JMIR Open Peer Review Submissions

Use of sentiment analysis for capturing patient experience from free-text comments posted online

Fri, 17 May 2013 14:32:48 EDT

Background: There are large amounts of unstructured, free-text information about the quality of healthcare available on the Internet in blogs, social networks and on physician rating websites that are not captured in a systematic way. New analytical techniques, such as sentiment analysis, may allow us to understand and use this information more effectively to improve the quality of health care. Objective: We attempted to use machine learning to understand patients’ unstructured comments about their care. We used sentiment analysis techniques to categorise online free-text comments by patients as either positive or negative descriptions of their healthcare. We tried to automatically predict whether a patient would recommend a hospital, whether the hospital was clean, and whether they were treated with dignity from their free-text description, compared to the patient’s own quantitative rating of their care. Methods: We applied machine learning techniques to all 6412 online comments about hospitals on the English National Health Service website in 2010 using Weka data-mining software. We also compared the results obtained from sentiment analysis with the paper-based national inpatient survey results at the hospital level using Spearman’s rank correlation for all (161) acute adult hospital trusts in England. Results: There was 81%, 83% and 89% agreement between quantitative ratings of care and those derived from free text comments using sentiment analysis for cleanliness, being treated with dignity and overall recommendation of hospital respectively (Kappa scores: 0.40 – 0.75, P<.001 for all). We observed mild to moderate associations between our machine learning predictions and responses to the large patient survey for the three categories examined (Spearman rho 0.37- 0.5, P<.001 for all). Conclusions: The prediction accuracy that we have achieved using this machine learning process suggests we are able to predict, from free-text, a reasonably accurate assessment of patients’ opinion about different performance aspects of a hospital and that these machine learning predictions are associated with results of more conventional surveys. Date Submitted: May 16, 2013. Open Peer Review Period: May 17, 2013 - Jul 12, 2013.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Facebook activities reveal depressive state of users

Thu, 16 May 2013 13:55:36 EDT

Background: As social media has become prominent there have been various efforts to find relations between social media and depression for early diagnosis, treatment, and even prevention. In this paper we focused on the particular social media, Facebook, to see whether there are any correlations between Facebook features and depressive symptoms. This attempt may be helpful to reach and detect large numbers of depressive individuals with ease. Objective: Our goal is to develop application and identify depression-related features from Facebook, a popular online social platform. Methods: Fifty five Facebook users (Male: Female = 40 : 15, mean age = 24.43 ± 3.90) were enrolled through both advertisement fliers and online community for university members. Using EmotionDiary, the Facebook application developed by us, we evaluated depressive symptoms such as Center for Epidemiological Studies-Depression (CES-D) scale. We also provided tips about depression to participants and measured their responses using EmotionDiary. To identify the Facebook features related to depression, correlation analyses were performed between CES-D and participants’ responses to tips or Facebook social features. Lastly, depressed participants (CES-D ≥ 25) were interviewed to assess their depression by a psychiatrist. Results: Facebook activities had predictive power in distinguishing depressed and non-depressed individuals. Participants’ response to tips, the number of app viewed tips and app points, had positive correlation (P = .04 for both cases), while the number of Friends and Location tagging had negative correlation with the CES-D scale (P = .08 and P = .045 respectively). Furthermore, with finding group differences in regard to the Facebook social activities, app viewed tips and app points resulted significant differences (P = .01 and P = .03 respectively) between depressed and non-depressed individuals. Conclusions: Our results using EmotionDiary demonstrates that the more depressed, the more read tips about depression. We also confirmed depressed individuals had significantly fewer interactions with others (e.g., decreased number of Friends and Location tagging). Our EmotionDiary can successfully evaluate depressive behaviors as well as provide useful tips. These results open the door for examining Facebook activities to identify depressed individuals. We aim to conduct the experiment via multiple cultures as well. Date Submitted: May 15, 2013. Open Peer Review Period: May 16, 2013 - Jul 11, 2013.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Promoting Positive Psychology Development with Online Social Network on College New Entrants in a Northern Taiwan University

Thu, 16 May 2013 13:49:03 EDT

Background: Positive psychology aims to study the development of positive characteristics, such as hope, creativity, courage, responsibility, and social relationship at both individual and group levels. The challenge for promoting such development may partially be attributed to the difficulties on observing evolution of influential factors at individual levels and collecting dynamics of social networks’ information at group levels. The popularity and acceptance of online social networks provide opportunities for university faculty and researchers to advance their understandings on the dynamics of student’s social networks. Objective: This study aims to promote positive psychology on college new entrants by using Facebook. Methods: Positive psychology aims to study the development of positive characteristics, such as hope, creativity, courage, responsibility, and social relationship at both individual and group levels. The challenge for promoting such development may partially be attributed to the difficulties on observing evolution of influential factors at individual levels and collecting dynamics of social networks’ information at group levels. The popularity and acceptance of online social networks provide opportunities for university faculty and researchers to advance their understandings on the dynamics of student’s social networks. Results: Of 120 subjects, 49(40.8%) were female and 71(59.2%) were male; average Facebook experience was 21.4 months, average time on using Internet was 30 hours and on Facebook was 16.5 hours per week. From data analysis of the questionnaire, the highest mean score in perceived usefulness is benefit on health promotion (mean=4.56, S.D=0.91), the lowest score is positive message direct from parents (mean=3.28, S.D=1.02). Perceived usefulness has a significant correlation with intention to use (r=0.675, P <0.01). From collected responses (average frequency of “Like” button being pressed in every three weeks) of each positive message, students from medical school have 17.1, 15.1, 17.6, and 14.3 times, and management school have 20.4, 14.6, 14.5, and 12.4 times respectively. The lease “Like” message (N=16) was straight aphorisms and the most “Like” message (N=49) was timely reminder. Conclusions: Of 120 subjects, 49(40.8%) were female and 71(59.2%) were male; average Facebook experience was 21.4 months, average time on using Internet was 30 hours and on Facebook was 16.5 hours per week. From data analysis of the questionnaire, the highest mean score in perceived usefulness is benefit on health promotion (mean=4.56, S.D=0.91), the lowest score is positive message direct from parents (mean=3.28, S.D=1.02). Perceived usefulness has a significant correlation with intention to use (r=0.675, P <0.01). From collected responses (average frequency of “Like” button being pressed in every three weeks) of each positive message, students from medical school have 17.1, 15.1, 17.6, and 14.3 times, and management school have 20.4,...

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

E-Health technology competencies for health professionals working in Home care to support older adults to age in place - outcome of a two day collaborative workshop

Tue, 14 May 2013 14:21:13 EDT

Background: The demand for care is increasing, whereas the number of people working in professional care is decreasing. E-health technology can help to meet the growing demand for care. Despite the apparent positive effects of e-health technology, there are still barriers for e-health technology adoption related to lack of knowledge and skills associated with use. Objective: The purpose of this paper is to discuss the competencies required by healthcare professionals working in Home care, with e-health technologies such as remote telecare and ambient assisted living; mobile health; and fall detection systems. Methods: A two-day collaborative workshop was undertaken with academics across multiple disciplines. Results: The findings revealed that healthcare professionals working in Home care require a subset of composite skills as well as technology-specific competencies to develop the necessary aptitude in e-healthcare. This paper argues that e-healthcare technology skills must be instilled in healthcare professionals to ensure that technologies become integral components of future care delivery, especially to support older adults to age-in-place. Educating healthcare professionals with the necessary skill training in e-healthcare will improve service delivery and optimise e-healthcare’s potential to reduce costs by improving efficiency. Moreover, embedding e-healthcare competencies within training and education for healthcare professionals ensures that the benefits of new technologies are realised 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 healthcare professionals competencies and requirements needed for the use of e-health technologies to support elderly adults to age in place. This paper underscores the need for further discussion of the changing role of healthcare professionals working in Home care within the context of emerging e-healthcare technologies. The findings are of value to local and central government, healthcare professionals, service delivery organisations and commissioners of care to use this paper as a framework to conduct and develop competencies for healthcare professionals working with e-health technologies. Date Submitted: May 14, 2013. Open Peer Review Period: May 14, 2013 - Jul 9, 2013.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Purposive Facebook Recruitment Endows Cost Effective Nutrition Education Program Evaluation

Tue, 14 May 2013 14:10:29 EDT

Background: Recent legislations established a requirement for nutrition education in federal assistance programs to be evidence-based. Recruitment of low-income persons to participate and evaluate nutrition education activities can be challenging and costly. Facebook has been shown to be a cost-effective strategy to recruit this target audience to a nutrition program. Objective: The purpose of this study was to examine Facebook as a strategy to recruit participants, especially Supplemental Nutrition Assistance Program Education eligible persons, to view and evaluate an online nutrition education program intended to be offered as having some evidence-base for SNAP-Ed programming. Methods: English-speaking, low-income Pennsylvania residents, 18-55 years, with key profile words (eg, Supplemental Nutrition Assistance Program, Food bank), responded to a Facebook ad inviting participation in either Eating Together as a Family is Worth It or Everyone Needs Folic Acid. Participants completed an online survey on food related behaviors, viewed a nutrition education program, and completed a program evaluation. Facebook set-up functions considered were costing mechanism, daily spending cap, and population reach. Results: Respondents for both Eating Together as a Family is Worth It and Everyone Needs Folic Acid evaluations were similar; the majority were white, < 40 y, overweight or obese body mass index, and not eating competent. 807 Facebook users clicked on the Eating Together as a Family is Worth It ad with 73 unique site visitors and 47 of these completing the program evaluation i.e., 5.8 % of clickers and 76% of site visitors completed the evaluation. Cost per completed evaluation was $25.48; cost per low-income completer was $39.92. Results were similar for the Everyone Needs Folic Acid evaluation; 795 Facebook users clicked on the ad with 110 unique site visitors, and 73 completing the evaluation i.e., 9.2 % of ad clickers and 66% of site visitors completed the evaluation. Cost per valid completed survey with program evaluation was $18.88; cost per low-income completer was $27.53. Conclusions: With Facebook we successfully recruited low-income Pennsylvanians to online nutrition program evaluations. Benefits using Facebook as a recruitment strategy included real-time recruitment management with lower costs and more efficiency compared to traditional research recruitment strategies. Limitations prompted by repeated survey attempts need to be addressed to optimize this recruitment strategy. Date Submitted: May 13, 2013. Open Peer Review Period: May 14, 2013 - Jul 9, 2013.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Correlation and Interaction Visualization of Altmetric Indicators Extracted from Scholarly Social Network Activities: Dimension and Structure

Tue, 14 May 2013 14:02:46 EDT

Background: Growing numbers of scholars are using scholarly social network tools to mediate their interaction with the literature. These scholars are leaving valuable footprints with potential to show informal paths of influence with unprecedented speed and resolution. Altmetric indicators can be extracted from these activities. There is currently little research into the dimensions and structure of altmetric indicators. Objective: The aim of this research was to reveal the dimension and structure of altmetric indicators. Methods: We used histogram and one-sample K-S tests to test whether the sample of data fits normal distribution. We analyzed the correlation among altmetric indicators by means of Spearman rank correlation. To reveal the dimension and structure of altmetric indicators, we employed three visualization methods: a color correlation matrix, a multidimensional scale diagram and a social network map. We visualized the multiple correlation coefficient matrixes by graduated colors. Results: Our sample is downloaded from Article-Level Metrics API website. It is a large dataset containing activity data in 20 kinds of metrics happened on 33,128 academic articles. We found that the distribution of altmetric indicators is significantly non-normal and positively skewed. In addition, our results suggest that the distribution of downloads and page views follows a Pareto law. The Spearman coefficients from 91.58% of pairs of variables indicate significance at the 0.01 level. We discovered that citation and download metrics cluster closely together. We drew not only a non-metric multidimensional scaling map, but also a network diagram for altmetric indicators. Conclusions: The results suggest that there may be three dimensions: traditional metrics and active and inactive altmetrics. The network of altmetrics indicates that there are intermediary altmetric indicators with dual attributes of both the traditional metrics and active altmetrics. Date Submitted: May 12, 2013. Open Peer Review Period: May 14, 2013 - Jul 9, 2013.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Evaluating Self-Management Behaviors of Diabetes Patients in Telehealthcare Program

Thu, 02 May 2013 15:05:28 EDT

Background: Self-management is an important skill for patients with diabetes, which involves frequent monitoring of glucose levels and behavior modification. Techniques of enhancing behavior changes for diabetes patients have been developed, such as diabetes self-management education (DSME) and telehealthcare. However, barriers still remain while the patients are carrying out self-management, and more works are required for addressing the impact of electronic media and telehealthcare on patient self-care behaviors. Objective: The aim of this research is to explore the behaviors of diabetes patients interacting with online applications, the impact of telehealthcare program on patient problems among the seven self-care behaviors, and the variation of glycosylated hemoglobin (HbA1c) level. Methods: This research assists patients with a telehealthcare program and DSME. The telehealthcare program includes an online diabetes self-management system and a tele-consultant service for 18 months, and DSME are provided every 3 months. The patient behaviors are evaluated based on the way they using the online diabetes self-management system and DSME documentation. 59 patients entering telehealthcare program and 103 patients not assisted with telehealthcare are recruited for analysis in this research. The data are compared between the beginning and the end of patient participation, between those with and without the assistance of telehealthcare, and between those with and without the assistance of telehealthcare during the last period of their participation. Results: 88% of the patients logged-in and used the online application and 70% of the patients documented the blood glucose regularly. 45% of the patients make use of telephone services and 33% patients choose to use text massages to contact their providers. Monitoring of blood glucose shows significant difference between the beginning and the end of patient participation (P = .046), but insignificant between patients with and without telehealthcare service (P = .94). The average number of education grows after patient participation. Five behaviors show significant differences between the patients assisted with and without telehealthcare services. Patients assisted with telehealthcare have more education than those without and less educated during the last period of their participation. The average value and the variability of HbA1c level decreases between the beginning and the end of patient participation. Less variability of HbA1c level shows on patients with telehealthcare. Conclusions: The result shows that adequate design of technology is able to increase the participation of patients. Telehealthcare has induced higher participation in self-management activities, raised patient awareness and patient engagement, especially the skill of monitoring of blood glucose. Patients are more capable in coping with their own problems and requiring less supports from the educators. It has also shown the tendency...

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Improving sexual health resources for youth: the use of sex positive Public Health websites.

Mon, 29 Apr 2013 12:09:39 EDT

Background: There are high rates of sexually transmitted infections and other high risks outcomes among youth, largely due to unsafe sexual practices. Technologies that bring more information to our fingertips often can mislead and misinform youth about the risks of practicing unsafe sex and, in a perverse way, may even encourage it. On the other hand, valid and trustworthy information can promote health and reduce harmful practice by shaping and encouraging safe sex practices. With rapid changes in technology, there is a generational shift in accessing health promotion information and sexual health promotion should take advantage of this; otherwise, past gains in sexual health may quickly be eroded. Objective: The study explores youths’ desire to access sexual health information and services; their perceptions of current sexual health services and their sources of information when seeking sexual health services. Methods: The qualitative study employed focus groups, targeting four populations: (1) urban residents, (2) rural residents, (3) semi-rural residents, and (4) youth self-identifying as gay, lesbian, bisexual or transgender (LGBT). Participants were invited to ‘follow-up’ focus groups to gain further insight into youths’ sexual health perceptions. Each group met three times over a 1 month period. Semi-structured interviews were based on a script developed by the researchers with the input of a community advisory committee. Interviews were audio recorded, transcribed and analysed using content analysis methods. Results: Thirty-two youth attended the focus groups. Youth awareness and access to sexual health services was related to geographical location. Many rural youth were unaware of sexual health clinics in the region as these clinics were not located in their vicinity nor were they promoted through their local health care providers. In terms of the known sexual health services, youth were concerned about accessibility, anonymity, confidentiality and comfort. All groups identified the Internet as a key source of information, and as the preferred medium for sexual health information. The Internet was said to be accessible, easy, anonymous, safe and convenient. Youth recognized the fallibility of websites, chat forums and other web 2.0 technologies and wanted more pragmatic sexual health information available on authoritative public health websites. Conclusions: Youth were concerned about being judged negatively when accessing sexual health services. Materials on sexual pleasure and intimacy and sexual services through enhanced internet technology are needed or youth may be forced to search questionable websites for this information. Date Submitted: Apr 27, 2013. Open Peer Review Period: Apr 29, 2013 - Jun 24, 2013.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Patients’ expectations of electronic record access

Fri, 26 Apr 2013 11:29:05 EDT

Background: The Department of Health in England recently published its information strategy, stating the objective to make electronic records available to all by 2015. There is little evidence, however, regarding the benefits and concerns that patients may anticipate, particularly in the UK. Objective: We aimed to capture the views of patients to inform the design of the My Diabetes My Way (MDMW) system, an electronic personal health record for people with diabetes in Scotland. Methods: People with diabetes signing up for MDMW were asked to complete a survey about their expectations and reasons for wishing to access their own information, prior to gaining access. The survey results were analysed anonymously using a mixed methods approach. Basic demographic information and internet usage habits were captured for additional multivariate analysis. Results: 144 (82%) of 176 MDMW registrants completed the survey. They had a high level of computer literacy as 98% owned a computer with internet access and 90% look for information about diabetes at least once a month, 67% use internet banking and 55% shop online at least once a week. The age distribution of the pilot population was younger than the general diabetes population and uptake was higher in people with Type 1 diabetes (35%) than those with type 2 diabetes (65%) when compared to the background population. 57% were male and all 144 were interested in viewing their information and viewing education tailored to their diabetes. Users indicated that they wished to check their diabetes control, medications and transfer home recordings. They wanted to check the accuracy of their data, report errors and ask questions. Additional motivational factors were to improve knowledge and assist in meeting goals. 98% believed the intervention would significantly improve diabetes care across Scotland. 26% were worried about security but proceeded with registration regardless. 49% didn't anticipate any problems with records access. In free-text comments, respondents wished to use the system to support a healthy lifestyle, monitor HbA1c and as a reminder system for information discussed during consultations. Users are more willing to transfer data to their electronic record when already banking online. Those with a longer duration of diabetes are more likely to want the ability to ask questions about their data. Conclusions: Respondents reported that peace of mind and the ability to better manage their condition are the main motives for using a personal electronic health record. These insights helped us to develop the system which aims to support patient empowerment, education and knowledge. The system went live in December 2010 and is undergoing continual evaluation. Our target is to achieve access for at least 5000 individuals by the end of 2013 and ongoing expansion across the Scottish diabetes population thereafter. Clinical Trial: N/A Date Submitted: Apr 26, 2013. Open Peer Review Period:...

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Anonymity versus Privacy: Selective Information Sharing in Online Cancer Communities

Mon, 22 Apr 2013 16:21:12 EDT

Background: Active sharing in online cancer communities benefits patients. However, many patients refrain from active information sharing because of privacy concerns. Research on privacy emphasizes data security and confidentiality and focuses on electronic medical records. Consequently, privacy concerns around information sharing in online communities remain poorly understood. Objective: We argue that patients think about the costs and benefits of online information sharing, weighing the privacy costs of losing anonymity against the benefits of participation when deciding whether to share certain types of information. Specifically, [1] patients prefer sharing clinical information relevant to their health over daily life and identifying information that potentially compromises anonymity, and [2] younger, healthier, and female patients are less willing to share information due to the perceived higher privacy costs. Methods: 115 cancer patients and ex-patients reported sharing intentions for 15 different types of information, expected community utility, and privacy concerns. Results: Factor analysis on the 15 information types revealed three factors coinciding with three proposed categories: clinical, daily life, and identifying information. As expected, a within-subject ANOVA showed a strong preference for sharing clinical information over daily life information and identifying information (F(1, 114)=135.59, P=.001, η2=.93). Also, adverse online privacy experiences, age, and health status negatively affected information sharing intentions. Female patients shared information less easily. Conclusions: Respondents have differential preferences for information sharing depending on dispositional and situational cues. Patients will share details of medical experience more than daily life or identifying information. The results suggest the need to focus on anonymity rather than privacy in online communities. Date Submitted: Apr 22, 2013. Open Peer Review Period: Apr 22, 2013 - Jun 17, 2013.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

Patients’ reported reasons for non-use of an Internet-based patient–provider communication service

Mon, 22 Apr 2013 16:09:21 EDT

Background: The adoption of Internet-based patient–provider communication services (IPPC) into health care has been slow. Patients want electronic communication, and the quality of health care can be improved by offering IPPCs. However, the rate of enrollment in such services remains low and the reasons for this are unclear. Knowledge about the barriers to use is valuable when implementing IPPCs into the health care services, and can help timing, targeting and tailoring IPPCs to different groups of patients. Objective: To investigate patients’ views about an IPPC that they could use from home to pose questions to nurses and physicians at their treatment facility, and their reported reasons for non use of the service. Methods: Qualitative study based on individual interviews with 22 patients who signed up for but did not use the IPPC. Results: Patients appreciated the availability and the possibility of using the IPPC at need, even if they did not make use of it. Their reported reasons for not using the IPPC fall into three main categories: they felt that they were not in need of the IPPC and had sufficient access to information elsewhere; they preferred other types of communication such as telephone or face-to-face contact; or they were hindered by IPPC attributes such as log-in problems. Conclusions: Patients were satisfied with having the opportunity to send messages to health care providers through an IPPC, even if they did not make use of the service. IPPCs should be offered to the patients at an appropriate time in the illness trajectory, both when they are in need of the service, and when they are receptive for information about the service. A live demonstration of the IPPC at the point of enrollment might have increased its use. Clinical Trial: ClinicalTrials.gov NCT00971139, http://clinicaltrial.gov/ct2/show/NCT00971139 Date Submitted: Apr 22, 2013. Open Peer Review Period: Apr 22, 2013 - Jun 17, 2013.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

The Sexunzipped pilot trial: optimizing the design of online randomized controlled trials

Tue, 16 Apr 2013 16:52:12 EDT

Background: Sexual health problems such as unwanted pregnancy and sexually transmitted infection are important public health concerns, and there is huge potential for health promotion using digital interventions. Evaluations of digital interventions are increasingly conducted online: online trial administration and data collection offers many advantages, but concerns remain over fraudulent registration to obtain incentives, the quality of self-reported data, and high attrition. Objective: This study addresses the feasibility of several dimensions of online trial design – recruitment, online consent, participant identity verification, randomization and concealment of allocation, online data collection, data quality, and retention at 3 month follow-up. Methods: 2,036 young people aged 16 to 21 registered for the Sexunzipped online trial between November 2010 and March 2011. Participants filled in baseline demographic and sexual health questionnaires online, and were randomized to the Sexunzipped interactive intervention website or to an information-only control website. Participants were also randomly allocated to a postal request for a urine sample for genital Chlamydia testing (or no request); and receipt of a lower (£10/$16) or higher (£20/$32) shopping voucher incentive for 3 month outcome data. Results: The majority of participants (91%) were aged between 18 and 20 at enrolment, from all four countries of the UK. Most were White (90%), most were in education or training (77%), and 63% of the sample were female. 3.9% of registrations appeared to be invalid, and 4% of participants gave inconsistent responses within the questionnaire. A higher incentive increased response rates by 6-10%. Retention at follow-up for online self-reported sexual health outcomes was maximal (77%) when a £20 incentive was offered. Response rates for postal Chlamydia urine testing were 47% with a £20 incentive. Conclusions: It was quick and efficient to recruit young people to this online trial. Our procedures for obtaining online consent, verifying participant identity, automated randomization and concealment of allocation worked well. The optimal response rate for the online sexual health outcome measurement was comparable to face-to-face trials. Multiple methods of participant contact, requesting online data only, and a higher incentive increased trial retention at 3 month follow-up. Clinical Trial: ISRCTN 55651027 Date Submitted: Apr 13, 2013. Open Peer Review Period: Apr 16, 2013 - Jun 11, 2013.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

The Effectiveness of a Web-based Physical Activity Intervention in Patients with Knee and/or Hip Osteoarthritis: A Randomized Controlled Trial

Wed, 10 Apr 2013 16:14:04 EDT

Background: Patients with knee and/or hip osteoarthritis (OA) are less physically active than the general population, while benefits of physical activity (PA) have been well documented. Based on the behavioral graded activity treatment, we developed a web-based intervention to improve PA levels in patients with knee and/or hip OA, entitled Join2move. The Join2move intervention is a self-paced nine week PA program in which patients’ favorite recreational activity is gradually increased in a time-contingent way. Objective: To investigate whether a fully automated web-based PA intervention in patients with knee and/or hip OA would result in improved levels of PA, physical function and self-perceived effect compared with a waiting list control group. Methods: The study design was a randomized, unblinded, controlled, two-armed trial. Volunteers were recruited via articles in newspapers and health-related websites. Eligibility criteria for participants were 1) age 50-75, 2) self-reported knee and/or hip OA, 3) self-reported inactivity (<30 minutes of moderate PA on fewer than five days per week, 4) no face-to-face consultation with a healthcare provider, other than general practitioners, for OA in the last 6 months, 5) ability to access the internet weekly, 6) and no contra-indications to exercise without supervision. Baseline, 3 and 12 months follow-up data were collected through online questionnaires. Primary outcomes were PA, physical function and self-perceived effect. In a subgroup of participants, PA was measured objectively using accelerometers. Secondary outcomes were pain, fatigue, anxiety, depression, symptoms, quality of life, self-efficacy, pain coping and locus of control. Results: Of the 581 interested respondents, 199 eligible participants were randomly assigned to the intervention (n=100) or waiting list control group (n=99). Response rates of questionnaires were 84.4% after 3 months and 75.4% after 12 months. In this study, 94 (94%) participants actually started the program and 46 users (46%) reached the adherence threshold of 6 out of 9 modules completed. At 3 months, participants in the intervention group reported a significantly improved physical function status (p=.02, d=.15) and a positive self-perceived effect (p=.001, OR=10.7) compared with the control group. No effect was found for self-reported PA. After 12 months, the intervention group showed higher levels of subjective and objective PA (p=.02, d=.18 and p=<.05,d=.19) compared with the control group. After 12 months, no effect was found for physical function (p=.31, d=.08) and self-perceived effect (p=.5, OR=1.2). For several secondary endpoints, the intervention group demonstrated improvements in favor of the intervention group. Conclusions: Join2move resulted in changes in the desired direction for several primary and secondary outcomes. Given the benefits and its self-help format, Join2move could be a component in the effort to enhance PA in sedentary patients with knee...

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Determinants of weight loss success after a half year use of an internet-based weight reduction program: An analysis of the KiloCoachTM database

Fri, 05 Apr 2013 13:33:54 EDT

Background: As the internet is widespread and its use, especially to search for health information, is common, internet-based weight loss programs seem to provide a great opportunity to deliver support for self-guided weight loss to large parts of the population. Previous studies showed that web-based weight loss interventions can be effective, depending on program quality. Program tools that were shown to be the most effective are visual progress charts or tools for self-monitoring of weight, diet and exercise. KiloCoach™, a program available so far in the German-speaking countries, incorporates these features. A previous investigation showed that it supports users effectively in loosing weight. Objective: We aimed at investigating weight loss dynamics stratified by weight loss success during the first six-months-usage of KiloCoach™. Further, we analyzed possible associations between the intensity of program usage and weight loss. The results intend to tailor user recommendations for weight-loss internet platforms. Methods: Datasets of KiloCoach™ users (between January 1st, 2008 und December 31st, 2010) who fulfilled eligibility criteria and contained weight entries after six months of program usage were assigned to this retrospective analysis (n=214 users (46% men), age: 46.5±12.1 years, body mass index (BMI): 31.2± 2.9 kg/m2). Based on achieved weight loss three success groups were generated. “Non-successors” lost <5%, “successors5” 5-9.9% and “successors10” ≥10% of their baseline body weight. At baseline non-successors (0succ, n=79), successors5 (5succ, n=71) and successors10 (10succ, n=64) were similar in age (P=.59), weight (P=.30), BMI (P=.12) or gender distribution (P=.36). Results: After six months 0succ lost 1.6±2.6%, 5succ 7.6±1.5% and 10succ 14.5±4.0% of their initial body weight (P<.001). Achieved weight loss already differed significantly among the groups in weeks 1-2 of program usage (P<.001). This early weight loss predicted weight loss outcome accomplished after six months (P<.001), one year (P=.02) and two years (P=.05).10succ lost weight faster and maintained weight more efficiently than the other groups (P<.001). 0succ lost weight only until weeks 19-20 and regained it by the six months time point. Usage of program tools also differed significantly among groups (P<.001). Weekly number of dietary protocols, logbook- and weight entries were significantly lower in 0succ compared to the other groups (P<.001), but did not differ between 5succ and 10succ. Interestingly, the percentage of male users was high (46%). Over six months, men compared to women entered significantly more dietary protocols (P=.04), logbook entries (P=.03) and weight data (P=.05) and were equally successful in loosing and maintaining weight. Conclusions: KiloCoach™ is an effective online device for weight reduction that extraordinarily attracts men. Our results suggest that close program adherence, i.e. six dietary protocols per week and weekly entering of...

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Young People’s Experiences of Participating in an Online Trial of the Sexunzipped Website

Fri, 05 Apr 2013 13:29:49 EDT

Background: Incidence of sexually transmitted infections (STIs) among young people in the United Kingdom (UK) is increasing. The Internet can be a suitable medium for delivery of sexual health information and sexual health promotion, given its high usage among young people, its potential for anonymity, and ease of access. Online randomized controlled trials (RCTs) are increasingly being used to evaluate online interventions, but while there are many advantages to online methodologies, they can be associated with a number of problems, including poor engagement with online interventions, poor trial retention and concerns about the validity of data collected through self-report online. We conducted an online feasibility trial that tested the effect of the Sexunzipped website for sexual health in comparison with an information-only website. This study reports on a qualitative evaluation of the trial procedures, reporting participants’ experiences and views of the Sexunzipped online trial including methods of recruitment, incentives, methods of contact, and sexual health outcome measurement. Objective: To determine young people's experiences and views of participating in the online trial of the Sexunzipped website for sexual health. Methods: We used three qualitative data sources to assess the acceptability and validity of the online pilot RCT methodology: 1) individual interviews with 22 participants from the pilot RCT; 2) 133 emails received by the trial coordinator from trial participants; and 3) 217 free-text comments from the baseline and follow-up questionnaires. Interviews were audio-recorded and transcribed verbatim. An iterative, thematic analysis of all three data sources was conducted to identify common themes related to the acceptability and feasibility of the online trial methodology. Results: Online recruitment via Facebook, online registration, email communication with the researchers, and online completion of sexual health questionnaires was viewed as highly acceptable by interview participants, and preferable to traditional research methods. Incentives might assist in recruiting those who would not otherwise participate. Participants generally enjoyed taking part in sexual health research online, and found the questionnaire itself thought-provoking. Completing the sexual health questionnaires online encouraged honesty in responding that might not be achieved with other methods. Most interview participants also thought that receiving and returning a urine sample for Chlamydia testing via post was acceptable. Conclusions: These findings provide strong support for the use of online research methods for sexual health research, emphasizing the importance of careful planning and execution of all trial procedures including recruitment, respondent validation, trial related communication, and methods to maximize follow up. Our findings suggest that sexual health outcome measurement can encourage reflection on behavior, sometimes leading to...

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.

EBMPracticeNet: A Bilingual National Electronic Point-Of-Care Project For Retrieval Of Evidence-Based Clinical Guideline Information And Decision Support.

Wed, 03 Apr 2013 11:11:13 EDT

In Belgium, the construction of a national electronic point-of-care information service EBMPracticeNet was initiated in 2011 to optimize quality of care by promoting evidence-based decision-making. The collaboration of the government, health care providers, Evidence-Based Medicine (EBM) partners and vendors of Electronic Health Records (EHR) is unique to this project. All Belgian healthcare professionals get free access to an up-to-date database of validated Belgian and nearly 1,000 international guidelines, incorporated in a portal that also provides EBM information from other sources than guidelines, including computerized clinical decision support that is integrated in the EHRs. The link between all the EHRs from different vendors and a national database held on a single platform and controlled by all EBM organizations in Belgium is the strength of EBMPracticeNet. This paper describes the development strategy, the overall content, the management and the future direction of EBMPracticeNet which may be of relevance to other health organizations creating national or regional electronic point-of-care information services. Date Submitted: Apr 3, 2013. Open Peer Review Period: Apr 3, 2013 - May 29, 2013.

This is an unpublished abstract - DO NOT CITE. To download the full submission and to peer-review this manuscript, please go to http://www.jmir.org/reviewer/openReview/abstracts.