.gov/pubmed/38358798 ID - info:doi/10.2196/45139 ER - TY - JOUR AU - Valdez, Danny AU - Mena-Meléndez, Lucrecia AU - Crawford, L. Brandon AU - Jozkowski, N. Kristen PY - 2024/2/14 TI - Analyzing Reddit Forums Specific to Abortion That Yield Diverse Dialogues Pertaining to Medical Information Seeking and Personal Worldviews: Data Mining and Natural Language Processing Comparative Study JO - J Med Internet Res SP - e47408 VL - 26 KW - abortion KW - social media KW - Reddit KW - natural language processing KW - NLP KW - neural networks N2 - Background: Attitudes toward abortion have historically been characterized via dichotomized labels, yet research suggests that these labels do not appropriately encapsulate beliefs on abortion. Rather, contexts, circumstances, and lived experiences often shape views on abortion into more nuanced and complex perspectives. Qualitative data have also been shown to underpin belief systems regarding abortion. Social media, as a form of qualitative data, could reveal how attitudes toward abortion are communicated publicly in web-based spaces. Furthermore, in some cases, social media can also be leveraged to seek health information. Objective: This study applies natural language processing and social media mining to analyze Reddit (Reddit, Inc) forums specific to abortion, including r/Abortion (the largest subreddit about abortion) and r/AbortionDebate (a subreddit designed to discuss and debate worldviews on abortion). Our analytical pipeline intends to identify potential themes within the data and the affect from each post. Methods: We applied a neural network?based topic modeling pipeline (BERTopic) to uncover themes in the r/Abortion (n=2151) and r/AbortionDebate (n=2815) subreddits. After deriving the optimal number of topics per subreddit using an iterative coherence score calculation, we performed a sentiment analysis using the Valence Aware Dictionary and Sentiment Reasoner to assess positive, neutral, and negative affect and an emotion analysis using the Text2Emotion lexicon to identify potential emotionality per post. Differences in affect and emotion by subreddit were compared. Results: The iterative coherence score calculation revealed 10 topics for both r/Abortion (coherence=0.42) and r/AbortionDebate (coherence=0.35). Topics in the r/Abortion subreddit primarily centered on information sharing or offering a source of social support; in contrast, topics in the r/AbortionDebate subreddit centered on contextualizing shifting or evolving views on abortion across various ethical, moral, and legal domains. The average compound Valence Aware Dictionary and Sentiment Reasoner scores for the r/Abortion and r/AbortionDebate subreddits were 0.01 (SD 0.44) and ?0.06 (SD 0.41), respectively. Emotionality scores were consistent across the r/Abortion and r/AbortionDebate subreddits; however, r/Abortion had a marginally higher average fear score of 0.36 (SD 0.39). Conclusions: Our findings suggest that people posting on abortion forums on Reddit are willing to share their beliefs, which manifested in diverse ways, such as sharing abortion stories including how their worldview changed, which critiques the value of dichotomized abortion identity labels, and information seeking. Notably, the style of discourse varied significantly by subreddit. r/Abortion was principally leveraged as an information and outreach source; r/AbortionDebate largely centered on debating across various legal, ethical, and moral abortion domains. Collectively, our findings suggest that abortion remains an opaque yet politically charged issue for people and that social media can be leveraged to understand views and circumstances surrounding abortion. UR - https://www.jmir.org/2024/1/e47408 UR - http://dx.doi.org/10.2196/47408 UR - http://www.ncbi.nlm.nih.gov/pubmed/38354044 ID - info:doi/10.2196/47408 ER - TY - JOUR AU - Meherali, Salima AU - Bhaumik, Soumyadeep AU - Idrees, Sobia AU - Kennedy, Megan AU - Lassi, S. Zohra PY - 2024/2/13 TI - Digital Knowledge Translation Tools for Disseminating Sexual and Reproductive Health Information to Adolescents: Protocol for an Evidence Gap Map Review JO - JMIR Res Protoc SP - e55081 VL - 13 KW - adolescents KW - sexual and reproductive health KW - digital tools KW - knowledge translation KW - mobile phone N2 - Background: Digital or eHealth knowledge translation (KT) interventions have been identified as useful public health tools, particularly to advance sexual and reproductive health (SRH) among adolescents. Existing literature reviews on digital health interventions for adolescents? SRH demonstrate limitations, including shortcomings in reporting and comprehensiveness that limit the utility and trustworthiness of findings. However, there is a lack of evidence synthesis on the effectiveness of available digital or mobile health KT tools to promote SRH interventions for adolescents. Objective: We aim to identify, map, and describe existing empirical evidence on the digital KT tools developed to improve adolescent SRH outcomes globally. Methods: This study will be conducted using an evidence gap map (EGM) approach to address the objectives, including reviewing relevant literature and a landscape analysis of the outcomes of interest. The following electronic databases will be searched for retrieval of literature: MEDLINE (1946-present), Embase (1974-present), and Global Health (1910-present) via OVID; CINAHL (1936-present) via EBSCOhost; Scopus (1976-present); and Cochrane Library (1993-present) via Wiley. We will include only those studies that focused on adolescents aged 10-19 years and addressed SRH outcomes. We will include experimental studies (randomized or cluster randomized and nonrandomized controlled trials, including quasi-randomized, controlled before-after, and interruptive time series) and observational studies, that is, including prospective cohort and case-control studies. The experimental and observational studies will only be included in the presence of control or comparison arms. Studies with a historical control arm will be excluded. The systematic review software, Covidence (Ventas Health Innovation), will be used to screen and select the studies. Further, 2 independent reviewers will complete the first and second levels of screening of studies and any conflicts arising will be resolved by consensus between the 2 reviewers or by involving the third reviewer. We will conduct the quality assessment of all included studies using the Risk of Bias tool for randomized controlled trials and nonrandomized controlled trials, and AMSTAR2 for systematic reviews. Results: Papers screening, data extraction, and synthesis will be completed by March 2024. We will use EPPI-Mapper (The International Public Policy Observatory) software to generate an online evidence map and to produce the tables and figures for the descriptive report. This EGM review will identify areas with high-quality, evidence-based digital KT tools (for immediate scale and spread) and areas where few or no KT tools exist (for targeted KT tool development and research or policy prioritization). Conclusions: This protocol focused on mapping eHealth KT tools that have been used in the literature to address SRH among adolescents. This will be the first EGM exercise to map digital KT tools to promote adolescents? SRH and will incorporate a range of published sources. International Registered Report Identifier (IRRID): DERR1-10.2196/55081 UR - https://www.researchprotocols.org/2024/1/e55081 UR - http://dx.doi.org/10.2196/55081 UR - http://www.ncbi.nlm.nih.gov/pubmed/38349722 ID - info:doi/10.2196/55081 ER - TY - JOUR AU - Hollestelle, J. Marieke AU - van der Graaf, Rieke AU - Sturkenboom, M. Miriam C. J. AU - Cunnington, Marianne AU - van Delden, M. Johannes J. PY - 2024/2/8 TI - Building a Sustainable Learning Health Care System for Pregnant and Lactating People: Interview Study Among Data Access Providers JO - JMIR Pediatr Parent SP - e47092 VL - 7 KW - ethics KW - learning health care systems KW - pregnancy KW - lactation KW - real-world data KW - governance KW - qualitative research N2 - Background: In many areas of health care, learning health care systems (LHSs) are seen as promising ways to accelerate research and outcomes for patients by reusing health and research data. For example, considering pregnant and lactating people, for whom there is still a poor evidence base for medication safety and efficacy, an LHS presents an interesting way forward. Combining unique data sources across Europe in an LHS could help clarify how medications affect pregnancy outcomes and lactation exposures. In general, a remaining challenge of data-intensive health research, which is at the core of an LHS, has been obtaining meaningful access to data. These unique data sources, also called data access providers (DAPs), are both public and private organizations and are important stakeholders in the development of a sustainable and ethically responsible LHS. Sustainability is often discussed as a challenge in LHS development. Moreover, DAPs are increasingly expected to move beyond regulatory compliance and are seen as moral agents tasked with upholding ethical principles, such as transparency, trustworthiness, responsibility, and community engagement. Objective: This study aims to explore the views of people working for DAPs who participate in a public-private partnership to build a sustainable and ethically responsible LHS. Methods: Using a qualitative interview design, we interviewed 14 people involved in the Innovative Medicines Initiative (IMI) ConcePTION (Continuum of Evidence from Pregnancy Exposures, Reproductive Toxicology and Breastfeeding to Improve Outcomes Now) project, a public-private collaboration with the goal of building an LHS for pregnant and lactating people. The pseudonymized transcripts were analyzed thematically. Results: A total of 3 themes were identified: opportunities and responsibilities, conditions for participation and commitment, and challenges for a knowledge-generating ecosystem. The respondents generally regarded the collaboration as an opportunity for various reasons beyond the primary goal of generating knowledge about medication safety during pregnancy and lactation. Respondents had different interpretations of responsibility in the context of data-intensive research in a public-private network. Respondents explained that resources (financial and other), scientific output, motivation, agreements collaboration with the pharmaceutical industry, trust, and transparency are important conditions for participating in and committing to the ConcePTION LHS. Respondents also discussed the challenges of an LHS, including the limitations to (real-world) data analyses and governance procedures. Conclusions: Our respondents were motivated by diverse opportunities to contribute to an LHS for pregnant and lactating people, primarily centered on advancing knowledge on medication safety. Although a shared responsibility for enabling real-world data analyses is acknowledged, their focus remains on their work and contribution to the project rather than on safeguarding ethical data handling. The results of our interviews underline the importance of a transparent governance structure, emphasizing the trust between DAPs and the public for the success and sustainability of an LHS. UR - https://pediatrics.jmir.org/2024/1/e47092 UR - http://dx.doi.org/10.2196/47092 UR - http://www.ncbi.nlm.nih.gov/pubmed/38329780 ID - info:doi/10.2196/47092 ER - TY - JOUR AU - Piltonen, T. Terhi AU - Allegranza, Deirdre AU - Hund, Martin AU - Buck, Katharina AU - Sillman, Johanna AU - Arffman, K. Riikka PY - 2024/2/6 TI - Validation of an Anti-Müllerian Hormone Cutoff for Polycystic Ovarian Morphology in the Diagnosis of Polycystic Ovary Syndrome in the HARMONIA Study: Protocol for a Prospective, Noninterventional Study JO - JMIR Res Protoc SP - e48854 VL - 13 KW - anti-Müllerian hormone KW - immunoassay KW - polycystic ovarian morphology KW - polycystic ovary syndrome KW - transvaginal ultrasound N2 - Background: Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders in women and is diagnosed using the Rotterdam criteria, including diagnosis of polycystic ovarian morphology (PCOM) by transvaginal ultrasound (TVUS). Due to high cost, availability, and the impact of the operator and ultrasound equipment on the reliability of the antral follicle count (AFC) by TVUS, an unmet need exists for a diagnostic test to determine PCOM without TVUS. A strong positive correlation between elevated anti-Müllerian hormone (AMH) levels and AFCs has been demonstrated in women with PCOS. In addition, recent updates to the international evidence-based PCOS guidelines state that serum AMH can be used as an alternative to TVUS-determined AFC, in the diagnosis of PCOM. The retrospective APHRODITE study derived and validated an AMH cutoff of 3.2 ng/mL for the Elecsys AMH Plus or Elecsys AMH assays (Roche) to diagnose PCOM in patients with PCOS. Objective: This study aims to further validate, in an independent prospective cohort, the AMH cutoff (3.2 ng/mL) for PCOM determination, which was previously derived and validated in the APHRODITE study. Methods: This large, prospective, multicenter, population-based, noninterventional study will evaluate the previously established AMH cutoff for the determination of PCOM during the diagnosis of PCOS using the Elecsys AMH Plus immunoassay in an independent population. Participants were women born between July 1985 and December 1987 in Northern Finland; the study partially links to the Northern Finland Birth Cohort 1986. We assessed the enrolled women, determined with the 2023 PCOS Guidelines, for current PCOS status and divided them by phenotype if positive. Each participant had 1 study visit to collect serum samples, record clinical data, and undergo a gynecological examination including TVUS. All data were collected by highly trained midwives or trained gynecologists. Sensitivity, specificity, and agreement measures were used to validate the previously determined cutoff in the whole population and in subpopulations based on phenotype and relevant demographic or clinical factors. The minimum target sample size was approximately 1800 women, including approximately 10% with PCOS. Results: At the time of manuscript submission, participant recruitment had concluded, and 1803 women were enrolled into the study. Data collection is complete and biostatistical analysis is planned for 2023. Conclusions: To limit variability, there were few TVUS operators and only 2 TVUS machines of the same type. Additionally, all women who were taking oral contraceptives were excluded from the primary analysis population. Selection bias was limited as this was a population-based study and participants were not seeking treatment for PCOS symptoms. Validating the AMH cutoff in a large, population-based study will provide further evidence on the utility of the Elecsys AMH Plus or Elecsys AMH assays in PCOM diagnosis as an alternative to TVUS. Measuring AMH for PCOM diagnosis could reduce delayed or missed diagnoses due to operator-dependent TVUS examinations. Trial Registration: ClinicalTrials.gov NCT05527353; http://tinyurl.com/2f3ffbdz International Registered Report Identifier (IRRID): DERR1-10.2196/48854 UR - https://www.researchprotocols.org/2024/1/e48854 UR - http://dx.doi.org/10.2196/48854 UR - http://www.ncbi.nlm.nih.gov/pubmed/38319689 ID - info:doi/10.2196/48854 ER - TY - JOUR AU - Lau, Po Bobo Hi AU - Tang, Kum Catherine So AU - Holroyd, Eleanor AU - Wong, Wai William Chi PY - 2024/1/26 TI - Challenges and Implications for Menopausal Health and Help-Seeking Behaviors in Midlife Women From the United States and China in Light of the COVID-19 Pandemic: Web-Based Panel Surveys JO - JMIR Public Health Surveill SP - e46538 VL - 10 KW - menopause KW - help-seeking KW - health beliefs KW - telehealth KW - COVID-19 KW - women KW - menopausal health KW - women's health KW - online survey KW - awareness KW - digital health KW - symptom management KW - health education N2 - Background: The global population of women of menopausal age is quickly increasing. The COVID-19 pandemic has led to an accelerated increase in the use of telehealth services, especially technological solutions targeting women?s health. Understanding the factors behind midlife women?s help-seeking behaviors amidst the pandemic will assist in the development of person-centered holistic telehealth solutions targeting menopausal and postreproductive health. Objective: This study aimed to compare the factors underlying help-seeking for menopausal distress among midlife women in the United States and China. Methods: We conducted 2 web-based panel surveys in the United States using Amazon Mechanical Turk and in China using Credamo between July and October 2022. A total of 1002 American and 860 Chinese women aged between 40 and 65 years took part in the survey. The survey was designed based on the Health Belief Model with questions related to their menopausal knowledge, perceived severity of menopausal symptoms, perceived susceptibility to menopausal distress, perceived benefits of help-seeking, perceived COVID-19? and non?COVID-19?related barriers against help-seeking, self-efficacy, and motivation to seek help. Structural equations models were fitted for the data using full information maximum likelihood to manage missing data. Results: Knowledge was not directly related to help-seeking motivation in both samples. Among the Chinese sample, knowledge was negatively related to perceived severity but positively related to COVID-19?related barriers; in turn, higher perceived severity, benefits, COVID-19?related barriers, and self-efficacy and lower non?COVID-19?related barriers were related to more motivation to seek help. In the US sample, knowledge was negatively related to perceived severity, susceptibility, benefits, barriers (COVID-19? and non?COVID-19?related), and self-efficacy; in turn, higher self-efficacy, COVID-19?related barriers, and benefits were associated with more help-seeking motivation. The factors explained 53% and 45.3% of the variance of help-seeking motivation among the American and Chinese participants, respectively. Conclusions: This study revealed disparate pathways between knowledge, health beliefs, and the motivation for help-seeking among American and Chinese midlife women with respect to menopausal distress. Our findings show that knowledge may not directly influence help-seeking motivation. Instead, perceived benefits and self-efficacy consistently predicted help-seeking motivation. Interestingly, concern over COVID-19 infection was related to higher help-seeking motivation in both samples. Hence, our findings recommend the further development of telehealth services to (1) develop content beyond health education and symptom management that serves to enhance the perceived benefits of addressing women?s multidimensional menopausal health needs, (2) facilitate patient?care provider communication with a focus on self-efficacy and a propensity to engage in help-seeking behaviors, and (3) target women who have greater midlife health concerns in the postpandemic era. UR - https://publichealth.jmir.org/2024/1/e46538 UR - http://dx.doi.org/10.2196/46538 UR - http://www.ncbi.nlm.nih.gov/pubmed/38277194 ID - info:doi/10.2196/46538 ER - TY - JOUR AU - Gordon, L. Jennifer AU - Poulter, L. Megan M. AU - Balsom, A. Ashley AU - Campbell, S. Tavis PY - 2024/1/18 TI - Testing an Evidence-Based Self-Help Program for Infertility-Related Distress: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e52662 VL - 13 KW - anxiety KW - cognitive-behavior therapy KW - depression KW - infertility KW - infertility-related distress KW - mHealth N2 - Background: Infertility?the inability to achieve pregnancy despite ?12 months of focused attempts to conceive?is experienced by 1 in 6 couples. Women typically carry a disproportionate share of the psychological burden associated with infertility, experiencing poor quality of life, and 30%-40% experiencing depressive mood or anxiety. Unfortunately, currently available psychological interventions targeting infertility-related distress are associated with modest effects. Objective: Our team, in collaboration with patient advisors, has designed a self-help intervention for infertility-related distress involving 7 weekly 10-minute videos addressing the cognitive, behavioral, and interpersonal challenges associated with infertility, delivered through a mobile app. A feasibility study suggests that it is well accepted and highly effective in reducing symptoms of anxiety and depressed mood among distressed individuals dealing with infertility. This study represents the next step in this line of research: a fully powered randomized controlled trial comparing the intervention to a waitlist control group. Methods: We will recruit 170 individuals struggling to become pregnant in Canada or the United States to be randomized to our 7-week self-help program or a treatment-as-usual condition. The primary outcome will be fertility quality of life, while secondary outcomes will include depressive symptoms, anxious symptoms, and relationship quality, assessed before and after the program as well as biweekly for 16 weeks following completion of the program. Self-reported health care use and the presence of diagnosed mood and anxiety disorders, assessed through a structured psychiatric interview, will also be assessed immediately following the intervention and at the 16-week follow-up assessment. Treatment adherence and retention will also be recorded throughout the intervention. Multilevel modeling will compare the intervention arm to the treatment-as-usual condition in terms of all continuous outcomes across the 9 measurement points. Logistic regression will be used to assess the occurrence of mood and anxiety disorders in the 2 treatment arms at the posttreatment assessment as well as at the 16-week follow-up. Sensitivity analyses will examine potential treatment moderators: membership in the LGBTQIA+ (lesbian, gay, bisexual, transgender, queer, intersex, and asexual) communities, baseline fertility quality of life, cultural background, disability status, and pursuit of conception through medical intervention. Results: We expect our intervention to be more effective than treatment-as-usual in improving all mental health parameters assessed and decreasing health care use related to both mental and reproductive health. Effects are expected to be larger with decreasing baseline quality of life and equally effective regardless of membership in the LGBTQIA+ communities, cultural background, or disability status. Conclusions: If our intervention is successful, this would suggest that it should be scaled up and made publicly available. The availability of this program would fill an important gap in light of the high rates of psychopathology among those experiencing infertility and considering the current lack of effective psychotherapy approaches for infertility. Trial Registration: Clinicaltrials.gov NCT06006936; https://classic.clinicaltrials.gov/ct2/show/NCT06006936 International Registered Report Identifier (IRRID): PRR1-10.2196/52662 UR - https://www.researchprotocols.org/2024/1/e52662 UR - http://dx.doi.org/10.2196/52662 UR - http://www.ncbi.nlm.nih.gov/pubmed/38236638 ID - info:doi/10.2196/52662 ER - TY - JOUR AU - Sirohi, Diksha AU - Ng, Man Cecilia Hoi AU - Bidargaddi, Niranjan AU - Slater, Helen AU - Parker, A. Melissa AU - Hull, Louise Mary AU - O'Hara, Rebecca PY - 2024/1/10 TI - High-Quality eHealth Websites for Information on Endometriosis: Systematic Search JO - J Med Internet Res SP - e48243 VL - 26 KW - digital health KW - endometriosis KW - eHealth websites KW - eHealth KW - pelvic pain KW - adenomyosis N2 - Background: eHealth websites are increasingly being used by community members to obtain information about endometriosis. Additionally, clinicians can use these websites to enhance their understanding of the condition and refer patients to these websites. However, poor-quality information can adversely impact users. Therefore, a critical evaluation is needed to assess and recommend high-quality endometriosis websites. Objective: This study aimed to evaluate the quality and provide recommendations for high-quality endometriosis eHealth websites for the community and clinicians. Methods: PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines informed 2 Google searches of international and Australian eHealth websites. The first search string used the terms ?endometriosis,? ?adenomyosis,? or ?pelvic pain,? whereas ?Australia? was added to the second search string. Only free eHealth websites in English were included. ENLIGHT, a validated tool, was used to assess the quality across 7 domains such as usability, visual design, user engagement, content, therapeutic persuasiveness, therapeutic alliance, and general subjective evaluation. Websites with a total score of 3.5 or more were classified as ?good? according to the ENLIGHT scoring system and are recommended as high-quality eHealth websites for information on endometriosis. Results: In total, 117 eHealth websites were screened, and 80 were included in the quality assessment. Four high-quality eHealth websites (ie, those that scored 3.5 or more) were identified (Endometriosis Australia Facebook Page, Endometriosis UK, National Action Plan for Endometriosis on EndoActive, and Adenomyosis by the Medical Republic). These websites provided easily understood, engaging, and accurate information. Adenomyosis by the Medical Republic can be used as a resource in clinical practice. Most eHealth websites scored well, 3.5 or more in the domains of usability (n=76, 95%), visual design (n=64, 80%), and content (n=63, 79%). However, of the 63 websites, only 25 provided references and 26 provided authorship details. Few eHealth websites scored well on user engagement (n=18, 23%), therapeutic persuasiveness (n=2, 3%), and therapeutic alliance (n=22, 28%). In total, 30 (38%) eHealth websites scored well on general subjective evaluation. Conclusions: Although geographical location can influence the search results, we identified 4 high-quality endometriosis eHealth websites that can be recommended to the endometriosis community and clinicians. To improve quality, eHealth websites must provide evidence-based information with appropriate referencing and authorship. Factors that enhance usability, visual design, user engagement, therapeutic persuasiveness, and therapeutic alliance can lead to the successful and long-term uptake of eHealth websites. User engagement, therapeutic persuasiveness, and therapeutic alliance can be strengthened by sharing lived experiences and personal stories and by cocreating meaningful content for both the community and clinicians. Reach and discoverability can be improved by leveraging search engine optimization tools. Trial Registration: PROSPERO CRD42020185475; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=185475&VersionID=2124365 UR - https://www.jmir.org/2024/1/e48243 UR - http://dx.doi.org/10.2196/48243 UR - http://www.ncbi.nlm.nih.gov/pubmed/38198205 ID - info:doi/10.2196/48243 ER - TY - JOUR AU - Gill, Roopan AU - Ogilvie, Gina AU - Norman, V. Wendy AU - Fitzsimmons, Brian AU - Maher, Ciana AU - Renner, Regina PY - 2024/1/9 TI - Feasibility and Acceptability of a Mobile Technology Intervention to Support Postabortion Care After Surgical Abortion (the FACTS Study Phase 3): Mixed Methods Prospective Pilot Study JO - JMIR Form Res SP - e46284 VL - 8 KW - mobile health KW - mHealth KW - digital health KW - abortion KW - human-centered design KW - sexual and reproductive health KW - qualitative research KW - mixed methods N2 - Background: In Canada, 1 in 3 women and people of gestational age undergo an abortion in their lifetime. Despite the liberal legal context, barriers continue to exist for women and people who can become pregnant to access this service. Objective: This study aims to (1) conduct a pilot study to demonstrate the feasibility and acceptability of myPostCare to support follow-up care after a procedural abortion; (2) use the findings to understand whether myPostCare has the potential to improve contraceptive behavior and knowledge, emotional well-being, and sexual health knowledge; and (3) develop a better understanding of how innovative mobile solutions can support integrative health programs in British Columbia with the goal of expanding to other sites across Canada. Methods: People of gestational age (aged 14-45 y) who underwent a procedural abortion were recruited from 2 urban abortion facilities in British Columbia. The participants completed a baseline quantitative survey and were provided access to myPostCare for up to 30 days. A follow-up quantitative survey was sent via email on day 30. Qualitative interviews were conducted to explore user satisfaction and usability of myPostCare. Responses to the survey questions were summarized using descriptive statistics, and the system usability scale (SUS) was scored according to the instructions. A secure analytics platform was implemented to obtain data on the overall use of the website by users. Qualitative analysis was conducted with NVivo using a thematic analysis approach. This study was approved by the Women?s and Children?s Research Ethics Board. Results: Overall, 62 participants were recruited (average age 30 y); 40% (25/62) of the participants completed the exit surveys, and 24% (6/25) consented to participate in the semistructured interviews; 40 participants had undergone an immediate postabortion intrauterine device (IUD) insertion, and 22 did not have an IUD inserted. Participants were satisfied with myPostCare. The SUS average score was 81.5 (SD 9.7; median 82.5, IQR 77.5-87.5), indicating high usability of the tool. Overall, 88% (22/25) of the participants changed their contraceptive method to an IUD. Web-based analytics demonstrated that there were 61 unique visitors to the site, and the top pages visited were Postprocedure Care, Emotional Well-Being, and Contraception Explorer. The longest time spent on the website was 56 minutes. The overall email open rate was 80%, with a click rate of 36%. Conclusions: This study demonstrates that communities and individuals are important collaborators in developing a mobile innovation that facilitates access to high-quality patient-centered abortion care. Through the cocreation process, a digital platform such as myPostCare highlighted a gap in abortion care in Canada, particularly around follow-up support after a procedural abortion. UR - https://formative.jmir.org/2024/1/e46284 UR - http://dx.doi.org/10.2196/46284 UR - http://www.ncbi.nlm.nih.gov/pubmed/38194252 ID - info:doi/10.2196/46284 ER - TY - JOUR AU - Yang, Ting AU - Wu, Yihan AU - Han, Nuo AU - Liu, Tianli PY - 2024/1/5 TI - Chinese Women?s Concept of Childbirth Based on the Social Media Topic ?What Does Childbirth Mean to a Woman?: Content and Thematic Analysis JO - JMIR Pediatr Parent SP - e50512 VL - 7 KW - childbirth willingness KW - social media KW - risk perception KW - childbirth cost KW - childbirth benefit N2 - Background: In recent years, women?s fertility desire has attracted increasing attention in China. Objective: This study aims to detect attitudes toward giving birth among young female users on Douban, a very popular Chinese social media platform. Methods: A total of 2634 valid posts from 2489 users discussing the topic ?What does childbirth mean to a woman? on Douban were crawled and retained for analysis. We utilized content and thematic analysis methods to capture users? concepts of childbirth. Results: The findings reveal that a significant majority of users conveyed generally neutral (1060/2634, 40.24%) or negative (1051/2634, 39.90%) attitudes toward childbirth, while only about one-fifth of users expressed positive (523/2634, 19.86%) sentiments. Notably, posts with negative attitudes garnered more replies and likes, and the proportion of posts expressing negativity exhibited fluctuations over time. Health risk (339/2634, 12.87%) emerged as the most frequently cited aspect of childbirth cost, with subjective happiness and the fulfillment of mental needs identified as primary benefits. Surprisingly, only a minimal number of posts (10/2634, 0.38%) touched upon the traditional objective benefits of raising children for old-age care. Thematic analysis results suggest that discussions about fertility on social media platforms might contribute to an exaggerated perception of health risks among women. Additionally, a lack of knowledge about childbirth was observed, partially attributable to longstanding neglect and avoidance of communication on these matters, likely influenced by traditional cultural biases. Moreover, there is a prevailing assumption that women should naturally sacrifice themselves for childbirth and childcare, influenced by the idealization of the female figure. Consequently, women may harbor hesitations about having a baby, fearing the potential loss of their own identity in the process. Conclusions: The results indicate a shift in the perception of childbirth among modern Chinese women over time, influenced by their increasing social status and the pursuit of self-realization. Implementing strategies such as public education on the health risks associated with pregnancy and delivery, safeguarding women?s rights, and creating a supportive environment for mothers may enhance women?s willingness to undergo childbirth. International Registered Report Identifier (IRRID): RR2-10.2196/preprints.50468 UR - https://pediatrics.jmir.org/2024/1/e50512 UR - http://dx.doi.org/10.2196/50512 UR - http://www.ncbi.nlm.nih.gov/pubmed/38180784 ID - info:doi/10.2196/50512 ER - TY - JOUR AU - Howell, Khadesia AU - Alvarado, Gabriela AU - Waymouth, Molly AU - Demirci, Jill AU - Rogers, Rhianna AU - Ray, Kristin AU - Uscher-Pines, Lori PY - 2023/12/29 TI - Acceptability of Telelactation Services for Breastfeeding Support Among Black Parents: Semistructured Interview Study JO - J Med Internet Res SP - e50191 VL - 25 KW - acceptance KW - barrier KW - black parent KW - black KW - breastfeeding KW - concordance KW - consultant KW - consultation KW - digital divide KW - digital equity KW - disparity KW - ethnic KW - health equity KW - lactation KW - mother KW - parent KW - racial KW - telehealth KW - telelactation KW - user N2 - Background: While breastfeeding rates have increased in the United States in recent years, racial and ethnic disparities persist. Telelactation may help reduce disparities by increasing access to lactation consultants, but there is limited research on acceptability among minoritized individuals. Objective: We aimed to explore experiences with telelactation among Black parents and identify strategies to make services more culturally appropriate. Methods: We selected 20 Black parents who were given access to telelactation services from an ongoing National Institutes of Health?funded randomized controlled trial (the Tele-MILC trial) to participate in semistructured interviews. Interviews addressed birth experiences, use and opinions about telelactation, comparison of telelactation to in-person lactation support, and recommendations to improve telelactation services. The thematic analysis was informed by a previously reported theoretical framework of acceptability and RAND Corporation?s equity-centered model. Results: Users appreciated the convenience of telelactation and reported that lactation consultants were knowledgeable and helpful. Participants wanted more options to engage with lactation consultants outside of video visits (eg, SMS text messaging and asynchronous resources). Users who had a lactation consultant of color mentioned that racial concordance improved the experience; however, few felt that racial concordance was needed for high-quality telelactation support. Conclusions: While Black parents in our sample found telelactation services to be acceptable, telelactation could not, in isolation, address the myriad barriers to long-duration breastfeeding. Several changes could be made to telelactation services to increase their use by minoritized populations. UR - https://www.jmir.org/2023/1/e50191 UR - http://dx.doi.org/10.2196/50191 UR - http://www.ncbi.nlm.nih.gov/pubmed/38157241 ID - info:doi/10.2196/50191 ER - TY - JOUR AU - Hao, Jie AU - Yang, Lin AU - Wang, Yaxin AU - Lan, Yushan AU - Xu, Xiaowei AU - Wang, Ziyang AU - Li, Zanmei AU - Ma, Liangkun AU - Li, Jiao AU - Zhang, Suhan AU - Sun, Yin PY - 2023/12/20 TI - Mobile Prenatal Education and Its Impact on Reducing Adverse Pregnancy Outcomes: Retrospective Real-World Study JO - JMIR Mhealth Uhealth SP - e46910 VL - 11 KW - adverse pregnancy outcome KW - mobile prenatal education KW - pregnancy KW - real-world study KW - retrospective study N2 - Background: Pregnancy is a pivotal phase in a woman?s life, demanding special attention to ensure maternal and fetal health. Prenatal education plays a vital role in promoting healthy pregnancies and reducing adverse outcomes for pregnant women. Mobile prenatal education programs have gained traction due to their accessibility and timeliness, especially in light of finite health care resources and the constraints imposed by the COVID-19 pandemic. Objective: This study aims to develop and evaluate the effectiveness of a mobile-based prenatal education program in improving pregnancy outcomes. Methods: We developed a mobile-based prenatal education curriculum in collaboration with a multidisciplinary maternal care team from Peking Union Medical College Hospital (PUMCH) in Beijing, China. Data were retrospectively collected from 1941 pregnant women who had registered for the PUMCH mobile prenatal education program and subsequently delivered at PUMCH between May 2021 and August 2022. The study compared pregnancy outcomes between the completing group, which were pregnant women who had completed at least 1 course, and the noncompleting group. We also analyzed differences among course topics within the completing group and assessed course topic popularity among pregnant women. Results: The PUMCH mobile prenatal education curriculum consists of 436 courses across 9 topics. Out of the participants, a total of 1521 did not complete any courses, while 420 completed at least 1 course. Compared with the noncompleting group, pregnant women who completed courses exhibited a significant reduction in the risk of gestational diabetes mellitus, induced abortion, postpartum infection, fetal intrauterine distress, and neonatal malformation. Among those in the completing group, a total of 86% (361/420) started course completion during the first and second trimesters. Furthermore, completing courses related to topics of pregnancy psychology and pregnancy nutrition was associated with reduced risks of premature rupture of membranes and small for gestational age infants, respectively. Pregnancy psychology and postpartum recovery were the preferred topics among pregnant women. Conclusions: The study demonstrates the potential of mobile-based prenatal education programs in improving pregnancy outcomes and supporting health care providers in delivering effective prenatal education. The rise of mobile prenatal education presents an opportunity to improve maternal and child health outcomes. Further research and broader implementation of such programs are warranted to continually improve maternal and child health. UR - https://mhealth.jmir.org/2023/1/e46910 UR - http://dx.doi.org/10.2196/46910 UR - http://www.ncbi.nlm.nih.gov/pubmed/38117555 ID - info:doi/10.2196/46910 ER - TY - JOUR AU - Chen, Xiaotian AU - Zhang, Yi AU - Chen, Hongyan AU - Dou, Yalan AU - Wang, Yin AU - He, Wennan AU - Ma, Xiaojing AU - Sheng, Wei AU - Yan, Weili AU - Huang, Guoying PY - 2023/12/12 TI - Association Between Serum Glycated Hemoglobin Levels at Early Gestation and the Risk of Subsequent Pregnancy Loss in Pregnant Women Without Diabetes Mellitus: Prospective Cohort Study JO - JMIR Public Health Surveill SP - e46986 VL - 9 KW - glycated hemoglobin KW - hemoglobin A1c KW - spontaneous pregnancy loss KW - gynecology KW - gynecological KW - obstetric KW - obstetrics KW - prospective cohort study KW - cohort KW - risk KW - risks KW - miscarriage KW - miscarriages KW - adverse outcome KW - adverse outcomes KW - risk ratio KW - pregnant women KW - pregnancy loss KW - gestational diabetes KW - fetal death KW - glycemic control KW - women KW - diabetes KW - diabetic KW - HbA1c KW - gestational KW - maternal KW - fetus KW - fetal KW - HbA1c levels KW - metabolic health KW - pregnant KW - pregnancy KW - association KW - associations KW - associated N2 - Background: As a severe morbidity during pregnancy, the etiology of spontaneous pregnancy loss (SPL) remains largely unknown. Serum glycated hemoglobin (HbA1c) level is an established predictor of SPL risk among women with diabetes, but little is known about whether such an association exists among pregnant women without diabetes when glycemic levels are within the normal range. Objective: This study aimed to quantify the association between maternal HbA1c levels in early pregnancy and subsequent SPL risk in a cohort of pregnant women without diabetes. Methods: This prospective cohort study involved 10,773 pregnant women without diabetes enrolled at their first antenatal care visit at a hospital?s early pregnancy clinic from March 2016 to December 2018 in Shanghai, China. HbA1c and fasting blood glucose (FBG) levels were examined at enrollment. Participants with diabetes before or pregnancy or those diagnosed with gestational diabetes were excluded. Diagnosis of SPL, defined as fetal death occurring before 28 gestational weeks, was derived from medical records and confirmed via telephone interviews. We used generalized linear models to quantify the associations of continuous and dichotomized maternal HbA1c levels with SPL risk and reported crude and adjusted risk ratios (RRs) and 95% CIs. A restricted cubic spline (RCS) regression model was used to assess the potential nonlinear dose-response relationship. Adjusted covariates included maternal age, education level, preconception BMI, gestational weeks, gravidity, history of adverse pregnancy outcomes, family history of diabetes, folic acid supplementation, and smoking and drinking during the periconception period. Results: In total, 273 (2.5%) SPL cases occurred. Every 0.5% increase in HbA1c levels was linearly associated with a 23% increase in SPL risk (adjusted RR [aRR] 1.23; 95% CI 1.01-1.50). The RCS model revealed that this association was linear (P=.77 for the nonlinearity test). Analyses based on dichotomized HbA1c levels showed a significantly increased risk of SPL when HbA1c levels were ?5.9% (aRR 1.67; 95% CI 0.67-3.67), and the significance threshold was ?5.6% (aRR 1.60; 95% CI 1.01-2.54). Sensitivity analyses showed similar results when including the participants with missing SPL records or HbA1c data. Linear associations of HbA1c levels remained significant even in the subgroups without overweight, alcohol consumption, and a family history of diabetes and adverse pregnancy outcomes. Every 1 mmol/L increment in maternal FBG levels was associated with a >2-fold higher risk of SPL (aRR 2.12; 95% CI 1.61-2.80; P<.001). Conclusions: Higher HbA1c levels in early pregnant women without diabetes are associated with an increased SPL risk in a dose-response manner. Pregnant women with an HbA1c level above 5.6% at early gestation need attention for its potentially increased risk for SPL. Our findings support the need to monitor HbA1c levels to identify individuals at high risk of subsequent SPL in the general population of pregnant women. Trial Registration: ClinicalTrials.gov NCT02737644; https://clinicaltrials.gov/study/NCT02737644 UR - https://publichealth.jmir.org/2023/1/e46986 UR - http://dx.doi.org/10.2196/46986 UR - http://www.ncbi.nlm.nih.gov/pubmed/38085559 ID - info:doi/10.2196/46986 ER - TY - JOUR AU - Shea, A. Amanda AU - Thornburg, Jonathan AU - Vitzthum, J. Virginia PY - 2023/12/1 TI - Assessment of App-Based Versus Conventional Survey Modalities for Reproductive Health Research in India, South Africa, and the United States: Comparative Cross-Sectional Study JO - JMIR Form Res SP - e44705 VL - 7 KW - mobile health KW - mHealth KW - femtech KW - reproductive health KW - menstrual health KW - sexual health KW - survey modalities KW - menstrual tracking app KW - India KW - South Africa KW - United States KW - mobile phone N2 - Background: There is a widely acknowledged global need for more research on reproductive health (including contraception, menstrual health, sexuality, and maternal morbidities) and its impact on overall well-being. However, several factors?notably, high costs, considerable effort, and the sensitivity of these topics?impede the collection of the necessary data, especially in less accessible and lower-income populations. The burgeoning ownership of smartphones and growing use of menstrual tracking apps (MTAs) may present an opportunity to conduct reproductive health research with fewer impediments than those associated with conventional survey methods. Objective: The main objective was to ascertain the feasibility, potential usefulness, and limitations of conducting reproductive health research using a mainstream MTA. Methods: In each of the 3 countries, we evaluated questionnaire responses from (1) current users of an MTA (Clue) and (2) participants surveyed using conventional survey modalities (in-person interviews, SMS text messaging, and web-based questionnaires). We compared these responses with published data collected from large nationally representative benchmark samples (the United States Census and the Demographic and Health Surveys for South Africa and India). Results: Given a sufficiently large user base, app-distributed surveys were able to quickly capture large samples on par with other methods and at low cost, with the additional advantage of being able to deploy remotely and simultaneously across countries. In each country, neither the app nor the conventional modality sample emerged as a consistently closer match to the distributions of the demographic attributes and the patterns of contraceptive use reported for the respective benchmark sample. Despite efforts to obtain representative samples, the conventional modality samples sometimes over- and other times underrepresented some subgroups (eg, underrepresentation of married persons in the United States and overrepresentation of rural residents in India). In all 3 countries, app users were younger, more educated, more likely to be urban residents, and more likely to use nonhormonal rather than hormonal contraceptive methods compared with the respective national benchmark. App users, compared with the conventional modality samples, consistently reported being more comfortable discussing their menstrual periods with other persons (eg, family, friends, and health care providers), suggesting that MTA users may be more likely to respond truthfully to questions on sensitive or taboo health topics. The app samples? consistency across countries regarding users? demographic profiles, contraceptive choices, and personal attitudes toward menstruation supports the validity of making cross-country comparisons of survey findings for a given app?s users. Conclusions: MTAs such as Clue can provide a quick, scalable, and cost-effective method for collecting health data, including on sensitive topics, across a wide variety of settings and countries. With expanding global access to technology and the increasing use of these tools, consumer MTAs can be a viable survey modality to strengthen reproductive health research. UR - https://formative.jmir.org/2023/1/e44705 UR - http://dx.doi.org/10.2196/44705 UR - http://www.ncbi.nlm.nih.gov/pubmed/38039064 ID - info:doi/10.2196/44705 ER - TY - JOUR AU - Ajayi, Toluwalase AU - Pawelek, Jeff AU - Bhargava, Hansa AU - Faksh, Arij AU - Radin, Jennifer PY - 2023/11/28 TI - Self-Reported Medication Use Across Racial and Rural or Urban Subgroups of People Who Are Pregnant in the United States: Decentralized App-Based Cohort Study JO - JMIR Form Res SP - e50867 VL - 7 KW - prenatal care KW - maternal health KW - digital study KW - underrepresented in biomedical research KW - pregnant KW - pregnancy KW - medications KW - vaccinations KW - vitamins N2 - Background: Maternal health outcomes have been underresearched due to people who are pregnant being underrepresented or excluded from studies based on their status as a vulnerable study population. Based on the available evidence, Black people who are pregnant have dramatically higher maternal morbidity and mortality rates compared to other racial and ethnic groups. However, insights into prenatal care?including the use of medications, immunizations, and prenatal vitamins?are not well understood for pregnant populations, particularly those that are underrepresented in biomedical research. Medication use has been particularly understudied in people who are pregnant; even though it has been shown that up to 95% of people who are pregnant take at least 1 or more medications. Understanding gaps in use could help identify ways to reduce maternal disparities and optimize maternal health outcomes. Objective: We aimed to characterize and compare the use of prenatal vitamins, immunizations, and commonly used over-the-counter and prescription medications among people who are pregnant, those self-identifying as Black versus non-Black, and those living in rural versus urban regions in the United States. Methods: We conducted a prospective, decentralized study of 4130 pregnant study participants who answered survey questionnaires using a mobile research app that was only available on iOS (Apple Inc) devices. All people who were pregnant, living in the United States, and comfortable with reading and writing in English were eligible. The study was conducted in a decentralized fashion with the use of a research app to facilitate enrollment using an eConsent and self-reported data collection. Results: Within the study population, the use of prenatal vitamins, antiemetics, antidepressants, and pain medication varied significantly among different subpopulations underrepresented in biomedical research. Black participants reported significantly lower frequencies of prenatal vitamin use compared to non-Black participants (P<.001). The frequency of participants who were currently receiving treatment for anxiety and depression was also lower among Black and rural groups compared to their non-Black and urban counterparts, respectively. There was significantly lower use of antidepressants (P=.002) and antiemetics (P=.02) among Black compared to non-Black participants. While prenatal vitamin use was lower among participants in rural areas, the difference between rural and urban groups did not reach statistical significance (P=.08). There were no significant differences in vaccine uptake for influenza or tetanus-diphtheria-pertussis (TDaP) across race, ethnicity, rural, or urban status. Conclusions: A prospective, decentralized app-based study demonstrated significantly lower use of prenatal vitamins, antiemetics, and antidepressants among Black pregnant participants. Additionally, significantly fewer Black and rural participants reported receiving treatment for anxiety and depression during pregnancy. Future research dedicated to identifying the root mechanisms of these differences can help improve maternal health outcomes, specifically for diverse communities. UR - https://formative.jmir.org/2023/1/e50867 UR - http://dx.doi.org/10.2196/50867 UR - http://www.ncbi.nlm.nih.gov/pubmed/38015604 ID - info:doi/10.2196/50867 ER - TY - JOUR AU - Mizubuti, B. Glenio AU - Ho, M-H Anthony AU - Phelan, Rachel AU - DuMerton, Deborah AU - Shelley, Jessica AU - Vowotor, Elorm AU - Xiong, Jessica AU - Smethurst, Bethany AU - McMullen, Michael AU - Hopman, M. Wilma AU - Martou, Glykeria AU - Edmunds, Wesley Robert AU - Tanzola, Robert PY - 2023/11/22 TI - Dobutamine and Goal-Directed Fluid Therapy for Improving Tissue Oxygenation in Deep Inferior Epigastric Perforator (DIEP) Flap Breast Reconstruction Surgery: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e48576 VL - 12 KW - breast cancer KW - breast cancer care KW - breast reconstruction KW - DIEP flap KW - dobutamine KW - epigastric perforator KW - implant-based surgery KW - flap surgery KW - flap oxygenation KW - fluid therapy KW - goal-directed therapy KW - oxygenation KW - perioperative care KW - tissue oxygenation KW - treatment algorithm N2 - Background: Breast reconstruction is an integral part of breast cancer care. There are 2 main types of breast reconstruction: alloplastic (using implants) and autologous (using the patient?s own tissue). The latter creates a more natural breast mound and avoids the long-term need for surgical revision?more often associated with implant-based surgery. The deep inferior epigastric perforator (DIEP) flap is considered the gold standard approach in autologous breast reconstruction. However, complications do occur with DIEP flap surgery and can stem from poor flap tissue perfusion/oxygenation. Hence, the development of strategies to enhance flap perfusion (eg, goal-directed perioperative fluid therapy) is essential. Current perioperative fluid therapy is traditionally guided by subjective criteria, which leads to wide variations in clinical practice. Objective: The main objective of this trial is to determine whether the use of minimally invasive cardiac output (CO) monitoring for guiding intravenous fluid administration, combined with low-dose dobutamine infusion (via a treatment algorithm), will increase tissue oxygenation in patients undergoing DIEP flap surgery. Methods: With appropriate institutional ethics board and Health Canada approval, patients undergoing DIEP flap surgery are randomly assigned to receive CO monitoring for the guidance of intraoperative fluid therapy in addition to a low-dose dobutamine infusion (which potentially improves flap oxygenation) versus the current standard of care. The primary outcome is tissue oxygenation measured via near-infrared spectroscopy at the perfusion zone furthest from the perforator vessels 45 minutes after vascular reanastomosis of the DIEP flap. Low dose (2.5 ?g/kg/hr) dobutamine infusion continues for up to 4 hours postoperatively, provided there are no associated complications (ie, persistent tachycardia). Flap oxygenation, hemodynamic parameters, and any medication-associated side effects/complications are monitored for up to 48 hours postoperatively. Complications, rehospitalizations, and patient satisfaction are also collected until 30 days postoperatively. Results: Funding and regulatory approvals were obtained in 2019, but the study recruitment was interrupted by the COVID-19 pandemic. As of October 4, 2023, 34 participants have been recruited. Because of the significant delays associated with the pandemic, the expected completion date was extended. We expect the study to be completed and ready for potential news release (as appropriate) and publication by July 2024. No patients have suffered any adverse effects/complications from participating in this study, and none have been lost to follow-up. Conclusions: CO-directed fluid therapy in combination with a low-dose dobutamine infusion via a treatment algorithm has the potential to improve DIEP flap tissue oxygenation and reduce complications following DIEP flap breast reconstruction surgery. However, given that the investigators remain blinded to group randomization, no comment can be made regarding the efficacy of this intervention for improving tissue oxygenation at this time. Nevertheless, no patients have been withdrawn for safety concerns thus far, and compliance remains high. Trial Registration: Clinicaltrials.gov NCT04020172; https://clinicaltrials.gov/study/NCT04020172 UR - https://www.researchprotocols.org/2023/1/e48576 UR - http://dx.doi.org/10.2196/48576 UR - http://www.ncbi.nlm.nih.gov/pubmed/37991835 ID - info:doi/10.2196/48576 ER - TY - JOUR AU - Ghadirian, Ziba Mona AU - Omer, Khalid AU - Cockcroft, Anne PY - 2023/11/17 TI - Determinants of Adolescent Sexual and Reproductive Health in Sub-Saharan Africa: Protocol for an Umbrella Review JO - JMIR Res Protoc SP - e51278 VL - 12 KW - adolescents KW - youth KW - sexual health KW - reproductive health KW - sexually transmitted infections KW - pregnancy KW - sub-Saharan Africa N2 - Background: Adolescents are a large proportion of the population in sub-Saharan Africa and face multiple risks to their health and well-being. Prior systematic reviews have focused on specific adolescent sexual and reproductive health outcomes such as teen pregnancies, HIV/AIDS, and sexually transmitted diseases. A comprehensive synthesis of the influential factors that shape different aspects of adolescent sexual and reproductive health can inform health policy and program development for this important segment of the population. Objective: This paper presents the protocol for an umbrella review that aims to synthesize the existing knowledge in the literature on the associations among individual, family, and societal factors and sexual and reproductive health outcomes among adolescents in sub-Saharan Africa. Methods: We will include systematic reviews that identify factors associated with sexual and reproductive health outcomes among adolescents, 10-19 years of age, in sub-Saharan Africa. Reviews can include quantitative and qualitative primary studies with or without meta-analysis. Academic and gray literature searches will identify reviews from PubMed, Scopus, CINAHL, Cochrane Database of Systematic Reviews, ProQuest, Google, and Google Scholar. Two reviewers (MZG and KO) will independently carry out title, abstract, and full text screening, assess methodological quality, and extract data. We will assess the methodological quality of the included studies using the Joanna Briggs Institute standard forms. The review will present findings in narrative form and in tables and will follow PRISMA (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Results: A preliminary search in April 2023 found 1351 articles to be screened. Conclusions: This umbrella review will permit a comprehensive and high-level understanding of the various factors that influence adolescent sexual and reproductive health in sub-Saharan Africa. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023394512; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=394512 International Registered Report Identifier (IRRID): DERR1-10.2196/51278 UR - https://www.researchprotocols.org/2023/1/e51278 UR - http://dx.doi.org/10.2196/51278 UR - http://www.ncbi.nlm.nih.gov/pubmed/37976499 ID - info:doi/10.2196/51278 ER - TY - JOUR AU - Ciolfi Felice, Marianela AU - Søndergaard, Juul Marie Louise AU - Balaam, Madeline PY - 2023/11/14 TI - Analyzing User Reviews of the First Digital Contraceptive: Mixed Methods Study JO - J Med Internet Res SP - e47131 VL - 25 KW - digital contraception KW - reproductive health KW - digital health KW - women?s health KW - intimate health KW - computational methods KW - natural language processing KW - NLP KW - user experience KW - health informatics N2 - Background: People in Western countries are increasingly rejecting hormone-based birth control and expressing a preference for hormone-free methods. Digital contraceptives have emerged as nonhormonal medical devices that make use of self-tracked data and algorithms to find a user?s fertile window. However, there is little knowledge about how people experience this seemingly new form of contraception, whose failure may result in unwanted pregnancies, high health risks, and life-changing consequences. As digital contraception becomes more widely adopted, examining its user experience is crucial to inform the design of technologies that not only are medically effective but also meet users? preferences and needs. Objective: We examined the user experience offered by Natural Cycles?the first digital contraceptive?through an analysis of app reviews written by its users worldwide. Methods: We conducted a mixed methods analysis of 3265 publicly available reviews written in English by users of Natural Cycles on the Google Play Store. We combined computational and human techniques, namely, topic modeling and reflexive thematic analysis. Results: For some users of digital contraception, the hormone-free aspect of the experience can be more salient than its digital aspect. Cultivating self-knowledge through the use of the technology can, in turn, feel empowering. Users also pointed to an algorithmic component that allows for increased accuracy over time as long as user diligence is applied. The interactivity of the digital contraceptive supports mutual learning and is experienced as agential and rewarding. Finally, a digital contraceptive can facilitate sharing the burden of contraceptive practices or highlight single-sided responsibilities while creating points of friction in the required daily routines. Conclusions: Digital contraception is experienced by users as a tamed natural approach?a natural method contained and regulated by science and technology. This means that users can experience a method based on a digital product as ?natural,? which positions digital contraceptives as a suitable option for people looking for evidence-based nonhormonal contraceptive methods. We point to interactivity as core to the user experience and highlight that a digital contraceptive might allow for collaboration between partners around contraceptive practices and responsibilities. We note that the user diligence required for the digital contraceptive to provide accurate and frequent data is sometimes not enough. Future research could look at designing (and redesigning) digital contraceptives with primary users and intimate partners, enhancing the experience of tamed naturalness; exploring how trust fluctuates among involved actors and in interactions with the technology; and, ultimately, designing more inclusive approaches to digital contraception. UR - https://www.jmir.org/2023/1/e47131 UR - http://dx.doi.org/10.2196/47131 UR - http://www.ncbi.nlm.nih.gov/pubmed/37962925 ID - info:doi/10.2196/47131 ER - TY - JOUR AU - Adnan, Tatheer AU - Li, Huichu AU - Peer, Komal AU - Peebles, Elizabeth AU - James, Kaitlyn AU - Mahalingaiah, Shruthi PY - 2023/10/27 TI - Evaluation of Menstrual Cycle Tracking Behaviors in the Ovulation and Menstruation Health Pilot Study: Cross-Sectional Study JO - J Med Internet Res SP - e42164 VL - 25 KW - reproductive informatics KW - menstrual health tracking apps KW - digital epidemiology KW - women's health KW - mobile health KW - mHealth KW - gynecology KW - health application KW - tracking health app KW - menstrual health KW - reproductive health N2 - Background: Menstrual cycle tracking apps (MCTAs) have potential in epidemiological studies of women?s health, facilitating real-time tracking of bleeding days and menstrual-associated signs and symptoms. However, information regarding the characteristics of MCTA users versus cycle nontrackers is limited, which may inform generalizability. Objective: We compared characteristics among individuals using MCTAs (app users), individuals who do not track their cycles (nontrackers), and those who used other forms of menstrual tracking (other trackers). Methods: The Ovulation and Menstruation Health Pilot Study tested the feasibility of a digitally enabled evaluation of menstrual health. Recruitment occurred between September 2017 and March 2018. Menstrual cycle tracking behavior, demographic, and general and reproductive health history data were collected from eligible individuals (females aged 18-45 years, comfortable communicating in English). Menstrual cycle tracking behavior was categorized in 3 ways: menstrual cycle tracking via app usage, that via other methods, and nontracking. Demographic factors, health conditions, and menstrual cycle characteristics were compared across the menstrual tracking method (app users vs nontrackers, app users vs other trackers, and other trackers vs nontrackers) were assessed using chi-square or Fisher exact tests. Results: In total, 263 participants met the eligibility criteria and completed the digital survey. Most of the cohort (n=191, 72.6%) was 18-29 years old, predominantly White (n=170, 64.6%), had attained 4 years of college education or higher (n= 209, 79.5%), and had a household income below US $50,000 (n=123, 46.8%). Among all participants, 103 (39%) were MCTA users (app users), 97 (37%) did not engage in any tracking (nontrackers), and 63 (24%) used other forms of tracking (other trackers). Across all groups, no meaningful differences existed in race and ethnicity, household income, and education level. The proportion of ever-use of hormonal contraceptives was lower (n=74, 71.8% vs n=87, 90%, P=.001), lifetime smoking status was lower (n=6, 6% vs n=15, 17%, P=.04), and diagnosis rate of gastrointestinal reflux disease (GERD) was higher (n=25, 24.3% vs n=12, 12.4%, P=.04) in app users than in nontrackers. The proportions of hormonal contraceptives ever used and lifetime smoking status were both lower (n=74, 71.8% vs n=56, 88.9%, P=.01; n=6, 6% vs n=11, 17.5%, P=.02) in app users than in other trackers. Other trackers had lower proportions of ever-use of hormonal contraceptives (n=130, 78.3% vs n=87, 89.7%, P=.02) and higher diagnostic rates of heartburn or GERD (n=39, 23.5% vs n=12, 12.4%, P.03) and anxiety or panic disorder (n=64, 38.6% vs n=25, 25.8%, P=.04) than nontrackers. Menstrual cycle characteristics did not differ across all groups. Conclusions: Our results suggest that app users, other trackers, and nontrackers are largely comparable in demographic and menstrual cycle characteristics. Future studies should determine reasons for tracking and tracking-related behaviors to further understand whether individuals who use MCTAs are comparable to nontrackers. UR - https://www.jmir.org/2023/1/e42164 UR - http://dx.doi.org/10.2196/42164 UR - http://www.ncbi.nlm.nih.gov/pubmed/37889545 ID - info:doi/10.2196/42164 ER - TY - JOUR AU - Davis, A. Jacqueline AU - Ohan, L. Jeneva AU - Gregory, Sonia AU - Kottampally, Keerthi AU - Silva, Desiree AU - Prescott, L. Susan AU - Finlay-Jones, L. Amy PY - 2023/10/17 TI - Perinatal Women?s Perspectives of, and Engagement in, Digital Emotional Well-Being Training: Mixed Methods Study JO - J Med Internet Res SP - e46852 VL - 25 KW - perinatal KW - digital mental health interventions KW - well-being KW - mindfulness KW - self-compassion KW - engagement KW - ORIGINS N2 - Background: Psychological distress in the early postpartum period can have long-lasting deleterious effects on a mother?s well-being and negatively affect her infant?s development. Intervention approaches based in contemplative practices such as mindfulness and loving-kindness and compassion are intended to alleviate distress and cultivate well-being and can be delivered effectively as digital mental health interventions (DMHIs). Objective: To understand the feasibility of engaging perinatal women in digital interventions, this study aimed to document participants? experiences in the Mums Minds Matter (MMM) study, a pilot randomized controlled trial comparing mindfulness, loving-kindness and compassion, and progressive muscle relaxation training delivered in a digital format and undertaken during pregnancy. To assess the different stages of engagement during and after the intervention, we adapted the connect, attend, participate, enact (CAPE) framework that is based on the idea that individuals go through different stages of engagement before they are able to enact change. Methods: The MMM study was nested within a longitudinal birth cohort, The ORIGINS Project. We aimed to recruit 25 participants per randomization arm. Data were collected sequentially during the intervention through regular web-based surveys over 8 weeks, with opportunities to provide regular feedback. In the postintervention phase, qualitative data were collected through purposive sampling. Results: Of 310 eligible women, 84 (27.1% [connect rate]) enrolled to participate in MMM. Of the remaining 226 women who did not proceed to randomization, 223 (98.7%) failed to complete the baseline surveys and timed out of eligibility (after 30 weeks? gestation), and 3 (1.3%) displayed high psychological distress scores. Across all program groups, 17 (20% [attend rate]) of the 84 participants actively opted out, although more may have disengaged from the intervention but did not withdraw. The main reasons for withdrawal were busy life and other priorities. In this study, we assessed active engagement and ongoing skills use (participate and enact) through postintervention interviews. We undertook 15 participant interviews, conducted 1 month to 3 months after the intervention. Our results provide insights into participant barriers and enablers as well as app changes, such as the ability to choose topics, daily reminders, case studies, and diversity in sounds. Implementing a DMHI that is brief, includes frequent prompts or nudges, and is easily accessible is a key strategy to target perinatal women. Conclusions: Our research will enable future app designs that are sufficiently nuanced to maximize the uptake, engagement, and application of mental health skills and contemplative practices in the perinatal period. Providing convenient access to engaging and effective prevention programs is critical and should be part of prenatal self-care. Our research underscores the appeal and feasibility of digital intervention approaches based in contemplative practices for perinatal women. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) 12620000672954p; https://anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12620000672954p International Registered Report Identifier (IRRID): RR2-10.2196/19803 UR - https://www.jmir.org/2023/1/e46852 UR - http://dx.doi.org/10.2196/46852 UR - http://www.ncbi.nlm.nih.gov/pubmed/37847537 ID - info:doi/10.2196/46852 ER - TY - JOUR AU - Kabukye, K. Johnblack AU - Namugga, Jane AU - Mpamani, Jackson Collins AU - Katumba, Andrew AU - Nakatumba-Nabende, Joyce AU - Nabuuma, Hanifa AU - Musoke, Senkomago Stephen AU - Nankya, Esther AU - Soomre, Edna AU - Nakisige, Carolyn AU - Orem, Jackson PY - 2023/10/2 TI - Implementing Smartphone-Based Telemedicine for Cervical Cancer Screening in Uganda: Qualitative Study of Stakeholders? Perceptions JO - J Med Internet Res SP - e45132 VL - 25 KW - telemedicine KW - cervical cancer KW - screening KW - visual inspection with acetic acid KW - cervicography KW - Uganda KW - digital health N2 - Background: In Uganda, cervical cancer (CaCx) is the commonest cancer, accounting for 35.7% of all cancer cases in women. The rates of human papillomavirus vaccination and CaCx screening remain low. Digital health tools and interventions have the potential to improve different aspects of CaCx screening and control in Uganda. Objective: This study aimed to describe stakeholders? perceptions of the telemedicine system we developed to improve CaCx screening in Uganda. Methods: We developed and implemented a smartphone-based telemedicine system for capturing and sharing cervical images and other clinical data, as well as an artificial intelligence model for automatic analysis of images. We conducted focus group discussions with health workers at the screening clinics (n=27) and women undergoing screening (n=15) to explore their perceptions of the system. The focus group discussions were supplemented with field observations and an evaluation survey of the health workers on system usability and the overall project. Results: In general, both patients and health workers had positive opinions about the system. Highlighted benefits included better cervical visualization, the ability to obtain a second opinion, improved communication between nurses and patients (to explain screening findings), improved clinical data management, performance monitoring and feedback, and modernization of screening service. However, there were also some negative perceptions. For example, some health workers felt the system is time-consuming, especially when it had just been introduced, while some patients were apprehensive about cervical image capture and sharing. Finally, commonplace challenges in digital health (eg, lack of interoperability and problems with sustainability) and challenges in cancer screening in general (eg, arduous referrals, inadequate monitoring and quality control) also resurfaced. Conclusions: This study demonstrates the feasibility and value of digital health tools in CaCx screening in Uganda, particularly with regard to improving patient experience and the quality of screening services. It also provides examples of potential limitations that must be addressed for successful implementation. UR - https://www.jmir.org/2023/1/e45132 UR - http://dx.doi.org/10.2196/45132 UR - http://www.ncbi.nlm.nih.gov/pubmed/37782541 ID - info:doi/10.2196/45132 ER - TY - JOUR AU - Uhawenimana, Claudien Thierry AU - Musabwasoni, Sandra Marie Grace AU - Nsengiyumva, Richard AU - Mukamana, Donatilla PY - 2023/9/27 TI - Sexuality and Sexual and Reproductive Health Depiction in Social Media: Content Analysis of Kinyarwanda YouTube Channels JO - J Med Internet Res SP - e46488 VL - 25 KW - sexuality KW - sexual and reproductive health KW - Kinyarwanda YouTube channels KW - content analysis KW - social media KW - media platform KW - COVID-19 N2 - Background: Social media platforms such as YouTube can be used to educate people of reproductive age about healthy and nonrisky sexual and reproductive health (SRH) practices and behaviors. However, there is a paucity of evidence to ascertain the authenticity of sexuality and SRH content on Kinyarwanda YouTube, making it difficult to determine the extent to which these topics are covered, the characteristics of available videos, and the themes covered by these videos. Objective: The aims of this study were (1) to determine the extent to which YouTube channels in Kinyarwanda-language videos address sexuality and SRH issues, identify the general characteristics of the available videos (type of video, when published, intention for the audience, and content focus), and the aspects of sexuality and SRH covered; and (2) to identify the themes covered by retrieved Kinyarwanda videos, and the extent to which the channels have been used to communicate issues of sexuality and SRH during the COVID-19 pandemic. Methods: Using a content analysis approach, we searched Kinyarwanda YouTube channels to analyze videos about sexuality and SRH. The adopted framework for data collection from social media platforms builds on three key steps: (1) development, (2) application, and (3) assessment of search filters. To be included, an audio and/or visual video had to be in Kinyarwanda and the video had to be directed to the general public. Descriptive statistics (frequency and percentages) were computed to characterize the basic characteristics of retrieved channels, portrayal of the videos, and presentation of sexuality and SRH themes that emerged from retrieved videos. Further analysis involved cross-tabulations to explore associations between the focus of the channel and the date when the channel was opened and the focus of the channel and who was involved in the video. Results: The YouTube search retrieved 21,506 videos that tackled sexuality and SRH topics. During the COVID-19 pandemic, there was a 4-fold increase (from 7.2% to 30.6%) in channels that solely focused on sexually explicit content. The majority of the 1369 retrieved channels (n=1150, 84.0%) tackled the topic of sexuality, with sexually explicit content predominantly found in the majority of these videos (n=1082, 79%), and only 16% (n=287) of the videos covered SRH topics. Conclusions: This is the first study to analyze the use of YouTube in communicating about sexuality and SRH in the Kinyarwanda language. This study relied on videos that appeared online. Further research should gather information about who accesses the videos, and how channel owners and individuals involved in the videos perceive the impact of their videos on the Rwandan community?s sexuality and SRH. UR - https://www.jmir.org/2023/1/e46488 UR - http://dx.doi.org/10.2196/46488 UR - http://www.ncbi.nlm.nih.gov/pubmed/37756040 ID - info:doi/10.2196/46488 ER - TY - JOUR AU - Cheung, Wang Ka AU - Au, Sin-Tung Tiffany AU - Wai, On Joan Kar AU - Seto, Tin-Yan Mimi PY - 2023/9/19 TI - Perceptions and Challenges of Telehealth Obstetric Clinics Among Pregnant Women in Hong Kong: Cross-Sectional Questionnaire Study JO - J Med Internet Res SP - e46663 VL - 25 KW - delivery KW - digital KW - portable electronic applications KW - smartphone KW - pregnancy KW - virtual clinics KW - telehealth KW - telemedicine N2 - Background: Integrating telehealth in an obstetric care model is important to prepare for possible infection outbreaks that require social distancing and limit in-person consultations. To ensure the successful implementation of obstetric telehealth in Hong Kong, it is essential to understand and address pregnant women?s concerns. Objective: This study aimed to assess pregnant women?s attitudes, concerns, and perceptions regarding telehealth obstetric clinic services in Hong Kong. Methods: We conducted a prospective cross-sectional questionnaire study at Queen Mary Hospital between November 2021 and August 2022. Utilizing a 5-point rating scale, the questionnaire aimed to capture pregnant women?s preferences, expectations, feasibility perceptions, and privacy concerns related to telehealth clinic services. We used statistical analyses, including chi-square tests and multinomial logistic regression, to compare questionnaire responses and investigate the association between advancing gestation and attitudes toward telehealth clinics. Results: The study included 664 participants distributed across different pregnancy stages: 269 (40.5%) before 18 gestational weeks, 198 (29.8%) between 24 and 31 weeks, and 197 (29.7%) after delivery. Among them, 49.8% (329/664) favored face-to-face consultations over telehealth clinics, and only 7.3% (48/664) believed the opposite. Additionally, 24.2% (161/664) agreed that telehealth clinics should be launched for obstetric services. However, the overall preference for telehealth clinics was <20% for routine prenatal checkups (81/664, 12.2%) and addressing pregnancy-related concerns, such as vaginal bleeding (76/664, 11.5%), vaginal discharge (128/664, 19.4%), reduced fetal movement (64/664, 9.7%), uterine contractions (62/664, 9.4%), and suspected leakage of amniotic fluid (54/664, 8.2%). Conversely, 76.4% (507/664) preferred telehealth clinics to in-person visits for prenatal education talks, prenatal and postpartum exercise, and addressing breastfeeding problems. Participants were more comfortable with telehealth clinic tasks for tasks like explaining pregnancy exam results (418/664, 63.1%), self-administering urinary dipsticks at home (373/664, 56.4%), medical history-taking (341/664, 51.5%), and self-monitoring blood pressure using an electronic machine (282/664, 42.8%). %). During the postpartum period, compared to before 18 weeks of gestation, significantly more participants agreed that telehealth clinics could be an option for assessing physical symptoms such as vaginal bleeding (aOR 2.105, 95% CI 1.448-3.059), reduced fetal movement (aOR 1.575, 95% CI 1.058-2.345), uterine contractions (aOR 2.906, 95% CI 1.945-4.342), suspected leakage of amniotic fluid (aOR 2.609, 95% CI 1.721-3.954), fever (aOR 1.526, 95% CI 1.109-2.100), and flu-like symptoms (aOR 1.412, 95% CI 1.030-1.936). They were also more confident with measuring the symphysis-fundal height, arranging further investigations, and making diagnoses with the doctor via the telehealth clinic. The main perceived public health advantage of telehealth clinics was the shorter traveling and waiting time (526/664, 79.2%), while the main concern was legal issues from wrong diagnosis and treatment (511/664, 77.4%). Conclusions: Face-to-face consultation remained the preferred mode of consultation among the participants. However, telehealth clinics could be an alternative for services that do not require physical examination or contact. An increased acceptance of and confidence in telehealth was found with advancing gestation and after delivery. Enforcing stricter laws and guidelines could facilitate the implementation of telehealth clinics and increase confidence in their use among pregnant women for obstetric care. UR - https://www.jmir.org/2023/1/e46663 UR - http://dx.doi.org/10.2196/46663 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725425 ID - info:doi/10.2196/46663 ER - TY - JOUR AU - Malhotra, Kashish AU - Kempegowda, Punith PY - 2023/9/11 TI - Appraising Unmet Needs and Misinformation Spread About Polycystic Ovary Syndrome in 85,872 YouTube Comments Over 12 Years: Big Data Infodemiology Study JO - J Med Internet Res SP - e49220 VL - 25 KW - polycystic ovary syndrome KW - PCOS KW - public KW - YouTube KW - global health KW - online trends KW - global equity KW - infodemiology KW - big data KW - comments KW - sentiment KW - network analysis KW - contextualization KW - word association KW - misinformation KW - endocrinopathy KW - women KW - gender KW - users KW - treatment KW - fatigue KW - pain KW - motherhood N2 - Background: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy in women, resulting in substantial burden related to metabolic, reproductive, and psychological complications. While attempts have been made to understand the themes and sentiments of the public regarding PCOS at the local and regional levels, no study has explored worldwide views, mainly due to financial and logistical limitations. YouTube is one of the largest sources of health-related information, where many visitors share their views as questions or comments. These can be used as a surrogate to understand the public?s perceptions. Objective: We analyzed the comments of all videos related to PCOS published on YouTube from May 2011 to April 2023 and identified trends over time in the comments, their context, associated themes, gender-based differences, and underlying sentiments. Methods: After extracting all the comments using the YouTube application programming interface, we contextually studied the keywords and analyzed gender differences using the Benjamini-Hochberg procedure. We applied a multidimensional approach to analyzing the content via association mining using Mozdeh. We performed network analysis to study associated themes using the Fruchterman-Reingold algorithm and then manually screened the comments for content analysis. The sentiments associated with YouTube comments were analyzed using SentiStrength. Results: A total of 85,872 comments from 940 PCOS videos on YouTube were extracted. We identified a specific gender for 13,106 comments. Of these, 1506 were matched to male users (11.5%), and 11,601 comments to female users (88.5%). Keywords including diagnosing PCOS, symptoms of PCOS, pills for PCOS (medication), and pregnancy were significantly associated with female users. Keywords such as herbal treatment, natural treatment, curing PCOS, and online searches were significantly associated with male users. The key themes associated with female users were symptoms of PCOS, positive personal experiences (themes such as helpful and love), negative personal experiences (fatigue and pain), motherhood (infertility and trying to conceive), self-diagnosis, and use of professional terminology detailing their journey. The key themes associated with male users were misinformation regarding the ?cure? for PCOS, using natural and herbal remedies to cure PCOS, fake testimonies from spammers selling their courses and consultations, finding treatment for PCOS, and sharing perspectives of female family members. The overall average positive sentiment was 1.6651 (95% CI 1.6593-1.6709), and the average negative sentiment was 1.4742 (95% CI 1.4683-1.4802) with a net positive difference of 0.1909. Conclusions: There may be a disparity in views on PCOS between women and men, with the latter associated with non?evidence-based approaches and misinformation. The improving sentiment noticed with YouTube comments may reflect better health care services. Prioritizing and promoting evidence-based care and disseminating pragmatic online coverage is warranted to improve public sentiment and limit misinformation spread. UR - https://www.jmir.org/2023/1/e49220 UR - http://dx.doi.org/10.2196/49220 UR - http://www.ncbi.nlm.nih.gov/pubmed/37695666 ID - info:doi/10.2196/49220 ER - TY - JOUR AU - Lanssens, Dorien AU - Vandenberk, Thijs AU - Storms, Valerie AU - Thijs, Inge AU - Grieten, Lars AU - Bamelis, Lotte AU - Gyselaers, Wilfried AU - Tang, Eileen AU - Luyten, Patrick PY - 2023/9/6 TI - Changes in Intrapersonal Factors of Participants in the Pregnancy Remote Monitoring Study Who Are at Risk for Pregnancy-Induced Hypertension: Descriptive Quantitative Study JO - J Med Internet Res SP - e42686 VL - 25 KW - intrapersonal factors KW - peripartum period KW - pregnancy KW - pregnancy-induced hypertension KW - remote monitoring N2 - Background: The peripartum period, defined as the period from the beginning of the gestation until 1 year after the delivery, has long been shown to be potentially associated with increased levels of stress and anxiety with regard to one?s transition to the status of parent and the accompanying parental tasks. Yet, no research to date has investigated changes in intrapersonal factors during the peripartum period in women at risk for pregnancy-induced hypertension (PIH). Objective: The aim of this study is to explore and describe changes in intrapersonal factors in participants at risk for PIH. Methods: We used an explorative design in which 3 questionnaires were sent by email to 110 participants the day following enrollment in the Pregnancy Remote Monitoring program for pregnant women at risk for PIH. Women were invited to complete the questionnaires at the beginning of their participation in the Pregnancy Remote Monitoring project (mostly at 14 weeks of gestation) and after approaching 32 weeks of gestational age (GA). The Generalized Anxiety Disorder-7 Scale (GAD-7) and the Patient Health Questionnaire-9 were used to assess anxiety and depression, and adaptation of the Pain Catastrophizing Scale was used to measure trait pain catastrophizing. Results: Scores were significantly higher at 32 weeks of GA than at the moment of enrollment (GAD-7 score=7, range 4-11 vs 5, range 3-8; P=.01; and Patient Health Questionnaire-9 score=6, range 4-10 vs 4, range 2-7; P<.001). The subscale scores of the Pain Catastrophizing Scale were all lower at 32 weeks of GA compared with 14 weeks of GA (rumination: 4, range 1-6 vs 5, range 2-9.5; P=.11; magnification: 3, range 1-5.5 vs 4, range 3-7; P=.04; and helplessness: 5, range 2-9 vs 6, range 3.5-12; P=.06). The proportion of women with a risk for depression (GAD-7 score >10) was 13.3% (10/75) at enrollment and had increased to 35.6% (26/75) at 32 weeks of GA. Conclusions: This study shows that pregnant women at risk for PIH have higher levels of stress and anxiety at 32 weeks of GA than at the moment of enrollment. Further research is recommended to investigate potential strategies to help pregnant women at risk for PIH manage feelings of stress and anxiety. Trial Registration: ClinicalTrials.gov NCT03246737; https://clinicaltrials.gov/study/NCT03246737 UR - https://www.jmir.org/2023/1/e42686 UR - http://dx.doi.org/10.2196/42686 UR - http://www.ncbi.nlm.nih.gov/pubmed/37672324 ID - info:doi/10.2196/42686 ER - TY - JOUR AU - Zhang, Jiayuan AU - Xu, Wei AU - Lei, Cheng AU - Pu, Yang AU - Zhang, Yubo AU - Zhang, Jingyu AU - Yu, Hongfan AU - Su, Xueyao AU - Huang, Yanyan AU - Gong, Ruoyan AU - Zhang, Lijun AU - Shi, Qiuling PY - 2023/9/1 TI - Using Clinician-Patient WeChat Group Communication Data to Identify Symptom Burdens in Patients With Uterine Fibroids Under Focused Ultrasound Ablation Surgery Treatment: Qualitative Study JO - JMIR Form Res SP - e43995 VL - 7 KW - social media KW - group chats KW - text mining KW - free texts KW - symptom burdens KW - WeChat KW - natural language processing KW - NLP N2 - Background: Unlike research project?based health data collection (questionnaires and interviews), social media platforms allow patients to freely discuss their health status and obtain peer support. Previous literature has pointed out that both public and private social platforms can serve as data sources for analysis. Objective: This study aimed to use natural language processing (NLP) techniques to identify concerns regarding the postoperative quality of life and symptom burdens in patients with uterine fibroids after focused ultrasound ablation surgery. Methods: Screenshots taken from clinician-patient WeChat groups were converted into free texts using image text recognition technology and used as the research object of this study. From 408 patients diagnosed with uterine fibroids in Chongqing Haifu Hospital between 2010 and 2020, we searched for symptom burdens in over 900,000 words of WeChat group chats. We first built a corpus of symptoms by manually coding 30% of the WeChat texts and then used regular expressions in Python to crawl symptom information from the remaining texts based on this corpus. We compared the results with a manual review (gold standard) of the same records. Finally, we analyzed the relationship between the population baseline data and conceptual symptoms; quantitative and qualitative results were examined. Results: A total of 408 patients with uterine fibroids were included in the study; 190,000 words of free text were obtained after data cleaning. The mean age of the patients was 39.94 (SD 6.81) years, and their mean BMI was 22.18 (SD 2.78) kg/m2. The median reporting times of the 7 major symptoms were 21, 26, 57, 2, 18, 30, and 49 days. Logistic regression models identified preoperative menstrual duration (odds ratio [OR] 1.14, 95% CI 5.86-6.37; P=.009), age of menophania (OR ?1.02 , 95% CI 11.96-13.47; P=.03), and the number (OR 2.34, 95% CI 1.45-1.83; P=.04) and size of fibroids (OR 0.12, 95% CI 2.43-3.51; P=.04) as significant risk factors for postoperative symptoms. Conclusions: Unstructured free texts from social media platforms extracted by NLP technology can be used for analysis. By extracting the conceptual information about patients? health-related quality of life, we can adopt personalized treatment for patients at different stages of recovery to improve their quality of life. Python-based text mining of free-text data can accurately extract symptom burden and save considerable time compared to manual review, maximizing the utility of the extant information in population-based electronic health records for comparative effectiveness research. UR - https://formative.jmir.org/2023/1/e43995 UR - http://dx.doi.org/10.2196/43995 UR - http://www.ncbi.nlm.nih.gov/pubmed/37656501 ID - info:doi/10.2196/43995 ER - TY - JOUR AU - Flynn, Nichols Anne AU - Koelper, C. Nathanael AU - Sonalkar, Sarita PY - 2023/8/28 TI - Telephone-Based Intervention to Improve Family Planning Care in Pregnancies of Unknown Location: Retrospective Pre-Post Study JO - J Med Internet Res SP - e42559 VL - 25 KW - contraception KW - electronic medical record KW - family planning KW - pregnancy intendedness KW - pregnancy of unknown location KW - pre-post study KW - telephone-based intervention N2 - Background: Patients followed for a pregnancy of unknown location are generally followed by a team of clinicians through telephone calls, and their contraceptive needs at the time of pregnancy resolution may not be addressed. Objective: This study aimed to assess contraceptive counseling and contraceptive uptake before and after a telephone-based intervention. Methods: This was a retrospective pre-post study assessing pregnancy intendedness in patients with a pregnancy of unknown location and the proportion of patients who received contraceptive counseling and a contraceptive prescription before and after the initiation of a telephone-based intervention. We reviewed medical records 1 year before and 1 year after implementation of our intervention for demographic characteristics, pregnancy intendedness, pregnancy outcome, contraceptive counseling documentation, receipt of contraception, and repeat pregnancy within 6 months. We assessed the effects of an implementation strategy to address family planning needs once pregnancy was resolved by comparing the proportions of patients who were counseled and received contraception before and after our intervention was implemented. We performed logistic regression to identify associations between covariates and the outcomes of contraceptive counseling documentation and receipt of contraception. Results: Of the 220 patients in the combined cohort, the majority were Black (161/220, 73%) and ultimately had a resolved pregnancy of unknown location (162/220, 74%), and the proportion of pregnancies documented as unintended was 60% (132/220). Before our intervention, 27 of 100 (27%) patients received contraceptive counseling, compared with 94 of 120 (78%) patients after the intervention (odds ratio [OR] 9.77, 95% CI 5.26-18.16). Before the intervention, 17 of 90 (19%) patients who did not desire repeat pregnancy received contraception, compared with 32 of 86 (37%) patients after the intervention (OR 2.54, 95% CI 1.28-5.05). Our postintervention cohort had an increased odds of receiving contraceptive counseling (OR 9.77, 95% CI 5.26-18.16) and of receiving a contraceptive prescription (OR 2.54, 95% CI 1.28-5.05) compared with our preintervention cohort. Conclusions: We found that over half of patients with a pregnancy of unknown location have an unintended pregnancy, and standardization of care through a telephone-based intervention improves contraceptive counseling and prescribing in patients with a resolved pregnancy of unknown location. This intervention could be used at any institution that follows patients with a pregnancy of unknown location remotely to improve care. UR - https://www.jmir.org/2023/1/e42559 UR - http://dx.doi.org/10.2196/42559 UR - http://www.ncbi.nlm.nih.gov/pubmed/37639302 ID - info:doi/10.2196/42559 ER - TY - JOUR AU - Emanuel, K. Rebecca H. AU - Docherty, D. Paul AU - Lunt, Helen AU - Campbell, E. Rebecca PY - 2023/8/25 TI - Comparing Literature- and Subreddit-Derived Laboratory Values in Polycystic Ovary Syndrome (PCOS): Validation of Clinical Data Posted on PCOS Reddit Forums JO - JMIR Form Res SP - e44810 VL - 7 KW - androgens KW - clinical treatment KW - cohort KW - laboratory tests KW - medical intervention KW - metabolic markers KW - online forum KW - ovary KW - PCOS KW - polycystic ovary syndrome KW - reddit KW - reproductive hormones KW - reproductive KW - social media KW - validation study N2 - Background: Polycystic ovary syndrome (PCOS) is a heterogeneous condition that affects 4% to 21% of people with ovaries. Inaccessibility or dissatisfaction with clinical treatment for PCOS has led to some individuals with the condition discussing their experiences in specialized web-based forums. Objective: This study explores the feasibility of using such web-based forums for clinical research purposes by gathering and analyzing laboratory test results posted in an active PCOS forum, specifically the PCOS subreddit hosted on Reddit. Methods: We gathered around 45,000 posts from the PCOS subreddit. A random subset of 5000 posts was manually read, and the presence of laboratory test results was labeled. These labeled posts were used to train a machine learning model to identify which of the remaining posts contained laboratory results. The laboratory results were extracted manually from the identified posts. These self-reported laboratory test results were compared with values in the published literature to assess whether the results were concordant with researcher-published values for PCOS cohorts. A total of 10 papers were chosen to represent published PCOS literature, with selection criteria including the Rotterdam diagnostic criteria for PCOS, a publication date within the last 20 years, and at least 50 participants with PCOS. Results: Overall, the general trends observed in the laboratory test results from the PCOS web-based forum were consistent with clinically reported PCOS. A number of results, such as follicle stimulating hormone, fasting insulin, and anti-Mullerian hormone, were concordant with published values for patients with PCOS. The high consistency of these results among the literature and when compared to the subreddit suggests that follicle stimulating hormone, fasting insulin, and anti-Mullerian hormone are more consistent across PCOS phenotypes than other test results. Some results, such as testosterone, sex hormone?binding globulin, and homeostasis model assessment?estimated insulin resistance index, were between those of PCOS literature values and normal values, as defined by clinical testing limits. Interestingly, other results, including dehydroepiandrosterone sulfate, luteinizing hormone, and fasting glucose, appeared to be slightly more dysregulated than those reported in the literature. Conclusions: The differences between the forum-posted results and those published in the literature may be due to the selection process in clinical studies and the possibility that the forum disproportionally describes PCOS phenotypes that are less likely to be alleviated with medical intervention. However, the degree of concordance in most laboratory test values implied that the PCOS web-based forum participants were representative of research-identified PCOS cohorts. This validation of the PCOS subreddit grants the possibility for more research into the contents of the subreddit and the idea of undertaking similar research using the contents of other medical internet forums. UR - https://formative.jmir.org/2023/1/e44810 UR - http://dx.doi.org/10.2196/44810 UR - http://www.ncbi.nlm.nih.gov/pubmed/37624626 ID - info:doi/10.2196/44810 ER - TY - JOUR AU - Baynes, Colin AU - Steyn, S. Petrus AU - Sherr, Kenneth AU - Kiarie, James PY - 2023/8/23 TI - Enhancing the Introduction and Scale Up of Self-Administered Injectable Contraception (DMPA-SC) in Health Systems (the EASIER Project): Protocol for Embedded Implementation Research JO - JMIR Res Protoc SP - e44222 VL - 12 KW - contraception KW - depo-medroxyprogesterone acetate subcutaneous KW - DMPA-SC KW - family planning KW - implementation research KW - scale up KW - self-care N2 - Background: The introduction of self-administered injectable contraception presents an opportunity to address the unmet need for family planning. As ministries of health scale up self-administered injectable contraception, there is a scarcity of knowledge on the implementation practices and contextual conditions that help and hinder these efforts. The World Health Organization has launched the ?enhancing self-administered family planning through embedded research project? (EASIER) to address this challenge. Objective: EASIER?s objectives are to: (1) assess the coverage of self-injectable contraception, and the readiness of health systems to integrate it into the contraceptive method mix; (2) document strategies used to introduce and scale up self-injectable contraception and understand practices that have led to success and challenges; (3) identify the contextual factors that affect the adoption and implementation of self-injectable contraception throughout health systems; (4) understand whether implementation addresses users? preferences and needs; (5) strengthen collaboration between decision makers, researchers, and implementers; support and build capacity to use evidence. Methods: EASIER developed a global protocol that implementation research (IR) teams in Burkina Faso, Ghana, and Kenya adapted into country-level embedded IR projects. In all countries (1) at the national level, IR teams evaluate the policy environment for scaling up by conducting a desk review and in-depth interviews; (2) at the local level, IR teams implement quantitative questionnaires on structural and organizational readiness to integrate self-injection into the method mix; (3) in ?case study? localities, IR teams conduct in-depth interviews and focus group discussions with implementers, method users, and community members; and (4) IR teams use participatory action research to elicit stakeholder participation and translate findings into programmatic decisions. Results: EASIER has been launched in all 3 countries. Preliminary findings are available from Burkina Faso and Kenya. In Burkina Faso, IR teams identified the need to strengthen health worker training approaches to ensure that family planning providers at primary health care facilities are adequately oriented to depo-medroxyprogesterone acetate subcutaneous (DMPA-SC) and self-injection and capacitated to initiate women to the method. In addition, they report the need for service communication strategies that reach potential users of the method with knowledge about self-injection and how to initiate the practice. In Kenya, the findings illuminate the need for practice guidelines that county health teams can use to coordinate the rollout of self-administered DMPA-SC. In addition, Kenya?s findings underscore the importance of addressing logistical bottlenecks to help avoid stock-outs. Conclusions: EASIER presents a strategy to embed IR in contraceptive method introduction and scale-up, address local knowledge needs, devise ways to maximize the impact of new technologies in health systems, and build capacity for using evidence in programmatic decisions. Adaptation and implementation of country-level IR studies will advance the use of IR to strengthen family planning programs. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12622001228774; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=384534&isReview=true International Registered Report Identifier (IRRID): DERR1-10.2196/44222 UR - https://www.researchprotocols.org/2023/1/e44222 UR - http://dx.doi.org/10.2196/44222 UR - http://www.ncbi.nlm.nih.gov/pubmed/37610819 ID - info:doi/10.2196/44222 ER - TY - JOUR AU - Haramati, Sharon AU - Firsow, Anastasia AU - Navarro, Abigail Daniela AU - Shechter, Ravid PY - 2023/8/22 TI - Novel At-Home Mother?s Milk Conductivity Sensing Technology as an Identification System of Delay in Milk Secretory Activation Progress and Early Breastfeeding Problems: Feasibility Assessment JO - JMIR Pediatr Parent SP - e43837 VL - 6 KW - breastfeeding KW - feasibility KW - human milk KW - biomarker KW - remote sensing technology KW - mobile health KW - retrospective KW - secretory activation KW - lactogenesis KW - milk supply KW - milk KW - sensing technology KW - monitoring tool KW - lactation KW - exclusive breastfeeding KW - breastfeed KW - maternal health KW - maternal and infant health KW - infant health KW - maternal and child health KW - prolactin KW - lactation consultant KW - lactation support provider KW - mother KW - milk maturation N2 - Background: Prolonged exclusive breastfeeding is a public health priority and a personal desire by mothers; however, rates are low with milk supply challenges as a predominant cause. Early breastfeeding management at home is key. Milk electrolytes, mainly sodium ions, are accepted as biomarkers of secretory activation processes throughout the first weeks after birth and predictors for prolonged breastfeeding success, although they are not incorporated into routine care practice. Objective: The aim of this study was to test the feasibility of a novel handheld smartphone-operated milk conductivity sensing system that was designed to compute a novel parameter, milk maturation percent (MM%), calculated from milk sample conductivity for tracking individual secretory activation progress in a real-world home setting. Methods: System performance was initially evaluated in data collected from laboratory-based milk analysis, followed by a retrospective analysis of observational real-world data gathered with the system, on the spot in an at-home setting, implemented by lactation support providers or directly by mothers (N=592). Data collected included milk sample sensing data, baby age, and self-reported breastfeeding status and breastfeeding-related conditions. The data were retroactively classified in a day after birth?dependent manner. Results were compared between groups classified according to breastfeeding exclusivity and breastfeeding problems associated with ineffective breastfeeding and low milk supply. Results: Laboratory analysis in a set of breast milk samples demonstrated a strong correlation between the system?s results and sodium ion levels. In the real-world data set, a total of 1511 milk sensing records were obtained on the spot with over 592 real-world mothers. Data gathered with the system revealed a typical time-dependent increase in the milk maturation parameter (MM%), characterized by an initial steep increase, followed by a moderate increase, and reaching a plateau during the first weeks postpartum. Additionally, MM% levels captured by the system were found to be sensitive to breastfeeding status classifications of exclusive breastfeeding and breastfeeding problems, manifested by differences in group means in the several-day range after birth, predominantly during the first weeks postpartum. Differences could also be demonstrated for the per-case time after birth?dependent progress in individual mothers. Conclusions: This feasibility study demonstrates that the use of smart milk conductivity sensing technology can provide a robust, objective measure of individual breastfeeding efficiency, facilitating remote data collection within a home setting. This system holds considerable potential to augment both self-monitoring and remote breastfeeding management capabilities, as well as to refine clinical classifications. To further validate the clinical relevance and potential of this home milk monitoring tool, future controlled clinical studies are necessary, which will provide insights into its impact on user and care provider satisfaction and its potential to meet breastfeeding success goals. UR - https://pediatrics.jmir.org/2023/1/e43837 UR - http://dx.doi.org/10.2196/43837 UR - http://www.ncbi.nlm.nih.gov/pubmed/37464893 ID - info:doi/10.2196/43837 ER - TY - JOUR AU - Goueth, Rose AU - Holt, Kelsey AU - Eden, B. Karen AU - Hoffman, Aubri PY - 2023/8/21 TI - Clinicians? Perspectives and Proposed Solutions to Improve Contraceptive Counseling in the United States: Qualitative Semistructured Interview Study With Clinicians From the Society of Family Planning JO - JMIR Form Res SP - e47298 VL - 7 KW - contraceptive counseling KW - qualitative study KW - decision making KW - decision aids KW - clinician engagement KW - user-centered design KW - contraceptive KW - birth control KW - clinicians? perspectives KW - patient-centered counseling KW - sexual health KW - family planning N2 - Background: Contraceptive care is a key element of reproductive health, yet only 12%-30% of women report being able to access and receive the information they need to make these complex, personal health care decisions. Current guidelines recommend implementing shared decision-making approaches; and tools such as patient decision aid (PtDA) applications have been proposed to improve patients? access to information, contraceptive knowledge, decisional conflict, and engagement in decision-making and contraception use. To inform the design of meaningful, effective, elegant, and feasible PtDA applications, studies are needed of all users? current experiences, needs, and barriers. While multiple studies have explored patients? experiences, needs, and barriers, little is known about clinicians? experiences, perspectives, and barriers to delivering contraceptive counseling. Objective: This study focused on assessing clinicians? experiences, including their perspectives of patients? needs and barriers. It also explored clinicians? suggestions for improving contraceptive counseling and the feasibility of a contraceptive PtDA. Methods: Following the decisional needs assessment approach, we conducted semistructured interviews with clinicians recruited from the Society of Family Planning. The Ottawa Decision Support Framework informed the interview guide and initial codebook, with a specific focus on decision support and decisional needs as key elements that should be assessed from the clinicians? perspective. An inductive content approach was used to analyze data and identify primary themes and suggestions for improvement. Results: Fifteen clinicians (12 medical doctors and 3 nurse practitioners) participated, with an average of 19 years of experience in multiple regions of the United States. Analyses identified 3 primary barriers to the provision of quality contraceptive counseling: gaps in patients? underlying sexual health knowledge, biases that impede decision-making, and time constraints. All clinicians supported the development of contraceptive PtDAs as a feasible solution to these main barriers. Multiple suggestions for improvement were provided, including clinician- and system-level training, tools, and changes that could support successful implementation. Conclusions: Clinicians and developers interested in improving contraceptive counseling and decision-making may wish to incorporate approaches that assess and address upstream factors, such as sexual health knowledge and existing heuristics and biases. Clinical leaders and administrators may also wish to prioritize solutions that improve equity and accessibility, including PtDAs designed to provide education and support in advance of the time-constrained consultations, and strategic training opportunities that support cultural awareness and shared decision-making skills. Future studies can then explore whether well-designed, user-centered shared decision-making programs lead to successful and sustainable uptake and improve patients? reproductive health contraceptive decision-making. UR - https://formative.jmir.org/2023/1/e47298 UR - http://dx.doi.org/10.2196/47298 UR - http://www.ncbi.nlm.nih.gov/pubmed/37603407 ID - info:doi/10.2196/47298 ER - TY - JOUR AU - Goel, Rahul AU - Modhukur, Vijayachitra AU - Täär, Katrin AU - Salumets, Andres AU - Sharma, Rajesh AU - Peters, Maire PY - 2023/8/15 TI - Users? Concerns About Endometriosis on Social Media: Sentiment Analysis and Topic Modeling Study JO - J Med Internet Res SP - e45381 VL - 25 KW - endometriosis KW - latent Dirichlet allocation KW - pain KW - Reddit KW - sentiment analysis KW - social media KW - surgery KW - topic modeling KW - user engagement N2 - Background: Endometriosis is a debilitating and difficult-to-diagnose gynecological disease. Owing to limited information and awareness, women often rely on social media platforms as a support system to engage in discussions regarding their disease-related concerns. Objective: This study aimed to apply computational techniques to social media posts to identify discussion topics about endometriosis and to identify themes that require more attention from health care professionals and researchers. We also aimed to explore whether, amid the challenging nature of the disease, there are themes within the endometriosis community that gather posts with positive sentiments. Methods: We retrospectively extracted posts from the subreddits r/Endo and r/endometriosis from January 2011 to April 2022. We analyzed 45,693 Reddit posts using sentiment analysis and topic modeling?based methods in machine learning. Results: Since 2011, the number of posts and comments has increased steadily. The posts were categorized into 11 categories, and the highest number of posts were related to either asking for information (Question); sharing the experiences (Rant/Vent); or diagnosing and treating endometriosis, especially surgery (Surgery related). Sentiment analysis revealed that 92.09% (42,077/45,693) of posts were associated with negative sentiments, only 2.3% (1053/45,693) expressed positive feelings, and there were no categories with more positive than negative posts. Topic modeling revealed 27 major topics, and the most popular topics were Surgery, Questions/Advice, Diagnosis, and Pain. The Survey/Research topic, which brought together most research-related posts, was the last in terms of posts. Conclusions: Our study shows that posts on social media platforms can provide insights into the concerns of women with endometriosis symptoms. The analysis of the posts confirmed that women with endometriosis have to face negative emotions and pain daily. The large number of posts related to asking questions shows that women do not receive sufficient information from physicians and need community support to cope with the disease. Health care professionals should pay more attention to the symptoms and diagnosis of endometriosis, discuss these topics with patients to reduce their dissatisfaction with doctors, and contribute more to the overall well-being of women with endometriosis. Researchers should also become more involved in social media and share new science-based knowledge regarding endometriosis. UR - https://www.jmir.org/2023/1/e45381 UR - http://dx.doi.org/10.2196/45381 UR - http://www.ncbi.nlm.nih.gov/pubmed/37581905 ID - info:doi/10.2196/45381 ER - TY - JOUR AU - Zhang, Wen AU - Wong, H. Carlos K. AU - Xin, Yiqiao AU - Fong, T. Daniel Y. AU - Wong, H. Janet Y. PY - 2023/8/10 TI - A Web-Based Sexual Health Intervention to Prevent Sexually Transmitted Infections in Hong Kong: Model-Based Cost-Effectiveness Analysis JO - J Med Internet Res SP - e45054 VL - 25 KW - economic evaluation KW - web-based intervention KW - young adult KW - cost-effectiveness KW - sexual health KW - sexually transmitted infection KW - STI KW - digital intervention N2 - Background: Sexually transmitted infections (STIs) remain a significant public health concern, particularly among young adults, and Chlamydia trachomatis (CT) infections are the most common STIs in young women. One of the most effective ways to prevent STIs is the consistent use of condoms during sexual intercourse. There has been no economic evaluation of the interactive web-based sexual health program, Smart Girlfriend, within the Chinese population. Objective: This study aimed to evaluate the long-term cost-effectiveness of Smart Girlfriend in preventing STIs in the Chinese population. The evaluation compared the program with a control intervention that used a 1-page information sheet on condom use. Methods: A decision-analytic model that included a decision tree followed by a Markov structure of CT infections was developed since CT is the most prevalent STI among young women. The model represents the long-term experience of individuals who received either the intervention or the control. One-way and probabilistic sensitivity analyses were conducted. The main outcomes were the number of CT infections and the incremental cost as per quality-adjusted life year (QALY). Results: A cohort of 10,000 sexually active nonpregnant young women initially entered the model in a noninfectious state (ie, ?well?). In the base-case analysis, the implementation of the Smart Girlfriend program resulted in the prevention of 0.45% of CT infections, 0.3% of pelvic inflammatory disease, and 0.04% of chronic pelvic pain, leading to a gain of 70 discounted QALYs and cost savings over a 4-year time horizon, compared to the control group. With more than 4548 users, the intervention would be cost-effective, and with more than 8315 users, the intervention would be cost saving. A 99% probability of being cost-effective was detected with a willingness to pay US $17,409 per QALY. Conclusions: Smart Girlfriend is a cost-effective and possibly cost-saving program over a 4-year time horizon. This result was particularly sensitive to the number of website users; launching the website would be cost-effective if more than 4548 people used it. Further work is warranted to explore if the findings could be expanded to apply to women who have sex with women and in the context of other STIs. Trial Registration: ClinicalTrial.gov NCT03695679; https://clinicaltrials.gov/study/NCT03695679 UR - https://www.jmir.org/2023/1/e45054 UR - http://dx.doi.org/10.2196/45054 UR - http://www.ncbi.nlm.nih.gov/pubmed/37561571 ID - info:doi/10.2196/45054 ER - TY - JOUR AU - Mills, Rhiana AU - Mangone, Rose Emily AU - Lesh, Neal AU - Mohan, Diwakar AU - Baraitser, Paula PY - 2023/8/9 TI - Chatbots to Improve Sexual and Reproductive Health: Realist Synthesis JO - J Med Internet Res SP - e46761 VL - 25 KW - chatbot KW - sexual and reproductive health KW - realist synthesis KW - social networks KW - service networks KW - disclosure KW - artificial intelligence KW - sexual KW - reproductive KW - social media KW - counseling KW - treatment KW - development KW - theory KW - digital device KW - device N2 - Background: Digital technologies may improve sexual and reproductive health (SRH) across diverse settings. Chatbots are computer programs designed to simulate human conversation, and there is a growing interest in the potential for chatbots to provide responsive and accurate information, counseling, linkages to products and services, or a companion on an SRH journey. Objective: This review aimed to identify assumptions about the value of chatbots for SRH and collate the evidence to support them. Methods: We used a realist approach that starts with an initial program theory and generates causal explanations in the form of context, mechanism, and outcome configurations to test and develop that theory. We generated our program theory, drawing on the expertise of the research team, and then searched the literature to add depth and develop this theory with evidence. Results: The evidence supports our program theory, which suggests that chatbots are a promising intervention for SRH information and service delivery. This is because chatbots offer anonymous and nonjudgmental interactions that encourage disclosure of personal information, provide complex information in a responsive and conversational tone that increases understanding, link to SRH conversations within web-based and offline social networks, provide immediate support or service provision 24/7 by automating some tasks, and provide the potential to develop long-term relationships with users who return over time. However, chatbots may be less valuable where people find any conversation about SRH (even with a chatbot) stigmatizing, for those who lack confidential access to digital devices, where conversations do not feel natural, and where chatbots are developed as stand-alone interventions without reference to service contexts. Conclusions: Chatbots in SRH could be developed further to automate simple tasks and support service delivery. They should prioritize achieving an authentic conversational tone, which could be developed to facilitate content sharing in social networks, should support long-term relationship building with their users, and should be integrated into wider service networks. UR - https://www.jmir.org/2023/1/e46761 UR - http://dx.doi.org/10.2196/46761 UR - http://www.ncbi.nlm.nih.gov/pubmed/37556194 ID - info:doi/10.2196/46761 ER - TY - JOUR AU - Godfrey, M. Emily AU - Schwartz, R. Malaika AU - Stukovsky, Hinckley Karen D. AU - Woodward, Danielle AU - Magaret, S. Amalia AU - Aitken, L. Moira PY - 2023/7/18 TI - Web-Based Survey Piloting Process as a Model for Developing and Testing Past Contraceptive Use and Pregnancy History: Cystic Fibrosis Case Study JO - JMIR Form Res SP - e46395 VL - 7 KW - contraception KW - chronic disease KW - genetic disease KW - questionnaire reliability KW - surveys and questionnaires KW - contraceptive KW - birth control KW - cystic fibrosis KW - reproductive health KW - pregnancy KW - electronic survey KW - obstetrical history N2 - Background: Individuals with complex, chronic diseases are now living longer, making reproductive health an important topic to address in the health care setting. Self-respondent surveys are a feasible way to collect past contraceptive use and pregnancy history to assess contraceptive safety and effectiveness. Because sensitive topics, such as contraception and pregnancy outcomes, can vary across social groups or cultures, piloting questions and evaluating survey administration procedures in the target population are necessary for precise and reliable responses before wide distribution. Objective: This study aimed to develop a precise and reliable survey instrument and related procedures among individuals with cystic fibrosis regarding contraceptive use and obstetrical history. Methods: We piloted and tested web-based questions related to contraceptive use and pregnancy history among 50 participants with and those without cystic fibrosis aged 18 to 45 years using a 3-tier process. Findings from each tier informed changes to the questionnaire before testing in the subsequent tier. Tier 1 used cognitive pretesting to assess question understanding and the need for memory prompts. In tier 2, we used test-retest self- and interviewer-administered approaches to assess question reliability, evaluate response missingness, and determine confidence between 2 types of survey administration approaches. In tier 3, we tested the questionnaire for clarity, time to complete, and whether additional prompts were necessary. Results: In tier 1, respondents suggested improvements to the web-based survey questions and to the written and visual prompts for better recall regarding past contraceptive use. In tier 2, the test-retest reliability between self- and interviewer-administrative procedures of ?ever use? contraceptive method questions was similar, with percent absolute agreement ranging between 84% and 100%. When the survey was self-administered, the percentage of missing responses was higher and respondent confidence about month and year when contraceptive methods were used was lower. Most respondents reported that they preferred the self-administered survey because it was more convenient and faster to complete. Conclusions: Our 3-tier process to pilot web-based survey questions related to contraceptive and obstetrical history in our complex disease population helped us tailor content and format questions before wide dissemination to our target population. Results from this pilot study informed the subsequent larger study design to include a 10% respondent test-retest self- and interviewer-administered quality control component to better inform imputation procedures of missing data. UR - https://formative.jmir.org/2023/1/e46395 UR - http://dx.doi.org/10.2196/46395 UR - http://www.ncbi.nlm.nih.gov/pubmed/37463015 ID - info:doi/10.2196/46395 ER - TY - JOUR AU - Silva de Medeiros, Cármem Máyra AU - de Oliveira, Costa Maiara AU - Gurgel, Barbosa Leonandro Valério AU - Ribeiro Rodrigues, Dantas Anna Giselle Câmara AU - Micussi, Cabral Maria Thereza Albuquerque Barbosa AU - Magalhães, Gomes Adriana PY - 2023/7/13 TI - A Health App for Evidence-Based Postpartum Information: Development and Validation Study JO - JMIR Hum Factors SP - e38706 VL - 10 KW - women's health KW - postpartum period KW - comprehensive health care KW - health technology KW - mobile applications N2 - Background: After childbirth, women undergo substantial physical and emotional changes. Therefore, it is important to provide them with information that helps them identify what is expected during this stage, as well as signs and symptoms that indicate complications after they have been discharged from the hospital. Objective: This study aimed to develop a health app?Towards Motherhood?that provides evidence-based information about the postpartum period and evaluate the usability of the app with the target population. Methods: This was a validation study involving 80 participants, including 24 professionals from the obstetric health field, 15 professionals from the technology field, and 41 postpartum women. The app was developed using React Native technology. Health professionals evaluated the app?s content using the Content Validity Index, technology professionals completed a validated evaluation to assess the appearance of the app, and postpartum women completed the System Usability Scale (SUS) to measure the usability of the app. Results: The measurement of content validity using a Likert scale obtained an approval score of 99%. Regarding the app?s appearance, 92% of responses were positive, reflecting favorable approval. The SUS usability score was 86.2, which represents excellent acceptance. Conclusions: The Towards Motherhood mobile app is a valid tool for promoting self-care during the postpartum period. The app?s evidence-based information, user-friendly design, and high usability make it an essential resource for women during this critical stage of their live. UR - https://humanfactors.jmir.org/2023/1/e38706 UR - http://dx.doi.org/10.2196/38706 UR - http://www.ncbi.nlm.nih.gov/pubmed/37440288 ID - info:doi/10.2196/38706 ER - TY - JOUR AU - Pleasants, Elizabeth AU - Ryan, Holmes Julia AU - Ren, Cheng AU - Prata, Ndola AU - Gomez, Manchikanti Anu AU - Marshall, Cassondra PY - 2023/6/30 TI - Exploring Language Used in Posts on r/birthcontrol: Case Study Using Data From Reddit Posts and Natural Language Processing to Advance Contraception Research JO - J Med Internet Res SP - e46342 VL - 25 KW - contraception KW - big data KW - Reddit KW - social networking site KW - contraceptive side effects KW - natural language processing KW - reproductive autonomy N2 - Background: Contraceptive choice is central to reproductive autonomy. The internet, including social networking sites like Reddit, is an important resource for people seeking contraceptive information and support. A subreddit dedicated to contraception, r/birthcontrol, provides a platform for people to post about contraception. Objective: This study explored the use of r/birthcontrol, from the inception of the subreddit through the end of 2020. We describe the web-based community, identify distinctive interests and themes based upon the textual content of posts, and explore the content of posts with the most user engagement (ie, ?popular? posts). Methods: Data were obtained from the PushShift Reddit application programming interface from the establishment of r/birthcontrol to the start date of analysis (July 21, 2011, to December 31, 2020). User interactions within the subreddit were analyzed to describe community use over time, specifically the commonality of use based on the volume of posts, the length of posts (character count), and the proportion of posts with any and each flair applied. ?Popular? posts on r/birthcontrol were determined based on the number of comments and ?scores,? or upvotes minus downvotes; popular posts had 9 comments and a score of ?3. Term Frequency-Inverse Document Frequency (TF-IDF) analyses were run on all posts with flairs applied, posts within each flair group, and popular posts within each flair group to characterize and compare the distinctive language used in each group. Results: There were 105,485 posts to r/birthcontrol during the study period, with the volume of posts increasing over time. Within the time frame for which flairs were available on r/birthcontrol (after February 4, 2016), users applied flairs to 78% (n=73,426) of posts. Most posts contained exclusively textual content (n=66,071, 96%), had comments (n=59,189, 86%), and had a score (n=66,071, 96%). Posts averaged 731 characters in length (median 555). ?SideEffects!?? was the most frequently used flair overall (n=27,530, 40%), while ?Experience? (n=719, 31%) and ?SideEffects!?? (n=672, 29%) were most common among popular posts. TF-IDF analyses of all posts showed interest in contraceptive methods, menstrual experiences, timing, feelings, and unprotected sex. While TF-IDF results for posts with each flair varied, the contraceptive pill, menstrual experiences, and timing were discussed across flair groups. Among popular posts, intrauterine devices and contraceptive use experiences were often discussed. Conclusions: People commonly wrote about contraceptive side effects and experiences using methods, highlighting the value of r/birthcontrol as a space to post about aspects of contraceptive use that are not well addressed by clinical contraceptive counseling. The value of real-time, open-access data on contraceptive users? interests is especially high given the shifting landscape of and increasing constraints on reproductive health care in the United States. UR - https://www.jmir.org/2023/1/e46342 UR - http://dx.doi.org/10.2196/46342 UR - http://www.ncbi.nlm.nih.gov/pubmed/37389907 ID - info:doi/10.2196/46342 ER - TY - JOUR AU - Merlot, Benjamin AU - Elie, Valéry AU - Périgord, Adrien AU - Husson, Zoé AU - Jubert, Amandine AU - Chanavaz-Lacheray, Isabella AU - Dennis, Thomas AU - Cotty-Eslous, Maryne AU - Roman, Horace PY - 2023/6/28 TI - Pain Reduction With an Immersive Digital Therapeutic in Women Living With Endometriosis-Related Pelvic Pain: At-Home Self-Administered Randomized Controlled Trial JO - J Med Internet Res SP - e47869 VL - 25 KW - randomized controlled trial KW - virtual reality KW - digital therapeutics KW - digital health KW - endometriosis KW - chronic pain KW - pelvic pain KW - women's health KW - digital health intervention KW - patient outcome N2 - Background: The management of chronic pelvic pain in women with endometriosis is complex and includes the long-term use of opioids. Patients not fully responsive to drugs or ineligible for surgical treatments need efficient alternatives to improve their quality of life and avoid long-term sequelae. Objective: This randomized controlled trial aimed to assess the effects of repeated at-home administrations of a 20-minute virtual reality (VR) solution (Endocare) compared with a sham condition on pain in women experiencing pelvic pain due to endometriosis. Methods: Patients were instructed to use the VR headsets twice daily for at least 2 days and for up to 5 days starting on their first day of painful periods. Pain perception was measured using a numerical scale (0-10) before and 60, 120, and 180 minutes after each treatment administration. General pain, stress, fatigue, medication intake, and quality of life were reported daily by patients. Results: A total of 102 patients with endometriosis were included in the final analysis (Endocare group: n=51, 50%; sham group: n=51, 50%). The mean age was 32.88 years (SD 6.96) and the mean pain intensity before treatment was 6.53 (SD 1.74) and 6.22 (SD 1.69) for the Endocare group and the sham control group, respectively (P=.48). Pain intensity decreased in both groups from day 1 to day 5 along with a decrease in medication use. Maximum pain intensity reduction of 51.58% (SD 35.33) occurred at day 2, 120 minutes after treatment for the Endocare group and of 27.37% (SD 27.23) at day 3, 180 minutes after treatment for the control group. Endocare was significantly superior to the sham on day 1 (120 minutes, P=.04; 180 minutes, P=.001), day 2 (0 minutes, P=.02; 60, 120, and 180 minutes, all P<.001), and day 3 (60 minutes, P=.01; 120 minutes, P=.005; 180 minutes, P=.001). Similarly, the mean perceived pain relief was significantly higher with Endocare on day 1 (120 and 180 minutes P=.004 and P=.001, respectively) and day 2 (60, 120, and 180 minutes P=.003, P=.004, and P=.007, respectively) compared to the control. No adverse event was reported. Conclusions: This study confirmed the effectiveness and safety of self-repeated administrations of a VR immersive treatment used at home while reducing overall pain medication intake in women diagnosed with endometriosis experiencing moderate-to-severe pelvic pain. Trial Registration: ClinicalTrials.gov NCT05172492; https://clinicaltrials.gov/ct2/show/NCT05172492 UR - https://www.jmir.org/2023/1/e47869 UR - http://dx.doi.org/10.2196/47869 UR - http://www.ncbi.nlm.nih.gov/pubmed/37260160 ID - info:doi/10.2196/47869 ER - TY - JOUR AU - Chen, Ling AU - Zhang, Danli AU - Li, Tiantian AU - Liu, Sha AU - Hua, Jie AU - Cai, Wenzhi PY - 2023/6/27 TI - Effect of a Mobile App?Based Urinary Incontinence Self-Management Intervention Among Pregnant Women in China: Pragmatic Randomized Controlled Trial JO - J Med Internet Res SP - e43528 VL - 25 KW - mobile health KW - mHealth KW - mobile apps KW - urinary incontinence KW - pregnancy KW - pragmatic randomized controlled trial KW - mobile phone N2 - Background: Urinary incontinence (UI) is a highly prevalent health concern commonly observed during and after pregnancy that can substantially impact women?s physical and psychological well-being and quality of life. Owing to its numerous advantages, mobile health may be a promising solution; however, it is unclear whether the app-based intervention can effectively improve UI symptoms during and after pregnancy. Objective: This study aimed to evaluate the effectiveness of the Urinary Incontinence for Women (UIW) app?based intervention for UI symptom improvement among pregnant women in China. Methods: Singleton pregnant women without incontinence before pregnancy who were aged ?18 years and between 24 and 28?weeks of gestation were recruited from a tertiary public hospital in China and were randomly allocated (1:1) to either an experimental group (n=63) or a control group (n=63). The experimental group received the UIW app intervention and oral pelvic floor muscle training (PFMT) instructions, whereas the control group received oral PFMT instructions alone. Neither the participants nor the researchers were blinded to the intervention. The primary outcome was UI severity. The secondary outcomes included quality of life, self-efficacy with PFMT, and knowledge of UI. All data were collected at baseline, 2 months after randomization, and 6 weeks post partum through electronic questionnaires or by checking the electronic medical record system. Data analysis followed the intention-to-treat principle. A linear mixed model was used to examine the intervention effect on primary and secondary outcomes. Results: Participants in the experimental and control groups were comparable at baseline. Of the 126 overall participants, 117 (92.9%) and 103 (81.7%) women completed follow-up visits at 2 months after randomization and 6 weeks after delivery, respectively. A statistically significant difference in UI symptom severity was observed between the experimental group and control group (2 months after randomization: mean difference ?2.86, 95% CI ?4.09 to ?1.64, P<.001; 6 weeks post partum: mean difference ?2.68, 95% CI ?3.87 to ?1.49, P<.001). For the secondary outcomes, a statistically significant intervention effect on the quality of life, self-efficacy, and UI knowledge was found at the 2-month follow-up (all P<.05) and 6 weeks post partum (all P<.001). Conclusions: The app-based UI self-management intervention (UIW) effectively improved UI symptom severity, quality of life, self-efficacy with PFMT, and knowledge of UI during the late pregnancy and early postnatal periods. Larger multicenter studies with a longer postpartum follow-up are required to further extend these findings. Trial Registration: Chinese Clinical Trial Registry ChiCTR1800016171; http://www.chictr.org.cn/showproj.aspx?proj=27455 International Registered Report Identifier (IRRID): RR2-10.2196/22771 UR - https://www.jmir.org/2023/1/e43528 UR - http://dx.doi.org/10.2196/43528 UR - http://www.ncbi.nlm.nih.gov/pubmed/37368465 ID - info:doi/10.2196/43528 ER - TY - JOUR AU - Squires, A. Natalie AU - Soyemi, Elizabeth AU - Yee, M. Lynn AU - Birch, M. Eleanor AU - Badreldin, Nevert PY - 2023/6/23 TI - Content Quality of YouTube Videos About Pain Management After Cesarean Birth: Content Analysis JO - JMIR Infodemiology SP - e40802 VL - 3 KW - health information KW - internet KW - YouTube KW - cesarean section KW - cesarean KW - C-section KW - postpartum KW - social media KW - web-based video KW - maternal KW - postnatal KW - pain KW - systematic search KW - patient education KW - information quality KW - accuracy KW - credibility KW - health education KW - educational video KW - education resource KW - health video N2 - Background: YouTube is an increasingly common source of health information; however, the reliability and quality of the information are inadequately understood. Several studies have evaluated YouTube as a resource during pregnancy and found the available information to be of poor quality. Given the increasing attention to postpartum health and the importance of promoting safe opioid use after birth, YouTube may be a source of information for birthing individuals. However, little is known about the available information on YouTube regarding postpartum pain. Objective: The purpose of this study is to systematically evaluate the quality of YouTube videos as an educational resource for postpartum cesarean pain management. Methods: A systematic search of YouTube videos was conducted on June 25, 2021, using 36 postpartum cesarean pain management?related keywords, which were identified by clinical experts. The search replicated a default YouTube search via a public account. The first 60 results from each keyword search were reviewed, and unique videos were analyzed. An overall content score was developed based on prior literature and expert opinion to evaluate the video?s relevance and comprehensiveness. The DISCERN instrument, a validated metric to assess consumer health information, was used to evaluate the reliability of video information. Videos with an overall content score of ?5 and a DISCERN score of ?39 were classified as high-quality health education resources. Descriptive analysis and intergroup comparisons by video source and quality were conducted. Results: Of 73 unique videos, video sources included medical videos (n=36, 49%), followed by personal video blogs (vlogs; n=32, 44%), advertisements (n=3, 4%), and media (n=2, 3%). The average overall content score was 3.6 (SD 2.0) out of 9, and the average DISCERN score was 39.2 (SD 8.1) out of 75, indicating low comprehensiveness and fair information reliability, respectively. High-quality videos (n=22, 30%) most frequently addressed overall content regarding pain duration (22/22, 100%), pain types (20/22, 91%), return-to-activity instructions (19/22, 86%), and nonpharmacologic methods for pain control (19/22, 86%). There were differences in the overall content score (P=.02) by video source but not DISCERN score (P=.45). Personal vlogs had the highest overall content score at 4.0 (SD 2.1), followed by medical videos at 3.3 (SD 2.0). Longer video duration and a greater number of comments and likes were significantly correlated with the overall content score, whereas the number of video comments was inversely correlated with the DISCERN score. Conclusions: Individuals seeking information from YouTube regarding postpartum cesarean pain management are likely to encounter videos that lack adequate comprehensiveness and reliability. Clinicians should counsel patients to exercise caution when using YouTube as a health information resource. UR - https://infodemiology.jmir.org/2023/1/e40802 UR - http://dx.doi.org/10.2196/40802 UR - http://www.ncbi.nlm.nih.gov/pubmed/37351938 ID - info:doi/10.2196/40802 ER - TY - JOUR AU - Bachelot, Guillaume AU - Dhombres, Ferdinand AU - Sermondade, Nathalie AU - Haj Hamid, Rahaf AU - Berthaut, Isabelle AU - Frydman, Valentine AU - Prades, Marie AU - Kolanska, Kamila AU - Selleret, Lise AU - Mathieu-D?Argent, Emmanuelle AU - Rivet-Danon, Diane AU - Levy, Rachel AU - Lamazière, Antonin AU - Dupont, Charlotte PY - 2023/6/21 TI - A Machine Learning Approach for the Prediction of Testicular Sperm Extraction in Nonobstructive Azoospermia: Algorithm Development and Validation Study JO - J Med Internet Res SP - e44047 VL - 25 KW - machine learning KW - azoospermia KW - prediction model KW - biomedical informatics KW - model KW - predict KW - sperm KW - men's health KW - infertility KW - infertile N2 - Background: Testicular sperm extraction (TESE) is an essential therapeutic tool for the management of male infertility. However, it is an invasive procedure with a success rate up to 50%. To date, no model based on clinical and laboratory parameters is sufficiently powerful to accurately predict the success of sperm retrieval in TESE. Objective: The aim of this study is to compare a wide range of predictive models under similar conditions for TESE outcomes in patients with nonobstructive azoospermia (NOA) to identify the correct mathematical approach to apply, most appropriate study size, and relevance of the input biomarkers. Methods: We analyzed 201 patients who underwent TESE at Tenon Hospital (Assistance Publique-Hôpitaux de Paris, Sorbonne University, Paris), distributed in a retrospective training cohort of 175 patients (January 2012 to April 2021) and a prospective testing cohort (May 2021 to December 2021) of 26 patients. Preoperative data (according to the French standard exploration of male infertility, 16 variables) including urogenital history, hormonal data, genetic data, and TESE outcomes (representing the target variable) were collected. A TESE was considered positive if we obtained sufficient spermatozoa for intracytoplasmic sperm injection. After preprocessing the raw data, 8 machine learning (ML) models were trained and optimized on the retrospective training cohort data set: The hyperparameter tuning was performed by random search. Finally, the prospective testing cohort data set was used for the model evaluation. The metrics used to evaluate and compare the models were the following: sensitivity, specificity, area under the receiver operating characteristic curve (AUC-ROC), and accuracy. The importance of each variable in the model was assessed using the permutation feature importance technique, and the optimal number of patients to include in the study was assessed using the learning curve. Results: The ensemble models, based on decision trees, showed the best performance, especially the random forest model, which yielded the following results: AUC=0.90, sensitivity=100%, and specificity=69.2%. Furthermore, a study size of 120 patients seemed sufficient to properly exploit the preoperative data in the modeling process, since increasing the number of patients beyond 120 during model training did not bring any performance improvement. Furthermore, inhibin B and a history of varicoceles exhibited the highest predictive capacity. Conclusions: An ML algorithm based on an appropriate approach can predict successful sperm retrieval in men with NOA undergoing TESE, with promising performance. However, although this study is consistent with the first step of this process, a subsequent formal prospective multicentric validation study should be undertaken before any clinical applications. As future work, we consider the use of recent and clinically relevant data sets (including seminal plasma biomarkers, especially noncoding RNAs, as markers of residual spermatogenesis in NOA patients) to improve our results even more. UR - https://www.jmir.org/2023/1/e44047 UR - http://dx.doi.org/10.2196/44047 UR - http://www.ncbi.nlm.nih.gov/pubmed/37342078 ID - info:doi/10.2196/44047 ER - TY - JOUR AU - Haricharan, Jensen Hanne AU - Hacking, Damian AU - Lau, Kwan Yan AU - Heap, Marion PY - 2023/5/22 TI - Improving Knowledge About Pregnancy for Deaf South African Women of Reproductive Age Through a Text Messaging?Based Information Campaign: Mixed Methods Study JO - JMIR Pediatr Parent SP - e40561 VL - 6 KW - SMS text messages KW - cell phones KW - mobile health KW - mHealth KW - health information KW - health literacy KW - healthy behavior KW - maternal health KW - antenatal care KW - Deaf KW - South Africa N2 - Background: Signing Deaf South Africans have limited access to health information and, consequently, limited knowledge about health. Maternal and neonatal mortality rates are high. Cell phone use is high, making it a potentially effective way of communicating about maternal and child health. Objective: The primary aim of this study was to assess whether an SMS text messaging?based health information campaign could improve knowledge about pregnancy, antenatal care, and healthy living during pregnancy for signing Deaf South African women of reproductive age. The secondary aim was to evaluate the acceptability of such an intervention. Methods: This study was designed as a pretest-posttest study. A baseline questionnaire assessed participants? knowledge about pregnancy, antenatal care, and healthy living during pregnancy before an SMS text messaging?based information campaign was conducted. After the campaign, an exit questionnaire was administered containing the same questions as the baseline questionnaire with additional questions on general acceptability and communication preferences. The results were compared between baseline and exit using the McNemar and Wilcoxon signed rank tests. A focus group aimed to obtain further information on the impact and acceptability of SMS text messages. The focus group was analyzed inductively. Results: The study showed a statistically significant improvement in overall health knowledge among participants. Despite this, some participants found the medical terminology challenging to understand. Several ways of improving SMS text messaging campaigns for the Deaf were identified, including using Multimedia Messaging Services with a person signing messages and linking information campaigns to a communication service that would enable Deaf people to pose questions. The focus group also suggested that SMS text messages might play a role in motivating healthy behaviors during pregnancy. Conclusions: The SMS text messaging campaign effectively improved Deaf women?s knowledge about pregnancy, antenatal care, and healthy living during pregnancy and has the potential to affect health behavior. This contrasts with a similar study on hearing pregnant women. This suggests that SMS text messages may be particularly effective in improving Deaf people?s health knowledge. However, attention should be paid to Deaf participants? specific needs and communication preferences to optimize impact. The potential of using SMS text messaging campaigns to affect behavior should be studied. Trial Registration: Pan-African Clinical Trials Registry (PACTR) PACTR201512001352180; https://tinyurl.com/3rxvsrbe UR - https://pediatrics.jmir.org/2023/1/e40561 UR - http://dx.doi.org/10.2196/40561 UR - http://www.ncbi.nlm.nih.gov/pubmed/37213174 ID - info:doi/10.2196/40561 ER - TY - JOUR AU - Hedges, Joanne AU - Sethi, Sneha AU - Garvey, Gail AU - Whop, J. Lisa AU - Canfell, Karen AU - Dodd, Zell AU - Larkins, Priscilla AU - Antonsson, Annika AU - Smith, A. Megan AU - Mittinty, Murthy AU - Leane, Catherine AU - Reid, Nicolas AU - Ooi, H. Eng AU - Ju, Xiangqun AU - Logan, Richard AU - Jamieson, Lisa PY - 2023/5/17 TI - The Indigenous Australian Human Papillomavirus (HPV) Cohort Study 2, Continuation for 5 to 10 Years: Protocol for a Longitudinal Study JO - JMIR Res Protoc SP - e44593 VL - 12 KW - Aboriginal South Australian KW - human papillomavirus KW - oral HPV infection KW - oral pharyngeal squamous cell carcinoma KW - OPSCC N2 - Background: Human papillomavirus (HPV) infection, a common sexually transmitted disease, is associated with cancers of the cervix, vulva, vagina, penis, anus, and head and neck. Oropharyngeal squamous cell carcinoma (OPSCC; throat cancer) is a type of cancer involving the head and neck area that is rapidly increasing across the globe. There are higher rates of OPSCC among Indigenous populations relative to non?Indigenous Australian populations, although the HPV-attributable fraction remains unknown. For the first time at a global level, we plan to extend an Indigenous Australian adult cohort to monitor, screen, and ultimately prevent HPV-associated OPSCC and to undertake extensive cost-effectiveness modelling around HPV vaccination. Objective: This study aims to (1) extend follow-up to a minimum of 7 years post recruitment to describe the prevalence, incidence, clearance, and persistence of oral HPV infection; and (2) conduct clinical examinations of the head and neck, oral cavity, and oropharynx and collect saliva samples for early-stage OPSCC testing. Methods: We will continue to implement a longitudinal design for the next study phase, where we will ascertain the prevalence, incidence, clearance, and persistence of oral HPV infection at 48, 60, and 72 months; undertake clinical examinations/saliva assessments to detect early-stage OPSCC; and refer for treatment. The primary outcome measures are changes in oral HPV infection status, biomarker measures of early HPV-related cancer, and clinical evidence of early-stage OPSCC. Results: Participant 48-month follow-up will commence in January 2023. The first results are expected to be submitted for publication 1 year after 48-month follow-up begins. Conclusions: Our findings have potential to change the way in which OPSCC among Australian Indigenous adults is managed, with desired impacts including cost-savings on expensive cancer treatments; improved nutritional, social, and emotional outcomes; and improved quality of life for both Indigenous adults and the Indigenous community more broadly. Continuing a large, representative Indigenous adult cohort to track oral HPV infection and monitor early OPSCC is essential to yield critical information to include in the management armamentarium of health and well-being recommendations for Australia?s First Nations. International Registered Report Identifier (IRRID): PRR1-10.2196/44593 UR - https://www.researchprotocols.org/2023/1/e44593 UR - http://dx.doi.org/10.2196/44593 UR - http://www.ncbi.nlm.nih.gov/pubmed/37195752 ID - info:doi/10.2196/44593 ER - TY - JOUR AU - Jahnke, R. Hannah AU - Rubin-Miller, Lily AU - Henrich, Natalie AU - Moss, Christa AU - Shah, Neel AU - Peahl, Alex PY - 2023/5/15 TI - Association Between the Use of a Digital Health Platform During Pregnancy and Helping Users Avoid Emergency and In-Person Care: Retrospective Observational Study JO - J Med Internet Res SP - e43180 VL - 25 KW - pregnancy KW - telehealth KW - web-based care KW - emergency room KW - value-based care KW - digital care KW - prenatal care N2 - Background: Almost one-third of pregnant people visit the emergency room during pregnancy. Although some emergency care is necessary, gaps in patient education and inaccessibility of preventive services have been identified as key reasons for high-cost, low-value care in pregnancy. Digital platforms present a promising solution for providing resources to supplement routine prenatal care, thereby reducing the use of low-value in-person services. Objective: This study aimed to describe the relationship between the use of Maven and in-person care avoidance (emergency room or office visits) during pregnancy. Maven is a digital prenatal health platform that supplements routine prenatal care. Maven offers educational content (articles, videos, and classes), care coordination (through a care advocate), and provider services (web-based appointments and communication with providers) designed to complement prenatal care. Specifically, the aims of this study were to examine whether the use of Maven is associated with in-person care avoidance overall and whether improvements in pregnancy-related knowledge facilitate in-person care avoidance. To assess aim 2, we tested if the use of Maven is associated with improvements in self-reported understanding of warning signs and medically accurate information and if self-reported understanding of medically accurate information and warning signs is associated with in-person care avoidance in a population of Maven users. Methods: In this retrospective study, we used adjusted logistic regression to examine the relationship between digital platform use, avoidance of in-person care, and the platform?s influence on pregnancy-related knowledge (learning medically accurate information and recognizing warning signs). Demographics, medical history, and in-person care avoidance were self-reported. Results: Of the 5263 users, 280 (5.32%) reported that Maven helped them avoid in-person care during pregnancy. More users who reported avoiding in-person care also reported that the digital platform helped them understand warning signs (231/280, 82.5%) and learned medically accurate information (185/280, 66.1%). In the adjusted models, all modes of digital service use (assessed as quartiles) were associated with avoiding in-person care in a dose-response manner (eg, web-based provider appointments: Q2 adjusted odds ratio [aOR] 1.57, 95% CI 1.00-2.41; Q3 aOR 2.53, 95% CI 1.72-3.72; Q4 aOR 5.26, 95% CI 3.76-7.42). Users were more likely to avoid in-person care if they reported that Maven helped them recognize warning signs (aOR 3.55, 95% CI 2.60-4.94) or learn medically accurate information (aOR 2.05, 95% CI 1.59-2.67). Conclusions: These results suggest that digital platforms can be effective in helping patients to avoid in-person care. The educational pathway suggests that digital platforms can be particularly effective in helping patients recognize warning signs and learn medically accurate information, which may help them avoid in-person care by recognizing when in-person care is medically appropriate. Future work is needed to assess other pathways through which digital resources can support pregnant people and improve perinatal care use. UR - https://www.jmir.org/2023/1/e43180 UR - http://dx.doi.org/10.2196/43180 UR - http://www.ncbi.nlm.nih.gov/pubmed/37184930 ID - info:doi/10.2196/43180 ER - TY - JOUR AU - Swanson, Karl AU - Ravi, Akshay AU - Saleh, Sameh AU - Weia, Benjamin AU - Pleasants, Elizabeth AU - Arvisais-Anhalt, Simone PY - 2023/5/12 TI - Effect of Recent Abortion Legislation on Twitter User Engagement, Sentiment, and Expressions of Trust in Clinicians and Privacy of Health Information: Content Analysis JO - J Med Internet Res SP - e46655 VL - 25 KW - Roe v Wade KW - Dobbs v Jackson?s Women?s Health Organization KW - abortion KW - family planning KW - sentiment analysis KW - women?s rights KW - twitter KW - trust KW - natural language processing KW - legislation KW - social media KW - reproductive health care KW - health information KW - users N2 - Background: The Supreme Court ruling in Dobbs v Jackson Women?s Health Organization (Dobbs) overrules precedents established by Roe v Wade and Planned Parenthood v Casey and allows states to individually regulate access to abortion care services. While many states have passed laws to protect access to abortion services since the ruling, the ruling has also triggered the enforcement of existing laws and the creation of new ones that ban or restrict abortion. In addition to denying patients the full spectrum of reproductive health care, one major concern in the medical community is how the ruling will undermine trust in the patient-clinician relationship by influencing perceptions of the privacy of patient health information. Objective: This study aimed to study the effect of recent abortion legislation on Twitter user engagement, sentiment, expressions of trust in clinicians, and privacy of health information. Methods: We scraped tweets containing keywords of interest between January 1, 2020, and October 17, 2022, to capture tweets posted before and after the leak of the Supreme Court decision. We then trained a Latent Dirichlet Allocation model to select tweets pertinent to the topic of interest and performed a sentiment analysis using Robustly Optimized Bidirectional Encoder Representations from Transformers Pre-training Approach model and a causal impact time series analysis to examine engagement and sentiment. In addition, we used a Word2Vec model to study the terms of interest against a latent trust dimension to capture how expressions of trust for our terms of interest changed over time and used term frequency, inverse-document frequency to measure the volume of tweets before and after the decision with respect to the negative and positive sentiments that map to our terms of interest. Results: Our study revealed (1) a transient increase in the number of daily users by 576.86% (95% CI 545.34%-607.92%; P<.001), tweeting about abortion, health care, and privacy of health information postdecision leak; (2) a sustained and statistically significant decrease in the average daily sentiment on these topics by 19.81% (95% CI ?22.98% to ?16.59%; P=.001) postdecision leak; (3) a decrease in the association of the latent dimension of trust across most clinician-related and health information?related terms of interest; (4) an increased frequency of tweets with these clinician-related and health information?related terms and concomitant negative sentiment in the postdecision leak period. Conclusions: The study suggests that the Dobbs ruling has consequences for health systems and reproductive health care that extend beyond denying patients access to the full spectrum of reproductive health services. The finding of a decrease in the expression of trust in clinicians and health information?related terms provides evidence to support advocacy and initiatives that proactively address concerns of trust in health systems and services. UR - https://www.jmir.org/2023/1/e46655 UR - http://dx.doi.org/10.2196/46655 UR - http://www.ncbi.nlm.nih.gov/pubmed/37171873 ID - info:doi/10.2196/46655 ER - TY - JOUR AU - Sheehan, Maria Orla AU - Greene, Anthony Richard AU - McKernan, Joye AU - Murphy, Brendan AU - Cahill, Caroline AU - Cleary, Brian AU - Lawlor, Fiona AU - Robson, Michael AU - PY - 2023/5/12 TI - Introduction of a Single Electronic Health Record for Maternity Units in Ireland: Outline of the Experiences of the Project Management Team JO - JMIR Form Res SP - e38938 VL - 7 KW - baby KW - babies KW - data management KW - data quality KW - electronic health record KW - health management KW - implementation KW - information management KW - Ireland KW - lessons learned KW - management system KW - maternity KW - maternal KW - mother KW - newborn KW - optimization KW - planning KW - pregnant KW - pregnancy KW - project management UR - https://formative.jmir.org/2023/1/e38938 UR - http://dx.doi.org/10.2196/38938 UR - http://www.ncbi.nlm.nih.gov/pubmed/37171841 ID - info:doi/10.2196/38938 ER - TY - JOUR AU - Wilson, A. Lindsay AU - Gandhi, Preet PY - 2023/5/10 TI - Opioid Agonist Therapies and Pregnancy Outcomes for Pregnant People With Opioid Use Disorder: Protocol for a Systematic Review JO - JMIR Res Protoc SP - e42417 VL - 12 KW - opioid agonist therapies KW - opioid use disorder KW - pregnancy KW - opioid KW - drug KW - symptoms KW - treatment KW - screening KW - data KW - risk KW - clinical KW - policy makers KW - community N2 - Background: Opioid use disorder (OUD) during pregnancy presents a significant risk to maternal, fetal, and neonatal health, increasing the likelihood of adverse events, such as maternal overdose, pregnancy loss, stillbirth, preterm birth, low birth weight, and neonatal abstinence syndrome. In order to reduce the risk of these outcomes, the standard of care for OUD during pregnancy in many jurisdictions within the United States and Canada is opioid agonist therapy (OAT). OAT refers to prescription medications that alleviate or eliminate opioid withdrawal symptoms, so that opioid use can be managed more safely. Although OAT has been recognized as a safe option for pregnant people with OUD, many jurisdictions do not have treatment guidelines regarding pharmacological options, dosing recommendations, side effect management, and individual preferences. There is currently a lack of systematic evidence on the impacts of different OAT regimens on pregnancy outcomes. Objective: We aim to evaluate the impacts of specific OAT agents on pregnancy outcomes and inform recommendations for practitioners treating pregnant people with OUD. Methods: The MEDLINE, Embase, CINAHL, and PsycINFO databases will be searched for published quantitative studies assessing pregnancy outcomes for individuals on OAT. Given the substantially increased risk of preterm birth, low birth weight, small for gestational age, and stillbirth among pregnant people with OUD, these four end points will comprise our primary outcomes. Database searches will not be restricted by date, and conference abstracts will be restricted to the past 2 years. Titles, abstracts, and full-text articles will be independently screened by 2 reviewers. Data will be extracted independently and in duplicate, using a data extraction form to reduce the risk of reviewer bias. The risk of bias within individual studies will be assessed by using the appropriate CASP (Critical Appraisal Skills Programme) checklists. For studies that consider the same research questions, interventions, or outcomes, meta-analyses will be conducted to synthesize the pooled effect size. In the event that studies cannot be compared directly, results will be synthesized in a narrative account. Between-study heterogeneity will be measured by using the ?2 statistic. If more than 10 studies are available for pooling, publication bias will be evaluated by using the Egger regression test. Results: As of January 2023, a total of 3266 abstracts have been identified for screening. Data extraction is expected to commence in February 2023. Conclusions: The topic of OAT and its effect on pregnancy is an understudied area that has the potential to improve health outcomes, clinical practice, education, and community advocacy. The results of our review will be used to inform clinical practice guidelines and improve health outcomes for pregnant people. Findings will be disseminated to diverse groups of stakeholders, including policy makers, clinicians, community partners, and individuals with lived experience of drug use. Trial Registration: PROSPERO CRD42022332082; https://tinyurl.com/2p94pkx5 International Registered Report Identifier (IRRID): DERR1-10.2196/42417 UR - https://www.researchprotocols.org/2023/1/e42417 UR - http://dx.doi.org/10.2196/42417 UR - http://www.ncbi.nlm.nih.gov/pubmed/37163329 ID - info:doi/10.2196/42417 ER - TY - JOUR AU - Pagoto, L. Sherry AU - Palmer, Lindsay AU - Horwitz-Willis, Nate PY - 2023/5/4 TI - The Next Infodemic: Abortion Misinformation JO - J Med Internet Res SP - e42582 VL - 25 KW - abortion KW - reproductive health KW - misinformation KW - online KW - infodemic KW - misleading information KW - online health information KW - health authority KW - public health KW - women's health UR - https://www.jmir.org/2023/1/e42582 UR - http://dx.doi.org/10.2196/42582 UR - http://www.ncbi.nlm.nih.gov/pubmed/37140975 ID - info:doi/10.2196/42582 ER - TY - JOUR AU - Zhaunova, Liudmila AU - Bamford, Ryan AU - Radovic, Tara AU - Wickham, Aidan AU - Peven, Kimberly AU - Croft, Jazz AU - Klepchukova, Anna AU - Ponzo, Sonia PY - 2023/4/26 TI - Characterization of Self-reported Improvements in Knowledge and Health Among Users of Flo Period Tracking App: Cross-sectional Survey JO - JMIR Mhealth Uhealth SP - e40427 VL - 11 KW - health knowledge KW - menstrual cycle KW - pregnancy KW - period-tracking app KW - digital health KW - women?s health N2 - Background: Research shows that poor knowledge and awareness of menstrual and pregnancy health among women are associated with adverse reproductive health and pregnancy outcomes. Menstrual cycle? and pregnancy-tracking mobile apps are promising tools for improving women?s awareness of and attitudes toward their reproductive health; however, there is little information about subscribers? perceptions of app functionality and its impact on their knowledge and health. Objective: This study aimed to explore knowledge and health improvements related to menstrual cycle and pregnancy, as well as improvements in general health among Flo app users. We also investigated what components of the Flo app were associated with the abovementioned improvements and evaluated whether those improvements differed based on education level, country of residence (low- and middle-income vs high-income countries), free or premium subscription to the app, short- or long-term use of the app, and frequency of use. Methods: Flo subscribers who had been using the app for no less than 30 days, completed a web-based survey. A total of 2212 complete survey responses were collected. The survey included demographic questions and questions about motivations guiding the use of the Flo app and which components of the app improved their knowledge and health, as well as to what extent. Results: Most study participants reported improvements in menstrual cycle (1292/1452, 88.98%) and pregnancy (698/824, 84.7%) knowledge from Flo app use. Participants with higher levels of education and those from high-income countries reported using the app predominantly for getting pregnant (?21=4.2, P=.04; ?21=52.3, P<.001, respectively) and pregnancy tracking (?21=19.3, P<.001; ?21=20.9, P=.001, respectively). Participants with less education reported using the app to avoid pregnancy (?21=4.2; P=.04) and to learn more about their body (?21=10.8; P=.001) and sexual health (?21=6.3; P=.01), while participants from low- and middle-income countries intended to mainly learn more about their sexual health (?21=18.2; P<.001). Importantly, the intended use of the app across education levels and country income levels matched areas in which they had gained knowledge and achieved their health goals upon use of the Flo app. Period, fertile days, and ovulation predictions as well as symptom tracking were consistently the top 3 components in the app that helped users with their cycle knowledge and general health. Reading articles or watching videos helped with users' education regarding their pregnancy. Finally, the strongest improvements in knowledge and health were observed in premium, frequent, and long-term users. Conclusions: This study suggests that menstrual health apps, such as Flo, could present revolutionary tools to promote consumer health education and empowerment on a global scale. UR - https://mhealth.jmir.org/2023/1/e40427 UR - http://dx.doi.org/10.2196/40427 UR - http://www.ncbi.nlm.nih.gov/pubmed/37099370 ID - info:doi/10.2196/40427 ER - TY - JOUR AU - Oh, Soyeon Sarah AU - Kang, Bada AU - Park, Jewel AU - Kim, SangMin AU - Park, Eun-Cheol AU - Lee, Hee Seung AU - Kawachi, Ichiro PY - 2023/4/21 TI - Racial/Ethnic Disparity in Association Between Fetal Alcohol Syndrome and Alcohol Intake During Pregnancy: Multisite Retrospective Cohort Study JO - JMIR Public Health Surveill SP - e45358 VL - 9 KW - fetal alcohol syndrome KW - ethnic disparity KW - alcohol intake KW - pregnancy KW - health disparity KW - public health KW - minority population KW - vulnerable population KW - women's health KW - pediatrics KW - fetal health N2 - Background: Alcohol consumption during pregnancy is associated with a range of adverse birth-related outcomes, including stillbirth, low birth weight, preterm birth, and fetal alcohol syndrome (FAS). With more than 10% of women consuming alcohol during pregnancy worldwide, it is increasingly important to understand how racial/ethnic variations affect FAS onset. However, whether race and ethnicity inform FAS risk assessment when daily ethanol intake is controlled for remains unknown. Objective: This study aimed to assess racial/ethnic disparities in FAS risk associated with alcohol consumption during pregnancy. Methods: We used data from a longitudinal cohort study (the Collaborative Initiative on Fetal Alcohol Spectrum Disorders) at 5 hospital sites around the United States of 595 women who consumed alcohol during pregnancy from 2007 to 2017. Questionnaires, in-person interviews, and reviews of medical, legal, and social service records were used to gather data on average alcoholic content (AAC) during pregnancy. Self-reports of maternal race (American Indian/Alaska Native [AI/AN], Asian, Native Hawaiian or other Pacific Islander, Black or African American, White, more than one race, and other) and ethnicity (Hispanic/Latino or not Hispanic/Latino), as well as FAS diagnoses based on standardized dysmorphological criteria, were used for analysis. Log-binomial regression was used to examine the risk of FAS associated with each 1-gram increase in ethanol consumption during pregnancy, stratified by race/ethnicity. Results: A total of 3.4% (20/595) of women who reported consuming alcohol during pregnancy gave birth to a baby with FAS. Women who gave birth to a baby with FAS had a mean AAC of 32.06 (SD 9.09) grams, which was higher than that of women who did not give birth to a baby with FAS (mean 12.07, SD 15.87 grams). AI/AN mothers with FAS babies had the highest AAC (mean 42.62, SD 8.35 grams), followed by White (mean 30.13, SD 4.88 grams) and Black mothers (mean 27.05, SD 12.78 grams). White (prevalence ratio [PR] 1.10, 95% CI 1.03-1.19), Black (PR 1.13, 95% CI 1.04-1.23), and AI/AN (PR 1.10, 95% CI 1.00-1.21) mothers had 10% to 13% increased odds of giving birth to a baby with FAS given the same exposure to alcohol during pregnancy. Regardless of race, a 1-gram increase in AAC resulted in a 4% increase (PR 1.04, 95% CI 1.02-1.07) in the chance of giving birth to a baby with ?2 facial anomalies (ie, short palpebral fissures, thin vermilion border of the upper lip, and smooth philtrum) and a 4% increase (PR 1.04, 95% CI 1.01-1.07) in the chance of deficient brain growth. Conclusions: The risk of delivering a baby with FAS was comparable among White, Black, and AI/AN women at similar levels of drinking during pregnancy. Regardless of race, a 1-gram increase in AAC resulted in increased odds of giving birth to a baby with facial anomalies or deficient brain growth. UR - https://publichealth.jmir.org/2023/1/e45358 UR - http://dx.doi.org/10.2196/45358 UR - http://www.ncbi.nlm.nih.gov/pubmed/37083819 ID - info:doi/10.2196/45358 ER - TY - JOUR AU - Stevens-Uninsky, Maya AU - Barkhad, Aisha AU - MacDonald, Tonya AU - Perez, Alexander AU - Mbuagbaw, Lawrence PY - 2023/4/14 TI - Decolonization in Sexual and Reproductive Health Research Methods: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e45771 VL - 12 KW - sexual and reproductive health KW - decolonized research KW - decolonized methodologies KW - community-centered research KW - indigenous research KW - scoping review KW - electronic database KW - colonialism KW - decolonization KW - indigenous peoples KW - decolonizing methodologies KW - decolonizing method KW - human sexuality, reproduction KW - reproductive health KW - Aboriginal N2 - Background: As researchers and implementors begin to acknowledge the repercussions of institutionalized colonialism on community and individual health, the need to decolonize research has become clear. Despite this, there is neither a singular definition of decolonizing methodologies nor an overview of the shared principles and characteristics of decolonized research needed to codify this work as common practice in global health. Objective: The review will identify papers that reference principles of decolonization and identify shared characteristics between them. The aim of this scoping review is to review decolonized research methodologies through the lens of sexual health as a step in creating a shared understanding of best practices. We will further examine the tools and methods used to collect and analyze data within the included studies. Methods: The protocol for this scoping review was developed using the framework from the Joanna Briggs Institute and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews). The search strategy will comprise a search of electronic databases (JSTOR, Embase, EMCare, MEDLINE [Ovid], Global Health Database, Web of Science), gray literature sources, and key studies. Titles and abstracts will be reviewed by 2 or more independent reviewers against inclusion criteria. Bibliometric details, study design, methodology, community involvement, and other indicators will be collected using a data extraction tool developed for this review. Extracted data will be analyzed using descriptive statistics and qualitative analysis of content and themes to identify common practices in decolonized methodologies within sexual health. Narrative summaries will be used to describe results in relation to the research question, and identified gaps will be discussed. Results: The initial title or abstract review of 4967 studies identified by the search strategy was completed in November 2022. In total, 1777 studies met initial inclusion criteria and were sent to a second round of title or abstract review, which was completed in January 2023. In total, 706 studies were downloaded for full-text inclusion, which is expected to be completed by April 2023. We aim to complete data extraction and analysis by May 2023 and expect to publish the findings by the end of July 2023. Conclusions: There remains a gap in the research on the meaning and application of decolonized research strategies, particularly within sexual and reproductive health. The findings of this study will contribute to a shared definition of decolonized methodologies and how they can be applied as a common practice in global health research. Applications include the development of decolonized frameworks, theoretical discourses, and methodologies. The study will inform the design and implementation of future decolonized research and evaluation strategies, particularly around sexual and reproductive health. International Registered Report Identifier (IRRID): DERR1-10.2196/45771 UR - https://www.researchprotocols.org/2023/1/e45771 UR - http://dx.doi.org/10.2196/45771 UR - http://www.ncbi.nlm.nih.gov/pubmed/37058333 ID - info:doi/10.2196/45771 ER - TY - JOUR AU - Sherer, L. Morgan AU - Malik, Abid AU - Osborne, M. Lauren AU - Rowther, A. Armaan AU - Zaidi, Ahmed AU - Atif, Najia AU - Rahman, Atif AU - Kahloon, E. Lubna AU - Salman, Muhammad AU - Yenokyan, Gayane AU - Surkan, J. Pamela PY - 2023/4/11 TI - Biological Mechanisms in Pregnant Women With Anxiety (Happy Mother-Healthy Baby Supplement Study): Protocol for a Longitudinal Mixed Methods Observational Study JO - JMIR Res Protoc SP - e43193 VL - 12 KW - antenatal anxiety KW - perinatal anxiety KW - pregnancy KW - cognitive behavioral therapy KW - inflammation KW - allopregnanolone KW - Pakistan KW - randomized controlled trial N2 - Background: Anxiety and depression are common in the perinatal period and negatively affect the health of the mother and baby. Our group has developed ?Happy Mother-Healthy Baby? (HMHB), a cognitive behavioral therapy?based psychosocial intervention to address risk factors specific to anxiety during pregnancy in low- and middle-income countries (LMICs). Objective: The purpose of this study is to examine biological mechanisms that may be linked to perinatal anxiety in conjunction with a randomized controlled trial of HMHB in Pakistan. Methods: We are recruiting 120 pregnant women from the Holy Family Hospital, a public facility in Rawalpindi, Pakistan. Participants are assessed for at least mild anxiety symptoms using the Hospital Anxiety and Depression Scale (ie, a score ?8 on the anxiety scale is necessary for inclusion in the anxiety groups and <8 for inclusion in the healthy control group). Women who meet the criteria for an anxiety group are randomized into either the HMHB intervention group or an enhanced usual care (EUC) control group. Participants receive HMHB or EUC throughout pregnancy and undergo blood draws at 4 time points (baseline, second trimester, third trimester, and 6 weeks post partum). We will assess peripheral cytokine concentrations using a multiplex assay and hormone concentrations using gas chromatography and mass spectrometry. The statistical analysis will use generalized linear models and mixed effects models to assess the relationships across time among anxiety, immune dysregulation, and hormone levels, and to assess whether these biological factors mediate the relationship between anxiety and birth and child development outcomes. Results: Recruitment started on October 20, 2020, and data collection was completed on August 31, 2022. The start date for recruitment for this biological supplement study was delayed by approximately half a year due to the COVID-19 pandemic. The trial was registered at ClinicalTrials.gov (NCT03880032) on September 22, 2020. The last blood samples were shipped to the United States on September 24, 2022, where they will be processed for analysis. Conclusions: This study is an important addition to the HMHB randomized controlled trial of an intervention for antenatal anxiety. The intervention itself makes use of nonspecialist providers and, if effective, will represent an important new tool for the treatment of antenatal anxiety in LMICs. Our biological substudy is one of the first attempts to link biological mechanisms to antenatal anxiety in an LMIC in the context of a psychosocial intervention, and our findings have the potential to significantly advance our knowledge of the biological pathways of perinatal mental illness and treatment efficacy. Trial Registration: ClinicalTrials.gov NCT03880032; https://clinicaltrials.gov/ct2/show/NCT03880032 International Registered Report Identifier (IRRID): DERR1-10.2196/43193 UR - https://www.researchprotocols.org/2023/1/e43193 UR - http://dx.doi.org/10.2196/43193 UR - http://www.ncbi.nlm.nih.gov/pubmed/37040167 ID - info:doi/10.2196/43193 ER - TY - JOUR AU - Hendricks-Sturrup, Rachele AU - Lu, Y. Christine PY - 2023/3/10 TI - An Assessment of Perspectives and Concerns Among Research Participants of Childbearing Age Regarding the Health-Relatedness of Data, Online Data Privacy, and Donating Data to Researchers: Survey Study JO - J Med Internet Res SP - e41937 VL - 25 KW - privacy KW - digital data KW - research KW - abortion KW - women's health KW - reproductive health KW - reproductive informatics KW - digital footprint KW - family planning N2 - Background: The June 2022 US Supreme Court decision to ban abortion care in Dobbs v Jackson Women?s Health Organization sparked ominous debate about the privacy and safety of women and families of childbearing age with digital footprints who actively engage in family planning, including abortion and miscarriage care. Objective: To assess the perspectives of a subpopulation of research participants of childbearing age regarding the health-relatedness of their digital data, their concerns about the use and sharing of personal data online, and their concerns about donating data from various sources to researchers today or in the future. Methods: An 18-item electronic survey was developed using Qualtrics and administered to adults (aged ?18 years) registered in the ResearchMatch database in April 2021. Individuals were invited to participate in the survey regardless of health status, race, gender, or any other mutable or immutable characteristics. Descriptive statistical analyses were conducted using Microsoft Excel and manual queries (single layer, bottom-up topic modeling) and used to categorize illuminating quotes from free-text survey responses. Results: A total of 470 participants initiated the survey and 402 completed and submitted the survey (for an 86% completion rate). Nearly half the participants (189/402, 47%) self-reported to be persons of childbearing age (18 to 50 years). Most participants of childbearing age agreed or strongly agreed that social media data, email data, text message data, Google search history data, online purchase history data, electronic medical record data, fitness tracker and wearable data, credit card statement data, and genetic data are health-related. Most participants disagreed or strongly disagreed that music streaming data, Yelp review and rating data, ride-sharing history data, tax records and other income history data, voting history data, and geolocation data are health-related. Most (164/189, 87%) participants were concerned about fraud or abuse based on their personal information, online companies and websites sharing information with other parties without consent, and online companies and websites using information for purposes that are not explicitly stated in their privacy policies. Free-text survey responses showed that participants were concerned about data use beyond scope of consent; exclusion from health care and insurance; government and corporate mistrust; and data confidentiality, security, and discretion. Conclusions: Our findings in light of Dobbs and other related events indicate there are opportunities to educate research participants about the health-relatedness of their digital data. Developing strategies and best privacy practices for discretion regarding digital-footprint data related to family planning should be a priority for companies, researchers, families, and other stakeholders. UR - https://www.jmir.org/2023/1/e41937 UR - http://dx.doi.org/10.2196/41937 UR - http://www.ncbi.nlm.nih.gov/pubmed/36897637 ID - info:doi/10.2196/41937 ER - TY - JOUR AU - Memon, Ali Zahid AU - Mian, Abeer AU - Reale, Sophie AU - Spencer, Rachael AU - Bhutta, Zulfiqar AU - Soltani, Hora PY - 2023/3/10 TI - Community and Health Care Provider Perspectives on Barriers to and Enablers of Family Planning Use in Rural Sindh, Pakistan: Qualitative Exploratory Study JO - JMIR Form Res SP - e43494 VL - 7 KW - gender KW - sexual and reproductive health KW - modern contraception KW - family planning N2 - Background: Unmet need for family planning in Pakistan is high, with 17% of all married women wanting to avoid or delay pregnancy. However, they cannot owing to a lack of access to modern contraception and sociocultural hindrances. With the modern contraceptive prevalence rate stagnant at approximately 25% over the last 5 years, it is important to explore barriers and enablers to modern contraception uptake to reduce maternal and child mortality and improve reproductive health outcomes for young girls and women. Objective: A formative research approach was taken to explore community member and health care provider perspectives on access to and use of family planning methods in 2 rural districts of Sindh, Pakistan. The broader goal of this study was to provide evidence to design and implement a socioculturally appropriate family planning intervention within the existing service delivery platforms to increase modern contraceptive uptake in the context of rural Sindh. Methods: A qualitative exploratory design was used. Between October 2020 and December 2020, 11 focus group discussions and 11 in-depth interviews were conducted. Focus group discussions were held with men and women from the community, including adolescents, to build an understanding of community beliefs and concepts regarding modern contraceptive methods. In-depth interviews were conducted with health care workers and explored intersections between family planning and reproductive health service delivery at the facility and outreach levels. Results: The findings revealed that limited financial autonomy, restricted women?s mobility, discriminatory gender norms, and cultural practices left women with little opportunity for independent decision-making on the use of modern contraceptive methods. Furthermore, facility-level and supply-side barriers, including frequent stock-outs of modern contraceptives combined with a lack of capacity of health workers to provide quality family planning services and counseling, played an important role in demotivating women from seeking services. In addition, a lack of integration of family planning with maternal and child health service delivery at the health system level was emphasized as a major missed opportunity for contraceptive uptake. Several demand-side barriers to family planning uptake were also highlighted. These included husbands? or in-laws? disapproval, social stigma, and perceived fear of side effects regarding modern family planning method use. More importantly, a lack of adolescent-friendly reproductive health services and spaces for counseling was identified as a critical intervention area. Conclusions: This study provides qualitative evidence on issues related to the effectiveness of family planning interventions, specifically in the context of rural Sindh. The findings emphasize the need to design socioculturally appropriate and health system?relevant family planning interventions?the effectiveness of which can be improved through their integration with maternal and child health service delivery mechanisms, consistent service provision, and opportunities for the capacity building of the health care workforce. International Registered Report Identifier (IRRID): RR2-10.2196/35291 UR - https://formative.jmir.org/2023/1/e43494 UR - http://dx.doi.org/10.2196/43494 UR - http://www.ncbi.nlm.nih.gov/pubmed/36897626 ID - info:doi/10.2196/43494 ER - TY - JOUR AU - Hojeij, Batoul AU - Schoenmakers, Sam AU - Willemsen, Sten AU - van Rossem, Lenie AU - Dinnyes, Andras AU - Rousian, Melek AU - Steegers-Theunissen, PM Regine PY - 2023/1/31 TI - The Effect of an eHealth Coaching Program (Smarter Pregnancy) on Attitudes and Practices Toward Periconception Lifestyle Behaviors in Women Attempting Pregnancy: Prospective Study JO - J Med Internet Res SP - e39321 VL - 25 KW - diet KW - lifestyle KW - attitudes KW - practices KW - eHealth KW - pregnancy KW - Smarter Pregnancy N2 - Background: Lifestyle behaviors during the periconception period contribute to achievement of a successful pregnancy. Assessment of attitudes and practices toward these modifiable behaviors can aid in identifying gaps in unhealthy lifestyle behaviors with impact on intervention effectiveness. Objective: This study investigates the effectiveness of coaching by the eHealth program Smarter Pregnancy during the periconception period on improvement of attitudes and practices toward fruit and vegetable intake and smoking in women attempting pregnancy through assisted reproductive technology (ART) or natural conception. Methods: Women attempting pregnancy through ART (n=1060) or natural conception (n=631) were selected during the periconception period. The intervention groups, conceived through ART or naturally, received Smarter Pregnancy coaching for 24 weeks, whereas the control group conceived through ART and did not receive coaching. Attitudes and practices at baseline and follow-up periods were obtained from self-administered online questionnaire provided by the program. Attitudes were assessed in women with unhealthy behaviors as their intention to increase their fruit and vegetable intake and to quit smoking using a yes/no question. Outcomes on practices, suggesting effectiveness, included daily fruit (pieces) and vegetable (grams) intake, and if women smoked (yes/no). Changes in attitudes and practices were compared at 12 and 24 weeks with baseline between the ART intervention and ART control groups, and within the intervention groups between ART and natural conception. Changes in practices at 12 and 24 weeks were also compared with baseline between women with negative attitude and positive attitude within the intervention groups: ART and natural conception. Analysis was performed using linear and logistic regression models adjusted for maternal confounders and baseline attitudes and practices. Results: The ART intervention group showed higher vegetable intake and lower odds for negative attitudes toward vegetable intake after 12 weeks (?adj=25.72 g, P<.001; adjusted odds ratio [ORadj] 0.24, P<.001) and 24 weeks of coaching (?adj=23.84 g, P<.001; ORadj 0.28, P<.001) compared with ART controls. No statistically significant effect was observed on attitudes and practices toward fruit intake (12 weeks: P=.16 and .08, respectively; 24 weeks: P=.16 and .08, respectively) and smoking behavior (12 weeks: P=.87; 24 weeks: P=.92). No difference was observed for the studied attitudes and practices between the ART intervention and natural conception intervention groups. Women with persistent negative attitude toward fruit and vegetable intake at week 12 showed lower fruit and vegetable intake at week 24 compared with women with positive attitude (?adj=?.49, P<.001; ?adj=?30.07, P<.001, respectively). Conclusions: The eHealth Smarter Pregnancy program may improve vegetable intake?related attitudes and practices in women undergoing ART treatment. Women with no intention to increase fruit and vegetable intake had less improvement in their intakes. Despite small changes, this study demonstrates again that Smarter Pregnancy can be used to improve vegetable intake, which can complemented by blended care that combines face-to-face and online care to also improve fruit intake and smoking behavior. UR - https://www.jmir.org/2023/1/e39321 UR - http://dx.doi.org/10.2196/39321 UR - http://www.ncbi.nlm.nih.gov/pubmed/36719733 ID - info:doi/10.2196/39321 ER - TY - JOUR AU - Sparidaens, Marie Ellen AU - Logger, M. Jade G. AU - Nelen, M. Willianne L. D. AU - Braat, M. Didi D. AU - Fleischer, Kathrin AU - Hermens, M. Rosella P. PY - 2023/1/24 TI - Web-based Guidance for Assisted Reproductive Technology With an Online App (myFertiCare): Quantitative Evaluation With the HOT-fit Framework JO - J Med Internet Res SP - e38535 VL - 25 KW - eHealth KW - personalized KW - interactive KW - evaluation KW - HOT-fit framework KW - assisted reproductive technologies KW - reproductive KW - technology KW - online KW - app KW - application KW - tool KW - internet KW - usability KW - infertility KW - variables KW - treatment KW - women KW - care KW - stress N2 - Background: Assisted reproductive technologies (ARTs) are considered to be physically and mentally stressful. During their treatment trajectory, couples express high information and communication needs. They appreciate using the internet to obtain fertility-related information. In a previous study, we developed myFertiCare, an eHealth tool providing personalized information and interactive functionalities for infertile couples in order to improve patient-centered care. The app has already been successful in qualitative evaluations of usability. Objective: The aim of the current study is to quantitatively evaluate the implementation of myFertiCare by using the human, organizational, and technology?fit (HOT-fit) framework and to study the effects of using myFertiCare on couples? knowledge about infertility, their experience of the burden of infertility, and their experience of patient-centered care. With these results, implementation can be further improved, and patient-centered care can be enhanced. Methods: A quantitative study was performed based on the HOT-fit framework using validated questionnaires focusing on the human, organizational, and technology domains. Questions were added on the effect of using myFertiCare on couples? knowledge about infertility and treatment. Questions regarding the burden of infertility, the burden of infertility treatment, and the experience of patient-centeredness were based on the main items of the validated fertility quality of life (FertiQoL) and Patient-Centredness Questionnaire?Infertility questionnaires, respectively. Also, nonusers of the app were included to explore motivations for not using the app and identify opportunities for improvement. Finally, user data were analyzed to provide insight into multiple variables concerning app use. Results: In the human and technology domains, myFertiCare showed good system usability, high user satisfaction, and high information and interface quality. In the organizational domain, implementation was considered to be sufficient by both patients and staff. Use of the app increased knowledge about the treatment, improved coping with the treatment, and enhanced the experience of patient-centeredness. User data showed that women were the main app users and that use of the app gradually declined during the treatment trajectory. Conclusions: A multi-faceted online app, myFertiCare, has been successfully evaluated quantitatively for implementation by using the HOT-fit framework. Use of the app increased knowledge about the treatment, improved coping with the treatment, and enhanced the experience of patient-centeredness. App use could be improved by creating more publicity. By providing myFertiCare, professionals in fertility care are supported in guiding patients through their treatment trajectory and in delivering patient-centered care. UR - https://www.jmir.org/2023/1/e38535 UR - http://dx.doi.org/10.2196/38535 UR - http://www.ncbi.nlm.nih.gov/pubmed/36692928 ID - info:doi/10.2196/38535 ER - TY - JOUR AU - van der Windt, Melissa AU - van Zundert, Maria Sofie Karolina AU - Schoenmakers, Sam AU - van Rossem, Lenie AU - Steegers-Theunissen, Maria Régine Patricia PY - 2023/1/20 TI - Prototyping of a Digital Life Course Care Platform for Preconception and Pregnancy Care: Pilot Feasibility and Acceptability Study JO - J Med Internet Res SP - e37537 VL - 25 KW - eHealth KW - app KW - lifestyle KW - lifestyle care KW - life course care KW - preconception KW - periconception KW - pregnancy KW - health care KW - pilot N2 - Background: A healthy lifestyle plays a key role in the prevention of lifestyle-related diseases, including subfertility and pregnancy complications. Although the benefits of a healthy lifestyle are well-known, long-term adherence is limited. Moreover, memory for lifestyle-related information as well as medical information provided by the medical professional is often poor and insufficient. In order to innovate and improve health care for both the patients and health care professionals, we developed a prototype of a digital life course care platform (Smarter Health app), providing personalized lifestyle care trajectories integrated in medical care journeys. Objective: This pilot study aimed to evaluate the feasibility, defined as the actual app use, and the acceptability, which included patient satisfaction and appreciation, of the Smarter Health app. Methods: Between March 17, 2021, and September 30, 2021, pregnant women familiar with the Dutch language seeking tertiary preconception and pregnancy care were offered the app as part of standard medical care at the outpatient clinic Healthy Pregnancy of the Department of Obstetrics and Gynecology of the Erasmus University Medical Center. Three months after activation of the app, patients received a digital questionnaire consisting of aspects of feasibility and acceptability. Results: During this pilot study, 440 patients visited the outpatient clinic Healthy Pregnancy. Of the 440 patients, 293 (66.6%) activated the app. Of the 293 patients who activated the app, 125 (42.7%) filled out the questionnaire. Of these 125 patients, 48 (38.4%) used the app. Most app users used it occasionally and logged in 8 times during their medical care trajectory. Overall, app users were satisfied with the app (median 5-point Likert scale=2.4, IQR 2.0-3.3). Conclusions: Our findings showed that the Smarter Health app, which integrates lifestyle care in medical care, is a feasible health care innovation, and that patients were satisfied with the app. Follow-up and evaluation of pregnancy outcomes should be performed to further substantiate wider clinical implementation. UR - https://www.jmir.org/2023/1/e37537 UR - http://dx.doi.org/10.2196/37537 UR - http://www.ncbi.nlm.nih.gov/pubmed/36662557 ID - info:doi/10.2196/37537 ER - TY - JOUR AU - Koech, Angela AU - Musitia, Muoga Peris AU - Mwashigadi, Mkanjala Grace AU - Kinshella, Woo Mai-Lei AU - Vidler, Marianne AU - Temmerman, Marleen AU - Craik, Rachel AU - von Dadelszen, Peter AU - Noble, Alison J. AU - Papageorghiou, T. Aris AU - PY - 2022/12/27 TI - Acceptability and Feasibility of a Low-Cost Device for Gestational Age Assessment in a Low-Resource Setting: Qualitative Study JO - JMIR Hum Factors SP - e34823 VL - 9 IS - 4 KW - gestational age KW - gestation KW - gynecology KW - gynecologist KW - prenatal KW - antenatal KW - maternal KW - fetus KW - fetal KW - ultrasound KW - imaging KW - pregnancy dating KW - handheld KW - portable KW - trust KW - artificial intelligence KW - sub-Saharan Africa KW - Africa KW - low cost KW - LMIC KW - low income KW - feasibility KW - acceptability KW - AI KW - pregnancy KW - pregnant KW - maternity KW - women's health KW - obstetrics KW - obstetrician KW - rural KW - remote KW - remote location KW - misconception KW - eHealth KW - digital health N2 - Background: Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with artificial intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal transcerebellar diameter and head circumference. Objective: The aim of this study was to assess the perceptions of pregnant women, their families, and health care workers regarding the feasibility and acceptability of the TraCer device in an appropriate setting. Methods: A descriptive study using qualitative methods was conducted in two public health facilities in Kilifi county in coastal Kenya prior to introduction of the new technology. Study participants were shown a video role-play of the use of TraCer at a typical antenatal clinic visit. Data were collected through 6 focus group discussions (N=52) and 18 in-depth interviews. Results: Overall, TraCer was found to be highly acceptable to women, their families, and health care workers, and its implementation at health care facilities was considered to be feasible. Its introduction was predicted to reduce anxiety regarding fetal well-being, increase antenatal care attendance, increase confidence by women in their care providers, as well as save time and cost by reducing unnecessary referrals. TraCer was felt to increase the self-image of health care workers and reduce time spent providing antenatal care. Some participants expressed hesitancy toward the new technology, indicating the need to test its performance over time before full acceptance by some users. The preferred cadre of health care professionals to use the device were antenatal clinic nurses. Important implementation considerations included adequate staff training and the need to ensure sustainability and consistency of the service. Misconceptions were common, with a tendency to overestimate the diagnostic capability, and expectations that it would provide complete reassurance of fetal and maternal well-being and not primarily the GA. Conclusions: This study shows a positive attitude toward TraCer and highlights the potential role of this innovation that uses AI-enabled automation to assess GA. Clarity of messaging about the tool and its role in pregnancy is essential to address misconceptions and prevent misuse. Further research on clinical validation and related usability and safety evaluations are recommended. UR - https://humanfactors.jmir.org/2022/4/e34823 UR - http://dx.doi.org/10.2196/34823 UR - http://www.ncbi.nlm.nih.gov/pubmed/36574278 ID - info:doi/10.2196/34823 ER - TY - JOUR AU - Gerdts, Caitlin AU - Jayaweera, T. Ruvani AU - Motana, Relebohile AU - Bessenaar, Tshegofatso AU - Wesson, Paul PY - 2022/12/8 TI - Incidence of and Experiences with Abortion Attempts in Soweto, South Africa: Respondent-Driven Sampling Study JO - JMIR Public Health Surveill SP - e38045 VL - 8 IS - 12 KW - induced abortion KW - respondent-driven sampling KW - self-managed abortion KW - abortion incidence N2 - Background: Estimation of abortion incidence, particularly in settings where most abortions occur outside of health facility settings, is critical for understanding information gaps and service delivery needs in different settings. However, the existing methods for measuring out-of-facility abortion incidence are plagued with methodological challenges. Respondent-driven sampling (RDS) may offer a methodological improvement in the estimation of abortion incidence. Objective: In this study, we tested the feasibility of using RDS to recruit participants into a study about abortion and estimated the proportion of people who ever attempted abortion as well as 1-year and 5-year incidence of abortion (both in-facility and out-of-facility settings) among women of reproductive age in Soweto, South Africa. Methods: Participants were eligible if they identified as a woman; were aged between 15 and 49 years; spoke English, Tswana, isiZulu, Sotho, or Xhosa; and lived in Soweto. Working with community partners, we identified 11 seeds who were provided with coupons to refer eligible peers to the study. Upon arrival at the study site, the recruits completed an interviewer-administered questionnaire that solicited information about demographic characteristics, social network composition, health behaviors, sexual history, pregnancy history, and experience with abortion; recruits also received 3 recruitment coupons. Recruitment was tracked using coupon numbering. We used the RDS-II estimator to estimate the population proportions of demographic characteristics and our primary outcome, the proportion of people who ever attempted abortion. Results: Between April 4, 2018, and December 17, 2018, 849 eligible participants were recruited into the study. The estimated proportion of people who ever attempted abortion was 12.1% (95% CI 9.7%-14.4%). A total of 7.1% (95% CI 5.4%-8.9%) reported a facility-based abortion, and 4.4% (95% CI 3.0%-5.8%) reported an out-of-facility abortion. Conclusions: The estimated proportion of people who ever attempted abortion of 12% (102/849) in our study likely represents a substantial underestimation of the actual proportion of abortion attempts among this study population?representing a failure of the RDS method to generate more reliable estimates of abortion incidence in our study. We caution against the use of RDS to measure the incidence of abortion because of persistent concerns with underreporting but consider potential alternative applications of RDS with respect to the study of abortion. UR - https://publichealth.jmir.org/2022/12/e38045 UR - http://dx.doi.org/10.2196/38045 UR - http://www.ncbi.nlm.nih.gov/pubmed/36480253 ID - info:doi/10.2196/38045 ER - TY - JOUR AU - Ami, Olivier AU - Maran, Jean-Christophe AU - Musset, Dominique AU - Dubray, Claude AU - Mage, Gérard AU - Boyer, Louis PY - 2022/11/30 TI - Using Magnetic Resonance Imaging During Childbirth to Demonstrate Fetal Head Moldability and Brain Compression: Prospective Cohort Study JO - JMIR Form Res SP - e27421 VL - 6 IS - 11 KW - parturition KW - magnetic resonance imaging KW - obstetrics KW - fetus KW - cephalopelvic disproportion N2 - Background: Childbirth is a physiological process with significant medical risk, given that neurological impairment due to the birthing process can occur at any time. Improvements in risk assessment and anticipatory interventions are constantly needed; however, the birthing process is difficult to assess using simple imaging technology because the maternal bony pelvis and fetal skeleton interfere with visualizing the soft tissues. Magnetic resonance imaging (MRI) is a noninvasive technique with no ionizing radiation that can monitor the biomechanics of the birthing process. However, the effective use of this modality requires teamwork and the implementation of the appropriate safeguards to achieve appropriate safety levels. Objective: This study describes a clinically effective and safe method to perform real-time MRI during the birthing process. We reported the experience of our team as part of the IMAGINAITRE study protocol (France), which aimed to better understand the biomechanics of childbirth. Methods: A total of 27 pregnant women were examined with 3D MRI sequences before going into labor using a 1-Tesla open-field MRI. Of these 27 patients, 7 (26%) subsequently had another set of 3D MRI sequences during the second stage of labor. Volumes of 2D images were transformed into finite element 3D reconstructions. Polygonal meshes for each part of the fetal body were used to study fetal head moldability and brain compression. Results: All 7 observed babies showed a sugarloaf skull deformity and brain compression at the middle strait. The fetus showing the greatest degree of molding and brain shape deformation weighed 4525 g and was born spontaneously but also presented with a low Apgar score. In this case, observable brain shape deformation demonstrated that brain compression had occurred, and it was not necessarily well tolerated by the fetus. Depending on fetal head moldability, these observations suggest that cephalopelvic disproportion can result in either obstructed labor or major fetal head molding with brain compression. Conclusions: This study suggests the presence of skull moldability as a confounding factor explaining why MRI, even with the best precision to measure radiological landmarks, fails to accurately predict the modality of childbirth. This introduces the fetal head compliance criterion as a way to better understand cephalopelvic disproportion mechanisms in obstetrics. MRI might be the best imaging technology by which to explore all combined aspects of cephalopelvic disproportion and achieve a better understanding of the underlying mechanisms of fetal head molding and moldability. UR - https://formative.jmir.org/2022/11/e27421 UR - http://dx.doi.org/10.2196/27421 UR - http://www.ncbi.nlm.nih.gov/pubmed/36322921 ID - info:doi/10.2196/27421 ER - TY - JOUR AU - Xu, Nuo AU - Chen, Sijing AU - Liu, Yan AU - Jing, Yuewen AU - Gu, Ping PY - 2022/11/23 TI - The Effects of Virtual Reality in Maternal Delivery: Systematic Review and Meta-analysis JO - JMIR Serious Games SP - e36695 VL - 10 IS - 4 KW - virtual reality technology KW - delivery KW - labor pain KW - anxiety KW - meta-analysis KW - systematic review KW - pain KW - pregnancy KW - virtual reality KW - maternity KW - labor KW - technology KW - pregnant women KW - review KW - childbirth KW - mental health N2 - Background: Extreme labor pain has negative effects; pharmacologic analgesic modalities are effective but are accompanied by adverse effects. Virtual reality (VR) works as a distracting nonpharmacologic intervention for pain and anxiety relief; however, the effects of VR use in laboring women is unknown. Objective: Our study aimed to determine the safety and effectiveness of VR technology during labor and delivery and investigate whether it impacts labor and patient satisfaction. Methods: In all, 7 databases (PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, and Wan-Fang Database) were systematically searched for randomized controlled trials of VR use in pregnancy and childbirth from the time of database construction until November 24, 2021. Two researchers extracted data and evaluated study quality using the Cochrane Risk of Bias tool 2.0. Outcome measures were labor pain, anxiety, duration, satisfaction, and adverse events. Meta-analyses were performed where possible. Results: A total of 12 studies with 1095 participants were included, of which 1 and 11 studies were rated as ?Low risk? and ?Some concerns? for risk of bias, respectively. Of the 12 studies, 11 reported labor pain, 7 reported labor anxiety, and 4 reported labor duration. Meta-analysis revealed that VR use could relieve pain during labor (mean difference ?1.81, 95% CI ?2.04 to ?1.57; P<.001) and the active period (standardized mean difference [SMD] ?0.41, 95% CI ?0.68 to ?0.14; P=.003); reduce anxiety (SMD ?1.39, 95% CI ?1.99 to ?0.78; P<.001); and improve satisfaction with delivery (relative risk 1.32, 95% CI 1.10-1.59; P=.003). The effects of VR on the duration of the first (SMD ?1.12, 95% CI ?2.38 to 0.13; P=.08) and second (SMD ?0.22, 95% CI ?0.67 to 0.24; P=.35) stages of labor were not statistically significant. Conclusions: VR is safe and effective in relieving maternal labor pain and anxiety; however, due to the heterogeneity among studies conducted to date, more rigorous, large-scale, and standardized randomized controlled trials are required to provide a higher-quality evidence base for the use of VR technology in maternal labor, with the aim of improving experience and outcomes. Trial Registration: PROSPERO CRD42021295410; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295410 UR - https://games.jmir.org/2022/4/e36695 UR - http://dx.doi.org/10.2196/36695 UR - http://www.ncbi.nlm.nih.gov/pubmed/36416881 ID - info:doi/10.2196/36695 ER - TY - JOUR AU - Birati, Yosefa AU - Yefet, Enav AU - Perlitz, Yuri AU - Shehadeh, Naim AU - Spitzer, Sivan PY - 2022/10/14 TI - Cultural and Digital Health Literacy Appropriateness of App- and Web-Based Systems Designed for Pregnant Women With Gestational Diabetes Mellitus: Scoping Review JO - J Med Internet Res SP - e37844 VL - 24 IS - 10 KW - gestational diabetes mellitus KW - maternal health KW - mobile health KW - mHealth KW - mobile apps KW - mobile phone KW - telemedicine KW - culture KW - health literacy KW - vulnerable populations KW - pregnancy outcome N2 - Background: The prevalence of women diagnosed with gestational diabetes mellitus (GDM) is increasing dramatically. Mobile technologies to enhance patient self-management offer many advantages for women diagnosed with GDM. However, to our knowledge, although mobile health (mHealth) and telemedicine systems for GDM management exist, evidence on their cultural and digital health literacy appropriateness levels is limited. Objective: This review aimed to search and assess the literature on mHealth and telemedicine systems designed for women diagnosed with GDM. Our assessment of these technologies focused on their cultural and digital health literacy appropriateness as well as the systems? effectiveness in improving glycemic control and maternal and infant outcomes. Methods: We conducted a scoping review using a framework adapted from Arksey and O?Malley. Four electronic databases were searched for relevant studies: PubMed, MEDLINE (EBSCO), Web of Science, and Scopus. The databases were searched between January 2010 and January 2022. The inclusion criteria were pregnant women diagnosed with GDM, use of telemedicine for monitoring and management, and vulnerable or disadvantaged patients. We used terms related to mobile apps and telemedicine: GDM, vulnerable populations, periphery, cultural appropriateness, and digital health literacy. Studies were screened and selected independently by 2 authors. We extracted the study data on a Microsoft Excel charting table and categorized them into final themes. The results were categorized according to the cultural and digital health literacy features presented. Results: We identified 17 studies that reported on 12 telemedicine and mHealth app interventions. We assessed the studies in three domains: cultural appropriateness, digital health literacy, and maternal and infant outcomes. In the literature, we found that existing digital technologies may improve glycemic control and diabetes self-management. However, there is a lack of assessment of cultural and digital health literacy appropriateness for pregnant women diagnosed with GDM. Considerations in app design regarding cultural appropriateness were found in only 12% (2/17) of the studies, and only 25% (3/12) of the interventions scored ?3 out of 5 in our assessment of digital health literacy. Conclusions: mHealth and telemedicine can be an effective platform to improve the clinical management of women with GDM. Although studies published on the use of mHealth and telemedicine systems exist, there is a limited body of knowledge on the digital health literacy and cultural appropriateness of the systems designed for women diagnosed with GDM. In addition, as our study was restricted to the English language, relevant studies may have been excluded. Further research is needed to evaluate, design, and implement better tailored apps regarding cultural and digital literacy appropriateness for enhancing pregnant women?s self-management as well as the effectiveness of these apps in improving maternal and infant health outcomes. UR - https://www.jmir.org/2022/10/e37844 UR - http://dx.doi.org/10.2196/37844 UR - http://www.ncbi.nlm.nih.gov/pubmed/36240008 ID - info:doi/10.2196/37844 ER - TY - JOUR AU - Lanssens, Dorien AU - Thijs, M. Inge AU - Dreesen, Pauline AU - Van Hecke, Ann AU - Coorevits, Pascal AU - Gaethofs, Gitte AU - Derycke, Joyce AU - Tency, Inge PY - 2022/10/11 TI - Information Resources Among Flemish Pregnant Women: Cross-sectional Study JO - JMIR Form Res SP - e37866 VL - 6 IS - 10 KW - pregnancy app KW - mobile app KW - questionnaire KW - pregnancy KW - pregnant KW - mHealth KW - mobile health KW - cross-sectional KW - user need KW - user expectation KW - survey KW - maternal KW - maternity KW - user experience N2 - Background: There has been an exponential growth in the availability of apps, resulting in increased use of pregnancy apps. However, information on resources and use of apps among pregnant women is relatively limited. Objective: The aim of this study is to map the current information resources and the use of pregnancy apps among pregnant women in Flanders. Methods: A cross-sectional study was conducted, using a semistructured survey (April-June 2019) consisting of four different domains: (1) demographics; (2) use of devices; (3) sources of information; and (4) use of pregnancy apps. Women were recruited by social media, flyers, and paper questionnaires at prenatal consultations. Statistical analysis was mainly focused on descriptive statistics. Differences in continuous and categorical variables were tested using independent Student t tests and chi-square tests. Correlations were investigated between maternal characteristics and the women?s responses. Results: In total, 311 women completed the entire questionnaire. Obstetricians were the primary source of information (268/311, 86.2%) for pregnant women, followed by websites/internet (267/311, 85.9%) and apps (233/311, 74.9%). The information that was most searched for was information about the development of the baby (275/311, 88.5%), discomfort/complaints (251/311, 80.7%) and health during pregnancy (248/311, 79.7%), administrative/practical issues (233/311, 74.9%), and breastfeeding (176/311, 56.6%). About half of the women (172/311, 55.3%) downloaded a pregnancy app, and primarily searched app stores (133/311, 43.0%). Pregnant women who are single asked their mothers (22/30, 73.3%) or other family members (13/30, 43.3%) for significantly more information than did married women (mother [in law]: 82/160, 51.3%, P=.02; family members: 35/160, 21.9%, P=.01). Pregnant women with lower education were significantly more likely to have a PC or laptop than those with higher education (72/73, 98.6% vs 203/237, 85.5%; P=.008), and to consult other family members for pregnancy information (30/73, 41.1% vs 55/237, 23.1%; P<.001), but were less likely to consult a gynecologist (70/73, 95.9% vs 198/237, 83.5%; P=.001). They also followed more prenatal sessions (59/73, 80.8% vs 77/237, 32.5%; P=.04) and were more likely to search for information regarding discomfort/complaints during pregnancy (65/73, 89% vs 188/237, 79.5%; P=.02). Compared to multigravida, primigravida were more likely to solicit advice about their pregnancy from other women in their social networks (family members: primigravida 44/109, 40.4% vs multigravida 40/199, 20.1%; P<.001; other pregnant women: primigravida 58/109, 53.2% vs multigravida 80/199, 40.2%; P<.03). Conclusions: Health care professionals need to be aware that apps are important and are a growing source of information for pregnant women. Concerns rise about the quality and safety of those apps, as only a limited number of apps are subjected to an external quality check. Therefore, it is important that health care providers refer to high-quality digital resources and take the opportunity to discuss digital information with pregnant women. UR - https://formative.jmir.org/2022/10/e37866 UR - http://dx.doi.org/10.2196/37866 UR - http://www.ncbi.nlm.nih.gov/pubmed/36222794 ID - info:doi/10.2196/37866 ER - TY - JOUR AU - Garcia-Manau, Pablo AU - Mendoza, Manel AU - Bonacina, Erika AU - Martin-Alonso, Raquel AU - Martin, Lourdes AU - Palacios, Ana AU - Sanchez, Luisa Maria AU - Lesmes, Cristina AU - Hurtado, Ivan AU - Perez, Esther AU - Tubau, Albert AU - Ibañez, Patricia AU - Alcoz, Marina AU - Valiño, Nuria AU - Moreno, Elena AU - Borrero, Carlota AU - Garcia, Esperanza AU - Lopez-Quesada, Eva AU - Diaz, Sonia AU - Broullon, Roman Jose AU - Teixidor, Mireia AU - Chulilla, Carolina AU - Gil, M. Maria AU - Lopez, Monica AU - Candela-Hidalgo, Amparo AU - Salinas-Amoros, Andrea AU - Moreno, Anna AU - Morra, Francesca AU - Vaquerizo, Oscar AU - Soriano, Beatriz AU - Fabre, Marta AU - Gomez-Valencia, Elena AU - Cuiña, Ana AU - Alayon, Nicolas AU - Sainz, Antonio Jose AU - Vives, Angels AU - Esteve, Esther AU - Ocaña, Vanesa AU - López, Ángel Miguel AU - Maroto, Anna AU - Carreras, Elena PY - 2022/10/11 TI - The Fetal Growth Restriction at Term Managed by Angiogenic Factors Versus Feto-Maternal Doppler (GRAFD) Trial to Avoid Adverse Perinatal Outcomes: Protocol for a Multicenter, Open-Label, Randomized Controlled Trial JO - JMIR Res Protoc SP - e37452 VL - 11 IS - 10 KW - fetal growth restriction KW - small for gestational age KW - PlGF KW - sFlt-1 KW - Doppler KW - angiogenic factors N2 - Background: Fetal smallness affects 10% of pregnancies. Small fetuses are at a higher risk of adverse outcomes. Their management using estimated fetal weight and feto-maternal Doppler has a high sensitivity for adverse outcomes; however, more than 60% of fetuses are electively delivered at 37 to 38 weeks. On the other hand, classification using angiogenic factors seems to have a lower false-positive rate. Here, we present a protocol for the Fetal Growth Restriction at Term Managed by Angiogenic Factors Versus Feto-Maternal Doppler (GRAFD) trial, which compares the use of angiogenic factors and Doppler to manage small fetuses at term. Objective: The primary objective is to demonstrate that classification based on angiogenic factors is not inferior to estimated fetal weight and Doppler at detecting fetuses at risk of adverse perinatal outcomes. Methods: This is a multicenter, open-label, randomized controlled trial conducted in 20 hospitals across Spain. A total of 1030 singleton pregnancies with an estimated fetal weight ?10th percentile at 36+0 to 37+6 weeks+days will be recruited and randomly allocated to either the control or the intervention group. In the control group, standard Doppler-based management will be used. In the intervention group, cases with a soluble fms-like tyrosine kinase to placental growth factor ratio ?38 will be classified as having fetal growth restriction; otherwise, they will be classified as being small for gestational age. In both arms, the fetal growth restriction group will be delivered at ?37 weeks and the small for gestational age group at ?40 weeks. We will assess differences between the groups by calculating the relative risk, the absolute difference between incidences, and their 95% CIs. Results: Recruitment for this study started on September 28, 2020. The study results are expected to be published in peer-reviewed journals and disseminated at international conferences in early 2023. Conclusions: The angiogenic factor?based protocol may reduce the number of pregnancies classified as having fetal growth restriction without worsening perinatal outcomes. Moreover, reducing the number of unnecessary labor inductions would reduce costs and the risks derived from possible iatrogenic complications. Additionally, fewer inductions would lower the rate of early-term neonates, thus improving neonatal outcomes and potentially reducing long-term infant morbidities. Trial Registration: ClinicalTrials.gov NCT04502823; https://clinicaltrials.gov/ct2/show/NCT04502823 International Registered Report Identifier (IRRID): DERR1-10.2196/37452 UR - https://www.researchprotocols.org/2022/10/e37452 UR - http://dx.doi.org/10.2196/37452 UR - http://www.ncbi.nlm.nih.gov/pubmed/36222789 ID - info:doi/10.2196/37452 ER - TY - JOUR AU - Agbadje, Tatiana Titilayo AU - Pilon, Chantale AU - Bérubé, Pierre AU - Forest, Jean-Claude AU - Rousseau, François AU - Rahimi, Abbasgholizadeh Samira AU - Giguère, Yves AU - Légaré, France PY - 2022/9/6 TI - User Experience of a Computer-Based Decision Aid for Prenatal Trisomy Screening: Mixed Methods Explanatory Study JO - JMIR Pediatr Parent SP - e35381 VL - 5 IS - 3 KW - shared decision-making KW - computer-based decision aid KW - prenatal screening KW - trisomy KW - Down syndrome KW - mixed methods N2 - Background: Mobile health tools can support shared decision-making. We developed a computer-based decision aid (DA) to help pregnant women and their partners make informed, value-congruent decisions regarding prenatal screening for trisomy. Objective: This study aims to assess the usability and usefulness of computer-based DA among pregnant women, clinicians, and policy makers. Methods: For this mixed methods sequential explanatory study, we planned to recruit a convenience sample of 45 pregnant women, 45 clinicians from 3 clinical sites, and 15 policy makers. Eligible women were aged >18 years and >16 weeks pregnant or had recently given birth. Eligible clinicians and policy makers were involved in prenatal care. We asked the participants to navigate a computer-based DA. We asked the women about the usefulness of the DA and their self-confidence in decision-making. We asked all participants about usability, quality, acceptability, satisfaction with the content of the DA, and collected sociodemographic data. We explored participants? reactions to the computer-based DA and solicited suggestions. Our interview guide was based on the Mobile App Rating Scale. We performed descriptive analyses of the quantitative data and thematic deductive and inductive analyses of the qualitative data for each participant category. Results: A total of 45 pregnant women, 14 clinicians, and 8 policy makers participated. Most pregnant women were aged between 25 and 34 years (34/45, 75%) and White (42/45, 94%). Most clinicians were aged between 35 and 44 years (5/14, 36%) and women (11/14, 79%), and all were White (14/14, 100%); the largest proportion of policy makers was aged between 45 and 54 years (4/8, 50%), women (5/8, 62%), and White (8/8, 100%). The mean usefulness score for preparing for decision-making for women was 80/100 (SD 13), and the mean self-efficacy score was 88/100 (SD 11). The mean usability score was 84/100 (SD 14) for pregnant women, 77/100 (SD 14) for clinicians, and 79/100 (SD 23) for policy makers. The mean global score for quality was 80/100 (SD 9) for pregnant women, 72/100 (SD 12) for clinicians, and 80/100 (SD 9) for policy makers. Regarding acceptability, participants found the amount of information just right (52/66, 79%), balanced (58/66, 88%), useful (38/66, 58%), and sufficient (50/66, 76%). The mean satisfaction score with the content was 84/100 (SD 13) for pregnant women, 73/100 (SD 16) for clinicians, and 73/100 (SD 20) for policy makers. Participants thought the DA could be more engaging (eg, more customizable) and suggested strategies for implementation, such as incorporating it into clinical guidelines. Conclusions: Pregnant women, clinicians, and policy makers found the DA usable and useful. The next steps are to incorporate user suggestions for improving engagement and implementing the computer-based DA in clinical practice. UR - https://pediatrics.jmir.org/2022/3/e35381 UR - http://dx.doi.org/10.2196/35381 UR - http://www.ncbi.nlm.nih.gov/pubmed/35896164 ID - info:doi/10.2196/35381 ER - TY - JOUR AU - Self, Alice AU - Chen, Qingchao AU - Desiraju, Koundinya Bapu AU - Dhariwal, Sumeet AU - Gleed, D. Alexander AU - Mishra, Divyanshu AU - Thiruvengadam, Ramachandran AU - Chandramohan, Varun AU - Craik, Rachel AU - Wilden, Elizabeth AU - Khurana, Ashok AU - AU - Bhatnagar, Shinjini AU - Papageorghiou, T. Aris AU - Noble, Alison J. PY - 2022/9/1 TI - Developing Clinical Artificial Intelligence for Obstetric Ultrasound to Improve Access in Underserved Regions: Protocol for a Computer-Assisted Low-Cost Point-of-Care UltraSound (CALOPUS) Study JO - JMIR Res Protoc SP - e37374 VL - 11 IS - 9 KW - ultrasound KW - obstetrics KW - artificial intelligence KW - machine learning KW - data annotation N2 - Background: The World Health Organization recommends a package of pregnancy care that includes obstetric ultrasound scans. There are significant barriers to universal access to antenatal ultrasound, particularly because of the cost and need for maintenance of ultrasound equipment and a lack of trained personnel. As low-cost, handheld ultrasound devices have become widely available, the current roadblock is the global shortage of health care providers trained in obstetric scanning. Objective: The aim of this study is to improve pregnancy and risk assessment for women in underserved regions. Therefore, we are undertaking the Computer-Assisted Low-Cost Point-of-Care UltraSound (CALOPUS) project, bringing together experts in machine learning and clinical obstetric ultrasound. Methods: In this prospective study conducted in two clinical centers (United Kingdom and India), participating pregnant women were scanned and full-length ultrasounds were performed. Each woman underwent 2 consecutive ultrasound scans. The first was a series of simple, standardized ultrasound sweeps (the CALOPUS protocol), immediately followed by a routine, full clinical ultrasound examination that served as the comparator. We describe the development of a simple-to-use clinical protocol designed for nonexpert users to assess fetal viability, detect the presence of multiple pregnancies, evaluate placental location, assess amniotic fluid volume, determine fetal presentation, and perform basic fetal biometry. The CALOPUS protocol was designed using the smallest number of steps to minimize redundant information, while maximizing diagnostic information. Here, we describe how ultrasound videos and annotations are captured for machine learning. Results: Over 5571 scans have been acquired, from which 1,541,751 label annotations have been performed. An adapted protocol, including a low pelvic brim sweep and a well-filled maternal bladder, improved visualization of the cervix from 28% to 91% and classification of placental location from 82% to 94%. Excellent levels of intra- and interannotator agreement are achievable following training and standardization. Conclusions: The CALOPUS study is a unique study that uses obstetric ultrasound videos and annotations from pregnancies dated from 11 weeks and followed up until birth using novel ultrasound and annotation protocols. The data from this study are being used to develop and test several different machine learning algorithms to address key clinical diagnostic questions pertaining to obstetric risk management. We also highlight some of the challenges and potential solutions to interdisciplinary multinational imaging collaboration. International Registered Report Identifier (IRRID): RR1-10.2196/37374 UR - https://www.researchprotocols.org/2022/9/e37374 UR - http://dx.doi.org/10.2196/37374 UR - http://www.ncbi.nlm.nih.gov/pubmed/36048518 ID - info:doi/10.2196/37374 ER - TY - JOUR AU - Meutia, Putri Alfa AU - Santoso, Iman Budi AU - Hestiantoro, Andon AU - Wuyung, Eka Puspita AU - Prihartono, Joedo AU - Boediono, Arief AU - Djusad, Suskhan AU - Fauzi, Amir AU - Budinurdjaja, Pribakti PY - 2022/8/9 TI - Mesh-Tissue Integration of Platelet-Rich Plasma?Decellularized Amnion Scaffold?Polypropylene Mesh Sandwiches Implanted in the Vesicovaginal Spaces of Hypoestrogenic Rabbit Models: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e37942 VL - 11 IS - 8 KW - pelvic organ prolapse KW - vaginal mesh KW - platelet-rich plasma N2 - Background: Mesh-augmented surgery with polypropylene meshes (PPMs) is often used in urogynecology and pelvic reconstructive surgery. However, the various complications that arise from its integration process have resulted in a decrease in the number of mesh-augmented surgeries performed worldwide. An approach to improving mesh-tissue integration is coating PPMs with anti-inflammatory and wound-healing molecules, such as platelet-rich plasma (PRP), which is a component of biotechnologies that are capable of accelerating wound healing. Estrogen is also known to have a beneficial effect on wound remodeling; therefore, a hypoestrogenic status may have negative implications for wound healing. The mechanism of how PRP plays a role in wound remodeling, especially among individuals in a hypoestrogenic state, has not been fully described until now. Objective: Our aim is to investigate the impact of applying PRP to PPMs in hypoestrogenic rabbit models. Methods: Our study will be a randomized controlled trial involving hypoestrogenic rabbit models. Samples were categorized into either the PRP group or the PPM group (1:1 ratio), with a minimum sample size of 16 in each arm, via simple random sampling. All samples were put into a hypoestrogenic state via bilateral oophorectomy. After confirming a decrease in estradiol level, the meshes were implanted in the vesicovaginal space. The samples were euthanized on the 14th, 28th, or 90th day of the surgery. The mesh-tissue integration process will be analyzed based on inflammatory parameters (inflammatory infiltrate, interleukin-17, and interleukin-1B expression); angiogenesis (CD31 expression); and collagen deposition, which will be assessed by using Masson trichrome staining. Results: Our study is in the protocol development stage. A preliminary study regarding its feasibility, including the feasibility of the preparation of hypoestrogenic rabbit models, mesh implantation in the rabbits? vesicovaginal spaces, the PRP and amnion scaffold, started in February 2022. The results of our study are expected to be available by the end of 2022. Conclusions: Our randomized controlled trial is designed to provide high-quality evidence on the effect of applying a PRP-decellularized amnion scaffold to PPMs in the vesicovaginal spaces of hypoestrogenic rabbit models. International Registered Report Identifier (IRRID): PRR1-10.2196/37942 UR - https://www.researchprotocols.org/2022/8/e37942 UR - http://dx.doi.org/10.2196/37942 UR - http://www.ncbi.nlm.nih.gov/pubmed/35943784 ID - info:doi/10.2196/37942 ER - TY - JOUR AU - Walker, Elizabeth Ruth AU - Quong, Sara AU - Olivier, Patrick AU - Wu, Ling AU - Xie, Jue AU - Boyle, Jacqueline PY - 2022/8/5 TI - Understanding Preconception Women?s Needs and Preferences for Digital Health Resources: Qualitative Study JO - JMIR Form Res SP - e39280 VL - 6 IS - 8 KW - digital health KW - preconception KW - health promotion KW - behavior change KW - women's health KW - maternal health KW - digital health resource KW - healthy life style KW - qualitative analysis KW - online health information N2 - Background: Improving preconception health can benefit all women, their children, and their families regardless of their individual pregnancy intentions. Rapidly increasing access to information technology and online engagement have created opportunities to use digital health resources to engage with preconception women regarding lifestyle behaviors. Objective: This study explores how preconception women engage with digital health resources and online platforms to inform the design and development of a digital health resource to support women to make positive behavior change for their preconception health. Methods: This codesign research followed the Double Diamond process, which focuses on contextualization and explorative processes in phase 1 and ideation and development processes in phase 2. Phase 1 is reported on in this study and was undertaken via a series of 1-on-1 in-depth interviews with female participants (N=12) aged 18-45 years over 3 months. Interviews were designed to explore participants? lived experiences in relation to their health and desired supports for healthy lifestyle behaviors. The first interview focused on participants? perceptions of health and health behaviors, the second interview focused on social connections for health, and the third interview focused on digital health information and supports. Conversations from the first interview informed the development of the second interview, and conversations from the second interview informed the development of the third interview. Community advisors (N=8) met to provide feedback and advice to the researchers throughout the interview process. Qualitative analyses of transcripts from interviews were undertaken by 2 researchers before a deductive process identified themes mapped to the capability, opportunity, motivation, and behavior (COM-B) framework. Results: In total, 9 themes and 8 subthemes were identified from 124 codes. In relation to digital health resources, specifically, participants were already engaging with a range of digital health resources and had high expectations of these. Digital health resources needed to be easy to access, make women?s busy lives easier, be evidence based, and be reputable. Social connectedness was also highly important to our participants, with information and advice from peers with similar experiences being preferred over yet more online health information. Online communities facilitated these social interactions. Participants were open to the idea of chatbots and virtual assistants but acknowledged that they would not replace authentic social interactions. Conclusions: Codesigned digital health resources should be evidence based, reputable, and easy to access. Social connections were considered highly important to women, and designers of digital health resources should consider how they can increase opportunities for women to connect and learn from each other to promote health behaviors. UR - https://formative.jmir.org/2022/8/e39280 UR - http://dx.doi.org/10.2196/39280 UR - http://www.ncbi.nlm.nih.gov/pubmed/35930344 ID - info:doi/10.2196/39280 ER - TY - JOUR AU - Moreira, Inês AU - Bartosch, Carla AU - Teixeira, Manuel AU - Ferreira, Marta PY - 2022/8/4 TI - Molecular Classification of Endometrial Carcinoma: Protocol for a Cohort Study JO - JMIR Res Protoc SP - e34461 VL - 11 IS - 8 KW - endometrial carcinoma KW - molecular classification KW - prognosis KW - POLE KW - mismatch repair KW - p53 N2 - Background: Endometrial carcinoma (EC) is the most common gynecologic malignancy in developed countries and the fourth most frequent in women worldwide. The cornerstone of treatment for EC is surgery. Clinicopathological features are currently used to help determine the individual risk of recurrence and the need for adjuvant treatment after surgery. Nonetheless, there is significant interobserver variability in assigning histologic subtype when using a morphological classification, revealing the need for a more unified approach. The Cancer Genome Atlas (TCGA) project identified 4 distinct prognostic EC subtypes based on genomic abnormalities. Surrogate assays including 3 immunohistochemical markers (p53, MSH6, and PMS2) and 1 molecular test (mutation analysis of the exonuclease domain of DNA polymerase epsilon; POLE) allowed the development and validation of a simplified molecular classifier that correlates with the TCGA classification, has prognostic value, and can easily be used in clinical practice. This molecular classification categorizes EC in 4 subtypes: POLE mutated, mismatch repair?deficient, p53 abnormal, and no specific molecular profile. Applying this classification in clinical practice will help tailor adjuvant treatment decisions. Objective: The aim of this study is to retrospectively apply this novel molecular classification to a cohort of patients with EC treated in a comprehensive cancer center, to assess its applicability in clinical practice, to evaluate clinical outcomes by molecular subtypes, and to assess its prognostic value. Methods: In this retrospective cohort study, patients with primary EC diagnosed during and after 2013 and treated or followed at our institution, after definite surgery, will be included. Demographic and clinicopathological data will be obtained from electronic health records and from pathology reports. Laboratory methods will include immunohistochemical study of p53 and mismatch repair proteins, as well as POLE mutational analysis by genetic sequencing. The primary end point is recurrence-free survival and secondary end points are disease-specific survival and overall survival. A descriptive analysis of variables will be carried out. Survival analysis will be performed using the Kaplan-Meier method and the groups will be compared using the log-rank test. Results: This protocol was reviewed and approved by the Instituto Português de Oncologia do Porto, Portugal, ethics committee in October 2021; patient selection from our cancer registry began the same month. A total of 160 patients will be included. This work will present real-life results that will allow a better understanding of the Portuguese EC population and the distribution of the molecular subgroups throughout. We will use these results to understand the prognostic value of this classification in our population and its role in adjuvant therapy decisions. This study is anticipated to conclude in December 2022. Conclusions: This study will provide important information regarding these women?s outcomes according to this new molecular classification and will support its use when discussing a patient?s need for adjuvant treatment. International Registered Report Identifier (IRRID): PRR1-10.2196/34461 UR - https://www.researchprotocols.org/2022/8/e34461 UR - http://dx.doi.org/10.2196/34461 UR - http://www.ncbi.nlm.nih.gov/pubmed/35925678 ID - info:doi/10.2196/34461 ER - TY - JOUR AU - Ng, Ada AU - Wei, Boyang AU - Jain, Jayalakshmi AU - Ward, A. Erin AU - Tandon, Darius S. AU - Moskowitz, T. Judith AU - Krogh-Jespersen, Sheila AU - Wakschlag, S. Lauren AU - Alshurafa, Nabil PY - 2022/8/2 TI - Predicting the Next-Day Perceived and Physiological Stress of Pregnant Women by Using Machine Learning and Explainability: Algorithm Development and Validation JO - JMIR Mhealth Uhealth SP - e33850 VL - 10 IS - 8 KW - explainability KW - just-in-time interventions KW - machine learning KW - prenatal stress KW - stress prediction KW - wearable KW - mobile phone N2 - Background: Cognitive behavioral therapy?based interventions are effective in reducing prenatal stress, which can have severe adverse health effects on mothers and newborns if unaddressed. Predicting next-day physiological or perceived stress can help to inform and enable pre-emptive interventions for a likely physiologically and perceptibly stressful day. Machine learning models are useful tools that can be developed to predict next-day physiological and perceived stress by using data collected from the previous day. Such models can improve our understanding of the specific factors that predict physiological and perceived stress and allow researchers to develop systems that collect selected features for assessment in clinical trials to minimize the burden of data collection. Objective: The aim of this study was to build and evaluate a machine-learned model that predicts next-day physiological and perceived stress by using sensor-based, ecological momentary assessment (EMA)?based, and intervention-based features and to explain the prediction results. Methods: We enrolled pregnant women into a prospective proof-of-concept study and collected electrocardiography, EMA, and cognitive behavioral therapy intervention data over 12 weeks. We used the data to train and evaluate 6 machine learning models to predict next-day physiological and perceived stress. After selecting the best performing model, Shapley Additive Explanations were used to identify the feature importance and explainability of each feature. Results: A total of 16 pregnant women enrolled in the study. Overall, 4157.18 hours of data were collected, and participants answered 2838 EMAs. After applying feature selection, 8 and 10 features were found to positively predict next-day physiological and perceived stress, respectively. A random forest classifier performed the best in predicting next-day physiological stress (F1 score of 0.84) and next-day perceived stress (F1 score of 0.74) by using all features. Although any subset of sensor-based, EMA-based, or intervention-based features could reliably predict next-day physiological stress, EMA-based features were necessary to predict next-day perceived stress. The analysis of explainability metrics showed that the prolonged duration of physiological stress was highly predictive of next-day physiological stress and that physiological stress and perceived stress were temporally divergent. Conclusions: In this study, we were able to build interpretable machine learning models to predict next-day physiological and perceived stress, and we identified unique features that were highly predictive of next-day stress that can help to reduce the burden of data collection. UR - https://mhealth.jmir.org/2022/8/e33850 UR - http://dx.doi.org/10.2196/33850 UR - http://www.ncbi.nlm.nih.gov/pubmed/35917157 ID - info:doi/10.2196/33850 ER - TY - JOUR AU - Selmouni, Farida AU - Guy, Marine AU - Muwonge, Richard AU - Nassiri, Abdelhak AU - Lucas, Eric AU - Basu, Partha AU - Sauvaget, Catherine PY - 2022/8/2 TI - Effectiveness of Artificial Intelligence?Assisted Decision-making to Improve Vulnerable Women?s Participation in Cervical Cancer Screening in France: Protocol for a Cluster Randomized Controlled Trial (AppDate-You) JO - JMIR Res Protoc SP - e39288 VL - 11 IS - 8 KW - cervical cancer KW - screening KW - chatbot KW - decision aid KW - artificial intelligence KW - cluster randomized controlled trial N2 - Background: The French organized population-based cervical cancer screening (CCS) program transitioned from a cytology-based to a human papillomavirus (HPV)?based screening strategy in August 2020. HPV testing is offered every 5 years, starting at the age of 30 years. In the new program, women are invited to undergo an HPV test at a gynecologist?s, primary care physician?s, or midwife?s office, a private clinic or health center, family planning center, or hospital. HPV self-sampling (HPVss) was also made available as an additional approach. However, French studies reported that less than 20% of noncompliant women performed vaginal self-sampling when a kit was sent to their home. Women with lower income and educational levels participate less in CCS. Lack of information about the disease and the benefits of CCS were reported as one of the major barriers among noncompliant women. This barrier could be addressed by overcoming disparities in HPV- and cervical cancer?related knowledge and perceptions about CCS. Objective: This study aimed to assess the effectiveness of a chatbot-based decision aid to improve women?s participation in the HPVss detection-based CCS care pathway. Methods: AppDate-You is a 2-arm cluster randomized controlled trial (cRCT) nested within the French organized CCS program. Eligible women are those aged 30-65 years who have not been screened for CC for more than 4 years and live in the disadvantaged clusters in the Occitanie Region, France. In total, 32 clusters will be allocated to the intervention and control arms, 16 in each arm (approximately 4000 women). Eligible women living in randomly selected disadvantaged clusters will be identified using the Regional Cancer Screening Coordinating Centre of Occitanie (CRCDC-OC) database. Women in the experimental group will receive screening reminder letters and HPVss kits, combined with access to a chatbot-based decision aid tailored to women with lower education attainment. Women in the control group will receive the reminder letters and HPVss kits (standard of care). The CRCDC-OC database will be used to check trial progress and assess the intervention?s impact. The trial has 2 primary outcomes: (1) the proportion of screening participation within 12 months among women recalled for CCS and (2) the proportion of HPVss-positive women who are ?well-managed? as stipulated in the French guidelines. Results: To date, the AppDate-You study group is preparing and developing the chatbot-based decision aid (intervention). The cRCT will be conducted once the decision aid has been completed and validated. Recruitment of women is expected to begin in January 2023. Conclusions: This study is the first to evaluate the impact of a chatbot-based decision aid to promote the CCS program and increase its performance. The study results will inform policy makers and health professionals as well as the research community. Trial Registration: ClinicalTrials.gov NCT05286034; https://clinicaltrials.gov/ct2/show/NCT05286034 International Registered Report Identifier (IRRID): PRR1-10.2196/39288 UR - https://www.researchprotocols.org/2022/8/e39288 UR - http://dx.doi.org/10.2196/39288 UR - http://www.ncbi.nlm.nih.gov/pubmed/35771872 ID - info:doi/10.2196/39288 ER - TY - JOUR AU - Griffin-Mathieu, Gabrielle AU - Haward, Ben AU - Tatar, Ovidiu AU - Zhu, Patricia AU - Perez, Samara AU - Shapiro, K. Gilla AU - McBride, Emily AU - Thompson, L. Erika AU - Smith, W. Laurie AU - Lofters, K. Aisha AU - Daley, M. Ellen AU - Guichon, R. Juliet AU - Waller, Jo AU - Steben, Marc AU - Decker, M. Kathleen AU - Mayrand, Marie-Helene AU - Brotherton, L. Julia M. AU - Ogilvie, S. Gina AU - Zimet, D. Gregory AU - Norris, Teresa AU - Rosberger, Zeev PY - 2022/6/16 TI - Ensuring a Successful Transition From Cytology to Human Papillomavirus?Based Primary Cervical Cancer Screening in Canada by Investigating the Psychosocial Correlates of Women?s Intentions: Protocol for an Observational Study JO - JMIR Res Protoc SP - e38917 VL - 11 IS - 6 KW - human papillomavirus KW - HPV-based primary screening KW - cervical cancer KW - cervical cancer screening KW - cancer prevention KW - knowledge KW - attitudes and beliefs KW - preferences KW - HPV test acceptability KW - HPV self-sampling KW - Pap testing KW - cytology KW - mobile phone N2 - Background: The human papillomavirus (HPV) test has emerged as a significant improvement over cytology for primary cervical cancer screening. In Canada, provinces and territories are moving toward implementing HPV testing in cervical cancer screening programs. Although an abundance of research exists on the benefits of HPV-based screening, there is a dearth of research examining women?s understanding of HPV testing. In other countries, failure to adequately address women?s concerns about changes has disrupted the implementation of HPV-based screening. Objective: The aims of the multipart study described in this paper are to develop psychometrically valid measures of cervical cancer screening?related knowledge, attitudes, and beliefs; to examine the feasibility of a questionnaire examining psychosocial factors related to HPV-based screening; and to investigate psychosocial correlates of women?s intentions to participate in HPV-based screening. Methods: We conducted a web-based survey (study 1) of Canadian women to assess the acceptability and feasibility of a questionnaire, including the validation of scales examining cervical cancer knowledge, HPV testing knowledge, HPV testing attitudes and beliefs, and HPV test self-sampling attitudes and beliefs. Preferences for cervical cancer screening were assessed using the best-worst scaling methodology. A second web-based survey (study 2) will be administered to a national sample of Canadian women between June 2022 and July 2022 using the validated scales. Differences in the knowledge, attitudes, beliefs, and preferences of women who are currently either underscreened or adequately screened for cervical cancer will be examined through bivariate analyses. Multinomial logistic regression will be used to estimate the associations between psychosocial and sociodemographic factors and intentions to undergo HPV-based screening. Results: Between October 2021 and November 2021, a total of 1230 participants completed the questionnaire in study 1, and 1027 (83.49%) responses were retained after data cleaning methods were applied. Feasibility was comparable with similar population-based surveys in terms of survey length, participant attrition, and the number of participants excluded after data cleaning. As of May 2022, analysis of study 1 is ongoing, and results are expected to be published in the summer of 2022. Data collection is expected to begin for study 2 in the summer of 2022. Results are expected to be published between late 2022 and early 2023. Conclusions: Findings will provide direction for Canadian public health authorities to align guidelines to address women?s concerns and optimize the acceptability and uptake of HPV-based primary screening. Validated scales can be used by other researchers to improve and standardize the measurement of psychosocial factors affecting HPV test acceptability. Study results will be disseminated through peer-reviewed journal articles; conference presentations; and direct communication with researchers, clinicians, policy makers, media, and specialty organizations. International Registered Report Identifier (IRRID): DERR1-10.2196/38917 UR - https://www.researchprotocols.org/2022/6/e38917 UR - http://dx.doi.org/10.2196/38917 UR - http://www.ncbi.nlm.nih.gov/pubmed/35708742 ID - info:doi/10.2196/38917 ER - TY - JOUR AU - Davidson, Lena AU - Canelón, P. Silvia AU - Boland, Regina Mary PY - 2022/6/7 TI - Medication-Wide Association Study Using Electronic Health Record Data of Prescription Medication Exposure and Multifetal Pregnancies: Retrospective Study JO - JMIR Med Inform SP - e32229 VL - 10 IS - 6 KW - pregnancy KW - pregnancy, multiple KW - assisted reproductive technique KW - electronic health record N2 - Background: Medication-wide association studies (MWAS) have been applied to assess the risk of individual prescription use and a wide range of health outcomes, including cancer, acute myocardial infarction, acute liver failure, acute renal failure, and upper gastrointestinal ulcers. Current literature on the use of preconception and periconception medication and its association with the risk of multiple gestation pregnancies (eg, monozygotic and dizygotic) is largely based on assisted reproductive technology (ART) cohorts. However, among non-ART pregnancies, it is unknown whether other medications increase the risk of multifetal pregnancies. Objective: This study aimed to investigate the risk of multiple gestational births (eg, twins and triplets) following preconception and periconception exposure to prescription medications in patients who delivered at Penn Medicine. Methods: We used electronic health record data between 2010 and 2017 on patients who delivered babies at Penn Medicine, a health care system in the Greater Philadelphia area. We explored 3 logistic regression models: model 1 (no adjustment); model 2 (adjustment for maternal age); and model 3?our final logistic regression model (adjustment for maternal age, ART use, and infertility diagnosis). In all models, multiple births (MBs) were our outcome of interest (binary outcome), and each medication was assessed separately as a binary variable. To assess our MWAS model performance, we defined ART medications as our gold standard, given that these medications are known to increase the risk of MB. Results: Of the 63,334 distinct deliveries in our cohort, only 1877 pregnancies (2.96%) were prescribed any medication during the preconception and first trimester period. Of the 123 medications prescribed, we found 26 (21.1%) medications associated with MB (using nominal P values) and 10 (8.1%) medications associated with MB (using Bonferroni adjustment) in fully adjusted model 3. We found that our model 3 algorithm had an accuracy of 85% (using nominal P values) and 89% (using Bonferroni-adjusted P values). Conclusions: Our work demonstrates the opportunities in applying the MWAS approach with electronic health record data to explore associations between preconception and periconception medication exposure and the risk of MB while identifying novel candidate medications for further study. Overall, we found 3 novel medications linked with MB that could be explored in further work; this demonstrates the potential of our method to be used for hypothesis generation. UR - https://medinform.jmir.org/2022/6/e32229 UR - http://dx.doi.org/10.2196/32229 UR - http://www.ncbi.nlm.nih.gov/pubmed/35671076 ID - info:doi/10.2196/32229 ER - TY - JOUR AU - Dunn, Sheila AU - Munro, Sarah AU - Devane, Courtney AU - Guilbert, Edith AU - Jeong, Dahn AU - Stroulia, Eleni AU - Soon, A. Judith AU - Norman, V. Wendy PY - 2022/5/5 TI - A Virtual Community of Practice to Support Physician Uptake of a Novel Abortion Practice: Mixed Methods Case Study JO - J Med Internet Res SP - e34302 VL - 24 IS - 5 KW - mifepristone KW - abortion KW - community of practice KW - virtual community of practice KW - diffusion of innovation KW - learning community N2 - Background: Virtual communities of practice (VCoPs) have been used to support innovation and quality in clinical care. The drug mifepristone was introduced in Canada in 2017 for medical abortion. We created a VCoP to support implementation of mifepristone abortion practice across Canada. Objective: The aim of this study was to describe the development and use of the Canadian Abortion Providers Support-Communauté de pratique canadienne sur l?avortement (CAPS-CPCA) VCoP and explore physicians? experience with CAPS-CPCA and their views on its value in supporting implementation. Methods: This was a mixed methods intrinsic case study of Canadian health care providers? use and physicians? perceptions of the CAPS-CPCA VCoP during the first 2 years of a novel practice. We sampled both physicians who joined the CAPS-CPCA VCoP and those who were interested in providing the novel practice but did not join the VCoP. We designed the VCoP features to address known and discovered barriers to implementation of medication abortion in primary care. Our secure web-based platform allowed asynchronous access to information, practice resources, clinical support, discussion forums, and email notices. We collected data from the platform and through surveys of physician members as well as interviews with physician members and nonmembers. We analyzed descriptive statistics for website metrics, physicians? characteristics and practices, and their use of the VCoP. We used qualitative methods to explore the physicians? experiences and perceptions of the VCoP. Results: From January 1, 2017, to June 30, 2019, a total of 430 physicians representing all provinces and territories in Canada joined the VCoP and 222 (51.6%) completed a baseline survey. Of these 222 respondents, 156 (70.3%) were family physicians, 170 (80.2%) were women, and 78 (35.1%) had no prior abortion experience. In a survey conducted 12 months after baseline, 77.9% (120/154) of the respondents stated that they had provided mifepristone abortion and 33.9% (43/127) said the VCoP had been important or very important. Logging in to the site was burdensome for some, but members valued downloadable resources such as patient information sheets, consent forms, and clinical checklists. They found email announcements helpful for keeping up to date with changing regulations. Few asked clinical questions to the VCoP experts, but physicians felt that this feature was important for isolated or rural providers. Information collected through member polls about health system barriers to implementation was used in the project?s knowledge translation activities with policy makers to mitigate these barriers. Conclusions: A VCoP developed to address known and discovered barriers to uptake of a novel medication abortion method engaged physicians from across Canada and supported some, including those with no prior abortion experience, to implement this practice. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2018-028443 UR - https://www.jmir.org/2022/5/e34302 UR - http://dx.doi.org/10.2196/34302 UR - http://www.ncbi.nlm.nih.gov/pubmed/35511226 ID - info:doi/10.2196/34302 ER - TY - JOUR AU - Cahill, Caitlin AU - Kruger, Natalia AU - Heine, John PY - 2022/4/29 TI - Buccal Mucosal Grafts as a Novel Treatment for the Repair of Rectovaginal Fistulas: Protocol for an Upcoming Prospective Single-Surgeon Case Series JO - JMIR Res Protoc SP - e31003 VL - 11 IS - 4 KW - surgical protocol KW - colorectal surgery, rectovaginal fistulas KW - fistula KW - surgery KW - gynecology KW - grafts KW - perioperative medicine N2 - Background: Rectovaginal fistulas (RVFs) are abnormal communications between the rectum/anus and the vagina. They are most frequently formed a result of obstetric injury and have deleterious effects on patients? quality of life. Despite several treatment modalities, RVFs remain difficult problems to manage, and many patients fail multiple attempts at surgical repair. Buccal mucosal grafts (BMGs) may be a solution to this problem. A BMG is an oral mucosal tissue harvested from the inner cheek. There are 2 case reports that describe the successful use of BMGs in the repair of RVFs. Objective: Our objective is to validate these findings with a prospective case series while also addressing the key issues of indication, technical details, procedure safety, and short-term outcomes. Methods: A prospective single-surgeon case series will be undertaken at a university-affiliated academic tertiary care hospital in Calgary, Alberta (Canada). The estimated recruitment is between 3 and 5 patients. Patients will undergo surgical repair of their RVFs with an autologous BMG. Data on patient characteristics, fistula characteristics, and surgical variables will be collected and analyzed prospectively. The primary outcome is fistula closure. This study has been approved by the Conjoint Health Research Ethics Board at the University of Calgary (REB20-1123). Results: Two previous case reports have described the successful use of BMGs in the repair of RVFs. We have received ethics approval to attempt to validate these findings through a prospective case series. Conclusions: RVFs cause significant patient morbidity and are difficult problems to manage. Bolstered by the successful use of BMGs in urologic surgery and the previously published case reports demonstrating success in RVFs, we believe that BMGs may be a solution to RVFs. International Registered Report Identifier (IRRID): PRR1-10.2196/31003 UR - https://www.researchprotocols.org/2022/4/e31003 UR - http://dx.doi.org/10.2196/31003 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486431 ID - info:doi/10.2196/31003 ER - TY - JOUR AU - Krishnamurti, Tamar AU - Birru Talabi, Mehret AU - Callegari, S. Lisa AU - Kazmerski, M. Traci AU - Borrero, Sonya PY - 2022/4/28 TI - A Framework for Femtech: Guiding Principles for Developing Digital Reproductive Health Tools in the United States JO - J Med Internet Res SP - e36338 VL - 24 IS - 4 KW - United States KW - North America KW - femtech KW - mHealth KW - health equity KW - pregnancy KW - women's health KW - preterm birth KW - contraception KW - family planning KW - reproductive care KW - sterilization KW - cystic fibrosis KW - rheumatic disease KW - eHealth KW - mobile health KW - reproductive health KW - digital health KW - health technology KW - health outcomes UR - https://www.jmir.org/2022/4/e36338 UR - http://dx.doi.org/10.2196/36338 UR - http://www.ncbi.nlm.nih.gov/pubmed/35482371 ID - info:doi/10.2196/36338 ER - TY - JOUR AU - Fuchs-Neuhold, Bianca AU - Staubmann, Wolfgang AU - Peterseil, Marie AU - Rath, Anna AU - Schweighofer, Natascha AU - Kronberger, Anika AU - Riederer, Monika AU - van der Kleyn, Moenie AU - Martin, Jochen AU - Hörmann-Wallner, Marlies AU - Waldner, Irmgard AU - Konrad, Manuela AU - Aufschnaiter, Lena Anna AU - Siegmund, Barbara AU - Berghold, Andrea AU - Holasek, Sandra AU - Pail, Elisabeth PY - 2022/4/27 TI - Investigating New Sensory Methods Related to Taste Sensitivity, Preferences, and Diet of Mother-Infant Pairs and Their Relationship With Body Composition and Biomarkers: Protocol for an Explorative Study JO - JMIR Res Protoc SP - e37279 VL - 11 IS - 4 KW - taste KW - preferences KW - nutrition KW - biomarkers KW - body composition KW - air displacement plethysmography KW - Baby Facial Actions Coding System KW - mother KW - infant KW - parenting KW - pediatrics KW - prenatal KW - postnatal N2 - Background: Early experiences with different flavors play an important role in infant development, including food and taste acceptance. Flavors are already perceived in utero with the development of the taste and olfactory system and are passed on to the child through breast and bottle feeding. Therefore, the first 1000 days of life are considered a critical window for infant developmental programming. Objective: The objective of our study is to investigate, both in the prenatal and postnatal period, taste sensitivity, preferences, and dietary diversity of mother-infant pairs. The explorative study design will also report on the impact of these variables on body composition (BC) and biomarkers. In contrast to conventional methods, this study involves long-term follow-up data collection from mother-infant pairs; moreover, the integration of audiovisual tools for recording infants' expressions pertaining to taste stimuli is a novelty of this study. Considering these new methodological approaches, the study aims to assess taste-related data in conjunction with BC parameters like fat-free mass or fat mass, biomarkers, and nutritional intake in infants and children. Methods: Healthy pregnant women aged between 18 and 50 years (BMI?18.5 kg/m2 to ?30 kg/m2; <28 weeks of gestation) were recruited from January 2014 to October 2014. The explorative design implies 2 center visits during pregnancy (24-28 weeks of gestation and 32-34 weeks of gestation) and 2 center visits after delivery (6-8 weeks postpartum and 14-16 weeks postpartum) as well as follow-up visits at 1, 3-3.5, and 6 years after delivery. Data collection encompasses anthropometric and biochemical measurements as well as BC analyses with air displacement plethysmography, taste perception assessments, and multicomponent questionnaires on demographics, feeding practices, and nutritional and lifestyle behaviors. Audiovisual data from infants? reactions to sensory stimuli are collected and coded by trained staff using Baby Facial Action Coding and the Body Action Posture System. Birth outcomes and weight development are obtained from medical records, and additional qualitative data are gathered from 24 semistructured interviews. Results: Our cohort represents a homogenous group of healthy women with stringent exclusion criteria. A total of 54 women met the eligibility criteria, whereas 47 mother-child pairs completed data collection at 4 center visits during and after pregnancy. Follow-up phases, data analyses, and dissemination of the findings are scheduled for the end of 2023. The study was approved by the ethics committee of the Medical University of Graz (EC No 26?066 ex 13/14), and all participants provided informed consent. Conclusions: The results of this study could be useful for elucidating the connections between maternal and infant statuses regarding diet, taste, biomarkers, and prenatal and postnatal weight development. This study may also be relevant to the establishment of further diagnostic and interventional strategies targeting childhood obesity and early body fat development. International Registered Report Identifier (IRRID): DERR1-10.2196/37279 UR - https://www.researchprotocols.org/2022/4/e37279 UR - http://dx.doi.org/10.2196/37279 UR - http://www.ncbi.nlm.nih.gov/pubmed/35475790 ID - info:doi/10.2196/37279 ER - TY - JOUR AU - Dhombres, Ferdinand AU - Bonnard, Jules AU - Bailly, Kévin AU - Maurice, Paul AU - Papageorghiou, T. Aris AU - Jouannic, Jean-Marie PY - 2022/4/20 TI - Contributions of Artificial Intelligence Reported in Obstetrics and Gynecology Journals: Systematic Review JO - J Med Internet Res SP - e35465 VL - 24 IS - 4 KW - artificial intelligence KW - systematic review KW - knowledge bases KW - machine learning KW - obstetrics KW - gynaecology KW - perinatology KW - medical informatics N2 - Background: The applications of artificial intelligence (AI) processes have grown significantly in all medical disciplines during the last decades. Two main types of AI have been applied in medicine: symbolic AI (eg, knowledge base and ontologies) and nonsymbolic AI (eg, machine learning and artificial neural networks). Consequently, AI has also been applied across most obstetrics and gynecology (OB/GYN) domains, including general obstetrics, gynecology surgery, fetal ultrasound, and assisted reproductive medicine, among others. Objective: The aim of this study was to provide a systematic review to establish the actual contributions of AI reported in OB/GYN discipline journals. Methods: The PubMed database was searched for citations indexed with ?artificial intelligence? and at least one of the following medical subject heading (MeSH) terms between January 1, 2000, and April 30, 2020: ?obstetrics?; ?gynecology?; ?reproductive techniques, assisted?; or ?pregnancy.? All publications in OB/GYN core disciplines journals were considered. The selection of journals was based on disciplines defined in Web of Science. The publications were excluded if no AI process was used in the study. Review, editorial, and commentary articles were also excluded. The study analysis comprised (1) classification of publications into OB/GYN domains, (2) description of AI methods, (3) description of AI algorithms, (4) description of data sets, (5) description of AI contributions, and (6) description of the validation of the AI process. Results: The PubMed search retrieved 579 citations and 66 publications met the selection criteria. All OB/GYN subdomains were covered: obstetrics (41%, 27/66), gynecology (3%, 2/66), assisted reproductive medicine (33%, 22/66), early pregnancy (2%, 1/66), and fetal medicine (21%, 14/66). Both machine learning methods (39/66) and knowledge base methods (25/66) were represented. Machine learning used imaging, numerical, and clinical data sets. Knowledge base methods used mostly omics data sets. The actual contributions of AI were method/algorithm development (53%, 35/66), hypothesis generation (42%, 28/66), or software development (3%, 2/66). Validation was performed on one data set (86%, 57/66) and no external validation was reported. We observed a general rising trend in publications related to AI in OB/GYN over the last two decades. Most of these publications (82%, 54/66) remain out of the scope of the usual OB/GYN journals. Conclusions: In OB/GYN discipline journals, mostly preliminary work (eg, proof-of-concept algorithm or method) in AI applied to this discipline is reported and clinical validation remains an unmet prerequisite. Improvement driven by new AI research guidelines is expected. However, these guidelines are covering only a part of AI approaches (nonsymbolic) reported in this review; hence, updates need to be considered. UR - https://www.jmir.org/2022/4/e35465 UR - http://dx.doi.org/10.2196/35465 UR - http://www.ncbi.nlm.nih.gov/pubmed/35297766 ID - info:doi/10.2196/35465 ER - TY - JOUR AU - Liang, Su-Ying AU - Stults, D. Cheryl AU - Jones, G. Veena AU - Huang, Qiwen AU - Sutton, Jeremy AU - Tennyson, Guy AU - Chan, S. Albert PY - 2022/3/30 TI - Effects of Behavioral Economics?Based Messaging on Appointment Scheduling Through Patient Portals and Appointment Completion: Observational Study JO - JMIR Hum Factors SP - e34090 VL - 9 IS - 1 KW - access to care KW - behavioral economics KW - online KW - web-based appointment scheduling KW - health service KW - behavior KW - health care N2 - Background: Behavioral economics?based techniques have been an increasingly utilized method in health care to influence behavior change by modifying language in patient communication (through choice architecture and the framing of words). Patient portals are a key tool for facilitating patient engagement in their health, and interventions deployed via patient portals have been effective in improving utilization of preventive health services. Objective: We examined the impacts of behavioral economics?based nudge health maintenance reminders on appointment scheduling through a patient portal and appointment completion for 2 preventive services: Medicare wellness visits and Pap smear. Methods: We conducted a retrospective observational study using electronic health record data from an integrated health care system in Northern California. Nudge health maintenance reminders with behavioral economics?based language were implemented for all sites in November 2017 for Medicare wellness visits and for selected sites in February 2018 for Pap smears. We analyzed 125,369 health maintenance reminders for Medicare wellness visits, and 585,358 health maintenance reminders for Pap smear sent between January 2017 and February 2020. The primary outcomes were rate of appointments scheduled through the patient portal and appointment completion rate. We compared the outcomes between those who received the new, behavioral economics?based health maintenance reminders (the nudge group) and those who received the original, standard health maintenance reminders (the control group). We used segmented regression with interrupted time series to assess the immediate and gradual effect of the nudge for Medicare wellness visits, and we used logistic regression to assess the association of nudge health maintenance reminders, adjusting for the propensity to receive a nudge health maintenance reminder, for Pap smear. Results: The rates of appointments scheduled through the patient portal were higher for nudge health maintenance reminder recipients than those for control health maintenance reminder recipients (Medicare wellness visits?nudge: 12,537/96,839, 13.0%; control: 2,769/28,530, 9.7%, P<.001; Pap smear?nudge: 8,239/287,149, 2.9%; control: 1,868/120,047, 1.6%; P<.001). Rates of appointment completion were higher for nudge health maintenance reminders for Pap smear (nudge: 67,399/287,149, 23.5% control: 20,393/120,047, 17.0%; P<.001) but were comparable for Medicare wellness visits (nudge: 49,835/96,839, 51.5% control: 14,781/28,530, 51.8%; P=.30). There was a marginally gradual effect of nudge on number of appointments scheduled through the patient portal for the overall Medicare wellness visits sample (at a monthly rate of 0.26%, P=.09), and a significant gradual effect among scheduled appointments (at a monthly rate of 0.46%, P=.04). For Pap smear, nudge health maintenance reminders were positively associated with number of appointments scheduled through the patient portal (overall sample: propensity adjusted odds ratio [OR] 1.62; 95% CI 1.50-1.74; among scheduled appointments: propensity adjusted OR 1.61, 95% CI 1.47-1.76) and with appointment completion (propensity adjusted OR 1.07; 1.04-1.10). Conclusions: Nudges, a behavioral economics?based approach to providing health maintenance reminders, increased the number of appointments scheduled through the patient portal for Medicare wellness visits and Pap smear. Our study demonstrates that a simple approach?framing and modifying language in an electronic message?can have a significant and long-term impact on patient engagement and access to care. UR - https://humanfactors.jmir.org/2022/1/e34090 UR - http://dx.doi.org/10.2196/34090 UR - http://www.ncbi.nlm.nih.gov/pubmed/35353051 ID - info:doi/10.2196/34090 ER - TY - JOUR AU - Zusman, Z. Enav AU - Lavu, Alekhya AU - Pawliuk, Colleen AU - Pawluski, Jodi AU - Hutchison, M. Sarah AU - Platt, W. Robert AU - Oberlander, F. Tim PY - 2022/3/28 TI - Associations Between Prenatal Exposure to Serotonergic Medications and Biobehavioral Stress Regulation: Protocol for a Systematic Review and Meta-analysis JO - JMIR Res Protoc SP - e33363 VL - 11 IS - 3 KW - pregnancy KW - serotonergic medications KW - antidepressants KW - stress regulation KW - systematic review KW - meta-analysis N2 - Background: Up to 20% of mothers experience antenatal depression and approximately 30% of these women are treated with serotonergic psychotropic pharmacological therapy during pregnancy. Serotonergic antidepressants readily cross the placenta and the fetal blood-brain barrier, altering central synaptic serotonin signaling and potentially altering serotonin levels in the developing fetal brain. Objective: The aim of this study is to assess the impact of prenatal exposure to serotonergic antidepressants, accounting for maternal mood disturbances, on markers of stress regulation during childhood. Methods: We will follow PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and will search MEDLINE, Embase, CINAHL, PsycINFO, and ClinicalTrials.gov for full-length studies that assessed physiological (eg, cortisol level, heart rate variability, salivary amylase, pupillary size, C-reactive protein) indices of stress regulation in children of pregnant people who were treated with a serotonergic antidepressant at any point during pregnancy. We will assess the quality of observational studies using the Newcastle-Ottawa Scale and the quality of experimental studies using the Cochrane risk-of-bias tool. When possible, we will conduct a random-effects meta-analysis. If meta-analysis is not possible, we will conduct a narrative review. If a sufficient number of studies are found, we will perform subgroup analysis and assess outcomes measured by drug class, dose, trimester of exposure, and child?s age and gender. Results: We registered our review protocol with PROSPERO (International Prospective Register of Systematic Reviews; CRD42021275750), completed the literature search, and initiated title and abstract review in August 2021. We expect to finalize this review by April 2022. Conclusions: Findings should identify the impact of prenatal antidepressant effects on stress regulation and distinguish it from the impact of prenatal exposure to maternal mood disturbances. This review should inform decisions about serotonergic antidepressant use during pregnancy. Trial Registration: PROSPERO CRD42021275750; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=275750 International Registered Report Identifier (IRRID): PRR1-10.2196/33363 UR - https://www.researchprotocols.org/2022/3/e33363 UR - http://dx.doi.org/10.2196/33363 UR - http://www.ncbi.nlm.nih.gov/pubmed/35343913 ID - info:doi/10.2196/33363 ER - TY - JOUR AU - Lok, YW Kris AU - Ko, WT Rachel AU - Fan, SL Heidi AU - Chau, PH AU - Wong, YH Janet AU - Wang, MP AU - Tsang, Vicky PY - 2022/3/9 TI - Feasibility and Acceptability of an Online WhatsApp Support Group on Breastfeeding: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e32338 VL - 11 IS - 3 KW - mHealth KW - breastfeeding KW - peer support KW - mobile health KW - parenting KW - instant messaging KW - online support KW - women's health KW - postpartum health KW - postpartum support N2 - Background: Mobile health, the use of mobile technology in delivering health care, has been found to be effective in changing health behaviors, including improving breastfeeding practices in postpartum women. With the widespread use of smartphones and instant messaging apps in Hong Kong, instant messaging groups could be a useful channel for delivering breastfeeding peer support. Objective: The aim of this paper is to study the feasibility and acceptability of an online instant messaging peer support group by trained peer counselors on improving breastfeeding outcome in primiparous women in Hong Kong. Methods: A two-arm, assessor-blind, randomized controlled feasibility study will be conducted on 40 primiparous women with the intention to breastfeed. Participants are recruited from the antenatal obstetrics and gynecology clinic of a public hospital in Hong Kong and randomly assigned at a 1:1 ratio to either intervention or control group. The intervention group receives peer support in an online instant messaging group with trained peer counselors on top of standard care, whereas the control group receives standard care. Breastfeeding outcome will be assessed for 6 months post partum or until weaned. The breastfeeding status, the proportion and duration of exclusive and any breastfeeding in each group, and the self-efficacy and attitude of participants will be assessed. The feasibility and acceptability of the study would also be assessed in preparation for a full randomized controlled trial. Results: This study (protocol version 1 dated January 5, 2021) has been reviewed and approved by the institutional review board of the University of Hong Kong, Hospital Authority Hong Kong West Cluster (reference UW 21-039), on January 26, 2021. Data collection is ongoing and expected to be completed in December 2021. The findings will be updated on clinical trial registry and disseminated in peer-reviewed journals. Conclusions: This study aims to assess the feasibility and effectiveness of an online instant messaging peer support group in improving the breastfeeding outcome of primiparous women in Hong Kong. Its findings could inform the feasibility of a full-scale trial with this intervention design. Trial Registration: ClinicalTrials.gov NCT04826796; https://clinicaltrials.gov/ct2/show/NCT04826796 International Registered Report Identifier (IRRID): DERR1-10.2196/32338 UR - https://www.researchprotocols.org/2022/3/e32338 UR - http://dx.doi.org/10.2196/32338 UR - http://www.ncbi.nlm.nih.gov/pubmed/35262504 ID - info:doi/10.2196/32338 ER - TY - JOUR AU - Memon, Ali Zahid AU - Reale, Sophie AU - Ahmed, Wardah AU - Spencer, Rachael AU - Lashari, Hussain Talib AU - Bhutta, Zulfiqar AU - Soltani, Hora PY - 2022/3/8 TI - Effects of Integrating Family Planning With Maternal, Newborn, and Child Health Services on Uptake of Voluntary Modern Contraceptive Methods in Rural Pakistan: Protocol for a Quasi-experimental Study JO - JMIR Res Protoc SP - e35291 VL - 11 IS - 3 KW - family planning KW - integrated health services KW - contraceptive prevalence rate KW - modern contraceptive prevalence rate KW - modern contraceptive method KW - rural Pakistan N2 - Background: The uptake of modern contraceptive methods (MCMs) remains low, with 25% of women reporting their use in Pakistan. The overarching interventions covering service delivery platforms at facility and community levels necessitate the integration of family planning (FP) with maternal, newborn, and child health (MNCH) services. Objective: The main aim of this study is to evaluate the impact of an integrated FP-MNCH service delivery model to increase coverage of MCMs in rural Pakistan. Moreover, we aim to measure the level of effectiveness of interventions regarding the uptake of MCMs. Methods: A quasi-experimental, sequential, mixed methods study design with pre- and postevaluation will be adopted to evaluate the impact of integration of FP with MNCH services. The interventions include the following: (1) capacity strengthening of health care providers, including technical trainings; training in counseling of women who attend immunization centers, antenatal care (ANC) clinics, and postnatal care (PNC) clinics; and provision of job aids; (2) counseling of women and girls attending ANC, PNC, and pediatric clinics; (3) ensuring sustained provision of supplies and commodities; (4) community engagement, including establishing adolescent-friendly spaces; and (5) use of District Health Information System data in decision-making. Descriptive statistics will be used to estimate prevalence (ie, proportions) and frequencies of outcome indicators. A univariate difference-in-difference analytical approach will be used to estimate the effect of the interventions. In addition, a Blinder-Oaxaca decomposition analysis will be conducted to identify and quantify determinants of the modern contraceptive prevalence rate. Results: The intervention phase began in July 2021 and will run until June 2022. The impact assessment will be conducted from July to September 2022. Conclusions: This project will evaluate the impact of integrating FP with MNCH services. Furthermore, this study will identify the drivers and barriers in uptake of MCMs and will simultaneously help in modifying the interventional strategies that can be scaled up through existing service delivery platforms within the public and private sectors, according to the local sociocultural and health system context. Trial Registration: ClinicalTrials.gov NCT05045599; https://clinicaltrials.gov/ct2/show/NCT05045599 International Registered Report Identifier (IRRID): DERR1-10.2196/35291 UR - https://www.researchprotocols.org/2022/3/e35291 UR - http://dx.doi.org/10.2196/35291 UR - http://www.ncbi.nlm.nih.gov/pubmed/35258461 ID - info:doi/10.2196/35291 ER - TY - JOUR AU - Andalibi, Nazanin AU - Bowen, Kristen PY - 2022/3/2 TI - Internet-Based Information Behavior After Pregnancy Loss: Interview Study JO - JMIR Form Res SP - e32640 VL - 6 IS - 3 KW - pregnancy loss KW - miscarriage KW - reproductive health KW - stigma KW - information behavior N2 - Background: Information behavior describes all human behaviors in relation to information. Individuals experiencing disruption or stigma often use internet-based tools and spaces to meet their associated information needs. One such context is pregnancy loss, which, although impactful and common, has been absent from much of feminist and reproductive health and information behavior scholarship. By understanding information behavior after pregnancy loss and accounting for it in designing internet-based information spaces, we can take a meaningful step toward countering the stigma and silence that many who experience such loss endure, facilitate coping, and make space for diverse pregnancy narratives in our society. Objective: This study?s objective is to provide a characterization of internet-based information behavior after pregnancy loss. Methods: We examined internet-based information behavior after pregnancy loss through 9 in-depth interviews with individuals residing in the United States. We analyzed the data by using open and axial coding. Results: We identified the following three themes in relation to participants? information behavior in internet-based spaces: needed information types, information-related concerns, and information outcomes. We drew from information behavior frameworks to interpret the processes and concerns described by participants as they moved from recognizing information needs to searching for information and to using information and experiencing outcomes. Specifically, we aligned these themes with information use concepts from the information behavior literature?information search, knowledge construction, information production, information application, and information effects. Participants? main concerns centered on being able to easily find information (ie, searchability), particularly on topics that had already been covered (ie, persistence), and, once found, being able to assess the information for its relevance, helpfulness, and credibility (ie, assessability). We suggest the following design implications that support health information behavior: assessability, persistence, and searchability. Conclusions: We examined internet-based information behavior in the context of pregnancy loss, an important yet silenced reproductive health experience. Owing to the prevalence of information seeking during pregnancy, we advocate that generic pregnancy-related information spaces should address the needs related to pregnancy loss that we identified in addition to spaces dedicated to pregnancy loss. Such a shift could not only support those who use these spaces to manage pregnancies and then experience a loss but also help combat the silence and stigma associated with loss and the linear and normative narrative by which pregnancies are often represented. UR - https://formative.jmir.org/2022/3/e32640 UR - http://dx.doi.org/10.2196/32640 UR - http://www.ncbi.nlm.nih.gov/pubmed/35234656 ID - info:doi/10.2196/32640 ER - TY - JOUR AU - Lu, Yu AU - Barrett, A. Laura AU - Lin, Z. Rebecca AU - Amith, Muhammad AU - Tao, Cui AU - He, Zhe PY - 2022/2/21 TI - Understanding Information Needs and Barriers to Accessing Health Information Across All Stages of Pregnancy: Systematic Review JO - JMIR Pediatr Parent SP - e32235 VL - 5 IS - 1 KW - pregnancy KW - information needs KW - ontology KW - systematic review KW - fertility KW - parenting KW - pregnancy information KW - online information KW - health database N2 - Background: Understanding consumers? health information needs across all stages of the pregnancy trajectory is crucial to the development of mechanisms that allow them to retrieve high-quality, customized, and layperson-friendly health information. Objective: The objective of this study was to identify research gaps in pregnancy-related consumer information needs and available information from different sources. Methods: We conducted a systematic review of CINAHL, Cochrane, PubMed, and Web of Science for relevant articles that were published from 2009 to 2019. The quality of the included articles was assessed using the Critical Appraisal Skills Program. A descriptive data analysis was performed on these articles. Based on the review result, we developed the Pregnancy Information Needs Ontology (PINO) and made it publicly available in GitHub and BioPortal. Results: A total of 33 articles from 9 countries met the inclusion criteria for this review, of which the majority were published no earlier than 2016. Most studies were either descriptive (9/33, 27%), interviews (7/33, 21%), or surveys/questionnaires (7/33, 21%); 20 articles mentioned consumers? pregnancy-related information needs. Half (9/18, 50%) of the human-subject studies were conducted in the United States. More than a third (13/33, 39%) of all studies focused on during-pregnancy stage; only one study (1/33, 3%) was about all stages of pregnancy. The most frequent consumer information needs were related to labor delivery (9/20, 45%), medication in pregnancy (6/20, 30%), newborn care (5/20, 25%), and lab tests (6/20, 30%). The most frequently available source of information was the internet (15/24, 63%). PINO consists of 267 classes, 555 axioms, and 271 subclass relationships. Conclusions: Only a few articles assessed the barriers to access to pregnancy-related information and the quality of each source of information; further work is needed. Future work is also needed to address the gaps between the information needed and the information available. UR - https://pediatrics.jmir.org/2022/1/e32235 UR - http://dx.doi.org/10.2196/32235 UR - http://www.ncbi.nlm.nih.gov/pubmed/35188477 ID - info:doi/10.2196/32235 ER - TY - JOUR AU - Aquino, Maria AU - Griffith, Janessa AU - Vattaparambil, Tessy AU - Munce, Sarah AU - Hladunewich, Michelle AU - Seto, Emily PY - 2022/2/7 TI - Patients? and Providers? Perspectives on and Needs of Telemonitoring to Support Clinical Management and Self-care of People at High Risk for Preeclampsia: Qualitative Study JO - JMIR Hum Factors SP - e32545 VL - 9 IS - 1 KW - high-risk pregnancy KW - blood pressure KW - preeclampsia KW - telemonitoring KW - home monitoring KW - mHealth N2 - Background: Preeclampsia is one of the leading causes of maternal mortality worldwide, with a global prevalence at 2%-8% of pregnancies. Patients at high risk for preeclampsia (PHRPE) have an increased risk of complications, such as fetal growth restriction, preterm delivery, abnormal clotting, and liver and kidney disease. Telemonitoring for PHRPE may allow for timelier diagnosis and enhanced management, which may improve maternal and perinatal outcomes. Objective: The objective of this study is to determine the perceptions and needs of PHRPE and their health care providers with respect to telemonitoring through semistructured interviews with both groups. This study explored (1) what the needs and challenges of monitoring PHRPE are during pregnancy and in the postpartum period and (2) what features are required in a telemonitoring program to support self-care and clinical management of PHRPE. Methods: This study used a qualitative descriptive approach, and thematic analysis was conducted. PHRPE and health care providers from a high-risk obstetrical clinic in a large academic hospital in Toronto, Canada, were asked to participate in individual semistructured interviews. Two researchers jointly developed a coding framework and separately coded each interview to ensure that the interviews were double-coded. The software program NVivo version 12 was used to help organize the codes. Results: In total, 7 PHRPE and 5 health care providers, which included a nurse practitioner and physicians, participated in the semistructured interviews. Using thematic analysis, perceptions on the benefits, barriers, and desired features were determined. Perceived benefits of telemonitoring for PHRPE included close monitoring of home blood pressure (BP) measurements and appropriate interventions for abnormal BP readings; the development of a tailored telemonitoring system for pregnant patients; and facilitation of self-management. Perceived barriers to telemonitoring for PHRPE included financial and personal barriers, as well as the potential for increased clinician workload. Desired features of a secure platform for PHRPE included the facilitation of self-management for patients and decision making for clinicians, as well as the inclusion of evidence-based action prompts. Conclusions: The perceptions of patients and providers on the use of telemonitoring for PHRPE support the need for a telemonitoring program for the management of PHRPE. Recommendations from this study include the specific features of a telemonitoring program for PHRPE, as well as the use of frameworks and design processes in the design and implementation of a telemonitoring program for PHRPE. UR - https://humanfactors.jmir.org/2022/1/e32545 UR - http://dx.doi.org/10.2196/32545 UR - http://www.ncbi.nlm.nih.gov/pubmed/35129445 ID - info:doi/10.2196/32545 ER - TY - JOUR AU - Baumert, O. Brittney AU - Fiedler, Nancy AU - Prapamontol, Tippawan AU - Suttiwan, Panrapee AU - Naksen, Warangkana AU - Panuwet, Parinya AU - Sittiwang, Supattra AU - Dokjunyam, Chayada AU - Smarr, M. Melissa AU - Marsit, J. Carmen AU - Ryan, Barry P. AU - Siriwong, Wattasit AU - Robson, G. Mark AU - Barr, Boyd Dana PY - 2022/2/7 TI - Investigation of Prenatal Pesticide Exposure and Neurodevelopmental Deficits in Northern Thailand: Protocol for a Longitudinal Birth Cohort Study JO - JMIR Res Protoc SP - e31696 VL - 11 IS - 2 KW - birth cohort KW - farmworker KW - neurodevelopment KW - organophosphate KW - pesticide KW - pregnant women KW - Thailand N2 - Background: Prenatal exposure to pesticides has been linked to adverse neurodevelopmental outcomes. Gaps exist in the current literature about the timing and magnitude of exposures that result in these adverse outcomes. Objective: The Study of Asian Women and their Offspring?s Development and Environmental Exposures (SAWASDEE) cohort was established to investigate the impact of prenatal exposure to pesticides on early indicators of cognitive and motor skills, inhibitory control, emotion regulation, and memory that have been found to be important in the development of subsequent neurobehavioral and neurodevelopmental diseases. The overarching goal is to find earlier predictors of potential adverse neurologic outcomes in order to enable earlier interventions that could result in better outcome prognoses. Methods: Recruitment of this prospective, longitudinal birth cohort began in July 2017 and was completed in June 2019 in Chom Thong and Fang, 2 farming districts in Chiang Mai Province in northern Thailand. Follow-up of the study participants is ongoing. During pregnancy, 7 questionnaires were administered. Time-resolved biospecimen samples were collected monthly (for urine) and during each trimester (for blood) during antenatal care visits. Medical records were abstracted. Infants were administered the NICU Network Neurobehavioral Scale (NNNS) test at 1 month of age. A total of 322 mother-child pairs completed the NNNS test. All children will be followed until 3 years of age and undergo a series of neurodevelopmental tests. We will complete several additional exposure related analyses. Results: A total of 1298 women were screened, and of those, 394 (30.35%) women were enrolled. The mean gestational age at enrollment was 9.9 weeks (SD 2.6). Differences in literacy were observed between Chom Thong and Fang participants. In Fang, about 54 of 105 (51.4%) participants reported being able to read in Thai compared to about 206 of 217 (94.9%) participants in Chom Thong. The percentages were comparable for reporting to be able to write in Thai. Conclusions: This longitudinal birth cohort study will inform risk assessment standards for pregnant women in Thailand and other countries. Building awareness of how insecticide exposure during specific windows of pregnancy affects the neurodevelopmental trajectories of children in developing countries is a specific need recognized by the World Health Organization. International Registered Report Identifier (IRRID): DERR1-10.2196/31696 UR - https://www.researchprotocols.org/2022/2/e31696 UR - http://dx.doi.org/10.2196/31696 UR - http://www.ncbi.nlm.nih.gov/pubmed/35129451 ID - info:doi/10.2196/31696 ER - TY - JOUR AU - Jaffar, Aida AU - Mohd-Sidik, Sherina AU - Foo, Nien Chai AU - Admodisastro, Novia AU - Abdul Salam, Nur Sobihatun AU - Ismail, Diana Noor PY - 2022/2/3 TI - Improving Pelvic Floor Muscle Training Adherence Among Pregnant Women: Validation Study JO - JMIR Hum Factors SP - e30989 VL - 9 IS - 1 KW - User-centered design KW - mHealth app KW - Digital intervention KW - mHealth Development and Evaluation Framework KW - Usability KW - Acceptability KW - Pelvic Floor Muscle Training KW - Urinary incontinence KW - Pregnancy N2 - Background: Mobile health apps, for example, the Tät, have been shown to be potentially effective in improving pelvic floor muscle training (PFMT) among women, but they have not yet been studied among pregnant women. Adherence to daily PFMT will improve pelvic floor muscle strength leading to urinary incontinence (UI) improvement during the pregnancy. Objective: This study aims to document the validation process in developing the Kegel Exercise Pregnancy Training app, which was designed to improve the PFMT adherence among pregnant women. Methods: We utilized an intervention mapping approach incorporated within the mobile health development and evaluation framework. The framework involved the following steps: (1) conceptualization, (2) formative research, (3) pretesting, (4) pilot testing, (5) randomized controlled trial, and (6) qualitative research. The user-centered design-11 checklist was used to evaluate the user-centeredness properties of the app. Results: A cross-sectional study was conducted to better understand PFMT and UI among 440 pregnant women. The study reported a UI prevalence of 40.9% (180/440), with less than half having good PFMT practice despite their good knowledge. Five focus group discussions were conducted to understand the app design preferred by pregnant women. They agreed a more straightforward design should be used for better app usability. From these findings, a prototype was designed and developed accordingly, and the process conformed to the user-centered design?11 (UCD-11) checklist. A PFMT app was developed based on the mHealth development and evaluation framework model, emphasizing higher user involvement in the application design and development. The application was expected to improve its usability, acceptability, and ease of use. Conclusions: The Kegel Exercise Pregnancy Training app was validated using a thorough design and development process to ensure its effectiveness in evaluating the usability of the final prototype in our future randomized control trial study. UR - https://humanfactors.jmir.org/2022/1/e30989 UR - http://dx.doi.org/10.2196/30989 UR - http://www.ncbi.nlm.nih.gov/pubmed/35113025 ID - info:doi/10.2196/30989 ER - TY - JOUR AU - Dempsey, B. AU - Callaghan, S. AU - Higgins, F. M. PY - 2022/2/2 TI - Providers? Experience of Abortion Care: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e35481 VL - 11 IS - 2 KW - abortion KW - termination of pregnancy KW - reproductive health KW - health care providers KW - experience KW - scoping review N2 - Background: Despite being one of the most common gynecological procedures in the world, abortion care remains highly stigmatized. Internationally, providers have noted negative impacts related to their involvement in the services, and abortion care has been described as ?dirty work.? Though much of the existing research focuses on the challenges of providing, many have also highlighted the positive aspects of working in abortion care. Despite the steadily increasing interest in this area over the past decade, however, no one has sought to systematically review the literature to date. Objective: The aim of this review is to systematically explore published studies on the experiences of abortion care providers to create a narrative review on the lived experience of providing abortion care, reflecting on what is already known and what areas require further exploration. Methods: This review will be conducted according to the framework outlined by Levac et al, which expanded on the popular Arksey and O?Malley framework. We will systematically search for peer-reviewed articles in 6 electronic databases: CINAHL, the Cochrane Library, EMBASE, PsycInfo, PubMed, and Web of Science. Following a pilot exercise, we devised a search strategy to identify relevant studies. In this protocol, we outline how citations will be assessed for eligibility and what information will be extracted from the included articles. We also highlight how this information will be combined in the review. Results: As of December 2021, at the time of writing, we have searched for articles in the electronic databases and identified 6624 unique citations. We intend to fully assess these citations for eligibility by the end of January 2022, chart and analyze data from the eligible citations by the end of March 2022, and submit a journal article for peer review by late spring 2022. Conclusions: The findings of this review will provide a comprehensive overview on the known experiences of providing abortion care. We also anticipate that the findings will identify aspects of care and experiences that are not reflected in the available literature. We will disseminate the results via a publication in a peer-reviewed academic journal and by presenting the findings at conferences in the areas of abortion care, obstetrics, and midwifery. As this review is a secondary analysis of published articles, ethical approval was not required. International Registered Report Identifier (IRRID): DERR1-10.2196/35481 UR - https://www.researchprotocols.org/2022/2/e35481 UR - http://dx.doi.org/10.2196/35481 UR - http://www.ncbi.nlm.nih.gov/pubmed/35107435 ID - info:doi/10.2196/35481 ER - TY - JOUR AU - Moon, Sungrim AU - Carlson, A. Luke AU - Moser, D. Ethan AU - Agnikula Kshatriya, Singh Bhavani AU - Smith, Y. Carin AU - Rocca, A. Walter AU - Gazzuola Rocca, Liliana AU - Bielinski, J. Suzette AU - Liu, Hongfang AU - Larson, B. Nicholas PY - 2022/1/28 TI - Identifying Information Gaps in Electronic Health Records by Using Natural Language Processing: Gynecologic Surgery History Identification JO - J Med Internet Res SP - e29015 VL - 24 IS - 1 KW - information gap KW - health information interoperability KW - natural language processing KW - electronic health records KW - gynecologic surgery KW - surgery KW - medical informatics KW - digital health KW - eHealth KW - gynecology N2 - Background: Electronic health records (EHRs) are a rich source of longitudinal patient data. However, missing information due to clinical care that predated the implementation of EHR system(s) or care that occurred at different medical institutions impedes complete ascertainment of a patient?s medical history. Objective: This study aimed to investigate information discrepancies and to quantify information gaps by comparing the gynecological surgical history extracted from an EHR of a single institution by using natural language processing (NLP) techniques with the manually curated surgical history information through chart review of records from multiple independent regional health care institutions. Methods: To facilitate high-throughput evaluation, we developed a rule-based NLP algorithm to detect gynecological surgery history from the unstructured narrative of the Mayo Clinic EHR. These results were compared to a gold standard cohort of 3870 women with gynecological surgery status adjudicated using the Rochester Epidemiology Project medical records?linkage system. We quantified and characterized the information gaps observed that led to misclassification of the surgical status. Results: The NLP algorithm achieved precision of 0.85, recall of 0.82, and F1-score of 0.83 in the test set (n=265) relative to outcomes abstracted from the Mayo EHR. This performance attenuated when directly compared to the gold standard (precision 0.79, recall 0.76, and F1-score 0.76), with the majority of misclassifications being false negatives in nature. We then applied the algorithm to the remaining patients (n=3340) and identified 2 types of information gaps through error analysis. First, 6% (199/3340) of women in this study had no recorded surgery information or partial information in the EHR. Second, 4.3% (144/3340) of women had inconsistent or inaccurate information within the clinical narrative owing to misinterpreted information, erroneous ?copy and paste,? or incorrect information provided by patients. Additionally, the NLP algorithm misclassified the surgery status of 3.6% (121/3340) of women. Conclusions: Although NLP techniques were able to adequately recreate the gynecologic surgical status from the clinical narrative, missing or inaccurately reported and recorded information resulted in much of the misclassification observed. Therefore, alternative approaches to collect or curate surgical history are needed. UR - https://www.jmir.org/2022/1/e29015 UR - http://dx.doi.org/10.2196/29015 UR - http://www.ncbi.nlm.nih.gov/pubmed/35089141 ID - info:doi/10.2196/29015 ER - TY - JOUR AU - Krukowski, Rebecca AU - Johnson, Brandi AU - Kim, Hyeonju AU - Sen, Saunak AU - Homsi, Riad PY - 2021/12/24 TI - A Pragmatic Intervention Using Financial Incentives for Pregnancy Weight Management: Feasibility Randomized Controlled Trial JO - JMIR Form Res SP - e30578 VL - 5 IS - 12 KW - pregnancy KW - weight KW - physical activity KW - self-weighing N2 - Background: Excessive gestational weight gain (GWG) is common and can result in maternal and child health complications. Pragmatic behavioral interventions that can be incorporated into standard obstetric care are needed, and financial incentives are a promising approach. Objective: The aim of this study is to evaluate the feasibility of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, in a behavioral program. The program provided small incentives for meeting behavioral goals of self-weighing and physical activity as well as larger outcome incentives for meeting GWG goals. Methods: We recruited 40 adult women in their first trimester of pregnancy from February 2019 to September 2019 at an obstetric clinic. Participants were randomized to 3 intervention components using a 2×2×2 factorial design: daily incentives for self-weighing (lottery vs certain loss), incentives for adhering to the Institute of Medicine?s GWG guidelines based on BMI category (monthly vs overall), and incentives for reaching physical activity goals (yes vs no). Participants were asked to complete daily weigh-ins using the Withings Body wireless scale provided by the study, as well as wear a physical activity tracker (Fitbit Flex 2). Feasibility outcomes of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, were assessed. Weight assessments were conducted at baseline, 32-week gestation, and 36-week gestation. Results: Participants were enrolled at, on average, 9.6 (SD 1.8) weeks? gestation. Of the 39 participants who were oriented to their condition and received the intervention, 24 (62%) were Black or African American, 30 (77%) were not married, and 29 (74%) had an annual household income of less than US $50,000. Of the 39 participants, 35 (90%) completed the follow-up data collection visit. Participants were generally quite positive about the intervention components, with a particular emphasis on the helpfulness of, and the enjoyment of using, the e-scale in both the quantitative and qualitative feedback. Participants who received the loss incentive, on average, had 2.86 times as many days of self-weighing as those who received the lottery incentive. Participants had a relatively low level of activity, with no difference between those who received a physical activity incentive and those who did not. Conclusions: A financial incentive?based pragmatic intervention was feasible and acceptable for pregnant women for promoting self-weighing, physical activity, and healthy GWG. Participants were successfully recruited early in their first trimester of pregnancy and retained for follow-up data collection in the third trimester. Participants demonstrated promising engagement in self-weighing, particularly with loss-based incentives, and reported finding the self-weighing especially helpful. This study supports further investigation of pragmatic, clinic-based financial incentive?based interventions for healthy GWG behaviors. Trial Registration: ClinicalTrials.gov NCT03834194; https://clinicaltrials.gov/ct2/show/NCT03834194 UR - https://formative.jmir.org/2021/12/e30578 UR - http://dx.doi.org/10.2196/30578 UR - http://www.ncbi.nlm.nih.gov/pubmed/34951594 ID - info:doi/10.2196/30578 ER - TY - JOUR AU - Sajnani, Jocelyn AU - Swan, Kimberly AU - Wolff, Sharon AU - Drummond, Kelsi PY - 2021/12/14 TI - Discharge Instruction Reminders Via Text Messages After Benign Gynecologic Surgery: Quasi-Experimental Feasibility Study JO - JMIR Perioper Med SP - e22681 VL - 4 IS - 2 KW - communication KW - hysterectomy KW - minimally invasive KW - laparoscopy KW - postoperative KW - patient satisfaction N2 - Background: With the implementation of enhanced recovery after surgery protocols and same-day hospital discharge, patients are required to take on increasing responsibility for their postoperative care. Various approaches to patient information delivery have been investigated and have demonstrated improvement in patient retention of instructions and patient satisfaction. Objective:  This study aimed to evaluate the feasibility of implementing a postoperative text messaging service in the benign gynecologic population. Methods:  We used a quasi-experimental study design to evaluate patients undergoing outpatient laparoscopic surgery for benign disease with a minimally invasive gynecologist at an academic medical center between October 2017 and March 2018. In addition to routine postoperative instructions, 19 text messages were designed to provide education and support to postoperative gynecologic patients. Patients were contacted by telephone 3 weeks postoperatively and surveyed about their satisfaction and feelings of connectedness during their recovery experience. Demographic and operative information was gathered through chart review. The cost to implement text messages was US $2.85 per patient. Results:  A total of 185 patients were eligible to be included in this study. Of the 100 intended intervention participants, 20 failed to receive text messages, leaving an 80% success in text delivery. No patients opted out of messaging. A total of 28 patients did not participate in the postrecovery survey, leaving 137 patients with outcome data (control, n=75; texting, n=62). Satisfaction, determined by a score ?9 on a 10-point scale, was 74% (46/62) in the texting group and 63% (47/75) in the control group (P=.15). Connectedness (score ?9) was reported by 64% (40/62) in the texting group compared with 44% (33/75) in the control group (P=.02). Overall, 65% (40/62) of those in the texting group found the texts valuable (score ?9). Conclusions:  Postoperative text messages increased patients? perceptions of connection with their health care team and may also increase their satisfaction with their recovery process. Errors in message delivery were identified. Given the increasing emphasis on patient experience and cost effectiveness in health care, an adequately powered future study to determine statistically significant differences in patient experience and resource use would be appropriate. UR - https://periop.jmir.org/2021/2/e22681 UR - http://dx.doi.org/10.2196/22681 UR - http://www.ncbi.nlm.nih.gov/pubmed/34904957 ID - info:doi/10.2196/22681 ER - TY - JOUR AU - Guedalia, Joshua AU - Lipschuetz, Michal AU - Cohen, M. Sarah AU - Sompolinsky, Yishai AU - Walfisch, Asnat AU - Sheiner, Eyal AU - Sergienko, Ruslan AU - Rosenbloom, Joshua AU - Unger, Ron AU - Yagel, Simcha AU - Hochler, Hila PY - 2021/12/10 TI - Transporting an Artificial Intelligence Model to Predict Emergency Cesarean Delivery: Overcoming Challenges Posed by Interfacility Variation JO - J Med Internet Res SP - e28120 VL - 23 IS - 12 KW - machine learning KW - algorithm transport KW - health outcomes KW - health care facilities KW - artificial intelligence KW - AI KW - ML KW - pregnancy KW - birth KW - pediatrics KW - neonatal KW - prenatal UR - https://www.jmir.org/2021/12/e28120 UR - http://dx.doi.org/10.2196/28120 UR - http://www.ncbi.nlm.nih.gov/pubmed/34890352 ID - info:doi/10.2196/28120 ER - TY - JOUR AU - Haßdenteufel, Kathrin AU - Lingenfelder, Katrin AU - Schwarze, E. Cornelia AU - Feisst, Manuel AU - Brusniak, Katharina AU - Matthies, Maria Lina AU - Goetz, Maren AU - Wallwiener, Markus AU - Wallwiener, Stephanie PY - 2021/12/10 TI - Evaluation of Repeated Web-Based Screening for Predicting Postpartum Depression: Prospective Cohort Study JO - JMIR Ment Health SP - e26665 VL - 8 IS - 12 KW - postpartum depression KW - Edinburgh Postnatal Depression Scale KW - screening KW - pregnancy KW - algorithm N2 - Background: Postpartum depression (PPD) is a severe mental disorder that often results in poor maternal-infant attachment and negatively impacts infant development. Universal screening has recently been recommended to identify women at risk, but the optimal screening time during pregnancy has not been defined so far. Thus, web-based technologies with widespread use among women of childbearing age create new opportunities to detect pregnancies with a high risk for adverse mental health outcomes at an early stage. Objective: The aim of this study was to stratify the risk for PPD and to determine the optimal screening time during pregnancy by using a web-based screening tool collecting electronic patient-reported outcomes (ePROs) as the basis for a screening algorithm. Methods: In total, 214 women were repeatedly tested for depressive symptoms 5 times during and 3 times after pregnancy by using the Edinburgh Postnatal Depression Scale (EPDS), accessible on a web-based pregnancy platform, developed by the authors of this study. For each prenatal assessment, the area under the curve (AUC), sensitivity, specificity, and predictive values for PPD were calculated. Multivariate logistic regression analyses were applied to identify further potential predictors, such as age, education, parity, relationship quality, and anxiety, to increase predictive accuracy. Results: Digitally collected data from 214 pregnant women were analyzed. The predictive accuracy of depressive symptoms 3 and 6 months postpartum was reasonable to good regarding the screening in the second (AUC=0.85) and third (AUC=0.75) trimester. The multivariate logistic regression analyses resulted in an excellent AUC of 0.93 at 3 months and a good AUC of 0.87 at 6 months postpartum. Conclusions: The best predictive accuracy for PPD has been shown for screening between the 24th and the 28th gestational week (GW) and seems to be beneficial for identifying women at risk. In combination with the aforementioned predictive factors, the discriminatory power improved, particularly at 3 months postpartum. Screening for depression during pregnancy, combined with the women?s personal risk profile, can be used as a starting point for developing a digital screening algorithm. Thereby, web-based assessment tools constitute feasible, efficient, and cost-effective approaches. Thus, they seem to be beneficial in detecting high-risk pregnancies in order to improve maternal and infant birth outcomes in the long term. UR - https://mental.jmir.org/2021/12/e26665 UR - http://dx.doi.org/10.2196/26665 UR - http://www.ncbi.nlm.nih.gov/pubmed/34890349 ID - info:doi/10.2196/26665 ER - TY - JOUR AU - van Barneveld, Esther AU - Lim, Arianne AU - van Hanegem, Nehalennia AU - Vork, Lisa AU - Herrewegh, Alexandra AU - van Poll, Mikal AU - Manders, Jessica AU - van Osch, Frits AU - Spaans, Wilbert AU - van Koeveringe, Gommert AU - Vrijens, Desiree AU - Kruimel, Joanna AU - Bongers, Marlies AU - Leue, Carsten PY - 2021/12/3 TI - Patient-Reported Outcome Measure for Real-time Symptom Assessment in Women With Endometriosis: Focus Group Study JO - JMIR Form Res SP - e28782 VL - 5 IS - 12 KW - endometriosis KW - pelvic pain KW - positive affect KW - negative affect KW - patient-reported outcome measure KW - focus groups KW - experience sampling method KW - momentary symptom assessment KW - mobile phone N2 - Background: Symptoms related to endometriosis have a significant impact on the quality of life, and symptoms often recur. The experience sampling method (ESM), a digital questioning method characterized by randomly repeated momentary assessments, has several advantages over traditionally used measurements, including the ability to assess the temporal relationship between variables such as physical, mental, and social factors. Objective: The aim of this study is to develop an ESM tool for patients with endometriosis to accurately measure symptoms and their course over time, allowing for personalized treatment and adequate monitoring of treatment efficacy in individual patients. Methods: On the basis of international guidelines, items from validated questionnaires were selected through a literature review and during focus groups and multidisciplinary expert meetings. Data analysis was conducted using ATLAS.ti (ATLAS.ti Scientific Software Development GmbH). The feasibility and usability of the newly developed momentary assessment tool were tested for 28 consecutive days in 5 patients with endometriosis-related pain symptoms. Results: Momentary assessment items contained questions concerning endometriosis symptoms, general somatic symptoms, psychological symptoms, contextual information, and the use of food and medication. A morning questionnaire on sleep and sexuality was included. In a pilot study, the patients considered the tool easy to use but time consuming. The average compliance rate of momentary assessments was 37.8% (106/280), with the highest completion rate during the first week (39/70, 56%). Therefore, it is advisable to use the ESM for a maximum of 7 days. Conclusions: A new digital tool for endometriosis symptom assessment was developed using the ESM, which may help overcome the limitations of current retrospective questionnaires. After validation and testing, future studies will be planned to evaluate the use of this tool in a clinical setting in order to propose a personalized treatment plan for women with endometriosis. UR - https://formative.jmir.org/2021/12/e28782 UR - http://dx.doi.org/10.2196/28782 UR - http://www.ncbi.nlm.nih.gov/pubmed/34870608 ID - info:doi/10.2196/28782 ER - TY - JOUR AU - Anneveldt, J. Kimberley AU - Nijholt, M. Ingrid AU - Schutte, M. Joke AU - Dijkstra, R. Jeroen AU - Frederix, J. Geert W. AU - Ista, Erwin AU - Verpalen, M. Inez AU - Veersema, Sebastiaan AU - Huirne, F. Judith A. AU - Hehenkamp, K. Wouter J. AU - Boomsma, F. Martijn PY - 2021/11/24 TI - Comparison of (Cost-)Effectiveness of Magnetic Resonance Image?Guided High-Intensity?Focused Ultrasound With Standard (Minimally) Invasive Fibroid Treatments: Protocol for a Multicenter Randomized Controlled Trial (MYCHOICE) JO - JMIR Res Protoc SP - e29467 VL - 10 IS - 11 KW - high-intensity?focused ultrasound ablation KW - magnetic resonance imaging, interventional KW - leiomyoma KW - randomized controlled trial KW - cost-effectiveness analysis KW - clinical trial protocol N2 - Background: Magnetic resonance image?guided high-intensity?focused ultrasound (MR-HIFU) is a rather new, noninvasive option for the treatment of uterine fibroids. It is safe, effective, and has a very short recovery time. However, a lack of prospectively collected data on long-term (cost-)effectiveness of the MR-HIFU treatment compared with standard uterine fibroid care prevents the MR-HIFU treatment from being reimbursed for this indication. Therefore, at this point, when conservative treatment for uterine fibroid symptoms has failed or is not accepted by patients, standard care includes the more invasive treatments hysterectomy, myomectomy, and uterine artery embolization (UAE). Primary outcomes of currently available data on MR-HIFU treatment often consist of technical outcomes, instead of patient-centered outcomes such as quality of life (QoL), and do not include the use of the latest equipment or most up-to-date treatment strategies. Moreover, data on cost-effectiveness are rare and seldom include data on a societal level such as productivity loss or use of painkillers. Because of the lack of reimbursement, broad clinical implementation has not taken place, nor is the proper role of MR-HIFU in uterine fibroid care sufficiently clear. Objective: The objective of our study is to determine the long-term (cost-)effectiveness of MR-HIFU compared with standard (minimally) invasive fibroid treatments. Methods: The MYCHOICE study is a national, multicenter, open randomized controlled trial with randomization in a 2:1 ratio to MR-HIFU or standard care including hysterectomy, myomectomy, and UAE. The sample size is 240 patients in total. Women are included when they are 18 years or older, in premenopausal stage, diagnosed with symptomatic uterine fibroids, conservative treatment has failed or is not accepted, and eligible for MR-HIFU. Primary outcomes of the study are QoL 24 months after treatment and costs of treatment including direct health care costs, loss of productivity, and patient costs. Results: Inclusion for the MYCHOICE study started in November 2020 and enrollment will continue until 2024. Data collection is expected to be completed in 2026. Conclusions: By collecting data on the long-term (cost-)effectiveness of the MR-HIFU treatment in comparison to current standard fibroid care, we provide currently unavailable evidence about the proper place of MR-HIFU in the fibroid treatment spectrum. This will also facilitate reimbursement and inclusion of MR-HIFU in (inter)national uterine fibroid care guidelines. Trial Registration: Netherlands Trial Register NL8863; https://www.trialregister.nl/trial/8863 International Registered Report Identifier (IRRID): DERR1-10.2196/29467 UR - https://www.researchprotocols.org/2021/11/e29467 UR - http://dx.doi.org/10.2196/29467 UR - http://www.ncbi.nlm.nih.gov/pubmed/34821569 ID - info:doi/10.2196/29467 ER - TY - JOUR AU - Pant, Ichhya AU - Rimal, Rajiv AU - Yilma, Hagere AU - Bingenheimer, Jeffrey AU - Sedlander, Erica AU - Behera, Sibabrata PY - 2021/11/22 TI - mHealth for Anemia Reduction: Protocol for an Entertainment Education?Based Dual Intervention JO - JMIR Res Protoc SP - e26252 VL - 10 IS - 11 KW - mHealth KW - interactive KW - voice response KW - entertainment KW - education KW - rural KW - anemia KW - bystander KW - violence against women N2 - Background: More than half of the women of reproductive age (aged 15-49 years) are anemic in India. The uptake of and adherence to iron folic acid (IFA) supplements remain low despite sustained efforts to increase their use. With India?s burgeoning digital environment, mobile phones offer a potential medium for increasing their uptake, especially when combined with interactive voice messages that deliver entertaining stories infused with norms-based educational messages. Objective: This study aims to investigate whether a norms-based entertainment education mobile health intervention can increase self-efficacy for IFA adherence among women of reproductive age in Odisha, India. Methods: Mobile reduction in anemia through normative innovations (mRANI) is a randomized 2-arm study that includes assessments before and after the intervention. All study participants will be recruited from the intervention arm of the parent reduction in anemia through normative innovations trial only. Although the usual practice is to randomize participants either to a treatment arm or a usual care control arm, we will assign the mRANI control group to another entertainment education?based treatment group that is designed to improve bystander intervention to reduce violence against women. Data collection for the mRANI study is embedded in the parent trial and will include baseline and end line assessments. The primary outcomes are self-efficacy for IFA adherence and violence against women?related bystander intervention. The inclusion criteria for the mRANI study are participation in the parent trial and phone ownership. Women (approximately n=400) who meet the mRANI inclusion criteria will be randomly assigned to the IFA arm or the bystander arm. Ordinary least squares regression with robust SEs will be conducted to assess between-group comparisons at the end line. A mediation analysis will be conducted to examine whether social norms and interactivity mediate the relationship between intervention exposure and primary outcomes in both arms. Real-time monitoring data will offer insights into intervention receptivity and audience engagement. Results: Data collection for the mRANI study is integrated within the parent trial. Household surveys were conducted between February and March of 2021. Responses on the mRANI study?s primary and secondary outcomes were collected from 381 participants. The data analysis is expected to be completed by October 2021. Conclusions: This study will provide evidence on whether a mobile health norms?based entertainment education intervention can increase self-efficacy for IFA adherence and violence against women?related bystander intervention. International Registered Report Identifier (IRRID): PRR1-10.2196/26252 UR - https://www.researchprotocols.org/2021/11/e26252 UR - http://dx.doi.org/10.2196/26252 UR - http://www.ncbi.nlm.nih.gov/pubmed/34812735 ID - info:doi/10.2196/26252 ER - TY - JOUR AU - Yang, Shi-Ping AU - Su, Hui-Luan AU - Chen, Xiu-Bei AU - Hua, Li AU - Chen, Jian-Xian AU - Hu, Min AU - Lei, Jian AU - Wu, San-Gang AU - Zhou, Juan PY - 2021/11/17 TI - Long-Term Survival Among Histological Subtypes in Advanced Epithelial Ovarian Cancer: Population-Based Study Using the Surveillance, Epidemiology, and End Results Database JO - JMIR Public Health Surveill SP - e25976 VL - 7 IS - 11 KW - ovarian epithelial carcinoma KW - survivors KW - histology KW - survival rate KW - survival KW - ovarian KW - cancer KW - surveillance KW - epidemiology KW - women?s health KW - reproductive health KW - Surveillance, Epidemiology, and End Results KW - ovary KW - oncology KW - survivorship KW - long-term outcome KW - epithelial N2 - Background: Actual long-term survival rates for advanced epithelial ovarian cancer (EOC) are rarely reported. Objective: This study aimed to assess the role of histological subtypes in predicting the prognosis among long-term survivors (?5 years) of advanced EOC. Methods: We performed a retrospective analysis of data among patients with stage III-IV EOC diagnosed from 2000 to 2014 using the Surveillance, Epidemiology, and End Results cancer data of the United States. We used the chi-square test, Kaplan?Meier analysis, and multivariate Cox proportional hazards model for the analyses. Results: We included 8050 patients in this study, including 6929 (86.1%), 743 (9.2%), 237 (2.9%), and 141 (1.8%) patients with serous, endometrioid, clear cell, and mucinous tumors, respectively. With a median follow-up of 91 months, the most common cause of death was primary ovarian cancer (80.3%), followed by other cancers (8.1%), other causes of death (7.3%), cardiac-related death (3.2%), and nonmalignant pulmonary disease (3.2%). Patients with the serous subtype were more likely to die from primary ovarian cancer, and patients with the mucinous subtype were more likely to die from other cancers and cardiac-related disease. Multivariate Cox analysis showed that patients with endometrioid (hazard ratio [HR] 0.534, P<.001), mucinous (HR 0.454, P<.001), and clear cell (HR 0.563, P<.001) subtypes showed better ovarian cancer-specific survival than those with the serous subtype. Similar results were found regarding overall survival. However, ovarian cancer?specific survival and overall survival were comparable among those with endometrioid, clear cell, and mucinous tumors. Conclusions: Ovarian cancer remains the primary cause of death in long-term ovarian cancer survivors. Moreover, the probability of death was significantly different among those with different histological subtypes. It is important for clinicians to individualize the surveillance program for long-term ovarian cancer survivors. UR - https://publichealth.jmir.org/2021/11/e25976 UR - http://dx.doi.org/10.2196/25976 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787583 ID - info:doi/10.2196/25976 ER - TY - JOUR AU - Jimah, Tamara AU - Borg, Holly AU - Kehoe, Priscilla AU - Pimentel, Pamela AU - Turner, Arlene AU - Labbaf, Sina AU - Asgari Mehrabadi, Milad AU - Rahmani, M. Amir AU - Dutt, Nikil AU - Guo, Yuqing PY - 2021/11/17 TI - A Technology-Based Pregnancy Health and Wellness Intervention (Two Happy Hearts): Case Study JO - JMIR Form Res SP - e30991 VL - 5 IS - 11 KW - ecological momentary assessment KW - heart rate KW - mHealth KW - physical activity KW - pregnancy KW - sleep KW - wearable electronic device N2 - Background: The physical and emotional well-being of women is critical for healthy pregnancy and birth outcomes. The Two Happy Hearts intervention is a personalized mind-body program coached by community health workers that includes monitoring and reflecting on personal health, as well as practicing stress management strategies such as mindful breathing and movement. Objective: The aims of this study are to (1) test the daily use of a wearable device to objectively measure physical and emotional well-being along with subjective assessments during pregnancy, and (2) explore the user?s engagement with the Two Happy Hearts intervention prototype, as well as understand their experiences with various intervention components. Methods: A case study with a mixed design was used. We recruited a 29-year-old woman at 33 weeks of gestation with a singleton pregnancy. She had no medical complications or physical restrictions, and she was enrolled in the Medi-Cal public health insurance plan. The participant engaged in the Two Happy Hearts intervention prototype from her third trimester until delivery. The Oura smart ring was used to continuously monitor objective physical and emotional states, such as resting heart rate, resting heart rate variability, sleep, and physical activity. In addition, the participant self-reported her physical and emotional health using the Two Happy Hearts mobile app?based 24-hour recall surveys (sleep quality and level of physical activity) and ecological momentary assessment (positive and negative emotions), as well as the Perceived Stress Scale, Center for Epidemiologic Studies Depression Scale, and State-Trait Anxiety Inventory. Engagement with the Two Happy Hearts intervention was recorded via both the smart ring and phone app, and user experiences were collected via Research Electronic Data Capture satisfaction surveys. Objective data from the Oura ring and subjective data on physical and emotional health were described. Regression plots and Pearson correlations between the objective and subjective data were presented, and content analysis was performed for the qualitative data. Results: Decreased resting heart rate was significantly correlated with increased heart rate variability (r=?0.92, P<.001). We found significant associations between self-reported responses and Oura ring measures: (1) positive emotions and heart rate variability (r=0.54, P<.001), (2) sleep quality and sleep score (r=0.52, P<.001), and (3) physical activity and step count (r=0.77, P<.001). In addition, deep sleep appeared to increase as light and rapid eye movement sleep decreased. The psychological measures of stress, depression, and anxiety appeared to decrease from baseline to post intervention. Furthermore, the participant had a high completion rate of the components of the Two Happy Hearts intervention prototype and shared several positive experiences, such as an increased self-efficacy and a normal delivery. Conclusions: The Two Happy Hearts intervention prototype shows promise for potential use by underserved pregnant women. UR - https://formative.jmir.org/2021/11/e30991 UR - http://dx.doi.org/10.2196/30991 UR - http://www.ncbi.nlm.nih.gov/pubmed/34787576 ID - info:doi/10.2196/30991 ER - TY - JOUR AU - Nuruddin, Rozina AU - Vadsaria, Khadija AU - Mohammed, Nuruddin AU - Sayani, Saleem PY - 2021/11/16 TI - The Efficacy of a Personalized mHealth Coaching Program During Pregnancy on Maternal Diet, Supplement Use, and Physical Activity: Protocol for a Parallel-Group Randomized Controlled Trial JO - JMIR Res Protoc SP - e31611 VL - 10 IS - 11 KW - coaching KW - compliance KW - diet KW - maternal health KW - mobile health KW - offspring health KW - physical activity KW - pregnancy KW - supplement use KW - usability N2 - Background: Adequate intake of macro- and micronutrients and adoption of an active lifestyle during pregnancy are essential for optimum maternal and fetal health and offspring development. Dietary counseling and advice regarding adequate physical activity are integral components of antenatal care. Personalized coaching through the use of mobile health (mHealth) that supports behavior modification is an innovative approach that needs exploration. Objective: Our primary aim is to assess the efficacy of an mHealth program in improving diet, supplement use, and physical activity during pregnancy. Secondary objectives include evaluation of the program?s effect on maternal and offspring health outcomes and assessment of its compliance and usability. Methods: A randomized controlled trial was initiated at the Aga Khan University Hospital in Karachi, Pakistan, in January 2020. We aim to recruit 300 pregnant women in their first trimester who have smartphones, do not have comorbidities, and are not taking medications. The intervention group will be trained to use an mHealth app called PurUmeed Aaghaz. Through this app, the subjects will report information about their diet, supplement use, and physical activity and will receive personalized advice and three push messages as weekly reminders. The research assistant will obtain similar information from the control group via a paperless questionnaire; this group will receive standard face-to-face counseling regarding diet, supplement use, and physical activity. Data will be collected at enrollment and during four follow-up sessions scheduled 6 weeks apart. Primary study outcomes include improvements in diet (ie, change in mean dietary risk score from baseline to each follow-up), supplement use (ie, changes in mean supplement use score and biochemical levels of folic acid, iron, calcium, and vitamin D on a study subset), and mean duration of reported physical activity (minutes). Secondary study outcomes relate to maternal health (ie, gestational diabetes mellitus, gestational hypertension, pre-eclampsia, and gestational weight gain), newborn health (ie, birth weight and length and gestational age at delivery), and infant health (ie, BMI and blood pressure at 1 year of age). Compliance will be determined by the proportion of participants who complete the 6-month coaching program. Usability will be assessed based on features related to design, interface, content, coaching, perception, and personal benefit. Results: The study was approved by the Ethics Review Committee of the Aga Khan University in 2017. The recruitment of study participants was completed in September 2021. All follow-ups and outcome assessments are expected to be completed by March 2023 and analysis is expected to be completed by June 2023. We expect the results to be published by the end of 2023. Conclusions: This study will be an important step toward evaluating the role of mHealth in improving behaviors related to a healthy diet, supplement use, and promotion of physical activity during pregnancy, as well as in influencing maternal and offspring outcomes. If proven effective, mHealth interventions can be scaled up and included in antenatal care packages at tertiary care hospitals of low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT04216446; https://clinicaltrials.gov/ct2/show/NCT04216446 International Registered Report Identifier (IRRID): DERR1-10.2196/31611 UR - https://www.researchprotocols.org/2021/11/e31611 UR - http://dx.doi.org/10.2196/31611 UR - http://www.ncbi.nlm.nih.gov/pubmed/34783675 ID - info:doi/10.2196/31611 ER - TY - JOUR AU - Doumouchtsis, K. Stergios AU - Nama, Vivek AU - Falconi, Gabriele AU - Rada, Patricia Maria AU - Manonai, Jittima AU - Iancu, George AU - Haddad, Milhem Jorge AU - Betschart, Cornelia PY - 2021/11/15 TI - Developing Core Outcome Sets (COS) and Core Outcome Measures Sets (COMS) in Cosmetic Gynecological Interventions: Protocol for a Development and Usability Study JO - JMIR Res Protoc SP - e28032 VL - 10 IS - 11 KW - core outcome sets KW - core outcome measures sets KW - cosmetic gynecological surgery KW - intervention KW - labiaplasty KW - vulva KW - gynecology KW - cosmetic surgery KW - surgery KW - framework KW - outcome KW - effective KW - implementation N2 - Background: Studies evaluating cosmetic gynecological interventions have followed variable methodology and reported a diversity of outcomes. Such variations limit the comparability of studies and the value of research-based evidence. The development of core outcome sets (COS) and core outcome measures sets (COMS) would help address these issues, ensuring a minimum of outcomes important to all stakeholders, primarily women requesting or having experienced cosmetic gynecological interventions. Objective: This protocol describes the methods used in developing a COS and COMS for cosmetic gynecological interventions. Methods: An international steering group within CHORUS, including health care professionals, researchers, and women with experience in cosmetic gynecological interventions from 4 continents, will guide the development of COS and COMS. Potential outcome measures and outcomes will be identified through comprehensive literature reviews. These potential COS and COMS will be entered into an international, multi-perspective web-based Delphi survey where Delphi participants judge which domains will be core. A priori thresholds for consensus will get established before each Delphi round. The Delphi survey results will be evaluated quantitatively and qualitatively in subsequent stakeholder group consensus meetings in the process of establishing ?core? outcomes. Results: Dissemination and implementation of the resulting COS and COMS within an international context will be promoted and reviewed. Conclusions: This protocol presents the steps in developing a COS and COMS for cosmetic gynecological interventions. Embedding the COS and COMS for cosmetic gynecological interventions within future clinical trials, systematic reviews, and practice guidelines could contribute to enhancing the value of research and improving overall patient care. Trial Registration: Core Outcome Measures in Effectiveness Trials (COMET) 1592; https://tinyurl.com/n8faysuh International Registered Report Identifier (IRRID): PRR1-10.2196/28032 UR - https://www.researchprotocols.org/2021/11/e28032 UR - http://dx.doi.org/10.2196/28032 UR - http://www.ncbi.nlm.nih.gov/pubmed/34779787 ID - info:doi/10.2196/28032 ER - TY - JOUR AU - Chukwu, Emeka AU - Gilroy, Sonia AU - Addaquay, Kojo AU - Jones, Nafisa Nki AU - Karimu, Gbadia Victor AU - Garg, Lalit AU - Dickson, Eva Kim PY - 2021/11/12 TI - Formative Study of Mobile Phone Use for Family Planning Among Young People in Sierra Leone: Global Systematic Survey JO - JMIR Form Res SP - e23874 VL - 5 IS - 11 KW - young people KW - short message service KW - SMS KW - chatbot KW - text message KW - interactive voice response KW - IVR KW - WhatsApp KW - Facebook KW - family planning KW - contraceptives KW - Sierra Leone N2 - Background: Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages. Objective: The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale. Methods: This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments. Results: Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media?only internet bundle, with the cost ranging from 1000 leones (US $0.11) to 1500 leones (US $0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US $0.11) and 5000 leones (US $0.52). Conclusions: mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale. UR - https://formative.jmir.org/2021/11/e23874 UR - http://dx.doi.org/10.2196/23874 UR - http://www.ncbi.nlm.nih.gov/pubmed/34766908 ID - info:doi/10.2196/23874 ER - TY - JOUR AU - Muwanguzi, A. Patience AU - Ngabirano, Denis Tom AU - Kiwanuka, Noah AU - Nelson, E. LaRon AU - Nasuuna, M. Esther AU - Osingada, Peter Charles AU - Nabunya, Racheal AU - Nakanjako, Damalie AU - Sewankambo, K. Nelson PY - 2021/11/1 TI - The Effects of Workplace-Based HIV Self-testing on Uptake of Testing and Linkage to HIV Care or Prevention by Men in Uganda (WISe-Men): Protocol for a Cluster Randomized Trial JO - JMIR Res Protoc SP - e25099 VL - 10 IS - 11 KW - Africa KW - workplace HIV testing KW - HIV self-testing KW - linkage to care KW - linkage to prevention N2 - Background: HIV testing uptake remains low among men in sub-Saharan Africa. HIV self-testing (HIVST) at the workplace is a novel approach to increase the availability of, and access to, testing among men. However, both access and linkage to posttest services remain a challenge. Objective: The aim of this protocol is to describe a cluster randomized trial (CRT)?Workplace-Based HIV Self-testing Among Men (WISe-Men)?to evaluate the effect of HIVST in workplace settings on the uptake of HIV testing services (HTS) and linkage to treatment and prevention services among men employed in private security services in Uganda. Methods: This is a two-arm CRT involving men employed in private security services in two Ugandan districts. The participants in the intervention clusters will undergo workplace-based HIVST using OraQuick test kits. Those in the control clusters will receive routine HTS at their work premises. In addition to HTS, participants in both the intervention and control arms will undergo other tests and assessments, which include blood pressure assessment, blood glucose and BMI measurement, and rapid diagnostic testing for syphilis. The primary outcome is the uptake of HIV testing. The secondary outcomes include HIV status reporting, linkage into HIV care and confirmatory testing following HIVST, initiation of antiretroviral therapy following a confirmatory HIV test, the uptake of voluntary medical male circumcision, consistent condom use, and the uptake of pre-exposure prophylaxis by the most at-risk populations. Results: Participant enrollment commenced in February 2020, and the trial is still recruiting study participants. Follow-up for currently enrolled participants is ongoing. Data collection and analysis is expected to be completed in December 2021. Conclusions: The WISe-Men trial will provide information regarding whether self-testing at worksites increases the uptake of HIV testing as well as the linkage to care and prevention services at male-dominated workplaces in Uganda. Additionally, the findings will help us propose strategies for improving men?s engagement in HTS and ways to improve linkage to further care following a reactive or nonreactive HIVST result. Trial Registration: ClinicalTrials.gov NCT04164433; https://clinicaltrials.gov/ct2/show/NCT04164433 International Registered Report Identifier (IRRID): DERR1-10.2196/25099 UR - https://www.researchprotocols.org/2021/11/e25099 UR - http://dx.doi.org/10.2196/25099 UR - http://www.ncbi.nlm.nih.gov/pubmed/34723826 ID - info:doi/10.2196/25099 ER - TY - JOUR AU - Diaz, Pilar Monica AU - Steen, Mary AU - Brown, Angela AU - Fleet, Julie-Anne AU - Williams, Jan PY - 2021/10/15 TI - Female Genital Mutilation/Cutting Education for Midwives and Nurses as Informed by Women?s Experiences: Protocol for an Exploratory Sequential Mixed Methods Study JO - JMIR Res Protoc SP - e32911 VL - 10 IS - 10 KW - education KW - midwives KW - nurses KW - female genital mutilation/cutting KW - maternity care KW - women?s health care, knowledge KW - attitude KW - practice N2 - Background: Female genital mutilation/cutting (FGM/C) is a complex and deeply rooted sociocultural custom that is innately entrenched in the lives of those who continue its practice despite the physical and psychological dangers it perpetrates. FGM/C is considered a significant independent risk factor for adverse maternal and fetal outcomes in pregnancy and childbirth. Several studies in high-income countries have explored the experiences and needs of women with FGM/C as well as the knowledge of the health professionals, particularly midwives and nurses, who care for them. However, to date, no studies have evaluated the implementation of education for health professionals in high-income countries to meet the specific needs of women with FGM/C. Objective: This study aims to explore the impact of an FGM/C education program for midwives and nurses as informed by the experiences of women with FGM/C accessing maternity, gynecological, and sexual health services in South Australia. Methods: This study will adopt a three-phase, exploratory sequential mixed methods design. Phase 1 will involve the exploration of women with FGM/C views and experiences accessing maternity and gynecological (including sexual health) services in South Australia. The findings from phase 1 will inform phase 2: the development of an educational program for midwives and nurses on the health and cultural needs of women with FGM/C. Phase 3 will involve the evaluation of the program by measuring midwives? and nurses? changes in knowledge, attitude, and practice immediately before and after the education as well as 4 months after completing the program. Phase 1 of this study has been approved by the Women?s and Children?s Health Network human research ethics committee (ID number 2021/HRE00156) and the University of South Australia human research ethics committee (ID number 204096). Results: Phase 1 will commence in August 2021, with the interpretation of findings being undertaken by November 2021. Phase 2 will be developed and facilitated by February 2022, and the final phase of this study will begin in March 2022. This study is expected to be completed by February 2023. Conclusions: The findings of this research will provide insight into the development and evaluation of education programs for midwives and nurses that includes collaboration with women from culturally and linguistically diverse backgrounds to address the specific cultural and health needs of communities. International Registered Report Identifier (IRRID): PRR1-10.2196/32911 UR - https://www.researchprotocols.org/2021/10/e32911 UR - http://dx.doi.org/10.2196/32911 UR - http://www.ncbi.nlm.nih.gov/pubmed/34652281 ID - info:doi/10.2196/32911 ER - TY - JOUR AU - Kruglova, Katya AU - O'Connell, Laura Siobhan Bernadette AU - Dawadi, Shrinkhala AU - Gelgoot, Noah Eden AU - Miner, A. Skye AU - Robins, Stephanie AU - Schinazi, Joy AU - Zelkowitz, Phyllis PY - 2021/10/12 TI - An mHealth App to Support Fertility Patients Navigating the World of Infertility (Infotility): Development and Usability Study JO - JMIR Form Res SP - e28136 VL - 5 IS - 10 KW - mHealth app KW - mHealth development process KW - infertility KW - intervention design KW - mobile phone N2 - Background: The experience of infertility and its treatment engenders considerable stress and is often described as an emotional rollercoaster. A mobile health (mHealth) app may be a novel solution to address the psychoeducational and psychosocial support needs of fertility patients because of its potential to reduce stress and increase patient empowerment. There are a few fertility-related apps that provide information and support to both men and women undergoing fertility treatment; however, none have documented their development and evaluation process. Objective: This study aims to describe the development and evaluation process of a bilingual mHealth app, Infotility, designed to meet the psychoeducational and psychosocial support needs of men and women undergoing fertility treatment. Methods: To develop the Infotility app, we adhered to the Medical Research Council guidelines for the development and evaluation of complex interventions. First, we conducted literature reviews and needs assessment surveys of fertility patients and health care providers who informed the content and design of the app. Second, we tested the intervention with a small group of end users who provided feedback on the design and appropriateness of the app?s content. Third, we evaluated the uptake and usability of the app using a pre-post study design. Finally, we updated the app?s content based on participants? feedback and searched for partners to disseminate the app to the broader public. Results: This study is the first to describe the development and evaluation process of an mHealth app for men and women undergoing fertility treatment. The app met its goal in providing fertility patients with a clinician-approved, portable resource for reliable information about medical and psychosocial aspects of infertility and its treatments and a confidential peer support forum monitored by trained peer supporters. Participants rated the engagement, functionality, information, and esthetics of the app positively, with an overall app quality mean score of 3.75 (SD 0.53) and a star rating of 3.43 (SD 0.75), with a total possible score and star rating of 5.00. Conclusions: By documenting the systematic development and evaluation of the mHealth app for men and women undergoing fertility treatment, this paper can facilitate the replication of the study intervention and the development of similar mHealth apps. UR - https://formative.jmir.org/2021/10/e28136 UR - http://dx.doi.org/10.2196/28136 UR - http://www.ncbi.nlm.nih.gov/pubmed/34636741 ID - info:doi/10.2196/28136 ER - TY - JOUR AU - Noddin, Katie AU - Bradley, Dani AU - Wolfberg, Adam PY - 2021/10/4 TI - Delivery Outcomes During the COVID-19 Pandemic as Reported in a Pregnancy Mobile App: Retrospective Cohort Study JO - JMIR Pediatr Parent SP - e27769 VL - 4 IS - 4 KW - digital health KW - COVID-19 KW - maternal health KW - obstetrics KW - COVID KW - pandemic KW - pregnant women KW - birth KW - hospital KW - delivery KW - women's health KW - Cesarean sections N2 - Background: The COVID-19 pandemic has presented obstacles for providers and patients in the maternal health care setting, causing changes to many pregnant women?s birth plans, as well as abrupt changes in hospital labor and delivery policies and procedures. Few data exist on the effects of the COVID-19 pandemic on the maternal health care landscape at the national level in the United States. Objective: The aim of this study is to assess the incidence of key obstetrics outcomes (preterm delivery, Cesarean sections, and home births) and length of hospital stay during the COVID-19 pandemic as compared to the 6 months prior. Methods: We conducted a retrospective cohort study of women aged 18-44 years in the United States who delivered between October 1, 2019, and September 30, 2020, had singleton deliveries, and completed a birth report in the Ovia Pregnancy mobile app. Women were assigned to the prepandemic cohort if they delivered between October 2019 and March 2020, and the pandemic cohort if they delivered between April and September 2020. Gestational age at delivery, delivery method, delivery facility type, and length of hospital stay were compared. Results: A total of 304,023 birth reports were collected, with 152,832 (50.26%) in the prepandemic cohort and 151,191 (49.73%) in the pandemic cohort. Compared to the prepandemic cohort, principal findings indicate a 5.67% decrease in preterm delivery rates in the pandemic cohort (P<.001; odds ratio [OR] 0.94, 95% CI 0.91-0.96), a 30.0% increase in home birth rates (P<.001; OR 1.3, 95% CI 1.23-1.4), and a 7.81% decrease in the average hospital length of stay postdelivery (mean 2.48 days, SD 1.35). There were no overall changes in Cesarean section rates between cohorts, but differences were observed between age, race, and ethnicity subgroups. Conclusions: Results suggest a need for continuous monitoring of maternal health trends as the COVID-19 pandemic progresses and underline the important role of digital data collection, particularly during the pandemic. UR - https://pediatrics.jmir.org/2021/4/e27769 UR - http://dx.doi.org/10.2196/27769 UR - http://www.ncbi.nlm.nih.gov/pubmed/34509975 ID - info:doi/10.2196/27769 ER - TY - JOUR AU - Myhre, Leren Enid AU - Garnweidner-Holme, Lisa AU - Dahl, Bente AU - Reigstad, Myhre Marte AU - Lukasse, Mirjam PY - 2021/9/27 TI - Development of and Experiences With an Informational Website on Early Labor: Qualitative User Involvement Study JO - JMIR Form Res SP - e28698 VL - 5 IS - 9 KW - early labor KW - latent phase KW - think aloud KW - usability KW - website KW - labor KW - pregnancy KW - user-friendliness KW - eHealth KW - user satisfaction N2 - Background: The period of regular contractions before 4 cm of cervical dilatation is often referred to as the latent phase or early labor. Women find it challenging to prepare for and cope with this phase of labor, and easily accessed web-based information from reliable sources may be useful in this preparation. Objective: The aim of this study is to describe the development of a Norwegian website, Latens.no, for people seeking information on early labor and to explore users? experiences with the website to increase its user-friendliness. Methods: We developed a website using an iterative process involving a multidisciplinary research team, health personnel, users, a graphic designer, and an expert in software development. We explored the website?s user-friendliness using semistructured individual interviews and the think-aloud method. All interviews were audio recorded and transcribed. We then analyzed the participants? feedback on the website. Results: Participants included women who had recently given birth to their first baby (n=2), women who were pregnant with their first baby (n=4), and their partners (n=2). Results from participants? experiences completing tasks included positive feedback related to the content of Latens.no, positive feedback related to the website?s design, and suggestions for improvement. Participants wanted to find information on early labor on the internet. Moreover, they found the information on the website relevant, trustworthy, and easy to read, and the design was attractive and easy to use. Overall, the participants performed the tasks easily, with few clicks and minimal effort. Conclusions: The think-aloud method, while performing tasks, allowed for detailed feedback. The participants confirmed the user-friendliness of the website but at the same time provided information enabling improvement. We expect that changes made based on this user-centered design study will further increase the usability and acceptability of Latens.no. UR - https://formative.jmir.org/2021/9/e28698 UR - http://dx.doi.org/10.2196/28698 UR - http://www.ncbi.nlm.nih.gov/pubmed/34569940 ID - info:doi/10.2196/28698 ER - TY - JOUR AU - Amod, Hafaza AU - Mkhize, Wellington Sipho AU - Muraraneza, Claudine PY - 2021/9/21 TI - Analyzing Evidence on Interventions to Strengthen the Clinical Support for Midwifery Students in Clinical Placements: Protocol for a Systematic Scoping Review JO - JMIR Res Protoc SP - e29707 VL - 10 IS - 9 KW - midwifery students KW - registered midwives KW - clinical support interventions KW - midwives KW - midwifery KW - students KW - mentorship KW - clinical supervision KW - collaboration KW - clinician attitudes N2 - Background: The benefits of clinical support are evident in various mentorship, preceptorship, or clinical supervision models. Poor collaboration between lecturers and clinical staff, lack of confidence about student support, large student intakes coupled with core demands create negative attitudes toward student supervision, and this poses a huge challenge to midwifery students who are expected to become competent in the process. Objective: This study aims to identify and analyze interventions, strategies, and/or mechanisms in order to strengthen the clinical support for midwifery students in clinical practice areas from a global perspective. Methods: This review will follow the Arksey and O?Malley framework (2005). The search strategy will include primary studies searched for in electronic databases such as EBSCOhost (CINAHL, MEDLINE, and Health Source: Nursing/Academic edition), PubMed, Google, and Google Scholar. Keywords such as ?midwifery students,? ?midwifery education,? and ?clinical support? will be used to search for related articles. The search will include articles from the cited by search, as well as citations from the reference list of included articles. All title-screened articles will be exported to an EndNote library, and duplicate studies will be removed. Two independent reviewers will concurrently carry out the abstract and full-text article screening according to the eligibility criteria. Extracted data will highlight the aims, geographical setting, and level of training; intervention outcomes; and the most relevant and most significant findings. This review will also include a mixed methods quality appraisal check. A narrative summary of data extracted will be analyzed using content analysis. Results: Interventions to strengthen the clinical support for midwifery students in practice will be extracted from this review, and data will be analyzed and extracted to develop a comprehensive guide or framework for clinical mentorship. As of August 2021, the electronic search, the data extraction, and the analysis have been completed. The results paper is expected to be published within the next 6 months. Conclusions: It is expected that this review will contribute to midwifery education by identifying quality evidence on clinical support interventions available to midwifery students globally, as well as best practice methods, procedures, or interventions that can be used to develop a midwifery mentorship training program. International Registered Report Identifier (IRRID): DERR1-10.2196/29707 UR - https://www.researchprotocols.org/2021/9/e29707 UR - http://dx.doi.org/10.2196/29707 UR - http://www.ncbi.nlm.nih.gov/pubmed/34546180 ID - info:doi/10.2196/29707 ER - TY - JOUR AU - Wessels, J. Nienke AU - Loohuis, M. Anne M. AU - van der Worp, Henk AU - Abbenhuis, Linde AU - Dekker, Janny AU - Berger, Y. Marjolein AU - van Gemert-Pijnen, C. Julia E. W. AU - Blanker, H. Marco PY - 2021/9/17 TI - Barriers and Facilitators Associated With App-Based Treatment for Female Urinary Incontinence: Mixed Methods Evaluation JO - JMIR Mhealth Uhealth SP - e25878 VL - 9 IS - 9 KW - mHealth KW - female KW - mixed methods KW - primary health care KW - urinary incontinence N2 - Background: App-based treatment for urinary incontinence is a proven effective and cost-effective alternative to care as usual, but successful implementation requires that we identify and address the barriers and facilitators associated with app use. Objective: The goal of the research was to explore the factors influencing app-based treatment for urinary incontinence and identify which barriers or facilitators are associated with treatment success or failure. Methods: We used a sequential explanatory mixed methods design to connect the results of a randomized controlled trial with data from semistructured interviews. This previous RCT had shown the noninferiority of app-based treatment compared with care as usual for urinary incontinence over 4 months. Participants who reported success or failure with app-based treatment, as measured by the change in International Consultation on Incontinence Modular Questionnaire Urinary Incontinence Short Form symptom score, were selected for telephone interview by purposive sampling (n=17). This study reports mainly on the qualitative component of our mixed methods study. Qualitative analyses were conducted in two ways. First, we analyzed the qualitative data of all interviewed participants and discussed the relationships between the main themes. Second, the experiences between the success (n=9) and failure group (n=8) were compared and contrasted to explore factors that were positively or negatively associated with the quantitative effect of app-based treatment. These factors were then interpreted as barriers to and facilitators of successful app-based treatment. Results: Four interrelated themes were identified as affecting the app based treatment effect: adherence, personal factors, app factors, and awareness. Qualitative analyses of the relationships between the themes showed that adherence-related factors directly influenced treatment effect in both a positive and negative matter. In turn, adherence was also positively and negatively influenced by the other 3 themes. Additionally, awareness was positively influenced by the treatment effect. Within these themes, several factors were identified that acted as barriers (eg, unrealistic expectation of time investment and interfering personal circumstances), facilitators (eg, strict integration of exercises and prior pelvic floor muscle therapy), or both (eg, personality traits and increased awareness of symptoms). Conclusions: This study shows that the effect of app-based treatment for urinary incontinence is mainly influenced by adherence, which in turn is affected by personal factors, app-based factors, and awareness. The identified factors could function as both facilitators and barriers depending on the user and interaction with other themes. Insight into these facilitators and barriers could lead to improved implementation and increased treatment effectiveness by targeting women most likely to benefit and through further development of the app. International Registered Report Identifier (IRRID): RR2-10.1002/nau.23507 UR - https://mhealth.jmir.org/2021/9/e25878 UR - http://dx.doi.org/10.2196/25878 UR - http://www.ncbi.nlm.nih.gov/pubmed/34533466 ID - info:doi/10.2196/25878 ER - TY - JOUR AU - Khodyakov, Dmitry AU - Jilani, M. Shahla AU - Dellva, Stephanie AU - Faherty, J. Laura PY - 2021/9/7 TI - Informing the Development of a Standardized Clinical Definition of Neonatal Abstinence Syndrome: Protocol for a Modified-Delphi Expert Panel JO - JMIR Res Protoc SP - e25387 VL - 10 IS - 9 KW - Delphi KW - ExpertLens KW - expert panel KW - neonatal abstinence syndrome KW - neonatal opioid withdrawal syndrome KW - neonatal withdrawal KW - neonatal KW - neonates KW - opioid KW - opioids KW - withdrawal KW - infants KW - clinical KW - newborn KW - newborns KW - perinatal KW - postnatal N2 - Background: Neonatal abstinence syndrome (NAS) is a postnatal withdrawal syndrome that most commonly results from prenatal opioid exposure. Every 15 minutes, an infant is born in the United States with signs of NAS. The field lacks a standardized clinical definition of NAS, complicating discussions on programmatic and policy development to support opioid-exposed mothers and infants. Objective: The goal of this paper is to describe a protocol for a systematic expert panel process to inform the development of a clinical definition of NAS. Methods: We will conduct two three-round online modified-Delphi panels using the ExpertLens system and will follow the recommendations for Conducting and REporting of DElphi Studies (CREDES). One panel will focus on developing key components of a clinical definition of NAS, and the second panel will focus on neonatal opioid withdrawal syndrome (NOWS), which is a term that has come into use to differentiate opioid-exposed infants from infants exposed to other substances in utero. However, there is lack of agreement on the precise clinical definition of NOWS and how it is distinct from or overlaps with NAS. Each panel will complete two rating rounds and a discussion round using a similar protocol. We will analyze all rating data descriptively and determine the presence of agreement within and between the two panels. We will also perform thematic analysis of the qualitative comments to contextualize the panel findings. Results: The panels were convened between October 29 and December 17, 2020. Their results were disseminated and discussed at a national conference on NAS that took place on March 17-18, 2021. Conclusions: A standardized clinical definition of NAS will help to better characterize NAS incidence and to design effective clinical, public health, and policy interventions to support opioid-exposed mother-infant dyads. International Registered Report Identifier (IRRID): DERR1-10.2196/25387 UR - https://www.researchprotocols.org/2021/9/e25387 UR - http://dx.doi.org/10.2196/25387 UR - http://www.ncbi.nlm.nih.gov/pubmed/34491203 ID - info:doi/10.2196/25387 ER - TY - JOUR AU - van der Windt, Melissa AU - Schoenmakers, Sam AU - Willemsen, Sten AU - van Rossem, Lenie AU - Steegers-Theunissen, Régine PY - 2021/9/3 TI - Optimizing the Periconception Lifestyle of Women With Overweight Using a Blended Personalized Care Intervention Combining eHealth and Face-to-face Counseling (eFUSE): Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e28600 VL - 10 IS - 9 KW - eHealth KW - periconception period KW - lifestyle intervention KW - maternal and child health KW - pregnancy KW - birth outcomes KW - healthy lifestyle KW - psychotherapy KW - obesity KW - randomized controlled trial KW - behavior change N2 - Background: Maternal overweight has a substantial impact on reproductive, maternal, pregnancy, and neonatal outcomes with long-term and transgenerational health consequences. Interventions that aim to optimize periconception maternal lifestyle can improve maternal and fetal health during pregnancy and throughout the life course. However, it remains difficult to change and adopt adequate lifestyle behaviors. We hypothesize that additional psychological therapy targeting cognitive and affective factors substantially contribute to the effectiveness of these interventions. Objective: The proposed study aims to examine the feasibility and effectiveness of a blended personalized periconception lifestyle care intervention with additional psychological therapy aimed at women with a BMI?25 and who are contemplating pregnancy or are already pregnant (?12 weeks) in reducing inadequate lifestyle behaviors and improving early and late pregnancy outcome. Methods: The eHealth and Face-to-face Counseling (eFUSE) study follows a single-center two-arm randomized controlled trial design at the Erasmus MC, University Medical Center, with a multicenter regional referral. The female patients with overweight (BMI?25), together with their male partner, will be stratified by pregnancy status (preconception vs pregnant) and randomized to receive either the blended personalized periconception lifestyle care intervention with additional psychological therapy (n=313) or usual care (n=313). The primary outcome is a change in the lifestyle risk score (between baseline and 24 weeks) between the randomization arms (difference in differences). Secondary outcomes include measurements defined as most relevant by the International Consortium for Health Outcomes Measurement, including behavioral determinants, patient satisfaction, provider feasibility, and maternal pregnancy and neonatal complications. Results: The study will be open for recruitment from Fall 2021 onward. Data collection is expected to be completed by the beginning of 2023, and the results are expected to be published by Fall 2023. Conclusions: This study will evaluate the feasibility and effectiveness of a blended periconception lifestyle intervention with additional psychological therapy, aimed at women with a BMI?25. Positive results of this innovative care approach will be used for implementation in routine medical care of all women with overweight, with the ultimate aim to improve clinical outcomes of these high-risk pregnancies. Trial Registration: Netherlands Trial Register NL9264; https://www.trialregister.nl/trial/9264 International Registered Report Identifier (IRRID): PRR1-10.2196/28600 UR - https://www.researchprotocols.org/2021/9/e28600 UR - http://dx.doi.org/10.2196/28600 UR - http://www.ncbi.nlm.nih.gov/pubmed/34477561 ID - info:doi/10.2196/28600 ER - TY - JOUR AU - Quinn, Marie Lauren AU - Olajide, Oluwafumbi AU - Green, Marsha AU - Sayed, Hazem AU - Ansar, Humera PY - 2021/8/31 TI - Patient and Professional Experiences With Virtual Antenatal Clinics During the COVID-19 Pandemic in a UK Tertiary Obstetric Hospital: Questionnaire Study JO - J Med Internet Res SP - e25549 VL - 23 IS - 8 KW - antenatal KW - virtual clinic KW - technology KW - COVID-19 KW - United Kingdom KW - pandemic KW - feasibility KW - effective KW - telehealth KW - virtual health N2 - Background: The COVID-19 pandemic required rapid implementation of virtual antenatal care to keep pregnant women safe. This transition from face-to-face usual care had to be embraced by patients and professionals alike. Objective: We evaluated patients? and professionals? experiences with virtual antenatal clinic appointments during the COVID-19 pandemic to determine satisfaction and inquire into the safety and quality of care received. Methods: A total of 148 women who attended a virtual antenatal clinic appointment at our UK tertiary obstetric care center over a 2-week period provided feedback (n=92, 62% response rate). A further 37 health care professionals (HCPs) delivering care in the virtual antenatal clinics participated in another questionnaire study (37/45, 82% response rate). Results: We showed that women were highly satisfied with the virtual clinics, with 86% (127/148) rating their experience as good or very good, and this was not associated with any statistically significant differences in age (P=.23), ethnicity (P=.95), number of previous births (P=.65), or pregnancy losses (P=.94). Even though 56% (83/148) preferred face-to-face appointments, 44% (65/148) either expressed no preference or preferred virtual, and these preferences were not associated with significant differences in patient demographics. For HCPs, 67% (18/27) rated their experience of virtual clinics as good or very good, 78% (21/27) described their experience as the same or better than face-to-face clinics, 15% (4/27) preferred virtual clinics, and 44% (12/27) had no preference. Importantly, 67% (18/27) found it easy or very easy to adapt to virtual clinics. Over 90% of HCPs agreed virtual clinics should be implemented long-term. Conclusions: Our study demonstrates high satisfaction with telephone antenatal clinics during the pandemic, which supports the transition toward widespread digitalization of antenatal care suited to 21st-century patients and professionals. UR - https://www.jmir.org/2021/8/e25549 UR - http://dx.doi.org/10.2196/25549 UR - http://www.ncbi.nlm.nih.gov/pubmed/34254940 ID - info:doi/10.2196/25549 ER - TY - JOUR AU - Timmers, Thomas AU - Keijsers, Manouk AU - Kremer, M. Jan A. AU - Janssen, Loes AU - Smeenk, Jesper PY - 2021/8/27 TI - Supporting Women Undergoing IVF Treatment With Timely Patient Information Through an App: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e28104 VL - 9 IS - 8 KW - patient education KW - fertilization in vitro KW - mobile health KW - health literacy KW - gynecology N2 - Background: Since the introduction of assisted reproductive technologies in 1978, over 2 million in vitro fertilization (IVF) babies have been born worldwide. Patients play a vital role in the success of this treatment. They are required to take fertility medication (hormone injections) to activate the ovaries to produce a sufficient number of oocytes. Later, they need to take medication to increase the chance of the embryo surviving inside the uterus. Patients are educated during an intake consultation at the start of the treatment to minimize the emotional burden and reduce noncompliance. The consultation lasts about 30 to 45 minutes and covers all essential subjects. Even though ample time and energy is spent on patient education, patients still feel anxious, unknowledgeable, and unsupported. As such, electronic health utilizing a smartphone or tablet app can offer additional support, as it allows health care professionals to provide their patients with the correct information at the right time by using push notifications. Objective: This randomized controlled trial aimed to evaluate the capacity of an app to support IVF patients throughout the different phases of their treatment and assess its effectiveness. The study's primary outcome was to determine the patients? level of satisfaction with the information provided. The secondary outcomes included their level of knowledge, ability to administer the medication, overall experienced quality of the treatment, health care consumption, and app usage. Methods: This study was performed at a specialized fertility clinic of the nonacademic teaching hospital Elisabeth-TweeSteden Ziekenhuis in Tilburg, the Netherlands. Patients who were scheduled for IVF or intracytoplasmic sperm injection treatments between April 2018 and August 2019 were invited to participate in a physician-blinded, randomized controlled trial. Results: In total, 54 patients participated (intervention group: n=29). Patients in the intervention group demonstrated a higher level of satisfaction on a 0 to 10 scale (mean 8.43, SD 1.03 vs mean 7.70, SD 0.66; P=.004). In addition, they were more knowledgeable about the different elements of the treatment on a 7 to 35 scale (mean 27.29, SD 2.94 vs mean 23.05, SD 2.76; P<.001). However, the difference disappeared over time. There were no differences between the two patient groups on the other outcomes. In total, 25 patients in the intervention group used the app 1425 times, an average of 57 times per patient. Conclusions: Our study demonstrates that, in comparison with standard patient education, using an app to provide patients with timely information increases their level of satisfaction. Furthermore, using the app leads to a higher level of knowledge about the steps and procedures of IVF treatment. Finally, the app?s usage statistics demonstrate patients? informational needs and their willingness to use an electronic health application as part of their treatment. Trial Registration: Netherlands Trial Register (NTR) 6959; https://www.trialregister.nl/trial/6959 UR - https://mhealth.jmir.org/2021/8/e28104 UR - http://dx.doi.org/10.2196/28104 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448725 ID - info:doi/10.2196/28104 ER - TY - JOUR AU - Ganie, Ashraf Mohd AU - Chowdhury, Subhankar AU - Suri, Vanita AU - Joshi, Beena AU - Bhattacharya, Kumar Prasanta AU - Agrawal, Sarita AU - Malhotra, Neena AU - Sahay, Rakesh AU - Rozati, Roya AU - Jabbar, Khadar Puthiyaveettil AU - Sreenivas, Vishnubhatla AU - Sriwastva, Mukesh AU - Wani, Ahmad Imtiyaz AU - Singh, Shalini AU - Sharma, Shyam Radhey PY - 2021/8/27 TI - Evaluation of the Prevalence, Regional Phenotypic Variation, Comorbidities, Risk Factors, and Variations in Response to Different Therapeutic Modalities Among Indian Women: Proposal for the Indian Council of Medical Research?Polycystic Ovary Syndrome (ICMR?PCOS) Study JO - JMIR Res Protoc SP - e23437 VL - 10 IS - 8 KW - polycystic ovary syndrome KW - prevalence KW - metabolic aberrations KW - community pool KW - therapeutic modalities KW - India KW - metabolic dysfunction KW - phenotypic variations KW - ovarian morphology KW - PCOS epidemiology N2 - Background: There is scanty data in India on polycystic ovary syndrome (PCOS) from several small, undersized, convenience-based studies employing differing diagnostic criteria and reporting varied regional prevalence. It is difficult to draw clear-cut conclusions from these studies; therefore, the present multicentric, well-designed, large-scale representative countrywide epidemiological study on PCOS across India was conceived with the aim to generate the actual prevalence rates of PCOS in India with a total sample size of approximately 9000 individuals. Objective: The primary objectives of the study are to estimate the national prevalence of PCOS in India and the burden of comorbidities and to compare the variation in efficacy of standard therapeutic modalities for metabolic dysfunction in women with PCOS. Methods: This multicentric umbrella study consists of three different substudies. Substudy 1 will involve recruitment of women aged 18-40 years using a multistage sampling technique from randomly selected polling booths across urban and rural areas to estimate national prevalence, phenotypic variation, and risk factors among regions. Substudy 2 involves recruitment of subjects from the community pool of substudy 1 and the institutional pool for quantitation of comorbidities among women with PCOS. Substudy 3, an interventional part of the study, aims for comparison of variation in efficacies of common treatment modalities and will be conducted only at 2 centers. The eligible consenting women will be randomized in a 1:1 ratio into 2 arms through a blinding procedure. All these women will undergo clinical, biochemical, and hormonal assessment at baseline and at 3 and 6 months. The data generated will be analyzed using the reliable statistical software SPSS (version 26). Results: The study is ongoing and is likely to be completed by April 2022. The data will be compiled and analyzed, and the results of the study will be disseminated through publications. Conclusions: The Indian Council of Medical Research?PCOS study is the first of its kind attempting to provide accurate and comprehensive data on prevalence of PCOS in India. Trial Registration: Clinical Trials Registry?India CTRI/2018/11/016252; ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=26366 International Registered Report Identifier (IRRID): DERR1-10.2196/23437 UR - https://www.researchprotocols.org/2021/8/e23437 UR - http://dx.doi.org/10.2196/23437 UR - http://www.ncbi.nlm.nih.gov/pubmed/34448720 ID - info:doi/10.2196/23437 ER - TY - JOUR AU - Swain, Dharitri AU - Begum, Jasmina AU - Parida, Prangnan Swayam PY - 2021/8/16 TI - Effect of Preconception Care Intervention on Maternal Nutritional Status and Birth Outcome in a Low-Resource Setting: Proposal for a Nonrandomized Controlled Trial JO - JMIR Res Protoc SP - e28148 VL - 10 IS - 8 KW - preconception care KW - maternal nutritional status KW - birth outcome KW - paternal preconception health KW - childbirth KW - birth outcomes KW - maternal and child health KW - maternal health KW - maternal and child nutrition KW - health education KW - pediatrics N2 - Background: The provision of preconception care approaches such as maternal assessments and education on healthy lifestyle (including physical activity, nutrition, and dietary supplements such as folic acid), general and sexual health, avoidance of high-risk behavior, and immunizations has been shown to identify and reduce the risk of adverse birth outcomes through appropriate management and preventive measures. Objective: The goal of the study is to determine the effect of an integrated preconception care intervention on delivery outcomes, which is a novel challenge for lowering unfavorable birth outcomes in India?s low-resource setting. The main objectives are to investigate the relationship of birth outcomes to both maternal and paternal preconception health and determine the effect of preconception care intervention on improvement of maternal nutritional status and reduction of the risk of adverse birth outcomes such as prematurity, low birth weight, and maternal and neonatal complications. Methods: A nonrandomized controlled trial design will be used for comparing 2 groups: preconception care with a standard maternal health care (MHC) program and an integrated MHC program (without preconception care). Two rural field areas of Khordha district, Odisha, will be selected for conducting the study. The study will enroll 782 married women between the ages of 18 and 35 years with their spouses, with 391 women in each group. The couples will receive preconception care based on their health circumstances, and they will be followed up at 3-month intervals before pregnancy. Following pregnancy, they will be followed up for 8 prenatal monitoring and care visits as well as 6 weeks after delivery as part of the standard MCH program. The preconception care intervention package includes couples counseling, contraceptive education and distribution, sex education, lifestyle modification, and nutritional supplementation of iron and folic acid, along with multivitamins if needed. Results: The proposal was approved by the institutional ethical committee for conducting the study in June 2020 (Ref No: T/EMF/Nursing/20/6). Participants were enrolled in phase 1 in April 2021, phase 2 of offering preconception services will begin in August 2021, and study outcomes will be measured from 2023 to 2024. Conclusions: Through preconception care and counseling, the eligible couples will recognize, embrace, and implement the actions to improve their preconception health. Finally, it is expected that maternal and paternal health will have a significant impact on enhancing maternal nutritional status and birth outcomes. Trial Registration: Clinical Trials Registry?India CTRI/2021/04/032836; http://ctri.nic.in/Clinicaltrials/pmaindet2.php?trialid=48239&EncHid=&userName=CTRI/2021/04/032836 International Registered Report Identifier (IRRID): PRR1-10.2196/28148 UR - https://www.researchprotocols.org/2021/8/e28148 UR - http://dx.doi.org/10.2196/28148 UR - http://www.ncbi.nlm.nih.gov/pubmed/34398798 ID - info:doi/10.2196/28148 ER - TY - JOUR AU - Artieta-Pinedo, Isabel AU - Paz-Pascual, Carmen AU - Bully, Paola AU - Espinosa, Maite AU - PY - 2021/8/9 TI - Design of the Maternal Website EMAeHealth That Supports Decision-Making During Pregnancy and in the Postpartum Period: Collaborative Action Research Study JO - JMIR Form Res SP - e28855 VL - 5 IS - 8 KW - prenatal education KW - women KW - patient decision aid KW - decision-making KW - clinical decision support systems KW - action research and pregnancy KW - implementation science KW - health service needs and demands N2 - Background: Despite the benefit maternal education has for women, it needs new tools to increase its effectiveness and scope, in tune with the needs of current users. Objective: We attempted to develop a multifunctional personalized eHealth platform aimed at the self-management of health in relation to maternity, which can be considered a flexible and adaptable maternal education tool. Methods: The International Patient Decision Aid Standards (IPDAS) were applied. A website prototype was developed for implementation in the public health system using a collaborative action research process, in which experts and patients participate, with qualitative research techniques, as well as focus groups, prioritization, and consensus techniques. Results: We have proposed a website that includes (1) systematically updated information related to clinical practice guidelines, (2) interaction between peers and users/professionals, (3) instruments for self-assessment of health needs as a basis for working on counseling, agreement on actions, help in the search for resources, support in decision-making, and monitoring and evaluation of results, and (4) access for women to their clinical data and the option of sharing the data with other health agents. These components, with different access requirements, would be reviewed through iterative cycles depending on the frequency and effectiveness resulting from their use and would be accessible from any digital device. Conclusions: A website that supports maternal education should contain not only information, but also resources for individual attention and social support. Its usefulness for the health and satisfaction of women should be evaluated in various different environments. UR - https://formative.jmir.org/2021/8/e28855 UR - http://dx.doi.org/10.2196/28855 UR - http://www.ncbi.nlm.nih.gov/pubmed/34383670 ID - info:doi/10.2196/28855 ER - TY - JOUR AU - Sparidaens, Marie Ellen AU - Hermens, M. Rosella P. AU - Braat, M. Didi D. AU - Nelen, M. Willianne L. D. AU - Fleischer, Kathrin PY - 2021/8/3 TI - Web-Based Guidance Through Assisted Reproductive Technology (myFertiCare): Patient-Centered App Development and Qualitative Evaluation JO - J Med Internet Res SP - e25389 VL - 23 IS - 8 KW - eHealth KW - infertility KW - interactive KW - mobile apps KW - patient education KW - patient-centered care KW - personalized KW - topic N2 - Background: Providing patient-centered fertility care is known to improve quality of life and can reduce anxiety and depression. In a previous study, we established the need for a web-based app providing personalized information and interactive functionalities among couples undergoing intracytoplasmic sperm injection with surgically retrieved sperm. Objective: This study aimed to design, develop, and qualitatively evaluate a multifaceted web-based app for infertile couples undergoing intracytoplasmic sperm injection with surgically retrieved sperm during their treatment trajectory. Methods: The web-based app was developed in three phases: (1) we established a patient-centered functional design, (2) developed the app in collaboration with medical and technical professionals, and (3) qualitatively evaluated the app among couples using a think-aloud method. Results: The basis of the app is the couple?s visualized treatment trajectory. The app provides personalized and interactive functionalities; for example, customized information and communication options. During qualitative evaluation, myFertiCare was highly appreciated and received a median score of 8 out of 10. The main improvements made upon conclusion of the think-aloud sessions were related to faster login and easier app navigation. Conclusions: A patient-centered web-based app aimed at guiding couples through their fertility treatment course was systematically designed, developed, and positively evaluated by patients and medical and technical professionals. UR - https://www.jmir.org/2021/8/e25389 UR - http://dx.doi.org/10.2196/25389 UR - http://www.ncbi.nlm.nih.gov/pubmed/34342591 ID - info:doi/10.2196/25389 ER - TY - JOUR AU - Lee, Kyong-No AU - Joo, Ji Yeon AU - Choi, Yeon So AU - Park, Taek Sung AU - Lee, Keun-Young AU - Kim, Youngmi AU - Son, Ga-Hyun PY - 2021/7/30 TI - Content Analysis and Quality Evaluation of Cesarean Delivery?Related Videos on YouTube: Cross-sectional Study JO - J Med Internet Res SP - e24994 VL - 23 IS - 7 KW - cesarean delivery KW - YouTube KW - internet KW - quality of information N2 - Background: YouTube is one of the most popular open-access video-sharing websites, and it is also used to obtain health care information. Cesarean delivery is the most common major surgical intervention in many countries. Videos related to cesarean delivery have also been uploaded to YouTube. However, no study has explored the overall quality of cesarean delivery videos on the platform. Objective: The objective of this study was to analyze the content and evaluate the quality of the most frequently viewed videos related to cesarean delivery that are accessible on YouTube. Methods: We searched for a total of 18 terms by combining the 6 terms retrieved from Google AdWords and the 3 terms c section, cesarean section, and cesarean delivery, which are used interchangeably. Videos were sorted by view count, and the 100 videos with the highest view counts were chosen. The number of views, duration, likes and dislikes, content type, and source of each video were recorded. In evaluating the quality of the videos, we referred to a previous study. Additionally, we developed a detailed scoring method that comprehensively evaluates the videos related to cesarean delivery by including the necessary information for each element of the cesarean delivery and whether scientific evidence was presented. Results: Of the 100 videos analyzed, the most prevalent content (n=28) was videos that contained the actual surgical procedure of a cesarean delivery, and the most common source of cesarean delivery videos was physicians (n=30). Videos directly related to cesarean delivery, such as explanation of the surgery and the actual surgical procedure, were mainly uploaded by medical groups and scored higher than the videos indirectly related to cesarean delivery, which were mainly uploaded by nonmedical groups. In addition, videos directly related to cesarean delivery were more often uploaded earlier in time, with lower like ratios compared to indirect videos. Conclusions: YouTube is currently not an appropriate source for patients seeking information on cesarean delivery. UR - https://www.jmir.org/2021/7/e24994 UR - http://dx.doi.org/10.2196/24994 UR - http://www.ncbi.nlm.nih.gov/pubmed/34328422 ID - info:doi/10.2196/24994 ER - TY - JOUR AU - Yousef, Hind AU - Al-Sheyab, Nihaya AU - Al Nsour, Mohannad AU - Khader, Yousef AU - Al Kattan, Malika AU - Bardus, Marco AU - Alyahya, Mohammad AU - Taha, Hana AU - Amiri, Mirwais PY - 2021/7/28 TI - Perceptions Toward the Use of Digital Technology for Enhancing Family Planning Services: Focus Group Discussion With Beneficiaries and Key Informative Interview With Midwives JO - J Med Internet Res SP - e25947 VL - 23 IS - 7 KW - family planning KW - mobile apps KW - social media KW - digital technology KW - contraceptives N2 - Background: Modern family planning (FP) methods allow married couples to discuss and determine the number of children and years of spacing between them. Despite many significant improvements in FP services in Jordan, there are still many issues related to the uptake of FP services for both host communities and Syrian refugees, due to limitations in the health care system based on public health facilities. Digital technologies can provide opportunities to address the challenges faced in the health system, thus offering the potential to improve both coverage and quality of FP services and practices. Objective: The aim of this study was to explore the perceptions of Jordanian women, Syrian refugees, and midwives in Jordan toward the use of digital health technology to support and enhance access to FP services. Methods: We employed a qualitative study based on semistructured, face-to face key informative interviews with 17 midwives (providers) and focus group discussions with 32 married women of reproductive age (clients). Both midwives and clients were recruited from 9 health centers in 2 major governorates in Jordan (Irbid and Mafraq), where 17 in-depth interviews were conducted with midwives and 4 focus groups were conducted with the women. Each focus group included 4 Syrian refugees and 4 Jordanian women. The transcribed narratives were analyzed using inductive thematic analysis. Results: Three major themes were derived from the narratives analysis, which covered the pros of using digital technology, concerns about digital technology use, and the ideal app or website characteristics. Ten subthemes emerged from these 3 main themes. Overall, midwives and women (Syrian refugees and host communities) agreed that digital technology can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman?s awareness and knowledge regarding the FP methods and their side effect. Furthermore, digital technology can assist in enabling women?s empowerment, which will allow them to make better decisions regarding FP use. No harmful risks or consequences were perceived to be associated with using digital technology. However, several concerns regarding digital technology use were related to eHealth literacy and the accuracy of the information provided. Midwives were mainly concerned about the patients who would rely mostly on the technology and choose to avoid consulting a health care professional. Conclusions: As perceived by midwives and women, incorporating digital technology in FP services can be feasible, cost-effective, well accepted, and potentially beneficial in increasing woman?s awareness regarding the FP methods and their side effect. It may also empower the women to play an active role in the shared (with their husband and family) decision-making process. Therefore, digital technologies are recommended to address the challenges faced in health system and to improve both the coverage and the quality of FP services and practices. UR - https://www.jmir.org/2021/7/e25947 UR - http://dx.doi.org/10.2196/25947 UR - http://www.ncbi.nlm.nih.gov/pubmed/34319250 ID - info:doi/10.2196/25947 ER - TY - JOUR AU - Karakoyun, Toeresin AU - Podhaisky, Hans-Peter AU - Frenz, Ann-Kathrin AU - Schuhmann-Giampieri, Gabriele AU - Ushikusa, Thais AU - Schröder, Daniel AU - Zvolanek, Michal AU - Lopes Da Silva Filho, Agnaldo PY - 2021/7/13 TI - Digital Medical Device Companion (MyIUS) for New Users of Intrauterine Systems: App Development Study JO - JMIR Med Inform SP - e24633 VL - 9 IS - 7 KW - medical device KW - levonorgestrel-releasing intrauterine system KW - mobile medical app KW - mobile phone N2 - Background: Women choosing a levonorgestrel-releasing intrauterine system may experience changes in their menstrual bleeding pattern during the first months following placement. Objective: Although health care professionals (HCPs) can provide counseling, no method of providing individualized information on the expected bleeding pattern or continued support is currently available for women experiencing postplacement bleeding changes. We aim to develop a mobile phone?based medical app (MyIUS) to meet this need and provide a digital companion to women after the placement of the intrauterine system. Methods: The MyIUS app is classified as a medical device and uses an artificial intelligence?based bleeding pattern prediction algorithm to estimate a woman?s future bleeding pattern in terms of intensity and regularity. We developed the app with the help of a multidisciplinary team by using a robust and high-quality design process in the context of a constantly evolving regulatory landscape. The development framework consisted of a phased approach including ideation, feasibility and concept finalization, product development, and product deployment or localization stages. Results: The MyIUS app was considered useful by HCPs and easy to use by women who were consulted during the development process. Following the launch of the sustainable app in selected pilot countries, performance metrics will be gathered to facilitate further technical and feature updates and enhancements. A real-world performance study will also be conducted to allow us to upgrade the app in accordance with the new European Commission Medical Device legislation and to validate the bleeding pattern prediction algorithm in a real-world setting. Conclusions: By providing a meaningful estimation of bleeding patterns and allowing an individualized approach to counseling and discussions about contraceptive method choice, the MyIUS app offers a useful tool that may benefit both women and HCPs. Further work is needed to validate the performance of the prediction algorithm and MyIUS app in a real-world setting. UR - https://medinform.jmir.org/2021/7/e24633 UR - http://dx.doi.org/10.2196/24633 UR - http://www.ncbi.nlm.nih.gov/pubmed/34255688 ID - info:doi/10.2196/24633 ER - TY - JOUR AU - Lee, Ji-Hyun AU - Park, Hyeoun-Ae AU - Song, Tae-Min PY - 2021/6/14 TI - A Determinants-of-Fertility Ontology for Detecting Future Signals of Fertility Issues From Social Media Data: Development of an Ontology JO - J Med Internet Res SP - e25028 VL - 23 IS - 6 KW - ontology KW - fertility KW - public policy KW - South Korea KW - social media KW - future KW - infodemiology KW - infoveillance N2 - Background: South Korea has the lowest fertility rate in the world despite considerable governmental efforts to boost it. Increasing the fertility rate and achieving the desired outcomes of any implemented policies requires reliable data on the ongoing trends in fertility and preparations for the future based on these trends. Objective: The aims of this study were to (1) develop a determinants-of-fertility ontology with terminology for collecting and analyzing social media data; (2) determine the description logics, content coverage, and structural and representational layers of the ontology; and (3) use the ontology to detect future signals of fertility issues. Methods: An ontology was developed using the Ontology Development 101 methodology. The domain and scope of the ontology were defined by compiling a list of competency questions. The terms were collected from Korean government reports, Korea?s Basic Plan for Low Fertility and Aging Society, a national survey about marriage and childbirth, and social media postings on fertility issues. The classes and their hierarchy were defined using a top-down approach based on an ecological model. The internal structure of classes was defined using the entity-attribute-value model. The description logics of the ontology were evaluated using Protégé (version 5.5.0), and the content coverage was evaluated by comparing concepts extracted from social media posts with the list of ontology classes. The structural and representational layers of the ontology were evaluated by experts. Social media data were collected from 183 online channels between January 1, 2011, and June 30, 2015. To detect future signals of fertility issues, 2 classes of the ontology, the socioeconomic and cultural environment, and public policy, were identified as keywords. A keyword issue map was constructed, and the defined keywords were mapped to identify future signals. R software (version 3.5.2) was used to mine for future signals. Results: A determinants-of-fertility ontology comprised 236 classes and terminology comprised 1464 synonyms of the 236 classes. Concept classes in the ontology were found to be coherently and consistently defined. The ontology included more than 90% of the concepts that appeared in social media posts on fertility policies. Average scores for all of the criteria for structural and representations layers exceeded 4 on a 5-point scale. Violence and abuse (socioeconomic and cultural factor) and flexible working arrangement (fertility policy) were weak signals, suggesting that they could increase rapidly in the future. Conclusions: The determinants-of-fertility ontology developed in this study can be used as a framework for collecting and analyzing social media data on fertility issues and detecting future signals of fertility issues. The future signals identified in this study will be useful for policy makers who are developing policy responses to low fertility. UR - https://www.jmir.org/2021/6/e25028 UR - http://dx.doi.org/10.2196/25028 UR - http://www.ncbi.nlm.nih.gov/pubmed/34125068 ID - info:doi/10.2196/25028 ER - TY - JOUR AU - Zhu, Y. Tracy AU - Rothenbühler, Martina AU - Hamvas, Györgyi AU - Hofmann, Anja AU - Welter, JoEllen AU - Kahr, Maike AU - Kimmich, Nina AU - Shilaih, Mohaned AU - Leeners, Brigitte PY - 2021/6/8 TI - The Accuracy of Wrist Skin Temperature in Detecting Ovulation Compared to Basal Body Temperature: Prospective Comparative Diagnostic Accuracy Study JO - J Med Internet Res SP - e20710 VL - 23 IS - 6 KW - ovulation KW - basal body temperature KW - BBT KW - oral temperature KW - wrist skin temperature KW - diagnostic accuracy KW - thermometer KW - fertility KW - menstruation KW - wearable KW - sensor KW - mobile phone N2 - Background: As a daily point measurement, basal body temperature (BBT) might not be able to capture the temperature shift in the menstrual cycle because a single temperature measurement is present on the sliding scale of the circadian rhythm. Wrist skin temperature measured continuously during sleep has the potential to overcome this limitation. Objective: This study compares the diagnostic accuracy of these two temperatures for detecting ovulation and to investigate the correlation and agreement between these two temperatures in describing thermal changes in menstrual cycles. Methods: This prospective study included 193 cycles (170 ovulatory and 23 anovulatory) collected from 57 healthy women. Participants wore a wearable device (Ava Fertility Tracker bracelet 2.0) that continuously measured the wrist skin temperature during sleep. Daily BBT was measured orally and immediately upon waking up using a computerized fertility tracker with a digital thermometer (Lady-Comp). An at-home luteinizing hormone test was used as the reference standard for ovulation. The diagnostic accuracy of using at least one temperature shift detected by the two temperatures in detecting ovulation was evaluated. For ovulatory cycles, repeated measures correlation was used to examine the correlation between the two temperatures, and mixed effect models were used to determine the agreement between the two temperature curves at different menstrual phases. Results: Wrist skin temperature was more sensitive than BBT (sensitivity 0.62 vs 0.23; P<.001) and had a higher true-positive rate (54.9% vs 20.2%) for detecting ovulation; however, it also had a higher false-positive rate (8.8% vs 3.6%), resulting in lower specificity (0.26 vs 0.70; P=.002). The probability that ovulation occurred when at least one temperature shift was detected was 86.2% for wrist skin temperature and 84.8% for BBT. Both temperatures had low negative predictive values (8.8% for wrist skin temperature and 10.9% for BBT). Significant positive correlation between the two temperatures was only found in the follicular phase (rmcorr correlation coefficient=0.294; P=.001). Both temperatures increased during the postovulatory phase with a greater increase in the wrist skin temperature (range of increase: 0.50 °C vs 0.20 °C). During the menstrual phase, the wrist skin temperature exhibited a greater and more rapid decrease (from 36.13 °C to 35.80 °C) than BBT (from 36.31 °C to 36.27 °C). During the preovulatory phase, there were minimal changes in both temperatures and small variations in the estimated daily difference between the two temperatures, indicating an agreement between the two curves. Conclusions: For women interested in maximizing the chances of pregnancy, wrist skin temperature continuously measured during sleep is more sensitive than BBT for detecting ovulation. The difference in the diagnostic accuracy of these methods was likely attributed to the greater temperature increase in the postovulatory phase and greater temperature decrease during the menstrual phase for the wrist skin temperatures. UR - https://www.jmir.org/2021/6/e20710 UR - http://dx.doi.org/10.2196/20710 UR - http://www.ncbi.nlm.nih.gov/pubmed/34100763 ID - info:doi/10.2196/20710 ER - TY - JOUR AU - Edelman, Alison AU - Hemon, Agnes AU - Creinin, Mitchell AU - Borensztein, Pascale AU - Scherrer, Bruno AU - Glasier, Anna PY - 2021/6/8 TI - Assessing the Pregnancy Protective Impact of Scheduled Nonadherence to a Novel Progestin-Only Pill: Protocol for a Prospective, Multicenter, Randomized, Crossover Study JO - JMIR Res Protoc SP - e29208 VL - 10 IS - 6 KW - protocol KW - missed pill KW - progestin-only pills KW - contraception KW - pharmacokinetics N2 - Background: Progestin-only contraceptive pills (POP) are commonly reserved for women with medical comorbidities but in actuality, POPs can be safely used by anyone wanting to prevent pregnancy. This wide safety profile makes them an ideal candidate for being available over the counter without a prescription, but adherence issues may be more common with over-the-counter use. We need a better understanding of the ability of POPs to prevent pregnancy when adherence issues occur in the form of a missed or delayed pill. Objective: This study aims to determine cervical mucus characteristics following a 6-hour delayed pill intake or after one missed pill as compared to typical daily use of norgestrel 75 mcg. Methods: This prospective, multicenter, randomized, crossover study assesses the effect of norgestrel 75 mcg (Opill) on cervical mucus and ovarian activity during reported compliant daily use, after a 6-hour delayed intake mid cycle, and after a mid-cycle missed pill. Subject participation will last approximately 4.5 months. We will recruit at 2 US sites: Oregon Health & Science University, Portland, Oregon and University of California Davis Health, Sacramento, California. Reproductive-aged subjects with regular menstrual cycles (21-35 days), BMI <32 kg/m2, and proven ovulation (screening luteal phase progesterone >3 ng/mL [>10 nmol/L]) are eligible to enroll. Participants cannot be at risk for pregnancy during the study period and not use other hormonal methods. Norgestrel 75 mcg will be taken at the same time daily except for one day in each of treatment periods 2 and 3, when the pill will be taken either 6 hours late (delayed pill) or omitted completely (missed pill). Every 3-4 days, we will monitor subjects for follicular activity with transvaginal ultrasound (TVUS) examination, cervical mucus, and blood sampling for ovarian hormones and gonadotropins. Subjects will undergo serial cervical mucus sampling on the days with missed and delayed pill intake at 8 hours after pill intake on the day before the delayed or missed pill, 3 hours following the scheduled time of pill intake if intake was delayed, 6 hours after the scheduled time if intake was omitted, and on the next day 30 minutes before the time of scheduled pill intake. The primary objective of the study is to determine the effect of a delayed or omitted pill intake on cervical mucus characteristics based on a modified Insler score compared to reported daily use. Results: Our protocol was successfully approved by a central institutional review board (Advarra, Columbia, MD), received ethical approval on March 23, 2018, and was registered with ClinicalTrials.gov (NCT03585712). As of January 2020, the study completed enrollment of 52 subjects. Analyses are pending. Conclusions: Our protocol was approved by a central review board, and study procedures were successfully executed with completed proposed enrollment. Trial Registration: ClinicalTrials.gov NCT03585712; https://clinicaltrials.gov/ct2/show/NCT03585712 International Registered Report Identifier (IRRID): DERR1-10.2196/29208 UR - https://www.researchprotocols.org/2021/6/e29208 UR - http://dx.doi.org/10.2196/29208 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970869 ID - info:doi/10.2196/29208 ER - TY - JOUR AU - Hoffman, Aubri AU - Crocker, Laura AU - Mathur, Aakrati AU - Holman, Deborah AU - Weston, June AU - Campbell, Sukhkamal AU - Housten, Ashley AU - Bradford, Andrea AU - Agrawala, Shilpi AU - Woodard, L. Terri PY - 2021/6/7 TI - Patients? and Providers? Needs and Preferences When Considering Fertility Preservation Before Cancer Treatment: Decision-Making Needs Assessment JO - JMIR Form Res SP - e25083 VL - 5 IS - 6 KW - cancer KW - decision support techniques KW - fertility preservation KW - oncofertility KW - oncology KW - needs assessment KW - patient decision aids KW - patient needs KW - shared decision making N2 - Background: As cancer treatments continue to improve, it is increasingly important that women of reproductive age have an opportunity to decide whether they want to undergo fertility preservation treatments to try to protect their ability to have a child after cancer. Clinical practice guidelines recommend that providers offer fertility counseling to all young women with cancer; however, as few as 12% of women recall discussing fertility preservation. The long-term goal of this program is to develop an interactive web-based patient decision aid to improve awareness, access, knowledge, and decision making for all young women with cancer. The International Patient Decision Aid Standards collaboration recommends a formal decision-making needs assessment to inform and guide the design of understandable, meaningful, and usable patient decision aid interventions. Objective: This study aims to assess providers? and survivors? fertility preservation decision-making experiences, unmet needs, and initial design preferences to inform the development of a web-based patient decision aid. Methods: Semistructured interviews and an ad hoc focus group assessed current decision-making experiences, unmet needs, and recommendations for a patient decision aid. Two researchers coded and analyzed the transcripts using NVivo (QSR International). A stakeholder advisory panel guided the study and interpretation of results. Results: A total of 51 participants participated in 46 interviews (18 providers and 28 survivors) and 1 ad hoc focus group (7 survivors). The primary themes included the importance of fertility decisions for survivorship, the existence of significant but potentially modifiable barriers to optimal decision making, and a strong support for developing a carefully designed patient decision aid website. Providers reported needing an intervention that could quickly raise awareness and facilitate timely referrals. Survivors reported needing understandable information and help with managing uncertainty, costs, and pressures. Design recommendations included providing tailored information (eg, by age and cancer type), optional interactive features, and multimedia delivery at multiple time points, preferably outside the consultation. Conclusions: Decision making about fertility preservation is an important step in providing high-quality comprehensive cancer care and a priority for many survivors? optimal quality of life. Decision support interventions are needed to address gaps in care and help women quickly navigate toward an informed, values-congruent decision. Survivors and providers support developing a patient decision aid website to make information directly available to women outside of the consultation and to provide self-tailored content according to women?s clinical characteristics and their information-seeking and deliberative styles. UR - https://formative.jmir.org/2021/6/e25083 UR - http://dx.doi.org/10.2196/25083 UR - http://www.ncbi.nlm.nih.gov/pubmed/34096871 ID - info:doi/10.2196/25083 ER - TY - JOUR AU - Temmesen, Gry Camilla AU - Nielsen, Svarre Henriette AU - Andersen, Myglegård Heidi Lene AU - Birch Petersen, Kathrine AU - Clemensen, Jane PY - 2021/5/31 TI - Using Social Media for Qualitative Health Research in Danish Women of Reproductive Age: Online Focus Group Study on Facebook JO - JMIR Form Res SP - e24108 VL - 5 IS - 5 KW - internet KW - social media KW - Facebook KW - online focus groups KW - women KW - reproduction KW - reproductive age KW - motherhood KW - participatory design N2 - Background: Social media platforms provide new possibilities within health research. With Facebook being the largest social network in the world, it constitutes a potential platform for recruitment and data collection from women of reproductive age. Women in Denmark and in other Western countries postpone motherhood and risk infertility due to their advanced age when they try to conceive. To date, no study has explored Danish women?s reflections on the timing of motherhood within a social media setting. Objective: The aim of this study was to explore the challenges and opportunities of using Facebook as a platform for qualitative health research in Danish women of reproductive age. Methods: This study was a qualitative study based on 3 online focus groups on Facebook with 26 Danish women of reproductive age discussing the timing of motherhood in January 2020. Results: Conducting online focus groups on Facebook was successful in this study as the web-based approach was found suitable for developing qualitative data with women of reproductive age and made recruitment easy and free of charge. All participants found participating in an online focus group to be a positive experience. More than half of the women participating in the online focus groups found it advantageous to meet on Facebook instead of meeting face-to-face. Conclusions: Conducting online focus groups on Facebook is a suitable method to access qualitative data from women of reproductive age. Participants were positive toward being a part of an online focus group. Online focus groups on social media have the potential to give women of reproductive age a voice in the debate of motherhood. UR - https://formative.jmir.org/2021/5/e24108 UR - http://dx.doi.org/10.2196/24108 UR - http://www.ncbi.nlm.nih.gov/pubmed/34057418 ID - info:doi/10.2196/24108 ER - TY - JOUR AU - Balikuddembe, S. Michael AU - Wakholi, K. Peter AU - Tumwesigye, M. Nazarius AU - Tylleskar, Thorkild PY - 2021/5/27 TI - An Algorithm (LaD) for Monitoring Childbirth in Settings Where Tracking All Parameters in the World Health Organization Partograph Is Not Feasible: Design and Expert Validation JO - JMIR Med Inform SP - e17056 VL - 9 IS - 5 KW - algorithm KW - software validation KW - childbirth monitoring KW - WHO partograph N2 - Background: After determining the key childbirth monitoring items from experts, we designed an algorithm (LaD) to represent the experts? suggestions and validated it. In this paper we describe an abridged algorithm for labor and delivery management and use theoretical case to compare its performance with human childbirth experts. Objective: The objective of this study was to describe the LaD algorithm, its development, and its validation. In addition, in the validation phase we wanted to assess if the algorithm was inferior, equivalent, or superior to human experts in recommending the necessary clinical actions during childbirth decision making. Methods: The LaD algorithm encompasses the tracking of 6 of the 12 childbirth parameters monitored using the World Health Organization (WHO) partograph. It has recommendations on how to manage a patient when parameters are outside the normal ranges. We validated the algorithm with purposively selected experts selecting actions for a stratified sample of patient case scenarios. The experts? selections were compared to obtain pairwise sensitivity and false-positive rates (FPRs) between them and the algorithm. Results: The mean weighted pairwise sensitivity among experts was 68.2% (SD 6.95; 95% CI 59.6-76.8), whereas that between experts and the LaD algorithm was 69.4% (SD 17.95; 95% CI 47.1-91.7). The pairwise FPR among the experts ranged from 12% to 33% with a mean of 23.9% (SD 9.14; 95% CI 12.6-35.2), whereas that between experts and the algorithm ranged from 18% to 43% (mean 26.3%; SD 10.4; 95% CI 13.3-39.3). The was a correlation (mean 0.67 [SD 0.06]) in the actions selected by the expert pairs for the different patient cases with a reliability coefficient (?) of .91. Conclusions: The LaD algorithm was more sensitive, but had a higher FPR than the childbirth experts, although the differences were not statistically significant. An electronic tool for childbirth monitoring with fewer WHO-recommended parameters may not be inferior to human experts in labor and delivery clinical decision support. UR - https://medinform.jmir.org/2021/5/e17056 UR - http://dx.doi.org/10.2196/17056 UR - http://www.ncbi.nlm.nih.gov/pubmed/34042599 ID - info:doi/10.2196/17056 ER - TY - JOUR AU - Diniz, Grilo Carmen Simone AU - Franzon, Arruda Ana Carolina AU - Fioretti-Foschi, Beatriz AU - Niy, Yoshie Denise AU - Pedrilio, Sanches Livia AU - Amaro Jr, Edson AU - Sato, Ricardo João PY - 2021/5/21 TI - Communication Intervention Using Digital Technology to Facilitate Informed Choices at Childbirth in the Context of the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e25016 VL - 10 IS - 5 KW - app KW - childbirth KW - communication KW - COVID-19 KW - health literacy KW - informatics KW - internet KW - intervention KW - maternal health KW - neonatal health KW - neonate public health KW - society KW - technology KW - women N2 - Background: In Brazil and other low- and middle-income countries, excess interventions in childbirth are associated with an increase in preterm and early-term births, contributing to stagnant morbidity and mortality of mothers and neonates. The fact that women often report a negative experience with vaginal childbirth, with physical pain and feelings of unsafety, neglect, or abuse, may explain the high acceptability of elective cesarean sections. The recognition of information needs and of the right to informed choice during childbirth can help change this reality. The internet has been the main source of health information, but its quality is highly variable. Objective: This study aimed to develop and evaluate an information and communication strategy through a smartphone app with respect to childbirth, to facilitate informed choices for access to safer and evidence-based care in the context of the COVID-19 pandemic. Methods: A randomized controlled trial, with 2 arms (intervention and control) and a closed, blind, parallel design, will be conducted with a smartphone app designed for behavior and opinion research in Brazil, with women of reproductive age previously registered on the app. After completing an entry questionnaire to verify the eligibility criteria and obtaining ethical consent, approximately 20,000 participants will be randomly allocated to the intervention and control groups at a 1:1 ratio. Participants allocated to the intervention group will be invited to engage in a digital information and communication strategy, which is designed to expand evidence-based knowledge on the advantages and disadvantages of options for labor and childbirth and the safety of the care processes. The information is based on the guidelines of the Ministry of Health and the World Health Organization for a positive childbirth experience and has been updated to include the new challenges and disruptions in maternity care within the context of the COVID-19 pandemic. The control group will receive information regarding disposable and reusable diapers as a placebo intervention. The groups will be compared in their responses in generating the birth plan and the entry and exit questionnaires, regarding responses less or more aligned with the guidelines for a positive childbirth experience. A qualitative component to map information needs is included. Results: The digital trial started recruiting participants in late October 2020, and data collection has been projected to be complete by December 2020. Conclusions: This study will evaluate an innovative intervention that has the potential to promote better communication between women and providers, such that they can make better choices using an approach suitable for use during the COVID-19 pandemic. Trial Registration: The Brazilian Clinical Trials Registry U1111-1255-8683; http://www.ensaiosclinicos.gov.br/rg/RBR-3g5f9f/ International Registered Report Identifier (IRRID): PRR1-10.2196/25016 UR - https://www.researchprotocols.org/2021/5/e25016 UR - http://dx.doi.org/10.2196/25016 UR - http://www.ncbi.nlm.nih.gov/pubmed/33945496 ID - info:doi/10.2196/25016 ER - TY - JOUR AU - Zhang, Kunli AU - Cai, Linkun AU - Song, Yu AU - Liu, Tao AU - Zhao, Yueshu PY - 2021/5/10 TI - Combining External Medical Knowledge for Improving Obstetric Intelligent Diagnosis: Model Development and Validation JO - JMIR Med Inform SP - e25304 VL - 9 IS - 5 KW - intelligent diagnosis KW - obstetric electronic medical record KW - medical knowledge KW - attention mechanism N2 - Background: Data-driven medical health information processing has become a new development trend in obstetrics. Electronic medical records (EMRs) are the basis of evidence-based medicine and an important information source for intelligent diagnosis. To obtain diagnostic results, doctors combine clinical experience and medical knowledge in their diagnosis process. External medical knowledge provides strong support for diagnosis. Therefore, it is worth studying how to make full use of EMRs and medical knowledge in intelligent diagnosis. Objective: This study aims to improve the performance of intelligent diagnosis in EMRs by combining medical knowledge. Methods: As an EMR usually contains multiple types of diagnostic results, the intelligent diagnosis can be treated as a multilabel classification task. We propose a novel neural network knowledge-aware hierarchical diagnosis model (KHDM) in which Chinese obstetric EMRs and external medical knowledge can be synchronously and effectively used for intelligent diagnostics. In KHDM, EMRs and external knowledge documents are integrated by the attention mechanism contained in the hierarchical deep learning framework. In this way, we enrich the language model with curated knowledge documents, combining the advantages of both to make a knowledge-aware diagnosis. Results: We evaluate our model on a real-world Chinese obstetric EMR dataset and showed that KHDM achieves an accuracy of 0.8929, which exceeds that of the most advanced classification benchmark methods. We also verified the model?s interpretability advantage. Conclusions: In this paper, an improved model combining medical knowledge and an attention mechanism is proposed, based on the problem of diversity of diagnostic results in Chinese EMRs. KHDM can effectively integrate domain knowledge to greatly improve the accuracy of diagnosis. UR - https://medinform.jmir.org/2021/5/e25304 UR - http://dx.doi.org/10.2196/25304 UR - http://www.ncbi.nlm.nih.gov/pubmed/33970113 ID - info:doi/10.2196/25304 ER - TY - JOUR AU - Mahalingaiah, Shruthi AU - Cheng, Jojo J. AU - Winter, R. Michael AU - Rodriguez, Erika AU - Fruh, Victoria AU - Williams, Anna AU - Nguyen, MyMy AU - Madhavan, Rashmi AU - Karanja, Pascaline AU - MacRae, Jill AU - Konanki, Charan Sai AU - Lane, J. Kevin AU - Aschengrau, Ann PY - 2021/4/16 TI - Multimodal Recruitment to Study Ovulation and Menstruation Health: Internet-Based Survey Pilot Study JO - J Med Internet Res SP - e24716 VL - 23 IS - 4 KW - polycystic ovary syndrome KW - PCOS KW - menstrual cycle KW - multimodal recruitment strategy KW - epidemiology KW - recruitment KW - pilot KW - strategy KW - women KW - feasibility KW - online survey KW - ovulation KW - menstrual N2 - Background: Multimodal recruitment strategies are a novel way to increase diversity in research populations. However, these methods have not been previously applied to understanding the prevalence of menstrual disorders such as polycystic ovary syndrome. Objective: The purpose of this study was to test the feasibility of recruiting a diverse cohort to complete a web-based survey on ovulation and menstruation health. Methods: We conducted the Ovulation and Menstruation Health Pilot Study using a REDCap web-based survey platform. We recruited 200 women from a clinical population, a community fair, and the internet. Results: We recruited 438 women over 29 weeks between September 2017 and March 2018. After consent and eligibility determination, 345 enrolled, 278 started (clinic: n=43; community fair: n=61; internet: n=174), and 247 completed (clinic: n=28; community fair: n=60; internet: n=159) the survey. Among all participants, the median age was 25.0 (SD 6.0) years, mean BMI was 26.1 kg/m2 (SD 6.6), 79.7% (216/271) had a college degree or higher, and 14.6% (37/254) reported a physician diagnosis of polycystic ovary syndrome. Race and ethnicity distributions were 64.7% (176/272) White, 11.8% (32/272) Black/African American, 7.7% (21/272) Latina/Hispanic, and 5.9% (16/272) Asian individuals; 9.9% (27/272) reported more than one race or ethnicity. The highest enrollment of Black/African American individuals was in clinic (17/42, 40.5%) compared to 1.6% (1/61) in the community fair and 8.3% (14/169) using the internet. Survey completion rates were highest among those who were recruited from the internet (159/174, 91.4%) and community fairs (60/61, 98.4%) compared to those recruited in clinic (28/43, 65.1%). Conclusions: Multimodal recruitment achieved target recruitment in a short time period and established a racially diverse cohort to study ovulation and menstruation health. There were greater enrollment and completion rates among those recruited via the internet and community fair. UR - https://www.jmir.org/2021/4/e24716 UR - http://dx.doi.org/10.2196/24716 UR - http://www.ncbi.nlm.nih.gov/pubmed/33861203 ID - info:doi/10.2196/24716 ER - TY - JOUR AU - Karra, Mahesh AU - Zhang, Kexin PY - 2021/4/5 TI - User-Centered Counseling and Male Involvement in Contraceptive Decision Making: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e24884 VL - 10 IS - 4 KW - user-centered counseling KW - male involvement KW - contraceptive use KW - family planning KW - randomized controlled trial KW - Malawi KW - Sub-Saharan Africa N2 - Background: To achieve informed choice within the framework of reproductive autonomy, family planning programs have begun to adopt user-centered approaches to service provision, which highlight the individual client as the focal point of interaction and key decision maker. However, little is known about how user-centered approaches to family planning, particularly family planning counseling, shape contraceptive preferences and choices. Objective: We conducted a multiarmed randomized controlled trial to identify the causal impact of user-centered approaches to family planning counseling on women?s contraceptive decision making in urban Malawi. This study aims to determine how a tailored, preference-driven approach to family planning counseling and the involvement of male partners during the counseling process may contribute to shaping women?s contraceptive preferences and choices. Methods: Married women aged 18-35 years were recruited and randomly assigned to 1 of the 3 intervention arms or a control arm characterized by the following two interventions: an intervention arm in which women were encouraged to invite their husbands to family planning counseling (husband invitation arm) and an intervention arm in which women received targeted, tailored counseling on up to five contraceptive methods (as opposed to up to 13 contraceptive methods) that reflected women?s stated preferences for contraceptive methods. Women were randomized into a control arm, T0 (no husband invitation, standard counseling); T1 (husband invitation, standard counseling); T2 (no husband invitation, targeted counseling); and T3 (husband invitation, targeted counseling). Following counseling, all women received a package of family planning services, which included free transportation to a local family planning clinic and financial reimbursement for family planning services. Follow-up surveys were conducted with women 1 month after counseling. Results: A total of 785 women completed the baseline survey, and 782 eligible respondents were randomized to 1 of the 3 intervention groups or the control group (T1, n=223; T2, n=225; T3, n=228; T0, n=108). Furthermore, 98.1% (767/782) of women were contacted for follow-up. Among the 767 women who were contacted, 95.3% (731/767) completed the follow-up survey. The analysis of the primary outcomes is ongoing and is expected to be completed by the end of 2021. Conclusions: The results from this trial will fill knowledge gaps on the effectiveness of tailored family planning counseling and male involvement in family planning on women?s stated and realized contraceptive preferences. More generally, the study will provide evidence on how user-centered counseling may affect women?s willingness to use and continue contraception to realize their contraceptive preferences. Trial Registration: American Economics Association?s Registry for Randomized Controlled Trials AEARCTR-0004194; https://www.socialscienceregistry.org/trials/4194/history/46808. Registry for International Development Impact Evaluations RIDIE-STUDY-ID-5ce4f42bbc2bf; https://ridie.3ieimpact.org/index.php?r=search/detailView&id=823. International Registered Report Identifier (IRRID): DERR1-10.2196/24884 UR - https://www.researchprotocols.org/2021/4/e24884 UR - http://dx.doi.org/10.2196/24884 UR - http://www.ncbi.nlm.nih.gov/pubmed/33818398 ID - info:doi/10.2196/24884 ER - TY - JOUR AU - Marlin, Nadine AU - Rivas, Carol AU - Allotey, John AU - Dodds, Julie AU - Horne, Andrew AU - Ball, Elizabeth PY - 2021/4/5 TI - Development and Validation of Clinical Prediction Models for Surgical Success in Patients With Endometriosis: Protocol for a Mixed Methods Study JO - JMIR Res Protoc SP - e20986 VL - 10 IS - 4 KW - endometriosis KW - algorithm KW - laparoscopy KW - pain KW - therapeutic N2 - Background: Endometriosis is a chronic inflammatory condition affecting 6%-10% of women of reproductive age and is defined by the presence of endometrial-like tissue outside the uterus (lesions), commonly affecting the pelvis and ovaries. It is associated with debilitating pelvic pain, infertility, and fatigue and often has devastating effects on the quality of life (QoL). Although it is as common as back pain, it is poorly understood, and treatment and diagnosis are often delayed, leading to unnecessary suffering. Endometriosis has no cure. Surgery is one of several management options. Quantifying the probability of successful surgery is important for guiding clinical decisions and treatment strategies. Factors predicting success through pain reduction after endometriosis surgery have not yet been adequately identified. Objective: This study aims to determine which women with confirmed endometriosis benefit from surgical improvement in pain and QoL and whether these women could be identified from clinical symptoms measured before laparoscopy. Methods: First, we will carry out a systematic search and review and, if appropriate, meta-analysis of observational cohort and case-control studies reporting one or more risk factors for endometriosis and postsurgical treatment success. We will search PubMed, Embase, and Cochrane databases from inception without language restrictions and supplement the reference lists by manual searches. Second, we will develop separate clinical prediction models for women with confirmed and suspected diagnoses of endometriosis. A total of three suitable databases have been identified for development and external validation (the MEDAL [ISRCTN13028601] and LUNA [ISRCTN41196151] studies, and the BSGE database), and access has been guaranteed. The models will be developed using a linear regression approach that links candidate factors to outcomes. Third, we will hold 2 stakeholder co-design workshops involving eight clinicians and eight women with endometriosis separately and then bring all 16 participants together. Participants will discuss the implementation, delivery, usefulness, and sustainability of the prediction models. Clinicians will also focus on the ease of use and access to clinical prediction tools. Results: This project was funded in March 2018 and approved by the Institutional Research Ethics Board in December 2019. At the time of writing, this study was in the data analysis phase, and the results are expected to be available in April 2021. Conclusions: This study is the first to aim to predict who will benefit most from laparoscopic surgery through the reduction of pain or increased QoL. The models will provide clinicians with robustly developed and externally validated support tools, improving decision making in the diagnosis and treatment of women. International Registered Report Identifier (IRRID): DERR1-10.2196/20986 UR - https://www.researchprotocols.org/2021/4/e20986 UR - http://dx.doi.org/10.2196/20986 UR - http://www.ncbi.nlm.nih.gov/pubmed/33818394 ID - info:doi/10.2196/20986 ER - TY - JOUR AU - Olaniyi, Adebola Adenike AU - Ncama, Purity Busisiwe AU - Amod, Hafaza PY - 2021/3/31 TI - Mapping Evidence of Neonatal Resuscitation Training on the Practices of Unskilled Birth Attendants in Low-Resource Countries: Protocol for a Scoping Review JO - JMIR Res Protoc SP - e18935 VL - 10 IS - 3 KW - neonatal resuscitation KW - newborn KW - neonatal KW - low- and middle-resource countries KW - training KW - birth KW - infant KW - baby KW - obstetrics KW - protocol KW - review N2 - Background: Competence in neonatal resuscitation of the newborn is very critical to ensure the safety and well-being of newborn infants. The acquisition of neonatal resuscitation skills by birth attendants improves self-efficacy, thereby reducing neonatal mortality as a result of asphyxia. Approximately one-quarter of all neonatal deaths globally are caused by birth asphyxia. The need for neonatal resuscitation is most imperative in resource-constrained settings, where access to intrapartum obstetric care is inadequate. Objective: This protocol describes the methodology of a scoping review on evidence of training in neonatal resuscitation and its association with practice in low-resource countries. The aim of the review is to map the available evidence of neonatal resuscitation training on the practices of unskilled birth attendants. Methods: The scoping review will use the Population, Concept, and Context (PCC) framework proposed by Arksey and O?Malley, refined by Levac et al, and published by Joanna Briggs Institute, while following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The search strategy was developed with the assistance of the college librarian. A number of databases of peer-reviewed research (PsycINFO and Wiley Online Library [via EBSCOhost], PubMed, MEDLINE with full text, Google Scholar [via ScienceDirect], and CINAHL Plus with full text [via EBSCOhost]) and databases committed to grey literature sources will be searched, and reference extraction will be performed. Two independent reviewers will screen and extract data, and discrepancies will be resolved by a third reviewer. The extracted data will undergo a descriptive analysis of contextual data and a quantitative analysis using appropriate statistical methods. Results: Data relating to neonatal resuscitation training and practices in low-resource settings will be extracted and included for analysis. We expect that the review will be completed 12 months from the publication of this protocol. Conclusions: This scoping review will focus on the review of evidence and provide an insight into the existing literature to guide further research and identify implementation strategies to improve the practices of unskilled birth attendants through the acquisition of skills and self-efficacy in neonatal resuscitation. The results of this review will be presented at relevant conferences related to newborn and child health and neonatal nursing studies and published in a peer-reviewed journal. International Registered Report Identifier (IRRID): DERR1-10.2196/18935 UR - https://www.researchprotocols.org/2021/3/e18935 UR - http://dx.doi.org/10.2196/18935 UR - http://www.ncbi.nlm.nih.gov/pubmed/33787506 ID - info:doi/10.2196/18935 ER - TY - JOUR AU - Tseng, Ling-Ming AU - Lien, Pei-Ju AU - Huang, Chen-Yu AU - Tsai, Yi-Fang AU - Chao, Ta-Chung AU - Huang, Sheng-Miauh PY - 2021/3/17 TI - Developing a Web-Based Shared Decision-Making Tool for Fertility Preservation Among Reproductive-Age Women With Breast Cancer: An Action Research Approach JO - J Med Internet Res SP - e24926 VL - 23 IS - 3 KW - breast cancer KW - shared decision making KW - website KW - action research KW - fertility preservation N2 - Background: The pregnancy rate after cancer treatment for female survivors is lower than that of the general population. Future infertility is a significant concern for patients with breast cancer and is associated with a poor quality of life. Reproductive-age patients with breast cancer have safe options when choosing a type of fertility preservation method to be applied. Better information and support resources aimed at women to support their decision making are needed. Objective: The objective of this study was to develop a web-based shared decision-making tool for helping patients with breast cancer make decisions on fertility preservation. Methods: We used the action research cycle of observing, reflecting, planning, and acting to develop a web-based shared decision-making tool. The following four phrases were applied: (1) observe and reflect?collect and analyze the decision-making experiences of patients and health care providers; (2) reflect and plan?apply the initial results to create a paper design and modify the content; (3) plan and act?brainstorm about the web pages and modify the content; (4) act and observe?evaluate the effectiveness and refine the website?s shared decision-making tool. Interviews, group meetings, and constant dialogue were conducted between the various participants at each step. Effectiveness was evaluated using the Preparation for Decision-Making scale. Results: Five major parts were developed with the use of the action research approach. The Introduction (part 1) describes the severity of cancer treatment and infertility. Options (part 2) provides the knowledge of fertility preservation. The shared decision-making tool was designed as a step-by-step process (part 3) that involves the comparison of options, patient values, and preferences; their knowledge regarding infertility and options; and reaching a collective decision. Resources (part 4) provides information on the hospitals that provide such services, and References (part 5) lists all the literature cited in the website. The results show the web-based shared decision-making meets both patients? and health providers? needs and helps reproductive-age patients with breast cancer make decisions about fertility preservation. Conclusions: We have created the first web-based shared decision-making tool for making fertility preservation decisions in Taiwan. We believe female patients of reproductive age will find the tool useful and its use will become widespread, which should increase patient autonomy and improve communication about fertility preservation with clinicians. Trial Registration: Clinicaltrials.gov NCT04602910; https://clinicaltrials.gov/ct2/show/NCT04602910 UR - https://www.jmir.org/2021/3/e24926 UR - http://dx.doi.org/10.2196/24926 UR - http://www.ncbi.nlm.nih.gov/pubmed/33729164 ID - info:doi/10.2196/24926 ER - TY - JOUR AU - Moseson, Heidi AU - Wollum, Alexandra AU - Seymour, W. Jane AU - Zuniga, Carmela AU - Thompson, Terri-Ann AU - Gerdts, Caitlin PY - 2021/2/24 TI - Comparison of Facebook, Google Ads, and Reddit for the Recruitment of People Who Considered but Did Not Obtain Abortion Care in the United States: Cross-sectional Survey JO - JMIR Form Res SP - e22854 VL - 5 IS - 2 KW - abortion, induced KW - abortion seekers KW - abortion surveys KW - bias, selection KW - pregnancy, unplanned KW - research subject recruitment KW - reproductive health KW - social media KW - social stigma N2 - Background: In the United States, abortion access is restricted by numerous logistical, financial, social, and policy barriers. Most studies on abortion-seeking experiences in the United States have recruited participants from abortion clinics. However, clinic-based recruitment strategies fail to capture the experiences of people who consider an abortion but do not make it to an abortion clinic. Research indicates that many people search for abortion information on the web; however, web-based recruitment remains underutilized in abortion research. Objective: This study aims to establish the feasibility of using Facebook, Google Ads, and Reddit as recruitment platforms for a study on abortion-seeking experiences in the United States. Methods: From August to September 2018, we posted recruitment advertisements for a survey about abortion-seeking experiences through Facebook, Google Ads, and Reddit. Eligible participants were US residents aged 15-49 years who had been pregnant in the past 5 years and had considered abortion for a pregnancy in this period but did not abort. For each platform, we recorded staff time to develop advertisements and manage recruitment, as well as costs related to advertisement buys and social marketing firm support. We summarized the number of views and clicks for each advertisement where possible, and we calculated metrics related to cost per recruited participant and recruitment rate by week for each platform. We assessed differences across platforms using the chi-square and Kruskal-Wallis tests. Results: Overall, study advertisements received 77,464 views in the 1-month period (from Facebook and Google; information not available for Reddit) and 2808 study page views. After clicking on the advertisements, there were 1254 initiations of the eligibility screening survey, which resulted in 98 eligible survey participants (75 recruited from Facebook, 14 from Google Ads, and 9 from Reddit). The cost for each eligible participant in each platform was US $49.48 for Facebook, US $265.93 for Google Ads, and US $182.78 for Reddit. A total of 84% (66/79) of those who screened eligible from Facebook completed the short survey compared with 73% (8/11) of those who screened eligible from Reddit and 13% (7/53) of those who screened eligible from Google Ads. Conclusions: These results suggest that Facebook advertisements may be the most time- and cost-effective strategy to recruit people who considered but did not obtain an abortion in the United States. Adapting and implementing Facebook-based recruitment strategies for research on abortion access could facilitate a more complete understanding of the barriers to abortion care in the United States. UR - https://formative.jmir.org/2021/2/e22854 UR - http://dx.doi.org/10.2196/22854 UR - http://www.ncbi.nlm.nih.gov/pubmed/33625368 ID - info:doi/10.2196/22854 ER - TY - JOUR AU - Benedict, Catherine AU - Dauber-Decker, L. Katherine AU - King, D'Arcy AU - Hahn, Alexandria AU - Ford, S. Jennifer AU - Diefenbach, Michael PY - 2021/1/22 TI - A Decision Aid Intervention for Family Building After Cancer: Developmental Study on the Initial Steps to Consider When Designing a Web-Based Prototype JO - JMIR Form Res SP - e20841 VL - 5 IS - 1 KW - patient-centered care KW - user-centered design KW - decision support techniques KW - decision aid KW - cancer KW - fertility KW - internet-based intervention KW - web-based intervention KW - mobile phone KW - psychosocial intervention N2 - Background: An important aspect of patient-centered care involves ensuring that patient-directed resources are usable, understandable, and responsive to patients? needs. A user-centered design refers to an empathy-based framework and an iterative design approach for developing a product or solution that is based on an in-depth understanding of users? needs, values, abilities, and limitations. Objective: This study presents the steps taken to develop a prototype for a patient resource for young women who have completed treatment for gonadotoxic cancer to support their decision making about follow-up fertility care and family building. Methods: User-centered design practices were used to develop Roadmap to Parenthood, a decision aid (DA) website for family building after cancer. A multidisciplinary steering group was assembled and input was provided. Guidelines from the International Patient DA Society and the Ottawa Decision Support Framework were used throughout the development process. In addition, guidelines for developing health DAs with respect to patient diversity and health literacy were also followed. Results: The Roadmap to Parenthood DA website prototype was systematically and iteratively developed. An extensive process of designing and developing solutions from the perspective of the end user was followed. The steps taken included formative work to identify user needs; determining goals, format, and delivery; design processes (eg, personas, storyboards, information architecture, user journey mapping, and wireframing); and content development. Additional design considerations addressed the unique needs of this patient population, including the emotional experiences related to this topic and decision-making context wherein decisions could be considered iteratively while involving a multistep process. Conclusions: The design strategies presented in this study describe important steps in the early phases of developing a user-centered resource, which will enhance the starting point for usability testing and further design modifications. Future research will pilot test the DA and a planning tool, and evaluate improvement in the decisional conflict regarding family building after cancer. Consistent with a patient-centered approach to health care, the strategies described here may be generalized and applied to the development of other patient resources and clinical contexts to optimize usability, empathy, and user engagement. UR - http://formative.jmir.org/2021/1/e20841/ UR - http://dx.doi.org/10.2196/20841 UR - http://www.ncbi.nlm.nih.gov/pubmed/33480848 ID - info:doi/10.2196/20841 ER - TY - JOUR AU - Terra, Lara AU - Hooning, J. Maartje AU - Heemskerk-Gerritsen, M. Bernadette A. AU - van Beurden, Marc AU - Roeters van Lennep, E. Jeanine AU - van Doorn, C. Helena AU - de Hullu, A. Joanne AU - Mom, Constantijne AU - van Dorst, L. Eleonora B. AU - Mourits, E. Marian J. AU - Slangen, M. Brigitte F. AU - Gaarenstroom, N. Katja AU - Zillikens, Carola M. AU - Leiner, Tim AU - van der Kolk, Lizet AU - Collee, Margriet AU - Wevers, Marijke AU - Ausems, M. Margreet G. E. AU - van Engelen, Klaartje AU - Berger, PV Lieke AU - van Asperen, J. Christi AU - Gomez-Garcia, B. Encarna AU - van de Beek, Irma AU - Rookus, A. Matti AU - Hauptmann, Michael AU - Bleiker, M. Eveline AU - Schagen, B. Sanne AU - Aaronson, K. Neil AU - Maas, M. Angela H. E. AU - van Leeuwen, E. Flora PY - 2021/1/22 TI - Long-Term Morbidity and Health After Early Menopause Due to Oophorectomy in Women at Increased Risk of Ovarian Cancer: Protocol for a Nationwide Cross-Sectional Study With Prospective Follow-Up (HARMOny Study) JO - JMIR Res Protoc SP - e24414 VL - 10 IS - 1 KW - risk-reducing salpingo-oophorectomy KW - BRCA1/2 KW - cardiovascular disease KW - osteoporosis KW - cognition KW - health-related quality of life N2 - Background: BRCA1/2 mutation carriers are recommended to undergo risk-reducing salpingo-oophorectomy (RRSO) at 35 to 45 years of age. RRSO substantially decreases ovarian cancer risk, but at the cost of immediate menopause. Knowledge about the potential adverse effects of premenopausal RRSO, such as increased risk of cardiovascular disease, osteoporosis, cognitive dysfunction, and reduced health-related quality of life (HRQoL), is limited. Objective: The aim of this study is to assess the long-term health effects of premenopausal RRSO on cardiovascular disease, bone health, cognitive functioning, urological complaints, sexual functioning, and HRQoL in women with high familial risk of breast or ovarian cancer. Methods: We will conduct a multicenter cross-sectional study with prospective follow-up, nested in a nationwide cohort of women at high familial risk of breast or ovarian cancer. A total of 500 women who have undergone RRSO before 45 years of age, with a follow-up period of at least 10 years, will be compared with 250 women (frequency matched on current age) who have not undergone RRSO or who have undergone RRSO at over 55 years of age. Participants will complete an online questionnaire on lifestyle, medical history, cardiovascular risk factors, osteoporosis, cognitive function, urological complaints, and HRQoL. A full cardiovascular assessment and assessment of bone mineral density will be performed. Blood samples will be obtained for marker analysis. Cognitive functioning will be assessed objectively with an online neuropsychological test battery. Results: This study was approved by the institutional review board in July 2018. In February 2019, we included our first participant. As of November 2020, we had enrolled 364 participants in our study. Conclusions: Knowledge from this study will contribute to counseling women with a high familial risk of breast/ovarian cancer about the long-term health effects of premenopausal RRSO. The results can also be used to offer health recommendations after RRSO. Trial Registration: ClinicalTrials.gov NCT03835793; https://clinicaltrials.gov/ct2/show/NCT03835793. International Registered Report Identifier (IRRID): DERR1-10.2196/24414 UR - http://www.researchprotocols.org/2021/1/e24414/ UR - http://dx.doi.org/10.2196/24414 UR - http://www.ncbi.nlm.nih.gov/pubmed/33480862 ID - info:doi/10.2196/24414 ER - TY - JOUR AU - Garg, Ria AU - Rebi?, Nevena AU - De Vera, A. Mary PY - 2020/12/2 TI - Information Needs About Cancer Treatment, Fertility, and Pregnancy: Qualitative Descriptive Study of Reddit Threads JO - JMIR Cancer SP - e17771 VL - 6 IS - 2 KW - cancer treatment KW - health information KW - oncofertility KW - fertility KW - pregnancy KW - reproduction KW - social support N2 - Background: A reproductive health implication of the increasing incidence of cancer among women is the impact of cancer treatment on fertility. Objective: As patients are increasingly using the internet, particularly online forums, to seek and share experiences, our objective was to understand information needs about cancer treatment, fertility, and pregnancy of women with cancer as well as their caregivers. Methods: We searched threads (original posts and responses) on four subreddit sites of Reddit (?r/Cancer,? ?r/TryingForABaby,? ?r/BabyBumps,? and ?r/Infertility?) over a 5?year period between February 4th, 2014 and February 4th, 2019. Threads with original posts involving a lived experience or question regarding cancer treatment and female fertility and/or pregnancy or parenting/having children from the perspective of either patient or caregiver were included in our analysis. We analyzed threads using thematic analysis. Results: From 963 Reddit threads identified, 69 were analyzed, including 56 with original posts by women with cancer and 13 with original posts by caregivers. From threads made by patients, we identified themes on becoming a part of an online community, impacts of cancer treatment and fertility concerns on self and social relationships, making family planning decisions, and experiences with medical team. We also identified a theme on the impact of cancer treatment and fertility concerns on caregivers. Conclusions: Reddit provided a rich pool of data for analyzing the information needs of women facing cancer. Our findings demonstrate the far-reaching impacts of cancer treatment and fertility on physical, mental, and psychosocial health for both patients and their caregivers. UR - http://cancer.jmir.org/2020/2/e17771/ UR - http://dx.doi.org/10.2196/17771 UR - http://www.ncbi.nlm.nih.gov/pubmed/33263547 ID - info:doi/10.2196/17771 ER - TY - JOUR AU - Steegers-Theunissen, Régine AU - Hoek, Annemieke AU - Groen, Henk AU - Bos, Annelies AU - van den Dool, Grada AU - Schoonenberg, Marieke AU - Smeenk, Jesper AU - Creutzberg, Eva AU - Vecht, Loes AU - Starmans, Luc AU - Laven, Joop PY - 2020/11/23 TI - Pre-Conception Interventions for Subfertile Couples Undergoing Assisted Reproductive Technology Treatment: Modeling Analysis JO - JMIR Mhealth Uhealth SP - e19570 VL - 8 IS - 11 KW - fertility, periconception, pregnancy chance, Smarter Pregnancy, cost-effectiveness, nutrition, obesity, IVF treatment KW - mobile and web-based lifestyle apps N2 - Background: Approximately 1 in 7 couples experience subfertility, many of whom have lifestyles that negatively affect fertility, such as poor nutrition, low physical activity, obesity, smoking, or alcohol consumption. Reducing lifestyle risk factors prior to pregnancy or assisted reproductive technology treatment contributes to the improvement of reproductive health, but cost-implications are unknown. Objective: The goal of this study was to evaluate reproductive, maternal pregnancy, and birth outcomes, as well as the costs of pre-conception lifestyle intervention programs in subfertile couples and obese women undergoing assisted reproductive technology. Methods: Using a hypothetical model based on quantitative parameters from published literature and expert opinion, we evaluated the following lifestyle intervention programs: (1) Smarter Pregnancy, an online tool; (2) LIFEstyle, which provides outpatient support for obese women; (3) concurrent use of both Smarter Pregnancy and LIFEstyle for obese women; (4) smoking cessation in men; and (5) a mindfulness mental health support program using group therapy sessions. The model population was based on data from the Netherlands. Results: All model-based analyses of the lifestyle interventions showed a reduction in the number of in vitro fertilization, intracytoplasmic sperm injection, or intrauterine insemination treatments required to achieve pregnancy and successful birth for couples in the Netherlands. Smarter Pregnancy was modeled to have the largest increase in spontaneous pregnancy rate (13.0%) and the largest absolute reduction in potential assisted reproductive technology treatments. Among obese subfertile women, LIFEstyle was modeled to show a reduction in the occurrence of gestational diabetes, maternal hypertensive pregnancy complications, and preterm births by 4.4%, 3.8%, and 3.0%, respectively, per couple. Modeled cost savings per couple per year were ?41 (US $48.66), ?360 (US $427.23), ?513 (US $608.80), ?586 (US $695.43), and ?1163 (US $1380.18) for smoking cessation, mindfulness, Smarter Pregnancy, combined Smarter Pregnancy AND LIFEstyle, and LIFEstyle interventions, respectively. Conclusions: Although we modeled the potential impact on reproductive outcomes and costs of fertility treatment rather than collecting real-world data, our model suggests that of the lifestyle interventions for encouraging healthier behaviors, all are likely to be cost effective and appear to have positive effects on reproductive, maternal pregnancy, and birth outcomes. Further real-world data are required to determine the cost-effectiveness of pre-conception lifestyle interventions, including mobile apps and web-based tools that help improve lifestyle, and their effects on reproductive health. We believe that further implementation of the lifestyle app Smarter Pregnancy designed for subfertile couples seeking assistance to become pregnant is likely to be cost-effective and would allow reproductive health outcomes to be collected. UR - https://mhealth.jmir.org/2020/11/e19570 UR - http://dx.doi.org/10.2196/19570 UR - http://www.ncbi.nlm.nih.gov/pubmed/33226349 ID - info:doi/10.2196/19570 ER - TY - JOUR AU - Tsai, FS Vincent AU - Zhuang, Bin AU - Pong, Yuan-Hung AU - Hsieh, Ju-Ton AU - Chang, Hong-Chiang PY - 2020/11/19 TI - Web- and Artificial Intelligence?Based Image Recognition For Sperm Motility Analysis: Verification Study JO - JMIR Med Inform SP - e20031 VL - 8 IS - 11 KW - Male infertility KW - semen analysis KW - home sperm test KW - smartphone KW - artificial intelligence KW - cloud computing KW - telemedicine N2 - Background: Human sperm quality fluctuates over time. Therefore, it is crucial for couples preparing for natural pregnancy to monitor sperm motility. Objective: This study verified the performance of an artificial intelligence?based image recognition and cloud computing sperm motility testing system (Bemaner, Createcare) composed of microscope and microfluidic modules and designed to adapt to different types of smartphones. Methods: Sperm videos were captured and uploaded to the cloud with an app. Analysis of sperm motility was performed by an artificial intelligence?based image recognition algorithm then results were displayed. According to the number of motile sperm in the vision field, 47 (deidentified) videos of sperm were scored using 6 grades (0-5) by a male-fertility expert with 10 years of experience. Pearson product-moment correlation was calculated between the grades and the results (concentration of total sperm, concentration of motile sperm, and motility percentage) computed by the system. Results: Good correlation was demonstrated between the grades and results computed by the system for concentration of total sperm (r=0.65, P<.001), concentration of motile sperm (r=0.84, P<.001), and motility percentage (r=0.90, P<.001). Conclusions: This smartphone-based sperm motility test (Bemaner) accurately measures motility-related parameters and could potentially be applied toward the following fields: male infertility detection, sperm quality test during preparation for pregnancy, and infertility treatment monitoring. With frequent at-home testing, more data can be collected to help make clinical decisions and to conduct epidemiological research. UR - http://medinform.jmir.org/2020/11/e20031/ UR - http://dx.doi.org/10.2196/20031 UR - http://www.ncbi.nlm.nih.gov/pubmed/33211025 ID - info:doi/10.2196/20031 ER - TY - JOUR AU - Han, Leo AU - Boniface, R. Emily AU - Han, Yin Lisa AU - Albright, Jonathan AU - Doty, Nora AU - Darney, G. Blair PY - 2020/10/26 TI - The Abortion Web Ecosystem: Cross-Sectional Analysis of Trustworthiness and Bias JO - J Med Internet Res SP - e20619 VL - 22 IS - 10 KW - internet KW - abortion KW - media KW - websites KW - infodemiology KW - infodemic KW - quality of health information KW - bias in patient education N2 - Background: People use the internet as a primary source for learning about medical procedures and their associated safety profiles and risks. Although abortion is one of the most common procedures worldwide among women in their reproductive years, it is controversial and highly politicized. Substantial scientific evidence demonstrates that abortion is safe and does not increase a woman?s future risk for depressive disorders or infertility. The extent to which information found on the internet reflects these medical facts in a trustworthy and unbiased manner is not known. Objective: The purpose of this study was to collate and describe the trustworthiness and political slant or bias of web-based information about abortion safety and risks of depression and infertility following abortion. Methods: We performed a cross-sectional study of internet websites using 3 search topics: (1) is abortion safe?, (2) does abortion cause depression?, and (3) does abortion cause infertility? We used the Google Adwords tool to identify the search terms most associated with those topics and Google?s search engine to generate databases of websites related to each topic. We then classified and rated each website in terms of content slant (pro-choice, neutral, anti-choice), clarity of slant (obvious, in-between, or difficult/can?t tell), trustworthiness (rating scale of 1-5, 5=most trustworthy), type (forum, feature, scholarly article, resource page, news article, blog, or video), and top-level domain (.com, .net, .org, .edu, .gov, or international domain). We compared website characteristics by search topic (safety, depression, or infertility) using bivariate tests. We summarized trustworthiness using the median and IQR, and we used box-and-whisker plots to visually compare trustworthiness by slant and domain type. Results: Our search methods yielded a total of 111, 120, and 85 unique sites for safety, depression, and infertility, respectively. Of all the sites (n=316), 57.3% (181/316) were neutral, 35.4% (112/316) were anti-choice, and 7.3% (23/316) were pro-choice. The median trustworthiness score was 2.7 (IQR 1.7-3.7), which did not differ significantly across topics (P=.409). Anti-choice sites were less trustworthy (median score 1.3, IQR 1.0-1.7) than neutral (median score 3.3, IQR 2.7-4.0) and pro-choice (median score 3.7, IQR 3.3-4.3) sites. Anti-choice sites were also more likely to have slant clarity that was ?difficult to tell? (41/112, 36.6%) compared with neutral (25/181, 13.8%) or pro-choice (4/23, 17.4%; P<.001) sites. A negative search term used for the topic of safety (eg, ?risks?) produced sites with lower trustworthiness scores than search terms with the word ?safety? (median score 1.7 versus 3.7, respectively; P<.001). Conclusions: People seeking information about the safety and potential risks of abortion are likely to encounter a substantial amount of untrustworthy and slanted/biased abortion information. Anti-choice sites are prevalent, often difficult to identify as anti-choice, and less trustworthy than neutral or pro-choice sites. Web searches may lead the public to believe abortion is riskier than it is. UR - http://www.jmir.org/2020/10/e20619/ UR - http://dx.doi.org/10.2196/20619 UR - http://www.ncbi.nlm.nih.gov/pubmed/33104002 ID - info:doi/10.2196/20619 ER - TY - JOUR AU - Hochberg, Irit AU - Orshalimy, Sharon AU - Yom-Tov, Elad PY - 2020/9/15 TI - Real-World Evidence on the Effect of Missing an Oral Contraceptive Dose: Analysis of Internet Search Engine Queries JO - J Med Internet Res SP - e20632 VL - 22 IS - 9 KW - search engines KW - birth control KW - abortion KW - miscarriage N2 - Background: Oral contraceptives (OCs) are a unique chronic medication with which a memory slip may result in a threat that could change a person?s life course. Subjective concerns of missed OC doses among women have been addressed infrequently. Anonymized queries to internet search engines provide unique access to concerns and information gaps faced by a large number of internet users. Objective: We aimed to quantitate the frequency of queries by women seeking information in an internet search engine, after missing one or more doses of an OC; their further queries on emergency contraception, abortion, and miscarriage; and their rate of reporting a pregnancy timed to the cycle of missing an OC. Methods: We extracted all English-language queries submitted to Bing in the United States during 2018, which mentioned a missed OC and subsequent queries of the same users on miscarriage, abortion, emergency contraceptives, and week of pregnancy. Results: We identified 26,395 Bing users in the United States who queried about missing OC pills and the fraction that further queried about miscarriage, abortion, emergency contraceptive, and week of pregnancy. Users under the age of 30 years who asked about forgetting an OC dose were more likely to ask about abortion (1.5 times) and emergency contraception (1.7 times) (P<.001 for both), while users at ages of 30-34 years were more likely to query about pregnancy (2.1 times) and miscarriage (5.4 times) (P<.001 for both). Conclusions: Our data indicate that many women missing a dose of OC might not have received sufficient information from their health care providers or chose to obtain it online. Queries about abortion and miscarriage peaking in the subsequent days indicate a common worry of possible pregnancy. These results reinforce the importance of providing comprehensive written information on missed pills when prescribing an OC. UR - http://www.jmir.org/2020/9/e20632/ UR - http://dx.doi.org/10.2196/20632 UR - http://www.ncbi.nlm.nih.gov/pubmed/32930672 ID - info:doi/10.2196/20632 ER - TY - JOUR AU - Yokota, Rie AU - Okuhara, Tsuyoshi AU - Ueno, Haruka AU - Okada, Hiroko AU - Furukawa, Emi AU - Kiuchi, Takahiro PY - 2020/8/25 TI - Online Japanese-Language Information on Lifestyle Factors Associated With Reduced Fertility: Content Analysis JO - J Med Internet Res SP - e19777 VL - 22 IS - 8 KW - content analysis KW - online information KW - lifestyle factor KW - fertility KW - infertility KW - reproductive health N2 - Background: Approximately one-third of Japanese couples currently worry or previously worried about infertility. To develop strategies for the primary prevention of infertility as a population approach, it is important for the general population to be knowledgeable about fertility and infertility. The internet may contribute to the dissemination of information regarding infertility and fertility. However, few studies have examined online information about fertility. Objective: This study aimed to quantitatively examine online Japanese-language information about lifestyle factors associated with reduced fertility. Methods: We conducted online searches, using the 10 search terms with the highest numbers of searches that people hoping to conceive are likely to input in two major search engines in Japan (Google Japan and Yahoo! Japan). From the 2200 retrieved websites, 1181 duplicates and 500 websites unrelated to our objective were excluded, resulting in a final dataset of 519 websites. Coding guidelines were developed for the following lifestyle factors associated with reduced fertility: sexually transmitted diseases, psychological stress, cigarette smoking, alcohol use, nutrition and diet, physical activity and exercise, underweight, overweight and obesity, and environmental pollutants. Results: In terms of the website author?s professional expertise, 69.6% of the coding instances for the selected lifestyle factors were mentioned by hospitals, clinics, or the media, whereas only 1.7% were mentioned by laypersons. Psychological stress (20.1%) and sexually transmitted diseases (18.8%) were the most frequently mentioned lifestyle factors associated with reduced fertility. In contrast, cigarette smoking, alcohol use, nutrition and diet, physical activity and exercise, underweight, overweight and obesity, and environmental pollutants were mentioned relatively infrequently. The association between reduced fertility and sexually transmitted diseases was mentioned significantly more frequently by hospitals and clinics than by the media (P<.001). The association between reduced fertility and nutrition and diet was mentioned significantly more frequently by the media than by hospitals and clinics (P=.008). With regard to the sex of the target audience for the information, female-specific references to psychological stress, sexually transmitted diseases, nutrition and diet, underweight, physical activity and exercise, and overweight and obesity were significantly more frequent than were male-specific references to these lifestyle factors (psychological stress: P=.002, sexually transmitted diseases: P<.001, nutrition and diet: P<.001, underweight: P<.001, physical activity and exercise: P<.001, overweight and obesity: P<.001). Conclusions: Of the lifestyle factors known to be related to reduced fertility, cigarette smoking, alcohol use, and male-specific lifestyle factors are mentioned relatively infrequently in online information sources in Japan, and these factors should be discussed more in information published on websites. UR - https://www.jmir.org/2020/8/e19777/ UR - http://dx.doi.org/10.2196/19777 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/19777 ER - TY - JOUR AU - Jongsma, Rolanda Karin AU - van den Heuvel, M. Josephus F. AU - Rake, Jasmijn AU - Bredenoord, L. Annelien AU - Bekker, N. Mireille PY - 2020/8/4 TI - User Experiences With and Recommendations for Mobile Health Technology for Hypertensive Disorders of Pregnancy: Mixed Methods Study JO - JMIR Mhealth Uhealth SP - e17271 VL - 8 IS - 8 KW - mobile health KW - hypertension KW - telemonitoring KW - ethics KW - high-risk pregnancy KW - preeclampsia KW - digital health N2 - Background: Hypertensive disorders of pregnancy (HDP) are a primary cause of adverse maternal and neonatal outcomes worldwide. For women at risk of hypertensive complications, guidelines recommend frequent surveillance of blood pressure and signs of preeclampsia. Clinic visits range from every 2 weeks to several times a week. Given the wide ubiquity of smartphones and computers in most countries and a growing attention for self-management, digital technologies, including mobile health (mHealth), constitute a promising component of monitoring (self-measured) blood pressure during pregnancy. Currently, little is known about the experiences of women using such platforms and how mHealth can be aligned with their needs and preferences. Objective: The objectives were twofold: (1) to explore the experiences of Dutch women who had an increased risk of HDP with a blended care approach (mHealth combined with face-to-face care) for remote self-monitoring of blood pressure and preeclampsia symptoms and (2) to formulate recommendations for the use and integration of mHealth in clinical care. Methods: Alongside a prospective blended care study (SAFE@home study) that monitors pregnant women at increased risk of HPD with mHealth technology, a mixed methods study was conducted, including questionnaires (n=52) and interviews (n=11). Results were analyzed thematically. Results: Of the 4 themes, 2 themes were related to the technologies themselves (expectations, usability), and 2 themes were related to the interaction and use of mHealth (autonomy and responsibilities of patients, responsibilities of health care professionals). First, the digital platform met the expectations of patients, which contributed to user satisfaction. Second, the platform was considered user-friendly, and patients favored different moments and frequencies for measuring their blood pressure. Third, patient autonomy was mentioned in terms of increased insight about their own condition and being able to influence clinical decision making. Fourth, clinical expertise of health care professionals was considered essential to interpret the data, which translates to subsequent responsibilities for clinical management. Data from the questionnaires and interviews corresponded. Conclusions: Blended care using an mHealth tool to monitor blood pressure in pregnancy was positively evaluated by its users. Insights from participants led to 7 recommendations for designing and implementing similar interventions and to enhance future, morally sound use of digital technologies in clinical care. UR - https://mhealth.jmir.org/2020/8/e17271 UR - http://dx.doi.org/10.2196/17271 UR - http://www.ncbi.nlm.nih.gov/pubmed/32749225 ID - info:doi/10.2196/17271 ER - TY - JOUR AU - Fatori, Daniel AU - Argeu, Adriana AU - Brentani, Helena AU - Chiesa, Anna AU - Fracolli, Lislaine AU - Matijasevich, Alicia AU - Miguel, C. Euripedes AU - Polanczyk, Guilherme PY - 2020/7/28 TI - Maternal Parenting Electronic Diary in the Context of a Home Visit Intervention for Adolescent Mothers in an Urban Deprived Area of São Paulo, Brazil: Randomized Controlled Trial JO - JMIR Mhealth Uhealth SP - e13686 VL - 8 IS - 7 KW - mHealth KW - early childhood development KW - maternal care KW - randomized clinical trial KW - daily diary KW - ambulatory assessment N2 - Background: Pregnancy during adolescence is prevalent in low- and middle-income countries (LMICs), which is associated with various adverse outcomes that can be prevented with home visiting programs. However, testing these interventions in LMICs can be challenging due to limited resources. The use of electronic data collection via smartphones can be an alternative and ideal low-cost method to measure outcomes in an environment with adverse conditions. Objective: Our study had two objectives: to test the efficacy of a nurse home visiting intervention on maternal parenting and well-being measured by an electronic daily diary (eDiary), and to investigate the compliance rate of the eDiary measurement method. Methods: We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse home visiting program, for adolescent mothers living in an urban deprived area of São Paulo, Brazil. A total of 169 pregnant adolescents were assessed for eligibility criteria, 80 of whom were included and randomized to the intervention (n=40) and control group (care as usual, n=40). Primeiros Laços is a home visiting intervention delivered by trained nurses tailored to first-time pregnant adolescents and their children, starting during the first 16 weeks of pregnancy until the child reaches 24 months of age. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and when the child was 3, 6, and 12 months of age. At 18 months, participants were assessed regarding maternal parenting and parental well-being using a 7-consecutive-day eDiary. The smartphone app was programmed to notify participants every day at 9:00 PM over a period of seven days. Results: We were able to contact 57/80 (71%) participants (29 from the intervention group and 28 from the control group) when the child was 18 months of age. Forty-eight of the 57 participants (84%) completed at least one day of the eDiary protocol. The daily compliance rate ranged from 49% to 70%. Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, 95% CI [0.06, 0.58], P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, 95% CI [1.20, 4.50], P=.01).Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, P=.01). Conclusions: The Primeiros Laços intervention improved maternal parenting and parental well-being, demonstrating its promise for low-income adolescent mothers. The compliance rate of the eDiary assessment showed that it was generally accepted by adolescent mothers with limited resources. Future studies can implement ambulatory assessment in LMICs via smartphones to measure mother and child behaviors. Trial Registration: ClinicalTrials.gov NCT02807818; https://clinicaltrials.gov/ct2/show/NCT02807818 UR - https://mhealth.jmir.org/2020/7/e13686 UR - http://dx.doi.org/10.2196/13686 UR - http://www.ncbi.nlm.nih.gov/pubmed/32720906 ID - info:doi/10.2196/13686 ER - TY - JOUR AU - Zepecki, Anne AU - Guendelman, Sylvia AU - DeNero, John AU - Prata, Ndola PY - 2020/7/6 TI - Using Application Programming Interfaces to Access Google Data for Health Research: Protocol for a Methodological Framework JO - JMIR Res Protoc SP - e16543 VL - 9 IS - 7 KW - Google KW - search data KW - infodemiology KW - infoveillance KW - infodemic KW - reproductive health KW - abortion KW - birth control KW - Google Trends KW - APIs N2 - Background: Individuals are increasingly turning to search engines like Google to obtain health information and access resources. Analysis of Google search queries offers a novel approach, which is part of the methodological toolkit for infodemiology or infoveillance researchers, to understanding population health concerns and needs in real time or near-real time. While searches predominantly have been examined with the Google Trends website tool, newer application programming interfaces (APIs) are now available to academics to draw a richer landscape of searches. These APIs allow users to write code in languages like Python to retrieve sample data directly from Google servers. Objective: The purpose of this paper is to describe a novel protocol to determine the top queries, volume of queries, and the top sites reached by a population searching on the web for a specific health term. The protocol retrieves Google search data obtained from three Google APIs: Google Trends, Google Health Trends (also referred to as Flu Trends), and Google Custom Search. Methods: Our protocol consisted of four steps: (1) developing a master list of top search queries for an initial search term using Google Trends, (2) gathering information on relative search volume using Google Health Trends, (3) determining the most popular sites using Google Custom Search, and (4) calculating estimated total search volume. We tested the protocol following key procedures at each step and verified its usefulness by examining search traffic on birth control in 2017 in the United States. Two separate programmers working independently achieved similar results with insignificant variation due to sample variability. Results: We successfully tested the methodology on the initial search term birth control. We identified top search queries for birth control, of which birth control pill was the most popular and obtained the relative and estimated total search volume for the top queries: relative search volume was 0.54 for the pill, corresponding to an estimated 9.3-10.7 million searches. We used the estimates of the proportion of search activity for the top queries to arrive at a generated list of the most popular websites: for the pill, the Planned Parenthood website was the top site. Conclusions: The proposed methodological framework demonstrates how to retrieve Google query data from multiple Google APIs and provides thorough documentation required to systematically identify search queries and websites, as well as estimate relative and total search volume of queries in real time or near-real time in specific locations and time periods. Although the protocol needs further testing, it allows researchers to replicate the steps and shows promise in advancing our understanding of population-level health concerns. International Registered Report Identifier (IRRID): RR1-10.2196/16543 UR - https://www.researchprotocols.org/2020/7/e16543 UR - http://dx.doi.org/10.2196/16543 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442159 ID - info:doi/10.2196/16543 ER - TY - JOUR AU - Grieger, A. Jessica AU - Norman, J. Robert PY - 2020/6/24 TI - Menstrual Cycle Length and Patterns in a Global Cohort of Women Using a Mobile Phone App: Retrospective Cohort Study JO - J Med Internet Res SP - e17109 VL - 22 IS - 6 KW - body mass index KW - follicular phase KW - fertility KW - luteal phase KW - menstrual cycle KW - mobile application KW - internet KW - ovulation KW - mobile phone N2 - Background: There is increasing information characterizing menstrual cycle length in women, but less information is available on the potential differences across lifestyle variables. Objective: This study aimed to describe differences in menstrual cycle length, variability, and menstrual phase across women of different ages and BMI among a global cohort of Flo app users. We have also reported on demographic and lifestyle characteristics across median cycle lengths. Methods: The analysis was run based on the aggregated anonymized dataset from a menstrual cycle tracker and ovulation calendar that covers all phases of the reproductive cycle. Self-reported information is documented, including demographics, menstrual flow and cycle length, ovulation information, and reproductive health and diseases. Data from women aged ?18 years and who had logged at least three cycles (ie, 2 completed cycles and 1 current cycle) in the Flo app were included (1,579,819 women). Results: Of the 1.5 million users, approximately half (638,683/1,579,819, 40.42%) were aged between 18 and 24 years. Just over half of those reporting BMIs were in the normal range (18.5-24.9 kg/m2; 202,420/356,598, 56.76%) and one-third were overweight or obese (>25 kg/m2; 120,983/356,598, 33.93%). A total of 16.32% (257,889/1,579,819) of women had a 28-day median cycle length. There was a higher percentage of women aged ?40 years who had a 27-day median cycle length than those aged between 18 and 24 years (22,294/120,612, 18.48% vs 60,870/637,601, 9.55%), but a lower percentage with a 29-day median cycle length (10,572/120,612, 8.77% vs 79,626/637,601, 12.49%). There were a higher number of cycles with short luteal phases in younger women, whereas women aged ?40 years had a higher number of cycles with longer luteal phases. Median menstrual cycle length and the length of the follicular and luteal phases were not remarkably different with increasing BMI, except for the heaviest women at a BMI of ?50 kg/m2. Conclusions: On a global scale, we have provided extensive evidence on the characteristics of women and their menstrual cycle length and patterns across different age and BMI groups. This information is necessary to support updates of current clinical guidelines around menstrual cycle length and patterns for clinical use in fertility programs. UR - http://www.jmir.org/2020/6/e17109/ UR - http://dx.doi.org/10.2196/17109 UR - http://www.ncbi.nlm.nih.gov/pubmed/32442161 ID - info:doi/10.2196/17109 ER - TY - JOUR AU - Shao, Fang AU - He, Zhiqiang AU - Zhu, Zheng AU - Wang, Xiang AU - Zhang, Jianping AU - Shan, Jinhua AU - Pan, Jiajia AU - Wang, Hui PY - 2020/6/10 TI - Internet Influence of Assisted Reproduction Technology Centers in China: Qualitative Study Based on WeChat Official Accounts JO - J Med Internet Res SP - e17997 VL - 22 IS - 6 KW - ART center KW - WeChat official account KW - Internet influence N2 - Background: The prevalence of infertility in China is high, but the advent of assisted reproduction technology (ART) has greatly eased this situation. Social media, such as WeChat official accounts, have become the preferred tool for ART centers to communicate with patients, but their attention and operational status differ, and the Internet influence of WeChat official accounts is insufficient. In addition, questions about whether Internet influence is consistent with academic influence and whether the Internet can influence patients? choice of medical treatment to a certain extent have not been explored. Objective: This study aimed to examine the operational status and Internet influence of WeChat official accounts for ART centers and to explore the degree of Internet influence on patients? choices of medical treatment. Methods: We collected information from the WeChat official accounts for ART centers approved by the National Health Commission of the People?s Republic of China and used the technique for order of preference by similarity to ideal solution to build an Internet influence model of the ART centers and obtained a Ranking of Internet Influence on Reproductive Centers (RIIRC) for each center. Results: We found there were 451 ART centers throughout the country by the end of 2016 and 498 by the end of 2018. The number of medical institutions is quite large, but their distribution is uneven, and their level of medical technical ability is very different. Analysis of the text data of posts of WeChat official accounts showed the ART centers have insufficient awareness of network exposure and publicity, and the RIIRC of some medical institutions was inconsistent with their medical level and academic status. Conclusions: ART institutions have varying degrees of emphasis and use of WeChat official accounts in China. They fail to realize that the Internet influence of WeChat may bring them potential patient resources and that Internet influence may affect the future market structure of ART and may also potentially affect academic rankings. UR - https://www.jmir.org/2020/6/e17997 UR - http://dx.doi.org/10.2196/17997 UR - http://www.ncbi.nlm.nih.gov/pubmed/32357124 ID - info:doi/10.2196/17997 ER - TY - JOUR AU - Watterson, L. Jessica AU - Castaneda, Diego AU - Catalani, Caricia PY - 2020/6/2 TI - Promoting Antenatal Care Attendance Through a Text Messaging Intervention in Samoa: Quasi-Experimental Study JO - JMIR Mhealth Uhealth SP - e15890 VL - 8 IS - 6 KW - mHealth KW - antenatal care KW - maternal health KW - text messages N2 - Background: Antenatal care (ANC) has the potential to improve maternal health, but it remains underutilized and unevenly implemented in many low- and middle-income countries. Increasingly, text messaging programs for pregnant women show evidence that they can improve the utilization of ANC during pregnancy; however, gaps remain regarding how implementation affects outcomes. Objective: This study aimed to assess facilitators and barriers to implementation of an SMS text messaging intervention for pregnant women in Samoa and to assess its impact on ANC attendance. Methods: This study took place in Upolu, Samoa, from March to August 2014 and employed a quasi-experimental design. Half (n=3) of the public antenatal clinics on the island offered adult pregnant women the SMS text messaging intervention, with 552 women registering for the messages. At the comparison clinics (n=3), 255 women registered and received usual care. The intervention consisted of unidirectional text messages containing health tips and appointment reminders. The outcome of interest was the number of attended antenatal visits. Implementation data were also collected through a survey of the participating midwives (n=7) and implementation notes. Data analysis included a comparison of women?s baseline characteristics between the two groups, followed by the use of negative binomial regressions to test for associations between participation in the intervention and increased ANC attendance, controlling for individual characteristics and accounting for the clustering of women within clinics. Results: The comparison of ANC attendance rates found that women receiving the SMS text messaging intervention attended 15% fewer ANC visits than the comparison group (P=.004), controlling for individual characteristics and clustering. Data analysis of the implementation process suggests that barriers to successful implementation include women registering very late in pregnancy, sharing their phone with others, and inconsistent explanation of the intervention to women. Conclusions: These results suggest that unidirectional text messages do not encourage, and might even discourage, ANC attendance in Samoa. Interpreted with other evidence in the literature, these results suggest that SMS text messaging interventions are more effective when they facilitate better communication between patients and health workers. This study is an important contribution to our understanding of when SMS text messaging interventions are and are not effective in improving maternal health care utilization. UR - https://mhealth.jmir.org/2020/6/e15890 UR - http://dx.doi.org/10.2196/15890 UR - http://www.ncbi.nlm.nih.gov/pubmed/32484446 ID - info:doi/10.2196/15890 ER - TY - JOUR AU - Bodnar, M. Lisa AU - Khodyakov, Dmitry AU - Himes, P. Katherine AU - Burke, G. Jessica AU - Parisi, Sara AU - Hutcheon, A. Jennifer PY - 2020/6/2 TI - Engaging Patients and Professionals to Evaluate the Seriousness of Maternal and Child Health Outcomes: Protocol for a Modified Delphi Study JO - JMIR Res Protoc SP - e16478 VL - 9 IS - 6 KW - children KW - Delphi method KW - ExpertLens KW - mothers KW - pregnancy KW - patient engagement KW - online stakeholder engagement panels N2 - Background: Maternal weight gain during pregnancy is one of the few potentially modifiable risk factors for many adverse maternal and child health outcomes. Defining the optimal pregnancy weight gain range is difficult because, while lower weight gain may prevent some outcomes, such as maternal and child obesity, it may increase the risk of others such as fetal growth restriction and infant death. These health outcomes vary in their seriousness to mothers and their health care providers, and these differences in seriousness should be taken into account when determining optimal weight gain ranges. However, the relative seriousness that women and their care providers place on different health outcomes is unknown. Objective: We will determine the seriousness of 11 maternal and child health outcomes that have been consistently associated with pregnancy weight gain. We will achieve this by engaging patients and maternal and child health professionals using an online modified Delphi panel process. Methods: We aim to recruit a racially/ethnically and geographically diverse group of 90 US maternal and child health professionals and 90 women who are pregnant or less than 2 years postpartum. We will conduct 3 concurrent panels using the ExpertLens system, a previously evaluated online modified Delphi system that combines 2 rounds of rating with 1 round of feedback and moderated online discussion. In Round 1, panelists are asked to rate the seriousness of each health outcome on a scale of 0-100 and to provide a rationale for their scores. In Round 2, panelists will review their responses relative to those of other panelists. They will discuss their seriousness ratings anonymously using a moderated online discussion board. In Round 3, participants will revise their Round 1 responses based on group feedback and discussion. Each round will be open for 1-2 weeks. Results: The study protocol was reviewed by our ethics boards and did not require approval as human research. A pilot study of 6 professionals and 7 patients was completed in December 2019. Conclusions: Our numeric estimates of the seriousness of maternal and child health outcomes will enable future studies to determine pregnancy weight gain ranges that balance the risks of low and high weight gain for mothers and children. International Registered Report Identifier (IRRID): DERR1-10.2196/16478 UR - https://www.researchprotocols.org/2020/6/e16478 UR - http://dx.doi.org/10.2196/16478 UR - http://www.ncbi.nlm.nih.gov/pubmed/32222699 ID - info:doi/10.2196/16478 ER - TY - JOUR AU - Laureij, T. Lyzette AU - Breunis, J. Leonieke AU - Steegers-Theunissen, M. Regine P. AU - Rosman, N. Ageeth PY - 2020/5/26 TI - Identifying the Needs for a Web-Based Postpartum Platform Among Parents of Newborns and Health Care Professionals: Qualitative Focus Group Study JO - JMIR Form Res SP - e16202 VL - 4 IS - 5 KW - newborn KW - focus groups KW - postpartum period KW - postnatal care KW - eHealth KW - pregnancy KW - obstetrics KW - qualitative research N2 - Background: During the turbulent postpartum period, there is an urgent need by parents for support and information regarding the care for their infant. In the Netherlands, professional support is provided during the first 8 days postpartum and for a maximum of 8 hours a day. This care is delivered by maternity care assistants (MCAs). Despite the availability of this extensive care, a majority of women prefer to make use of a lesser amount of postpartum care. After this period, access to care is less obvious. Where parents are automatically offered care in the first 8 days after birth, they must request care in the period thereafter. To compensate for a possible gap in information transfer, electronic health (eHealth) can be a valuable, easily accessible addition to regular care. Objective: We explored the needs and preferred content by new parents and health care professionals of a web-based platform dedicated to the postpartum period and identified barriers and facilitators for using such a platform. Methods: We conducted 3 semistructured focus groups among (1) parents of newborns, (2) MCAs, and (3) clinicians and administrators in maternity care. A topic list based on a framework designed for innovation processes was used. Thematic content analysis was applied. Results: In the focus group for parents, 5 mothers and 1 male partner participated. A total of 6 MCAs participated in the second focus group. A total of 5 clinicians and 2 administrators?a member of a stakeholder party and a manager of a maternity care organization?participated in the third focus group. All user groups underlined that a platform focusing on the postpartum period was missing in current care, especially by parents experiencing a gap following the intensive care ending after the first week of childbirth. Parents indicated that they would perceive a postpartum platform as a proper source of reliable information on topics regarding breastfeeding, growth, and developmental milestones, but also as a tool to support them in seeking care with appropriate professionals. They also emphasized the need to receive personalized information and the opportunity to ask questions via the platform. MCAs acknowledged added value of providing additional information on topics that they address during the early postpartum period. MCAs as well as clinicians and administrators would guide parents to such a platform for additional support. All user groups experienced disadvantages of using an authentication procedure and filling out extra questionnaires to receive tailored information. Conclusions: Our research shows that parents of newborns, MCAs, and clinicians and administrators foresee the additional value of a web-based postpartum platform for at least the whole postpartum period. The platform should be easily accessible and personalized. Content on the platform should contain information regarding breastfeeding, growth, and developmental milestones. A chat function with professionals could be considered as an option. UR - http://formative.jmir.org/2020/5/e16202/ UR - http://dx.doi.org/10.2196/16202 UR - http://www.ncbi.nlm.nih.gov/pubmed/32452805 ID - info:doi/10.2196/16202 ER - TY - JOUR AU - Rodriguez, Marie Erika AU - Thomas, Daniel AU - Druet, Anna AU - Vlajic-Wheeler, Marija AU - Lane, James Kevin AU - Mahalingaiah, Shruthi PY - 2020/5/14 TI - Identifying Women at Risk for Polycystic Ovary Syndrome Using a Mobile Health App: Virtual Tool Functionality Assessment JO - JMIR Form Res SP - e15094 VL - 4 IS - 5 KW - polycystic ovary syndrome KW - mobile health app KW - Clue KW - menstrual irregularities KW - telemedicine KW - mHealth, mobile phone N2 - Background: Polycystic ovary syndrome (PCOS) is an endocrine disrupting disorder affecting about 10% of reproductive-aged women. PCOS diagnosis may be delayed several years and may require multiple physicians, resulting in lost time for risk-reducing interventions. Menstrual tracking apps are a potential tool to alert women of their risk while also prompting evaluation from a medical professional. Objective: The primary objective of this study was to develop and pilot test the irregular cycle feature, a predictive model that generated a PCOS risk score, in the menstrual tracking app, Clue. The secondary objectives were to run the model using virtual test subjects, create a quantitative risk score, compare the feature?s risk score with that of a physician, and determine the sensitivity and specificity of the model before empirical testing on human subjects. Methods: A literature review was conducted to generate a list of signs and symptoms of PCOS, termed variables. Variables were then assigned a probability and built into a Bayesian network. Questions were created based on these variables. A total of 9 virtual test subjects were identified using self-reported menstrual cycles and answers to the feature?s questions. Upon completion of the questionnaire, a Result Screen and Doctor?s Report summarizing the probability of having PCOS was displayed. This provided information about PCOS and data to facilitate diagnosis by a medical professional. To assess the accuracy of the feature, the same set of 9 virtual test subjects was assigned probabilities by the feature and the physician, who served as the gold standard. The feature recommended individuals with a score greater than or equal to 25% to follow-up with a physician. Differences between the feature and physician scores were evaluated using a t test and a Pearson correlation coefficient in 8 of the 9 virtual test subjects. A second iteration was conducted to assess the feature?s probability capabilities. Results: The irregular cycle feature?s first iteration produced 1 false-positive compared with the physician score and had an absolute mean difference of 15.5% (SD 15.1%) among the virtual test subjects. The second iteration had 2 false positives compared with the physician score and had an absolute mean difference of 18.8% (SD 13.6%). The feature overpredicted the virtual test subjects? risk of PCOS compared with the physician. However, a significant positive correlation existed between the feature and physician score (Pearson correlation coefficient=0.82; P=.01). The second iteration performed worse, with a Pearson correlation coefficient of 0.73 (P=.03). Conclusions: The first iteration of the feature outperformed the second and better predicted the probability of PCOS. Although further research is needed with a more robust sample size, this pilot study indicates the potential value for developing a screening tool to prompt high-risk subjects to seek evaluation by a medical professional. UR - https://formative.jmir.org/2020/5/e15094 UR - http://dx.doi.org/10.2196/15094 UR - http://www.ncbi.nlm.nih.gov/pubmed/32406861 ID - info:doi/10.2196/15094 ER - TY - JOUR AU - Hoyos, R. Luis AU - Putra, Manesha AU - Armstrong, A. Abigail AU - Cheng, Y. Connie AU - Riestenberg, K. Carrie AU - Schooler, A. Tery AU - Dumesic, A. Daniel PY - 2020/4/21 TI - Measures of Patient Dissatisfaction With Health Care in Polycystic Ovary Syndrome: Retrospective Analysis JO - J Med Internet Res SP - e16541 VL - 22 IS - 4 KW - PCOS KW - fibroid KW - Google KW - healthcare quality KW - infoveillance KW - infodemiology KW - medical education KW - health care KW - internet KW - satisfaction N2 - Background: Polycystic ovary syndrome (PCOS) is a common reproductive and metabolic disorder in women; however, many clinicians may not be well versed in scientific advances that aid understanding of the associated reproductive, metabolic, and psychological abnormalities. Women with PCOS are dissatisfied with health care providers, the diagnostic process, and the initial treatment of PCOS and seek information through alternative sources. This has affected the patient-physician relationship by allowing medical information acquired through the internet, whether correct or not, to become accessible to patients and reshape their health care perspective. Patient dissatisfaction with health care providers regarding PCOS raises questions about the responsibilities of academic institutions to adequately train and maintain the competence of clinicians and government agencies to sufficiently support scientific investigation in this field. Objective: The primary aim was to examine internet searching behaviors of the public regarding PCOS vs another highly prevalent gynecologic disorder. The secondary aim was to explore satisfaction with health care among patients with PCOS and their internet use. The tertiary aim was to examine medical education in reproductive endocrinology and infertility (REI) during obstetrics and gynecology (Ob/Gyn) residency as a proxy for physician knowledge in this field. Methods: Google search trends and StoryBase quantified monthly Google absolute search volumes for search terms related to PCOS and fibroids (January 2004 to December 2017; United States). The reproductive disorder, fibroids, was selected as a comparison group because of its high prevalence among women. Between female groups, monthly absolute search volumes and their trends were compared. A Web-based questionnaire (June 2015 to March 2018) explored health care experiences and the internet use of women with PCOS. REI rotation information during Ob/Gyn residency in the United States was obtained from the Association of Professors of Gynecology and Obstetrics website. Results: For PCOS (R=0.89; P<.01), but not fibroids (R=0.09; P=.25), monthly absolute search volumes increased significantly. PCOS-related monthly absolute search volumes (mean 384,423 searches, SD 88,756) were significantly greater than fibroid-related monthly absolute search volumes (mean 348,502 searches, SD 37,317; P<.05). PCOS was diagnosed by an Ob/Gyn in 60.9% (462/759) of patients, and 57.3% (435/759) of patients were dissatisfied with overall care. Among patients with PCOS, 98.2% (716/729) searched for PCOS on the Web but only 18.8% (143/729) of patients joined an online PCOS support group or forum. On average, Ob/Gyn residencies dedicated only 4% (2/43) of total block time to REI, whereas 5.5% (11/200) of such residencies did not offer any REI rotations. Conclusions: Over time, PCOS has been increasingly searched on the Web compared with another highly prevalent gynecologic disorder. Patients with PCOS are dissatisfied with their health care providers, who would benefit from an improved understanding of PCOS during Ob/Gyn residency training. UR - http://www.jmir.org/2020/4/e16541/ UR - http://dx.doi.org/10.2196/16541 UR - http://www.ncbi.nlm.nih.gov/pubmed/32314967 ID - info:doi/10.2196/16541 ER - TY - JOUR AU - Reis, Nogueira Zilma Silveira AU - Gaspar, Souza Juliano De AU - Vitral, Nogueira Gabriela Luiza AU - Abrantes, Barbosa Vitor AU - de-Souza, Fonseca Ingrid Michelle AU - Moreira, Silveira Maria Tereza AU - Lopes Pessoa Aguiar, Amélia Regina PY - 2020/4/15 TI - Quality of Pregnancy Dating and Obstetric Interventions During Labor: Retrospective Database Analysis JO - JMIR Pediatr Parent SP - e14109 VL - 3 IS - 1 KW - gestational age KW - parturition KW - ultrasound KW - pregnancy dating KW - information systems N2 - Background: The correct dating of pregnancy is critical to support timely decisions and provide obstetric care during birth. The early obstetric ultrasound assessment before 14 weeks is considered the best reference to assist in determining gestational age (GA), with an accuracy of ±5 to 7 days. However, this information is limited in many settings worldwide. Objective: The aim of this study is to analyze the association between the obstetric interventions during childbirth and the quality of GA determination, according to the first antenatal ultrasound assessment, which assisted the calculation. Methods: This is a hospital-based cohort study using medical record data of 2113 births at a perinatal referral center. The database was separated into groups and subgroups of analyses based on the reference used by obstetricians to obtain GA at birth. Maternal and neonatal characteristics, mode of delivery, oxytocin augmentation, and forceps delivery were compared between groups of pregnancies with GA determination at different reference points: obstetric ultrasound assessment 14 weeks, 20 weeks, and ?20 weeks or without antenatal ultrasound (suboptimal dating). Ultrasound-based GA information was associated with outcomes between the interest groups using chi-square tests, odds ratios (OR) with 95% CI, or the Mann-Whitney statistical analysis. Results: The chance of nonspontaneous delivery was higher in pregnancies with 14 weeks ultrasound-based GA (OR 1.64, 95% CI 1.35-1.98) and 20 weeks ultrasound-based GA (OR 1.58, 95% CI 1.31-1.90) when compared to the pregnancies with ?20 weeks ultrasound-based GA or without any antenatal ultrasound. The use of oxytocin for labor augmentation was higher for 14 weeks and 20 weeks ultrasound-based GA, OR 1.41 (95% CI 1.09-1.82) and OR 1.34 (95% CI 1.04-1.72), respectively, when compared to those suboptimally dated. Moreover, maternal blood transfusion after birth was more frequent in births with suboptimal ultrasound-based GA determination (20/657, 3.04%) than in the other groups (14 weeks ultrasound-based GA: 17/1163, 1.46%, P=.02; 20 weeks ultrasound-based GA: 25/1456, 1.71%, P=.048). Cesarean section rates between the suboptimal dating group (244/657, 37.13%) and the other groups (14 weeks: 475/1163, 40.84%, P=.12; 20 weeks: 584/1456, 40.10%, P=.20) were similar. In addition, forceps delivery rates between the suboptimal dating group (17/657, 2.6%) and the other groups (14 weeks: 42/1163, 3.61%, P=.24; 20 weeks: 46/1456, 3.16%, P=.47) were similar. Neonatal intensive care unit admission was more frequent in newborns with suboptimal dating (103/570, 18.07%) when compared with the other groups (14 weeks: 133/1004, 13.25%, P=.01; 20 weeks: 168/1263, 13.30%, P=.01), excluding stillbirths and major fetal malformations. Conclusions: The present analysis highlighted relevant points of health care to improve obstetric assistance, confirming the importance of early access to technologies for pregnancy dating as an essential component of quality antenatal care. UR - http://pediatrics.jmir.org/2020/1/e14109/ UR - http://dx.doi.org/10.2196/14109 UR - http://www.ncbi.nlm.nih.gov/pubmed/32293572 ID - info:doi/10.2196/14109 ER - TY - JOUR AU - Tzilos Wernette, Golfo AU - Countryman, Kristina AU - Khatibi, Kristie AU - Riley, Erin AU - Stephenson, Rob PY - 2020/3/30 TI - Love My Body: Pilot Study to Understand Reproductive Health Vulnerabilities in Adolescent Girls JO - J Med Internet Res SP - e16336 VL - 22 IS - 3 KW - adolescent KW - alcohol KW - sexually transmitted infections KW - risky sex KW - pregnancy N2 - Background: Sexually transmitted infections (STIs) are on the rise in the United States, and adolescent girls (15-19 years old) are more susceptible to acquiring STIs than their male peers. The co-occurrence of alcohol use and sexual risk taking contribute significantly to STI acquisition. Mobile health (mHealth) interventions are ideally suited for our target population and have demonstrated increases in STI testing in young people, as well as reductions in alcohol use. Objective: This pilot study used both qualitative and quantitative methods to explore the views of adolescent girls (age range 15-19 years old; 74.6%, 279/374 white) on the desired qualities and content of an mHealth app for sexual health. Methods: We conducted nine 60-min in-depth interviews (IDIs) to gather information and identify themes of sexual health and alcohol use, and we tested the feasibility of using a two-week social media campaign to collect survey information regarding sexual health risk in adolescent girls. Results: We iteratively coded IDIs and identified major themes around pressure of alcohol use, lack of STI knowledge, male pressure to not use condoms, and pregnancy as a worse outcome than STIs. Results from the web-based survey on risky health behaviors, which was completed by 367 participants, support the use of a sexual health app designed for girls. Conclusions: Future work will integrate these themes to inform the development of a culturally sensitive mHealth app to prevent STIs among adolescent girls. UR - http://www.jmir.org/2020/3/e16336/ UR - http://dx.doi.org/10.2196/16336 UR - http://www.ncbi.nlm.nih.gov/pubmed/32224484 ID - info:doi/10.2196/16336 ER - TY - JOUR AU - Swartzendruber, Andrea AU - Lambert, N. Danielle PY - 2020/3/27 TI - A Web-Based Geolocated Directory of Crisis Pregnancy Centers (CPCs) in the United States: Description of CPC Map Methods and Design Features and Analysis of Baseline Data JO - JMIR Public Health Surveill SP - e16726 VL - 6 IS - 1 KW - directory KW - crisis pregnancy center KW - abortion, induced KW - reproductive health KW - policy KW - access to information N2 - Background: Crisis pregnancy centers (CPCs) are nonprofit organizations that aim to dissuade people considering abortion. The centers frequently advertise in misleading ways and provide inaccurate health information. CPCs in the United States are becoming more medicalized and gaining government funding and support. We created a CPC Map, a Web-based geolocated database of all CPCs currently operating in the United States, to help individuals seeking health services know which centers are CPCs and to facilitate academic research. Objective: This study aimed to describe the methods used to develop and maintain the CPC Map and baseline findings regarding the number and distribution of CPCs in the United States. We also examined associations between direct state funding and the number of CPCs and relationships between the number of CPCs and state legislation proposed in 2018-2019 to ban all or most abortions. Methods: In 2018, we used standard protocols to identify and verify the locations of and services offered by CPCs operating in the United States. The CPC Map was designed to be a publicly accessible, user-friendly searchable database that can be easily updated. We examined the number of CPCs and, using existing data, the ratios of women of reproductive age to CPCs and CPCs to abortion facilities nationally and by region, subregion, and state. We used unadjusted and adjusted negative binomial regression models to examine associations between direct state funding and the number of CPCs. We used unadjusted and adjusted logistic regression models to examine associations between the number of CPCs by state and legislation introduced in 2018-2019 to ban all or most abortions. Adjusted models controlled for the numbers of women of reproductive age and abortion facilities per state. Results: We identified 2527 operating CPCs. Of these, 66.17% (1672/2527) offered limited medical services. Nationally, the ratio of women of reproductive age to CPCs was 29,304:1. The number of CPCs per abortion facility was 3.2. The South and Midwest had the greatest numbers of CPCs. The number of CPCs per state ranged from three (Rhode Island) to 203 (Texas). Direct funding was associated with a greater number of CPCs in unadjusted (coefficient: 0.87, 95% CI 0.51-1.22) and adjusted (coefficient: 0.45, 95% CI 0.33-0.57) analyses. The number of CPCs was associated with the state legislation introduced in 2018-2019 to ban all or most abortions in unadjusted (odds ratio [OR] 1.04, 95% CI 1.01-1.06) and adjusted analyses (OR 1.11, 95% CI 1.04-1.19). Conclusions: CPCs are located in every state and particularly prevalent in the South and Midwest. Distribution of CPCs in the United States is associated with state funding and extreme proposals to restrict abortion. Researchers should track CPCs over time and examine factors that influence their operations and impact on public health and policy. UR - http://publichealth.jmir.org/2020/1/e16726/ UR - http://dx.doi.org/10.2196/16726 UR - http://www.ncbi.nlm.nih.gov/pubmed/32217502 ID - info:doi/10.2196/16726 ER - TY - JOUR AU - Osadchiy, Vadim AU - Mills, Nelson Jesse AU - Eleswarapu, Venkata Sriram PY - 2020/3/10 TI - Understanding Patient Anxieties in the Social Media Era: Qualitative Analysis and Natural Language Processing of an Online Male Infertility Community JO - J Med Internet Res SP - e16728 VL - 22 IS - 3 KW - social media KW - infertility, male KW - online social networking KW - Reddit KW - discussion board N2 - Background: Couples struggling with infertility are increasingly turning to the internet for infertility-related content and to connect with others. Most of the published data on infertility and the internet only address the experiences of women, with limited studies focusing exclusively on internet discussions on male factor infertility. Objective: The aim of this study was to understand the concerns and experiences of discussants on an online male infertility community and to provide insight into their perceptions of interactions with health care professionals. Methods: Using the large-scale data analytics tool BigQuery, we extracted all posts in the r/MaleInfertility community (877 members) of the social media website and discussion board Reddit from November 2017 to October 2018. We performed a qualitative thematic analysis and quantitative semantic analysis using Language Inquiry and Word Count 2015 of the extracted posts to identify dominant themes and subthemes of discussions. Descriptive statistics and semantic analytic Z-scores were computed. Results: From the analysis of 97 posts, notable themes and subthemes emerged: 70 (72%) posts shared personal experiences, including feeling emasculated or isolated or describing a negative (28/97, 29%), positive (13/97, 13%), or neutral (56/97, 58%) experience with a health care professional; 19% (18/97) of the posts posed questions about personal semen analysis results. On the basis of semantic analysis, posts by men had higher authenticity scores (Z=3.44; P<.001), suggesting more honest or personal texts, but lower clout scores (Z=4.57; P<.001), suggesting a more tentative or anxious style of writing, compared with posts by women. Conclusions: To our knowledge, this study represents the first evaluation of a social media community focused exclusively on male infertility using mixed methodology. These results suggest a role for physicians on social media to engage with patients and connect them to accurate resources, in addition to opportunities to improve in-office patient education. UR - http://www.jmir.org/2020/3/e16728/ UR - http://dx.doi.org/10.2196/16728 UR - http://www.ncbi.nlm.nih.gov/pubmed/32154785 ID - info:doi/10.2196/16728 ER - TY - JOUR AU - Hill, Jeremy AU - McGinn, Jourdan AU - Cairns, John AU - Free, Caroline AU - Smith, Chris PY - 2020/2/25 TI - A Mobile Phone?Based Support Intervention to Increase Use of Postabortion Family Planning in Cambodia: Cost-Effectiveness Evaluation JO - JMIR Mhealth Uhealth SP - e16276 VL - 8 IS - 2 KW - mHealth KW - digital health KW - cost-effectiveness KW - contraception KW - postabortion contraception KW - postabortion family planning KW - Cambodia N2 - Background: Despite progress over the last decade, there is a continuing unmet need for contraception in Cambodia. Interventions delivered by mobile phone could help increase uptake and continuation of contraception, particularly among hard-to-reach populations, by providing interactive personalized support inexpensively wherever the person is located and whenever needed. Objective: The objective of this study was to evaluate the cost-effectiveness of mobile phone?based support added to standard postabortion family planning care in Cambodia, according to the results of the MOTIF (MObile Technology for Improved Family planning) trial. Methods: A model was created to estimate the costs and effects of the intervention versus standard care. We adopted a societal perspective when estimating costs, including direct and indirect costs for users. The incremental cost-effectiveness ratio was calculated for the base case, as well as a deterministic and probabilistic sensitivity analysis, which we compared against a range of likely cost-effectiveness thresholds. Results: The incremental cost of mobile phone?based support was estimated to be an additional US $8160.49 per 1000 clients, leading to an estimated 518 couple-years of protection (CYPs) gained per 1000 clients and 99 disability-adjusted life-years (DALYs) averted. The incremental cost-effectiveness ratio was US $15.75 per additional CYP and US $82.57 per DALY averted. The model was most sensitive to personnel and mobile service costs. Assuming a range of cost-effectiveness thresholds from US $58 to US $176 for Cambodia, the probability of the intervention being cost-effective ranged from 11% to 95%. Conclusions: This study demonstrates that the cost-effectiveness of the intervention delivered by mobile phone assessed in the MOTIF trial lies within the estimated range of the cost-effectiveness threshold for Cambodia. When assessing value in interventions to improve the uptake and adherence of family planning services, the use of interactive mobile phone messaging and counselling for women who have had an abortion should be considered as an option by policy makers. Trial Registration: ClinicalTrials.gov NCT01823861; https://clinicaltrials.gov/ct2/show/NCT01823861 UR - http://mhealth.jmir.org/2020/2/e16276/ UR - http://dx.doi.org/10.2196/16276 UR - http://www.ncbi.nlm.nih.gov/pubmed/32130166 ID - info:doi/10.2196/16276 ER - TY - JOUR AU - Wang, Jiani AU - Rogge, A. Alizé AU - Armour, Mike AU - Smith, A. Caroline AU - D?Adamo, R. Christopher AU - Pischke, R. Claudia AU - Yen, Hung-Rong AU - Wu, Mei-Yao AU - Moré, Ocampo Ari Ojeda AU - Witt, M. Claudia AU - Pach, Daniel PY - 2020/2/11 TI - International ResearchKit App for Women with Menstrual Pain: Development, Access, and Engagement JO - JMIR Mhealth Uhealth SP - e14661 VL - 8 IS - 2 KW - dysmenorrhea KW - mHealth KW - mobile applications KW - acupressure KW - pain KW - behavior change techniques (BCTs) KW - ResearchKit KW - recruitment N2 - Background: Primary dysmenorrhea is a common condition in women of reproductive age. A previous app-based study undertaken by our group demonstrated that a smartphone app supporting self-acupressure introduced by a health care professional can reduce menstrual pain. Objective: This study aims to evaluate whether a specific smartphone app is effective in reducing menstrual pain in 18- to 34-year-old women with primary dysmenorrhea in a self-care setting. One group of women has access to the full-featured study app and will be compared with 2 control groups who have access to fewer app features. Here, we report the trial design, app development, user access, and engagement. Methods: On the basis of the practical implications of the previous app-based study, we revised and reengineered the study app and included the ResearchKit (Apple Inc) framework. Behavior change techniques (BCTs) were implemented in the app and validated by expert ratings. User access was estimated by assessing recruitment progress over time. User evolution and baseline survey respondent rate were assessed to evaluate user engagement. Results: The development of the study app for a 3-armed randomized controlled trial required a multidisciplinary team. The app is accessible for the target population free of charge via the Apple App Store. In Germany, within 9 months, the app was downloaded 1458 times and 328 study participants were recruited using it without external advertising. A total of 98.27% (5157/5248) of the app-based baseline questions were answered. The correct classification of BCTs used in the app required psychological expertise. Conclusions: Conducting an innovative app study requires multidisciplinary effort. Easy access and engagement with such an app can be achieved by recruitment via the App Store. Future research is needed to investigate the determinants of user engagement, optimal BCT application, and potential clinical and self-care scenarios for app use. Trial Registration: ClinicalTrials.gov NCT03432611; https://clinicaltrials.gov/ct2/show/NCT03432611 (Archived by WebCite at http://www.webcitation.org/75LLAcnCQ). UR - https://mhealth.jmir.org/2020/2/e14661 UR - http://dx.doi.org/10.2196/14661 UR - http://www.ncbi.nlm.nih.gov/pubmed/32058976 ID - info:doi/10.2196/14661 ER - TY - JOUR AU - Dieng, Aissata AU - He, Jie AU - Poder, G. Thomas PY - 2020/2/6 TI - Web Comparison of Three Contingent Valuation Techniques in Women of Childbearing Age: The Case of Ovulation Induction in Quebec JO - Interact J Med Res SP - e13355 VL - 9 IS - 1 KW - contingent valuation KW - elicitation technique KW - dichotomous choice KW - multiple-bounded discrete choice KW - willingness to pay KW - failed ovulation KW - ovulation induction N2 - Background: In Canada, 11.5% to 15.7% of couples suffer from infertility. Anovulation, or failed ovulation, is one of the main causes of infertility in women. In Quebec, the treatment for ovulation induction and other services related to assisted reproductive technology (ART) have been partially reimbursed by the government since 2010. Objective: This study aimed to compare the willingness to pay (WTP) of women of childbearing age to receive drug treatment in the event of failed ovulation according to 3 different contingent valuation methods. Methods: The following elicitation techniques were used: simple bid price dichotomous choice (DC), followed by an open-ended question (DC-OE), and a simplified multiple-bounded discrete choice (MBDC). Each participant was randomly assigned to 1 of 3 elicitation techniques. Bid prices ranged from Can $200 to Can $5000. Of the 7 bid prices, 1 was randomly proposed to each participant in the DC and DC-OE groups. For the DC-OE group, if the answer to the DC bid price was no, respondents were asked what was the maximum amount they were willing to pay. For the MBDC group, each respondent was offered an initial bid price of Can $1500, and the subsequent bid price offer increased or decreased according to the answer provided. ?Do not know? responses were considered as a ?no?, and each individual was questioned as to their certainty after each choice. WTP values were estimated using probit and bivariate models; the Welsh and Poe model was also performed for the MBDC group. Results: The survey was conducted from 2009 to 2010 with a total sample of 680 women. Analyses were performed on 610 respondents (199 DC, 230 DC-OE, and 181 MBDC). Of the 70 respondents who were excluded, 6 did not meet the age criterion, 45 had an annual income less than Can $2500, and 19 did not respond to the WTP question. Mean WTP values were Can $4033.26, Can $1857.90, and Can $1630.63 for DC, DC-OE, and MBDC, respectively. The WTP for MBDC ?definitely yes? and ?probably yes? values were Can $1516.73 and Can $1871.22, respectively. The 3 elicitation techniques provided WTP value differences that were statistically significant (P<.01). The MBDC was the most accurate method, with a lower confidence interval (Can $557) and a lower (CI/mean) ratio (0.34). Conclusions: A positive WTP for ovulation induction was found in Quebec. Adding a follow-up question resulted in more accurate WTP values. The MBDC technique provided a more accurate estimate of the WTP with a smaller and, therefore, more efficient confidence interval. To help decision making and improve the effectiveness of the fiscal policy related to the ART program, the WTP value elicited with the MBDC technique should be used. UR - https://www.i-jmr.org/2020/1/e13355 UR - http://dx.doi.org/10.2196/13355 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/13355 ER - TY - JOUR AU - Noben, Lore AU - Goossens, Anna Simone Maria Theresia AU - Truijens, Marieke Sophie Eva AU - van Berckel, Georgine Marijn Marthe AU - Perquin, Wilhelmina Christel AU - Slooter, Dirk Gerrit AU - van Rooijen, Johannes Stefanus PY - 2019/12/18 TI - A Virtual Reality Video to Improve Information Provision and Reduce Anxiety Before Cesarean Delivery: Randomized Controlled Trial JO - JMIR Ment Health SP - e15872 VL - 6 IS - 12 KW - virtual reality KW - cesarean section KW - counseling KW - preoperative care KW - surgery KW - anxiety KW - childbirth N2 - Background: Anxiety levels before cesarean delivery (CD) can lead to a negative birth experience, which may influence several aspects of the woman?s life in the long term. Improving preoperative information may lower preoperative anxiety and lead to a more positive birth experience. Objective: This study aimed to determine whether a virtual reality (VR) video in addition to standard preoperative information decreases anxiety levels before a planned CD. Methods: Women scheduled to undergo term elective CD were recruited from the outpatient clinic. They were randomized and stratified based on history of emergency CD (yes or no). All participants received standard preoperative information (folder leaflets and counseling by the obstetrician); the VR group additionally watched the VR video showing all aspects of CD such as the ward admission, operating theater, spinal analgesia, and moment of birth. The primary outcome measure was a change in score on the Visual Analogue Scale for Anxiety (?VAS-A) measured at admission for CD, compared with the baseline VAS-A score. Results: A total of 97 women were included for analysis. The baseline characteristics were similar in both groups, except for a significantly higher level of education in the control group. There was no significant decrease in the VAS-A score of the women in the VR group (n=49) compared with those in the control group (n=48; ?VAS-A=1.0; P=.08; 95% CI ?0.1 to 2.0). Subgroup analysis for the group of women with a history of emergency CD showed a trend toward decreased preoperative anxiety, despite the small sample size of this subgroup (n=17; P=.06). Of the 26 participants who provided completed questionnaires, 22 (85%) in the VR group reported feeling more prepared after seeing the VR video; of the 24 participants? partners who completed the questionnaires, 19 (79%) agreed with the participants. No discomfort or motion sickness was reported. Conclusions: A VR video may help patients and their partners feel better prepared when planning a CD. This study showed that VR does not lead to a decrease in preoperative anxiety. However, subgroups such as women with a history of emergency CD may benefit from VR videos. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN) 74794447; http://www.isrctn.com/ISRCTN74794447 (retrospectively registered) UR - http://mental.jmir.org/2019/12/e15872/ UR - http://dx.doi.org/10.2196/15872 UR - http://www.ncbi.nlm.nih.gov/pubmed/31850850 ID - info:doi/10.2196/15872 ER - TY - JOUR AU - Brochu, Felicia AU - Robins, Stephanie AU - Miner, A. Skye AU - Grunberg, H. Paul AU - Chan, Peter AU - Lo, Kirk AU - Holzer, G. Hananel E. AU - Mahutte, Neal AU - Ouhilal, Sophia AU - Tulandi, Togas AU - Zelkowitz, Phyllis PY - 2019/12/12 TI - Searching the Internet for Infertility Information: A Survey of Patient Needs and Preferences JO - J Med Internet Res SP - e15132 VL - 21 IS - 12 KW - infertility KW - internet KW - consumer health information KW - patient satisfaction KW - stress, psychological N2 - Background: Given the complexity of infertility diagnoses and treatments and the convenience of the internet for finding health-related information, people undergoing infertility treatments often use Web-based resources to obtain infertility information and support. However, little is known about the types of information and support resources infertility patients search for on the internet and whether these resources meet their needs. Objective: The aims of this study were to (1) examine what individual factors, namely, demographic characteristics and distress, are associated with searching the internet for different types of infertility-related information and support resources and (2) determine whether Web-based resources meet the needs of patients. Methods: Men and women seeking infertility care responded to a survey assessing use of Web-based resources for accessing infertility-related information and support. The survey further assessed satisfaction with Web-based resources as well as perceived stress and depressive symptomatology. Results: A total of 567 participants, including 254 men and 313 women, completed the survey. Most participants (490/558, 87.8%) had searched the internet for infertility information and support. Searchers were more likely to be women (P<.001), highly educated (P=.04), long-term patients (P=.03), and more distressed (P=.04). Causes of infertility, treatment options, and scientific literature about infertility were the three most frequently searched topics, whereas ways to discuss treatment with family and friends as well as surrogacy and ways to find peer support were the three least searched topics. Of those who searched the internet, 70.9% (346/488) indicated that their needs were met by Web-based information, whereas 29.1% (142/488) said that their needs were not met. Having unmet needs was related to greater levels of perceived stress (P=.005) and depressive symptomatology (P=.03). Conclusions: This study provides evidence for the important role of the internet in accessing infertility information and support and for the ability of Web-based resources to meet patients? needs. However, although distressed patients reported particularly high rates of searching, their needs were not always met, suggesting that they may benefit from alternative sources of information and support or guidance from health care providers when searching the internet. UR - https://www.jmir.org/2019/12/e15132 UR - http://dx.doi.org/10.2196/15132 UR - http://www.ncbi.nlm.nih.gov/pubmed/31829963 ID - info:doi/10.2196/15132 ER - TY - JOUR AU - Werlang, Ribas Isabel Cristina AU - Bernardi, Rombaldi Juliana AU - Nunes, Marina AU - Marcelino, Beltram Thiago AU - Bosa, Lucia Vera AU - Michalowski, Bohns Mariana AU - da Silva, Homrich Clécio AU - Goldani, Zubaran Marcelo PY - 2019/11/12 TI - Impact of Perinatal Different Intrauterine Environments on Child Growth and Development: Planning and Baseline Data for a Cohort Study JO - JMIR Res Protoc SP - e12970 VL - 8 IS - 11 KW - observational study KW - growth KW - development KW - fetal development child health KW - maternal health N2 - Background: Several studies have shown that exposure of the fetus and newborn to prenatal and perinatal events, respectively, may influence the health outcomes of the child throughout their life cycle. Objective: This study aimed to increase the knowledge on the impact of different intrauterine environments on child growth and development, as we know that pregnancy and early years are a window of opportunity for health promotion and prevention interventions of diseases. Methods: The recruitment occurred 24 to 48 hours after delivery and involved mothers and their newborns in 2 public hospitals in Porto Alegre, Brazil, from December 2011 to January 2016. The mothers-newborns dyads were allocated to 5 groups: diabetes mellitus, mothers with a clinical diagnosis of diabetes; systemic arterial hypertension (SAH), mothers with a clinical diagnosis of systematic arterial hypertensive disease during pregnancy; maternal smoking, mothers who smoked at any moment of gestation; small for gestational age (SGA), mothers with SGA newborns because of intrauterine growth restriction; and control, mothers without the clinical characteristics previously mentioned. Several protocols and anthropometric measurements were applied in the interviews at immediate postpartum and 7 and 15 days and 1, 3, and 6 months after birth. For this study, we analyzed only data collected during postpartum interviews. The statistical analyses were performed using Pearson chi-square test, Mann-Whitney test, or Kruskal-Wallis test with Dunn post hoc. The significance level was set at 5%. The Hospital Ethics and Research Committees approved the study. Results: Of the 485 eligible mothers-newborns dyads, 400 agreed to participate (82.5%, 400/485). As expected, newborns from the SGA group had significantly lower birth weight, smaller stature, and lower cephalic perimeter (P<.001). This group also had the highest percentage of primiparous women in comparison with other groups (P=.005) except for control. Mothers from the SAH group had the highest mean age, the highest percentage of cesarean sections, and presented greater gestational weight gain. Conclusions: In this study, we describe the planning and structure for the systematic follow-up of mother-newborn dyads in the first 6 months after birth, considering the important demographic and epidemiological transition scenario in Brazil. The results of this prospective longitudinal study may provide a better understanding of the causal mechanisms involved in health and life course disease related to different adverse intrauterine environments. UR - http://www.researchprotocols.org/2019/11/e12970/ UR - http://dx.doi.org/10.2196/12970 UR - http://www.ncbi.nlm.nih.gov/pubmed/31714249 ID - info:doi/10.2196/12970 ER - TY - JOUR PY - 2019// TI - Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review JO - Online J Public Health Inform SP - e9468 VL - 11 IS - 2 UR - UR - http://dx.doi.org/10.5210/ojphi.v11i2.9468 UR - http://www.ncbi.nlm.nih.gov/pubmed/31632604 ID - info:doi/10.5210/ojphi.v11i2.9468 ER - TY - JOUR AU - Keenan, Katherine AU - Footman, Katharine AU - Sadekin, Munnaf AU - Reiss, Kate AU - Yasmin, Reena AU - Franklin, Hannah AU - Church, Kathryn PY - 2019/8/4 TI - Using a Call Center to Reduce Harm From Self-Administration of Reproductive Health Medicines in Bangladesh: Interrupted Time-Series JO - JMIR Public Health Surveill SP - e12233 VL - 5 IS - 3 KW - reproductive health KW - call center KW - Bangladesh KW - menstrual regulation KW - abortion, induced KW - abortion, legal KW - health behavior KW - help-seeking behavior N2 - Background: Annually, there are approximately 25 million unsafe abortions, and this remains a leading cause of maternal morbidity and mortality. In settings where abortion is restricted, women are increasingly able to self-manage abortions by purchasing abortion medications such as misoprostol and mifepristone (RU-486) from pharmacies or other drug sellers. Better availability of these drugs has been shown to be associated with reductions in complications from unsafe abortions. In Bangladesh, abortion is restricted; however, menstrual regulation (MR) was introduced in the 1970s as an interim method of preventing pregnancy. Pharmacy provision of medications for MR is widespread, but customers purchasing these drugs from pharmacies often do not have access to quality information on dosage and potential complications. Objective: This study aimed to describe a call center intervention in Bangladesh, and assess call center use over time and how this changed when a new MR product (combined mifepristone-misoprostol) was introduced into the market. Methods: In 2010, Marie Stopes Bangladesh established a care provider?assisted call center to reduce potential harm from self-administration of MR medications. The call center number was advertised widely in pharmacies and on MR product packaging. We conducted a secondary analysis of routine data collected by call center workers between July 2012 and August 2016. We investigated the reported types of callers, the reason for call, and reported usage of MR products before and after November 2014. We used an interrupted time series (ITS) analysis to formally assess levels of change in caller characteristics and reasons for calling. Results: Over the 4-year period, 287,095 calls about MR were received and the number of users steadily increased over time. The most common callers (of 287,042 callers) were MR users (67,438, 23.49%), their husbands (65,999, 22.99%), pharmacy workers (65,828, 22.93%), and village doctors (56,036, 19.52%). Most MR calls were about misoprostol, but after November 2014, a growing proportion of calls were about the mifepristone-misoprostol regimen. The most common reasons (of 287,042 reasons) for calling were to obtain information about the regimen (208,605, 72.66%), to obtain information about side effects (208,267, 72.54%), or to report side effects (49,930, 17.39%). The ITS analyses showed that after November 2014, an increasing number of calls were from MR users who had taken the complete regimen (P=.02 and who were calling to discuss reported side effects (P=.01) and pain medication (P=.01), and there were fewer calls asking about dosages (P<.001). Conclusions: The high call volume suggests that this call center intervention addressed an unmet demand for information about MR medications from both MR users and health care providers. Call center interventions may improve the quality of information available by providing information directly to MR users and drug sellers, and thus reducing the potential harm from self-management of MR medications. UR - http://publichealth.jmir.org/2019/3/e12233/ UR - http://dx.doi.org/10.2196/12233 UR - http://www.ncbi.nlm.nih.gov/pubmed/31418425 ID - info:doi/10.2196/12233 ER - TY - JOUR AU - Dalhaug, Mass Emilie AU - Haakstad, Hagen Lene Annette PY - 2019/07/05 TI - What the Health? Information Sources and Maternal Lifestyle Behaviors JO - Interact J Med Res SP - e10355 VL - 8 IS - 3 KW - pregnancy KW - physical activity KW - gestational weight gain KW - diet KW - prenatal care KW - behavior N2 - Background: Regular physical activity (PA), adequate gestational weight gain (GWG), and healthy eating are important for the long-term health of both mother and baby. Hence, it is important that women receive current and updated advice on these topics and are encouraged to adopt a healthy lifestyle during pregnancy. Objective: The aim of this study was to investigate the main information sources among pregnant women regarding PA, GWG, and nutrition as well as to evaluate how these information sources may affect their health behaviors. Methods: A cross-sectional study design, comprising an electronic questionnaire, was distributed to 2 antenatal clinics, as well as pregnancy-related online chat forums and social media. The inclusion criteria were ?18 years, ?20 weeks gestation, and able to read and write Norwegian. In total, 150 pregnant women answered the questionnaire, which was a mix of 11-point Likert scales, close-ended questions, and semi?close-ended questions with the option to elaborate. The relationship between information sources and selected variables, including health behaviors and descriptive variables, were assessed by logistic regression, linear regression, or chi-square as appropriate (P<.05). Results: Mean age (years), gestation week, and prepregnancy body mass index (kg/m2) were 31.1 (SD 4.3), 30.6 (SD 5.9), and 24.2 (SD 4.2), respectively. More than eight out of 10 had received or retrieved information about nutrition (88.7%, 133/150) and PA (80.7%, 121/150), whereas 54.0% (81/150) reported information on GWG. When combining all 3 lifestyle factors, 38.5% had retrieved information from blogs and online forums and 26.6%, from their midwife or family physician. Women who reportedthe internet and media as their primary source of information on weight gain had increased odds of gaining weight below the Institute of Medicine (IOM) guidelines compared with gaining within the guidelines (odds ratio [OR] 15.5, 95% CI 1.4-167.4; P=.02). Higher compliance with nutritional guidelines was seen among those who cited the internet and media as their main source of information on nutrition (beta=.7, 95% CI 0.07-1.3; P=.03). On the other side, receiving advice from friends and family on weight gain was significantly associated with gaining weight above the IOM guidelines compared with gaining within the guidelines (OR 12.0, 95% CI 1.3-111.7; P=.03). No other associations were found between information sources and health behaviors. Conclusions: The small number of health professionals giving information and the extensive use of internet- and media-based sources emphasize the need to address the quality of internet advice and guide women toward trustworthy sources of information during pregnancy. The association between information sources and PA, GWG, and nutrition requires further research. UR - https://www.i-jmr.org/2019/3/e10355/ UR - http://dx.doi.org/10.2196/10355 UR - http://www.ncbi.nlm.nih.gov/pubmed/31278731 ID - info:doi/10.2196/10355 ER - TY - JOUR AU - Huppelschoten, Gerarda Aleida AU - de Bruin, Peter Jan AU - Kremer, AM Jan PY - 2019/06/04 TI - Independent and Web-Based Advice for Infertile Patients Using Fertility Consult: Pilot Study JO - JMIR Form Res SP - e13916 VL - 3 IS - 2 KW - patient-centered care KW - remote consultation KW - decision making KW - telemedicine N2 - Background: Patient-centered care?that is, care tailored to personal wishes and needs of patients?has become increasingly important. It is especially relevant in health care areas where patients suffer from a high burden of disease, such as fertility care. At present, both diagnosis and treatment for infertile couples is provided at a single hospital. As a consequence, patients are not likely to receive optimal, independent advice regarding their fertility problems. Internet-based, independent advice could be feasible for large groups of patients because it is not limited by travel distance and overhead costs. Objective: The aim of this study was to explore the experiences of both patients and professionals with an online platform using video consultations for patients with infertility seeking independent advice for their fertility problem. Methods: This pilot study evaluated an online platform, Fertility Consult, where patients with infertility can get independent advice by a gynecologist through a video consultation, thus eliminating the need of meeting the doctor physically. Semistructured interviews were performed with 2 gynecologists and the chairman of the Dutch patients association. This information was used for a patients? questionnaire about their first experiences with Fertility Consult, including questions about the level of patient-centeredness and shared decision making, using the Patient-Centered Questionnaire-Infertility (PCQ-Infertility) and the CollaboRATE questionnaire, respectively. Results: Of the first 27 patients enrolled at Fertility Consult, 22 responded (82%). Most patients (82%) visited Fertility Consult for a second opinion, seeking more personal attention and independent advice. The mean level of patient-centeredness on the PCQ-Infertility questionnaire was 2.78 (SD 0.58) on a scale of 0 to 3. For the CollaboRATE questionnaire (scale 0-9), patients provided a median score of 8.0 (range 7-9) on all 3 questions about shared decision making. Conclusions: Patients were satisfied with independent, well-prepared, Web-based advice; health care professionals felt they were able to provide patients with proper advice in a manner befitting patients? needs, without any loss of quality. Future studies should focus more on the separation of advice and treatment and on Web-based consultations compared with face-to-face consultations to ascertain the possibility of increased patient involvement in the process to improve the level of patient-centered care. UR - http://formative.jmir.org/2019/2/e13916/ UR - http://dx.doi.org/10.2196/13916 UR - http://www.ncbi.nlm.nih.gov/pubmed/31165714 ID - info:doi/10.2196/13916 ER - TY - JOUR AU - Schramm, Katharina AU - Grassl, Niklas AU - Nees, Juliane AU - Hoffmann, Janine AU - Stepan, Holger AU - Bruckner, Thomas AU - Haun, W. Markus AU - Maatouk, Imad AU - Haist, Markus AU - Schott, C. Timm AU - Sohn, Christof AU - Schott, Sarah PY - 2019/01/07 TI - Women?s Attitudes Toward Self-Monitoring of Their Pregnancy Using Noninvasive Electronic Devices: Cross-Sectional Multicenter Study JO - JMIR Mhealth Uhealth SP - e11458 VL - 7 IS - 1 KW - eHealth KW - fetal monitoring KW - pregnancy KW - telemedicine N2 - Background: Pregnancy can be distressing, particularly if expectant mothers are worried about the well-being of their fetus. Consequently, the desire for reassurance and frequent fetal monitoring is often pronounced. Smart wearable devices and telemedicine are promising tools that could assist women in self-monitoring their pregnancy at home, hence disburdening emergency departments (EDs). They present the possibility to clarify the need for urgent care remotely and offer tighter pregnancy monitoring. However, patients? acceptance of such new technologies for fetal monitoring has not yet been explored extensively. Objective: This survey aimed to elucidate the attitudes of women toward self-monitoring of their pregnancy using noninvasive electronic devices. The technical details of the proposed devices were not specified. Methods: A cross-sectional multicenter study was conducted at the departments of obstetrics of the University Hospitals of Heidelberg and Leipzig, Germany. All patients seen in the obstetrics clinic who were above 18 years were offered participation. We designed a survey questionnaire including validated instruments covering population characteristics, issues in current and past pregnancies, as well as attitudes toward self-monitoring of pregnancy with smart devices. Results: A total of 509 pregnant women with no previous experience in telemedicine participated. Only a small minority of 5.9% (29/493) regarded self-monitoring with wearable devices as an alternative to consulting their physicians. Along these lines, only 7.7% (38/496) strongly believed they would visit the ED less often if such devices were readily available. However, if the procedure were combined with a Web-based telemetric physician consult, 13.5% (66/487) would be highly motivated to use the devices. Furthermore, significantly more women regarded it as an alternative prior to seeing a doctor when they perceived a decline in fetal movements (P<.001). Interestingly, women with university degrees had a higher propensity to engage in pregnancy self-monitoring compared with women without one (37% vs 23%; P=.001). Of the participants, 77.9% (381/489) would like smart wearable devices to measure fetal heart sounds, and 62.6% (306/489) wished to use the devices on their own. Feedback from a doctor or midwife was also very important in their choice of such devices (61.8%, 301/487 wished feedback). The intended frequency of use differed vastly among women, ranging from 13.8% (65/471) who would like to use such a device several times per day to 31.6% (149/471) who favored once per week at most. Conclusions: Our results point to a skeptical attitude toward pregnancy self-monitoring among pregnant women. Nevertheless, many women are open to using devices for pregnancy monitoring in parallel to consulting their physician. The intention to use such devices several times daily or weekly, expressed by more than half of the participants, highlights the potential of such technologies. UR - https://mhealth.jmir.org/2019/1/e11458/ UR - http://dx.doi.org/10.2196/11458 UR - http://www.ncbi.nlm.nih.gov/pubmed/30617040 ID - info:doi/10.2196/11458 ER - TY - JOUR AU - Kelly-Hedrick, Margot AU - Grunberg, H. Paul AU - Brochu, Felicia AU - Zelkowitz, Phyllis PY - 2018/05/23 TI - ?It?s Totally Okay to Be Sad, but Never Lose Hope?: Content Analysis of Infertility-Related Videos on YouTube in Relation to Viewer Preferences JO - J Med Internet Res SP - e10199 VL - 20 IS - 5 KW - infertility KW - internet KW - YouTube KW - social media KW - online health information N2 - Background: Infertility patients frequently use the internet to find fertility-related information and support from people in similar circumstances. YouTube is increasingly used as a source of health-related information and may influence health decision making. There have been no studies examining the content of infertility-related videos on YouTube. Objective: The purpose of this study was to (1) describe the content of highly viewed videos on YouTube related to infertility and (2) identify video characteristics that relate to viewer preference. Methods: Using the search term ?infertility,? the 80 top-viewed YouTube videos and their viewing statistics (eg, views, likes, and comments) were collected. Videos that were non-English, unrelated to infertility, or had age restrictions were excluded. Content analysis was used to examine videos, employing a coding rubric that measured the presence or absence of video codes related to purpose, tone, and demographic and fertility characteristics (eg, sex, parity, stage of fertility treatment). Results: A total of 59 videos, with a median of 156,103 views, met the inclusion criteria and were categorized into 35 personal videos (35/59, 59%) and 24 informational-educational videos (24/59, 41%). Personal videos did not differ significantly from informational-educational videos on number of views, dislikes, subscriptions driven, or shares. However, personal videos had significantly more likes (P<.001) and comments (P<.001) than informational-educational videos. The purposes of the videos were treatment outcomes (33/59, 56%), sharing information (30/59, 51%), emotional aspects of infertility (20/59, 34%), and advice to others (6/59, 10%). The tones of the videos were positive (26/59, 44%), neutral (25/59, 42%), and mixed (8/59, 14%); there were no videos with negative tone. No videos contained only male posters. Videos with a positive tone did not differ from neutral videos in number of views, dislikes, subscriptions driven, or shares; however, positive videos had significantly more likes (P<.001) and comments (P<.001) than neutral videos. A majority (21/35, 60%) of posters of personal videos shared a pregnancy announcement. Conclusions: YouTube is a source of both technical and personal experience-based information about infertility. However, videos that include personal experiences may elicit greater viewer engagement. Positive videos and stories of treatment success may provide hope to viewers but could also create and perpetuate unrealistic expectations about the success rates of fertility treatment. UR - http://www.jmir.org/2018/5/e10199/ UR - http://dx.doi.org/10.2196/10199 UR - http://www.ncbi.nlm.nih.gov/pubmed/29792296 ID - info:doi/10.2196/10199 ER - TY - JOUR AU - Cartwright, F. Alice AU - Karunaratne, Mihiri AU - Barr-Walker, Jill AU - Johns, E. Nicole AU - Upadhyay, D. Ushma PY - 2018/05/14 TI - Identifying National Availability of Abortion Care and Distance From Major US Cities: Systematic Online Search JO - J Med Internet Res SP - e186 VL - 20 IS - 5 KW - abortion seekers KW - reproductive health KW - internet KW - access to information KW - information seeking KW - abortion patients KW - reproductive health services KW - information seeking behavior N2 - Background: Abortion is a common medical procedure, yet its availability has become more limited across the United States over the past decade. Women who do not know where to go for abortion care may use the internet to find abortion facility information, and there appears to be more online searches for abortion in states with more restrictive abortion laws. While previous studies have examined the distances women must travel to reach an abortion provider, to our knowledge no studies have used a systematic online search to document the geographic locations and services of abortion facilities. Objective: The objective of our study was to describe abortion facilities and services available in the United States from the perspective of a potential patient searching online and to identify US cities where people must travel the farthest to obtain abortion care. Methods: In early 2017, we conducted a systematic online search for abortion facilities in every state and the largest cities in each state. We recorded facility locations, types of abortion services available, and facility gestational limits. We then summarized the frequencies by region and state. If the online information was incomplete or unclear, we called the facility using a mystery shopper method, which simulates the perspective of patients calling for services. We also calculated distance to the closest abortion facility from all US cities with populations of 50,000 or more. Results: We identified 780 facilities through our online search, with the fewest in the Midwest and South. Over 30% (236/780, 30.3%) of all facilities advertised the provision of medication abortion services only; this proportion was close to 40% in the Northeast (89/233, 38.2%) and West (104/262, 39.7%). The lowest gestational limit at which services were provided was 12 weeks in Wyoming; the highest was 28 weeks in New Mexico. People in 27 US cities must travel over 100 miles (160 km) to reach an abortion facility; the state with the largest number of such cities is Texas (n=10). Conclusions: Online searches can provide detailed information about the location of abortion facilities and the types of services they provide. However, these facilities are not evenly distributed geographically, and many large US cities do not have an abortion facility. Long distances can push women to seek abortion in later gestations when care is even more limited. UR - http://www.jmir.org/2018/5/e186/ UR - http://dx.doi.org/10.2196/jmir.9717 UR - http://www.ncbi.nlm.nih.gov/pubmed/29759954 ID - info:doi/10.2196/jmir.9717 ER - TY - JOUR AU - Sohda, Satoshi AU - Suzuki, Kenta AU - Igari, Ichiro PY - 2017/11/27 TI - Relationship Between the Menstrual Cycle and Timing of Ovulation Revealed by New Protocols: Analysis of Data from a Self-Tracking Health App JO - J Med Internet Res SP - e391 VL - 19 IS - 11 KW - self-tracking KW - person generated health data KW - calendar calculation KW - fertility KW - menstrual cycle N2 - Background: There are many mobile phone apps aimed at helping women map their ovulation and menstrual cycles and facilitating successful conception (or avoiding pregnancy). These apps usually ask users to input various biological features and have accumulated the menstrual cycle data of a vast number of women. Objective: The purpose of our study was to clarify how the data obtained from a self-tracking health app for female mobile phone users can be used to improve the accuracy of prediction of the date of next ovulation. Methods: Using the data of 7043 women who had reliable menstrual and ovulation records out of 8,000,000 users of a mobile phone app of a health care service, we analyzed the relationship between the menstrual cycle length, follicular phase length, and luteal phase length. Then we fitted a linear function to the relationship between the length of the menstrual cycle and timing of ovulation and compared it with the existing calendar-based methods. Results: The correlation between the length of the menstrual cycle and the length of the follicular phase was stronger than the correlation between the length of the menstrual cycle and the length of the luteal phase, and there was a positive correlation between the lengths of past and future menstrual cycles. A strong positive correlation was also found between the mean length of past cycles and the length of the follicular phase. The correlation between the mean cycle length and the luteal phase length was also statistically significant. In most of the subjects, our method (ie, the calendar-based method based on the optimized function) outperformed the Ogino method of predicting the next ovulation date. Our method also outperformed the ovulation date prediction method that assumes the middle day of a mean menstrual cycle as the date of the next ovulation. Conclusions: The large number of subjects allowed us to capture the relationships between the lengths of the menstrual cycle, follicular phase, and luteal phase in more detail than previous studies. We then demonstrated how the present calendar methods could be improved by the better grouping of women. This study suggested that even without integrating various biological metrics, the dataset collected by a self-tracking app can be used to develop formulas that predict the ovulation day when the data are aggregated. Because the method that we developed requires data only on the first day of menstruation, it would be the best option for couples during the early stages of their attempt to have a baby or for those who want to avoid the cost associated with other methods. Moreover, the result will be the baseline for more advanced methods that integrate other biological metrics. UR - http://www.jmir.org/2017/11/e391/ UR - http://dx.doi.org/10.2196/jmir.7468 UR - http://www.ncbi.nlm.nih.gov/pubmed/29180346 ID - info:doi/10.2196/jmir.7468 ER - TY - JOUR AU - Sherifali, Diana AU - Nerenberg, A. Kara AU - Wilson, Shanna AU - Semeniuk, Kevin AU - Ali, Usman Muhammad AU - Redman, M. Leanne AU - Adamo, B. Kristi PY - 2017/10/13 TI - The Effectiveness of eHealth Technologies on Weight Management in Pregnant and Postpartum Women: Systematic Review and Meta-Analysis JO - J Med Internet Res SP - e337 VL - 19 IS - 10 KW - eHealth KW - technology KW - pregnancy KW - postpartum KW - weight N2 - Background: The emergence and utilization of electronic health (eHealth) technologies has increased in a variety of health interventions. Exploiting the real-time advantages offered by mobile technologies during and after pregnancy has the potential to empower women and encourage behaviors that may improve maternal and child health. Objective: The objective of this study was to assess the effectiveness of eHealth technologies for weight management during pregnancy and the postpartum period and to review the efficacy of eHealth technologies on health behaviors, specifically nutrition and physical activity. Methods: A systematic search was conducted of the following databases: MEDLINE, EMBASE, Cochrane database of systematic reviews (CDSR), Cochrane central register of controlled trials (CENTRAL), CINAHL (Cumulative Index to Nursing and Allied Health Literature), and PsycINFO. The search included studies published from 1990 to July 5, 2016. All relevant primary studies that involved randomized controlled trials (RCTs), non-RCTs, before-and-after studies, historically controlled studies, and pilot studies were included. The study population was adult women of childbearing age either during pregnancy or the postpartum period. eHealth weight management intervention studies targeting physical activity, nutrition, or both, over a minimum 3-month period were included. Titles and abstracts, as well as full-text screening were conducted. Study quality was assessed using Cochrane?s risk of bias tool. Data extraction was completed by a single reviewer, which was then verified by a second independent reviewer. Results were meta-analyzed to calculate pooled estimates of the effect, wherever possible. Results: Overall, 1787 and 176 citations were reviewed at the abstract and full-text screening stages, respectively. A total of 10 studies met the inclusion criteria ranging from high to low risk of bias. Pooled estimates from studies of the effect for postpartum women resulted in a significant reduction in weight (?2.55 kg, 95% CI ?3.81 to ?1.28) after 3 to 12 months and six studies found a nonsignificant reduction in weight gain for pregnant women (?1.62 kg, 95% CI ?3.57 to 0.33) at approximately 40 weeks. Conclusions: This review found evidence for benefits of eHealth technologies on weight management in postpartum women only. Further research is still needed regarding the use of these technologies during and after pregnancy. UR - http://www.jmir.org/2017/10/e337/ UR - http://dx.doi.org/10.2196/jmir.8006 UR - http://www.ncbi.nlm.nih.gov/pubmed/29030327 ID - info:doi/10.2196/jmir.8006 ER - TY - JOUR AU - Saremi, AboTaleb AU - Bahrami, Homa AU - Feizy, Fariba PY - 2017/10/10 TI - Uterine Fundectomy in Patients With Benign Etiology Undergoing Hysterectomy: New Surgical Technique JO - JMIR Res Protoc SP - e150 VL - 6 IS - 10 KW - hysterectomy KW - uterine KW - fundectomy N2 - Background: Hysterectomy is the most common surgical procedure in gynecology, not only in cases of malignancies but also in many benign cases. Many uterine preservation techniques have been introduced as alternatives to hysterectomy. Objective: We aimed to propose a new uterine surgical procedure. In this paper, we compare the utility of this new technique to the limitations of current procedures. Methods: Uterine fundectomy may be considered as a subtotal hysterectomy. In this new technique, the uterine fundus including all pathologic tissue is cut as a reverse trapezoid by monopolar cautery. The upper side of the trapezoid, which includes the whole uterine fundus, is removed, but the fallopian tubes and cornual segment are preserved. A small uterine cavity remains, as well as the endometrial tissue lining it. Results: Patient recruitment for this study began in April 2017 and is expected to end approximately 12 months later. Assessment of the primary outcomes is expected to take place in April 2018. Conclusions: Uterine preservation is particularly critical in developing new surgical approaches that can lead to a positive impact on patient satisfaction. This protocol outlines the first attempt to prospectively test surgical fundectomy in candidates for hysterectomy for benign indications. UR - http://www.researchprotocols.org/2017/10/e150/ UR - http://dx.doi.org/10.2196/resprot.7536 UR - http://www.ncbi.nlm.nih.gov/pubmed/29017989 ID - info:doi/10.2196/resprot.7536 ER - TY - JOUR AU - Balikuddembe, S. Michael AU - Tumwesigye, M. Nazarius AU - Wakholi, K. Peter AU - Tylleskär, Thorkild PY - 2017/06/15 TI - Computerized Childbirth Monitoring Tools for Health Care Providers Managing Labor: A Scoping Review JO - JMIR Med Inform SP - e14 VL - 5 IS - 2 KW - childbirth KW - obstetric labor KW - fetal monitoring KW - medical informatics applications KW - systematic review N2 - Background: Proper monitoring of labor and childbirth prevents many pregnancy-related complications. However, monitoring is still poor in many places partly due to the usability concerns of support tools such as the partograph. In 2011, the World Health Organization (WHO) called for the development and evaluation of context-adaptable electronic health solutions to health challenges. Computerized tools have penetrated many areas of health care, but their influence in supporting health staff with childbirth seems limited. Objective: The objective of this scoping review was to determine the scope and trends of research on computerized labor monitoring tools that could be used by health care providers in childbirth management. Methods: We used key terms to search the Web for eligible peer-reviewed and gray literature. Eligibility criteria were a computerized labor monitoring tool for maternity service providers and dated 2006 to mid-2016. Retrieved papers were screened to eliminate ineligible papers, and consensus was reached on the papers included in the final analysis. Results: We started with about 380,000 papers, of which 14 papers qualified for the final analysis. Most tools were at the design and implementation stages of development. Three papers addressed post-implementation evaluations of two tools. No documentation on clinical outcome studies was retrieved. The parameters targeted with the tools varied, but they included fetal heart (10 of 11 tools), labor progress (8 of 11), and maternal status (7 of 11). Most tools were designed for use in personal computers in low-resource settings and could be customized for different user needs. Conclusions: Research on computerized labor monitoring tools is inadequate. Compared with other labor parameters, there was preponderance to fetal heart monitoring and hardly any summative evaluation of the available tools. More research, including clinical outcomes evaluation of computerized childbirth monitoring tools, is needed. UR - http://medinform.jmir.org/2017/2/e14/ UR - http://dx.doi.org/10.2196/medinform.6959 UR - http://www.ncbi.nlm.nih.gov/pubmed/28619702 ID - info:doi/10.2196/medinform.6959 ER - TY - JOUR AU - Fredriksen, Haukeland Eva AU - Harris, Janet AU - Moland, Marie Karen PY - 2016/05/26 TI - Web-based Discussion Forums on Pregnancy Complaints and Maternal Health Literacy in Norway: A Qualitative Study JO - J Med Internet Res SP - e113 VL - 18 IS - 5 KW - qualitative research KW - Internet KW - pregnancy KW - health literacy KW - web-based discussion forums KW - pelvic girdle pain N2 - Background: The Internet is one of the fastest growing information sources for pregnant women and seems to be used across social and economic strata. However, we still lack knowledge on how interaction in Web-based discussion forums influence maternal health literacy, in terms of how pregnant women access, appraise, and apply information to promote and maintain good health. Objective: The aim of this study was to understand how Web-based discussion forums influence maternal health literacy; hence, we explored the role of interactions in Web-based discussion forums among women who experienced health problems during pregnancy. More specifically, we explored why media-literate women experiencing the medically unexplained condition, pelvic girdle pain (PGP), during pregnancy participated in Web-based discussion forums and how they appraised and applied the information and advice that they gained from the Web-based interaction with other women. Methods: Women were invited to participate in the study via postings on 3 different open websites for pregnant women and mothers. The sample included 11 Norwegian women who participated in open Web-based discussion forums when experiencing PGP in pregnancy. The data were collected using synchronous qualitative email interviews and were analyzed using thematic analysis. Results: In our study sample, interaction in Web-based discussion forums influenced maternal health literacy in terms of increased health-related knowledge and competencies, increased awareness of health promotion and health protection, and increased system navigation. The women appraised and selectively applied information and advice that resonated with their own experiences. For many, the information provided online by other women in the same situation was valued more highly than advice from health professionals. Women reported that they used their knowledge and competency in encounters with health professionals but hesitated to disclose the origin of their knowledge. Those with a high level of education in medicine-related fields raised a concern about the Internet as a source of horror stories and erroneous information and were actively engaged in trying to minimize potential negative effects, by providing biomedical information. Conclusions: The popularity of Web-based discussion forums among pregnant women suggests that this group needs additional sources of information and support to complement traditional consultations with the health professionals. The professionals need to recognize that pregnant women access Web-based discussion forums for support and information to increase their ability to take better health decisions for themselves. This is a potential resource that health professionals may find useful in consultations with pregnant women. UR - http://www.jmir.org/2016/5/e113/ UR - http://dx.doi.org/10.2196/jmir.5270 UR - http://www.ncbi.nlm.nih.gov/pubmed/27230094 ID - info:doi/10.2196/jmir.5270 ER - TY - JOUR AU - Holton, Sara AU - Rowe, Heather AU - Kirkman, Maggie AU - Jordan, Lynne AU - McNamee, Kathleen AU - Bayly, Christine AU - McBain, John AU - Sinnott, Vikki AU - Fisher, Jane PY - 2016/02/15 TI - Barriers to Managing Fertility: Findings From the Understanding Fertility Management in Contemporary Australia Facebook Discussion Group JO - Interact J Med Res SP - e7 VL - 5 IS - 1 KW - fertility management KW - Australia KW - Facebook KW - social media N2 - Background: As part of research investigating the complexities of managing fertility in Australia, public opinions about how Australians manage their fertility were sought from women and men. Objective: To identify public opinion about sexual and reproductive health in Australia. Methods: To ensure access to a diverse group of people throughout Australia, an online group was advertised and convened on Facebook from October through December 2013. In a closed-group moderated discussion, participants responded to questions about how people in Australia attempt to manage three aspects of fertility: avoiding pregnancy, achieving pregnancy, and difficulties conceiving. Nonidentifiable demographic information was sought; no personal accounts of fertility management were requested. The discussion transcript was analyzed thematically. Results: There were 61 female and 2 male Facebook users aged 18 to 50 years living in Australia participating in the study. Four main themes about fertility management were identified: access, geographical location, knowledge, and cost. Participants reported that young people and people from rural areas face barriers accessing contraception and fertility services. Limited knowledge about sex and reproduction and the cost of fertility services and contraception were also said to impede effective fertility management. Conclusions: Reasons for inequalities in effective fertility management that are amenable to change were identified. Facebook is an effective method for gaining insights into public opinion about sexual and reproductive health. UR - http://www.i-jmr.org/2016/1/e7/ UR - http://dx.doi.org/10.2196/ijmr.4492 UR - http://www.ncbi.nlm.nih.gov/pubmed/26878865 ID - info:doi/10.2196/ijmr.4492 ER - TY - JOUR AU - Logsdon, Cynthia M. AU - Davis, Deborah AU - Eckert, Diane AU - Smith, Frances AU - Stikes, Reetta AU - Rushton, Jeff AU - Myers, John AU - Capps, Joshua AU - Sparks, Kathryn PY - 2015/10/08 TI - Feasibility of Two Educational Methods for Teaching New Mothers: A Pilot Study JO - Interact J Med Res SP - e20 VL - 4 IS - 4 KW - Patient Education as Topic KW - Video Recording KW - Postpartum Period KW - Utilization KW - Nurses KW - Personal Satisfaction N2 - Background: Printed health educational materials are commonly issued to prepare patients for hospital discharge. Teaching methods that engage multiple senses have been shown to positively affect learning outcomes, suggesting that paper materials may not be the most effective approach when educating new mothers. In addition, many written patient educational materials do not meet national health literacy guidelines. Videos that stimulate visual and auditory senses provide an alternative, potentially more effective, strategy for delivering health information. The acceptability of these methods, as perceived by nurses executing patient education initiatives, is important for determining the most appropriate strategy. Objective: The purpose of this study was to determine the feasibility of 2 educational methods for teaching new mothers how to care for themselves and their infants after hospital discharge. Feasibility was measured by adequate enrollment, acceptability of the intervention to patients and nurses, and initial efficacy. Methods: New mothers (n=98) on a Mother-Baby Unit received health information focused on self-care and infant care delivered as either simple printed materials or YouTube videos on an iPad. Mothers completed a pretest, post-test, and an acceptability survey. Following completion of the initiative, nurses who participated in delivering the health education using one of these 2 methods were asked to complete a survey to determine their satisfaction with and confidence in using the materials. Results: Mothers, on average, were 26 years old; 72% had a high school education; and 41% were African American. The improvement in knowledge scores was significantly higher for the iPad group (8.6% vs 4.4%, P=.02) compared to the pamphlet group. Group (B=4.81, P=.36) and time (B=6.12, P<.001) significantly affected scores, while no significant interaction effect was observed (B=5.69, P=.09). There were no significant differences in responses between the groups (all P values >.05). The nurses had a mean age of 44.3 years (SD 13.9) and had, on average, 16.6 years of experience (SD 13.8). The nurses felt confident and satisfied administering both educational modalities. Conclusions: The pamphlet and iPad were identified as feasible and acceptable modalities for educating new mothers about self-care and infant care, though the iPad was more effective in improving knowledge. Understanding the acceptability of different teaching methods to patient educators is important for successful delivery of informational materials at discharge. UR - http://www.i-jmr.org/2015/4/e20/ UR - http://dx.doi.org/10.2196/ijmr.4583 UR - http://www.ncbi.nlm.nih.gov/pubmed/26449647 ID - info:doi/10.2196/ijmr.4583 ER -