TY - JOUR AU - Välimäki, Maritta AU - Hätönen, Heli AU - Adams, E. Clive PY - 2012/08/02 TI - Mobile.net: Mobile Telephone Text Messages to Encourage Adherence to Medication and to Follow up With People With Psychosis: Methods and Protocol for a Multicenter Randomized Controlled Two-Armed Trial JO - JMIR Res Protoc SP - e8 VL - 1 IS - 2 KW - Adherence KW - text messages KW - psychosis N2 - Background: Schizophrenia is a high-cost, chronic, serious mental illness. There is a clear need to improve treatments and expand access to care for persons with schizophrenia, but simple, tailored interventions are missing. Objective: To evaluate the impact of tailored mobile telephone text messages to encourage adherence to medication and to follow up with people with psychosis at 12 months. Methods: Mobile.Net is a pragmatic randomized trial with inpatient psychiatric wards allocated to two parallel arms. The trial will include 24 sites and 45 psychiatric hospital wards providing inpatient care in Finland. The participants will be adult patients aged 18?65 years, of either sex, with antipsychotic medication (Anatomical Therapeutic Chemical classification 2011) on discharge from a psychiatric hospital, who have a mobile phone, are able to use the Finnish language, and are able to give written informed consent to participate in the study. The intervention group will receive semiautomatic system (short message service [SMS]) messages after they have been discharged from the psychiatric hospital. Patients will choose the form, content, timing, and frequency of the SMS messages related to their medication, keeping appointments, and other daily care. SMS messages will continue to the end of the study period (12 months) or until participants no longer want to receive the messages. Patients will be encouraged to contact researchers if they feel that they need to adjust the message in any way. At all times, both groups will receive usual care at the discretion of their team (psychiatry and nursing). The primary outcomes are service use and healthy days by 12 months based on routine data (admission to a psychiatric hospital, time to next hospitalization, time in hospital during this year, and healthy days). The secondary outcomes are service use, coercive measures, medication, adverse events, satisfaction with care, the intervention, and the trial, social functioning, and economic factors. Data will be collected 12 months after baseline. The outcomes are based on the national health registers and patients? subjective evaluations. The primary analysis will be by intention-to-treat. Trial Registration: International Standard Randomised Controlled Trial Number (ISRCTN): 27704027; http://www.controlled-trials.com/ISRCTN27704027 (Archived by WebCite at http://www.webcitation.org/69FkM4vcq) UR - http://www.researchprotocols.org/2012/2/e8/ UR - http://dx.doi.org/10.2196/resprot.2136 UR - http://www.ncbi.nlm.nih.gov/pubmed/23611874 ID - info:doi/10.2196/resprot.2136 ER - TY - JOUR AU - Rosal, C. Milagros AU - Heyden, Robin AU - Mejilla, Roanne AU - Rizzo DePaoli, Maria AU - Veerappa, Chetty AU - Wiecha, M. John PY - 2012/12/17 TI - Design and Methods for a Comparative Effectiveness Pilot Study: Virtual World vs. Face-to-Face Diabetes Self-Management JO - JMIR Res Protoc SP - e24 VL - 1 IS - 2 KW - Technology KW - Virtual systems KW - Education-distance KW - Patient education KW - Minority health KW - Health disparities KW - African Americans KW - Type 2 diabetes KW - Health behavior KW - Clinical trials N2 - Background: Type 2 diabetes (diabetes) is a serious threat to public health in the United States and disproportionally affects many racial/ethnic minority groups, including African Americans. Limited access to treatment and high attrition rates further contribute to health disparities in diabetes-related morbidity and mortality among minorities. Greater opportunities for increasing access and decreasing barriers to treatment are needed. Technology-based interventions have potential for accomplishing this goal but evidence of feasibility and potential effectiveness is lacking, especially for populations that traditionally have limited educational attainment and low computer literacy. Objective: This paper describes the design and methods of a pilot randomized clinical trial that will compare the feasibility and potential efficacy of delivering a diabetes self-management intervention via a virtual world vs. a face-to-face format. Methods: Study participants (n=100) will be African American women with uncontrolled type 2 diabetes recruited from primary care practices and affiliated health centers at a large safety net hospital in Massachusetts. Participants will be randomized into a virtual world-based (VW) intervention condition or a face-to-face control condition. Both conditions provide the same theory-based curriculum and equivalent exposure to the self-management program (eight group sessions), and both will be delivered by a single intervention team (a dietitian and a diabetes educator). Assessments will be conducted at baseline and 4 months. Feasibility will be determined by evaluating the degree to which participants engage in the VW-based intervention compared to face to face (number of sessions completed). Potential efficacy will be determined by comparing change in physiological (glycemic control) and behavioral (self-reported dietary intake, physical activity, blood glucose self-monitoring, and medication adherence) outcomes between the experimental and control groups. Results: The primary outcomes of interest are feasibility of the VW intervention and its potential efficacy on glucose control and diabetes self-management behaviors, compared to the face-to-face condition. Analysis will use a two-sample Kolmogorov-Smirnov test for changes in variable distribution. P values will be calculated using binomial tests for proportions and t tests for continuous variables. Conclusions: If the intervention is found to be feasible and promising, it will be tested in a larger RCT. UR - http://www.researchprotocols.org/2012/2/e24/ UR - http://dx.doi.org/10.2196/resprot.2415 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612567 ID - info:doi/10.2196/resprot.2415 ER - TY - JOUR AU - Thompson, Debbe AU - Bhatt, Riddhi AU - Lazarus, Melanie AU - Cullen, Karen AU - Baranowski, Janice AU - Baranowski, Tom PY - 2012/11/21 TI - A Serious Video Game to Increase Fruit and Vegetable Consumption Among Elementary Aged Youth (Squire?s Quest! II): Rationale, Design, and Methods JO - JMIR Res Protoc SP - e19 VL - 1 IS - 2 KW - video game, nutrition, fruit, vegetable, children, intervention, action implementation intention, coping implementation intention, goal setting N2 - Background: Youths eat fewer fruits and vegetables than recommended. Effective methods are needed to increase and maintain their fruit and vegetable consumption. Goal setting has been an effective behavior change procedure among adults, but has had limited effectiveness among youths. Implementation intentions are specific plans to facilitate goal attainment. Redefining goal setting to include implementation intentions may be an effective way to increase effectiveness. Video games offer a controlled venue for conducting behavioral research and testing hypotheses to identify mechanisms of effect. Objective: This report describes the protocol that guided the design and evaluation of Squire?s Quest! II, a video game aimed to increase child fruit and vegetable consumption. Methods: Squire?s Quest! II is a 10-episode videogame promoting fruit and vegetable consumption to 4th and 5th grade children (approximately 9-11 year old youths). A four group randomized design (n=400 parent/child dyads) was used to systematically test the effect of two types of implementation intentions (action, coping) on fruit and vegetable goal attainment and consumption of 4th and 5th graders. Data collection occurred at baseline, immediately post game-play, and 3 months later. Child was the unit of assignment. Three dietary recalls were collected at each data collection period by trained interviewers using the Nutrient Data System for Research (NDSR 2009). Psychosocial and process data were also collected. Results: To our knowledge, this is the first research to explore the effect of implementation intentions on child fruit and vegetable goal attainment and consumption. Conclusions: This intervention will contribute valuable information regarding whether implementation intentions are effective with elementary age children. Trial Registration: ClinicalTrials.gov NCT01004094 UR - http://www.researchprotocols.org/2012/2/e19/ UR - http://dx.doi.org/10.2196/resprot.2348 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612366 ID - info:doi/10.2196/resprot.2348 ER - TY - JOUR AU - Yuan, Juntao Michael AU - Hébert, T. Emily AU - Johnson, K. Ron AU - Long, Ju AU - Vandewater, A. Elizabeth AU - Vickers, J. Andrew PY - 2012/11/28 TI - A Personalized Automated Messaging System to Improve Adherence to Prostate Cancer Screening: Research Protocol JO - JMIR Res Protoc SP - e20 VL - 1 IS - 2 KW - Early Detection of Cancer KW - Text Messaging KW - Prostatic Neoplasms N2 - Background: Public adherence to cancer screening guidelines is poor. Patient confusion over multiple recommendations and modalities for cancer screening has been found to be a major barrier to screening adherence. Such problems will only increase as screening guidelines and timetables become individualized. Objective: We propose to increase compliance with cancer screening through two-way rich media mobile messaging based on personalized risk assessment. Methods: We propose to develop and test a product that will store algorithms required to personalize cancer screening in a central database managed by a rule-based workflow engine, and implemented via messaging to the patient?s mobile phone. We will conduct a randomized controlled trial focusing on prostate cancer screening to study the hypothesis that mobile reminders improve adherence to screening guidelines. We will also explore a secondary hypothesis that patients who reply to the messaging reminders are more engaged and at lower risk of non-adherence. We will conduct a randomized controlled trial in a sample of males between 40 and 75 years (eligible for prostate cancer screening) who are willing to receive text messages, email, or automated voice messages. Participants will be recruited from a primary care clinic and asked to schedule prostate cancer screening at the clinic within the next 3 weeks. The intervention group will receive reminders and confirmation communications for making an appointment, keeping the appointment, and reporting the test results back to the investigators. Three outcomes will be evaluated: (1) the proportion of participants who make an appointment with a physician following a mobile message reminder, (2) the proportion of participants who keep the appointment, and (3) the proportion of participants who report the results of the screening (via text or Web). Results: This is an ongoing project, supported by by a small business commercialization grant from the National Center for Advancing Translational Sciences of the National Institutes of Health. Conclusions: We believe that the use of centralized databases and text messaging could improve adherence with screening guidelines. Furthermore, we anticipate this method of increasing patient engagement could be applied to a broad range of health issues, both inside and outside of the context of cancer. This project will be an important first step in determining the feasibility of personalized text messaging to improve long-term adherence to screening recommendations. UR - http://www.researchprotocols.org/2012/2/e20/ UR - http://dx.doi.org/10.2196/resprot.2398 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612443 ID - info:doi/10.2196/resprot.2398 ER - TY - JOUR AU - Ho, Kendall AU - Marsden, Julian AU - Jarvis-Selinger, Sandra AU - Novak Lauscher, Helen AU - Kamal, Noreen AU - Stenstrom, Rob AU - Sweet, David AU - Goldman, D. Ran AU - Innes, Grant PY - 2012/07/12 TI - A Collaborative Quality Improvement Model and Electronic Community of Practice to Support Sepsis Management in Emergency Departments: Investigating Care Harmonization for Provincial Knowledge Translation JO - JMIR Res Protoc SP - e6 VL - 1 IS - 2 KW - Knowledge translation KW - continuous quality improvement KW - emergency medicine KW - sepsis UR - http://www.researchprotocols.org/2012/2/e6/ UR - http://dx.doi.org/10.2196/resprot.1597 UR - http://www.ncbi.nlm.nih.gov/pubmed/23611816 ID - info:doi/10.2196/resprot.1597 ER - TY - JOUR AU - Hebden, Lana AU - Cook, Amelia AU - van der Ploeg, P. Hidde AU - Allman-Farinelli, Margaret PY - 2012/08/22 TI - Development of Smartphone Applications for Nutrition and Physical Activity Behavior Change JO - JMIR Res Protoc SP - e9 VL - 1 IS - 2 KW - cellular phone KW - young adult KW - primary prevention KW - lifestyle KW - health behavior N2 - Background: Young adults (aged 18 to 35) are a population group at high risk for weight gain, yet we know little about how to intervene in this group. Easy access to treatment and support with self-monitoring of their behaviors may be important. Smartphones are gaining in popularity with this population group and software applications (?apps?) used on these mobile devices are a novel technology that can be used to deliver brief health behavior change interventions directly to individuals en masse, with potentially favorable cost-utility. However, existing apps for modifying nutrition or physical activity behaviors may not always reflect best practice guidelines for weight management. Objective: This paper describes the process of developing four apps aimed at modifying key lifestyle behaviors associated with weight gain during young adulthood, including physical activity, and consumption of take-out foods (fast food), fruit and vegetables, and sugar-sweetened drinks. Methods: The development process involved: (1) deciding on the behavior change strategies, relevant guidelines, graphic design, and potential data collection; (2) selecting the platform (Web-based versus native); (3) creating the design, which required decisions about the user interface, architecture of the relational database, and programming code; and (4) testing the prototype versions with the target audience (young adults aged 18 to 35). Results: The four apps took 18 months to develop, involving the fields of marketing, nutrition and dietetics, physical activity, and information technology. Ten subjects provided qualitative feedback about using the apps. The slow running speed of the apps (due to a reliance on an active Internet connection) was the primary issue identified by this group, as well as the requirement to log in to the apps. Conclusions: Smartphone apps may be an innovative medium for delivering individual health behavior change intervention en masse, but researchers must give consideration to the target population, available technologies, existing commercial apps, and the possibility that their use will be irregular and short-lived. UR - http://www.researchprotocols.org/2012/2/e9/ UR - http://dx.doi.org/10.2196/resprot.2205 UR - http://www.ncbi.nlm.nih.gov/pubmed/23611892 ID - info:doi/10.2196/resprot.2205 ER - TY - JOUR AU - Baggott, Christina AU - Gibson, Faith AU - Coll, Beatriz AU - Kletter, Richard AU - Zeltzer, Paul AU - Miaskowski, Christine PY - 2012/12/11 TI - Initial Evaluation of an Electronic Symptom Diary for Adolescents with Cancer JO - JMIR Res Protoc SP - e23 VL - 1 IS - 2 KW - mHealth, eHealth, patient-reported outcomes, symptom assessment, adolescent, cancer N2 - Background: The delivery of optimal care depends on accurate communication between patients and clinicians regarding untoward symptoms. Documentation of patients? symptoms necessitates reliance on memory, which is often imprecise. We developed an electronic diary (eDiary) for adolescents and young adults (AYAs) with cancer to record symptoms. Objective: The purpose of this paper is to describe the utility of an eDiary designed for AYAs with cancer, including dependability of the mobile application, the reasons for any missing recorded data, patients? adherence rates to daily symptom queries, and patients? perceptions of the usefulness and acceptability of symptom data collection via mobile phones. Methods: Our team developed an electronic symptom diary based on interviews conducted with AYAs with cancer and their clinicians. This diary included daily severity ratings of pain, nausea, vomiting, fatigue, and sleep. The occurrence of other selected physical sequelae was assessed daily. Additionally, patients selected descriptors of their mood. A 3-week trial of the eDiary was conducted with 10 AYA cancer patients. Mobile phones with service plans were loaned to patients who were instructed to report their symptoms daily. Patients completed a brief questionnaire and were interviewed to elicit their perceptions of the eDiary and any technical difficulties encountered. Results: Overall adherence to daily symptom reports exceeded 90%. Young people experienced few technical difficulties and reported benefit from daily symptom reports. Symptom occurrence rates were high and considerable inter- and intra-patient variability was noted in symptom and mood reports. Conclusions: We demonstrated the utility of an eDiary that may contribute insight into patients? symptom patterns to promote effective symptom management. UR - http://www.researchprotocols.org/2012/2/e23/ UR - http://dx.doi.org/10.2196/resprot.2175 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612521 ID - info:doi/10.2196/resprot.2175 ER - TY - JOUR AU - Sassen, Barbara AU - Kok, Gerjo AU - Mesters, Ilse AU - Crutzen, Rik AU - Cremers, Anita AU - Vanhees, Luc PY - 2012/12/14 TI - A Web-Based Intervention for Health Professionals and Patients to Decrease Cardiovascular Risk Attributable to Physical Inactivity: Development Process JO - JMIR Res Protoc SP - e21 VL - 1 IS - 2 KW - Internet intervention KW - Intervention Mapping KW - Health education KW - Health behaviour change KW - Health professionals KW - Cardiovascular risk N2 - Background: Patients with cardiovascular risk factors can reduce their risk of cardiovascular disease by increasing their physical activity and their physical fitness. According to the guidelines for cardiovascular risk management, health professionals should encourage their patients to engage in physical activity. Objective: In this paper, we provide insight regarding the systematic development of a Web-based intervention for both health professionals and patients with cardiovascular risk factors using the development method Intervention Mapping. The different steps of Intervention Mapping are described to open up the ?black box? of Web-based intervention development and to support future Web-based intervention development. Methods: The development of the Professional and Patient Intention and Behavior Intervention (PIB2 intervention) was initiated with a needs assessment for both health professionals (ie, physiotherapy and nursing) and their patients. We formulated performance and change objectives and, subsequently, theory- and evidence-based intervention methods and strategies were selected that were thought to affect the intention and behavior of health professionals and patients. The rationale of the intervention was based on different behavioral change methods that allowed us to describe the scope and sequence of the intervention and produced the Web-based intervention components. The Web-based intervention consisted of 5 modules, including individualized messages and self-completion forms, and charts and tables. Results: The systematic and planned development of the PIB2 intervention resulted in an Internet-delivered behavior change intervention. The intervention was not developed as a substitute for face-to-face contact between professionals and patients, but as an application to complement and optimize health services. The focus of the Web-based intervention was to extend professional behavior of health care professionals, as well as to improve the risk-reduction behavior of patients with cardiovascular risk factors. Conclusions: The Intervention Mapping protocol provided a systematic method for developing the intervention and each intervention design choice was carefully thought-out and justified. Although it was not a rapid or an easy method for developing an intervention, the protocol guided and directed the development process. The application of evidence-based behavior change methods used in our intervention offers insight regarding how an intervention may change intention and health behavior. The Web-based intervention appeared feasible and was implemented. Further research will test the effectiveness of the PIB2 intervention. Trial Registration: Dutch Trial Register, Trial ID: ECP-92 UR - http://www.researchprotocols.org/2012/2/e21/ UR - http://dx.doi.org/10.2196/resprot.1804 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612470 ID - info:doi/10.2196/resprot.1804 ER - TY - JOUR AU - Furberg, D. Robert AU - Uhrig, D. Jennifer AU - Bann, M. Carla AU - Lewis, A. Megan AU - Harris, L. Jennie AU - Williams, Peyton AU - Coomes, Curtis AU - Martin, Nicole AU - Kuhns, Lisa PY - 2012/11/16 TI - Technical Implementation of a Multi-Component, Text Message?Based Intervention for Persons Living with HIV JO - JMIR Res Protoc SP - e17 VL - 1 IS - 2 KW - short message service KW - SMS KW - text message KW - mobile phone KW - mHealth KW - HIV KW - tailored messaging N2 - Background: Men who have sex with men (MSM) continue to be severely and disproportionately affected by the HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome) epidemic in the United States. Effective antiretroviral therapy has altered the HIV epidemic from being an acute disease to a chronic, manageable condition for many people living with HIV. The pervasiveness, low cost, and convenience of Short Message Service (SMS) suggests its potential suitability for supporting the treatment of conditions that must be managed over an extended period. Objective: The purpose of this proof-of-concept study was to develop, implement, and test a tailored SMS-based intervention for HIV-positive MSM. Prior studies do not routinely provide sufficiently detailed descriptions of their technical implementations, restricting the ability of subsequent efforts to reproduce successful interventions. This article attempts to fill this gap by providing a detailed description of the implementation of an SMS-based intervention to provide tailored health communication messages for HIV-positive MSM. Methods: We used archives from the SMS system, including participant responses to messages and questions sent via SMS, as the data sources for results reported in this article. Consistent with the purpose of this article, our analysis was limited to basic descriptive statistics, including frequency distributions, means and standard deviations. Results: During the implementation period, we sent a total of 7,194 messages to study participants, received 705 SMS responses to our two-way SMS questions of participants, and 317 unprompted SMS message acknowledgements from participants. Ninety two percent of participants on antiretroviral therapy (ART) responded to at least one of the weekly medication adherence questions administered via SMS, and 27% of those had their medication adherence messages changed over the course of the study based on their answers to the weekly questions. Participants who responded to items administered via SMS to assess satisfaction with and use of the messages reported generally positive perceptions, although response rates were low overall. Conclusions: Results confirm the technical feasibility of deploying a dynamically tailored, SMS-based intervention designed to provide ongoing behavioral reinforcement for HIV-positive MSM. Lessons learned related to text programming, message delivery and study logistics will be helpful to others planning and implementing similar interventions. UR - http://www.researchprotocols.org/2012/2/e17/ UR - http://dx.doi.org/10.2196/resprot.2017 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612237 ID - info:doi/10.2196/resprot.2017 ER - TY - JOUR AU - Toledo, G. Frederico AU - Triola, Amy AU - Ruppert, Kristine AU - Siminerio, M. Linda PY - 2012/11/07 TI - Telemedicine Consultations: An Alternative Model to Increase Access to Diabetes Specialist Care in Underserved Rural Communities JO - JMIR Res Protoc SP - e14 VL - 1 IS - 2 KW - Rural KW - teleconsultation KW - telemedicine KW - diabetes N2 - Background: Diabetes care in rural communities often suffers because of physician shortages. When patients need to see an endocrinologist, long-distance travel to urban centers can constitute a barrier to care. Objective: To address this problem, we tested whether diabetes telemedicine consultations would be acceptable to rural patients and their primary care providers as an alternative care model. Methods: Twenty-five patients with diabetes in a rural, medically underserved community received glycemic management recommendations via videoconferencing-based teleconsultation with an endocrinologist at an urban center. At the rural site, a nurse trained in diabetes care assisted with the visits. Outcomes measured were patient and primary care provider satisfaction (measured by structured questionnaires) and glycosylated hemoglobin (HbA1c) levels. Results: Patients and providers uniformly reported high levels of satisfaction and acceptability. Mean HbA1c decreased from 9.6% to 8.5% (P < .001). Conclusions: Teleconsultations are well accepted by users (patients and primary care physicians) and glycemic control seems to improve in patients with diabetes. This new model of care could potentially expand access to specialist care in isolated rural communities. UR - http://www.researchprotocols.org/2012/2/e14/ UR - http://dx.doi.org/10.2196/resprot.2235 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612044 ID - info:doi/10.2196/resprot.2235 ER - TY - JOUR AU - Arnold, JG Renée AU - Stingone, A. Jeanette AU - Claudio, Luz PY - 2012/11/13 TI - Computer-Assisted School-Based Asthma Management: A Pilot Study JO - JMIR Res Protoc SP - e15 VL - 1 IS - 2 KW - Asthma KW - disease management KW - Internet KW - child KW - underserved KW - Asthma Action Plan KW - outcomes KW - urban KW - low-income N2 - Background: The high prevalence of asthma among children continues to be a major public health issue. In particular, low-income African-American and Hispanic children often receive asthma care in the emergency department and lack access to continuity of care. Objective: The aim of the current study was to test the feasibility of implementing a computerized program for empowering low-income children with asthma to manage their own disease. This pilot program consisted of a guided, personalized, Web-based computer program as the main component of a school-based asthma intervention. Methods: The Automated Live E-Health Response Tracking System (ALERTS), a computer-assisted, Web-based tracking program, was tested for implementation in a school in East Harlem, New York. The program required children with asthma, assisted by trained researchers, to routinely measure their peak flow meter readings and answer a symptom questionnaire. The program provided individualized feedback on their disease status based on peak flow meter input. The computer program sent reports to the child?s physician and the nurse practitioner at the on-site school health center. The children were also encouraged to bring the reports home to their parents. A pre/post study design was employed such that each participant acted as his/her own control. Comparisons of preintervention and postintervention outcomes were calculated using the paired t-test and the McNemar test for dichotomous data. Results: Twenty-four children (6 to 12 years) participated in the program over 2 to 15 months. Improvements in health outcomes showed the greatest significance among the group of participants who were enrolled for 8 months or longer. Statistically significant improvements were seen in the average physical health score of the children (from 65.64 preintervention to 76.28 postintervention, P = .045). There was a significant decrease in the number of participants experiencing wheezing episodes (n = 9 to n = 2, P = .03), and in the average number of wheezing episodes per child (1.86 to 0.43, P = .02). Although not statistically significant, decreases were also seen in the number of children experiencing an asthma attack and in the average number of asthma attacks among participants. There was also a significant decrease in the average number of visits to doctors? offices or clinics (1.23 to 0.38, P = .04). There were no overnight hospitalizations in the two-week period following the end of the pilot program, a nonsignificant reduction from an average of 0.21 per child. Conclusion: This individualized, computer-assisted intervention resulted in improvements in some health outcomes among low-income children in an urban, public school-based setting. Consistent peak flow meter self-measurements, management of medication usage, and a computerized approach to symptom tracking resulted in fewer asthma exacerbations and improved overall physical health among this pediatric population with asthma. UR - http://www.researchprotocols.org/2012/2/e15/ UR - http://dx.doi.org/10.2196/resprot.1958 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612058 ID - info:doi/10.2196/resprot.1958 ER - TY - JOUR AU - Robben, HM Sarah AU - Huisjes, Mirjam AU - van Achterberg, Theo AU - Zuidema, U. Sytse AU - Olde Rikkert, GM Marcel AU - Schers, J. Henk AU - Heinen, M. Maud AU - Melis, JF René AU - PY - 2012/09/19 TI - Filling the Gaps in a Fragmented Health Care System: Development of the Health and Welfare Information Portal (ZWIP) JO - JMIR Res Protoc SP - e10 VL - 1 IS - 2 KW - Self-care KW - cooperative behavior KW - interdisciplinary communication KW - electronic health records KW - frail elderly N2 - Background: Current health care systems are not optimally designed to meet the needs of our aging populations. First, the fragmentation of care often results in discontinuity of care that can undermine the quality of care provided. Second, patient involvement in care decisions is not sufficiently facilitated. Objective: To describe the development and the content of a program aimed at: (1) facilitating self-management and shared decision making by frail older people and informal caregivers, and (2) reducing fragmentation of care by improving collaboration among professionals involved in the care of frail older people through a combined multidisciplinary electronic health record (EHR) and personal health record (PHR). Methods: We used intervention mapping to systematically develop our program in six consecutive steps. Throughout this development, the target populations (ie, professionals, frail older people, and informal caregivers) were involved extensively through their participation in semi-structured interviews and working groups. Results: We developed the Health and Welfare Information Portal (ZWIP), a personal, Internet-based conference table for multidisciplinary communication and information exchange for frail older people, their informal caregivers, and professionals. Further, we selected and developed methods for implementation of the program, which included an interdisciplinary educational course for professionals involved in the care of frail older people, and planned the evaluation of the program. Conclusions: This paper describes the successful development and the content of the ZWIP as well as the strategies developed for its implementation. Throughout the development, representatives of future users were involved extensively. Future studies will establish the effects of the ZWIP on self-management and shared decision making by frail older people as well as on collaboration among the professionals involved. UR - http://www.researchprotocols.org/2012/2/e10/ UR - http://dx.doi.org/10.2196/resprot.1945 UR - http://www.ncbi.nlm.nih.gov/pubmed/23611877 ID - info:doi/10.2196/resprot.1945 ER - TY - JOUR AU - Cartreine, Albert James AU - Locke, E. Steven AU - Buckey, C. Jay AU - Sandoval, Luis AU - Hegel, T. Mark PY - 2012/09/25 TI - Electronic Problem-Solving Treatment: Description and Pilot Study of an Interactive Media Treatment for Depression JO - JMIR Res Protoc SP - e11 VL - 1 IS - 2 KW - Depression KW - problem-solving therapy KW - computer-based therapy KW - interactive media KW - Internet intervention KW - problem-solving treatment KW - cognitive behavioral therapy N2 - Background: Computer-automated depression interventions rely heavily on users reading text to receive the intervention. However, text-delivered interventions place a burden on persons with depression and convey only verbal content. Objective: The primary aim of this project was to develop a computer-automated treatment for depression that is delivered via interactive media technology. By using branching video and audio, the program simulates the experience of being in therapy with a master clinician who provides six sessions of problem-solving therapy. A secondary objective was to conduct a pilot study of the program?s usability, acceptability, and credibility, and to obtain an initial estimate of its efficacy. Methods: The program was produced in a professional multimedia production facility and incorporates video, audio, graphics, animation, and text. Failure analyses of patient data are conducted across sessions and across problems to identify ways to help the user improve his or her problem solving. A pilot study was conducted with persons who had minor depression. An experimental group (n = 7) used the program while a waitlist control group (n = 7) was provided with no treatment for 6 weeks. Results: All of the experimental group participants completed the trial, whereas 1 from the control was lost to follow-up. Experimental group participants rated the program high on usability, acceptability, and credibility. The study was not powered to detect clinical improvement, although these pilot data are encouraging. Conclusions: Although the study was not powered to detect treatment effects, participants did find the program highly usable, acceptable, and credible. This suggests that the highly interactive and immersive nature of the program is beneficial. Further clinical trials are warranted. Trial Registration: ClinicalTrials.gov NCT00906581; http://clinicaltrials.gov/ct2/show/NCT00906581 (Archived by WebCite at http://www.webcitation.org/6A5Ni5HUp) UR - http://www.researchprotocols.org/2012/2/e11/ UR - http://dx.doi.org/10.2196/resprot.1925 UR - http://www.ncbi.nlm.nih.gov/pubmed/23611902 ID - info:doi/10.2196/resprot.1925 ER - TY - JOUR AU - Flight, H. Ingrid AU - Wilson, J. Carlene AU - Zajac, T. Ian AU - Hart, Elizabeth AU - McGillivray, A. Jane PY - 2012/09/26 TI - Decision Support and the Effectiveness of Web-based Delivery and Information Tailoring for Bowel Cancer Screening: An Exploratory Study JO - JMIR Res Protoc SP - e12 VL - 1 IS - 2 KW - Colorectal cancer KW - mass screening KW - multimedia KW - communication KW - decision support techniques N2 - Background: Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females throughout the developed world. Population screening using fecal occult blood tests (FOBTs) facilitates early detection and greater chance of survival, but participation rates are low. We developed a Web-based decision tool to provide information tailored to an individual?s decision stage for CRC screening and attitude toward screening utilizing the Preventive Health Model (PHM) and Precaution Adoption Process Model (PAPM) as theoretical frameworks for screening behavior. We describe the practical steps employed in the tool?s design and the subsequent conduct of an exploratory study. Objective: To design a decision tool for CRC screening and conduct an exploratory study among average-risk men and women to (1) test the impact of message type (tailored vs non-tailored) and message delivery modality (Web-based vs paper-based) on attitudes toward screening and screening uptake, and (2) investigate the acceptability of the decision tool and relevance of materials. Methods: Participants (n = 100), recruited from a population sample of men and women aged 50-76 residing in urban Adelaide, Australia, were randomly assigned to a control group or one of 4 interventions: (1) Web-based and tailored information, (2) paper-based and tailored information, (3) Web-based and non-tailored (generic) information, or (4) paper-based and non-tailored information. Participation was augmented by snowball recruitment (n = 19). Questionnaires based on PHM variables were administered pre- and post-intervention. Participants were given the opportunity to request an FOBT. Following the intervention, participants discussed the acceptability of the tool. Results: Full data were available for 87.4% (104/119) of participants. Post-intervention, perceived susceptibility scores for individuals receiving tailored information increased from mean 10.6 (SD 2.1) to mean 11.8 (SD 2.2). Scores on self-efficacy increased in the tailored group from mean 11.7 (SD 2.0) to mean 12.6 (SD 1.8). There were significant time x modality x message effects for social influence and salience and coherence, reflecting an increase in these scores for tailored Web-based participants only; social influence scores increased from mean 11.7 (SD 2.6) to mean 14.9 (SD 2.3), and salience and coherence scores increased from mean 16.0 (SD 2.2) to mean 17.7 (SD 2.1). There was no greater influence of modality or message type on movement toward a decision to screen or screening uptake, indicating that neither tailored messages nor a Web modality had superior effect. Overall, participants regarded tailored messages positively, but thought that the Web tool lacked ?media richness.? Conclusions: This exploratory study confirms that tailoring on PHM predictors of CRC screening has the potential to positively address attitudes toward screening. However, tailoring on these variables did not result in significantly increased screening uptake. Future research should consider other possible psychosocial influences. Mode of delivery did not affect outcomes, but as a delivery medium, the Web has economic and logistical advantages over paper. UR - http://www.researchprotocols.org/2012/2/e12/ UR - http://dx.doi.org/10.2196/resprot.2135 UR - http://www.ncbi.nlm.nih.gov/pubmed/23611950 ID - info:doi/10.2196/resprot.2135 ER - TY - JOUR AU - Or, Calvin AU - Tao, Da PY - 2012/11/08 TI - Usability Study of a Computer-Based Self-Management System for Older Adults with Chronic Diseases JO - JMIR Res Protoc SP - e13 VL - 1 IS - 2 KW - Usability evaluation KW - self-management KW - patient participation KW - chronic disease N2 - Background: Usability can influence patients? acceptance and adoption of a health information technology. However, little research has been conducted to study the usability of a self-management health care system, especially one geared toward elderly patients. Objective: This usability study evaluated a new computer-based self-management system interface for older adults with chronic diseases, using a paper prototype approach. Methods: Fifty older adults with different chronic diseases participated. Two usability evaluation methods were involved: (1) a heuristics evaluation and (2) end-user testing with a think-aloud testing method, audio recording, videotaping, and interviewing. A set of usability metrics was employed to determine the overall system usability, including task incompletion rate, task completion time, frequency of error, frequency of help, satisfaction, perceived usefulness, and perceived ease of use. Interviews were used to elicit participants? comments on the system design. The quantitative data were analyzed using descriptive statistics and the qualitative data were analyzed for content. Results: The participants were able to perform the predesigned self-management tasks with the current system design and they expressed mostly positive responses about the perceived usability measures regarding the system interface. However, the heuristics evaluation, performance measures, and interviews revealed a number of usability problems related to system navigation, information search and interpretation, information presentation, and readability. Design recommendations for further system interface modifications were discussed. Conclusions: This study verified the usability of the self-management system developed for older adults with chronic diseases. Also, we demonstrated that our usability evaluation approach could be used to quickly and effectively identify usability problems in a health care information system at an early stage of the system development process using a paper prototype. Conducting a usability evaluation is an essential step in system development to ensure that the system features match the users? true needs, expectations, and characteristics, and also to minimize the likelihood of the users committing user errors and having difficulties using the system. UR - http://www.researchprotocols.org/2012/2/e13/ UR - http://dx.doi.org/10.2196/resprot.2184 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612015 ID - info:doi/10.2196/resprot.2184 ER - TY - JOUR AU - Carswell, Kenneth AU - McCarthy, Ona AU - Murray, Elizabeth AU - Bailey, V. Julia PY - 2012/11/19 TI - Integrating Psychological Theory Into the Design of an Online Intervention for Sexual Health: The Sexunzipped Website JO - JMIR Res Protoc SP - e16 VL - 1 IS - 2 KW - Internet KW - sex education KW - adolescents KW - young adults KW - health behavior KW - psychological theory N2 - Background: The Internet can provide a confidential and convenient medium for sexual health promotion for young people. Objective: This paper describes the development of an interactive, theory-based website (Sexunzipped) aimed at increasing safe sexual behavior of young people, as well as an outline of the evaluation protocol. Methods: The website focuses on safer sex, relationships, and sexual pleasure. An overview of the site is provided, including a description of the theoretical constructs which form the basis of the site development. An integrated behavioral model was chosen as the guiding theory for the Sexunzipped intervention. A randomized trial design will be used to evaluate the site quantitatively. Results: The content of the site is described in detail with examples of the main content types: information pages, quizzes, and decision-making activities. We describe the protocol for quantitative evaluation of the website using a randomized trial design and discuss the principal challenges involved in developing the site, including the challenge of balancing the requirements of theory with young people?s views on website content and design. Conclusions: Considerations for future interventions are discussed. Developing an online behavior-change intervention is costly and time consuming. Given the large public health potential, the cost involved in developing online interventions, and the need for attractive design, future interventions may benefit from collaborating with established sites that already have a user base, a brand, and a strong Internet presence. It is vital to involve users in decisions about intervention content, design, and features, paying attention to aspects that will attract and retain users? interest. A central challenge in developing effective Internet-based interventions for young people is to find effective ways to operationalize theory in ways that address the views and perspectives of young people. UR - http://www.researchprotocols.org/2012/2/e16/ UR - http://dx.doi.org/10.2196/resprot.2114 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612122 ID - info:doi/10.2196/resprot.2114 ER - TY - JOUR AU - Danaher, G. Brian AU - Milgrom, Jeannette AU - Seeley, R. John AU - Stuart, Scott AU - Schembri, Charlene AU - Tyler, S. Milagra AU - Ericksen, Jennifer AU - Lester, Whitney AU - Gemmill, W. Alan AU - Lewinsohn, Peter PY - 2012/11/22 TI - Web-Based Intervention for Postpartum Depression: Formative Research and Design of the MomMoodBooster Program JO - JMIR Res Protoc SP - e18 VL - 1 IS - 2 KW - postpartum depression KW - Web-based intervention KW - formative research N2 - Background: Postpartum depression is a significant public health problem affecting approximately 13% of women. There is strong evidence supporting Cognitive Behavioral Therapy (CBT) for successful psychosocial treatment. This treatment model combines cognitive and behavioral strategies to address pessimism, attributions for failure, low self-esteem, low engagement in pleasant activities, social withdrawal, anxiety, and low social support. Encouraging results have been reported for using Web-based CBT interventions for mental health domains, including the treatment of panic disorder, post-traumatic stress disorder, and complicated grief and depression. To date, however, Web-based interventions have not been used and evaluated specifically for the treatment of postpartum depression. Objective: We describe the formative work that contributed to the development of our Web-based intervention for helping to ameliorate symptoms of postpartum depression, and the design and key components of the program. Methods: A total of 17 focus group participants and 22 usability testers, who shared key characteristics with the participants of our planned feasibility study, took part. The proposed structure and ingredients of the program and mock-ups of selected webpages were presented to focus group participants. At various points, participants were asked a series of thought questions designed to elicit opinions and set the occasion for group discussion. At the end of the session, participants were asked to describe their overall reaction to the proposed features of the program emphasizing candid opinions about what they did not like and features they thought were missing and should be added. Usability testers were asked to interact with a series of seven different Web-based interactions planned for the program while receiving minimal direction. Each tester was asked to describe her thoughts using a think-aloud technique. They were then asked to consider all that they had learned about the program and complete the System Usability Scale that we adapted slightly to be appropriate for evaluating the proposed website. Transcripts from the focus groups and usability tests were reviewed by research team members for overarching themes with particular emphasis on suggested changes. A list emerged, and iterative and incremental adjustments were made as a result. Results: The qualitative and quantitative data gathered in the focus groups and usability sessions reported here suggest that the new mothers involved had largely positive reactions to the major features of the program and that those program features performed well in terms of usability. Conclusions: An overview of the eventual design, architecture, and key program ingredients of the MomMoodBooster program is provided including innovative features supplementing 6 core CBT sessions, which include a partner?s website, a library, and individual feedback by a personal coach. UR - http://www.researchprotocols.org/2012/2/e18/ UR - http://dx.doi.org/10.2196/resprot.2329 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612274 ID - info:doi/10.2196/resprot.2329 ER - TY - JOUR AU - Välimäki, Maritta AU - Kurki, Marjo AU - Hätönen, Heli AU - Koivunen, Marita AU - Selander, Maarit AU - Saarijärvi, Simo AU - Anttila, Minna PY - 2012/12/12 TI - Developing an Internet-Based Support System for Adolescents with Depression JO - JMIR Res Protoc SP - e22 VL - 1 IS - 2 KW - adolescent, Internet, depression, development, intervention, support N2 - Background: Depression is the most common mental health problem among adolescents. Despite policy guidance and governmental support to develop usable mental health services, there is still a lack of easily accessible and modern interventions available for adolescents in Finland?s majority official language. Objective: Our objective was to develop a user-friendly and feasible Internet-based support system for adolescents with depression. Methods: The Internet-based support system for adolescents with depression was developed. To create this new intervention, some examples of existing interventions were studied, the theoretical basis for the intervention was described, and the health needs of adolescents identified. As an outcome of the process, the results were combined and the content and delivery of a new intervention will be described here. Results: Six individual weekly Internet-based support sessions were delivered by a tutor over a 6-week period of time and developed to form an intervention called Depis.Net. This was an Internet-based support system for adolescents with depression tailored to improve self-management skills and increase awareness of their own well-being and mental health. The intervention was accessible via an electronic platform, which was secured and password protected for users. The intervention on the Depis.Net website consisted of elements identifying adolescents? needs, and offering self-monitoring, access to health information and self-reflective written exercises. An educated nurse tutor gave written feedback to each adolescent via the electronic platform. Conclusions: An Internet-based support system for adolescents with depression was developed using a systematic approach with four steps. This was done to ensure that the intervention had a sound theoretical background and at the same time caters flexibly for the problems that adolescents commonly face in their daily lives. Its potential for adolescents visiting outpatient clinics will be evaluated in the next phase by means of a randomized controlled trial. UR - http://www.researchprotocols.org/2012/2/e22/ UR - http://dx.doi.org/10.2196/resprot.2263 UR - http://www.ncbi.nlm.nih.gov/pubmed/23612485 ID - info:doi/10.2196/resprot.2263 ER - TY - JOUR AU - Skordis-Worrall, Jolene AU - Pulkki-Brännström, Anni-Maria AU - Utley, Martin AU - Kembhavi, Gayatri AU - Bricki, Nouria AU - Dutoit, Xavier AU - Rosato, Mikey AU - Pagel, Christina PY - 2012/12/21 TI - Development and Formative Evaluation of a Visual E-Tool to Help Decision Makers Navigate the Evidence Around Health Financing JO - JMIR Res Protoc SP - e25 VL - 1 IS - 2 KW - health care systems KW - financing KW - policy makers KW - software tools N2 - Background: There are calls for low and middle income countries to develop robust health financing policies to increase service coverage. However, existing evidence around financing options is complex and often difficult for policy makers to access. Objective: To summarize the evidence on the impact of financing health systems and develop an e-tool to help decision makers navigate the findings. Methods: After reviewing the literature, we used thematic analysis to summarize the impact of 7 common health financing mechanisms on 5 common health system goals. Information on the relevance of each study to a user?s context was provided by 11 country indicators. A Web-based e-tool was then developed to assist users in navigating the literature review. This tool was evaluated using feedback from early users, collected using an online survey and in-depth interviews with key informants. Results: The e-tool provides graphical summaries that allow a user to assess the following parameters with a single snapshot: the number of relevant studies available in the literature, the heterogeneity of evidence, where key evidence is lacking, and how closely the evidence matches their own context. Users particularly liked the visual display and found navigating the tool intuitive. However there was concern that a lack of evidence on positive impact might be construed as evidence against a financing option and that the tool might over-simplify the available financing options. Conclusions: Complex evidence can be made more easily accessible and potentially more understandable using basic Web-based technology and innovative graphical representations that match findings to the users? goals and context. UR - http://www.researchprotocols.org/2012/2/e25/ UR - http://dx.doi.org/10.2196/resprot.2173 UR - http://www.ncbi.nlm.nih.gov/pubmed/23611764 ID - info:doi/10.2196/resprot.2173 ER - TY - JOUR AU - Møller, Anne AU - Mortensen, Steen Ole AU - Reventlow, Susanne AU - Skov, Georg Peder AU - Andersen, Hviid Johan AU - Rubak, Steen Tine AU - Hansen, Marie Åse AU - Andersen, L. Lars AU - Lund, Rikke AU - Osler, Merete AU - Christensen, Ulla AU - Avlund, Kirsten PY - 2012/07/27 TI - Lifetime Occupational Physical Activity and Musculoskeletal Aging in Middle-Aged Men and Women in Denmark: Retrospective Cohort Study Protocol and Methods JO - JMIR Res Protoc SP - e7 VL - 1 IS - 2 KW - Occupational exposure KW - work load KW - physical fitness KW - musculoskeletal system KW - aging N2 - Background: Physical function is essential for performing most aspects of daily life and musculoskeletal aging leads to a decline in physical function. The onset and rate of this process vary and are influenced by environmental, genetic, and hormonal factors. Although everyone eventually experiences musculoskeletal aging, it is beneficial to study the factors that influence the aging process in order to prevent disability. The role of occupational physical activity in the musculoskeletal aging process is unclear. In the past, hard physical work was thought to strengthen the worker, but current studies in this field fail to find a training effect in jobs with a high level of occupational physical activity. Objective: The aim of this study is to examine the influence of lifetime occupational physical activity on physical function in midlife. The study follows the ?occupational life-course perspective,? emphasizing the importance of occupational exposures accumulated throughout life on the musculoskeletal aging process taking socioeconomic and lifestyle factors into consideration. Methods: This study is a retrospective cohort study including a cross-sectional measurement of physical function in 5000 middle-aged Danes. Data was obtained from the Copenhagen Aging and Midlife Biobank (CAMB) which is based on three existing Danish cohorts. Using questionnaire information about the five longest-held occupations, the job history was coded from the Danish version of the International Standard Classification of Occupations (D-ISCO 88) and a job exposure matrix containing information about occupational physical activity in Danish jobs was applied to the dataset. The primary outcomes are three tests of physical function: handgrip strength, balance, and chair rise. In the analyses, we will compare physical function in midlife according to accumulated exposure to high levels of occupational physical activity. Conclusions: We have a unique opportunity to study the influence of work on early musculoskeletal aging taking other factors into account. In this study, the ?healthy worker effect? is reduced due to inclusion of people from the working population and people who are already retired or have been excluded from the labor market. However, low participation in the physical tests can lead to selection bias. UR - http://www.researchprotocols.org/2012/2/e7/ UR - http://dx.doi.org/10.2196/resprot.2191 UR - http://www.ncbi.nlm.nih.gov/pubmed/23611836 ID - info:doi/10.2196/resprot.2191 ER -