%0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 3 %N 2 %P e5 %T The Diabetes App Challenge: User-Led Development and Piloting of Internet Applications Enabling Young People With Diabetes to Set the Focus for Their Diabetes Consultations %A Ashurst,Emily J %A Jones,Ray B %A Abraham,Charles %A Jenner,Martin %A Boddy,Kate %A Besser,Rachel EJ %A Hammersley,Suzanne %A Pinkney,Jonathan %+ Plymouth University, School of Nursing and Midwifery, 3 Portland Villas, Plymouth, PL4 8AA, United Kingdom, 44 1752661577, ray.jones@plymouth.ac.uk %K Type 1 diabetes %K adolescents %K mobile technology %K clinic appointment %K user-innovation %K self-care %K user-centered design %D 2014 %7 07.11.2014 %9 Original Paper %J Med 2.0 %G English %X Background: Traditionally, some teenagers and young adults with diabetes have not engaged well at diabetes appointments, giving rise to concerns about long-term health risks. We considered that apps might help this group of patients to improve preparation for, and therefore engagement at their appointments. Although there are already many apps for young people with type 1 diabetes (YPD), we thought that by supporting YPD themselves to develop apps, the resulting products would have greater “authenticity” and relevance. Objective: To test the feasibility of an online competition to (1) recruit and support YPD to develop apps (mobile or Internet based) to help prepare for clinic appointments, and (2) for these apps to be tested and rated by YPD. Methods: The “Diabetes App Challenge” was a United Kingdom (UK) national competition, run between June and October 2012 for teams including at least one YPD (aged 16-25) to pilot the design and development of apps for use by other YPD prior to clinic appointments. The competition was advertised by social media, email, AdWords and postings on the Diabetes UK website. Registrants for the competition were supported via email and discussion forum. After app development, other YPD were invited (November 2012-February 2013) to trial the apps, choose and use one prior to a clinic appointment, and review their experiences. Results: Of 56 people (including 28 YPD) who expressed interest in the competition, 6 teams (14 people) developed and submitted an app. Two apps aimed to facilitate agenda setting in clinic consultations, 2 enabled data logging and 2 helped insulin dose calculation. Of 135 YPD who registered to trial the apps, 83 (61.5%) took part (mean age 18.98, 37/83 male). Agenda setting apps were considered most useful for preparing for and setting the focus of clinic appointments (P=.02). Just over half (46/83, 55%) said they would use their chosen app again and 4/5 (67/83, 81%) would recommend it to a friend. Conclusions: This competition to engage YPD in developing and reviewing apps proved successful. App designers and testers saw a need for a range of functions. However, this may, in part, reflect a lack of detailed knowledge of all existing apps and be limited by the technical skills of YPD. App competitions appear worth applying to other patient groups, but future competitions should include a review stage and perhaps focus on ideas for app design for subsequent professional implementation. %M 25654312 %R 10.2196/med20.3032 %U http://www.medicine20.com/2014/2/e5/ %U https://doi.org/10.2196/med20.3032 %U http://www.ncbi.nlm.nih.gov/pubmed/25654312 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 8 %P e196 %T Mobile Phone Text Messaging Intervention for Cervical Cancer Screening: Changes in Knowledge and Behavior Pre-Post Intervention %A Lee,Hee Yun %A Koopmeiners,Joseph S %A Rhee,Taeho Greg %A Raveis,Victoria H %A Ahluwalia,Jasjit S %+ School of Social Work and University of Minnesota Masonic Cancer Center, College of Education and Human Development, University of Minnesota, Twin Cities, 1404 Gortner Ave, St Paul, MN, 55108, United States, 1 612 624 3689, hylee@umn.edu %K cervical cancer %K Pap test %K mobile health %K text-messaging intervention %K health behavior change %K Korean American women %K health disparity %D 2014 %7 27.08.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Cervical cancer poses a significant threat to Korean American women, who are reported to have one of the highest cervical cancer mortality rates in the United States. Studies consistently report that Korean American women have the lowest Pap test screening rates across US ethnic groups. Objective: In response to the need to enhance cervical cancer screening in this vulnerable population, we developed and tested a 7-day mobile phone text message-based cervical cancer Screening (mScreening) intervention designed to promote the receipt of Pap tests by young Korean American women. Methods: We developed and assessed the acceptability and feasibility of a 1-week mScreening intervention to increase knowledge of cervical cancer screening, intent to receive screening, and the receipt of a Pap test. Fogg’s Behavior Model was the conceptual framework that guided the development of the mScreening intervention. A series of focus groups were conducted to inform the development of the intervention. The messages were individually tailored for each participant and delivered to them for a 7-day period at each participant’s preferred time. A quasi-experimental research design of 30 Korean American women aged 21 to 29 years was utilized with baseline, post (1 week after the completion of mScreening), and follow-up (3 months after the completion of mScreening) testing. Results: Findings revealed a significant increase in participants’ knowledge of cervical cancer (P<.001) and guidelines for cervical cancer screening (P=.006). A total of 23% (7/30) (95% CI 9.9-42.3) of the mScreening participants received a Pap test; 83% (25/30) of the participants expressed satisfaction with the intervention and 97% (29/30) reported that they would recommend the program to their friends, indicating excellent acceptability and feasibility of the intervention. Conclusions: This study provides evidence of the effectiveness and feasibility of the mScreening intervention. Mobile technology is a promising tool to increase both knowledge and receipt of cervical cancer screening. Given the widespread usage of mobile phones among young adults, a mobile phone-based health intervention could be a low-cost and effective method of reaching populations with low cervical cancer screening rates, using individually tailored messages that cover broad content areas and overcome restrictions to place and time of delivery. %M 25164545 %R 10.2196/jmir.3576 %U http://www.jmir.org/2014/8/e196/ %U https://doi.org/10.2196/jmir.3576 %U http://www.ncbi.nlm.nih.gov/pubmed/25164545 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 8 %P e184 %T Promoting Business and Entrepreneurial Awareness in Health Care Professionals: Lessons From Venture Capital Panels at Medicine 2.0 Conferences %A Miron-Shatz,Talya %A Shatz,Itamar %A Becker,Stefan %A Patel,Jigar %A Eysenbach,Gunther %+ Institute for Drug Safety, University Hospital Essen, Hufelandstr 55, Essen, 45122, Germany, 49 201 723 83844, Stefan.Becker@uk-essen.de %K start-up %K entrepreneurship %K health technology %K capital funding, telehealth, eHealth, mobile health, health technology, technology transfer %K health 2.0 %K business pitch %K entrepreneurship programs %D 2014 %7 06.08.2014 %9 Viewpoint %J J Med Internet Res %G English %X There are few mechanisms that bring the academic and business worlds together in a way that would maximize the success of health technology (health tech) start-ups by increasing researchers’ knowledge about how to operate in the business world. Existing solutions (eg, technology transfer offices and dual degree MD/MBA programs) are often unavailable to researchers from outside the institution or to those who have already completed their primary education, such as practicing physicians. This paper explores current solutions and offers a partial solution: include venture capital (VC) panels in medical conferences. These VC panels educate academics on 2 important and interconnected issues: how to “pitch” their ideas in the business world and what to consider when creating a company. In these sessions, academia-based start-up companies present their ideas before a VC panel composed of professional investors and receive feedback on their idea, business plan, and presentation techniques. Recent panel recommendations from Medicine 2.0 conferences fell into 7 categories: (1) the product, service, or idea you are developing into a company, (2) determine market forces and identify the target audience, (3) describe your competitive advantage, (4) the business plan, (5) current and future resources and capabilities, (6) legal aspects, and (7) general advice on the art of pitching. The academic and business literature validates many of these recommendations suggesting that VC panels may be a viable and cost-effective introduction to business and entrepreneurial education for physicians and other health care professionals. Panels benefit not only the presenting companies, but also the physicians, psychologists, and other health care professionals attending the session. Incorporating VC panels into academic conferences might also illuminate the need for incorporating relevant business training within academia. %M 25100579 %R 10.2196/jmir.3390 %U http://www.jmir.org/2014/8/e184/ %U https://doi.org/10.2196/jmir.3390 %U http://www.ncbi.nlm.nih.gov/pubmed/25100579 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 3 %N 2 %P e4 %T Health Information on the Web and Consumers’ Perspectives on Health Professionals’ Responses to Information Exchange %A Seçkin,Gül %+ University of North Texas, Department of Sociology, University of North Texas, 1155 Union Circle # 305189, Denton, TX, 76203=5017, United States, 1 323 371 5912, gulseckin@msn.com %K health communication %K Internet %K information %K patient-physician relationship %D 2014 %7 08.07.2014 %9 Original Paper %J Med 2.0 %G English %X Background: Health information technology, which is sometimes referred to as informaticization of medicine, is changing the extent to which patients become competent producers of their own health by enabling them access to health information anytime and anywhere. Objective: This research provides preliminary information on users' perceptions of the extent to which use of the Internet for health information impacts medical encounters. We specifically explored the following questions: (1) To what extent perceptions of positive or negative changes in medical encounters are associated with sociodemographic background of online health information seekers, and how often the Internet information is discussed with providers? (2) To what extent is there an association between perceived changes in medical encounters and frequency of referring to the Internet during medical encounters? (3) To what extent is there an association between sociodemographic background of online health information users and frequency of discussing of the Internet information with providers? Methods: The data for this study was derived from a national sampling of online health and medical information users who participated in the Study of Health and Medical Information in Cyberspace—Survey of User Perceptions (N=710). This study used a nationally representative online research panel of the US adults maintained by the Knowledge Networks. Analysis of variance (ANOVA), chi-square, and t tests were performed to examine the data. Results: Although Internet sources allow people the opportunity to gather health or medical information, discussion of this information was not a very common activity. It is noteworthy that half of the sample never or rarely discussed health/medical information obtained from Internet sources with health professionals. Chi-square analyses revealed that discussion of online health information with providers were associated with education, income, and marital status. We also found that discussion of the Internet information mostly promotes better physician-patient interactions. Analyses with post-hoc tests identified that perceived changes in medical encounters were associated with age, education, and income. However, 9.1% (64/703) of our respondents strongly agreed that the interactions with their providers have been strained. T test analyses showed that marital status, race, and gender were not significant. Conclusions: Embracing new technologies, and adapting to changing roles and relationships in delivery of medical care are critical to effective delivery of patient-centered care. Health professionals could also guide patients on how to evaluate information and where to access to reliable and accurate information. %M 25075248 %R 10.2196/med20.3213 %U http://www.medicine20.com/2014/2/e4/ %U https://doi.org/10.2196/med20.3213 %U http://www.ncbi.nlm.nih.gov/pubmed/25075248 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 3 %N 1 %P e3 %T Employee and Family Assistance Video Counseling Program: A Post Launch Retrospective Comparison With In-Person Counseling Outcomes %A Veder,Barbara %A Pope,Stan %A Mani,Michèle %A Beaudoin,Kelly %A Ritchie,Janice %+ Shepell·fgi, 350 Sparks Street, Suite 501, Ottawa, ON, K1R 7S8, Canada, 1 613 851 1055, bveder@shepellfgi.com %K EAP %K EFAP %K counseling %K video counseling %K technology %K mental health %K online counseling %K therapy %K online therapy %D 2014 %7 24.04.2014 %9 Original Paper %J Med 2.0 %G English %X Background: Access to technologically mediated information and services under the umbrella of mental and physical health has become increasingly available to clients via Internet modalities, according to a recent study. In May 2010, video counseling was added to the counseling services offered through the Employee and Family Assistance Program at Shepell·fgi as a pilot project with a full operational launch in September 2011. Objective: The objective of this study was to conduct a retrospective post launch examination of the video counseling service through an analysis of the reported clinical outcomes of video and in-person counseling modalities. Methods: A chronological sample of 68 video counseling (VC) cases and 68 in-person (IP) cases were collected from a pool of client clinical files closed in 2012. To minimize the variables impacting the study and maintain as much clinical continuity as possible, the IP and the VC clients must have attended clinical sessions with any one of six counselors who provided both the VC and the IP services. The study compared the two counseling modalities along the following data points (see glossary of terms): (1) client demographic profiles (eg, age, gender, whether the sessions involved individuals or conjoint sessions with couples or families, etc), (2) presenting issue, (3) average session hours, (4) client rating of session helpfulness, (5) rates of goal completion, (6) client withdrawal rates, (7) no show and late cancellation rates, and (8) pre/post client self-assessment. Specific to VC, we examined client geographic location. Results: Data analysis demonstrates that the VC and the IP showed a similar representation of presenting issues with nearly identical outcomes for client ratings of session helpfulness, rates of goal completion, pre/post client self-assessment, average session duration, and client geographic location. There were no statistically significant differences in the rates of withdrawal from counseling, no shows, and late cancellations between the VC and the IP counseling. The statistical analysis of the data was done on SPSS statistical software using 2-sample and pairwise comparison t tests at a 95% level of significance. Conclusions: Based on the study, VC and IP show similar outcomes in terms of client rating of session and goal attainment. %M 25075247 %2 PMC4084764 %R 10.2196/med20.3125 %U http://www.medicine20.com/2014/1/e3/ %U https://doi.org/10.2196/med20.3125 %U http://www.ncbi.nlm.nih.gov/pubmed/25075247 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 3 %N 1 %P e2 %T Transforming Patient Experience: Health Web Science Meets Medicine 2.0 %A McHattie,Lynn-Sayers %A Cumming,Grant %A French,Tara %+ The Institute of Design Innovation, The Glasgow School of Art, 167 Renfrew Street, Glasgow, G36RQ, United Kingdom, 44 7800897110, l.mchattie@gsa.ac.uk %K patient-centered medicine %K co-creation %K co-design %K Health Web Science %K Medicine 2.0 %K P4 medicine %D 2014 %7 20.03.2014 %9 Viewpoint %J Med 2.0 %G English %X Until recently, the Western biomedical paradigm has been effective in delivering health care, however this model is not positioned to tackle complex societal challenges or solve the current problems facing health care and delivery. The future of medicine requires a shift to a patient-centric model and in so doing the Internet has a significant role to play. The disciplines of Health Web Science and Medicine 2.0 are pivotal to this approach. This viewpoint paper argues that these disciplines, together with the field of design, can tackle these challenges. Drawing together ideas from design practice and research, complexity theory, and participatory action research we depict design as an approach that is fundamentally social and linked to concepts of person-centered care. We discuss the role of design, specifically co-design, in understanding the social, psychological, and behavioral dimensions of illness and the implications for the design of future care towards transforming the patient experience. This paper builds on the presentations and subsequent interdisciplinary dialogue that developed from the panel session "Transforming Patient Experience: Health Web Science Meets Web 2.0" at the 2013 Medicine 2.0 conference in London. %M 25075246 %2 PMC4084774 %R 10.2196/med20.3128 %U http://www.medicine20.com/2014/1/e2/ %U https://doi.org/10.2196/med20.3128 %U http://www.ncbi.nlm.nih.gov/pubmed/25075246 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 3 %N 1 %P e1 %T Analysis of Twitter Users’ Sharing of Official New York Storm Response Messages %A Genes,Nicholas %A Chary,Michael %A Chason,Kevin %+ Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, Box 1620, One Gustave L Levy Place, 1190 Fifth Avenue, New York, NY, 10029, United States, 1 212 824 8073, nicholas.genes@mountsinai.org %K social media %K disaster response %K emergencies %K public health %K emergency management %D 2014 %7 20.03.2014 %9 Original Paper %J Med 2.0 %G English %X Background: Twitter is a social network where users read, send, and share snippets of text (“tweets”). Tweets can be disseminated through multiple means; on desktop computers, laptops, and mobile devices, over ethernet, Wi-Fi or cellular networks. This redundancy positions Twitter as a useful tool for disseminating information to the public during emergencies or disasters. Previous research on dissemination of information using Twitter has mostly investigated the characteristics of tweets that are most effective in raising consumer awareness about a new product or event. In particular, they describe characteristics that increase the chance the messages will be shared ("retweeted") by users. In comparison, little has been published on how information from municipal or state government agencies spreads on Twitter during emergency situations. Retweeting these messages is a way to enhance public awareness of potentially important instructions from public officials in a disaster. Objective: The aim of this study is to (1) describe the tweets of select New York State and New York City agencies by public officials surrounding two notable recent winter storms that required a large-scale emergency response, and (2) identify the characteristics of the tweets of public officials that were most disseminated (retweeted). Methods: For one week surrounding Superstorm Sandy (October 2012) and the winter blizzard Nemo (February 2013), we collected (1) tweets from the official accounts for six New York governmental agencies, and (2) all tweets containing the hashtags #sandy (or #nemo) and #nyc. From these data we calculated how many times a tweet was retweeted, controlling for differences in baseline activity in each account. We observed how many hashtags and links each tweet contained. We also calculated the lexical diversity of each tweet, a measure of the range of vocabulary used. Results: During the Sandy storm, 3242 shared (retweeted) messages from public officials were collected. The lexical diversity of official tweets was similar (2.25-2.49) and well below the average for non-official tweets mentioning #sandy and #nyc (3.82). Most official tweets were with substantial retweets including a link for further reading. Of the 448 tweets analyzed from six official city and state Twitter accounts from the Nemo blizzard, 271 were related to the storm, and 174 had actionable information for the public. Actionable storm messages were retweeted approximately 24x per message, compared to 31x per message for general storm information. Conclusions: During two weather emergencies, New York public officials were able to convey storm-related information that was shared widely beyond existing follower bases, potentially improving situational awareness and disaster response. Official Sandy tweets, characterized by a lower lexical diversity score than other city- and Sandy-related tweets, were likely easier to understand, and often linked to further information and resources. Actionable information in the Nemo blizzard, such as specific instructions and cancellation notices, was not shared as often as more general warnings and “fun facts,” suggesting agencies mix important instructions with more general news and trivia, as a way of reaching the broadest audience during a disaster. %M 25075245 %2 PMC4084767 %R 10.2196/med20.3237 %U http://www.medicine20.com/2014/1/e1/ %U https://doi.org/10.2196/med20.3237 %U http://www.ncbi.nlm.nih.gov/pubmed/25075245 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 3 %P e83 %T Implementing a Virtual Community of Practice for Family Physician Training: A Mixed-Methods Case Study %A Barnett,Stephen %A Jones,Sandra C %A Caton,Tim %A Iverson,Don %A Bennett,Sue %A Robinson,Laura %+ General Practice Academic Unit, Faculty of Science, Medicine and Health, University of Wollongong, Northfields Avenue, Wollongong, 2522, Australia, 61 42214613, sbarnett@uow.edu.au %K community of practice %K virtual community of practice %K general practice %K family physician %K training %K medical graduate %K education %K social media %D 2014 %7 12.03.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: GP training in Australia can be professionally isolating, with trainees spread across large geographic areas, leading to problems with rural workforce retention. Virtual communities of practice (VCoPs) may provide a way of improving knowledge sharing and thus reducing professional isolation. Objective: The goal of our study was to review the usefulness of a 7-step framework for implementing a VCoP for general practitioner (GP) training and then evaluated the usefulness of the resulting VCoP in facilitating knowledge sharing and reducing professional isolation. Methods: The case was set in an Australian general practice training region involving 55 first-term trainees (GPT1s), from January to July 2012. ConnectGPR was a secure, online community site that included standard community options such as discussion forums, blogs, newsletter broadcasts, webchats, and photo sharing. A mixed-methods case study methodology was used. Results are presented and interpreted for each step of the VCoP 7-step framework and then in terms of the outcomes of knowledge sharing and overcoming isolation. Results: Step 1, Facilitation: Regular, personal facilitation by a group of GP trainers with a co-ordinating facilitator was an important factor in the success of ConnectGPR. Step 2, Champion and Support: Leadership and stakeholder engagement were vital. Further benefits are possible if the site is recognized as contributing to training time. Step 3, Clear Goals: Clear goals of facilitating knowledge sharing and improving connectedness helped to keep the site discussions focused. Step 4, A Broad Church: The ConnectGPR community was too narrow, focusing only on first-term trainees (GPT1s). Ideally there should be more involvement of senior trainees, trainers, and specialists. Step 5, A Supportive Environment: Facilitators maintained community standards and encouraged participation. Step 6, Measurement Benchmarking and Feedback: Site activity was primarily driven by centrally generated newsletter feedback. Viewing comments by other participants helped users benchmark their own knowledge, particularly around applying guidelines. Step 7, Technology and Community: All the community tools were useful, but chat was limited and users suggested webinars in future. A larger user base and more training may also be helpful. Time is a common barrier. Trust can be built online, which may have benefit for trainees that cannot attend face-to-face workshops. Knowledge sharing and isolation outcomes: 28/34 (82%) of the eligible GPT1s enrolled on ConnectGPR. Trainees shared knowledge through online chat, forums, and shared photos. In terms of knowledge needs, GPT1s rated their need for cardiovascular knowledge more highly than supervisors. Isolation was a common theme among interview respondents, and ConnectGPR users felt more supported in their general practice (13/14, 92.9%). Conclusions: The 7-step framework for implementation of an online community was useful. Overcoming isolation and improving connectedness through an online knowledge sharing community shows promise in GP training. Time and technology are barriers that may be overcome by training, technology, and valuable content. In a VCoP, trust can be built online. This has implications for course delivery, particularly in regional areas. VCoPs may also have a specific role assisting overseas trained doctors to interpret their medical knowledge in a new context. %M 24622292 %R 10.2196/jmir.3083 %U http://www.jmir.org/2014/3/e83/ %U https://doi.org/10.2196/jmir.3083 %U http://www.ncbi.nlm.nih.gov/pubmed/24622292 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e12 %T Online Activity and Participation in Treatment Affects the Perceived Efficacy of Social Health Networks Among Patients With Chronic Illness %A Magnezi,Racheli %A Bergman,Yoav S %A Grosberg,Dafna %+ Department of Public Health and Health Systems Management Program, Bar Ilan University, Department of Management, Ramat Gan, 52900, Israel, 972 35317128, magnezir@biu.ac.il %K Internet %K social health network %K Patient Activation Measure (PAM) %K online health network %D 2014 %7 10.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of online health-related social networks for support, peer-to-peer connections, and obtaining health information has increased dramatically. Participation in an online health-related social network can enhance patients’ self-efficacy and empowerment, as they are given knowledge and tools to manage their chronic health condition more effectively. Thus, we can deduce that patient activation, the extent to which individuals are able to manage their own health care, also increases. However, little is known about the effects of participation in online health-related social networks and patient activation on the perceived usefulness of a website across disease groups. Objective: The intent of the study was to evaluate the effects and benefits of participation in an online health-related social network and to determine which variables predict perceived site usefulness, while examining patient activation. Methods: Data were collected from “Camoni”, the first health-related social network in the Hebrew language. It offers medical advice, including blogs, forums, support groups, internal mail, chats, and an opportunity to consult with experts. This study focused on the site’s five largest and most active communities: diabetes, heart disease, kidney disease, spinal injury, and depression/anxiety. Recruitment was conducted during a three-month period in which a link to the study questionnaire was displayed on the Camoni home page. Three questionnaires were used: a 13-item measure of perceived usefulness (Cronbach alpha=.93) to estimate the extent to which an individual found the website helpful and informative, a 9-item measure of active involvement in the website (Cronbach alpha=.84), and The Patient Activation Measure (PAM-13, Cronbach alpha=.86), which assesses a patient’s level of active participation in his or her health care. Results: There were 296 participants. Men 30-39 years of age scored higher in active involvement than those 40-49 years (P=.03), 50-64 years (P=.004), or 65+ years (P=.01). Respondents 20-29 years of age scored higher in perceived usefulness than those 50-64 years (P=.04) and those 65+ years (P=.049). Those aged 20-29 years scored significantly lower on the PAM-13 scale than those aged 30-39 years (P=.01) and 50-64 years (P=.049). Men and women had similar PAM-13 scores (F9,283=0.17, P=.76). Several variables were significant predictors of perceived usefulness. Age was a negative predictor; younger age was indicative of higher perceived usefulness. Active involvement was a positive predictor. There was a negative relationship found between PAM-13 scores and perceived usefulness, as taking a less active role in one’s own medical care predicted higher perceived website usefulness. A trend toward higher frequency of website activity was associated with increased perception of usefulness. Conclusions: Online health-related social networks can be particularly helpful to individuals with lower patient activation. Our findings add information regarding the social and medical importance of such websites, which are gradually becoming an inseparable part of day-to-day chronic disease management in the community. %M 24413148 %R 10.2196/jmir.2630 %U http://www.jmir.org/2014/1/e12/ %U https://doi.org/10.2196/jmir.2630 %U http://www.ncbi.nlm.nih.gov/pubmed/24413148 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 2 %N 2 %P e13 %T Embedding a Learning Management System Into an Undergraduate Medical Informatics Course in Saudi Arabia: Lessons Learned %A Zakaria,Nasriah %A Jamal,Amr %A Bisht,Shekhar %A Koppel,Cristina %+ Medical Informatics and E-learning Unit, Medical Education Department, College of Medicine, King Saud University, PO Box 2925 (37), Riyadh, 11461, Saudi Arabia, 966 530231826, nzakaria@ksu.edu.sa %K medical education %K medical informatics %K learning management systems (LMS) %D 2013 %7 27.11.2013 %9 Original Paper %J Med 2.0 %G English %X Background: Public universities in Saudi Arabia today are making substantial investments in e-learning as part of their educational system, especially in the implementation of learning management systems (LMS). To our knowledge, this is the first study conducted in Saudi Arabia exploring medical students’ experience with an LMS, particularly as part of a medical informatics course. Objective: This study investigates students’ use of various features of the LMS embedded in a recently implemented medical informatics course. Methods: A mixed methodology approach was employed. Survey questionnaires were distributed to all third year medical informatics students at the end of the course. In addition, two focus group sessions were conducted with twelve students. A thematic analysis of the focus group was performed. Results: A total of 265 third year medical student surveys (167/265, 63% male and 98/265, 37% female) were completed and analyzed. Overall, 50.6% (134/265) of the students agreed that the course was well planned and up-to-date, had clearly stated objectives and clear evaluation methods, appropriate course assignment, and that the LMS offered easy navigation. Most of the students rated the course as good/fair overall. In general, females were 10.4% more likely to prefer the LMS, as revealed by higher odd ratios (odds ratio [OR] 1.104, 95% CI 0.86-1.42) compared to males. Survey results showed that students’ use of LMS tools increased after taking the course compared to before taking the course. The full model containing all items were statistically significant (χ225=69.52, P<.001, n=243), indicating that the model was able to distinguish between students who had positive attitudes towards LMS and those who did not. The focus group, however, revealed that the students used social networking for general use rather than learning purposes, but they were using other Internet resources and mobile devices for learning. Male students showed a higher preference for using technology in general to enhance learning activities. Overall, medical student attitudes towards the LMS were generally positive. Students also wanted a reminder and notification tool to help them stay updated with course events. Interestingly, a subset of students had been running a parallel LMS of their own that has features worth exploring and could be integrated with an official LMS in the future. Conclusions: To our knowledge, this was the first time that an LMS was used in a medical informatics course. Students showed interest in adapting various LMS tools to enhance their learning and gained more knowledge through familiarity with the tool. Researching an official LMS also revealed the existence of a parallel student-created LMS. This could allow teacher-led and student-led platforms to be integrated in the future for an enhanced student-centered experience. %M 25075236 %R 10.2196/med20.2735 %U http://www.medicine20.com/2013/2/e13/ %U https://doi.org/10.2196/med20.2735 %U http://www.ncbi.nlm.nih.gov/pubmed/25075236 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 2 %N 2 %P e12 %T Participatory Design With Seniors: Design of Future Services and Iterative Refinements of Interactive eHealth Services for Old Citizens %A Scandurra,Isabella %A Sjölinder,Marie %+ Division of Visual Information and Interaction, Department of Information Technology, Uppsala University, Box 337, Uppsala, 75105, Sweden, 46 703681299, isabella.scandurra@it.uu.se %K Internet %K community-based participatory research %K systems analysis %K interdisciplinary communication %K community networks %K professional-patient relations %K seniors %K elderly users %K television %K social inclusion %D 2013 %7 08.10.2013 %9 Original Paper %J Med 2.0 %G English %X Background: There is an increasing social isolation among the elderly today. This will be an even larger issue in the future with growing numbers of elderly and less resources, for example, in terms of economy and staff. Loneliness and social isolation can, however, be addressed in several ways using different interactive eHealth services. Objective: This case study investigated novel eHealth services for the elderly, and their usage of a social interactive device designed especially for them. Methods: In this work, we used an innovative mobile communication device connected to the television (TV), which worked as a remotely controlled large interactive screen. The device was tested by 8 volunteers who visited a senior center. They were between 65 and 80 years of age and lived in their own homes. Throughout the 1.5 year-long project, 7 design workshops were held with the seniors and the staff at the center. During these workshops, demands and preferences regarding existing and new services were gathered. At the end of the project the participants’ experience of the device and of the services was elaborated in 3 workshops to get ideas for improved or new meaningful services. During the data analyses and development process, what seniors thought would be useful in relation to what was feasible was prioritized by the development company. Results: Regarding daily usage, the seniors reported that they mainly used the service for receiving information from the senior center and for communication with other participants in the group or with younger relatives. They also read information about events at the senior center and they liked to perform a weekly sent out workout exercise. Further, they played games such as Memory and Sudoku using the device. The service development focused on three categories of services: cognitive activities, social activities, and physical activities. A cognitive activity service that would be meaningful to develop was a game for practicing working memory. In the social activities category, the seniors wanted different quizzes and multi-player games. For physical activities, the seniors desired more workout exercises and suggestions for guided walking routes. A new category, “information and news”, was suggested since they lacked services like senior-customized global and local news. Conclusions: This study showed the importance of input from a group of seniors when designing new services for elderly citizens. Besides input to interactive eHealth service development for seniors, this study showed the importance of a social context around such work. The seniors were very engaged throughout the project and workshops were frequently visited and the seniors became friends. The high amount of input from the seniors could be explained in terms of social inclusion; they belonged to a group and each member was considered important for the work. The friendly workshop atmosphere facilitated new ideas and redesign of the services. %M 25075235 %R 10.2196/med20.2729 %U http://www.medicine20.com/2013/2/e12/ %U https://doi.org/10.2196/med20.2729 %U http://www.ncbi.nlm.nih.gov/pubmed/25075235 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 2 %N 2 %P e11 %T Clinicians’ Assessment of Mobile Monitoring: A Comparative Study in Japan and Spain %A Okazaki,Shintaro %A Castañeda,José Alberto %A Sanz,Silvia %+ Department of Marketing, College of Economics & Business Administration, Universidad Autónoma de Madrid, Cantoblanco, Madrid, , Spain, 34 914972872, shintaro.okazaki@uam.es %K comparative study %K health monitoring %K personal innovativeness %K smartphone %K psychic distance %D 2013 %7 18.09.2013 %9 Original Paper %J Med 2.0 %G English %X Background: The gradual but steady shift toward telemedicine during the past decades is a clear response to important health problems that most industrialized countries have been facing. The growing elderly population and changing dietary habits have led to an increase in people with chronic diseases and overall health care expenditures. As more consumers use their mobile device as their preferred information and communication technology (ICT) device, mobile health monitoring has been receiving increasing attention in recent years. Objective: This study examines clinicians’ perception of factors determining mobile health monitoring acceptance in Japan and Spain. The study proposes a causal model consisting of innovation seeking, new ICT attributes (perceived value, time-place flexibility, and compatibility), and usage intention. In addition, cross-country differences are posited for the hypothesized relationships among the proposed constructs. Methods: A questionnaire survey was performed to test our research model and hypotheses. The sample consisted of clinicians from various medical specialties. In total, 471 and 497 usable responses were obtained in Japan and Spain, respectively. Results: In both countries, the collected data fit the model well with all the hypothesized paths among the constructs being supported. Furthermore, the moderating effects of psychic distance were observed in most of the paths. Conclusions: Our study demonstrates the importance of new ICT attributes, namely perceived value, time-place flexibility, and compatibility, in the clinicians' adoption of mobile health monitoring. In particular, our results clearly indicated that perceived medical value and ubiquitous nature of the tool are the two main benefits clinicians are likely to perceive (and appreciate) in both countries. This tendency will be stronger for those with a greater propensity to seek innovation in ICT. In terms of cross-country comparison, the strength of the path from innovation seeking to perceived value was greater in Japan than in Spain. Since the number of clinicians per 10,000 residents is substantially fewer in Japan compared with Spain, clinicians with a greater propensity to seek innovation in ICT may have perceived greater value in using mobile health monitoring to improve remote patient care. %M 25075234 %R 10.2196/med20.2874 %U http://www.medicine20.com/2013/2/e11/ %U https://doi.org/10.2196/med20.2874 %U http://www.ncbi.nlm.nih.gov/pubmed/25075234 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 2 %N 2 %P e10 %T eHealth Technology Competencies for Health Professionals Working in Home Care to Support Older Adults to Age in Place: Outcomes of a Two-Day Collaborative Workshop %A Barakat,Ansam %A Woolrych,Ryan D %A Sixsmith,Andrew %A Kearns,William D %A Kort,Helianthe SM %+ Demand Driven Care, Research Centre for Innovations in Healthcare, Faculty of Healthcare, University of Applied Sciences Utrecht, Bolognalaan 101, Utrecht, 3508 AD, Netherlands, 31 884815342, helianthe.kort@hu.nl %K competencies %K nurses %K professionals %K technology %K CanMEDS %K health care %K eHealth %K health information technologies %K ambient assisted living %K mobile health %D 2013 %7 05.09.2013 %9 Original Paper %J Med 2.0 %G English %X Background: The demand for care is increasing, whereas in the near future the number of people working in professional care will not match with the demand for care. eHealth technology can help to meet the growing demand for care. Despite the apparent positive effects of eHealth technology, there are still barriers to technology adoption related to the absence of a composite set of knowledge and skills among health care professionals regarding the use of eHealth technology. Objective: The objective of this paper is to discuss the competencies required by health care professionals working in home care, with eHealth technologies such as remote telecare and ambient assisted living (AAL), mobile health, and fall detection systems. Methods: A two-day collaborative workshop was undertaken with academics across multiple disciplines with experience in working on funded research regarding the application and development of technologies to support older people. Results: The findings revealed that health care professionals working in home care require a subset of composite skills as well as technology-specific competencies to develop the necessary aptitude in eHealth care. This paper argues that eHealth care technology skills must be instilled in health care professionals to ensure that technologies become integral components of future care delivery, especially to support older adults to age in place. Educating health care professionals with the necessary skill training in eHealth care will improve service delivery and optimise the eHealth care potential to reduce costs by improving efficiency. Moreover, embedding eHealth care competencies within training and education for health care professionals ensures that the benefits of new technologies are realized by casting them in the context of the larger system of care. These care improvements will potentially support the independent living of older persons at home. Conclusions: This paper describes the health care professionals’ competencies and requirements needed for the use of eHealth technologies to support elderly adults to age in place. In addition, this paper underscores the need for further discussion of the changing role of health care professionals working in home care within the context of emerging eHealth care technologies. The findings are of value to local and central government, health care professionals, service delivery organizations, and commissioners of care to use this paper as a framework to conduct and develop competencies for health care professionals working with eHealth technologies. %M 25075233 %R 10.2196/med20.2711 %U http://www.medicine20.com/2013/2/e10/ %U https://doi.org/10.2196/med20.2711 %U http://www.ncbi.nlm.nih.gov/pubmed/25075233 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 2 %N 2 %P e9 %T Development of a Questionnaire and Cross-Sectional Survey of Patient eHealth Readiness and eHealth Inequalities %A Jones,Ray %+ University of Plymouth, Faculty of Health, Education, and Society, 3 Portland Villas, Plymouth, PL4 8AA, United Kingdom, 44 7972563340, ray.jones@plymouth.ac.uk %K eHealth readiness %K eHealth inequalities %K digital divide %K questionnaire development %D 2013 %7 02.09.2013 %9 Original Paper %J Med 2.0 %G English %X Background: Many speak of the digital divide, but variation in the opportunity of patients to use the Internet for health (patient eHealth readiness) is not a binary difference, rather a distribution influenced by personal capability, provision of services, support, and cost. Digital divisions in health have been addressed by various initiatives, but there was no comprehensive validated measure to know if they are effective that could be used in randomized controlled trials (RCTs) covering both non-Internet-users and the range of Internet-users. Objective: The aim of this study was to develop and validate a self-completed questionnaire and scoring system to assess patient eHealth readiness by examining the spread of scores and eHealth inequalities. The intended use of this questionnaire and scores is in RCTs of interventions aiming to improve patient eHealth readiness and reduce eHealth inequalities. Methods: Based on four factors identified from the literature, a self-completed questionnaire, using a pragmatic combination of factual and attitude questions, was drafted and piloted in three stages. This was followed by a final population-based, cross-sectional household survey of 344 people used to refine the scoring system. Results: The Patient eHealth Readiness Questionnaire (PERQ) includes questions used to calculate four subscores: patients’ perception of (1) provision, (2) their personal ability and confidence, (3) their interpersonal support, and (4) relative costs in using the Internet for health. These were combined into an overall PERQ score (0-9) which could be used in intervention studies. Reduction in standard deviation of the scores represents reduction in eHealth inequalities. Conclusions: PERQ appears acceptable for participants in British studies. The scores produced appear valid and will enable assessment of the effectiveness of interventions to improve patient eHealth readiness and reduce eHealth inequalities. Such methods need continued evolution and redevelopment for other environments. Full documentation and data have been published to allow others to develop the tool further. %R 10.2196/med20.2559 %U http://www.medicine20.com/2013/2/e9/ %U https://doi.org/10.2196/med20.2559 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 2 %N 2 %P e8 %T Validity and Reliability of the eHealth Analysis and Steering Instrument %A Blanson Henkemans,Olivier A %A Dusseldorp,Elise ML %A Keijsers,Jolanda FEM %A Kessens,Judith M %A Neerincx,Mark A %A Otten,Wilma %+ Nederlandse Organisatie voor Toegepast Natuurwetenschappelijk Onderzoek (TNO), Department Lifestyle, Room 208, Wassenaarseweg 56, Leiden, 2333AL, Netherlands, 31 888666186, olivier.blansonhenkemans@tno.nl %K self-care %K psychometrics %K validity %K reliability %K scale analysis %K effectiveness %K self-management support %D 2013 %7 22.08.2013 %9 Original Paper %J Med 2.0 %G English %X Background: eHealth services can contribute to individuals’ self-management, that is, performing lifestyle-related activities and decision making, to maintain a good health, or to mitigate the effect of an (chronic) illness on their health. But how effective are these services? Conducting a randomized controlled trial (RCT) is the golden standard to answer such a question, but takes extensive time and effort. The eHealth Analysis and Steering Instrument (eASI) offers a quick, but not dirty alternative. The eASI surveys how eHealth services score on 3 dimensions (ie, utility, usability, and content) and 12 underlying categories (ie, insight in health condition, self-management decision making, performance of self-management, involving the social environment, interaction, personalization, persuasion, description of health issue, factors of influence, goal of eHealth service, implementation, and evidence). However, there are no data on its validity and reliability. Objective: The objective of our study was to assess the construct and predictive validity and interrater reliability of the eASI. Methods: We found 16 eHealth services supporting self-management published in the literature, whose effectiveness was evaluated in an RCT and the service itself was available for rating. Participants (N=16) rated these services with the eASI. We analyzed the correlation of eASI items with the underlying three dimensions (construct validity), the correlation between the eASI score and the eHealth services’ effect size observed in the RCT (predictive validity), and the interrater agreement. Results: Three items did not fit with the other items and dimensions and were removed from the eASI; 4 items were replaced from the utility to the content dimension. The interrater reliabilities of the dimensions and the total score were moderate (total, κ=.53, and content, κ=.55) and substantial (utility, κ=.69, and usability, κ=.63). The adjusted eASI explained variance in the eHealth services’ effect sizes (R2=.31, P<.001), as did the dimensions utility (R2=.49, P<.001) and usability (R2=.18, P=.021). Usability explained variance in the effect size on health outcomes (R2=.13, P=.028). Conclusions: After removing 3 items and replacing 4 items to another dimension, the eASI (3 dimensions, 11 categories, and 32 items) has a good construct validity and predictive validity. The eASI scales are moderately to highly reliable. Accordingly, the eASI can predict how effective an eHealth service is in regard to supporting self-management. Due to a small pool of available eHealth services, it is advised to reevaluate the eASI in the future with more services. %M 25075243 %R 10.2196/med20.2571 %U http://www.medicine20.com/2013/2/e8/ %U https://doi.org/10.2196/med20.2571 %U http://www.ncbi.nlm.nih.gov/pubmed/25075243 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 2 %P e21 %T Differences in Trunk Accelerometry Between Frail and Nonfrail Elderly Persons in Sit-to-Stand and Stand-to-Sit Transitions Based on a Mobile Inertial Sensor %A Galán-Mercant,Alejandro %A Cuesta-Vargas,Antonio I %+ Faculty of Health Sciences, Department of Physiotherapy, University of Malaga, Av. Martiricos s/n 29009 Malaga, Malaga, , Spain, 34 0034667455544, acuesta@uma.es %K frail syndrome %K sit-to-stand %K stand-to-sit %K mobile phone %K inertial sensor %D 2013 %7 16.08.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Clinical frailty syndrome is a common geriatric syndrome, which is characterized by physiological reserve decreases and increased vulnerability. The changes associated to ageing and frailties are associated to changes in gait characteristics and the basic functional capacities. Traditional clinical evaluation of Sit-to-Stand (Si-St) and Stand-to-Sit (St-Si) transition is based on visual observation of joint angle motion to describe alterations in coordination and movement pattern. The latest generation smartphones often include inertial sensors with subunits such as accelerometers and gyroscopes, which can detect acceleration. Objective: Firstly, to describe the variability of the accelerations, angular velocity, and displacement of the trunk during the Sit-to-Stand and Stand-to-Sit transitions in two groups of frail and physically active elderly persons, through instrumentation with the iPhone 4 smartphone. Secondly, we want to analyze the differences between the two study groups. Methods: A cross-sectional study that involved 30 subjects over 65 years, 14 frail and 16 fit subjects. The participants were classified with frail syndrome by the Fried criteria. Linear acceleration was measured along three orthogonal axes using the iPhone 4 accelerometer. Each subject performed up to three successive Si-St and St-Si postural transitions using a standard chair with armrest. Results: Significant differences were found between the two groups of frail and fit elderly persons in the accelerometry and angular displacement variables obtained in the kinematic readings of the trunk during both transitions. Conclusions: The inertial sensor fitted in the iPhone 4 is able to study and analyze the kinematics of the Si-St and St-Si transitions in frail and physically active elderly persons. The accelerometry values for the frail elderly are lower than for the physically active elderly, while variability in the readings for the frail elderly is also lower than for the control group. %M 25098977 %R 10.2196/mhealth.2710 %U http://mhealth.jmir.org/2013/2/e21/ %U https://doi.org/10.2196/mhealth.2710 %U http://www.ncbi.nlm.nih.gov/pubmed/25098977 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 2 %N 2 %P e5 %T The Ligurian Human Immunodeficiency Virus Clinical Network: A Web Tool to Manage Patients With Human Immunodeficiency Virus in Primary Care and Multicenter Clinical Trials %A Fraccaro,Paolo %A Pupella,Valeria %A Gazzarata,Roberta %A Dentone,Chiara %A Cenderello,Giovanni %A De Leo,Pasqualina %A Bozzano,Federica %A Casalino Finocchio,Giorgetta %A De Maria,Andrea %A Fenoglio,Daniela %A Filaci,Gilberto %A Guerra,Michele %A Di Biagio,Antonio %A Mantia,Eugenio %A Orofino,Giancarlo %A Ferrea,Giuseppe %A Viscoli,Claudio %A Giacomini,Mauro %+ Department of Informatics, Bioengineering, Robotics and System Engineering, University of Genoa, MEDINFO, Via Opera Pia 13, Genoa, 16145, Italy, 39 010 3536546, paolo.fraccaro.dms@gmail.com %K multicenter clinical trials %K human immunodeficiency virus %K health level 7 %K biomedical ontologies %K z score %D 2013 %7 13.08.2013 %9 Original Paper %J Med 2.0 %G English %X Background: In recent years, Highly-Active Anti-Retroviral Therapies (HAARTs) have modified the Human Immunodeficiency Virus (HIV) life-cycle and the disease is now considered chronic. Consequently, a longitudinal and complex follow-up is now required for HIV positive patients during their lifetime. Moreover, patients often encounter various complications due to comorbidities, related to the immunodeficiency state and HAARTs’ side effects. Thus, HIV positive patients are involved in multicenter clinical trials (MCTs) to improve treatments and discover a preventive vaccine. Therefore, physicians require proper instruments to access comprehensive patient data for managing patients during follow-ups, and tools for data collection and analysis in MCTs. Objective: The Ligurian HIV Clinical Network aims to provide physicians with a Web-tool to administrate HIV positive patients’ data within primary-care and to reuse the collected clinical information to perform MCTs in Northern Italy. Methods: The key aspect of the system is a relational database which allows the storage of various types of clinical information (eg, related to HIV, cardiovascular, or hepatic diseases) in multiple formats. The modular design of the database permits a rapid insertion of new parameters without requiring any changes in the database structure. Furthermore, codes from biomedical ontologies controlled vocabularies (“Logical Observation Identifier Names and Codes”, and “International Classification of Diseases 9”) and ontologies (“Systematized Nomenclature of Medicine Clinical Terms”), units and normality ranges used by all partners participating in the project were collected to achieve a complete semantic interoperability. Accordingly, data can be automatically normalized through the z score formula and physicians can extract and correctly compare information with external statistical tools. Moreover, to respect patients’ privacy and legal issues, a local identifier, determined through an HASH cryptography algorithm, is assigned to each patient during the registration process. The database is managed by a user-friendly Web-platform which allows quick access to information during medical examinations and the reusing of the collected data for present and future MCTs. Furthermore, a bidirectional middleware was created in order to import/export information through HL7 messaging. Hence, data can be manually entered by physicians or automatically collected within HL7-compliant Hospital Information systems. Results: Presently, the direct storage of patients’ information from the San Paolo Hospital (Savona, Italy), and San Martino and Galliera hospitals in Genoa is in a test phase. Currently, 8 centers of Infectious Diseases (located in Liguria and Piedmont) are participating in the project and almost 400 HIV positive patients have been recorded in the system. Patient data has been used for primary care and research purposes. Currently, there are 4 on-going MCTs and preliminary results have already been presented at International HIV congresses. Conclusions: The Web-platform allows effective management, sharing and reuse of information within primary care and clinical research. In the future it is planned to share the clinical information from this network with other HL7-compliant workgroups and to extend the platform to other infective diseases (eg, hepatitis). %M 25075240 %R 10.2196/med20.2712 %U http://www.medicine20.com/2013/2/e5/ %U https://doi.org/10.2196/med20.2712 %U http://www.ncbi.nlm.nih.gov/pubmed/25075240 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 2 %N 2 %P e7 %T Live Long and Prosper: Potentials of Low-Cost Consumer Devices for the Prevention of Cardiovascular Diseases %A Meyer,Jochen %A Hein,Andreas %+ R&D Division Health, OFFIS Institute for Information Technology, Escherweg 2, Oldenburg, 26121, Germany, 49 4419722 ext 185, meyer@offis.de %K primary prevention %K cardiovascular diseases %K user-computer interface %D 2013 %7 12.08.2013 %9 Original Paper %J Med 2.0 %G English %X Background: Cardiovascular diseases (CVD) are one of the major causes of death worldwide. Personal behavior such as physical activity considerably influences the risk of incurring a CVD. In the last years numerous products such as pedometers have become available on the mass market that allow monitoring relevant behaviors and vital parameters. These devices are sufficiently precise, affordable, and easy to use. While today they are mostly lifestyle oriented they also have considerable potential for health and prevention. Objective: Our goal is to investigate how recent low-cost devices can be used in real-life settings for the prevention of CVD, and whether using these devices has an advantage over subjective self-assessment. We also examine whether it is feasible to use multiple of such devices in parallel. Methods: We observe whether and how persons are willing and able to use multiple devices in their daily lives. We compare the devices’ measurements with subjective self-assessment. We make use of existing low-cost consumer devices to monitor a user's behavior. By mapping the devices' features with pre-defined prevention goals we ensure that the system collects meaningful data that can be used to monitor the individual's behavior. We conducted a user study with 10 healthy adults to measure usability and to identify problems with sensor use in real life. The participants used the devices' original portals to monitor their behavior. The subjects (age range 35-75) used an off-the-shelf pedometer and a sports watch for 4 weeks. Results: The participants responded in principle positively to the use of the devices. Analyzing the sensor data, we found that the users had some difficulties in operating the devices. We also found that the participants' self-assessment of their health behavior was too optimistic compared to the monitored data. They rated the usability of the overall system with 71 of up to 100 points in the "System Usability Scale". Conclusions: Our study indicates that today's devices are suitable for a long term monitoring of health for the prevention of CVD. Using the devices provides more precise data than a subjective self-assessment. However usability and acceptance of the systems are still major topics. %M 25075242 %R 10.2196/med20.2667 %U http://www.medicine20.com/2013/2/e7/ %U https://doi.org/10.2196/med20.2667 %U http://www.ncbi.nlm.nih.gov/pubmed/25075242 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 2 %N 2 %P e4 %T Health Care Social Media: Expectations of Users in a Developing Country %A Amrita, %A Biswas,Dhrubes %+ Indian Institute of Technology (IIT), Rajendra Mishra School of Engineering Entrepreneurship (RMSOEE), Indian Institute of Technology, Kharagpur, 721302, India, 91 03222 ext 281091, iamthealchemist@gmail.com %K health care %K social media %K developing economy %K user expectations %K networking %K eHealth %K online patient care %K online medical advice %D 2013 %7 09.08.2013 %9 Original Paper %J Med 2.0 %G English %X Background: Affordability, acceptability, accommodation, availability, and accessibility are the five most important dimensions of access to health services. Seventy two percent of the Indian population lives in semi-urban and rural areas. The strong mismatched ratio of hospitals to patients, rising costs of health care, rapidly changing demographics, increasing population, and heightened demands in pricing for technological health care usage in emerging economies necessitate a unique health delivery solution model using social media. A greater disease burden lies in the health care delivery in developing country like India. This is due to the lack of health care infrastructure in the majority of semi-urban and rural regions. New techniques need to be introduced in these regions to overcome these issues. In the present scenario, people use social media from business, automobiles, arts, book marking, cooking, entertainment, and general networking. Developed and advanced countries like the United States have developed their communication system for many years now. They have already established social media in a number of domains including health care. Similar practice incidences can be used to provide a new dimension to health care in the semi-urban regions of India. Objective: This paper describes an extended study of a previous empirical study on the expectations of social media users for health care. The paper discusses what the users of social media expect from a health care social media site. Methods: Multiple regression analysis was used to determine the significance of the affect of four factors (privacy, immediacy, usability, and communication) on the usage of health care social media. Privacy, immediacy, usability, and communication were the independent variables and health care social media was the dependant variable. Results: There were 103 respondents who used the online questionnaire tool to generate their responses. The results from the multiple regression analysis using SPSS 20 showed that the model is acceptable, with P=.011, which is statistically significant on a P<.05 level. The observed F value (2.082) in ANOVA was less than the given value in the F table (2.61), which allowed us to accept the hypothesis that the independent variables influence the dependant variable. The users of social media in India expect that they can best utilize social media through emergency service information. They want to be able to learn the operations of the social media site quickly and expect to know about health camps and insurance collaborations. However, people like to become friends with people with similar interests based on their interests identified. Conclusions: Health care social media requires intelligent implementation in developing economies. It needs to cater to the expectations of the users. The people in India, especially those in urban and semi-urban regions, are very interested in accepting the system. %M 25075239 %R 10.2196/med20.2720 %U http://www.medicine20.com/2013/2/e4/ %U https://doi.org/10.2196/med20.2720 %U http://www.ncbi.nlm.nih.gov/pubmed/25075239 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 2 %N 2 %P e3 %T Developing a Framework to Generate Evidence of Health Outcomes From Social Media Use in Chronic Disease Management %A Merolli,Mark %A Gray,Kathleen %A Martin-Sanchez,Fernando %+ Health and Biomedical Informatics Centre, The University of Melbourne, Level 1, 202 Berkeley St, Parkville, Melbourne, 3010, Australia, 61 39035 4943, mmerolli@student.unimelb.edu.au %K chronic disease %K social media %K Internet %K evidence-based practice, affordances %K patient-reported outcomes %D 2013 %7 08.08.2013 %9 Original Paper %J Med 2.0 %G English %X Background: While there is an abundance of evidence-based practice (EBP) recommendations guiding management of various chronic diseases, evidence suggesting best practice for using social media to improve health outcomes is inadequate. The variety of social media platforms, multiple potential uses, inconsistent definitions, and paucity of rigorous studies, make it difficult to measure health outcomes reliably in chronic disease management. Most published investigations report on an earlier generation of online tools, which are not as user-centered, participatory, engaging, or collaborative, and thus may work differently for health self-management. Objective: The challenge to establish a sound evidence base for social media use in chronic disease starts with the need to define criteria and methods to generate and evaluate evidence. The authors’ key objective is to develop a framework for research and practice that addresses this challenge. Methods: This paper forms part of a larger research project that presents a conceptual framework of how evidence of health outcomes can be generated from social media use, allowing social media to be utilized in chronic disease management more effectively. Using mixed methods incorporating a qualitative literature review, a survey and a pilot intervention, the research closely examines the therapeutic affordances of social media, people with chronic pain (PWCP) as a subset of chronic disease management, valid outcome measurement of patient-reported (health) outcomes (PRO), the individual needs of people living with chronic disease, and finally translation of the combined results to improve evidence-based decision making about social media use in this context. Results: Extensive review highlights various affordances of social media that may prove valuable to understanding social media’s effect on individual health outcomes. However, without standardized PRO instruments, we are unable to definitively investigate these effects. The proposed framework that we offer outlines how therapeutic affordances of social media coupled with valid and reliable PRO measurement may be used to generate evidence of improvements in health outcomes, as well as guide evidence-based decision making in the future about social media use as part of chronic disease self-management. Conclusions: The results will (1) inform a framework for conducting research into health outcomes from social media use in chronic disease, as well as support translating the findings into evidence of improved health outcomes, and (2) inform a set of recommendations for evidence-based decision making about social media use as part of chronic disease self-management. These outcomes will fill a gap in the knowledge and resources available to individuals managing a chronic disease, their clinicians and other researchers in chronic disease and the field of medicine 2.0. %M 25075238 %R 10.2196/med20.2717 %U http://www.medicine20.com/2013/2/e3/ %U https://doi.org/10.2196/med20.2717 %U http://www.ncbi.nlm.nih.gov/pubmed/25075238 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 8 %P e157 %T An Analysis of Online Evaluations on a Physician Rating Website: Evidence From a German Public Reporting Instrument %A Emmert,Martin %A Meier,Florian %+ Institute of Management (IFM), School of Business and Economics, Friedrich-Alexander-University Erlangen-Nuremberg, Lange Gasse 20, Nuremberg, 90403, Germany, 49 911 5302 ext 253, Martin.Emmert@fau.de %K physician rating website %K public reporting %K quality of care %K Internet %K patient satisfaction %D 2013 %7 06.08.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Physician rating websites (PRW) have been gaining in popularity among patients who are seeking a physician. However, little evidence is available on the number, distribution, or trend of evaluations on PRWs. Furthermore, there is no published evidence available that analyzes the characteristics of the patients who provide ratings on PRWs. Objective: The objective of the study was to analyze all physician evaluations that were posted on the German PRW, jameda, in 2012. Methods: Data from the German PRW, jameda, from 2012 were analyzed and contained 127,192 ratings of 53,585 physicians from 107,148 patients. Information included medical specialty and gender of the physician, age, gender, and health insurance status of the patient, as well as the results of the physician ratings. Statistical analysis was carried out using the median test and Kendall Tau-b test. Results: Thirty-seven percent of all German physicians were rated on jameda in 2012. Nearly half of those physicians were rated once, and less than 2% were rated more than ten times (mean number of ratings 2.37, SD 3.17). About one third of all rated physicians were female. Rating patients were mostly female (60%), between 30-50 years (51%) and covered by Statutory Health Insurance (83%). A mean of 1.19 evaluations per patient could be calculated (SD 0.778). Most of the rated medical specialties were orthopedists, dermatologists, and gynecologists. Two thirds of all ratings could be assigned to the best category, “very good”. Female physicians had significantly better ratings than did their male colleagues (P<.001). Additionally, significant rating differences existed between medical specialties (P<.001). It could further be shown that older patients gave better ratings than did their younger counterparts (P<.001). The same was true for patients covered by private health insurance; they gave more favorable evaluations than did patients covered by statutory health insurance (P<.001). No significant rating differences could be detected between female and male patients (P=.505). The likelihood of a good rating was shown to increase with a rising number of both physician and patient ratings. Conclusions: Our findings are mostly in line with those published for PRWs from the United States. It could be shown that most of the ratings were positive, and differences existed regarding sociodemographic characteristics of both physicians and patients. An increase in the usage of PRWs might contribute to reducing the lack of publicly available information on physician quality. However, it remains unclear whether PRWs have the potential to reflect the quality of care offered by individual health care providers. Further research should assess in more detail the motivation of patients who rate their physicians online. %M 23919987 %R 10.2196/jmir.2655 %U http://www.jmir.org/2013/8/e157/ %U https://doi.org/10.2196/jmir.2655 %U http://www.ncbi.nlm.nih.gov/pubmed/23919987 %0 Journal Article %@ 1923-2195 %I Gunther Eysenbach %V 2 %N 2 %P e2 %T How Twitter Is Studied in the Medical Professions: A Classification of Twitter Papers Indexed in PubMed %A Williams,Shirley Ann %A Terras,Melissa %A Warwick,Claire %+ School of Systems Engineering, University of Reading, Whiteknights, Reading, RG6 6AY, United Kingdom, 44 118 378 8613, shirley.williams@reading.ac.uk %K Twitter messaging %K Twitter messenging %K information science %K Twitter %K microblogging %K papers %K classification, social network systems %D 2013 %7 18.07.2013 %9 Original Paper %J Med 2.0 %G English %X Background: Since their inception, Twitter and related microblogging systems have provided a rich source of information for researchers and have attracted interest in their affordances and use. Since 2009 PubMed has included 123 journal articles on medicine and Twitter, but no overview exists as to how the field uses Twitter in research. Objective: This paper aims to identify published work relating to Twitter within the fields indexed by PubMed, and then to classify it. This classification will provide a framework in which future researchers will be able to position their work, and to provide an understanding of the current reach of research using Twitter in medical disciplines. Methods: Papers on Twitter and related topics were identified and reviewed. The papers were then qualitatively classified based on the paper’s title and abstract to determine their focus. The work that was Twitter focused was studied in detail to determine what data, if any, it was based on, and from this a categorization of the data set size used in the studies was developed. Using open coded content analysis additional important categories were also identified, relating to the primary methodology, domain, and aspect. Results: As of 2012, PubMed comprises more than 21 million citations from biomedical literature, and from these a corpus of 134 potentially Twitter related papers were identified, eleven of which were subsequently found not to be relevant. There were no papers prior to 2009 relating to microblogging, a term first used in 2006. Of the remaining 123 papers which mentioned Twitter, thirty were focused on Twitter (the others referring to it tangentially). The early Twitter focused papers introduced the topic and highlighted the potential, not carrying out any form of data analysis. The majority of published papers used analytic techniques to sort through thousands, if not millions, of individual tweets, often depending on automated tools to do so. Our analysis demonstrates that researchers are starting to use knowledge discovery methods and data mining techniques to understand vast quantities of tweets: the study of Twitter is becoming quantitative research. Conclusions: This work is to the best of our knowledge the first overview study of medical related research based on Twitter and related microblogging. We have used 5 dimensions to categorize published medical related research on Twitter. This classification provides a framework within which researchers studying development and use of Twitter within medical related research, and those undertaking comparative studies of research, relating to Twitter in the area of medicine and beyond, can position and ground their work. %M 25075237 %R 10.2196/med20.2269 %U http://www.medicine20.com/2013/2/e2/ %U https://doi.org/10.2196/med20.2269 %U http://www.ncbi.nlm.nih.gov/pubmed/25075237 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 1 %N 1 %P e9 %T “Let’s get Wasted!” and Other Apps: Characteristics, Acceptability, and Use of Alcohol-Related Smartphone Applications %A Weaver,Emma R %A Horyniak,Danielle R %A Jenkinson,Rebecca %A Dietze,Paul %A Lim,Megan SC %+ Burnet Institute, Centre for Population Health, 85 Commercial Rd, Melbourne, 3004, Australia, 61 383442403, lim@burnet.edu.au %K alcohol drinking %K young adult %K mobile phone %K applications %D 2013 %7 25.06.2013 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Smartphone applications (“apps”) offer a number of possibilities for health promotion activities. However, young people may also be exposed to apps with incorrect or poor quality information, since, like the Internet, apps are mostly unregulated. Little is known about the quality of alcohol-related apps or what influence they may have on young people’s behavior. Objective: To critically review popular alcohol-related smartphone apps and to explore young people’s opinions of these apps, their acceptability, and use for alcohol-related health promotion. Methods: First, a content analysis of 500 smartphone apps available via Apple iTunes and Android Google Play stores was conducted. Second, all available blood alcohol concentration (BAC) apps were tested against four individual case profiles of known BAC from a previous study. Third, two focus group discussions explored how young people use alcohol-related apps, particularly BAC apps. Results: 384 apps were included; 50% (192) were entertainment apps, 39% (148) were BAC apps, and 11% (44) were health promotion and/or stop drinking–related apps. When testing the BAC apps, there was wide variation in results, with apps tending to overestimate BAC scores compared with recorded scores. Participants were skeptical of the accuracy of BAC apps, and there was an overall concern that these apps would be used as a form of entertainment, further encouraging young people to drink, rather than reduce their drinking and risk taking. Conclusions: The majority of popular alcohol-related apps encouraged alcohol consumption. Apps estimating blood alcohol concentration were widely available but were highly unreliable. Health departments and prominent health organizations need to endorse alcohol smartphone apps that are accurate and evidence-based to give specific apps credibility in the ever-expanding market of unregulated apps. %M 25100681 %R 10.2196/mhealth.2709 %U http://mhealth.jmir.org/2013/1/e9/ %U https://doi.org/10.2196/mhealth.2709 %U http://www.ncbi.nlm.nih.gov/pubmed/25100681