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Medical News |
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Journal of Medical Internet Research
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JMIR (ISSN: 1438-8871) is the leading Open Access journal for eHealth and healthcare in the Internet age
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Interpreting the Outcomes of Automated Internet-Based Randomized Trials:
Example of an International Smoking Cessation Study
Background: Smoking is one of the largest contributors to the global burden of disease. Internet interventions have been shown to reduce smoking rates successfully. However, improved methods of evaluating effectiveness need to be developed for large-scale Internet intervention trials. Objective: To illustrate a method to interpret outcomes of large-scale, fully automated, worldwide Internet intervention trials. Methods: A fully automated, international, Internet-based smoking cessation randomized controlled trial was conducted in Spanish and English, with 16,430 smokers from 165 countries. The randomized controlled trial replicated a published efficacy trial in which, to reduce follow-up attrition, 1000 smokers were followed up by phone if they did not provide online follow-up data. Results: The 7-day self-reported abstinence rates ranged from 36.18% (2239/6189) at 1 month to 41.34% (1361/3292) at 12 months based on observed data. Given high rates of attrition in this fully automated trial, when participants unreachable at follow-up were presumed to be smoking, the abstinence rates ranged from 13.63% (2239/16.430) at 1 month to 8.28% (1361/16,430) at 12 months. We address the problem of interpreting results with high follow-up attrition rates and propose a solution based on a smaller study with intensive phone follow-up. Conclusions: Internet-based smoking cessation interventions can help large numbers of smokers quit. Large-scale international outcome studies can be successfully implemented using automated Internet sites. Interpretation of the studies’ results can be aided by extrapolating from results obtained from subsamples that are followed up by phone or similar cohort maintenance methods. Trial Registration: ClinicalTrials.gov NCT00721786; http://clinicaltrials.gov/ct2/show/NCT00721786 (Archived by WebCite at http://www.webcitation.org/63mhoXYPw)
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Usability Evaluation of a Web-Based Support System for People With a Schizophrenia Diagnosis
Background: Routine Outcome Monitoring (ROM) is a systematic way of assessing service users’ health conditions for the purpose of better aiding their care. ROM consists of various measures used to assess a service user’s physical, psychological, and social condition. While ROM is becoming increasingly important in the mental health care sector, one of its weaknesses is that ROM is not always sufficiently service user-oriented. First, clinicians tend to concentrate on those ROM results that provide information about clinical symptoms and functioning, whereas it has been suggested that a service user-oriented approach needs to focus on personal recovery. Second, service users have limited access to ROM results and they are often not equipped to interpret them. These problems need to be addressed, as access to resources and the opportunity to share decision making has been indicated as a prerequisite for service users to become a more equal partner in communication with their clinicians. Furthermore, shared decision making has been shown to improve the therapeutic alliance and to lead to better care. Objective: Our aim is to build a web-based support system which makes ROM results more accessible to service users and to provide them with more concrete and personalized information about their functioning (ie, symptoms, housing, social contacts) that they can use to discuss treatment options with their clinician. In this study, we will report on the usability of the web-based support system for service users with schizophrenia. Methods: First, we developed a prototype of a web-based support system in a multidisciplinary project team, including end-users. We then conducted a usability study of the support system consisting of (1) a heuristic evaluation, (2) a qualitative evaluation and (3) a quantitative evaluation. Results: Fifteen service users with a schizophrenia diagnosis and four information and communication technology (ICT) experts participated in the study. The results show that people with a schizophrenia diagnosis were able to use the support system easily. Furthermore, the content of the advice generated by the support system was considered meaningful and supportive. Conclusions: This study shows that the support system prototype has valuable potential to improve the ROM practice and it is worthwhile to further develop it into a more mature system. Furthermore, the results add to prior research into web applications for people with psychotic disorders, in that it shows that this group of end users can work with web-based and computer-based systems, despite the cognitive problems they experience.
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Development and Implementation of a Web-Enabled 3D Consultation Tool for Breast Augmentation Surgery Based on 3D-Image Reconstruction of 2D Pictures
Background: Producing a rich, personalized Web-based consultation tool for plastic surgeons and patients is challenging. Objective: (1) To develop a computer tool that allows individual reconstruction and simulation of 3-dimensional (3D) soft tissue from ordinary digital photos of breasts, (2) to implement a Web-based, worldwide-accessible preoperative surgical planning platform for plastic surgeons, and (3) to validate this tool through a quality control analysis by comparing 3D laser scans of the patients with the 3D reconstructions with this tool from original 2-dimensional (2D) pictures of the same patients. Methods: The proposed system uses well-established 2D digital photos for reconstruction into a 3D torso, which is then available to the user for interactive planning. The simulation is performed on dedicated servers, accessible via Internet. It allows the surgeon, together with the patient, to previsualize the impact of the proposed breast augmentation directly during the consultation before a surgery is decided upon. We retrospectively conduced a quality control assessment of available anonymized pre- and postoperative 2D digital photographs of patients undergoing breast augmentation procedures. The method presented above was used to reconstruct 3D pictures from 2D digital pictures. We used a laser scanner capable of generating a highly accurate surface model of the patient’s anatomy to acquire ground truth data. The quality of the computed 3D reconstructions was compared with the ground truth data used to perform both qualitative and quantitative evaluations. Results: We evaluated the system on 11 clinical cases for surface reconstructions and 4 clinical cases of postoperative simulations, using laser surface scan technologies showing a mean reconstruction error between 2 and 4 mm and a maximum outlier error of 16 mm. Qualitative and quantitative analyses from plastic surgeons demonstrate the potential of these new emerging technologies. Conclusions: We tested our tool for 3D, Web-based, patient-specific consultation in the clinical scenario of breast augmentation. This example shows that the current state of development allows for creation of responsive and effective Web-based, 3D medical tools, even with highly complex and time-consuming computation, by off-loading them to a dedicated high-performance data center. The efficient combination of advanced technologies, based on analysis and understanding of human anatomy and physiology, will allow the development of further Web-based reconstruction and predictive interfaces at different scales of the human body. The consultation tool presented herein exemplifies the potential of combining advancements in the core areas of computer science and biomedical engineering with the evolving areas of Web technologies. We are confident that future developments based on a multidisciplinary approach will further pave the way toward personalized Web-enabled medicine.
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Comparing the Use of an Online Expert Health
Network against Common Information Sources to Answer Health
Questions
Background: Many workers have questions about occupational safety and health (OSH). It is unknown whether workers are able to find correct, evidence-based answers to OSH questions when they use common information sources, such as websites, or whether they would benefit from using an easily accessible, free-of-charge online network of OSH experts providing advice. Objective: To assess the rate of correct, evidence-based answers to OSH questions in a group of workers who used an online network of OSH experts (intervention group) compared with a group of workers who used common information sources (control group). Methods: In a quasi-experimental study, workers in the intervention and control groups were randomly offered 2 questions from a pool of 16 standardized OSH questions. Both questions were sent by mail to all participants, who had 3 weeks to answer them. The intervention group was instructed to use only the online network ArboAntwoord, a network of about 80 OSH experts, to solve the questions. The control group was instructed that they could use all information sources available to them. To assess answer correctness as the main study outcome, 16 standardized correct model answers were constructed with the help of reviewers who performed literature searches. Subsequently, the answers provided by all participants in the intervention (n = 94 answers) and control groups (n = 124 answers) were blinded and compared with the correct model answers on the degree of correctness. Results: Of the 94 answers given by participants in the intervention group, 58 were correct (62%), compared with 24 of the 124 answers (19%) in the control group, who mainly used informational websites found via Google. The difference between the 2 groups was significant (rate difference = 43%, 95% confidence interval [CI] 30%–54%). Additional analysis showed that the rate of correct main conclusions of the answers was 85 of 94 answers (90%) in the intervention group and 75 of 124 answers (61%) in the control group (rate difference = 29%, 95% CI 19%–40%). Remarkably, we could not identify differences between workers who provided correct answers and workers who did not on how they experienced the credibility, completeness, and applicability of the information found (P > .05). Conclusions: Workers are often unable to find correct answers to OSH questions when using common information sources, generally informational websites. Because workers frequently misjudge the quality of the information they find, other strategies are required to assist workers in finding correct answers. Expert advice provided through an online expert network can be effective for this purpose. As many people experience difficulties in finding correct answers to their health questions, expert networks may be an attractive new source of information for health fields in general.
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Web-Based Recruiting for Health Research Using a Social Networking Site: An Exploratory Study
Background: Recruitment of young people for health research by traditional methods has become more expensive and challenging over recent decades. The Internet presents an opportunity for innovative recruitment modalities. Objective: To assess the feasibility of recruiting young females using targeted advertising on the social networking site Facebook. Methods: We placed an advertisement on Facebook from May to September 2010, inviting 16- to 25-year-old females from Victoria, Australia, to participate in a health study. Those who clicked on the advertisement were redirected to the study website and were able to express interest by submitting their contact details online. They were contacted by a researcher who assessed eligibility and invited them to complete a health-related survey, which they could do confidentially and securely either at the study site or remotely online. Results: A total of 551 females responded to the advertisement, of whom 426 agreed to participate, with 278 completing the survey (139 at the study site and 139 remotely). Respondents’ age distribution was representative of the target population, while 18- to 25-year-olds were more likely to be enrolled in the study and complete the survey than 16- to 17-year-olds (prevalence ratio = 1.37, 95% confidence interval 1.05–1.78, P = .02). The broad geographic distribution (major city, inner regional, and outer regional/remote) and socioeconomic profile of participants matched the target population. Predictors of participation were older age, higher education level, and higher body mass index. Average cost in advertising fees per compliant participant was US $20, making this highly cost effective. Conclusions: Results demonstrate the potential of using modern information and communication technologies to engage young women in health research and penetrate into nonurban communities. The success of this method has implications for future medical and population research in this and other demographics.
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HealthTrust: A Social Network Approach for Retrieving Online Health Videos
Background: Social media are becoming mainstream in the health domain. Despite the large volume of accurate and trustworthy health information available on social media platforms, finding good-quality health information can be difficult. Misleading health information can often be popular (eg, antivaccination videos) and therefore highly rated by general search engines. We believe that community wisdom about the quality of health information can be harnessed to help create tools for retrieving good-quality social media content. Objectives: To explore approaches for extracting metrics about authoritativeness in online health communities and how these metrics positively correlate with the quality of the content. Methods: We designed a metric, called HealthTrust, that estimates the trustworthiness of social media content (eg, blog posts or videos) in a health community. The HealthTrust metric calculates reputation in an online health community based on link analysis. We used the metric to retrieve YouTube videos and channels about diabetes. In two different experiments, health consumers provided 427 ratings of 17 videos and professionals gave 162 ratings of 23 videos. In addition, two professionals reviewed 30 diabetes channels. Results: HealthTrust may be used for retrieving online videos on diabetes, since it performed better than YouTube Search in most cases. Overall, of 20 potential channels, HealthTrust’s filtering allowed only 3 bad channels (15%) versus 8 (40%) on the YouTube list. Misleading and graphic videos (eg, featuring amputations) were more commonly found by YouTube Search than by searches based on HealthTrust. However, some videos from trusted sources had low HealthTrust scores, mostly from general health content providers, and therefore not highly connected in the diabetes community. When comparing video ratings from our reviewers, we found that HealthTrust achieved a positive and statistically significant correlation with professionals (Pearson r10 = .65, P = .02) and a trend toward significance with health consumers (r7 = .65, P = .06) with videos on hemoglobinA1c, but it did not perform as well with diabetic foot videos. Conclusions: The trust-based metric HealthTrust showed promising results when used to retrieve diabetes content from YouTube. Our research indicates that social network analysis may be used to identify trustworthy social media in health communities.
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What Are Young Adults Saying About Mental Health? An Analysis of Internet Blogs
Background: Despite the high prevalence of mental health concerns, few young adults access treatment. While much research has focused on understanding the barriers to service access, few studies have explored unbiased accounts of the experiences of young adults with mental health concerns. It is through hearing these experiences and gaining an in-depth understanding of what is being said by young adults that improvements can be made to interventions focused on increasing access to care. Objective: To move beyond past research by using an innovative qualitative research method of analyzing the blogs of young adults (18–25 years of age) with mental health concerns to understand their experiences. Methods: We used an enhanced Internet search vehicle, DEVONagent, to extract Internet blogs using primary keywords related to mental health. Blogs (N = 8) were selected based on age of authors (18–25 years), gender, relevance to mental health, and recency of the entries. Blogs excerpts were analyzed using a combination of grounded theory and consensual qualitative research methods. Results: Two core categories emerged from the qualitative analysis of the bloggers accounts: I am powerless (intrapersonal) and I am utterly alone (interpersonal). Overall, the young adult bloggers expressed significant feelings of powerlessness as a result of their mental health concerns and simultaneously felt a profound sense of loneliness, alienation, and lack of connection with others. Conclusions: The present study suggests that one reason young adults do not seek care might be that they view the mental health system negatively and feel disconnected from these services. To decrease young adults’ sense of powerlessness and isolation, efforts should focus on creating and developing resources and services that allow young adults to feel connected and empowered. Through an understanding of the experiences of young adults with mental health problems, and their experiences of and attitudes toward receiving care, we provide some recommendations for improving receptivity and knowledge of mental health care services.
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eHealth Literacy: Extending the Digital Divide to the Realm of Health Information
Background: eHealth literacy is defined as the ability of people to use emerging information and communications technologies to improve or enable health and health care. Objective: The goal of this study was to explore whether literacy disparities are diminished or enhanced in the search for health information on the Internet. The study focused on (1) traditional digital divide variables, such as sociodemographic characteristics, digital access, and digital literacy, (2) information search processes, and (3) the outcomes of Internet use for health information purposes. Methods: We used a countrywide representative random-digital-dial telephone household survey of the Israeli adult population (18 years and older, N = 4286). We measured eHealth literacy; Internet access; digital literacy; sociodemographic factors; perceived health; presence of chronic diseases; as well as health information sources, content, search strategies, and evaluation criteria used by consumers. Results: Respondents who were highly eHealth literate tended to be younger and more educated than their less eHealth-literate counterparts. They were also more active consumers of all types of information on the Internet, used more search strategies, and scrutinized information more carefully than did the less eHealth-literate respondents. Finally, respondents who were highly eHealth literate gained more positive outcomes from the information search in terms of cognitive, instrumental (self-management of health care needs, health behaviors, and better use of health insurance), and interpersonal (interacting with their physician) gains. Conclusions: The present study documented differences between respondents high and low in eHealth literacy in terms of background attributes, information consumption, and outcomes of the information search. The association of eHealth literacy with background attributes indicates that the Internet reinforces existing social differences. The more comprehensive and sophisticated use of the Internet and the subsequent increased gains among the high eHealth literate create new inequalities in the domain of digital health information. There is a need to educate at-risk and needy groups (eg, chronically ill) and to design technology in a mode befitting more consumers.
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An Internet-Based Virtual Coach to Promote Physical Activity Adherence in Overweight Adults: Randomized Controlled Trial
Background: Addressing the obesity epidemic requires the development of effective, scalable interventions. Pedometers and Web-based programs are beneficial in increasing activity levels but might be enhanced by the addition of nonhuman coaching. Objectives: We hypothesized that a virtual coach would increase activity levels, via step count, in overweight or obese individuals beyond the effect observed using a pedometer and website alone. Methods: We recruited 70 participants with a body mass index (BMI) between 25 and 35 kg/m2 from the Boston metropolitan area. Participants were assigned to one of two study arms and asked to wear a pedometer and access a website to view step counts. Intervention participants also met with a virtual coach, an automated, animated computer agent that ran on their home computers, set goals, and provided personalized feedback. Data were collected and analyzed in 2008. The primary outcome measure was change in activity level (percentage change in step count) over the 12-week study, split into four 3-week time periods. Major secondary outcomes were change in BMI and participants’ satisfaction. Results: The mean age of participants was 42 years; the majority of participants were female (59/70, 84%), white (53/70, 76%), and college educated (68/70, 97%). Of the initial 70 participants, 62 completed the study. Step counts were maintained in intervention participants but declined in controls. The percentage change in step count between those in the intervention and control arms, from the start to the end, did not reach the threshold for significance (2.9% vs –12.8% respectively, P = .07). However, repeated measures analysis showed a significant difference when comparing percentage changes in step counts between control and intervention participants over all time points (analysis of variance, P = .02). There were no significant changes in secondary outcome measures. Conclusions: The virtual coach was beneficial in maintaining activity level. The long-term benefits and additional applications of this technology warrant further study. Trial Registration: ClinicalTrials.gov NCT00792207; http://clinicaltrials.gov/ct2/show/NCT00792207 (Archived by WebCite at http://www.webcitation.org/63sm9mXUD)
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MEMO—A Mobile Phone Depression Prevention Intervention for Adolescents: Development Process and Postprogram Findings on Acceptability From a Randomized Controlled Trial
Background: Prevention of the onset of depression in adolescence may prevent social dysfunction, teenage pregnancy, substance abuse, suicide, and mental health conditions in adulthood. New technologies allow delivery of prevention programs scalable to large and disparate populations. Objective: To develop and test the novel mobile phone delivery of a depression prevention intervention for adolescents. We describe the development of the intervention and the results of participants’ self-reported satisfaction with the intervention. Methods: The intervention was developed from 15 key messages derived from cognitive behavioral therapy (CBT). The program was fully automated and delivered in 2 mobile phone messages/day for 9 weeks, with a mixture of text, video, and cartoon messages and a mobile website. Delivery modalities were guided by social cognitive theory and marketing principles. The intervention was compared with an attention control program of the same number and types of messages on different topics. A double-blind randomized controlled trial was undertaken in high schools in Auckland, New Zealand, from June 2009 to April 2011. Results: A total of 1348 students (13–17 years of age) volunteered to participate at group sessions in schools, and 855 were eventually randomly assigned to groups. Of these, 835 (97.7%) self-completed follow-up questionnaires at postprogram interviews on satisfaction, perceived usefulness, and adherence to the intervention. Over three-quarters of participants viewed at least half of the messages and 90.7% (379/418) in the intervention group reported they would refer the program to a friend. Intervention group participants said the intervention helped them to be more positive (279/418, 66.7%) and to get rid of negative thoughts (210/418, 50.2%)—significantly higher than proportions in the control group. Conclusions: Key messages from CBT can be delivered by mobile phone, and young people report that these are helpful. Change in clinician-rated depression symptom scores from baseline to 12 months, yet to be completed, will provide evidence on the effectiveness of the intervention. If proven effective, this form of delivery may be useful in many countries lacking widespread mental health services but with extensive mobile phone coverage. ClinicalTrial: Australia New Zealand Clinical Trials Registry (ACTRN): 12609000405213; http://www.anzctr.org.au/trial_view.aspx?ID=83667 (Archived by WebCite at http://www.webcitation.org/64aueRqOb)
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