Background: Paper-based patient decision aids generally present risk information using numbers and/or static images. However, limited psychological research has suggested that when people interactively graph risk information, they process the statistics more actively, making the information more available for decision making. Such interactive tools could potentially be incorporated in a new generation of Web-based decision aids. Objective: The objective of our study was to investigate whether interactive graphics detailing the risk of side effects of two treatments improve knowledge and decision making over standard risk graphics. Methods: A total of 3371 members of a demographically diverse Internet panel viewed a hypothetical scenario about two hypothetical treatments for thyroid cancer. Each treatment had a chance of causing 1 of 2 side effects, but we randomly varied whether one treatment was better on both dimensions (strong dominance condition), slightly better on only one dimension (mild dominance condition), or better on one dimension but worse on the other (trade-off condition) than the other treatment. We also varied whether respondents passively viewed the risk information in static pictograph (icon array) images or actively manipulated the information by using interactive Flash-based animations of “fill-in-the-blank” pictographs. Our primary hypothesis was that active manipulation would increase respondents’ ability to recognize dominance (when available) and choose the better treatment. Results: The interactive risk graphic conditions had significantly worse survey completion rates (1110/1695, 65.5% vs 1316/1659, 79.3%, P < .001) than the static image conditions. In addition, respondents using interactive graphs were less likely to recognize and select the dominant treatment option (234/380, 61.6% vs 343/465, 73.8%, P < .001 in the strong dominance condition). Conclusions: Interactivity, however visually appealing, can both add to respondent burden and distract people from understanding relevant statistical information. Decision-aid developers need to be aware that interactive risk presentations may create worse outcomes than presentations of static risk graphic formats.

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Background: When patients need health information to manage their personal health, they turn to both health professionals and other patients. Yet, we know little about how the information exchanged among patients (ie, patient expertise) contrasts with the information offered by health professionals (ie, clinician expertise). Understanding how patients’ experiential expertise contrasts with the medical expertise of health professionals is necessary to inform the design of peer-support tools that meet patients’ needs, particularly with the growing prevalence of largely unguided advice sharing through Internet-based social software. Objective: The objective of our study was to enhance our understanding of patient expertise and to inform the design of peer-support tools. We compared the characteristics of patient expertise with that of clinician expertise for breast cancer. Methods: Through a comparative content analysis of topics discussed and recommendations offered in Internet message boards and books, we contrasted the topic, form, and style of expertise shared in sources of patient expertise with sources of clinician expertise. Results: Patient expertise focused on strategies for coping with day-to-day personal health issues gained through trial and error of the lived experience; thus, it was predominately personal in topic. It offered a wealth of actionable advice that was frequently expressed through the narrative style of personal stories about managing responsibilities and activities associated with family, friends, work, and the home during illness. In contrast, clinician expertise was carried through a prescriptive style and focused on explicit facts and opinions that tied closely to the health care delivery system, biomedical research, and health professionals’ work. These differences were significant between sources of patient expertise and sources of clinician expertise in topic (P < .001), form (P < .001), and style (P < .001). Conclusion: Patients offer other patients substantial expertise that differs significantly from the expertise offered by health professionals. Our findings suggest that experienced patients do not necessarily serve as “amateur doctors” who offer more accessible but less comprehensive or detailed medical information. Rather, they offer valuable personal information that clinicians cannot necessarily provide. The characteristics of patient expertise and the resulting design implications that we identified will help informaticians enhance the design of peer-support tools that will help meet patients’ diverse information needs.

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Background: Many hospitals have adopted mobile nursing carts that can be easily rolled up to a patient’s bedside to access charts and help nurses perform their rounds. However, few papers have reported data regarding the use of wireless computers on wheels (COW) at patients’ bedsides to collect questionnaire-based information of their perception of hospitalization on discharge from the hospital. Objective: The purpose of this study was to evaluate the relative efficiency of computerized adaptive testing (CAT) and the precision of CAT-based measures of perceptions of hospitalized patients, as compared with those of nonadaptive testing (NAT). An Excel module of our CAT multicategory assessment is provided as an example. Method: A total of 200 patients who were discharged from the hospital responded to the CAT-based 18-item inpatient perception questionnaire on COW. The numbers of question administrated were recorded and the responses were calibrated using the Rasch model. They were compared with those from NAT to show the advantage of CAT over NAT. Results: Patient measures derived from CAT and NAT were highly correlated (r = 0.98) and their measurement precisions were not statistically different (P = .14). CAT required fewer questions than NAT (an efficiency gain of 42%), suggesting a reduced burden for patients. There were no significant differences between groups in terms of gender and other demographic characteristics. Conclusions: CAT-based administration of surveys of patient perception substantially reduced patient burden without compromising the precision of measuring patients’ perceptions of hospitalization. The Excel module of animation-CAT on the wireless COW that we developed is recommended for use in hospitals.

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Background: Informing policy decisions about the cost-effectiveness of health care systems (ie, packages of clinical interventions) is probably best done using a modeling approach. To this end, an alcohol model (ALCMOD) was developed. Objective: The aim of ALCMOD is to estimate the cost-effectiveness of competing health care systems in curbing alcohol use at the national level. This is illustrated for scenarios where new eHealth technologies for alcohol use disorders are introduced in the Dutch health care system. Method: ALCMOD assesses short-term (12-month) incremental cost-effectiveness in terms of reductions in disease burden, that is, disability adjusted life years (DALYs) and health care budget impacts. Results: Introduction of new eHealth technologies would substantially increase the cost-effectiveness of the Dutch health care system for alcohol use disorders: every euro spent under the current system returns a value of about the same size (€ 1.08, ie, a “surplus” of 8 euro cents) while the new health care system offers much better returns on investment, that is, every euro spent generates € 1.62 in health-related value. Conclusion: Based on the best available evidence, ALCMOD's computations suggest that implementation of new eHealth technologies would make the Dutch health care system more cost-effective. This type of information may help (1) to identify opportunities for system innovation, (2) to set agendas for further research, and (3) to inform policy decisions about resource allocation.

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Background: Mobile phone sensors can be used to develop context-aware systems that automatically detect when patients require assistance. Mobile phones can also provide ecological momentary interventions that deliver tailored assistance during problematic situations. However, such approaches have not yet been used to treat major depressive disorder. Objective: The purpose of this study was to investigate the technical feasibility, functional reliability, and patient satisfaction with Mobilyze!, a mobile phone- and Internet-based intervention including ecological momentary intervention and context sensing. Methods: We developed a mobile phone application and supporting architecture, in which machine learning models (ie, learners) predicted patients’ mood, emotions, cognitive/motivational states, activities, environmental context, and social context based on at least 38 concurrent phone sensor values (eg, global positioning system, ambient light, recent calls). The website included feedback graphs illustrating correlations between patients’ self-reported states, as well as didactics and tools teaching patients behavioral activation concepts. Brief telephone calls and emails with a clinician were used to promote adherence. We enrolled 8 adults with major depressive disorder in a single-arm pilot study to receive Mobilyze! and complete clinical assessments for 8 weeks. Results: Promising accuracy rates (60% to 91%) were achieved by learners predicting categorical contextual states (eg, location). For states rated on scales (eg, mood), predictive capability was poor. Participants were satisfied with the phone application and improved significantly on self-reported depressive symptoms (betaweek = –.82, P < .001, per-protocol Cohen d = 3.43) and interview measures of depressive symptoms (betaweek = –.81, P < .001, per-protocol Cohen d = 3.55). Participants also became less likely to meet criteria for major depressive disorder diagnosis (bweek = –.65, P = .03, per-protocol remission rate = 85.71%). Comorbid anxiety symptoms also decreased (betaweek = –.71, P < .001, per-protocol Cohen d = 2.58). Conclusions: Mobilyze! is a scalable, feasible intervention with preliminary evidence of efficacy. To our knowledge, it is the first ecological momentary intervention for unipolar depression, as well as one of the first attempts to use context sensing to identify mental health-related states. Several lessons learned regarding technical functionality, data mining, and software development process are discussed. Trial Registration: Clinicaltrials.gov NCT01107041; http://clinicaltrials.gov/ct2/show/NCT01107041 (Archived by WebCite at http://www.webcitation.org/60CVjPH0n)

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Background: There is a major campaign involving large expenditures of public money to increase the adoption rate of electronic health record (EHR) systems in Canada. To maximize the chances of success in this effort, physician views on EHRs must be addressed, since user perceptions are key to successful implementation of technology innovations. Objective: We propose a theoretical model comprising behavioral factors either favoring or against EHR adoption and use in Canadian medical practices, from the physicians’ point of view. EHR perceptions of physicians already using EHR systems are compared with those not using one, through the lens of this model. Methods: We conducted an online cross-sectional survey in both English and French among medical practitioners across Canada. Data were collected both from physicians using EHRs and those not using EHRs, and analyzed with structural equation modeling (SEM) techniques. Results: We collected 119 responses from EHR users and 100 from nonusers, resulting in 2 valid samples of 102 and 83 participants, respectively. The theoretical adoption model explained 55.8% of the variance in behavioral intention to continue using EHRs for physicians already using them, and 66.8% of the variance in nonuser intention to adopt such systems. Perception of ease of use was found to be the strongest motivator for EHR users (total effect .525), while perceptions of usefulness and of ease of use were the key determinants for nonusers (total effect .538 and .519, respectively) to adopt the system. Users see perceived overall risk associated with EHR adoption as a major obstacle (total effect –.371), while nonusers perceive risk only as a weak indirect demotivator. Of the 13 paths of the SEM model, 5 showed significant differences between the 2 samples (at the .05 level): general doubts about using the system (P = .02), the necessity for the system to be relevant for their job (P < .001), and the necessity for the system to be useful (P = .049) are more important for EHR nonusers than for users, while perceptions of overall obstacles to adoption (P = .03) and system ease of use (P = .042) count more for EHR users than for nonusers. Conclusions: Relatively few differences in perceptions about EHR system adoption and use exist between physicians already using such systems and those not yet using the systems. To maximize the chances of success for new EHR implementations from a behavioral point of view, general doubts about the rationale for such systems must be mitigated through improving design, stressing how EHRs are relevant to physician jobs, and providing substantiating evidence that EHRs are easier to use and more effective than nonusers might expect.

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Background: As the popularity of e-therapies grows, so too has the body of literature supporting their effectiveness. However, these interventions are often plagued by high attrition rates and varying levels of user adherence. Understanding the role of adherence may be crucial to understanding how program usage influences the effectiveness of e-therapy interventions. Objective: The aim of this study was to systematically review the e-therapy literature to (1) describe the methods used to assess adherence and (2) evaluate the association of adherence with outcome of these interventions. Methods: A systematic review of e-therapy interventions was conducted across disease states and behavioral targets. Data were collected on adherence measures, outcomes, and analyses exploring the relationship between adherence measures and outcomes. Results: Of 69 studies that reported an adherence measure, only 33 (48%) examined the relationship between adherence and outcomes. The number of logins was the most commonly reported measure of adherence, followed by the number of modules completed. The heterogeneity of adherence and outcome measures limited analysis. However, logins appeared to be the measure of adherence most consistently related to outcomes in physical health interventions, while module completion was found to be most related to outcomes in psychological health interventions. Conclusions: There is large variation in the reporting of adherence and the association of adherence with outcomes. A lack of agreement about how best to measure adherence is likely to contribute to the variation in findings. Physical and psychological outcomes seem influenced by different types of adherence. A composite measure encompassing time online, activity completion, and active engagements with the intervention may be the best measure of adherence. Further research is required to establish a consensus for measuring adherence and to understand the role of adherence in influencing outcomes.

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Background: Ongoing initiatives to filter online health searches exclude consumer-generated content from search returns, though its inferiority compared with professionally controlled content is not demonstrated. The antidepressant escitalopram and the antipsychotic quetiapine have ranked over the last 5 years as top-selling agents in their respective drug classes. Both drugs have various off-label mental health and non–mental health uses, ranging from the relief of insomnia and migraines to the treatment of severe developmental disorders. Objective: Our objective was to describe the most frequently reported effects of escitalopram and quetiapine in online consumer reviews, to compare them with effects described in professionally controlled commercial health websites, and to gauge the usability of online consumer medication reviews. Methods: A stratified simple random sample of 960 consumer reviews was selected from all 6998 consumer reviews of the two drugs in 2 consumer-generated (www.askapatient.com and www.crazymeds.us) and 2 professionally controlled (www.webmd.com and www.revolutionhealth.com) health websites. Professional medication descriptions included all standard information on the medications from the latter 2 websites. All textual data were inductively coded for medication effects, and intercoder agreement was assessed. Chi-square was used to test for associations between consumer-reported effects and website origination. Results: Consumers taking either escitalopram (n = 480) or quetiapine (n = 480) most frequently reported symptom improvement (30.4% or 146/480, 24.8% or 119/480) or symptom worsening (15.8% or 76/480, 10.2% or 49/480), changes in sleep (36% or 173/480, 60.6% or 291/480) and changes in weight and appetite (22.5% or 108/480, 30.8% or 148/480). More consumers posting reviews on consumer-generated rather than professionally controlled websites reported symptom worsening on quetiapine (17.3% or 38/220 versus 5% or 11/220, P < .001), while more consumers posting on professionally controlled websites reported symptom improvement (32.7% or 72/220 versus 21.4% or 47/220, P = .008). Professional descriptions more frequently listed physical adverse effects and warnings about suicidal ideation while consumer reviews emphasized effects disrupting daily routines and provided richer descriptions of effects in context. The most recent 20 consumer reviews on each drug from each website (n = 80) were comparable to the full sample of reviews in the frequency of commonly reported effects. Conclusion: Consumer reviews and professional medication descriptions generally reported similar effects of two psychotropic medications but differed in their descriptions and in frequency of reporting. Professional medication descriptions offer the advantage of a concise yet comprehensive listing of drug effects, while consumer reviews offer greater context and situational examples of how effects may manifest in various combinations and to varying degrees. The dispersion of consumer reviews across websites limits their integration, but a brief browsing strategy on the two target medications nonetheless retrieved representative consumer content. Current strategies for filtering online health searches to return only trusted or approved websites may inappropriately address the challenge to identify quality health sources on the Internet because such strategies unduly limit access to an entire complementary source for health information.

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Background: How do people decide which sites to use when seeking health advice online? We can assume, from related work in e-commerce, that general design factors known to affect trust in the site are important, but in this paper we also address the impact of factors specific to the health domain. Objective: The current study aimed to (1) assess the factorial structure of a general measure of Web trust, (2) model how the resultant factors predicted trust in, and readiness to act on, the advice found on health-related websites, and (3) test whether adding variables from social cognition models to capture elements of the response to threatening, online health-risk information enhanced the prediction of these outcomes. Methods: Participants were asked to recall a site they had used to search for health-related information and to think of that site when answering an online questionnaire. The questionnaire consisted of a general Web trust questionnaire plus items assessing appraisals of the site, including threat appraisals, information checking, and corroboration. It was promoted on the hungersite.com website. The URL was distributed via Yahoo and local print media. We assessed the factorial structure of the measures using principal components analysis and modeled how well they predicted the outcome measures using structural equation modeling (SEM) with EQS software. Results: We report an analysis of the responses of participants who searched for health advice for themselves (N = 561). Analysis of the general Web trust questionnaire revealed 4 factors: information quality, personalization, impartiality, and credible design. In the final SEM model, information quality and impartiality were direct predictors of trust. However, variables specific to eHealth (perceived threat, coping, and corroboration) added substantially to the ability of the model to predict variance in trust and readiness to act on advice on the site. The final model achieved a satisfactory fit: χ25 = 10.8 (P = .21), comparative fit index = .99, root mean square error of approximation = .052. The model accounted for 66% of the variance in trust and 49% of the variance in readiness to act on the advice. Conclusions: Adding variables specific to eHealth enhanced the ability of a model of trust to predict trust and readiness to act on advice.

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Background: In the past decade, the use of technologies to persuade, motivate, and activate individuals’ health behavior change has been a quickly expanding field of research. The use of the Web for delivering interventions has been especially relevant. Current research tends to reveal little about the persuasive features and mechanisms embedded in Web-based interventions targeting health behavior change. Objectives: The purpose of this systematic review was to extract and analyze persuasive system features in Web-based interventions for substance use by applying the persuasive systems design (PSD) model. In more detail, the main objective was to provide an overview of the persuasive features within current Web-based interventions for substance use. Methods: We conducted electronic literature searches in various databases to identify randomized controlled trials of Web-based interventions for substance use published January 1, 2004, through December 31, 2009, in English. We extracted and analyzed persuasive system features of the included Web-based interventions using interpretive categorization. Results: The primary task support components were utilized and reported relatively widely in the reviewed studies. Reduction, self-monitoring, simulation, and personalization seem to be the most used features to support accomplishing user’s primary task. This is an encouraging finding since reduction and self-monitoring can be considered key elements for supporting users to carry out their primary tasks. The utilization of tailoring was at a surprisingly low level. The lack of tailoring may imply that the interventions are targeted for too broad an audience. Leveraging reminders was the most common way to enhance the user-system dialogue. Credibility issues are crucial in website engagement as users will bind with sites they perceive credible and navigate away from those they do not find credible. Based on the textual descriptions of the interventions, we cautiously suggest that most of them were credible. The prevalence of social support in the reviewed interventions was encouraging. Conclusions: Understanding the persuasive elements of systems supporting behavior change is important. This may help users to engage and keep motivated in their endeavors. Further research is needed to increase our understanding of how and under what conditions specific persuasive features (either in isolation or collectively) lead to positive health outcomes in Web-based health behavior change interventions across diverse health contexts and populations.

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Background: Medication misuse results in considerable problems for both patient and society. It is a complex problem with many contributing factors, including timely access to product information. Objective: To investigate the value of 3-dimensional (3D) visualization paired with video conferencing as a tool for pharmaceutical advice over distance in terms of accessibility and ease of use for the advice seeker. Methods: We created a Web-based communication service called AssistancePlus that allows an advisor to demonstrate the physical handling of a complex pharmaceutical product to an advice seeker with the aid of 3D visualization and audio/video conferencing. AssistancePlus was tested in 2 separate user studies performed in a usability lab, under realistic settings and emulating a real usage situation. In the first study, 10 pharmacy students were assisted by 2 advisors from the Swedish National Co-operation of Pharmacies’ call centre on the use of an asthma inhaler. The student-advisor interview sessions were filmed on video to qualitatively explore their experience of giving and receiving advice with the aid of 3D visualization. In the second study, 3 advisors from the same call centre instructed 23 participants recruited from the general public on the use of 2 products: (1) an insulin injection pen, and (2) a growth hormone injection syringe. First, participants received advice on one product in an audio-recorded telephone call and for the other product in a video-recorded AssistancePlus session (product order balanced). In conjunction with the AssistancePlus session, participants answered a questionnaire regarding accessibility, perceived expressiveness, and general usefulness of 3D visualization for advice-giving over distance compared with the telephone and were given a short interview focusing on their experience of the 3D features. Results: In both studies, participants found the AssistancePlus service helpful in providing clear and exact instructions. In the second study, directly comparing AssistancePlus and the telephone, AssistancePlus was judged positively for ease of communication (P = .001), personal contact (P = .001), explanatory power (P < .001), and efficiency (P < .001). Participants in both studies said that they would welcome this type of service as an alternative to the telephone and to face-to-face interaction when a physical meeting is not possible or not convenient. However, although AssistancePlus was considered as easy to use as the telephone, they would choose AssistancePlus over the telephone only when the complexity of the question demanded the higher level of expressiveness it offers. For simpler questions, a simpler service was preferred. Conclusions: 3D visualization paired with video conferencing can be useful for advice-giving over distance, specifically for issues that require a higher level of communicative expressiveness than the telephone can offer. 3D-supported advice-giving can increase the range of issues that can be handled over distance and thus improve access to product information.

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Background: The onset of type 2 diabetes mellitus can be prevented or delayed by lifestyle changes. Communication technologies such as a mobile phone can be used as a means of delivering these lifestyle changes. Objectives: The purposes of this analysis were to explore applicability of potential components of a mobile phone-based healthy lifestyle program and to understand motivators and barriers to continued engagement in a mobile phone healthy lifestyle program. Methods: We conducted 6 focus groups (4 female and 2 male groups) in May and June 2010 with 35 focus group participants. The qualitative data were analyzed by 3 researchers using a qualitative description method in an ATLAS.ti software program. Inclusion criteria for enrollment in a focus group were as follows: (1) being aged from 30 to 69 years, (2) speaking and reading English, (3) having a sedentary lifestyle at work or during leisure time (screened by the Brief Physical Activity Survey questionnaire), and (4) having a body mass index (BMI) >25 kg/m2 (Asian >23 kg/m2) based on self-reported weight and height or 5) having a self-reported prediabetic condition. Results: The mean age was 51 (SD 10.6) years; 54% (n = 19) were white; 71% (n = 25) used a mobile phone at least once a week during the last month prior to the study enrollment; and mean BMI was 32.5 (SD 6.5) kg/m2. In the qualitative analyses, the following 4 major themes and their subthemes emerged: (1) real-time social support (real-time peer support from participants who are similarly engaged in a diet or physical activity program, and professional support from health care providers or a researcher), (2) tailoring of mobile phone programs (3) self-monitoring and motivation, and (4) potential barriers and sustainability of the program (fear of failing, age and mobile technologies, and loss of interest over time). Conclusions: Participants from a wide range of age and racial groups expressed interest in a mobile phone-based lifestyle program. Such a program that incorporates the themes that we identified may be able to help motivate participants to increase their physical activity and to improve their diet.

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Background: A growing body of research has employed information and communication technologies (ICTs) such as the Internet and mobile phones for disseminating physical activity (PA) interventions with young populations. Although several systematic reviews have documented the effects of ICT-based interventions on PA behavior, very few have focused on children and adolescents specifically. Objectives: The present review aimed to systematically evaluate the efficacy and methodological quality of ICT-based PA interventions for children and adolescents based on evidence from randomized controlled trials. Methods: Electronic databases Medline, PsycInfo, CINAHL, and Web of Science were searched to retrieve English language articles published in international academic peer-reviewed journals from January 1, 1997, through December 31, 2009. Included were articles that provided descriptions of interventions designed to improve PA-related cognitive, psychosocial, and behavioral outcomes and that used randomized controlled trial design, included only children (6-12 years old) and adolescents (13-18 years old) in both intervention and control groups, and employed Internet, email, and/or short message services (SMS, also known as text messaging) as one or more major or assistive modes to deliver the intervention. Results: In total, 9 studies were analyzed in the present review. All studies were published after 2000 and conducted in Western countries. Of the 9 studies, 7 demonstrated positive and significant within-group differences in at least one psychosocial or behavioral PA outcome. In all, 3 studies reported positive and significant between-group differences favoring the ICT group. When between-group differences were compared across studies, effect sizes were small in 6 studies and large in 3 studies. With respect to methodological quality, 7 of the 9 studies had good methodological quality. Failure to report allocation concealment, blinding to outcome assessment, and lack of long-term follow-up were the criteria met by the fewest studies. In addition, 5 studies measured the intervention exposure rate and only 1 study employed objective measures to record data. Conclusion: The present review provides evidence supporting the positive effects of ICTs in PA interventions for children and adolescents, especially when used with other delivery approaches (ie, face-to-face). Because ICT delivery approaches are often mixed with other approaches and these studies sometimes lack a comparable control group, additional research is needed to establish the true independent effects of ICT as an intervention delivery mode. Although two-thirds of the studies demonstrated satisfactory methodological quality, several quality criteria should be considered in future studies: clear descriptions of allocation concealment and blinding of outcome assessment, extension of intervention duration, and employment of objective measures in intervention exposure rate. Due to the small number of studies that met inclusion criteria and the lack of consistent evidence, researchers should be cautious when interpreting the findings of the present review.

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Background: Adverse drug events are a major safety issue in ambulatory care. Improving medication self-management could reduce these adverse events. Researchers have developed medication applications for tethered personal health records (PHRs), but little has been reported about medication applications for interoperable PHRs. Objective: Our objective was to develop two complementary personal health applications on a common PHR platform: one to assist children with complex health needs (MyMediHealth), and one to assist older adults in care transitions (Colorado Care Tablet). Methods: The applications were developed using a user-centered design approach. The two applications shared a common PHR platform based on a service-oriented architecture. MyMediHealth employed Web and mobile phone user interfaces. Colorado Care Tablet employed a Web interface customized for a tablet PC. Results: We created complementary medication management applications tailored to the needs of distinctly different user groups using common components. Challenges were addressed in multiple areas, including how to encode medication identities, how to incorporate knowledge bases for medication images and consumer health information, how to include supplementary dosing information, how to simplify user interfaces for older adults, and how to support mobile devices for children. Conclusions: These prototypes demonstrate the utility of abstracting PHR data and services (the PHR platform) from applications that can be tailored to meet the needs of diverse patients. Based on the challenges we faced, we provide recommendations on the structure of publicly available knowledge resources and the use of mobile messaging systems for PHR applications.

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Background: In the past 10 years, the Internet has emerged as a venue for men who have sex with men (MSM) to meet sex partners. Because online sex seeking has increased among MSM, Internet-based human immunodeficiency virus (HIV) prevention interventions are of interest. However, few online studies to date have demonstrated an ability to retain study participants, specifically MSM of color, in longitudinal online studies. Objective: The current analysis examines data from a 3-month online prospective study of MSM to determine the association of race and incentive level with two retention outcomes: (1) agreeing to participate in a follow-up survey and providing an email address and (2) linking into the follow-up survey at the follow-up time point. Methods: Internet-using MSM were recruited through banner advertisements on MySpace.com. White, black, and Hispanic participants from 18 to 35 years of age were randomized to an offer of enrollment in an online follow-up survey at four levels of incentive (US $0, US $5, US $10, and US $20). Multivariable logistic regression models were used to estimate the odds of the two outcome measures of interest controlling for additional independent factors of interest. Results: Of eligible participants, 92% (2405/2607) agreed to participate in the follow-up survey and provided an email address. Hispanic men had decreased odds (adjusted odds ratio [OR] = 0.66, 95% confidence interval [CI] 0.47-0.92) of agreeing to participate in the follow-up survey compared with white men. Men reporting unprotected anal intercourse with a male sex partner in the past 12 months had increased odds of agreeing to participate in the follow-up survey (adjusted OR = 1.42, 95% CI 1.05-1.93). Of the participants who provided an email address, 22% (539/2405) linked into the follow-up survey at the 3-month follow-up time point. The odds of linking into the follow-up survey for black men were approximately half the odds for white men (adjusted OR = 0.47, 95% CI 0.35-0.63). Participants who were offered an incentive had increased odds of linking into the follow-up survey (adjusted OR = 1.29, 95% CI 1.02-1.62). Email addresses provided by participants that were used for online financial management and email accounts that were checked daily were associated with increased odds of linking into the follow-up survey (adjusted OR = 1.97, 95% CI 1.54-2.52; adjusted OR = 1.51, 95% CI 1.22-1.87, respectively). Conclusions: This analysis identified factors that predicted retention in an online, prospective study of MSM. Hispanic and black study participants were less likely to be retained in the study compared with white study participants. Because these men bear the greatest burden of HIV incidence among MSM in the United States, it is critical that new research methods be developed to increase retention of these groups in online research studies.

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Background: Self-help interventions without professional contact to curb adult problem drinking in the community are increasingly being delivered via the Internet. Objective: The objective of this meta-analysis was to assess the overall effectiveness of these eHealth interventions. Methods: In all, 9 randomized controlled trials (RCTs), all from high-income countries, with 9 comparison conditions and a total of 1553 participants, were identified, and their combined effectiveness in reducing alcohol consumption was evaluated by means of a meta-analysis. Results: An overall medium effect size (g = 0.44, 95% CI 0.17-0.71, random effect model) was found for the 9 studies, all of which compared no-contact interventions to control conditions. The medium effect was maintained (g = 0.39; 95% CI 0.23-0.57, random effect model) after exclusion of two outliers. Type of control group, treatment location, type of analysis, and sample size did not have differential impacts on treatment outcome. A significant difference (P = .04) emerged between single-session personalized normative feedback interventions (g = 0.27, 95% CI 0.11-0.43) and more extended e- self-help (g = 0.61, 95% CI 0.33-0.90). Conclusion: E-self-help interventions without professional contact are effective in curbing adult problem drinking in high-income countries. In view of the easy scalability and low dissemination costs of such interventions, we recommend exploration of whether these could broaden the scope of effective public health interventions in low- and middle-income countries as well.

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Background: In recent years, interventions that deliver online personalized feedback on alcohol use have been developed and appear to be a feasible way to curb heavy drinking. Randomized controlled trials (RCTs) among the general adult population, however, are scarce. The present study offers an RCT of Drinktest.nl, an online personalized feedback intervention in the Netherlands. Objective: The aim of this study was to assess the effectiveness of computer-based personalized feedback on heavy alcohol use in male adults. Methods: Randomization stratified by age and educational level was used to assign participants to either the intervention consisting of online personalized feedback or an information-only control condition. Participants were told as a cover story that they would evaluate newly developed health education materials. Participants were males (n = 450), aged 18 to 65 years, presenting with either heavy alcohol use (> 20 units of alcohol weekly) and/or binge drinking (> 5 units of alcohol at a single occasion at least 1 day per week) in the past 6 months. They were selected with a screener from a sampling frame of 25,000 households. The primary outcome measure was the percentage of the participants that had successfully reduced their drinking levels to below the Dutch guideline threshold for at-risk drinking. Results: Intention-to-treat analysis showed that in the experimental condition, 42% (97/230) of the participants were successful in reducing their drinking levels to below the threshold at the 1-month follow-up as compared with 31% (67/220) in the control group (odds ratio [OR] = 1.7, number needed to treat [NNT] = 8.6), which was statistically significant (χ21 = 6.67, P = .01). At the 6-month follow-up, the success rates were 46% (105/230) and 37% (82/220) in the experimental and control conditions, respectively (OR = 1.4, NNT = 11.9), but no longer statistically significant (χ21 = 3.25, P = .07). Conclusions: Personalized online feedback on alcohol consumption appears to be an effective and easy way to change unhealthy drinking patterns in adult men, at least in the short-term. Trial registration: International Standard Randomized Controlled Trial Number: NTR836; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=836 (Archived by WebCite at http://www.webcitation.org/5ytnEz2vp)

This is the abstract only. Read the full article on the JMIR site. JMIR is the leading open access journal for eHealth and healthcare in the Internet age.

Background: Older adults often have multiple chronic problems requiring them to manage complex medication regimens overseen by various clinicians. Personal health applications (PHAs) show promise assisting in medication self-management, but adoption of new computer technologies by this population is challenging. Optimizing the utility of PHAs requires a thorough understanding of older adults’ needs, preferences, and practices. Objective: The objective of our study was to understand the medication self-management issues faced by older adults and caregivers that can be addressed by an electronic PHA. Methods: We conducted a qualitative analysis of a series of individual and group semistructured interviews with participants who were identified through purposive sampling. Results: We interviewed 32 adult patients and 2 adult family caregivers. We identified 5 core themes regarding medication self-management challenges: seeking reliable medication information, maintaining autonomy in medication treatment decisions, worrying about taking too many medications, reconciling information discrepancies between allopathic and alternative medical therapies, and tracking and coordinating health information between multiple providers. Conclusions: This study provides insights into the latent concerns and challenges faced by older adults and caregivers in managing medications. The results suggest that PHAs should have the following features to accommodate the management strategies and information preferences of this population: (1) provide links to authoritative and reliable information on side effects, drug interactions, and other medication-related concerns in a way that is clear, concise, and easy to navigate, (2) facilitate communication between patients and doctors and pharmacists through electronic messaging and health information exchange, and (3) provide patients the ability to selectively disclose medication information to different clinicians.

This is the abstract only. Read the full article on the JMIR site. JMIR is the leading open access journal for eHealth and healthcare in the Internet age.

Background: Internet-based cognitive behavior therapy (CBT) has been shown to be a promising method to disseminate cognitive behavior therapy for social anxiety disorder (SAD). Several trials have demonstrated that Internet-based CBT can be effective for SAD in the shorter term. However, the long-term effects of Internet-based CBT for SAD are less well known. Objective: Our objective was to investigate the effect of Internet-based CBT for SAD 5 years after completed treatment. Method: We conducted a 5-year follow-up study of 80 persons with SAD who had undergone Internet-based CBT. The assessment comprised a diagnostic interview and self-report questionnaires. The main outcome measure was the Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR). Additional measures of social anxiety were the Social Interaction Anxiety Scale (SIAS) and the Social Phobia Scale (SPS). Attrition rates were low: 89% (71/80) of the participants completed the diagnostic interview and 80% (64/80) responded to the questionnaires. Results: Mixed-effect models analysis showed a significant effect of time on the three social anxiety measures, LSAS-SR, SIAS, and SPS (F3,98-102 = 16.05 - 29.20, P < .001) indicating improvement. From baseline to 5-year follow-up, participants’ mean scores on the LSAS-SR were reduced from 71.3 (95% confidence interval [CI] 66.1-76.5) to 40.3 (95% CI 35.2 - 45.3). The effect sizes of the LSAS-SR were large (Cohen’s d range 1.30 - 1.40, 95% CI 0.77 - 1.90). Improvements gained at the 1-year follow-up were sustained 5 years after completed treatment. Conclusions: Internet-based CBT for SAD is a treatment that can result in large and enduring effects. Trial registration: Clinicaltrials.gov NCT01145690; http://clinicaltrials.gov/ct2/show/NCT01145690 (Archived by WebCite at http://www.webcitation.org/5ygRxDLfK)

This is the abstract only. Read the full article on the JMIR site. JMIR is the leading open access journal for eHealth and healthcare in the Internet age.

Background: Patient satisfaction has not been widely studied with respect to implementation of the electronic medical record (EMR). There are few reports of the impact of the EMR in pediatrics. Objective: The objective of this study was to assess the impact of implementation of an electronic medical record system on families in an academic pediatric rheumatology practice. Methods: Families were surveyed 1 month pre-EMR implementation and 3 months post-EMR implementation. Results: Overall, EMR was well received by families. Compared with the paper chart, parents agreed the EMR improved the quality of doctor care (55% or 59/107 vs 26% or 26/99, P < .001). More parents indicated they would prefer their pediatric physicians to use an EMR (68% or 73/107 vs 51% or 50/99, P = .01). Conclusions: Transitioning an academic pediatric rheumatology practice to an EMR can increase family satisfaction with the office visit.

This is the abstract only. Read the full article on the JMIR site. JMIR is the leading open access journal for eHealth and healthcare in the Internet age.