TY - JOUR AU - Laestadius, Linnea AU - Hamad, Fridarose AU - Le, Leena AU - Buchtel, Rosemary AU - Campos-Castillo, Celeste PY - 2025/4/10 TI - Amplifying the Voices of Youth for Equity in Wellness and Technology Research: Reflections on the Midwest Youth Wellness Initiative on Technology (MYWIT) Youth Advisory Board JO - JMIR Public Health Surveill SP - e69013 VL - 11 KW - advisory boards KW - adolescents KW - social media KW - qualitative research KW - community engagement UR - https://publichealth.jmir.org/2025/1/e69013 UR - http://dx.doi.org/10.2196/69013 ID - info:doi/10.2196/69013 ER - TY - JOUR AU - Zuair, Areeg PY - 2025/2/19 TI - Effect of the Reassured Self-Compassion?Based School Program on Anxiety, Video Game Addiction, and Body Image Among Rural Female Adolescents: Retrospective Study JO - JMIR Form Res SP - e68840 VL - 9 KW - adolescents KW - rural KW - compassion-focused therapy KW - mental health KW - Saudi Arabia KW - school N2 - Background: The COVID-19 pandemic has amplified mental health challenges among adolescents, particularly in rural areas with limited access to services. In response, the Saudi government launched mental health campaigns and mandated schools to implement mental health programs. However, the effectiveness of these programs remains largely unreported. Objective: This study aims to determine the prevalence of anxiety disorder symptoms, video game addiction, and body image dissatisfaction, as well as to examine the effect of a school-based program, The Reassured Self, grounded in compassion-focused therapy, on anxiety symptoms, video game addiction, and body image dissatisfaction among rural adolescent females in Saudi Arabia. Methods: A retrospective secondary analysis of pre-post intervention data was used. All female middle school students (N=133; age: mean 13.7, SD 1.01 years) in grades 1-3 from a rural setting were included, with no exclusion criteria. Participants were recruited as part of a school-mandated mental health program. Data were collected at baseline (2 weeks before the intervention) and 2-3 weeks post intervention during school hours in a quiet classroom setting using teacher-supervised, printed surveys. Survey completion was voluntary, and students exhibiting high distress based on post data analysis were referred to the school health counselor for support. The intervention consisted of 3 sessions (30-35 minutes each) delivered over 2 weeks. Validated Arabic versions of the Spence Children's Anxiety Scale, Game Addiction Scale, and Body Image Discrepancy Assessment were used to measure outcomes 2 weeks post intervention (April to June 2024). Data were analyzed using linear mixed-effects regression models. Data were analyzed using linear mixed effects regression models. Results: Among the students, 25.8% (32/124) were identified as having high anxiety levels, with 19.3% (24/124) falling into the clinical concern or very high clinical concern categories. Additionally, 26% (32/123) were classified as problem gamers, while 14% (18/123) were categorized as addicted gamers. A smaller proportion, 5.1% (6/117), expressed a strong desire for thinness. Compared to pre-intervention levels, students exhibited significant reductions in anxiety symptoms (mean difference ?4.11, 95% CI ?6.98 to ?1.24; P=.005) and video game addiction (mean difference ?1.62, 95% CI ?2.83 to ?0.42; P=.009) following the program. However, changes in body image dissatisfaction were minimal and not statistically significant (mean difference 0.067, 95% CI ?0.046 to 0.18; P=.057). High satisfaction scores, with a mean of 28.49 out of 35 (SD 6.31), indicated strong acceptability and cultural alignment of the intervention. High satisfaction scores indicated strong acceptability and cultural alignment with the intervention. Conclusions: The results highlight the potential for compassion-focused school programs to address mental health disparities in underserved adolescent populations. Future research should explore the long-term effects and scalability of such culturally adapted interventions. UR - https://formative.jmir.org/2025/1/e68840 UR - http://dx.doi.org/10.2196/68840 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/68840 ER - TY - JOUR AU - Nakagomi, Atsushi AU - Ide, Kazushige AU - Kondo, Katsunori AU - Shiba, Koichiro PY - 2025/1/27 TI - Digital Gaming and Subsequent Health and Well-Being Among Older Adults: Longitudinal Outcome-Wide Analysis JO - J Med Internet Res SP - e69080 VL - 27 KW - digital gaming KW - older adults KW - flourishing KW - well-being KW - physical activity KW - social engagement KW - mobile phone N2 - Background: Digital gaming has become increasingly popular among older adults, potentially offering cognitive, social, and physical benefits. However, its broader impact on health and well-being, particularly in real-world settings, remains unclear. Objective: This study aimed to evaluate the multidimensional effects of digital gaming on health and well-being among older adults, using data from the Japan Gerontological Evaluation Study conducted in Matsudo City, Chiba, Japan. Methods: Data were drawn from 3 survey waves (2020 prebaseline, 2021 baseline, and 2022 follow-up) of the Japan Gerontological Evaluation Study, which targets functionally independent older adults. The exposure variable, digital gaming, was defined as regular video game play and was assessed in 2021. In total, 18 outcomes across 6 domains were evaluated in 2022; domain 1?happiness and life satisfaction, domain 2?physical and mental health, domain 3?meaning and purpose, domain 4?character and virtue, domain 5?close social relationships, and domain 6?health behavior. Furthermore, 10 items from the Human Flourishing Index were included in domains 1-5, with 2 items for each domain. Overall flourishing was defined as the average of the means across these 5 domains. In addition, 7 items related to domains 2, 5, and 6 were assessed. The final sample consisted of 2504 participants aged 65 years or older, with questionnaires containing the Human Flourishing Index randomly distributed to approximately half of the respondents (submodule: n=1243). Consequently, we used 2 datasets for analysis. We applied targeted maximum likelihood estimation to estimate the population average treatment effects, with Bonferroni correction used to adjust for multiple testing. Results: Digital gaming was not significantly associated with overall flourishing or with any of the 5 domains from the Human Flourishing Index. Although initial analyses indicated associations between digital gaming and participation in hobby groups (mean difference=0.12, P=.005) as well as meeting with friends (mean difference=0.076, P=.02), these associations did not remain significant after applying the Bonferroni correction for multiple testing. In addition, digital gaming was not associated with increased sedentary behavior or reduced outdoor activities. Conclusions: This study provides valuable insights into the impact of digital gaming on the health and well-being of older adults in a real-world context. Although digital gaming did not show a significant association with improvements in flourishing or in the individual items across the 5 domains, it was also not associated with increased sedentary behavior or reduced outdoor activities. These findings suggest that digital gaming can be part of a balanced lifestyle for older adults, offering opportunities for social engagement, particularly through hobby groups. Considering the solitary nature of gaming, promoting social gaming opportunities may be a promising approach to enhance the positive effects of digital gaming on well-being. UR - https://www.jmir.org/2025/1/e69080 UR - http://dx.doi.org/10.2196/69080 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/69080 ER - TY - JOUR AU - Abogazalah, Naif AU - Yiannoutsos, Constantin AU - Soto-Rojas, E. Armando AU - Bindayeld, Naif AU - Yepes, F. Juan AU - Martinez Mier, Angeles Esperanza PY - 2024/12/20 TI - Distal and Proximal Influences on Self-Reported Oral Pain and Self-Rated Oral Health Status in Saudi Arabia: Retrospective Study Using a 2017 Nationwide Database JO - JMIR Public Health Surveill SP - e53585 VL - 10 KW - dental health surveys KW - nationwide database KW - public health dentistry KW - path analysis KW - oral health influences KW - oral pain KW - self-rated oral health KW - cross-sectional study KW - dental health KW - dentistry KW - oral health KW - self-reported KW - retrospective study KW - Saudi Arabia KW - proximal KW - distal KW - adult KW - children KW - youth KW - adolescent KW - teen KW - sociodemographic N2 - Background: Oral health significantly influences overall well-being, health care costs, and quality of life. In Saudi Arabia, the burden of oral diseases, such as dental caries and periodontal disease, has increased over recent decades, driven by various lifestyle changes. Objective: To explore the associations between proximal (direct) and distal (indirect) influences that affect oral pain (OP) and self-rated oral health (SROH) status in the Kingdom of Saudi Arabia (KSA) using an adapted conceptual framework. Methods: This retrospective cross-sectional study used data from a national health survey conducted in KSA in 2017. The sample included adults (N=29,274), adolescents (N=9910), and children (N=11,653). Sociodemographic data, health characteristics, and access to oral health services were considered distal influences, while frequency and type of dental visits, tooth brushing frequency, smoking, and consumption of sweets and soft drinks were considered proximal influences. Path analysis modeling was used to estimate the direct, indirect, and total effects of proximal and distal influences on OP and SROH status. Results: The mean age of adult respondents was 42.2 years; adolescents, 20.4 years; and children, 10.58 years. Despite OP reports from 39% of children, 48.5% of adolescents, and 47.1% of adults, over 87% across all groups rated their oral health as good, very good, or excellent. A higher frequency of tooth brushing showed a strong inverse relationship with OP and a positive correlation with SROH (P<.001). Frequent dental visits were positively associated with OP and negatively with SROH (P<.001). Sweet consumption increased OP in adolescents (?=0.033, P=.007) and negatively affected SROH in children (?=?0.086, P<.001), adolescents (?=?0.079, P<.001), and adults (?=?0.068, P<.001). Soft drink consumption, however, was associated with lower OP in adolescents (?=?0.034, P=.005) and improved SROH in adolescents (?=0.063, P<.001) and adults (?=0.068, P<.001). Smoking increased OP in adults (?=0.030, P<.001). Distal influences like higher education were directly linked to better SROH (?=0.046, P=.003) and less OP (indirectly through tooth brushing, ?=?0.004, P<.001). For children, high household income correlated with less OP (?=?0.030, P=.02), but indirectly increased OP through other pathways (?=0.024, P=.003). Lack of access was associated with negative oral health measures (P<.001). Conclusions: Among the KSA population, OP and SROH were directly influenced by many proximal and distal influences that had direct, indirect, or combined influences on OP and SROH status. UR - https://publichealth.jmir.org/2024/1/e53585 UR - http://dx.doi.org/10.2196/53585 UR - http://www.ncbi.nlm.nih.gov/pubmed/39706582 ID - info:doi/10.2196/53585 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 - Yang, Si Myung AU - Taira, Kazuya PY - 2024/11/11 TI - Predicting Prefecture-Level Well-Being Indicators in Japan Using Search Volumes in Internet Search Engines: Infodemiology Study JO - J Med Internet Res SP - e64555 VL - 26 KW - well-being KW - spatial indicator KW - infodemiology KW - search engine KW - public health KW - health policy KW - policy-making KW - Google KW - Japan N2 - Background: In recent years, the adoption of well-being indicators by national governments and international organizations has emerged as an important tool for evaluating state governance and societal progress. Traditionally, well-being has been gauged primarily through economic metrics such as gross domestic product, which fall short of capturing multifaceted well-being, including socioeconomic inequalities, life satisfaction, and health status. Current well-being indicators, including both subjective and objective measures, offer a broader evaluation but face challenges such as high survey costs and difficulties in evaluating at regional levels within countries. The emergence of web log data as an alternative source of well-being indicators offers the potential for more cost-effective, timely, and less biased assessments. Objective: This study aimed to develop a model using internet search data to predict well-being indicators at the regional level in Japan, providing policy makers with a more accessible and cost-effective tool for assessing public well-being and making informed decisions. Methods: This study used the Regional Well-Being Index (RWI) for Japan, which evaluates prefectural well-being across 47 prefectures for the years 2010, 2013, 2016, and 2019, as the outcome variable. The RWI includes a comprehensive approach integrating both subjective and objective indicators across 11 domains, including income, job, and life satisfaction. Predictor variables included z score?normalized relative search volume (RSV) data from Google Trends for words relevant to each domain. Unrelated words were excluded from the analysis to ensure relevance. The Elastic Net methodology was applied to predict RWI using RSVs, with ? balancing ridge and lasso effects and ? regulating their strengths. The model was optimized by cross-validation, determining the best mix and strength of regularization parameters to minimize prediction error. Root mean square errors (RMSE) and coefficients of determination (R2) were used to assess the model?s predictive accuracy and fit. Results: An analysis of Google Trends data yielded 275 words related to the RWI domains, and RSVs were collected for 211 words after filtering out irrelevant terms. The mean search frequencies for these words during 2010, 2013, 2016, and 2019 ranged from ?1.587 to 3.902, with SDs between 3.025 and 0.053. The best Elastic Net model (?=0.1, ?=0.906, RMSE=1.290, and R2=0.904) was built using 2010-2016 training data and 2-13 variables per domain. Applied to 2019 test data, it yielded an RMSE of 2.328 and R2 of 0.665. Conclusions: This study demonstrates the effectiveness of using internet search log data through the Elastic Net machine learning method to predict the RWI in Japanese prefectures with high accuracy, offering a rapid and cost-efficient alternative to traditional survey approaches. This study highlights the potential of this methodology to provide foundational data for evidence-based policy making aimed at enhancing well-being. UR - https://www.jmir.org/2024/1/e64555 UR - http://dx.doi.org/10.2196/64555 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64555 ER - TY - JOUR AU - Yang, Yanrong AU - Tavares, Jorge AU - Oliveira, Tiago PY - 2024/11/11 TI - A New Research Model for Artificial Intelligence?Based Well-Being Chatbot Engagement: Survey Study JO - JMIR Hum Factors SP - e59908 VL - 11 KW - artificial intelligence?based chatbot KW - AI-based chatbot KW - mental well-being KW - intention to engage KW - engagement behavior KW - theoretical models KW - mobile phone N2 - Background: Artificial intelligence (AI)?based chatbots have emerged as potential tools to assist individuals in reducing anxiety and supporting well-being. Objective: This study aimed to identify the factors that impact individuals? intention to engage and their engagement behavior with AI-based well-being chatbots by using a novel research model to enhance service levels, thereby improving user experience and mental health intervention effectiveness. Methods: We conducted a web-based questionnaire survey of adult users of well-being chatbots in China via social media. Our survey collected demographic data, as well as a range of measures to assess relevant theoretical factors. Finally, 256 valid responses were obtained. The newly applied model was validated through the partial least squares structural equation modeling approach. Results: The model explained 62.8% (R2) of the variance in intention to engage and 74% (R2) of the variance in engagement behavior. Affect (?=.201; P=.002), social factors (?=.184; P=.007), and compatibility (?=.149; P=.03) were statistically significant for the intention to engage. Habit (?=.154; P=.01), trust (?=.253; P<.001), and intention to engage (?=.464; P<.001) were statistically significant for engagement behavior. Conclusions: The new extended model provides a theoretical basis for studying users? AI-based chatbot engagement behavior. This study highlights practical points for developers of AI-based well-being chatbots. It also highlights the importance of AI-based well-being chatbots to create an emotional connection with the users. UR - https://humanfactors.jmir.org/2024/1/e59908 UR - http://dx.doi.org/10.2196/59908 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59908 ER - TY - JOUR AU - Dill, Sebastian AU - Müller, Niklas Philipp AU - Caserman, Polona AU - Göbel, Stefan AU - Hoog Antink, Christoph AU - Tregel, Thomas PY - 2024/11/5 TI - Sensing In Exergames for Efficacy and Motion Quality: Scoping Review of Recent Publications JO - JMIR Serious Games SP - e52153 VL - 12 KW - exergame efficacy KW - motion quality assessment KW - vital signs KW - body sensors KW - camera KW - virtual reality N2 - Background: Many studies have shown a direct relationship between physical activity and health. It has also been shown that the average fitness level in Western societies is lower than recommended by the World Health Organization. One tool that can be used to increase physical activity for individual people is exergaming, that is, serious games that motivate players to do physical exercises. Objective: This scoping review of recent studies regarding exergame efficacy aims to evaluate which sensing modalities are used to assess exergame efficacy as well as motion quality. We also analyze how the collected motion sensing data is being leveraged with respect to exergame efficacy and motion quality assessment. Methods: We conducted 2 extensive and systematic searches of the ACM Digital Library and the PubMed database, as well as a single search of the IEEE Xplore database, all according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Overall, 343 studies were assessed for eligibility by the following criteria: The study should be peer-reviewed; the year of publication should be between 2015 and 2023; the study should be available in English or German; the study evaluates the efficacy of at least 1 exergame; sensor data is recorded during the study and is used for evaluation; and the study is sufficiently described to extract information on the exergames, sensors, metrics, and results. Results: We found 67 eligible studies, which we analyzed with regard to sensor usage for both efficacy evaluation and motion analysis. Overall, heart rate (HR) was the most commonly used vital sign to evaluate efficacy (n=52), while the Microsoft Kinect was the most commonly used exergame sensor (n=26). The results of the analysis show that the sensors used in the exergames and the sensors used in the evaluation are, in most cases, mutually exclusive, with motion quality rarely being considered as a metric. Conclusions: The lack of motion quality assessment is identified as a problem both for the studies and the exergames themselves since incorrectly executed motions can reduce an exergame?s effectiveness and increase the risk of injury. Here we propose how to use the same sensors both as input for the exergame and to assess motion quality by presenting recent developments in motion recognition and sensing. UR - https://games.jmir.org/2024/1/e52153 UR - http://dx.doi.org/10.2196/52153 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/52153 ER - TY - JOUR AU - Palucci Vieira, H. Luiz AU - Clemente, Manuel Filipe AU - Chang Marquez, Armando Felipe AU - Rea Olivares, Manuel Walter AU - Vargas Villafuerte, R. Kelly AU - Carpes, P. Felipe PY - 2024/11/4 TI - Accuracy Standards of Wearable Technologies for Assessment of Soccer Kicking: Protocol for a Systematic Literature Review JO - JMIR Res Protoc SP - e57433 VL - 13 KW - skill-related performance KW - shooting KW - team sports KW - sports engineering KW - measurement error KW - validity KW - reliability KW - quality control N2 - Background: Wearable technology is widely applied in performance monitoring, an integral part of sports and exercise sciences. The kick movement in soccer exemplifies a sports technique that could benefit from appropriate biomechanics assessment methodologies. However, the accuracy of wearables in quantifying soccer kick mechanics, particularly under field conditions, remains unclear. Objective: This study aims to present a protocol for a systematic review to discuss the measurement properties (validity, reliability, and/or accuracy aspects) of wearable technology systems explicitly used to measure ball-kicking features in soccer. Methods: This review protocol was preregistered in the Open Science Framework. A total of 2 authors will perform searches in major electronic databases using specific keyword combinations in PubMed, Physical Therapy and Sports Medicine, Web of Science, ProQuest, IEEE Xplore, EBSCOHost, and Scopus. Following a specific population, intervention, comparison, outcome framework (population: soccer players and/or collected human data in a football-related environment; intervention: at least 1 wearable used; comparator: criterion measures, repeated testing sessions and/or actual values; outcome: ball kicking data), studies will be screened based on predetermined inclusion and exclusion criteria. The methodological quality of the included studies will be assessed using the ?consensus-based standards for the selection of health measurement instruments? checklist (in studies concerning validity or reliability) or the ?quality assessment of diagnostic accuracy studies? tool (in studies concerning accuracy). Data extraction will be conducted to determine the level of evidence according to the ?best evidence synthesis method,? and an evidence gap map will be constructed. The Cohen ? coefficient will be used to estimate the interevaluator agreement. Results: This ongoing systematic review has completed database searches and is currently in the screening phase. Depending on the number and consistency of studies, results may be presented by meta-analysis or qualitative synthesis, with subgroup analyses considering factors such as gender, age, and playing level. The final results are expected by July 2024, with manuscript submission anticipated by November 2024. Conclusions: Our study will provide a comprehensive summary of the highest level of evidence available on the use of wearables for the assessment of soccer kick mechanics, providing practical guidance for athletes and sports sciences professionals regarding the validity and reliability aspects of using wearable technology to measure ball-kicking features in soccer. Trial Registration: OSF registries https://osf.io/zm3j6 International Registered Report Identifier (IRRID): DERR1-10.2196/57433 UR - https://www.researchprotocols.org/2024/1/e57433 UR - http://dx.doi.org/10.2196/57433 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57433 ER - TY - JOUR AU - Griffin, C. Ashley AU - Mentch, Lucas AU - Lin, Feng-Chang AU - Chung, E. Arlene PY - 2024/9/24 TI - mHealth Physical Activity and Patient-Reported Outcomes in Patients With Inflammatory Bowel Diseases: Cluster Analysis JO - J Med Internet Res SP - e48020 VL - 26 KW - inflammatory bowel diseases KW - patient-reported outcome measures KW - cluster analysis KW - wearable electronic devices KW - medical informatics KW - mHealth KW - mobile health KW - physical activity KW - bowel disease KW - psychosocial KW - smartphone KW - wearables KW - mobile phone N2 - Background: Regular physical activity is associated with improved quality of life in patients with inflammatory bowel diseases (IBDs), although much of the existing research is based on self-reported data. Wearable devices provide objective data on many rich physical activity dimensions including steps, duration, distance, and intensity. Little is known about how patients with IBDs engage in these varying dimensions of exercise and how it may influence their symptom and disease-specific patient-reported outcomes (PROs). Objective: This study aims to (1) cluster physical activity patterns from consumer-grade wearable devices and (2) assess the relationship between the clusters and PROs in patients with IBDs. Methods: We conducted a cross-sectional and longitudinal cohort study among adults with IBDs in the Crohn?s and Colitis Foundation IBD Partners cohort. Participants contribute physical activity data through smartphone apps or wearable devices in a bring-your-own-device model. Participants also complete biannual PRO questionnaires from the Patient-Reported Outcomes Measurement Information System short forms and IBD-specific questionnaires. K-means cluster analysis was used to generate physical activity clusters based on 3 key features: number of steps, duration of moderate to vigorous activity (minutes), and distance of activity (miles). Based on the clusters, we conducted a cross-sectional analysis to examine differences in mean questionnaire scores and participant characteristics using one-way ANOVA and chi-square tests. We also conducted a longitudinal analysis to examine individual cluster transitions among participants who completed multiple questionnaires, and mean differences in questionnaire scores were compared using 2-tailed paired sample t tests across 6-month periods. Results: Among 430 participants comprising 1255 six-week physical activity periods, we identified clusters of low (33.7%, n=423), moderate (46%, n=577), and high (20.3%, n=255) physical activity. Scores varied across clusters for depression (P=.004), pain interference (P<.001), fatigue (P<.001), sleep disturbance (P<.001), social satisfaction (P<.001), and short Crohn Disease Activity Index (P<.001), with those in the low activity cluster having the worst scores. Sociodemographic characteristics also differed, and those with low physical activity were older (P=.002), had higher BMIs (P<.001), and had longer disease durations (P=.02) compared to other clusters. Among 246 participants who completed at least 2 consecutive questionnaires consisting of 726 questionnaire periods, 67.8% (n=492) remained in the same cluster, and only 1.2% (n=9) moved to or from the furthest clusters of low and high activity across 6-month periods. Conclusions: For patients with IBDs, there were positive associations between physical activity and PROs related to disease activity and psychosocial domains. Physical activity patterns mostly did not fluctuate over time, suggesting little variation in exercise levels in the absence of an intervention. The use of real-world data to identify subgroups with similar lifestyle behaviors could be leveraged to develop targeted interventions that provide support for psychosocial symptoms and physical activity for personalized IBD care. UR - https://www.jmir.org/2024/1/e48020 UR - http://dx.doi.org/10.2196/48020 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/48020 ER - TY - JOUR AU - Jafari, Mahtab PY - 2024/7/22 TI - Can an Online Course, Life101: Mental and Physical Self-Care, Improve the Well-Being of College Students? JO - JMIR Med Educ SP - e50111 VL - 10 KW - self-care course KW - stress management KW - student mental health KW - multimodal online course KW - mental health interventions UR - https://mededu.jmir.org/2024/1/e50111 UR - http://dx.doi.org/10.2196/50111 ID - info:doi/10.2196/50111 ER - TY - JOUR AU - Sebo, Paul AU - Tudrej, Benoit AU - Bernard, Augustin AU - Delaunay, Bruno AU - Dupuy, Alexandra AU - Malavergne, Claire AU - Maisonneuve, Hubert PY - 2024/7/16 TI - Validation and Refinement of the Sense of Coherence Scale for a French Population: Observational Study JO - Interact J Med Res SP - e50284 VL - 13 KW - French KW - sense of coherence KW - salutogenesis KW - SOC KW - Sense of Coherence scale KW - validation KW - validscale KW - well-being KW - promoting KW - resilience KW - validity KW - reliability KW - primary care patients KW - manageability N2 - Background: Salutogenesis focuses on understanding the factors that contribute to positive health outcomes. At the core of the model lies the sense of coherence (SOC), which plays a crucial role in promoting well-being and resilience. Objective: Using the validscale Stata command, we aimed to assess the psychometric properties of the French version of the 3-dimension 13-item SOC questionnaire (SOC-13), encompassing the comprehensibility, manageability, and meaningfulness dimensions. We also aimed to determine if a refined scale, assessed through this method, exhibits superior psychometric properties compared to the SOC-13. Methods: A sample of 880 consecutive primary care patients recruited from 35 French practices were asked to complete the SOC-13. We tested for internal consistency and scalability using the Cronbach ? and Loevinger H coefficients, respectively, and we tested for construct validity using confirmatory factor analysis and goodness-of-fit indices (root mean square error of approximation [RMSEA] and comparative fit index [CFI]). Results: Of the 880 eligible patients, 804 (91.4%) agreed to participate (n=527, 65.6% women; median age 51 years). Cronbach ? and Loevinger H coefficients for the SOC-13 were all <0.70 and <0.30, respectively, indicating poor internal consistency and poor scalability (0.64 and 0.29 for comprehensibility, 0.56 and 0.26 for manageability, and 0.46 and 0.17 for meaningfulness, respectively). The RMSEA and CFI were >0.06 (0.09) and <0.90 (0.83), respectively, indicating a poor fit. By contrast, the psychometric properties of a unidimensional 8-item version of the SOC questionnaire (SOC-8) were excellent (Cronbach ?=0.82, Loevinger H=0.38, RMSEA=0.05, and CFI=0.97). Conclusions: The psychometric properties of the 3-dimension SOC-13 were poor, unlike the unidimensional SOC-8. A questionnaire built only with these 8 items could be a good candidate to measure the SOC. However, further validation studies are needed before recommending its use in research. UR - https://www.i-jmr.org/2024/1/e50284 UR - http://dx.doi.org/10.2196/50284 UR - http://www.ncbi.nlm.nih.gov/pubmed/39012689 ID - info:doi/10.2196/50284 ER - TY - JOUR AU - Liu, Wenhua AU - Wang, Quan AU - Zheng, Danli AU - Mei, Junhua AU - Lu, Jiajia AU - Chen, Guohua AU - Wang, Wei AU - Ding, Fengfei PY - 2024/7/12 TI - The Effects of a Complex Interactive Multimodal Intervention on Personalized Stress Management Among Health Care Workers in China: Nonrandomized Controlled Study JO - J Med Internet Res SP - e45422 VL - 26 KW - multimodal intervention KW - stress management KW - health care workers KW - perceived stress KW - autonomic nervous system KW - stress KW - management KW - mental health KW - engagement KW - human support KW - physiological stress KW - psychological stress KW - social network KW - mobile phone N2 - Background: Health care workers (HCWs) frequently face multiple stressors at work, particularly those working night shifts. HCWs who have experienced distress may find it difficult to adopt stress management approaches, even if they are aware of the effects of stress and coping processes. Therefore, an individualized intervention may be required to assist distressed HCWs in bridging the ?knowledge-practice? gap in stress management and effectively alleviating stress symptoms. Objective: The main objective of this research was to compare the effects of a complex interactive multimodal intervention (CIMI) to self-guided stress management interventions on stress symptoms of distressed HCWs, as measured by physiological (heart rate variability), psychological (perceived stress, mental distress, and subjective happiness), and sleep disorder (fatigue and sleepiness) indicators. Methods: We conducted a nonrandomized, controlled study in 2 Chinese general hospitals. The participants in this study were 245 HCWs who fulfilled at least 1 of the 3 dimensions on the Depression, Anxiety, and Stress Scale. All eligible individuals were required to complete a questionnaire and wear a 24-hour Holter device to determine the physiological signs of stress as indexed by heart rate variability at both baseline and after the intervention. The CIMI group received a 12-week online intervention with 4 components?mobile stress management instruction, a web-based WeChat social network, personalized feedback, and a nurse coach, whereas the control group simply received a self-guided intervention. Results: After a 12-week intervention, the Perceived Stress Scale (PSS) scores reduced significantly in the CIMI group (mean difference [MD] ?5.31, 95% CI ?6.26 to ?4.37; P<.001) compared to the baseline levels. The changes in PSS scores before and after the intervention exhibited a significant difference between the CIMI and control groups (d=?0.64; MD ?4.03, 95% CI ?5.91 to ?2.14; P<.001), and the effect was medium. In terms of physiological measures, both the control group (MD ?9.56, 95% CI ?16.9 to ?2.2; P=.01) and the CIMI group (MD ?8.45, 95% CI ?12.68 to ?4.22; P<.001) demonstrated a significant decrease in the standard deviation of normal-to-normal intervals (SDNN) within the normal clinical range; however, there were no significant differences between the 2 groups (d=0.03; MD 1.11, 95% CI ?7.38 to 9.59; P=.80). Conclusions: The CIMI was an effective intervention for improving sleep disorders, as well as parts of the psychological stress measures in distressed HCWs. The findings provide objective evidence for developing a mobile stress management intervention that is adaptable and accessible to distressed HCWs, but its long-term effects should be investigated in future research. Trial Registration: ClinicalTrials.gov NCT05239065; https://clinicaltrials.gov/ct2/show/NCT05239065 UR - https://www.jmir.org/2024/1/e45422 UR - http://dx.doi.org/10.2196/45422 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/45422 ER - TY - JOUR AU - Chen, Jiangyun AU - Wan, Jiahuan AU - Wu, Yibo AU - Gan, Li AU - Li, Haomiao AU - Zhou, Yan AU - Liu, Siyuan AU - Luo, Lan AU - Zhou, Haozheng AU - Yin, Xuanhao AU - Chang, Jinghui PY - 2024/7/5 TI - The Association Between Personality Traits and Health-Related Quality of Life and the Mediating Role of Smoking: Nationwide Cross-Sectional Study JO - JMIR Public Health Surveill SP - e51416 VL - 10 KW - Big Five personality KW - HRQOL KW - smoking KW - mediation KW - tobacco control KW - China KW - neuroticism KW - extraversion KW - agreeableness KW - health-related quality of life N2 - Background: There are positive and negative correlations in different directions between smoking, personality traits, and health-related quality of life (HRQOL), where smoking may mask the pathway between personality traits and HRQOL. Understanding the masking pathway of smoking between personality traits and HRQOL can elucidate the mechanisms of smoking?s psychosocial effects and provide new ideas for developing tobacco control strategies. Objective: The purpose of this study was to investigate the correlation between Big Five personality traits and HRQOL and whether smoking mediates the relationship between them. Methods: This was a cross-sectional study using data from 21,916 respondents from the 2022 Psychology and Behavior Investigation of Chinese Residents survey. Linear regression models were used to analyze the correlations between smoking, Big Five personality traits, and HRQOL while controlling for potential confounders. The mediating role of smoking on the association between Big Five Personality traits and HRQOL was analyzed using the Sobel-Goodman mediation test. Results: Extraversion (?=.001; P=.04), agreeableness (?=.003; P<.001), and neuroticism (?=.003; P<.001) were positively correlated with HRQOL, whereas openness was negatively correlated with HRQOL (?=?.001; P=.003). Smoking was associated with a decrease in HRQOL and mediated the positive effect of HRQOL on extraversion (z=?2.482; P=.004), agreeableness (z=?2.264; P=.02), and neuroticism (z=?3.230; P=.001). Subgroup analyses further showed that smoking mediated the effect of neuroticism on HRQOL in the population with chronic illnesses (z=?2.724; P=.006), and in the population without chronic illnesses, smoking contributed to the effect of HRQOL on extraversion (z=?2.299; P=.02), agreeableness (z=?2.382; P=.02), and neuroticism (z=?2.213; P=.03). Conclusions: This study provided evidence that there is a correlation between personality traits and HRQOL. It also found that smoking plays a role in mediating the connection between personality traits and HRQOL. The development of future tobacco control strategies should consider the unique traits of each individual?s personality, highlighting the significance of extraversion, agreeableness, and neuroticism. UR - https://publichealth.jmir.org/2024/1/e51416 UR - http://dx.doi.org/10.2196/51416 ID - info:doi/10.2196/51416 ER - TY - JOUR AU - McCallum, Meaghan AU - Baldwin, Matthew AU - Thompson, Paige AU - Blessing, Kelly AU - Frisch, Maria AU - Ho, Annabell AU - Ainsworth, Cole Matthew AU - Mitchell, Siobhan Ellen AU - Michaelides, Andreas AU - May, N. Christine PY - 2024/6/27 TI - Long-Term Efficacy of a Mobile Mental Wellness Program: Prospective Single-Arm Study JO - JMIR Mhealth Uhealth SP - e54634 VL - 12 KW - mHealth KW - psychological distress KW - Noom Mood KW - digital mental wellness programs KW - mobile phone N2 - Background: Rising rates of psychological distress (symptoms of depression, anxiety, and stress) among adults in the United States necessitate effective mental wellness interventions. Despite the prevalence of smartphone app?based programs, research on their efficacy is limited, with only 14% showing clinically validated evidence. Our study evaluates Noom Mood, a commercially available smartphone-based app that uses cognitive behavioral therapy and mindfulness-based programming. In this study, we address gaps in the existing literature by examining postintervention outcomes and the broader impact on mental wellness. Objective: Noom Mood is a smartphone-based mental wellness program designed to be used by the general population. This prospective study evaluates the efficacy and postintervention outcomes of Noom Mood. We aim to address the rising psychological distress among adults in the United States. Methods: A 1-arm study design was used, with participants having access to the Noom Mood program for 16 weeks (N=273). Surveys were conducted at baseline, week 4, week 8, week 12, week 16, and week 32 (16 weeks? postprogram follow-up). This study assessed a range of mental health outcomes, including anxiety symptoms, depressive symptoms, perceived stress, well-being, quality of life, coping, emotion regulation, sleep, and workplace productivity (absenteeism or presenteeism). Results: The mean age of participants was 40.5 (SD 11.7) years. Statistically significant improvements in anxiety symptoms, depressive symptoms, and perceived stress were observed by week 4 and maintained through the 16-week intervention and the 32-week follow-up. The largest changes were observed in the first 4 weeks (29% lower, 25% lower, and 15% lower for anxiety symptoms, depressive symptoms, and perceived stress, respectively), and only small improvements were observed afterward. Reductions in clinically relevant anxiety (7-item generalized anxiety disorder scale) and depression (8-item Patient Health Questionnaire depression scale) criteria were also maintained from program initiation through the 16-week intervention and the 32-week follow-up. Work productivity also showed statistically significant results, with participants gaining 2.57 productive work days from baseline at 16 weeks, and remaining relatively stable (2.23 productive work days gained) at follow-up (32 weeks). Additionally, effects across all coping, sleep disturbance (23% lower at 32 weeks), and emotion dysregulation variables exhibited positive and significant trends at all time points (15% higher, 23% lower, and 25% higher respectively at 32 weeks). Conclusions: This study contributes insights into the promising positive impact of Noom Mood on mental health and well-being outcomes, extending beyond the intervention phase. Though more rigorous studies are necessary to understand the mechanism of action at play, this exploratory study addresses critical gaps in the literature, highlighting the potential of smartphone-based mental wellness programs to lessen barriers to mental health support and improve diverse dimensions of well-being. Future research should explore the scalability, feasibility, and long-term adherence of such interventions across diverse populations. UR - https://mhealth.jmir.org/2024/1/e54634 UR - http://dx.doi.org/10.2196/54634 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/54634 ER - TY - JOUR AU - Moreno, I. Patricia AU - Worch, M. Sarah AU - Thomas, L. Jessica AU - Nguyen, L. Rebecca AU - Medina, N. Heidy AU - Penedo, J. Frank AU - Moskowitz, T. Judith AU - Yanez, Betina AU - Kircher, M. Sheetal AU - Kundu, D. Shilajit AU - Flury, C. Sarah AU - Cheung, O. Elaine PY - 2024/6/18 TI - Quality of Life in Patients and Their Spouses and Cohabitating Partners in the Year Following a Cancer Biopsy (the Couples Cope Study): Protocol for a Prospective Observational Study JO - JMIR Res Protoc SP - e52361 VL - 13 KW - quality of life KW - cancer KW - biopsy KW - couples KW - dyads KW - caregiver KW - patients KW - patient KW - cancer biopsy KW - spouse KW - spouses KW - partner KW - partners KW - diagnostic KW - diagnostic procedure KW - feasibility of recruitment KW - recruitment KW - prostate biopsy KW - breast biopsy KW - screening KW - electronic health record KW - survey KW - surveys N2 - Background: Receiving a diagnosis of cancer is a profound and often very stressful experience. Few studies have prospectively recruited patients prior to receiving a new diagnosis of cancer and included spouses or partners. Objective: The aim of the Couples Cope Study is to understand the impact of undergoing a diagnostic biopsy and receiving a new cancer diagnosis on quality of life (QoL) in both patients and their spouses or partners, as well as on the quality of their relationship. This protocol paper describes the study design and assesses the feasibility of recruitment and retention. Methods: Study staff reviewed the schedules of collaborating physicians using specific encounter codes to identify patients scheduled for breast or prostate biopsies. Potential participants were prescreened via the electronic health record and sent a recruitment letter at least 2 to 3 weeks prior to their biopsy procedure. Patients subsequently underwent a phone screening to determine eligibility. Patients who enrolled provided study staff with contact information for their spouses or partners. All consent forms were completed online. Surveys were completed online prior to receiving the biopsy results (baseline), and at 1, 3, 6, and 9 months after the biopsy. Study staff engaged in ongoing, personalized contact with participants and sent assessment completion reminders via phone and email. Results: A total of 2294 patients undergoing a breast or prostate biopsy were identified and 69% (n=1582) were eligible for phone screening following electronic health record prescreening. Of the 431 patients who underwent phone screening, 75% (n=321) were eligible to participate. Of the eligible patients, 72% (n=231) enrolled and 82% (n=190) of enrolled patients had an accompanying partner or spouse who also enrolled. A total of 77% (34/44) of patients who received a cancer diagnosis and 72% (26/36) of their spouses or partners were retained through 9 months, while 80% (53/66) of patients who received a benign diagnosis and 68% (42/62) of their partners were retained. Conclusions: Prospective recruitment of patients undergoing diagnostic biopsy and their partners is feasible and requires both strategic collaboration with providers and concerted prescreening and recruitment efforts by study staff. Importantly, this study was able to conduct all study activities online without disrupting clinical workflow and without requiring patients and their spouses or partners to come into the laboratory. Consideration should be given to the ratio of biopsies to cancer diagnoses, which can vary significantly by cancer type. Prospective studies are needed and can inform our ability to provide effective support earlier to couples facing a possible cancer diagnosis. Future studies should examine other tumor types that have received less attention in QoL studies, include behavioral and neurobiological assessments beyond self-report measures, and follow couples beyond 9 months in order to examine long-term effects on QoL. International Registered Report Identifier (IRRID): DERR1-10.2196/52361 UR - https://www.researchprotocols.org/2024/1/e52361 UR - http://dx.doi.org/10.2196/52361 UR - http://www.ncbi.nlm.nih.gov/pubmed/38889402 ID - info:doi/10.2196/52361 ER - TY - JOUR AU - Wijekoon, Ashan AU - Gamage Dona, Dilanthi AU - Jayawardana, Subashini AU - Beane, Abigail PY - 2024/6/13 TI - Quality of Life, Physical Activity Participation, and Perceptions of Physical Rehabilitation Among Community-Reintegrated Veterans With Lower Limb Amputation in Sri Lanka: Convergent Parallel Mixed Methods Study JO - JMIR Rehabil Assist Technol SP - e52811 VL - 11 KW - amputation KW - community-based rehabilitation KW - lower limb KW - military KW - physical activity KW - quality of life N2 - Background: Lower limb amputation (LLA) impacts physical activity (PA) participation and quality of life (QoL). To minimize the effects of these challenges, LLA survivors need to have opportunities to engage in appropriately tailored rehabilitation throughout their lives. However, in Sri Lanka, where a 3-decade civil war resulted in trauma-related LLA among young male soldiers, access to rehabilitation was limited to the immediate postinjury period. Developing rehabilitation interventions for these veterans requires an understanding of their current health status and rehabilitation perceptions. Objective: This study was conducted to evaluate the QoL and PA participation of veterans with LLA and explore perceptions of factors influencing their PA participation and expectations for a future community-based physical rehabilitation (CBPR) intervention. Methods: This mixed methods study combined a comparative cross-sectional quantitative survey with qualitative semistructured interviews in 5 districts of Sri Lanka. QoL and PA participation were assessed among community-reintegrated veterans with LLA (n=85) and compared with a matched able-bodied cohort (control; n=85) using Mann-Whitney U and Chi-square tests. PA was assessed in terms of metabolic equivalent of task (MET) minutes per week and was computed for walking, moderate-intensity, and vigorous-intensity activities. PA was classified as sufficiently active, low, or sedentary. The design of interview questions was guided by the Theoretical Domains Framework and followed a phenomenological approach. Interviews were conducted with 25 veterans and were analyzed thematically, and the perceptions regarding PA participation and CBPR were codified using the Consolidated Framework for Implementation Research (CFIR). Results: Based on the quantitative survey findings, scores for both physical (P<.001) and psychological (P<.001) well-being and participation in walking (P=.004) and vigorous-intensity activities (P<.001) were significantly lower among veterans than among controls. A ?sedentary? classification was made for 43% (34/79) of veterans and 12% (10/82) of controls. Veterans mostly engaged in moderate-intensity PA inside the house (49/79, 62%) and in the yard (30/79, 38%). Qualitative interviews revealed that barriers to PA exist at individual (eg, comorbidity burden), primary care (eg, absence of community rehabilitation services), and policy levels (eg, limited resources) and facilitators exist primarily at societal (eg, inclusive community) and individual levels (eg, preinjury activity baseline and positive attitudes toward exercise). Expectations regarding CBPR included individualized rehabilitation parameters; functional exercises; and involvement of peers, amputee societies, and community health care providers. The nonresponse rate for interviews was 7% (2/27). Conclusions: The findings of reduced PA participation, poor QoL, and physical and psychological impairments among relatively young veterans reveal the long-term impacts of living with LLA in the absence of long-term rehabilitation. Policy-level changes need to be implemented along with behavior-change strategies to promote PA participation and minimize physical inactivity?induced health issues. Veterans? perceptions regarding future CBPR programs were positive and centered on holistic, individualized, and peer-led activities. UR - https://rehab.jmir.org/2024/1/e52811 UR - http://dx.doi.org/10.2196/52811 UR - http://www.ncbi.nlm.nih.gov/pubmed/38869933 ID - info:doi/10.2196/52811 ER - TY - JOUR AU - Weng, Huiqin Janice AU - Hu, Yanyan AU - Heaukulani, Creighton AU - Tan, Clarence AU - Chang, Kuiyu Julian AU - Phang, Sheng Ye AU - Rajendram, Priyanka AU - Tan, Mooi Weng AU - Loke, Chiong Wai AU - Morris, T. Robert J. PY - 2024/6/4 TI - Mental Wellness Self-Care in Singapore With mindline.sg: A Tutorial on the Development of a Digital Mental Health Platform for Behavior Change JO - J Med Internet Res SP - e44443 VL - 26 KW - digital mental health KW - artificial intelligence KW - AI KW - AI chatbot KW - digital therapeutics KW - mental health KW - mental wellness KW - mobile phone N2 - Background: Singapore, like the rest of Asia, faces persistent challenges to mental health promotion, including stigma around unwellness and seeking treatment and a lack of trained mental health personnel. The COVID-19 pandemic, which created a surge in mental health care needs and simultaneously accelerated the adoption of digital health solutions, revealed a new opportunity to quickly scale innovative solutions in the region. Objective: In June 2020, the Singaporean government launched mindline.sg, an anonymous digital mental health resource website that has grown to include >500 curated local mental health resources, a clinically validated self-assessment tool for depression and anxiety, an artificial intelligence (AI) chatbot from Wysa designed to deliver digital therapeutic exercises, and a tailored version of the website for working adults called mindline at work. The goal of the platform is to empower Singapore residents to take charge of their own mental health and to be able to offer basic support to those around them through the ease and convenience of a barrier-free digital solution. Methods: Website use is measured through click-level data analytics captured via Google Analytics and custom application programming interfaces, which in turn drive a customized analytics infrastructure based on the open-source platforms Titanium Database and Metabase. Unique, nonbounced (users that do not immediately navigate away from the site), engaged, and return users are reported. Results: In the 2 years following launch (July 1, 2020, through June 30, 2022), the website received >447,000 visitors (approximately 15% of the target population of 3 million), 62.02% (277,727/447,783) of whom explored the site or engaged with resources (referred to as nonbounced visitors); 10.54% (29,271/277,727) of those nonbounced visitors returned. The most popular features on the platform were the dialogue-based therapeutic exercises delivered by the chatbot and the self-assessment tool, which were used by 25.54% (67,626/264,758) and 11.69% (32,469/277,727) of nonbounced visitors. On mindline at work, the rates of nonbounced visitors who engaged extensively (ie, spent ?40 seconds exploring resources) and who returned were 51.56% (22,474/43,588) and 13.43% (5,853/43,588) over a year, respectively, compared to 30.9% (42,829/138,626) and 9.97% (13,822/138,626), respectively, on the generic mindline.sg site in the same year. Conclusions: The site has achieved desired reach and has seen a strong growth rate in the number of visitors, which required substantial and sustained digital marketing campaigns and strategic outreach partnerships. The site was careful to preserve anonymity, limiting the detail of analytics. The good levels of overall adoption encourage us to believe that mild to moderate mental health conditions and the social factors that underly them are amenable to digital interventions. While mindline.sg was primarily used in Singapore, we believe that similar solutions with local customization are widely and globally applicable. UR - https://www.jmir.org/2024/1/e44443 UR - http://dx.doi.org/10.2196/44443 UR - http://www.ncbi.nlm.nih.gov/pubmed/38833294 ID - info:doi/10.2196/44443 ER - TY - JOUR AU - Yeshurun, Shlomo AU - Cramer, Tomer AU - Souroujon, Daniel AU - Mor, Merav PY - 2024/4/1 TI - The Association of Macronutrient Consumption and BMI to Exhaled Carbon Dioxide in Lumen Users: Retrospective Real-World Study JO - JMIR Mhealth Uhealth SP - e56083 VL - 12 KW - app KW - applications KW - association KW - BMI KW - body mass index KW - carbohydrate KW - carbon dioxide KW - consumption KW - correlate KW - correlation KW - diet KW - dietary KW - exhalation KW - exhale KW - food KW - Lumen KW - macronutrient KW - meal KW - metabolic flexibility KW - metabolic KW - metabolism KW - mHealth KW - mobile health KW - nutrient KW - nutrition KW - nutritional KW - obese KW - obesity KW - postprandial KW - prandial KW - retrospective KW - weight N2 - Background: Metabolic flexibility is the ability of the body to rapidly switch between fuel sources based on their accessibility and metabolic requirements. High metabolic flexibility is associated with improved health outcomes and a reduced risk of several metabolic disorders. Metabolic flexibility can be improved through lifestyle changes, such as increasing physical activity and eating a balanced macronutrient diet. Lumen is a small handheld device that measures metabolic fuel usage through exhaled carbon dioxide (CO2), which allows individuals to monitor their metabolic flexibility and make lifestyle changes to enhance it. Objective: This retrospective study aims to examine the postprandial CO2 response to meals logged by Lumen users and its relationship with macronutrient intake and BMI. Methods: We analyzed deidentified data from 2607 Lumen users who logged their meals and measured their exhaled CO2 before and after those meals between May 1, 2023, and October 18, 2023. A linear mixed model was fitted to test the association between macronutrient consumption, BMI, age, and gender to the postprandial CO2 response, followed by a 2-way ANOVA. Results: The model demonstrated significant associations (P<.001) between CO2 response after meals and both BMI and carbohydrate intake (BMI: ?=?0.112, 95% CI ?0.156 to ?0.069; carbohydrates: ?=0.046, 95% CI 0.034-0.058). In addition, a 2-way ANOVA revealed that higher carbohydrate intake resulted in a higher CO2 response compared to low carbohydrate intake (F2,2569=24.23; P<.001), and users with high BMI showed modest responses to meals compared with low BMI (F2,2569=5.88; P=.003). Conclusions: In this study, we show that Lumen?s CO2 response is influenced both by macronutrient consumption and BMI. The results of this study highlight a distinct pattern of reduced metabolic flexibility in users with obesity, indicating the value of Lumen for assessing postprandial metabolic flexibility. UR - https://mhealth.jmir.org/2024/1/e56083 UR - http://dx.doi.org/10.2196/56083 UR - http://www.ncbi.nlm.nih.gov/pubmed/38439744 ID - info:doi/10.2196/56083 ER - TY - JOUR AU - Esumi, Ryo AU - Ito-Masui, Asami AU - Kawamoto, Eiji AU - Ito, Mami AU - Hayashi, Tomoyo AU - Shinkai, Toru AU - Hane, Atsuya AU - Okuno, Fumito AU - Park, Jeong Eun AU - Kaku, Ryuji AU - Shimaoka, Motomu PY - 2023/11/29 TI - Correlation Between the Social Network Structure and Well-Being of Health Care Workers in Intensive Care Units: Prospective Observational Study JO - Interact J Med Res SP - e50148 VL - 12 KW - social network analysis KW - Center for Epidemiological Studies?Depression KW - CES-D KW - distributed leadership KW - intensive care unit KW - wearable sensor KW - face-to-face interaction N2 - Background: Effective communication strategies are becoming increasingly important in intensive care units (ICUs) where patients at high risk are treated. Distributed leadership promotes effective communication among health care professionals (HCPs). Moreover, beyond facilitating patient care, it may improve well-being among HCPs by fostering teamwork. However, the impact of distributed leadership on the communication structure and well-being of HCPs remains unclear. Objective: We performed a social network analysis (SNA) to assess the characteristics of each HCP in the network, identify the number of HCP connections, analyze 4 centralities that can measure an HCP?s importance, and evaluate the impact of distributed leadership structure on the well-being and communication structure of the medical staff. Methods: Wearable sensors were used to obtain face-to-face interaction data from the ICU medical staff at Mie University Hospital, Japan. Participants wore a badge on the front of their clothing during working hours to measure the total frequency of face-to-face interactions. We collected data about the well-being of medical staff using the Center for Epidemiological Studies?Depression (CES-D) questionnaire and measured 4 centralities using SNA analysis. A CES-D questionnaire was administered during the study to measure the well-being of the HCPs. Results: Overall, 247 ICU workers participated in this clinical study for 4 weeks yearly in February 2016, 2017, and 2018. The distributed leadership structure was established within the ICU in 2017 and 2018. We compared these results with those of the traditional leadership structure used in 2016. Most face-to-face interactions in the ICU were among nurses or between nurses and other professionals. In 2016, overall, 10 nurses could perform leadership tasks, which significantly increased to 24 in 2017 (P=.046) and 20 in 2018 (P=.046). Considering the increased number of nurses who could perform leadership duties and the collaboration created within the organization, SNA in 2018 showed that the betweenness (P=.001), degree (P<.001), and closeness (P<.001) centralities significantly increased compared with those in 2016. However, the eigenvector centrality significantly decreased in 2018 compared with that in 2016 (P=.01). The CES-D scores in 2018 also significantly decreased compared with those in 2016 (P=.01). The betweenness (r=0.269; P=.02), degree (r=0.262; P=.03), and eigenvector (r=0.261; P=.03) centralities and CES-D scores were positively correlated in 2016, whereas the closeness centrality and CES-D scores were negatively correlated (r=?0.318; P=.01). In 2018, the degree (r=?0.280; P=.01) and eigenvector (r=?0.284; P=.01) centralities were negatively correlated with CES-D scores. Conclusions: Face-to-face interactions of HCPs in the ICU were measured using wearable sensors, and nurses were found to be centrally located. However, the introduction of distributed leadership created collaboration and informal leadership in the organization, altering the social network structure of HCPs and increasing organizational well-being. Trial Registration: University Hospital Medical Information Network (UMIN) UMIN000037046; https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000042211 UR - https://www.i-jmr.org/2023/1/e50148 UR - http://dx.doi.org/10.2196/50148 UR - http://www.ncbi.nlm.nih.gov/pubmed/37935050 ID - info:doi/10.2196/50148 ER - TY - JOUR AU - Hodgson, William AU - Kirk, Alison AU - Lennon, Marilyn AU - Janssen, Xanne AU - Russell, Eilidh AU - Wani, Carolina AU - Eskandarani, Dina PY - 2023/11/13 TI - RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) Evaluation of the Use of Activity Trackers in the Clinical Care of Adults Diagnosed With a Chronic Disease: Integrative Systematic Review JO - J Med Internet Res SP - e44919 VL - 25 KW - activity trackers KW - clinical care KW - physical activity KW - sedentary behavior KW - adults KW - chronic diseases KW - Reach, Effectiveness, Adoption, Implementation, and Maintenance KW - RE-AIM KW - mortality KW - sedentary lifestyle KW - intervention KW - mobile phone N2 - Background: Chronic diseases are a leading cause of adult mortality, accounting for 41 million deaths globally each year. Low levels of physical activity and sedentary behavior are major risk factors for adults to develop a chronic disease. Physical activity interventions can help support patients in clinical care to be more active. Commercial activity trackers that can measure daily steps, physical activity intensity, sedentary behavior, and distance moved are being more frequently used within health-related interventions. The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a planning and evaluation approach to explore the reach, effectiveness, adoption, implementation, and maintenance of interventions. Objective: The objective of this study is to conduct an integrative systematic review and report the 5 main RE-AIM dimensions in interventions that used activity trackers in clinical care to improve physical activity or reduce sedentary behavior in adults diagnosed with chronic diseases. Methods: A search strategy and study protocol were developed and registered on the PROSPERO platform. Inclusion criteria included adults (18 years and older) diagnosed with a chronic disease and have used an activity tracker within their clinical care. Searches of 10 databases and gray literature were conducted, and qualitative, quantitative, and mixed methods studies were included. Screening was undertaken by more than 1 researcher to reduce the risk of bias. After screening, the final studies were analyzed using a RE-AIM framework data extraction evaluation tool. This tool assisted in identifying the 28 RE-AIM indicators within the studies and linked them to the 5 main RE-AIM dimensions. Results: The initial search identified 4585 potential studies. After a title and abstract review followed by full-text screening, 15 studies were identified for data extraction. The analysis of the extracted data found that the RE-AIM dimensions of adoption (n=1, 7% of studies) and maintenance (n=2, 13% of studies) were underreported. The use of qualitative thematic analysis to understand the individual RE-AIM dimensions was also underreported and only used in 3 of the studies. Two studies used qualitative analysis to explore the effectiveness of the project, while 1 study used thematic analysis to understand the implementation of an intervention. Conclusions: Further research is required in the use of activity trackers to support patients to lead a more active lifestyle. Such studies should consider using the RE-AIM framework at the planning stage with a greater focus on the dimensions of adoption and maintenance and using qualitative methods to understand the main RE-AIM dimensions within their design. These results should form the basis for establishing long-term interventions in clinical care. Trial Registration: PROSPERO CRD42022319635; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=319635 UR - https://www.jmir.org/2023/1/e44919 UR - http://dx.doi.org/10.2196/44919 UR - http://www.ncbi.nlm.nih.gov/pubmed/37955960 ID - info:doi/10.2196/44919 ER - TY - JOUR AU - Pyper, Evelyn AU - McKeown, Sarah AU - Hartmann-Boyce, Jamie AU - Powell, John PY - 2023/10/11 TI - Digital Health Technology for Real-World Clinical Outcome Measurement Using Patient-Generated Data: Systematic Scoping Review JO - J Med Internet Res SP - e46992 VL - 25 KW - real-world evidence KW - real-world data KW - digital tools KW - digital health KW - digital biomarkers KW - patient-generated health data KW - mobile health KW - mHealth KW - wearables KW - digital health management KW - clinical intervention KW - electronic health record KW - health outcomes KW - mobile phone N2 - Background: Digital health technologies (DHTs) play an ever-expanding role in health care management and delivery. Beyond their use as interventions, DHTs also serve as a vehicle for real-world data collection to characterize patients, their care journeys, and their responses to other clinical interventions. There is a need to comprehensively map the evidence?across all conditions and technology types?on DHT measurement of patient outcomes in the real world. Objective: We aimed to investigate the use of DHTs to measure real-world clinical outcomes using patient-generated data. Methods: We conducted this systematic scoping review in accordance with the Joanna Briggs Institute methodology. Detailed eligibility criteria documented in a preregistered protocol informed a search strategy for the following databases: MEDLINE (Ovid), CINAHL, Cochrane (CENTRAL), Embase, PsycINFO, ClinicalTrials.gov, and the EU Clinical Trials Register. We considered studies published between 2000 and 2022 wherein digital health data were collected, passively or actively, from patients with any specified health condition outside of clinical visits. Categories for key concepts, such as DHT type and analytical applications, were established where needed. Following screening and full-text review, data were extracted and analyzed using predefined fields, and findings were reported in accordance with established guidelines. Results: The search strategy identified 11,015 publications, with 7308 records after duplicates and reviews were removed. After screening and full-text review, 510 studies were included for extraction. These studies encompassed 169 different conditions in over 20 therapeutic areas and 44 countries. The DHTs used for mental health and addictions research (111/510, 21.8%) were the most prevalent. The most common type of DHT, mobile apps, was observed in approximately half of the studies (250/510, 49%). Most studies used only 1 DHT (346/510, 67.8%); however, the majority of technologies used were able to collect more than 1 type of data, with the most common being physiological data (189/510, 37.1%), clinical symptoms data (188/510, 36.9%), and behavioral data (171/510, 33.5%). Overall, there has been real growth in the depth and breadth of evidence, number of DHT types, and use of artificial intelligence and advanced analytics over time. Conclusions: This scoping review offers a comprehensive view of the variety of types of technology, data, collection methods, analytical approaches, and therapeutic applications within this growing body of evidence. To unlock the full potential of DHT for measuring health outcomes and capturing digital biomarkers, there is a need for more rigorous research that goes beyond technology validation to demonstrate whether robust real-world data can be reliably captured from patients in their daily life and whether its capture improves patient outcomes. This study provides a valuable repository of DHT studies to inform subsequent research by health care providers, policy makers, and the life sciences industry. Trial Registration: Open Science Framework 5TMKY; https://osf.io/5tmky/ UR - https://www.jmir.org/2023/1/e46992 UR - http://dx.doi.org/10.2196/46992 UR - http://www.ncbi.nlm.nih.gov/pubmed/37819698 ID - info:doi/10.2196/46992 ER - TY - JOUR AU - Camp, Nicola AU - Johnston, Julie AU - Lewis, C. Martin G. AU - Zecca, Massimiliano AU - Di Nuovo, Alessandro AU - Hunter, Kirsty AU - Magistro, Daniele PY - 2022/5/5 TI - Perceptions of In-home Monitoring Technology for Activities of Daily Living: Semistructured Interview Study With Community-Dwelling Older Adults JO - JMIR Aging SP - e33714 VL - 5 IS - 2 KW - aging KW - wearable sensors KW - environmental sensors KW - social robots KW - activities of daily living KW - older adults KW - elderly KW - robots KW - wearables N2 - Background: Many older adults prefer to remain in their own homes for as long as possible. However, there are still questions surrounding how best to ensure that an individual can cope with autonomous living. Technological monitoring systems are an attractive solution; however, there is disagreement regarding activities of daily living (ADL) and the optimal technologies that should be used to monitor them. Objective: This study aimed to understand older adults? perceptions of important ADL and the types of technologies they would be willing to use within their own homes. Methods: Semistructured interviews were conducted on the web with 32 UK adults, divided equally into a younger group (aged 55-69 years) and an older group (?70 years). Results: Both groups agreed that ADL related to personal hygiene and feeding were the most important and highlighted the value of socializing. The older group considered several activities to be more important than their younger counterparts, including stair use and foot care. The older group had less existing knowledge of monitoring technology but was more willing to accept wearable sensors than the younger group. The younger group preferred sensors placed within the home but highlighted that they would not have them until they felt that daily life was becoming a struggle. Conclusions: Overall, technological monitoring systems were perceived as an acceptable method for monitoring ADL. However, developers and carers must be aware that individuals may express differences in their willingness to engage with certain types of technology depending on their age and circumstances. UR - https://aging.jmir.org/2022/2/e33714 UR - http://dx.doi.org/10.2196/33714 UR - http://www.ncbi.nlm.nih.gov/pubmed/35511248 ID - info:doi/10.2196/33714 ER - TY - JOUR AU - Ye, Jiancheng AU - Wang, Zidan AU - Hai, Jiarui PY - 2022/4/29 TI - Social Networking Service, Patient-Generated Health Data, and Population Health Informatics: National Cross-sectional Study of Patterns and Implications of Leveraging Digital Technologies to Support Mental Health and Well-being JO - J Med Internet Res SP - e30898 VL - 24 IS - 4 KW - patient-generated health data KW - social network KW - population health informatics KW - mental health KW - social determinants of health KW - health data sharing KW - technology acceptability KW - mobile phone KW - mobile health N2 - Background: The emerging health technologies and digital services provide effective ways of collecting health information and gathering patient-generated health data (PGHD), which provide a more holistic view of a patient?s health and quality of life over time, increase visibility into a patient?s adherence to a treatment plan or study protocol, and enable timely intervention before a costly care episode. Objective: Through a national cross-sectional survey in the United States, we aimed to describe and compare the characteristics of populations with and without mental health issues (depression or anxiety disorders), including physical health, sleep, and alcohol use. We also examined the patterns of social networking service use, PGHD, and attitudes toward health information sharing and activities among the participants, which provided nationally representative estimates. Methods: We drew data from the 2019 Health Information National Trends Survey of the National Cancer Institute. The participants were divided into 2 groups according to mental health status. Then, we described and compared the characteristics of the social determinants of health, health status, sleeping and drinking behaviors, and patterns of social networking service use and health information data sharing between the 2 groups. Multivariable logistic regression models were applied to assess the predictors of mental health. All the analyses were weighted to provide nationally representative estimates. Results: Participants with mental health issues were significantly more likely to be younger, White, female, and lower-income; have a history of chronic diseases; and be less capable of taking care of their own health. Regarding behavioral health, they slept <6 hours on average, had worse sleep quality, and consumed more alcohol. In addition, they were more likely to visit and share health information on social networking sites, write online diary blogs, participate in online forums or support groups, and watch health-related videos. Conclusions: This study illustrates that individuals with mental health issues have inequitable social determinants of health, poor physical health, and poor behavioral health. However, they are more likely to use social networking platforms and services, share their health information, and actively engage with PGHD. Leveraging these digital technologies and services could be beneficial for developing tailored and effective strategies for self-monitoring and self-management. UR - https://www.jmir.org/2022/4/e30898 UR - http://dx.doi.org/10.2196/30898 UR - http://www.ncbi.nlm.nih.gov/pubmed/35486428 ID - info:doi/10.2196/30898 ER - TY - JOUR AU - Pilgrim, Katharina AU - Bohnet-Joschko, Sabine PY - 2022/2/21 TI - Effectiveness of Digital Forced-Choice Nudges for Voluntary Data Donation by Health Self-trackers in Germany: Web-Based Experiment JO - J Med Internet Res SP - e31363 VL - 24 IS - 2 KW - quantified self KW - health self-tracking KW - digital nudge KW - data donation KW - health data KW - mobile phone N2 - Background: Health self-tracking is an evidence-based approach to optimize health and well-being for personal self-improvement through lifestyle changes. At the same time, user-generated health-related data can be of particular value for (health care) research. As longitudinal data, these data can provide evidence for developing better and new medications, diagnosing rare diseases faster, or treating chronic diseases. Objective: This quantitative study aims to investigate the impact of digital forced-choice nudges on the willingness of German health self-trackers to donate self-tracked health-related data for research. This study contributes to the body of knowledge on the effectiveness of nonmonetary incentives. Our study enables a gender-specific statement on influencing factors on the voluntary donation of personal health data and, at the same time, on the effectiveness of digital forced-choice nudges within tracking apps. Methods: We implemented a digital experiment using a web-based questionnaire by graphical manipulation of the Runtastic tracking app interface. We asked 5 groups independently to indicate their willingness to donate tracked data for research. We used a digital forced-choice nudge via a pop-up window, which framed the data donation request with 4 different counter values. We generated the counter values according to the specific target group needs identified from the research literature. Results: A sample of 919 was generated, of which, 625 (68%) were women and 294 (32%) were men. By dividing the sample into male and female participants, we take into account research on gender differences in privacy tendencies on the web and offline, showing that female participants display higher privacy concerns than male participants. A statistical group comparison shows that with a small effect size (r=0.21), men are significantly more likely (P=.04) to donate their self-tracked data for research if the need to take on social responsibility is addressed (the prosocial counter value in this case?contributing to society) compared with the control group without counter value. Selfish or pseudoprosocial counter values had no significant effect on willingness to donate health data among male or female health self-trackers in Germany when presented as a forced-choice nudge within a tracking app. Conclusions: Although surveys regularly reveal an 80% to 95% willingness to donate data on average in the population, our results show that only 41% (377/919) of the health self-trackers would donate their self-collected health data to research. Although selfish motives do not significantly influence willingness to donate, linking data donation to added societal value could significantly increase the likelihood of donating among male self-trackers by 15.5%. Thus, addressing the need to contribute to society promotes the willingness to donate data among male health self-trackers. The implementation of forced-choice framing nudges within tracking apps presented in a pop-up window can add to the accessibility of user-generated health-related data for research. UR - https://www.jmir.org/2022/2/e31363 UR - http://dx.doi.org/10.2196/31363 UR - http://www.ncbi.nlm.nih.gov/pubmed/35188472 ID - info:doi/10.2196/31363 ER - TY - JOUR AU - Thivel, David AU - Corteval, Alice AU - Favreau, Jean-Marie AU - Bergeret, Emmanuel AU - Samalin, Ludovic AU - Costes, Frédéric AU - Toumani, Farouk AU - Dualé, Christian AU - Pereira, Bruno AU - Eschalier, Alain AU - Fearnbach, Nicole AU - Duclos, Martine AU - Tournadre, Anne PY - 2022/1/14 TI - Fine Detection of Human Motion During Activities of Daily Living as a Clinical Indicator for the Detection and Early Treatment of Chronic Diseases: The E-Mob Project JO - J Med Internet Res SP - e32362 VL - 24 IS - 1 KW - indicator KW - fine body motion KW - movement behaviors KW - decomposition KW - structuration KW - sequencing UR - https://www.jmir.org/2022/1/e32362 UR - http://dx.doi.org/10.2196/32362 UR - http://www.ncbi.nlm.nih.gov/pubmed/35029537 ID - info:doi/10.2196/32362 ER - TY - JOUR AU - Zhang, Yuankai AU - Pathiravasan, H. Chathurangi AU - Hammond, M. Michael AU - Liu, Hongshan AU - Lin, Honghuang AU - Sardana, Mayank AU - Trinquart, Ludovic AU - Borrelli, Belinda AU - Manders, S. Emily AU - Kornej, Jelena AU - Spartano, L. Nicole AU - Nowak, Christopher AU - Kheterpal, Vik AU - Benjamin, J. Emelia AU - McManus, D. David AU - Murabito, M. Joanne AU - Liu, Chunyu PY - 2022/1/7 TI - Comparison of Daily Routines Between Middle-aged and Older Participants With and Those Without Diabetes in the Electronic Framingham Heart Study: Cohort Study JO - JMIR Diabetes SP - e29107 VL - 7 IS - 1 KW - diabetes KW - mobile health KW - smartwatch KW - daily physical activities KW - daily routine pattern KW - sleep KW - step counts KW - diabetes self-management KW - mobile phone N2 - Background: Daily routines (eg, physical activity and sleep patterns) are important for diabetes self-management. Traditional research methods are not optimal for documenting long-term daily routine patterns in participants with glycemic conditions. Mobile health offers an effective approach for collecting users? long-term daily activities and analyzing their daily routine patterns in relation to diabetes status. Objective: This study aims to understand how routines function in diabetes self-management. We evaluate the associations of daily routine variables derived from a smartwatch with diabetes status in the electronic Framingham Heart Study (eFHS). Methods: The eFHS enrolled the Framingham Heart Study participants at health examination 3 between 2016 and 2019. At baseline, diabetes was defined as fasting blood glucose level ?126 mg/dL or as a self-report of taking a glucose-lowering medication; prediabetes was defined as fasting blood glucose level of 100-125 mg/dL. Using smartwatch data, we calculated the average daily step counts and estimated the wake-up times and bedtimes for the eFHS participants on a given day. We compared the average daily step counts and the intraindividual variability of the wake-up times and bedtimes of the participants with diabetes and prediabetes with those of the referents who were neither diabetic nor prediabetic, adjusting for age, sex, and race or ethnicity. Results: We included 796 participants (494/796, 62.1% women; mean age 52.8, SD 8.7 years) who wore a smartwatch for at least 10 hours/day and remained in the study for at least 30 days after enrollment. On average, participants with diabetes (41/796, 5.2%) took 1611 fewer daily steps (95% CI 863-2360; P<.001) and had 12 more minutes (95% CI 6-18; P<.001) in the variation of their estimated wake-up times, 6 more minutes (95% CI 2-9; P=.005) in the variation of their estimated bedtimes compared with the referents (546/796, 68.6%) without diabetes or prediabetes. Participants with prediabetes (209/796, 26.2%) also walked fewer daily steps (P=.04) and had a larger variation in their estimated wake-up times (P=.04) compared with the referents. Conclusions: On average, participants with diabetes at baseline walked significantly fewer daily steps and had larger variations in their wake-up times and bedtimes than the referent group. These findings suggest that modifying the routines of participants with poor glycemic health may be an important approach to the self-management of diabetes. Future studies should be designed to improve the remote monitoring and self-management of diabetes. UR - https://diabetes.jmir.org/2022/1/e29107 UR - http://dx.doi.org/10.2196/29107 UR - http://www.ncbi.nlm.nih.gov/pubmed/34994694 ID - info:doi/10.2196/29107 ER - TY - JOUR AU - Kim, Ben AU - Ghasemi, Peyman AU - Stolee, Paul AU - Lee, Joon PY - 2021/11/5 TI - Clinicians and Older Adults? Perceptions of the Utility of Patient-Generated Health Data in Caring for Older Adults: Exploratory Mixed Methods Study JO - JMIR Aging SP - e29788 VL - 4 IS - 4 KW - mobile health KW - mHealth KW - older adults KW - wearables KW - patient generated health data KW - chronic disease management KW - home care KW - self-care KW - activities of daily living KW - sleep N2 - Background: Many people are motivated to self-track their health and optimize their well-being through mobile health apps and wearable devices. The diversity and complexity of these systems have evolved over time, resulting in a large amount of data referred to as patient-generated health data (PGHD), which has recently emerged as a useful set of data elements in health care systems around the world. Despite the increased interest in PGHD, clinicians and older adults? perceptions of PGHD are poorly understood. In particular, although some clinician barriers to using PGHD have been identified, such as concerns about data quality, ease of use, reliability, privacy, and regulatory issues, little is known from the perspectives of older adults. Objective: This study aims to explore the similarities and differences in the perceptions of older adults and clinicians with regard to how various types of PGHD can be used to care for older adults. Methods: A mixed methods study was conducted to explore clinicians and older adults? perceptions of PGHD. Focus groups were conducted with older adults and health care providers from the Greater Toronto area and the Kitchener-Waterloo region. The participants were asked to discuss their perceptions of PGHD, including facilitators and barriers. A questionnaire aimed at exploring the perceived usefulness of a range of different PGHD was also embedded in the study design. Focus group interviews were transcribed for thematic analysis, whereas the questionnaire results were analyzed using descriptive statistics. Results: Of the 9 participants, 4 (44%) were clinicians (average age 38.3 years, SD 7 years), and 5 (56%) were older adults (average age 81.0 years, SD 9.1 years). Four main themes were identified from the focus group interviews: influence of PGHD on patient-provider trust, reliability of PGHD, meaningful use of PGHD and PGHD-based decision support systems, and perceived clinical benefits and intrusiveness of PGHD. The questionnaire results were significantly correlated with the frequency of PGHD mentioned in the focus group interviews (r=0.42; P=.03) and demonstrated that older adults and clinicians perceived blood glucose, step count, physical activity, sleep, blood pressure, and stress level as the most useful data for managing health and delivering high-quality care. Conclusions: This embedded mixed methods study generated several important findings about older adults and clinicians? perceptions and perceived usefulness of a range of PGHD. Owing to the exploratory nature of this study, further research is needed to understand the concerns about data privacy, potential negative impact on the trust between older adults and clinicians, data quality and quantity, and usability of PGHD-related technologies for older adults. UR - https://aging.jmir.org/2021/4/e29788 UR - http://dx.doi.org/10.2196/29788 UR - http://www.ncbi.nlm.nih.gov/pubmed/34738913 ID - info:doi/10.2196/29788 ER - TY - JOUR AU - Milton, Alyssa AU - Hambleton, Ashlea AU - Roberts, Anna AU - Davenport, Tracey AU - Flego, Anna AU - Burns, Jane AU - Hickie, Ian PY - 2021/11/4 TI - Body Image Distress and Its Associations From an International Sample of Men and Women Across the Adult Life Span: Web-Based Survey Study JO - JMIR Form Res SP - e25329 VL - 5 IS - 11 KW - body image KW - mental health KW - well-being KW - web-based survey KW - sex differences KW - age N2 - Background: Previous research on body image distress mainly relied on samples that were small, generally homogeneous in age or sex, often limited to one geographical region, and were characterized by a lack of comprehensive analysis of multiple psychosocial domains. The research presented in this paper extends the international literature using the results of the web-based Global Health and Wellbeing Survey 2015. The survey included a large sample of both men and women aged ?16 years from Australia, Canada, New Zealand, the United Kingdom, or the United States. Objective: The main objectives of this study are to examine body image distress across the adult life span (?16 years) and sex and assess the association between body image distress and various psychosocial risk and protective factors. Methods: Data were extracted from the Global Health and Wellbeing Survey 2015, a web-based international self-report survey with 10,765 respondents, and compared with previous web-based surveys conducted in 2009 and 2012. Results: The body image distress of young Australians (aged 16-25 years) significantly rose by 33% from 2009 to 2015. In 2015, 75.19% (961/1278) of 16- to 25-year-old adults reported body image distress worldwide, and a decline in body image distress was noted with increasing age. More women reported higher levels of body image distress than men (1953/3338, 58.51% vs 853/2175, 39.22%). Sex, age, current dieting status, perception of weight, psychological distress, alcohol and other substance misuse, and well-being significantly explained 24% of the variance in body image distress in a linear regression (F15,4966=105.8; P<.001). Conclusions: This study demonstrates the significant interplay between body image distress and psychosocial factors across age and sex. UR - https://formative.jmir.org/2021/11/e25329 UR - http://dx.doi.org/10.2196/25329 UR - http://www.ncbi.nlm.nih.gov/pubmed/34734831 ID - info:doi/10.2196/25329 ER - TY - JOUR AU - Pyatak, Ann Elizabeth AU - Hernandez, Raymond AU - Pham, T. Loree AU - Mehdiyeva, Khatira AU - Schneider, Stefan AU - Peters, Anne AU - Ruelas, Valerie AU - Crandall, Jill AU - Lee, Pey-Jiuan AU - Jin, Haomiao AU - Hoogendoorn, J. Claire AU - Crespo-Ramos, Gladys AU - Mendez-Rodriguez, Heidy AU - Harmel, Mark AU - Walker, Martha AU - Serafin-Dokhan, Sara AU - Gonzalez, S. Jeffrey AU - Spruijt-Metz, Donna PY - 2021/10/22 TI - Function and Emotion in Everyday Life With Type 1 Diabetes (FEEL-T1D): Protocol for a Fully Remote Intensive Longitudinal Study JO - JMIR Res Protoc SP - e30901 VL - 10 IS - 10 KW - ecological momentary assessments KW - type 1 diabetes KW - patient-centered outcomes research KW - actigraphy KW - ambulatory monitoring KW - continuous glucose monitoring KW - EMA KW - diabetes KW - patient-centered outcome KW - outcome KW - monitoring KW - function KW - emotion KW - longitudinal KW - well-being N2 - Background: Although short-term blood glucose levels and variability are thought to underlie diminished function and emotional well-being in people with type 1 diabetes (T1D), these relationships are poorly understood. The Function and Emotion in Everyday Life with T1D (FEEL-T1D) study focuses on investigating these short-term dynamic relationships among blood glucose levels, functional ability, and emotional well-being in adults with T1D. Objective: The aim of this study is to present the FEEL-T1D study design, methods, and study progress to date, including adaptations necessitated by the COVID-19 pandemic to implement the study fully remotely. Methods: The FEEL-T1D study will recruit 200 adults with T1D in the age range of 18-75 years. Data collection includes a comprehensive survey battery, along with 14 days of intensive longitudinal data using blinded continuous glucose monitoring, ecological momentary assessments, ambulatory cognitive tasks, and accelerometers. All study procedures are conducted remotely by mailing the study equipment and by using videoconferencing for study visits. Results: The study received institutional review board approval in January 2019 and was funded in April 2019. Data collection began in June 2020 and is projected to end in December 2021. As of June 2021, after 12 months of recruitment, 124 participants have enrolled in the FEEL-T1D study. Approximately 87.6% (7082/8087) of ecological momentary assessment surveys have been completed with minimal missing data, and 82.0% (82/100) of the participants provided concurrent continuous glucose monitoring data, ecological momentary assessment data, and accelerometer data for at least 10 of the 14 days of data collection. Conclusions: Thus far, our reconfiguration of the FEEL-T1D protocol to be implemented remotely during the COVID-19 pandemic has been a success. The FEEL-T1D study will elucidate the dynamic relationships among blood glucose levels, emotional well-being, cognitive function, and participation in daily activities. In doing so, it will pave the way for innovative just-in-time interventions and produce actionable insights to facilitate tailoring of diabetes treatments to optimize the function and well-being of individuals with T1D. International Registered Report Identifier (IRRID): DERR1-10.2196/30901 UR - https://www.researchprotocols.org/2021/10/e30901 UR - http://dx.doi.org/10.2196/30901 UR - http://www.ncbi.nlm.nih.gov/pubmed/34463626 ID - info:doi/10.2196/30901 ER - TY - JOUR AU - Phanareth, Klaus AU - Dam, Laura Astrid AU - Hansen, C. Martin A. B. AU - Lindskrog, Signe AU - Vingtoft, Sřren AU - Kayser, Lars PY - 2021/10/19 TI - Revealing the Nature of Chronic Obstructive Pulmonary Disease Using Self-tracking and Analysis of Contact Patterns: Longitudinal Study JO - J Med Internet Res SP - e22567 VL - 23 IS - 10 KW - COPD KW - exacerbations KW - patient-reported outcomes KW - Epital Care Model KW - early interventions N2 - Background: Chronic obstructive pulmonary disease (COPD) is the fourth leading cause of death and is characterized by a progressive loss of pulmonary function over time with intermittent episodes of exacerbations. Rapid and proactive interventions may reduce the burden of the condition for the patients. Telehealth solutions involving self-tracking of vital parameters such as pulmonary function, oxygen saturation, heart rate, and temperature with synchronous communication of health data may become a powerful solution as they enable health care professionals to react with a proactive and adequate response. We have taken this idea to the next level in the Epital Care Model and organized a person-centered technology-assisted ecosystem to provide health services to COPD patients. Objective: The objective is to reveal the nature of COPD by combining technology with a person-centered design aimed to benefit from interactions based on patient-reported outcome data and to assess the needed kind of contacts to best treat exacerbations. We wanted to know the following: (1) What are the incidences of mild, moderate, and severe exacerbations in a mixed population of COPD patients? (2) What are the courses of mild, moderate, and severe exacerbations? And (3) How is the activity and pattern of contacts with health professionals related to the participant conditions? Methods: Participants were recruited by convenience sampling from November 2013 to December 2015. The participants? sex, age, forced expiratory volume during the first second, pulse rate, and oxygen saturation were registered at entry. During the study, we registered number of days, number of exacerbations, and number of contact notes coded into care and treatment notes. Each participant was classified according to GOLD I-IV and risk factor group A-D. Participants reported their clinical status using a tablet by answering 4 questions and sending 3 semiautomated measurements. Results: Of the 87 participants, 11 were in risk factor group A, 24 in B, 13 in C, and 39 in D. The number of observed days was 31,801 days with 12,470 measurements, 1397 care notes, and 1704 treatment notes. A total of 254 exacerbations were treated and only 18 caused hospitalization. Those in risk factor group D had the highest number of hospitalizations (16), exacerbations (151), and contacts (1910). The initial contacts during the first month declined within 3 months to one-third for care contacts and one-half for treatment contacts and reached a plateau after 4 months. Conclusions: The majority of COPD patients in risk factor group D can be managed virtually, and only 13% of those with severe exacerbations required hospitalization. Contact to the health care professionals decreases markedly within the first months after enrollment. These results provide a new and detailed insight into the course of COPD. We propose a resilience index for virtual clinical management making it easier to compare results across settings. UR - https://www.jmir.org/2021/10/e22567 UR - http://dx.doi.org/10.2196/22567 UR - http://www.ncbi.nlm.nih.gov/pubmed/34665151 ID - info:doi/10.2196/22567 ER - TY - JOUR AU - Feng, Shan AU - Mäntymäki, Matti AU - Dhir, Amandeep AU - Salmela, Hannu PY - 2021/9/21 TI - How Self-tracking and the Quantified Self Promote Health and Well-being: Systematic Review JO - J Med Internet Res SP - e25171 VL - 23 IS - 9 KW - self-tracking KW - quantified self KW - health KW - well-being KW - systematic literature review KW - literature review N2 - Background: Self-tracking technologies are widely used in people?s daily lives and health care. Academic research on self-tracking and the quantified self has also accumulated rapidly in recent years. Surprisingly, there is a paucity of research that reviews, classifies, and synthesizes the state of the art with respect to self-tracking and the quantified self. Objective: Our objective was to identify the state of the art of self-tracking and the quantified self in terms of health and well-being. Methods: We have undertaken a systematic literature review on self-tracking and the quantified self in promoting health and well-being. After a rigorous literature search, followed by inclusions, exclusions, and the application of article quality assessment protocols, 67 empirical studies qualified for the review. Results: Our results demonstrate that prior research has focused on 3 stakeholders with respect to self-tracking and the quantified self, namely end users, patients and people with illnesses, and health care professionals and caregivers. We used these stakeholder groups to cluster the research themes of the reviewed studies. We identified 11 research themes. There are 6 themes under the end-user cluster: user motivation and goal setting, usage and effects of self-tracking, continuance intention and long-term usage, management of personal data, rejection and discontinuance, and user characteristics. The patient and people with illnesses cluster contains three themes: usage experience of patients and people with illnesses, management of patient-generated data, and advantages and disadvantages in the clinical context. The health care professional and caregiver cluster contains two themes: collaboration among patients, health care professionals, and caregivers, and changes in the roles of patients and professionals. Moreover, we classified the future research suggestions given in the literature into 5 directions in terms of research designs and research topics. Finally, based on our reflections on the observations from the review, we suggest four future research directions: (1) users? cognitions and emotions related to processing and interpreting the information produced by tracking devices and apps; (2) the dark side of self-tracking (eg, its adverse psychosocial consequences); (3) self-tracking as a societal phenomenon; and (4) systemic impacts of self-tracking on health care and the actors involved. Conclusions: This systematic literature review contributes to research and practice by assisting future research activities and providing practitioners with a concise overview of the state of the art of self-tracking and the quantified self. UR - https://www.jmir.org/2021/9/e25171 UR - http://dx.doi.org/10.2196/25171 UR - http://www.ncbi.nlm.nih.gov/pubmed/34546176 ID - info:doi/10.2196/25171 ER - TY - JOUR AU - Greshake Tzovaras, Bastian AU - Senabre Hidalgo, Enric AU - Alexiou, Karolina AU - Baldy, Lukaz AU - Morane, Basile AU - Bussod, Ilona AU - Fribourg, Melvin AU - Wac, Katarzyna AU - Wolf, Gary AU - Ball, Mad PY - 2021/9/10 TI - Using an Individual-Centered Approach to Gain Insights From Wearable Data in the Quantified Flu Platform: Netnography Study JO - J Med Internet Res SP - e28116 VL - 23 IS - 9 KW - symptom tracking KW - COVID-19 KW - wearable devices KW - self-tracking KW - citizen science KW - netnographic analysis KW - cocreation N2 - Background: Wearables have been used widely for monitoring health in general, and recent research results show that they can be used to predict infections based on physiological symptoms. To date, evidence has been generated in large, population-based settings. In contrast, the Quantified Self and Personal Science communities are composed of people who are interested in learning about themselves individually by using their own data, which are often gathered via wearable devices. Objective: This study aims to explore how a cocreation process involving a heterogeneous community of personal science practitioners can develop a collective self-tracking system for monitoring symptoms of infection alongside wearable sensor data. Methods: We engaged in a cocreation and design process with an existing community of personal science practitioners to jointly develop a working prototype of a web-based tool for symptom tracking. In addition to the iterative creation of the prototype (started on March 16, 2020), we performed a netnographic analysis to investigate the process of how this prototype was created in a decentralized and iterative fashion. Results: The Quantified Flu prototype allowed users to perform daily symptom reporting and was capable of presenting symptom reports on a timeline together with resting heart rates, body temperature data, and respiratory rates measured by wearable devices. We observed a high level of engagement; over half of the users (52/92, 56%) who engaged in symptom tracking became regular users and reported over 3 months of data each. Furthermore, our netnographic analysis highlighted how the current Quantified Flu prototype was a result of an iterative and continuous cocreation process in which new prototype releases sparked further discussions of features and vice versa. Conclusions: As shown by the high level of user engagement and iterative development process, an open cocreation process can be successfully used to develop a tool that is tailored to individual needs, thereby decreasing dropout rates. UR - https://www.jmir.org/2021/9/e28116 UR - http://dx.doi.org/10.2196/28116 UR - http://www.ncbi.nlm.nih.gov/pubmed/34505836 ID - info:doi/10.2196/28116 ER - TY - JOUR AU - Costanza, Alessandra AU - Chytas, Vasileios AU - Piguet, Valérie AU - Luthy, Christophe AU - Mazzola, Viridiana AU - Bondolfi, Guido AU - Cedraschi, Christine PY - 2021/6/4 TI - Meaning in Life Among Patients With Chronic Pain and Suicidal Ideation: Mixed Methods Study JO - JMIR Form Res SP - e29365 VL - 5 IS - 6 KW - suicide KW - suicidal behavior KW - suicidal ideation KW - suicide attempt KW - chronic pain KW - meaning in life KW - protective factors KW - risk factors KW - mental health N2 - Background: Patients with chronic pain have elevated risk of suicidal ideation and behavior, including suicide attempts and completed suicides. In most studies, associations between chronic pain and suicidal ideation/suicidal behavior are robust even after adjusting for the effect of sociodemographics and psychiatric comorbidity. However, to refine the risk profile of these patients, further exploration of other possible risk and protective factors is necessary. Objective: There is a common clinical observation that experiencing chronic pain often requires a revision of life goals and expectations, and hence, it impacts the existential domain including one?s perception of the meaning in life (MiL). This study aimed to characterize the main domains that constitute the personal MiL, including the ?presence of? and ?search for? constructs, in a group of patients with chronic pain and suicidal ideation. Methods: Seventy participants were enlisted by ongoing recruitment through a larger project anchored in daily clinical practice at the Multidisciplinary Pain Center of the Geneva University Hospitals. It was an observational mixed method study. Data were recorded through both validated quantitative questionnaires and qualitative open-ended questions. Results: The total sample consisted of 70 patients. Responses to questionnaires showed a depressive episode in 68 (97%) patients and anxious disorders in 25 (36%) patients. With a score threshold for positive MiL of 24, the mean score for the ?presence of? construct was 20.13 (SD 8.23), and 63% (44/70) of respondents had a score <24. The mean score for the ?search for? construct was lower at 18.14 (SD 8.64), and 70% (49/70) of respondents had a score <24. The ?presence of? and ?search for? constructs were significantly positively correlated (R=0.402; P=.001). An open question addressed the ?presence of? construct by inviting the respondents to cite domains they consider as providing meaning in their life at the present time. All patients responded to this question, citing one or more domains. The three main dimensions that emerged from content analysis of this qualitative section were as follows: the domain of relationships, the domain of personal activities, and pain and its consequences on MiL. Conclusions: The study results provide insights into patients with chronic pain and suicidal ideation, including the domains that provide them with meaning in their lives and the impact of pain on these domains with regard to suicidal ideation. The main clinical implications concern both prevention and supportive/psychotherapeutic interventions. They are based on a narrative approach aiming to explore with the patients the content of their suffering and the MiL domains that they could identify to mitigate it, in order to restructure/reinforce these domains and thus possibly reduce suicidal ideation. Specifically, a focus on maintaining the domains of interpersonal relationships and personal activities can allow patients to ultimately escape the biopsychosocial vicious cycle of chronic pain?induced deep moral suffering. UR - https://formative.jmir.org/2021/6/e29365 UR - http://dx.doi.org/10.2196/29365 UR - http://www.ncbi.nlm.nih.gov/pubmed/34003136 ID - info:doi/10.2196/29365 ER - TY - JOUR AU - Lorenz, Arnold Kent AU - Yeshurun, Shlomo AU - Aziz, Richard AU - Ortiz-Delatorre, Julissa AU - Bagley, Robert James AU - Mor, Merav AU - Kern, Marialice PY - 2021/5/17 TI - A Handheld Metabolic Device (Lumen) to Measure Fuel Utilization in Healthy Young Adults: Device Validation Study JO - Interact J Med Res SP - e25371 VL - 10 IS - 2 KW - resting metabolic rate KW - Lumen KW - ParvoMedics TrueOne 2400 KW - validation KW - respiratory exchange ratio KW - metabolism KW - fuel utilization KW - indirect calorimetry KW - breath KW - lung KW - respiratory KW - young adult KW - measurement KW - testing N2 - Background: Metabolic carts measure the carbon dioxide (CO2) produced and oxygen consumed by an individual when breathing to assess metabolic fuel usage (carbohydrates versus fats). However, these systems are expensive, time-consuming, and only available in health care laboratory settings. A small handheld device capable of determining metabolic fuel usage via CO2 from exhaled air has been developed. Objective: The aim of this study is to evaluate the validity of a novel handheld device (Lumen) for measuring metabolic fuel utilization in healthy young adults. Methods: Metabolic fuel usage was assessed in healthy participants (n=33; mean age 23.1 years, SD 3.9 years) via respiratory exchange ratio (RER) values obtained from a metabolic cart as well as % CO2 from the Lumen device. Measurements were performed at rest in two conditions: fasting, and after consuming 150 grams of glucose, in order to determine changes in metabolic fuel usage. Reduced major axis regression and simple linear regression were performed to test for agreement between RER and Lumen % CO2. Results: Both RER and Lumen % CO2 significantly increased after glucose intake (P<.001 for both) compared with fasting conditions, by 0.089 and 0.28, respectively. Regression analyses revealed an agreement between the two measurements (F1,63=18.54; P<.001). Conclusions: This study shows the validity of Lumen for detecting changes in metabolic fuel utilization in a comparable manner with a laboratory standard metabolic cart, providing the ability for real-time metabolic information for users under any circumstances. UR - https://www.i-jmr.org/2021/2/e25371 UR - http://dx.doi.org/10.2196/25371 UR - http://www.ncbi.nlm.nih.gov/pubmed/33870899 ID - info:doi/10.2196/25371 ER - TY - JOUR AU - Fahey, C. Margaret AU - Klesges, C. Robert AU - Kocak, Mehmet AU - Gladney, A. Leslie AU - Talcott, W. Gerald AU - Krukowski, A. Rebecca PY - 2021/5/5 TI - Counselor Efficiency at Providing Feedback in a Technology-Based Behavioral Weight Loss Intervention: Longitudinal Analysis JO - JMIR Form Res SP - e23974 VL - 5 IS - 5 KW - technology-based intervention KW - counselor communication KW - counselor feedback KW - counselor KW - weight loss KW - lifestyle KW - wellness N2 - Background: Feedback for participants? self-monitoring is a crucial and costly component of technology-based weight loss interventions. Detailed examination of interventionist time when reviewing and providing feedback for online self-monitoring data is lacking. Objective: The aim of this study was to longitudinally examine the time counselors spent providing feedback on participant self-monitoring data (ie, diet, physical activity, weight) in a 12-month technology-based weight loss intervention. We hypothesized that counselors would compose feedback for participants more quickly over time. Methods: The time the lay counselors (N=10) spent reviewing self-monitoring records and providing feedback to participants via email was longitudinally examined for all counselors across the three years of study implementation. Descriptives were observed for counselor feedback duration across counselors by 12 annual quarters (ie, 3-month periods). Differences in overall duration times by each consecutive annual quarter were analyzed using Wilcoxon-Mann-Whitney tests. Results: There was a decrease in counselor feedback duration from the first to second quarter (mean 53 to 46 minutes; P<.001), and from the second to third (mean 46 to 30 minutes; P<.001). A trend suggested a decrease from the third to fourth quarter (mean 30 to 26 minutes; P=.053), but no changes were found in subsequent quarters. Consistent with the hypothesis, counselors may be increasing their efficiency in providing feedback; across 12 months, counselors spent less time reviewing participant self-monitoring and composing feedback (decreasing from mean 53 to 26 minutes). Conclusions: Counselors used increasingly less time to review online self-monitoring data and compose feedback after the initial 9 months of study implementation. Results inform counselor costs for future technology-based behavioral weight loss interventions. For example, regardless of increasing counselor efficiency, 25-30 minutes per feedback message is a high cost for interventions. One possibility for reducing costs would be generating computer-automated feedback. Trial Registration: ClinicalTrials.gov NCT02063178; https://clinicaltrials.gov/ct2/show/NCT02063178 UR - https://formative.jmir.org/2021/5/e23974 UR - http://dx.doi.org/10.2196/23974 UR - http://www.ncbi.nlm.nih.gov/pubmed/33949954 ID - info:doi/10.2196/23974 ER - TY - JOUR AU - Drijver, Josephine A. AU - Reijneveld, C. Jaap AU - Wesselman, P. Linda M. AU - Klein, Martin PY - 2021/4/26 TI - A Web-Based Lifestyle Intervention Aimed at Improving Cognition in Patients With Cancer Returning to Work in an Outpatient Setting: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e22670 VL - 10 IS - 4 KW - cancer KW - cognitive functioning KW - lifestyle KW - web-based intervention KW - RCT KW - cancer-related cognitive impairment N2 - Background: A high percentage of patients with cancer experience cognitive impairment after cancer treatment, resulting in a decreased health-related quality of life and difficulty returning to work. Consequently, there is a need for effective treatment options to improve cognitive functioning in these patients. In a healthy aging population, multidomain web-based lifestyle interventions have been found to be effective in preventing cognitive decline and improving cognitive functioning. Objective: This study aims to investigate the feasibility and effectiveness of the web-based lifestyle intervention Mijn Fitte Brein (My Fit Brain [MFB]) on cognitive functioning in patients with cancer returning to work. Methods: The study consists of a feasibility study (N=10), followed by a randomized controlled trial (RCT; N=220). Patients will be recruited by their occupational physicians after their return to work following cancer treatment. Mijn Fitte Brein is organized into 4-week cycles in which patients set a lifestyle goal using the Goal Attainment Scale, receive weekly tips and support, and finally evaluate whether they succeeded in achieving this goal. Lifestyle goals are based on 6 domains: physical exercise, diet, sleep, stress, alcohol use, and smoking. In the feasibility study, data on user experience (structured interview) and usability, assessed with the Post-Study System Usability Scale, will be collected and used to optimize Mijn Fitte Brein. In the RCT, patients will be randomized 1:1 between an intervention group and a control group. Patients will be assessed at baseline, 3 months, and 6 months. The primary outcome measure is subjective cognitive functioning, assessed with the Functional Assessment of Cancer Therapy?Cognitive Function (FACT-Cog). Secondary outcome measures are lifestyle, objective cognitive functioning, and work and psychosocial factors. Results: Recruitment for the feasibility study has started in February 2020. As of July 2020, however, no patients have been enrolled (due to COVID-19 restrictions). The findings of the feasibility study will be used to optimize the Mijn Fitte Brein intervention. Enrollment for the RCT will continue when possible. The feasibility study will take 6 months (including making adjustments to the intervention), and the RCT will take 2 years. The final results are expected in 2024. The results of the feasibility study and the RCT will be published in peer-reviewed journals. Conclusions: This is the first time the feasibility and efficacy of a multidomain web-based lifestyle intervention will be studied in patients with cancer. If Mijn Fitte Brein is found to be effective in decreasing cognitive complaints in these patients returning to work, it will be a promising treatment option because of being both affordable and accessible. Trial Registration: Netherlands Trial Register NL8407; https://www.trialregister.nl/trial/8407 International Registered Report Identifier (IRRID): DERR1-10.2196/22670 UR - https://www.researchprotocols.org/2021/4/e22670 UR - http://dx.doi.org/10.2196/22670 UR - http://www.ncbi.nlm.nih.gov/pubmed/33900201 ID - info:doi/10.2196/22670 ER - TY - JOUR AU - Smith, Cassandra AU - Lin, Xuzhu AU - Scott, David AU - Brennan-Speranza, C. Tara AU - Al Saedi, Ahmed AU - Moreno-Asso, Alba AU - Woessner, Mary AU - Bani Hassan, Ebrahim AU - Eynon, Nir AU - Duque, Gustavo AU - Levinger, Itamar PY - 2021/4/9 TI - Uncovering the Bone-Muscle Interaction and Its Implications for the Health and Function of Older Adults (the Wellderly Project): Protocol for a Randomized Controlled Crossover Trial JO - JMIR Res Protoc SP - e18777 VL - 10 IS - 4 KW - acute exercise KW - clinical trial KW - bone KW - adult KW - aging KW - osteocalcin KW - muscles KW - sarcopenia KW - progenitor cells KW - stem cells N2 - Background: Bone and muscle are closely linked anatomically, biochemically, and metabolically. Acute exercise affects both bone and muscle, implying a crosstalk between the two systems. However, how these two systems communicate is still largely unknown. We will explore the role of undercarboxylated osteocalcin (ucOC) in this crosstalk. ucOC is involved in glucose metabolism and has a potential role in muscle maintenance and metabolism. Objective: The proposed trial will determine if circulating ucOC levels in older adults at baseline and following acute exercise are associated with parameters of muscle function and if the ucOC response to exercise varies between older adults with low muscle quality and those with normal or high muscle quality. Methods: A total of 54 men and women aged 60 years or older with no history of diabetes and warfarin and vitamin K use will be recruited. Screening tests will be performed, including those for functional, anthropometric, and clinical presentation. On the basis of muscle quality, a combined equation of lean mass (leg appendicular skeletal muscle mass in kg) and strength (leg press; one-repetition maximum), participants will be stratified into a high or low muscle function group and randomized into the controlled crossover acute intervention. Three visits will be performed approximately 7 days apart, and acute aerobic exercise, acute resistance exercise, and a control session (rest) will be completed in any order. Our primary outcome for this study is the effect of acute exercise on ucOC in older adults with low muscle function and those with high muscle function. Results: The trial is active and ongoing. Recruitment began in February 2018, and 38 participants have completed the study as of May 26, 2019. Conclusions: This study will provide novel insights into bone and muscle crosstalk in older adults, potentially identifying new clinical biomarkers and mechanistic targets for drug treatments for sarcopenia and other related musculoskeletal conditions. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12618001756213; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=375925. International Registered Report Identifier (IRRID): DERR1-10.2196/18777 UR - https://www.researchprotocols.org/2021/4/e18777 UR - http://dx.doi.org/10.2196/18777 UR - http://www.ncbi.nlm.nih.gov/pubmed/33835038 ID - info:doi/10.2196/18777 ER - TY - JOUR AU - Asikainen, Henna AU - Katajavuori, Nina PY - 2021/3/9 TI - Development of a Web-Based Intervention Course to Promote Students? Well-Being and Studying in Universities: Protocol for an Experimental Study Design JO - JMIR Res Protoc SP - e23613 VL - 10 IS - 3 KW - approaches to learning KW - psychological flexibility KW - well-being KW - online intervention tool KW - peer support KW - reflection N2 - Background: The decline in the well-being among university students well as increasing dropouts has become a serious issue in universities around the world. Thus, effective ways to support students? well-being and their ability to study are highly needed. Objective: The purpose of this study was to build an intervention course for university students, which promotes both students? well-being as well as their learning and study skills, and to describe the experimental study design that explores the effects of this intervention course. Methods: Research has shown that psychological flexibility has a great effect on the well-being as well as the study skills of students pursuing higher education. The basis of our intervention course was to promote psychological flexibility and students? study skills with the help of peer support and reflection. Results: This course was offered as a voluntary course to all the students at the University of Helsinki twice during the academic year 2020-2021. The first course was from October to December and the second course was from January to March. This course was advertised in fall 2020 through social media and by different student organizations and program leaders at different faculties of the University of Helsinki. As of October 2020, we enrolled 566 students comprising 310 students for the course in fall 2020 and 256 students for the course in spring 2021. Of the 256 students who enrolled in the second course, 170 students voluntarily participated in this study and they answered the questionnaires, including all the measures, simultaneously with the participants in the first group and thus served as the control group. The effect of this course will be measured with multiple data, including questionnaire data, reflective journals, and physiological data of well-being with a longitudinal experimental design. This research very strictly follows the ethical guidelines drawn up by the Finnish National Board on Research Integrity. We expect to publish the results of this study in fall 2021 at the latest. Conclusions: We argue that a web-based, 8-week intervention course, which promotes both student well-being and their study skills, is a good way to support students pursuing higher education, and both aspects should be considered when supporting university students. International Registered Report Identifier (IRRID): DERR1-10.2196/23613 UR - https://www.researchprotocols.org/2021/3/e23613 UR - http://dx.doi.org/10.2196/23613 UR - http://www.ncbi.nlm.nih.gov/pubmed/33687336 ID - info:doi/10.2196/23613 ER - TY - JOUR AU - Heidary, Zahra AU - Cochran, M. Jeffrey AU - Peters-Strickland, Timothy AU - Knights, Jonathan PY - 2021/3/2 TI - A Rest Quality Metric Using a Cluster-Based Analysis of Accelerometer Data and Correlation With Digital Medicine Ingestion Data: Algorithm Development JO - JMIR Form Res SP - e17993 VL - 5 IS - 3 KW - serious mental illness KW - rest quality KW - actimetry KW - behavioral health KW - digital medicine KW - accelerometer KW - medication adherence N2 - Background: Adherence to medication regimens and patient rest are two important factors in the well-being of patients with serious mental illness. Both of these behaviors are traditionally difficult to record objectively in unsupervised populations. Objective: A digital medicine system that provides objective time-stamped medication ingestion records was used by patients with serious mental illness. Accelerometer data from the digital medicine system was used to assess rest quality and thus allow for investigation into correlations between rest and medication ingestion. Methods: Longest daily rest periods were identified and then evaluated using a k-means clustering algorithm and distance metric to quantify the relative quality of patient rest during these periods. This accelerometer-derived quality-of-rest metric, along with other accepted metrics of rest quality, such as duration and start time of the longest rest periods, was compared to the objective medication ingestion records. Overall medication adherence classification based on rest features was not performed due to a lack of patients with poor adherence in the sample population. Results: Explorations of the relationship between these rest metrics and ingestion did seem to indicate that patients with poor adherence experienced relatively low quality of rest; however, patients with better adherence did not necessarily exhibit consistent rest quality. This sample did not contain sufficient patients with poor adherence to draw more robust correlations between rest quality and ingestion behavior. The correlation of temporal outliers in these rest metrics with daily outliers in ingestion time was also explored. Conclusions: This result demonstrates the ability of digital medicine systems to quantify patient rest quality, providing a framework for further work to expand the participant population, compare these rest metrics to gold-standard sleep measurements, and correlate these digital medicine biomarkers with objective medication ingestion data. UR - https://formative.jmir.org/2021/3/e17993 UR - http://dx.doi.org/10.2196/17993 UR - http://www.ncbi.nlm.nih.gov/pubmed/33650981 ID - info:doi/10.2196/17993 ER - TY - JOUR AU - Hollander, B. Justin AU - Folta, C. Sara AU - Graves, Michelle Erin AU - Allen, D. Jennifer AU - Situ, Minyu PY - 2021/3/1 TI - A Fitness App for Monitoring Walking Behavior and Perception (Runkeeper): Mixed Methods Pilot Study JO - JMIR Form Res SP - e22571 VL - 5 IS - 3 KW - physical activity KW - smartphone KW - mobile app KW - sense of belongingness KW - community cohesion N2 - Background: Physical activity has a strong positive impact on both physical and mental health, and public health interventions often encourage walking as a means to promote physical activity. Social connectivity, such as that among spouses, families, friends, and colleagues, highly influences physical activity. Although technology-based interventions have some influence on human behavior, they have not been fully implemented and evaluated for their influence on walking through social connectivity. Objective: We aimed to pilot-test the organization of neighborhood walking clubs and use of a mobile app (Runkeeper) to encourage social connectedness and neighborhood cohesion, as well as to increase physical activity. Methods: We used a convenience sampling method to recruit 46 adults from an urban location in Greater Boston, Massachusetts. We assigned participants to teams based on their geographic location and neighborhood and required them to use the app (Runkeeper). Participants completed 2 self-administered web-based surveys before and after the intervention period. The surveys included standard measures to evaluate physical activity, social connectedness, perceived social support, and neighborhood cohesion (Buckner Neighborhood Cohesion Scale) before and after the intervention. Following the intervention, we randomly selected 14 participants to participate in postintervention, in-depth phone interviews to gain an understanding of their experiences. Results: This study was approved by the institutional review board in June 2018 and funded in January 2018. Recruitment started in May 2019 and lasted for 2 months. Data were collected from July 2019 to January 2020. In this study, Runkeeper was of limited feasibility as an app for measuring physical activity or promoting social connectedness. Data from the app recorded sparse and uneven walking behaviors among the participants. Qualitative interviews revealed that users experienced difficulties in using the settings and features of the app. In the questionnaire, there was no change between pre-post assessments in walking minutes (b=?.79; 95% CI ?4.0 to 2.4; P=.63) or miles (b=?.07; 95% CI ?0.15 to 0.01; P=.09). We observed a pre-post increase in social connectedness and a decrease in neighborhood cohesion. Both quantitative and qualitative results indicated that the psychosocial aspects of walking motivated the participants and helped them relieve stress. Interview results showed that participants felt a greater virtual connection in their assigned groups and enhanced connections with friends and family members. Conclusions: Our study found that Runkeeper created a virtual connection among walking group members and its data sharing and ranking motivated walking. Participants felt that walking improved their mental health, helped to relieve stress, and made them feel more connected with friends or family members. In future studies, it will be important to use an app that integrates with a wearable physical activity device. There is also a need to develop and test intervention components that might be more effective in fostering neighborhood cohesion. UR - https://formative.jmir.org/2021/3/e22571 UR - http://dx.doi.org/10.2196/22571 UR - http://www.ncbi.nlm.nih.gov/pubmed/33646132 ID - info:doi/10.2196/22571 ER - TY - JOUR AU - Gilson, D. Nicholas AU - Papinczak, E. Zoe AU - Mielke, Iven Gregore AU - Haslam, Catherine AU - Fooken, Jonas AU - McKenna, Jim AU - Brown, J. Wendy PY - 2021/2/24 TI - Effects of the Active Choices Program on Self-Managed Physical Activity and Social Connectedness in Australian Defence Force Veterans: Protocol for a Cluster-Randomized Trial JO - JMIR Res Protoc SP - e21911 VL - 10 IS - 2 KW - military service veterans KW - self-managed physical activity KW - behavioral support program KW - psychological well-being KW - social connectedness KW - health service utilization KW - health service costs KW - physical activity KW - well-being KW - health professional KW - veterans KW - behavioral KW - support program N2 - Background: A stepped-down program is one in which clients transition from the care of a health professional to self-managed care. Very little is known about the effectiveness of stepped-down physical activity (PA) programs for military service veterans. Objective: This study will test Active Choices, a stepped-down behavioral support program designed to help Australian Defence Force veterans and their dependents who are clients of the Department of Veterans? Affairs, transition from treatment by an exercise physiologist or physiotherapist to self-managed PA. Methods: The study is a parallel-group, randomized trial, with city-based exercise physiology or physiotherapy practices that recruit eligible Department of Veterans? Affairs clients assigned to Active Choices or a comparison program. The study aims to recruit 52 participants (26 in each group). The Active Choices program will consist of 2 face-to-face (Weeks 1, 12) and 2 telephone (Weeks 4 and 8) consultations. During these sessions, the participant and Active Choices consultant will utilize an evidence-based resource booklet to review the key benefits of an active lifestyle, build an action plan for PA preferences, set and review goals, self-monitor progress relative to set goals, and discuss strategies to overcome PA barriers. Linking participants to local PA communities to overcome social isolation will be a program priority. The comparison program will consist of 2 consultations (Weeks 1 and 12) and use fewer behavioral support strategies (education, self-monitoring, and action planning only) than Active Choices. Outcome measures will be administered at baseline, end-intervention (12 weeks), and follow-up (24 weeks) to assess changes in moderate intensity self-managed PA, psychological well-being, and social connectedness. We will also measure health service utilization and costs as well as PA choices across the intervention period. End-intervention interviews will capture participant experiences. Results: Due to the impacts of the COVID-19 pandemic on human research activities in Australia, participant recruitment will commence when it is safe and feasible to do so. Conclusions: Findings will provide valuable pilot data to support up-scaling of the program and larger effectiveness trials with regional and rural as well as city-based Australian Defence Force veterans and their dependents. Trial Registration: Australian and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12620000559910; https://www.anzctr.org.au/ACTRN12620000559910.aspx International Registered Report Identifier (IRRID): PRR1-10.2196/21911 UR - https://www.researchprotocols.org/2021/2/e21911 UR - http://dx.doi.org/10.2196/21911 UR - http://www.ncbi.nlm.nih.gov/pubmed/33625365 ID - info:doi/10.2196/21911 ER - TY - JOUR AU - Gustafson Sr, H. David AU - Mares, Marie-Louise AU - Johnston, C. Darcie AU - Mahoney, E. Jane AU - Brown, T. Randall AU - Landucci, Gina AU - Pe-Romashko, Klaren AU - Cody, J. Olivia AU - Gustafson Jr, H. David AU - Shah, V. Dhavan PY - 2021/2/19 TI - A Web-Based eHealth Intervention to Improve the Quality of Life of Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial JO - JMIR Res Protoc SP - e25175 VL - 10 IS - 2 KW - eHealth KW - telemedicine KW - aged KW - geriatrics KW - multiple chronic conditions KW - depression KW - social support KW - quality of life KW - primary care KW - health expenditures KW - mobile phone N2 - Background: Multiple chronic conditions (MCCs) are common among older adults and expensive to manage. Two-thirds of Medicare beneficiaries have multiple conditions (eg, diabetes and osteoarthritis) and account for more than 90% of Medicare spending. Patients with MCCs also experience lower quality of life and worse medical and psychiatric outcomes than patients without MCCs. In primary care settings, where MCCs are generally treated, care often focuses on laboratory results and medication management, and not quality of life, due in part to time constraints. eHealth systems, which have been shown to improve multiple outcomes, may be able to fill the gap, supplementing primary care and improving these patients? lives. Objective: This study aims to assess the effects of ElderTree (ET), an eHealth intervention for older adults with MCCs, on quality of life and related measures. Methods: In this unblinded study, 346 adults aged 65 years and older with at least 3 of 5 targeted high-risk chronic conditions (hypertension, hyperlipidemia, diabetes, osteoarthritis, and BMI ?30 kg/m2) were recruited from primary care clinics and randomized in a ratio of 1:1 to one of 2 conditions: usual care (UC) plus laptop computer, internet service, and ET or a control consisting of UC plus laptop and internet but no ET. Patients with ET have access for 12 months and will be followed up for an additional 6 months, for a total of 18 months. The primary outcomes of this study are the differences between the 2 groups with regard to measures of quality of life, psychological well-being, and loneliness. The secondary outcomes are between-group differences in laboratory scores, falls, symptom distress, medication adherence, and crisis and long-term health care use. We will also examine the mediators and moderators of the effects of ET. At baseline and months 6, 12, and 18, patients complete written surveys comprising validated scales selected for good psychometric properties with similar populations; laboratory data are collected from eHealth records; health care use and chronic conditions are collected from health records and patient surveys; and ET use data are collected continuously in system logs. We will use general linear models and linear mixed models to evaluate primary and secondary outcomes over time, with treatment condition as a between-subjects factor. Separate analyses will be conducted for outcomes that are noncontinuous or not correlated with other outcomes. Results: Recruitment was conducted from January 2018 to December 2019, and 346 participants were recruited. The intervention period will end in June 2021. Conclusions: With self-management and motivational strategies, health tracking, educational tools, and peer community and support, ET may help improve outcomes for patients coping with ongoing, complex MCCs. In addition, it may relieve some stress on the primary care system, with potential cost implications. Trial Registration: ClinicalTrials.gov NCT03387735; https://www.clinicaltrials.gov/ct2/show/NCT03387735. International Registered Report Identifier (IRRID): DERR1-10.2196/25175 UR - http://www.researchprotocols.org/2021/2/e25175/ UR - http://dx.doi.org/10.2196/25175 UR - http://www.ncbi.nlm.nih.gov/pubmed/33605887 ID - info:doi/10.2196/25175 ER - TY - JOUR AU - Hemmings, R. Nicola AU - Kawadler, M. Jamie AU - Whatmough, Rachel AU - Ponzo, Sonia AU - Rossi, Alessio AU - Morelli, Davide AU - Bird, Geoffrey AU - Plans, David PY - 2021/2/9 TI - Development and Feasibility of a Digital Acceptance and Commitment Therapy?Based Intervention for Generalized Anxiety Disorder: Pilot Acceptability Study JO - JMIR Form Res SP - e21737 VL - 5 IS - 2 KW - anxiety KW - depression KW - acceptance and commitment therapy KW - person-based approach KW - mHealth KW - mental health KW - digital KW - remote KW - smartphone KW - mobile phone N2 - Background: Generalized anxiety disorder (GAD) is characterized by excessive worry that is difficult to control and has high comorbidity with mood disorders including depression. Individuals experience long wait times for diagnosis and often face accessibility barriers to treatment. There is a need for a digital solution that is accessible and acceptable to those with GAD. Objective: This paper aims to describe the development of a digital intervention prototype of acceptance and commitment therapy (ACT) for GAD that sits within an existing well-being app platform, BioBase. A pilot feasibility study evaluating acceptability and usability is conducted in a sample of adults with a diagnosis of GAD, self-referred to the study. Methods: Phase 1 applied the person-based approach (creation of guiding principles, intervention design objectives, and the key intervention features). In Phase 2 participants received the app-based therapeutic and paired wearable for 2 weeks. Self-report questionnaires were obtained at baseline and posttreatment. The primary outcome was psychological flexibility (Acceptance and Action Questionnaire-II [AAQ-II]) as this is the aim of ACT. Mental well-being (Warwick-Edinburgh Mental Well-being Scale [WEMWBS]) and symptoms of anxiety (7-item Generalized Anxiety Disorder Assessment [GAD-7]) and depression (9-item Patient Health Questionnaire [PHQ-9]) were also assessed. Posttreatment usability was assessed via self-report measures (System Usability Scale [SUS]) in addition to interviews that further explored feasibility of the digital intervention in this sample. Results: The app-based therapeutic was well received. Of 13 participants, 10 (77%) completed the treatment. Results show a high usability rating (83.5). Participants found the digital intervention to be relevant, useful, and helpful in managing their anxiety. Participants had lower anxiety (d=0.69) and depression (d=0.84) scores at exit, and these differences were significantly different from baseline (P=.03 and .008 for GAD-7 and PHQ-9, respectively). Participants had higher psychological flexibility and well-being scores at exit, although these were not significantly different from baseline (P=.11 and .55 for AAQ-II and WEMWBS, respectively). Conclusions: This ACT prototype within BioBase is an acceptable and feasible digital intervention in reducing symptoms of anxiety and depression. This study suggests that this intervention warrants a larger feasibility study in adults with GAD. UR - https://formative.jmir.org/2021/2/e21737 UR - http://dx.doi.org/10.2196/21737 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560232 ID - info:doi/10.2196/21737 ER - TY - JOUR AU - Bur, Thomas Oliver AU - Krieger, Tobias AU - Moritz, Steffen AU - Klein, Philipp Jan AU - Berger, Thomas PY - 2021/2/2 TI - Optimizing the Context of Support to Improve Outcomes of Internet-Based Self-help in Individuals With Depressive Symptoms: Protocol for a Randomized Factorial Trial JO - JMIR Res Protoc SP - e21207 VL - 10 IS - 2 KW - depression KW - self-help KW - adherence KW - internet-based intervention KW - factorial design KW - problem-solving therapy KW - online KW - mental health KW - multiphase optimization strategy KW - digital health N2 - Background: Internet-based self-help interventions for individuals with depressive symptoms, in which the main component is often a web-based self-help program, have been shown to be efficacious in many controlled trials. However, there are also trials on self-help programs showing no significant effect when delivered in routine care, and some studies report high dropout and low adherence rates. Research suggests that these findings do not emerge primarily due to the specific content of a self-help program. It seems more important how a program is embedded in the context of human and automated support before and during the use of a self-help program. Objective: This study aims to better understand the effects of 4 supportive contextual factors on outcomes of and adherence to a web-based self-help program for depressive symptoms. In a factorial experiment, 2 of 4 supportive factors, for which there is evidence for their role on outcomes and adherence, are realized during the intervention?personal guidance and automated email reminders. The other 2 factors are realized before the intervention?a diagnostic interview and a preintervention module aimed at increasing the motivation to use the program with motivational interviewing techniques. Methods: The study is a full factorial randomized trial. Adults with mild to moderate depressive symptoms (Patient Health Questionnaire?9 score: 5-14) are recruited from the community through the internet and conventional media. All participants receive access to a web-based self-help program based on problem-solving therapy. They are randomized across 4 experimental factors, each reflecting the presence versus absence of a supportive factor (guidance, automated reminders, diagnostic interview, preintervention module) resulting in a 16-condition balanced factorial design. The primary outcome is depressive symptoms at 10 weeks post assessment. Secondary outcomes include adherence to the program, anxiety, stress, health-related quality of life, possible negative effects, and treatment satisfaction. Potential moderators and mediators (eg, treatment expectancy, problem-solving skills, working alliance with the study team) will also be investigated. Results: Ethical approval was received on January 20, 2020. The study was initiated in February 2020, and 240 participants have been enrolled in the study as of November 1, 2020. Recruitment for a total of 255 participants is ongoing. Data collection is expected to be completed by May 2021. Conclusions: A better understanding of relevant supportive factors in the dissemination of web-based interventions is necessary to improve outcomes of and adherence to web-based self-help programs. This study may inform health care systems and guide decisions to optimize the implementation context of web-based self-help programs for depressive symptoms. Trial Registration: ClinicalTrials.gov NCT04318236; https://clinicaltrials.gov/ct2/show/NCT04318236 International Registered Report Identifier (IRRID): DERR1-10.2196/21207 UR - http://www.researchprotocols.org/2021/2/e21207/ UR - http://dx.doi.org/10.2196/21207 UR - http://www.ncbi.nlm.nih.gov/pubmed/33528377 ID - info:doi/10.2196/21207 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 - Sturge, Jodi AU - Meijering, Louise AU - Jones, Allyson C. AU - Garvelink, Mirjam AU - Caron, Danielle AU - Nordin, Susanna AU - Elf, Marie AU - Légaré, France PY - 2021/1/21 TI - Technology to Improve Autonomy and Inform Housing Decisions for Older Adults With Memory Problems Who Live at Home in Canada, Sweden, and the Netherlands: Protocol for a Multipronged Mixed Methods Study JO - JMIR Res Protoc SP - e19244 VL - 10 IS - 1 KW - aging in place KW - co-design KW - cross-country comparison KW - electronic decision support intervention KW - housing decisions KW - memory problems KW - mixed methods KW - mobility patterns KW - shared decision making KW - technology N2 - Background: Understanding the mobility patterns and experiences of older adults with memory problems living at home has the potential to improve autonomy and inform shared decision making (SDM) about their housing options. Objective: We aim to (1) assess the mobility patterns and experiences of older adults with memory problems, (2) co-design an electronic decision support intervention (e-DSI) that integrates users? mobility patterns and experiences, (3) explore their intention to use an e-DSI to support autonomy at home, and (4) inform future SDM processes about housing options. Methods: Informed by the Good Reporting of A Mixed Methods Study (GRAMMS) reporting guidelines, we will conduct a 3-year, multipronged mixed methods study in Canada, Sweden, and the Netherlands. For Phase 1, we will recruit a convenience sample of 20 older adults living at home with memory problems from clinical and community settings in each country, for a total of 60 participants. We will ask participants to record their mobility patterns outside their home for 14 days using a GPS tracker and a travel diary; in addition, we will conduct a walking interview and a final debrief interview after 14 days. For Phase 2, referring to results from the first phase, we will conduct one user-centered co-design process per country with older adults with memory issues, caregivers, health care professionals, and information technology representatives informed by the Double Diamond method. We will ask participants how personalized information about mobility patterns and experiences could be added to an existing e-DSI and how this information could inform SDM about housing options. For Phase 3, using online web-based surveys, we will invite 210 older adults with memory problems and/or their caregivers, split equally across the three countries, to use the e-DSI and provide feedback on its strengths and limitations. Finally, in Phase 4, we will triangulate and compare data from all phases and countries to inform a stakeholder meeting where an action plan will be developed. Results: The study opened for recruitment in the Netherlands in November 2018 and in Canada and Sweden in December 2019. Data collection will be completed by April 2021. Conclusions: This project will explore how e-DSIs can integrate the mobility patterns and mobility experiences of older adults with memory problems in three countries, improve older adults? autonomy, and, ultimately, inform SDM about housing options. Trial Registration: ClinicalTrials.gov NCT04267484; https://clinicaltrials.gov/ct2/show/NCT04267484 International Registered Report Identifier (IRRID): DERR1-10.2196/19244 UR - http://www.researchprotocols.org/2021/1/e19244/ UR - http://dx.doi.org/10.2196/19244 UR - http://www.ncbi.nlm.nih.gov/pubmed/33475512 ID - info:doi/10.2196/19244 ER - TY - JOUR AU - White, Judith AU - Knight, Laura AU - da Cruz, Lyndon AU - Stanga, E. Paulo AU - Patrick, Hannah AU - Powell, Helen AU - Berry, Lee AU - Withers, Kathleen AU - Carolan-Rees, Grace AU - Jackson, L. Timothy PY - 2021/1/20 TI - Effects of the Argus II Retinal Prosthesis System on the Quality of Life of Patients With Ultra-Low Vision Due to Retinitis Pigmentosa: Protocol for a Single-Arm, Mixed Methods Study JO - JMIR Res Protoc SP - e17436 VL - 10 IS - 1 KW - patient-reported outcomes KW - quality of life KW - qualitative methods KW - artificial vision KW - visual function KW - functional vision KW - ultra-low vision KW - low vision KW - visual function questionnaire N2 - Background: Retinitis pigmentosa is an incurable, degenerative retinal condition causing progressive sight loss, significantly affecting patients? quality of life. The Argus II Retinal Prosthesis is a surgically implanted medical device that delivers electrical stimulation to the retina. It is intended to produce a form of artificial vision for blind people with severe-to-profound retinitis pigmentosa by stimulating the remaining viable retinal cells to induce visual perception. This study has been initiated by National Health Service England?s Commissioning through Evaluation program and funded through the National Institute of Health Research of the United Kingdom. Objective: The aim of this study was to assess the effect of the Argus II device on patient?s daily activities and quality of life. Methods: This protocol is a prospective, single-arm, open-label, mixed methods study on 10 consecutive participants receiving the Argus II device. The patient representatives played an integral role in the design of this study. Eligibility criteria include ultra-low vision in both eyes as a result of end-stage retinitis pigmentosa and a willingness and capacity to complete the postimplantation rehabilitation program. Participants will be interviewed by independent researchers at baseline and 12 months later by using a semistructured, in-depth approach, alongside validated questionnaires (Impact of Vision Impairment-Very Low Vision, 5-level EuroQoL-5 dimensions scale, EuroQoL-visual analog scale, and Hospital Anxiety and Depression Scale) and a bespoke device-related questionnaire, which includes questions about users? experiences with the procedure, the device, and rehabilitation. The effect of the device on patients? functional vision and activities of daily living will be assessed by vision rehabilitation specialists using a set of tests measured on an ordinal scale (eg, ability to locate objects and avoid obstacles). Clinical outcomes include full-field stimulus light threshold, square localization, direction of motion, grating visual acuity, Landolt-C, procedural success, and adverse events. Qualitative and quantitative outcomes will be linked in a single database to enable individual participant measures to be considered in toto, comparing baseline to the final review. Results: This study was approved by the local ethics committee on April 24, 2019 (London-Camberwell St. Giles Research Ethics Committee, reference 19/LO/0429). It has also been approved by the Health Research Authority and Health and Care Research Wales. At the time of protocol writing, Argus II was available for use in the United Kingdom; however, the manufacturer recently withdrew the Argus II device from sale in the United Kingdom. Therefore, the study is not going ahead at this time. Conclusions: The mixed methods approach provides a rich and in-depth assessment of the effect of the device on participants? quality of life. Despite the work not going ahead, the publication of this publicly funded protocol is important for researchers planning similar work. International Registered Report Identifier (IRRID): PRR1-10.2196/17436 UR - http://www.researchprotocols.org/2021/1/e17436/ UR - http://dx.doi.org/10.2196/17436 UR - http://www.ncbi.nlm.nih.gov/pubmed/33470946 ID - info:doi/10.2196/17436 ER - TY - JOUR AU - Daudén Roquet, Claudia AU - Sas, Corina PY - 2021/1/18 TI - A Mindfulness-Based Brain-Computer Interface to Augment Mandala Coloring for Depression: Protocol for a Single-Case Experimental Design JO - JMIR Res Protoc SP - e20819 VL - 10 IS - 1 KW - brain-computer interface KW - mental well-being KW - depression KW - mindfulness KW - mandala coloring N2 - Background: The regular practice of mindfulness has been shown to provide benefits for mental well-being and prevent depression relapse. Technology-mediated interventions can facilitate the uptake and sustained practice of mindfulness, yet the evaluation of interactive systems, such as brain-computer interfaces, has been little explored. Objective: The objective of this paper is to present an interactive mindfulness-based technology to improve mental well-being in people who have experienced depression. The system, Anima, is a brain-computer interface that augments mandala coloring by providing a generative color palette based on the unfolding mindfulness states during the practice. In addition, this paper outlines a multiple-baseline, single-case experimental design methodology to evaluate training effectiveness. Methods: Adult participants who have experienced depression in the past, have finished treatment within the last year, and can provide informed consent will be able to be recruited. The Anima system, consisting of 2 tablets and a nonintrusive mental activity headband, will be delivered to participants to use during the study. Measures include state and trait mindfulness, depression symptoms, mental well-being, and user experience, and these measures will be taken throughout the baseline, intervention, and monitoring phases. The data collection will take place in the form of a questionnaire before and after each mandala-coloring session and a semistructured interview every 2 weeks. Trial results will be analyzed using structured visual analysis, supplemented with statistical analysis appropriate to single-case methodology. Results: Study results will offer new insights into the deployment and evaluation of novel interactive brain-computer interfaces for mindfulness training in the context of mental health. Moreover, findings will validate the effectiveness of this training protocol to improve the mental well-being of people who have had depression. Participants will be recruited locally through the National Health Service. Conclusions: Evidence will assist in the design and evaluation of brain-computer interfaces and mindfulness technologies for mental well-being and the necessary services to support people who have experienced depression. International Registered Report Identifier (IRRID): PRR1-10.2196/20819 UR - http://www.researchprotocols.org/2021/1/e20819/ UR - http://dx.doi.org/10.2196/20819 UR - http://www.ncbi.nlm.nih.gov/pubmed/33459604 ID - info:doi/10.2196/20819 ER - TY - JOUR AU - Mueller, Christian AU - Schauerte, Isabel AU - Martin, Stephan PY - 2021/1/11 TI - Evaluation of Self-Care Activities and Quality of Life in Patients With Type 2 Diabetes Mellitus Treated With Metformin Using the 2D Matrix Code of Outer Drug Packages as Patient Identifier: Protocol for the DePRO Proof-of-Concept Observational Study JO - JMIR Res Protoc SP - e21727 VL - 10 IS - 1 KW - self-care activities KW - quality of life KW - type 2 diabetes mellitus KW - patient-reported outcome measures KW - digital observational study KW - bring your own device N2 - Background: Diabetes mellitus (DM) is one of the most common noncommunicable diseases. DM has a substantial negative impact on patients? quality of life, which is measured using a variety of diabetes-specific measures covering multiple aspects of patients? psychological state, behavior, and treatment satisfaction. A fully digital data collection system, including patient identification, would represent a substantial advance in how these patient-reported outcome (PRO) data are measured. Within the European Union, one way to identify patients without the involvement of health care professionals is to use the unique 2D matrix codes on the packaging of prescription medication?for example, metformin, the recommended initial treatment for patients with type 2 DM (T2DM). Objective: In the DePRO study we aim to (1) describe the self-care activities of patients with T2DM using metformin-containing medication; (2) describe the self-reported health status (eg, presence of diabetes complications and quality of life) of these patients; (3) describe associations between self-care activities and demographics and disease characteristics; and (4) assess the usability of the my ePRO app. Methods: DePRO is an observational, multicenter, cross-sectional, digital, patient-driven study conducted in Germany. Patients with a prescription for a metformin-containing medication will be given a postcard by their pharmacist, which will include a download link for the my ePRO app. In total, 12 diabetes-focused pharmacies, selected to represent urban and rural areas, will be recruited. Participants will use their own mobile device (bring your own device) to download the my ePRO app and access the DePRO study, for which they can register using the 2D matrix code on their medication. An electronic informed consent form will be displayed to the patients and only after giving consent will patients be able to complete the study questionnaires. The PRO instruments used in the study are the Summary of Diabetes Self-Care Activities Scale, the Diabetes Treatment Satisfaction Questionnaire, and the 5 level, 5-dimension EuroQol Questionnaire. Patients will also be asked to complete a questionnaire with items addressing demographics, patient characteristics, disease history, complications, and concomitant medications. Data will be transferred to the study database by the app upon completion of each questionnaire. Statistical analyses of primary and secondary endpoints will be exploratory and descriptive. Results: Enrollment began in June 2020. The estimated study completion date is December 31, 2020, and the planned sample size is 300 patients. Conclusions: The DePRO study uses completely digital data collection, including authentication of eligible patients and completion of the study questionnaires. Therefore, the design of the DePRO study represents a substantial advance in the evaluation of the digital capturing of PRO data. Trial Registration: ClinicalTrials.gov NCT04383041; https://clinicaltrials.gov/ct2/show/NCT04383041 International Registered Report Identifier (IRRID): PRR1-10.2196/21727 UR - http://www.researchprotocols.org/2021/1/e21727/ UR - http://dx.doi.org/10.2196/21727 UR - http://www.ncbi.nlm.nih.gov/pubmed/33427685 ID - info:doi/10.2196/21727 ER - TY - JOUR AU - Luo, Yuhan AU - Oh, Young Chi AU - Jean, St Beth AU - Choe, Kyoung Eun PY - 2020/12/22 TI - Interrelationships Between Patients? Data Tracking Practices, Data Sharing Practices, and Health Literacy: Onsite Survey Study JO - J Med Internet Res SP - e18937 VL - 22 IS - 12 KW - consumer health informatics KW - patient-generated health data KW - self-tracking KW - doctor-patient data sharing KW - health literacy KW - surveys and questionnaires N2 - Background: Although the use of patient-generated data (PGD) in the optimization of patient care shows great promise, little is known about whether patients who track their PGD necessarily share the data with their clinicians. Meanwhile, health literacy?an important construct that captures an individual?s ability to manage their health and to engage with their health care providers?has often been neglected in prior studies focused on PGD tracking and sharing. To leverage the full potential of PGD, it is necessary to bridge the gap between patients? data tracking and data sharing practices by first understanding the interrelationships between these practices and the factors contributing to these practices. Objective: This study aims to systematically examine the interrelationships between PGD tracking practices, data sharing practices, and health literacy among individual patients. Methods: We surveyed 109 patients at the time they met with a clinician at a university health center, unlike prior research that often examined patients? retrospective experience after some time had passed since their clinic visit. The survey consisted of 39 questions asking patients about their PGD tracking and sharing practices based on their current clinical encounter. The survey also contained questions related to the participants? health literacy. All the participants completed the survey on a tablet device. The onsite survey study enabled us to collect ecologically valid data based on patients? immediate experiences situated within their clinic visit. Results: We found no evidence that tracking PGD was related to self-reports of having sufficient information to manage one?s health; however, the number of data types participants tracked positively related to their self-assessed ability to actively engage with health care providers. Participants? data tracking practices and their health literacy did not relate to their data sharing practices; however, their ability to engage with health care providers positively related to their willingness to share their data with clinicians in the future. Participants reported several benefits of, and barriers to, sharing their PGD with clinicians. Conclusions: Although tracking PGD could help patients better engage with health care providers, it may not provide patients with sufficient information to manage their health. The gaps between tracking and sharing PGD with health care providers call for efforts to inform patients of how their data relate to their health and to facilitate efficient clinician-patient communication. To realize the full potential of PGD and to promote individuals? health literacy, empowering patients to effectively track and share their PGD is important?both technologies and health care providers can play important roles. UR - http://www.jmir.org/2020/12/e18937/ UR - http://dx.doi.org/10.2196/18937 UR - http://www.ncbi.nlm.nih.gov/pubmed/33350960 ID - info:doi/10.2196/18937 ER - TY - JOUR AU - Kim, Ki-Hun AU - Kim, Kwang-Jae PY - 2020/12/17 TI - Missing-Data Handling Methods for Lifelogs-Based Wellness Index Estimation: Comparative Analysis With Panel Data JO - JMIR Med Inform SP - e20597 VL - 8 IS - 12 KW - lifelogs-based wellness index KW - missing-data handling KW - health behavior lifelogs KW - panel data KW - smart wellness service N2 - Background: A lifelogs-based wellness index (LWI) is a function for calculating wellness scores based on health behavior lifelogs (eg, daily walking steps and sleep times collected via a smartwatch). A wellness score intuitively shows the users of smart wellness services the overall condition of their health behaviors. LWI development includes estimation (ie, estimating coefficients in LWI with data). A panel data set comprising health behavior lifelogs allows LWI estimation to control for unobserved variables, thereby resulting in less bias. However, these data sets typically have missing data due to events that occur in daily life (eg, smart devices stop collecting data when batteries are depleted), which can introduce biases into LWI coefficients. Thus, the appropriate choice of method to handle missing data is important for reducing biases in LWI estimations with panel data. However, there is a lack of research in this area. Objective: This study aims to identify a suitable missing-data handling method for LWI estimation with panel data. Methods: Listwise deletion, mean imputation, expectation maximization?based multiple imputation, predictive-mean matching?based multiple imputation, k-nearest neighbors?based imputation, and low-rank approximation?based imputation were comparatively evaluated by simulating an existing case of LWI development. A panel data set comprising health behavior lifelogs of 41 college students over 4 weeks was transformed into a reference data set without any missing data. Then, 200 simulated data sets were generated by randomly introducing missing data at proportions from 1% to 80%. The missing-data handling methods were each applied to transform the simulated data sets into complete data sets, and coefficients in a linear LWI were estimated for each complete data set. For each proportion for each method, a bias measure was calculated by comparing the estimated coefficient values with values estimated from the reference data set. Results: Methods performed differently depending on the proportion of missing data. For 1% to 30% proportions, low-rank approximation?based imputation, predictive-mean matching?based multiple imputation, and expectation maximization?based multiple imputation were superior. For 31% to 60% proportions, low-rank approximation?based imputation and predictive-mean matching?based multiple imputation performed best. For over 60% proportions, only low-rank approximation?based imputation performed acceptably. Conclusions: Low-rank approximation?based imputation was the best of the 6 data-handling methods regardless of the proportion of missing data. This superiority is generalizable to other panel data sets comprising health behavior lifelogs given their verified low-rank nature, for which low-rank approximation?based imputation is known to perform effectively. This result will guide missing-data handling in reducing coefficient biases in new development cases of linear LWIs with panel data. UR - http://medinform.jmir.org/2020/12/e20597/ UR - http://dx.doi.org/10.2196/20597 UR - http://www.ncbi.nlm.nih.gov/pubmed/33331831 ID - info:doi/10.2196/20597 ER - TY - JOUR AU - Jaana, Mirou AU - Paré, Guy PY - 2020/11/27 TI - Comparison of Mobile Health Technology Use for Self-Tracking Between Older Adults and the General Adult Population in Canada: Cross-Sectional Survey JO - JMIR Mhealth Uhealth SP - e24718 VL - 8 IS - 11 KW - mobile health KW - older adults KW - self-tracking KW - wearable technology KW - smart devices KW - mobile apps KW - survey KW - mobile phone KW - seniors KW - elderly N2 - Background: The burden of population aging and chronic conditions has been reported worldwide. Older adults, especially those with high needs, experience social isolation and have high rates of emergency visits and limited satisfaction with the care they receive. Mobile health (mHealth) technologies present opportunities to address these challenges. To date, limited information is available on Canadian older adults? attitudes toward and use of mHealth technologies for self-tracking purposes?an area that is increasingly important and relevant during the COVID-19 era. Objective: This study presents contributions to an underresearched area on older adults and mHealth technology use. The aim of this study was to compare older adults? use of mHealth technologies to that of the general adult population in Canada and to investigate the factors that affect their use. Methods: A cross-sectional survey on mHealth and digital self-tracking was conducted. A web-based questionnaire was administered to a national sample of 4109 Canadian residents who spoke either English or French. The survey instrument consisted of 3 sections assessing the following items: (1) demographic characteristics, health status, and comorbidities; (2) familiarity with and use of mHealth technologies (ie, mobile apps, consumer smart devices/wearables such as vital signs monitors, bathroom scales, fitness trackers, intelligent clothing); and (3) factors influencing the continued use of mHealth technologies. Results: Significant differences were observed between the older adults and the general adult population in the use of smart technologies and internet (P<.001). Approximately 47.4% (323/682) of the older adults in the community reported using smartphones and 49.8% (340/682) indicated using digital tablets. Only 19.6% (91/463) of the older adults using smartphones/digital tablets reported downloading mobile apps, and 12.3% (47/383) of the older adults who heard of smart devices/wearables indicated using them. The majority of the mobile apps downloaded by older adults was health-related; interestingly, their use was sustained over a longer period of time (P=.007) by the older adults compared to that by the general population. Approximately 62.7% (428/682) of the older adults reported tracking their health measures, but the majority did so manually. Older adults with one or more chronic conditions were mostly nontrackers (odds ratio 0.439 and 0.431 for traditional trackers and digital trackers, respectively). No significant differences were observed between the older adults and the general adult population with regard to satisfaction with mHealth technologies and their intention to continue using them. Conclusions: Leveraging mHealth technologies in partnership with health care providers and sharing of health/well-being data with health care professionals and family members remain very limited. A culture shift in the provision of care to older adults is deemed necessary to keep up with the development of mHealth technologies and the changing demographics and expectations of patients and their caregivers. UR - http://mhealth.jmir.org/2020/11/e24718/ UR - http://dx.doi.org/10.2196/24718 UR - http://www.ncbi.nlm.nih.gov/pubmed/33104517 ID - info:doi/10.2196/24718 ER - TY - JOUR AU - Shaw, Ryan AU - Stroo, Marissa AU - Fiander, Christopher AU - McMillan, Katlyn PY - 2020/10/28 TI - Selecting Mobile Health Technologies for Electronic Health Record Integration: Case Study JO - J Med Internet Res SP - e23314 VL - 22 IS - 10 KW - mobile health KW - mHealth KW - electronic health record KW - health technology KW - mobile phone UR - http://www.jmir.org/2020/10/e23314/ UR - http://dx.doi.org/10.2196/23314 UR - http://www.ncbi.nlm.nih.gov/pubmed/33112248 ID - info:doi/10.2196/23314 ER - TY - JOUR AU - Morton, Emma AU - Hole, Rachelle AU - Murray, Greg AU - Buzwell, Simone AU - Michalak, Erin PY - 2019/12/4 TI - Experiences of a Web-Based Quality of Life Self-Monitoring Tool for Individuals With Bipolar Disorder: A Qualitative Exploration JO - JMIR Ment Health SP - e16121 VL - 6 IS - 12 KW - bipolar disorder KW - self-monitoring KW - self-management KW - qualitative KW - recovery KW - quality of life KW - eHealth N2 - Background: Self-monitoring of symptoms is a cornerstone of psychological interventions in bipolar disorder (BD), but individuals with lived experience also value tracking holistic outcomes, such as quality of life (QoL). Importantly, self-monitoring is not always experienced positively by people with BD and may have lower than expected rates of engagement. Therefore, before progressing into QoL tracking tools, it is important to explore user perspectives to identify possible risks and benefits, optimal methods to support engagement, and possible avenues to integrate QoL self-monitoring practices into clinical work. Objective: This study aimed to conduct a qualitative exploration of how individuals with BD engaged with a Web-based version of a BD-specific QoL self-monitoring instrument, the QoL tool. Methods: A total of 43 individuals with BD engaged with a self-management intervention with an optional Web-based QoL self-assessment tool as part of an overarching mixed method study. Individuals were later interviewed about personal experiences of engagement with the intervention, including experiences of gauging their own QoL. A thematic analysis was used to identify salient aspects of the experience of QoL self-monitoring in BD. Results: In total, 4 categories describing people?s experiences of QoL self-monitoring were identified: (1) breadth of QoL monitoring, (2) highlighting the positive, (3) connecting self-monitoring to action, and (4) self-directed patterns of use. Conclusions: The findings of this research generate novel insights into ways in which individuals with BD experience the Web-based QoL self-assessment tool. The value of tracking the breadth of domains was an overarching aspect, facilitating the identification of both areas of strength and life domains in need of intervention. Importantly, monitoring QoL appeared to have an inherently therapeutic quality, through validating flourishing areas and reinforcing self-management efforts. This contrasts the evidence suggesting that symptom tracking may be distressing because of its focus on negative experiences and positions QoL as a valuable adjunctive target of observation in BD. Flexibility and personalization of use of the QoL tool were key to engagement, informing considerations for health care providers wishing to support self-monitoring and future research into Web- or mobile phone?based apps. UR - https://mental.jmir.org/2019/12/e16121 UR - http://dx.doi.org/10.2196/16121 UR - http://www.ncbi.nlm.nih.gov/pubmed/31799936 ID - info:doi/10.2196/16121 ER - TY - JOUR AU - Chung, Yong Il AU - Jung, Miyeon AU - Lee, Byul Sae AU - Lee, Won Jong AU - Park, Rang Yu AU - Cho, Daegon AU - Chung, Haekwon AU - Youn, Soyoung AU - Min, Ha Yul AU - Park, Jin Hye AU - Lee, Minsun AU - Chung, Seockhoon AU - Son, Ho Byung AU - Ahn, Sei-Hyun PY - 2019/09/06 TI - An Assessment of Physical Activity Data Collected via a Smartphone App and a Smart Band in Breast Cancer Survivors: Observational Study JO - J Med Internet Res SP - e13463 VL - 21 IS - 9 KW - telemedicine KW - breast neoplasms KW - mobile apps KW - quality of life KW - stress, psychological KW - patient compliance KW - smartphone KW - mobile phone KW - wearable electronic devices KW - survivorship N2 - Background: Although distress screening is crucial for cancer survivors, it is not easy for clinicians to recognize distress. Physical activity (PA) data collected by mobile devices such as smart bands and smartphone apps have the potential to be used to screen distress in breast cancer survivors. Objective: The aim of this study was to assess data collection rates of smartphone apps and smart bands in terms of PA data, investigate the correlation between PA data from mobile devices and distress-related questionnaires from smartphone apps, and demonstrate factors associated with data collection with smart bands and smartphone apps in breast cancer survivors. Methods: In this prospective observational study, patients who underwent surgery for breast cancer at Asan Medical Center, Seoul, Republic of Korea, between June 2017 and March 2018 were enrolled and asked to use both a smartphone app and smart band for 6 months. The overall compliance rates of the daily PA data collection via the smartphone walking apps and wearable smart bands were analyzed in a within-subject manner. The longitudinal daily collection rates were calculated to examine the dropout pattern. We also performed multivariate linear regression analysis to examine factors associated with compliance with daily collection. Finally, we tested the correlation between the count of daily average steps and distress level using Pearson correlation analysis. Results: A total of 160 female patients who underwent breast cancer surgeries were enrolled. The overall compliance rates for using a smartphone app and smart bands were 88.0% (24,224/27,513) and 52.5% (14,431/27,513), respectively. The longitudinal compliance rate for smartphone apps was 77.8% at day 180, while the longitudinal compliance rate for smart bands rapidly decreased over time, reaching 17.5% at day 180. Subjects who were young, with other comorbidities, or receiving antihormonal therapy or targeted therapy showed significantly higher compliance rates to the smartphone app. However, no factor was associated with the compliance rate to the smart band. In terms of the correlation between the count of daily steps and distress level, step counts collected via smart band showed a significant correlation with distress level. Conclusions: Smartphone apps or smart bands are feasible tools to collect data on the physical activity of breast cancer survivors. PA data from mobile devices are correlated with participants? distress data, which suggests the potential role of mobile devices in the management of distress in breast cancer survivors. Trial Registration: ClinicalTrials.gov NCT03072966; https://clinicaltrials.gov/ct2/show/NCT03072966 UR - https://www.jmir.org/2019/9/e13463 UR - http://dx.doi.org/10.2196/13463 UR - http://www.ncbi.nlm.nih.gov/pubmed/31493319 ID - info:doi/10.2196/13463 ER - TY - JOUR AU - McKinney, Pamela AU - Cox, Martin Andrew AU - Sbaffi, Laura PY - 2019/08/01 TI - Information Literacy in Food and Activity Tracking Among Parkrunners, People With Type 2 Diabetes, and People With Irritable Bowel Syndrome: Exploratory Study JO - J Med Internet Res SP - e13652 VL - 21 IS - 8 KW - activity logging KW - food logging KW - information literacy KW - irritable bowel syndrome KW - personal informatics KW - quantified self KW - running KW - self-tracking KW - type 2 diabetes N2 - Background: The tracking, or logging, of food intake and physical activity is increasing among people, and as a result there is increasing evidence of a link to improvement in health and well-being. Crucial to the effective and safe use of logging is a user?s information literacy. Objective: The aim of this study was to analyze food and activity tracking from an information literacy perspective. Methods: An online survey was distributed to three communities via parkrun, diabetes.co.uk and the Irritable Bowel Syndrome Network. Results: The data showed that there were clear differences in the logging practices of the members of the three different communities, as well as differences in motivations for tracking and the extent of sharing of said tracked data. Respondents showed a good understanding of the importance of information accuracy and were confident in their ability to understand tracked data, however, there were differences in the extent to which food and activity data were shared and also a lack of understanding of the potential reuse and sharing of data by third parties. Conclusions: Information literacy in this context involves developing awareness of the issues of accurate information recording, and how tracked information can be applied to support specific health goals. Developing awareness of how and when to share data, as well as of data ownership and privacy, are also important aspects of information literacy. UR - https://www.jmir.org/2019/8/e13652/ UR - http://dx.doi.org/10.2196/13652 UR - http://www.ncbi.nlm.nih.gov/pubmed/31373277 ID - info:doi/10.2196/13652 ER - TY - JOUR AU - Vizer, M. Lisa AU - Eschler, Jordan AU - Koo, Mi Bon AU - Ralston, James AU - Pratt, Wanda AU - Munson, Sean PY - 2019/04/29 TI - ?It?s Not Just Technology, It?s People?: Constructing a Conceptual Model of Shared Health Informatics for Tracking in Chronic Illness Management JO - J Med Internet Res SP - e10830 VL - 21 IS - 4 KW - consumer health informatics KW - chronic illness KW - patient generated health data KW - patient reported outcomes KW - workflow KW - information seeking behavior KW - shared decision making N2 - Background: For many people, tracking health indicators is central to managing a chronic illness. However, previous informatics research has largely viewed tracking as a solitary process that lacks the characteristics essential to tracking in support of chronic illness management. Objective: To inform development of effective technologies that aid tracking of health indicators to support chronic illness management, this study aimed to construct a health informatics model that accurately describes the work and social context of that tracking work. Methods: As part of a larger project, we conducted semistructured interviews with 40 adults concerning their chronic illness management practices, including tracking and communication. We also assembled transcripts of 30 publicly available videos of 24 adults discussing tracking processes for managing their own chronic illness. We used qualitative methods to analyze interviews and video transcripts through the lens of ongoing personal and health informatics research. Results: We have described the people and work involved in tracking in support of chronic illness management and contributed a Conceptual Model of Shared Health Informatics (CoMSHI). Specifically, we identified the need for a health informatics model that (1) incorporates the ongoing nature of tracking work and (2) represents the social dimension of tracking for illness management. Our model depicts communication, information, collection, integration, reflection, and action work in the social context of the person with chronic illness, informal carers, health care providers, and community members. Conclusions: The resulting CoMSHI yields a more detailed and nuanced viewpoint of tracking in support of chronic illness management and can inform technology design to improve tracking tools to support people in more confident and capable chronic illness management. UR - http://www.jmir.org/2019/4/e10830/ UR - http://dx.doi.org/10.2196/10830 UR - http://www.ncbi.nlm.nih.gov/pubmed/31033452 ID - info:doi/10.2196/10830 ER - TY - JOUR AU - Holtz, Bree AU - Vasold, Kerri AU - Cotten, Shelia AU - Mackert, Michael AU - Zhang, Mi PY - 2019/01/22 TI - Health Care Provider Perceptions of Consumer-Grade Devices and Apps for Tracking Health: A Pilot Study JO - JMIR Mhealth Uhealth SP - e9929 VL - 7 IS - 1 KW - physicians KW - primary care KW - APRN KW - nurse practitioners KW - technology N2 - Background: The use of Web- or mobile phone?based apps for tracking health indicators has increased greatly. However, provider perceptions of consumer-grade devices have not been widely explored. Objective: The purpose of this study was to determine primary care physicians? and advanced practice registered nurses? perceptions of consumer-grade sensor devices and Web- or mobile phone?based apps that allow patients to track physical activity, diet, and sleep. Methods: We conducted a cross-sectional mailed survey with a random sample of 300 primary care physicians and 300 advanced practice registered nurses from Michigan, USA. Providers? use and recommendation of these types of technologies, and their perceptions of the benefits of and barriers to patients? use of the technologies for physical activity, diet, and sleep tracking were key outcomes assessed. Results: Most of the respondents (189/562, 33.6% response rate) were advanced practice registered nurses (107/189, 56.6%). Almost half of the sample (93/189, 49.2%) owned or used behavioral tracking technologies. Providers found these technologies to be helpful in clinical encounters, trusted the data, perceived their patients to be interested in them, and did not have concerns over the privacy of the data. However, the providers did perceive patient barriers to using these technologies. Additionally, those who owned or used these technologies were up to 6.5 times more likely to recommend them to their patients. Conclusions: Our study demonstrated that many providers perceived benefits for their patients to use these technologies, including improved communication. Providers? concerns included their patients? access and the usability of these technologies. Providers who encountered data from these technologies during patient visits generally perceive this to be helpful. We additionally discuss the barriers perceived by the providers and offer suggestions and future research to realize the potential benefits to using these data in clinical encounters. UR - https://mhealth.jmir.org/2018/1/e9929/ UR - http://dx.doi.org/10.2196/mhealth.9929 UR - http://www.ncbi.nlm.nih.gov/pubmed/30668515 ID - info:doi/10.2196/mhealth.9929 ER - TY - JOUR AU - Lancaster, Karla AU - Abuzour, Aseel AU - Khaira, Manmeet AU - Mathers, Annalise AU - Chan, April AU - Bui, Vivian AU - Lok, Annie AU - Thabane, Lehana AU - Dolovich, Lisa PY - 2018/12/18 TI - The Use and Effects of Electronic Health Tools for Patient Self-Monitoring and Reporting of Outcomes Following Medication Use: Systematic Review JO - J Med Internet Res SP - e294 VL - 20 IS - 12 KW - eHealth KW - mHealth KW - electronic health record KW - telemedicine KW - self-report KW - patient portals KW - patient-centered care KW - drug monitoring KW - adverse effects N2 - Background: Electronic health (eHealth) tools are becoming increasingly popular for helping patients? self-manage chronic conditions. Little research, however, has examined the effect of patients using eHealth tools to self-report their medication management and use. Similarly, there is little evidence showing how eHealth tools might prompt patients and health care providers to make appropriate changes to medication use. Objective: The objective of this systematic review was to determine the impact of patients? use of eHealth tools on self-reporting adverse effects and symptoms that promote changes to medication use. Related secondary outcomes were also evaluated. Methods: MEDLINE, EMBASE, and CINAHL were searched from January 1, 2000, to April 25, 2018. Reference lists of relevant systematic reviews and included articles from the literature search were also screened to identify relevant studies. Title, abstract, and full-text review as well as data extraction and risk of bias assessment were performed independently by 2 reviewers. Due to high heterogeneity, results were not meta-analyzed and instead presented as a narrative synthesis. Results: A total of 14 studies, including 13 randomized controlled trials (RCTs) and 1 open-label intervention, were included, from which 11 unique eHealth tools were identified. In addition, 14 RCTs found statistically significant increases in positive medication changes as a result of using eHealth tools, as did the single open-label study. Moreover, 8 RCTs found improvement in patient symptoms following eHealth tool use, especially in adolescent asthma patients. Furthermore, 3 RCTs showed that eHealth tools might improve patient self-efficacy and self-management of chronic disease. Little or no evidence was found to support the effectiveness of eHealth tools at improving medication recommendations and reconciliation by clinicians, medication-use behavior, health service utilization, adverse effects, quality of life, or patient satisfaction. eHealth tools with multifaceted functionalities and those allowing direct patient-provider communication may be more effective at improving patient self-management and self-efficacy. Conclusions: Evidence suggests that the use of eHealth tools may improve patient symptoms and lead to medication changes. Patients generally found eHealth tools useful in improving communication with health care providers. Moreover, health-related outcomes among frequent eHealth tool users improved in comparison with individuals who did not use eHealth tools frequently. Implementation issues such as poor patient engagement and poor clinician workflow integration were identified. More high-quality research is needed to explore how eHealth tools can be used to effectively manage use of medications to improve medication management and patient outcomes. UR - https://www.jmir.org/2018/12/e294/ UR - http://dx.doi.org/10.2196/jmir.9284 UR - http://www.ncbi.nlm.nih.gov/pubmed/30563822 ID - info:doi/10.2196/jmir.9284 ER - TY - JOUR AU - Degroote, Laurent AU - De Bourdeaudhuij, Ilse AU - Verloigne, Maďté AU - Poppe, Louise AU - Crombez, Geert PY - 2018/12/13 TI - The Accuracy of Smart Devices for Measuring Physical Activity in Daily Life: Validation Study JO - JMIR Mhealth Uhealth SP - e10972 VL - 6 IS - 12 KW - physical activity KW - fitness trackes KW - accelerometry N2 - Background: Wearables for monitoring physical activity (PA) are increasingly popular. These devices are not only used by consumers to monitor their own levels of PA but also by researchers to track the behavior of large samples. Consequently, it is important to explore how accurately PA can be tracked via these devices. Objectives: The aim of this study was, therefore, to investigate convergent validity of 3 Android Wear smartwatches?Polar M600 (Polar Electro Oy, Kempele, Finland), Huawei Watch (Huawei Technologies Co, Ltd, Shenzhen, Guangdong, China), Asus Zenwatch3 (AsusTek Computer Inc, Taipei, Taiwan)?and Fitbit Charge with an ActiGraph accelerometer for measuring steps and moderate to vigorous physical activity (MVPA) on both a day level and 15-min level. Methods: A free-living protocol was used in which 36 adults engaged in usual daily activities over 2 days while wearing 2 different wearables on the nondominant wrist and an ActiGraph GT3X+ accelerometer on the hip. Validity was evaluated on both levels by comparing each wearable with the ActiGraph GT3X+ accelerometer using correlations and Bland-Altman plots in IBM SPSS 24.0. Results: On a day level, all devices showed strong correlations (Spearman r=.757-.892) and good agreement (interclass correlation coefficient, ICC=.695-.885) for measuring steps, whereas moderate correlations (Spearman r=.557-.577) and low agreement (ICC=.377-.660) for measuring MVPA. Bland-Altman revealed a systematic overestimation of the wearables for measuring steps but a variation between over- and undercounting of MVPA. On a 15-min level, all devices showed strong correlations (Spearman r=.752-.917) and good agreement (ICC=.792-.887) for measuring steps, whereas weak correlations (Spearman r=.116-.208) and low agreement (ICC=.461-.577) for measuring MVPA. Bland-Altman revealed a systematic overestimation of the wearables for steps but under- or overestimation for MVPA depending on the device. Conclusions: In sum, all 4 consumer-level devices can be considered accurate step counters in free-living conditions. This study, however, provides evidence of systematic bias for all devices in measurement of MVPA. The results on a 15-min level also indicate that these devices are not sufficiently accurate to provide correct real-time feedback. UR - https://mhealth.jmir.org/2018/12/e10972/ UR - http://dx.doi.org/10.2196/10972 UR - http://www.ncbi.nlm.nih.gov/pubmed/30545810 ID - info:doi/10.2196/10972 ER - TY - JOUR AU - Rönnby, Sara AU - Lundberg, Oscar AU - Fagher, Kristina AU - Jacobsson, Jenny AU - Tillander, Bo AU - Gauffin, Hĺkan AU - Hansson, Per-Olof AU - Dahlström, Örjan AU - Timpka, Toomas PY - 2018/08/13 TI - mHealth Self-Report Monitoring in Competitive Middle- and Long-Distance Runners: Qualitative Study of Long-Term Use Intentions Using the Technology Acceptance Model JO - JMIR Mhealth Uhealth SP - e10270 VL - 6 IS - 8 KW - running KW - mHealth KW - health technology KW - diagnostic self-evaluation KW - remote sensing technology KW - self-evaluation programs KW - qualitative research N2 - Background: International middle- and long-distance running competitions attract millions of spectators in association with city races, world championships, and Olympic Games. It is therefore a major concern that ill health and pain, as a result of sports overuse, lead to numerous hours of lost training and decreased performance in competitive runners. Despite its potential for sustenance of performance, approval of mHealth self-report monitoring (mHSM) in this group of athletes has not been investigated. Objective: The objective of our study was to explore individual and situational factors associated with the acceptance of long-term mHSM in competitive runners. Methods: The study used qualitative research methods with the Technology Acceptance Model as the theoretical foundation. The study population included 20 middle- and long-distance runners competing at national and international levels. Two mHSM apps asking for health and training data from track and marathon runners were created on a platform for web survey development (Briteback AB). Data collection for the technology acceptance analysis was performed via personal interviews before and after a 6-week monitoring period. Preuse interviews investigated experience and knowledge of mHealth monitoring and thoughts on benefits and possible side effects. The postuse interviews addressed usability and usefulness, attitudes toward nonfunctional issues, and intentions to adhere to long-term monitoring. In addition, the runners? trustworthiness when providing mHSM data was discussed. The interview data were investigated using a deductive thematic analysis. Results: The mHSM apps were considered technically easy to use. Although the runners read the instructions and entered data effortlessly, some still perceived mHSM as problematic. Concerns were raised about the selection of items for monitoring (eg, recording training load as running distance or time) and about interpretation of concepts (eg, whether subjective well-being should encompass only the running context or daily living on the whole). Usefulness of specific mHSM apps was consequently not appraised on the same bases in different subcategories of runners. Regarding nonfunctional issues, the runners competing at the international level requested detailed control over who in their sports club and national federation should be allowed access to their data; the less competitive runners had no such issues. Notwithstanding, the runners were willing to adhere to long-term mHSM, provided the technology was adjusted to their personal routines and the output was perceived as contributing to running performance. Conclusions: Adoption of mHSM by competitive runners requires clear definitions of monitoring purpose and populations, repeated in practice tests of monitoring items and terminology, and meticulousness regarding data-sharing routines. Further naturalistic studies of mHSM use in routine sports practice settings are needed with nonfunctional ethical and legal issues included in the evaluation designs. UR - http://mhealth.jmir.org/2018/8/e10270/ UR - http://dx.doi.org/10.2196/10270 UR - http://www.ncbi.nlm.nih.gov/pubmed/30104183 ID - info:doi/10.2196/10270 ER - TY - JOUR AU - Paré, Guy AU - Leaver, Chad AU - Bourget, Claire PY - 2018/05/02 TI - Diffusion of the Digital Health Self-Tracking Movement in Canada: Results of a National Survey JO - J Med Internet Res SP - e177 VL - 20 IS - 5 KW - self-tracking KW - quantified-self KW - wearable devices KW - activity trackers KW - survey methodology N2 - Background: With the ever-increasing availability of mobile apps, consumer wearables, and smart medical devices, more and more individuals are self-tracking and managing their personal health data. Objective: The aim of this study was to investigate the diffusion of the digital self-tracking movement in Canada. It provides a comprehensive, yet detailed account of this phenomenon. It examines the profile of digital self-trackers, traditional self-trackers, and nontrackers, further investigating the primary motivations for self-tracking and reasons for nontracking; barriers to adoption of connected care technologies; users? appreciation of their self-tracking devices, including what they perceive to be the main benefits; factors that influence people?s intention to continue using connected care technologies in the future; and the reasons for usage discontinuance. Methods: We conducted an online survey with a sample of 4109 Canadian adults, one of the largest ever. To ensure a representative sample, quota method was used (gender, age), following stratification by region. The maximum margin of error is estimated at 1.6%, 19 times out of 20. Results: Our findings reveal that 66.20% (2720/4109) of our respondents regularly self-track one or more aspects of their health. About one in 4 respondents (1014/4109, 24.68%) currently owns a wearable or smart medical device, and 57.20% (580/1014) use their devices on a regular basis for self-tracking purposes. Digital self-trackers are typically young or mature adults, healthy, employed, university educated, with an annual family income of over $80,000 CAD. The most popular reported device is the fitness tracker or smartwatch that can capture a range of parameters. Currently, mobile apps and digital self-tracking devices are mainly used to monitor physical activity (856/1669, 51.13%), nutrition (545/1669, 32.65%), sleep patterns (482/1669, 28.88%) and, to a much lesser extent, cardiovascular and pulmonary biomarkers (215/1669, 12.88%), medication intake (126/1669, 7.55%), and glucose level (79/1669, 4.73%). Most users of connected care technologies (481/580, 83.0%) are highly satisfied and 88.2% (511/580) intend to continue using their apps and devices in the future. A majority said smart digital devices have allowed them to maintain or improve their health condition (398/580, 68.5%) and to be better informed about their health in general (387/580, 66.6%). About 33.80% of our sample (1389/4109) is composed of people who do not monitor their health or well-being on a regular basis. Conclusions: Our study shows an opportunity to advance the health of Canadians through connected care technologies. Our findings can be used to set baseline information for future research on the rise of digital health self-tracking and its impacts. Although the use of mobile apps, consumer wearables, and smart medical devices could potentially benefit the growing population of patients with chronic conditions, the question remains as to whether it will diffuse broadly beyond early adopters and across cost inequities. UR - http://www.jmir.org/2018/5/e177/ UR - http://dx.doi.org/10.2196/jmir.9388 UR - http://www.ncbi.nlm.nih.gov/pubmed/29720359 ID - info:doi/10.2196/jmir.9388 ER - TY - JOUR AU - Régnier, Faustine AU - Chauvel, Louis PY - 2018/04/20 TI - Digital Inequalities in the Use of Self-Tracking Diet and Fitness Apps: Interview Study on the Influence of Social, Economic, and Cultural Factors JO - JMIR Mhealth Uhealth SP - e101 VL - 6 IS - 4 KW - diet KW - digital divide KW - fitness trackers KW - France KW - healthy diet KW - physical activity KW - social networking KW - social participation KW - weight loss N2 - Background: Digital devices are driving economic and social transformations, but assessing the uses, perceptions, and impact of these new technologies on diet and physical activity remains a major societal challenge. Objective: We aimed to determine under which social, economic, and cultural conditions individuals in France were more likely to be actively invested in the use of self-tracking diet and fitness apps for better health behaviors. Methods: Existing users of 3 diet and fitness self-tracking apps (Weight Watchers, MyFitnessPal, and sport apps) were recruited from 3 regions of France. We interviewed 79 individuals (Weight Watchers, n=37; MyFitnessPal, n=20; sport apps, n=22). In-depth semistructured interviews were conducted with each participant, using open-ended questions about their use of diet and fitness apps. A triangulation of methods (content, textual, and quantitative analyses) was performed. Results: We found 3 clusters of interviewees who differed by social background and curative goal linked to use under constraint versus preventive goal linked to chosen use, and intensity of their self-quantification efforts and participation in social networks. Interviewees used the apps for a diversity of uses, including measurement, tracking, quantification, and participation in digital communities. A digital divide was highlighted, comprising a major social gap. Social conditions for appropriation of self-tracking devices included sociodemographic factors, life course stages, and cross-cutting factors of heterogeneity. Conclusions: Individuals from affluent or intermediate social milieus were most likely to use the apps and to participate in the associated online social networks. These interviewees also demonstrated a preventive approach to a healthy lifestyle. Individuals from lower milieus were more reluctant to use digital devices relating to diet and physical activity or to participate in self-quantification. The results of the study have major implications for public health: the digital self-quantification device is intrinsically less important than the way the individual uses it, in terms of adoption of successful health behaviors. UR - http://mhealth.jmir.org/2018/4/e101/ UR - http://dx.doi.org/10.2196/mhealth.9189 UR - http://www.ncbi.nlm.nih.gov/pubmed/29678807 ID - info:doi/10.2196/mhealth.9189 ER - TY - JOUR AU - Imschloss, Monika AU - Lorenz, Jana PY - 2018/04/11 TI - How Mobile App Design Impacts User Responses to Mixed Self-Tracking Outcomes: Randomized Online Experiment to Explore the Role of Spatial Distance for Hedonic Editing JO - JMIR Mhealth Uhealth SP - e81 VL - 6 IS - 4 KW - mobile apps KW - self-tracking KW - user interaction design KW - goal setting N2 - Background: Goal setting is among the most common behavioral change techniques employed in contemporary self-tracking apps. For these techniques to be effective, it is relevant to understand how the visual presentation of goal-related outcomes employed in the app design affects users? responses to their self-tracking outcomes. Objective: This study examined whether a spatially close (vs distant) presentation of mixed positive and negative self-tracking outcomes from multiple domains (ie, activity, diet) on a digital device?s screen can provide users the opportunity to hedonically edit their self-tracking outcome profile (ie, to view their mixed self-tracking outcomes in the most positive light). Further, this study examined how the opportunity to hedonically edit one?s self-tracking outcome profile relates to users? future health behavior intentions. Methods: To assess users? responses to a spatially close (vs distant) presentation of a mixed-gain (vs mixed-loss) self-tracking outcome profile, a randomized 2×2 between-subjects online experiment with a final sample of 397 participants (mean age 27.4, SD 7.2 years; 71.5%, 284/397 female) was conducted in Germany. The experiment started with a cover story about a fictitious self-tracking app. Thereafter, participants saw one of four manipulated self-tracking outcome profiles. Variables of interest measured were health behavior intentions, compensatory health beliefs, health motivation, and recall of the outcome profile. We analyzed data using chi-square tests (SPSS version 23) and moderated mediation analyses with the PROCESS macro 2.16.1. Results: Spatial distance facilitated hedonic editing, which was indicated by systematic memory biases in users? recall of positive and negative self-tracking outcomes. In the case of a mixed-gain outcome profile, a spatially close (vs distant) presentation tended to increase the underestimation of the negative outcome (P=.06). In the case of a mixed-loss outcome profile, a spatially distant (vs close) presentation facilitated the exact recognition of the positive outcome (P=.04). When the presentation of self-tracking outcomes provided the opportunity for hedonic editing, users with a low (vs high) health motivation produced compensatory health beliefs, which led to lower health behavior intentions (index of moderated mediation=0.0352, 95% CI 0.0011-0.0923). Conclusions: When spatial distance between the presentations of mixed self-tracking outcomes provided the opportunity to hedonically edit one?s self-tracking outcome profile, users recalled their self-tracking outcomes in a more positive light. Especially for users with lower health motivation, the opportunity to hedonically edit one?s mixed self-tracking outcome profile led to reduced health behavior intentions. To prevent the occurrence of hedonic editing in users? responses to visually presented self-tracking outcome profiles, further research is necessary to determine the ideal distance that should be employed in the app design for the presentation of mixed self-tracking outcomes on a digital device?s screen. UR - http://mhealth.jmir.org/2018/4/e81/ UR - http://dx.doi.org/10.2196/mhealth.9055 UR - http://www.ncbi.nlm.nih.gov/pubmed/29643051 ID - info:doi/10.2196/mhealth.9055 ER - TY - JOUR AU - Gabriels, Katleen AU - Moerenhout, Tania PY - 2018/01/12 TI - Exploring Entertainment Medicine and Professionalization of Self-Care: Interview Study Among Doctors on the Potential Effects of Digital Self-Tracking JO - J Med Internet Res SP - e10 VL - 20 IS - 1 KW - mobile applications KW - wearable electronic devices KW - self-recorded health data KW - self care KW - quantified self KW - qualitative research N2 - Background: Nowadays, digital self-tracking devices offer a plethora of possibilities to both healthy and chronically ill users who want to closely examine their body. This study suggests that self-tracking in a private setting will lead to shifting understandings in professional care. To provide more insight into these shifts, this paper seeks to lay bare the promises and challenges of self-tracking while staying close to the everyday professional experience of the physician. Objective: The aim of this study was to (1) offer an analysis of how medical doctors evaluate self-tracking methods in their practice and (2) explore the anticipated shifts that digital self-care will bring about in relation to our findings and those of other studies. Methods: A total of 12 in-depth semistructured interviews with general practitioners (GPs) and cardiologists were conducted in Flanders, Belgium, from November 2015 to November 2016. Thematic analysis was applied to examine the transcripts in an iterative process. Results: Four major themes arose in our body of data: (1) the patient as health manager, (2) health obsession and medicalization, (3) information management, and (4) shifting roles of the doctors and impact on the health care organization. Our research findings show a nuanced understanding of the potentials and pitfalls of different forms of self-tracking. The necessity of contextualization of self-tracking data and a professionalization of self-care through digital devices come to the fore as important overarching concepts. Conclusions: This interview study with Belgian doctors examines the potentials and challenges of self-monitoring while focusing on the everyday professional experience of the physician. The dialogue between our dataset and the existing literature affords a fine-grained image of digital self-care and its current meaning in a medical-professional landscape. UR - http://www.jmir.org/2018/1/e10/ UR - http://dx.doi.org/10.2196/jmir.8040 UR - http://www.ncbi.nlm.nih.gov/pubmed/29330140 ID - info:doi/10.2196/jmir.8040 ER - TY - JOUR AU - Whelan, E. Maxine AU - Morgan, S. Paul AU - Sherar, B. Lauren AU - Kingsnorth, P. Andrew AU - Magistro, Daniele AU - Esliger, W. Dale PY - 2017/11/08 TI - Brain Activation in Response to Personalized Behavioral and Physiological Feedback From Self-Monitoring Technology: Pilot Study JO - J Med Internet Res SP - e384 VL - 19 IS - 11 KW - functional magnetic resonance imaging KW - neuroimaging KW - physical activity KW - sedentary behavior KW - interstitial glucose N2 - Background: The recent surge in commercially available wearable technology has allowed real-time self-monitoring of behavior (eg, physical activity) and physiology (eg, glucose levels). However, there is limited neuroimaging work (ie, functional magnetic resonance imaging [fMRI]) to identify how people?s brains respond to receiving this personalized health feedback and how this impacts subsequent behavior. Objective: Identify regions of the brain activated and examine associations between activation and behavior. Methods: This was a pilot study to assess physical activity, sedentary time, and glucose levels over 14 days in 33 adults (aged 30 to 60 years). Extracted accelerometry, inclinometry, and interstitial glucose data informed the construction of personalized feedback messages (eg, average number of steps per day). These messages were subsequently presented visually to participants during fMRI. Participant physical activity levels and sedentary time were assessed again for 8 days following exposure to this personalized feedback. Results: Independent tests identified significant activations within the prefrontal cortex in response to glucose feedback compared with behavioral feedback (P<.001). Reductions in mean sedentary time (589.0 vs 560.0 minutes per day, P=.014) were observed. Activation in the subgyral area had a moderate correlation with minutes of moderate-to-vigorous physical activity (r=0.392, P=.043). Conclusion: Presenting personalized glucose feedback resulted in significantly more brain activation when compared with behavior. Participants reduced time spent sedentary at follow-up. Research on deploying behavioral and physiological feedback warrants further investigation. UR - http://www.jmir.org/2017/11/e384/ UR - http://dx.doi.org/10.2196/jmir.8890 UR - http://www.ncbi.nlm.nih.gov/pubmed/29117928 ID - info:doi/10.2196/jmir.8890 ER - TY - JOUR AU - Almalki, Manal AU - Gray, Kathleen AU - Martin-Sanchez, Fernando PY - 2017/11/03 TI - Development and Validation of a Taxonomy for Characterizing Measurements in Health Self-Quantification JO - J Med Internet Res SP - e378 VL - 19 IS - 11 KW - health KW - self-management KW - self-experimentation KW - wearables KW - quantified self KW - taxonomy KW - classification N2 - Background: The use of wearable tools for health self-quantification (SQ) introduces new ways of thinking about one?s body and about how to achieve desired health outcomes. Measurements from individuals, such as heart rate, respiratory volume, skin temperature, sleep, mood, blood pressure, food consumed, and quality of surrounding air can be acquired, quantified, and aggregated in a holistic way that has never been possible before. However, health SQ still lacks a formal common language or taxonomy for describing these kinds of measurements. Establishing such taxonomy is important because it would enable systematic investigations that are needed to advance in the use of wearable tools in health self-care. For a start, a taxonomy would help to improve the accuracy of database searching when doing systematic reviews and meta-analyses in this field. Overall, more systematic research would contribute to build evidence of sufficient quality to determine whether and how health SQ is a worthwhile health care paradigm. Objective: The aim of this study was to investigate a sample of SQ tools and services to build and test a taxonomy of measurements in health SQ, titled: the classification of data and activity in self-quantification systems (CDA-SQS). Methods: Eight health SQ tools and services were selected to be examined: Zeo Sleep Manager, Fitbit Ultra, Fitlinxx Actipressure, MoodPanda, iBGStar, Sensaris Senspod, 23andMe, and uBiome. An open coding analytical approach was used to find all the themes related to the research aim. Results: This study distinguished three types of measurements in health SQ: body structures and functions, body actions and activities, and around the body. Conclusions: The CDA-SQS classification should be applicable to align health SQ measurement data from people with many different health objectives, health states, and health conditions. CDA-SQS is a critical contribution to a much more consistent way of studying health SQ. UR - http://www.jmir.org/2017/11/e378/ UR - http://dx.doi.org/10.2196/jmir.6903 UR - http://www.ncbi.nlm.nih.gov/pubmed/29101092 ID - info:doi/10.2196/jmir.6903 ER - TY - JOUR AU - Rodríguez, Iyubanit AU - Herskovic, Valeria AU - Gerea, Carmen AU - Fuentes, Carolina AU - Rossel, O. Pedro AU - Marques, Maíra AU - Campos, Mauricio PY - 2017/10/27 TI - Understanding Monitoring Technologies for Adults With Pain: Systematic Literature Review JO - J Med Internet Res SP - e364 VL - 19 IS - 10 KW - systematic review KW - pain KW - technology KW - patient monitoring KW - ubiquitous and mobile computing N2 - Background: Monitoring of patients may decrease treatment costs and improve quality of care. Pain is the most common health problem that people seek help for in hospitals. Therefore, monitoring patients with pain may have significant impact in improving treatment. Several studies have studied factors affecting pain; however, no previous study has reviewed the contextual information that a monitoring system may capture to characterize a patient?s situation. Objective: The objective of this study was to conduct a systematic review to (1) determine what types of technologies have been used to monitor adults with pain, and (2) construct a model of the context information that may be used to implement apps and devices aimed at monitoring adults with pain. Methods: A literature search (2005-2015) was conducted in electronic databases pertaining to medical and computer science literature (PubMed, Science Direct, ACM Digital Library, and IEEE Xplore) using a defined search string. Article selection was done through a process of removing duplicates, analyzing title and abstract, and then reviewing the full text of the article. Results: In the final analysis, 87 articles were included and 53 of them (61%) used technologies to collect contextual information. A total of 49 types of context information were found and a five-dimension (activity, identity, wellness, environment, physiological) model of context information to monitor adults with pain was proposed, expanding on a previous model. Most technological interfaces for pain monitoring were wearable, possibly because they can be used in more realistic contexts. Few studies focused on older adults, creating a relevant avenue of research on how to create devices for users that may have impaired cognitive skills or low digital literacy. Conclusions: The design of monitoring devices and interfaces for adults with pain must deal with the challenge of selecting relevant contextual information to understand the user?s situation, and not overburdening or inconveniencing users with information requests. A model of contextual information may be used by researchers to choose possible contextual information that may be monitored during studies on adults with pain. UR - http://www.jmir.org/2017/10/e364/ UR - http://dx.doi.org/10.2196/jmir.7279 UR - http://www.ncbi.nlm.nih.gov/pubmed/29079550 ID - info:doi/10.2196/jmir.7279 ER - TY - JOUR AU - Duncan, Mitch AU - Murawski, Beatrice AU - Short, E. Camille AU - Rebar, L. Amanda AU - Schoeppe, Stephanie AU - Alley, Stephanie AU - Vandelanotte, Corneel AU - Kirwan, Morwenna PY - 2017/08/14 TI - Activity Trackers Implement Different Behavior Change Techniques for Activity, Sleep, and Sedentary Behaviors JO - Interact J Med Res SP - e13 VL - 6 IS - 2 KW - health behavior KW - public health KW - exercise KW - sleep KW - behavior change KW - fitness trackers KW - adult, mobile applications N2 - Background: Several studies have examined how the implementation of behavior change techniques (BCTs) varies between different activity trackers. However, activity trackers frequently allow tracking of activity, sleep, and sedentary behaviors; yet, it is unknown how the implementation of BCTs differs between these behaviors. Objective: The aim of this study was to assess the number and type of BCTs that are implemented by wearable activity trackers (self-monitoring systems) in relation to activity, sleep, and sedentary behaviors and to determine whether the number and type of BCTs differ between behaviors. Methods: Three self-monitoring systems (Fitbit [Charge HR], Garmin [Vivosmart], and Jawbone [UP3]) were each used for a 1-week period in August 2015. Each self-monitoring system was used by two of the authors (MJD and BM) concurrently. The Coventry, Aberdeen, and London-Refined (CALO-RE) taxonomy was used to assess the implementation of 40 BCTs in relation to activity, sleep, and sedentary behaviors. Discrepancies in ratings were resolved by discussion, and interrater agreement in the number of BCTs implemented was assessed using kappa statistics. Results: Interrater agreement ranged from 0.64 to 1.00. From a possible range of 40 BCTs, the number of BCTs present for activity ranged from 19 (Garmin) to 33 (Jawbone), from 4 (Garmin) to 29 (Jawbone) for sleep, and 0 (Fitbit) to 10 (Garmin) for sedentary behavior. The average number of BCTs implemented was greatest for activity (n=26) and smaller for sleep (n=14) and sedentary behavior (n=6). Conclusions: The number and type of BCTs implemented varied between each of the systems and between activity, sleep, and sedentary behaviors. This provides an indication of the potential of these systems to change these behaviors, but the long-term effectiveness of these systems to change activity, sleep, and sedentary behaviors remains unknown. UR - http://www.i-jmr.org/2017/2/e13/ UR - http://dx.doi.org/10.2196/ijmr.6685 UR - http://www.ncbi.nlm.nih.gov/pubmed/28807889 ID - info:doi/10.2196/ijmr.6685 ER - TY - JOUR AU - Lentferink, J. Aniek AU - Oldenhuis, KE Hilbrand AU - de Groot, Martijn AU - Polstra, Louis AU - Velthuijsen, Hugo AU - van Gemert-Pijnen, EWC Julia PY - 2017/08/01 TI - Key Components in eHealth Interventions Combining Self-Tracking and Persuasive eCoaching to Promote a Healthier Lifestyle: A Scoping Review JO - J Med Internet Res SP - e277 VL - 19 IS - 8 KW - telemedicine KW - review KW - health promotion KW - remote sensing technology N2 - Background: The combination of self-tracking and persuasive eCoaching in automated interventions is a new and promising approach for healthy lifestyle management. Objective: The aim of this study was to identify key components of self-tracking and persuasive eCoaching in automated healthy lifestyle interventions that contribute to their effectiveness on health outcomes, usability, and adherence. A secondary aim was to identify the way in which these key components should be designed to contribute to improved health outcomes, usability, and adherence. Methods: The scoping review methodology proposed by Arskey and O?Malley was applied. Scopus, EMBASE, PsycINFO, and PubMed were searched for publications dated from January 1, 2013 to January 31, 2016 that included (1) self-tracking, (2) persuasive eCoaching, and (3) healthy lifestyle intervention. Results: The search resulted in 32 publications, 17 of which provided results regarding the effect on health outcomes, 27 of which provided results regarding usability, and 13 of which provided results regarding adherence. Among the 32 publications, 27 described an intervention. The most commonly applied persuasive eCoaching components in the described interventions were personalization (n=24), suggestion (n=19), goal-setting (n=17), simulation (n=17), and reminders (n=15). As for self-tracking components, most interventions utilized an accelerometer to measure steps (n=11). Furthermore, the medium through which the user could access the intervention was usually a mobile phone (n=10). The following key components and their specific design seem to influence both health outcomes and usability in a positive way: reduction by setting short-term goals to eventually reach long-term goals, personalization of goals, praise messages, reminders to input self-tracking data into the technology, use of validity-tested devices, integration of self-tracking and persuasive eCoaching, and provision of face-to-face instructions during implementation. In addition, health outcomes or usability were not negatively affected when more effort was requested from participants to input data into the technology. The data extracted from the included publications provided limited ability to identify key components for adherence. However, one key component was identified for both usability and adherence, namely the provision of personalized content. Conclusions: This scoping review provides a first overview of the key components in automated healthy lifestyle interventions combining self-tracking and persuasive eCoaching that can be utilized during the development of such interventions. Future studies should focus on the identification of key components for effects on adherence, as adherence is a prerequisite for an intervention to be effective. UR - http://www.jmir.org/2017/8/e277/ UR - http://dx.doi.org/10.2196/jmir.7288 UR - http://www.ncbi.nlm.nih.gov/pubmed/28765103 ID - info:doi/10.2196/jmir.7288 ER - TY - JOUR AU - Painter, Lynn Stefanie AU - Ahmed, Rezwan AU - Hill, O. James AU - Kushner, F. Robert AU - Lindquist, Richard AU - Brunning, Scott AU - Margulies, Amy PY - 2017/05/12 TI - What Matters in Weight Loss? An In-Depth Analysis of Self-Monitoring JO - J Med Internet Res SP - e160 VL - 19 IS - 5 KW - behavior KW - body mass index KW - fitness trackers KW - self-monitoring KW - obesity KW - overweight KW - weight loss N2 - Background: Using technology to self-monitor body weight, dietary intake, and physical activity is a common practice used by consumers and health companies to increase awareness of current and desired behaviors in weight loss. Understanding how to best use the information gathered by these relatively new methods needs to be further explored. Objective: The purpose of this study was to analyze the contribution of self-monitoring to weight loss in participants in a 6-month commercial weight-loss intervention administered by Retrofit and to specifically identify the significant contributors to weight loss that are associated with behavior and outcomes. Methods: A retrospective analysis was performed using 2113 participants enrolled from 2011 to 2015 in a Retrofit weight-loss program. Participants were males and females aged 18 years or older with a starting body mass index of ?25 kg/m2, who also provided a weight measurement at the sixth month of the program. Multiple regression analysis was performed using all measures of self-monitoring behaviors involving weight measurements, dietary intake, and physical activity to predict weight loss at 6 months. Each significant predictor was analyzed in depth to reveal the impact on outcome. Results: Participants in the Retrofit Program lost a mean ?5.58% (SE 0.12) of their baseline weight with 51.87% (1096/2113) of participants losing at least 5% of their baseline weight. Multiple regression model (R2=.197, P<0.001) identified the following measures as significant predictors of weight loss at 6 months: number of weigh-ins per week (P<.001), number of steps per day (P=.02), highly active minutes per week (P<.001), number of food log days per week (P<.001), and the percentage of weeks with five or more food logs (P<.001). Weighing in at least three times per week, having a minimum of 60 highly active minutes per week, food logging at least three days per week, and having 64% (16.6/26) or more weeks with at least five food logs were associated with clinically significant weight loss for both male and female participants. Conclusions: The self-monitoring behaviors of self-weigh-in, daily steps, high-intensity activity, and persistent food logging were significant predictors of weight loss during a 6-month intervention. UR - http://www.jmir.org/2017/5/e160/ UR - http://dx.doi.org/10.2196/jmir.7457 UR - http://www.ncbi.nlm.nih.gov/pubmed/28500022 ID - info:doi/10.2196/jmir.7457 ER - TY - JOUR AU - Dooley, E. Erin AU - Golaszewski, M. Natalie AU - Bartholomew, B. John PY - 2017/03/16 TI - Estimating Accuracy at Exercise Intensities: A Comparative Study of Self-Monitoring Heart Rate and Physical Activity Wearable Devices JO - JMIR Mhealth Uhealth SP - e34 VL - 5 IS - 3 KW - motor activity KW - physical exertion KW - exercise KW - monitoring, physiologic KW - energy metabolism KW - heart rate KW - photoplethysmography N2 - Background: Physical activity tracking wearable devices have emerged as an increasingly popular method for consumers to assess their daily activity and calories expended. However, whether these wearable devices are valid at different levels of exercise intensity is unknown. Objective: The objective of this study was to examine heart rate (HR) and energy expenditure (EE) validity of 3 popular wrist-worn activity monitors at different exercise intensities. Methods: A total of 62 participants (females: 58%, 36/62; nonwhite: 47% [13/62 Hispanic, 8/62 Asian, 7/62 black/ African American, 1/62 other]) wore the Apple Watch, Fitbit Charge HR, and Garmin Forerunner 225. Validity was assessed using 2 criterion devices: HR chest strap and a metabolic cart. Participants completed a 10-minute seated baseline assessment; separate 4-minute stages of light-, moderate-, and vigorous-intensity treadmill exercises; and a 10-minute seated recovery period. Data from devices were compared with each criterion via two-way repeated-measures analysis of variance and Bland-Altman analysis. Differences are expressed in mean absolute percentage error (MAPE). Results: For the Apple Watch, HR MAPE was between 1.14% and 6.70%. HR was not significantly different at the start (P=.78), during baseline (P=.76), or vigorous intensity (P=.84); lower HR readings were measured during light intensity (P=.03), moderate intensity (P=.001), and recovery (P=.004). EE MAPE was between 14.07% and 210.84%. The device measured higher EE at all stages (P<.01). For the Fitbit device, the HR MAPE was between 2.38% and 16.99%. HR was not significantly different at the start (P=.67) or during moderate intensity (P=.34); lower HR readings were measured during baseline, vigorous intensity, and recovery (P<.001) and higher HR during light intensity (P<.001). EE MAPE was between 16.85% and 84.98%. The device measured higher EE at baseline (P=.003), light intensity (P<.001), and moderate intensity (P=.001). EE was not significantly different at vigorous (P=.70) or recovery (P=.10). For Garmin Forerunner 225, HR MAPE was between 7.87% and 24.38%. HR was not significantly different at vigorous intensity (P=.35). The device measured higher HR readings at start, baseline, light intensity, moderate intensity (P<.001), and recovery (P=.04). EE MAPE was between 30.77% and 155.05%. The device measured higher EE at all stages (P<.001). Conclusions: This study provides one of the first validation assessments for the Fitbit Charge HR, Apple Watch, and Garmin Forerunner 225. An advantage and novel approach of the study is the examination of HR and EE at specific physical activity intensities. Establishing validity of wearable devices is of particular interest as these devices are being used in weight loss interventions and could impact findings. Future research should investigate why differences between exercise intensities and the devices exist. UR - http://mhealth.jmir.org/2017/3/e34/ UR - http://dx.doi.org/10.2196/mhealth.7043 UR - http://www.ncbi.nlm.nih.gov/pubmed/28302596 ID - info:doi/10.2196/mhealth.7043 ER - TY - JOUR AU - Kim, Young Ju AU - Wineinger, E. Nathan AU - Taitel, Michael AU - Radin, M. Jennifer AU - Akinbosoye, Osayi AU - Jiang, Jenny AU - Nikzad, Nima AU - Orr, Gregory AU - Topol, Eric AU - Steinhubl, Steve PY - 2016/11/17 TI - Self-Monitoring Utilization Patterns Among Individuals in an Incentivized Program for Healthy Behaviors JO - J Med Internet Res SP - e292 VL - 18 IS - 11 KW - health behavior KW - mobile health KW - mobile apps KW - reward KW - self blood pressure monitoring KW - blood glucose self-monitoring N2 - Background: The advent of digital technology has enabled individuals to track meaningful biometric data about themselves. This novel capability has spurred nontraditional health care organizations to develop systems that aid users in managing their health. One of the most prolific systems is Walgreens Balance Rewards for healthy choices (BRhc) program, an incentivized, Web-based self-monitoring program. Objective: This study was performed to evaluate health data self-tracking characteristics of individuals enrolled in the Walgreens? BRhc program, including the impact of manual versus automatic data entries through a supported device or apps. Methods: We obtained activity tracking data from a total of 455,341 BRhc users during 2014. Upon identifying users with sufficient follow-up data, we explored temporal trends in user participation. Results: Thirty-four percent of users quit participating after a single entry of an activity. Among users who tracked at least two activities on different dates, the median length of participating was 8 weeks, with an average of 5.8 activities entered per week. Furthermore, users who participated for at least twenty weeks (28.3% of users; 33,078/116,621) consistently entered 8 to 9 activities per week. The majority of users (77%; 243,774/315,744) recorded activities through manual data entry alone. However, individuals who entered activities automatically through supported devices or apps participated roughly four times longer than their manual activity-entering counterparts (average 20 and 5 weeks, respectively; P<.001). Conclusions: This study provides insights into the utilization patterns of individuals participating in an incentivized, Web-based self-monitoring program. Our results suggest automated health tracking could significantly improve long-term health engagement. UR - http://www.jmir.org/2016/11/e292/ UR - http://dx.doi.org/10.2196/jmir.6371 UR - http://www.ncbi.nlm.nih.gov/pubmed/27856407 ID - info:doi/10.2196/jmir.6371 ER - TY - JOUR AU - Almalki, Manal AU - Gray, Kathleen AU - Martin-Sanchez, Fernando PY - 2016/05/27 TI - Activity Theory as a Theoretical Framework for Health Self-Quantification: A Systematic Review of Empirical Studies JO - J Med Internet Res SP - e131 VL - 18 IS - 5 KW - activities of daily living KW - diagnostic self-evaluation KW - patient activation KW - patient participation KW - self-care KW - self-experimentation KW - self-management KW - user-computer interface KW - activity theory KW - human-computer interaction KW - self-quantification KW - self-tracking KW - personal informatics KW - quantified self KW - self-monitoring N2 - Background: Self-quantification (SQ) is a way of working in which, by using tracking tools, people aim to collect, manage, and reflect on personal health data to gain a better understanding of their own body, health behavior, and interaction with the world around them. However, health SQ lacks a formal framework for describing the self-quantifiers? activities and their contextual components or constructs to pursue these health related goals. Establishing such framework is important because it is the first step to operationalize health SQ fully. This may in turn help to achieve the aims of health professionals and researchers who seek to make or study changes in the self-quantifiers? health systematically. Objective: The aim of this study was to review studies on health SQ in order to answer the following questions: What are the general features of the work and the particular activities that self-quantifiers perform to achieve their health objectives? What constructs of health SQ have been identified in the scientific literature? How have these studies described such constructs? How would it be possible to model these constructs theoretically to characterize the work of health SQ? Methods: A systematic review of peer-reviewed literature was conducted. A total of 26 empirical studies were included. The content of these studies was thematically analyzed using Activity Theory as an organizing framework. Results: The literature provided varying descriptions of health SQ as data-driven and objective-oriented work mediated by SQ tools. From the literature, we identified two types of SQ work: work on data (ie, data management activities) and work with data (ie, health management activities). Using Activity Theory, these activities could be characterized into 6 constructs: users, tracking tools, health objectives, division of work, community or group setting, and SQ plan and rules. We could not find a reference to any single study that accounted for all these activities and constructs of health SQ activity. Conclusions: A Health Self-Quantification Activity Framework is presented, which shows SQ tool use in context, in relation to the goals, plans, and competence of the user. This makes it easier to analyze issues affecting SQ activity, and thereby makes it more feasible to address them. This review makes two significant contributions to research in this field: it explores health SQ work and its constructs thoroughly and it adapts Activity Theory to describe health SQ activity systematically. UR - http://www.jmir.org/2016/5/e131/ UR - http://dx.doi.org/10.2196/jmir.5000 UR - http://www.ncbi.nlm.nih.gov/pubmed/27234343 ID - info:doi/10.2196/jmir.5000 ER - TY - JOUR AU - Cadmus-Bertram, Lisa AU - Marcus, H. Bess AU - Patterson, E. Ruth AU - Parker, A. Barbara AU - Morey, L. Brittany PY - 2015/11/19 TI - Use of the Fitbit to Measure Adherence to a Physical Activity Intervention Among Overweight or Obese, Postmenopausal Women: Self-Monitoring Trajectory During 16 Weeks JO - JMIR mHealth uHealth SP - e96 VL - 3 IS - 4 KW - exercise KW - health behavior KW - health promotion KW - Internet KW - mHealth KW - motor activity KW - physical activity KW - technology KW - women N2 - Background: Direct-to-consumer trackers and devices have potential to enhance theory-based physical activity interventions by offering a simple and pleasant way to help participants self-monitor their behavior. A secondary benefit of these devices is the opportunity for investigators to objectively track adherence to physical activity goals across weeks or even months, rather than relying on self-report or a small number of accelerometry wear periods. The use of consumer trackers for continuous monitoring of adherence has considerable potential to enhance physical activity research, but few studies have been published in this rapidly developing area. Objective: The objective of the study was to assess the trajectory of physical activity adherence across a 16-week self-monitoring intervention, as measured by the Fitbit tracker. Methods: Participants were 25 overweight or obese, postmenopausal women enrolled in the intervention arm of a randomized controlled physical activity intervention trial. Each participant received a 16-week technology-based intervention that used the Fitbit physical activity tracker and website. The overall study goal was 150 minutes/week of moderate to vigorous intensity physical activity (MVPA) and 10,000 steps/day; however, goals were set individually for each participant and updated at Week 4 based on progress. Adherence data were collected by the Fitbit and aggregated by Fitabase. Participants also wore an ActiGraph GT3X+ accelerometer for 7 days prior to the intervention and again during Week 16. Results: The median participant logged 10 hours or more/day of Fitbit wear on 95% of the 112 intervention days, with no significant decline in wear over the study period. Participants averaged 7540 (SD 2373) steps/day and 82 minutes/week (SD 43) of accumulated ?fairly active? and ?very active? minutes during the intervention. At Week 4, 80% (20/25) of women chose to maintain/increase their individual MVPA goal and 72% (18/25) of participants chose to maintain/increase their step goal. Physical activity levels were relatively stable after peaking at 3 weeks, with only small declines of 8% for steps (P=.06) and 14% for MVPA (P=.05) by 16 weeks. Conclusions: These data indicate that a sophisticated, direct-to-consumer activity tracker encouraged high levels of self-monitoring that were sustained over 16 weeks. Further study is needed to determine how to motivate additional gains in physical activity and evaluate the long-term utility of the Fitbit tracker as part of a strategy for chronic disease prevention. Trial Registration: Clinicaltrials.gov NCT01837147; http://clinicaltrials.gov/ct2/show/NCT01837147 (Archived by WebCite at http://www.webcitation.org/6d0VeQpvB) UR - http://mhealth.jmir.org/2015/4/e96/ UR - http://dx.doi.org/10.2196/mhealth.4229 UR - http://www.ncbi.nlm.nih.gov/pubmed/26586418 ID - info:doi/10.2196/mhealth.4229 ER - TY - JOUR AU - Wark, D. John AU - Henningham, Lucy AU - Gorelik, Alexandra AU - Jayasinghe, Yasmin AU - Hartley, Stefanie AU - Garland, Marie Suzanne PY - 2015/10/05 TI - Basal Temperature Measurement Using a Multi-Sensor Armband in Australian Young Women: A Comparative Observational Study JO - JMIR mHealth uHealth SP - e94 VL - 3 IS - 4 KW - basal body temperature KW - young female health initiative KW - BodyMedia SenseWear KW - ovulation KW - menstrual cycle, young women N2 - Background: The menstrual cycle is a key marker of health in women of reproductive age. Monitoring ovulation is useful in health studies involving young women. The upward shift in basal body temperature, which occurs shortly after ovulation and continues until the next menses, is a potentially useful marker of ovulation, which has been exploited in clinical and research settings. Objective: We investigated the utility of BodyMedia SenseWear (BMSW) in monitoring ovulation in young women by analyzing the correlation and agreement of basal temperatures measured using BMSW and a digital oral thermometer. Methods: Kappa statistics were used to determine the agreement in ovulation detection between the two devices, for each participant, under each form of analysis. Participants also completed an online questionnaire assessing the acceptability of both devices. Results: We recruited 16 participants with 15 of them providing analyzable data (11 OCP non-users, 4 OCP users). Weak to moderate correlations were observed between thermometer and BMSW temperature measurements averaged over 5 different time intervals. However, no agreement between methods was observed using Bland-Altman plots. There was a significant difference in the range of temperatures that each device recorded (thermometer: 35.3-37.2°C, BMSW: 29.7-36.7°C) with BMSW temperatures significantly lower than thermometer temperatures: mean 34.6°C (SD 1.2) versus 36.4°C (SD 0.3) respectively, P<.001. Poor agreement was observed between devices under quantitative analysis of ovulation while fair agreement was observed under visual analysis. Under both quantitative and visual analysis, there was 0% agreement for evidence of ovulation. Conclusions: This study demonstrated the importance of evaluating biomeasures collected using mobile monitoring devices by comparison with standard methods. It revealed a relatively poor correlation between BMSW and oral thermometer temperature readings and suggested that BMSW is unlikely to detect an upward shift in basal body temperature. Participant behavior suggested poor compliance in the use of BMSW for basal temperature measurement and that the basal body temperature method may not be suitable for use in unselected samples of young women. There is a need for research tools for monitoring ovulation that are simple, self-administered, and inexpensive, yet appealing to young women. UR - http://mhealth.jmir.org/2015/4/e94/ UR - http://dx.doi.org/10.2196/mhealth.4263 UR - http://www.ncbi.nlm.nih.gov/pubmed/26441468 ID - info:doi/10.2196/mhealth.4263 ER - TY - JOUR AU - Chung, Chia-Fang AU - Cook, Jonathan AU - Bales, Elizabeth AU - Zia, Jasmine AU - Munson, A. Sean PY - 2015/08/21 TI - More Than Telemonitoring: Health Provider Use and Nonuse of Life-Log Data in Irritable Bowel Syndrome and Weight Management JO - J Med Internet Res SP - e203 VL - 17 IS - 8 KW - life logs KW - behavioral self-monitoring KW - clinical care KW - chronic disease KW - health KW - wellness KW - personal informatics KW - quantified self N2 - Background: The quantified self, self-monitoring or life-logging movement is a trend to incorporate technology into data acquisition on aspects of a person's daily life in terms of inputs (eg food consumed), states (eg mood), and performance (mental and physical). Consumer self-monitoring mobile phone apps have been widely studied and used to promote healthy behavior changes. Data collected through life-logging apps also have the potential to support clinical care. Objective: We sought to develop an in-depth understanding of providers? facilitators and barriers to successfully integrating life-log data into their practices and creating better experiences. We specifically investigated three research questions: How do providers currently use patient-collected life-log data in clinical practice? What are provider concerns and needs with respect to this data? What are the constraints for providers to integrate this type of data into their workflows? Methods: We interviewed 21 health care providers?physicians, dietitians, a nurse practitioner, and a behavioral psychologist?who work with obese and irritable bowel syndrome patients. We transcribed and analyzed interviews according to thematic analysis and an affinity diagramming process. Results: Providers reported using self-monitoring data to enhance provider-patient communication, develop personalized treatment plans, and to motivate and educate patients, in addition to using them as diagnostic and adherence tools. However, limitations associated with current systems and workflows create barriers to regular and effective review of this data. These barriers include a lack of time to review detailed records, questions about providers' expertise to review it, and skepticism about additional benefits offered by reviewing data. Current self-monitoring tools also often lack flexibility, standardized formats, and mechanisms to share data with providers. Conclusions: Variations in provider needs affect tracking and reviewing needs. Systems to support diagnosis might require better reliability and resolution, while systems to support interaction should support collaborative reflection and communication. Automatic synthesis of data logs could help providers focus on educational goals while communication of contextual information might help providers better understand patient values. We also discuss how current mobile apps and provider systems do, and do not, support these goals, and future design opportunities to realize the potential benefits of using life-logging tools in clinical care. UR - http://www.jmir.org/2015/8/e203/ UR - http://dx.doi.org/10.2196/jmir.4364 UR - http://www.ncbi.nlm.nih.gov/pubmed/26297627 ID - info:doi/10.2196/jmir.4364 ER - TY - JOUR AU - Ancker, S. Jessica AU - Witteman, O. Holly AU - Hafeez, Baria AU - Provencher, Thierry AU - Van de Graaf, Mary AU - Wei, Esther PY - 2015/08/19 TI - ?You Get Reminded You?re a Sick Person?: Personal Data Tracking and Patients With Multiple Chronic Conditions JO - J Med Internet Res SP - e202 VL - 17 IS - 8 KW - medical informatics KW - consumer health information KW - health knowledge, attitudes, practices KW - self-care KW - chronic disease N2 - Background: Consumer health information technologies (HIT) that encourage self-tracking, such as diet and fitness tracking apps and disease journals, are attracting widespread interest among technology-oriented consumers (such as ?quantified self? advocates), entrepreneurs, and the health care industry. Such electronic technologies could potentially benefit the growing population of patients with multiple chronic conditions (MCC). However, MCC is predominantly a condition of the elderly and disproportionately affects the less affluent, so it also seems possible that the barriers to use of consumer HIT would be particularly severe for this patient population. Objective: Our aim was to explore the perspectives of individuals with MCC using a semistructured interview study. Our research questions were (1) How do individuals with MCC track their own health and medical data? and (2) How do patients and providers perceive and use patient-tracked data? Methods: We used semistructured interviews with patients with multiple chronic diseases and providers with experience caring for such patients, as well as participation in a diabetes education group to triangulate emerging themes. Data were analyzed using grounded theory and thematic analysis. Recruitment and analysis took place iteratively until thematic saturation was reached. Results: Interviews were conducted with 22 patients and 7 health care providers. The patients had an average of 3.5 chronic conditions, including type 2 diabetes, heart disease, chronic pain, and depression, and had regular relationships with an average of 5 providers. Four major themes arose from the interviews: (1) tracking this data feels like work for many patients, (2) personal medical data for individuals with chronic conditions are not simply objective facts, but instead provoke strong positive and negative emotions, value judgments, and diverse interpretations, (3) patients track for different purposes, ranging from sense-making to self-management to reporting to the doctor, and (4) patients often notice that physicians trust technologically measured data such as lab reports over patients? self-tracked data. Conclusions: Developers of consumer health information technologies for data tracking (such as diet and exercise apps or blood glucose logs) often assume patients have unlimited enthusiasm for tracking their own health data via technology. However, our findings potentially explain relatively low adoption of consumer HIT, as they suggest that patients with multiple chronic illnesses consider it work to track their own data, that the data can be emotionally charged, and that they may perceive that providers do not welcome it. Similar themes have been found in some individual chronic diseases but appeared more complex because patients often encountered ?illness work? connected to multiple diseases simultaneously and frequently faced additional challenges from aging or difficult comorbidities such as chronic pain, depression, and anxiety. We suggest that to make a public health impact, consumer HIT developers should engage creatively with these pragmatic and emotional issues to reach an audience that is broader than technologically sophisticated early adopters. Novel technologies are likely to be successful only if they clearly reduce patient inconvenience and burden, helping them to accomplish their ?illness work? more efficiently and effectively. UR - http://www.jmir.org/2015/8/e202/ UR - http://dx.doi.org/10.2196/jmir.4209 UR - http://www.ncbi.nlm.nih.gov/pubmed/26290186 ID - info:doi/10.2196/jmir.4209 ER - TY - JOUR AU - Vooijs, Martijn AU - Alpay, L. Laurence AU - Snoeck-Stroband, B. Jiska AU - Beerthuizen, Thijs AU - Siemonsma, C. Petra AU - Abbink, J. Jannie AU - Sont, K. Jacob AU - Rövekamp, A. Ton PY - 2014/10/27 TI - Validity and Usability of Low-Cost Accelerometers for Internet-Based Self-Monitoring of Physical Activity in Patients With Chronic Obstructive Pulmonary Disease JO - Interact J Med Res SP - e14 VL - 3 IS - 4 KW - accelerometers KW - activity monitoring KW - chronic obstructive pulmonary disease KW - validity KW - usability N2 - Background: The importance of regular physical activity for patients with chronic obstructive pulmonary disease (COPD) is well-established. However, many patients do not meet the recommended daily amount. Accelerometers might provide patients with the information needed to increase physical activity in daily life. Objective: Our objective was to assess the validity and usability of low-cost Internet-connected accelerometers. Furthermore we explored patients? preferences with regards to the presentation of and feedback on monitored physical activity. Methods: To assess concurrent validity we conducted a field validation study with patients who wore two low-cost accelerometers, Fitbit and Physical Activity Monitor (PAM), at the same time along with a sophisticated multisensor accelerometer (SenseWear Armband) for 48 hours. Data on energy expenditure assessed from registrations from the two low-cost accelerometers were compared to the well validated SenseWear Armband which served as a reference criterion. Usability was examined in a cross-over study with patients who, in succession, wore the Fitbit and the PAM for 7 consecutive days and filled out a 16 item questionnaire with regards to the use of the corresponding device Results: The agreement between energy expenditure (METs) from the SenseWear Armband with METs estimated by the Fitbit and PAM was good (r=.77) and moderate (r=.41), respectively. The regression model that was developed for the Fitbit explained 92% whereas the PAM-model could explain 89% of total variance in METs measured by the SenseWear. With regards to the usability, both the Fitbit and PAM were well rated on all items. There were no significant differences between the two devices. Conclusions: The low-cost Fitbit and PAM are valid and usable devices to measure physical activity in patients with COPD. These devices may be useful in long-term interventions aiming at increasing physical activity levels in these patients. UR - http://www.i-jmr.org/2014/4/e14/ UR - http://dx.doi.org/10.2196/ijmr.3056 UR - http://www.ncbi.nlm.nih.gov/pubmed/25347989 ID - info:doi/10.2196/ijmr.3056 ER - TY - JOUR AU - Lyons, J. Elizabeth AU - Lewis, H. Zakkoyya AU - Mayrsohn, G. Brian AU - Rowland, L. Jennifer PY - 2014/08/15 TI - Behavior Change Techniques Implemented in Electronic Lifestyle Activity Monitors: A Systematic Content Analysis JO - J Med Internet Res SP - e192 VL - 16 IS - 8 KW - electronic activity monitor KW - mobile KW - mhealth KW - physical activity KW - behavior change technique N2 - Background: Electronic activity monitors (such as those manufactured by Fitbit, Jawbone, and Nike) improve on standard pedometers by providing automated feedback and interactive behavior change tools via mobile device or personal computer. These monitors are commercially popular and show promise for use in public health interventions. However, little is known about the content of their feedback applications and how individual monitors may differ from one another. Objective: The purpose of this study was to describe the behavior change techniques implemented in commercially available electronic activity monitors. Methods: Electronic activity monitors (N=13) were systematically identified and tested by 3 trained coders for at least 1 week each. All monitors measured lifestyle physical activity and provided feedback via an app (computer or mobile). Coding was based on a hierarchical list of 93 behavior change techniques. Further coding of potentially effective techniques and adherence to theory-based recommendations were based on findings from meta-analyses and meta-regressions in the research literature. Results: All monitors provided tools for self-monitoring, feedback, and environmental change by definition. The next most prevalent techniques (13 out of 13 monitors) were goal-setting and emphasizing discrepancy between current and goal behavior. Review of behavioral goals, social support, social comparison, prompts/cues, rewards, and a focus on past success were found in more than half of the systems. The monitors included a range of 5-10 of 14 total techniques identified from the research literature as potentially effective. Most of the monitors included goal-setting, self-monitoring, and feedback content that closely matched recommendations from social cognitive theory. Conclusions: Electronic activity monitors contain a wide range of behavior change techniques typically used in clinical behavioral interventions. Thus, the monitors may represent a medium by which these interventions could be translated for widespread use. This technology has broad applications for use in clinical, public health, and rehabilitation settings. UR - http://www.jmir.org/2014/8/e192/ UR - http://dx.doi.org/10.2196/jmir.3469 UR - http://www.ncbi.nlm.nih.gov/pubmed/25131661 ID - info:doi/10.2196/jmir.3469 ER - TY - JOUR AU - Kim, Jeongeun PY - 2014/03/04 TI - A Qualitative Analysis of User Experiences With a Self-Tracker for Activity, Sleep, and Diet JO - Interact J Med Res SP - e8 VL - 3 IS - 1 KW - self-tracker KW - quantified-self KW - health consumer KW - qualitative research N2 - Background: The recent increase in chronic diseases and an aging population warrant the necessity of health self-management. As small electronic devices that track one?s activity, sleep, and diet, called self-trackers, are being widely distributed, it is prudent to investigate the user experience and the effectiveness of these devices, and use the information toward engineering better devices that would result in increased efficiency and usability. Objective: The aim of this study was to abstract the constructs that constitute the user experiences of the self-tracker for activity, sleep, and diet. Additionally, we aimed to develop and verify the Health Information Technology Acceptance Model-II (HITAM-II) through a qualitative data analysis approach. Methods: The study group consisted of 18 female college students who participated in an in-depth interview after completing a 3-month study of utilizing a self-tracker designed to monitor activity, sleep, and diet. The steps followed in the analysis were: (1) extraction of constructs from theoretical frameworks, (2) extraction of constructs from interview data using a qualitative methodology, and (3) abstraction of constructs and modeling of the HITAM-II. Results: The constructs that constitute the HITAM-II are information technology factors, personal factors, social factors, attitude, behavioral intention, and behavior. These constructs are further divided into subconstructs to additionally support the HITAM-II. Conclusions: The HITAM-II was found to successfully describe the health consumer?s attitude, behavioral intention, and behavior from another perspective. The result serves as the basis for a unique understanding of the user experiences of HIT. UR - http://www.i-jmr.org/2014/1/e8/ UR - http://dx.doi.org/10.2196/ijmr.2878 UR - http://www.ncbi.nlm.nih.gov/pubmed/24594898 ID - info:doi/10.2196/ijmr.2878 ER -